RP-School of Health Sciences

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Immunization of Mice and Baboons with the Recombinant Sm28GST Affects Both Worm Viability and Fecundity after Experimental Infection with Schistosoma Mansoni.
(PubMed, 1991-09) Otieno, Micheal Frederick; Boulanger, D.; Reid, G. D.; Sturrock, R. F.; Wolowczuk, I.; Balloul, J. M.; Grezel, D.; Pierce, R. J.; Guerret, S.; Grimaud, J. A.
A member of the glutathione S-transferase family, Sm28GST has previously demonstrated a good ability to protect rodents against experimental infection with Schistosoma mansoni. In order to evaluate its efficacy in a model closer to man, two different protocols of immunization with recombinant Sm28GST were tested on baboons in a large-scale trial. Three injections in the presence of aluminium hydroxide as adjuvant resulted in a significant 38% reduction in the adult worm burden together with a trend for a lower percentage of inflammatory tissue in the liver. Individual levels of protection, ranging from 0 to 80%, underlined the heterogeneity of the immune response to this purified molecule in outbred primates. On the other hand, two injections of Sm28GST in the presence of aluminium hydroxide and Bordetella pertussis reduced female schistosome fecundity by 33%, with a more pronounced effect (66%) on faecal egg output; there was also a trend, in this protocol, for decrease of the mean granuloma surface in the liver. Individual anti-Sm28GST IgG antibodies were apparently unrelated to levels of immunity, but there was partial evidence that cytophilic IgE might play a role in the immune mechanisms affecting worm viability, but not fecundity. In the mouse model, Sm28GST vaccination resulted in a lower hatching ability of tissue eggs recovered from immunized mice whereas passive transfer of specific anti-Sm28GST T-lymphocytes, one day before infection, significantly reduced the number of eggs in the liver of mice. We propose that different protocols of immunization with a recombinant molecule can impede Schistosoma mansoni worm viability and fecundity, but can also affect miracidium physiology, with important consequences for disease transmission and granuloma-derived pathology.
Immune Complex Levels in Children with Severe Plasmodium Falciparum Malaria.
(The American Society of Tropical Medicine, 2000-05) Mibei, Erick Kipsang; Orago, A. S.; Stoute, J. A.
Malaria infection leads to the formation of circulating immune complexes. However, it is unclear whether these complexes play a role in the pathogenesis of complicated Plasmodium falciparum malaria. This study aimed at determining if there are differences in the levels of immune complexes between children with severe malaria-associated anemia and cerebral malaria and between each of these two groups and their respective uncomplicated symptomatic malaria or healthy asymptomatic controls. Children with severe malaria-associated anemia and cerebral malaria had significantly higher immune complex levels than their respective controls, but there were no significant differences in the levels between the two severe malaria groups. In addition, there was an inverse relationship between the hemoglobin levels and immune complex levels in the severe anemia controls, suggesting that immune complexes may contribute to erythrocyte destruction in these children. These results suggest that immune complex levels alone cannot account for the differences in the distinct clinical presentation between severe malaria-associated anemia and cerebral malaria.
A Study of awareness of malaria among Kibera population; implication for community based intervention
(2002) Karanja, J.; Wambari, E.; Okumu, D.; Odhiambo, E.; Karuri, I.; Muthwii, S. M.; Kibe, M.; Osawa, N.; Osaki, Y.
Partner notification in the management of sexually transmitted infections in Nairobi, Kenya
(Kenya Medical Association, 2003) Wakasiaka, S. N.; Bwayo, J. J.; Weston, K.; Mbithi, J.; Ogol, C.
Objective: To assess utilization of partner notification as a tool in prevention and control of Sexually transmitted infections in Nairobi City Council clinics. Design: A cross-sectional study carried out between April and September 2000. Setting: Nairobi City Council health clinics were stratified into eight administrative divisions and a total of 16 out of 54 primary health clinics with at least four STIs patients per day were selected. A standard questionnaire was administered to every fourth patient with clinical diagnosis of STIs who gave consent on exist. Sexual partners referred by index cases during the five day period from each clinic were also enrolled into the study. An additional questionnaire was administered to HCP who were managing STIs patients and their sex partners. Results: Of 407 STIs patients recruited between April and September 2000, 20.6% were primary and 2% were secondary referrals giving an average referral rate of 23%. Respondents with multiple sex partners were less likely to refer their partners compared to those who had one partner (17.9% vs 82.1%, p<0.005). Counseling of STI patients on the importance of partner referral was more effective than issuing referral cards alone (72.8% vs 56.8% % p= <0.006). Barriers to partner notification included partners being out of town (44.6%) fear of quarrels and violence from partners (32.5%) and casual partners (15.1%) whose sex partners were unknown. Conclusion: Counseling and understanding of STIs patients on the need to treat all sexual partners is pivotal to the success of partner referral.
