Browsing by Author "Kering, Kelvin"

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    Epidemiology of Enterotoxigenic Escherichia Coli among Children under Five Years in Kenya’s Urban Informal Settlement
    (Frontiers in Microbiology, 2025-08) Njuguna, Amos; Maingi, John M.; Mbae, Cecilia; Otieno, Phelgona; Kering, Kelvin; Mbithi, Winfred; Kioko, Christine; Osman, Rahma; Kibet, Evans; Kariuki, Samuel
    Introduction: Enterotoxigenic Escherichia coli (ETEC) is a significant cause of diarrheal morbidity and mortality among children under 5 years, particularly in low and middle-income countries. This study aimed to determine the prevalence of ETEC and associated risk factors among children under five presenting with diarrhea in health facilities in Mukuru slums of Nairobi, Kenya, where poor sanitation and hygiene practices are prevalent. Methods: Using a cross-sectional design, we recruited 387 children under five years of age with acute diarrhea. Total nucleic acid (TNA) was extracted from stool samples and analyzed using a PCR-based customized TaqMan Array Card (TAC), which included three ETEC toxin genes (LT, STh, and STp) and six ETEC colonization factors (CFs). A structured questionnaire was employed to collect participants information. Findings: ETEC was detected in 148/387 samples, yielding a prevalence of 38.2% (95% CI: 34.2–42.2%). Both heat-labile and heat-stable (LT/ST) enterotoxin genes were the most common (43%) followed by heat-labile (30%), and heatstable (27%). Colonization factors (CF) were present in 52% (77/148) of ETECpositive samples with CS6 being the most frequently detected CF at 36.3% (28/77). Children aged 13–24 months had significantly elevated odds of infection (aOR = 2.48; 95% CI: 1.36–4.52, p = 0.003), as well as those aged 25–36 month (aOR = 2.12; 95% CI: 1.10–4.10, p = 0.025), 37–48 months (aOR = 2.45; 95% CI: 1.21–4.97, p = 0.013), and 49–59 months (aOR = 2.59; 95% CI: 1.12–6.01, p = 0.027). Households lacking access to private flush toilets exhibited a tripled risk (aOR = 3.04; 95% CI: 1.38–6.71, p = 0.006) of ETEC positivity. Conclusion: These findings highlight the urgent need for targeted public health interventions, including improved sanitation and hygiene practices and vaccine introduction, to mitigate the burden of ETEC-related diarrhea among high-risk populations in disease endemic settings.
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    Molecular detection and antibiotic resistance of diarrheagenic Escherichia coli from street food and water in mukuru slums, Nairobi County
    (PLoS, 2026-01-28) Mundalo, Sheillah; Ntabo, Regina; Kering, Kelvin; Too, Rael; Kariuki, Kevin; Imoli, Diana; Silantoi, Brian; Kiptanui, Evans; Kavai, Susan; Kariuki, Samuel; Mbae, Cecilia
    Globally, diarrheal diseases account for 550 million cases of foodborne illnesses annually. In Kenya, Escherichia coli (E. coli) infections from contaminated food and water pose a serious health concern, especially in settings with poor sanitation and hygiene practices This study examined the genetic characteristics and antimicrobial resistance profiles of diarrheagenic E. coli (DEC) recovered from street foods and water from Mukuru informal settlements, Nairobi. Between September and December 2023, 384 (each 77) samples of street foods (Mandazi, githeri, French fries), wastewater, and drinking water were collected and E. coli isolation performed through microbiological culture and antibiotic susceptibility testing done using Kirby-Bauer disc diffusion method. Conventional Polymerase chain reaction (PCR) was used to screen for six DEC and extended-spectrum beta-lactamase (ESBL) resistance genes. Descriptive and inferential statistics (Pearson’s chi-square test) were used to assess associations between sample types, E. colipositivity, pathotypes, and antibiotic resistance. E. coli was isolated in 16% (62/384) of the samples, with 77.4% (48/62) of the isolated E. coli being DEC. Majority (64.6%, 31/48) of DEC isolates were recovered from wastewater followed by drinking water (22.9%, 11/48), githeri (8.3%, 4/48), mandazi (4.2, 2/48), and none from french fries. The most common pathotypes were; ETEC 69% (33/48), STEC 52.1% (25/48), EIEC 50% (24/48)), EPEC 10% (5/48), and EAEC 6% (3/48) Of the 48 DEC isolates, 30 were hybrid isolates Overall, the E. coli isolates were highly resistant to tetracycline (77.4%), trimethoprim-sulfamethoxazole (71.0%), ampicillin (59.7%) and least resistant to kanamycin (16.1%); chloramphenicol (8.1%) and amoxicillin + clavulanic acid (4.8%). A huge proportion (72.6%, 45/62) of the isolated E. coli were multidrug-resistant (MDR). Of the 45 MDR isolates, 60% (27) were from wastewater, 28.9% (13) from drinking water, 4.4% (2) from githeri, 4.4% (2) from mandazi and 2.2% (1) french fries 2.2%. ESBL genes bla-TEM and bla were detected in 12.9% and 3.2% of the E. coli isolates. isolates. The high prevalence of MDR in the E.coli isolates recovered from environmental compartments and food is a huge public health risk to the population in these settings. The detection of E. coli indicates fecal contamination underscoring the need to improve water, and sanitation infrastructure in urban slums.