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Mirieri H, Nduati R, Dawa J, Okutoyi L, Osoro E, Mugo C, Wamalwa D, Jin H, Mwaengo D, Otieno N, Marwanga D, Shabibi M, Munyua P, Kinuthia J, Clancey E, Widdowson MA, Njenga MK, Verani JR, Inwani I. Risk factors of adverse birth outcomes among a cohort of pregnant women in Coastal Kenya, 2017-2019. BMC Pregnancy Childbirth 2024; 24:127. [PMID: 38347445 PMCID: PMC10860222 DOI: 10.1186/s12884-024-06320-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Adverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya. METHODS From October 2017 to July 2019, pregnant women < 28 weeks gestation were enrolled and followed up until delivery in three hospitals in coastal Kenya. Newborns were examined at delivery. Among women with birth outcome data, we assessed the frequency of congenital anomalies defined as gastroschisis, umbilical hernia, limb abnormalities and Trisomy 21, and adverse birth outcomes, defined as either stillbirth, miscarriage, preterm birth, small for gestational age, or microcephaly. We used log-binomial regression to identify maternal characteristics associated with the presence of at least one adverse outcome. RESULTS Among the 2312 women enrolled, 1916 (82.9%) had birth outcome data. Overall, 402/1916 (20.9%; 95% confidence interval (CI): 19.1-22.8) pregnancies had adverse birth outcomes. Specifically, 66/1916 (3.4%; 95% CI: 2.7-4.4) were stillbirths, 34/1916 (1.8%; 95% CI: 1.2-2.4) were miscarriages and 23/1816 (1.2%; 95% CI: 0.8-1.9) had congenital anomalies. Among the participants with anthropometric measurements data, 142/1200 (11.8%; 95% CI: 10.1 - 13.8) were small for gestational age and among the participants with ultrasound records, 143/1711 (8.4%; 95% CI: 7.1-9.8) were preterm. Febrile illnesses in current pregnancy (adjusted risk ratio (aRR): 1.7; 95% CI: 1.1-2.8), a history of poor birth outcomes in prior pregnancy (aRR: 1.8; 95% CI: 1.3-2.4) and high blood pressure in pregnancy (aRR: 3.9, 95% CI: (1.7-9.2) were independently associated with adverse birth outcomes in a model that included age, education, human immunodeficiency virus status and high blood pressure at enrolment. CONCLUSION We found similar rates of overall adverse birth outcomes, congenital anomalies, and small for gestational age but higher rates of stillbirths and lower rates of prematurity compared to the rates that have been reported in the sub-Saharan Africa region. However, the rates of adverse birth outcomes in this study were comparable to other studies conducted in Kenya. Febrile illnesses during the current pregnancy, previous history of poor birth outcomes and high blood pressure in pregnancy are predictive of an increased risk of adverse birth outcomes.
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Affiliation(s)
- Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya.
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Lydia Okutoyi
- Department of Health Care Quality, Kenyatta National Hospital, Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Hafsa Jin
- Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Dufton Mwaengo
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Nancy Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Doris Marwanga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | | | - Peninah Munyua
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Erin Clancey
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Irene Inwani
- Department of Paediatrics, Kenyatta National Hospital, Nairobi, Kenya
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Dawa J, Jalang'o R, Mirieri H, Kalani R, Marwanga D, Lafond KE, Muriuki MM, Ejoi J, Chiguba F, Patta S, Amoth P, Okunga E, Tabu C, Chaves SS, Ebama MS, Muthoka P, Njenga V, Kiptoo E, Jewa I, Mwanyamawi R, Bresee J, Njenga MK, Osoro E, Mecca L, Emukule GO. Comparing performance of year-round and campaign-mode influenza vaccination strategies among children aged 6-23 months in Kenya: 2019-2021. Vaccine 2023:S0264-410X(23)01380-4. [PMID: 38105140 DOI: 10.1016/j.vaccine.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/03/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION In 2016, the Kenya National Immunization Technical Advisory Group requested additional programmatic and cost effectiveness data to inform the choice of strategy for a national influenza vaccination program among children aged 6-23 months of age. In response, we conducted an influenza vaccine demonstration project to compare the performance of a year-round versus campaign-mode vaccination strategy. Findings from this demonstration project will help identify essential learning lessons for a national program. METHODS We compared two vaccine delivery strategies: (i) a year-round vaccination strategy where influenza vaccines were administered throughout the year at health facilities. This strategy was implemented in Njoro sub-county in Nakuru (November 2019 to October 2021) and Jomvu sub-county in Mombasa (December 2019 to October 2021), (ii) a campaign-mode vaccination strategy where vaccines were available at health facilities