Autopsy Findings on a Pair of Dicephalic Parapagus Twins: A Case Report

Conjoined twins are a rare occurrence that presents significant challenges to both parents and medical care givers with many theories being advanced to explain this occurrence.“Parapagus” is a fairly recent term, in which the twins lie side by side with ventro-lateral fusion and are extremely rare representing 0.5% of all reported cases. We present a case report on post mortem findings on a set of parapagus twins delivered through caesarian section at Narok district hospital. We illustrate the various anomalies of the thoracic, abdominal cavity and central nervous system and discuss the embryologic etiologic theories.Key Words: Conjoined, Dicephalic, Malformations, Autops

Trends in outpatient malaria cases, following Mass Long Lasting Insecticidal Nets (LLIN) distribution in epidemic prone and endemic areas of Kenya

Background: There were over 6 million case of malaria reported in Kenya in 2015 and it remains a major public health priority despite significant investments in interventions to control and prevent infections in high risk areas.Objectives: To analyse trends from 2011-2015, and report i) outpatient department (OPD) malaria case prevalence, ii) the proportion of confirmed malaria cases of all OPD cases stratified by age category, and iii) the proportion of the population potentially protected by long-lasting insecticidal nets (LLINs), following mass distribution of LLINs in malaria epidemic prone and endemic areas.Design: A retrospective study.Setting: Kenya’s Coast endemic, Lake endemic and Highland epidemic zones.Subjects: All outpatient malaria cases reported in the District Health Information System.Results: The proportion of people who received mass LLINs ranged from 80-95% in epidemic prone and endemic areas of Kenya. The coastal endemic zone had the lowest number of reported malaria cases at almost 840,000 in 2011, compared with the lake endemic zone which reported 4.3 million total cases. Confirmed malaria cases of all the OPD morbidity increased by 1%, 20% and 4% in the Highland epidemic prone, the Lake and Coast endemic region in 2011 to 2015, respectively. There was a trend towards fewer cases across all three high risk regions from 2012-2013, but this reversed with increasing cases being reported in 2014-2015.Conclusion: Despite a high LLIN coverage malaria cases increased over time. There is need for patient-level studies to assess if LLINs are being used appropriately and to look towards other complimentary malaria prevention strategies

Scientific Communication: Reporting on Mental Health Illness (MHI) in Kenya: how well are we doing?

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Trends of reported outpatient malaria cases to assess the Test, Treat and Track (T3) policy in Kenya

Background: Kenya reports over six million malaria cases annually. In 2012 the country adopted the Test, Treat and Track (T3) policy to ensure that all suspected malaria cases are tested, confirmed cases are treated with quality-assured drugs and timely accurate malaria surveillance are in place to guide policy and practice.Objective: To describe the trends of confirmed outpatient malaria cases and the consumption of artemisinin-based combination therapy (ACT) in the government health facilities in Kenya following the roll out of the T3 initiative.Design: A retrospective review study.Setting: All government health facilities in the 47 counties.Subjects: Secondary data on all outpatient malaria cases and ACT consumed as reported in the District Helth Information Software (DHIS).Results: Total malaria cases decreased from 8.5 to 6.8million cases in 2012 and 2015, respectively. Confirmed malaria cases increased from 1.97 (23%) to 4.9 (72%) million cases. The greatest decrease in total malaria cases and the greatest rise in confirmation of suspected cases occurred in the lower level health facilities. More confirmation of suspected cases occurred in the malaria endemic regions compared to other epidemiological zones. Excess ACT consumption reduced by 46% to reach 27% in 2015.Conclusion: Though there was increased confirmation of suspected malaria, still onethird of the outpatients were treated clinically in 2015. About one-third of ACTs were also used in excess in 2015. There is need for enhanced efforts to adhere to the T3 policy and malaria elimination guidelines

Intermittent preventive treatment and bed nets uptake among pregnant women in Kenya

