Temporal variation in confirmed diagnosis of fever-related malarial cases among children under-5 years by community health workers and in health facilities between years 2013 and 2015 in Siaya County, Kenya.

BACKGROUND: Malaria case management continues to experience dynamic changes. Building community capacity is instrumental in both prevention and treatment of malaria. The World Health Organization (WHO) recommends utilization of well-trained and supervised community health workers (CHWs) to reduce the burden of malaria deaths among children under-5 years of age in Africa. Longitudinally-tracked information on utilization of CHWs by communities in terms of trends in diagnosis of malaria in children under-5 years of age is essential in influencing national and local malaria control policies and strategies. METHODS: A desktop review was carried out of a database consisting of confirmed uncomplicated malaria cases in 10 villages using CHWs and out-patient departments of 10 health facilities in children under-five for the period of 3 years between January 2013 and December 2015. Analyses of association between the diagnosed cases and satellite-based rainfall, village and time (months and years) were carried out using a Poisson regression model. RESULTS: Analysis of malaria diagnoses made by CHWs showed the following trends: (i) the incidence of reported documented malaria-positive fever cases increased with time (2013-2015) and the difference over the years was statistically significant (P < 0.001), (ii) specific village was significantly associated (P < 0.001) with reporting malaria-positive fever cases, (iii) the long-term monthly sequence starting from highest to lowest incidence of reported malaria-positive fever cases was July, May and June, March, August, April, September, November, and February, October and, finally, January, and the difference in reported malaria-positives between the months was statistically significant (P = 0.001) and (iv) none of the tested rainfall regimes (current, lagged or cumulative) was associated with reported malaria-positive fever cases during the 3-year period (P > 0.1). Looking at the number of diagnoses made at the health facilities, (i) The number of reported malaria-positive fever cases decreased with time (2013-2015) and the difference among the years was not statistically significant (P = 0.399), (ii) The long-term monthly sequence starting from highest to lowest number of reported malaria-positive fever cases was July, June, May, April, January, August, March, February, September, November, October and December, and the difference between the months was statistically significant (P < 0.001). CONCLUSIONS: CHWs have the potential to play a major role in diagnosing and treating malaria, thereby decreasing under-five children mortality. Temporally, the risk of diagnosing malaria seems predictable and this may present opportunities for policy-targeted malaria preparedness and control. The findings are expected to support policy actions that may scale-up community health services in remote rural settings.

Sero-epidemiology of Peste des petits ruminants virus infection in Turkana County, Kenya.

BACKGROUND: Peste des petits ruminants (PPR) is a contagious viral disease of small ruminants. Serum samples from sheep (n = 431) and goats (n = 538) of all ages were collected in a cross-sectional study in Turkana County, Kenya. The objective was to estimate the sero-prevalence of PPR virus (PPRV) infection and associated risk factors in both species. PPRV competitive enzyme-linked immuno-sorbent assay (c-ELISA) analysed the presence of antibodies in the samples. All analyses were conducted for each species separately. Multivariable logistic regression models were fitted to the data to assess the relationship between the risk factors and PPRV sero-positivity. Mixed-effect models using an administrative sub-location as a random effect were also fitted to adjust for possible clustering of PPRV sero-positivity. Intra-cluster correlation coefficients (ρ) that described the degree of similarity among sero-positive responses for each species in each of the six administrative divisions were estimated. RESULTS: Goats had a significantly higher sero-prevalence of 40% [95% confidence interval (CI): 36%, 44%] compared to sheep with 32% [95% CI: 27%, 36%] (P = 0.008). Combined sero-prevalence estimates were heterogeneous across administrative divisions (n = 6) (range 22% to 65%) and even more across sub-locations (n = 46) (range 0% to 78%). Assuming that PPRV antibodies are protective of infection, a large pool of PPRV susceptible middle age group (>6 months and < 24 months) in both species was estimated. This was based on the low sero-prevalence in this group in goats (14% [95% CI: 10%, 20%]) and in sheep (18% [95% CI: 13%, 25%]). Regression analysis returned significant risk factors across species: in sheep - vaccination status, age and administrative division; in goats - sex, age, administrative division and sex*age interaction. The intra-sub-location correlation coefficients varied widely across divisions (range <0.001 to 0.42) and across species within divisions. CONCLUSIONS: Biological, spatial and socio-ecological factors are hypothesized as possible explanations for variation in PPRV sero-positivity in the Turkana pastoral ecosystem.

Community preferred drug delivery approaches for pilot roll-out of a potential novel paediatric schistosomiasis treatment option in two endemic counties of Kenya: A mixed methods study.

Treating preschool age children (PSAC) for schistosomiasis has remained a challenge due to lack of a pediatric formulation. In response to this unmet need, the Paediatric Praziquantel Consortium has developed a potential novel paediatric treatment option. In advance to its roll-out to follow regulatory response, we conducted a social science study to gather information on preferred drug delivery approaches to inform implementation. A cross-sectional study was conducted in eight villages in two purposively selected Kenyan counties. A questionnaire was administered on 690 parents/guardians of PSAC at household level. Preferred drug delivery approaches were analyzed using frequencies and proportions. We conducted key informant interviews with 17 opinion leaders and 28 healthcare workers, and 12 focus group discussions with parents/guardians of PSAC and 7 with community health volunteers (CHVs). Thematic analysis was performed on the qualitative data. Majority of the 690 respondents were women 594 (86.1%) with a mean age of 34.1 (SD = 11.3, min-max = 18-86). Community-based mass drug administration (cMDA) was the most preferred drug delivery method by 598 participants (86.7%), followed by health facility/fixed points by 398 participants (57.7%). Similarly, in the qualitative data participants indicated they prefer cMDA since the CHVs who would distribute the medication are familiar with households with PSAC and are trusted to explain the drug effects. Health facilities/fixed points were the second most preferred drug delivery approach, but some health workers we interviewed expressed concern about potential understaffing and overcrowding of facilities. Appropriate timing of the drug distribution, not to interfere with farming activities, was considered critical, irrespective of the approach used. All profiles of study participants preferred cMDA over the other delivery approaches due to the convenience of receiving drugs at home and providing explanations about the new drug. For positive outcomes, adequate planning, proper timings and community involvement are highly recommended.

