PHD-Department of Community Health

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    Effects of bednet use, topography and targeted vector control on malaria transmission in the highlands of Vihiga and Kakamega counties, Western Kenya
    (2013-03-26) Atieli, Harrysone Etemesi
    Insecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality. However, there is scanty information on actual usage of owned nets which varies among households. Such variations may limit the potential effect of nets and cause spatial heterogeneity on malaria transmission. Likewise there is limited information and utilization of topographic parameters such as the shape of the underlying valley ecosystem in identification of high-risk malaria foci to help enhance surveillance and targeted vector control activities in regions where they are most needed. The objective of this study was to determine the effect of ITNs use, topography and targeted vector control on malaria transmission. The study was done in; Iguhu, Mbale and Emutete in Vihiga and Kakamega counties, in malaria hypomeso-endemic highlands of western Kenya. All houses in study sites were geo-referenced and mapped. Using a randomized-repeated cross-sectional study design, residents of 300 households randomly selected from each site in Iguhu and Emutete were interviewed for ITN s ownership/usage, their houses sprayed for vector abundance and occupants screened of malaria during the dry and rainy seasons of 2009-2010. Association of topography and spatial distribution of malaria vectors and infections were determined between broad 'U'-shaped versus narrow 'V'-shaped valley ecosystems in the three sites. Baseline information from spatio-temporal data above was used to identify intense transmission areas for target vector control using Indoor Residual Spray (IRS) and Biological larviciding. Entomological and parasitological data were used for impact evaluation. Data was managed in excel spread sheets and analyzed by STATA software. Student t-test was done to determine differences in adult vectors and larval densities while Chi-square test was done to determine differences in occurrence of malaria infection prevalence. Univariate and multivariate' analysis of Turkey HSD test was done to determine the most predictive independent variable for the occurrence of larvae, adult vectors and malaria cases. Despite ITN ownership reaching more than 71%, usage was low at 56.3%. The proportion of non-adherence to ITN use was significantly higher during the dry season than rainy season, 46.6% vs. 32.9% in Iguhu (X2= 12.42, d.f = 1, P <0.001) and 53.4% vs. 41.8% in Emutete (X2 = 21.12, d.f = 1, P < 0.0001), respectively. Indoor resting female An. gambiae s.l. density was lower (43% t = 2.38, d.f = 167, P = 0.02) in houses with functional ITNs. Infection prevalence for all age groups was significantly lower by 30% among net users compared to non-net users during the rainy season (OR 0.72,95% CI 0.51-1.00, P < 0.05). Broad flat bottomed valleys had significantly high number of anopheles larvae per habitat (P=0.024 Tukey HSD test), indoor resting vector density (f-=5.7, P<0.000I) and malaria infections (t=9.96, P<0.000I) than narrow valleys ecosystem during both seasons. Targeted vector control was associated with up to 61.3% reduction in indoor resting vector densities although. the reduction/effect on malaria infection was not significant. The findings of this study highlight the wide gap between ITN ownership and usage and effect on malaria transmission. Likewise, it recognises the importance of topographic parameters on vector abundance and malaria transmission. Based on this study, there is need to sensitize households on sustained use of owned ITN s in order to optimize their role as a malaria control tool and the need to consider topographic parameters in identification of high-risk malaria foci and use of this in programmatic targeted vector control to fight malaria.
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    The inference of immunochromatographic test, microscopy and polymerase chain reaction in diagnosis of lymphatic filariasis in Tana Delta, Kenya
    (2013-08-14) Kagai, James Mwaniki
    The current diagnostictests for Wuchereriabancrofti infections are insensitive and logistically unsuitable in epidemiological studies and disease surveillance. Although needing refinement, potentially sensitive polymerase chain reaction (PCR) assays have been developed. The suitability of these assays as molecular epidemiological and surveillance tools has not been extensively studied. These assays can be used to estimate disease indices, such as vector infection rate and are important in estimation of the infection pattern in the suspect areas. The main objective of this work was to study W. bancrofti infections in an identified population in the Tana Delta district, using modified molecular assays. The Tana delta, situated along the Kenyan north coast lies in a potentially lymphatic filariasis endemic region but no data on the disease has been documented. This study improved and evaluated PCR assays in monitoring of W. bancrofti infections in humans and the vectors in the Tana Delta. Samples which included, blood, sputum and urine were collected from consenting participants along with mosquitoes which were collected from their homes. The mosquitoes were identified and examined for W. bancrofti infections. Observations from the study indicated that PCR assays had sensitivity and specificity above 84%. This study demonstrated that the W. bancrofti infections exist in the Northern part of the Kenyan coast with prevalence of 6.4% to 9.6% using traditional diagnostic tests and PCR assays respectively. The prevalence of W. bancrofti in mosquito vectors was 1.0% microfilariae by dissection and 1.6% by PCR mosquito assay. A relationship between LF prevalence in the population and vector prevalence was observed. Through a calculation of a factorש (Hebrewshin), the relationship could enable projection of LF prevalence in the population from the determined vector prevalence. The study suggests that this factor ש would be directly proportional to the disease prevalence in the population (p=0.005). By using the modified PCR assays which are both sensitive and specific (p<0.005), an end point (denoted as a prevalence of 0.1%) for the mass drugs administration (MDA) can be determined. The age group 11-20 years was found to be more enthused in participating in the study, with the best turn out of 31% compared to all other age groups (p=0.001). This group had the highest lymphatic filariasis prevalence too. The results from sputum and urine are comparable, suggesting that either of these samples may be used in LF surveillance studies. It is observed that whereas the molecular methods are sensitive and specific, the cost involved is high. The study therefore recommends the use of PCR assays in determination of end-point for MDA. Further, it is recommended that where a survey of lymphatic filariasis is required; 11-20 age group be used to represent the community.
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    Assessment of Heavy Metal Concentration in the Environment and Perceived Health Risks by the Community around Kadhodeki Dumpsite, Nairobi county
    (2014-02-22) Njagi, Joan Murugi; Njagi, E.N.M.; Akungah, Daniel Nyagetiria; Afullo, A. T. O
    Solid wastes constitute a disaster for human health and environmental degradation. Dumpsites in Kenyan urban settlements are used as sources of nutrient rich soils for cultivating crops without regard to the risks of perceived toxic heavy metal pollution from the wastes. Water sources near the dumpsites are used as domestic water source for the people living near such sites. This water is often contaminated by toxic heavy metals leaching from the dumpsite. Heavy metals are known to accumulate in the plants then passed to the humans through the food chain. Prolonged consumption of unsafe concentrations of heavy metals through foodstuffs may lead to the accumulation of heavy metals in the humans causing disruption of numerous biochemical processes. The aim of this study was to determine the level of heavy metals in the vegetables, soil and water samples collected around Kadhodeki dumpsite. The study also sought to assess the knowledge, attitude and perceptions of the health risks posed by the site to the residents of the village. Heavy metal determination samples collected was carried out using X- ray fluorescence (XRF) analytical method. A descriptive cross sectional survey was carried out to assess the knowledge, attitudes and perceptions of people living around the study area. The analytical data was subjected to statistical tests of significance using ANOVA and post hoc analysis by Tukeys test (P<0.05) to determine whether there was any significant difference between the study sites. Chi square was used to determine if there were associations between the study variables in the survey. The research found that the vegetables under study had low levels of essential metals Fe, Mn, Zn and Cu while they had higher levels of Ni, Co, V, and more than maximum allowable levels (MAL) of Hg and Pb. V, Mn, Cu, Ni, Hg concentrations in the soil were higher than MAL for agricultural soils while Fe, Zn were within the limits. The water was contaminated by high than allowed levels of Mn (366-856 μg/l) and Fe (5132-12402 μg/l) in drinking water while Zn (40-336 μg/l) was below the WHO limits. The people living in Kadhodeki village had inadequate knowledge about the health risks which was significantly associated with the level of education (χ2 = 20.86 df=1 P<0.01). A significant association between level of education and perception was also revealed (χ2=13.57, df=1, p<0.01). Insignificant associations between age and the number of years the participants had lived in the village were found for the variables of knowledge, attitude and perception. Health education to the people living in Kadhodeki village on the dangers posed by the vegetables grown around the dumpsite should be done to prevent further consumption of contaminated crops. Farmers growing edible crops around the site should be advised to stop doing so and instead encouraged to grow other crops which can provide some earning and at the same time reclaim the land.
