COMMUNITY PERCEPTIONS OF SCHISTOSOMIASIS TRANSMISSION, PREVALENCE AND CONTROL IN RELATION TO AQUATIC HABITATS IN THE LAKE VICTORIA BASIN OF KENYA.

BACKGROUND: Intestinal schistosomiasis caused by Schistosoma mansoni and urinary schistosomiasis caused by Schistosoma haematobium are widely distributed parasites in several localities of the Lake Victoria basin of Kenya, the former being more prevalent. In Kenya, transmission of the intestinal form of bilharzia (S. mansoni) tends to be closely confined to narrow zones along the shores of large bodies of water such as Lake Victoria where it is endemic and the intermediate host is found. The prevalence of S. mansoni along the Kenyan Lake Victoria basin ranges between 40% and 80%. OBJECTIVE: To assess the community's knowledge and perceptions of schistosomiasis prevalence, transmission and control in relation to aquatic habitats in the Lake Victoria basin of Kenya. DESIGN: Community-based cross-sectional study. SETTING: The Kenyan Lake Victoria basin. SUBJECTS: Two hundred and forty three individuals (both women and men residing in the beaches and surrounding areas) were interviewed about their knowledge and perceptions regarding schistosomiasis. RESULTS: The community regarded schistosomiasis as a naturalistic disease not caused by supernatural forces but by an agent of contamination in water. Knowledge on schistosomiasis transmission and control was low, with 42% of the respondents having no idea on how schistosomiasis is contracted, while 22% and 18% of the respondents mentioned contact with contaminated water and drinking / eating dirty water / food, respectively. Most respondents were familiar with the snails' habitats, but had poor knowledge on aquatic plants harbouring snails, as 57% of the respondents did not know about aquatic plants being associated with schistosomiasis snails. Only 3% of the respondents associated snails with schistosomiasis transmission. Sixty percent (60%) of the respondents mentioned use of tablets and injections as means of treating schistosomiasis, while 38% had no idea how it is treated and 2% mentioned use of local herbs and services of medicine men. CONCLUSION: Majority of Kenyan Lake Victoria basin inhabitants had little awareness about schistosomiasis despite high prevalence of the disease in the region. There is need to adapt prevention and control strategies to the people's livelihoods. There is also need to target the less advantaged members of the community such as women, uneducated and subsistence farmers for intense health education strategies aimed at increasing participation in the control of schistosomiasis. Study to elicit divergence between biomedical and local understandings of schistosomiasis/bilharzia is suggested.

Community perceptions of schistosomiasis transmission, prevalence and control in relation to aquatic habitats in the Lake Victoria Basin of Kenya

Background: Intestinal schistosomiasis caused by Schistosoma mansoni and urinary schistosomiasis caused by Schistosoma haematobium are widely distributed parasites in several localities of the Lake Victoria basin of Kenya; the former being more prevalent. In Kenya; transmission of the intestinal form of bilharzia (S. mansoni) tends to be closely confined to narrow zones along the shores of large bodies of water such as Lake Victoria where it is endemic and the intermediate host is found. The prevalence of S. mansoni along the Kenyan Lake Victoria basin ranges between 40. Objective: To assess the community's knowledge and perceptions of schistosomiasis prevalence; transmission and control in relation to aquatic habitats in the Lake Victoria basin of Kenya. Design: Community-based cross-sectional study. Setting: The Kenyan Lake Victoria basin. Subjects: Two hundred and forty three individuals (both women and men residing in the beaches and surrounding areas) were interviewed about their knowledge and perceptions regarding schistosomiasis. Results: The community regarded schistosomiasis as a naturalistic disease not caused by supernatural forces but by an agent of contamination in water. Knowledge on schistosomiasis transmission and control was low; with 42of the respondents having no idea on how schistosomiasis is contracted; while 22 and 18of the respondents mentioned contact with contaminated water and drinking / eating dirty water / food; respectively. Most respondents were familiar with the snails' habitats; but had poor knowledge on aquatic plants harbouring snails; as 57of the respondents did not know about aquatic plants being associated with schistosomiasis snails. Only 3 of the respondents associated snails with schistosomiasis transmission. Sixty percent (60) of the respondents mentioned use of tablets and injections as means of treating schistosomiasis; while 38 had no idea how it is treated and 2 mentioned use of local herbs and services of medicine men. Conclusion: Majority of Kenyan Lake Victoria basin inhabitants had little awareness about schistosomiasis despite high prevalence of the disease in the region. There is need to adapt prevention and control strategies to the people's livelihoods. There is also need to target the less advantaged members of the community such as women; uneducated and subsistence farmers for intense health education strategies aimed at increasing participation in the control of schistosomiasis. Study to elicit divergence between biomedical and local understandings of schistosomiasis/bilharzia is suggested

Thryroid hormones and hematological indices levels in thyroid disorders patients at moi teaching and referral hospital, Western kenya.

