Early Warning Systems for Improved Human Health and Resilience to Climate – Sensitive Vector Borne Diseases in Kenya Project ID No. B Jaramogi Oginga Odinga University of Science and Technology University of Nairobi WHO PRE-COLLOQIUM MEETING 6 th – 7 th June 2016

To develop a framework for integrated early warning system for improved human health and resilience to malaria and Rift Valley Fever Virus

Project Objectives and Responsible components Overall Objective To assess vulnerability of dry-land human populations to VBDs and develop strategies and improve their resilience to climate-sensitive vector-borne diseases. Responsible Components Anthropology, Parasitology, Virology. 1. To determine factors (climatic and non climatic) that contribute to population health vulnerability to VBDs in the selected study sites Anthropology, Parasitology. 3. To develop tools for detection of the likely occurrence of climate sensitive vector borne diseases Virology, Spatial Modelling. 4. To assess and compare the temporal and spatial characteristics of climatic, hydrological, ecosystems, and vector bionomics variability Entomology, Virology, Spatial Modelling. 5. To build capacity of stakeholders to promote the utilization of the developed strategies 2. To assess existing adaptation strategies and develop innovative solutions for enhancing resilience using participatory action research approaches Anthropology, Entomology, Parasitology, Virology, Spatial Modelling. Specific Objectives

Baringo County (Central Rift Valley in Kenya) Lies between Long °E °E and Lat °N °N Altitudes range: 870m – 2,499m asl. Rainfall range: 1, ,500mm Temp. range: min. 10 o C - max 35 o C Population: 556,000 County sub divisions: 6 Study focus: 3 Marigat, Baringo Central and Baringo North. Area: 11,051.3km 2 (65km 2 is surface water comprising of 4 lakes)

 The study area has 4 agro-ecological zones  Run parallel to each other (N-S direction)  Identified based on: hydrology, soil types, rainfall patterns, vegetation cover and altitude.  The 4 zones (east to west) include 1)the low lying areas (Lowlands); 2)mid-altitude areas (Midlands); 3)the Highlands; and 4)the Riverine (floor of the RV)bordering the Kerio River.  The zones: ◦ Are embedded within a rich hydrological profile of 4 lakes, ◦ 2 permanent namely;  freshwater Lake Baringo (130km 2 surface area) and  the salty Lake Bogoria (covering 34 km 2 ). ◦ 2 others are temporary namely;  Lake Kamnarok located in the Kerio Valley within the riverine zone;  Lake 94 which formed in 1994 due to extensive flooding of Lake Baringo and Lake Bogoria.

1.Agro-pastoralist mainly the Tugen community, 2.Other include the Ilchamus and the Pokot. 3.The varying ecosystem dictates the lifestyle of these communities. 4.The different lifestyles which the people lead differentially expose them to VBDs putting them at different risk levels. 5.Ecological conditions dictate the extent to which different vectors survive in the given environment. 6. In the recent times, climatic changes have also meant changes in disease burden, specifically, vector-borne diseases. 7.Due to differences in socio-cultural backgrounds of the communities, differences in mechanisms of responses from them are expected. 8.The social and cultural set-up dictates the support mechanisms within and between families. 9.These support mechanisms play a critical role in the health seeking behavior

 Inception WorkshopJan, 2014  Reconnaissance Mission (Baringo County) Feb, 2014 Meeting with the Baringo CHMT, CVS, MOA, Livestock and Fisheries officials,  Initial preparations Feb-April 2014  Commencement of workApril 2014  End of Year Workshop 24 th –26 th Nov 14  Data Management Training Workshop12 th –6 th Jan, 15  Project Review Meeting10 th May 2015  Meeting with VES-TDR site visit team, 25 th –29 th May15  Scientific Writing Training Workshop23 rd –27 th Nov 15  Data Sharing Workshop 7 th –12 th March16  Project Data Collection endsMay 2016