Traditional remedies and other characteristics among human snakebite survivors in Baringo county, Kenya, 2010-2020: a case series.

BACKGROUND: Seeking traditional remedies following snakebites leads to avoidable deaths in rural settings in developing countries. METHODS: In this case series study, we identified and recruited 169 snakebite survivors in Baringo county, a hard-to-reach region in northwestern Kenya, who experienced snakebites from 2010 to 2020 using a snowballing technique. We explored associations between traditional and hospital care in managing snakebites and other characteristics. χ2 tests assessed these categorical differences. RESULTS: Fifty-four (33%) of the survivors used traditional remedies to manage snakebites. The majority (56%) were men and aged >18 y (72%); 59% had low education levels and income. They sourced water from rivers or lakes (93%) and used charcoal as an energy source (74%). These survivors (>67%) resided in households practicing free-range and stall-feeding animal husbandry systems and in houses with thatch roofing or an earthen floor structure. Also, >62% reported muscle tremors, fever and chills, while 80% visited health facilities for further treatment. CONCLUSION: Community sensitization covering the risks of non-effective remedies and escalation of training to traditional healers could improve the speed of referrals in hard-to-reach snakebite hotspots. Medical anthropology studies could explore the enablers of continued use of traditional remedies in snakebite management in rural communities.

Environment and farm factors associated with exposure to Theileria parva infection in cattle under traditional mixed farming system in Mbeere District, Kenya.

The objective of this study was to investigate the relationship between seroprevalence to Theileria parva infection in cattle and potential environmental and farm-level effects in 80 farms under traditional crop-livestock system in Mbeere District, Kenya. A standardized questionnaire was used to collect the effects characteristics as related to T. parva infection epidemiology. Serum samples were collected from 440 cattle of all ages for detection of T. parva antibodies by the enzyme-linked immunosorbent assay technique. The association between the variables was assessed using a generalized estimation equation logistic regression model. The overall T. parva seroprevalence, accounting for correlation of responses, was 19.3% (95% confidence interval (CI) 14%, 25%). Two variables, "administrative division" and "presence of the vector tick on the farm", were significantly associated with the T. parva seroresponse. Respectively, cattle from farms in Gachoka, Evurore, and Mwea divisions were (and their 95% CI) 1.3 (0.36, 4.8), 4.4 (1.2, 15.9), and 15.2 (4.9, 47.1) times more likely to be seropositive relative to those from Siakago Division (P = 0.000). Cattle from farms in which the vector tick was present were 2.9 (1.2, 6.7) times more likely to be seropositive (P = 0.011). Results of this study suggested that both environmental and farm factors may be associated with T. parva infection epidemiology in Mbeere District. Under such circumstances, characterization of environmental suitability for the vector tick and corresponding environment-specific farm management practices in the district is required both for improved understanding of the disease and in planning disease control programs.

Correction: Modelling Vaccination Strategies against Rift Valley Fever in Livestock in Kenya.

[This corrects the article DOI: 10.1371/journal.pntd.0005049.].

Modelling Vaccination Strategies against Rift Valley Fever in Livestock in Kenya.

BACKGROUND: The impacts of vaccination on the transmission of Rift Valley fever virus (RVFV) have not been evaluated. We have developed a RVFV transmission model comprising two hosts-cattle as a separate host and sheep and goats as one combined host (herein after referred to as sheep)-and two vectors-Aedes species (spp) and Culex spp-and used it to predict the impacts of: (1) reactive vaccination implemented at various levels of coverage at pre-determined time points, (2) targeted vaccination involving either of the two host species, and (3) a periodic vaccination implemented biannually or annually before an outbreak. METHODOLOGY/PRINCIPAL FINDINGS: The model comprises coupled vector and host modules where the dynamics of vectors and hosts are described using a system of difference equations. Vector populations are structured into egg, larva, pupa and adult stages and the latter stage is further categorized into three infection categories: susceptible, exposed and infectious mosquitoes. The survival rates of the immature stages (egg, larva and pupa) are dependent on rainfall densities extracted from the Tropical Rainfall Measuring Mission (TRMM) for a Rift Valley fever (RVF) endemic site in Kenya over a period of 1827 days. The host populations are structured into four age classes comprising young, weaners, yearlings and adults and four infection categories including susceptible, exposed, infectious, and immune categories. The model reproduces the 2006/2007 RVF outbreak reported in empirical surveys in the target area and other seasonal transmission events that are perceived to occur during the wet seasons. Mass reactive vaccination strategies greatly reduce the potential for a major outbreak. The results also suggest that the effectiveness of vaccination can be enhanced by increasing the vaccination coverage, targeting vaccination on cattle given that this species plays a major role in the transmission of the virus, and using both periodic and reactive vaccination strategies. CONCLUSION/SIGNIFICANCE: Reactive vaccination can be effective in mitigating the impacts of RVF outbreaks but practically, it is not always possible to have this measure implemented satisfactorily due to the rapid onset and evolution of RVF epidemics. This analysis demonstrates that both periodic and reactive vaccination ought to be used strategically to effectively control the disease.