Publications

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2019
Kawakyu N, Nduati R, Obimbo E, Munguambe K, Coutinho J, Mburu N, DeCastro G, Inguane C, Zunt A, Abburi N, Sherr K, S. G. "Development and Implementation of a Mobile Phone-Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique." JMIR Mhealth Uhealth. 2019;13;7(5):( doi: 10.2196/13963.):e13963.
Simonich CA, Doepker L, Ralph D, Williams JA, Dhar A, Yaffe Z, Gentles L, Small CT, Oliver B, Vigdorovich V, Mangala Prasad V, NNduati R. "Kappa chain maturation helps drive rapid development of an infant HIV-1 broadly neutralizing antibody lineage.". 2019.
2018
Farquhar C, Nduati RW, JN. W. "Ethical Obligations in Short-Term Global Health Clinical Experiences: The Devil Is in the Details." Ann Intern Med.. 2018; 1;(168(9):):672-673.
Gaitho D, Kumar M, Wamalwa D, Farquhar C, Wambua GN, R. N. "Understanding mental health difficulties and associated psychosocial outcomes in adolescents in the HIV clinic at Kenyatta National Hospital, Kenya." Ann Gen Psychiatry. 2018;10;(17:):29.
2017
Buttolph J, Inwani I, Agot K, Cleland CM, Cherutich P, Kiarie JN, Osoti A, Celum CL, Baeten JM, Ruth Nduati, John Kinuthia, James N Kiarie, Hallett TB, Alsallaq R, Kurth AE. "Gender-Specific Combination HIV Prevention for Youth in High-Burden Settings: The MP3 Youth Observational Pilot Study Protocol." JMIR Res Protoc. 2017;6(3):e22. Abstract

Nearly three decades into the epidemic, sub-Saharan Africa (SSA) remains the region most heavily affected by human immunodeficiency virus (HIV), with nearly 70% of the 34 million people living with HIV globally residing in the region. In SSA, female and male youth (15 to 24 years) are at a disproportionately high risk of HIV infection compared to adults. As such, there is a need to target HIV prevention strategies to youth and to tailor them to a gender-specific context. This protocol describes the process for the multi-staged approach in the design of the MP3 Youth pilot study, a gender-specific, combination, HIV prevention intervention for youth in Kenya.

Newman LP, Njoroge A, Magaret A, Chohan BH, Gitomea VW, Wald A, Gorstein J, Overbaugh J, Dalton Wamalwa, Maleche-Obimbo E, Ruth Nduati, Farquhar C. "Sustained Responses to Measles Revaccination at 24 Months in HIV-Infected Children on Antiretroviral Therapy in Kenya." Pediatr. Infect. Dis. J.. 2017. Abstract

There are limited data on whether HIV-infected children in resource-limited countries who are receiving antiretroviral therapy (ART) are able to produce sustained, protective levels of measles antibody after multiple measles vaccinations.

2016
Rustagi AS, Gimbel S, Ruth Nduati, de Cuembelo MF, Wasserheit JN, Farquhar C, Gloyd S, Sherr K. "Health facility factors and quality of services to prevent mother-to-child HIV transmission in Côte d'Ivoire, Kenya, and Mozambique." Int J STD AIDS. 2016. Abstract

This study aimed to identify facility-level characteristics associated with prevention of mother-to-child HIV transmission service quality. This cross-sectional study sampled 60 health facilities in Mozambique, Côte d'Ivoire, and Kenya (20 per country). Performance score - the proportion of pregnant women tested for HIV in first antenatal care visit, multiplied by the proportion of HIV-positive pregnant women who received appropriate antiretroviral medications - was calculated for each facility using routine data from 2012 to 2013. Facility characteristics were ascertained during on-site visits, including workload. Associations between facility characteristics and performance were quantified using generalized linear models with robust standard errors, adjusting for country. Over six months, facilities saw 38,611 first antenatal care visits in total. On-site CD4 testing, Pima CD4 machine, air conditioning, and low or high (but not mid-level) patient volume were each associated with higher performance scores. Each additional first antenatal care visit per nurse per month was associated with a 4% (95% confidence interval: 1%-6%) decline in the odds that an HIV-positive pregnant woman would receive both HIV testing and antiretroviral medications. Physician workload was only modestly associated with performance. Investments in infrastructure and human resources - particularly nurses - may be critical to improve prevent mother-to-child HIV transmission service delivery and protect infants from HIV.

Nduati EW, Nkumama IN, Gambo FK, Muema DM, Knight MG, Hassan AS, Jahangir MN, Etyang TJ, Berkley JA, Urban BC. "HIV-exposed uninfected infants show robust memory B cell responses in spite of a delayed accumulation of memory B cells: An observational study in the first two years of life." Clin. Vaccine Immunol.. 2016. Abstract

Improved HIV care has led to an increase in the number of HIV-exposed uninfected (HEU) infants born to HIV infected women. Although uninfected, these infants experience increased morbidity and mortality. One explanation may be that their developing immune system is altered by HIV-exposure predisposing them to increased post-natal infections.

Richardson BA, John-Stewart G, Atkinson C, Ruth Nduati, Ásbjörnsdóttir K, Boeckh M, Overbaugh J, Emery V, Slyker JA. "Vertical Cytomegalovirus Transmission From HIV-Infected Women Randomized to Formula-Feed or Breastfeed Their Infants." J. Infect. Dis.. 2016;213(6):992-8. Abstract

Cytomegalovirus (CMV) is associated with morbidity and mortality in human immunodeficiency virus (HIV)-exposed infants. We assessed the effect of and relative contribution of breastfeeding to CMV acquisition among infants delivered by HIV-infected mothers.

Simonich CA, Williams KL, Verkerke HP, Williams JA, Ruth Nduati, Lee KK, Overbaugh J. "HIV-1 Neutralizing Antibodies with Limited Hypermutation from an Infant." Cell. 2016. Abstract

HIV-1 broadly neutralizing antibodies (bnAbs) develop in a subset of infected adults and exhibit high levels of somatic hypermutation (SHM) due to years of affinity maturation. There is no precedent for eliciting highly mutated antibodies by vaccination, nor is it practical to wait years for a desired response. Infants develop broad responses early, which may suggest a more direct path to generating bnAbs. Here, we isolated ten neutralizing antibodies (nAbs) contributing to plasma breadth of an infant at ∼1 year post-infection, including one with cross-clade breadth. The nAbs bind to envelope trimer from the transmitted virus, suggesting that this interaction may have initiated development of the infant nAbs. The infant cross-clade bnAb targets the N332 supersite on envelope but, unlike adult bnAbs targeting this site, lacks indels and has low SHM. The identification of this infant bnAb illustrates that HIV-1-specific neutralization breadth can develop without prolonged affinity maturation and extensive SHM.

Odeny BM, Pfeiffer J, Farquhar C, Igonya EK, Gatuguta A, Kagwaini F, Ruth Nduati, Kiarie J, Bosire R. "The Stigma of Exclusive Breastfeeding Among Both HIV-Positive and HIV-Negative Women in Nairobi, Kenya." Breastfeed Med. 2016;11:252-8. Abstract

Exclusive breastfeeding (EBF) means giving only breast milk to an infant. Although it is the optimal mode of feeding for infants younger than 6 months, its prevalence is low in HIV-endemic regions. Extensive promotion of EBF for 6 months in prevention of mother-to-child HIV transmission (PMTCT) programs could inadvertently result in stigma due to women's perceived association of EBF with HIV infection. In this qualitative study, we describe how stigma impacts the uptake of EBF among HIV-positive and -negative women.

Rustagi AS, Gimbel S, Ruth Nduati, de Cuembelo MF, Wasserheit JN, Farquhar C, Gloyd S, Sherr K. "Implementation and Operational Research: Impact of a Systems Engineering Intervention on PMTCT Service Delivery in Côte d'Ivoire, Kenya, Mozambique: A Cluster Randomized Trial." J. Acquir. Immune Defic. Syndr.. 2016;72(3):e68-76. Abstract

Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Previous studies of systems engineering applications to PMTCT lacked comparison groups or randomization.

Milligan C, Omenda MM, Chohan V, Odem-Davis K, Richardson BA, Ruth Nduati, Overbaugh J. "Maternal Neutralization-Resistant Virus Variants Do Not Predict Infant HIV Infection Risk." MBio. 2016;7(1):e02221-15. Abstract

Mother-to-child transmission (MTCT) of HIV provides a setting for studying immune correlates of protection. Neutralizing antibodies (NAbs) are suggested to contribute to a viral bottleneck during MTCT, but their role in blocking transmission is unclear, as studies comparing the NAb sensitivities of maternal viruses have yielded disparate results. We sought to determine whether transmitting mothers differ from nontransmitting mothers in the ability to neutralize individual autologous virus variants present at transmission. Ten transmitting and 10 nontransmitting HIV-infected mothers at high risk of MTCT were included in this study. Full-length HIV envelope genes (n = 100) were cloned from peripheral blood mononuclear cells obtained near transmission from transmitting mothers and at similar time points from nontransmitting mothers. Envelope clones were tested as pseudoviruses against contemporaneous, autologous maternal plasma in neutralization assays. The association between transmission and the log2 50% inhibitory concentration (IC50) for multiple virus variants per mother was estimated by using logistic regression with clustered standard errors. t tests were used to compare proportions of neutralization-resistant viruses. Overall, transmitting mothers had a median IC50 of 317 (interquartile range [IQR], 202 to 521), and nontransmitting mothers had a median IC50 of 243 (IQR, 95 to 594). Transmission risk was not significantly associated with autologous NAb activity (odds ratio, 1.25; P = 0.3). Compared to nontransmitting mothers, transmitting mothers had similar numbers of or fewer neutralization-resistant virus variants, depending on the IC50 neutralization resistance cutoff. In conclusion, HIV-infected mothers harbor mostly neutralization-sensitive viruses, although resistant variants were detected in both transmitting and nontransmitting mothers. These results suggest that MTCT during the breastfeeding period is not driven solely by the presence of maternal neutralization escape variants.

Bosire R, Betz B, Aluisio A, Hughes JP, Ruth Nduati, Kiarie J, Chohan BH, Merkel M, Lohman-Payne B, John-Stewart G, Farquhar C. "High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women." Breastfeed Med. 2016;11:56-63. Abstract

Exclusive breastfeeding (EBF) is recommended for 6 months after delivery as the optimal infant feeding method and is especially important for prevention of mother-to-child HIV transmission (PMTCT). However, EBF promotion efforts among HIV-infected mothers in sub-Saharan Africa have achieved mixed success and require context-specific interventions.

Aluisio AR, Bosire R, Betz B, Gatuguta A, Kiarie JN, Nduati R, John-Stewart G, Farquhar C. "Male Partner Participation in Antenatal Clinic Services is Associated with Improved HIV-free survival Among Infants in Nairobi, Kenya: A Prospective Cohort Study." J. Acquir. Immune Defic. Syndr.. 2016. Abstract

This prospective study investigated the relationship between male antenatal clinics (ANC) involvement and infant HIV-free survival.

2015
Milligan C, Richardson BA, John-Stewart G, Ruth Nduati, Overbaugh J. "FCGR2A and FCGR3A Genotypes in Human Immunodeficiency Virus Mother-to-Child Transmission." Open Forum Infect Dis. 2015;2(4):ofv149. Abstract

Background.  Fc-mediated effector functions have been suggested to influence human immunodeficiency virus (HIV) acquisition and disease progression. Analyzing the role of host Fc gamma receptor (FcγR) polymorphisms on HIV outcome in mother-to-child transmission (MTCT) will increase our understanding of how host genetics may alter immune responses in prevention, therapy, and disease. This study analyzed the impact of FCGR2A and FCGR3A genotypes on MTCT in a cohort in which Fc-mediated antibody functions are predictive of infant HIV outcome. Methods.  Human immunodeficiency virus-positive mothers and their infants from a historical MTCT cohort were genotyped for FCGR2A and FCGR3A. We assessed the impact of these genotypes on transmission and acquisition of HIV and disease progression using χ(2) tests, survival analyses, and logistic regression. Results.  Among 379 mother-infant pairs, infant FCGR2A and FCGR3A genotypes were not associated with infant HIV infection or disease progression. Maternal FCGR2A was not associated with transmission, but there was a trend between maternal FCGR3A genotype and transmission (P = .07). When dichotomizing mothers into FCGR3A homozygotes and heterozygotes, heterozygotes had a 64.5% higher risk of transmission compared with homozygotes (P = .02). This risk was most evident in the early breastfeeding window, but a trend was only observed when restricting analyses to breastfeeding mothers (hazards ratio, 1.64; P = .064). Conclusions.  Infant FCGR2A and FCGR3A genotypes were not associated with HIV infection or disease progression, and, thus, host FcγR genotype may not significantly impact vaccination or therapeutic regimens that depend on Fc-mediated antibody functions. Maternal FCGR3A genotype may influence early breastfeeding transmission risk, but more studies should be conducted to clarify this association and its mechanism.

Muema DM, Macharia GN, Hassan AS, Mwaringa SM, Fegan GW, Berkley JA, Nduati EW, Urban BC. "Control of Viremia Enables Acquisition of Resting Memory B Cells with Age and Normalization of Activated B Cell Phenotypes in HIV-Infected Children." J. Immunol.. 2015;195(3):1082-91. Abstract

HIV affects the function of all lymphocyte populations, including B cells. Phenotypic and functional defects of B cells in HIV-infected adults have been well characterized, but defects in children have not been studied to the same extent. We determined the proportion of B cell subsets and frequencies of Ag-specific memory B cells in peripheral blood from HIV-infected children and healthy controls, using flow cytometry and B cell ELISPOT, respectively. In addition, we measured the quantities and avidities of plasma Abs against various Ags by ELISA. We also determined plasma levels of BAFF and expression of BAFF receptors on B cells. Children with high HIV viremia had increased proportions of activated mature B cells, tissue-like memory B cells and plasmablasts, and low proportions of naive B cells when compared with community controls and children with low HIV viremia, similar to adults infected with HIV. HIV-infected groups had lower proportions of resting memory B cells than did community controls. Notably, high HIV viremia prevented the age-dependent accumulation of class-switched resting memory B cells. HIV-infected children, regardless of the level of viremia, showed lower quantities and avidities of IgG and lower frequencies of memory B cells against Expanded Program on Immunization vaccines. The HIV-infected children had an altered BAFF profile that could have affected their B cell compartment. Therefore, B cell defects in HIV-infected children are similar to those seen in HIV-infected adults. However, control of HIV viremia is associated with normalization of activated B cell subsets and allows age-dependent accumulation of resting memory B cells.

