Background The role of Plasmodium falciparum malaria in EBV transmission among infants early in life remain elusive. We hypothesized that infection with malaria during pregnancy could cause EBV reactivation leading to high EBV load in circulation, which could subsequently enhance early age of EBV infection. Method Pregnant women in Kisumu, where P. falciparum malaria is holoendemic, were actively followed monthly through antenatal visits (up to 4 per mother) and delivery. Using real-time quantitative (Q) – PCR, we quantified and compared EBV and P. falciparum DNA levels in the blood of pregnant women with and without P. falciparum malaria. Results Pregnant women that had malaria detected during pregnancy were more likely to have detectable EBV DNA than pregnant women who had no evidence of malaria infection during pregnancy (64% vs. 36%, p=0.01). EBV load as analyzed by quantifying area under the longitudinal observation curve (AUC) was significantly higher in pregnant women with P. falciparum malaria than in women without evidence of malaria infection (p =0.01) regardless of gestational age of pregnancy. Increase in malaria load correlated with increase in EBV load (p <0.0001). EBV load was higher in third trimester (p =0.04) than first and second trimester of pregnancy independent of known infections. Conclusion Significantly higher frequency and elevated EBV loads were found in pregnant women with malaria than in women without evidence of P. falciparum infection during pregnancy. The loss of control of EBV latency following P. falciparum infection during pregnancy and subsequent increase in EBV load in circulation could contribute to enhanced shedding of EBV in maternal saliva and breast milk postpartum, but further studies are needed.

Introduction The Government of Kenya instituted the free maternity services (FMS) policy to improve utilization of maternal healthcare services and thus improve maternal health. The aim of this study was to evaluate the effect of the FMS policy on the uptake of maternal health services in Nyamira County in western Kenya. Methods An interrupted time series study design was used to design the study and to analyze the collected data. Forty-two data sets were collected for each outcome variable i.e. 24 pre- and 18 post-intervention. Monthly data was abstracted from the District Health Information System-2 (DHIS-2) and verified using facility data. The collected data was then keyed into SPSS-17, cleaned and analyzed. Results During the study period, there was a significant increase in births attended by skilled attendants up to the 12 th month (p<0.05) and caesarean section up to the ninth month (p<0.05). There was a decrease in obstetric complications up to the 12 month (p<0.05). In addition there was a significant increase in institutional maternal mortality ratio (iMMR) in the 12 th and 18 th months (p<0.05) following the implementation of free maternity service policy. There was a significant increase in deliveries in hospitals from the 1 st to the 18 th month (p<0.05) whereas in primary health care facilities the increase in deliveries was only significant up to the 6 th month (p<0.05). Conclusions The FMS policy led to progress towards improving maternal health by improving access to maternal health services. The improved utilization of maternal health services was more marked in hospitals. There was a worsening of institutional maternal mortality ratio.

Malaria drug resistance is a global public health concern. Though parasite mutations have been associated with resistance, other factors could influence the resistance. A robust surveillance system is required to monitor and help contain the resistance. This study established the role of travel and gender in dispersion of chloroquine resistant genotypes in malaria epidemic zones in Kenya. A total of 1,776 individuals presenting with uncomplicated malaria at hospitals selected from four malaria transmission zones in Kenya between 2008 and 2014 were enrolled in a prospective surveillance study assessing the epidemiology of malaria drug resistance patterns. Demographic and clinical information per individual was obtained using a structured questionnaire. Further, 2 mL of blood was collected for malaria diagnosis, parasitemia quantification and molecular analysis. DNA extracted from dried blood spots collected from each of the individuals was genotyped for polymorphisms in Plasmodium falciparum chloroquine transporter gene (Pfcrt 76), Plasmodium falciparum multidrug resistant gene 1 (Pfmdr1 86 and Pfmdr1 184) regions that are putative drug resistance genes using both conventional polymerase chain reaction (PCR) and real-time PCR. The molecular and demographic data was analyzed using Stata version 13 (College Station, TX: StataCorp LP) while mapping of cases at the selected geographic zones was done in QGIS version 2.18. Chloroquine resistant (CQR) genotypes across gender revealed an association with chloroquine resistance by both univariate model (p = 0.027) and by multivariate model (p = 0.025), female as reference group in both models. Prior treatment with antimalarial drugs within the last 6 weeks before enrollment was associated with carriage of CQR genotype by multivariate model (p = 0.034). Further, a significant relationship was observed between travel and CQR carriage both by univariate model (p = 0.001) and multivariate model (p = 0.002). These findings suggest that gender and travel are significantly associated with chloroquine resistance. From a gender perspective, males are more likely to harbor resistant strains than females hence involved in strain dispersion. On the other hand, travel underscores the role of transport network in introducing spread of resistant genotypes, bringing in to focus the need to monitor gene flow and establish strategies to minimize the introduction of resistance strains by controlling malaria among frequent transporters.

