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Colebunders R, Raimon S, Siewe Fodjo JN, Carter JY. Increased cost‐benefit of strengthening onchocerciasis elimination efforts in areas with high onchocerciasis‐associated epilepsy. Trop Med Int Health 2019; 24:1259. [DOI: 10.1111/tmi.13300] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R. Colebunders
- Global Health Institute University of Antwerp Antwerp Belgium
| | - S. Raimon
- Amref Health Africa Juba Republic of South Sudan
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Solomon N, Zeyhle E, Subramanian K, Fields PJ, Romig T, Kern P, Carter JY, Wachira J, Mengiste A, Macpherson CNL. Cystic echinococcosis in Turkana, Kenya: 30 years of imaging in an endemic region. Acta Trop 2018; 178:182-189. [PMID: 29155205 DOI: 10.1016/j.actatropica.2017.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Received: 07/03/2017] [Revised: 11/06/2017] [Accepted: 11/15/2017] [Indexed: 12/28/2022]
Abstract
Cystic echinococcosis (CE), a widespread, complex zoonosis, causes chronic disease associated with high morbidity. The pastoral Turkana people of Kenya have one of the highest prevalence rates of CE in the world. Between 1983 and 2015, a CE control program in the Turkana region used ultrasound (US) screening surveys and surgical outreach visits to evaluate CE prevalence and treat those with the disease. As the gold standard modality for diagnosing CE, US reveals a great deal of information about the disease in affected populations. The aim of this study is to discuss the characteristics of untreated CE in the Turkana people as revealed by US data collected during the CE control program and evaluate disease presentation, factors influencing the risk of transmission, and the timeline of disease progression. Data were obtained from written patient notes from US screenings and images; cysts were classified using the World Health Organization (WHO) standardized US classification of CE. Findings include greater prevalence of cysts, later stages of cysts, and multiple cysts in older age groups, with no multiple cysts occurring in patients under six years of age, which are consistent with the assertion that rates of exposure, transmission, and infection increase with age in endemic regions. Findings also raise questions regarding the timeline of disease progression, and factors potentially influencing disease transmission within this and other endemic populations. A comprehensive survey focusing on cultural and community observations (e.g., changing behaviors, hygienic practices, etc.) may provide more detailed information regarding factors that facilitate transmission.
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Affiliation(s)
- N Solomon
- Windward Islands Research and Education Foundation (WINDREF), P.O. Box 7, St. George's, Grenada; St. George's University School of Medicine, P.O. Box 7, St. George's, Grenada.
| | - E Zeyhle
- Meru University of Science and Technology, Mararo Road, Carlton Court, C1, Nairobi, Kenya.
| | - K Subramanian
- St. George's University School of Medicine, P.O. Box 7, St. George's, Grenada.
| | - P J Fields
- Windward Islands Research and Education Foundation (WINDREF), P.O. Box 7, St. George's, Grenada; St. George's University School of Medicine, P.O. Box 7, St. George's, Grenada; St. George's University School of Veterinary Medicine, P.O. Box 7, St. George's, Grenada.
| | - T Romig
- University of Hohenheim, FG Parasitologie 220B, Emil-Wolff-Str. 31, 70599, Stuttgart, Germany.
| | - P Kern
- University of Ulm, Division of Infectious Diseases and Clinical Immunology, Department of Medicine III, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
| | - J Y Carter
- Outreach Program, Amref Health Africa, PO Box 30125, 00100 GPO, Nairobi, Kenya.
| | - J Wachira
- Outreach Program, Amref Health Africa, PO Box 30125, 00100 GPO, Nairobi, Kenya.
| | - A Mengiste
- Outreach Program, Amref Health Africa, PO Box 30125, 00100 GPO, Nairobi, Kenya.
| | - C N L Macpherson
- Windward Islands Research and Education Foundation (WINDREF), P.O. Box 7, St. George's, Grenada; St. George's University School of Medicine, P.O. Box 7, St. George's, Grenada; St. George's University School of Veterinary Medicine, P.O. Box 7, St. George's, Grenada.