Background: Malaria in pregnancy is a preventable disease which results in poor pregnancy outcomes. The use of intermittent preventive treatment in pregnancy (IPTp) and long-lasting insecticide treated nets (LLINs) have been shown to reduce maternal malaria episodes.Objectives: To describe i) The proportion receiving first and second dose (IPTp1 and 2) in malaria endemic zones, ii) proportion receiving IPTp 1 and 2 stratified by coast and lake endemic zones iii) proportion receiving LLINs, stratified by coastal and lake endemic zones.Design: A retrospective descriptive study.Setting: Lake and Coast region malaria endemic zones.Subjects: Pregnant women.Results: IPTp2 dose during an ANC revisit fell by 29% between 2012 and 2015, with 76% receiving an IPTp2 in 2012 and only 47% receiving it in 2015. More pregnant women in Coastal endemic areas received IPTp2 compared to Lake, with 88% versus 73% in 2012, and 53% versus 44% in 2015, respectively.There was steady increase in bed net usage from 69% and 54% in 2012 to 96% and 95% in 2015 for lake and coast endemic zones respectively. The uptake of LLINs was 15% higher in the lake region compared to the coastal endemic region in 2012 and significantly declined over the five years to 6%, 7% and 1% in 2013, 2014 and 2015, respectively.Conclusion: Our study found that there has been a significant decline from 2012 through 2015, in the number of pregnant women in Kenya receiving recommended malaria prophylaxis in the regions of highest malaria burden. However, the coverage of LLIN has consistently improved over the same period

Spatial distribution and co-infection with urogenital and intestinal schistosomiasis among primary school children in Migori County, Kenya

Background: Schistosomiasis is the most prevalent helminthic infection in sub-Saharan Africa. School age children have the highest burden. Chronic schistosome infections in children can have irreversible effects lasting throughout adulthood.Objective: To determine the prevalence, intensity and distribution of urogenital and intestinal schistosomiasis among primary school children in Migori County, Kenya.Design: Descriptive cross-sectional study.Setting: Primary schools in Migori County, Kenya.Subjects: Children aged seven to fourteen years.Results: We enrolled 1,784 children with the ratio of female to males being 1:1. Their mean age was 11.4 years (standard deviation ± 1.6). The overall prevalence of infection was 26%, with urogenital and intestinal schistosomiasis being found in 9% and 20% of children, respectively. A trend of increasing prevalence with increasing age of children was observed. Boys had a 50% higher risk of being infected with schistosomiasis when compared to girls (adjusted odds ratio 1.5, 95% confidence interval 1.2-1.9). Intensities of schistosome infections did not vary significantly across gender and age. Nyatike Constituency had the highest prevalence of schistosomiasis (54%).Prevalence in schools ranged from 1.7 to 89%. Seven schools (23%) had a schistosomiasis prevalence of at least 50% while 12 (39%) schools had schistosomiasis prevalence of between 10 and 50%.Conclusion: Our study showed that schistosomiasis is endemic in the study area and represents a significant public health problem among school children. The area should be prioritised for interventions including mass deworming, public health education and sanitation improvement

Prevalence of Hepatitis C Virus and its genotypes among a cohort of drug users in Kenya

Background: Prevalence of hepatitis C virus and that of its main genotypes varies between the worlds geographic regions. The risk factors for infection with HCV include blood transfusion, tattoing and injecting drug use. Objectives: To examine the prevalence of HCV and determine its main genotypes among a cohort of drug users in Kenya. Design: A laboratory based study. Setting: Hepatitis research laboratory in the Centre for Virus Research at the Kenya Medical Research Institute, Nairobi. Subjects: Three hundred and fourteen male and 19 female intravenous and non-intravenous drug users aged between 15-55 years. Results: Seventy four (22.2%) out of 333 samples tested positive for anti-HCV. Sixty nine out of the 74 serum samples were assayed for HCV RNA and 38 (55.5%) were positive. The RNA positive samples were further subjected to sequencing and 19 (73%) of the samples were classified as genotype la, while seven (27%) samples were classified as genotype 4. Genotypes 2, 3, 5 and 6 were not identified in this study. Conclusions: These results demonstrate a high HCV infection prevalence among this cohort of drug users (22.2 %) as compared to that of the general population, which is estimated to be 0.2- 0.9%. The study also confirms the presence of at least two major genotypes among Kenyan drug users (genotypes 1 and 4). East African Medical Journal Vol. 85 (7) 2008: pp. 318-32

Editorial: Structured operational research and training in the public health sector: the Kenyan experience

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Phylogenetic diversity of cassava green mite, Mononychellus progresivus from different geographical sites in East Africa

