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Economics of health and nutrition in Kenya.

This paper starts by outlining the present state of health and nutrition in Kenya. Health status for Kenyans has shown spectacular improvement since Kenya's attainment of independence in 1963. Both the infant mortality and crude death rates fell by about 30% between 1963 and 1982. Life expectancy at birth has risen dramatically from 40 years to 54 years over the same period. However, this picture could be misleading because it is possible for the morbidity rate to have risen, or declined only slightly, over the twenty-year period during which mortality rates in Kenya fell substantially. It is further indicated that despite Kenya having per capita availability of nutrients exceeding that recommended by FAO/WHO; about one-third of Kenya's population is unable to meet its food or nutritional requirements.

Child↗

Evaluation criteria for district health management information systems: lessons from the Ministry of Health, Kenya.

INTRODUCTION: There has been no comprehensive evaluation of the district health management information systems (DHMISs) since the establishment of these systems by the Ministry of Health (MoH), in Kenya. This is partly due to lack of defined criteria for evaluating the systems. The objective of this study is to design evaluation criteria for assessing the viability, sustainability and ultimate contribution of DHMIS in the management of the district health system (DHS) in Kenya. METHODS: This descriptive cross-sectional study was undertaken in three DHSs in Kenya. Empirical evidence was collected through interviews, complemented by a comprehensive review of relevant literature, reports and operational manuals of various health information systems in Kenya. RESULTS: A set of evaluation criteria for DHMISs in Kenya was designed for each of the three phases of implementation: phase one-pre-implementation evaluation criteria (categorized as policy and objectives, technical feasibility, financial viability, political viability and administrative operability) to be applied at the design stage; phase two-concurrent (operational) implementation evaluation criteria to be applied during implementation of the new system; phase three-post-implementation evaluation criteria (classified as internal-quality of information; external-resources and managerial support; ultimate-systems impact) to be applied after operating the implemented system for at least 3 years. CONCLUSIONS: In designing a DHMIS model there is need to have built-in these three sets of evaluation criteria which should be used in a phased manner. Pre-implementation evaluation criteria should be used to evaluate the system's viability before more resources are committed to its implementation; concurrent (operational) implementation evaluation criteria should be used to ascertain the status of the on-going implementation with the view to either fine-tune or abandon it altogether before more resources are used on it; and post-implementation evaluation criteria should be used to assess its overall effectiveness (if it has achieved its hypothesized benefits) towards the management of DHS.

Cross-Sectional Studies↗

A survey on management perspectives of the state of workplace health and safety practices in Kenya.

A baseline survey was conducted in 1995 on management perspectives of occupational health and safety (OHS) structures and practices in Kenya. This was achieved by interviewing management and supervisory staff attending 1 week multi-disciplinary courses that were organized by the Federation of Kenya Employers (FKE) and the International Labour Office (ILO) at hotel venues in Kenya. The purpose of the survey was to gain some insight into work safety conditions in Kenya and to assess the potential for a new OHS manual to meet existing knowledge gaps. The manual was locally developed in 1993/4 by Kenyan OHS experts in collaboration with colleagues from the Swedish National Institute for Working Life. Results of the survey from 65 participants indicated that most workplace managers were not familiar with the Kenyan work safety legislation. Work injuries were largely attributable to working with dangerous machinery. Occupational diseases and HIV/AIDS were cited as other causes of workplace morbidity and mortality. Although most respondents (70%) were satisfied with their work safety conditions, only 37% said their workplaces were annually audited by labour inspectors while 45% said injured workers were not treated well by management. Many workplaces (65%) violated the mandatory legal requirement on the establishment of health and safety committees. The OHS resource person and course content were rated highly by most respondents (96%). The foregoing results provided the basis of a needs analysis for future OHS programs in Kenya.

Accidents, Occupational↗

Kenya.

