Prevalence of trypanosomes associated with drug resistance in Shimba Hills, Kwale County, Kenya.

OBJECTIVE: Animal African trypanosomiasis (AAT) is a life-threatening vector-borne disease, caused by trypanosome parasites, which are principally transmitted by tsetse flies. In Kenya, the prevalence of drug-resistant trypanosomes in endemic regions remains poorly understood. The objective of this study was to establish AAT point prevalence, drug susceptibility of associated trypanosomes, and measure infectivity by multiple AAT mammalian hosts to tsetse flies in Shimba hills, a resource-poor region with high bovine trypanosomiasis prevalence and morbidity rates at the coast of Kenya. We collected tsetse flies using traps (1 Ngu and 2 biconical), and then sorted them on sex and species. Trypanosomes present in tsetse flies were detected by first extracting all genomic DNA, and then performing PCR reactions with established primers of the internal transcribed spacer regions. Polymorphisms associated with trypanocide resistance in the TbAT1 gene were also detected by performing PCR reactions with established primers. RESULTS: Our findings suggest low trypanosome prevalence (3.7%), low trypanocide resistance, and low infectivity by multiple mammalian hosts to tsetse flies in Shimba hills. We conclude that enhanced surveillance is crucial for informing disease management practices that help prevent the spread of drug-resistant trypanosomiasis.

Community-led data collection using Open Data Kit for surveillance of animal African trypanosomiasis in Shimba hills, Kenya.

OBJECTIVE: In Sub-Saharan Africa, there is an increase in trypanosome non-susceptibility to multiple trypanocides, but limited information on judicious trypanocide use is accessible to smallholder farmers and agricultural stakeholders in disease endemic regions, resulting in widespread multi-drug resistance. Huge economic expenses and the laborious nature of extensive field studies have hindered collection of the requisite large-scale prospective datasets required to inform disease management. We examined the efficacy of community-led data collection strategies using smartphones by smallholder farmers to acquire robust datasets from the trypanosomiasis endemic Shimba hills region in Kenya. We used Open Data Kit, an open-source smartphone application development software, to create a data collection App. RESULTS: Our study provides proof of concept for the viability of using smartphone Apps to remotely collect reliable large-scale information from smallholder farmers and veterinary health care givers in resource poor settings. We show that these datasets can be reliably collated remotely, analysed, and the findings can inform policies that improve farming practices and economic wellbeing while restricting widespread multi-drug resistance. Moreover, this strategy can be used to monitor and manage other infectious diseases in other rural, resource poor settings.

Modelling appropriate use of trypanocides to restrict wide-spread multi-drug resistance during chemotherapy of animal African trypanosomiasis.

Trypanocide resistance remains a huge challenge in the management of animal African trypanosomiasis. Paucity of data on the prevalence of multi-drug resistant trypanosomes has greatly hindered optimal veterinary management practices. We use mathematical model predictions to highlight appropriate drug regimens that impede trypanocide resistance development in cattle. We demonstrate that using drugs in decreasing resistance order results in a negligible increase in number of cattle with resistant infection, in contrast to a more pronounced increase from trypanocide use in increasing resistance order. We demonstrate that the lowest levels of trypanocide resistance are achieved with combination therapy. We also show that increasing the number of cattle treated leads to a progressive reduction in the number of cattle with drug resistant infections for treatments of up to 80% of the cattle population for the combination treatment strategy. Our findings provide an initial evidence-based framework on some essential practices that promote optimal use of the handful of trypanocides. We anticipate that our modest forecasts will improve therapeutic outcomes by appropriately informing on the best choice, and combination of drugs that minimize treatment failure rates.