BSL-3 Laboratory User Training Program at NUITM-KEMRI

Pathogens handled in a Biosafety Level 3 (BSL-3) containment laboratory pose significant risks to laboratory staff and the environment. It is therefore necessary to develop competency and proficiency among laboratory workers and to promote appropriate behavior and practices that enhance safety through biosafety training. Following the installation of our BSL-3 laboratory at the Center for Microbiology Research-Kenya Medical Research Institute in 2006, a biosafety training program was developed to provide training on BSL-3 safety practices and procedures. The training program was developed based on World Health Organization specifications, with adjustments to fit our research activities and biosafety needs. The program is composed of three phases, namely initial assessment, a training phase including theory and a practicum, and a final assessment. This article reports the content of our training program.     

Genetic analysis of H3N2 influenza A viruses isolated in 2006–2007 in Nairobi,Kenya

Background Minimal influenza surveillance has been carried out in sub‐Saharan Africa to provide information on circulating influenza subtypes for the purpose of vaccine production and monitoring trends in virus spread and mutations. Objective The aim of this study was to investigate a surveillance program in Kenya to isolate and characterize influenza viruses. Results In the 2006–2007 influenza season, nine influenza A viruses were isolated. All were of H3N2 subtype with key amino acid (aa) changes indicating that they were more closely related to recent World Health Organization recommended vaccine strains than to older vaccine strains, and mirroring the evolution of circulating influenza A globally. Hemagglutination inhibition data showed that the 2006 Kenya isolates had titers identical to the 2005–2006 H3N2 vaccine strain but two‐ to threefold lower titers to the 2006–2007 vaccine strain, suggesting that the isolates were antigenic variants of the 2006–2007 vaccine strains. Analysis of aa substitutions of hemagglutinin‐1 (HA1) protein of the 2006 Kenyan viruses revealed unique genetic variations with several aa substitutions located at immunodominant epitopes of the HA1 protein. These mutations included the V112I change at site E, the K 173 E substitution at site D and N 278 K change at site C, mutations that may result in conformational change on the HA molecule to expose novel epitopes thus abrogating binding of pre‐existing antibodies at these sites. Conclusion Characterization of these important genetic variations in influenza A viruses isolated from Kenya highlights the importance of continuing surveillance and characterization of emerging influenza drift variants in sub‐Saharan Africa.     

The seroprevalence and seroincidence of dengue virus infection in western Kenya

Epidemics of dengue fever have been documented throughout the African continent over the past several decades, however little is known about the prevalence or incidence of dengue virus infection in the absence of an outbreak. No studies have analyzed the prevalence of dengue infection in western Kenya to date. This study describes the seroincidence and seroprevalence of dengue infection in western Kenya. Banked sera obtained from 354 healthy, afebrile children ages 12–47 months from Kisumu District, Kenya, were analyzed for antibodies to dengue virus using an IgG indirect ELISA. We found a seroprevalence of 1.1% (4 of 354 samples) and incidence of 8.5 seroconversions per 1000 persons per year in this study population. This appears to be similar to that previously reported in coastal regions of the country outside of known epidemic periods. Since there has never been a reported dengue epidemic in western Kenya, continued investigation and evaluation in a patient population presenting with fever is necessary to further confirm this finding.     

T-2毒素对软骨细胞P53、Bcl—xL和Caspase-3表达的影响

目的 观察T-2毒素对软骨细胞P53、Bcl-xL和caspase-3表达的影响.方法 采用胎儿软骨细胞体外培养,培养基中加入不同浓度的T-2毒素(1～20μ/L)连续培养5 d.采用Western blot检测软骨细胞P53、Bcl-xL和Caspase-3蛋白表达水平;用RT-PCR法检测软骨细胞P53、Bcl-xL和Caspase-3 mRNA的表达.结果 与对照组比较,不同浓度(1～20μL)的T-2毒素均能引起Caspase-3蛋白表达水平升高而Bcl-xL蛋白表达水平下降(P＜0.05);当T-2毒素浓度达到10～20μg/L时,P53蛋白和Caspase-3 mRNA表达水平明显升高(P＜0.05)而Bcl-xLmRNA的表达水平无显著性下调(P＞0.05);T-2毒素浓度达到20μ/L可以引起P53 mRNA表达水平明显升高(P＜0.05).结论 T-2毒素诱导软骨细胞发生的凋亡可能与T-2毒素上调软骨细胞P53、caspase-3表达,同时下调Bcl-xL表达有关.     

