Survey of Urinary Aflatoxin Levels Among Residents of Makueni County, Kenya: A Follow-Up Study

Although fungi are known to be less pathogenic and mostly saprophytic in their nature as compared to other groups of microbes, those that produce aflatoxin have been associated with severe human disease. An example of such disease is Aflatoxicosis caused by soil-borne pathogenic fungi of the species Aspergillus parasiticus and Aspergillus flavus. They produce a mycotoxin substance that is carcinogenic to the human liver with severe outcomes. The objective of this study was to determine urinary aflatoxin levels among the residents of Makueni County, previously affected by Aflatoxicosis. This was a cross-sectional study that involved the use of primary data collected from 106 participants. The method for data collection included a structured questionnaire and the collection of the urine samples for aflatoxin M1 analysis at Bora Biotech Laboratories LTD. The urinary levels of AFM1 were detected by use of an ELISA kit. Data was entered in SPSS and analysed through Chi-Square for the association. The study participants, including both male and female, had an age of between 15 and 91 years and with an average age of 41±18. Out of the 106 study participants, n=68 (72%) were females and n=26 (28%) were males. Majority of the study participants were with a median age of 24 years old. AFM1 levels were detected in 99.1% % of all urine samples at a range of 25-2337 pg./ml. The mean and median concentration of AFM1 in urine was 637.6 ± 512.7and 525 pg./mL, respectively. The results of this study provide information on the current situation of aflatoxin exposure. From what is evident from our study a lot needs to be done to mitigate on the long-term effect of this high exposure. Therefore, the study encourages the concerned ministry to have a broader focus on the extent of aflatoxin food contamination from this region plus other regions across the country.

The effect of coexistence between larvae of Anopheles gambiae and Culex quinquefasciatus on larvicidal efficacy of Bacillus thuringiensis var. israelensis

Background: The efficacy of Bacillus thuringiensis var. israelensis (Bti) is affected by several factors including the species of the mosquito. Mosquito larvae of different species are found to coexist in larval breeding habitats. This study evaluated whether the coexistence between Anopheles gambiae and Culex quinquefasciatus affect the larvicidal activity of Bti. Methods: Two parallel larval bioassay experiments were conducted to test A. gambiae sensu stricto (s.s) and C. quinquefasciatus larvae susceptibility to Bti. They were followed by three parallel bioassays in which A. gambiae s.s and C. quinquefasciatus larvae were mixed in different proportions such that the earlier species contributed three quarters, half and a quarter of the larvae in each testing cup respectively. In each bioassay, six Bti concentrations were tested in four replicates and repeated on three different days. Larvae mortality was scored 24 hours after application of Bti and subjected to Probit analysis. Results: C. quinquefasciatus was significantly more susceptible to Bti than A. gambiae s.s at both lethal concentration values (LC50 and LC95). In coexisting scenario, LC50 of Bti was significantly lower when the proportion of C. quinquefasciatus exceeded 50%. No significant variation in susceptibility to Bti was observed at LC95 in any proportion of coexistence between the two species. Conclusion: The findings show that larvae of C. quinquefasciatus were significantly more susceptible to Bti than those of A. gambiae s.s. Moreover, when larvae of the two species coexisted, there was a general trend of increase in sensitivity to Bti with higher proportion of C. quinquefasciatus. Although this increase in sensitivity of coexisting larvae to Bti is worth noting, our findings suggest that it will not impact larval control where A. gambiae s.s and C. quinquefasciatus coexist.

Detectable viral load among HIV -1 positive pregnant women on ART (Option B +) in northern Tanzania: Baseline results from the HIVDR study

Introduction: In Tanzania, the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDEC) has implemented the Option B+ as one of the strategies to facilitate achievement of elimination of mother to child transmission of HIV. To prevent emergence of drug resistance mutations early identification of option B+ failure is critical. The emergence of drug resistance mutation and subsequent treatment failure poses a major concern for HIV program in low- and middle-income resource settings where treatment options are limited. Methodology: We recruited treatment naïve, treatment experienced HIV-1 positive pregnant women and those who had prophylaxis in their previous pregnancy in Kilimanjaro, northern Tanzania August 2016 to February 2017. Whole blood (2ml) for biochemistry, viral load and drug resistance testing were taken at baseline. ARV drug resistance testing was done on women with VL ≥ 1000 copies/ml. We used descriptive statistic and logistic regression to determine the strength of association between virologic outcome (virologic failure) and independent predictors. Results: One hundred and forty eight (148) pregnant HIV-positive women were enrolled in the study with mean age of 29.82 years (SD=6.17) from August, 2016 to February, 2017. Virologic failure was demonstrated in 34 (23%) with viral load ≥ 1,000 copies/ml. Genotyping results were available from 26 women, mutations associated with ARV resistance were detected in 23.1% (n = 6/26). Among the six women with ARV resistance mutation 4(66.7%) had high level resistance and 2(33.3%) had low level resistance. Among the 26 samples genotyped 15(58%) viruses were subtype A, while eight were subtype C (31%) and three subtypes D (11%). The most dominant drug resistance mutations against the reverse transcriptase inhibitors for the women with high level resistance were K103N, Y188L, D67N, K70R, M184V, T215F, K219EQ, and the low-level resistance was E138A. The older age was associated with virological failure compared to those who were < 20 year of age. Conclusion: Viral load testing should be done on women who were already on antiretroviral treatment on their first antenatal visit to ensure early detection of virological failure and enable clinicians to take an appropriate course of action on their management. Educational intervention on adherence should be targeted at an early stage to women with virological failure during pregnancy to reduce the emergence of HIV-1 drug resistance mutations.

