Campylobacter jejuni and Campylobacter coli infection, determinants and antimicrobial resistance patterns among under-five children with diarrhea in Amhara National Regional State, Northwest Ethiopia.

BACKGROUND: Children with under-five year age disproportionally affected with foodborne illness. Campylobacteriosis is the most common foodborne disease next to Norovirus infection. Macrolides are commonly prescribed as the first line of treatment for Campylobacter gastroenteritis, with fluoroquinolone and tetracycline as secondary options. However, resistance to these alternatives has been reported in various regions worldwide. OBJECTIVE: To determine the prevalence, associated risk-factors and antimicrobial resistance of Campylobacter jejuni and C. coli among under-five children with diarrhea. METHODS: Institution-based cross-sectional study was conducted from November, 2022 to April 2023. The study sites were selected using a random sampling technique, while the study subjects were included using a convenient sampling technique. The data were collected using a structured questionnaire. Stool samples were inoculated onto modified charcoal cefoperazone deoxycholate agar and incubated for 48 hours. The suspected colonies were analyzed using matrix-assisted laser desorption ionization-time of flight mass spectrometry to confirm the species. Antimicrobial susceptibility testing was performed using a disc diffusion technique. All potential covariates (independent variables) were analyzed one by one using bivariate logistic regression model to identify candidate variables with P value < 0.25. Multivariable logistic analysis was used to identify potential associated factors using the candidate variables. A p value ≤ 0.05 at a 95% confidence interval was statistically significant. RESULT: Among the 428 samples, 7.0% (CI: 4.5-9.3) were confirmed Campylobacter species. The prevalence of C. jejuni and C. coli among under-five children was 5.1% (CI: 3.0-7.0) and 1.9% (CI: 0.7-3.3), respectively. C. jejuni (73.3%) was dominant over C. coli (26.7%). The resident, contact with domestic animals, and parents/guardians education level were significantly associated with campylobacteriosis among under-five children. One-third of the Campylobacter isolates (33.3%, 10/30) were resistant to ciprofloxacin and tetracycline whereas 10.0% (3/30) were resistant to erythromycin. Furthermore, 3.3% (1/30) of the Campylobacter were found to be multidrug-resistant. CONCLUSION: The prevalence of Campylobacter species was 7.0%. The resistance rate of Campylobacter species of ciprofloxacin and tetracycline-resistance strains was 33.3%. Peri-urban residence, contact with domestic animals, and low parental educational statuses were significantly associated factors with increased risk of Campylobacter infection. Continuous surveillance on antimicrobial resistance and health education of personal and environmental hygiene should be implemented in the community.

Type I interferons and Mycobacterium tuberculosis whole cell lysate induce distinct transcriptional responses in M. tuberculosis infection.

Type I interferon (IFN)-induced genes have the potential for distinguishing active tuberculosis (ATB) from latent TB infection (LTBI) and healthy controls (HC), monitoring treatment, and detection of individuals at risk of progression to active disease. We examined the differential effects of IFN-α, IFN-ß and Mycobacterium tuberculosis whole cell lysate (Mtb WCL) stimulation on the expression of selected IFN-stimulated genes in peripheral blood mononuclear cells from individuals with either LTBI, ATB, and healthy controls. Stimulation with IFN-α and IFN-ß induced a higher expression of the interrogated genes while Mtb WCL stimulation induced expression similar to that observed at baseline, with the exception of IL-1A and IL-1B genes that were downregulated. The expression of IFN-α-induced FCGR1A gene, IFN-ß-induced FCGR1A, FCGR1B, and SOCS3 genes, and Mtb WCL-induced IFI44, IFI44L, IFIT1, and IFITM3 genes differed significantly between LTBI and ATB. These findings suggest stimulation-driven gene expression patterns could potentially discriminate LTBI and ATB. Mechanistic studies are necessary to define the processes through which distinct type I IFNs and downstream ISGs determine infection outcomes and identify potential host-directed therapeutic strategies.

Antimicrobial Use by Peri-Urban Poultry Smallholders of Kajiado and Machakos Counties in Kenya.