Problem Statement. Thyroid disorders are prevalent in western Kenya, but the effects of disorders on thyroid hormones and hematological indices levels have not been documented. Study Population. Patients treated for thyroid disorders at the MTRH between January 2008 and December 2011. Objectives. To determine the thyroid hormones and hematological indices levels in thyroid disorders patients at the MTRH, western Kenya. Methodology. A retrospective study in which patient data and stored samples of patients, who presented with thyroid pathologies, underwent thyroidectomy, and histological examinations are done. Thyroid stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3) blood levels, white blood cells (WBCs), red blood cells (RBCs), platelet counts, and hemoglobin (Hb) levels were analyzed. Results. Male : female ratio was 1 : 10.9 with female representing 368 (95%). The median age was 41 (IQR: 32-48) with a range of 14-89 years. HHormonal levels for immunological thyroid disease patients were higher (P = 0.0232; 0.040) for TSH and (T3) for those aged 30-39 years, respectively. The WBCs, RBCs, HGB, and platelets in immunological thyroid disease were not statistically significant with P values of 0.547, 0.205, 0.291, and 0.488 respectively. Conclusion. The presence of anaemia due to low RBCs in thyroid disease is not significantly associated with thyroid hormone with a P value of 0.512.

LIVER FUNCTION MARKERS AND ASSOCIATED SERUM ELECTROLYTES CHANGES IN HIV PATIENTS ATTENDING PATIENT SUPPORT CENTRE OF JARAMOGI OGINGA ODINGA TEACHING AND REFERRAL HOSPITAL, KISUMU COUNTY, KENYA.

OBJECTIVE: To determine the distribution of markers of liver function disorders and their association with co-existing fluids and electrolytes states in ambulatory HIV infected individuals. DESIGN: A case-control study. SETTING: Jaramogi Oginga Odinga Teaching and Referral Hospital's Patient Support Centre. INTERVENTION: Biochemical analysis were performed for serum alanine-aminotranferase (ALT), aspartate-amino transferase (AST), total protein, albumin, glucose, urea, potassium, sodium, chloride, creatinine phosphate, total and direct bilirubin levels as well as CD4 lymphocyte levels. RESULTS: Serum liver function markers were significantly altered in HIV infected individuals compared to uninfected individuals (mean serum aspartate-amino transferase (AST); 45.1 U/l v/s 36.9 U/l; alanine-aminotransferase (ALT), 36.5U/l v/s 30.7 U/l; direct bilirubin, 4.9 micromol/l v/s 4.2 micromol/l; total bilirubin, 6.2 micromol/l v/s 5 micromol/l; albumin32.8 g/l v/s 34.3 g/l and protein 64 g/l vls 67.1 g/l; p <0.0001). The prevalence of pathological levels of serum liver function markers was also higher in HIV-infected patients than HIV-negative participants (ALT, 4.4% v/s 0.7%, p=0.001; AST, 24.5% v/s 6.7%, p<0.0001; direct bilirubin, 43.1% v/s 36.5%, p=0.026; total bilirubin, 2.3% v/s 0%, p=0.002; serum albumin, 60.1% v/s 52.2%, p= 0.009 and serum total protein levels, 52.8% v/s 36%, p<0.0001). Gender, age and anti-retroviral treatment were not predictors of aberrations in levels of liver function markers in HIV infected patients. Marked CD4 depletion was associated with enhanced deterioration of liver function markers. Liver function anomalies did not conduce co-existing electrolyte anomalies as clinically altered ALT states only correlated and co-varied with AST states (r = 0.917); direct biliribun states co-varied with total bilirubin levels (r = 0.958) and serum album states correlated with protein levels (r = 0.917) and vice versa. CONCLUSION: Liverfunction disorders are not infrequent in HIV infected individuals and routine review of liver health status is essential in comprehensive care of HIV patients.

Urine markers of kidney disorders and their risk associations in HIV-infected patients attending Nyanza Provincial General Hospital in Kisumu, Western Kenya.