Muema DM, Nduati EW, Uyoga M, Bashraheil M, Scott JAG, Hammitt LL, Urban BC. "10-valent pneumococcal non-typeable Haemophilus influenzae protein-D conjugate vaccine (PHiD-CV) induces memory B cell responses in healthy Kenyan toddlers." Clin. Exp. Immunol.. 2015;181(2):297-305. Abstract

Memory B cells are long-lived and could contribute to persistence of humoral immunity by maintaining the plasma-cell pool or making recall responses upon re-exposure to an antigen. We determined the ability of a pneumococcal conjugate vaccine to induce anti-pneumococcal memory B cells. Frequencies of memory B cells against pneumococcal capsular polysaccharides from serotypes 1, 6B, 14, 19F and 23F were determined by cultured B cell enzyme-linked immunospot (ELISPOT) in 35 children aged 12-23 months who received pneumococcal non-typeable Haemophilus influenzae protein-D conjugate vaccine (PHiD-CV). The relationships between plasma antibodies and memory B cell frequencies were also assessed. After two doses of PHiD-CV, the proportion of subjects with detectable memory B cells against pneumococcal capsular polysaccharides increased significantly for serotypes 1 (3-45%; P < 0·01), 19F (21-66%; P < 0·01) and 23F (13-36%; P = 0·02), but not serotypes 6B (24-42%; P = 0·24) and 14 (21-40%; P = 0·06). Correlations between antibodies and memory B cells were weak. Carriage of serotype 19F at enrolment was associated with poor memory B cell responses against this serotype at subsequent time-points (day 30: non-carriers, 82% versus carriers, 0%, P < 0·01; day 210: non-carriers, 72% versus carriers, 33%, P = 0·07). PHiD-CV is capable of inducing memory B cells against some of the component pneumococcal capsular polysaccharides.

Milligan C, Richardson BA, John-Stewart G, Ruth Nduati, Overbaugh J. "Passively acquired antibody-dependent cellular cytotoxicity (ADCC) activity in HIV-infected infants is associated with reduced mortality." Cell Host Microbe. 2015;17(4):500-6. Abstract

In addition to direct effects on virus infectivity, antibodies mediate antibody-dependent cellular cytotoxicity (ADCC), the killing of an antibody-coated virus-infected cell by cytotoxic effector cells. Although ADCC has been suggested to protect against HIV, the relationship between HIV-specific ADCC antibodies at the time of HIV exposure and infection outcome in humans remains to be assessed. We evaluated the ADCC activity of passively acquired antibodies in infants born to HIV-infected mothers. ADCC levels were higher in uninfected than infected infants, although not significantly. Increase in ADCC antibody activity in infected infants was associated with reduced mortality risk. Infant ADCC positively correlated with the magnitude of IgG1 binding, and IgG1 levels were associated with survival in infected infants. Infant IgG3-binding antibodies were not associated with infected infant survival. These data suggest a therapeutic benefit of pre-existing HIV-specific ADCC antibodies and support a role for eliciting ADCC-mediating IgG1 in HIV vaccines.

Garcia-Knight MA, Nduati E, Hassan AS, Gambo F, Odera D, Etyang TJ, Hajj NJ, Berkley JA, Urban BC, Rowland-Jones SL. "Altered Memory T-Cell Responses to Bacillus Calmette-Guerin and Tetanus Toxoid Vaccination and Altered Cytokine Responses to Polyclonal Stimulation in HIV-Exposed Uninfected Kenyan Infants." PLoS ONE. 2015;10(11):e0143043. Abstract

Implementation of successful prevention of mother-to-child transmission of HIV strategies has resulted in an increased population of HIV-exposed uninfected (HEU) infants. HEU infants have higher rates of morbidity and mortality than HIV-unexposed (HU) infants. Numerous factors may contribute to poor health in HEU infants including immunological alterations. The present study assessed T-cell phenotype and function in HEU infants with a focus on memory Th1 responses to vaccination. We compared cross-sectionally selected parameters at 3 and 12 months of age in HIV-exposed (n = 42) and HU (n = 28) Kenyan infants. We measured ex vivo activated and bulk memory CD4 and CD8 T-cells and regulatory T-cells by flow cytometry. In addition, we measured the magnitude, quality and memory phenotype of antigen-specific T-cell responses to Bacillus Calmette-Guerin and Tetanus Toxoid vaccine antigens, and the magnitude and quality of the T cell response following polyclonal stimulation with staphylococcal enterotoxin B. Finally, the influence of maternal disease markers on the immunological parameters measured was assessed in HEU infants. Few perturbations were detected in ex vivo T-cell subsets, though amongst HEU infants maternal HIV viral load positively correlated with CD8 T cell immune activation at 12 months. Conversely, we observed age-dependent differences in the magnitude and polyfunctionality of IL-2 and TNF-α responses to vaccine antigens particularly in Th1 cells. These changes mirrored those seen following polyclonal stimulation, where at 3 months, cytokine responses were higher in HEU infants compared to HU infants, and at 12 months, HEU infant cytokine responses were consistently lower than those seen in HU infants. Finally, reduced effector memory Th1 responses to vaccine antigens were observed in HEU infants at 3 and 12 months and higher central memory Th1 responses to M. tuberculosis antigens were observed at 3 months only. Long-term monitoring of vaccine efficacy and T-cell immunity in this vulnerable population is warranted.

Kurth AE, Inwani I, Wangombe A, Ruth Nduati, Owuor M, Njiri F, Akinyi P, Cherutich P, Osoti A, John Kinuthia, James N Kiarie, Chhun N, Kiarie J. "The Gender Context of HIV Risk and Pregnancy Goals in Western Kenya." East Afr Med J. 2015;92(4):163-169. Abstract

Intentional childbearing may place heterosexual couples at risk of HIV infection in resource-limited settings with high HIV prevalence areas where society places great value on having children.

Kibaru EG, Ruth Nduati, Dalton Wamalwa, Kariuki N. "Impact of highly active antiretroviral therapy on hematological indices among HIV-1 infected children at Kenyatta National Hospital-Kenya: retrospective study." AIDS Res Ther. 2015;12:26. Abstract

HIV infected children experience a range of hematological complications which show marked improvement within 6 months of initiating anti-retroviral therapy. The Objectives of the study was to describe the changes in hematological indices of HIV-1 infected children following 6 months of treatment with first line antiretroviral drugs (ARVs) regimen.

Nduati EW, Hassan AS, Knight MG, Muema DM, Jahangir MN, Mwaringa SL, Etyang TJ, Rowland-Jones S, Urban BC, Berkley JA. "Outcomes of prevention of mother to child transmission of the human immunodeficiency virus-1 in rural Kenya--a cohort study." BMC Public Health. 2015;15:1008. Abstract

Success in prevention of mother-to-child transmission (PMTCT) raises the prospect of eliminating pediatric HIV infection. To achieve global elimination, however, strategies are needed to strengthen PMTCT interventions. This study aimed to determine PMTCT outcomes and identify challenges facing its successful implementation in a rural setting in Kenya.

Daniels J, Ruth Nduati, Kiarie J, Farquhar C. "Supporting early career health investigators in Kenya: A qualitative study of HIV/AIDS research capacity building." Pan Afr Med J. 2015;20:192. Abstract

Strategies to transfer international health research training programs to sub-Saharan African institutions focus on developing cadres of local investigators who will lead such programs. Using a critical leadership theory framework, we conducted a qualitative study of one program to understand how collaborative training and research can support early career investigators in Kenya toward the program transfer goal.

Pope WH, Bowman CA, Russell DA, Jacobs-Sera D, Asai DJ, Cresawn SG, Jacobs WR, Hendrix RW, Lawrence JG, Hatfull GF. "Whole genome comparison of a large collection of mycobacteriophages reveals a continuum of phage genetic diversity." Elife. 2015;4:e06416. Abstract

The bacteriophage population is large, dynamic, ancient, and genetically diverse. Limited genomic information shows that phage genomes are mosaic, and the genetic architecture of phage populations remains ill-defined. To understand the population structure of phages infecting a single host strain, we isolated, sequenced, and compared 627 phages of Mycobacterium smegmatis. Their genetic diversity is considerable, and there are 28 distinct genomic types (clusters) with related nucleotide sequences. However, amino acid sequence comparisons show pervasive genomic mosaicism, and quantification of inter-cluster and intra-cluster relatedness reveals a continuum of genetic diversity, albeit with uneven representation of different phages. Furthermore, rarefaction analysis shows that the mycobacteriophage population is not closed, and there is a constant influx of genes from other sources. Phage isolation and analysis was performed by a large consortium of academic institutions, illustrating the substantial benefits of a disseminated, structured program involving large numbers of freshman undergraduates in scientific discovery.

Cournil A, Van de Perre P, Cames C, de Vincenzi I, Read JS, Luchters S, Meda N, Naidu K, Newell M-L, Bork K. "Early infant feeding patterns and HIV-free survival: findings from the Kesho-Bora trial (Burkina Faso, Kenya, South Africa)." Pediatr. Infect. Dis. J.. 2015;34(2):168-74. Abstract

To investigate the association between feeding patterns and HIV-free survival in children born to HIV-infected mothers and to clarify whether antiretroviral (ARV) prophylaxis modifies the association.

2014
Kibore MW, Daniels JA, Child MJ, Ruth Nduati, Njiri FJ, Kinuthia RM, O'Malley G, John-Stewart G, Kiarie J, Farquhar C. "Kenyan medical student and consultant experiences in a pilot decentralized training program at the University of Nairobi." Educ Health (Abingdon). 2014;27(2):170-6. Abstract

Over the past decade, the University of Nairobi (UoN) has increased the number of enrolled medical students threefold in response to the growing need for more doctors. This has resulted in a congested clinical training environment and limited opportunities for students to practice clinical skills at the tertiary teaching facility. To enhance the clinical experience, the UoN Medical Education Partnership Initiative Program Undertook training of medical students in non-tertiary hospitals around the country under the mentorship of consultant preceptors at these hospitals. This study focused on the evaluation of the pilot decentralized training rotation.

Newman LP, Njoroge A, Ben-Youssef L, Merkel M, Gatuguta A, Ton Q, Elizabeth Maleche Obimbo, Dalton Wamalwa, Lohman-Payne B, Richardson BA, Ruth Nduati, Farquhar C. "Measles Seropositivity in HIV-Infected Kenyan Children on Antiretroviral Therapy." Pediatr. Infect. Dis. J.. 2014. Abstract

This paper describes results from a cross-sectional study among HIV-infected children 15 months to 12 years of age who were receiving antiretroviral therapy. We found a low prevalence of measles IgG seropositivity (45.7%) and identified CD4% ≥ 25 as a predictor. Most HIV-infected children on ART were not measles seropositive and might benefit from revaccination.

Marangu D, Jowi C, Aswani J, Wambani S, Ruth Nduati. "Prevalence and associated factors of pulmonary hypertension in Kenyan children with adenoid or adenotonsillar hypertrophy." Int. J. Pediatr. Otorhinolaryngol.. 2014. Abstract

Adenotonsillar hypertrophy is a common condition in childhood, whose serious complications of pulmonary hypertension and cor pulmonale are devastating but local prevalence is unknown. This study determined the prevalence and associated factors of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at Kenyatta National Hospital, Kenya.

Goo L, Chohan V, Ruth Nduati, Overbaugh J. "Early development of broadly neutralizing antibodies in HIV-1-infected infants." Nat. Med.. 2014;20(6):655-8. Abstract

Eliciting protective neutralizing antibodies (NAbs) against HIV-1 is daunting because of the extensive genetic and antigenic diversity of HIV-1. Moreover, broad and potent responses are uncommon even during persistent infection, with only a subset of adults developing broadly neutralizing antibodies (bNAbs) that recognize viral variants from different HIV-1 clades. It is not known whether bNAbs can also arise in HIV-1-infected infants, who typically progress to disease faster than adults, presumably in part due to an immature immune system. Here, we show that bNAbs develop at least as commonly in infants as in adults. Cross-clade NAb responses were detected in 20/28 infected infants, in some cases within 1 year of infection. Among infants with breadth of responses within the top quartile, neutralization of tier 2 or 3 variants from multiple clades was detected at 20 months after infection. These findings suggest that, even in early life, there is sufficient B cell functionality to mount bNAbs against HIV-1. Additionally, the relatively early appearance of bNAbs in infants may provide a unique setting for understanding the pathways of B cell maturation leading to bNAbs.

Cames C, Cournil A, de Vincenzi I, Gaillard P, Meda N, Luchters S, Ruth Nduati, Naidu K, Newell M-L, Read JS, Bork K. "Postpartum weight change among HIV-infected mothers by antiretroviral prophylaxis and infant feeding modality in a research setting." AIDS. 2014;28(1):85-94. Abstract

To assess the relationship between infant feeding, triple-antiretroviral prophylaxis and weight from 2 weeks (baseline) to 6 months postpartum among HIV-infected mothers in a mother-to-child transmission (MTCT) of HIV-prevention trial in five sub-Saharan African sites.

Daniels J, Ruth Nduati, Farquhar C. "Right from primary school, I liked science: understanding health research capacity building in sub-Saharan Africa through Kenyan training experiences." Glob Health Promot. 2014;21(2):32-42. Abstract

Defining research career paths that enable Africans to address local and global health issues is essential for population health. This study was conducted to better understand how international health training programs contribute to human resource capacity building in health research. Research career motivations, decision-making and experiences were explored among a small group of Kenyan HIV/AIDS researchers who had completed an international training program. We found that intersecting social dynamics within specific geographic spaces influenced individual training decision-making and motivated research career decisions over time. The concept that 'geo-social motivation' is an important determinant of success for an African considering a research career developed from this study, and may be used to tailor future health research human resource capacity-building programs.