Antimicrobial use (AMU) is a major driver of antimicrobial resistance (AMR). An understanding of current practices can lead to better targeting of AMU-reducing interventions. An analysis of the distribution and current usage of veterinary drugs in peri-urban smallholder poultry systems in Kenya was undertaken. A survey among poultry farmers and key informant interviews with agrovet operators and other players in the value chain was conducted in Machakos and Kajiado counties. Interview data were analyzed using descriptive and thematic approaches. A total of 100 farmers were interviewed. The majority (58%) were > 50 years old, and all kept chickens, while 66% kept other livestock. Antibiotics constituted 43% of the drugs reportedly used on the farms (n = 706). These were mostly administered by the farmers themselves (86%) through water (98%). Leftover drugs were stored for later use (89%) or disposed of (11%). Incineration was the main method for the disposal of leftover drugs and empty containers. As described by the key informants (n = 17), the drug distribution chain relied on agrovet shops that were supplied by local distributors and pharmaceutical companies, which, in turn, supplied drugs to the farmers. Farmers reportedly purchased drugs without prescriptions and rarely observed the withdrawal periods. Drug quality was a concern, especially for products requiring reconstitution.

Food safety interventions in low- and middle-income countries in Asia: A systematic review.

Effective and sustainable interventions are necessary for long-term improvement of food safety. This review provides a summary of food safety interventions evaluated in selected low- and middle-income countries in Asia between 2000 and 2020. A systematic screening of published articles from PubMed and CabDirect databases was carried out with the aid of Rayyan QCRI software. A total of 25 studies were considered in the review. A 'before and after' study design was the most frequently used design (64%), while five studies (20%) used a randomized control trial (RCT) design. Interventions applied focused on training to improve knowledge, attitudes, and practices (KAP) towards safe food (60%) or on specific technologies (40%). Nine of the 25 studies were specific on the value chain considered: cattle (1), poultry (1), pigs (4) and fish value chains (3). Except for one study, all interventions reported some level of success; 17 were rated as having a high level of success, defined differently across studies. However, there is a clear evidence gap for the efficacy and cost-effectiveness of food safety interventions in market settings, both consumer- and vendor-facing. A rigorous and standardized assessment of intervention effectiveness and sustainability is recommended, to not only identify areas of improvement, but also to ensure scaling of interventions with demonstrated evidence of success and sustainability.

One Health gains momentum in Africa but room exists for improvement.

Objectives: The degree of One-Healthiness of a system relates to the effectiveness of an institution to operate within the six main dimensions which identify to what extent it complies with One Health concept. This paper evaluates institutional compliance with One Health concept in 14 institutions from eight African countries. Methods: We utilised the adapted Network for the Evaluation of One Health (NEOH) tool. The institutions included six national One Health platforms and eight other institutions utilizing One Health approaches. Semi-quantitative evaluation of One Health platforms' competencies in six aspects/dimensions concerning One Health operations and infrastructure: Systems Thinking, Planning, Transdisciplinary working, Sharing, Learning and Systemic Organization, was conducted. Results: The evaluation revealed that although all aspects of One Health scored above average, systemic organization and working in One Health were the strongest areas where tremendous gains had been made across the evaluated countries. The aspects of planning, sharing, learning, and thinking should be optimized to achieve gains emanating from One Health approaches in Africa. Cultural and social balance, and integrated health approach were the strongest areas under working and thinking respectively. Thinking was particularly challenged in areas of dimensions coverage and balance, while planning was challenged in the areas of capacity for detection, identification, monitoring of infectious diseases; biosafety and quality management; skills through taught and distance-learning programmes; information and communication technologies to support learning and skills through research apprenticeships. Conclusion: We conclude that although One Health has gained momentum in Africa, there still exists room for improvement. The revealed strengths, weaknesses, opportunities, and gaps in One Health implementation provide an opportunity for prioritization and refocusing of efforts and resources to strengthen the identified weak areas.

Comparing the Effectiveness of Different Approaches to Raise Awareness About Antimicrobial Resistance in Farmers and Veterinarians of India.

