An integrated study of human and animal infectious disease in the Lake Victoria crescent small-holder crop-livestock production system, Kenya

Background: The neglected zoonotic diseases (NZD) are an understudied group that are a major cause of illness throughout the developing world. In general, little is known about the prevalence and burden of NZDs in affected communities, particularly in relation to other infectious diseases with which they are often co-endemic. We describe the design and descriptive epidemiological outputs from an integrated study of human and animal zoonotic and non-zoonotic disease in a rural farming community in western Kenya. Methods: This cross-sectional survey involved 2113 people, their cattle (n = 983) and pigs (n = 91). People and animals were tested for infection or exposure to a wide range of zoonotic and non-zoonotic pathogens. Prevalence estimates, with adjustment for the complex study design, were derived. Evidence for spatial clustering in exposure or infection was identified using the spatial scan statistic. Results: There was a high prevalence of human parasitism in the community, particularly with hookworm (Ancylostoma duodenale or Necator americanus) (36.3% (95% CI 32.8–39.9)), Entamoeba histolytica/dispar (30.1% (95% CI 27.5–32.8)), and Plasmodium falciparum (29.4% (95% CI 26.8–32.0)). Human infection with Taenia spp. was also prevalent (19.7% (95% CI 16. 7–22.7)), while exposure to other zoonotic pathogens was comparatively rarer (Brucella spp., 0.6% (95% CI 0.2–0.9); Coxiella burnetii, 2.2% (95% CI 1.5–2.9); Rift Valley fever, 0.5% (95% CI 0.2–0.8)). A low prevalence of exposure to Brucella spp. was observed in cattle (0.26% (95% CI 0–0.56). This was higher for Rift Valley fever virus (1.4% (95% CI 0.5–2.22)) and C. burnetii (10.0% (95% CI 7.7–12.2)). The prevalence of Taenia spp. cysticercosis was 53.5% (95% CI 48.7–58.3) in cattle and 17.2% (95% CI 9.1–25.3) in pigs. Mycobacterium bovis infection was found in 2.2% of cattle (95% CI 1.3–3.2), while the prevalence of infection with Mycobacterium spp. was 8.2% (95% CI 6.8–9.6) in people. Conclusion: Zoonotic infections in people and animals occur in the context of a wide range of co-endemic pathogens in a rural community in western Kenya. The wide diversity of pathogens under study provides a unique opportunity to explore the distribution and determinants of infection in a multi-pathogen, multi-host system

Animal health emergencies: a gender-based analysis for planning and policy

There has been increasing recognition of gender-based inequity as a barrier to successful policy implementation. This consensus, coupled with an increasing frequency of emergencies in human and animal populations, including infectious disease events, has prompted policy makers to re-evaluate gender-sensitivity in emergency management planning. Seeking to identify key publications relating to gendered impacts and considerations across diverse stakeholders in different types of animal health emergencies, we conducted a non-exhaustive, targeted scoping review. We developed a matrix for both academic and policy literature that separated animal health emergencies into two major categories: humanitarian crises and infectious disease events. We then conducted semi-structured interviews with key animal health experts. We found minimal evidence of explicit gender responsive planning in animal health emergencies, whether humanitarian or infectious disease events. This was particularly salient in Global North literature and policy planning documents. Although there are some references to gender in policy documents pertaining to endemic outbreaks of African swine fever (ASF) in Uganda, most research remains gender blind. Despite this, implicit gendered themes emerged from the literature review and interviews as being direct or indirect considerations of some research, policy, and implementation efforts: representation; gendered exposure risks; economic impact; and unpaid care. Absent from both the literature and our conversations with experts were considerations of mental health, gender-based violence, and intersectional impacts. To remedy the gaps in gender-based considerations, we argue that the intentional inclusion of a gender transformative lens in animal health emergency planning is essential. This can be done in the following ways: (1) collection of disaggregated data (race, gender, sexual orientation, etc.); (2) inclusion of gender experts; and (3) inclusion of primary gendered impacts (minimal representation of women in policy positions, gender roles, economic and nutrition impacts) and secondary gendered impacts (gender-based violence, mental health, additional unpaid care responsibilities) in future planning

