Prevalence of vitamin D deficiency in exclusively breastfed infants at a tertiary healthcare facility in Nairobi, Kenya

ABSTRACT Objective: To determine the prevalence of vitamin D deficiency (VDD) in exclusively breastfed infants at the Aga Khan University Hospital Nairobi, Kenya (AKUHN). The relationships between 25-hydroxyvitamin D; 25OHD, parathyroid hormone (PTH), maternal vitamin D supplementation, and sunlight exposure were also determined. Subjects and methods: Blood from 98 infants was assayed for 25OHD, calcium, phosphate, and PTH. Socio-demographic and clinical characteristics were analyzed using descriptive statistics and inferential analysis (p < 0.05). Results: The prevalence of VDD (25OHD <12 ng/mL), vitamin D insufficiency (VDI, 25OHD 12-20 ng/mL) and vitamin D sufficiency (VDS, 25OHD >20 ng/mL) was 11.2% (95% CI 8.0%-14.4%), 12.2% (95% CI 8.9%-15.5%), and 76.5% (95% CI 72.3%-80.8%) respectively. There was no difference in the mean age, head circumference, length, or weight of infants in VDD, VDI, and VDS groups. PTH was elevated when 25OHD was <12 ng/mL and normal when 25OHD was between 12-20 ng/mL. 25OHD and PTH were normal in infants whose mothers received vitamin D supplements. Infants who received <30 minutes/day of exposure to sunlight were 5 times more likely to have VDI than infants who received ≥30 minutes/day (p = 0.042). Conclusions: The prevalence of VDD in exclusively breastfed infants at AKUHN is low. The current national policy that recommends exclusive breastfeeding of infants in the first 6 months of life appears to be effective in staving off vitamin D deficiency but those infants with < 30 minutes sunlight exposure may benefit from low dose supplemental vitamin D during times of low sunlight exposure.

Outcomes and effects of homeopathic treatment of malaria in Kenya, a multi-centre study

Background InKenya malaria is the leading cause for illness and death; homeopathy is used for many years to treat this disease. A previous study in Ghana in 1996, showed comparable effects of homeopathy and chloroquine. MethodsIn three studies we documented homeopathic treatment in a retrospective qualitative study, a prospective single arm study, and a comparison between one cohort receiving homeopathic treatment and the other artemether.ResultsIn the qualitative retrospective study (2014) (n=54), we related typicalmalaria and individual symptoms, with remedy prescriptions and affected organs. Principal Component Analysis (PCA) showed, that specific remedies were prescribed for patterns of affected organs.In the prospective study (2014) (n=70),the primary outcome was the parasitological status at the first follow up (median 8 days), secondary outcome was the quality of life measure with Outcome Related to Impact on Daily Life. In the third study, of the group (n=79) (b) exposed to homeopathy, n=6 (a) were still parasite-positive after one week, in the control (co-artem) group of n=35 (c) no patient was positive (d). The odds ratio was 5.8068 (95% CI 0.3183 ­105.8794), with z = 1.187 and P = 0.2352. The difference was not statistically significant; homeopathic remedies and coartem tablets had similar effect for uncomplicated malaria in that region.Co-morbidity was treated with different remedies.ConclusionHomeopathic treatment can be used as a valuable option, also when other treatments are ineffective by microbial resistance, not indicated (as in pregnancy) and financially not affordable.(AU)

Survival and mortality among users and non-users of hydroxyurea with sickle cell disease / Sobrevida e mortalidade em usuários e não usuários de hidroxiureia com doença falciforme / Sobrevida y mortalidad en usuarios y no usuarios de hidroxiurea con enfermedad falciforme

OBJECTIVE: to estimate survival, mortality and cause of death among users or not of hydroxyurea with sickle cell disease. METHOD: cohort study with retrospective data collection, from 1980 to 2010 of patients receiving inpatient treatment in two Brazilian public hospitals. The survival probability was determined using the Kaplan-Meier estimator, survival calculations (SPSS version 10.0), comparison between survival curves, using the log rank method. The level of significance was p=0.05. RESULTS: of 63 patients, 87% had sickle cell anemia, with 39 using hydroxyurea, with a mean time of use of the drug of 20.0±10.0 years and a mean dose of 17.37±5.4 to 20.94±7.2 mg/kg/day, raising the fetal hemoglobin. In the comparison between those using hydroxyurea and those not, the survival curve was greater among the users (p=0.014). A total of 10 deaths occurred, with a mean age of 28.1 years old, and with Acute Respiratory Failure as the main cause. CONCLUSION: the survival curve is greater among the users of hydroxyurea. The results indicate the importance of the nurse incorporating therapeutic advances of hydroxyurea in her care actions. .

