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Integrated community-directed intervention for schistosomiasis and soil transmitted helminths in western Kenya – a pilot study
Mwinzi Pauline NM,Montgomery Susan P,Owaga Chrispin O,Mwanje Mariam
Parasites & Vectors , 2012, DOI: 10.1186/1756-3305-5-182
Abstract: Background Schistosome and soil-transmitted helminth (STH) infections are recognized as major global public health problems, causing severe and subtle morbidity, including significant educational and nutritional effects in children. Although effective and safe drugs are available, ensuring access to these drugs by all those at risk of schistosomiasis and STHs is still a challenge. Community-directed intervention (CDI) has been used successfully for mass distribution of drugs for other diseases such as onchocerciasis and lymphatic filariasis. A national control programme is yet to be instituted in Kenya and evidence for cost-effective strategies for reaching most affected communities is needed. This study evaluated the effectiveness and feasibility of the CDI strategy in the control of schistosomiasis and STHs, in East Uyoma location, Rarieda district, a community of western Kenya that is highly endemic for both infections. Results Pre-treatment prevalence of S. mansoni averaged 17.4% (range 5-43%) in the entire location. Treatment coverage in different villages ranged from 54.19 to 96.6% by community drug distributor (CDD) records. Assessment from a household survey showed coverage of 52.3 -91.9% while the proportion of homesteads (home compounds) covered ranged from 54.9-98.5%. Six months after one round of drug distribution, the prevalence levels of S. mansoni, hookworm and Trichuris trichura infections were reduced by 33.2%, 69.4% and 42.6% respectively. Conclusions This study shows that CDI is an accepted and effective strategy in the mass treatment of schistosomiasis and STH infections in resource constrained communities in Kenya and may be useful in similar communities elsewhere. A controlled trial comparing CDI and school based mass drug administration to demonstarte their relative advantages is ongoing.
Simulation of malaria epidemiology and control in the highlands of western Kenya
Stuckey Erin M,Stevenson Jennifer C,Cooke Mary K,Owaga Chrispin
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-357
Abstract: Background Models of Plasmodium falciparum malaria epidemiology that provide realistic quantitative predictions of likely epidemiological outcomes of existing vector control strategies have the potential to assist in planning for the control and elimination of malaria. This work investigates the applicability of mathematical modelling of malaria transmission dynamics in Rachuonyo South, a district with low, unstable transmission in the highlands of western Kenya. Methods Individual-based stochastic simulation models of malaria in humans and a deterministic model of malaria in mosquitoes as part of the OpenMalaria platform were parameterized to create a scenario for the study area based on data from ongoing field studies and available literature. The scenario was simulated for a period of two years with a population of 10,000 individuals and validated against malaria survey data from Rachuonyo South. Simulations were repeated with multiple random seeds and an ensemble of 14 model variants to address stochasticity and model uncertainty. A one-dimensional sensitivity analysis was conducted to address parameter uncertainty. Results The scenario was able to reproduce the seasonal pattern of the entomological inoculation rate (EIR) and patent infections observed in an all-age cohort of individuals sampled monthly for one year. Using an EIR estimated from serology to parameterize the scenario resulted in a closer fit to parasite prevalence than an EIR estimated using entomological methods. The scenario parameterization was most sensitive to changes in the timing and effectiveness of indoor residual spraying (IRS) and the method used to detect P. falciparum in humans. It was less sensitive than expected to changes in vector biting behaviour and climatic patterns. Conclusions The OpenMalaria model of P. falciparum transmission can be used to simulate the impact of different combinations of current and potential control interventions to help plan malaria control in this low transmission setting. In this setting and for these scenarios, results were highly sensitive to transmission, vector exophagy, exophily and susceptibility to IRS, and the detection method used for surveillance. The level of accuracy of the results will thus depend upon the precision of estimates for each. New methods for analysing and evaluating uncertainty in simulation results will enhance the usefulness of simulations for malaria control decision-making. Improved measurement tools and increased primary data collection will enhance model parameterization and epidemiological monitori
