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PubMed1980

Machakos Project Studies. Agents affecting health of mother and child in a rural area of Kenya. XIX. The utilization of health services in a rural area of Kenya.

The health services utilization pattern of 20.000 inhabitants was surveyed during the last four months of 1976 in eight fortnightly interview rounds. One quarter of the population reported to have been unwell during the weeks prior to interview. Of those 21% went to a medical authority (traditional or modern), 35% used self medication and 37% did not take any action. Data were collected about the type of illness and its disabling effect. On those who went to a medical authority information was collected regarding cost, time lost in travelling and receiving treatment and about improvement as perceived by the patient. Furthermore the use of self medication was analysed. Special attention is given to methods and materials of the survey and its accuracy. Pitfalls and problems encountered are discussed. The survey results show influence of modern medical care especially in the use of self medication.

Adult↗
PubMed2003

Population genetic structure of the African malaria mosquito Anopheles funestus in Kenya.

Anopheles funestus Giles is a major malaria vector in Africa, but little is known about the genetic structure of natural populations. In this study, microsatellite markers were used to investigate the genetic structure of A. funestus populations from Kenya. Two populations from western Kenya 80 km apart and two from coastal Kenya 50 km apart were collected and examined for allelic variation at five trinucleotide microsatellite loci. We found A. funestus Giles was the predominant species (> 98%) in the A. funestus group in these populations. The western Kenya populations exhibited higher genetic diversity than the coastal populations. No significant genetic structure for populations within the coastal or western Kenya regions was detected. However, population genetic differentiation between the two regions was high (F(ST) = 0.208, R(ST) = 0.158), approximately two-fold higher than A. gambiae populations from the same area. The results suggest that the minimum area associated with a deme of A. funestus in western or coastal Kenya is larger than 50 km in diameter. The Great Rift Valley in east Africa, high-elevation mountains in western Kenya, and the vast arid area east to the Great Rift Valley may all play a role in restricting A. funestus gene flow between coastal and western Kenya.

Alleles↗
PubMed1986

Characterization of Simulium (Edwardsellum) damnosum s.l. populations from six river systems in Kenya by cellulose acetate electrophoresis.

Isoenzyme characterization of the Simulium damnosum Theobald sibling species complex from two widely separated geographical areas in Kenya is presented based on 10 enzymatic loci. Four river systems in Western and Nyanza Provinces, namely, the Yala, Lusumu, Isiukhu and the Nzoia harbouring S. damnosum s.l. were compared among themselves and with S. damnosum s.l. collected from the Thiba and the Nyamindi river systems in the Mt. Kenya area. The two populations were easily separable using PGM, HK and, more than 73% of the time, with PGI. Using the first two enzymatic loci, PGM and HK, all the western Kenya S. damnosum s.l. belong to the same population while those from Mt. Kenya areas belong to a different population. In both geographical zones there was less than 20% qualitative and quantitative polymorphism within infraspecific forms in any given breeding area of S. damnosum s.l. Three enzymes, ME, XDH, and G-6-PDH had isomorphic mobilities for both the Mt. Kenya and western Kenya populations. Four other enzyme/substrate systems tested had no satisfactory resolution as a diagnostic value.

Animals↗
PubMedDate not supplied

Models to predict the intensity of Plasmodium falciparum transmission: applications to the burden of disease in Kenya.

There is an increasing need to provide spatial distribution maps of the clinical burden of Plasmodium falciparum malaria in Africa. Recent evidence suggests that risk groups and the clinical spectrum of severe malaria are related to the intensity of P. falciparum transmission. Climate operates to affect the vectorial capacity of P. falciparum transmission and this is particularly important in the Horn of Africa and parts of East Africa. We have used a fuzzy logic climate suitability model to define areas of Kenya unsuitable for stable transmission. Kenya's unstable transmission areas can be divided into areas where transmission potential is limited by low rainfall or low temperature and, combined, encompass over 8 million people. Among areas of stable transmission we have used empirical data on P. falciparum infection rates among 124 childhood populations in Kenya to develop a climate-based statistical model of transmission intensity. This model correctly identified 75% (95% confidence interval CI 70-85) of 3 endemicity classes (low, < 20%; high, > or = 70%; and intermediate parasite prevalences). The model was applied to meteorological and remote sensed data using a geographical information system to provide estimates of endemicity for all of the 1080 populated fourth level administrative regions in Kenya. National census data for 1989 on the childhood populations within each administrative region were projected to provide 1997 estimates. Endemicity-specific estimates of morbidity and mortality were derived from published and unpublished sources and applied to their corresponding exposed-to-risk childhood populations. This combined transmission, population and disease-risk model suggested that every day in Kenya approximately 72 and 400 children below the age of 5 years either die or develop clinical malaria warranting in-patient care, respectively. Despite several limitations, such an approach goes beyond 'best guesses' to provide informed estimates of the geographical burden of malaria and its fatal consequences in Kenya.

