Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
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A protracted cholera outbreak among residents in an urban setting, Nairobi County, Kenya, 2015
Kigen HT , Boru W , Gura Z , Githuka G , Mulembani R , Rotich J , Abdi I , Galgalo T , Githuku J , Obonyo M , Muli R , Njeru I , Langat D , Nsubuga P , Kioko J , Lowther S . Pan Afr Med J 2020 36 127 INTRODUCTION: in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. METHODS: we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli. RESULTS: during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). CONCLUSION: we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak. |
Cholera outbreak in Dadaab refugee camp, Kenya - November 2015-June 2016
Golicha Q , Shetty S , Nasiblov O , Hussein A , Wainaina E , Obonyo M , Macharia D , Musyoka RN , Abdille H , Ope M , Joseph R , Kabugi W , Kiogora J , Said M , Boru W , Galgalo T , Lowther SA , Juma B , Mugoh R , Wamola N , Onyango C , Gura Z , Widdowson MA , DeCock KM , Burton JW . MMWR Morb Mortal Wkly Rep 2018 67 (34) 958-961 Dadaab Refugee camp in Garissa County, Kenya, hosts nearly 340,000 refugees in five subcamps (Dagahaley, Hagadera, Ifo, Ifo2, and Kambioos) (1). On November 18 and 19, 2015, during an ongoing national cholera outbreak (2), two camp residents were evaluated for acute watery diarrhea (three or more stools in </=24 hours); Vibrio cholerae serogroup O1 serotype Ogawa was isolated from stool specimens collected from both patients. Within 1 week of the report of index cases, an additional 45 cases of acute watery diarrhea were reported. The United Nations High Commissioner for Refugees and their health-sector partners coordinated the cholera response, community outreach and water, sanitation, and hygiene (WASH) activities; Medecins Sans Frontieres and the International Rescue Committee were involved in management of cholera treatment centers; CDC performed laboratory confirmation of cases and undertook GIS mapping and postoutbreak response assessment; and the Garissa County Government and the Kenya Ministry of Health conducted a case-control study. To prevent future cholera outbreaks, improvements to WASH and enhanced disease surveillance systems in Dadaab camp and the surrounding area are needed. |
Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015
Curran KG , Wells E , Crowe SJ , Narra R , Oremo J , Boru W , Githuku J , Obonyo M , De Cock KM , Montgomery JM , Makayotto L , Langat D , Lowther SA , O'Reilly C , Gura Z , Kioko J . BMC Public Health 2018 18 (1) 723 BACKGROUND: From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya's 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June-July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers' (HCW) experiences during outbreak response. METHODS: Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns. RESULTS: Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs' personal passion to help others. CONCLUSIONS: The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans. |
Notes from the field: Ongoing cholera outbreak - Kenya, 2014-2016
George G , Rotich J , Kigen H , Catherine K , Waweru B , Boru W , Galgalo T , Githuku J , Obonyo M , Curran K , Narra R , Crowe SJ , O'Reilly CE , Macharia D , Montgomery J , Neatherlin J , De Cock KM , Lowther S , Gura Z , Langat D , Njeru I , Kioko J , Muraguri N . MMWR Morb Mortal Wkly Rep 2016 65 (3) 68-69 On January 6, 2015, a man aged 40 years was admitted to Kenyatta National Hospital in Nairobi, Kenya, with acute watery diarrhea. The patient was found to be infected with toxigenic Vibrio cholerae serogroup O1, serotype Inaba. A subsequent review of surveillance reports identified four patients in Nairobi County during the preceding month who met either of the Kenya Ministry of Health suspected cholera case definitions: 1) severe dehydration or death from acute watery diarrhea (more than four episodes in 12 hours) in a patient aged ≥5 years, or 2) acute watery diarrhea in a patient aged ≥2 years in an area where there was an outbreak of cholera. An outbreak investigation was immediately initiated. A confirmed cholera case was defined as isolation of V. cholerae O1 or O139 from the stool of a patient with suspected cholera or a suspected cholera case that was epidemiologically linked to a confirmed case. By January 15, 2016, a total of 11,033 suspected or confirmed cases had been reported from 22 of Kenya's 47 counties. The outbreak is ongoing. |
Tuberculosis and latent tuberculosis infection among health care workers in Kisumu, Kenya
