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Background: Antimicrobial resistance (AMR) is an increasingly severe threat to global public health that requires action across different sectors. Selection of appropriate antimicrobials is an urgent challenge due to the emergence of drug resistance. In 2017, Kenya developed an AMR policy and National Action Plan to drive prevention and containment of AMR. A priority activity under AMR surveillance strategic objective was to develop a national AMR training curriculum for in-service healthcare workers. In this paper we discuss the development process, gains achieved through implementation across the country and lessons learned. Methods: An initial stakeholders' forum was convened to brainstorm on the process for developing the curriculum and some issues deliberated upon include the design approach, development roadmap, curriculum outline and scope, delivery, and evaluation methodologies. A dedicated team of subject matter experts (SMEs), drawn from the project and government ministries, compiled the initial draft of the curriculum and later the training materials. A series of other stakeholders' meetings were convened to review these materials. The National Antimicrobial Stewardship Interagency Committee (NASIC) of the MOH in Kenya identified a team of experts from academia, research, and government to work with the SMEs in reviewing and providing valuable inputs to the curriculum. Additionally, principles of adult learning and a One Health approach for development were considered as AMR has drivers and impacts across sectors. A validation workshop was held to finalize the documents with a formal launch conducted during the World Antibiotics Awareness Week of 2020. Results: A multisectoral AMR surveillance training curriculum and facilitator and trainee manuals were developed and endorsed by MOH and Ministry of Agriculture, Livestock, Fisheries and Cooperatives within one year. Over 500 healthcare workers in 19 counties were trained, with overwhelming adoption by other stakeholders in Kenya and beyond. Conclusion: This curriculum was developed to standardize training for AMR detection and surveillance. The central role played by the MOH ensured expeditious development and roll-out of this curriculum. The in-service curriculum, now available on an e-learning platform, provides a ready opportunity to build capacity of healthcare professionals. Additional resources are needed to standardize and scale these efforts to reach all healthcare workers.
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Background and Aim: Camels have adaptive features to harsh climatic conditions, which make them a valued stable source of livelihood in arid lands. This study estimated the total bacterial and coliform counts (CCs), their associated factors in raw camel milk from the pastoral camel keepers, and the entire milk value chain in Isiolo County and Nairobi, Kenya. This study elucidates the bacterial load in camel milk and its potential risk. Moreover, this study provides recommendations on how to avert a human health hazard. Materials and Methods: This cross-sectional study targeted the camel pastoralists in Isiolo County, in the northern central part of Kenya. The study was conducted in July and August 2021. In addition, camel milk samples were collected along the value chain key points, including the producers, transporters, one bulker, and small traders in Isiolo town, and other retailers in Nairobi City. Eight camel herds were purposively selected and visited for a sample collection from pooled milking containers (10 mL each). In addition, milk was collected from pooled milk through the transporters, two milk bulkers, and several milk retailers in Isiolo town. Milk was further collected from retailers in Eastleigh town, Nairobi City. At each sampling point, 20 mL of milk sample was collected aseptically. The milk samples were assessed for total viable bacterial counts (TVBC) and CCs using the plate count and digital colony count, respectively. Results: A total of 76 respondents were selected and 213 milk samples were collected in this study. The respondents included the 1 (1.3%) bulker, 32 (42.1%) producers, 26 (34.2%) traders, and 17 (22.4%) transporters. Most respondents were male (62%), with most being over 40 years old. Overall, the TVBC had a mean of 2436835 ± 9276636 and a median of 3600. Furthermore, the multivariable multilevel mixed-effects linear regression model indicated that gender and practice of smoking milk-handling containers were positively and negatively associated with high counts of the natural logarithm of total viable bacteria, respectively. Of the milk samples evaluated for the CC, 10.3% (22/213) had counts greater than or equal to (≥) 100,000, where some also indicated extreme outliers of about 9.3 million. Conclusion: This study reports a low proportion of camel milk samples with high total viable bacterial and CCs. The material of the milk container and level of education interactively affected the total viable bacteria.
