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Assefa N, Regassa LD, Teklemariam Z, Oundo J, Madrid L, Dessie Y, Scott J. Seroprevalence of anti-SARS-CoV-2 antibodies in women attending antenatal care in eastern Ethiopia: a facility-based surveillance. BMJ Open 2021; 11:e055834. [PMID: 34819290 PMCID: PMC8613670 DOI: 10.1136/bmjopen-2021-055834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/01/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We conducted serosurveillance of anti-SARS-CoV-2 antibodies among pregnant women attending their first antenatal care. SETTING The surveillance was set in one referral hospital in Harar, one district hospital and one health centre located in Haramaya district in rural eastern Ethiopia. PARTICIPANTS We collected questionnaire data and a blood sample from 3312 pregnant women between 1 April 2020 and 31 March 2021. We selected 1447 blood samples at random and assayed these for anti-SARS-CoV-2 antibodies at Hararghe Health Research laboratory using WANTAI SARS-CoV-2 Rapid Test for total immunoglobulin. OUTCOME We assayed for anti-SARS-CoV-2 antibodies and temporal trends in seroprevalence were analysed with a χ2 test for trend and multivariable binomial regression. RESULTS Among 1447 sera tested, 83 were positive for anti-SARS-CoV-2 antibodies giving a crude seroprevalence of 5.7% (95% CI 4.6% to 7.0%). Of 160 samples tested in April-May 2020, none was seropositive; the first seropositive sample was identified in June and seroprevalence rose steadily thereafter (χ2 test for trend, p=0.003) reaching a peak of 11.8% in February 2021. In the multivariable model, seroprevalence was approximately 3% higher in first-trimester mothers compared with later presentations, and rose by 0.75% (95% CI 0.31% to 1.20%) per month of calendar time. CONCLUSIONS This clinical convenience sample illustrates the dynamic of the SARS-CoV-2 epidemic in pregnant women in eastern Ethiopia; infection was rare before June 2020 but it spread in a linear fashion thereafter, rather than following intermittent waves, and reached 10% by the beginning of 2021. After 1 year of surveillance, most pregnant mothers remained susceptible.
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Affiliation(s)
- Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Zelalem Teklemariam
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Joseph Oundo
- London School of Hygiene & Tropical Medicine, London, UK
| | - Lola Madrid
- London School of Hygiene & Tropical Medicine, London, UK
| | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Jag Scott
- London School of Hygiene & Tropical Medicine, London, UK
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Assefa N, Hassen JY, Admassu D, Brhane M, Deressa M, Marami D, Teklemariam Z, Dessie Y, Oundo J. COVID-19 Testing Experience in a Resource-Limited Setting: The Use of Existing Facilities in Public Health Emergency Management. Front Public Health 2021; 9:675553. [PMID: 34195170 PMCID: PMC8236620 DOI: 10.3389/fpubh.2021.675553] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) is a public health emergency with little testing and treatment experiences at its occurrence. Diagnostic and treatment rapidly changed in the world including Ethiopia. Haramaya University has strived to change its diagnostic capacity using existing facilities in response to the national call to the pandemic. Objective: This summary aims to detail experiences of setting up COVID-19 testing in Haramaya University laboratories, Eastern Ethiopia. Methods: Desktop exercise was conducted to understand the start-up and implementations of COVID-19 testing in two Haramaya University laboratories, Hararghe Health Research Partnership and Campylobacter Genomics and Environmental Enteric Dysfunction laboratories. Communication, formats, guidelines, and standards were reviewed and summarized. Discussion with those involved in the start-up and implementation of the testing were also held. Ideas were summarized to learn the experiences the COVID-19 testing exercises. Lesson Learned: This is a huge experience for Haramaya University to participate in the national call to increase the testing platform in the management of COVID19. Close work relationship with the public health authorities at all levels demonstrated the university's commitment to public service. The university has used the opportunity to advance its molecular testing capability by training its staff and students. The University has also contributed to the capacity development for laboratories in the surrounding areas of Harar, Somali, Oromia, and Dire Dawa. The pandemic has been an opportunity in harnessing existing resource for the benefit of the public during such times of dire needs to provide critical public health laboratory interventions.
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Affiliation(s)
- Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Jemal Yousuf Hassen
- College of Agriculture and Environmental Sciences, Haramaya University, East Hararghe, Ethiopia
| | - Desalegn Admassu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mussie Brhane
- Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Mersen Deressa
- Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Dadi Marami
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Zelalem Teklemariam
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Joseph Oundo
- Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
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Bartonjo G, Oundo J, Ng'ang'a Z. Prevalence and associated risk factors of transfusion transmissible infections among blood donors at Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital, Kenya. Pan Afr Med J 2019; 34:31. [PMID: 31762899 PMCID: PMC6859030 DOI: 10.11604/pamj.2019.34.31.17885] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/29/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Unsafe transfusion practices can put millions of people at risk of Transfusion Transmissible Infections (TTIs). In Kenya the current blood transfusion scheme involves screening of blood for HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV) and syphilis. Malaria is also a blood-borne disease which is not currently screened for. In Kenya blood donor selection criteria were reviewed in 2009. Regular review of effectiveness of donor selection criteria can help reduce TTIs prevalence amongst donors and thus make the blood supply safer. Methods A cross sectional study was conducted between November 2011 to January 2012 among 594 blood donors in the Regional Blood Transfusion Center Nakuru and Tenwek Mission Hospital. Socio-demographic characteristics and associated risk factors were collected using a standard blood transfusion service questionnaire. Donors were obtained through systematic sampling. Each donor sample was screened, for HIV-1 and HIV-2, HBV, HCV, syphilis and malaria parasites. Results The overall prevalence of TTIs was 14.1%, which ranged from 0.7% for malaria to 5.6% for HBsAg. Blood donors who were married (P=0.0057), had non-formal or just primary education (P=0.0262), had multiple sexual partners (P=0.0144) and in informal occupation (P=0.0176) were at higher risk of HIV positivity. History of blood transfusion/blood products (P=0.0055), being married (P=0.0053) were high risk factors associated with positive syphilis. Being male (P=0.0479) was a high risk factor to HBV infection. Conclusion The prevalence of TTIs indicates a need to review the questionnaire and apply it strictly for donor selection. The 0.7% prevalence of malaria, poses a serious health risk to non-immune recipients of transfusion. Malaria should be included among mandatory TTI tests in Kenya.