Child MJ, Kiarie JN, Allen SM, Ruth Nduati, Wasserheit JN, Kibore MW, John-Stewart G, Njiri FJ, O'Malley G, Kinuthia R, Norris TE, Farquhar C. "Expanding clinical medical training opportunities at the University of Nairobi: adapting a regional medical education model from the WWAMI program at the University of Washington." Acad Med. 2014;89(8 Suppl):S35-9. Abstract

A major medical education need in Sub-Saharan Africa includes expanding clinical training opportunities to develop health professionals. Medical education expansion is a complicated process that requires significant investment of financial and human resources, but it can also provide opportunities for innovative approaches and partnerships. In 2010, the U.S. President's Emergency Plan for AIDS Relief launched the Medical Education Partnership Initiative to invest in medical education and health system strengthening in Africa. Building on a 30-year collaborative clinical and research training partnership, the University of Nairobi in Kenya developed a pilot regional medical education program modeled on the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) medical education program at the University of Washington in the United States. The University of Nairobi adapted key elements of the WWAMI model to expand clinical training opportunities without requiring major capital construction of new buildings or campuses. The pilot program provides short-term clinical training opportunities for undergraduate students and recruits and trains clinical faculty at 14 decentralized training sites. The adaptation of a model from the Northwestern United States to address medical education needs in Kenya is a successful transfer of knowledge and practices that can be scaled up and replicated across Sub-Saharan Africa.

Kiarie JN, Farquhar C, Redfield R, Bosire K, Nduati RW, Mwanda W, M'Imunya JM, Kibwage I. "Strengthening health systems by integrating health care, medical education, and research: University of Nairobi experience." Acad Med. 2014;89(8 Suppl):S109-10.
Afran L, Garcia Knight M, Nduati E, Urban BC, Heyderman RS, Rowland-Jones SL. "HIV-exposed uninfected children: a growing population with a vulnerable immune system?" Clin. Exp. Immunol.. 2014;176(1):11-22. Abstract

Through the successful implementation of policies to prevent mother-to-child-transmission (PMTCT) of HIV-1 infection, children born to HIV-1-infected mothers are now much less likely to acquire HIV-1 infection than previously. Nevertheless, HIV-1-exposed uninfected (HEU) children have substantially increased morbidity and mortality compared with children born to uninfected mothers (unexposed uninfected, UU), predominantly from infectious causes. Moreover, a range of phenotypical and functional immunological differences between HEU and UU children has been reported. As the number of HEU children continues to increase worldwide, two questions with clear public health importance need to be addressed: first, does exposure to HIV-1 and/or ART in utero or during infancy have direct immunological consequences, or are these poor outcomes simply attributable to the obvious disadvantages of being born into an HIV-affected household? Secondly, can we expect improved maternal care and ART regimens during and after pregnancy, together with optimized infant immunization schedules, to reduce the excess morbidity and mortality of HEU children?

Monroe-Wise A, Kibore M, Kiarie J, Ruth Nduati, Mburu J, Drake FT, Bremner W, Holmes K, Farquhar C. "The Clinical Education Partnership Initiative: an innovative approach to global health education." BMC Med Educ. 2014;14:1043. Abstract

Despite evidence that international clinical electives can be educationally and professionally beneficial to both visiting and in-country trainees, these opportunities remain challenging for American residents to participate in abroad. Additionally, even when logistically possible, they are often poorly structured. The Universities of Washington (UW) and Nairobi (UoN) have enjoyed a long-standing research collaboration, which recently expanded into the UoN Medical Education Partnership Initiative (MEPI). Based on MEPI in Kenya, the Clinical Education Partnership Initiative (CEPI) is a new educational exchange program between UoN and UW. CEPI allows UW residents to partner with Kenyan trainees in clinical care and teaching activities at Naivasha District Hospital (NDH), one of UoN's MEPI training sites in Kenya.

Sherr K, Gimbel S, Rustagi A, Ruth Nduati, Cuembelo F, Farquhar C, Wasserheit J, Gloyd S. "Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial." Implement Sci. 2014;9:55. Abstract

Despite significant increases in global health investment and the availability of low-cost, efficacious interventions to prevent mother-to-child HIV transmission (pMTCT) in low- and middle-income countries with high HIV burden, the translation of scientific advances into effective delivery strategies has been slow, uneven and incomplete. As a result, pediatric HIV infection remains largely uncontrolled. A five-step, facility-level systems analysis and improvement intervention (SAIA) was designed to maximize effectiveness of pMTCT service provision by improving understanding of inefficiencies (step one: cascade analysis), guiding identification and prioritization of low-cost workflow modifications (step two: value stream mapping), and iteratively testing and redesigning these modifications (steps three through five). This protocol describes the SAIA intervention and methods to evaluate the intervention's impact on reducing drop-offs along the pMTCT cascade.

2013
Omenda MM, Milligan C, Odem-Davis K, Ruth Nduati, Richardson BA, Lynch J, John-Stewart G, Overbaugh J. "Evidence for efficient vertical transfer of maternal HIV-1 envelope-specific neutralizing antibodies but no association of such antibodies with reduced infant infection." J. Acquir. Immune Defic. Syndr.. 2013;64(2):163-6. Abstract

: Little is known about the efficiency of vertical transfer of HIV-1-specific antibodies. Antibody levels in plasma from 60 mother-infant pairs near the time of birth, including 14 breast-feeding transmission pairs, were compared. The envelope-binding titers were strongly correlated (r = 0.91, P < 0.0001) and similar (1.4-fold greater in maternal plasma) between a mother and her corresponding infant as were the neutralizing antibody (Nab) levels (r = 0.80, P < 0.0001; 1.3-fold higher), suggesting efficient transfer. There was no significant difference in Nab responses between transmitting and nontransmitting mothers, although there was a trend for transmitting mothers to have higher HIV-1-specific Nabs.

Ochola SA, Labadarios D, Nduati RW. "Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial." Public Health Nutr. 2013;16(10):1732-40. Abstract

To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya.

Mudany MA, Ruth Nduati, Mboori-Ngacha D, Rutherford GW. "Perceptions of child discipline and its contributions to child abuse in a low-income community in Nairobi, Kenya." Paediatr Int Child Health. 2013;33(4):228-32. Abstract

There is a fine line between child discipline and maltreatment. Perceptions of child discipline in three tribal groups living in an informal community in Kenya are reported.

Daniels J, Ruth Nduati, Farquhar C. "Kenyan women medical doctors and their motivations to pursue international research training." Educ Health (Abingdon). 2013;26(2):89-97. Abstract

There is a need to understand the factors that influence African women medical doctors to pursue international health research training because they remain under-represented in research fields but increasingly represented in medicine.

Daniels J, Ruth Nduati, Farquhar C. "Kenyan women medical doctors and their motivations to pursue international research training." Educ Health (Abingdon). 2013;26(2):89-97. Abstract

There is a need to understand the factors that influence African women medical doctors to pursue international health research training because they remain under-represented in research fields but increasingly represented in medicine.

Mabuka J, Goo L, Omenda MM, Ruth Nduati, Overbaugh J. "HIV-1 maternal and infant variants show similar sensitivity to broadly neutralizing antibodies, but sensitivity varies by subtype." AIDS. 2013;27(10):1535-44. Abstract

To protect against HIV infection, passively transferred and/or vaccine-elicited neutralizing antibodies (NAbs) need to effectively target diverse subtypes that are transmitted globally. These variants are a limited subset of those present during chronic infection and display some unique features. In the case of mother-to-child transmission (MTCT), transmitted variants tend to be resistant to neutralization by maternal autologous NAbs.

Cournil A, de Vincenzi I, Gaillard P, Cames C, Fao P, Luchters S, Rollins N, Newell M-L, Bork K, Read JS. "Relationship between mortality and feeding modality among children born to HIV-infected mothers in a research setting: the Kesho Bora study." AIDS. 2013;27(10):1621-30. Abstract

To assess the relationship between infant feeding practices and mortality by 18 months of age among children born to HIV-infected mothers in the Kesho Bora trial (Burkina-Faso, Kenya and South Africa).

Slyker JA, Casper C, Tapia K, Richardson B, Bunts L, Huang M-L, Maleche-Obimbo E, Ruth Nduati, John-Stewart G. "Clinical and virologic manifestations of primary Epstein-Barr virus (EBV) infection in Kenyan infants born to HIV-infected women." J. Infect. Dis.. 2013;207(12):1798-806. Abstract

Human immunodeficiency virus (HIV) infection is a risk factor for Epstein-Barr virus (EBV)-associated lymphomas. Characterizing primary infection may elucidate risk factors for malignancy.

Sartorius BKD, Chersich MF, Mwaura M, Meda N, Temmerman M, Newell ML, Farley TMM, Luchters S. "Maternal anaemia and duration of zidovudine in antiretroviral regimens for preventing mother-to-child transmission: a randomized trial in three African countries." BMC Infect. Dis.. 2013;13:522. Abstract

Although substantiated by little evidence, concerns about zidovudine-related anaemia in pregnancy have influenced antiretroviral (ARV) regimen choice for preventing mother-to-child transmission of HIV-1, especially in settings where anaemia is common.

2012
Renaud Becquet, Milly Marston, Franc¸ois Dabis, Lawrence H. Moulton, Glenda Gray, Hoosen M. Coovadia, Max Essex, iDidier K. Ekouevi, Debra Jackson, Anna Coutsoudis, Charles Kilewo, Vale´ riane Leroy, Stefan Z. Wiktor, Ruth Nduati, Philippe Msellati, Basia Zaba PGD, the survival group" Marie-Louise Newell UNAIDSC. "Children Who Acquire HIV Infection Perinatally Are at Higher Risk of Early Death than Those Acquiring Infection through Breastmilk: A Meta-Analysis." PLoS ONE | www.plosone.org 2 February 2012 | Volume 7 | Issue 2 | e28510. 2012. Abstractchildren_who_acquire_hiv.pdfWebsite

Abstract
Background: Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be
updated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant
survival by timing of HIV-infection (perinatally or postnatally) are thus needed.
Methodology/Principal Findings: A pooled analysis was conducted of individual data of all available intervention cohorts and
randomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant
antiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant
characteristics. The Kaplan-Meier method was used to estimate survival curves by child’s HIV infection status and timing of HIV
infection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000
child-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of
HIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected
children by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6–3.0),
maternal CD4,350 cells/ml (1.4, 1.1–1.7), postnatal (3.1, 2.1–4.1) or peri-partum HIV-infection (12.4, 10.1–15.3).
Conclusions/Results: These results update previous work and inform future UNAIDS modelling by providing survival
estimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the
prevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate
antiretroviral care and support for HIV-infected children.

Rositch, A F; Cherutich BKNRW; FP; P; J. "HIV infection and sexual partnerships and behaviour among adolescent girls in Nairobi, Kenya.". 2012. Abstract

Early sexual partnerships place young women in sub-Saharan Africa at high risk for HIV. Few studies have examined both individual- and partnership-level characteristics of sexual relationships among adolescent girls. A cross-sectional survey of sexual history and partnerships was conducted among 761 adolescent girls aged 15–19 years in Nairobi, Kenya. Rapid HIV testing was conducted and correlates of HIV infection were determined using multivariate logistic regression. The HIV prevalence was 7% and seropositive adolescents had a younger age at sexual debut (P < 0.01), more sexual partners in 12 months (P = 0.03), and were more likely to report transactional or non-consensual sex (P < 0.01). Girls who reported not knowing their partner’s HIV status were 14 times as likely to be HIV-seropositive than girls who knew their partner’s status (adjusted odds ratio: 14.2 [1.8, 109.3]). Public health messages to promote HIV testing and disclosure within partnerships could reduce sexual risk behaviours and HIV transmission among adolescents.

Mabuka, Jennifer; Nduati RW; O-DK; PD; OJ. "HIV-Specific Antibodies Capable of ADCC Are Common in Breastmilk and Are Associated with Reduced Risk of Transmission in Women with High Viral Loads.". 2012. Abstract

There are limited data describing the functional characteristics of HIV-1 specific antibodies in breast milk (BM) and their role in breastfeeding transmission. The ability of BM antibodies to bind HIV-1 envelope, neutralize heterologous and autologous viruses and direct antibody-dependent cell cytotoxicity (ADCC) were analyzed in BM and plasma obtained soon after delivery from 10 non-transmitting and 9 transmitting women with high systemic viral loads and plasma neutralizing antibodies (NAbs). Because subtype A is the dominant subtype in this cohort, a subtype A envelope variant that was sensitive to plasma NAbs was used to assess the different antibody activities. We found that NAbs against the subtype A heterologous virus and/or the woman's autologous viruses were rare in IgG and IgA purified from breast milk supernatant (BMS) – only 4 of 19 women had any detectable NAb activity against either virus. Detected NAbs were of low potency (median IC50 value of 10 versus 647 for the corresponding plasma) and were not associated with infant infection (p=0.58). The low NAb activity in BMS versus plasma was reflected in binding antibody levels: HIV-1 envelope specific IgG titers were 2.2 log10 lower (compared to 0.59 log10 lower for IgA) in BMS versus plasma. In contrast, antibodies capable of ADCC were common and could be detected in the BMS from all 19 women. BMS envelope-specific IgG titers were associated with both detection of IgG NAbs (p=0.0001)and BMS ADCC activity (p=0.014). Importantly, BMS ADCC capacity was inversely associated with infant infection risk (p=0.039). Our findings indicate that BMS has low levels of envelope specific IgG and IgA with limited neutralizing activity. However, this small study of women with high plasma viral loads suggests that breastmilk ADCC activity is a correlate of transmission that may impact infant infection risk.

