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Owiny MO, Ngare BK, Mugo BC, Rotich J, Mutembei A, Chepkorir K, Sitawa R, Obonyo M, Onono JO. Assessment of community perceptions and risk to common zoonotic diseases among communities living at the human-livestock-wildlife interface in Nakuru West, Kenya: A participatory epidemiology approach. PLoS Negl Trop Dis 2023; 17:e0011086. [PMID: 36701376 PMCID: PMC9904458 DOI: 10.1371/journal.pntd.0011086] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/07/2023] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Zoonoses account for most of the emerging and re-emerging infections in Kenya and in other low to medium-income countries across the world. The human-livestock-wildlife interface provides a nexus where transmission and spread of these zoonotic diseases could occur among communities farming in these areas. We sought to identify perceptions of the community living near the Lake Nakuru National Park in Kenya. METHODS We used participatory epidemiology techniques (PE) involving Focus Group Discussion (FGD) among community members and Key Informant Interviews (KII) with the health, veterinary, and administration officers in July 2020. We used listing, pairwise matching, and proportional piling techniques during the FGDs in the randomly selected villages in the study area from a list of villages provided by the area government officers. Kruskal-Wallis test was used to compare the median scores between the zoonotic diseases, source of information, and response to disease occurrence. Medians with a z-score greater than 1.96 at 95% Confidence Level were considered to be significant. Content analysis was used to rank qualitative variables. RESULTS We conducted seven FGDs and four KIIs. A total of 89 participants took part in the FGDs with their ages ranging from 26 to 85 years. Common zoonotic diseases identified by participants included anthrax, rabies, and brucellosis. Anthrax was considered to have the greatest impact by the participants (median = 4, z>1.96), while 4/7 (57%) of the FGDs identified consumption of uninspected meat as a way that people can get infected with zoonotic diseases. Community Health Volunteers (Median = 28, z = 2.13) and the government veterinary officer (median = 7, z = 1.8) were the preferred sources of information during disease outbreaks. CONCLUSION The participants knew the zoonotic diseases common in the area and how the diseases can be acquired. We recommend increased involvement of the community in epidemio-surveillance of zoonotic diseases at the human-wildlife-livestock interface.
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Affiliation(s)
- Maurice Omondi Owiny
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
- * E-mail:
| | - Ben Kipchumba Ngare
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Bernard Chege Mugo
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Jacob Rotich
- Department of Health, County Government of Nakuru, Nakuru, Kenya
| | - Arithi Mutembei
- Department of Agriculture, Wajir County Government, Wajir, Kenya
| | | | - Rinah Sitawa
- Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Mark Obonyo
- Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Joshua Orungo Onono
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
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Mbai J, Njoroge S, Obonyo M, Otieno C, Owiny M, Fèvre EM. Campylobacter positivity and public health risks in live bird markets in Busia, Kenya: A value chain analysis. Transbound Emerg Dis 2022; 69:e1839-e1853. [PMID: 35293702 PMCID: PMC9790384 DOI: 10.1111/tbed.14518] [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: 05/16/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/30/2022]
Abstract
Live bird markets (LBMs) provide integral hubs for 95% of poultry produced for food. Surveillance systems in LBMs serving smallholder farmers in sub-saharan Africa are often non-functional, and data about public health risks and emerging pathogens are lacking. Studies in Kenya have reported 29-44% Campylobacter prevalence in poultry. We analysed such LBMs in Kenya for likely transmission of Campylobacter from poultry to humans. We conducted a cross-sectional survey among 186 live poultry traders (LPTs) in 14 LBMs in a region with widespread backyard poultry systems. A pretested structured questionnaire was administered to all LPTs having regular contacts with poultry to gather market data and risk information on campylobacteriosis. Campylobacter was detected in individual cloacal cultures and identified through PCR. The median score obtained from the outcome of risk assessment dichotomized respondents into high and low risk categories. We performed logistic regression at 95% confidence interval (CI) to compare market characteristics and Campylobacter positivity to risk categories to identify LBM-associated public health risks. Markets had a median of 13 traders, and mean age of 46.3 ± 13.7 years. Majority 162/186 (87.1%) were males. Market behavioural processes by LPTs varied: Only 58.6% LPTs held bird species separate; onsite slaughter (38.7%); encountered sick-bird (93%) and dead-bird (83%) amidst limited health inspection (31.2%). Campylobacter positivity in live birds was 43/112 (38.4%, 95% CI: 29.4-48.1). Risk information on campylobacteriosis was low 41/114 (36%, 95% CI: 27.2-45.5). Sanitary risks were related to accumulation of litter (adjusted prevalence odds ratio [aPOR]: 19.67, 95% CI: 3.01-128.52). Accessing hand-wash facilities (aPOR: .32, 95% CI: .13-.78) and access to information (aPOR: .24, 95% CI: .09-.61) were protective. Sanitary risks were related to poor hygiene. LBMs could be central surveillance sites for Campylobacter. Public health authorities/actors should consider appropriate targeting to improve sanitary measures and Campylobacter control strategies.
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Affiliation(s)
- Josephat Mbai
- Kenya Field Epidemiology and Laboratory Training Program, Kenyatta Hospital Grounds, Nairobi, Kenya
- International Livestock Research Institute, Nairobi, Kenya
- Government of Makueni County, Makueni, Kenya
| | - Samuel Njoroge
- International Livestock Research Institute, Nairobi, Kenya
- Kenya Medical Research Institute KEMRI, Nairobi, Kenya
| | - Mark Obonyo
- Kenya Field Epidemiology and Laboratory Training Program, Kenyatta Hospital Grounds, Nairobi, Kenya
| | | | - Maurice Owiny
- Kenya Field Epidemiology and Laboratory Training Program, Kenyatta Hospital Grounds, Nairobi, Kenya
| | - Eric M Fèvre
- International Livestock Research Institute, Nairobi, Kenya
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
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Mangesho PE, Caudell MA, Mwakapeje ER, Ole-Neselle M, Kabali E, Obonyo M, Dorado-Garcia A, Valcarce A, Kimani T, Price C, Eckford S, Fasina FO. "We are doctors": Drivers of animal health practices among Maasai pastoralists and implications for antimicrobial use and antimicrobial resistance. Prev Vet Med 2021; 188:105266. [PMID: 33517159 DOI: 10.1016/j.prevetmed.2021.105266] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 06/15/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
Animal health service providers can play an important role in limiting drug resistance by promoting responsible and prudent use of veterinary drugs. Recognizing this potential, international agencies and governments have called for these providers to receive drug stewardship training, particularly providers in low- and middle-income countries where top-down regulations (e.g., national regulation of veterinary prescriptions) are largely unfeasible. The success of these stewardship trainings to promote responsible and prudent use will depend on many factors, including understanding how livestock-keeping communities currently interact with animal health service providers. Here, we use a mixed methods approach to identify and understand animal health seeking practices among Maasai pastoralists in Tanzania. Combining qualitative interviews (N = 31) and structured surveys (N = 195), we show the majority of Maasai respondents (≈80 %) do not frequently consult animal health service providers with most relying on advice from family and friends. Logistic regression models of health seeking practices find that increasing age, education, observance of treatment failure, and herd disease burdens are associated with greater odds of seeking out health services. Quantitative results were supported by data from focus group discussions and in-depth interviews that showed Maasai view animal health service providers as measures of last resort, whose input is largely sought after self-treatment with veterinary drugs fail. We argue patterns of animal health seeking among the Maasai are partially the consequence of their high confidence in their own abilities in livestock disease and treatment and generally low confidence in the skills of animal health service providers. We link this high sense of self-efficacy to the culturally engrained process by which Maasai develop mastery in animal health and how the roles and norms in Maasai culture surrounding animal health influence Maasai perceptions of animal health professionals. Our results highlight the need for more research to understand Maasai perceptions of animal health service providers as well as the knowledge, attitudes, and practices of these providers. Finally, our study emphasizes that the success of drug stewardship trainings will require efforts to first understand the cultural and historical contexts driving health seeking practices that impact perceptions of animal health service providers and animal health practices more generally.
