Fumonisin contamination of maize (Zea mays) in aflatoxin ‘hot’ zones in eastern province of Kenya

Natural Fusarium and fumonisin contamination were evaluated in 86 stored maize samples and correlated to damaged kernels (%). Maize samples were collected from selected farmers in Aflatoxin ‘hot’ zones of Eastern province. Samples were collected from Kitui and Kibwezi districts in May to June 2008. Fusarium species were isolated and identified using morphological characteristics at Mycology Laboratory, Kenya Medical Research Institute. Fumonisinquantification was done using ELISA (RIDASCREEN ® ELISA test kit (Art. No.: R3401) at Bora Biotech, Nairobi. Colony Forming Unit (CFU) counts indicated that apart from Aspergillus a common contaminant in maize, Fusarium species infestation was also high. The most common species being F. verticillioides isolated at (39.9 %) in the two districts. Other isolated Fusarium species included, F. proliferatum (15.1 %), F. solani (9.0 %), F. anthophilium (9.0 %), F. oxysporium (15.1 %), and F. Lateritium (12.1 %). Damaged kernels analysed in this study included insect infestation, mouldy kernels, and off coloured kernels. Results showed up to 20 % of the grains were damaged in some samples. Contamination with fumonisin toxin was observed to be high. Most of the samples exceeded 1 mg / kg the maximum tolerable levels recommended by the European commission. Fusarium species count and fumonisin levels showed positive correlation (p < 0.05). In addition, there was a positive correlation between damaged kernels (%) and Fusarium species count (p < 0.05). Positive correlation was also observed between damaged kernels (%) and Fusarium species count (p < 0.05). In general, F. verticillioides and F. proliferatum were isolated in samples with the highest percentage of kernel damage and highest fumonisin concentrations. These findings indicate wide spread infestation and contamination of maize by Fusarium species and fumonisin toxins. It is apparent that apart from aflatoxins contamination there is also high level of fumonisin exposure in the high risk population necessitating urgent intervention measures to curb the long term health consequences in the population. Keywords: Fusarium spp, Mycotoxin, Fumonisin, Zea maize, Aflatoxin ‘Hot’ zone

Occupational risk factors of Low Back Pain among tea pickers and non-tea pickers in James Finlay (K) Ltd, Kericho County, Kenya

Low back pain (LBP) is a major public health problem in the world. It is estimated that 60% of all employees experience LBP at some point in their life during their employment career. It is also the most prevalent musculo-skeletal condition in rural communities in Kenya and it is estimated that 64% of the tea pickers are suffering from LBP in Kenya, of these, 29% had a history of back pain before they started picking tea. The study aimed at determining the prevalence and assessing the occupational risk factors of LBP among tea pickers and non-tea pickers in James Finlay (K) Limited tea estates in Kericho County. Data were collected using structured questionnaires. Bivariate, multivariate analysis and Pearson’s chi square (χ2) test was used to measure the associations. This study was a cross-sectional comparative study that sampled 454 adults (335 tea pickers and 119 non-tea pickers). The prevalence of LBP was found to be 45.4% (125/335) and 39.5% (47/119) among tea pickers and non-tea pickers respectively. The following characteristics were significant at bivariate level including age, parity and duration of work were found to be related to LBP among tea pickers and non-tea pickers (χ2=8.643; P=0.034 and χ2=6.013; p=0.049) respectively. However, the number of hours worked per day was significantly associated with LBP among tea pickers only (χ2=17.192; p=0.000).  Further, the number of kilograms of tea leaves picked and the number of kgs carried per day was also significantly associated with LBP (χ2=16.882; p=0.000 and χ2=15.978; p=0.001) respectively. There was also a significant association of LBP with carrying of heavy load and how one sharpened farm tools among the non tea pickers who reported to have suffered LBP (χ2=13.129; p=0.000 and χ2=4.125; p=0.042) respectively. However, age (p=0.0022; 95% CI -9.4-7); absenteeism from work (P=0.010; 95% CI 2.7-19.5), work duration per day (P=0.000; 95% CI 23.1-38.5), type of occupation (P=0.000; 95% CI 62.2-79.3) and the no. of Kgs (P=0.011; 95% CI -17.8-2.3) carried were found to contribute independently to LBP among tea pickers whereas absenteeism from work (P=0.000; 95% CI 11.9-29.1), work duration per day (P=0.000; 95% CI 69.8-86.8), alcohol uptake (P=0.008; 95% CI 3.2-20.7), heavy load carried (P=0.018; 95% CI 1.8-18.2) and work duration (P=0.002; 95% CI -14.3-3.2) among non-tea pickers were also found to contribute independently to LBP. The prevalence of LBP was found to be high among both tea and non-tea pickers. We recommend that there is need to consider reviewing tea picking policies for instance introduction of tea picking devices in order to alleviate occupational health hazards associated with tea picking. Key words: Low Back Pain, tea pickers, non-tea pickers.

