Search

In artisanal small-scale gold mines (ASGM), mercury (Hg) is known to pollute nearby river waters and sediments where it can be methylated to the highly bioavailable methylmercury (MeHg). The assessment of Hg speciation in water samples has been challenging for many years, with recommended procedures often not adequately allowing for analysis of samples in a suitable timeframe. Using a novel solid-phase extraction (SPE) method for sampling and preservation of Hg species, representative speciation data can be safely and easily collected and retained for up to 4-weeks (MeHg = 115 ± 8% refrigerated and 109 ± 13% unrefrigerated storage; Hg 2+  = 100 ± 14% refrigerated and 94 ± 12% unrefrigerated storage). Concentrations of MeHg in environmental water samples and drinking water were below detection limit across two ASGM sites in western Kenya and concentrations of Hg 2+ were below drinking water guidelines; however, drinking water sources contribute 20-30% of the tolerable weekly intake of Hg, indicating a need to minimise exposure of Hg from dietary sources to prevent Hg poisoning. Sediments from receiving rivers at ASGM sites showed total Hg concentrations above guideline limits (0.08-1.84 mg kg -1 total Hg) along the length of the river; however, MeHg concentrations fluctuated dependent on the stagnation of the river due to damns and ponds (5.9 ± 14.3 µg kg -1 MeHg). The findings show that SPE can be used as a robust sample collection and preservation approach for Hg speciation, which can better inform mitigation measures, understand ecological and human health implications, and improve environmental monitoring., (© 2024. British Geological Survey (UKRI), Nottingham Trent University, Odipo Osano, Robert Mortimer.)

Climate change poses an immediate threat to tropical soils with changes in rainfall patterns resulting in accelerated land degradation processes. To ensure the future sustainability of arable land, it is essential to improve our understanding of the factors that influence soil erosion processes. This work aimed to evaluate patterns of soil erosion using the activity of plutonium isotopes (Pu) at sites with different land use and clearance scale in the Winam Gulf catchment of Lake Victoria in Kenya. Erosion rates were modelled at potential erosive sites using the MODERN model to understand small-scale erosion processes and the effect of different management practices. The lowest soil redistribution rates for arable land were 0.10 Mg ha -1  yr -1 showing overall deposition, resulting from community-led bottom-up mitigation practices. In contrast erosion rates of 8.93 Mg ha -1  yr -1 were found in areas where steep terraces have been formed. This demonstrates the significance of community-led participation in effectively managing land degradation processes. Another key factor identified in the acceleration of soil erosion rates was the clearance of land with an increased rate of erosion over three years reported (0.45 to 0.82 Mg ha -1  yr -1 ) underlining the importance vegetation cover plays in limiting soil erosion processes. This novel application of fallout plutonium as a tracer, highlights its potential to inform the understanding of how soil erosion processes respond to land management, which will better support implementation of effective mitigation strategies., (© 2024. Crown.)

The Kakamega gold belt's natural geological enrichment and artisanal and small-scale gold mining (ASGM) have resulted in food and environmental pollution, human exposure, and subsequent risks to health. This study aimed to characterise exposure pathways and risks among ASGM communities. Human hair, nails, urine, water, and staple food crops were collected and analysed from 144 ASGM miners and 25 people from the ASGM associated communities. Exposure to PHEs was predominantly via drinking water from mine shafts, springs and shallow-wells (for As>Pb>Cr>Al), with up to 366 µg L -1 arsenic measured in shaft waters consumed by miners. Additional exposure was via consumption of locally grown crops (for As>Ni>Pb>Cr>Cd>Hg>Al) besides inhalation of Hg vapour and dust, and direct dermal contact with Hg. Urinary elemental concentrations for both ASGM workers and wider ASGM communities were in nearly all cases above bioequivalents and reference upper thresholds for As, Cr, Hg, Ni, Pb and Sb, with median concentrations of 12.3, 0.4, 1.6, 5.1, 0.7 and 0.15 µg L -1 , respectively. Urinary As concentrations showed a strong positive correlation (0.958) with As in drinking water. This study highlighted the importance of a multidisciplinary approach in integrating environmental, dietary, and public health investigations to better characterise the hazards and risks associated with ASGM and better understand the trade-offs associated with ASGM activities relating to public health and environmental sustainability. Further research is crucial, and study results have been shared with Public Health and Environmental authorities to inform mitigation efforts., Competing Interests: Declaration of Competing Interest Michael Watts reports financial support was provided by Natural Environment Research Council. Michael Watts reports financial support was provided by The Royal Society. Michael Watts reports financial support was provided by The British Academy. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Analysis of mercury (Hg) in natural water samples has routinely been impractical in many environments, for example, artisanal and small-scale gold mines (ASGM), where difficult conditions make monitoring of harmful elements and chemicals used in the processes highly challenging. Current sampling methods require the use of hazardous or expensive materials, and so difficulties in sample collection and transport are elevated. To solve this problem, a solid-phase extraction-based method was developed for the sampling and preservation of dissolved Hg in natural water samples, particularly those found around ASGM sites. Recoveries of 85% ± 10% total Hg were obtained during 4 weeks of storage in refrigerated (4 °C, dark) and unrefrigerated (16 °C, dark) conditions, and from a representative river water spiked to 1 μg L -1 Hg 2+ , 94% ± 1% Hg recovery was obtained. Solid-phase extraction loading flow rates were tested at 2, 5, and 10 mL min -1 with no breakthrough of Hg, and sorbent stability showed no breakthrough of Hg up to 2 weeks after functionalisation. The method was deployed across five artisanal gold mines in Kakamega gold belt, Kenya, to assess Hg concentrations in mine shaft water, ore washing ponds, and river and stream water, including drinking water sources. In all waters, Hg concentrations were below the WHO guideline limit value of 6 μg L -1 , but drinking water sources contained trace concentrations of up to 0.35 μg L -1 total Hg, which may result in negative health effects from long-term exposure. The SPE method developed and deployed here is a robust sampling method that can therefore be applied in future Hg monitoring, toxicology, and environmental work to provide improved data that is representative of total dissolved Hg in water samples.

