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Mutono N, Basáñez MG, James A, Stolk WA, Makori A, Kimani TN, Hollingsworth TD, Vasconcelos A, Dixon MA, de Vlas SJ, Thumbi SM. Elimination of transmission of onchocerciasis (river blindness) with long-term ivermectin mass drug administration with or without vector control in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e771-e782. [PMID: 38484745 PMCID: PMC11009120 DOI: 10.1016/s2214-109x(24)00043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND WHO has proposed elimination of transmission of onchocerciasis (river blindness) by 2030. More than 99% of cases of onchocerciasis are in sub-Saharan Africa. Vector control and mass drug administration of ivermectin have been the main interventions for many years, with varying success. We aimed to identify factors associated with elimination of onchocerciasis transmission in sub-Saharan Africa. METHODS For this systematic review and meta-analysis we searched for published articles reporting epidemiological or entomological assessments of onchocerciasis transmission status in sub-Saharan Africa, with or without vector control. We searched MEDLINE, PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, African Index Medicus, and Google Scholar databases for all articles published from database inception to Aug 19, 2023, without language restrictions. The search terms used were "onchocerciasis" AND "ivermectin" AND "mass drug administration". The three inclusion criteria were (1) focus or foci located in Africa, (2) reporting of elimination of transmission or at least 10 years of ivermectin mass drug administration in the focus or foci, and (3) inclusion of at least one of the following assessments: microfilarial prevalence, nodule prevalence, Ov16 antibody seroprevalence, and blackfly infectivity prevalence. Epidemiological modelling studies and reviews were excluded. Four reviewers (NM, AJ, AM, and TNK) extracted data in duplicate from the full-text articles using a data extraction tool developed in Excel with columns recording the data of interest to be extracted, and a column where important comments for each study could be highlighted. We did not request any individual-level data from authors. Foci were classified as achieving elimination of transmission, being close to elimination of transmission, or with ongoing transmission. We used mixed-effects meta-regression models to identify factors associated with transmission status. This study is registered in PROSPERO, CRD42022338986. FINDINGS Of 1525 articles screened after the removal of duplicates, 75 provided 282 records from 238 distinct foci in 19 (70%) of the 27 onchocerciasis-endemic countries in sub-Saharan Africa. Elimination of transmission was reported in 24 (9%) records, being close to elimination of transmission in 86 (30%) records, and ongoing transmission in 172 (61%) records. I2 was 83·3% (95% CI 79·7 to 86·3). Records reporting 10 or more years of continuous mass drug administration with 80% or more therapeutic coverage of the eligible population yielded significantly higher odds of achieving elimination of transmission (log-odds 8·5 [95% CI 3·5 to 13·5]) or elimination and being close to elimination of transmission (42·4 [18·7 to 66·1]) than those with no years achieving 80% coverage or more. Reporting 15-19 years of ivermectin mass drug administration (22·7 [17·2 to 28·2]) and biannual treatment (43·3 [27·2 to 59·3]) were positively associated with elimination and being close to elimination of transmission compared with less than 15 years and no biannual mass drug administration, respectively. Having had vector control without vector elimination (-42·8 [-59·1 to -26·5]) and baseline holoendemicity (-41·97 [-60·6 to -23·2]) were associated with increased risk of ongoing transmission compared with no vector control and hypoendemicity, respectively. Blackfly disappearance due to vector control or environmental change contributed to elimination of transmission. INTERPRETATION Mass drug administration duration, frequency, and coverage; baseline endemicity; and vector elimination or disappearance are important determinants of elimination of onchocerciasis transmission in sub-Saharan Africa. Our findings underscore the importance of improving and sustaining high therapeutic coverage and increasing treatment frequency if countries are to achieve elimination of onchocerciasis transmission. FUNDING The Bill & Melinda Gates Foundation and Neglected Tropical Diseases Modelling Consortium, UK Medical Research Council, and Global Health EDCTP3 Joint Undertaking. TRANSLATIONS For the Swahili, French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Nyamai Mutono
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA.
| | - Maria-Gloria Basáñez
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK; London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Ananthu James
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anita Makori
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Teresia Njoki Kimani
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA; Ministry of Health Kenya, Kiambu Town, Kenya
| | | | | | - Matthew A Dixon
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK; London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - S M Thumbi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Paul G Allen School for Global Health, Washington State University, Pullman, WA, USA; Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
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Vasconcelos A, King JD, Nunes-Alves C, Anderson R, Argaw D, Basáñez MG, Bilal S, Blok DJ, Blumberg S, Borlase A, Brady OJ, Browning R, Chitnis N, Coffeng LE, Crowley EH, Cucunubá ZM, Cummings DAT, Davis CN, Davis EL, Dixon M, Dobson A, Dyson L, French M, Fronterre C, Giorgi E, Huang CI, Jain S, James A, Kim SH, Kura K, Lucianez A, Marks M, Mbabazi PS, Medley GF, Michael E, Montresor A, Mutono N, Mwangi TS, Rock KS, Saboyá-Díaz MI, Sasanami M, Schwehm M, Spencer SEF, Srivathsan A, Stawski RS, Stolk WA, Sutherland SA, Tchuenté LAT, de Vlas SJ, Walker M, Brooker SJ, Hollingsworth TD, Solomon AW, Fall IS. Accelerating Progress Towards the 2030 Neglected Tropical Diseases Targets: How Can Quantitative Modeling Support Programmatic Decisions? Clin Infect Dis 2024; 78:S83-S92. [PMID: 38662692 PMCID: PMC11045030 DOI: 10.1093/cid/ciae082] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Over the past decade, considerable progress has been made in the control, elimination, and eradication of neglected tropical diseases (NTDs). Despite these advances, most NTD programs have recently experienced important setbacks; for example, NTD interventions were some of the most frequently and severely impacted by service disruptions due to the coronavirus disease 2019 (COVID-19) pandemic. Mathematical modeling can help inform selection of interventions to meet the targets set out in the NTD road map 2021-2030, and such studies should prioritize questions that are relevant for decision-makers, especially those designing, implementing, and evaluating national and subnational programs. In September 2022, the World Health Organization hosted a stakeholder meeting to identify such priority modeling questions across a range of NTDs and to consider how modeling could inform local decision making. Here, we summarize the outputs of the meeting, highlight common themes in the questions being asked, and discuss how quantitative modeling can support programmatic decisions that may accelerate progress towards the 2030 targets.