Reliability of School Surveys in Estimating Geographic Variation in Malaria Transmission in the Western Kenyan Highlands
Jennifer C. Stevenson, Gillian H. Stresman, Caroline W. Gitonga, Jonathan Gillig, Chrispin Owaga, Elizabeth Marube, Wycliffe Odongo, Albert Okoth, Pauline China, Robin Oriango, Simon J. Brooker, Teun Bousema, Chris Drakeley, Jonathan Cox
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077641
Abstract: Background School surveys provide an operational approach to assess malaria transmission through parasite prevalence. There is limited evidence on the comparability of prevalence estimates obtained from school and community surveys carried out at the same locality. Methods Concurrent school and community cross-sectional surveys were conducted in 46 school/community clusters in the western Kenyan highlands and households of school children were geolocated. Malaria was assessed by rapid diagnostic test (RDT) and combined seroprevalence of antibodies to bloodstage Plasmodium falciparum antigens. Results RDT prevalence in school and community populations was 25.7% (95% CI: 24.4-26.8) and 15.5% (95% CI: 14.4-16.7), respectively. Seroprevalence in the school and community populations was 51.9% (95% CI: 50.5-53.3) and 51.5% (95% CI: 49.5-52.9), respectively. RDT prevalence in schools could differentiate between low (<7%, 95% CI: 0-19%) and high (>39%, 95% CI: 25-49%) transmission areas in the community and, after a simple adjustment, were concordant with the community estimates. Conclusions Estimates of malaria prevalence from school surveys were consistently higher than those from community surveys and were strongly correlated. School-based estimates can be used as a reliable indicator of malaria transmission intensity in the wider community and may provide a basis for identifying priority areas for malaria control.
Influence of selected washing treatments and drying temperatures on proximate composition of dagaa (Rastrineobola argentea), a small pelagic fish specie.
EE Owaga, CA Onyango, CK Njoroge
African Journal of Food, Agriculture, Nutrition and Development , 2010,
Abstract: Proximate analysis for moisture, crude protein, crude fat and total ash was carried out on dagaa (Rastrineobola argentea), a small pelagic fish specie found in Lake Victoria. The first phase of the study involved sampling of fresh, sundried (for 1 day, 2 days, 3 days, 4 days) and retail market dagaa. The second phase of the study involved pre-washing of fresh dagaa with selected solutions namely, salted solution (3% NaCl), chlorinated solution (100 ppm) or potable tap water (control) and thereafter oven-drying the respective pre-washed samples at 30oC (31hrs), 40oC (23hrs) or 50oC (15hrs). Results showed that the crude protein composition of fresh dagaa (74.4% dry weight basis, dwb) was significantly higher (p<0.05) than values in market samples (62.5% dwb). After oven-drying at 30oC, the salted-wash treatments resulted to significantly lower (p<0.05) crude protein content of 60.4% (dwb) when compared with the chlorinated (64.6% dwb) and control-wash treatments (64.1% dwb).The crude fat content in fresh dagaa (14.8% dwb) was significantly higher (p<0.05) than levels in market samples (13.9% dwb).The salted-wash treatments showed significantly lower (p<0.05) crude fat content (15.9% dwb) than the chlorinated (17.0% dwb) and control (16.9% dwb) wash treatments after ovendrying at 30oC.The total ash content in fresh dagaa (10.3% dwb) was significantly lower (p<0.05) than levels in market samples (13.5% dwb).The salted and chlorinated-wash treatments exhibited significantly higher (p<0.05) total ash content (19.9%, 16.7% dwb, respectively) than the control-wash treatment (15.9% dwb) after drying at 40oC. In this study, oven-drying of dagaa at 40oC after washing with chlorinated (100ppm) solution was suggested with regard to the optimal retention of the crude protein and fat levels of the dried dagaa.These conditions are achievable at the local community level through use of solar driers whereas sodium hypochlorite products are accessible to most of the households involved in dried fish processing.
