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Background In Kenya, long-distance truck drivers (LDTDs) using the Northern Corridor highway have a high prevalence of HIV and other sexually transmitted infections (STIs) due to their risky sexual networks. However, the spatial distribution of the sexual network locations used by LDTDs is not well understood. Consequently, healthcare stakeholders have found it difficult to provide spatially targeted HIV/STI interventions among LDTDs. Thus, the study sought to establish the spatial distribution of sexual network locations used by LDTDs along the Northern Corridor highway, to inform efficient distribution and use of limited HIV/STI-prevention resources. Methods A cross-sectional study design was used. The study adopted a systematic sampling technique. 296 LDTDs were interviewed using interviewer-administered questionnaires at the Mlolongo weighbridge in Kenya. The LDTDs listed their history of sexual interactions and highway stopovers used during the week preceding data collection. Geospatial modelling techniques, using R statistical software packages for spatial mapping, were employed. Shapefiles were created and overlaid over a map of Kenya using R statistical software to create maps of sexual networks. Results Forty-two highway stopovers used by LDTDs were spatially distributed along the highway, from the Kenya coast to the Kenya–Uganda border. In general, LDTDs' sexual network hotspots were restricted to the outskirts of major cities along the Northern Corridor highway (Nairobi, Mombasa and Nakuru) as well as the Kenya–Uganda international border. Conclusions On the Northern Corridor highway, stopovers situated proximal to major urban areas, as well as those at international border points, frequently serve as sexual network hotspots among LDTDs and their sexual partners. Thus, healthcare stakeholders should improve access to HIV/STI-prevention services targeted for LDTDs at the sexual network hotspots identified in this study. [ABSTRACT FROM AUTHOR]

Background: Coxiella burnetii is a widely distributed pathogen, but data on its epidemiology in livestock, and human populations remains scanty, especially in developing countries such as Kenya. We used the One Health approach to estimate the seroprevalance of C. burnetii in cattle, sheep, goats and human populations in Tana River county, and in humans in Garissa county, Kenya. We also identified potential determinants of exposure among these hosts. Methods: Data were collected through a cross-sectional study with a cluster sampling design. Serum samples were taken from 2,727 animals (466 cattle, 1,333 goats, and 928 sheep) and 974 humans and screened for Phase I/II IgG antibodies against C. burnetii using enzyme-linked immunosorbent assay (ELISA). Data on potential factors associated with animal and human exposure were collected using a structured questionnaire. Multivariable analyses were performed with households as random effects to adjust for the within-household correlation of C. burnetii exposure among animals and humans, respectively. Results: The overall apparent seroprevalence estimates of C. burnetii in livestock and humans were 12.80% (95% confidence interval [CI]: 11.57–14.11) and 24.44% (95% CI: 21.77–27.26), respectively. In livestock, the seroprevalence differed significantly by species (p < 0.01). The highest seroprevalence estimates were observed in goats 15.22% (95% CI: 13.34–17.27), then sheep 14.22% (95% CI: 12.04–16.64) and with cattle 3.00% (95% CI; 1.65–4.99) showing lower values. Herd-level seropositivity of C. burnetii in livestock was not positively associated with human exposure. Multivariable results showed that female animals had higher odds of seropositivity for C. burnetii than males, while for animal age groups, adult animals had higher odds of seropositivity than calves, kids or lambs. For livestock species, both sheep and goats had significantly higher odds of seropositivity than cattle. In human populations, men had a significantly higher odds of testing positive for C. burnetii than women. Conclusions: This study provides evidence of livestock and human exposure to C. burnetii which could have serious economic implications on livestock production and impact on human health. These results also highlight the need to establish active surveillance in the study area to reduce the disease burden associated with this pathogen. Author summary: Q fever caused by Coxiella burnetii is a significant zoonotic disease that affects wildlife, domestic animals and humans. This study determined the prevalence of antibodies to C. burnetii in livestock (cattle, sheep, and goats) and human populations in arid and semi-arid areas of Kenya between December 2013 and February 2014. We also identified potential factors that were associated with exposure among the above-targeted hosts. Results from this study showed considerable exposure in both livestock and human populations. However, human exposure to this pathogen at the household level was not correlated with herd-level seropositivity. Further studies are needed to elucidate the transmission routes of this pathogen among humans. [ABSTRACT FROM AUTHOR]

