Age assessment services in public dental health facilities in Kenya: burden and sources of referral (a cross-sectional study).

Introduction: the need for age assessment remains relevant due to unregistered births or lack of identification documents as a result of political and socioeconomic conflicts. Dentists play a significant role in age assessment. In order to establish the need for capacity building and collaboration, the study set out to determine the proportion of dental patients referred for age assessment and their sources of referral. Methods: a cross-sectional study, based on 5-year records (2014-2018) of dental patients and a selected sample of 316 patients who visited for age assessment in 2019-2020 in the same hospitals. The study centers were 8 county hospitals. Variables included gender, dental visits, health facility, and sources of referral. One-way Analysis of Variance (ANOVA) and Fisher´s Exact test were used to identify a significant association between variables. Results: from the records, 12,738 (5.7%) patients sought age assessment services. Females 6,410 (50.3%) and males 6,328 (49.7%) were nearly equal. There was a statistically significant difference in the average number of patients who required age assessment services from different facilities, p=0.000. The selected sample comprised of 186 (58.9%) and 130 (41.1%) males and females respectively. Sources of referral included; court of law (267, 84.5%), prior to acquiring identification documents (47, 14.9%), and others (2, 0.6%). Conclusion: an average of 5% of dental patients seek age assessment services signifying the need for sustained capacity building so as to ensure competent service delivery. The majority of the sampled patients were referrals from the court of law. Further research on how the dental fraternity can collaborate with the Judiciary to ensure justice in age disputes is recommended.

A Review on the Present Advances on Studies of Toxoplasmosis in Eastern Africa.

Toxoplasmosis is a zoonotic infection caused by the protozoan parasite, Toxoplasma gondii. It was discovered over 100 years ago and is credited as the most successful parasitic organism worldwide, able to infect and multiply in all warm blooded animals including an estimated 2.3 billion people. Toxoplasmosis is asymptomatic in immunocompetent individuals. Infection in the developing fetus and immunocompromised individuals can cause severe clinical disease. Toxoplasmosis is also a major cause of reproductive failure in livestock. The economic impact of toxoplasmosis is believed to be substantial. Factors associated with toxoplasmosis infection have been defined. Eastern Africa region is a high-risk area mainly due to the close association of humans and livestock as well as sociocultural practices, poor environmental hygiene, and poverty. The present paper provides a narrative review of published data on toxoplasmosis in Eastern Africa.

Development of Neurological Mouse Model for Toxoplasmosis Using Toxoplasma gondii Isolated from Chicken in Kenya.

Animal models for the toxoplasmosis are scarce and have limitations. In this study, a neurological mouse model was developed in BALB/c mice infected intraperitoneally with 15 cysts of a Toxoplasma gondii isolate. The mice were monitored for 42 days and euthanized at different time points. Another group of mice were orally treated with dexamethasone (DXM: 2.66 mg/kg daily, 5.32 mg/kg daily) at 42 days after infection and monitored for a further 42 days. A mortality rate of 15% and 28.6% was observed in mice given 2.66 mg/kg/day and 5.32 mg/kg/day of DXM, respectively. The mean cyst numbers in the brain of DXM treated mice increased up to twofold compared with chronically infected untreated mice. Infections up to 42 days were associated with an increase in both IgM and IgG levels but following dexamethasone treatment, IgM levels declined but IgG levels continued on rising. The brain of toxoplasmosis infected mice showed mononuclear cellular infiltrations, neuronal necrosis, and cuffing. The severity of pathology was higher in mice treated with dexamethasone compared to the positive control groups. The findings of this study demonstrate that DXM-induced reactivation of chronic toxoplasmosis may be a useful development of laboratory animal model in outbred mice used for in vivo studies.

Detection of Natural Toxoplasma gondii Infection in Chicken in Thika Region of Kenya Using Nested Polymerase Chain Reaction.

