Search Results (122)

Background: Drug therapy remains the principal management strategy for malaria but is increasingly challenged by the emergence of drug-resistant malaria parasites. The need for new antimalarial drugs is urgent, yet drug discovery and development are hindered by high costs, long durations, and safety concerns that prevent approval. The current study aimed to determine antiplasmodial activities of approved drugs in combination with artemether (ART) and lumefantrine (LU). Methods: Using the SYBR Green I assay test, this study investigated the efficacy of epirubicin (EPI) and pelitinib (PEL) combined with ART and LU at fixed drug–drug ratios (4:1, 3:1, 1:1, 1:2, 1:3 and 1:4) and volume/volume. These combinations, as well as single drug treatments, were tested against cultured strains of Plasmodium falciparum (W2, DD2, D6, 3D7 and F32-ART) and fresh and cultured clinical isolates. The fifty percent inhibition concentration (IC₅₀) and a mean sum of fifty percent fractional inhibition concentration (FIC₅₀) were determined. Results: Synergism was observed when EPI was combined with both ART and LU across all fixed ratios with a mean of mean FIC₅₀ values of <0.6. The combination of LU and EPI against the 3D7 strain demonstrated the highest efficacy with a synergism FIC₅₀ value of 0.18. Most combinations of PEL with ART and LU showed antagonism (FIC₅₀ > 1) when tested against strains of P. falciparum and clinical isolates. Conclusions: This study underscores the utility of alternative drug discovery and development strategies to bypass cost, time, and safety barriers, thereby enriching the antimalarial drug pipeline and accelerating the transition from lab to market. Full article

The novel benzanthrone derivative, 2-bromo-3-aminobenzo[de]anthracene-7-one (2-Br-3-NH₂BA), was synthesized and extensively characterized to investigate its photophysical behavior in various solvents. It was prepared through selective bromination of 3-aminobenzanthrone using N-bromosuccinimide in dimethylformamide at −20 °C. Featuring a donor–π–acceptor (D–π–A) structure, 2-Br-3-NH₂BA exhibits pronounced solvatochromism due to the intramolecular charge transfer (ICT) between the amino donor and the carbonyl acceptor groups. Optical measurements conducted in eight solvents of varying polarity revealed a significant bathochromic shift in both absorption and fluorescence emission, with emission maxima red-shifting by over 110 nm from non-polar to polar environments. Corresponding reductions in the optical band gap energies, as calculated from Tauc plots, further support solvent-induced electronic state modulation. Additionally, quantum yield analysis showed higher fluorescence efficiency in non-polar solvents, while polar solvents induced twisted intramolecular charge transfer (TICT), leading to emission quenching. These findings demonstrate the sensitivity of 2-Br-3-NH₂BA to environmental polarity, making it a promising candidate for color-tunable luminescent applications in optoelectronics and sensing. However, further studies in the solid state are required to validate its applicability in device architectures such as OLEDs. Full article

Aedes aegypti is the primary vector of arboviral diseases such as dengue, chikungunya, yellow fever, and Zika, posing significant global health and economic challenges. The effective control of this mosquito species requires understanding its seasonality, feeding behavior, and ecological dynamics. Modern molecular techniques, such as amplicon metagenomic sequencing, provide insights into vector–host interactions and feeding patterns. This study investigated the temporal variation of Ae. aegypti abundance and its blood meal sources in coastal and western Kenya over 16 months. A total of 64,360 mosquitoes were collected, with Ae. aegypti comprising 10.9% (7035/64,360). Coastal sites had a higher proportion (64.7%) of Ae. aegypti than western Kenya. Seasonal variation in abundance was observed, with peaks during the long rainy season and decline during the dry season. Blood meal analysis identified 15 vertebrate hosts, with humans being the primary source (86.6–95.9%). Other hosts included domestic animals such as turkey, sheep, cow, goat, and chicken. These findings highlight the role of rainfall in arboviral disease transmission and Ae. aegypti’s strong preference for human hosts. Additionally, this study demonstrates the cost-effectiveness of group testing for identifying blood meal sources, with implications for public health interventions. Full article

