Vitamin D status in healthy black African adults at a tertiary hospital in Nairobi, Kenya: a cross sectional study

Background: Vitamin D has been known since the twentieth Century for its benefits in bone health. Recent observational studies have demonstrated its benefits in infectious diseases such as tuberculosis and non-communicable diseases such as diabetes mellitus, cardiovascular diseases and cancer. This has led to a dramatic increase in testing among adults. The cut-offs for vitamin D deficiency have been debated for decades and the current cut off is derived from a Caucasian population. Studies done among black African adults in Africa are few with vitamin D deficiency ranging from 5 to 91%. A few cut- offs have correlated vitamin D deficiency to physiological markers such as parathyroid hormone (PTH), calcium and phosphate with varying results. Methods: This was a cross sectional study carried out among blood donors at Aga Khan University hospital, Nairobi (AKUHN) from March to May 2015. Vitamin D (25(OH)D) levels were assayed and correlated with PTH, calcium and phosphate. Results: A total of 253 individuals were included in the final analysis. The proportion of study participants who had a 25(OH) D level of \u3c 20 ng/ml thus classified as vitamin D deficient was 17.4% (95% C.I 12.73–22.07). The 25(OH) D level that coincided with a significant increase in PTH was 30 ng/ml. Males were less likely to be vitamin D deficient (O.R 0.48 (C.I 0.233–0.993) p 0.04). Sunshine exposure for ≥3 h per day reduced the odds of being Vitamin D deficient though this was not statistically significant after multivariate regression analysis. Conclusions: We found a much lower prevalence of Vitamin D deficiency compared to many similar studies carried out in sub-Saharan Africa possibly due to the recruitment of healthy individuals and the proximity of Nairobi to the equator which allows for considerable exposure to sunshine. Vitamin D levels below 30 ng/mL was associated with a significant rise in PTH levels, suggesting that this cut off could be appropriate for defining Vitamin D deficiency in the population served by our laboratory

Genetic studies on host-plant resistance to bean fly (Ophiomyia spp.) and seed yield in common bean (Phaseolus vulgaris) under semi-arid conditions.

Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.Bean fly (Ophiomyia spp.) is a major pest of common bean (Phaseolus vulgaris L.) throughout eastern and southern Africa. In the semi-arid areas, apart from drought, the insect pest is reported to cause high crop losses up to 100%, particularly when drought occurs and under low soil fertility. Host-plant resistance is part of the integrated pest management strategies that have been widely employed against major insect pests of tropical legumes. However, information regarding its use in control of bean fly in common bean is limited. Therefore, the objectives of this study were to: (1) validate farmers’ perceptions of major constraints responsible for yield losses, particularly the major insect pests of beans; (2) asses the level of adoption of improved bean varieties and determine factors that influence farmers’ preferences of the varieties and criteria for selection; (3) identify sources of resistance to bean fly available in landraces; (4) determine the nature of gene action controlling bean fly resistance and seed yield in common bean; (5) describe a procedure for generating optimal bean fly populations for artificial cage screening for study of the mechanisms of resistance available in common bean against bean fly. Farmers considered drought and insect pest problems as main causes for low yields. The adoption rate for improved varieties was high but self-sufficiency in beans stood at 23% in the dry transitional (DT) agro-ecology and at 18% in the dry mid-altitude (DM) agroecology, respectively. Drought, earliness, yield stability, and insect pest resistance were the factors determining the choice of varieties by farmers. Bean fly (Ophiomyia spp.), African bollworm (Helicoverpa armigera) and bean aphid (Aphis fabae) were identified as key crop pests of beans limiting yield. The study to identify new sources of resistance included 64 genotypes consisting of landraces, bean fly resistant lines and local checks. The experiment was done under drought stressed (DS) and non-stressed (NS) environments and two bean fly treatments (insecticide sprayed and natural infestation) for three cropping seasons between 2008 and 2009. Genotypes differed in their reaction to natural bean fly attack under drought stressed (DS) and non-stressed environments (NS) over different cropping seasons. However, the effect of bean fly appeared to vary between the long rains (LR) and short rains (SR). It was observed that an increase in the number of pupae per stem resulted in a higher plant mortality. The range of seed yield was from 345 to1704 kg ha-1 under natural infestation and from 591 to 2659 kg ha-1 under insecticide protection. Seed yield loss ranged from 3 to 69 %. The resistance of most of the bean fly resistant lines seemed to be ineffective in presence of DS. To determine the nature of gene action controlling the inheritance of resistance to bean fly, four parents with known reaction to bean fly were crossed with four locally adapted genotypes in an 8 x 8 half-diallel mating design. Similarly, two resistant and two susceptible parents were selected and crossed to produce populations for generations means and variance components analysis. Results revealed that both general combining ability (GCA) and specific combining ability (SCA) mean squares were significant (p A 0.05) for all four traits studied, except SCA for stem damage during one cropping season. Among the parents, GBK 047858 was the best general combiner for all the traits studied across seasons except for stem damage during LR 2009. Genotypes GBK 047821 and Kat x 69 (a locally adapted variety) were generally good general combiners for resistance traits as well as seed yield. General predictability ratio values ranging from 0.63 to 0.90 were obtained for plant mortality, stem damage, pupae in stem and seed yield across cropping seasons. These results established the predominance of additive gene effects (fixable variation) over the non-additive effects in controlling the traits. Low to moderate narrow sense heritability values ranging from 0.22 to 0.45 were obtained for pupae in stem. Such heritability estimates indicate that although additive gene components were critical in the inheritance of resistance for the trait, non-additive gene action was also important in addition to the environmental effects. A major disadvantage in screening for resistance to bean fly in common bean by controlled means in net cages has been the lack of a method to use for raising adequate fly populations for screening. Due to this problem, a simple procedure for raising sufficient numbers of adult bean flies required for screening was described. Through this method, up to 62 % emergence of the adult flies was achieved. Moreover, the flies retained their ability to infest bean plants. To determine the presence of antibiosis and antixenosis mechanisms of resistance in common bean, five genotypes [CC 888 (G15430), GBK 047821, GBK 047858, Ikinimba and Macho (G22501)] and two local check varieties (Kat B1 and Kat B9) were screened under free-choice in outdoor net cages and no-choice conditions in net cages placed in a shadehouse. All the five resistant genotypes tested had relatively long internodes. It was established that long internode was a morphological trait associated with reduced pupation rate in bean stems, hence an antixenosis component of resistance. Both ovipositional non-preference and antibiosis mechanisms were found to exist in three genotypes namely CC 888 (G45430), GBK 047858 and Macho (G22501). These genotypes were resistant when they were subjected to bean fly under both free-choice and no-choice conditions. They had fewer feeding/oviposition punctures, low number of pupae in the stem, reduced damage to the stems and low percent plant mortality. The remaining genotypes, Ikinimba and GBK 047821 only expressed antixenosis. To maximize the effectiveness of host-plant resistance against bean fly, multiple insect resistances should be incorporated into a single bean genotype in order to ensure durability. However, this should be within the background of integrated pest management strategy

Prevalence of gastric mucosal interleukin-1 polymorphisms in Kenyan patients with advanced gastric cancer