Quality of care provided to febrile children presenting in rural private clinics on the Kenyan coast
(Makerere University Medical School, 2004) Abuya, T.O.; Molynuex, C.S.; Orago, A. S.; Were, S.; Marsh, V.
Background: Private sector health facilities are diverse in nature, and offer widely varying quality of care (QOC). Objectives: The study aimed to describe the QOC provided to febrile children at rural private clinics on the Kenyan coast and stakeholder perspectives on standards of practice and opportunities for change. Methods: Data collection methods were structured observations of consultations; interviews with users on exit from clinic and at home and in depth interviews with private practitioners (PP) and district health managers. Findings: Private clinics have basic structural features for health care delivery. The majority of the clinics in this study were owned and run by single-handed trained medical practitioners. Amongst 92 observed consultations, 62% of diagnoses made were consistent with the history, examinations and tests performed. 74% of childhood fevers were diagnosed as malaria, and 88% of all prescriptions contained an antimalarial drug. Blood slides for malaria parasites were performed in 55 children (60%). Of those whose blood slide was positive (n=27), 52% and 48% were treated with a nationally recommended first or second line antimalarial drug, respectively. Where no blood slide was done (n=37), 73% were prescribed a nationally recommended first line and 27% received a second line antimalarial drug. Overall, 68 % of antimalarial drugs were prescribed in an appropriate dose and regime. Both private practitioners and district health managers expressed the view that existing linkages between the public and private health sectors within the district are haphazard and inadequate. Conclusions: Although rural PPs are potentially well placed for treatment of febrile cases in remote settings, they exhibit varying QOC. Practitioners, users and district managers supported the need to develop interventions to improve QOC. The study identifies the need to consider involvement of the for-profit providers in the implementation of the IMCI guidelines in Kenya.
Maternal Use of Insecticide-treated Nets in the Prevention of Malaria among Children under Five Years in Nyamira district, Kenya.
(East African medical journal, 2005-10) Osero, O.J.S.; Otieno, Micheal Frederick; Orago, A. S.
BACKGROUND: Insecticide treated nets (ITNs) have been proved as one of the most effective ways of reducing malaria morbidity and mortality in children and pregnant women. Proper use and care of insecticide treated nets reduce malaria health risk to children. OBJECTIVE: To determine maternal use of insecticide treated nets in the prevention of malaria among children under five years in Nyamira district. DESIGN: Cross-sectional, descriptive study. SETTING: Eight health centres in Nyamira district. SUBJECTS: Four hundred mothers bringing their children aged five years and below to the child health clinics between August and October 2003. RESULTS: There was very low usage of mosquito nets (33.8%) with the proportion of under five using bed nets and insecticide treated nets being 33.3% and 23.8% respectively. The possibility of a mother having an insecticide treated net was significantly related with the level of education of the mother (p = 0.003), occupation (p = 0.001) and knowledge (p = 0.000). Among the reasons given by mothers regarding non usage of insecticide treated nets included lack of money, they were expensive, ignorance and carelessness. CONCLUSION: There was low use of ITNs (23.8%) among children. There is need for health information, education and communication campaigns to sensitise the mothers on most risk groups from malaria so as to create awareness of who needed more protection through use of ITNs. There is need for ITNs intervention projects for malaria prevention in the area.