Factors associated with superficial mycoses in patients visiting Alupe Clinic and its environs in Busia western Kenya

Background: Globally, Superficial fungal infections are common problems in patients infected human immunodeficiency virus (HIV).The most common, predisposition being unknown HIV status and low socio-economic factors.Objective: The aim of this study was to identify factors associated with Superficial mycoses in patients attending Alupe Outpatient Clinic and its environs. After ethical approval, was obtained from ethical review committee, KEMRI.Methods: A cross-sectional study was conducted in 371 patients from two health facilities in Busia County Kenya. Data was collected using semi structured questionnaire after patients had consented. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 20.Results: Of 371 respondents; 42.86% (159) were males and 57.14% (212) were females. The mean age for both sexes was 30.8 years with std. dev of 20.0046 and a range of [1,89].The HIV status for respondents were; negative 49.33%, positive 6.20%, unknown status 44.47% respectively.Conclusion: The factors associated with superficial mycoses in patients visiting Alupe Outpatient Clinic and its environs were statistically significant and were majorly associated with; age, gender, HIV status, occupation, site of infection and County. Further research is needed to establish why there is high prevalence of superficial mycoses among; Farmers, business, pupils, students, teachers and those who are unemployed. HIV/AIDS testing and awareness as a predisposition should be prioritized in future studies.Keywords: Superficial mycosis, Human Immunodeficiency Virus, Busi

'Pregnancy comes accidentally - like it did with me': reproductive decisions among women on ART and their partners in rural Uganda

<p>Abstract</p> <p>Background</p> <p>As highly active antiretroviral therapy (ART) restores health, fertility and sexual activity among HIV-infected adults, understanding how ART influences reproductive desires and decisions could inform interventions to reduce sexual and vertical HIV transmission risk.</p> <p>Methods</p> <p>We performed a qualitative sub-study among a Ugandan cohort of 1,000 adults on ART with four purposively selected categories of participants: pregnant, not pregnant, delivered, and aborted. In-depth interviews examined relationships between HIV, ART and pregnancy, desire for children, perceived risks and benefits of pregnancy, decision-making regarding reproduction and family planning (FP) among 29 women and 16 male partners. Analysis focused on dominant explanations for emerging themes across and within participant groups.</p> <p>Results</p> <p>Among those who had conceived, most couples stated that their pregnancy was unintentional, and often occurred because they believed that they were infertile due to HIV. Perceived reasons for women not getting pregnant included: ill health (included HIV infection and ART), having enough children, financial constraints, fear of mother-to-child HIV transmission or transmission to partner, death of a child, and health education. Most women reported FP experiences with condoms and hormonal injections only. Men had limited FP information apart from condoms.</p> <p>Conclusions</p> <p>Counselling at ART initiation may not be sufficient to enable women who do not desire children to adopt relevant family planning practices. On-going reproductive health education and FP services, with emphasis on the restoration of fertility after ART initiation, should be integrated into ART programs for men and women.</p

Prevention of mother-to-child transmission of HIV in Zambia: implementing efficacious ARV regimens in primary health centers

<p>Abstract</p> <p>Background</p> <p>Safety and effectiveness of efficacious antiretroviral (ARV) regimens beyond single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) have been demonstrated in well-controlled clinical studies or in secondary- and tertiary-level facilities in developing countries. This paper reports on implementation of and factors associated with efficacious ARV regimens among HIV-positive pregnant women attending antenatal clinics in primary health centers (PHCs) in Zambia.</p> <p>Methods</p> <p>Blood sample taken for CD4 cell count, availability of CD4 count results, type of ARV prophylaxis for mothers, and additional PMTCT service data were collected for HIV-positive pregnant women and newborns who attended 60 PHCs between April 2007 and March 2008.</p> <p>Results</p> <p>Of 14,815 HIV-positive pregnant women registered in the 60 PHCs, 2,528 (17.1%) had their CD4 cells counted; of those, 1,680 (66.5%) had CD4 count results available at PHCs; of those, 796 (47.4%) had CD4 count ≤ 350 cells/mm³and thus were eligible for combination antiretroviral treatment (cART); and of those, 581 (73.0%) were initiated on cART. The proportion of HIV-positive pregnant women whose blood sample was collected for CD4 cell count was positively associated with (1) blood-draw for CD4 count occurring on the same day as determination of HIV-positive status; (2) CD4 results sent back to the health facilities within seven days; (3) facilities <it>without </it>providers trained to offer ART; and (4) urban location of PHC. Initiation of cART among HIV-positive pregnant women was associated with the PHC's capacity to provide care and antiretroviral treatment services. Overall, of the 14,815 HIV-positive pregnant women registered, 10,015 were initiated on any type of ARV regimen: 581 on cART, 3,041 on short course double ARV regimen, and 6,393 on sdNVP.</p> <p>Conclusion</p> <p>Efficacious ARV regimens beyond sdNVP can be implemented in resource-constrained PHCs. The majority (73.0%) of women identified eligible for ART were initiated on cART; however, a minority (11.3%) of HIV-positive pregnant women were assessed for CD4 count and had their test results available. Factors associated with implementation of more efficacious ARV regimens include timing of blood-draw for CD4 count and capacity to initiate cART onsite where PMTCT services were being offered.</p

