RP-Department of Medical Laboratory Sciences

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    Diagnosis of Visceral Leishmaniasis by Enzyme-Linked Immunosorbent Assay Using Urine Samples
    (American Society for Microbiology, 2002-07) Manohar, R.; Shamsuzzaman, S. M.; Mirza, R.; Shamsuzzaman Choudhury, A. K. M.; Furuya, M.; Leafasia, J. L
    A diagnostic method has been developed to detect anti-Leishmania donovani immunoglobulin G (IgG) in urine by enzyme-linked immunosorbent assay (ELISA). In measuring anti-L. donovani IgG, IgA, and IgM in urine, the method performed best in the detection of IgG. The sensitivity and specificity of the assay were determined with panels of urine samples from 62 visceral leishmaniasis (VL) patients, 59 healthy controls from areas of endemicity, 53 healthy controls from areas of nonendemicity, 59 malaria patients, 13 tuberculosis patients, 23 cutaneous leishmaniasis patients, and 7 patients with other diseases. Using L. donovani promastigote crude antigen, the test had 93.5% sensitivity (58 positives of 62 VL patient samples) and 89.3% specificity (191 negatives of 214 non-VL patient samples). The ELISA with acetone-treated L. donovani promastigote antigen raised the sensitivity and specificity to 95.0 and 95.3%, respectively. Western blot analysis revealed that most of the samples that cross-reacted with crude antigen in ELISA did not recognize any antigenic component of L. donovani crude antigen. We also checked 40 serum samples from the same group of VL patients for anti-L. donovani IgG and got 90.0% sensitivity with both crude and acetone-treated antigens. As collection of urine is much easier than collection of serum, the detection of anti-L. donovani IgG in urine with acetone-treated antigen will be useful in epidemiological studies. It could be an adjunct of laboratory diagnosis.Visceral leishmaniasis (VL) is caused by protozoan parasites of the genus Leishmania and is transmitted by an insect vector, the phlebotomine sandfly. More than 47 countries are currently affected by leishmaniasis, with at least 200 million people at risk and approximately 100,000 new cases annually (2). Ninety percent of the cases occur in Bangladesh, India, Nepal, and Sudan. Bangladesh alone contributes about 15,000 new cases annually (10). Both the disease incidence and its severity—it is lethal if left untreated—are linked to poverty: malnutrition is associated with 8.7-times-higher risk for VL (7). Since the disease occurs mainly in areas where health services are poorly developed, the development of a simple, cheap, and reliable diagnostic method is necessary. Demonstration of the parasites in bone marrow aspirates or needle biopsy specimens of the spleen and lymph node or by vitro cultivation are the definitive methods of diagnosis (27). However, these methods are insufficiently sensitive, and the techniques are invasive, painful, and even hazardous (24). A number of serological tests have been developed and evaluated for the diagnosis of VL, including immunofluorescent-antibody tests (40, 43), enzyme-linked immunosorbent assay (ELISA) (12, 14, 15, 20, 22, 25, 33, 42, 46), dot ELISA (23, 31, 36), immunoblot analysis (28, 34, 35), and the direct agglutination test (DAT) (6, 17, 18, 19, 29, 30, 32, 41). Due to its simplicity and high sensitivity and specificity, the DAT has already been introduced as a routine serological test for diagnosis of VL in India and Bangladesh, and the parameters of the test have been established under local conditions (1, 8, 9, 10, 13, 41).In general, urine samples can be collected more easily than serum samples. To take advantage of this, several immunodiagnostic methods using urine have been established for some other diseases, like filariasis (21) and schistosomiasis (37). Kohanteb et al. (26) reported the detection of soluble antigen and antibody in the urine of VL patients by double-countercurrent immunoelectrophoresis, and de Colmenares et al. (11) detected antigenic compounds in urine by the Western blot technique. More recently, a latex agglutination test for the detection of Leishmania donovani antigen in urine was reported with good specificity but with sensitivity similar to that of microscopic diagnosis (3). In this paper, we report a sensitive and specific ELISA to detect anti-L. donovani immunoglobulin G (IgG) in urine using acetone-treated promastigote antigen.
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    Alterations on Peripheral B cell Subsets following an Acute Uncomplicated Clinical Malaria Infection in Children
    (BioMed Central Ltd., 2008-11) Asito, A. S.; Moormann, A. M.; Kiprotich, C.; Ng'ang'a, Z. W.; Ploutz-Snyder, R.; Rochford, R.
