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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) 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]

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 [...]

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 [...]

Introduction A marked increase in malaria has recently been noted in the African highlands, largely due to the rise of drug-resistant strains of Plasmodium falciparum parasites. (1-4) The ecological features [...], Objective To assess the contributions of both microbial larvicides and insecticide-treated nets (ITNs) in terms of reducing malaria incidence in an integrated vector management programme in an area moderately endemic for malaria in the western Kenyan highlands. Methods A pre-post, control group design was used. Larval and adult vector populations were surveyed weekly in six separate valley communities. The incidence of Plasmodium infections in children 6 months to 13 years of age was measured during the long and short rainy seasons each year. Baseline data were collected for 17 months, after which Bacillus-based larvicides were applied weekly to aquatic habitats in three of the valleys for another 19 months. At around the same time the larviciding was initiated, ITNs were introduced gradually into all study communities by the National Malaria Control Programme. The effect of larviciding, ITNs and other determinants of malaria risk was assessed by means of generalized estimating equations. Findings The risk of acquiring new parasite infections in children was substantially and independently reduced by ITN use (odds ratio, OR: 0.69; 95% confidence interval, Ch 0.48-0.99) and larvicide application (OR: 0.44; 95% CI: 0.23-0.82), after adjusting for confounders. Conclusion Vector control with microbial larvicides enhanced the malaria control achieved with ITNs alone. Anti-larval measures are a promising complement to ITN distribution in the economically important highland areas and similar transmission settings in Africa. Objectif Evaluer les contributions des larvicides microbiens et des moustiquaires impregnees d'insecticide (Mil) a la reduction de l'incidence du paludisme dans le cadre d'un programme de lutte antivectorielle integree, applique a une zone d'endemie moderee de cette maladie, dans les hauts plateaux du Kenya occidental. Methodes On a fait appel a une etude de type avant-apres avec groupe temoin. On a surveille chaque semaine les populations de larves et de vecteurs adultes menacant les communautes vivant dans six vallees separees. On a mesure chaque annee l'incidence des infections a Plasmodium chez les enfants de 6 mois a 13 ans au cours des deux saisons des pluies (Iongue et courte). On a collecte des donnee de reference pendant 17 mois, apres quoi on applique chaque semaine des larvicides a base de Bacillus sur les habitats aquatiques de trois des vallees pendant 19 autres mois. En meme temps a peu pres que debutait la destruction des larves, le Programme kenyan de lutte contre le paludisme a commence a introduire progressivement des Mil dans toutes los communautes etudiees. Les effets de la destruction larvaire, des Mil et d'autres determinants du risque de paludisme ont ete evalues a l'aide d'equations d'estimation generalisee. Resultats Apres ajustement pour les facteurs de confusion, le risque de contracter une nouvelle infestation parasitaire chez l'enfant etait substantiellement et independamment reduit par l'utilisation de Mil (Odds ratio, OR : 0,69, intervalle de confiance a 95%, IC : 0,48-0,99) et par l'application de larvicide (OR : 0,44 ; IC a 95% : 0,23-0,82). Conclusion La lutte antivectorielle par application de larvicides microbiens a permis de renforcer les resultats obtenus contre le paludisme avec les Mil seules. Les mesures de lutte antilarvaire representent un complement prometteur a la distribution de Mil dans les zones importantes sur le plan economique des hauts plateaux et dans d'autres contextes similaires en Afrique ou se transmet actuellement le paludisme. Objetivo Determinar la contribucion de los larvicidas microbianos y los mosquiteros tratados con insecticida (MTI) a la reduccion de la incidencia de malaria en un programa de lucha antivectorial integrada emprendido en una zona con malaria moderadamente endemica de las tierras altas dei oeste de Kenya. Metodos Se Ilevo a cabo un estudio pre-post con un grupo de control en el que se procedio a vigilar las poblaciones de larvas y vectores adultos en las comunidades de seis valles. Anualmente se midio la incidencia de infeccion por Plasmodium en los ninos de 6 meses a 13 anos durante cada estacion de las Iluvias cortas y largas. Se reunieron datos de referencia por espacio de 17 meses, tras lo cual se procedio a aplicar todas las semanas larvicidas basados en Bacillus en habitats acuaticos entres de los valles durante otros 19 meses. Aproximadamente al mismo tiempo que se iniciaba la aplicacion de larvicidas, el Programa Nacional de Control de la Malaria comenzo tambien a introducir gradualmente los MTI en todas las comunidades estudiadas. El efecto de los larvicidas, los MTI y otros determinantes dei riesgo de malaria se evaluo mediante ecuaciones de estimacion generalizadas. Resultados El riesgo de los nifios de contraer nuevas infecciones por el parasito se vio reducido de forma sustancial e independiente por el uso de MTI (razon de posibilidades, OR: 0,69; intervalo de confianza [IC] del 95%: 0,48-0,99) y por la aplicacion de larvicidas (OR: 0,44; IC 95%: 0,23-0,82), despues de ajustar por los factores de confusion. Conclusion La lucha antivectorial con larvicidas microbianos potencio el control de la malaria logrado solo con MTI. Las medidas antilarvarias son un complemento prometedor de la distribucion de MTI en las zonas montanosas economicamente importantes y otros entornos de transmision similares en Africa.