Land degradation resulting from soil erosion is a global concern, with the greatest risk in developing countries where food and land resources can be limited. The use of fallout radionuclides (FRNs) is a proven method for determining short and medium-term rates of soil erosion, to help improve our understanding of soil erosion processes. There has been limited use of these methods in tropical Africa due to the analytical challenges associated with 137 Cs, where inventories are an order of magnitude lower than in the Europe. This research aimed to demonstrate the usability of 239+240 Pu as a soil erosion tracer in western Kenya compared to conventional isotopes 210 Pb ex and 137 Cs through the determination of FRN depth profiles at reference sites. Across six reference sites 239+240 Pu showed the greatest potential, with the lowest coefficient of variation and the greatest peak-to-detection limit ratio of 640 compared to 5 and 1 for 210 Pb ex and 137 Cs respectively. Additionally, 239+240 Pu was the only radionuclide to meet the 'allowable error' threshold, demonstrating applicability to large scale studies in Western Kenya where the selection of suitable reference sites presents a significant challenge. The depth profile of 239+240 Pu followed a polynomial function, with the maximum areal activities found between depths 3 and 12 cm, where thereafter areal activities decreased exponentially. As a result, 239+240 Pu is presented as a robust tracer to evaluate soil erosion patterns and amounts in western Kenya, providing a powerful tool to inform and validate mitigation strategies with improved understanding of land degradation., Competing Interests: Declaration of competing interest There are no conflicts to declare., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

The analysis of plutonium (Pu) in soil samples can inform the understanding of soil erosion processes globally. However, there are specific challenges associated for analysis in tropical soils and so an optimal analytical methodology ensuring best sensitivity is critical. This method aimed to demonstrate the feasibility of sample preparation and analysis of Pu isotopes in African soils, considering the environmental and cost implications applicable to low-resource laboratories. The separation procedure builds upon previous work using TEVA columns, further demonstrating their usefulness for the reduction of uranium (U) interference in ICP-MS analysis with enhanced selectivity for Pu. Here several steps were optimised to enhance Pu recovery, reducing method blank concentration, and improving the separation efficiency through the determination of the elution profiles of U and Pu. The elimination of the complexing agent in the eluent, increased the spike recovery by improving matrix tolerance of the plasma, and simplified the separation procedure, improving throughput by 20%. The subsequent method was validated through the analysis of Certified Reference Material IAEA-384, where high accuracy and improved precision of measurement were demonstrated (measured value 114 ± 12 versus certified value 108 ± 13 Bq kg -1 ). Optimisation of the column separation, along with the analysis of the samples using O 2 gas in ICP-MS/MS mode to mass shift Pu isotopes away from interfering molecular U ions provided a simple, robust, and cost-effective method with low achievable method detection limits of 0.18 pg kg -1 239+240 Pu, applicable to the detection of ultra-trace fallout Pu in African soils.

