MST-Department of Medical Laboratory Sciences

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    Acute Viral Respiratory Infections in Intensive Care Unit and Ventilator Support Patients in Moi Teaching and Referral Hospital, Uasin-Gishu County, Kenya.
    (Kenyatta University, 2022) Kipsang, K. Amos; Washingtone Arodi; Marion Burugu
    Acute respiratory tract infections (ARTIs) are among the five most common causes of morbidity and mortality globally, accounting for approximately 3.9 million deaths annually. Most of these deaths occur among young children in developing countries Mechanical ventilation supports the breathing system but does not change any pre-existing condition. Associated challenges include viral and bacterial infections. The prevalence of these infections is high, however these infections mimic bacterial infections. There is no documentation of these infections in many healthcare facilities In Africa. This study aimed at assessing the prevalence rates of Influenza virus, HRV, RSV, HPIV, hMPV, Human Adenovirus and HCoV in study subjects on ventilator support as well as those on critical care in the intensive care unit. The study was done at MTRH in Uasin Gishu County. Samples were collected from April 2017 to August 2017. 200 samples of bronchoalveolar lavage were collected. The samples were then transported to KEMRI Nairobi at 2-8°C for analysis. The RNA/DNA of the viruses was detected using real time PCR and multiplex PCR. Data analysis as well as coding and entry were done using statistical package for social studies (SPSS). The results were log-transformed to obtain equal distribution. The results were also expressed as mean±standard deviation. The results were then compared with respect to whether in ICU or on mechanical ventilation as well age using ANOVA with Bonferroni’s post-test using GenStat Release 14.1 (PC/Windows). Presentation of the data was done using graphs, pie charts and tables/figures. The samples that tested positive for Influenza A virus, HPIV-1, HPIV-2, HPIV-3, RSV, Adenovirus, HRV Human Metapneumovirus and HCoV was 33 (16.5%) 12 (6%), 8 (4%), 11 (5.5%), 19 (9.5%), 5(2.5%), 42(21%), 22 (11%) and 9(4.5%) respectively. However significant difference in viral infection among study participants in the intensive care unit and those on ventilator support in the different age groups of the patients analyzed was noted. There was noted difference among the patients in different age categories based on whether in ICU or ventilator support by Influenza A Virus, HPIV-1, HRV and hMPV viral infections at P-Value ≤0.05. Highest infection means were indicated in age group >65 for Influenza A Virus, HPIV-1 and HRV and age group <5 for hMPV in both ICU and those on ventilator support. Lowest infection means were also observed only in age group 20-34 for Influenza A Virus HPIV-1, HRV and Human metapneumovirus in the intensive care unit and also those on ventilator support. There were 34 cases of multiple viral infections. 20 cases were in those on ventilator support while 14 cases were present in those in the intensive care unit. It is evident that these infections are common in patients in ICU and those under ventilator support at MTRH. It is also clear that these infections are common in the various age categories. Those below 5 years and those above 50 years have higher prevalence of majority of the infections in comparison to other age groups. Surveillance for viral respiratory infections should be improved in order to implement treatment and also understand seasonality of these viruses and other new respiratory viruses. Co-infections should be closely monitored especially in mechanical ventilation in order to understand the impact of ventilator support on infection rates by these viruses. More studies needs to be done focusing on nosocomial respiratory viral infections.
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    Antibiotic Susceptibility Patterns of Bacteria Isolated from Wards, Operating Room and Post-Operative Wound Infections among Patients Attending Mama Lucy Hospital, Kenya.
    (Kenyatta University, 2021) Auna, Amulioto Johnstone; Margaret Muturi; Scholastica Mathenge
    Surgical site infections are a worldwide problem in the field of surgery contributing to increased mortality and morbidity. However, despite advances in the control of surgical site infections, the risk of acquiring these infections has not fully been eliminated due to the emergence and spread of resistant bacteria pathogens. In Kenya, there were scanty published reports on the antibiogram of surgical site infection pathogens lurking in the hospitals. The objective of this research was to determine the prevalence and antibiotic susceptibility patterns of bacteria isolated from the wards, operating room, and surgical site infections among patients attending Mama Lucy Hospital. This was a cross-sectional descriptive study of patients with post-operative wound infections in the hospital wards. Purposive sampling was employed and a total of 126 samples collected. Of these, 58 came from surgical site infected patients and 68 were obtained from predefined areas of the wards and operating room of the facility. The samples were processed through Gram stain, culture, and an array of biochemical tests. Subsequently, antibiotic susceptibility tests by Kirby bauer disc diffusion technique were performed on the isolated bacteria. Data collected was analyzed using a statistical package for the social sciences (SPSS) version 20 and chi-square (p<0.05). A total of 137 bacteria were isolated from the culture positive swabs, 78 of these came from the wound pus swabs while 59 were recovered from the hospital surface swabs. Among the SSI bacteria, Staphylococcus aureus (28.2%) was the preponderant bacteria followed by E.coli (15.4%). In the wards and operating room, the main bacterial contaminant was Staphylococcus aureus. Based on the sensitivity report, all the SSI bacteria isolates were sensitive to Chloramphenicol (69.2%). Wherease the environmental bacteria isolates had sensitivity to Ciprofloxacin (86.4%), Doxycycline (88.1%), Chloramphenicol (93.2%) and Vancomycin (100%). Majority of the environmental isolates were highly resistant to Ampicillin/cloxacillin. In conclusion, the most prevalent SSI bacteria was Staphylococcus aureus, while Chloramphenicol was seen as the best drug for treating SSI at the hospital. The facility therefore needs to identify the most frequent bacteria associated with SSI. In addition, they need to monitor the bacteria that frequently contaminate the wards and operating room. The current antibiogram profile will help policy makers in the healthcare sector and the current setting to improve the current local guidelines on antibiotic prophylaxis for treatment of surgical site infection. The profiling will also assist in monitoring bacteria resistance trends within the institution and the country. Information generated from the hospital environment will help the infection control team at the current set-up to improve on the prevention of healthcare associated infections by carrying out active monitoring of hospital contaminants.