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Affiliation(s)
- Grace Bartonjo
- National Public Health Laboratory Services (NPHLS), Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Kenya.,Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Joseph Oundo
- United States Army Medical Research Unit, Nairobi, Kenya
| | - Zipporah Ng'ang'a
- Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
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Delahoy MJ, Omore R, Ayers TL, Schilling KA, Blackstock AJ, Ochieng JB, Moke F, Jaron P, Awuor A, Okonji C, Juma J, Farag TH, Nasrin D, Panchalingam S, Nataro JP, Kotloff KL, Levine MM, Oundo J, Roellig DM, Xiao L, Parsons MB, Laserson K, Mintz ED, Breiman RF, O'Reilly CE. Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS). PLoS Negl Trop Dis 2018; 12:e0006640. [PMID: 30001340 PMCID: PMC6057667 DOI: 10.1371/journal.pntd.0006640] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 04/20/2018] [Revised: 07/24/2018] [Accepted: 06/27/2018] [Indexed: 01/20/2023] Open
Abstract
Background Cryptosporidium is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with Cryptosporidium infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012. Methodology/Principal findings At health facility enrollment, stool samples were tested for enteric pathogens and data on clinical, environmental, and behavioral characteristics collected. Each child’s health status was recorded at 60-day follow-up. Data were analyzed using logistic regression. Of the 1,778 children with MSD enrolled as cases in the GEMS-Kenya case-control study, 11% had Cryptosporidium detected in stool by enzyme immunoassay; in a genotyped subset, 81% were C. hominis. Among MSD cases, being an infant, having mucus in stool, and having prolonged/persistent duration diarrhea were associated with being Cryptosporidium-positive. Both boiling drinking water and using rainwater as the main drinking water source were protective factors for being Cryptosporidium-positive. At follow-up, Cryptosporidium-positive cases had increased odds of being stunted (adjusted odds ratio [aOR] = 1.65, 95% CI: 1.06–2.57), underweight (aOR = 2.08, 95% CI: 1.34–3.22), or wasted (aOR = 2.04, 95% CI: 1.21–3.43), and had significantly larger negative changes in height- and weight-for-age z-scores from enrollment. Conclusions/Significance Cryptosporidium contributes significantly to diarrheal illness in young children in western Kenya. Advances in point of care detection, prevention/control approaches, effective water treatment technologies, and clinical management options for children with cryptosporidiosis are needed. Cryptosporidium is an important cause of childhood diarrhea. Research on cryptosporidiosis in countries where it is endemic remains limited; few studies have comprehensively examined risk factors for children in Kenya and similar settings. We examined characteristics associated with Cryptosporidium in children with moderate-to-severe diarrhea in rural western Kenya. We found there is little to clinically distinguish cryptosporidiosis from other childhood diarrhea in the absence of point of care diagnostics. Infants had the highest odds of Cryptosporidium infection; it has been previously established that Cryptosporidium infections in infancy can have severe consequences. Prolonged/persistent duration diarrhea and growth shortfalls were significantly more pronounced among cases with Cryptosporidium. Undernutrition and stunting in children in low- and middle-income countries have predicted decreased cognitive and school performance, thus long-term consequences could be appreciable. Using rainwater as the primary drinking water source and boiling drinking water were protective against Cryptosporidium infection, thus certain water sources may contribute to transmission. Like other studies in Kenya, we predominantly identified Cryptosporidium hominis, an anthropogenic species. Advances in point of care detection, prevention and control approaches, effective water treatment technologies, and clinical management options are needed to mitigate the potentially severe and long-term consequences of Cryptosporidium infection in children.
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Affiliation(s)
- Miranda J. Delahoy
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Richard Omore
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Tracy L. Ayers
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Katharine A. Schilling
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Anna J. Blackstock
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - J. Benjamin Ochieng
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Feny Moke
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Peter Jaron
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alex Awuor
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Caleb Okonji
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Tamer H. Farag
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Dilruba Nasrin
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Sandra Panchalingam
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - James P. Nataro
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Myron M. Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Dawn M. Roellig
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Lihua Xiao
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Michele B. Parsons
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kayla Laserson
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- CDC-India, Delhi, India
| | - Eric D. Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- CDC-Kenya, Nairobi, Kenya
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Ciara E. O'Reilly
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Fidhow AM, Samwel A, Ng’ang’a Z, Oundo J, Nyangao J, Wences A. Molecular epidemiology and associated risk factors of rotavirus infection among children < 5 yrs hospitalized for acute gastroenteritis in North Eastern, Kenya, 2012. Pan Afr Med J 2017; 28:3. [PMID: 30167031 PMCID: PMC6113712 DOI: 10.11604/pamj.supp.2017.28.1.2486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 10/18/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Rotavirus is a leading cause of morbidity and mortality among children under five years worldwide. This study aimed to characterize the circulating genotypes of rotavirus and to determine risk factors of rotavirus infection in North Eastern, Kenya before the introduction of rotavirus vaccines. METHODS we conducted a cross sectional study among children < 5 years old hospitalized for acute gastroenteritis at the study hospital. Rotavirus was detected in stool specimens and further characterized using PAGE and RT-PCR. Socio-demographic and risk factor information was collected using a standard questionnaire. RESULTS we enrolled 237 children into the study hospitalized with acute gastroenteritis. Of these, 41 (17%) tested positive for group A rotavirus in stool specimens. Age < 2 years, unboiled tap water, underweight and low birth weight were identified as independent risk factors of rotavirus infection. Majority 8 (57%) of the detected rotavirus RNA profiles were long electropherotypes. G3, G9 and P4 were the predominant genotypes identified. CONCLUSION Rotavirus is an important aetiology of acute gastroenteritis among children under five years in this region. Risk factors common in other regions and rotavirus vaccine preventable genotypes are responsible for infection. We recommend the introduction of rotavirus vaccines, coupled with good infant nutrition, safe water supply and maternal hygienic practices during infant feeding.
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Affiliation(s)
- Ahmed Mohamed Fidhow
- Field Epidemiology and Laboratory Training Program,
Ministry of Public Health and Sanitation, Kenya
- Jomo Kenyatta University of Agriculture and
Technology, Kenya
| | - Amwayi Samwel
- Field Epidemiology and Laboratory Training Program,
Ministry of Public Health and Sanitation, Kenya
| | | | | | | | - Arvelo Wences
- Field Epidemiology and Laboratory Training Program,
Ministry of Public Health and Sanitation, Kenya
- Centers of Disease Control and Prevention, Kenya
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Oluoch P, Orwa J, Lugalia F, Mutinda D, Gichangi A, Oundo J, Karama M, Nganga Z, Galbraith J. Application of psychosocial models to Home-Based Testing and Counseling (HBTC) for increased uptake and household coverage in a large informal urban settlement in Kenya. Pan Afr Med J 2017; 27:285. [PMID: 29187954 PMCID: PMC5660906 DOI: 10.11604/pamj.2017.27.285.10104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/04/2017] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Home Based Testing and Counselling (HBTC) aims at reaching individuals who have low HIV risk perception and experience barriers which prevent them from seeking HIV testing and counseling (HTC) services. Saturating the community with HTC is needed to achieve the ambitious 90-90-90 targets of knowledge of HIV status, ARV treatment and viral suppression. This paper describes the use of health belief model and community participation principles in HBTC to achieve increased household coverage and HTC uptake. METHODS This cross sectional survey was done between August 2009 and April 2011 in Kibera slums, Nairobi city. Using three community participation principles; defining and mobilizing the community, involving the community, overcoming barriers and respect to cultural differences and four constructs of the health belief model; risk perception, perceived severity, perceived benefits of changed behavior and perceived barriers; we offered HTC services to the participants. Descriptive statistics were used to describe socio-demographic characteristics, calculate uptake and HIV prevalence. RESULTS There were 72,577 individuals enumerated at the start of the program; 75,141 residents were found during service delivery. Of those, 71,925 (95.7%) consented to participate, out of which 71,720 (99.7%) took the HIV test. First time testers were (39%). The HIV prevalence was higher (6.4%) among repeat testers than first time testers (4.0%) with more women (7.4%) testing positive than men (3.6%) and an overall 5.5% slum prevalence. CONCLUSION This methodology demonstrates that the use of community participation principles combined with a psychosocial model achieved high HTC uptake, coverage and diagnosed HIV in individuals who believed they are HIV free. This novel approach provides baseline for measuring HTC coverage in a community.