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Affiliation(s)
- Andreia Vasconcelos
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
- Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
| | - Jonathan D King
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Cláudio Nunes-Alves
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
| | - Roy Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Daniel Argaw
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Shakir Bilal
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, USA
| | - David J Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Anna Borlase
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - Oliver J Brady
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Raiha Browning
- The Department of Statistics, The University of Warwick, Coventry, United Kingdom
| | - Nakul Chitnis
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emily H Crowley
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Zulma M Cucunubá
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Universidad Pontificia Javeriana, Bogotá, Colombia
| | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Christopher Neil Davis
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Emma Louise Davis
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Matthew Dixon
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Andrew Dobson
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
| | - Louise Dyson
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Michael French
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, United Kingdom
- RTI International, Washington, D.C., USA
| | - Claudio Fronterre
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Emanuele Giorgi
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Ching-I Huang
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Saurabh Jain
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Ananthu James
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sung Hye Kim
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Klodeta Kura
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Ana Lucianez
- Communicable Diseases Prevention, Control, and Elimination, Pan American Health Organization, Washington D.C., USA
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pamela Sabina Mbabazi
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Graham F Medley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Edwin Michael
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Antonio Montresor
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Nyamai Mutono
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Thumbi S Mwangi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Kat S Rock
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Mathematics Institute, The University of Warwick, Coventry, United Kingdom
| | - Martha-Idalí Saboyá-Díaz
- Communicable Diseases Prevention, Control, and Elimination, Pan American Health Organization, Washington D.C., USA
| | - Misaki Sasanami
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Markus Schwehm
- ExploSYS GmbH, Interdisciplinary Institute for Exploratory Systems, Leinfelden-Echterdingen, Germany
| | - Simon E F Spencer
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ariktha Srivathsan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Robert S Stawski
- Institute of Public Health and Wellbeing, School of Health and Social Care, University of Essex, Essex, United Kingdom
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Samuel A Sutherland
- Zeeman Institute for System Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom
- Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | | | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martin Walker
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, United Kingdom
| | | | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahima Socé Fall
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
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3
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Kura K, Mutono N, Basáñez MG, Collyer BS, Coffeng LE, Thumbi SM, Anderson RM. How Does Treatment Coverage and Proportion Never Treated Influence the Success of Schistosoma mansoni Elimination as a Public Health Problem by 2030? Clin Infect Dis 2024; 78:S126-S130. [PMID: 38662698 PMCID: PMC11045018 DOI: 10.1093/cid/ciae074] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The 2030 target for schistosomiasis is elimination as a public health problem (EPHP), achieved when the prevalence of heavy-intensity infection among school-aged children (SAC) reduces to <1%. To achieve this, the new World Health Organization guidelines recommend a broader target of population to include pre-SAC and adults. However, the probability of achieving EPHP should be expected to depend on patterns in repeated uptake of mass drug administration by individuals. METHODS We employed 2 individual-based stochastic models to evaluate the impact of school-based and community-wide treatment and calculated the number of rounds required to achieve EPHP for Schistosoma mansoni by considering various levels of the population never treated (NT). We also considered 2 age-intensity profiles, corresponding to a low and high burden of infection in adults. RESULTS The number of rounds needed to achieve this target depends on the baseline prevalence and the coverage used. For low- and moderate-transmission areas, EPHP can be achieved within 7 years if NT ≤10% and NT <5%, respectively. In high-transmission areas, community-wide treatment with NT <1% is required to achieve EPHP. CONCLUSIONS The higher the intensity of transmission, and the lower the treatment coverage, the lower the acceptable value of NT becomes. Using more efficacious treatment regimens would permit NT values to be marginally higher. A balance between target treatment coverage and NT values may be an adequate treatment strategy depending on the epidemiological setting, but striving to increase coverage and/or minimize NT can shorten program duration.