The Kenya coast is bathed by the northward-flowing warm waters of the East Africa Coastal Current, located between latitudes 1 and 5 degrees S. With a narrow continental shelf, the coastal marine environments are dominated by coral reefs, seagrass beds and mangroves, with large expanses of sandy substrates where river inputs from Kenya's two largest rivers, the Tana and Athi rivers, prevent the growth of coral reefs. The northern part of the coast is seasonally influenced by upwelling waters of the Somali Current, resulting in lower water temperatures for part of the year. The coast is made up of raised Pleistocene reefs on coastal plains and hills of sedimentary origin, which support native habitats dominated by scrub bush and remnant pockets of the forests that used to cover East Africa and the Congo basin. The marine environment is characterized by warm tropical conditions varying at the surface between 25 degrees C and 31 degrees C during the year, stable salinity regimes, and moderately high nutrient levels from terrestrial runoff and groundwater. The semi-diurnal tidal regime varies from 1.5 to 4 m amplitude from neap to spring tides, creating extensive intertidal platform and rocky-shore communities exposed twice-daily during low tides. Fringing reef crests dominate the whole southern coast and parts of the northern coast towards Somalia, forming a natural barrier to the wave energy from the ocean. Coral reefs form the dominant ecosystem along the majority of the Kenya coast, creating habitats for seagrasses and mangroves in the lagoons and creeks protected by the reef crests. Kenya's marine environment faces a number of threats from the growing coastal human population estimated at just under three million in 2000. Extraction of fish and other resources from the narrow continental shelf, coral reef and mangrove ecosystems increases each year with inadequate monitoring and management structures to protect the resource bases. Coastal development in urban and tourist centers proceeds with little regard for environmental and social impacts. With a faltering economy, industrial development in Mombasa proceeds with few checks on pollution and other impacts. In 1998 Kenya's coral reefs suffered 50-80% mortality from the El Niño-related coral bleaching event that affected the entire Indian Ocean. The institutional, human resource and legal infrastructure for managing the coastal environment has in the past been low, however these are rapidly improving with the revitalization of national institutions and the passing in 1999 of an Environment Act. Marine Protected Areas are the key tool currently used in management of marine ecosystems, and focus principally on coral reefs and biodiversity protection. New initiatives are underway to improve application of fisheries regulations, and to use Integrated Coastal Area Management (ICAM) as a framework for protecting marine and coastal environments.

Animals↗

Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania.

BACKGROUND: Access to HIV-1 voluntary counselling and testing (VCT) is severely limited in less-developed countries. We undertook a multisite trial of HIV-1 VCT to assess its impact, cost, and cost-effectiveness in less-developed country settings. METHODS: The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10000 people seeking VCT in urban east Africa. Outcomes were modelled based on results from a randomised controlled trial of HIV-1 VCT in Tanzania and Kenya. Our main outcome measures included programme cost, number of HIV-1 infections averted, cost per HIV-1 infection averted, and cost per disability-adjusted life-year (DALY) saved. We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population, and the proportion of clients who receive VCT as a couple compared with as individuals. Sensitivity analysis was done on all model parameters. FINDINGS: HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year. The cost per HIV-1 infection averted was US$249 and $346, respectively, and the cost per DALY saved was $12.77 and $17.78. The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple. The cost-effectiveness of VCT was robust, with a range for the average cost per DALY saved of $5.16-27.36 in Kenya, and $6.58-45.03 in Tanzania. Analysis of targeting showed that increasing the proportion of couples to 70% reduces the cost per DALY saved to $10.71 in Kenya and $13.39 in Tanzania, and that targeting a population with HIV-1 prevalence of 45% decreased the cost per DALY saved to $8.36 in Kenya and $11.74 in Tanzania. INTERPRETATION: HIV-1 VCT is highly cost-effective in urban east African settings, but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence settings. With the targeting of VCT to populations with high HIV-1 prevalence and couples the cost-effectiveness of VCT is improved significantly.

AIDS Serodiagnosis↗

Estimated risk of HIV transmission by blood transfusion in Kenya.