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Carter JY. Modern technology in peripheral health care in developing countries. East Afr Med J 2004; 81:277-8. [PMID: 16167673 DOI: 10.4314/eamj.v81i6.9175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Verhoef H, Hodgins E, Eggelte TA, Carter JY, Lema O, West CE, Kok FJ. Anti-malarial drug use among preschool children in an area of seasonal malaria transmission in Kenya. Am J Trop Med Hyg 1999; 61:770-5. [PMID: 10586910 DOI: 10.4269/ajtmh.1999.61.770] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aims of this study were to estimate the proportion of asymptomatic Kenyan preschool children using anti-malarial drugs, to identify factors associated with chloroquine use, and to assess the validity of frequency of febrile episodes and drug use reported by mothers or carers. Of 318 children studied, 38% (95% confidence interval [CI] = 30-47%]) tested positive for chloroquine or sulfadoxine. Of chloroquine-positive children, 15% had concentrations exceeding the estimated minimum therapeutically effective values. Among those testing negative for sulfadoxine, chloroquine-positive children were more frequently parasitemic (odds ratio = 2.6, 95% CI = 1.3-5.2), and had lower mean hemoglobin concentrations (6.1 g/L, 95% CI = 2.1-10.1) than chloroquine-negative children. Mothers over-reported the frequency of malaria or fever episodes as usually defined in medical studies, and underreported anti-malarial drug use. We conclude that anti-malarials are frequently given for treatment of malaria or malaria-associated illness, rather than prophylactically or for symptoms unrelated to malaria. Questionnaire surveys cannot replace biochemical markers to obtain information on anti-malarial drug use.
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Affiliation(s)
- H Verhoef
- Division of Human Nutrition and Epidemiology, Wageningen Agricultural University, The Netherlands
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Carter JY, Lema OE. Role of laboratory services in health care: the present status in eastern Africa and recommendations for the future. East Afr Med J 1999; 76:237-8. [PMID: 10750499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Carter JY, Lema OE, Mukunza HK, Varia HN, Munyere AS, Watkins WM, Watkins KM. Prevalence of anaemia in patients attending an outpatient clinic in western Rift Valley in Kenya during a low malaria season. East Afr Med J 1999; 76:251-4. [PMID: 10750503] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To assess the prevalence of anaemia in outpatients attending a rural health clinic in an area of seasonal malaria, during the low transmission season. METHODS Haemoglobin estimation and blood slide examination for malaria parasites were performed on 280 consecutive patients attending outpatient curative services at Entasopia Health Centre, Kajiado District, Kenya, between April-May 1996. Anaemia was defined according to World Health Organisation guidelines for age, sex and pregnancy status. RESULTS In all groups except adult males, more than half of the patients tested had haemoglobin values below the lower reference limits, suggesting that anaemia is widely present in this population even during the low malaria season. Only 5% of patients were positive for Plasmodium falciparum malaria. Peripheral blood film examination suggested iron deficiency as the major cause of anaemia. CONCLUSIONS Further studies to define the underlying causes of anaemia and to develop community strategies to prevent anaemia are required. The association between fever and anaemia and the use of pallor to diagnose anaemia, are discussed.
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Affiliation(s)
- J Y Carter
- African Medical and Research Foundation, Nairobi, Kenya
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Lema OE, Carter JY, Nagelkerke N, Wangai MW, Kitenge P, Gikunda SM, Arube PA, Munafu CG, Materu SF, Adhiambo CA, Mukunza HK. Comparison of five methods of malaria detection in the outpatient setting. Am J Trop Med Hyg 1999; 60:177-82. [PMID: 10072132 DOI: 10.4269/ajtmh.1999.60.177] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In eastern Africa where 90% of the malaria is due to Plasmodium falciparum, the accuracy of malaria diagnosis at the outpatient level is becoming increasingly important due to problems of drug resistance and use of alternative, costly antimalarial drugs. The quantitative buffy coat (QBC) technique, acridine orange staining with an interference filter system, and the ParaSight-F test have been introduced as alternative methods to conventional microscopy for the diagnosis of malaria. Two hundred thirteen outpatients were tested using these alternative methods and conventional microscopy by five experienced technologists; two were randomly allocated to read the results of each test. Paired results showed the highest level of agreement with the ParaSight-F test (99%), followed by Field stain (92%). The results of the QBC technique showed the least agreement (73%). Using conventional microscopy as the reference standard, the ParaSight-F test had a sensitivity range of 90-92% and a specificity of 99%, staining with acridine orange had a sensitivity range of 77-96% and a specificity range of 81-98% and the QBC technique had a sensitivity range of 88-98% and a specificity range of 58-90%. All microscopic tests showed lower sensitivities (as low as 20% using staining with acridine orange) in detecting low parasitemias (< or = 320/microl) than the ParaSight-F test (70%). Due to the high cost of the ParaSight-F test, Field-stained blood films remain the most appropriate method for diagnosis of P. falciparum in eastern Africa. The ParaSight-F test may be used in situations where no trained microscopists are available, or where malaria is strongly suspected and the results of microscopy are negative.
