acknowledgements - kenya medical research institute ntd conference... · 1 acknowledgements ntd...
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ACKNOWLEDGEMENTS
NTD Conference Organizing Committee
Dr. Sultani Matendechero
Dr. Doris Njomo
Dr. Maurice Odiere
NTD Conference Secretariat and Logistics
Mr. Fredrick Rawago Ms. Rosemary Musuva
Ms. Apollonia Ayoo Ms. Alice Ngoni
Ms. Cecilia Wandera Dr. Davis Wachira
Mr. Michael Ofire Mr. Dan Korir
Dr. Kepha Bota Mr. Isaac Onkanga
Mr. Kennedy Andiego Ms. Doris Night
Dr. Stella Kepha
Editorial
Dr. Pauline Mwinzi
Dr. Maurice Odiere
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THE ORGANIZERS OF THE 11TH NEGLECTED
TROPICAL DISEASES CONFERENCE WOULD LIKE TO
THANK OUR SPONSORS
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MESSAGE FROM THE DIRECTOR MEDICAL SERVICES
Distinguished Guests, Ladies and Gentlemen,
It is my pleasure to welcome you to this year’s annual
Neglected Tropical Diseases (NTD) Conference. This is the
second time the Ministry of Health, through the NTD
Program, is co-hosting this event with KEMRI. I am pleased
to observe that within a short period of one year, the
collaboration has yielded a remarkable growth in the caliber
and quality of this important activity.
There is good news; and it is that the elimination of the tool
ready NTDs is attainable within the next decade. In maintaining our focus on seizing this
opportunity, the Ministry of Health is tirelessly working towards putting the necessary
strategies in place, which will result in the eventual elimination of all NTDS in the country.
The second national strategic plan for control of the neglected tropical diseases (2016-
2020), outlines the approaches with which control and elimination of all NTDs of public
health importance will be pursued and achieved. These diseases are still a major problem
partly due to poverty, lack of safe water, proper sanitation and housing. This conference
provides a platform on which major progress towards achievement of this goal, can be
reported.
The Ministry recognizes the need for increased financial support and stronger political will
towards the control of NTDs. In addition to immense support that our NTD program
receives from foreign donors and partners, the ministry has trained staff and equipped
regional labs, deliberately to build capacity in terms of mapping of NTDs and monitoring
interventions. This year Kenya is looking forward to being declared Guinea worm free;
and to this end, the Kenya government has led from the front in conducting a high level
Guinea worm advocacy campaign.
Building on past successes, the ministry aims to foster and build more partnerships through
effective advocacy. This is driven by a need for a strong coordination mechanism, resulting
in a well-integrated NTD Program. The NTD Unit was established within the Ministry to
spearhead resource mobilization and leverage on cost cutting through a well-coordinated,
integrated and efficient Program. For example, where there is geographical overlap of
NTDs would it be possible to have one platform for delivery of Mass drug administration?
The Kenya National school based deworming program is a big success story with an
estimated 80% of all eligible school-age children receiving preventive chemotherapy every
year. This has been shown to reduce absenteeism by almost 25%. However, with the
resultant reducing levels of the soil-transmitted helminthiasis (STH) prevalence among
school-age children, we ought to re-think how we can best reach the adult population,
whom studies have shown, bear a big burden of the STH infection. The Lymphatic
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Filariasis control program, re-launched recently in 2015 is currently in its 3rd year of
consistent implementation. More than 2.5 million people at risk of morbidity, disability
and stigmatization are receiving drugs every year within the coast region. This has put us
well on course towards achieving the global goal of eliminating Lymphatic Filariasis by
the year 2020.
Ladies and gentlemen,
In order to inform policy formulation and change, there is need for extensive operational
research for NTD control activities. As we roll out the much needed interventions, we
appreciate the need for a robust monitoring and evaluation system which will be backed by
an equally robust national and regional/county surveillance mechanism. I am hoping that
this will be the major focus of discussion in this conference, because it is only with an
effective monitoring and evaluation system in place, that we can demonstrate achievement
of transmission breaking-points.
Finally ladies and gentlemen,
It is my sincere hope, that this conference will live up to its theme which is ‘partnership
towards achievement of the global goals for control, elimination and eradication of
Neglected Tropical Diseases ’. Looking around I believe that interaction among all
stakeholders present will inspire stronger, more productive partnerships as we move
towards of our goal of eliminating all NTDs from our country.
And now, it is my pleasure to declare the 2017 Kenya National NTD Conference
officially open.
Dr. Kioko Jackson K., OGW
DIRECTOR OF MEDICAL SERVICES
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MESSAGE FROM THE DIRECTOR KEMRI
Distinguished Guests, Ladies and Gentlemen,
I extend a warm welcome to you all to the 11th Annual Neglected
Tropical Diseases (NTDs) Conference which is jointly being co-
hosted by Kenya Medical Research Institute (KEMRI) and its
parent Ministry of Health of the Republic of Kenya.
In line with this year’s theme ‘‘Partnership towards
achievement of the global goals for control, elimination and
eradication of Neglected Tropical Diseases”, this conference strives to foster
partnerships and collaborations in controlling and eventually eliminating NTDs.
Besides moving research more quickly and strategically from the laboratory to clinical
trials and patient treatment, such strategic partnerships bring together complementary
strengths and deepen the impact of cross-disciplinary research within NTDs.
The 2017 conference brings together health professionals including researchers, policy
makers, implementers and other stakeholders working on all aspects of NTDs to share
experiences, review progress and chart the way forward in the research and control of
NTDs in Kenya and the African region as a whole.
As a leading centre of excellence in research for human health and working closely with
the Ministries of Health and Education, KEMRI is committed to strengthening
collaborations and linkages with local, regional and international institutions in NTD
control activities.
To this end, we would like to recognize the tremendous job done so far by our partners
who support various NTD control activities. KEMRI has over the years actively carried
out research on NTDs which is the most common condition affecting the poorest estimated
to be 500 million people living in sub-Saharan Africa (SSA) especially children leading to
stigma, increased absenteeism and drop-out rates from school. Affected adults suffer
reduced economic activity due to poor health, leading to a vicious cycle of poverty. The
common NTDs of priority are Lymphatic Filariasis, Soil-Transmitted Helminthiasis,
schistosomiasis, Trachoma, Leishmaniasis, Hydatidosis, Tungiasis, Buruli Ulcer,
Onchocerciasis, and Guinea worm disease among others.
Recent times have witnessed an increased global momentum towards the control and
elimination of these diseases through the use of safe diagnostic tools, mass drug
administrations, provision of safe water sanitation facilities, and health education among
other intervention strategies.
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KEMRI intends to build even more partnerships and collaborations so as to fully exploit
this new momentum, both in terms of generation of new research knowledge and in control
and prevention activities. Indeed, research in NTDs in Kenya has come a long way and
grown tremendously over the years, contributing significantly to progress in NTD control
in the region. Some of this is very well attested in the oral and poster presentations lined
up for this two-day conference. Please join me in appreciating the important work and
contribution from our NTD researchers, control program managers and other
stakeholders/partners who have ensured the annual conferences are a success.
In conclusion, I cordially welcome our keynote speakers, representatives of County
Ministries of Health and our International colleagues and guests who may have travelled
into the country for this year’s conference. I hope that the discussions in this conference
will foster collaborations that will provide roadmaps for integrated control and eventual
elimination of NTDs not just in Kenya, but also regionally.
I wish you fruitful deliberations and a successful conference.
Dr. Yeri Kombe, PhD
Ag. DIRECTOR AND CEO KEMRI
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MESSAGE FROM THE CHAIRS, NEGLECTED TROPICAL
DISEASES CONFERENCE
On behalf of the NTD organizing committee, we are pleased to present you with a rich
scientific program in the 11th NTD conference, 2017. This year’s NTD conference has
attracted abstracts covering current issues in NTDs from a wide profile including but not
limited to leishmaniasis, lymphatic filariasis, trachoma, soil-transmitted helminths,
podoconiosis, Guinea worm, Echinostomosis, leprosy, snake bite, schistosomiasis, rabies,
West Nile Virus, Echinococcosis, dengue virus, fascioliasis and tungiasis (jiggers) from
many authors representing different organizations.
In line with this year’s theme “Partnership towards achievement of the global goals for
control, elimination and eradication of Neglected Tropical Diseases’’, we hope to
foster partnerships and offer many opportunities for structured dialogue on the major issues
facing NTD research in Kenya and the African region. With a wide variety of presentations
– from oral presentations in 6 scientific sessions and several posters to be displayed
throughout the conference duration, as well as a wide display of exhibitions from our
partners and sponsors, there is something for everyone!
Our full program includes an address from the Director, Medical Services Dr. Jackson
Kioko, who will speak during the opening session. A special welcome to him! In addition,
several renowned keynote speakers are slated to present during the scientific sessions
followed by a great mix of established and upcoming young scientists with a good number
of presentations whose great efforts we highly commend. During tea breaks, please take
time to visit the poster session which presents an excellent opportunity to learn, to mentor
and to network. Please also find time to visit a range of exhibitions from our partners and
sponsors to whom we’re very grateful.
We are confident that this conference will present us with a great opportunity for sharing,
cross-learning and mentoring of younger scientists as well as a platform for the discussion
of current health challenges, the exchange of new knowledge and discussion on the way
forward in the control and elimination of NTDs.
A special welcome to all!
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NEGLECTED TROPICAL DISEASES CONFERENCE
SECRETARIAT AND LOGISTICS
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TUMIKIA PROJECT
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CHRISTIAN BLIND MISSION
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THE PROGRAM AT A GLANCE
WEDNESDAY DECEMBER 6TH 2017
CHIEF GUEST: DIRECTOR, MEDICAL SERVICES
7.30 a.m. – 8:30 a.m. ARRIVALS AND REGISTRATION
Conference announcement slides
8:30 0a.m. - 10.00 a.m.
Opening Session Session Chair: Dr. Sultani Matendechero
Co- Chair- Dr. Doris Njomo
Repertoire- Mr. Kennedy Andiego
8.30 a.m. - 10.00
a.m.
Introductions
Opening Plenary Session
Dr. Sultani Matendechero-
MoH NTD Unit
Dr. Jackson Kioko– Director,
Medical Services
Dr. Yeri Kombe-Ag.
Director, KEMRI
8.30 a.m-8.40 a.m. Welcome Speech
Dr. Sultani Matendechero
8.40 a.m.- 9.05 a.m. Opening Address Dr. Jackson Kioko
9.05 a.m.- 9.20 a.m. Remarks Dr. Yeri Kombe
9.20 a.m. -9.50 a.m. Opening Plenary Dr. Ruth Chunge
10.00 a.m-10.30 a.m.
TEA BREAK
MEDIA BRIEFING – Organizers: James Wodera
10.30 a.m-12.30p.m.
Scientific Session A: Epidemiology and Public Health Session Chair: Dr. Bartholomew Ondigo
Co-Chair : Mr. Isaac Onkanga
Rapporteur: Mr. Philip Leakey
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10.30 a.m-11.00 a.m. KEYNOTE ADDRESS Prof. Eric Fevre (University
of Liverpool & ILRI)
11.00 a.m-12.30 p.m. Oral presentations Session Speakers
Plenary Panelists:
Session speakers
LUNCH BREAK 12.30 p.m-1.30 p.m.
1.30 p.m.-2.30 p.m.
Scientific Session B: Basic Sciences Chair: Dr. Maurice Odiere
Co-Chair- Mr. Fredrick Rawago
Rapporteur: Mr. George Ogara
1.30 p.m. – 2.30 p.m. Oral Presentations Session Speakers
Plenary Panelists:
Session speakers
2.30pm-3.45pm
Chair: Dr. Stella Kepha
Rapporteur: Ms. Rosemary Musuva
Scientific Session B1
Special Session : Snake Bite
2.30pm- 2.50pm KEYNOTE ADDRESS Dr. Robert Harrison (Alistair
Reid Venom Research Unit,
Liverpool School of Tropical
Medicine)
2.50pm-3.00pm Preclinical antivenom-
efficacy testing reveals
potentially disturbing
deficiencies of snakebite
treatment capability in East
Africa
Dr. George Omondi (Kenya
Snakebite Research and
Intervention Centre)
3.00pm- 3.40pm
Video
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THURSDAY, DECEMBER 7TH 2017
8.00a.m. - 8.30 a.m.
ARRIVALS AND REGISTRATION
Conference announcement slides
8.45 a.m. – 10.30 a.m.
Scientific session D: Operational Research & Control Programs Chair: Ms. Elizabeth Ochola
Co-Chair: Dr. Mwatha
Rapporteur: Mr. Wycliffe Omondi
8.45 a.m. - 9.15 a.m. KEYNOTE ADRESS Dr. John Amuasi (African
Research Network for
Neglected Tropical Diseases)
9.15 a.m. – 10.30 a.m. Oral Presentations Session speakers
Plenary Panelists:
3.45 p.m. – 4.10 p.m.
TEA BREAK
POSTER SESSION
SCIENTIFIC EXHIBITIONS
______________________________________________________________________
4.10pm- 5.10pm
Scientific Session C: Health Behavioral Studies and Social Sciences Chair: Dr. Doris Njomo
Co-Chair- Rosemary Musuva
Repertoire: Mr. Musa Auta
Organizer : Dr. George Omondi
4.10 p.m. – 5.10 p.m. Oral Presentations Session Speakers
Plenary Panelists:
Session speakers
5.30pm – 7.30pm
Snake Bite Reception (Invite Only)
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Session speakers
10.30 a.m. -11.00 a.m.
TEA BREAK
POSTER SESSION
SCIENTIFIC EXHIBITIONS
11.00 a.m. – 12.30 noon
Scientific session E: Zoonosis/One Health Chair: Dr. Kepha Bota
Co-Chair: Dr. Maurice Odiere
Rapporteur: Mr. Michael Ofire
11.00 a.m. - 11.30 a.m. KEYNOTE ADDRESS Prof. Mwangi Thumbi
11.30 a.m. – 12.15 a.m. Oral Presentations Session speakers
12.15 a.m. – 12.30 a.m. Talk INNOSAN Antivenom
Plenary Panelists:
Session speakers
12.30 p.m. – 2.00 p.m.
Lunch Break
2.00 p.m. - 3.30 p.m.
Scientific Session F: Water, Sanitation and Hygiene (WASH) Chair: Dr. Davis Wachira
Co-Chair: Ms. Emmy Kavere
Rapporteur: Ms. Cecilia Wandera
2.00 p.m. - 2.30 p.m. KEYNOTE ADDRESS Mr. Alex Mwaki (SWAP
Kenya)
2.30 p.m. - 3.30 p.m. Oral Presentations Session speakers
Plenary Panelists:
Session speakers
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3.30 p.m. - 4.30 p.m.
Closing Ceremony
Chair: Dr. Sultani Matendechero
Co-Chair: Elizabeth Ochola
Chief Guest: Dr. Yeri Kombe, Director, KEMRI
3.30 p.m. - 3.40 p.m. Chief Rapporteur Fredrick Rawago
3.40 p.m. – 4.00 p.m. NTD Investigator Awards
(Best oral and poster)
MoH
4.00 p.m. – 4.30 p.m. Closing Remarks Dr. Yeri Kombe Director,
KEMRI
4.30 p.m.
Tea Break
PARTICIPANTS AND GUESTS LEAVE AT OWN PLEASURE
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KEYNOTE SPEAKER
Prof. Eric Fèvre is Professor of Veterinary Infectious
Diseases at the Institute of Infection and Global Health (IGH),
University of Liverpool and is jointly based at the
International Livestock Research Institute, Nairobi, Kenya,
where he manages field-orientated projects researching
disease transmission and control at the interface between
animals and human beings. His research team, the Zoonotic
and Emerging Diseases group (www.zoonotic-diseases.org;
Twitter: @ZoonoticDisease) is a 25-strong grouping of
epidemiologists, ecologists, biologists, veterinarians and
medical practitioners interested in the biology and control of (re-)emerging diseases. The
group conducts field studies to acquire a wider understanding of pathogen epidemiology
to inform policy on optimal and cost-effective methods of disease control.
He obtained his BSc in Biology/Geography from the University of Bristol (UK), his MSc
in Applied Parasitology and Medical Entomology at the Liverpool School of Tropical
Medicine (LSTM) and his PhD in Epidemiology from the University of Edinburgh's Centre
for Tropical Veterinary Medicine. He worked for many years on the epidemiology of
zoonotic trypanosomiasis in East Africa, before expanding his work to cover a wider range
of zoonotic diseases in endemic areas. He held a Wellcome Trust Research Fellowship
from 2009-2012. The UK Research Councils, UK DFID, the European Union and the
CGIAR Research Program on Agriculture for Nutrition and Health are currently the
primary funders of the work in his team.
Prof Fèvre is the Chair the World Health Organization Working Group on zoonotic
Neglected Tropical Diseases (zNTDs), is a member of the WHO Expert Committee on
Human African Trypanosomiasis and was a member of the WHO Initiative to Estimate the
Global Burden of Foodborne Disease (FERG). In Kenya, he is a member of the Zoonoses
Technical Working Group (ZTWG), the advisory body to the Government of Kenya
National Zoonotic Disease Unit
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KEYNOTE SPEAKER
Prof. Thumbi Mwangi is a Clinical Assistant Professor at the
Paul G. Allen School for Global Animal Health, Washington
State University, a Wellcome Trust Public Health and Tropical
Medicine Fellow at the Kenya Medical Research Institute, and
a visiting scientist at the University of Nairobi Institute of
Tropical and Infectious Diseases.
He attained his PhD in Infectious Disease Epidemiology from
the University of Edinburgh (2012) studying co-infections
with multiple pathogens and their consequence on host
survival and growth. Previously he worked on the molecular diagnosis and spatial
epidemiology of African Animal trypanosomiasis at the International Livestock Research
Institute (ILRI). He holds a Masters of Science degree in Genetics and Animal breeding
(2008) at the University of Nairobi, and a Bachelor’s in Veterinary Medicine and Surgery
(2005) from the same University.
Currently, Dr. Thumbi leads the One-Health research group at the Center for Global Health
Research, Kenya Medical Research Institute investigating the zoonotic, socio-economic
and nutritional pathways that link animal health to human health and welfare. He is actively
involved in post-graduate education supervising several Masters and PhD students in local
and international universities. In 2017, he was appointed an affiliate fellow of the African
Academy of Sciences, and has received several awards including the 2016 Aspen Institute
New Voices fellowship, 2016 Kenya’s top 40 under 40 for his contribution towards rabies
elimination in Kenya, 2015 Kenya Research Veterinarian of the Year Award, 2015
Outstanding Research Article Award by the International Society for Disease Surveillance
among others.
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KEYNOTE SPEAKER
Dr Ruth Chunge was born in India where she spent her early
childhood. She graduated with a BSc in Zoology from University
College, Galway, Ireland, in 1977. She then spent one and a half
years in Nigeria working as a secondary school teacher and it was
there that she developed an interest in parasitic infections. After
working as a zoologist in Ireland for a year she joined the 1980
MSc Medical Parasitology class in the London School of
Hygiene and Tropical Medicine, UK, graduating in 1981. In
January 1982 she travelled to Kenya to join her former MSc
classmate, Dr. Charles Chunge, whom she married in December of the same year. They
are the parents of two grown-up sons.
In 1982 she was employed as a lecturer in the Medical Training College where she taught
parasitology and medical entomology to trainee laboratory technologists. In 1983 she
joined the Kenya Medical Research Institute as a Research Officer and for several years,
up to 1992, carried out research on a range of parasitological topics, specializing in studies
of intestinal protozoa in rural communities. During this period she was appointed as an
Honorary Lecturer at the University of Nairobi's College of Health Sciences and lectured
in parasitology to medical and pharmacy students, nurses and laboratory technologists. She
was awarded her PhD from University College, Galway, Ireland in 1989, for her
longitudinal studies of giardiasis in young Kenyan children.
During their stay in Canada from 1989 to 1990 she worked as a consultant parasitologist
for a public health department. Back in Nairobi she spent four years, 1993 to 1996, working
as a Programme Officer for the IUCN African Elephant Specialist Group. In 1997 she
teamed up with her husband to develop their own company, the Centre for Tropical and
Travel Medicine (CTTM), which offers clinical, laboratory and travel vaccination services.
In her role as Co-Director, she oversees the diagnostic services and administrative
functions of the centre. She also continues to teach, participate in laboratory-based projects
and work as a consultant in Nairobi and elsewhere when requested.
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KEYNOTE SPEAKER
Dr Robert Harrison Reader & Head of Alistair Reid Venom Research Unit
Background Born in Kenya, and a graduate of Nottingham University (BSc
Zoology) and the London School of Hygiene and Tropical Medicine
(MSc-Medical Parasitology; PhD-immunology of schistosomiasis),
Harrison’s interests in the development of vaccines against
schistosomiasis and onchocerciasis took him on various
postdoctoral scientific adventures to Kenya, California and Egypt
before he found a more permanent home in Liverpool. Now, leading
the Alistair Reid Venom Research Unit and Senior Lecturer at the Liverpool School of
Tropical Medicine, Harrison and his team conduct a variety of research activities with the
objective to ‘improve the treatment of snakebite’. This includes the provision of antivenom
to treat rural snakebite victims in Nigeria through a collaboration (the EchiTAb Study
Group) with the Nigerian Federal Ministry of Health, the University of Oxford and
antivenom producers in UK and Costa Rica. This collaboration has resulted in the provision
of 34,000 vials of new antivenoms (17,000 life-saving treatments) to resolve the crisis in
antivenom supply to Nigeria. Harrison is also am a member of the executive committee of
the Global Snakebite Initiative which aims to raise the awareness of, and stimulate new
funding to address the neglected problem of snakebite that primarily affects the most
impoverished and geopolitically disadvantaged rural communities of Africa and Asia - who
rarely have affordable access to effective healthcare.
Research Harrison’s research focus is to exploit advances in ‘high volume-high throughput’ gene
and protein technologies to develop new antivenoms that are (i) more toxin-specific (to
improve efficacy), (ii) more cross-generically effective (to improve geographical clinical
utility), (iii) clinically safer and, for the first time, (iv) effective against the local tissue-
destructive effects of envenoming. The intent is to design an antivenom-production system
whose clinical and logistic improvements provide compelling incentives to international
health agencies and commercial antivenom manufacturers to improve the delivery of
effective, safe and affordable snakebite therapies to the rural poor African and Asian
communities that most need it.
The group is also keen to harness the pharmacological potential of snake venom proteins
to develop novel drugs for cardiovascular, cancer and neurological diseases. Our resources
(venoms, venom gland EST data, toxin-specific antibodies) have also enrolled us in diverse
collaborations involving venom toxin evolution, venom proteomics, antivenom
production, pre-clinical and clinical assessment of new antivenoms.
KEYNOTE SPEAKER
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Mr. Alex Kilasi Mwaki is currently the country director at the
Safe Water and Aids project and previosuly served as the director
programs and research in the same institution. Alex has a strong
background in community health and developmet which he has
studied at diploma, higher diploma and masters level at the Great
Lakes University.
He also has formal training in research and has attended over 20
short courses focusing on: good clinical practise, abortion and
family planning requirements as well as protection of human
research partiticpants. Mr. Kilasi has extensive eperience in project planning and
management demosstrated in the various positions held in the past. He was the project
manager- Western Kenya Region at CARE International in Kenya based in Kisumu, Kenya
and as a Sustaining and Scaling Schools Water, Sanitation and Hygiene plus Community
Impact (SWASH+ I) Project in the same organisation.
He has greatly contributed to science and has over ten publications in high impact journals
focusing on sanitation delivery and handwashing, diarhoea prevention in high risk
populations, water treatment and implementation challenges on point of use water. Mr.
Kilasi is a former chairman- Board of management at Kibos Special Secondary School,
Secretary Board of Director for Safe Water and AIDS Project, member of Association of
Public Health Officers (Kenya) and is registered with the Public Health Officers and
Technicians Council.
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KEYNOTE SPEAKER
Dr. John Amuasi holds an undergraduate degree in human
biology and was trained as a medical doctor, both at the Kwame
Nkrumah University of Science and Technology – Kumasi,
Ghana. John also graduated from the University of Minnesota
School of Public Health, USA, with an MPH in Public Health
Policy and Administration and an MS is Health Services
Research. He completed a PhD in Health Services Research,
Policy and Administration also at the University of Minnesota.
In between his Masters and PhD studies, he served as head of the R&D Unit at the Komfo
Anokye teaching Hospital in Kumasi, Ghana for 3 years.
Dr. Amuasi has been consulted by a number of international organizations including the
Drugs for Neglected Diseases initiative (DNDi), Medicines for Malaria Venture (MMV),
World Health Organization (WHO), Health Action International (HAI) Africa, Dalberg
Global Development Partners, the International Centre for Trade and Sustainable
Development (ICTSD), and France Expertise Internationale (FEI) on a wide range of issues
related to health services, policy and systems in Ghana and other parts of Africa.
John is currently a Senior Research Fellow at the Kumasi Centre for Collaborative
Research in Tropical Medicine (KCCR) in Kumasi, Ghana and the Executive Director of
the African Research Network for Neglected Tropical Diseases (ARNTD)
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PROGRAM
WEDNDESDAY DECEMBER 6TH 2017
CHIEF GUEST: DIRECTOR, MEDICAL SERVICES
7.30 a.m. - 8.30 a.m. ARRIVALS AND REGISTRATION
Conference announcement slides
8.30 a.m. - 10.00 a.m.
Opening Session
Session Chair: Dr. Sultani Matendechero
Co- Chair- Dr. Doris Njomo
Repertoire- Mr. Kennedy Andiego
8.30 a.m. - 10.00 a.m. Introductions
Opening Plenary Session
Dr. Sultani
Matendechero-MoH NTD
Unit
Dr. Jackson Kioko,
Director, Medical
Services
Dr. Yeri Kombe Director,
KEMRI
8.30 a.m-8.40 a.m. Welcome Speech
Dr. Sultani Matendechero
8.40a.m - 9.05 a.m. Opening Address Dr. Jackson Kioko
9.05 a.m.- 9.20 a.m. Remarks Dr. Yeri Kombe
9.20 a.m-9.50.a.m Opening Plenary Dr. Ruth Chunge
10.00 a.m-10.30 a.m.
TEA BREAK
MEDIA BRIEFING – Organizers: James Wodera and Duke Isaboke
10.30 a.m-12.30 p.m.
