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Gachohi J, Njoki P, Mogoa E, Otieno F, Muturi M, Mwatondo A, Ngere I, Dawa J, Nasimiyu C, Osoro E, Bett B, Njenga K. Higher livestock abortion burden in arid and semi-arid lands, Kenya, 2019-2020. PLoS One 2024; 19:e0297274. [PMID: 38386647 PMCID: PMC10883554 DOI: 10.1371/journal.pone.0297274] [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: 06/06/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024] Open
Abstract
Tracking livestock abortion patterns over time and across factors such as species and agroecological zones (AEZs) could inform policies to mitigate disease emergence, zoonoses risk, and reproductive losses. We conducted a year-long population-based active surveillance of livestock abortion between 2019 and 2020, in administrative areas covering 52% of Kenya's landmass and home to 50% of Kenya's livestock. Surveillance sites were randomly selected to represent all AEZs in the country. Local animal health practitioners electronically transmitted weekly abortion reports from each ward, the smallest administrative unit, to a central server, using a simple short messaging service (SMS). Data were analyzed descriptively by administrative unit, species, and AEZ to reveal spatiotemporal patterns and relationships with rainfall and temperature. Of 23,766 abortions reported in all livestock species, sheep and goats contributed 77%, with goats alone contributing 53%. Seventy-seven per cent (n = 18,280) of these abortions occurred in arid and semi-arid lands (ASALs) that primarily practice pastoralism production systems. While spatiotemporal clustering of cases was observed in May-July 2019 in the ASALs, there was a substantial seasonal fluctuation across AEZs. Kenya experiences high livestock abortion rates, most of which go unreported. We recommend further research to document the national true burden of abortions. In ASALs, studies linking pathogen, climate, and environmental surveillance are needed to assign livestock abortions to infectious or non-infectious aetiologies and conducting human acute febrile illnesses surveillance to detect any links with the abortions.
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Affiliation(s)
- John Gachohi
- Department of Environmental Health and Disease Control, School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, Washington, United States of America
| | - Peris Njoki
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
| | - Eddy Mogoa
- Department of Clinical Studies, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Fredrick Otieno
- Animal and human health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Mathew Muturi
- Animal and human health Program, International Livestock Research Institute, Nairobi, Kenya
- Kenya Zoonotic Disease Unit, Nairobi, Kenya
- Dahlem Research School (DRS), Faculty of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Athman Mwatondo
- Animal and human health Program, International Livestock Research Institute, Nairobi, Kenya
- Kenya Zoonotic Disease Unit, Nairobi, Kenya
- Kenya One Health Platform, Ministry of Health, Nairobi, Kenya
| | - Isaac Ngere
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, Washington, United States of America
| | - Jeanette Dawa
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, Washington, United States of America
| | - Carolyne Nasimiyu
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, Washington, United States of America
| | - Eric Osoro
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, Washington, United States of America
| | - Bernard Bett
- Animal and human health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Kariuki Njenga
- Washington State University Global Health Program, Washington State University, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, Washington, United States of America
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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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Hunsperger E, Osoro E, Munyua P, Njenga MK, Mirieri H, Kikwai G, Odhiambo D, Dayan M, Omballa V, Agogo GO, Mugo C, Widdowson MA, Inwani I. Seroconversion and seroprevalence of TORCH infections in a pregnant women cohort study, Mombasa, Kenya, 2017-2019. Epidemiol Infect 2024; 152:e68. [PMID: 38305089 PMCID: PMC11077605 DOI: 10.1017/s0950268824000165] [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: 01/03/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Women infected during pregnancy with TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, and Herpes simplex viruses) pathogens have a higher risk of adverse birth outcomes including stillbirth / miscarriage because of mother-to-child transmission. To investigate these risks in pregnant women in Kenya, we analyzed serum specimens from a pregnancy cohort study at three healthcare facilities. A sample of 481 participants was selected for TORCH pathogen antibody testing to determine seroprevalence. A random selection of 285 from the 481 participants was selected to measure seroconversion. These sera were tested using an IgG enzyme-linked immunosorbent assay against 10 TORCH pathogens. We found that the seroprevalence of all but three of the 10 TORCH pathogens at enrollment was >30%, except for Bordetella pertussis (3.8%), Treponema pallidum (11.4%), and varicella zoster virus (0.5%). Conversely, very few participants seroconverted during their pregnancy and were herpes simplex virus type 2 (n = 24, 11.2%), parvovirus B19 (n = 14, 6.2%), and rubella (n = 12, 5.1%). For birth outcomes, 88% of the participant had live births and 12% had stillbirths or miscarriage. Cytomegalovirus positivity at enrolment had a statistically significant positive association with a live birth outcome (p = 0.0394). Of the 10 TORCH pathogens tested, none had an association with adverse pregnancy outcome.
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Affiliation(s)
- Elizabeth Hunsperger
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Peninah Munyua
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - M. Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Gilbert Kikwai
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Dennis Odhiambo
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Moshe Dayan
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Victor Omballa
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - George O. Agogo
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Cyrus Mugo
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Irene Inwani
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
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Gharpure R, Akumu AO, Dawa J, Gobin S, Adhikari BB, Lafond KE, Fischer LS, Mirieri H, Mwazighe H, Tabu C, Jalang'o R, Kamau P, Silali C, Kalani R, Oginga P, Jewa I, Njenga V, Ebama MS, Bresee JS, Njenga MK, Osoro E, Meltzer MI, Emukule GO. Costs of seasonal influenza vaccine delivery in a pediatric demonstration project for children aged 6-23 months - Nakuru and Mombasa Counties, Kenya, 2019-2021. Vaccine 2023:S0264-410X(23)01475-5. [PMID: 38154992 DOI: 10.1016/j.vaccine.2023.12.029] [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: 08/28/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND During November 2019-October 2021, a pediatric influenza vaccination demonstration project was conducted in four sub-counties in Kenya. The demonstration piloted two different delivery strategies: year-round vaccination and a four-month vaccination campaign. Our objective was to compare the costs of both delivery strategies. METHODS Cost data were collected using standardized questionnaires and extracted from government and project accounting records. We reported total costs and costs per vaccine dose administered by delivery strategy from the Kenyan government perspective in 2021 US$. Costs were separated into financial costs (monetary expenditures) and economic costs (financial costs plus the value of existing resources). We also separated costs by administrative level (national, regional, county, sub-county, and health facility) and program activity (advocacy and social mobilization; training; distribution, storage, and waste management; service delivery; monitoring; and supervision). RESULTS The total estimated cost of the pediatric influenza demonstration project was US$ 225,269 (financial) and US$ 326,691 (economic) for the year-round delivery strategy (30,397 vaccine doses administered), compared with US$ 214,753 (financial) and US$ 242,385 (economic) for the campaign strategy (25,404 doses administered). Vaccine purchase represented the largest proportion of costs for both strategies. Excluding vaccine purchase, the cost per dose administered was US$ 1.58 (financial) and US$ 5.84 (economic) for the year-round strategy and US$ 2.89 (financial) and US$ 4.56 (economic) for the campaign strategy. CONCLUSIONS The financial cost per dose was 83% higher for the campaign strategy than the year-round strategy due to larger expenditures for advocacy and social mobilization, training, and hiring of surge staff for service delivery. However, the economic cost per dose was more comparable for both strategies (year-round 22% higher than campaign), balanced by higher costs of operating equipment and monitoring activities for the year-round strategy. These delivery cost data provide real-world evidence to inform pediatric influenza vaccine introduction in Kenya.
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Affiliation(s)
- Radhika Gharpure
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Angela Oloo Akumu
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Stacie Gobin
- Gobin Global, LLC, Asheville, NC, USA; Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | | | - Kathryn E Lafond
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leah S Fischer
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Henry Mwazighe
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Collins Tabu
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Rose Jalang'o
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Peter Kamau
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Catherine Silali
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Rosalia Kalani
- Division of Disease Surveillance and Response, Ministry of Health, Kenya
| | | | - Isaac Jewa
- Department of Health, Mombasa County, Kenya
| | | | - Malembe S Ebama
- Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | - Joseph S 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
| | - Martin I Meltzer
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gideon O Emukule
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
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Mirieri H, Nasimiyu C, Dawa J, Mburu C, Jalang'o R, Kamau P, Igboh L, Ebama M, Wainaina D, Gitonga J, Karanja J, Njenga E, Kariuki J, Machani J, Oginga P, Baraka I, Wamaru P, Muhula S, Ratemo P, Ayugi J, Kariuki Njenga M, Emukule GO, Osoro E, Otieno NA. Resilience of routine childhood immunization services in two counties in Kenya in the face of the COVID-19 pandemic. Vaccine 2023; 41:7695-7704. [PMID: 38008664 DOI: 10.1016/j.vaccine.2023.09.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 11/28/2023]
Abstract
The recently emerged coronavirus disease 2019 (COVID-19) has caused considerable morbidity and mortality worldwide and disrupted health services. We describe the effect of the COVID-19 pandemic on utilization of childhood vaccination services during the pandemic. Using a mixed methods approach combining retrospective data review, a cross-sectional survey, focus group discussions among care givers and key informant interviews among nurses, we collected data between May and September 2021 in Mombasa and Nakuru counties. Overall, there was a <2 % decline in the number of vaccine doses administered during the pandemic period compared to the pre-pandemic period but this was statistically insignificant, both for the pentavalent-1 vaccine (ß = -0.013, p = 0.505) and the pentavalent-3 vaccine (ß = -0.012, p = 0.440). In government health facilities, there was 7.7 % reduction in the number of pentavalent-1 (ß = -0.08, p = 0.010) and 10.4 % reduction in the number of pentavalent-3 (ß = -0.11, p < 0.001) vaccine doses that were administered during the pandemic period. In non-government facilities, there was a 25.8 % increase in the number of pentavalent-1 (ß=0.23, p < 0.001) and 31.0 % increase in the number of pentavalent-3 (ß = -0.27, p < 0.001) vaccine doses that were administered facilities during the pandemic period. The strategies implemented to maintain immunization services during the pandemic period included providing messaging on the availability and importance of staying current with routine vaccination and conducting catch-up vaccinations and vaccination outreaches. Our findings suggest that the COVID-19 pandemic did not impact childhood vaccination services in Mombasa and Nakuru counties in Kenya. The private health facilities cushioned vaccination services against the effects of the pandemic and the strategies that were put in place by the ministry of health ensured continuation of vaccination services and encouraged uptake of the services during the pandemic period in the two counties in Kenya. These findings provide useful information to safeguard vaccination services during future pandemics.