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    Constructive Men’s Engagement (CME) in Enhancing Reproductive Health in Makindu and Mutitu Sub-Counties of Kenya.
    (2014-09-01) Kimathi, George
    Reproductive health problems are the leading cause of women's ill health and death worldwide. Approximately 99% of all maternal deaths occur in developing countries, with Sub-Saharan Africa registering a maternal mortality ratio of 1,000/100,000 live births. Maternal mortality in Kenya has continued to rise since 2003, from a ratio of 414 deaths per 100,000 live births to 488 deaths per 100,000 live births in 2009. Over 56% of deliveries in Kenya are attended by unskilled people and outside health facilities. Only 28% of women receive skilled care within the first 4 critical hours following delivery. Men play cardinal and dominant roles in reproductive health. However, increasing their participation has not always been achieved. The main objective of this study was to establish individual, programmatic and healthcare provider related determinants of Constructive Men’s Engagement (CME) in reproductive health, and explore their potential for improving women’s health. An interventional quasi-experimental design was applied with interventions to promote CME-RH being implemented in Makindu Sub-county for 12 months following baseline while Mutitu Sub-county served as a control site. A total of 968 men and 32 nurses participated with 484 men respondents being interviewed at baseline and end-term in both sites. Furthermore, 8 men and 10 women FGDs, in addition to 18 KII were undertaken. A GEM Scale for CME- RH was adapted and applied to establish CME-RH levels among respondents. Similarly, a Trainer of Trainers’ manual on CME-RH was also developed and used to facilitate fortnightly CME-RH sessions with groups of men in Makindu. SPSS Ver 19.1 was used for data management with Chi-square tests, correlation and regression statistics applied for analysis. At baseline, Makindu and Mutitu had 43.4% and 44.6% of men who had CME-RH respectively. However Makindu recorded 60.3%, while Mutitu had only 47.1% of men who were CME-RH compliant at post-test. On individual characteristics, education level OR= 2.095 (0.902- 4.839) p=0.004, age of respondent OR= 1.716 (1.328 -2.438) p<0.010, knowledge on the number of times a pregnant woman should attend ante-natal clinic OR =1.738 (1.239 - 2.925) p=0.008 and knowledge of conventional family planning methods OR= 0.733 (0.579 - 0.968) p=0.043 were identified as independent predictors of CME-RH. Spousal approval for use of family planning OR= 1.316 (0.06 - 2.296) p=0.002 as well as approval for access to FP services by young unmarried couples OR= 2.881 (1.783 - 5.271) p<0.001 were also significant. Programmatic independent predictors of CME-RH were identified as having male only RH meetings/trainings OR= 1.094 (0.766 - 1.703) p=0.015, lack of confidentiality among ANC/MCH staff OR=1.297 (0.793 - 2.237) p=0.016 and the perception that RH programs have done little to involve men OR=1.963 (1.289 - 2.19) p=0.003. The capacity of health care providers including their skills, competencies and attitude also greatly influenced CME-RH. This study recommends promotion of CME-RH to be prioritized while reproductive health programs should adopt a multi-sectoral approach in design and implementation. Trainings and health promotion meetings targeting men on RH matters should always be organized for men only. Ways must also be devised to ensure staff at ANC/MCH clinics observe confidentiality with regard to client information, while RH programs must engender men to play seminal roles as prevalent at household and community level. Research would be valuable to unravel cultural values and practices that could be harnessed to promote CME-RH in Kitui and Makueni Counties.
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    Determinants of health inequalities among adults in Korogocho informal settlement, Nairobi, Kenya
    (2014-09-12) Eboreime-oikeh, Imesidayo Omua
    Dearth of actionable evidence of the magnitude, determinants, and mediators of health inequalities in deprived communities has hampered efforts to eliminate invidious health inequalities. The objectives of this study, which set out to bridge the knowledge gap, were to assess the magnitude of health inequalities, identify the determinants of health inequalities, and determine which material, psychosocial, and behavioral factors mediate health inequalities in Korogocho, an informal settlement in Nairobi, capital city of Kenya. Eligible, consenting adults were selected from each of Korogocho informal settlement's nine villages, for this cross-sectional, field-based study, through multi-stage mixed cluster sampling. The independent variables comprised demographic, socioeconomic, and environmental determinants while the mediating variables were material, psychosocial, and behavioral factors. Differences in the prevalence of the dependent variables: self-rated health status and self-reported chronic health conditions, were the indicators of health inequalities. Health inequalities were measured in three dimensions: health disadvantage, health gap, and social health gradient using prevalence difference, odds ratio, and concentration curves respectively. Complementary qualitative data were collected from six focus group discussions and key informant interviews. The study population comprised 719 adults aged 25 to 59 years, mean age 34.20 ± 8.68 years with 188 (26.1%) males. Ngomongo village respondents had the highest prevalence of poor self-rated health status (44.3%) while Grogan B village respondents had the highest prevalence (29.7%) of self-reported chronic health conditions. Compared to Korogocho informal settlement, Ngomongo village (Odds ratio [OR], 2.22; 95% CI, 1.44 to 3.44; P = 0.0003) and Kisumu Ndogo village (OR, 1.76; 95% CI, 1.06 to 2.93; P = 0.029) respondents suffered significant health disadvantage. Varying magnitudes of health gaps and gradients were detected in the villages except in Highridge village where the magnitude of health inequalities was not statistically significant. Social health gradients were most marked within Gitathuru and Kisumu Ndogo villages but not across Korogocho informal settlement. From binary logistic regression, older age (45 to 59 years), female gender, lack of access to health care, and village of residence were the significant determinants of health inequalities. Significant mediators of health inequalities were alcohol intake, lack of voluntary physical exercise, having multiple, concurrent sexual partners, and unprotected sex. Mediators contributed between 10.5% and 14% in females and between 30.3% and 40.4% in males, to health inequalities. The qualitative interviewees attributed ill-health mainly, to environmental pollution, poor sanitation, and poverty. To conclude, despite mass deprivations and concentrated poverty, disaggregated data showed significant magnitudes of health inequalities within and across some villages of Korogocho informal settlement. Most of the identified determinants and mediators of health inequalities were socially constructed and therefore remediable. This study provides needed policy-relevant evidence, which is based on local priorities and should help stakeholders to target policies and design interventions such as social protection, gender mainstreaming, environmental regeneration, and health promotion to eliminate health inequalities and hence leverage aggregate population health. Future large scale, longitudinal studies that incorporate life-courses perspectives are recommended to further validate the findings of this study in other deprived communities in Africa and globally.
