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BackgroundSince Aedes aegypti mosquitoes preferentially breed in domestic containers, control efforts focus on larval source reduction. Our objectives were to design and test the effectiveness of a source reduction intervention to improve caregiver knowledge and behaviors in coastal Kenya.Methodology/principal findingsWe conducted a cluster-randomized controlled trial with 261 households from 5 control villages and 259 households from 5 intervention villages. From each household, one child (10-16 years old) and his or her primary caregiver participated in the intervention. We assessed caregiver knowledge and behavior at baseline, as well as 3 and 12 months after the intervention. We assessed household entomological indices at baseline and 12 months after the intervention to avoid seasonal interference. We conducted qualitative interviews with 34 caregivers to understand barriers and facilitators to change. We counted and weighed containers collected by children and parents during a community container clean-up and recycling event. After 12 months, caregiver knowledge about and self-reported behavior related to at least one source reduction technique was more than 50 percentage points higher in the intervention compared to control arm (adjusted risk differences for knowledge: 0.69, 95% CI [0.56 to 0.82], and behavior: 0.58 [0.43 to 0.73]). Respondents stated that other family members' actions were the primary barriers to proper container management. The number of containers at households did not differ significantly across arms even though children and parents collected 17,200 containers (1 ton of plastics) which were used to planted 4,000 native trees as part of the community event.Conclusions/significanceOur study demonstrates that source reduction interventions can be effective if designed with an understanding of the social and entomological context. Further, source reduction is not an individual issue, but rather a social/communal issue, requiring the participation of other household and community members to be sustained.

Dengue virus (DENV) and chikungunya virus (CHIKV) are causes of endemic febrile disease among Kenyan children. The exposure risk to these infections is highly multifactorial and linked to environmental factors and human behavior. We investigated relationships between household, socio-economic, demographic, and behavioral risk factors for DENV and CHIKV seropositivity and seroconversion in four settlements in Kenya. We prospectively followed a pediatric cohort of 3,445 children between 2014–2018. We utilized the Kaplan–Meier curves to describe the temporal patterns of seroconversion among tested participants. We employed logistic regression built using generalized linear mixed models, to identify potential exposure risk factors for DENV and CHIKV seroconversion and seropositivity. Overall, 5.2% children were seropositive for DENV, of which 59% seroconverted during the study period. The seroprevalence for CHIKV was 9.2%, of which 54% seroconverted. The fraction of seroconversions per year in the study cohort was <2% for both viruses. Multivariable analysis indicated that older age and the presence of water containers ((OR: 1.15 [95% CI: 1.10, 1.21]), (OR: 1.50 [95% CI: 1.07, 2.10])) increased the odds of DENV seropositivity, whereas higher wealth (OR: 0.83 [95% CI: 0.73, 0.96]) decreased the odds of DENV seropositivity. Multivariable analysis for CHIKV seropositivity showed older age and the presence of trash in the housing compound to be associated with increased odds of CHIKV seropositivity ((OR: 1.11[95% CI: 1.07, 1.15]), (OR: 1.34 [95% CI: 1.04, 1.73])), while higher wealth decreased the odds of CHIKV seropositivity (OR: 0.74[95% CI: 0.66, 0.83]). A higher wealth index (OR: 0.82 [95% CI: 0.69, 0.97]) decreased the odds of DENV seroconversion, whereas a higher age (OR: 1.08 [95% CI: 1.02, 1.15]) and the presence of water containers in the household (OR: 1.91[95% CI: 1.24, 2.95]) were significantly associated with increased odds of DENV seroconversion. Higher wealth was associated with decreased odds for CHIKV seroconversion (OR: 0.75 [95% CI: 0.66, 0.89]), whereas presence of water containers in the house (OR: 1.57 [95% CI: 1.11, 2.21]) was a risk factor for CHIKV seroconversion. Our study links ongoing CHIKV and DENV exposure to decreased wealth and clean water access, underscoring the need to combat inequity and poverty and further enhance ongoing surveillance for arboviruses in Kenya to decrease disease transmission. The study emphasizes the co-circulation of DENV and CHIKV and calls for strengthening the targeted control strategies of mosquito borne diseases in Kenya including vector control, environmental management, public education, community engagement and personal protection. Author summary: Dengue virus (DENV) and chikungunya virus (CHIKV) are important arboviral infections that cause endemic febrile disease specially among children in Kenya. Since there is no active surveillance for DENV and CHIKV infections in Kenya, the actual burden of these infections and their associated risk factors remains unknown. In this longitudinal cohort study spanning over a period of five years between 2014–2018, we investigate relationships between household, socio-economic, demographic, and behavioral risk factors for DENV and CHIKV seropositivity and seroconversion in four settlements in Kenya and describe the temporal patterns of seroconversion among the tested participants. The study emphasizes the existence of active DENV and CHIKV disease transmission in Kenya. The results also highlight older age, presence of water containers and trash on the housing compounds to increase the odds of DENV and CHIKV seropositivity and seroconversion whereas a higher wealth index decreased the odds of DENV and CHIKV seropositivity and seroconversion. The results of our study link ongoing CHIKV and DENV exposure in Kenya to lower income and resources, underscoring the need to combat inequity and poverty and enhance ongoing surveillance for arboviruses in Kenya. [ABSTRACT FROM AUTHOR]