    BACKGROUND: The effects of Plasmodium falciparum on B-cell homeostasis have not been well characterized. This study investigated whether an episode of acute malaria in young children results in changes in the peripheral B cell phenotype. METHODS: Using flow-cytofluorimetric analysis, the B cell phenotypes found in the peripheral blood of children aged 2-5 years were characterized during an episode of acute uncomplicated clinical malaria and four weeks post-recovery and in healthy age-matched controls. RESULTS: There was a significant decrease in CD19+ B lymphocytes during acute malaria. Characterization of the CD19+ B cell subsets in the peripheral blood based on expression of IgD and CD38 revealed a significant decrease in the numbers of naive 1 CD38-IgD+ B cells while there was an increase in CD38+IgD- memory 3 B cells during acute malaria. Further analysis of the peripheral B cell phenotype also identified an expansion of transitional CD10+CD19+ B cells in children following an episode of acute malaria with up to 25% of total CD19+ B cell pool residing in this subset. CONCLUSION: Children experiencing an episode of acute uncomplicated clinical malaria experienced profound disturbances in B cell homeostasis.
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    Short Report: Childhood Coinfections with Plasmodium Falciparum and Schistosoma Mansoni Result in Lower Percentages of Activated T cells and T Regulatory Memory Cells than Schistosomiasis Only.
    (PubMed, 2009) Gicheru, M. M.; Muok, E. M.; Mwinzi, P. N.; Black, C. L.; Carter, J. M.; Ng'ang'a, Z. W.; Secor, W. E.; Karanja, D. M.; Colley, D. G.
    Flow cytometric analyses were performed to evaluate HLA-DR (+) activated T lymphocytes (Tact; CD3 (+)/CD4 (+)/CD25(medium)) and T regulatory cells (Treg; CD3 (+)/CD4(+)/CD25(high)) in the circulation of children 8-10 years of age living in an area endemic for both Plasmodium falciparum and Schistosoma mansoni in western Kenya. Those children with only S. mansoni had a higher mean percentage of HLA-DR (+) Tact than those who were co-infected with these two intravascular parasites. The proportion of circulating Treg was comparable in children with only schistosomiasis and both schistosomiasis and malaria. However, the mean level of memory Treg (Treg expressing CD45RO (+)) in those with dual infections was lower than in children with schistosomiasis alone. These imbalances in Tact and Treg memory subsets in children infected with both schistosomiasis and malaria may be related to the differential morbidity or course of infection attributed to coinfections with these parasites.
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    Bacteriological quality and diarrhoeagenic pathogens on River Njoro and Nakuru Municipal water, Kenya
    (Academic Journals, 2011) Mwaniki, N.E.N.; Okemo, P. O.; Silas, K.; Moses, L.K.
    Waterborne diarrhoeal pathogens are considered a re-emerging threat and are responsible for considerable morbidity and mortality, especially in developing countries. The objective of this study was to determine bacteriological quality, biochemical oxygen demand and presence of diarrhoeagenic pathogens in water samples collected from River Njoro and Nakuru Municipal water. A total of 432 samples were tested, 216 from River Njoro and 216 from Nakuru Municipal water. Bacteria indicator numbers (arithmetic mean MPN/ml) varied from 24.4 (source) to >2700.0 (midstream) for total coliforms and 3.6 (source) to 1880.0 (midstream) for faecal coliforms in River Njoro. There was a consistent increase in bacteria loading as the river flowed from the source (Nessuit) to downstream sites. The biochemical oxygen demand (BOD) ranged from 2.0 mg/L at the source of the river to 44.0 mg/L at Njoro bridge. The frequency of enteropathogenic bacteria isolated in 216 samples collected from River Njoro were; Aeromonas hydrophila 52%, Hafnia alvei 29.2%, Salmonella typhimurium 18%, Salmonella typhi 17%,Enteroaggregative Escherichia coli 9.2%, Necrotoxigenic E. coli 7.4% and Enteropathogenic E. coli 3.2%. Only H. alvei 4.6% and A. hydrophila 6.5% were isolated from Nakuru Municipality water and no enteropathogens were detected at Nakuru town centre, Kiti and Milimani estates. River Njoro has been found to be heavily contaminated with indicator bacteria, organic material and diarrhoegenic pathogens. This suggests need to educate people regarding good health practices, proper waste disposal, boiling drinking water and seek alternative sources of drinking water in the study area.
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    HIV Type 1 Gag genetic Diversity among Antenatal Clinic Attendees in North Rift Valley, Kenya
    (PubMed, 2012) Gicheru, M. M.; Nyagaka, B.; Kiptoo, M. K.; Lihana, R. W.; Khamadi, S. A.; Makokha, E. P.; Kinyua, J. G.; Mwangi, J.; Osman, S.; Lagat, N. J.; Muriuki, J.; Okoth, V.; Ng'ang'a, Z.; Songok, E. M.
