Intimate partner violence among HIV-positive women in Nairobi, Kenya.

PURPOSE: This study was conducted to identify the prevalence and sociodemographic factors associated with four forms of intimate partner violence (IPV) among HIV-positive women attending the Comprehensive Care Centre at the Kenyatta National Hospital in Nairobi, Kenya. METHODS: A cross-sectional study was conducted among 600 sexually active HIV-positive women aged 18-69 years from May to August of 2012. A structured questionnaire including questions pertaining to sociodemographic characteristics, health care decisions, and forms of IPV (controlling behavior, emotional abuse, physical violence, and sexual violence) was administered to each woman. RESULTS: All women reported experiencing emotional abuse; 20%, 17%, and 15% experienced controlling behavior, physical violence, and sexual violence, respectively. Women who reported low/below average socioeconomic status (SES) had a greater likelihood of experiencing controlling behavior than women with high/average SES (adjusted odds ratio [aOR] =1.62, 95% CI 1.05-2.51). Women who were unemployed had greater odds of experiencing physical violence than those who were employed (aOR =2.35, 95% CI 1.31-4.23). Non-Christian women had higher odds of experiencing controlling behavior, physical violence, and sexual violence than Christian women (aOR =4.41, 95% CI 1.81-10.76 and aOR =3.33, 95% CI 1.43-7.80). CONCLUSION: Based on the prevalence of IPV and the sociodemographic factors identified to be associated with IPV among women in this study it may be beneficial to include IPV screening as part of routine clinic visits for HIV-positive and other women. Furthermore, women who report emotional abuse or controlling behavior from spouse should not be overlooked, as these two forms of IPV may precede or accompany physical and sexual IPV. Women who report experiencing IPV during clinic visits may be referred to organizations and resources available to battered women in Kenya. Increased funding for anti-IPV programs and changes in policy may also contribute to a reduction in IPV among HIV-positive and other women in Kenya.

ANTIBIOTIC SUSCEPTIBILITY OF ORGANISMS CAUSING URINARY TRACT INFECTION IN PATIENTS PRESENTING AT KENYATTA NATIONAL HOSPITAL, NAIROBI.

BACKGROUND: Changes in susceptibility patterns of bacterial pathogens isolated from urinary tract infections emphasize the need for regional surveillance to generate information that can be used in management of patients. Knowledge on the current status of antimicrobial resistance in uropathogens, and the prevalence of expanding spectrum beta-lactamases (ESBLs) in the isolates will guide policy formulations and encourage prudent use of antimicrobials. OBJECTIVE: Identify bacterial pathogens causing UTI and determine the association between the pathogens isolated from patients attending KNH. Determine antimicrobial susceptibility patterns of the UTI pathogens and the prevalence of ESBL in the isolated pathogens. DESIGN: Laboratory-based study. SETTING: Department of Medical Microbiology University of Nairobi and Kenyatta National Hospital microbiology laboratory, Nairobi, Kenya. SUBJECTS: Nine hundred and forty eight patients presenting directly to the Kenyatta National Hospital's diagnostic lab. Patients were only classified as in-patients if at the time of specimen collection they were being admitted to one of KNH wards. RESULTS: Out of the 948 urine samples processed, 189 in-patients and 37 out-patients samples had significant bacterial growth. The uropathogens identified from in-patient specimens were Escherichia coli (56), Klebsiellapneumoniae (33), Enterococcus spp. (34) and Entrobacter (16) making up 30%, 18%, 18% and 9% respectively. ESBL isolates were found to be resistant to the locally administered antibiotics; Augmentin (37%), Levofloxacin (37%), Cefoperazone (37%), Ampicillin (39%), Doxycyline (41%), Gentamicin (30%) and Nalidixic Acid (38%). CONCLUSION: The increased prevalence of multidrug resistant ESBL pathogens poses challenges for health care providers at KNH and signifies the need for new approach to treat UTI. It would be prudent for laboratories to include specialized tests for detection of ESBL producing pathogens from isolates obtained from in-patients. Further studies on the mechanisms and pathways utilized by these bacteria to cause UTI will highlight other avenues in patient management.

Pregnancy rates among female participants in phase I and phase IIA AIDS vaccine clinical trials in Kenya.

BACKGROUND: Female participants in AIDS candidate vaccine clinical trials must agree to use effective contraception to be enrolled into the studies, and for a specified period after vaccination, since the candidate vaccines' effects on the embryo or foetus are unknown. OBJECTIVES: To review data on female participants' pregnancy rates from phase I and IIA AIDS vaccine clinical trials conducted at the Kenya AIDS Vaccine Initiative (KAVI) and to discuss the challenges of contraception among female participants. DESIGN: Descriptive observational retrospective study. SETTING: KAVI clinical trial site, Kenyatta National Hospital and University of Nairobi, Kenya. SUBJECTS: Thirty nine female participants were enrolled into these trials. They received family planning counselling and were offered a choice of different contraceptive methods, as per the protocols. All contraception methods chosen by the participants were offered at the study site at no cost to the participant. RESULTS: Four women conceived during the study period when pregnancies were to be avoided. All four had opted for sexual abstinence as a contraceptive method, but reported having been coerced by their partners to have unprotected sexual intercourse. CONCLUSION: Abstinence is clearly not a reliable contraceptive option for women in developing-country settings. Effective female-controlled contraceptives, administered at the clinical trial site, may empower female participants to better control their fertility, leading to more complete clinical trial data.

A simple and quick method for enhanced detection of specific IgE in serum from lymphatic filariasis patients.