Cassava green mite (CGM) of the Mononychellus genus is an invasive species in Africa, introduced from South America. Its phylogenetic diversity over geographical localities has never been assessed in East Africa, where mite density dynamics oscillate from few individuals to a peak of hundreds. The objective of this study was to determine CGM species comparative phylogenetic diversity from seven distinct geographical sites in East Africa. Six sites were sampled for CGM races, two samples from each country. DNA was extracted on internal transcribed spacer 2 (ITS2) and cytochrome oxidase subunit I (COI), and compared for phylogenetic variations of CGM from different locations of East African region. A comparative search from the NCBI Gene bank resulted into identical species nucleotides from Congo and Benin. Sequences from the two sites in Kenya were 99-100% similar to CGM nucleotide from the Congo-Benin accessions (X79902.1) on ITS2 gene region. On COI, a 98-99% site sequences similarity was observed on M. progresivus accession X79901.1. A closely related divergence of specimens collected from Tanzania and Uganda was determined. Both Uganda and Tanzania had 99% match to X79901.1 on COI region. Similarly, the Uganda and Tanzania samples had 99% match to emb/X79902.1 on the 18Sr RNA region. The CGM sequence from coastal Kenya had the highest phylogenetic divergence from the Congo-Benin sequences. A small biogeographic phylogenetic divergence (0-1%) was evident from the analyses among the six collection sites. The results confirm M. progresivus identity in East Africa it also indicates intra-species phylogenetic variations on the COI gene region of interest.L\u2019acarien vert du manioc (CGM) du genre Mononychellus est espece invasive Introduite de l\u2019Amerique du Sud en Afrique. Sa diversite phyllogenetique au sein et entre les localites n\u2019a jamais ete evaluee en Afrique de l\u2019Est, ou la densite d\u2019acarien varie de quelques individus a plusieurs centaines. L\u2019objectif de cette etude etait de determiner la diversite phyllogenetiques des especes CGM et de comparer sept sites geographiquement differents en Afrique de l\u2019Est. six sites ont ete echantillonnes pour des races de CGM, a raison de deux echantillons par pays. De l\u2019AND a ete extrait sur l\u2019espaceur interne transcrit 2 (ITS2) et sous-unite I de cytochrome oxidase (COI), ces echantillons ont ete compares pour les variations phyllogenetiques de CGM provenant de localites differentes de la region Est Africaine. Une etude comparee a la banque de gene de NCBI a revele des especes identiques en provenance de Congo et du Benin, de point de vue de leur nucleotides. Des sequences provenant des deux sites au Kenya ont exhibe 99-100% de similarite avec les nucleotides de CGM provenant des accessions Congo-Benin (X79902.1) sur la region genetique ITS2. Sur COI, une similarite de 98-99% a ete observee sur l\u2019accession M. progresivus X79901.1. Une divergence de sujets genetiquement proches a ete observe chez des specimens collectes en Tanzannie et en Ouganda. Ouganda et Tanzanie ont exhibe 99% de similitude a X79901.1 sur la region COI. De meme, les echantillons provenant de Ouganda et de Tanzannie presentaient 99% de similitude avec emb/X79902.1 sur la region 18Sr RNA. La sequence de CGM provenant de cote kenyane avait la divergence phyllogenique la plus elevee d\u2019avec les sequences Congo-Benin. Une legere divergence phyllogenetique geographiaque (0-1%) a ete note des analyses dans les sites de collection. Les resultats conferment l\u2019identite de M. progresivus identity en Afrique de l\u2019Est. l\u2019etude a aussi revele des variations phyllogenetiques sur la region de gene d\u2019interet COI

Transcriptomic analysis of field-droughted sorghum from seedling to maturity reveals biotic and metabolic responses.

Drought is the most important environmental stress limiting crop yields. The C4 cereal sorghum [Sorghum bicolor (L.) Moench] is a critical food, forage, and emerging bioenergy crop that is notably drought-tolerant. We conducted a large-scale field experiment, imposing preflowering and postflowering drought stress on 2 genotypes of sorghum across a tightly resolved time series, from plant emergence to postanthesis, resulting in a dataset of nearly 400 transcriptomes. We observed a fast and global transcriptomic response in leaf and root tissues with clear temporal patterns, including modulation of well-known drought pathways. We also identified genotypic differences in core photosynthesis and reactive oxygen species scavenging pathways, highlighting possible mechanisms of drought tolerance and of the delayed senescence, characteristic of the stay-green phenotype. Finally, we discovered a large-scale depletion in the expression of genes critical to arbuscular mycorrhizal (AM) symbiosis, with a corresponding drop in AM fungal mass in the plants' roots