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Affiliation(s)
- Patricia Oluoch
- Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - James Orwa
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Fillet Lugalia
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - David Mutinda
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Anthony Gichangi
- Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Joseph Oundo
- United States Army Medical Research Unit (USAMRU) Kericho, Kenya
| | - Mohamed Karama
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Zipporah Nganga
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Jennifer Galbraith
- Division of Global HIV/AIDS and Tuberculosis (DGHT), Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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Schilling KA, Omore R, Derado G, Ayers T, Ochieng JB, Farag TH, Nasrin D, Panchalingam S, Nataro JP, Kotloff KL, Levine MM, Oundo J, Parsons MB, Bopp C, Laserson K, Stauber CE, Rothenberg R, Breiman RF, O'Reilly CE, Mintz ED. Factors Associated with the Duration of Moderate-to-Severe Diarrhea among Children in Rural Western Kenya Enrolled in the Global Enteric Multicenter Study, 2008-2012. Am J Trop Med Hyg 2017; 97:248-258. [PMID: 28719331 DOI: 10.4269/ajtmh.16-0898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Diarrheal disease is a leading cause of death among young children worldwide. As rates of acute diarrhea (AD; 1-6 days duration) have decreased, persistent diarrhea (PD; > 14 days duration) accounts for a greater proportion of the diarrheal disease burden. We describe factors associated with the duration of moderate-to-severe diarrhea in Kenyan children < 5 years old enrolled in the Global Enteric Multicenter Study. We found 587 (58%) children experienced AD, 360 (35%) had prolonged acute diarrhea (ProAD; 7-13 days duration), and 73 (7%) had PD. We constructed a Cox proportional hazards model to identify factors associated with diarrheal duration. Risk factors independently associated with longer diarrheal duration included infection with Cryptosporidium (hazard ratio [HR]: 0.868, P = 0.035), using an unimproved drinking water source (HR: 0.87, P = 0.035), and being stunted at enrollment (HR: 0.026, P < 0.0001). Diarrheal illness of extended duration appears to be multifactorial; given its association with adverse health and development outcomes, effective strategies should be implemented to reduce the duration and severity of diarrheal illness. Effective treatments for Cryptosporidium should be identified, interventions to improve drinking water are imperative, and nutrition should be improved through exclusive breastfeeding in infants ≤ 6 months and appropriate continued feeding practices for ill children.
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Affiliation(s)
- Katharine A Schilling
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Omore
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Gordana Derado
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John B Ochieng
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Tamer H Farag
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Dilruba Nasrin
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Sandra Panchalingam
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.,Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Karen L Kotloff
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Myron M Levine
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Joseph Oundo
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Michelle B Parsons
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheryl Bopp
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kayla Laserson
- Centers for Disease Control and Prevention, Delhi, India.,Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | | | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia.,Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Ciara E O'Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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8
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Oluoch P, Achia T, Mutinda D, Orwa J, Oundo J, Karama M, Ng'ang'a Z. Do clients receiving Home based testing and counselling (HBTC) utilize the HIV prevention messages delivered? A study among residents in an urban informal settlement in Kenya who previously received HBTC. Afr J Health Sci 2017; 30:139-158. [PMID: 30686907 PMCID: PMC6345175] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Home based HIV testing and counseling (HBTC) increases access to services and is associated with high testing uptake. Alongside testing, individuals are offered HIV prevention messages with an aim of helping them reduce HIV high risk sexual behaviors. This study explored the level of provision and subsequent utilization of HIV prevention messages and associated change in behavior among individuals who had received HBTC previously in an informal settlement. METHODS In a mixed method cross sectional study, we interviewed 1257 individuals and conducted 6 focus group discussions (FGD). Multiple correspondence analysis (MCA) was used to construct provision of prevention messages and behavior change indices using STATA 3.0. Pearson's chi-square statistics was used to test for bivariate association between the outcomes and logistic regression analysis was carried out with the behavior change index as the outcome of interest and the predictors considered significant (p<0.1). Thematic content analysis for qualitative data was done using Atlas 3.0. RESULTS Out of the 1257participants, 1078 (85.8%) had ever tested for HIV, with 74.2% having tested in the Kibera HBTC program. Nearly all (97.4%) rated HBTC experience as either excellent (62.4%) or good (37%) and would recommend it to a friend. Provision of prevention messages was high among HBTC clients compared to clients from other testing sites; partner reduction counselling (64% versus 52%) and faithfulness (78.3% versus 67%); p=0.001. Self-reported behavior change after HBTC was generally low with condom use at 10.7% and men more likely to practice safer sex (p = 0.002). Trust of the sexual partners and fear of suspicion were the main reasons given for not using condoms. Clients testing HIV positive after previous negative result were 3.4%. The focus group discussions reported multiple sexual partnerships among both HIV negative and positive residents alike. CONCLUSION Although prevention messages delivered during HBTC are accepted and appreciated in this community, their utilization is low in both HIV negative and positive individuals. Innovative strategies for change of normative beliefs about sexual behavior are urgently needed.
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Affiliation(s)
- P Oluoch
- Division of Global HIV/AIDS & TB (DGHT), US Centers for Disease Control and Prevention (CDC), Kenya and Institute of Tropical Medicine and Infectious Diseases (ITROMID)
| | - T Achia
- Division of Global HIV/AIDS & TB (DGHT), US Centers for Disease Control and Prevention (CDC), Kenya and Institute of Tropical Medicine and Infectious Diseases (ITROMID)
| | - D Mutinda
- Kenya Medical Research Institute (KEMRI), Kenya
| | - J Orwa
- Kenya Medical Research Institute (KEMRI), Kenya
| | - J Oundo
- United States Army Medical Research Unit (USAMRU), Kericho, Kenya
| | - M Karama
- Kenya Medical Research Institute (KEMRI), Kenya
| | - Z Ng'ang'a
- Jomo Kenyatta University of Agriculture and Technology. Nairobi, Kenya
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9
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Thani TS, Symekher SML, Boga H, Oundo J. Isolation and characterization of Escherichia coli pathotypes and factors associated with well and boreholes water contamination in Mombasa County. Pan Afr Med J 2016; 23:12. [PMID: 27200121 PMCID: PMC4856485 DOI: 10.11604/pamj.2016.23.12.7755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/17/2015] [Accepted: 12/07/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Safe water for human consumption is important, but there is a limited supply. Mombasa County has water shortages making residences rely on other sources of water including boreholes and wells. Microbiological evaluation of drinking water is important to reduce exposure to water borne enteric diseases. This cross sectional study aimed at determining the frequency and characterization of Escherichia coli (E. coli) pathotypes from water samples collected from wells and boreholes in Mombasa County. METHODS One hundred and fifty seven (157) water samples were collected from four divisions of the county and a questionnaire administered. The samples were inoculated to double strength MacConkey broth and incubated at 370C for up to 48 hours. Positive results were compared to the 3 tube McCrady MPN table. The E. coli were confirmed by Eijkman's test and antibiotic susceptibility carried out. Using polymerase chain reaction (PCR), the E. coli were characterized to establish pathotypes. RESULTS One hundred and thirty one (n = 131; 83.4%) samples had coliform bacteria with only 79 (60.3%) samples having E. coli. Significant values (<0.05) were noted when coliforms were compared to variables with E. Coli showing no significance when compared to similar variables. E. coli (n = 77; 100%) tested were sensitive to Gentamicin, while all (n = 77; 100%) isolates were resistant to Ampicillin. PCR typed isolates as enteroinvasive E. Coli (EIEC). CONCLUSION Findings suggest that coliforms and E. coli are major contaminants of wells and boreholes in Mombasa County. The isolates have a variety of resistant and sensitivity patterns to commonly used antibiotics.