AIM To establish the extent of communities adaptation to Malaria and RVF in Baringo County The objectives 1.To establish communities knowledge of the relationship between climate variability, Malaria and RVF 2.To determine the link between socio-cultural practices and vulnerability to Malaria and RVF among communities 3.To describe the effect of resource factors to communities’ vulnerability to Malaria and RVF 4.To establish communities’ strategies for coping with Malaria and RVF

RVF 1. Community is knowledgeable of malaria signs and symptoms 2. Knowledge co-exists with myths 3. Conventional and herbal treatments used 4. Bed net main prevention strategy but mainly sourced from government health facilities 1.The communities have limited knowledge of RVF and its transmission mechanisms in humans and livestock 2.The communities have practices that would expose them to RVF infection in the event of an outbreak. These include handling and/or consumption of products from sick, dead livestock and management of livestock diseases 3.Knowledge of RVF transmission routes has not translated to adoption of prevention mechanisms by communities MALARIA

Overall Objective:  To assess the influence of seasonal climatic variability on malaria and RVF vectors breeding habitat preferences, adult densities and infection status Specific Objectives 1. To determine the diversity of Mosquito vectors of Rift Valley Fever and Malaria in Baringo County of Kenya 2. To establish the distribution of Vectors Rift Valley Fever and Malaria along altitudinal transect in Baringo County, Kenya

Immature mosquitoes were collected by standard dipper (350ml) and pipette Larvae were identified morphologically under dissecting microscope using taxonomic keys Shannon diversity index was used to determine spp diversity & Shannon t -test to compare diversity in zones

Thirteen larval species belonging to Anopheles (4), Culex (6) & Aedes (3) were collected Most abundant spp occuring in all zones was Cx. quinquefasciatus, secondary vector of RVF An.gambiae & An.pharoensis larvae,vectors of malaria, were in high density at lowland & midland regions Lowland zone had greatest diversity of breeding habitats while riverine had the lowest Spring had highest number of larval species(10) while water pan had lowest no. of species(4)

There was variation in spp diversity between some zones There was no significant difference in species diversity between highland/riverine and highland/lowland but midland was different from all other zones.

The presence of Anopheline species in all study zones indicates risk of malaria more so at lowlands and midlands of the County. The presence of Aedes and Culex species previously reported as vectors indicate the potential for virus transmission in case of RVF outbreak. Information on larval species diversity and distribution is necessary to guide targeted vector control measures.

: Objectives 1. To determine the sero-prevalence of RVF in livestock in Baringo County during the inter-epidemic period 2. To determine the sero-prevalence of RVF in humans in Baringo County during the inter-epidemic period 3. To determine Knowledge, attitudes and practices towards RVF among the livestock keepers in Baringo County

 Serum sampling was done concurrently in Animals and humans, Human sampling was done in eight selected health facilities while animal sampling was done in 16 locations in the county. The samples were tested for RVF antibodies using competitive ELISA KIT.  KAP study was done by a preformed questionnaire on 200 livestock keepers, filled questionnaires were analyzed using SPSS software

A total of 286 animal serum samples were analyzed using IDVET multispecies competitive ELISA, out of which 16 (5.59%) tested positive for RVF IgG antibodies. Lowlands which are prone to flooding had the highest numbers of animals testing positive for RVF antibodies at 11.25%, followed by riverine at 4.35%, Midlands at 2.94% while highlands had 3.22% % of the animals that tested positive had no clinical symptoms of any disease. Goats and cattle had the highest number testing positive for RVF IgG antibodies at 37.5% KAP Survey 160 respondents 95% reported having heard about RVF with 92% hearing about the disease only during the last ( ) outbreak, while 13% had personal experience. All (100%) respondents considered RVF a serious disease, though more than 50% could not identify the clinical signs, transmission pathways and control measures.

The study on livestock showed there was no active RVF outbreak during the time of study but a low level of RVFV activity was evident. The KAP study pointed out that the community is aware of the RVF but have little knowledge on the clinical signs, transmission pathways and control measures.

