School of Public Health, Biomedical Sciences and Technology

SPATIO-TEMPORAL DISTRIBUTION OF PLASMODIUM FALCIPARUM INFECTIONS AND KELCH-13 ARTEMETHER-LUMEFANTRINE RESISTANCE IN MBALE TOWNSHIP, WESTERN KENYA

2024-08-01T00:00:00Z

SPATIO-TEMPORAL DISTRIBUTION OF PLASMODIUM FALCIPARUM INFECTIONS AND KELCH-13 ARTEMETHER-LUMEFANTRINE RESISTANCE IN MBALE TOWNSHIP, WESTERN KENYA Muzame, Beatrice Aleyo Malaria is the leading cause of mortality and morbidity in Sub Saharan Africa. Various intensive control strategies and measures have been put in place to reduce and ultimately eradicate malaria but it still exists at disproportionately high levels in many regions of Kenya. The study in Mbale town and its environs was carried out at Mbale Provincial Rural Training Health Center in Vihiga County, Western Kenya. The study determined spatio- temporal distribution of Plasmodium species by microscopy, effect of genotype of P. falciparum kelch 13 on efficacy of artemether-lumefantrine by P. falciparum’s DNA extraction from dry blood spots using Qiagen method, DNA genotyping by polymerase chain reaction and Sanger sequencing and influence of socio-economic factors on malaria prevalence done by structured questionnaire. A total of 768 malaria confirmed patients were purposively recruited from December 2019 to November 2020 and stratified according to demographic status and their geographical locations. Data was analysed using SPSS software version 17. Descriptive and inferential statistics were used to compare variables in the study population. In all tests p-value ≤ 0.05 was considered statistically significant. Out of 768 malaria patients recruited, 98.7% recorded P. falciparum positive, while P. ovale, P. malariae and P. vivax accounted for 1.3%. Edzava ward recorded all the four Plasmodium species. Lugaga/Wamuluma ward recorded more malaria patients than Edzava and Central Maragoli wards. Male malaria patients accounted for 49.3% recording all Plasmodium species while female constituted 51.7% without Plasmodium ovale. All age groups were diagnosed with P. falciparum while P. malariae and P. ovale were not identified among 14-18 years old age group. Children below 5 years old were not diagnosed with P. ovale. Multinomial regression analysis showed effect of wards, age and gender to malaria prevalence was ([F (3,764) = 1.854], < 0.136). Wards according to multinomial regression (p = 0.034) and Chi-Squared p value = 0.036) were statistically significant to malaria prevalence as opposed to gender and age. Multiple linear regression analysis showed effect of time trend on malaria prevalence was ([F (3, 8) = 2.976], p < 0.097). Months however had a statistically significant effect on malaria prevalence (p = 0.036) as opposed to rainfall and temperature. Correlation between average temperature and months were statistically significant (p = 0.013). From the results obtained synonymous mutations identified in P. falciparum kelch 13 among study population did not compromise the efficacy of Artemether-lumefantrine in the study area. Chi- squared analysis showed influence of socio-economic factors on malaria prevalence in the study area as follows: - level of education (p-value = 0.014), wealth (p-value = 0.000), size of land (p-value = 0.035), house type (p-value = 0.006), salary (p-value = 0.043) and ventilation in the house (p value = 0.000) were statistically significant to malaria prevalence as opposed to household size. Space, time trend and socio-economic factors influenced malaria prevalence in the study area as opposed to P. falciparum kelch 13. Malaria management bodies should strengthen malaria control strategies in relation to space, time trend, antimalarial efficacy and socio-economic factors at household level.

PREVALENCE, RISK FACTORS AND OUTCOMES OF LATE PRETERM AND EARLY TERM NEONATES COMPARED TO FULL-TERM BORN AT GARISSA COUNTY REFERRAL HOSPITAL

