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Kimani R, Wakaba P, Kamita M, Mbogo D, Mutai W, Ayodo C, Suliman E, Kanoi BN, Gitaka J. Detection of multidrug-resistant organisms of concern including Stenotrophomonas maltophilia and Burkholderia cepacia at a referral hospital in Kenya. PLoS One 2024; 19:e0298873. [PMID: 38626173 PMCID: PMC11020837 DOI: 10.1371/journal.pone.0298873] [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] [Received: 07/19/2023] [Accepted: 02/01/2024] [Indexed: 04/18/2024] Open
Abstract
Regular monitoring of bacterial susceptibility to antibiotics in clinical settings is key for ascertaining the current trends as well as re-establish empirical therapy. This study aimed to determine bacterial contaminants and their antimicrobial susceptibility patterns from medical equipment, inanimate surfaces and clinical samples obtained from Thika Level V Hospital (TLVH), Thika, in Central Kenya. Three hundred and five samples were collected between the period of March 2021 to November 2021 and comprised urine, pus swabs, catheter swabs, stool, and environmental samples. Bacterial identification and antimicrobial susceptibility were performed using VITEK 2 and disc diffusion respectively. We observed that Coagulase-negative Staphylococci (28 /160, 17.5%) were the most commonly isolated species from clinical samples followed by E. coli (22 /160 13.8%) and S. aureus (22/160, 13.8%). The bed rails were the mostly contaminated surface with S. aureus accounting for 14.2% (6/42). Among the clinical samples, pus swabs yielded the highest number of pathogens was pus (92/160). Trauma patients had the highest proportion of isolates (67/160, 41.8%). High level of antimicrobial resistance to key antimicrobials, particularly among Enterobacterales was observed. Extended Spectrum Beta Lactamase (ESBL) phenotype was noted in 65.9% (29/44) of enteric isolates. While further ESBL genetic confirmatory studies are needed, this study highlights the urgent need for actions that mitigate the spread of antibiotic-resistant bacteria.
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Affiliation(s)
- Racheal Kimani
- Centre for Research in Infectious Diseases, Directorate of Research Innovation, Mount Kenya University, Thika, Kenya
| | - Patrick Wakaba
- Centre for Research in Infectious Diseases, Directorate of Research Innovation, Mount Kenya University, Thika, Kenya
| | - Moses Kamita
- Centre for Research in Infectious Diseases, Directorate of Research Innovation, Mount Kenya University, Thika, Kenya
| | | | - Winnie Mutai
- Department of Medical Microbiology & Immunology, University of Nairobi, Nairobi, Kenya
| | - Charchil Ayodo
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Essuman Suliman
- Department of Microbiology, Mount Kenya University, Thika, Kenya
| | - Bernard N. Kanoi
- Centre for Research in Infectious Diseases, Directorate of Research Innovation, Mount Kenya University, Thika, Kenya
| | - Jesse Gitaka
- Centre for Research in Infectious Diseases, Directorate of Research Innovation, Mount Kenya University, Thika, Kenya
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Kamondo D, Mwancha-Kwasa M, Kamita M, Mwangi C, Murage M, Juttla PK, Gicheru D, Gitaka J. The impact of the COVID-19 pandemic on reproductive, maternal, neonatal, and child health care services in Kiambu County, Kenya. Afr J Reprod Health 2024; 28:20-29. [PMID: 38582973 DOI: 10.29063/ajrh2024/v28i3.3] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
The global response to COVID-19 undermined established public health goals. This study investigated the impact of COVID-19 on reproductive, maternal, neonatal, and child health (RMNCH) services in Kiambu County, Kenya. It was a retrospective cross-sectional study, where data on antenatal care (ANC), delivery, postnatal care (PNC), and family planning (FP) before and after COVID-19 was retrieved and compared. New ANC clients and 4th ANC visits decreased by 2.9% and 17% respectively. New clients attending PNC increased by 13.3% (p = 0.007). Skilled deliveries reduced by 0.3%, maternal, neonatal deaths, and fresh stillbirths reduced by 0.7%, 23.9%, and 15.8% respectively. Caesarean sections rose by 12.7% (p=0.001). New clients and revisits for family planning reduced by 15.4% and 6.6% respectively. The pandemic adversely affected most of the RMNCH services. There is a need for health departments to institute robust strategies to recover the gains lost during COVID-19.
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Affiliation(s)
- Davis Kamondo
- Department of Health Services, County Government of Kiambu, Kiambu County, Kiambu, Kenya
| | - Magoma Mwancha-Kwasa
- Department of Health Services, County Government of Kiambu, Kiambu County, Kiambu, Kenya
| | - Moses Kamita
- Department of Research and Innovation, Mount Kenya University, Thika, Kiambu County, Kenya
| | - Caroline Mwangi
- Department of Health Services, County Government of Kiambu, Kiambu County, Kiambu, Kenya
| | - Maxwell Murage
- Department of Health Services, County Government of Kiambu, Kiambu County, Kiambu, Kenya
| | - Prabhjot K Juttla
- Department of Health Services, County Government of Kiambu, Kiambu County, Kiambu, Kenya
| | - Daniel Gicheru
- Department of Health Services, County Government of Kiambu, Kiambu County, Kiambu, Kenya
| | - Jesse Gitaka
- Department of Health Services, County Government of Kiambu, Kiambu County, Kiambu, Kenya
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Shiluli C, Kamath S, Kanoi BN, Kimani R, Maina M, Waweru H, Kamita M, Ndirangu I, Abkallo HM, Oduor B, Pamme N, Dupaty J, Klapperich CM, Lolabattu SR, Gitaka J. Improving gonorrhoea molecular diagnostics: Genome mining-based identification of identical multi-repeat sequences (IMRS) in Neisseria gonorrhoeae. Heliyon 2024; 10:e27344. [PMID: 38533083 PMCID: PMC10963193 DOI: 10.1016/j.heliyon.2024.e27344] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Background Curable sexually transmitted infections (STIs), such as Neisseria gonorrhoeae (N. gonorrhoeae), are a major cause of poor pregnancy outcomes. The infection is often asymptomatic in pregnant women, and a syndrome-based approach of testing leads to a missed diagnosis. Culture followed by microscopy is inadequate and time-consuming. The gold standard nucleic acid amplification tests require advanced infrastructure settings, whereas point-of-care tests are limited to immunoassays with sensitivities and specificities insufficient to accurately diagnose asymptomatic cases. This necessitates the development and validation of assays that are fit for purpose. Methods We identified new diagnostic target biomarker regions for N. gonorrhoeae using an algorithm for genome mining of identical multi-repeat sequences (IMRS). These were then developed as DNA amplification primers to design better diagnostic assays. To test the primer pair, genomic DNA was 10-fold serially diluted (100 pg/μL to 1 × 10-3 pg/μL) and used as DNA template for PCR reactions. The gold standard PCR using 16S rRNA primers was also run as a comparative test, and both assay products were resolved on 1% agarose gel. Results Our newly developed N. gonorrhoeae IMRS-PCR assay had an analytical sensitivity of 6 fg/μL representing better sensitivity than the 16S rRNA PCR assay with an analytical sensitivity of 4.3096 pg/μL. The assay was also successfully validated using clinical urethral swab samples. We further advanced this technique by developing an isothermal IMRS, which was both reliable and sensitive for detecting cultured N. gonorrhoeae isolates at a concentration of 38 ng/μL. Combining isothermal IMRS with a low-cost lateral flow assay, we were able to detect N. gonorrhoeae amplicons at a starting concentration of 100 pg/μL. Conclusion Therefore, there is a potential to implement this concept within miniaturized, isothermal, microfluidic platforms, and laboratory-on-a-chip diagnostic devices for highly reliable point-of-care testing.
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Affiliation(s)
- Clement Shiluli
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, Thika, Kenya
| | - Shwetha Kamath
- Division of Research and Development, Jigsaw Bio Solutions Private Limited, Bangalore, India
| | - Bernard N. Kanoi
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, Thika, Kenya
| | - Racheal Kimani
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, Thika, Kenya
| | - Michael Maina
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, Thika, Kenya
| | - Harrison Waweru
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, Thika, Kenya
| | - Moses Kamita
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, Thika, Kenya
| | - Ibrahim Ndirangu
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, Thika, Kenya
| | - Hussein M. Abkallo
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Bernard Oduor
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Nicole Pamme
- Department of Materials and Environmental Chemistry, Stockholm University, Sweden
| | - Joshua Dupaty
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | | | | | - Jesse Gitaka
- Centre for Research in Infectious Diseases, College of Graduate Studies and Research, Mount Kenya University, Thika, Kenya
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Mukala J, Mogere D, Kirira P, Kanoi BN, Akisa V, Kobia F, Waweru H, Gitaka J. Predictors of birth weight in pregnant women with malaria: a prospective cohort facility-based study in Webuye-Kenya. BMC Pregnancy Childbirth 2024; 24:187. [PMID: 38459499 PMCID: PMC10921604 DOI: 10.1186/s12884-024-06355-9] [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] [Received: 11/15/2023] [Accepted: 02/18/2024] [Indexed: 03/10/2024] Open
Abstract
In sub-Saharan Africa, malaria, which remains a major public health burden, has a prevalence of 9 to 28% and malaria in pregnancy is associated with severe adverse outcomes for the mother and her baby. Here, we sought to determine the predictors of birth weight in a cohort of 140 women with malaria in pregnancy, who were recruited at the Webuye County hospital in Western Kenya. All study participants underwent malaria diagnosis through microscopic examination of blood smear samples and were grouped into the malaria-positive and malaria-negative groups. Both groups were followed up beginning at the first antenatal visit (March 2022) until delivery (December 2022) and various data, including demographic, parity, gravidity, socioeconomic, maternal and fetal outcomes were collected. Data analyses were done using SPSS version 27. Chi-square and Fisher's Exact tests were used for bivariate and relative risk analyses at a p-value of ≤0.05 (95%) confidence level. Most of the participants were aged 18-25 years, were primigravidas and married, had secondary school-level education, earned 20-30 thousand Kenya shillings, resided in rural areas, and were in the second trimester. There were 6 (4.6%) cases of low birth weight, 3 (4.5%) in the malaria-negative group and 3 (4.7%) in the malaria-positive group. During pregnancy, 41 (31.5%) were anaemic, 5 (3.8%) were HIV-positive, 5 (3.8%) had preeclampsia, and 2 (1.5%) had gestational diabetes. Our analyses show that confounding factors like anaemia, HIV, pre-eclampsia and gestational diabetes did not influence birthweight (p ≥ 0.923). The malaria-positive and malaria-negative groups did not differ significantly with regard to the low birth weight (relative risk: 0.999, 95% confidence interval: 0.926-1.077). Marital status, gestational age, and area of residence were associated with malaria p ≤ 0.001, ≤ 0.001 and 0.028 respectively. In both groups, 124 of the 140 deliveries had normal birth weights and of these 63 (95.4%, n = 70) were in the malaria-negative group, whereas 61 (95.3%, n = 70) belonged to the malaria-positive group.
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Affiliation(s)
- Joseph Mukala
- School of Public Health, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya.
| | - Dominic Mogere
- School of Public Health, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
| | - Peter Kirira
- School of Applied Sciences, Mount Kenya University, Thika, Kenya
| | - Bernard N Kanoi
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Centre for Malaria Elimination, Mount Kenya University, Thika, Kenya
| | | | - Francis Kobia
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Centre for Malaria Elimination, Mount Kenya University, Thika, Kenya
| | - Harrison Waweru
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Centre for Malaria Elimination, Mount Kenya University, Thika, Kenya
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Centre for Malaria Elimination, Mount Kenya University, Thika, Kenya
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Matsumoto T, Nagashima M, Kagaya W, Kongere J, Gitaka J, Kaneko A. Evaluation of a financial incentive intervention on malaria prevalence among the residents in Lake Victoria basin, Kenya: study protocol for a cluster-randomized controlled trial. Trials 2024; 25:165. [PMID: 38438925 PMCID: PMC10913238 DOI: 10.1186/s13063-024-07991-4] [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: 10/31/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND In the Lake Victoria basin of western Kenya, malaria remains highly endemic despite high coverage of interventions such as mass distribution of long-lasting insecticidal nets (LLIN), indoor residual spraying (IRS) programs, and improvement of availability and accessibility of rapid diagnostic tests (RDT) and artemisinin-based combination therapy (ACT) at community healthcare facilities. We hypothesize that one major cause of the residual transmission is the lack of motivation among residents for malaria prevention and early treatment. METHODS This study will aim to develop a demand-side policy tool to encourage local residents' active malaria prevention and early treatment-seeking behaviors. We examine the causal impact of a financial incentive intervention complemented with malaria education to residents in malaria-prone areas. A cluster-randomized controlled trial is designed to assess the effect of the financial incentive intervention on reducing malaria prevalence in residents of Suba South in Homa Bay County, Kenya. The intervention includes two components. The first component is the introduction of a financial incentive scheme tied to negative RDT results for malaria infection among the target population. This study is an attempt to promote behavioral changes in the residents by providing them with monetary incentives. The project has two different forms of incentive schemes. One is a conditional cash transfer (CCT) that offers a small reward (200 Ksh) for non-infected subjects during the follow-up survey, and the other is a lottery incentive scheme (LIS) that gives a lottery with a 10% chance of winning a large reward (2000 Ksh) instead of the small reward. The second component is a knowledge enhancement with animated tablet-based malaria educational material (EDU) developed by the research team. It complements the incentive scheme by providing the appropriate knowledge to the residents for malaria elimination. We evaluate the intervention's impact on the residents' malaria prevalence using a cluster-randomized control trial. DISCUSSION A policy tool to encourage active malaria prevention and early treatment to residents in Suba South, examined in this trial, may benefit other malaria-endemic counties and be incorporated as part of Kenya's national malaria elimination strategy. TRIAL REGISTRATION UMIN000047728. Registered on 29th July 2022.