Knowledge and social change in Samia,Western Kenya

Cross-cultural studies have demonstrated the significance of control of knowledge for the status and treatment of old people. This paper is a case study of information processing activities of elderly Samia in colonial Kenya and changes in those activities with modernization. Some ways elders controlled knowledge in the traditional context of the past are reconstructed from interviews with older Samia persons. This is compared to the situation in the 1980s as observed during two years' field research. Implications of the changes for the status and treatment of elderly Samia, for intergenerational relations among the Samia, and for gerontological theory are discussed.A shorter version of this paper entitled Gender, Aging, Change: The Life Course inA shorter version of this paper entitled Gender, Aging, Change: The Life Course inA shorter version of this paper entitled Gender, Aging, Change: The Life Course in     

Motivations and Methods for Self-disclosure of HIV Seropositivity in Nairobi,Kenya

This study employed structured interviews with 307 people living with HIV (PLHIVs) in Nairobi, Kenya to investigate their serostatus disclosure with respect to four types of relationships in their lives: partners, friends, family members, and religious leaders/clergy. Regarding motivations for disclosure, it was found that a sense of duty and seeking material support motivated disclosure to family and partners, fear of loss of confidentiality inhibited disclosure to friends, and the need for advice encouraged disclosure to religious leaders. The method of disclosure most frequently mentioned was direct, with males less likely than females to use direct methods when disclosing to spouses or partners. Intermediated disclosure was common in partner/spouse relationships with around one-third of partners preferring to disclose through a third party. Methods used to disclose as well as reasons for doing so varied by relationship type.     

Food security in HIV/AIDS response: Insights from Homa Bay,Kenya

This paper examines the viability and effectiveness of a pilot farming initiative in reversing impacts of HIV/AIDS on the most affected households in Homa Bay, Kenya. The paper argues that once patients are stable, they can effectively be engaged in farming with minimal financial and technical support, resulting in enhanced food security of the affected households. More importantly, it helps to reduce HIV/AIDS-related stigma and improve the individual's self-esteem. Some of the key challenges of the pilot initiative were the limited number of agricultural extension workers and absence of facilities to enable them to deliver services to the farmers, the high cost of farm inputs, the unavailability of farm inputs when they were needed, poorly developed agricultural markets, and the absence of irrigation facilities. The paper recommends the sensitive scaling-up of this approach. However, farming initiatives by HIV/AIDS service NGOs should be linked to at least three key aspects: (a) treatment, care and support to HIV/AIDS affected households; (b) micro grant schemes or subsidies to enable farmers to purchase farming tools and farm inputs; and (c) comprehensive on-farm training support. To ensure effectiveness and wider reach, government needs to view agriculture through an HIV lens and promote a multisectoral approach that recognises the relationship between HIV/AIDS and food security. A number of immediate actions are required to strengthen this relationship, such as increased public investment to augment extension services, subsidise farm inputs, and develop infrastructure including agricultural markets.     