BACKGROUND: During the past decade, developing countries have received limited support for blood safety programmes. The Kenya Ministry of Health did a collaborative multicentre assessment to establish the risk of HIV transmission by transfusion in Kenya, to promote awareness of blood safety issues in this country with a mature HIV epidemic, and to identify methods to reduce the risk of HIV transmission by blood transfusion in Kenya. METHODS: For 12 weeks, from April to July 1994, we collected information and blood samples from all blood donors, and pretransfusion samples were collected from all recipients in six government hospitals in Kenya. Blood donations were collected and screened for HIV according to standard practice in the hospital laboratories. Test results at a reference laboratory were compared with those of the hospital laboratories and risk of transfusion-associated HIV transmission was calculated. FINDINGS: The prevalence of HIV among blood donors was 6.4% (120 of 1877) and varied by hospital (range 2-20%). HIV test results were available for 1290 donor-recipient pairs. Of these, 26 HIV-positive donations were given to HIV-negative patients. We estimate that 2.0% of transfusions transmitted HIV. Problems in the hospitals that contributed to transfusion risk included inconsistent refrigeration, data entry errors, equipment failure, and lack of a quality-assurance programme. INTERPRETATION: A high proportion of blood transfusions transmitted HIV in this high-prevalence area of Africa, primarily because of erroneous laboratory practices. On the basis of these results, the Kenya Ministry of Health introduced a number of practical and inexpensive interventions to improve national blood safety.

Blood Banks↗

The epidemiology of trachoma in rural Kenya. Variation in prevalence with lifestyle and environment. Study Survey Group.

PURPOSE: Ocular examination surveys were carried out in Kenya by the International Eye Foundation as a component of the Kenya Rural Blindness Prevention Project to determine the national prevalence of blindness and ocular morbidity and major causes. A goal of the surveys was to determine the overall geographic distribution and severity of trachoma throughout Kenya. METHODS: Using a random cluster household sampling technique, 13,803 people of all ages and of diverse cultural and ethnic backgrounds were identified in eight regions of Kenya. A detailed examination for active and inactive trachoma was carried out on each person surveyed as part of the general ocular examination. RESULTS: The prevalence rate of visual loss (< 20/60) due to trachoma in the better eye was 7.2/1000. Active trachoma was present in 19% of all persons examined, and 50% of all those with trachoma were found to have moderate to severe inflammation. Prevalence varied according to survey region from less than 1% in four regions where agriculture is the economic base, to 57% and 63% in two arid pastoral regions. Trachoma prevalence varied from 28% in children younger than 3 years of age to 11% in persons older than 60 years of age. Potentially blinding eyelid deformities secondary to chronic trachoma occurred in 5.0% of the rural population, and 1.2% of the rural population displayed associated corneal scarring. Lid scarring, corneal scarring, and lid deformities were greater in prevalence among females of all age groups when compared with males. CONCLUSIONS: Trachoma prevalence in Kenya varies widely from region to region. High prevalence is associated with high climatic aridity, and lower prevalence is associated with areas of greater rainfall, sustainable agriculture, and a higher general standard of living. Within high-risk regions, there are wide variations in age-specific prevalence and severity of the disease. Potentially blinding sequelae of trachoma are more prevalent in females than in males.

Adolescent↗

Anaemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal.

OBJECTIVE: To investigate the prevalence of anaemia (haemoglobin<11.0 to 13.0 g dl(-1) depending on age and sex group), iron deficiency (transferrin receptor concentration>8.3 microg ml(-1)) and vitamin A deficiency (serum retinol <0.7 micromol l(-1)) in adolescent refugees. DESIGN: Cross-sectional surveys. SETTING: Kakuma refugee camp in Kenya and seven refugee camps in Nepal. SUBJECTS: Adolescent refugee residents in these camps. RESULTS: Anaemia was present in 46% (95% confidence interval (CI): 42-51) of adolescents in Kenya and in 24% (95% CI: 20-28) of adolescents in Nepal. The sensitivity of palmar pallor in detecting anaemia was 21%. In addition, 43% (95% CI: 36-50) and 53% (95% CI: 46-61) of adolescents in Kenya and Nepal, respectively, had iron deficiency. In both surveys, anaemia occurred more commonly among adolescents with iron deficiency. Vitamin A deficiency was found in 15% (95% CI: 10-20) of adolescents in Kenya and 30% (95% CI: 24-37) of adolescents in Nepal. Night blindness was not more common in adolescents with vitamin A deficiency than in those without vitamin A deficiency. In Kenya, one of the seven adolescents with Bitot's spots had vitamin A deficiency. CONCLUSIONS: Anaemia, iron deficiency and vitamin A deficiency are common among adolescents in refugee populations. Such adolescents need to increase intakes of these nutrients; however, the lack of routine access makes programmes targeting adolescents difficult. Adolescent refugees should be considered for assessment along with other at-risk groups in displaced populations.