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Affiliation(s)
- Tomoya Matsumoto
- Department of Economics, Faculty of Commerce, Otaru University of Commerce, Hokkaido, Japan.
| | - Masaru Nagashima
- Institute of Developing Economies Japan External Trade Organization (IDE-JETRO), Chiba, Japan
| | - Wataru Kagaya
- Department of Protozoology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Department of Ecoepidemiology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - James Kongere
- Department of Virology and Parasitology, Graduate School of Medicine/Osaka International Research Center for Infectious Diseases, Osaka Metropolitan University, Osaka, Japan
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Akira Kaneko
- Department of Protozoology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Department of Virology and Parasitology, Graduate School of Medicine/Osaka International Research Center for Infectious Diseases, Osaka Metropolitan University, Osaka, Japan
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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Musundi SD, Gitaka J, Kanoi BN. Identification of conserved cross-species B-cell linear epitopes in human malaria: a subtractive proteomics and immuno-informatics approach targeting merozoite stage proteins. Front Immunol 2024; 15:1352618. [PMID: 38404581 PMCID: PMC10884153 DOI: 10.3389/fimmu.2024.1352618] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Human malaria, caused by five Plasmodium species (P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi), remains a significant global health burden. While most interventions target P. falciparum, the species associated with high mortality rates and severe clinical symptoms, non-falciparum species exhibit different transmission dynamics, remain hugely neglected, and pose a significant challenge to malaria elimination efforts. Recent studies have reported the presence of antigens associated with cross-protective immunity, which can potentially disrupt the transmission of various Plasmodium species. With the sequencing of the Plasmodium genome and the development of immunoinformatic tools, in this study, we sought to exploit the evolutionary history of Plasmodium species to identify conserved cross-species B-cell linear epitopes in merozoite proteins. We retrieved Plasmodium proteomes associated with human malaria and applied a subtractive proteomics approach focusing on merozoite stage proteins. Bepipred 2.0 and Epidope were used to predict B-cell linear epitopes using P. falciparum as the reference species. The predictions were further compared against human and non-falciparum databases and their antigenicity, toxicity, and allergenicity assessed. Subsequently, epitope conservation was carried out using locally sequenced P. falciparum isolates from a malaria-endemic region in western Kenya (n=27) and Kenyan isolates from MalariaGEN version 6 (n=131). Finally, physiochemical characteristics and tertiary structure of the B-cell linear epitopes were determined. The analysis revealed eight epitopes that showed high similarity (70-100%) between falciparum and non-falciparum species. These epitopes were highly conserved when assessed across local isolates and those from the MalariaGEN database and showed desirable physiochemical properties. Our results show the presence of conserved cross-species B-cell linear epitopes that could aid in targeting multiple Plasmodium species. Nevertheless, validating their efficacy in-vitro and in-vivo experimentally is essential.
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Affiliation(s)
| | | | - Bernard N. Kanoi
- Centre for Malaria Elimination, Institute of Tropical Medicine, Mount Kenya University, Thika, Kenya
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Phelan JE, Turkiewicz A, Manko E, Thorpe J, Vanheer LN, van de Vegte-Bolmer M, Ngoc NTH, Binh NTH, Thieu NQ, Gitaka J, Nolder D, Beshir KB, Dombrowski JG, Di Santi SM, Bousema T, Sutherland CJ, Campino S, Clark TG. Rapid profiling of Plasmodium parasites from genome sequences to assist malaria control. Genome Med 2023; 15:96. [PMID: 37950308 PMCID: PMC10636944 DOI: 10.1186/s13073-023-01247-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Malaria continues to be a major threat to global public health. Whole genome sequencing (WGS) of the underlying Plasmodium parasites has provided insights into the genomic epidemiology of malaria. Genome sequencing is rapidly gaining traction as a diagnostic and surveillance tool for clinical settings, where the profiling of co-infections, identification of imported malaria parasites, and detection of drug resistance are crucial for infection control and disease elimination. To support this informatically, we have developed the Malaria-Profiler tool, which rapidly (within minutes) predicts Plasmodium species, geographical source, and resistance to antimalarial drugs directly from WGS data. RESULTS The online and command line versions of Malaria-Profiler detect ~ 250 markers from genome sequences covering Plasmodium speciation, likely geographical source, and resistance to chloroquine, sulfadoxine-pyrimethamine (SP), and other anti-malarial drugs for P. falciparum, but also providing mutations for orthologous resistance genes in other species. The predictive performance of the mutation library was assessed using 9321 clinical isolates with WGS and geographical data, with most being single-species infections (P. falciparum 7152/7462, P. vivax 1502/1661, P. knowlesi 143/151, P. malariae 18/18, P. ovale ssp. 5/5), but co-infections were identified (456/9321; 4.8%). The accuracy of the predicted geographical profiles was high to both continental (96.1%) and regional levels (94.6%). For P. falciparum, markers were identified for resistance to chloroquine (49.2%; regional range: 24.5% to 100%), sulfadoxine (83.3%; 35.4- 90.5%), pyrimethamine (85.4%; 80.0-100%) and combined SP (77.4%). Markers associated with the partial resistance of artemisinin were found in WGS from isolates sourced from Southeast Asia (30.6%). CONCLUSIONS Malaria-Profiler is a user-friendly tool that can rapidly and accurately predict the geographical regional source and anti-malarial drug resistance profiles across large numbers of samples with WGS data. The software is flexible with modifiable bioinformatic pipelines. For example, it is possible to select the sequencing platform, display specific variants, and customise the format of outputs. With the increasing application of next-generation sequencing platforms on Plasmodium DNA, Malaria-Profiler has the potential to be integrated into point-of-care and surveillance settings, thereby assisting malaria control. Malaria-Profiler is available online (bioinformatics.lshtm.ac.uk/malaria-profiler) and as standalone software ( https://github.com/jodyphelan/malaria-profiler ).
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Affiliation(s)
- Jody E Phelan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK.
| | - Anna Turkiewicz
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Emilia Manko
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Joseph Thorpe
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Leen N Vanheer
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Marga van de Vegte-Bolmer
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - Nguyen Thi Hong Ngoc
- Molecular Biology Department, Parasitology and Entomology, Vietnam National Institute of Malariology, Hanoi, Vietnam
| | - Nguyen Thi Huong Binh
- Molecular Biology Department, Parasitology and Entomology, Vietnam National Institute of Malariology, Hanoi, Vietnam
| | - Nguyen Quang Thieu
- Molecular Biology Department, Parasitology and Entomology, Vietnam National Institute of Malariology, Hanoi, Vietnam
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Gen. Kago Rd, Thika, Kenya
| | - Debbie Nolder
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
- UK Health Security Agency Malaria Reference Laboratory, LSHTM, London, WC1E 7HT, UK
| | - Khalid B Beshir
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Jamille G Dombrowski
- Department of Parasitology, Institute of Biomedical Sciences, Univ. of São Paulo, São Paulo, Brazil
| | - Silvia Maria Di Santi
- School of Medicine, Instituto de Medicina Tropical, University of São Paulo, São Paulo, Brazil
| | - Teun Bousema
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - Colin J Sutherland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK
- UK Health Security Agency Malaria Reference Laboratory, LSHTM, London, WC1E 7HT, UK
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK.
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, WC1E 7HT, UK.
- Faculty of Epidemiology and Population Health, LSHTM, London, WC1E 7HT, UK.
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Adam KY, Moses OM, Gitaka J, Walong E, Ogutu O, Ojwang SBO. Histomorphometric features of placentae from women having malaria and HIV coinfection with preterm births. medRxiv 2023:2023.10.30.23297751. [PMID: 37961170 PMCID: PMC10635241 DOI: 10.1101/2023.10.30.23297751] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Malaria and HIV are associated with preterm births possibly due to partial maternal vascular malperfusion resulting from altered placental angiogenesis. There is a paucity of data describing structural changes associated with malaria and HIV coinfection in the placentae of preterm births thus limiting the understanding of biological mechanisms by which preterm birth occurs. Objectives This study aimed to determine the differences in clinical characteristics, placental parenchymal histological, and morphometric features of the terminal villous tree among women with malaria and HIV coinfection having preterm births. Methods Twenty-five placentae of preterm births with malaria and HIV coinfection (cases) were randomly selected and compared to twenty-five of those without both infections (controls). Light microscopy was used to determine histological features on H&E and MT-stained sections while histomorphometric features of the terminal villous were analyzed using image analysis software. Clinical data regarding maternal age, parity, marital status, level of education, gestational age and placental weight were compared. Results Placental weight, villous perimeter and area were significantly lower in cases as compared to controls 454g vs. 488g, 119.32μm vs. 130.47μm, and 937.93μm2 vs. 1132.88μm2 respectively. Increased syncytial knots and accelerated villous maturity were significantly increased in the cases. The relative risk of development of partial maternal vascular malperfusion was 2.1 (CI: 1.26-3.49). Conclusion These findings suggest that malaria and HIV coinfection leads to partial maternal vascular malperfusion that may lead to chronic hypoxia in the placenta and altered weight, villous perimeter and surface area. This may represent a mechanism by which malaria and HIV infection results in pre-term births.
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Affiliation(s)
- Khalil Y Adam
- Department of Obstetrics and Gynaecology, University of Nairobi. Kenya
- Basic Clinical and Translational Research Laboratory, Nairobi. Kenya
| | - Obimbo M Moses
- Department of Obstetrics and Gynaecology, University of Nairobi. Kenya
- Department of Human Anatomy and Physiology, University of Nairobi. Kenya
- Basic Clinical and Translational Research Laboratory, Nairobi. Kenya
| | - Jesse Gitaka
- College of Health Sciences, Mount Kenya University. Kenya
| | - Edwin Walong
- Department of Human Pathology, University of Nairobi. Kenya
| | - Omondi Ogutu
- Department of Obstetrics and Gynaecology, University of Nairobi. Kenya
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Nshimirimana DA, Kokonya D, Gitaka J, Wesonga B, Mativo JN, Rukanikigitero JMV. Impact of COVID-19 on health-related quality of life in the general population: A systematic review and meta-analysis. PLOS Glob Public Health 2023; 3:e0002137. [PMID: 37883383 PMCID: PMC10602258 DOI: 10.1371/journal.pgph.0002137] [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: 04/21/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023]
Abstract
The World Health Organization declared coronavirus disease of 2019 as an epidemic and public health emergency of international concern on January 30th, 2020. Different factors during a pandemic can contribute to low quality of life in the general population. Quality of life is considered multidimensional and subjective and is assessed by using patient reported outcome measures. The aim and objective of this review is to assess the impact of coronavirus disease of 2019 and associated factors on the Quality of Life in the general population. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A protocol was registered in the international Prospective Register of Systematic Reviews database(CRD42021269897). A comprehensive electronic search in PubMed, EBSCO Host Research Databases, MEDLINE and Google scholar search engine was conducted. A total number of 1,7000,074 articles were identified from electronic search. 25 full text articles were retained for qualitative synthesis and seventeen articles for quantitative analysis. Seven main quality of life scales were used to assess the quality of life of the general population; World Health Organization Quality of Life-bref, EuroQuality of Life-Five dimensions, Short Form, European Quality of Life Survey, coronavirus disease of 2019 Quality of Life, General Health Questionnaire12 and My Life Today Questionnaire. The mean World Health Organization Quality of Life-brief was found to be 53.38% 95% confidence interval [38.50-68.27] and EuroQuality of Life-Five dimensions was 0.89 95% confidence interval [0.69-1.07]. Several factors have been linked to the Coronavirus disease of 2019 such as sociodemographic factors, peoples living with chronic diseases, confinement and financial constraints. This review confirms that the Coronavirus disease of 2019 pandemic affected the quality of life of the general population worldwide. Several factors such as sociodemographic, peoples living with chronic diseases, confinement and financial constraints affected the quality of life.
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Affiliation(s)
- Desire Aime Nshimirimana
- Departement of Research & Innovation, Mont Kenya University, Thika, Kenya
- Department of Health Systems Management, School of Health Sciences, Nairobi Campus, Kenya Methodist University (KeMU), Meru, Kenya
- College of Doctoral Studies, Grand Canyon University, Phoenix, Arizona, United States of America
| | - Donald Kokonya
- Department of Community Health & Behavioral Sciences, School of Medicine, Masinde Muliro University of Science & Technology, Kakamega, Kenya
| | - Jesse Gitaka
- Departement of Research & Innovation, Mont Kenya University, Thika, Kenya
| | - Bernard Wesonga
- Department of Community Health & Behavioral Sciences, School of Medicine, Masinde Muliro University of Science & Technology, Kakamega, Kenya
| | - Japheth Nzioki Mativo
- Department of Environmental Health, Colleges of Health Sciences, Jumeira University, Dubai, The United Arab Emirates
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Osborne A, Phelan JE, Vanheer LN, Manjurano A, Gitaka J, Drakeley CJ, Kaneko A, Kita K, Campino S, Clark TG. High throughput human genotyping for variants associated with malarial disease outcomes using custom targeted amplicon sequencing. Sci Rep 2023; 13:12062. [PMID: 37495620 PMCID: PMC10371994 DOI: 10.1038/s41598-023-39233-z] [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: 01/04/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023] Open
Abstract
Malaria has exhibited the strongest known selective pressure on the human genome in recent history and is the evolutionary driving force behind genetic conditions, such as sickle-cell disease, glucose-6-phosphatase deficiency, and some other erythrocyte defects. Genomic studies (e.g., The 1000 Genomes project) have provided an invaluable baseline for human genetics, but with an estimated two thousand ethno-linguistic groups thought to exist across the African continent, our understanding of the genetic differences between indigenous populations and their implications on disease is still limited. Low-cost sequencing-based approaches make it possible to target specific molecular markers and genes of interest, leading to potential insights into genetic diversity. Here we demonstrate the versatility of custom dual-indexing technology and Illumina next generation sequencing to generate a genetic profile of human polymorphisms associated with malaria pathology. For 100 individuals diagnosed with severe malaria in Northeast Tanzania, variants were successfully characterised on the haemoglobin subunit beta (HBB), glucose-6-phosphate dehydrogenase (G6PD), atypical chemokine receptor 1 (ACKR1) genes, and the intergenic Dantu genetic blood variant, then validated using pre-existing genotyping data. High sequencing coverage was observed across all amplicon targets in HBB, G6PD, ACKR1, and the Dantu blood group, with variants identified at frequencies previously observed within this region of Tanzania. Sequencing data exhibited high concordance rates to pre-existing genotyping data (> 99.5%). Our work demonstrates the potential utility of amplicon sequencing for applications in human genetics, including to personalise medicine and understand the genetic diversity of loci linked to important host phenotypes, such as malaria susceptibility.
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Affiliation(s)
- Ashley Osborne
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Jody E Phelan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Leen N Vanheer
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Alphaxard Manjurano
- Mwanza Medical Research Centre, National Institute for Medical Research, Mwanza, Tanzania
- Joint Malaria Program, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Centre for Malaria Elimination, Mount Kenya University, Thika, Kenya
| | - Christopher J Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Akira Kaneko
- Department of Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Kiyoshi Kita
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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11
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Osborne A, Phelan JE, Kaneko A, Kagaya W, Chan C, Ngara M, Kongere J, Kita K, Gitaka J, Campino S, Clark TG. Drug resistance profiling of asymptomatic and low-density Plasmodium falciparum malaria infections on Ngodhe island, Kenya, using custom dual-indexing next-generation sequencing. Sci Rep 2023; 13:11416. [PMID: 37452073 PMCID: PMC10349106 DOI: 10.1038/s41598-023-38481-3] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023] Open
Abstract
Malaria control initiatives require rapid and reliable methods for the detection and monitoring of molecular markers associated with antimalarial drug resistance in Plasmodium falciparum parasites. Ngodhe island, Kenya, presents a unique malaria profile, with lower P. falciparum incidence rates than the surrounding region, and a high proportion of sub-microscopic and low-density infections. Here, using custom dual-indexing and Illumina next generation sequencing, we generate resistance profiles on seventy asymptomatic and low-density P. falciparum infections from a mass drug administration program implemented on Ngodhe island between 2015 and 2016. Our assay encompasses established molecular markers on the Pfcrt, Pfmdr1, Pfdhps, Pfdhfr, and Pfk13 genes. Resistance markers for sulfadoxine-pyrimethamine were identified at high frequencies, including a quintuple mutant haplotype (Pfdhfr/Pfdhps: N51I, C59R, S108N/A437G, K540E) identified in 62.2% of isolates. The Pfdhps K540E biomarker, used to inform decision making for intermittent preventative treatment in pregnancy, was identified in 79.2% of isolates. Several variants on Pfmdr1, associated with reduced susceptibility to quinolones and lumefantrine, were also identified (Y184F 47.1%; D1246Y 16.0%; N86 98%). Overall, we have presented a low-cost and extendable approach that can provide timely genetic profiles to inform clinical and surveillance activities, especially in settings with abundant low-density infections, seeking malaria elimination.