A Review on Serenoa serrulata: A Potential Medicinal Plant for Prostatic Diseases

Background: Prostatic diseases which include prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer are the benign or malignant disorders that affect the prostate. Phytotherapies have been adopted as the alternative treatment/ management option especially for BPH since the current modern methods of treatment presents a lot of adverse effects. Methodology: The literature was searched using different databases including Medline/PubMed, Cochrane library, Scopus, Proquest library, Embase, EBooks and Google Scholar for relevant records for a period from 1988 to 2018 to identify all the published articles of S. serrulata regarding treatment of prostatic diseases. The key search terms were Serenoa serrulata, S. repens, Saw palmetto, Prostate cancer treatment with Serenoa serrulata, treatment of Benign Prostatic Hyperplasia with Serenoa serrulata, phytochemicals of Serenoa serrulata, ethnobotanical uses of Serenoa serrulata, toxicity of Serenoa serrulata, pharmacological activities of Serenoa serrulata and also traditional management and treatment of prostatic diseases using Serenoa serrulata and also clinical trials on treatment of prostatic diseases with Serenoa serrulata. The retrieved articles were reviewed, synthesized and analyzed qualitatively. The reference list of the retrieved articles was also reviewed and synthesized. The original research articles which reported an investigation of S. serrulata of any study design, original published research articles, any time of publication and grey literature (conference papers, reported articles, academic thesis) were included. The articles whose full texts were not freely available by the time of search and those without clear information about methodology and study design were excluded. Results: This review reported that Serenoa serrulata belonging to the Arecaceae family commonly known as saw palmetto is used traditionally for treating prostatic disease conditions and other infertility conditions in both men and women. Phytochemical screening of hexanic and ethanolic extracts of S. serrulata comprised of free fatty acids and phytosterols which together contribute to their antiprostatic activities. These extracts of S. serrulata exhibited antiandrogenic, anti-inflammatory and anti-proliferative activities through inhibition of both isoenzymes 5α- reductase and inhibition of binding of dihydrotestosterone (DHT) to the cytosolic androgen receptors. This is a similar mechanism exhibited by finasteride and Tamsulosin both antiprostatic conventional drugs though the plant phytochemicals do not interfere with PSA secretion. S. serrulata has also been reported to be non-toxic in both non clinical and clinical trial studies. The medicinal plants reported by this review to be used in combination include; stinging nettle (Urtica dioca), Zingiber officinalis, Echinacea angustifolia and pumpkin (Cucurbita pepo). The antiprostatic conventional drugs reported include finasteride and Tamsulosin. Conclusion and Recommendation: The results showed that S. serrulata is effective in treating prostatic diseases. The potency and safety is improved when used in combination with Urtica dioca, Cucurbita pepo, Zingiber officinalis and Echinacea angustifolia as compared with anti-prostatic conventional drugs Finasteride and Tamsulosin alone. The plant combination has also been shown to have improvement in the quality of life and as well enhancing the synergy of Finasteride and Tamsulon and their adverse effects. Effective medicinal plant combinations should be formulated into products and integrated into the usual treatment for prostatic diseases.

Health related vulnerabilities and enabling institutions to facilitate responses to climate change in East Africa

It is now accepted that climate change is having and will continue to have a direct or an indirect impact on human health and in most cases, it will be negative. In this review the links between climate and climate sensitive diseases is established. The review goes further to examine what it will take for health research institutions to address adaptation to climate change, while reducing institutional vulnerability and improving their response to climate change. Evidence has emerged that range expansion of climate sensitive diseases such as malaria, meningitis, Rift Valley Fever, chikungunya and cryptosporidium is occurring and this will increase pressure on the health systems across Africa. Climate related risks in health will require a proactive approach in order to prevent rather than manage health disasters. Diseases epidemic predictive models will enable early detection of the risks and intervention. The health system is dependent on several national and foreign partners forming a critical network. If these networks malfunction then the health systems will be highly susceptible to failure. Governance and leadership of the institutions will determine the rate of adaption to climate change. There is need to strengthen research institutions in Africa because they can run long term programs addressing climate change. Furthermore these institutions must expand their research agenda to include a multidisciplinary approach to solving problems. A closer collaboration between departments of meteorology, remote sensing and mapping and medical research institutions is now more urgent than ever. Development partners and national governments must invest in infrastructure that will enable adaptation with the aim of increasing the institutional capacity to cope and minimize the potential impacts of climate driven diseases.

