Populations in tropical and subtropical developing countries are exposed to largely uncontrolled levels of aflatoxins through food. These countries (especially in Africa and Asia) also present a high prevalence of stunting. Studies have reported an association between aflatoxin exposure and growth impairment in children but there is not yet conclusive evidence that aflatoxins are a significant cause of stunting in children, thus further research is warranted. In this cross-sectional study, 204 low-income households were randomly selected in two low-income areas of Nairobi, Kenya. Korogocho is a higher population density area and Dagoretti a lower population density area. We asked questions about household demographics and a 24-hour dietary recall was conducted in children aged 1-3 years. Child anthropometric measurements were also conducted. Height-forage Z-scores (HAZ), weight-forage Z-scores (WAZ) and weight-for-height Z-scores (WHZ) were calculated for each child using World Health Organization (WHO) growth standards reference data. Samples of foods were taken from the household or from the retailer for analysis using competitive enzyme-linked immunosorbent assay (ELISA). Laboratory results for aflatoxin levels in the food samples collected were used to calculate the daily aflatoxin intake, according to the results from the dietary assessment. The study found 41% of children sampled had stunted growth. Boys were more stunted than girls (p=0.057) and Korogocho had more stunted children than Dagoretti (p=0.041). In all, 98% of food samples collected tested positive for aflatoxin and there was an average exposure to aflatoxins of 21.3 ng/kg bodyweight per day. Exposure to aflatoxin M1 (AFM1), location and sex were significantly associated with HAZ, with boys and children from Korogocho having lower HAZ, and AFM1 was negatively associated with HAZ (p=0.047), indicating that AFM1 was associated with stunting. There was no association between total aflatoxins (aflatoxin B [AFB] and aflatoxin G [AFG]) and HAZ, WAZ and WHZ. The study showed a high prevalence of malnutrition, especially stunting, in two low-income urban sites, and this was most pronounced in the high-density area. The reported association between AFM1 and stunted children indicates that more research is needed on the health impacts of this aflatoxin in growing children.

Parenteral immunization with either formalin-fixed whole cells of the fimbriate Bgdl7 strain or purified fimbriae protected against Vibrio cholerae 01 infection in rabbits, independent of biotype and serotype. Parenteral immunization of adult rabbits with purified fimbriae prior to V. cholerae 01 challenge resulted in a reduction of 2 to 3 orders of magnitude in the number of bacteria recovered from the small intestines of immunized rabbits in comparison to non-immunized controls. IgG and IgA antibodies against fimbrillin of V. cholerae 01 were detected in the convalescent sera of patients with cholera; however, little fimbrial antigen was detected in the commercially available cholera vaccines when examined by polyclonal and monoclonal antibodies against fimbriae. These data suggest that fimbrial hemagglutinin is a major adhesin of V. cholerae 01 and that parenteral immunization with fimbriae generates a specific immune response in the gut that may serve as one means of mitigating subsequent V. cholerae 01 gut infection.Key words: Cholera, Fimbriae, Vaccine Cholera is an acute diarrheal disease that is caused by the Gram-negative bacillus Vibrio cholerae 01. V. cholerae 01 infects via uptake of contaminated water and foods and preferentially colonizes the upper small intestine.Fimbriae of V. cholerae 01 consist of cell-associated hemagglutinin that is proposed to be one of the major adhesins mediating the interaction of V. cholerae 01 and human epithelial cells in the small intestine (1). Passive protection tests with anti-mannose-binding hemagglutinin pili antibodies (polyclonal and monoclonal) have been proven effective in protection against experimental cholera caused by El Tor vibrios in infant mouse and in rabbit intestinal loop models (7): but to date, there has been no correlation between serum antibody titers to known antigens purified from V. cholerae 01 and clinical protection. Naturally occurring V. cholerae 01 infection confers longlasting protection against reinfection, but such effective V. cholerae 01 antigens remain to be elucidated.Experimentally infecting rabbits with V. cholerae 01 using the ligated ileal loop test has shown that the bacteria are associated with small intestinal epithelial cells (4,5,8). Therefore, small intestinal infection of rabbits may be used to analyze parameters of immunity that interfere with the persistence of V. cholerae 01 at the intestinal epithelium. As previously reported (2, 3), fimbriate V. cholerae 01 strain of Bgd17 (classical biotype, Inaba serotype) was selectively induced and hydrophobic fimbriae were purified from the fimbriate strain.

Background: Hospital environment can serve as an important reservoir and thus a critical element in the transmission of bacterial infections especially in critical care settings such as Surgical and new-born units. Contact with contaminated surfaces may lead to Hospital Acquired Infections (HAIs) among healthcare workers, visitors and patients. Further, HAIs may contribute to the spread of drug-resistant bacterial infections. This study sought to determine bacteriological characteristics and distribution in patient care environmental surfaces (Surgical and new-born units) at Mbagathi hospital Nairobi Kenya. Methods: A total of 700 samples were obtained from different surfaces: beds, bedside tables, sink taps handle, door handles, nursery incubators, paediatric weighing scale and new-born resuscitation machine by means of repeated screens over a period of three months. Microbiological isolation and identification were done by following standard laboratory methods established at Aga Khan University Hospital. Antibiotic susceptibility testing was carried out by using Vitek 2 system. Result: Five bacterial genera were isolated, S. Aureus was 3% (19/700), E. coli 0.9% (6/700), Acinetobacter species was 1.4% (10/700), Pseudomonas species 0.1% (1/700) and coagulase negative staphylococcus (CoNS)13.0% (88/700). Trimethoprim/Sulfamethoxazole and Benzylpenicillin were the most resistant antimicrobial agents while Oxacillin, Cefoxitin, Levofloxacin, Linezolid was most sensitive. Conclusion: All S. aureus were methicillin sensitive (MSSA). Patient beds surfaces were the most contaminated among the selected items while the nursery incubator was the least contaminated.

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Introduction: Worldwide tuberculosis was top ten cause of death alongside, Human Immunodeficiency Virus (HIV) in 2018; 10.0 million people became ill with tuberculosis with 1.2 million deaths occurring among HIV negative people while an additional 251,000 were HIV positive. Isoniazid preventive therapy (IPT), intensified case finding, and infection control have been widely recommended to reduce the burden of TB in people living with Human Immunodeficiency Virus (PLHIV). IPT works synergistically but independently of antiretroviral therapy (ART) to reduce the morbidity, mortality and incidence of tuberculosis among PLHIV, but its uptake has been slow in most developing countries.Objective: This study sought to find the effect of isoniazid preventive therapy on prevalence of tuberculosis among HIV patients attending Bahati comprehensive care centre. Materials and Methods:A retrospective cohort study was conducted over a seven month period among consented 346 people living with Human Immunodeficiency Virus (HIV) residing in Makadara Nairobi County, attending Bahati comprehensive care centre with signs and symptoms of TB. Sampled sputa from the participants were analyzed for detection of Mycobacterium tuberculosis by GeneXpert MTB/RIF assay and culture by BACTEC MGIT 960. Socio demographic and laboratory data was collected and the data was analyzed using SPSS version 20.0.Results: Of the three hundred and forty six sputa sampled and analyzed, 10(6.5%) and 67(35.1%) IPT and non-IPT patients had Mycobacterium tuberculosis detected respectively; P=0.001. On the other hand 57(18.2%) and 20(60.6%) new and retreatment patients had Mycobacterium tuberculosis detected respectively.