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Affiliation(s)
- O E Lema
- African Medical and Research Foundation, and Department of Medical Microbiology, University of Nairobi, Kenya
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Abstract
Pathology services represent the rational, scientific basis of the practice of clinical care. It does not represent deus ex machina, an implausible solution to a complex plot, but rather the way in which clinical care can be audited, controlled, guided and kept appropriate to the funds and the skills available. Arguments are presented to support this statement as well as to analyse what is wrong with health care, from the point of view of laboratory medicine, in sub-Saharan Africa. In most African countries 'first world' technology has to be imported by economies barely able to sustain the basic requirements of human life. Badly needed foreign exchange is obtained by growing export crops at the cost of traditional lifestyle, disenfranchising communities, urbanisation, and even at the cost not being able to grow food. War, corruption, lack of accountability even in the Western sense of being able to go to the polls every so often, lack of empowerment, low literacy rate etc all debase the communities, with minimal exceptions, of Africa. Health care is under the same capricious rule as all other public services: investment in laboratories is poor and most have no access to a professional laboratory at all. More investment, not less; expansion of pathology services not restricting them, is needed throughout the continent.
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Affiliation(s)
- I P Gray
- Department of Chemical Pathology, University of the Witwatersrand, Johannesburg, South Africa
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Materu SF, Lema OE, Mukunza HM, Adhiambo CG, Carter JY. Antibiotic resistance pattern of Vibrio cholerae and Shigella causing diarrhoea outbreaks in the eastern Africa region: 1994-1996. East Afr Med J 1997; 74:193-7. [PMID: 9185422] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Between March 1994 and December 1996, 1797 rectal swabs were transported to the AMREF laboratory from sites in six countries in the eastern Africa region: 1749 were cultured for Vibrio cholerae and 48 for Shigella/Salmonella. Culture, isolation, identification and antibiotic susceptibility testing were performed using standardized techniques. The isolates were categorized as sensitive or resistant based on standardized zones of inhibition. The rate of isolation of V. cholerae from rectal swabs increased progressively from less than 20% to more than 45% between 1994 and 1996, 80-100% of isolates of V. cholerae from Kenya and south Sudan, and 65-90% from Somalia were sensitive to tetracycline, although in 1995 isolates from Mogadishu showed only 44% sensitivity. All isolates from Tanzania and Rwanda were 100% resistant to tetracycline. In Kenya and Somalia, the percentage of isolates sensitive to chloramphenicol and cotrimoxazole reduced markedly from 85% in 1994 to < 10% in 1996. 100% of isolates from Rwanda and Tanzania were resistant to chloramphenicol and cotrimoxazole while in south Sudan > 70% of isolates were sensitive. Nalidixic acid and erythromycin retained > 75% sensitivity in all areas. Shigella dysenteriae and Shigella flexneri were recovered from dysentery specimens in northern Kenya. Both species showed similar antibiotic sensitivity patterns and were sensitive only to nalidixic acid and furazolidone. Due to variations of resistance patterns within countries in the region, antibiotic sensitivity testing should be performed at the start of an outbreak, and antibiotic use should be restricted to severe cases of V. cholerae and Shigella infection.
