Peter Ngure

A review of Leishmaniasis in Eastern Africa

Abstract The review presents the epidemiology of leishmaniasis in the Eastern Africa region. We searched PUB MED and MEDLINE with several key words-namely, “leishmaniasis”;“cutaneous”, “diffuse cutaneous”, “mucosal”, and “visceral leishmaniasis”; “kala azar”, and “post kala azar dermal leishmaniasis”, -for recent clinical and basic science articles related to leishmaniasis in countries in the Eastern Africa region. Poverty, wars, conflicts and migration have significantly aggravated leishmaniases in Eastern Africa. Of particular concern is the increasing incidence of Leishmania-HIV co-infection in Ethiopia where 20∼40% of the persons affected by visceral leishmaniasis are HIV-co-infected. Sudan has the highest prevalence rate of post kala-azar dermal leishmaniasis(PKDL) in the world, a skin complication of visceral leishmaniasis(VL) that mainly afflicts children below age ten. In view of its spread to previously non-endemic areas and an increase in imported cases, leishmaniasis in Eastern Africa should be considered a health emergency.

Factors Influencing the Utilization of Voluntary Counselling and Testing Services among University Students in Kenya

Voluntary Counselling and Testing (VCT) is recognized as a critical component of effective HIV prevention initiative and has therefore been promoted nationally and within universities in Kenya. Upon successful counselling and testing those found to be HIV negative are informed to take the necessary measures to protect themselves while the infected are advised to start the required medication. This study examined the attitudes toward VCT services among university students in four Kenyan universities. 980 students filled self administered questionnaires. Results showed that 38.5% of the subjects had tested for HIV in the last 12 months and students (55.8%) felt less susceptible to HIV infection. Findings from a factor analysis revealed that the intention to seek the services was associated with five attitude subscales that were ranked as follows (i) people’s and personal concerns, (ii) friends concerns, (iii) value of testing, (iv) confidentiality and support, and (v) perceived susceptibility. The first three items are associated with stigma which was evidenced in the subjects’ report that admitting that one should test for HIV would imply that one has engaged in immoral behaviour. Secondly, subjects felt that their friends would look down on them if they tested for HIV. Knowing the students’ attitudes will therefore assist in the development of appropriate VCT interventions that will promote HIV testing and behaviour change.

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...

Immunostimulatory responses to crude extracts of Warburgia ugandensis (Sprague) subsp ugandensis (Canellaceae) by BALB/c mice infected with Leishmania major.

Introduction To determine the immunostimulatory potential of crude extracts of Warburgia ugandensis subsp. ugandensis with a soluble leishmanial antigen in vaccinating BALB/c mice. Methods Seventy two female BALB/c mice were randomly assigned into six groups. The mice were vaccinated with soluble leishmania antigens (SLA) alone, hexane, ethyl acetate, and dichloromethane extract co-administered with SLA. Unvaccinated mice formed the control group. The induction of cell-mediated immunity following vaccination was determined by measuring in vitro lymphocyte proliferation and the production of interleukin (IL)-4 and gamma interferon (IFN-γ) determined by flow cytometry. Protection against L. major was determined by quantifying parasite burdens in L. major infected footpads using a limiting dilution assay and by measuring lesion sizes of the infected footpad compared to the contralateral uninfected footpad. Results On vaccination with extracts of W. ugandensis subsp. ugandensis alone or as adjuvants when used in combination with Leishmania antigens, the hexane extract and the dichloromethane extract plus SLA stimulated moderate production of IFN-γ and low levels of IL-4.These mice were partially protected from cutaneous leishmaniasis as shown by the slow development of lesions and comparatively less parasite burdens. Conclusion These data suggest that extracts of W. ugandensis subsp. ugandensis are suitable adjuvants for Leishmania vaccines. However, since W. ugandensis subsp. ugandensis has been shown to be effective against Leishmania parasites in vitro and in vivo, further studies ought to be conducted to determine its immunochemotherapeutic potential when co-administered with a soluble leishmanial antigen in vaccinating BALB/c mice.

From Mud and Stick-walled Houses to Corrugated Iron sheet Houses: A New Strategy for Preventing Human-Vector Contact in Marigat Sub-county a Leishmaniasis-endemic Area in Kenya

Department of Technical and Applied Biology, Technical University of Kenya, Kenya 2 Department of Science and Health, Daystar University, Kenya 3 Centre for Biotechnology, Research and Development, Leishmaniasis Laboratory, Kenya Medical Research Institute, Kenya

A Descriptive Survey on Knowledge, Attitude, Practices and Beliefs (KAPBs) on Kala-azar among the Residents of Marigat Sub-County, Baringo County -

ABSTRACT Objective: To establish the level of knowledge, attitude, practices and beliefs (KAPBs) related to kala-azar among residents of Marigat sub- County, Baringo County. Methods: The sub- County is divided into 37 sub-locations and of these 8 herein referred to as villages were considered for this study. A total of 670 households were randomly drawn from the 8 villages and this formed the sample population. Data was collected using structured questionnaires and in depth interviews of key informants. Results: The findings indicated that the respondents were well informed on kala-azar; the cause and treatment. They also had favorable attitude towards the disease. They were aware that the disease was curable and sought treatment from health facilities as opposed to traditional alternatives. In seeking treatment, the residents were faced with challenges such as the long distance to the health facility, long period of treatment and the attendant cost of caring for a leishmaniasis patient. The respondents were aware that the disease was spread by an insect however, they were not aware of preventive measures. Most live in destitute houses which predisposed them to the infective bite of the vector. Most of the respondents are not employed and the cost of treatment, in addition to attendant costs places a heavy economic burden on them. Conclusion: The results showed good awareness of leishmaniasis, positive attitude and practices among the respondents which are important attributes in community participation. These findings are quite encouraging to researchers planning control programs because such a community would be more receptive to suggested control measures.