Background: Antimicrobial resistance (AMR) is a global public health threat. The indiscriminate use of antibiotics in the animal health sector contributes to increasing rates of AMR and studies involving dairy farmers in India have found knowledge levels regarding antibiotics and AMR to be very low. The purpose of this study was to assess different methods to raise awareness and knowledge about AMR and antibiotic use among dairy farmers, paravets (veterinary assistants), and veterinarians. Materials and Methods: The study was conducted in September-December of 2018 in some parts of Haryana, Assam, Karnataka, and West Bengal. It had two parts: an intervention meeting (September-October 2018) which consisted of focus group discussions (FGD) with farmers, key informant interviews (KII) with veterinary professionals along with distribution of information packages, and then a follow-up survey (November-December 2018). The villages were randomly allocated to either one of the four intervention approaches (1-FGD/KII and information package on AMR; 2-FGD/KI and information on animal health; 3- FGD/KII and information package on animal health plus information on AMR; or 4- only the FGD/KII). A follow-up survey was done to assess the effect of interventions. Results: In total, 274 dairy farmers and 51 veterinary professionals (21 veterinarians and 30 paravets) participated in the follow-up survey. Many of the farmers and veterinary professionals who participated in the follow-up survey had been part of the intervention meetings. The average knowledge score of farmers was 7.8. It was found that the knowledge score was higher amongst farmers who had participated in the intervention meetings (p < 0.05), had received intervention approach 2 (p = 0.03) or approach 3 (p = 0.01), and amongst female farmers (p = 0.03) compared to male. The veterinary professionals had good knowledge but lacked interest in training the farmers about antimicrobial resistance. Conclusion: Our research demonstrated that a higher percentage of farmers and veterinary professionals who attended the intervention meeting had improved knowledge. Dairy farmers should be regularly educated on antibiotic usage and how to avoid misusing them. Also, veterinary experts should be provided with tools and strategies to educate farmers on the use of antimicrobials.

Assessment of Foodborne Disease Hazards in Beverages Consumed in Nigeria: A Systematic Literature Review.

Risk assessment is a formal process of identifying hazards and assessing the risk associated with them (risk is a combination of the severity of illness and the probability of occurrence). This review highlights foodborne disease hazards reported in beverages consumed in Nigeria for the period between 2000 and 2020. Based on a preregistered protocol and search syntax, studies were retrieved from the PubMed, Google Scholar, and ScienceDirect databases. Rayyan QCRI software was used to screen the articles. Data were then extracted from the included full-text articles, into a standardized excel workbook. A total of 18,762 articles were identified, from which 126 were included in the final analyses. The common beverages studied were sachet water (14.9%), borehole/well water (13.9%), cereal-based beverages (12.1%), raw/fresh milk (8.3%) and nono/nunu, which is a fermented milk-cereal beverage (7.2%). Sufficient data were available to undertake pooled prevalence estimates for some hazards within select beverages and revealed contamination rates for Staphylococcus spp. in raw/fresh milk, 12.3% (95% CI 6.3-20.0); Salmonella spp. in borehole/well water, 19.8% (95% CI 13.1-27.4); Klebsiella spp. in sachet water, 40.0% (95% CI 12.4-71.7); Staphylococcus spp. in nono/nunu, 32.6% (95% CI 14.7-53.8), and Escherichia spp. in nono/nunu, 30.7% (95% CI 21.9-40.2). Heterogeneity was present in the aggregate summary estimates. This review has highlighted the presence of several hazards of high importance to public health in commonly consumed beverages in Nigeria. The data presented here provide an entry point for future quantitative risk assessments both to determine the level of exposure of the community to these hazards and also for the identification of the most effective mitigation strategies to reduce these risks and improve health outcomes in Nigeria.

The Context of Application of Biosecurity for Control of African Swine Fever in Smallholder Pig Systems: Current Gaps and Recommendations.

African swine fever (ASF) is a highly fatal disease of pigs. It is a threat to the pig industry as it lowers production and significantly impacts on livelihoods. ASF has no cure and a vaccine against it is yet to be developed. Outbreaks continue to be reported in Africa and Asia, where the setting of the pig value chain (farm, market, and slaughter practices) coupled with the risky behaviors of actors, contribute to persistence of the virus in pig populations. The role of these factors in the epidemiology of the disease is reviewed with a focus on smallholder pig systems in Africa. Biosecurity at the farm level is particularly emphasized, and factors influencing its adoption highlighted. Socio-cultural factors and weaknesses at the disease control policy level are critical and should not be ignored. Gender and equity are important aspects and ought to be considered in discussions to improve the sector. The findings are expected to define priorities for interventions to improve pig productivity (as these regions wait for the vaccine to be developed).

Effectiveness of Training and Use of Novasil Binder in Mitigating Aflatoxins in Cow Milk Produced in Smallholder Farms in Urban and Periurban Areas of Kenya.