Helicobacter pylori is the main cause of peptic ulceration, distal gastric adenocarcinoma, and gastric lymphoma.1 Worldwide, gastric cancer is the second most common malignancy in men and women.1 According to data from the Nairobi Cancer Registry, gastric cancer is the fourth most common malignancy in adult males and the fifth most common in adult females. However, this may not represent the true situation because of under-reporting of cases. In the development of gastric cancer, environmental factors such as smoking, diet and, in particular, infection with H. pylori are significant.1 Based on epidemiological studies, the International Agency for Research on Cancer (IARC) identified H. pylori as a ‘group 1 agent (definite carcinogen)’.2 H. pylori infection can result in decreased acid secretion with subsequent mucosal atrophy and intestinal metaplasia.1 Another precondition for mucosal atrophy is autoimmunity against parietal cells, which can mimic classic autoimmune gastritis with the presence of various autoantibodies in up to 40% of H. pylori-infected individuals.1 The occurrence of intestinal metaplasia, for which a relationship with gastric cancer is strongly suggested, has been demonstrated in approximately 60% of patients with H. pylori infection.1 The metaplasia may then progress to gastric cancer, especially to tumours of the intestinal type.1 Findings by Uemura et al. support the importance of these histological findings as a precancerous condition in H. pyloriassociated gastritis.3 However, only a minority of H. pyloriinfected patients develop gastric cancer, which underscores the notion that the host genetic background could be of critical importance. Data strongly suggest that the susceptibility to infection from H. pylori is mainly conferred by genes involved in inflammatory processes following colonisation with H. pylori.1 Chronic gastritis is characterised by the release of pro-inflammatory cytokines such as interleukin-1β (IL-1β) or tumour-necrosis factor alpha (TNFα), which are potent inhibitors of gastric acid secretion.1 Advanced-stage gastric cancer has been repeatedly associated with polymorphisms of the IL-1 gene cluster on chromosome 2q, which contains 3 related genes within a 430 kb region (IL-1A, IL-1B, and IL-1RN), encoding for IL-1α , IL-1β, and the endogenous receptor antagonist IL-1ra, respectively. It was hypothesised that genetic differences within these genes could influence the immune response against pathogens such as H. pylori and the development of premalignant histological alterations in the gastric mucosa.1 In patients with advanced-stage gastric cancer, an increased frequency of the IL-1B-31C and IL-1B-511T alleles and the uncommon IL-1B-31C/IL-1B-511T haplotype was demonstrated. In addition, the IL-1RN*2 allele and the homozygous genotype IL-1RN*2/2 were found in increased prevalence in gastric cancers.1 Subsequent studies confirmed these genetic associations.1 El-Omar et al. genotyped patients with gastric cancer according to tumour localisation (cardia v. non-cardia) and oesophageal cancers (adenocarcinomas v. squamous cell carcinomas) for various polymorphisms of genes encoding for pro- and anti-inflammatory cytokines.4 They described an increased risk for non-cardia gastric cancer in carriers of the IL-1B-511T allele, IL-1RN*2 homozygotes, carriers of the TNF-A-308A allele and the haplotype IL-10- 1082A/-819T/-592A. The cumulative risk depends on the number of high-risk alleles or genotypes per patient.4 A previous study confirmed the risk increase for development of gastric carcinoma in carriers of multiple proinflammatory genotypes.1 The alleles IL-1RN*2 and IL-1B-511T are associated with increased synthesis of the proinflammatory cytokine IL-1ß, and the allele TNFA-308A results in an increased production of the proinflammatory cytokine TNF.

Comparison of equations for estimating glomerular filtration rate in screening for chronic kidney disease in asymptomatic black Africans: A cross sectional study

Background: Several equations have been developed to estimate glomerular filtration rate (eGFR). The common equations used were derived from populations predominantly comprised of Caucasians with chronic kidney disease (CKD). Some of the equations provide a correction factor for African-Americans due to their relatively increased muscle mass and this has been extrapolated to black Africans. Studies carried out in Africa in patients with CKD suggest that using this correction factor for the black African race may not be appropriate. However, these studies were not carried out in healthy individuals and as such the extrapolation of the findings to an asymptomatic black African population is questionable. We sought to compare the proportion of asymptomatic black Africans reported as having reduced eGFR using various eGFR equations. We further compared the association between known risk factors for CKD with eGFR determined using the different equations. Methods: We used participant and laboratory data collected as part of a global reference interval study conducted by the Committee of Reference Intervals and Decision Limits (C-RIDL) under the International Federation of Clinical Chemistry (IFCC). Serum creatinine values were used to calculate eGFR using the Cockcroft-Gault (CG), re-expressed 4 variable modified diet in renal disease (4v–MDRD), full age spectrum (FAS) and chronic kidney disease epidemiology collaboration equations (CKD-EPI). CKD classification based on eGFR was determined for every participant. Results: A total of 533 participants were included comprising 273 (51.2%) females. The 4v–MDRD equation without correction for race classified the least number of participants (61.7%) as having an eGFR equivalent to CKD stage G1 compared to 93.6% for CKD-EPI with correction for race. Only age had a statistically significant linear association with eGFR across all equations after performing multiple regression analysis. The multiple correlation coefficients for CKD risk factors were higher for CKD-EPI determined eGFRs. Conclusions: This study found that eGFR determined using CKD-EPI equations better correlated with a prediction model that included risk factors for CKD and classified fewer asymptomatic black Africans as having a reduced eGFR compared to 4v–MDRD, FAS and CG corrected for body surface area

