Macroscopic, Radiographic and Histopathologic Changes of Claws with Laminitis and Laminitis-Related Disorders in Zero-Grazed Dairy Cows

Laminitis and laminitis-related claw disorders are prevalent in zero-grazed dairy cows. Confinement and limited movement influences claw size and shape. Abnormal claw size and shape causes imbalanced body weight distribution on the claws. Claw horn growth and wear is impaired, further aggravating laminitis disorders. The objective of this study was to determine: macroscopic disorders on the claws, as well as radiographic features and histopathologic changes on the claws with laminitis/laminitis-related disorders. A total of 159 dairy cow forelimb and hind limb feet (318 claws) were collected from an abattoir and a slaughter slab around Nairobi, Kenya. The claws were examined for macroscopic abnormalities, dorso-palmar or dorso-plantar radiography done, sagittal claw sections done, corium gross changes observed and corium tissues harvested for histopathology. Macroscopic disorders observed were: sole bruising, claw deformities, heel erosion, subclinical laminitis sole haemorrhages, double soles, chronic laminitis and white line separation. Radiographic changes observed mainly on distal phalanges were dilated vascular channels, irregular margins, exostoses/periostitis, distal phalangeal narrowing and lysis. Histopathologic changes in the corium included arterio-venous shunts, vascular wall rupture and thickening, vascular proliferation and thrombosis, corium and connective tissue oedema, degeneration, haemorrhages and spongiosis. Hence macroscopic, radiographic and histopathologic changes in laminitis claws affect locomotion

The role of maternal, psychosocial and social-cultural factors in HIV-exposed infants’ service uptake; Nakuru County Referral Hospital, Kenya

Objective: To assess relationship between maternal determinants, psychosocial, social-cultural factors and uptake of routine HEI services among HIV- Exposed Infants in Nakuru County Referral Hospital, Kenya.Design: A cross-sectional descriptive studySetting: Nakuru County Referral Hospital, Kenya.Subjects: Three hundred and twenty-nine (329) mother/baby pairs were enrolled in to the study.Result: The study showed significant statistical association between maternal factors and immunization services uptake timeliness (X2 =7.67, df=1, P=0.001). Psycho-social factors had significant association with timeliness in immunization (X2 =8.87, df= 1, P=0.03) while timeliness in uptake of Early Infant Diagnosis (EID) was (X2 =28.9, df=1, P=˂0.001). Further findings on the respondents who had disclosed their HIV status to their male partners showed significant statistical association (X2 =6.88, P=0.009).Conclusion: Maternal characteristics, psychosocial and social-cultural factors influenced service uptake and recommended for promotion of PMTCT psychosocial support groups among all HIV positive women and inclusion of mentor mothers as champions in demand creation, campaigns and interpersonal communication to improve the timely uptake of early infant diagnosis (EID) and immunization services

Effect of ruminal plastic bags on haematological and biochemical parameters of sheep and goats

A study was carried out with the objective of determining the haematological and blood biochemical parameters in sheep and goats with plastic bags in the rumen for a period of 42 days. This was to indicate the possible influence of plastic bags in the rumen on blood parameters. 16, one-year old castrate Dorper sheep with a mean body weight of 26.8 kg (± 0.3 kg) and 16 one-year old castrate small East African goats with a mean weight of 24.5 kg (± 0.3 kg) were used for the study. The 16 sheep and 16 goats were divided into 4 groups of 4 animals each (n = 4). Three groups of each species were implanted with 129 g, 258 g and 387 g of plastic bags, respectively, in the rumen through rumenotomy and the fourth group of each species was control on which rumenotomy was done but with no implanting of plastic bags. Blood samples were obtained by jugular venipuncture from all sheep and goats every 2 weeks for analysis. The only haematological parameter that had significant change was platelets, which significantly (p < 0.05) increased in both sheep and goats with plastic bags in the rumen. However, mean values of erythrocytes, packed cell volume, haemoglobin and mean corpuscular volume decreased but not significantly in the sheep and goats with plastic bags in the rumen. The sheep and goats with plastic bags in the rumen had hyponatraemmia, hypochloridaemia and decreased aspartate aminotransferase enzyme activity. The changes observed in haematological and biochemical parameters could be an indication of adverse effects on the production and well-being of sheep and goats that ingest these plastic bags. These finding may be of diagnostic importance in cases of rumen impaction with indigestible foreign bodies, particularly, plastic bags