Introduction: harsh working conditions among long-distance truck drivers (LDTDs) expose them to risky sexual interactions while on transit. As a result, the risky sexual interactions among the LDTDs place them at a high risk of contracting human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). This study sought to assess the sexual interactions and associated factors among the LDTDs in Kenya. Methods: two hundred ninety-six (296) LDTDs were interviewed using interviewer-administered questionnaires. A systematic sampling technique was adopted. The number of sexual acts reported by the respondents was used to generate an ordered outcome variable (frequency of sexual interactions), in the order of; no sexual acts (zero), one to three sexual acts (1), and four to six sexual acts (2). Association between the predictor variables and the outcome variable was analysed using ordered logistic regression analysis in R statistical software. Results: the mean age of the study participants was 38.4 years, with the youngest being 24 years and the oldest 57 years. Slightly above half of the participants (52.4%) reported no sexual interactions, while the rest (47.6%) had sexual interactions with either casual or regular sexual partners on the week preceding the survey. Age, the number of weeks spent on a transit journey, and drug use were independently associated with the frequency of sexual interactions among LDTDs involved in the study. Conclusion: the frequencies of sexual interactions are likely to be higher among the younger LDTDs, those who spent more than one week on transit, and those who use alcohol and khat, hence a high exposure risk to HIV/STIs among them. [ABSTRACT FROM AUTHOR]

Foot-and-mouth disease (FMD) is endemic in Kenya affecting cloven-hoofed ruminants. The epidemiology of the disease in small ruminants (SR) in Kenya is not documented. We carried out a cross-sectional study, the first in Kenya, to estimate the sero-prevalence of FMD in SR and the associated risk factors nationally. Selection of animals to be sampled used a multistage cluster sampling approach. Serum samples totaling 7564 were screened for FMD antibodies of non-structural-proteins using ID Screen® NSP Competition ELISA kit. To identify the risk factors, generalized linear mixed effects (GLMM) logistic regression analysis with county and villages as random effect variables was used. The country animal level sero-prevalence was 22.5% (95% CI: 22.3%-24.3%) while herd level sero-prevalence was 77.6% (95% CI: 73.9%-80.9%). The risk factor that was significantly positively associated with FMD sero-positivity in SR was multipurpose production type (OR = 1.307; p = 0.042). The risk factors that were significantly negatively associated with FMD sero-positivity were male sex (OR = 0.796; p = 0.007), young age (OR = 0.470; p = 0.010), and sedentary production zone (OR = 0.324; p<0.001). There were no statistically significant intra class correlations among the random effect variables but interactions between age and sex variables among the studied animals were statistically significant (p = 0.019). This study showed that there may be widespread undetected virus circulation in SR indicated by the near ubiquitous spatial distribution of significant FMD sero-positivity in the country. Strengthening of risk-based FMD surveillance in small ruminants is recommended. Adjustment of husbandry practices to control FMD in SR and in-contact species is suggested. Cross-transmission of FMD and more risk factors need to be researched. [ABSTRACT FROM AUTHOR]