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    Antibiotic Susceptibility Profile of Enteric Bacterial Isolates from Stool in Children below Five Years with Diarrhoeal Disease in Muranga County, Kenya
    (Kenyatta University, 2019-06) Mbuthia, Oliver Waithaka
    Diarrhoea is a major cause of morbidity and mortality in developing countries. Bacterial agents are among pathogens implicated to cause diarrhoea in children and are of major concern in public health. Antibiotic use has paradoxically led to bacterial resistance and the situation continues to worsen. The main objective of the study, therefore, was to determine enteric bacterial isolates and their susceptibility to antibiotics from diarrhoeal stool samples among children below five years in Murang`a County. A hospital-based cross-sectional study approach was applied to 163 randomly selected diarrhoeal stool samples from children below five years in Murang`a and Muriranja`s hospitals. Enteric bacterial pathogens were cultured and identified using polymerase chain reaction and biochemical methods. A questionnaire was used to collect information from the guardian. Statistical analyses were performed using STATA v.13. Fisher’s exact test was used to check for evidence of relationship (p<0.05). Regression model analysis was used to estimate the association between pathogenic bacterial isolates and demographic, clinical, and hygienic factors. There were nearly equal distributions in gender 86(52.8%) female vs. 77(47.2%) male, the majority (35.6%) aged within 1 day - 12 months. Clinically, 153(93.9%) had a fever, while 117(71.8%) had a nutritional problem. A total of 188 enteric bacterial isolates belonging to 11 genera were recovered from stool samples of children under investigation. Predominant bacteria from stool samples was nonpathogenic Escherichia coli 85(43.8%), while 13(7.0%) E. coli were positive for virulence genes, including 8(4.3%) positive for both LT and STp Shiga-like or Enterotoxigenic E. coli, 3(1.6%) for eae Enteropathogenic E. coli and 2(1.1%) for Enteroaggregative E. coli gene. Others included: Salmonella 21(10.8%), Pseudomonas 14(7.2%), Shigella 14(7.2%), Klebsiella 12(6.2%), Aeromonas 8(4.1%), Enterobacter 7(3.6%), Proteus 8(4.1%), Citrobacter 3(1.6%), Yersinia 2(1.1%) and Vibrio species 1(0.5%). Children between 1 day - 12 months (OR 0.3, 95% CI 0.1-0.8) were more likely to be infected with pathogenic bacteria than those between 49-60 months. Enteric bacterial isolates were highly diverse in female and among those aged 49-60 months. Female participants (OR 1.8, 95% CI 1.1-3.4) were nearly twice likely to be infected with pathogenic bacteria. Those who presented with watery stool (OR 0.4, 95% CI 0.2-0.9) or mucoid stool (OR 0.3, 95% CI 0.2-0.7) remained associated with pathogenic bacterial infection but less likely to be infected compared to those who presented with watery-blood stained stools. Piped water and storing water with a lid were associated with a less bacterial infection. Almost all the isolates were resistant to Ampicillin, Amoxicillin, Chloramphenicol, Ciprofloxacin, Ceftriaxone, Kanamycin and Cotrimoxazole. Bacterial identification and subsequent antibiotic susceptibility testing from stool samples should be scaled up to confirm and guide therapeutic use thereby minimizing bacterial resistance
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    Antifungal Activities of Camellia Sinensis Crude Extract on Selected Pathogenic and Mycotoxic Fungi
    (2014-02-26) Sigei, Erolls Cheruiyot; Muturi, Margret; Bii, Christine
    Human fungal infections pose serious medical issues. Up to now, more than a hundred thousand fungal species are considered as natural contaminants. During the last decade, the incidence of superficial and deep mycotic infections has continued to increase explosively. There is a general consensus among researchers, clinicians and pharmaceutical companies that new, potent, effective and safe antifungal drugs are needed. Majority of work has been conducted on Camellia sinensis extracts against bacterial agent’s activity but little work for antifungal activity. In this study, in vitro antifungal activities of Camellia sinensis crude extracts compared with azole group of compounds on selected pathogenic and mycotoxic fungi were determined. That was done by evaluating the difference in antifungal activities of green and black tea crude extracts having a concentration of 100mg mL-1. Quantitative bioassay was done using disc diffusion method and Minimum Inhibition Concentration was done using broth dilution methods. The fungal isolates used for bioactivity testing were yeasts; Candida famata, C. lusitaniae, C. tropicalis ATCC 750, C. parapsilosis ATCC 22019, C. glabrata ATCC 24433, C. krusei ATCC 6258 and Cryptococcus neoformans ATCC 66031; and moulds, Trichophyton mentagrophytes, Microsporum gypseum, Fusarium monilliforme, Aspergillus spp and Penicillium chrysogeneum. ATCC standard fungal strains and clinical isolates were included. Green tea crude extract showed stronger inhibitory effect against the fungal strains tested than black tea crude extract. There was a significant difference in zone of inhibitions (T=4.09, P<0.05). Zone of inhibition exhibited by green tea crude extracts (11.92±0.00mm) were higher than black tea crude extracts (8.14±0.56mm). The pattern of activity by tea crude extracts against ATCC standard fungal strains and clinical isolates strains were similar. C. famata, C. lusitaniae, C. tropicalis ATCC 750 and dermatophyte, T. mentangrophyte were inhibited by green tea crude extract (IZD≥15mm). Clinical isolates of Candida albicans (strain 4 and strain 5); Cryptococcus neoformans (strain 3, 5 and 12), showed susceptibility to Camellia sinensis green crude extracts. The MIC of Camellia sinensis crude extracts against fungal isolates tested ranged from 50 mg mL-1 to 1.6 mg mL-1. Hot green tea crude extract (mean MIC 12.25mg mL-1) had a higher MIC on clinical fungal isolates than cold green tea crude extract (Mean MIC 12.167 mg mL-1). The concentrates of aqueous Camellia sinensis crude extracts showed synergistic activity with conventional antifungal drug. However, level of synergism differed as observed in difference in inhibitory effect. The difference in inhibitory effect was significant (P<0.05). The crude tea extract restored the activity of lower concentration of antifungal, Fluconazole below MIC to susceptible breakpoints. Generally, the MFC (Minimum Fungicidal Concentration) of Mixture crude extracts were slightly higher as compared to that of green tea crude extract. These results are suggestive that addition of milk to blend the crude extracts altered the bioactive ingredients resulting to higher concentration for its MFC as compared to crude extracts alone. The studies on Camellia sinensis crude extracts (green and black) have shown remarkable antifungal activity against different strains of fungi and highlighted its significance to humans as potential health products.
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    Bacterial Flora as Determinants of Ventilator Associated Pneumonia in Intubated Patients in an Intensive Care Unit
    (Kenyatta University, 2015-01-14) Nkoroi, Beatrice Nkirote
    Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. Of these, ventilator associated pneumonia (VAP), a common complication of endotracheal intubation and subsequent mechanical ventilatory support in critically ill ICU patients is a major concern for intensivists and other health care players. The issue of concern is whether the microbial agent present in the respiratory tract of patients at the time of intubation is likely to cause VAP in the intubated and mechanically ventilated patient. Studies done internationally have established a profile of some of the common bacterial agents responsible for VAP, however no studies have been done in Kenya to profile the common pathogens responsible for VAP and therefore, relatively little information is available about the Kenyan epidemiology of such infections. The purpose of this study was to provide an up-to-date picture of the demographic characteristics of patients who develop VAP, the prevalence of VAP and the common bacterial causative agents and the antimicrobial sensitivity patterns in a mixed medical – surgical ICU of the Aga Khan University Hospital, Nairobi Kenya. One hundred patients admitted into the ICU who were intubated during the study period were enrolled. Endotracheal aspirates were taken at the time of intubation and repeated when a clinical suspicion of VAP was made. Data was collected using preprinted case report forms and analyzed using chi-square and Pearson’s correlation as appropriate using the statistical software for social sciences (SPSS) version 17. Data was presented in tables, histograms, and other pictorial presentations as appropriate. The mean age of the patients was 55.86 years (95 % CI: 52.15, 59.67). Males were 57(57 %) and females were 43 (43 %).Most of the patients were admitted to ICU via A and E (35 %). Patients with medical conditions were (57) 57 %, those with surgical conditions were 25 (25 %) while 18 (18 %) had both a medical and surgical condition. A total of 78 (78 %) patients had chronic comorbidities while twenty two (22) patients did not have any comorbidity. Among the 78 who had comorbidities only 9 (12 %) had respiratory related comorbidities. A total of 21 (21 %) patients had a history of respiratory infection at the time of admission into ICU. Sixteen patients developed VAP, giving the prevalence of VAP at the AKUH, N ICU of 16 % (95 % CI: 14.0-23.6 %).The most common bacterial pathogens isolated from the patients with VAP were Acinetobacter baumanii (37.5 %), Pseudomonas aeruginosa (12.5 %), Klebsiella pneumoniae (6.3 %). Candida albicans was isolated in 12.5 % of patients with VAP. Thirty two percent (32 %) of the pathogens isolated demonstrated high resistance and MDR patterns to the antibiotics commonly prescribed in this ICU. Meronem (26 %), Tazopipril and Rocephine each at 12 % were the most commonly prescribed antimicrobial agents. Further studies are recommended to establish the susceptibility patterns of the individual antimicrobial agents and evaluate the clinical outcomes of patients with VAP
