ZIEHL-NEELSEN MICROSCOPY IN THE DIAGNOSIS OF TUBERCULOSIS IN SETTINGS OF HIGH HUMAN IMMUNODEFICIENCY VIRUS PREVALENCE.

OBJECTIVE: To determine the accuracy of Ziehl-Neelsen microscopy in the diagnosis of TB in setings of high HIV prevalence. DESIGN: Cross-sectional descriptive study. SETTING: Hospitals serving areas of high human immunodeficiency virus prevalence in western Kenya. The study was conducted between September 2007 and September 2009. RESULTS: In total, 341/872(39.1%) of the TB suspects were positive in ZN, 53.1% (181/341) of them culture positive. Only 3.8% (20/531) of the ZN smear negatives were culture positive. Of the 695 suspects evaluated for both Mycobacterium and HIV infection, 255 (36.7%) were ZN smear positive, 42.7% of them HIV positive. Out of the 440 ZN smear negatives, 37% were HIV positive. Similarly, 168 suspects were culture positive, 46.4% of them HIV positive. The HIV infection did not significantly reduce ZN smear positivity rate (P = 0.42) and culture sensitivity (P = 0.09). The ZN sensitivity and specificity were 88.1% and 79.7%, respectively. The predictive values were 58.0 (PPV), and 95.5% (NPV), respectively. However, the area under the ROC curve was 0.84, with 95% CI between 0.80-0.87 and P < 0.001). The ZN smear microscopy had a lesser ability to distinguish between TB and non-TB cases compared to culture. CONCLUSION: ZN microscopy causes a significant over-diagnosis of TB in settings of high HIV/AIDS prevalence. There is need for further studies on this subject taking into consideration the various confounding factors.

A qualitative study on alcohol and drug abuse among undergraduate (University Students) in the coastal region of Kenya

BACKGROUND: Substance use poses a significant threat to the health, social and economic fabric of families, communities and nations. In Kenya, alcohol and drug abuse has been identified as a hindrance to education, development and by extension, to national development. Alcohol and drug abuse has been associated with crime and indiscipline e.g. poor class attendance, poor performance, school dropout and destructive strikes that lead to damage the institution property or even death. Alcohol and drug abusers are also likely to lower their morals and engage in risky sexual activities that can lead to sexually transmitted diseases including HIV infection and AIDS. OBJECTIVES: The aim of this study therefore was to explore on the perceptions and the magnitude of substance abuse among undergraduate (University students) in the two public Universities in the coastal region of Kenya. Also find amicable solutions to curb the menace that can destroy the future of a generation aged between 18­29 years at the peak of their life. METHODOLOGY: This was a qualitative study involving undergraduate (University students), dean of students and counsellors from Pwani University and Technical University of Mombasa. Focus Group Discussions(FGDs) and Key informant interviews were used to collect data. The number of KIIs was guided by data saturation. Thematic analysis was done by identifying, coding, and categorizing patterns or themes found in the data. RESULTS: The problem of alcohol and substance abuse among undergraduate students was a reality. The commonly abused substances were alcohol, miraa (khat), marijuana (cannabis) and cigarettes. Some of the factors predisposing students to abuse drugs were; easy accessibility to drugs, peer pressure, availability of funds, excess freedom, male gender, stress, not being active in religious activities, poor parenting and the African culture that uphold substances such as alcohol as an acceptable social drink. Participants noted that alcohol and drug abuse had led to various negative effects. The major ones affecting the students being poor performance, risky sexual behaviour, and mental disturbances. Participants suggested that Universities ought to intensify awareness campaigns to sensitize students against substance use. CONCLUSION: The commonly abused substances were alcohol, marijuana, miraa (Khat) and tobacco. Alcohol and drug abuse has left a negative impact among undergraduates (university students). The main consequences being; discontinuation of studies, mental disturbances and risky sexual activities. All stakeholders must take action creating awareness among students on the negative effects of substance abuse. Universities should set up programs with an aim to curb substance abuse in the institutions of higher learning. The government should reinforce the set laws and regulations and deal with trafficking of illicit substances into the country

Combating cholera epidemics by targeting reservoirs of infection and transmission routes: a review.

OBJECTIVES: To determine the parameters which can be investigated for prevention and effective control of cholera. DATA SOURCES: Literature search on compact disk-read only memory (CD-ROM), medline and internet, using the key words: cholera outbreaks, and cholera transmission. A few reviews were manually reviewed. STUDY SELECTION: Relevant studies or articles on cholera outbreaks and transmission worldwide, with special reference to Kenya is included in the review. DATA EXTRACTION: From individual study or articles. DATA SYNTHESIS: Information on cholera epidemics worldwide and in Kenya is synchronized under the headings; Introduction, History and predisposing factors, Current situation, Bioecology and transmission patterns, and, Use of molecular epidemiological and geographic information system (GIS) techniques in mapping out the bioecology, reservoirs and transmission routes of cholera. CONCLUSION: Cholera can be prevented and controlled more effectively at environment level. This requires a multi-disciplinary approach including poverty alleviation.

Childhood immunisation in Bungoma County, Kenya, from 2008 to 2011: need for improved uptake.