Artisanal and small-scale gold mining (ASGM) represents 20% of gold supply and 90% of gold mining workforce globally, which operates in highly informal setups. Pollutants from mined ores and chemicals introduced during gold processing pose occupational and inadvertent health risks to the extent that has not been well elucidated in Africa. Trace and major elements were analysed using inductively coupled plasma mass spectrometry in soil, sediment and water samples from 19 ASGM villages in Kakamega and Vihiga counties. Associated health risks for residents and ASGM workers were assessed. This paper focuses on As, Cd, Cr, Hg, Ni and Pb for which 96% of soil samples from mining and ore processing sites had As concentrations up to 7937 times higher than the US EPA 12 mg kg -1 standard for residential soils. Soil Cr, Hg and Ni concentrations in 98%, 49% and 68% of the samples exceeded respective USEPA and CCME standards, with 1-72% bioaccessibility. Twenty-five percentage of community drinking water sources were higher than the WHO 10 µg L -1 drinking water guideline. Pollution indices indicated significant enrichment and pollution of soils, sediment and water in decreasing order of As > Cr > Hg > Ni > Pb > Cd. The study revealed increased risks of non-cancer health effects (98.6) and cancer in adults (4.93 × 10 -2 ) and children (1.75 × 10 -1 ). The findings will help environment managers and public health authorities better understand the potential health risks in ASGM and support evidence-based interventions in ASGM processes, industrial hygiene and formulation of public health policy to protect residents and ASGM workers' health in Kenya., (© 2023. Crown.)

Studies on parasite biogeography and host spectrum provide insights into the processes driving parasite diversification. Global geographical distribution and a multi-host spectrum make the tapeworm Ligula intestinalis a promising model for studying both the vicariant and ecological modes of speciation in parasites. To understand the relative importance of host association and biogeography in the evolutionary history of this tapeworm, we analysed mtDNA and reduced-represented genomic SNP data for a total of 139 specimens collected from 18 fish-host genera across a distribution range representing 21 countries. Our results strongly supported the existence of at least 10 evolutionary lineages and estimated the deepest divergence at approximately 4.99-5.05 Mya, which is much younger than the diversification of the fish host genera and orders. Historical biogeography analyses revealed that the ancestor of the parasite diversified following multiple vicariance events and was widespread throughout the Palearctic, Afrotropical, and Nearctic between the late Miocene and early Pliocene. Cyprinoids were inferred as the ancestral hosts for the parasite. Later, from the late Pliocene to Pleistocene, new lineages emerged following a series of biogeographic dispersal and host-switching events. Although only a few of the current Ligula lineages show narrow host-specificity (to a single host genus), almost no host genera, even those that live in sympatry, overlapped between different Ligula lineages. Our analyses uncovered the impact of historical distribution shifts on host switching and the evolution of host specificity without parallel host-parasite co-speciation. Historical biogeography reconstructions also found that the parasite colonized several areas (Afrotropical and Australasian) much earlier than was suggested by only recent faunistic data., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Soil erosion accelerated by poor agricultural practices, land degradation, deprived infrastructure development and other anthropogenic activities has important implications for nutrient cycling, land and lake productivity, loss of livelihoods and ecosystem services, as well as socioeconomic disruption. Enhanced knowledge of dynamic factors influencing soil erosion is critical for policymakers engaged in land use decision-making. This study presents the first spatio-temporal assessment of soil erosion risk modelling in the Winam Gulf, Kenya using the Revised Universal Soil Loss Equation (RUSLE) within a geospatial framework at a monthly resolution between January 2017 and June 2020. Dynamic rainfall erosivity and land cover management factors were derived from existing datasets to determine their effect on average monthly soil loss by water erosion. By assessing soil erosion rates with enhanced temporal resolution, it is possible to provide greater knowledge regarding months that are particularly susceptible to soil erosion and can better inform future strategies for targeted mitigation measures. Whilst the pseudo monthly average soil loss was calculated (0.80 t ha -1  month -1 ), the application of this value would lead to misrepresentation of monthly soil loss throughout the year. Our results indicate that the highest erosion rates occur between February and April (average 0.95 t ha -1  month -1 ). In contrast, between May and August, there is a significantly reduced risk (average 0.72 t ha -1  month -1 ) due to the low rainfall erosivity and increased vegetation cover as a result of the long rainy season. The mean annual gross soil loss by water erosion in the Winam Gulf catchment amounts to 10.71 Mt year -1 , with a mean soil loss rate of 9.63 t ha -1  year -1 . These findings highlight the need to consider dynamic factors within the RUSLE model and can prove vital for identifying areas of high erosion risk for future targeted investigation and conservation action., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2021. Published by Elsevier B.V. All rights reserved.)