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Affiliation(s)
- Peter E Mangesho
- National Institute for Medical Research, Amani Medical Research Centre, P.O Box 81, Muheza, Tanzania.
| | - Mark A Caudell
- Food and Agriculture Organization of the United Nations, United Nations Complex, PO Box 30470, Nairobi, Kenya
| | - Elibariki R Mwakapeje
- Food and Agriculture Organization of the United Nations, Ali Hassan Mwinyi Rd, P.O Box 2 Dar es Salaam, Tanzania
| | - Moses Ole-Neselle
- Food and Agriculture Organization of the United Nations, Ali Hassan Mwinyi Rd, P.O Box 2 Dar es Salaam, Tanzania
| | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, 00153, Rome, Italy
| | - Mark Obonyo
- Food and Agriculture Organization of the United Nations, Tendeseka Office Park, PO Box 3730, Harare, Zimbabwe
| | | | - Antonio Valcarce
- Food and Agriculture Organization of the United Nations, 00153, Rome, Italy
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, United Nations Complex, PO Box 30470, Nairobi, Kenya
| | - Cortney Price
- Food and Agriculture Organization of the United Nations, 00153, Rome, Italy
| | - Suzanne Eckford
- Veterinary Medicines Directorate, Woodham La, Addlestone, KT15 3LS, United Kingdom
| | - Folorunso O Fasina
- Food and Agriculture Organization of the United Nations, Ali Hassan Mwinyi Rd, P.O Box 2 Dar es Salaam, Tanzania
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Mbai JM, Omolo JO, Wamamba D, Maritim D, Gura Z, Obonyo M. Assessment of knowledge, attitudes and practices towards anthrax in Narok County, Southern Kenya. Pan Afr Med J 2021; 38:120. [PMID: 33912290 PMCID: PMC8051217 DOI: 10.11604/pamj.2021.38.120.19439] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/28/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction anthrax is endemic in some parts of Kenya causing mortalities in livestock and morbidity in humans. On January 20th, 2018, news media reported suspected anthrax in a remote southern Kenyan village after villagers became ill following consumption of meat from a dead cow that was confirmed, by microscopy, to have died of anthrax. We assessed community knowledge, attitude and practices (KAP) to identify intervention gaps for anthrax prevention. Methods we conducted a KAP survey in randomly selected households (HHs) in villages from selected wards. Using multi-stage sampling approach, we administered structured questionnaire to persons aged ≥15 years to collect KAP information from February 11th-21st, 2018. From a set of questions for KAP, we scored participants’ response as “1” for a correct response and “0” for an incorrect response. Univariate analysis and Chi-square tests were performed to explore determinants of KAP. Concurrently, we gathered qualitative data using interview guides for thematic areas on anthrax KAP from key informant interviews and focus group discussions. Qualitative data were transcribed in Ms Word and analyzed along themes by content analysis. Results among 334 respondents: 187/334 (56%) were male; mean age, 40.7±13.6 years; 331/334 (99.1%) had heard of anthrax and 304/331 (91.8%) knew anthrax to be zoonotic. Transmission was considered to be through eating dead-carcasses by 273/331 (82.5%) and through contact with infected tissue by 213/331 (64.4%). About 59% (194/329) regularly vaccinated their livestock against anthrax, 53.0% (174/328) had slaughtered or skinned a dead-animal and 59.5% (195/328) practiced home slaughter while 52.9% (172/325) treated sick-animals by themselves. Sex (p≤0.001), age (p=0.007) and livestock-rearing years (p≤0.001) were significantly associated with knowledge and practice. Conclusion there were differences in knowledge and practices towards anthrax by age-group and sex. Enhanced public health education and targeted interventions by relevant government agencies is recommended.
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Affiliation(s)
- Josephat Mutiso Mbai
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Jack Owiti Omolo
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Dominic Wamamba
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Daniel Maritim
- Department of Health, County Government of Narok, Narok, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
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Roka ZG, Oyugi EO, Githuku JN, Kanyina E, Obonyo M, Omballa V, Boru WG, Ransom J. Impact Evaluation of the Kenya Frontline Field Epidemiology Training Program: Repeated-Measures Study. JMIR Med Educ 2021; 7:e18956. [PMID: 33416507 PMCID: PMC7822718 DOI: 10.2196/18956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND In 2014, Kenya's Field Epidemiology and Laboratory Training Program (FELTP) initiated a 3-month field-based frontline training, Field Epidemiology Training Program (FETP-F), for local public health workers. OBJECTIVE This study aimed to measure the effect of FETP-F on participant workplace practices regarding quality and consistency of public health data, critical interaction with public health data, and improvements in on-time reporting (OTR). METHODS Between February and April 2017, FELTP conducted a mixed methods evaluation via online survey to examine outcomes achieved among all 215 graduates from 2014 and 2015. Data quality assessment (DQA) and data consistency assessment (DCA) scores, OTR percentages, and ratings of the training experience were the quantitative measures tracked from baseline and then at 6-month intervals up to 18 months postcompletion of the training. The qualitative component consisted of semistructured face-to-face interviews and observations. Quantitative data were analyzed using descriptive statistics and one-way analysis of variance (ANOVA). Qualitative data were transcribed and analyzed to identify key themes and dimensions. RESULTS In total, 103 (47%) graduates responded to the survey. Quantitative analyses showed that the training significantly increased the mean DQA and OTR scores but there was a nonsignificant increase in mean DCA scores. Qualitative analyses found that 68% of respondents acquired new skills, 83% applied those skills to their day-to-day work, and 91% improved work methods. CONCLUSIONS FETP-F improved overall data quality and OTR at the agency level but had minimal impact on data consistency between local, county, and national public health agencies. Participants reported that they acquired practical skills that improved data collation and analysis and OTR.
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Affiliation(s)
- Zeinab Gura Roka
- Ministry of Health, Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | | | - Jane Njoki Githuku
- Ministry of Health, Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Evalyne Kanyina
- Ministry of Health, Emergency Operations Centre, Directorate of Public Health, Nairobi, Kenya
| | - Mark Obonyo
- Food and Agriculture Organization, United Nations, Subregional Office of Southern Africa, Harare, Zimbabwe
| | - Victor Omballa
- Bioreference Laboratories, Elmwood Park, NJ, United States
| | - Waqo Gufu Boru
- Ministry of Health, Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - James Ransom
- Piret Partners Consulting, Washington, DC, United States
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6
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Sitawa R, Folorunso F, Obonyo M, Apamaku M, Kiambi S, Gikonyo S, Kiptiness J, Njagi O, Githinji J, Ngoci J, VonDobschuetz S, Morzaria S, Ihab E, Gardner E, Wiersma L, Makonnen Y. Risk factors for serological evidence of MERS-CoV in camels, Kenya, 2016-2017. Prev Vet Med 2020; 185:105197. [PMID: 33186881 PMCID: PMC7605751 DOI: 10.1016/j.prevetmed.2020.105197] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 02/08/2023]
Abstract
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging viral disease and dromedary camels are known to be the source of human spill over events. A cross-sectional epidemiological surveillance study was carried out in Kenya in 2017 to, 1) estimate MERS-CoV antibody seropositivity in the camel-dense counties of Turkana, Marsabit, Isiolo, Laikipia and Nakuru to identify, and 2) determine the risk factors associated with seropositivity in camels. Blood samples were collected from a total of 1421 camels selected using a multi-stage sampling method. Data were also collected from camel owners or herders using a pre-tested structured questionnaire. The sera from camel samples were tested for the presence of circulating antibodies to MERS-CoV using the anti-MERS-CoV IgG ELISA test. Univariate and multivariable statistical analysis were used to investigate factors potentially associated with MERS-CoV seropositivity in camels. The overall seropositivity in camel sera was 62.9 %, with the highest seropositivity recorded in Isiolo County (77.7 %), and the lowest seropositivity recorded in Nakuru County (14.0 %). When risk factors for seropositivity were assessed, the "Type of camel production system" {(aOR = 5.40(95 %CI: 1.67-17.49)}, "Age between 1-2 years, 2-3 years and above 3 years" {(aOR = 1.64 (95 %CI: 1.04-2.59}", {(aOR = 3.27 (95 %CI: 3.66-5.61)}" and {(aOR = 6.12 (95 %CI: 4.04-9.30)} respectively and "Sex of camels" {(aOR = 1.75 (95 %CI: 1.27-2.41)} were identified as significant predictors of MERS-CoV seropositivity. Our studies indicate a high level of seropositivity to MERS-CoV in camels in the counties surveyed, and highlights the important risk factors associated with MERS-CoV seropositivity in camels. Given that MERS-CoV is a zoonosis, and Kenya possesses the fourth largest camel population in Africa, these findings are important to inform the development of efficient and risk-based prevention and mitigation strategies against MERS-CoV transmission to humans.