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    Effects of HIV-Intestinal Parasites Co-Infection on Selected Hematological Parameters among Pregnant Women in Selected Health Facilities in Nyeri County, Kenya
    (Kenyatta University, 2014-10-09) Nyambura, Anthony Wanjohi; Kabiru, Ephantus W.; Gicheru, Michael
    Pregnancy places extreme stress on the haematological system and understanding of the physiological changes that result is obligatory in order to interpret any need for therapeutic intervention. Iron deficiency is the most common cause of anaemia in pregnancy. Intestinal parasitic infections increase anaemia in pregnant women. The results are low pregnancy weight gain and intra uterine development retardation (IUDR), followed by low birth weight (LBW), with its associated greater risk of infection and higher perinatal mortality rates. On the other hand HIV and AIDS is one of leading cause of mortality worldwide. HIV damage a person's body by destroying specific blood cells including CD4 T cells which are crucial to helping the body fight diseases resulting to AIDS. Sub-Saharan Africa is the region most affected by both HIV and intestinal parasites disease burdens. In Kenya, HIV infection remains a major public health problem where women are most affected. Studies have documented the effects of parasite infection on haemoglobin among pregnant women. Effects of HIV infection on haemoglobin level have been documented as well. However, there is paucity of data on effect of HIV - Intestinal parasite co-infection on haematological changes among pregnant women in Kenya. The co-infection is likely to aggravate the haematological changes. Therefore, this study aims to establish the prevalence of co-infection with HIV and intestinal parasites, the effect of HIV -Intestinal parasites co-infection on haemoglobin, red blood cells, white blood cells, platelets and CD4 cells; management practices of the co-infection and challenges encountered by health facilities during management. A cross sectional study will be conducted where a sample population of 344 pregnant women in selected health facilities in Nyeri County will participate. Structured interviewer administered questionnaires will be used to collect quantitative data. Qualitative data will be collected using six focused group discussions among pregnant women and key informant interviews among health care providers. Stool and blood samples will be analysed in the laboratory using standard procedures. The data collected will be managed and analysed using SPSS for windows (version 20). The information generated will inform policy development to address the problem of HIV and intestinal parasites co-infection among pregnant women.
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    Effectiveness of Isoniazid Prophylaxis in Prevention of Tuberculosis in Child Household Contacts of Adults With Pulmonary Tuberculosis in Nairobi County, Kenya
    (Kenyatta University, 2015) Okwara, F. N.
    Sub-Saharan Africa continues to document high burden of pediatric TB, driven by the HIV epidemic. The urban poor are at highest risk of infection. Infected children experience rapid disease progression and severer disease. Contacts‟ tracing and isoniazid prophylaxis is an effective prevention strategy, but has been administered inconsistently in most resource poor countries. Perceived obstacles have been sub-optimal effectiveness in view of continuous transmission and re-infections, as well as adherence and safety concerns. The objectives of this study was to evaluate the effectiveness of IPT in preventing TB related morbidity in children in household contact with adults with TB from informal settlements in Nairobi. A prospective longitudinal cohort study was done. Child contacts of recently diagnosed PTB smear-positive adults were enrolled. Recruitment started in December 2011 to July 2013. Consent was sought. A structured questionnaire was used to get information on source case TB treatment, socio-demographic characteristics and TB knowledge. Contacts underwent baseline clinical evaluations to exclude TB disease using clinical algorithms. TST, microscopy and histology were done whenever indicated. Contacts with chronic illnesses were excluded. A blood sample was obtained at baseline for liver enzymes assays and for PCR for HIV DNA. Contacts were then put on isoniazid for 6 months and followed up monthly for 1 year for new TB infection, and compliance and adverse events monitored. Qualitative data was provided by 2FGD and KIIs. Data was analyzed using SPSS. IPT acceptability was 320 out of 366(87.3%) of eligible source cases. Most (96%) were from poor social backgrounds, and 83.4% had below tertiary level of education. All source cases were on first line anti-TB treatment. Of 428 contacts screened, 6.3% were HIV positive. The baseline prevalence of latent TB was 92 (22.2%), while 14 (3.2%) had TB disease. IPT completion rate was 368 of 414 (88.8%). Overall compliance rate was 89%. IPT failure was documented in 6 (1.6%) cases, the relative risk of new TB disease in contacts on IPT was 0.49 (95% CI 0.21 -0.86). IPT effectiveness in preventing TB in exposed contacts was 50%. On multivariate logistic regression of factors influencing IPT failure, only weight faltering of contact was significant (p= 0.005). The leading programmatic challenges reported were too many hospital visits (65.2%) and difficulties in administering tablets to children (44.3%). Side effects were documented in 22.2%, mainly skin rash (12.5%), but significant hepatotoxicity occurred in only 3(0.08%). In conclusion, child TB is prevalent in exposed contacts in informal settlings. Contact screening and IPT is an effective, acceptable and safe child TB prevention strategy for exposed child contacts in these settings, however its implementation is fraught by various social and programmatic challenges minimizing overall benefits realized. Therefore, there is need to prioritize these children in informal settlements in TB screening programs. Furthermore, linkage of IPT strategy to nutrition interventions programs, and the provision of minimal adherence support to households could greatly optimize overall effectiveness attained.