Child malnutrition and mortality in Swaziland: Situation analysis of the immediate, underlying and basic causes
SKS Masuku-Maseko, EE Owaga
African Journal of Food, Agriculture, Nutrition and Development , 2012,
Abstract: Malnutrition is a major confounding factor for child morbidity and mortality in developing countries. In Swaziland, about 31% of the under-five children are stunted in growth, where-as 1% and 6% are wasted and underweight, respectively. Hhohho region has the highest prevalence of underweight children (8.2%) relative to other regions such as Shiselweni (7.3%), Lubombo (6.7%) and Manzini (6.4%). The prevalence of infant and under-five children mortality rate (per 1,000 live births) are 85 and 102 deaths, respectively. Lubombo region has the highest cases of under-five mortality rate (deaths per 1,000 live births) of 115 when compared to rates in other regions, namely; Manzini (112), Shiselweni (100) and Hhohho (96). Despite the several child healthcare programmes, the problem of high child malnutrition places a significant hindrance towards the attainment of the Millennium Development Goals (MDG) 4 on reduction of child mortality. Potential determinants of childhood malnutrition and mortality in Swaziland can be categorized into three levels, namely: (a) immediate causes (inadequate dietary intake of protein, energy and micronutrients; diseases such as pneumonia, diarrhoeal diseases and HIV/AIDS, (b) underlying causes (inadequate access to food due to poverty and decline in food production; inadequate care of children and women, insufficient health services and unhealthy environment), and (c) basic causes (inadequate mother’s education and nutrition knowledge, insufficient human resources in child health care; inadequate policies on child nutrition and health care; inequitable distribution of household and national socioeconomic resources). This paper presents an in-depth analysis of the causal factors of childhood malnutrition and mortality in Swaziland, and further explores opportunities that could be adopted to address the malnutrition and mortality problem. It also aims to reinforce that in order to ensure effectiveness and sustainability of intervention programmes, there is need for multi-dimensional strategies and collaboration between all the stakeholders concerned with child nutrition, health and socio-economic development. However, the interventions must recognize the existing socio-economic differentials between the rural and urban areas, and the administrative regions.
Effects of selected washing treatments and drying temperatures on biochemical and microbiological quality of dagaa (Rastrineobola argentea).
EE Owaga, CA Onyango, CK Njoroge
African Journal of Food, Agriculture, Nutrition and Development , 2009,
Abstract: Dagaa (Rastrineobola argentea) is one of the most important fish foods for the lowincome households in the Nyanza Province, Kenya. However, the off-flavour and offodour that results from the traditional sun-drying process of sun-dried dagaa is a major disincentive to the use of the fish for human consumption, hence leading to utilization in animal feed. Chemical analyses for pH, Thiobarbituric reactive substances (TBARS), Total volatile bases-nitrogen (TVBN) and aerobic bacterial counts were carried out on dagaa sampled from various process steps within the open field sun-drying and market conditions. Dagaa was also oven-dried at 30oC, 40oC and 50oC after washing with selected solutions namely salted (3% sodium chloride), chlorinated solutions (100ppm) and potable tap water (control). Results indicated that TBARS values increased significantly (p<0.05) from 1.39 mgMA/kg in fresh fish to 10.55 mgMA/kg in the market samples. The TVBN values increased significantly (p<0.05) from 9.42 mgMA/kg in fresh fish to 29.51 mg/ 100g in the market samples. The pH values declined significantly (p<0.05) from pH 6.72 in the fresh fish to pH 5.88 in the market samples .Lipid oxidation (TBARS) was significantly (p<0.05) higher in dagaa subjected to salted-wash treatments when compared to the chlorinated and control-wash treatments. The rate of lipid oxidation was significantly (p<0.05) higher at elevated temperatures of 50oC relative to 30oC and 40oC conditions. The TVBN levels observed in the salted and chlorinated-wash treatments showed significantly (p<0.05) lower TVBN values when compared with the control-wash treatments. However, the values of TVBN obtained at 30oC were significantly (p<0.05) higher when compared with the 40oC and 50oC drying temperature conditions. The salted-wash treatments resulted in lower pH values relative to the chlorinated and control-wash treatments on drying at 30oC and 40oC. In this study, the most appropriate treatment that showed the least TVBN and moderate TBARS values was drying the dagaa at 50oC after washing with chlorinated solution.