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    Blood Cell Count Changes and Haemoglobin Genotypes in Children with Malaria and Bacteraemia in Siaya County Referral Hospital, Kenya
    (Kenyatta University, 2022) Ogulla, Godfrey Adongo; Margaret Muturi; Collins Ouma
    Malaria and bacteraemia co-infection in children, normally produce changes in blood cellular components. Full blood count results from children whose haemoglobin genotypes and bacteraemia is not known can greatly influence the reporting of the cellular components results from automated cell counter and this formed the aim of the on the clinical management and interpretation of the results. Nevertheless, there was missing information on the role of malaria and bacteraemia co-infection on cellular components of normal haemoglobin and sickle cell trait in children. A total number of 384 children were recruited and complete blood count test were analyzed by automated cell counter machine. Other tests done included malaria smear microscopy, blood culture by Bactec 9050 machine and haemoglobin genotype determined by Helena Haemoglobin electrophoresis method. Children were stratified into two study groups; Malaria positive and bacteraemia negative and malaria positive and bavteraemia positive. Across groups analysis against region established normal ranges, showed lymphocytopnia and thrombocytopenia. Bacteria isolated were all from children with Hb genotype AS with malaria and bacteraemia co-infection with bacteraemia prevalence of 8.1% (31,of 384). The isolated bacteria species included non-typhi salmonella (NTS) (32%), Escherichia coli (3%) Enterobacter cloacae (6.5%), Staphylococcus aureus (39), Listeria monocytogenes (10%), Streptococcus pyogenes (3%) and viridans streptococci (6.5%). Obtained results indicated that salmonella species and staphylococcus aureus bacteria as the most prevalent isolates associated with bacteraemia in children with haemoglobin genotype AS with malaria infection. Haemoglobin genotypes AS children are seen to be prone to malaria and bacteraemia co-infection and lymphocytopenia and thrombocytopenia being the common cellular changes seen in full blood count results. Staphylococcus aureus and salmonella spp were the most prevalent bacterial isolates. Recommended that haemoglobin electrophoresis should be considered for all paediatric patients admitted with malaria and bacteraemia co-infection with complete blood count indicating lymphocytopenia.
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    Comparative Study of Hepatitis B and Hepatitis C Viruses Among Hiv-1 Infected Intravenous Drug Users and Non-Users in Mombasa County
    (Kenyatta University, 2017-09) Kinya, Caroline Mercy
    HIV/AIDS is a debilitating disease associated with high mortality and morbidity globally. In Kenya, it is the major cause of mortality across all gender and age groups, in effect, putting a huge demand on the healthcare system and the economy. The HIV 1 positive population faces major challenges such as the drug resistance, severe hepatic coupled with immunological deficiencies and toxicity. The problems are aggravated by co-infection with blood borne diseases, varied responses to the infection and therapy among vulnerable groups. This study purposed to determine and compare; the CD4 counts, HIV viral loads, liver enzyme markers and the prevalence of viral hepatitis among the HIV- 1 positive IDUs and NDUs. A cross-sectional study was carried out in Mombasa County. A structured questionnaire was used to collect information on HIV AIDS, Hepatitis and social demographics. Blood samples were collected, screened and analyzed for HIV, HBV and HCV, CD4+ cell, HIV viral load and liver enzyme markers. Pearson’s Chi square, Student T test and one way Anova were used to analyze data. A P value ≤ 0.05 was considered statistically significant. A total of 200 participants consisting of 78 males and 122 females were recruited. Sero-prevalence of Hepatitis B and Hepatitis C was at 16% and 20% respectively among the IDUs and 11% and 8% respectively among the NDUs. The sero-prevalence of HIV+HBV+/HCV infection among IDUs and NDUs was 6% and 4% respectively. The liver enzyme markers (Alkaline phosphate, Aspartate aminotransferase and Alanine transferase) were markedly elevated among the co-infected participants than the mono-infected in both the NDU and IDU groups. IDUs showed elevated mean liver enzymes than the NDUs. The IDUs had a lower mean CD4+ cell count of 350.2 (±225.27) cells/μl than the NDUs 485.9 (±243.38) cells/μl (P˂0.0001). Participants who were co-infected showed remarkably low mean CD4+ cell counts of 192. 91(±84.08) cells/μl than the mono-infected with mean count of 536.79 (±218.76) cells/μl (P=˂0.0004). A statistically significant high mean viral load of 153392.97(±395699.65) copies/ml was reported among co-infected participants than the mono-infected at 2435.05(±5596.88) copies/ml (P˂0.0001) across the study population. The study established that the co-infection rates with HBVand HCV was higher among the IDUs than the NDUs. The liver profile indices indicated elevated liver enzymes among IDUs than NDUs. Co-infected participants had statistically significant higher liver enzyme markers than the mono-infected. Immunologically, CD4+ cell counts were lower among IDUs than the NDUs. Co-infected individuals had a lower mean CD4+ cell count than the mono-infected. IDUs had a statistically significant higher HIV viral load than the NDUs. The co-infected also indicated a statistically significant higher mean viral load than the mono-infected. This study proposes routine baseline screening of HBV and HCV for IDUs and NDUs owing to the high frequency of co-infections. A people driven campaign is also necessary to create awareness on the effects of the use of substances of abuse in relation to viral infections and treatment. Also the campaign is necessary to create awareness on the HBV vaccination.
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    Comparative Study of Hepatitis B and Hepatitis C Viruses among HIV-1 Infected Intravenous Drug Users and Non-Users In Mombasa County
    (Kenyatta University, 2017) Kinya, Caroline Mercy
    HIV/AIDS is a debilitating disease associated with high mortality and morbidity globally. In Kenya, it is the major cause of mortality across all gender and age groups, in effect, putting a huge demand on the healthcare system and the economy. The HIV 1 positive population faces major challenges such as the drug resistance, severe hepatic coupled with immunological deficiencies and toxicity. The problems are aggravated by co-infection with blood borne diseases, varied responses to the infection and therapy among vulnerable groups. This study purposed to determine and compare; the CD4 counts, HIV viral loads, liver enzyme markers and the prevalence of viral hepatitis among the HIV- 1 positive IDUs and NDUs. A cross-sectional study was carried out in Mombasa County. A structured questionnaire was used to collect information on HIV AIDS, Hepatitis and social demographics. Blood samples were collected, screened and analyzed for HIV, HBV and HCV, CD4+ cell, HIV viral load and liver enzyme markers. Pearson’s Chi square, Student T test and one way Anova were used to analyze data. A P value ≤ 0.05 was considered statistically significant. A total of 200 participants consisting of 78 males and 122 females were recruited. Sero-prevalence of Hepatitis B and Hepatitis C was at 16% and 20% respectively among the IDUs and 11% and 8% respectively among the NDUs. The sero-prevalence of HIV+HBV+/HCV infection among IDUs and NDUs was 6% and 4% respectively. The liver enzyme markers (Alkaline phosphate, Aspartate aminotransferase and Alanine transferase) were markedly elevated among the co-infected participants than the mono-infected in both the NDU and IDU groups. IDUs showed elevated mean liver enzymes than the NDUs. The IDUs had a lower mean CD4+ cell count of 350.2 (±225.27) cells/μl than the NDUs 485.9 (±243.38) cells/μl (P˂0.0001). Participants who were co-infected showed remarkably low mean CD4+ cell counts of 192. 91(±84.08) cells/μl than the mono-infected with mean count of 536.79 (±218.76) cells/μl (P=˂0.0004). A statistically significant high mean viral load of 153392.97(±395699.65) copies/ml was reported among co-infected participants than the mono-infected at 2435.05(±5596.88) copies/ml (P˂0.0001) across the study population. The study established that the co-infection rates with HBVand HCV was higher among the IDUs than the NDUs. The liver profile indices indicated elevated liver enzymes among IDUs than NDUs. Co-infected participants had statistically significant higher liver enzyme markers than the mono-infected. Immunologically, CD4+ cell counts were lower among IDUs than the NDUs. Co-infected individuals had a lower mean CD4+ cell count than the mono-infected. IDUs had a statistically significant higher HIV viral load than the NDUs. The co-infected also indicated a statistically significant higher mean viral load than the mono-infected. This study proposes routine baseline screening of HBV and HCV for IDUs and NDUs owing to the high frequency of co-infections. A people driven campaign is also necessary to create awareness on the effects of the use of substances of abuse in relation to viral infections and treatment. Also the campaign is necessary to create awareness on the HBV vaccination.
