Malaria Rapid Testing by Community Health Workers Is Effective and Safe for Targeting Malaria Treatment: Randomised Cross-Over Trial in Tanzania

Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients. Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. Primary outcome was provision of ACT and main secondary outcomes were referral rates and health status by days 3 and 7. The CHWs enrolled 2930 fever patients during five months of whom 1988 (67.8%) presented within 24 hours of fever onset. ACT was provided to 775 of 1457 (53.2%) patients during RDT weeks and to 1422 of 1473 (96.5%) patients during CD weeks (Odds Ratio (OR) 0.039, 95% CI 0.029-0.053). The CHWs adhered to the RDT results in 1411 of 1457 (96.8%, 95% CI 95.8-97.6) patients. More patients were referred on inclusion day during RDT weeks (10.0%) compared to CD weeks (1.6%). Referral during days 1-7 and perceived non-recovery on days 3 and 7 were also more common after RDT aided diagnosis. However, no fatal or severe malaria occurred among 682 patients in the RDT group who were not treated with ACT, supporting the safety of withholding ACT to RDT negative patients. RDTs in the hands of CHWs may safely improve early and well-targeted ACT treatment in malaria patients at community level in Africa.\ud \ud \ud \u

Changing malaria intervention coverage, transmission and hospitalization in Kenya

<p>Abstract</p> <p>Background</p> <p>Reports of declining incidence of malaria disease burden across several countries in Africa suggest that the epidemiology of malaria across the continent is in transition. Whether this transition is directly related to the scaling of intervention coverage remains a moot point.</p> <p>Methods</p> <p>Paediatric admission data from eight Kenyan hospitals and their catchments have been assembled across two three-year time periods: September 2003 to August 2006 (pre-scaled intervention) and September 2006 to August 2009 (post-scaled intervention). Interrupted time series (ITS) models were developed adjusting for variations in rainfall and hospital use by surrounding communities to show changes in malaria hospitalization over the two periods. The temporal changes in factors that might explain changes in disease incidence were examined sequentially for each hospital setting, compared between hospital settings and ranked according to plausible explanatory factors.</p> <p>Results</p> <p>In six out of eight sites there was a decline in Malaria admission rates with declines between 18% and 69%. At two sites malaria admissions rates increased by 55% and 35%. Results from the ITS models indicate that before scaled intervention in September 2006, there was a significant month-to-month decline in the mean malaria admission rates at four hospitals (trend P < 0.05). At the point of scaled intervention, the estimated mean admission rates for malaria was significantly less at four sites compared to the pre-scaled period baseline. Following scaled intervention there was a significant change in the month-to-month trend in the mean malaria admission rates in some but not all of the sites. Plausibility assessment of possible drivers of change pre- versus post-scaled intervention showed inconsistent patterns however, allowing for the increase in rainfall in the second period, there is a suggestion that starting transmission intensity and the scale of change in ITN coverage might explain some but not all of the variation in effect size. At most sites where declines between observation periods were documented admission rates were changing before free mass ITN distribution and prior to the implementation of ACT across Kenya.</p> <p>Conclusion</p> <p>This study provides evidence of significant within and between location heterogeneity in temporal trends of malaria disease burden. Plausible drivers for changing disease incidence suggest a complex combination of mechanisms, not easily measured retrospectively.</p

On-farm maize storage systems and rodent postharvest losses in six maize growing agro-ecological zones of Kenya

Rodents are one of the major postharvest pests that affect food security by impacting on both food availability and safety. However, knowledge of the impact of rodents in on-farm maize storage systems in Kenya is limited. A survey was conducted in 2014 to assess magnitudes of postharvest losses in on-farm maize storage systems in Kenya, and the contribution of rodents to the losses. A total of 630 farmers spread across six maize growing agro-ecological zones (AEZs) were interviewed. Insects, rodents and moulds were the main storage problems reported by farmers. Storage losses were highest in the moist transitional and moist mid-altitude zones, and lowest in the dry-transitional zone. Overall, rodents represented the second most important cause of storage losses after insects, and were ranked as the main storage problem in the lowland tropical zone, while insects were the main storage problem in the other AEZs. Where maize was stored on cobs, total farmer perceived (farmer estimation) storage weight losses were 11.1 ± 0.7 %, with rodents causing up to 43 % of these losses. Contrastingly, where maize was stored as shelled grain, the losses were 15.5 ± 0.6 % with rodents accounting for up to 30 %. Regression analysis showed that rodents contributed significantly to total storage losses (p < 0.0001), and identified rodent trapping as the main storage practice that significantly (p = 0.001) lowered the losses. Together with insecticides, rodent traps were found to significantly decrease total losses. Improved awareness and application of these practices could mitigate losses in on farm-stored maize

Participation in ICT-based market information projects, smallholder farmers’ commercialisation, and agricultural income effects: findings from Kenya