Spatiotemporal dynamics of wild herbivore species richness and occupancy across a savannah rangeland:Implications for conservation

Private lands are critical for maintaining biodiversity beyond protected areas. Across Kenyan rangelands, wild herbivores frequently coexist with people and their livestock. Human population and livestock numbers are projected to increase dramatically over the coming decades. Therefore, a better understanding of wildlife-livestock interactions and their consequences for biodiversity conservation on private lands is needed. We used a Bayesian hierarchical, multi-species and multi-year occupancy model on aerial survey data of 15 wild-herbivore species, spanning 15 years (2001–2016) to investigate a) spatiotemporal trends in species occurrence and richness across a mosaic of properties with different land uses in Laikipia County, central Kenya; and b) the effects of distance to water, vegetation and livestock relative abundance on species occurrence and richness. Although mean herbivore species richness varied little over time, we observed high spatial variation in species occurrence across Laikipia, mainly driven by negative effects of high livestock relative abundance. As expected, ‘wildlife friendly’ properties had higher herbivore species richness than other areas. However, high variability suggests that some pastoral properties support rich herbivore communities. The area occupied by five species with global conservation concerns (reticulated giraffe, Grevy's zebra, Beisa Oryx, Defassa waterbuck and gerenuk) and for which Laikipia County is one of the last refuges was <50% across years. We conclude that ‘wildlife friendly’ properties remain crucial for conservation, although some pastoralist areas offer suitable habitats for wild herbivores. Effective management of stocking rates is critical for maintaining ecosystems able to sustain livestock and wildlife on private lands, ensuring protection for endangered species

Metabolic syndrome and its predictors in an urban population in Kenya: A cross sectional study

Background: The metabolic syndrome (MetS) is a clustering of interrelated risk factors which doubles the risk of cardio-vascular disease (CVD) in 5–10 years and increases the risk of type 2 diabetes 5 fold. The identification of modifiable CVD risk factors and predictors of MetS in an otherwise healthy population is necessary in order to identify individuals who may benefit from early interventions. We sought to determine the prevalence of MetS as defined by the harmonized criteria and its predictors in subjectively healthy black Africans from various urban centres in Kenya. Method: We used data collected from healthy black Africans in Kenya as part of a global study on establishing reference intervals for common laboratory tests. We determined the prevalence of MetS and its components using the 2009 harmonized criterion. Receiver operator characteristic (ROC) curve analysis was used to determine the area under the curves (AUC) for various predictors of MetS. Youden index was used to determine optimum cut-offs for quantitative measurements such as waist circumference (WC). Results: A total of 528 participants were included in the analysis. The prevalence of MetS was 25.6% (95% CI: 22. 0%–29.5%). Among the surrogate markers of visceral adiposity, lipid accumulation product was the best predictor of MetS with an AUC of 0.880 while triglyceride was the best predictor among the lipid parameters with an AUC of 0.816 for all participants. The optimal WC cut-off for diagnosing MetS was 94 cm and 86 cm respectively for males and females. Conclusions: The prevalence of MetS was high for a healthy population highlighting the fact that one can be physically healthy but have metabolic derangements indicative of an increased CVD risk. This is likely to result in an increase in the cases of CVD and type 2 diabetes in Kenya if interventions are not put in place to reverse this trend. We have also demonstrated the inappropriateness of the WC cut-off of 80 cm for black African women in Kenya when defining MetS and recommend adoption of 86 cm

Complete blood count reference intervals from a healthy adult urban population in Kenya