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    Correlation between an early 6 and early 7 oncogenes detection method and conventional cytology for cervical cancer screening at Kenyatta National Hospital, Kenya
    (Kenyatta University, 2016-10) Muyabwa, Cosmas
    The oncogenic potential of human papilloma virus (HPV) early genes E6 and E7 is of interest in HPV testing for cervical carcinoma. The current study included women less than 40 years attending the Kenyatta National Hospital family planning clinic, with an objective of comparing the performance of cytological tests done in Kenya with the Pretect SEE assay developed by Norchip AS (Norway). Two hundred and four (204) samples were obtained in which the HPV E6 and E7 HPV mRNA was evaluated using the Pretect SEE assay for detection of high risk HPV types 16, 18 and 45. The HPV 35 and 52 may not be involved as the cause of invasive cervical cancer in Kenya. The real-time nucleic acid sequence-based on amplification was also included. The Pap test and cytological analysis were done locally at the Kenyatta National Hospital and the results were recorded and compared to the Pretect SEE results. Three (3) out of two hundred and four (203) women were positive with Pretect SEE (samples that expressed E6 and E7 HPV oncogenes), whereas only one sample(1) out of two hundred and three 203 samples was positive with Pap test. One sample (1) was rejected due to lack of cells. The overall diagnostic prevalence of HPV was 1.47% (3/203) after testing with pretect SEE and 0.5% (11203) after testing the pap smears. The Pretect SEE showed a specificity of 100% and a sensitivity of 100% using Pap smear as Gold standard. The PreTect SEE showed a positive predictive value (PPV) of 33 % and a 99% negative predictive value using Pap smear as the gold standard. The Pap smear showed a specificity of 100% and a sensitivity of 33% when using PreTect SEE as the gold standard. If all the PreTect SEE contains CIN2+ cases, the sensitivity, specificity, PPV and NPV would be 100%. In conclusion, the Pretect SEE™ assay was found to be more sensitive than the Pap smear. Therefore the use of PreTect SEE as a primary screening method with a high coverage rate may reduce the incidence of cervical pre-cancer to a minimum in Kenya. Using a very sensitive and specific method in a very representative female population in Kenya has strongly indicated that the prevalence of cervical cancer in Kenya may be lower due to false positive and lack of differentiation between transient and transforming infections. The estimated number of annual cervical cancer cases may be around 1000 and not 4800 as indicated by the IeO HPV Information (2012). The estimated prevalence of HPV 16 and/or HPV 18 DNA (2012) reported by ICO HPV Information Centre among cytological women in Kenya, may be less than 2,5%and not 9.1%. Around 40% of the HPV 16 and 18 HPV DNA in cytological normal cases may not express E6 and E7 mRNA. This also show that the prevalence of HIV in the whole Kenya population may not be 6.2% but rather less than 2%. The study showed that it is important to perform national screening in more than 3.2% of typical national population's in Africa.
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    Culicine Mosquito Species Diversity, Host Feeding Preferences and Insecticide Resistance Status in Taita-Taveta County, Kenya
    (Kenyatta University, 2020) Ngami, Munyao Vanessa
    Culicine mosquitoes are vectors of human disease-causing pathogens like lymphatic filariasis and several arboviruses such as dengue fever, chikungunya virus and so on. Due to intensifying land use land cover (LULC) with increasing pressure on natural environments because of urbanization and agricultural activities, there has been an increasing risk of mosquito-human contact leading to transmission of vector borne diseases. In recent years, along the coastal region, Kenya, there have been increased occurrences of emerging and re-emerging vector borne diseases, with subsequent social -economic concerns implications. Therefore, this study determined Culicine mosquito species abundance, diversity and their host feeding preferences in Taita -Taveta County, Coastal Kenya. A Cross sectional study design was adopted in this study. Entomological sampling was done in the months of March and October 2018, which are dry and wet season respectively. Adult mosquitoes were collected indoors and outdoors using CDC light traps and Backpack aspiration. The collected mosquitoes were sorted according to their sub-families as Anopheline and Culicine. The Culicine mosquitoes were identified morphologically into species and categorized according to their physiological status. The fully blood fed mosquitoes were tested for blood meal sources using Enzyme Linked Immunosorbent Assay (ELISA) for different hosts found within the peri -domestic environment mainly human, goat, chicken and bovine. For insecticide resistance characterization, mosquito larvae were collected using dipping sampling method, the mosquito larvae were reared into adults. The 3-5 old emergent mosquitoes were exposed to pyrethroids using WHO protocol. Three thousand two hundred and seventy-eight (3,278) mosquitoes were collected indoors (22.5%, n=738) and outdoors (77.5%, n=2,540). The collected Culicine mosquitoes were identified to be consisting of eighteen (18) species including; Aedes (7 species), Culex (8 species), Mansonia (2 species), Coquilletadia (1 species). Culex quinquefasciatus (69.1%) was the predominant species observed in all the six sites, though varied across the sites (χ2=85.5, df=5, P<0.001). Culex straitipes and Cx. Culicioma (0.03%) had the lowest numbers of mosquitoes. Overall, there was high mosquito species diversity (H) in outdoors (H = 2.4339) than in indoors (H =2.2523) with even distribution (EH) being higher in indoors (EH =0.9064) than outdoors (EH =0.8266). Of the mosquitoes collected, 1,241 mosquitoes were tested for blood meal sources. Majority of the blood meals sources identified were from multiple blood meal sources (51.6%), single hosts (41.3%) and least were unidentified (7.2%). There was significant difference of Human Blood Index between indoor and outdoor for Cx. Quinquefasciatus species (χ2=19.40, df=1, P<0.0001). Culex quinquefasciatus showed some existence of resistance to bediocarb, deltamethrin, DDT and fenitrothion, but were found to be susceptible to Permethrin. The study demonstrated that Culicine mosquitoes were highly zoophilic. It is therefore essential to evaluate the impact of zooprophylaxis on arboviruses transmission. There is a need for more studies on species distribution and abundance beyond what this study has accomplished and conduct vector competence and blood meal assays for a comprehensive assessment of lymphatic filariasis and arboviruses risk to public health in Taita-Taveta, Kenya.