Background: The COVID-19 pandemic highlighted the crucial role of community preventive behaviors in controlling the virus’ spread. Studies show that people’s risk perceptions and awareness significantly contribute to the containment and prevention of infections by motivating adoption of desired actions and behaviors. This study aimed at assessing the role of risk communication and factors that influenced responses during the COVID-19 pandemic in rural communities in Western Kenya. Methods: A descriptive cross-sectional study was conducted using a quantitative research approach, collecting data from 806 individuals across Kisumu, Vihiga, and Kakamega counties. Descriptive statistics were used to detail the demographic characteristics of the study population, while logistic regression analysis estimated the associations between risk communication and demographic characteristics on COVID-19 vaccine acceptance, compliance with mitigation behaviors, perceived severity, and perceived susceptibility. Results: The results showed that 55% of participants were male and 45% were female, with an average moderate compliance with safety measures (mean = 5.15). A significant portion of participants wore face masks (85.3%), practiced hand hygiene (78.9%), and avoided close contact behaviors (66.6%). Most respondents received information through mass media (86.1%) and health workers (72.9%). Compliance with COVID-19 mitigation measures was highest among those who trusted information from official institutions, health professionals, and mass media, compared to social media, with increased odds of 2.7 times and 2.5 times, respectively. Higher risk perception was significantly associated with older age groups (above 50 years), being male, and working in the private sector. Effective risk communication significantly influenced risk perception, compliance with COVID-19 measures, and vaccination acceptance. Conclusions: The findings suggest that effective risk communication strategies are critical during public health emergencies and hence implications for future public health crises. The results underscore the importance of targeted communication and tailored interventions to improve compliance and vaccine acceptance among different demographic groups, ensuring a more robust public health response during outbreaks and pandemics. Full article

Depression among adolescents and young adults with HIV affects both their wellbeing and clinical care outcomes. Integrated care models are needed. We hypothesized that the SEARCH-Youth intervention, a life-stage-based care model that improved viral suppression, would reduce depressive symptoms as compared to the standard of care. We conducted a mixed-methods study of youth with HIV aged 15–24 years in SEARCH-Youth, a cluster-randomized trial in rural Uganda and Kenya (NCT03848728). Depression was assessed cross-sectionally with the PHQ-9 screening tool and compared by arm using targeted minimum loss-based estimation. In-depth semi-structured interviews with young participants, family members, and providers were analyzed using a modified framework of select codes pertaining to depression. We surveyed 1,234 participants (median age 21 years, 80% female). Having any depressive symptoms was less common in the intervention arm (53%) compared to the control (73%), representing a 28% risk reduction (risk ratio: 0.72; CI: 0.59–0.89). Predictors of at least mild depression included pressure to have sex, physical threats, and recent major life events. Longitudinal qualitative research among 113 participants found that supportive counseling from providers helped patients build confidence and coping skills. Integrated models of care that address social threats, adverse life events, and social support can be used to reduce depression among adolescents and young adults with HIV. Full article

Background/Objectives: A contributory factor to childhood undernutrition is poor gut health occurring within the first 6–12 weeks of life despite exclusive breastfeeding. Pro/synbiotic administration may protect gut health. A qualitative study was conducted amongst mothers/carers and healthcare workers (HCWs) to explore their perceptions and the acceptability of pro/synbiotics administration in early life. Methods: This study was nested within a randomised, open, clinical trial of pro/synbiotics with 32 doses administered under supervision to infants between ages 0 and 5 months in western Kenya. Semi-structured interviews were conducted with 14 mothers/carers, 12 Peer Mothers and 7 healthcare workers (HCWs) selected by purposive critical and key informant sampling. Interviews were transcribed and analysed using a thematic coding framework. Results: The satisfaction with the pro/synbiotic administration was very high amongst all three groups. Commonly perceived benefits included protection from diseases, healthy growth of the infant and improved appetite. The main barriers were working mothers and other commitments making it difficult to stick to scheduled administration visits, adverse judgement and opinions in the community, and a lack of engagement from fathers. Insights were gained into different means of administering pro/synbiotics to young infants. Triangulation of the findings of the mothers/carers with HCWs showed that most identified motivations and challenges were similar. Conclusions: Pro/synbiotic administration was well accepted by the mothers/carers and HCWs and generally perceived to have health benefits. The administration of pro/synbiotics by the mothers/carers themselves to their infants may be feasible and overcome logistical challenges. Greater efforts to sensitise and engage fathers and communities would likely be critical for a community-based program. Full article