Aflatoxins, which commonly contaminate animal feeds and human food, present a major public health challenge in sub-Saharan Africa. After ingestion by cows, aflatoxin B1 is metabolized to aflatoxin M1 (AFM1), some of which is excreted in milk. This study involved smallholder dairy farms in urban and periurban areas of Nairobi and Kisumu, Kenya. The objective was to determine the effectiveness of training and providing farmers with aflatoxin binder (NovaSil®) on AFM1 contamination in raw milk. A baseline survey was undertaken and 30 farmers whose milk had AFM1 levels above 20 ppt were randomly selected for inclusion in the study. Of these, 20 farmers were part of the intervention, and were given training on the usage of the NovaSil® binder, while 10 served as a control group. All farmers were visited biweekly for three months for interviews and milk samples were collected to measure the AFM1 levels. The AFM1 levels were quantified by enzyme linked immunosorbent assay. The NovaSil® binder significantly reduced AFM1 concentrations in the raw milk produced by the farmers in the intervention group over the duration of the study (p < 0.01). The control farms were more likely to have milk with AFM1 levels exceeding the regulatory limit of 50 ppt compared to the intervention farms (p < 0.001) (odds ratio = 6.5). The farmers in the intervention group perceived that there was an improvement in milk yield, and in cow health and appetite. These farmers also felt that the milk they sold, as well as the one they used at home, was safer. In conclusion, the use of binders by dairy farmers can be effective in reducing AFM1 in milk. Further research is needed to understand their effectiveness, especially when used in smallholder settings.

Evaluating farm-level livestock interventions in low-income countries: a scoping review of what works, how, and why.

Livestock interventions can improve nutrition, health, and economic well-being of communities. The objectives of this review were to identify and characterize livestock interventions in developing countries and to assess their effectiveness in achieving development outcomes. A scoping review, guided by a search strategy, was conducted. Papers needed to be written in English, published in peer-reviewed journals, and describe interventions in animal health and production. Out of 2739 publications systematically screened at the title, abstract, and full publication levels, 70 met our inclusion criteria and were considered in the study. Eight relatively high-quality papers were identified and added, resulting in 78 reviewed publications. Only 15 studies used randomized controlled trial designs making it possible to confidently link interventions with the resulting outcomes. Eight studies had human nutrition or health as outcomes, 11 focused on disease control, and four were on livestock production. Eight interventions were considered successful, but only four were scalable. We found good evidence that livestock-transfer programs, leveraging livestock products for nutrition, and helping farmers manage priority diseases, can improve human well-being. Our report highlights challenges in garnering evidence for livestock interventions in developing countries and provides suggestions on how to improve the quantity and quality of future evaluations.

Calcium channel blockers for people with chronic kidney disease requiring dialysis.

