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Mutono N, Basáñez MG, James A, Stolk WA, Makori A, Kimani TN, Hollingsworth TD, Vasconcelos A, Dixon MA, de Vlas SJ, Thumbi SM. Elimination of transmission of onchocerciasis (river blindness) with long-term ivermectin mass drug administration with or without vector control in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e771-e782. [PMID: 38484745 PMCID: PMC11009120 DOI: 10.1016/s2214-109x(24)00043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND WHO has proposed elimination of transmission of onchocerciasis (river blindness) by 2030. More than 99% of cases of onchocerciasis are in sub-Saharan Africa. Vector control and mass drug administration of ivermectin have been the main interventions for many years, with varying success. We aimed to identify factors associated with elimination of onchocerciasis transmission in sub-Saharan Africa. METHODS For this systematic review and meta-analysis we searched for published articles reporting epidemiological or entomological assessments of onchocerciasis transmission status in sub-Saharan Africa, with or without vector control. We searched MEDLINE, PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, African Index Medicus, and Google Scholar databases for all articles published from database inception to Aug 19, 2023, without language restrictions. The search terms used were "onchocerciasis" AND "ivermectin" AND "mass drug administration". The three inclusion criteria were (1) focus or foci located in Africa, (2) reporting of elimination of transmission or at least 10 years of ivermectin mass drug administration in the focus or foci, and (3) inclusion of at least one of the following assessments: microfilarial prevalence, nodule prevalence, Ov16 antibody seroprevalence, and blackfly infectivity prevalence. Epidemiological modelling studies and reviews were excluded. Four reviewers (NM, AJ, AM, and TNK) extracted data in duplicate from the full-text articles using a data extraction tool developed in Excel with columns recording the data of interest to be extracted, and a column where important comments for each study could be highlighted. We did not request any individual-level data from authors. Foci were classified as achieving elimination of transmission, being close to elimination of transmission, or with ongoing transmission. We used mixed-effects meta-regression models to identify factors associated with transmission status. This study is registered in PROSPERO, CRD42022338986. FINDINGS Of 1525 articles screened after the removal of duplicates, 75 provided 282 records from 238 distinct foci in 19 (70%) of the 27 onchocerciasis-endemic countries in sub-Saharan Africa. Elimination of transmission was reported in 24 (9%) records, being close to elimination of transmission in 86 (30%) records, and ongoing transmission in 172 (61%) records. I2 was 83·3% (95% CI 79·7 to 86·3). Records reporting 10 or more years of continuous mass drug administration with 80% or more therapeutic coverage of the eligible population yielded significantly higher odds of achieving elimination of transmission (log-odds 8·5 [95% CI 3·5 to 13·5]) or elimination and being close to elimination of transmission (42·4 [18·7 to 66·1]) than those with no years achieving 80% coverage or more. Reporting 15-19 years of ivermectin mass drug administration (22·7 [17·2 to 28·2]) and biannual treatment (43·3 [27·2 to 59·3]) were positively associated with elimination and being close to elimination of transmission compared with less than 15 years and no biannual mass drug administration, respectively. Having had vector control without vector elimination (-42·8 [-59·1 to -26·5]) and baseline holoendemicity (-41·97 [-60·6 to -23·2]) were associated with increased risk of ongoing transmission compared with no vector control and hypoendemicity, respectively. Blackfly disappearance due to vector control or environmental change contributed to elimination of transmission. INTERPRETATION Mass drug administration duration, frequency, and coverage; baseline endemicity; and vector elimination or disappearance are important determinants of elimination of onchocerciasis transmission in sub-Saharan Africa. Our findings underscore the importance of improving and sustaining high therapeutic coverage and increasing treatment frequency if countries are to achieve elimination of onchocerciasis transmission. FUNDING The Bill & Melinda Gates Foundation and Neglected Tropical Diseases Modelling Consortium, UK Medical Research Council, and Global Health EDCTP3 Joint Undertaking. TRANSLATIONS For the Swahili, French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Nyamai Mutono
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA.
| | - Maria-Gloria Basáñez
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK; London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Ananthu James
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anita Makori
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Teresia Njoki Kimani
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA; Ministry of Health Kenya, Kiambu Town, Kenya
| | | | | | - Matthew A Dixon
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK; London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - S M Thumbi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA; Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
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Kura K, Mutono N, Basáñez MG, Collyer BS, Coffeng LE, Thumbi SM, Anderson RM. How Does Treatment Coverage and Proportion Never Treated Influence the Success of Schistosoma mansoni Elimination as a Public Health Problem by 2030? Clin Infect Dis 2024; 78:S126-S130. [PMID: 38662698 PMCID: PMC11045018 DOI: 10.1093/cid/ciae074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The 2030 target for schistosomiasis is elimination as a public health problem (EPHP), achieved when the prevalence of heavy-intensity infection among school-aged children (SAC) reduces to <1%. To achieve this, the new World Health Organization guidelines recommend a broader target of population to include pre-SAC and adults. However, the probability of achieving EPHP should be expected to depend on patterns in repeated uptake of mass drug administration by individuals. METHODS We employed 2 individual-based stochastic models to evaluate the impact of school-based and community-wide treatment and calculated the number of rounds required to achieve EPHP for Schistosoma mansoni by considering various levels of the population never treated (NT). We also considered 2 age-intensity profiles, corresponding to a low and high burden of infection in adults. RESULTS The number of rounds needed to achieve this target depends on the baseline prevalence and the coverage used. For low- and moderate-transmission areas, EPHP can be achieved within 7 years if NT ≤10% and NT <5%, respectively. In high-transmission areas, community-wide treatment with NT <1% is required to achieve EPHP. CONCLUSIONS The higher the intensity of transmission, and the lower the treatment coverage, the lower the acceptable value of NT becomes. Using more efficacious treatment regimens would permit NT values to be marginally higher. A balance between target treatment coverage and NT values may be an adequate treatment strategy depending on the epidemiological setting, but striving to increase coverage and/or minimize NT can shorten program duration.
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Affiliation(s)
- Klodeta Kura
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
| | - Nyamai Mutono
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
| | - Benjamin S Collyer
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
| | - Luc E Coffeng
- Department of Public Health, Erasmus University Medical Center, University Medical Center Rotterdam, The Netherlands
| | - S M Thumbi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman
- Institute of Immunology and Infection Research, University of Edinburgh, United Kingdom
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
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Thumbi SM, Oliwa J, Silal SP. Strengthening health policy modelling in Africa. Lancet Glob Health 2024; 12:e555-e556. [PMID: 38485421 DOI: 10.1016/s2214-109x(24)00027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 03/19/2024]
Affiliation(s)
- S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi 30197-00100, Kenya; Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK; Paul Allen School for Global Health, Washington State University, Pullman, WA, USA.
| | - Jacquie Oliwa
- Health Services Unit, KEMRI-Wellcome Trust Research Program, Nairobi, Kenya
| | - Sheetal P Silal
- Modelling and Simulation Hub, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Ogoti BM, Riitho V, Wildemann J, Mutono N, Tesch J, Rodon J, Harichandran K, Emanuel J, Möncke-Buchner E, Kiambi S, Oyugi J, Mureithi M, Corman VM, Drosten C, Thumbi SM, Müller MA. Biphasic MERS-CoV Incidence in Nomadic Dromedaries with Putative Transmission to Humans, Kenya, 2022-2023. Emerg Infect Dis 2024; 30:581-585. [PMID: 38407189 PMCID: PMC10902546 DOI: 10.3201/eid3003.231488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is endemic in dromedaries in Africa, but camel-to-human transmission is limited. Sustained 12-month sampling of dromedaries in a Kenya abattoir hub showed biphasic MERS-CoV incidence; peak detections occurred in October 2022 and February 2023. Dromedary-exposed abattoir workers (7/48) had serologic signs of previous MERS-CoV exposure.
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Affiliation(s)
| | | | | | - Nyamai Mutono
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Julia Tesch
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Jordi Rodon
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Kaneemozhe Harichandran
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Jackson Emanuel
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Elisabeth Möncke-Buchner
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Stella Kiambi
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Julius Oyugi
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Marianne Mureithi
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Victor M. Corman
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Christian Drosten
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
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Thumbi SM, Muema J, Mutono N, Njuguna J, Jost C, Boyd E, Tewoldeberhan D, Mutua I, Gacharamu G, Wambua F, Allport R, Olesambu E, Osman AM, Souza D, Kimani I, Oyugi J, Bukania Z, Oboge H, Palmer GH, Yoder J. The Livestock for Health Study: A Field Trial on Livestock Interventions to Prevent Acute Malnutrition Among Women and Children in Pastoralist Communities in Northern Kenya. Food Nutr Bull 2023; 44:S119-S123. [PMID: 37850922 DOI: 10.1177/03795721231195427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Livestock-dependent communities in Africa's drylands disproportionately experience acute malnutrition, especially during drought seasons. We detail the design and implementation of the Livestock for Health (L4H) study aimed at determining the effect of providing livestock feed and nutritional counselling to prevent seasonal spikes of acute malnutrition. METHODS The L4H study employed a 3-arm cluster randomized controlled trial to compare households in pastoralist settings in northern Kenya receiving livestock feeds during critical dry periods, with or without nutritional counseling, with control households. Over 4 dry seasons, 2019 to 2021, the study collected data on household milk production, consumption patterns, mothers'/children's nutritional status, household socioeconomic status, herd dynamics, and human and animal health status every 6 weeks. RESULTS L4H recruited 1734 households, with 639, 585, and 510 households assigned to intervention arms 1 and 2 and control arm 3, respectively. From these households, 1734 women and 1748 children younger than 3 years were recruited. In total, 19 419 household visits were completed, obtaining anthropometric measures 9 times on average for each child and mother. Eighty-one households (5%) were lost from the study due to the mother's death, child's death, migration, and withdrawal for other reasons. DISCUSSION L4H's success in a challenging environment was possible due to strong community engagement, formative studies to inform trial design, collaboration with local authorities, and effective interdisciplinary collaboration. Subsequent manuscripts will report the study findings. TRIAL REGISTRATION The study was registered October 29, 2020, and is online at ClinicalTrials.gov (ID: NCT04608656).
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Affiliation(s)
- Samuel M Thumbi
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Immunology and Infection Research, University of Edinburgh
| | - Josphat Muema
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Nyamai Mutono
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Christine Jost
- Global Health Training, Advising, and Support Contract, Credence Management Solutions LLC, supporting the United States Agency for International Development (USAID) Bureau for Humanitarian Assistance
| | - Erin Boyd
- United States Agency for International Development's Bureau for Humanitarian Assistance (USAID/BHA), Washington, DC
| | | | - Immaculate Mutua
- Ministry of Health, Government of Marsabit County, Marsabit, Kenya
| | | | | | | | - Emmanuella Olesambu
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Abdal Monium Osman
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Darana Souza
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Irene Kimani
- United States Agency for International Development's Bureau for Humanitarian Assistance (USAID/BHA), Washington, DC
| | - Julius Oyugi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
| | - Harriet Oboge
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Jonathan Yoder
- Feed the Future Innovation Lab for Animal Health, Washington State University
- School of Economic Sciences, Washington state University, Pullman, USA
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Muturi M, Mwatondo A, Nijhof AM, Akoko J, Nyamota R, Makori A, Nyamai M, Nthiwa D, Wambua L, Roesel K, Thumbi SM, Bett B. Ecological and subject-level drivers of interepidemic Rift Valley fever virus exposure in humans and livestock in Northern Kenya. Sci Rep 2023; 13:15342. [PMID: 37714941 PMCID: PMC10504342 DOI: 10.1038/s41598-023-42596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
Nearly a century after the first reports of Rift Valley fever (RVF) were documented in Kenya, questions on the transmission dynamics of the disease remain. Specifically, data on viral maintenance in the quiescent years between epidemics is limited. We implemented a cross-sectional study in northern Kenya to determine the seroprevalence, risk factors, and ecological predictors of RVF in humans and livestock during an interepidemic period. Six hundred seventy-six human and 1,864 livestock samples were screened for anti-RVF Immunoglobulin G (IgG). Out of the 1,864 livestock samples tested for IgG, a subset of 1,103 samples was randomly selected for additional testing to detect the presence of anti-RVFV Immunoglobulin M (IgM). The anti-RVF virus (RVFV) IgG seropositivity in livestock and humans was 21.7% and 28.4%, respectively. RVFV IgM was detected in 0.4% of the livestock samples. Participation in the slaughter of livestock and age were positively associated with RVFV exposure in humans, while age was a significant factor in livestock. We detected significant interaction between rainfall and elevation's influence on livestock seropositivity, while in humans, elevation was negatively associated with RVF virus exposure. The linear increase of human and livestock exposure with age suggests an endemic transmission cycle, further corroborated by the detection of IgM antibodies in livestock.
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Affiliation(s)
- Mathew Muturi
- Department of Veterinary Medicine, Dahlem Research School of Biomedical Sciences (DRS), Freie Universität Berlin, Berlin, Germany.
- International Livestock Research Institute, Nairobi, Kenya.
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Nairobi, Kenya.
