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1.
Can J Surg ; 63(5): E418-E421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009901

RESUMO

SUMMARY: The Canadian Network for International Surgery (CNIS) hosted a workshop in May of 2020 with a goal of critically evaluating Trauma Team Training courses. The workshop was held virtually because of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-three participants attended from 8 countries: Canada, Guyana, Kenya, Nigeria, Switzerland, Tanzania, Uganda and the United States. More participants were able to attend the virtual meeting than the traditional in-person meetings. Web-based videoconference software was used, participants presented prerecorded PowerPoint videos, and questions were raised using a written chat. The review proved successful, with discussions and recommendations for improvements surrounding course quality, lecture content, skills sessions, curriculum variations and clinical practical scenarios. The CNIS's successful experience conducting an online curriculum review involving international participants may prove useful to others proceeding with collaborative projects during the COVID-19 pandemic.


Assuntos
Congressos como Assunto/organização & administração , Infecções por Coronavirus/prevenção & controle , Currículo , Cirurgia Geral/educação , Cooperação Internacional , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus/patogenicidade , Canadá/epidemiologia , Congressos como Assunto/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Cirurgia Geral/métodos , Guiana/epidemiologia , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Quênia/epidemiologia , Nigéria/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Suíça/epidemiologia , Tanzânia/epidemiologia , Uganda/epidemiologia , Estados Unidos/epidemiologia , Comunicação por Videoconferência/organização & administração , Comunicação por Videoconferência/normas , Ferimentos e Lesões/cirurgia
2.
Zootaxa ; 4778(1): zootaxa.4778.1.8, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33055837

RESUMO

Two species of the genus Phytodietus Gravenhorst, 1829 are recorded from Kenya: the previously documented P. (Phytodietus) varicolor Seyrig, 1935 and a newly described P. (Weisia) kasarani sp. n. A key to the Afrotropical Phytodietus species of the subgenus Weisia Schmiedeknecht, 1907 is provided.


Assuntos
Himenópteros , Animais , Quênia
3.
Environ Monit Assess ; 192(10): 668, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33005999

RESUMO

Watershed morphometric assessment is about measurements and calculations of land surface forms for the purpose of understanding hydro-geomorphological character and patterns. Important natural environment geo-information and summary of the spatial characteristics of Tana River Basin (TRB) in Kenya have been obtained through hydro-geomorphometric analysis. Advanced Spaceborne Thermal Emission and Reflection Radiometer Digital Elevation Model (ASTERDEM) data and ArcGIS (ESRI Inc., version 10.4.1) together with published mathematical equations were applied to extract morphometric parameters of the drainage basin, which covers a total area of 94,930 km2 and a span of 527.75 km. The quantitative morphometric analysis considered a total of 28 relief, areal, and linear hydro-morphometric characteristics of the TRB. Relief parameters of the basin suggest moderate-to-low overall watershed steepness, upland with rolling land surface patterns, rugged landforms susceptible to erosion and sediment transportation, and a landscape in evolution process tending towards maturity. This means stability of the land surface can be attained with intensive land degradation reversing strategies like erosion control measures. Areal characteristics further support the basin's susceptibility to erosion as shown by stream length, stream drainage density, and circulatory ratio values. Also, the areal aspects portray peak runoffs with short duration flashes. Linear parameter value results such as bifurcation ratio imply that infiltration capacity varies with stream orders across the watershed. This hydro-geomorphometric analysis would be useful to land and water managers, researchers and practitioners of TRB, and other similar systems in designing and planning soil and water conservation and management practices such as soil erosion control, groundwater recharge activities, catchment modelling, runoff and flood studies, prospecting groundwater mapping, and biological applications.