General contextual effects on neglected tropical disease risk in rural Kenya

The neglected tropical diseases (NTDs) are characterized by their tendency to cluster within groups of people, typically the poorest and most marginalized. Despite this, measures of clustering, such as within-group correlation or between-group heterogeneity, are rarely reported from community-based studies of NTD risk. We describe a general contextual analysis that uses multi-level models to partition and quantify variation in individual NTD risk at multiple grouping levels in rural Kenya. The importance of general contextual effects (GCE) in structuring variation in individual infection with Schistosoma mansoni, the soil-transmitted helminths, Taenia species, and Entamoeba histolytica/dispar was examined at the household-, sublocation- and constituency-levels using variance partition/intra-class correlation co-efficients and median odds ratios. These were compared with GCE for HIV, Plasmodium falciparum and Mycobacterium tuberculosis. The role of place of residence in shaping infection risk was further assessed using the spatial scan statistic. Individuals from the same household showed correlation in infection for all pathogens, and this was consistently highest for the gastrointestinal helminths. The lowest levels of household clustering were observed for E. histolytica/dispar, P. falciparum and M. tuberculosis. Substantial heterogeneity in individual infection risk was observed between sublocations for S. mansoni and Taenia solium cysticercosis and between constituencies for infection with S. mansoni, Trichuris trichiura and Ascaris lumbricoides. Large overlapping spatial clusters were detected for S. mansoni, T. trichiura, A. lumbricoides, and Taenia spp., which overlapped a large cluster of elevated HIV risk. Important place-based heterogeneities in infection risk exist in this community, and these GCEs are greater for the NTDs and HIV than for TB and malaria. Our findings suggest that broad-scale contextual drivers shape infectious disease risk in this population, but these effects operate at different grouping-levels for different pathogens. A general contextual analysis can provide a foundation for understanding the complex ecology of NTDs and contribute to the targeting of interventions

Prevalence of Epilepsy, Human Cysticercosis, and Porcine Cysticercosis in Western Kenya

Cysticercosis is the leading cause of acquired epilepsy worldwide and has been shown to be highly prevalent in pig populations in western Kenya. We conducted a community-based door-to-door survey in a region of western Kenya with a high proportion of pig-keeping households. Persons with epilepsy (PWE) were determined using a screening questionnaire followed by a neurologist evaluation. Cysticercosis serum apDia antigen ELISAs and Western blot for LLGP and rT24h antigen were performed on all PWE and 2% of screen-negative patients. All PWE or people with positive apDia underwent contrast-enhanced brain computed tomography (CT). Of a sample of 810 village residents, 660 (81%) were present in the homestead, of whom 648 (98%) participated. Of these, 17 were confirmed to have lifetime epilepsy, an estimated crude prevalence of 2.6%. No humans with (N = 17) or without (N = 12) epilepsy had serological evidence of cysticercosis infection. Fourteen PWE and one individual with borderline positive apDia antigen ELISA underwent brain CT; none had radiographic findings consistent with neurocysticercosis. Nearly 30% of households kept pigs, with 69% always tethered in both wet and dry seasons. More than 8% (6/72) of pigs had palpable lingual cysts; these pigs all originated from homesteads with latrines, one-third of which were free-ranging at least some of the time. Epilepsy prevalence in our study was greater than the national prevalence, but we found no individuals with epilepsy attributable to cysticercosis. Additional studies are required to identify causes of epilepsy, human and porcine cysticercosis, the role of spatial clustering, and protective factors like host-pathogen immunity

Peut-on prédire la progression de l'atteinte structurale à 2 ans devant un rhumatisme inflammatoire débutant? (intérêt des marqueurs ostéo-cartilagineux dans la cohorte VErA (Very Early Arthritis))

Objectif : Etudier l'intérêt des marqueurs ostéo-cartilagineux pour prédire la progression de l'atteinte structurale à 2 ans chez des patients présentant un rhumatisme inflammatoire débutant (RID). 310 adultes (âge moyen 52 ans ; 68.5% de femmes) ont été inclus à partir d'un recrutement de type population générale . Etait retenu comme RID, la présence d'au moins 2 articulations gonflées pendant au moins 4 semaines, depuis moins de 6 mois (durée médiane : 4.1 mois). Aucun traitement de fond ou corticothérapie préalable n'était reçu. A l'inclusion ont été colligées : données cliniques, biologiques (VS, CRP, facteurs rhumatoïdes (FR), anti-CCP, Pyridinoline (PYD), Déoxypyridinoline (DPD), CTX sérique, Cartilage Oligomeric Matrix Protein (COMP), Ostéoprotégérine (OPG)), et radiologiques (Score de Sharp érosion, modifié par Van Der Heidje, par 2 lecteurs,avec séance de consensus). Les données ont été étudiées en analyse univariée puis en analyse en composante principale. Le critère de jugement à 2 ans était un delta du score de Sharp érosion >= 1. RESULTATS : L'analyse à 2 ans a porté sur 213 patients (1 décès, 1 perdu de vue, 29 refus de continuer, 61 autres rhumatismes classés, 5 données radiologiques manquantes). Parmi ces 213 patients, seuls 42 étaient évolutifs (19.7%). En analyse univariée, il existe une association significative de la COMP (p=0.01,7), de la VS (p=0.036), du FR IgG et IgA (p=0.007et p=0.044) et des anti-CCP (p=4.16 10-5) avec la progression de l'atteinte structurale. L'association de la PYD et du FR IgM est à la limite de la significativité (p=0.05.~. L'OPG, le CTX sérique, la DPD et la CRP ne sont pas associés à l'aggravation structurale. En analyse en composante principale, 75% des patients sont classés correctement en progresseurs ou non progresseurs à l'aide de ces 5 marqueurs. La COMP permet un gain de sensibilité (Se=61.5%) dans la détection des patients à risque (Se=52% pour les autres marqueurs). CONCLUSION : Devant un RID, la progression de l'atteinte structurale à 2 ans peut-être prédite à l'aide des paramètres suivants : Anti CCP, FR Ig A et IgG, VS et COMP, permettant ainsi d'identifier plus de 75% des patients à risque d'avoir une progression de l'atteinte structurale.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Epilepsy Prevalence, Treatment Gap, and Stigma in Western Kenya (P1.272)

