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Papers by mark obonyo

Research paper thumbnail of Campylobacter positivity and public health risks in live bird markets in Busia, Kenya: A value chain analysis

Transboundary and Emerging Diseases, 2022

Live bird markets (LBMs) provide integral hubs for 95% of poultry produced for food. Surveillance... more Live bird markets (LBMs) provide integral hubs for 95% of poultry produced for food. Surveillance systems in LBMs serving smallholder farmers in sub-saharan Africa are often non-functional, and data about public health risks and emerging pathogens are lacking. Studies in Kenya have reported 29-44% Campylobacter prevalence in poultry. We analysed such LBMs in Kenya for likely transmission of Campylobacter from poultry to humans. We conducted a cross-sectional survey among 186 live poultry traders (LPTs) in 14 LBMs in a region with widespread backyard poultry systems. A pretested structured questionnaire was administered to all LPTs having regular contacts with poultry to gather market data and risk information on campylobacteriosis. Campylobacter was detected in individual cloacal cultures and identified through PCR. The median score obtained from the outcome of risk assessment dichotomized respondents into high and low risk categories. We performed logistic regression at 95% confidence interval (CI) to compare market characteristics and Campylobacter positivity to risk categories to identify LBM-associated public health risks. Markets had a median of 13 traders, and mean age of 46.3 ± 13.7 years. Majority 162/186 (87.1%) were males. Market behavioural processes by LPTs varied: Only 58.6% LPTs held bird species separate; onsite slaughter (38.7%); encountered sick-bird (93%) and dead-bird (83%) amidst limited health inspection (31.2%). Campylobacter positivity in live birds was 43/112 (38.4%, 95% CI: 29.4-48.1). Risk information on campylobacteriosis was low 41/114 (36%, 95% CI: 27.2-45.5). Sanitary risks were related to accumulation of litter (adjusted prevalence odds ratio [aPOR]: 19.67, 95% CI: 3.01-128.52). Accessing hand-wash facilities (aPOR: .32, 95% CI: .13-.78) and access to information (aPOR: .24, 95% CI: .09-.61) were protective. Sanitary risks were related to poor hygiene. LBMs could be central surveillance sites for Campylobacter. Public health authorities/actors should consider appropriate targeting to improve sanitary measures and Campylobacter control strategies. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Research paper thumbnail of Cholera Community Knowledge, Attitudes, and Practices Questionnaire

Research paper thumbnail of Additional file 1: of Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011â 2016

Kenya animal bites dataset. (XLSX 1570 kb)

Research paper thumbnail of Investigation of anthrax in an endemic region in Kenya: a mixed methods approach

Pan African Medical Journal, 2018

In Kenya, human anthrax cases most often occur linked to animal anthrax. In most cases, human beh... more In Kenya, human anthrax cases most often occur linked to animal anthrax. In most cases, human behaviors, especially slaughter and consumption of meat from animal anthrax cases, has been implicated. This case study is based on an anthrax outbreak investigation conducted in an endemic region in Kenya in May 2016.The case study simulates how a mixed methods approach can be used in epidemiologic research.To fully benefit from this case study, participants should have had prior lectures or other instruction in quantitative and qualitative study designs and sampling approachesused in epidemiologic research. The case study is ideally suited for trainees at intermediate or advance level training in field epidemiology who should be able to complete the case study in approximately 3 hours.

Research paper thumbnail of Sero-Prevalence and Factors Associated with Brucellosis in Goats and Sheep and Assessment of Pastoralists, Knowledge Attitude and Practices Towards Brucellosis in Garissa County

Research paper thumbnail of Prevalence of diabetes and co-morbidities in five rural and semi-urban Kenyan counties, 2010–2015

International Journal of Diabetes in Developing Countries, 2017

Globally, >80% of diabetes-related deaths occur in low-and middle-income countries. In 2014, the ... more Globally, >80% of diabetes-related deaths occur in low-and middle-income countries. In 2014, the International Diabetes Federation ranked Kenya 31st in Africa in terms of diabetes with an estimated prevalence of 460 cases per 10,000 population. This study characterizes the prevalence and associated co-morbidities of diabetes in five rural and semi-urban counties in Kenya. We conducted a descriptive cross-sectional review of diabetes registry data in five selected rural and semi-urban hospitals between 2010 and 2015. Patients with clinical or laboratory diagnosis of diabetes were included in the study. Demographic and epidemiologic data were abstracted, entered into MS-Excel 2007, and descriptive and correlation statistics were calculated using Epi-Info 7. We identified 1548 cases (59% female) across the 5 sites, with a mean age of 58 ± 13.5 years. We calculated diabetes prevalence measures of 310, 30, 20, and 4 per 10,000 in Isiolo, Othaya, Mukurweini, Thika, and Meru, respectively. Type 2 diabetes comprised 98% of cases from Othaya and Mukurweini, 96% from both Isiolo and Meru counties, and 94% from Thika. The most common co-morbidity was hypertension, with 80% affected from Othaya and Mukurweini, 52% in Thika, and 34% in Isiolo County. The correlation between age, gender, and presence of a comorbidity and diabetes varied across counties. Diabetes and its complications are prevalent in rural and semi-urban areas of Kenya and women seem to be more affected by the disease, indicating an increasing population who are at risk for type 2 diabetes and associated complications.

Research paper thumbnail of “We are doctors”: Drivers of animal health practices among Maasai pastoralists and implications for antimicrobial use and antimicrobial resistance

