47 research outputs found
Am J Trop Med Hyg
No full textNairobi is considered a low-risk area for malaria transmission, but travel can influence transmission of malaria. We investigated the demographic characteristics and travel history of patients with documented fever and malaria in a study clinic in a population-based surveillance system over a 5-year period, January 1, 2007 to December 31, 2011. During the study period, 11,480 (68%) febrile patients had a microscopy test performed for malaria, of which 2,553 (22%) were positive. Malaria was detected year-round with peaks in January, May, and September. Children aged 5-14 years had the highest proportion (28%) of positive results followed by children aged 1-4 years (23%). Almost two-thirds of patients with malaria reported traveling outside Nairobi; 79% of these traveled to three counties in western Kenya. History of recent travel (i.e., in past month) was associated with malaria parasitemia (odds ratio: 10.0, 95% confidence interval: 9.0-11.0). Malaria parasitemia was frequently observed among febrile patients at a health facility in the urban slum of Kibera, Nairobi. The majority of patients had traveled to western Kenya. However, 34% reported no travel history, which raises the possibility of local malaria transmission in this densely populated, urban setting. These findings have important implications for malaria control in large Nairobi settlements
Emerg Infect Dis
No full textTo study the association of multidrug-resistant enteroaggregative Escherichia coli with persistent diarrhea in Kenyan children, stool specimens were obtained from 862 outpatients under 5 years of age from July 1991 to June 1993. E. coli O44 was identified as the sole bacterial pathogen in four patients experiencing at least 14 days of fever, vomiting, and diarrhea. Disk diffusion testing showed E. coli O44 resistance to tetracycline, ampicillin, erythromycin, trimethoprim-sulphamethoxazole, and amoxicillin/clavulanate and sensitivity to chloramphenicol, nalidixic acid, azithromycin, and cefuroxime. Further studies are needed to clarify the epidemiology, clinical spectrum, and pathogenesis of enteroaggregative E. coli infection
Virulence determinants of diarrhoegenic <i>Escherichia coli</i> - A Mini Review
No full textDiarrhoegenic Escherichia coli are of a broad variety. A clear understanding of the virulence/pathogenicity determinants of pathogenic Escherichia coli is important as they affect a large section of the population in the tropical and developing areas of the world. Faecal contamination of food and water is the major route of infection for humans. Based on minor differences in surface structure chemistry there are over 800 serotypes of Escherichia coli. Diagnostic methods used nowadays focus on the detection of either specific toxins such as heat stable (ST), heat labile (LT) and their specific attributes for example colonization factors (CF's) and specific target genes for example eaeA, which permit the identification of the corresponding pathotype. Classification of E. coli is an evolving science and more categories of pathogenic E. coli will be identified in the future. The virulence determinants in E. coli play the major role in infections in both humans and animals. Journal of Tropical Microbiology and Biotechnology Vol. 3(1) 2007: pp. 29-3
Isolation of Enterotoxigenic E. coli from Food-Handlers in Selected Tourist - Class Hotels in Nairobi
No full textA total of 3866 stool samples from food-handlers from tourist hotels in Nairobi were screened for the presence of enterotoxigenic Escherichia coli (ETEC). This was done using the “salting out” (hydrophobicity) technique. Results showed an ETEC carriage of 3.4% among the tested hotel food-handlers. This is significant in the sense that it requires only one carrier to infect several people who eat/drink the contaminated food/drink. Thus, hygiene needs to be exercised all the time, otherwise the infected workers could easily pass-on the infection through food/drink contamination. Workers also need to be scanned regularly and those found infected kept from handling foods/drinks in hotels and other food/drink places. Some of these isolates exhibited multi-drug resistances, a characteristic which would worsen the situation for those infected, making treatment difficult. The Kenya Veterinarian Vol. 29 2005: pp. 14-1
Guidelines and mindlines: why do clinical staff over-diagnose malaria in Tanzania? A qualitative study.
