Factors associated with Mother to child transmission of HIV in a Semi-arid County in Kenya, 2014-201

Introduction: To eliminate mother-to-child-transmission of HIV eMTCT) a rate of <5% was recommended by the WHO in 2015. The rate was 8.3% for Kenya and 8.8% for Kajiado County in 2016. To identify causes of these higher rates, we described  factors associated with HIV transmission among HIV exposed infants (HEI) in Kajiado. Methods: We reviewed HEI 2014-2017 records downloaded from the national early-infant-diagnosis (EID) database. A case was defined as any record of HEI undergoing EID in Kajiado in 2014–2017. Dependent variable was HIV test result and the independent variables were demographic and clinical characteristics. To describe the study population means were calculated for continuous variables and proportions for categorical variables. We performed Multivariate logistic regression to study the factors associated with MTCT while controlling for other factors and we reported the Prevalence OR and their 95% Confidence Intervals. Results: We reviewed 4,195 HEI records. Males were 1,999 (47.7%); median age was 2 months (range of 1.5 – 6months) and 199 (4.7%) tested positive for HIV. Antiretroviral (ARV) prophylaxis was not provided to 308 (7.34%) infants and 291 (6.94%) mothers of the infants. Exclusive-breastfeeding was offered to 2,976 (70.9%) infants and 320 (7.6%) had mixed-feeding. Odds of having a positive HIV result was higher in infants not on ARV prophylaxis compared to those who received ARV prophylaxis (POR: 8.3; 95% CI: 5.9 –11.5); in infants whose mothers received no ARV prophylaxis compared to those whose mothers received ARV prophylaxis (POR: 6.8; 95% CI: 4.9 – 9.6) and in those mixed-fed compared to those who received exclusive breastfeeding (POR: 2.4; 95% CI: 1.3 – 4.3). In infants not on ARV prophylaxis (aOR: 2.86; 95% CI: 1.02 – 6.93); infants whose mothers received no ARV prophylaxis (aOR: 2.45; 95% CI: 1.52 – 3.92) and those mixed-fed (aOR: 2.00; 95% CI: 1.05 – 3.79) were independently associated with a positive HIV result. Conclusion: Transmission was higher where infants missed ARV prophylaxis or had mixed-feeding. Infant prophylaxis and exclusive breastfeeding by HIV positive women should be encouraged

Cholera outbreak at a city hotel in Kenya, 2017: a retrospective cohort study

Introduction: The Ministry of Health, Kenya (MOH) investigated a report on acute watery diarrhea (AWD) cases at a city hotel to confirm the cause, characterize, and identify associated factors. Methods: A suspected case of cholera was defined as AWD in any person aged >2 years at the hotel from August 31, 2017, to September 6, 2017. We took rectal swabs for laboratory confirmation and summarized the AWD data by person, place, and time. We defined a cohort of hotel staff with those who ate dinner on August 31, 2017, considered exposed and conducted a retrospective cohort study. We calculated attack rates (AR) and risk ratios (RR) with 95% confidence interval. Variables with p<0.1 at bivariate analysis were entered into a multivariate model and those with p<0.05 in the final model considered independently associated with the AWD. Results: Vibrio cholera was isolated from seven (10.1%) out of 69 samples. Line listed 139 cases with a median age of 32 years (Range: 20–58 years) included 127 (91.4%) male and 127 (91.4%) guests. Index case was reported on August 31, 2017, cases peaked at 95 cases on September 3, 2017, and declined to three on September 6, 2017. A total of 30 (81.1%) of 37 hotel staff were exposed with 17 (56.7%) cases. Food specific ARs were: steamed spinach 78.6% and pineapples 26.3%. Spinach (RR: 3.0 (95%CI: 1.76-72.97)) was a risk factor while pineapples (RR: 0.4 (95%CI: 0.01-0.58)) was protective. Conclusion: This was a point source cholera outbreak likely due to eating contaminated spinach

Prevalence and spatial distribution of Trematode cercariae in Vector Snails within different Agro-Ecological Zones in Western Kenya, 2016.

