RESUMEN
The importance of household socio-economic position (SEP) in shaping individual infectious disease risk is increasingly recognised, particularly in low income settings. However, few studies have measured the extent to which this association is consistent for the range of pathogens that are typically endemic among the rural poor in the tropics. This cross-sectional study assessed the relationship between SEP and human infection within a single community in western Kenya using a set of pathogens with diverse transmission routes. The relationships between household SEP and individual infection with Plasmodium falciparum, hookworm (Ancylostoma duodenale and/or Necator americanus), Entamoeba histolytica/dispar, Mycobacterium tuberculosis, and HIV, and co-infections between hookworm, P. falciparum and E. histolytica/dispar, were assessed using multivariable logistic and multinomial regression. Individuals in households with the lowest SEP were at greatest risk of infection with P. falciparum, hookworm and E. histolytica/dispar, as well as co-infection with each pathogen. Infection with M. tuberculosis, by contrast, was most likely in individuals living in households with the highest SEP. There was no evidence of a relationship between individual HIV infection and household SEP. We demonstrate the existence of a household socio-economic gradient within a rural farming community in Kenya which impacts upon individual infectious disease risk. Structural adjustments that seek to reduce poverty, and therefore the socio-economic inequalities that exist in this community, would be expected to substantially reduce overall infectious disease burden. However, policy makers and researchers should be aware that heterogeneous relationships can exist between household SEP and infection risk for different pathogens in low income settings.
Asunto(s)
Enfermedades Transmisibles/epidemiología , Factores Socioeconómicos , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Entamebiasis/epidemiología , Composición Familiar , Femenino , Infecciones por VIH/epidemiología , Infecciones por Uncinaria/epidemiología , Humanos , Kenia/epidemiología , Malaria Falciparum/epidemiología , Masculino , Persona de Mediana Edad , Pobreza , Factores de Riesgo , Población Rural , Tuberculosis/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the treatment suggested to sexually transmitted infections (STI) self-medicating patients in retail pharmacies. DESIGN: A descriptive cross-sectional survey. SETTING: Kibera slum, Nairobi City, Kenya. SUBJECTS: Staff of 50 convenient randomly selected retail pharmacies. RESULTS: The majority (97%) of the pharmacy staff who attended to self-medicating patients asked questions. Most of these questions centered around the onset of the stated symptoms, the health of the partner, patient's current health status and previous medications taken. Of the 99 staff evaluated, 60% correctly diagnosed gonorrhoea and 82% correctly diagnosed genital ulcer disease (GUD). Only nine out of fifty (18%) offered the recommended treatment for gonorrhoea and only one individual offered recommended treatment for GUD. The most commonly offered treatment for gonorrhoea and GUD was metronidazole and penicillin, respectively. Overall, only 10% correctly diagnosed both conditions and offered appropriate treatment. The staff also counselled patients on a wide range of issues including condom use, abstinence and being faithful, contact treatment, seeking prompt treatment and completing treatment. CONCLUSION: With only about 10% offering appropriate government recommended treatment for gonorrhoea and GUD, these pharmacy staff working in retail pharmacies in Kibera slum put slum dwellers seeking care at an increased risk of STI related morbidity and transmission due to inappropriate or inadequate treatment. RECOMMENDATION: To improve management of these conditions, in-service training and enforcement of the relevant legislation and policy is needed.
Asunto(s)
Servicios Comunitarios de Farmacia , Conocimientos, Actitudes y Práctica en Salud , Simulación de Paciente , Automedicación , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Estudios Transversales , Humanos , Kenia/epidemiología , Áreas de Pobreza , Factores de Riesgo , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/microbiología , Encuestas y CuestionariosRESUMEN
Background: Cyclosporiasis is an emerging gastro-enteric disease caused by the coccidia protozoan Cyclospora cayetanensis. It isassociated with diarrhoea among children in developing countries; in the Americas where C. cayetanensis is endemic; traveller's diarrhoea and/or food and waterborne outbreaks in the developed countries. Objectives: The aim of this review is to highlight cyclosporiasis and its relevance to public health in East Africa and Africa at large. Methods: All literature on Cyclospora; C. cayetanensis; cyclosporiasis in Africa; and endemic cyclosporiasis was searched from libraries;colleagues and internet but only literature on its history; clinical presentation; epidemiology in endemic settings; and occurrence inAfrica were scrutinised. Results: In Sub Saharan Africa; cyclosporiasis has been reported in at least 3 countries; including Tanzania; in East Africa; occurring inboth immunocompromised and immunocompetent patients. Zoonotic species of Cyclospora have also been identified in East African primates; indicating likely endemicity of this little reported disease in the region. This can be attributed to lack of awareness in thepublic and medical profession concerning the disease; and therefore not routinely checked at the health centres. Cyclosporiasis ischaracterized by intermittent diarrhoea; and secondary conditions or sequelae such as reactive arthritis syndrome (Reiter's syndrome); have been associated with progression of the disease. Its management is based on antibiotics; an unusual scenario for a protozoa. Conclusions: Although many aspects of this disease and its transmission remain an enigma; the situation has been rapidly changing since the disease first came to medical attention in the 1970s