脑出血神经元凋亡及P53、caspase-3蛋白表达与中风闭脱证的关系

目的 探讨脑出血（ICH）中风闭脱证与细胞凋亡及相关基因P53、caspase-3蛋白表达和临床神经功能缺损积分值的关系。方法 采用TUNEL技术观测细胞凋亡形态学变化及细胞凋亡率；采用免疫组化法观察P53、caspase-3蛋白表达变化；按照《脑卒中临床神经功能缺损程度评分标准》评分。结果 ICH组血肿周围组织细胞凋亡率及P53、caspase-3蛋白表达升高，与正常对照组比较差异有统计学意义（P〈0．01）；ICH中风阴闭、阳闭、脱证各组之间血肿周围组织细胞凋亡率及P53、caspase-3蛋白表达、临床神经功能缺损积分差异有统计学意义（P〈0．01）。结论脑组织细胞凋亡及P53、caspase-3蛋白表达与ICH有关，能反映ICH脑实质的损害程度，表明细胞凋亡参与了脑出血后继发性神经细胞损伤，P53、caspase-3表达对细胞凋亡具有调控作用。     

HIV voluntary counselling and testing in Nakuru, Kenya: findings from a community survey

OBJECTIVES: HIV voluntary counselling and testing (VCT) is important for prevention, detection and treatment of HIV infection. A study was conducted to determine the extent of utilization of VCT, and to study the attitudes and preferences of the community regarding VCT. METHODS: A total of 301 adults, aged 18-49 years, residing in Nakuru, Kenya were randomly selected using a two-stage sampling process. A self-administered questionnaire delivered during home visits was used to collect data over a 4-week period. RESULTS: The majority of study participants (184 of 287; 64.1%) had never been tested for HIV; 77 (26.8%) had received VCT, and 26 (9.1%) had received HIV testing without counselling. A total of 219 (78.2%) of the 280 responding participants expressed readiness to have VCT. The majority of participants (216 of 296; 73%) preferred VCT, while 46 (15.5%) preferred testing without counselling. The majority (227; 76.7%) preferred couple testing and dedicated clinics and private doctors' offices as testing facilities. The choice of a nearby facility was ranked above the provision of anonymity by most participants (162 of 298; 54.4%; vice versa for 136 of 298; 45.6%). CONCLUSIONS: With HIV/AIDS continuing to be a major public health concern in Kenya, the issues surrounding acceptance and use of VCT need to be addressed. Enhancing community awareness of the benefits of early HIV diagnosis, providing couple-based VCT as an integral part of VCT and increasing access to VCT testing sites may enhance utilization of VCT.     

Increased Risk of HIV in Women Experiencing Physical Partner Violence in Nairobi,Kenya

As part of a study on etiology of sexually transmitted infections (STI) among 520 women presenting at the STI clinic in Nairobi, data on partner violence and its correlates were analyzed. Prevalence of lifetime physical violence was 26%, mainly by an intimate partner (74%). HIV seropositive women had an almost twofold increase in lifetime partner violence. Women with more risky sexual behavior such as early sexual debut, number of sex partners, history of condom use and of STI, experienced more partner violence. Parity and miscarriage were associated with a history of lifetime violence. We found an inverse association between schooling and level of violence. Six percent of the women had been raped. Gender-based violence screening and services should be integrated into voluntary counseling and testing programs as well as in reproductive health programs. Multi-sector approaches are needed to change prevailing attitudes towards violence against women. An erratum to this article can be found at     

Auditory P3 in female alcoholics

BACKGROUND: The P3 (P300) has been considered to be a phenotypical marker of the risk for alcoholism. Although reductions in visual P3 in male and female alcoholics have been replicated, studies of auditory target P3 have been inconsistent. Our objective was to study the magnitude of auditory P3 reduction in female alcoholics and to establish the association between P3 reduction and alcoholism while taking into account comorbid depression and psychoactive drug dependence. The characteristics of P3 reduction were further examined by studying the reduction in family history-positive and -negative individuals. METHODS: Auditory target P3s recorded from 61 scalp electrodes in female alcoholics (n = 71) were compared with P3s from female controls (n = 159) ranging in age from 18 to 50 years. The amplitudes and latencies were statistically analyzed, by using repeated-measures ANOVA, in six regional electrode arrays and at representative electrode sites, with age and comorbid depression as covariates. The effects of family density and clinical variables such as depression and drug dependence were also examined with correlation analysis. RESULTS: Alcoholic women had significantly lower P3 amplitudes in all six regions and at midline electrode sites. The reductions were not associated with comorbid depression, as shown by low correlations and similar P3 amplitudes at Pz in female alcoholics with and without depression. The P3 amplitudes in women with a high family density were smaller than those in women with a low family density of alcohol dependence. Drug dependency did not influence P3 amplitude, as shown by similar responses in drug-dependent and non-drug-dependent alcoholic women. CONCLUSIONS: These findings highlight the significance of P3 reductions associated with alcoholism in women, independently of comorbid depression. Family density effects further support the evidence that these findings are heritable. These results suggest that P3 can be considered as a phenotypical marker of vulnerability to alcoholism in women.     

