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Page 1: ACKNOWLEDGEMENTS - Kenya Medical Research Institute NTD Conference... · 1 ACKNOWLEDGEMENTS NTD Conference Organizing Committee Dr. Sultani Matendechero Dr. Doris Njomo Dr. Maurice
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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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.

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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

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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

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(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

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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

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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

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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

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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

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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.

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

[email protected]

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

[email protected]

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

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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.

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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

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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

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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

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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.

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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:

[email protected]

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

Ministry of Health

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Nairobi Kenya

Copyright @ Kenya Medical Research Institute 2017

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