    HIV genetic recombination and high mutation rate increase diversity allowing it to escape from host immune response or antiretroviral drugs. This diversity has enabled specific viral subtypes to be predominant in specific regions. To determine HIV-1 subtypes among seropositive antenatal clinic attendees in Kenya's North Rift Valley, a cross-sectional study was carried out on 116 HIV-1-positive blood samples. Proviral DNA was extracted from peripheral blood mononuclear cells by DNAzol lysis and ethanol precipitation. Polymerase chain reactions using specific primers for HIV-1 gag and population sequencing on resulting amplicons were carried out. Phylogenetic analysis revealed that 81 (70%) were subtype A1, 13 (11%) subtype D, 8 (7%) subtype C, 3 (3%) subtype A2, 1 (1%) subtype G, and 10 showed possible recombinants: 5 (4%) subtype A1D, 4 (3%) subtype A1C, and 1 (1%) subtype A2C. These data support the need to establish circulating subtypes for better evaluation of effective HIV diagnostic and treatment options in Kenya.
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    Communicating African Spirituality through Ecology: Challenges and Prospects for the 21st Century
    (MDPI, 2012) Gumo, S.; Gisege, S.O.; Raballah, E.; Ouma, C.
    This review was set in the context of African spirituality and ecology. Specifically, the review addressed issues of African spirituality and the environment from a Kenyan context. Through analyses on existing literature, we examined African worldviews, determined how African spirituality was communicated through the environment, evaluated African ways of regulating the use of the environment, and explored challenges facing African spirituality and ecology today. Results show that African spirituality has been enhanced through the environment where humanity worshipped and venerated everything under the earth, on earth, between the earth and heavens and in the heavens above. Consequently, various methods to restrict the utilization of certain natural resources are employed as a way of conserving the environment. Additional findings demonstrate that African spirituality and ecology are currently facing a number of challenges, hence a major challenge of sustainability of African spirituality in regard to environment. From a spiritual point of view, it is therefore recommended that environmental diversity should be conserved through sustainable development where every person from grassroots level is involved in protecting and maintaining God‘s creation. We conclude that African knowledge and belief systems on environmental sustainability could be revitalized and used in environmental conservation.
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    Persistence of Schistosoma Haematobium and Geohelminthes Infection in Residents of Two Villages in Msambweni District of Coast Province, Kenya
    (American Journal of Epidemiology and Infectious Disease, 2013) Matonge, P. M.; Muturi, M.; Kamau, L. M.
    Urinary Schistosomiasis and soil transmitted helminths (STH) infections are serious problems in developing countries owing to climatic, environmental, and behavioral factors of the people that favor transmission. A cross-sectional survey involving 1,232 people aged 5-78 years in two villages in Vingujini Sub-Location, Msambweni District of Coast Province in Kenya was conducted to determine prevalence of Schistosoma haematobium and soil transmitted helminths infections. Urine and stool samples were collected from 1,232 people in two villages in Vingujini Sub-Location. The samples were examined for eggs of Schistosoma haematobium and intestinal helminths respectively. Hematuria was determined using urine dip strips. Hemoglobin levels were determined for all participants to establish the relationship between hookworm disease and anemia. The overall occurrence of helminth infections were; 44% for Schistosoma haematobium, 29.6% for hookworm disease, 0.5% for Ascaris and 24.6% for trichuriasis (N = 1,232). Only 32.7% were free from any of the four types of parasitic infections screened. Infection with schistosome was highly correlated with Trichuris infection (r = 0.96, p = 0.006) and also highly correlated with age (f = 95.17, p > 0.01). Infections with Schistosoma haematobium (f = 95.17, p > 0.01), hookworm disease (f = 11.51, p = 0.010) and trichuriasis (f = 26.46, p > 0.01) were also age correlated. High intensities of Schistosoma haematobium were associated with hematuria (f = 639.99, p > 0.01). Prevalence of hookworm disease was not correlated with anemia, but there was a relationship between intensity of hookworm infection and anemia (r = -0.091, P< 0.01). Individuals with heavy and medium intensity of hookworm infections were more likely to suffer from anemia than individuals with low intensities or the non-infected (f = 5.5, p < 0.01). The current study has established high (44%) prevalence of urinary schistosomiasis, hookworm (29.6%) and Trichuris (24.6%) infections in Msambweni compared to national prevalence for schistosomiasis (23%), and global prevalence for hookworms (10-20%). Infections with Ascaris were low. Majority of Schistosome infected subjects were also infected with hookworms or at least one STH. The data suggests that measures of intensity are required for increasing effectiveness of current control programs and stresses the need for enhanced public health interventions against these diseases.
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    Water-Borne Bacterial Pathogens in Surface Waters of Nairobi River and Health Implication to Communities Downstream Athi River
    (IJLPR, 2013) Musyoki, A.M.; Mbaruk, A.S.; Mbithi, J. N.; Maingi, J.M.