Scientific Session A: Epidemiology and Public Health
Session Chair: Dr. Bartholomew Ondigo
Co- Chair : Mr. Isaac Onkanga
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Rapporteur: Mr. Philip Leakey
10.30 a.m-11.00 a.m. KEY NOTE ADDRESS
Prof. Eric Fevre (University
of Liverpool & ILRI)
11.00 a.m.- 11.15 a.m. Two unusual parasitic
infections diagnosed in
Kenya
Dr. Ruth Chunge
11.15 a.m.- 11.25 a.m. Prevalence of Schistosomes
and soil transmitted
Helminthes among patients
attending Busia County
Referral Hospital Between
Jan 2016-Aug 2017
Oscar Gaunya
11.25 a.m.- 11.35 p.m. Factors associated with
trachomatous trichiasis
recurrence among trachoma
patients operated in
Enkorika Division of
Kajiado County, Kenya
John Soine
11.35 a.m. - 11.45p.m. Prevalence of human cystic
echinococcosis in pastoral
communities of Kenya
Dorothy Kagendo
11.45 a.m. 11.55 a.m. Intestinal Poly-parasitism
with special emphasis on
Age-Sex Distribution of
Intestinal Parasitic
Infections among Residents
of Rural Kitui County: A
Community Based Cross
Sectional Survey
Raphael Mando Onyango
11.55 a.m. – 12.05 p.m. Comparative efficiency of
Biomphalaria pfeifferi and
B. sudanica as intermediate
host snails for Schistosoma
mansoni and its implications
on transmission of intestinal
schistosomiasis in Kenya
Mutuku Martin
Plenary Panelists:
Session speakers
12.30 p.m. -1.30 p.m.
LUNCH BREAK
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1.30 p.m.-2.30 p.m.
Scientific Session B: Basic Sciences
Chair: Dr. Bartholomew Ondigo
Rapporteur: Mr. Isaac Onkanga
1.30 p.m. – 1.45 p.m. Relationships between
levels of plasma total
IgE, antigen specific
IgE, and soluble CD23
in children exposed to
schistosomiasis in
western Kenya
Dr. Bartholomew Ondigo
1.45 p.m. – 2.00 p.m. Immunopotentiation of
the host innate response
against dengue virus by
a nucleoside analogue
inhibitor
Edna M. Ondari
2.00 p.m. – 2.15 p.m. Moving towards
interruption of
transmission of soil-
transmitted helminths:
impact of a cluster
randomised trial
evaluating alternative
treatment strategies and
delivery systems in
Kenya
Racheal Pullan
2.15 p.m. – 2.30 p.m. Five years monitoring
of the impact of mass
drug administration on
soil-transmitted
helminths
Dr. Charles Mwandawiro
Plenary Panelists:
Session speakers
2.30pm-3.45pm
Chair: Dr. Stella Kepha
Rapporteur: Ms. Rosemary Musuva
Scientific Session B1
Special Session : Snake Bite
30
2.30 p.m. – 2.45 p.m. KEYNOTE ADDRESS Dr. Robert Harrison ( Alistair
Reid Venom Research Unit,
Liverpool School of Tropical
Medicine)
2.45 p.m. – 2. 55 p.m. Preclinical antivenom-
efficacy testing reveals
potentially disturbing
deficiencies of
snakebite treatment
capability in East
Africa
Dr. George Omondi (Kenya
Snakebite Research and
Intervention Centre)
2.55 p.m. – 3.35 p.m. Video Snake Bite
Plenary Panelists:
Session speakers
3.45 p.m. – 4.10 p.m.
TEA BREAK
POSTER SESSION
SCIENTIFIC EXHIBITIONS
4.10pm- 5.10pm
Scientific Session C: Health Behavioral Studies and Social Sciences
Chair: Dr. Doris Njomo
Repertoire: Rosemary Musuva
4.10 p.m. – 4.20 p.m. Implementation of the
positive deviance
approach in the
management of
tungiasis in elgeyo
marakwet county
Jacob Ayienda
4.20 p.m. – 4.30 p.m. Perceptions and
Experiences of School
Teachers during
Implementation of
School-based
Deworming Activity in
Kenya
Dr. Doris Njomo
31
THURSDAY, DECEMBER 7TH 2017
8.00a.m. - 8.45 a.m.
ARRIVALS AND REGISTRATION
Conference Announcement slides
8.45 a.m. - 10.30 a.m.
Scientific session D: Operational Research & Control Programs
Chair: Mr. Fredrick Rawago
Rapporteur: Mrs. Emmy Kavere
8.45 a.m. – 9.10 a.m. KEYNOTE ADRESS Dr. John Amuasi (African
Research Network for
Neglected Tropical Diseases)
4.30 p.m. – 4.40 p.m. Knowledge, Attitude
and Practices on
Visceral Leishmaniasis
among residence and
health care workers in
Wajir County 2017,
Kenya
Ihahi Josphine
4.40 p.m. – 4.50 p.m. Behavioral changes in
trachoma management
among the pastoralist in
Samburu, Kenya
Solomon Mwaniki
4.50 p.m. – 5.00 p.m. Knowledge, attitude
and practices towards
jigger infestation in
Marachi central, Butula
Charles Omeny
Plenary Panelists:
Session Speakers
5.30pm – 7.30pm
Snake Bite Reception
(Invite Only)
Organizer : Dr. George Omondi
32
9.10 a.m. – 9.20 a.m. Kenya on the road to
elimination of Lymphatic
filariasis as a public
health problem
Dr. Sammy Njenga
9.20 a.m. – 9.30 a.m. Factors associated with
unsuccessful treatment
outcome of leprosy
patients in Kilifi County-
Kenya: A seven year
retrospective study
profile
Geoffrey Katana
9.30 a.m. – 9.40 a.m. Characteristics of
visceral leishmaniasis
patients attending
Namouruputh dispensary
Jan 2015 – Sep 2017
Getrude Nasike
9.40 a.m. – 9.50 a.m. Piloting OptimizeNTD
solution for real time
surveillance and
prevalence mapping of
Lymphatic Filariasis at
community and
household level in Kenya
Justus Ogando
9.50 a.m. – 10.00 a.m. Getting towards
Trachoma Elimination;
Case of accelerated
surgical outreach
approach among the
pastoralists in Samburu
County, Kenya
Solomon Mwaniki
Plenary Panelists:
Session speakers
10.30 a.m. -11.00 a.m.
TEA BREAK
POSTER SESSION
SCIENTIFIC EXHIBITIONS
11.00 a.m. – 12.30 p.m.
Scientific session E: Zoonosis and One Health
Chair: Dr. Bartholomew Ondigo
Rapporteur: Mr. George Ogara
33
11.00 a.m. - 11.30 am KEYNOTE ADDRESS
Prof. Mwangi Thumbi
11.30 a.m. – 11.40 a.m. Interlinks between
wildlife and domestic
cycles of Echinococcus
spp in Kenya
Dorothy Kagendo
11.40 a.m. – 11.50 a.m. Echinococcus species in
dogs from four regions of
Kenya
Erastus Mulinge
11.50 a.m. – 12.00 p.m. Cystic echinococcosis in
donkeys in Kenya
Eberhard Zeyhle
12.00 p.m. – 12.15 p.m. Inosan Biopharma-Third
generation
Jean Bernard Delbarre/ Fadia
Karam
Plenary Panelists:
Session speakers
12.30 p.m. - 2.00 p.m.
LUNCH BREAK
2.00 p.m. - 3.30 p.m.
Scientific Session F: Water, Sanitation and Hygiene (WASH)
Chair: Dr. Davis Wachira
Rapporteur: Philip Leakey
2.00 p.m. – 2.30 p.m. KEY NOTE ADDRESS Mr. Alex Mwaki (SWAP
Kenya)
2.30 p.m. 2.40 p.m. Efficacy of maerua
decumbens and moringa
oleifera extracts in water
treatment
Derrick Ochieng
2.40 p.m. – 2.50 p.m. Role of CLTS+ model in
Trachoma elimination in
Turkana County, The case
of Turkana South Sub
County
Ochwal Victoria
2.50 p.m. – 3.00 p.m. Effectiveness of wash in
control of neglected
tropical diseases
Walter K. Bartai
3.00 p.m. – 3.15 p.m. Household access to
improved water and
sanitation facilities among
Paul Gichuki
34
a community living in an
irrigation scheme set up in
central Kenya
3.15 p.m. – 3.25 p.m. Plenary Panelists:
Session speakers
3.30 p.m. - 4.30 p.m.
Closing Ceremony
Chair: Dr. Maurice Odiere
Chief Guest: Dr. Yeri Kombe Director, KEMRI
3.30 p.m. - 3.40 p.m. Chief Rapporteur Fredrick Rawago
3.40 p.m. – 4.00 p.m. NTD Investigator Awards
(Best oral and poster)
MoH
4.00 p.m. – 4.30 p.m. Closing Remarks Dr. Yeri Kombe Director,
KEMRI
4.15 p.m.
Tea Break
PARTICIPANTS AND GUESTS LEAVE AT OWN PLEASURE
35
POSTER SESSIONS
NTD11-A7: A risk factor study for the prediction of the distribution of Schistosoma
host snails in freshwater habitats in western Kenya. Ganatra et al
NTD11-A8: Regulatory influence of Procambarus clarkii, Girad (Decapoda:
Cambaridae) on schistosome-transmitting snails in lotic habitats within the River Athi
Basin, Kenya. Maina et al
NTD11-A9: Risk Factors for tungiasis in Kilifi County, Kenya. Mwadai et al
NTD11-A10: Schistosomiasis, Malaria and Soil Transmitted Helminth Burden and
Their Association with Anemia Among Children Aged 1-10 years from Schistosoma
mansoni Hotspot Areas of Siaya County in western Kenya. Rawago et al
NTD11-A11: Prevalence and risk factors associated with Schistosomiasis infection
among children aged 1-5 years in Western Kenya. Andiego et al
NTD11- A12: Understanding Leishamnia vector distribution in Turkana County. Leting
et al
NTD11-A13: Identification of risk factors associated with transmission of Plague
disease in Eastern Zambia. Nyirenda et al
NTD11-A14: Leonine facies - always due to leprosy? Pancholi et al
NTD11-A15: Podoconiosis. Pancholi et al
NTD11-A16: Sero-Prevalence of Lymphatic Filariasis in Mombasa County, Coastal
Region of Kenya, 2016. Otieno et al
NTD11- A17: Impact of helminth infections on clinical and epidemiological features of
microbial infections, and vaccine responses in ruminants: a systematic review. Ndungu
et al
NTD11-A18: Evaluation of Guinea Worm Disease Surveillance System – Kenya. Ngere
et al
NTD11-B4: Innate lymphoid cells (ILCs) in pre-adolescent children with
schistosomiasis. Onkanga et al
36
NTD11-B5: Multiplex Serologic Assessment of Schistosomiasis in western Kenya:
Antibody Responses in Pre-school Aged Children as a Measure of Reduced
Transmission. Odiere et al
NTD11-B6: Molecular identification of Zoonotic hookworm species in dogs in Kenya.
Mulinge et al
NTD11-C6: Gender Specific Levels of Community Knowledge, Attitude and Practice
on Schistosomiasis after 5 years of annual mass schistosomiasis control program
Among Adult Population in western Kenya. Musuva et al
NTD11-C7: Awareness and opinions of pre-school children parents on the National
School Based Deworming Programme in Coastal region of Kenya. Masaku et al
NTD11-C8: Assessing knowledge, sources of information and health-seeking behaviour
for schistosomiasis control by primary school health teachers in Seme sub-county,
Western Kenya. Kavere et al
NTD11-C9: Knowledge, attitude and practice regarding common zoonotic diseases
among healthcare workers in Nyagatare District. Ngendahayo et al
NTD11-C10: Factors affecting perceived stigma in leprosy affected persons in Eastern
Nepal. Khadgi et al
NTD11-D6: Safety efficacy and acceptability of praziquantel in the treatment of
Schistosoma haematobium in pre-school children of Kwale County, Kenya. Kimani et al
NTD11-D7: Partnership between Contract Research Organization and Investigator
sites to optimize Neglected Tropical Diseases Clinical trials efficiency and Quality.
Kisengese et al
NTD11-D8: Community-based Control of Tungiasis. Baya et al
NTD11-D9: Hydatid disease situation in Waso East, Samburu East Sub-County. Nakuo
et al
NTD11-D10: Combating Schistosomiasis: The critical role of community health
volunteers in Migori County. Odhong et al
NTD11-D11- Secondary Bacterial Infections and Antibiotic Resistance among
Tungiasis Patients in Western, Kenya. Nyangacha et al
NTD11-D12- Partnership Towards Elimination of Trachoma in Baringo County. Sang
et al
37
NTD11-D13: Treatment Compliance: Impact of Missed Mass Drug Administration on
Filarial Infection in Malindi District, Kenya. Mkandawire et al
NTD11-D14: Western Province external quality assessment (wepeqas) the gains and
lessons [Neglected Tropical Diseases] in Kakamega. Rajula et al
NTD11-D15: From Mud and Stick-walled Houses to Corrugated Iron sheet Houses: A
New Strategy for Preventing Human-Vector Contact in Marigat Sub-County; a
Leishmaniasis-endemic Area in Kenya. Kiarie et al
NTD11-D16: Once bitten, twice scratched: vicious sandfly in Turkana County.
Maragia et al
NTD11-D17: Strongyloides stercolaris hyperinfection with pneumonia in an (ISS)
patient on HAART at CGH Kakamega in 2015. Ojango et al
NTD11- D18: Biosafety in vector borne laboratories. Wesiela et al
NTD11-D19: Accelerating control of visceral leishmaniasis in Turkana County, Kenya,
through improved access to diagnostics. Ebei et al
NTD11-D20: A post-intervention survey on prevalence of Soil-Transmitted Helminths
infection among primary school children in the Tiko Health District, Cameroon. Egbe
et al
NTD11-D21: Control of flea vectors of plague: Used engine oil as a proposed tool.
Banda et al
NTD11-D22: Study on functional activity limitation of leprosy affected person in
Eastern Nepal. Khadgi et al
NTD11-D23: Acute West –Nile Viraemia amongst Febrile Patients attending a Tertiary
Hospital in Abuja, Nigeria. Kehinde et al
NTD11-D24: Raising Awareness in Kenya: Improving Occupational Performance in
women with Lymphedema. Lunzalu et al
NTD11-E4: Factors of dog population demographics and ecology relevant to
transmission of rabies in rural Western Kenya. Kwoba et al
NTD11-F5: Effectiveness of CLTS intervention as an effective means of prevention of
cholera outbreaks, participation of CHVs. Okello et al
38
ABSTRACTS
SCIENTIFIC SESSION A: EPIDEMIOLOGY AND PUBLIC HEALTH
NTD11-A1 Prevalence of human cystic Echinococcosis in pastoral communities of Kenya.
Dorothy Kagendo1 Japhet Magambo1 Eric Muchiri1 Eberhard Zeyhle1, Erastus Mulinge2,
Cecilia Mbae2, Marion Wassermann3, Thomas Romig3, Peter Kern4. 1Meru University of Science and Technology, Meru, Kenya 2Kenya Medical Research Institute, Nairobi, Kenya 3Parasitology Unit, University of Hohenheim, Stuttgart, Germany 4Complehensive Infectious Diseases Center, University Hospitals, Ulm, Germany
Introduction
Cystic Echinococcosis (CE), a chronic debilitating parasitic disease caused by the larval stage of
dog tapeworm, Echinococcus granulosus has a worldwide distribution. Over time, Turkana in
Kenya was the only known endemic region worldwide. This study reports current situation of
CE in nomadic communities of Kenya
Methods
Using a portable ultrasound imaging machine (Titan Ultrasound system, SonoSite with a 5.2
MHz transducer), a total of 14,088 persons were examined for presence of hydatid cysts.
Participation was voluntary and only for those who gave informed consent prior to examination.
Information about the disease and its causative agents and Ultrasound procedure was provided
NTD11-F6: Using CLTS programming to ensure equity and inclusion is achieved in ODF
villages. Langat et al
NTD11-F7: Household hygiene: Evaluating the efficacy of cleaning and hand washing
products to reduce health risks to health workers and the community. Apondi et al
39
using a chart showing pictures of different stages. Screening was done in a lying or standing
position inside a local house or school behind a screen for privacy
Results
Prevalence varied from 2.5% Turkana North, 1.6 % Tharaka, 1.2 % Isiolo, 0.9 % Samburu and
Maasai Mara respectively. Most cysts were located in liver 65.5%, kidneys 18.6%, abdomen
11.3%, spleen 2.7%, lungs 1.7% and heart 0.2% cysts. Cysts Classification (WHO-IGWE CE
classification of Ultrasound image) varied considerably
Conclusion
Low prevalence recorded in Samburu (0.9 %) and Maasai Mara communities is surprising
compared with Turkana North (2.5 %). This is despite higher infection rates in livestock (>25%)
and having more dogs per household. Tharaka and Isiolo had comparatively high numbers of
human CE cases. Tharaka north is located at the periphery of Meru National park and often wild
animals frequent homesteads. People in this area keep large numbers of domestic dogs to keep
away wild animals at night, which could contribute to the reported numbers in the area. A
possible reason for the numbers in Isiolo (an ethnically mixed community) could be due to
cultural and behavioral practices amongst the three major communities (Borana, Samburu and
Turkana)
NTD11-A2 Comparative efficiency of Biomphalaria pfeifferi and B. sudanica as intermediate host snails
for Schistosoma mansoni and its implications on transmission of intestinal schistosomiasis
in Kenya
Mutuku, M. W1 , Mwangi, I. N1 , Kinuthia, J1, Maina, G. M1, Lelo, E. A1, Loker, E. S2, Ochanda,
H3, and Mkoji, G. M1
1. Centre for Biotechnology Research and Development, Kenya Medical Research Institute
(KEMRI), Kenya.
2. Department of Biology, Parasitology Division, Museum of Southwestern Biology,
University of New Mexico, Albuquerque, NM87131
3. School of Biological Sciences, College of Biological and Physical Sciences, University
of Nairobi, Kenya, P.O Box 30197, Nairobi, Kenya.
Introduction
Schistosomiasis is one of the world’s neglected tropical diseases that has proven to be refractory
to control with 258 million cases estimated to exist. S. mansoni is commonly transmitted by
Biomphalaria pfeifferi which is an inhabitant of streams and small water bodies and B. sudanica
which is mostly found in shores of lakes and other large water bodies especially lake Victoria.
Though chemotherapy is effective in eliminating mature worms and subsequently bringing down
prevalence rates, reinfections occur because it doesn’t interfere with snails involved in
transmission of the parasite. with laboratory studies showing that infected snails can survive for
over a year shedding cercariae daily.
Methods
40
We examined compatibility of this two snail species derived from the field (B. pfeifferi from
Kirinyaga, and B. sudanica from Kisumu) using allopatric and sympatric S. mansoni in relation
to snail size (Juveniles < 5mm, Young adults 6-9 mm and old adults > 9mm shell diameter)
through a reciprocal cross infection experiment.
Results
Overall, B. pfeifferi had higher infection rates compared to B. sudanica (39.6% – 80.7%) and
(2.4% - 21.5%) respectively. Allopatric B. pfeifferi - S. mansoni combination had high infection
rates than sympatric combinations while B. sudanica sympatric combinations had higher
infection rates than allopatric combinations. Infection rates were inversely proportional to snails
size. Mean cercariae production was more among Mwea snails-parasite sympatric combinations
(624 – 2465) compared to Mwea allopatric combination (100 – 1232) and this increased with
increase in snail’s size. Mean cercariae production amongst all B. sudanica were low ( 50 – 590)
with no significant differences between sympatric or allopatric combinations nor among the
different snail sizes (p < 0.05).
Conclusion B. pfeifferi snails are more efficient in transmitting schistosomiasis than B. sudanica though this
could be compensated by the abundance in which they occur in natural habitats.
NTD11-A3 Factors associated with trachomatous trichiasis recurrence among trachoma patients
operated in Enkorika Division of Kajiado County, Kenya
Authors: John Soine1, Francis Dikir2, Solomon Mwaniki2, Chitiavi Juma2
1Ophthalmic Department, Ministry of Health, Kajiado County, P.O Box 11 – 01100, Kajiado.
2Amref Health Africa in Kenya, P.O Box 30125 – 0100, Nairobi
Background
Trachomatous Trichiasis (TT) is an infectious disease caused by the bacterium Chlamydia
trachomatis. Untreated, repeated trachoma infections can result in permanent blindness. It has
contributed to 5.9million blindness globally as well as being the second leading cause of
avoidable blindness in Kenya (19%) with prevalence of 28.1% in Kajiado County.
Methods
A community based retrospective cohort study was conducted in Enkorika Division of Kajiado
County. The main objective of the study was to determine TT recurrence rate after surgery.
Specific objectives were; to describe social demographics characteristic of patients with TT
recurrence after surgery, to establish relationship between economic status of households and
rate of TT recurrence and to find out association between active trachoma (TF) and TT recurrence
amongst patients operated 1 year and beyond. All TT patients operated more than one year from
the time of the study were examined for TT recurrence and success rates determined clinically.
Factors associated with the recurrence were established by examining post-surgical scar on the
eye lid, presence of active trachoma (TF) and inquiring use of azithromycin during MDA.
Secondary data on TT operations were also reviewed for relevant information.
41
Results
Kajiado eye care specialists were used to screen for TT recurrence and its associated factors.
Data was organized, categorized and analysed. Factors associated with TT recurrence were each
analysed separately and interpretation done per category. The responses were analysed using
both qualitative and quantitative research techniques. The statistical tests that were carried out
included: Non-parametric tests, chi square and Pearson’s R to measure statistical significance of
relationships between variables. Variables were subjected to the test and 95% confidence level
was used. Calculation of frequencies and percentages was done using SPSS version 18.0.
Univariate data analysis was first done to get the frequencies and then cross tabulation was done
to compare relationships by computing chi-square.
Of the total patients examined (n=84, N=90) comprising of 82.1% female and 27.9% male, 11
(13.1%) had TT recurrence. The youngest participant was aged 35yrs while the oldest was 95yrs.
Ages with highest frequency were between 61 and 70 (36.9%) while the one with the lowest
frequency was ages between 91 and 100 (2.3%). For TT recurrence and age p-value was 0.546
> 0.05 and therefore no significance difference between the two variables. Among the 11 with
recurrence eight (8)-72.7% were females. (P-value for TT recurrence verses gender = 0.280), of
the 8 females,-72.7% were poor. (P-value = 0.729) and seven (7) - 63.6% had TF. (P-value =
0.005). Majority of the respondents 72 (85.7%) out of 84, examined to determine quality of TT
surgical scars and lid margins following TT surgery were found to be fine. Among the 11 with
TT recurrence 9 (81.8%) had deficient scar or abnormal lid margins on the operated eyes. (P-
value= 0.00).
Conclusions and Recommendations: In order to eliminate trichiasis recurrence, the length of
surgical incision, experience of surgeon and quality of surgery are critical components during
surgery as shown from the findings in the research.
NTD11-A4 Intestinal Poly-parasitism with special emphasis on Age-Sex Distribution of Intestinal
Parasitic Infections among Residents of Rural Kitui County: A Community Based Cross
Sectional Survey.
Raphael Mando Onyango, MPH1. Curtis Henry Kariuki, PhD1
1. School of Medicine and Health Sciences, Kenya Methodist University, P.O.BOX 267,
MERU, Kenya
Background
Despite its ubiquity, public health impact of polyparasitism has been inadequately studied.The
aim of this survey was to describe polyparasitism with special emphasies on age-sex distribution
of intestinal parasites among residents of rural Kitui County, Kenya.
Methods
We used crosssectional study design. Stool samples were collected from 543 participants in 110
households in Kitui in 2014. Sample processing and microscopic examination took place within
4h of collection by direct wet mount, and on the portion of the stool sample Kato-Katz thick-
smear techniques was prepared simultaneously and examined microscopically. Data
management and statistical analysis were done using STATA 13MP. Demographics were
42
compared by test results (positive/negative).Polyparasitism by age, sex was analysed using chi-
square. Risk of infection, polyparasitism was analysed using logistic regresion for reporting
Odds Ratio(OR), incooperating sociodemographics in the model.
Results
Prevalence of any intestinal parasite was (326/543)-60%. Test results were associated with
gender p=0.037. Thirteen parasites were detected, protozoa was predominat compared to soil
transmitted helminths, i.e., (403/543)-74.2% vs (61/543)-11.2%. The most prevalent protozoa
and STH were Entamoeba coli (176/543)-32.41% and Hookworm (34/543)-6.26% respectively.
Male gender was associated with infection with STHs p=0.042). Polyparasitism was reported
among (120/543) 22.1%, double polyparasitism was most common. Risk of infection was higher
among participants from Katuka-Tene village, p<0.001. Risk of polyparasitism was only
associated with soft stool conformity, p=0.04, Abscence of any parasite protected participants
from polyparasitism.
Conclusions Protozan infections were the most predominant form of infection. Geographical location put
participants at a higher risk of infection with intestinal parasitic infection. Polyparasitism was
mostly attributed to protozoal infectections-this is essential for choosing drugs for mass drug
adminstration.Since most of the intestinal parasites are transmitted by the feco-oral route,
provision of safe water supply and latrines, improvement of sanitation and health education on
personal and environmental hygiene is crucial to control and reduce intestinal parasite infections.
NTD11-A5: Two unusual parasitic infections diagnosed in Kenya
Chunge, Ruth N., Chunge, Charles N. and Wafula, Serah N.
Centre for Tropical and Travel Medicine, P.O. Box 73548, Nairobi 00200, Kenya
In January 2017, we received stool samples from six travellers returning to Kenya, who had
visited Lake Tanganyika in Tanzania within the previous two weeks. They were complaining of
abdominal pain and other intestinal symptoms. All of them had caught and eaten raw fish from
the lake which they prepared as “sushi”.
In four of the concentrated faecal samples we identified eggs of the zoonotic trematode fluke,
Echinostoma, which is a parasite normally found in the Far East and which has been described
as a neglected tropical disease. These cases of echinostomiasis are the first to be reported in
Africa which definitely originated from ingestion of locally caught raw fish.
In May 2017, we received a stool sample from a man who had travelled from Kenya to
Indonesia in the previous month, where he developed diarrhoea which became profuse after his
return to Kenya. He admitted to eating street food while he was there. Microscopic examination
of his stool revealed oocysts of the coccidian parasite Cyclospora cayetanensis. Identification
was confirmed by staining faecal smears with a modified Ziehl-Neelsen stain. Although the
infection originated in Indonesia, we found no previous reports of diagnosis of Cyclospora in
Kenya.
