Adapting Longstanding Public Health Collaborations between Government of Kenya and CDC Kenya in Response to the COVID-19 Pandemic, 2020–2021

Herman‐Roloff, Amy; Aman, Rashid; Samandari, Taraz; Kasera, Kadondi; Emukule, Gideon O.; Amoth, Patrick; Chen, Tai-Ho; Kisivuli, Jackton; Weyenga, Herman; Hunsperger, Elizabeth; Onyango, Clayton; Juma, Bonventure; Munyua, Peninah; Wako, Daniel; Akelo, Victor; Kimanga, Davies; Ndegwa, Linus; Mohamed, Ahmed Abade; Okello, Peter; Kariuki, Samuel; Cock, Kevin M. De; Bulterys, Marc

doi:10.3201/eid2813.211550

Cited by 7 publications

(8 citation statements)

References 15 publications

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“…The Kenyan government countermeasures in place during the study period may have had an impact on the spread of SARS-CoV-2 within the study households. In June 2020, the Kenyan government announced guidelines for home-based care for asymptomatic or mildly symptomatic patients without co-morbidities 37 . Kenya started vaccinating its population in March 2021, but the coverage was low (<15%) during the study period 38 , and thus it is unlikely that it affected transmission during our study.…”

Section: Discussionmentioning

confidence: 99%

Genomic epidemiology of SARS-CoV-2 within households in coastal Kenya: a case ascertained cohort study

Agoti

Gallagher

Nyiro

et al. 2022

Preprint

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Background Analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomic sequence data from household infections should aid its detailed epidemiological understanding. Using viral genomic sequence data, we investigated household SARS-CoV-2 transmission and evolution in coastal Kenya households. Methods We conducted a case-ascertained cohort study between December 2020 and February 2022 whereby 573 members of 158 households were prospectively monitored for SARS-CoV-2 infection. Households were invited to participate if a member tested SARS-CoV-2 positive or was a contact of a confirmed case. Follow-up visits collected a nasopharyngeal/oropharyngeal (NP/OP) swab on days 1, 4 and 7 for RT-PCR diagnosis. If any of these were positive, further swabs were collected on days 10, 14, 21 and 28. Positive samples with an RT-PCR cycle threshold of <33.0 were subjected to whole genome sequencing followed by phylogenetic analysis. Ancestral state reconstruction was used to determine if multiple viruses had entered households. Results Of 2,091 NP/OP swabs that were collected, 375 (17.9%) tested SARS-CoV-2 positive. Viral genome sequences (>80% coverage) were obtained from 208 (55%) positive samples obtained from 61 study households. These genomes fell within 11 Pango lineages and four variants of concern (Alpha, Beta, Delta and Omicron). We estimated 163 putative transmission events involving members of the sequenced households, 40 (25%) of which were intra-household transmission events while 123 (75%) were infections that likely occurred outside the households. Multiple virus introductions (up-to-5) were observed in 28 (47%) households with the 1-month follow-up period. Conclusions We show that a considerable proportion of SARS-CoV-2 infections in coastal Kenya occurred outside the household setting. Multiple virus introductions frequently occurred into households within the same infection wave in contrast to observations from high income settings, where single introduction appears to be the norm. Our findings suggests that control of SARS-CoV-2 transmission by household member isolation may be impractical in this setting.

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Section: Discussionmentioning

confidence: 99%

Genomic epidemiology of SARS-CoV-2 within households in coastal Kenya: a case ascertained cohort study

Agoti

Gallagher

Nyiro

et al. 2022

Preprint

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“…In Kenya, the universal national SARS-CoV-2 surveillance was led by MoH focusing initially on points of entry and contact of people exposed to individuals who tested positive for SARS-CoV-2. Once there was evidence of community spread of SARS-CoV-2 infections in Kenya, all persons suspected to have COVID-19 or presenting with ILI in health facilities were tested for COVID-19 [ 26 ]. In addition, cargo vessel crew at all entry points were screened for SARS-CoV-2.…”

Section: Methodsmentioning

confidence: 99%

Use of Sentinel Surveillance Platforms for Monitoring SARS-CoV-2 Activity: Evidence From Analysis of Kenya Influenza Sentinel Surveillance Data