The difference between effectiveness and efficacy of antimalarial drugs in Kenya

OBJECTIVE: To demonstrate the difference between effectiveness and efficacy of antimalarial (AM) drugs in Kenya. METHODS: We undertook a series of linked surveys in four districts of Kenya between 2001 and 2002 on (i) community usage of nationally recommended first- and second-line AM drugs; (ii) commonly stocked AM products in the retail and wholesale sectors; and (iii) quality of the most commonly available first- and second-line AM products. These were combined with estimates of adherence and clinical efficacy to derive overall drug effectiveness. RESULTS: The overall modelled effectiveness for sulphadoxine-pyrimethamine (SP) was estimated to be 62% compared with 85% for reported SP clinical efficacy. For amodiaquine the modelled effectiveness was 48% compared with 99% reported efficacy during the same time period. CONCLUSIONS: The quality of AM products and patient adherence to dosage regimens are important determinants of drug effectiveness, and should be measured alongside clinical efficacy. Post-registration measures to regulate drug quality and improve patient adherence would contribute significantly to AM drug performance.     

Microcredit for people affected by HIV and AIDS: Insights from Kenya

Consequences of HIV and AIDS are exponential in Kenya, touching not only the health of those infected, but also depleting socioeconomic resources of entire families. Access to financial services is one of the important ways to protect and build economic resources. Unfortunately, the norm of financial viability discourages microfinance institutions from targeting people severely impacted by HIV and AIDS. Thus, HIV and AIDS service NGOs have been increasingly getting involved in microcredit activity in recent years for economic empowerment of their clients. Despite limited human resources and funding in the area of microcredit activity, these NGOs have demonstrated that nearly 50% of their microcredit beneficiaries invested money in income-generating activities, resulting in enhancement to their livelihood security. In the short term these NGOs need to improve their current practices. However, this does not mean launching microfinance initiatives within their AIDS-focused programmes, as financial services are best provided by specialised institutions. Longer-term cooperation between microfinance institutions and other AIDS service organisations and donors is necessary to muster appropriate and rapid responses in areas experiencing severe impacts of HIV and AIDS.     

包含P2X3亚基的受体与内脏高敏感性

三磷酸腺苷(ATP)门控阳离子通道型受体P2X31995年克隆成功,特别在小直径伤害性感觉神经元中高表达。越来越多的研究表明,包含P2X3亚基的同聚体P2X3及异聚体P2X2/3在介导内脏伤害性信息传递过程中起重要作用,有可能成为功能性胃肠疾病新的治疗靶点。     

3P实验、D-二聚体、FDP在肝硬化患者中的表达及其意义

探讨3P实验、D-二聚体、FDP在肝硬化患者中的表达及其意义。将47例肝硬化患者按照Child- Pugh分级分为三级,分析3P实验、D-二聚体、FDP检测结果在各组中的表达。3P实验、D-二聚体、FDP阳性表达在所检测患者中普遍存在,D-二聚体、FDP检测结果与Child-Pugh分级情况呈正相关。肝硬化患者凝血及纤维蛋白溶解发生了异常改变,导致3P、D-二聚体、FDP检测出现阳性结果。凝血及纤溶系统改变的程度与肝功能损伤的程度相关。     