Etiologies of bloodstream infection and antimicrobial resistance: A cross sectional study among patients in a tertiary hospital, Northern Tanzania

Background: Bloodstream infections are important causes of morbidity and mortality in people of all age groups, especially in sub-Saharan Africa. In Tanzania, a recent report indicates that case fatality rate of 37% is attributed to bloodstream infections. The aim of this study was to determine the prevalence and factors associated with bloodstream infections as well as to determine resistance pattern of bacterial isolates among patients visiting Kilimanjaro Christian Medical Centre (KCMC). Methods: A cross-sectional study was conducted from April to June 2019 at KCMC. A total of 200 patients were included in the study. Blood samples were collected for culture, malaria rapid test, typhoid and brucella tests. Clinical features, co-morbid conditions and patients' hospitalization data were recorded in the questionnaire. Logistic regression was used to examine the factors associated with bloodstream infections. Predictors of the outcome were considered significant at p<0.05. Results: The prevalence of bloodstream infections was 52(26%). Participants with stomachache had less odds of having bloodstream infections as compared to other patients with symptoms (AOR=0.22, 5.33, 95%CI=0.05-0.97; p=0.04). Of the XX identified isolates Staphylococcus aureus showed the highest rates of resistance for Meropenem 8(88.8%), Cefotaxime 6(66.6%, Amikacin 6(66.6%), Gentamicin 6(66.6%) and Imipenem 6(66.6%). The lowest level of resistance was observed in Ceftriaxone 1(11.1%). Conclusion: Bloodstream infections were highly prevalent in this sample (26%). Staphylococcus spp was the most commonly isolated organism and exhibited a high resistance rate to most antibiotics. This calls for increased and coordinated efforts to improve the identification, treatment and management of bloodstream infections and antimicrobial resistance, thereby improving clinical practice.

Chlamydia trachomatis and Neisseria gonorrhoea Co-Infection Among Patients Attending a Teaching Hospital in Nairobi County: A Retrospective Study

Background: Chlamydia trachomatis and Neisseria gonorrhoea are microbes that have been associated with urethritis in both male and female genders, which often may lead to complicated conditions such as pelvic inflammatory disease (PID) and infertility globally among others health complications. In Kenya and other developing countries, sexually transmitted infections associated with Chlamydia trachomatis and Neisseria gonorrhoea still pose a challenge in public health. Methods: A retrospective study was conducted by reviewing laboratory data from Jan 2018 to Dec 2018 to estimate the prevalence of C trachomatis and N gonorrhoea coinfections in patients attending a tertiary institution and its satellite clinics spread across the country. A total of 1228 patient’s data aged 3-69 years was reviewed; with age, gender and Chlamydia trachomatis and Neisseria gonorrhoea status being analyzed. Results: A total of 1228 patients who visited the hospital in 2018 had their urine samples being tested for Chlamydia trachomatis and Neisseria gonorrhoea by use of a PCR technique. Majority of the patients were males (63.7%). The patients who tested for Chlamydia trachomatis and Neisseria gonorrhoea had an average age of 34 years (range: 3–69 years). Of those 1.4% tested positive for both Chlamydia trachomatis and Neisseria gonorrhoea infections, and males were more infected than females (1.1% vs 0.3). From the information gathered during the study period, the proportion of patients with Chlamydia trachomatis infection was (16.1 %) (95 % CI 9.5, 17.9), and with N. gonorrhoea infection was 5.4%. Coinfection was highest among sexually active group that is those aged between 21 years to 40 years. Conclusion: The prevalence of C. trachomatis is significantly high among male patients. We recommend the implement a molecular screening for Chlamydia trachomatis and Neisseria gonorrhoea to identifying asymptomatic female cases. This study further provides evidence on the importance of contact tracing in the management of Chlamydia trachomatis and other STIs. There is an urgent need for studies designed to investigate the prevalence and risk factors of Chlamydia trachomatis and Neisseria gonorrhoea among female patients who are majorly asymptomatic in Kenya.