43
Both infections were successfully treated with appropriate medication. These cases serve to
remind us that the world has become a “global village” and we should always be on the lookout
for unusual parasites in routine stool examinations, especially in travellers and those with
adventurous diets.
NTD11-A6 Prevalence of Schistosomes and soil transmitted Helminthes among patients attending
Busia County Referral Hospital Between Jan 2016-Aug 2017
Oscar Gaunya
Busia County Referral Hospital
Email: [email protected]
Background
Intestinal schistosomiasis and soil-transmitted helminthiasis are the major medical
and public health problems in many parts of the world. Schistosomiasis remains a
serious public health concern in sub-Saharan Africa (SSA) and approximately one-
third of the 192 million cases of schistosomiasis in the SSA are caused by
Schistosoma mansoni, the causal agent of intestinal schistosomiasis.
Soil-transmitted helminths (STH) of major concern to humans are Ascaris
lumbricoides, Trichuris trichiura, Necator americanus and Ancylostoma duodenale.
Infection results from ingestion of eggs and contact with fecally contaminated soil,
and occurs primarily in areas where the sanitation is poor sanitation and water
supplies are unsafe. The latest estimates indicate that more than 2 billion people are
infected with these parasites and Busia County is not exceptional especially being at
the Kenya –Uganda boarder where sanitation compromised sometimes.
Methodology A retrospective record review was done using monthly workload load
summary forms and Laboratory register from Parasitology department
whereby total number of patients tested for direct saline stool examination
between Jan 2016-Aug 2017 was noted .Summary sheets together with
register were critically scrutinized to determine if there were any samples
which tested positive for the presence of Schistosomes and Soil transmitted
helminthes.In addition ,Laboratory register was used to determine the most
susceptible age group and gender together with the period when the infection
was at peak. Data was analyzed using Microsoft Excel 2010.
Results
Of the 1310 samples tested which also denoted the number of patients, the overall
prevalence of Schistosomes & Helmiths stands at 5.0%.Ascaris lumbricoides was the
44
predominant isolate representing 38(2.9%), followed by hookworm 12(0.9%),
Schistosoma mansoni 8(0.6%) whereas Trichuria trichuris accounted for
7(0.5%).The study also depicted that the infection was confined between the months
of January and June during the entire period of the survey. Finally, all gender were at
risk of Helmithes/Schistosome infection though Ascaris lumbricoides manifested
more commonly among the age group of below 10 years which is school going age.
Conclusion
With an overall prevalence rate of 5.0 % which showed relatively low level of STH
and S. mansoni infection among patients attending Busia County referral hospital,
these findings call for continued need of public health education and provision of
safe water to reduce the burden of soil-transmitted intestinal helminthiasis and
schistosomiaisis in the region. In addition, Laboratory plays a major role in diagnosis
therefore County Government s should invest heavily in Equipments e.g (Kato Tech)
a method sensitive in detection of STH and Schistosomiasis to render this Neglected
Tropical Parasitic Diseases totally eradicated in Kenya and in the entire African
Continent.
NTD11-A7 A risk factor study for the prediction of the distribution of Schistosoma host snails in
freshwater habitats in western Kenya
Akbar Ganatra, Faith Kandie, Jeremias Becker, Ulrike Fillinger, Eric Lelo, Werner
Brack, Matthias Leiss
1 International Centre for Insect Physiology and Ecology, Human Health Theme, Thomas
Odhiambo Campus, Mbita 40305, Kenya;
2 School of Freshwater ecology & Parasitology, Egerton University; P.O Box 536 Egerton
20115 Kenya Egerton University Nakuru Town campus
Introduction
Schistosomiasis is the second most prevalent disease within tropical and sub-tropical areas of the
globe, affecting over 250 million people and killing an estimated 200,000 annually. Schistosoma
infect humans and livestock when in contact with water after being released as miracidia from
intermediate host snails of the family Planorbidae. The area surrounding Lake Victoria is home
to millions of people, in villages, towns, and cities that are heavily reliant on the freshwaters for
domestic use.
Methodology
Our study aimed to investigate the distribution of the host snails in inland waters western Kenya,
and evaluate the effect of various pollutants: agricultural, industrial and pharmaceutical, on the
same. We visited 48 sites: 28 rivers, 8 dams, 2 oxbow lakes, 4 rice channels and 6 rice fields,
selecting sites to compare the difference in subsistence (27 sites) and commercial agriculture
45
(16), as well as between the different agricultural landscapes: tea (8), sugarcane (9) and rice (11).
We found and collected snails of various species in 21 sites, both host snails, their competitors
and predators and are currently analysing water, sediment and snail soft tissues for the presence
of various pollutants. Here we present the outline of a novel study and preliminary results that
are aimed at a more effective risk mapping of schistosomiasis in context of freshwater pollution.
NTD11-A8 Regulatory influence of Procambarus clarkii, Girad (Decapoda: Cambaridae) on
schistosome-transmitting snails in lotic habitats within the River Athi Basin, Kenya
Geoffrey M. Maina1,3, Joseph M. Kinuthia1, Martin W. Mutuku1, Ibrahim N. Mwangi1, Eric L.
Agola1, Helen L. Kutima2, Gerald M. Mkoji1
1Centre for Biotechnology Research and Development, Kenya Medical Research Institute,
Nairobi, Kenya. 2Department of Zoology, Jomo Kenyatta University College of Agriculture and Technology,
Juja, Kenya. 3College of Health Sciences, Institute of Tropical Medicine and Infectious Diseases
(ITROMID), Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya.
Background: Control of schistosomiasis, a neglected tropical disease has for a long time overly
relied on praziquantel. Crayfish, though voracious snail eaters have been tested in small man-
made impoundments but not in lotic habitats. The present study aimed to determine the ability of
the crayfish, Procambarus clarkii to reduce populations of schistosome transmitting snails in
lotic habitats.
Methods: Data was collected bi-monthly on the presence or absence of snails and crayfish in4
stream habitats, over a period of 10 months, and these were identified from a baseline survey to
be habitats for Biomphalaria snails, transmitters of intestinal schistosomiasis, and were located
in the Machakos County within the Athi River basin in south-eastern Kenya. Subsequently, 2 of
the habitats were selected for introduction of crayfish (and were designated “experimental sites”)
and the other 2 habitats were designated “control sites.” Each of the “experimental sites” received
110 crayfish. The study sites were sampled for snails using standard snail scoops and for crayfish
using meat-baited crayfish traps. The bi-monthly sampling of the habitats was done to determine
snail abundance, crayfish survival, and obtain information on biotic and abiotic parameters.
Results: Snail abundance in the habitats that received crayfish rapidly declined within 2 months
to a significant level compared with the initial abundance (paired t test = 5.524, p value = 0.0001),
relative to the decline observed in the control habitats (paired t test = 7.727, p value = 0.082).
Interpretation & Conclusion: While P. clarkii holds much promise as a complimentary
schistosomiasis control strategy to chemotherapy, restocking of habitats should be considered
when habitats dry up during extreme weather conditions, for effectiveness of this approach.
NTD11-A9 Risk Factors for tungiasis in Kilifi County, Kenya
46
Shadrak Mwadai1, Susanne Wiese2, Lynne Elson1, Felix Reichert3, Barbara Mambo4,
Hermann Feldmeier2
1 WAJIMIDA Jigger Campaign, Dabaso Tujengane CBO, Watamu, Kenya 2Institute of Microbiology and Hygiene, Charité University Medicine, Berlin, Germany 3 Department of Pediatrics, Charité University Medicine, Berlin, Germany 4 Kilifi County Research Group, Kilifi County Hospital, Kenya
Background: Tungiasis is a neglected tropical skin disease caused by female sand fleas (Tunga
penetrans) embedded in the skin. The disease is associated with important morbidity. Tungiasis
is endemic along the Coast of Kenya but little is known of its epidemiological characteristics.
Methods: In a cross-sectional study 1,086 individuals from 233 households in eight villages
located in Kakuyuni and Malanga Sub-locations of Kilifi County, were investigated in 2014.
Study participants were examined systematically and the presence and severity of tungiasis
were determined using standard methods. Demographic, socio-economic, environmental and
behavioral risk factors of tungiasis were assessed using a structured questionnaire. Data were
analyzed using bivariate and multivariate regression analysis.
Results: The overall prevalence of tungiasis was 25.0% (95% CI 22.4 – 27.5%), but varied
considerably between villages. Residence in Yembe and Bahati was a significant risk factor for
tungiasis (OR 17.3 and 21.8 respectively, p<0.0001). In 42.5% of the households at least one
individual had tungiasis. 15.1% of patients were severely infected (≥ 30 lesions). Multivariate
analysis showed that the occurrence of tungiasis was related to male sex (severe disease OR =
2.29, p=0.01), age <15 and >60 years (OR 7.2 and 5.6, p<0.0001 and p<0.01 respectively),
living in a traditional house with mud walls and floors (OR 3.35; 95% CI 1.71-6.58), sleeping
directly on the floor (OR 1.68; 95% CI 1.03-2.74), more than four people sharing a sleeping
room (OR = 1.77; 95% CI 1.07 – 2.93) and never using soap when washing the body (OR =
7.36; 95% CI 3.08 – 17.62). Although known to be a zoonotic disease, no specific animal
species was identified as a risk factor for tungiasis.
Conclusions: The results of this study show that in rural Kenya characteristics of poverty
determine the occurrence and the severity of tungiasis.
NTD11-A10 Schistosomiasis, Malaria and Soil Transmitted Helminth Burden and Their Association
with Anemia Among Children Aged 1-10 years from Schistosoma mansoni Hotspot Areas
of Siaya County in western Kenya
47
Fredrick Rawago1, Boaz Mulonga1, Musa Autta1, Isaiah Omondi1, Maurice Odiere1 and
Pauline Mwinzi1
1Neglected Tropical Diseases Branch, Center for Global Health Research, Kenya Medical
Research Institute (KEMRI), Kisumu, Kenya
Introduction: In western Kenya, malaria and schistosomiasis are the two most important
parasitic infections and may occur as co-infections. Though such infections could contribute to
more detrimental health consequences including anemia, which can be exacerbated in the
presence of soil transmitted helminthes (STH), there is paucity of data on the current burden of
these infections and their correlation with anemia among young children in Siaya County.
Methods: This cross-sectional study, conducted in 2017 among 1315 children in Siaya County,
determined Schistosoma mansoni, STH and malaria infections as well as anemia associated
with the infections. Three consecutive stool samples were collected from each participant and
presence of both Schistosoma mansoni and STH infections determined by duplicate slides using
Kato-Katz technique. In-addition, blood samples were collected for malaria and hemoglobin
determination.
Results: Overall prevalence for S.mansoni, STH, malaria, concurrent infections and anemia
was 42.8%, 3.8%, 13%, 9.2% and 37.5% respectively. Whereas children aged >5 years were
over 29 times more likely to be infected with S.mansoni than those aged 1-5 (O.R=29.6;
95%CI=21.2- 41.5%, P<0.001), overall mean infection intensity was (177±370) with children
>5 years showing higher mean (310±433) compared to <5 years (46±230), P<0.001.In-
addition, mean malaria parasite density was (25.7±108.8) per µl of blood. Children infected
with malaria only were twice as likely to be anemic (O.R=2.17; 95%CI=1.27-3.72; P=0.005)
compared with S.mansoni only (OR=1.05;95%CI=0.75-1.45; P=0.789P) and STH only
(OR=0.47;95%CI=0.05-4.27;P=0.502) .Besides, those co-infected with S. mansoni and malaria
were 1.39 times more likely to be infected with anemia(OR= 1.39; 95%CI=0.85-2.28;P=0.192)
compared to malaria and STH (OR=0.94;95%CI=0.08-10.5,P=0.96)and S.mansoni and STH
(OR=1.06;95%CI=0.45-2.49;P=0.899),and S.mansoni.
Conclusion: Anemia is associated with both malaria and S.mansoni Infections among young
children in Siaya County. Control programs should focus on both infections to improve on the
health of these children
NTD11-A11 Prevalence and risk factors associated with Schistosomiasis infection among children aged
1-5 years in Western Kenya
Ken Andiego1, P. Leakey1, Musa Autah1, George Ogara1, Simon Oteno1, Fredrick Rawago1,
M.Odiere1 and P.Mwinzi1
48
1Neglected Tropical Diseases Branch, Center for Global Health Research, Kenya Medical
Research Institute (KEMRI), Kisumu, Kenya
Introduction: Schistosomiasis is a major public health problem especially in tropical Africa in
terms of distribution and morbidity however, most control studies have focussed on adults school
age children with minimal attention on the preschool aged children who may also bear the brunt
of the disease. The current study assessed prevalence and risk factors associated with
schistosomiasis infection among children aged 1-5 years from previously identified
schistosomiasis hotspot areas of western Kenya.
Methods: This cross-sectional study, conducted between January-August 2017 among 436
children from 12 villages in western Kenya, utilized three consecutive stool samples collected
from each participant and presence of Schistosoma mansoni infection determined by duplicate
slides using Kato-Katz technique. A semi structured questionnaire based on known risk factors
to schistosomiasis infection including age, sex, water contact activities and household sanitation
was also administered among the mothers.
Results: Of the 436 children included into the study, 222 (51.9%) were boys and 214 (49.1%)
girls. The overall prevalence of Schistosoma mansoni was 35 % (95% CI= 31.2-40.3%) with no
significant difference in infection between boys and girls (P<0.909).As expected, 338(77.5%)
children who accompanied their mothers to the lake showed significantly higher S.mansoni
prevalence compared to 98(22.5%) who that did not accompany their mothers to the lake
(P<0.001).In-addition, significant relationship between having latrines and being infected was
established(P<0.001) with a majority,75% of mothers reported owning latrines with only 25%
lacking own latrines. Nonetheless, most children 310 (71.3%) bathed in the lake water and
another 116(26.4%) swum/played in the lake water though, either water contact activities showed
a significant association with being infected (P. <0.001).
Conclusion: Children aged 1-5 years and are predisposed to schistosome infection just like
other members of the community. Therefore, there is an urgent need to include these young
children in the national control program.
NTD11-A12 Understanding leishamania vector distribution in Turkana County
Author: Simon Leting; [email protected]
Background: The presence and the distribution of disease vectors in a certain geographical
locality is key in confirming the correlation to disease burden, control and prevention of disease
in a given geographical area. It is well known that sand flies transmit leishmaniasis to a healthy
individual. In Turkana, Kala-azar is still a burden and vector distribution is so far unknown/not
clearly understood. The presences of a considerable number of confirmed cases in the region
49
poses a great burden to the community and therefore concerted efforts are necessary to fight the
problem.
Methodology: A study is thus essential to be carried out to identify the vector species,
distribution and their significance in various parts of Turkana. The study shall involve the
trapping of sand flies randomly in designated areas presumed to be endemic. The vectors shall
be trapped and thereafter the samples categorized. Sand fly species can then be later identified.
Characteristic factors to correlate with the samples collected include; weather conditions of the
area (temperature and rainfall), land cover (bushes) nearness to a water source, deserted
anthills, human population, the presence of particular kind of trees and the economic activity of
the inhabitants. Specific areas of study to be identified based on endemicity. The number of
sand flies to be picked, method of identification shall be determined before the study begins.
Thereafter, known prevalence of visceral leishmaniasis shall be compared with the vector
distribution. Analysis of data shall later be done.
Results: The outcome of the study is expected to prevail in the control and intervention
measures. It is also anticipated to provide correlating information on vector habitat to certain
climatic (weather), geographical conditions. The results if vectors species identification is
expected to assist the study understand vector behavior and to confirm the type of leishmaniasis
in the region.
Conclusion: The understanding of vector distribution and vector behavior in the region should
enhance sand fly management strategies and methodologies to ensure elimination of breeding
and resting sites and direct intervention measures accordingly. Understanding the vector
behavior enhances ease of elimination and eventual eradication of the disease.
NTD11-A13 Identification of risk factors associated with transmission of Plague disease in Eastern
Zambia
Stanley S. Nyirenda*1,2, Bernard M. Hang’ombe3, Jackson Mwanza1, Robert Machangu2 and
Bukheti S. Kilonzo4
1Central Veterinary Research Institute, P.O. BOX 33980, Lusaka, Zambia 2Department of Microbiology, Parasitology and Immunology, Sokoine University of
Agriculture, P.O. BOX 30Morogoro, Tanzania,
3Department of Clinical Microbiology, The University of Zambia, P.O. BOX 32379, Lusaka,
Zambia,
4Pest Management Centre, Sokoine University of Agriculture, Morogoro, Tanzania
50
Abstract.
Background
Plague is a fatal, primarily rodent-flea borne zoonotic disease caused by Yersinia pestis. The
identification of risk factors of plague was investigated through questionnaire interview and
conducting focus group discussion (FGD) in Sinda and Nyimba districts of eastern Zambia.
Results
A total of 104 questionnaires were administered to individual respondents and 20 groups
consisting of 181 discussants, which comprised FGD team in this study. The study revealed that
trapping, transportation and preparation of rodents for food exposed the community to rodent and
their fleas suggesting that plague may have occurred primarily by either flea bites or contact with
infected wild rodents. The study also revealed that most people in communities consumed
rodents as part of their regular diet, therefore, contact with small wild mammals was a common
practice. The mode of transportation of freshly trapped rodents, in particular, carcasses risked
human to flea bites. Questionnaire respondents and FGD discussants 75% and 55%, respectively,
indicated that trappers preferred to carry rodent carcasses in small bags while 55.8% and 20%
respectively, reported hunters carrying carcasses in their pockets. Carrying of carcass skewers on
trappers’ shoulders was reported by 38.4% and 20% of individual respondents and FGD
respectively. This study also showed that there is a statistically significant (X2=4.6878,p<0.05),
between digging of rodents from their burrows and the presence of fleas on the hunters’ bodies
or clothes.
Conclusion
Trapping, transportation and preparation of rodents were conveniently exposing man to rodents
and their fleas, the natural reservoirs and vectors of plague respectively. These activities expose
humans to potentially flea bites in an enzootic cycle.
NTD11-A14 LEONINE FACIES-Always due to Leprosy?
DR. MAHENDRA PANCHOLI
Dermatologist Pandya Memorial Hospital Mombasa & Yaya Centre Nairobi
Email: flscmbp @yahoo.com
Introduction: Face is the Forward, Preface, Prime, Charming, Fore-runner index of the human
body & very valuable parameter deciding the personality at first sight.
Methods: There are a number of conditions affecting the face most of them are dermatological
as it is covered by the skin
Study of the presently available Literature is done & shows that changes on the face often
reflect Dermatological as well systemic changes, metabolic disorders & other internal
disorders.
51
Leprosy is one of the common causes of making the face Leonine but is not the sole cause,
other causes are discussed mentioning treatment options where applicable.
Results: As per presentation different causes discussed mentioning treatment where applicable
Conclusion: Clinically important to differential at earliest for optimum results.
NTD11-A15 PODOCONIOSIS
Dr. Mahendra Pancholi
Dermatologist Pandya Memorial Hospital Mombasa & Yaya Centre Nairobi
email:[email protected]
Introduction: Feet are like foundations for a standing Human being.
Method: Any painful or inflammatory disorder of the feet would cause problems in standing,
walking running & various shorts of discomforts-even causing sleep disturbance.
Survey of presently available Literature
Results: One of the very badly neglected condition affecting feet is Podoconiosis-which makes
individual almost Non-mobile causing lot of Socio-economic problems in addition to extremely
poor quality of Life.
It’s Pathophysiology & treatment options are discussed.
As per presentation clinical manifestations & various treatment options.
Conclusion: Need to raise awareness of importance of early diagnosis 7 treatment among
clinicians.
NTD11-A16 Sero-Prevalence of Lymphatic Filariasis in Mombasa County, Coastal Region of Kenya,
2016
Author: Oloo. J. Otieno 1Neglected Tropical Diseases Unit, Ministry of Health 2County Government of Mombasa
*Corresponding Author: [email protected]
Background: Lymphatic Filariasis (LF) is a neglected tropical disease targeted for elimination
in Kenya. In Kenya’s coastal region, LF affects about 3.5 million people. We aimed to determine
the sero-prevalence and distribution of LF in Mombasa County.
Methods: This was a cross-sectional survey involving multistage sampling in which one village
was randomly selected from each of the six sub-counties. In each village, a minimum of 300
individuals were randomly selected from 233 randomly selected households (HHs). Persons aged
≥3 years, a resident of the county between January and December 2016 was included in the study.
52
Persons on anti-filarial chemotherapy were excluded. We collected blood samples from
participants and collected demographic information using questionnaires. We used Filarial test
strip (sensitivity = 98% and specificity = 99%) for detecting circulating LF antigens in blood.
We analyzed data using Microsoft Excel and Epi-Info, calculated proportions for and used chi-
square (χ2) to compare sero-prevalence with demographic characteristics.
Results: A total of 1,826 individuals from 233 HHs were sampled. The overall sero-prevalence
was 1.1% (95% CI: 0.7-1.7). There were 14 (6%) HHs with at-least a positive case. The sero-
prevalence in males was 1.4% [(11/772); (95% CI: 0.8-2.5)] compared to females 0.9%
[(9/1056); (95% CI: 0.4-1.6)]; [(χ2 =0.87; p-value=0.352)]. The mean age of the sero-positive
individuals was 17.4± 9.8 years compared to sero-negative which was 21.8 ± 15.6 years (t
Stat=1.28; p-value=0.201). All positive cases were from Jomvu sub-county where 14 (35%) of
40 HHs had at-least one positive case. Clustering was seen in 4 (29%) of 14 HHs; 2 HHs had 3
cases each while 2 HHs had 2 cases each.
Conclusion: Sero-prevalence estimates from this study shows presence of LF in Jomvu Sub-
County. We recommend intensification of anti-filarial chemotherapy in Jomvu. The findings
provide baseline information for future public health investigations and response to LF in
Mombasa County.
NTD11-A17 Impact of helminth infections on clinical and epidemiological features of microbial
infections, and vaccine responses in ruminants: a systematic review
Robert Ndungu1, Helena Helmby2, Lucilla Steinaa 3, M. Kariuki Njenga1,4, S M Thumbi1,4 1Center for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578 -
40100, Kisumu, Kenya 2Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical
Medicine, London WC1E 7HT, UK 3International Livestock Research Institute, P.O. Box 30709-00100, Nairobi, Kenya 4Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA
99164 –7090, USA
Corresponding Author: S M Thumbi, Email: [email protected]
Helminth infections are ubiquitous in animal populations, and their interactions with
concurrent or subsequent microbial infections can alter clinical and epidemiological features
of infectious diseases and vaccines’ outcomes. We used the PRISMA 2009 guidelines to conduct
a systematic review of helminthmicrobial-pathogen interactions and their impact epidemiology
and clinical outcomes of microbial infections in ruminants. Of the 1,375 probable studies
identified through Google Scholar and PubMed databases, 20 studies met our inclusion criteria
and were qualitatively analysed. Fourteen studies were on domestic ruminants, while six were
on African buffaloes. Individual helminths investigated were Fasciola hepatica (six studies),
Haemonchus contortus (Three studies), Ostertagia ostertagi (one study) and Dicrocoelium
dendriticum (one study), while the rest looked at gastrointestinal nematodes in general.
Thirteen studies evaluated interactions between helminths and bovine TB (BTB), trypanosomes
and theileria pathogens while four focused on responses to vaccines against rabies, bovine
respiratory pathogens and BCG. Helminths interacted with Trypanosoma spp, Mycobacterium
53
bovis, Theileria parva synergistically to aggravate clinical anaemia as measured by PCV and
mortality. Furthermore, concurrent helminth infections were reported to lower the sensitivity of
BTB diagnostic tests, but they did not appear to affect antibodyresponses to vaccines. We discuss
that helminths may interact with microbial pathogens in a number of ways, but mainly through
immune pathways to modify clinical and epidemiological features of infectious diseases
in ruminant populations. The implications of these interactions include missed diagnosis,
underestimation of disease burden and increased severity of disease outcomes.
NTD11-A18 Evaluation of Guinea Worm Disease Surveillance System - Kenya
Philip Ngere1*, Oyugi E1, Gura Z1, Kamau T2, Karanja J3, Makayotto L3, Lowther S4 1Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya 2Vector Borne Disease Unit, Ministry of Health, Kenya 3Integrated Disease Surveillance Unit, Ministry of Health, Kenya 4Centers for Disease Prevention and Control, Kenya
*Corresponding author: Email: [email protected]
Introduction: Guinea worm disease (GWD), contracted by drinking water contaminated with
cyclops carrying infective larvae, results in considerable health, social, educational and economic
costs. It has no definitive medical treatment and is currently targeted for eradication through
public health interventions. Kenya is in the pre-certification stage of eradication undertaking
surveillance to meet the WHO threshold for certification. We evaluated Kenya’s guinea worm
surveillance system from 2012 to 2016.
Methods: Case based surveillance data was abstracted from the rumor log and register.
Aggregated weekly surveillance data was also obtained from the integrated disease surveillance
and response (IDSR) bulletins and Kenya Health Information Systems (KHIS). Means and
medians for continuous data and proportions for categorical data was done using Microsoft
Excel. The surveillance system was evaluated using CDC and ECDC guidelines while data
quality was audited using Microsoft Excel.
Results: A total of 209 and 106 rumors cases were reported and investigated respectively, while
286 and 301 facilities reported through the bulletin and KHIS respectively. Of the investigated
rumors that had crossed into Kenya, 5 (71.4%) were from guinea worm endemic countries.
Mombasa County reported 22 (10.5%) of the rumors while 28 (26.4%) rumors were investigated
in Turkana County. Surveillance did not include animals, data completeness was 0% for the
rumor log while reporting rates were 89.5% and 10.4% for the Bulletin and KHIS respectively.
Median diagnosis turnaround time was 1 day (<1 - 40 days) and data quality audit score for the
reported and investigated rumors were 60.2% and 85.1% respectively.
Conclusion: Guinea worm disease transmission has been interrupted in Kenya and surveillance
remains important due to the risk of importation of cases and the need to meet the WHO threshold
54
for guinea worm free certification. To achieve this, gaps in the surveillance system should be
addressed and scope expanded to include animals.