Overall Objective  To determine the prevalence of Plasmodium falciparum infections among primary school children in Baringo county of Kenya Specific Objective  To compare malaria prevalence among primary school children within the four zones of the study area  To determine incidence of P. falciparum infection among primary school children in Baringo County  To determine the sensitivity and specificity of SD and Care Start RDT kits in the diagnosis of Plasmodium spp. infections among primary school children in Baringo County  To determine the decadal ( ) seasonal trends of malaria in Baringo County

 Clinical examination, medical status and history of medication recorded  5µl collected from each child using a 5µl pipette for RDT kits and10µl for thick and thin smear  RDT kits were used to examine the presence of malaria parasite antigens in blood  Thick and thin blood smears examination  Retrospective health records of reported treated malaria cases spanning 10 years (January 2004-December 2013) were extracted from 14 selected health facilities

Malaria prevalence within riverine schools Malaria point prevalence

Malaria is prevalent in Baringo county, mainly occurring in the riverine Highest prevalence in the months of January and February Proportion of asymptomatic malaria cases are high within the riverine zone Performance of the three kits were fairly better towards diagnosis of P. falciparum infections PROPORTION OF ASYMPTOMATIC MALARIA

 High malaria prevalence was recorded during the dry season in the months of January to March which is preceded by short rains in the months of October and November  Malaria transmission within riverine zone seemed to be perennial and not seasonal  The overall risk of Plasmodium species infections in Baringo County was relatively low however, when the risk of infection was categorized per ecological zones, riverine zone recorded a higher incidence of malaria transmission

Overall Objective To model the spatial distribution of RVF vectors in Baringo County, Kenya. Specific Objectives: 1. To evaluate the effect of climate change on RVF vector distribution in Baringo County, Kenya. 2. To develop spatial risk maps for prediction of possible RVF outbreaks foci.

The study used data on vector presence and ecological niche modelling (MaxEnt) algorithm to predict the effect of climatic change on habitat suitability and the spatial distribution of RVF vectors in Baringo County. Data on species occurrence was obtained from longitudinal sampling of adult mosquitoes and larvae in the study area. The study used present (2000) and future (2050) RCP 4.5 Bioclim climate databases to model the vector distribution. Outdoor sampling Indoor sampling

 Model results predicted potential suitable areas with high success rates for Culex quinquefasciatus, Culex unvitattus, Mansonia africana and Mansonia uniformis.  Under the present climatic conditions, the lowlands were found to be highly suitable for all the species.  Future climatic conditions indicate a shift in the spatial distribution of Cx. quinquefasciatus and M. africana.

Summary of the Epidemiological, climatic and environmental data collected during the study period Months (seasons)1 YearNear term trend (1 – 10yr) Long term trend (10 years and above Local Epidemiological data: 1.RVF seroprevalence in animals (one cross sectional survey) 2.Malaria prevalence among school children (four surveys N/A Epidemiological data from hospital records: 1.Malaria cases 2.RVF cases Climatic and environmental measurements: 1.Rainfall 2.Temperature 3.Enhanced vegetation index (EVI) Sub-nationalN/A NationalN/A RegionalN/A Climatic and environmental measurements: 1.Rainfall 2.Inferred maximum temperature 3.Land surface temperature 4.NDVI 5.Soil moisture 6.Digital Elevation Map 7.Digital Soil map