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Affiliation(s)
| | | | - Hamadi Boga
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Joseph Oundo
- Field Epidemiology Training Program, Kenya; Walter Reed Program, kenya
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10
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Ofula V, Oundo J, Irura Z, Chepkorir E, Tigoi C, Ongus J, Coldren R, Sang R, Schoepp R, Rossi C. Evidence of presence of antibodies against selected arboviruses in Ijara and Marigat Districts, Kenya. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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11
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Ingle DJ, Tauschek M, Edwards DJ, Hocking DM, Pickard DJ, Azzopardi KI, Amarasena T, Bennett-Wood V, Pearson JS, Tamboura B, Antonio M, Ochieng JB, Oundo J, Mandomando I, Qureshi S, Ramamurthy T, Hossain A, Kotloff KL, Nataro JP, Dougan G, Levine MM, Robins-Browne RM, Holt KE. Evolution of atypical enteropathogenic E. coli by repeated acquisition of LEE pathogenicity island variants. Nat Microbiol 2016; 1:15010. [PMID: 27571974 DOI: 10.1038/nmicrobiol.2015.10] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 11/02/2015] [Indexed: 01/25/2023]
Abstract
Atypical enteropathogenic Escherichia coli (aEPEC) is an umbrella term given to E. coli that possess a type III secretion system encoded in the locus of enterocyte effacement (LEE), but lack the virulence factors (stx, bfpA) that characterize enterohaemorrhagic E. coli and typical EPEC, respectively. The burden of disease caused by aEPEC has recently increased in industrialized and developing nations, yet the population structure and virulence profile of this emerging pathogen are poorly understood. Here, we generated whole-genome sequences of 185 aEPEC isolates collected during the Global Enteric Multicenter Study from seven study sites in Asia and Africa, and compared them with publicly available E. coli genomes. Phylogenomic analysis revealed ten distinct widely distributed aEPEC clones. Analysis of genetic variation in the LEE pathogenicity island identified 30 distinct LEE subtypes divided into three major lineages. Each LEE lineage demonstrated a preferred chromosomal insertion site and different complements of non-LEE encoded effector genes, indicating distinct patterns of evolution of these lineages. This study provides the first detailed genomic framework for aEPEC in the context of the EPEC pathotype and will facilitate further studies into the epidemiology and pathogenicity of EPEC by enabling the detection and tracking of specific clones and LEE variants.
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Affiliation(s)
- Danielle J Ingle
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Victoria 3010, Australia.,Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Victoria 3010, Australia.,Centre for Systems Genomics, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Marija Tauschek
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Victoria 3010, Australia
| | - David J Edwards
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Victoria 3010, Australia.,Centre for Systems Genomics, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Dianna M Hocking
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Victoria 3010, Australia
| | - Derek J Pickard
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Kristy I Azzopardi
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Victoria 3010, Australia
| | - Thakshila Amarasena
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Victoria 3010, Australia
| | - Vicki Bennett-Wood
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Victoria 3010, Australia
| | - Jaclyn S Pearson
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Victoria 3010, Australia
| | - Boubou Tamboura
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Martin Antonio
- Medical Research Council Unit (United Kingdom), Fajara, The Gambia
| | - John B Ochieng
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Joseph Oundo
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça, (CISM), CP 1929, Maputo, Mozambique.,Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Shahida Qureshi
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | | | - Anowar Hossain
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Karen L Kotloff
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
| | - Gordon Dougan
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Myron M Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Roy M Robins-Browne
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Victoria 3010, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria 3052, Australia
| | - Kathryn E Holt
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Victoria 3010, Australia.,Centre for Systems Genomics, The University of Melbourne, Parkville, Victoria 3010, Australia
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12
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Blanton E, Wilhelm N, O'Reilly C, Muhonja E, Karoki S, Ope M, Langat D, Omolo J, Wamola N, Oundo J, Hoekstra R, Ayers T, De Cock K, Breiman R, Mintz E, Lantagne D. A rapid assessment of drinking water quality in informal settlements after a cholera outbreak in Nairobi, Kenya. J Water Health 2015; 13:714-725. [PMID: 26322757 DOI: 10.2166/wh.2014.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Populations living in informal settlements with inadequate water and sanitation infrastructure are at risk of epidemic disease. In 2010, we conducted 398 household surveys in two informal settlements in Nairobi, Kenya with isolated cholera cases. We tested source and household water for free chlorine residual (FCR) and Escherichia coli in approximately 200 households. International guidelines are ≥0.5 mg/L FCR at source, ≥0.2 mg/L at household, and <1 E. coli/100 mL. In these two settlements, 82% and 38% of water sources met FCR guidelines; and 7% and 8% were contaminated with E. coli, respectively. In household stored water, 82% and 35% met FCR guidelines and 11% and 32% were contaminated with E. coli, respectively. Source water FCR≥0.5 mg/L (p=0.003) and reported purchase of a household water treatment product (p=0.002) were associated with increases in likelihood that household stored water had ≥0.2 mg/L FCR, which was associated with a lower likelihood of E. coli contamination (p<0.001). These results challenge the assumption that water quality in informal settlements is universally poor and the route of disease transmission, and highlight that providing centralized water with ≥0.5 mg/L FCR or (if not feasible) household water treatment technologies reduces the risk of waterborne cholera transmission in informal settlements.
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Affiliation(s)
- Elizabeth Blanton
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natalie Wilhelm
- Tufts University, Boston, USA and 200 College Avenue, Medford, MA 02155, USA E-mail:
| | - Ciara O'Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Everline Muhonja
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya; Ministry of Public Health & Sanitation, Nairobi, Kenya
| | - Solomon Karoki
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya; Ministry of Public Health & Sanitation, Nairobi, Kenya
| | - Maurice Ope
- Ministry of Public Health & Sanitation, Nairobi, Kenya
| | - Daniel Langat
- Ministry of Public Health & Sanitation, Nairobi, Kenya
| | - Jared Omolo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya; Ministry of Public Health & Sanitation, Nairobi, Kenya
| | | | - Joseph Oundo
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Hoekstra
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tracy Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin De Cock
- Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Robert Breiman
- Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya; Emory Global Health Institute, Emory University, Atlanta, GA, USA and Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniele Lantagne
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Tufts University, Boston, USA and 200 College Avenue, Medford, MA 02155, USA E-mail:
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13
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Lindsay B, Saha D, Sanogo D, Das SK, Omore R, Farag TH, Nasrin D, Li S, Panchalingam S, Levine MM, Kotloff K, Nataro JP, Magder L, Hungerford L, Faruque ASG, Oundo J, Hossain MA, Adeyemi M, Stine OC. Association Between Shigella Infection and Diarrhea Varies Based on Location and Age of Children. Am J Trop Med Hyg 2015; 93:918-24. [PMID: 26324734 DOI: 10.4269/ajtmh.14-0319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/01/2015] [Indexed: 11/07/2022] Open
Abstract
Molecular identification of the invasion plasmid antigen-H (ipaH) gene has been established as a useful detection mechanism for Shigella spp. The Global Enteric Multicenter Study (GEMS) identified the etiology and burden of moderate-to-severe diarrhea (MSD) in sub-Saharan Africa and south Asia using a case-control study and traditional culture techniques. Here, we used quantitative polymerase chain reaction (qPCR) to identify Shigella spp. in 2,611 stool specimens from GEMS and compared these results to those using culture. Demographic and nutritional characteristics were assessed as possible risk factors. The qPCR identified more cases of shigellosis than culture; however, the distribution of demographic characteristics was similar by both methods. In regression models adjusting for Shigella quantity, age, and site, children who were exclusively breast-fed had significantly lower odds of MSD compared with children who were not breast-fed (odds ratio [OR] = 0.47, 95% confidence interval (CI) = 0.28-0.81). The association between Shigella quantity and MSD increased with age, with a peak in children of 24-35 months of age (OR = 8.2, 95% CI = 4.3-15.7) and the relationship between Shigella quantity and disease was greatest in Bangladesh (OR = 13.2, 95% CI = 7.3-23.8). This study found that qPCR identified more cases of Shigella and age, site, and breast-feeding status were significant risk factors for MSD.