IntroductionFreshwater vector snails' distribution, infection with cercariae, preferred habitat and possible trematodiases transmission foci is not well known in Western Kenya. We sought to determine the distribution and prevalence of infection of snails per agro-ecological zone and environmental factors in vector snail habitats.MethodsWe conducted a cross-sectional survey from March, 2016 - May, 2016, harvested and identified snails using shell morphology, determined their infection with trematode cercariae using microscopy, used descriptive statistics to estimate the prevalence of infection and relationship between snail abundance and environmental factors.ResultsWe sampled a total of 1,678 vector snails from 47 sampling sites of which 42% were Lymnaeid, 23% Biomphalaria, 10% Bulinus, 22% Oncomelaniae and 2% Melanoides. Lower Midland I Ago-Ecological Zones had 44% of the snails and streams from springs had 41% of the snails. Overall, 26.5% (445/1678) (95% CI: 24.4 - 28.6) of the snails shed cercariae. Cercariae were found in 11 (23%) of the sites and in all zones. F. gigantica cercariae were shed by L. natalensis, B. pfeifferi, B. sudanica. Lakeshore had both F. gigantica and S. mansoni cercariae shed by B. sudanica. About 72% (1,202/1,678) of snails were found in water with a pH 6.5 - 7.5. Grass habitat had 54% (912/1,678) of the snails.ConclusionLymnaeid snails were present in all the zones, while streams from springs and near neutral habitats had most of the snails. Infection with trematode cercariae was noted in all the zones. Trematodiases control should be focused on all zones especially in freshwater streams and lakeshores

Prevalence and spatial distribution of trematode cercariae in vector snails within different agro-ecological zones in Western Kenya, 2016

Introduction: freshwater vector snails' distribution, infection with cercariae, preferred habitat and possible trematodiases transmission foci is not well known in Western Kenya. We sought to determine the distribution and prevalence of infection of snails per agro-ecological zone and environmental factors in vector snail habitats. Methods: we conducted a cross-sectional survey from March, 2016 - May, 2016, harvested and identified snails using shell morphology, determined their infection with trematode cercariae using microscopy, used descriptive statistics to estimate the prevalence of infection and relationship between snail abundance and environmental factors. Results: we sampled a total of 1,678 vector snails from 47 sampling sites of which 42% were Lymnaeid, 23% Biomphalaria, 10% Bulinus, 22% Oncomelaniae and 2% Melanoides. Lower Midland I Ago-Ecological Zones had 44% of the snails and streams from springs had 41% of the snails. Overall, 26.5% (445/1678) (95% CI: 24.4 - 28.6) of the snails shed cercariae. Cercariae were found in 11 (23%) of the sites and in all zones. F. gigantica cercariae were shed by L. natalensis, B. pfeifferi, B. sudanica. Lakeshore had both F. gigantica and S. mansoni cercariae shed by B. sudanica. About 72% (1,202/1,678) of snails were found in water with a pH 6.5 - 7.5. Grass habitat had 54% (912/1,678) of the snails. Conclusion: lymnaeid snails were present in all the zones, while streams from springs and near neutral habitats had most of the snails. Infection with trematode cercariae was noted in all the zones. Trematodiases control should be focused on all zones especially in freshwater streams and lakeshores

Perinatal Mortality in Emergency Obstetric Health Care Facilities, Nakuru County, Kenya, 2014–2017: A descriptive cross sectional surveillance data analysis

Introduction: Perinatal mortality is a major global public health problem. In 2016, 2.6 million perinatal deaths were reported globally, in Kenya, it accounted for 22.6 deaths/1000 live births. We sought to describe perinatal mortality in Nakuru County. Methods: We reviewed “perinatal mortality” on System data report between 2014–2017. Perinatal death was defined as any record of death in the first seven days of life and stillbirths that occurred in health facilities that provided emergency obstetric care. We assessed age, time and place of death occurrence, neonatal and maternal clinical characteristics. We calculated the perinatal mortality rate (PNMR), trends, frequencies and proportions for characteristics of interest. Results: A total of 59,152 births were reported in 9 facilities from 2014–2017, 929 of these births were subsequently classified as perinatal deaths. Overall PNMR was 15 deaths/1000 live births. Among those who died their mean age was 0.83±0.05 day. Early neonatal deaths: 533(57.6%), Stillbirths: 382(41.0%) and 14(1.4%) cause of deaths were not recorded. Nakuru Level-5 Hospital recorded 835(90%) perinatal 15 deaths. In 2014, PNMR was 25.1 deaths/1000 live births which reduced to 12.5 deaths/1000 live births in 2017. Of the infants who died 570(61.4%) were <1 day old. Partograph was not used in 464(49.9%) of the pregnant women. Reported contributors of perinatal deaths were birth asphyxia 275(29.6%), prematurity 267(28.7%) and low-birth-weight 252(27.1%). Conclusion: Nakuru County PNMR was higher compared to WHO recommendation of < 12 deaths/1000 live births, therefore, there is need to identify strategies to reduce incidences of asphyxia, prematurity and low birth weight. Comprehensive antenatal coverage, adequate care of infants at birth is likely to improve quality of life among the survivors and reduce PNMR