BACKGROUND: Calcium channel blockers (CCBs) are used to manage hypertension which is highly prevalent among people with chronic kidney disease (CKD). The treatment for hypertension is particularly challenging in people undergoing dialysis. OBJECTIVES: To assess the benefits and harms of calcium channel blockers in patients with chronic kidney disease requiring dialysis. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies to 27 April 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: All randomised controlled trials (RCTs) and quasi-RCTs that compared any type of CCB with other CCB, different doses of the same CCB, other antihypertensives, control or placebo were included. The minimum study duration was 12 weeks. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using a random-effects model and results expressed as risk ratio (RR), risk difference (RD) or mean difference (MD) with 95% confidence intervals (CI). MAIN RESULTS: This review included 13 studies (24 reports) randomising 1459 participants treated with long-term haemodialysis. Nine studies were included in the meta-analysis (622 participants). No studies were performed in children or in those undergoing peritoneal dialysis. Overall, risk of bias was assessed as unclear to high across most domains. Random sequence generation and allocation concealment were at low risk of bias in eight and one studies, respectively. Two studies reported low risk methods for blinding of participants and investigators, and outcome assessment was blinded in 10 studies. Three studies were at low risk of attrition bias, eight studies were at low risk of selective reporting bias, and five studies were at low risk of other potential sources of bias. Overall, the certainty of the evidence was low to very low for all outcomes. No events were reported for cardiovascular death in any of the comparisons. Other side effects were rarely reported and studies were not designed to measure costs. Five studies (451 randomised adults) compared dihydropyridine CCBs to placebo or no treatment. Dihydropyridine CCBs may decrease predialysis systolic (1 study, 39 participants: MD -27.00 mmHg, 95% CI -43.33 to -10.67; low certainty evidence) and diastolic blood pressure level (2 studies, 76 participants; MD -13.56 mmHg, 95% CI -19.65 to -7.48; I2 = 0%, low certainty evidence) compared to placebo or no treatment. Dihydropyridine CCBs may make little or no difference to occurrence of intradialytic hypotension (2 studies, 287 participants; RR 0.54, 95% CI 0.25 to 1.15; I2 = 0%, low certainty evidence) compared to placebo or no treatment. Other side effects were not reported. Eight studies (1037 randomised adults) compared dihydropyridine CCBs to other antihypertensives. Dihydropyridine CCBs may make little or no difference to predialysis systolic (4 studies, 180 participants: MD 2.44 mmHg, 95% CI -3.74 to 8.62; I2 = 0%, low certainty evidence) and diastolic blood pressure (4 studies, 180 participants: MD 1.49 mmHg, 95% CI -2.23 to 5.21; I2 = 0%, low certainty evidence) compared to other antihypertensives. There was no evidence of a difference in the occurrence of intradialytic hypotension (1 study, 92 participants: RR 2.88, 95% CI 0.12 to 68.79; very low certainty evidence) between dihydropyridine CCBs to other antihypertensives. Other side effects were not reported. Dihydropyridine CCB may make little or no difference to predialysis systolic (1 study, 40 participants: MD -4 mmHg, 95% CI -11.99 to 3.99; low certainty evidence) and diastolic blood pressure (1 study, 40 participants: MD -3.00 mmHg, 95% CI -7.06 to 1.06; low certainty evidence) compared to non-dihydropyridine CCB. There was no evidence of a difference in other side effects (1 study, 40 participants: RR 0.13, 95% CI 0.01 to 2.36; very low certainty evidence) between dihydropyridine CCB and non-dihydropyridine CCB. Intradialytic hypotension was not reported. AUTHORS' CONCLUSIONS: The benefits of CCBs over other antihypertensives on predialysis blood pressure levels and intradialytic hypotension among people with CKD who required haemodialysis were uncertain. Effects of CCBs on other side effects and cardiovascular death also remain uncertain. Dihydropyridine CCBs may decrease predialysis systolic and diastolic blood pressure level compared to placebo or no treatment. No studies were identified in children or peritoneal dialysis. Available studies have not been designed to measure the effects on costs. The shortcomings of the studies were that they recruited very few participants, had few events, had very short follow-up periods, some outcomes were not reported, and the reporting of outcomes such as changes in blood pressure was not done uniformly across studies. Well-designed RCTs, conducted in both adults and children with CKD requiring both haemodialysis and peritoneal dialysis, evaluating both dihydropyridine and non-dihydropyridine CCBs against other antihypertensives are required. Future research should be focused on outcomes relevant to patients (including death and cardiovascular disease), blood pressure changes, risk of side effects and healthcare costs to assist decision-making in clinical practice.

A qualitative study on antibiotic use and animal health management in smallholder dairy farms of four regions of India.

BACKGROUND: Antimicrobial resistance (AMR) is a major global public health issue. In India, access to medicines is poorly regulated and therefore antibiotics in dairy cattle are commonly used by farmers without consulting with veterinarians. This study was conducted to understand practices and knowledge related to antibiotic use and AMR among dairy farmers and veterinary professionals in selected urban and peri-urban areas of India. METHODS: A total of 28 focus group discussions with farmers and 53 interviews with veterinary professionals were carried out. RESULTS: Mastitiswas identified as the main animal health challenge. Antibiotic consultation behavior of farmers depended on the availability of veterinarians. Except in Bangalore, farmers were found to often treat animals on their own. They were found unaware of the concept of AMR, but knew the importance of vaccination. Veterinarians included in the study had a good understanding of antibiotics, AMR, and zoonotic diseases. CONCLUSION: The knowledge level and practices observed in the study related to the use/abuse of antibiotics can potentially increase the risk of development of AMR and its transfer in the community. Our findings can help support AMR - mitigation efforts in the country, including the design of better policies on antibiotic use in dairy.

A review of animal health and drug use practices in India, and their possible link to antimicrobial resistance.

