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The health and economic burden of podoconiosis in East Africa: A systematic review and meta-analysis of health outcomes with narrative synthesis of economic evidence.

BACKGROUND: Podoconiosis is a neglected tropical disease (NTD) causing chronic lower limb lymphoedema through prolonged barefoot exposure to … c scope. RESULTS: Fourteen studies met the inclusion criteria, comprising 10 from Ethiopia, 2 from Kenya, and 1 each from Uganda and Rwanda, collectively examining 1,720,437 individuals. The overall pooled prevalence was 1.19 (95% CI: 1.14-1.25) on the transformed scale, with extreme heterogeneity (I² = 99.0%). The Ethiopia-specific pooled prevalence w …

Oral rehydration for severe malnutrition in children with moderate and severe dehydration (GASTROSAM): a phase 2, open-label, superiority randomised controlled trial.

BACKGROUND: International guidelines for treatment of children with severe acute malnutrition advise against giving standard oral rehydratio … abel, superiority randomised controlled trial conducted at six hospitals in four African countries (Kenya, Niger, Nigeria, and Uganda). Children aged 6 months to 12 years with severe acute malnutrition who were admitted to hospital with severe (stratum A) or moderate (stratum B) dehydration and diarrhoea were randomly assigned in a 1:1 ratio to receive …

Safety, pharmacokinetics, and neutralisation activity of PGDM1400LS, VRC07-523LS, and PGT121.414.LS infused intravenously or subcutaneously (HVTN 140/HPTN 101 part B): a phase 1, randomised trial.

BACKGROUND: Passive immunisation with a combination of broadly neutralising monoclonal antibodies (mAbs) presents a potential HIV-1 prevention modality. This study (HVTN 140/HPTN 101) sought to evaluate PGDM1400LS (targeting V3-glycan) administered alone (part A, previously reported), and in combination (part B) with VRC07-523LS (targeting CD4 binding site) and PGT121.414.LS (targeting V2-apex) in healthy adults without HIV-1. METHODS: The study was a phase 1, multicentre, randomised, open-label trial done across the USA (five sites), Kenya (one site), South Africa (four sites), and Zimbabwe …

Pre-operative MELD-Na score as an independent predictor of post-operative mortality after valve surgery in rheumatic valvular heart disease patients.

BACKGROUND: Rheumatic heart disease (RHD) poses a significant global health challenge due to its high rates of premature morbidity, mortalit … gery in RHD patients. METHODS: This retrospective cohort study was conducted at Tenwek Hospital in Kenya and included 93 patients who underwent open heart valve replacement surgery between March 2022 and March 2023. Patients who underwent mechanical mitral valve replacement (MVR), mechanical aortic valve replacement (AVR), and tricuspid valve repair su …

Trends in Prevalence of Tobacco Use by Sex and Socioeconomic Status in 22 Sub-Saharan African Countries, 2003-2019.

IMPORTANCE: Tobacco companies have shifted their marketing and production to sub-Saharan African countries, which are in an early stage of t … in 15 countries: Cameroon, Namibia, Mozambique, Mali, Liberia, Nigeria, Burundi, Tanzania, Malawi, Kenya, Rwanda, Zimbabwe, Ethiopia, Burkina Faso, and Zambia. For both sexes, the prevalence of tobacco use and the decrease in prevalence of tobacco use were higher among less-educated individuals and individuals with low income. In both groups, the magni …

Presentation and survival of multiple myeloma patients in Ghana: a review of 169 cases.

BACKGROUND: Africans have an increased risk for multiple myeloma (MM) compared to other races. Reports from Africa are few and involve small cohorts, but suggest significant epidemiological and clinical differences from Caucasian patients. OBJECTIVE: This report describes the clinic-pathological features of MM patients in Ghana at diagnosis, and the factors affecting their survival. METHODS: A retrospective review of 169 MM cases diagnosed in a Ghanaian tertiary hospital from 2002-2016. RESULTS: Median age was 58 years, with 29% ≤50 years. One-third presented >12 months after onset of sympt

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… Bone pain was the most common presenting complaint, consistent with other reports in African patients. 11 , 15 , 16 Half of the patients in this study presented with weight loss, which represents a significantly higher prevalence than reported for patients in Kenya 11 and the United States. 10 One-third … This is similar to reports from Nigeria 16 and Burkina Faso, 13 but less than reported from Kenya 11 (52%), and twice that reported from Cameroon 15 (17%). In Ghana, diclofenac and other NSAIDs are frequently prescribed analgesics. …

Protocol of a randomised controlled trial characterising the immune responses induced by varicella-zoster virus (VZV) vaccination in healthy Kenyan women: setting the stage for a potential VZV-based HIV vaccine.

INTRODUCTION: A protective HIV vaccine would be expected to induce durable effector immune responses at the mucosa, restricting HIV infectio … . METHODS AND ANALYSIS: This open-label, randomised, longitudinal crossover study includes healthy Kenyan VZV-seropositive women at low risk for HIV infection. Participants receive a single dose of a commercial live-attenuated VZVOka vaccine at either week 0 (n=22) or at week 12 (n=22) of the study and are followed for 48 and 36 weeks postvaccination, …

Prevalence, clinical and virologic outcomes of hepatitis B virus co-infection in HIV-1 positive Kenyan women on antiretroviral therapy.

