MST-Department of Community Health

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A study of how commercial sex workers care for and arrange for future support to their children: case of Kibera, Nairobi
(Kenyatta University, 2001-12) Chege, Margaret Jambi
Childcare is necessary for child survival growth and development. It is influenced by certain factors such as the maternal health status and resource availability. It has been estimated that 50-80% of Kenya's commercial sex workers are HIV positive. They are the primary caregivers for their children. Yet while considerable body of research in Kenya has focused on commercial sex workers as a high-risk group for the fatal HIV/AIDS and on their role in relation to HIV epidemic, no data were available on how they care and plan for future support of their children. This descriptive cross-sectional survey was carried out among 385 commercial sex workers in Kibera Slum in Nairobi Kenya, between July and December 2000. The aim of this study was to evaluate the commercial sex workers' childcare practices and how they plan for future support of their children. The study respondents were women aged between 18 and 49 years. They all had children whose age groups included the 0-18 years. Data were collected over a period of 18 weeks, using a structured questionnaire, observations of the under five years old children, verification of child health cards and Focus Group Discussions. Data were analysed using Statistical Package for Social Sciences (SPSS). The results indicated that 81.2% of the study population lived with their children despite the fact that 75.1% practised prostitution at home. In this study 89.9% of the study population had taken their children to school. However continuous education was undermined by lack of school fees (52.5%) and truancy (46.6%) with more of the illiterate mothers (65.%) reporting school dropouts. A larger proportion (42.2%) of the respondents who practised prostitution at home (42.2%) reported more school dropouts of their children than those who practised elsewhere. Results of health promotion indicated that 96.8% of the under five years old children were fully immunized. More respondents who knew their HIV status discussed HIV/STDs with their children than those that did not know (X2 25.3, p
HIV/AIDS: Factors influencing risky sexual behaviour among the youth in selected secondary school in Bondo District, Kenya.
(Kenyatta University, 2002-08) Okweso, Joseph Arung
HIVIAIDS is a major global public health problem. Approximately 36.1 million people were estimated to be living with HIV/AIDS worldwide by the end of the year 2000, while 21.8 million people had died from HIVIAIDS related illnesses. Some 25.3 million of those infected live in sub-Saharan Africa alone. In Kenya, HIVI AIDS claims an average of 700 lives per day, and has an average annual incidence of about 250,000 cases each year. Approximately 65% of new HIV infections are found in the youth aged between 15 - 25 years. The factors that predispose the youth at the above age group to account for the highest incidence of new HIV infections have not been established in Kenya. The study was done in Bondo District, Nyanza province; an area of high HIV prevalence, which by the year 2001 was estimated to be 24.9%. This cross-sectional, exploratory study aimed at determining the factors that influence risky -- sexual behaviour among the youth in the selected secondary schools in Bondo district, Kenya. The schools were selected by purposive sampling, while the study subjects were selected randomly using a table of random numbers. Data was collected using self-administered questionnaires. Key informant interviews. focus group discussions and observations. The collected data was entered, cleaned and analysed using the SPSS statistical package. Chi-square tests were done to establish the association between various variables. The results of the study showed that approximately 94% of the youth who engaged in risky sexual behaviour knew HIV IAIDS was not curable and 60% still had multiple sexual partners. The majority of those who abused drugs also had current or previous multiple sexual partners. Some 79% of the youth prefered lovers who were in employment. Similarly. despite 59% of the youth recognizing the presence of traditional norms and values in their communities that regulated pre-marital sexual practices, 50% still had had sexual intercourse. There was a low coverage of HIV/AIDS awareness campaigns in the District and cultural ceremonies such as after-death dances among the Luo provided opportunities for the youth to indulge in risky sexual practices. The media had a great influence on the youth, with 66% of the youth having copied and performed certain activities picked from the media. The results of this study have policy implications and call for the need to give particular attention to health and sex education to the youth in and out of secondary schools in an attempt to stem the increasing incidence of HIV IAIDS among the youth.