BACKGROUND: Livestock production, particularly the dairy sector, is important for food and nutritional wellbeing of communities in India, it supports livelihoods of many farmers, and contributes to the economy of the country. India is a high consumer of antibiotics and antimicrobial resistant (AMR) bacteria are a major public health concern. OBJECTIVES: Our objectives were to identify animal health and drug use practices that may contribute to emergence and spread of AMR in the country, review previous AMR- mitigation strategies, and discuss "theory of change" as an approach to informing the choice of interventions. METHODS: We undertook a desk review of literature to identify practices with potential to contribute to emergence and spread of antimicrobial resistance in India. Searches were done in PubMed, Google scholar, and Google. Data were synthesized and discussed by themes. RESULTS: Animal disease surveillance is less developed and infrastructure to support delivery of services is inadequate. Several groups are known to offer animal health services. The untrained "animal health workers" and para-veterinarians are more popular with farmers as they charge less for consultations (compared to veterinarians who are few and charge more). Over-the-counter access of antibiotics, without prescription, and direct marketing of drugs to farmers are common. Because of this, farmers are able to treat their animals and only consult when cases become non- responsive to treatment. Antibiotics are mostly used in management of mastitis cases. Drug withdrawal periods are rarely observed and occurrence of antibiotic- contaminated milk has been reported. Awareness on AMR is low and antimicrobial stewardship in livestock is yet to be developed. Initiatives such as the National programme for containment of AMR, National Action Plan on AMR, and the National Health policy point to government's commitment in addressing the problem of AMR in the country. CONCLUSION: Several animal health and drug use practices, with potential to cause AMR, have been described, and their contribution can be discussed further by engaging stakeholders in a "theory of change" exercise. Interventions that address AMR from the animal health perspective should be promoted, and incentives to increase their adoption explored.

Possibilities of establishing a smallholder pig identification and traceability system in Kenya.

Consumers have a right to safer foods, and traceability is one approach to meeting their expectations. Kenya does not have an operational animal traceability system, and while a few initiatives have been piloted, these have only focused on the beef value chain. In this paper, we begin a discussion on traceability in the pig value chain, with an initial focus on smallholder systems of Western Kenya. First, a background to local pig production is given, and a description of animal identification and traceability options applicable to these systems is explained. Based on this, a "butcher-to-farm" traceability system, with health, production and food safety as objectives, is discussed. Requirements for establishing such a system (including actor incentives) are additionally discussed. The proposed approach can be piloted in the field and findings used to inform the design of a larger pilot and possibly pave way for implementation of a national traceability system, in line with the guidelines provided by the World Organization for Animal Health (OIE). Organized systems in the area (including commercial producer and trader groups) would offer a useful starting point.

Occurrence of aflatoxin M1 in raw milk traded in peri-urban Nairobi, and the effect of boiling and fermentation.

Background: Dairy production in Kenya is important and dominated by small-holder farmers who market their produce through small-scale traders in the informal sector. Method: This study aimed to determine the prevalence of aflatoxin (AFM1) in informally marketed milk in peri-urban Nairobi, Kenya, and to assess knowledge of milk traders on aflatoxins using questionnaires. A total of 96 samples were analyzed for AFM1 using enzyme-linked immunosorbent assay. In addition, boiling and fermentation experiments were carried out in the laboratory. Results: All samples had AFM1 above the limit of detection (5 ng/kg) (mean of 290.3 ± 663.4 ng/kg). Two-thirds of the samples had AFM1 levels above 50 ng/kg and 7.5% of the samples exceeded 500 ng/kg. Most of the traders had low (69.8%) or medium (30.2%) knowledge. Educated (p = 0.01) and female traders (p= 0.04) were more knowledgeable. Experimentally, fermenting milk to lala (a traditional fermented drink) and yogurt significantly reduced AFM1 levels (p< 0.01) (71.8% reduction in lala after incubation at room temperature for 15 h, and 73.6% reduction in yogurt after incubation at 45ºC for 4h). Boiling had no effect. Conclusion: The study concluded that the prevalence of raw milk with AFM1 was high, while knowledge was low. Fermentation reduced the AFM1 levels.

Status of aflatoxin contamination in cow milk produced in smallholder dairy farms in urban and peri-urban areas of Nairobi County: a case study of Kasarani sub county, Kenya.