Adolescent↗

The Kenya form of hereditary persistence of fetal haemoglobin: structural studies and evidence for homogeneous distribution of haemoglobin F using fluorescent anti-haemoglobin F antibodies.

Several members of a Ugandan family were heterozygous for the gamma beta fusion gene of Haemoglobin Kenya. Levels of Hb Kenya were significantly higher than those in subjects of previous reports, ranging from 20.68 to 23.35% of the total haemoglobin. The individuals had also 5-8% Hb F, consisting solely of alpha and Ggamma chains. Investigation of the distribution of Hb F among the red cells of Hb Kenya heterozygotes, using monospecific antibodies absorbed against pure Hb Kenya and rendered fluorescent by conjugation with fluorescein isothiocyanate, showed the presence of fetal haemoglobin in all red cells. The data suggest that the phenotype of the Hb Kenya trait resembles that of the Ggamma form of hereditary persistence of fetal haemoglobin rather than that of thalassaemia.

Amino Acid Sequence↗

A comparison of susceptibility to stocks of Trypanosoma simiae of Glossina pallidipes originating from allopatric populations in Kenya.

A colony of Glossina pallidipes which originated from Nguruman, Rift Valley Province, Kenya, was significantly more susceptible than a colony of the same species which originated from Shimba Hills, Coast Province, Kenya, to infection with a stock of Trypanosoma simiae CP 11 isolated from wild G. austeni in Coast Province, Kenya, irrespective of whether pigs or goats were used as infecting hosts. Male G.pallidipes from both the colonies were more susceptible than females to this T.simiae stock. Similarly, a G.pallidipes colony of Nguruman origin was significantly more susceptible than the colony of Shimba Hills origin to infection with another stock of T.simiae CP 813 isolated from wild G.pallidipes in Coast Province, Kenya, again irrespective of whether pigs or goats were used as infecting hosts. The susceptibility of the sexes of G.pallidipes from both the colonies to T.simiae CP 813 did not differ significantly when pigs were used as as infecting hosts, but male G.pallidipes from both the colonies were significantly more susceptible than female tsetse to this T.simiae stock when goats were used as infecting hosts. Nevertheless, if the observed differences in susceptibility of the two G.pallidipes colonies reflect transmission of trypanosomes by the two allopatric populations of tsetse in the field, then the epidemiology of simiae-trypanosomiasis probably differs between these two areas of Kenya.

Animals↗

Subtypes of human immunodeficiency virus type 1 and disease stage among women in Nairobi, Kenya.

In sub-Saharan Africa, where the effects of human immunodeficiency virus type 1 (HIV-1) have been most devastating, there are multiple subtypes of this virus. The distribution of different subtypes within African populations is generally not linked to particular risk behaviors. Thus, Africa is an ideal setting in which to examine the diversity and mixing of viruses from different subtypes on a population basis. In this setting, it is also possible to address whether infection with a particular subtype is associated with differences in disease stage. To address these questions, we analyzed the HIV-1 subtype, plasma viral loads, and CD4 lymphocyte levels in 320 women from Nairobi, Kenya. Subtype was determined by a combination of heteroduplex mobility assays and sequence analyses of envelope genes, using geographically diverse subtype reference sequences as well as envelope sequences of known subtype from Kenya. The distribution of subtypes in this population was as follows: subtype A, 225 (70.3%); subtype D, 65 (20.5%); subtype C, 22 (6.9%); and subtype G, 1 (0.3%). Intersubtype recombinant envelope genes were detected in 2.2% of the sequences analyzed. Given that the sequences analyzed represented only a small fraction of the proviral genome, this suggests that intersubtype recombinant viral genomes may be very common in Kenya and in other parts of Africa where there are multiple subtypes. The plasma viral RNA levels were highest in women infected with subtype C virus, and women infected with subtype C virus had significantly lower CD4 lymphocyte levels than women infected with the other subtypes. Together, these data suggest that women in Kenya who are infected with subtype C viruses are at more advanced stages of immunosuppression than women infected with subtype A or D. There are at least two models to explain the data from this cross-sectional study; one is that infection with subtype C is associated with a more rapid disease progression, and the second is that subtype C represents an older epidemic in Kenya. Discriminating between these possibilities in a longitudinal study will be important for increasing our understanding of the role of specific subtypes in the transmission and pathogenesis of HIV-1.