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Affiliation(s)
- Ashley Osborne
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Jody E Phelan
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Akira Kaneko
- Department of Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Wataru Kagaya
- Department of Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Chim Chan
- Department of Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Mtakai Ngara
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - James Kongere
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Centre for Research in Tropical Medicine and Community Development (CRTMCD), Hospital Road Next to Kenyatta National Hospital, Nairobi, Kenya
| | - Kiyoshi Kita
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Centre for Malaria Elimination, Mount Kenya University, Thika, Kenya
| | - Susana Campino
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Taane G Clark
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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12
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Abuya T, Odwe G, Ndwiga C, Okondo C, Liambila W, Mungai S, Mwaura P, K’Oduol K, Natecho A, Gitaka J, Warren CE. Measuring implementation outcomes in the context of scaling up possible serious bacterial infection guidelines: Implications for measurement and programs. PLoS One 2023; 18:e0287345. [PMID: 37384785 PMCID: PMC10310014 DOI: 10.1371/journal.pone.0287345] [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] [Received: 01/19/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Reducing the burden of neonatal sepsis requires timely identification and initiation of suitable antibiotic treatment in primary health care (PHC) settings. Countries are encouraged to adopt simplified antibiotic regimens at the PHC level for treating sick young infants (SYI) with signs of possible serious bacterial infection (PSBI). As countries implement PSBI guidelines, more lessons on effective implementation strategies and outcome measurements are needed. We document pragmatic approaches used to design, measure and report implementation strategies and outcomes while adopting PSBI guidelines in Kenya. METHODS We designed implementation research using longitudinal mixed methods embedded in a continuous regular systematic learning and adoption of evidence in the PHC context. We synthesized formative data to co-create with stakeholders, implementation strategies to incorporate PSBI guidelines into routine service delivery for SYIs. This was followed by quarterly monitoring for learning and feedback on the effect of implementation strategies, documented lessons learned and tracked implementation outcomes. We collected endline data to measure the overall effect on service level outcomes. RESULTS Our findings show that characterizing implementation strategies and linking them with implementation outcomes, helps illustrate the pathway between the implementation process and outcomes. Although we have demonstrated that it is feasible to implement PSBI in PHC, effective investment in continuous capacity strengthening of providers through blended approaches, efficient use of available human resources, and improving the efficiency of service areas for managing SYIs optimizes timely identification and management of SYI. Sustained provision of commodities for management of SYI facilitates increased uptake of services. Strengthening facility-community linkages supports adherence to scheduled visits. Enhancing the caregiver's preparedness during postnatal contacts in the community or facility will facilitate the effective completion of treatment. CONCLUSION Careful design, and definition of terms related to the measurement of implementation outcomes and strategies enable ease of interpretation of findings. Using the taxonomy of implementation outcomes help frame the measurement process and provides empirical evidence in a structured way to demonstrate causal relationships between implementation strategies and outcomes. Using this approach, we have illustrated that the implementation of simplified antibiotic regimens for treating SYIs with PSBI in PHC settings is feasible in Kenya.
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Affiliation(s)
| | | | | | | | | | - Samuel Mungai
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Peter Mwaura
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Kezia K’Oduol
- Kenya Paediatric Research Consortium, Nairobi, Kenya
| | | | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
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Kagaya W, Chan CW, Kongere J, Kanoi BN, Ngara M, Omondi P, Osborne A, Barbieri L, Kc A, Minakawa N, Gitaka J, Kaneko A. Evaluation of the protective efficacy of Olyset®Plus ceiling net on reducing malaria prevalence in children in Lake Victoria Basin, Kenya: study protocol for a cluster-randomized controlled trial. Trials 2023; 24:354. [PMID: 37231429 DOI: 10.1186/s13063-023-07372-3] [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] [Received: 03/30/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND In the Lake Victoria Basin of western Kenya, malaria remains highly endemic despite high coverage of interventions such as insecticide-impregnated long-lasting insecticidal nets (LLIN). The malaria-protective effect of LLINs is hampered by insecticide resistance in Anopheles vectors and its repurposing by the community. Ceiling nets and LLIN with synergist piperonyl butoxide (PBO-LLIN) are novel tools that can overcome the problems of behavioral variation of net use and metabolic resistance to insecticide, respectively. The two have been shown to reduce malaria prevalence when used independently. Integration of these two tools (i.e., ceiling nets made with PBO-LLIN or Olyset®Plus ceiling nets) appears promising in further reducing the malaria burden. METHODS A cluster-randomized controlled trial is designed to assess the effect of Olyset®Plus ceiling nets on reducing malaria prevalence in children on Mfangano Island in Homa Bay County, where malaria transmission is moderate. Olyset®Plus ceiling nets will be installed in 1315 residential structures. Malaria parasitological, entomological, and serological indicators will be measured for 12 months to compare the effectiveness of this new intervention against conventional LLIN in the control arm. DISCUSSION Wider adoption of Olyset®Plus ceiling nets to complement existing interventions may benefit other malaria-endemic counties and be incorporated as part of Kenya's national malaria elimination strategy. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000045079. Registered on 4 August 2021.
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Affiliation(s)
- Wataru Kagaya
- Department of Virology and Parasitology/Research Center for Infectious Diseases, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Chim W Chan
- Department of Virology and Parasitology/Research Center for Infectious Diseases, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - James Kongere
- Department of Virology and Parasitology/Research Center for Infectious Diseases, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Bernard N Kanoi
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Mtakai Ngara
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Protus Omondi
- Department of Virology and Parasitology/Research Center for Infectious Diseases, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Ashley Osborne
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura Barbieri
- Department of Virology and Parasitology/Research Center for Infectious Diseases, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Achyut Kc
- Department of Virology and Parasitology/Research Center for Infectious Diseases, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Noboru Minakawa
- Department of Vector Ecology and Environment, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Akira Kaneko
- Department of Virology and Parasitology/Research Center for Infectious Diseases, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Vector Ecology and Environment, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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14
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Rodriguez-Mateos P, Ngamsom B, Ameyo D, Wakaba P, Shiluli C, Iles A, Gitaka J, Pamme N. Integrated microscale immiscible phase extraction and isothermal amplification for colorimetric detection of Neisseria gonorrhoeae. Anal Bioanal Chem 2023:10.1007/s00216-023-04734-3. [PMID: 37198361 PMCID: PMC10191819 DOI: 10.1007/s00216-023-04734-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
Gonorrhea is the second most common sexually transmitted infection (STI) with around 87 million cases worldwide estimated in 2016 by the World Health Organization. With over half of the cases being asymptomatic, potential life-threatening complications and increasing numbers of drug-resistant strains, routine monitoring of prevalence and incidence of infections are key preventive measures. Whilst gold standard qPCR tests have excellent accuracy, they are neither affordable nor accessible in low-resource settings. In this study, we developed a lab-on-a-chip platform based on microscale immiscible filtration to extract, concentrate and purify Neisseria gonorrhoeae DNA with an integrated detection assay based on colorimetric isothermal amplification. The platform was capable of detecting as low as 500 copies/mL from spiked synthetic urine and showed no cross-reactivity when challenged with DNAs from other common STIs. The credit card-size device allows DNA extraction and purification without power or centrifuges, and the detection reaction only needs a low-tech block heater, providing a straightforward and visual positive/negative result within 1 h. These advantages offer great potential for accurate, affordable and accessible monitoring of gonorrhea infection in resource-poor settings.
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Affiliation(s)
- Pablo Rodriguez-Mateos
- Department of Materials and Environmental Chemistry, Stockholm University, Stockholm, Sweden
| | - Bongkot Ngamsom
- Centre for Biomedicine, Hull York Medical School, University of Hull, Hull, UK
| | - Daglus Ameyo
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Patrick Wakaba
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Clement Shiluli
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Alexander Iles
- Department of Materials and Environmental Chemistry, Stockholm University, Stockholm, Sweden
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya.
| | - Nicole Pamme
- Department of Materials and Environmental Chemistry, Stockholm University, Stockholm, Sweden.
- School of Natural Sciences, University of Hull, Hull, UK.
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Sagoe KO, Kyama MC, Maina N, Kamita M, Njokah M, Thiong'o K, Kanoi BN, Wandera EA, Ndegwa D, Kinyua DM, Gitaka J. Application of Hybridization Chain Reaction/CRISPR-Cas12a for the Detection of SARS-CoV-2 Infection. Diagnostics (Basel) 2023; 13:diagnostics13091644. [PMID: 37175035 PMCID: PMC10178590 DOI: 10.3390/diagnostics13091644] [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] [Received: 04/05/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Globally, the emergence of the coronavirus disease (COVID-19) has had a significant impact on life. The need for ongoing SARS-CoV-2 screening employing inexpensive and quick diagnostic approaches is undeniable, given the ongoing pandemic and variations in vaccine administration in resource-constrained regions. This study presents results as proof of concept to use hybridization chain reaction (HCR) and clustered regularly interspaced short palindromic repeats (CRISPR)/Cas12a complex for detecting SARS-CoV-2. HCR hairpin probes were designed using the NUPACK web-based program and further used to amplify the SARS-CoV-2 N gene in archived nasopharyngeal samples. The results were visualized using agarose gels and CRISPR Cas12a-based lateral flow strips. The assay was evaluated using the gold standard, real-time polymerase chain reaction (RT-PCR), as recommended by the World Health Organization (WHO). The results show the comparative efficiency of HCR to RT-PCR. This study shows that HCR and CRISPR are viable alternatives for diagnosing SARS-CoV-2 in samples.
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Affiliation(s)
- Kate Obaayaa Sagoe
- Department of Molecular Biology and Biotechnology, Pan African University Institute for Basic Sciences, Technology and Innovation (PAUSTI), Nairobi P.O. Box 62000-00200, Kenya
| | - Mutinda Cleophas Kyama
- Department of Medical Laboratory Science, College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi P.O. Box 62000-00200, Kenya
| | - Naomi Maina
- Department of Biochemistry, College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi P.O. Box 62000-00200, Kenya
| | - Moses Kamita
- Directorate of Research and Innovation, Mount Kenya University, Thika P.O. Box 342-01000, Kenya
| | - Muturi Njokah
- Department of Biochemistry, College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi P.O. Box 62000-00200, Kenya
| | - Kelvin Thiong'o
- Center for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi P.O. Box 54840-00200, Kenya
| | - Bernard N Kanoi
- Directorate of Research and Innovation, Mount Kenya University, Thika P.O. Box 342-01000, Kenya
| | - Ernest Apondi Wandera
- Directorate of Research and Innovation, Mount Kenya University, Thika P.O. Box 342-01000, Kenya
- Center for Virus Research, Kenya Medical Research Institute, Nairobi P.O. Box 54840-00200, Kenya
| | - Davies Ndegwa
- Department of Medical Laboratory Sciences, Kenya Medical Training College, Nairobi P.O. Box 30195-00100, Kenya
| | - Dickson Mwenda Kinyua
- Department of Physical Sciences, Meru University of Science & Technology, Meru P.O. Box 972-60200, Kenya
- Department of Pure and Applied Sciences, Kirinyaga University, Kerugoya P.O. Box 143-10300, Kenya
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika P.O. Box 342-01000, Kenya
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Liambila W, Were F, Abuya T, Odwe G, Natecho A, Mungai S, Mwaura P, Githanga D, Mbuthia J, Kinuthia D, Govoga A, Warren CE, K'Oduol K, Gitaka J. Institutionalizing the Management of Sick Young Infants: Kenya's Experience in Revising National Guidelines on Integrated Management of Newborn and Childhood Illnesses. Glob Health Sci Pract 2023; 11:GHSP-D-22-00482. [PMID: 37116923 PMCID: PMC10141433 DOI: 10.9745/ghsp-d-22-00482] [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: 10/29/2022] [Accepted: 03/07/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION In 2015, the World Health Organization (WHO) developed guidelines for the management of sick young infants (SYIs) with possible serious bacterial infection (PSBI) where referral is not feasible. The Ponya Mtoto project was designed as an implementation research project to demonstrate how to adopt the WHO PSBI guidelines in the Kenyan context. PONYA MTOTO PROJECT DESCRIPTION Between October 2017 and June 2021, Ponya Mtoto was implemented in 4 Kenyan counties with higher infant and newborn mortality rates than the national mean. A total of 48 health facilities stratified by level of services were selected as study sites. IMPLEMENTATION APPROACH The following activities were done to institutionalize the management of SYIs with PSBI where referral is not feasible in Kenya's health system: (1) participating in a cocreation workshop and development of a theory of change; (2) revising the national integrated management of newborn and childhood illnesses guidelines to incorporate the management of PSBI where referral is not feasible; (3) improving availability of essential commodities; (4) strengthening provider confidence in the management of SYIs; (5) strengthening awareness about PSBI services for SYIs at the community level; and (6) harmonizing the national integrated management of newborn and childhood illnesses guidelines to address discrepancies in the content on the management of PSBI. In addition, the project focused on strengthening quality of care for SYIs and using implementation research to track progress in achieving project targets and outcomes. CONCLUSION Using an implementation research approach to introduce new WHO guidelines on PSBI where referral is not feasible into Kenya's health care service was critical to fostering engagement of a diverse range of stakeholders, monitoring provider skills and confidence-building, strengthening provision of key commodities for managing SYIs with PSBI, and sustaining community-facility linkages.
