Genetic characterization of influenza A(H3N2) viruses circulating in coastal Kenya, 2009-2017

Background Influenza viruses evolve rapidly and undergo immune driven selection, especially in the hemagglutinin (HA) protein. We report amino acid changes affecting antigenic epitopes and receptor‐binding sites of A(H3N2) viruses circulating in Kilifi, Kenya, from 2009 to 2017. Methods Next‐generation sequencing (NGS) was used to generate A(H3N2) virus genomic data from influenza‐positive specimens collected from hospital admissions and health facility outpatients presenting with acute respiratory illness to health facilities within the Kilifi Health and Demographic Surveillance System. Full‐length HA sequences were utilized to characterize A(H3N2) virus genetic and antigenic changes. Results From 186 (90 inpatient and 96 outpatient) influenza A virus‐positive specimens processed, 101 A(H3N2) virus whole genomes were obtained. Among viruses identified in inpatient specimens from 2009 to 2015, divergence of circulating A(H3N2) viruses from the vaccine strains A/Perth/16/2009, A/Texas/50/2012, and A/Switzerland/9715293/2013 formed 6 genetic clades (A/Victoria/208/2009‐like, 3B, 3C, 3C.2a, 4, and 7). Among viruses identified in outpatient specimens from 2015 to 2017, divergence of circulating A(H3N2) viruses from vaccine strain A/Hong Kong/4801/2014 formed clade 3C.2a, subclades 3C.2a2 and 3C.2a3, and subgroup 3C.2a1b. Several amino acid substitutions were associated with the continued genetic evolution of A(H3N2) strains in circulation. Conclusions Our results suggest continuing evolution of currently circulating A(H3N2) viruses in Kilifi, coastal Kenya and suggest the need for continuous genetic and antigenic viral surveillance of circulating seasonal influenza viruses with broad geographic representation to facilitate prompt and efficient selection of influenza strains for inclusion in future influenza vaccines

Agricultural and Finance Intervention Increased Dietary Intake and Weight of Children Living in HIV-Affected Households in Western Kenya.

We tested whether a multisectoral household agricultural and finance intervention increased the dietary intake and improved the nutritional status of HIV-affected children. Two hospitals in rural Kenya were randomly assigned to be either the intervention or the control arm. The intervention comprised a human-powered water pump, microfinance loan for farm commodities, and training in sustainable farming practices and financial management. In each arm, 100 children (0-59 mo of age) were enrolled from households with HIV-infected adults 18-49 y old. Children were assessed beginning in April 2012 and every 3 mo for 1 y for dietary intake and anthropometry. Children in the intervention arm had a larger increase in weight (β: 0.025 kg/mo, P = 0.030), overall frequency of food consumption (β: 0.610 times · wk-1 · mo-1, P = 0.048), and intakes of staples (β: 0.222, P = 0.024), fruits and vegetables (β: 0.425, P = 0.005), meat (β: 0.074, P < 0.001), and fat (β: 0.057, P = 0.041). Livelihood interventions have potential to improve the nutrition of HIV-affected children. This trial was registered at clinicaltrials.gov as NCT01548599

Situational analysis of the BDS Market : empirical evidence from Kenya

Published in the African Journal of Business and Economic Research (AJBER) Volume 8, Number 1, 2013 Pp 33-60The paper analyses the situational forces in the Business Development Services (BDS) market in Kenya showing how BDS Providers’ (BDSPs) strategically respond to the forces in their environment. The study was done through the use of grounded theory methodology on eleven BDSPs, four micro and small enterprises (MSEs) and two BDS facilitators in Kenya over twelve months between May 2008 and August 2010. The study established that BDSPs operate under weak regulatory framework which encourages unfair competition longside donor agencies who continue to give free and/or subsidized services. The study also revealed that BDS services are largely unappreciated by MSEs many of who are operating under serious resource constraints. In addition, some of the MSEs do not appreciate professionalism. BDSPs respond to the situational forces in their environments using a number of strategies which evolve over time namely: client, product, differentiation, price, self-regulation diversification, and a simultaneous competition and collaboration. The study revealed paradoxical relationship between donor agencies and BDSPs showing how on one hand, BDSPs perceive donor agencies negatively as distorting the market by compromising small scale entrepreneurs’ willingness to pay for services and on the other hand, benefiting from the donor support.The paper analyses the situational forces in the Business Development Services (BDS) market in Kenya showing how BDS Providers’ (BDSPs) strategically respond to the forces in their environment. The study was done through the use of grounded theory methodology on eleven BDSPs, four micro and small enterprises (MSEs) and two BDS facilitators in Kenya over twelve months between May 2008 and August 2010. The study established that BDSPs operate under weak regulatory framework which encourages unfair competition longside donor agencies who continue to give free and/or subsidized services. The study also revealed that BDS services are largely unappreciated by MSEs many of who are operating under serious resource constraints. In addition, some of the MSEs do not appreciate professionalism. BDSPs respond to the situational forces in their environments using a number of strategies which evolve over time namely: client, product, differentiation, price, self-regulation diversification, and a simultaneous competition and collaboration. The study revealed paradoxical relationship between donor agencies and BDSPs showing how on one hand, BDSPs perceive donor agencies negatively as distorting the market by compromising small scale entrepreneurs’ willingness to pay for services and on the other hand, benefiting from the donor support