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Affiliation(s)
- Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya.
| | - Carolyne Nasimiyu
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Caroline Mburu
- Department of Social Anthropology, University of St Andrews, Fife, Scotland, UK
| | - Rose Jalang'o
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Peter Kamau
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Ledor Igboh
- Global Immunization Division, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jorim Ayugi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, 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
| | - Gideon O Emukule
- Influenza Division, US Centers for Disease Control and Prevention, 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
| | - Nancy A Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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Ndegwa L, Ngere P, Makayotto L, Patel NN, Nzisa L, Otieno N, Osoro E, Oreri E, Kiptoo E, Maigua S, Crawley A, Clara AW, Arunmozhi Balajee S, Munyua P, Herman-Roloff A. Kenya's experience implementing event-based surveillance during the COVID-19 pandemic. BMJ Glob Health 2023; 8:e013736. [PMID: 38114236 DOI: 10.1136/bmjgh-2023-013736] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/12/2023] [Indexed: 12/21/2023] Open
Abstract
Event-based surveillance (EBS) can be implemented in most settings for the detection of potential health threats by recognition and immediate reporting of predefined signals. Such a system complements existing case-based and sentinel surveillance systems. With the emergence of the COVID-19 pandemic in early 2020, the Kenya Ministry of Health (MOH) modified and expanded an EBS system in both community and health facility settings for the reporting of COVID-19-related signals. Using an electronic reporting tool, m-Dharura, MOH recorded 8790 signals reported, with 3002 (34.2%) verified as events, across both community and health facility sites from March 2020 to June 2021. A subsequent evaluation found that the EBS system was flexible enough to incorporate the addition of COVID-19-related signals during a pandemic and maintain high rates of reporting from participants. Inadequate resources for follow-up investigations to reported events, lack of supportive supervision for some community health volunteers and lack of data system interoperability were identified as challenges to be addressed as the EBS system in Kenya continues to expand to additional jurisdictions.
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Affiliation(s)
- Linus Ndegwa
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Philip Ngere
- Global Health Program, Washington State University, Nairobi, Kenya
- Division of Disease Surveillance and Response, Kenya Ministry of Health, Nairobi, Kenya
| | - Lyndah Makayotto
- Division of Disease Surveillance and Response, Kenya Ministry of Health, Nairobi, Kenya
| | - Neha N Patel
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Liku Nzisa
- Global Health Program, Washington State University, Nairobi, Kenya
| | - Nancy Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eric Osoro
- Global Health Program, Washington State University, Nairobi, Kenya
| | - Eunice Oreri
- Department of Health, County Government of Siaya, Siaya, Kenya
| | - Elizabeth Kiptoo
- Department of Health, County Government of Nakuru, Nakuru, Kenya
| | - Susan Maigua
- Medic Mobile Inc, San Francisco, California, USA
| | - Adam Crawley
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexey W Clara
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Arunmozhi Balajee
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peninah Munyua
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Amy Herman-Roloff
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
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7
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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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Kyobe Bosa H, Njenga MK, Wayengera M, Kirenga B, Muttamba W, Dawa J, Breiman RF, Osoro E, Ngere I, Omaswa F, Okware S, Kabanda R, Mwebesa H, Atwine D, Woldemariam YT, Aceng JR. Leveraging the structures of the COVID-19 pandemic response for successful control of Ebola in Uganda. Nat Med 2023; 29:1892-1893. [PMID: 37353647 DOI: 10.1038/s41591-023-02395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Affiliation(s)
- Henry Kyobe Bosa
- Uganda Ministry of Health, Kampala, Uganda.
- Makerere University Lung Institute, Kampala, Uganda.
- Kellogg College, University of Oxford, Oxford, UK.
| | - M Kariuki Njenga
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
- Washington State University Global Health Program, Nairobi, Kenya
| | - Misaki Wayengera
- Makerere University Lung Institute, Kampala, Uganda
- Departments of Pathology, Immunology & Molecular Biology, Makerere University, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Winters Muttamba
- Makerere University Lung Institute, Kampala, Uganda
- Division of Infection and Global Health, University of St Andrews, St Andrews, UK
| | - Jeanette Dawa
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
- Washington State University Global Health Program, Nairobi, Kenya
| | - Robert F Breiman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eric Osoro
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
- Washington State University Global Health Program, Nairobi, Kenya
| | - Isaac Ngere
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
- Washington State University Global Health Program, Nairobi, Kenya
| | - Francis Omaswa
- Africa Centre for Global Health and Social Transformation, Kampala, Uganda
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9
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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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10
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Emukule GO, Osoro E, Nyawanda BO, Ngere I, Macharia D, Bigogo G, Otieno NA, Chaves SS, Njenga MK, Widdowson MA. Healthcare-seeking behavior for respiratory illnesses in Kenya: implications for burden of disease estimation. BMC Public Health 2023; 23:353. [PMID: 36797727 PMCID: PMC9936639 DOI: 10.1186/s12889-023-15252-3] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Understanding healthcare-seeking patterns for respiratory illness can help improve estimation of disease burden and target public health interventions to control acute respiratory disease in Kenya. METHODS We conducted a cross-sectional survey to determine healthcare utilization patterns for acute respiratory illness (ARI) and severe pneumonia in four diverse counties representing urban, peri-urban, rural mixed farmers, and rural pastoralist communities in Kenya using a two-stage (sub-locations then households) cluster sampling procedure. Healthcare seeking behavior for ARI episodes in the last 14 days, and severe pneumonia in the last 12 months was evaluated. Severe pneumonia was defined as reported cough and difficulty breathing for > 2 days and report of hospitalization or recommendation for hospitalization, or a danger sign (unable to breastfeed/drink, vomiting everything, convulsions, unconscious) for children < 5 years, or report of inability to perform routine chores. RESULTS From August through September 2018, we interviewed 28,072 individuals from 5,407 households. Of those surveyed, 9.2% (95% Confidence Interval [CI] 7.9-10.7) reported an episode of ARI, and 4.2% (95% CI 3.8-4.6) reported an episode of severe pneumonia. Of the reported ARI cases, 40.0% (95% CI 36.8-43.3) sought care at a health facility. Of the74.2% (95% CI 70.2-77.9) who reported severe pneumonia and visited a medical health facility, 28.9% (95% CI 25.6-32.6) were hospitalized and 7.0% (95% CI 5.4-9.1) were referred by a clinician to the hospital but not hospitalized. 21% (95% CI 18.2-23.6) of self-reported severe pneumonias were hospitalized. Children aged < 5 years and persons in households with a higher socio-economic status were more likely to seek care for respiratory illness at a health facility. CONCLUSION Our findings suggest that hospital-based surveillance captures less than one quarter of severe pneumonia in the community. Multipliers from community household surveys can account for underutilization of healthcare resources and under-ascertainment of severe pneumonia at hospitals.
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Affiliation(s)
- Gideon O Emukule
- US Centers for Disease Control and Prevention - Kenya Country Office, KEMRI Headquarters, Mbagathi Rd, Off Mbagathi Way, Village Market, P.O Box 606, Nairobi, 00621, Kenya.
| | - Eric Osoro
- Washington State University Global Health, Nairobi, Kenya
| | | | - Isaac Ngere
- Washington State University Global Health, Nairobi, Kenya
| | - Daniel Macharia
- US Centers for Disease Control and Prevention - Kenya Country Office, KEMRI Headquarters, Mbagathi Rd, Off Mbagathi Way, Village Market, P.O Box 606, Nairobi, 00621, Kenya
| | | | | | - Sandra S Chaves
- US Centers for Disease Control and Prevention - Kenya Country Office, KEMRI Headquarters, Mbagathi Rd, Off Mbagathi Way, Village Market, P.O Box 606, Nairobi, 00621, Kenya
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Marc-Alain Widdowson
- US Centers for Disease Control and Prevention - Kenya Country Office, KEMRI Headquarters, Mbagathi Rd, Off Mbagathi Way, Village Market, P.O Box 606, Nairobi, 00621, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
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11
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Waringa NMA, Waiboci LW, Bebora L, Kinyanjui PW, Kosgei P, Kiambi S, Osoro E. Human brucellosis in Baringo County, Kenya: Evaluating the diagnostic kits used and identifying infecting Brucella species. PLoS One 2023; 18:e0269831. [PMID: 36719875 PMCID: PMC9888686 DOI: 10.1371/journal.pone.0269831] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Human brucellosis diagnosis has been a challenge in Brucella-endemic areas. In Kenya, diagnosis is usually carried out using Febrile Brucella Antigen agglutination test (FBAT) whose performance is not well documented. This paper reports on the sensitivity and specificity of the FBAT used for brucellosis diagnosis on blood samples/serum collected in three healthcare facilities in Baringo County, Kenya, and on Brucella species present in the study area. The FBAT test results at the hospitals were used to guide patient management. Patients who visited the hospital's laboratory with a clinician's request for brucellosis testing also filled a questionnaire to assess knowledge and attitudes associated with transmission of the disease in the study area. The remaining serum samples were tested again using FBAT and Rose Bengal Plate Test (RBPT) within a month of blood collection at the University Nairobi Laboratory. The two rapid tests were then compared, with respect to brucellosis diagnostic sensitivity and specificity. To identify infecting Brucella species, a proportion 43% (71/166) of the blood clots were analyzed by multiplex polymerase chain reaction (PCR) using specific primers for B. abortus, B. melitensis, B. ovis and B. suis. Out of 166 serum samples tested, 26.5% (44/166) were positive using FBAT and 10.2% (17/166) positive using RBPT. The sensitivity and specificity of FBAT compared to RBPT was 76.47% and 71.19%, respectively while the positive and negative predictive values were 29.55% and 96.72%, respectively. The FBAT showed higher positivity then RBPT. The difference in sensitivity and specificity of FBAT and RBPTs was relatively low. The high FBAT positivity rate would be indication of misdiagnosis; this would lead to incorrect treatment. Brucella abortus was detected from 9.9% (7/71) of the blood clots tested; no other Brucella species were detected. Thus human brucellosis, in Baringo was mainly caused by B. abortus.