Child, Preschool↗
PubMed2002

Chlorproguanil-dapsone versus sulfadoxine-pyrimethamine for sequential episodes of uncomplicated falciparum malaria in Kenya and Malawi: a randomised clinical trial.

BACKGROUND: Chlorproguanil-dapsone exerts lower resistance pressure on Plasmodium falciparum than does sulfadoxine-pyrimethamine, but is rapidly eliminated. We aimed to find out whether chlorproguanil-dapsone results in a higher retreatment rate for malaria than sulfadoxine-pyrimethamine. METHODS: In a randomised trial of paediatric outpatients with uncomplicated falciparum malaria, patients received either chlorproguanil-dapsone or sulfadoxine-pyrimethamine and were followed up for up to 1 year. Sites were in Kenya (n=410) and Malawi (n=500). We used per-protocol analysis to assess the primary outcome of annual malaria incidence. FINDINGS: Drop-outs were 117 of 410 (28.5%) in Kenya, and 342 of 500 (68.4%) in Malawi. Follow-up was for a median of 338 days (IQR 128-360) and 342 days (152-359) in Kilifi (chlorproguanil-dapsone and sulfadoxine-pyrimethamine, respectively), and for 120 days (33-281) and 84 days (26-224) in Blantyre. Mean annual malaria incidence was 2.5 versus 2.1 in Kenya (relative risk 1.16, 95% CI 0.98-1.37), and 2.2 versus 2.8 in Malawi (0.77, 0.63-0.94). 4.3% versus 12.8%, and 5.4% versus 20.1%, of patients were withdrawn for treatment failure in Kenya and Malawi, respectively. In Kenya haemoglobin concentration of 50 g/L or less caused exit in 6.9% of chlorproguanil-dapsone patients and 1.5% of sulfadoxine-pyrimethamine patients, but most anaemia occurred before re-treatment. In Malawi only one patient exited because of anaemia. INTERPRETATION: Despite the rapid elimination of chlorproguanil-dapsone, children treated with this drug did not have a higher incidence of malaria episodes than those treated with sulfadoxine-pyrimethamine. Treatment failure was more common with sulfadoxine-pyrimethamine. Cause of anaemia in Kenya was probably not adverse reaction to chlorproguanil-dapsone, but this observation requires further study.

Antimalarials↗
PubMed1989

A history of sleeping sickness in Kenya.

Gambian sleeping sickness entered what is now Kenya from Uganda in about 1901 and quickly spread along the Kenyan shores and islands of Lake Victoria, reaching Tanzania in 1902. By 1910 the disease had spread 25 miles inland along the Kuja and Migori rivers and their tributaries. Sleeping sickness waxed and waned in these areas despite attempts to control tsetse fly populations by various methods. It was not until 1950, when the use of insecticides (DDT) applied by backpack sprayer proved successful against Glossina fuscipes at Kibigori, that eradication of G. fuscipes and Gambian sleeping sickness seemed possible. Subsequently the Kuja-Migori endemic area was cleared of flies and disease, as well as the South and Central Nyanza lake shores and islands. By 1965 Gambian sleeping sickness had virtually disappeared from Kenya. A more virulent form of the disease, Rhodesian sleeping sickness, may have also spread to Kenya from Uganda, although its appearance in diverse areas of the Gambian disease suggest that local ecological factors may have played a role in enhanced virulence of trypanosomes stocks. The Rhodesian form of sleeping sickness appeared in the Lambwe Valley, South Nyanza, in about 1959, and despite attempts to eradicate this disease it still persists as the only remaining endemic area in Kenya at this time. The usual transmission of Rhodesian sleeping sickness by G. pallidipes in Kenya was altered when an outbreak occurred at Alego, in Central Nyanza, in 1964. It was discovered that G. fuscipes was the vector and that domestic cattle were an important reservoir of infection. Glossina fuscipes was also the vector of Rhodesian sleeping sickness in an outbreak in Samia in 1976 and another along the lakeshore in South Nyanza in 1981. Sleeping sickness has been restricted primarily to the Western and Nyanza Provinces of Kenya (Fig. 1).

Animals↗
PubMed2002

The effects of climatic factors on the distribution and abundance of malaria vectors in Kenya.

