A systematic review was conducted by a multidisciplinary team to analyze qualitatively best available scientific evidence on the effect of agricultural intensification and environmental changes on ...the risk of zoonoses for which there are epidemiological interactions between wildlife and livestock. The study found several examples in which agricultural intensification and/or environmental change were associated with an increased risk of zoonotic disease emergence, driven by the impact of an expanding human population and changing human behavior on the environment. We conclude that the rate of future zoonotic disease emergence or reemergence will be closely linked to the evolution of the agriculture-environment nexus. However, available research inadequately addresses the complexity and interrelatedness of environmental, biological, economic, and social dimensions of zoonotic pathogen emergence, which significantly limits our ability to predict prevent, and respond to zoonotic disease emergence.
African swine fever (ASF) is a highly fatal disease of pigs. It is a threat to the pig industry as it lowers production and significantly impacts on livelihoods. ASF has no cure and a vaccine against ...it is yet to be developed. Outbreaks continue to be reported in Africa and Asia, where the setting of the pig value chain (farm, market, and slaughter practices) coupled with the risky behaviors of actors, contribute to persistence of the virus in pig populations. The role of these factors in the epidemiology of the disease is reviewed with a focus on smallholder pig systems in Africa. Biosecurity at the farm level is particularly emphasized, and factors influencing its adoption highlighted. Socio-cultural factors and weaknesses at the disease control policy level are critical and should not be ignored. Gender and equity are important aspects and ought to be considered in discussions to improve the sector. The findings are expected to define priorities for interventions to improve pig productivity (as these regions wait for the vaccine to be developed).
Background Livestock production, particularly the dairy sector, is important for food and nutritional wellbeing of communities in India, it supports livelihoods of many farmers, and contributes to ...the economy of the country. India is a high consumer of antibiotics and antimicrobial resistant (AMR) bacteria are a major public health concern. Objectives Our objectives were to identify animal health and drug use practices that may contribute to emergence and spread of AMR in the country, review previous AMR- mitigation strategies, and discuss "theory of change" as an approach to informing the choice of interventions. Methods We undertook a desk review of literature to identify practices with potential to contribute to emergence and spread of antimicrobial resistance in India. Searches were done in PubMed, Google scholar, and Google. Data were synthesized and discussed by themes. Results Animal disease surveillance is less developed and infrastructure to support delivery of services is inadequate. Several groups are known to offer animal health services. The untrained "animal health workers" and para-veterinarians are more popular with farmers as they charge less for consultations (compared to veterinarians who are few and charge more). Over-the-counter access of antibiotics, without prescription, and direct marketing of drugs to farmers are common. Because of this, farmers are able to treat their animals and only consult when cases become non- responsive to treatment. Antibiotics are mostly used in management of mastitis cases. Drug withdrawal periods are rarely observed and occurrence of antibiotic- contaminated milk has been reported. Awareness on AMR is low and antimicrobial stewardship in livestock is yet to be developed. Initiatives such as the National programme for containment of AMR, National Action Plan on AMR, and the National Health policy point to government's commitment in addressing the problem of AMR in the country. Conclusion Several animal health and drug use practices, with potential to cause AMR, have been described, and their contribution can be discussed further by engaging stakeholders in a "theory of change" exercise. Interventions that address AMR from the animal health perspective should be promoted, and incentives to increase their adoption explored. Keywords: Antimicrobial use, Antimicrobial resistance, Animal health, Theory of change
Consumers have a right to safer foods, and traceability is one approach to meeting their expectations. Kenya does not have an operational animal traceability system, and while a few initiatives have ...been piloted, these have only focused on the beef value chain. In this paper, we begin a discussion on traceability in the pig value chain, with an initial focus on smallholder systems of Western Kenya. First, a background to local pig production is given, and a description of animal identification and traceability options applicable to these systems is explained. Based on this, a “butcher-to-farm” traceability system, with health, production and food safety as objectives, is discussed. Requirements for establishing such a system (including actor incentives) are additionally discussed. The proposed approach can be piloted in the field and findings used to inform the design of a larger pilot and possibly pave way for implementation of a national traceability system, in line with the guidelines provided by the World Organization for Animal Health (OIE). Organized systems in the area (including commercial producer and trader groups) would offer a useful starting point.