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    The Cytokine Profile and Prostate Specific Antigen Levels in Prostate Cancer Patients at Kenyatta National Hospital
    (Kenyatta University, 2015-08) Mwirigi, Liza Kiende
    Prostate cancer (PCa) is Kenya‘s most frequently diagnosed cancer of men with an incidence rate of 32 per 100,000 and mortality rate of 12 per 100,000. It is also the leading cancer in terms of incidence and mortality in men from Africa and the Caribbean and the numbers may double by 2030. Prostate Specific Antigen (PSA) is the main diagnostic biomarker used for screening patients currently. Biopsy histology is the only confirmatory test, but it is invasive and tedious to perform. There is an urgent need to develop other accurate biomarkers that can be used for screening and diagnosis. Cytokines have potential but have not been extensively studied as biomarkers. The objectives of this study were to evaluate the cytokine profile, determine the PSA levels in PCa patients and the risk factors that lead to the development of PCa. The study profiled six cytokines (interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), interferon gamma (IFN-Gamma) and tumor necrosis factor alpha (TNF-Alpha) and the total PSA levels in the serum of 45 PCa patients, 7 benign prostate enlargement (BPE) patients and 7 healthy males as controls. Cytokines were measured using a highly sensitive cytometric bead array technique. PSA levels were determined using enzyme linked immunosorbent assay (ELISA) technique. A questionnaire was used to determine the demographic and risk factors that lead to the development of PCa. Statistical analysis was performed using statistical package for social sciences (SPSS) version 21. Analysis of variance (ANOVA) was used to compare the means of the cytokines and PSA levels in the different Gleason scores of the PCa patients. Pearson correlation was used to correlate the six individual cytokines and PSA levels. Statistical significance was set at the level of p<0.05 for both the ANOVA and the Pearson correlation test. The results showed that serum levels of all cytokines and PSA were significantly (p<0.05) higher in the PCa and the BPE patients. The PCa patients with a Gleason score of 8-10 had the highest levels of all the cytokines followed by those with a Gleason score of 5-7, then those with a Gleason score of 2-4. TNF-Alpha and IL-6 were the cytokines with the highest levels while IL-4 and IL-10 had the lowest levels. The cytokine levels among the BPE patients were less than those of the PCa patients. The PSA levels were also significantly higher (p=0.002) in the BPE and PCa patients and they were significantly correlated (p=0.01) with the six cytokines in the two study groups. Kenyan men who are above 50 years are at risk of suffering from PCa. These results indicated that cytokine profiles in PCa patients are distinct by the stage of the disease. TNF-Alpha, IL-6, IFN-Gamma, IL-2 and IL-4 may be potential early diagnostic biomarkers for prostate cancer. The current data forms a basis for further investigations.
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    Dengue 2 infection in wild caught papio anubis (olive Baboons) and chlorocebus aethiops (african green Monkey) from selected regions of Kenya
    (Kenyatta University, 2014) Ambala, Peris Auma
    Dengue viruses, family Flaviviridae and genus Flavivirus occur as four antigenically distinct serotypes denoted as dengue virus 1, 2, 3, 4 (DENY-I, 2, 3, 4). The four serotypes are known to broadly infect different vertebrate hosts including humans, wild animals and various species of non-human primates (NHPs). Despite the fact that NHPs have increasingly been implicated as potential sources of emerging zoonotic viral diseases, there is no available scientific data on sylvatic dengue virus surveillance in Kenya. The present study investigated the sero-prevalence of DENY-2 exposure and characterized DENY serotypes circulating in NHPs from Laikipia, Aberdares, Kajiado, Kibwezi, Kitale, Nairobi and Namanga regions. A total of 287 wild-caught NHPs, comprising of 115 Olive baboons (Papio anubis) and 172 Africa Green monkey-AGM (Chlorocebus aethiops) were sampled. Sera prepared from the 287 blood samples were tested for anti-dengue viral immunoglobulin gamma (IgG) antibody using enzyme linked immunosorbent assay (ELISA). Samples which were positive for anti-dengue IgG were subsequently subjected to a nested polymerase chain reaction (PCR) test with specific primers targeting the capsid and pre-membrane genes of the virus. The sero-prevalence of dengue virus exposure was 35.7% (41/115) in P anubis and 39.5% (68/172) C. aethiops. RT-PCR confirmed that 1.7% (2/115) P anubis and 2.3% (4/172) C. aethiops were positive for dengue virus. The 2 baboons and 4 AGMs were from Laikipia, Kakamega, Kibwezi and Kitale respectively. Chi-square test indicated no statistical significance in sero-prevalence (P = 0.537) results between the species. In conclusion, this study provides strong evidence of dengue virus infection among P anubis and C. aethiops in Kenya. Although this epidemiological study indicates high dengue exposure in NHPs, there was significantly low active infection as evidenced by PCR results. My conclusion is that sylvatic dengue viruses 2 circulates in non-human primates found in Kenya. I recommend that the country should strengthen its surveillance on sylvati cengue viruses which will likely become a serious public-health problem in the near future in human population that live in close proximity to animals.
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    Determination and Characterization of Occult Hepatitis B in High-Risk Populations in Kenya
    (kenyatta university, 2023) Kiptoon, Beatrice Jepkemei; George Gachara; Carla Oswioy
    Occult hepatitis B virus (OBI) refers to the detection of HBV DNA in the serum or liver of individuals lacking the HBV surface antigen (HBsAg). It is often described among individuals having antibody to the core antigen as the sole serological marker of infection ("anti-HBc only"). However, it has also been observed in the absence of any serological markers ("seronegative OBI"). In cases of "seropositive" OBI, the presence and quantity of anti-HBs may provide an indication of putative risk for OBI, as isolated studies have shown absent or low levels (≤100 mIU/mL) of anti-HBs are more frequently associated with OBI. This has important consequences for blood donation screening and vaccination policy. The lack of HBsAg detection maybe attributed to the window period during acute infection, the virus's low replication phenotype, or a flaw in the expression or release of HBsAg. Mutations within the surface antigen-coding region have also been associated with loss of immunoassay detection for HBsAg. OBI often results in a non-symptomatic or benign infection, although it has been allied to serious hepatic disease, particularly in those co-infected with HCV or HIV, in which occult HBV is more frequently detected. The prevalence and characteristics of OBI in high-risk groups remain unknown in Kenya. Relying solely detection of HBV surface antigen (HBsAg) may lead to under-diagnosis of OBI cases, emphasizing the need for a comprehensive investigation to inform targeted public health interventions and strategic policies to combat HBV in Kenya. This study aimed at investigating the prevalence and molecular characterization of OBI in high-risk Kenyan populations. Sera from 65 HBsAg-negative patients presenting with jaundice at Kenyan medical facilities and 99 male sex workers (MSM-SW), along with 13 non-MSM men having HIV-positive partners were analyzed. Testing included HBV serological markers and additional hepatitis C virus (HCV) screening for MSM-SW patients. HBV DNA was extracted and analyzed using real-time polymerase chain reaction (rt-PCR). Of the 166 HBsAg-negative samples, 31 (18.7%; 95% CI 13.5 – 25.3) tested positive for HBV DNA, classifying them as OBI positive with an overall prevalence of 18.7%. Notably, 64.5% (20/31) of these cases were found to have HBV core protein antibody (anti-HBc positive). Among the MSM-SW cohort, a 10.1% (10/99; 95% CI 5.6 – 17.6) HBsAg positivity rate was observed. All samples tested negative for HCV. HBV genotype A predominated, with distinct genetic clustering patterns observed among the study cases, indicating potential common networks or non-African sources. The high prevalence of OBI across examined cohorts, along with the occurrence of chronic HBV infection in the MSM-SW population, highlights the necessity for targeted screening programs to enable preventive measures, including HBV vaccination, and ensure access to treatment and care.