over four months. This strategy was implemented in Nakuru North sub-county in Nakuru (June to September 2021) and Likoni sub-county in Mombasa (July to October 2021). We assessed differences in coverage, dropout rates, vaccine wastage, and operational needs. RESULTS We observed similar performance between strategies in coverage of the first dose of influenza vaccine (year-round strategy 59.7 %, campaign strategy 63.2 %). The coverage obtained in the year-round sub-counties was similar (Njoro 57.4 %; Jomvu 63.1 %); however, more marked differences between campaign sub-counties were observed (Nakuru North 73.4 %; Likoni 55.2 %). The campaign-mode strategy exceeded the cold chain capacity of participating health facilities, requiring thrice monthly instead of once monthly deliveries, and was associated with a two-fold increase in workload compared to the year-round strategy (168 vaccines administered per day in the campaign strategy versus 83 vaccines administered per day in the year-round strategy). CONCLUSION Although both strategies had similar coverage levels, the campaign-mode strategy was associated with considerable operational needs that could significantly impact the immunization program.
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Affiliation(s)
- Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya.
| | - Rose Jalang'o
- National Vaccines and Immunisation Program, Ministry of Health, Kenya
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Rosalia Kalani
- Division of Disease Surveillance and Response, Ministry of Health, Kenya
| | - Doris Marwanga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joyce Ejoi
- Department of Health, Nakuru County, Kenya
| | | | - Shem Patta
- Department of Health, Mombasa County, Kenya
| | | | - Emmanuel Okunga
- Division of Disease Surveillance and Response, Ministry of Health, Kenya
| | - Collins Tabu
- National Vaccines and Immunisation Program, Ministry of Health, Kenya
| | - Sandra S Chaves
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Malembe S Ebama
- Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | | | | | | | - Isaac Jewa
- Department of Health, Mombasa County, Kenya
| | | | - Joseph Bresee
- Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Lucy Mecca
- National Vaccines and Immunisation Program, Ministry of Health, Kenya
| | - Gideon O Emukule
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
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Kiama C, Okunga E, Muange A, Marwanga D, Langat D, Kuria F, Amoth P, Were I, Gachohi J, Ganda N, Martinez Valiente M, Njenga MK, Osoro E, Brunkard J. Mapping of cholera hotspots in Kenya using epidemiologic and water, sanitation, and hygiene (WASH) indicators as part of Kenya's new 2022-2030 cholera elimination plan. PLoS Negl Trop Dis 2023; 17:e0011166. [PMID: 36930650 PMCID: PMC10058159 DOI: 10.1371/journal.pntd.0011166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/29/2023] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
Cholera is an issue of major public health importance. It was first reported in Kenya in 1971, with the country experiencing outbreaks through the years, most recently in 2021. Factors associated with the outbreaks in Kenya include open defecation, population growth with inadequate expansion of safe drinking water and sanitation infrastructure, population movement from neighboring countries, crowded settings such as refugee camps coupled with massive displacement of persons, mass gathering events, and changes in rainfall patterns. The Ministry of Health, together with other ministries and partners, revised the national cholera control plan to a multisectoral cholera elimination plan that is aligned with the Global Roadmap for Ending Cholera. One of the key features in the revised plan is the identification of hotspots. The hotspot identification exercise followed guidance and tools provided by the Global Task Force on Cholera Control (GTFCC). Two epidemiological indicators were used to identify the sub-counties with the highest cholera burden: incidence per population and persistence. Additionally, two indicators were used to identify sub-counties with poor WASH coverage due to low proportions of households accessing improved water sources and improved sanitation facilities. The country reported over 25,000 cholera cases between 2015 and 2019. Of 290 sub-counties, 25 (8.6%) sub-counties were identified as a high epidemiological priority; 78 (26.9%) sub-counties were identified as high WASH priority; and 30 (10.3%) sub-counties were considered high priority based on a combination of epidemiological and WASH indicators. About 10% of the Kenyan population (4.89 million) is living in these 30-combination high-priority sub-counties. The novel method used to identify cholera hotspots in Kenya provides useful information to better target interventions in smaller geographical areas given resource constraints. Kenya plans to deploy oral cholera vaccines in addition to WASH interventions to the populations living in cholera hotspots as it targets cholera elimination by 2030.
