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Githua A, Macharia JK, Nduhiu JG, McDermott JJ;, Omore AO, Arimi SM, Kang'ethe EK. "Testing for Antibodies to Brucella abortus in Milk From Consumers and Market Agents in Kenya Using Milk Ring Test and Enzyme Immunoassay.". 2004. Abstract

Over 85% of all milk sales on Kenya pass through informal channels. The extent of the risk posed by the sale of this raw milk to human health in respect to brucellosis is unknown. This paper presents the results of a study on the occurrence of antibodies to Brucella abortus in milk from households consuming raw unpasteurized milk and market agent selling the same. Four hundred thirty four (434) raw milk samples from consumer households and 508 from informal market agents were collected between January 1999 and January 2000 from Nakuru /Narok and Nairobi/Kiambu. Milk agents sampled included co-operative societies, milk collecting centers and self-help groups, milk bars, shops and kiosks and mobile traders on foot, bicycle or motorized transport. In addition, 147 samples from the formal market chain (pasteurized) were collected. All the samples from the samples were screened for antibodies to Brucella abortus using ELISA and Milk Ring Test (MRT), except for the formal milk that was tested using ELISA only. Five percent of the consumer household samples and 4% of the samples form informal milk market agents tested positive on ELISA. There was poor agreement between the two antibody surrogate tests (Kappa =0.40, 95% confidence interval =0.19-0.60). ELISA detected 3.2% more samples from consumer households and 0.4% from informal market agents than MRT. Of the formal market samples, 16.4% were positive. Ways of reducing the risk of contracting brucellosis from drinking raw milk are proposed.

Githua A, Macharia JK, Nduhiu JG, McDermott JJ, Omore AO, Arimi SM, E K K'the. "The prevalence of antibodies to Brucella abortus in marketed milk in Kenya and its public health implications.". 2000. Abstract

The risk of infection by milk-borne brucellosis is one reason for public health regulations which discourage informal milk markets that sell unpasteurized milk. However, these regulations are not generally implemented in many developing countries. Kenya is a typical example, with over 85% of milk sales passing through informal channels. Consumer practices to reduce or eliminate potential infection by milk-borne health hazards under these circumstances have rarely been studied. Seasonal survey data were collected between January 1999 and January 2000 from informal milk market agents of various cadres and from households consuming unpasteurized milk in rural and urban locations in central Kenya. Respondents were randomly selected within production system (extensive and intensive) and human population density (urban, peri-urban and rural) strata. In addition, pasteurized and packaged milk samples from five processors were collected. Samples were screened for antibodies to Brucella abortus using the milk ring test (MRT) (unpasteurized milk) and indirect antibody ELISA (both unpasteurized and pasteurized milk). Milk samples originating from farms in the extensive production system and those containing milk from many sources were associated with higher antibody detection proportions. Five percent of all raw milk samples collected from consumer households and 4% of samples collected from various levels of bulking of market samples were positive to the ELISA. There was poor to no agreement between the two antibody detection tests. All urban consumers and 96% of rural consumers of unpasteurized milk indicated that they boil the milk (in tea or otherwise) before consumption. The implications of these results on milk marketing in Kenya are discussed.

Grace D, Gilbert J, Randolph T, Kang’ethe E. "The multiple burdens of zoonotic disease and an ecohealth approach to their assessment.". 2012. Abstract

Zoonoses occur at the interface of human and animal disease and partly because their impact and management fall across two sectors they are often neglected. The Global Burden of Disease captures the impact of zoonoses on human health in terms of disability-adjusted life years (DALYs). Based on this, we estimate that in low income countries, zoonoses and diseases which recently emerged from animals make up 26 % of the DALYs lost to infectious disease and 10 % of the total DALYs lost. In contrast, in high income countries, zoonoses and diseases recently which emerged from animals represent less than 1 % of DALYs lost to infectious disease and only 0.02 % of the total disease burden. We present a framework that captures the costs of zoonoses and emerging disease to human, animal and ecosystem health in terms of cost of treatment, cost of prevention, health burden and intangible and opportunity costs. We also discuss how ecohealth concepts of transdisciplinarity, participation and equity can help in assessing the importance of zoonoses in developing countries and illustrate these with an example of assessing milk-borne disease.

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