Background: There are racial, ethnic and geographical differences in complete blood count (CBC) reference intervals (RIs) and therefore it is necessary to establish RIs that are population specific. Several studies have been carried out in Africa to derive CBC RIs but many were not conducted with the rigor recommended for RI studies hence limiting the adoption and generalizability of the results. Method: By use of a Beckman Coulter ACT 5 DIFF CP analyser, we measured CBC parameters in samples collected from 528 healthy black African volunteers in a largely urban population. The latent abnormal values exclusion (LAVE) method was used for secondary exclusion of individuals who may have had sub-clinical diseases. The RIs were derived by both parametric and non-parametric methods with and without LAVE for comparative purposes. Results: Haemoglobin (Hb) levels were lower while platelet counts were higher in females across the 4 age stratifications. The lower limits for Hb and red blood cell parameters significantly increased after applying the LAVE method which eliminated individuals with latent anemia and inflammation. We adopted RIs by parametric method because 90% confidence intervals of the RI limits were invariably narrower than those by the non-parametric method. The male and female RIs for Hb after applying the LAVE method were 14.5-18.7 g/dL and 12.0-16.5 g/dL respectively while the platelet count RIs were 133-356 and 152-443 x10(3) per μL respectively. Conclusion: Consistent with other studies from Sub-Saharan Africa, Hb and neutrophil counts were lower than Caucasian values. Our finding of higher Hb and lower eosinophil counts compared to other studies conducted in rural Kenya most likely reflects the strict recruitment criteria and healthier reference population after secondary exclusion of individuals with possible sub-clinical diseases

Determination of reference intervals for common chemistry and immunoassay tests for Kenyan adults based on an internationally harmonized protocol and up-to-date statistical methods

Background: Due to a lack of reliable reference intervals (RIs) for Kenya, we set out to determine RIs for 40 common chemistry and immunoassay tests as part of the IFCC global RI project. Methods: Apparently healthy adults aged 18–65 years were recruited according to a harmonized protocol and samples analyzed using Beckman-Coulter analyzers. Value assigned serum panels were measured to standardize chemistry results. The need for partitioning reference values by sex and age was based on between-subgroup differences expressed as standard deviation ratio (SDR) or bias in lower or upper limits (LLs and ULs) of the RI. RIs were derived using a parametric method with/without latent abnormal value exclusion (LAVE). Results: Sex-specific RIs were required for uric acid, creatinine, total bilirubin (TBil), total cholesterol (TC), ALT, AST, CK, GGT, transferrin, transferrin saturation (TfSat) and immunoglobulin-M. Age-specific RIs were required for glucose and triglyceride for both sexes, and for urea, magnesium, TC, HDL-cholesterol ratio, ALP, and ferritin for females. LAVE was effective in optimizing RIs for AST, ALT, GGT iron-markers and CRP by reducing influence of latent anemia and metabolic diseases. Thyroid profile RIs were derived after excluding volunteers with anti-thyroid antibodies. Kenyan RIs were comparable to those of other countries participating in the global study with a few exceptions such as higher ULs for TBil and CRP. Conclusions: Kenyan RIs for major analytes were established using harmonized protocol from well-defined reference individuals. Standardized RIs for chemistry analytes can be shared across sub-Saharan African laboratories with similar ethnic and life-style profile

The use of common bean (Phaseolus vulgaris ) traditional varieties and their mixtures with commercial varieties to manage bean fly (Ophiomyia spp .) infestations in Uganda

The bean fly (Ophiomyia spp.) is considered the most economically damaging field insect pest of common beans in Uganda. Despite the use of existing pest management approaches, reported damage has remained high. Forty-eight traditional and improved common bean varieties currently grown in farmers’ fields were evaluated for resistance against bean fly. Data on bean fly incidence, severity and root damage from bean stem maggot were collected. Generalized linear mixed model (GLMM) revealed significant resistance to bean fly in the Ugandan traditional varieties. A popular resistant traditional variety and a popular susceptible commercial variety were selected from the 48 varieties and evaluated in pure and mixed stands. The incidence of bean fly infestation on both varieties in mixtures with different arrangements (systematic random versus rows), and different proportions within each of the two arrangements, was measured and analysed using GLMMs. The proportion of resistant varieties in a mixture and the arrangement type significantly decreased bean fly damage compared to pure stands, with the highest decrease in damage registered in the systematic random mixture with at least 50 % of resistant variety. The highest reduction in root damage, obvious 21 days after planting, was found in systematic random mixtures with at least 50 % of the resistant variety. Small holder farmers in East Africa and elsewhere in the world have local preferences for growing bean varieties in genetic mixtures. These mixtures can be enhanced by the use of resistant varieties in the mixtures to reduce bean fly damage on susceptible popular varieties