RSV: Geography’s Effect on Seasonality

The A and B sub-types of the respiratory syncytial virus (RSV) cause an acute respiratory tract infection in infants characterized by vigorous T cell-derived cytokine release, inflammation, and increased mucus production. Reinfection with RSV can occur throughout life. For example, seasonal epidemics of RSV are common in Kilifi and inter-epidemic transmissions are not effectively detected by hospital-based surveillance systems.

In a phylogenetic study comparing RSV sub-type B nucleotide sequences isolated from Kilifi with global RSV sequences obtained from the National Institutes of Health GenBank database, Agoti and colleagues aimed to employ computer science and mathematics to determine if seasonal epidemics of RSV were due to RSV newly introduced into Kilifi from a Kenyan source or from a global source.

Agoti and colleagues conducted a computer-based phylogenetic study where 651 RSV sub-type B nucleotide sequences from pediatric patients residing in Kilifi were compared to 833 RSV nucleotide sequences deposited into GenBank by researchers from other parts of Kenya and 18 other countries.

The investigators discovered the following: from 2002-2012, RSV epidemics occurred annually in Kilifi with RSV subtype B involvement noted in six out of eleven epidemics; and RSV nucleotide sequences from Kilifi demonstrated Maximum Likelihood phylogenetic tree clustering and minimal relatedness with RSV from the 18 other countries.

Overall, these findings were supportive of a regional instead of a global source of RSV during seasonal epidemics in Kilifi. However, extension of findings to the entire Kilifi population was limited by the sampling frame, which did not include older patients.

Taken together, evidence of a geographically restricted source of RSV in Kilifi sheds new light on the mechanism of RSV transmission among pediatric patients. This study is expected to bolster ongoing RSV vaccine development initiatives and optimize infection control strategies during seasonal RSV epidemics in Coastal Kenya.

Discover. Inspire. Prosper.

The STEM

University of Nairobi

[Original article]: Agoti CN, Otieno JR, Ngama M, Mwihuri AG, Medley GF, Cane PA, Nokes DJ: Successive respiratory syncytial virus epidemics in local populations arise from multiple variant introductions providing insights into virus persistence. J Virol 2015, pii: JVI.01972-15.

[Image]: Worgall S: Editorial: RSV, dendritic cells, and allergens—a bad combination. J Leukoc Biol 2013, 94: 1-3.

 

Dying to Live

It was a fizzy afternoon, sitting in my office probably anticipating to go home after a not so busy day, I gazed through the window, light showers, probably hoping that someone fell off a bike on the slippery road so that at least I could get something else to do apart from building castles in the air.

Going past the self-righteous act, you see we doctors couldn’t be in the profession if people weren’t getting constantly ill, save the whole being there for the patients not the money preaching for the local pastor cause reality is, even the pastors have a different message at the beginning of the month and at the end of the month.

In short, I too was waiting upon someone’s misfortune so that I could feed my family. Anyway, by luck, either bad or good depending on if you are the doctor or patient, the cyclists were careful, so that meant the end of my shift, but there was more waiting for me, probably a punishment for my sadistic thoughts.

As I was stepping out, I met with my attending nurse together with what seemed like a mother and her young girl. By the look of their dressing, they seemed to be not so well off.

“Daktari tusaidieko,” doctor help us said the mother in rather broken Kiswahili, my heart melted at the sight of the mother trying to hide the tears of despondency welding up her eyes.

“Nini mbaya mama?”whats wrong I inquired now adjusting my spectacles so as to sound authentic.

“Nataka unisaidieko kutoa masichana yangu mimba” I want you to help terminate my child’s pregnancy.

My heart almost dropped to my stomach. I can’t say this is exactly what I had in mind when I was praying for some excitement. I only managed a “what” statement after what seemed like a decade. I had to sit down after which I came to find out that the young girl, 15 years old, had been raped and impregnated by her stepfather. I was at cross roads, here a young girl with a promising future ahead and my conscience which I had vowed by taking the Hippocratic Oath that I wouldn’t take a life.

This is a dilemma that many of our modern day doctors face. A hospital, a place meant to protect life, can it be used to take away life?

A saying goes, a pregnant woman has one foot in the grave. This disturbing quotation clearly indicates the danger of maternity. It is devastating that 1 in 11 women in the world don’t live to see the happiness they anticipate during pregnancy, not to add those who die due to unsafe abortions.

According to World health organization, (WHO) every 8 minutes a woman in a developing nation will die of complications from an unsafe abortion. With the fifth United Nations millennium development goal recommending a 75% reduction in maternal mortality by 2015, unsafe abortion provides one of the easiest preventable causes of maternal mortality and a staggering public health issues.

Worldwide, 5 million women are hospitalized each year for treatment of abortion related complications, and abortion related deaths leave 220,00 children motherless, and this are just the documented cases. Imagine if we add those who died in the quacks backyards and buried with a cover story of having died from food poisoning. What would the numbers look like? It’s shocking that Kenya produces about 300,000 abortions each year out of the estimated over 1.5 million abortions that are procured in Africa. This numbers are worrying.

Although daunting, the predicament is not without solution. Preventing unintended pregnancies should be a priority to all nations because the burden of unsafe abortion lies not only with the women and families, but also with the public health system. Talk of those women admitted for emergency post abortion requiring blood, oxytocin, antibiotics, just but to mention but a few.

Educating women regarding their reproductive health should be incorporated in schools. Both the government and non-governmental organizations should find ways of overcoming cultural and social misconceptions that restrict women from receiving necessary health care.