Knowledge, Attitude and Practice Towards HIV/AIDS in a Rural Kenyan Community
(Cambridge University Press, 2006) Karama, Mohamed; Yamamoto, Taro; Shimada, Masaaki; Orago, A. S.; Moji, Kazuhiko
The aim of this research was to explore people’s knowledge, attitude, behaviour and practice towards HIV/AIDS and sexual activity in rural Kenya, where HIV is widespread. The study community was located in south-eastern Kenya, 50 km north of Mombassa, and had an estimated population of 1500. Subjects aged between 16 and 49 were recruited using a stratified cluster-sampling method and they completed self-administered questionnaires.Almost all respondents knew the word ‘HIV’. Around 50% knew of a person living with HIV. About 80% gave ‘death’ or ‘fear’ as words representing their image of AIDS. With regard to sexual activity, the distribution of answers to the question ‘how many partners have you ever had in your life’ was bimodal in males but had only one peak in females, indicating that some men have a large number of sexual partners in their lifetime. First sexual intercourse was at around 12–13 years for both sexes, but female teenagers were more sexually experienced than their male counterparts.
Association of FCgamma receptor IIA (CD32) polymorphism with malarial anemia and high-density parasitemia in infants and young children.
(American Journal of Tropical Medicine and Hygiene, 2006-04) Ouma, C.; Keller, C.C.; Opondo, D.A.; Were, T.; Otieno, Richard O.; Otieno, Micheal Frederick; Orago, A. S.; Ong'echa, J. M.; Vulule, JM; Ferrell, RE; Perkins, D. J.
Suppression of RANTES in children with Plasmodium falciparum malaria.
(Haematologica, 2006-10) Were, T.; Hittner, James B.; Ouma, C.; Otieno, Richard O.; Orago, A. S.; Ong'echa, J. M.; Vulule, J. M.; Keller, C. C.; Perkins, D. J.
Severe malarial anemia (MA) is the primary manifestation of severe malaria among children in areas of holoendemic Plasmodium falciparum transmission. Although overproduction of inflammatory-derived cytokines are implicated in the immunopathogenesis of severe MA, chemokines such as regulated on activation, normal T-cell expressed and secreted (RANTES, CCL5) are largely unexplored in childhood malaria. We found that RANTES is decreased during severe MA (p<0.01), and associated with suppression of erythropoiesis (p<0.05) and malaria-induced thrombocytopenia (p<0.05). These findings suggest that thrombocytopenia may be a source of reduced RANTES which may contribute, at least in part, to suppression of erythropoiesis in children with malarial anemia.
Antimicrobial Resistant Pattern among Foodhandlers in Nairobi (Kenya)
(2007) Otieno, Micheal Frederick; Hussein, Ahmed Abdulrahman; sharma, R. R.; kombe, Y.
Antibiotic resistance represents a serious problem for clinicians, veterinarians, community and government at large. This involves cost implications as far as treatment is concerned. Multiple drug resistance as a result of empirical treatment have rendered most drugs ineffective. In view of the above, this descriptive cross-sectional study, aimed at isolating resistant entero-bacteria E. coli from food-handlers working in both high and low budget hotels. Specimens in the form of stool were collected from 297 food-handlers in their respective hotels were considered and analyzed for resistant E. coli bacteria at KEMRI-Centre for Microbiological. Research (CMR), in Nairobi. Besides, questionnaires were administered in order to assess health-seeking behaviour of the study subjects prior to medical examination. Antibiotics used in this study were amoxicillin-clavulanic acid, co-trimoxazole,ampicillin tetracycline, kanamycin, gentamycin, cefuroxime and chloramphenicol. These antibiotics were chosen on the basis of their use in the management of enteric bacterial nfections. The results from high budget hotels (i.e. three, four hotels ( i. e two stars and below) indicates high frequency of resistance in both hotel categories was seen in co-trimoxazole.and five stars) and low budget resistance. The highest level of 66.3% in high budget hotels and 66.4% in low budget hotels. Resistance difference between high budget hotels and low budget hotels was not statistically significant (P=0.56681). This was followed by ampicillin showing resistance of 55% in high budget hotels and 46% in low budget hotels, (P=0.8235). Tetracycline showed a resistance level of 34% in high budget hotels and 58% in low budget hotels, (P=0.2835) and co-amoxyclav showed resistance of 37% in high budget hotels and 38% in low budget hotels, (P=0.5074). The P-value results clearly indicate no significant relationship between taking medication by food-handlers prior to medical examination and the pattern of antibiotic resistance. Comparatively, the resistance pattern for the antibiotics tested is somehow the same for low and high budget hotels, indicating that, irrespective of the hotel category, if those working in hotels are potential carriers of drug resistant E. coli, then the category of hotel is irrelevant and either has a potential of transmitting resistant E. coli.