Preventive Veterinary Medicine, 2021

Animal health service providers can play an important role in limiting drug resistance by promoti... more Animal health service providers can play an important role in limiting drug resistance by promoting responsible and prudent use of veterinary drugs. Recognizing this potential, international agencies and governments have called for these providers to receive drug stewardship training, particularly providers in low- and middle-income countries where top-down regulations (e.g., national regulation of veterinary prescriptions) are largely unfeasible. The success of these stewardship trainings to promote responsible and prudent use will depend on many factors, including understanding how livestock-keeping communities currently interact with animal health service providers. Here, we use a mixed methods approach to identify and understand animal health seeking practices among Maasai pastoralists in Tanzania. Combining qualitative interviews (N = 31) and structured surveys (N = 195), we show the majority of Maasai respondents (≈80 %) do not frequently consult animal health service providers with most relying on advice from family and friends. Logistic regression models of health seeking practices find that increasing age, education, observance of treatment failure, and herd disease burdens are associated with greater odds of seeking out health services. Quantitative results were supported by data from focus group discussions and in-depth interviews that showed Maasai view animal health service providers as measures of last resort, whose input is largely sought after self-treatment with veterinary drugs fail. We argue patterns of animal health seeking among the Maasai are partially the consequence of their high confidence in their own abilities in livestock disease and treatment and generally low confidence in the skills of animal health service providers. We link this high sense of self-efficacy to the culturally engrained process by which Maasai develop mastery in animal health and how the roles and norms in Maasai culture surrounding animal health influence Maasai perceptions of animal health professionals. Our results highlight the need for more research to understand Maasai perceptions of animal health service providers as well as the knowledge, attitudes, and practices of these providers. Finally, our study emphasizes that the success of drug stewardship trainings will require efforts to first understand the cultural and historical contexts driving health seeking practices that impact perceptions of animal health service providers and animal health practices more generally.

Research paper thumbnail of Factors associated with cholera outbreaks, Nairobi County, July 2017: a case control study

BackgroundCholera affects 1.3-4 million people globally and causes 21000-143,000 deaths annually.... more BackgroundCholera affects 1.3-4 million people globally and causes 21000-143,000 deaths annually. Nairobi County in Kenya reported cholera cases since April 2017. We investigated to identify associated factors and institute control measures.MethodsWe reviewed the line-list of patients admitted at the Kenyatta National referral Hospital, Nairobi and performed descriptive epidemiology. We carried out a frequency-matched case control study, using facility-based cases and community controls. We defined a case as acute onset of watery diarrhoea of at least >3 stools/24hours with or without vomiting in person of any age, admitted in Kenyatta National Hospital as from July 1st, 2017. We calculated odds ratios and their respective 95% confidence intervals. We also took water samples at water reservoirs, distribution and consumer points, and made observation on hygiene and sanitation conditions in the community.ResultsWe reviewed 71 line-listed cases; median age 30 years (range 2-86 years...

Research paper thumbnail of Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011–2016

BMC Public Health, 2018

Background: Human animal-bite injuries are a serious public health problem due to associated risk... more Background: Human animal-bite injuries are a serious public health problem due to associated risk for rabies virus exposure. Animal-bite injuries especially dog bites are useful indicators for assessing the risk of rabies virus transmission and need for rabies post exposure prophylaxis (PEP). Understanding the epidemiology and surveillance of animal bites and rabies post-exposure prophylaxis is critical in implementing Kenya's national rabies elimination strategy. We aimed to describe the incidence of human animal-bite injuries, patient/biting animal characteristics, uptake of rabies PEP and factors associated with animal bite incidents. Methods: We reviewed animal bite records from outpatient and anti-rabies vaccine (ARV) registers of 17 health facilities from five counties. An animal bite was defined as an entry of an animal bite of the class mammal including humans in registers in a person of any age from January 2011 to December 2016. We collected demographic and information on PEP uptake. We calculated descriptive statistics, odds ratios (OR) and 95% confidence interval (CI) to examine factors associated with being an animal bite case-patient. We also calculated incidence of animal bites using health facility catchment population for year 2016 as the denominator. Results: We analyzed 7307 records. The median age was 22 years (IQR = 31 years); there were 4019 (55%) male and age < 15 years were 2607 (37%). Dogs accounted for 6720 (93%) of bites of which 78% were owned free-roaming dogs. Of the 5674 (88%) cases that received rabies PEP, 2247 (40%) got at least three-doses. The median time from bite to seeking medical care was 2 days (IQR = 4 days). Being bitten on the head/face (OR = 5.8; CI: 3.3-10.2); being bitten by owned free-roaming dog (OR = 1.7; CI: 1.5-1.9) and being male (OR = 1.4; CI: 1.3-1.5) were significantly associated with being an animal-bite case-patient. Being male, being bitten on head/face and being bitten by owned freeroaming dog remained independently associated with being an animal bite case-patient at multivariable logistic regression. Bite-incidence was 289 bites /100,000 persons among all counties. Conclusion: Preventing dog bites would most effectively reduce bite injuries by improving public health education among children below 15 years, encouraging early PEP initiation and completion, development and implementation of responsible dog ownership and animal behaviour educational programmes as well as improving human and veterinary health linkages.

Research paper thumbnail of An outbreak of cholera in western Kenya, 2015: a case control study

Pan African Medical Journal, 2017

Introduction: in February 2015, an outbreak of acute watery diarrhea was reported in two sub coun... more Introduction: in February 2015, an outbreak of acute watery diarrhea was reported in two sub counties in western Kenya. Vibrio cholerae 01 serotype Ogawa was isolated from 26 cases and from water samples collected from a river mainly used by residents of the two sub-counties for domestic purposes. We carried out an investigation to determine factors associated with the outbreak. Methods: we conducted a frequency matched case control study in the community. We defined cases as episodes of watery diarrhea (at least three motions in 24 hours) in persons ≥ 2 years who were residents of Rongo or Ndhiwa sub-counties from January 23-February 25, 2015. Cases were systematically recruited from a cholera line list and matched to two controls (persons without diarrhea since January 23, 2015) by age category and residence. A structured questionnaire was administered to evaluate exposures in cases and controls and multivariable logistic regression done to determine independent factors associated with the outbreak. Results: we recruited 52 cases and 104 controls. Females constituted 61% (95/156) of all participants. Overall latrine coverage was 58% (90/156). Latrine coverage was 44% (23/52) for cases and 64% (67/104) for controls. Having no latrine at home (aOR = 10.9; 95% CI: 3.02-39.21), practicing communal hand washing in a basin (aOR = 6.5; 95% CI: 2.30-18.11) and vending of food as an occupation (aOR = 3.4; 95% CI: 1.06-10.74) were independently associated with the outbreak. Conclusion: poor latrine coverage and personal hygiene practices were identified as the main drivers of the outbreak. We recommended improved public health education on latrine usage and promotion of hand washing with soap and water in the community.