The reliability of a questionnaire-based self-diagnosis in estimating the prevalence of schistosoma haematobium in Kwale District
(Kenyatta University, 2002-08) Karama, Mohamed
Schistosomiasis is a chronic debilitating parasitic infection. It is currently estimated, that 200 million people are infected by this worlds most prevalent parasitic disease and 600million are at risk of infection. It is endemic in 76 countries, 85% of all cases and virtually all of the most severe are in African countries. Not withstanding the situation in sub Sahara Africa over the past 20 years schistosomiasis control has been successful in other geographical regions especially due to reduction of morbidity by chemotherapy. In Kenya the distribution is along the lake Victoria, in central, eastern and coast provinces. In most cases the occurrence of schistosomiasis is in areas where irrigation and settlement schemes as well as water development projects have been established. Prevalence of up to 80% and above have been recorded among primary school children in endemic areas of the country. Routine diagnosis of urinary schistosomiasis is by microscopic or chemical reagent strips. Both methods are expensive and are not available at the peripheral health units in the country where the disease is endemic. Before treatment the prevalence of schistosomiasis by microscopic method was 79.9% f I while by reagent strip haematuria was 77.9 % and proteinuria 76.9%. Self diagnosis: . prevalence was 73.3%. Sensitivity and specificity of the self diagnosis was 84.8% and:' 71.1% while positive and negative predictive values were 92.4% and 55.7% respectively. After treatment the prevalence of schistosomiasis by microscopic" method was 27.1% while by reagent strip haematuria was 18.2 % and proteinuria 22.6%. Self diagnosis prevalence was 43.4%. The aim of this study was to assess the reliability of self-diagnosis through a t questionnaire to estimate the prevalence of urinary schistosomiasis before and after I treatment among 470 boys in 4 primary schools in Kinango division ofKwale district. These results suggest that self-diagnosis is a reliable method of assessing prevalence before treatment and that despite the infection in terms of egg count being reduced by treatment, morbidity continued beyond three months after treatment and therefore self diagnosis is a better tool to assess morbidity as well.
Community participation in health development in Nyandarua District, Kenya
(Kenyatta University, 2003) Muriithi, Jackson Githinji; Mbithi, N.; Ng'ang'a, Z.
Although community participation in health development exists III Kenya, Community perceptions and attitude towards its role in health development is unexplored. Similarly the effect of community participation on health development on health care provision is undermined and the waiver system meant to promote community participation in health development in the health care provision remains unevaluated. Hence, this study attempted to establish the existence of needs assessment, organization, leadership and resource mobilization as factors that influence community participation in health development in rural community setup in Nyandarua district. Both structured interviews and focus group discussion were used to collect data from Community Respondents, Rural Health Facility Staff and the Rural Health Facility Management Committees. In terms of knowledge, significant differences (X2 = 46.94972; P = 0.00007) on the role of community respondents in health development were found between rural health facility staff and community respondents. There were also significant differences in knowledge between age groups (X2 = 28.49994; P = 0.00150) but marital status and gender were insignificant. Significant differences were also noted in knowledge between those who attended barazas (X2 = 16.31502; p= 0.00029) and those who did not and also between those who accessed waivers and those who did not (X2 = 28.21035; P = 0.00001). Only 5.7% of the community respondents had good perception on their role in health care provision. There were significant differences (X2 = 14.10904; P = 0.00086) in perception between gender as well as baraza attendees and non-attendants (X2 = 109.69402; P = 0.0000). Almost all the Rural Health Facility Staff 94.7% had good knowledge of health care provision compared to only 5.3% who had fair knowledge. Majority of Rural Health Facility Staff interviewed 76.3% had fair perception of health care provision. Significant differences in leadership were noted between gender (X: = 9.87759; p = 0.00716), waivers (X2 = 33.45095; p = 0.0000) and education levels (X2 = 12.9204; p = 0.04432) of the community respondents. Further, significant differences (X2 = 14.38694; P = 0.00075) were found in organization between gender, baraza attendance (X2 = 35.56165; P = 0.0000) and waivers (X2 = 59.84615; P = 0.0000). There was a significant difference in resource mobilization between marital status (X2 = 6.62548; p = 0.03642) and those who accessed health service without payment (X2 = 32.59359; p = 0.0000). The overall level of community participation was fair (score 7.8) and the order of the indicator factors was leadership (score 2.2), organization (score 2.0) resource mobilization (score l.9) and needs assessment (score l.8). Since the community had gradually been involved in the work of the rural health facilities, the government should give the Rural Health Facility Management Committees legal status from which specific obligations and regulations should be laid down. In this way the community will be given the responsibility to increase their contribution to the financ ng of promotional, preventive and curative health care activities. Community participation takes place through the RHFMC, which are loosely established, in the public health organizational structures.