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Affiliation(s)
- Klodeta Kura
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
| | - Nyamai Mutono
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
| | - Benjamin S Collyer
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
| | - Luc E Coffeng
- Department of Public Health, Erasmus University Medical Center, University Medical Center Rotterdam, The Netherlands
| | - S M Thumbi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman
- Institute of Immunology and Infection Research, University of Edinburgh, United Kingdom
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
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4
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Ogoti BM, Riitho V, Wildemann J, Mutono N, Tesch J, Rodon J, Harichandran K, Emanuel J, Möncke-Buchner E, Kiambi S, Oyugi J, Mureithi M, Corman VM, Drosten C, Thumbi SM, Müller MA. Biphasic MERS-CoV Incidence in Nomadic Dromedaries with Putative Transmission to Humans, Kenya, 2022-2023. Emerg Infect Dis 2024; 30:581-585. [PMID: 38407189 PMCID: PMC10902546 DOI: 10.3201/eid3003.231488] [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] [Indexed: 02/27/2024] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is endemic in dromedaries in Africa, but camel-to-human transmission is limited. Sustained 12-month sampling of dromedaries in a Kenya abattoir hub showed biphasic MERS-CoV incidence; peak detections occurred in October 2022 and February 2023. Dromedary-exposed abattoir workers (7/48) had serologic signs of previous MERS-CoV exposure.
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Affiliation(s)
| | | | | | - Nyamai Mutono
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Julia Tesch
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Jordi Rodon
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Kaneemozhe Harichandran
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Jackson Emanuel
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Elisabeth Möncke-Buchner
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Stella Kiambi
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Julius Oyugi
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Marianne Mureithi
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Victor M. Corman
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
| | - Christian Drosten
- University of Nairobi, Nairobi, Kenya (B.M. Ogoti, V. Riitho, N. Mutono, J. Oyugi, M. Mureithi, S.M. Thumbi)
- Queen Mary University of London, London, UK (V. Riitho)
- Charité–Universitätsmedizin Berlin, Berlin, Germany (J. Wildemann, J. Tesch, J. Rodon, K. Harichandran, J. Emanuel, E. Möncke-Buchner, V.M. Corman, C. Drosten, M.A. Müller)
- Washington State University, Pullman, Washington, USA (N. Mutono, S.M. Thumbi)
- Food and Agriculture Organization, Dar es Salaam, Tanzania (S. Kiambi)
- Labor Berlin–Charité Vivantes GmbH, Berlin (V.M. Corman)
- German Center for Infection Research, Berlin (V.M. Corman, C. Drosten, M.A. Müller)
- University of Edinburgh, Edinburgh, Scotland, UK (S.M. Thumbi)
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Thumbi SM, Muema J, Mutono N, Njuguna J, Jost C, Boyd E, Tewoldeberhan D, Mutua I, Gacharamu G, Wambua F, Allport R, Olesambu E, Osman AM, Souza D, Kimani I, Oyugi J, Bukania Z, Oboge H, Palmer GH, Yoder J. The Livestock for Health Study: A Field Trial on Livestock Interventions to Prevent Acute Malnutrition Among Women and Children in Pastoralist Communities in Northern Kenya. Food Nutr Bull 2023; 44:S119-S123. [PMID: 37850922 DOI: 10.1177/03795721231195427] [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] [Indexed: 10/19/2023]
Abstract
BACKGROUND Livestock-dependent communities in Africa's drylands disproportionately experience acute malnutrition, especially during drought seasons. We detail the design and implementation of the Livestock for Health (L4H) study aimed at determining the effect of providing livestock feed and nutritional counselling to prevent seasonal spikes of acute malnutrition. METHODS The L4H study employed a 3-arm cluster randomized controlled trial to compare households in pastoralist settings in northern Kenya receiving livestock feeds during critical dry periods, with or without nutritional counseling, with control households. Over 4 dry seasons, 2019 to 2021, the study collected data on household milk production, consumption patterns, mothers'/children's nutritional status, household socioeconomic status, herd dynamics, and human and animal health status every 6 weeks. RESULTS L4H recruited 1734 households, with 639, 585, and 510 households assigned to intervention arms 1 and 2 and control arm 3, respectively. From these households, 1734 women and 1748 children younger than 3 years were recruited. In total, 19 419 household visits were completed, obtaining anthropometric measures 9 times on average for each child and mother. Eighty-one households (5%) were lost from the study due to the mother's death, child's death, migration, and withdrawal for other reasons. DISCUSSION L4H's success in a challenging environment was possible due to strong community engagement, formative studies to inform trial design, collaboration with local authorities, and effective interdisciplinary collaboration. Subsequent manuscripts will report the study findings. TRIAL REGISTRATION The study was registered October 29, 2020, and is online at ClinicalTrials.gov (ID: NCT04608656).