Introduction: Milk consumption in Kenya supersedes other countries in East Africa. However, milk contamination with aflatoxin M1 (AFM1) is common, but the magnitude of this exposure and the health risks are poorly understood and need to be monitored routinely. This study aimed at assessing the awareness, knowledge and practices of urban and peri-urban farmers about aflatoxins and determining the levels of aflatoxin contamination in on-farm milk in a selected area within Nairobi County. Materials and methods: A cross-sectional study was undertaken to assess aflatoxin contamination levels of milk in Kasarani sub-county. A total of 84 milk samples were collected from small-holder dairy farms and analyzed for AFM1 using Enzyme-Linked Immunosorbent Assay (ELISA). Results and Discussion: Ninety nine percent of the samples (83/84) analysed were contaminated with AFM1. The mean aflatoxin level was 84 ng/kg with 64% of the samples exceeding the EU legal limit of 50 ng/kg. Whereas 80% of the farmers were aware of aflatoxin, there was no correlation between farmers' knowledge and gender with AFM1 prevalence. Conclusion: This study concludes that AFM1 is a frequent contaminant in milk and there is need to enhance farmers awareness on mitigation.

Analysis of pastoralists' perception on challenges and opportunities for sheep and goat production in Northern Kenya.

Small ruminants' production contributes to livelihood of pastoral communities, but this faces myriad constraints. This study aimed at identifying challenges facing producers of small ruminants, prioritizing diseases and their control measures and documenting opportunities for improvement. Sixteen focus group discussions with livestock owners and 13 key informant interviews were done in selected areas in Mandera County, Northern Kenya, and both quantitative and qualitative data collected using a questionnaire guide. Occurrences of diseases (27.4%) and drought (25%) were consistently ranked high in all groups. Other production challenges included increased predation of livestock, inadequate delivery of veterinary services, and increased livestock mortalities. Peste des Petit ruminants was ranked high with a median rank of 21.5%, while contagious caprine pleuropneumonia and sheep and goat pox were ranked second and third, respectively. Other diseases included tick-borne diseases, helminthosis, and pneumonia. Vaccination was ranked as the most effective control strategy for infectious diseases. Other control measures included recitation of Quran and cauterization. However, several opportunities exist for support of small ruminants' production: increased budgetary allocation for disease control by government, initiation of projects that enhance livestock production in the region by government and its development partners. These findings are useful for policy makers for disease control and organizations that are working on projects that focuses on enhancement of pastoralists' resilience, while future research could also identify appropriate technologies that reduces these impacts.

Piloting a livestock identification and traceability system in the northern Tanzania-Narok-Nairobi trade route.

We designed and piloted a livestock identification and traceability system (LITS) along the Northern Tanzania-Narok-Nairobi beef value chain. Animals were randomly selected and identified at the primary markets using uniquely coded ear tags. Data on identification, ownership, source (village), and the site of recruitment (primary market) were collected and posted to an online database. Similar data were collected in all the markets where tagged animals passed through until they got to defined slaughterhouses. Meat samples were collected during slaughter and later analyzed for tetracycline and diminazene residues using high-performance liquid chromatography (HPLC). Follow up surveys were done to assess the pilot system. The database captured a total of 4260 records from 741 cattle. Cattle recruited in the primary markets in Narok (n = 1698) either came from farms (43.8%), local markets (37.7%), or from markets in Tanzania (18.5%). Soit Sambu market was the main source of animals entering the market from Tanzania (54%; n = 370). Most tagged cattle (72%, n = 197) were slaughtered at the Ewaso Ng'iro slaughterhouse in Narok. Lesions observed (5%; n = 192) were related to either hydatidosis or fascioliasis. The mean diminazene aceturate residue level was 320.78 ± 193.48 ppb. We used the traceability system to identify sources of animals with observable high drug residue levels in tissues. Based on the findings from this study, we discuss opportunities for LITS-as a tool for surveillance for both animal health and food safety, and outline challenges of its deployment in a local beef value chain-such as limited incentives for uptake.

Diagnostic performance of smear microscopy and incremental yield of Xpert in detection of pulmonary tuberculosis in Rwanda.