Female Genital Mutilation: health related problems among the Somali Community in Garissa Town, Kenya.
(2003) Elmi, Major Mohammed Yussuf
Female circumcision or Female Genital Mutilation (FGM) is a tradition since antiquity and its exact origin is unknown. The spectrum of these genital procedures has been termed as female circumcision and more frequently FGM as a collective name describing several types of traditional female circumcision. According to the World Health Organisation (WHO), FGM is a form of violence against girls and women with serious physical and psychological consequences on health and must be abolished entirely. FGM is a deeply rooted cultural practice and most of the adherent communities consider WHO version as Eurocentric and cultural imperialism. Circumcision of girls and women among the Somali community in Garissa is almost universal Despite the widespread practice of FGM among the Somali community in Garissa District, no previous study had investigated health-related effects that should be associated with this practice. A descriptive cross-sectional survey was conducted in Garissa town Kenya between January and March 2002 to evaluate the health related effects of female genital mutilation among the Somali community in Garissa town. A total of 250 respondents were interviewed and nine focus group discussions (FGD) were held comprising of 90 participants in total. Some 99.6% of the respondents in this study were circumcised and the majority (94%) were circumcised at the tender age of 0 - 10 years. FGM appeared hazardous to health, as the majority of the study population (63.5%) had developed health problems after circumcision and there was a significant relationship between number xi of health problems and type of circumcision (X2 = 12, P::;0.05). However, there was a dramatic shift from the traditionally preferred type of circumcision, namely infubilation, to a milder type of FGM, the clitoridectomy adopted by most of the respondents (42.2%) compared to only (24.1%) who had undergone infubilation. Education had played an important role in this change of attitude from infubilation to clitoridectomy and there was a significant association between education level of respondent and the type of FGM preferred (X2 = 9, P< 0.05) Despite education and health problems associated with FGM some 67.6% of the respondents wanted FGM to be continued and believed it had some benefits. Eradication of FGM did not appear easy and achievable in the near future but there was a change from harmful type of FGM to the relatively harmless type, clitoridectomy. Most of the respondents (52%) preferred the Islamic Sunna type, which involved the removal of the prepuce of the clitoris and was as harmless as the male circumcision. The study has contributed to a deeper understanding of health related effects of FGM. Modification and or elimination of FGM is an all around effort Othat involves legal, social, political and economic measures. The immediate efforts should focus on information, education, and communication in order to facilitate change in the society's attitude towards the practice.
Utilization of HIV post exposure prophylaxis among healthcare workers in selected health institutions in Nairobi, Kenya
(2004) Maina, Jane Wangeci
Although avoiding contact with infected blood is one of the primary strategies of preventing occupationally acquired Human Immunodeficiency Virus (HIV) infection, appropriate post-exposure management (PEP) is an important element in workplace safety. The concern to optirnise such interventions is heightened if the institution caters for populations in which the prevalence of HIV is high, as is the case of health facilities in Nairobi Province, Kenya. In their practice the exposure of Health Care Workers (HCWs) to blood and other potentially infectious body fluids is of major concern and justifies a specific prevention and surveillance strategy. Tills was a descriptive cross-sectional study that sought to establish the main factors that underlie utilization of PEP services among the occupationally exposed Health Care Workers in Nairobi Province, Kenya. The instruments used for data collection included a questionnaire for HCWs in direct