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    Use of mobile phone short text message service to enhance cervical cancer screening at the thika level 5 hospital, Kiambu County, Kenya
    (2015) Wanyoro, Anthony Karanja
    Cervical cancer is a major public health problem among adult women especially in developing countries and its control is of paramount importance. Organized screening programmes have led to a large decline in cervical cancer incidence and mortality in developed countries. In Kenya very few women at risk have regular repeat cervical cancer screening and there exists no effective recall mechanism to enhance scheduled screening. The Short Message Service (SMS) Text may be used as a recall tool to enhancing cervical cancer screening in developing countries such as Kenya where other communication means may not be easily available. This blinded randomized controlled trial where participants were recruited from among eligible women attending the general female outpatient clinic at Thika Level 5 hospital; randomly allocated to an intervention (SMS text reminders) arm and a control (no SMS) study aimed to determine the influence of using SMS text reminders in enhancing adherence to scheduled repeat screening for cervical cancer. Data was collected using interview guide and analyzed using STATA version 11. Categorical variables were summarized by frequencies and proportions while continuous variables were summarized by means, medians and standard deviations. Chi square test was used to establish the relationship between categorical variables while logistical regression analysis was conducted to evaluate the influence of the independent variables on adherence to scheduled screening while using the SMS reminders. The mean age of the participants was 38.8 ± 10.8, most were married and of low socio- economic status. Only 20% of the eligible women attending the general outpatient’s clinic had ever been screened with only 8.8% having had regular screening. A total of 7.4% of the study population had abnormal cytological smears of which 3.2% were invasive cancer. It was found that 67.1% of participants in the intervention arm and 20.3% in the control arm re-attended to rescreening at end line as scheduled. The participants who received SMS text reminders were 8 times more likely to adhere to scheduled rescreening than those who did not (OR 8.02; CI 95% 4.69-13.73; p-<0.001). The age group 30-34 years, participants those whose spouses were employed and those who used public transport to access the hospital were significantly associated with return to scheduled screening after sending SMS text reminders (OR 2.24 P<0.005); (OR 2.2 P<0.05); (OR3.29 P< 0.005) respectively. On multiple logistical analyses having owned a mobile phone for more than two years was found to be more important in influencing re-attendance if one was educated above secondary school level. It was concluded that many women attending the general outpatient’s clinic were not screened and almost 10% of such women had abnormal cervical lesions including cervical cancer. Screening such women and reminding them of the next screening dates increases their chances of adherence to scheduled screening by up to 8 times when compared to those not reminded. The study recommended that the Short Text Message Service (SMS) reminders should be integrated into the cervical cancer screening programmes and cervical cancer screening services should be integrated in the female general outpatient clinic
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    The effect of selenium intake in progression of asymptomatic hiv type 1 infected children in Nyamasaria sub county Kisumu County Kenya
    (2015) Otieno, Samwel Boaz
    The prevalence of the Human-Immuno-deficiency Virus has been observed to be inversely related to selenium levels in foods. More recent Demographic Health Surveys have shown that despite the prevalence of HIV reducing by half in Kenya the prevalence in Kisumu County still remains twice the National prevalence, which suggests that there could be other factors involved in HIV epidemiology in the County. The hypothesis of this study was that selenium intake does not cause rapid progression of to AIDS from HIV infected children in Kisumu County. The main objective was to determine the effect the intake of yeast selenium on CD4 T cells and Weight for Age Z Score in HIV positive children (3-16 years). In this study a total of 68 HIV positive children were registered in the study to asses the efficacy of selenium. Yeast selenium (50μgm) was given to 34 children while the remaining 34 were put on a placebo.Blood samples and weight of the both groups were taken at 3 months intervals from 0, 3months and 6 months. The blood samples were analyzed by Enzyme Linked Immunosorbent Assay for CD4T cells while Weight for Age Z score was analyzed by Epi.Info version 3.4 and SPSS version16 for significance.In the study it was shown that children on selenium had progressive improvement of WAZ and which was significantly different at six months between children on selenium and the controls {F (5,12) = 5.758, P=0.006}.By using -2 standard deviations Z scores as a measure of cut-off, 15% boys and no girl on selenium was wasted at six months. Among the controls 64% of boys and 38% of girls were wasted at six months. The children on selenium had weight gain of up to 2.5 kilograms in six months. There was a significant mean increase CD4 T cell count at six months among the children on selenium,{ t( 1, N=30) = -2.943, p=0.006} compared to the matched controls {t =(1,N=30) =1.258 p= 0.0.0218}. CD4 T cell count increased among all age groups on test,3-5years (+ 267.1),5-8 years (+200.3) 9-15 years (+71.2) cells/mm3 . In matched controls a decrease was observed in all age categories, 3-5 years (-71),5-8 years (-125) and 9-13years (-10.1) cells/mm3 . There was no significant difference in CD4 T cell count between boys {F (2, 32) = 1.531 p= 0.232} and between girls {F (2, 49) = 1.040, p= 0.361} and between boys and girls {F (5, 81) = 1.379, p= 0.241} among the children on test. Similarly no significant difference was observed between boys and girls {F (5, 86) = 1.168, p= 0.332} in matched controls. In the test group there was a significant positive correlation between weight for age (WAZ), and CD4 T Cell Count p=0.007, R2= 0.252, F<0.05, β =252.23.There was a significant correlation observed between Weight for Z score and CD4 T cell count{ t( 2, N=27) = 2.94 p=0.007} with β = +252.23 and adjusted R² of 0.2016..In matched controls no significant correlation between weight for age Z-Score and CD4 T cell count change was observed at six months{ t (2, N=26) =0.08 p = 0.934} with β coefficient of +3.366 and adjusted R² =0.0337 .No positive correlation was observed among the children on selenium between CD4 T Cell count, and gender {t (2,27) = -0.69 p=0.0.495} with β coefficient of -138.23. Similarly in a matched control there was no significant correlation between CD4 T cell count and gender {t (2, N=26) = -0.90 p= -0.380} with β coefficient of -135.50.Majority (96.78%) of children on test either remained or progressed to WHO immunological stage I. It can be concluded that selenium intake slowed the rate of progression to AIDS from HIV positive patients as shown by increase in CD4 T cell count and further that there was no significant response between girls and boys. It is recommended that selenium be given as supplement to the HIV positive children on WHO clinical stage I to III as away of delaying progression to WHO stage IV.
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    Epidemiology of tuberculosis and human immunodeficiency virus co-infection, clinical presentations and impact on immunohaematological parameters in Mombasa county, Kenya.
    (Kenyatta University, 2015-01) Ayieko, Yonge Shadrack; Otieno, Michael F.; Sharma, Rekha R.