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Affiliation(s)
- Catherine Kiama
- Washington State University, Global Health Kenya, Nairobi, Kenya
- * E-mail:
| | | | | | - Doris Marwanga
- Washington State University, Global Health Kenya, Nairobi, Kenya
| | | | | | | | - Ian Were
- Kenya Ministry of Health, Nairobi, Kenya
| | - John Gachohi
- Washington State University, Global Health Kenya, Nairobi, Kenya
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | | | - M. Kariuki Njenga
- Washington State University, Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
| | - Eric Osoro
- Washington State University, Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
| | - Joan Brunkard
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Ngere I, Dawa J, Hunsperger E, Otieno N, Masika M, Amoth P, Makayotto L, Nasimiyu C, Gunn BM, Nyawanda B, Oluga O, Ngunu C, Mirieri H, Gachohi J, Marwanga D, Munywoki PK, Odhiambo D, Alando MD, Breiman RF, Anzala O, Njenga MK, Bulterys M, Herman-Roloff A, Osoro E. High seroprevalence of SARS-CoV-2 but low infection fatality ratio eight months after introduction in Nairobi, Kenya. Int J Infect Dis 2021; 112:25-34. [PMID: 34481966 PMCID: PMC8411609 DOI: 10.1016/j.ijid.2021.08.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The lower than expected COVID-19 morbidity and mortality in Africa has been attributed to multiple factors, including weak surveillance. This study estimated the burden of SARS-CoV-2 infections eight months into the epidemic in Nairobi, Kenya. METHODS A population-based, cross-sectional survey was conducted using multi-stage random sampling to select households within Nairobi in November 2020. Sera from consenting household members were tested for antibodies to SARS-CoV-2. Seroprevalence was estimated after adjusting for population structure and test performance. Infection fatality ratios (IFRs) were calculated by comparing study estimates with reported cases and deaths. RESULTS Among 1,164 individuals, the adjusted seroprevalence was 34.7% (95% CI 31.8-37.6). Half of the enrolled households had at least one positive participant. Seropositivity increased in more densely populated areas (spearman's r=0.63; p=0.009). Individuals aged 20-59 years had at least two-fold higher seropositivity than those aged 0-9 years. The IFR was 40 per 100,000 infections, with individuals ≥60 years old having higher IFRs. CONCLUSION Over one-third of Nairobi residents had been exposed to SARS-CoV-2 by November 2020, indicating extensive transmission. However, the IFR was >10-fold lower than that reported in Europe and the USA, supporting the perceived lower morbidity and mortality in sub-Saharan Africa.
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Affiliation(s)
- Isaac Ngere
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Elizabeth Hunsperger
- Center for Global Health, US Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya
| | - Nancy Otieno
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Moses Masika
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi, Kenya
| | | | - Lyndah Makayotto
- Department of Health, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Carolyne Nasimiyu
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Bronwyn M Gunn
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Bryan Nyawanda
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Ouma Oluga
- Department of Health, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Carolyne Ngunu
- Department of Health, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - John Gachohi
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA; School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kiambu, Kenya
| | - Doris Marwanga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Patrick K Munywoki
- Center for Global Health, US Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya
| | - Dennis Odhiambo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Moshe D Alando
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Omu Anzala
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi, Kenya
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Marc Bulterys
- Center for Global Health, US Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya
| | - Amy Herman-Roloff
- Center for Global Health, US Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA.