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    Determination of Urinary Tract Infections aand Antibiotic Sensitivity among Non-Insulin Dependent Diabetes Mellitus Patients Visiting Kisii Teaching And Referral Hospital, Kenya
    (Kenyatta University, 2018) Mogaka, Mageto Vincent
    People with non-insulin dependent diabetes mellitus have been found to be prone to urinary tract infections. There is a wide gap of information in developing countries regarding the prevalence and antibiotic sensitivity of the pathogens causing urinary tract infections in diabetic patients. Developed nations also face a relatively huge burden of managing urinary tract infections among non-insulin dependent diabetics. The objective of this study was to determine the prevalence and antibiotic sensitivity of bacteria causing urinary tract infections among non-insulin dependent diabetic patients as well as determining the bacterial causative agents of urinary tract infections through biochemical confirmatory tests. The study was carried out in Kisii Teaching and Referral Hospital in Kisii County, Kenya. One hundred and eighty diabetic patients were enrolled in a cross-sectional study design. Clean catch midstream urine was collected from all participants and cultured in cysteine lactose electrolyte deficient agar for bacteria isolation. The isolates were later cultured in Mueller Hinton for antibiotic sensitivity testing. Classification of a positive culture for urinary tract infection was based on more than 100,000 (≥105) colony-forming units of a single bacterial species. All the data was extracted and analyzed with the statistical package for the social science (SPSS) version 20. The data was analyzed using frequencies, chi square (P<0.05) and logic regression to find the odds ratio. One hundred and seven participants were male (59.4 %) and 73 (40.6 %) were female. Sixty-three participants (35 %) showed symptoms of urinary tract infections. The overall prevalence of urinary tract infections was 20.6 % with 37 participants testing positive for urinary tract infection. The duration of diabetes mellitus was revealed to be significant (p=0.01) while age was also found to have a significant association with urinary tract infection (p=0.002). Out of the 37 (100 %) isolates, 35 (94.6 %) were gram negative and the remaining 2 (5.4 %) were gram positive. Escherichia coli was the most predominant isolate with 21 (56.8 %) isolates followed by 10 (27 %) isolates of Klebsiella pneumonia and then 4 (10.8 %) isolates of Proteus mirabilis. There were two (5.4 %) isolates of Enterococcus faecalis. Out of the 21 E. coli isolates, five isolates showed resistance to ampicillin, three isolates were resistant to nitrofurantoin and three isolates were resistant to co-trimoxazole. Out of 10 K. pneumoniae isolates, two were resistant to ampicillin, one was resistant to cephalexin and two were resistant to co-trimoxazole. Out of the four P. mirabilis isolates, there were three cases where one strain was each resistant to ampicillin, nitrofurantoin and cotrimoxazole. All 21 isolates of E. coli (100 %) were sensitive to gentamicin and cephalexin. All ten K. pneumoniae isolates (100 %) were sensitive to gentamicin and nitrofurantoin. These findings suggest an increasing antibiotic resistance among pathogenic causative agents of UTI among non-insulin dependent diabetic patients. A longitudinal study is recommended with a higher number of participants, in order to understand the risk factors of urinary tract infection among diabetic patients
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    Development, Stability Testing, and Performance of Xpert MTB/RIF Proficiency Testing Material in National Tuberculosis Reference Laboratory, Nairobi City County, Kenya
    (Kenyatta University, 2024-01) Nganga, Margaret Wairimu
    Systematic and ongoing proficiency testing (PT) program is a fundamental element of external quality assurance in diagnosis of TB using Xpert MTB/RIF assay. In many resource-limited setting, particularly in Kenya, PT is poorly covered and largely inconsistent following inadequate supply of dried tube specimens (DTS). This has serious negative implications on patients‘ management and TB control programs. The aim of this study was to develop, assess stability and performance of local DTS panels for Xpert MTB/RIF assay PT in Kenya. This study was conducted at the National Tuberculosis Reference Laboratory (NTRL) and DTS piloting was done in Xpert MTB/RIF sites in Nairobi City County. An experimental study design was adopted to develop and assess stability DTS panels, and a cross sectional study design was adopted to pilot panels. The piloting sites were purposively selected to include all the twenty (20) TB diagnostic laboratories that were using Xpert machine in Nairobi City County, from August 2019 to December 2019.Bacterial strains stored in a -80oC freezer at the NTRL were retrieved and processed following standard bacteriological procedures. The strains were sub-cultured in liquid culture media (MGIT), growth detected by the BACTEC® MGIT 960® system, and their purity confirmed. Bacterial cultures were then heat-inactivated and pre-tested using Xpert MTB/RIF assay before preparing DTS. To assess the effect of drying on the stability of DTS panels, DTS panels were left uncapped inside a biosafety cabinet for 7, 10, and 14 days, and immediately subjected to Xpert MTB/RIF assay. In assessing the stability of the DTS panels at various temperatures as anticipated in TB diagnostic laboratories that use Xpert machine across the Kenya, 36 DTS panels from 7, 10, and 14 days drying periods were held at 18oC, 20oC, 24oC, 33oC, and 40oC for 12 weeks, and subjected to Xpert MTB/RIF weekly. For piloting, a set of 5DTS panels, 5 disposable sterile dispensing pipettes, processing instructions, and PT results evaluation form were delivered to the targeted piloting sites in a sealable transparent bag for testing by the Xpert MTB/RIF personnel who printed the results, entered them into the reporting form, and a scanned image send to the principal investigator for analysis. Data were analyzed using STATA v17 and variables were summed up in medians, interquartile range, means, and standard deviation (SD). Each of the five pilot DTS panels was assigned an accuracy score of 20 points, and individual laboratory scores as follows; incorrect determination of either MTB detection (0 points), unsuccessful result (error, invalid, or no results) (5 points), RIF-indeterminate result (10 points), and correct determination of both MTB detection and RIF resistance (20 points). Total scores for each laboratory were computed, with 100% being considered Excellent, ≥80% Satisfactory, and <80% Unsatisfactory. The DTS panels‘ probe A Ct values were within the expected mean range (16-23) and SD limit (≤3), with100% concordance between those dried for 7, 10 or 14 days and the pretest results. Except for DTS panels held at -80oC, the probe A mean Ct values of panels dried for 7 and 14 days increased with increasing temperature (from -20oC to 40oC) during the 12 weeks‘ study period (p= <0.001), with the greatest mean Ct value increment was at 40ᵒC.Ninety-five per cent (18/20) of piloted laboratories reported the expected, with 10% (2/20) of sites giving discordant results, false MTB detection (5%, 1/20) and error (code 5007) (5%, 1/20). 90% (18/20) of the piloted sites had satisfactory, 80% had excellent, and 10% (2/20) had unsatisfactory results. This study recommends adoption of 7-day DTS drying period, -80oC and 40oC storage up to 2 weeks, and up scaling DTS production for profic
