Philip Kitala

Community-based active surveillance for rabies In Machakos District, Kenya

The rabies problem in Kenya has been greatest in Machakos District where the disease has persisted endemically for over 40 years. This paper presents the results of a one-year community-based active surveillance for rabies in six randomly selected sublocations in the district for the period 1992-1993. Approximately 860 rabid dogs per 100000 dogs were confirmed in this study, compared to approximately 12 per 100000 confirmed rabid dogs reported by the existing passive-surveillance system. This active surveillance underestimated the true rabies incidence, because only 41% (130/317) of the potential specimens could be diagnosed. Dogs accounted for 92% (179/194) of primary animal-rabies suspects, 80% (66/83) of secondary suspects, and 81% of the confirmed animal-rabies cases. The annual incidence of animal-bites of humans was 234 per 100000 people and the point estimate of human-rabies incidence per year was 25 per million people. Almost all (97%) animal-bites of humans were due to dogs.The traditional passive-surveillance system grossly underestimated the importance of rabies as a public-health problem in Machakos District. Community-based active surveillance provides a potential cost-effective strategy for greatly improving estimates of rabies incidence and epidemiology to inform veterinary and policy decision-making.

Comparison of vaccination strategies for the control of dog rabies in Machakos District, Kenya.

Demographic and epidemiological field data were used in a deterministic model to describe dog rabies transmission in Machakos District, Kenya and to predict the impact of potential vaccination strategies for its control. The basic reproduction number (R0) was estimated to be 2.44 (1.52-3.36, 95% confidence limits). There were three key model predictions. The first was that a threshold dog density (K(T)) of 4.5 dogs km(-2) (3.8-5.2 dogs km(-2), 95% confidence limits) was required to maintain transmission. The second was that the estimated annual vaccination rate of 24% failed to decrease incidence and actually increased the stability of transmission and may be counter-productive. Thirdly, to control rabies, it was predicted that 59% (34%-70%, 95% confidence limits) of dogs should be vaccinated at any one time. This requires approximately 70% coverage for annual but only 60% coverage for semi-annual vaccination campaigns. Community-level vaccination trials are needed to test these predictions.

Epidemiology of East Coast fever (Theileria parva infection) in Kenya: past, present and the future.

In this article, we review the epidemiology of East Coast fever (ECF), a tick-borne infection of cattle, in Kenya. The major factors associated with epidemiology of ECF include the agro-ecological zone (AEZ), livestock production system (LPS) and both animal breed and age. These factors appear to influence the epidemiology of ECF through structured gradients. We further show that the gradients are dynamically shaped by socio-demographic and environmental processes. For a vector-borne disease whose transmission depends on environmental characteristics that influence vector dynamics, a change in the environment implies a change in the epidemiology of the disease. The review recommends that future ECF epidemiological studies should account for these factors and the dynamic interactions between them. In Kenya, ECF control has previously relied predominantly on tick control using acaricides and chemotherapy while ECF immunization is steadily being disseminated. We highlight the contribution of ECF epidemiology and economics in the design of production system and/or geographical area-specific integrated control strategies based on both the dynamic epidemiological risk of the disease and economic impacts of control strategies. In all production systems (except marginal areas), economic analyses demonstrate that integrated control in which ECF immunization is always an important component, can play an important role in the overall control of the disease. Indeed, Kenya has recently approved ECF immunization in all production systems (except in marginal areas). If the infrastructure of the vaccine production and distribution can be heightened, large ECF endemic areas are expected to be endemically stable and the disease controlled. Finally, the review points the way for future research by identifying scenario analyses as a critical methodology on which to base future investigations on how both dynamic livestock management systems and patterns of land use influence the dynamics and complexity of ECF epidemiology and the implications for control.

Community perceptions of important camel diseases in Lapur Division of Turkana District, Kenya.

This paper presents the results of a study conducted in Lapur Division of Turkana District, Kenya, to estimate the incidence and mortality of camel trypanosomosis using participatory methods. Four livestock camps (‘adakars’) were conveniently selected for the study. Four informant groups comprising 6–8 key persons were used for the participatory exercises. The camel diseases identified by the pastoralists in their order of importance according to annual incidence were: trypanosomosis (11.4%); mange (10.8%); tick infestation (7.9%); haemorrhagic septicaemia (7.7%); and non-specific diarrhoea (7.6%). Almost half (49.3%) of the camel population suffered from at least one disease over the previous year. The annual incidence and mortality rates of trypanosomosis were estimated at 15% and 9.9% in adult camels and 6.9% and 5.2% in young camels, respectively. There was a seasonal occurrence of trypanosomosis, with most cases reported in the dry season. The prevalence levels of the disease reportedly declined from about 100% in 1978 to an almost stable state of about 15% in 2002. This study revealed that camel trypanosomosis is still an important disease in Turkana District, exacting a heavy toll in terms of morbidity and mortality. The economic losses due to the disease were likely to have been great owing to the central role the camel plays in this arid district of Kenya.