Background
Calcium channel blockers (CCBs) are used to manage hypertension which is highly prevalent among people with chronic kidney disease (CKD). The treatment for hypertension is particularly ...challenging in people undergoing dialysis.
Objectives
To assess the benefits and harms of calcium channel blockers in patients with chronic kidney disease requiring dialysis.
Search methods
We searched the Cochrane Kidney and Transplant Register of Studies to 27 April 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.
Selection criteria
All randomised controlled trials (RCTs) and quasi‐RCTs that compared any type of CCB with other CCB, different doses of the same CCB, other antihypertensives, control or placebo were included. The minimum study duration was 12 weeks.
Data collection and analysis
Two authors independently assessed study quality and extracted data. Statistical analyses were performed using a random‐effects model and results expressed as risk ratio (RR), risk difference (RD) or mean difference (MD) with 95% confidence intervals (CI).
Main results
This review included 13 studies (24 reports) randomising 1459 participants treated with long‐term haemodialysis. Nine studies were included in the meta‐analysis (622 participants). No studies were performed in children or in those undergoing peritoneal dialysis. Overall, risk of bias was assessed as unclear to high across most domains.
Random sequence generation and allocation concealment were at low risk of bias in eight and one studies, respectively. Two studies reported low risk methods for blinding of participants and investigators, and outcome assessment was blinded in 10 studies. Three studies were at low risk of attrition bias, eight studies were at low risk of selective reporting bias, and five studies were at low risk of other potential sources of bias. Overall, the certainty of the evidence was low to very low for all outcomes. No events were reported for cardiovascular death in any of the comparisons. Other side effects were rarely reported and studies were not designed to measure costs.
Five studies (451 randomised adults) compared dihydropyridine CCBs to placebo or no treatment. Dihydropyridine CCBs may decrease predialysis systolic (1 study, 39 participants: MD ‐27.00 mmHg, 95% CI ‐43.33 to ‐10.67; low certainty evidence) and diastolic blood pressure level (2 studies, 76 participants; MD ‐13.56 mmHg, 95% CI ‐19.65 to ‐7.48; I2 = 0%, low certainty evidence) compared to placebo or no treatment. Dihydropyridine CCBs may make little or no difference to occurrence of intradialytic hypotension (2 studies, 287 participants; RR 0.54, 95% CI 0.25 to 1.15; I2 = 0%, low certainty evidence) compared to placebo or no treatment. Other side effects were not reported.
Eight studies (1037 randomised adults) compared dihydropyridine CCBs to other antihypertensives. Dihydropyridine CCBs may make little or no difference to predialysis systolic (4 studies, 180 participants: MD 2.44 mmHg, 95% CI ‐3.74 to 8.62; I2 = 0%, low certainty evidence) and diastolic blood pressure (4 studies, 180 participants: MD 1.49 mmHg, 95% CI ‐2.23 to 5.21; I2 = 0%, low certainty evidence) compared to other antihypertensives. There was no evidence of a difference in the occurrence of intradialytic hypotension (1 study, 92 participants: RR 2.88, 95% CI 0.12 to 68.79; very low certainty evidence) between dihydropyridine CCBs to other antihypertensives. Other side effects were not reported.
Dihydropyridine CCB may make little or no difference to predialysis systolic (1 study, 40 participants: MD ‐4 mmHg, 95% CI ‐11.99 to 3.99; low certainty evidence) and diastolic blood pressure (1 study, 40 participants: MD ‐3.00 mmHg, 95% CI ‐7.06 to 1.06; low certainty evidence) compared to non‐dihydropyridine CCB. There was no evidence of a difference in other side effects (1 study, 40 participants: RR 0.13, 95% CI 0.01 to 2.36; very low certainty evidence) between dihydropyridine CCB and non‐dihydropyridine CCB. Intradialytic hypotension was not reported.
Authors' conclusions
The benefits of CCBs over other antihypertensives on predialysis blood pressure levels and intradialytic hypotension among people with CKD who required haemodialysis were uncertain. Effects of CCBs on other side effects and cardiovascular death also remain uncertain. Dihydropyridine CCBs may decrease predialysis systolic and diastolic blood pressure level compared to placebo or no treatment. No studies were identified in children or peritoneal dialysis. Available studies have not been designed to measure the effects on costs. The shortcomings of the studies were that they recruited very few participants, had few events, had very short follow‐up periods, some outcomes were not reported, and the reporting of outcomes such as changes in blood pressure was not done uniformly across studies.