Assuntos
Monitoramento Ambiental , Sistemas de Informação Geográfica , Quênia , Rios , Solo
4.
Environ Monit Assess ; 192(11): 692, 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33037524

RESUMO

Residue levels of seven commonly used pesticides were determined in random samples of tomatoes, French beans, and kale collected from horticultural farms in Buuri, Imenti North, and Imenti South sub-counties in Meru, Kenya, just before delivery to the consumers. QuEChERS method for extraction followed by LC-MS/MS was used to determine the concentrations. The concentrations (µg kg-1 wet weight) in French beans, kale, and tomatoes ranged from below detection limit (BDL): BDL-48.65 (carbendazim), BDL-290.76 (imidacloprid), BDL-2.81 (acetamiprid), BDL-25.76 (azoxystrobin), BDL-105.18 (metalaxyl), BDL-0.15 (diazinon), and BDL-0.17(chlorpyrifos). The maximum residue levels determined in the horticultural produce from the three regions were 290 µg kg-1 for imidacloprid in tomatoes from Buuri and 25.76 µg kg-1for azoxystrobin in French beans from Imenti South. The pesticide residue levels generally were extremely low and met the MRLs set by EU and other countries, except for carbendazim and metalaxyl in French beans, and posed no concern to human health. The estimated daily intakes (EDI) (mg kg-1 BW/day) for the population of Meru County were very low ranging from 1.685 × 10-8 (acetamiprid) to 2.381 × 10-5 (imidacloprid) in tomatoes, 2.849 × 10-9 (metalaxyl) to 3.633 × 10-7 (azoxystrobin) in French beans, and 1.392 × 10-8 (diazinon) in kale, respectively. The health risk indices were subsequently extremely low for the detectable pesticide residues, ranging from 6.74 × 10-7 (acetamiprid) to 3.97 × 10-4 (imidacloprid) in tomatoes, 3.56 × 10-8 (metalaxyl) to 5.52 × 10-5 (chlorpyrifos) in French beans, and 6.96 × 10-5 (diazinon) in kale, respectively, indicating no health risk in the population, but their presence in these vegetables cannot be ignored as long-term exposure can still cause health risks.


Assuntos
Brassica , Lycopersicon esculentum , Resíduos de Praguicidas , Praguicidas , Cromatografia Líquida , Monitoramento Ambiental , Contaminação de Alimentos/análise , Humanos , Quênia , Resíduos de Praguicidas/análise , Praguicidas/análise , Espectrometria de Massas em Tandem
5.
BMC Med ; 18(1): 316, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33012285

RESUMO

BACKGROUND: Many low- and middle-income countries have implemented control measures against coronavirus disease 2019 (COVID-19). However, it is not clear to what extent these measures explain the low numbers of recorded COVID-19 cases and deaths in Africa. One of the main aims of control measures is to reduce respiratory pathogen transmission through direct contact with others. In this study, we collect contact data from residents of informal settlements around Nairobi, Kenya, to assess if control measures have changed contact patterns, and estimate the impact of changes on the basic reproduction number (R0). METHODS: We conducted a social contact survey with 213 residents of five informal settlements around Nairobi in early May 2020, 4 weeks after the Kenyan government introduced enhanced physical distancing measures and a curfew between 7 pm and 5 am. Respondents were asked to report all direct physical and non-physical contacts made the previous day, alongside a questionnaire asking about the social and economic impact of COVID-19 and control measures. We examined contact patterns by demographic factors, including socioeconomic status. We described the impact of COVID-19 and control measures on income and food security. We compared contact patterns during control measures to patterns from non-pandemic periods to estimate the change in R0. RESULTS: We estimate that control measures reduced physical contacts by 62% and non-physical contacts by either 63% or 67%, depending on the pre-COVID-19 comparison matrix used. Masks were worn by at least one person in 92% of contacts. Respondents in the poorest socioeconomic quintile reported 1.5 times more contacts than those in the richest. Eighty-six percent of respondents reported a total or partial loss of income due to COVID-19, and 74% reported eating less or skipping meals due to having too little money for food. CONCLUSION: COVID-19 control measures have had a large impact on direct contacts and therefore transmission, but have also caused considerable economic and food insecurity. Reductions in R0 are consistent with the comparatively low epidemic growth in Kenya and other sub-Saharan African countries that implemented similar, early control measures. However, negative and inequitable impacts on economic and food security may mean control measures are not sustainable in the longer term.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Relações Interpessoais , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/estatística & dados numéricos , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Quênia/epidemiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pobreza/estatística & dados numéricos , Isolamento Social , Fatores Socioeconômicos , Inquéritos e Questionários
6.
Zootaxa ; 4852(5): zootaxa.4852.5.9, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-33056401