    The quality of surface water in Nairobi River and the adjacent river Athi was assessed to ascertain whether it meets local and international microbiological standards for safe human consumption. Standard bacteriological techniques were used to describe bacteria content from water samples collected from the two confluent sources. The waters were highly contaminated with human pathogenic bacteria. The most dominant bacteria in combined waters of the two rivers was Escherichia coli (1.0 x 104± 2.6 x 103/ 100 mL) while the least was Shigella flexneri (1.2 x 101± 1.2 x 101/ 100 mL). Other bacteria were Klebsiella aerogenes (7.4 x 101± 1.8 x 101 /100 mL), Enterococcus faecalis (3.6 x 103± 3.2 x 103 / 100 mL),Salmonella typhi (2.1 x 102± 1.3 x 102 / 100 mL), Pseudomonas aeruginosa(6.5 x 102± 1.1 x 102 / 100 mL), Salmonella paratyphi (1.6 x 101±1.1 x 101 / 100 mL),andVibrio cholerae (5.6 x 102± 1.0 x 102/ 100 mL). Microbiological quality of the surface water was unacceptably high above compliance level of nationalstandards, and the World Health Organization (WHO) guidelines for drinking water and agricultural use.The water from these rivers is not potable, and poses a health risk to communities that rely on the rivers as primary sources of domestic and subsistence irrigation use. These findings in water scarce region of the world underline the challenges a number of developing countries are facing currently and in long5term into the future. Lessons learnt in this study would suggest appropriate measures are necessary to control pollution of similar rivers in sub5Saharan regions in particular and developing countries in general to ensure availability of clean water supplies to large concentrated populations in cities within the Millennium Development Goals. KEY WORDS: Microbiological water quality, bacterial pathogens, low5 income countries, water scarce region.
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    Identification and Susceptibility Profile of vaginal Candida species to Antifungal agents among pregnant women attending the antenatal clinic of Thika District Hospital, Kenya
    (Open Journal of Medical Microbiology, 2013) Menza, N.; Wanyoike, W.; Muturi, M.
    Fungal infections have emerged as a world-wide health care problem in recent years, owing to the extensive use of broad-spectrum antibiotics. We screened 104 pregnant women with symptoms of vaginal candidiasis in the antenatal clinic of Thika District Hospital, Kenya in order to identify vaginal Candida species and determine their susceptibility profile to commonly used antifungal drugs for treatment of the infection. The drugs tested were fluconazole, ketocona-zole, itraconazole, clotrimazole and topical nystatin. Vaginal swabs were collected and subjected to mycological and biochemical tests for Candida species identification. Susceptibility profile of the identified vaginal Candida species to the antifungal drugs was carried out using broth micro-dilution minimum inhibiting concentration method based on the approved National Committee for Clinical Laboratory Standards (NCCLS, 2002) guidelines. Candida albicans was susceptible to most of the azoles drugs while the other species had varying responses. Candida krusei and Candida glabrata species isolated were resistant to fluconazole and ketoconazole. Candida albicans isolates had a high suscepti-bility to itraconazole (88.33%). Five percent (5%) of the isolates were susceptible in dose dependent (S-DD) with Minimum Inhibitory Concentrations (MICs) of 0.25 - 0.5 μg/ml while 11.67% of C. albicans isolates were resistant (MICs ≥ 1 μg/ml). Itraconazole resistance was highest among C. glabrata isolates (50%) while 32.14% were S-DD (MICs 0.25 - 0.5 μg/ml). Only 17.85% of the C. glabrata isolates were susceptible (MICs of ≤ 0.125 μg/ml). All iso-lates of Candida isolates were susceptible to itraconazole and clotrimazole except C. krusei which was 100% resistant to clotrimazole. All Candida species isolates had low susceptibility to topical nystatin except Candida parapsilosis that was 100% susceptible. Data also showed an emerging resistance of Candida krusei to most of the drugs used except itraconazole. The results of this study support the continued use of these antifungal drugs for the treatment of vaginal candidiasis in the pregnant women except topical nystatin.
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    Prevalence of Vaginal Candidiasis and Determination of the Occurrence of Candida Species in Pregnant Women Attending the Antenatal Clinic of Thika District Hospital, Kenya
    (Open Journal of Medical Microbiology, 2013) Menza, N.; Wanyoike, W.; Muturi, M.
