Magambo Jk

Echinococcosis in sub-Saharan Africa: emerging complexity.

Cystic echinococcosis occurs in most regions of sub-Saharan Africa, but the frequency of this zoonosis differs considerably among and within countries. Especially human cases seem to be focally distributed. A number of environmental and behavioural factors partially explain this pattern, i.e. density of livestock, presence of dogs, uncontrolled slaughter, and hygiene. In addition, the various taxa of Echinococcus spp. are known to differ considerably in infectivity to different host species including humans. Genetic characterizations of isolates, which are necessary to evaluate the impact of this factor - so far done in only a few countries - indicate that the diversity of Echinococcus spp. in Sub-Saharan Africa is greater than on any other continent. The very incomplete data which are available show that sympatrical taxa may infect different hosts, others may be geographically restricted, some life cycles involve livestock, others wild animals. Possible implications of this complexity for public health, livestock economy and conservation are briefly discussed.

A survey for Echinococcus spp. of carnivores in six wildlife conservation areas in Kenya.

To investigate the presence of Echinococcus spp. in wild mammals of Kenya, 832 faecal samples from wild carnivores (lions, leopards, spotted hyenas, wild dogs and silver-backed jackals) were collected in six different conservation areas of Kenya (Meru, Nairobi, Tsavo West and Tsavo East National Parks, Samburu and Maasai Mara National Reserves). Taeniid eggs were found in 120 samples (14.4%). In total, 1160 eggs were isolated and further analysed using RFLP-PCR of the nad1 gene and sequencing. 38 of these samples contained eggs of Echinococcus spp., which were identified as either Echinococcus felidis (n=27) or Echinococcus granulosus sensu stricto (n=12); one sample contained eggs from both taxa. E. felidis was found in faeces from lions (n=20) and hyenas (n=5) while E. granulosus in faeces from lions (n=8), leopards (n=1) and hyenas (n=3). The host species for two samples containing E. felidis could not be identified with certainty. As the majority of isolated eggs could not be analysed with the methods used (no amplification), we do not attempt to give estimates of faecal prevalences. Both taxa of Echinococcus were found in all conservation areas except Meru (only E. felidis) and Tsavo West (only E. granulosus). Host species identification for environmental faecal samples, based on field signs, was found to be unreliable. All samples with taeniid eggs were subjected to a confirmatory host species RLFP-PCR of the cytochrome B gene. 60% had been correctly identified in the field. Frequently, hyena faeces were mistaken for lion and vice versa, and none of the samples from jackals and wild dogs could be confirmed in the tested sub-sample. This is the first molecular study on the distribution of Echinococcus spp. in Kenyan wildlife. The presence of E. felidis is confirmed for lions and newly reported for spotted hyenas. Lions and hyenas are newly recognized hosts for E. granulosus s.s., while the role of leopards remains uncertain. These data provide the basis for further studies on the lifecycles and the possible link between wild and domestic cycles of cystic echinococcosis in eastern Africa.

The Role of Personal Opinions and Experiences in Compliance with Mass Drug Administration for Lymphatic Filariasis Elimination in Kenya

Background The main strategy adopted for Lymphatic Filariasis (LF) elimination globally is annual mass drug administration (MDA) for 4 to 6 rounds. At least 65% of the population at risk should be treated in each round for LF elimination to occur. In Kenya, MDA using diethylcarbamazine citrate (DEC) and albendazole data shows declining compliance (proportion of eligible populations who receive and swallow the drugs) levels (85%–62.8%). The present studys aim was to determine the role of personal opinions and experiences in compliance with MDA. Methods/Findings This was a retrospective cross-sectional study conducted between January and September 2009 in two districts based on December 2008 MDA round. In each district, one location with high and one with low compliance was selected. Through systematic sampling, nine villages were selected and interviewer-based questionnaires administered to 965 household heads or adult representatives also systematically sampled. The qualitative data were generated from opinion leaders, LF patients with clinical signs and community drug distributors (CDDs) all purposively selected and interviewed. Sixteen focus group discussions (FGDs) were also conducted with single-sex adult and youth male and female groups. Chi square test was used to assess the statistical significance of differences in compliance with treatment based on the records reviewed. The house-to-house method of drug distribution influenced compliance. Over one-quarter (27%) in low compared to 15% in high compliance villages disliked this method. Problems related to size, number and taste of the drugs were more common in low (16.4%) than in high (14.4%) compliance villages. Reasons for failure to take the drugs were associated with compliance (p<0.001). The reasons given included: feeling that the drugs were not necessary, CDD not visiting to issue the drugs, being absent and thinking that the drugs were meant for only the patients with LF clinical signs. A dislike for modern medicine prevailed more in low (6.7%) than in high (1.2%) compliance villages. Experience of side effects influenced compliance (P<0.001). The common side effects experienced included giddiness, fever, headache and vomiting. Social support, alcohol and substance use were not associated with compliance in both types of villages (p>0.05). Conclusions/Significance Community sensitization on treatment, drugs used, their regimen and distribution method involving all leaders should be strengthened by the Programme Implementers. The communities need to be made aware of the potential side effects of the drugs and that health personnel are on standby for the management of side effects in order to build confidence and increase the compliance levels.

