134 research outputs found
Pan Afr Med J
No full textLaboratories are integral to the delivery of quality health care and for public health functions; however laboratory systems and services are often neglected in resource-poor settings such as the East African region. In order to sustainably strengthen national laboratory systems in resource-poor countries, there is a need to train laboratory personnel to work in clinical as well as public health laboratories. In 2004,Kenya, Uganda, Tanzania, and South Sudan began training public health laboratory workers jointly with field epidemiologists in the Kenya Field Epidemiology and Laboratory Training Program (FELTP), and later through the Tanzania FELTP, as a strategy to strengthen public health laboratories. These programs train laboratory epidemiologists through a two-year public health leadership development course, and also offer various types of short course training for frontline staff. The FELTP laboratory graduates in Kenya, Tanzania, Uganda, and South Sudan are working in their respective countries to strengthen public health laboratory systems while the short course participants provide a pool of frontline implementers with the capacity to support the lower tiers of health systems, as well as serve as surge capacity for the regions and the national level. Through training competent public health laboratory workers, the East African ministries of health, in collaboration with other regional partners and stakeholders are now engaged in developing and implementing a holistic approach that will guarantee an overall strengthening of the health system by using well-trained public health laboratory leaders to drive the process. Strengthening public health laboratory medicine in East Africa is critical to improve health-care systems. The experience with the FELTP model in East Africa is a step in the right direction towards ensuring a stronger role for the laboratory in public health.201122359702PMC3266675665
Phenotypic Characterization of Non-Typid Salmonella Species Associated with Severe Malaria in Children Admitted to Kilifi District Hospital
No full textInfections caused by both typhoid salmonella and non-typhoid Salmonellae (NTS) species cause major health problems such as acute gastroenteritis, typhoid
fever, severe bacteraemia and septicaemia that result in high morbidity and
mortality. Non-typhoid Salmonellae species are amongst the most common causes
of invasive bacterial childhood disease in sub-Saharan Africa. Malaria is a major
cause of global morbidity and mortality and may be responsible for between one to
two million childhood deaths each year in sub-Saharan Africa alone. A study to
determine the association between ~~~!~~ malaria and non-typhi salmonella in children was carried out during a 54-month period between January 1997 and June
2001 at the Kilifi District Hospital on the coast of Kenya. The ages of the children
varied between 3 months and 123 months (median 21 months, Inter Quartile Range
10 - 35 months). During this period 9147 children with severe malaria were
admitted at this hospital. A total of 19,118 blood cultures obtained from all
admissions and 1820 stool cultures were performed which yielded positive growth
of 7.3 % and 19% respectively. Non-typhi salmonella were isolated from 18.6% of
the positive blood cultures and 28.4% of the stool cultures out of which a total of
101 NTS occurred in children with severe malaria. Out of the 9147 malaria cases
admitted during this period of time 1.10% had concomitant NTS infection. Non
typhi Salmonella with severe malaria as a ratio of all malaria admissions for the
period varied between 0.8% and 1.5%. The NTS isolates occurring with severe
malaria showed varying levels of antibiotic resistance. They were resistant to
ampicillin (35%), chloramphenicol (18%), gentamicin (22%), Cefuroxime (29%), co-trimoxazole (39%), ciprofloxacin (3%), cefotaxime (14%), amoxycillinclavulanic
acid (26%) and tobramycin (18%). Multidrug resistance (MDR) was
seen in 34% of the isolates. Some of this resistance was transferable. There was a
significant association between clinical outcome and male sex of the patient. It can
be concluded from this study that NTS and severe malaria occurring together are a
major problem in this area and that a large number of the isolates are MDR. A high
mortality has also been associated with these diseases in this area with a significant
association with the male patients. Two major salmonella serotypes are responsible
for this infection namely S. typhimurium and S. enteritidis. It is proposed that
during the sequestration of Plasmodium parasites, they make these vessels porous
and hence open them up to invasion by salmonella from the gut. The salmonellae
find a medium rich in iron, which it needs both for growth and virulence. This may
explain why an occurrence of both NTS and Plasmodium leads to a severe illness,
which has high mortality. A more controlled study is required to elucidate the chain
of events of both NTS and malaria parasite co-existence
Epidemiological and antibiotic susceptibility profiles of infectious bacterial diarrhoea in Juba, South Sudan
No full textBackground: Diarrhoeal diseases have remained a major health problem in South Sudan where they accounted 45% prevalence in under five-year olds. Between 2006 and 2007, the country reported a morbidity of 8,337 cases and 176 deaths due to diarrhoeal outbreaks.
Methodology: We investigated causative agents of diarrhoeal diseases and their antibiogram in persons presenting with diarrhoea to selected health facilities in Juba.
