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.