Ochola SA, Labadarios D, RW. N. "Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial. ." Public Health Nutr. 2012 Oct 8:1-9. [Epub ahead of print]. 2012. Abstract

Abstract
OBJECTIVE:
To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya.
DESIGN:
A cluster randomized controlled trial in which nine villages were assigned on a 1:1:1 ratio, by computer, to two intervention groups and a control group. The home-based intensive counselling group (HBICG) received seven counselling sessions at home by trained peers, one prenatally and six postnatally. The facility-based semi-intensive counselling group (FBSICG) received only one counselling session prenatally. The control group (CG) received no counselling from the research team. Information on infant feeding practices was collected monthly for 6 months after delivery. The data-gathering team was blinded to the intervention allocation. The outcome was EBF prevalence at 6 months.
SETTING:
Kibera slum, Nairobi.
SUBJECTS:
A total of 360 HIV-negative women, 34-36 weeks pregnant, were selected from an antenatal clinic in Kibera; 120 per study group.
RESULTS:
Of the 360 women enrolled, 265 completed the study and were included in the analysis (CG n 89; FBSICG n 87; HBICG n 89). Analysis was by intention to treat. The prevalence of EBF at 6 months was 23•6 % in HBICG, 9•2 % in FBSICG and 5•6 % in CG. HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG (adjusted relative risk = 4•01; 95 % CI 2•30, 7•01; P = 0•001). There was no significant difference between EBF rates in FBSICG and CG.
CONCLUSIONS:
EBF can be promoted in low socio-economic conditions using home-based intensive counselling. One session of facility-based counselling is not sufficient to sustain EBF

Goo L, Milligan C, Simonich CA, Nduati R, Obimbo E, J. O. "Neutralizing antibody escape during HIV-1 mother-to-child transmission involves conformational masking of distal epitopes in envelope. ." J Virol. 2012 Sep;86(18):9566-82. doi: 10.1128/JVI.00953-12. Epub 2012 Jun 27.. 2012. Abstract

Abstract
HIV-1 variants transmitted to infants are often resistant to maternal neutralizing antibodies (NAbs), suggesting that they have escaped maternal NAb pressure. To define the molecular basis of NAb escape that contributes to selection of transmitted variants, we analyzed 5 viruses from 2 mother-to-child transmission pairs, in which the infant virus, but not the maternal virus, was resistant to neutralization by maternal plasma near transmission. We generated chimeric viruses between maternal and infant envelope clones obtained near transmission and examined neutralization by maternal plasma. The molecular determinants of NAb escape were distinct, even when comparing two maternal variants to the transmitted infant virus within one pair, in which insertions in V4 of gp120 and substitutions in HR2 of gp41 conferred neutralization resistance. In another pair, deletions and substitutions in V1 to V3 conferred resistance, but neither V1/V2 nor V3 alone was sufficient. Although the sequence determinants of escape were distinct, all of them involved modifications of potential N-linked glycosylation sites. None of the regions that mediated escape were major linear targets of maternal NAbs because corresponding peptides failed to compete for neutralization. Instead, these regions disrupted multiple distal epitopes targeted by HIV-1-specific monoclonal antibodies, suggesting that escape from maternal NAbs occurred through conformational masking of distal epitopes. This strategy likely allows HIV-1 to utilize relatively limited changes in the envelope to preserve the ability to infect a new host while simultaneously evading multiple NAb specificities present in maternal plasma.

McGrath CJ, R W Nduati, Richardson BA, Kristal AR, Mbori-Ngacha DA, Farquhar C, John-Stewart GC. "The Prevalence of Stunting Is High in HIV-1–Exposed Uninfected Infants in Kenya.". 2012. Abstractthe_prevalence_of_stunting.pdf

As prevention of mother-to-child HIV-1 transmission (PMTCT) programs decrease the numbers of HIV-1–infected infants, it remains important to improve growth in HIV-1–exposed, uninfected (EU) infants. To determine the growth rate and predictors of growth faltering in breast-fed and formula-fed EU infants, growth analyses [weight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores] were conducted by using data from a randomized feeding trial in HIV-1–infected women in Kenya. Growth faltering in EU infants was compared based on randomization to breastfeeding (BF) or formula feeding (FF) using Cox proportional hazards regression models. Linear mixed-effects models determined rate and cofactors of length growth. Among 338 EU infants, 164 (49%) were breast-fed and 174 (51%) formula-fed. In both arms, growth declined steadily during follow-up. By 2 y, 29% of children were underweight (WAZ < −2), 18% were wasted (WLZ < −2), and 58% were stunted (LAZ < −2), with no differences by feeding arm. Higher maternal education (y) and taller stature (cm) were associated with a decreased risk of underweight and stunting [underweight: adjusted HR (aHR) = 0.90 (95% CI: 0.83, 0.99), P = 0.03, and aHR = 0.92 (95% CI: 0.87, 0.97), P = 0.002; and stunting: aHR = 0.91 (95% CI: 0.85, 0.97), P = 0.003, and aHR = 0.96 (95% CI: 0.92, 0.99), P = 0.02, respectively]. Diarrhea was associated with an increased risk of wasting [aHR = 2.26 (95% CI: 1.11, 4.62), P = 0.03]. In multivariate analyses, FF was associated with slower declines in length velocity [0.24 LAZ/y (95% CI: 0.06, 0.43), P = 0.009]. Despite being uninfected, HIV-1–exposed infants showed frequent growth faltering, suggesting the need for vigilance in recognizing stunting within PMTCT programs. The slower rate of decline in length growth with FF may reflect benefits of micronutrients. Because BF is the best option for HIV-1–infected mothers in resource-limited settings, nutritional interventions should be examined for their impact on growth in EU breast-fed infants.

Shiroya-Wandabwa M, Yuko-Jowi C, R W Nduati, Githanga J, Wamalwa D. "Risk factors for cardiac dysfunction in children on treatment for cancer at Kenyatta National Hospital, Nairobi.". 2012. Abstract

To determine the point prevalence of abnormal cardiac function and to assess the risk factors for cardiac dysfunction in paediatric oncology patients on treatment at Kenyatta National Hospital. DESIGN: Descriptive cross-sectional study with a nested case control. SETTING: Kenyatta National Hospital between February and April 2006. MAIN OUTCOME MEASURES: Left ventricular dysfunction if ejection fraction (EF) <55% or fractional shortening (FS) <29% defined cases. Controls had EF >55% or FS >29%. RESULTS: One hundred and eleven patients were enrolled of whom 32 had abnormal cardiac function and were classified as cases while 79 had normal cardiac function. About a third, point prevalence 29% (95% CI 21.2-37.9), had cardiac dysfunction. Cumulative anthracycline dose was a risk factor for cardiac dysfunction in this population. Above 200 mg/m2 the attributable risk percentage of cardiac dysfunction was 77%. CONCLUSIONS: Serial echocardiography should be performed to identify patients at risk. Alternative treatment protocols should be used when the cumulative anthracycline dose exceeds 200 mg/m2 due to the high attributable risk. Studies to further assess the other associated risk factors and long term effects of anthracycline are recommended.

John-Stewart G, R W Nduati. "Should women with HIV-1 infection breastfeed their infants? It depends on the setting.". 2012. Abstract

Breastfeeding is the ideal infant food—it provides both optimal nutrition and numerous factors that contribute to infant immunity, growth, cognition, and health. It also enhances maternal–infant bonding and child-spacing and may provide long-term benefits to mothers. An estimated 7.7 million children under 5 years of age die annually, with >30% dying of infectious diseases [1, 2]. Breastfeeding has been identified as the most effective intervention to prevent under-5 mortality [3]. It was therefore a huge public health and policy challenge to discern the best infant feeding strategy when it was discovered that HIV-1 could be transmitted through breastfeeding. While nonbreastfeeding could entirely prevent transmission of a rapidly fatal infection, implementation of artificial feeding could be associated with increased infant mortality and morbidity. Over the past two decades, mothers, clinicians, and policy makers have wrestled with balancing infant risk of HIV-1 acquisition against risk of infant mortality in the context of concurrently changing interventions that decrease transmission of HIV-1.

2011
Tindyebwa, D. KMENC &BJPB. "Handbook on paediatric AIDS in Africa for medical students, doctors and primary care workers .". In: Handbook on paediatric AIDS in Africa for medical students, doctors and primary care workers . ANECCA; 2011.
John Kinuthia, James N Kiarie, Farquhar C, Ruth Nduati, Mbori-Ngacha D, and John-Stewart G. "Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma." Journal of the International AIDS Society 2011, 14:61. 2011. Abstract

Abstract
Background: We set out to determine the relative roles of stigma versus health systems in non-uptake of
prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional
assessment of all consenting mothers accompanying infants for six-week immunizations.
Methods: Between September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya’s
Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy.
Stigma was ascertained using a previously published standardized questionnaire and infant HIV-1 status
determined by HIV-1 polymerase chain reaction.
Results: Among 2663 mothers, 2453 (92.1%) reported antenatal HIV-1 testing. Untested mothers were more likely
to have less than secondary education (85.2% vs. 74.9%, p = 0.001), be from Nyanza (47.1% vs. 32.2%, p < 0.001)
and have lower socio-economic status. Among 318 HIV-1-infected mothers, 90% reported use of maternal or infant
antiretrovirals. Facility delivery was less common among HIV-1-infected mothers (69% vs. 76%, p = 0.009) and was
associated with antiretroviral use (p < 0.001). Although internal or external stigma indicators were reported by
between 12% and 59% of women, stigma was not associated with lower HIV-1 testing or infant HIV-1 infection
rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors
contributed to about 60% of non-testing among mothers who attended antenatal clinics and to missed
opportunities in offering antiretrovirals and utilization of facility delivery. Eight percent of six-week-old HIV-1-
exposed infants were HIV-1 infected.
Conclusions: Antenatal HIV-1 testing and antiretroviral uptake was high (both more than 90%) and infant HIV-1
infection risk was low, reflecting high PMTCT coverage. Investment in health systems to deliver HIV-1 testing and
antiretrovirals can effectively prevent infant HIV-1 infection despite substantial HIV-1 stigma.
Keywords: mother-to-child HIV transmission, HIV/AIDS, Health system, testing, antiretrovirals, facility delivery

2010
Mukelabai, N. O. Bwibo M(E& R. " Growth monitoring and promotion during early childhood. .". In: Primary health care manual for medical students and other health workers (3rd edition). UNICEF; 2010.
Mukelabai, N. O. Bwibo M(E)& R. "Accidents and Poisoning. In Kenya .". In: Accidents and Poisoning. In Kenya . UNICEF; 2010.
Migowa AN, Gatinu B, RW. N. "Adherence to oral rehydration therapy among in-patient children aged 1-59 months with some or no dehydration. ." J Trop Pediatr. 2010 Apr;56(2):103-7. doi: 10.1093/tropej/fmp059. Epub 2009 Jul 14.. 2010. Abstract

Abstract
OBJECTIVE:

To determine adherence to oral rehydration solution (ORS) among in-patients aged 1-59 months suffering from gastroenteritis and having some dehydration (SD) or no dehydration (ND) in two rural hospitals in Kenya.
METHODS:

Children aged 1-59 months suffering from acute gastroenteritis with (SD) or (ND) were enrolled into the study, examined and medical records reviewed. On the second and third day of follow up, children were re-examined to ascertain hydration status and care-takers interviewed.
RESULTS:

Ninety-nine children were enrolled. Forty-five (75%) of the 60 children with SD received a correct prescription for ORS but only 12 (20%) received the correct amount. Among the 39 children with ND, 23 (59%) received a correct prescription for ORS, however only 16 (41%) received the correct amount. On the 3rd day, 9 (15%) of the 60 children with SD at baseline and 2 (5%) of the 39 with ND were classified as having SD.
CONCLUSION:

Four in five children with SD and 6 in 10 children with ND fail to receive the correct amounts of ORS.

Mukelabai, N. O. Bwibo M(E)& R. "Child Nutrition.". In: Primary health care manual for medical students and other health workers (3rd edition). UNICEF; 2010.
John Kinuthia, James N Kiarie, Farquhar C, Ruth Nduati, and Dorothy Mbori-Ngacha GJ-S. "Cofactors for HIV-1 Incidence during Pregnancy and Postpartum Period." Curr HIV Res. 2010 October ; 8(7): 510–514.. 2010. Abstract

Abstract
Objectives—To estimate HIV-1 incidence and cofactors for HIV-1 incidence during pregnancy
and postpartum.
Design—Retrospective study among women who were HIV seronegative during pregnancy.
Methods—Mothers accompanying their infants for routine 6-week immunizations at 6 maternal
child health clinics in Nairobi and Western Kenya were tested for HIV-1 after completing a
questionnaire that included assessment of sociodemographics, obstetric history and HIV-1 risk
perception.
Results—Of 2,135 mothers who had tested HIV-1 seronegative antenatally, 2,035 (95.3%)
accepted HIV-1 re-testing at 6 weeks postpartum. Of these, 53 (2.6%) were HIV-1 seropositive
yielding an estimated HIV-1 incidence of 6.8 (95% CI: 5.1-8.8) per 100 woman-years). Mothers
who seroconverted were more likely to be employed (45.3% vs 29.0%, p=0.01), married (96.2 vs
86.6%, p=0.04) and from a higher HIV-1 prevalence region (60.4% in Western Kenya vs 28.8% in
Nairobi, p<0.001). Among married women, those in polygamous relationship were significantly
more likely to seroconvert (19.6% vs 6.7%, p<0.001). In multivariate analysis, region and
employment independently predicted seroconversion.
Conclusions—Repeat HIV-1 testing in early postpartum was highly acceptable and resulted in
detection of substantial HIV-1 incidence during pregnancy and postpartum period. Within
prevention of mother-to-child HIV-1 transmission programs strategic approaches to prevent
maternal HIV-1 acquisition during pregnancy are urgently needed.

Migowa AN;, Murungi CW;, Gatinu BW;, Mbithe J;, Kimani E;, Okiro P;, Rana FS;, Ochieng R;, R W Nduati. "Harlequin ichthyosis in an African child: case report.". 2010. Abstract

Severe congenital skin abnormalities are a rare event. This case is unique in that it is a case of harlequin ichthyosis in sub-sahara Africa in a child of African origin and elaborates the challenges faced in its management. We present a neonate who was managed for this condition at Chogoria Mission Hospital. In presenting this case, we aim to sensitise healthcare providers to promptly recognise and manage this rare skin condition.