Asunto(s)
Cyclospora , Ciclosporiasis , Salud PúblicaRESUMEN
OBJECTIVE: To determine the significance of Pneumocystis jirovecii infection in the Kenyan paediatric population. DESIGN: Sixty samples of induced sputum from children aged < or =23 months, half of whom were human immunodeficiency virus (HIV) positive, admitted with severe pneumonia in Nairobi were subjected to immunofluorescent staining for detection of P. jirovecii and microbiological culture. RESULTS: P. jirovecii was detected in 8/60 (13%) as a copathogen with other respiratory pathogens. Five of eight samples with >5 oocysts were from HIV-positive children aged < or =6 months, while equivocally scored samples (< or =5 oocysts) were from HIV-negative children aged >6 months. Klebsiella pneumoniae was significantly recovered in 26/ 60 (43%), followed by Escherichia coli 11/60 (18%) and Staphylococcus aureus 8/60 (13%). Streptococcus pneumoniae, Haemophilus influenzae and Pseudomonas aeruginosa were isolated infrequently. Candida albicans was recovered from 27/60 (45%), while the frequency of C. tropicalis, C. glabrata and C. parapsilosis was 7%, 5% and 3% respectively. Multidrug resistance among E. coli and K. pneumoniae were: sulphamethoxazoletrimethoprim 100% vs. 69%, chloramphenicol 55% vs. 73% and ampicillin 100% vs. 89%. CONCLUSION: Paediatricians in Kenya should be aware of Pneumocystis pneumonia, irrespective of the patient's HIV status.
Asunto(s)
Pneumocystis carinii/aislamiento & purificación , Neumonía por Pneumocystis/microbiología , Población Urbana , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Preescolar , Humanos , Incidencia , Lactante , Kenia/epidemiología , Neumonía por Pneumocystis/epidemiología , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
We conducted a prospective; cross-sectional study to examine and compare treatment coverage of lymphatic filariasis by the health system (HST) and a health system implemented; community-directed treatment for the control of lymphatic filariasis (ComDT/HS) in 44 randomly selected villages in coastal Kenya. Demographic information on the villages and peripheral health facilities to guide design and implementation was obtained from a situation analysis phase of this study. A series of interactive training sessions on basic biology of lymphatic filariasis; concept and philosophy of ComDT/HS were given to members of the District Health Management Team (DHMT); peripheral health staff; community leaders and community drug distributors (CDDs) prior to ivermectin distribution. An intensive sensitization process of the community by the trained peripheral health staff and community leaders followed before selection of the CDDs. Quantitative and qualitative data for evaluation of the study were collected by coverage surveys of randomly selected households; focus group discussions and interviews; immediately after the drug distribution. Treatment coverage of all eligible persons was 46.5 and 88in HST and ComDT/HS villages; respectively; P 0.001. In comparing treatment coverage by the two study arms in relationship to the distance from a health facility; coverage among HST and not ComDT/HS villages was influenced by distance. In Kenya; ComDT/HS can effectively be implemented by the regular health system and can attain coverage levels compatible with the global filariasis elimination goal
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Servicios de Salud Comunitaria , Elefantiasis , Programas Nacionales de Salud , OncocercosisRESUMEN
We compared serotypes, drug susceptibility and presence of virulence-related genes in diarrhoeagenic Escherichia coli isolates from children < 5 years from Kenya (n = 82) and Japan (n = 47). Multiplex PCR was used to detect genes coding for enteroaggregative adherence (aggR), heat-stable toxin (st), heat-labile toxin (It), verotoxin (vt), attaching and effacing mechanism (eaeA), enteroaggregative E. coli heat-stable enterotoxin 1 (astA) and enteroinvasive mechanism (invE). Kenyan E. coli O-serotypes were more diverse than those from Japan (29 vs. 12 serotypes) and exhibited high level multidrug resistance to World Health Organization (WHO) recommended antibiotics. Resistance rates to tetracycline, ampicillin and sulphamethoxazole-trimethoprim were 70.7, 65.9 and 68.3% respectively, but resistance to sulphamethoxazole-trimethoprim among the E. coli isolates from Japan was low (21%). Kenyan isolates harboured virulence-related genes in high frequency (82.9%) compared to those from Japan (25.5%) with aggR and astA being the most frequently detected genes. The presence of multiple virulence genes was associated with multidrug resistance and this merits further investigation.