- Center for Epidemiological Modelling and Analysis-University of Nairobi, Nairobi, Kenya.
| | - Athman Mwatondo
- International Livestock Research Institute, Nairobi, Kenya
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Nairobi, Kenya
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
| | - Ard M Nijhof
- Veterinary Centre for Resistance Research, Freie Universität Berlin, Berlin, Germany
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Univesität Berlin, Berlin, Germany
| | - James Akoko
- International Livestock Research Institute, Nairobi, Kenya
| | | | - Anita Makori
- Center for Epidemiological Modelling and Analysis-University of Nairobi, Nairobi, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Mutono Nyamai
- Center for Epidemiological Modelling and Analysis-University of Nairobi, Nairobi, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Daniel Nthiwa
- Department of Biological Sciences, University of Embu, Embu, Kenya
| | - Lilian Wambua
- International Livestock Research Institute, Nairobi, Kenya
| | | | - S M Thumbi
- Center for Epidemiological Modelling and Analysis-University of Nairobi, Nairobi, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA
- Institute for Immunology and Infection Research, University of Edinburgh, Edinburgh, Scotland, UK
| | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
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Muema J, Mutono N, Kisaka S, Ogoti B, Oyugi J, Bukania Z, Daniel T, Njuguna J, Kimani I, Makori A, Omulo S, Boyd E, Osman AM, Gwenaelle L, Jost C, Thumbi SM. The impact of livestock interventions on nutritional outcomes of children younger than 5 years old and women in Africa: a systematic review and meta-analysis. Front Nutr 2023; 10:1166495. [PMID: 37485389 PMCID: PMC10358768 DOI: 10.3389/fnut.2023.1166495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Nutrition-sensitive livestock interventions have the potential to improve the nutrition of communities that are dependent on livestock for their livelihoods by increasing the availability and access to animal-source foods. These interventions can also boost household income, improving purchasing power for other foods, as well as enhance determinants of health. However, there is a lack of synthesized empirical evidence of the impact and effect of livestock interventions on diets and human nutritional status in Africa. Objective To review evidence of the effectiveness of nutrition-sensitive livestock interventions in improving diets and nutritional status in children younger than 5 years old and in pregnant and lactating women. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of published studies reporting on the effect of livestock interventions on maternal and child nutrition in Africa. Data were extracted, synthesized, and summarized qualitatively. Key outcomes were presented in summary tables alongside a narrative summary. Estimation of pooled effects was undertaken for experimental studies with nutritional outcomes of consumption of animal-source foods (ASFs) and minimum dietary diversity (MDD). Fixed effects regression models and pooled effect sizes were computed and reported as odds ratios (ORs) together with their 95% confidence intervals (CI). Results After the screening, 29 research papers were included in the review, and of these, only 4 were included in the meta-analysis. We found that nutrition-sensitive livestock interventions have a significant positive impact on the consumption of ASFs for children < 5 years (OR = 5.39; 95% CI: 4.43-6.56) and on the likelihood of meeting minimum dietary diversity (OR = 1.89; 95% CI: 1.51-2.37). Additionally, the impact of livestock interventions on stunting, wasting, and being underweight varied depending on the type of intervention and duration of the program/intervention implementation. Therefore, because of this heterogeneity in reporting metrics, the pooled estimates could not be computed. Conclusion Nutrition-sensitive livestock interventions showed a positive effect in increasing the consumption of ASFs, leading to improved dietary diversity. However, the quality of the evidence is low, and therefore, more randomized controlled studies with consistent and similar reporting metrics are needed to increase the evidence base on how nutrition-sensitive livestock interventions affect child growth outcomes.
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Affiliation(s)
- Josphat Muema
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
| | - Nyamai Mutono
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Stevens Kisaka
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Brian Ogoti
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Irene Kimani
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Anita Makori
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Sylvia Omulo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
| | - Erin Boyd
- United States Agency for International Development’s Bureau for Humanitarian Assistance, Washington, DC, United States
| | - Abdal Monium Osman
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Luc Gwenaelle
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Christine Jost
- United States Agency for International Development’s Bureau for Humanitarian Assistance, Washington, DC, United States
- Global Health Support Initiative III, Social Solutions International, Washington, DC, United States
| | - SM Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
- South African Center for Epidemiological Modelling and Analysis, Stellenbosch, South Africa
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
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8
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Chuchu VM, Mutono N, Bichanga P, Kitala PM, Ksee D, Muturi M, Mwatondo A, Nasimiyu C, Akunga L, Amiche A, Hampson K, Thumbi SM. Effect of Phone Text Message Reminders on Compliance with Rabies Post-Exposure Prophylaxis following Dog Bites in Rural Kenya. Vaccines (Basel) 2023; 11:1112. [PMID: 37376501 DOI: 10.3390/vaccines11061112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
The prompt administration of post-exposure prophylaxis (PEP) is one of the key strategies for ending human deaths from rabies. A delay in seeking the first dose of rabies PEP, or failure to complete the recommended dosage, may result in clinical rabies and death. We assessed the efficacy of short message system (SMS) phone texts in improving the adherence to scheduled PEP doses among bite patients in rural eastern Kenya. We conducted a single-arm, before-after field trial that compared adherence among bite patients presenting at Makueni Referral Hospital between October and December 2018 (control) and between January and March 2019 (intervention). Data on their demographics, socio-economic status, circumstances surrounding the bite, and expenditures related to the bite were collected. A total of 186 bite patients were enrolled, with 82 (44%) in the intervention group, and 104 (56%) in the control group. The odds of PEP completion were three times (OR 3.37, 95% CI 1.28, 10.20) more likely among patients who received the SMS reminder, compared to the control. The intervention group had better compliance on the scheduled doses 2 to 5, with a mean deviation of 0.18 days compared to 0.79 days for the control group (p = 0.004). The main reasons for non-compliance included lack of funds (30%), and forgetfulness (23%) on days for follow-up treatment, among others. Nearly all (96%, n = 179) the bite patients incurred indirect transport costs, at an average of USD 4 (USD 0-45) per visit. This study suggests that the integration of SMS reminders into healthcare service delivery increases compliance with PEP, and may strengthen rabies control and elimination strategies.
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Affiliation(s)
- Veronicah M Chuchu
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 1578-40100, Kenya
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi 29053-00625, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
| | - Nyamai Mutono
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi 19676-00202, Kenya
| | - Philet Bichanga
- Department of Health Services, Government of Makueni County, Makueni 95-90300, Kenya
| | - Philip M Kitala
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi 29053-00625, Kenya
| | - Daniel Ksee
- Department of Agriculture, Irrigation, Livestock and Fisheries Development, Government of Makueni County, Makueni 78-90300, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Joint One Health Office of the Ministry of Health and the Ministry of Agriculture, Livestock and Fisheries, Government of Kenya, Nairobi 20811-00202, Kenya
| | - Athman Mwatondo
- Zoonotic Disease Unit, Joint One Health Office of the Ministry of Health and the Ministry of Agriculture, Livestock and Fisheries, Government of Kenya, Nairobi 20811-00202, Kenya
| | - Carolyne Nasimiyu
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
| | | | | | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, Graham Kerr Building, University of Glasgow, Glasgow G12 8QQ, UK
| | - Samuel M Thumbi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 1578-40100, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi 19676-00202, Kenya
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh EH8 9YL, UK
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9
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Mwatondo A, Rahman-Shepherd A, Hollmann L, Chiossi S, Maina J, Kurup KK, Hassan OA, Coates B, Khan M, Spencer J, Mutono N, Thumbi SM, Muturi M, Mutunga M, Arruda LB, Akhbari M, Ettehad D, Ntoumi F, Scott TP, Nel LH, Ellis-Iversen J, Sönksen UW, Onyango D, Ismail Z, Simachew K, Wolking D, Kazwala R, Sijali Z, Bett B, Heymann D, Kock R, Zumla A, Dar O. A global analysis of One Health Networks and the proliferation of One Health collaborations. Lancet 2023; 401:605-616. [PMID: 36682370 DOI: 10.1016/s0140-6736(22)01596-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/14/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023]
Abstract
There has been a renewed focus on threats to the human-animal-environment interface as a result of the COVID-19 pandemic, and investments in One Health collaborations are expected to increase. Efforts to monitor the development of One Health Networks (OHNs) are essential to avoid duplication or misalignment of investments. This Series paper shows the global distribution of existing OHNs and assesses their collective characteristics to identify potential deficits in the ways OHNs have formed and to help increase the effectiveness of investments. We searched PubMed, Google, Google Scholar, and relevant conference websites for potential OHNs and identified 184 worldwide for further analysis. We developed four case studies to show important findings from our research and exemplify best practices in One Health operationalisation. Our findings show that, although more OHNs were formed in the past 10 years than in the preceding decade, investment in OHNs has not been equitably distributed; more OHNs are formed and headquartered in Europe than in any other region, and emerging infections and novel pathogens were the priority focus area for most OHNs, with fewer OHNs focusing on other important hazards and pressing threats to health security. We found substantial deficits in the OHNs collaboration model regarding the diversity of stakeholder and sector representation, which we argue impedes effective and equitable OHN formation and contributes to other imbalances in OHN distribution and priorities. These findings are supported by previous evidence that shows the skewed investment in One Health thus far. The increased attention to One Health after the COVID-19 pandemic is an opportunity to focus efforts and resources to areas that need them most. Analyses, such as this Series paper, should be used to establish databases and repositories of OHNs worldwide. Increased attention should then be given to understanding existing resource allocation and distribution patterns, establish more egalitarian networks that encompass the breadth of One Health issues, and serve communities most affected by emerging, re-emerging, or endemic threats at the human-animal-environment interface.
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Affiliation(s)
- Athman Mwatondo
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya; International Livestock Research Institute, Nairobi, Kenya; Royal Institute of International Affairs, London, UK.
| | - Afifah Rahman-Shepherd
- London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Royal Institute of International Affairs, London, UK
| | - Lara Hollmann
- Royal Institute of International Affairs, London, UK
| | - Scott Chiossi
- Royal Institute of International Affairs, London, UK
| | - Josphat Maina
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya; International Livestock Research Institute, Nairobi, Kenya
| | | | | | | | - Mishal Khan
- London School of Hygiene & Tropical Medicine, London, UK; Department of Community Health Sciences and Department of Pathology, Aga Khan University, Karachi, Pakistan; Royal Institute of International Affairs, London, UK
| | - Julia Spencer
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nyamai Mutono
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Samuel M Thumbi
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Agriculture, Livestock, and Fisheries, Nairobi, Kenya; International Livestock Research Institute, Nairobi, Kenya
| | - Mumbua Mutunga
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Liã Bárbara Arruda
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Melika Akhbari
- Clinical Academic Training Office, University of Cambridge, Cambridge, UK
| | - Dena Ettehad
- Academic Foundation Programme, Faculty of Medicine, Imperial College London, Imperial College Healthcare NHS Trust, London, UK
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, Democratic Republic of the Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | | | - Louis H Nel
- Department of Biochemistry, Genetics, and Microbiology, University of Pretoria, Pretoria, South Africa
| | | | - Ute Wolff Sönksen
- National Centre for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Diana Onyango
- The One Health for Humans, Environment, Animals and Livelihoods Project, Addis Ababa, Ethiopia
| | - Zuleka Ismail
- The One Health for Humans, Environment, Animals and Livelihoods Project, Addis Ababa, Ethiopia
| | - Kebadu Simachew
- The One Health for Humans, Environment, Animals and Livelihoods Project, Addis Ababa, Ethiopia
| | - David Wolking
- One Health Institute, University of California, Davis, CA, USA
| | - Rudovick Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Zikankuba Sijali
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
| | - David Heymann
- Department of Infectious Disease Epidemiology, London, UK
| | - Richard Kock
- Royal Veterinary College, University of London, London, UK
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; National Institute for Health and Care Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Osman Dar
- Global Health Programme, Royal Institute of International Affairs, London, UK; Global Operations, UK Health Security Agency, London, UK
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10
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Moeti M, Makubalo L, Gueye AS, Balde T, Karamagi H, Awandare G, Thumbi SM, Zhang F, Mutapi F, Woolhouse M. Conflicting COVID-19 excess mortality estimates. Lancet 2023; 401:431. [PMID: 36774149 PMCID: PMC9910847 DOI: 10.1016/s0140-6736(23)00112-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Matshidiso Moeti
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Lindiwe Makubalo
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Abdou Salam Gueye
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Thierno Balde
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Humphrey Karamagi
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Gordon Awandare
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | - S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA; Tackling Infections to Benefit Africa, University of Edinburgh, Edinburgh EH9 3FL, UK
| | - Feifei Zhang
- National Institute of Health Data Science, Peking University, Beijing, China; Tackling Infections to Benefit Africa, University of Edinburgh, Edinburgh EH9 3FL, UK
| | - Francisca Mutapi
- Tackling Infections to Benefit Africa, University of Edinburgh, Edinburgh EH9 3FL, UK
| | - Mark Woolhouse
- Tackling Infections to Benefit Africa, University of Edinburgh, Edinburgh EH9 3FL, UK.
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11
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Thumbi SM, Blumberg L, le Roux K, Salahuddin N, Abela B. A call to accelerate an end to human rabies deaths. Lancet 2022; 400:2261-2264. [PMID: 36528379 PMCID: PMC9754655 DOI: 10.1016/s0140-6736(22)02487-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Affiliation(s)
- S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA.
| | - Lucille Blumberg
- Right to Care, Centurion, South Africa; Faculty of Veterinary Science, University of Pretoria, Tshwane, South Africa
| | - Kevin le Roux
- Epidemiology Unit, Veterinary Services, Department of Agriculture and Rural Development, KwaZulu-Natal, South Africa; South African Rabies Advisory Group, Pretoria, South Africa
| | - Naseem Salahuddin
- Faculty of Medicine and Infectious Diseases, Indus Hospital and Health Network, Karachi, Pakistan
| | - Bernadette Abela
- Department of the Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2022; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (inter quartile range) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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13
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Kisaka S, Makumbi FE, Majalija S, Muwanga M, Thumbi SM. The potential for the double risk of rabies and antimicrobial resistance in a high rabies endemic setting: detection of antibiotic resistance in bacterial isolates from infected dog bite wounds in Uganda. Antimicrob Resist Infect Control 2022; 11:142. [PMID: 36372895 PMCID: PMC9655799 DOI: 10.1186/s13756-022-01181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/02/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Post-exposure treatment for dog bites in humans aims at alleviating the risk of rabies and promoting wound healing. Wound healing may be complicated by bacteria. This study identified the different bacteria and their antibiotic susceptibilities in infected dog bite wounds (DBWs) in Uganda. METHODS A cross-sectional study was conducted among 376 dog bite patients. Wound swabs from patients with infected DBWs were collected and inoculated into recommended media. They were cultured for both aerobic and anaerobic bacteria. All isolated bacteria were identified based on colony characteristics, gram stain, and standard biochemical tests. Molecular identification was performed for strains that were resistant to three or more antibiotics. Antibiotic susceptibility testing was conducted using the disc diffusion method following the modified Kirby-Bauer method. The data were analysed using Stata version 15 software. RESULTS Approximately half of the patients (52.9%, 199/376) presented with infected wounds. Majority of the swabs (84.4%, 168/199) were culture positive, and yielded a total of 768 isolates where about half (52.9%, 406/768) were gram positive bacteria, and about two-thirds (64.6%, 496/768) were recovered from category II wounds. Among the gram positive bacteria, 339 (83.5%) were aerobes where Staphylococcus aureus (103, 30.4%), Coagulase-negative staphylococci (68, 20.1%), and Corynebacterium spp (33, 9.7%) had the highest prevalence. For the 362 Gram negative isolates, 217 (59.9%) were aerobes and the commonest isolates were P. maltocida (64, 29.5%), Capnocytophaga canimorsus (36, 16.6%) and P. canis (26, 12.0%). Gram-positive isolates were resistant to metronidazole (93.6%), oxacillin (68.5%), ceftriaxone (14.6%) and amoxicillin/clavulanic acid (14.0%). Gram negative isolates were resistant to metronidazole (100%), ampicillin (30.7%), oxacillin (29.3%), and doxycycline (22.9%). Multidrug resistance was in 105 (29.0%) and 121/406 (29.8%) of the gram-negative and gram-positive isolates, respectively. All gram-positive isolates were susceptible to vancomycin and ciprofloxacin. CONCLUSIONS Infection rates of DBWs in Uganda are high and the dominant bacterial isolates are Staphylococcus aureus, Pasteurella spps, and Capnocytophaga canimorsus. Multidrug resistance to commonly used antibiotics is high. The recommendation in the Uganda Clinical Guidelines to use metronidazole in the management of DBWs should be reviewed. DBWs should be enlisted for routine antimicrobial resistance surveillance and rational use of antimicrobial agents should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya.