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Njenga MK, Ogolla E, Thumbi SM, Ngere I, Omulo S, Muturi M, Marwanga D, Bitek A, Bett B, Widdowson MA, Munyua P, Osoro EM. Comparison of knowledge, attitude, and practices of animal and human brucellosis between nomadic pastoralists and non-pastoralists in Kenya. BMC Public Health 2020; 20:269. [PMID: 32093689 PMCID: PMC7041083 DOI: 10.1186/s12889-020-8362-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 02/17/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The seroprevalence of brucellosis among nomadic pastoralists and their livestock in arid lands is reported to be over10-fold higher than non-pastoralists farmers and their livestock in Kenya. Here, we compared the seroprevalence of nomadic pastoralists and mixed farming with their knowledge of the disease and high-risk practices associated with brucellosis infection. METHODS Across-sectional study was conducted in two counties - Kiambu County where farmers primarily practice smallholder livestock production and crop farming, and Marsabit County where farmers practice nomadic pastoral livestock production. Stratified random sampling was applied, in which sublocations were initially selected based on predominant livestock production system, before selecting households using randomly generated geographical coordinates. In each household, up to three persons aged 5 years and above were randomly selected, consented, and tested for Brucella spp IgG antibodies. A structured questionnaire was administered to the household head and selected individuals on disease knowledge and risky practices among the pastoralists and mixed farmers compared. Multivariable mixed effects logistic regression model was used to assess independent practices associated with human Brucella spp. IgG seropositivity. RESULTS While the majority (74%) of pastoralist households had little to no formal education when compared to mixed (8%), over 70% of all households (pastoralists and mixed farmers) had heard of brucellosis and mentioned its clinical presentation in humans. However, fewer than 30% of all participants (pastoralists and mixed farmers) knew how brucellosis is transmitted between animals and humans or how its transmission can be prevented. Despite their comparable knowledge, significantly more seropositive pastoralists compared to mixed farmers engaged in risky practices including consuming unboiled milk (79.5% vs 1.7%, p < 0.001) and raw blood (28.3% vs 0.4%, p < 0.001), assisting in animal birth (43.0% vs 9.3%, p < 0.001), and handling raw hides (30.6% vs 5.5%, p < 0.001). , CONCLUSION Nomadic pastoralists are more likely to engage in risky practices that promote Brucella Infection, probably because of their occupation and culture, despite having significant knowledge of the disease.
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Affiliation(s)
- M Kariuki Njenga
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
| | - Eric Ogolla
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Samuel Mwangi Thumbi
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
| | - Isaac Ngere
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
| | - Sylvia Omulo
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
| | - Mathew Muturi
- Kenya Ministry of Agriculture and Fisheries, Nairobi, Kenya
| | - Doris Marwanga
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Austine Bitek
- United Nations Food and Agriculture Organization-Kenya Office, Nairobi, Kenya
| | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - Peninah Munyua
- Division of Global Health Protection, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - Eric Mogaka Osoro
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya.
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Osoro EM, Lidechi S, Nyaundi J, Marwanga D, Mwatondo A, Muturi M, Ng'ang'a Z, Njenga K. Detection of pandemic influenza A/H1N1/pdm09 virus among pigs but not in humans in slaughterhouses in Kenya, 2013-2014. BMC Res Notes 2019; 12:628. [PMID: 31551085 PMCID: PMC6760099 DOI: 10.1186/s13104-019-4667-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/19/2019] [Indexed: 02/07/2023] Open
Abstract
Objective We conducted four cross-sectional studies over 1 year among humans and pigs in three slaughterhouses in Central and Western Kenya (> 350 km apart) to determine infection and exposure to influenza A viruses. Nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected from participants who reported acute respiratory illness (ARI) defined as fever, cough or running nose. Nasal swabs and blood samples were collected from pigs. Human NP/OP and pig nasal swabs were tested for influenza A virus by real-time reverse transcriptase polymerase chain reaction (PCR) and pig serum was tested for anti-influenza A antibodies by ELISA. Results A total of 288 participants were sampled, 91.3% of them being male. Fifteen (5.2%) participants had ARI but the nine swabs collected from them were negative for influenza A virus by PCR. Of the 1128 pigs sampled, five (0.4%) nasal swabs tested positive for influenza A/H1N1/pdm09 by PCR whereas 214 of 1082 (19.8%) serum samples tested for Influenza A virus antibodies. There was higher seroprevalence in colder months and among pigs reared as free-range. These findings indicate circulation of influenza A/H1N1/pdm09 among pigs perhaps associated with good adaptation of the virus to the pig population after initial transmission from humans to pigs.