Prevalence of porcine cysticercosis and associated risk factors in Homa Bay District, Kenya

BackgroundTaenia solium is an important zoonosis in many developing countries. Cysticercosis poses a serious public health risk and leads to economic losses to the pig production industry. Due to scarcity of data on the epidemiology of porcine cysticercosis in Kenya, the present study was conducted to determine the prevalence and risk factors for porcine cysticercosis within Homa Bay district. A cross-sectional survey was carried out in 2010, and a total of 392 pigs were recruited in a household survey, with all being tested by ante-mortem lingual palpation (together with questionnaire data on pig production, occurrence and transmission of porcine cysticercosis, risk factors and awareness of porcine cysticercosis collected from the households from which pigs were sampled). Sufficient serum was collected from 232 of the pigs to be tested for the presence of circulating parasite antigen using a monoclonal antibody-based sandwich enzyme-linked immunosorbent assay (Ag-ELISA).ResultsSeventy six pigs were found positive by the Ag-ELISA (32.8%, 95% C.I. 26.8-39.2%), while by tongue inspection cysticerci were detected in 22/ 392 pigs (5.6% 95% C.I. 3.6-8.4%).The most important risk factor for porcine cysticercosis in the Homa Bay area was for pigs to belong to a farm where latrine use by members of the household was not evident (OR = 1.9, 95% CI = 1.13–2.37).ConclusionThe present findings indicate that porcine cysticercosis is endemic in Homa Bay District, and that latrine provision, in conjunction with free-range pig keeping contributes significantly to porcine cysticercosis transmission.

A survey of bovine cysticercosis/human taeniosis In Northern Turkana District, Kenya

Bovine cysticercosis is a zoonosis that is mainly of socioeconomic and public health importance. A survey of this disease was carried out in Northern Turkana District, Kenya to estimate the prevalence through both serology and meat inspection, to determine the prevalence of the adult tapeworm in the human definitive host, and to determine risk factors for cattle seropositivity. This information is of public health importance and will be of use in assessing economic losses due to downgrading, refrigeration or condemnation of infested carcasses. The study area was stratified into the three livestock grazing regions of Oropoi to the south, Lokichoggio-Mogilla centrally and Kibish in the north for the purposes of the serological and questionnaire (n = 53 herd owners) data. Five adakaars (grazing units) were selected and 34, 63, 49, 75 and 571 cattle serum samples obtained from these. The slaughter slabs of Lokichoggio and Kakuma were visited and 188 serum samples were obtained from slaughter cattle and compared to results of meat inspection. Human stool samples were collected in each of the three grazing areas and 66, 97 and 78 samples were obtained. The seroprevalence of cysticercosis in cattle was estimated at 16.7% (95% CI 13-20.9%) using a secretory-excretory antigen detection ELISA. There was poor agreement between meat inspection and serology (k = 0.025; p = 0.2797). The prevalence of taeniosis was estimated as 2.5% (95% CI 0.8-5.6%) by microscopy. A backwards elimination logistic regression analysis indicated that the grazing unit (Adakaar), the deworming history of household members and the distance (>2 km) of grazing fields from the homestead were significant explanatory variables for cattle being found to be positive on serology. An intra-cluster correlation coefficient (ICC) of 0.07 (0.02-0.12); p < 0.0001 was calculated for bovine cysticercosis in this area.

Comparison of African swine fever virus prevalence and risk in two contrasting pig-farming systems in South-west and Central Kenya

We describe a horizontal survey of African swine fever virus (ASFV) prevalence and risk factors associated with virus infection in domestic pigs in two contrasting production systems in Kenya. A free range/tethering, low input production system in Ndhiwa District of South-western Kenya is compared with a medium input stall fed production system in Kiambu District of Central Kenya. Analysis of variance (ANOVA) of data derived from cluster analysis showed that number of animals, number of breeding sows and number of weaner pigs were a significant factor in classifying farms in Nhiwa and Kiambu. Analysis of blood and serum samples using a PCR assay demonstrated an average animal level positivity to ASFV of 28% in two independent samplings in South-western Kenya and 0% PCR positivity in Central Kenya. No animals were sero-positive in either study site using the OIE indirect-ELISA and none of the animals sampled exhibited clinical symptoms of ASF. The farms that contained ASFV positive pigs in Ndhiwa District were located in divisions bordering the Ruma National Park from which bushpig (Potamochoerus larvatus) incursions into farms had been reported. ASFV prevalence (P<0.05) was significantly higher at distances between 6 and 16km from the National Park than at distances closer or further away. One of the 8 bushpigs sampled from the park, from which tissues were obtained was PCR positive for ASFV. The data therefore indicated a potential role for the bushpig in virus transmission in South-western Kenya, but there was no evidence of a direct sylvatic virus transmission cycle in Central Kenya. ASF control strategies implemented in these areas will need to take these epidemiological findings into consideration.