- School of Public Health, Makerere University, Kampala, Uganda.
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.
| | | | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Moses Muwanga
- Department of Medicine, Entebbe General Referral Hospital, Entebbe, Uganda
| | - S M Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
- Rabies Free Africa, Washington State University, Pullman, USA
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, USA
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14
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Kimani TN, Nyamai M, Owino L, Makori A, Ombajo LA, Maritim M, Anzala O, Thumbi SM. Infectious disease modelling for SARS-CoV-2 in Africa to guide policy: A systematic review. Epidemics 2022; 40:100610. [PMID: 35868211 PMCID: PMC9281458 DOI: 10.1016/j.epidem.2022.100610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 06/13/2022] [Accepted: 07/12/2022] [Indexed: 01/21/2023] Open
Abstract
Applied epidemiological models have played a critical role in understanding the transmission and control of disease outbreaks. Their utility and accuracy in decision-making on appropriate responses during public health emergencies is however a factor of their calibration to local data, evidence informing model assumptions, speed of obtaining and communicating their results, ease of understanding and willingness by policymakers to use their insights. We conducted a systematic review of infectious disease models focused on SARS-CoV-2 in Africa to determine: a) spatial and temporal patterns of SARS-CoV-2 modelling in Africa, b) use of local data to calibrate the models and local expertise in modelling activities, and c) key modelling questions and policy insights. We searched PubMed, Embase, Web of Science and MedRxiv databases following the PRISMA guidelines to obtain all SARS-CoV-2 dynamic modelling papers for one or multiple African countries. We extracted data on countries studied, authors and their affiliations, modelling questions addressed, type of models used, use of local data to calibrate the models, and model insights for guiding policy decisions. A total of 74 papers met the inclusion criteria, with nearly two-thirds of these coming from 6% (3) of the African countries. Initial papers were published 2 months after the first cases were reported in Africa, with most papers published after the first wave. More than half of all papers (53, 78%) and (48, 65%) had a first and last author affiliated to an African institution respectively, and only 12% (9) used local data for model calibration. A total of 60% (46) of the papers modelled assessment of control interventions. The transmission rate parameter was found to drive the most uncertainty in the sensitivity analysis for majority of the models. The use of dynamic models to draw policy insights was crucial and therefore there is need to increase modelling capacity in the continent.
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Affiliation(s)
- Teresia Njoki Kimani
- KAVI-Institute of Clinical Research, University of Nairobi, Kenya; Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Ministry of Health Kenya, Kiambu County, Kenya.
| | - Mutono Nyamai
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Lillian Owino
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Anita Makori
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Loice Achieng Ombajo
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya
| | - MaryBeth Maritim
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya
| | - Omu Anzala
- KAVI-Institute of Clinical Research, University of Nairobi, Kenya
| | - S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya; Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya; South African Center for Epidemiological Modelling and Analysis, South Africa; Institute of Immunology and Infection Research, University of Edinburgh, Scotland
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15
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Kiarie H, Temmerman M, Nyamai M, Liku N, Thuo W, Oramisi V, Nyaga L, Karimi J, Wamalwa P, Gatheca G, Mwenda V, Ombajo LA, Thumbi SM. The COVID-19 pandemic and disruptions to essential health services in Kenya: a retrospective time-series analysis. Lancet Glob Health 2022; 10:e1257-e1267. [PMID: 35961349 PMCID: PMC9363041 DOI: 10.1016/s2214-109x(22)00285-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Public health emergencies can disrupt the provision of and access to essential health-care services, exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services in Kenya. METHODS Using county-level data routinely collected from the health information system from health facilities across the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care workers' strike (from December, 2020 to January, 2021). FINDINGS In the pre-pandemic period, we observed a positive trend for multiple indicators. The onset of the pandemic was associated with statistically significant decreases in multiple indicators, including outpatient visits (28·7%; 95% CI 16·0-43·5%), cervical cancer screening (49·8%; 20·6-57·9%), number of HIV tests conducted (45·3%; 23·9-63·0%), patients tested for malaria (31·9%; 16·7-46·7%), number of notified tuberculosis cases (26·6%; 14·7-45·1%), hypertension cases (10·4%; 6·0-39·4%), vitamin A supplements (8·7%; 7·9-10·5%), and three doses of the diphtheria, tetanus toxoid, and pertussis vaccine administered (0·9%; 0·5-1·3%). Pneumonia cases reduced by 50·6% (31·3-67·3%), diarrhoea by 39·7% (24·8-62·7%), and children attending welfare clinics by 39·6% (23·5-47·1%). Cases of sexual violence increased by 8·0% (4·3-25·0%). Skilled deliveries, antenatal care, people with HIV infection newly started on antiretroviral therapy, confirmed cases of malaria, and diabetes cases detected were not significantly affected negatively. Although most of the health indicators began to recover during the pandemic, the health-care workers' strike resulted in nearly all indicators falling to numbers lower than those observed at the onset or during the pre-strike pandemic period. INTERPRETATION The COVID-19 pandemic and the associated health-care workers' strike in Kenya have been associated with a substantial disruption of essential health services, with the use of outpatient visits, screening and diagnostic services, and child immunisation adversely affected. Efforts to maintain the provision of these essential health services during a health-care crisis should target the susceptible services to prevent the exacerbation of associated disease burdens during such health crises. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Helen Kiarie
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Mutono Nyamai
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Nzisa Liku
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Wangari Thuo
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Violet Oramisi
- National AIDS and STIs Control Programme, Ministry of Health, Nairobi, Kenya
| | - Lilly Nyaga
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Janette Karimi
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | | | - Gladwell Gatheca
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Valerian Mwenda
- Division of Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Loice Achieng Ombajo
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - S M Thumbi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA; Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, UK.
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16
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Ombajo LA, Mutono N, Sudi P, Mutua M, Sood M, Loo AM, Juma P, Odhiambo J, Shah R, Wangai F, Maritim M, Anzala O, Amoth P, Kamuri E, Munyu W, Thumbi SM. Epidemiological and clinical characteristics of patients hospitalised with COVID-19 in Kenya: a multicentre cohort study. BMJ Open 2022; 12:e049949. [PMID: 35589368 PMCID: PMC9121111 DOI: 10.1136/bmjopen-2021-049949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess outcomes of patients admitted to hospital with COVID-19 and to determine the predictors of mortality. SETTING This study was conducted in six facilities, which included both government and privately run secondary and tertiary level facilities in the central and coastal regions of Kenya. PARTICIPANTS We enrolled 787 reverse transcriptase-PCR-confirmed SARS-CoV2-infected persons. Patients whose records could not be accessed were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was COVID-19-related death. We used Cox proportional hazards regressions to determine factors related to in-hospital mortality. RESULTS Data from patients with 787 COVID-19 were available. The median age was 43 years (IQR 30-53), with 505 (64%) being men. At admission, 455 (58%) were symptomatic with an additional 63 (9%) developing clinical symptoms during hospitalisation. The most common symptoms were cough (337, 43%), loss of taste or smell (279, 35%) and fever (126, 16%). Comorbidities were reported in 340 (43%), with cardiovascular disease, diabetes and HIV documented in 130 (17%), 116 (15%), 53 (7%), respectively. 90 (11%) were admitted to the Intensive Care Unit (ICU) for a mean of 11 days, 52 (7%) were ventilated with a mean of 10 days, 107 (14%) died. The risk of death increased with age (HR 1.57 (95% CI 1.13 to 2.19)) for persons >60 years compared with those <60 years old; having comorbidities (HR 2.34 (1.68 to 3.25)) and among men (HR 1.76 (1.27 to 2.44)) compared with women. Elevated white cell count and aspartate aminotransferase were associated with higher risk of death. CONCLUSIONS The risk of death from COVID-19 is high among older patients, those with comorbidities and among men. Clinical parameters including patient clinical signs, haematology and liver function tests were associated with risk of death and may guide stratification of high-risk patients.
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Affiliation(s)
- Loice Achieng Ombajo
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Nyamai Mutono
- Paul G Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Paul Sudi
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Mbuvi Mutua
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Mohammed Sood
- Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Alliyy Muhammad Loo
- Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Phoebe Juma
- Department of Medicine, Nairobi Hospital, Nairobi, Kenya
| | | | - Reena Shah
- Department of Medicine, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Frederick Wangai
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Marybeth Maritim
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Patrick Amoth
- Office of The Director General, Kenya Ministry of Health, Nairobi, Kenya
| | - Evans Kamuri
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Waweru Munyu
- Department of Medicine, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi College of Health Sciences, Nairobi, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, Washington, USA
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17
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Nyamwaya DK, Otiende M, Mwango L, Kariuki SM, Otieno B, Omuoyo DO, Githinji G, Kitsao BS, Karanja HK, Gitonga JN, de Laurent ZR, Davies A, Mwarumba S, Agoti CN, Thumbi SM, Hamaluba MM, Newton CR, Bejon P, Warimwe GM. Incidence of chikungunya virus infections among Kenyan children with neurological disease, 2014-2018: A cohort study. PLoS Med 2022; 19:e1003994. [PMID: 35550620 PMCID: PMC9135332 DOI: 10.1371/journal.pmed.1003994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Neurological complications due to chikungunya virus (CHIKV) infection have been described in different parts of the world, with children being disproportionately affected. However, the burden of CHIKV-associated neurological disease in Africa is currently unknown and given the lack of diagnostic facilities in routine care it is possible that CHIKV is an unrecognized etiology among children with encephalitis or other neurological illness. METHODS AND FINDINGS We estimated the incidence of CHIKV infection among children hospitalized with neurological disease in Kilifi County, coastal Kenya. We used reverse transcriptase polymerase chain reaction (RT-PCR) to systematically test for CHIKV in cerebrospinal fluid (CSF) samples from children aged <16 years hospitalized with symptoms of neurological disease at Kilifi County Hospital between January 2014 and December 2018. Clinical records were linked to the Kilifi Health and Demographic Surveillance System and population incidence rates of CHIKV infection estimated. There were 18,341 pediatric admissions for any reason during the 5-year study period, of which 4,332 (24%) had CSF collected. The most common clinical reasons for CSF collection were impaired consciousness, seizures, and coma (47%, 22%, and 21% of all collections, respectively). After acute investigations done for immediate clinical care, CSF samples were available for 3,980 admissions, of which 367 (9.2%) were CHIKV RT-PCR positive. Case fatality among CHIKV-positive children was 1.4% (95% CI 0.4, 3.2). The annual incidence of CHIKV-associated neurological disease varied between 13 to 58 episodes per 100,000 person-years among all children <16 years old. Among children aged <5 years, the incidence of CHIKV-associated neurological disease was 77 per 100,000 person-years, compared with 20 per 100,000 for cerebral malaria and 7 per 100,000 for bacterial meningitis during the study period. Because of incomplete case ascertainment due to children not presenting to hospital, or not having CSF collected, these are likely minimum estimates. Study limitations include reliance on hospital-based surveillance and limited CSF sampling in children in coma or other contraindications to lumbar puncture, both of which lead to under-ascertainment of incidence and of case fatality. CONCLUSIONS In this study, we observed that CHIKV infections are relatively more common than cerebral malaria and bacterial meningitis among children hospitalized with neurological disease in coastal Kenya. Given the wide distribution of CHIKV mosquito vectors, studies to determine the geographic extent of CHIKV-associated neurological disease in Africa are essential.
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Affiliation(s)
| | - Mark Otiende
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lilian Mwango
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | | | | | | | | | | | | | - Alun Davies
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Samuel M. Thumbi
- Paul G Allen School for Global Animal Health, Washington State University, Washington, United States of America
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
- Center for Epidemiological Modelling and Analysis, Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | | | | | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - George M. Warimwe
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
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18
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Tidman R, Thumbi SM, Wallace R, de Balogh K, Iwar V, Dieuzy-Labaye I, Song J, Shadomy S, Qiu Y, Torres G, Hutchison J, Abela-Ridder B, Bote K, Beeching S, Cronin K, Trees A. United Against Rabies Forum: The One Health Concept at Work. Front Public Health 2022; 10:854419. [PMID: 35493394 PMCID: PMC9043483 DOI: 10.3389/fpubh.2022.854419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/21/2022] [Indexed: 01/13/2023] Open
Abstract
Human deaths from rabies are preventable and can be eliminated by applying a systematic One Health approach. However, this ancient disease still threatens the lives of millions of people in up to 150 countries and kills an estimated 59, 000 people every year. Rabies today is largely a disease of poverty, almost always linked to dog bites, with most deaths occurring in neglected communities in Africa and Asia. The disease places an immense economic burden on its victims, a cost that far outweighs the investment needed to control it. A global framework for rabies elimination in humans is set out in Zero by 30: The Global Strategic Plan to end human deaths from dog-mediated rabies by 2030. Despite the existence of proven control strategies and agreement on the path to eliminating human rabies deaths, mortality numbers from rabies remain high, and COVID-19 has set back efforts even further. But COVID-19 has also highlighted the value of a One Health approach to zoonotic disease and pandemic prevention. Rabies control programs offer a practical route to building One Health capacities that can also address other zoonotic threats, including those with pandemic potential. The United Against Rabies Forum aims to accelerate progress on rabies elimination while applying a One Health approach. The Forum promotes cross-sector collaboration among stakeholders and supports countries in their rabies elimination efforts. Increased political engagement and resource mobilization, both internationally and nationally, will be needed to achieve global rabies goals and can also make One Health implementation a reality.