Perinatal mortality in emergency obstetric health care facilities, Nakuru County, Kenya, 2014–2017: A descriptive cross sectional surveillance data analysis

Introduction: Perinatal mortality is a major global public health problem. In 2016, 2.6 million perinatal deaths were reported globally, in Kenya, it accounted for 22.6 deaths/1000 live births. We sought to describe perinatal mortality in Nakuru County. Methods: We reviewed “perinatal mortality” on System data report between 2014–2017. Perinatal death was defined as any record of death in the first seven days of life and stillbirths that occurred in health facilities that provided emergency obstetric care. We assessed age, time and place of death occurrence, neonatal and maternal clinical characteristics. We calculated the perinatal mortality rate (PNMR), trends, frequencies and proportions for characteristics of interest. Results: A total of 59,152 births were reported in 9 facilities from 2014–2017, 929 of these births were subsequently classified as perinatal deaths. Overall PNMR was 15 deaths/1000 live births. Among those who died their mean age was 0.83±0.05 day. Early neonatal deaths: 533(57.6%), Stillbirths: 382(41.0%) and 14(1.4%) cause of deaths were not recorded. Nakuru Level-5 Hospital recorded 835(90%) perinatal 15 deaths. In 2014, PNMR was 25.1 deaths/1000 live births which reduced to 12.5 deaths/1000 live births in 2017. Of the infants who died 570(61.4%) were <1 day old. Partograph was not used in 464(49.9%) of the pregnant women. Reported contributors of perinatal deaths were birth asphyxia 275(29.6%), prematurity 267(28.7%) and low-birth-weight 252(27.1%). Conclusion: Nakuru County PNMR was higher compared to WHO recommendation of < 12 deaths/1000 live births, therefore, there is need to identify strategies to reduce incidences of asphyxia, prematurity and low birth weight. Comprehensive antenatal coverage, adequate care of infants at birth is likely to improve quality of life among the survivors and reduce PNMR

Minyoo Matata - The Vicious Worm A Taenia solium Computer-Based Health-Education Tool - in Swahili

Biotechnology and Biological Sciences Research Council, United KingdomDepartment for International Development, United KingdomEconomic and Social Research Council, United KingdomMedical Research Council, United KingdomNatural Environment Research Council, United KingdomDefence Science and Technology Laboratory, United KingdomPeer Revie

Campylobacter positivity and public health risks in live bird markets in Busia, Kenya: A value chain analysis

Introduction: Live bird markets (LBMs) provide integral hubs for 95% of poultry produced for food. Surveillance systems in LBMs serving smallholder farmers in sub-saharan Africa are often non-functional and data about public health risks and emerging pathogens are lacking. Studies in Kenya have reported 29% – 44% Campylobacter-prevalence in poultry. We analyzed such LBMs in Kenya for likely transmission of Campylobacter from poultry to humans. Methods: We conducted a cross-sectional survey among 186 live poultry traders (LPTs) in 14 LBMs in a region with widespread backyard poultry systems. A pretested structured questionnaire was administered to all LPTs having regular contacts with poultry to gather market data and risk information on campylobacteriosis. Campylobacter was detected in individual cloacal cultures and identified through PCR. The median score obtained from the outcome of risk assessment dichotomized respondents into high and low risk categories. We performed logistic regression at 95% confidence interval (CI) to compare market characteristics and Campylobacter positivity to risk categories to identify LBM-associated public health risks. Results: Markets had a median of 13 traders. Mean age; 46.3 ± 13.7 years. Majority 162/186 (87.1%) were males. Market behavioral processes by LPTs varied: Only 58.6% LPTs held bird-species separate; onsite slaughter (38.7%); encountered sick-bird (93%) and dead-bird (83%) amidst limited health inspection (31.2%). Campylobacter positivity in live-birds was 43/112 (38.4%, 95% CI: 29.4 – 48.1). Risk information on campylobacteriosis was low 41/114 (36%, 95% C.I: 27.2 – 45.5). Sanitary risks were related to accumulation of litter [adjusted prevalence odds ratio (aPOR): 19.67, 95% CI: 3.01–128.52]. Accessing hand-wash facilities (aPOR: 0.32, 95% CI: 0.13–0.78) and access to information (aPOR: 0.24, 95% CI: 0.09–0.61) were protective. Conclusion: Sanitary risks were related to poor hygiene. LBMs could be central surveillance sites for Campylobacter. Public health authorities/actors should consider appropriate targeting to improve sanitary measures and Campylobacter control strategies

