Space-time clustering of Burkitt's lymphoma in the West Nile district of Uganda: 1961-1975.

Epidemiological data relating to all 202 patients diagnosed with Burkitt's Lymphoma (BL) in the West Nile District of Uganda in the period 1961 to 1975 have been reviewed and analysed. Statistically significant evidence of space-time clustering of cases, first reported for the period 1961-65, was also present during 1972-73, but not during other periods. The patients involved in such clusters were found to be older than other patients (P less than 0.001). The average annual incidence of BL in the District was 2.45 x 10(-5) and overall there was no change in the incidence during the study period. However, there were statistically significant changes in incidence in different counties, which could not be explained as case-ascertainment artifacts. One sib pair of patients with BL was found and the series also included 7 instances of BL in two cousins. It is suggested that study of variation in the intensity and type of malarial infestation in different areas at different times may help explain the epidemiological findings and suggest what, if any, aspects of this infection are critical for inducing BL

A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

Background: Kenya experienced rapid scale up of HIV testing and counselling services in government health services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health policy reform (policy analysis triangle). Methods: Qualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the importance of the local context in which scale up occurred. Results: The scale up of VCT in Kenya had a number of human resource policy implications resulting from the introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals, counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key groups underpinned the process. The process of reaching consensus required compromise and time commitment but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring standardisation of content and approach. Conclusion: The introduction and scale up of new health service initiatives such as HIV voluntary counselling and testing necessitates changes to existing health systems and modification of entrenched interests around professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities of scale up of HIV testing and counselling in Kenya. We argue that a better understanding of the diverse actors, the context and the process, is required to mitigate risks and maximise impact

Limited duration of vaccine poliovirus and other enterovirus excretion among human immunodeficiency virus infected children in Kenya

<p>Abstract</p> <p>Background</p> <p>Immunodeficient persons with persistent vaccine-related poliovirus infection may serve as a potential reservoir for reintroduction of polioviruses after wild poliovirus eradication, posing a risk of their further circulation in inadequately immunized populations.</p> <p>Methods</p> <p>To estimate the potential for vaccine-related poliovirus persistence among HIV-infected persons, we studied poliovirus excretion following vaccination among children at an orphanage in Kenya. For 12 months after national immunization days, we collected serial stool specimens from orphanage residents aged <5 years at enrollment and recorded their HIV status and demographic, clinical, immunological, and immunization data. To detect and characterize isolated polioviruses and non-polio enteroviruses (NPEV), we used viral culture, typing and intratypic differentiation of isolates by PCR, ELISA, and nucleic acid sequencing. Long-term persistence was defined as shedding for ≥ 6 months.</p> <p>Results</p> <p>Twenty-four children (15 HIV-infected, 9 HIV-uninfected) were enrolled, and 255 specimens (170 from HIV-infected, 85 from HIV-uninfected) were collected. All HIV-infected children had mildly or moderately symptomatic HIV-disease and moderate-to-severe immunosuppression. Fifteen participants shed vaccine-related polioviruses, and 22 shed NPEV at some point during the study period. Of 46 poliovirus-positive specimens, 31 were from HIV-infected, and 15 from HIV-uninfected children. No participant shed polioviruses for ≥ 6 months. Genomic sequencing of poliovirus isolates did not reveal any genetic evidence of long-term shedding. There was no long-term shedding of NPEV.</p> <p>Conclusion</p> <p>The results indicate that mildly to moderately symptomatic HIV-infected children retain the ability to clear enteroviruses, including vaccine-related poliovirus. Larger studies are needed to confirm and generalize these findings.</p

Yellow fever in Kenya: the need for a country-wide surveillance programme.

Since the emergence of yellow fever (YF) as a public health threat in Kenya in 1992-1993, low level transmission of the virus to humans has continued to occur. A programme of YF surveillance has been instrumental in the monitoring of YF activity and has clearly demonstrated an expansion of the zone of virus activity into regions that were not affected in the 1992-1993 epidemic. This is of major concern for the approximately 29 million Kenyans who are unvaccinated and therefore at risk of infection. A revision of the surveillance programme is underway to create a more efficient system of recognition of suspect YF cases, laboratory diagnosis and reporting to the appropriate authorities for action. In addition, a research programme to study YF ecology in Kenya will benefit the surveillance programme, enabling it to target potential 'hotspots' of YF activity. As it may not be possible, for financial reasons, to incorporate YF vaccination into the Kenya Expanded Programme of immunization in the immediate future, the need for continued surveillance to monitor the emergence of YF in Kenya is vital

Knowledge, attitudes and practices regarding rabies and its control among dog owners in Kigali city, Rwanda.