In K. Mukelabai, N. O. Bwibo M(E)& R. "HIV infection and AIDS in children.". In: , Primary health care manual for medical students and other health workers (3rd . UNICEF; 2010.
RW. N. "HIV prevention--a public health priority. ." East Afr Med J. 2010 Mar;87(3):89-90. No abstract available. PMID: 23057303 [PubMed - indexed for MEDLINE] . 2010.
"Primary health care manual for medical students and other health workers (3rd edition). .". In: Infant and young child feeding (IYCF). In Kenya. UNICEF.; 2010.
2009
Inwani I, Nduati R, Obimbo E, Obimbo E, Wamalwa D, G J-S, Farquhar C. " Performance of clinical algorithms for HIV-1 diagnosis and antiretroviral initiation among HIV-1-exposed children aged less than 18 months in Kenya." J Acquir Immune Defic Syndr. 2009 Apr 15;50(5):492-8. doi: 10.1097/QAI.0b013e318198a8a4.. 2009. Abstract

Abstract
BACKGROUND:
Ninety percent of HIV-1-infected children live in sub-Saharan Africa. In the absence of diagnosis and antiretroviral therapy, approximately 50% die before 2 years.
METHODS:
We evaluated sensitivity and specificity of clinical algorithms for diagnosis of HIV-1 infection and antiretroviral therapy initiation among HIV-1-exposed children aged less than 18 months. Children were identified with routine HIV-1 testing and assessed using 3 sets of criteria: (1) Integrated Management of Childhood Illnesses (IMCI), (2) World Health Organization Presumptive Diagnosis (WHO-PD) for HIV-1 infection, and (3) CD4 T-lymphocyte cell subsets. HIV-1 infection status was determined using DNA polymerase chain reaction testing.
FINDINGS:
A total of 1418 children (median age 5.4 months) were screened for HIV-1 antibodies, of whom 144 (10.2%) were seropositive. Of these, 134 (93%) underwent HIV-1 DNA testing and 80 (60%) were found to be HIV-1 infected. Compared with HIV-1 DNA testing, sensitivity and specificity of the IMCI criteria were 19% and 96% and for WHO-PD criteria 43% and 88%, respectively. Inclusion of severe immune deficiency determined by CD4% improved sensitivity of IMCI and WHO-PD criteria to 74% and 84%, respectively; however, specificity declined to 43% and 41%, respectively.
INTERPRETATION:
Diagnosis of HIV-1 infection among exposed children less than 18 months in a high-prevalence resource-limited setting remains a challenge, and current recommended algorithms have low sensitivity. This underscores the need for rapid scale-up of viral assays for early infant diagnosis.

2008
Richardson BA, R W Nduati, Mbori-Ngacha DA, Overbaugh J, John-Stewart GC. "Acute HIV infection among Kenyan infants.". 2008. AbstractWebsite

BACKGROUND:
Clinical signs and symptoms of acute human immunodeficiency virus (HIV) infection in infants are not well characterized.
METHODS:
Serial clinical assessments and HIV PCR assays were conducted in a cohort of children born to HIV-seropositive mothers from birth to 2 years of age. Acute HIV infection visits were defined as those up to 3 months prior to and including the visit at which HIV DNA was first detected. Noninfection visits included all visits at which the child had test results negative for HIV, including the last visit at which a test result negative for HIV DNA was obtained in children who later acquired HIV infection. Differences in the prevalence of symptoms at acute infection versus noninfection visits were determined overall and were stratified by age at infection (<2 months vs. >or=2 months). HIV RNA was measured serially in infected infants and was compared between infants with and infants without symptoms of acute HIV infection.
RESULTS:
There were 125 acute infection visits (among 56 infants) and 3491 noninfection visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants <2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >or=2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symptoms had higher viral levels later in the course of infection than did those without symptoms (P=.05).
CONCLUSIONS:
Infants may manifest symptoms early during the course of HIV infection, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants.

Grace Irimu, R W Nduati, R W Nduati, E Wafula, Lenja J. "Community understanding of pneumonia in Kenya ." African Health Sciences Vol 8 No 2 June 2008. 2008. Abstract

Abstract
Background: Effective management of pneumonia demands active participation by the caretaker to facilitate early seeking of
appropriate health care and adequate compliance to home
care messages. This would only be possible if the caretakers’ perception of pneumonia is appropriate. This study aims to determine
community’s perception of childhood pneumonia in a suburb of Nairobi.
Objectives: To determine community perception of childhood pneumonia.
Design: Cross sectional study utilizing qualitative ethnographic methodology.
Participants: Six key informants for in-depth interview and eight groups for focus group discussions from the study community.
Results: Pneumonia was perceived to be the most serious childhood illness. There was a great deal of diversity of Kikuyu phrases for
chest-in drawing. There was no term for rapid breathing. Chest in-drawing, fever, difficult in breathing, startling at night and
convulsions were perceived as features of pneumonia. Chest in-drawing, fever and convulsions were indicative of severe disease.
Conclusion: The caretakers perceived severe pneumonia as outlined in the IMCI guidelines. Non-severe pneumonia was not
perceived for what it should be. Inappropriate knowledge on causes of pneumonia and signs of non severe pneumonia are likely to
interfere with compliance with home care messages.

Farquhar C, VanCott T, Bosire R, Bermudez C, Mbori-Ngacha D, Lohman-Payne B, Nduati R, Otieno P, John-Stewart G. "Salivary human immunodeficiency virus (HIV)-1-specific immunoglobulin A in HIV-1-exposed infants in Kenya.". 2008.
2007
Irene W. Inwani, Ruth W. Nduati, Rachel M. Musoke. "Feasibility of infant cord blood HIV testing for anti-retroviral post-exposure prophylaxis." J Infect Developing Countries 2007; 1(3):308-314.. 2007. Abstract

Abstract
Background: Many maternity hospitals in developing country settings deliver women who are of unknown HIV status. The main
objectives of this study were to evaluate the acceptability of post-partum infant cord blood HIV testing and the subsequent
uptake of interventions to prevent mother-to-child transmission of HIV.
Methodology: This was a cross-sectional study among infants delivered to women of unknown HIV status at the maternity ward
of the Kenyatta National hospital, Kenya. At the time of delivery, five milliliters of cord blood was collected from consecutive
singleton-birth infants born to women with unknown HIV status. After delivery, the women were counseled and consent was
sought for HIV antibody testing of the cord blood. Anti-retroviral post-exposure prophylaxis was provided for HIV exposed infants
and their mothers counseled on infant feeding.
Results: Overall 220 (87%) of the 253 mothers gave consent for HIV testing. This included 35 (90%) of 40 mothers of babies
with HIV positive cord blood and 184 (86.4%) of 213 with HIV negative cord blood. Seventeen (48.6%) of the 35 women who
knew their status accepted to administer anti-retroviral prophylaxis to their infants, and 28 (80%) chose to breast-feed their
infants.
Conclusions: Infant cord blood testing is highly acceptable among women who deliver with an unknown HIV status and provides
an additional entry point for prevention of mother-to-child transmission of HIV.

MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH, ELIZABETH DROBIMBO. "HIV-1 Disease Progression in Breast-Feeding and Formula-Feeding Mothers: A Prospective 2-Year Comparison of T Cell Subsets, HIV-1 RNA Levels, and Mortality. Otieno PA, Brown ER, Mbori-Ngacha DA, Nduati RW, Farquhar C, Obimbo EM, Bosire RK, Emery S, Overba.". In: J Infect Dis. 2007 Jan 15;195(2):220-9. Epub 2006 Dec 13. Journal of School of Continuous and Distance Education ; 2007. Abstract

Centre for Clinical Research, Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya. Background. There is conflicting evidence regarding the effects of breast-feeding on maternal mortality from human immunodeficiency virus type 1 (HIV-1) infection, and little is known about the effects of breast-feeding on markers of HIV-1 disease progression.Methods. HIV-1-seropositive women were enrolled during pregnancy and received short-course zidovudine. HIV-1 RNA levels and CD4 cell counts were determined at baseline and at months 1, 3, 6, 12, 18, and 24 postpartum and were compared between breast-feeding and formula-feeding mothers.Results. Of 296 women, 98 formula fed and 198 breast-fed. At baseline, formula-feeding women had a higher education level and prevalence of HIV-1-related illness than did breast-feeding women; however, the groups did not differ with respect to CD4 cell counts and HIV-1 RNA levels. Between months 1 and 24 postpartum, CD4 cell counts decreased 3.9 cells/ mu L/month (P<.001), HIV-1 RNA levels increased 0.005 log(10) copies/mL/month (P=.03), and body mass index (BMI) decreased 0.03 kg/m(2)/month (P<.001). The rate of CD4 cell count decline was higher in breast-feeding mothers (7.2 cells/ mu L/month) than in mothers who never breast-fed (4.0 cells/ mu L/month) (P=.01). BMI decreased more rapidly in breast-feeding women (P=.04), whereas HIV-1 RNA levels and mortality did not differ significantly between breast-feeding and formula-feeding women.Conclusions. Breast-feeding was associated with significant decreases in CD4 cell counts and BMI. HIV-1 RNA levels and mortality were not increased, suggesting a limited adverse impact of breast-feeding in mothers receiving extended care for HIV-1 infection.

Mbori-Ngacha DA, Richardson BA, Overbaugh J, Panteleeff DD, R W Nduati, Steele M, John-Stewart G. "Short-term effect of zidovudine on plasma and genital human immunodeficiency virus type 1 and viral turnover in these compartments.". 2007. Abstractshort-term_effect_of_zidovudine_on_plasma_and_genital_human.pdf

The effect of zidovudine on plasma and genital human immunodeficiency virus type 1 (HIV-1) was determined in 42 antiretroviral-naive HIV-1-seropositive women in Nairobi. After 7 days of zidovudine treatment, HIV-1 RNA levels decreased by 0.5 to 1.1 log(10) in plasma and genital secretions. HIV-1 RNA half-life following zidovudine treatment was 4.7, 1.3, and 0.9 days in plasma, cervix, and vagina, respectively, and significantly shorter in genital secretions than in plasma (P < 0.001). Defining the short-term effect of zidovudine on plasma and genital HIV-1 is important for improving perinatal HIV-1 interventions