RESUMO

The ichneumonid parasitoid wasps of the subfamily Rhyssinae are distributed worldwide with the highest species richness focused in the Oriental region (Yu et al. 2016). The total number of species in the subfamily exceeds 450 species. Nevertheless, the Afrotropical region remains poorly studied, numbering only 13 known species, almost a half of which were described recently (Rousse and van Noort 2014; Hopkins et al. 2019). The majority of the Afrotropical rhyssines belong to the genus Epirhyssa Cresson, 1865. The species of the genus are mostly known from the humid part of Equatorial Africa: Cameroon, Democratic Republic of Congo and Uganda. Since 2011 an extensive Malaise trap collecting programme has been conducted throughout Kenya by Robert Copeland and coordinated by the International Centre of Insect Physiology and Ecology in Nairobi. The present paper provides one of first results from the programme: a description of a new Epirhyssa species from Kenya and, thus expanding the distribution of the genus in Equatorial part of the Afrotropical region eastward (Fig. 1).


Assuntos
Vespas , Animais , Quênia
7.
Hum Resour Health ; 18(1): 75, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028347

RESUMO

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidado do Lactente/organização & administração , Serviços de Saúde Materna/organização & administração , Tocologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Betacoronavirus , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Quênia/epidemiologia , Pandemias , Gravidez
9.
J UOEH ; 42(3): 237-249, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32879188

RESUMO

Access to water and sanitation remain a challenge in many developing countries, especially in pro-poor urban informal settlements where socioeconomic livelihoods are generally low. The aim of this study was to characterise the water and sanitation facilities in the informal settlements of Kisumu City and to evaluate their effect on community hygiene and health. The study focussed on the five urban informal settlements of Nyalenda A, Nyalenda B, Manyatta A, Manyatta B and Obunga, and the three Peri-urban informal settlements of Kogony, Usoma and Otonglo. Using descriptive techniques, the researcher surveyed 114 water sources and all sanitation facilities within 0-15 m and 15-30 m radii of the water sources. The findings revealed dominance of shallow wells and traditional pit latrines as the primary water sources and sanitation facilities, respectively. Out of the water sources studied, 87.7% (100) were shallow wells (mean depth 1.5 m), 9.6% (11) springs and 2.6% (3) boreholes. Most of these shallow wells (83%) were within the urban informal settlements where uses range from washing and cleaning, cooking, and even drinking (13.5%), despite the majority being unprotected. The analysis of the density of sanitation facilities near the water points showed that 32.3% existed within a 15 m radius of the nearest water sources, in violation of the recommended safe distance of 30 m. With an increased density of toilets near critical water sources and other sanitary practices, public health is highly compromised.


Assuntos
Planejamento em Saúde , Pobreza , Saneamento , Classe Social , Toaletes , Saúde da População Urbana , Abastecimento de Água , Humanos , Quênia
10.
Proc Biol Sci ; 287(1934): 20201013, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32900310

RESUMO

Across group-living animals, linear dominance hierarchies lead to disparities in access to resources, health outcomes and reproductive performance. Studies of how dominance rank predicts these traits typically employ one of several dominance rank metrics without examining the assumptions each metric makes about its underlying competitive processes. Here, we compare the ability of two dominance rank metrics-simple ordinal rank and proportional or 'standardized' rank-to predict 20 traits in a wild baboon population in Amboseli, Kenya. We propose that simple ordinal rank best predicts traits when competition is density-dependent, whereas proportional rank best predicts traits when competition is density-independent. We found that for 75% of traits (15/20), one rank metric performed better than the other. Strikingly, all male traits were best predicted by simple ordinal rank, whereas female traits were evenly split between proportional and simple ordinal rank. Hence, male and female traits are shaped by different competitive processes: males are largely driven by density-dependent resource access (e.g. access to oestrous females), whereas females are shaped by both density-independent (e.g. distributed food resources) and density-dependent resource access. This method of comparing how different rank metrics predict traits can be used to distinguish between different competitive processes operating in animal societies.


Assuntos
Papio/fisiologia , Comportamento Social , Predomínio Social , Animais , Feminino , Quênia , Masculino
11.
Artigo em Inglês | MEDLINE | ID: mdl-32992966

RESUMO

In Kenya, millions of children have limited access to nurturing care. With the Coronavirus disease 2019 (COVID-19) pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems; economic protection; social and child protection; and child development and early learning. The review proposes program and policy strategies to guide the reorientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children's ecology to provide nurturing care is needed, as is further testing of new ideas.