Research paper thumbnail of Antimicrobial residues and compositional quality of informally marketed raw cow milk, Lamu West Sub-County, Kenya, 2015

Pan African Medical Journal, 2017

Introduction: unadulterated milk, free of antimicrobial residues is important for industrial proc... more Introduction: unadulterated milk, free of antimicrobial residues is important for industrial processing and consumers' health. Antimicrobial residues in foods of animal origin can cause adverse public health effects like drug resistance and hypersensitivity. Milk produced in Lamu West sub-county is sold raw directly to consumers. We estimated the compositional quality and prevalence of antimicrobial residues in informally marketed raw cow milk in Lamu West Sub-County, Kenya. Methods: we randomly recruited 152 vendors and 207 farmers from four randomly selected urban centers in a cross-sectional study and interviewed them using a pretested standardized questionnaire. A100-ml raw milk sample was aseptically collected from each vendor and farm and tested for antimicrobial residues using Charm Blue Yellow II kit following the European Union Maximum Residue Limits (EU-MRLs) while an Ekomilk® Analyzer was used to measure compositional quality where samples with either solid not fat (SNF) < 8.5 or added water ≥ 0.01% or both were considered adulterated. We analyzed data using univariate analysis and unconditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: thirty-two of the 207 (15.5%) samples from farmers and 28 (18.4%) of the 152 samples from vendors tested positive for antimicrobial residues. Thirty-six (17.4 %) samples from farmers and 38 (25.0%) from vendors were found to be adulterated with water. Farmers' awareness of the danger of consuming milk with antimicrobial residues and farmers having training on good milking practices were protective against selling milk with antimicrobial residues (adjusted OR and 95% CI 0.20, 0.07-0.55 and 0.33, 0.11-0.99, respectively). Conclusion: the antimicrobial residues above EU MRLs and adulteration of raw marketed cow milk observed in this study provide evidence for routine testing of marketed milk and educating farmers to observe antimicrobial withdrawal period.

Research paper thumbnail of of Livestock Development, the World Health Organization’s International Health

to rabies-endemic regions should avoid contact with wild and feral animals, even in seemingly saf... more to rabies-endemic regions should avoid contact with wild and feral animals, even in seemingly safe captive settings (2). Any mammal can be rabid, and infectious animals might appear healthy for several days before illness onset; avoiding all wild and feral animals while traveling is the ideal preventive measure. All animal bites and scratches should be washed thoroughly with soap and water and receive immediate medical attention (2). Acknowledgments We thank affected travelers for participating in this investigation and the safari lodge staff and travel agents for their assistance in reaching travelers. We are also grateful to the Kenya Central Veterinary Laboratory and to Michael Niezgoda, Ivan Kuzmin, and the staff of the CDC Rabies Program for laboratory support. Finally, we thank all collaborators at the Department for Disease Surveillance and Response and Field Epidemiology

Research paper thumbnail of Generalized Cowpox Virus Infection in a Patient with HIV , Germany , 2012

flab gene was targeted by using multiplex qPCR according to a previous described protocol (1). Fo... more flab gene was targeted by using multiplex qPCR according to a previous described protocol (1). For quality control of qPCRs, we included positive and negative controls. Sequences of qPCR products were analyzed and compared with sequences available in GenBank. B. miyamotoi was detected in 7 ticks: 2 (1.59%) of 126 males, 2 (0.68%) of 296 females, and 3 (6.52%) of 46 nymphs. A. phagocytophilum was detected in 16 ticks: 1 (0.79%) of 126 males, 11 (3.72%) of 296 females, and 4 (8.70%) of 46 nymphs. Candidatus N. mikurensis was detected in 25 ticks: 5 (3.97%) of 126 males, 18 (6.08%) of 296 females, and 2 (4.35%) of 46 nymphs. Overall prevalences were 1.50% for B. miyamotoi, 3.42% for A. phagocytophilum, and 5.34% for Candidatus N. mikurensis. Prevalences of each pathogen in specific varied by locality (Table). No co-infections were detected. We analyzed flab, msp2, and groEL gene sequences obtained by qPCR. These sequences showed 99%–100% identities with gene sequences of B. miyamotoi (...

Research paper thumbnail of Assessment of knowledge, attitudes and practices towards anthrax in Narok County, Southern Kenya

Introduction anthrax is endemic in some parts of Kenya causing mortalities in livestock and morbi... more Introduction anthrax is endemic in some parts of Kenya causing mortalities in livestock and morbidity in humans. On January 20th, 2018, news media reported suspected anthrax in a remote southern Kenyan village after villagers became ill following consumption of meat from a dead cow that was confirmed, by microscopy, to have died of anthrax. We assessed community knowledge, attitude and practices (KAP) to identify intervention gaps for anthrax prevention. Methods we conducted a KAP survey in randomly selected households (HHs) in villages from selected wards. Using multi-stage sampling approach, we administered structured questionnaire to persons aged ≥15 years to collect KAP information from February 11th-21st, 2018. From a set of questions for KAP, we scored participants’ response as “1” for a correct response and “0” for an incorrect response. Univariate analysis and Chi-square tests were performed to explore determinants of KAP. Concurrently, we gathered qualitative data using int...

Research paper thumbnail of Epidemiological characteristics and factors associated with Visceral Leishmaniasis in Marsabit County, Northern Kenya

Journal of Interventional Epidemiology and Public Health, 2019

INTRODUCTION: Visceral Leishmaniasis (VL) is endemic in 14 of the 47 counties in Kenya. An upsurg... more INTRODUCTION: Visceral Leishmaniasis (VL) is endemic in 14 of the 47 counties in Kenya. An upsurge of VL cases started in March 2017, the number of cases continued rising and by June 2017, 104 cases and 3 deaths had been reported. We conducted an investigation to describe the magnitude and pattern of the outbreak and to assess factors associated with VL infection among the cases. METHODS: We conducted a secondary data analysis of VL data from 1st January 2014 to 11th July 2017 obtained from Marsabit county referral hospital and Laisamis Mission Hospitals, with a VL case being defined as any entry with a clinical or laboratory diagnosis of VL. We also conducted a frequency matched case-control study among 76 case-patients and 152 controls. A confirmed case was a person with positive rK39 serology for VL from 1st April 2017 through 11th July 2017; whereas a control was a person within a defined age-category as a case, without signs/symptoms of VL since 1st January 2017, and negative o...