2024-05-01T00:00:00Z

PREVALENCE, RISK FACTORS AND OUTCOMES OF LATE PRETERM AND EARLY TERM NEONATES COMPARED TO FULL-TERM BORN AT GARISSA COUNTY REFERRAL HOSPITAL Amolo, Tom J. H. Late preterm neonates (LPNs) and early term neonates (ETNs) represent substantial proportions of global births. Despite this, the prevalence, risk factors, and neonatal outcomes within these subgroups are understudied in Garissa County, Kenya. The purpose of this study was to determine the prevalence, establish risk factors associated with late preterm, and early term births relative to full-term, their neonatal outcomes, and predictors of their survival at Garissa County Referral Hospital. Utilizing a prospective cohort study design, this research employed convenience sampling to enroll LPNs, ETNs, and full-term neonates (FTNs) as a control group. After obtaining informed consent, data was collected at five distinct time points: days 1, 3, 7, 14, and 28 of neonatal life. A range of maternal and fetal factors, along with neonatal outcomes, were captured using pre-tested, validated structured questionnaires. Data were entered, cleaned, and analyzed using Statistical Package for the Social Sciences version 27 and STATA version 17. Various statistical tests such as Chi-square, independent sample t tests, and Kruskal-Wallis were applied to determine significant differences. Multinomial and ordinal logistic regression models were used to identify potential risk factors, while Kaplan-Meier survival analysis was used to estimate neonatal survival rates. The findings of this study revealed that LPNs, ETNs and FTNs have a prevalence of 8.47%, 11.86% and 9.2%, respectively. Maternal related risk factors associated with birth of LPN, ETN and FTN were maternal age (P=0.042), occupation (P=0.024), ethnicity (P=0.021), religion (P=0.016) and absence of previous abortion/still birth/premature deliveries (P = 0.015). Birth weight was significantly associated with LPN (P=0.00), while FTN had significantly higher likelihood of delayed initiation of breastfeeding (P=0.038) but were less likely to have feeding difficulties compared to LPN and ETN (P=0.012). However, the survival rates were remarkably high across all groups, with 100% for LPNs, 98.7% for ETNs, and 98.2% for FTNs. In conclusion, the study provides vital insights into the prevalence, risk factors, and neonatal outcomes for LPN’s and ETN’s in Garissa County. It further establishes that there is increased likelihood of delay in initiation of breastfeeding among FTN compared to their LPN and ETN counterparts. Nevertheless, the survival rate remains high across all categories. This study underscores the need for targeted interventions to improve outcomes for these vulnerable populations. Key words: Late Preterm Neonate; Early Term Neonate, Full Term Neonate; Morbidity, Mortality, Survival, Garissa

PHENOTYPIC, GENOTYPIC, VIRULENCE AND AZOLE RESISTANCE CHARACTERIZATION OF CANDIDA SPECIES FROM CLINICAL SPECIMENS IN NAIROBI COUNTY, KENYA

2024-11-01T00:00:00Z

PHENOTYPIC, GENOTYPIC, VIRULENCE AND AZOLE RESISTANCE CHARACTERIZATION OF CANDIDA SPECIES FROM CLINICAL SPECIMENS IN NAIROBI COUNTY, KENYA SIGEI, EROLLS CHERUIYOT Invasive and systemic candidiasis are prevalent mycoses complicating immune suppressive conditions and leading to high mortality. The development and spread of azole antimycotic drug resistance hampers their effective utilisation in therapy and prophylaxis of candidiasis. Candida albicans (CA), consisting of genotypes A-H with varying virulence, is the most prevalent species. Several virulence factors including biofilm formation, haemolysins, proteases, and phospholipase (PLs) activities confer the fungi with invasiveness and dissemination of disease. This study determined the distribution and anti-azole resistance of CA and non-albicans candida (NAC), including genotypes and virulence factor expression in CA isolates. This cross sectional research was conducted on clinical samples (n=141) of patients presenting with different candidal mycoses at various metropolitan health facilities in Nairobi city, Kenya. Candida isolate identification was done via mycological culture, morphological, biochemical, and VITEK® 2-YST methods. Itraconazole (ITZ) and voriconazole (VOR) resistance were evaluated by the disk diffusion and broth micro dilution tests. Genotyping and virulence factor expression were determined for the CA isolates (n=94) using PCR-RFLP and virulence expression culture methods, respectively. Overall, 141 isolates were recovered, consisting of CA (66.7%) and NAC (C. glabrata, 16.3%; C. parapsilosis, 7.8%; C. tropicalis, 3.6%; C. krusei, 2.8%; C. guilliermondii, 1.4%; and C. famata, 1.4%). Anti-azole sensitivity was low for ITZ (21.3%) and VOR (24.5%) with high cross-resistance (74.5%) in the CA isolates. In the NAC isolates, sensitivity to ITZ, VOR, and cross-resistance were: C. glabrata (8.7%, 13.0% and 87.0%); C. parapsilosis (36.4%, 45.5% and 54.5%); C. tropicalis (40.0%, 60.0% and 40.0%); C. krusei (0.0%, 33.3% and 66.7%); C. famata (50.0%, 50.0% and 50.0%); and C. guilliermondii (0.0%, 50.0% and 50.0%), respectively. The mean (range) mg/ml minimum inhibitory concentrations (MIC) at MIC50 and MIC90 of sensitive CA isolates were 0.125 and 0.250 (0.031-0.500) for ITZ; and 0.250 and 0.250 (0.031-1.000) for VOR, respectively. For NAC, the MIC50 and MIC90 mean (range) mg/ml were 0.063 and 0.125 (0.025-0.500) for ITZ; and 0.094 and 0.250 (0.031-1.250) for VOR, respectively. CA A (66.0%) versus B (4.3%), and C (19.1%) genotypes was more frequent. All CA isolates had higher activities of biofilm production (75.5%) and PLs (73.4%) compared to haemolysin (21.3%) and proteinase (36.2%). Higher expressions of biofilm (95.2% vs. 42.9%; P<0.0001), PLs (96.8% vs. 28.6%; P<0.0001), and proteinase (52.4% vs. 9.5%; P=0.001) activities were also noted in A relative to non-A genotypes, respectively. Additionally, PLs activity was higher in ITZ resistant vs. sensitive strains (84.8% vs. 61.1%; P=0.044). Altogether, these results demonstrate that CA and its genotype A are the most prevalent isolates. Candida isolates exhibit low sensitivity rates to ITZ and VOR. Production of biofilm and PLs are the most expressed virulence factors in CA isolates linked to genotype A and ITZ resistance. Implications of these results include adoption of a combination and/or use of different antifungal agents for candidiasis treatment and prophylaxis

