IntroductionMedication non-adherence is a common problem facing health care providers treating adult type 2 diabetes mellitus patients. Poor glycaemic control associated with increased morbidity and mortality are resulting consequences. The objective of this study was to assess medication adherence among Type 2 diabetes mellitus patients.MethodsThis is a cross-sectional study conducted at Kenyatta National Hospital from November 2015 to January 2016. 290 Type 2 diabetic patients were enrolled. A questionnaire was used for data collection. Adherence levels were determined by patient scores on Morisky Medication Adherence Scale-8 and glycaemic control by blood assay for glycosylated haemoglobin. Ordinal logistic regression modelling was done using STATA software to determine factors associated with poor medication adherenceResultsThe prevalence of medication adherence low for 28.3 % [95% CI: 23.1, 33.5], medium for 26.2% (95% CI: 21.1, 31.3) and high for 45.5% (95% CI: 39.6, 51.3) of study participants. Glycaemic control was good (HbA1c < 7%) for 107 (36.9 %) of study participants. Dissatisfaction with family members support (OR = 2.99, CI = 1.12-7.98), patients with 2-10 years duration of disease (OR = 2.07, CI = 1.01-4.22), ever being admitted for diabetes mellitus (OR = 2.94, CI = 1.60-5.41), challenge in drug access (OR = 1.76, CI = 1.01-3.05) and dissatisfaction with attending clinicians (OR = 3.58, CI= 1.36 - 9.43) were factors found associated with poor medication adherence.ConclusionA majority of type 2 diabetes mellitus patients have suboptimal medication adherence. Family support, affordability of medications and good healthcare provider-patient communication are important in ensuring medication adherence.

Objective-Several fastidious bacteria have been associated with bacterial vaginosis (BV), but their role in lactobacilli recolonization failure is unknown. We studied the effect of seven BVassociated bacterial species and two Lactobacillus species on vaginal colonization with L. crispatus CTV-05 (LACTIN-V).Methods-Twenty four women with BV were given a 5-day course of metronidazole vaginal gel and then randomized 3:1 to receive either LACTIN-V or placebo applied vaginally once daily for 5 initial consecutive days, followed by a weekly application over 2 weeks. Vaginal swabs for L. crispatus CTV-05 culture and 9-bacterium specific 16S rRNA gene quantitative PCR assays were analyzed on several study visits for the 18 women receiving LACTIN-V.Results-Vaginal colonization with CTV-05 was achieved in 61% of the participants receiving LACTIN-V at either the day 10 or the 28 visit and 44% at day 28. Participants not colonized with CTV-05 had generally higher median concentrations of BV-associated bacteria compared to those who colonized. Between enrollment and day 28, the median concentration of Gardnerella vaginalis minimally reduced from 10 4.5 to 10 4.3 16S rRNA gene copies per swab in women who colonized with CTV-05 but increased from 10 5.7 to 10 7.3 in those who failed to colonize (p=0.19). Similarly, the median concentration of Atopobium spp. reduced from 10 2.7 16S rRNA gene copies per swab to below limit of detection in women who colonized with CTV-05 but increased from 10 2.7 to 10 6.6 in those who failed to colonize (p=0.04). The presence of endogenous L. crispatus at enrollment was found to be significantly associated with a reduced odds of colonization with CTV-05 on day 28 (p=0.003) and vaginal intercourse during the study significantly impaired successful CTV-05 colonization (p=0.018).Corresponding Author Benjamin M. Ngugi, Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 19464-00202 Nairobi, Kenya, Tel: +254-20-2720794; +254-725-808838, Fax: +254-20-2720030, bm_ngugi@yahoo.com. NIH Public Access