SCIENTIFIC SESSION B: BASIC SCIENCE
NTD11-B1 Relationships between levels of plasma total IgE, antigen specific IgE, and soluble CD23 in
children exposed to schistosomiasis in western Kenya.
Bartholomew N. Ondigo, Isaac Onkanga, Hulda Sang, Boaz Mulonga, Isaiah Omondi, Rachael
Hamilton, Maurice Odiere, Pauline N. Mwinzi, Lisa Ganley –Leal
Neglected Tropical Diseases Branch, Center for Global Health Research, Kenya Medical
Research Institute (KEMRI), Kisumu, Kenya
Background: Schistosomiasis infection, is characterized by high levels of IgE antibodies, which
has been associated with helminthic specific protective responses. CD23, a low affinity IgE
receptor, is expressed on B-cells, monocytes and dendritic cells. An increase in circulating
CD23+ B cells as well as soluble (sCD23) has been associated with resistance to schistosome re-
infection. The aim of this study was to analyze the relationships between levels of plasma total
IgE, antigen specific IgE, and soluble CD23 in children exposed to Schistosomiasis in western
Kenya. Understanding this relationships is important for determining mechanisms regulating IgE
production for the development of successful schistosome vaccines.
Methods: A cohort of 388 participants was recruited from twelve primary schools with different
levels of S. mansoni infection in western Kenya. Total and antigen specific IgE and soluble
CD23 were measured by ELISA assays.
Results: Median total IgE levels were 2548.6 (1900-3353) vs. 2035. 1(1466 -2917 (p = 0.0551)
for infected and uninfected individuals respectively. Antigen specific IgE levels were similar
between infected and uninfected individuals for both SEA and SWAP, (p = 0.4994 and 0.6085)
respectively. Infected individuals had higher sCD23 median levels compared to uninfected
participants, 2.63 (1.3 – 3.6) vs. 1.37 (0.6 – 2.8) p = 0.0161. There was a significant correlation
between egg intensity and total IgE, r = 0.24 (p = 0.0005). Furthermore egg intensities were
negatively associated to both SEA or SWAP specific IgE levels, -0.06(p =0. 4495), between
egg intensity and anti-SWAP IgE, -0.09 (p < 0.0858) respectively; and between egg intensity and
sCD23, 0.118(p = 0.0988).
Conclusion: The results are consistent with the characterized high levels of IgE
55
antibodies in helminthic infections. These IgE responses are associated with
increased sCD23.
NTD11-B2 Identification of biomarkers for diagnosis of Cystic Echinococcosis
Samson Nzou1, 2, Yoshito Fujii1, Matilu Mwau1, 2, Satoshi Kaneko1, Tony Teya1, Dorothy
Kagendo3, Erastus Mulinge2, Cecilia Mbae2, Japhet Magambo3, Eberhard Zeyhle3, Thomas
Romig4, Peter Kern5
1 Nagasaki University Institute of Tropical Medicine 1-12-4 Sakamoto Nagasaki 852-8523
Japan 2 Kenya Medical Research Institute, P.O. Box 54840 00100, Nairobi, Kenya 3 Meru University of Science and Technology, P.O. Box 927 60200, Meru, Kenya 4 Parasitology Unit, University of Hohenheim, 70599 Stuttgart, Germany 5 Comprehensive Infectious Diseases Center, University Hospitals, 89081 Ulm, Germany
Background The current diagnosis of cystic echinococcosis (CE) in humans and animals is majorly by
imaging which suffers from several challenges including difficulties in differentiating hydatid
cysts mainly CL, CE4 and CE5 type of cyst (WHO IWGE standardized classification) from other
cystic lesions. For such purposes, there is need to develop a robust diagnosis system to bridge
the gaps and act as a confirmation method to the already existing methods. To identify possible
antigens as biomarkers of diagnosis of CE.
Methods
We cloned loci encoding Echinococcus granulosus calcium binding protein (Eg CaBP),
Echinococcus granulosus component 1 (Eg_C1), Echinococcus granulosus antigen B1
(Eg_AgB2) and Echinococcus granulosus malate dehydrogenase (EgMDH) antigens expressed
the genes in bacterial systems and purified the resulting proteins. Antigens were subjected to
Luminex multiplex assays using sera from different CE patients to assess the antigens
immunodiagnostic potential. The cystic stages of the patients were classified according to WHO
classification into CL, CE1 CE2A CE2B, CE3A CE3B, CE4 and CE5 by ultrasonography.
Results
Eg_C1, Eg_CaBP and Eg_AgB2 antigens had high sensitivity yielding Area Under the Curve
(AUC) values of 0.842, 0.737 and 0.727 respectively in ricer operating characteristics (ROC)
analysis. Eg_MDH antigens elicited no significant reaction so analysis for it was not performed.
Conclusion: Our results however preliminary demonstrate the utility of applying multiplex
assays for development and evaluation of CE antigens for use in sero-epidemiological
surveillance. When fully optimized, this diagnosis can be used as a confirmatory test for imaging
findings.
NTD11-B3 Title: Immunopotentiation of the host innate response against dengue virus by a nucleoside
analogue inhibitor
56
Edna M. Ondari1,2,3 Paola Florez de Sessions1,4, Mark J. Schreiber1,5
1Novartis Institute for Tropical Diseases, 10 Biopolis Rd, Singapore 138670
2Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
3University of Basel, Petersplatz 1, 4001 Basel, Switzerland
4Genome Institute of Singapore, 60 Biopolis St, Singapore 138672
5Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115
Introduction/Background: Dengue viruses cause approximately 400 million infections and
over 20,000 deaths in tropical regions annually. Several host and virus-associated factors
determine the outcome of a dengue virus infection, resulting any of three known dengue
syndromes, or fatality. There are currently no specific dengue antivirals. While current and
prospective vaccines are important for controlling the disease, antibody-dependent enhancement,
a dysregulated immune response, limits the uptake and efficacy vaccines. Achieving quadrivalent
vaccine efficacy has also restricted vaccine approval in some endemic countries. Antiviral
therapies, therefore, can boost efforts against the virus.
Methods: This study characterized the cellular response to NITD008, a nucleoside analogue
inhibitor, using the HepG2 cell line with DEV2 reference strain NGC infection model. Cells were
exposed to three concentrations of NITD008; 0.5, 3, and 18μM, for 24, 48, and 72 hours. Global
gene expression levels associated with exposure to NITD008 both during and in the absence of
viral infection were then analysed by microarrays, and verified by real-time PCR.
Results: There was a significant increase in mRNA levels of genes associated with the innate
antiviral response, particularly of the interferon pathway, which increased with both time and
NITD008 concentration. There was also marked up-regulation of other innate immune system
genes, such as OAS1, SH3BGRL, RSAD2, and SAMHD1, which were among highest up-
regulated genes at 18μM. Strong induction of innate antiviral responses by molecules by
triggering the toll-like receptor 7 (TLR7)-MyD88-dependent signaling pathway has also been
demonstrated by other compounds with potent antiviral properties, such as imidazoquinoline
compounds, which induce interferons and other antiviral cytokines. This efect was absent in
vehicle (DMSO-treated) controls, and aapplication of NITD008 did not induce cytokines
associated with severe dengue.
Conclusions: These results suggest that nucleoside analogs, in addition to direct antiviral effects,
can be useful as immunopotentiators for both vaccines and chemoprophylaxis.
NTD11-B4 Innate lymphoid cells (ILCs) in pre-adolescent children with schistosomiasis
57
Isaac Onkanga1, Bartholomew Ondigo1, Rachael Hamilton2, Jason Defuria2, Maurice R
Odiere1, Pauline NM Mwinzi1 and Lisa Ganley-Leal2 1Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya 3LEAF Therapeutics, USA
Introduction
Innate lymphoid cells (ILCs) constitute recently identified cell types to be added to the complex
cellular map of the immune system. ILCs are morphologically similar to their counterpart of the
adaptive immune system, T- and B-cells but do not express rearranged antigen receptors that
recognize ‘non-self’ structures. They exhibit a functional diversity similar to that of T cells and
have been classified into three subsets – group 1 (ILC1), group 2 (ILC2) and group 3 (ILC3) –
depending on their phenotype, function and transcriptional regulation. It is well established that
ILC2s mediate resistance to helminth infections such as Nippostrongylus brasiliensis by
secreting cytokines such as IL-5 and IL-13. However, most of these studies have been conducted
in mice and the relative abundance of ILCs in human schistosomiasis has not yet been
characterized.
Methods
In this study, we provide an overview of the characteristics of ILCs in the context of Schistoma
mansoni infection by flow cytometry based on specific surface markers. In addition, we assessed
the activation of ILCs by one or a combination of the following cytokines; IL-33, IL-9 and IL-
17.
Results
In summary, based on expression of surface markers, we demonstrated that ILC1, ILC2 and ILC3
subsets are present in human schistosomiasis. We also characterized ILCs responses to IL-33,
IL-9, IL-17 and IL-9+IL-17.
Conclusion
However, further research on the function of ILC subsets is needed to address whether ILCs are
possible targets for new therapeutics in human schistosomiasis.
NTD11-B5 Multiplex Serologic Assessment of Schistosomiasis in Western Kenya: Antibody
Responses in Preschool Aged Children as a Measure of Reduced Transmission
Kimberly Y. Won,1* Henry M. Kanyi,2 Faith M. Mwende,2 Ryan E. Wiegand,1 E. Brook
Goodhew,1 Jeffrey W. Priest,3Yeuk-Mui Lee,1 Sammy M. Njenga,2 W. Evan Secor,1 Patrick J.
Lammie,1 and Maurice R. Odiere4
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1Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention,
Atlanta, Georgia; 2Eastern and Southern Africa Centre of International Parasite Control,
Kenya Medical Research Institute, Nairobi, Kenya; 3Division of Foodborne, Waterborne and
Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; 4Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
Background
Currently, impact of schistosomiasis control programs in Schistosoma mansoni–endemic areas
is monitored primarily by assessment of parasitologic indicators only. Our study was conducted
to evaluate the use of antibody responses as a way to measure the impact of schistosomiasis
control programs.
Methods
A total of 3,612 serum samples collected at three time points from children 1–5 years of age were
tested for antibody responses to two schistosome antigens (soluble egg antigen [SEA] and Sm25)
by multiplex bead assay.
Results
The overall prevalence of antibody responses to SEA was high at baseline (50.0%). After one
round of mass drug administration (MDA), there was minimal change in odds of SEA positivity
(odds ratio [OR] = 1.02, confidence interval [CI] = 0.79–1.32, P = 0.89). However, after two
rounds of treatment, there was a slight decrease in odds of SEA positivity (OR = 0.80, CI = 0.63–
1.02, P = 0.08). In contrast to the SEA results, prevalence of antibody responses to Sm25 was
lowest at baseline (14.1%) and higher in years 2 (19.8%) and 3 (18.4%). After one round of
MDA, odds of Sm25 positivity increased significantly (OR = 1.51, CI = 1.14–2.02, P = 0.005)
and remained significantly higher than baseline after two rounds of MDA (OR = 1.37, CI = 1.07–
1.76, P = 0.01). There was a significant decrease in the proportion of 1-year-olds with positive
SEA responses from 33.1% in year 1 to 13.2% in year 3 and a corresponding decrease in the odds
(OR = 3.25, CI = 1.75–6.08, P < 0.001).
Conclusion
These results provide preliminary evidence that schistosomiasis program impact can be
monitored using serologic responses.
NTD11-B6 Molecular identification of zoonotic hookworm species in dogs in Kenya
Erastus Mulinge1, 3, Japhet Magambo2, David Odongo3, Sammy Njenga1, Eberhard Zeyhle2,
Cecilia Mbae1, Dorothy Kagendo2, Henry Kanyi1, Rebecca Traub5, Marion Wasserman4, Peter
Kern6, Thomas Romig4
1, 3 Kenya Medical Research Institute, P.O. Box 54840 00100 Nairobi, Kenya. 2 Meru University of Science and Technology, P.O. Box 927 60200 Meru, Kenya. 3 University of Nairobi, P.O. Box 30197 00100 Nairobi, Kenya 4 Parasitology Unit, University of Hohenheim, 220 B, 70599 Stuttgart, Germany 5 Faculty of Veterinary and Agricultural Science, University of Melbourne, Parkville, VIC 3010,
Australia
59
6 Center for Internal Medicine, University Hospital, Albert-Einstein-Allee 23, 89081 Ulm,
Germany.
Background
Hookworms are the most common soil-transmitted helminths (STH) in humans in sub-Saharan
Africa and contribute to the greatest burden among neglected tropical diseases. In Kenya control
of STH has been through mass drug administration. However this program is faced by several
challenges such as re-infection. The role of animals in transmission of hookworm infections in
human is often overlooked, yet hookworms of cats and dogs are known to cause disease in
humans. Little is known of canine hookworm species in Kenya. This study sought to determine
the prevalence and species of hookworm in dogs’ from four regions of Kenya.
Methods
Dog faecal samples were collected from the environment and hookworm eggs isolated by zinc
chloride flotation – sieving method and subjected to DNA extraction. Polymerase chain reaction
(PCR) based on the internal transcribed spacer 1 and 2, 5.8S and 28S ribosomal RNA was done
and hookworm species identified by restriction fragment length polymorphism (RFLP) and/ or
sequencing.
Results
Hookworm eggs were detected in 490/1621 (30.2%) faecal samples by microscopy. Prevalence
differed across the study sites; Maasai Mara (46.8%), Meru (44.8%), Isiolo (19.7%) and 11.8%
in Turkana. Of the 70/78 DNA samples yielded PCR products and identified as Ancylostoma
caninum (n = 59), A. braziliense (n = 10) and A. duodenale (n = 1). Ancylostoma caninum was a
common species in all study sites, A. braziliense and A. duodenale were reported in three and
one study site(s) respectively.
Conclusions
This study reports for the first time hookworm species in dogs in Kenya and a rare case of A.
duodenale in a dog. The findings of this study highlight the need of recognising dogs as
reservoirs of zoonotic agents such as hookworm, specifically their contribution in environmental
contamination with helminths eggs. Therefore effective control measures would necessitate ways
of preventing environmental contamination by dogs, deworming among other control strategies.
NTD11-B7 Moving towards interruption of transmission of soil-transmitted helminths: impact of a
cluster randomised trial evaluating alternative treatment strategies and delivery systems in
Kenya
RL Pullan1, KE Halliday1, W Oswald1, S Kepha1, C Mcharo2, S Witek-McManus1, PM Gichuki2,
HS Matendechero3, E Beaumont4, SJ Brooker1, A Chiguzo5, C Teti6, C Gwayi-Chore6, JE
Truscott7, HC Turner7, E Allen4, RM Anderson7, SM Njenga2, CS Mwandawiro2
BACKGROUND: WHO guidelines for soil-transmitted helminths focus on morbidity control
through mass treatment targeting children and women of reproductive age. There is now growing
interest in elimination in some settings, supported by mathematical models. The TUMIKIA
60
project aims to provide empirical evidence addressing if mass treatment can interrupt
transmission, and if so, through which strategy.
METHODS: In 2015-2017, a cluster-randomised trial was implemented in Kwale, Kenya. 120
community units (~1000 households each) were randomised to one of three groups: annual
school-based deworming (SBD) for ages 2-14 years; annual community-based deworming
(CBD) targeting all ages; or biannual CBD. The primary outcome was hookworm prevalence,
assessed by annual cross-sectional surveys using kato-katz. Secondary outcomes were prevalence
of other STH species, infection intensity and treatment coverage.
FINDINGS: In total, 20,842 individuals were included in the baseline survey, 24,357 at 12
months and 21,761 at 24 months. Two years of SBD reduced hookworm prevalence from 19 to
14%, annual CBD from 18 to 8% (adjusted risk ratio (RR): 0.61, 95% CI 0.50-0.75) and biannual
CBD from 21 to 6% (adjusted RR 0.48, 95% CI 0.41-0.57). Impacts on hookworm infection
intensity were large; adjusted incidence rate ratio for CBD was 0.45 (95% CI 0.29-0.72) and
biannual CBD was 0.31 (95% CI 0.20-0.48). Impact results were consistent across all sub-groups,
and treatment coverage was stable across arms and treatment rounds, ranging from 84-87% of
children and 59%-63% of adults. No strategy had an impact on A. lumbricoides or T. trichiura
infections, which were both less than 4% throughout
CONCLUSION: Impact was consistent with that predicted by mathematical models,
highlighting the potential of community-based treatment targeting all ages to reduce transmission
in hookworm-dominated settings. Results emphasise the equity of mass drug administration, but
demonstrate how achieving high treatment coverage remains a challenge, even in rigorous trial
settings.
1 Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine,
London, UK 2 Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research
Institute, Nairobi, Kenya 3 Neglected Tropical Diseases Unit, Division of Communicable Disease Prevention and Control,
Ministry of Health, Nairobi, Kenya 4 Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical
Medicine, London, UK 5 Office of the Executive Committee, Medical Services and Public Health, Kwale County
Government, Kwale, Kenya 6 Evidence Action, Nairobi, Kenya 7 Faculty of Medicine, Department of Infectious Disease Epidemiology, London Centre for
Neglected Tropical Disease Research, School of Public Health, St Mary's Campus, Imperial
College London, London, UK
NTD11-B8 Five years monitoring of the impact of mass drug administration on soil-transmitted
helminths
61
Charles Mwandawiro1, Jimmy H. Kihara1, 3 Collins Okoyo1, Elses Simiyu1, Joyce Nyambura2
and Sammy Njenga1
1 ESACIPAC, Kenya Medical Research Institute, Box 54840, Nairobi, Kenya 2 Centre for Microbiology Research, Kenya Medical Research Institute, Box 54840, Nairobi. 3 Vector-Borne Diseases Control Unit, Ministry of Health, Nairobi, Kenya
Soil-transmitted helminths (STH) are the most prevalent Neglected Tropical Diseases (NTD) in
the world, affecting more than 2 billion people, 800 million of whom are children. Children of
school-age are particularly vulnerable to chronic infection that can impair mental and physical
development and reduce school attendance and educational achievement. The impact of Mass
Drug Administration (MDA) using Albendazole on STH was monitored for 5 years (2012-2017)
in 16 counties from Western, Nyanza, Rift Valley and Coast regions in the Kenya National
School-Based Deworming Programme (KNSBDP). Stool samples were examined using the
Kato-Katz technique from 20,000 pupils (200 schools) in years 1,3 and 5 before MDA and from
6,000 pupils (60 schools) every year before and after MDA. Stool samples were collected from
18 children each in one ECD class then classes 2 to 6 making a total of 108 children per school.
The combined STH prevalence substantially dropped from 33.6% to 15.2% with a significant
relative reduction (RR) rate of 54.9%. Similarly, there was a significant drop in the specific STH
species prevalence. For instance, prevalence of A. lumbricoides dropped from 20.7 to 11.1%,
Hookworm from 15.2 to 1.3% and T. trichiura from 6.3 to 4.6%. Reductions in the pre- and
post-MDA prevalence for each infection were also. There are inter-county variations in the
decline of STH prevalence. Re-infections, especially with Ascaris lumbricoides, often occurs
following MDAs. Other interventions such as WASH-based ones have to be introduced to sustain
chemotherapeutic gains of MDAs and to accelerate attainment of the breaking point that could
lead possible elimination of STH as a public health problem.
SCIENTIFIC SESSION B1
SPECIAL SESSION : SNAKE BITE
SNAKEBITE CRISIS IN KENYA
Introduction:
Snakebite is defined as incision of human skin by a snakes’ fang, causing envenomation of
various degrees, which can result in death or disability. It is also important to mention that not
all snakebites are fatal nor all cause disability. In Africa, snakebite is associated with rural
lifestyle, which is categorized either as an occupational, environmental or a domestic hazard and
is mostly associated with poor people who may not have a health cover or other means of
protecting themselves from such hazard.
In Kenya, snakebite is a serious public health problem that has not been well addressed because
it occurs mostly in rural areas and it does not get the attention it deserves, both as a health problem
as well as a socio-economic problem.
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The most affected areas are the dry tropicals and the lowlands. In Kenya, the geographical areas
that report high snakebite cases include areas such as the greater areas of Eastern Kenya (Kitui
and greater Ukambani), most parts of Rift valley, the Coast (mostly Kilifi) and a few pockets in
Western Kenya and Homa-bay.
Disease Burden
Modest estimates show that more than 5 million people suffer snakebite every year, leading to
25,000–125,000 deaths, while an estimated 400,000 people are left with permanent disabilities.
8000 amputations are estimated to be performed annually in Africa alone. However, community-
based surveys illustrate that the actual burden of human suffering is likely to be even greater. In
Despite this global impact, snakebite has received little attention from the global health
community, the pharmaceutical industry, governments, and public health advocacy groups, and
has a disappointingly low priority in the global health research agenda. As a consequence, the
paucity of health programs addressing snakebite at national, regional, and global levels allows
deaths or maiming of snakebite victims to continue.
The Kenya scenario is no different, modest estimates by Kenya Domestic Health Information
Survey (KDHIS 2015) indicate that by June 2017 there were 26,496 and in 2016, there were
17,446 cases of snakebites reported in Kenya. These figures may not be the true reflection of the
situation as there are a number of victims who seek treatment from traditional healers and are not
captured statistically.
It is interesting to know that the burden of suffering caused by snakebites could be significantly
reduced if effective preventive and therapeutic resources are available. Unfortunately these
resources are not distributed equitably because of systemic neglect. On a positive note, there has
been progress in highlighting the neglect of snakebite thus the recent inclusion of snakebite in
the WHO list of Neglected Tropical Diseases (NTDs), and the development of initiatives by the
WHO and its regional offices and other efforts at nationally and at regional levels, have
improved the global awareness of this disease. However, the impact of these projects has been
rather limited, particularly in light of the progress made in control of other NTDs.
Global efforts launched in the last decade to confront NTDs have recruited the important support
of the World Health Organization (WHO), governments, (e.g. the NTD unit at MOH which has
taken up snakebites), diverse funding agencies, and other advocacy groups/foundations. As a
result, there is a growing awareness of the socio-medical importance of this group of ancient
human scourges. Several strategies are being implemented to reduce the burden of these diseases
within the framework of the Millennium Development Goals (MDGs). A significant achievement
has been the conceptualization of NTDs as a group of health problems that share many common
demographic, sociological, epidemiological, and clinical features. Implementing integrated
initiatives conducted by advocates, involving research and development, control, treatment, and
attention to the needs of affected populations, is now a primary strategy to reduce disease burden.
Classical Features of Snake envenoming that make it a true NTD
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The recent inclusion of snakebites into the WHO list of NTD is another breakthrough
achievement of long term lobbying by international organizations, governments and other stake
stakeholders that snakebites is rightly so an NTD because it epitomizes the following 6 features,
which are similar to the other NTDs
1. Snakebite causes significant rates of mortality, morbidity, disfigurement, and chronic
psychological anguish, and incurs a heavy loss of productivity due to physical disability.
Since impoverished rural dwellers are the group at highest risk snakebite exerts a direct
economic and social impact on families and communities and thereby significantly
contributes to the prevailing vicious cycle of poverty and inequity.
2. Since snakebite mainly afflicts low-profile, rural populations that lack a political voice,
victims cannot influence regional and national administrative and political policy makers,
and their needs remain largely unheard and politically neglected.
3. Snakebite does not represent a health risk to high-income peoples and countries. This
contributes to the negligible interest shown by governments to combat this problem with
the financial and political resources appropriate to that task.
4. Snakebite causes stigma and discrimination, especially in people suffering from venom-
induced permanent physical deformity and disability, as well as from amputations and
other surgical procedures employed in the management of these complications. This
affects working performance and greatly limits the chances of victims' finding jobs and
leading productive and fulfilling lives. In addition, since a high proportion of cases occur
in children, snakebite may have profound implications for their development, education,
and future opportunities, blighting their entire lives.
5. The true rates of snakebite-induced morbidity and mortality are still largely unknown in
many regions of the world because estimates are based mostly on extrapolations of
hospital statistics. Recent national community-based surveys have highlighted the fact
that the actual magnitude of this disease is much greater than was previously thought
because many snakebite victims never manage to reach hospitals and therefore remain
unrecorded and invisible to the health system.
6. Snakebite has been largely omitted from research agendas and does not feature as a listed
research priority for any health funding agency. Despite significant advances in the
biochemical and toxicological understanding of snake venoms, including the realization
of their potential as pharmacological agents, there are serious deficiencies in our
knowledge of the epidemiological and clinical features of snakebite envenomings in
many countries. There has also been negligible funding for research to improve the
technologies for anti-venom manufacture—the only validated therapy for snakebite
envenoming. Likewise, topics related to economic impacts, public health policies, and
cultural perceptions of snakebite have failed to attract the attention of research groups
and their funders.
7. The tragedy of snakebite is that effective solutions already exist but are not being
delivered in many countries. Timely administration by a trained practitioner of effective
and appropriate anti-venoms can be expected to prevent most deaths and sequelae
resulting from these envenoming. Although approved methods for anti-venom production
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are readily available in the public domain, anti-venoms are neither available nor
accessible in many regions of the world.
Differences between Snakebites and other NTDs
Some distinctions between snakebite and the other NTDs pose significant challenges to
establishing effective snakebite control programs. Thus, because it is not an infectious disease,
there is no potential for elimination or eradication of snakebites, unlike the expectation for most
other NTDs. Highly effective and logistically efficient mass vaccination or administration of
antihelminthics, antibiotics, and other interventions, such as vector control, and provision of safe
food, water, and sanitation , are not applicable to snakebite envenoming. Furthermore, unlike the
near global effectiveness of most antihelminthics and antibiotics, snakebite envenoming therapy
is regionally specific and this limits the implementation of “economics of scale” to anti-venom
production.
The Way forward
The Kenyan government together with the global community and other stakeholders should work
together in an integrated approach that encompasses interventions to bring to an end the long
suffering of snakebite victims. The key actions to achieve this should be coordinated with the
more general efforts to combat NTDs, such as:
1. Improving health information systems to generate reliable disease-burden data in regions
of high snakebite incidences.
2. International research efforts dedicated to achieving a better understanding of the
biological and venom composition of the snake species of greatest medical importance,
thereby fostering the development of anti-venoms with broader coverage of snake species
and geographical areas.
3. Improving the availability and accessibility of safe and effective anti-venoms. This
resolution of the snakebite problem should go hand in hand with the strengthening of
public health systems, especially with the provision of health services to vulnerable
populations in areas of high coincidence of all the NTDs.