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Affiliation(s)
- Rinah Sitawa
- Food and Agriculture Organization of the United Nations (FAO), Kenya.
| | - Fasina Folorunso
- Food and Agriculture Organization of the United Nations (FAO), Tanzania
| | - Mark Obonyo
- Food and Agriculture Organization of the United Nations (FAO), Kenya
| | - Michael Apamaku
- Food and Agriculture Organization of the United Nations (FAO), Kenya
| | - Stella Kiambi
- Food and Agriculture Organization of the United Nations (FAO), Kenya
| | - Stephen Gikonyo
- Food and Agriculture Organization of the United Nations (FAO), Kenya
| | - Joshua Kiptiness
- Food and Agriculture Organization of the United Nations (FAO), Kenya
| | - Obadiah Njagi
- Ministry of Agriculture, Livestock, Fisheries and Irrigation, Kenya
| | - Jane Githinji
- Ministry of Agriculture, Livestock, Fisheries and Irrigation, Kenya
| | - James Ngoci
- Ministry of Agriculture, Livestock, Fisheries and Irrigation, Kenya
| | | | - Subhash Morzaria
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - ElMasry Ihab
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Emma Gardner
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Lidewij Wiersma
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Yilma Makonnen
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
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Mwenda V, Niyomwungere A, Oyugi E, Githuku J, Obonyo M, Gura Z. Corrigendum to: Cholera outbreak during a scientific conference at a Nairobi hotel, Kenya 2017. J Public Health (Oxf) 2020; 42:871. [DOI: 10.1093/pubmed/fdz112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Valerian Mwenda
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
| | - Alexis Niyomwungere
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
- Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya
| | - Elvis Oyugi
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
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Kigen HT, Boru W, Gura Z, Githuka G, Mulembani R, Rotich J, Abdi I, Galgalo T, Githuku J, Obonyo M, Muli R, Njeru I, Langat D, Nsubuga P, Kioko J, Lowther S. A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015. Pan Afr Med J 2020; 36:127. [PMID: 32849982 PMCID: PMC7422748 DOI: 10.11604/pamj.2020.36.127.19786] [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] [Received: 07/18/2019] [Accepted: 06/03/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. Methods we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli. Results during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). Conclusion we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.
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Affiliation(s)
- Hudson Taabukk Kigen
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Waqo Boru
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Zeinab Gura
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - George Githuka
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Robert Mulembani
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Jacob Rotich
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Isack Abdi
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Tura Galgalo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.,African Field Epidemiology Network, Nairobi, Kenya
| | - Jane Githuku
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Raphael Muli
- Department of Health, County Government of Nairobi, Nairobi, Kenya
| | - Ian Njeru
- Ministry of Health, Nairobi, Kenya.,Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | - Daniel Langat
- Ministry of Health, Nairobi, Kenya.,Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | | | | | - Sara Lowther
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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9
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Gudu E, Obonyo M, Omballa V, Oyugi E, Kiilu C, Githuku J, Gura Z, Ransom J. Factors associated with malnutrition in children < 5 years in western Kenya: a hospital-based unmatched case control study. BMC Nutr 2020; 6:33. [PMID: 32742713 PMCID: PMC7389647 DOI: 10.1186/s40795-020-00357-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/09/2019] [Accepted: 06/18/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Globally, under-nutrition accounts for > 3 million deaths annually among children < 5 years, with Kenya having ~ 35,000 deaths. This study aimed to identify factors associated with malnutrition in children aged < 5 years in western Kenya. METHODS We conducted a hospital-based unmatched case-control study between May and June 2017. Cases were defined as children aged 6-59 months with either z-score for weight-for-height ≤ -2SD or ≥ +2SD; weight-for-age ≤ -2SD or ≥ +2SD; or height-for-age ≤ -2SD. Controls were children aged 6-59 months with age-appropriate anthropometric measurements. Cases were consecutively recruited while systematic random sampling was used to select controls. Data from interviews and clinical records were collected and entered into Epi-Info, which was used to run unconditional logistic regression analyses. RESULTS A total of 94 cases and 281 controls were recruited. Of the cases, 84% (79/94) were under-nourished. Mother not having attended ante-natal clinic (OR = 7.9; 95% CI: 1.5-41.2), deworming (OR = 0.8; 95% CI: 0.4-1.2), and pre-lacteal feeding (OR = 1.8; 95% CI: 1.1-3.0) were associated with under-nutrition. Delayed developmental milestones (AOR = 13.9; 95% CI: 2.8-68.6); low birth weight (AOR = 3.3; 95% CI: 1.4-7.6), and paternal lack of formal education (AOR = 4.9; 95% CI: 1.3-18.9) were independently associated with under-nutrition. CONCLUSION Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition.
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Affiliation(s)
- Edwin Gudu
- Ministry of Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Ministry of Health, Field Epidemiology & Laboratory Training Program, Nairobi, Kenya
| | - Mark Obonyo
- Ministry of Health, Field Epidemiology & Laboratory Training Program, Nairobi, Kenya
| | - Victor Omballa
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elvis Oyugi
- Ministry of Health, Field Epidemiology & Laboratory Training Program, Nairobi, Kenya
| | - Cecilia Kiilu
- West Pokot County Health Department, Kapenguria, West Pokot Kenya
| | - Jane Githuku
- Ministry of Health, Field Epidemiology & Laboratory Training Program, Nairobi, Kenya
| | - Zeinab Gura
- Ministry of Health, Division for Human Resource for Health Development, Nairobi, Kenya
| | - James Ransom
- Piret Partners Consulting, 611 Pennsylvania Avenue SE, Unit 358, Washington, DC 20003 USA
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Ongaki D, Obonyo M, Nyanga N, Ransom J. Factors Affecting Uptake of PMTCT Services, Lodwar County Referral Hospital, Turkana County, Kenya, 2015 to 2016. J Int Assoc Provid AIDS Care 2020; 18:2325958219838830. [PMID: 30931683 PMCID: PMC6748522 DOI: 10.1177/2325958219838830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Kenya is one of 22 countries globally that account for 90% of all HIV-positive pregnant women. This study aimed to determine factors affecting uptake of prevention of mother-to-child transmission (PMTCT) services among HIV-positive pregnant women at Lodwar County Referral Hospital in Turkana County, an arid area in northern Kenya. We conducted a retrospective review of HIV-positive pregnant women attending antenatal care (ANC) and accessing PMTCT services between January 2015 and December 2016. We used infant prophylaxis as a proxy measure of PMTCT uptake, and records across programs were linked using the mother's unique medical identification number. A total of 230 participants were included in the study. Bivariate analyses showed maternal prophylaxis (odds ratio [OR] = 45.71; 95% confidence interval [CI]: 10.35-202.00), residing in urban center (OR = 2.64, 95% CI: 1.45-4.81), and having at least one ANC visit (OR = 2.78; 95% CI: 1.25-6.17) were significantly associated with uptake of PMTCT.
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Affiliation(s)
- Dominic Ongaki
- 1 Lodwar County Referral Hospital, Lodwar, Turkana County, Kenya.,2 Turkana County Health Department, Lodwar, Turkana County, Kenya
| | - Mark Obonyo
- 3 Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Nancy Nyanga
- 1 Lodwar County Referral Hospital, Lodwar, Turkana County, Kenya
| | - James Ransom
- 3 Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya.,4 Piret Partners Consulting, Research & Evaluation, Washington, DC, USA
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11
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Orimbo EO, Oyugi E, Dulacha D, Obonyo M, Hussein A, Githuku J, Owiny M, Gura Z. Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: A mixed-methods approach. PLoS One 2020; 15:e0229437. [PMID: 32101587 PMCID: PMC7043758 DOI: 10.1371/journal.pone.0229437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 02/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cholera remains a public health problem in Kenya despite increased efforts to create awareness. Assessment of knowledge, attitude and practice (KAP) in the community is essential for the planning and implementation of preventive measures. We assessed cholera KAP in a community in Isiolo County, Kenya. METHODS This cross-sectional study involved a mixed-methods approach utilizing a questionnaire survey and focus group discussions (FGDs). Using multistage sampling with household as the secondary sampling unit, interviewers administered structured questionnaires to one respondent aged ≥18 years old per household. We created knowledge score by allotting one point for each correct response, considered any total score ≥ median score as high knowledge score, calculated descriptive statistics and used multivariate logistic regression to examine factors associated with high knowledge score. In FGDs, we randomly selected the participants aged ≥18 years and had lived in Isiolo for >1 year, conducted the FGDs using an interview guide and used content analysis to identify salient emerging themes. RESULTS We interviewed 428 participants (median age = 30 years; Q1 = 25, Q3 = 38) comprising 372 (86.9%) females. Of the 425/428 (99.3%) who had heard about cholera, 311/425 (73.2%) knew that it is communicable. Although 273/428 (63.8%) respondents knew the importance of treating drinking water, only 216/421 (51.3%) treated drinking water. Those with good defecation practice were 209/428 (48.8%). Respondents with high knowledge score were 227/428 (53.0%). Positive attitude (aOR = 2.88, 95% C.I = 1.34-6.20), treating drinking water (aOR = 2.21, 95% C.I = 1.47-3.33), age <36 years (aOR = 1.75, 95% C.I = 1.11-2.74) and formal education (aOR = 1.71, 95% C.I = 1.08-2.68) were independently associated with high knowledge score. FGDs showed poor latrine coverage, inadequate water treatment and socio-cultural beliefs as barriers to cholera prevention and control. CONCLUSIONS There was a high knowledge score on cholera with gaps in preventive practices. We recommend targeted health education to the old and uneducated persons and general strengthening of health education in the community.