Assuntos
Desenvolvimento Infantil , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Criança , Cuidado da Criança , Pré-Escolar , Humanos , Quênia , Pandemias , Políticas
12.
PLoS One ; 15(8): e0228366, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866142

RESUMO

The role of questing ticks in the epidemiology of tick-borne diseases in Kenya's Maasai Mara National Reserve (MMNR), an ecosystem with intensified human-wildlife-livestock interactions, remains poorly understood. We surveyed the diversity of questing ticks, their blood-meal hosts, and tick-borne pathogens to understand potential effects on human and livestock health. By flagging and hand-picking from vegetation in 25 localities, we collected 1,465 host-seeking ticks, mostly Rhipicephalus and Amblyomma species identified by morphology and molecular analysis. We used PCR with high-resolution melting (HRM) analysis and sequencing to identify Anaplasma, Babesia, Coxiella, Ehrlichia, Rickettsia, and Theileria pathogens and blood-meal remnants in 231 tick pools. We detected blood-meals from humans, wildebeest, and African buffalo in Rh. appendiculatus, goat in Rh. evertsi, sheep in Am. gemma, and cattle in Am. variegatum. Rickettsia africae was detected in Am. gemma (MIR = 3.10) that had fed on sheep and in Am. variegatum (MIR = 250) that had fed on cattle. We found Rickettsia spp. in Am. gemma (MIR = 9.29) and Rh. evertsi (MIR = 200), Anaplasma ovis in Rh. appendiculatus (MIR = 0.89) and Rh. evertsi (MIR = 200), Anaplasma bovis in Rh. appendiculatus (MIR = 0.89), and Theileria parva in Rh. appendiculatus (MIR = 24). No Babesia, Ehrlichia, or Coxiella pathogens were detected. Unexpectedly, species-specific Coxiella sp. endosymbionts were detected in all tick genera (174/231 pools), which may affect tick physiology and vector competence. These findings show that ticks from the MMNR are infected with zoonotic R. africae and unclassified Rickettsia spp., demonstrating risk of African tick-bite fever and other spotted-fever group rickettsioses to locals and visitors. The protozoan pathogens identified may also pose risk to livestock production. The diverse vertebrate blood-meals of questing ticks in this ecosystem including humans, wildlife, and domestic animals, may amplify transmission of tick-borne zoonoses and livestock diseases.


Assuntos
Infestações por Carrapato/epidemiologia , Doenças Transmitidas por Carrapatos/epidemiologia , Carrapatos/patogenicidade , Animais , Animais Selvagens , Babesia , Bovinos , Doenças dos Bovinos/microbiologia , Coxiella , Ecossistema , Ehrlichia , Humanos , Ixodidae/microbiologia , Quênia/epidemiologia , Rhipicephalus , Rickettsia , Ovinos , Theileria , Infestações por Carrapato/veterinária , Doenças Transmitidas por Carrapatos/microbiologia , Carrapatos/parasitologia , Zoonoses
13.
PLoS One ; 15(8): e0237656, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866167

RESUMO

OBJECTIVE: Preterm birth is the primary driver of neonatal mortality worldwide, but it is defined by gestational age (GA) which is challenging to accurately assess in low-resource settings. In a commitment to reducing preterm birth while reinforcing and strengthening facility data sources, the East Africa Preterm Birth Initiative (PTBi-EA) chose eligibility criteria that combined GA and birth weight. This analysis evaluated the quality of the GA data as recorded in maternity registers in PTBi-EA study facilities and the strength of the PTBi-EA eligibility criteria. METHODS: We conducted a retrospective analysis of maternity register data from March-September 2016. GA data from 23 study facilities in Migori, Kenya and the Busoga Region of Uganda were evaluated for completeness (variable present), consistency (recorded versus calculated GA), and plausibility (falling within the 3rd and 97th birth weight percentiles for GA of the INTERGROWTH-21st Newborn Birth Weight Standards). Preterm birth rates were calculated using: 1) recorded GA <37 weeks, 2) recorded GA <37 weeks, excluding implausible GAs, 3) birth weight <2500g, and 4) PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks. RESULTS: In both countries, GA was the least recorded variable in the maternity register (77.6%). Recorded and calculated GA (Kenya only) were consistent in 29.5% of births. Implausible GAs accounted for 11.7% of births. The four preterm birth rates were 1) 14.5%, 2) 10.6%, 3) 9.6%, 4) 13.4%. CONCLUSIONS: Maternity register GA data presented quality concerns in PTBi-EA study sites. The PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks accommodated these concerns by using both birth weight and GA, balancing issues of accuracy and completeness with practical applicability.