Well‐designed RCTs, conducted in both adults and children with CKD requiring both haemodialysis and peritoneal dialysis, evaluating both dihydropyridine and non‐dihydropyridine CCBs against other antihypertensives are required. Future research should be focused on outcomes relevant to patients (including death and cardiovascular disease), blood pressure changes, risk of side effects and healthcare costs to assist decision‐making in clinical practice.
Although prevention and control of spread of multi-drug resistant tuberculosis strains is a global challenge, there is paucity of data on the prevalence of DR-TB in patients diagnosed with TB in ...referral hospitals in Kenya. The present study assessed patients' characteristics and prevalence of drug resistant TB in sputa smear positive TB patients presenting to Coast Provincial General Hospital (CPGH) in Mombasa, Kenya.
Drug resistance was evaluated in 258 randomly selected sputa smear TB positive cases between the periods of November 2011 to February 2012 at the CPGH-Mombasa. Basic demographic data was obtained using administered questionnaires, and clinical history extracted from the files. For laboratory analyses, 2mls of sputum was obtained, decontaminated and subjected to mycobacteria DNA analyses. Detection of first line drug resistance genes was done using MDRTDR plus kit. This was followed with random selection of 83 cases for second line drug resistance genes testing using Genotype MDRTBsl probe assay kit (HAINS Lifesciences, GmbH, Germany), in which ethambutol mutation probes were included. The data was then analyzed using SPSS statistical package version 19.0.
Male to female ratio was 1:2. Age range was 9 to 75 years, with median of 30 years. New treatment cases constituted 253(98%), among which seven turned out to be PTB negative, and further grouped as 4 (1.6%) PTB negative and 3(1.1%) NTM. 237(91.7%) new cases were fully susceptible to INH and RIF. The remaining, 8 (3.1%) and 1(0.4%) had mono- resistance to INH and RIF, respectively. All the retreatment cases were fully susceptible to the first line drugs. HIV positivity was found in 48 (18.6%) cases, of which 46(17.8%) were co-infected with TB. Of these, 44 (17.1%) showed full susceptibility to TB drugs, while 2 (0.8%) were INH resistant. For the second line drugs, one case each showed mono resistance to both and FQ. Also, one case each showed drug cross poly resistance to both ETH and FQ, with second line injectable antibiotics. However, no significant statistical correlation was established between TB and resistance to the second line drugs p = 0.855.
The findings of this study showed the existence of resistance to both first and second line anti-tubercular drugs, but no MDR-TB and XDR-TB was detected among patients attending TB clinic at CPGH using molecular techniques.
Introduction Informal markets play a crucial role in providing fresh and nutritious foods for people in low and middle-income countries. However, the safety of food sold in these markets remains a ...major concern, contributing to a high burden of foodborne illnesses. Methods This study was designed to analyze stakeholder perceptions of food safety in selected informal public markets in Kenya. Eight focus group discussions and 15 key informant interviews were conducted. In addition, two workshops were held to validate the findings. Results and discussion We found that consumers and vendors confounded food quality, especially freshness, with safety, and paid more attention to appearance and physical qualities than food safety. Information (such as branding and expiry dates) and heuristic cues (such as the flow of buyers and the presence of flies) were used to assess food safety. Meat was perceived as the food most likely to cause disease. Chemical hazards in fresh produce and aflatoxins in maize were mentioned as priority hazards by both vendors and consumers. Stakeholders more knowledgeable about food safety considered microbial hazards as a top priority. Although diarrheal diseases were reported to be prevalent in the communities, these were often thought to be the result of agri-chemical residues in fresh produce or the consumption of high-fat foods, and not commonly linked to bacteria in food. Gaps identified during the interviews included poor infrastructure, inadequate food safety knowledge, insufficient or prohibitive policies, insufficient political will, and poor food safety-related practices. There were few mentions of lack of motivation or incentives for behavior change, or insufficient consumer demand for food safety. To fill the gaps, several opportunities were discussed, including contextualizing policies and regulations, investing in infrastructure, capacity building, and training, and promoting involvement and collaboration among various stakeholders. Conclusion This study has highlighted gaps and misperceptions that need to be addressed through proper knowledge and awareness to effectively combat foodborne disease challenges. Behavioral change approaches to improve food safety are recommended.