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Affiliation(s)
- Samuel M Thumbi
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Immunology and Infection Research, University of Edinburgh
| | - Josphat Muema
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Nyamai Mutono
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Christine Jost
- Global Health Training, Advising, and Support Contract, Credence Management Solutions LLC, supporting the United States Agency for International Development (USAID) Bureau for Humanitarian Assistance
| | - Erin Boyd
- United States Agency for International Development's Bureau for Humanitarian Assistance (USAID/BHA), Washington, DC
| | | | - Immaculate Mutua
- Ministry of Health, Government of Marsabit County, Marsabit, Kenya
| | | | | | | | - Emmanuella Olesambu
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Abdal Monium Osman
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Darana Souza
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Irene Kimani
- United States Agency for International Development's Bureau for Humanitarian Assistance (USAID/BHA), Washington, DC
| | - Julius Oyugi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
| | - Harriet Oboge
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Jonathan Yoder
- Feed the Future Innovation Lab for Animal Health, Washington State University
- School of Economic Sciences, Washington state University, Pullman, USA
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Muema J, Mutono N, Kisaka S, Ogoti B, Oyugi J, Bukania Z, Daniel T, Njuguna J, Kimani I, Makori A, Omulo S, Boyd E, Osman AM, Gwenaelle L, Jost C, Thumbi SM. The impact of livestock interventions on nutritional outcomes of children younger than 5 years old and women in Africa: a systematic review and meta-analysis. Front Nutr 2023; 10:1166495. [PMID: 37485389 PMCID: PMC10358768 DOI: 10.3389/fnut.2023.1166495] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Nutrition-sensitive livestock interventions have the potential to improve the nutrition of communities that are dependent on livestock for their livelihoods by increasing the availability and access to animal-source foods. These interventions can also boost household income, improving purchasing power for other foods, as well as enhance determinants of health. However, there is a lack of synthesized empirical evidence of the impact and effect of livestock interventions on diets and human nutritional status in Africa. Objective To review evidence of the effectiveness of nutrition-sensitive livestock interventions in improving diets and nutritional status in children younger than 5 years old and in pregnant and lactating women. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of published studies reporting on the effect of livestock interventions on maternal and child nutrition in Africa. Data were extracted, synthesized, and summarized qualitatively. Key outcomes were presented in summary tables alongside a narrative summary. Estimation of pooled effects was undertaken for experimental studies with nutritional outcomes of consumption of animal-source foods (ASFs) and minimum dietary diversity (MDD). Fixed effects regression models and pooled effect sizes were computed and reported as odds ratios (ORs) together with their 95% confidence intervals (CI). Results After the screening, 29 research papers were included in the review, and of these, only 4 were included in the meta-analysis. We found that nutrition-sensitive livestock interventions have a significant positive impact on the consumption of ASFs for children < 5 years (OR = 5.39; 95% CI: 4.43-6.56) and on the likelihood of meeting minimum dietary diversity (OR = 1.89; 95% CI: 1.51-2.37). Additionally, the impact of livestock interventions on stunting, wasting, and being underweight varied depending on the type of intervention and duration of the program/intervention implementation. Therefore, because of this heterogeneity in reporting metrics, the pooled estimates could not be computed. Conclusion Nutrition-sensitive livestock interventions showed a positive effect in increasing the consumption of ASFs, leading to improved dietary diversity. However, the quality of the evidence is low, and therefore, more randomized controlled studies with consistent and similar reporting metrics are needed to increase the evidence base on how nutrition-sensitive livestock interventions affect child growth outcomes.
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Affiliation(s)
- Josphat Muema
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
| | - Nyamai Mutono
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Stevens Kisaka
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Brian Ogoti
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Irene Kimani
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Anita Makori
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Sylvia Omulo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
| | - Erin Boyd
- United States Agency for International Development’s Bureau for Humanitarian Assistance, Washington, DC, United States
| | - Abdal Monium Osman
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Luc Gwenaelle
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Christine Jost
- United States Agency for International Development’s Bureau for Humanitarian Assistance, Washington, DC, United States
- Global Health Support Initiative III, Social Solutions International, Washington, DC, United States
| | - SM Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
- South African Center for Epidemiological Modelling and Analysis, Stellenbosch, South Africa
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
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7
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Chuchu VM, Mutono N, Bichanga P, Kitala PM, Ksee D, Muturi M, Mwatondo A, Nasimiyu C, Akunga L, Amiche A, Hampson K, Thumbi SM. Effect of Phone Text Message Reminders on Compliance with Rabies Post-Exposure Prophylaxis following Dog Bites in Rural Kenya. Vaccines (Basel) 2023; 11:1112. [PMID: 37376501 DOI: 10.3390/vaccines11061112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/10/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
The prompt administration of post-exposure prophylaxis (PEP) is one of the key strategies for ending human deaths from rabies. A delay in seeking the first dose of rabies PEP, or failure to complete the recommended dosage, may result in clinical rabies and death. We assessed the efficacy of short message system (SMS) phone texts in improving the adherence to scheduled PEP doses among bite patients in rural eastern Kenya. We conducted a single-arm, before-after field trial that compared adherence among bite patients presenting at Makueni Referral Hospital between October and December 2018 (control) and between January and March 2019 (intervention). Data on their demographics, socio-economic status, circumstances surrounding the bite, and expenditures related to the bite were collected. A total of 186 bite patients were enrolled, with 82 (44%) in the intervention group, and 104 (56%) in the control group. The odds of PEP completion were three times (OR 3.37, 95% CI 1.28, 10.20) more likely among patients who received the SMS reminder, compared to the control. The intervention group had better compliance on the scheduled doses 2 to 5, with a mean deviation of 0.18 days compared to 0.79 days for the control group (p = 0.004). The main reasons for non-compliance included lack of funds (30%), and forgetfulness (23%) on days for follow-up treatment, among others. Nearly all (96%, n = 179) the bite patients incurred indirect transport costs, at an average of USD 4 (USD 0-45) per visit. This study suggests that the integration of SMS reminders into healthcare service delivery increases compliance with PEP, and may strengthen rabies control and elimination strategies.