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Affiliation(s)
| | | | - Lilly Bebora
- Department of Veterinary Pathology, Microbiology and Parasitology, University of Nairobi, Nairobi, Kenya
| | | | - Philemon Kosgei
- Department of Veterinary Pathology, Microbiology and Parasitology, University of Nairobi, Nairobi, Kenya
| | - Stella Kiambi
- Department of Livestock and Fisheries, Ministry of Agriculture, Nairobi, Kenya
| | - Eric Osoro
- Ministry of Health, Zoonotic Diseases Unit, Nairobi, Kenya
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12
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Ngere P, Onsongo J, Langat D, Nzioka E, Mudachi F, Kadivane S, Chege B, Kirui E, Were I, Mutiso S, Kibisu A, Ihahi J, Mutethya G, Mochache T, Lokamar P, Boru W, Makayotto L, Okunga E, Ganda N, Haji A, Gathenji C, Kariuki W, Osoro E, Kasera K, Kuria F, Aman R, Nabyonga J, Amoth P. Characterization of COVID-19 cases in the early phase (March to July 2020) of the pandemic in Kenya. J Glob Health 2022; 12:15001. [PMID: 36583253 PMCID: PMC9801068 DOI: 10.7189/jogh.12.15001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Kenya detected the first case of COVID-19 on March 13, 2020, and as of July 30, 2020, 17 975 cases with 285 deaths (case fatality rate (CFR) = 1.6%) had been reported. This study described the cases during the early phase of the pandemic to provide information for monitoring and response planning in the local context. Methods We reviewed COVID-19 case records from isolation centres while considering national representation and the WHO sampling guideline for clinical characterization of the COVID-19 pandemic within a country. Socio-demographic, clinical, and exposure data were summarized using median and mean for continuous variables and proportions for categorical variables. We assigned exposure variables to socio-demographics, exposure, and contact data, while the clinical spectrum was assigned outcome variables and their associations were assessed. Results A total of 2796 case records were reviewed including 2049 (73.3%) male, 852 (30.5%) aged 30-39 years, 2730 (97.6%) Kenyans, 636 (22.7%) transporters, and 743 (26.6%) residents of Nairobi City County. Up to 609 (21.8%) cases had underlying medical conditions, including hypertension (n = 285 (46.8%)), diabetes (n = 211 (34.6%)), and multiple conditions (n = 129 (21.2%)). Out of 1893 (67.7%) cases with likely sources of exposure, 601 (31.8%) were due to international travel. There were 2340 contacts listed for 577 (20.6%) cases, with 632 contacts (27.0%) being traced. The odds of developing COVID-19 symptoms were higher among case who were aged above 60 years (odds ratio (OR) = 1.99, P = 0.007) or had underlying conditions (OR = 2.73, P < 0.001) and lower among transport sector employees (OR = 0.31, P < 0.001). The odds of developing severe COVID-19 disease were higher among cases who had underlying medical conditions (OR = 1.56, P < 0.001) and lower among cases exposed through community gatherings (OR = 0.27, P < 0.001). The odds of survival of cases from COVID-19 disease were higher among transport sector employees (OR = 3.35, P = 0.004); but lower among cases who were aged ≥60 years (OR = 0.58, P = 0.034) and those with underlying conditions (OR = 0.58, P = 0.025). Conclusion The early phase of the COVID-19 pandemic demonstrated a need to target the elderly and comorbid cases with prevention and control strategies while closely monitoring asymptomatic cases.
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Affiliation(s)
- Philip Ngere
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya,Washington State University, Global Health, Kenya
| | | | - Daniel Langat
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya
| | - Elizabeth Nzioka
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Faith Mudachi
- Department of Promotive and Preventive Health, Ministry of Health, Kenya
| | - Samuel Kadivane
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya
| | - Bernard Chege
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Elvis Kirui
- National Public Health Laboratory Services, Ministry of Health, Kenya
| | - Ian Were
- Office of the Director General, Ministry of Health, Kenya
| | - Stephen Mutiso
- Department of Promotive and Preventive Health, Ministry of Health, Kenya
| | - Amos Kibisu
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Josephine Ihahi
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Gladys Mutethya
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | | | - Peter Lokamar
- National Public Health Laboratory Services, Ministry of Health, Kenya
| | - Waqo Boru
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Lyndah Makayotto
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya
| | - Emmanuel Okunga
- Department of Disease Surveillance and Epidemic Response, Ministry of Health, Kenya
| | | | - Adam Haji
- World Health Organization, Nairobi Kenya
| | | | | | - Eric Osoro
- Washington State University, Global Health, Kenya
| | - Kadondi Kasera
- Public Health Emergency Operation Centre, Ministry of Health, Kenya
| | - Francis Kuria
- Directorate of Public Health, Ministry of Health, Kenya
| | - Rashid Aman
- Cabinet Administrative Secretary, Ministry of Health, Kenya
| | | | - Patrick Amoth
- Office of the Director General, Ministry of Health, Kenya
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13
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Nasimiyu C, Ngere I, Dawa J, Amoth P, Oluga O, Ngunu C, Mirieri H, Gachohi J, Dayan M, Liku N, Njoroge R, Odinoh R, Owaka S, Khamadi SA, Konongoi SL, Galo S, Elamenya L, Mureithi M, Anzala O, Breiman R, Osoro E, Njenga MK. Near-Complete SARS-CoV-2 Seroprevalence among Rural and Urban Kenyans despite Significant Vaccine Hesitancy and Refusal. Vaccines (Basel) 2022; 11:68. [PMID: 36679913 PMCID: PMC9862465 DOI: 10.3390/vaccines11010068] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Considering the early inequity in global COVID-19 vaccine distribution, we compared the level of population immunity to SARS-CoV-2 with vaccine uptake and refusal between rural and urban Kenya two years after the pandemic onset. A population-based seroprevalence study was conducted in the city of Nairobi (n = 781) and a rural western county (n = 810) between January and February 2022. The overall SARS-CoV-2 seroprevalence was 90.2% (95% CI, 88.6−91.2%), including 96.7% (95% CI, 95.2−97.9%) among urban and 83.6% (95% CI, 80.6−86.0%) among rural populations. A comparison of immunity profiles showed that >50% of the rural population were strongly immunoreactive compared to <20% of the urban population, suggesting more recent infections or vaccinations in the rural population. More than 45% of the vaccine-eligible (≥18 years old) persons had not taken a single dose of the vaccine (hesitancy), including 47.6% and 46.9% of urban and rural participants, respectively. Vaccine refusal was reported in 19.6% of urban and 15.6% of rural participants, attributed to concern about vaccine safety (>75%), inadequate information (26%), and concern about vaccine effectiveness (9%). Less than 2% of vaccine refusers cited religious or cultural beliefs. These findings indicate that despite vaccine inequity, hesitancy, and refusal, herd immunity had been achieved in Kenya and likely other African countries by early 2022, with natural infections likely contributing to most of this immunity. However, vaccine campaigns should be sustained due to the need for repeat boosters associated with waning of SARS-CoV-2 immunity and emergence of immune-evading virus variants.
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Affiliation(s)
- Carolyne Nasimiyu
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi 00202, Kenya
| | - Isaac Ngere
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Jeanette Dawa
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Patrick Amoth
- Directorate of Public Health, Kenya Ministry of Health, Nairobi 00100, Kenya
| | - Ouma Oluga
- Directorate of Health, Nairobi Metropolitan Services, Nairobi 00100, Kenya
| | - Carol Ngunu
- Directorate of Health, Nairobi Metropolitan Services, Nairobi 00100, Kenya
| | - Harriet Mirieri
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - John Gachohi
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi P.O. Box 62000-00200, Kenya
| | - Moshe Dayan
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Nzisa Liku
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Ruth Njoroge
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Raymond Odinoh
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Samuel Owaka
- Center for Virus Research, Kenya Medical Research Institute, Nairobi 00200, Kenya
| | - Samoel A. Khamadi
- Center for Virus Research, Kenya Medical Research Institute, Nairobi 00200, Kenya
| | - Samson L. Konongoi
- Center for Virus Research, Kenya Medical Research Institute, Nairobi 00200, Kenya
| | - Sudi Galo
- Department of Health Services, County Government of Kakamega, Kakamega 50100, Kenya
| | - Linet Elamenya
- Department of Health Services, County Government of Kakamega, Kakamega 50100, Kenya
| | - Marianne Mureithi
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi 00202, Kenya
| | - Omu Anzala
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi 00202, Kenya
| | - Robert Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Eric Osoro
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - M. Kariuki Njenga
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
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14
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Gachohi J, Bett B, Otieno F, Mogoa E, Njoki P, Muturi M, Mwatondo A, Osoro E, Ngere I, Dawa J, Nasimiyu C, Oyas H, Njagi O, Canfield S, Blackburn J, Njenga K. Anthrax hotspot mapping in Kenya support establishing a sustainable two-phase elimination program targeting less than 6% of the country landmass. Sci Rep 2022; 12:21670. [PMID: 36522381 PMCID: PMC9755300 DOI: 10.1038/s41598-022-24000-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
Using data collected from previous (n = 86) and prospective (n = 132) anthrax outbreaks, we enhanced prior ecological niche models (ENM) and added kernel density estimation (KDE) approaches to identify anthrax hotspots in Kenya. Local indicators of spatial autocorrelation (LISA) identified clusters of administrative wards with a relatively high or low anthrax reporting rate to determine areas of greatest outbreak intensity. Subsequently, we modeled the impact of vaccinating livestock in the identified hotspots as a national control measure. Anthrax suitable areas included high agriculture zones concentrated in the western, southwestern and central highland regions, consisting of 1043 of 1450 administrative wards, covering 18.5% country landmass, and hosting 30% of the approximately 13 million cattle population in the country. Of these, 79 wards covering 5.5% landmass and hosting 9% of the cattle population fell in identified anthrax hotspots. The rest of the 407 administrative wards covering 81.5% of the country landmass, were classified as low anthrax risk areas and consisted of the expansive low agricultural arid and semi-arid regions of the country that hosted 70% of the cattle population, reared under the nomadic pastoralism. Modelling targeted annual vaccination of 90% cattle population in hotspot administrative wards reduced > 23,000 human exposures. These findings support an economically viable first phase of anthrax control program in low-income countries where the disease is endemic, that is focused on enhanced animal and human surveillance in burden hotspots, followed by rapid response to outbreaks anchored on public education, detection and treatment of infected humans, and ring vaccination of livestock. Subsequently, the global anthrax elimination program focused on sustained vaccination and surveillance in livestock in the remaining few hotspots for a prolonged period (> 10 years) may be implemented.