Base Sequence↗

The cost of health professionals' brain drain in Kenya.

BACKGROUND: Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. METHODS: The costs of primary, secondary, medical and nursing schools were estimated in 2005. The cost information used in this study was obtained from one non-profit primary and secondary school and one public university in Kenya. The cost estimates represent unsubsidized cost. The loss incurred by Kenya through emigration was obtained by compounding the cost of educating a medical doctor and a nurse over the period between the average age of emigration (30 years) and the age of retirement (62 years) in recipient countries. RESULTS: The total cost of educating a single medical doctor from primary school to university is 65,997 US dollars; and for every doctor who emigrates, a country loses about 517,931 US dollars worth of returns from investment. The total cost of educating one nurse from primary school to college of health sciences is 43,180 US dollars; and for every nurse that emigrates, a country loses about 338,868 US dollars worth of returns from investment. CONCLUSION: Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health. If the current trend of poaching of scarce human resources for health (and other professionals) from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Kenya and to keeping a majority of her people in the vicious circle of ill-health and poverty. Therefore, both developed and developing countries need to urgently develop and implement strategies for addressing the health human resource crisis.

Adolescent↗

Diversity and utilization of antimalarial ethnophytotherapeutic remedies among the Kikuyus (Central Kenya).

Plants in Kenya are becoming increasingly important as sources of traditional medicines. The World Health Organization (WHO) has estimated that malaria kills about 2.7 million people every year, 90% of who are from Africa. Malaria continues to be a national concern in Kenya as it plays a major role in the high mortality rates being experienced currently. The use and mis-use of chloroquine to prevent and treat falciparium malaria has led to widespread appearance of chloroquine resistant parasites in Kenya and other tropical countries. These factors and the rising costs of non-chloroquine drugs have made the local people to turn to traditional remedies for management of this menace. This paper examines the current utilization of traditional plant medicines in managing malaria menace in Central Kenya. The results show both indigenous and introduced species are in use indicating traditional medicinal practices in this region are dynamic. In total 58 species in 54 genera and 33 families were identified. The family Rubiaceae was found to have the highest number of reported species. Use of the various taxa is compared between five districts within Central Province of Kenya. The commonest species in this pharmacopoeia are: Caesalpinia volkensii Harms, Strychnos henningsii Gilg, Ajuga remota Benth., Warbugia ugandensis Sprague and Olea europaea L. The first three species are used in all the five districts while the others are restricted in some of the districts. In 74% of the anti-malarial plant species reported in this study, the remedies are obtained in destructive manner and may need conservation measures to ensure sustainable utilization. The results of this study become a basis for selecting plants for further pharmacological and phytochemical studies in developing new and locally relevant anti-malarial agents.

Antimalarials↗

Molecular examination of the sympatry and distribution of sheep and camel strains of Echinococcus granulosus in Kenya.