    Tuberculosis still represents an important global public health threat and it is one of the world‘s leading causes of death and HIV/AID has substantially altered the epidemiology of the infection especially in Sub-Saharan Africa. Most of death due TB and TB-HIV co-infection could be averted if clinicians recognized the signs and symptoms of the two diseases and instituted appropriate measures without delay. The magnitude of TB and TB-HIV co-infection is increasing despite progress made in the ART/DOTs control programs. There is no adequate knowledge on TB-HIV coinfection and effect on immune system since immunohaematological cell counts are not routinely carried out on TB patients. This hospital and laboratory based descriptive cross-sectional study was carried in Mombasa County. The main objective was to determine the magnitude of TB and TB-HIV co-infection and their relationship with clinical markers. Sputum from five hundred tuberculosis suspects were examined for AFB and cultured on solid and liquid media. Drug susceptibility test was done using BACTEC MGIT 960 incubator. Blood samples from tuberculosis suspects were screened for human immunodeficiency virus. Complete blood cell count was done using Sysmex Kx-2 and CD4+T cells analysed using FACS count flow cytometer. A questionnaire was used to collect demographic and medical history of the tuberculosis suspects. The data was entered in MS Excel 8.0 and analysed using Epi-Info 6.04b and statistical package for social sciences (SPSS) version 16.0 software. Pearson‘s chi-square test of independence was used to determine level of associations between TB-HIV co-infection and clinical outcomes. Student t test was used to test differences of means between two or more groups and Odds ratio to assess risk factors related to outcomes. Results showed tuberculosis prevalence was 42.0% and it was significantly higher in females (45.9%) than males 38.7% (P<0.05). Two hundred and two patients (96.2%) had pulmonary tuberculosis and eight (3.8%) extra-pulmonary tuberculosis. Smear positivity rate was 81.1% and culture positives 100%. Tuberculosis recurrence rate was 14.3% and was significantly associated with HIV infection (p<0.05). The majority of the TB cases (38.6%) were aged between 25-34 years (OR=58; CI; 0.340.94; p<0.05). Tuberculosis-HIV co-infection rate was 37.1% and it was not significantly associated with gender (P>0.05). Clinical features of chronic dry cough, fever, night sweats and weight loss were common in both TB and TB-HIV co-infected patients. Tuberculosis patients had higher CD4+T cell counts (474.5±198.8 cells/mm3) than co-infected patients (276.44±142.71) (t=5.6,df=461,p<0.05) but lower than reference group (1054.9 ± 156.1 cells/mm3, t=34.6, df=485, p<0.05). HIV/AIDS patients had significantly higher body mass index (19.9±2.2 kg/m2) than tuberculosis HIV/AIDS co-infected patients (BMI 18.8±2.7, t=0.70, df=58, p<0.05). The mean packed cell volume in TB-HIV co-infected patients was (32.31±4.8%) lower than TB patients without HIV/AIDS (34.21±4.4%) and the control group (36.41±4.2%). A high rate of drug resistance was observed in isoniazid (17.6%) and rifampicin (2.1%). Eight patients had multi-drug resistant-TB (4.8%). Any type of drug resistance in TBHIV co-infection patients was 19.1% suggesting a positive correlation (p<0.05). The high prevalence of tuberculosis and high co-infection in this study underscores the need for more efforts and resources to increase knowledge and access health care. There is also need to improve drug susceptibility testing to all newly diagnosed tuberculosis patients in all health facilities to monitor drug resistance. Immunohaematological indices (CD4 count, FBC and ESR) be performed routinely to monitor both TB and TB-HIV co-infection patients.
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    Determinants of Utilization of Hospital Delivery among Post-Natal Mothers in Thika and Kangundo Hospitals, Kenya
    (Kenyatta University, 2015-01-22) Kabue, Priscillah Njeri
    Maternal mortality rate due to pregnancy-related complications remains high at 488 per 100,000 live births in Kenya. If mothers are treated appropriately and in a timely manner, in a hospital almost all women who develop pregnancy-related complications can be saved from death and disability. The purpose of study was to assess why hospital deliveries in Kenya have remained low despite government strategies on improving health system and human resources. The objective of the study was to assess the determinants of utilization of hospital delivery and the rating of the health care services among postnatal mothers in Thika and Kangundo District Hospitals which are in Kiambu and Machakos Counties respectively. In view of this a cross- sectional study was conducted with an aim of establishing the factors that determine utilization of hospital during delivery. The study population was composed of eight hundred post natal mothers from Thika and Kangundo Districts attending Maternal Child Health Clinics who had delivered less than one year ago. Structured questionnaires and interviews were used to collect the data. In addition, Focus Group Discussions were conducted in each District and Key informants interviewed. Quantitative data was analyzed using SPSS for windows version 16 and data presented in form of tables and bar charts. The qualitative data from the focus group and Key informants was transcribed and a summary written. From the study Client oriented factors that were found to be associated with hospital delivery in both Kangundo and Thika included occupation (p = 0.028, p = 0.007), having money to go to the hospital (p = 0.000, p = 0.00), short distance from the health facility (p = 0.001, p = 0.029), and client having delivered in the hospital before (p = 0.000, p = 0.000) respectively among others. On binary regression Client oriented factors that predicted place of delivery in Kangundo were education level, previous delivery in a hospital and number of antenatal clinic attendance while in Thika they included client view of health worker, previous delivery in a hospital and economic factors. Health facility oriented factors that were associated with hospital delivery in Kangundo were lack of privacy (p = 0.000) while in Thika the manner in which the mother was handled by the health care worker (p = 0.001) and whether the mother received expected care (p =0.017). Rating of the health care services in terms of acceptability was average with only half of respondents feeling that the services were acceptable in both hospitals. In terms of accessibility 74% could access the hospital through matatus. In terms of availability time taken to be attended was rated above average while availability of health facilities and services required was below average in both districts. Quality of care during delivery was rated high in both districts with 72% of the respondents being assisted during head delivery but in terms of infection control this was above average. The research concludes that mothers do not utilize the health facility for delivery in both areas because of cost of the services, distance from the hospital, negative attitude of the health workers, lack of privacy and poor quality of care. Information generated by this study will be recommended to the policy makers in the Ministries of Health for use in addressing the challenges facing hospital delivery therefore promoting it leading to reduction in maternal morbidity and mortality.
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    Effects of Public Health Interventions on Intestinal Parasitic Infections among School-Going Children in Murang’a County, Kenya
    (Kenyatta University, 2016-06) Muiruri-Gitahi, Mary G. Wangui
    Intestinal parasitic infections have been found to form at least a quarter of all human infections globally. School-going children are the worst affected by these infections as it impairs their growth and cognitive development. Following the WHO recommendation, the Government of Kenya rolled out a school deworming programme under the School Health Programme in 2009. The study was embedded in the School Health Programme. The main objective of the study was to investigate the effects of public health interventions against intestinal parasitic infections among school going children in Murang’a County. It was a quasi-experimental study with schools assigned to intervention and control groups. The schools were selected through multi-stage sampling. Data was collected in three phases: baseline, intervention and post intervention evaluation. A total of 446 pupils from six primary schools provided stool samples for examination of intestinal parasitic infections. Structured interview guides and observation were used to collect more information on school sanitation, pupils’ hygiene practices and their level of knowledge of intestinal parasites. Qualitative data was collected through Key Informants Interviews and observations of school sanitation and hygiene practices compared with School Health Policy. Installation of tippy taps, provision of soap and water, and health education were some of the public health interventions which were implemented in intervention group. A post intervention evaluation was conducted to determine the effect of these interventions. Data was analyzed using SPSS version 20. Association of variables was tested using chi-square while t-test was used to compare means. At the baseline phase the overall prevalence of intestinal protozoan infections was 51.2% and 55.1% in the intervention and control group respectively. Prevalence of intestinal helminthic infections was 12% and 16.5% in intervention and control groups respectively. A comparison of mean percentage of infected pupils at baseline revealed that there was no statistically significant difference in the prevalence of intestinal parasites between intervention and control groups (t =0.32, P = 0.37). Level of knowledge of intestinal parasites was 52.3% and 48.8% in the intervention and control group respectively. The difference between the two was not statistically significant (2= 3.4, df = 5, P=0.13). There was a statistically significant relationship between protozoan infections and school sanitation (2= 10.3, df = 1, P = 0.001). Association between helminthic infections and school sanitation was also found to be significant (2= 2.4, df = 1, P=0.01). Key informants interview revealed that there were no health clubs at schools through which health promotion would be propagated among the pupils. After intervention a comparison of mean percentage of infected pupils revealed that there was a statistically significant reduction in intestinal protozoan infections in intervention group from 55.1% to 6.0% (t=12.6, P=0.001). There was also a statistically significant reduction in the prevalence of helminthic infections in the intervention group from 12.4% to 0.0% (t = -3.78, P<0.001). This has led to the conclusion that public health interventions influenced the reduction of the prevalence of intestinal parasites. The findings of this study are useful to the ministry of Education in formulating policies that will shape the future of the School Health Programme in Kenya. There is a suggestion to conduct a community based study to rule out the infections from the home environment.