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Affiliation(s)
- Erick Otieno Orimbo
- Field Epidemiology and Laboratory Training (FELTP) Kenya, Ministry of Health, Nairobi, Kenya
- County Government of Migori, Migori, Kenya
| | - Elvis Oyugi
- Field Epidemiology and Laboratory Training (FELTP) Kenya, Ministry of Health, Nairobi, Kenya
| | - Diba Dulacha
- Field Epidemiology and Laboratory Training (FELTP) Kenya, Ministry of Health, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training (FELTP) Kenya, Ministry of Health, Nairobi, Kenya
| | - Abubakar Hussein
- Field Epidemiology and Laboratory Training (FELTP) Kenya, Ministry of Health, Nairobi, Kenya
- Department of Health, County Government of Isiolo, Isiolo, Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training (FELTP) Kenya, Ministry of Health, Nairobi, Kenya
| | - Maurice Owiny
- Field Epidemiology and Laboratory Training (FELTP) Kenya, Ministry of Health, Nairobi, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training (FELTP) Kenya, Ministry of Health, Nairobi, Kenya
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12
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Ngere I, Gufu Boru W, Isack A, Muiruri J, Obonyo M, Matendechero S, Gura Z. Burden and risk factors of cutaneous leishmaniasis in a peri-urban settlement in Kenya, 2016. PLoS One 2020; 15:e0227697. [PMID: 31971945 PMCID: PMC6977748 DOI: 10.1371/journal.pone.0227697] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Cutaneous leishmaniasis is a neglected disease known to cause significant morbidity among the poor. We investigated a suspected outbreak to determine the magnitude of cases, characterize the cases and identify risk factors of cutaneous leishmaniasis in Gilgil, a peri-urban settlement in Central Kenya. Methods Hospital records for the period 2010–2016 were reviewed and additional cases were identified through active case search. Clinical diagnosis of cutaneous leishmaniasis was made based on presence of ulcerative, nodular or papular skin lesion. The study enrolled 58 cases matched by age and neighbourhood to 116 controls in a case control study. Data was collected using structured questionnaires and simple proportions, means and medians were computed, and logistic regression models were constructed for analysis of individual, indoor and outdoor risk factors. Results Of the 255 suspected cases of cutaneous leishmaniasis identified, females constituted 56% (142/255) and the median age was 7 years (IQR 7–21). Cases occurred in clusters and up to 43% of cases originated from Gitare (73/255) and Kambi-Turkana (36/255) villages. A continuous transmission pattern was depicted throughout the period under review. Individual risk factors included staying outside the residence in the evening after sunset (OR 4.1, CI 1.2–16.2) and visiting forests (OR 4.56, CI 2.04–10.22). Sharing residence with a case (OR 14.4, CI 3.8–79.3), residing in a thatched house (OR 7.9, CI 1.9–45.7) and cracked walls (OR 2.3, CI 1.0–4.9) were identified among indoor factors while sighting rock hyraxes near residence (OR 5.3, CI 2.2–12.7), residing near a forest (OR 7.8, CI 2.8–26.4) and having a close neighbour with cutaneous leishmaniasis (OR 6.8, CI 2.8–16.0) were identified among outdoor factors. Conclusions We identify a large burden of cutaneous leishmaniasis in Gilgil with evidence of individual, indoor and outdoor factors of disease spread. The role of environmental factors and rodents in disease transmission should be investigated further
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Affiliation(s)
- Isaac Ngere
- Global Health Program-Kenya, Washington State University, Nairobi, Kenya
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
- * E-mail:
| | - Waqo Gufu Boru
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
- Ministry of Health, Nairobi, Republic of Kenya
| | - Abdikadir Isack
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
- Ministry of Health, Nairobi, Republic of Kenya
| | - Joshua Muiruri
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
- Ministry of Health, Nairobi, Republic of Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
- Ministry of Health, Nairobi, Republic of Kenya
| | | | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
- Ministry of Health, Nairobi, Republic of Kenya
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13
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Ngugi JN, Fèvre EM, Mgode GF, Obonyo M, Mhamphi GG, Otieno CA, Cook EAJ. Seroprevalence and associated risk factors of leptospirosis in slaughter pigs; a neglected public health risk, western Kenya. BMC Vet Res 2019; 15:403. [PMID: 31703588 PMCID: PMC6842184 DOI: 10.1186/s12917-019-2159-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 06/26/2019] [Accepted: 10/28/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Leptospirosis is a neglected zoonosis of public health importance transmitted through contact with contaminated soil, water or urine of infected animals. In pigs the disease is characterized by abortion, still births and weak piglets. A cross-sectional study was conducted in May to July 2018 to estimate the sero-prevalence of leptospirosis and factors associated with seropositivity in slaughter pigs. A questionnaire was used to collect information on animal demographics. Serum was tested for anti-leptospiral antibodies using microscopic agglutination test (MAT) with a panel of 8 serovars. Sera were considered positive for sero-reactivity at a MAT titre ≥1:40 against at least one serovar. Chi-square tests were used to measure the strength of association between the MAT test result and exploratory variables. RESULTS A total of 252 pig serum samples from seven slaughterhouses were tested for Leptospira antibodies by MAT. Of the 252 pigs sampled, 88.8% (244/252) were indigenous breeds; 55.6% (140/252) were female and 88.7% (220/252) were reared in extensive production systems. Eighty-three (32.9%; 83/252) sera samples tested positive on MAT against at least one serovar. Of the 8 serovars, the highest prevalence was recorded for serovar Lora 21.4% followed by Kenya 5.2%, Sokoine 3.6% and Grippotyphosa at 3.2%. Risk factors for leptospirosis seropositivity in pigs were: originating from farms with other types of livestock (OR 2.3; 95% CI 1.0-4.5) and mature pigs (OR 1.9; 95% CI 1.1-3.3). CONCLUSION This study demonstrates that there is a high prevalence of leptospirosis positive pigs at slaughter in a small-holder livestock keeping region of the Lake Victoria basin. The potential for cross species transmission of pathogenic serovars is highlighted as well as the potential for occupational exposure to slaughterhouse personnel. Improvements in husbandry practices (confinement and rodent control) and public health education among slaughterhouse workers and other high-risk groups is recommended.
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Affiliation(s)
- Jeremiah N Ngugi
- Field Epidemiology and Laboratory Training Program, Kenyatta National Hospital, P.O. Box 22313, Nairobi, 00100, Kenya. .,County Government of Taita Taveta, P.O. Box 1066-80304, Wundanyi, Kenya.
| | - Eric M Fèvre
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709, Nairobi, 00100, Kenya.,Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - Georgies F Mgode
- Pest Management Centre, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Kenyatta National Hospital, P.O. Box 22313, Nairobi, 00100, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Directorate of Veterinary Services, Nairobi, Kenya
| | - Ginethon G Mhamphi
- Pest Management Centre, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | - Elizabeth Anne Jessie Cook
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709, Nairobi, 00100, Kenya. .,Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK.