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Affiliation(s)
- Veronicah M Chuchu
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 1578-40100, Kenya
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi 29053-00625, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
| | - Nyamai Mutono
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi 19676-00202, Kenya
| | - Philet Bichanga
- Department of Health Services, Government of Makueni County, Makueni 95-90300, Kenya
| | - Philip M Kitala
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi 29053-00625, Kenya
| | - Daniel Ksee
- Department of Agriculture, Irrigation, Livestock and Fisheries Development, Government of Makueni County, Makueni 78-90300, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Joint One Health Office of the Ministry of Health and the Ministry of Agriculture, Livestock and Fisheries, Government of Kenya, Nairobi 20811-00202, Kenya
| | - Athman Mwatondo
- Zoonotic Disease Unit, Joint One Health Office of the Ministry of Health and the Ministry of Agriculture, Livestock and Fisheries, Government of Kenya, Nairobi 20811-00202, Kenya
| | - Carolyne Nasimiyu
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
| | | | | | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, Graham Kerr Building, University of Glasgow, Glasgow G12 8QQ, UK
| | - Samuel M Thumbi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 1578-40100, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA 99164-7090, USA
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi 19676-00202, Kenya
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh EH8 9YL, UK
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8
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Mwatondo A, Rahman-Shepherd A, Hollmann L, Chiossi S, Maina J, Kurup KK, Hassan OA, Coates B, Khan M, Spencer J, Mutono N, Thumbi SM, Muturi M, Mutunga M, Arruda LB, Akhbari M, Ettehad D, Ntoumi F, Scott TP, Nel LH, Ellis-Iversen J, Sönksen UW, Onyango D, Ismail Z, Simachew K, Wolking D, Kazwala R, Sijali Z, Bett B, Heymann D, Kock R, Zumla A, Dar O. A global analysis of One Health Networks and the proliferation of One Health collaborations. Lancet 2023; 401:605-616. [PMID: 36682370 DOI: 10.1016/s0140-6736(22)01596-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/14/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023]
Abstract
There has been a renewed focus on threats to the human-animal-environment interface as a result of the COVID-19 pandemic, and investments in One Health collaborations are expected to increase. Efforts to monitor the development of One Health Networks (OHNs) are essential to avoid duplication or misalignment of investments. This Series paper shows the global distribution of existing OHNs and assesses their collective characteristics to identify potential deficits in the ways OHNs have formed and to help increase the effectiveness of investments. We searched PubMed, Google, Google Scholar, and relevant conference websites for potential OHNs and identified 184 worldwide for further analysis. We developed four case studies to show important findings from our research and exemplify best practices in One Health operationalisation. Our findings show that, although more OHNs were formed in the past 10 years than in the preceding decade, investment in OHNs has not been equitably distributed; more OHNs are formed and headquartered in Europe than in any other region, and emerging infections and novel pathogens were the priority focus area for most OHNs, with fewer OHNs focusing on other important hazards and pressing threats to health security. We found substantial deficits in the OHNs collaboration model regarding the diversity of stakeholder and sector representation, which we argue impedes effective and equitable OHN formation and contributes to other imbalances in OHN distribution and priorities. These findings are supported by previous evidence that shows the skewed investment in One Health thus far. The increased attention to One Health after the COVID-19 pandemic is an opportunity to focus efforts and resources to areas that need them most. Analyses, such as this Series paper, should be used to establish databases and repositories of OHNs worldwide. Increased attention should then be given to understanding existing resource allocation and distribution patterns, establish more egalitarian networks that encompass the breadth of One Health issues, and serve communities most affected by emerging, re-emerging, or endemic threats at the human-animal-environment interface.
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Affiliation(s)
- Athman Mwatondo
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya; International Livestock Research Institute, Nairobi, Kenya; Royal Institute of International Affairs, London, UK.
| | - Afifah Rahman-Shepherd
- London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Royal Institute of International Affairs, London, UK
| | - Lara Hollmann
- Royal Institute of International Affairs, London, UK
| | - Scott Chiossi
- Royal Institute of International Affairs, London, UK
| | - Josphat Maina
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya; International Livestock Research Institute, Nairobi, Kenya
| | | | | | | | - Mishal Khan
- London School of Hygiene & Tropical Medicine, London, UK; Department of Community Health Sciences and Department of Pathology, Aga Khan University, Karachi, Pakistan; Royal Institute of International Affairs, London, UK
| | - Julia Spencer
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nyamai Mutono
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Samuel M Thumbi
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Agriculture, Livestock, and Fisheries, Nairobi, Kenya; International Livestock Research Institute, Nairobi, Kenya
| | - Mumbua Mutunga
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Liã Bárbara Arruda
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Melika Akhbari
- Clinical Academic Training Office, University of Cambridge, Cambridge, UK
| | - Dena Ettehad
- Academic Foundation Programme, Faculty of Medicine, Imperial College London, Imperial College Healthcare NHS Trust, London, UK
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, Democratic Republic of the Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | | | - Louis H Nel
- Department of Biochemistry, Genetics, and Microbiology, University of Pretoria, Pretoria, South Africa
| | | | - Ute Wolff Sönksen
- National Centre for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Diana Onyango
- The One Health for Humans, Environment, Animals and Livelihoods Project, Addis Ababa, Ethiopia
| | - Zuleka Ismail
- The One Health for Humans, Environment, Animals and Livelihoods Project, Addis Ababa, Ethiopia
| | - Kebadu Simachew
- The One Health for Humans, Environment, Animals and Livelihoods Project, Addis Ababa, Ethiopia
| | - David Wolking
- One Health Institute, University of California, Davis, CA, USA
| | - Rudovick Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Zikankuba Sijali
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
| | - David Heymann
- Department of Infectious Disease Epidemiology, London, UK
| | - Richard Kock