care of patients, a question guide for focus group discussions (rODs) and interview schedules (or hospital administrators in charge of the infection control units and the pharmacists in the hospitals. Four research assistants were recruited and trained to assist in data collection. A total of 179 purposively sampled health-care workers consisting of nurses, physicians, surgeons, dentists and laboratory personnel were interviewed. Three focus group discussions were carried out among HCWs in the three hospitals XVll namely Kenyatta National Hospital, Aga Khan Hospital and Mbagathi District HospitaJ. Knowledge of risk of occupational HIV transmission and available options for PEP was below average with only 54.8% having adequate knowledge. Although the majority (92.2%) of the respondents strongly believed that they were at risk of contracting HIV/ AIDS [ro111occupational exposure and 83.2% of these had taken a protective measure against occupational exposure to HIV, they did not know the options available for PEP. However, they also correctly identified other blood borne diseases that pose a risk to the HCWs at the work place such as Hepatits B virus (HBV), Hepatitis C virus (HCV) and Human T Lymhotropic Virus (T·ITLV) I and II. " Almost half (45.8%) of the respondents had rational attitude towards PEP. However they had the misconception that adverse effects caused by antiretroviral regimens used were irreversible. Only 14.7'1;, of the previously exposed respondents reported that they had utiliscd PEP services that is, had sought professional attention. There was need to increase awareness of occupational HIV transmission and the available options for PEP so that a more rational attitude towards PEP is developed. Improving HCW education, information and communication would bridge the knowledgepractice gap and achieve this. An urgent need for the government to formulate and enforce through appropriate strategies, a policy on HIV-PEP for public health institutions has become evident. This cans for a multidisciplinary expert consultation to put together feasible suggestions and assess the most appropriate implementation process
Mothers' diagnosis of childhood malaria, Household referral patterns and drug use in Muthurwa and Kibera, Nairobi, Kenya
(Kenyatta University, 2005-06) Ogutu, Caroline A.
This study sought to identify the mothers' understanding of malaria among the under-fives in Muthurwa and Kibera; knowledge of the symptoms of the disease and type of actions taken. The study also assessed the association between drug utilization in households and preferred sequence of care. Decision making process in households was studied with emphasis on how it affected health-seeking behavior. The study was cross-sectional and a total of 345 questionnaires were administered with Muthurwa and Kibera having 150 and 195 questionnaires respectively. Data was collected using open-structured questionnaires and focus group discussions. Questionnaires were read out in English and translated into Kiswahili where necessary. Results from the study indicated that most of the mothers linked malaria with mosquitoes in both sites (p0.05) compared to 141/195 (72%) in Kibera (pO.05) while Kibera (p>0.05) was 4/195 (2%). Muthurwa residents reported seven sequences of care when their children were ill and Kibera residents reported five of such sequences. When sequences of care were tested against household drug administration in Muthurwa, there was significant relationship in all sequences (pO.05) and in Kibera (p>0.05).Based on the findings of this study, it is concluded that there is significant relationship between household drug administration and sequence of care. There is also significant relationship between the time of recognition of symptoms and action taken. Decisions on source of help are not necessarily influenced by mothers' occupational status. It is the recommendations of this study that personnel in charge of drug outlets be trained by a trusted agency so that they are made partners in healthcare network. Further research has been proposed to find out how cost of services and perceived seriousness of illness in children influence choice of referral sites and sequence of care.