Injury Pattern among Non-fatal Road Traffic Crash Victims
(East African Orthopaedic Journal, 2007) Kinuthia, Gichuhi
Objective: To study and analyse the pattern of injuries among non-fatal road traffic crash victims. Design: Retrospective analytical study. Setting: Kenyatta National Hospital, Nairobi over a six-month period from February to July 2004. Subjects: Road traffic crashes victims treated at Kenyatta National Hospital, Nairobi during the period under study. Results: One thousand four hundred and twenty four victims of road traffic crashes were treated over a sixmonth period. The male: female ratio was 3:1 and the pedestrians were the majority (69.7%). The commonest injuries were fractures (69.0%) and the tibia/fibula being the most fractured bones (30.3%). Age group 15-44 years was the most affected (81.9%). There was one incidence of a ruptured eye in a passenger. Conclusion: Road traffic injuries are a major cause of death and disability globally with disproportionate number occurring in the developing countries. The most affected age group 15-44 years lead to double tragedy to these countries with loss of productive man-hours and expenditure incurred to treat them.
Prescription Audit Carried Out at the Pharmacy Practice Centre of the University of Nairobi between June and November 2004.
(2007) Karimi, P.N.; Ndungu, T.K.; Kuria, K.A.M.; Bururia, J.M.; Maru, S.M.
A retrospective descriptive study was carried out from June to November 2004 in a retail pharmacy situated at the School of Pharmacy, University of Nairobi within the Kenyatta National Hospital complex. The objective was to evaluate prescribing habits and to determine the frequency of prescribing of commonly used drug classes in a hospital. The average number of drugs per prescription was 2.20  1.16. The prevalence of prescribing was 28.6% anti-infective drugs, 21.1% musculoskeletal agents, 16.6% respiratory system drugs, 8.1% cardiovascular system drugs, 7.2% central nervous system drugs, 7.1% gastrointestinal system drugs, 4.3% minerals and vitamins, 2.1% ear, nose and throat drugs, 1.1% endocrine drugs, 2% skin preparations, 0.9% anticancer drugs and 0.74% eye preparations. The prescribing habits evaluated were compared to the legal requirements in Kenya and to recommended international practice. The information gathered may serve as a basis for rational use of drugs.
Combining Evidence of Natural Selection with Association Analysis Increases Power to Tetect Malaria-Resistance Variants.
(PubMed, 2007) Otieno, Micheal Frederick; Ayodo, G.; Price, A. L.; Keinan, A.; Ajwang, A.; Orago, A. S.; Patterson, N.; Reich, D.
Statistical power to detect disease variants can be increased by weighting candidates by their evidence of natural selection. To demonstrate that this theoretical idea works in practice, we performed an association study of 10 putative resistance variants in 471 severe malaria cases and 474 controls from the Luo in Kenya. We replicated associations at HBB (P=.0008) and CD36 (P=.03) but also showed that the same variants are unusually differentiated in frequency between the Luo and Yoruba (who historically have been exposed to malaria) and the Masai and Kikuyu (who have not been exposed). This empirically demonstrates that combining association analysis with evidence of natural selection can increase power to detect risk variants by orders of magnitude--up to P=.000018 for HBB and P=.00043 for CD36.
Environmental Covariates of Anopheles Arabiensis in a Rice Agroecosystem in Mwea, Central Kenya
(2007) Mwangangi, J. M.; Muturi, E. J.; Shililu, J. I.; Muriu, S.; Jacob, B.; Kabiru, Ephantus W.; Mbogo, C. M.; Githure, J. I.; Novak, R. J.