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Affiliation(s)
- Eric Mogaka Osoro
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
| | | | | | | | | | - Mathew Muturi
- Ministry of Agriculture and Irrigation, Nairobi, Kenya
| | - Zipporah Ng'ang'a
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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Osoro EM, Lidechi S, Marwanga D, Nyaundi J, Mwatondo A, Muturi M, Ng'ang'a Z, Njenga K. Seroprevalence of influenza A virus in pigs and low risk of acute respiratory illness among pig workers in Kenya. Environ Health Prev Med 2019; 24:53. [PMID: 31421676 PMCID: PMC6698327 DOI: 10.1186/s12199-019-0808-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/02/2019] [Indexed: 01/27/2023] Open
Abstract
Background Influenza A viruses pose a significant risk to human health because of their wide host range and ability to reassort into novel viruses that can cause serious disease and pandemics. Since transmission of these viruses between humans and pigs can be associated with occupational and environmental exposures, we investigated the association between occupational exposure to pigs, occurrence of acute respiratory illness (ARI), and influenza A virus infection. Methods The study was conducted in Kiambu County, the county with the highest level of intensive small-scale pig farming in Kenya. Up to 3 participants (> 2 years old) per household from pig-keeping and non-pig-keeping households were randomly recruited and followed up in 2013 (Sept-Dec) and 2014 (Apr-Aug). Oropharyngeal (OP) and nasopharyngeal (NP) swabs were collected from participants with ARI at the time of study visit. For the animal study, nasal and oropharyngeal swabs, and serum samples were collected from pigs and poultry present in enrolled households. The human and animal swab samples were tested for viral nucleic acid by RT-PCR and sera by ELISA for antibodies. A Poisson generalized linear mixed-effects model was developed to assess the association between pig exposure and occurrence of ARI. Results Of 1137 human participants enrolled, 625 (55%) completed follow-up visits including 172 (27.5%) pig workers and 453 (72.5%) non-pig workers. Of 130 human NP/OP swabs tested, four (3.1%) were positive for influenza A virus, one pig worker, and three among non-pig workers. Whereas none of the 4462 swabs collected from pig and poultry tested positive for influenza A virus by RT-PCR, 265 of 4273 (6.2%) of the sera tested positive for virus antibodies by ELISA, including 11.6% (230/1990) of the pigs and 1.5% (35/2,283) of poultry. The cumulative incidence of ARI was 16.9% among pig workers and 26.9% among the non-pig workers. The adjusted risk ratio for the association between being a pig worker and experiencing an episode of ARI was 0.56 (95% CI [0.33, 0.93]), after adjusting for potential confounders. Conclusions Our findings demonstrate moderate seropositivity for influenza A virus among pigs, suggesting the circulation of swine influenza virus and a potential for interspecies transmission.
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Affiliation(s)
- Eric Mogaka Osoro
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
| | | | | | | | | | - Mathew Muturi
- Ministry of Agriculture and Irrigation, Nairobi, Kenya
| | - Zipporah Ng'ang'a
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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Muturi M, Bitek A, Mwatondo A, Osoro E, Marwanga D, Gura Z, Ngere P, Nganga Z, Thumbi SM, Njenga K. Risk factors for human brucellosis among a pastoralist community in South-West Kenya, 2015. BMC Res Notes 2018; 11:865. [PMID: 30518420 PMCID: PMC6282298 DOI: 10.1186/s13104-018-3961-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/29/2018] [Indexed: 12/31/2022] Open
Abstract
Objective Brucellosis is one of the top five priority zoonosis in Kenya because of the socio-economic burden of the disease, especially among traditional, livestock keeping communities. We conducted a 1 year, hospital based, unmatched case–control study to determine risk factors for brucellosis among Maasai pastoralists of Kajiado County in 2016. A case was defined by a clinical criteria; fever or history of fever and two clinical signs suggestive of brucellosis and a positive competitive enzyme-linked immunosorbent assay test (c-ELISA). A control was defined as patients visiting the study facility with negative c-ELISA. Unconditional logistic regression was used to study association between exposure variables and brucellosis using odds ratios (OR) and 95% confidence intervals (CI). Results Forty-three cases and 86 controls were recruited from a population of 4792 individuals in 801 households. The mean age for the cases was 48.7 years while that of the controls was 37.6 years. The dominant gender for both cases (62.7%) and controls (58.1%) groups was female. Regular consumption of un-boiled raw milk and assisting animals in delivery were significantly associated with brucellosis by OR 7.7 (95% CI 1.5–40.1) and OR 3.7 (95% CI 1.1–13.5), respectively.