Research paper thumbnail of Cryptosporidium infection in calves and the environment in Asembo, Western Kenya: 2015

Pan African Medical Journal, 2017

Introduction: Cryptosporidium species, a zoonotic enteric coccidian parasite, is among the leadin... more Introduction: Cryptosporidium species, a zoonotic enteric coccidian parasite, is among the leading causes of diarrhea in children. We evaluated the prevalence of Cryptosporidium infections in calves, factors associated with calf infection, environmental contamination of manure by Cryptosporidium and factors that expose humans to zoonotic transmission in Asembo. Methods: in a cross-sectional study conducted from January to July 2015, we collected fecal specimens from 350 randomly selected calves aged ≤ 6 months old and 187 manure samples from the same farms. We assessed farmers' knowledge about Cryptosporidium and collected data on characteristics using structured questionnaires. Modified Ziehl Nielsen staining was used to detect Cryptosporidium oocysts from calves' stool and manure. The prevalence of infected calves and 95% confidence interval (CI) were calculated. Odds ratios (OR) and 95% (CI) were calculated to identify possible factors associated with Cryptosporidium infection; multivariable logistic regression performed to identify factors independently associated with the presence of Cryptosporidium. Results: calves' fecal Cryptosporidium prevalence was 8.3% (95% CI: 5.7-11.8) and 7.5% (95% CI: 4.2-12.2) in manure. Odds of infection was higher in calves with loose stool compared to those with normal stool (AOR = 6.1, 95% C.I: 2.2-16.9), calves ≤ 2 months old compared to older calves (AOR=12.7, 95% C.I: 4.5-35.8) and calves in poor sanitation compared to calves in good hygienic conditions (AOR = 9.9, 95% C.I: 3.1-30.7). Conclusion: presence of Cryptosporidium species in calves and environment and reported human contact with animals increases zoonotic risk. We recommend further studies that determine specific Cryptosporidium species infecting animals and humans which would better estimate risk of disease transmission to humans.

Research paper thumbnail of Factors Affecting Uptake of PMTCT Services, Lodwar County Referral Hospital, Turkana County, Kenya, 2015 to 2016

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2019

Kenya is one of 22 countries globally that account for 90% of all HIV-positive pregnant women. Th... more Kenya is one of 22 countries globally that account for 90% of all HIV-positive pregnant women. This study aimed to determine factors affecting uptake of prevention of mother-to-child transmission (PMTCT) services among HIV-positive pregnant women at Lodwar County Referral Hospital in Turkana County, an arid area in northern Kenya. We conducted a retrospective review of HIV-positive pregnant women attending antenatal care (ANC) and accessing PMTCT services between January 2015 and December 2016. We used infant prophylaxis as a proxy measure of PMTCT uptake, and records across programs were linked using the mother’s unique medical identification number. A total of 230 participants were included in the study. Bivariate analyses showed maternal prophylaxis (odds ratio [OR] = 45.71; 95% confidence interval [CI]: 10.35-202.00), residing in urban center (OR = 2.64, 95% CI: 1.45-4.81), and having at least one ANC visit (OR = 2.78; 95% CI: 1.25-6.17) were significantly associated with uptake...

Research paper thumbnail of Risk factors for serological evidence of MERS-CoV in camels, Kenya, 2016–2017

Preventive Veterinary Medicine, 2020

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging viral disease and dromedar... more Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging viral disease and dromedary camels are known to be the source of human spill over events. A cross-sectional epidemiological surveillance study was carried out in Kenya in 2017 to, 1) estimate MERS-CoV antibody seropositivity in the camel-dense counties of Turkana, Marsabit, Isiolo, Laikipia and Nakuru to identify, and 2) determine the risk factors associated with seropositivity in camels. Blood samples were collected from a total of 1421 camels selected using a multi-stage sampling method. Data were also collected from camel owners or herders using a pre-tested structured questionnaire. The sera from camel samples were tested for the presence of circulating antibodies to MERS-CoV using the anti-MERS-CoV IgG ELISA test. Univariate and multivariable statistical analysis were used to investigate factors potentially associated with MERS-CoV seropositivity in camels. The overall seropositivity in camel sera was 62.9 %, with the highest seropositivity recorded in Isiolo County (77.7 %), and the lowest seropositivity recorded in Nakuru County (14.0 %). When risk factors for seropositivity were assessed, the "Type of camel production system" {(aOR = 5.40(95 %CI: 1.67-17.49)}, "Age between 1-2 years, 2-3 years and above 3 years" {(aOR = 1.64 (95 %CI: 1.04-2.59}", {(aOR = 3.27 (95 %CI: 3.66-5.61)}" and {(aOR = 6.12 (95 %CI: 4.04-9.30)} respectively and "Sex of camels" {(aOR = 1.75 (95 %CI: 1.27-2.41)} were identified as significant predictors of MERS-CoV seropositivity. Our studies indicate a high level of seropositivity to MERS-CoV in camels in the counties surveyed, and highlights the important risk factors associated with MERS-CoV seropositivity in camels. Given that MERS-CoV is a zoonosis, and Kenya possesses the fourth largest camel population in Africa, these findings are important to inform the development of efficient and risk-based prevention and mitigation strategies against MERS-CoV transmission to humans.

Research paper thumbnail of A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015

Pan African Medical Journal, 2020

Introduction: in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we invest... more Introduction: in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. Methods: we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli.

Research paper thumbnail of Leptospira spp. seroprevalence in humans involved in a cross-sectional study in Garissa and Tana River Counties, Kenya

IntroductionLeptospirosis is a neglected bacterial zoonotic infection caused by spirochetes of Le... more IntroductionLeptospirosis is a neglected bacterial zoonotic infection caused by spirochetes of Leptospira genus. Humans get infected through direct or indirect contact with urine of infected animals or environment. It accounts for more than 300,000 severe cases annually worldwide with case fatality rates of over 30%. Costs of diagnosis and treatment for human and animals, disruption of international trade of animals and products, reduced productivity and reproductivity in animals constitute economic importance. In Kenya, leptospirosis burden is significant but under-diagnosis and under-reporting affects the awareness of the disease. This study aimed to determine and compare the sero-prevalence and factors associated with Leptospira spp. in the two counties.MethodsWe conducted a cross-sectional study that involved apparently healthy people of at least 5 years of age in randomly selected households in Garissa and Tana River Counties. Blood samples were collected and tested for Leptosp...

