Biomedical subjects

David Mwaniki

Publications and source records attributed to David Mwaniki.

5 recordsLinked to original sources

PubMed2005

Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya.

We conducted a longitudinal study among 827 pregnant women in Nyanza Province, western Kenya, to determine the effect of earth-eating on geohelminth reinfection after treatment. The women were recruited at a gestational age of 14-24 weeks (median: 17) and followed up to 6 months postpartum. The median age was 23 (range: 14-47) years, the median parity 2 (range: 0-11). After deworming with mebendazole (500 mg, single dose) of those found infected at 32 weeks gestation, 700 women were uninfected with Ascaris lumbricoides, 670 with Trichuris trichiura and 479 with hookworm. At delivery, 11.2%, 4.6% and 3.8% of these women were reinfected with hookworm, T. trichiura and A. lumbricoides respectively. The reinfection rate for hookworm was 14.8%, for T. trichiura 6.65, and for A. lumbricoides 5.2% at 3 months postpartum, and 16.0, 5.9 and 9.4% at 6 months postpartum. There was a significant difference in hookworm intensity at delivery between geophagous and non-geophagous women (P=0.03). Women who ate termite mound earth were more often and more intensely infected with hookworm at delivery than those eating other types of earth (P=0.07 and P=0.02 respectively). There were significant differences in the prevalence of A. lumbricoides between geophagous and non-geophagous women at 3 (P=0.001) and at 6 months postpartum (P=0.001). Women who ate termite mound earth had a higher prevalence of A. lumbricoides, compared with those eating other kinds of earth, at delivery (P=0.02), 3 months postpartum (P=0.001) and at 6 months postpartum (P=0.001). The intensity of infections with T. trichiura at 6 months postpartum was significantly different between geophagous and non-geophagous women (P=0.005). Our study shows that geophagy is associated with A. lumbricoides reinfection among pregnant and lactating women and that intensities built up more rapidly among geophagous women. Geophagy might be associated with reinfection with hookworm and T. trichiura, although these results were less unequivocal. These findings call for increased emphasis, in antenatal care, on the potential risks of earth-eating, and for deworming of women after delivery.

Adolescent↗

PubMed2004

Public-private mix for DOTS implementation: what makes it work?

OBJECTIVE: To compare processes and outcomes of four public-private mix (PPM) projects on DOTS implementation for tuberculosis (TB) control in New Delhi, India; Ho Chi Minh City, Viet Nam; Nairobi, Kenya; and Pune, India. METHODS: Cross-project analysis of secondary data from separate project evaluations was used. Differences among PPM project sites in impact on TB control (change in case detection, treatment outcomes and equity in access) were correlated with differences in chosen intervention strategies and structural conditions. FINDINGS: The analysis suggests that an effective intervention package should include the following provider-side components: (1) orienting private providers (PPs) and the staff of the national TB programme (NTP); (2) improving the referral and information system through simple practical tools; (3) the NTP adequately supervising and monitoring PPs; and (4) the NTP providing free anti-TB drugs to patients treated in the private sector. CONCLUSION: Getting such an intervention package to work requires that the NTP be strongly committed to supporting, supervising and evaluating PPM projects. Further, using a local nongovernmental organization or a medical association as an intermediary may facilitate collaboration. Investing time and effort to ensure that sufficient dialogue takes place among all stakeholders is important to help build trust and achieve a high level of agreement.

Communicable Disease Control↗

PubMed2004

Low-dose iron supplementation does not increase HIV-1 load.

Observational data suggest that iron may increase HIV replication and the rate of progression of HIV infection. This is worrying, and may impede the international commitment to combat iron deficiency. However, it is crucial to clarify the role of iron in HIV infections, since iron is universally administered to anaemic patients and pregnant women, even in areas with high HIV prevalence. Based on a historical iron trial, we assessed the effect of 60 mg of elemental iron given twice weekly over four month on HIV-1 viral load. There was no effect on viral load, but effects of higher doses of iron cannot be excluded.

Adolescent↗

PubMed2004

Geophagy among pregnant and lactating women in Bondo District, western Kenya.

Geophagy was studied among 827 pregnant women in western Kenya, during and after pregnancy. The women were recruited at a gestational age of 14-24 weeks and followed-up to 6 months post-partum. The median age (range) of the women was 23 years and median parity 2. At recruitment, 378 were eating earth, of which most (65%) reported earth-eating before pregnancy. The preferred type of earth eaten was soft stone, known locally as odowa (54.2%) and earth from termite mounds (42.8%). The prevalence remained high during pregnancy, and then declined to 34.5% and 29.6% at 3 and 6 months post-partum respectively (P < 0.001). The mean daily earth intake was 44.5 g during pregnancy, which declined to 25.5 g during lactation (P < 0.001). A random sample of 204 stools was collected from the women and analysed for silica content as a tracer for earth-eating. The mean silica content was 2.1% of the dry weight of stool. Geophagous women had a higher mean silica content than the non-geophagous ones (3.1% vs. 1.4%, P < 0.001). Faecal silica and reported geophagy were strongly correlated (P < 0.001).

Adolescent↗

PubMedDate not supplied

Effects of multimicronutrient supplementation on helminth reinfection: a randomized, controlled trial in Kenyan schoolchildren.

A randomized, placebo-controlled, double-blind, two-by-two factorial trial was carried out among 977 schoolchildren from 19 primary schools in Nyanza Province, Kenya from February 1995 to February 1996. The interventions were multimicronutrient supplementation (vitamin A, 1000 micrograms; vitamin B1, 1.4 mg; vitamin B2, 1.6 mg; vitamin B6, 1.7 mg; vitamin B12, 2.0 micrograms; folate, 150 micrograms; niacin, 16 mg; vitamin C, 50 mg; vitamin D, 5 micrograms; vitamin E, 8 mg; iron, 18 mg; zinc, 20 mg; copper, 2.0 mg; iodine, 150 micrograms; selenium, 40 micrograms) and multihelminth chemotherapy (albendazole 600 mg in a single dose and/or praziquantel 40 mg/kg in a single dose). This paper reports the effects of the supplementation given on all school days on reinfection with hookworm, Ascaris lumbricoides, Trichuris trichiura and Schistosoma mansoni after 11 months. Baseline prevalence and geometric mean intensity for hookworm, A. lumbricoides, T. trichiura and S. mansoni in all children investigated were 54.7%, 13.8%, 45.6% and 70.0%, respectively and 8.6, 2.7, 5.9 and 19.4 eggs per gram (epg), respectively. Children received a mean of 2.3 multimicronutrient/placebo tablets per school week, giving a compliance rate of 46%. Children given multimicronutrients had a slightly, but significantly, lower intensity of S. mansoni reinfection compared with children given placebo (5.5 epg vs. 7.7 epg, P = 0.047). Multiple linear regression analyses controlling for baseline infection status confirmed this, as children who received micronutrients were reinfected with S. mansoni at only 69% of the intensity of those who received placebo. Multiple logistic regression analyses revealed that micronutrient supplementation was associated with a lower S. mansoni reinfection rate (odds ratio = 0.7) although this was only of borderline significance (P = 0.090). There were no significant differences in reinfection rates or intensities of hookworm, A. lumbricoides and T. trichiura. The effect on S. mansoni infection intensity is particularly interesting given the low compliance, suggesting that full micronutrient supplementation might have a role to play in S. mansoni control programmes.

Adolescent↗