The detection of Toxoplasma gondii in free-range chickens is a good indicator of possible risk to human beings. The aim of this study was to investigate the occurrence of T. gondii in free-range chicken using polymerase chain reaction (PCR). Brain samples from 105 free-range chickens from three administrative areas in Thika region, Kenya, were collected, DNA-extracted, and analyzed using PCR to detect presence of T. gondii. The overall prevalence of T. gondii in all the three areas was 79.0% (95% CI: 70.0-86.4%) and the prevalence across the three areas was not significantly different (P = 0.5088; χ2 = 1.354). Female chickens had higher (79.4%) prevalence than males (78.6%), although the difference was not significant (P = 0.922, χ2 = 0.01). However, chickens that were more than 2 years old had significantly (P = 0.003; χ2 = 11.87) higher prevalence compared to younger ones. The study indicates that there was a high occurrence of T. gondii infection in free-range chickens from Thika region and that the infection rate is age dependent. Further studies should be carried out to determine the possible role of roaming chickens in the epidemiology of the disease among humans in the area.

Loop Mediated Isothermal Amplification for Detection of Trypanosoma brucei gambiense in Urine and Saliva Samples in Nonhuman Primate Model.

Human African trypanosomiasis (HAT) is a vector-borne parasitic zoonotic disease. The disease caused by Trypanosoma brucei gambiense is the most prevalent in Africa. Early diagnosis is hampered by lack of sensitive diagnostic techniques. This study explored the potential of loop mediated isothermal amplification (LAMP) and polymerase chain reaction (PCR) in the detection of T. b. gambiense infection in a vervet monkey HAT model. Six vervet monkeys were experimentally infected with T. b. gambiense IL3253 and monitored for 180 days after infection. Parasitaemia was scored daily. Blood, cerebrospinal fluid (CSF), saliva, and urine samples were collected weekly. PCR and LAMP were performed on serum, CSF, saliva, and urine samples. The detection by LAMP was significantly higher than that of parasitological methods and PCR in all the samples. The performance of LAMP varied between the samples and was better in serum followed by saliva and then urine samples. In the saliva samples, LAMP had 100% detection between 21 and 77 dpi, whereas in urine the detection it was slightly lower, but there was over 80% detection between 28 and 91 dpi. However, LAMP could not detect trypanosomes in either saliva or urine after 140 and 126 dpi, respectively. The findings of this study emphasize the importance of LAMP in diagnosis of HAT using saliva and urine samples.

Factors associated with late presentation of suspected tuberculosis cases to tuberculosis management facilities: The case in Dagoretti district, Nairobi, Kenya.

BACKGROUND: Tuberculosis is a highly contagious disease accounting for a high number of deaths in the developing countries; its control can be effectively achieved if individuals with the disease receive adequate and timely treatment. The objective of this study was to determine the factors associated with late presentation of suspects to tuberculosis management facilities in Dagoretti district in Nairobi, Kenya. METHOD: A cross sectional study was conducted on patients aged 18 years and above attending TB clinics in Dagoretti District, Nairobi Kenya. A total of 426 TB suspects were interviewed. The study covered 8 clinics in Dagoretti district. Analysis was done using SPSS version 16.0 and Epi info version 6, this included Chi Square for Bivariate analysis and Binary Logistic Regression for Multivariate Analysis. RESULTS: Out of the 426 tuberculosis suspects, 248 (58.2%) suspects had delayed in seeking medical care. In Bivariate analysis male gender (P = 0.039, O.R = 1.51; 95% Confidence Interval; 1.00- 2.27), level of education (Primary class 5-8) (P = 0.001, O.R= 2.06; 95% C.I 1.34-3.19) and place of first medical care (drug store) (P= 0.013, O.R = 1.63; 95% C.I 1.09-2.46) were all significantly associated with late presentation. After multivariate logistic regression, gender (P = 0,019, OR = 1.6), level of education (p = 0.029, OR = 1.26) and place of first medical care (P= 0.01 OR = 1.27), were found to be significantly associated with late presentation. CONCLUSION: This study shows that age, level of education and place of first medical care are the factors associated with late presentation of suspects to tuberculosis management facilities.