Poor solid waste management in Kisumu, Kenya, contributes to adverse health, social, and environmental outcomes as a result of open burning, illegal dumping, and reliance on landfills. Taking Kisumu as a case study, we use behavioural systems mapping (BSM) for the purpose of understanding the role of behaviour in this complex problem. We qualitatively analysed transcripts from focus groups and interviews with 45 stakeholders in Kisumu to construct a BSM of the perceived actors, behaviours, and behavioural influences affecting waste management, as well as causal links. Influences were analysed using the capability, opportunity, and motivation model of behaviour (COM-B). The resulting BSM connects 24 behaviours by 12 different actors and 49 unique influences (30 related to opportunity, 16 to motivation, and 3 to capability). It reflects three sub-systems: policy-making, public waste management, and the policy–public interface. Six key feedback loops are described, which suggest that cycles of underfunding are interlinked with problematic practices around the build-up, handling, and segregation of waste and conflicting public and political views around responsibility. We demonstrate how the BSM method can be used with transcript data and provide steps that others can follow to inform the design of systemic behaviour change interventions. Further research to validate and adapt this approach may extend the learnings to other countries and health and sustainability challenges. Full article

Maize productivity has remained low and has worsened in the wake of a changing climate, resulting in new invasive pests, with pests that were earlier designated as minor becoming major and with pathogens being transported by pests and/or entering their feeding sites. A study was conducted in 2021 in the Kisumu and Makueni counties, Kenya, to determine how different maize cropping systems affect insect diversity, insect damage to maize, and insects’ ability to spread mycotoxigenic fungi in pre-harvest maize. The field experiments used a randomized complete block design, with the four treatments being maize monocrop, maize intercropped with beans, maize–bean intercrop with the addition of Trichoderma harzianum at planting, and push–pull technology. The FAW, Spodoptera frugiperda (J.E Smith) (Lepidoptera: Noctuidae), was the most damaging pest in the two regions. The push–pull and the maize–bean intercropping technologies significantly reduced the maize foliage and ear damage caused by the FAW. Beetles passively spread mycotoxigenic Aspergillus spp. and Fusarium verticillioides on pre-harvest maize. Maize weevils, namely, Sitophilus zeamais Motschulsky, 1855 (Coleoptera: Curculionidae), and Carpophilus dimidiatus Fabricius, 1792 (Coleoptera: Nitidulidae), earwigs, namely, Forficula spp. L. (Dermaptera: Forficulidae), and carpenter ants, namely, Camponotus spp. L. (Hymenoptera: Formicidae) carried the highest number of spores on their exoskeletons. This study stresses the role of insects in the spread of fungi on pre-harvest maize and their possible control by intercropping and other cropping technologies. Full article

Background: Front-of-package labeling (FOPL) is shown to support healthier consumer choices. Many countries have adopted different FOPL systems. Objective: This study explored perceptions and understanding of three FOPLs and identified features that could enhance their effectiveness in Kenya. Methods: A qualitative study was conducted across four Kenyan counties—Nairobi, Mombasa, Garissa, and Kisumu. Data from 12 focus group discussions with 137 adults of diverse socio-demographic backgrounds were analysed. Participants evaluated three FOPLs: Red and Green (RG) Octagon, Red and Green Octagon with icons and text (RGI), and Black Octagon Warning Label (WL). The FGDs assessed visibility and memorability, comprehension, potential effectiveness, and cultural relevance of each label. NVivo version 14.0 was used for thematic analysis. Results: Kenyan consumers had mixed perceptions of the proposed FOPLs. The black Octagon WL was found to be the most visible and memorable due to its bright colours. Although the RG and RGI symbols were visually engaging, some participants reported confusion with the colour meanings. The WL was also more readily understood due to its text. Overall, WL was preferred for its potential to influence purchasing decisions, while all three FOPLs were considered culturally suitable. Conclusions: The Black Octagon Warning Label was the most visible and comprehensible of the three FOPLs and shows promise in influencing consumer behaviour in Kenya. While RG and RGI symbols are appealing, their colour scheme could reduce their effectiveness. Educating consumers on FOPLs could enhance their impact in reducing unhealthy food purchases. Full article

