Exploring the use of solid fuels for cooking and household air pollution in informal settlements through photovoice: The Fuel to Pot study in Ndirande (Malawi) and Mukuru (Kenya).

Introduction: Worldwide, 2.4 billion people rely on solid fuels such as wood or charcoal for cooking, leading to approximately 3.2 million deaths per year from illnesses attributable to household air pollution.

Transitional Infrastructures Extending Access to Safe Water in Informal Settlements: A Cross-Sectional Study in Nairobi, Kenya.

There is a pressing need for transitional water infrastructures in rapidly growing cities where conventional infrastructures lag behind human settlement expansion. In Kenya, sectoral innovations have addressed local socioeconomic challenges, but empirical evidence on their efficacy (combining quantitative indicators of safety and continuity) is lacking. We addressed this gap by comparing different water infrastructures in their ability to provide constant access to safe water in informal settlements in Nairobi, Kenya.

Household carbon monoxide (CO) concentrations in a large African city: An unquantified public health burden?

Carbon monoxide (CO) is a poisonous gas produced by incomplete combustion of carbon-based fuels that is linked to mortality and morbidity. Household air pollution from burning fuels on poorly ventilated stoves can lead to high concentrations of CO in homes. There are few datasets available on household concentrations of CO in urban areas of sub-Saharan African countries.

Preterm birth, birth weight, infant weight gain and their associations with childhood asthma and spirometry: a cross-sectional observational study in Nairobi, Kenya.

Background: In sub-Saharan Africa, the origins of asthma and high prevalence of abnormal lung function remain unclear. In high-income countries (HICs), associations between birth measurements and childhood asthma and lung function highlight the importance of antenatal and early life factors in the aetiology of asthma and abnormal lung function in children. We present here the first study in sub-Saharan Africa to relate birth characteristics to both childhood respiratory symptoms and lung function.

Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya.

Background: Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms.

Methods: Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared.

Environmental determinants of access to shared sanitation in informal settlements: a cross-sectional study in Abidjan and Nairobi.

Background: Universal access to basic sanitation remains a global challenge, particularly in low- and middle-income countries. Efforts are underway to improve access to sanitation in informal settlements, often through shared facilities. However, access to these facilities and their potential health gains-notably, the prevention of diarrheal diseases-may be hampered by contextual aspects related to the physical environment.

Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries.

Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022. Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs.

Chronic respiratory disease in adult outpatients in three African countries: a cross-sectional study.

The greatest burden of chronic respiratory disease is in low- and middle-income countries, with recent population-based studies reporting substantial levels of obstructive and restrictive lung function. To characterise the common chronic respiratory diseases encountered in hospital outpatient clinics in three African countries. This was a cross-sectional study of consecutive adult patients with chronic respiratory symptoms (>8 weeks) attending hospital outpatient departments in Ethiopia, Kenya and Sudan.

Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting.

Background: Early access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings.

Methods: Using the implementation of WHO approved TB diagnostics, Xpert /rifampicin (MTB/RIF) and Line Probe Assay (LPA) as a benchmark, we evaluated the barriers and how they could be unlocked to maximise uptake and utilisation of molecular diagnostics.

Qualitative assessment of the impact of socioeconomic and cultural barriers on uptake and utilisation of tuberculosis diagnostic and treatment tools in East Africa: a cross-sectional study.

Objectives: Early diagnosis and timely treatment are key elements of a successful healthcare system. We assessed the role of socioeconomic and cultural norms in accelerating or decelerating uptake and utilisation of health technologies into policy and practice.

Setting: Secondary and tertiary level healthcare facilities (HCFs) in three East African countries.

Reframing Non-Communicable Diseases and Injuries for Equity in the Era of Universal Health Coverage: Findings and Recommendations from the Kenya NCDI Poverty Commission.

Background: Kenya has implemented a robust response to non-communicable diseases and injuries (NCDIs); however, key gaps in health services for NCDIs still exist in the attainment of Universal Health Coverage (UHC). The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya.

Methods: Burden of NCDIs in Kenya was determined using desk review of published literature, estimates from the Global Burden of Disease Study, and secondary analysis of local health surveillance data.

Intrinsic and extrinsic factors associated with sputum characteristics of presumed tuberculosis patients.

Background: Sputum remains the most preferred specimen for detection of Mycobacterium tuberculosis due to its non-invasive method of production. Good quality sputum specimen is essential for accurate diagnosis of pulmonary tuberculosis (PTB). It is therefore imperative to assess factors that are related to the production of sputum that is of the best quality.

Screening strategies for tuberculosis prevalence surveys: the value of chest radiography and symptoms.