A new simple and quick technique, using a suspension of protein A agarose beads to absorb IgG4 from sera prior to determination of filarial-specific IgE in ELISA, is presented. The optimal ratio between serum and absorbant was determined by absorbing fixed volumes of sera from individuals from a Wuchereria bancrofti endemic area with different volumes of the protein A agarose bead suspension and testing supernatants for filaria-specific IgG4 and IgE. The effect of absorption on measured IgG4 and IgE intensities in sera from various categories of individuals from the endemic area was thereafter examined. Overall, absorption resulted in a 96.5% decrease in mean ELISA OD values for IgG4 and a 41.6% increase in mean ELISA OD values for IgE. Higher increases in IgE measurements were seen with sera from circulating filarial antigen (CFA) negative individuals (64.7%), microfilaria (mf) negative individuals (56.1%) and individuals with chronic filarial disease (62.7%) than with sera from individuals who were CFA positive (23.4%), mf positive (10.0%), or without chronic disease (36.5%). These differences indicate that the degree to which IgE detection in unabsorbed serum is blocked by IgG4 varies with infection and disease status. Absorption of IgG4 from serum with a protein A agarose bead suspension prior to measurement of specific IgE is a useful alternative to conventional gel column absorption methods, particularly when processing many samples.

Transmission intensity and the immunoepidemiology of bancroftian filariasis in East Africa.

Previous attempts to determine the interactions between filariasis transmission intensity, infection and chronic disease have been limited by a lack of a theoretical framework that allows the explicit examination of mechanisms that may link these variables at the community level. Here, we show how deterministic mathematical models, in conjunction with analyses of standardized field data from communities with varying parasite transmission intensities, can provide a particularly powerful framework for investigating this topic. These models were based on adult worm population dynamics, worm initiated chronic disease and two major forms of acquired immunity (larval- versus adult-worm generated) explicitly linked to community transmission intensity as measured by the Annual Transmission Potential (ATP). They were then fitted to data from low, moderate and moderately high transmission communities from East Africa to determine the mechanistic relationships between transmission, infection and observed filarial morbidity. The results indicate a profound effect of transmission intensity on patent infection and chronic disease, and on the generation and impact of immunity on these variables. For infection, the analysis indicates that in areas of higher parasite transmission, community-specific microfilarial rates may increase proportionately with transmission intensity until moderated by the generation of herd immunity. This supports recent suggestions that acquired immunity in filariasis is transmission driven and may be significant only in areas of high transmission. In East Africa, this transmission threshold is likely to be higher than an ATP of at least 100. A new finding from the analysis of the disease data is that per capita worm pathogenicity could increase with transmission intensity such that the prevalences of both hydrocele and lymphoedema, even without immunopathological involvement, may increase disproportionately with transmission intensity. For lymphoedema, this rise may be further accelerated with the onset of immunopathology. An intriguing finding is that there may be at least two types of immunity operating in filariasis: one implicated in anti-infection immunity and generated by past experience of adult worms, the other involved in immune-mediated pathology and based on cumulative experience of infective larvae. If confirmed, these findings have important implications for the new global initiative to achieve control of this disease.

Wuchereria bancrofti in a community with seasonal transmission: stability of microfilaraemia, antigenaemia and filarial-specific antibody concentrations.

The effect of seasonal transmission on microfilaraemia, antigenaemia and filarial-specific antibody levels in individuals infected with Wuchereria bancrofti was investigated in a follow-up study in an endemic community in north-eastern Tanzania. The subjects were 37 adult male residents who were found to be positive for circulating filarial antigen (CFA) at the beginning of the study (26 of whom were also found microfilaraemic with W. bancrofti at this time). Blood samples were collected from each subject in July 1998, January 1999 and July 1999, during the seasons when transmission intensity was high, low and high, respectively. The mean intensities of microfilaraemia and the mean concentrations of CFA were each slightly higher during the low-transmission season than during the two high-transmission seasons but the differences were not statistically significant (P > 0.05). Similarly, the mean levels of filarial-specific IgG1, IgG2, IgG3, IgG4 or IgE did not differ to a statistically significant degree between the three examination times. Microfilaraemias and the levels of CFA and filarial-specific antibodies all therefore appeared to be remarkably stable and largely unaffected by the seasonal variation in transmission. That no variation in the mean IgG4/IgE ratio was observed over the study period may indicate that the level of resistance to W. bancrofti infection in the study subjects was also unaffected by the transmission season.

Praziquantel side effects during treatment of Schistosoma mansoni infected pupils in Kibwezi, Kenya.

Four hundred and thirty six pupils in two primary schools in Kibwezi, Kenya aged between seven and sixteen years and positive for S. mansoni were treated as follows: 320 pupils with a single dose of praziquantel at 40 mg/kg body weight and 116 controls with a placebo. Immediate and delayed side effects of praziquantel were observed. The main side-effects were abdominal pain (36.3%), headache (35.3%) and nausea (13.1%). There was correlation between frequencies of these side-effects and intensity of infection measured as eggs per gram of faeces. Other side-effects included dizziness (9.7%), fever (7.8%), urticaria and bloody diarrhoea. Overall, the side-effects of praziquantel were mild and transient, and did not require any intervention. For ethical reasons, all pupils who served as controls were treated with praziquantel after the study.

Loa loa antigen detection by ELISA: a new approach to diagnosis.

Circulating immune complexes associated Loa loa antigen in sera of 27 subjects with Loa loa (13 'occult' and 14 microfilaraemic infections) was detected with Polyethylene glycol enzyme linked immunosorbent assay (PEG-ELISA) in a controlled study. Loa loa antigen was detected in all 27 sera. There was no correlation between antigen levels and microfilaraemia density. Cross reaction with Mansonella perstans was found. Although this serological test is able to detect all Loa loa infections, its use is limited by cross reaction with other filariasis. It is hoped that sensitivity will be improved by using monoclonal antibodies.