Introduction: The human-restricted sexually transmitted Neisseria gonorrhoeae (NG) has been shown to modulate the immune response against it and consequently the cytokines produced. The levels of cytokines in NG infection in the African population have not been well described. We aimed to quantify the systemic and mucosal cytokines in NG infection. Methods: This was a comparative cross-sectional study. Levels of nine cytokines (IL-1β, IL-2, IL-4, 1L-6, 1L-10, 1L-12p70, IL-17A, TNF-α and INF-γ) were measured from plasma and genital samples (urethral swabs in men and cervicovaginal lavage in women) from 61 Neisseria gonorrhoeae infected individuals seeking treatment for sexually transmitted infections (STIs) at Casino Health Centre in Nairobi, Kenya. A comparative group of 61 NG-uninfected individuals, seeking treatment at the same facility but with laboratory-confirmed negative Neisseria gonorrhoeae, Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Trichomonas vaginalis(TV) was also included. The Mann-Whitney U test was used to compare the cytokine levels between NG-infected and uninfected individuals. Data was analyzed using STATA ver. 15.1. Results: Overall, systemic IL-6, TNF-α and IL-10 were elevated while genital IL-10 and TNF-α were lower in NG positive participants. On subgroup analysis by sex, the levels of genital IL-1β and IL-6 and systemic IL-6 were elevated in NG-infected men. None of the genital cytokines were elevated in NG-infected women, while all systemic cytokines, except INF-γ, were elevated in NG-infected women. Conclusions: Neisseria gonorrhoeae induced the production of different cytokines in men and women, with men having a pro-inflammatory genital response. These differences should be taken into consideration during development of various interventions e.g. vaccine development.
Background Antibiotic resistance is a growing global health threat worldwide and especially in developing countries. Irrational antibiotic prescription as well as lack of the requisite knowledge and awareness of proper antibiotic use are major drivers of antibiotic resistance. In Kenya, although the Ministry of Health has developed antibiotic use guidelines, these guidelines are not widely followed. Antibiotic prescription is, therefore, hugely at the discretion of the clinician. It is thus necessary to understand the knowledge, attitude, and practices (KAP) of antibiotic prescription among medical practitioners in the country. This study aimed to evaluate the knowledge, attitude, and practices (KAP) among antibiotic prescribers in three counties (Kiambu, Nakuru, and Bungoma) in Kenya. Methods This was a cross-sectional study using a self-administered questionnaire. Simple descriptive statistics were used to generate frequencies, percentages, and proportions. Where necessary, univariate analyses such as Pearson’s chi-square were performed to compare proportions for statistical significance. Results From the three counties, 240 respondents recorded their responses: 30% from Kiambu, 34.6% from Nakuru, and 35.4% from Bungoma. The respondents included 19 (7.9%) consultants, 66 (27.4%) medical officers, 135 (56.3%) clinical officers and 20 (8.3%) pharmacists. Of all respondents, more than 90% agreed or strongly agreed that antibiotic resistance (ABR) is a catastrophe worldwide and in Kenya. However, the proportion of the respondents who either agreed or strongly agreed (71.6%) that antibiotic resistance is a problem in their respective health facilities was significantly lower (ρ=0.013). Conclusion This study revealed that most medical practitioners were aware and knowledgeable about antibiotic resistance. However, there was a disconnect with mitigation measures such as active antibiotic stewardship and laboratory analyses to support judicious prescription. There is, therefore, a need for continuous education and stewardship interventions.
Background Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (inter quartile range) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.
Background: Urbanization is an important indicator of economic growth and social change but is associated with environmental degradation, which threatens the sustainable growth of African cities. One of the most vulnerable ecosystems in urban areas are wetlands. In Uganda, wetlands cover an area of 11% of the country’s land area. Half of the wetland areas in Ugandan cities have been converted to industrial and residential areas, and urban agriculture. There is limited information on the extent of wetland conversion or utilization for urban agriculture. The objective of this study was to investigate the extent of wetlands lost in two Ugandan cities, Wakiso and Kampala, in the last 30 years. Secondly, we extracted crop agriculture in the wetlands of Kampala and Wakiso from hyper-temporal satellite image analysis in an attempt to produce a spatial detail of wetland encroachment maps of urban agriculture using a reproducible mapmaking method. Methods: Using a field survey and free remote sensing data from Landsat TM 1986 and Landsat ETM 2016 we classified the rate of wetland loss and encroachment between the years 1986 and 2016. We used MODIS NDVI 16-day composites at a 500-meter spatial resolution to broaden the analysis to distinguish distinctive crops and crop mixtures in the encroached wetlands for urban agriculture using the ISODATA clustering algorithm. Results: Over 30 years, 72,828 ha (73%) of the Wakiso-Kampala wetlands have been lost meanwhile agriculture areas have doubled. Of this 16,488 ha (23%) were converted from wetlands. All cultivated agriculture in Kampala was in the wetlands while in Wakiso, 73% of crop agriculture was in the wetlands. The major crops grown in these urban wetlands were banana (20%), sugarcane (22%), maize (17%), Eucalyptus trees (12%), sweet potatoes (10%), while ornamental nurseries, pine trees, vegetables, and passion fruits were each at 5%.
Background: Recent studies have observed vectors resting predominantly outdoors in settings where anti-vector tools are extensively deployed, attributed to selection pressure from use of control tools. This present study examined if the outdoor resting behaviour in the vector population is random or indicative of a consistent preference of one resting site over the other. Methods: Mark-release-recapture experiments were conducted with outdoor-resting Anopheles gambiae and An. funestus mosquitoes collected from two villages in northern Ghana during rainy and dry seasons. Mosquitoes were marked with fluorescent dyes and released indoors. The experiments were controlled with indoor-resting mosquitoes, which were marked and released outdoors. Species of all recaptured mosquitoes were identified and assessed for consistency in their resting behaviour. Results: A total of 4,460 outdoor-resting mosquitoes comprising An. gambiae sensu lato (s.l.) (2,636, 59%) and An. funestus complex (1,824, 41%) were marked and released. Overall, 31 (0.7%) mosquitoes were recaptured mostly from outdoor location comprising 25 (81%) An. gambiae s.l. and 6 (19%) An. funestus complex. Only 3 (10%) of the recaptured mosquitoes were found resting indoors where they were released. The majority of the outdoor-recaptured mosquitoes were An. arabiensis (11, 39%), followed by An. coluzzii (7, 25%); whereas all indoor-recaptured mosquitoes were An. coluzzii. For the control experiment, 324 indoor-resting mosquitoes constituting 313 (97%) An. gambiae s.l. and 11 (3%) An. funestus complex were marked and released. However, none of these was recaptured neither indoors nor outdoors. More mosquitoes were captured and recaptured during rainy season, but this was not statistically significant (Z=0.79, P=0.21). Conclusions: These results suggested the tendency for the mosquitoes to retain their outdoor-resting behaviour. Further investigations are required to ascertain if emerging preference for outdoor resting behaviour in malaria vector populations is consistent or a random occurrence.