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14
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Mwenda V, Niyomwungere A, Oyugi E, Githuku J, Obonyo M, Gura Z. Cholera outbreak during a scientific conference at a Nairobi hotel, Kenya 2017. J Public Health (Oxf) 2019; 43:e140-e144. [DOI: 10.1093/pubmed/fdz078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cholera globally affects 1.3–4.0 million people and causes 21 000–143 000 deaths annually. In June 2017, a cluster of diarrhoeal illness occurred among participants of an international scientific conference at a hotel in Nairobi, Kenya. Culture confirmed Vibrio cholerae, serotype Ogawa. We investigated to assess magnitude, identify likely exposures and suggest control measures.
Methods
We carried out a retrospective cohort study utilizing a structured questionnaire administered by telephone, email and internet-based survey. We calculated food-specific attack rates, risk ratios and in a nested-case control analysis, performed logistic regression to identify exposures independently associated with the outbreak.
Results
We interviewed 249 out of 456 conference attendees (response rate=54.6%). Mean age of respondents was 37.8 years, ±8.3 years, 131 (52.6%) were male. Of all the respondents, 137 (55.0%) were cases. Median incubation time was 35 (11–59) hours. Eating chicken (adjusted OR 2.49, 95% CI, 1.22–5.06) and having eaten lunch on Tuesday (adjusted OR 2.34, 95% CI 1.09–5.05) were independently associated with illness; drinking soda was protective (adjusted OR 0.17, 95% CI 0.07–0.42).
Conclusion
Point source outbreak, associated with chicken eaten at lunch on Tuesday 20th June 2017 occurred. We recommend better collaboration between the food and health sectors in food-borne outbreak investigations.
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Affiliation(s)
- Valerian Mwenda
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
| | - Alexis Niyomwungere
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
- Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya
| | - Elvis Oyugi
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya
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15
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Oyugi EO, Boru W, Obonyo M, Githuku J, Onyango D, Wandeba A, Omesa E, Mwangi T, Kigen H, Muiruri J, Gura Z. An outbreak of cholera in western Kenya, 2015: a case control study. Pan Afr Med J 2018; 28:12. [PMID: 30167037 PMCID: PMC6113693 DOI: 10.11604/pamj.supp.2017.28.1.9477] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/03/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction in February 2015, an outbreak of acute watery diarrhea was reported in two sub counties in western Kenya. Vibrio cholerae 01 serotype Ogawa was isolated from 26 cases and from water samples collected from a river mainly used by residents of the two sub-counties for domestic purposes. We carried out an investigation to determine factors associated with the outbreak. Methods we conducted a frequency matched case control study in the community. We defined cases as episodes of watery diarrhea (at least three motions in 24 hours) in persons ≥ 2 years who were residents of Rongo or Ndhiwa sub-counties from January 23-February 25, 2015. Cases were systematically recruited from a cholera line list and matched to two controls (persons without diarrhea since January 23, 2015) by age category and residence. A structured questionnaire was administered to evaluate exposures in cases and controls and multivariable logistic regression done to determine independent factors associated with the outbreak. Results we recruited 52 cases and 104 controls. Females constituted 61% (95/156) of all participants. Overall latrine coverage was 58% (90/156). Latrine coverage was 44% (23/52) for cases and 64% (67/104) for controls. Having no latrine at home (aOR = 10.9; 95% CI: 3.02-39.21), practicing communal hand washing in a basin (aOR = 6.5; 95% CI: 2.30-18.11) and vending of food as an occupation (aOR = 3.4; 95% CI: 1.06-10.74) were independently associated with the outbreak. Conclusion poor latrine coverage and personal hygiene practices were identified as the main drivers of the outbreak. We recommended improved public health education on latrine usage and promotion of hand washing with soap and water in the community.
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Affiliation(s)
- Elvis O Oyugi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Waqo Boru
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Dickens Onyango
- Kisumu County Department of Health, Ministry of Health, Kenya
| | - Alfred Wandeba
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Eunice Omesa
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Tabitha Mwangi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Hudson Kigen
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Joshua Muiruri
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
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16
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Golicha Q, Shetty S, Nasiblov O, Hussein A, Wainaina E, Obonyo M, Macharia D, Musyoka RN, Abdille H, Ope M, Joseph R, Kabugi W, Kiogora J, Said M, Boru W, Galgalo T, Lowther SA, Juma B, Mugoh R, Wamola N, Onyango C, Gura Z, Widdowson MA, DeCock KM, Burton JW. Cholera Outbreak in Dadaab Refugee Camp, Kenya - November 2015-June 2016. MMWR Morb Mortal Wkly Rep 2018; 67:958-961. [PMID: 30161101 PMCID: PMC6124821 DOI: 10.15585/mmwr.mm6734a4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dadaab Refugee camp in Garissa County, Kenya, hosts nearly 340,000 refugees in five subcamps (Dagahaley, Hagadera, Ifo, Ifo2, and Kambioos) (1). On November 18 and 19, 2015, during an ongoing national cholera outbreak (2), two camp residents were evaluated for acute watery diarrhea (three or more stools in ≤24 hours); Vibrio cholerae serogroup O1 serotype Ogawa was isolated from stool specimens collected from both patients. Within 1 week of the report of index cases, an additional 45 cases of acute watery diarrhea were reported. The United Nations High Commissioner for Refugees and their health-sector partners coordinated the cholera response, community outreach and water, sanitation, and hygiene (WASH) activities; Médecins Sans Frontiéres and the International Rescue Committee were involved in management of cholera treatment centers; CDC performed laboratory confirmation of cases and undertook GIS mapping and postoutbreak response assessment; and the Garissa County Government and the Kenya Ministry of Health conducted a case-control study. To prevent future cholera outbreaks, improvements to WASH and enhanced disease surveillance systems in Dadaab camp and the surrounding area are needed.
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Ngugi JN, Maza AK, Omolo OJ, Obonyo M. Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011-2016. BMC Public Health 2018; 18:996. [PMID: 30092769 PMCID: PMC6085719 DOI: 10.1186/s12889-018-5888-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 10/12/2017] [Accepted: 07/25/2018] [Indexed: 11/29/2022] Open
Abstract
Background Human animal-bite injuries are a serious public health problem due to associated risk for rabies virus exposure. Animal-bite injuries especially dog bites are useful indicators for assessing the risk of rabies virus transmission and need for rabies post exposure prophylaxis (PEP). Understanding the epidemiology and surveillance of animal bites and rabies post-exposure prophylaxis is critical in implementing Kenya’s national rabies elimination strategy. We aimed to describe the incidence of human animal-bite injuries, patient/biting animal characteristics, uptake of rabies PEP and factors associated with animal bite incidents. Methods We reviewed animal bite records from outpatient and anti-rabies vaccine (ARV) registers of 17 health facilities from five counties. An animal bite was defined as an entry of an animal bite of the class mammal including humans in registers in a person of any age from January 2011 to December 2016. We collected demographic and information on PEP uptake. We calculated descriptive statistics, odds ratios (OR) and 95% confidence interval (CI) to examine factors associated with being an animal bite case-patient. We also calculated incidence of animal bites using health facility catchment population for year 2016 as the denominator. Results We analyzed 7307 records. The median age was 22 years (IQR = 31 years); there were 4019 (55%) male and age < 15 years were 2607 (37%). Dogs accounted for 6720 (93%) of bites of which 78% were owned free-roaming dogs. Of the 5674 (88%) cases that received rabies PEP, 2247 (40%) got at least three-doses. The median time from bite to seeking medical care was 2 days (IQR = 4 days). Being bitten on the head/face (OR = 5.8; CI: 3.3–10.2); being bitten by owned free-roaming dog (OR = 1.7; CI: 1.5–1.9) and being male (OR = 1.4; CI: 1.3–1.5) were significantly associated with being an animal-bite case-patient. Being male, being bitten on head/face and being bitten by owned free-roaming dog remained independently associated with being an animal bite case-patient at multivariable logistic regression. Bite-incidence was 289 bites /100,000 persons among all counties. Conclusion Preventing dog bites would most effectively reduce bite injuries by improving public health education among children below 15 years, encouraging early PEP initiation and completion, development and implementation of responsible dog ownership and animal behaviour educational programmes as well as improving human and veterinary health linkages. Electronic supplementary material The online version of this article (10.1186/s12889-018-5888-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeremiah Ngurimu Ngugi
- Kenya Field epidemiology and Laboratory Training Program, Nairobi, Kenya. .,Department of Veterinary Services, County Government of Taita Taveta, Taveta, Kenya.
| | | | - Owiti Jack Omolo
- Kenya Field epidemiology and Laboratory Training Program, Nairobi, Kenya.,Department of Veterinary Services, County Government of Kilifi, Kilifi, Kenya
| | - Mark Obonyo
- Kenya Field epidemiology and Laboratory Training Program, Nairobi, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Directorate of Veterinary Services, Nairobi, Kenya
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18
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Curran KG, Wells E, Crowe SJ, Narra R, Oremo J, Boru W, Githuku J, Obonyo M, De Cock KM, Montgomery JM, Makayotto L, Langat D, Lowther SA, O'Reilly C, Gura Z, Kioko J. Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015. BMC Public Health 2018; 18:723. [PMID: 29890963 PMCID: PMC5996545 DOI: 10.1186/s12889-018-5584-5] [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: 09/23/2017] [Accepted: 05/22/2018] [Indexed: 11/26/2022] Open
Abstract
Background From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya’s 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June–July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers’ (HCW) experiences during outbreak response. Methods Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns. Results Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs’ personal passion to help others. Conclusions The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans.