OBJECTIVE: To identify abnormal levels of urine metabolites and cells that serve as markers of existing kidney disorders in ambulatory HIV-infected patients. DESIGN: A cross sectional study. SETTING: Nyanza Provincial General Hospital's patient support centre. SUBJECTS: A total of 593 HIV infected patients were studied. INTERVENTION: Dipstick urinalysis test was used to screen mid stream urine to detect constituents with altered levels. RESULTS: Out of the 593 participants, the urine of 214 (36.1%) had abnormally altered levels of urine constituents, with more females afflicted than males [41.5% vs. 27.8%; OR 1.84 (1.28-2.63), chi2 = 11.08, p = 0.0009]. Urobilinogen was the most common urine metabolite while ketones were least commonly present. More participants had altered levels of leucocytes than erythrocytes in urine. Patients with pyuria were three times more likely to have elevated erythrocytes in their urine as well (chi2 = 34.37, p < 0.0001). Similarly, the risk of having proteinuria was three times higher in patients with pyuria (p < 0.0003, Fisher's test). Patients with erythrocytes in urine also had a threefold likelihood of having proteinuria (P < 0.0003, Fisher's test). Fewer ARV users had abnormal urine markers [15.7% vs 24.3% OR 0.62 (0.41-0.94), chi2 = 5.2, p < 0.05]. CONCLUSION: Metabolites and cellular markers of kidney disorders were prevalent in the urine of HIV patients especially females and those with pronounced immune depletion (CD4 counts equal to or below 500). ARVs use was associated with reduced manifestation of these markers.

A simple perfusion technique for isolation of maternal intervillous blood mononuclear cells from human placentae.

A noninvasive perfusion method for the recovery of maternal placental (intervillous) blood for use in immunologic assays is described. 60% of the perfused blood samples tested for fetal red blood cell (RBC) contamination were found to be pure maternal blood; in the remainder, fetal RBC contamination, with a single exception, was less than 6%. The intervillous mononuclear cells (IVBMC) isolated from this blood were of predominantly maternal origin as demonstrated by a polymerase chain reaction-based DNA typing technique. The number of IVBMC obtained was within the range of 9 to 55 X 10(6) cells. Phenotypic analysis of IVBMC surface antigens revealed that 61% of the cells were CD3 + T-cells and 18% were CD19 + B-cells. The CD4 + and CD8 + T-lymphocyte subsets accounted for 28 and 26% of the IVBMC, respectively. The IVBMC were functionally competent as evidenced by in vitro lymphoproliferation and cytokine production in response to mitogen and PPD stimulation. This technique allows for rapid and safe isolation of large numbers of IVBMC which are functionally active up to 12 h post-delivery, thus representing a significant improvement over previously described methods. It should facilitate more vigorous research in the study of uteroplacental immunity and infectious disease research, particularly in field settings where sample collection and laboratory facilities are distant.

The impact of permethrin-impregnated bednets on malaria vectors of the Kenyan coast.

The effects of introducing permethrin-impregnated bednets on local populations of the malaria vector mosquitoes Anopheles funestus and the An.gambiae complex was monitored during a randomized controlled trial at Kilifi on the Kenyan coast. Pyrethrum spray collections: inside 762 households were conducted between May 1994 and April 1995 after the introduction of bednets in half of the study area. All-night human bait collections were performed in two zones (one control and one intervention) for two nights each month during the same period. PCR identifications of An.gambiae sensu lato showed that proportions of sibling species were An.gambiae sensu stricto > An.merus > An.arabiensis. Indoor-resting densities of An.gambiae s.l. and the proportion of engorged females decreased significantly in intervention zones as compared to control zones. However, the human blood index and Plasmodium falciparum sporozoite rate remained unaffected. Also vector parous rates were unaltered by the intervention, implying that survival rates of malaria vectors were not affected. The human-biting density of An.gambiae s.l., the predominant vector, was consistently higher in the intervention zone compared to the control zone, but showed 8% reduction compared to pre-intervention biting rates-versus 94% increase in the control zone. Bioassay, susceptibility and high-performance liquid chromatography results all indicated that the permethrin content applied to the nets was sufficient to maintain high mortality of susceptible vectors throughout the trial. Increased rates of early outdoor-biting, as opposed to indoor-biting later during the night, were behavioural or vector composition changes associated with this intervention, which would require further monitoring during control programmes employing insecticide-treated bednets.

Some observations on the biting behavior of Anopheles gambiae s.s., Anopheles arabiensis, and Anopheles funestus and their implications for malaria control.

