First cases of SARS-CoV-2 infection and secondary transmission in Kisumu, Kenya.

We investigated the first 152 laboratory-confirmed SARS-CoV-2 cases (125 primary and 27 secondary) and their 248 close contacts in Kisumu County, Kenya. Conducted June 10-October 8, 2020, this study included interviews and sample collection at enrolment and 14-21 days later. Median age was 35 years (IQR 28-44); 69.0% reported COVID-19 related symptoms, most commonly cough (60.0%), headache (55.2%), fever (53.3%) and loss of taste or smell (43.8%). One in five were hospitalized, 34.4% >25 years of age had at least one comorbidity, and all deaths had comorbidities. Adults ≥25 years with a comorbidity were 3.15 (95% CI 1.37-7.26) times more likely to have been hospitalized or died than participants without a comorbidity. Infectious comorbidities included HIV, tuberculosis, and malaria, but no current cases of influenza, respiratory syncytial virus, dengue fever, leptospirosis or chikungunya were identified. Thirteen (10.4%) of the 125 primary infections transmitted COVID-19 to 27 close contacts, 158 (63.7%) of whom resided or worked within the same household. Thirty-one percent (4 of 13) of those who transmitted COVID-19 to secondary cases were health care workers; no known secondary transmissions occurred between health care workers. This rapid assessment early in the course of the COVID-19 pandemic identified some context-specific characteristics which conflicted with the national line-listing of cases, and which have been substantiated in the year since. These included over two-thirds of cases reporting the development of symptoms during the two weeks after diagnosis, compared to the 7% of cases reported nationally; over half of cases reporting headaches, and nearly half of all cases reporting loss of taste and smell, none of which were reported at the time by the World Health Organization to be common symptoms. This study highlights the importance of rapid in-depth assessments of outbreaks in understanding the local epidemiology and response measures required.

Maturity assessment of Kenya's health information system interoperability readiness.

BACKGROUND: The use of digital technology in healthcare promises to improve quality of care and reduce costs over time. This promise will be difficult to attain without interoperability: facilitating seamless health information exchange between the deployed digital health information systems (HIS). OBJECTIVE: To determine the maturity readiness of the interoperability capacity of Kenya's HIS. METHODS: We used the HIS Interoperability Maturity Toolkit, developed by MEASURE Evaluation and the Health Data Collaborative's Digital Health and Interoperability Working Group. The assessment was undertaken by eHealth stakeholder representatives primarily from the Ministry of Health's Digital Health Technical Working Group. The toolkit focused on three major domains: leadership and governance, human resources and technology. RESULTS: Most domains are at the lowest two levels of maturity: nascent or emerging. At the nascent level, HIS activities happen by chance or represent isolated, ad hoc efforts. An emerging maturity level characterises a system with defined HIS processes and structures. However, such processes are not systematically documented and lack ongoing monitoring mechanisms. CONCLUSION: None of the domains had a maturity level greater than level 2 (emerging). The subdomains of governance structures for HIS, defined national enterprise architecture for HIS, defined technical standards for data exchange, nationwide communication network infrastructure, and capacity for operations and maintenance of hardware attained higher maturity levels. These findings are similar to those from interoperability maturity assessments done in Ghana and Uganda.

Community interventions in Low-And Middle-Income Countries to inform COVID-19 control implementation decisions in Kenya: A rapid systematic review.