Research paper thumbnail of Campylobacter positivity and public health risks in live bird markets in Busia, Kenya: A value chain analysis

Transboundary and Emerging Diseases, 2022

Live bird markets (LBMs) provide integral hubs for 95% of poultry produced for food. Surveillance... more Live bird markets (LBMs) provide integral hubs for 95% of poultry produced for food. Surveillance systems in LBMs serving smallholder farmers in sub-saharan Africa are often non-functional, and data about public health risks and emerging pathogens are lacking. Studies in Kenya have reported 29-44% Campylobacter prevalence in poultry. We analysed such LBMs in Kenya for likely transmission of Campylobacter from poultry to humans. We conducted a cross-sectional survey among 186 live poultry traders (LPTs) in 14 LBMs in a region with widespread backyard poultry systems. A pretested structured questionnaire was administered to all LPTs having regular contacts with poultry to gather market data and risk information on campylobacteriosis. Campylobacter was detected in individual cloacal cultures and identified through PCR. The median score obtained from the outcome of risk assessment dichotomized respondents into high and low risk categories. We performed logistic regression at 95% confidence interval (CI) to compare market characteristics and Campylobacter positivity to risk categories to identify LBM-associated public health risks. Markets had a median of 13 traders, and mean age of 46.3 ± 13.7 years. Majority 162/186 (87.1%) were males. Market behavioural processes by LPTs varied: Only 58.6% LPTs held bird species separate; onsite slaughter (38.7%); encountered sick-bird (93%) and dead-bird (83%) amidst limited health inspection (31.2%). Campylobacter positivity in live birds was 43/112 (38.4%, 95% CI: 29.4-48.1). Risk information on campylobacteriosis was low 41/114 (36%, 95% CI: 27.2-45.5). Sanitary risks were related to accumulation of litter (adjusted prevalence odds ratio [aPOR]: 19.67, 95% CI: 3.01-128.52). Accessing hand-wash facilities (aPOR: .32, 95% CI: .13-.78) and access to information (aPOR: .24, 95% CI: .09-.61) were protective. Sanitary risks were related to poor hygiene. LBMs could be central surveillance sites for Campylobacter. Public health authorities/actors should consider appropriate targeting to improve sanitary measures and Campylobacter control strategies. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Research paper thumbnail of Cholera Community Knowledge, Attitudes, and Practices Questionnaire

Research paper thumbnail of Additional file 1: of Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011â 2016

Kenya animal bites dataset. (XLSX 1570 kb)

Research paper thumbnail of Investigation of anthrax in an endemic region in Kenya: a mixed methods approach

Pan African Medical Journal, 2018

In Kenya, human anthrax cases most often occur linked to animal anthrax. In most cases, human beh... more In Kenya, human anthrax cases most often occur linked to animal anthrax. In most cases, human behaviors, especially slaughter and consumption of meat from animal anthrax cases, has been implicated. This case study is based on an anthrax outbreak investigation conducted in an endemic region in Kenya in May 2016.The case study simulates how a mixed methods approach can be used in epidemiologic research.To fully benefit from this case study, participants should have had prior lectures or other instruction in quantitative and qualitative study designs and sampling approachesused in epidemiologic research. The case study is ideally suited for trainees at intermediate or advance level training in field epidemiology who should be able to complete the case study in approximately 3 hours.

Research paper thumbnail of Sero-Prevalence and Factors Associated with Brucellosis in Goats and Sheep and Assessment of Pastoralists, Knowledge Attitude and Practices Towards Brucellosis in Garissa County

Research paper thumbnail of Prevalence of diabetes and co-morbidities in five rural and semi-urban Kenyan counties, 2010–2015

International Journal of Diabetes in Developing Countries, 2017

Globally, >80% of diabetes-related deaths occur in low-and middle-income countries. In 2014, the ... more Globally, >80% of diabetes-related deaths occur in low-and middle-income countries. In 2014, the International Diabetes Federation ranked Kenya 31st in Africa in terms of diabetes with an estimated prevalence of 460 cases per 10,000 population. This study characterizes the prevalence and associated co-morbidities of diabetes in five rural and semi-urban counties in Kenya. We conducted a descriptive cross-sectional review of diabetes registry data in five selected rural and semi-urban hospitals between 2010 and 2015. Patients with clinical or laboratory diagnosis of diabetes were included in the study. Demographic and epidemiologic data were abstracted, entered into MS-Excel 2007, and descriptive and correlation statistics were calculated using Epi-Info 7. We identified 1548 cases (59% female) across the 5 sites, with a mean age of 58 ± 13.5 years. We calculated diabetes prevalence measures of 310, 30, 20, and 4 per 10,000 in Isiolo, Othaya, Mukurweini, Thika, and Meru, respectively. Type 2 diabetes comprised 98% of cases from Othaya and Mukurweini, 96% from both Isiolo and Meru counties, and 94% from Thika. The most common co-morbidity was hypertension, with 80% affected from Othaya and Mukurweini, 52% in Thika, and 34% in Isiolo County. The correlation between age, gender, and presence of a comorbidity and diabetes varied across counties. Diabetes and its complications are prevalent in rural and semi-urban areas of Kenya and women seem to be more affected by the disease, indicating an increasing population who are at risk for type 2 diabetes and associated complications.

Research paper thumbnail of “We are doctors”: Drivers of animal health practices among Maasai pastoralists and implications for antimicrobial use and antimicrobial resistance