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Affiliation(s)
- John Gachohi
- grid.411943.a0000 0000 9146 7108School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya ,Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Bernard Bett
- grid.419369.00000 0000 9378 4481International Livestock Research Institute, Nairobi, Kenya
| | - Fredrick Otieno
- grid.419369.00000 0000 9378 4481International Livestock Research Institute, Nairobi, Kenya
| | - Eddy Mogoa
- grid.10604.330000 0001 2019 0495Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Peris Njoki
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya
| | - Mathew Muturi
- grid.419369.00000 0000 9378 4481International Livestock Research Institute, Nairobi, Kenya ,Kenya Zoonotic Disease Unit, Nairobi, Kenya ,grid.463427.0Kenya Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Athman Mwatondo
- grid.419369.00000 0000 9378 4481International Livestock Research Institute, Nairobi, Kenya ,Kenya Zoonotic Disease Unit, Nairobi, Kenya ,grid.415727.2Ministry of Health, Nairobi, Kenya
| | - Eric Osoro
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Isaac Ngere
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Jeanette Dawa
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Carolyne Nasimiyu
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Harry Oyas
- grid.463427.0Kenya Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Obadiah Njagi
- grid.463427.0Kenya Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Samuel Canfield
- grid.15276.370000 0004 1936 8091Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL 32611 USA
| | - Jason Blackburn
- grid.15276.370000 0004 1936 8091Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL 32611 USA ,grid.15276.370000 0004 1936 8091Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL 32611 USA
| | - Kariuki Njenga
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
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15
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Osoro E, Inwani I, Mugo C, Hunsperger E, Verani JR, Omballa V, Wamalwa D, Rhee C, Nduati R, Kinuthia J, Jin H, Okutoyi L, Mwaengo D, Maugo B, Otieno NA, Mirieri H, Shabibi M, Munyua P, Njenga MK, Widdowson MA. Prevalence of microcephaly and Zika virus infection in a pregnancy cohort in Kenya, 2017-2019. BMC Med 2022; 20:291. [PMID: 36100910 PMCID: PMC9470235 DOI: 10.1186/s12916-022-02498-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV), first discovered in Uganda in 1947, re-emerged globally in 2013 and was later associated with microcephaly and other birth defects. We determined the incidence of ZIKV infection and its association with adverse pregnancy and fetal outcomes in a pregnancy cohort in Kenya. METHODS From October 2017 to July 2019, we recruited and followed up women aged ≥ 15 years and ≤ 28 weeks pregnant in three hospitals in coastal Mombasa. Monthly follow-up included risk factor questions and a blood sample collected for ZIKV serology. We collected anthropometric measures (including head circumference), cord blood, venous blood from newborns, and any evidence of birth defects. Microcephaly was defined as a head circumference (HC) < 2 standard deviations (SD) for sex and gestational age. Severe microcephaly was defined as HC < 3 SD for sex and age. We tested sera for anti-ZIKV IgM antibodies using capture enzyme-linked immunosorbent assay (ELISA) and confirmed positives using the plaque reduction neutralization test (PRNT90) for ZIKV and for dengue (DENV) on the samples that were ZIKV neutralizing antibody positive. We collected blood and urine from participants reporting fever or rash for ZIKV testing. RESULTS Of 2889 pregnant women screened for eligibility, 2312 (80%) were enrolled. Of 1916 recorded deliveries, 1816 (94.6%) were live births and 100 (5.2%) were either stillbirths or spontaneous abortions (< 22 weeks of gestation). Among 1236 newborns with complete anthropometric measures, 11 (0.9%) had microcephaly and 3 (0.2%) had severe microcephaly. A total of 166 (7.2%) participants were positive for anti-ZIKV IgM, 136 of whom became seropositive during follow-up. Among the 166 anti-ZIKV IgM positive, 3 and 18 participants were further seropositive for ZIKV and DENV neutralizing antibodies, respectively. Of these 3 and 18 pregnant women, one and 13 (72.2%) seroconverted with antibodies to ZIKV and DENV, respectively. All 308 samples (serum and urine samples collected during sick visits and samples that were anti-ZIKV IgM positive) tested by RT-PCR were negative for ZIKV. No adverse pregnancy or neonatal outcomes were reported among the three participants with confirmed ZIKV exposure. Among newborns from pregnant women with DENV exposure, four (22.2%) were small for gestational age and one (5.6%) had microcephaly. CONCLUSIONS The prevalence of severe microcephaly among newborns in coastal Kenya was high relative to published estimates from facility-based studies in Europe and Latin America, but little evidence of ZIKV transmission. There is a need for improved surveillance for microcephaly and other congenital malformations in Kenya.
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Affiliation(s)
- Eric Osoro
- Washington State University Global Health Kenya, One Padmore Place, George Padmore Road, Off Ngong Road, Nairobi, Kenya. .,Paul G. Allen School of Global Health, Washington State University, Pullman, USA.
| | - Irene Inwani
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Cyrus Mugo
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Elizabeth Hunsperger
- Division of Global Health Protection, Centers for Disease Control and Prevention, CDC Kenya, Nairobi, Kenya
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, CDC Kenya, Nairobi, Kenya
| | - Victor Omballa
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Chulwoo Rhee
- Division of Global Health Protection, CentersforDiseaseControlandPrevention, Atlanta, USA
| | - Ruth Nduati
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Research and Programs Department, Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya
| | - Hafsa Jin
- Coast General Hospital, Mombasa, Kenya
| | - Lydia Okutoyi
- Department of Obstetrics and Gynecology/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Dufton Mwaengo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Brian Maugo
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Nancy A Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Harriet Mirieri
- Washington State University Global Health Kenya, One Padmore Place, George Padmore Road, Off Ngong Road, Nairobi, Kenya
| | | | - Peninah Munyua
- Division of Global Health Protection, Centers for Disease Control and Prevention, CDC Kenya, Nairobi, Kenya
| | - M Kariuki Njenga
- Washington State University Global Health Kenya, One Padmore Place, George Padmore Road, Off Ngong Road, Nairobi, Kenya.,Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, CDC Kenya, Nairobi, Kenya.,Institute of Tropical Medicine, Antwerp, Belgium
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16
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Mugo C, Nduati R, Osoro E, Nyawanda BO, Mirieri H, Hunsperger E, Verani JR, Jin H, Mwaengo D, Maugo B, Machoki J, Otieno NA, Ombok C, Shabibi M, Okutoyi L, Kinuthia J, Widdowson MA, Njenga K, Inwani I, Wamalwa D. Comparable Pregnancy Outcomes for HIV-Uninfected and HIV-Infected Women on Antiretroviral Treatment in Kenya. J Infect Dis 2022; 226:678-686. [PMID: 35403695 PMCID: PMC10155227 DOI: 10.1093/infdis/jiac128] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/28/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of human immunodeficiency virus (HIV) on pregnancy outcomes for women on antiretroviral therapy (ART) in sub-Saharan Africa remains unclear. METHODS Pregnant women in Kenya were enrolled in the second trimester and followed up to delivery. We estimated effects of treated HIV with 3 pregnancy outcomes: loss, premature birth, and low birth weight and factors associated with HIV-positive status. RESULTS Of 2113 participants, 311 (15%) were HIV infected and on ART. Ninety-one of 1762 (5%) experienced a pregnancy loss, 169/1725 (10%) a premature birth (<37 weeks), and 74/1317 (6%) had a low-birth-weight newborn (<2500 g). There was no evidence of associations between treated HIV infection and pregnancy loss (adjusted relative risk [aRR], 1.19; 95% confidence interval [CI], .65-2.16; P = .57), prematurity (aRR, 1.09; 95% CI, .70-1.70; P = .69), and low birth weight (aRR, 1.36; 95% CI, .77-2.40; P = .27). Factors associated with an HIV-positive status included older age, food insecurity, lower education level, higher parity, lower gestation at first antenatal clinic, anemia, and syphilis. Women who were overweight or underweight were less likely to be HIV infected compared to those with normal weight. CONCLUSIONS Currently treated HIV was not significantly associated with adverse pregnancy outcomes. HIV-infected women, however, had a higher prevalence of other factors associated with adverse pregnancy outcomes.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Ruth Nduati
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Eric Osoro
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | | | - Harriet Mirieri
- Washington State University Global Health Kenya, Nairobi, Kenya
| | | | - Jennifer R Verani
- CDC-Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Hafsa Jin
- Coast Referral and Teaching Hospital, Mombasa, Kenya
| | - Dufton Mwaengo
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Brian Maugo
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - James Machoki
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | | | - Cynthia Ombok
- Washington State University Global Health Kenya, Nairobi, Kenya
| | | | - Lydia Okutoyi
- Department of Health Care Quality, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Marc Alain Widdowson
- CDC-Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Kariuki Njenga
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | - Irene Inwani
- Department of Pediatrics, Kenyatta National Hospital, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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17
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Omulo S, Oluka M, Achieng L, Osoro E, Kinuthia R, Guantai A, Opanga SA, Ongayo M, Ndegwa L, Verani JR, Wesangula E, Nyakiba J, Makori J, Sugut W, Kwobah C, Osuka H, Njenga MK, Call DR, Palmer GH, VanderEnde D, Luvsansharav UO. Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya. PLoS One 2022; 17:e0270048. [PMID: 35709220 PMCID: PMC9202938 DOI: 10.1371/journal.pone.0270048] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children <5 years (70%, 150/224) than among other age groups (40%, 339/847; P < 0.001). Critical care (82%, 14/17 patients) and pediatric wards (59%, 155/265) had the highest proportion of antibiotic users. Amoxicillin/clavulanate was the most frequently used antibiotic at KNH (17%, 64/383 antibiotic doses), and ceftriaxone was most used at CPGH (29%, 55/189) and MTRH (31%, 57/184). Forty-three percent (326/756) of all antibiotic prescriptions had at least one missed dose recorded. Forty-six percent (204/489) of patients on antibiotics had a specific infectious disease diagnosis, of which 18% (37/204) had soft-tissue infections, 17% (35/204) had clinical sepsis, 15% (31/204) had pneumonia, 13% (27/204) had central nervous system infections and 10% (20/204) had obstetric or gynecological infections. Of these, 27% (56/204) had bacterial culture tests ordered, with culture results available for 68% (38/56) of tests. Missed antibiotic doses, low use of specimen cultures to guide therapy, high rates of antibiotic use, particularly in the pediatric and surgical population, and preference for broad-spectrum antibiotics suggest antibiotic use in these tertiary care hospitals is not optimal. Antimicrobial stewardship programs, policies, and guidelines should be tailored to address these areas.
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Affiliation(s)
- Sylvia Omulo
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Loice Achieng
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Eric Osoro
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | | | - Anastasia Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia Adisa Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Linus Ndegwa
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jennifer R Verani
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Eveline Wesangula
- Patient and Health Workers Safety Unit, Ministry of Health, Nairobi, Kenya
| | - Jarred Nyakiba
- Patient and Health Workers Safety Unit, Ministry of Health, Nairobi, Kenya
| | - Jones Makori
- Coast Provincial General Hospital, Mombasa, Kenya
| | - Wilson Sugut
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Charles Kwobah
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Hanako Osuka
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - M Kariuki Njenga
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Douglas R Call
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Daniel VanderEnde
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Ulzii-Orshikh Luvsansharav
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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18
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Munywoki PK, Nasimiyu C, Alando MD, Otieno N, Ombok C, Njoroge R, Kikwai G, Odhiambo, D, Osita MP, Ouma A, Odour C, Juma B, Ochieng CA, Mutisya I, Ngere I, Dawa J, Osoro E, Njenga MK, Bigogo G, Munyua P, Lo TQ, Hunsperger E, Herman-Roloff A. Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020. F1000Res 2022; 10:853. [PMID: 35528961 PMCID: PMC9065925 DOI: 10.12688/f1000research.72914.2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomic challenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection. Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27
th November and 5
th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity. Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 – 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 – 21.3%) among children (<5 years), 32.7% (95% CI, 22.9 – 44.4%) among children 5 – 9 years, 41.8% (95% CI, 33.0 – 51.1%) for those 10-19 years, and 54.9%(46.2 – 63.3%) for adults (≥20 years). Relative to those from medium-sized households (3 and 4 individuals), participants from large (≥5 persons) households had significantly increased odds of being seropositive, aOR, 1.98(95% CI, 1.17 – 1.58), while those from small-sized households (≤2 individuals) had increased odds but not statistically significant, aOR, 2.31 (95% CI, 0.93 – 5.74). Conclusion: In densely populated urban settings, close to half of the individuals had an infection to SARS-CoV-2 after eight months of the COVID-19 pandemic in Kenya. This highlights the importance to prioritize mitigation measures, including COVID-19 vaccine distribution, in the crowded, low socioeconomic settings.