2006
Tindyebwa, D. KMENC &BJPB. "Handbook on paediatric AIDS in Africa for medical students, doctors and primary care workers (revised 1st ed.) .". In: Handbook on paediatric AIDS in Africa for medical students, doctors and primary care workers (revised 1st ed.) . ANECCA.; 2006.
W. PROFNDUATIRUTH. "Domestic violence and prevention of mother-to-child transmission of HIV-1. AIDS . 2006 Aug 22; 20 ( 13 ): 1763-9 . PMID: 16931941 [PubMed - indexed for MEDLINE] Kiarie JN, Farquhar C, Richardson BA, Kabura MN, John FN, Nduati RW, John-Stewart GC.". In: AIDS . 2006 Aug 22; 20 ( 13 ): 1763-9 . Journal of School of Continuous and Distance Education ; 2006. Abstract
Department of Obstetrics/Gynaecology, University of Nairobi, PO Box 3085-00506, Nairobi, Kenya. jkiarie@swiftkenya.com OBJECTIVES: To determine the prevalence of life-time domestic violence by the current partner before HIV-1 testing, its impact on the uptake of prevention of mother-to-child transmission (PMTCT) interventions and frequency after testing. DESIGN: A prospective cohort. METHODS: Antenatally, women and their partners were interviewed regarding physical, financial, and psychological abuse by the male partner before HIV-1 testing and 2 weeks after receiving results. RESULTS: Before testing, 804 of 2836 women (28%) reported previous domestic violence, which tended to be associated with increased odds of HIV-1 infection [univariate odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3-2.2; P < 0.0001, adjusted OR 1.2, 95% CI 0.9-1.6; P = 0.1], decreased odds of coming with partners for counseling (adjusted OR 0.7, 95% CI 0.5-1.0; P = 0.04), and decreased odds of partner notification (adjusted OR 0.7, 95% CI 0.5-1.1; P = 0.09). Previous domestic violence was not associated with a reduced uptake of HIV-1 counseling, HIV-1 testing, or nevirapine. After receiving results, 15 out of 1638 women (0.9%) reported domestic violence. After notifying partners of results, the odds of HIV-1-seropositive women reporting domestic violence were 4.8 times those of HIV-1-seronegative women (95% CI 1.4-16; P = 0.01). Compared with women, men reported similar or more male-perpetrated domestic violence, suggesting a cultural acceptability of violence. CONCLUSION: Domestic violence before testing may limit partner involvement in PMTCT. Although infrequent, immediate post-test domestic violence is more common among HIV-1-infected than uninfected women. Domestic violence prevention programmes need to be integrated into PMTCT, particularly for HIV-1-seropositive women. PMID: 16931941 [PubMed - indexed for MEDLINE]
2005
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "John-Stewart GC, Nduati RW, Rousseau CM, Mbori-Ngacha DA, Richardson BA, Rainwater S, Pantaleef DD, Overbaugh J. ubtype C is associated with increased vaginal shedding of HIV-1 J Infect. Dis Di 2005;192:492-6.". In: Dis Di 2005;192:492-6. Journal of School of Continuous and Distance Education ; 2005. Abstract
Department of Obstetrics/Gynaecology, University of Nairobi, PO Box 3085-00506, Nairobi, Kenya. jkiarie@swiftkenya.com OBJECTIVES: To determine the prevalence of life-time domestic violence by the current partner before HIV-1 testing, its impact on the uptake of prevention of mother-to-child transmission (PMTCT) interventions and frequency after testing. DESIGN: A prospective cohort. METHODS: Antenatally, women and their partners were interviewed regarding physical, financial, and psychological abuse by the male partner before HIV-1 testing and 2 weeks after receiving results. RESULTS: Before testing, 804 of 2836 women (28%) reported previous domestic violence, which tended to be associated with increased odds of HIV-1 infection [univariate odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3-2.2; P < 0.0001, adjusted OR 1.2, 95% CI 0.9-1.6; P = 0.1], decreased odds of coming with partners for counseling (adjusted OR 0.7, 95% CI 0.5-1.0; P = 0.04), and decreased odds of partner notification (adjusted OR 0.7, 95% CI 0.5-1.1; P = 0.09). Previous domestic violence was not associated with a reduced uptake of HIV-1 counseling, HIV-1 testing, or nevirapine. After receiving results, 15 out of 1638 women (0.9%) reported domestic violence. After notifying partners of results, the odds of HIV-1-seropositive women reporting domestic violence were 4.8 times those of HIV-1-seronegative women (95% CI 1.4-16; P = 0.01). Compared with women, men reported similar or more male-perpetrated domestic violence, suggesting a cultural acceptability of violence. CONCLUSION: Domestic violence before testing may limit partner involvement in PMTCT. Although infrequent, immediate post-test domestic violence is more common among HIV-1-infected than uninfected women. Domestic violence prevention programmes need to be integrated into PMTCT, particularly for HIV-1-seropositive women. PMID: 16931941 [PubMed - indexed for MEDLINE]
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Subtype C Is associated with increased vaginal shedding of HIV-1. J Infect Dis. 2005 Aug 1;192(3):492-6. Epub 2005 Jun 23. PMID: 15995964 [PubMed - indexed for MEDLINE] John-Stewart GC, Nduati RW, Rousseau CM, Mbori-Ngacha DA, Richardson BA, Rainwater S, .". In: J Infect Dis. 2005 Aug 1;192(3):492-6. Epub 2005 Jun 23. PMID: 15995964 [PubMed - indexed for MEDLINE]. Journal of School of Continuous and Distance Education ; 2005. Abstract
Department of Obstetrics/Gynaecology, University of Nairobi, PO Box 3085-00506, Nairobi, Kenya. jkiarie@swiftkenya.com OBJECTIVES: To determine the prevalence of life-time domestic violence by the current partner before HIV-1 testing, its impact on the uptake of prevention of mother-to-child transmission (PMTCT) interventions and frequency after testing. DESIGN: A prospective cohort. METHODS: Antenatally, women and their partners were interviewed regarding physical, financial, and psychological abuse by the male partner before HIV-1 testing and 2 weeks after receiving results. RESULTS: Before testing, 804 of 2836 women (28%) reported previous domestic violence, which tended to be associated with increased odds of HIV-1 infection [univariate odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3-2.2; P < 0.0001, adjusted OR 1.2, 95% CI 0.9-1.6; P = 0.1], decreased odds of coming with partners for counseling (adjusted OR 0.7, 95% CI 0.5-1.0; P = 0.04), and decreased odds of partner notification (adjusted OR 0.7, 95% CI 0.5-1.1; P = 0.09). Previous domestic violence was not associated with a reduced uptake of HIV-1 counseling, HIV-1 testing, or nevirapine. After receiving results, 15 out of 1638 women (0.9%) reported domestic violence. After notifying partners of results, the odds of HIV-1-seropositive women reporting domestic violence were 4.8 times those of HIV-1-seronegative women (95% CI 1.4-16; P = 0.01). Compared with women, men reported similar or more male-perpetrated domestic violence, suggesting a cultural acceptability of violence. CONCLUSION: Domestic violence before testing may limit partner involvement in PMTCT. Although infrequent, immediate post-test domestic violence is more common among HIV-1-infected than uninfected women. Domestic violence prevention programmes need to be integrated into PMTCT, particularly for HIV-1-seropositive women. PMID: 16931941 [PubMed - indexed for MEDLINE]
2004
Oyieke J, Mbori-Ngacha DA, R W Nduati, Mbayaki R, Musyoka R. "Strategies to improve HIV test acceptance and uptake of interventions in PMCT sites.". 2004. Abstract

HIV testing in the antenatal clinic is an entry point for interventions to prevent mother to child transmission. It is therefore crucial that all women learn their HIV status during pregnancy. The approach used may influence the uptake of testing. HIV testing at the Kisumu District Hospital was initially offered using and ‘opt-in’ approach whereby in-depth counseling is instituted and women are required to request for the test as a separate component of their care.

MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr. 2004 Dec 15;37(5):1620-6. Farquhar C, Kiarie JN, Richardson BA, Kabura MN, John FN, Nduati RW, Mbori-Ngacha DA, John-Stewart GC.". In: J Infect Dis. 2007 Jan 15;195(2):220-9. Epub 2006 Dec 13. Journal of School of Continuous and Distance Education ; 2004. Abstract
Centre for Clinical Research, Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya. Background. There is conflicting evidence regarding the effects of breast-feeding on maternal mortality from human immunodeficiency virus type 1 (HIV-1) infection, and little is known about the effects of breast-feeding on markers of HIV-1 disease progression.Methods. HIV-1-seropositive women were enrolled during pregnancy and received short-course zidovudine. HIV-1 RNA levels and CD4 cell counts were determined at baseline and at months 1, 3, 6, 12, 18, and 24 postpartum and were compared between breast-feeding and formula-feeding mothers.Results. Of 296 women, 98 formula fed and 198 breast-fed. At baseline, formula-feeding women had a higher education level and prevalence of HIV-1-related illness than did breast-feeding women; however, the groups did not differ with respect to CD4 cell counts and HIV-1 RNA levels. Between months 1 and 24 postpartum, CD4 cell counts decreased 3.9 cells/ mu L/month (P<.001), HIV-1 RNA levels increased 0.005 log(10) copies/mL/month (P=.03), and body mass index (BMI) decreased 0.03 kg/m(2)/month (P<.001). The rate of CD4 cell count decline was higher in breast-feeding mothers (7.2 cells/ mu L/month) than in mothers who never breast-fed (4.0 cells/ mu L/month) (P=.01). BMI decreased more rapidly in breast-feeding women (P=.04), whereas HIV-1 RNA levels and mortality did not differ significantly between breast-feeding and formula-feeding women.Conclusions. Breast-feeding was associated with significant decreases in CD4 cell counts and BMI. HIV-1 RNA levels and mortality were not increased, suggesting a limited adverse impact of breast-feeding in mothers receiving extended care for HIV-1 infection.
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Association of levels of HIV-1-infected breast milk cells and risk of mother-to-child transmission. J Infect Dis. 2004 Nov 15;190(10):1880-8. 2004 Oct 07. Rousseau CM, Nduati RW, Richardson BA, John-Stewart GC,Mbori-Ngacha DA, Kreiss JK, Overbaugh J.". In: J Infect Dis. 2007 Jan 15;195(2):220-9. Epub 2006 Dec 13. Journal of School of Continuous and Distance Education ; 2004. Abstract
Centre for Clinical Research, Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya. Background. There is conflicting evidence regarding the effects of breast-feeding on maternal mortality from human immunodeficiency virus type 1 (HIV-1) infection, and little is known about the effects of breast-feeding on markers of HIV-1 disease progression.Methods. HIV-1-seropositive women were enrolled during pregnancy and received short-course zidovudine. HIV-1 RNA levels and CD4 cell counts were determined at baseline and at months 1, 3, 6, 12, 18, and 24 postpartum and were compared between breast-feeding and formula-feeding mothers.Results. Of 296 women, 98 formula fed and 198 breast-fed. At baseline, formula-feeding women had a higher education level and prevalence of HIV-1-related illness than did breast-feeding women; however, the groups did not differ with respect to CD4 cell counts and HIV-1 RNA levels. Between months 1 and 24 postpartum, CD4 cell counts decreased 3.9 cells/ mu L/month (P<.001), HIV-1 RNA levels increased 0.005 log(10) copies/mL/month (P=.03), and body mass index (BMI) decreased 0.03 kg/m(2)/month (P<.001). The rate of CD4 cell count decline was higher in breast-feeding mothers (7.2 cells/ mu L/month) than in mothers who never breast-fed (4.0 cells/ mu L/month) (P=.01). BMI decreased more rapidly in breast-feeding women (P=.04), whereas HIV-1 RNA levels and mortality did not differ significantly between breast-feeding and formula-feeding women.Conclusions. Breast-feeding was associated with significant decreases in CD4 cell counts and BMI. HIV-1 RNA levels and mortality were not increased, suggesting a limited adverse impact of breast-feeding in mothers receiving extended care for HIV-1 infection.
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Farquhar C, Kiarie JN, Richardson BA, Kabura MN, John FN, Nduati RW, Mbori-Ngacha DA, John-Stewart GC. Antenatal couple counselling increases uptake of intervention to prevent HIV-1 tranmission. J Acquir Immune Defic Syndr 2004;37:1620-1626.". In: J Acquir Immune Defic Syndr 2004;37:1620-1626. Journal of School of Continuous and Distance Education ; 2004. Abstract
Centre for Clinical Research, Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya. Background. There is conflicting evidence regarding the effects of breast-feeding on maternal mortality from human immunodeficiency virus type 1 (HIV-1) infection, and little is known about the effects of breast-feeding on markers of HIV-1 disease progression.Methods. HIV-1-seropositive women were enrolled during pregnancy and received short-course zidovudine. HIV-1 RNA levels and CD4 cell counts were determined at baseline and at months 1, 3, 6, 12, 18, and 24 postpartum and were compared between breast-feeding and formula-feeding mothers.Results. Of 296 women, 98 formula fed and 198 breast-fed. At baseline, formula-feeding women had a higher education level and prevalence of HIV-1-related illness than did breast-feeding women; however, the groups did not differ with respect to CD4 cell counts and HIV-1 RNA levels. Between months 1 and 24 postpartum, CD4 cell counts decreased 3.9 cells/ mu L/month (P<.001), HIV-1 RNA levels increased 0.005 log(10) copies/mL/month (P=.03), and body mass index (BMI) decreased 0.03 kg/m(2)/month (P<.001). The rate of CD4 cell count decline was higher in breast-feeding mothers (7.2 cells/ mu L/month) than in mothers who never breast-fed (4.0 cells/ mu L/month) (P=.01). BMI decreased more rapidly in breast-feeding women (P=.04), whereas HIV-1 RNA levels and mortality did not differ significantly between breast-feeding and formula-feeding women.Conclusions. Breast-feeding was associated with significant decreases in CD4 cell counts and BMI. HIV-1 RNA levels and mortality were not increased, suggesting a limited adverse impact of breast-feeding in mothers receiving extended care for HIV-1 infection.
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Infant feeding practices of women in a perinatal HIV-1 prevention study in Nairobi, Kenya. J Acquir Immune Defic Syndr. 2004 Jan 1;35(1):75-81. Kiarie JN, Richardson BA,Mbori-Ngacha D, Nduati RW, John-Stewart GC.". In: J Acquir Immune Defic Syndr. 2004 Jan 1;35(1):75-81. Journal of School of Continuous and Distance Education ; 2004. Abstract
Centre for Clinical Research, Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya. Background. There is conflicting evidence regarding the effects of breast-feeding on maternal mortality from human immunodeficiency virus type 1 (HIV-1) infection, and little is known about the effects of breast-feeding on markers of HIV-1 disease progression.Methods. HIV-1-seropositive women were enrolled during pregnancy and received short-course zidovudine. HIV-1 RNA levels and CD4 cell counts were determined at baseline and at months 1, 3, 6, 12, 18, and 24 postpartum and were compared between breast-feeding and formula-feeding mothers.Results. Of 296 women, 98 formula fed and 198 breast-fed. At baseline, formula-feeding women had a higher education level and prevalence of HIV-1-related illness than did breast-feeding women; however, the groups did not differ with respect to CD4 cell counts and HIV-1 RNA levels. Between months 1 and 24 postpartum, CD4 cell counts decreased 3.9 cells/ mu L/month (P<.001), HIV-1 RNA levels increased 0.005 log(10) copies/mL/month (P=.03), and body mass index (BMI) decreased 0.03 kg/m(2)/month (P<.001). The rate of CD4 cell count decline was higher in breast-feeding mothers (7.2 cells/ mu L/month) than in mothers who never breast-fed (4.0 cells/ mu L/month) (P=.01). BMI decreased more rapidly in breast-feeding women (P=.04), whereas HIV-1 RNA levels and mortality did not differ significantly between breast-feeding and formula-feeding women.Conclusions. Breast-feeding was associated with significant decreases in CD4 cell counts and BMI. HIV-1 RNA levels and mortality were not increased, suggesting a limited adverse impact of breast-feeding in mothers receiving extended care for HIV-1 infection.
2003
Lohman BL, Slyker J, Mbori-Ngacha DA, Bosire R, Farquhar C, Obimbo E, Otieno P, R W Nduati, Rowland-Jones S, John-Stewart G. "Prevalence and magnitude of human immunodeficiency virus (HIV) type 1-specific lymphocyte responses in breast milk from HIV-1-seropositive women.  .". 2003. Abstract

Human immunodeficiency virus (HIV) type 1-specific cell-mediated immunity of breast milk may influence the likelihood of mother-to-child transmission of HIV-1 via breast-feeding. In breast-milk specimens collected during the first month postpartum from HIV-1-seropositive women in Nairobi, HIV-1 gag-specific cellular responses were detected in 17 (47%) of 36, and env-specific cellular responses were present in 20 (40%) of 50. Peripheral blood lymphocyte responses against either gag or env were detected in 35 (66%) of the 53 subjects, 18 (51%) of whom had positive gag or env responses in their breast milk. In paired analyses of blood and breast milk, the mean magnitude of responses to env or gag stimulation in breast milk was significantly higher than that in blood and remained higher in breast milk after normalization of responses according to CD8+ lymphocyte count. These results suggest that CD8+ lymphocytes present in breast milk have the capacity to recognize HIV-1-infected cells and may be selectively transported to breast milk to reduce either viral replication or transmission in breast milk

MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. Rousseau CM, Nduati RW, Richardson BA, Steele MS, John-Stewart GC, Mbori-Ngacha DA, Kreiss JK, Overbaugh J.". In: J Infect Dis. 2003 Mar 1;187(5):741-7. Epub 2003 Feb 18. Journal of School of Continuous and Distance Education ; 2003. Abstract
Transmission of human immunodeficiency virus type 1 (HIV-1) via breast-feeding can occur throughout lactation. Defining both fluctuation in breast-milk virus level over time and how breast-milk virus correlates with mother-to-child transmission is important for establishing effective interventions. We quantified breast-milk HIV-1 RNA levels in serial samples collected from 275 women for up to 2 years after delivery. Higher maternal plasma virus load, lower maternal CD4 T cell count, and detection of HIV-1 DNA in maternal genital secretions were significantly associated with elevated breast-milk HIV-1 RNA. Within women who breast-fed, median virus load in colostrum/early milk was significantly higher than that in mature breast milk collected 14 days after delivery (P< or =.004). Breast-feeding mothers who transmitted HIV-1 to their infants had both significantly higher breast-milk viral RNA throughout lactation and more-consistent viral shedding, compared with mothers who did not transmit HIV-1. In breast-feeding women, a 2-fold-increased risk of transmission was associated with every 10-fold increase in breast-milk virus load (95% confidence interval, 1.3-3.0; P<.001). These results indicate that the risk of infant infection from breast-feeding is influenced by breast-milk virus load, which is highest early after delivery.
W. PROFNDUATIRUTH, MASIBO PROFWAFULAEZEKIEL, E DRSIMIYUMAJORD. "Mothers' knowledge, attitudes and practices regarding acute respiratory infections in children in Baringo District, Kenya. Simiyu DE, Wafula EM, Nduati RW.". In: East Afr Med J. 2003 Jun;80(6):303-7. Journal of School of Continuous and Distance Education ; 2003. Abstract
BACKGROUND: Control of acute respiratory infections (ARI) is a major public health problem in developing countries. Implementation of case management protocols requires participation of the community to reduce morbidity and mortality from ARI. Health education programmes can only be effective when designed to take into account the prevailing knowledge, attitudes and practices (KAP) of the community towards ARI in their children. OBJECTIVE: To determine the KAP of mothers regarding ARI in their children aged less than five years. DESIGN: Community based cross-sectional survey. SETTING: Baringo District, Kenya. SUBJECTS: Mothers with children aged 0-5 years were recruited following stratified random sampling in three areas of Baringo District to represent low, medium and high potential areas based on agricultural productivity. INTERVENTION: A mixed structured and unstructured questionnaire was administered to each of the respondent mothers by the investigator; with the help of an interpreter where necessary. RESULTS: A total of 309 mothers were interviewed. Their mean age was 31.5 years (range 16-51) and 34% had no formal education. Only 18% of mothers described pneumonia satisfactorily. 60.2% knew that measles is preventable by immunisation. 87.1% of the mothers said they would seek health centre services for severe ARI. Formal education had a positive influence on the KAP of the mothers. CONCLUSION: The study reveals that the mothers had good knowledge of mild forms of ARI but not the severe forms. Their attitude to ARI was appropriate but subsequent practices were not. Low utilisation of health services for moderate ARI may result in continued high mortality because of delayed identification of seriously ill children.
2002
Essex, S. Mboup KKPJ & MR. "Prevention of Breastmilk Transmission of HIV: Balancing the Benefits and the Risks. .". In: AIDS in Africa (2nd ed.). New York: Raven Press.; 2002.
2001
John GC, Bird T, Overbaugh J, R W Nduati, Mbori-Ngacha DA, Rostron T, Dong T, Kostrikis L, Richardson B, Rowland-Jones SL. "CCR5 Promoter Polymorphisms in a Kenyan Perinatal Human Immunodeficiency Virus Type 1 Cohort: Association with Increased 2-Year Maternal Mortality.". 2001. AbstractWebsite

The CCR5 chemokine receptor acts as a coreceptor with CD4 to permit infection by primary macrophage-tropic human immunodeficiency virus type 1 (HIV-1) strains. The CCR5Δ32 mutation, which is associated with resistance to infection in homozygous individuals and delayed disease progression in heterozygous individuals, is rare in Africa, where the HIV-1 epidemic is growing rapidly. Several polymorphisms in the promoter region of CCR5 have been identified, the clinical and functional relevance of which remain poorly defined. We evaluated the effect of 4 CCR5 promoter mutations on systemic and mucosal HIV-1 replication, disease progression, and perinatal transmission in a cohort of 276 HIV-1–seropositive women in Nairobi, Kenya. Mutations at positions 59353, 59402, and 59029 were not associated with effects on mortality, virus load, genital shedding, or transmission in this cohort. However, women with the 59356 C/T genotype had a 3.1-fold increased risk of death during the 2-year follow-up period (95% confidence interval [CI], 1.0–9.5) and a significant increase in vaginal shedding of HIV-1–infected cells (odds ratio, 2.1; 95% CI, 1.0–4.3), compared with women with the 59356 C/C genotype.

Grace C. John, Ruth W. Nduati, Dorothy A. Mbori-Ngacha, Carey Farquhar, Barbra A. Richardson, Dana Panteleeff, Anthony Mwatha JO, Job Bwayo, Jeckoniah O. Ndinya-Achola, and Kreiss JK. "Correlates of Mother-to-Child Human Immunodeficiency Virus Type 1 (HIV-1) Transmission: Association with Maternal Plasma HIV-1 RNA Load, Genital HIV-1 DNA Shedding, and Breast Infections." The Journal of Infectious Diseases 2001;183:206–12. 2001. Abstract

To determine the effects of plasma, genital, and breast milk human immunodeficiency virus
type 1 (HIV-1) and breast infections on perinatal HIV-1 transmission, a nested case-control
study was conducted within a randomized clinical trial of breast-feeding and formula feeding
among HIV-1–seropositive mothers in Nairobi, Kenya. In analyses comparing 92 infected
infants with 187 infants who were uninfected at 2 years, maternal viral RNA levels 143,000
copies/mL (cohort median) were associated with a 4-fold increase in risk of transmission (95%
confidence interval [CI], 2.2–7.2). Maternal cervical HIV-1 DNA (odds ratio [OR], 2.4; 95%
CI, 1.3–4.4), vaginal HIV-1 DNA (OR, 2.3; 95% CI, 1.1–4.7), and cervical or vaginal ulcers
(OR, 2.7; 95% CI, 1.2–5.8) were significantly associated with infant infection, independent of
plasma virus load. Breast-feeding (OR, 1.7; 95% CI, 1.0–2.9) and mastitis (relative risk [RR],
3.9; 95% CI, 1.2–12.7) were associated with increased transmission overall, and mastitis (RR,
21.8; 95% CI, 2.3–211.0) and breast abscess (RR, 51.6; 95% CI, 4.7–571.0) were associated
with late transmission (occurring 12 months postpartum). Use of methods that decrease infant
exposure to HIV-1 in maternal genital secretions or breast milk may enhance currently recommended
perinatal HIV-1 interventions.

(Eds.) L& GPRHD. "Mother-to-Child Transmission of HIV through Breastfeeding: Strategies for prevention.". In: HIV/AIDS Prevention and Care in Resource-Constrained Settings: A Handbook for the Design and Management of Programs. Arlington, VA: Family Health International. ; 2001.
Mwai C, Rutenberg N, Kalibala S, R W Nduati, Mbori-Ngacha DA, Nganda B, Oyieke J, Muthami L. "Provider Time For Women Seeking Mch Care In The Kenyan Prevention Of Mother-to-child Transmission (pmct) Of Hiv Project: Baseline Findings.". 2001.
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Partner notification by HIV-1 seropositive pregnant women: association with infant feeding decisions. AIDS. 2001 Apr 13;15(6):815-7. Farquhar C, Mbori-Ngacha DA, Bosire RK, Nduati RW, Kreiss JK, John GC.". In: 2001 Apr 13;15(6):815-7. Journal of School of Continuous and Distance Education ; 2001. Abstract
No abstract available.
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Timing of breast milk HIV-1 transmission: a meta-analysis. John GC, Richardson BA, Nduati RW, Mbori-Ngacha D, Kreiss JK.". In: East Afr Med J. 2001 Feb;78(2):75-9. Journal of School of Continuous and Distance Education ; 2001. Abstract
OBJECTIVE: To define the frequency and timing of breast milk transmission of HIV-1. DESIGN: Meta-analysis of data abstracted from published literature. SUBJECTS: Participants in prospective cohort studies of MTCT of HIV-1. Cohorts were separated on the basis of breast feeding duration. INTERVENTIONS: None. MAIN OUTCOME MEASURES: HIV-1 transmission rates. RESULTS: Two thousand three hundred and seventy five HIV-1 infected women and their infants, 499 of whom breast fed, the estimated risk of breast milk HIV-1 transmission was 16% (95% CI: 9, 22%). Among breastfeeding infants, forty seven per cent of HIV-1 infections were attributable to breast feeding. Breast milk transmission risk was 21% (95% CI: 10, 33%) in cohorts with mean/median duration of breast feeding > or = 3 months and 13% (95% CI: 4, 21%) in cohorts with median duration of breast feeding < 2 months. In a separate analysis of 702 infants with prolonged duration of breast feeding, the risk of late postnatal transmission (infection occurring later than three to six months of age) was four per cent (95% CI 2, 5%). CONCLUSIONS: This analysis suggests that breast milk transmission of HIV-1 is substantial and continues throughout the postnatal period. Early cessation of breast feeding at six months would avert some but not most infant HIV-1 infections due to breast feeding. While recently published studies showing some effectiveness of antiretrovirals early during the breast feeding period are encouraging, prevention of breast milk HIV-1 transmission needs to remain a high research priority.
2000
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Correlates of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections. John GC, Nduati RW, Mbori-Ngacha DA, Richardson BA, Panteleeff D, M.". In: J Infect Dis. 2001 Jan 15;183(2):206-212. Epub 2000 Dec 15. Journal of School of Continuous and Distance Education ; 2000. Abstract
To determine the effects of plasma, genital, and breast milk human immunodeficiency virus type 1 (HIV-1) and breast infections on perinatal HIV-1 transmission, a nested case-control study was conducted within a randomized clinical trial of breast-feeding and formula feeding among HIV-1-seropositive mothers in Nairobi, Kenya. In analyses comparing 92 infected infants with 187 infants who were uninfected at 2 years, maternal viral RNA levels >43,000 copies/mL (cohort median) were associated with a 4-fold increase in risk of transmission (95% confidence interval [CI], 2.2-7.2). Maternal cervical HIV-1 DNA (odds ratio [OR], 2.4; 95% CI, 1.3-4.4), vaginal HIV-1 DNA (OR, 2.3; 95% CI, 1.1-4.7), and cervical or vaginal ulcers (OR, 2.7; 95% CI, 1.2-5.8) were significantly associated with infant infection, independent of plasma virus load. Breast-feeding (OR, 1.7; 95% CI, 1.0-2.9) and mastitis (relative risk [RR], 3.9; 95% CI, 1.2-12.7) were associated with increased transmission overall, and mastitis (RR, 21.8; 95% CI, 2.3-211.0) and breast abscess (RR, 51.6; 95% CI, 4.7-571.0) were associated with late transmission (occurring >2 months postpartum). Use of methods that decrease infant exposure to HIV-1 in maternal genital secretions or breast milk may enhance currently recommended perinatal HIV-1 interventions.
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "The efficacy of pyrimethamine-sulfadoxine (Fansidar) in the treatment of uncomplicated Plasmodium falciparum malaria in Kenyan children. Ogutu BR, Smoak BL, Nduati RW, Mbori-Ngacha DA, Mwathe F, Shanks GD.". In: Trans R Soc Trop Med Hyg. 2000 Jan-Feb;94(1):83-4. Journal of School of Continuous and Distance Education ; 2000. Abstract
To determine the effects of plasma, genital, and breast milk human immunodeficiency virus type 1 (HIV-1) and breast infections on perinatal HIV-1 transmission, a nested case-control study was conducted within a randomized clinical trial of breast-feeding and formula feeding among HIV-1-seropositive mothers in Nairobi, Kenya. In analyses comparing 92 infected infants with 187 infants who were uninfected at 2 years, maternal viral RNA levels >43,000 copies/mL (cohort median) were associated with a 4-fold increase in risk of transmission (95% confidence interval [CI], 2.2-7.2). Maternal cervical HIV-1 DNA (odds ratio [OR], 2.4; 95% CI, 1.3-4.4), vaginal HIV-1 DNA (OR, 2.3; 95% CI, 1.1-4.7), and cervical or vaginal ulcers (OR, 2.7; 95% CI, 1.2-5.8) were significantly associated with infant infection, independent of plasma virus load. Breast-feeding (OR, 1.7; 95% CI, 1.0-2.9) and mastitis (relative risk [RR], 3.9; 95% CI, 1.2-12.7) were associated with increased transmission overall, and mastitis (RR, 21.8; 95% CI, 2.3-211.0) and breast abscess (RR, 51.6; 95% CI, 4.7-571.0) were associated with late transmission (occurring >2 months postpartum). Use of methods that decrease infant exposure to HIV-1 in maternal genital secretions or breast milk may enhance currently recommended perinatal HIV-1 interventions.
1999
Mwatha AK;, Nduati RN;, Reilly M;, John G;, Mbori-Ngacha DA;, Bwayo JJ;, Kreiss J. "The cost of supplying formula feed to HIV-1 infected women as an intervention against vertical transmission. Journal of Clinical.". 1999.
Nduati RW;, John GC;, Mbori-Ngacha D. "Nipple disease in HIV-1 infected women.". 1999.Website
Overbaugh J, Kreiss J, Poss M, Lewis P, Mostad S, John G, R W Nduati, Mbori-Ngacha DA, Martin JH, Richardson B, Jackson S, Neilson J, Long EM, Panteleeff D, Welch M, Rakwar J, Jackson D, Chohan B, Lavreys L, Mandaliya K, Ndinya-Achola JO, Bwayo JJ. "Studies of human immunodeficiency virus type 1 mucosal viral shedding and transmission in Kenya.". 1999. Abstract

If human immunodeficiency virus type 1 (HIV-1) vaccines are to be highly effective, it is essential to understand the virologic factors that contribute to HIV-1 transmission. It is likely that transmission is determined, in part, by the genotype or phenotype (or both) of infectious virus present in the index case, which in turn will influence the quantity of virus that may be exchanged during sexual contact. Transmission may also depend on the fitness of the virus for replication in the exposed individual, which may be influenced by whether a virus encounters a target cell that is susceptible to infection by that specific variant. Of interest, our data suggest that the complexity of the virus that is transmitted may be different in female and male sexual exposures.