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Affiliation(s)
| | - Fred Were
- Kenya Paediatric Research Consortium, Nairobi, Kenya
| | | | | | | | - Samuel Mungai
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Peter Mwaura
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | | | - Joe Mbuthia
- Kenya Paediatric Research Consortium, Nairobi, Kenya
| | | | - Allan Govoga
- Division of Neonatal and Child Health, Ministry of Health, Nairobi, Kenya
| | | | | | - Jesse Gitaka
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
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Waweru H, Kanoi BN, Kuja JO, Maranga M, Kongere J, Maina M, Kinyua J, Gitaka J. Limited genetic variations of the Rh5-CyRPA-Ripr invasion complex in Plasmodium falciparum parasite population in selected malaria-endemic regions, Kenya. Front Trop Dis 2023; 4:1102265. [PMID: 38406638 PMCID: PMC7615667 DOI: 10.3389/fitd.2023.1102265] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
The invasion of human erythrocytes by Plasmodium falciparum merozoites requires interaction between parasite ligands and host receptors. Interaction of PfRh5-CyRPA-Ripr protein complex with basigin, an erythrocyte surface receptor, via PfRh5 is essential for erythrocyte invasion. Antibodies raised against each antigen component of the complex have demonstrated erythrocyte invasion inhibition, making these proteins potential blood-stage vaccine candidates. Genetic polymorphisms present a significant challenge in developing efficacious vaccines, leading to variant-specific immune responses. This study investigated the genetic variations of the PfRh5 complex proteins in P. falciparum isolates from Lake Victoria islands, Western Kenya. Here, twenty-nine microscopically confirmed P. falciparum field samples collected from islands in Lake Victoria between July 2014 and July 2016 were genotyped by whole genome sequencing, and results compared to sequences mined from the GenBank database, from a study conducted in Kilifi, as well as other sequences from the MalariaGEN repository. We analyzed the frequency of polymorphisms in the PfRh5 protein complex proteins, PfRh5, PfCyRPA, PfRipr, and PfP113, and their location mapped on the 3D protein complex structure. We identified a total of 58 variants in the PfRh5 protein complex. PfRh5 protein was the most polymorphic with 30 SNPs, while PfCyRPA was relatively conserved with 3 SNPs. The minor allele frequency of the SNPs ranged between 1.9% and 21.2%. Ten high-frequency alleles (>5%) were observed in PfRh5 at codons 147, 148, 277, 410, and 429 and in PfRipr at codons 190, 255, 259, and 1003. A SNP was located in protein-protein interaction region C203Y and F292V of PfRh5 and PfCyRPA, respectively. Put together, this study revealed low polymorphisms in the PfRh5 invasion complex in the Lake Victoria parasite population. However, the two mutations identified on the protein interaction regions prompts for investigation on their impacts on parasite invasion process to support the consideration of PfRh5 components as potential malaria vaccine candidates.
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Affiliation(s)
- Harrison Waweru
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Bernard N. Kanoi
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Centre for Research in Tropical Medicine and Community Development, Nairobi, Kenya
| | - Josiah O. Kuja
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Mary Maranga
- Malopolska Centre of Biotechnology, Jagiellonian University, Kraków, Poland
| | - James Kongere
- Centre for Research in Tropical Medicine and Community Development, Nairobi, Kenya
| | - Michael Maina
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Johnson Kinyua
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Jesse Gitaka
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Centre for Research in Tropical Medicine and Community Development, Nairobi, Kenya
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18
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Baptista S, Naidoo S, Suliman S, Nepolo E, Kanoi BN, Gitaka J, Blessing OM, Enany S. COVID-19 vaccinology landscape in Africa. Front Immunol 2022; 13:955168. [PMID: 36544758 PMCID: PMC9760752 DOI: 10.3389/fimmu.2022.955168] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
More than two years after the start of COVID-19 pandemic, Africa still lags behind in terms vaccine distribution. This highlights the predicament of Africa in terms of vaccine development, deployment, and sustainability, not only for COVID-19, but for other major infectious diseases that plague the continent. This opinion discusses the challenges Africa faces in its race to vaccinate its people, and offers recommendations on the way forward. Specifically, to get out of the ongoing vaccine shortage trap, Africa needs to diversify investment not only to COVID-19 but also other diseases that burden the population. The continent needs to increase its capacity to acquire vaccines more equitably, improve access to technologies to enable local manufacture of vaccines, increase awareness on vaccines both in rural and urban areas to significantly reduce disease incidence of COVID-19 and as well as other prevalent diseases on the African continent such as HIV and TB. Such efforts will go a long way to reduce the disease burden in Africa.
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Affiliation(s)
- Sara Baptista
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Instituto de Medicina Molecular, João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sanushka Naidoo
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria, South Africa
| | - Sara Suliman
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Zuckerberg San Francisco General Hospital, Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, United States,Chan Zuckerberg Biohub, San Francisco, CA, United States
| | - Emmanuel Nepolo
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Department of Human, Biological and Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Bernard N. Kanoi
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Jesse Gitaka
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Oyedemi Mbaebie Blessing
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Department of Biotechnology, Michael Okpara University of Agriculture, Umudike, Nigeria
| | - Shymaa Enany
- Department of Biology & Physiology of Malaria, Next Einstein Forum Community of Scientists, Kigali, Rwanda,Department of Microbiology and Immunology, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt,*Correspondence: Shymaa Enany,
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19
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Ngamsom B, Iles A, Kamita M, Kimani R, Wakaba P, Rodriguez-Mateos P, Mungai M, Dyer CE, Walter C, Gitaka J, Pamme N. A sample-to-answer COVID-19 diagnostic device based on immiscible filtration and CRISPR-Cas12a-assisted detection. Talanta Open 2022; 6:100166. [PMID: 36406953 PMCID: PMC9640297 DOI: 10.1016/j.talo.2022.100166] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
Abstract
In response to the ongoing coronavirus disease 2019 (COVID-19) pandemic and disparities of vaccination coverage in low-and middle-income countries, it is vital to adopt a widespread testing and screening programme, combined with contact tracing, to monitor and effectively control the infection dispersion in areas where medical resources are limited. This work presents a lab-on-a-chip device, namely 'IFAST-LAMP-CRISPR', as an affordable, rapid and high-precision molecular diagnostic means for detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The herein proposed 'sample-to-answer' platform integrates RNA extraction, amplification and molecular detection with lateral flow readout in one device. The microscale dimensions of the device containing immiscible liquids, coupled with the use of silica paramagnetic beads and guanidine hydrochloride, streamline sample preparation (including RNA extraction, concentration and purification) in 15 min with minimal hands-on steps. The pre-amplification in combination with CRISPR-Cas12a detection assays targeting the nucleoprotein (N) gene achieved visual identification of ≥ 470 copies mL-1 genomic SARS-CoV-2 samples in 45 min. On-chip assays showed the ability to isolate and detect SARS-CoV-2 RNA from 100 genome copies mL-1 of replication-deficient viral particles in 1 h. This simple, affordable and integrated platform demonstrated a visual, faster, and yet specificity- and sensitivity-comparable alternative to the costly gold-standard reverse transcription-polymerase chain reaction (RT-PCR) assay, requiring only a simple heating source. Initial testing illustrates the platform viability both on nasopharyngeal swab and saliva samples collected using the easily accessible Swan-brand cigarette filter, providing a complete workflow for COVID-19 diagnostics in low-resource settings.
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Affiliation(s)
- Bongkot Ngamsom
- School of Natural Sciences, University of Hull, Hull HU6 7RX, UK
| | - Alexander Iles
- School of Natural Sciences, University of Hull, Hull HU6 7RX, UK,Department of Materials and Environmental Chemistry, Stockholm University, SE 106 91, Sweden
| | - Moses Kamita
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Racheal Kimani
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Patrick Wakaba
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Pablo Rodriguez-Mateos
- Department of Materials and Environmental Chemistry, Stockholm University, SE 106 91, Sweden
| | - Mary Mungai
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Charlotte E. Dyer
- Centre for Biomedicine, Hull-York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Cheryl Walter
- Centre for Biomedicine, Hull-York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya,Corresponding author at: Stockholm University, Sweden
| | - Nicole Pamme
- School of Natural Sciences, University of Hull, Hull HU6 7RX, UK,Department of Materials and Environmental Chemistry, Stockholm University, SE 106 91, Sweden,Corresponding author at: Stockholm University, Sweden
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20
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Rotich AK, Takashima E, Yanow SK, Gitaka J, Kanoi BN. Towards identification and development of alternative vaccines against pregnancy-associated malaria based on naturally acquired immunity. Front Trop Dis 2022. [DOI: 10.3389/fitd.2022.988284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pregnant women are particularly susceptible to Plasmodium falciparum malaria, leading to substantial maternal and infant morbidity and mortality. While highly effective malaria vaccines are considered an essential component towards malaria elimination, strides towards development of vaccines for pregnant women have been minimal. The leading malaria vaccine, RTS,S/AS01, has modest efficacy in children suggesting that it needs to be strengthened and optimized if it is to be beneficial for pregnant women. Clinical trials against pregnancy-associated malaria (PAM) focused on the classical VAR2CSA antigen are ongoing. However, additional antigens have not been identified to supplement these initiatives despite the new evidence that VAR2CSA is not the only molecule involved in pregnancy-associated naturally acquired immunity. This is mainly due to a lack of understanding of the immune complexities in pregnancy coupled with difficulties associated with expression of malaria recombinant proteins, low antigen immunogenicity in humans, and the anticipated complications in conducting and implementing a vaccine to protect pregnant women. With the accelerated evolution of molecular technologies catapulted by the global pandemic, identification of novel alternative vaccine antigens is timely and feasible. In this review, we discuss approaches towards novel antigen discovery to support PAM vaccine studies.
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21
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Kanoi BN, Maina M, Likhovole C, Kobia FM, Gitaka J. Malaria vaccine approaches leveraging technologies optimized in the COVID-19 era. Front Trop Dis 2022. [DOI: 10.3389/fitd.2022.988665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Africa bears the greatest burden of malaria with more than 200 million clinical cases and more than 600,000 deaths in 2020 alone. While malaria-associated deaths dropped steadily until 2015, the decline started to falter after 2016, highlighting the need for novel potent tools in the fight against malaria. Currently available tools, such as antimalarial drugs and insecticides are threatened by development of resistance by the parasite and the mosquito. The WHO has recently approved RTS,S as the first malaria vaccine for public health use. However, because the RTS,S vaccine has an efficacy of only 36% in young children, there is need for more efficacious vaccines. Indeed, based on the global goal of licensing a malaria vaccine with at least 75% efficacy by 2030, RTS,S is unlikely to be sufficient alone. However, recent years have seen tremendous progress in vaccine development. Although the COVID-19 pandemic impacted malaria control, the rapid progress in research towards the development of COVID-19 vaccines indicate that harnessing funds and technological advances can remarkably expedite vaccine development. In this review, we highlight and discuss current and prospective trends in global efforts to discover and develop malaria vaccines through leveraging mRNA vaccine platforms and other systems optimized during COVID-19 vaccine studies.
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22
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Kagaya W, Takehara I, Kurihara K, Maina M, Chan CW, Okomo G, Kongere J, Gitaka J, Kaneko A. Potential application of the haematology analyser XN-31 prototype for field malaria surveillance in Kenya. Malar J 2022; 21:252. [PMID: 36050757 PMCID: PMC9434510 DOI: 10.1186/s12936-022-04259-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Simple and accurate diagnosis is a key component of malaria control programmes. Microscopy is the current gold standard, however it requires extensive training and the results largely rely on the skill of the microscopists. Malaria rapid diagnostic tests (RDT) can be performed with minimal training and offer timely diagnosis, but results are not quantitative. Moreover, some Plasmodium falciparum parasites have evolved and can no longer be detected by existing RDT. Developed by the Sysmex Corporation, the XN-31 prototype (XN-31p) is an automated haematology analyser capable of detecting Plasmodium-infected erythrocytes and providing species differentiation and stage specific parasite counts in venous blood samples without any preparation in approximately one minute. However, factors such as stable electricity supply in a temperature-controlled room, cost of the instrument and its initial set-up, and need for proprietary reagents limit the utility of the XN-31p across rural settings. To overcome some of these limitations, a hub and spoke diagnosis model was designed, in which peripheral health facilities were linked to a central hospital where detection of Plasmodium infections by the XN-31p would take place. To explore the feasibility of this concept, the applicability of capillary blood samples with the XN-31p was evaluated with respect to the effect of sample storage time and temperature on the stability of results. Methods Paired capillary and venous blood samples were collected from 169 malaria-suspected outpatients in Homa Bay County Referral Hospital, Kenya. Malaria infections were diagnosed with the XN-31p, microscopy, RDT, and PCR. Capillary blood samples were remeasured on the XN-31p after 24 h of storage at either room (15–25 °C) or chilled temperatures (2–8 °C). Results Identical results in malaria diagnosis were observed between venous and capillary blood samples processed immediately after collection with the XN-31p. Relative to PCR, the sensitivity and specificity of the XN-31p with capillary blood samples were 0.857 and 1.000, respectively. Short-term storage of capillary blood samples at chilled temperatures had no adverse impact on parasitaemia and complete blood counts (CBC) measured by the XN-31p. Conclusion These results demonstrate the potential of the XN-31p to improve routine malaria diagnosis across remote settings using a hub and spoke model. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04259-7.
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Affiliation(s)
- Wataru Kagaya
- Department of Virology and Parasitology/Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.,Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, NagasakiNagasaki, 852-8523, Japan
| | - Ikki Takehara
- Sysmex Corporation, 4-4-4 Takatsukadai, Nishiku, Kobe, Hyogo, 651-2271, Japan
| | - Kyoko Kurihara
- Sysmex Corporation, 4-4-4 Takatsukadai, Nishiku, Kobe, Hyogo, 651-2271, Japan
| | - Michael Maina
- Department of Clinical Medicine, Mount Kenya University, PO Box 342-01000, Thika, Kenya
| | - Chim W Chan
- Department of Virology and Parasitology/Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | | | - James Kongere
- Nairobi Research Station, Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, Institute of Tropical Medicine (NEKKEN), Nagasaki University, PO Box 19993-00202, Nairobi, Kenya.,Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Jesse Gitaka
- Department of Clinical Medicine, Mount Kenya University, PO Box 342-01000, Thika, Kenya.,Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, NagasakiNagasaki, 852-8523, Japan.,Centre for Malaria Elimination, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
| | - Akira Kaneko
- Department of Virology and Parasitology/Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan. .,Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, NagasakiNagasaki, 852-8523, Japan. .,Island Malaria Group, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Biomedicum, Solnavägen 9, Solna, 171 65, Stockholm, Sweden.
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23
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Kuja JO, Kanoi BN, Balboa RF, Shiluli C, Maina M, Waweru H, Gathii K, Mungai M, Masika M, Anzala O, Mwau M, Clark TG, Waitumbi J, Gitaka J. Genomic surveillance of SARS-COV-2 reveals diverse circulating variant lineages in Nairobi and Kiambu Counties, Kenya. BMC Genomics 2022; 23:627. [PMID: 36050650 PMCID: PMC9434529 DOI: 10.1186/s12864-022-08853-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
Genomic surveillance and identification of COVID-19 outbreaks are important in understanding the genetic diversity, phylogeny, and lineages of SARS-CoV-2. Genomic surveillance provides insights into circulating infections, and the robustness and design of vaccines and other infection control approaches. We sequenced 57 SARS-CoV-2 isolates from a Kenyan clinical population, of which 55 passed quality checks using the Ultrafast Sample placement on the Existing tRee (UShER) workflow. Phylo-genome-temporal analyses across two regions in Kenya (Nairobi and Kiambu County) revealed that B.1.1.7 (Alpha; n = 32, 56.1%) and B.1 (n = 9, 15.8%) were the predominant lineages, exhibiting low Ct values (5-31) suggesting high infectivity, and variant mutations across the two regions. Lineages B.1.617.2, B.1.1, A.23.1, A.2.5.1, B.1.596, A, and B.1.405 were also detected across sampling sites within target populations. The lineages and genetic isolates were traced back to China (A), Costa Rica (A.2.5.1), Europe (B.1, B.1.1, A.23.1), the USA (B.1.405, B.1.596), South Africa (B.1.617.2), and the United Kingdom (B.1.1.7), indicating multiple introduction events. This study represents one of the genomic SARS-CoV-2 epidemiology studies in the Nairobi metropolitan area, and describes the importance of continued surveillance for pandemic control.