Assuntos
Coleta de Dados/normas , Idade Gestacional , Serviços de Saúde Materna/organização & administração , Nascimento Prematuro/epidemiologia , Sistema de Registros/estatística & dados numéricos , Peso ao Nascer , Coleta de Dados/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Quênia/epidemiologia , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Nascimento Prematuro/prevenção & controle , Melhoria de Qualidade , Sistema de Registros/normas , Reprodutibilidade dos Testes , Estudos Retrospectivos , Uganda/epidemiologia
14.
BMC Infect Dis ; 20(1): 703, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32977759

RESUMO

BACKGROUND: Treatment of gonorrhea is complicated by the development of antimicrobial resistance in Neisseria gonorrhoeae (GC) to the antibiotics recommended for treatment. Knowledge on types of plasmids and the antibiotic resistance genes they harbor is useful in monitoring the emergence and spread of bacterial antibiotic resistance. In Kenya, studies on gonococcal antimicrobial resistance are few and data on plasmid mediated drug resistance is limited. The present study characterizes plasmid mediated resistance in N. gonorrhoeae isolates recovered from Kenya between 2013 and 2018. METHODS: DNA was extracted from 36 sub-cultured GC isolates exhibiting varying drug resistance profiles. Whole genome sequencing was done on Illumina MiSeq platform and reads assembled de-novo using CLC Genomics Workbench. Genome annotation was performed using Rapid Annotation Subsystem Technology. Comparisons in identified antimicrobial resistance determinants were done using Bioedit sequence alignment editor. RESULTS: Twenty-four (66.7%) isolates had both ß-lactamase (TEM) and TetM encoding plasmids. 8.3% of the isolates lacked both TEM and TetM plasmids and had intermediate to susceptible penicillin and tetracycline MICs. Twenty-six (72%) isolates harbored TEM encoding plasmids. 25 of the TEM plasmids were of African type while one was an Asian type. Of the 36 isolates, 31 (86.1%) had TetM encoding plasmids, 30 of which harbored American TetM, whereas 1 carried a Dutch TetM. All analyzed isolates had non-mosaic penA alleles. All the isolates expressing TetM were tetracycline resistant (MIC> 1 mg/L) and had increased doxycycline MICs (up to 96 mg/L). All the isolates had S10 ribosomal protein V57M amino acid substitution associated with tetracycline resistance. No relation was observed between PenB and MtrR alterations and penicillin and tetracycline MICs. CONCLUSION: High-level gonococcal penicillin and tetracycline resistance in the sampled Kenyan regions was found to be mediated by plasmid borne blaTEM and tetM genes. While the African TEM plasmid, TEM1 and American TetM are the dominant genotypes, Asian TEM plasmid, a new TEM239 and Dutch TetM have emerged in the regions.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/genética , Gonorreia/tratamento farmacológico , Gonorreia/epidemiologia , Neisseria gonorrhoeae/genética , Penicilinas/uso terapêutico , Plasmídeos/genética , Resistência a Tetraciclina/genética , Tetraciclina/uso terapêutico , DNA Bacteriano/genética , Feminino , Genótipo , Gonorreia/microbiologia , Humanos , Quênia/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae/isolamento & purificação , Sequenciamento Completo do Genoma , beta-Lactamases/genética
15.
Middle East Afr J Ophthalmol ; 27(2): 91-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874041