Objective: To determine the prevalence of epilepsy and neurocysticercosis, epilepsy treatment gap, and stigma Background: Epilepsy-associated stigma leads to poor health outcomes, higher treatment gaps and reduced quality-of-life for people with epilepsy (PWE), particularly in resource-limited settings. Methods: We conducted a community-based door-to-door epilepsy and cysticercosis prevalence study in a village with suspected high prevalence of porcine cysticercosis. Epilepsy cases were identified with screening questionnaire and neurologist evaluation. Neurocysticercosis was determined with blood apDia ELISA and contrast-enhanced brain CT. Results: Most village households [94[percnt](145/154)] and residents [80[percnt](648/810)] participated; 57[percnt](368/648) were female and 60[percnt](392/648) were children. Among adults, 72[percnt](185/256) had a primary school education or less, and 75[percnt](193/256) were farmers. Crude prevalence of lifetime epilepsy was 2.6[percnt](17/648)[95[percnt]CI:1.5-4.2] and age-sex-adjusted prevalence was 3.5[percnt] [95[percnt]CI:1.3-5.9]. None had neurocysticercosis. The treatment gap was 53[percnt](9/17). Nearly 53[percnt](136/256) of adults did not know the cause of epilepsy though 23[percnt] (59/256) thought epilepsy was caused by a curse from god, spirit possession, or witchcraft and 46[percnt](116/256) thought that epilepsy was contagious. Most adults knew that daily anti-epilepsy drugs could treat epilepsy 63[percnt](160/256), though 18[percnt](45/256) would recommend church healing sessions. Most adults felt that PWE should have equal rights 83[percnt] (209/256), employment opportunities 54[percnt](137/256) and education 79[percnt](200/256). Most adults would feel comfortable working with PWE 68[percnt](172/256), being seen in the company of PWE 69[percnt](175/256) and having a friend with epilepsy 65[percnt](165/256). However, most adults would not date or marry a PWE 54[percnt](162/256), would advise family members not to marry PWE 60[percnt](152/256), and felt that PWE should study in a special schools 63[percnt] (158/256) or classrooms 43[percnt](108/256). Conclusions: Epilepsy prevalence and treatment gaps were high in this region of Western Kenya. Knowledge of causes of epilepsy was poor. While most adults supported equal rights and opportunities for PWE, significant stigma exists around marriage and integration of PWE into communities

The Sero-epidemiology of Coxiella burnetii in Humans and Cattle, Western Kenya: Evidence from a Cross-Sectional Study

Evidence suggests that the intracellular bacterial pathogen Coxiella burnetii (which causes Q fever) is widespread, with a near global distribution. While there has been increasing attention to Q fever epidemiology in high-income settings, a recent systematic review highlighted significant gaps in our understanding of the prevalence, spatial distribution and risk factors for Q fever infection across Africa. This research aimed to provide a One Health assessment of Q fever epidemiology in parts of Western and Nyanza Provinces, Western Kenya, in cattle and humans. A cross-sectional survey was conducted: serum samples from 2049 humans and 955 cattle in 416 homesteads were analysed for C. burnetii antibodies. Questionnaires covering demographic, socio-economic and husbandry information were also administered. These data were linked to environmental datasets based on geographical locations (e.g., land cover). Correlation and spatial-cross correlation analyses were applied to assess the potential link between cattle and human seroprevalence. Multilevel regression analysis was used to assess the relationships between a range of socio-economic, demographic and environmental factors and sero-positivity in both humans and animals. The overall sero-prevalence of C. burnetii was 2.5% in humans and 10.5% in cattle, but we found no evidence of correlation between cattle and human seroprevalence either within households, or when incorporating spatial proximity to other households in the survey. Multilevel modelling indicated the importance of several factors for exposure to the organism. Cattle obtained from market (as opposed to those bred in their homestead) and those residing in areas with lower precipitation levels had the highest sero-prevalence. For humans, the youngest age group had the highest odds of seropositivity, variations were observed between ethnic groups, and frequent livestock contact (specifically grazing and dealing with abortion material) was also a risk factor. These results illustrate endemicity of C. burnetii in western Kenya, although prevalence is relatively low. The analysis indicates that while environmental factors may play a role in cattle exposure patterns, human exposure patterns are likely to be driven more strongly by livestock contacts. The implication of livestock markets in cattle exposure risks suggests these may be a suitable target for interventions