Estimation of tsetse challenge and its relationship with trypanosomosis incidence in cattle kept under pastoral production systems in Kenya

In an on-farm trial conducted amongst the Maasai pastoralists in Nkuruman and Nkineji areas of Kenya between April 2004 and August 2005 designed to evaluate the effectiveness of a synthetic tsetse repellent technology, we assessed the relationship between tsetse challenge and trypanosomosis incidence in cattle. Six villages were used in each area. Each of these villages had a sentinel cattle herd that was screened for trypanosomosis on monthly basis using buffy coat technique. Animals found infected at each sampling were treated with diminazene aceturate at 7 mg kg(-1) body weight. Treatments administered by the owners over the sampling intervals were recorded as well. Tsetse flies were trapped at the time of sampling using baited stationary traps and apparent tsetse density estimated as flies per trap per day (FTD). A fixed proportion (10%) of the flies was dissected and their infection status determined through microscopy. Blood meals were also collected from some of the flies and their sources identified using enzyme-linked immunosorbent assay (ELISA). Tsetse challenge was obtained as a product of tsetse density, trypanosome prevalence and the proportion of blood meals obtained from cattle. This variable was transformed using logarithmic function and fitted as an independent factor in a Poisson model that had trypanosomosis incidence in the sentinel cattle as the outcome of interest. The mean trypanosomosis incidence in the sentinel group of cattle was 7.2 and 10.2% in Nkuruman and Nkineji, respectively. Glossina pallidipes was the most prevalent tsetse species in Nkuruman while G. swynnertoni was prevalent in Nkineji. The proportions of tsetse that had mature infections in the respective areas were 0.6 and 4.2%. Most tsetse (28%) sampled in Nkuruman had blood meals from warthogs while most of those sampled in Nkineji (30%) had blood meals from cattle. A statistically significant association between tsetse challenge and trypanosomosis incidence was obtained only in Nkuruman when data was pooled and analyzed at the area but not at the village-level. In the later scenario, lagging tsetse challenge by 1 month improved the strength but not the significance of the association. These findings show that when the spatial unit of analysis in observational studies or on-farm trials is small, for instance a village, it may not be possible to demonstrate a statistically significant association between tsetse challenge and trypanosomosis incidence in livestock so as to effectively control for tsetse challenge.

Environment and farm factors associated with exposure to Theileria parva infection in cattle under traditional mixed farming system in Mbeere District, Kenya

The objective of this study was to investigate the relationship between seroprevalence to Theileria parva infection in cattle and potential environmental and farm-level effects in 80 farms under traditional crop–livestock system in Mbeere District, Kenya. A standardized questionnaire was used to collect the effects characteristics as related to T. parva infection epidemiology. Serum samples were collected from 440 cattle of all ages for detection of T. parva antibodies by the enzyme-linked immunosorbent assay technique. The association between the variables was assessed using a generalized estimation equation logistic regression model. The overall T. parva seroprevalence, accounting for correlation of responses, was 19.3% (95% confidence interval (CI) 14%, 25%). Two variables, “administrative division” and “presence of the vector tick on the farm”, were significantly associated with the T. parva seroresponse. Respectively, cattle from farms in Gachoka, Evurore, and Mwea divisions were (and their 95% CI) 1.3 (0.36, 4.8), 4.4 (1.2, 15.9), and 15.2 (4.9, 47.1) times more likely to be seropositive relative to those from Siakago Division (P = 0.000). Cattle from farms in which the vector tick was present were 2.9 (1.2, 6.7) times more likely to be seropositive (P = 0.011). Results of this study suggested that both environmental and farm factors may be associated with T. parva infection epidemiology in Mbeere District. Under such circumstances, characterization of environmental suitability for the vector tick and corresponding environment-specific farm management practices in the district is required both for improved understanding of the disease and in planning disease control programs.

Field trial of a synthetic tsetse-repellent technology developed for the control of bovine trypanosomosis in Kenya.

We conducted a field trial among Maasai cattle-keepers in Nkuruman and Nkineji areas of Kenya to evaluate the effectiveness of a synthetic tsetse-repellent technology developed for the control of trypanosomosis in cattle. The technology was a repellent (2-methoxy 4-methylphenol) emitted from dispensers attached to collars worn by cattle. Treatment was allocated at the herd level to ensure adequate protection of all the animals in a herd, with measurements of effectiveness conducted at the individual-animal level. The trial began in April 2005 and ran for 16 months including a baseline phase of 4 months. We recruited 12 herds in each area using a restricted random-sampling technique and distributed them equally into intervention (repellent) and control groups. Sample size was determined using a formal power calculation. Effectiveness or minimal worthwhile difference was defined as a 50% reduction in the incidence of trypanosome infection in the treated versus control group (effectiveness below which the technology was considered by experts as not viable compared to existing control techniques). All the animals in the recruited herds were screened monthly (buffy-coat technique) for trypanosome infections. The analysis followed the principle of intention-to-treat by which subjects are analysed according to their initial treatment assignment, regardless of the mechanical performance of the device. Crude and adjusted effects of the technology were 23% (p<0.001) and 18% (p=0.08) reduction in the infection incidence in the treatment compared to the control groups, respectively. The impact of the technology estimated in this study did not achieve the threshold of 50% reduction in the trypanosome infection incidence set a priori to indicate effectiveness (p<0.001). We therefore concluded that the prototype repellent technology package was not sufficiently effective in reducing trypanosome infection incidence under natural tsetse challenge to merit commercial development.