- Royal Veterinary College, University of London, London, UK
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; National Institute for Health and Care Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Osman Dar
- Global Health Programme, Royal Institute of International Affairs, London, UK; Global Operations, UK Health Security Agency, London, UK
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Muema J, Oboge H, Mutono N, Makori A, Oyugi J, Bukania Z, Njuguna J, Jost C, Ogoti B, Omulo S, Thumbi SM. Sero - epidemiology of brucellosis in people and their livestock: A linked human - animal cross-sectional study in a pastoralist community in Kenya. Front Vet Sci 2022; 9:1031639. [PMID: 36467641 PMCID: PMC9716101 DOI: 10.3389/fvets.2022.1031639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/31/2022] [Accepted: 11/03/2022] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Brucellosis is associated with massive livestock production losses and human morbidity worldwide. Efforts to control brucellosis among pastoralist communities are limited by scarce data on the prevalence and risk factors for exposure despite the high human-animal interactions in these communities. This study simultaneously assessed the seroprevalence of brucellosis and associated factors of exposure among pastoralists and their livestock in same households. METHODS We conducted a cross-sectional study in pastoralist communities in Marsabit County - Kenya. A total of 1,074 women and 225 children participated and provided blood samples. Blood was also drawn from 1,876 goats, 322 sheep and 189 camels. Blood samples were collected to be screened for the presence of anti-Brucella IgG antibodies using indirect IgG Enzyme-Linked Immunosorbent Assay (ELISA) kits. Further, Individual, household and herd-level epidemiological information were captured using a structured questionnaire. Group differences were compared using the Pearson's Chi-square test, and p-values < 0.05 considered statistically significant. Generalized mixed-effects multivariable logistic human and animal models using administrative ward as the random effect was used to determine variables correlated to the outcome. RESULTS Household-level seropositivity was 12.7% (95% CI: 10.7-14.8). The individual human seroprevalence was 10.8% (9.1-12.6) with higher seroprevalence among women than children (12.4 vs. 3.1%, p < 0.001). Herd-level seroprevalence was 26.1% (23.7-28.7) and 19.2% (17.6-20.8) among individual animals. Goats had the highest seroprevalence 23.1% (21.2 - 25.1), followed by sheep 6.8% (4.3-10.2) and camels 1.1% (0.1-3.8). Goats and sheep had a higher risk of exposure OR = 3.8 (95% CI 2.4-6.7, p < 0.001) and 2.8 (1.2-5.6, p < 0.007), respectively relative to camels. Human and animal seroprevalence were significantly associated (OR = 1.8, [95%CI: 1.23-2.58], p = 0.002). Herd seroprevalence varied by household head education (OR = 2.45, [1.67-3.61, p < 0.001]) and herd size (1.01, [1.00-1.01], p < 0.001). CONCLUSIONS The current study showed evidence that brucellosis is endemic in this pastoralist setting and there is a significant association between animal and human brucellosis seropositivity at household level representing a potential occupational risk. Public health sensitization and sustained human and animal brucellosis screening are required.
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Affiliation(s)
- Josphat Muema
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
| | - Harriet Oboge
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
| | - Nyamai Mutono
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Centre for Epidemiological Modeling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Anita Makori
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Centre for Epidemiological Modeling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Christine Jost
- United States Agency for International Development's Bureau for Humanitarian Assistance (USAID/BHA), Washington, DC, United States
- Global Health Support Initiative III, Social Solutions International, Washington, DC, United States
| | - Brian Ogoti
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Centre for Epidemiological Modeling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Sylvia Omulo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
| | - S. M. Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
- South African Center for Epidemiological Modeling Analysis, Stellenbosch, South Africa
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
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10
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Mutono N, Wright JA, Mutunga M, Mutembei H, Thumbi SM. Impact of traffic congestion on spatial access to healthcare services in Nairobi. Front Health Serv 2022; 2:788173. [PMID: 36925766 PMCID: PMC10012710 DOI: 10.3389/frhs.2022.788173] [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] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/25/2022] [Indexed: 11/17/2022]
Abstract
Background Geographic accessibility is an important determinant of healthcare utilization and is critical for achievement of universal health coverage. Despite the high disease burden and severe traffic congestion in many African cities, few studies have assessed how traffic congestion impacts geographical access to healthcare facilities and to health professionals in these settings. In this study, we assessed the impact of traffic congestion on access to healthcare facilities, and to the healthcare professionals across the healthcare facilities. Methods Using data on health facilities obtained from the Ministry of Health in Kenya, we mapped 944 primary, 94 secondary and four tertiary healthcare facilities in Nairobi County. We then used traffic probe data to identify areas within a 15-, 30- and 45-min drive from each health facility during peak and off-peak hours and calculated the proportion of the population with access to healthcare in the County. We employed a 2-step floating catchment area model to calculate the ratio of healthcare and healthcare professionals to population during these times. Results During peak hours, <70% of Nairobi's 4.1 million population was within a 30-min drive from a health facility. This increased to >75% during off-peak hours. In 45 min, the majority of the population had an accessibility index of one health facility accessible to more than 100 people (<0.01) for primary health care facilities, one to 10,000 people for secondary facilities, and two health facilities per 100,000 people for tertiary health facilities. Of people with access to health facilities, a sub-optimal ratio of <4.45 healthcare professionals per 1,000 people was observed in facilities offering primary and secondary healthcare during peak and off-peak hours. Conclusion Our study shows access to healthcare being negatively impacted by traffic congestion, highlighting the need for multisectoral collaborations between urban planners, health sector and policymakers to optimize health access for the city residents. Additionally, growing availability of traffic probe data in African cities should enable similar analysis and understanding of healthcare access for city residents in other countries on the continent.