No full textBACKGROUND: Malaria over-diagnosis in Africa is widespread and costly both financially and in terms of morbidity and mortality from missed diagnoses. An understanding of the reasons behind malaria over-diagnosis is urgently needed to inform strategies for better targeting of antimalarials. METHODS: In an ethnographic study of clinical practice in two hospitals in Tanzania, 2,082 patient consultations with 34 clinicians were observed over a period of three months at each hospital. All clinicians were also interviewed individually as well as being observed during routine working activities with colleagues. Interviews with five tutors and 10 clinical officer students at a nearby clinical officer training college were subsequently conducted. RESULTS: Four, primarily social, spheres of influence on malaria over-diagnosis were identified. Firstly, the influence of initial training within a context where the importance of malaria is strongly promoted. Secondly, the influence of peers, conforming to perceived expectations from colleagues. Thirdly, pressure to conform with perceived patient preferences. Lastly, quality of diagnostic support, involving resource management, motivation and supervision. Rather than following national guidelines for the diagnosis of febrile illness, clinician behaviour appeared to follow 'mindlines': shared rationales constructed from these different spheres of influence. Three mindlines were identified in this setting: malaria is easier to diagnose than alternative diseases; malaria is a more acceptable diagnosis; and missing malaria is indefensible. These mindlines were apparent during the training stages as well as throughout clinical careers. CONCLUSION: Clinicians were found to follow mindlines as well as or rather than guidelines, which incorporated multiple social influences operating in the immediate and the wider context of decision making. Interventions to move mindlines closer to guidelines need to take the variety of social influences into account
Decreasing incidence of severe malaria and community-acquired bacteraemia among hospitalized children in Muheza, north-eastern Tanzania, 2006-2010.
No full textBACKGROUND: The annual incidence and temporal trend of severe malaria and community-acquired bacteraemia during a four-year period in Muheza, Tanzania was assessed. METHODS: Data on severely ill febrile children aged 2 months to 14 years from three prospective studies conducted at Muheza District Hospital from 2006 to 2010 was pooled and analysed. On admission, each enrolled child had a thin and thick blood film and at least one rapid diagnostic test for falciparum malaria, as well as a blood culture. The annual incidence of bacteraemia and severe malaria among children coming from Muheza was calculated and their temporal trend was assessed. RESULTS: Overall, 1, 898 severe falciparum malaria and 684 bacteraemia cases were included. Of these, 1, 356 (71%) and 482 (71%), respectively, were from the referral population of Muheza. The incidence of falciparum malaria and all-cause bacteraemia in Muheza decreased five-fold and three-fold, respectively, from the first to the fourth year of surveillance (p < 0.0001). During this period, the median ages of children from Muheza admitted with severe malaria increased from 1.7 to 2.5 years (p < 0.0001). The reduction in all-cause bacteraemia was mainly driven by the 11-fold decline in the incidence of non-typhoidal salmonellosis. The annual incidences of Haemophilus influenzae and pneumococcal invasive bacterial infections decreased as well but were much fewer in number. CONCLUSIONS: These results add to the growing evidence of the decline in malaria associated with a decrease in non-typhoidal salmonellosis and possibly other bacteraemias. Malarial prevention and control strategies may provide a greater benefit than the mere reduction of malaria alone
Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya
No full textBackground
Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with
the greatest burden falling on young children living in less-developed countries. Vaccines
directed against this virus have shown promise in recent trials, and are undergoing
effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are
available on the incidence and clinical characteristics of severe group A rotavirus disease.
Advocacy for vaccine intervention and interpretation of effectiveness following implementation
will benefit from accurate base-line estimates of the incidence and severity of rotavirus
paediatric admissions in relevant populations. The study objective was to accurately define the
incidence and severity of group A rotavirus disease in a resource-poor setting necessary to
make informed decisions on the need for vaccine prevention.