Uptake of immunisations in children aged 1-2 years in Bungoma County, Kenya, was determined as part of the 6-monthly Health and Demographic Surveillance System surveys. A total of 2699 children were assessed between 2008 and 2011. During this time period, full immunisation declined significantly from 84% to 58%, and measles vaccine declined uptake from 89% to 60% (P < 0.001). Each year there was a significant fall-off for the third doses of the oral polio and pentavalent vaccines (P < 0.001). These findings are of concern, as low immunisation coverage may lead to vaccine-preventable disease outbreaks. Further investigations into the reasons for declining immunisation trends are required.

La couverture vaccinale des enfants de âgés de 1 à 2 ans dans la conté de Bungoma au Kenya a été déterminée dans le cadre d'un enquête du Système de surveillance sanitaire et démographique. Au total 2699 enfants ont été évalués de 2008 à 2011. Au cours de cette période, le taux de vaccination complète a diminué de façon significative, de 84% à 58%, et celui de la vaccination contre la rougeole de 89% à 60% (P < 0,001). Chaque année, on a constaté une chute de l'administration de la 3e dose du vaccin polio oral et du vaccin pentavalent (P < 0,001). Ces résultats sont préoccupants car cette faible couverture vaccinale pourrait conduire à des épidémies de maladies évitables. Il est nécessaire de faire d'autres investigations à la recherche des causes de ce déclin de la vaccination.

La vacunación de los niños de 1 a 2 años de edad en el condado de Bungoma, en Kenia, se investigó como parte de las encuestas semestrales del Sistema de Vigilancia Sanitaria y Demográfica. Se evaluaron 2699 niños del 2008 al 2011. Durante este período se observó una disminución considerable de la administración de un esquema completo de vacunación, de 84% a 58%, y la aplicación de la vacuna antisarampionosa disminuyó de 89% a 60% (P < 0,001). En cada año, se redujo de manera notable la administración de la tercera dosis de la vacuna antipoliomielítica oral y la vacuna pentavalente (P < 0,001). Estas observaciones son fuente de preocupación, pues una baja cobertura de vacunación puede dar origen a brotes epidémicos de enfermedades prevenibles. Se justifica la realización de nuevas investigaciones que aclaren las razones de esta tendencia decreciente de las vacunaciones.

Webuye Health and Demographic Surveillance Systems Baseline Survey of Soil-Transmitted Helminths and Intestinal Protozoa among Children up to Five Years.

Background. The intestinal parasitic infections (IPIs) are globally endemic, and they constitute the greatest cause of illness and disease worldwide. Transmission of IPIs occurs as a result of inadequate sanitation, inaccessibility to potable water, and poor living conditions. Objectives. To determine a baseline prevalence of IPIs among children of five years and below at Webuye Health and Demographic Surveillance (HDSS) area in western Kenya. Methods. Cross-sectional survey was used to collect data. Direct saline and formal-ether-sedimentation techniques were used to process the specimens. Descriptive and inferential statistics such as Chi-square statistics were used to analyze the data. Results. A prevalence of 52.3% (417/797) was obtained with the male child slightly more infected than the female (53.5% versus 51%), but this was not significant (χ (2) = 0.482, P > 0.05). Giardia lamblia and Entamoeba histolytica were the most common pathogenic IPIs with a prevalence of 26.1% (208/797) and 11.2% (89/797), respectively. Soil-transmitted helminths (STHs) were less common with a prevalence of 4.8% (38/797), 3.8% (30/797), and 0.13% (1/797) for Ascaris lumbricoides, hookworms, and Trichuris trichiura, respectively. Conclusions. Giardia lamblia and E. histolytica were the most prevalent pathogenic intestinal protozoa, while STHs were less common. Community-based health promotion techniques are recommended for controlling these parasites.

HIV co-infection with tuberculous and non-tuberculous mycobacteria in western Kenya: challenges in the diagnosis and management.

BACKGROUND: Tuberculosis (TB) and HIV co-infections have a global prevalence with devastating morbidity and massive mortality, Sub-Saharan Africa being the worst hit. OBJECTIVES: To evaluate the prevalence of TB-HIV co-infection and demonstrate the confusion caused by NTM and HIV/AIDS co-infection in TB diagnosis and treatment in western Kenya. METHODS: In a cross-sectional study carried out at 10 hospitals in western Kenya, sputa from consenting 872 TB suspects underwent microscopy, and culture on Lowenstein-Jensen and Mycobacteria Growth Index Tube media. Isolates were identified using the Hain's GenoType(®) Mycobacterium CM and GenoType(®) Mycobacterium AS kits. A total of 695 participants were screened for HIV using Uni-Gold™ test and positives confirmed with the enzyme linked immunosorbent assay. RESULTS: A total of 346 (39.7%) participants were diagnosed with TB. Out of the 346 TB cases, 263 (76%) were tested for HIV infection and 110 (41.8%) of these were sero-positive (co-infected). The female to male TB-HIV co-infection prevalence ratio (PR) was 1.35. This study reports isolation of non-tuberculous mycobacteria from TB suspects at a rate of 1.7%. CONCLUSION: A high TB-HIV co-infection rate was observed in this study. The NTM disease could be misdiagnosed and treated as TB in western Kenya.