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    The Effects of Using Oral HIV Self-Testing Kits on Uptake of Male Partner Testing Among Pregnant Women in Selected Counties In Kenya
    (Kenyatta University, 2018) Machera, Tom Marwa
    Adult HIV prevalence peaked at 14% in Kenya in the mid-nineties and has since continued to drop and thereafter stabilized at below 5% since 2014 due mainly to a scale up of various evidence based HIV interventions including HIV care and treatment, PMTCT, VMMC, HTS among other. HIV-testing and counselling (HTC) is a very effective strategy in getting those infected with HIV into care and treatment and in making appropriate referrals to other HIV support services. Kenya has adopted a number of strategies including Provider initiated testing and counselling (PITC), outreach testing and counselling and home based testing and counselling. Women are more likely to be tested for HIV (79.8%) than their male counterparts (62.5%) are. Other strategies that have proved effective are integration of HTC in antenatal care and reproductive health services. The Kenya AIDS Indicator Survey (KAIS) of 2012 showed that up to 6.5% of pregnant women in Kenya were living with HIV, and that each year, close to about 45,000 infants becomes infected with HIV through mother-to-child transmission of HIV (MTCT). PMTCT is offered as part of routine ANC for pregnant women, alongside other important services such as HTC, linkages to care and treatment, and helps to prevent infant exposure to HIV during pregnancy, delivery and breastfeeding. However, many approaches to promote male involvement in HIV counselling and testing during ANC services, such as having male-only clinics on special days or evening clinics have been tried without much success. ANC in Kenya have the potential of being key entry points to HTC not only for pregnant women, but also their partners. This study was designed as randomized controlled trial (RCT) with three study arms, where 475 study participants were to be rolled randomly into each arm. The study participants were women attending ANC clinic for the first time in their current pregnancy. Fourteen (14) study sites were selected randomly from 180HIV testing, care and treatment sites in Eastern and Central regions of Kenya. The aim of the study was to determine if provision of oral HIV home testing kits would increase male partner testing rates, self-testing acceptability rates and identify operational challenges experienced by the ANC mothers when providing test kits to their male partners. Data was collected using pre-tested questionnaire which were administered to each of the 1217 women and 1133 men randomized into the three study arms. Four focus group discussions were conducted for females whose partners tested and those who never tested. Data analysis was done using SPSS and “R” statistical software and descriptive statistics used to examine the frequency and analysis of variance. The equivalence t-test showed a statistically significant differences (p-value=0.01, n=737, df= 2) between arm one and two while arm three was superior to arm 2 with significantly higher testing rates (P-value<0.001,n=758,df=2).Men who got the two intervention (special letter and a test kit)were 5.08 times more likely to test compared to men who got the special letter alone when controlling for age, employment, education and if the couples discussed HIV testing)The study presented a new understanding and dynamics of self-testing among men while also bringing about health impact for their pregnant partners, because it did not require men to go to ANC clinics in person. In arm three (those who got two interventions), over 80%of the men took HIV test compared to only 37.0 %in arm two (those who got one intervention; a card with HIV prevention messages alone) and 28.3%in arm one (standard package, a letter given to the ANC mother inviting her male spouse to come to the clinic, this is the current practice in Kenya). Men who discussed HIV testing with their wives were twelve times more likely to test for HIV compared to men who did not discuss HIV testing with their wives. This findings will inform HIV programs and policy makers on the best way to improve low testing rates among partners of ANC clients and also demonstrates how self-testing may provide males who are not currently reached by HTS an opportunity to test in private.
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    Relationship between Socio-Demographic Characteristics of Motorcycle Taxi Riders and Their Socio-Economic Wellbeing: Case of Homa Bay County, Kenya
    (Kenyatta University, 2018) Owuor, Irene Awuor
    Motorcycle taxis have become a popular means of transportation which generates income for many riders in Kenya. However, there are various factors which expose riders to internal and external shocks and stresses which inevitably influences the riders’ socio-economic wellbeing (SEWB). Studies that have been conducted so far largely focus on “social vices” allegedly being committed by motorcycle taxi riders (MTRs) hence a persistent knowledge gap about SEWB of riders’. Acknowledging that MTRs are a valuable community resource because they facilitate transportation of people and goods, this study investigated the relationship between socio-demographic characteristics of motorcycle taxi riders and their socio-economic wellbeing: Case of Homa Bay County, Kenya. The study objectives included to: establish the relationship between demographic characteristics of MTRs and their SEWB, assess the relationship between social connectedness among MTRs and their communities and the riders’ SEWB, determine the relationship between involvement of MTRs in groups and their SEWB, analyze the relationship between ownership status of motorcycle taxi among MTRs and their SEWB and establish the levels of socio-economic wellbeing of motorcycle taxi riders in Homa Bay County. Cross-sectional community-based analytical survey design was used to investigate the problem, guided by social capital theory. Social protection approach was adopted to conceptualize this study. Simple random sampling was used to select 322 MTRs out of which 315 participated in the study, hence a 98% response rate was established. Key informants including six traffic police officers, nine officials of Homa Bay County boda boda SACCO and 10 community leaders were purposively sampled and interviewed for additional information. Research instruments used included: questionnaires, interview guide and focus group discussion guide as well as observation checklist. Data from this study was analyzed both quantitatively and qualitatively. Descriptive and inferential statistics were used to analyze quantitative data whereas qualitative data were thematically analyzed and also used to complement quantitative data. Findings were presented using tables and bar graphs. Chi-square test statistically confirmed a significant relationship (p=0.013) between localities of motorcycle taxi operation (rural and urban) and SEWB and a significant relationship (p=0.036) between ownership status of motorcycle taxi and SEWB of MTRs. Chi-square tests also revealed that there is no significant relationship (p=0.622) between genders of MTRs and their SEWB, MTRs riding license possession status and their SEWB (p=0.783), social connectedness among MTRs and their communities and the riders’ SEWB (p=0.226) as well as MTRs involvement in groups and their SEWB (p=0.176). The study concluded that motorcycle taxi riders in Homa Bay County experience high levels of SEWB at 63% with probability error of 5%. Implications of the study findings to MTRs, policy makers and academic researchers were also outlined. The study recommended the following for policy, practice and further study respectively: Designing policies that promote the establishment of medical facilities within reach for MTRs and their families, promotion of riding of self-owned motorcycle taxi if disposable income of MTRs were to increase hence possibility of higher SEWB and comparative study of socio-economic wellbeing of motorcycle taxi riders who operate in the rural and urban locality.
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    Burden of Diabetes Mellitus among Patients in Thika Level Five Hospital, Kiambu County, Kenya
    (Kenyatta University, 2019-05) Kipkalom, Rosebella J.