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Affiliation(s)
| | - SM Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
| | - Ryan Wallace
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Katinka de Balogh
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Vivian Iwar
- Economic Community of West African States Commission, Abuja, Nigeria
| | | | - Junxia Song
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Sean Shadomy
- Centers for Disease Control and Prevention, Atlanta, GA, United States
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Yu Qiu
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | | | | | | | - Katrin Bote
- World Health Organization, Geneva, Switzerland
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19
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Iles RA, Marsh TL, Thumbi SM, Palmer GH. Effects of changes in short-term human cognition on reported healthcare utilisation. PLOS Glob Public Health 2022; 2:e0000690. [PMID: 36962603 PMCID: PMC10021600 DOI: 10.1371/journal.pgph.0000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 08/28/2022] [Indexed: 11/11/2022]
Abstract
Growing empirical evidence indicates that financial anxiety causes reductions in short-term cognitive capacity. Results from urban communities in Delhi, India show sizable differences in the number of health events recalled between the poor and non-poor respondents over experimentally controlled recall periods. One explanation for this recall difference is 'poor memory'. Such results provide additional reasons for healthy skepticism of the accuracy of self-reported health survey data. The present research identifies which forms of cognitive capacity are related to health event recall and assesses the roles of poverty and illiteracy as mediating variables. Results indicate that underreporting of health events among the poor in rural Kenya is not solely due to 'poor memory'. Data used comes from a repeated cross-sectional study conducted in Samburu county, Kenya over 10-months between 2017-2018. This period coincided with the ending of a protracted and severe drought in East Africa. The results presented in the current study confirm the poor and non-poor distinction, but provide a more detailed cognitive explanation for such results. Reflective throught, as measured by fluid intelligence and heuristic use, is shown to be good predictors of fever recall among relatively poor rura communities in central Kenya.
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Affiliation(s)
- Richard A Iles
- Federation Business School, Federation University, Mt.Helen, Australia
| | - Thomas L Marsh
- School of Economic Sciences, Washington State University, Pullman, Washington, United States of America
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - S M Thumbi
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
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20
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Nyamwaya DK, Thumbi SM, Bejon P, Warimwe GM, Mokaya J. The global burden of Chikungunya fever among children: A systematic literature review and meta-analysis. PLOS Glob Public Health 2022; 2:e0000914. [PMID: 36962807 PMCID: PMC10022366 DOI: 10.1371/journal.pgph.0000914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
Chikungunya fever (CHIKF) is an arboviral illness that was first described in Tanzania (1952). In adults, the disease is characterised by debilitating arthralgia and arthritis that can persist for months, with severe illness including neurological complications observed in the elderly. However, the burden, distribution and clinical features of CHIKF in children are poorly described. We conducted a systematic literature review and meta-analysis to determine the epidemiology of CHIKF in children globally by describing its prevalence, geographical distribution, and clinical manifestations. We searched electronic databases for studies describing the epidemiology of CHIKF in children. We included peer-reviewed primary studies that reported laboratory confirmed CHIKF. We extracted information on study details, sampling approach, study participants, CHIKF positivity, clinical presentation and outcomes of CHIKF in children. The quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal tool for case reports and National Institute of Health quality assessment tool for quantitative studies and case series. Random-effects meta-analysis was used to estimate the pooled prevalence of CHIKF among children by geographical location. We summarised clinical manifestations, laboratory findings, administered treatment and disease outcomes associated with CHIKF in children. We identified 2104 studies, of which 142 and 53 articles that met the inclusion criteria were included in the systematic literature review and meta-analysis, respectively. Most of the selected studies were from Asia (54/142 studies) and the fewest from Europe (5/142 studies). Included studies were commonly conducted during an epidemic season (41.5%) than non-epidemic season (5.1%). Thrombocytopenia was common among infected children and CHIKF severity was more prevalent in children <1 year. Children with undifferentiated fever before CHIKF was diagnosed were treated with antibiotics and/or drugs that managed specific symptoms or provided supportive care. CHIKF is a significant under-recognised and underreported health problem among children globally and development of drugs/vaccines should target young children.
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Affiliation(s)
- Doris K Nyamwaya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Samuel M Thumbi
- Paul G Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
- Center for Epidemiological Modelling and Analysis, Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - George M Warimwe
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Jolynne Mokaya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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21
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Abstract
Since the initial use of vaccination in the eighteenth century, our understanding of human and animal immunology has greatly advanced and a wide range of vaccine technologies and delivery systems have been developed. The COVID-19 pandemic response leveraged these innovations to enable rapid development of candidate vaccines within weeks of the viral genetic sequence being made available. The development of vaccines to tackle emerging infectious diseases is a priority for the World Health Organization and other global entities. More than 70% of emerging infectious diseases are acquired from animals, with some causing illness and death in both humans and the respective animal host. Yet the study of critical host-pathogen interactions and the underlying immune mechanisms to inform the development of vaccines for their control is traditionally done in medical and veterinary immunology 'silos'. In this Perspective, we highlight a 'One Health vaccinology' approach and discuss some key areas of synergy in human and veterinary vaccinology that could be exploited to accelerate the development of effective vaccines against these shared health threats.
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Affiliation(s)
- George M Warimwe
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- The Pirbright Institute, Woking, UK.
| | | | - Thomas A Bowden
- Wellcome Centre for Human Genetics, Division of Structural Biology, University of Oxford, Oxford, UK
| | - Samuel M Thumbi
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
- Center for Epidemiological Modelling and Analysis, Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
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22
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2021; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods: A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results: Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (inter quartile range) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations: Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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23
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2021; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods: A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results: Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (IQR) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations: Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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24
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Okotto-Okotto J, Yu W, Kwoba E, Thumbi SM, Okotto LG, Wanza P, Trajano Gomes da Silva D, Wright J. A mixed methods study to evaluate participatory mapping for rural water safety planning in western Kenya. PLoS One 2021; 16:e0255286. [PMID: 34320036 PMCID: PMC8318241 DOI: 10.1371/journal.pone.0255286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
Water safety planning is an approach to ensure safe drinking-water access through comprehensive risk assessment and water supply management from catchment to consumer. However, its uptake remains low in rural areas. Participatory mapping, the process of map creation for resource management by local communities, has yet to be used for rural water safety planning. In this mixed methods study, to evaluate the validity of participatory mapping outputs for rural water safety planning and assess community understanding of water safety, 140 community members in Siaya County, Kenya, attended ten village-level participatory mapping sessions. They mapped drinking-water sources, ranked their safety and mapped potential contamination hazards. Findings were triangulated against a questionnaire survey of 234 households, conducted in parallel. In contrast to source type ranking for international monitoring, workshop participants ranked rainwater's safety above piped water and identified source types such as broken pipes not explicitly recorded in water source typologies often used for formal monitoring. Participatory mapping also highlighted the overlap between livestock grazing areas and household water sources. These findings were corroborated by the household survey and subsequent participatory meetings. However, comparison with household survey data suggested participatory mapping outputs omitted some water sources and landscape-scale contamination hazards, such as open defecation areas or flood-prone areas. In follow-up visits, participant groups ranked remediation of rainwater harvesting systems as the most acceptable intervention to address hazards. We conclude that participatory mapping can complement other established approaches to rural water safety planning by capturing informally managed source use and facilitating community engagement.
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Affiliation(s)
- Joseph Okotto-Okotto
- Victoria Institute for Research on Environment and Development (VIRED) International, Rabuor, Kisumu, Kenya
| | - Weiyu Yu
- School of Geography and Environmental Science, University of Southampton, Highfield, Southampton, United Kingdom
| | - Emmah Kwoba
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Samuel M. Thumbi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Lorna Grace Okotto
- School of Spatial Planning and Natural Resource Management, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Peggy Wanza
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Jim Wright
- School of Geography and Environmental Science, University of Southampton, Highfield, Southampton, United Kingdom
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25
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Laing G, Vigilato MAN, Cleaveland S, Thumbi SM, Blumberg L, Salahuddin N, Abdela-Ridder B, Harrison W. One Health for neglected tropical diseases. Trans R Soc Trop Med Hyg 2021; 115:182-184. [PMID: 33169163 PMCID: PMC7842102 DOI: 10.1093/trstmh/traa117] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 08/06/2020] [Revised: 09/23/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022] Open
Abstract
The forthcoming World Health Organization road map for neglected tropical
diseases (NTDs) 2021–2030 recognises the complexity surrounding control
and elimination of these 20 diseases of poverty. It emphasises the need for a
paradigm shift from disease-specific interventions to holistic cross-cutting
approaches coordinating with adjacent disciplines. The One Health approach
exemplifies this shift, extending beyond a conventional model of zoonotic
disease control to consider the interactions of human and animal health systems
within their shared environment and the wider social and economic context. This
approach can also promote sustainability and resilience within these systems. To
achieve the global ambition on NTD elimination and control, political will,
along with contextualised innovative scientific strategies, is required.
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Affiliation(s)
| | - Marco Antonio Natal Vigilato
- Pan American Center for Foot and Mouth Disease and Veterinary Public Health, Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organisation, Brazil
| | - Sarah Cleaveland
- Institute of Biodiversity Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - S M Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.,Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh EH9 3FL, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh EH9 3FL, UK.,Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA 99164, USA
| | - Lucille Blumberg
- Centre for Emerging, Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg 2192, South Africa.,Faculty of Veterinary Science, University of Pretoria, Pretoria 0110, South Africa
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26
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Keshavamurthy R, Thumbi SM, Charles LE. Digital Biosurveillance for Zoonotic Disease Detection in Kenya. Pathogens 2021; 10:pathogens10070783. [PMID: 34206236 PMCID: PMC8308926 DOI: 10.3390/pathogens10070783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Infectious disease surveillance is crucial for early detection and situational awareness of disease outbreaks. Digital biosurveillance monitors large volumes of open-source data to flag potential health threats. This study investigates the potential of digital surveillance in the detection of the top five priority zoonotic diseases in Kenya: Rift Valley fever (RVF), anthrax, rabies, brucellosis, and trypanosomiasis. Open-source disease events reported between August 2016 and October 2020 were collected and key event-specific information was extracted using a newly developed disease event taxonomy. A total of 424 disease reports encompassing 55 unique events belonging to anthrax (43.6%), RVF (34.6%), and rabies (21.8%) were identified. Most events were first reported by news media (78.2%) followed by international health organizations (16.4%). News media reported the events 4.1 (±4.7) days faster than the official reports. There was a positive association between official reporting and RVF events (odds ratio (OR) 195.5, 95% confidence interval (CI); 24.01-4756.43, p < 0.001) and a negative association between official reporting and local media coverage of events (OR 0.03, 95% CI; 0.00-0.17, p = 0.030). This study highlights the usefulness of local news in the detection of potentially neglected zoonotic disease events and the importance of digital biosurveillance in resource-limited settings.
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Affiliation(s)
- Ravikiran Keshavamurthy
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA 99164, USA; (R.K.); (S.M.T.)
- Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Samuel M. Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA 99164, USA; (R.K.); (S.M.T.)
- Center for Epidemiological Modelling and Analysis, Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi 30197, Kenya
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh EH9 3FL, UK
| | - Lauren E. Charles
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA 99164, USA; (R.K.); (S.M.T.)
- Pacific Northwest National Laboratory, Richland, WA 99354, USA
- Correspondence:
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27
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Laing G, Natal Vigilato MA, Cleaveland S, Thumbi SM, Blumberg L, Salahuddin N, Abela-Ridder B, Harrison W. Corrigendum to: One Health for Neglected Tropical Diseases. Trans R Soc Trop Med Hyg 2021; 115:940. [PMID: 34044449 PMCID: PMC8326959 DOI: 10.1093/trstmh/trab086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Marco Antonio Natal Vigilato
- Pan American Center for Foot and Mouth Disease and Veterinary Public Health, Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organisation, Brazil
| | - Sarah Cleaveland
- Institute of Biodiversity Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - S M Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.,Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh EH9 3FL, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh EH9 3FL, UK.,Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA 99164, USA
| | - Lucille Blumberg
- Centre for Emerging, Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg 2192, South Africa.,Faculty of Veterinary Science, University of Pretoria, Pretoria 0110, South Africa
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28
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Otiang E, Thumbi SM, Campbell ZA, Njagi LW, Nyaga PN, Palmer GH. Impact of routine Newcastle disease vaccination on chicken flock size in smallholder farms in western Kenya. PLoS One 2021; 16:e0248596. [PMID: 33735266 PMCID: PMC7971550 DOI: 10.1371/journal.pone.0248596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/18/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Poultry represent a widely held economic, nutritional, and sociocultural asset in rural communities worldwide. In a recent longitudinal study in western Kenya, the reported mean number of chickens per household was 10, with increases in flock size constrained principally by mortality. Newcastle disease virus is a major cause of chicken mortality globally and hypothesized to be responsible for a large part of mortality in smallholder flocks. Our goal was to determine the impact of routine Newcastle disease virus (NDV) vaccination on flock size and use this data to guide programs to improve small flock productivity. Methods We conducted a factorial randomized controlled trial in 537 households: in 254 households all chickens were vaccinated every 3 months with I-2 NDV vaccine while chickens in 283 households served as unvaccinated controls. In both arms of the trial, all chickens were treated with endo- and ecto parasiticides every 3 months. Data on household chicken numbers and reported gains and losses were collected monthly for 18 months. Results Consistent with prior studies, the overall flock size was small but with increases in both arms of the study over time. The mean number of chickens owned at monthly census was 13.06±0.29 in the vaccinated households versus 12.06±0.20 in the control households (p = 0.0026) with significant gains in number of chicks (p = 0.06), growers (p = 0.09), and adults (p = 0.03) in the vaccinated flocks versus the controls. Household reported gains were 4.50±0.12 total chickens per month when vaccinated versus 4.15±0.11 in the non-vaccinated controls (p = 0.03). Gains were balanced by voluntary decreases, reflecting household decision-making for sales or household consumption, which were marginally higher, but not statistically significant, in vaccinated households and by involuntary losses, including mortality and loss due to predation, which were marginally higher in control households. Conclusion Quarterly NDV vaccination and parasiticidal treatment resulted in an increase in flock size by a mean of one bird per household as compared to households where the flock received only parasiticidal treatment. While results suggest that the preventable fraction of mortality attributable to Newcastle disease is comparatively small relatively to all-cause mortality in smallholder households, there was a significant benefit to vaccination in terms of flock size. Comparison with previous flock sizes in the study households indicate a more significant benefit from the combined vaccination and parasiticidal treatment, supporting a comprehensive approach to improving flock health and improving household benefits of production in the smallholder setting.