Agaya J , Nnadi CD , Odhiambo J , Obonyo C , Obiero V , Lipke V , Okeyo E , Cain K , Oeltmann JE . Trop Med Int Health 2015 20 (12) 1797-804 OBJECTIVE: To assess prevalence and occupational risk factors of latent TB infection and history of TB disease ascribed to work in a health care setting in western Kenya. METHODS: We conducted a cross-sectional survey among health care workers in western Kenya in 2013. They were recruited from dispensaries, health centers, and hospitals that offer both TB and HIV services. School workers from the health facilities' catchment communities were randomly selected to serve as the community comparison group. Latent TB infection was diagnosed by tuberculin skin testing. HIV status of participants was assessed. Using a logistic regression model, we determined the adjusted odds of latent TB infection among health care workers compared to school workers; and among health care workers only, we assessed work-related risk factors for latent TB infection. RESULTS: We enrolled 1,005 health care workers and 411 school workers. Approximately 60% of both groups were female. 22% of 958 health care workers and 12% of 392 school workers tested HIV positive. Prevalence of self-reported history of TB disease was 7.4% among health care workers and 3.6% among school workers. Prevalence of latent TB infection was 60% among health care workers and 48% among school workers. Adjusted odds of latent TB infection were 1.5 times higher among health care workers than school workers (95% confidence interval 1.2-2.0). Health care workers at all three facility types had similar prevalence of latent TB infection, (p=0.72), but increasing years of employment was associated with increased odds of LTBI (p<0.01). CONCLUSION: Health care workers at facilities in western Kenya which offer TB and HIV services are at increased risk of latent TB infection, and the risk is similar across facility types. The WHO-recommended TB infection control measures are urgently needed in health facilities to protect health care workers. This article is protected by copyright. All rights reserved. |
Using health and demographic surveillance system (HDSS) data to analyse geographical distribution of socio-economic status; an experience from KEMRI/CDC HDSS
Amek N , Vounatsou P , Obonyo B , Hamel M , Odhiambo F , Slutsker L , Laserson K . Acta Trop 2015 144 24-30 BACKGROUND: Continuous monitoring in Health and Demographic Surveillance sites (HDSS) allows for collection of longitudinal demographic data, health related and socio-economic indicators of the site population. We sought to use household survey data collected between 2002-2006 in the Kenya Medical Research Institute in collaboration with Centers for Disease Control and prevention (KEMRI/CDC) HDSS site in Asembo and Gem western Kenya to estimate socio-economic status (SES) and assess changes of SES over time and space. METHODS: Data on household assets and characteristics, mainly source of drinking water, cooking fuel and occupation of household head was annually collected from 44,313 unique households during the study period. An SES index was calculated as a weighted average of assets using weights generated via Principal Component Analysis (PCA), Polychoric PCA and Multiple Correspondence Analysis (MCA) methods applied to the pooled data. The index from the best method was used to rank households into SES quintiles and assess their transition over time across SES categories. Kriging was employed to produce SES maps at the start and the end of the study period. RESULTS: First component of PCA, Polychoric PCA and MCA accounted for 13.7%, 31.8% and 47.3% respectively of the total variance of all variables. The gap between the poorest and the least poor increased from 1% at the start to 6% at the end of the study period. Spatial analysis revealed that the increase in least poor households was centered in the lower part of study area (Asembo) over time. No significant changes were observed in Gem. CONCLUSION: The HDSS sites can provide a platform to assess spatial-temporal changes in the SES status of the population. Evidence on how SES varied over time and space within the same geographical area may provide a useful tool to design interventions in health and other areas that have a close bearing to the SES of the population. |
Exposure of US travelers to rabid zebra, Kenya, 2011
Lankau EW , Montgomery JM , Tack DM , Obonyo M , Kadivane S , Blanton JD , Arvelo W , Jentes ES , Cohen NJ , Brunette GW , Marano N , Rupprecht CE . Emerg Infect Dis 2012 18 (7) 1202-4 TO THE EDITOR: Rabies is an acute progressive encephalitis caused by infection with a lyssavirus (genus Lyssavirus, family Rhabdoviridae). Most human infections are caused by bites from rabid animals, but the virus also can be transmitted by contact of open wounds or mucous membranes with animal saliva. Prompt administration of postexposure prophylaxis (PEP) is recommended to prevent rabies. Canids are common sources of human exposures in many regions of Africa, Asia, and Latin America. However, all mammals are susceptible, including herbivores such as horses, cattle, and antelope. |