Previous studies have shown that camel and sheep strains of the cystic hydatid parasite Echinococcus granulosus occur in Kenya. We examined 208 larval isolates and 40 worm samples of E. granulosus from various hosts in Kenya using restriction fragment length polymorphism analysis of a segment of ribosomal DNA amplified by the polymerase chain reaction. This was in an effort to determine whether additional strains of E. granulosus occur in Kenya, to examine the level of genetic heterogeneity within the sheep/dog and camel/dog strains previously identified, and to map out their intermediate host range and geographic distribution in Kenya. We confirmed the existence of the two strains in Kenya and showed that the distribution of the camel strain appears restricted to the Turkana region, where camels are kept as livestock. The intermediate host range for both strains seems to be similar except that humans appear refractory to infection with the camel strain. We have also shown that although the life-cycle patterns of the two strains overlap both geographically and in intermediate and definitive hosts, the strains maintain their homogeneous genetic identity.

Abattoirs↗

Diagnostic potential of serum vitamin E tocopherol and cholesterol levels in children with protein energy malnutrition in western Kenya.

OBJECTIVE: To determine the levels and diagnostic potential of vitamin E (alpha-tocopherol) in protein energy malnutrition (PEM) in western Kenya. DESIGN: Passive Hospital based study conducted on inpatients and outpatients. SETTING: Webuye sub-District and Moi Teaching and referral Hospitals, Western Kenya. SUBJECTS AND METHODS: Serum levels for vitamin E and cholesterol concentrations in children < 5 years of age (n=56) admitted to Webuye District Hospital, Bungoma, Western Kenya and some (n=3) admitted to Moi teaching and referral Hospital, Eldoret Kenya suffering from Kwashiorkor, Marasmus or PEM and malaria plus there controls, for a period of one year (January-December, 2001) were examined. High Performance Liquid Chromatography (HPLC) and Spectrophotometry were used for the analysis. RESULTS: The serum vitamin E levels were higher in Kwashiorkor (0.078 mg/ml, SD 0.034) than marasmus (0.075 mg/ml; SD 0.069) and controls (0.057 mg/ml; SD 0.022). The mean serum cholesterol levels were higher in marasmus (204.6 mg/dl; SD 104.8) than Kwashiorkor (186.0 mg/dl; SD 119.3) and controls (154.3; SD 33.3). There was a significant correlation in vitamin E concentrations between Kwashiorkor and controls only at P<0.01 as compared to Marasmus and Marasmic/Kwashiorkor. Vitamin E levels did not show significant correlation to cholesterol in malnourished children from Webuye, Bungoma in western Kenya at P<0.01. CONCLUSION: Vitamin E could be a useful diagnostic tool for PEM in this area.

Case-Control Studies↗

Molecular characterisation of the rotavirus strains prevalent in Maua, Meru North, Kenya.

BACKGROUND: Rotavirus is the most common cause of severe infantile diarrhoea disease in infants and young children below five years worldwide. Rotavirus is associated with high cases of morbidity and mortality and it is estimated that up to 650,000 deaths in young children occur annually in the less developed countries and approximately 150,000-200,000 deaths occur in Africa alone. OBJECTIVE: To characterise the circulating rotavirus strains in Maua, Meru North district, Kenya. DESIGN: A prospective study to investigate and characterise rotavirus serotypes/genotypes and electropherotypes in infants and children with severe diarrhoea hospitalised and/or attending the outpatient department of Maua Methodist Hospital during the period April 2004 to September 2005. SETTING: Maua Methodist Hospital, Meru North, Kenya. SUBJECTS: Faecal samples were collected from 135 infants and children with acute diarrhoea and were screened first for the presence of human Group A rotavirus antigen using commercially available enzyme linked immunosorbent assay kit (ELISA). The positive samples were evaluated by sodium dodecyl polycrylamide gel electrophoresis (SDS-PAGE) to determine the viral RNA electropherotype profile. Rotavirus strains were also genotyped using reverse transcriptase polymerase chain reaction (RT-PCR) of the VP7 gene. RESULTS: Assay of these samples with commercial ELISA showed that 17.8% (24/135) were positive for group A rotavirus antigen. Twenty of these ELISA positive samples were also analysed by SDS-PAGE of which 75% (15/20) gave detectable electropherotype pattern with the long electropherotype being predominant 80.0% (12/15) followed by the short RNA profile 20.0% (2/ 15). Seventeen of the ELISA positive samples were genotyped for VP7 and the results showed that G9 was the most predominant genotype comprising 47.1% (8/17) followed by G8 29.4% (5/17), GI 17.4% (3/17) and the mixed genotype was G8/G9 5.9% (1/17). Most patients with rotavirus infection were of the age of 3 - 60 months, with 79% being less than 18 months old. CONCLUSION: The overall prevalence of rotavirus infection in young children with diarrhoea hospitalised and/or attending the out-patient department of Maua Methodist Hospital was 17.8% with the predominant serotype being G9. These results show that rotavirus plays an important role in severe viral diarrhoea in young children in Maua Meru North district, Kenya. Furthermore, this high G9 rotavirus prevalence in Kenya may require vaccine trials to be held in Kenya so as to determine the efficacy of new rotavirus vaccine candidates that do not include the G9 serotype.