4. Ensuring that the health workforce in areas of snakebites is appropriately trained in the
clinical management of these diseases. Establishing and maintaining “best clinical
practice” education programs for all the NTDs in high-risk regions would improve health
outcomes significantly.
5. Attention and follow-up for people suffering from physical and psychological sequelae
secondary to snakebites. Snakebite, like some of the other NTDs, causes substantial
disfigurement and disability that frequently results in chronic psychological morbidity..
6. Implementation of preventive and educational campaigns to reduce the incidence of
Snakebites and to promote effective first aid intervention. The involvement of local
communities in the design and performance of these activities is of paramount relevance
to increasing the likelihood of community compliance.
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Conclusion
The fulfillment of these tasks demands an integrated, inter-programmatic, and inter-sectoral
strategy at the global level, involving a wide spectrum of active protagonists, such as:
The medical and scientific community,
Technology development groups,
Anti-venom manufacturers,
National and international public health authorities,
Advocacy groups, international partners, and nongovernmental organizations working in
the public health sector, and
Diverse community organizations and local initiatives in the regions where snakebites are
frequent
To quote from the Director-General of the WHOs’ address (2007) to the Regional Committee
for Africa: “Last year, WHO launched an integrated strategy for the management of several of
the neglected tropical diseases, all of which disproportionately affect the poorest of the poor in
Africa. Instead of a host of individual programs going their separate ways, we now have a unified
strategy that simplifies drug distribution, reduces duplication, and lessens some of the demands
on health systems and staff.” The incorporation of the proposed snakebite initiatives within the
general struggle against all the NTDs will result in a significant and more logistically efficient
reduction of human suffering.
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NTD11-B1-1
NTD11-B1-2 Preclinical antivenom-efficacy testing reveals potentially disturbing deficiencies of
snakebite treatment capability in East Africa
Harrison RA1, Oluoch GO2, Ainsworth S1, Alsolaiss J1, Bolton F1, Arias AS3, Gutiérrez
JM3, Rowley P1, Kalya S4, Ozwara H2, Casewell NR1.
1 The Alistair Reid Venom Research Unit, Parasitology Department, Liverpool School of
Tropical Medicine, Liverpool, Merseyside, United Kingdom.
2 The Institute of Primate Research, National Museums of Kenya, Karen, Nairobi, Kenya.
3 Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José,
Costa Rica.
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4 County Health Services, County Government of Baringo, Kabarnet, Baringo, Kenya.
Background: Antivenom is the treatment of choice for snakebite, which annually kills an
estimated 32,000 people in sub-Saharan Africa and leaves approximately 100,000 survivors with
permanent physical disabilities that exerts considerable socioeconomic burden. Over the past two
decades, the high costs of the most polyspecifically-effective antivenoms have sequentially
reduced demand, commercial manufacturing incentives and production volumes that have
combined to create a continent-wide vacuum of effective snakebite therapy. This was quickly
filled with new, less expensive antivenoms, many of which are of untested efficacy. Some of
these successfully marketed antivenoms for Africa are inappropriately manufactured with
venoms from non-African snakes. The uncertain efficacy of available antivenoms exacerbates
the complexity of designing intervention measures to reduce the snakebite burden in sub-Saharan
Africa. The objective of this study was to preclinically determine the ability of antivenoms
available in Kenya to neutralise the lethal effects of venoms from the most medically important
snakes in East Africa.
Methods: We collected venom samples from the most medically important snakes in East Africa
and determined their toxicity in a mouse model. Using a ‘gold standard’ comparison protocol,
we preclinically tested the comparative venom-neutralising efficacy of four antivenoms available
in Kenya with two antivenoms of clinically-proven efficacy. To explain the variant efficacies of
these antivenoms we tested the IgG-venom binding characteristics of each antivenom using in
vitro IgG titre, avidity, venom-protein specificity assays and the IgG concentration of each
antivenom.
Findings: None of the six antivenoms are preclinically effective, at the doses tested, against all
of the most medically important snakes of the region. The very limited snake polyspecific
efficacy of two locally available antivenoms is of concern. In vitro assays of the abilities of ‘test’
antivenom IgGs to bind venom proteins were not substantially different from that of the ‘gold
standard’ antivenoms. The least effective antivenoms had the lowest IgG content/vial.
Conclusions: Manufacture-stated preclinical efficacy statements guide decision making by
physicians and antivenom purchasers. This is because of the lack of both clinical data on the
efficacy of most of the many antivenoms used to treat patients and independent preclinical
assessment. Our preclinical efficacy assessment of antivenoms identifies important limitations
for two of the most commonly-used antivenoms, and that no antivenom is preclinically effective
against all the regionally important snakes. The potential implication is of serious concern, and
underscores the dilemma physicians’ face, the need for clinical data on antivenom efficacy and
the medical and societal value of establishing independent preclinical antivenom-efficacy testing
facilities throughout the continent.
SCIENTIFIC SESSION C: HEALTH BEVAVIOURAL STUDIES AND SOCIAL
SCIENCES
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NTD11-C1 Perceptions and Experiences of School Teachers during Implementation of School-based
Deworming Activity in Kenya
Authors: Njomo DW1, Kairu C1, Masaku J1, Mwende F1, Odhiambo G2, Musuva R2, Matey
E3, Thuita IG4 and Kihara JH5
Institutional Affiliations: 1Eastern & Southern Africa Centre of International Parasite Control, 2Centre for Global Health Research, 3Centre for Microbiology Research, Kenya Medical
Research Institute, 4Ministry of Education, Science and Technology, Kenya, 5Ministry of
Health, Division of Vector Borne Diseases, Kenya
Introduction: Primary school teachers are key stakeholders in success of school-based
deworming activity as they are responsible for drug administration and provision of health
education to the school children. In Kenya, the National School-Based Deworming Programme
(NSBDP) for soil-transmitted helminths and schistosomiasis was initiated in the year 2012. By
the year 2013 over 6 million children had been treated. The current study sought to assess
teachers’ perceptions of and experiences during school-based deworming activity so as to
improve programme effectiveness.
Methods: A cross-sectional study using a qualitative method for data collection was conducted
in four sub-counties of coastal region. In-depth interviews were administered to thirty-eight (38)
purposively selected primary school teachers. Data was audio recorded, transcribed, coded and
analysed manually by study themes which included; reason why selected for training to
administer drugs; perceptions of training content and duration; experiences during drug
acquisition, administration and record-keeping and motivation to continue participating in
deworming exercise.
Results: Being in charge of school health was the main reason why teachers were selected to
administer drugs. The duration and content of training was considered as sufficient and no
challenges were faced during drug acquisition. Challenges faced during drug administration
included non-compliance and experience of side effects of drugs. No major problems were
experienced in record-keeping although teachers felt that the forms needed to be simplified.
Improvement of children’s health and class performance was reported as a motivating factor for
teachers to continue administering drugs. Fellow teachers were reported to have given moral
support while parents did not provide much support.
Conclusion: Teachers have positive experiences and perceptions of the deworming activity.
There is need to solicit all stakeholders’ support to help counter non-compliance and address
issues of side effects after drug consumption. Inadequate moral support and incentives are
negative factors on teachers’ motivation.
Key words: primary school teachers, experiences, opinions, school-based deworming
NTD11-C2 Behavioural changes in trachoma management among the pastoralist in Samburu, Kenya
Solomon Mwaniki1, Francis Dikir1, Chitiavi Juma1 & Erastus Sinoti2
1Amref Health Africa in Kenya, P.O Box 30125 – 0100, Nairobi
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2Department of Public Health, Ministry of Health, Samburu County, P.O Box 14, Maralal.
Key words: Trachoma, behavioral change, transmission, household
Background: Aims at assessing knowledge, attitude, practice and behavioral change of the
pastoral community in the management of Trachoma, its linkage to fly control and to identify
any probable myths and misconception on fly control contributing to the disease occurrence and
transmission. In the study area, the prevalence of active trachoma (Trachomatous inflammation
– follicular) among children 1-9 years stands at 35% and 6% for blinding trachoma
(Trachomatous trichiasis) among people above 15 years as compared to WHO minimum
threshold of 10% and 1% respectively.
Methods: Study was conducted in Kirisia Division, Samburu Central where 360 respondents
were identified through multistage sampling technique. A Cross-sectional descriptive study
employing both quantitative and qualitative methods was used. Household interviews, Key
Informant Interviews and Focused Group Discussions were used for data collection. Qualitative
data was analyzed using SPSS while qualitative data was analyzed using atlas.ti7.
Results: Respondents were age between 18 and 97 of which 69% were female and 31% were
male. Most of them were rearing livestock as their main economic activity, 47.3% followed by
38.8% unemployed. Women were twice as likely to be unemployed compared to males (X2=10.9,
p=0.05). Education levels did not predict the utilization of trachoma interventions and there was
perfect likelihood of error explaining the use of hand washing facilities as education dependent
(kruskal lambda = 0.00, Goodman and Kruskal tau = 0.013, p=0.008) even though the most
reported reasons were lack of money and ignorance. For log linear analysis; K-way and Higher
order effects for a model to explain the knowledge of where flies breed (as a representative of
knowledge) explains latrine ownership was highly significant, p=0.00 in both cases but removing
education level from the model that predicts use of trachoma interventions will not affect the
model significantly p=0.73. Further there was significant association between training and use of
trachoma interventions like latrine, hand washing and ownership of hand washing facility
(X2=3.929, df =1, p=0.73). There were no sociocultural issues affecting latrine usage.
Conclusions and Recommendations: Behavioral changes that enhance use of trachoma and fly
control interventions likely explained in terms of availability of resources and individual
knowledge probably gained through informal training and education level whose effects could
not be removed from any model predicting the use of trachoma intervention. And because there
were no major sociocultural factors reported, to enhance adoption of interventions for trachoma
control, interventions that enhance economic capacity and knowledge would probably have
better results.
NTD11-C3 Knowledge, Attitude and Practices on Visceral Leishmaniasis among residence and health
care workers in Wajir County 2017, Kenya
Ihahi Josphine 1*, Dr Adam Haji1
1 Wajir County Department of Health, Wajir County, Kenya
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Background: Neglected tropical diseases such as visceral leishmaniasis (VL) also known as
kala-azar is a diseases caused by protozoan parasites transmitted through the bites of infected
female sand-flies. Knowledge, attitudes and practices (KAPs) of communities and health care
workers (HCWs) contribute immensely to sustainable control which include primary prevention
focusing on vector elimination, personal protection and environmental control through consistent
use of Insecticide-treated nets and prompt effective case management. This study was conducted
to assess KAPs of residence and HCWs on VL to identify gaps in effective control in Wajir
County.
Method: We conducted a cross-sectional study in Wajir West and Eldas sub-counties, used
purposive sampling to select community residents and HCWs. Structured questionnaires were
administered upon receipt of informed consent for participation. Data obtained was coded and
analysed using MS excel 2010.
Results: A total of ninety participants were interviewed. Overall knowledge on causative vector,
risk factors was high. All study subjects knew at least one of the classical signs and symptoms
including fever and distended stomach. Eight (40%) HCWs had low knowledge on VL case
management. Compared to HCWs, 48 (68.6%) residence were unaware of key prevention and
control measures. Participants 89(99%) had positive attitude towards early diagnosis and
effectiveness of medical treatment of VL. Poverty was perceived as a risk factor by 12 (60%)
HCWs. Unavailability of drugs in most health facilities forced 16(23%) patients to seek
medication 10 kilometres away. Fifteen (75%) HCWs did not conduct defaulter tracing for
patients on medication, siting nomadic lifestyle and lack of communication being the major
setback. Most residents 66(96%) did not practice any prevention and control measures.
Conclusion: HCWs had moderate knowledge on VL case management. Little was known and
done on environmental preventive and control measures at community level. We recommend
HCWs capacity building on VL cases management and community sensitization on personal
protection and vector control measures.
NTD11-C4 Implementation of the positive deviance approach in the management of
tungiasis in Elgeyo Marakwet County
Jacob Ayienda Institution: Department of Health and Sanitation, Elgeyo Marakwet
County
Contacts: [email protected]
Background
This paper examines the implementation of the Positive Deviance Approach in Kiptuilong
Community Unit of Elgeyo Marakwet County in the control of tungiasis. The paper highlights
the processes that were undertaken from the period of April – May 2017. The overall objective
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was to enhance sustained reduction in reported cases of tungiasis by rehabilitating affected
children, sustaining rehabilitation and prevention of future infections.
Methodology
Firstly, a baseline survey was conducted to identify children below 15 years infected with
tungiasis. Positive (PD), non-positive (NPD) and negative (ND) deviant children were then
identified using the baseline survey data and the communities’ criteria of who encompasses the
poor and those who are not poor. A Positive Deviance Inquiry (PDI) with caregivers of positive,
non-positive and negative deviant children was then done to discover the positive deviant
caregiver’s successful or desired practices that can be replicated by others to address the problem
of tungiasis which was then used to design and conduct the PD approach sessions facilitated by
the mother of the PD child.
Results
From the baseline survey analysis, 17 children (25.8%) were found to be positive deviants, 23
(34.8%) were found to be non-positive deviants and 16 (24.2%) were found to be negative
deviants. Ten children (15.2%) were neither of the above. In addition, results revealed that 12
children (18.2%) were mildly infected (only feet), 8 children (12.1%) were severely infected
(both feet and hands) and 46 children (69.7%) were normal. Results from the sessions showed
that four children showed improvement in their status during the 12 days of the sessions.
Conclusion and recommendations
It could be generally concluded from the whole process of PD approach implementation that in
a poor resource setting, it is possible to find solutions to a problem within a community itself.
This is evidenced by a good number of PD children that were found in the community amidst
poverty and other factors that hinder attainment of good health.
NTD11-C5 Knowledge, attitude and practices towards jigger infestation in Marachi central, Butula
Charles Omeny
SCNTDC/ SCDSC-Butula
Introduction
In Kenya, over 2.6 million rural communities are infected with jigger flea. Busia, Nyeri,
Murang’a and Kwale Counties are among the tungiasis endemic counties in Kenya. In the year
2015, 71 households and 416 individuals in Busia were affected by the jigger menace. Of which
45 households and 246 cases were reported in Marachi central ward. We carried out a study to
assess the status of knowledge, attitude and practices on jigger infestation among residents of
Marachi Central ward, Butula Sub-county, Busia County.
Methods
The study design was descriptive cross-sectional and random sampling was used to select ten
villages and from each village, the same technique was used to select 10 homes and 350
respondents interviewed. People seeking health care services from Khunyangu sub-county
hospital were also randomly selected and interviewed.
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Results
All the people in the region know what tungiasis is, have seen people infested with tungiasis and
acknowledged that it was actually a ‘silent’ menace. The number of people who felt that tungiasis
is a curse was surprisingly high and even those who associated it with witchcraft were equally
many. 67% of respondents felt that jigger infected people suffered stigma and were always
discriminated in the society. They were not allowed to share the same dining table with
uninfected ones for fear of transmitting the flea. Infected children were always hidden whenever
visitors were expected. At school, such children were often ridiculed by their uninfected
colleagues.
Conclusion
Good will seems to be lacking in the prevention and control of Jigger menace. All the concerned
duty bearers should step in to provide the good will in order to realize a sound prevention and
control of the menace.
NTD11-C6 Gender Specific Levels of Community Knowledge, Attitude and Practice on
Schistosomiasis after 5 years of annual mass schistosomiasis control program Among Adult
Population in western Kenya
Rosemary Musuva1, Fredrick Rawago1, Kennedy Andiego1, Isiah Omondi1, Maurice Odiere1 and
Pauline Mwinzi1.
1 Kenya Medical Research Institute, Centre for global health and research.
Introduction: schistosomiasis related knowledge, attitude and practice (KAP) studies continue
to generalize communities’ perceptions on the infection despite the possibility of gender related
participation disparities in community health related surveys. This study sought to evaluate the
gender specific levels of community KAP on schistosomiasis among adult populations in western
Kenya.
Methods: This cross-sectional survey was conducted between June-August 2016 in 25 villages
post a 5 year mass annual deworming study in western Kenya. A standard questionnaire with
information on participant’s socio-demographics and KAP concerning schistosomiasis was
administered among household heads.
Results: Of the 486 respondents interviewed, 142 (29.2%) were males and 344 (70.8%) females.
Interestingly, only 68 (13.9%) considered schistosomiasis as a common disease in their
communities with no significant association between gender. Knowledge on transmission was
generally low with 62(43.7%) males compared to 100(29.1%) females citing correct ways of
disease transmission (OR=2.59;95%CI=1.19-5.63;P=0.017). No significant association between
gender and knowledge on disease signs, symptoms, prevention measures and defecation practices
was established. Out of 388 (79.8%) who believed bilharzia can be prevented, 245 (50.4%), 71
(14.6%) and 72(14.8%) acknowledged one, two and more than two correct prevention measure
respectively with no significant association between the gender. Majority of the respondents
225(46.3%) got information on schistosomiasis from their respective community health workers
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with about 7% males compared to 1.5% females getting information from other community
leaders(P=0.001).
Conclusion: Knowledge on schistosomiasis transmission and disease importance is low in
western Kenya, regardless of gender influence, further compounding control strategies.
NTD11-C7 Awareness and opinions of pre-school children parents on the National School Based
Deworming Programme in Coastal region of Kenya
Janet Masaku1, Rosemary Musuva1, Elizabeth Matey1, Gladys Odhiambo1, Faith Mwende1,
Jimmy Kihara 2 Isaac Thuita3, and Doris Njomo1. 1Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya; 2Ministry of Health,
Division of Vector Borne Diseases P.O. Box 20750-00202, Nairobi, Kenya; 3Ministry of
Education, Directorate of Basic Education, Early Childhood Education Section P.O. Box 30040-
00100, Nairobi, Kenya.
Background: Soil transmitted helminths (STHs) are a major public health problem among
school age children which has caused significant nutritional and educational effects. In 2012, the
National school-based deworming programme (NSBDP) was introduced in 28 endemic counties
of Kenya. Treatment of over five million school age children (SAC) both in pre-schools and
primary schools using trained primary school teachers has since been conducted for the last five
years. We sought to assess parents of pre-school age children’s awareness and opinions of the
NSBDP so as to improve programme implementation.
Methodology: A qualitative cross-sectional study was conducted in four endemic sub-counties
(Msambweni, Matuga,Lungalunga and Malindi) of two counties of coastal region of Kenya. A
total of 20 focus group discussions (FGDs) categorized by gender were conducted among parents
of the pre-school age children (PSAC). Study participants were purposively selected based on
homogenous characteristics with the saturation model determining the number of FGDs to be
conducted. The data collected was analyzed manually by study themes.
Findings: A majority of the participants in one-half (n=10) of the FGDs reported that they were
aware of the ongoing NSBDP, citing improved health among their pre-school age children. In 18
FGDs, majority of the participants reported that the deworming exercise was very important and
accepted by most of the community members. Regarding suggestions for improvement of the
NSBDP, a majority in 18 FGDs reported that there was need to inform them before treating their
children to prevent misconception about the drugs. Other suggestions given included, testing of
the children to be done prior treatment and more research to be conducted on the drugs.
Conclusions: Our results show that the deworming of pre-school age children is accepted as an
important exercise by the community members. Adequate sensitization is needed to avoid
rumours and suspicions about the drugs.
NTD11 –C8 Title: Assessing knowledge, sources of information and health-seeking behaviour for
schistosomiasis control by primary school health teachers in Seme sub-county, Western
Kenya
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Awino Emmy Kavere1, Diana Karanja1, Collins Ouma2, Rosebella Onyango2, Brian Ogembo1,
Evan Secor3
1,Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical
Research Institute, P.O. Box 1578-40100, Kisumu, Kenya; 2-School of Public Health and
Community Development, Maseno University; P.O Box Private Bag, Maseno-Kenya, 3-Centers
for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
Introduction: Health education is a key element in schistosomiasis control. Health teachers
implement regular deworming for schistosomiasis control for school age children, however their
knowledge of health education for schistosomiasis control will improve reduction in
schistosomiasis infection. This study assessed health teachers’ knowledge, sources of
information and health-seeking behaviour for the control of schistosomiasis Seme Sub County
in Western Kenya.
Methods: A descriptive cross-sectional design was used where both qualitative and quantitative
approaches were employed. Saturated sampling was used for participants’ selection and data
collected by use of exploratory survey and focus group discussions. Qualitative data was
analysed by Atlas ti through thematic decomposition while quantitative analysis was done using
Chi-square and logistic regression. Statistical significance was tested at P≤0.05.
Results: knowledge results demonstrated that 117 (56.80%) did not know correct signs and
symptoms of schistosomiasis while 169 (82.04%) did not know mode of transmission. 87
(42.23%) of the participants obtained information on bilharzia from the print/media, 61 (29.61%)
from professionals during trainings or seminars and 58 (28.16%) from awareness meetings done
by chiefs or other agencies. Those obtaining information from the media had a 99.7% likelihood
of seeking healthcare relative to those who obtained the information from professionals (OR,
3.2177, 95% CI, 1.4878-6.9592, P=0.003).Findings for associations revealed that participants
knowledge of signs and symptoms and mode of transmission was insufficient for health-seeking
behaviour (OR, 0.6592, 95% CI, 0.2652-1.6235, P=0.362) and (OR, 0.4853, 95% CI, 0.1581-
1.4898, P=0.206 Findings from qualitative analyses supported these trends and further revealed
that schistosomiasis was not perceived as a life threatening condition.
Conclusion: Results demonstrate that despite implementing MDA in schools the teachers’
knowledge for schistosomiasis control needs to be strengthened; print and media play a big role
in information despite preferences for health professionals. There’s need for MDA providers and
other schistosomiasis agencies to review training content and help provide basis of health
education on schistosomiasis if control and elimination is to be achieved.
NTD11–C9 Knowledge, attitude and practice regarding common zoonotic diseases among healthcare
workers in Nyagatare District
Christophe Ngendahayo – University of Rwanda
Background: Many factors have been mentioned as contributing to under diagnosis and under
reporting of zoonotic diseases particularly in sub Saharan African region and some are NTDs.
Nyagatare district is the district with the highest number of domestic and wild animals in the
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country, the presence of Akagera National Park, and it shares boarders with countries like
Tanzania and Uganda where other zoonotic transmissions have been reported. This study
investigated the knowledge and attitudes of health care workers regarding common zoonotic
diseases as a potential contributing factor to their under diagnosis and hence under reporting.
Method: A total of 156 health care workers in Nyagatare district were included in this cross
sectional study. A questionnaire was administered among health care workers and their responses
coded, scored and analyzed with SPSS version 21.
Results: A hundred and fifty (96.15%) respondents had poor knowledge regarding zoonoses,
five respondents had fair knowledge and only one respondent had an excellent knowledge on
zoonosis. The mean knowledge score were 9.4 ± 7 SD from 59 score. About 95 % of the
respondents had positive attitude towards zoonosis, whereas 4.5% of the respondents had the
negative attitudes. The mean attitude score was 34 ± 6 SD from 44 scores. There was no
statistically significant association between either knowledge or attitude and demographic
characteristics of the respondents (P values >0.05).
Conclusions: According to the results, health care practitioners in Nyagatare district showed
poor knowledge regarding zoonotic disease. Most of the respondents were not able to name
zoonotic diseases, their causative agents, and their mode of transmission though most of the
respondents in this study showed the right attitude towards zoonoses. Ministry of health should
provide refresher programmes on zoonoses among health care workers and teaching curricular
of health sciences in universities should put more emphasis on zoonoses.
NTD11 –C10 Factors affecting perceived stigma in leprosy affected persons in Eastern Nepal
Authors: Khadgi A1*, Agrawa S2, Uprety S1, Bhattarai S1, Yadav KD1 1School of Public Health and Community Medicine, BPKIHS 2Department of Dermatology and Venereology, BPKIHS
Affiliation: School of Public Health and Community Medicine
*Correspondence address: Dr. Amit Khadgi, Junior Resident, School of Public Health and
Community Medicine, [email protected]
Background: There are various factors which construct the perception of stigma in leprosy
affected persons. The main purpose of this study was to determine the level of perceived stigma
and the risk factors contributing to it among leprosy affected person in Eastern Nepal.
Objective: To assess the levels of perceived stigma in leprosy affected person.
Materials & Methods: A cross-sectional study was conducted among 120 people affected by
leprosy from Jhapa, Morang, and Sunsari. Participants were interviewed using a set of
questionnaire form Explanatory Model Interview Catalogue (EMIC) stigma scale developed by
the International Federation of Anti-Leprosy Association (ILEP) to assess level of perceived
stigma.
Results: Among 120 leprosy affected persons, the median score of perceived stigma was 23
while it ranged from 3–42. Higher perceived stigma score was found in participants residence in
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Morang (p=0.002), participants from Dalit ethnic group (p = o.oo1), illiterate ( p = 0.001), who
were manual workers (p = 0.049), who had MB leprosy ( p= 0.011), who had disability onset of
more than 2 years (0.021), who had grade II impairment grading ( p= <0.001), who were release
from treatments ( p = <0.001), and who got vocational training ( p = 0.001).
Conclusion: Higher perceived stigma score was mainly found in participants from Dalit ethnic
group, illiterate, manual workers, disability onset of more than 2 years. So there is an urgent need
of stigma reduction strategies focused on health education and health awareness programs in
addition to the necessary rehabilitation support.
NTD11-C11 Capturing the impact of structural inequities on the prevalence and experience of Neglected
Tropical Diseases (NTDs) and how this affects health and wellbeing in sub-Saharan Africa
(SSA) - A case study of Kenya
Elizabeth A. Ochola1 and Susan J. Elliott1
Department of Geography and Environmental Management
University of Waterloo
200 University Avenue west,Waterloo,Ontario
N2L3G1
Over the past decade, the study of Neglected Tropical Diseases (NTDs) has attracted much
attention in the local and global arena. NTDs are a diverse group of communicable diseases and
conditions with distinct characteristics that affect the poorest populations. These diseases affect
more than 1.4 billion people and cost developing economies billions of dollars annually in lost
revenue. The association between poverty and NTD infection seems to be well documented.
However, it remains unclear how structural inequities contribute to the prevalence and experience
of NTDs within the broader context of health and wellbeing. The purpose of this research is to
investigate the structural inequities that exist in Low to Middle-Income Countries (LIMCs) of
Sub-Saharan Africa (SSA), with Kenya as a case study. Additionally, the research will make use
of a capability approach using political ecology of health theory to explore how political,
economic, social, and cultural factors shape access to resources in vulnerable populations living
in NTD endemic regions of SSA. Furthermore, the research will use a mixed method approach
(quantitative and qualitative) to find the link between NTDs health and wellbeing. The results of
the study will advise policy makers on how best governments can achieve equity in systems for
improved health and wellbeing of populations and further inform the development of a Global
Index of Wellbeing (GLOWING) currently under development.