Results: Bacterial agents were prevalent in 20(6.9%) of the 286 patients with 5.7%(4/70) in under five-year olds alone. S. dysenteriae 50% (10/20) accounted for the majority of the identified pathogens followed S. flexneri 25% (5/20) and S. typh 25% (5/20). Antibiotic testing showed that S. flexneri (5/5) and S. typhi (5/5) were all 100% sensitive to ceftriaxone, and gentamicin while S. dysenteriae had varying sensitivity to ciprofloxacin (70%), nalidixic acid (90%), and ceftriaxone(100%). These pathogens had 100% resistance to amoxicillin, ampicillin, tetracycline and cotrimoxazole. No difference existed in isolation rates among different age groups, educational status, gender, water drank, use of chlorine, toilet use, exposure at home to diarrhoea patient, hand washing with soap and location of residence. However, diarrhoeagenic bacteria isolation was higher for participants with no source of income (OR=6.08, p<0.05).
Conclusion: With emerging menace of resistance to commonly used antibiotics in South Sudan we recommend antibiotic resistance monitoring and regulation of antibiotic use
Isolation, Identification and Antibiotic Susceptibility Profiles of Diarrheagenic Bacteria Associated with Food Handlers in Kericho Town, Kenya
No full textBackground: Diarrhea as a result of food contamination from food handlers continues to pose serious public health concern. Food handlers as reservoirs of diarrheagenic bacteria are a constant source of infection to clientele visiting food establishments within both urban and rural settings. Isolating diarrheagenic bacteria from food handlers is necessary for accurate prediction on the frequency of these pathogens and potential changes in antibiotic resistance patterns.Methods: A cross sectional study was conducted in Kericho town to determine the burden of diarrheagenic bacteria among food handlers. A total of 384 stool samples were collected from January 2015 to March 2015.Bacterial pathogens were identified by conventional microbiological methods; antibiotic susceptibility of bacterial isolates was ascertained using the disk diffusion and agar dilution methods.Results: Significant isolates were the Escherichia coli (Enteroinvasive Escherichia coli 5.7%, Enteroaggregative Escherichia coli 2.1%, Enteropathogenic Escherichia coli 2.1%, and Enterotoxigenic Escherichia coli 1.6%), Salmonella isolates 3.1% and Shigella isolates 1.0%. Conclusions: The study findings emphasize the importance of food handlers as potential sources of infections and suggest appropriate hygienic and sanitary control measures. Accurate epidemiologic information on diarrheagenic bacteria associated with food handlers in Kericho town will be critical for augmenting existing diarrhea management policies in terms of treatment and to strengthen future awareness and health promotion programs. Keywords: Diarrheagenic bacteria, antimicrobial resistance, food handlers, Kericho town
Pan Afr Med J
No full textBackground: Road traffic injuries continue to exert a huge burden on the health care system in Kenya. Few studies on the severity of road traffic injuries have been conducted in Kenya. We carried out a cross-sectional study to determine factors associated with severity of road traffic injuries in a public hospital in Thika district, Kenya. Methods: Road crash victims attending the Thika district hospital, a 265-bed public hospital, emergency room were recruited consecutively between 10th August 2009 and 15th November 2009. Epidemiologic and clinical information was collected from medical charts and through interview with the victims or surrogates using a semi-structured questionnaire. Injuries were graded as severe or non-severe based on the Injury Severity Score (ISS). Independent factors associated with injury severity were assessed using multivariate logistic regression. Results: The mean age of participants was 32.4 years, three quarters were between 20-49 years-old and 73% (219) were male. Nineteen percent (56/300) of the victims had severe injury. Five percent (15) had head injury while 38% (115) had fractures. Vulnerable road users (pedestrians and two-wheel users) comprised 33% (99/300) of the victims. Vulnerable road users (OR=2.0, 95%CI=1.0-3.9), road crashes in rainy weather (OR=2.9, 95%CI=1.3-6.5) and night time crashes (OR=2.0, 95%CI=-1.1-3.9) were independent risk factors for sustaining severe injury. Conclusion: Severe injury was associated with vulnerable road users, rainy weather and night time crashes. Interventions and measures such as use of reflective jackets and helmets by two wheel users and enhanced road visibility could help reduce the severity of road traffic injuries
A microsporidian impairs Plasmodium falciparum transmission in Anopheles arabiensis mosquitoes
No full textA possible malaria control approach involves the dissemination in mosquitoes of inherited symbiotic microbes to block Plasmodium transmission. However, in the Anopheles gambiae complex, the primary African vectors of malaria, there are limited reports of inherited symbionts that impair transmission. We show that a vertically transmitted microsporidian symbiont (Microsporidia MB) in the An. gambiae complex can impair Plasmodium transmission. Microsporidia MB is present at moderate prevalence in geographically dispersed populations of An. arabiensis in Kenya, localized to the mosquito midgut and ovaries, and is not associated with significant reductions in adult host fecundity or survival. Field-collected Microsporidia MB infected An. arabiensis tested negative for P. falciparum gametocytes and, on experimental infection with P. falciparum, sporozoites aren’t detected in Microsporidia MB infected mosquitoes. As a microbe that impairs Plasmodium transmission that is non-virulent and vertically transmitted, Microsporidia MB could be investigated as a strategy to limit malaria transmission
Public health laboratory systems development in East Africa through training in laboratory management and field epidemiology