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Affiliation(s)
- Kathryn G Curran
- US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA, 30329, USA.
| | - Emma Wells
- US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA, 30329, USA
| | - Samuel J Crowe
- US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA, 30329, USA
| | - Rupa Narra
- US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA, 30329, USA
| | | | - Waqo Boru
- Ministry of Health, Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Jane Githuku
- Ministry of Health, Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Mark Obonyo
- Ministry of Health, Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Kevin M De Cock
- US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA, 30329, USA.,US Centers for Disease Control and Prevention , Nairobi, Kenya
| | - Joel M Montgomery
- US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA, 30329, USA.,US Centers for Disease Control and Prevention , Nairobi, Kenya
| | - Lyndah Makayotto
- Ministry of Health, Disease Surveillance and Response Unit, Nairobi, Kenya
| | - Daniel Langat
- Ministry of Health, Disease Surveillance and Response Unit, Nairobi, Kenya
| | - Sara A Lowther
- US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA, 30329, USA.,US Centers for Disease Control and Prevention , Nairobi, Kenya
| | - Ciara O'Reilly
- US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA, 30329, USA
| | - Zeinab Gura
- Ministry of Health, Kenya Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Jackson Kioko
- Ministry of Health, Department of Preventive and Promotive Health, Nairobi, Kenya
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Abstract
The first laboratory confirmed dengue outbreak in Kenya was reported in coastal towns of Malindi and Kilifi in 1982. Since then, no other outbreak had been confirmed in Kenya. Dengue outbreak was confirmed among African Mission soldiers in Somalia (AMISOM) between May to October 2011. From September 2011, an upsurge of febrile patients who were negative for malaria on microscopy were reported in several health facilities in Mandera town, an adjacent area to Somalia in northern Kenya. We investigated a suspected dengue outbreak in Mandera town from 26th September 2011 to 5th October 2011. A suspected case was defined as acute onset of fever with two or more of the following: headache, arthralgia, myalgia, rash and hemorrhages and negative malaria microscopy results in a person presenting to a health facility in Mandera town from 1st August to 2nd October 2011. We prospectively identified new cases meeting the suspect case definition from 2nd October to 5th October 2011 and we collected blood samples from consenting patients. Blood was collected into plastic vacutainers and stored in dry shipper at -80oc to laboratory for dengue virus testing using real time reverse transcriptase polymerase chain reaction (rRT-PCR). We administered a standardized form to obtain clinical information. We calculated descriptive statistics to describe the outbreak. A total of 1,332 patients had been line listed by the district surveillance team, of which 381 (29%) met our suspect case definition of dengue. Cases peaked between 10th September and 1st October 2011 and thereafter declined. We prospectively identified 33 cases meeting the suspect case definition, of whom 30 (91%) were positive for dengue virus serotype 3 by PCR. Among the 30 laboratory confirmed patients, 20 (67%) required hospitalization (Median hospitalization period, two days with a range: 1-4 days)). And of these, 26 (86%) patients reported aches and pain, 16 (53%) reported vomiting, and four (13%) gingival bleeding. Twenty-three (77%) received anti-malarial therapy. Among laboratory-confirmed dengue patients, seven (23%) had malaria co-infection. This was the second confirmed Dengue outbreak in Kenya, and highlighted the need for improved surveillance to better define disease burden and continuous education to medical personnel to improve detection and clinical management. We also recommended enhanced community education for disease prevention.
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Affiliation(s)
- Mark Obonyo
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Public Health and Sanitation, Nairobi, Kenya
- * E-mail:
| | - Ahmed Fidhow
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Victor Ofula
- Arbovirology/Viral Hemorrhagic Fever Laboratory, Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
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Wamamba D, Onyango D, Oyugi E, Kanyina E, Obonyo M, Githuku J, Ransom J. Transfusion Transmissible Infections Among Walk-In Blood Donors at Kisumu Regional Blood Transfusion Centre, Kisumu County, Kenya, 2015. Lab Med 2018; 48:362-366. [PMID: 29036415 DOI: 10.1093/labmed/lmx059] [Citation(s) in RCA: 7] [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] [Indexed: 11/13/2022] Open
Abstract
Background Transfusion transmissible infections (TTIs) are threats to blood safety. This study investigated TTIs among volunteer blood donors at the Kisumu Regional Blood Transfusion Centre (KRBTC) in Kenya. Methods We performed a retrospective record review of blood donor registers at KRBTC, 2015. Walk-in donors accepted for donation were analyzed to determine prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV), hepatitis C (HCV), and syphilis. Descriptive and associative statistics were calculated using Microsoft Excel and Open-Epi software. Results The records of a total of 3690 walk-in donors were reviewed, and 2046 were included in the analysis. Mean age was 30 ± 9.6 years, 76% male, 51% married, and 80% were Kisumu residents. Seroprevalence of HIV, HBV, HCV, and syphilis was 2.4%, 3.1%, 2.3%, and 1%, respectively. Conclusions HBV was the most common TTI among the volunteers. KRBTC should be proactive and address issues of donor self-exclusion, strict adherence to donor selection criteria, and vaccination.
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Affiliation(s)
- Dominic Wamamba
- Kisumu County Health Department, Kisumu, Kenya.,Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | | | - Elvis Oyugi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Evalyne Kanyina
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
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21
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Ogendo A, Obonyo M, Wasswa P, Bitek A, Mbugua A, Thumbi SM. Cryptosporidium infection in calves and the environment in Asembo, Western Kenya: 2015. Pan Afr Med J 2017; 28:9. [PMID: 30167034 PMCID: PMC6113697 DOI: 10.11604/pamj.supp.2017.28.1.9313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 03/12/2016] [Accepted: 09/16/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction Cryptosporidium species, a zoonotic enteric coccidian parasite, is among the leading causes of diarrhea in children. We evaluated the prevalence of Cryptosporidium infections in calves, factors associated with calf infection, environmental contamination of manure by Cryptosporidium and factors that expose humans to zoonotic transmission in Asembo. Methods in a cross-sectional study conducted from January to July 2015, we collected fecal specimens from 350 randomly selected calves aged ≤ 6 months old and 187 manure samples from the same farms. We assessed farmers’ knowledge about Cryptosporidium and collected data on characteristics using structured questionnaires. Modified Ziehl Nielsen staining was used to detect Cryptosporidium oocysts from calves’ stool and manure. The prevalence of infected calves and 95% confidence interval (CI) were calculated. Odds ratios (OR) and 95% (CI) were calculated to identify possible factors associated with Cryptosporidium infection; multivariable logistic regression performed to identify factors independently associated with the presence of Cryptosporidium. Results calves’ fecal Cryptosporidium prevalence was 8.3% (95% CI: 5.7-11.8) and 7.5% (95% CI: 4.2-12.2) in manure. Odds of infection was higher in calves with loose stool compared to those with normal stool (AOR = 6.1, 95% C.I: 2.2-16.9), calves ≤ 2 months old compared to older calves (AOR=12.7, 95% C.I: 4.5-35.8) and calves in poor sanitation compared to calves in good hygienic conditions (AOR = 9.9, 95% C.I: 3.1-30.7). Conclusion presence of Cryptosporidium species in calves and environment and reported human contact with animals increases zoonotic risk. We recommend further studies that determine specific Cryptosporidium species infecting animals and humans which would better estimate risk of disease transmission to humans.