The laboratory diagnosis of pulmonary tuberculosis and smear-negative pulmonary tuberculosis in resourcelimited countries are often based on X-ray and sputum smear microscopy. These diagnostic tools require experts, have long turnaround time, and cannot detect resistance to Tuberculosis (TB) drugs and TB in individuals with Human immunodeficiency virus. Recently there was development of GeneXpert MTB/Rif assay that has a short turnaround time and can detect resistance to rifampicin among TB patients but its utility has not been evaluated in Kenya. This study investigated the comparative sensitivity and specificity of smear microscopy and culture relative to GeneXpert MTB/Rif assay among suspected TB patients. A cross-sectional study was conducted in Nyamira County Referral Hospital among suspected TB patients and both results recorded. Culture for Mycobacterium tuberculosis served as the reference standard. The results of this study showed that among 682 enrolled participants, 182(26.69%) were diagnosed TB positive while 500 (73.31%) no TB. GeneXpert mtb/rif had a higher sensitivity (100%) and specificity (99.4%) relative to culture and a positive predictive value of (98.4%) and a negative predictive value of (100%). Smear microscopy revealed low sensitivity (26.4%) and a higher specificity (98.2%). A concordance analysis of smear microscopy and GeneXpert was done. The findings revealed a significant (patients showed resistance to either one of the TB drugs (rifampicin, isoniazid and Ethambutol) while none of the enrolled patients were resistant to streptomycin. In conclusion Gene Xpert MTB/Rif test had high sensitivity compared to smear microscopy. For rifampicin resistance detection, it provided accurate results. My recommendation to the Division of TB and lung diseases is to roll out the Gene Xpert mtb/rif machines to all health care facilities.

Background Epstein Barr virus (EBV)-associated endemic Burkitt's Lymphoma pediatric cancer is associated with morbidity and mortality among children resident in holoendemic Plasmodium falciparum regions in western Kenya. P. falciparum exerts a strong selection pressure on sickle cell trait (SCT), alpha thalassemia (-α3.7/αα), glucose-6-phosphate dehydrogenase (G6PD), and merozoite surface protein 2 (MSP-2) variants (FC27, 3D7) that confer reduced malarial disease severity Methods Data on infant EBV infection status (<6 and ≥6-12 months of ages) was abstracted from a previous longitudinal study. Archived infant DNA (n=81) and mothers DNA (n=70) samples were used for genotyping hemoglobinopathies and MSP-2. Presence of MSP-2 genotypes in maternal DNA samples was used to indicate infant in utero malarial exposure. Genetic variants were determined by TaqMan assays or standard PCR. Group differences were determined by Chi-square or Fisher’s analysis. Bivariate regression modelling was used to determine the relationship between carriage of genetic variants and EBV acquisition. Results EBV acquisition for infants <6 months was not associated with -α3.7/αα (OR=1.824, P =0.354), SCT (OR=0.897, P=0.881), or G6PD [Viangchan (871G>A)/Chinese (1024C>T) (OR=2.614, P=0.212)] and [Union (1360C>T)/Kaiping (1388G>A) (OR=0.321, P=0.295)]. There was no relationship between EBV acquisition and in utero exposure to either FC27 (OR=0.922, P=0.914) or 3D7 (OR=0.933, P=0.921). In addition, EBV acquisition in infants ≥6-12 months also showed no association with -α3.7/αα (OR=0.681, P=0.442), SCT (OR=0.513, P=0.305), G6PD [(Viangchan (871G>A)/Chinese (1024C>T) (OR=0.640, P=0.677)], [Mahidol (487G>A)/Coimbra (592C>T) (OR=0.948, P=0.940)], [(Union (1360C>T)/Kaiping (1388G>A) (OR=1.221, P=0.768)], African A (OR=0.278, P=0.257)], or in utero exposure to either FC27 (OR=0.780, P=0.662) or 3D7 (OR=0.549, P=0.241). Conclusion: Although hemoglobinopathies (-α3.7/αα, SCT, and G6PD mutations) and in utero exposure to MSP-2 was not associated with EBV acquisition in infants 0-12 months, novel G6PD variants were discovered in the population from western Kenya. To definitely establish that the known and novel hemoglobinopathies, and in utero MSP-2 exposure do not confer susceptibility to EBV, future studies with larger sample sizes are required.