Spot urinary elemental concentrations are presented for 357 adults from Western Kenya collected between 2016 and 2019 as part of a wider environmental geochemical survey. The aim of this study was to establish population level urinary elemental concentrations in Western Kenya for micronutrients and potentially harmful elements for inference of health status against established thresholds. For elements where thresholds inferring health status were not established in the literature using urine as a non-invasive matrix, this study generated reference values with a 95% confidence interval (RV 95 s) to contextualise urinary elemental data for this population group. Data are presented with outliers removed based upon creatinine measurements leaving 322 individuals, for sub-categories (e.g. age, gender) and by county public health administrative area. For Western Kenya, reference values with a 95% confidence interval (RV 95 s) were calculated as follows (μg/L): 717 (I), 89 (Se), 1753 (Zn), 336 (Mo), 24 (Cu), 15.6 (Ni), 22.1 (As), 0.34 (Cd), 0.47 (Sn), 0.46 (Sb), 7.0 (Cs), 13.4 (Ba and 1.9 (Pb). Urinary concentrations at the 25th/75th percentiles were as follows (μg/L): 149/368 (I), 15/42 (Se), 281/845 (Zn), 30/128 (Mo), 6/13 (Cu), 1.7/6.1 (Ni), 2.0/8.2 (As). 0.1/0.3 (Cd), 0.05/0.22 (Sn), 0.04/0.18 (Sb), 1.2/3.6 (Cs), 0.8/4.0 (Ba) and 0.2/0.9 (Pb). Urinary concentrations at a population level inferred excess intake of micronutrients I, Se, Zn and Mo in 38, 6, 57 and 14% of individuals, respectively, versus a bioequivalent (BE) upper threshold limit, whilst rates of deficiency were relatively low at 15, 15, 9 and 18%, respectively. Each of the administrative counties showed a broadly similar range of urinary elemental concentrations, with some exceptions for counties bordering Lake Victoria where food consumption habits may differ significantly to other counties e.g. I, Se, Zn. Corrections for urinary dilution using creatinine, specific gravity and osmolality provided a general reduction in RV 95 s for I, Mo, Se, As and Sn compared to uncorrected data, with consistency between the three correction methods., (Crown Copyright © 2021. Published by Elsevier GmbH. All rights reserved.)

Competing Interests: CAFG declares consulting fees from the Planetary Health Alliance. CH declares consulting fees from the Lancet Countdown on Health and Climate Change and from CODA Change and board positions or steering committee for Global Climate and Health Alliance, the WHO-Civil Society Working Group on Climate Change and Health, the Planetary Health Alliance, the Canadian Association of Physicians for the Environment, and the Canadian Medical Association. EB declares being the chair of the WONCA Working Party on the Environment and was a grant recipient from WONCA Air Health Train-the-Trainer. JP declares being recipient of the Chanchlani Award for Global Health Research. MZ declares consulting work with the Organization for Noetic Ecology NPO and Wildlands Studies; and pro-bono advisor or associate to Sea Change Trust (South Africa), Masiyembo Association (South Africa), The Connective (Australia), and Earthfire Institute (USA). NE declares a previous role as a data analysis consultant at HowGood starting March 17, 2021. Brunel University London has supported provision on OM's time in-kind for this project and preparation of this manuscript. TP declares budget for travel to Planetary Health events, but funds were not used during the writing of this paper. All other authors declare no competing interests.

Spot urinary iodine concentrations (UIC) are presented for 248 individuals from western Kenya with paired drinking water collected between 2016 and 2018. The median UIC was 271 µg L -1 , ranging from 9 to 3146 µg L -1 , unadjusted for hydration status/dilution. From these data, 12% were potentially iodine deficient (< 100 µg L -1 ), whilst 44% were considered to have an excess iodine intake (> 300 µg L -1 ). The application of hydration status/urinary dilution correction methods was evaluated for UICs, using creatinine, osmolality and specific gravity. The use of specific gravity correction for spot urine samples to account for hydration status/urinary dilution presents a practical approach for studies with limited budgets, rather than relying on unadjusted UICs, 24 h sampling, use of significantly large sample size in a cross-sectional study and other reported measures to smooth out the urinary dilution effect. Urinary corrections did influence boundary assessment for deficiency-sufficiency-excess for this group of participants, ranging from 31 to 44% having excess iodine intake, albeit for a study of this size. However, comparison of the correction methods did highlight that 22% of the variation in UICs was due to urinary dilution, highlighting the need for such correction, although creatinine performed poorly, yet specific gravity as a low-cost method was comparable to osmolality corrections as the often stated 'gold standard' metric for urinary concentration. Paired drinking water samples contained a median iodine concentration of 3.2 µg L -1 (0.2-304.1 µg L -1 ). A weak correlation was observed between UIC and water-I concentrations (R = 0.11).