    Epidemiological monitoring of vaginal candidiasis infections associated with preterm delivery and death of the infant is highly desirable especially in pregnant women. The objectives were to determine the prevalence of vaginal candidiasis and the occurrence of Candida species in pregnant women attending the antenatal clinic of Thika District Hospital, Kenya. Vaginal swabs were collected from 104 pregnant women between the months of June and August 2010. The Candida species were identified by standard mycological and biochemical methods and the prevalence was determined by 100%OxP, where: O is the number of individuals with the disease and P is the total number of individuals in the population involved in the study. Out of 104 samples obtained from the pregnant women with symptoms of vaginal candidiasis, 94 (90.38%) patients were tested positive and 10 (9.62%) were tested negative for vaginal candidiasis. The percentage distribution of vaginal candidiasis within age group was highest in the age brackets 26 - 35 years with 56(60%) patients and in the 3rd trimester of pregnancy with 64(68.09%) patients. The percentage occurrence of vaginal Candida species showed that Candida albicans was the most isolated species with 60(63.83%) isolates. The results in-dicated a high prevalence of vaginal candidiasis: 42.7%. The women at great risk were those between 26 - 35 years and in their 3rd trimester. Candida albicans was the most prevalent vaginal Candida species across all age groups and tri-mesters.
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    Diurnal and Seasonal Variations of Pathogenic Bacteria in Dandora Sewage Treatment Plant Wastewater, Nairobi, Kenya
    (International Research Journals, 2013-02) Musyoki, A.M.; Suleiman, M.A.; Mbithi, J. N.; Maingi, J.M.
    Diurnal and seasonal variation of pathogenic bacteria diversity and loads at Dandora Sewage Treatment Plant (DSTP), and compliance of effluent with local and international statutory requirements was assessed. Standard bacteriological techniques were used to describe bacteria content from wastewater samples collected from influent and effluent sources. Diurnal variation of bacterial loads occurred only in the effluent (F ꞊ 22.788, p ꞊ 0.000) with lower counts in the afternoon. Seasonal variation was observed in both influent (F ꞊ 14.795, p ꞊ 0.001) and the effluent (F ꞊ 23.574, p = 0.000), with more pollution during the dry season. The effluent microbiological quality, irrespective of diurnal and seasonal changes, did not adhere to local and international statutory requirements for discharge into natural environment. The effluents were polluted with pathogens including; Escherichia coli, Enterococcus faecalis, Staphylococcus typhi, Pseudomonas aeruginosa, and Klebsiella aerogenes. The health risk posed to downstream users of DSTP effluent occurs notwithstanding the time of the day or season. The findings in this study suggest need for appropriate measures to monitor and control the microbiological quality of DSTP effluent
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    Seroprevalence of Cytomegalo Virus (CMV) among pregnant women in Thika, Kenya
    (BioMed Central, 2014-11) Maingi, Z.; Nyamache, A. K.
    Background The fetal consequences of CMV infection have made it one of the most serious infections contracted during pregnancy. Despite the posed teratogenic risk during pregnancy, there is no national screening test for CMV infection is available during pregnancy in Kenya. Thus little is known on its epidemiological data that is necessary for health planners and care providers. Methods A cross sectional study was conducted at Thika district level 5 hospital, Kenya to investigate seroprevalence of CMV infections and associated possible risk factors among pregnant women. Structured questionnaires were used to gather socio-demographic data and ELISA was used to detect CMV infections using IgG and IgM. Results Out of 260 pregnant women, 201 (77.3%) were CMV IgG 21(8.1%) CMV IgM being on acute stage of the disease. Marital status (OR = 3.7533, 95% CI =3.0231-6.9631, P < 0.0001), parity (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), and education (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), history of blood transfusion (OR = 0.0374, 95% CI = 0.00120-0.1168, OR = 0.3804) were found to significantly influence seropostivity in univariate analysis. Conclusion The 88.4% CMV prevalence rate being detected among pregnant women calls for vaccine and routine screening for CMV infections and its associated risk factors in this kind of settings. Background The fetal consequences of CMV infection have made it one of the most serious infections contracted during pregnancy. Despite the posed teratogenic risk during pregnancy, there is no national screening test for CMV infection is available during pregnancy in Kenya. Thus little is known on its epidemiological data that is necessary for health planners and care providers. Methods A cross sectional study was conducted at Thika district level 5 hospital, Kenya to investigate seroprevalence of CMV infections and associated possible risk factors among pregnant women. Structured questionnaires were used to gather socio-demographic data and ELISA was used to detect CMV infections using IgG and IgM. Results Out of 260 pregnant women, 201 (77.3%) were CMV IgG 21(8.1%) CMV IgM being on acute stage of the disease. Marital status (OR = 3.7533, 95% CI =3.0231-6.9631, P < 0.0001), parity (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), and education (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), history of blood transfusion (OR = 0.0374, 95% CI = 0.00120-0.1168, OR = 0.3804) were found to significantly influence seropostivity in univariate analysis. Conclusion The 88.4% CMV prevalence rate being detected among pregnant women calls for vaccine and routine screening for CMV infections and its associated risk factors in this kind of settings.
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    Incidence, Types and Levels of Aflatoxin in Different Peanuts Varieties Produced in Busia and Kisii Central Districts, Kenya
    (Scientific Research Publishing, 2015) Menza, Nelson C.; Muturi, Margaret W.; Kamau, Lucy M.