KEY MESSAGESACTIVITIESTARGET AUDIENCE MEANS OF DISSEMINATION RESPONSIBLE COMPONENT 1.Climate change models, projections and scenarios are key sources of information that show a likely increase of vector density and occurrence of rift valley fever and malaria in Baringo County of Kenya. Sensitization of stakeholders on the importance of decision making tools for disease prediction. County GovernmentMeetings, bulletins, flyersMODELLING RVF vaccination exercises should focus on all areas predicted as being suitable habitats for the vectors. Veterinary services Local community County administration Meetings, brochures Posters/flyers, billboards, local fm radio stations, video clips Sensitization on the risk of RVFVeterinary services County administrators Researchers, local communities Schools, health care workers Meetings, Brochures, Posters/flyers, Billboards Radio,video clips 2.Livestock in the lowlands are at a higher risk of rift valley fever infection than those from other areas of the County. Demonstration of risk maps to show risk areas for resource allocation and exposure reduction actions. County Government Veterinary services Local community County administrators Meetings Bulletins Flyers VIROLOGY COMMUNICATION 3.Low knowledge on transmission mechanisms of RVF increases the risk of infection in the event of an outbreak Public sensitization on transmission pathways of RVF and how to avoid them. Veterinary services County administrators Researchers Local communities Schools Health institutions Meetings Brochures Posters/flyers Billboards FM radio stations Video clips 4.Intensified surveillance and community-wide interventions against malaria, particularly with regard to prevention, diagnosis and treatment, will mitigate malaria risk in the County. Mass school- and community-based screening and treatment; Provision of bed nets Demonstration on malaria prevention and management School childrenBrochures, Posters Termly visits to schools Sports days PARASITOLOGY Local community Dept of Health Dept of Education Local public meetings Posters, brochures Seminars, conferences Publications

Communication Strategy 2 KEY MESSAGESACTIVITIESTARGET AUDIENCE MEANS OF DISSEMINATION RESPONSIBLE COMPONENT 5.The community and livestock living in the lowland and riverine areas of Baringo County are at a much higher risk of malaria and RVF due to high vector densities. 6.There is need to sensitise the local inhabitants to actively participate in integrated vector management. Demonstration of risk of transmission of RVF and malaria in the County Demonstration of integrated vector management in Baringo County Local community Local public meetings Infotainment (eg roadshows), Booklets, posters, calendars, T- shirts, caps, lessos/kangas, branded jerricans, training on proper use of bed nets  ENTOMOLO GY Administration Local public meetings Calendars, posters, booklets, T-shirts, caps County Government and website uploads, Twitter account Facebook page, Posters, Reports Research community Conferences/seminars/ workshops, publications and booklets, VBD platform, and website Facilitators/ implementersConferences and seminars VBD platform and s Twitter account, Facebook page, Posters

TitleJournalStatusComponent 1Lay knowledge and management of malaria in Baringo County, Kenya Malaria JournalSubmittedAnthropology 2An assessment of RVF risk factors in Baringo County, Kenya Proposed BMC Public Health Under going internal review Anthropology 3Diversity and distribution of mosquitoes transmitting malaria and RVF in Baringo County Journal of Vector Ecology SubmittedEntomology 4Effect of altitudinal variation on the distribution of immature malaria and RVF Vectors in Baringio County, Kenya Not decidedUndergoing internal review Entomology 5Interepidemic seroepidemiogical survey of RVF in Livestock and Humans in Baringo County, Kenya PLOS Neglected Tropical Disease Undergoing internal review Virology 6 Ecological Niche Modelling of Rift Valley Fever Virus Vectors in Baringo, Kenya. Journal of Infection Ecology and Epidemiology SubmittedModeling

Also in progress Seasonal trends of clinically-diagnosed and treated malaria cases and their relationship with climatic variables within Baringo County, Kenya

NameLevelInstitutionComponent 1Alfred OchiengPhD FellowJOOUSTSpatial Modeling 2Edna MutuaPhD FellowUONAnthropology 3Isabella MoraaPhD FellowUONEntomology 4Jacinta AmadiPhD FellowUONEco-hydrology 5Dancun KobiaMsc StudentUONEntomology 6Juma EvansMsc StudentUONVirology 7Collins OmondiMsc StudentKUParasitology 8Calvin LoyeMsc StudentUONEntomology 9Lavinca AchiengMsc StudentUONHealth Economics

Thank you Data sharing workshop at Eldoret (March 2016)