SCIENTIFIC SESSION D: OPERATIONAL RESEARCH AND CONTROL
PROGRAMS
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NTD11-D1 Factors associated with unsuccessful treatment outcome of leprosy patients in Kilifi
County-Kenya: A seven year retrospective study profile.
Geoffrey Katana1, Patrick Makazi1, Bob Opiyo2
1Department of Health, Kilifi County, P.O Box 9-80108, Kilifi, Kenya; 2Technical University of
Mombasa, P.O Box 90420-80100, Mombasa-Kenya
Contact Email: [email protected]
Introduction: Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae. The
disease mainly affects the skin, peripheral nerves, upper respiratory tract mucosa, and eyes.
Leprosy patients can be classified as paucibacillary (PB) or multibacillary (MB). Leprosy is
curable with multidrug therapy (MDT). World Health Organization branded leprosy as Neglected
Tropical Disease (NTD) to enable stakeholders focus on it. Efforts in reducing the burden have
been compromised by unsuccessful timely care and treatment. However, in Kilifi analytical
profile of existing data is lacking to inform evidence-based renewed commitment for the final
push for leprosy elimination at national and county level. The study aimed at describing the
factors of unsuccessful treatment outcome of leprosy in Kilifi County.
Methods: The study was a retrospective audit. Secondary leprosy data was extracted from the
National Leprosy Control Program database (TIBU). Included were all notified cases of leprosy
for the period of 2010 to 2017. Excluded were relapse, those resuming treatment and all those
transferred out to another health facility. Descriptive analysis and logistic regression was done
using R- Statistical package version 3.0.2.
Results: Of the 174 patients with PB/MB leprosy registered between March 2010 and May 2017,
PB comprised of 11% males and 10% females whereas MB were 91% males and 62% females.
Type of patient was not statistically significant (X-squared = 6.8601, p-value = 0.1435). Risk
factors associated with unsuccessful treatment outcomes were leprosy reaction (X-squared =
6.9676, p-value = 0.03069) and zone of treatment (X-squared = 19.953, p-value = 0.002823).
Conclusion: Unsuccessful leprosy treatment outcome is associated with the leprosy reaction and
the zone which the leprosy patient resides. Targeting high risk groups by initiating clusters among
sub county tuberculosis, Leprosy and Lung Disease coordinators and Community Health
Strategy approach will help early detection and referral.
NTD11-D2 Tungiasis Impairs the Quality of Life of Infected Children
Lynne Elson1, Susanne Wiese2, Billy Mwangemi3, Hermann Feldmeier2
1 WAJIMIDA Jigger Campaign, Dabaso Tujengane CBO, Box 323 Watamu, Kenya 2 Institute of Microbiology and Hygiene, University Medicine Berlin, Germany 3Malindi Sub-County, Community Health Department.
Background: Tungiasis (sand flea disease) is a neglected tropical skin disease caused by female
sand fleas (Tunga penetrans) embedded in the skin of the host. The disease is common in sub-
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Saharan Africa and predominantly affects children living in impoverished rural communities. In
these settings tungiasis is associated with important morbidity. Whether tungiasis impairs life
quality has never been studied.
Methods: The study was performed with 50 children with tungiasis age 5-14 years, in coastal
Kenya. Based on the Dermatology Life Quality Index (DLQI) a tool was developed to determine
life quality impairment associated with tungiasis in children, the tungiasis-related Dermatology
of Life Quality Index (tungiasis-related-DLQI). All parameters were assessed using visual
analogue scales ranging from 0-3 points. The intensity of infection and the acute and chronic
pathology of tungiasis were determined using standard methods.
Results: For the 50 enrolled children, 41% had more than 10 viable embedded fleas, with a
median of 53 embedded fleas, of which 7 were alive. Seventy eight percent of the patients
reported a moderate to very large effect of tungiasis on life quality at the time of the diagnosis.
The degree of impairment correlated with the number of viable sand fleas present in the skin (rho
= 0.64, p < 0.001), the severity score of acute clinical pathology (rho = 0.74, p < 0.001), and the
intensity of pain (rho = 0.82, p < 0.001). Disturbance of sleep and concentration difficulties were
the most frequent restriction categories (86% and 84%, respectively). Four weeks after curative
treatment, life quality had improved significantly. On the individual level the amelioration of life
quality correlated closely with the regression of clinical pathology (rho= 0.61, p < 0.001).
Conclusion: The parasitic skin disease tungiasis considerably impairs life quality in children in
rural Kenya. After effective treatment, life quality improves rapidly.
NTD11-D3 Getting towards Trachoma Elimination; Case of accelerated surgical outreach approach
among the pastoralists in Samburu County, Kenya.
Solomon Mwaniki1, Francis Dikir1, Chitiavi Juma1 & Philip Sinei2
1Amref Health Africa in Kenya, P.O Box 30125 – 0100, Nairobi.
1Ophthalmic Department, Ministry of Health, Samburu County, P.O Box 14, Maralal.
Background:
Trachoma is an infectious chronic eye disease caused by a Chlamydia Trachomatis which is
preventable, treatable and leads to irreversible blindness. Trachoma is the World’s leading cause
of preventable blindness globally with 8 million people with potentially blinding stage (TT) ,
84M cases with active Trachoma, 110M live in confirmed endemic areas and 230M people lives
in suspected regions. Africa is the most affected continent with over 80% of the global burden.
In Kenya, trachoma is the 2nd leading cause of avoidable blindness after cataract accounting for
19% of the blind and about 7 million live in endemic Counties. According to a baseline survey,
Samburu was 35% and 6% for TF and TT prevalence against the WHO threshold of less than 5%
and less than 0.2% on adults for elimination respectively.
Approach:
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Trachoma is managed using the WHO recommended strategy called SAFE. Accelerated surgical
outreach approach is a remodeled strategy adopted to mitigate and address the myriad of gaps
identified during the routine surgical outreach process in Samburu County. The main gap was
getting the set surgical target towards TT backlog clearance. It involves participatory planning,
intensive and diversified mobilization, strategic mapping on screening routes and potential TT
patients’ hotspots, caravan systematic style of household screening to harvest trachomatous
trichiasis cases for surgery. The cases are onsite counselled and transported to the nearest selected
strategic health facility for surgery. The approach is intertwined and integrated with cataract and
other ocular mobility to holistically address all eye illnesses ensuring increased TT surgical
uptake and client satisfaction. Subsequent post operation patients follow up are conducted to
ensure any complication is addressed, counter romours and attitudes.
Rationale:
Prior to the buy-in and adoption of accelerated outreach model, routine outreaches were
commonly used and the cases presenting themselves for surgery at the static facilities became
fewer and fewer hence the set targets and objectives could not be met. Due to the diminishing
number of presenting TT patients, Amref Health Africa and MoH partners coined and adopted
an alternative effective accelerated strategy that could reach out to the vulnerable pastoral
community members who were previously not able to benefit from surgical services with an aim
of increasing surgical uptake, TT backlog clearance to achieve the ultimate intervention goal.
Innovations and creativity:
The approach utilizes the existing pastoralist’s community structures and decision making
processes providing an excellent opportunity to address trachoma and other health issues at the
community level. Identify and use key champions, role models as positive deviants in trachoma
treatment and operations for counselling hence increasing the surgical uptake.
Achievement and benefits:
Improved surgical uptake leading to impressive TT backlog clearance progress as a result of
continuous direct bounding and engagement with the patients during awareness creation,
counselling, surgery and follow ups. Holistic, integrated and quality eye care service provision
have been realized using the approach. Other endemic Counties who are trending towards
trachoma elimination status in Kenya are fast buying-in and adopting the accelerated model.
Lessons learnt:
Domesticated accelerated integrated approach is effective and rewarding especially in a
pastoralist community settings. Tapping into the existing community structures for integrated
interventions coupled with community participation is critical for sustainability, ownership and
significant improvements in trachoma elimination.
Challenges:
The model involves intensive and vigorous undertakings and is expensive that requires more
technical and support human and logistical resource base.
Next steps:
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Need for upscaling and replication of this tailor made effective innovation to all other trachoma
endemic Counties in Kenya and beyond.
NTD11-D4 Piloting Optimize NTD solution for real time surveillance and prevalence mapping of
Lymphatic Filariasis at community and household level in Kenya
Author(s) Justus Ogando
1Clara Nyukuri, 1Frankline Keter
Affiliations 1Spectrum Strategic Consulting Ltd, P. O. Box 15810 - 00509, Nairobi, Kenya.
Justus Ogando. Email: [email protected]
Introduction / Background
Current methods of tracking Lymphatic Filariasis (LF) cases is not integrated, is complicated,
costly, time consuming and prone to human error e.g. calls, SMS, paper. Multiple data
aggregations between subcounties and national level are manually, often lasting >3 months.
Yet data on LF is not captured on DHIS2.
OptimizeNTD is a mobile App for real-time data collection on LF at household level. Its backend
analyses, validates and presents aggregated (anonymized) and disaggregated data on dashboard.
It is modular to securely interface and transmit data into DHIS2.OptimizeNTD is intuitive for
intensified disease management, continuous surveillance and mapping of disease at community
level to ensure early detection, linkage to treatment, and breaking barriers to poor care-seeking
behavior among infected and affected (e.g. illiteracy, stigma, ignorance, lack of awareness).
It is a better data-capture and transmission solution to overcoming data flow challenges between
LastMile (Community) and National level (DHIS2 and MOH).
Methods
OptimizeNTD is built on open-source database. We setup a modest LF surveillance pilot in 2
peri-urban Sub-counties. With the help of a Community Health Worker affiliated to a partner
NGO, we tracked down suspects with visible epidemiological-linked LF symptoms. Patient and
household data was captured on the App. The backend is built with data indicators to aggregate
data and generate reports.
Results
As infections occur in real-time, OptimizeNTD enhances continuous collection of quality
and credible household and case data, leading to early detection, risk assessment and triage of
outbreaks for quick action. OptimizeNTD uses programmed set of indicators to aggregate data
with flexible forms of reports.
Conclusion
OptimizeNTD is customizable and expandable for detailed data-capture, aggregated into
visual reports for easy tracking of outbreak patterns. OptimizeNTD pilot demonstrated ease
and convenience of collecting household (patient) data continuously, and its aggregation and
integration into national and international database.
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NTD11-D5 Characteristics of visceral leishmaniasis patients attending Namouruputh dispensary Jan
2015 – Sep 2017
Getrude Nasike1, Davis Wachira2 1Lodwar County and Referral Hospital,
P.O. BOX 18,
Lodwar. 2Neglected Tropical Diseases Unit – Kenya,
P.O. BOX 20250 - KNH
Nairobi.
Background: Visceral Leishmaniasis (VL) is one of the Neglected Tropical Diseases caused by
the sand flies of genera Phlebotomus, causing morbidity and mortality mainly to the poor
population. In Kenya an estimated 5 million people are at risk of infection and is endemic in arid
and semi-arid regions. Turkana County is one of the prevalent areas with Loima sub-county,
where the study was done, having highest prevalence. We investigated to determine the
characteristics of patients presenting with visceral leishmaniasis at Namouruputh dispensary.
Method: We retrospectively reviewed data of patients testing positive for visceral leishmaniasis
between January 2015 and September 2017. Data was abstracted from out-patient and laboratory
registers and information on age, gender, residence, treatment regimen, length of treatment, and
relapse cases were abstracted. Data was managed and analyzed on MS-Excel. We calculated
descriptive statistics for continuous and categorical variables.
Results: A total of 159 participants were included in the study. The median age was 11(IQR =
13) years; males were most affected at 66%. The most affected age group was <11 years (47.5%).
Majority, 95% were on pentostam only while the 5% were recently started on pentostam and
paramomycin combination. Relapse cases were 3 (1.6%). The areas (Urum, Kalelekol,
Lokwatubwa, and Puch) which recorded high number of cases were among the most rural areas
of Loima sub-county.
Conclusion and recommendation: The most affected population were males and the age group
< 11 years. Majority were from Urum, Kalelekol, Lokwatubwa, and Puch villages. This could be
attributed to homestead being located near anthills, the breeding sites of sand flies and their
pastoralist lifestyle. Also majority of patients from these villages were not aware about the
disease and engage in traditional practices (cutting skin with sharp blade and putting dung) which
would worsen the situation and that’s when they resolve to visit a health facility. We recommend
community awareness creation on various ways that may be used to control and prevent sandflies
we also recommend a qualitative study that will assess the factors associated with the
transmission of this disease within this set up.
NTD11-D6 Safety efficacy and acceptability of praziquantel in the treatment of Schistosoma
haematobium in pre-school children of Kwale County, Kenya
Kimani B.W, 1, 4* Mbugua A.4, Kihara J.H, 2, 3 Ng’ang’a P, M³, Njomo D.W²
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1. Centre for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI)
2. Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC),
Kenya Medical Research Institute (KEMRI)
3. Division of Vector Borne Diseases & Neglected Tropical Diseases (DVBD-NTD), Ministry
of Health
4. Jomo Kenyatta University of Agriculture and Technology (JKUAT)
Corresponding author: Bridget W. Kimani Centre for Microbiology Research (CMR), Kenya
Medical Research Institute (KEMRI) P.O. Box 54840-00200 Nairobi, Kenya. E-mail
Background
The recommended strategy to control Schistosomiasis is preventive chemotherapy. Pre-school
aged children are excluded from population treatment programs. In high endemic areas, these
children are also at risk, and require treatment with praziquantel (PZQ).
Objectives
This study investigated the safety, efficacy and acceptability of praziquantel for the treatment of
S. haematobium infection among pre-school age children aged ≤6 years. The burden of urinary
schistosomiasis was also investigated
Materials & Methods
400 pre-school aged children form Kwale County, Kenya were enrolled. The children were
weighed and treated with praziquantel tablets at a single dose of 40 mg/kg body. Adverse events
were assessed 1 hour and 24 hours via in-depth interviews administered to the teachers and
community health extension workers and questionnaires administered to the parents or guardians.
Efficacy of treatment was assessed 5 weeks post-treatment by examining urine samples for
Schistosoma haematobium eggs. Acceptability was determined by the number of children who
spat or vomited during drug administration
Results
Among pre-school children aged ≤6 years, the burden of urinary Schistosomiasis was (20%).
Before treatment, 41 of the 80 children (48.8%) who were infected with S. haematobium had
heavy intensity (≥50 eggs/10 ml urine), 39 children had light intensity (1–49 eggs/10 ml urine).
After treatment with praziquantel, ten children were found to have an infection of light intensity
(1–49 eggs/10 ml urine). Reduction in the intensities of infection was significant even when
analysis was stratified by sex and age. Overall pre-treatment and post-treatment prevalence of S.
haematobium infections was 20.0% (95% confidence interval (CI) 16.4% - 24.2%) and 2.8%
(95% CI 1.5% - 4.9%) respectively. Prevalence was higher in boys 22.9% (95% CI 17.7%-
29.2%) when compared to girls 16.9 %( 95% CI 12.3%-22.8%). Significantly higher cure rates
were observed in girls when compared with boys (92.6% versus 78.1% respectively, p=0.009).
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Egg count decreased considerably with post treatment geometric mean egg reductions ranging
from 45.9 (95% CI: 31.0 - 68.0) eggs/ 10 ml urine to1.4 (95% CI: 1.1 - 1.7) eggs/ 10 ml urine at
5 weeks. Acceptability of Praziquantel treatment was high with no child spitting or vomiting.
Drug related adverse events were few during follow up 1 and 24 hours and included nausea,
dizziness, abdominal pains, itching, vomiting and headaches.
Discussion
The burden of Schistosoma haematobium among pre-school age children is high. Without early
treatment, this often leads to serious health consequences including nutritional deficiencies.
Conclusion & Recommendation
Pre-school children represent a high risk group for Schistosomiasis and should be included in
population treatment programs.
NTD11-D7 Partnership between Contract Research Organization and Investigator sites to optimize
Neglected Tropical Diseases Clinical trials efficiency and Quality.
Nick Kisengese and Mutinda Mumu
ClinWin Research Services
Nairobi
Background
Africa populations live in areas at risk of acquiring Neglected Tropical Diseases (NTDs), as
result poor health infrastructure, unskilled personnel and political instability. The pharma
industry investment in NTDs research is declining year by year as result of the rising cost of
health technologies development and return on investment. The policy makers have advocated
for affordable, safe and effective health technologies to reduce the burden of NTDs. Clinical
trials provide an opportunity for the access to new and improved health technologies to
populations living in resource poor countries. Clinical trials must comply with international
regulatory, safety and quality standards. Partnership with Local Contract Research
Organizations (LCRO) offer cost efficient and effective solutions, human resource capacity and
experience, ethical and regulatory expertise to new and existing investigator sites.
Methods and Results
We report on LCRO partnership with investigator sites in Kenya. ClinWin Research Services is
LCRO that provides clinical development services and strategic consulting. It has partnered
with investigator sites conducting sponsored and Investigator initiated NTD clinical trials to
provide outsourced clinical research services, including: training, trials monitoring, quality
assurance, ethical and regulatory expertise; contracts negotiations and trials coordination.
Leveraging on its indigenous knowledge of the clinical trials landscape in the region, , linking
sponsors with potential sites, cultural orientation; and delivery of the assigned clinical trials on
time, quality and cost.
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Conclusion:
Efficient and quality clinical trials are not only cost effective but reduces time to registration
and deployment of essential health technologies for NTDs. Leveraging on LCRO capacity
enables the in experience and experience investigator sites to participate in NTDs clinical trials,
at cost, time and quality. Africa is attractive for industry sponsored trials for NTDs. The lessons
learned in each project should be documented and shared with investigator staff at current and
new sites.
NTD11-D8 Community-based Control of Tungiasis
Sammy Baya1, Jackson Mwamure1 and Lynne Elson1
1WAJIMIDA Jigger Campaign, Dabaso Tujengane CBO, Kilifi County
Background: Tungiasis is caused by the female sand flea Tunga penetrans which embeds in the
skin of the feet and causes immense pain and suffering in millions of children across Kenya. In
2014, there were no efforts to control the disease. In their desperation, Community Health
Volunteers (CHV) in Dabaso sub-location of Kilifi County sought to control the menace
themselves. This is not the report of a research study, but a unique, successful, community-led,
disease-control effort.
Methods: The group used a multipronged approach incorporating a neem-based oil to kill
embedded fleas. Prevention included education on personal hygiene; household waste
management and sanitation; wearing of closed shoes; keeping animals away from houses and
resting areas; and spraying floors with an aqueous neem solution prepared from neem leaves.
The group also distributed TOMS shoes to every school child in the area twice a year. The group
focussed on 4 sub-locations: Dabaso, Jimba, Mida and Mijomboni and involved a total of 30
CHV. The impact was monitored through foot surveys during shoe distribution.
Results: Most shoe distribution and screening was done in May–July and again in September–
November. Between 5,934 and 9,991 students were screened and received shoes at these times.
Peak transmission is during the hot and dry season of December-March. When screening first
started in January/February 2015, the prevalence of infection (at least one embedded flea) was
17.6%. This gradually declined over time to less than 1% in January/February 2017. Severe
disease with more than 10 embedded fleas, appears to have been eliminated completely, declining
from 2% to 0% in May/June 2016 and remaining at 0% to Jan/Feb 2017.
Conclusion Tungiasis can be easily controlled through a sustained, comprehensive strategy of
prevention and treatment, managed at the community level.
NTD11-D9 Hydatid disease situation in Waso East, Samburu East Sub-County
Mr. Tarcisio Nakuo Bsc. Environmental Health.
Sub - County Public Health Officer.
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SAMBURU EAST SUB - COUNTY.
Introduction
The disease also known as dog tapeworm (Echinococcus granulosus) is prevalent in areas where
human is in close proximity and body contact with infected dogs. The dog is the definitive host
while other domestic animals such as sheep, goats, cattle and camel are intermediate host. Human
are proxy intermediate host or accidental host.
Objectives of study/research
The prevalence of the hydatid disease in Waso East sub – location of Samburu East sub-
county.
Hydatid disease burden among the population.
Study /research design
Carry out random sampling of seven (7) villages with population of between 700-1000 for
study/research investigation. Capacity building of Community own Resource Persons (CORPS)
on the cardinal signs of the disease and the lifecycle of the parasite. Mass screening for
identified/selected villages and intensified case search for households with dogs. Diagnosis and
referral of identified patients for further investigations through ultra sound, x-tray, CT scan and
MRI. Sample collection (30) from slaughter slabs and referral for confirmatory lab test using
molecular DNA genetic analysis. Sample collection (100) of dog feces collected from households
for analysis using ELISA antigen test. Duration of the study/research was 6 weeks (November,
December 2015). Study/research carried out in conjunction with Meru University of science &
technology and KEMRI.
Findings/results
1. The prevalence of Hydatid disease in the selected villages was 17%.
2. The number of patients positively identified with Hydatid disease was 25.
3. Presence of dog’s tapeworm in dog’s fecal matter was 62%.
Interventions carried out after study/research
Mass de-worming of entire population was carried out for the affected villages – subsequent 3
mon. Health education and promotion on hand washing after contact/handling dogs.
Condemnation and proper disposal of affected organs.
Recommendations to other stakeholders
Surgical removal of cysts in affected patient – Director of medical services (Samburu
County).
Regular de-worming of dogs – Veterinary department (Samburu County).
Conclusion
Hydatid disease is prevalent among the pastoral communities in Samburu East sub-county. It is
among the NTDs that contribute to disease burden in the population. More resources need to be
put in to address the situation.
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NTD11-D10 Combating Schistosomiasis: The critical role of community health volunteers in Migori
County
Tom Odhong 1, [email protected], peter Okello1, [email protected].
1 Ministry of Health, Department of community Health, Migori County Government.
Background.
Schistosomiasis is a neglected tropical disease caused by parasitic worms. Infection is through
contact with infected water during routine occupational and recreational activities,
Community education remains a vital and sustainable approach that can lead to future
elimination. Community Health volunteers (CHV) remains the engine of primary Health Care
and control of neglected communicable diseases at household level.is one of their roles
Methods:
In 2016, prevalence of Schistosomiasis disease in Nyatike Sub County was (3.2%). Suspected
cases were reported to the community health assistants and Public Health officers during
routine school health programs. Screening was conducted at house hold level and schools and
samples taken for laboratory examination revealed that 62% of the samples were confirmed
positive for Schistosoma haematobium and 30% Schistosoma mansoni. The health department in
partnership with World Vision Kenya (WVK), conducted mass treatment of the cases and trained
230 CHVs on Schistosomiasis prevention and control strategies. Key messages were developed
and disseminated through health talks conducted in households, Churches, Chief’s barazas,
health facilities, women groups, youth groups, funerals, schools and during market days to
influence behavior change
Additionally, community sensitization meetings were conducted in the two endemic wards and
mapping of fresh water sources infested with Schistosome parasites conducted. The community
health volunteers drew a roaster of consistent health talks at the water sources using the bill
boards which were erected by WVK to enhance information education and communication on
prevention and control measures.
Results:
The number of Schistosomiasis infected cases reduced from 395 in 2016 to 216 in 2017 thus 26%
decrease. Community awareness on schistosomiasis control was enhanced and sustainable
preventive and control strategies adopted.
Conclusion
Community health Volunteers are critical in achieving sustainable community based prevention
and control of neglected tropical diseases.
NTD11-D11 Secondary Bacterial Infections and Antibiotic Resistance among Tungiasis Patients in
Western, Kenya
Ruth Monyenye Nyangacha a,b, David Odongo b, Florence Oyieke b, Missiani Ochwotoc,
Richard Korire, Ronald Kiprotich Ngetiche, Gladys Nginyaa , Olipher Makwagad , Christine Bii e , Peter Mwitari a and Festus Tolo a.
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aCenter for Traditional Medicine and Drug Research , Kenya Medical Research Institute,
Nairobi, Kenya bSchool of Biological Sciences, University of Nairobi,Nairobi, Kenya c Production Department , Kenya Medical Research Institute, Nairobi, Kenya dCenter for Infectious and Parasitic Diseases Control Research , Kenya Medical Research
Institute, Nairobi, Kenya eCenter for Microbiology Research , Kenya Medical Research Institute, Nairobi, Kenya
Background
Tungiasis or jigger infestation is a parasitic disease caused by the female sand flea Tunga
penetrans. Secondary infection of the lesions caused by this flea is common in endemic
communities. This study sought to shed light on the bacterial pathogens causing secondary
infections in tungiasis lesions and their susceptibility profiles to commonly prescribed
antibiotics.
Methodology
Participants were recruited with the help of Community Health Workers. Swabs were taken from
lesions which showed signs of secondary infection. Identification of suspected bacteria colonies
was done by colony morphology, Gram staining, and biochemical tests. The Kirby Bauer disc
diffusion test was used to determine the drug susceptibility profiles.
Results
Out of 37 participants, from whom swabs were collected, specimen were positive in 29 and 8
had no growth. From these, 10 different strains of bacteria were isolated. Two were Gram positive
bacteria and they were, Staphylocccus epidermidis (38.3%) and Staphylococcus aureus (21.3%).
Eight were Gram negative namely Enterobacter cloacae (8.5%), Proteus species (8.5%),
Klebsiellla species (6.4%), Aeromonas sobria (4.3%), Citrobacter species (4.3%), Proteus
mirabillis(4.3%), Enterobacter amnigenus (2.1%) and Klebsiella pneumoniae (2.1%). The
methicillin resistant S. aureus (MRSA) isolated were also resistant to clindamycin, kanamycin,
erythromycin, nalidixic acid, trimethorprim sulfamethoxazole and tetracycline. All the Gram
negative and Gram positive bacteria isolates were sensitive to gentamicin and norfloxacin drugs.
Conculsions
Results from this study confirms the presence of resistant bacteria in tungiasis lesions hence
highlighting the significance of secondary infection of the lesions in endemic communties. This
therefore suggests that antimicrobial susceptibility testing may be considered to guide in
identification of appropriate antibiotics and treatment therapy among tungiasis patients.
NTD11-D12 Partnership towards elimination of trachoma in Baringo County
Sang, M. Abakalwa, G. Tallam, E.1.