Socioeconomic factors associated with compliance with mass drug administration for lymphatic filariasis elimination in Kenya: Descriptive study results

Background: Annual Mass Drug Administration (MDA) to at least 65 - 80% of the population at risk is necessary for Lymphatic Filariasis (LF) elimination. In Kenya, MDA based on diethylcarbamazine and albendazole, using the community-directed treatment (ComDT) approach has been implemented thrice in the Kwale and Malindi districts. To identify the socioeconomic factors influencing compliance with MDA, a retrospective cross-sectional study was conducted in the two districts after the 2008 MDA. Materials and Methods: In Kwale, the Tsimba location was selected for high and Gadini for low coverage, while in Malindi, the Goshi location represented high and Gongoni, low coverage. Using systematic sampling, nine villages were selected from the four locations. Quantitative data was collected from 965 systematically selected household heads and analyzed using SPSS v. 15. For qualitative data, which was analyzed manually according to core themes of the study, 80 opinion leaders and 80 LF patients with clinical signs were purposively selected and interviewed, and 16 focus group discussions (FGDs) conducted with adult and youth male and female groups. Results: Christians were slightly more (49.1%) in the high compliance areas compared to Muslims (34.3%), while Muslims prevailed (40.6%) in the low compliance areas compared to Christians (29%). On the income level, 27% from the low compared to 12.2% from the high compliance areas had a main occupation, indicative of a higher income, and 95% from the low compared to 78% from high compliance areas owned land, also an indicator of higher economic status. Accurate knowledge of the cause of swollen limbs was higher (37%) in the high compared to 25.8% in the low compliance areas, and so was accurate knowledge about the cause of swollen genitals (26.8% in high compared to 14% in low). Risk perception was higher in the high compliance areas (52% compared to 45%) and access to MDA information seemed to have been better in the high compared to low compliance areas. Patients from the high compliance areas had a higher mean number of years with chronic disease (15.2 compared to 9.7). Conclusions: There is a need for more investment in reaching out to groups that are often missed during MDAs. Different strategies have to be devised to reach those in specific religious groupings and those in casual employment. This could include prolonging the duration of MDA to capture those who are out during the week seeking for casual and other forms of employment.

Factors associated with the motivation of community drug distributors in the lymphatic Filariasis Elimination Programme in Kenya

Annual mass drug administration (MDA) is the main strategy for elimination of lymphatic flariasis (LF), globally. In Kenya, community drug distributors (CDDs) are used to deliver drugs to household members. To determine factors infuencing CDDs’ motivation, a retrospective cross-sectional study based on qualitative data was conducted in Kwale and Malindi districts after the 2008 MDA. In Kwale, Tsimba location represented high and Gadini low compliance while in Malindi, Goshi and Gongoni locations represented high and low compliance areas, respectively. Fifteen CDDs, 80 opinion leaders, 80 LF patients, fve health personnel, four LF coordinators and the National Programme Manager were purposively selected and interviewed. Sixteen focus group discussions (FGDs) were conducted with single-sex adult and youth male and female groups. The factors that possibly had a positive infuence on CDDs’ motivation were: higher education level, trust and familiarity with community members. All CDDs reported that getting reco...

Gross and Histopathological Findings in Cercopithecus Aethiops with Experimental Cyclospora Infection in Kenya

Purity N Nguhiu1 Claire N Wamae2,3 Japheth K Magambo4 Paul G Mbuthia5 Daniel C Chai6 Dorcas S Yole6 1Department of Veterinary Services, Kabete, Ministry of Livestock Development, Nairobi, 2Directorate of Research and Development, Kenya Methodist University, Meru, 3Kenya Medical Research Institute, Nairobi, 4Meru University College of Science and Technology, Meru, 5Department of Veterinary Pathology, Microbiology and Parasitology, University of Nairobi, 6Department of Tropical Infectious Diseases, Institute of Primate Research, Karen, Nairobi, Kenya