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Affiliation(s)
- Josiah O Kuja
- Mount Kenya University, Thika, Kenya.
- University of Copenhagen, Copenhagen, Denmark.
| | | | | | | | | | | | - Kimita Gathii
- United States Army Medical Research Directorate, Kisumu, Kenya
| | - Mary Mungai
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Omu Anzala
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Matilu Mwau
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Taane G Clark
- London School of Hygiene & Tropical Medicine, London, UK
| | - John Waitumbi
- United States Army Medical Research Directorate, Kisumu, Kenya
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24
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Kawser Z, Hossain M, Suliman S, Lockman S, Gitaka J, Bandawe G, Rahmat R, Hasan I, Siddik AB, Afrad MH, Rahman MZ, Miller G, Walt DR, Ivers LC, LaRocque RC, Harris JB, Qadri F. An Assessment of a Rapid SARS-CoV-2 Antigen Test in Bangladesh. Am J Trop Med Hyg 2022; 107:845-849. [PMID: 35970285 DOI: 10.4269/ajtmh.22-0068] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/21/2021] [Indexed: 11/07/2022] Open
Abstract
Early detection of SARS-CoV-2 infection is crucial to prevent its spread. This study aimed to document test sensitivity/specificity, correlation with cycle threshold value from polymerase chain reaction (PCR), fitness-for-use in different populations and settings, and user perspectives that could inform large-scale implementation. In this study, we evaluated the performance of a rapid antigen detection test, BD Veritor, and compared this (and another rapid test, Standard Q) against reverse transcription PCR (RT-PCR) in terms of sensitivity and specificity in 130 symptomatic and 130 asymptomatic adults. In addition, we evaluated the suitability and ease of use of the BD Veritor test in a subsample of study participants (n = 42) and implementers (n = 5). At 95% confidence interval, the sensitivity of the BD Veritor and Standard Q test were 70% and 63% in symptomatic and 87% and 73% in asymptomatic individuals, respectively, regarding positive SARS-CoV-2 RT-PCR results. Overall, the BD Veritor test was 78% sensitive and 99.5% specific compared with RT-PCR irrespective of the cycle threshold. This warrants large field evaluation as well as use of the rapid antigen test for quick assessment of SARS-CoV-2 for containment of epidemics in the country.
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Affiliation(s)
- Zannat Kawser
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Mohabbat Hossain
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Sara Suliman
- Division of Experimental Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Shahin Lockman
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya.,Centre for Malaria Elimination, Mount Kenya University, Thika, Kenya
| | - Gama Bandawe
- Biological Sciences Department, Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi
| | - Redwan Rahmat
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Imrul Hasan
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Abu Bakar Siddik
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Mokibul Hassan Afrad
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Glenn Miller
- Mass General Brigham Center for COVID Innovation, Boston, Massachusetts
| | - David R Walt
- Mass General Brigham Center for COVID Innovation, Boston, Massachusetts.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston Massachusetts.,MGH Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Regina C LaRocque
- MGH Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Jason B Harris
- MGH Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Firdausi Qadri
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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25
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Takashima E, Kanoi BN, Nagaoka H, Morita M, Hassan I, Palacpac NMQ, Egwang TG, Horii T, Gitaka J, Tsuboi T. Meta-Analysis of Human Antibodies Against Plasmodium falciparum Variable Surface and Merozoite Stage Antigens. Front Immunol 2022; 13:887219. [PMID: 35757771 PMCID: PMC9218060 DOI: 10.3389/fimmu.2022.887219] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Concerted efforts to fight malaria have caused significant reductions in global malaria cases and mortality. Sustaining this will be critical to avoid rebound and outbreaks of seasonal malaria. Identifying predictive attributes that define clinical malaria will be key to guide development of second-generation tools to fight malaria. Broadly reactive antibodies against variable surface antigens that are expressed on the surface of infected erythrocytes and merozoites stage antigens are targets of naturally acquired immunity and prime candidates for anti-malaria therapeutics and vaccines. However, predicting the relationship between the antigen-specific antibodies and protection from clinical malaria remains unresolved. Here, we used new datasets and multiple approaches combined with re-analysis of our previous data to assess the multi-dimensional and complex relationship between antibody responses and clinical malaria outcomes. We observed 22 antigens (17 PfEMP1 domains, 3 RIFIN family members, merozoite surface protein 3 (PF3D7_1035400), and merozoites-associated armadillo repeats protein (PF3D7_1035900) that were selected across three different clinical malaria definitions (1,000/2,500/5,000 parasites/µl plus fever). In addition, Principal Components Analysis (PCA) indicated that the first three components (Dim1, Dim2 and Dim3 with eigenvalues of 306, 48, and 29, respectively) accounted for 66.1% of the total variations seen. Specifically, the Dim1, Dim2 and Dim3 explained 52.8%, 8.2% and 5% of variability, respectively. We further observed a significant relationship between the first component scores and age with antibodies to PfEMP1 domains being the key contributing variables. This is consistent with a recent proposal suggesting that there is an ordered acquisition of antibodies targeting PfEMP1 proteins. Thus, although limited, and further work on the significance of the selected antigens will be required, these approaches may provide insights for identification of drivers of naturally acquired protective immunity as well as guide development of additional tools for malaria elimination and eradication.
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Affiliation(s)
- Eizo Takashima
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Bernard N Kanoi
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Hikaru Nagaoka
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Masayuki Morita
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Ifra Hassan
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Nirianne M Q Palacpac
- Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | | | - Toshihiro Horii
- Department of Malaria Vaccine Development, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Jesse Gitaka
- Centre for Research in Infectious Diseases, Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Takafumi Tsuboi
- Division of Cell-Free Sciences, Proteo-Science Center, Ehime University, Matsuyama, Japan
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Kobia FM, Maiti K, Obimbo MM, Smith R, Gitaka J. Potential pharmacologic interventions targeting TLR signaling in placental malaria. Trends Parasitol 2022; 38:513-524. [DOI: 10.1016/j.pt.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
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Abstract
The coronavirus disease of 2019 (COVID-19) pandemic, caused by infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has undoubtedly resulted in significant morbidities, mortalities, and economic disruptions across the globe. Affordable and scalable tools to monitor the transmission dynamics of the SARS-CoV-2 virus and the longevity of induced antibodies will be paramount to monitor and control the pandemic as multiple waves continue to rage in many countries. Serologic assays detect humoral responses to the virus, to determine seroprevalence in target populations, or induction of antibodies at the individual level following either natural infection or vaccination. With multiple vaccines rolling out globally, serologic assays to detect anti-SARS-CoV-2 antibodies will be important tools to monitor the development of herd immunity. To address this need, serologic lateral flow assays (LFAs), which can be easily implemented for both population surveillance and home use, will be vital to monitor the evolution of the pandemic and inform containment measures. Such assays are particularly important for monitoring the transmission dynamics and durability of immunity generated by natural infections and vaccination, particularly in resource-limited settings. In this review, we discuss considerations for evaluating the accuracy of these LFAs, their suitability for different use cases, and implementation opportunities.
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Affiliation(s)
- Lucy Ochola
- Department of Tropical and Infectious Diseases, Institute of Primate Research, National Museums of Kenya, PO Box 24481, Nairobi 00502, Kenya
| | - Paul Ogongo
- Department of Tropical and Infectious Diseases, Institute of Primate Research, National Museums of Kenya, PO Box 24481, Nairobi 00502, Kenya; Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Samuel Mungai
- Directorate of Research and Innovation, Mount Kenya University, PO Box 342-01000, Thika, Kenya
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, PO Box 342-01000, Thika, Kenya
| | - Sara Suliman
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Muthamia E, Mungai S, Mungai M, Bandawe G, Qadri F, Kawser Z, Lockman S, Ivers LC, Walt D, Suliman S, Mwau M, Gitaka J. Assessment of performance and implementation characteristics of rapid point of care SARS-CoV-2 antigen testing. AAS Open Res 2022. [DOI: 10.12688/aasopenres.13323.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The COVID-19 pandemic has resulted in a need for rapid identification of infectious cases. Testing barriers have prohibited adequate screening for SARS-CoV-2, resulting in significant delays in commencement of treatment and outbreak control measures. This study aimed to generate evidence on the performance and implementation characteristics of the BD Veritor™ Plus System rapid antigen test as compared to reverse transcription polymerase chain reaction (RT-PCR) for diagnosis of SARS-CoV-2 in Kenya. Methods: This was a field test performance evaluation in adults undergoing testing for SARS-CoV-2. Recruited participants were classified as SARS-CoV-2-positive based on RT-PCR carried out on nasopharyngeal swabs. Antigen tests were performed with simultaneous RT-PCR on 272 participants, allowing estimation of sensitivity, specificity, positive and negative predictive values for the rapid antigen test. Implementation characteristics were assessed. Results: We enrolled 97 PCR negative symptomatic and 128 PCR negative asymptomatic, and 28 PCR positive symptomatic and 19 PCR positive asymptomatic participants. Compared to RT-PCR, the sensitivity of the rapid antigen test was 94% (95% confidence interval [CI] 86.6 to 100.0) while the specificity was 98% (95% CI 96 to 100). There was no association between sensitivity and symptom status, or between the cycle threshold value and sensitivity of the BD Veritor. The rapid test had a quick turnaround time, required minimal resources, and laboratory personnel conducting testing found it easier to use than RT-PCR. The relatively high sensitivity of BD Veritor may be partially attributed to shortages of RT-PCR testing materials, resulting in specimen analysis delays and potential degradation of viral genetic material. Therefore, in resource-constrained settings, rapid antigen tests may perform better than the reference RT-PCR, resulting in prompt institution of isolation and treatment measures. Conclusion: The BD Veritor rapid antigen test’s high sensitivity should be interpreted with consideration to the challenges occasioned by RT-PCR testing in resource-constrained settings.
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Kamita M, Mutungi JK, Mungai S, Mureithi D, Kijogi C, Kimani R, Ndegwa D, Maina J, Gitaka J. A survey on knowledge, attitude, and practice about antibiotic prescribing and resistance among medical practitioners in Kenya. AAS Open Res 2022. [DOI: 10.12688/aasopenres.13328.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Antibiotic resistance is a growing global health threat worldwide and especially in developing countries. Irrational antibiotic prescription as well as lack of the requisite knowledge and awareness of proper antibiotic use are major drivers of antibiotic resistance. In Kenya, although the Ministry of Health has developed antibiotic use guidelines, these guidelines are not widely followed. Antibiotic prescription is, therefore, hugely at the discretion of the clinician. It is thus necessary to understand the knowledge, attitude, and practices (KAP) of antibiotic prescription among medical practitioners in the country. This study aimed to evaluate the knowledge, attitude, and practices (KAP) among antibiotic prescribers in three counties (Kiambu, Nakuru, and Bungoma) in Kenya. Methods This was a cross-sectional study using a self-administered questionnaire. Simple descriptive statistics were used to generate frequencies, percentages, and proportions. Where necessary, univariate analyses such as Pearson’s chi-square were performed to compare proportions for statistical significance. Results From the three counties, 240 respondents recorded their responses: 30% from Kiambu, 34.6% from Nakuru, and 35.4% from Bungoma. The respondents included 19 (7.9%) consultants, 66 (27.4%) medical officers, 135 (56.3%) clinical officers and 20 (8.3%) pharmacists. Of all respondents, more than 90% agreed or strongly agreed that antibiotic resistance (ABR) is a catastrophe worldwide and in Kenya. However, the proportion of the respondents who either agreed or strongly agreed (71.6%) that antibiotic resistance is a problem in their respective health facilities was significantly lower (ρ=0.013). Conclusion This study revealed that most medical practitioners were aware and knowledgeable about antibiotic resistance. However, there was a disconnect with mitigation measures such as active antibiotic stewardship and laboratory analyses to support judicious prescription. There is, therefore, a need for continuous education and stewardship interventions.
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Gitaka J, Mbugua S, Mwaura P, Gatungu D, Githanga D, Ndwiga C, Abuya T, K'Oduol K, Liambila W, Were F. Devolved health system capacity in the provision of care for sick newborns and young infants in four counties serving vulnerable populations in Kenya. PLOS Glob Public Health 2022; 2:e0000183. [PMID: 36962529 PMCID: PMC10022333 DOI: 10.1371/journal.pgph.0000183] [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: 09/08/2021] [Accepted: 09/15/2022] [Indexed: 03/26/2023]
Abstract
Possible severe bacterial infections (PSBI) is one of the three leading causes of newborn and young infant mortality globally that can be prevented by timely diagnosis and treatment using suitable antibiotics. High impact interventions such as use of out-patient injectable gentamicin and dispersible Amoxicillin with community-based follow up have been shown to reduce mortality in clinical trials. The objective of this study was to assess the health systems' preparedness and organizational gaps that may impact execution in providing care for newborns and sick young infants. This formative research study was embedded within a three-year implementation research project in 4 Counties in Kenya. The indicators were based on facility audits for existing capacity to care for newborns and young infants as well as County organizational capacity assessment. The organizational capacity assessment domains were derived from the World Health Organization's Health Systems Building blocks for health service delivery. The scores were computed by adding average scores in each domain and calculated against the total possible scores to generate a percentage outcome. Statistical analyses were descriptive with adjustment for clustering of data. Overall, the Counties have inadequate organizational capacity for management of sick young infants with Organizational Capacity Index scores of between 61-64%. Among the domains, the highest score was in Health Management Information System and service delivery. The lowest scores were in monitoring and evaluation (M&E). Counties scored relatively low scores in human resources for health and health products and commodities with one scoring poorly for both areas while the rest scored average performance. The four counties revealed varying levels of organizational capacity deficit to effectively manage sick young infants. The key underlying issues for the below par performance include poor coordination, low funding, inadequate supportive supervision, and M&E to enable data utilisation for quality improvement. It was evident that newborn and young infant health services suffer from inadequate infrastructure, equipment, staffing, and coordination. As Kenya, continuously rolls out the guidelines on management of sick young infants, there is need to focus attention to these challenges to enhance sustainable adoption and reduction of young infant morbidity and mortality.
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Affiliation(s)
- Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Samuel Mbugua
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Peter Mwaura
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Daniel Gatungu
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | | | | | | | | | | | - Fred Were
- Kenya Paediatric Research Consortium, Nairobi, Kenya
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Abstract
With the coronavirus disease of 2019 (COVID-19) becoming a full-blown outbreak in Africa, coupled with many other challenges faced on the African continent, it is apparent that Africa continues to need diagnostics to enable case identification and recovery to this and future challenges. With the slow vaccination rates across the continent, reliable diagnostic tests will be in demand, likely for years to come. Thus, access to reliable diagnostic tools to detect the severe acute respiratory syndrome of the coronavirus-2 (SARS-CoV-2), the virus responsible for COVID-19, remain a critical pillar to monitor and contain new waves of COVID-19. Increasing the local capacity to manufacture and roll-out vaccines and decentralized COVID-19 testing are paramount for fighting the pandemic in Africa.