Effectiveness of Azadirachta indica (neem tree) on prevention and treatment of clinical human malaria: A systematic review

Introduction: Neem tree parts such as leaves, stem barks, and roots are known to have some medicinal values in both humans and animals. However, the evidence is scattered and vary with populations and regions. This systematic review sought to explore the effectiveness of neem as a therapeutic and prophylactic agent against malaria. Methodology: The systematic review examined the effectiveness of neem using the pre-registered review protocol and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The Population Intervention Comparator Outcome (PICO) question was: “What is the effectiveness of neem (Azadirachta indica) when used as a therapeutic and prophylactic agent for malaria infection?” It included all cross-sectional survey studies, qualitative studies, case-control studies, randomised controlled trials, quasi-experimental studies, and cohort studies with or without comparison groups. Studies that had both children and adult patients who were diagnosed with malaria were included in the survey. Malaria patients using traditional medications other than neem as well as those who did not use neem were excluded from this study. The search for articles, screening, and synthesis were conducted using the Rayyan software. Results: Out of the total 1089 articles retrieved, only 3 fitted the inclusion criteria, 1 article could not be retrieved. A narrative synthesis was therefore done on 2 final research articles that were retrievable. The pooled evidence shows that Azadirachta indica is effective against malaria. The medicinal effects are more on symptoms and curbing development to clinical disease than ant parasitic effects. Conclusion: Neem is potential traditional medicine for malaria symptoms’ treatment, but evidence on ant parasitic effects is still not conclusive. The study recommends further primary studies to enhance the power of results to further recommend this plant for the prevention of or treatment of malaria symptoms.

The Rate of Sample Rejection and Pre-Analytical Errors at KCMC Clinical Laboratory in Moshi, Kilimanjaro

Background: Over the years, modern medicine has been able to provide a better quality services to patients. However, medical error is still prevalent and has a lot of negative consequences on patients’ outcome. These may include delayed treatment, longer hospital stays, or even worsening of the patient’s condition. The aim of this study was to determine the rate of sample rejection at KCMC Clinical Laboratory and the different pre-analytical errors that contribute to it. Methods: Data extraction sheet was used to collect information from rejection forms from January to December 2016. Information on types of sample rejected, the wards/departments from which they were collected and the clinical laboratory section in which they were to be analysed were collected. Results: Out of the 117181 samples received from January to December 2016, 234 were rejected, giving a 0.19% rate of rejection. The highest rates of rejection were from haematology section 78 (33.3%). The major type of rejected sample was blood (86.3%) and 20% of the rejected samples came from internal medicine department, mainly from its inpatient department (13.6%). The commonest reason for rejection was unpaid specimens 84 (35.9%). Conclusion: The impact of pre-analytical errors on patient care is not negligible. A joint collaboration of all the stakeholders involved in patient care, specimen handling and analysis, and policymaking is necessary to arrive at quick and tangible solutions. Better communication between laboratory staff and other health care personnel is essential.

Prophylactic Effects of ARTAVOL® on Plasmodium berghei Infected Mice

Introduction: Despite the efforts of governments and health organisations to eradicate malaria, it is still endemic in sub-Saharan Africa and this could be due to cost of antimalarial drugs, resistance to these drugs and climate change among others. Traditional medicine practitioners and scientists have started developing antimalarial drugs from medicinal plants among which is ARTAVOL®. ARTAVOL® is a herbal product that is used to prevent malaria in some communities in Uganda, however, its prophylactic effects on Plasmodium berghei infected mice has not been established yet. Methods: The infusion of ARTAVOL® powder was prepared, cooled, filtered, concentrated in vacuo at 55 0C and freeze-dried. The freeze-dried extract was reconstituted with distilled water for antimalarial using prophylactic model mice. Thirty-six mice were randomised into 6 groups of 6 mice each. Groups I to III mice were orally administered with the extract at 15 to 60 mg/kg/day while group IV received Pyrimethamine (1.25 mg/kg) while groups V and VI (uninfected) received 0.2 mL distilled water for seven days before the inoculation of Plasmodium berghei ANKA parasites on day 7 (D7). The parasitaemia levels were examined after 72 hours using standard procedure and blood collected through cardiac puncture for haematological study. Results: The Lethal Dose (LD50) of the crude ARTAVOL extract was greater than 5000 mg/kg. Also, there was calmness and paw licking immediately after dosing which stopped after few minutes. Significant reduction in parasitaemia level was observed in all test doses when compared with negative control. At 30 mg/kg, the extract gave 62.9% suppression, which was not significantly different from that of 60 mg/kg (68.7%) on day 3. On day 5, the extract gave 62.3% and 66.4% Suppressions At 30 And 60 Mg/Kg That Were Not Significantly Different From Each Other. A Dose Dependent Reversal of Hematocrit (HCT) reduction was observed at the 3 dose levels but their parameters did not show any significant difference when compared to the normal group but significant when compared with negative control. Conclusion: ARTAVOL® extract has shown a dose dependent reducing effect on the level of parasitaemia in P.berghei infected mice; it is acutely safe and has ability to increase RBC counts.