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Affiliation(s)
- Brianna Lindsay
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Debasish Saha
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Doh Sanogo
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Sumon Kumar Das
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Richard Omore
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Tamer H Farag
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Dilruba Nasrin
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Shan Li
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Sandra Panchalingam
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Myron M Levine
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Karen Kotloff
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - James P Nataro
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Laurence Magder
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Laura Hungerford
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - A S G Faruque
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Joseph Oundo
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - M Anowar Hossain
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Mitchell Adeyemi
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
| | - Oscar Colin Stine
- University of Maryland School of Medicine, Baltimore, Maryland; Medical Research Council, Basse, The Gambia; Centre pour le Developpement des Vaccins du Mali, Bamako, Mali; icddr,b, Mirzapur, Bangladesh; School of Medicine, University of Virginia, Charlottesville, Virginia; U.S. Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya; Centre for Nutrition and Food Security, Mohakhali, Dhaka, Bangladesh
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14
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Pop M, Walker AW, Paulson J, Lindsay B, Antonio M, Hossain MA, Oundo J, Tamboura B, Mai V, Astrovskaya I, Corrada Bravo H, Rance R, Stares M, Levine MM, Panchalingam S, Kotloff K, Ikumapayi UN, Ebruke C, Adeyemi M, Ahmed D, Ahmed F, Alam MT, Amin R, Siddiqui S, Ochieng JB, Ouma E, Juma J, Mailu E, Omore R, Morris JG, Breiman RF, Saha D, Parkhill J, Nataro JP, Stine OC. Diarrhea in young children from low-income countries leads to large-scale alterations in intestinal microbiota composition. Genome Biol 2014; 15:R76. [PMID: 24995464 PMCID: PMC4072981 DOI: 10.1186/gb-2014-15-6-r76] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/27/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diarrheal diseases continue to contribute significantly to morbidity and mortality in infants and young children in developing countries. There is an urgent need to better understand the contributions of novel, potentially uncultured, diarrheal pathogens to severe diarrheal disease, as well as distortions in normal gut microbiota composition that might facilitate severe disease. RESULTS We use high throughput 16S rRNA gene sequencing to compare fecal microbiota composition in children under five years of age who have been diagnosed with moderate to severe diarrhea (MSD) with the microbiota from diarrhea-free controls. Our study includes 992 children from four low-income countries in West and East Africa, and Southeast Asia. Known pathogens, as well as bacteria currently not considered as important diarrhea-causing pathogens, are positively associated with MSD, and these include Escherichia/Shigella, and Granulicatella species, and Streptococcus mitis/pneumoniae groups. In both cases and controls, there tend to be distinct negative correlations between facultative anaerobic lineages and obligate anaerobic lineages. Overall genus-level microbiota composition exhibit a shift in controls from low to high levels of Prevotella and in MSD cases from high to low levels of Escherichia/Shigella in younger versus older children; however, there was significant variation among many genera by both site and age. CONCLUSIONS Our findings expand the current understanding of microbiota-associated diarrhea pathogenicity in young children from developing countries. Our findings are necessarily based on correlative analyses and must be further validated through epidemiological and molecular techniques.
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15
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Karambu S, Matiru V, Kiptoo M, Oundo J. Characterization and factors associated with diarrhoeal diseases caused by enteric bacterial pathogens among children aged five years and below attending Igembe District Hospital, Kenya. Pan Afr Med J 2013; 16:37. [PMID: 24570797 PMCID: PMC3932116 DOI: 10.11604/pamj.2013.16.37.2947] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/05/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Diarrhoea remains a major public health problem in East African nations such as Kenya. Surveillance for a broad range of enteric pathogens is necessary to accurately predict the frequency of pathogens and potential changes in antibiotic resistance patterns. METHODS A cross sectional study was conducted in Igembe District Hospital in Meru County to determine the burden and factors associated enteric bacterial infection among children aged five years and below. Stool samples were collected between March and July 2012. Bacterial pathogens were identified and antibiotic susceptibility of bacterial isolates was ascertained. Questionnaire was administered to the 308 study participants to identify the modifiable risk factors. Data was entered and analyzed using Epi Info version 3.5.3. RESULTS The study recruited 308 children. The mean age was 27.25 months, median of 26.0 months and age range between 2-60 months. The bacterial isolation rates were ETEC 9.1%, EPEC 6.8% and EAEC 12.3%, Salmonella paratyphoid (10.4%), Shigella flexineri (1.9%) and Shigella dysentriae (0.9%). Over 95%, of the isolates were resistance to amoxicillin, sulphinatozole, cotrimoxazole. Six factors were independently associated with diarrhoeal diseases, occupation of the parent/ guardian (miraa business) (OR=1.8, CI:1.44-4.99),care taker not washing hands after changing napkins (OR= 1.6, CI:1.2-19.7), child drank untreated water from the river (OR= 2.7, CI:2.4-9.9) child not exclusively breastfed (OR= 2.4, CI:2.1-10.5),child did not Wash hands before eating (OR=2.2, CI:1.91-16.3) and after visiting toilet (OR=3.7,CI:2.8-39.4). Eating of mangoes was found to be protective against diarrhoea (OR=0.5, CI:0.03-0.89). CONCLUSION The bacterial pathogens were found to be a significant cause of diarrhoea in the study participants. We established higher resistance to several commonly prescribed antibiotics. Several factors were significantly association with diarrhoea illness. We recommend multifaceted approach that acknowledges the public health aspects that would reduce the burden of diarrhoea infections as identified in this study.