Soil, water and food supply composition data have been combined to primarily estimate micronutrient intakes and subsequent risk of deficiencies in each of the regions studied by generating new data to supplement and update existing food balance sheets. These data capture environmental influences, such as soil chemistry and the drinking water sources to provide spatially resolved crop and drinking water composition data, where combined information is currently limited, to better inform intervention strategies to target micronutrient deficiencies. Approximately 1500 crop samples were analysed, representing 86 food items across 50 sites in Tanzania in 2013 and >230 sites in Western Kenya between 2014 and 2018. Samples were analysed by ICP-MS for 58 elements, with this paper focussing on calcium (Ca), copper (Cu), iron (Fe), magnesium (Mg), selenium (Se), iodine (I), zinc (Zn) and molybdenum (Mo). In general, micronutrient supply from food groups was higher from Kilimanjaro,Tanzania than Counties in Western Kenya, albeit from a smaller sample. For both countries leafy vegetable and vegetable food groups consistently contained higher median micronutrient concentrations compared to other plant based food groups. Overall, calculated deficiency rates were <1% for Cu and Mo and close to or >90% for Ca, Zn and I in both countries. For Mg, a slightly lower risk of deficiency was calculated for Tanzania at 0 to 1% across simplified soil classifications and for female/males, compared to 3 to 20% for Kenya. A significant difference was observed for Se, where a 3 to 28% risk of deficiency was calculated for Tanzania compared to 93 to 100% in Kenya. Overall, 11 soil predictor variables, including pH and organic matter accounted for a small proportion of the variance in the elemental concentration of food. Tanzanian drinking water presented several opportunities for delivering greater than 10% of the estimated average requirement (EAR) for micronutrients. For example, 1 to 56% of the EAR for I and up to 10% for Se or 37% for Zn could be contributed via drinking water.

There are no studies of oral health in relation to esophageal cancer in Africa, or of Eastern Africa's endemic dental fluorosis, an irreversible enamel hypo-mineralization due to early-life excessive fluoride intake. During 2014-18, we conducted a case-control study of squamous cell esophageal cancer in Eldoret, western Kenya. Odds ratios (AORs (95% confidence intervals)) were adjusted for design factors, tobacco, alcohol, ethnicity, education, oral hygiene and missing/decayed teeth. Esophageal cancer cases (N = 430) had poorer oral health and hygiene than controls (N = 440). Compared to no dental fluorosis, moderate/severe fluorosis, which affected 44% of cases, had a crude OR of 20.8 (11.6, 37.4) and on full adjustment was associated with 9.4-fold (4.6, 19.1) increased risk, whilst mild fluorosis (43% of cases) had an AOR of 2.3 (1.3, 4.0). The prevalence of oral leukoplakia and tooth loss/decay increased with fluorosis severity, and increased cancer risks associated with moderate/severe fluorosis were particularly strong in individuals with more tooth loss/decay. Using a mswaki stick (AOR = 1.7 (1.0, 2.9)) rather than a commercial tooth brush and infrequent tooth brushing also independently increased risk. Geographic variations showed that areas of high esophageal cancer incidence and those of high groundwater fluoride levels have remarkably similar locations across Eastern Africa. In conclusion, poor oral health in combination with, or as a result of, high-altitude susceptibility to hydro-geologically influenced dental fluorosis may underlie the striking co-location of Africa's esophageal cancer corridor with the Rift Valley. The findings call for heightened research into primary prevention opportunities of this highly fatal but common cancer., (© 2018 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Oesophageal squamous cell carcinoma (ESCC) has markedly high incidence rates in Kenya and much of East Africa, with a dire prognosis and poorly understood aetiology. Consumption of hot beverages-a probable carcinogen to humans-is associated with increased ESCC risk in other settings and is habitually practiced in Kenya. We conducted a case-control study in Eldoret, western Kenya between August 2013 and March 2018. Cases were patients with endoscopically confirmed oesophageal cancer whose histology did not rule out ESCC. Age and sex-matched controls were hospital visitors and hospital out and in-patients excluding those with digestive diseases. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for self-reported drinking temperatures; consumption frequency; mouth burning frequency and hot porridge consumption using logistic regression models adjusted for potential confounders. Drinking temperature association with tumour sub-location was also investigated. The study included 430 cases and 440 controls. Drinkers of 'very hot' and 'hot' beverages (>95% tea) had a 3.7 (95% CI: 2.1-6.5) and 1.4-fold (1.0-2.0) ESCC risk, respectively compared to 'warm' drinkers. This trend was consistent in males, females, never and ever alcohol/tobacco and was stronger over than under age 50 years. The tumour sub-location distribution (upper/middle/lower oesophagus) did not differ by reported drinking temperature. Our study is the first comprehensive investigation in this setting to-date to observe a link between hot beverage consumption and ESCC in East Africa. These findings provide further evidence for the role of this potentially modifiable risk factor in ESCC aetiology., (© 2018 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Element deficiencies and excesses play important roles in non-communicable disease aetiology. When investigating their roles in epidemiologic studies without prospective designs, reverse-causality limits the utility of transient biomarkers in cases. This study aimed to investigate whether surrogate participants may provide viable proxies by assessing concentration correlations within households. We obtained spot urine samples from 245 Tanzanian and Kenyan adults (including 101 household pairs) to investigate intra-household correlations of urinary elements (As, Ba, Ca, Cd, Co, Cs, Cu, Fe, Li, Mn, Mo, Ni, Pb, Rb, S, Se, Sr, Tl, V and Zn) and concentrations (also available for: Bi, Ce, Sb, Sn and U) relative to external population-levels and health-based values. Moderate-strong correlations were observed for As (r = 0.65), Cs (r = 0.67), Li (r = 0.56), Mo (r = 0.57), Se (r = 0.68) and Tl (r = 0.67). Remaining correlations were <0.41. Median Se concentrations in Tanzania (29 µg/L) and Kenya (24 µg/L) were low relative to 5738 Canadians (59 µg/L). Exceedances (of reference 95th percentiles) were observed for: Co, Mn, Mo, Ni and U. Compared to health-based values, exceedances were present for As, Co, Mo and Se but deficiencies were also present for Mo and Se. For well correlated elements, household members in East African settings provide feasible surrogate cases to investigate element deficiencies/excesses in relation to non-communicable diseases.