Child, Preschool↗

Dosages of anti-tuberculosis medications in the national tuberculosis programs of Kenya, Nepal, and Senegal.

SETTING: National tuberculosis programs in Kenya, Nepal, and Senegal. OBJECTIVES: To ascertain adequacy of initial prescriptions of dosages of anti-tuberculosis medications in the three national tuberculosis programs. METHODS: Collection of patient treatment cards in a representative sample of treatment centers in Kenya, Nepal, and Senegal. Calculation of drug dosages in milligram per kilogram body weight of isoniazid, rifampicin, and pyrazinamide and comparison with international recommendations for dosage of these medications. RESULTS: A total of 12,346 patient treatment cards were available. Yet of these only 8640 were analyzed: 5575 (65% of total) from Kenya, 612 (53% of total) from Nepal, and 2453 (95% of total) from Senegal had the patient's weight recorded and were given a nationally recommended treatment regimen. The proportions of patients receiving an internationally recommended isoniazid dosage were 34%, 15%, and 15%, respectively in Kenya, Nepal and Senegal; the corresponding figures for rifampicin were 77%, 77%, and 93% and for pyrazinamide 25%, 3% and 75%, respectively, in the three countries. The majority of errors were over-dosage, but some cases of under-dosage were also identified. CONCLUSIONS: This study shows that over-dosage was a frequent event in all three countries. Two major reasons for this error are inadequate drug combinations in Kenya and Senegal, and in all three countries recommendations for weight brackets that did not ideally fit internationally recommended dosages. It is vital to address these problems to reduce both the risk of unnecessary drug toxicity on one end of the spectrum, and suboptimal drug levels on the other.

Adolescent↗

Malaria in travelers returning from short organized tours to holiday resorts in Mombassa, Kenya.

BACKGROUND: Short trips to holiday resorts in Mombassa, Kenya, have gained popularity among Israelis since the early 1990s. A cluster of cases of malaria among returned travelers raised concern that preventive measures were being neglected. OBJECTIVES: To characterize the demographic and clinical features of malaria acquired in Kenya, and to assess the adequacy of preventive measures. METHODS: Data were collected from investigation forms at the Ministry of Health. All persons who acquired malaria in Kenya during the years 1999-2001 were contacted by phone and questioned about use of chemoprophylaxis, attitudes towards malaria prevention, and disease course. Further information was extracted from hospital records. RESULTS: Kenya accounted for 30 (18%) of 169 cases of malaria imported to Israel and was the leading source of malaria in the study period. Of 30 malaria cases imported from Kenya, 29 occurred after short (1-2 weeks) travel to holiday resorts in Mombassa. Average patient age was 43 +/- 12 years, which is older than average for travelers to tropical countries. Only 10% of the patients were fully compliant with malaria chemoprophylaxis. The most common reason for non-compliance was the belief that a short trip to a holiday resort carries a negligible risk of malaria. Only 3 of 13 patients (23%) who consulted their primary physician about post-travel fever were correctly diagnosed with malaria. Twenty percent of cases were severe enough to warrant admission to an intensive care unit; one case was fatal. CONCLUSIONS: Measures aimed at preventing malaria and its severe sequelae among travelers should concentrate on increasing awareness of risks and compliance with malaria chemoprophylaxis.

Adult↗