GENOTYPIC CHARACTERISTICS AND MOLECULAR MARKERS OF ANTIBIOTIC RESISTANT NONTUBERCULOUS MYCOBACTERIA AND ASSOCIATED CLINICAL OUTCOMES AMONG PATIENTS ATTENDING BUNGOMA COUNTY, KENYA

2024-11-01T00:00:00Z

GENOTYPIC CHARACTERISTICS AND MOLECULAR MARKERS OF ANTIBIOTIC RESISTANT NONTUBERCULOUS MYCOBACTERIA AND ASSOCIATED CLINICAL OUTCOMES AMONG PATIENTS ATTENDING BUNGOMA COUNTY, KENYA Wamalwa, Ronald Free-living, saprophytic non-tuberculous mycobacteria (NTM) are widely distributed and mostly found in sediment, aquatic habitats, biofilms, aerosols, animals, and people. M. tuberculosis (MTB) and NTM are both members of the Mycobacterium genus. It could display similar microscopic, radiological, and clinical features as MTB. Studies have reported 33.4% of cases are in North America, 23.8% are in Europe, 20.8% are in Asia, and 7.5% are in Africa. Worldwide, non-tuberculous mycobacterial infection prevalence varies. Currently, NTM infections and the rising incidence of antibiotic resistance (AMR)are the two major global health issues are. A significant prevalence of 33.6% for MTB among HIV patients have been reported in Kenyan counties like Bungoma. This study examined the antibiotic susceptibility profiles and genotypic traits of NTM isolates from people living with HIV (PLWH) at Bungoma County Referral Hospital (BCRH). This study assessed the relationship between AMR molecular markers and clinical outcomes such underweight status, immunosuppression, and viral suppression. A total of 167 suspected TB patients were selected purposively in an analytical cross-sectional study. Smear microscopy and culture were used to determine presence of NTM, while ELISA determined HIV status. The Abbott m2000 system was used to establish viral load and flow cytometry was used to measure CD4+ T cell count, and NTM infection. While NTM isolates' minimum inhibitory concentrations were assessed using microdilution broth, NTM species in positive cultures were identified using the Hain Genotype Mycobacterium CM/AS assay. Continuous data were analysed using the Mann-Whitney U test, while categorical variables were compared using chi-square testing. Using logistic regression and Pearson correlation, the relationship between AMR in NTM isolates and clinical outcomes among PLWH was evaluated. PLWH had a 41.1% prevalence of positive NTM cultures, whereas HIV-negative individuals had a 21.3% prevalence (P = 0.280). The most common species was M. intracellulare (42.9%), which was followed by M. fortuitum (26.3%). Less often found were M. lentiflavum, M. scrofulaceum, and M. abscessus. Drug-resistant NTM isolates from PLWH and HIV negative individuals showed resistance to pyrazinamide (15.2% vs. 4.3%, P<0.001), ethambutol (9.1% vs. 0.0%, P < 0.001), and isoniazid (12.1% vs. 8.7%, P < 0.043). HIV-negative individuals had a median CD4+ T cell count of 853 cells/mm³, whereas PLWH had a median of 454 cells/mm³. In 9.6% and 3.2% of PLWH cases, respectively, the presence of the rpoB and katG genes was associated with AMR. In HIV-negative individuals’ the prevalence of mutations in the inhA gene were 2.1%, while PLWH had a 2.7% prevalence. PLWH co-infected with inhA-carrying NTM had a twofold increased risk of underweight (OR: 2.409, 95% CI: 1.858-7.871; P = 0.040). The rpoB and katG genes were not associated with outcomes like underweight, viral load, or immunosuppression. The study's findings highlight how common AMR is in NTM isolates from PLWH, which has significant implications for therapeutic treatment. In addition, mutations in the inhA gene were associated with a higher risk of underweight status in PLWH. Therefore, there is need of molecular surveillance as well as addressing educational and vocational variables in the management of AMR among PLWH in Bungoma County.