    Busia and Kisii Central districts are areas in western Kenya that have repeatedly reported high levels of stunting growth in children and an increase in hepatocellular carcinoma (HCC); an aspect often positively associated with chronic exposure to aflatoxins especially through consumption of foods such as peanuts. The objectives of the study were to determine the incidence, types and levels of aflatoxin in different varieties of peanuts produced in Busia and Kisii Central districts. One hundred and two (102) peanuts samples were collected from farmers’ in each district. Aflatoxin types and levels of aflatoxins were analyzed using high performance liquid chromatography (HPLC) technique. All the peanuts samples from Kisii Central and 97.06% samples from Busia were contaminated with aflatoxins. However, aflatoxin was not detected in 2.94% of samples from Busia district. The levels of total aflatoxin ranges were 0.1 to 268 μg/kg and 1.63 to 591.1 μg/kg in peanuts from Busia and Kisii Central respectively. Majority of peanuts samples had levels within Kenya Bureau of Standards (KEBS) and European Union (EU) regulatory limits for total aflatoxins. Improved variety (Valencia red) had significantly lower aflatoxin contamination compared to local varieties (Uganda local red, Homabay local and Local red). Aflatoxins B1, B2, G1 and G2 were found in peanuts; B1 was the most predominant in both districts (t = 12.4, df = 3, P = 0.034). The levels of aflatoxins especially in peanuts from Kisii Central district were high (591.1 μg/kg) where 44.6% of samples analyzed were unfit for even animal feed (USFDA regulatory limit). An assessment on the levels of aflatoxins should be done by the relevant stakeholders in other key foods in the areas for example maize. The most lethal aflatoxin type B1 was found to be the most predominant peanuts from both districts of study. This calls for frequent aflatoxin screening of peanuts from the districts particularly aflatoxin type B.
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    Drug Susceptibility Patterns of Mycobacterium tuberculosis Isolates from Tuberculosis Patients in Coastal Kenya
    (Scientific Research Publishing, 2017) Yonge, Shadrack A.; Otieno, Michael F.; Sharma, Rekha R.; Nteka, Sarah S.
    Background: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis . Anti-tuberculosis drug resistance is an emerging health problem in Kenya and especially in Coastal region. This is a major challenge in tuberculosis control. Diagnosis is based on Ziel-Neelsen staining alone and patients are treated without information on sensitivity patterns. Aim: This study aimed to determine drug susceptibility patterns of Mycobacterium tuberculosis in Coastal Kenya. Study Design: Hospital and laboratory based cross-sectional study was carried between April 2015 and July 2016 at Coast General Referral hospital; Tudor, Port-Reitz, Likoni Sub-County hospitals; Mlaleo, Kongowea and Mikindani health centers. Methodology: Sputum samples from patients with bacteriological confirmed TB on microscopy were cultured on Lowenstein Jensen (LJ) media. Strains of MTB complex from Lowenstein Jensen (LJ) slopes were subjected to drug susceptibility testing (DST) to first-line drugs including isoniazid (H), rifampicin (R), streptomycin (S) and Ethambutol (E) using proportional method on the Mycobacterium Growth Indicator Tube (MGIT) conventional method. Participants were offered diagnostic testing and counselling for HIV testing. Results: Drug sensitivity test was performed for a total of 210 Mycobacterium tuberculosis isolates for the first line anti-TB drugs. About seventy eight percent and twenty nine percent of the strains from new patients and previously treated patients were fully sensitive to all the drugs tested respectively. Prevalence of any resistance to one drug was 102 (48.6%, 95% CI: 20.45 - 28.23). Any single drug resistance was most frequent in isoniazid 30 (16.0%), Ethambutol 20 (10.0%), Streptomycin 18 (18.3%) and Rifampicin 4 (2.1%) in newly diagnosed patients. Among previously treated patients any resistance to streptomycin, ethambutol, isoniaziad and rifampicin was 10 (58.8%), 9 (52.9%), 7 (41.2%) and 4 (23.5%) respectively. Prevalence of MDR-TB defined as resistant to at least both isoniazid and rifampicin was 10 (4.8%) among new and previously treated patients respectively. Conclusion: The current study reveals that the overall resistance to first line anti-TB drugs was high. Although the rate of MDR-TB was relatively low, this signifies that conditions favouring the spread of MDR-TB are on high rise. Therefore, it is essential to address the problems of development of drug resistant strains of TB by establishing good TB programmes (DOTS). Patients’ adherence to anti-TB drugs and introducing drug sensitivity testing (DST) services at County level hospitals will minimize occurrence of drug resistant.
