by Eric Osoro, a physician and medical epidemiologist with the Paul G. Allen School for Global Animal Health. Dr. Osoro serves as the Deputy Director of Public Health for WSU Global Health-Kenya. This column is a personal account of his research in Kenya on the Zika virus.

Dr. Eric Osoro (left) with field study coordinator Harriet Mireiri going over study procedures at the Bomu Hospital in Mombasa, Kenya.
Dr. Eric Osoro (left) with field study coordinator Harriet Mireiri going over study procedures at the Bomu Hospital in Mombasa, Kenya.

On a typical day, the maternal and child health unit at Coast General Hospital in Mombasa, Kenya, will be bustling with dozens of pregnant women waiting to be attended by the doctor and find out how their babies were progressing. For the women, this is a reassuring monthly routine in a country with high numbers of maternal and infant deaths. Besides the maternal and neonatal deaths, a worry which occupies the pregnant women is the possibility of a baby born with birth defects.

When the World Health Organization determined that Zika virus causes microcephaly, a birth defect that causes a baby’s head to be smaller than normal, there was concern about the potential implications in Kenya. Zika virus is transmitted by the Aedes aegypti mosquito, which is prevalent in coastal regions and was already associated with an outbreak of dengue fever—a disease related to the Zika virus. Furthermore, Zika virus was first detected in a neighboring country whose disease profile is similar to that of Kenya.

Could it be possible that Zika was responsible for some of the birth defects in Kenya and the health authorities were not aware?

In October 2017, researchers from the WSU Allen School commenced a study to determine the outcomes of Zika infection among pregnant women and infants in Kenya. In the study, we are recruiting pregnant women in early pregnancy in selected Mombasa hospitals. We will follow the women over the course of their pregnancy to identify any evidence of Zika virus infection and outcomes.

The pregnant women are often at the prenatal unit area early in the morning, well before the health workers start attending to them. While at the waiting bay, we approach the women and talk with them about the study. Typically, they would vaguely recall aspects of Zika virus, but could readily identify the mosquito transmitting the virus once we described it.

“If it is the same mosquito which bites during the day and brings dengue, I have been bitten by them several times,” said one woman, and it is a typical response.

We then provide them with information on the study and their involvement for purposes of informed consent. Once informed consent is obtained, the mother is taken through a questionnaire before a blood sample is drawn for Zika virus testing. She is then scheduled for monthly follow up until delivery. After delivery we will follow up with the infants to assess for growth and neurodevelopment.

The study is funded by Centers for Disease Control and Prevention and is collaboratively implemented by WSU and local partners including the Kenyatta National Hospital, University of Nairobi, Kenya Medical Research Institute, and Mombasa County government.

Laboratory technologist Samwel Wakithae processing blood from study participants in the Bomu hospital, Mombasa, Kenya.
Laboratory technologist Samwel Wakithae processing blood from study participants in the Bomu hospital, Mombasa, Kenya.

As part of the entry and preparation for implementation of the study, we conducted sensitization meetings with stakeholders including community women groups, local health workers, religious leaders, and the local administration.

“We have a lot of these mosquitoes and we thought they only spread dengue,” said one of the community women leaders. “We are very willing to learn how much Zika we have and what problems it is causing in our area.”

Dr. Hafsa Jin, an obstetrician in one of the study sites, welcomed the study and looks forward to the findings.

“We do see some children with microcephaly, but we rarely get to know the cause,” said Dr Jin. “This study gives us an opportunity to quantify the burden of birth defects and probably establish their causes. This will be very useful information for planning prevention.”

The study will provide data leading to evidence-based strategies to prevent Zika virus infection in pregnancy in Africa. It could lead to improved counseling of patients about risks to their pregnancies and their children. The information will also contribute to effective preparedness for health facilities providing services to affected children and families.