National poverty reduction strategies and HIV/AIDS governance in Malawi: A preliminary study of shared health governance

The public health and development communities understand clearly the need to integrate anti-poverty efforts with HIV/AIDS programs. This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi’s National HIV/AIDS Strategic Framework (NSF). In this article we ask, how does the PRSP process support NSF accountability, participation, access to information, funding, resource planning and allocation, monitoring, and evaluation?     

TB training in Kenya: building capacity for care and prevention

BACKGROUND:Devolution of healthcare services in Kenya resulted in a large number of newly recruited tuberculosis (TB) coordinators. We describe a unique collaboration between a national tuberculosis program (NTP), a local, and an international non-governmental organization to build human resource capacity in TB care and prevention.METHODS:From 2016 to 2021, the Kenya Division of National Tuberculosis, Leprosy and Lung Disease Program, Centre for Health Solutions-Kenya, and the International Union Against Tuberculosis and Lung Disease developed and conducted a series of 7-day training courses. A key focus of training was the introduction of TBData4Action, an approach involving the local use of routinely available data to strengthen decision-making and support supervision.RESULTS:Implementation outcomes included training 331 (96%) coordinators out of 344, representing all 47 counties, 37 national officers and 21 other stakeholders using the country-tailored curriculum, including hands-on group work by county teams and field practicals. Thirty-five national facilitators were identified and mentored as local faculty. Training costs were reduced by 75% compared with international alternatives.CONCLUSION:The collaboration resulted in the training of the majority of the coordinators in a standardized approach to TB care. A sustainable approach to capacity building in local data use was found feasible; the model could be adapted by other NTPs.     

Kenyan purple tea anthocyanins ability to cross the blood brain barrier and reinforce brain antioxidant capacity in mice

Studies on antioxidants as neuroprotective agents have been hampered by the impermeability of the blood brain barrier (BBB) to many compounds. However, previous studies have shown that a group of tea flavonoids, the catechins, are brain permeable and neuroprotective. Despite this remarkable observation, there exist no data on the bioavailability and pharmacological benefits of tea anthocyanins (ACNs) in the brain tissue. This study investigated the ability of Kenyan purple tea ACNs to cross the BBB and boost the brain antioxidant capacity. Mice were orally administered with purified and characterized Kenyan purple tea ACNs or a combination of Kenyan purple tea ACNs and coenzyme-Q₁₀ at a dose of 200 mg/kg body weight in an experiment that lasted for 15 days. Twenty-four hours post the last dosage of antioxidants, CO₂ was used to euthanize the mice after which the brain was excised and used for various biochemical analyses. Brain extracts were analysed by high-performance liquid chromatography for ACN metabolites and spectrophotometry for cellular glutathione (GSH). Kenyan purple tea ACNs significantly (P < 0.05) raised brain GSH levels implying boost in brain antioxidant capacity. However, co-administration of both antioxidants caused a reduction of these beneficial effects implying a negative interaction. Notably, ACN metabolites were detected in brain tissue of ACN-fed mice. Our results constitute the first demonstration that Kenyan purple tea ACNs can cross the BBB reinforcing the brain's antioxidant capacity. Hence, the need to study them as suitable candidates for dietary supplements that could support antioxidant capacity in the brain and have potential to provide neuroprotection in neurodegenerative conditions.     

Frequency and spectrum of outpatient musculoskeletal diagnoses at a pediatric hospital in Kenya

Clinical Rheumatology - Chronic pediatric musculoskeletal (MSK) conditions are a major cause of morbidity. The burden of pediatric rheumatic diseases in East Africa is largely unknown. The purposes...     

Serologic Evidence of the Geographic Distribution of Bacterial Zoonotic Agents in Kenya, 2007

Diseases of zoonotic origin contribute to the burden of febrile illnesses in developing countries. We evaluated serologic evidence of exposure to Bacillus anthracis, Brucella spp., spotted fever group rickettsioses (SFGR), and typhus group rickettsioses (TGR) from samples of persons aged 15–64 years collected during a nationwide human immunodeficiency virus (HIV) serosurvey conducted in 2007 in Kenya. The seropositivity observed for pathogens was B. anthracis 11.3%, Brucella spp. 3.0%, SFGR 23.3%, and TGR 0.6%. On univariate analysis, seropositivity for each pathogen was significantly associated with the following risk factors: B. anthracis with province of residence; Brucella spp. with sex, education level, and wealth; SFGR with age, education level, wealth, and province of residence; and TGR with province of residence. On multivariate analysis, seropositivity remained significantly associated with wealth and province for B. anthracis; with sex and age for Brucella spp; and with sex, education level, and province of residence for SFGR whereas TGR had no significance. High IgG seropositivity to these zoonotic pathogens (especially, B. anthracis and SFGR) suggests substantial exposure. These pathogens should be considered in the differential diagnosis of febrile illness in Kenya.     