Rotavirus disease burden and impact and cost-effectiveness of a rotavirus vaccination program in Kenya
Tate JE , Rheingans RD , O'Reilly CE , Obonyo B , Burton DC , Tornheim JA , Adazu K , Jaron P , Ochieng B , Kerin T , Calhoun L , Hamel M , Laserson K , Breiman RF , Feikin DR , Mintz ED , Widdowson MA . J Infect Dis 2009 200 S76-84 BACKGROUND: The projected impact and cost-effectiveness of rotavirus vaccination are important for supporting rotavirus vaccine introduction in Africa, where limited health intervention funds are available. METHODS: Hospital records, health utilization surveys, verbal autopsy data, and surveillance data on diarrheal disease were used to determine rotavirus-specific rates of hospitalization, clinic visits, and deaths due to diarrhea among children <5 years of age in Nyanza Province, Kenya. Rates were extrapolated nationally with use of province-specific data on diarrheal illness. Direct medical costs were estimated using record review and World Health Organization estimates. Household costs were collected through parental interviews. The impact of vaccination on health burden and on the cost-effectiveness per disability-adjusted life-year and lives saved were calculated. RESULTS: Annually in Kenya, rotavirus infection causes 19% of hospitalizations and 16% of clinic visits for diarrhea among children <5 years of age and causes 4471 deaths, 8781 hospitalizations, and 1,443,883 clinic visits. Nationally, rotavirus disease costs the health care system $10.8 million annually. Routine vaccination with a 2-dose rotavirus vaccination series would avert 2467 deaths (55%), 5724 hospitalizations (65%), and 852,589 clinic visits (59%) and would save 58 disability-adjusted life-years per 1000 children annually. At $3 per series, a program would cost $2.1 million in medical costs annually; the break-even price is $2.07 per series. CONCLUSIONS: A rotavirus vaccination program would reduce the substantial burden of rotavirus disease and the economic burden in Kenya. |
Cost-effectiveness of routine rapid human immunodeficiency virus antibody testing before DNA-PCR testing for early diagnosis of infants in resource-limited settings
Menzies NA , Homsy J , Pitter JYC , Pitter C , Mermin J , Downing R , Finkbeiner T , Obonyo J , Kekitiinwa A , Tappero J , Blandford JM . Pediatr Infect Dis J 2009 28 (9) 819-825 ![]() BACKGROUND: Infants born to HIV-infected women should receive HIV testing to allow early diagnosis and treatment. Recommendations for resource-limited settings stress laboratory-based virologic assays. While effective, these tests are logistically complex and expensive. This study explored the cost-effectiveness of incorporating initial screening with rapid HIV tests (RHT) into the conventional testing algorithm to screen-out HIV-uninfected infants, thereby reducing the need for costly virologic testing. METHODS: Data on HIV prevalence, RHT sensitivity and specificity, and costs were collected from 820 HIV-exposed children (1.5-18 months) attending 2 postnatal screening programs in Uganda during July 2005 to December 2006. Cost-effectiveness models compared the conventional testing algorithm DNA polymerase chain reaction (DNA-PCR with Roche Amplicor v1.5) with a modified algorithm (initial RHT to screen-out HIV-uninfected infants before DNA-PCR). RESULTS: The model estimated that the conventional algorithm would identify 94.3% (91.8%-94.7%) of HIV-infected infants, compared with 87.8% (79.4%-90.5%) for a modified algorithm using RHT (HIV 1/2 Determine) and excluding the need for DNA-PCR for HIV antibody-negative infants. Costs per infant were $23.47 ($23.32-$23.76) for the conventional algorithm and between $22.75 ($21.89-$23.31) and $7.58 ($6.41-$10.75) for the modified algorithm, depending on infant age and symptoms. Compared with the conventional algorithm, costs per HIV-infected infant identified using the modified algorithm were higher in 1.5- to 3-month-old infants, but significantly lower in 3-month-old and older infants. Models replicating the whole infant testing program showed the modified algorithm would have marginally lower sensitivity, but would reduce total program costs by 27% to 40%, producing an incremental cost-effectiveness ratio of $1489 ($686-$6781) for the conventional versus modified algorithms. CONCLUSIONS: Screening infants with RHT before DNA-PCR is cost-effective in infants 3 months old or older. Incorporating RI-IT into early infant testing programs could improve cost-effectiveness and reduce program costs. |
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