Demographic characteristics and home based care services for people living with HIV/AIDs: a case study of Thika municipality, Kenya
(Kenyatta University, 2006-05) Mungai, Naomi Njeri
Human Immunodeficiency Virus /Acquired Immunodeficiency Syndrome is the greatest challenge for poverty alleviation and development worldwide and the most pressing public health emergency. The national health systems in developing countries cannot cope with the accelerating financial demand from HIV/AIDS scourge. Because of inadequate health budgets in developing countries, People Living With HIV /AIDS are discharged from hospitals to go home to be cared for by relatives (Home Based Care). World Health Organisation recommends periodic evaluation of Home Based care programs to determine their effectiveness .The objective of this study was therefore to determine demographic characteristics of PLWAs and the nature of Home Based Care provided to PLWAs within Thika Municipality. The design of the study was crosssectional descriptive study and structured questionnaires were used to collect data through interviews of 100 PLWAs and 100 care givers. Qualitative data was collected through interviews with key informants and a focus group discussion with PLWAs support group members. Purposeful sampling method was used to determine the study location while snowballing method was used to get the required number of informants. Findings of the study indicated that 89 % of the PLWAs were females and 66 % were between 20- 40 years.72 % of the PLWAs were not living with spouses. Circumstances that led to diagnosis in 82 % of the PLWAs were opportunistic infections. The nature of care provided to PLWAs included support to meet basic needs which was reported by 57 %, nursing care (28 %), emotional/psychosocial support (23 %), financial support (21 %), medical care /drug supply (13 %) and care for children (4 %). Majority (96 %) of the PLWAs had inadequately met needs which included financial support (62.5 %), support for children (40.6 %), basic needs (36.5 %), emotional support (27.1 %) and medical care (12.5 %). There was significant association between the age of the PLWAs and their perception of emotional support as an inadequately met need (X2 =4.300, df =1, P< 0.038). The main care providers were family members (84 %), followed by self care (26 %), community members (22 %), CHW volunteers (9 %) and house helps (2 %) with 75 % of the care givers being females. Although 74 % of the care givers had been trained on HBC skills, 26 % were providing care without prior relevant training. The results also indicated that 76 % of care givers were practicing universal precautions when handling PLWAs but 20 % were not and 4 % were improvising gloves with plastic bags. Challenges experienced by care givers included inadequate financial and material support (74 %), stigma, (48 %), being overburdened (33 %), lack of support for OVCs (25, %), dependency (16 %) and inaccessibility to treatment and ARV s for PLWAs (12 %). The association between the training status of the care givers and the inadequate supply of drugs and ARVs challenge while caring for PLWAs was significant (X2 = 4.082, df =1, P> 0.043). These findings are of value to policy makers, program implementers and to researchers interested in HBC for improved care and future planning of HBC programs.
Oral Health Education and Practices Among Community Members in Central Division, Machakos District, Kenya
(Kenyatta University, 2008-06) Kasusu, Mutinda Agnes
Althoughoral health problems are not life threatening, they are of public health concern globally due to their high prevalence, morbidity, general discomfort and negative effects on the overall quality of life. The under privileged and rural communities are the most affected in both developed and developing countries. Poor distribution of oral health facilities, equipment and qualified personnel for the services have been implicated as some of the obstacles for people's acquisition of oral health services in Kenya. The aim of this study was to examine Oral health education and practices among community membersin Central Division of Machakos District. Data for the study was drawn from a cross sectional survey of community members in Mumbuni and Mutituni locations in April and May 2006. The data was collected using pre-tested self administered questionnaires and interviews. Cluster sampling was used to select a sample of 391 respondents. The collected data was cleaned, coded, scored, then entered into the computerand analyzed using SPSS Statistical package. Descriptive statistics such as the mean, standard deviation, range and percentages were worked out to describe data. Pearson- Chi -square was used to test statistical associations between variables. The variables considered were utilization of oral health services (visits to the dentist) as the (dependent) variable and oral hygiene practices, availability of oral health services, accessibilityto oral health services, alternative treatment of oral diseases and oral health education(awareness) as the (independent) variables. Level of significance was fixed at 0.05 (p=O.OS).The results of this study revealed that there was no relationship between distancefrom area of residence and visits to the dentist p > O.Osas the respondents were forced to seek health care by urgent health needs. Further, a statistical significant difference was observed in tooth brushing habits among gender and age groups as females observed better oral health care practices than males pO.OS.Majority of the respondents (77.5%) brushed teeth using industrial toothbrush / chewing stick and paste which are considered as the correct tooth cleaning devices. Oral health services were provided as 94% of the respondents were treated upon presentation to the dentist. Majorityof the respondents (61.9%) had never sought oral health care, which is a major requirementin prevention and early diagnosis of oral diseases. Among those who never visited a dentist, (83.8%) believed they should only visit when they have oral health problems.Urgent 'need' (85.3%) or when there were oral health problems was the main reason of visiting a dentist, as was in painful tooth (S2%). Most of the respondents presented themselves late, with advanced disease for treatment and tooth extraction (82.9%)was the treatment of choice. Oral health education, which is mainly preventive, was poor among all age groups, as there was no significant difference observed p>O.OS. Only(30.4%) of the respondents had received various oral health messages mainly from teachersin schools. This study recommends strengthening of oral health services in the studycommunityby provision of trained manpower to teach oral health education and for early diagnosis of oral diseases. The education should aim to motivate the individuals to self-oral health care. The results of this study would greatly contribute in designing interventions geared towards change of people's attitudes on utilization of oral health services.