Sexual Prejudice and Comfort to Provide Services to Men Who Have Sex with Men Among HIV Healthcare Workers in Western Kenya: Role of Interpersonal Contact

AIDS and Behavior - Sexual minority men living in Africa, where many countries criminalize same-sex behavior, are vulnerable to HIV and experience significant barriers to HIV care. Sexual prejudice...     

Incidence and pattern of oesophageal perforations in Kenyatta National Hospital

A retrospective study of 42 patients with perforations of the oesophagus during the period 1981-1987 indicated that 57.1% of the perforations were iatrogenic. Diseases of the oesophagus and in contiguous structures and foreign bodies in the oesophagus caused perforations in 31% of the cases. Perforations in 35.7% of the patients were located in the middle third of the oesophagus. The lower and upper thirds were affected in 31% of the patients in each site. The presenting physical signs included tachycardia (78.6%), fever (76.2%) and dyspnoea (59.5%). The main accompanying symptoms were chest pain and coughs in 100% and in 50% of the patients respectively. Radiographic findings showed hydropneumothorax in 40.5% of the cases and consolidation in 38.1% of the patients. Oesophagoscopy was positive in 78% of cases tested while thoracocentesis was positive in all cases that were tested.     

Ultrastructural study of Echnococcus granulosus larval forms

The larval forms of Echinococcus granulosus were surgically removed from Turkana hydatid patients and studied on the electron microscope. It was found that the larval forms "hydatid cyst" consists of a protective laminated layer that surrounds the germinal layer. The germinal layer is made up of numerous germinal cells that transform to brood capsules within which protoscolices are formed. Protoscolices are formed from accumulations of undifferentiated germinal cells. The brood capsule wall is similar to germinal layer and they were found to contain numerous invaginated protoscolices. The invaginated protoscolices were of various sizes and they were not attached to the wall of the brood capsule. The evaginated protoscolex has two body regions, the head (scolex) and body (soma). The scolex is covered by numerous long microtriches whereas the soma is covered with few short microtriches.     

Prevalence of Oncocerca volvulus in Southern Sudan

Onchocerciasis is endemic in southern Sudan. The prevalence in human population may range from 10% to 40%. In the Eastern Equatorial Region of Southern Sudan, more cases are found in Nimule on the Sudan-Uganda border than in rural highlands of Labone and Chukudum basins. Onchocerciasis was highest in males (with a prevalence of 70.2% based on data from hospital records)) than in females, with prevalence of 19%. Overall, prevalence of onchocerciasis in children was 10.8%.Considering cost-effectiveness, public health priorities and the security situation in this area, we recommend active search on onchocerciasis cases in the community and treatment.     

Prevalence of human hydatid disease in southern Sudan

A total of 3443 people were screened by ultrasound to determine the prevalence of hydatid disease in southern Sudan. Hydatid cysts were found in 16 (0.5%) of the people screened. Thirteen of the 16 hydatid cases were from among the Bouya people who showed an overall hydatid prevalence of 2% by ultrasound. All ultra-sound positive cases were further confirmed by dot-blot ELISA. At the time of the survey, Chukudum Hospital had five cases with histories and clinical manifestations consistent with hydatidosis. However, on scan examination only three of them were confirmed to be cases of hydatid disease. The proportion of hydatid infected women in south-western Sudan was almost twice that of men (M:F ratio of 1:1.7), with most of those infected being women in the child-bearing age bracket. Dogs are common in this area and they could be the main reservoirs of Echinococcus granulosus in the Sudan. Due to the low prevalence of hydatid in humans in the study area, and the dispersed nature of the population, it is recommended that hydatid control measures for south-western Sudan include an educational component coupled with treatment of the infected people.