    The burden of diabetes is reflected not only in the increasing numbers of people with diabetes, but also in the growing numbers of premature deaths due to diabetes. One measure of burden of disease is disability-adjusted life years (DALYs), which combines estimates of years of life lost due to premature death (YLL) and years lived with disability (YLD) to count the total years of healthy life lost from disease and injury. In Kenya, Non-Communicable Diseases (NCDs) accounts for more than 50% of total hospital admissions and over 55% of hospital deaths. The major NCDs are cardiovascular conditions, cancers, diabetes, and chronic obstructive pulmonary diseases. In Kenya there were 1,976,337 NCDs cases in 2012. Nairobi and Kiambu led all other counties in NCDs with 155,899 and 126,754 cases respectively. The Kenyan health sector is predominantly financed by private sector sources (including out-of-pocket Expenses (OoPE) borne by patients, family members and relatives). However, there are only sparse data available from developing countries on the expenditure on diabetes care. Knowing the medical cost of diabetes is critical to understanding the long-term economic consequences of diabetes prevention. The broad objective of the study was to quantify the burden of Diabetes Mellitus among patients attending Thika level 5 Hospital, Kiambu County, Kenya. The study employed prospective prognostic study design and was carried out in Thika level 5 Hospital, Kiambu County. The study population comprised of diabetic patients attending outpatient diabetic clinic. The respondents were recruited into the study till saturation of 594 respondents. Data was collected for YLL, YLD, Direct costs and Indirect costs. EQ-5D-5L tool was used to measure HRQoL. Data analysis was done using SPSS, Microsoft Excel Worksheet and DISMOD II. The results showed that diabetic patient incurs a mean of KSHs 28,433 within six months (translating to approximately KSHs 56,866 per annum). According to the results from this study,43% was attributed to direct costs while 57% for indirect costs spent by a diabetes patient. A total of 805/1000 DALYs was lost as a result of premature mortality and disability associated with diabetes. Most of the diabetes patients in the study had a reduced Health Related Quality of Life(HRQoL) as per the EQ-5D-5L tool with a mean VAS of 0.55. Knowledge on burden of diabetes especially medical cost of diabetes is critical to understanding the long-term economic consequences of diabetes prevention. Thus, assuming prevention costs can be kept sufficiently low, effective diabetes prevention efforts would likely lead to a reduction in long-term medical costs. The results of this study informs policy makers in Kiambu County and Ministry of Health on need to work towards comprehensive and sustainable solutions in regard to diabetes. Based on the study findings, it is recommended that the National government and Kiambu County government of Kiambu to give priority to diabetes disease by providing free insulin and oral glycemic drugs to diabetes patients. It also recommends that the National government and Kiambu County government to prioritize diabetes care by ensuring all patients subscribe to NHIF and to cover management costs of diabetes, both for outpatient and in-patient services through NHIF, thereby reducing the economic burden of a diabetic patient and also improve HRQoL and reduce DALYs.
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    Determinants of Psychosocial Well-Being of Children (10-17 Years) Affected by Hiv and Aids in Kiambu County, Kenya
    (Kenyatta University, 2019-09) Ashioya, Damaris Shihundu
    Children affected by HIV and AIDS (CAHA) are faced with psychological, social and economic challenges among others. HIV and AIDS has compounded the situation posing more suffering to children whose parents have died of the same. Children affected by HIV and AIDS have been supported in various ways by their extended families and many other organizations. While there are a number of programmes that address the material needs of CAHA, there is less emphasis in assisting these children cope with the distress associated with nursing or living with sick members of the family, witnessing deaths of their parents and suffering the consequences thereafter. The psychosocial well-being of CAHA may be affected as a result of illness and death of their parents, exploitation, stigma and separation from siblings as well as lack of adult support. The purpose of this study was to examine the determinants of psychosocial well-being of children affected by HIV and AIDS. This was a cross-sectional survey targeting 3780 children between 10-17 years affected by HIV and AIDS living in foster families from registered CBOs in Kiambu County. Multi-stage cluster sampling was used to select 345 children aged 10-17 years. First, Thika Sub County was purposively selected, in the second stage systematic random sampling was done for supporting families with CAHA and the third stage simple random sampling was carried out in foster families with more than one CAHA to select the participant for the study. Key informant interview guides, questionnaires, observation checklist and child drawings were used to collect data. Both quantitative and qualitative data were organized and categorized for analysis. Using Statistical Package for Social Sciences (SPSS) Version 20, quantitative data was analyzed using descriptive statistics; frequencies, means and percentages. Chi-square and factor analysis were used to test the formulated hypotheses. Qualitative data was transcribed, coded and categorized into themes and words to allow for analysis and presentation. Results of the study established that there was a significant relationship between care provided by foster families and psychosocial well-being of CAHA based on results of factor analysis at 61.4% and chi-square results (χ2= 4.6607; df= 4; p=0.001). This study showed that there existed a significant relationship between the types of support available in the community and psychosocial well-being of children affected by HIV and AIDS (χ2=7.8207; df =6; p=0.012). In addition, this study identified a significant relationship between coping strategies adopted by children affected by HIV and AIDS and their psychosocial well-being (χ2 = 6.4420; df= 6; p=0.003). This study concluded that there were established relationships between care provided by foster families, type of support available by the community and coping strategies adopted by children affected by HIV and AIDS and their psychosocial well-being. The study recommended that the Kenya government should commit resources to promote the psychosocial well-being of CAHA at various levels through government mandated departments. Parents can be guided to develop permanency plans for their children and finally stakeholders; County governments, schools and non-governmental organizations can work together to ensure sustainability of families and communities so that children are retained in responsive environments.
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    Use of Counseling to Mitigate Psychological Morbidity After Stillbirth Among Women in Kitui And Machakos Counties, Kenya
    (Kenyatta University, 2019-11) Kanini, Caroline Mumbe
    Stillbirth is a baby born without any signs of life weighing at least 1000grams or with at least 28 weeks gestation. There is no burden affecting families is big and yet invisible in society and global arena as stillbirth. Stillbirth is a traumatizing experience for most women and a risk factor to development of psychological morbidity. The kind of care women receive during this critical period influences exhibition of psychological morbidity such as depression, anxiety and post traumatic stress disorder which can be mitigated by counseling. Supporting psychological consequences of women enable them to take care of the present and subsequent children. The main aim of this study was to determine the use of counseling in mitigating psychological morbidity after stillbirth among women in Kitui and Machakos Counties. Specifically the study aimed to determine care offered to women after stillbirth, to evaluate psychological morbidity exhibited by women after stillbirth, to determine the effect of counseling on psychological morbidity after stillbirth, determine factors that influence psychological morbidity exhibited by women who deliver stillbirth after counseling and to determine the coping strategies employed by women after stillbirth. This was a quasi experimental study (non randomized controlled trial) with an interventional (Machakos County) and control group (Kitui County). Edinburgh Postnatal Depression Scale 1, Hopkins Symptom Checklist 25 (first 10 for assessing anxiety) and Impact of Events Scale-revised measured Depression, anxiety and post traumatic stress disorder respectively. Women in the interventional group were counseled while those in the control group received routine care offered by midwives in the ward. Descriptive and inferential statistics were used to analyze the data. Fishers exact test with significant p <0.05 was used to determine factors influencing psychological morbidity exhibited by women who delivered stillbirth after counseling. Student t test for unpaired and paired data determined the effect of the intervention between and within the study groups respectively. Significant variables were further subjected to multi-variable logistic analysis to measure the strength of the association and control for confounding factors. The study findings revealed that women received minimal psychological support on grief reaction, memories creation and need to ascertain the cause of death. Women who delivered stillbirth experienced depression, anxiety and post traumatic stress disorder. Counseling was found to mitigate the selected psychological morbidity in this study (all P values < 0.01). Various factors influenced psychological morbidity after stillbirth (p values: age = 0.05, education < 0.01, occupation = 0.04, years of marriage = 0.019, partners‘ education = 0.017, viewing the baby = 0.04, timing of death = 0.039, informed on the cause of death < 0.0108 and myths < 0.01). Key informants expressed need for professional and psychological support since they are also affected by the stillbirth experience to avoid compromising care offered to the women. The study concluded that counseling can mitigate psychological morbidity after stillbirth and women need holistic care from health care providers, families and communities where they live. The study recommends that the county governments need to integrate counseling into care of women after stillbirth, engage stakeholders to discuss stillbirth as a public health concern to address misconceptions and offer support to health care providers to offer proper care to women to mitigate the psychological morbidity.
