Syndromic Early Warning Surveillance Networks in Kenya

Early detection is key to controlling disease outbreaks in the developing countries. In Kenya a small scale surveillance system is being established by a local network known as Khwisero Animal Health Surveillance Network (KAHSN), In Kakamega County of Western Kenya, KAHSN draws on the disease detection capabilities of practicing veterinarians, district and regional diagnostic laboratories and the national government.

The KAHSN bolsters Khwisero’s domestic early warning surveillance capacity for detecting new and emerging diseases of animals that could affect animal health, the food supply or public health. It brings together animal disease surveillance information from many sources - veterinary practitioners, veterinary diagnostic laboratories and animal health agencies - so that baselines can be established and trends identified. By amalgamating information gathered from surveys, syndromic surveillance and rumour reports from the field, tracking the on-going animal health status of the country will be improved.

The identification of aberrant trends of disease outbreaks prompts further investigation and assessment of situations. Since early detection is key to early control of any disease outbreak, the KAHSN is an important component of Kenyas’ defense against serious threats to animal and human health.

Animal disease surveillance supports Kenyas’ ability to recognize and deal with emerging animal disease problems. Surveillance also plays an import role in providing Kenyan livestock and poultry products access to more markets. Major notifiable diseases of livestock are routinely monitored and outbreaks reported in a established but laborious, if not erratic system.
Avian influenza (H1N1) is of major focus and its invariably undetected due to inadequate surveillance personell and laboratory facilities in the marginalized and rural areas. A collaboration between the Veterinary offices and regional research laboratories would enhance the detection and reporting of this(H1N1) and other Zoonotic infections.

The Khwisero District Veterinary Office is establishing a small scale model “Khwisero Animal Health Surveillance Network (KAHSN)” ; its collaborative network of animal health surveillance and diagnostic system to improve the capacity to detect emerging animal disease threats in real time. The KAHSN focuses particularly on those animal disease threats that could have zoonotic potential and provide a rapid response to minimize the human health and economic risks to Khwisero District.

The KAHSN combines surveillance data received from many sources and simultaneously alerts both human and animal health authorities in other jurisdictions within Western Kenya when potential animal disease threats are identified.

The key outputs of the KAHSN are:
• An early warning system for animal disease threats to the food supply, food safety or public health;
• A regional laboratory network for the rapid diagnosis of serious infectious animal diseases; and
• An information-sharing network linking national and international research agencies and departments of animal and human health

Features of the KAHSN
The model is set on open source softwares that enable suite of to collect, aggregate and visualize data, Mainly Open data Kit (ODK), will be utilised to aggreagate GIS data and mobile phone devices with The Android Emulators SDK, these successfuly ran a realtime data collection and synchronization to local internet servers. The use of interactive risk maps will enable faster emergency reactions in suspected outbreaks.

KAHSN will collaborate with the Khwisero Network for Public Health Intelligence (KNPHI) to establish rapid communication and identification of emerging animal and human disease issues. This newly established network increases the surge capacity of regional laboratories to rapidly diagnose serious and infectious animal diseases. By combining their diagnostic surge capacities with those of provincial and university laboratories that have diagnostic capabilities for foreign animal disease, the response to an outbreak is being enhanced. This establishes interoperability between laboratories by using common protocols and reagents. It also allows technical and scientific staff to exchange, participate in and share expertise.

Early detection of Zoonotic diseases by Syndromic Surveillance Networks (KAHSN)

Syndromic Surveillance Networks in Early detection of Zoonotic diseases

po

Impact of Sanitary and Phytosanitary (SPS) Measures on Kenya in Global Trade

Dr. Nanyingi M.O

In the recent years the international trade arena has witnessed the growing importance of “within the border” barriers. Standards and technical regulations are the new critical issue on the international trade agenda. Among these, sanitary and phytosanitary measures occupy a special place because of their crucial aim: safeguard of health and safety of human beings in accordance with the WHO. From the point of view of economic efficiency there are very few circumstances in which it can be accepted a departure from free trade. Sanitary and phytosanitary measures pose a fundamental challenge to this traditional “economic perspective”. This study attempts to disentangle the complexity of sanitary and phytosanitary measures that, uniquely amongst “potential trade obstacles”, in Kenya mix elements of genuine protection and elements of disguised protectionism.