RESUMO

PURPOSE: This study compares a web-based teleophthalmology assessment with a clinical slit lamp examination to screen for diabetic retinopathy (DR) and age-related macular degeneration (AMD) among diabetic patients in a rural East African district. METHODS: Six hundred and twelve eyes from 306 diabetic patients underwent both a clinical slit lamp examination and a teleretina (TR) assessment by an experienced ophthalmologist. Both assessments were compared for any DR and AMD using the early treatment diabetic retinopathy study and age-related eye disease study grading scales, respectively. RESULTS: Of the 612 TR assessment photos, 74 (12%) were deemed ungradable due to media opacities, poor patient cooperation, or unsatisfactory photographs. The ability to detect DR and AMD showed a fair agreement (kappa statistic 0.27 and 0.23, respectively) between the TR and clinical slit lamp examination. Relative to a clinical slit lamp evaluation, a positive TR diagnosis carried a 75.0% positive predictive value when diagnosing DR and a 27.3% positive predictive value when diagnosing AMD. A negative TR diagnosis carried a 97.2% negative predictive value for the diagnosis of DR and a 98.1% negative predictive value for the diagnosis of AMD. CONCLUSION: When comparing TR assessments to clinical slit lamp examinations to diagnose DR and AMD, there was a fair agreement. Although further validation is needed, the TR approach provides a promising method to diagnose DR and AMD, two major causes of ocular impairment worldwide.


Assuntos
Retinopatia Diabética/diagnóstico , Degeneração Macular/diagnóstico , Oftalmologia/métodos , Exame Físico , Consulta Remota/métodos , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus , Feminino , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Microscopia com Lâmpada de Fenda
17.
Nature ; 585(7826): 579-583, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32939086

RESUMO

Malaria has had a major effect on the human genome, with many protective polymorphisms-such as the sickle-cell trait-having been selected to high frequencies in malaria-endemic regions1,2. The blood group variant Dantu provides 74% protection against all forms of severe malaria in homozygous individuals3-5, a similar degree of protection to that afforded by the sickle-cell trait and considerably greater than that offered by the best malaria vaccine. Until now, however, the protective mechanism has been unknown. Here we demonstrate the effect of Dantu on the ability of the merozoite form of the malaria parasite Plasmodium falciparum to invade red blood cells (RBCs). We find that Dantu is associated with extensive changes to the repertoire of proteins found on the RBC surface, but, unexpectedly, inhibition of invasion does not correlate with specific RBC-parasite receptor-ligand interactions. By following invasion using video microscopy, we find a strong link between RBC tension and merozoite invasion, and identify a tension threshold above which invasion rarely occurs, even in non-Dantu RBCs. Dantu RBCs have higher average tension than non-Dantu RBCs, meaning that a greater proportion resist invasion. These findings provide both an explanation for the protective effect of Dantu, and fresh insight into why the efficiency of P. falciparum invasion might vary across the heterogenous populations of RBCs found both within and between individuals.


Assuntos
Antígenos de Grupos Sanguíneos/genética , Eritrócitos/citologia , Eritrócitos/parasitologia , Malária Falciparum/patologia , Malária Falciparum/prevenção & controle , Plasmodium falciparum/metabolismo , Polimorfismo Genético , Antígenos de Grupos Sanguíneos/classificação , Antígenos de Grupos Sanguíneos/metabolismo , Criança , Eritrócitos/metabolismo , Eritrócitos/patologia , Feminino , Genótipo , Humanos , Quênia , Ligantes , Masculino , Merozoítos/metabolismo , Merozoítos/patogenicidade , Microscopia de Vídeo , Plasmodium falciparum/crescimento & desenvolvimento , Plasmodium falciparum/patogenicidade
18.
PLoS Negl Trop Dis ; 14(9): e0008499, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32936792

RESUMO

Since the prioritization of Lymphatic Filariasis (LF) elimination in 1997, progress has been made in reducing disease transmission and burden. Validation of elimination through Transmission Assessment Surveys (TAS) in implementation units (IUs) that have received at least 5 rounds of mass drug administration (MDA) and achieved minimum threshold of 65% treatment coverage is required. There are IUs that do not qualify for TAS due to achievement of low treatment coverage. This study sought to identify barriers of community participation and access to MDA, develop and test strategies to be recommended for improved uptake. Two wards in Kaloleni sub-county, Kilifi county with an average treatment coverage of 56% in 2015, 50.5% in 2016 were purposively sampled and a quasi-experimental study conducted. Through systematic random sampling, 350 (pre-intervention) and 338 (post-intervention) household heads were selected and interviewed for quantitative data. For qualitative data, 16 Focus Group Discussions (FGDs) with purposively selected community groups were conducted. Participatory meetings were held with county stakeholders to agree on strategies for improved community participation in MDA. The quantitative data were analyzed using STATA version 14.1, statistical significance assessed by chi square test and qualitative data by QSR NVIVO version 10. The identified strategies were tested in experimental sites during the 2018 MDA and the usual MDA strategies applied in control sites. The results showed an increase in community participation and access to MDA in both sites 80.6% (pre-intervention), 82.9% (post-intervention). The proportion of participants who considered the treatment as necessary significantly (p = 0.001) increased to 96.2% from 88.3% and significantly dropped for those with drug swallowing problems associated with: size (p<0.001), number (p<0.027) and taste (p = 0.001). The implemented strategies may have contributed to increased participation and access to MDA and should be applied for improved treatment uptake. Health education on disease aetiology and importance of drug uptake in all rounds is key to program's success.