Studies were carried out in three villages in western Kenya on the biting behavior of Anopheles gambiae s.s., Anopheles arabiensis, and Anopheles funestus. Blood feeding behavior and departure from houses were studied under the impact of permethrin-impregnated eaves-sisal curtains. Only 2-13% of the female vector population was collected biting before 2200 hr. Over 90% of the villagers went to bed by 2100 hr. An. funestus was 6.6-8.2 times more likely to bite people indoors than outdoors, while An. gambiae s.l. females were only 2 times as likely. Under the influence of permethrin-impregnated sisal curtains placed under the eaves of village houses, there was a marked egress of blood-fed An. funestus and An. gambiae s.s. Permethrin seems to have induced exophily of half-gravid female An. gambiae s.s. While An. gambiae s.s. remained highly anthropophagic under the impact of permethrin, An. funestus shifted to feeding more on cattle. An arabiensis were largely zoophilic. Our results underline the difficulties of controlling An. gambiae s.s., the principal African malaria vector. New strategies must be found to control this vector.

Response of falciparum malaria to chloroquine and three second line antimalarial drugs in a Kenyan coastal school age population.

Ambulatory rural school children in the Mombasa area with P. falciparum parasitaemia were examined and randomly assigned to treatment with one of three second-line antimalarials--amodiaquine, pyrimethamine/sulphadoxine (P/SD) and pyrimethamine/sulfalene (P/SL). Clinical signs and parasitaemia were followed daily for the first week and on days 14 and 28. WHO Mark II schizont inhibition tests were performed for all the above 3 drugs and chloroquine. The total number of cases was 73. The mean parasite density was 142.1 +/- 207; 102.7 +/- 166; 82.74 +/- 93 parasites per 300 WBC for amodiaquine, P/SD, and P/SL, respectively. In vitro tests showed a chloroquine resistance rate of 60% and no resistance to all of the second line drugs. Also, all children treated successfully cleared their parasitaemia with mean clearance rates of 2.05 +/- 0.57; 1.86 +/- 0.47; 2.05 +/- 0.50 days for amodiaquine, P/SD and P/SL, respectively. Even though, no difference in the effectiveness between the second line drugs used was found, reinfection rates as depicted by day 28 parasitaemia differed--amodiaquine 16%; P/SD 0%; and P/SL4.35%. This difference could be attributed to the difference in the pharmacokinetic properties of the drugs.

PIP: In Kenya, in May-June 1990, clinicians screened 728 primary school children in Mazeras, a coastal village, for Plasmodium falciparum parasitemia and randomly assigned them to receive 1 of 3 second-line antimalarials (amodiaquine, pyrimethamine/sulfadoxine [P/SD], and pyrimethamine/sulfalene [P/SL] to treat malaria. Laboratory personnel at the Coast Provincial General Hospital conducted WHO Mark II schizont inhibition tests for all 3 antimalarials and chloroquine. The clinicians followed the children every day for the first week and at 2 and 4 weeks. 10.44% (76) of the children had falciparum malaria (=or 40 asexual parasites/300 WBC). 3 were lost to follow-up, so 73 children were part of the in vivo study. Prior to treatment, mean parasite densities were 142.1/300 WBC for the amodiaquine group, 102.7/300 WBC for the P/SD group, and 82.74/300 WBC for the P/SL group. The mean clearance time for 2.05 days for amodiaquine, 1.86 days for P/SD, and 2.05 days for P/SL. By day 14, none of the children had parasitemia and no differences in mean body temperatures existed. On day 28, 16% of the children in the amodiaquine group and 4.35% of those in the P/SL group were reinfected compared to none in the P/SD group (p .05). Differences in the pharmacokinetic properties of these second line antimalarials may account for the difference in reinfection rates. 60% of the isolates were resistant to chloroquine. None were resistant to the second line drugs. Isolates were highly sensitive to both P/SD and P/SL. These findings show the need for the Kenyan Ministry of Health to reexamine chloroquine as a treatment for falciparum malaria in areas of confirmed high chloroquine resistance.

Cultivation of Plasmodium falciparum parasites in a serum-free medium.

The elimination of serum from Plasmodium falciparum culture media could decrease costs, enhance procurement, and improve the feasibility of large-scale production of parasite material. We provide a semi-defined, serum-free formulation, of commercially available constituents that supports P. falciparum parasite growth at rates comparable with those obtained with serum-supplemented media. The medium is composed of RPMI 1640 to which HEPES, extra glucose, bicarbonate, and hypoxanthine have been added. Bovine albumin and serum-derived, lipids-cholesterol-rich mixture are then used in place of serum.