1Department of Health Services, Baringo County Government, P.O Box 393-30400, Kabarnet
Introduction and situation
88
Trachoma is a leading cause of blindness in many parts of Kenya. It is endemic in 22 counties,
Baringo included. East pokot sub-county is greatly affected because the problem is more
pronounced among pastoralist communities. About 7000 people with Trachoma trichiasis are at
risk of becoming blind. Recurrent episodes of infection with Chlamydia trachomatis leads to
scarring of the eyelids which turn inwards and distort the eyelashes. This leads to disturbance of
the corneal surface, inflammation and eventually blindness. Flies (present where there is poor
hygiene) carry the organism from one person to another (Cook and Zumla, 2003).
Efforts
It is a great concern to the County that a large percentage of its population could become blind
and therefore become unproductive. That is why the County government has forged partnerships
in order to reduce the burden. It has partnered with The Queen Elizabeth Diamond Jubilee Trust
Fund and Fred Hollows Foundation to make concerted efforts to bring an end to this cause of
debilitating blindness. Efforts have included six rounds of mass drug administration (MDA) to
greatly reduce parasitemia and subsequent risk of transmission. The social mobilization and
publicity that surrounds the MDAs has helped the community become more aware that the
condition is treatable and preventable.
Other interventions include regular planned outreaches to target people who would otherwise not
be reached. So far over 50,000 people have benefitted from the arrangement.
Plans and conclusion
Due to the large number of people still needing the services, the County government is committed
to increasing its capacity to offer eye health services. Currently five health workers are
undergoing training. This kind of teamwork between the community, the County government
and development partners has helped bring hope to many. It is believed that such combined
efforts will bring an end to Trachoma.
NTD11-D13 Treatment Compliance: Impact of Missed Mass Drug Administration on Filarial Infection
in Malindi District, Kenya
Mercy Mkandawire
Background
The Global Program to Eliminate Lymphatic Filariasis depends on mass drug administration
(MDA) of antifilarial and antihelminthic drugs to interrupt transmission of the disease. In Kenya,
MDA was initiated in 2002 and parasitologic surveys were conducted in eight sentinel villages
in Malindi District. MDA was not administered in 2004, 2006 and 2007 due to financial
constraints. This study determined the impact of staggered annual treatments, on the overall mf
and CFA prevalence trends in a population that has missed three rounds of MDAs and what
impact the staggering of regular rounds of MDA had on the overall success of interrupting
transmission.
89
Methods
Analysis of Variance (ANOVA) and Kruskal-Wallis tests were used to determine quantitative
differences in more than two groups. The McNemars and Wilcoxon signed ranks test were used
to test for change using paired data collection before and after the MDA at (α=0.05). Prevalence
rates were compared using a chi-square test.
Results
Filarial antigen prevalence’s ranged from 34.4% in 2002 to 11.4% in 2009 respectively, while
the microfilaria (mf) prevalence’s ranged from 20.9% in 2002 to 0.9% in 2009. After four rounds
of MDA in 2009 the number of mf positive individuals, 10 compared to the 297 in 2002, was
statistically significant (P < 0.001). The mean value for the mf count had decreased from a mean
of 43.6 in 2002 to 0.1 in 2009.
Conclusions
The prevalence reductions may be attributed to several things: 1) MDA treatment; 2) The use of
integrated vector management; 3) Reduced parasite intensities; or 4) Environmental factors
affecting vector breeding. Even with the reduced microfilaremia and antigenemia levels, it will
be imperative that surveillance and comprehensive monitoring to evaluate the program end-
points. As the mf and CFA levels further decline, more W. bancrofti sensitive specific tests
molecular xenomonitoring.
NTD11-D14 WESTERN PROVINCE EXTERNAL QUALITY ASSESSMENT (WEPEQAS)
THE GAINS AND LESSONS [NEGLECTED TROPICAL DISEASES] IN KAKAMEGA Rajula Paul – P. O. Box 15-50100 Kakamega, Kenya
Co-Author: Francis Wesiela- P.O. Box 359-50200, Kakamega
Introduction
Neglected tropical diseases are a problem in Kakamega county. Soil transmitted helminthes
(STH) account for 20% of infections in children of school going age in the county. The diagnosis
and treatment of the soil transmitted helminthes has been there for five years. However quality
assessment of the programme has been lacking. The Western Province Quality Assessment
Scheme (WEPEQAS) was started by Government Laboratory Health Workers in January 2009
with APHIA II in western province of Kenya. After several meetings between the GOK lab health
workers and APHIA II the roll-out meeting was held in June 2009. This was successfully done
with the attendance of 18 level 3 &4 hospital laboratory staffs from the province.
Objective
In assessment of the gains and lessons learnt in the control of Neglected Tropical Diseases,
“External Quality Assessments (EQAs) should be the pillar of laboratory compliance with
International Health Regulation IHR (2005) to help international community to trust or not to
trust a laboratory result.” The tests that were included STH, CD4, HIV,HB,, and malaria , this
incudes 20 laboratories in Kakamega for 2 monthly periods
90
Method
Kakamega PGH, which was enrolled in UKNEQAS would cascade the beneficial effect of
participating in an EQA to the 13(non-EQA enrolled) labs through CDC mentoring. The first
fresh blood split samples were successfully sent out on the 15th of August 2009. The fresh split
sample panels were prepared in Kakamega PGH with Busia DH, packed and sent to the 13 labs.
Since then 32 panels have been sent to the 21 participating labs.
Conclusion:
This saw a great improvement from 30% to 70% of the labs scoring within 1 SD.
NTD11-D15 From Mud and Stick-walled Houses to Corrugated Iron sheet Houses: A New Strategy for
Preventing Human-Vector Contact in Marigat Sub-County; a Leishmaniasis-endemic Area
in Kenya
Martha W. Kiarie1, Anastasia M. Nzau2, Philip M. Ngumbi3, Abraham Waithima1, Michael K.
Bowen1, Johnstone M. Ingonga3
1Department of Science and Health, Daystar University, Nairobi, Kenya, 2Department of
Technical and Applied Biology, Technical University of Kenya, Nairobi, Kenya, 3Centre for
Biotechnology, Research and Development, Leishmaniasis Laboratory, Kenya Medical Research
Institute, Nairobi, Kenya.
Introduction
The objective of this study was to assess if improved housing would result in reduced sand fly-
human contact which in turn would be assumed to result in reduced chances of leishmaniasis
transmission. The transmission of leishmaniasis is heavily influenced by socio-economic factors
and this is the main reason why it has been described as the disease of the poor.
Methods
This studied compared the sand flies densities in targeted houses before and after improvement.
The houses to be improved were selected based on indoor sand fly density, construction materials
and economic status of the household. These houses were upgraded in to two-roomed corrugated
iron sheet houses. Sand fly densities were determined using CDC light traps in the mud and stick-
walled grass-thatched houses before moving the occupants to houses made of corrugated iron
sheets. 146 houses were used, selected from 670 in the 4 villages.
Results
There were significant differences (< 0.05) in sand fly densities between the mud, stick-walled
houses and the corrugated iron sheet houses; the improved houses had fewer sand flies. The
average density of sand flies in stick-walled houses ranged from 32 to 13 compared to 4 to 1 in
corrugated iron sheet houses.
Conclusion
91
The improved housing reduces the density of sand flies indoors; in turn reducing the vector–
human contact hence reducing the chances of infective bites. This strategy is long lasting and has
additional benefits residents.
NTD11-D16 ONCE BITTEN, TWICE SCRATCHED: VICIOUS SANDFLY IN TURKANA
COUNTY
James Marcomic Maragia1 1Lodwar County and Referral Hospital (LCRH), Turkana County, P. O Box 18-30500, Lodwar-
Kenya.
Background
Turkana county has been at the forefront in championing the elimination of Leishmaniasis.
The infection is one of the twenty World Health Organization (WHO) Neglected Tropical
Diseases (NTD) which is transmitted by the bites of infected female sandflies that belong to
the Phlebotomus and Lutzomyia genera in the Old and the New World respectively. WHO
estimates 700 000–1 million new cases and 20 000 to 30 000 deaths occur annually. The
disease is largely associated to afflict the poor populations. The aim of this paper is to share
the Leishmaniasis information that has been generated in LCRH laboratory.
Method
The data was collated from January 2017 to July 2017 retrospectively from the Kala-azar
registers. The data was analyzed based on age group, sex and positivity rate. K39 BIO-RAD
test kit was used to test the patients, the laboratory did not carry out the confirmatory test.
Results
For a period of seven months, a total of 76 suspected cases were sent to the laboratory for
testing of whom 56.6% (43) and 43.4% (33) were male and female respectively. 27.6 % (21)
of the suspected cases were positive where 19.7% men turned positive while female
contributed positivity rate of 7.9%. Alarmingly, the children under the age of 15 years were
the most afflicted recording a positivity rate of 17.1%, however, the male were the most hit
by the sandfly recording a positivity rate of 13.2%. This could be contributed to herding habits
in a scourging sun forcing the boys to sleep under the anti-hills conducive habitat for the
sandflies. The age group between 16-30 years and above 31 years recorded a positivity rate
of 7.9% and 2.6 % respectively.
Conclusion
The result vividly indicates that children under 15 years are the most affected. It is also crystal
clear that the boy child is the most hit by this vicious sandfly. Interventions in form of disease
prevention and health promotion should be targeted in this naïve age group to avert further
incidences.
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NTD11-D17 STRONGYLOIDES STERCOLARIS HYPERINFECTION WITH PNEUMONIA IN AN (ISS)
PATIENT ON HAART AT CG H kakamega IN 2015:
1) George Ojango ( CMLT -Kakamega CGH) P.O. Box 15-50100,Kakamega
2) James Sakwa (SMLS - MMUST) P. O. Box 150-50100,Kakamega
Introduction
Occurrence of Strongyloides stercolaris larvae in sputum is rare and uncommon in clinical
practice. Their presence is considered a medical emergency. To refresh health care providers on
the possibility of miss diagnosis and miss management of patients with this neglected tropical
disease’ that mimics bronchial asthma or pneumonia during migratory phase of the larvae
through the respiratory tree that presents with cough and pneumonitis.
Methodology
Sputum specimen of a 56 year old, hospitalised man on HAART was presented in the laboratory
with provisional diagnosis of Pneumonia rule out Pulmonary Tuberculosis (AFB).The specimen
was undertaken through standard Pre , analytical and post analytical phases by the use of
WHO/IUATLD approved SOP of Flourouresnce staining/ Microscopy (FM) by experienced
medical laboratory technologist.
Results
Well fluorescing single, interwoven and buddle straight, coiled and bent larvae’s of S. stercolaris
in a blue stained background were demonstrated under dry objective(X40). Confirmation of
the parasitic diagnosis was followed by running a wet microscopically specimen from the original
sputum sample and stool specimen from the same patient to compare both intestinal and sputum
findings. On microscopy there was results correlation that demonstrated numerous highly motile
larvae of the same
Conclusion
The patient was both infested (intestinal) and infected (tissue) with S. stercolaris. The larvae
hyper infection was the cause of the symptoms (Lofflers syndrome) but not tuberculosis
Recommendation
Strongyloidiasis need suspected and in every patient with cough especially ISS in known
endemic regions. Awareness exercises of HCW on Strongyloidiasis need to be considered in
management of PLWHIV.
NTD11-D18 Biosafety in vector borne laboratories
Francis Wesiela- P. O. Box 359-50200, Kakamega
Co-Author: Rajula Paul – P. O. Box 15-50100 Kakamega, Kenya
INTRODUCTION
93
Working with Vector borne diseases in the Laboratory
Vector-borne diseases are among the most complex of all infectious diseases to prevent and
control. Not only is it difficult to predict the habits of mosquitoes, ticks and fleas, but most vector-
borne viruses or bacteria infect animals as well as humans. West Nile virus (WNV), which is
primarily a disease of birds, is a good example.
Vector-borne diseases are major public health concern. Lyme disease causes over 300,000
estimated human illnesses annually in the U.S. Tick-borne rickettsia diseases, such as Rocky
Mountain spotted fever (RMSF), ehrlichiosis, and anaplasmosis, are responsible for over 4,000
U.S. cases each year, including some that result in death. Dengue fever causes millions of cases
worldwide, including thousands of cases in Puerto Rico each year. DVBD uses information about
the number of cases, and when and where they occur, to aid health departments and other partners
to reduce cases, save lives, reduce suffering, and reduce the financial impact to the public.
OBJECTIVE
DVBD research focuses on prevention and control strategies that can reach the targeted disease
or vector at multiple levels while being mindful of cost, acceptability, and the world’s ecology.
The implementation of the 6 pillars of laboratory biosafety measures should be applied.
METHOD
A supportive supervision was carried out in the DVBD lab in Kakamega, by use of structured
questionnaire. The questionnaire focused laboratory, ISO 15189 laboratory accreditation
checklist.
RESULTS AND RECOMMENDATIONS
It has been noted with concern that biosafety of laboratory testing of Vector been diseases is an
emerging challenge to the lab staff and the community in Kakamega county.
NTD11-D19 Accelerating control of visceral leishmaniasis in Turkana County, Kenya, through
improved access to diagnostics
Ebei S.E.1, Munai G. 1, Shamalla O. 1, Lomuria K. 1, Wachira D. 2, Bessell P.R., Magiri C., Cruz
I., Ndung’u J.M. 1Turkana County Ministry of Health, Lodwar, Turkana, Kenya. 2Kenya Ministry of Health,
Nairobi, Kenya. Kenyan Medical Research Institute, Nairobi, Kenya. Foundation for Innovative
new Diagnostics, Geneva, Switzerland
Introduction
More than five million people live at risk of contracting visceral leishmaniasis (VL) in Kenya,
which is ranked among the top 14 high burden countries for the disease. The World Health
Organization (WHO) has encouraged stakeholders to explore strategies to address VL in specific
foci in eastern Africa. Turkana County (TC) reports the highest number of cases in Kenya and,
due to the focal nature of the disease in this county, has been identified as one where elimination
could be achieved by implementation of appropriate strategies.
94
Aim: To accelerate control and eventual elimination of VL in Turkana County, Kenya by
improving access to diagnosis and treatment of the disease.
Methods
Between September and December 2016 FIND, in collaboration with the TC and Kenyan
Ministries of Health (MoH) and KEMRI, conducted training of medical officers and laboratory
technicians, and characterized all health facilities from three endemic sub-counties (Loima,
Turkana West and Turkana South).
Results
Sixty nine health facilities were characterized by collecting data on 108 variables for each of
them, including among others, their geolocation, population served, structural details, type and
number of staff, capacity for diagnosis and treatment of VL, as well as number of VL suspects
tested and confirmed. Maps were generated according to the type of facility and staffing capacity,
number and origin of VL suspects, capacity for VL diagnosis, etc. These maps were used to
identify facilities that are strategically located to give best access to villages that report cases.
These facilities were then equipped with RDTs or upgraded to perform microscopy, in order to
facilitate access to diagnosis. Efforts to improve awareness on availability of VL diagnosis
included production and distribution of information and sensitization materials in the health
facilities and to patients, as well as radio spots in Kiswahili and local languages.
Conclusion
The project has demonstrated how VL can be easily included in the diagnostic algorithms of
health facilities to improve access and contribute to efforts by WHO to control and eventually
eliminate the disease in eastern Africa. The project is being expanded to other endemic regions
in Kenya.
NTD11-D20 A post-intervention survey on prevalence of Soil-Transmitted Helminths infection among
primary school children in the Tiko Health District, Cameroon.
Egbe Sarah1, Esum M. Eyong1, Kenneth O. Juma2, Achidi E. Akum1
1 Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon; 2 Aga Khan University
Hospital, Nairobi, Kenya, P.O. Box 30270-00100, Nairobi, Kenya.
Background
Soil-transmitted helminths (STH) infection remains a public health problem in sub-Saharan
Africa with children being most vulnerable. STH infection may result in death, impairment or
permanent disability accompanied with lifelong physical pain and stigmatization. Annual mass
deworming with Mebendazole has been implemented in the Tiko Health District (THD) since
2008. However, no study has assessed the current prevalence of STH infection following eight
years of mass treatment. This study aimed to determine the prevalence and intensity of STH
infections, among school children aged 5-15years in THD.
Methods
Three months after the annual school based deworming exercise, 400 primary school children
were sampled from 10 randomly selected schools in THD. Stool samples were collected and
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parasitological analysis conducted using the Kato-katz technique. Data on socio-demographic
and behavioral factors were collected using questionnaires. Data was analyzed using SPSS
version 22, and intensity of infection categorized based on WHO recommendations. Descriptive
statistics involved generating proportions of categorical variables and cross tabulations.
Relationship between independent and dependent variables were assessed using chi-square test.
Results
The prevalence of STH was 1% (4/400) [95% CI = (0.02–1.98)]. Ascaris lumbricoides was the
only STH species detected and all cases were of low intensities. The arithmetic mean egg
intensity was 3.1egg per gram of faeces. Rates of infection were similar between gender and age.
Site of defecation showed an association with STH infection (p 0.03).
Conclusion
There was a low prevalence of STH infection which could be explained by the prior deworming
of children leading to reduction in infection intensities. Modification in environmental and
behavioral factors may also have contributed to the low prevalence of STH infections. Questions
on effectiveness of annual mass deworming targeting school children in achieving STH
elimination targets need to be investigated further.
NTD11-D21 Control of flea vectors of plague: Used engine oil as a proposed tool
Annabel Banda
Introduction
The aim of the study was to evaluate the efficacy of used engine oil in the control of rat fleas
which are vectors of plague.
Methods
The study was conducted in Mbare and Chitungwiza surbubs of Harare, Zimbabwe in 2013.
Farmers markets were used for comparison. Removal trapping was used to capture Rattus rattus,
from which fleas were collected and identified. Three flea species, Xenopsylla brasiliensis Jordan
and Rothchild, Dinopsyllus lypusus Jordan and Ctenophthalmus calceatus Waterson were
collected from captured rats.
Results
Both prevalence (proportion of animals infested) and specific flea index (SFI=number of fleas
per animal) were lower on rats captured in the oil-contaminated habitats compared to oil-free
habitats. The prevalence of X. brasiliensis was significantly (χ2=27.82, df=1, p<0.001) different
while the SFI varied from 0.4 t0 1.9 between the two habitat types. Similarly, the prevalence of
D. lypusus, was significantly (χ2=8.53, n=1, p<0.005) different between the two habitats and the
SFI varied from 0.1 to 0.6. There was no significant difference in prevalence of C. calceatus
across the two habitats.
Conclusion
The lower flea abundance observed in the oil contaminated habitat compared to the oil-free
habitat seems to suggest that oil had an insecticidal effect on rat fleas.
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NTD11-D22 Study on functional activity limitation of leprosy affected person in eastern Nepal
Khadgi A1*, Yadav DK1, Agrawal S2, Uprety S1, Bhattarai S1 1School of Public Health and Community Medicine, BPKIHS 2Department of Dermatology and Venereology, BPKIHS
School of Public Health and Community Medicine
*Correspondence address: Dr. Amit Khadgi, Junior Resident, School of Public Health and
Community Medicine, BPKIHS. Email: [email protected]
Background and objectives: Leprosy-related disability is a challenge to public health. Disability
includes activity limitation, impairment and participation restriction. We assessed the extent of
disability and its determinants among persons only with leprosy-related functional activity
limitations (FAL).The objective of the study was to determine the factors associated with leprosy
related functional disabilities
Materials & Methods: This cross-sectional study was done among leprosy affected persons in
Eastern Nepal, over the period of September 2015 to August 2016 using a Rapid Disability
Appraisal toolkit based on the International Classification of Functioning, Disability and Health
(IFD). The toolkit included the Screening of Activity Limitation and Safety Awareness (SALSA)
scale. Binary logistic regression was done to identify factors associated with activity limitation.
Results: Overall 120 persons with leprosy-related disability (PLD) were taken from Jhapa,
Morang, and Sunsari Districts. Seventy-eight percent of PLD had activity limitations. In bivariate
analysis middle age group participants, having lowered level of education, manual workers,
person with multi-Bacillary Leprosy and Participants release from treatment (RFT) were
associated with Activity limitation. While after adjusting all other variables in binary logistic
regression only Type of Leprosy was associated with activity limitation ( P = 0.001), multi-
Bacillary leprosy was about 7.8 times more likely to had activity limitation with compare to
Pauci-Bacillary OR 7.81 and CI (2.30 – 26.48).
Conclusion: The majority of the respondents were found to be problems in all components of
disability. They had functional activity limitations even after complete MDT, which justifies
need of awareness programs, empowerment of the leprosy affected persons by technical
education; vocational training and social participation.
NTD11-D23 Acute West –Nile Viraemia amongst Febrile Patients attending a Tertiary Hospital in
Abuja, Nigeria
Aina Kehinde 1,Olajide Agbede 1, Ashaka Sedowhe 1, Idris A.N1
1, Department of Medical Microbiology and Parasitology (Virology Unit) University of Ilorin.
Background
West Nile virus (WNV) has ubiquitous distribution in Africa. Clinical symptoms
of WNV fever often overlap with other agents of febrile illnesses. Over the years, the
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geographical range of WNV activity has increased and the virus has become established
even in non-endemic areas where it has not been previously detected.
Methods
This serological-survey investigated the prevalence of anti-WNV IgM among
patients with febrile illnesses at Gwagwalada metropolis, Abuja. Between the period of May
and August 2016, a total of 171 participants attending the University of Abuja Teaching
Hospital were recruited for the study. Serum samples were immediately harvested, stored
and analyzed using the indirect ELISA for anti-WNV IgM antibodies using kits endorsed by
The World Health Organization. Socio-demographic variables and clinical data was gotten
using a self-administered interviewer-based questionnaires.
Results
Out of the 171 febrile participants, the overall prevalence of WNV IgM antibodies
was 66.1%. Significant association was observed in prevalence of WNV IgM and
Malaria/WNV co-infection (p< 0.5). Sixty two (54.9%) of WNV seropositive females and
51/113 (45.1%) seropositive males was recorded. With regards to participants’ knowledge,
attitude and practice towards preventive measures against WNV, significant association was
observed between the WNV IgM seropositivity and the use of mosquito repellants (p
=0.016).
Conclusions
Findings from this study necessitate the need for routine diagnosis and
surveillance of WNV as possible agents of febrile illness in Nigeria. More so, infected
Patients should be closely monitored in order to detect possible associated sequelae.
NTD11-24 Raising Awareness in Kenya: Improving Occupational Performance in women with
Lymphedema
Abigail Lunzalu, OTD, OTR/L/CLT, Diana Aketch Lunzalu, RCO ACIM
Rocky Mountain University of Health Professionals
2601 Cinnamon park Circle Apt 523
Arlington, Texas, 76016
Introduction
There is a lack of awareness of comprehensive, complete decongestive therapy, an effective
evidence-based intervention for lymphedema, among health professionals and the community of
Kenya. Hence, there is a need to bridge the gap among health professionals and community
members with a lymphedema awareness campaign in Kenya.
Purpose and content of the presentation
Approach/ AOTA’s Centennial vision
The focus of this capstone project is to fulfil the AOTA’s centennial vision. “We occupational
therapy is a powerful, widely recognized, science driven, and evidence- based profession with a
globally connected and diverse work force meeting” (AOTA, 2007, P.613).
Practical implications
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Lymphedema leads to deficits in body image, poor quality of life, limitation in work and leisure
pursuits, and decreased participation in occupational performance (Pergolotti et al., 2016).
Occupational therapists use client-centered services, and evidence-based interventions
(complete decongestive therapy) to effectively manage lymphedema with clients impacted by
this condition with the aim of promoting functional performance, participation in occupations,
health, and well-being Pergolotti et al., 2016.
Conclusion
Occupational therapists can use the following marketing strategies to raise lymphedema
awareness in developing countries to increase the role of occupational therapists in promoting
quality of life in lymphedema clients: Print media and electronic media.
NTD11-D25 Kenya on the road to elimination of lymphatic filariasis as a public health problem
Sammy M. Njenga1, Henry M. Kanyi1, Cassian M. Mwatele1, Collins Okoyo1, Hadley S.
Matendechero2, Joseph O. Oloo2, Claire N. Wamae3, Joyce K. Onsongo4, Kimberly Y. Won5
1Kenya Medical Research Institute, Nairobi, Kenya, 2Ministry of Health, Nairobi, Kenya, 3Mount
Kenya University, Thika, Kenya, 4WHO Country office, Nairobi, Kenya, 5Centers for Disease
Control and Prevention, Atlanta, USA
Background: Lymphatic filariasis (LF) is a mosquito-borne parasitic disease associated with
painful and profoundly disfiguring clinical manifestations mainly affecting the limbs
(lymphoedema) and male genitalia (hydrocele). The World Health Organization (WHO)
launched the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000 with the
goal of interrupting transmission and alleviating suffering among the patients. In Kenya the LF
elimination programme was restarted in 2015, with the current survey conducted prior to mass
drug administration (MDA) campaign so as to provide an update on the status of LF infection.
Methods: A cross-sectional survey was conducted in October 2015 in ten LF sentinel sites
located across Lamu, Tana River, Kilifi, Kwale, and Taita Taveta counties. One hundred
microliters (100 µl) of finger stick blood was used to test for circulating filarial antigen (CFA)
using the immunochromatographic test (ICT) and those individuals who tested positive were
requested to provide a night-time blood sample for microfilariae (MF) examination. A
questionnaire was used to collect information on bed net use and deworming against soil-
transmitted helminths.
Results: The overall prevalence of filarial antigenaemia was 1.3% (95% CI: 0.9–1.8%). Ndau
Island in Lamu County had the highest prevalence (6.3%; 95% CI: 4.1–9.7%). Mean microfilarial
density was also higher in Ndau Island (234 MF/ml) compared to sentinel sites in Kwale and
Kilifi counties (< 25 MF/ml). No LF infection was detected in Tana River and Taita-Taveta
counties. Overall, more than 88% of the study participants reported to have used a bed net the
previous night.
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Conclusions: The ongoing annual MDA rounds are expected to result in elimination of the
disease in coastal Kenya. However, Islands in Lamu may require consideration for the recently
WHO-recommended triple drug therapy with ivermectin, diethylcarbamazine (DEC) and
albendazole to accelerate elimination of the disease. Transmission assessment surveys (TAS)
should be conducted in areas where there was no evidence of LF infection with a view of stopping
MDA.