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Affiliation(s)
- Nyamai Mutono
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
| | - Jim A. Wright
- School of Geography and Environment Science, University of Southampton, Southampton, United Kingdom
| | - Mumbua Mutunga
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Henry Mutembei
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya
- Department of Clinical Studies, University of Nairobi, Nairobi, Kenya
| | - S. M. Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
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11
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Ombajo LA, Mutono N, Sudi P, Mutua M, Sood M, Loo AM, Juma P, Odhiambo J, Shah R, Wangai F, Maritim M, Anzala O, Amoth P, Kamuri E, Munyu W, Thumbi SM. Epidemiological and clinical characteristics of patients hospitalised with COVID-19 in Kenya: a multicentre cohort study. BMJ Open 2022; 12:e049949. [PMID: 35589368 PMCID: PMC9121111 DOI: 10.1136/bmjopen-2021-049949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess outcomes of patients admitted to hospital with COVID-19 and to determine the predictors of mortality. SETTING This study was conducted in six facilities, which included both government and privately run secondary and tertiary level facilities in the central and coastal regions of Kenya. PARTICIPANTS We enrolled 787 reverse transcriptase-PCR-confirmed SARS-CoV2-infected persons. Patients whose records could not be accessed were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was COVID-19-related death. We used Cox proportional hazards regressions to determine factors related to in-hospital mortality. RESULTS Data from patients with 787 COVID-19 were available. The median age was 43 years (IQR 30-53), with 505 (64%) being men. At admission, 455 (58%) were symptomatic with an additional 63 (9%) developing clinical symptoms during hospitalisation. The most common symptoms were cough (337, 43%), loss of taste or smell (279, 35%) and fever (126, 16%). Comorbidities were reported in 340 (43%), with cardiovascular disease, diabetes and HIV documented in 130 (17%), 116 (15%), 53 (7%), respectively. 90 (11%) were admitted to the Intensive Care Unit (ICU) for a mean of 11 days, 52 (7%) were ventilated with a mean of 10 days, 107 (14%) died. The risk of death increased with age (HR 1.57 (95% CI 1.13 to 2.19)) for persons >60 years compared with those <60 years old; having comorbidities (HR 2.34 (1.68 to 3.25)) and among men (HR 1.76 (1.27 to 2.44)) compared with women. Elevated white cell count and aspartate aminotransferase were associated with higher risk of death. CONCLUSIONS The risk of death from COVID-19 is high among older patients, those with comorbidities and among men. Clinical parameters including patient clinical signs, haematology and liver function tests were associated with risk of death and may guide stratification of high-risk patients.
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Affiliation(s)
- Loice Achieng Ombajo
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Nyamai Mutono
- Paul G Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Paul Sudi
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Mbuvi Mutua
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Mohammed Sood
- Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Alliyy Muhammad Loo
- Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Phoebe Juma
- Department of Medicine, Nairobi Hospital, Nairobi, Kenya
| | | | - Reena Shah
- Department of Medicine, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Frederick Wangai
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Marybeth Maritim
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Patrick Amoth
- Office of The Director General, Kenya Ministry of Health, Nairobi, Kenya
| | - Evans Kamuri
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Waweru Munyu
- Department of Medicine, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi College of Health Sciences, Nairobi, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, Washington, USA
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12
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Chuchu VM, Kitala PM, Bichanga P, Ksee D, Muturi M, Mwatondo A, Nasimiyu C, Maritim M, Mutono N, Beyene TJ, Druelles S, Hampson K, Thumbi SM. Rabies Elimination in Rural Kenya: Need for Improved Availability of Human Vaccines, Awareness and Knowledge on Rabies and Its Management Among Healthcare Workers. Front Public Health 2022; 10:769898. [PMID: 35356016 PMCID: PMC8960031 DOI: 10.3389/fpubh.2022.769898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/31/2022] [Indexed: 12/25/2022] Open
Abstract
BackgroundIn Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya.MethodologyWe interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed.ResultsRabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% (n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent (n = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies.ConclusionThe availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa.