OBJETIVO: estimar a sobrevida, mortalidade e causa de morte em usuários ou não de hidroxiureia com doença falciforme. MÉTODO: coorte retrospectiva de 1980 a 2010, de pacientes internados em dois hospitais públicos brasileiros. Determinou-se a probabilidade de sobrevida com Kaplan-Meier, cálculos de sobrevida (SPSS versão 10.0), comparação entre curvas de sobrevida e método Log Rank. Nível de significância p=0,05. RESULTADOS: de 63 pacientes, 87% estavam com anemia falciforme, sendo 39 em uso de hidroxiureia, com média de idade na instituição do fármaco de 20,0±10,0 anos e dosagem média de 17,37±5,4 a 20,94±7,2mg/kg/dia, elevando a hemoglobina fetal. Na comparação de usuários e não usuários de hidroxiureia, a curva de sobrevida foi maior nos usuários (p=0,014). Ocorreram 10 óbitos, com idade média de 28,1 anos, tendo como causa principal a Insuficiência Respiratória Aguda. CONCLUSÃO: a curva de sobrevida é maior nos usuários de hidroxiureia. Os resultados apontam a importância do enfermeiro incorporar avanços terapêuticos da hidroxiureia em suas ações assistenciais. .

OBJETIVO: estimar la sobrevida, la mortalidad y la causa de muerte de usuarios y no usuarios de hidroxiurea con enfermedad falciforme. MÉTODO: cohorte retrospectiva de 1980 a 2010 de pacientes internados en dos hospitales públicos brasileños. Se determinó la probabilidad de sobrevida con Kaplan-Meier, cálculos de sobrevida (SPSS versión 10.0), comparación entre curvas de sobrevida, método Log Rank. Nivel de significado p=0,05. RESULTADOS: de 63 pacientes, 87% estaban con anemia falciforme, siendo que 39 usaban hidroxiurea, promedio de edad en la institución del fármaco de 20,0±10,0 años y dosificación promedio de 17,37±5,4 a 20,94±7,2mg/kg/día, elevando la hemoglobina fetal. En la comparación de usuarios y no usuarios de hidroxiurea, la curva de sobrevida fue mayor en los usuarios (p=0,014). Ocurrieron 10 muertes, edad promedio de 28,1 años, siendo la Insuficiencia Respiratoria Aguda la causa principal. CONCLUSIÓN: la curva de sobrevida es mayor en los usuarios de hidroxiurea. Los resultados apuntan la importancia de que el enfermero incorpore los avances terapéuticos de la hidroxiurea en sus acciones asistenciales. .

Long-term outcomes of school-based treatment for control of urinary schistosomiasis: a review of experience in Coast Province, Kenya

Urinary schistosomiasis remains a significant burden for Africa and the Middle East. The success of population-based control programs will depend on their impact, over many years, on Schistosoma haematobium reinfection and associated disease. In a multi-year (1984-1992) control program in Kenya, we examined risk for S. haematobium reinfection and late disease during and after annual school-based treatment. In this setting, long-term risk of new infection was independently associated with location, age, hematuria, and incomplete treatment, but not with sex or frequency of water contact. Thus, very local environmental features and age-related factors played an important role in S. haematobium transmission, such that population-based control programs should optimally tailor their efforts to local conditions on a village-by-village basis. In 2001-2002, the late benefits of earlier participation in school-based antischistosomal therapy were estimated in a cohort of formerly-treated adult residents compared to never-treated adults from the same villages. Among age-matched subjects, current infection prevalence was lower among those who had received remote therapy. In addition, prevalence of bladder abnormality was lower in the treated group, who were free of severe bladder disease. Treatment of affected adults resulted in rapid resolution of infection and any detectable bladder abnormalities. We conclude that continued treatment into adulthood, as well as efforts at long-term prevention of infection (transmission control) are necessary to achieve optimal morbidity control in affected communities.

Relationship between malaria and filariasis transmission indices in an endemic area along the Kenyan Coast.