BackgroundRabies is a zoonotic viral disease that can occur in all warm-blooded animals, including humans. Vaccinating dogs can protect people from contracting rabies. Rabies is a public health threat in Rwanda, but the country does not have information on the epidemiology of rabies. The present study aimed to understand the knowledge, attitudes and practices (KAP) of rabies and its control among dog owners in Kigali city of Rwanda.MethodsWe conducted a cross-sectional survey using a structured questionnaire among 137 dog owners selected from nine administrative study sites. A two-stage random sampling procedure was used to select the participants. Frequency distributions analysis and a series of chi-square tests of associations as well as binary logistic regressions were performed to determine the important factors associated with the response variables.ResultsThe results showed that 99.5% of respondents knew at least a host susceptible to rabies. Only 22.4% and 21.3% knew that dogs and people can develop rabies, respectively. Nearly 73.6% knew that human rabies can be transmitted through dog-bites and 99% could identify at least a clinical sign of canine rabies. Overall, 81.8% knew that regular vaccination of dogs helps to prevent dog-transmitted human rabies and 43.1% and 26.3% were aware that rabies in humans and in dogs are fatal once clinical symptoms have shown, respectively. Only 69% would observe a dog for 10 days after it bites a man or an animal. Approximately 20.4% were familiar with appropriate cleaning of dog-bites wounds, and 20.6% knew that puppies could receive rabies vaccination before they are three months old. Of those who owned vaccinated dogs, 78% were happy about the cost (US $ ≤ 34) of rabies vaccination. Of all the respondents, 58% had their dogs vaccinated at home by veterinarians while 86% indicated their veterinarians kept rabies vaccines on ice in a cool box. Overall, 53% of the dog owners had sufficient knowledge of rabies, whilst 66% and 17% adopted adequate practices and positive attitudes towards rabies, respectively. Multivariable logistic regression analyses indicated that none of the respondents' sex, educational level, and the length of dog ownership were statistically associated with their knowledge, attitudes and practices of rabies.ConclusionsThis study showed that majority of the dog owners had sufficient knowledge and adopted appropriate practices of rabies. However there exist some knowledge gaps among the dog owners particularly on treatment, transmission and control methods. Therefore, rabies awareness campaign is required to upgrade rabies knowledge of the dog owners on rabies prevention and control in Rwanda

MEASLES TRENDS AND VACCINE EFFECTIVENESS IN NAIROBI, KENYA

ABSTRACTObjectives: To determine morbidity and mortality from measles and to estimate measlesvaccine effectiveness among children hospitalised with measles in two hospitals in Nairobi.Design: A review of hospital records (index cards).Setting: Kenyatta National Hospital and Mbagathi District Hospitals covering the years1996-2000.Method: A review of index cards for measles morbility and mortality was undertaken in thetwo hospitals. Measles data at the Kenya Expanded Programme on Immunisation coveringboth hospitals was analysed for vaccine effectiveness.Results: The incidence of measles was unusually high in 1998 between July and November(monthly range 130-305), reflecting on the occurrence of an outbreak at that time. There wasno definite monthly incidence trend of measles in 1996, 1997, 1999 and 2000. The median ageof cases was 13 months (range 0-420 months) for Kenyatta hospital and 18 months (range 1-336 months) for Mbagathi Hospital. Significantly, 29.8% of all cases were aged below ninemonths when routine immunisation for measles had not begun. The median number of daysspent in hospital were five days (range 0-87 days) for Kenyatta and four days (range 1-13days) for Mbagathi. The overall case fatality rate was 5.6% and was similar for both malesand females. The overall measles vaccine effectiveness among measles cases admitted toKenyatta and Mbagathi Hospitals was 84.1%.Conclusion: The case admissions in Kenyatta and Mbagathi Hospitals suggest measles wasprevalent in Nairobi over the latter half decade of the 1990’s. Apart from 1998 when therewas an outbreak, the seasonality of measles was dampened. The 1998 outbreak suggests abuild up of susceptible children the majority of whom were born in the last quarter of 1996.The high mortality may have had to do with the majority of cases presenting late whensymptoms were already complicated and severe

Measles trends and vaccine effectiveness in Nairobi, Kenya

Objectives: To determine morbidity and mortality from measles and to estimate measles vaccine effectiveness among children hospitalised with measles in two hospitals in Nairobi. Design: A review of hospital records (index cards). Setting: Kenyatta National Hospital and Mbagathi District Hospitals covering the years 1996-2000. Method: A review of index cards for measles morbility and mortality was undertaken in the two hospitals. Measles data at the Kenya Expanded Programme on Immunisation covering both hospitals was analysed for vaccine effectiveness. Results: The incidence of measles was unusually high in 1998 between July and November (monthly range 130-305), reflecting on the occurrence of an outbreak at that time. There was no definite monthly incidence trend of measles in 1996, 1997, 1999 and 2000. The median age of cases was 13 months (range 0-420 months) for Kenyatta hospital and 18 months (range 1- 336 months) for Mbagathi Hospital. Significantly, 29.8% of all cases were aged below nine months when routine immunisation for measles had not begun. The median number of days spent in hospital were five days (range 0-87 days) for Kenyatta and four days (range 1-13 days) for Mbagathi. The overall case fatality rate was 5.6% and was similar for both males and females. The overall measles vaccine effectiveness among measles cases admitted to Kenyatta and Mbagathi Hospitals was 84.1%. Conclusion: The case admissions in Kenyatta and Mbagathi Hospitals suggest measles was prevalent in Nairobi over the latter half decade of the 1990's. Apart from 1998 when there was an outbreak, the seasonality of measles was dampened. The 1998 outbreak suggests a build up of susceptible children the majority of whom were born in the last quarter of 1996. The high mortality may have had to do with the majority of cases presenting late when symptoms were already complicated and severe. East African Medical Journal Vol.80(7) 2003: 361-36

Genital ulcers in Kenya : clinical and laboratory study

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