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Affiliation(s)
- Elkanah Otiang
- College of Agriculture and Veterinary Sciences, University of Nairobi, Nairobi, Kenya
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Samuel M. Thumbi
- College of Agriculture and Veterinary Sciences, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health-Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
| | | | - Lucy W. Njagi
- College of Agriculture and Veterinary Sciences, University of Nairobi, Nairobi, Kenya
| | - Philip N. Nyaga
- College of Agriculture and Veterinary Sciences, University of Nairobi, Nairobi, Kenya
| | - Guy H. Palmer
- Washington State University Global Health-Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
- * E-mail:
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29
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Nyamwaya DK, Otiende M, Omuoyo DO, Githinji G, Karanja HK, Gitonga JN, R de Laurent Z, Otieno JR, Sang R, Kamau E, Cheruiyot S, Otieno E, Agoti CN, Bejon P, Thumbi SM, Warimwe GM. Endemic chikungunya fever in Kenyan children: a prospective cohort study. BMC Infect Dis 2021; 21:186. [PMID: 33602147 PMCID: PMC7889702 DOI: 10.1186/s12879-021-05875-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 11/18/2020] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
Background Chikungunya fever (CHIKF) was first described in Tanzania in 1952. Several epidemics including East Africa have occurred, but there are no descriptions of longitudinal surveillance of endemic disease. Here, we estimate the incidence of CHIKF in coastal Kenya and describe the associated viral phylogeny. Methods We monitored acute febrile illnesses among 3500 children visiting two primary healthcare facilities in coastal Kenya over a 5-year period (2014–2018). Episodes were linked to a demographic surveillance system and blood samples obtained. Cross-sectional sampling in a community survey of a different group of 435 asymptomatic children in the same study location was done in 2016. Reverse-transcriptase PCR was used for chikungunya virus (CHIKV) screening, and viral genomes sequenced for phylogenetic analyses. Results We found CHIKF to be endemic in this setting, associated with 12.7% (95% CI 11.60, 13.80) of all febrile presentations to primary healthcare. The prevalence of CHIKV infections among asymptomatic children in the community survey was 0.7% (95% CI 0.22, 2.12). CHIKF incidence among children < 1 year of age was 1190 cases/100,000-person years and 63 cases/100,000-person years among children aged ≥10 years. Recurrent CHIKF episodes, associated with fever and viraemia, were observed among 19 of 170 children with multiple febrile episodes during the study period. All sequenced viral genomes mapped to the ECSA genotype albeit distinct from CHIKV strains associated with the 2004 East African epidemic. Conclusions CHIKF may be a substantial public health burden in primary healthcare on the East African coast outside epidemic years, and recurrent infections are common. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05875-5.
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Affiliation(s)
- Doris K Nyamwaya
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Mark Otiende
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | | | - George Githinji
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Henry K Karanja
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - John N Gitonga
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | | | - James R Otieno
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | | | - Everlyn Kamau
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Stanley Cheruiyot
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Edward Otieno
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Charles N Agoti
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, NDM Research Building, Oxford, OX3 7FZ, UK
| | - Samuel M Thumbi
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164-7090, USA.,Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-4100, Kisumu, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, P.O Box 19676, Nairobi, 00202, Kenya
| | - George M Warimwe
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya. .,Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, NDM Research Building, Oxford, OX3 7FZ, UK.
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30
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Omulo S, Lofgren ET, Lockwood S, Thumbi SM, Bigogo G, Ouma A, Verani JR, Juma B, Njenga MK, Kariuki S, McElwain TF, Palmer GH, Call DR. Carriage of antimicrobial-resistant bacteria in a high-density informal settlement in Kenya is associated with environmental risk-factors. Antimicrob Resist Infect Control 2021; 10:18. [PMID: 33482919 PMCID: PMC7821723 DOI: 10.1186/s13756-021-00886-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between antibiotic use and antimicrobial resistance varies with cultural, socio-economic, and environmental factors. We examined these relationships in Kibera, an informal settlement in Nairobi-Kenya, characterized by high population density, high burden of respiratory disease and diarrhea. METHODS Two-hundred households were enrolled in a 5-month longitudinal study. One adult (≥ 18 years) and one child (≤ 5 years) participated per household. Biweekly interviews (n = 1516) that included questions on water, sanitation, hygiene, and antibiotic use in the previous two weeks were conducted, and 2341 stool, 2843 hand swabs and 1490 drinking water samples collected. Presumptive E. coli (n = 34,042) were isolated and tested for susceptibility to nine antibiotics. RESULTS Eighty percent of presumptive E. coli were resistant to ≥ 3 antibiotic classes. Stool isolates were resistant to trimethoprim (mean: 81%), sulfamethoxazole (80%), ampicillin (68%), streptomycin (60%) and tetracycline (55%). Ninety-seven households reported using an antibiotic in at least one visit over the study period for a total of 144 episodes and 190 antibiotic doses. Enrolled children had five times the number of episodes reported by enrolled adults (96 vs. 19). Multivariable linear mixed-effects models indicated that children eating soil from the household yard and the presence of informal hand-washing stations were associated with increased numbers of antimicrobial-resistant bacteria (counts increasing by 0·27-0·80 log10 and 0·22-0·51 log10 respectively, depending on the antibiotic tested). Rainy conditions were associated with reduced carriage of antimicrobial-resistant bacteria (1·19 to 3·26 log10 depending on the antibiotic tested). CONCLUSIONS Antibiotic use provided little explanatory power for the prevalence of antimicrobial resistance. Transmission of resistant bacteria in this setting through unsanitary living conditions likely overwhelms incremental changes in antibiotic use. Under such circumstances, sanitation, hygiene, and disease transmission are the limiting factors for reducing the prevalence of resistant bacteria.
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Affiliation(s)
- Sylvia Omulo
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA. .,Washington State University Global Health-Kenya, Nairobi, Kenya. .,Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Eric T Lofgren
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Svetlana Lockwood
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Samuel M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya.,Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alice Ouma
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | | | - M Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Samuel Kariuki
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Terry F McElwain
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Guy H Palmer
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya.,Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Douglas R Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya.,Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
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Gigante CM, Yale G, Condori RE, Costa NC, Long NV, Minh PQ, Chuong VD, Tho ND, Thanh NT, Thin NX, Hanh NTH, Wambura G, Ade F, Mito O, Chuchu V, Muturi M, Mwatondo A, Hampson K, Thumbi SM, Thomae BG, de Paz VH, Meneses S, Munyua P, Moran D, Cadena L, Gibson A, Wallace RM, Pieracci EG, Li Y. Portable Rabies Virus Sequencing in Canine Rabies Endemic Countries Using the Oxford Nanopore MinION. Viruses 2020; 12:v12111255. [PMID: 33158200 PMCID: PMC7694271 DOI: 10.3390/v12111255] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
As countries with endemic canine rabies progress towards elimination by 2030, it will become necessary to employ techniques to help plan, monitor, and confirm canine rabies elimination. Sequencing can provide critical information to inform control and vaccination strategies by identifying genetically distinct virus variants that may have different host reservoir species or geographic distributions. However, many rabies testing laboratories lack the resources or expertise for sequencing, especially in remote or rural areas where human rabies deaths are highest. We developed a low-cost, high throughput rabies virus sequencing method using the Oxford Nanopore MinION portable sequencer. A total of 259 sequences were generated from diverse rabies virus isolates in public health laboratories lacking rabies virus sequencing capacity in Guatemala, India, Kenya, and Vietnam. Phylogenetic analysis provided valuable insight into rabies virus diversity and distribution in these countries and identified a new rabies virus lineage in Kenya, the first published canine rabies virus sequence from Guatemala, evidence of rabies spread across an international border in Vietnam, and importation of a rabid dog into a state working to become rabies-free in India. Taken together, our evaluation highlights the MinION's potential for low-cost, high volume sequencing of pathogens in locations with limited resources.
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Affiliation(s)
- Crystal M. Gigante
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.M.G.); (R.E.C.); (R.M.W.); (E.G.P.)
| | - Gowri Yale
- Mission Rabies, Tonca, Panjim, Goa 403001, India;
| | - Rene Edgar Condori
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.M.G.); (R.E.C.); (R.M.W.); (E.G.P.)
| | - Niceta Cunha Costa
- Disease Investigation Unit, Directorate of Animal Health and Veterinary Services, Patto, Panjim, Goa 403001, India;
| | - Nguyen Van Long
- Vietnam Department of Animal Health, Hanoi 100000, Vietnam; (N.V.L.); (P.Q.M.); (V.D.C.)
| | - Phan Quang Minh
- Vietnam Department of Animal Health, Hanoi 100000, Vietnam; (N.V.L.); (P.Q.M.); (V.D.C.)
| | - Vo Dinh Chuong
- Vietnam Department of Animal Health, Hanoi 100000, Vietnam; (N.V.L.); (P.Q.M.); (V.D.C.)
| | - Nguyen Dang Tho
- National Center for Veterinary Diseases, Hanoi 100000, Vietnam;
| | - Nguyen Tat Thanh
- Sub-Department of Animal Health, Phú Thọ Province 35000, Vietnam; (N.T.T.); (N.X.T.); (N.T.H.H.)
| | - Nguyen Xuan Thin
- Sub-Department of Animal Health, Phú Thọ Province 35000, Vietnam; (N.T.T.); (N.X.T.); (N.T.H.H.)
| | - Nguyen Thi Hong Hanh
- Sub-Department of Animal Health, Phú Thọ Province 35000, Vietnam; (N.T.T.); (N.X.T.); (N.T.H.H.)
| | - Gati Wambura
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi 00100, Kenya; (G.W.); (F.A.); (O.M.); (V.C.); (S.M.T.)
| | - Frederick Ade
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi 00100, Kenya; (G.W.); (F.A.); (O.M.); (V.C.); (S.M.T.)
| | - Oscar Mito
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi 00100, Kenya; (G.W.); (F.A.); (O.M.); (V.C.); (S.M.T.)
| | - Veronicah Chuchu
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi 00100, Kenya; (G.W.); (F.A.); (O.M.); (V.C.); (S.M.T.)
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi 00100, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Health, Ministry of Agriculture, Livestock and Fisheries, Nairobi 00100, Kenya; (M.M.); (A.M.)
| | - Athman Mwatondo
- Zoonotic Disease Unit, Ministry of Health, Ministry of Agriculture, Livestock and Fisheries, Nairobi 00100, Kenya; (M.M.); (A.M.)
| | - Katie Hampson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Samuel M. Thumbi
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi 00100, Kenya; (G.W.); (F.A.); (O.M.); (V.C.); (S.M.T.)
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi 00100, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA 99164, USA
| | - Byron G. Thomae
- Ministry of Agriculture Livestock and Food, Guatemala City 01013, Guatemala;
| | - Victor Hugo de Paz
- National Health Laboratory, MSPAS, Villa Nueva 01064, Guatemala; (V.H.d.P.); (S.M.)
| | - Sergio Meneses
- National Health Laboratory, MSPAS, Villa Nueva 01064, Guatemala; (V.H.d.P.); (S.M.)
| | - Peninah Munyua
- Division of Global Health Protection, Centers for Disease Control, Nairobi 00100, Kenya;
| | - David Moran
- University del Valle de Guatemala, Guatemala City 01015, Guatemala;
| | - Loren Cadena
- Division of Global Health Protection, Centers for Disease Control, Guatemala City 01001, Guatemala;
| | - Andrew Gibson
- The Roslin Institute and The Royal (Dick) School of Veterinary Studies, Division of Genetics and Genomics, The University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, UK;
| | - Ryan M. Wallace
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.M.G.); (R.E.C.); (R.M.W.); (E.G.P.)
| | - Emily G. Pieracci
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.M.G.); (R.E.C.); (R.M.W.); (E.G.P.)
| | - Yu Li
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (C.M.G.); (R.E.C.); (R.M.W.); (E.G.P.)
- Correspondence:
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Ferguson AW, Muloi D, Ngatia DK, Kiongo W, Kimuyu DM, Webala PW, Olum MO, Muturi M, Thumbi SM, Woodroffe R, Murugi L, Fèvre EM, Murray S, Martins DJ. Volunteer based approach to dog vaccination campaigns to eliminate human rabies: Lessons from Laikipia County, Kenya. PLoS Negl Trop Dis 2020; 14:e0008260. [PMID: 32614827 PMCID: PMC7331976 DOI: 10.1371/journal.pntd.0008260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/03/2019] [Accepted: 03/29/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND An estimated 59,000 people die from rabies annually, with 99% of those deaths attributable to bites from domestic dogs (Canis lupus familiaris). This preventable Neglected Tropical Disease has a large impact across continental Africa, especially for rural populations living in close contact with livestock and wildlife. Mass vaccinations of domestic dogs are effective at eliminating rabies but require large amounts of resources, planning, and political will to implement. Grassroots campaigns provide an alternative method to successful implementation of rabies control but remain understudied in their effectiveness to eliminate the disease from larger regions. METHODOLOGY/PRINCIPAL FINDINGS We report on the development, implementation, and effectiveness of a grassroots mass dog rabies vaccination campaign in Kenya, the Laikipia Rabies Vaccination Campaign. During 2015-2017, a total of 13,155 domestic dogs were vaccinated against rabies in 17 communities covering approximately 1500 km2. Based on an estimated population size of 34,275 domestic dogs, percent coverages increased across years, from 2% in 2015 to 24% in 2017, with only 3 of 38 community-years of vaccination exceeding the 70% target. The average cost of vaccinating an animal was $3.44 USD with in-kind contributions and $7.44 USD without in-kind contributions. CONCLUSIONS/SIGNIFICANCE The evolution of the Laikipia Rabies Vaccination Campaign from a localized volunteer-effort to a large-scale program attempting to eliminate rabies at the landscape scale provides a unique opportunity to examine successes, failures, and challenges facing grassroots campaigns. Success, in the form of vaccinating more dogs across the study area, was relatively straightforward to achieve. However, lack of effective post-vaccination monitoring and education programs, limited funding, and working in diverse community types appeared to hinder achievement of 70% coverage levels. These results indicate that grassroots campaigns will inevitably be faced with a philosophical question regarding the value of local impacts versus their contributions to a larger effort to eliminate rabies at the regional, country, or global scale.