Improved latrine coverage may reduce porcine cysticercosis: a comparative cross-sectional study, Busia County, Kenya 2021

IntroductionSmallholder pig farming is an important economic activity for many poor, rural communities in developing countries. Porcine cysticercosis is a growing public health risk in countries where pig rearing is popular. A sanitation-based intervention to reduce the prevalence of open defecation was completed in Busia County, Kenya in 2016. We capitalized on this third party intervention to evaluate its impact on porcine cysticercosis prevalence.MethodsWe conducted a comparative cross-sectional survey from August through to September 2021. Household selection was done using multistage sampling. Household questionnaire data on pig production, transmission, risk factors and awareness of porcine cysticercosis were collected from 251 households. Lingual palpation was used to test for cysticerci in 370 pigs while serum was tested for circulating antigen using Ag-ELISA. We compared results of our survey to an effective baseline, which was a near equivalent cross sectional survey conducted in 2012 before the third party sanitary intervention was established. The difference in prevalence was measured using Chi-square tests. Multivariable logistic regression analysis was used to identify risk factors for lingual cysts in pigs.ResultsThe prevalence of palpable lingual cysts was estimated to be 3.8% (95% CI 2.3–6.3%) (14/370). This was 6% (95% CI 0.8–13.9%; p-value 0.0178) lower than the prevalence reported in the pre-implementation period of 9.7% (95% CI: 4.5–17.6%). Circulating antigen was detected in 2 samples (0.54%, 95% CI: 0.2–1.9). Latrine coverage was 86% (95% CI: 81–90%), which was 11% (95% CI: 4.8–16.8%; p &amp;lt; 0.001) higher than the pre-implementation period coverage of 75% (95% CI: 71–79%). There was reduced prevalence of lingual cysts in pigs from households that had a latrine (OR = 0.14; 95% CI: 0.05–0.43; p &amp;lt; 0.001) and where pigs were confined or tethered (OR = 0.27; 95% CI: 0.07–1.02; p = 0.053).ConclusionThere was a reduction in the prevalence of porcine cysticercosis in Busia County over the study period from 2012 to 2021. This was not a trial design so we are unable to directly link the decline to a specific cause, but the data are consistent with previous research indicating that improved sanitation reduces porcine cysticercosis. Programs for controlling porcine cysticercosis should include a focus on sanitation in addition to other integrated One Health approaches.</jats:sec

Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016—A randomised controlled trial

Introduction: Globally about 830 women die daily due to complications of pregnancy and child birth out of which 550 occur in Sub-Saharan Africa, with about 8,000 maternal deaths occurring annually in Kenya. 66% of maternal deaths occur within the first week and 85% of maternal deaths occur within two weeks post-delivery. Attendance of postnatal services during this time could significantly reduce morbidity and mortality. We determined effectiveness of short text message (SMS) in reducing failure-to-attend rates (FTA) of postnatal clinic at the largest maternity hospital in Nairobi, Kenya. Methods: We conducted a hospital-based randomised controlled trial. Women who delivered between March and May 2016 at Pumwani Maternity Hospital were recruited, enrolled and randomised into SMS (intervention) or no SMS (control) arms. Women were masked to which arm they belonged during randomisation but were unmasked during the appointments as the intervention had been sent. The investigators were not masked. Reminders were sent three days prior to and on the morning of the appointment. Relative Risk (RR) at 95% Confidence Interval were calculated to estimate the effectiveness of intervention at two and six-weeks. Results: We enrolled 754 women, with 377 randomly assigned into each arm. There were no differences in socio-demographic characteristics between the study arms at baseline. After two-weeks, women in the intervention arm had an 80% reduction in FTA risk (RR=0.2, 95% CI 0.1–0.3). After six weeks, women in the intervention arm had a 60% reduction in FTA risk (RR=0.4, 95% CI 0.2–0.6). Among participants, 80 (42.1%) women at two-weeks and 30 (41.7%) women at six-weeks cited forgetting appointment as the most common reason for failing to attend postnatal clinic. Conclusion: SMS reminders were effective in reducing failure-to-attend clinic appointments. We recommend the use of SMS reminder strategy for postnatal care