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Affiliation(s)
- Shirley Karambu
- Field epidemiology and Laboratory training programme, Kenya ; Ministry of Public Health and Sanitation, Kenya
| | - Viviene Matiru
- Jomo Kenyatta University of Agriculture and Technology, Kenya
| | | | - Joseph Oundo
- United States Army Medical Research Unit - Kenya
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Boru WG, Kikuvi G, Omollo J, Abade A, Amwayi S, Ampofo W, Luman ET, Oundo J. Aetiology and factors associated with bacterial diarrhoeal diseases amongst urban refugee children in Eastleigh, Kenya: A case control study. Afr J Lab Med 2013; 2:63. [PMID: 29043163 PMCID: PMC5637770 DOI: 10.4102/ajlm.v2i1.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Received: 05/07/2012] [Accepted: 10/11/2012] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Kenya is home to over 400 000 refugees from neighbouring countries. There is scanty information about diarrhoea amongst urban refugees in Kenya. OBJECTIVES We investigated the enteric bacteria causing diarrhoea amongst urban refugee children and described the associated factors. METHOD During the period of August-December 2010, urban refugee children between the ages of two and five who attended Eastleigh County Council Health Centre were enrolled into the study. Diarrhoeal cases were compared with age-matched children with no diarrhoea (controls). Stool specimens were collected and enteric bacteria isolated. A questionnaire was administered to identify risk factors. RESULTS A total of 41 cases and 41 controls were enrolled in the study. The age and country of origin were similar for cases and controls. The bacterial isolation rates amongst the cases were: non-pathogenic Escherichia coli 71%, Shigella dysenteriae 2.4%, Shigella flexneri 2.4%, Salmonella paratyphi 5%. For the controls, non-pathogenic E. coli 90% and enterotoxigenic E. coli (ETEC) 2.4% were amongst the organisms isolated. All isolates were resistant to amoxicillin; resistance to other antibiotics varied by isolate type. Factors associated independently with diarrhoea included children not washing their hands with soap (aOR 5.9, p < 0.05), neighbour(s) having diarrhoea (aOR 39.8, p < 0.05), children not exclusively breastfed for their first 6 months (aOR 7.6, p < 0.05) and children eating food cooked the previous day (aOR 23.8, p = 0.002). CONCLUSIONS Shigella species, Salmonella species and ETEC were found to be responsible for diarrhoea amongst the urban refugee children. Measures to control and guide the use of antibiotics are critical for the prevention of antibiotic resistance. Efforts to improve personal and domestic hygiene, including educational campaigns to promote appropriate handwashing, should be encouraged.
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Affiliation(s)
- Waqo G Boru
- Field Epidemiology and Laboratory Training Programme, Kenya
| | - Gideon Kikuvi
- Institute of Tropical Medicine, Jomo Kenyatta University of Agriculture and Technology, Kenya
| | - Jared Omollo
- Field Epidemiology and Laboratory Training Programme, Kenya
| | - Ahmed Abade
- Field Epidemiology and Laboratory Training Programme, Kenya
| | - Samuel Amwayi
- Field Epidemiology and Laboratory Training Programme, Kenya
| | - William Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon
| | - Elizabeth T Luman
- Center for Global Health, U.S. Centers for Disease Control and Prevention, United States
| | - Joseph Oundo
- Field Epidemiology and Laboratory Training Programme, Kenya.,Centre for Disease Control and Prevention, Kenya
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Panchalingam S, Antonio M, Hossain A, Mandomando I, Ochieng B, Oundo J, Ramamurthy T, Tamboura B, Zaidi AKM, Petri W, Houpt E, Murray P, Prado V, Vidal R, Steele D, Strockbine N, Sansonetti P, Glass RI, Robins-Browne RM, Tauschek M, Svennerholm AM, Berkeley LY, Kotloff K, Levine MM, Nataro JP. Diagnostic microbiologic methods in the GEMS-1 case/control study. Clin Infect Dis 2013; 55 Suppl 4:S294-302. [PMID: 23169941 PMCID: PMC3502308 DOI: 10.1093/cid/cis754] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [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: 01/04/2023] Open
Abstract
To understand the etiology of moderate-to-severe diarrhea among children in high mortality areas of sub-Saharan Africa and South Asia, we performed a comprehensive case/control study of children aged <5 years at 7 sites. Each site employed an identical case/control study design and each utilized a uniform comprehensive set of microbiological assays to identify the likely bacterial, viral and protozoal etiologies. The selected assays effected a balanced consideration of cost, robustness and performance, and all assays were performed at the study sites. Identification of bacterial pathogens employed streamlined conventional bacteriologic biochemical and serological algorithms. Diarrheagenic Escherichia coli were identified by application of a multiplex polymerase chain reaction assay for enterotoxigenic, enteroaggregative, and enteropathogenic E. coli. Rotavirus, adenovirus, Entamoeba histolytica, Giardia enterica, and Cryptosporidium species were detected by commercially available enzyme immunoassays on stool samples. Samples positive for adenovirus were further evaluated for adenovirus serotypes 40 and 41. We developed a novel multiplex assay to detect norovirus (types 1 and 2), astrovirus, and sapovirus. The portfolio of diagnostic assays used in the GEMS study can be broadly applied in developing countries seeking robust cost-effective methods for enteric pathogen detection.
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Affiliation(s)
- Sandra Panchalingam
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
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18
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Balinandi S, Bakamutumaho B, Kayiwa JT, Ongus J, Oundo J, Awor AC, Lutwama JJ. The viral aetiology of influenza-like illnesses in Kampala and Entebbe, Uganda, 2008. Afr J Lab Med 2013; 2:65. [PMID: 29043164 PMCID: PMC5637772 DOI: 10.4102/ajlm.v2i1.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 04/09/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As the threat of zoonoses and the emergence of pandemic-prone respiratory viruses increases, there is a need to establish baseline information on the incidence of endemic pathogens in countries worldwide. OBJECTIVES To investigate the presence of viruses associated with influenza-like illnesses (ILI) in Uganda. METHODS A cross-sectional study was conducted in which nasopharyngeal swab specimens were collected from patients diagnosed with ILI in Kampala and Entebbe between 14 August 2008 - 15 December 2008. A multiplex polymerase chain reaction assay for detecting 12 respiratory viruses was used. RESULTS A total of 369 patients (52.3% females) was enrolled; the median age was 6 years (range 1-70). One or more respiratory viruses were detected in 172 (46.6%) cases and their prevalence were influenza A virus (19.2%), adenovirus (8.7%), human rhinovirus A (7.9%), coronavirus OC43 (4.3%), parainfluenza virus 1 (2.7%), parainfluenza virus 3 (2.7%), influenza B virus (2.2%), respiratory syncytial virus B (2.2%), human metapneumovirus (1.4%), respiratory syncytial virus A (1.1%), parainfluenza virus 2 (0.5%) and coronavirus 229E (0.5%). There were 24 (14.0%) mixed infections. CONCLUSIONS This study identified some of the respiratory viruses associated with ILI in Uganda. The circulation of some of the viruses was previously unknown in the study population. These results are useful in order to guide future surveillance and case management strategies involving respiratory illnesses in Uganda.