Let’s face it, in Africa, it will take being colonized by the Europeans again before we become flexible and legalize abortion, and I get it. Give it a pass and this might and will be the cause of open pervasiveness among the youth. Am no advocate for abortion. That explains why I jotted down some contacts for the woman in my office. But would it hurt if a nation set aside funds to train some of the open minded doctors on how to conduct safe abortions?

The emotional, psychological, and financial cost on women and families as well as the burden on the economic health system should no longer be ignored.

Laventa Obare

Moi University

Editor, MSAKE

Certificate Course in Global Health Training: How it all went down

Medical Students’ Association of Kenya was able to host a two-day certificate training on Global Health. It took place on the 14th and 15th of August and saw a representation of 44 students from 5 local colleges of health sciences. The training was initially scheduled for Rwanda and the change in venue to Kenyatta University- Nairobi, Kenya came as a blessing as more students got a chance to attend.

The venue: Kenyatta University

The training ran in 12 intensive sessions interspersed between tea breaks and some hearty lunch meals, under the facilitation of Professor Don Eliseo Lucero and Kennedy Opondo, both gurus in their own right in global health. The sessions were thought-provoking, involving and interesting. They covered a wide range of topics including: perspectives in global health, global health architecture and instruments, disasters and humanitarian emergencies, economic evaluation in global health, only to mention but a few. Below is a taste of the mind-stimulating sessions.

Under Perspectives in Global Health, the bone of contention was the ‘right to healthcare’. Is healthcare really a patient’s right? Many would be quick to argue yes. However, take for instance, a patient who comes to hospital seeking medical attention but does not have money to pay for the services. Would a hospital then opt to offer the service to the patient for free since it is their right? Well, not really. At that point, does access to healthcare still remain to be the patient’s right? I let you ponder on that.

Kennedy Opondo in one of the sessions

One of the ways is having a national health insurance fund. You probably wonder why all Kenyan workers pay a monthly subscription fee to NHIF, yet some of them wouldn’t even dare use it. This is the money that enables the government to subsidize health care services, or offer some services for ‘free’. How free then is ‘free’ health care service?

Discussion sessions

Switching gears, we also had an interesting session on Migration and Health where the menace of brain drain was discussed. Did you know that brain drain can be both internal and external? Most doctors, for example, prefer to practice in big cities, consequently leaving the rural areas with inadequate qualified medical personnel. This is an example of internal brain drain. The external one is quite well understood. Brain drain is disadvantageous to a country because, apart from denying it top medical expertise, the government incurs loses since there is no return on investment in educating doctors and other health professionals. To curb brain drain, the government comes up with incentives such as bonuses and sponsorship for post-graduate programs. Now you know why doctors get post-graduate sponsorship.

And of course, a conversation on global health cannot be complete without discussing the contributions of the United Nations and World Health Organization to global health. The Evolution of Global Health Themes was outlined, including the Millennium Development Goals and the newly-developed Sustainable Development Goals. The development process, importance and impact of these themes was discussed.

A discussion on United Nations and World Health Organization

The last session was on navigating a successful career in Global Health, delivered by the very charismatic Dr. Aduragbemi Thomas. He talked about his personal journey from medical school, through post-graduate to being a Global Health professional. He also emphasized on the need to be outstanding and more involved in community health issues, considering the cut-throat competition that is in the present world. By the end of his inspiring speech, he already had a few disciples!

As the curtains fell on Certificate Course in Global Health, Kenya, the well-deserving graduates were awarded certificates after 2 days of intensive albeit interesting training. The knowledge obtained was simply invaluable. For those who were unable to be part of it, you need not worry. The training will soon be done on a regular basis.
We have a Kiswahili saying: ‘Mganga hajigangi’ which literally means a doctor cannot treat himself. Our responsibility to the community is our core value and the training just made this crystal clear. Things can only get better.

The proud graduates!

What the students had to say…

Report by:

Dilys Kemunto

Secretary General, MSAKE

Daniel Baraka

Editor-in-Chief, MSAKE

Devolution of Health; Did the Devil Come Riding on a Horseback?

Lying on a precolonial rusty bed is a malnourished girl. The hospital is hazily illuminated, the curtains swaying quietly to the rhythm of the wind. The window panes are long broken. The only medicine that the girl can afford is probably laughter. This is not a ghost story, but the hotbed of truths of the situation in our county hospitals thanks to devolution of health.

On the other side of the world, county executives and their secretaries (read MCAs) are busy traversing the universe and visiting the tomb of Jesus; it would not meet us by surprise that some have never attended churches back home.

The state of our county hospitals is in unspeakable agony: no medications, no healthcare providers, yet we are persistently treated to the rhetoric that the matter is in safe hands. How long will innocent Kenyans continue to suffer as healthcare is subjected to political theatrics and innuendos?

What about the delayed remuneration of the workers. An ideal society is that which is free from charity; these are the words that should echo in every county executive office. The doctors and other staff must be paid; in time and place. Devolution of health should serve and not reserve funds meant for health institutions.

We are cognizant of the fact that, these generals (read governors) will seek medical attention at Mayo Clinic even at the thought of a stomach ache. What about the peasant farmer who is suffering from cancer? Who will be their Messiah? The hottest place in hell is reserved for those who take a neutral stance in times of a moral crisis; and this is a moral crisis.

We should shout to expose the rot in the devolved health system that is in a comatose state. We should not listen to the weasel talks of our politicians that bear no fruits. Let the medics be in the front line in championing for access to quality medical care. Let the word spread that we are tired of stocking our hospitals with paracetamols only. Hail thee that will mobilize the masses in their quest for improved services.

Have a healthy day, won’t you?

Gibson Gaitho

Kenyatta University

Editor, MSAKE