IntroductionSnake bites are a silent public health problem in Kenya. Previous studies on snake bites in the country have mainly focused on identifying offending snake species, assessing the severity of envenomation and testing the efficacy of antivenom. Factors associated with snake bites in the country are yet to be fully understood. The aim of this work was to determine pharmaco-epidemiological factors associated with snake bites in areas of Kenya where incidence, severity and species responsible for snake bites have been reported.MethodsKakamega provincial hospital, Kabarnet, Kapenguria and, Makueni district hospitals were selected as study sites based on previous findings on incidence, severity and species responsible for snake bites in catchment areas of these hospitals. Persistent newspaper reports of snake bites in these areas and distribution of snakes in Kenya were also considered. Cases of snake bites reported between 2007-2009 were retrospectively reviewed and data on incidence, age, site of the bites, time of bite and antivenom use was collected.Results176 bites were captured, 91 of which occurred in 2009. Individual incidence was between 2.7/100,000/year and 6.7/100,000/year. Bites peaked in the 1-15 year age group while 132/176 bites were in the lower limb area and 49/176 victims received antivenom. Most bites occurred during the dry season, in the bush and in the evening. Overall mortality was 2.27%.ConclusionThere is a need to sensitize the Kenyan public and healthcare personnel on preventive measures, first aid and treatment of snake bites.

Cystic Echinococcosis (CE) is a widespread neglected zoonotic disease and is caused by the larval stage of the dog tapeworm Echinococcus granulosus sensu lato. CE is more frequent in livestock-rearing areas and where people live a nomadic or seminomadic lifestyle such as in Kajiado County, Kenya. There is limited data on CE disease situation in the county of Maasailand; the present study, therefore, reports on the prevalence of CE in cattle, sheep, and goats and their relative importance in CE transmission in Kajiado County. In total, 1,486 livestock (388 cattle, 625 sheep, and 473 goats) slaughtered in two abattoirs were examined for the presence of hydatid cysts in various organs. Cyst isolates were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of the NADH dehydrogenase subunit 1 gene (nad1). The overall prevalence of CE was 14.8% (220/1486), while prevalence per livestock species was 15.2% (72/473) in goats, 14.9% (93/625) in sheep, and 14.2% (55/388) in cattle. Out of the 421 cysts isolated, 389 cysts were successfully characterized to be either E. granulosus sensu stricto (s. s.), 356/389 (91.5%), E. canadensis (G6/7), 26/389 (6.7%), or E. ortleppi, 7/389 (1.8%). This record confirms predominance of E. granulosus s. s. in Maasailand and other parts of Kenya, while the importance of E. ortleppi and E. canadensis (G6/7) to the general CE burden in Maasailand might be higher than previously thought. More so, a higher infection pressure for humans by E. granulosus s. s. based on its abundance could be speculated. The study sheds significant light on CE situation in livestock in the nomadic/seminomadic society of the Maasai in Kajiado County and provides good bases to investigate human CE in the area.

Background: Data on the cost of snakebite injuries may inform key pillars of universal health coverage including proper planning, allocation, and utility of resources. This study evaluated the injuries, management, and costs resulting from snakebites at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kenya.  Methods: In total, medical records of 127 snakebite victims attending JOOTRH between January 2011 and December 2016 were purposely selected and data on the age, gender, type of residence (urban or rural), part of the body bitten, time of bite, injuries, pre-hospital first aid, time to hospital, length of stay, treatment, and costs were collected. Regression analysis was used to predict the total indirect cost of snakebite injuries and p≤ 0.05 was considered significant. Mortality and loss of income of hospitalized victims were considered as direct costs. Results: It was found that 43 victims were 13-24 years of age, 64 were female, 94 were from rural areas, 92 were bitten on the lower limbs, 49 were bitten between 6.00 pm and midnight, 43 attempted pre-hospital first aid, and the median time to hospital was 4.5 hours. Antivenom, supportive therapy, antibiotics, antihistamines, corticosteroids, analgesics, and non-steroidal anti-inflammatory drugs were used. Cellulitis, compartment syndrome, gangrenous foot, psychiatric disorder, and death were the main complications. Most victims spent 1-5 days in hospital and the median cost of treating a snakebite was 2652 KES (~$26). Drugs, ward charges, and nursing procedures were the highest contributors to the total indirect cost. Victims hospitalized for 6-10 days and >10 days incurred 32% and 62% more costs, respectively, compared to those hospitalized for 1-5 days.  Conclusions: The longer snakebite victims are hospitalized, the higher the cost incurred. Continuous medical education on the correct management of snakebites should be encouraged to minimize complications that may increase hospital stays and costs incurred.