Since 1988 malaria epidemics have occurred in multiple sites in western Kenya highlands. Climatic variability has been associated with some of the recent epidemics. We examined influences of climatic factors on the distribution and abundance of three malaria vector species, Anopheles gambiae, Anopheles arabiensis, and Anopheles funestus in western Kenya and in the Great Rift Valley. Mosquito samples were collected from the lowland and highland areas with various climatic conditions. The three vector species were abundant in the lower part of western Kenya. An. arabiensis was not found in the areas above 1,400 m elevation in western Kenya Although An. gambiae and An. funestus were found in the sites above 1,700 m in western Kenya, their densities were < 1 per house. In the Great Rift Valley, An. gambiae was not recorded. An. funestus was more widely distributed than the other two species. A stepwise multiple regression analysis found that moisture index was the most important variable in shaping species composition of the An. gambiae complex. Relative abundance of An. gambiae was positively associated with moisture index, suggesting that An. gambiae is more adapted to moist climate. Seasonal differences in species composition were significant in western Kenya, and the proportion of An. funestus was higher in the dry season than the rainy season. Influence of temperature on vector density was significant for all three species. These results imply that climate changes alter the distribution and abundance of malaria vectors in future.

Animals↗
PubMed2002

The prevalence and economic importance of bovine fasciolosis in Kenya--an analysis of abattoir data.

A retrospective study covering a period of 10 years (1990-1999) was carried out using post mortem meat inspection records at the Veterinary Department Headquarters at Kabete to determine the prevalence and economic importance of bovine fasciolosis in Kenya. Meat inspection records from abattoirs in 38 districts distributed over seven out of the eight provinces of Kenya were examined. Prevalence of fasciolosis was calculated as the number of cattle found to be infected with Fasciola, expressed as a percentage of the total number of cattle slaughtered. Using the average weight and market price of a bovine liver, the monetary loss occasioned by condemnation of Fasciola infected livers was calculated. A survey was also carried out at Dagoretti slaughterhouse complex in Nairobi to determine the relative occurrence of F. gigantica and F. hepatica in slaughtered cattle. Cattle slaughtered at Dagoretti slaughterhouse originate from all parts of the country. A total of 5,421,188 cattle were slaughtered in the seven provinces of Kenya during the 10-year period and 427,931 (8%) of these cattle were infected with Fasciola. The region with the highest prevalence of fasciolosis was Western Province (16%) followed, in descending order, by Eastem Province (11%), Nyanza Province (9%), Rift Valley Province (8%), Central Province (6%), Nairobi Province (4%) and Coast Province (3.5%). The total economic loss incurred by the country during the 10-year period as a result of condemnation of the infected livers was approximately US$2.6 million. The total annual economic losses during this period ranged from approximately US$0.2-0.3 million. The highest total economic losses for the 10-year period were recorded in Western Province (US$0.8 million) and Central Province (US$0.7 million). A total of 1584 cattle originating from five provinces of Kenya were slaughtered at Dagoretti slaughterhouse over a period of two months of which 147 (9.3%) were infected with liver flukes. All the liver flukes obtained from the infected livers were identified as F. gigantica. It is concluded that fasciolosis is prevalent in cattle in all provinces of Kenya, that it causes great economic losses as a result of condemnation of infected livers, and that F. gigantica is the main species of liver flukes affecting cattle in Kenya. Local climatic factors, cattle trade, rustling and population numbers, and the presence of the snail intermediate hosts are probably the main factors influencing the incidence of the disease in the various regions of the country.

Abattoirs↗
PubMed1994

Onset and evolution of stunting in infants and children. Examples from the Human Nutrition Collaborative Research Support Program. Kenya and Egypt studies.

The etiology of the early onset of stunting is diverse among populations of varying biological, environmental and cultural circumstances. This is exemplified within the Nutrition CRSP project, which took place in three different populations and ecological conditions. Within each study area a different mix and varying proportions of causative factors were identified. At least in Kenya, and probably in Mexico, the problem has its antecedents in prepregnancy and pregnancy. Powerful determinants of the infants' size at birth and during the first 6 months of life are maternal size upon entry into pregnancy, and weight and fat gain during pregnancy and lactation. In all three countries a low pregnancy weight gain was observed. Notably in Kenya, where the energy intake of the mother decreases progressively throughout pregnancy, not only do mothers gain only half as much as European or North American women, but they even lose weight and fat in the last month of pregnancy, and some mothers gain no weight or lose weight during the whole of pregnancy. Mothers in Kenya start lactation with relatively poor fat stores. Although their energy intake increases somewhat during lactation, preliminary estimates suggest that these increases may be insufficient to maintain their bodily integrity, to carry out their normal tasks of daily living, and to produce a sufficient amount of milk for optimal infant growth. In addition to an energy deficit, diet quality is a problem, particularly in Kenya and Mexico and less so in Egypt. Intakes of animal products and animal protein are very low. Zinc and iron intakes are not only low, but the bioavailability of these nutrients is poor because of the high phytate, fiber and tea content of the diet. Also vitamin B12 intake is extremely low, and at least mild-to-moderate iodine deficiency (IDD) is present in Kenya. The above micronutrients have been demonstrated to affect the linear growth of the Kenyan children, even after confounding factors have been controlled. The early use of supplemental feeding in Kenya is a double-edged sword. On the one hand, there is a slight increase in febrile illness and possible displacement of breast milk intake in the supplemented infants, although mothers do not decrease breast feeding frequency and duration. On the other hand, even the modest amounts of available zinc and B12 in supplemental foods appear to have a positive effect on linear growth.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1999