Situational forces in the BDS market and BDS providers’ strategic responses : empirical evidence from Kenya

Paper presented at the International Academy of African Business and Development (IAABD) Conference, 15th May – 19th May 2012, at El Jadida Polydisciplinary University, El Jadida, MoroccoThe paper presents situational analysis of the BDS market in Kenya showing how BDS Providers (BDSPs) respond in each situational context. The study was done through the use of grounded theory on eleven BDSPs, four small-scale entrepreneurs and two BDS facilitators in Kenya over twelve months between May 2008 and August 2010. The study established that BDSPs operate under weak regulatory framework which encourages unfair competition alongside donor agencies some of which continue to give free and/or subsidized services. BDSPs respond to the situational contexts in their environments using client, product, price, focus, diversification, and simultaneous competition and collaboration strategies.The paper presents situational analysis of the BDS market in Kenya showing how BDS Providers (BDSPs) respond in each situational context. The study was done through the use of grounded theory on eleven BDSPs, four small-scale entrepreneurs and two BDS facilitators in Kenya over twelve months between May 2008 and August 2010. The study established that BDSPs operate under weak regulatory framework which encourages unfair competition alongside donor agencies some of which continue to give free and/or subsidized services. BDSPs respond to the situational contexts in their environments using client, product, price, focus, diversification, and simultaneous competition and collaboration strategies

Motives for starting and sustaining BDS : empirical evidence Kenya

Paper presented at the 8th Annual London Business Research Conference, 8th -9th July, 2013, at the Imperial College, London, UKThe paper explains what motivates Business Development Services Providers (BDSPs) in Kenya to venture into and sustain their businesses. The study was done through the use of grounded theory methodology on eleven BDSPs in Kenya over twelve months between May 2008 and August 2010. The start-up motives were classified into three: extrinsic, intrinsic and philanthropic. Contrary to the dominant view that small business start-ups are driven principally by economic necessity, the study revealed that some BDSPs venture into and sustain their businesses mainly for intrinsic and philanthropic motives. These findings suggest that evaluation of sustainable BDS business should not be limited to the traditional economic theory of recovering costs but should take into account intrinsic and philanthropic rewards as well. The study enhances our understanding of “start-up motives” and “success” and in particular in the context of small firms. This knowledge is invaluable to scholars, teachers and policy makers involved in promoting small firms.The paper explains what motivates Business Development Services Providers (BDSPs) in Kenya to venture into and sustain their businesses. The study was done through the use of grounded theory methodology on eleven BDSPs in Kenya over twelve months between May 2008 and August 2010. The start-up motives were classified into three: extrinsic, intrinsic and philanthropic. Contrary to the dominant view that small business start-ups are driven principally by economic necessity, the study revealed that some BDSPs venture into and sustain their businesses mainly for intrinsic and philanthropic motives. These findings suggest that evaluation of sustainable BDS business should not be limited to the traditional economic theory of recovering costs but should take into account intrinsic and philanthropic rewards as well. The study enhances our understanding of “start-up motives” and “success” and in particular in the context of small firms. This knowledge is invaluable to scholars, teachers and policy makers involved in promoting small firms

Sustainabillty of business development services : gaps analysis of the Kenyan market

