DR. MWANGI JOSEPH CEGE

{ OBJECTIVES: To profile and quantify the psychometric properties of the NOK (Ndetei-Othieno-Kathuku) scale against internationally used Gold-standards and benchmarks for mild psychiatric disorders and post-traumatic stress disorders and to provide a potential easy to administer culture sensitive instrument for screening and assessing those with possible psychiatric disorders for the Kenyan and similar social-cultural situations. <br>DESIGN: Cross-Sectional quantitative study. <br>SETTING: A psychiatric clinical consultation setting and Kyanguli Secondary School psychotrauma counselling clinical set-up. <br>SUBJECTS: Survivors of the Nairobi USA Embassy bombing who were referred for psychiatric treatment and survivors of a fire disaster from a rural Kenyan school (Kyanguli School fire disaster) including students, parents of the diseased children and staff members. <br>RESULTS: Positive correlation was found between the NOK and all the instruments. The highest correlations were between the NOK and the BDI and SCL-90 (r = 0.557 to 0.786). The differences between the NOK scores among the different groups were statistically significant (F ratio = 13.54 to 160.34, p < 0.01). The reliability coefficient (internal consistency) of the scale

Kenya Medical Research Institute, Centre for Biotechnology Research and Development, Nairobi, Kenya. A quantitative nucleic acid sequence-based amplification (QT-NASBA) assay was employed to predict retrospectively the outcome of sulfadoxine-pyrimethamine (SP) treatment of uncomplicated malaria in children aged <6 years in an endemic region. Blood samples were collected at initial diagnosis and during follow-up. Mutation-specific nested PCR methods to analyse DHFR (Arg-59) and DHPS (Glu-540) mutations that are associated with SP drug resistance were applied. Parasite genotyping was performed to distinguish between re-infection and recrudescence. Eighty-six patients were recruited of which 66 were available for follow-up. Nine children were classified as early treatment failure, 13 cases were classified as late clinical failure, 32 as late parasitological failure, and only 12 children had an adequate clinical and parasitological response. DHFR and DHPS mutations conferring SP resistance were abundant in the Plasmodium population. Blood samples obtained 7 days after treatment were used to predict retrospectively the outcome of SP treatment. QT-NASBA was able to give a correct prediction of treatment outcome in 85.7% of the cases. Positive predictive value (PPV) of QT-NASBA case was 95% (95% confidence interval = 88.3-100) and negative predictive value (NPV) was 63% (95% CI = 39.5-86.5). In contrast, microscopy correctly predicted outcome in only 37.5% of the cases. PPV of microscopy was 100% (95% CI = 73.9-100) and the NPV was 25.5% (95% CI = 13.0-38.0). The analysis of a day 7 blood sample with QT-NASBA allows for the prediction of late clinical or parasitological treatment failure in the majority of the cases analysed in the present study. PMID: 15804381 [PubMed - indexed for MEDLINE]

Kenya Medical Research Institute, Nairobi, Kenya. skhamadi@nairobi.mimcom.net The genetic subtypes of HIV-1 circulating in northern Kenya have not been characterized. Here we report the partial sequencing and analysis of samples collected in the years 2003 and 2004 from 72 HIV-1-positive patients in northern Kenya, which borders Ethiopia, Somalia, and Sudan. From the analysis of partial env sequences, it was determined that 50% were subtype A, 39% subtype C, and 11% subtype D. This shows that in the northern border region of Kenya subtypes A and C are the dominant HIV-1 subtypes in circulation. Ethiopia is dominated mainly by HIV-1 subtype C, which incidentally is the dominant subtype in the town of Moyale, which borders Ethiopia. These results show that cross-border movements play an important role in the circulation of subtypes in Northern Kenya.

U.S. Army Medical Research Unit, Nairobi, Kenya. The drug resistance profiles of Plasmodium falciparum isolated from four regions in Kenya were analyzed for drug resistance profiles. We observed variability in resistance to a broad range of antimalarial drugs across Kenya as determined from in vitro drug susceptibility screening and genotyping analysis.

Department of Psychiatry, University of Nairobi, P.O. Box 19676, Nairobi, Kenya. Following the death of 67 boys in a fire tragedy at Kyanguli School in rural Kenya, the level of traumatic grief was assessed in a sample of 164 parents and guardians whose sons died in the fire. The study was cross-sectional. Counseling services were offered to all the bereaved parents soon after the tragedy. The subjects were interviewed using the Traumatic Grief Scale. A group of 92 parents/guardians was interviewed 2 months after the event, while the other group of 72 was assessed 7 days later. The second group of bereaved parents also completed the Self Rating Questionnaire (SRQ) and the Ndetei-Othieno-Kathuku scale (NOK). Over 90% of parents from both groups had a yearning for the departed and found themselves searching for him quite often. There was no much difference in terms of symptoms profile or intensity between the two groups. It appears that the counseling offered had minimal impact on the levels of distress.

