Integrating tuberculosis screening in Kenyan Prevention of Mother-To-Child Transmission programs.

BACKGROUND: Tuberculosis (TB) screening in Prevention of Mother-To-Child Transmission (PMTCT) programs is important to improve TB detection, prevention and treatment. METHODS: As part of a national PMTCT program evaluation, mother-infant pairs attending 6-week and 9-month immunization visits were enrolled at 141 maternal and child health clinics throughout Kenya. Clinics were selected using population-proportion-to-size sampling with oversampling in a high human immunodeficiency virus (HIV) prevalence region. The World Health Organization (WHO) TB symptom screen was administered to HIV-infected mothers, and associations with infant cofactors were determined. RESULTS: Among 498 HIV-infected mothers, 165 (33%) had a positive TB symptom screen. Positive maternal TB symptom screen was associated with prior TB (P = 0.04). Women with a positive TB symptom screen were more likely to have an infant with HIV infection (P = 0.02) and non-specific TB symptoms, including cough (P = 0.003), fever (P = 0.05), and difficulty breathing (P = 0.01). TB exposure was reported by 11% of the women, and 15% of the TB-exposed women received isoniazid preventive therapy. CONCLUSIONS: Postpartum HIV-infected mothers frequently had a positive TB symptom screen. Mothers with a positive TB symptom screen were more likely to have infants with HIV or non-specific TB symptoms. Integration of maternal TB screening and prevention into PMTCT programs may improve maternal and infant outcomes.

Investigation into the prevalence of bovine cryptosporidiosis among small-holder dairy households in Dagoretti Division, Nairobi, Kenya.

OBJECTIVES: To determine the prevalence of bovine cryptosporidiosis and knowledge of this disease among smallholder dairy households in Dagoretti Division, Nairobi, Kenya. DESIGN: Cross-sectional survey of 299 dairy households and 149 non-dairy neighbouring households. SETTING: Dagoretti Division, a mixed urban and peri-urban area of Nairobi. SUBJECTS: Dairy householders and their immediate, non-cattle keeping neighbours. RESULTS: There were 50 positive households from 285 households where a fecal sample was collected giving an apparent prevalence of 18% [13, 23]%. Positive households were positively associated with watering cattle with well water, presence of shallow well, cemented cattle shed flooring and number of household cattle. (p < 0.05) Knowledge of cryptosporidiosis was generally low with more dairy respondents, 19% (56/292), who said they had heard of the disease than their non-dairy neighbours, 4% (6/146). CONCLUSION: This 18% bovine cryptosporidiosis prevalence does not constitute a risk to human health unless Cryptosporidium parvum is present. Typing of these positive samples is needed to assist in accurately determining the risk and enable evidence based management of urban dairy farming.

Prevalence of Helicobacter pylori in children less than three years of age in health facilities in Nairobi Province.

OBJECTIVES: To determine the prevalence of Helicobacter pylori in children less than three years of age and to determine socio-demographic correlates of Helicobacter pylori infection in these children. DESIGN: Cross sectional study. SETTING: The "well baby clinics", in Nairobi Province. SUBJECTS: Children less than three years of age. RESULTS: A total of 195 children were analysed in the study. There were 103 (52.8%) males and 92(47.2%) females giving a male to female ratio of 1.1:1. The mean age was 17.7 months and the median age was 16 months (range 2 weeks to 36 months). H. pylori antigen was found in stool of 89(45.6%) of the children. Low socio-economic status, crowding in the homes and poor sanitation were associated with H. pylori infection. CONCLUSION: There is a high prevalence rate of H. pylori infection in children less than three years as found in this study which is in agreement with studies done in other developing countries. Family income is associated with H. pylori infection and families with low income are at higher predisposition to H. pylori infection when compared to families with high income.