Agricultural projects that use information and communication technologies (ICT) to provide market information have increased considerably in developing countries in the last decade. These projects aim to strengthen smallholder farmers’ linkage to input and output markets. This article examines the impact of such projects on smallholder farmers’ input and output commercialisation, and household income, using propensity score matching technique and data collected from farmers in Kenya. The study finds that participation in ICT-based projects increases farmers’ participation in input and output markets, and their household income. The article highlights the implications of these findings for ICT policy and practice

Determinants of Fertility Desires and Intentions among HIV Infected and Uninfected Women and Contraceptive use among HIV-infected women in the study at Six hospitals in two regions of Kenya

HIV epidemic in Kenya is geographically diverse ranging from a prevalence of 26 percent and 0.4 percent. Evidence indicates that a higher proportion of HIV infected women are more likely to be associated with unintended pregnancies.Despite this evidence, little is known about determinants of fertility desires and intentions of HIVinfectedand HIV-uninfected women in Kenya. 437 HIV-infected and 365 HIV-uninfected women were enrolled in the study. Using a cross-sectional mixed method, the study sought to investigate determinants of fertility desires and intentions among HIV-infected and uninfected women, and further determined factors associated with desire and intention to use contraceptives among HIV-infected women. Focus group discussions and key informant interviews were conducted with HIV-infected and uninfected women and Health providers respectively. Sampling was proportionate to the size based on client volumes at each study hospital. Similar factors including; age, region ofresidence, place of residence, level of education, employment and marital status were found to significantly influence desire and intention to have children among HIV-infected and uninfected women. Older women were more likely to desire or intend to have more children P&lt;0.001), marital status was the only factor that influenced desire and intention to utilize contraceptives among HIV-infected women. Myths and misconception and poor provider -client interactions on family planning methods were some of the demand and supply system gaps that hinder utilization of family planning methods Innovative approaches are required to promote use of contraceptives among HIV infected women to reduce maternal morbidity, mortality and vertical transmission of HIV

Value chain analysis of the Kenyan poultry industry: The case of Kiambu, Kilifi, Vihiga, and Nakuru Districts

The Kenyan poultry industry is characterized by dualism, comprised of both smallholder and large-scale poultry producers. The industry is characterized by two main production systems namely (i) the commercial hybrid poultry production system and (ii) the indigenous poultry production system. This study examines the poultry industry in Kenya with the aim of identifying the actors, assessing poultry and poultry product flows, and highlighting some of the policies and regulations relevant to potential outbreaks of highly pathogenic avian influenza (HPAI) in Kenya. Specific aims included: i) Characterizing the structure of the value chain; ii) Assessing the relative importance of specific flows of poultry and poultry products; iii) Identifying the various actors involved in the poultry trade and their linkages; iv) Providing insights on potential pathways of HPAI introduction in the value chain The study was conducted in Kikuyu and Ndeiya Divisions in Kiambu District, Vihiga and Sabatia Divisions in Vihiga District, Nakuru and Rongai Divisions of Nakuru District, and Kikambala and Ganze Divisions of Kilifi District. The study areas were selected based on their relative density of poultry populations. A value chain approach was employed that entailed the use of semi-structured interviews and focus group discussions with various stakeholders including hatcheries, farmers, input sellers, processors, retailers and other intermediaries in four different value chains: commercial broilers, commercial layers/eggs, indigenous chicken, and guinea fowl/ducks

Endemic chikungunya fever in Kenyan children: a prospective cohort study.

Background Chikungunya fever (CHIKF) was first described in Tanzania in 1952. Several epidemics including East Africa have occurred, but there are no descriptions of longitudinal surveillance of endemic disease. Here, we estimate the incidence of CHIKF in coastal Kenya and describe the associated viral phylogeny. Methods We monitored acute febrile illnesses among 3500 children visiting two primary healthcare facilities in coastal Kenya over a 5-year period (2014–2018). Episodes were linked to a demographic surveillance system and blood samples obtained. Cross-sectional sampling in a community survey of a different group of 435 asymptomatic children in the same study location was done in 2016. Reverse-transcriptase PCR was used for chikungunya virus (CHIKV) screening, and viral genomes sequenced for phylogenetic analyses. Results We found CHIKF to be endemic in this setting, associated with 12.7% (95% CI 11.60, 13.80) of all febrile presentations to primary healthcare. The prevalence of CHIKV infections among asymptomatic children in the community survey was 0.7% (95% CI 0.22, 2.12). CHIKF incidence among children < 1 year of age was 1190 cases/100,000-person years and 63 cases/100,000-person years among children aged ≥10 years. Recurrent CHIKF episodes, associated with fever and viraemia, were observed among 19 of 170 children with multiple febrile episodes during the study period. All sequenced viral genomes mapped to the ECSA genotype albeit distinct from CHIKV strains associated with the 2004 East African epidemic. Conclusions CHIKF may be a substantial public health burden in primary healthcare on the East African coast outside epidemic years, and recurrent infections are common