Influenza-Related Hospitalizations and Associated Comorbidities in Nebraska: 2007-2011  [PDF]
Guang-Ming Han, Sandra Gonzalez, Chrispin Chisanga, Cole Vanicek, K. M. Islam
Advances in Infectious Diseases (AID) , 2014, DOI: 10.4236/aid.2014.42015

Objective: Influenza afflicts approximately 5% - 20% of the US population annually. Although prevalence statistics are useful, they are insufficient to understand completely influenza on a health care system. This study estimated Nebraska’s annual hospitalization and comorbidity rates due to influenza from 2007 to 2011. Methods: Influenza was defined according to ICD-9-CM primary codes beginning with 487 or 488 in hospital discharge records. The comorbidities of patients with influenza were defined according to ICD-9-CM secondary diagnosis codes. Results: The highest yearly age-adjusted hospitalization rates were 30.6 and 31.1 per 100,000 populations for 2008 and 2009, respectively. In 2008, the highest hospitalization rate was among those aged 65 yrs and older; in 2009, the highest rate was among those younger than 5 yrs. Asthma was the most frequent comorbidity overall and among those younger than 50 yrs. Conversely, hypertension and heart failure were the most frequent comorbidities among those aged 50 yrs and older. Conclusion: These findings provide a better understanding of the influenza burden and may contribute to developing more effective influenza prevention strategies.

Evidence for Placental HPV Infection in Both HIV Positive and Negative Women  [PDF]
Chrispin Chisanga, Dawn Eggert, Charles D. Mitchell, Charles Wood, Peter C. Angeletti
Journal of Cancer Therapy (JCT) , 2015, DOI: 10.4236/jct.2015.615140
Abstract: Human papillomaviruses (HPVs) have previously been reported to infect epithelial trophoblast cells of the placenta. To investigate this possibility, 200 placental samples from Zambian women were separated into HIV+ and HIV- groups and tested for HPV by redundant primer PCR, using GP5+/GP6+ and CPI/CPII primer sets. Three HPV genotypes (HPV6, 16 and 90) were detected in placental samples. Whereas, 20 different HPV genotypes were detected in vaginal sampling of the same patients, suggesting that compartment specific sub-populations of HPV may exist. The incidence of HPV16 in placental samples was almost 2-fold greater in HIV+ women compared to HIV- (p = 0.0241). HPV16 L1 expression, detected by immunochemistry, was significantly higher in HIV+ than HIV- samples (p = 0.0231). HPV16 DNA was detected in the nuclei of trophoblast cells by in situ hybridization. Overall, these results suggest that HPVs infect the placenta and that HIV significantly influences these infections.
Input Subsidies to Improve Smallholder Maize Productivity in Malawi: Toward an African Green Revolution
Glenn Denning,Patrick Kabambe,Pedro Sanchez,Alia Malik,Rafael Flor,Rebbie Harawa,Phelire Nkhoma,Colleen Zamba,Clement Banda,Chrispin Magombo,Michael Keating,Justine Wangila,Jeffrey Sachs
PLOS Biology , 2012, DOI: 10.1371/journal.pbio.1000023
Input Subsidies to Improve Smallholder Maize Productivity in Malawi: Toward an African Green Revolution
Glenn Denning ,Patrick Kabambe,Pedro Sanchez,Alia Malik,Rafael Flor,Rebbie Harawa,Phelire Nkhoma,Colleen Zamba,Clement Banda,Chrispin Magombo,Michael Keating,Justine Wangila,Jeffrey Sachs
PLOS Biology , 2009, DOI: 10.1371/journal.pbio.1000023
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