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    Effectiveness of Albendazole on Soil Transmitted Nematodes Among School Going Children in Kakamega County, Kenya
    (Kenyatta University, 2020-02) Ngonjo, Teresia Wambui
    Soil-Transmitted Nematodes (STNs) are roundworms transmitted through faecally contaminated soil. Globally, major STNs include Ascaris lumbricoides, Trichuris trichiura and hookworm (Necator americanus and Ancylostoma duodenale). School going children are mostly affected by STN infections. STNs cause malnutrition, intellectual retardation and cognitive deficits. They are distributed worldwide, Kenya included and they are of public health importance. Kenya has embarked on mass deworming programs since 2012.The study is entrenched in school mass deworming programs. Kakamega county has high edemicity of STNs and treatment using albendazole has been going on since 2009. The main objective of the study was to determine the effectiveness of a single 400 milligram dose of albendazole against STNs infections. A longitudinal study was conducted in selected public primary schools selected through random sampling from three randomly selected sub counties, Kakamega East, Kakamega Central and Kakamega South in Kakamega County, in Kenya. A structured checklist was used to establish demographics of the school pupils and schools’ WASH conditions. Kato Katz technique examined STN infections both at baseline and follow up survey. The prevalence of infection was determined as the percentage of children that tested positive for each STNs species to the total number of children examined. Intensity of infection was determined using Arithmetic mean of the number of eggs per gram of feaces. A total of 731 children in baseline from seven primary schools provided stools and were examined for STN infections. A post treatment survey was conducted after two weeks where total of 665 children were examined. Effectiveness of albendazole was analyzed using prevalence reduction and the fecal egg reduction rate (ERR). Data was analyzed using STATA version 12.0. Associations were assessed between WASH predictors and STNs; Infection prevalence of either gender or age group was analysed using Pearson chi-square test. Infection mean intensity was assessed using two sample independent t- test and significance for age group was assessed using ANOVA test. Prevalence of infections based on 95% CIs was calculated using binomial logistic regression. Arithmetic mean expressed mean egg counts and negative binomial regression model estimated mean intensity. At baseline, STNs prevalence was 44.0% (95% CI: 35.8 – 54.2). Common STN was Ascaris lumbricoides. 43.5%. The baseline STN mean intensity was 3674 eggs per gram. There was significant prevalence reduction of combined STN prevalence infection to 2.3% (PR=94.9%, P=0.001). STNs mean intensity was significantly reduced from 3674 epg to 59 epg (ERR=98.4%, P=0.001). Prevalence of T. trichiura significantly reduced, 0.8% to 0 (100%, P<0.001). Pupil latrine ratio was significantly associate with STN infection intensity (χ2 = 3.7333, df=1, p=0.047).Imroved water source was not significantly associated with both lower infection prevalence (χ2 = 0.875, df = 1, p=0.350) or intensity (χ2 = 0.1944, df = 1, p=0.659). Hand-wash facility with water and soap did not associate with both lower infection prevalence (χ2 =0.4667, p=0.495). In this study, mass treatment with Albendazole was highly effective on the STNs. These findings are important to Ministry of Health and Ministry of Education in assessing the national deworming guidelines and policies. Mass Deworming programmes be extended to communities to ensure all possible transmission focal points are covered.
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    Contraceptive Uptake and Adherence amongst Post Abortion Women Following Contraceptive Counselling By Physicians and Midwives in Kisumu County, Kenya
    (Kenyatta University, 2020-12) Odero, Theresa Mary Awuor
    Complications of unsafe abortion and those of incomplete abortion, led to 120,000 Kenyan women receiving Post Abortion Care (PAC) in 2012, and of these women, 70% had not used contraception before pregnancy and repeat abortion is common. The aim of the research was to explore contraceptive uptake, adherence to contraceptive use, associated factors and satisfaction with care among women seeking post abortion-care (PAC) in Kisumu, Kenya and to determine the technical competence of midwives as compared to physicians in terms of contraceptive counselling. The study (included 128 women in the quantitative study and 20 in the qualitative study) nested in a larger randomized controlled trial, where women sought PAC at two public hospitals in Kisumu, in October 2015–September 2017. The 128 women randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed-up after 7–10 days and three months. Associated factors for contraceptive uptake analyzed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0 while framework analysis was used to analyze qualitative data. The results showed that of the 128 randomly selected PAC-seeking women, 95.3% accepted the use of contraception. The women were between the age of 15 and 40 years. Methods chosen after contraceptive counselling were hormonal injections (39%); contraceptive pills (33.3%) condoms (22.8%), hormonal implant (4.1%) and fertility (0.8%). None chose intrauterine device (IUD) or a permanent contraceptive method. After 3-months, follow-up 79.7% retained the chosen contraceptive method while 20.3% had changed the chosen type of contraception to another method. Women (96.1%) still used contraception, and were satisfied with the chosen contraceptive method (x2= 1.0112, df = 3, p =0.799). The twenty (20) women in the qualitative study selected from the 128 who had participated in the quantitative study, to determine their experiences of contraceptive counselling that was provided during counselling and provision of contraceptive methods. Women generally had positive experiences with contraceptive counselling from service providers and it helped them in making informed choice of contraceptives and were able to discuss the contraceptives in general and more in detail on the method of choice. Follow up visits well planned and women could visit facilities anytime they had a problem following post abortion care, before planned visits women were given a call a day before to remind them of visits. The counselling they received was effective in supporting contraceptive uptake and adherence. In conclusion, the study shows that there were no statistical difference in contraceptive uptake and adherence provided by midwives (98.5%) as compared to physicians (93.5%) in providing contraceptive methods to post abortion women effectively. Women have good experiences during interaction with midwives and physicians during counselling. Since the post abortion women were satisfied with the contraceptives counselling provided and services dispensed, meaning both physicians and midwives can provide services effectively therefore recommend the midwives to counsel and provide contraceptives to post abortion women.