Squamous cell esophageal cancer is common throughout East Africa, but its etiology is poorly understood. We investigated the contribution of alcohol consumption to esophageal cancer in Kenya, based on a hospital-based case-control study conducted from 08/2013 to 03/2018 in Eldoret, western Kenya. Cases had an endoscopy-confirmed esophageal tumor whose histology did not rule out squamous cell carcinoma. Age and gender frequency-matched controls were recruited from hospital visitors/patients without digestive diseases. Logistic regression was used to calculate odds ratios (ORs) and their 95% confidence intervals (CI) adjusting for tobacco (type, intensity) and 6 other potential confounders. A total of 422 cases (65% male, mean at diagnosis 60 (SD 14) years) and 414 controls were included. ORs for ever-drinking were stronger in ever-tobacco users (9.0, 95% CI: 3.4, 23.8, with few tobacco users who were never drinkers) than in never-tobacco users (2.6, 95% CI: 1.6, 4.1). Risk increased linearly with number of drinks: OR for >6 compared to >0 to ≤2 drinks/day were 5.2 (2.4, 11.4) in ever-tobacco users and 2.1 (0.7, 4.4) in never-tobacco users. Although most ethanol came from low ethanol alcohols (busaa or beer), for the same ethanol intake, if a greater proportion came from the moonshine chang'aa, it was associated with a specific additional risk. The population attributable fraction for >2 drinks per day was 48% overall and highest in male tobacco users. Alcohol consumption, particularly of busaa and chang'aa, contributes to half of the esophageal cancer burden in western Kenya., (© 2018 UICC.)

Background: The commonly accepted gold standard diagnostic method for detecting malaria is a microscopic reading of Giemsa-stained blood films. However, symptomatic diagnosis remains the basis of therapeutic care for the majority of febrile patients in malaria endemic areas. This study aims to compare the discrepancy in malaria and anaemia burdens between symptomatic diagnosed patients with those diagnosed through the laboratory., Methods: Data were collected from Western Kenya during a follow-up study of 887 children with suspected cases of malaria visiting the health facilities. In the laboratory, blood samples were analysed for malaria parasite and haemoglobin levels. Differences in malaria prevalence between symptomatic diagnosis and laboratory diagnosis were analysed by Chi-square test. Bayesian probabilities were used for the approximation of the malaria and anaemia burdens. Regression analysis was applied to: (1) determine the relationships between haemoglobin levels, and malaria parasite density and (2) relate the prevalence of anaemia and the prevalence of malaria., Results: The prevalence of malaria and anaemia ranged from 10% to 34%, being highest during the rainy seasons. The predominant malaria parasite was P. falciparum (92.3%), which occurred in higher density in children aged 2‒5 years. Fever, high temperature, sweating, shivering, vomiting and severe headache symptoms were associated with malaria during presumptive diagnosis. After conducting laboratory diagnosis, lower malaria prevalence was reported among the presumptively diagnosed patients. Surprisingly, there were no attempts to detect anaemia in the same cohort. There was a significant negative correlation between Hb levels and parasite density. We also found a positive correlation between the prevalence of anaemia and the prevalence of malaria after laboratory diagnosis indicating possible co-occurrence of malaria and anaemia., Conclusion: Symptomatic diagnosis of malaria overestimates malaria prevalence, but underestimates the anaemia burden in children. Good clinical practice dictates that a laboratory should confirm the presence of parasites for all suspected cases of malaria.