Assuntos
Participação da Comunidade/métodos , Filariose Linfática/tratamento farmacológico , Educação em Saúde , Administração Massiva de Medicamentos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição , Filariose Linfática/prevenção & controle , Características da Família , Feminino , Filaricidas/uso terapêutico , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia , Masculino , Pessoa de Meia-Idade
19.
Proc Natl Acad Sci U S A ; 117(37): 23174-23181, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32868437

RESUMO

Schistosomiasis is among the most common parasitic diseases in the world, with over 142 million people infected in low- and middle-income countries. Measuring population-level transmission is centrally important in guiding schistosomiasis control programs. Traditionally, human Schistosoma mansoni infections have been detected using stool microscopy, which is logistically difficult at program scale and has low sensitivity when people have low infection burdens. We compared serological measures of transmission based on antibody response to S. mansoni soluble egg antigen (SEA) with stool-based measures of infection among 3,663 preschool-age children in an area endemic for S. mansoni in western Kenya. We estimated force of infection among children using the seroconversion rate and examined how it varied geographically and by age. At the community level, serological measures of transmission aligned with stool-based measures of infection (ρ = 0.94), and serological measures provided more resolution for between-community differences at lower levels of infection. Force of infection showed a clear gradient of transmission with distance from Lake Victoria, with 94% of infections and 93% of seropositive children in communities <1.5 km from the lake. Force of infection increased through age 3 y, by which time 65% (95% CI: 53%, 75%) of children were SEA positive in high-transmission communities-2 y before they would be reached by school-based deworming programs. Our results show that serologic surveillance platforms represent an important opportunity to guide and monitor schistosomiasis control programs, and that in high-transmission settings preschool-age children represent a key population missed by school-based deworming programs.


Assuntos
Formação de Anticorpos/imunologia , Schistosoma mansoni/imunologia , Esquistossomose mansoni/imunologia , Esquistossomose/imunologia , Animais , Pré-Escolar , Fezes/parasitologia , Feminino , Humanos , Lactente , Quênia , Masculino , Prevalência , Esquistossomose/parasitologia , Esquistossomose mansoni/parasitologia
20.
Matern Child Health J ; 24(9): 1170-1178, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32754861

RESUMO

INTRODUCTION: Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in Kenya, where illicit drug use is on the rise. In this paper, we report factors influencing women's decisions to use drugs during pregnancy. METHODS: In 2015, we conducted in-depth interviews and focus group discussions with 45 women who inject drugs and five key stakeholders involved in provision of services to people who use drugs in coastal Kenya. Inductive thematic analysis was conducted to draw out themes related to key determinants of drug use during pregnancy. RESULTS: Four key themes emerged outlining determinants of drug use during pregnancy: (i) the use of drugs to cope with the stress of unexpected pregnancy, (ii) the continued drug use during pregnancy to manage withdrawal, (iii) the dual effect of pregnancy on drug use either as a facilitator or as a moderator of drug use, and (iv) the role of male intimate partner in influencing women's drug use during pregnancy. CONCLUSION: Our paper reports women's drug use during pregnancy and the factors influencing this phenomenon. To safeguard the health and well-being of pregnant women and their unborn children, there is a need for education and awareness raising, implementing couple-based harm reduction approaches to leverage on positive male influences, improving availability of drug treatment, and provision of family planning interventions for women who use drugs.


Assuntos
Gestantes/psicologia , Parceiros Sexuais/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Feminino , Grupos Focais , Redução do Dano , Humanos , Relações Interpessoais , Entrevistas como Assunto , Quênia , Pessoa de Meia-Idade , Gravidez , Gestantes/etnologia , Pesquisa Qualitativa , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
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