ABSTRACT
Background and Aim: The one-humped camels (Camelus dromedarius) adapt very well to arid and semi-arid (ASALs) environments and continue to thrive and produce milk even during severe droughts when cattle, sheep, and goats experience high mortalities. These attributes make the dromedaries very vital for the survival of pastoralists, especially in the ASALs of Africa. Mastitis is among the most important diseases of camels and can cause significant economic losses, thereby endangering the livelihoods of pastoralists. This study aimed to estimate the prevalence, risk factors, and antimicrobial sensitivity of mastitis-causing pathogens in lactating camels in Isiolo County, Kenya. Materials and Methods: This was a cross-sectional study conducted in July and August 2021. A questionnaire was administered to the camel keepers to capture data on herd-level factors. Lactating camels were then examined for any visible signs of clinical mastitis and as well as to capture data on other animal-level factors such as age, weight, and body condition score. A composite milk sample was collected aseptically from randomly selected camels in a herd. The samples were initially tested for somatic cell counts (SCC) using Somatos mini® automatic cell counter. Culture and sensitivity testing was then carried out on any milk sample that had SCC ≥ 200,000 cells/mL. The descriptive analysis was initially used to summarize the continuous and categorical farm and camel factors, while mixed regression models were used to explore the association between/across mastitis and the farm as well as camel-level factors. Results: A total of 210 lactating camels from 23 herds were selected and sampled in this study. The average age of camel keepers was 48.3 ± 16.3 years and they were involved in rearing camels for a mean of about 14.3 ± 8.6 years. The total number of camels in a herd ranged from 10 to 287, with the mean total herd milk production being 34.5 ± 24.9 L/day. The mean daily milk production per camel was 2.8 ± 1.7 L while the range for days in milk was between 21 and 787 days. The average age of camel first calving and the inter-calving interval was 56.3 ± 9.9 and 27.7 ± 9.9 months, respectively. The median parity of the dam was three and the body condition score was two. About 39.7% (83/210) of the sampled camels had clinical mastitis during the current lactation. The overall prevalence of mastitis (SCC ≥ 200,000 cells/mL) in camels was 17.6%. The main pathogens isolated were Streptococcus and Staphylococcus bacteria. Streptococcus isolates were mainly sensitive to ampicillin and resistant to cefaclor. All 18 Staphylococcus isolates were sensitive to tetracycline, while 12/18 isolates were resistant to ampicillin. The factors that were significantly associated with mastitis were the age of the respondent (p = 0.038), the number of years involved in camel rearing (p = 0.024), presence of clinical mastitis since calving (p = 0.039), body condition score (p = 0.040), and age of the dam at the time of examination (p = 0.072). Conclusion: Results from this study revealed that mastitis is an important condition among camels in the pastoral communities of Isiolo County, Kenya. Thus, pastoralists should continue to be aware of and trained on mastitis occurrence and its control in the pastoral ecosystem to reduce potential economic losses.
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AIM: This was a systematic review conducted to evaluate the analgesic drugs and techniques used in the management of pain in dogs undergoing ovariohysterectomy. MATERIALS AND METHODS: Systematic searches in PubMed, Google Scholar, and ScienceDirect were conducted for peer-reviewed articles written in English and published from 1995 to 2015. The key search words were dogs, ovariohysterectomy, pain, and analgesics. This was followed by a manual search of the references within the primary data sources. Inclusion and exclusion of studies and data extraction were performed independently by two reviewers. All randomized studies evaluating the effects of analgesics during ovariohysterectomy in dogs were included. RESULTS: A total of 31 trials met the criteria and were, therefore, included in the study. Data on the type of analgesic drugs used, the technique of administration, and the need for rescue analgesia were extracted from the papers. Individual analgesic protocols were used in 83.9% of the studies compared to multimodal drug therapy, which was used in 16.1% of the studies. Opioids were used in 39.0% of studies, nonsteroidal anti-inflammatory drugs (NSAIDs) in 19.4%, a combination of NSAIDs and opioids in 19.4%, local analgesics in 6.5%, and acupuncture in 3.2% of the studies. Drug administration was done using three approaches that included pre-operative (64.5%), post-operative (22.6%) as well as combined pre- and post-operative approach (12.9%). In 77.4% of the studies, administration of analgesics was done once, while in 12.9%, it was done as a 72-h post-operative course. 24-h and 48-h courses of post-operative pain therapy were done in 6.5% and 3.2% of the studies, respectively. About 57% of the dogs in the control groups required rescue analgesia as compared to 21.6% in the single and 11.3% in multimodal drug therapy groups. The requirement for rescue analgesics was highest in dogs treated using acupuncture (43.8%) and lowest in dogs treated using NSAID-opioid combination (8.6%). Fewer dogs among those that received pain medication preoperatively and postoperatively required rescue analgesia compared to those in groups given drugs before and after surgery only. More dogs (26.4%) among those given analgesics only once postoperatively required rescue analgesia as compared to those that received analgesics daily for 72 h (4.4%). CONCLUSIONS: This study provides evidence that opioids are the mainstream analgesic drugs used in managing acute post-operative pain in dogs' post-ovariohysterectomy. In addition, multimodal drug therapy, particularly, NSAID-opioids combination is more effective for pain management than single drug administration. Administering analgesics both before and after surgery is associated with better outcomes and so is a protracted course of post-operative pain therapy. Although these practices should be encouraged, controlled studies should be conducted to conclusively determine the best practices for pain management in dogs undergoing ovariohysterectomy.