Kenya Medical Research Institute, Centre for Biotechnology Research and Development, Nairobi, Kenya. A quantitative nucleic acid sequence-based amplification (QT-NASBA) assay was employed to predict retrospectively the outcome of sulfadoxine-pyrimethamine (SP) treatment of uncomplicated malaria in children aged <6 years in an endemic region. Blood samples were collected at initial diagnosis and during follow-up. Mutation-specific nested PCR methods to analyse DHFR (Arg-59) and DHPS (Glu-540) mutations that are associated with SP drug resistance were applied. Parasite genotyping was performed to distinguish between re-infection and recrudescence. Eighty-six patients were recruited of which 66 were available for follow-up. Nine children were classified as early treatment failure, 13 cases were classified as late clinical failure, 32 as late parasitological failure, and only 12 children had an adequate clinical and parasitological response. DHFR and DHPS mutations conferring SP resistance were abundant in the Plasmodium population. Blood samples obtained 7 days after treatment were used to predict retrospectively the outcome of SP treatment. QT-NASBA was able to give a correct prediction of treatment outcome in 85.7% of the cases. Positive predictive value (PPV) of QT-NASBA case was 95% (95% confidence interval = 88.3-100) and negative predictive value (NPV) was 63% (95% CI = 39.5-86.5). In contrast, microscopy correctly predicted outcome in only 37.5% of the cases. PPV of microscopy was 100% (95% CI = 73.9-100) and the NPV was 25.5% (95% CI = 13.0-38.0). The analysis of a day 7 blood sample with QT-NASBA allows for the prediction of late clinical or parasitological treatment failure in the majority of the cases analysed in the present study. PMID: 15804381 [PubMed - indexed for MEDLINE]

Medecins Sans Frontieres, Geneva, Switzerland. elisasti@tin.it To provide advice on the rational use of antimalarial drugs, Medecins Sans Frontieres conducted a randomized, an open label efficacy study in Kajo Keji, an area of high transmission of malaria in southern Sudan. The efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) were measured in a 28-day in vivo study, with results corrected by PCR genotyping. Of 2010 children screened, 115 children aged 6-59 months with uncomplicated Plasmodium falciparum malaria were randomized into each group to receive a supervised course of treatment. Of these, 114, 103 and 111 were analysed in the CQ, SP and AQ groups, respectively. The overall parasitological failure rates at day 28 were 93.9% [95% confidence interval (CI) 87.3-97.3] for CQ, 69.9% (95% CI 60.0-78.3) for SP, and 25.2% (95% CI 17.7-34.5) for AQ. These results provide important missing data on antimalarial drug efficacy in southern Sudan. They indicate that none of the drugs could be used in monotherapy and suggest that even in combination with artemisinin, cure rates might not be efficacious enough. We recommend a combination of artemether and lumefantrine as first-line treatment for uncomplicated P. falciparum malaria cases in Kajo Keji county.

Participatory Approaches to Veterinary Epidemiology Project, Sustainable Agriculture and Rural Livelihoods Programme, International Institute for Environment and Development, 3 Endsleigh Street, London WC1H 0DD, UK. andy.catley@oau-ibar.org In southern Sudan, livestock keepers identified a chronic wasting disease in adult cattle as one of their most-serious animal-health problems. Participatory-appraisal (PA) methods and conventional veterinary-investigation methods were used to characterise the chronic wasting disease and identify linkages between indigenous knowledge and modern veterinary knowledge. The local characterisation of chronic wasting encompassed trypanosomosis, fasciolosis, parasitic gastroenteritis and schistosomosis (as both single and mixed infections).A standardised PA method called matrix scoring had good reproducibility when investigating local perceptions of disease-signs and disease causes. Comparison of matrix-scoring results showed much overlap with modern veterinary descriptions of cattle diseases and the results of conventional veterinary investigation. Applications of PA methods in remote areas with very limited veterinary infrastructure are discussed. The validation of data derived from PA is discussed by reference to the low sensitivity of 'field-friendly' diagnostic tests for important cattle diseases.