BACKGROUND AND OBJECTIVES: An entomological survey was conducted to determine the relationship between malaria and lymphatic filariasis transmission by Anopheles gambiae s.l. and An. funestus in two inland villages along the Kenyan coast. METHODS: Mosquitoes were sampled inside houses by pyrethrum spray sheet collection (PSC). In the laboratory, the mosquitoes were sorted to species, dissected for examination of filarial infection and the anophelines later tested for Plasmodium falciparum circumsporozoite proteins by an enzyme-linked immunosorbent assay (ELISA). RESULTS: From a total of 2,032 female mosquitoes collected indoors, An. gambiae s.l constituted 94.4% while the remaining 5.6% comprised of An. funestus and Culex quinquefasciatus. None of the Cx. quinquefasciatus was positive for filarial worms. P. falciparum sporozoite rate for An. gambiae s.l. from both villages was significantly higher than Wuchereria bancrofti infectivity rate. Similarly, the entomological inoculation rate for An. gambiae s.l. was significantly higher than the corresponding W. bancrofti infective biting rate and transmission potential for both the villages. Mass treatment of people with filaricidal drugs in Shakahola in the ongoing global elimination of lymphatic filariasis campaign seemed to have reduced the indices of filariasis transmission but had no effect on malaria transmission. INTERPRETATION AND CONCLUSION: These results indicate the intensity of malaria transmission by anophelines to be much higher than that of lymphatic filariasis in areas where both diseases co-exist and re-emphasise the need to integrate the control of the two diseases in such areas.

A comparative study of gastrointestinal parasites between ranched and free ranging Burchell's zebra (Equus burchelli antiquorum) in Isiolo district, Kenya

Parasites were collected from 20 Burchell's zebra, Equus burchelli antiquorum, from Isiolo district, Kenya. 10 were ranched animals from the Lewa Downs Ranch and 10 free ranging from the areas adjacent to the ranch to the north. The animals were culled from 4th to 18th June 1995. The gastrointestinal tract was removed from the carcass and separated as stomach, small and large intestines and searched for parasites. The abdominal cavity was scrutinized for Setaria species. The parasites were identified to genus and in some cases species level. All animals were infected with at least three genera of parasites of which at least one genus was a nematode. A total of 10 genera representing eight families were recovered from the two groups. These included six nematode families, Strongylidae, Atractidae, Oxyuridae, Spiruridae, Setariidae, and Ascaridae, one cestode family, Anoplocephalidae and one family of the larvae of Gasterophilus bot flies, Gasterophilidae. The most prevalent families were Atractidae (100%) and Gasterophilidae (100%). The principle nematode genera was Crossocephalus whose total burden, plus or minus the standard deviation, was 3,471,129 +/- 1,352,922. Setaria species were recovered from the abdominal cavity of 45% of all the animals examined. The overall total worm burden was higher in the free ranging zebra 2,743,410 +/- 849,604 than the ranched zebra, 787,669 +/- 246,006. The range of individual genera varied from 0 to 269,225 in the free ranging group, which was higher than 0 to 77,890 in the ranched animals. From statistical analysis, no significant difference could be found between males and females. However, the burdens of genera Strongylus, Triodontophorus, Crossocephalus and Parascaris were significantly higher in free ranging animals.

How specific is the immune response to malaria in adults living in endemic areas?

It is documented that people living in malaria endemic areas acquire immunity against malaria after repeated infections. Studies involving passive transfer of IgG from immune adults to the nonimmune subjects have shown that circulating antibodies play an important role, and that immune adults possess protective antibodies, which susceptible malaria patients do not. Through a differential immunoscreen, we have identified several novel cDNA clones, which react exclusively and yet extensively with immune sera samples. Specific antisera raised against the immunoclones inhibit the growth of parasites in culture. The clones studied so far turn out to be novel conserved Plasmodium genes. In order to study the response of sera of adults from malaria endemic areas of India and Africa to these immunogens, we carried out ELISA assays using these immunopeptides, other P. falciparum specific antigens, peptides, antigens from other infections such as mycobacterial infections and other proteins such as BSA. Children from the same areas and normal healthy urban people showed very little activity to each of these categories. A large percentage of adults from endemic areas responded positively to all the malarial immunogens tested. However, the same persons also showed high response to other antigens and proteins as well. The implications of these results are reported in this paper.