There is need to exemplify the crucial elements that characterize regulations in general and SPS measures, a synthetic overview of the institutional framework set by the WTO’s SPS agreement in order to situate the issue of SPS in its concrete settings outlining the set of rules that bind their use. Understanding the difficulties posed to “economic analysis” by domestic regulations are tackled and a potential solution will be deliberated making use of a partial equilibrium economic model for evaluating the impact of SPS measures.

The main objective is demonstrate the complexity that traditional economic reasoning do have when tackling the relationships between regulations-standards and international trade. A simulation to present an econometric method to measure the effect of standards and domestic regulations on trade flows taking as example the aflatoxins standards and trade in food between Kenya and EU. This is a direct attempt to tackle the problem of empirically “quantifying” the impact of some specific domestic standards on international exchange, which is clearly a first step towards the objective of evaluating the trade-off posed by the introduction of standards. In conclusion the limits of economic “output based” rationality and the need for integrating it with legal “procedure based” rationality when evaluating SPS measures in Kenya will be discussed.

Key words: Kenya, Trade barriers, SPS.

Zoonoses - Success, challenges and possibilities

Background

Khwisero District Veterinary Office continues to enhance its outreach in cross-platform and multidisciplinary efforts for improved Veterinary Public health and Clinical service delivery. it will publish a regular quarterly electronic Newsletter on a list-serve basis temporarily,(as the website is under construction) to keep a regional and global up-date with developments in veterinary practice and other news and features that might benefit to global communities in the veterinary industry.

In this publication we focus on Zoonosis by outlining the Challenges, Successes and possible improvements that can be achieved with coordinated collaborative linkages between mainstream government departments, paraprofessionals and research institutes

Progress

Disease control: Pests and Vectors can be effectively managed by establishment of community dips.Rehabilitation of community dips can enhance effective disease control.

Epidemiology: An Epidemio-surveillance system (ESS) has been established enhancing detection and reporting of notifiable diseases in partnership with paraprofessionals.

Phytosanitary department: The Sanitary and Phytosanitary Measures according to World Trade Organization have been implemented in order to protect human and animal health. Meat inspectorate services have improved consumption leading to a 75% revenue increment with a 27% decline in condemnation.

Collaborative Linkages: Establishment of Khwisero Animal /Public Health Surveillance Network (KAHSN) to share information across districts and provinces for coordinated human/animal health databases for zoonotic infections.

Challenges: Knowledge gap on Sanitary and Phytosanitary Measures (SPS), legislation and regularization of private practitioners combined with imprudent drug dispensation has a significant negative impact on clinical services (67%). Workforce deprivation and Staff demotivation can lead to suboptimal discharge of duties at 30% (p<0.001). Insufficient funding (-60%) continues to be a major a contributor to poor service delivery.


Possibilities: New approaches for the efficient and cost-effective delivery of reliable and accurate information to users in rural areas are required. Staff recruitment, training and motivation will foster service delivery. Establishment of regional laboratories to provide accurate diagnosis is essential for field research. A requisite combination of epidemiological and economic tools must be underpinned by detailed knowledge of livestock disease patterns for public-policy formulations in effective Veterinary Public health systems.

The Role of Veterinary Medicine in Public Health; The Khwisero example

The role of VPH within the global health agenda is to promote activities that contribute to the achievement of health for all and help realize its objectives. Veterinarians assist in planning, policy-setting, allocating resources, and providing technical guidance, orientation, and support to the operational staff.

Public health is dependent on animal health in rural area because poor animal health directly affects the human food supply. New information and new approaches for the efficient and cost-effective delivery of reliable and accurate information to VPH users in these areas are required.