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Affiliation(s)
- Mathew Muturi
- Kenya Zoonotic Disease Unit-Ministry of Agriculture, Livestock and Fisheries and Ministry of Health, P.O. Box 20811-00202, Nairobi, Kenya.
| | - Austine Bitek
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Athman Mwatondo
- Kenya Zoonotic Disease Unit-Ministry of Agriculture, Livestock and Fisheries and Ministry of Health, P.O. Box 20811-00202, Nairobi, Kenya
| | - Eric Osoro
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | | | - Zeinab Gura
- Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | | | - Zipporah Nganga
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - S M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
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Dellicour S, Hill J, Bruce J, Ouma P, Marwanga D, Otieno P, Desai M, Hamel MJ, Kariuki S, Webster J. Effectiveness of the delivery of interventions to prevent malaria in pregnancy in Kenya. Malar J 2016; 15:221. [PMID: 27091142 PMCID: PMC4835845 DOI: 10.1186/s12936-016-1261-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
Background Coverage with malaria in pregnancy interventions remains unacceptably low. Implementation research is needed to identify and quantify the bottlenecks for the delivery and use of these life-saving interventions through antenatal clinics (ANC). Methods A cross-sectional study was carried out in ANC across nine health facilities in western Kenya. Data were collected for an individual ANC visit through structured observations and exit interviews with the same ANC clients. The cumulative and intermediate systems effectiveness for the delivery of intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) to eligible pregnant women on this one specific visit to ANC were estimated. Results Overall the ANC systems effectiveness for delivering malaria in pregnancy interventions was suboptimal. Only 40 and 53 % of eligible women received IPTp by directly observed therapy as per policy in hospitals and health centres/dispensaries respectively. The overall systems effectiveness for the receipt of IPTp disregarding directly observed therapy was 62 and 72 % for hospitals and lower level health facilities, respectively. The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively. Conclusion This study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities. This illustrates missed opportunities and provider level bottlenecks to the scale up and use of interventions to control malaria in pregnancy delivered through ANC. The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1261-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jane Bruce
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Ouma
- Malaria Branch, Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Doris Marwanga
- Malaria Branch, Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Peter Otieno
- Malaria Branch, Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Meghna Desai
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary J Hamel
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Simon Kariuki
- Malaria Branch, Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Jayne Webster
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
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10
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Gimnig JE, Otieno P, Were V, Marwanga D, Abong’o D, Wiegand R, Williamson J, Wolkon A, Zhou Y, Bayoh MN, Lobo NF, Laserson K, Kariuki S, Hamel MJ. The Effect of Indoor Residual Spraying on the Prevalence of Malaria Parasite Infection, Clinical Malaria and Anemia in an Area of Perennial Transmission and Moderate Coverage of Insecticide Treated Nets in Western Kenya. PLoS One 2016; 11:e0145282. [PMID: 26731524 PMCID: PMC4701193 DOI: 10.1371/journal.pone.0145282] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022] Open
Abstract
Background Insecticide treated nets (ITNs) and indoor residual spraying (IRS) have been scaled up for malaria prevention in sub-Saharan Africa. However, there are few studies on the benefit of implementing IRS in areas with moderate to high coverage of ITNs. We evaluated the impact of an IRS program on malaria related outcomes in western Kenya, an area of intense perennial malaria transmission and moderate ITN coverage (55–65% use of any net the previous night). Methods The Kenya Division of Malaria Control, with support from the US President’s Malaria Initiative, conducted IRS in one lowland endemic district with moderate coverage of ITNs. Surveys were conducted in the IRS district and a neighboring district before IRS, after one round of IRS in July-Sept 2008 and after a second round of IRS in April-May 2009. IRS was conducted with pyrethroid insecticides. At each survey, 30 clusters were selected for sampling and within each cluster, 12 compounds were randomly selected. The primary outcomes measured in all residents of selected compounds included malaria parasitemia, clinical malaria (P. falciparum infection plus history of fever) and anemia (Hb<8) of all residents in randomly selected compounds. At each survey round, individuals from the IRS district were matched to those from the non-IRS district using propensity scores and multivariate logistic regression models were constructed based on the matched dataset. Results At baseline and after one round of IRS, there were no differences between the two districts in the prevalence of malaria parasitemia, clinical malaria or anemia. After two rounds of IRS, the prevalence of malaria parasitemia was 6.4% in the IRS district compared to 16.7% in the comparison district (OR = 0.36, 95% CI = 0.22–0.59, p<0.001). The prevalence of clinical malaria was also lower in the IRS district (1.8% vs. 4.9%, OR = 0.37, 95% CI = 0.20–0.68, p = 0.001). The prevalence of anemia was lower in the IRS district but only in children under 5 years of age (2.8% vs. 9.3%, OR = 0.30, 95% CI = 0.13–0.71, p = 0.006). Multivariate models incorporating both IRS and ITNs indicated that both had an impact on malaria parasitemia and clinical malaria but the independent effect of ITNs was reduced in the district that had received two rounds of IRS. There was no statistically significant independent effect of ITNs on the prevalence of anemia in any age group. Conclusions Both IRS and ITNs are effective tools for reducing malaria burden and when implemented in an area of moderate to high transmission with moderate ITN coverage, there may be an added benefit of IRS. The value of adding ITNs to IRS is less clear as their benefits may be masked by IRS. Additional monitoring of malaria control programs that implement ITNs and IRS concurrently is encouraged to better understand how to maximize the benefits of both interventions, particularly in the context of increasing pyrethroid resistance.
