Seroprevalence of HAV, HBV, HCV, and HEV among acute hepatitis patients at Kenyatta National Hospital in Nairobi, Kenya

Background: Acute viral hepatitis is most frequently caused by the hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV).Objectives: To determine seroprevalence of HAV, HBV, HCV and HEV among patients with acute hepatitis in Nairobi, Kenya, elucidate various risk factors for hepatitis viral infection and determine the co-infection rates with these viruses in the acute hepatitis patients.Design: Across sectional descriptive study.Setting: Kenyatta National Hospital, from November 2007 to April 2008.Subjects: One hundred patients were recruited by purposive sampling method and comprised of 57 males and 43 females.Results: Among the enrolled patients, twenty three tested positive for one or more markers of acute viral hepatitis, that is, HAV, HBV, HCV and HEV. No markers were detected in 77 patients, 2% tested positive for IgM anti-HAV; 11% for IgM anti-HBc; 3% for HBsAg; 5% for HCV RNA and 7% for IgM anti-HEV.Various risk factors associated with acute viral hepatitis were identified; poor sanitation, source of water, occupation, place of residence, level of education,household size, drug abuse and sexual behaviours. Co-infection rate with hepatitis Viruses was at 4%, IgM anti-HAV and IgM anti-HEV 1 % (n=1); IgM anti-HBc and IgM anti-HEV 1% (n=1); IgM anti-HBc and anti-HCV 2% (n=2).Three patients were positive for HBsAg; among this two were negative for IgM anti-HBc and this accounted for HBV carriage (2 %).Conclusion: Hepatitis viruses’ infections are common cause of hepatitis among patients with acute hepatitis at Kenyatta National Hospital. Co-infection with these viruses was also identified among these patients

Conceptualising metabolic disorder in Southern Africa: Biology, history and global health

This paper traces the history of the concept of metabolic disorder in global health and its application to the collection of health metrics relating to the ‘epidemic’ of non-communicable diseases in Southern Africa, with a focus on Malawi. Although the contemporary science of metabolism points to complexity and contingency, the application of a simplified version of ‘metabolic disorder’ or ‘metabolic syndrome’ as the supposed central driver of non-communicable disease in low- and middle-income countries runs the risk of obscuring the ways in which local circumstances and histories interact with global forces to produce epidemiological change. The paper discusses health data collection and its interpretation in Malawi to demonstrate how the use of this concept has led to a narrowing of the category of non-communicable disease and a neglect of the role of infectious disease in producing chronic conditions. Finally, the paper points to alternative approaches which might yield a better understanding of pressing health problems