Environmental modifications disturb the equilibrium of mosquito populations, altering the risk of mosquito-borne diseases. Mosquito distribution, diversity, and bloodmeal sources were examined to compare Rift Valley fever (RVF) risk among irrigated, riverine, and pastoral ecosystems in Bura, Tana River County, Kenya, between September 2014 and June 2015. Thirty-eight households and 21 irrigation fields were selected for the study. Mosquitoes were trapped with carbon dioxide-impregnated CDC traps, one trap per household and three traps per irrigated field, and morphologically identified using taxonomic keys. Host DNA was extracted from engorged females and cytochrome b genes amplified by PCR to identify sources of bloodmeals. A total of 21,015 mosquitoes were collected; 5742 within households in the 3 ecosystems and 15,273 within irrigated fields. Mosquitoes collected within irrigated fields belonged to 8 genera and 37 species, while those from households within the irrigation scheme belonged to 6 genera and 29 species. Collections from riverine and pastoral households belonged to five and four genera, respectively. The most abundant genera in the irrigated fields were Aedes (21%) and Mansonia (22%), while Anopheles (43%) was the most abundant within households. Most mosquitoes in riverine and pastoral households belonged to Anopheles (76%) and Aedes (65%) genera, respectively. Seasonal variation driven by rainfall was evidenced by spikes in mosquito numbers within irrigated and riverine ecosystems. Host species identification revealed that goats and humans were the main sources of bloodmeal. There was an overall increase in mosquito abundance and diversity as a result of the presence of the irrigated ecosystem in this county, and an increased availability of highly RVF-susceptible hosts as a result of the establishment and concentration of residential areas, promoting potential vector–host contacts. These results highlight the impact of anthropogenic changes on mosquito ecology, potentially heightening the risk of transmission and maintenance of RVF in this region. [ABSTRACT FROM AUTHOR]

Brucella spp. is a zoonotic bacterial agent of high public health and socio-economic importance. It infects many species of animals including wildlife, and people may get exposed through direct contact with an infected animal or consumption of raw or undercooked animal products. A linked livestock-human cross-sectional study to determine seroprevalences and risk factors of brucellosis in livestock and humans was designed. Estimates were made for intra-cluster correlation coefficients (ICCs) for these observations at the household and village levels. The study was implemented in Garissa (specifically Ijara and Sangailu areas) and Tana River (Bura and Hola) counties. A household was the unit of analysis and the sample size was derived using the standard procedures. Serum samples were obtained from selected livestock and people from randomly selected households. Humans were sampled in both counties, while livestock could be sampled only in Tana River County. Samples obtained were screened for anti-Brucella IgG antibodies using ELISA kits. Data were analyzed using generalized linear mixed effects logistic regression models with the household (herd) and village being used as random effects. The overall Brucella spp. seroprevalences were 3.47% (95% confidence interval [CI]: 2.72–4.36%) and 35.81% (95% CI: 32.87–38.84) in livestock and humans, respectively. In livestock, older animals and those sampled in Hola had significantly higher seroprevalences than younger ones or those sampled in Bura. Herd and village random effects were significant and ICC estimates associated with these variables were 0.40 (95% CI: 0.22–0.60) and 0.24 (95% CI: 0.08–0.52), respectively. In humans, Brucella spp. seroprevalence was significantly higher in older people, males, and people who lived in pastoral areas than younger ones, females or those who lived in irrigated or riverine areas. People from households that had at least one seropositive animal were 3.35 (95% CI: 1.51–7.41) times more likely to be seropositive compared to those that did not. Human exposures significantly clustered at the household level; the ICC estimate obtained was 0.21 (95% CI: 0.06–0.52). The presence of a Brucella spp.-seropositive animal in a household significantly increased the odds of Brucella spp. seropositivity in humans in that household. Exposure to Brucella spp. of both livestock and humans clustered significantly at the household level. This suggests that risk-based surveillance measures, guided by locations of primary cases reported, either in humans or livestock, can be used to detect Brucella spp. infections in livestock or humans, respectively. Brucellosis is an important zoonotic disease that primarily affects livestock and wildlife. In humans, the disease is characterized by prolonged fever, body aches, joint pains and weakness, while in livestock, the disease mainly causes abortions and infertility. We carried out a study in northeastern Kenya (Garissa and Tana River Counties) to identify factors that affect the distribution of the disease in people and livestock. Livestock and people from randomly selected households were recruited and serum samples were obtained and screened using ELISA kits for Brucella IgG antibodies as a measure to determine the level of exposure to Brucella spp. Data obtained were analyzed using mixed effects logistic regression models. Results obtained show that human and animal Brucella spp seroprevalences cluster at the household level. The odds of exposure in humans were at least three times higher in households that had at least one seropositive animal compared to those that had not. These results can be used to design risk-based surveillance systems where each Brucella spp. infection identified in livestock or humans could signal potential locations of additional brucellosis cases in humans and animals. [ABSTRACT FROM AUTHOR]