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Affiliation(s)
- John E. Gimnig
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Peter Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Vincent Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Doris Marwanga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Daisy Abong’o
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ryan Wiegand
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Williamson
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adam Wolkon
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ying Zhou
- Eck Institute for Global Health, Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - M. Nabie Bayoh
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Neil F. Lobo
- Eck Institute for Global Health, Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Kayla Laserson
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Mary J. Hamel
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Gimnig JE, Walker ED, Otieno P, Kosgei J, Olang G, Ombok M, Williamson J, Marwanga D, Abong'o D, Desai M, Kariuki S, Hamel MJ, Lobo NF, Vulule J, Bayoh MN. Incidence of malaria among mosquito collectors conducting human landing catches in western Kenya. Am J Trop Med Hyg 2012; 88:301-8. [PMID: 23249685 DOI: 10.4269/ajtmh.2012.12-0209] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The human landing catch (HLC) has long been the gold standard for estimating malaria transmission by mosquitoes, but has come under scrutiny because of ethical concerns of exposing collectors to infectious bites. We estimated the incidence of Plasmodium falciparum malaria infection in a cohort of 152 persons conducting HLCs and compared it with that of 147 non-collectors in western Kenya. Participants were presumptively cleared of malaria with Coartem™ (artemether-lumefantrine) and tested for malaria every 2 weeks for 12 weeks. The HLC collections were conducted four nights per week for six weeks. Collectors were provided chemoprophylaxis with Malarone™ (atovaquone-proguanil) during the six weeks of HLC activities and one week after HLC activities were completed. The incidence of malaria was 96.6% lower in collectors than in non-collectors (hazard ratio = 0.034, P < 0.0001). Therefore, with proper prophylaxis, concern about increased risk of malaria among collectors should not be an impediment to conducting HLC studies.
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Affiliation(s)
- John E Gimnig
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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Hamel MJ, Otieno P, Bayoh N, Kariuki S, Were V, Marwanga D, Laserson KF, Williamson J, Slutsker L, Gimnig J. The combination of indoor residual spraying and insecticide-treated nets provides added protection against malaria compared with insecticide-treated nets alone. Am J Trop Med Hyg 2012; 85:1080-6. [PMID: 22144448 DOI: 10.4269/ajtmh.2011.10-0684] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Both insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS) reduce malaria in high malaria transmission areas. The combined effect of these interventions is unknown. We conducted a non-randomized prospective cohort study to determine protective efficacy of IRS with ITNs (ITN + IRS) compared with ITNs alone (ITN only) in preventing Plasmodium falciparum parasitemia. At baseline, participants provided blood samples for malaria smears, were presumptively treated for malaria, and received ITNs. Blood smears were made monthly and at sick visits. In total, 1,804 participants were enrolled. Incidence of P. falciparum parasitemia in the ITN + IRS and ITN only groups was 18 and 44 infections per 100 persons-years at risk, respectively (unadjusted rate ratio = 0.41; 95% confidence interval [CI] = 0.31-0.56). Adjusted protective efficacy of ITN + IRS compared with ITN only was 62% (95% CI = 0.50-0.72). The combination of IRS and ITN might be a feasible strategy to further reduce malaria transmission in areas of persistent perennial malaria transmission.
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Affiliation(s)
- Mary J Hamel
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia 30301, USA.
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