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Affiliation(s)
- Patrick K Munywoki
- Center for Global Health, Division of Public Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, USA
| | - Caroline Nasimiyu
- Global Health Kenya, Washington State University, Nairobi, USA
- Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | - Moshe Dayan Alando
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Nancy Otieno
- Centre for Global Health Research,, Kenya Medical Research Institute, Kisumu, Kenya
| | - Cynthia Ombok
- Global Health Kenya, Washington State University, Nairobi, USA
| | - Ruth Njoroge
- Global Health Kenya, Washington State University, Nairobi, USA
| | - Gilbert Kikwai
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Dennis Odhiambo,
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Mike Powel Osita
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Alice Ouma
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Clifford Odour
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Bonventure Juma
- Center for Global Health, Division of Public Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, USA
| | - Caroline A Ochieng
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Immaculate Mutisya
- Center for Global Health, Division of Public Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, USA
| | - Isaac Ngere
- Global Health Kenya, Washington State University, Nairobi, USA
- Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | - Jeanette Dawa
- Global Health Kenya, Washington State University, Nairobi, USA
- Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | - Eric Osoro
- Global Health Kenya, Washington State University, Nairobi, USA
- Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | - M Kariuki Njenga
- Global Health Kenya, Washington State University, Nairobi, USA
- Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | - Godfrey Bigogo
- Centre for Global Health Research,, Kenya Medical Research Institute, Kisumu, Kenya
| | - Peninah Munyua
- Center for Global Health, Division of Public Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, USA
| | - Terrence Q Lo
- Center for Global Health, Division of Public Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, USA
| | - Elizabeth Hunsperger
- Center for Global Health, Division of Public Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, USA
| | - Amy Herman-Roloff
- Center for Global Health, Division of Public Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, USA
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19
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Nasimiyu C, Matoke-Muhia D, Rono GK, Osoro E, Obado DO, Mwangi JM, Mwikwabe N, Thiong’o K, Dawa J, Ngere I, Gachohi J, Kariuki S, Amukoye E, Mureithi M, Ngere P, Amoth P, Were I, Makayotto L, Nene V, Abworo EO, Njenga MK, Seifert SN, Oyola SO. Imported SARS-COV-2 Variants of Concern Drove Spread of Infections Across Kenya During the Second Year of the Pandemic. medRxiv 2022:2022.02.28.22271467. [PMID: 35262086 PMCID: PMC8902869 DOI: 10.1101/2022.02.28.22271467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Using classical and genomic epidemiology, we tracked the COVID-19 pandemic in Kenya over 23 months to determine the impact of SARS-CoV-2 variants on its progression. Methods SARS-CoV-2 surveillance and testing data were obtained from the Kenya Ministry of Health, collected daily from 306 health facilities. COVID-19-associated fatality data were also obtained from these health facilities and communities. Whole SARS-CoV-2 genome sequencing were carried out on 1241 specimens. Results Over the pandemic duration (March 2020 - January 2022) Kenya experienced five waves characterized by attack rates (AR) of between 65.4 and 137.6 per 100,000 persons, and intra-wave case fatality ratios (CFR) averaging 3.5%, two-fold higher than the national average COVID-19 associated CFR. The first two waves that occurred before emergence of global variants of concerns (VoC) had lower AR (65.4 and 118.2 per 100,000). Waves 3, 4, and 5 that occurred during the second year were each dominated by multiple introductions each, of Alpha (74.9% genomes), Delta (98.7%), and Omicron (87.8%) VoCs, respectively. During this phase, government-imposed restrictions failed to alleviate pandemic progression, resulting in higher attack rates spread across the country. Conclusions The emergence of Alpha, Delta, and Omicron variants was a turning point that resulted in widespread and higher SARS-CoV-2 infections across the country.
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Affiliation(s)
- Carolyne Nasimiyu
- Washington State Global Health Program-Kenya, Washington State University, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
| | | | | | - Eric Osoro
- Washington State Global Health Program-Kenya, Washington State University, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
| | | | | | | | | | - Jeanette Dawa
- Washington State Global Health Program-Kenya, Washington State University, Nairobi, Kenya
| | - Isaac Ngere
- Washington State Global Health Program-Kenya, Washington State University, Nairobi, Kenya
| | - John Gachohi
- Washington State Global Health Program-Kenya, Washington State University, Nairobi, Kenya
| | | | | | - Marianne Mureithi
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | | | | | - Ian Were
- Kenya Ministry of Health, Nairobi, Kenya
| | | | | | | | - M. Kariuki Njenga
- Washington State Global Health Program-Kenya, Washington State University, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
| | - Stephanie N. Seifert
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
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Carbonell-Estrany X, Simões EAF, Bont LJ, Gentile A, Homaira N, Scotta MC, Stein RT, Torres JP, Sheikh J, Broor S, Khuri-Bulos N, Nokes DJ, Munywoki PK, Bassat Q, Sharma AK, Basnet S, Garba M, De Jesus-Cornejo J, Lupisan SP, Nunes MC, Divarathna M, Fullarton JR, Rodgers-Gray BS, Keary I, Reñosa MDC, Verwey C, Moore DP, Noordeen F, Kabra S, do Vale MS, Paternina-De La Ossa R, Mariño C, Figueras-Aloy J, Krilov L, Berezin E, Zar HJ, Paudel K, Safadi MAP, Dbaibo G, Jroundi I, Jha R, Rafeek RAM, Pinheiro RDS, Bracht M, Muthugala R, Lanari M, Martinón-Torres F, Mitchell I, Irimu G, Pandey A, Krishnan A, Mejias A, da Costa MSC, Shrestha S, Pernica JM, de Carvalho FC, Jalango RE, Ibrahim H, Ewa A, Ensinck G, Ulloa-Gutierrez R, Miralha AL, Lucion MF, Hassan MZ, Akhtar Z, Aleem MA, Chowdhury F, Rojo P, Sande C, Musau A, Zaman K, Helena L, Arlant F, Ghimire P, Price A, Subedi KU, Brenes-Chacon H, Goswami DR, Rahman MZ, Hossain ME, Chisti MJ, Vain NE, Lim A, Chiu A, Papenburg J, Juarez MDV, Senaratne T, Arunasalam S, Strand TA, Ayuk A, Ogunrinde O, Tavares LVDS, Garba C, Garba BI, Dawa J, Gordon M, Osoro E, Agoti CN, Nyawanda B, Ngama M, Tabu C, Mathew JL, Cornacchia A, Rai GK, Jain A, Giongo MS, Paes BA. Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries. Front Pediatr 2022; 10:1033125. [PMID: 36440349 PMCID: PMC9682277 DOI: 10.3389/fped.2022.1033125] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. METHODS A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. RESULTS Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. CONCLUSION Seven key actions for improving RSV prevention and management in LMICs are proposed.
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Affiliation(s)
| | - Eric A F Simões
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, United States.,Department of Epidemiology, Center for Global Health, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Louis J Bont
- Laboratory of Translational Immunology and Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Angela Gentile
- Epidemiology Department, Austral University, Buenos Aires, Argentina.,Ricardo Gutiérrez Children Hospital, Buenos Aires, Argentina
| | - Nusrat Homaira
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Marcelo Comerlato Scotta
- Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Renato T Stein
- Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Juan P Torres
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Jarju Sheikh
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Shobha Broor
- All India Institute of Medical Sciences, New Delhi, India
| | | | - D James Nokes
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,School of Life Sciences, University of Warwick, Coventry, United Kingdom
| | - Patrick K Munywoki
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Institución Catalana de Investigación y Estudios Avanzados (ICREA), Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Arun K Sharma
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sudha Basnet
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.,University of Bergen, Bergen, Norway
| | - Maria Garba
- Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria
| | | | - Socorro P Lupisan
- RITM-Tohoku Research Collaborating Center for Emerging Infections, Manila, Philippines
| | - Marta C Nunes
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maduja Divarathna
- Diagnostic and Research Virology Laboratory, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Ian Keary
- Violicom Medical Limited, Aldermaston, United Kingdom
| | | | - Charl Verwey
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David P Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Faseeha Noordeen
- Diagnostic and Research Virology Laboratory, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sushil Kabra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Rolando Paternina-De La Ossa
- Hospital Santa Casa de Ribeirão Preto, São Paulo, Brazil.,Centro Universitário Barão de Mauá, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Leonard Krilov
- NYU Long Island School of Medicine, Mineola, NY, United States
| | | | - Heather J Zar
- Child Health and the SA-MRC Unit on Child and Adolescent Health, Department of Paediatrics, University of Cape Town (UCT), Cape Town, South Africa
| | | | | | - Ghassan Dbaibo
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | - Imane Jroundi
- School of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco
| | - Runa Jha
- National Public Health Laboratory, Ministry of Health & Population, Teku, Kathmandu, Nepal
| | - Rukshan A M Rafeek
- Diagnostic and Research Virology Laboratory, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | | | | | | | | | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Apsara Pandey
- Department of Pediatric Nursing, Maharajgunj Nursing Campus, Institute of Medicine, Tribhuwan University, Kathmandu, Nepal.,Pediatric Nurses Association of Nepal, Kathmandu, Nepal
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Asuncion Mejias
- Nationwide Childrens Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | | | | | | | | | | | - Hafsat Ibrahim
- Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Atana Ewa
- University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Gabriela Ensinck
- Hospital de Niños Víctor J. Vilela de Rosario, Santa Fe, Argentina
| | - Rolando Ulloa-Gutierrez
- Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | | | - Maria Florencia Lucion
- Epidemiology Department, Austral University, Buenos Aires, Argentina.,Ricardo Gutiérrez Children Hospital, Buenos Aires, Argentina
| | - Md Zakiul Hassan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Zubair Akhtar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pablo Rojo
- University Hospital October 12, Madrid, Spain
| | - Charles Sande
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Luiza Helena
- Metropolitan University of Santos, São Paulo, Brazil
| | | | - Prakash Ghimire
- Department of Paediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - April Price
- London Health Sciences Centre, London, ON, Canada
| | | | - Helena Brenes-Chacon
- Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Doli Rani Goswami
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Nestor E Vain
- Hospital Sanatorio Trinidad, Buenos Aires, Argentina
| | - Audrey Lim
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Aaron Chiu
- The Children's Hospital of Winnipeg, Winnipeg, MB, Canada
| | | | - Maria Del Valle Juarez
- Epidemiology Department, Austral University, Buenos Aires, Argentina.,Ricardo Gutiérrez Children Hospital, Buenos Aires, Argentina
| | | | - Shiyamalee Arunasalam
- Diagnostic and Research Virology Laboratory, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Adaeze Ayuk
- University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | | | - Comfort Garba
- Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria
| | - Bilkisu I Garba
- Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Jeanette Dawa
- Washington State University - Global Health Kenya, Nairobi, Kenya
| | - Michelle Gordon
- Orillia Soldiers' Memorial Hospital, Orillia, Ontario, Canada
| | - Eric Osoro
- Washington State University - Global Health Kenya, Nairobi, Kenya
| | - Charles N Agoti
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bryan Nyawanda
- Kenya Medical Research Institute- Center for Global Health Research, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Mwanajuma Ngama
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Joseph L Mathew
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Ganesh Kumar Rai
- Nepal Pediatric Society (NEPAS), Kanti Children's Hospital, Kathmandu, Nepal
| | - Amita Jain
- King George's Medical University, Uttar Pradesh, India
| | | | - Bosco A Paes
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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21
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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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22
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Munywoki PK, Nasimiyu C, Alando MD, Otieno N, Ombok C, Njoroge R, Kikwai G, Odhiambo, D, Osita MP, Ouma A, Odour C, Juma B, Ochieng CA, Mutisya I, Ngere I, Dawa J, Osoro E, Njenga MK, Bigogo G, Munyua P, Lo TQ, Hunsperger E, Herman-Roloff A. Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020. F1000Res 2021; 10:853. [PMID: 35528961 PMCID: PMC9065925 DOI: 10.12688/f1000research.72914.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomic challenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection. Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27th November and 5th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity. Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 – 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 – 21.3%) among children (<5 years), 32.7% (95% CI, 22.9 – 44.4%) among children 5 – 9 years, 41.8% (95% CI, 33.0 – 51.1%) for those 10-19 years, and 54.9%(46.2 – 63.3%) for adults (≥20 years). Relative to those from medium-sized households (3 and 4 individuals), participants from large (≥5 persons) households had significantly increased odds of being seropositive, aOR, 1.98(95% CI, 1.17 – 1.58), while those from small-sized households (≤2 individuals) had increased odds but not statistically significant, aOR, 2.31 (95% CI, 0.93 – 5.74). Conclusion: In densely populated urban settings, close to half of the individuals had an infection to SARS-CoV-2 after eight months of the COVID-19 pandemic in Kenya. This highlights the importance to prioritize mitigation measures, including COVID-19 vaccine distribution, in the crowded, low socioeconomic settings.