Preventive Veterinary Medicine, 2021

Animal health service providers can play an important role in limiting drug resistance by promoti... more Animal health service providers can play an important role in limiting drug resistance by promoting responsible and prudent use of veterinary drugs. Recognizing this potential, international agencies and governments have called for these providers to receive drug stewardship training, particularly providers in low- and middle-income countries where top-down regulations (e.g., national regulation of veterinary prescriptions) are largely unfeasible. The success of these stewardship trainings to promote responsible and prudent use will depend on many factors, including understanding how livestock-keeping communities currently interact with animal health service providers. Here, we use a mixed methods approach to identify and understand animal health seeking practices among Maasai pastoralists in Tanzania. Combining qualitative interviews (N = 31) and structured surveys (N = 195), we show the majority of Maasai respondents (≈80 %) do not frequently consult animal health service providers with most relying on advice from family and friends. Logistic regression models of health seeking practices find that increasing age, education, observance of treatment failure, and herd disease burdens are associated with greater odds of seeking out health services. Quantitative results were supported by data from focus group discussions and in-depth interviews that showed Maasai view animal health service providers as measures of last resort, whose input is largely sought after self-treatment with veterinary drugs fail. We argue patterns of animal health seeking among the Maasai are partially the consequence of their high confidence in their own abilities in livestock disease and treatment and generally low confidence in the skills of animal health service providers. We link this high sense of self-efficacy to the culturally engrained process by which Maasai develop mastery in animal health and how the roles and norms in Maasai culture surrounding animal health influence Maasai perceptions of animal health professionals. Our results highlight the need for more research to understand Maasai perceptions of animal health service providers as well as the knowledge, attitudes, and practices of these providers. Finally, our study emphasizes that the success of drug stewardship trainings will require efforts to first understand the cultural and historical contexts driving health seeking practices that impact perceptions of animal health service providers and animal health practices more generally.

Research paper thumbnail of Factors associated with cholera outbreaks, Nairobi County, July 2017: a case control study

BackgroundCholera affects 1.3-4 million people globally and causes 21000-143,000 deaths annually.... more BackgroundCholera affects 1.3-4 million people globally and causes 21000-143,000 deaths annually. Nairobi County in Kenya reported cholera cases since April 2017. We investigated to identify associated factors and institute control measures.MethodsWe reviewed the line-list of patients admitted at the Kenyatta National referral Hospital, Nairobi and performed descriptive epidemiology. We carried out a frequency-matched case control study, using facility-based cases and community controls. We defined a case as acute onset of watery diarrhoea of at least >3 stools/24hours with or without vomiting in person of any age, admitted in Kenyatta National Hospital as from July 1st, 2017. We calculated odds ratios and their respective 95% confidence intervals. We also took water samples at water reservoirs, distribution and consumer points, and made observation on hygiene and sanitation conditions in the community.ResultsWe reviewed 71 line-listed cases; median age 30 years (range 2-86 years...

Research paper thumbnail of Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011–2016

BMC Public Health, 2018

Background: Human animal-bite injuries are a serious public health problem due to associated risk... more Background: Human animal-bite injuries are a serious public health problem due to associated risk for rabies virus exposure. Animal-bite injuries especially dog bites are useful indicators for assessing the risk of rabies virus transmission and need for rabies post exposure prophylaxis (PEP). Understanding the epidemiology and surveillance of animal bites and rabies post-exposure prophylaxis is critical in implementing Kenya's national rabies elimination strategy. We aimed to describe the incidence of human animal-bite injuries, patient/biting animal characteristics, uptake of rabies PEP and factors associated with animal bite incidents. Methods: We reviewed animal bite records from outpatient and anti-rabies vaccine (ARV) registers of 17 health facilities from five counties. An animal bite was defined as an entry of an animal bite of the class mammal including humans in registers in a person of any age from January 2011 to December 2016. We collected demographic and information on PEP uptake. We calculated descriptive statistics, odds ratios (OR) and 95% confidence interval (CI) to examine factors associated with being an animal bite case-patient. We also calculated incidence of animal bites using health facility catchment population for year 2016 as the denominator. Results: We analyzed 7307 records. The median age was 22 years (IQR = 31 years); there were 4019 (55%) male and age < 15 years were 2607 (37%). Dogs accounted for 6720 (93%) of bites of which 78% were owned free-roaming dogs. Of the 5674 (88%) cases that received rabies PEP, 2247 (40%) got at least three-doses. The median time from bite to seeking medical care was 2 days (IQR = 4 days). Being bitten on the head/face (OR = 5.8; CI: 3.3-10.2); being bitten by owned free-roaming dog (OR = 1.7; CI: 1.5-1.9) and being male (OR = 1.4; CI: 1.3-1.5) were significantly associated with being an animal-bite case-patient. Being male, being bitten on head/face and being bitten by owned freeroaming dog remained independently associated with being an animal bite case-patient at multivariable logistic regression. Bite-incidence was 289 bites /100,000 persons among all counties. Conclusion: Preventing dog bites would most effectively reduce bite injuries by improving public health education among children below 15 years, encouraging early PEP initiation and completion, development and implementation of responsible dog ownership and animal behaviour educational programmes as well as improving human and veterinary health linkages.

Research paper thumbnail of An outbreak of cholera in western Kenya, 2015: a case control study

Pan African Medical Journal, 2017

Introduction: in February 2015, an outbreak of acute watery diarrhea was reported in two sub coun... more Introduction: in February 2015, an outbreak of acute watery diarrhea was reported in two sub counties in western Kenya. Vibrio cholerae 01 serotype Ogawa was isolated from 26 cases and from water samples collected from a river mainly used by residents of the two sub-counties for domestic purposes. We carried out an investigation to determine factors associated with the outbreak. Methods: we conducted a frequency matched case control study in the community. We defined cases as episodes of watery diarrhea (at least three motions in 24 hours) in persons ≥ 2 years who were residents of Rongo or Ndhiwa sub-counties from January 23-February 25, 2015. Cases were systematically recruited from a cholera line list and matched to two controls (persons without diarrhea since January 23, 2015) by age category and residence. A structured questionnaire was administered to evaluate exposures in cases and controls and multivariable logistic regression done to determine independent factors associated with the outbreak. Results: we recruited 52 cases and 104 controls. Females constituted 61% (95/156) of all participants. Overall latrine coverage was 58% (90/156). Latrine coverage was 44% (23/52) for cases and 64% (67/104) for controls. Having no latrine at home (aOR = 10.9; 95% CI: 3.02-39.21), practicing communal hand washing in a basin (aOR = 6.5; 95% CI: 2.30-18.11) and vending of food as an occupation (aOR = 3.4; 95% CI: 1.06-10.74) were independently associated with the outbreak. Conclusion: poor latrine coverage and personal hygiene practices were identified as the main drivers of the outbreak. We recommended improved public health education on latrine usage and promotion of hand washing with soap and water in the community.