Microbiological characteristics of clinical isolates of Cryptococcus spp. in Bahia, Brazil: molecular types and antifungal susceptibilities

To determine the profiles of susceptibility to antifungal and the genotypes of clinical isolates of Cryptococcus in Bahia, Brazil, 62 isolates were collected from cases of meningitis in the period from 2006 to 2010. Their susceptibilities to fluconazole, itraconazole, amphotericin B and 5-flucytosine were determined by the broth microdilution technique described by the Clinical and Laboratory Standards Institute and genotyping of the URA5 gene was accomplished by restriction fragment length polymorphism. C. neoformans accounted for 79% of the identified yeast and C. gattii represented the remaining 21%. Evaluation of the genotypes determined that 100% of the C. gattii isolates belong to the VGII genotype, and 98% of the C. neoformans isolates belong to the VNI genotype. Determination of susceptibility revealed isolates resistant to fluconazole (4.8%), 5-flucytosine (1.6%) and amphotericin B (3.2%); the stratification of sensitivity results for each species showed significant differences in susceptibility to azoles. This study is the first to describe the susceptibility profiles of molecular and clinical isolates of Cryptococcus in Bahia, Brazil. The high percentage of C. gattii isolates belonging to the VGII genotype and its lower susceptibility to antifungal agents highlight the importance of knowing which species are involved in cryptococcal infections in northeastern Brazil

Oral candidiasis among African human immunodeficiency virus-infected individuals: 10 years of systematic review and meta-analysis from sub-Saharan Africa

Oral candidiasis (OC) is the most common opportunistic fungal infection among immunocompromised individuals. This systematic review and meta-analysis reports on the contribution of non-albicans Candida species in causing OC among human immunodeficiency virus (HIV)-infected individuals in sub-Saharan Africa between 2005 and 2015. Thirteen original research articles on oral Candida infection/colonization among HIV-infected African populations were reviewed. The prevalence of OC ranged from 7.6% to 75.3%. Pseudomembranous candidiasis was found to range from 12.1% to 66.7%. The prevalence of non-albicans Candida species causing OC was 33.5% [95% confidence interval (CI) 30.9–36.39%]. Of 458 non-albicans Candida species detected, C. glabrata (23.8%; 109/458) was the most common, followed by C. tropicalis (22%; 101/458) and C. krusei (10.7%; 49/458). The overall fluconazole resistance was 39.3% (95% CI 34.4–44.1%). Candida albicans was significantly more resistant than non-albicans Candida species to fluconazole (44.7% vs 21.9%; p < 0.001). One-quarter of the cases of OC among HIV-infected individuals in sub-Saharan Africa were due to non-albicans Candida species. Candida albicans isolates were more resistant than the non-albicans Candida species to fluconazole and voriconazole. Strengthening the capacity for fungal diagnosis and antifungal susceptibility testing in sub-Saharan Africa is mandatory in order to track the azole resistance trend

High Oral Carriage of Non-albicans Candida spp. among HIV-infected individuals

Background: Non-albicans Candida (NAC) spp. in immunocompromised patients are linked to invasive infections with narrow treatment choice. This study aimed at comparing the oral colonization of NAC spp. between HIV and non-HIV infected individuals in Mwanza, Tanzania. Method: Oral rinse of 351 HIV-infected and 639 non-HIV infected individuals were collected between March and July 2015. Phenotypic identifications of Candida spp. was done using Candida Chromogenic agar and confirmed by MALDI-TOF MS. Results: NAC spp. were detected in 36/351 (10.3%) HIV-infected individuals compared to 28/639 (4.4%) of non-HIV infected individuals; P=0.0003. In HIV infected individuals, commonly isolated NAC spp. were Candida tropicalis, 10(2.8%), C. krusei (Issatschenki orientalis) 9(2.6%) and C. glabrata 8(2.3%). While for non-HIV infected individuals C. dubliniensis 8(1.3%) and C. tropicalis 5(0.9%) were commonly detected. As CD4 count/μl decreases by one unit the risk of being colonized by NAC spp. among HIV infected individuals increases by 1% (OR 1.01, 95% CI; 1.001-1.004, P=0.001). Conclusion: The prevalence of NAC spp. is high among HIV-infected individuals with low CD4 count placing them at higher risk of invasive infections. Further studies to investigate the role of NAC spp. in causing invasive infections among immunocompromised patients are recommended