Published paper.A key challenge in entrepreneurship and private sector development is the provision of sustainable Business Development Services (BDS). particularly for microand small enterprises. This study investigates how sustainability of BDS can be achieved, and how some providers manage to develop sustainable BDS and not others. using Grounded Theory. The .findings suggest that there are at least nine specific demand-and-supply-side gaps in the BDS market which providers need to identify and fiil if they are to become sustainable. The gaps relate to awareness. value, trust, quality, capacity, unwillingness to pay, appreciation, inability to pay and perception. How providers identify and fill these gaps depends on their strategic orientation, which is in turn shaped by their capabilities, their motivation to sustain the business and e:xternal factors. The findings have both theoretical and practical implications. Success in the industry requires a high level of dedication, commitment and patience than is typicaliy needed in other industries. It takes time and personal sacrifice to invest in building relationships and trust with clients and incremental learning and innovation to fiil the gaps. Filling some of the gaps requires collaboration among service providers. Some others require the action of the industry as a whole. The implications for policy is that BDS development endeavours should take into account the specific demands of the industry and take a holistic view that encourages the right kind ofpeople to join the sector andfor the gaps to be addressed at alllevels.A key challenge in entrepreneurship and private sector development is the provision of sustainable Business Development Services (BDS). particularly for micro and small enterprises. This study investigates how sustainability of BDS can be achieved, and how some providers manage to develop sustainable BDS and not others. using Grounded Theory. The .findings suggest that there are at least nine specific demand-and-supply-side gaps in the BDS market which providers need to identify and fill if they are to become sustainable. The gaps relate to awareness. value, trust, quality, capacity, unwillingness to pay, appreciation, inability to pay and perception. How providers identify and fill these gaps depends on their strategic orientation, which is in turn shaped by their capabilities, their motivation to sustain the business and e:external factors. The findings have both theoretical and practical implications. Success in the industry requires a high level of dedication, commitment and patience than is typically needed in other industries. It takes time and personal sacrifice to invest in building relationships and trust with clients and incremental learning and innovation to fill the gaps. Filling some of the gaps requires collaboration among service providers. Some others require the action of the industry as a whole. The implications for policy is that BDS development endeavors should take into account the specific demands of the industry and take a holistic view that encourages the right kind of people to join the sector and for the gaps to be addressed at all levels

Evaluation of textile substrates for dispensing synthetic attractants for malaria mosquitoes

Background: The full-scale impact of odour-baited technology on the surveillance, sampling and control of vectors of infectious diseases is partly limited by the lack of methods for the efficient and sustainable dispensing of attractants. In this study we investigated whether locally-available and commonly used textiles are efficient substrates for the release of synthetic odorant blends attracting malaria mosquitoes. Methods: The relative efficacy of (a) polyester, (b) cotton, (c) cellulose + polyacrylate, and (d) nylon textiles as substrates for dispensing a synthetic odour blend (Ifakara blend 1(IB1)) that attracts malaria mosquitoes was evaluated in western Kenya. The study was conducted through completely randomized Latin square experimental designs under semi-field and field conditions. Results: Traps charged with IB1-impregnated polyester, cotton and cellulose + polyacrylate materials caught significantly more female Anopheles gambiae sensu stricto (semi-field conditions) and An. gambiae sensu lato (field conditions) mosquitoes than IB1-treated nylon (P = 0.001). The IB1-impregnated cellulose + polyacrylate material was the most attractive to female An. funestus mosquitoes compared to all other dispensing textile substrates (P < 0.001). The responses of female An. funestus mosquitoes to IB1-treated cotton and polyester were equal (P = 0.45). Significantly more female Culex mosquitoes were attracted to IB1-treated cotton than to the other treatments (P < 0.001). Whereas IB1-impregnated cotton and cellulose + polyacrylate material attracted equal numbers of female Mansonia mosquitoes (P = 0.44), the catches due to these two substrates were significantly higher than those associated with the other substrates (P < 0.001). Conclusion: The number and species of mosquitoes attracted to a synthetic odour blend is influenced by the type of odour-dispensing material used. Thus, surveillance and intervention programmes for malaria and other mosquito vectors using attractive odour baits should select an odour-release material that optimizes the odour blend

Human metapneumovirus prevalence and patterns of subgroup persistence identified through surveillance of pediatric pneumonia hospital admissions in coastal Kenya, 2007–2016