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23
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Njenga MK, Dawa J, Nanyingi M, Gachohi J, Ngere I, Letko M, Otieno CF, Gunn BM, Osoro E. Why is There Low Morbidity and Mortality of COVID-19 in Africa? Am J Trop Med Hyg 2020; 103:564-569. [PMID: 32484156 PMCID: PMC7410455 DOI: 10.4269/ajtmh.20-0474] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
Three months since the detection of the first COVID-19 case in Africa, almost all countries of the continent continued to report lower morbidity and mortality than the global trend, including Europe and North America. We reviewed the merits of various hypotheses advanced to explain this phenomenon, including low seeding rate, effective mitigation measures, population that is more youthful, favorable weather, and possible prior exposure to a cross-reactive virus. Having a youthful population and favorable weather appears compelling, particularly their combined effect; however, progression of the pandemic in the region and globally may dispel these in the coming months.
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Affiliation(s)
- M. Kariuki Njenga
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
| | - Jeanette Dawa
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Mark Nanyingi
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
- Institute of Global Health and Infection, University of Liverpool, Liverpool, United Kingdom
| | - John Gachohi
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Isaac Ngere
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
| | - Michael Letko
- Paul G. Allen School of Global Animal Health, Washington State University, Pullma, Washington
| | - C. F. Otieno
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Bronwyn M. Gunn
- Paul G. Allen School of Global Animal Health, Washington State University, Pullma, Washington
| | - Eric Osoro
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
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24
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Muturi M, Gachohi J, Mwatondo A, Lekolool I, Gakuya F, Bett A, Osoro E, Bitek A, Thumbi SM, Munyua P, Oyas H, Njagi ON, Bett B, Njenga MK. Recurrent Anthrax Outbreaks in Humans, Livestock, and Wildlife in the Same Locality, Kenya, 2014-2017. Am J Trop Med Hyg 2019; 99:833-839. [PMID: 30105965 PMCID: PMC6159598 DOI: 10.4269/ajtmh.18-0224] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Epidemiologic data indicate a global distribution of anthrax outbreaks associated with certain ecosystems that promote survival and viability of Bacillus anthracis spores. Here, we characterized three anthrax outbreaks involving humans, livestock, and wildlife that occurred in the same locality in Kenya between 2014 and 2017. Clinical and epidemiologic data on the outbreaks were collected using active case finding and review of human, livestock, and wildlife health records. Information on temporal and spatial distribution of prior outbreaks in the area was collected using participatory epidemiology. The 2014-2017 outbreaks in Nakuru West subcounty affected 15 of 71 people who had contact with infected cattle (attack rate = 21.1%), including seven with gastrointestinal, six with cutaneous, and two with oropharyngeal forms of the disease. Two (13.3%) gastrointestinal human anthrax cases died. No human cases were associated with infected wildlife. Of the 54 cattle owned in 11 households affected, 20 died (attack rate = 37%). The 2015 outbreak resulted in death of 10.5% of the affected herbivorous wildlife at Lake Nakuru National Park, including 745 of 4,500 African buffaloes (species-specific mortality rate = 17%) and three of 18 endangered white rhinos (species-specific mortality rate = 16%). The species mortality rate ranged from 1% to 5% for the other affected wildlife species. Participatory epidemiology identified prior outbreaks between 1973 and 2011 in the same area. The frequency and severity of outbreaks in this area suggests that it is an anthrax hotspot ideal for investigating risk factors associated with long-term survival of anthrax spores and outbreak occurrence.
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Affiliation(s)
| | - John Gachohi
- Washington State University Global Health Program-Kenya, Washington State University, Pullman, Washington
| | | | | | | | | | - Eric Osoro
- Washington State University Global Health Program-Kenya, Washington State University, Pullman, Washington
| | - Austine Bitek
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - S Mwangi Thumbi
- Washington State University Global Health Program-Kenya, Washington State University, Pullman, Washington
| | - Peninah Munyua
- Division of Global Health Protection, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Harry Oyas
- Kenya Directorate of Veterinary Services, Nairobi, Kenya
| | | | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
| | - M Kariuki Njenga
- Washington State University Global Health Program-Kenya, Washington State University, Pullman, Washington
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25
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Bitek AO, Osoro E, Munyua PM, Nanyingi M, Muthiani Y, Kiambi S, Muturi M, Mwatondo A, Muriithi R, Cleaveland S, Hampson K, Njenga MK, Kitala PM, Thumbi SM. A hundred years of rabies in Kenya and the strategy for eliminating dog-mediated rabies by 2030. AAS Open Res 2019; 1:23. [PMID: 32259023 PMCID: PMC7117960 DOI: 10.12688/aasopenres.12872.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Rabies causes an estimated 59,000 human deaths annually. In Kenya, rabies was first reported in a dog in 1912, with the first human case reported in 1928. Here we examine retrospective rabies data in Kenya for the period 1912 - 2017 and describe the spatial and temporal patterns of rabies occurrence in the country. Additionally, we detail Kenya's strategy for the elimination of dog-mediated human rabies by 2030. Methods: Data on submitted samples and confirmed cases in humans, domestic animals and wildlife were obtained from Kenya's Directorate of Veterinary Services. These data were associated with the geographical regions where the samples originated, and temporal and spatial trends examined. Results: Between 1912 and the mid 1970's, rabies spread across Kenya gradually, with fewer than 50 cases reported per year and less than half of the 47 counties affected. Following an outbreak in the mid 1970's, rabies spread rapidly to more than 85% of counties, with a 4 fold increase in the percent positivity of samples submitted and number of confirmed rabies cases. Since 1958, 7,584 samples from domestic animals (93%), wildlife (5%), and humans (2%) were tested. Over two-thirds of all rabies cases came from six counties, all in close proximity to veterinary diagnostic laboratories, highlighting a limitation of passive surveillance. Conclusions: Compulsory annual dog vaccinations between 1950's and the early 1970's slowed rabies spread. The rapid spread with peak rabies cases in the 1980's coincided with implementation of structural adjustment programs privatizing the veterinary sector leading to breakdown of rabies control programs. To eliminate human deaths from rabies by 2030, Kenya is implementing a 15-year step-wise strategy based on three pillars: a) mass dog vaccination, b) provision of post-exposure prophylaxis and public awareness and c) improved surveillance for rabies in dogs and humans with prompt responses to rabies outbreaks.
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Affiliation(s)
- Austine O Bitek
- Zoonotic Disease Unit, Ministry of Agriculture and Livestock, Nairobi, Kenya
| | - Eric Osoro
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya
| | - Peninah M Munyua
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Mark Nanyingi
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
| | - Yvonne Muthiani
- Zoonotic Disease Unit, Ministry of Agriculture and Livestock, Nairobi, Kenya
| | - Stella Kiambi
- Zoonotic Disease Unit, Ministry of Agriculture and Livestock, Nairobi, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Agriculture and Livestock, Nairobi, Kenya
| | | | - Rees Muriithi
- Directorate of Veterinary Services, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, UK
| | - M. Kariuki Njenga
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - PM Kitala
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
| | - SM Thumbi
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
- Rabies Free Africa, Washington State University, Pullman, WA, USA
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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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Abstract
BACKGROUND The East African region is endemic with multiple zoonotic diseases and is one of the hotspots for emerging infectious zoonotic diseases with reported multiple outbreaks of epidemic diseases such as Ebola, Marburg and Rift Valley Fever. Here we present a systematic assessment of published research on zoonotic diseases in the region and thesis research in Kenya to understand the regional research focus and trends in publications, and estimate proportion of theses research transitioning to peer-reviewed journal publications. METHODS We searched PubMed, Google Scholar and African Journals Online databases for publications on 36 zoonotic diseases identified to have occurred in the East Africa countries of Burundi, Ethiopia, Kenya, Tanzania, Rwanda and Uganda, for the period between 1920 and 2017. We searched libraries and queried online repositories for masters and PhD theses on these diseases produced between 1970 and 2016 in five universities and two research institutions in Kenya. RESULTS We identified 771 journal articles on 22, and 168 theses on 21 of the 36 zoonotic diseases investigated. Research on zoonotic diseases increased exponentially with the last 10 years of our study period contributing more than half of all publications 460 (60%) and theses 102 (61%) retrieved. Endemic diseases were the most studied accounting for 656 (85%) and 150 (89%) of the publication and theses studies respectively, with publications on epidemic diseases associated with outbreaks reported in the region or elsewhere. Epidemiological studies were the most common study types but limited to cross-sectional studies while socio-economics were the least studied. Only 11% of the theses research transitioned to peer-review publications, taking an average of 2.5 years from theses production to manuscript publication. CONCLUSION Our findings demonstrate increased attention to zoonotic diseases in East Africa but reveal the need to expand the scope, focus and quality of studies to adequately address the public health, social and economic threats posed by zoonoses.