Background: Kenya and Uganda have reported different Human African Trypanosomiasis incidences in the past more than three decades, with the latter recording more cases. This cross-sectional study assessed the demographic characteristics, tsetse and trypanosomiasis control practices, socio-economic and cultural risk factors influencing Trypanosoma brucei rhodesiense (T.b.r.) infection in Teso and Busia Districts, Western Kenya and Tororo and Busia Districts, Southeast Uganda. A conceptual framework was postulated to explain interactions of various socio-economic, cultural and tsetse control factors that predispose individuals and populations to HAT., Methods: A cross-sectional household survey was conducted between April and October 2008. Four administrative districts reporting T.b.r and lying adjacent to each other at the international boundary of Kenya and Uganda were purposely selected. Household data collection was carried out in two villages that had experienced HAT and one other village that had no reported HAT case from 1977 to 2008 in each district. A structured questionnaire was administered to 384 randomly selected household heads or their representatives in each country. The percent of respondents giving a specific answer was reported. Secondary data was also obtained on socio-economic and political issues in both countries., Results: Inadequate knowledge on the disease cycle and intervention measures contributed considerable barriers to HAT, and more so in Uganda than in Kenya. Gender-associated socio-cultural practices greatly predisposed individuals to HAT. Pesticides-based crop husbandry in the 1970's reportedly reduced vector population while vegetation of coffee and banana's and livestock husbandry directly increased occurrence of HAT. Livestock husbandry practices in the villages were strong predictors of HAT incidence. The residents in Kenya (6.7%) applied chemoprophylaxis and chemotherapeutic controls against trypanosomiasis to a larger extent than Uganda (2.1%)., Conclusion: Knowledge on tsetse and its control methods, culture, farming practice, demographic and socio-economic variables explained occurrence of HAT better than landscape features.

Geologically enriched environments may contain high concentrations of some metals. In areas where industrial exposures remain superficial, children may be exposed to these geological metals through soil, drinking water and consumption of food locally grown. The aim of this study was to assess the contribution of soil, water and food consumption to cadmium (Cd), chromium (Cr), copper (Cu), zinc (Zn), cobalt (Co) and titanium (Ti) body burden of children in the geologically metal rich coastal zone of Lake Victoria, Kenya. We evaluated the relationship between the metal body burden of children by analyzing the hair samples and the estimated metal intake through exposure to soil, drinking water, and food consumption. The body burdens of all metals in children at the exposed sites were high, suggesting environmental exposure. Most of the foods consumed resulted in metal intake below the maximum recommended daily intake. However, the net contribution of all food items jointly exceeded the recommended maximum daily intake at some of the exposure sites. Our results further demonstrated that the highest intake of metals occurred via ingestion of high quantities of the cyprinid fish Rastrineobola argentea. Positive linear relationships between the metal body burden in children and estimated daily intake were observed for Cd, Cr, Ti in children consuming high quantity of R. argentea; for Zn and Co in children highly exposed to soils and consuming high quantity of Brassica oleraceae, while Co burden in the body was associated with high consumption of maize meal. This study demonstrated that exposure to soil and consumption of higher quantities of some foods contributed to the increased metal body burdens of children in a geologically exposed region., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

Infestation of fish by endoparasites may potentially influence metal uptake and elimination by the host. We quantified the metal uptake rate constant (k(u)) and efflux rate constants (k(e)) of radiolabeled Cd and Co in the cyprinid fish Rastrineobola argentea experimentally infected with the parasite Ligula intestinalis. During 24h, the accumulation of Cd and Co increased linearly with no evident steady state in uninfected fish, infected fish and in the parasite. Following aqueous exposures, the k(u) for Cd in parasites was about 3× higher than that of infected fish and 6× higher than for the uninfected fish. The k(u) for Co was up to 15× higher in the parasites than that of infected fish and 7.5× higher than for the uninfected fish. The k(e) for excretion of Cd were consistently higher for the uninfected fish than for the infected fish and also higher for uninfected fish than the parasite. The k(e) for Co for the uninfected fish was 1.4-2.0× lower than in the infected fish, but higher for parasites compared to uninfected fish (1.3-2.3×). Pulse-chase feeding experiments with radiolabeled copepods showed that Cd assimilation efficiency from food was higher in infected fish, while Co was assimilated more effectively by uninfected fish. The observed differences in metal dynamics between infected and uninfected R. argentea in the laboratory concord with differences in metal concentrations measured in natural populations in Lake Victoria. Our findings provide evidence that L. intestinalis infection enhances Cd accumulation, but depletes the essential Co in the cyprinid fish R. argentea. We conclude that the combined stress of parasites and pollution changes metal risks to fish hosts in a metal specific manner., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The present study evaluated if the element profiles in hair and nails of children from the Lake Victoria region in Kenya reflect uptake from food and the environment. To this purpose, the element concentrations in hair and nails were related to element concentrations measured in food items, water, and soil. The highest intake of most elements occurred via ingestion of the fish Rastrineobola argentea, which is consumed in higher quantities than other fish and food items. Element concentrations in hair and nails were correlated to food and soil in element-specific patterns. Multivariate analysis combining principal component analysis and multidimensional scaling enabled us to cluster individuals from specific sites and to relate differences between sites to food-consumption patterns and environmental exposures. Site-specific differences in macroelement concentrations among the children were attributed to patterns of food consumption, while those in microelement concentrations reflected differences in geochemical background. It is concluded that the simultaneous analysis of elements in human hair and nails allows separation of populations based on food consumption and geochemical background., (Copyright © 2012 SETAC.)

