Using GIS and Remote Sensing Technologies to Identify Environmental Variables of Malaria Vector Breeding Sites in Western Kenya

This study used Landsat 8 satellite imagery to identify environmental variables of households with malaria vector breeding sites in a malaria endemic rural district in Western Kenya. Understanding the influence of environmental variables on the distribution of malaria has been critical in the strengthening of malaria control programs. Using remote sensing and GIS technologies, this study performed a land classification, NDVI, Tasseled Cap Wetness Index, and derived land surface temperature values of the study area and examined the significance of each variable in predicting the probability of a household with a mosquito breeding site with and without larvae. The findings of this study revealed that households with any potential breeding sites were characterized by higher moisture, higher vegetation density (NDVI) and in urban areas or roads. The results of this study also confirmed that land surface temperature was significant in explaining the presence of active mosquito breeding sites (P< 0.000). The present study showed that freely available Landsat 8 imagery has limited use in deriving environmental characteristics of malaria vector habitats at the scale of the Bungoma East District in Western Kenya.

The Use of Agricultural Chemicals and Mosquito Response to Pyrethroids in Bungoma Sub-county,Western Kenya

Insecticide treated bed nets and indoor residual spraying are the most widely used vector control methods in Africa. The World Health Organization now recommends four classes of insecticides for use against adult mosquitoes in public health programs. Of these four classes of insecticides, pyrethroids have become the insecticides of choice in treating mosquito bed nets and in the use of indoor spraying to prevent malaria transmission. Pyrethroids are not only used in malaria control but also in agriculture to protect against pest insects. This concurrent use of pyrethroids in vector control and protection of crops from pests in agriculture may exert selection pressure on mosquito larval population and induce resistance to this class of insecticides. The main objective of our study was to explore the role of agricultural chemicals and the response of mosquitoes to pyrethroids in an area of high malaria transmission.

We used a cross-sectional study design. This was a two-step study involving both mosquitoes and human subjects. In this study, we collected larvae growing in breeding sites affected by different agricultural practices. We used purposive sampling to identify active mosquito breeding sites and then interviewed households adjacent to those breeding sites to learn about their agricultural practices that might influence the response of mosquitoes to pyrethroids. We also performed secondary analysis of larval data from a previous case-control study by Obala et al.

Q Fever, Scrub Typhus, and Rickettsial Diseases in Children, Kenya, 2011-2012.

To increase knowledge of undifferentiated fevers in Kenya, we tested paired serum samples from febrile children in western Kenya for antibodies against pathogens increasingly recognized to cause febrile illness in Africa. Of patients assessed, 8.9%, 22.4%, 1.1%, and 3.6% had enhanced seroreactivity to Coxiella burnetii, spotted fever group rickettsiae, typhus group rickettsiae, and scrub typhus group orientiae, respectively.

Men's knowledge and attitudes about cervical cancer screening in Kenya.

BACKGROUND: A number of studies have identified male involvement as an important factor affecting reproductive health outcomes, particularly in the areas of family planning, antenatal care, and HIV care. As access to cervical cancer screening programs improves in resource-poor settings, particularly through the integration of HIV and cervical cancer services, it is important to understand the role of male partner support in women's utilization of screening and treatment. METHODS: We administered an oral survey to 110 men in Western Kenya about their knowledge and attitudes regarding cervical cancer and cervical cancer screening. Men who had female partners eligible for cervical cancer screening were recruited from government health facilities where screening was offered free of charge. RESULTS: Specific knowledge about cervical cancer risk factors, prevention, and treatment was low. Only half of the men perceived their partners to be at risk for cervical cancer, and many reported that a positive screen would be emotionally upsetting. Nevertheless, all participants said they would encourage their partners to get screened. CONCLUSIONS: Future interventions should tailor cervical cancer educational opportunities towards men. Further research is needed among both men and couples to better understand barriers to male support for screening and treatment and to determine how to best involve men in cervical cancer prevention efforts.

A randomized trial comparing the diagnostic accuracy of visual inspection with acetic acid to Visual Inspection with Lugol's Iodine for cervical cancer screening in HIV-infected women.

Visual inspection with Acetic Acid (VIA) and Visual Inspection with Lugol’s Iodine (VILI) are increasingly recommended in various cervical cancer screening protocols in low-resource settings. Although VIA is more widely used, VILI has been advocated as an easier and more specific screening test. VILI has not been well-validated as a stand-alone screening test, compared to VIA or validated for use in HIV-infected women. We carried out a randomized clinical trial to compare the diagnostic accuracy of VIA and VILI among HIV-infected women. Women attending the Family AIDS Care and Education Services (FACES) clinic in western Kenya were enrolled and randomized to undergo either VIA or VILI with colposcopy. Lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+) were biopsied. Between October 2011 and June 2012, 654 were randomized to undergo VIA or VILI. The test positivity rates were 26.2% for VIA and 30.6% for VILI (p = 0.22). The rate of detection of CIN2+ was 7.7% in the VIA arm and 11.5% in the VILI arm (p = 0.10). There was no significant difference in the diagnostic performance of VIA and VILI for the detection of CIN2+. Sensitivity and specificity were 84.0% and 78.6%, respectively, for VIA and 84.2% and 76.4% for VILI. The positive and negative predictive values were 24.7% and 98.3% for VIA, and 31.7% and 97.4% for VILI. Among women with CD4+ count < 350, VILI had a significantly decreased specificity (66.2%) compared to VIA in the same group (83.9%, p = 0.02) and compared to VILI performed among women with CD4+ count ≥ 350 (79.7%, p = 0.02). VIA and VILI had similar diagnostic accuracy and rates of CIN2+ detection among HIV-infected women.

Developing and Validating a Perinatal Depression Screening Tool in Bungoma County, Kenya

Background: Depression-screening tools exist and are widely used in Western settings. There have been few studies done to explore whether or not existing tools are valid and effective to use in sub-Saharan Africa. Our study aimed to develop and validate a perinatal depression-screening tool in rural Kenya.

Methods: We utilized conducted free listing and card sorting exercises with a purposive sample of 12 women and 38 CHVs living in a rural community to explore the manifestations of perinatal depression in that setting. We used the information obtained to produce a locally relevant depression-screening tool that comprised of existing Western psychiatric concepts and locally derived items. Subsequently, we administered the novel depression-screening tool and two existing screening tools (the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9) to 193 women and compared the results of the screening tool with that of a gold standard structured clinical interview to determine validity.

Results: The free listing and card sorting exercise produced a set of 60 screening items. Of the items in this set, we identified the 10 items that most accurately classified cases and non-cases. This 10-item scale had a sensitivity of 100.0 and specificity of 81.2. This compared to 90.0, 31.5 and 90.0, 49.7 for the EPDS and the PHQ-9, respectively. Overall, we found a prevalence of depression of 5.2 percent.

Conclusions: The new scale does very well in terms of diagnostic validity, having the highest scores in this domain compared to the EPDS, EPDS-R and PHQ-9. The adapted scale does very well with regards to convergent validity-illustrating clear distinction between mean scores across the different categories. It does well with regards to discriminant validity, internal consistency reliability, and test-retest reliability- not securing top scores in those domains but still yielding satisfactory results.