Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.

BACKGROUND: In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. METHODS: A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. RESULTS: A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. CONCLUSION: This review revealed important gaps in the policy environment for prevention, control and management of CVDs in PHC settings in Kenya. There is need to continuously engage the ministry of health and other sectors to prioritize inclusion of CVD services in PHC.

Histopathology and molecular identification of Sarcocystis species forming macrocysts in slaughtered sheep and goats of Duhok, Iraq.

This study aimed to identify Sarcocystis species isolated from macroscopic sarcocysts of naturally infected sheep and goats using histopathological and molecular studies. A total of 260 macrosarcocyst samples were randomly collected from 1,337 infected sheep and goats slaughtered at different abattoirs in Duhok province, Iraq, from May 2021 to June 2022. The macroscopic cysts, which were found in the esophagus, diaphragm, and abdominal muscles, were classified into fat and thin cysts. Histopathological examination of the observed fat and thin cysts showed a thick eosinophilic wall, several internal septa-forming compartments enclosing numerous bradyzoites, and mild mononuclear inflammatory cells infiltrating around the cysts. The 18 Subunit ribosomal RNA (18S rRNA) and 28 Subunit ribosomal RNA (28S rRNA) genes of Sarcocystis spp. were amplified by polymerase chain reaction (PCR) from 200 macrosarcocysts samples. Molecularly, the DNA sequencing results obtained from fat macrocysts of sheep and goats were found to be identical to Sarcocystis gigantea, and from thin cysts of sheep proved to be similar to Sarcocystis medusiformis, while from thin macrocysts of goats were found to be identical to Sarcocystis moulei. Alignment and phylogenetic analysis observed a very close relationship between identified species of Sarcocystis and other Sarcocystis DNA sequences of sheep and goats across the world. To our knowledge, this is the first histopathological and molecular study for identification of Sarcocystis spp. isolated from different macroscopic forms of sarcocysts of sheep and goats in Iraq.