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    Diversity and Endosymbionts of Tick Borne Pathogens at Human-Wild Life Livestock Interfaces in Coastal National Reserves, Kenya
    (Kenyatta University, 2024-04) Godani, Salim Kobo
    Ticks are vectors that can harbor pathogens like viruses, protozoa, and bacteria that can cause zoonotic diseases in humans. Human gets infected through tick bites where the pathogens are passed into the human blood. The lack of surveillance information about tick-borne pathogens and diseases has made it impossible to assess its impact on human and livestock. This study determined the diversity and endosymbionts of tick borne pathogens at human-wild life livestock interfaces in coastal national reserves, Kenya. Ticks were collected from both near Tsavo National Reserve in Taita Taveta County and Shimba hills national gane reserves in Kwale County using sterile forceps from restrained cattle and detected morphologically with the aid of morphological keys. Representative of the morphologicaly identified ticks were molecularly identified. Identity as well as characterization of pathogens carried by ticksand endosymbionts was done by Anaplasma, Ehrlichia, and Rickettsia specific RT-PCR product sequencing and HRM analysis.The sum of 317 (281 adult ticks and 36 nymphs) was sampled near Tsavo National Reserve, which includes seven species. Amblyomma was the most sampled genus withAmblyomma gemma being the most sampled species (n=135, 42.6%). Another Amblyomma species sampled was Amblyomma Variegatum (n= 40, 12.62%). Greatest species diversity was identified in Rhipicephalus genus with four species identified that includes; Rhipicephalus appendiculatus (n=44, 13.9%), Rhipicephalus Averts (n=1, 0.31%), Rhipicephalus Decoloratus (n=5, 1.6%), Rhipicephalus Pulchellus (n= 91, 28.7%). A single species of Hyalomma sp. was sampled. From near Shimba Hill game reserve (SHNR), a total of 240 adult ticks were sampled comprises of eight species. Amblyomma was the most sampled genus and againAmblyomma gemma was the most sampled species (n=156, 65 %). Other Amblyomma species sampled includes; Amblyomma Lepidum (n= 5, 2.1 %), Amblyomma Variegatum (n= 15, 6.3 %). Greatest species diversity was also identified in Rhipicephalus genus with four species identified that includes; Rhipicephalus appendiculatus (n=18, 7.5 %), Rhipicephalus Averts (n=6, 2.5 %), Rhipicephalus Decoloratus (n=4, 1.7 %), Rhipicephalus Pulchellus (n= 34, 14.2 %). The least sampled species was a single species of Hyalomma Scupense (n=2, 0.83 %). At near Tsavo National Reserve (TNR), a total of three pools of Rhipicephaline appendiculatus were positive for Theileria parva, two pools of Rhipicephaline evertsi for Anaplasma platys, and one pool of Amblyomma variegatum nymphs for Rickettsia africae. From near Shimba Hill game reserve (SHNR), , Rickettsia africae pathogen was detected in two pools of Am. variegatum and one pool of Am. Gemma. Rickettsia sp. and Anaplasma sp. were detected in Am. Gemma and Rh. evertsi respective. R. aeschlimannii was isolated in a pool of Am. Gemma.Coxiella spp.endosymbionts were detected in Rhipicephalus ticks in both study area. Robust vector surveillance and biological control programs against ticks should be emphasized in both Tsavo and Shimba Hills National Reserves. Biological control mechanisms for tick endosymbionts should be encouraged for employment as a tick control methods due to their ability to limit vector competency.
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    Effects of Schistosomiasis on Haemoglobin Concentration and Nutritional Status in Children under 5 Years, Taita/Taveta County, Kenya.
    (Kenyatta University, 2022) Nyika, Paul Ngaluma; Washingtone Arodi; George Gachara
    Bilharziasis is a common parasitic disease caused by flatworms called schistosomes. Generally, this infection is common and prevalent disease in Sub-Saharan Africa Middle East, Asia and the Caribbean. With slowed down treatment, the infection in young children (under 5 years) can potentially cause long term harm health effects. This disease causes unsatisfactory development and advancement in this early critical phase of life. This study was meant to attest to the burden of schistosomiasis in Taita Taveta County, by unmasking the prevalence and intensity of the disease among 5 years and below of age. The study recruited children under 5 years from six villages using stratified random technique. The selected children were referred to the nearest health facility for specimen collection. Stool and urine specimens were examined microscopically for helminths. Blood specimens were analyzed for malaria parasites and hemoglobin concentration. Data on anthropometric indices were also collected. Analysis were done using WHO Anthros and IBM SPSS. 132 participants were admitted in the study, predominant sex (53.8%) being males. The age of the participants ranged from 7 to 59 complete months with a median age of 48 (39 – 59) months. The number of participants who tested positive for bilharziasis was 37 (28%; 95% CI 21.1% - 36.2%). Cases of haematobium and mansoni were discovered in 18.9 percent (95% CI 13.2% - 26.5%) and 15.9 percent (95% CI 10.7% - 23.1%) of the sampled participants sequentially. Participants who were positive for other intestinal nematodes 6.8 percent; 95% CI 3.6% - 12.5%. The other STH infections were: ascariasis (6.8%), hookworm infection (4.5%) and trichuriasis (1.5%). The proportion of study participants whohad heavy intensity infections of urinary schistosomiasis were 16.0%. Heavy intensity infections were not detected in STH and S. mansoni. Bilharziasis was associated with nutritional aspects which comprises of stunting (odds ratio (OR) 3.665 (95% CI 1.443 - 9.309), p=0.006) and underweight (OR 12.698 (95% CI 3.107 - 51.900, p<0.001). Anemia was evidenced among the participants with schistosome infection when compared with the schistosome-negative participants (57.1 percent versus 42.9 percent respectively, OR 7.897 (95% CI 3.383 – 18.438), p<0.001). This survey confirmed a significant burden of schistosomiasis among population aged 5 years and below in the study area. Additionally, this study indisputable demonstrated that a lot of concerted efforts need to be prioritized for interventions including treatment and deworming to the pre-school age children (PSAC) in the study area. For example, in line with WHO exhortation, since the ova patent prevalence of schistosomiasis in this age group is within the range of more than 10% but not exceeding 50%, then biennial treatment with praziquantel should be conducted. With the great ambitious goal of World health organization of outstretching 75% coverage of prophylactic chemotherapy with a target of major helminthiases among PSAC, the findings from this study emphasizes the need for quick implementation of specific interventions to avoid accelerated morbidity while improving the general health of the population. Our data support the call for institutionalized mass treatment in lieu of school-based approaches only. This will ensure that deserving PSAC are reached by pertinent interventions via alternative delivery platforms such as through the Integrated Management of Childhood Illnesses and through Early Childhood Development and Education Centers. This work equally revealed the connection between flatworm’s infections, anemia and nutritional stature in the preferred population.