SCIENTIFIC SESSION E: ZOONOSIS/ONE HEALTH
NTD11-E1 Echinococcus species in dogs from four regions of Kenya
Erastus Mulinge1, 3, Japhet Magambo2, David Odongo3, Sammy Njenga1, Eberhard Zeyhle2,
Cecilia Mbae1, Dorothy Kagendo2, Francis Addy4, Dennis Ebi4, Marion Wasserman4, Peter
Kern5, Thomas Romig4
1, 3 Kenya Medical Research Institute, P.O. Box 54840 00100 Nairobi, Kenya. 2 Meru University of Science and Technology, P.O. Box 927 60200 Meru, Kenya. 3 University of Nairobi, P.O. Box 30197 00100 Nairobi, Kenya 4 Parasitology Unit, University of Hohenheim, 70599 Stuttgart, Germany
5 Center for Internal Medicine, University Hospital, 89081 Ulm, Germany.
Background
Cystic echinococcosis (CE) is endemic both in livestock and humans in many parts of Kenya.
However, very little data exists on Echinococcus infection in dogs and therefore their role in
transmission and environmental contamination with Echinococcus spp. eggs is unknown. The
aim of this study was to establish the prevalence and distribution of Echinococcus granulosus
sensu lato causing infection in dogs in Kenya.
Methods
A total of 1,621 dog faecal samples were collected from the environment in four different regions
and examined microscopically for the presence of taeniid eggs. Up to 20 individual taeniid eggs
per faecal sample were picked, lysed and genotyped by polymerase chain reaction-restriction
fragment length polymorphism (PCR-RFLP) and sequencing of NADH dehydrogenase subunit
1 (nad1) gene.
Results
Eleven percent (178/1,621) of faecal samples had taeniid eggs, of which 4.4 % (71/1,621) were
identified to contain Echinococcus spp. eggs. Areawise, the prevalence of Echinococcus spp. was
9.2 % (48/524) in Turkana, 4 % (20/500) in Maasai Mara, 0.7 % (2/294) in Isiolo and 0.3 %
(1/303) in Meru. E. granulosus sensu stricto (s. s.) was the most dominant Echinococcus taxon
present, followed by E. canadensis G6/7 that were detected in 51 and 23 faecal samples,
respectively. E. ortleppi was found in 5 faecal samples only. For the very first time, E. felidis
was isolated from two dog faecal samples. Mixed infections of these taxa were also found,
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including: E. granulosus s. s. and E. canadensis G6/7 (n = 7), E. granulosus s. s. and E. ortleppi
(n = 1) and all three species (n = 1).
Conclusions
The data presented here reveal the diversity of Echinococcus spp. infection in domestic dogs in
CE endemic regions of Kenya and hinted a possible sympatric existence of domestic and sylvatic
cycles of Echinococcus spp. in dogs
NTD11-E2 Interlinks between wildlife and domestic cycles of Echinococcus spp in Kenya
Dorothy Kagendo1 Japhet Magambo1 Eric Muchiri1 Eberhard Zeyhle1, Erastus Mulinge2,
Cecilia Mbae2, Francis Addy3, Marion Wassermann3, Thomas Romig3, Peter Kern4 1Meru University of Science and Technology, Meru, Kenya 2Kenya Medical Research Institute, Nairobi, Kenya 3Parasitology Unit, University of Hohenheim, Stuttgart, Germany 4Complehensive Infectious Diseases Center, University Hospitals, Ulm, Germany
Introduction
This study aimed at investigating possible inter-links between wild life and domestic cycles of
Echinococcus spp, in Maasai Mara and Samburu wildlife-human interface areas.
Methods
Amplification of NAD1 gene was done on all taeniid positive samples, and amplicons sequenced,
edited and analyzed with GENtle VI.94 program, before comparison with those in Gen-bank
using Basic local alignment search tool (BLAST) System. The environmentally collected faecal
samples were subjected to molecular identification of specific host species origin
Results
In 53 wild carnivore taeniid positive samples (Samburu 27 and Maasai Mara 26), 521 taeniid
eggs were isolated, of which 183 were positive for NAD 1, 53% in Samburu and 47% in Maasai
Mara. Specific genotypes in Samburu included 31 E. granulosus G1-3, 53 E. felidis, 2 E.
canadensis G6/7, 9 T. hyadtigena, 1 T. multiceps, and a T. saginata, while in Maasai Mara 1 E.
granulosus G1-3, 57 E. felidis, 6T. Multiceps, and 22 T. hyadtigena were found
In Samburu Molecular analysis of 304 eggs from 21 domestic dog feacal samples yielded 92
positives and included 9 Echinococcus granulosus, 47 Echinococcus felidis, 7 Taenia multiceps,
10 Taenia hydatigena, 10 Taenia madoquae with 9 undetermined. In Maasai Mara, 34 samples
had taenia from which 213 individual eggs included 86 Echinococcus Granulosus, 3
Echinococcus felidis, 2 Echinococcus orttlepi and 1 Echinococcus canadensis
Molecular host species identification of 26 samples from Maasai Mara showed 4 Lion, 17 Hyena
and a wilddog and four samples undetermined. In Samburu 27 faecal samples included 3 Lion,
13 Hyena, 6 Wilddog and Five undetermined. Distribution of Echinococcus and Taenia spp
varied with host species, most genotypes recovered from Hyena. Most animals had mixed
infections of Echinococcus, taenia multiceps and Taenia hydatigena
Conclusion
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High infections with domestic and wild genotypes show clear interactions between the two
cycles, though epidemiological consequences are unknown. Presence of Taenia saginata in
Hyena is an indication of wild animals feeding on human faecal matter. Reported taxas
(Echinococcus, T. multiceps, T. hydatigena, T. modaquae and T. saginata) within the two cycles
is rather alarming and indicates possible human exposure to zoonotic infections of public health
importance. These results shed light on existing Echinococcus taxas and other tapeworms inter-
linking wildlife and domestic cycles of dog tapeworm in Kenya, laying basis for prevention and
control of Echinococcosis and other Taenia related infections in the country
NTD11-E3 Cystic echinococcosis in donkeys in Kenya
Eberhard Zeyhle1, Japhet Magambo1, Erastus Mulinge2, Cecilia Mbae2, Dorothy Kagendo1,
Marion Wasserman3, Peter Kern4, Thomas Romig3
1 Meru University of Science and Technology, P.O. Box 927 60200 Meru, Kenya. 2 Kenya Medical Research Institute, P.O. Box 54840 00100 Nairobi, Kenya. 3 Parasitology Unit, University of Hohenheim, 70599 Stuttgart, Germany. 4 Center for Internal Medicine, University Hospital, 89081 Ulm, Germany.
Background
Despite existence of epidemiological data on cystic echinococcosis (CE) in other hosts (definitive
and intermediate) in Kenya, none is available on donkeys. Not until recently, donkeys were not
gazetted as food animals and therefore not slaughtered in large scale and rarely at home. The aim
of the study was to establish the prevalence of cystic echinococcosis and Echinococcus spp. in
donkeys in Kenya
Methods
Suspected hydatid cysts were collected from three donkey abattoirs in Kinamba, Mogotio and
Lodwar and preserved in 80% ethanol. DNA was extracted and subjected to nested polymerase
chain reaction (PCR) targeting NADH dehydrogenase subunit 1 (nad1) gene. Genotyping was
done by restriction fragment length polymorphism (RFLP) and/ or sequencing.
Results
A total of 3083 donkeys, 1716 in Mogotio, 1204 in Kinamba and 163 in Lodwar were examined
for the presence of CE in various organs. Hydatid cysts or lesions were found mainly in liver,
lungs and kidneys. The majority of cysts were calcified, few viable and only one had
protoscolices. CE prevaelence in donkeys was 2.1% (66/3083). Genotyping revealed 52/68 cysts
as E. granulosus s. s. (n = 33), E. ortleppi (n =2), E. canadensis G6/7 (n = 15), E. equinus (n =
1) and Spirometra spp. (n = 1). The species of 16 isolates are yet to be determnined.
Conclusion
This is the first study in sub-Saharan Africa to describe Echinococcus spp. in donkeys. The results
show a very low prevalence in donkeys compared to other livestock species from the same areas,
hinting at donkey’s low susceptibility to CE as compared to other livestock species. This can be
attributed to limited home slaughter of donkeys and hence low transmission of Echinococcus ssp.
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to definitive hosts and in particular the transmission of E. equinus which was rare. This results
show that donkeys might not play a major role in transmission of CE in Kenya.
NTD11-E4 Factors of dog population demographics and ecology relevant to transmission of rabies in
rural Western Kenya
Emmah N Kwoba1*3, Elkanah Otiang 1*2, Robert Ndungu1, Gati Wambura1, Linus Ochieng’ 1
Philip Kitala3, S.M Thumbi 1*2
Corresponding author: Email: [email protected] 1Center for Global Health Research, Kenya Medical Institute of Research, Kisian Campus,
Kenya 2Paul G Allen School for Global Animal Health, Washington State University, USA 3University of Nairobi, Department of Public Health, Pharmacology and Toxicology, Kenya
Background: Domestic dogs remain the principle reservoir and sole maintenance host for rabies
in Africa. Eliminating dog-mediated human rabies can be achieved by mass vaccination of at
least 70% of the dog population and maintaining the herd immunity via revaccinations.
Achieving and maintaining herd immunity within dog populations is influenced by demographic
and ecological factors. Thus, understanding the dog population demographics, ecology and
dynamics is a key step in any rabies control and prevention program especially vaccination
campaigns.
Method: We set up a dog health and demographic surveillance study within an ongoing linked
human-animal syndromic surveillance study in rural western Kenya. Here, we present the design
of the dog cohort study, identified the important demographic and ecological factors underlying
rabies transmission, and estimated their values using baseline data. Findings: A total of 1213
households with 802 dogs were recruited. The dog ownership was 40.4%, 0.7 dogs/household
and 1.8 dogs/dog-owning household. The dog density was 10.2 dogs /km2, male: female ratio of
1.3:1 and a dog: human ratio of 1:7.1. Half of the population was young (1 year and below).
Most dogs (97.4%) scavenge for leftovers. Only 0.4% restricted their dogs’ movement
completely. Only 12.5% and 4.4% of the dogs were castrated and spayed respectively. Rabies
vaccination coverage was 5.4%.
Conclusion: Low vaccination coverage, unrestricted dog movement, and the high dog population
turnover support rabies endemicity in domestic dog populations. Without any intervention, these
demographic features would continue to support rabies transmission and impede achievement of
required 70% vaccination reach. Data from a longitudinal study is imperative to understand dog
populations dynamics and help answer policy questions and inform the design of better, effective
and sustainable rabies control programs.
Key words: rabies, domestic dog, vaccination, demographic, ecology
SCIENTIFIC SESSION F: WASH
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NTD11-F1 Role of CLTS+ model in Trachoma elimination in Turkana County, The case of Turkana
South Sub County
Ochwal Victoria1, Alwenya Kennedy1, Kafahamu Kai1,
1 The Fred Hollows Foundation, P.O. BOX 8683 - 00200, Nairobi, Kenya.
Trachoma is the leading infectious cause of preventable blindness in the world; at least 229
million people live in areas with its burden.3 million people live where Trachoma is prevalent in
Kenya. Turkana County is among the 12 Trachoma endemic Counties in Kenya. A baseline
survey conducted in 2010i showed prevalence of active trachoma (TF) among children as 42.3%
and potentially blinding trachoma (TT) in adults as 8.9%, the prevalence varied, for instance the
Northern district had TF 46.4% and TT 8.7% compared to the Southern with TF 31.2% and TT
8.8% .World Health Organization advocates for elimination by “SAFE”, Surgery for
Triachiasis/entropion, Antibiotics for active disease, Facial cleanliness, and Environmental
sanitation. Fred Hollows Foundation supported by Queen Elizabeth Diamond Jubilee Trust
through Sightsavers coordination introduced a plus component into the Community Led Total
Sanitation (CLTS) approach. CLTS+ incorporates facial cleanliness into the CLTS approach for
open defecation free (ODF) village certification. It was implemented through 15 Ministry of
Health workers in 15 schools and 15 villages in Turkana South Sub County in 2016, whereas the
North and Kibish and East sub counties implemented the S&A components. A first ever village
in Turkana was afterwards certified as open defecation free in Turkana South. The Kenya
Trachoma impact survey 2017ii currently show the prevalence of TF as 9.11%, TT as 0.52% in
Turkana County with the South TF as 6.9% and TT 0.26% compared to North, TF 9.31% and
TT 0.54%, however there is limited demonstration on the role of F&E innovative models in
trachoma elimination. The study findings will contribute to health policy makers F&E budgetary
prioritization.
NTD11-F2 Household access to improved water and sanitation facilities among a community living in
an irrigation scheme set up in central Kenya.
Paul M Gichuki1, 2*, Gabriel G Mbugua2, Damaris Mulewa1, Stella Kepha3, Janet Masaku1
Ng’ethe Muhoho4, Sammy M Njenga1, and Charles Mwandawiro1
1Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya
Medical Research Institute (KEMRI), Mbagathi Road, Nairobi, Kenya 2Meru University of Science and Technology, School of Health Sciences 3London School of Tropical Medicine and Hygiene 4Kenyatta University, School of Medicine
Corresponding author e mail: [email protected]; [email protected]
Introduction: Access to safe drinking water and hygienic sanitation are essential for a healthy
and dignified life. Poor access to water, sanitation and hygiene (WASH) is a big contributor to
most diseases including diarrheal and cholera. Adequate WASH contributes significantly to the
prevention and control of most of the Neglected tropical diseases (NTDs). Millennium
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Development Goal (MDGs) number 7c, and the current Sustainable Development Goal (SDGs)
number 6 are aimed at addressing WASH. This study describes household access to water and
sanitation in Mwea irrigation scheme, Kirinyaga County, Kenya.
Methods: A cross sectional study where two districts (Mwea East and West) were purposively
selected. Three villages from each district were selected using simple random technique, and
systematic random sampling applied to reach the households. Data was analyzed using STATA
(14.0) statistical package.
Results: A total of 911 households were sampled. Only 17% had access to an improved water
source. This is far below the 54% and 59% (rural areas) recorded in the 2009 and 2014 Kenya
demographic and health surveys respectively. It’s also far below the 2015 MDGs target of 88%.
63% did not treat water in any way. Those who treated water either used chlorine (61%) boiled
(36%) or left the water to settle (3%). 79% of the households had access to an improved
sanitation facility. Only 21% of the households used a shared facility.
Conclusion: The results indicate low household access to an improved water source and
adequate access to an improved sanitation facility. The results also indicate that a majority do
not treat their water in any way. These findings show that more efforts are required to increase
access to an improved water source in the irrigation scheme in order to achieve the SDGs, and
also for prevention and control of water borne diseases.
NTD11-F3 Efficacy of Maerua decumbens and Moringa oleifera extracts in water treatment
Derrick Ochieng1, Sichangi Kasili1 And Vitalis Wafula Wekesa2
1Center for Global Health Research, Kenya Medical Research Institute
2 Department of Biological Sciences South Eastern Kenya University
2 Department of Biological Sciences, Technical University of Kenya
Introduction: Water of adequate quantity and quality is essential for healthy life. Its provision
has been ensured in semiarid areas by construction of water reservoirs including dams and
boreholes. These water sources face a high risk of contamination from anthropogenic activities,
run offs and wildlife migration. Contamination may result in many diseases including various
parasitic, fungal diseases, skin diseases, eye infections and diarrhoeagenic diseases. There is
therefore need to assess efficacy of various locally available plant extracts in purifying water
since use of chemical treatments may not be possible at all times.
Methods: Water samples were taken from Katangi dam in Machakos County, Kenya.
Bacteriological water analysis was done using the multiple tube fermentation method which
provided various MPN indices for different water samples. The bacterial determination
confirmed the presence of coliforms which was an indicator bacterium for other pathogenic
bacteria such as salmonella and Shigella species.
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Results: The water samples from the dam had a mean Most Probable Number (MPN) index
that exceeded that recommended by WHO. Water treatments with 1.2% sodium hypochlorite
and extracts of Moringa oleifera seeds and Maerua decumbens roots recorded significant
differences from the untreated water.
Conclusion and Recommendations: M. decumbens roots and M. oleifera seeds significantly
reduced bacterial load from contaminated water. All substances including sodium hypochlorite
did not however, reduce the bacterial load to levels acceptable for human consumption. If
safety of M. decumbens and effective doses of both plants are established, the two plant
preparations can be used to treat water when commercial alternatives are unavailable or
disliked. The cost effectiveness of using of both plants in water treatment requires further
investigation.
NTD11-F4 Effectiveness of wash in control of Neglected tropical diseases
Walter K. Bartai
Elgeyo Marakwet County, Iten County Refferal Hospital, P. O. BOX 332, Iten. Email:
Background: Neglected tropical diseases (NTDs) affect over 1 billion people causing chronic
disability and death, primarily among the poorest populations. Provision of safe water, adequate
sanitation and hygiene (WASH) is one of five key public health strategies to control, eliminate
or eradicate NTDs. The county has been implementing WASH with the aim of reducing diarrhea.
Despite the implementation of WASH within the county, few are aware that controlling and
eliminating NTDs also requires WASH. In addition, existing plans and strategies rarely offer
specific guidance on the way in which collaboration between WASH and NTDs stakeholders can
be strengthened hence no evaluation had been done to ascertain the effectiveness of WASH in
control of NTDs.
Objectives: This study investigated the effectiveness of WASH in control of NTDs within
Elgeyo Marakwet County and made recommendations about ideal conditions and best practices
critical to control of NTDs. Its specific objectives were: to describe the association between
community led total sanitation (CLTS) and the control of NTDs, to determine how Social
behavior change (SBCC) has contributed to the control of NTDs and to find out how knowledge
on WASH influences the control of NTDs.
Methodology: Case control study design was used. A semi structured questionnaire was
administered to a sample of 80 WASH officers that was determined using Fishers formula and
are directly involved in implementation of WASH within the County. Data collected were
analyzed and presented using descriptive and inferential statistics. The findings were reported in
summary form using tables, figures and graphs.
Results: 60% of the officers were aware that WASH can be used to control NTDs. The study
found that CLTS and BCC were associated with control of NTDs with a p<0.05
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Conclusion: This study concluded that Implementation of CLTS and BCC was critical in control
of NTDs and it further recommended on the need for the counties to scale up CLTS and BCC in
their Counties.
NTD11-F5 Effectiveness of CLTS intervention as an effective means of prevention of cholera
outbreaks, participation of CHVs
1. Department of Health, Migori County, Disease Surveillance Coordinator
Correspondence: Email: [email protected]
Background
In Migori County, two experienced cholera epidemics, between 1st February 2015 and 15th July
2015 which had a total of 1316 cases, recording a case fatality rate (CFR) of 3.1 % (the highest
experienced in our county) .
This study was a pilot of CLTS intervention in Rongo sub-county, Migori County as an effective
means of prevention of cholera outbreaks, and this paper presents findings that report on the
qualitative exploratory phase of the study.
Methods
The study design was a cross-sectional, mixed methods study was conducted in the villages
(600HH) where cases of cholera were reported. Methods included interviews, focus group
discussions, observation, household mapping and CLTS data review. 200 CHV participated and
5 key informants.
Results
Results have shown that the frequently visited villages by CHVs and utilizes household water
treatment as well as Open Defecation free had no cases of cholera. There was marked increase
in the provision and use of pit latrines where CLTS had been implemented in the Rongo sub-
county (78%). The key risk factors to cholera in our county include inadequacy of improved
portable water and open surface wells, low latrine coverage and usage, knowledge gap on proper
hand washing with soap, un hygienic food handling, lack of sanitary facilities in schools which
are poorly maintained and poor solid waste management practices in markets and institutions .
Conclusions
Community-Led Total Sanitation is an effective way of improving sanitation. With Open
defecation free status, communities experience no cholera outbreaks. Participation of the CHVs
is very important since they are in constant contact with the Community, a sure way of ensuring
sustainability.
NTD11-F6 Using CLTS programming to ensured equity and inclusion is achieved in ODF villages
by John Kagira and Denis Langat, Kenya
Background
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The program of integrating equity and inclusion began in 2012 as we were implementing CLTS
in Kenya. During this period, we realized that the community led total sanitation was not keen in
ensuring that none was left behind. During follow ups of first villages, we realized that the
communities were not able to attain ODF status due to vulnerable groups which were among the
community members. CLTS is zero subsidy there was need of an integrated approach to ensure
that the needs to the vulnerable groups who are likely to be barred from using sanitation facilities.
This also was informed further when there was a review of sanitation and hygiene indicators in
Kenya to be shared in High Level Meeting on disabilities. We realized as a country that we had
no indicator which could be shared nationally on issues of equity and inclusion. From that point
we began pushing for consideration of equity and inclusion in sanitation by sharing what we have
been doing to help achieve this endeavour. As we continued with implementation, a lot we learnt
and shared with different partners through capacity building in the country. This made us feel to
share lessons learnt during implementation period.
Methodology
The methodology used was purely CLTS approach which was as per the CLTS protocol for
Kenya. The country had training manual and protocol which all partners in Kenya were expected
to follow. We integration of equity and inclusion in social mobilization, triggering, follow ups,
celebration of ODF villages. At social mobilization, the village leaders were orientated in on
equity and inclusion so that during mapping exercise they became observant without practicing
discrimination. During mapping all households were mapped and any form of disability was
captured and of interest were the mobility challenged persons we are likely to be barred from
using available sanitation facilities. After which follow ups were done to reinforce on behaviour
change of all in the community the vulnerable groups were never left behind. During this period,
local solutions were promoted as per the social model. Local solutions were implemented and
technical advices were received from the public health officers.
Review of equity and inclusion options was done. All stakeholders dealing with the vulnerable
groups were brought together to assist in ensuring that the solutions or options communities came
up with were not dangerous to the community members who used them. With this review
modifications were done which made the facilities friendly.
Results
The results to be shown in this section will be from the 2 programs carried out in Kenya. The
program which began in 2012 to 2014 under USAID/WASHpluswith about 20 NGOs and from
2015 to 2016 the program was carried out by Kenya Sanitation and Hygiene Improvement
Program with 11 sub-grantees. All lessons learnt and approaches used in this paper are part of
the results achieved in this program.
The program covered the entire country using the USAID model where the country was split into
7 regions and overseen by consortium of partners per every region. What we did during this
period was to bring on board all the representatives of these consortiums in country and trained
them on equity and inclusion. After training they went and did implementation in their respective
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regions. Review meetings were done to get the feedback from the implementers. Some did well
others never did well in this area.
The other approach was to deal with other partners who were under the USAID model. These
trained on equity and inclusion and expected to carry out the implementation
The other approach was to deal with institutions such as early childhood development centres
dealing with children who are likely to be barred from using sanitation facilities involuntarily by
the status of the sanitation facilities, absence the sanitation and hygiene facilities and exposed to
various diseases.
Implementation under Kenya sanitation and Hygiene improvement program supported by Global
sanitation fund. Under this programme, we did exactly what we did with the WASHPlus team
with additional lessons learnt during the previous implementations.
The approach added in this was linkages with different stakeholders to make equity and inclusion
an integrated approach involving more than one stakeholder. With them the battle is easily won.
We worked the county government, NGOs, Ministry of health and other stakeholders. This will
be shared in the full paper.
Recommendations
The recommendation listed in this section are those which we gathered during our implantation
and those one done by other partners.
Always map out the people who are likely to be discriminated in the community with issues of
sanitation and hygiene. Using CLTS approach it is possible to track these population using the
available Ministry of health reporting tools and the CLTS reporting tools as will be detailed in
the report
Always orientate natural leaders, partners, government health officials, education leaders and
local administration who are interacting with the communities on a day to day basis to assist them
in ensuring that equity and inclusion is achieved
Reinforcing on linkages with relevant stakeholders whom were can’t do without in the efforts of
ensuring equity and inclusion is achieved. These linkages have advantages which include
leveraging on the resources of other partners in ensuring that equity and inclusion is achieved by
relevant partners.
Continual review meetings held by people of different stakeholders and review of options
innovated by the community to ensure that access to sanitation and hygiene is achieve in the
effort of becoming open defecation free.
Detailed equity and inclusion ladder which can be shared by all partners across the world to held
achieve equity and inclusion in CLTS implementation.
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NTD11-F7 Household hygiene: Evaluating the efficacy of cleaning and hand washing products to
reduce health risks to health workers and the community.
Evans Apondi 1, Caroline Ouma 1,Arthur Odoyo 1, Dorothy Odindo 1, Jairus Abuom1,
1Center for Global Health Research, Kenya Medical Research Institute.
Introduction:
Use of house hold, medical laboratory cleaning and personal hygiene products containing
antibacterial ingredients is in practice despite their effects on the disease causing pathogens not
reported. Studies have reported the results of interventions to reduce illness through
improvements in drinking water, sanitation facilities, and hygiene practices. Medical laboratory
hygiene is a practice in the laboratory. Although the precise risk of infection after an exposure
remains poorly defined, surveys of laboratory-acquired infections suggest that Brucella species,
Shigella species, Salmonella species, Mycobacterium tuberculosis, and Neisseria meningitidis
are the most common causes. Evaluating the effect of antimicrobial hand washing products for
laboratory use is key in determining the occurrence of infectious disease symptoms in
communities.
Methods:
Benches were marked for disinfection. Products were checked for dates of manufacture and
expiry, right concentrations and ingredients. Disinfectants were blinded and labeled. A
monitoring chart was put in place. Disinfection was done after bench activity, followed by
swabbing and plating on the different media. Samples were incubated at 37ºC for 18 -24 hour for
growth examination and microbial growth Identification.
Results:
Chlorine compounds kill bacteria, spores and fungi. Glutaraldehyde is an excellent
tuberculocidal, kills spores, bacteria, fungi and viruses. Iodophores are excellent for killing
bacteria, fungi and viruses. Phenolic compounds are excellent for killing viruses,fungi,bacteria
and spores. Quaternary Ammonium Compounds are good for killing Viruses and fungi but
excellent for bacteria.70% Alcohol evaporate hence reduced contact time.
Conclusions:
Disinfectants must be used depending on the types of microbes and infectious agents they are
effective against. The effectiveness of a disinfectant is influenced by, length of exposure,
concentration of disinfectant, temperature, and pH.
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Congratulations to the 2016 young Investigator award winners
Fatihiyya Wangara
Kennedy Andiego
Philip Leakey
Isaac Onkanga
Copyright @ Neglected Tropical Diseases (NTD) Unit 2017
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