Clinical manifestations in sheep with plastic bags in the rumen

Sixteen 1-year-old castrate Dorper sheep were used for the study. The animals were divided into four groups of four animals (n = 4). Three groups were implanted with 129 g, 258 g and 387 g of thin plastic bags into the rumen through rumenotomy, while the fourth group was subjected to rumenotomy without implanting plastic bags, and served as control. All the animals were monitored daily for 6 weeks following implantation. Presence of plastic bags in the rumen was characterized by anorexia, severe depression, discomfort, dehydration, firmness and asymmetrical distension of the abdomen, ruminal hypomotility and diarrhoea with intermittent constipation, weight loss, terminal recumbency and death. The severity of these clinical manifestations increased with increased quantities of plastic bags and their duration in the rumen. Sheep implanted with 258 g and 387 g lost 7.8 percent and 14.2 percent of their initial mean body weight, respectively, by the end of 6 weeks. Presence of plastic bags in the rumen could interfere with digestion, with a gradual loss in body weight, productivity and occasional mortality. Plastic bags in the rumen should be considered as a differential diagnosis in sheep presenting the observed clinical signs, especially in urban and periurban areas

Intestical polyparasitism in a rural Kenyan community

Background: Polyparasitism seems to be a common feature in human populations in sub-Saharan Africa. However, very little is known about its epidemiological significance, its long term impact on human health or the types of interactions that occur between the different parasite species involved.Objectives: To determine the prevalence and co-occurrence of intestinal parasites in a rural community in the Kibwezi, Makueni district, Kenya.Design: A cross sectional study.Setting: Kiteng’ei village, Kibwezi, Makueni district, between May and September 2006.Subjects: One thousand and forty five who comprised of 263 adult males, 271 adult females> 15 years of age and 232 boys, and 279 girls < 15 years of age.Interventions: All infected members of the community were offered Praziquantel (at dosages of 40 mg/ kg body weight) for Schistosomiasis and Albendazole (600 mg) for soil transmitted helminths.Results: A total of ten intestinal parasite species (five protozoan and five helminth parasite species) were present in this community and polyparasitsm was common in individuals 5- 24 years of age with no gendar related differences. Most of the infections were mild. The protozoan parasites of public health significance present were Entamoeba histolytica and Giardia lamblia with prevalence of 12.6% and 4.2%, respectively. The helminth parasites of public health significance in the locality were Schistosoma mansoni with a prevalence of 28%, and hookworms prevalence of 10%. About 53% of the study population harboured intestinal parasite infections, with 31 % of the infected population carrying single parasite species infections, and 22% harbouring two or more intestinal parasite species per individual. Significant positive associations (p value

Facility-level intervention to improve attendance and adherence among patients on anti-retroviral treatment in Kenya—a quasi-experimental study using time series analysis

Background: Achieving high rates of adherence to antiretroviral therapy (ART) in resource-poor settings comprises serious, but different, challenges in both the first months of treatment and during the life-long maintenance phase. We measured the impact of a health system-oriented, facility-based intervention to improve clinic attendance and patient adherence. Methods: This was a quasi-experimental, longitudinal, controlled intervention study using interrupted time series analysis. The intervention consisted of (1) using a clinic appointment diary to track patient attendance and monitor monthly performance; (2) changing the mode of asking for self-reported adherence; (3) training staff on adherence concepts, intervention methods, and use of monitoring data; (4) conducting visits to support facility teams with the implementation. We conducted the study in 12 rural district hospitals (6 intervention, 6 control) in Kenya and randomly selected 1894 adult patients over 18 years of age in two cohorts: experienced patients on treatment for at least one year, and newly treated patients initiating ART during the study. Outcome measures were: attending the clinic on or before the date of a scheduled appointment, attending within 3 days of a scheduled appointment, reporting perfect adherence, and experiencing a gap in medication supply of more than 14 days. Results: Among experienced patients, the percentage attending the clinic on or before a scheduled appointment increased in both level (average total increase immediately after intervention) (+5.7%; 95% CI = 2.1, 9.3) and trend (increase per month) (+1.0% per month; 95% CI = 0.6, 1.5) following the intervention, as did the level and trend of those keeping appointments within three days (+4.2%; 95% CI = 1.6, 6.7; and +0.8% per month; 95% CI = 0.6, 1.1, respectively). The relative difference between the intervention and control groups based on the monthly difference in visit rates increased significantly in both level (+6.5; 95% CI = 1.4, 11.6) and trend (1.0% per month; 95% CI = 0.2, 1.8) following the intervention for experienced patients attending the clinic within 3 days of their scheduled appointments. The decrease in the percentage of experienced patients with a medication gap greater than 14 days approached statistical significance (-11.3%; 95% CI = -22.7, 0.1), and the change seemed to persist over 11 months after the intervention. All facility staff used appointment-keeping data to calculate adherence and discussed outcomes regularly. Conclusion: The appointment-tracking system and monthly performance monitoring was strengthened, and patient attendance was improved. Scale-up to national level may be considered