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Affiliation(s)
- Adam W. Ferguson
- Global Health Program, Smithsonian Conservation Biology Institute, Washington, United States of America
| | - Dishon Muloi
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Charlotte Auerbach Road,Edinburgh, United Kingdom
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom
- International Livestock Research Institute,Nairobi, Kenya
| | - Dedan K. Ngatia
- School of Natural Resources & Environmental Studies, Karatina University, Karatina, Kenya
| | - Wangechi Kiongo
- School of Natural Resources & Environmental Studies, Karatina University, Karatina, Kenya
| | - Duncan M. Kimuyu
- School of Natural Resources & Environmental Studies, Karatina University, Karatina, Kenya
| | - Paul W. Webala
- Department of Forestry and Wildlife Management, Maasai Mara University, Narok, Kenya
| | - Moses O. Olum
- Kenya Agricultural and Livestock Research Organization, Muguga North,Kikuyu, Kenya
| | - Mathew Muturi
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock, and Fisheries, Nairobi, Kenya
| | - Samuel M. Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Rabies Free Africa, Washington State University, Pullman, Washington, United States of America
| | - Rosie Woodroffe
- Institute of Zoology, Zoological Society of London, Regent’s Park, London, United Kingdom
| | - Lucy Murugi
- Ministry of Agriculture, Livestock, and Fisheries, County Government of Laikipia, Nanyuki, Kenya
| | - Eric M. Fèvre
- International Livestock Research Institute,Nairobi, Kenya
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, United Kingdom
| | - Suzan Murray
- Global Health Program, Smithsonian Conservation Biology Institute, Washington, United States of America
| | - Dino J. Martins
- Mpala Research Centre, Nanyuki, Kenya
- Department of Ecology and Evolution, Princeton University, Princeton, New Jersey, United States of America
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Otiang E, Campbell ZA, Thumbi SM, Njagi LW, Nyaga PN, Palmer GH. Mortality as the primary constraint to enhancing nutritional and financial gains from poultry: A multi-year longitudinal study of smallholder farmers in western Kenya. PLoS One 2020; 15:e0233691. [PMID: 32470070 PMCID: PMC7259595 DOI: 10.1371/journal.pone.0233691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/10/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chickens are a widely held economic and nutritional asset in rural Africa and are frequently managed by women. Despite potential benefits of larger flock sizes, the average number of chickens kept at the household level is reported to be low. Whether this reflects decision-making to maximize benefits per unit labor by voluntary reduction of chicken numbers by consumption or sale versus involuntary losses due to mortality is a significant gap in knowledge relevant to improving smallholder household welfare. METHODS In a 4-year longitudinal study of 1,908 smallholder households in rural western Kenya, the number of chickens owned by quarterly census at each household was determined. Households reported gains and losses of chicken over the immediate previous quarter. Gains were classified as on-farm or off-farm; losses were classified as voluntary (sales, gifts, consumption) or involuntary (mortality, unclassified loss). RESULTS The mean number of chickens owned over the 16 quarters was 10, consistent with prior cross-sectional data. Involuntary losses represented 70% of total off-take, while voluntary off-take represented the remaining 30%. Mortality composed 60% of total reported off-take and accounted for most of the involuntary losses. Household consumption, sales, and gifts represented 18%, 9%, and 3% of off-take, respectively. CONCLUSION The overwhelming majority of off-take can be classified as involuntary off-take, principally due to mortality, that does not reflect the owner's decision to maximize value through nutritional gain, income, or social capital. This strongly suggests that there is substantial opportunity to enhance the value of chickens as an asset, both nutritional and income generating, for smallholder households living at poverty level. Our findings suggest that programs emphasizing community level poultry vaccination and feed supplementation are much more likely to be effective than those solely focused on providing chickens.
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Affiliation(s)
- Elkanah Otiang
- University of Nairobi, Nairobi, Kenya
- Kenya Medical Research Centre, Kisumu, Kenya
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Zoë A. Campbell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- International Livestock Research Institute, Nairobi, Kenya
| | - Samuel M. Thumbi
- University of Nairobi, Nairobi, Kenya
- Kenya Medical Research Centre, Kisumu, Kenya
- Washington State University Global Health-Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
| | | | | | - Guy H. Palmer
- University of Nairobi, Nairobi, Kenya
- Washington State University Global Health-Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- * E-mail:
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Sheath DJ, Castañeda RRD, Bempong NE, Raviglione M, Machalaba C, Pepper MS, Vayena E, Ray N, Wernli D, Escher G, Grey F, Elger BS, Helbing D, Kleineberg KK, Beran D, Miranda JJ, Huffman MD, Hersch F, Andayi F, Thumbi SM, D’Acremont V, Hartley MA, Zinsstag J, Larus J, Rodríguez Martínez M, Guerin PJ, Merson L, Ngyuen VK, Rühli F, Geissbuhler A, Salathé M, Bolon I, Boehme C, Berkley S, Valleron AJ, Keiser O, Kaiser L, Eckerle I, Utzinger J, Flahault A. Precision global health: a roadmap for augmented action. ACTA ACUST UNITED AC 2020. [DOI: 10.21037/jphe.2020.01.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wentworth D, Hampson K, Thumbi SM, Mwatondo A, Wambura G, Chng NR. A social justice perspective on access to human rabies vaccines. Vaccine 2019; 37 Suppl 1:A3-A5. [PMID: 30952501 PMCID: PMC7612387 DOI: 10.1016/j.vaccine.2019.01.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/24/2018] [Accepted: 01/30/2019] [Indexed: 12/24/2022]
Abstract
Rabies kills tens of thousands of people every year despite being entirely vaccine preventable. Key global health actors have launched a country-driven plan to achieve zero human deaths from dog-mediated rabies by 2030 worldwide. This partnership has recently been strengthened by Gavi, the Vaccine Alliance’s decision to invest in human rabies vaccines for post-exposure prophylaxis (PEP). While nation states are key to rabies elimination, the importance of Gavi’s role cannot be understated. Unlike any other actor, Gavi can directly address an otherwise intractable market failure in the inadequate supply of rabies PEP. In this commentary, we employ the Capabilities Approach to identify the barriers to PEP access that lead to this market failure and, as a result, unnecessary deaths and suffering. We show the role that Gavi can play in reducing exposure of PEP supply to market forces as a matter of social justice, and hence redress the inequity underlying human rabies deaths.
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Affiliation(s)
- Diorbhail Wentworth
- Institute of Health & Wellbeing, College of Social Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | - Samuel M Thumbi
- Center for Global Health Research, Kenya Medical Institute of Research, Kisumu, Kenya; Washington State University - Global Health Program, Nairobi, Kenya; Paul G. Allen School for Global Animal Health, Washington State University, Pullman, USA
| | - Athman Mwatondo
- Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Gati Wambura
- Center for Global Health Research, Kenya Medical Institute of Research, Kisumu, Kenya
| | - Nai Rui Chng
- Institute of Health & Wellbeing, College of Social Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
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Campbell ZA, Thumbi SM, Marsh TL, Quinlan MB, Shirima GM, Palmer GH. Why isn't everyone using the thermotolerant vaccine? Preferences for Newcastle disease vaccines by chicken-owning households in Tanzania. PLoS One 2019; 14:e0220963. [PMID: 31415629 PMCID: PMC6695108 DOI: 10.1371/journal.pone.0220963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/26/2019] [Indexed: 01/06/2023] Open
Abstract
Understanding preferences for veterinary vaccines in low and middle-income countries is important for increasing vaccination coverage against infectious diseases, especially when the consumer is responsible for choosing between similar vaccines. Over-the-counter sales of vaccines without a prescription gives decision-making power to consumers who may value vaccine traits differently from national or international experts and vaccine producers and distributers. We examine consumer preferences for La Sota and I-2 Newcastle disease vaccines in Tanzania to understand why two vaccines co-exist in the market when I-2 is considered technically superior because of its thermotolerance. Household survey and focus group results indicate consumers perceive both vaccines to be effective, use the two vaccines interchangeably when the preferred vaccine is unavailable, and base preferences more on administration style than thermotolerance. Considering the consumers’ perspectives provides a way to increase vaccination coverage by targeting users with a vaccine that fits their preferences.
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Affiliation(s)
- Zoë A. Campbell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
- * E-mail:
| | - Samuel M. Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Kenya Medical Research Institute (KEMRI), Kisian, Kenya
| | - Thomas L. Marsh
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- School of Economic Sciences, Washington State University, Pullman, Washington, United States of America
| | - Marsha B. Quinlan
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Department of Anthropology, Washington State University, Pullman, Washington, United States of America
| | - Gabriel M. Shirima
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Guy H. Palmer
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
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Thumbi SM, Njenga MK, Otiang E, Otieno L, Munyua P, Eichler S, Widdowson MA, McElwain TF, Palmer GH. Mobile phone-based surveillance for animal disease in rural communities: implications for detection of zoonoses spillover. Philos Trans R Soc Lond B Biol Sci 2019; 374:20190020. [PMID: 31401960 PMCID: PMC6711315 DOI: 10.1098/rstb.2019.0020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Improving the speed of outbreak detection and reporting at the community level are critical in managing the threat of emerging infectious diseases, many of which are zoonotic. The widespread use of mobile phones, including in rural areas, constitutes a potentially effective tool for real-time surveillance of infectious diseases. Using longitudinal data from a disease surveillance system implemented in 1500 households in rural Kenya, we test the effectiveness of mobile phone animal syndromic surveillance by comparing it with routine household animal health surveys, determine the individual and household correlates of its use and examine the broader implications for surveillance of zoonotic diseases. A total of 20 340 animal and death events were reported from the community through the two surveillance systems, half of which were confirmed as valid disease events. The probability of an event being valid was 2.1 times greater for the phone-based system, compared with the household visits. Illness events were 15 times (95% CI 12.8, 17.1) more likely to be reported through the phone system compared to routine household visits, but not death events (OR 0.1 (95% CI 0.09, 0.11)). Disease syndromes with severe presentations were more likely to be reported through the phone system. While controlling for herd and flock sizes owned, phone ownership was not a determinant of using the phone-based surveillance system, but the lack of a formal education, and having additional sources of income besides farming were associated with decreased likelihood of reporting through the phone system. Our study suggests that a phone-based surveillance system will be effective at detecting outbreaks of diseases such as Rift Valley fever that present with severe clinical signs in animal populations, but in the absence of additional reporting incentives, it may miss early outbreaks of diseases such as avian influenza that present primarily with mortality. This article is part of the theme issue ‘Dynamic and integrative approaches to understanding pathogen spillover’.
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Affiliation(s)
- Samuel M Thumbi
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA 99164-7090, USA.,Center for Global Health Research, Kenya Medical Research Institute, PO Box 1578-4100, Kisumu, Kenya.,Washington State University-Global Health Program, Washington State University, PO Box 72938-00200, Nairobi, Kenya
| | - M Kariuki Njenga
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA 99164-7090, USA.,Center for Global Health Research, Kenya Medical Research Institute, PO Box 1578-4100, Kisumu, Kenya.,Washington State University-Global Health Program, Washington State University, PO Box 72938-00200, Nairobi, Kenya
| | - Elkanah Otiang
- Center for Global Health Research, Kenya Medical Research Institute, PO Box 1578-4100, Kisumu, Kenya
| | - Linus Otieno
- Center for Global Health Research, Kenya Medical Research Institute, PO Box 1578-4100, Kisumu, Kenya
| | - Peninah Munyua
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, PO Box 606-00621, Nairobi, Kenya
| | - Sarah Eichler
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA 99164-7090, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, PO Box 606-00621, Nairobi, Kenya.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Terry F McElwain
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA 99164-7090, USA
| | - Guy H Palmer
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA 99164-7090, USA.,Washington State University-Global Health Program, Washington State University, PO Box 72938-00200, Nairobi, Kenya
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Cleaveland S, Thumbi SM, Sambo M, Lugelo A, Lushasi K, Hampson K, Lankester F. Proof of concept of mass dog vaccination for thecontrol and elimination of canine rabies. REV SCI TECH OIE 2019; 37:559-568. [PMID: 30747125 DOI: 10.20506/rst.37.2.2824] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
For more than 100 years, canine rabies vaccination has been available as a tool for rabies control and elimination. However, domestic dogs still remain a major reservoir for rabies, and although canine rabies has been eliminated through mass dog vaccination in some parts of the world, the disease continues to kill tens of thousands of people every year in Africa and Asia. This review focuses on the situation on those two continents, presenting evidence to show that canine rabies elimination is both epidemiologically and operationally feasible, and could be achieved across a wide range of settings in Africa and Asia. The challenges of achieving the large-scale, comprehensive dog vaccination coverage that is required are discussed, and opportunities for developing new strategies that generate multiple benefits for human and animal health and welfare are highlighted. Finally, the substantial progress that has been made in developing the tools, partnerships and frameworks needed to move towards global canine rabies elimination is outlined.
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Bitek AO, Osoro E, Munyua PM, Nanyingi M, Muthiani Y, Kiambi S, Muturi M, Mwatondo A, Muriithi R, Cleaveland S, Hampson K, Njenga MK, Kitala PM, Thumbi SM. A hundred years of rabies in Kenya and the strategy for eliminating dog-mediated rabies by 2030. AAS Open Res 2019; 1:23. [PMID: 32259023 PMCID: PMC7117960 DOI: 10.12688/aasopenres.12872.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Rabies causes an estimated 59,000 human deaths annually. In Kenya, rabies was first reported in a dog in 1912, with the first human case reported in 1928. Here we examine retrospective rabies data in Kenya for the period 1912 - 2017 and describe the spatial and temporal patterns of rabies occurrence in the country. Additionally, we detail Kenya's strategy for the elimination of dog-mediated human rabies by 2030. Methods: Data on submitted samples and confirmed cases in humans, domestic animals and wildlife were obtained from Kenya's Directorate of Veterinary Services. These data were associated with the geographical regions where the samples originated, and temporal and spatial trends examined. Results: Between 1912 and the mid 1970's, rabies spread across Kenya gradually, with fewer than 50 cases reported per year and less than half of the 47 counties affected. Following an outbreak in the mid 1970's, rabies spread rapidly to more than 85% of counties, with a 4 fold increase in the percent positivity of samples submitted and number of confirmed rabies cases. Since 1958, 7,584 samples from domestic animals (93%), wildlife (5%), and humans (2%) were tested. Over two-thirds of all rabies cases came from six counties, all in close proximity to veterinary diagnostic laboratories, highlighting a limitation of passive surveillance. Conclusions: Compulsory annual dog vaccinations between 1950's and the early 1970's slowed rabies spread. The rapid spread with peak rabies cases in the 1980's coincided with implementation of structural adjustment programs privatizing the veterinary sector leading to breakdown of rabies control programs. To eliminate human deaths from rabies by 2030, Kenya is implementing a 15-year step-wise strategy based on three pillars: a) mass dog vaccination, b) provision of post-exposure prophylaxis and public awareness and c) improved surveillance for rabies in dogs and humans with prompt responses to rabies outbreaks.