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Affiliation(s)
- Naomi Kemunto
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, USA
- Washington State University Global Health Program Kenya, Nairobi, Kenya
| | - Eddy Mogoa
- Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Eric Osoro
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, USA
- Washington State University Global Health Program Kenya, Nairobi, Kenya
| | - Austin Bitek
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - M. Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, USA
- Washington State University Global Health Program Kenya, Nairobi, Kenya
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - S. M. Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, USA
- Washington State University Global Health Program Kenya, Nairobi, Kenya
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
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Bitek AO, Osoro E, Munyua PM, Nanyingi M, Muthiani Y, Kiambi S, Muturi M, Mwatondo A, Muriithi R, Cleaveland S, Hampson K, Njenga MK, Kitala PM, Thumbi SM. A hundred years of rabies in Kenya and the strategy for eliminating dog-mediated rabies by 2030. AAS Open Res 2018. [DOI: 10.12688/aasopenres.12872.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Rabies causes an estimated 59,000 human deaths annually. In Kenya, rabies was first reported in a dog in 1912, with the first human case reported in 1928. Here we examine retrospective rabies data in Kenya for the period 1912 – 2017 and describe the spatial and temporal patterns of rabies occurrence in the country. Additionally, we detail Kenya’s strategy for the elimination of dog-mediated human rabies by 2030. Methods: Data on submitted samples and confirmed cases in humans, domestic animals and wildlife were obtained from Kenya’s Directorate of Veterinary Services. These data were associated with the geographical regions where the samples originated, and temporal and spatial trends examined. Results: Between 1912 and the mid 1970’s, rabies spread across Kenya gradually, with fewer than 50 cases reported per year and less than half of the 47 counties affected. Following an outbreak in the mid 1970’s, rabies spread rapidly to more than 85% of counties, with a 4 fold increase in the percent positivity of samples submitted and number of confirmed rabies cases. Since 1958, 7,584 samples from domestic animals (93%), wildlife (5%), and humans (2%) were tested. Over two-thirds of all rabies cases came from six counties, all in close proximity to veterinary diagnostic laboratories, highlighting a limitation of passive surveillance. Conclusions: Compulsory annual dog vaccinations between 1950’s and the early 1970’s slowed rabies spread. The rapid spread with peak rabies cases in the 1980’s coincided with implementation of structural adjustment programs privatizing the veterinary sector leading to breakdown of rabies control programs. To eliminate human deaths from rabies by 2030, Kenya is implementing a 15-year step-wise strategy based on three pillars: a) mass dog vaccination, b) provision of post-exposure prophylaxis and public awareness and c) improved surveillance for rabies in dogs and humans with prompt responses to rabies outbreaks.
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Oyas H, Holmstrom L, Kemunto NP, Muturi M, Mwatondo A, Osoro E, Bitek A, Bett B, Githinji JW, Thumbi SM, Widdowson MA, Munyua PM, Njenga MK. Enhanced surveillance for Rift Valley Fever in livestock during El Niño rains and threat of RVF outbreak, Kenya, 2015-2016. PLoS Negl Trop Dis 2018; 12:e0006353. [PMID: 29698487 PMCID: PMC5919633 DOI: 10.1371/journal.pntd.0006353] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background In mid-2015, the United States’ Pandemic Prediction and Forecasting Science and Technical Working Group of the National Science and Technology Council, Food and Agriculture Organization Emergency Prevention Systems, and Kenya Meteorological Department issued an alert predicting a high possibility of El-Niño rainfall and Rift Valley Fever (RVF) epidemic in Eastern Africa. Methodology/Principal findings In response to the alert, the Kenya Directorate of Veterinary Services (KDVS) carried out an enhanced syndromic surveillance system between November 2015 and February 2016, targeting 22 RVF high-risk counties in the country as identified previously through risk mapping. The surveillance collected data on RVF-associated syndromes in cattle, sheep, goats, and camels from >1100 farmers through 66 surveillance officers. During the 14-week surveillance period, the KDVS received 10,958 reports from participating farmers and surveillance officers, of which 362 (3.3%) had at least one syndrome. The reported syndromes included 196 (54.1%) deaths in young livestock, 133 (36.7%) abortions, and 33 (9.1%) hemorrhagic diseases, with most occurring in November and December, the period of heaviest rainfall. Of the 69 herds that met the suspect RVF herd definition (abortion in flooded area), 24 (34.8%) were defined as probable (abortions, mortalities in the young ones, and/or hemorrhagic signs) but none were confirmed. Conclusion/Significance This surveillance activity served as an early warning system that could detect RVF disease in animals before spillover to humans. It was also an excellent pilot for designing and implementing syndromic surveillance in animals in the country, which is now being rolled out using a mobile phone-based data reporting technology as part of the global health security system. Occurrence of Rift Valley Fever (RVF) outbreak is associated with heavy El-Niño rainfall. In July 2015, an alert on the likelihood of El-Niño rainfall and RVF outbreak in Eastern Africa region was issued by the United States, Food and Agriculture Organization, and Kenya Meteorological Department. In response to the alert, the Kenya Directorate of Veterinary Services (KDVS) carried out an enhanced syndromic surveillance system between November 2015 and February 2016 in the 22 counties that had previously been identified as RVF high-risk counties. The surveillance system collected data on RVF-associated syndromes and risk factors in cattle, sheep, goats and camels from more than 1100 farmers. Of the 10,958 field reports submitted, 45 were consistent with suspect RVF disease and 24 of these identified as probable RVF, triggering an immediate response. Whereas investigations of the suspect cases and laboratory testing did not confirm RVF cases, the surveillance system served as an excellent early warning system that could detect disease in animal before spillover to humans.
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Affiliation(s)
- Harry Oyas
- Veterinary Epidemiology and Economics Unit, Kenya Ministry of Agriculture, livestock and Fisheries, Nairobi, Kenya
| | - Lindsey Holmstrom
- College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, United States of America
| | - Naomi P. Kemunto
- Washington State University Global Health Program-Kenya, Washington State University, Nairobi, Kenya
| | - Matthew Muturi
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Athman Mwatondo
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Eric Osoro
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Austine Bitek
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Bernard Bett
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Jane W. Githinji
- Veterinary Epidemiology and Economics Unit, Kenya Ministry of Agriculture, livestock and Fisheries, Nairobi, Kenya
| | - Samuel M. Thumbi
- Washington State University Global Health Program-Kenya, Washington State University, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, United States’ Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Peninah M. Munyua
- Division of Global Health Protection, United States’ Centers for Disease Control and Prevention, Nairobi, Kenya
| | - M. Kariuki Njenga
- Washington State University Global Health Program-Kenya, Washington State University, Nairobi, Kenya
- * E-mail:
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Mwatondo A, Munyua P, Gura Z, Muturi M, Osoro E, Obonyo M, Bitek A, Oyas H, Mbabu M, Kioko J, Njenga K, Lowther S, Thumbi SM. Catalysts for implementation of One Health in Kenya. Pan Afr Med J 2017; 28:1. [PMID: 30167029 PMCID: PMC6113684 DOI: 10.11604/pamj.supp.2017.28.1.13275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 11/27/2022] Open
Abstract
The recent Zika outbreak in the Americas, Ebola epidemic in West Africa and the increased frequency and impact of emerging and re-emerging infections of animal origin have increased the calls for greater preparedness in early detection and responses to public health events. One-Health approaches that emphasize collaborations between human health, animal health and environmental health sectors for the prevention, early detection and response to disease outbreaks have been hailed as a key strategy. Here we highlight three main efforts that have progressed the implementation of One Health in Kenya.
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Affiliation(s)
| | - Peninah Munyua
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Eric Osoro
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Austine Bitek
- Zoonotic Disease Unit, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Harry Oyas
- Veterinary Epidemiology and Economics Unit, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Murithi Mbabu
- Disease Surveillance, Vector and Zoological Services, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Jackson Kioko
- Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Centers for Global Health Research, Kenya Medical Research Institute, Kenya
| | - Sara Lowther
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Samuel Mwangi Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Centers for Global Health Research, Kenya Medical Research Institute, Kenya
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Muema J, Thumbi SM, Obonyo M, Wanyoike S, Nanyingi M, Osoro E, Bitek A, Karanja S. Seroprevalence and Factors Associated with Coxiella burnetii Infection in Small Ruminants in Baringo County, Kenya. Zoonoses Public Health 2017; 64:e31-e43. [PMID: 28117947 DOI: 10.1111/zph.12342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 02/04/2016] [Indexed: 01/06/2023]
Abstract
To improve estimates of C. burnetii epidemiology in Kenya, a survey was undertaken in small ruminants in Baringo County, where acute cases of Q fever in humans had been reported in 2014. From 140 household herds selected, 508 (60.5%) goats and 332 (39.5%) sheep were included and an indirect ELISA assay for C. burnetii IgG antibodies performed. In addition, epidemiological information at both herd and animal level was collected. Generalized mixed-effects multivariable logistic model using herd as the random effect was used to determine variables correlated to the outcome. Overall seroprevalence was 20.5% (95% CI: 17.8%, 23.3%). Goats had 26.0% (95% CI: 22.2%, 30.0%) compared to sheep 12.2% (95% CI: 8.7%, 16.0%). Nomadic pastoralism, goats and older animals (>1 year) were associated with greater risk of C. burnetii seropositivity (P = ≤0.05). Heterogeneity in C. burnetii seropositivity was observed across the sublocations (P = 0.028). Evidence of C. burnetii exposure in small ruminants revealed poses a potential risk of exposure to the people living in close proximity to the animals. We recommended integrated animal-human surveillance and socio-economic studies for C. burnetii, to aid our understanding of the risk of transmission between the animals and humans, and in the design of prevention and control strategies for the disease in the region.