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Affiliation(s)
- Stephen Balinandi
- Field Epidemiology and Laboratory Training Program, Kenya.,Uganda Virus Research Institute, Uganda
| | | | | | - Juliette Ongus
- Department of Medical Laboratory Sciences, Jomo Kenyatta University of Agriculture and Technology, Kenya
| | - Joseph Oundo
- Field Epidemiology and Laboratory Training Program, Kenya
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Mohamed AA, Oundo J, Kariuki SM, Boga HI, Sharif SK, Akhwale W, Omolo J, Amwayi AS, Mutonga D, Kareko D, Njeru M, Li S, Breiman RF, Stine OC. Molecular epidemiology of geographically dispersed Vibrio cholerae, Kenya, January 2009-May 2010. Emerg Infect Dis 2012; 18:925-31. [PMID: 22607971 PMCID: PMC3358164 DOI: 10.3201/eid1806.111774] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [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: 12/05/2022] Open
Abstract
Isolates represent multiple genetic lineages, a finding consistent with multiple emergences from endemic reservoirs. Numerous outbreaks of cholera have occurred in Kenya since 1971. To more fully understand the epidemiology of cholera in Kenya, we analyzed the genetic relationships among 170 Vibrio cholerae O1 isolates at 5 loci containing variable tandem repeats. The isolates were collected during January 2009–May 2010 from various geographic areas throughout the country. The isolates grouped genetically into 5 clonal complexes, each comprising a series of genotypes that differed by an allelic change at a single locus. No obvious correlation between the geographic locations of the isolates and their genotypes was observed. Nevertheless, geographic differentiation of the clonal complexes occurred. Our analyses showed that multiple genetic lineages of V. cholerae were simultaneously infecting persons in Kenya. This finding is consistent with the simultaneous emergence of multiple distinct genetic lineages of V. cholerae from endemic environmental reservoirs rather than recent introduction and spread by travelers.
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Talkington D, Bopp C, Tarr C, Parsons MB, Dahourou G, Freeman M, Joyce K, Turnsek M, Garrett N, Humphrys M, Gomez G, Stroika S, Boncy J, Ochieng B, Oundo J, Klena J, Smith A, Keddy K, Gerner-Smidt P. Characterization of toxigenic Vibrio cholerae from Haiti, 2010-2011. Emerg Infect Dis 2012; 17:2122-9. [PMID: 22099116 PMCID: PMC3310580 DOI: 10.3201/eid1711.110805] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [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: 11/19/2022] Open
Abstract
In October 2010, the US Centers for Disease Control and Prevention received reports of cases of severe watery diarrhea in Haiti. The cause was confirmed to be toxigenic Vibrio cholerae, serogroup O1, serotype Ogawa, biotype El Tor. We characterized 122 isolates from Haiti and compared them with isolates from other countries. Antimicrobial drug susceptibility was tested by disk diffusion and broth microdilution. Analyses included identification of rstR and VC2346 genes, sequencing of ctxAB and tcpA genes, and pulsed-field gel electrophoresis with SfiI and NotI enzymes. All isolates were susceptible to doxycycline and azithromycin. One pulsed-field gel electrophoresis pattern predominated, and ctxB sequence of all isolates matched the B-7 allele. We identified the tcpETCIRS allele, which is also present in Bangladesh strain CIRS 101. These data show that the isolates from Haiti are clonally and genetically similar to isolates originating in Africa and southern Asia and that ctxB-7 and tcpET(CIRS) alleles are undergoing global dissemination.
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Affiliation(s)
- Deborah Talkington
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Lado D, Maina N, Lado M, Abade A, Amwayi S, Omolo J, Oundo J. BRUCELLOSIS IN TEREKEKA COUNTY, CENTRAL EQUATORIA STATE, SOUTHERN SUDAN. East Afr Med J 2012; 89:28-33. [PMID: 26845808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To identify factors associated with Brucellosis in patients attending Terekeka Health Facility, Terekeka County, Central Equatoria State, Southern Sudan and to evaluate the utility of the rapid test kit Euracil®. DESIGN A facility based case-control study. SETTING Terekeka Health Facility, Terekeka County, Central Equatoria State, Southern Sudan. SUBJECTS Cases were patients presenting at the Terekeka Health Facility with clinical symptoms suggestive of Brucellosis and tested positive for Brucellosis by rapid antigen test while controls were selected from individuals attending Terekeka Health facility with health problems unrelated to brucellosis or febrile illness. RESULTS A total of fifty eight cases with clinical symptoms suggestive of and tested positive for Brucellosis by rapid antigen test presented. A total of 116 consented controls were recruited into the study. Males accounted for 52% of the cases and 53% of the controls. The mean age was 31 years for both groups. Cases without formal education were 84% while 40% had no source of income, 20% of the cases and 14% of the controls were cattle keepers while 5% of the cases and 13% of the controls were students. In multivariate analysis there were many factors associated with Brucellosis like consumption of raw meat, living with animals at the same place, raising of goats, farm cleaning contact, eating of aborted and wild animals. Logistic regression revealed two factors associated with the disease; consumption of raw milk (OR=3.9, P-value 0.001, 95% CI 1.6666-9.0700) was a risk factor while drinking boiled milk was protective (OR = 0.09, p-value 0.000, 95% CI, 0.1-0.2). CONCLUSIONS The main age-groups affected were 20-30 years with males being affected more than females. Drinking of raw milk was significantly associated with Brucellosis while drinking boiled milk was protective. There should be active public health education on the benefits of boiling milk before consumption. Further studies to elucidate the extent and epidemiology of brucellosis in humans and animals in Southern Sudan are recommended.
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Mosha F, Oundo J, Mukanga D, Njenga K, Nsubuga P. Public health laboratory systems development in East Africa through training in laboratory management and field epidemiology. Pan Afr Med J 2011; 10 Supp 1:14. [PMID: 22359702 PMCID: PMC3266675] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/07/2011] [Indexed: 12/02/2022] Open
Abstract
Laboratories are integral to the delivery of quality health care and for public health functions; however laboratory systems and services are often neglected in resource-poor settings such as the East African region. In order to sustainably strengthen national laboratory systems in resource-poor countries, there is a need to train laboratory personnel to work in clinical as well as public health laboratories. In 2004,Kenya, Uganda, Tanzania, and South Sudan began training public health laboratory workers jointly with field epidemiologists in the Kenya Field Epidemiology and Laboratory Training Program (FELTP), and later through the Tanzania FELTP, as a strategy to strengthen public health laboratories. These programs train laboratory epidemiologists through a two-year public health leadership development course, and also offer various types of short course training for frontline staff. The FELTP laboratory graduates in Kenya, Tanzania, Uganda, and South Sudan are working in their respective countries to strengthen public health laboratory systems while the short course participants provide a pool of frontline implementers with the capacity to support the lower tiers of health systems, as well as serve as surge capacity for the regions and the national level. Through training competent public health laboratory workers, the East African ministries of health, in collaboration with other regional partners and stakeholders are now engaged in developing and implementing a holistic approach that will guarantee an overall strengthening of the health system by using well-trained public health laboratory leaders to drive the process. Strengthening public health laboratory medicine in East Africa is critical to improve health-care systems. The experience with the FELTP model in East Africa is a step in the right direction towards ensuring a stronger role for the laboratory in public health.
