Survey of faecal parasites in patients from western Kenya.

Faecal specimens were collected from patients complaining of diarrhoea and abdominal or epigastric discomfort at two hospitals. Information obtained by questionnaires completed at the time of specimens collection, included demographic and clinical data. Specimens were preserved in 10% formalin and polyvinyl alcohol (PVA) and examined, as wet mounts and stained with Wheatley's Trichrome, Weber, modified acid-fast and hot safranin stains. One hundred patients were examined, in 30 of them parasites were detected. The most common organism identified was Cryptosporidium parvum, in specimens of five patients, followed by Entamoeba histolytica/E. dispar in four patients. The recently described "emerging parasites" were detected. Helminth eggs were found in two patients only. HIV status was not known for most of the patients, and the parasites commonly proliferate in the immuno-compromised individuals were not frequently found.

Rectal dihydroartemisinin versus intravenous quinine in the treatment of severe malaria: a randomised clinical trial.

OBJECTIVE: To compare the clinical efficacy and safety of rectal dihydroartemisinin (DATM--Cotecxin) and intravenous quinine in the treatment of severe malaria in children and adults. SETTING: Moi Teaching and Referral Hospital, Eldoret, Kenya between July and November 1998. PATIENTS: A total of sixty seven patients aged two to sixty years with severe malaria were studied. DESIGN: This was an open randomised comparative clinical trial. OUTCOME MEASURES: These were parasite clearance time, fever clearance time, efficacy and the side effect profile of the two drugs. RESULTS: The two groups were comparable on admission on the clinical and laboratory parameters. The parasite clearance time was shorter in the rectal DATM group than quinine group. There was no statistical difference on the fever clearance time and cure rates in the two groups. The adverse reaction profile was better with rectal DATM than with quinine, tinnitus observed more in the quinine group. CONCLUSION: Rectal DATM is faster in parasite clearance than quinine and is a safe and convenient alternative to quinine in the treatment of severe malaria.

Malaria prevalence and morbidity in relation to the use of permethrin-treated wall cloths in Kenya.

The effect of permethrin-treated wall cloths (Mbu cloth) on malaria parasitaemia prevalences and malaria morbidity, was evaluated in a population of over 10,000 for a period of three years in the Marigat area, Baringo District, Kenya. The use of the treated cloth in 2,000 houses resulted in significantly lower rates of malaria parasite prevalences with an overall reduction rate of 73% (P < 0.001) in the treated area. Control areas had an initial increase in rate of malaria parasite prevalence of 30% and later a reduction of 31%. There was a slight reduction in spleen rates in the control and treated areas but it was not significant for either between the surveys or among the villages.

PIP: The use of pyrethroid-treated fabrics against disease vectors is a well-accepted vector control strategy worldwide. Most studies have assessed the merits of using impregnated bednets, but this prevention strategy is inappropriate for many households in many communities due to incompatible cultural norms, high cost, the lack of conventional western style beds, sleeping arrangements which differ between cultures, and differences between housing construction styles in rural communities. The International Center of Insect Physiology and Ecology recently developed a technology using cotton wall cloth, Mbu cloth, to control vectors of malaria and leishmaniasis in rural communities in Kenya. Other fabrics such as polyester have even improved the technology by making the cloth lighter and cheaper. The authors evaluated the effect of permethrin-treated Mbu cloth on malaria parasitemia prevalences and malaria morbidity in a population of over 10,000 for a period of 3 years in the Marigat area of Baringo District, Kenya. 2000 houses were fitted with the cloth. The prevalence of malaria parasites was reduced an overall 73% in the treated area. Control areas saw a 30% initial increase in the rate of malaria parasite prevalence followed by a reduction of 31%. Slight reductions in spleen rates were also observed in the control and treated areas, but were insignificant between the surveys and among the villages.

Visceral leishmaniasis and malaria prevalence in West Pokot District, Kenya.

The prevalence of visceral leishmaniasis and malaria in the human population of West Pokot district of Kenya was studied in 1986. A total of 2139 people was proportionately screened for the two diseases according to four age categories (0-4, 5-14, 15-44 and greater than 45 years). Diagnostic methods included the enzyme linked immunosorbent assay (ELISA) and Leishmanin skin test for visceral leishmaniasis, and parasitological examination for malaria. The epidemiological value of the spleen rate was evaluated in relation to visceral leishmaniasis and malaria endemicity. A general decline of infection rates with altitude was observed for both diseases. Visceral leishmaniasis was less prevalent than malaria, with less than 2% active cases in any age group and had the same distribution in both sexes. Malaria infection rate was highest in the younger age groups, declining from 21.5% in the 0-4 year old age group to 5.5% in people more than 45 years old. Malaria affected significantly more males than females. The spleen rate was inappropriate for epidemiological survey of either malaria or visceral leishmaniasis due to an overlap in the distribution of the two diseases.

Viral haemorrhagic fever surveillance in Kenya, 1980-1981.

Following two cases of Marburg virus disease in Kenya in 1980, viral haemorrhagic fever surveillance was undertaken in western Kenya. Over a 21-month period investigations, including virus isolation attempts, patient and contact serology, visits to areas where suspected cases occurred, interviewing family members and neighbours of suspected cases and following up any additional illnesses in these areas, were carried out. During the study two cases were found that were likely to have been Ebola haemorrhagic fever based on rising antibody titres or positive serology in contacts. Diagnoses of hepatitis A, hepatitis B, malaria, bacterial septicaemia or other causes were arrived at in 24 cases. No diagnosis could be made in 26 instances. 741 human sera were tested for antibodies against Marburg, Ebola, Congo haemorrhagic fever, Rift Valley fever or Lassa fever viruses by indirect fluorescence. Eight sera were positive for Ebola virus antibodies, all of which were from suspected cases or contacts of suspected cases. Two sera were antibody positive to Congo virus and one had antibodies against Rift Valley fever virus. No Marburg or Lassa virus antibodies were detected.