Research paper thumbnail of Antimicrobial residues and compositional quality of informally marketed raw cow milk, Lamu West Sub-County, Kenya, 2015

Pan African Medical Journal, 2017

Introduction: unadulterated milk, free of antimicrobial residues is important for industrial proc... more Introduction: unadulterated milk, free of antimicrobial residues is important for industrial processing and consumers' health. Antimicrobial residues in foods of animal origin can cause adverse public health effects like drug resistance and hypersensitivity. Milk produced in Lamu West sub-county is sold raw directly to consumers. We estimated the compositional quality and prevalence of antimicrobial residues in informally marketed raw cow milk in Lamu West Sub-County, Kenya. Methods: we randomly recruited 152 vendors and 207 farmers from four randomly selected urban centers in a cross-sectional study and interviewed them using a pretested standardized questionnaire. A100-ml raw milk sample was aseptically collected from each vendor and farm and tested for antimicrobial residues using Charm Blue Yellow II kit following the European Union Maximum Residue Limits (EU-MRLs) while an Ekomilk® Analyzer was used to measure compositional quality where samples with either solid not fat (SNF) < 8.5 or added water ≥ 0.01% or both were considered adulterated. We analyzed data using univariate analysis and unconditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: thirty-two of the 207 (15.5%) samples from farmers and 28 (18.4%) of the 152 samples from vendors tested positive for antimicrobial residues. Thirty-six (17.4 %) samples from farmers and 38 (25.0%) from vendors were found to be adulterated with water. Farmers' awareness of the danger of consuming milk with antimicrobial residues and farmers having training on good milking practices were protective against selling milk with antimicrobial residues (adjusted OR and 95% CI 0.20, 0.07-0.55 and 0.33, 0.11-0.99, respectively). Conclusion: the antimicrobial residues above EU MRLs and adulteration of raw marketed cow milk observed in this study provide evidence for routine testing of marketed milk and educating farmers to observe antimicrobial withdrawal period.

Research paper thumbnail of of Livestock Development, the World Health Organization’s International Health

to rabies-endemic regions should avoid contact with wild and feral animals, even in seemingly saf... more to rabies-endemic regions should avoid contact with wild and feral animals, even in seemingly safe captive settings (2). Any mammal can be rabid, and infectious animals might appear healthy for several days before illness onset; avoiding all wild and feral animals while traveling is the ideal preventive measure. All animal bites and scratches should be washed thoroughly with soap and water and receive immediate medical attention (2). Acknowledgments We thank affected travelers for participating in this investigation and the safari lodge staff and travel agents for their assistance in reaching travelers. We are also grateful to the Kenya Central Veterinary Laboratory and to Michael Niezgoda, Ivan Kuzmin, and the staff of the CDC Rabies Program for laboratory support. Finally, we thank all collaborators at the Department for Disease Surveillance and Response and Field Epidemiology

Research paper thumbnail of Generalized Cowpox Virus Infection in a Patient with HIV , Germany , 2012

flab gene was targeted by using multiplex qPCR according to a previous described protocol (1). Fo... more flab gene was targeted by using multiplex qPCR according to a previous described protocol (1). For quality control of qPCRs, we included positive and negative controls. Sequences of qPCR products were analyzed and compared with sequences available in GenBank. B. miyamotoi was detected in 7 ticks: 2 (1.59%) of 126 males, 2 (0.68%) of 296 females, and 3 (6.52%) of 46 nymphs. A. phagocytophilum was detected in 16 ticks: 1 (0.79%) of 126 males, 11 (3.72%) of 296 females, and 4 (8.70%) of 46 nymphs. Candidatus N. mikurensis was detected in 25 ticks: 5 (3.97%) of 126 males, 18 (6.08%) of 296 females, and 2 (4.35%) of 46 nymphs. Overall prevalences were 1.50% for B. miyamotoi, 3.42% for A. phagocytophilum, and 5.34% for Candidatus N. mikurensis. Prevalences of each pathogen in specific varied by locality (Table). No co-infections were detected. We analyzed flab, msp2, and groEL gene sequences obtained by qPCR. These sequences showed 99%–100% identities with gene sequences of B. miyamotoi (...

Research paper thumbnail of Assessment of knowledge, attitudes and practices towards anthrax in Narok County, Southern Kenya

Introduction anthrax is endemic in some parts of Kenya causing mortalities in livestock and morbi... more Introduction anthrax is endemic in some parts of Kenya causing mortalities in livestock and morbidity in humans. On January 20th, 2018, news media reported suspected anthrax in a remote southern Kenyan village after villagers became ill following consumption of meat from a dead cow that was confirmed, by microscopy, to have died of anthrax. We assessed community knowledge, attitude and practices (KAP) to identify intervention gaps for anthrax prevention. Methods we conducted a KAP survey in randomly selected households (HHs) in villages from selected wards. Using multi-stage sampling approach, we administered structured questionnaire to persons aged ≥15 years to collect KAP information from February 11th-21st, 2018. From a set of questions for KAP, we scored participants’ response as “1” for a correct response and “0” for an incorrect response. Univariate analysis and Chi-square tests were performed to explore determinants of KAP. Concurrently, we gathered qualitative data using int...

Research paper thumbnail of Epidemiological characteristics and factors associated with Visceral Leishmaniasis in Marsabit County, Northern Kenya

Journal of Interventional Epidemiology and Public Health, 2019

INTRODUCTION: Visceral Leishmaniasis (VL) is endemic in 14 of the 47 counties in Kenya. An upsurg... more INTRODUCTION: Visceral Leishmaniasis (VL) is endemic in 14 of the 47 counties in Kenya. An upsurge of VL cases started in March 2017, the number of cases continued rising and by June 2017, 104 cases and 3 deaths had been reported. We conducted an investigation to describe the magnitude and pattern of the outbreak and to assess factors associated with VL infection among the cases. METHODS: We conducted a secondary data analysis of VL data from 1st January 2014 to 11th July 2017 obtained from Marsabit county referral hospital and Laisamis Mission Hospitals, with a VL case being defined as any entry with a clinical or laboratory diagnosis of VL. We also conducted a frequency matched case-control study among 76 case-patients and 152 controls. A confirmed case was a person with positive rK39 serology for VL from 1st April 2017 through 11th July 2017; whereas a control was a person within a defined age-category as a case, without signs/symptoms of VL since 1st January 2017, and negative o...