The occurrence of aflatoxin M1 (AFM1) in milk has been widely reported in Kenya, with levels freqently exceeding national and international thresholds. Exposure to aflatoxin increases the risk of ...hepatic cancers and can also have other negative health impacts in children such as growth impairment and immunosuppression. Anti-mycotoxin agents (AMAs) included in contaminated feeds can greatly reduce the amount of AFM1 released in milk. A 45-day trial was designed to assess secretion of AFM1 in milk from individual cows fed commercial Kenyan dairy feed, as well as the efficacy of Novasil™ Plus in reducing the levels. A four-by-four Latin square cross-over design was used for the experiment. Four cows were fed on naturally contaminated with AFB1 feed, with levels ranging from 19 to 47 µg/kg, and either no binder or inclusion of binder at the rate of 0.6 or 1.2%. Milk samples were collected each day and analyzed for AFM1. The results showed that AFM1 levels in the milk varied between the cows, even when fed similar levels of contaminated feed. On average, inclusion of 0.6% binder into the diet resulted in 34% decline in milk AFM1 levels, while 1.2% binder dose resulted in a decline of 45%. Significant reduction in AFM1 secretion was observed in all experimental units (p < 0.005), though only minimal reduction was recorded in one of the units (Cow 4) compared to the other three. This trial shows novel data on aflatoxin exposure and excretion in Kenyan dairy cows in a field setting where AFB1 level is uncontrolled. We demonstrate significant reduction in AFM1 secretion in milk using AMA, though AFM1 levels were still above the recommended EC standard of 50 ŋg/kg. This study suggests that AMAs alone cannot be relied on to reduce AFM1 in milk to safe levels. Training and good feeding practices are recommended in addition to use of AMAs.
Globally, foodborne zoonoses are responsible for approximately one third of all foodborne disease burden and this picture is likely to worsen if consumption of animal source foods continues to rise ...with insufficient attention to risk mitigation. Traditional markets represent highly important nodes that can be targeted for risk mitigation; in this series of case studies, we discuss food safety interventions relevant to this nexus. We illustrate that to improve food safety within traditional markets it is essential to consider some of the motivations and incentives of the stakeholders involved and the cultural, social, and economic context in which interventions are undertaken, highlighting barriers, enablers future interventions should aim to avoid, embrace. We also conclude that a holistic approach to foodborne zoonoses control will require the institutionalization of One Health across food systems of which traditional markets are part.
Introduction Approximately 70% of diarrheal cases in Kenya are attributed to ingestion of contaminated food and water and costs an estimated $ 1 billion USD due to morbidity and cost of treatment. ...This study aimed to assess the levels of microbiological contamination of meat sold in selected butcheries in Nairobi and the handling practices of butcher shop attendants. Methods A cross-sectional study design was used during which 200 meat samples were collected, and meat handling practices were observed. Total coliforms and Escherichia coli were enumerated using 3M™ Petrifilm® count plates. Additionally, quantification of tetracycline- and cefotaxime-resistant Enterobacteriaceae was done on agar plates containing the respective antibiotics. Bacterial species were confirmed by Matrix-Assisted Laser Desorption/Ionization-Time of Flight mass spectrometry. Results and discussion Seventy two percent and 84% of the samples had E. coli and total coliforms respectively above the acceptable regulatory limits (i.e. E. coli >100 CFU/g, Total coliforms >361 CFU/g,) respectively as per the Kenya Bureau of Standards South African microbiological standards the European Union. Enterobacteriaceae resistant to tetracycline and cefotaxime were detected in 35% and 9.5% of the samples respectively. Eighty-five percent of the butcher shop attendants neither washed their hands before nor after handling the meat, 91% handled money while selling meat concurrently, and 99% did not wear gloves while handling meat. These poor meat handling practices coupled with the presence of microbial loads above the regulatory acceptable limits imply an increased risk of foodborne illness to consumers. Therefore, there is an urgent need for education of butcher shop attendants on appropriate handling of meat, highlighting the importance of good hygienic practices and their relationship to food safety, and provision of incentives for behavior change. This study is important and serves to inform policymakers in the identification of key control points for designing meat safety intervention(s).
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