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    Evaluation of Enriched Rapid Diagnostic Method for Detection of Vibrio Cholerae and Antibiotic Susceptibility Patterns of Serotypes in Juba, South Sudan
    (Kenyatta University, 2018-09) Nyangena, Ontweka Lameck
    The global cholera burden is not precisely known since many of the cases lack proper investigation and documentation systems. More importantly, the situation is exacerbated by defective epidemiological surveillance as well as inadequate diagnostic procedures. Isolation of Vibrio cholerae is critical for disease outbreak confirmation. Rapid diagnostic testing of fecal specimens, on basis of lipopolysaccharide detection of V. cholerae O1 or O139 sub-types may enhance early outbreak detection and surveillance. The gold standard for V. cholerae diagnosis is stool culture, although, it’s not feasible in resource constrained settings since it warrants greater than 24 hours of bacterial isolation. As such, the present investigation aimed at evaluating the enriched rapid diagnostic method for V. cholerae detection while also assessing antimicrobial susceptibility patterns of associated V. cholerae serotypes present in Juba, South Sudan. A cross-sectional laboratory-based experimental study was conducted on 109 consenting participants in Juba, South Sudan. Purposive sampling technique was employed. Stool samples were collected and tested using both conventional and the rapid enriched method (alkaline peptone water; APW), with results obtained being compared to V. cholerae stool cultures (gold standard). On the other hand, V. cholerae sero-typing was undertaken using both polyvalent and monovalent antisera. Additionally, antimicrobial susceptibility testing (AST) was carried out on study samples to determine drug sensitivity profiles. All tests were conducted onsite with exception of cultures and AST which were performed in public health laboratory Juba, South Sudan. Out of 109 stool samples only 31.2 % (n=34) were positive for V. cholerae; Inaba serotype 100 % (n=34). Demographic information revealed that 70.6 % (n=24) of all V. cholerae infections were among males aged (26-30 yrs; 32.4 %). Data on antibiotic susceptibility pattern showed that V. cholerae was most sensitive to ceftriaxone (n=31; 91.2 %). Conversely, V. cholerae demonstrated highest resistance against nalidixic acid (n=34; 100 %). Conclusively, enriched method for detection of V. cholerae exhibited notable diagnostic performance compared to V. cholerae culture (control).Sensitivity for enriched and Culture was 68 % in O1 and 0 % in O139 respectively while specificity for enriched was 100 % in O1 and 99.08 % in O139 and on culture was 100 % in both specificity and sensitivity. Additionally, Inaba serotype of V. cholerae showed highest prevalence amongst subjects attending cholera treatment centers and oral rehydration points in Juba, South Sudan. On the other hand, ceftriaxone displayed highest potency agent against V. cholerae. The study concludes that there was high prevalence of Inaba serotype in the region. The findings also inform selection of ceftriaxone as an effective chemotherapeutic agent against V. cholerae Inaba serotype.
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    Evaluation of safety and therapeutic potential of environmental waste water lytic bacteriophage against multidrug resistant staphylococcus aureus (MDRSA) in BALB/c mice
    (Kenyatta University, 2016-04) Oduor, Joseph Michael O.
    Methicillin resistant Staphylococcus aureus (MRSA) pose a great threat to the global public health. Control of these bacteria has become difficult due to acquisition of resistance against even some of the best antibiotics. Thus, phage therapy could be the better alternative as they are easy to isolate and produce in mass within a short time. However, phage therapy has been a subject of debate over the years but recently there has been a renewed interest due to their proved therapeutic potential and have, therefore, found commercial application in some countries. Thus, this study was specifically designed to evaluate the efficacy of phages against MRSA both in vitro and in vivo. A litre of environmental waste water and sewage samples were collected around the county of Nairobi. The MRSA isolates were obtained from environmental waste water and sewage samples from Nairobi and its environs and evaluated for drug resistance using antibiogram test. In addition, lytic phages were isolated from these samples too. Thereafter, the in vitro efficacy of the phages against MRSA was done by spot assay and tube culture tests. Only the most virulent phage isolate was used for in vivo efficacy study which involved six groups of mice of n=5 per group (BALB/c mice; both sex). The first three groups acted as controls (group 1=only physiological saline, group 2=MRSA bacteria only and group 3=phage only) while the remaining groups were used for efficacy studies using a dosage of 108 CFU/ml for MRSA bacteria, 108 PFU/ml for phage and clindamycin at 8mg/kg. The efficacy study groups (groups 4-6) were first infected by MRSA and observed for 3 days before treatment with either antibiotic (group 4), or phage (group 5) or phage + antibiotic (cocktail therapy group 6). The mice were then observed for an additional 7 days. During the entire 10 days of observation blood samples were collected daily for bacteremia level determination before being euthanized. Different organs including the liver, brain, kidney and lungs were harvested for histopathological studies. All studies were done in accordance with the IPR Institutional Ethical Committee approved protocols. Antibiogram test indicated that MRSA isolated was a multidrug resistant strain (Figure 1). While the in vitro test showed the virulence of the phage isolates after 24 hrs culture at 370C. Toxicity test showed that phages were safe. There was no significant difference in survival rates between phage infected group and non-infected control group (p>0.05). Bacteremia was significantly lower in phage treated group as compared to other treatment groups and bacteria non-treated group (p<0.001) (Figure 2). In addition, pathological results show that phage prevented organ damage by the bacteria (Figure 3). Thus, a single dose of phage was more effective than other therapeutic agents used in the study. Results of this study show that phage therapy is safe and its application should be considered for the treatment of multidrug resistant bacterial infections.
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    Evaluation of Serum Agglutination and Rose Bengal Tests against Immunofluorescence Antibody Assay in Diagnosis of Brucellosis in Narok and Kiambu County, Kenya
    (Kenyatta University, 2015) Nyagah, Susan, Nyawira
    Brucellosis in human is characterized by non specific signs and often misdiagnosed as malaria, typhoid, rheumatic fever and pyrexia of unknown origin. Definitive diagnosis of brucellosis requires isolation of Brucella '\PP.but chances of successful isolation decrease as the disease progresses. In Kenya, the current routine diagnostic test, Serum Agglutination Test (SAT) has a major drawback in that its not suitable for patient follow-up, since titers can remain high for a prolonged period. The alternative test, Rose Bengal Test (RBT) is not reproducible as it is very sensitive to vaccinal antibody limiting its use in vaccinated animals. Immunotlourescence antibody assay (IF A) has been described as the gold standard for diagnosis ofbrucellosis, To date there is no study in Kenya that has examined performance of the two ronrme tests STand RBT in the face of IFA The objective of this study was to evaluate SAT and RBT against IFA and to estimate the prevalence of brucellosis in Kiambu and Narok counties by the three diagnostic methods. Human blood and unpasteurised milk samples were collected between December 2009 and August2010 in Kiambu and Narok counties. A total of 250 human serum and 250 milk samples were collected from arok and Kiambu counties. Human serum sample was obtained from Kijabe referral hospital and other neighbouring health facilities. Antibodies to Brucella spp. were screened using SAT and RBTin the hospital and later transported to Kabete Veterinary Laboratory for IFA Milk samples were collected from milk vendors packed in cool boxes and transported to Kabete Veterinary Laboratory where screening was done using one step bovine Brucella antibody rapid test. All samples were subjected to IFA to determine the prevalence of brucellosis. The overall prevalence ofbnlcella antibodies by IFAas a gold standard was 3.2% and 70.4% and 14.4% and 54.4% in human samples and milk samples in Kiambu and Narok respectively. Prevalence by SAT was 10.4% and 77.6% and 8.3% and 80% by RBT in Kiambu and Narok respectively. Comparison of SAT and IFA gave PPV (63%), NPV (16.4%), sensitivity (75%) and specificity (74%). Comparison of RBT and IFA gave sensitivity (69.56%), specificity (72.78%), PPV(59.81 %) and NPV(19.58%). Comparison of One step bovine brucella rapid agglutination test and IFA gave sensitivity (16.5%), specificity (53.0%), PPV (19.76%) and NPV (52.43%). Prevalence was higher in females (68%) than males (32%) in Narok particulary 21-30 years. Both SAT and RBT should be scrapped as they lack sensitivity and specificity. IFA which is accurate, sensitive, specific, rapid should be recommended as the diagnostic test of choice. People handling animals and their products are at higher risk of infection.