Background: We conducted a tuberculosis (TB) prevalence survey and evaluated the screening methods used in our survey, to assess if screening in TB prevalence surveys could be simplified, and to assess the accuracy of screening algorithms that may be applicable for active case finding.

Methods: All participants with a positive screen on either a symptom questionnaire, chest radiography (CXR) and/or sputum smear microscopy submitted sputum for culture. HIV status was obtained from prevalent cases.

High sensitivity of chest radiograph reading by clinical officers in a tuberculosis prevalence survey.

Background: Chest radiographs (CXRs) are used in tuberculosis (TB) prevalence surveys to identify participants for bacteriological examination. Expert readers are rare in most African countries. In our survey, clinical officers scored CXRs of 19 216 participants once.

High prevalence of pulmonary tuberculosis and inadequate case finding in rural western Kenya.

Rationale: Limited information exists on the prevalence of tuberculosis and adequacy of case finding in African populations with high rates of HIV.

Objectives: To estimate the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) and the fraction attributable to HIV, and to evaluate case detection.

Methods: Residents aged 15 years and older, from 40 randomly sampled clusters, provided two sputum samples for microscopy; those with chest radiograph abnormalities or symptoms suggestive of PTB provided one additional sputum sample for culture.

The role and performance of chest X-ray for the diagnosis of tuberculosis: a cost-effectiveness analysis in Nairobi, Kenya.

Background: The objective of this study was to establish 1) the performance of chest X-ray (CXR) in all suspects of tuberculosis (TB), as well as smear-negative TB suspects and 2) to compare the cost-effectiveness of the routine diagnostic pathway using Ziehl-Neelsen (ZN) sputum microscopy followed by CXR if case of negative sputum result (ZN followed by CXR) with an alternative pathway using CXR as a screening tool (CXR followed by ZN).

Methods: From TB suspects attending a chest clinic in Nairobi, Kenya, three sputum specimens were examined for ZN and culture (Lowenstein Jensen). Culture was used as gold standard.

Planning for PPM-DOTS implementation in urban slums in Kenya: knowledge, attitude and practices of private health care providers in Kibera slum, Nairobi.

Setting: Kibera, the largest slum in Nairobi, Kenya.

Objective: To determine the tuberculosis (TB) knowledge, attitude and practices (KAP) of private health care providers (PHCPs) to identify their training needs and willingness to participate in a National Leprosy and Tuberculosis Control Programme (NLTP) guided TB control effort in the slum.

Design And Methodology: A cross-sectional survey.

Sex-specific performance of routine TB diagnostic tests.

Setting: City Council Chest Clinic, Nairobi, Kenya.

Objective: To determine to what extent the performance of smear microscopy is responsible for sex differences in notification rates.

Methodology: Three sputum samples from TB suspects were subjected to smear microscopy with Ziehl-Neelsen (ZN) and auramine (FM) staining.

Isolation of multidrug-resistant tuberculosis strains in patients from private and public health care facilities in Nairobi, Kenya.

Setting: Health care facilities in Nairobi, Kenya.

Objective: To document the presence of multidrug-resistant tuberculosis (MDR-TB) strains in patients from Nairobi between September 1999 and October 2001.

Design: Descriptive study.

Identification of MDR-TB Beijing/W and other Mycobacterium tuberculosis genotypes in Nairobi, Kenya.

Setting: Suspected tuberculosis (TB) patients in Nairobi, Kenya.

Objective: To identify the presence of multidrug-resistant (MDR) Beijing/W type and other genotypes of Mycobacterium tuberculosis.

Methods: Thirty-three isolates resistant to one or more drugs (resistance ratio method), including 15 MDR isolates and 40 susceptible isolates selected at random, were analysed by dot-blot hybridisation for mutations associated with resistance to isoniazid, rifampicin, streptomycin and ethambutol.

Is cough alone adequate to screen HIV-positive persons for tuberculosis preventive therapy in developing countries?

Although the efficacy of isoniazid in the prevention of tuberculosis in HIV-infected persons with a positive tuberculin skin test is proven, several feasibility issues remain unanswered. In resource poor settings where a chest radiograph may not be readily available, the question of whether cough alone is an adequate screening tool needs to be considered. We analysed screening data collected as part of an isoniazid efficacy study.

Isoniazid preventive therapy for tuberculosis in HIV-1-infected adults: results of a randomized controlled trial.

Objectives: To determine the efficacy of isoniazid 300 mg daily for 6 months in the prevention of tuberculosis in HIV-1-infected adults and to determine whether tuberculosis preventive therapy prolongs survival in HIV-1-infected adults.

Design And Setting: Randomized, double-blind, placebo-controlled trial in Nairobi, Kenya.

Subjects: Six hundred and eighty-four HIV-1-infected adults.