To investigate the effects of irrigation on land cover changes and the risk of selected zoonotic pathogens, we carried out a study in irrigated, pastoral and riverine areas in the eastern Kenya. Activities implemented included secondary data analyses to determine land use and land cover (LULC) changes as well as human, livestock and wildlife population trends; entomological surveys to characterize mosquitoes population densities and species distribution by habitat and season; and serological surveys in people to determine the risk of Rift Valley fever virus (RVFV), West Nile fever virus (WNV), dengue fever virus (DFV), Leptospira spp. and Brucella spp. Results demonstrate a drastic decline in vegetation cover over ≈25 years particularly in the irrigated areas where cropland increased by about 1,400% and non-farm land (under closed trees, open to closed herbaceous vegetation, bushlands and open trees) reduced by 30–100%. The irrigated areas had high densities of Aedes mcintoshi, Culex spp. and Mansonia spp. (important vectors for multiple arboviruses) during the wet and dry season while pastoral areas had high densities of Ae. tricholabis specifically in the wet season. The seroprevalences of RVFV, WNV and DFV were higher in the irrigated compared to the pastoral areas while those for Leptospira spp and Brucella spp. were higher in the pastoral compared to the irrigated areas. It is likely that people in the pastoral areas get exposed to Leptospira spp by using water fetched from reservoirs that are shared with livestock and wildlife, and to Brucella spp. by consuming raw or partially cooked animal-source foods such as milk and meat. This study suggests that irrigation increases the risk of mosquito-borne infections while at the same time providing a protective effect against zoonotic pathogens that thrive in areas with high livestock population densities. [ABSTRACT FROM AUTHOR]

A One Health (OH) approach that integrates human, animal and environmental approaches to management of zoonotic diseases has gained momentum in the last decade as part of a strategy to prevent and control emerging infectious diseases. However, there are few examples of how an OH approach can be established in a country. Kenya established an OH office, referred to as the Zoonotic Disease Unit (ZDU) in 2011. The ZDU bridges the animal and human health sectors with a senior epidemiologist deployed from each ministry; and with the goal of maintaining collaboration at the animal and human health interface towards better prevention and control of zoonoses. The country is adding an ecologist to the ZDU to ensure that environmental risks are adequately addressed in emerging disease control. [ABSTRACT FROM AUTHOR]

Background: Maternal anaemia is a public health problem worldwide, and its aetiology is linked to iron deficiency. The high nutrient demand during pregnancy exacerbates the condition. To meet the increased nutritional demand, supplementation of iron and folic acid (IFA) is key. The supplements are provided freely to pregnant women during antenatal visits at public health facilities, however, their uptake and adherence in Kenya remain unacceptably low. Methods: A hospital-based cross-sectional study involving 241 postnatal mothers seeking maternal and child healthcare (MCH) care at Kakamega level 5 hospital was conducted. Both quantitative and qualitative data were collected. Quantitative data were collected from 241 eligible postnatal mothers, while qualitative data were obtained through key informant interviews with community health volunteers and healthcare providers. Results: There was a moderate adherence to IFA supplementation (60.6%) during pregnancy among postnatal mothers seeking MCH care at Kakamega level 5 hospital. Some of the reasons for non-adherence stated by the respondents included; IFA related side effects (41.3%), forgetfulness (37.3%) and bad smell of the IFA supplements (10.3%). Higher IFA adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants, and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts with low anaemia knowledge. Other factors that showed correlation with IFA adherence were: IFA education, pregnancy counselling before conception and the number of antenatal care visits attained. Conclusion: There is a moderate adherence to IFA supplementation during pregnancy among mothers seeking MCH at Kakamega level 5 hospital. The greatest impediments of IFA compliance during pregnancy are IFA side effects, forgetfulness and the bad smell of the IFA tablets. Therefore, providing IFA education to pregnant mothers incorporated with probable ways of managing the IFA side effects would contribute to IFA supplementation adherence., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Bahati F et al.)