Infestation of fish by parasites may influence metal accumulation patterns in the host. However, the subcellular mechanisms of these processes have rarely been studied. Therefore, this study determined how a cyprinid fish (Rastrineobola argentea) partitioned four metals (Cd, Cr, Zn and Cu) in the subcellular fractions of the gut in presence of an endoparasite (Ligula intestinalis). The fish were sampled along four sites in Lake Victoria, Kenya differing in metal contamination. Accumulation of Cd, Cr and Zn was higher in the whole body and in the gut of parasitized fish compared to non-parasitized fish, while Cu was depleted in parasitized fish. Generally, for both non-parasitized and parasitized fish, Cd, Cr and Zn partitioned in the cytosolic fractions and Cu in the particulate fraction. Metal concentrations in organelles within the particulate fractions of the non-parasitized fish were statistically similar except for Cd in the lysosome, while in the parasitized fish, Cd, Cr and Zn were accumulated more by the lysosome and microsomes. In the cytosolic fractions, the non-parasitized fish accumulated Cd, Cr and Zn in the heat stable proteins (HSP), while in the parasitized fish the metals were accumulated in the heat denatured proteins (HDP). On the contrary, Cu accumulated in the HSP in parasitized fish. The present study revealed specific binding of metals to potentially sensitive sub-cellular fractions in fish in the presence of parasites, suggesting interference with metal detoxification, and potentially affecting the health status of fish hosts in Lake Victoria., (Copyright © 2011 Elsevier B.V. All rights reserved.)

This study used hair and nails to biomonitor heavy metals (Pb, Cd, Cr and Cu) from geological source and exposure through regular fish consumption among children in Lake Victoria, Kenya. Concentration of Pb and Cu in water reflected anthropogenic pathways, while Cd and Cr reflected accumulation from the catchment basin. Higher concentration of heavy metals in the nails samples than the hair samples suggested longer term exposure. The estimated intake of Cd and Cr from fish in one site associated with high concentration of the metals from geological source was appreciably above the respective recommended daily allowance, signifying possible health risks to humans. Significant correlations between Pb, Cd and Cu in hair, nails and heavy metals from fish consumed suggested fish consumption as possible pathway of heavy metals in humans. Possible health risks from heavy metals were likely due to consumption of higher quantities of fish and from geological basins., (Copyright © 2010 Elsevier Inc. All rights reserved.)

When evaluating metal accumulation patterns in parasite-host assemblages species specific metal requirements should be taken into account. The aim of the present study was therefore to determine the metal specific partitioning in a parasite-host assemblage of the cestode Ligula intestinalis and the cyprinid fish Rastrineobola argentea and to determine the effect of the parasites on the metal balance of the fish. To this purpose the host-parasite assemblage was analysed for several metals at sites in the coastal zone of Lake Victoria differing in metal contamination. Our results showed that some elements (Ca, Sr, and Mg) reflected the physiological differences of bone formation and ionic balance and pointed to physiological disturbances of infested R. argentea. Other essential metals including Cu and Co were subject of element competition between fish and parasite, while only a micro-element (Cr) and a non-essential metal (Cd) displayed a partitioning with high concentration in the parasite. The present study clearly demonstrated the impact of the large cestodes on their small fish hosts and it is concluded that the partitioning of metals in the assemblage of R. argentea and L. intestinalis is subject to metal specific mechanisms for essential and non-essential elements.

The use of buccal mucosa and a tongue flap in reconstruction of full-thickness defects of the lower lip is described. The patient's face received a heavy blow in a traffic accident. Necrosis caused by hematogenous disturbance occurred in more than half of the entire lower lip vermilion. The patient underwent a two-stage operation for reconstruction of the lower lip. First, vestibuloplasty was performed using a buccal mucosal flap. Subsequently, the vermilion was surgically reconstructed using a flap from the tip of the tongue. This operative method is less risky because of its favorable prognosis. An effective way to recover motor function of the lower lip is to practice a rehabilitation program against scar contraction. An extension movement with the fingers that requires two or three repetitions every day was selected. Rehabilitation was started 7 days after the tongue flap was divided. The patient had a favorable recovery after the operation and is now able to wear a denture and to eat without slobbering.