No full textLaboratories are integral to the delivery of quality health care and for public health functions; however laboratory systems and services are often neglected in resource-poor settings such as the East African region. In order to sustainably strengthen national laboratory systems in resource-poor countries, there is a need to train laboratory personnel to work in clinical as well as public health laboratories. In 2004,Kenya, Uganda, Tanzania, and South Sudan began training public health laboratory workers jointly with field epidemiologists in the Kenya Field Epidemiology and Laboratory Training Program (FELTP), and later through the Tanzania FELTP, as a strategy to strengthen public health laboratories. These programs train laboratory epidemiologists through a two-year public health leadership development course, and also offer various types of short course training for frontline staff. The FELTP laboratory graduates in Kenya, Tanzania, Uganda, and South Sudan are working in their respective countries to strengthen public health laboratory systems while the short course participants provide a pool of frontline implementers with the capacity to support the lower tiers of health systems, as well as serve as surge capacity for the regions and the national level. Through training competent public health laboratory workers, the East African ministries of health, in collaboration with other regional partners and stakeholders are now engaged in developing and implementing a holistic approach that will guarantee an overall strengthening of the health system by using welltrained public health laboratory leaders to drive the process. Strengthening public health laboratory medicine in East Africa is critical to improve health-care systems. The experience with the FELTP model in East Africa is a step in the right direction towards ensuring a stronger role for the laboratory in public health.Pan African Medical Journal 2011; 10(Supp1):1
BMC Infect Dis
No full textBackgroundAlthough causing substantial morbidity, the burden of pneumococcal disease among older children and adults in Africa, particularly in rural settings, is not well-characterized. We evaluated pneumococcal bacteremia among 21,000 persons 655 years old in a prospective cohort as part of population-based infectious disease surveillance in rural western Kenya from October 2006-September 2008.MethodsBlood cultures were done on patients meeting pre-defined criteria - severe acute respiratory illness (SARI), fever, and admission for any reason at a referral health facility within 5 kilometers of all 33 villages where surveillance took place. Serotyping of Streptococcus pneumoniae was done by latex agglutination and quellung reaction and antibiotic susceptibility testing was done using broth microdilution. We extrapolated incidence rates based on persons with compatible illnesses in the surveillance population who were not cultured. We estimated rates among HIV-infected persons based on community HIV prevalence. We projected the national burden of pneumococcal bacteremia cases based on these rates.ResultsAmong 1,301 blood cultures among persons 655 years, 52 (4%) yielded pneumococcus, which was the most common bacteria isolated. The yield was higher among those 6518 years than 5-17 years (6.9% versus 1.6%, p 95%). The crude rate of pneumococcal bacteremia was 129/100,000 person-years, and the adjusted rate was 419/100,000 person-years. Nineteen (61%) of 31 patients with HIV results were HIV-positive. The adjusted rate among HIV-infected persons was 2,399/100,000 person-years (Rate ratio versus HIV-negative adults, 19.7, 95% CI 12.4-31.1). We project 58,483 cases of pneumococcal bacteremia will occur in Kenyan adults in 2010.ConclusionsPneumococcal bacteremia rates were high among persons 655 years old, particularly among HIV-infected persons. Ongoing surveillance will document if expanded use of highly-active antiretroviral treatment for HIV and introduction of PCV10 for Kenyan children (anticipated in late 2010) result in substantial secondary benefits by reducing pneumococcal disease in adults
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
PLoS One
No full textBackgroundWorldwide, Shigella causes an estimated 160 million infections and >1 million deaths annually. However, limited incidence data are available from African urban slums. We investigated the epidemiology of shigellosis and drug susceptibility patterns within a densely populated urban settlement in Nairobi, Kenya through population-based surveillance.MethodsSurveillance participants were interviewed in their homes every 2 weeks by community interviewers. Participants also had free access to a designated study clinic in the surveillance area where stool specimens were collected from patients with diarrhea ( 653 loose stools within 24 hours) or dysentery ( 651 stool with visible blood during previous 24 hours). We adjusted crude incidence rates for participants meeting stool collection criteria at household visits who reported visiting another clinic.ResultsShigella species were isolated from 224 (23%) of 976 stool specimens. The overall adjusted incidence rate was 408/100,000 person years of observation (PYO) with highest rates among adults 34\u201349 years old (1,575/100,000 PYO). Isolates were: Shigella flexneri (64%), S. dysenteriae (11%), S. sonnei (9%), and S. boydii (5%). Over 90% of all Shigella isolates were resistant to trimethoprim-sulfamethoxazole and sulfisoxazole. Additional resistance included nalidixic acid (3%), ciprofloxacin (1%) and ceftriaxone (1%).ConclusionMore than 1 of every 200 persons experience shigellosis each year in this Kenyan urban slum, yielding rates similar to those in some Asian countries. Provision of safe drinking water, improved sanitation, and hygiene in urban slums are needed to reduce disease burden, in addition to development of effective Shigella vaccines
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