National tuberculosis spending efficiency and its associated factors in 121 low-income and middle-income countries, 2010-19: a data envelopment and stochastic frontier analysis

BACKGROUND: Maximising the efficiency of national tuberculosis programmes is key to improving service coverage, outcomes, and progress towards End TB targets. We aimed to determine the overall efficiency of tuberculosis spending and investigate associated factors in 121 low-income and middle-income countries between 2010 and 2019. METHODS: In this data envelopment and stochastic frontier analysis, we used data from the WHO Global TB report series on tuberculosis spending as the input and treatment coverage as the output to estimate tuberculosis spending efficiency. We investigated associations between 25 independent variables and overall efficiency. FINDINGS: We estimated global tuberculosis spending efficiency to be between 73·8% (95% CI 71·2-76·3) and 87·7% (84·9-90·6) in 2019, depending on the analytical method used. This estimate suggests that existing global tuberculosis treatment coverage could be increased by between 12·3% (95% CI 9·4-15·1) and 26·2% (23·7-28·8) for the same amount of spending. Efficiency has improved over the study period, mainly since 2015, but a substantial difference of 70·7-72·1 percentage points between the most and least efficient countries still exists. We found a consistent significant association between efficiency and current health expenditure as a share of gross domestic product, out-of-pocket spending on health, and some Sustainable Development Goal (SDG) indicators such as universal health coverage. INTERPRETATION: To improve efficiency, treatment coverage will need to be increased, particularly in the least efficient contexts where this might require additional spending. However, progress towards global End TB targets is slow even in the most efficient countries. Variables associated with TB spending efficiency suggest efficiency is complimented by commitments to improving health-care access that is free at the point of use and wider progress towards the SDGs. These findings support calls for additional investment in tuberculosis care. FUNDING: None

Costs incurred by people receiving tuberculosis treatment in low-income and middle-income countries: a meta-regression analysis.

BACKGROUND: People accessing and completing treatment for tuberculosis can face large economic costs, even when treatment is provided free of charge. The WHO End TB Strategy targets the elimination of catastrophic costs among tuberculosis-affected households. While low-income and middle-income countries (LMICs) represent 99% of global tuberculosis cases, only 29 of 135 LMICs had conducted national surveys of costs for patients with tuberculosis by December, 2022. We estimated costs for patients with tuberculosis in countries that have not conducted a national survey, to provide evidence on the economic burden of tuberculosis in these settings and inform estimates of global economic burden. METHODS: We extracted data from 22 national surveys of costs faced by patients with tuberculosis that were completed across 2015-22 and met inclusion criteria. Using a Bayesian meta-regression approach, we used these data and covariate data for all 135 LMICs to estimate per-patient costs (2021 US$) by cost category (ie, direct medical, direct non-medical, and indirect), country, drug resistance, and household income quintile. We also estimated the proportion of households experiencing catastrophic total costs (defined as >20$211 (95% uncertainty interval 154-302), direct non-medical costs were $512 (428-620), and indirect costs were$530 (423-663) per episode of tuberculosis. Overall, per-patient costs were $1253 (1127-1417). Estimated proportions of tuberculosis-affected households experiencing catastrophic total costs ranged from 75·2% (70·3-80·0) in the poorest quintile to 42·5% (34·3-51·5) in the richest quintile, compared with 54·9% (47·0-63·2) overall. INTERPRETATION: Tuberculosis diagnosis and treatment impose substantial costs on affected households. Eliminating these economic losses is crucial for removing barriers to accessing tuberculosis diagnosis and completing treatment among affected households and achieving the targets set in WHO's End TB Strategy. FUNDING: World Health Organization