BackgroundClinicians in low resource settings in malaria endemic regions face many challenges in diagnosing and treating febrile illnesses in children. Given the change in WHO guidelines in 2010 that recommend malaria testing prior to treatment, clinicians are now required to expand the differential when malaria testing is negative. Prior studies have indicated that resource availability, need for additional training in differentiating non-malarial illnesses, and lack of understanding within the community of when to seek care play a role in effective diagnosis and treatment. The objective of this study was to examine the various factors that influence clinician behavior in diagnosing and managing children presenting with fever to health centres in Kenya.MethodsA total of 20 clinicians (2 paediatricians, 1 medical officer, 2 nurses, and 15 clinical officers) were interviewed, working at 5 different government-sponsored public clinic sites in two areas of Kenya where malaria is prevalent. Clinicians were interviewed one-on-one using a structured interview technique. Interviews were then analysed qualitatively for themes.ResultsThe following five themes were identified: (1) Strong familiarity with diagnosis of malaria and testing for malaria; (2) Clinician concerns about community understanding of febrile illness, use of traditional medicine, delay in seeking care, and compliance; (3) Reliance on clinical guidelines, history, and physical examination to diagnose febrile illness and recognize danger signs; (4) Clinician discomfort with diagnosis of primary viral illness leading to increased use of empiric antibiotics; and (5) Lack of resources including diagnostic testing, necessary medications, and training modalities contributes to the difficulty clinicians face in assessing and treating febrile illness in children. These themes persisted across all sites, despite variation in levels of medical care. Within these themes, clinicians consistently expressed a need for reliable basic testing, especially haemograms and bacterial cultures. Clinicians discussed the use of counseling and education to improve community understanding of febrile illness in order to decrease preventable deaths in children.ConclusionResults of this study suggest that since malarial testing has become more widespread, clinicians working in resource-poor environments still face difficulty when evaluating a child with fever, especially when malaria testing is negative. Improving access to additional diagnostics, continuing medical education, and ongoing evaluation and revision of clinical guidelines may lead to more consistent management of febrile illness by providers, and may potentially decrease prescription of unnecessary antibiotics. Additional interventions at the community level may also have an important role in managing febrile illness, however, more studies are needed to identify targets for intervention at both the clinic and community levels.

Dengue virus (DENV) is a reemerging arbovirus with an expansive worldwide range (1). Recent modeling studies suggest wider dengue circulation in Africa than previously recognized (2). In addition, both major [...]

We enrolled 21 patients with laboratory-confirmed yellow fever (YF), hospitalized at Eduardo de Menezes Hospital, Brazil, to be treated with sofosbuvir, a drug approved for hepatitis C. Given the absence of specific YF antiviral treatments, the off-label nonrandomized sofosbuvir treatment aimed to address high disease severity and the risk of fatal outcomes. Patients received a daily dose of 400 mg sofosbuvir from 4 to 10 days post–symptom onset. YF viral load (VL) comparisons were made between treated and nontreated patients who either survived or died. The genomic VL for the treated group steadily decreased after day 7 post–symptom onset, suggesting that sofosbuvir might reduce YF VL. This study underscores the urgent need for YF antiviral therapies, advocating for randomized clinical trials to further explore sofosbuvir's role in YF treatment. [ABSTRACT FROM AUTHOR]

The environments in which we live affect individual and community risk for disease transmission and illness severity. Communities’ and neighborhoods’ waste stream management designs and health care organizations’ spatial and structural architecture also influence individuals’ and communities’ pathogenic vulnerabilities and how well health sector industrial hygiene practices support them. This article describes a One Health approach to planetary environmental health and suggests strategies for implementing a One Health or Planetary Health approach in the context of climate change. [ABSTRACT FROM AUTHOR]

Introduction: dengue cases occur frequently in Kenya, although the trend is not uniform across the country, making this infectious disease a major public health problem that is transmitted without detection. The purpose of this review study was to determine the seroprevalence of dengue virus (DENV) infection in the Kenyan population during the last ten years to reveal geographical areas with unreported dengue fever activity. For that purpose, this review describes the recent (2010 to 2020) DENV incidences, methods of detection, and the circulating genotypes in Kenya. Methods: studies were identified to summarize reported dengue fever infections and epidemic activities in Kenya using a search approach (terms "Dengue", "Dengue Virus" and "DENV" in combination with "Infection in Kenya"). All published studies between 2010 and 2020 retrieved through search engines PubMed, Google Scholar, Research4life, and ScienceDirect were screened for eligibility. Results: a total of 21 eligible articles containing 24 studies, covering five general geographic regions and 39 sampling sites, were included in this review. The results indicate a surveillance gap in dengue fever infection serosurvey in Kenya. There was transmission between epidemics in the reported areas. Seroprevalence ranged from 0.4% to 100% during outbreaks. Coast region was the most studied region with Mombasa being the most sampled site. Conclusion: about 76.6% of Kenyan Counties' DENV seroprevalence status was found to be unknown or unreported. In addition, DENV infection was unrecognized and/or unreported in most areas of the country, especially rural Kenya. This information may serve as a basis for better awareness and detection of DENV infection during outbreaks and in establishing appropriate prevention and control measures to further avoid outbreaks. [ABSTRACT FROM AUTHOR]

Due to lack of national surveillance programs, the extent of infection with dengue viruses (DENV) among children is largely unknown in much of sub-Saharan Africa (1). Uncovering this hidden burden [...]