Molecular epidemiology of human rhinovirus infections in Kilifi, coastal Kenya

This study reports pediatric surveillance over 3 years for human rhinovirus (HRV) at the District Hospital of Kilifi, coastal Kenya. Nasopharyngeal samples were collected from children presenting at outpatient clinic with no signs of acute respiratory infection, or with signs of upper respiratory tract infection, and from children admitted to the hospital with lower respiratory tract infection. Samples were screened by real-time reverse transcriptase polymerase chain reaction (real-time RT-PCR) and classified further to species by nucleotide sequencing of the VP4/VP2 junction. Of 441 HRV positives by real-time RT-PCR, 332 were classified to species, with 47% (155) being HRV-A, 5% (18) HRV-B, and 48% (159) HRV-C. There was no clear seasonal pattern of occurrence for any species. The species were present in similar proportions in the inpatient and outpatient sample sets, and no significant association between species distribution and the severity of lower respiratory tract infection in the inpatients could be determined. HRV sequence analysis revealed multiple but separate clusters in circulation particularly for HRV-A and HRV-C. Most HRV-C clusters were distinct from reference sequences downloaded from GenBank. In contrast, most HRV-A and HRV-B sequences clustered with either known serotypes or strains from elsewhere within Africa and other regions of the world. This first molecular epidemiological study of HRV in the region defines species distribution in accord with reports from elsewhere in the world, shows considerable strain diversity and does not identify an association between any species and disease severity

Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya : a prospective comparison of point of care diagnostic methods.

Background: Early diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting. Methods: Eligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference. Results: Six hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity. Conclusions: POC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify sensitive and specific POC GDM screening strategies using adverse pregnancy outcomes as end points are required

Methodologies of the 4-beaches Survey and Stakeholder Workshops

As it is clearly indicated in the title of this book section, it overviews the methodologies used in the 4-beaches Survey and in the various Stakeholders' Workshops held in all the three riparian countries of the Lake Victoria

Village Baseline Study: Site Analysis Report for Xai Xai, Zongoene Village, Bairro 1, Mozambique

This is the report of the village baseline study of Zongoene Village, Bairro 1, in the CCAFS benchmark site of Xai Xai, Mozambique in May 2013 to complement an earlier household baseline survey done in the same village. Zongoene village is located by the coast at the mouth of the Limpopo River where there are extensive wetlands along with forests and sand dunes. The village is divided into five sections: Bairro 1, Bairro 2, Bairro 3, Bairro 4 and Bairro 5. Zongoene is the result of a government resettlement program that brought people together to ease service provision. Nonetheless, the level and quality of services remain very low with roads in bad condition, local schools poorly built and lacking water, one hospital with insufficient staff and resources, and nascent electrical availability. The concentrated and expanding population is also increasing pressures on the environment as demand for food and farmland grows

Genetic relatedness of infecting and reinfecting respiratory syncytial virus strains identified in a birth cohort from rural Kenya

Background: Respiratory syncytial virus (RSV) reinfects individuals repeatedly. The extent to which this is a consequence of RSV antigenic diversity is unclear. Methods: Six-hundred thirty-five children from rural Kenya were closely monitored for RSV infection from birth through 3 consecutive RSV epidemics. RSV infections were identified by immunofluorescence testing of nasal washing samples collected during acute respiratory illnesses, typed into group A and B, and sequenced in the attachment (G) protein. A positive sample separated from a previous positive by ≥14 days was defined as a reinfection a priori. Results: Phylogenetic analysis was undertaken for 325 (80%) of 409 identified infections, including 53 (64%) of 83 reinfections. Heterologous group reinfections were observed in 28 episodes, and homologous group reinfections were observed in 25 episodes; 10 involved homologous genotypes, 5 showed no amino acid changes, and 3 were separated by 21–24 days and were potentially persistent infections. The temporal distribution of genotypes among reinfections did not differ from that of single infections. Conclusions: The vast majority of infection and reinfection pairs differed by group, genotype, or G amino acid sequence (ie, comprised distinct viruses). The extent to which this is a consequence of immune memory of infection history or prevalent diversity remains unclear

An intensive, active surveillance reveals continuous invasion and high diversity of rhinovirus in households

We report on infection patterns in 5 households (78 participants) delineating the natural history of human rhinovirus (HRV). Nasopharyngeal collections were obtained every 3–4 days irrespective of symptoms, over a 6-month period, with molecular screening for HRV and typing by sequencing VP4/VP2 junction. Overall, 311/3468 (8.9%) collections were HRV positive: 256 were classified into 3 species: 104 (40.6%) HRV-A; 14 (5.5%) HRV-B, and 138 (53.9%) HRV-C. Twenty-six known HRV types (13 HRV-A, 3 HRV-B, and 10 HRV-C) were identified (A75, C1, and C35 being most frequent). We observed continuous invasion and temporal clustering of HRV types in households (range 5–13 over 6 months). Intrahousehold transmission was independent of clinical status but influenced by age. Most (89.0%) of HRV infection episodes were limited to <14 days. Individual repeat infections were frequent (range 1–7 over 6 months), decreasing with age, and almost invariably heterotypic, indicative of lasting type-specific immunity and low cross-type protection

Village Baseline Study: Site Analysis Report for Chicualacuala, Maluana, Mozambique (MO0145)

This is the report of the village baseline study of Maluana village in the CCAFS benchmark site of Chicualacuala, Mozambique from May 5-12, 2013 to complement an earlier household baseline survey done in the same village

Institutional stakeholders' perceptions of a sustainable neighbourhood in metropolitan Lagos

Understanding the term urban sustainability continues to dominate discourse in the built environment as societies explore how cities can be considered sustainable. Due to the increasing rate of urbanization, scholars argue that the battle for sustainability will be won or lost in cities; recognizing the crucial role that neighbourhoods can play as building blocks of urban areas. However, while the context-specificity of the several approaches to sustainability at the neighbourhood level has been recognised, no single accepted understanding of a sustainable neighbourhood has emerged. This paper explores institutional stakeholders’ understanding of a sustainable neighbourhood using questionnaire data from metropolitan Lagos. This aligns with the critical realism philosophical stance which believes that knowledge can be sourced through the perception of people with respect to an underlying structure based on their reality. The findings show variations in the perceptions with institutions having similar responsibilities differing in their understanding of the concept. It was unclear why a single common understanding was missing and why certain elements were more emphasised than others even in institutions having similar roles. Further research should explore the mechanisms at play in influencing these understandings and how they may differ in various urban contexts in Sub-Sahara Africa