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Affiliation(s)
- Sanushka Naidoo
- Next Einstein Forum Community of Scientists, Kigali, Rwanda.,Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria, South Africa
| | - Jesse Gitaka
- Next Einstein Forum Community of Scientists, Kigali, Rwanda.,Directorate of Research and Innovation, School of Medicine, Mount Kenya University, Thika, Kenya
| | - Sara Suliman
- Next Einstein Forum Community of Scientists, Kigali, Rwanda.,Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Baptista
- Next Einstein Forum Community of Scientists, Kigali, Rwanda.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Blessing Mbabie Oyedemi
- Next Einstein Forum Community of Scientists, Kigali, Rwanda.,Department of Biotechnology, Michael Okpara University of Agriculture, Umudike, Nigeria
| | - Emmanuel Nepolo
- Next Einstein Forum Community of Scientists, Kigali, Rwanda.,Department of Human, Biological & Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Shymaa Enany
- Next Einstein Forum Community of Scientists, Kigali, Rwanda.,Department of Microbiology and Immunology, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
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Osborne A, Manko E, Takeda M, Kaneko A, Kagaya W, Chan C, Ngara M, Kongere J, Kita K, Campino S, Kaneko O, Gitaka J, Clark TG. Characterizing the genomic variation and population dynamics of Plasmodium falciparum malaria parasites in and around Lake Victoria, Kenya. Sci Rep 2021; 11:19809. [PMID: 34615917 PMCID: PMC8494747 DOI: 10.1038/s41598-021-99192-1] [Citation(s) in RCA: 3] [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: 07/16/2021] [Accepted: 09/22/2021] [Indexed: 11/08/2022] Open
Abstract
Characterising the genomic variation and population dynamics of Plasmodium falciparum parasites in high transmission regions of Sub-Saharan Africa is crucial to the long-term efficacy of regional malaria elimination campaigns and eradication. Whole-genome sequencing (WGS) technologies can contribute towards understanding the epidemiology and structural variation landscape of P. falciparum populations, including those within the Lake Victoria basin, a region of intense transmission. Here we provide a baseline assessment of the genomic diversity of P. falciparum isolates in the Lake region of Kenya, which has sparse genetic data. Lake region isolates are placed within the context of African-wide populations using Illumina WGS data and population genomic analyses. Our analysis revealed that P. falciparum isolates from Lake Victoria form a cluster within the East African parasite population. These isolates also appear to have distinct ancestral origins, containing genome-wide signatures from both Central and East African lineages. Known drug resistance biomarkers were observed at similar frequencies to those of East African parasite populations, including the S160N/T mutation in the pfap2mu gene, which has been associated with delayed clearance by artemisinin-based combination therapy. Overall, our work provides a first assessment of P. falciparum genetic diversity within the Lake Victoria basin, a region targeting malaria elimination.
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Affiliation(s)
- Ashley Osborne
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Emilia Manko
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mika Takeda
- Department of Protozoology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Akira Kaneko
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Wataru Kagaya
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Chim Chan
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Mtakai Ngara
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - James Kongere
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Centre for Research in Tropical Medicine and Community Development (CRTMCD), Hospital Road Next to Kenyatta National Hospital, Nairobi, Kenya
| | - Kiyoshi Kita
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Osamu Kaneko
- Department of Protozoology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
- Centre for Malaria Elimination, Mount Kenya University, Thika, Kenya
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Rodriguez-Mateos P, Ngamsom B, Walter C, Dyer CE, Gitaka J, Iles A, Pamme N. A lab-on-a-chip platform for integrated extraction and detection of SARS-CoV-2 RNA in resource-limited settings. Anal Chim Acta 2021; 1177:338758. [PMID: 34482896 PMCID: PMC8202086 DOI: 10.1016/j.aca.2021.338758] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 02/08/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the unprecedented global pandemic of coronavirus disease-2019 (COVID-19). Efforts are needed to develop rapid and accurate diagnostic tools for extensive testing, allowing for effective containment of the infection via timely identification and isolation of SARS-CoV-2 carriers. Current gold standard nucleic acid tests require many separate steps that need trained personnel to operate specialist instrumentation in laboratory environments, hampering turnaround time and test accessibility, especially in low-resource settings. We devised an integrated on-chip platform coupling RNA extraction based on immiscible filtration assisted by surface tension (IFAST), with RNA amplification and detection via colorimetric reverse-transcription loop mediated isothermal amplification (RT-LAMP), using two sets of primers targeting open reading frame 1a (ORF1a) and nucleoprotein (N) genes of SARS-CoV-2. Results were identified visually, with a colour change from pink to yellow indicating positive amplification, and further confirmed by DNA gel electrophoresis. The specificity of the assay was tested against HCoV-OC43 and H1N1 RNAs. The assay based on use of gene N primers was 100% specific to SARS-CoV-2 with no cross-reactivity to HCoV-OC43 nor H1N1. Proof-of-concept studies on water and artificial sputum containing genomic SARS-CoV-2 RNA showed our IFAST RT-LAMP device to be capable of extracting and detecting 470 SARS-CoV-2 copies mL-1 within 1 h (from sample-in to answer-out). IFAST RT-LAMP is a simple-to-use, integrated, rapid and accurate COVID-19 diagnostic platform, which could provide an attractive means for extensive screening of SARS-CoV-2 infections at point-of-care, especially in resource-constrained settings.
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Affiliation(s)
| | - Bongkot Ngamsom
- Department of Chemistry and Biochemistry, University of Hull, UK
| | - Cheryl Walter
- Department of Biomedical Sciences, University of Hull, UK
| | | | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Republic of Kenya
| | - Alexander Iles
- Department of Chemistry and Biochemistry, University of Hull, UK
| | - Nicole Pamme
- Department of Chemistry and Biochemistry, University of Hull, UK,Corresponding author. Department of Chemistry, Faculty of Science and Engineering, University of Hull, Cottingham Road, Hull, East Riding of Yorkshire, HU6 7RX, UK
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Singoei M, Obimbo MM, Odula PO, Gitaka J, Ongidi IH. Changes in the structure of chorioamniotic membrane in patients with malaria in pregnancy. Placenta 2021; 114:42-49. [PMID: 34425402 DOI: 10.1016/j.placenta.2021.08.054] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/25/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Malaria infection in pregnancy has adverse consequences for both fetal and maternal health. There is insufficient data on the effect malaria in pregnancy has on the structure of the chorioamniotic membrane. Our objective was to determine the structure of the chorioamniotic membrane in patients with malaria in pregnancy. METHODS Specimens of the chorioamniotic membrane from 58 women with malaria in pregnancy and 58 women without malaria in pregnancy were used for this study. Biopsies of the fetal membranes were obtained immediately after delivery and processed for light microscopy. They were stained using H & E. Photomicrographs were taken for morphological analysis and statistical analyses were performed using Statistical Package for Social Sciences (SPSS, Version 23.0, Chicago, Illinois). The independent-sample t-test and odds ratios were used to compare the appropriate values between the two groups at a 95% confidence interval. RESULTS Photomicrographs of the chorioamniotic membrane showed histological alterations, including a change of amniotic epithelium to columnar and stratified types, epithelial delamination, extensive fibrin deposition, and leukocyte infiltration in women with malaria in pregnancy. Statistical analysis found significant differences in epithelial type (p-value 0.001, ×2 = 17.9), epithelial denudation (p-value <0.001, ×2 = 19.4) and extensive fibrin deposition (p-value of 0.02 and ×2 = 7.5) between the study groups. DISCUSSION This study has demonstrated histological alterations in the chorioamniotic membrane in association with malaria in pregnancy. Further studies may be conducted to characterize chorioamnionitis in malaria in pregnancy and associations with adverse pregnancy outcomes.
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Affiliation(s)
- Mercy Singoei
- Department of Human Anatomy, University of Nairobi. P.O. Box 30197, 00100, Nairobi, Kenya.
| | - Moses Madadi Obimbo
- Department of Human Anatomy, University of Nairobi. P.O. Box 30197, 00100, Nairobi, Kenya.
| | - Paul Ochieng Odula
- Department of Human Anatomy, University of Nairobi. P.O. Box 30197, 00100, Nairobi, Kenya.
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University. P.O. Box 342, 01000, Thika, Kenya.
| | - Ibsen Henric Ongidi
- Department of Human Anatomy, University of Nairobi. P.O. Box 30197, 00100, Nairobi, Kenya.
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Mbugua S, Gitaka J, Gitau T, Odwe G, Mwaura P, Liambila W, Ndwiga C, K'Oduol K, Warren C, Abuya T. Family and provider perceptions of quality of care in the management of sick young infants in primary healthcare settings in four counties of Kenya. BMJ Open Qual 2021; 10:bmjoq-2020-001125. [PMID: 34233958 PMCID: PMC8264895 DOI: 10.1136/bmjoq-2020-001125] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 06/28/2021] [Indexed: 11/06/2022] Open
Abstract
Background Understanding the perceptions of quality of care given to sick young infants in primary healthcare settings is key for developing strategies for effective uptake and utilisation of possible severe bacterial infection guidelines. The purpose of this study is to assess families and providers’ perceptions of care given to sick young infants at primary healthcare facilities in four diverse counties in Kenya. Methods A cross-sectional qualitative design involving 37 in-depth interviews and 39 focus group discussions with very young (15–18 years), young (19–24 years) and older (25–45 years) caregivers of young infants aged 0–59 days; and key informant interviews with community-based and facility-based front-line health providers (14) in primary healthcare facilities. Qualitative data were captured using audio tapes and field notes, transcribed, translated and exported into QSR NVivo V.12 for analysis. A thematic framework approach was adopted to classify and analyse data. Results Perceived care given to sick young infants was described around six domains of the WHO framework for the quality of maternal and newborn healthcare: evidence-based practices for routine and emergency care; functional referral systems; effective communication; respect and preservation of dignity; availability of competent, motivated human resources; and availability of physical resources. Views of caregivers and providers regarding sick young infant care in primary healthcare settings were similar across the four sites. Main hindrance to sick young infant care includes stockout of essential drugs, limited infrastructure, lack of functional referral system, inadequate providers which led to delays in receiving treatment, inadequate provider skills and poor provider attitudes. Despite these challenges, motivation and teamwork of health providers were key tenets in care provision. Conclusion The findings underscore the need to prioritise improving quality of sick young infant services at primary healthcare settings by building capacity of providers through training, ensuring continuous supply of essential medicines and equipment and improving infrastructure including referral.
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Affiliation(s)
- Samuel Mbugua
- Nursing Education, Leadership, Management and Research, Mount Kenya University, Thika, Kenya
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Tabither Gitau
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | | | - Peter Mwaura
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
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Kosiyo P, Otieno W, Gitaka J, Munde EO, Ouma C. Haematological abnormalities in children with sickle cell disease and non-severe malaria infection in western Kenya. BMC Infect Dis 2021; 21:329. [PMID: 33827455 PMCID: PMC8028187 DOI: 10.1186/s12879-021-06025-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/08/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background In Plasmodium falciparum infection, clinical conditions such as anaemia, thrombocytopenia and leukocytosis are common. Mutation in haemoglobin sub-unit beta gene (HBB) may be a genetic factor responsible for these haematological changes during infection. However, the contributions of the carriage of different HBB genotypes on these changes remain largely unknown. Methodology In this cross-sectional study, we evaluated haematological abnormalities in P. falciparum-infected children (n = 217, aged 1–192 months) with different haemoglobin sub-unit beta (HBB) genotypes (HbAA, HbAS and HbSS). Children with acute febrile conditions were recruited at Jaramogi Oginga Odinga Teaching and Referral Hospital at the outpatient clinic. Haematological parameters were determined using Beckman Coulter counter ACTdiff2™ while HBB genotyping was done using TaqMan® SNP genotyping assay. Chi-square (χ2) was used to determine differences between proportions. Differences in haematological parameters were compared across groups using Kruskal Wallis test and between groups using Mann Whitney U test. Partial correlation test was used to determine correlation between haematological parameters and sickle cell genotypes while controlling for age and sex. Results Haemoglobin (Hb), [median (IQR); 7.3 (1.3), P = 0.001], haematocrit (HCT), [median (IQR); 26.4 (4.4), P = 0.009], red blood cells (RBC), [median (IQR); 3.2 (1.7), P = 0.048] were markedly reduced in HbSS, however, red cell distribution with (RDW) [median (IQR); 14.9 (3.3), P = 0.030] was increased in malaria infected children with HbSS. Severe anaemia was highest in HbSS (23.1%) followed by HbAA (8.6%) and HbAS (7.1%). There were no differences in platelet count (P = 0.399) hence no severe thrombocytopeania across the genotypes. Leukocytosis was highest in HbSS (69.2%), 42% in HbAS and 31% in HbAA. The RBC, HCT and Hb had negative correlation with RDW in HbSS in malarial-infected children (r = − 0.725, P = 0.008), (r = − 0.718, P = 0.009) and (r = − 0.792, P = 0.002), respectively. Conclusion Our study reveals that anaemia is the most common abnormality in malaria-infected children with carriage of HbSS. The RBC, HCT and Hb concentration decrease with increase in RDW levels in infected children with carriage of HbSS compared to other HBB genotypes. Therefore, carriage of HbSS genotype is correlated with severity of haematological abnormalities. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06025-7.
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Affiliation(s)
- Paul Kosiyo
- Department of Biomedical Science and Technology, School of Public Health and Community Development, Maseno University, Private Bag, Maseno, Kenya.,Department of Medical Laboratory Sciences, School of Medicine, Maseno University, Private Bag, Maseno, Kenya
| | - Walter Otieno
- Department of Paediatrics and Child Health, School of Medicine, Maseno University, Private Bag, Maseno, Kenya
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, General Kago Road, P.O. Box 342-01000, Thika, Kenya
| | - Elly O Munde
- Department of Clinical Medicine, School of Health Sciences, Kirinyaga University, P.O. Box 143-10300, Kerugoya, Kenya
| | - Collins Ouma
- Department of Biomedical Science and Technology, School of Public Health and Community Development, Maseno University, Private Bag, Maseno, Kenya.