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Affiliation(s)
- Austine O Bitek
- Zoonotic Disease Unit, Ministry of Agriculture and Livestock, Nairobi, Kenya
| | - Eric Osoro
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya
| | - Peninah M Munyua
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Mark Nanyingi
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
| | - Yvonne Muthiani
- Zoonotic Disease Unit, Ministry of Agriculture and Livestock, Nairobi, Kenya
| | - Stella Kiambi
- Zoonotic Disease Unit, Ministry of Agriculture and Livestock, Nairobi, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Agriculture and Livestock, Nairobi, Kenya
| | | | - Rees Muriithi
- Directorate of Veterinary Services, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, UK
| | - M. Kariuki Njenga
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - PM Kitala
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
| | - SM Thumbi
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
- Rabies Free Africa, Washington State University, Pullman, WA, USA
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Hampson K, Ventura F, Steenson R, Mancy R, Trotter C, Cooper L, Abela-Ridder B, Knopf L, Ringenier M, Tenzin T, Ly S, Tarantola A, Moyengar R, Oussiguéré A, Bonfoh B, Narayana DHA, Sudarshan MK, Muturi M, Mwatondo A, Wambura G, Andriamandimby SF, Baril L, Edosoa GT, Traoré A, Jayme S, Kotzé J, Gunesekera A, Chitnis N, Hattendorf J, Laager M, Lechenne M, Zinsstag J, Changalucha J, Mtema Z, Lugelo A, Lushasi K, Yurachai O, Metcalf CJE, Rajeev M, Blanton J, Costa GB, Sreenivasan N, Wallace R, Briggs D, Taylor L, Thumbi SM, Huong NTT. The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study. Lancet Infect Dis 2019; 19:102-111. [PMID: 30472178 PMCID: PMC6300480 DOI: 10.1016/s1473-3099(18)30512-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/18/2018] [Accepted: 08/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply. METHODS We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs. FINDINGS We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and $33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use. INTERPRETATION Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies. FUNDING World Health Organization.
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Muturi M, Bitek A, Mwatondo A, Osoro E, Marwanga D, Gura Z, Ngere P, Nganga Z, Thumbi SM, Njenga K. Risk factors for human brucellosis among a pastoralist community in South-West Kenya, 2015. BMC Res Notes 2018; 11:865. [PMID: 30518420 PMCID: PMC6282298 DOI: 10.1186/s13104-018-3961-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/29/2018] [Indexed: 12/31/2022] Open
Abstract
Objective Brucellosis is one of the top five priority zoonosis in Kenya because of the socio-economic burden of the disease, especially among traditional, livestock keeping communities. We conducted a 1 year, hospital based, unmatched case–control study to determine risk factors for brucellosis among Maasai pastoralists of Kajiado County in 2016. A case was defined by a clinical criteria; fever or history of fever and two clinical signs suggestive of brucellosis and a positive competitive enzyme-linked immunosorbent assay test (c-ELISA). A control was defined as patients visiting the study facility with negative c-ELISA. Unconditional logistic regression was used to study association between exposure variables and brucellosis using odds ratios (OR) and 95% confidence intervals (CI). Results Forty-three cases and 86 controls were recruited from a population of 4792 individuals in 801 households. The mean age for the cases was 48.7 years while that of the controls was 37.6 years. The dominant gender for both cases (62.7%) and controls (58.1%) groups was female. Regular consumption of un-boiled raw milk and assisting animals in delivery were significantly associated with brucellosis by OR 7.7 (95% CI 1.5–40.1) and OR 3.7 (95% CI 1.1–13.5), respectively.
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Affiliation(s)
- Mathew Muturi
- Kenya Zoonotic Disease Unit-Ministry of Agriculture, Livestock and Fisheries and Ministry of Health, P.O. Box 20811-00202, Nairobi, Kenya.
| | - Austine Bitek
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Athman Mwatondo
- Kenya Zoonotic Disease Unit-Ministry of Agriculture, Livestock and Fisheries and Ministry of Health, P.O. Box 20811-00202, Nairobi, Kenya
| | - Eric Osoro
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | | | - Zeinab Gura
- Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | | | - Zipporah Nganga
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - S M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
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Campbell ZA, Marsh TL, Mpolya EA, Thumbi SM, Palmer GH. Newcastle disease vaccine adoption by smallholder households in Tanzania: Identifying determinants and barriers. PLoS One 2018; 13:e0206058. [PMID: 30356260 PMCID: PMC6200240 DOI: 10.1371/journal.pone.0206058] [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: 04/26/2018] [Accepted: 10/06/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Food security is critical to achieving sustainable growth, poverty reduction, and political and economic stability. Livestock have the potential to improve the food security of smallholder households in developing countries, but livestock productivity is constrained by disease. The extent to which households adopt innovations such as vaccines impacts disease control; however, the behavioral and economic drivers underlying household decisions to adopt or forgo vaccination are not well understood. We address this gap with a study of adoption of Newcastle disease (ND) vaccines by chicken-owning households in Tanzania. METHODS A cross-sectional survey was administered to 535 households owning indigenous chickens in Arusha, Singida, and Mbeya regions in Tanzania. We measured potential predictors of ND vaccine adoption including knowledge, attitudes, and practices. Logistic regression was used to identify predictors correlated with three stages of household adoption: awareness of ND vaccines, previous vaccination, and recent vaccination (within four months) consistent with veterinary guidelines. RESULTS Eighty percent of households were aware of ND vaccines, 57% had previously vaccinated, and 26% had recently vaccinated. Knowing someone who vaccinated increased the odds of a household previously vaccinating [adjusted odds ratio (AOR): 1.32, 95% CI: 1.1-1.5]. Larger flock size was also associated with higher odds of previous vaccination (AOR: 1.03 for a one chicken increase, 95% CI: 1.01-1.05). Usage of traditional medicine decreased the odds of previously vaccination (AOR: 0.58, 95% CI: 0.36-0.95). CONCLUSION Our findings suggest that encouraging the flow of professional-level knowledge within the community by vaccine adopters is a strategy to increase vaccine adoption. Enhancing local chicken productivity through increased vaccine coverage would strengthen a key smallholder household resource for food and economic security.
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Affiliation(s)
- Zoë A. Campbell
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
- * E-mail:
| | - Thomas L. Marsh
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- School of Economic Sciences, Washington State University, Pullman, Washington, United States of America
| | - Emmanuel A. Mpolya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Samuel M. Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Kenya Medical Research Institute (KEMRI), Kisian, Kenya
| | - Guy H. Palmer
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
- Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
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Abstract
Animal pathogens attract attention in both the livestock and public health sectors for their impacts on socio-economics, food safety and security, and human health. These impacts are felt at the household, national, regional and global levels. Whereas the World Organisation for Animal Health (OIE) has identified 118 animal diseases as notifiable, based on their potential for impact on trade, there is a selected subset that have been classified as posing a greater threat to countries due to unique characteristics, such as being highly transmissible, spreading rapidly within and between countries, and requiring cooperation between several countries to control their spread or exclude them. While these 'transboundary diseases' are endemic in much of the world, particularly the developing nations, many countries are classified as disease free. Following the terrorist events of 11 September 2001 in the United States, a small group of zoonotic pathogens and a group of animal-specific pathogens (those that cause what are referred to as `high-consequence foreign animal diseases'), were classified as high-risk, biothreat 'select agents'. Rather than providing a comprehensive review of all animal pathogens, the authors briefly review the impact of these high-risk biothreat agents on animal health, the economy, food security and safety, and public health, using highly pathogenic avian influenza, foot and mouth disease and brucellosis as examples. They focus on the impact of these diseases in the context of high-income countries and low- and middle-income countries, comparing and contrasting their impact at the national and individual household levels.
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Bitek AO, Osoro E, Munyua PM, Nanyingi M, Muthiani Y, Kiambi S, Muturi M, Mwatondo A, Muriithi R, Cleaveland S, Hampson K, Njenga MK, Kitala PM, Thumbi SM. A hundred years of rabies in Kenya and the strategy for eliminating dog-mediated rabies by 2030. AAS Open Res 2018. [DOI: 10.12688/aasopenres.12872.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Rabies causes an estimated 59,000 human deaths annually. In Kenya, rabies was first reported in a dog in 1912, with the first human case reported in 1928. Here we examine retrospective rabies data in Kenya for the period 1912 – 2017 and describe the spatial and temporal patterns of rabies occurrence in the country. Additionally, we detail Kenya’s strategy for the elimination of dog-mediated human rabies by 2030. Methods: Data on submitted samples and confirmed cases in humans, domestic animals and wildlife were obtained from Kenya’s Directorate of Veterinary Services. These data were associated with the geographical regions where the samples originated, and temporal and spatial trends examined. Results: Between 1912 and the mid 1970’s, rabies spread across Kenya gradually, with fewer than 50 cases reported per year and less than half of the 47 counties affected. Following an outbreak in the mid 1970’s, rabies spread rapidly to more than 85% of counties, with a 4 fold increase in the percent positivity of samples submitted and number of confirmed rabies cases. Since 1958, 7,584 samples from domestic animals (93%), wildlife (5%), and humans (2%) were tested. Over two-thirds of all rabies cases came from six counties, all in close proximity to veterinary diagnostic laboratories, highlighting a limitation of passive surveillance. Conclusions: Compulsory annual dog vaccinations between 1950’s and the early 1970’s slowed rabies spread. The rapid spread with peak rabies cases in the 1980’s coincided with implementation of structural adjustment programs privatizing the veterinary sector leading to breakdown of rabies control programs. To eliminate human deaths from rabies by 2030, Kenya is implementing a 15-year step-wise strategy based on three pillars: a) mass dog vaccination, b) provision of post-exposure prophylaxis and public awareness and c) improved surveillance for rabies in dogs and humans with prompt responses to rabies outbreaks.
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Oyas H, Holmstrom L, Kemunto NP, Muturi M, Mwatondo A, Osoro E, Bitek A, Bett B, Githinji JW, Thumbi SM, Widdowson MA, Munyua PM, Njenga MK. Enhanced surveillance for Rift Valley Fever in livestock during El Niño rains and threat of RVF outbreak, Kenya, 2015-2016. PLoS Negl Trop Dis 2018; 12:e0006353. [PMID: 29698487 PMCID: PMC5919633 DOI: 10.1371/journal.pntd.0006353] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background In mid-2015, the United States’ Pandemic Prediction and Forecasting Science and Technical Working Group of the National Science and Technology Council, Food and Agriculture Organization Emergency Prevention Systems, and Kenya Meteorological Department issued an alert predicting a high possibility of El-Niño rainfall and Rift Valley Fever (RVF) epidemic in Eastern Africa. Methodology/Principal findings In response to the alert, the Kenya Directorate of Veterinary Services (KDVS) carried out an enhanced syndromic surveillance system between November 2015 and February 2016, targeting 22 RVF high-risk counties in the country as identified previously through risk mapping. The surveillance collected data on RVF-associated syndromes in cattle, sheep, goats, and camels from >1100 farmers through 66 surveillance officers. During the 14-week surveillance period, the KDVS received 10,958 reports from participating farmers and surveillance officers, of which 362 (3.3%) had at least one syndrome. The reported syndromes included 196 (54.1%) deaths in young livestock, 133 (36.7%) abortions, and 33 (9.1%) hemorrhagic diseases, with most occurring in November and December, the period of heaviest rainfall. Of the 69 herds that met the suspect RVF herd definition (abortion in flooded area), 24 (34.8%) were defined as probable (abortions, mortalities in the young ones, and/or hemorrhagic signs) but none were confirmed. Conclusion/Significance This surveillance activity served as an early warning system that could detect RVF disease in animals before spillover to humans. It was also an excellent pilot for designing and implementing syndromic surveillance in animals in the country, which is now being rolled out using a mobile phone-based data reporting technology as part of the global health security system. Occurrence of Rift Valley Fever (RVF) outbreak is associated with heavy El-Niño rainfall. In July 2015, an alert on the likelihood of El-Niño rainfall and RVF outbreak in Eastern Africa region was issued by the United States, Food and Agriculture Organization, and Kenya Meteorological Department. In response to the alert, the Kenya Directorate of Veterinary Services (KDVS) carried out an enhanced syndromic surveillance system between November 2015 and February 2016 in the 22 counties that had previously been identified as RVF high-risk counties. The surveillance system collected data on RVF-associated syndromes and risk factors in cattle, sheep, goats and camels from more than 1100 farmers. Of the 10,958 field reports submitted, 45 were consistent with suspect RVF disease and 24 of these identified as probable RVF, triggering an immediate response. Whereas investigations of the suspect cases and laboratory testing did not confirm RVF cases, the surveillance system served as an excellent early warning system that could detect disease in animal before spillover to humans.