Owusu,

Ndegwa,

Ayugi

et al. 2024

JMIR Public Health Surveill

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Background Little is known about the cocirculation of influenza and SARS-CoV-2 viruses during the COVID-19 pandemic and the use of respiratory disease sentinel surveillance platforms for monitoring SARS-CoV-2 activity in sub-Saharan Africa. Objective We aimed to describe influenza and SARS-CoV-2 cocirculation in Kenya and how the SARS-CoV-2 data from influenza sentinel surveillance correlated with that of universal national surveillance. Methods From April 2020 to March 2022, we enrolled 7349 patients with severe acute respiratory illness or influenza-like illness at 8 sentinel influenza surveillance sites in Kenya and collected demographic, clinical, underlying medical condition, vaccination, and exposure information, as well as respiratory specimens, from them. Respiratory specimens were tested for influenza and SARS-CoV-2 by real-time reverse transcription polymerase chain reaction. The universal national-level SARS-CoV-2 data were also obtained from the Kenya Ministry of Health. The universal national-level SARS-CoV-2 data were collected from all health facilities nationally, border entry points, and contact tracing in Kenya. Epidemic curves and Pearson r were used to describe the correlation between SARS-CoV-2 positivity in data from the 8 influenza sentinel sites in Kenya and that of the universal national SARS-CoV-2 surveillance data. A logistic regression model was used to assess the association between influenza and SARS-CoV-2 coinfection with severe clinical illness. We defined severe clinical illness as any of oxygen saturation <90%, in-hospital death, admission to intensive care unit or high dependence unit, mechanical ventilation, or a report of any danger sign (ie, inability to drink or eat, severe vomiting, grunting, stridor, or unconsciousness in children younger than 5 years) among patients with severe acute respiratory illness. Results Of the 7349 patients from the influenza sentinel surveillance sites, 76.3% (n=5606) were younger than 5 years. We detected any influenza (A or B) in 8.7% (629/7224), SARS-CoV-2 in 10.7% (768/7199), and coinfection in 0.9% (63/7165) of samples tested. Although the number of samples tested for SARS-CoV-2 from the sentinel surveillance was only 0.2% (60 per week vs 36,000 per week) of the number tested in the universal national surveillance, SARS-CoV-2 positivity in the sentinel surveillance data significantly correlated with that of the universal national surveillance (Pearson r=0.58; P<.001). The adjusted odds ratios (aOR) of clinical severe illness among participants with coinfection were similar to those of patients with influenza only (aOR 0.91, 95% CI 0.47-1.79) and SARS-CoV-2 only (aOR 0.92, 95% CI 0.47-1.82). Conclusions Influenza substantially cocirculated with SARS-CoV-2 in Kenya. We found a significant correlation of SARS-CoV-2 positivity in the data from 8 influenza sentinel surveillance sites with that of the universal national SARS-CoV-2 surveillance data. Our findings indicate that the influenza sentinel surveillance system can be used as a sustainable platform for monitoring respiratory pathogens of pandemic potential or public health importance.

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“…Local government health workers and CHV representation at training sessions ensured that our messaging was consistent with the broad principles adopted by the Kenyan government and the county health authorities. During this period, the Kenyan government implemented interventions including daily curfews, social distancing (minimum of 1.5m), maskwearing, hand sanitation, and COVID-19 testing when possible through a variety of means [40,43,44]. At times, strict punitive measures were employed by police to ensure compliance in response to the rapidly changing transmission rates, with spikes of COVID 19 cases being recorded in early August and in mid-November [45,46].…”

Section: Plos Onementioning

confidence: 99%

“…The number of COVID-19 tests that were performed in the country also saw a steep rise during this period [47,48]. Even though attempts were made to ease some measures nationwide in August, movement restrictions were re-imposed in November 2020, coinciding with a rapid rise in case numbers [44]. The guidance issued jointly by the Africa CDC and African Union [49,50] was the basis of policy making in Kenya, which though comprehensive, did not make any provisions for daily wage earners (mostly casual labourers) living in informal settlements.…”

Section: Plos Onementioning

confidence: 99%

A cross-sectional survey on the effectiveness of public health campaigns for changing knowledge, attitudes, and practices in Kenyan informal settlements during the COVID-19 pandemic

Scholfield,

Kavembe,

Duncan

et al. 2023

PLoS ONE

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We performed two cross-sectional surveys across three informal settlements in Kenya (within Kisii county, Nairobi, and Nakuru county) to study the effectiveness of public health interventions during the COVID-19 pandemic. A total of 720 participants were surveyed from 120 randomly selected geographical locations (240 participants/settlement/survey), and a coordinated health promotion campaign was delivered between the two surveys by trained staff. Information relating to knowledge, attitudes, and practices (KAP) were collected by trained field workers using a validated questionnaire. The main outcomes showed improvements in: (i) mask-wearing (% of participants ‘Always’ using their mask increased from 71 to 74%, and the percentage using their masks ‘Sometimes’ decreased from 15% to 6%; p<0.001); (ii) practices related to face mask usage (% of subjects covering the mouth and nose increased from 91 to 95%, and those covering only part of their face decreased from around 2.5% to <1%; p<0.001). Significant improvements were also seen in the attitudes and expectations relating to mask wearing, and in the understanding of government directives. Over 50% of subjects in the post-campaign survey reported that social distancing was not possible in their communities and fears associated with COVID-19 testing were resistant to change (unchanged at 10%). Access to COVID-19 testing facilities was limited, leaving a large proportion of people unable to test. As willingness to take a COVID-19 test did not change between surveys (69 vs 70%; p = 0.57), despite increased availability, we recommend that policy level interventions are needed, aimed at mitigating adverse consequences of a positive test. Improvements of KAPs in the more crowded urban environment (Nairobi) were less than at settlements in rural or semi-urban settings (Nakuru and Kisii). We conclude that coordinated public health campaigns are effective in facilitating the change of KAPs amongst people living amidst challenging socio-economic conditions in informal settlements.

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Adapting Longstanding Public Health Collaborations between Government of Kenya and CDC Kenya in Response to the COVID-19 Pandemic, 2020–2021

Cited by 7 publications

References 15 publications

Genomic epidemiology of SARS-CoV-2 within households in coastal Kenya: a case ascertained cohort study

Genomic epidemiology of SARS-CoV-2 within households in coastal Kenya: a case ascertained cohort study

Use of Sentinel Surveillance Platforms for Monitoring SARS-CoV-2 Activity: Evidence From Analysis of Kenya Influenza Sentinel Surveillance Data

A cross-sectional survey on the effectiveness of public health campaigns for changing knowledge, attitudes, and practices in Kenyan informal settlements during the COVID-19 pandemic

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