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Affiliation(s)
- S F Materu
- Laboratory Service, African Medical and Research Foundation (AMREF), Nairobi
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Lema OE, Carter JY, Arube PA, Munafu CG, Wangai MW, Rees PH. Evaluation of the alkaline haematin D-575 method for haemoglobin estimation in east Africa. Bull World Health Organ 1994; 72:937-41. [PMID: 7867140 PMCID: PMC2486729] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In many health facilities in east Africa, haemoglobin estimation is performed using visual colour comparison methods. Efforts to establish colorimetric methods face numerous constraints, including the unavailability of standards for quality control. In contrast, the alkaline haematin D-575 method for haemoglobin estimation is a colorimetric method that uses primary standards prepared from pure, crystalline chlorohaemin. There is no significant difference in the accuracy of the alkaline haematin D-575 method and that of the reference haemiglobincyanide method (P > 0.05), and the response of the alkaline haematin D-575 method is linear for serially diluted blood samples over the haemoglobin concentration range 19.6-3.3 g/dl (r = 0.994, y = 1.01 x - 0.3). The method has a precision of +/-0.3 g/dl (coefficient of variation = (1.8%) for whole blood, and is suitable for use with fixed-wavelength haemglobinometers (lambda = 565 nm) or with colorimeters at lambda = 580 nm. Stable quality control standards could be prepared at provincial, zonal, or reference laboratories and distributed regularly to outlying laboratories.
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Affiliation(s)
- O E Lema
- Clinical Department, African Medical and Research Foundation (AMREF), Nairobi, Kenya
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Carter JY, Lema OE, Munafu CG, Wangai MW, Rees PH. Laboratory services in primary health care. East Afr Med J 1993; 70:12-3. [PMID: 8223299] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Y Carter
- Laboratory Services, African Medical Research Foundation, Nairobi
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Abstract
One hundred and ninety students aged 6 to 18 at a boarding school 120 km west of Nairobi in the Rift Valley participated in a comparative trial of malaria prophylaxis. Treatment with a combination of amodiaquine 25 mg/kg over three days plus doxycycline 100 mg twice daily for five days cleared their blood of Plasmodium falciparum. They were then randomly divided into the following three groups matched for age and sex: one group slept under mosquito nets; one group received one or two tablets (100 mg each) of proguanil hydrochloride daily according to weight; one group received one or two placebo tablets daily which were the same size and colour as the proguanil tablets. Malaria was diagnosed when asexual P falciparum were seen on blood films and was treated with pyrimethamine-sulphadoxine. At the end of one school term 188 of the 190 students had completed the study. One new infection was found during 3893 days of follow up in the mosquito net group, eight new infections over 3667 days in the proguanil group, and 35 new infections over 3677 days in the placebo group, representing a reduction of 97.3% and 77.1% in attack rates for the mosquito net method and for treatment with proguanil respectively. Both provide effective protection from malaria.
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Affiliation(s)
- C G Nevill
- Clinical Department, African Medical Research Foundation, Nairobi, Kenya
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Watkins WM, Brandling-Bennett AD, Nevill CG, Carter JY, Boriga DA, Howells RE, Koech DK. Chlorproguanil/dapsone for the treatment of non-severe Plasmodium falciparum malaria in Kenya: a pilot study. Trans R Soc Trop Med Hyg 1988; 82:398-403. [PMID: 3068855 DOI: 10.1016/0035-9203(88)90133-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [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: 01/04/2023] Open
Abstract
Chlorocycloguanil, the active metabolite of chlorproguanil, was synergistic in vitro with dapsone against 2 culture-adapted Plasmodium falciparum isolates from Kenya; maximal synergy occurred at lower concentrations that it did with pyrimethamine and sulfadoxine. 48 children with asymptomatic P. falciparum infections were treated with chlorproguanil (at a target dose of 1.2 mg/kg) and dapsone (target dose of 1.2 or 2.4 mg/kg); all were free of parasitaemia by day 7. The following numbers had recurrences on days 14, 21, and 28, respectively: 1 of 48, 7 of 47, and 7 of 40. All 39 children treated with pyrimethamine (target dose 1.2 mg/kg) and sulfadoxine (target dose 24 mg/kg) were cleared of infection, while the following had recurrences on days 14, 21, and 28: 1 of 39, 2 of 38, and 2 of 36. The rate of decrease in parasitaemia was the same in the 2 groups, and there was no change in haematocrit or haemoglobin during the follow-up. The rate of recurrence in the children receiving chlorporguanil/dapsone was higher, probably because these drugs have a much shorter clearance time than pyrimethamine/sulfadoxine. Chlorproguanil/dapsone is an effective combination for treating P. falciparum malaria and deserves further study.
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Affiliation(s)
- W M Watkins
- Biomedical Sciences Research Centre, Kenya Medical Research Institute, (KEMRI), Nairobi
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