VETERINARY PUBLIC HEALTH IN KHWISERO, KENYA; SUCCESS,CHALLENGES AND OPPORTUNITIES.

Mark Nanyingi1§, Alfred Koballa 1, Humphrey Ongili1, Christopher Okello1, Tindi Bushuru 2, Kelly Nelima3

1Ministry of Livestock and Development, District Veterinary Office, PO BOX 60 -50135, Khwisero, Kenya
2Ministry of Livestock and Development, District Veterinary Office, PO BOX 1160, Butere, Kenya
3Ministry of Livestock and Development, Provincial Veterinary Office, PO BOX 871, Kakamega, Kenya

Abstract

Background
Public health is dependent on animal health in rural areas because poor animal health directly affects the human food supply. Veterinary public health entails the diagnosis, surveillance, epidemiology, control, prevention and elimination of Zoonoses. Unsatisfactory implementation of stringent disease control, meat inspectorate and drug dispensation legislations prevents the efficient production of food of animal origin; creating obstacles to international trade in animals and animal products and hence an impediment to overall socioeconomic development.

Methods

Data were extracted from the Khwisero veterinary relational database including clinical, meat inspectorate, disease surveillance, and extension from October 2009 to March 2010. Participatory approaches were used to collect data from private service providers and stakeholders concerning the status of veterinary service delivery. A qualitative and quantitative analysis was conducted to determine the challenges, incentives, cost-effectiveness and policies that would improve veterinary public health.

Results

An Epidemio-surveillance system (ESS) has been established enhancing detection and reporting of notifiable diseases in partnership with paraprofessionals. Meat inspectorate services improved consumption leading to a 75% revenue increment with a 27% decline in condemnation. Knowledge gap on legislation and regularization of private practitioners was combined with imprudent drug dispensation and home use had a significant negative impact on clinical services (67%). Workforce deprivation and Staff demotivation leads to suboptimal discharge of duties at 30% (p<0.001). Insufficient funding (-60%) was a contributor to poor service delivery.

Conclusions

New information and approaches for the efficient and cost-effective delivery of reliable and accurate information to VPH users in rural areas are required. Staff recruitment, training and motivation will foster service delivery. Establishment of regional laboratories to provide accurate diagnosis is essential for field research. A requisite combination of epidemiological, statistical and economic tools must be underpinned by detailed knowledge of livestock disease patterns for public-policy formulations in effective Veterinary Public health systems.

Key words: Veterinary Public Health, Khwisero, Zoonoses.

© 2010 Khwisero District Veterinary Office

Spatio-temporal epidemiology of dog bite injuries at Kakamega Provincial Hospital, Kenya

Spatial epidemiology is the study of spatial variation in disease risk or incidence. Several ecological processes can result in strong spatial patterns of such risk or incidence: for example, pathogen dispersal might be highly localized, vectors or reservoirs for pathogens might be spatially restricted, or susceptible hosts might be clumped.(Ostefield et al 2005).

In Kakamega District of Western Kenya We Assesed The Reporting patterns of Vertebrate bites in the Provinicial Referral General Hospital.

Spatio-temporal epidemiology of dog bite injuries at Kakamega Provincial Hospital, Kenya

Kelly A Nelima1, 6, Mark OO Nanyingi 2, 3§, Gideon M. Kikuvi4, Willis Akhwale5, Jared Omolo6
1Ministry of Livestock and Development, Provincial Veterinary Office, PO BOX 871, Kakamega, Kenya
2 Ministry of Livestock and Development, District Veterinary Office, PO BOX 60 -50135, Khwisero, Kenya,
3 Kenya Scientific Analysts, P.O. Box 531-00202, Kenyatta National Hospital, Nairobi, Kenya,
4Jomo Kenyatta University of Agriculture and Technology, Box 3249-00200, Nairobi, Kenya
5 Ministry of Public Health and Sanitation, PO Box 30016- 00100 Nairobi, Kenya
6 Field Epidemiology and Laboratory Training Program, US centers for Disease Control, PO Box Nairobi, Kenya

Abstract

Background
Endemic canine rabies is a reemerging neglected zoonosis often underestimated in Kenya but remains a public health and economic burden to the rural poor. Understanding the transmission dynamics and distribution of dog bites over specified time period can assist in assessment of risk factors, design of interventions to exposure and the estimation of rabies burden.