Water quality of aquatic habitats is an important determinant of female mosquito oviposition and successful larval development. This study examined the influence of environmental covariates on Anopheles arabiensis mosquito abundance in the Mwea Irrigation Scheme, Central Province of Kenya, prior to implementation of a malaria vector control program. Experimental rice plots were used to examine the environmental covariates responsible for regulating abundance and diversity of the aquatic stages of malaria vectors. Mosquito larval sampling and water quality analysis were done weekly from the flooding stage to the rice maturation stage. Sampling for mosquito larvae was conducted using standard dipping technique. During each larval collection, environmental covariates such as pH, temperature, conductivity, salinity, dissolved oxygen, water depth, and rice stage were measured. Anopheles arabiensis larval density was highest between 1 wk before transplanting and 4 wk after transplanting with peaks at weeks 0, 3, and 8. The fluctuation in values of the various environmental covariates showed characteristic patterns in different rice growth phases depending on the changes taking place due to the agronomic practices. Using a backward linear regression model, the factors that were found to be associated with abundance of An. arabiensis larvae at any of the rice growing phases included the following: dissolved oxygen, pH, turbidity, water depth, rice height, number of rice tillers, salinity, conductivity, and temperature. The environmental covariates associated with abundance of An. arabiensis were associated with early vegetative stage of the rice growth. For effective control of developmental stages of mosquito larvae, the application of larvicides should be done at the vegetative stage and the larvicides should persist until the beginning of the reproductive stage of the rice.
Over-diagnosis and co-morbidity of severe malaria in African children: a guide for clinicians.
(The American Journal of Tropical Medicine and Hygiene, 2007-12) Gwer, S.; Newton, C.R.; Berkley, J.A.
Severe malaria is clinically similar to other severe febrile illnesses. However, in endemic areas, parasitological confirmation of parasitemia is often unavailable or unreliable. False-positive malaria microscopy is common. The most important consequence of treating only for malaria when no parasitemia exists is failure to address other life-threatening conditions. Invasive bacterial infections are detected in up to one third of children with clinical features of severe malaria but a slide with results negative for malaria. Even among genuinely parasitized children, severe illness is not always due to malaria in endemic areas. We believe that routine use of parenteral antibiotics among children with a slide that indicates malaria and life-threatening disease is warranted because invasive bacterial infections are likely to be under-ascertained and are associated with increased mortality. Published data on co-morbidity with HIV infection and malnutrition are reviewed. A structured approach to assessment and care is essential, and is largely independent of underlying etiology.
Recycling of wastes as a strategy for environmental conservation in the Lake Victoria Basin: The case of women groups in Kisumu, Kenya
(Academic Journals, 2008) Subbo, Wilfred K.; Moindi, Margaret N.
This paper examines the roles, opportunities and challenges that women groups in Kisumu City face as they recycle polythene papers and water hyacinth plant materials to make various saleable products such as bags, mats and baskets. The study objectives were: To analyze the roles of women groups in environmental conservation; To examine the opportunities that the women groups had in the recycling of polythene papers and water hyacinth plants; To examine the challenges faced by the women groups in their recycling efforts; To analyze the policy implications of the recycling effort of the women groups involved in environmental conservation. The study utilized the following methodologies, structured interviews, participant observations, Key informants, focus group discussions. Thirty-five women groups were analyzed. The findings indicate that recycling of polythene papers and water hyacinth plants contribute to environmental conservation, as well presenting opportunities for the creation of wealth among women in the groups.
Promotion of Neuronal Differentiation Through Activation of N-Methyl-D-Aspartate Receptors Transiently Expressed by Undifferentiated Neural Progenitor Cells in Fetal Rat Neocortex
(Wiley Library Online, 2008) Yoneyama, Masanori; Nakamichi, Noritaka; Fukui, Masaki; Kitayama, Tomoya; Georgiev, Danko D.; Makanga, Juliet O.; Nakamura, Nobuhiro; Taniura, Hideo; Yoneda, Yukio
Neural progenitor cell is a generic term for undifferentiated cell populations composed of neural stem, neuronal progenitor, and glial progenitor cells with abilities for self-renewal and multipotentiality. In this study, we have attempted to evaluate the possible functional expression of N-methyl-D-aspartate (NMDA) receptors by neural progenitor cells prepared from neocortex of 18-day-old embryonic rats. Cells were cultured in the presence of basic fibroblast growth factor (bFGF) for different periods up to 12 days under floating conditions. Reverse transcription-polymerase chain reaction and fluorescence imaging analyses revealed transient expression of functional NMDA receptors in neurospheres formed by clustered progenitors during the culture with bFGF. A similarly potent increase was seen in the fluorescence intensity after brief exposure to NMDA in cells differentiated after the removal of bFGF under adherent conditions, and an NMDA receptor antagonist invariably prevented these increases by NMDA. Moreover, sustained exposure to NMDA not only inhibited the formation of neurospheres when exposed for 10 days from day 2 to day 12 but also promoted spontaneous and induced differentiation of neurospheres to cells immunoreactive for a neuronal marker protein on immunocytochemistry and Western blotting analyses. These results suggest that functional NMDA receptors may be transiently expressed to play a role in mechanisms underlying the modulation of proliferation along with the determination of subsequent differentiation fate toward a neuronal lineage in neural progenitor cells of developing rat
Distinct Pattern of Class and Subclass Antibodies in Immune Complexes of Children with Cerebral Malaria and Severe Malarial Anaemia.