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Affiliation(s)
- Fausta Mosha
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania,Corresponding author: Fausta Mosha, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Joseph Oundo
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | - Kariuki Njenga
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Peter Nsubuga
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Nsubuga P, Johnson K, Tetteh C, Oundo J, Weathers A, Vaughan J, Elbon S, Tshimanga M, Ndugulile F, Ohuabunwo C, Evering-Watley M, Mosha F, Oleribe O, Nguku P, Davis L, Preacely N, Luce R, Antara S, Imara H, Ndjakani Y, Doyle T, Espinosa Y, Kazambu D, Delissaint D, Ngulefac J, Njenga K. Field Epidemiology and Laboratory Training Programs in sub-Saharan Africa from 2004 to 2010: need, the process, and prospects. Pan Afr Med J 2011; 10:24. [PMID: 22187606 PMCID: PMC3224071 DOI: 10.4314/pamj.v10i0.72235] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 10/05/2011] [Accepted: 10/14/2011] [Indexed: 11/17/2022] Open
Abstract
As of 2010 sub-Saharan Africa had approximately 865 million inhabitants living with numerous public health challenges. Several public health initiatives [e.g., the United States (US) President's Emergency Plan for AIDS Relief and the US President's Malaria Initiative] have been very successful at reducing mortality from priority diseases. A competently trained public health workforce that can operate multi-disease surveillance and response systems is necessary to build upon and sustain these successes and to address other public health problems. Sub-Saharan Africa appears to have weathered the recent global economic downturn remarkably well and its increasing middle class may soon demand stronger public health systems to protect communities. The Epidemic Intelligence Service (EIS) program of the US Centers for Disease Control and Prevention (CDC) has been the backbone of public health surveillance and response in the US during its 60 years of existence. EIS has been adapted internationally to create the Field Epidemiology Training Program (FETP) in several countries. In the 1990s CDC and the Rockefeller Foundation collaborated with the Uganda and Zimbabwe ministries of health and local universities to create 2-year Public Health Schools Without Walls (PHSWOWs) which were based on the FETP model. In 2004 the FETP model was further adapted to create the Field Epidemiology and Laboratory Training Program (FELTP) in Kenya to conduct joint competency-based training for field epidemiologists and public health laboratory scientists providing a master's degree to participants upon completion. The FELTP model has been implemented in several additional countries in sub-Saharan Africa. By the end of 2010 these 10 FELTPs and two PHSWOWs covered 613 million of the 865 million people in sub-Saharan Africa and had enrolled 743 public health professionals. We describe the process that we used to develop 10 FELTPs covering 15 countries in sub-Saharan Africa from 2004 to 2010 as a strategy to develop a locally trained public health workforce that can operate multi-disease surveillance and response systems.
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Affiliation(s)
- Peter Nsubuga
- Division of Public Health Systems and Workforce Development, Center for Global Health, US Centers for Disease Control and Prevention, USA
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Mogaka EO, Ng'ang'a Z, Oundo J, Omolo J, Luman E. Factors associated with severity of road traffic injuries, Thika, Kenya. Pan Afr Med J 2011; 8:20. [PMID: 22121429 PMCID: PMC3201586 DOI: 10.4314/pamj.v8i1.71076] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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: 01/18/2011] [Accepted: 03/02/2011] [Indexed: 11/21/2022] Open
Abstract
Background: Road traffic injuries continue to exert a huge burden on the health care system in Kenya. Few studies on the severity of road traffic injuries have been conducted in Kenya. We carried out a cross-sectional study to determine factors associated with severity of road traffic injuries in a public hospital in Thika district, Kenya. Methods: Road crash victims attending the Thika district hospital, a 265-bed public hospital, emergency room were recruited consecutively between 10th August 2009 and 15th November 2009. Epidemiologic and clinical information was collected from medical charts and through interview with the victims or surrogates using a semi-structured questionnaire. Injuries were graded as severe or non-severe based on the Injury Severity Score (ISS). Independent factors associated with injury severity were assessed using multivariate logistic regression. Results: The mean age of participants was 32.4 years, three quarters were between 20-49 years-old and 73% (219) were male. Nineteen percent (56/300) of the victims had severe injury. Five percent (15) had head injury while 38% (115) had fractures. Vulnerable road users (pedestrians and two-wheel users) comprised 33% (99/300) of the victims. Vulnerable road users (OR=2.0, 95%CI=1.0-3.9), road crashes in rainy weather (OR=2.9, 95%CI=1.3-6.5) and night time crashes (OR=2.0, 95%CI=-1.1-3.9) were independent risk factors for sustaining severe injury. Conclusion: Severe injury was associated with vulnerable road users, rainy weather and night time crashes. Interventions and measures such as use of reflective jackets and helmets by two wheel users and enhanced road visibility could help reduce the severity of road traffic injuries.
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Affiliation(s)
- Eric Osoro Mogaka
- Jomo Kenyatta University of Agriculture and Technology, Field Epidemiology and Laboratory Training Program and Ministry of Public Health and Sanitation, Nakuru, Kenya
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Moïsi JC, Saha SK, Falade AG, Njanpop-Lafourcade BM, Oundo J, Zaidi AKM, Afroj S, Bakare RA, Buss JK, Lasi R, Mueller J, Odekanmi AA, Sangaré L, Scott JAG, Knoll MD, Levine OS, Gessner BD. Enhanced diagnosis of pneumococcal meningitis with use of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen: a multisite study. Clin Infect Dis 2009; 48 Suppl 2:S49-56. [PMID: 19191619 DOI: 10.1086/596481] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Accurate etiological diagnosis of meningitis in developing countries is needed, to improve clinical care and to optimize disease-prevention strategies. Cerebrospinal fluid (CSF) culture and latex agglutination testing are currently the standard diagnostic methods but lack sensitivity. METHODS We prospectively assessed the utility of an immunochromatographic test (ICT) of pneumococcal antigen (NOW Streptococcus pneumoniae Antigen Test; Binax), compared with culture, in 5 countries that are conducting bacterial meningitis surveillance in Africa and Asia. Most CSF samples were collected from patients aged 1-59 months. RESULTS A total of 1173 CSF samples from suspected meningitis cases were included. The ICT results were positive for 68 (99%) of the 69 culture-confirmed pneumococcal meningitis cases and negative for 124 (99%) of 125 culture-confirmed bacterial meningitis cases caused by other pathogens. By use of culture and latex agglutination testing alone, pneumococci were detected in samples from 7.4% of patients in Asia and 15.6% in Africa. The ICT increased pneumococcal detection, resulting in similar identification rates across sites, ranging from 16.2% in Nigeria to 20% in Bangladesh. ICT detection in specimens from culture-negative cases varied according to region (8.5% in Africa vs. 18.8% in Asia; P< .001), prior antibiotic use (24.2% with prior antibiotic use vs. 12.2% without; P< .001), and WBC count (9.0% for WBC count of 10-99 cells/mL, 22.1% for 100-999 cells/mL, and 25.4% for >or=1000 cells/mL; P< .001 by test for trend). CONCLUSIONS The ICT provided substantial benefit over the latex agglutination test and culture at Asian sites but not at African sites. With the addition of the ICT, the proportion of meningitis cases attributable to pneumococci was determined to be similar in Asia and Africa. These results suggest that previous studies have underestimated the proportion of pediatric bacterial meningitis cases caused by pneumococci.
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Affiliation(s)
- Jennifer C Moïsi
- GAVI Alliance's PneumoADIP, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
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Shanks GD, Smoak BL, Aleman GM, Oundo J, Waiyaki PG, Dunne MW, Petersen L. Single dose of azithromycin or three-day course of ciprofloxacin as therapy for epidemic dysentery in Kenya. Acute Dysentery Study Group. Clin Infect Dis 1999; 29:942-3. [PMID: 10589921 DOI: 10.1086/520469] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- G D Shanks
- U.S. Army Medical Research Unit-Kenya and Kenya Medical Research Institute, Nairobi.
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