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Affiliation(s)
- Allan Ogendo
- Jomo Kenyatta University of Agriculture and Technology, College of Health Sciences, Kenya.,Ministry of Health, Kenya Field Epidemiology and Laboratory Training Program, Kenya
| | - Mark Obonyo
- Ministry of Health, Kenya Field Epidemiology and Laboratory Training Program, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Directorate of Veterinary Services, Kenya
| | - Peter Wasswa
- African Field Epidemiology Network, Kampala, Uganda
| | - Austine Bitek
- Ministry of Agriculture, Livestock and Fisheries, Directorate of Veterinary Services, Kenya.,Kenya Zoonotic Disease Unit, Kenya
| | - Amos Mbugua
- Jomo Kenyatta University of Agriculture and Technology, College of Health Sciences, Kenya
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Ondieki GK, Ombui JN, Obonyo M, Gura Z, Githuku J, Orinde AB, Gikunju JK. Antimicrobial residues and compositional quality of informally marketed raw cow milk, Lamu West Sub-County, Kenya, 2015. Pan Afr Med J 2017; 28:5. [PMID: 30197734 PMCID: PMC6125110 DOI: 10.11604/pamj.supp.2017.28.1.9279] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/06/2016] [Accepted: 01/19/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction unadulterated milk, free of antimicrobial residues is important for industrial processing and consumers’ health. Antimicrobial residues in foods of animal origin can cause adverse public health effects like drug resistance and hypersensitivity. Milk produced in Lamu West sub-county is sold raw directly to consumers. We estimated the compositional quality and prevalence of antimicrobial residues in informally marketed raw cow milk in Lamu West Sub-County, Kenya. Methods we randomly recruited 152 vendors and 207 farmers from four randomly selected urban centers in a cross-sectional study and interviewed them using a pretested standardized questionnaire. A100-ml raw milk sample was aseptically collected from each vendor and farm and tested for antimicrobial residues using Charm Blue Yellow II kit following the European Union Maximum Residue Limits (EU-MRLs) while an Ekomilk® Analyzer was used to measure compositional quality where samples with either solid not fat (SNF) < 8.5 or added water ≥ 0.01% or both were considered adulterated. We analyzed data using univariate analysis and unconditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI). Results thirty-two of the 207 (15.5%) samples from farmers and 28 (18.4%) of the 152 samples from vendors tested positive for antimicrobial residues. Thirty-six (17.4 %) samples from farmers and 38 (25.0%) from vendors were found to be adulterated with water. Farmers’ awareness of the danger of consuming milk with antimicrobial residues and farmers having training on good milking practices were protective against selling milk with antimicrobial residues (adjusted OR and 95% CI 0.20, 0.07-0.55 and 0.33, 0.11-0.99, respectively). Conclusion the antimicrobial residues above EU MRLs and adulteration of raw marketed cow milk observed in this study provide evidence for routine testing of marketed milk and educating farmers to observe antimicrobial withdrawal period.
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Affiliation(s)
- George Kiage Ondieki
- Field Epidemiology and Laboratory Training Program Kenya (K-FELTP), Kenya.,Jomo Kenyatta University of Agriculture and Technology, Institute of Tropical Medicine and Infectious Diseases (ITROMID), Department of Medical Laboratory Science, Kenya
| | - Jackson Nyarongi Ombui
- Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program Kenya (K-FELTP), Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program Kenya (K-FELTP), Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Program Kenya (K-FELTP), Kenya
| | - Austine Bitek Orinde
- Zoonotic Disease Unit, Ministry of Agriculture, Livestock Development and Fisheries, Kenya
| | - Joseph Kangangi Gikunju
- Jomo Kenyatta University of Agriculture and Technology, Institute of Tropical Medicine and Infectious Diseases (ITROMID), Department of Medical Laboratory Science, Kenya
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Mwatondo A, Munyua P, Gura Z, Muturi M, Osoro E, Obonyo M, Bitek A, Oyas H, Mbabu M, Kioko J, Njenga K, Lowther S, Thumbi SM. Catalysts for implementation of One Health in Kenya. Pan Afr Med J 2017; 28:1. [PMID: 30167029 PMCID: PMC6113684 DOI: 10.11604/pamj.supp.2017.28.1.13275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 11/27/2022] Open
Abstract
The recent Zika outbreak in the Americas, Ebola epidemic in West Africa and the increased frequency and impact of emerging and re-emerging infections of animal origin have increased the calls for greater preparedness in early detection and responses to public health events. One-Health approaches that emphasize collaborations between human health, animal health and environmental health sectors for the prevention, early detection and response to disease outbreaks have been hailed as a key strategy. Here we highlight three main efforts that have progressed the implementation of One Health in Kenya.
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Affiliation(s)
| | - Peninah Munyua
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Eric Osoro
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Austine Bitek
- Zoonotic Disease Unit, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Harry Oyas
- Veterinary Epidemiology and Economics Unit, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Murithi Mbabu
- Disease Surveillance, Vector and Zoological Services, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Jackson Kioko
- Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Centers for Global Health Research, Kenya Medical Research Institute, Kenya
| | - Sara Lowther
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Samuel Mwangi Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Centers for Global Health Research, Kenya Medical Research Institute, Kenya
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Muema J, Thumbi SM, Obonyo M, Wanyoike S, Nanyingi M, Osoro E, Bitek A, Karanja S. Seroprevalence and Factors Associated with Coxiella burnetii Infection in Small Ruminants in Baringo County, Kenya. Zoonoses Public Health 2017; 64:e31-e43. [PMID: 28117947 DOI: 10.1111/zph.12342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 02/04/2016] [Indexed: 01/06/2023]
Abstract
To improve estimates of C. burnetii epidemiology in Kenya, a survey was undertaken in small ruminants in Baringo County, where acute cases of Q fever in humans had been reported in 2014. From 140 household herds selected, 508 (60.5%) goats and 332 (39.5%) sheep were included and an indirect ELISA assay for C. burnetii IgG antibodies performed. In addition, epidemiological information at both herd and animal level was collected. Generalized mixed-effects multivariable logistic model using herd as the random effect was used to determine variables correlated to the outcome. Overall seroprevalence was 20.5% (95% CI: 17.8%, 23.3%). Goats had 26.0% (95% CI: 22.2%, 30.0%) compared to sheep 12.2% (95% CI: 8.7%, 16.0%). Nomadic pastoralism, goats and older animals (>1 year) were associated with greater risk of C. burnetii seropositivity (P = ≤0.05). Heterogeneity in C. burnetii seropositivity was observed across the sublocations (P = 0.028). Evidence of C. burnetii exposure in small ruminants revealed poses a potential risk of exposure to the people living in close proximity to the animals. We recommended integrated animal-human surveillance and socio-economic studies for C. burnetii, to aid our understanding of the risk of transmission between the animals and humans, and in the design of prevention and control strategies for the disease in the region.
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Affiliation(s)
- J Muema
- Field Epidemiology and Laboratory Training Program (FELTP), Nairobi, Kenya.,Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya.,College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi, Kenya
| | - S M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Center for Global Health Research, Kenya Medical Research Institute, Kenya
| | - M Obonyo
- Field Epidemiology and Laboratory Training Program (FELTP), Nairobi, Kenya.,Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya
| | - S Wanyoike
- Directorate of Veterinary Services, Nairobi, Kenya
| | - M Nanyingi
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Kenya.,Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - E Osoro
- Zoonotic Disease Unit, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - A Bitek
- Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya
| | - S Karanja
- College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi, Kenya
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Roka ZG, Githuku J, Obonyo M, Boru W, Galgalo T, Amwayi S, Kioko J, Njoroge D, Ransom JA. Strengthening health systems in Africa: a case study of the Kenya field epidemiology training program for local frontline health workers. Public Health Rev 2017; 38:23. [PMID: 29450095 PMCID: PMC5809989 DOI: 10.1186/s40985-017-0070-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/04/2017] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
The logistical and operational challenges to improve public health practice capacity across Africa are well documented. This report describes Kenya's Field Epidemiology and Laboratory Training Program's (KFELTP) experience in implementing frontline public health worker training to transfer knowledge and practical skills that help strengthen their abilities to detect, document, respond to, and report unusual health events. Between May 2014 and May 2015, KFELTP hosted five training courses across the country to address practice gaps among local public health workers. Participants completed a 10-week process: two 1-week didactic courses, a 7-week field project, and a final 1-week course to present and defend the findings of their field project. The first year was a pilot period to determine whether the program could fit into the existing 2-year KFELTP model and whether this frontline-level training would have an impact on local practice. At the end of the first year, KFELTP certified 167 frontline health workers in field epidemiology and data management. This paper concludes that local, national, and international partnerships are critical for improving local public health response capacity and workforce development training in an African setting.