(Parasite Immunology Journal, 2008) Mibei, Erick Kipsang; Otieno, W. O.; Orago, A. S.; Stoute, J. A.
Plasmodium falciparum infection can lead to deadly complications such as severe malaria-associated anaemia (SMA) and cerebral malaria (CM). Children with severe malaria have elevated levels of circulating immune complexes (ICs). To further investigate the quantitative differences in antibody class/subclass components of ICs in SMA and CM, we enrolled 75 children with SMA and 32 children with CM from hospitals in western Kenya and matched them to 74 and 52 control children, respectively, with uncomplicated symptomatic malaria. Total IgG IC levels were always elevated in children with malaria upon enrollment, but children with CM had the highest levels of any group. Conditional logistic regression showed a borderline association between IgG4-containing IC levels and increased risk of SMA (OR = 3.11, 95% CI 1.01-9.56, P = 0.05). Total IgG ICs (OR = 2.84, 95% CI 1.08-7.46, P = 0.03) and IgE-containing ICs (OR = 6.82, OR 1.88-24.73, P < or = 0.01) were associated with increased risk of CM. These results point to differences in the contribution of the different antibody class and subclass components of ICs to the pathogenesis of SMA and CM and give insight into potential mechanisms of disease.
Growth Disruption Activity of Polar Extracts from Kotschya Uguenensis (Fabaceae) against Anopheles Gambiae S.S. (Diptera: Culicidae) Larvae
(2008) Hassanali, Ahmed; Innocent, E.; Cosam, C.J.; Gikonyo, N.K.; Nkunya, M.H.H.
Studies on the larvicidal properties of extracts and fractions from Kotschya uguenensis Verdc. were done by long-term exposure of Anopheles gambiae s.s. larvae. The cumulative mean percentage mortalities and deformities at different concentrations for the extracts and fractions were recorded after every 24 h. Treatment of A. gambiae s.s. larvae with K. uguenensis extracts showed growth disruption by forming elongated guts and resulting in eventual death. Larvae treated with the methanol extracts from the stem and root barks, and fractions of the former extract attained complete mortality in 6–8 days at 50 and 100 ppm. More deformed larvae were observed from the methanol extract of the stem bark (40%) and methanol-soluble fraction (88%) than those treated with water-soluble fraction (22%) and methanol extract of the root bark (5%). The growth disruption may be associated with constituents in the plant that interfere with the normal endocrine system functions.
Repellency property of long chain aliphatic methyl ketones against Anopheles gambiae s.s
(African Journals Online, 2008) Innocent, E.; Gikonyo, N. K.; Nkunya, M. H. H.
Long chain aliphatic methyl ketone series of C7-C15 were tested for repellency activity against the malaria transmitting mosquito Anopheles gambiae s.s. All methyl ketones produced a dose dependent (P<0.001) repellency response with 2-tridecanone giving comparable protection efficacy to DEET at 10% and 1% concentrations. Aliphatic methyl ketones of C7-C10 had lower activity than those of C11-C15. However, within this range compounds with odd carbon atoms (2-undecanone, 2-tridecanone and 2-pentadecanone) were more effective than compounds with even carbon atoms (2-decanone and 2- dodecanone). Comparable repellency activity of 2-tridecanone to DEET show that, it may save as Anopheles gambiae s.s. mosquito repellent.

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