Globally, public health measures like face masks, hand hygiene and maintaining social distancing have been implemented to delay and reduce local transmission of COVID-19. To date there is emerging evidence to provide effectiveness and compliance to intervention measures on COVID-19 due to rapid spread of the disease. We synthesized evidence of community interventions and innovative practices to mitigate COVID-19 as well as previous respiratory outbreak infections which may share some aspects of transmission dynamics with COVID-19. In the study, we systematically searched the literature on community interventions to mitigate COVID-19, SARS (severe acute respiratory syndrome), H1N1 Influenza and MERS (middle east respiratory syndrome) epidemics in PubMed, Google Scholar, World Health Organization (WHO), MEDRXIV and Google from their inception until May 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO (CRD42020183064). Of 41,138 papers found, 17 studies met the inclusion criteria in various settings in Low- and Middle-Income Countries (LMICs). One of the papers from LMICs originated from Africa (Madagascar) with the rest from Asia 9 (China 5, Bangladesh 2, Thailand 2); South America 5 (Mexico 3, Peru 2) and Europe 2 (Serbia and Romania). Following five studies on the use of face masks, the risk of contracting SARS and Influenza was reduced OR 0.78 and 95% CI = 0.36-1.67. Equally, six studies on hand hygiene practices reported a reduced risk of contracting SARS and Influenza OR 0.95 and 95% CI = 0.83-1.08. Further two studies that looked at combined use of face masks and hand hygiene interventions showed the effectiveness in controlling the transmission of influenza OR 0.94 and 95% CI = 0.58-1.54. Nine studies on social distancing intervention demonstrated the importance of physical distance through closure of learning institutions on the transmission dynamics of disease. The evidence confirms the use of face masks, good hand hygiene and social distancing as community interventions are effective to control the spread of SARS and influenza in LMICs. However, the effectiveness of community interventions in LMICs should be informed by adherence of the mitigation measures and contextual factors taking into account the best practices. The study has shown gaps in adherence/compliance of the interventions, hence a need for robust intervention studies to better inform the evidence on compliance of the interventions. Nevertheless, this rapid review of currently best available evidence might inform interim guidance on similar respiratory infectious diseases like Covid-19 in Kenya and similar LMIC context.

Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya.

BACKGROUND: The study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility. METHODS: The study utilises a quasi experimental design. A two tailed unpaired t-test with unequal variance is used to test for the significance variation in the mean access. The difference in difference (DiD) estimates of program effect on long term family planning methods is done to estimate the causal effect by exploiting the group level difference on two or more dimensions. The study also uses a linear regression model to evaluate the predictors of choice of long-term family planning methods. Data was analysed using SPSS version 17. RESULTS: All the methods (Bilateral tubal ligation-BTL, Vasectomy, intrauterine contraceptive device -IUCD, Implants, and Total or combined long-term family planning methods -LTFP) showed a statistical significant difference in the mean utilization between OBA versus non-OBA clients. The difference in difference estimates reveal that the difference in access between OBA and non OBA clients can significantly be attributed to the implementation of the OBA program for intrauterine contraceptive device (p = 0.002), Implants (p = 0.004), and total or combined long-term family planning methods (p = 0.001). The county of residence is a significant determinant of access to all long-term family planning methods except vasectomy and the year of registration is a significant determinant of access especially for implants and total or combined long-term family planning methods. The management level and facility type does not play a role in determining the type of long-term family planning method preferred; however, non-governmental organisations (NGOs) as management level influences the choice of all methods (Bilateral tubal ligation, intrauterine contraceptive device, Implants, and combined methods) except vasectomy. The adjusted R2 value, representing the percentage of the variance explained by various models, is larger than 18% for implants and total or combined long-term family planning. CONCLUSION: The study showed that the voucher services in Kenya has been effective in providing long-term family planning services and improving access of care provided to women of reproductive age. Therefore, voucher scheme can be used as a tool for bridging the gap of unmet needs of family planning in Kenya and could potentially be more effective if rolled out to other counties.

Hospitalized patients with pandemic (H1N1) 2009, Kenya.

To describe the epidemiology and clinical course of patients hospitalized with pandemic (H1N1) 2009 in Kenya, we reviewed medical records of 49 such patients hospitalized during July-November 2009. The median age (7 years) was lower than that in industrialized countries. More patients had HIV than the general Kenyan population.

Are Kenyan healthcare workers willing to receive the pandemic influenza vaccine? Results from a cross-sectional survey of healthcare workers in Kenya about knowledge, attitudes and practices concerning infection with and vaccination against 2009 pandemic influenza A (H1N1), 2010.

Over 1200 cases of 2009 pandemic influenza A H1N1 (pH1N1) have been identified in Kenya since the first case in June 2009. In April 2010 the Kenyan government launched a program to immunize high-risk groups and healthcare workers (HCWs) with pH1N1 vaccines donated by the World Health Organization. To characterize HCWs' knowledge, attitudes and practices regarding pH1N1 vaccination, we conducted a quantitative and qualitative survey in 20 healthcare facilities across Kenya between January 11 and 26, 2010. Of 659 HCWs interviewed, 55% thought there was a vaccine against pH1N1, and 89% indicated that they would receive pH1N1 vaccine if it became available. In focus group discussions, many HCWs said that pH1N1 virus infection did not cause severe disease in Kenyans and questioned the need for vaccination. However, most were willing to accept vaccination if they had adequate information on safety and efficacy. In order for the influenza vaccination campaign to be successful, HCWs must understand that pH1N1 can cause severe disease in Kenyans, that pH1N1 vaccination can prevent HCWs from transmitting influenza to their patients, and that the vaccine has been widely used globally with few recognized adverse events.