Background: Front-of-pack-labels (FOPLs) on packaged foods provide essential information to help consumers make informed dietary choices. However, evidence on their effectiveness, particularly in low- and middle-income countries like Kenya, is limited. Objective: This study assessed the effectiveness of three FOPLs in helping consumers identify nutrients of concern in packaged food products and influencing their purchase intention in Kenya. Methods: A total of 2198 shoppers from supermarkets in Nairobi, Mombasa, Kisumu, and Garissa were randomized into three groups: Red and Green Octagon label (RG), Red and Green Octagon with icons (RGI), and Black Octagon Warning label (WL). In the control phase, participants were shown unlabeled images of packaged foods, followed by questions. In the experimental phase, the same images were presented with one assigned FOPL, and participants responded again to the same set of questions. Differences in correct identification of nutrients of concern and changes in purchase intention were analyzed using frequency tables and Chi-Square tests, while modified Poisson regression assessed FOPL effectiveness. Results: FOPLs significantly improved correct nutrient identification and reduced the intention to purchase unhealthy foods, with the WL proving most effective. Conclusions: These findings highlight the potential of FOPLs, particularly the WL, as an effective regulatory tool for promoting healthier food choices in Kenya. Full article

Lake Victoria, which is shared by Kenya, Tanzania, and Uganda, faces escalating concerns over sustainable fisheries amidst expanding fishing efforts. This study aims to investigate how technical efficiency (TE) and labor productivity (LP) of the Nile perch fishing fleet vary across the three riparian countries. Using a nine-year dataset spanning from 2005 to 2021 and employing Stochastic Frontier Analysis, this study evaluates the TE of the fleet, where LP is determined as catch per crew hour fished in a day for three vessel types: motorized, paddled, and sailed. Motorized fleets had the highest mean technical efficiency (0.60–0.66), compared to paddled (0.29–0.49), and sailed vessel categories (0.24–0.46). Sailed vessels declined in all countries owing to their low TE. In Kenya, TE and LP increased for paddled vessels, especially in the period from 2015 to 2021, and a slight increase was also indicated for motorized vessels. Conversely, Uganda and Tanzania experienced gradual declines in TE and LP, particularly from 2015 to 2021, a period of rigorous law enforcement that led to declines in the number of paddled vessels by 50% and 7%, respectively, and a contrasting increase in motorized vessels. By 2021, the number of Ugandan motorized vessels had increased greatly but TE had declined compared to Kenya and Tanzania, a sign of overcapacity. The findings underscore the need for region-specific policies that address economic differences, policy implementation impacts, and resource health to promote sustainable transboundary fisheries management on Lake Victoria. Full article

Background: Childhood vitamin A deficiency leads to increased morbidity and mortality. Human milk is the only source of vitamin A for exclusively breastfed infants. Dried Moringa oleifera leaf powder (moringa) is a good food source of provitamin A and other carotenoids. Its effect during lactation on human milk vitamin A and carotenoid content is unclear. Objectives: Our objective was to investigate the effect of maternal moringa consumption on human milk retinol and carotenoid concentrations and maternal and infant vitamin A status. Methods: We conducted a 3-month pilot single-blinded cluster-randomized controlled trial in breastfeeding mother–infant pairs (n = 50) in Kenya. Mothers received corn porridge with (20 g/d) or without moringa with complete breast expressions and maternal and infant serum collected at enrollment (infant <30 days old) and 3 months. Milk was analyzed for retinol and selected carotenoids; maternal/infant serum was analyzed for retinol binding protein (RBP). Results: 88% (n = 44) pairs completed milk and serum samples. Four mothers (9%) had vitamin A deficiency (RBP <0.07 µmol/L); 11 (25%) were vitamin A insufficient (VAI; RBP <1.05 µmol/L). Alpha-carotene concentration in milk was higher in the moringa than the control group at baseline (p = 0.024) and at exit (least squares means, LSM, 95%CI µg/mL 0.003, 0.003–0.004 moringa vs. 0.002, 0.001–0.003 control, n = 22/cluster; p = 0.014). In mothers with VAI, alpha-carotene was higher in the moringa group than controls at exit (LSM, 95%CI µg/mL 0.005, 0.003–0.009 moringa, n = 3, vs. 0.002, 0.000–0.004 control, n = 8, p = 0.027) with no difference at baseline. Milk carotenoids did not correlate with vitamin A status (serum RBP) in infants or mothers. Conclusions: Maternal moringa consumption did not impact concentration of milk vitamin A and resulted in limited increase in milk carotenoids in this cohort. Full article