BACKGROUND: Tuberculosis control program of Rwanda is currently phasing in light emitting diode-fluorescent microscopy (LED-FM) as an alternative to Ziehl-Neelsen (ZN) smear microscopy. This, alongside the newly introduced Xpert (Cepheid, Sunnyvale, CA, USA) is expected to improve diagnosis of tuberculosis and detection of rifampicin resistance in patients at health facilities. We assessed the accuracy of smear microscopy and the incremental sensitivity of Xpert at tuberculosis laboratories in Rwanda. METHODS: This was a cross-sectional study involving four laboratories performing ZN and four laboratories performing LED-FM microscopy. The laboratories include four intermediate (ILs) and four peripheral (PLs) laboratories. After smear microscopy, the left-over of samples, of a single early-morning sputum from 648 participants, were tested using Xpert and mycobacterial culture as a reference standard. Sensitivity of each test was compared and the incremental sensitivity of Xpert after a negative smear was assessed. RESULTS: A total of 96 presumptive pulmonary tuberculosis participants were culture positive for M. tuberculosis. The overall sensitivity in PL of ZN was 55.1 % (40.2-69.3 %), LED-FM was 37 % (19.4-57.6 %) and Xpert was 77.6 % (66.6-86.4 %) whereas in ILs the same value for ZN was 58.3 % (27.7-84.8 %), LED-FM was 62.5 % (24.5-91.5 %) and Xpert was 90 (68.3-98.8 %). The sensitivity for all tests was significantly higher among HIV-negative individuals (all test p <0.05). The overall incremental sensitivity of Xpert over smear microscopy was 32.3 %; p < 0.0001. The incremental sensitivity of Xpert was statistically significant for both smear methods at PL (32.9 %; p = 0.001) but not at the ILs (30 %; p = 0.125) for both smear methods. CONCLUSIONS: Our study findings of the early implementation of the LED-FM did not reveal significant increment in sensitivity compared to the method being phased out (ZN). This study showed a significant incremental sensitivity for Xpert from both smear methods at peripheral centers where majority of TB patients are diagnosed. Overall our findings support the recommendation for Xpert as an initial diagnostic test in adults and children presumed to have TB.

Prevalence of Drug Resistance Mycobacterium Tuberculosis among Patients Seen in Coast Provincial General Hospital, Mombasa, Kenya.

BACKGROUND: Although prevention and control of spread of multi-drug resistant tuberculosis strains is a global challenge, there is paucity of data on the prevalence of DR-TB in patients diagnosed with TB in referral hospitals in Kenya. The present study assessed patients' characteristics and prevalence of drug resistant TB in sputa smear positive TB patients presenting to Coast Provincial General Hospital (CPGH) in Mombasa, Kenya. METHODS: Drug resistance was evaluated in 258 randomly selected sputa smear TB positive cases between the periods of November 2011 to February 2012 at the CPGH-Mombasa. Basic demographic data was obtained using administered questionnaires, and clinical history extracted from the files. For laboratory analyses, 2mls of sputum was obtained, decontaminated and subjected to mycobacteria DNA analyses. Detection of first line drug resistance genes was done using MDRTDR plus kit. This was followed with random selection of 83 cases for second line drug resistance genes testing using Genotype MDRTBsl probe assay kit (HAINS Lifesciences, GmbH, Germany), in which ethambutol mutation probes were included. The data was then analyzed using SPSS statistical package version 19.0. RESULTS: Male to female ratio was 1:2. Age range was 9 to 75 years, with median of 30 years. New treatment cases constituted 253(98%), among which seven turned out to be PTB negative, and further grouped as 4 (1.6%) PTB negative and 3(1.1%) NTM. 237(91.7%) new cases were fully susceptible to INH and RIF. The remaining, 8 (3.1%) and 1(0.4%) had mono- resistance to INH and RIF, respectively. All the retreatment cases were fully susceptible to the first line drugs. HIV positivity was found in 48 (18.6%) cases, of which 46(17.8%) were co-infected with TB. Of these, 44 (17.1%) showed full susceptibility to TB drugs, while 2 (0.8%) were INH resistant. For the second line drugs, one case each showed mono resistance to both and FQ. Also, one case each showed drug cross poly resistance to both ETH and FQ, with second line injectable antibiotics. However, no significant statistical correlation was established between TB and resistance to the second line drugs p = 0.855. CONCLUSION: The findings of this study showed the existence of resistance to both first and second line anti-tubercular drugs, but no MDR-TB and XDR-TB was detected among patients attending TB clinic at CPGH using molecular techniques.