BACKGROUND: Sub-Saharan Africa carries a high burden of co-infection with HIV-1 and hepatitis B virus (HBV). In this region, individuals with HIV-1/HBV co-infection on antiretroviral therapy (ART) frequently receive lamivudine as the only agent active against HBV, raising concerns for development of HBV resistance to lamivudine. We aimed to determine the prevalence, clinical, and virologic outcomes of chronic HBV infection, including HBV resistance to lamivudine, in a cohort of HIV-1 seropositive Kenyan women on long-term ART. METHODS: In this prospective cohort study, HIV-1 seropositive wome…

Mucosal serpin A1 and A3 levels in HIV highly exposed sero-negative women are affected by the menstrual cycle and hormonal contraceptives but are independent of epidemiological confounders.

OBJECTIVE: Serpins (serine protease inhibitors) are associated with protection against HIV infection. Here, we characterized mucosal serpin expression in the genital tract of HIV highly exposed sero-negative (HESN) women meeting our epidemiological definition of HIV resistance in relation to epidemiological variables. METHODS: Cervicovaginal lavage (CVL) fluid and plasma were collected from 84 HIV-resistant, 54 HIV-uninfected, and 66 HIV-infected female commercial sex workers. Serpin A1 and A3 concentrations were measured by ELISA and compared with clinical information. RESULTS: Mucosal serp

A comparison of genital HIV-1 shedding and sexual risk behavior among Kenyan women based on eligibility for initiation of HAART according to WHO guidelines.

BACKGROUND: Guidelines for initiating antiretrovirals are based on markers of advanced disease and are not directly linked to markers of HIV-1 transmission such as viral shedding. METHODS: We evaluated genital HIV-1 shedding and risk behavior among 650 antiretroviral-naïve women stratified by WHO criteria for initiating antiretrovirals based on CD4 count and symptoms. RESULTS: Genital HIV-1 concentrations increased in stepwise fashion with declining CD4 counts and the presence of symptoms. Compared with the reference group (asymptomatic with CD4 >350 cells/microL), those with advanced immuno

Specific antibody responses to three schistosome-related carbohydrate structures in recently exposed immigrants and established residents in an area of Schistosoma mansoni endemicity.

By the use of surface plasmon resonance spectroscopy, immunoglobulin G (IgG) subclass and IgM antibodies against three schistosome-derived carbohydrate structures, FLDN (Fucalpha1-3GalNAcbeta1-4GlcNAcbeta1-3Galalpha1), LDN-DF [GalNAcbeta1-4(Fucalpha1-2Fucalpha1-3)GlcNAcbeta1], and LDNF [GalNAcbeta1-4(Fucalpha1-3)GlcNAcbeta1-3Galalpha1], were measured in 184 previously unexposed Kenyan immigrants who moved into the Masongaleni area, where Schistosoma mansoni is endemic. They were sampled within their first year of exposure and again 2 years later. A cohort selected out of the original residents…

Human Immunodeficiency Virus-Infected Women Have High Numbers of CD103-CD8+ T Cells Residing Close to the Basal Membrane of the Ectocervical Epithelium.

BACKGROUND: Genital mucosa is the main portal of entry for various incoming pathogens, including human immunodeficiency virus (HIV), hence it is an important site for host immune defenses. Tissue-resident memory T (TRM) cells defend tissue barriers against infections and are characterized by expression of CD103 and CD69. In this study, we describe the composition of CD8+ TRM cells in the ectocervix of healthy and HIV-infected women. METHODS: Study samples were collected from healthy Swedish and Kenyan HIV-infected and uninfected women. Customized computerized image-based in situ analysis was …

Clinical study of cerebral malaria in African children.

Of 51 consecutive children with cerebral malaria, fever, convulsions, and drowsiness were the commonest presenting symptoms. Decerebrate and decorticate postures and absent cornea reflex were the commonest brain stem signs. Opening lumbar cerebrospinal (CSF) pressure was raised in all but one of 24 children in whom it was reliably measured [mean 15.2 +/- 5.7 mmHg, range 6-24]. Hyponatraemia occurred in 17 (33%). Acute renal failure was not uncommon; the combination of hypercreatininaemia (plasma creatinine > 100 mumol/L) and hyperkalaemia (plasma potassium > 6.0 mumol/L) was fatal in 5 out of

Antibody to chlamydial hsp60 predicts an increased risk for chlamydial pelvic inflammatory disease.

To determine whether serum antibody to Chlamydia trachomatis antigens alters the risk of C. trachomatis pelvic inflammatory disease (PID), 280 female sex workers were prospectively evaluated over a 33-month period for incident C. trachomatis and Neisseria gonorrhoeae cervical infection and for clinical PID. At enrollment, women were tested for antibody to C. trachomatis elementary bodies by an indirect microimmunofluorescence assay and to recombinant chlamydial hsp60 (Chsp60) by an ELISA format. At each follow-up visit, women were tested for cervical chlamydial and gonococcal infection and wer

Prevalence of antimalaria drug resistance-conferring mutations associated with sulphadoxine-pyrimethamineine-resistant Plasmodium falciparum in East Africa: a systematic review and meta-analysis.

BACKGROUND: The emergence and spread of drug resistance to antimalarial drugs pose a severe threat to effective malaria control and treatmen … owed that the pooled prevalence of dhfr N51I, dhfr C59R, dhfr S108N, dhps A437G, and dhps K540E, in Kenya was 85.88%, 84.02%, 86.56%, 90.7%, and 77.55%, respectively. CONCLUSIONS: This systematic review and meta-analysis reveal a high prevalence of drug resistance markers  associated with sulphadoxine-pyrimethamine resistance in Plasmodium falciparum a …