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    Evaluating adherence to antiretroviral therapy using pharmacy refill records in a rural treatment site in South Africa
    (Hindawi Publishing Corporation, 2017) Gachara, George; Mavhandu, Lufuno G.; Rogawski, Elizabeth T.; Manhaeve, Cecile; Bessong, Pascal O.
    Optimal adherence to combination antiretroviral therapy (cART) is critical to maintain virologic suppression, thereby ensuring the global success of HIV treatment. We evaluated adherence to cART using pharmacy refill records and determined the adherence threshold resulting in >90% virologic suppression in a community run treatment site in South Africa. Additionally, we analysed factors associated with adherence using univariable and multivariable logistic regression models. Logistic regression was also performed to determine the relationship between adherence and virologic suppression and the adherence threshold resulting in <10% virologic failure. The overall median (interquartile range) adherence was 95% (88.6–98.4%). Out of the study participants, 210/401 (52.4%) had optimal (≥95%) adherence while only 37/401 (9.2%) had poor (≤80%) adherence. The majority (90.5%) of patients with optimal adherence had virologic suppression.Having TB at registration into care was found to be negatively associated with adherence (adjusted odds ratio [AOR], 0.382; 𝑝 ≤ .05). Compared to nonadherent individuals, optimally adherent participants were more likely to achieve virologic suppression (OR 2.92; 95% CI: 1.63–5.22). Only adherence rates above 95% were observed to lead to <10% virologic failure. cART adherence measured by pharmacy refill records could serve as a useful predictor of virologic failure; adherence rates >95% are needed to maintain optimal virologic suppression
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    Antibiotic Susceptibility Pattern among Male Patients with Urinary Tract Infection in Special Treatment Centre, Nairobi County, Kenya.
    (International Journal of Advanced Multidisciplinary Research and Review (IJAMRR), 2019) Moraa, Dinah; Mathenge, Scholastica; Arodi, Washington; Torome, Tom; Mbuthia, Oliver; Kinyua, Martin
    The occurrence of urinary tract infections in men can be very serious although not very common. Antibiotic resistance is becoming a global concern and Kenya is no exception. The aim and objective of the study was to investigate the causative bacteria and antibiotic susceptibility patterns among male patients with urinary tract infection visiting Special Treatment Centre, Nairobi County. Method: A descriptive cross-sectional study design was adopted from January 2018 to March 2018. Three hundred and eighty four (384) participants were recruited into the study using systematic sampling technique using structured questioners. Clean morning midstream urine was then cultured on Cysteine-Lactose-Electrolyte Deficient (CLED) agar and blood agar medium as per the standard urine culture. Antibiotic sensitivity test was then done on Mueller-Hinton agar using Kirby-Bauer disk diffusion method according to CLSI guidelines. Appropriate biochemical tests were done to identify the isolated bacteria. Results: The highest number of isolates was found to be Escherichia coli isolates (105) and the least was Pseudomonas auroginosa (12). Ofloxacin, 113(45.2) was found to be most effective antibiotic (x²=18.2, p=0.01) and the least effective being Augmentin (x²=1.56, p=0.811). Resistance was found to be high to Nitrofurantoin (65%) and least to Oflocaxin (13%). Conclusion: Bacterial cultures and sensitivity should be done on all cases of UTI’s to determine causative agents so as to guide clinicians in determining the most appropriate treatment. This will help in addressing cases of emerging multidrug resistance to the commonly used antibiotics. Follow-up of treated individuals to determine effectiveness of treatment would also help in addressing cases of failed treatment and prevention of resistance.
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    Human Papillomavirus Infection: Molecular Epidemiology and Acceptability of Screening and Vaccination among Women in Eastern Kenya Counties
    (AJOL, 2021) Njue, James Kinoti; Muturi, Margaret W.; Kamau, Lucy; Muriuki, Joseph; Lwembe, Raphael
    BACKGROUND Human Papillomavirus associated cervical cancer in Kenya caused 3,286 deaths where cervical screening rate was 3.2% in 2018. This study examined knowledge, attitudes, practices, and perceptions (KAPP) on HPV screening and vaccination and how these influenced HPV infections among HIV-infected and uninfected women seeking reproductive health services. MATERIALS AND METHODS This was a cross-sectional study where socio-demographic and KAPP data on HPV screening and vaccination data was collected by the use of a questionnaire. Cervical swabs were obtained for HPV DNA-PCR and cytology. Logistic regression and Pearson chi-square tests were used to analyze statistical relationships. RESULTS Among the 317 women recruited, HPV infections were significantly associated with marital status, number of sexual partners, hormonalcontraceptives use, HIV infection, presence of genital warts, recurrent UTIs, and TB infection. The number of participants with knowledge on HPV screening was significant in Embu County, among those younger than 30 years, with secondary and college level education, marital status, religion, and contraceptives use. Having a relative with a history of any cancer was significantly associated with knowledge and perceiving HPV screening as important. Participants who perceived HPV vaccination as important were significant across age, family planning, and parity. Fear of embarrassment, procedures, and results, lack of time, and cost of the test were reported as reasons for failing to screen for HPV. CONCLUSION Knowledge, willingness, and perceiving HPV screening as important as well as willingness to vaccinate against HPV may reduce HPV infections among women seeking reproductive health services in Eastern Kenya.