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Affiliation(s)
- Zeinab Gura Roka
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Waqo Boru
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Tura Galgalo
- African Field Epidemiology Network, Nairobi, Kenya
| | - Samuel Amwayi
- 3Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya
| | - Jackson Kioko
- 4Division of Preventive and Promotive Health, Ministry of Health, Nairobi, Kenya
| | - David Njoroge
- 5Human Resources Department, Ministry of Health, Nairobi, Kenya
| | - James Anthony Ransom
- Piret Partners Consulting, 611 Pennsylvania Avenue SE, Unit 358, Washington, DC 20003-4303 USA
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George G, Rotich J, Kigen H, Catherine K, Waweru B, Boru W, Galgalo T, Githuku J, Obonyo M, Curran K, Narra R, Crowe SJ, O’Reilly CE, Macharia D, Montgomery J, Neatherlin J, De Cock KM, Lowther S, Gura Z, Langat D, Njeru I, Kioko J, Muraguri N. Notes from the Field: Ongoing Cholera Outbreak — Kenya, 2014–2016. MMWR Morb Mortal Wkly Rep 2016; 65:68-9. [DOI: 10.15585/mmwr.mm6503a7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Obonyo M, Arvelo W, Kadivane S, Orundu M, Lankau E, Gakuya F, Munyua P, Githinji J, Marano N, Njenga K, Omolo J, Montgomery J. Investigation to determine staff exposure and describe animal bite surveillance after detection of a rabid zebra in a safari lodge in Kenya, 2011. Pan Afr Med J 2014; 19:10. [PMID: 25815092 PMCID: PMC4286215 DOI: 10.11604/pamj.2014.19.10.3434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/02/2013] [Accepted: 02/08/2014] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Rabies is a fatal viral infection, resulting in >55,000 deaths globally each year. In August 2011, a young orphaned zebra at a Kenyan safari lodge acquired rabies and potentially exposed >150 tourists and local staff. An investigation was initiated to determine exposures among the local staff, and to describe animal bite surveillance in the affected district. METHODS We interviewed lodge staff on circumstances surrounding the zebra's illness and assessed their exposure status. We reviewed animal bite report forms from the outpatient department at the district hospital. RESULTS The zebra was reported bitten by a dog on 31(st) July 2011, became ill on 23(rd)August, and died three days later. There were 22 employees working at the lodge during that time. Six (27%) had high exposure due to contact with saliva (bottle feeding, veterinary care) and received four doses of rabies vaccine and one of immune-globulin, and 16 (73%) had low exposure due to casual contact and received only four doses of rabies vaccine. From January 2010 to September 2011, 118 cases of animal bites were reported in the district; 67 (57%) occurred among males, 65 (57%) in children <15 years old, and 61 (52%) were inflicted in a lower extremity. Domestic and stray dogs accounted for 98% of reported bites. CONCLUSION Dog bites remains the main source of rabies exposure in the district, but exposure can result from wildlife. This highlights the importance of a one health approach with strong communication between wildlife, veterinary, and human health sectors to improve rabies prevention and control.
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Affiliation(s)
- Mark Obonyo
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Wences Arvelo
- Global Disease Detection, US Centers for Disease Control and Prevention, Kenya
| | - Samuel Kadivane
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Moses Orundu
- Loitoktoik District Hospital, Ministry of Public Health and Sanitation, Kenya
| | - Emily Lankau
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, USA ; Epidemic Intelligence Service, US Centers for Disease Control and Prevention, USA
| | - Francis Gakuya
- Kenya Wildlife Service, Ministry of Forestry and Wildlife, Kenya
| | - Peninah Munyua
- Global Disease Detection, US Centers for Disease Control and Prevention, Kenya
| | - Jane Githinji
- Central Veterinary Laboratory, Ministry of Livestock Development, Department of Veterinary Services, Kenya
| | - Nina Marano
- Epidemic Intelligence Service, US Centers for Disease Control and Prevention, USA
| | - Kariuki Njenga
- Global Disease Detection, US Centers for Disease Control and Prevention, Kenya
| | - Jared Omolo
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Joel Montgomery
- Global Disease Detection, US Centers for Disease Control and Prevention, Kenya
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Lankau EW, Montgomery JM, Tack DM, Obonyo M, Kadivane S, Blanton JD, Arvelo W, Jentes ES, Cohen NJ, Brunette GW, Marano N, Rupprecht CE. Exposure of US travelers to rabid zebra, Kenya, 2011. Emerg Infect Dis 2012; 18:1202-4. [PMID: 22709948 PMCID: PMC3376810 DOI: 10.3201/eid1807.120081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ofula V, Ochieng C, Limbaso S, Wurapa E, Sang R, Obonyo M, Bii E. Laboratory confirmation of dengue-3 virus outbreak in Mandera, Northern Kenya, 2011. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.919] [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] [Indexed: 10/28/2022] Open
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Laurila A, Cole SP, Merat S, Obonyo M, Palinski W, Fierer J, Witztum JL. High-fat, high-cholesterol diet increases the incidence of gastritis in LDL receptor-negative mice. Arterioscler Thromb Vasc Biol 2001; 21:991-6. [PMID: 11397709 DOI: 10.1161/01.atv.21.6.991] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 11/16/2022]
Abstract
Transgenic and knockout mice are widely used as models for atherogenesis studies. While developing a Helicobacter infection model in LDL receptor-negative (LDLR(-/-)) mice, we noticed that mice fed a high-fat, high-cholesterol diet often contracted gastritis independent of infection. To further investigate this finding, we studied 27 male and 18 female LDLR(-/-) mice fed high-fat, 1% or 1.25% cholesterol diets for 3 to 4 months. The extent of atherosclerosis was morphometrically analyzed in the whole aorta, and the degree of gastric inflammation was scored histologically in hematoxylin-eosin-stained stomach sections. The autoantibody titers to epitopes of oxidized LDL were also measured. Mice fed high-fat, high-cholesterol diets had a significantly higher incidence of gastritis than mice fed normal chow, 62% versus 5%, respectively (P<0.0001). This effect was specific for LDLR(-/-) mice, because no difference in gastritis was found in wild-type mice fed either diet. Animals with gastritis showed slightly more atherosclerosis than animals without gastritis: 16.3+/-6.4% versus 12.8+/-3.4% in males and 9.4+/-3.5% versus 6.5+/-3.3% in females. Cholesterol-fed mice also had significantly higher IgG autoantibody titers against modified LDL than normal chow-fed animals, but no difference was seen between the gastritis and nongastritis groups. We conclude that the standard high-fat, high-cholesterol diet commonly used in many murine models to induce atherosclerosis increased the incidence of gastritis significantly in LDLR(-/-) mice.
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Affiliation(s)
- A Laurila
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0682, USA
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Obonyo M, Munderloh UG, Fingerle V, Wilske B, Kurtti TJ. Borrelia burgdorferi in tick cell culture modulates expression of outer surface proteins A and C in response to temperature. J Clin Microbiol 1999; 37:2137-41. [PMID: 10364575 PMCID: PMC85101 DOI: 10.1128/jcm.37.7.2137-2141.1999] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [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: 11/20/2022] Open
Abstract
The Lyme disease spirochete Borrelia burgdorferi sensu stricto downregulates outer surface protein A (OspA) and upregulates outer surface protein C (OspC) during tick feeding. The switching of these proteins correlates with increased spirochetal infectivity for the mammal. We examined the effect of temperature on differential expression of OspA and OspC by B. burgdorferi cocultivated with a cell line isolated from the vector tick Ixodes scapularis. The effect of incubation at 31, 34, or 37 degrees C on expression of OspA and OspC by B. burgdorferi JMNT and N40 was analyzed by indirect fluorescent-antibody microscopy, polyacrylamide gel electrophoresis, and immunoblotting. The amount of OspA relative to the amount of flagellin was highest in spirochetes cocultivated with tick cells at 31 degrees C and declined with increasing temperature in both strains. OspC production was enhanced in spirochetes cocultivated with tick cells at 37 degrees C. Spirochetes grown axenically in BSK-H medium also produced more OspC at 37 degrees C, but OspA content was not appreciably affected by temperature. Our findings indicate that temperature, along with cultivation in a tick cell culture system, plays a role in the differential expression of OspA and enhances differential expression of OspC by spirochetes.
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Affiliation(s)
- M Obonyo
- Department of Entomology, University of Minnesota, St. Paul, Minnesota 55108, USA
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