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AIM: The current study was undertaken to evaluate the findings of canine hip dysplasia screening in Kenya. MATERIALS AND METHODS: Records for 591 dogs were included in this study. The data was obtained from the national screening office, Kenya Veterinary Board, for the period between the years 1998 and 2014. Monthly screening records were assessed and information relating to year of evaluation, breed, sex, age, and hip score captured. Descriptive statistics of hip scores was computed based on year, sex, age, and breed. RESULTS: A total of 591 records from the year 1998 to 2014 were retrieved at the National Screening Centre, the Kenya Veterinary Board. Each record was examined and data pertaining to year of screening, the breed, sex, age of the dogs, and the total hip score were recorded. The highest number of dogs screened for hip dysplasia (HD) was in the year 2009 and the lowest in the year 1998. More females than males were screened for HD and the mean age of all the dogs was 22.9±12.7 months. The most common breeds of dogs screened during the study period were German Shepherd (67.0%), Rottweiler (15.6%), and Labrador Retriever (12.2%). The mean hip score for the 591 dogs was 15.1±10.9 and the median 12.0. The mean hip scores per breed were; German Shepherd (16.3±12.1); Golden Retriever (16.0); Hungarian Vizla (15.0); Labrador Retriever (3.0±6.7); Great Dane (13.3±3.2); Rottweiler (12.2±8.2); Doberman (10.3±4.2); Rhodesian Ridgeback (9.6±3.8); and Boxer (9.3±0.6). Based on the hip score, moderate to severe HD was diagnosed in 16.6% of the dogs, mild HD in 32.7%, Borderline HD in 37.7%, fair HD in 6.9%, and good HD in 6.1%. CONCLUSION: Canine HD is a common occurrence in Kenya with most dogs suffering mild to border line HD. In addition, German Shepherd and Golden Retriever appear to be the most affected breeds. It is therefore recommended that stringent measures be imposed to dog breeding programs to avoid transmission of this undesirable trait and consequently improve the welfare and the quality of dog breeds in Kenya.
ABSTRACT
BACKGROUND: Regional anaesthetic techniques have been used in combination with systemic analgesics during small animal surgery to provide multimodal analgesia. Brachial plexus nerves block using local anaesthetics provides analgesia of the thoracic limb through desensitization of the nerves that provide sensory and motor innervation. This has been shown to reduce intra-operative anesthetic requirements and provide postoperative pain relief. Decreasing the doses of general anaesthetics allows more stable cardiopulmonary function during anaesthesia and the development of less side effects. The present case reports a successful use of brachial plexus blockade to supplement medetomidine-ketamine-isoflurane anaesthesia for repair of radio-ulna fracture in an adult cheetah (acinonyx jubatus). CASE PRESENTATION: An adult male Cheetah weighing about 65 kg was presented with a history of leg carrying lameness of the left forelimb sustained following a car accident a week earlier. Clinical examination under general anaesthesia revealed slight dehydration and a swelling with a wound on the caudo-medial aspect of the left radio-ulna region. Crepitation was present on manipulation and radiography confirmed a complete transverse radio-ulna fracture of the left forelimb, which required open reduction and internal fixation. Brachial plexus blockade using lignocaine hydrochloride was used to supplement medetomidine-ketamine-isoflurane anaesthesia for the surgical procedure. Isoflurane anaesthesia was maintained at 0.5 - 2.0% throughout the surgical procedure, which was uneventful. Temperature and cardio-pulmonary parameters remained stable intra-operatively. Limb paralysis extended for 5 hours post-operatively, suggesting prolonged anaesthesia. CONCLUSION: To the researchers' knowledge, this is the first reported case of the use of brachial plexus blockade to supplement general anaesthesia to facilitate forelimb surgery in an adult cheetah. The use of brachial plexus block with a light plane of general anaesthesia proved to be successful. Brachial plexus block had a sparing effect on isoflurane anaesthesia as evidenced by the concentration used for maintenance of anaesthesia and the stability of the cardiopulmonary function. Moreover, absence of autonomic cardiopulmonary reactions to the surgical manipulation may be attributed to the efficacy of brachial plexus block. This anaesthesia protocol is therefore recommended for surgeries of the forelimb in wild cats.