Epidemiological study of the G serotype distribution of group A rotaviruses in Kenya from 1991 to 1994.

An epidemiological study on the G serotype distribution of group A rotaviruses (GARV) isolated in Kenya was carried out in one urban hospital in Nairobi and in two rural hospitals in Nanyuki and Kitui to clarify the prevalent G serotypes before future introduction of the ready licensed rotavirus vaccine in Kenya. A total of 1,431 stool specimens were collected from children, who were mainly outpatients, aged from 0 to 6 years old with acute gastroenteritis from August 1991 to July 1994. Samples positive for GARV by conventional ELISA were then analyzed by subgrouping and serotyping ELISA and by PAGE. To ascertain the G serotypes of viruses in samples that were unable to be typed by serotyping ELISA, polymerase chain reaction was also attempted. The prevalence of GARV was 28.4% in the urban hospital, 22.5% in Nanyuki, and 13.7% in Kitui. Among rotavirus-positive samples, subgroup II rotaviruses were detected in 63.1%, and subgroup I rotaviruses were 25.9%. Serotype G4 was most prevalent, accounting for 41.6% followed by 23.3% of serotype G1, 17.0% of serotype G2, and serotype G3 was rarely isolated. Seven strains of serotype G8/P1B rotavirus was detected for the first time in Kenya by RT-PCR. Eleven specimens with an unusual composition of subgroup, serotype, and electropherotype were atypical GARV in which the P-serotype was P1A, P1B, or P2. Although uncommon GARV serotype G8/P1B and atypical GARV were detected, the four major GARV serotypes, G1 through G4, should be targeted at this moment for vaccination to control this diarrheal disease in Kenya. Continuous monitoring of the G- and P-serotype distribution of GARV should provide important information about the impact of rotavirus vaccination in Kenya.

Child↗
PubMed1978

Economic losses resulting from bovine cysticercosis with special reference to Botswana and Kenya.

Economic losses from cysticercosis are determined by disease prevalence, grade of animals infested, potential markets, prices of cattle and treatment costs for detained carcasses. The main features of the livestock economics of Botswana and Kenya are discussed. Botswana is more dependent on meat exports than Kenya and its cattle prices are much higher. The incidence of cysticercosis at export abattoirs in Botswana and Kenya is about 8 and 20% respectively. Annual losses in Botswana now approach 0-5 million pounds, while in Kenya they are about 1 million pounds. The loss per animal slaughtered is 2-25 pounds in Botswana and 1-50 pounds in Kenya. Some implications for veterinary research in this area are examined. Blanket treatment with a drug or vaccine would only be economical where prevalence was very high. An in vivo diagnostic test would be of use mainly with high value cattle.

Animals↗
PubMed1984

Going up in smoke: the case of British American tobacco in Kenya.

Faced in the developed world by increasing restrictions on cigarette advertising and sales, and with declining markets, the tobacco transnationals are opening up new markets in developing countries, where they face few controls and little health education. As cigarette sales increase in the Third World, so does the evidence of an increasing incidence of smoking-related diseases. This paper considers the case study of BAT (Kenya) Ltd, a subsidiary of the London-based transnational, which since 1974 has encouraged both local leaf production and increased cigarette sales in Kenya. We examine: the relationship between BAT (K) and the Kenya state, the recruitment of farmers into the leaf growing scheme, how BAT (K)'s directorships interlock with those of other leading Kenyan firms and the implications of these for the company's power and influence; BAT (K)'s marketing strategies, how successful they have been, and how they compare with codes of conduct agreed in developed countries; and we estimate the likely success of possible strategies to combat the smoking hazard in Kenya. We conclude that although BAT (K) might make minor concessions to the "health lobby' in Kenya, it is sufficiently powerful, and the leaf growing programme is given sufficient Government support, as to make fundamental changes unlikely in the near future.

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