Background In low-resource, malaria-endemic settings, accurate diagnosis of febrile illness in children is challenging. The World Health Organization (WHO) currently recommends laboratory-confirmed diagnosis of malaria prior to starting treatment in stable children. Factors guiding management of children with undifferentiated febrile illness outside of malaria are not well understood. Methods This study examined clinical presentation and management of a cohort of febrile Kenyan children at 5 hospital/clinic sites from January 2014 to December 2017. Chi-squared and multivariate regression analyses were used to compare frequencies and correlate demographic, environmental, and clinical factors with patient diagnosis and prescription of antibiotics. Results Of 5735 total participants, 68% were prescribed antibiotic treatment (n = 3902), despite only 28% given a diagnosis of bacterial illness (n = 1589). Factors associated with prescription of antibiotic therapy included: negative malaria testing, reporting head, ears, eyes, nose and throat (HEENT) symptoms (ie, cough, runny nose), HEENT findings on exam (ie, nasal discharge, red throat), and having a flush toilet in the home (likely a surrogate for higher socioeconomic status). Conclusion In a cohort of acutely ill Kenyan children, prescription of antimalarial therapy and malaria test results were well correlated, whereas antibiotic treatment was prescribed empirically to most of those who tested malaria negative. Clinical management of febrile children in these settings is difficult, given the lack of diagnostic testing. Providers may benefit from improved clinical education and implementation of enhanced guidelines in this era of malaria testing, as their management strategies must rely primarily on critical thinking and decision-making skills. [ABSTRACT FROM AUTHOR]

Abstract Background Recent resurgence of malaria in the highlands of Western Kenya has called for a more comprehensive understanding of the previously neglected complex highland vector ecology. Besides other drivers of malaria epidemiology, topography is likely to have a major effect on spatial vector and parasite distribution. The aim of this study was to determine the effects of topography on malaria spatial vector distribution and parasite prevalence. Methodology Indoor resting adult malaria vectors and blood parasites were collected in three villages along a 4 km transect originating from the valley bottom and ending at the hilltop for 13 months. Members of the Anopheles gambiae complex were identified by PCR. Blood parasites were collected from children 6–13 years old and densities categorized by site of home location and age of the children. Results Ninety eight percent (98%) of An. gambiae s.s. and (99%) Anopheles funestus were collected in houses located at the edge of the valley bottom, whereas 1% of An. gambiae s.s. were collected at mid hill and at the hilltop respectively. No An. funestus were collected at the hilltop. Malaria prevalence was 68% at the valley bottom, 40.2% at mid hill and 26.7% at the hilltop. Children aged six years and living at the edge of the valley bottom had an annual geometric mean number of 66.1 trophozoites for every 200 white blood cells, while those living at mid-hill had a mean of 84.8, and those living at hilltop had 199.5 trophozoites. Conclusion Malaria transmission in this area is mainly confined to the valley bottom. Effective vector control could be targeted at the foci. However, the few vectors observed at mid-hill maintained a relatively high prevalence rate. The higher variability in blood parasite densities and their low correlation with age in children living at the hilltop suggests a lower stability of transmission than at the mid-hill and valley bottom.

Little is known about the extent and serotypes of dengue viruses circulating in Africa. We evaluated the presence of dengue viremia during 4 years of surveillance (2014-2017) among children with febrile illness in Kenya. Acutely ill febrile children were recruited from 4 clinical sites in western and coastal Kenya, and 1,022 participant samples were tested by using a highly sensitive real-time reverse transcription PCR. A complete case analysis with genomic sequencing and phylogenetic analyses was conducted to characterize the presence of dengue viremia among participants during 2014-2017. Dengue viremia was detected in 41.9% (361/862) of outpatient children who had undifferentiated febrile illness in Kenya. Of children with confirmed dengue viremia, 51.5% (150/291) had malaria parasitemia. All 4 dengue virus serotypes were detected, and phylogenetic analyses showed several viruses from novel lineages. Our results suggests high levels of dengue virus infection among children with undifferentiated febrile illness in Kenya. [ABSTRACT FROM AUTHOR]