Microgeographical patterns of schistosomiasis and water contact behavior; examples from Africa and Brazil

This paper examines the results of spatial (microgeographical) water contact/schistosomiasis studies in two African (Egyptian and Kenyan) and one Brazilian communities. All three studies used traditional cartographic and statistical methods but one of them employed also GIS (geographical information systems) tools. The advantage of GIS and their potential role in schistosomiasis control are briefly described. The three cases revealed considerable variation in the spatial distribution of water contact, transmission parameters and infection levels at the household and individual levels. All studies showed considerable variation in the prevalence and intensity of infection between households. They also show a variable influence of distance water contact behavoir associated with type of activity, age, sex, socioeconomic level, perception of water quality, season and availability of water in the home. Water contact behavior and schistosomiasis were evaluated in the Brazilian village of Nova Uniäo within the context of water sharing between household and sex/age groups. Recommendations are made for futher spatial studies on the transmission and control of schistosomiasis.

Occurrence of midline diastema and frenum attachments amongst school children in Nairobi, Kenya.

The aim of this study was to determine the prevalence of midline diastema, tongue tie and frenum attachments amongst school children in Nairobi. A total of 1802 children aged between 4 and 16 years were selected randomly using multistage sampling technique. To avoid oversampling in either sex, a proportionate sampling procedure was used. Thereafter, a thorough intra-oral examination was carried out using a mouth mirror under artificial or natural light with the children lying on a supine position. Presence or absence of midline interdental spaces unusually bigger than other interdental spaces were noted and recorded on a prepared dateacollection form. Accurate location of the origin of the frenum was done using Placek et al Morphological-functional classification of the labial frenum attachments. Data was analyzed manually by tally method. Results showed that 35% had upper and lower midline diastema. 55% were females and 45% were males. Their mean age was 7.6 years. 0.2% had a high lingual frenum. The commonest location of frenum attachment amongst children with lower midline diastema was the mucogingival junction (86%) whereas amongst those with upper midline diastema it was attached gingiva (50%). None of the children had frenum attachment on the interdental papilla. It was concluded that the maxilla had a higher prevalence of midline diastema than the mandible and that papillary penetrating frenum attachments amongst these patients were higher in the maxilla than the mandible.

Periodontal health status of patients attending Diabetic Clinic at Kenyatta National Hospital, Nairobi, Kenya.

The periodontal health status of diabetic patients and the association between periodontal disease and treatment mode, age and duration of diabetes were investigated in 86 dentulous men and women aged between 20 years and 69 years. 43 were diabetics regularly controlled at Kenyatta National Hospital Diabetic Clinic and 43 were non-diabetics attending medical outpatient clinic at the same hospital for minor ailments. Diabetic patients were found to have significant severer levels of periodontal disease than the non-diabetics. The difference persisted with increasing age. No correlation was found between treatment mode and duration of diabetes on one hand and the severity of periodontal disease on the other.

Dynamics of malaria transmission near two permanent breeding sites in Baringo district, Kenya.

Entomological and malario-metric measurements were made near two permanent breeding sites in Baringo district, Kenya in order to determine the prevalence and seasonality of malaria and the relative importance of two local anopheline mosquitoes as malaria vectors. The breeding sites studied were the Perkerra irrigation scheme and the Loboi swamp, whereas the mosquito species involved were Anopheles gambiae Giles (sensu lato) and Anopheles funestus Giles. Malaria accounted for 54 per cent of annual clinic attendance in the district and transmission occurred throughout the year. Overall values of vector density, man biting rate and crude inoculation rates did not differ significantly between the two areas. However, there was a strong seasonal trend in the values of these parameters which varied between the two sites, resulting in peak transmission occurring at different times of the year, April-July in Lobio and August-October in Perkerra. Crude inoculation rates were about 5 times higher in An. gambiae than in An. funestus, indicating that the former was the more efficient and more important vector in the district.

A comparative study on the periodontal health status of adult populations of Kenya and India.

The purpose of this study was to compare the oral hygiene and periodontal health status of 497 randomly selected Kenyan and Indian adult populations aged between 20 and 35 years. Oral hygiene and periodontal health status were assessed using Silness and Loe plaque Index and Russel's Periodontal Index respectively. Results revealed that the overall mean plaque and periodontal index scores of Kenyan participants were significantly lower than those of Indians. Increase of mean Periodontal index with age was found to be significant among Kenyan participants and insignificant among Indian participants Kenyan female participants were found to have significant lower mean plaque and periodontal index scores than males. However, the mean periodontal index score of Indian male participants was found to be lower than that of female participants. It is concluded that Kenyan participants had better periodontal and oral hygiene status than Indian participants and that Indian females unlike Kenyan females had poorer periodontal health status than male.