Severe malarial anemia (SMA, Hb < 6.0 g/dL) is a leading cause of childhood morbidity and mortality in holoendemic Plasmodium falciparum transmission zones. This study explored the entire expressed human transcriptome in whole blood from 66 Kenyan children with non-SMA (Hb ≥ 6.0 g/dL, n = 41) and SMA (n = 25), focusing on host immune response networks. RNA-seq analysis revealed 6862 differentially expressed genes, with equally distributed up-and down-regulated genes, indicating a complex host immune response. Deconvolution analyses uncovered leukocytic immune profiles indicative of a diminished antigenic response, reduced immune priming, and polarization toward cellular repair in SMA. Weighted gene co-expression network analysis revealed that immune-regulated processes are central molecular distinctions between non-SMA and SMA. A top dysregulated immune response signaling network in SMA was the HSP60-HSP70-TLR2/4 signaling pathway, indicating altered pathogen recognition, innate immune activation, stress responses, and antigen recognition. Validation with high-throughput gene expression from a separate cohort of Kenyan children (n = 50) with varying severities of malarial anemia (n = 38 non-SMA and n = 12 SMA) confirmed the RNA-seq findings. Proteomic analyses in 35 children with matched transcript and protein abundance (n = 19 non-SMA and n = 16 SMA) confirmed dysregulation in the HSP60-HSP70-TLR2/4 signaling pathway. Additionally, glutamine transporter and glutamine synthetase genes were differentially expressed, indicating altered glutamine metabolism in SMA. This comprehensive analysis underscores complex immune dysregulation and novel pathogenic features in SMA. Full article

Background: Assisted partner services (APS) is a recommended public health approach to promote HIV testing for sexual partners of individuals diagnosed with HIV. We evaluated the cost and cost-effectiveness of integrating oral HIV self-testing (HIVST) into existing APS programs. Methods: Within the APS-HIVST study conducted in western Kenya (2021–2022), we conducted micro-costing, time-and-motion, and provider surveys to determine incremental HIVST distribution cost (2022 USD). Using a decision tree model, we estimated the incremental cost per new diagnosis (ICND) for HIVST incorporated into APS, compared to APS with provider-delivered testing only. Scenario, parameter and probabilistic sensitivity analyses were conducted to explore influential assumptions. Results: The cost per HIVST distributed within APS was USD 8.97, largest component costs were testing supplies (38%) and personnel (30%). Under conditions of a facility-based testing uptake of <91%, or HIVST utilization rates of <27%, HIVST integration into APS is potentially cost-effective. At a willing-to-pay threshold of USD 1000, the net monetary benefit was sensitive to the effectiveness of HIVST in increasing testing rates, phone call rates, HIVST sensitivity, HIV prevalence, cost of HIVST, space allocation at facilities, and personnel time during facility-based testing. In a best-case scenario, the HIVST option was cheaper by USD 3037 and diagnosed 11 more cases (ICND = 265.82). Conclusions: Implementers and policy makers should ensure that HIVST programs are implemented under conditions that guarantee efficiency by focusing on facilities with low uptake for provider-delivered facility-based testing, while deliberately targeting HIVST utilization among the few likely to benefit from remote testing. Additional measures should focus on minimizing costs relating to personnel and testing supplies. Full article

Emerging antimicrobial-resistant (AMR) Candida auris presents a formidable global health challenge, causing severe healthcare-associated infections (HAIs) with high mortality rates. Its ability to colonize surfaces and resist standard disinfectants undermines traditional hygiene practices, prompting an urgent need for new strategies. Ultraviolet C (UVC) light offers a promising approach with rapid and broad-spectrum germicidal efficacy. This review examines current literature on UVC LED technology in combating C. auris, highlighting its effectiveness, limitations, and applications in healthcare hygiene. UVC light has potent activity against C. auris, with up to 99.9999% inactivation depending on certain conditions such as microbial load, type of organism, surface, environmental, equipment, and UVC radiation factors. UVC LEDs can effectively combat C. auris, driving down healthcare costs and reducing attributable global mortality. Here, we explore implementation strategies for the targeted disinfection of high-risk areas and equipment, air handling units (AHUs), and water treatment systems. Challenges associated with UVC LED disinfection devices in healthcare settings, current performance limitations, and radiation safety are discussed. This will help in optimizing application protocols for effective disinfection and radiation safety. To further strengthen healthcare facility hygiene practices and curb the global spread of C. auris, recommendations for integrating UVC LED disinfection into infection control programs are shared. Full article