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Affiliation(s)
- Veronicah Mbaire Chuchu
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Washington State University Global Health Program, Nairobi, Kenya
| | - Philip Mwanzia Kitala
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
| | - Philet Bichanga
- Government of Makueni County, Department of Health Services, Wote, Kenya
| | - Daniel Ksee
- Government of Makueni County, Department of Agriculture, Irrigation, Livestock, and Fisheries Development, Wote, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Athman Mwatondo
- Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Carolyne Nasimiyu
- Washington State University Global Health Program, Nairobi, Kenya
- Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Marybeth Maritim
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Nyamai Mutono
- Washington State University Global Health Program, Nairobi, Kenya
- Center for Epidemiological and Modelling Analysis, Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Tariku J. Beyene
- Center for Health Equity and Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Sophie Druelles
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Lyon, France
| | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - S. M. Thumbi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Center for Epidemiological and Modelling Analysis, Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), The University of Edinburgh, Edinburgh, United Kingdom
- Paul G Allen School for Global Health, Washington State University, Pullman, WA, United States
- *Correspondence: S. M. Thumbi
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13
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Mutono N, Wright JA, Mutembei H, Muema J, Thomas MLH, Mutunga M, Thumbi SM. The nexus between improved water supply and water-borne diseases in urban areas in Africa: a scoping review. AAS Open Res 2021; 4:27. [PMID: 34368620 PMCID: PMC8311817 DOI: 10.12688/aasopenres.13225.1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The sub-Saharan Africa has the fastest rate of urbanisation in the world. However, infrastructure growth in the region is slower than urbanisation rates, leading to inadequate provision and access to basic services such as piped safe drinking water. Lack of sufficient access to safe water has the potential to increase the burden of waterborne diseases among these urbanising populations. This scoping review assesses how the relationship between waterborne diseases and water sufficiency in Africa has been studied. Methods: In April 2020, we searched the Web of Science, PubMed, Embase and Google Scholar databases for studies of African cities that examined the effect of insufficient piped water supply on selected waterborne disease and syndromes (cholera, typhoid, diarrhea, amoebiasis, dysentery, gastroneteritis, cryptosporidium, cyclosporiasis, giardiasis, rotavirus). Only studies conducted in cities that had more than half a million residents in 2014 were included. Results: A total of 32 studies in 24 cities from 17 countries were included in the study. Most studies used case-control, cross-sectional individual or ecological level study designs. Proportion of the study population with access to piped water was the common water availability metrics measured while amounts consumed per capita or water interruptions were seldom used in assessing sufficient water supply. Diarrhea, cholera and typhoid were the major diseases or syndromes used to understand the association between health and water sufficiency in urban areas. There was weak correlation between the study designs used and the association with health outcomes and water sufficiency metrics. Very few studies looked at change in health outcomes and water sufficiency over time. Conclusion: Surveillance of health outcomes and the trends in piped water quantity and mode of access should be prioritised in urban areas in Africa in order to implement interventions towards reducing the burden associated with waterborne diseases and syndromes.
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Affiliation(s)
- Nyamai Mutono
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya.,Washington State University Global Health Program - Kenya, Nairobi, Kenya.,Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Jim A Wright
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Henry Mutembei
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya.,Department of Clinical Studies, Faculty of Veterinary Medicine,, University of Nairobi, Nairobi, Kenya
| | - Josphat Muema
- Washington State University Global Health Program - Kenya, Nairobi, Kenya.,Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Mair L H Thomas
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Mumbua Mutunga
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Samuel Mwangi Thumbi
- Centre for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.,Paul G Allen School for Global Animal Health, Washington State University, Pullman, USA.,Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
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14
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Mutono N, Wright J, Mutembei H, Muema J, Thomas M, Mutunga M, Thumbi SM. The nexus between improved water supply and water-borne diseases in urban areas in Africa: a scoping review protocol. AAS Open Res 2020; 3:12. [PMID: 33629030 PMCID: PMC7883317 DOI: 10.12688/aasopenres.13063.2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 01/24/2023] Open
Abstract
Introduction: Currently, an estimated two thirds of the world population is water insufficient. As of 2015, one out of every five people in developing countries do not have access to clean sufficient drinking water. In an attempt to share the limited resource, water has been distributed at irregular intervals in cities in developing countries. Residents in these cities seek alternative water sources to supplement the inadequate water supplied. Some of these alternative sources of water are unsafe for human consumption, leading to an increased risk in water-borne diseases. Africa contributes to 53% of the diarrheal cases reported globally, with contaminated drinking water being the main source of transmission. Water-borne diseases like diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus are a major public health concern. The main objective of this scoping review is to map the available evidence to understand the sources of water among residents in cities in Africa and the relationship between clean water sufficiency and water-borne diseases in urban Africa. Methods and analysis: The search strategy will identify studies published in scientific journals and reports that are directly relevant to African cities that have a population of more than half a million residents as of 2014 AND studies on the ten emerging water-borne diseases, which are diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus. Ethics and dissemination: This scoping review did not require any formal ethical approval. The findings will be published in a peer-reviewed journal.
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Affiliation(s)
- Nyamai Mutono
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya.,Washington State University Global Health - Kenya, Nairobi, Kenya
| | - James Wright
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Henry Mutembei
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya.,Department of Clinical Studies, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Josphat Muema
- Washington State University Global Health - Kenya, Nairobi, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Mair Thomas
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Mumbua Mutunga
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Samuel Mwangi Thumbi
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.,Paul G Allen School for Global Animal Health, Washington State University, Pullman, USA.,Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK
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15
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Mutono N, Wright J, Mutembei H, Muema J, Thomas M, Mutunga M, Thumbi SM. The nexus between water sufficiency and water-borne diseases in cities in Africa: a scoping review protocol. AAS Open Res 2020; 3:12. [DOI: 10.12688/aasopenres.13063.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: Currently, an estimated two thirds of the world population is water insufficient. As of 2015, one out of every five people in developing countries do not have access to clean sufficient drinking water. In an attempt to share the limited resource, water has been distributed at irregular intervals in cities in developing countries. Residents in these cities seek alternative water sources to supplement the inadequate water supplied. Some of these alternative sources of water are unsafe for human consumption, leading to an increased risk in water-borne diseases. Africa contributes to 53% of the diarrheal cases reported globally, with contaminated drinking water being the main source of transmission. Water-borne diseases like diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus are a major public health concern. The main objective of this scoping review is to map the available evidence to understand the sources of water among residents in cities in Africa and the relationship between clean water sufficiency and water-borne diseases in urban Africa. Methods and analysis: The search strategy will identify studies published in scientific journals and reports that are directly relevant to African cities that have a population of more than half a million residents as of 2014 AND studies on the ten emerging water-borne diseases, which are diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus. Ethics and dissemination: This scoping review did not require any formal ethical approval. The findings will be published in a peer-reviewed journal.
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