Introduction: delayed diagnosis of Mycobacterium tuberculosis infection leads to accelerated individual to individual transmission. This study evaluated this aspect of delayed diagnosis among patients visiting Isiolo level four hospital in northern Kenya., Methods: this was a cross-sectional cohort study conducted during January, 2018-January, 2019 with systematically sampled 172 tuberculosis (TB) patients. Epidemiological and clinical characteristics were abstracted from records to serve as independent variables. Outcome variable was delayed diagnosis dichotomised into < 21 or > 21 days and treated as a binary outcome. Pre-tested interviewer-administered questionnaires, focused group discussions, and key informant interview guides were used to collect relevant information., Results: most (n=89, 57.8%) of the TB diagnosis fell in the category of > 21 day delay. Overall, among all patients, delay in days constituted a median of 27.6, a mean of 37.3 ± 57 days (range 0-414 days). Factors associated with delayed diagnosis (happening > 21 days) included (i) use of dispensary and private health facilities, (OR=4.3, 95% CI: 1.44,13.14; P=0.009) and (OR= 4.9, 95% CI: 1.64, 14.73; P=0.004), respectively (ii) Self-employed individuals (OR=21.7, 95% CI: 2.47,190.93; P=0.006) and employed individuals (OR=9.9, 95% CI: 1.14, 85.80; P=0.038) (iii) secondary-level education (OR=0.03, 95% CI: 0.01,0.21; P=0.000) and tertiary education (OR=0.033, 95% CI: 0.01, 0.23; P=0.001)., Conclusion: delayed diagnosis of TB was found to be associated with health-seeking behaviour of TB patients, proxied by diagnosis facility, occupation, and education levels in our study area. Curtailment of local transmission of M. tuberculosis needs intensified health promotion and education in affected communities complemented with active case findings., Competing Interests: The authors declare no competing interests., (Copyright: David Majuch Kunjok et al.)

Environmental modifications disturb the equilibrium of mosquito populations, altering the risk of mosquito-borne diseases. Mosquito distribution, diversity, and bloodmeal sources were examined to compare Rift Valley fever (RVF) risk among irrigated, riverine, and pastoral ecosystems in Bura, Tana River County, Kenya, between September 2014 and June 2015. Thirty-eight households and 21 irrigation fields were selected for the study. Mosquitoes were trapped with carbon dioxide-impregnated CDC traps, one trap per household and three traps per irrigated field, and morphologically identified using taxonomic keys. Host DNA was extracted from engorged females and cytochrome b genes amplified by PCR to identify sources of bloodmeals. A total of 21,015 mosquitoes were collected; 5742 within households in the 3 ecosystems and 15,273 within irrigated fields. Mosquitoes collected within irrigated fields belonged to 8 genera and 37 species, while those from households within the irrigation scheme belonged to 6 genera and 29 species. Collections from riverine and pastoral households belonged to five and four genera, respectively. The most abundant genera in the irrigated fields were Aedes (21%) and Mansonia (22%), while Anopheles (43%) was the most abundant within households. Most mosquitoes in riverine and pastoral households belonged to Anopheles (76%) and Aedes (65%) genera, respectively. Seasonal variation driven by rainfall was evidenced by spikes in mosquito numbers within irrigated and riverine ecosystems. Host species identification revealed that goats and humans were the main sources of bloodmeal. There was an overall increase in mosquito abundance and diversity as a result of the presence of the irrigated ecosystem in this county, and an increased availability of highly RVF-susceptible hosts as a result of the establishment and concentration of residential areas, promoting potential vector-host contacts. These results highlight the impact of anthropogenic changes on mosquito ecology, potentially heightening the risk of transmission and maintenance of RVF in this region.