Epidemiology and risk factors for serogroup X meningococcal meningitis during an outbreak in western Kenya, 2005-2006.

The epidemiology of serogroup X meningococcal meningitis in Africa is unknown. During a serogroup X meningococcus outbreak in Kenya, case finding involved record review at health facilities and interviews with health workers and community leaders in West Pokot district. An age- and location-matched case-control study for risk factors was done. From December 2005 to April 2006, 82 suspect cases of meningitis were reported; the epidemic threshold was surpassed within two administrative divisions. Most (58%) cases were 5-24 years old; the case-fatality ratio was 21%. Serogroup X meningococcus was the most common serogroup - 5 (63%) of eight isolates serogrouped. Living in the same compound as another case, preceding upper respiratory tract infection and cooking outside the house were significant risk factors for disease. Serogroup X meningococcus caused an outbreak with similar epidemiology and risk factors as other serogroups. Serogroup-specific laboratory-based surveillance for meningococcus in Africa to detect serogroup X disease should be enhanced.

"If you don't abstain, you will die of AIDS": AIDS education in Kenyan public schools.

We explored constraints of implementing AIDS education in public schools in Kenya. Sixty interviews with teachers and 60 focus group discussions with students were conducted in 21 primary and nine secondary schools. System/school-level constraints included lack of time in the curriculum, limited reach of secondary-school students (because AIDS education is embedded in biology, which is not compulsory), and disapproval of openness about sex and condoms by the Ministry of Education and parents. Alternative strategies to teach about AIDS had their own constraints. Teachers lacked training and support and felt uncomfortable with the topic. They were not used to interactive teaching methods and sometimes breached confidentiality. Teachers' negative attitudes constrained students from seeking information. Training interventions should be provided to teachers to increase their self-confidence, foster more positive attitudes, and stimulate interactive teaching methods. The Ministry of Education needs to have a clear policy toward the promotion of condoms.

Rapid spread of Vibrio cholerae O1 throughout Kenya, 2005.

Between January and June 2005, 5 distinct cholera outbreaks occurred in Kenya. Overall, 990 cases and 25 deaths (2.5%) were reported. Four outbreaks occurred in towns along major highways, and 1 occurred in a refugee camp near the Sudanese border, accessible to Nairobi by daily flights. Matched case-control studies from 2 outbreaks showed that failure to treat drinking water and storing drinking water in wide-mouthed containers were significantly associated with disease. Isolates from all 5 outbreaks were Vibrio cholerae O1, Inaba serotype, and had genetically similar PFGE patterns of SfiI-digested chromosomal DNA. Linkage of the outbreak locations by major transportation routes, their temporal proximity, and similar PFGE patterns of isolates suggests the outbreaks might have been linked epidemiologically, showing the speed and distance of cholera spread in countries like Kenya with pockets of susceptible populations connected by modern transportation. Prevention measures remain implementation of point-of-use safe water systems and case finding and referral.

Unwanted pregnancy and sexually transmitted infection among young women in rural Kenya.

Early sexual debut and premarital sex are increasingly common features of female adolescence in Kenya-putting girls at the risk of unwanted pregnancy and infection by sexually transmitted infections and HIV/AIDS. Levels of knowledge concerning the protective value of condoms and other contraceptives are high, but unprotected sex is still common. Against this background, this paper examines the strategies used by young women to deal with these risks. Qualitative data were obtained from eight focus group discussions conducted with school attending girls aged between 15 and 19 years in Makueni District of Eastern Kenya. Findings suggest that, despite knowledge of the protective value of condoms and other contraceptives, the use of these methods by girls is hampered by inability to access them, the fear of the side effects of contraceptives, and the desire by girls to remain faithful to their religious calling. Most girls also resort to the use of traditional methods such whose potency and efficacy is unproven. These findings suggest the need to make condoms more easily accessible to girls in rural areas, and also for education in the proper use of 'natural' family planning methods. Young women may also benefit from training in how to be more assertive in sexual negotiations.