The relationship between collective action and serious illness in western Kenya

By 2012 HIV had infected about 1.6 million Kenyans and an estimated 58 000 had died due to HIV/AIDS. HIV/AIDS rates in western Kenya are disproportionately high compared to the rate in Kenya as a whole. This study aimed to assess gender differences in participation in collective action in households affected by serious illness (e.g., HIV/ AIDS, TB) in western Kenya. We expected serious illnesses would reduce collective action due to a reduction in the number of adults and their ability to care for themselves and others. We used data from a mixed-methods study that used multiple-case embedded-case studies for rural households in western Kenya. The study investigated the relationship between collective action and households affected by serious illnesses. Household health was assessed from information about seriously ill members in 120 households. This information was compared with data about collective action activities and demographic data. Nearly half (48%) the households reported serious illness. More than 1 in 4 (28%) had HIV/AIDS, TB or AIDS-associated illnesses. Women engaged in a moderate level of participation in collective action groups and were statistically more likely to report serious household illness (OR=8.08, 95% CI 2.89, 22.56). Men, who were moderately (OR=3.24, 95% CI 1.27, 8.25) or highly involved in collective action groups (OR=15.43, 95% CI 1.30, 183.06), were statistically more likely to report serious household illness. Collective action groups may help households cope with illness and should be encouraged in communities hard hit with serious illness.     

Pregnancy interval and delivery outcome among HIV-seropositive and HIV-seronegative women in Kisumu, Kenya

Objective A short pregnancy interval (PI) has been associated with increased child mortality, but mechanisms are unclear. We studied factors associated with PI and the effect of PI on birthweight and haemoglobin. Methods Information was analysed from 2218 multigravidae who were recruited at the prenatal clinic (1758) or in the labour ward (460) of the Provincial Hospital in Kisumu between June 1996 and July 2000 for a study to assess the interaction between placental malaria and vertical HIV transmission. Results The HIV prevalence was 28.9%. HIV seropositivity, older age, being unmarried, and <8 years of education were associated with a prolonged PI; among all women, a stillbirth, abortion, or death of a liveborn child as outcome of the previous pregnancy, and death of a child other than the last born among HIV‐seronegative women, were associated with a shortened PI. No significant effect of short PI (an interval <24 months) on low birth weight (LBW), prematurity, small‐for‐gestational‐age infants or maternal anaemia was evident. An abortion, stillbirth, or death of a liveborn child as outcome of the previous pregnancy was associated at the present delivery with LBW among HIV‐seronegative women [adjusted odds ratio (AOR) 3.33, 95% confidence interval (CI) 1.63–6.81], and a low haemoglobin (<11 g/dl) among HIV‐seropositive women (AOR 2.01, 95% CI 1.05–4.03 in the third trimester). Conclusion Public health efforts to ensure ‘adequate’ birth spacing may run contrary to family planning decisions to replace a deceased child and may be spent on prenatal issues like prevention of anaemia, and vertical HIV transmission.     

Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya

Objective To learn how children in rural schools in Nyando District, Kenya clean themselves after defecation. Methods Six focus group discussions were held with boys and girls ages 12–15 in three rural schools in mid‐2009. Parents were interviewed in one setting. In early 2010, a survey of head teachers was conducted in 114 schools in Nyanza Province, Kenya, to assess the provision of anal cleansing materials and handwashing water and soap in schools. Results Anal cleansing behaviour is linked with access to materials, age, social pressure, perceived personal risk of illness and emotional factors. Materials used for anal cleansing include schoolbook paper, leaves, grasses, stones, corncobs and one’s own hands. Students have knowledge gaps in terms of personal hygiene. They were forthcoming with information on their anal cleansing practices. Almost no schools budgeted for or provided anal cleansing materials regularly. Conclusion Anal cleansing is a necessary human activity. However, because of social taboos, there are few articles on the topic. School health plans overlook it as well. Researchers need to determine if and how current practices could harm child health to inform policy.