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Affiliation(s)
- Harry Oyas
- Veterinary Epidemiology and Economics Unit, Kenya Ministry of Agriculture, livestock and Fisheries, Nairobi, Kenya
| | - Lindsey Holmstrom
- College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, United States of America
| | - Naomi P. Kemunto
- Washington State University Global Health Program-Kenya, Washington State University, Nairobi, Kenya
| | - Matthew Muturi
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Athman Mwatondo
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Eric Osoro
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Austine Bitek
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Bernard Bett
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Jane W. Githinji
- Veterinary Epidemiology and Economics Unit, Kenya Ministry of Agriculture, livestock and Fisheries, Nairobi, Kenya
| | - Samuel M. Thumbi
- Washington State University Global Health Program-Kenya, Washington State University, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, United States’ Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Peninah M. Munyua
- Division of Global Health Protection, United States’ Centers for Disease Control and Prevention, Nairobi, Kenya
| | - M. Kariuki Njenga
- Washington State University Global Health Program-Kenya, Washington State University, Nairobi, Kenya
- * E-mail:
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Muema J, Thumbi SM, Obonyo M, Wanyoike S, Nanyingi M, Osoro E, Bitek A, Karanja S. Seroprevalence and Factors Associated with Coxiella burnetii Infection in Small Ruminants in Baringo County, Kenya. Zoonoses Public Health 2017; 64:e31-e43. [PMID: 28117947 DOI: 10.1111/zph.12342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Indexed: 01/06/2023]
Abstract
To improve estimates of C. burnetii epidemiology in Kenya, a survey was undertaken in small ruminants in Baringo County, where acute cases of Q fever in humans had been reported in 2014. From 140 household herds selected, 508 (60.5%) goats and 332 (39.5%) sheep were included and an indirect ELISA assay for C. burnetii IgG antibodies performed. In addition, epidemiological information at both herd and animal level was collected. Generalized mixed-effects multivariable logistic model using herd as the random effect was used to determine variables correlated to the outcome. Overall seroprevalence was 20.5% (95% CI: 17.8%, 23.3%). Goats had 26.0% (95% CI: 22.2%, 30.0%) compared to sheep 12.2% (95% CI: 8.7%, 16.0%). Nomadic pastoralism, goats and older animals (>1 year) were associated with greater risk of C. burnetii seropositivity (P = ≤0.05). Heterogeneity in C. burnetii seropositivity was observed across the sublocations (P = 0.028). Evidence of C. burnetii exposure in small ruminants revealed poses a potential risk of exposure to the people living in close proximity to the animals. We recommended integrated animal-human surveillance and socio-economic studies for C. burnetii, to aid our understanding of the risk of transmission between the animals and humans, and in the design of prevention and control strategies for the disease in the region.
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Affiliation(s)
- J Muema
- Field Epidemiology and Laboratory Training Program (FELTP), Nairobi, Kenya.,Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya.,College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi, Kenya
| | - S M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Center for Global Health Research, Kenya Medical Research Institute, Kenya
| | - M Obonyo
- Field Epidemiology and Laboratory Training Program (FELTP), Nairobi, Kenya.,Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya
| | - S Wanyoike
- Directorate of Veterinary Services, Nairobi, Kenya
| | - M Nanyingi
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Kenya.,Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - E Osoro
- Zoonotic Disease Unit, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - A Bitek
- Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya
| | - S Karanja
- College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi, Kenya
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47
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Omulo S, Thumbi SM, Lockwood S, Verani JR, Bigogo G, Masyongo G, Call DR. Evidence of superficial knowledge regarding antibiotics and their use: Results of two cross-sectional surveys in an urban informal settlement in Kenya. PLoS One 2017; 12:e0185827. [PMID: 28968447 PMCID: PMC5624622 DOI: 10.1371/journal.pone.0185827] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/19/2017] [Accepted: 09/20/2017] [Indexed: 01/08/2023] Open
Abstract
We assessed knowledge and practices related to antibiotic use in Kibera, an urban informal settlement in Kenya. Surveys was employed at the beginning (entry) and again at the end (exit) of a 5-month longitudinal study of AMR. Two-hundred households were interviewed at entry, of which 149 were also interviewed at exit. The majority (>65%) of respondents in both surveys could name at least one antibiotic, with amoxicillin and cotrimoxazole jointly accounting for 85% and 77% of antibiotics mentioned during entry and exit, respectively. More than 80% of respondents felt antibiotics should not be shared or discontinued following the alleviation of symptoms. Nevertheless, 66% and 74% of respondents considered antibiotics effective for treating colds and flu in the entry and exit surveys, respectively. There was a high (87%, entry; 70% exit) level of reported antibiotic use (past 12 months) mainly for colds/flu, coughs and fever, with >80% of respondents obtaining antibiotics from health facilities and pharmacies. Less than half of respondents remembered getting information on the correct use of antibiotics, although 100% of those who did reported improved attitudes towards antibiotic use. Clinicians and community pharmacists were highly trusted information sources. Paired household responses (n = 149) generally showed improved knowledge and attitudes by the exit survey although practices were largely unchanged. Weak agreement (κ = -0.003 to 0.22) between survey responses suggest both that unintended learning had not occurred, and that participant responses were not based on established knowledge or behaviors. Targeted public education regarding antibiotics is needed to address this gap.
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Affiliation(s)
- Sylvia Omulo
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
- Community Health Analytics Initiative, Washington State University, Pullman, WA, United States of America
| | - Samuel M. Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Svetlana Lockwood
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
| | - Jennifer R. Verani
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Geoffrey Masyongo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Douglas R. Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
- Community Health Analytics Initiative, Washington State University, Pullman, WA, United States of America
- The Nelson Mandela African Institute for Science and Technology, Arusha, Tanzania
- * E-mail:
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48
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Munyua P, Corman VM, Bitek A, Osoro E, Meyer B, Müller MA, Lattwein E, Thumbi SM, Murithi R, Widdowson MA, Drosten C, Njenga MK. No Serologic Evidence of Middle East Respiratory Syndrome Coronavirus Infection Among Camel Farmers Exposed to Highly Seropositive Camel Herds: A Household Linked Study, Kenya, 2013. Am J Trop Med Hyg 2017; 96:1318-1324. [PMID: 28719257 DOI: 10.4269/ajtmh.16-0880] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractHigh seroprevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) among camels has been reported in Kenya and other countries in Africa. To date, the only report of MERS-CoV seropositivity among humans in Kenya is of two livestock keepers with no known contact with camels. We assessed whether persons exposed to seropositive camels at household level had serological evidence of infection. In 2013, 760 human and 879 camel sera were collected from 275 and 85 households respectively in Marsabit County. Data on human and animal demographics and type of contact with camels were collected. Human and camel sera were tested for anti-MERS-CoV IgG using a commercial enzyme-linked immunosorbent assay (ELISA) test. Human samples were confirmed by plaque reduction neutralization test (PRNT). Logistic regression was used to identify factors associated with seropositivity. The median age of persons sampled was 30 years (range: 5-90) and 50% were males. A quarter (197/760) of the participants reported having had contact with camels defined as milking, feeding, watering, slaughtering, or herding. Of the human sera, 18 (2.4%) were positive on ELISA but negative by PRNT. Of the camel sera, 791 (90%) were positive on ELISA. On univariate analysis, higher prevalence was observed in female and older camels over 4 years of age (P < 0.05). On multivariate analysis, only age remained significantly associated with increased odds of seropositivity. Despite high seroprevalence among camels, there was no serological confirmation of MERS-CoV infection among camel pastoralists in Marsabit County. The high seropositivity suggests that MERS-CoV or other closely related virus continues to circulate in camels and highlights ongoing potential for animal-to-human transmission.
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Affiliation(s)
- Peninah Munyua
- Global Disease Detection Program, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Victor Max Corman
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany
| | - Austine Bitek
- State Department of Veterinary Services; Ministry of Agriculture Livestock and Fisheries, Nairobi, Kenya
| | - Eric Osoro
- Department of Preventive and Promotive Health, Ministry of Health, Nairobi, Kenya
| | - Benjamin Meyer
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Marcel A Müller
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | | | - S M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington.,Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rees Murithi
- State Department of Veterinary Services; Ministry of Agriculture Livestock and Fisheries, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Global Disease Detection Program, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Christian Drosten
- German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany.,Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - M Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington.,Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
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49
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Mosites E, Sammons M, Otiang E, Eng A, Noecker C, Manor O, Hilton S, Thumbi SM, Onyango C, Garland-Lewis G, Call DR, Njenga MK, Wasserheit JN, Zambriski JA, Walson JL, Palmer GH, Montgomery J, Borenstein E, Omore R, Rabinowitz PM. Microbiome sharing between children, livestock and household surfaces in western Kenya. PLoS One 2017; 12:e0171017. [PMID: 28152044 PMCID: PMC5289499 DOI: 10.1371/journal.pone.0171017] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 07/25/2016] [Accepted: 01/13/2017] [Indexed: 12/18/2022] Open
Abstract
The gut microbiome community structure and development are associated with several health outcomes in young children. To determine the household influences of gut microbiome structure, we assessed microbial sharing within households in western Kenya by sequencing 16S rRNA libraries of fecal samples from children and cattle, cloacal swabs from chickens, and swabs of household surfaces. Among the 156 households studied, children within the same household significantly shared their gut microbiome with each other, although we did not find significant sharing of gut microbiome across host species or household surfaces. Higher gut microbiome diversity among children was associated with lower wealth status and involvement in livestock feeding chores. Although more research is necessary to identify further drivers of microbiota development, these results suggest that the household should be considered as a unit. Livestock activities, health and microbiome perturbations among an individual child may have implications for other children in the household.
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Affiliation(s)
- Emily Mosites
- University of Washington, Department of Environmental and Occupational Health Sciences, Seattle, Washington, United States of America
- Washington State University, Paul G. Allen School for Global Animal Health, Pullman, Washington, United States of America
| | - Matt Sammons
- Washington State University, Paul G. Allen School for Global Animal Health, Pullman, Washington, United States of America
| | - Elkanah Otiang
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Alexander Eng
- University of Washington, Department of Genome Sciences, Seattle, Washington, United States of America
| | - Cecilia Noecker
- University of Washington, Department of Genome Sciences, Seattle, Washington, United States of America
| | - Ohad Manor
- University of Washington, Department of Genome Sciences, Seattle, Washington, United States of America
| | - Sarah Hilton
- University of Washington, Department of Genome Sciences, Seattle, Washington, United States of America
| | - Samuel M. Thumbi
- Washington State University, Paul G. Allen School for Global Animal Health, Pullman, Washington, United States of America
| | - Clayton Onyango
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Gemina Garland-Lewis
- University of Washington, Department of Environmental and Occupational Health Sciences, Seattle, Washington, United States of America
- * E-mail:
| | - Douglas R. Call
- Washington State University, Paul G. Allen School for Global Animal Health, Pullman, Washington, United States of America
| | - M. Kariuki Njenga
- Washington State University, Paul G. Allen School for Global Animal Health, Pullman, Washington, United States of America
| | - Judith N. Wasserheit
- University of Washington, Department of Global Health, Seattle, Washington, United States of America
- University of Washington, Department of Medicine, Seattle, Washington, United States of America
- University of Washington, Department of Epidemiology, Seattle, Washington, United States of America
| | - Jennifer A. Zambriski
- Washington State University, Paul G. Allen School for Global Animal Health, Pullman, Washington, United States of America
| | - Judd L. Walson
- University of Washington, Department of Global Health, Seattle, Washington, United States of America
- University of Washington, Department of Medicine, Seattle, Washington, United States of America
- University of Washington, Department of Epidemiology, Seattle, Washington, United States of America
- University of Washington, Department of Pediatrics, Seattle, Washington, United States of America
| | - Guy H. Palmer
- Washington State University, Paul G. Allen School for Global Animal Health, Pullman, Washington, United States of America
| | - Joel Montgomery
- Centers for Disease Control and Prevention, Division of Global Health Protection, Center for Global Health, Atlanta, Georgia, United States of America
| | - Elhanan Borenstein
- University of Washington, Department of Genome Sciences, Seattle, Washington, United States of America
- University of Washington, Department of Computer Science and Engineering, Seattle, Washington, United States of America
- Santa Fe Institute, Santa Fe, New Mexico, United States of America
| | - Richard Omore
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Peter M. Rabinowitz
- University of Washington, Department of Environmental and Occupational Health Sciences, Seattle, Washington, United States of America
- University of Washington, Department of Global Health, Seattle, Washington, United States of America
- University of Washington, Department of Family Medicine, Seattle, Washington, United States America
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50
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Nanyingi MO, Muchemi GM, Thumbi SM, Ade F, Onyango CO, Kiama SG, Bett B. Seroepidemiological Survey of Rift Valley Fever Virus in Ruminants in Garissa, Kenya. Vector Borne Zoonotic Dis 2016; 17:141-146. [PMID: 27929928 DOI: 10.1089/vbz.2016.1988] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Rift Valley fever (RVF) is a vector-borne zoonotic disease caused by phlebovirus in the family Bunyaviridae. In Kenya, major outbreaks occurred in 1997-1998 and 2006-2007 leading to human deaths, huge economic losses because of livestock morbidity, mortality, and restrictions on livestock trade. AIM This study was conducted to determine RVF seroprevalence in cattle, sheep, and goats during an interepidemic period in Garissa County in Kenya. METHODS In July 2013, we performed a cross-sectional survey and sampled 370 ruminants from eight RVF-prone areas of Garissa County. Rift Valley fever virus (RVFV) antibodies were detected using a multispecies competitive enzyme-linked immunosorbent assay. Mixed effect logistic regression models were used to determine the association between RVF seropositivity and species, sex, age, and location of the animals. RESULTS A total of 271 goats, 87 sheep, and 12 cattle were sampled and the overall immunoglobulin G seroprevalence was 27.6% (95% CI [23-32.1]). Sheep, cattle, and goats had seroprevalences of 32.2% (95% CI [20.6-31]), 33.3% (95% CI [6.7-60]), and 25.8% (95% CI [22.4-42]), respectively. Seropositivity in males was 31.8% (95% CI [22.2-31.8]), whereas that of females was 27% (95% CI [18.1-45.6]). CONCLUSIONS The high seroprevalence suggests RVFV circulation in domestic ruminants in Garissa and may be indicative of a subclinal infection. These findings provide evidence of RVF disease status that will assist decision-makers to flag areas of high risk of RVF outbreaks and prioritize the implementation of timely and cost-effective vaccination programs.
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Affiliation(s)
- Mark O Nanyingi
- 1 Department of Public Health, Pharmacology and Toxicology, University of Nairobi , Nairobi, Kenya .,2 Department of Biomedical Sciences, Colorado State University , Fort Collins, Colorado.,3 Center for Global Health Research, Kenya Medical Research Institute , Kisumu, Kenya
| | - Gerald M Muchemi
- 1 Department of Public Health, Pharmacology and Toxicology, University of Nairobi , Nairobi, Kenya
| | - Samuel M Thumbi
- 3 Center for Global Health Research, Kenya Medical Research Institute , Kisumu, Kenya .,4 Paul G. Allen School for Global Animal Health, Washington State University , Pullman, Washington
| | - Fredrick Ade
- 3 Center for Global Health Research, Kenya Medical Research Institute , Kisumu, Kenya
| | - Clayton O Onyango
- 3 Center for Global Health Research, Kenya Medical Research Institute , Kisumu, Kenya
| | - Stephen G Kiama
- 5 Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi , Nairobi, Kenya
| | - Bernard Bett
- 6 International Livestock Research Institute , Nairobi, Kenya
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