Background: Globally there is a rapid increase in the prevalence of Gestational diabetes mellitus (GDM) associated with adverse maternal and neonatal outcomes. However, screening for GDM is not part of the standard routine antenatal (ANC) services in Kenya. There is a paucity of data on the factors associated with and predictors of GDM. Therefore, this study sought to determine factors associated with and predictors of GDM among pregnant women in western Kenya. Methods: A case-control study was conducted from September 2021-October 2022. Using a validated questionnaire, data were obtained from 210 randomly sampled pregnant women attending antenatal clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu city, western Kenya. Screening and diagnosis for Gestational Diabetes mellitus was performed using the 2013 World Health Organization (WHO) criteria. Both descriptive and inferential statistical analysis were done in SPSS V.23 using Chi-square (χ2) test to test for associations and Binary logistic regression analysis to determine predictors of GDM. Results. Among the 105 GDM cases, majority were in 30-34 years age group (51%), overweight with a BMI of 25-29.9 kg/m2 (56%), had history of hypertension (53%), had hypertensive relatives (64%), had history of glycosuria (64%), were multiparous (69%), had history of cesarean delivery (61%), had history of macrosomic delivery (63%) and had history of neonatal intensive care unit (NICU) admission (53%). Multivariate analysis revealed that living in peri-urban area (adjusted OR [aOR] 3.30, 95%CI: 1.04-11.3, p=0.048), having a diabetic relative (aOR 8.09, 95%CI: 1.44- 73.0, p=0.031), being on iron-folic acid supplementation (IFAS) (aOR 13.0, 95%CI: 4.37-47.8, <0.001), having history of neonatal intensive care unit admission (NICU) (aOR 13.9, 95%CI: 3.45-70.5, p<0.001) and history of caesarean delivery (aOR 5.02, 95%CI: 1.42-19.5, p=0.015) significantly increased the odds of having GDM. Conclusion: The predictors of GDM include having a diabetic relative, history of cesarean section, NICU admission and being on IFAS. There is need to incorporate GDM screening in the standard ANC services for optimal pregnancy outcomes. Multicenter studies looking at the long term effects of IFAS should be carried out to inform evidence based nutrition interventions during pregnancy.

Background Epstein Barr virus (EBV)-associated endemic Burkitt’s Lymphoma pediatric cancer is associated with morbidity and mortality among children resident in holoendemic Plasmodium falciparum regions in western Kenya. P. falciparum exerts strong selection pressure on sickle cell trait (SCT), alpha thalassemia (-α3.7/αα), glucose-6-phosphate dehydrogenase (G6PD), and merozoite surface protein 2 (MSP-2) variants (FC27, 3D7) that confer reduced malarial disease severity. The current study tested the hypothesis that SCT, (-α3.7/αα), G6PD mutation and (MSP-2) variants (FC27, 3D7) are associated with an early age of EBV acquisition. Methods Data on infant EBV infection status (< 6 and ≥ 6–12 months of age) was abstracted from a previous longitudinal study. Archived infant DNA (n = 81) and mothers DNA (n = 70) samples were used for genotyping hemoglobinopathies and MSP-2. The presence of MSP-2 genotypes in maternal DNA samples was used to indicate infant in-utero malarial exposure. Genetic variants were determined by TaqMan assays or standard PCR. Group differences were determined by Chi-square or Fisher’s analysis. Bivariate regression modeling was used to determine the relationship between the carriage of genetic variants and EBV acquisition. Results EBV acquisition for infants < 6 months was not associated with -α3.7/αα (OR = 1.824, P = 0.354), SCT (OR = 0.897, P = 0.881), or G6PD [Viangchan (871G > A)/Chinese (1024 C > T) (OR = 2.614, P = 0.212)] and [Union (1360 C > T)/Kaiping (1388G > A) (OR = 0.321, P = 0.295)]. There was no relationship between EBV acquisition and in-utero exposure to either FC27 (OR = 0.922, P = 0.914) or 3D7 (OR = 0.933, P = 0.921). In addition, EBV acquisition in infants ≥ 6–12 months also showed no association with -α3.7/αα (OR = 0.681, P = 0.442), SCT (OR = 0.513, P = 0.305), G6PD [(Viangchan (871G > A)/Chinese (1024 C > T) (OR = 0.640, P = 0.677)], [Mahidol (487G > A)/Coimbra (592 C > T) (OR = 0.948, P = 0.940)], [(Union (1360 C > T)/Kaiping (1388G > A) (OR = 1.221, P = 0.768)], African A (OR = 0.278, P = 0.257)], or in utero exposure to either FC27 (OR = 0.780, P = 0.662) or 3D7 (OR = 0.549, P = 0.241). Conclusion Although hemoglobinopathies (-α3.7/αα, SCT, and G6PD mutations) and in-utero exposure to MSP-2 were not associated with EBV acquisition in infants 0–12 months, novel G6PD variants were discovered in the population from western Kenya. To establish that the known and novel hemoglobinopathies, and in utero MSP-2 exposure do not confer susceptibility to EBV, future studies with larger sample sizes from multiple sites adopting genome-wide analysis are required.