Participatory Approaches to Veterinary Epidemiology Project, Sustainable Agriculture and Rural Livelihoods Programme, International Institute for Environment and Development, 3 Endsleigh Street, London WC1H 0DD, UK. andy.catley@oau-ibar.org In southern Sudan, livestock keepers identified a chronic wasting disease in adult cattle as one of their most-serious animal-health problems. Participatory-appraisal (PA) methods and conventional veterinary-investigation methods were used to characterise the chronic wasting disease and identify linkages between indigenous knowledge and modern veterinary knowledge. The local characterisation of chronic wasting encompassed trypanosomosis, fasciolosis, parasitic gastroenteritis and schistosomosis (as both single and mixed infections).A standardised PA method called matrix scoring had good reproducibility when investigating local perceptions of disease-signs and disease causes. Comparison of matrix-scoring results showed much overlap with modern veterinary descriptions of cattle diseases and the results of conventional veterinary investigation. Applications of PA methods in remote areas with very limited veterinary infrastructure are discussed. The validation of data derived from PA is discussed by reference to the low sensitivity of 'field-friendly' diagnostic tests for important cattle diseases.

Hepatocellular carcinoma is the third most common malignancy in Kenyan males occurring with a peak incidence at 40 years of age. A worldwide correlation has been noted between the incidence of hepatocellular carcinoma and prevalence of hepatitis B virus. Liver biopsies with histological diagnosis of hepatocellular carcinoma (HCC), cirrhosis and the normals were reviewed by the authors. They were then stained for hepatitis B surface antigen (HBsAg) and hepatitis e core antigen (HBcAg). Only 2.5% of normal livers were positive for HBsAg compared with 33% of HCC and 25% of cirrhosis respectively. Hepatitis core antigen was not demonstrated in normal liver biopsies but it was present in 11.5% of HCC and 14% of cirrhosis. Background cirrhosis was noted in 52% of biopsies showing HCC. It is clear that a causal association exists between hepatitis B virus (HBV) and both liver cirrhosis and hepatocellular carcinoma. Higher antigen markers, up to 80% have been reported in South East Asia and India. This difference may be due to the type of biopsy examined (needle biopsy vs open biopsy) but the possibility that other factors such as aflatoxin and non A/non B hepatitis viruses play a more significant role in the causation of liver disease in Kenya than has previously been assumed should be explored.

A bisquinaldine, 1,6-bis-(6-amino-2-methyl-4-quinolylamino) hexane, was tested against Trypanosoma brucei ssp. in goats and against T. brucei, T. congolense and T. vivax in mice. At doses of 25 and 100 mg kg-1, the drug protected goats for at least 90 days against blood challenge with T. brucei ssp. Fifty to sixty per cent of goats challenged 180 days after treatment were protected, but all goats challenged 270 days after treatment became infected. In mice, bisquinaldine also had a marked effect on T. brucei, but only a minimal effect on T. vivax and no apparent effect on T. congolense. No drug toxicity was noted in mice even at doses of 2000 mg kg-1. Both a short-term (25 and 100 mg kg-1) and long term (100 mg kg-1) toxicity was apparent in goats treated with bisquinaldine.

During a recent outbreak of Rhodesian sleeping sickness in the Lambwe Valley no asymptomatic Rhodesian sleeping sickness patients were found although 54% of the primary patients had mild symptoms and 9% were stuporous or comatose at presentation. The duration of symptoms was three months or less in 90% of the patients. Headache, weakness, joint and back pains and weight loss were claimed by at least 75% of the patients, while 82% of the females reported amenorrhoea and 70% of the males claimed impotency. Physical examination revealed lymphadenopathy in 86% but fever in only 36% of the patients, while chancres were found in only 16%. Patients had significantly lower levels of haemoglobin and thrombocytes than controls and their erythrocyte sedimentation rates were elevated. A comparison of both blood group and haemoglobin type between patients and controls yielded no significant differences. Fifty-seven per cent of the primary patients reporting mild symptoms had abnormal levels of leucocytes in their CSF. All relapse patients had abnormal CSF parameters. Levels of serum urea nitrogen were significantly elevated in patients, but SGOT, SGPT and total bilirubin were not. Levels of albumin and beta-globulin in patients were significantly lower than controls while gamma-globulin was elevated. Mean serum IgM levels in patients were elevated to nearly three-fold those of controls, but 35% of the individual patient values fell within the 95% range of control values. Some patients had extended prothrombin and thrombin times while fibrinogen levels were significantly elevated. No patients reported haemorrhage, and none was seen.