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    Signatures of selection and drivers for novel mutation on transmission-blocking vaccine candidate Pfs25 gene in western Kenya
    (PLOS ONE, 2022-04) Ochwedo, Kevin O.; Onyango, Shirley A.; Omondi, Collince J.; Orondo, Pauline W.; Ondeto, Benyl M.; Lee, Ming-Chieh; Atieli, Harrysone E.; Ogolla, Sidney O.; Githeko, Andrew K.; Otieno, Antony C. A.; Mukabana, Wolfgang R.; Yan, Guiyun; Zhong, Daibin; Kazura, James W.
    Background Leading transmission-blocking vaccine candidates such as Plasmodium falciparum surface protein 25 (Pfs25 gene) may undergo antigenic alterations which may render them ineffective or allele-specific. This study examines the level of genetic diversity, signature of selection and drivers of Pfs25 polymorphisms of parasites population in regions of western Kenya with varying malaria transmission intensities. Methods Dry blood spots (DBS) were collected in 2018 and 2019 from febrile outpatients with malaria at health facilities in malaria-endemic areas of Homa Bay, Kisumu (Chulaimbo) and the epidemic-prone highland area of Kisii. Parasites DNA were extracted from DBS using Chelex method. Species identification was performed using real-time PCR. The 460 base pairs (domains 1–4) of the Pfs25 were amplified and sequenced for a total of 180 P. falciparuminfected blood samples. Results Nine of ten polymorphic sites were identified for the first time. Overall, Pfs25 exhibited low nucleotide diversity (0.04×10−2) and low mutation frequencies (1.3% to 7.7%). Chulaimbo had the highest frequency (15.4%) of mutated sites followed by Kisii (6.7%) and Homa Bay (5.1%). Neutrality tests of Pfs25 variations showed significant negative values of Tajima’s D (-2.15, p<0.01) and Fu’s F (-10.91, p<0.001) statistics tests. Three loci pairs (123, 372), (364, 428) and (390, 394) were detected to be under linkage disequilibrium and none hadhistory of recombination. These results suggested that purifying selection and inbreeding might be the drivers of the observed variation in Pfs25. Conclusion Given the low level of nucleotide diversity, it is unlikely that a Pfs25 antigen-based vaccine would be affected by antigenic variations. However, continued monitoring of Pfs25 immunogenic domain 3 for possible variants that might impact vaccine antibody binding is warranted.
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    Determination of Sarcosine in Urine as a Predictor of Prostate Cancer Using Enzyme Linked Immunosorbent Method
    (JMR, 2023) Januaris, Mukaa M.; Njoroge, Wachuka Gathigia; Rado, Antony Omondi; Waweru, Jeremiah Gathirwa
    Prostate cancer is a type of malignancy that is defined by abnormal development of cells in the prostate tissue. Prostate cancer needs early intervention since its incidence and prevalence is high across the world leading to high morbidity and mortality. Prostatic specific antigen test which is the commonly used screening test in Kenya and across the world is nonspecific, expensive and inaccessible to many people in rural setting who are in need. The definitive histological test is invasive and requires specialized facilities and personnel. This study sought to investigate sarcosine in urine as a predictor of prostate cancer to supplement prostatic specific antigen test in the diagnosis of prostate carcinoma. Cross sectional study design was employed in this study for all suspected prostate cancer identified according to clinical assessment during the study period. Midstream urine samples of about 30mls was collected in plastic tubes, centrifuged and supernatant collected and analyzed using ELISA method for sarcosine. Raw data obtained was tabulated in excel and transferred to statistical package for social science. Differences in means and standard deviation from various age groups was analyzed using one-way Anova and Independent t test. The Bonferroni was used as post Hoc to test the means that were significant from others. Significance level was set at 95%. The concentration of sarcosine (4.30±0.11nmol/ml) in prostate cancer participants was significantly higher than the concentration (0.47±0.06nmol/ml) of control participants using ELISA (p<0.001;). Hence Sarcosine in urine needs to be analyzed for the testing of prostate tumor since it is raised in confirmed prostate carcinoma participants as compared to negative control units. The age groups of the prostate tumor participants had no significant variation in sarcosine concentration using ELISA method (p=0.57). Similarly, the age groups of the control individuals were not significantly different in sarcosine concentration (p=0.17). Future studies need to dwell in incorporating sarcosine metabolite in urine.