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Kolluri N, Kamath S, Lally P, Zanna M, Galagan J, Gitaka J, Kamita M, Cabodi M, Lolabattu SR, Klapperich CM. Development and Clinical Validation of Iso-IMRS: A Novel Diagnostic Assay for P. falciparum Malaria. Anal Chem 2021; 93:2097-2105. [PMID: 33464825 PMCID: PMC7859932 DOI: 10.1021/acs.analchem.0c03847] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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In many countries
targeting malaria elimination, persistent malaria
infections can have parasite loads significantly below the lower limit
of detection (LLOD) of standard diagnostic techniques, making them
difficult to identify and treat. The most sensitive diagnostic methods
involve amplification and detection of Plasmodium DNA by polymerase chain reaction (PCR), which requires expensive
thermal cycling equipment and is difficult to deploy in resource-limited
settings. Isothermal DNA amplification assays have been developed,
but they require
complex primer design, resulting in high nonspecific amplification,
and show a decrease in sensitivity than PCR methods. Here, we have
used a computational approach to design a novel isothermal amplification
assay with a simple primer design to amplify P. falciparum DNA with analytical sensitivity comparable to PCR. We have identified
short DNA sequences repeated throughout the parasite genome to be
used as primers for DNA amplification and demonstrated that these
primers can be used, without modification, to isothermally amplify P. falciparum parasite DNA via strand displacement
amplification. Our novel assay shows a LLOD of ∼1 parasite/μL
within a 30 min amplification time. The assay was demonstrated with
clinical samples using patient blood and saliva. We further characterized
the assay using direct amplicon next-generation sequencing and modified
the assay to work with a visual readout. The technique developed here
achieves similar analytical sensitivity to current gold standard PCR
assays requiring a fraction of time and resources for PCR. This highly
sensitive isothermal assay can be more easily adapted to field settings,
making it a potentially useful tool for malaria elimination.
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Affiliation(s)
- Nikunja Kolluri
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Room 702, Boston, Massachusetts 02215, United States
| | - Shwetha Kamath
- Division of Research and Development, Jigsaw Bio Solutions Private Limited, No. 87, 4th Floor, Mundhra Chambers, 22nd Main, Banashankari 2nd Stage, Bangalore 560070, Karnataka, India
| | - Patrick Lally
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Room 702, Boston, Massachusetts 02215, United States
| | - Mina Zanna
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Room 702, Boston, Massachusetts 02215, United States
| | - James Galagan
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Room 702, Boston, Massachusetts 02215, United States
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, General Kago Road, P.O. Box 342, Thika 01000, Kenya
| | - Moses Kamita
- Directorate of Research and Innovation, Mount Kenya University, General Kago Road, P.O. Box 342, Thika 01000, Kenya
| | - Mario Cabodi
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Room 702, Boston, Massachusetts 02215, United States
| | - Srinivasa Raju Lolabattu
- Division of Research and Development, Jigsaw Bio Solutions Private Limited, No. 87, 4th Floor, Mundhra Chambers, 22nd Main, Banashankari 2nd Stage, Bangalore 560070, Karnataka, India
| | - Catherine M Klapperich
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Room 702, Boston, Massachusetts 02215, United States
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Kosiyo P, Otieno W, Gitaka J, Munde EO, Ouma C. Association between haematological parameters and sickle cell genotypes in children with Plasmodium falciparum malaria resident in Kisumu County in Western Kenya. BMC Infect Dis 2020; 20:887. [PMID: 33238928 PMCID: PMC7690073 DOI: 10.1186/s12879-020-05625-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/23/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Sickle cell disease (SCD) is a monogenic disorder due to point mutation in the β-globin gene resulting in substitution of Valine for Glutamic acid. The SCD is prevalent in P. falciparum endemic regions such as western Kenya. Carriage of different sickle cell genotypes may influence haematological parameter during malaria. Children resident in malaria holoendemic regions suffer more from malaria-related complications and this is moderated by the presence of the SCD. In the current study, we determined the association between sickle cell genotypes and haematological parameters in children with P. falciparum malaria resident in Kisumu County in Western Kenya. Methodology Children (n = 217, aged 1–192 months) with acute febrile condition were recruited at Jaramogi Oginga Odinga Teaching and Referral Hospital. Chi-square (χ2) analysis was used to determine differences between proportions. Differences in haematological parameters were compared across groups using Kruskal Wallis test and between groups using Mann Whitney U test. Multivariate logistic regression analysis controlling for infection status was used to determine the association between sickle cell genotypes and haematological parameters. Results Using HbAA as the reference group, multivariate logistic regression analysis revealed that carriage of HbSS was associated with reduced haemoglobin [OR = 0.310, 95% CI = 0.101–0.956, P = 0.041], reduced haematocrit [OR = 0.318, 95% CI = 0.128–0.793, P = 0.014], reduced RBC count [OR = 0.124, 95% CI = 0.045–0.337, P = 0.001], reduced MCHC [OR = 0.325, 95% CI = 0.118–0.892, P = 0.029], increased leucocytosis [OR = 9.283, 95% CI = 3.167–27.210, P = 0.001] and reduced monocytosis [OR = 0.319, 95% CI = 0.123–0.830, P = 0.019]. However, carriage of HbAS was only associated with increased micro-platelets [OR = 3.629, 95% CI = 1.291–8.276, P = 0.012]. Conclusion Results show that carriage of HbSS in children influence the levels of haemoglobin, haematocrit, RBC, MCHC, WBC and Monocytes. Therefore prior knowledge of HbSS should be considered to improve clinical management of haematological alterations during malaria in children. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05625-z.
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Affiliation(s)
- Paul Kosiyo
- Department of Biomedical Science and Technology, School of Pub;ic Health and Community Development, Maseno University, Maseno, Kenya.,Department of Medical Laboratory Sciences, School of Medicine, Kisii University, P.O. Box 408-40200, Kisii, Kenya
| | - Walter Otieno
- Department of Paediatrics and Child Health, School of Medicine, Maseno University, Private Bag, Maseno, Kenya
| | - Jesse Gitaka
- School of Clinical Medicine, Mount Kenya University, Gen Kago Rd, P.O. Box 342 01000, Thika, Kenya
| | - Elly O Munde
- Department of Clinical Medicine, School of Health Sciences, Kirinyaga University, P.O Box 143-10300, Kerugoya, Kenya
| | - Collins Ouma
- Department of Biomedical Science and Technology, School of Pub;ic Health and Community Development, Maseno University, Maseno, Kenya.
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Mbugua SM, Njoroge G, Kijogi C, Kamita M, Kimani R, Mwaura P, Aidi BW, Gitaka J. Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya. Glob Health Res Policy 2020; 5:49. [PMID: 33292855 PMCID: PMC7670798 DOI: 10.1186/s41256-020-00177-w] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory. Perspectives and insights of health managers on antimicrobial stewardship (AMS), complementary health services and building blocks are imperative towards implementation of robust AMS programs. This study aimed to understand perspectives of hospital managers on AMS and identify areas of management engagement while addressing potential blockades to change. METHODS A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant interviews on perspectives on AMS were administered to hospital managers. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants. RESULTS Perspectives on AMS are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There lacked contextualized, hospital specific antimicrobial formulary and adequate laboratory competency. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment. CONCLUSIONS The practice of antimicrobial stewardship is not implemented and well developed as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to hospitals and their clients. The findings underpin the importance of understanding and incorporating perspectives of health managers on existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against antimicrobial resistance.
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English M, Strachan B, Esamai F, Ngwiri T, Warfa O, Mburugu P, Nalwa G, Gitaka J, Ngugi J, Zhao Y, Ouma P, Were F. The paediatrician workforce and its role in addressing neonatal, child and adolescent healthcare in Kenya. Arch Dis Child 2020; 105:927-931. [PMID: 32554508 PMCID: PMC7513261 DOI: 10.1136/archdischild-2019-318434] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the availability of paediatricians in Kenya and plans for their development. DESIGN Review of policies and data from multiple sources combined with local expert insight. SETTING Kenya with a focus on the public, non-tertiary care sector as an example of a low-income and middle-income country aiming to improve the survival and long-term health of newborns, children and adolescents. RESULTS There are 305 practising paediatricians, 1.33 per 100 000 individuals of the population aged <19 years which in total numbers approximately 25 million. Only 94 are in public sector, non-tertiary county hospitals. There is either no paediatrician at all or only one paediatrician in 21/47 Kenyan counties that are home to over a quarter of a million under 19 years of age. Government policy is to achieve employment of 1416 paediatricians in the public sector by 2030, however this remains aspirational as there is no comprehensive training or financing plan to reach this target and health workforce recruitment, financing and management is now devolved to 47 counties. The vast majority of paediatric care is therefore provided by non-specialist healthcare workers. DISCUSSION The scale of the paediatric workforce challenge seriously undermines the ability of the Kenyan health system to deliver on the emerging survive, thrive and transform agenda that encompasses more complex health needs. Addressing this challenge may require innovative workforce solutions such as task-sharing, these may in turn require the role of paediatricians to be redefined. Professional paediatric communities in countries like Kenya could play a leadership role in developing such solutions.
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Affiliation(s)
- Mike English
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya .,Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Fabian Esamai
- Department of Paediatrics and Child Health, College of Health Sciences, Moi University, Kenya, Eldoret, Kenya
| | | | | | - Patrick Mburugu
- Department of Paediatrics and Child Health, School of Medicine, Jomo Kenyatta University of Africulture and Technology, Nairobi, Kenya
| | - Grace Nalwa
- Department of Paediatrics and Child Health, Maseno University, Maseno, Nyanza, Kenya
| | - Jesse Gitaka
- Directorate of Research and Innovation, School of Medicine, Mount Kenya University, Thika, Kenya
| | - John Ngugi
- Department of Paediatrics and Child Health, Kenyatta University, Nairobi, Kenya
| | - Yingxi Zhao
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Paul Ouma
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Fred Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Badu K, Thorn JP, Goonoo N, Dukhi N, Fagbamigbe AF, Kulohoma BW, Oyebola K, Abdelsalam SI, Doorsamy W, Awe O, Sylverken AA, Egeru A, Gitaka J. Africa’s response to the COVID-19 pandemic: A review of the nature of the virus, impacts and implications for preparedness. AAS Open Res 2020. [DOI: 10.12688/aasopenres.13060.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: COVID-19 continues to wreak havoc in different countries across the world, claiming thousands of lives, increasing morbidity and disrupting lifestyles. The global scientific community is in urgent need of relevant evidence, to understand the challenges and knowledge gaps, as well as the opportunities to contain the spread of the virus. Considering the unique socio-economic, demographic, political, ecological and climatic contexts in Africa, the responses which may prove to be successful in other regions may not be appropriate on the continent. This paper aims to provide insight for scientists, policy makers and international agencies to contain the virus and to mitigate its impact at all levels. Methods: The Affiliates of the African Academy of Sciences (AAS), came together to synthesize the current evidence, identify the challenges and opportunities to enhance the understanding of the disease. We assess the potential impact of this pandemic and the unique challenges of the disease on African nations. We examine the state of Africa’s preparedness and make recommendations for steps needed to win the war against this pandemic and combat potential resurgence. Results: We identified gaps and opportunities among cross-cutting issues which is recommended to be addressed or harnessed in this pandemic. Factors such as the nature of the virus and the opportunities for drug targeting, point of care diagnostics, health surveillance systems, food security, mental health, xenophobia and gender-based violence, shelter for the homeless, water and sanitation, telecommunications challenges, domestic regional coordination and financing. Conclusion: Based on our synthesis of the current evidence, while there are plans for preparedness in several African countries, there are significant limitations. Multi-sectoral efforts from the science, education, medical, technological, communication, business and industry sectors as well as local communities is required in order to win this fight.
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Ocholla IA, Agutu NO, Ouma PO, Gatungu D, Makokha FO, Gitaka J. Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya. BMC Pregnancy Childbirth 2020; 20:287. [PMID: 32397969 PMCID: PMC7216545 DOI: 10.1186/s12884-020-02977-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/22/2019] [Accepted: 04/30/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neonatal mortality rate in Kenya continues to be unacceptably high. In reducing newborn deaths, inequality in access to care and quality care have been identified as current barriers. Contributing to these barriers are the bypassing behaviour and geographical access which leads to delay in seeking newborn care. This study (i) measured geographical accessibility of inpatient newborn care, and (ii), characterized bypassing behaviour using the geographical accessibility of the inpatient newborn care seekers. METHODS Geographical accessibility to the inpatient newborn units was modelled based on travel time to the units across Bungoma County. Data was then collected from 8 inpatient newborn units and 395 mothers whose newborns were admitted in the units were interviewed. Their spatial residence locations were geo-referenced and were used against the modelled travel time to define bypassing behaviour. RESULTS Approximately 90% of the sick newborn population have access to nearest newborn units (< 2 h). However, 36% of the mothers bypassed their nearest inpatient newborn facility, with lack of diagnostic services (28%) and distrust of health personnel (37%) being the major determinants for bypassing. Approximately 75% of the care seekers preferred to use the higher tier facilities for both maternal and neonatal care in comparison to sub-county facilities which mostly were bypassed and remained underutilised. CONCLUSION Our findings suggest that though majority of the population have access to care, sub-county inpatient newborn facilities have high risk of being bypassed. There is need to improve quality of care in maternal care, to reduce bypassing behaviour and improving neonatal outcome.
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Affiliation(s)
- Ian A. Ocholla
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Nathan O. Agutu
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Paul O. Ouma
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Daniel Gatungu
- Research and Innovation Directorate, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
| | | | - Jesse Gitaka
- Research and Innovation Directorate, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
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Abstract
Since its emergence in Wuhan, China in December 2019, novel Coronavirus disease - 2019 (COVID-19) has rapidly spread worldwide, achieving pandemic status on 11
th March, 2020. As of 1
st April 2020, COVID-19, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had infected over 800,000 people and caused over 40,000 deaths in 205 countries and territories. COVID-19 has had its heaviest toll on Europe, United States and China. As of 1
st of April 2020, the number of confirmed COVID-19 cases in Africa was relatively low, with the highest number registered by South Africa, which had reported 1,380 confirmed cases. On the same date (also the date of this review), Africa had reported 5,999 confirmed cases, of which 3,838 (almost 65%) occurred in South Africa, Algeria, Egypt, Morocco and Tunisia, with the remaining 2,071 cases distributed unevenly across the other African countries. We speculate that while African nations are currently experiencing much lower rates of COVID-19 relative to other continents, their significantly lower testing rates may grossly underestimate incidence rates. Failure to grasp the true picture may mean crucial windows of opportunity shut unutilized, while limited resources are not deployed to maximum effect. In the absence of extensive testing data, an overestimation of spread may lead to disproportionate measures being taken, causing avoidable strain on livelihoods and economies. Here, based on the African situation, we discuss COVID-19 diagnostic challenges and how they may blunt responses.
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Affiliation(s)
- Francis Kobia
- Research and Innovation, Mount Kenya University, Thika, 01000, Kenya.,Department of Biosciences, University of Milan - via Celoria 26, Milan, 20133, Italy
| | - Jesse Gitaka
- Research and Innovation, Mount Kenya University, Thika, 01000, Kenya.,Implementation Research, Centre for Resarch in Tropical Medicine and Community Development, Nairobi, 00100, Kenya
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Ngamsom B, Wandera EA, Iles A, Kimani R, Muregi F, Gitaka J, Pamme N. Rapid detection of Group B Streptococcus (GBS) from artificial urine samples based on IFAST and ATP bioluminescence assay: from development to practical challenges during protocol testing in Kenya. Analyst 2020; 144:6889-6897. [PMID: 31621696 DOI: 10.1039/c9an01808e] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report the rapid detection (20 min) of Streptococcus agalactiae, Group B Streptococcus (GBS) employing on-chip magnetic isolation of GBS based on immiscible filtration assisted by surface tension (IFAST), followed by detection of the isolated GBS using an adenosine triphosphate (ATP) bioluminescence assay. Up to 80% GBS cells were isolated from spiked artificial urine samples with linear responses of bioluminescence signals from isolated cells at 2.3 × 102-9.1 × 105 CFU mL-1, demonstrating great promise for point-of-care detection of pathogenic bacteria in screening urine samples from pregnant women. Practical challenges during initial testing of the developed protocol with urine samples in Kenya are also described.