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Affiliation(s)
- J Muema
- Field Epidemiology and Laboratory Training Program (FELTP), Nairobi, Kenya.,Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya.,College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi, Kenya
| | - S M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Center for Global Health Research, Kenya Medical Research Institute, Kenya
| | - M Obonyo
- Field Epidemiology and Laboratory Training Program (FELTP), Nairobi, Kenya.,Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya
| | - S Wanyoike
- Directorate of Veterinary Services, Nairobi, Kenya
| | - M Nanyingi
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Kenya.,Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - E Osoro
- Zoonotic Disease Unit, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - A Bitek
- Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya
| | - S Karanja
- College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi, Kenya
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Munyua P, Corman VM, Bitek A, Osoro E, Meyer B, Müller MA, Lattwein E, Thumbi SM, Murithi R, Widdowson MA, Drosten C, Njenga MK. No Serologic Evidence of Middle East Respiratory Syndrome Coronavirus Infection Among Camel Farmers Exposed to Highly Seropositive Camel Herds: A Household Linked Study, Kenya, 2013. Am J Trop Med Hyg 2017; 96:1318-1324. [PMID: 28719257 DOI: 10.4269/ajtmh.16-0880] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractHigh seroprevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) among camels has been reported in Kenya and other countries in Africa. To date, the only report of MERS-CoV seropositivity among humans in Kenya is of two livestock keepers with no known contact with camels. We assessed whether persons exposed to seropositive camels at household level had serological evidence of infection. In 2013, 760 human and 879 camel sera were collected from 275 and 85 households respectively in Marsabit County. Data on human and animal demographics and type of contact with camels were collected. Human and camel sera were tested for anti-MERS-CoV IgG using a commercial enzyme-linked immunosorbent assay (ELISA) test. Human samples were confirmed by plaque reduction neutralization test (PRNT). Logistic regression was used to identify factors associated with seropositivity. The median age of persons sampled was 30 years (range: 5-90) and 50% were males. A quarter (197/760) of the participants reported having had contact with camels defined as milking, feeding, watering, slaughtering, or herding. Of the human sera, 18 (2.4%) were positive on ELISA but negative by PRNT. Of the camel sera, 791 (90%) were positive on ELISA. On univariate analysis, higher prevalence was observed in female and older camels over 4 years of age (P < 0.05). On multivariate analysis, only age remained significantly associated with increased odds of seropositivity. Despite high seroprevalence among camels, there was no serological confirmation of MERS-CoV infection among camel pastoralists in Marsabit County. The high seropositivity suggests that MERS-CoV or other closely related virus continues to circulate in camels and highlights ongoing potential for animal-to-human transmission.
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Affiliation(s)
- Peninah Munyua
- Global Disease Detection Program, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Victor Max Corman
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany
| | - Austine Bitek
- State Department of Veterinary Services; Ministry of Agriculture Livestock and Fisheries, Nairobi, Kenya
| | - Eric Osoro
- Department of Preventive and Promotive Health, Ministry of Health, Nairobi, Kenya
| | - Benjamin Meyer
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Marcel A Müller
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | | | - S M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington.,Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rees Murithi
- State Department of Veterinary Services; Ministry of Agriculture Livestock and Fisheries, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Global Disease Detection Program, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Christian Drosten
- German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany.,Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - M Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington.,Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
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Munyua P, Bitek A, Osoro E, Pieracci EG, Muema J, Mwatondo A, Kungu M, Nanyingi M, Gharpure R, Njenga K, Thumbi SM. Prioritization of Zoonotic Diseases in Kenya, 2015. PLoS One 2016; 11:e0161576. [PMID: 27557120 PMCID: PMC4996421 DOI: 10.1371/journal.pone.0161576] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/08/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Zoonotic diseases have varying public health burden and socio-economic impact across time and geographical settings making their prioritization for prevention and control important at the national level. We conducted systematic prioritization of zoonotic diseases and developed a ranked list of these diseases that would guide allocation of resources to enhance their surveillance, prevention, and control. METHODS A group of 36 medical, veterinary, and wildlife experts in zoonoses from government, research institutions and universities in Kenya prioritized 36 diseases using a semi-quantitative One Health Zoonotic Disease Prioritization tool developed by Centers for Disease Control and Prevention with slight adaptations. The tool comprises five steps: listing of zoonotic diseases to be prioritized, development of ranking criteria, weighting criteria by pairwise comparison through analytical hierarchical process, scoring each zoonotic disease based on the criteria, and aggregation of scores. RESULTS In order of importance, the participants identified severity of illness in humans, epidemic/pandemic potential in humans, socio-economic burden, prevalence/incidence and availability of interventions (weighted scores assigned to each criteria were 0.23, 0.22, 0.21, 0.17 and 0.17 respectively), as the criteria to define the relative importance of the diseases. The top five priority diseases in descending order of ranking were anthrax, trypanosomiasis, rabies, brucellosis and Rift Valley fever. CONCLUSION Although less prominently mentioned, neglected zoonotic diseases ranked highly compared to those with epidemic potential suggesting these endemic diseases cause substantial public health burden. The list of priority zoonotic disease is crucial for the targeted allocation of resources and informing disease prevention and control programs for zoonoses in Kenya.
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Affiliation(s)
- Peninah Munyua
- Global Disease Detection Program, Division of Global Health Protection, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Austine Bitek
- Zoonotic Disease Unit, State Department of Veterinary Services; Ministry of Agriculture Livestock and Fisheries, Nairobi, Kenya
| | - Eric Osoro
- Zoonotic Disease Unit, Department of Preventive and Promotive Heath; Ministry of Health, Nairobi, Kenya
| | - Emily G. Pieracci
- Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Josephat Muema
- Zoonotic Disease Unit, State Department of Veterinary Services; Ministry of Agriculture Livestock and Fisheries, Nairobi, Kenya
- Field Epidemiology and Laboratory Training program, Ministry of Health, Nairobi, Kenya
| | - Athman Mwatondo
- Zoonotic Disease Unit, Department of Preventive and Promotive Heath; Ministry of Health, Nairobi, Kenya
| | - Mathew Kungu
- Zoonotic Disease Unit, State Department of Veterinary Services; Ministry of Agriculture Livestock and Fisheries, Nairobi, Kenya
| | - Mark Nanyingi
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Kenya
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Radhika Gharpure
- Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kariuki Njenga
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
| | - Samuel M. Thumbi
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
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35
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Mbabu M, Njeru I, File S, Osoro E, Kiambi S, Bitek A, Ithondeka P, Kairu-Wanyoike S, Sharif S, Gogstad E, Gakuya F, Sandhaus K, Munyua P, Montgomery J, Breiman R, Rubin C, Njenga K. Establishing a One Health office in Kenya. Pan Afr Med J 2014; 19:106. [PMID: 25722779 PMCID: PMC4337352 DOI: 10.11604/pamj.2014.19.106.4588] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 05/14/2014] [Accepted: 08/08/2014] [Indexed: 11/16/2022] Open
Abstract
A One Health (OH) approach that integrates human,animal and environmental approaches to management of zoonotic diseases has gained momentum in the last decadeas part of a strategy to prevent and control emerging infectious diseases. However, there are few examples of howan OH approach can be established in a country. Kenya establishment of an OH office, referred to asthe Zoonotic Disease Unit (ZDU) in 2011. The ZDU bridges theanimal and human health sectors with a senior epidemiologist deployed from each ministry; and agoal of maintaining collaboration at the animal and human health interface towards better prevention and control of zoonoses. The country is adding an ecologist to the ZDU to ensure that environmental risks are adequately addressed in emerging disease control.
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Affiliation(s)
- Murithi Mbabu
- Ministry of Agriculture, Livestock and Fisheries Nairobi, Kenya
| | | | - Sarah File
- One Health Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Osoro
- Zoonotic Disease Unit, Government of Kenya, Nairobi, Kenya
| | - Stella Kiambi
- Zoonotic Disease Unit, Government of Kenya, Nairobi, Kenya
| | - Austine Bitek
- Zoonotic Disease Unit, Government of Kenya, Nairobi, Kenya
| | - Peter Ithondeka
- Ministry of Agriculture, Livestock and Fisheries Nairobi, Kenya
| | | | | | - Eric Gogstad
- Global Disease Detection Division, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya ; Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Peninah Munyua
- Global Disease Detection Division, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - Joel Montgomery
- Global Disease Detection Division, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya ; Global Implementation Solutions, Chicago, Illinois, USA
| | - Robert Breiman
- Global Disease Detection Division, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya ; Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carol Rubin
- One Health Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kariuki Njenga
- Global Disease Detection Division, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
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Bachani AM, Herbert HK, Mogere S, Akungah D, Osoro E, Maina W, Stevens K, Hyder AA. Burden and risk factors for road traffic injuries in two districts of Kenya: a descriptive analysis. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590u.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bachani AM, Koradia P, Herbert HK, Mogere S, Akungah D, Nyamari J, Osoro E, Maina W, Stevens KA. Road traffic injuries in Kenya: the health burden and risk factors in two districts. Traffic Inj Prev 2012; 13 Suppl 1:24-30. [PMID: 22414125 DOI: 10.1080/15389588.2011.633136] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Road traffic injuries (RTIs) contribute to a significant proportion of the burden of disease in Kenya. They also have a significant impact on the social and economic well-being of individuals, their families, and society. However, though estimates quantifying the burden of RTIs in Kenya do exist, most of these studies date back to the early 2000s-more than one decade ago. OBJECTIVE This article aims to present the current status of road safety in Kenya. Using data from the police and vital registration systems in Kenya, we present the current epidemiology of RTIs in the nation. We also sought to assess the status of 3 well-known risk factors for RTIs-speeding and the use of helmets and reflective clothing. METHODS Data for this study were collected in 2 steps. The first step involved the collection of secondary data from the Kenya traffic police as well as the National Vital Registration System to assess the current trends of RTIs in Kenya. Following this, observational studies were conducted in the Thika and Naivasha districts in Kenya to assess the current status of speeding among all vehicles and the use of helmets and reflective clothing among motorcyclists. RESULTS The overall RTI rate in Kenya was 59.96 per 100,000 population in 2009, with vehicle passengers being the most affected. Notably, injuries to motorcyclists increased at an annual rate of approximately 29 percent (95% confidence interval [CI]: 27-32; P < .001). The mean age of death due to road traffic crashes was 35 years. Fatalities due to RTIs increased at an annual rate of 7 percent (95% CI: 6-8; P < .001) for the period 2004 to 2009. Observational studies revealed that 69.45 percent of vehicles in Thika and 34.32 percent of vehicles in Naivasha were speeding. Helmets were used by less than one third of motorcycle drivers in both study districts, with prevalence rates ranging between 3 and 4 percent among passengers. CONCLUSIONS This study highlights the significant burden of RTIs in Kenya. A renewed focus on addressing this burden is necessary. Focusing on increasing helmet and reflective clothing use and enforcement of speed limits has the potential to prevent a large number of road traffic crashes, injuries, and fatalities. However, it is difficult to demonstrate the magnitude of the injury problem to policymakers with minimal or inaccurate data, and this study illustrates the need for national continuous, systematic, and sustainable data collection efforts, echoing similar calls for action throughout the injury literature.
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Affiliation(s)
- Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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