Methods
Retrospective and cross-sectional analysis of surveillance data of reported dog bite incidents from Kakamega Provincial General Hospital from 2006 to 2009 was performed to estimate the prevalence of dog bites. Univariate and Multivariate analysis were performed to assess the risk factors and prevalence of dog bites. The temporal distribution and spatial patterns of bites was mapped and analysed to estimate population at risk to rabies.

Results
There were 148 dog bite incidents with children below 10years being more involved (33.8%).Most bites occurred on the lower extremities 124/148 (83.8. 1.0% of bites resulted in rabies and death after post exposure treatment and were located more than 45km away from the PGH. Spatial-temporal clustering of dog bites showed irregular pattern of spread with declining incidence rates from the periurban center. On visual inspection, the highest (30%, 95% CI 14-52% N = 45) densities of dog bites were in areas around the central place of the study area, bites clustered in not more than 15km radius from the hospital. The second cluster centered around Lubao dog market 7.4 %( 95% CI, 5-12%, N = 11). 12% of the bites were along roads and rivers while 5% occurred in and around forests. The retrospective analysis revealed a temporal increase in prevalence 114 % (P<0.05) with high peaks in March and August with a mean monthly bite incidence of 22.44%. 2008 had the highest mean monthly incidence of 30%.

Conclusions
Spatiotemporally dynamic approaches and epidemiological models may predict emergence or spread of diseases to new geographic regions and could be effective in spatially targeting interventions. Descriptive spatial epidemiology of bites can assist in accurate measure of rabies burden where underreporting, inequity in vaccine provision and improper policies of disease mitigation exist.

Key words: Spatial epidemiology; Dog bites, Rabies.

© 2010 Khwisero District Veterinary Office

§Corresponding author and presenter: mnanyingi@gmail.com, +254721117845.

Potential of African Medicinal Plants in Malaria Therapy

Nanyingi et al 2010. Aspects of African Biodiversity, ISBN:1847559484, 9781847559487

ABSTRACT

Malaria is one of the most prevalent diseases in the world and a major public health problem, affecting 40% of the world population. It infects about half a billion people causing about 3 million deaths a year with 90 % of them being in sub-Saharan Africa.1,2 In Kenya, malaria is the leading cause of morbidity and mortality, accounting for 30-50% of all outpatient attendance and 20% of all admissions to health facilities.

Kenya has revised its treatment policy by adopting artemisinin combination therapy (ACT) as the first line drugs for treatment of uncomplicated malaria. Spread of multidrug-resistant (MDR) strains of Plasmodium and the adverse side effects of the existing antimalarial drugs have necessitated the search for novel, well tolerated and more efficient antimalarial drugs.3 Indigenous plants are important sources of biologically active compounds and have potential for the development of novel antimalarial drugs.

Drug-resistant strains of P. falciparum are endemic in many areas of the world and the majority of conventional antimalarial drugs have been associated with treatment failure. These developments and the difficulty of creating efficient vaccines, coupled with adverse reactions to chemotherapy, underline the urgent need for novel, cheap, safe and efficacious antimalarial drugs.8 It is estimated that 80% of people worldwide use herbal remedies, due to limited access to modern medicine because of low income and the shortage of efficient health care facilities.9 There is a dearth of evidence on the efficacy and safety of these remedies, despite the fact that validation of traditional practices could lead to innovative strategies in malaria control.

Read more http://www.rsc.org/shop/books/2009/9781847559487.asp