O PROFWASUNNAAGGREY, W. PROFNDUATIRUTH, N PROFMUSOKERACHEL. "Growth and development of abandoned babies in institutional care in Nairobi. Otieno PA, Nduati RW, Musoke RN, Wasunna AO.". In: East Afr Med J. 1999 Aug;76(8):430-5. Journal of School of Continuous and Distance Education ; 1999. Abstract

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Subtypes of human immunodeficiency virus type 1 and disease stage among women in Nairobi, Kenya. Neilson JR, John GC, Carr JK, Lewis P, Kreiss JK, Jackson S, Nduati RW, Mbori-Ngacha D, Panteleeff DD, Bodrug S, Giachetti C, Bott MA, Richardson BA, Bwayo J,.". In: J Virol. 1999 May;73(5):4393-403. Journal of School of Continuous and Distance Education ; 1999. Abstract
In sub-Saharan Africa, where the effects of human immunodeficiency virus type 1 (HIV-1) have been most devastating, there are multiple subtypes of this virus. The distribution of different subtypes within African populations is generally not linked to particular risk behaviors. Thus, Africa is an ideal setting in which to examine the diversity and mixing of viruses from different subtypes on a population basis. In this setting, it is also possible to address whether infection with a particular subtype is associated with differences in disease stage. To address these questions, we analyzed the HIV-1 subtype, plasma viral loads, and CD4 lymphocyte levels in 320 women from Nairobi, Kenya. Subtype was determined by a combination of heteroduplex mobility assays and sequence analyses of envelope genes, using geographically diverse subtype reference sequences as well as envelope sequences of known subtype from Kenya. The distribution of subtypes in this population was as follows: subtype A, 225 (70.3%); subtype D, 65 (20.5%); subtype C, 22 (6.9%); and subtype G, 1 (0.3%). Intersubtype recombinant envelope genes were detected in 2.2% of the sequences analyzed. Given that the sequences analyzed represented only a small fraction of the proviral genome, this suggests that intersubtype recombinant viral genomes may be very common in Kenya and in other parts of Africa where there are multiple subtypes. The plasma viral RNA levels were highest in women infected with subtype C virus, and women infected with subtype C virus had significantly lower CD4 lymphocyte levels than women infected with the other subtypes. Together, these data suggest that women in Kenya who are infected with subtype C viruses are at more advanced stages of immunosuppression than women infected with subtype A or D. There are at least two models to explain the data from this cross-sectional study; one is that infection with subtype C is associated with a more rapid disease progression, and the second is that subtype C represents an older epidemic in Kenya. Discriminating between these possibilities in a longitudinal study will be important for increasing our understanding of the role of specific subtypes in the transmission and pathogenesis of HIV-1.
1998
Lewis P, Nduati R, Kreiss JK, John GC, Richardson BA, Mbori-Ngacha D, Ndinya-Achola J, Overbaugh J. "Cell-free human immunodeficiency virus type 1 in breast milk." J Infect Dis. Jan;177. 1998;(1)::34-9.Website
1997
Nduati R&WK. Communicating with adolescents about HIV/AIDS: Experience from Eastern and Southern Africa. . Ottowa, Onterio: International Development Research Centre, 1997.; 1997.
MBORI- PROFNGACHADOROTHYA, W. PROFNDUATIRUTH. "Genital shedding of human immunodeficiency virus type 1 DNA during pregnancy: association with immunosuppression, abnormal cervical or vaginal discharge, and severe vitamin A deficiency. J Infect Dis. 1997 Jan;175(1):57-62. John GC, Nduati RW, Mbori-Ngach.". In: J Infect Dis. 1997 Jan;175(1):57-62. Journal of School of Continuous and Distance Education ; 1997. Abstract

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

W. PROFNDUATIRUTH. "Prevention of HIV infection: a continuing challenge. East Afr Med J. 1997 Jul;74(7):405. No abstract available. Nduati RW.". In: East Afr Med J. 1999 Aug;76(8):430-5. Journal of School of Continuous and Distance Education ; 1997. Abstract

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

W. PROFNDUATIRUTH. "Prevention of mother-to-child transmission of HIV-1 in Africa. AIDS. 1997;11 Suppl B:S79-87. Review. Wiktor SZ, Ekpini E, Nduati RW.". In: East Afr Med J. 1999 Aug;76(8):430-5. Journal of School of Continuous and Distance Education ; 1997. Abstract

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

1995
14. Nduati, R.W. BOGJ & C. "Accidents and Poisoning.". In: Primary health care: A manual for medical students and other health workers (2nd ed.). UNICEF. ; 1995.
Jitta, Jessica &RN. "Growth monitoring and promotion during early childhood development.". In: Primary health care: A manual for medical students and other health workers (2nd ed.). UNICEF. ; 1995.
Ndugwa, C.M. N &BRWGJ. "HIV infection and AIDS in children.". In: Primary health care: A manual for medical students and other health workers (2nd ed.). UNICEF. ; 1995.
W. PROFNDUATIRUTH. "Human immunodeficiency virus type 1-infected cells in breast milk: association with immunosuppression and vitamin A deficiency. J Infect Dis. 1995 Dec;172(6):1461-8. Nduati RW, John GC, Richardson BA, Overbaugh J, Welch M, Ndinya-Achola J, Moses S, Holmes.". In: J Infect Dis. 1997 Jan;175(1):57-62. Journal of School of Continuous and Distance Education ; 1995. Abstract

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

1994
co-author Nduati, R. "AIDS in Women.". In: AIDS in Africa. New York: Raven Press.; 1994.
W. PROFNDUATIRUTH. "Postnatal transmission of HIV-1 through pooled breast milk. Lancet. 1994 Nov 19;344(8934):1432. No abstract available. Erratum in: Lancet 1994 Dec 17;344(8938):1712. Nduati RW, John GC, Kreiss J.". In: J Infect Dis. 1997 Jan;175(1):57-62. Journal of School of Continuous and Distance Education ; 1994. Abstract

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

1993
co-author Nduati, R. " Childhood diseases.". In: GOK/Family Life Training Center Your Family Health Guide. Nairobi, Kenya: English Press. ; 1993.
1992
Nduati R. " Accidents, Poisoning, and Child Abuse. A Primary Health Care Manual for Medical Students. East African Primary Health Care Fellowship. .". In: Primary Health Care: A manual for medical students and other health workers.; 1992.
W. PROFNDUATIRUTH. "Sexual abuse of children as seen at Kenyatta National Hospital. East Afr Med J. 1992 Jul;69(7):350-4. Nduati RW, Muita JW.". In: East Afr Med J. 1992 Jul;69(7):350-4. Journal of School of Continuous and Distance Education ; 1992. Abstract

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

1991
W. PROFNDUATIRUTH. "Bacteriology of acute septic arthritis. J Trop Pediatr. 1991 Aug;37(4):172-5. Nduati RW, Wamola IA.". In: J Trop Pediatr. 1991 Aug;37(4):172-5. Journal of School of Continuous and Distance Education ; 1991. Abstract

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

1990
W. PROFNDUATIRUTH. "Battered baby syndrome at Kenyatta National Hospital, Nairobi. East Afr Med J. 1990 Dec;67(12):900-6. Muita JW, Nduati RW.". In: East Afr Med J. 1990 Dec;67(12):900-6. Journal of School of Continuous and Distance Education ; 1990. Abstract

Thirty children presenting with Battered Baby Syndrome over a five year period were studied retrospectively. The male:female ratio was 1:1.1. The majority (60%) were aged 0-11 months. 14 children (46%) were abandoned while six (20%) had multiple fractures, six (20%) multiple bruises and bites, and four (13.3%) had other forms of abuse. Twelve (40%) children were malnourished while eight of the babies (26.6%) were small for gestational age. Children were most frequently brought to hospital by the police or their mothers. The children were most frequently abused by their mothers either through abandonment or through physical battering. Details of mothers of the 14 abandoned children were unknown. Among the mothers of the other children, nine mothers were single, seven married and living with spouses and one stepmother. Two children (6.6%) died while the fate of two others was not known. Three children were sent home without intervention of the social worker, while twenty three children were discharged following intervention of the social worker; fourteen sent home, nine to a childrens' home and one through the juvenile court.

O PROFBWIBONIMROD, W. PROFNDUATIRUTH. "Jitta J, Nduati RW Growth monitoring and promotion during early childhood development. In: Primary Health Care: A manual for medical students and other health workers. Ed. Mukelebai K, Bwibo NO, Onyango FE. 2nd edition, UNICEF.". In: Book. Journal of School of Continuous and Distance Education ; 1990. Abstract

Thirty children presenting with Battered Baby Syndrome over a five year period were studied retrospectively. The male:female ratio was 1:1.1. The majority (60%) were aged 0-11 months. 14 children (46%) were abandoned while six (20%) had multiple fractures, six (20%) multiple bruises and bites, and four (13.3%) had other forms of abuse. Twelve (40%) children were malnourished while eight of the babies (26.6%) were small for gestational age. Children were most frequently brought to hospital by the police or their mothers. The children were most frequently abused by their mothers either through abandonment or through physical battering. Details of mothers of the 14 abandoned children were unknown. Among the mothers of the other children, nine mothers were single, seven married and living with spouses and one stepmother. Two children (6.6%) died while the fate of two others was not known. Three children were sent home without intervention of the social worker, while twenty three children were discharged following intervention of the social worker; fourteen sent home, nine to a childrens' home and one through the juvenile court.

O PROFBWIBONIMROD, W. PROFNDUATIRUTH. "Nduati RW, Bhatt GJ, Osborne CM Accidents and Poisoning. In: Primary Health Care: A manual for medical students and other health workers. Ed. Mukelebai K, Bwibo NO, Onyango FE. 2nd edition, UNICEF.". In: Book. Journal of School of Continuous and Distance Education ; 1990. Abstract

Thirty children presenting with Battered Baby Syndrome over a five year period were studied retrospectively. The male:female ratio was 1:1.1. The majority (60%) were aged 0-11 months. 14 children (46%) were abandoned while six (20%) had multiple fractures, six (20%) multiple bruises and bites, and four (13.3%) had other forms of abuse. Twelve (40%) children were malnourished while eight of the babies (26.6%) were small for gestational age. Children were most frequently brought to hospital by the police or their mothers. The children were most frequently abused by their mothers either through abandonment or through physical battering. Details of mothers of the 14 abandoned children were unknown. Among the mothers of the other children, nine mothers were single, seven married and living with spouses and one stepmother. Two children (6.6%) died while the fate of two others was not known. Three children were sent home without intervention of the social worker, while twenty three children were discharged following intervention of the social worker; fourteen sent home, nine to a childrens' home and one through the juvenile court.

O PROFBWIBONIMROD, W. PROFNDUATIRUTH. "Ndugwa CM, Nduati RW, Bhat GJ. HIV infection and AIDS in children. In: Primary Health Care: A manual for medical students and other health workers. Ed. Mukelebai K, Bwibo NO, Onyango FE. 2nd edition, UNICEF.". In: Book. Journal of School of Continuous and Distance Education ; 1990. Abstract

Thirty children presenting with Battered Baby Syndrome over a five year period were studied retrospectively. The male:female ratio was 1:1.1. The majority (60%) were aged 0-11 months. 14 children (46%) were abandoned while six (20%) had multiple fractures, six (20%) multiple bruises and bites, and four (13.3%) had other forms of abuse. Twelve (40%) children were malnourished while eight of the babies (26.6%) were small for gestational age. Children were most frequently brought to hospital by the police or their mothers. The children were most frequently abused by their mothers either through abandonment or through physical battering. Details of mothers of the 14 abandoned children were unknown. Among the mothers of the other children, nine mothers were single, seven married and living with spouses and one stepmother. Two children (6.6%) died while the fate of two others was not known. Three children were sent home without intervention of the social worker, while twenty three children were discharged following intervention of the social worker; fourteen sent home, nine to a childrens' home and one through the juvenile court.

1987
R W Nduati. Acute Septic Arthritis As It Is Seen In Children At Kenyatta National Hospital.; 1987. Abstract

A nine-month study was done on children with acute septic arthritis admitted to the Paediatric Orthopaedic and general paediatric wards. The aims of the study were to elucidate the clinical characteristics and aetiological agents of septic arthritis in children admitted to Kenyatta National Hospital. Thirty one children were recruited into the study and of these 58% were infants and 32.3% were school age children. There was a striking male predominance in the school age children - 9:1 while male/female ratio was 1.2:1 in the
younger children. Knees and shoulders were the most frequently affected by septic arthritis and together were responsible for
71% of the septic joints. It is of interest that all the septic

shoulder joints occurred in infancy. Non-typhoidal salmonella species especially Salmonella typhimurium, Klebsiella species and Staphylococcus aureus were the most frequently isolated bacteria.

The rate of bacterial isolation was as high as 72.2% when both blood cultures and joint aspirate cultures were done. Salmonella species had 75% sensitivity to the aminoglycosides (Gentamicin,Kanamycin) and Chloramphenicol while only two thirds of the Klebsiella species were sensitive to the same antibiotics. Staphylococcus aureus isolated in this study were sensitive to Erythromycin and uniformly resistant to
Ampicillin,.Cloxacillin and Cotrimoxazole. There was full

recovery in 63.7% of the patients while 23% went home without appropriate follow-up.

The author recommends that blood and joint aspirate cultures should be done in all patients suspected to have septic arthritis. Antibiotic sensitivity testing should be done r~gularly to facilitate appropriate drug therapy. Clinicians should ensure adequate follow-up of patients following discharge from hospital.

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