Research paper thumbnail of Cryptosporidium infection in calves and the environment in Asembo, Western Kenya: 2015

Pan African Medical Journal, 2017

Introduction: Cryptosporidium species, a zoonotic enteric coccidian parasite, is among the leadin... more Introduction: Cryptosporidium species, a zoonotic enteric coccidian parasite, is among the leading causes of diarrhea in children. We evaluated the prevalence of Cryptosporidium infections in calves, factors associated with calf infection, environmental contamination of manure by Cryptosporidium and factors that expose humans to zoonotic transmission in Asembo. Methods: in a cross-sectional study conducted from January to July 2015, we collected fecal specimens from 350 randomly selected calves aged ≤ 6 months old and 187 manure samples from the same farms. We assessed farmers' knowledge about Cryptosporidium and collected data on characteristics using structured questionnaires. Modified Ziehl Nielsen staining was used to detect Cryptosporidium oocysts from calves' stool and manure. The prevalence of infected calves and 95% confidence interval (CI) were calculated. Odds ratios (OR) and 95% (CI) were calculated to identify possible factors associated with Cryptosporidium infection; multivariable logistic regression performed to identify factors independently associated with the presence of Cryptosporidium. Results: calves' fecal Cryptosporidium prevalence was 8.3% (95% CI: 5.7-11.8) and 7.5% (95% CI: 4.2-12.2) in manure. Odds of infection was higher in calves with loose stool compared to those with normal stool (AOR = 6.1, 95% C.I: 2.2-16.9), calves ≤ 2 months old compared to older calves (AOR=12.7, 95% C.I: 4.5-35.8) and calves in poor sanitation compared to calves in good hygienic conditions (AOR = 9.9, 95% C.I: 3.1-30.7). Conclusion: presence of Cryptosporidium species in calves and environment and reported human contact with animals increases zoonotic risk. We recommend further studies that determine specific Cryptosporidium species infecting animals and humans which would better estimate risk of disease transmission to humans.

Research paper thumbnail of Factors Affecting Uptake of PMTCT Services, Lodwar County Referral Hospital, Turkana County, Kenya, 2015 to 2016

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2019

Kenya is one of 22 countries globally that account for 90% of all HIV-positive pregnant women. Th... more Kenya is one of 22 countries globally that account for 90% of all HIV-positive pregnant women. This study aimed to determine factors affecting uptake of prevention of mother-to-child transmission (PMTCT) services among HIV-positive pregnant women at Lodwar County Referral Hospital in Turkana County, an arid area in northern Kenya. We conducted a retrospective review of HIV-positive pregnant women attending antenatal care (ANC) and accessing PMTCT services between January 2015 and December 2016. We used infant prophylaxis as a proxy measure of PMTCT uptake, and records across programs were linked using the mother’s unique medical identification number. A total of 230 participants were included in the study. Bivariate analyses showed maternal prophylaxis (odds ratio [OR] = 45.71; 95% confidence interval [CI]: 10.35-202.00), residing in urban center (OR = 2.64, 95% CI: 1.45-4.81), and having at least one ANC visit (OR = 2.78; 95% CI: 1.25-6.17) were significantly associated with uptake...

Research paper thumbnail of Risk factors for serological evidence of MERS-CoV in camels, Kenya, 2016–2017

Preventive Veterinary Medicine, 2020

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging viral disease and dromedar... more Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging viral disease and dromedary camels are known to be the source of human spill over events. A cross-sectional epidemiological surveillance study was carried out in Kenya in 2017 to, 1) estimate MERS-CoV antibody seropositivity in the camel-dense counties of Turkana, Marsabit, Isiolo, Laikipia and Nakuru to identify, and 2) determine the risk factors associated with seropositivity in camels. Blood samples were collected from a total of 1421 camels selected using a multi-stage sampling method. Data were also collected from camel owners or herders using a pre-tested structured questionnaire. The sera from camel samples were tested for the presence of circulating antibodies to MERS-CoV using the anti-MERS-CoV IgG ELISA test. Univariate and multivariable statistical analysis were used to investigate factors potentially associated with MERS-CoV seropositivity in camels. The overall seropositivity in camel sera was 62.9 %, with the highest seropositivity recorded in Isiolo County (77.7 %), and the lowest seropositivity recorded in Nakuru County (14.0 %). When risk factors for seropositivity were assessed, the "Type of camel production system" {(aOR = 5.40(95 %CI: 1.67-17.49)}, "Age between 1-2 years, 2-3 years and above 3 years" {(aOR = 1.64 (95 %CI: 1.04-2.59}", {(aOR = 3.27 (95 %CI: 3.66-5.61)}" and {(aOR = 6.12 (95 %CI: 4.04-9.30)} respectively and "Sex of camels" {(aOR = 1.75 (95 %CI: 1.27-2.41)} were identified as significant predictors of MERS-CoV seropositivity. Our studies indicate a high level of seropositivity to MERS-CoV in camels in the counties surveyed, and highlights the important risk factors associated with MERS-CoV seropositivity in camels. Given that MERS-CoV is a zoonosis, and Kenya possesses the fourth largest camel population in Africa, these findings are important to inform the development of efficient and risk-based prevention and mitigation strategies against MERS-CoV transmission to humans.

Research paper thumbnail of A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015

Pan African Medical Journal, 2020

Introduction: in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we invest... more Introduction: in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. Methods: we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli.

Research paper thumbnail of Leptospira spp. seroprevalence in humans involved in a cross-sectional study in Garissa and Tana River Counties, Kenya

IntroductionLeptospirosis is a neglected bacterial zoonotic infection caused by spirochetes of Le... more IntroductionLeptospirosis is a neglected bacterial zoonotic infection caused by spirochetes of Leptospira genus. Humans get infected through direct or indirect contact with urine of infected animals or environment. It accounts for more than 300,000 severe cases annually worldwide with case fatality rates of over 30%. Costs of diagnosis and treatment for human and animals, disruption of international trade of animals and products, reduced productivity and reproductivity in animals constitute economic importance. In Kenya, leptospirosis burden is significant but under-diagnosis and under-reporting affects the awareness of the disease. This study aimed to determine and compare the sero-prevalence and factors associated with Leptospira spp. in the two counties.MethodsWe conducted a cross-sectional study that involved apparently healthy people of at least 5 years of age in randomly selected households in Garissa and Tana River Counties. Blood samples were collected and tested for Leptosp...