Methods and Findings
Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus
infection at Kilifi District Hospital in coastal Kenya. Children < 13 y of age were eligible as
"cases" if admitted with diarrhoea, and "controls" if admitted without diarrhoea. We calculated
the incidence of hospital admission with group A rotavirus using data from a demographic
surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296
(22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%)
were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95%
confidence interval [CI] 1.9–4.7) were rotavirus positive. The annual incidence (per 100,000
children) of rotavirus-positive admissions was 1,431 (95% CI 1,275–1,600) in infants and 478
(437–521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with
rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting
illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance
except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9%
among rotavirus-negative children.
Conclusions
In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first
5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across
Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is
associated with acute life-threatening metabolic derangement in otherwise healthy children.
Although mortality is low in this clinical research setting this may not be generally true in
African hospitals lacking rapid and appropriate management
A decline in the incidence of invasive non-typhoidal Salmonella infection in The Gambia temporally associated with a decline in malaria infection.
No full textBACKGROUND: Malaria is a risk factor for invasive non-typhoidal Salmonella (NTS) infection in children. In the last 10 years, indices of malaria infection in The Gambia have fallen substantially. METHODS: We compared temporal trends of childhood malaria and NTS infection in two Gambian locations. In Fajara, on the coast, the incidence of NTS infection at three time points between 1979 and 2005 was compared to the percentage of malaria positive outpatient thick blood films and the percentage of admissions associated with malaria over time. In Basse, in the eastern part of the country, the incidence of NTS infection at three time points between 1989 and 2008 was compared to the prevalence of malaria parasitaemia at four time points between 1992 and 2008. RESULTS: The estimated incidence of NTS infection in Fajara fell from 60 (1979-1984) to 10 (2003-05) cases per 100,000 person years. The proportion of outpatients in Fajara with suspected malaria who were parasitaemic fell from 33% (1999) to 6% (2007) while the proportion of admissions associated with malaria fell from 14.5% (1999) to 5% (2007). In Basse, the estimated incidence of NTS infection fell from 105 (1989-1991) to 29 (2008) cases per 100,000 person years while the prevalence of malaria parasitaemia fell from 45% (1992) to 10% (2008). The incidence of pneumococcal bacteraemia in Fajara and Basse did not fall over the study period. CONCLUSIONS: These data support an association between malaria and NTS infection. Reductions in malaria infection may be associated with reduced rates of invasive childhood NTS infection
Epidemiol Infect
No full textGiven the challenges in accurately identifying unexposed controls in case-control studies of diarrhoea, we examined diarrhoea incidence, subclinical enteric infections and growth stunting within a reference population in the Global Enteric Multicenter Study, Kenya site. Within 'control' children (0-59 months old without diarrhoea in the 7 days before enrolment, n = 2384), we examined surveys at enrolment and 60-day follow-up, stool at enrolment and a 14-day post-enrolment memory aid for diarrhoea incidence. At enrolment, 19% of controls had \u2a7e1 enteric pathogen associated with moderate-to-severe diarrhoea ('MSD pathogens') in stool; following enrolment, many reported diarrhoea (27% in 7 days, 39% in 14 days). Controls with and without reported diarrhoea had similar carriage of MSD pathogens at enrolment; however, controls reporting diarrhoea were more likely to report visiting a health facility for diarrhoea (27% vs. 7%) or fever (23% vs. 16%) at follow-up than controls without diarrhoea. Odds of stunting differed by both MSD and 'any' (including non-MSD pathogens) enteric pathogen carriage, but not diarrhoea, suggesting control classification may warrant modification when assessing long-term outcomes. High diarrhoea incidence following enrolment and prevalent carriage of enteric pathogens have implications for sequelae associated with subclinical enteric infections and for design and interpretation of case-control studies examining diarrhoea.CC999999/Intramural CDC HHSUnited States
Replication Data for: Seroprevalence of anti–SARS-CoV-2 antibodies in women attending antenatal care in eastern Ethiopia
No full textData from a Sero-survey done in Ethiopia. Participants were mothers going for their first ANC visit. Serology results alongside other demographic and clinical information included in the datase