Background Human metapneumovirus (HMPV) is an important respiratory pathogen that causes seasonal epidemics of acute respiratory illness and contributes significantly to childhood pneumonia. Current knowledge and understanding on its patterns of spread, prevalence and persistence in communities in low resource settings is limited. Methods We present findings of a molecular-epidemiological analysis of nasal samples from children < 5 years of age admitted with syndromic pneumonia between 2007 and 2016 to Kilifi County Hospital, coastal Kenya. HMPV infection was detected using real-time RT-PCR and positives sequenced in the fusion (F) and attachment (G) genes followed by phylogenetic analysis. The association between disease severity and HMPV subgroup was assessed using Fisher’s exact test. Results Over 10 years, 274/6756 (4.1%) samples screened were HMPV positive. Annual prevalence fluctuated between years ranging 1.2 to 8.7% and lowest in the recent years (2014–2016). HMPV detections were most frequent between October of one year to April of the following year. Genotyping was successful for 205/274 (74.8%) positives revealing clades A2b (41.0%) and A2c (10.7%), and subgroups B1 (23.4%) and B2 (24.9%). The dominance patterns were: clade A2b between 2007 and 11, subgroup B1 between 2012 and 14, and clade A2c in more recent epidemics. Subgroup B2 viruses were present in all the years. Temporal phylogenetic clustering within the subgroups for both local and global sequence data was seen. Subgroups occurring in each epidemic season were comprised of multiple variants. Pneumonia severity did not vary by subgroup (p = 0.264). In both the F and G gene, the sequenced regions were found to be predominantly under purifying selection. Conclusion Subgroup patterns from this rural African setting temporally map with global strain distribution, suggesting a well-mixed global virus transmission pool of HMPV. Persistence in the local community is characterized by repeated introductions of HMPV variants from the global pool. The factors underlying the declining prevalence of HMPV in this population should be investigated

Clinico-pathologic characteristics and treatment outcomes in children with neuroblastoma at the Kenyatta National Hospital, Nairobi.

Objective: To determine clinical-pathologic characteristics, treatment modalities and treatment outcomes of children diagnosed with neuroblastoma. Design: Cross- sectional descriptive study based on secondary data from patient records. Setting: Records department of Kenyatta National Hospital (KNH), a tertiary teaching and referral hospital based in Nairobi. Subjects: Children aged 15 years and below, admitted with the diagnosis of neuroblastoma, between January 1997 and December 2005. Main outcome measures: Presenting clinical features, diagnostic modalities including laboratory and imaging data, treatment modalities, response to treatment and patient survival. Results: Twenty six patients were eligible for the study; 13 males and 13 females giving a M: F ratio of 1: 1. The age range was 5 days to 12 years, with a median age of five years. Abdominal swelling (53.8%), inability to walk due to bone pains,(50%), and cranial or periorbital swelling, (38.5%) were the commonest presenting features. Diagnosis of neuroblastoma was based on tissue biopsy in 50% (95% CI40.6-79.8%) of the patients, and on fine needle aspiration cytology of mass or bone marrow in the rest. Bone marrow involvement was present in 16, (75%). Anaemia,was common with 72.7% patients having a haemoglobin (HB) \u3c8g/dl at presentation. Immunohistochemistry and cytological grading were done in two, (8%), patients. Urinary vanilly l mandelic acid (VMA), screening was positive in 50% (95% CI 29.9%-70.1%). The most frequently involved organs were abdomen (88.9%), and skeleton,(84.6%). Majority of patients, (92.3%), presented with advanced stage IV disease. Three patients died before commencement of treatment. All treated patients (100%), received cytotoxic therapy. Only two patients (8.6%) had surgery as part of treatment while one, (4.3%) was treated with radiotherapy. The initial treatment regimen was similar for all the patients. Although most patients had a complete initial response to treatment, early relapse, treatment failure, death or loss to follow up of patients with progressive disease were common. Overall survival (OS) at one year and two years were 19.2% (95% CI 6.6-39.4%) and 7.7% (95% CI 0.9%-25 1%) respectively. Only one patient was alive, (also free of disease), five years after diagnosis. Conclusion: Although other clinical- pathologic findings of the patients were similar to those reported elsewhere, virtually all study patients presented with advanced stage IV disease, which would be associated with poor prognosis irrespective of quality of care. Priority must therefore be on ensuring early diagnosis and referral of patients with neuroblastoma before any other interventions can be expected to positively impact on outcome. The limited role of surgery and radiotherapy observed over the study period may be attributed to late presentation of the patients. Pathologic evaluation of patients was inadequate, to some extent due to unavailability of facilities, but extra important information could have been availed at minimal extra cost. To be at par with current internationally accepted treatment approaches that have been associated with improved survival, there is need to base choice of regimens for individual patients on clinical and readily accessible pathologic markers