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Affiliation(s)
- Bongkot Ngamsom
- Department of Chemistry and Biochemistry, Faculty of Science and Engineering. University of Hull, Hull, HU6 7RX, UK.
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Gitaka J, Kamita M, Mureithi D, Ndegwa D, Masika M, Omuse G, Ngari M, Makokha F, Mwaura P, Mathai R, Muregi F, Mwau M. Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach. BMJ Open 2020; 10:e030823. [PMID: 32234736 PMCID: PMC7170570 DOI: 10.1136/bmjopen-2019-030823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 12/17/2019] [Accepted: 03/06/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of the guideline is highly dependent on the settings in which they are rolled out. This study, employing an implementation science approach, aims to address the knowledge gap in this area and provide critical data as well as practical experiences when using antibiotic guidelines and stewardship programmes in the public health sector. This will provide evidence of ASP performance and potentially contribute to the county, national and regional policies on antibiotics use. METHODS AND ANALYSIS The study will be conducted in three geographically diverse regions, each represented by two hospitals. A baseline study on antibiotic usage, resistance and de-escalation, duration of hospital stay, rates of readmission and costs will be carried out in the preimplementation phase. The intervention, that is, the use of antibiotic guidelines and ASPs will be instituted for 18 months using a stepwise implementation strategy that will facilitate learning and continuous improvement of stewardship activities and updating of guidelines to reflect the evolving antibiotic needs. ETHICS AND DISSEMINATION Approvals to carry out the study have been obtained from the National Commission for Science, Technology and Innovation and the Mount Kenya University Ethics Review Committee. The approvals from the two institutions were used to obtain permission to conduct the study at each of the participating hospitals. Study findings will be presented to policy stakeholders and published in peer-reviewed scientific journals. It is anticipated that the findings will inform the appropriate antibiotic use guidelines within our local context.
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Affiliation(s)
- Jesse Gitaka
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Moses Kamita
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Dominic Mureithi
- Department of Animal Health and Production, Maasai Mara University, Narok, Kenya
| | - Davies Ndegwa
- Department of Medical Laboratory Sciences, Kenya Medical Training College, Nairobi, Kenya
| | - Moses Masika
- Department of Medical Microbiology, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Geoffrey Omuse
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - Moses Ngari
- Clinical Trial Facility, KEMRI/Wellcome Trust, Kilifi, Kenya
| | - Francis Makokha
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Peter Mwaura
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Ronald Mathai
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Francis Muregi
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Matilu Mwau
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Nairobi, Kenya
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Kagaya W, Gitaka J, Chan CW, Kongere J, Md Idris Z, Deng C, Kaneko A. Malaria resurgence after significant reduction by mass drug administration on Ngodhe Island, Kenya. Sci Rep 2019; 9:19060. [PMID: 31836757 PMCID: PMC6910941 DOI: 10.1038/s41598-019-55437-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022] Open
Abstract
Although WHO recommends mass drug administration (MDA) for malaria elimination, further evidence is required for understanding the obstacles for the optimum implementation of MDA. Just before the long rain in 2016, two rounds of MDA with artemisinin/piperaquine (Artequick) and low-dose primaquine were conducted with a 35-day interval for the entire population of Ngodhe Island (~500 inhabitants) in Lake Victoria, Kenya, which is surrounded by areas with moderate and high transmission. With approximately 90% compliance, Plasmodium prevalence decreased from 3% to 0% by microscopy and from 10% to 2% by PCR. However, prevalence rebounded to 9% by PCR two months after conclusion of MDA. Besides the remained local transmission, parasite importation caused by human movement likely contributed to the resurgence. Analyses of 419 arrivals to Ngodhe between July 2016 and September 2017 revealed Plasmodium prevalence of 4.6% and 16.0% by microscopy and PCR, respectively. Risk factors for infection among arrivals included age (0 to 5 and 11 to 15 years), and travelers from Siaya County, located to the north of Ngodhe Island. Parasite importation caused by human movement is one of major obstacles to sustain malaria elimination, suggesting the importance of cross-regional initiatives together with local vector control.
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Affiliation(s)
- Wataru Kagaya
- Department of Parasitology & Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Jesse Gitaka
- Department of Clinical Medicine, Mount Kenya University, PO Box 342-01000, Thika, Kenya
| | - Chim W Chan
- Department of Parasitology & Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.,Island Malaria Group, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Biomedicum, Solnavägen 9, 171 65, Solna, Stockholm, Sweden.,Department of Anthropology, Binghamton University, Binghamton, NY, 13905, USA
| | - James Kongere
- Nairobi Research Station, Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, Institute of Tropical Medicine (NEKKEN), Nagasaki University, PO Box 19993-00202, Nairobi, Kenya
| | - Zulkarnain Md Idris
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Biomedicum, Solnavägen 9, 171 65, Solna, Stockholm, Sweden.,Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000, Kuala Lumpur, Malaysia
| | - Changsheng Deng
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Akira Kaneko
- Department of Parasitology & Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan. .,Island Malaria Group, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Biomedicum, Solnavägen 9, 171 65, Solna, Stockholm, Sweden. .,Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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Kobia F, Gitaka J, Makokha F, Kamita M, Kibera J, Mwenda C, Mucee G, Kilingo B. The state of cancer in Meru, Kenya: a retrospective study. AAS Open Res 2019. [DOI: 10.12688/aasopenres.13027.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: It is projected that by 2030, 70% of all cancer related deaths will occur in low-middle income countries. However, data on the state of cancer in most African countries is scanty. Cancer estimates for Kenya are based on the Nairobi and Eldoret cancer registries, leaving most parts of the country unrepresented. Lacking national coverage, these data do not accurately reflect Kenya’s cancer burden. The paucity of reliable data impedes formulation of effective cancer control strategies and cancer research prioritization. Here, we report the findings of a retrospective study of the cancer state in Meru County, Kenya. Methods: A retrospective analysis of patient files at Meru hospice was carried out. 2349 cancer cases seen at the Meru hospice between 2003 and 2018 were analyzed. Data abstracted from the records included patient age, gender and cancer type. The abstracted data was analyzed by descriptive statistics. Results: Our results indicate that cancer is almost evenly distributed across genders, with men accounting for 49% and women 51%. Stomach cancer rates are strikingly elevated and equal to those in countries with the highest stomach cancer rates globally – making it the commonest cancer in this region (14%). Among men, the most common cancers affect the prostate (18%), stomach (17%), esophagus (14%), head & neck (12%), liver (8%) and colorectum (5%). Among women, the commonest are cancers of the breast (22%), cervix (20%), stomach (11%), esophagus (8%), head & neck (6%) and liver (5%). Breast cancer occurs at a notably early age, with 20% of those affected aged below 40. Lung cancer rates are notably low in this region (1.3%) relative to world estimates. Conclusion: Cancer distribution in Meru is nearly even between sexes. Our analysis suggests that the Meru region is a stomach cancer hotspot and that it also experiences elevated esophageal cancer levels.
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Gutiérrez Rico EM, Kikuchi A, Saito T, Kumondai M, Hishinuma E, Kaneko A, Chan CW, Gitaka J, Nakayoshi T, Oda A, Saito S, Hirasawa N, Hiratsuka M. CYP2D6 genotyping analysis and functional characterization of novel allelic variants in a Ni-Vanuatu and Kenyan population by assessing dextromethorphan O-demethylation activity. Drug Metab Pharmacokinet 2019; 35:89-101. [PMID: 32037159 DOI: 10.1016/j.dmpk.2019.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/18/2019] [Revised: 07/03/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022]
Abstract
While CYP2D6 allele and phenotype frequencies have been extensively studied, currently, very little ethnically specific data is available regarding the East African and South Pacific region, including Kenya and Vanuatu. The absence of information regarding gene polymorphisms and their resulting clinical effects in these populations may hinder treatment strategies and patient outcome. Given the scarceness of CYP2D6 related data in these populations, the purpose of this study was to perform a pharmacogenomic analysis of the Kenyan and Ni-Vanuatu population and ultimately characterize the enzymatic properties of eight novel CYP2D6 variant proteins expressed in 293FT cells in vitro using dextromethorphan as a substrate. Our study revealed a prevalence of functional alleles in both populations a low frequency for decreased function defining genotypes in the Ni-Vanuatu population, with approximately 36% of our Kenyan subjects presenting substrate-dependent decreased function alleles. Additionally, 6 variants (P171L, G306R, V402L, K1, K2, and K3) showed significantly reduced intrinsic clearance compared to wild-type CYP2D6.1. Our findings aid in efforts to bridge the gap between pharmacogenomic analysis and clinical application, by providing useful information in the development of ethnic-specific strategies as well as stressing the importance of population-specific genotyping when conducting multi-regional clinical trials and designing therapeutic strategies.
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Affiliation(s)
- Evelyn Marie Gutiérrez Rico
- Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Aoi Kikuchi
- Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Takahiro Saito
- Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Masaki Kumondai
- Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Eiji Hishinuma
- Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan; Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University, Sendai, 980-8575, Japan; Tohoku Medical Megabank Organization, Tohoku University, Sendai, 980-8575, Japan
| | - Akira Kaneko
- Department of Parasitology and Research Center for Infectious Disease Sciences, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Chim Wai Chan
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden
| | | | | | - Akifumi Oda
- Faculty of Pharmacy, Meijo University, Nagoya 468-8503, Japan
| | - Sakae Saito
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, 980-8575, Japan
| | - Noriyasu Hirasawa
- Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan; Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University, Sendai, 980-8575, Japan; Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Masahiro Hiratsuka
- Laboratory of Pharmacotherapy of Life-Style Related Diseases, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan; Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University, Sendai, 980-8575, Japan; Tohoku Medical Megabank Organization, Tohoku University, Sendai, 980-8575, Japan; Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai 980-8574, Japan.
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Gitaka J, Mwaura P, Oware K, Kongere J, Wasonga J, Matendechero S. Evaluating community’s knowledge on integrated malaria, schistosomiasis and soil transmitted helminth (STH) infections in a Lake Victoria island, Kenya: A mixed method approach. AAS Open Res 2019. [DOI: 10.12688/aasopenres.12897.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The burden of malaria, schistosomiasis and soil transmitted helminthes (STH) in the islands of Lake Victoria, Kenya, poses a considerable public health challenge. Although many studies have been conducted on the co-infection arising from these parasites, few have evaluated communities’ knowledge of the same. Increasing the level of knowledge about a disease or preventive chemotherapy is important, but efforts need to be focused on community perception and understanding of the problem so as to encourage engagement with the proposed control measures. This study aimed at understanding a community’s knowledge of malaria, schistosomiasis and STH in Lake Victoria island where an integrated preventive chemotherapy intervention was implemented. Methods: This study was conducted in Ngodhe Island in Lake Victoria in Homa Bay County, western Kenya region between April and May 2016. The study adopted a mixed method approach where both qualitative and quantitative data collection was performed concurrently. Results: A total of 239 people participated in this study. All the respondents reported that they had heard about malaria, 89.1% had heard about schistosomiasis while 87.4% had heard about STH. The majority of the respondents (93.3%) drew their drinking water directly from the lake and 80.3% reported bathing in the lake. Out of all the respondents, 96.2% knew about the ongoing preventive chemotherapy. Most respondents (94.1%) said they would participate in a preventive chemotherapy again, while 0.4% was not sure. The majority of the respondents (86.6%) reported that integrated strategy is the most effective approach to control the three infections in the Island. Conclusion: The findings show a very high knowledge about these diseases. Although this study found majority of the respondents are aware of the co-infection of malaria, schistosomiasis and STH, their behaviors such as bathing in the lake exacerbates the problem.
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Gitaka J, Natecho A, Mwambeo HM, Gatungu DM, Githanga D, Abuya T. Evaluating quality neonatal care, call Centre service, tele-health and community engagement in reducing newborn morbidity and mortality in Bungoma county, Kenya. BMC Health Serv Res 2018; 18:493. [PMID: 29940941 PMCID: PMC6019716 DOI: 10.1186/s12913-018-3293-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/13/2017] [Accepted: 06/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Neonatal mortality is a major health burden in Bungoma County with the rate estimated at 31 per 1000 live births and is above the national average of 22 per 1000. Nonetheless, out of the nine sub county hospitals, only two are fairly equipped with necessary infrastructure and skilled personnel to manage neonatal complications such as prematurity, neonatal sepsis, neonatal jaundice, birth asphyxia and respiratory distress syndrome. Additionally, with more than 50% of neonates delivered without skilled attendance, in below par hygiene environments such as home and on the roadsides, with non-existent community based referral system, the situation is made worse. The study aims to evaluate the progress made by an intervention “Collaborative Newborn Support Project” geared towards reducing neonatal mortality rate by 30% between October 2015 and December 2018 in Bungoma County, Kenya. Methods/Design This intervention will take a quasi-experimental design approach with experimental and control sites. The project will involve pre- and post-intervention data collection with comparison group to assess intervention effects. The primary outcome will be the percentage reduction of neonatal mortality in Bungoma County. Secondary outcomes include; a) Percentage of mothers or care givers able to identify at least three danger signs in neonates in the project area, b) Proportion of neonates with complications referred to specialized neonatal centers, through the call center, c) Percentage of health providers in neonatal care units who adhere to expected neonatal standards of care (rapid and complete application of standard protocols), d) Percentage increase in neonates with severe complications in the specialized neonatal units and e) Percentage of neonates who stay in neonatal care units beyond 5 days. Discussion We outline implementation details of the ongoing ‘Collaborative Newborn Support Project’ in Bungoma County, Kenya. This includes strategies in the operations of the telehealth platform, call centre service, community engagement and measuring of the outputs and outcomes. The funding and ethical approvals have been obtained and the study commenced. Trial registration PACTR201712002802638 Retrospectively registered on 5th December 2017 at Pan African Clinical Trials Registry. Electronic supplementary material The online version of this article (10.1186/s12913-018-3293-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jesse Gitaka
- Research and Innovation Centre, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya.
| | - Alice Natecho
- Fountain Africa Trust, P.O. Box 1632-50205, Webuye, Bungoma, Kenya
| | - Humphrey M Mwambeo
- Research and Innovation Centre, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
| | - Daniel Maina Gatungu
- Research and Innovation Centre, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
| | - David Githanga
- Kenya Paediatric Association, P.O. Box 45821-00100, GPO, Nairobi, Kenya
| | - Timothy Abuya
- Population Council, Kenya P. O. Box, Nairobi, 17643-00500, Kenya
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