Malaria vector control practices in Mwea Division, Kirinyaga District, Central Kenya
(2011-12-02) Ng'ang'a, Peter Njoroge; Kabiru, Ephantus W.; Kimani, Violet
Malaria continues to be an important vector-bome disease in Africa South of Sahara where the conventional treatment strategies have proved ineffective du? rapid spread of drug resistance. This has generated renewed global interest in vector control with an aim of minimizing man- vector contact both at household and community level. A cross-sectional ethnographic household survey was conducted in Mwea Division, Central Kenya in April 2005. The main goal of the study was to explore and determine currently used malaria vector control practices as well as determine the level of community participation in malaria vector control. Four villages were purposefully selected to represent socio-economic and geographical diversity within the study area. A total of 400 households were randomly selected from the four villages. Both semi-structured questionnaires and focus group discussions were used to gather information on community's biomedical knowledge of the disease including the role of the vector in malaria transmission. Results of the study showed that malaria was perceived to be a major public health problem in the study area by 93% of respondents and the role of mosquitoes in malaria transmission was recognized by 95% of respondents (n=368). However, some respondents perceived that malaria could also be caused by other factors like being rained on (13%) with significant difference between the four villages (x2=24.336; df 3; P=0.000). Other perceived causes were wet and cold conditions (11%), taking of raw foods like mangoes and fermented porridge (5%) with significant variation between gender (X2 =19.24; df 3; P=0.000). Personal protection methods applied included; use of treated mosquito nets (57%), with significant variations among: different occupational groups (x2=7.955; df 3; P=0.047) and education level of respondent (x2=33.622; df 6; P=0.000). Other methods reported were: untreated bednets (351o), coils (21%), traditional methods (8%), insecticide sprays (6%), and skin repellents (2%). Main reason for using bednets was protection against mosquito bites (95%) while protection against malaria became second (54%). Source reduction methods reported at household level included clearing of bushes/vegetations (45.7%), refuse/waste disposal, (26.9%) and filling of breeding sites (13.6%). Reported environmental management practices at community level included levelling and draining areas of stagnant water (4.3%), clearing vegetations in water canals (0.3%) and destruction of discarded water receptacles (1.1%). Despite malaria being a major public health problem in the area, 39% of respondents (n=365) could not apply some of the known vector control methods. Reasons for regular non-use ranged from unaffordability (67.7%), side effects (26.6%), lack of effectiveness (21.5%), and lack time (3.5%). Methods said to be unaffordable included use of mosquito nets (91.7%) and insecticide sprays (50%), while untreated mosquito nets were ineffective (59%). Results from this study underscored the need for understanding the existing local needs during design and implemention of vector control interventions at community level. The non-scientific explanations given for malaria aetiology may have important implications on the treatment, prevention and control of malaria in irrigated ecosystems, where vectors of malaria are abundant and disease transmission stable.
Insecticide treated Bednets Ownership, Use and Maintenance Behaviour in Kwale, Msambweni and Kinango Districts in Kenya.
(2013) Khambira, Maureen
Malaria is associated with more than 216 million episodes and an estimated 655,000 deaths annually world-wide. In Africa, it remains the leading cause of childhood and maternal morbidity and mortality, accounting for more than two-thirds (81%) of reported cases of disease, as well as approximately 91% of the deaths. Out of the five species of Plasmodium (P falciparum, P vivax, P ovale, P malariae, and P knowlesi) that cause malaria in humans, Plasmodium falciparum is the most dangerous in Africa. In Kenya, a third of out-patient attendance to health facilities are due to malaria and 26, 000 children die annually from it. In recent years following a massive introduction and campaign for the use of insecticide-treated bed nets (ITNs), morbidity and mortality particularly of pregnant women and children has declined significantly. However, many challenges regarding ITN distribution, acceptance, consistent and appropriate use persist, and there has also been lack of follow-up studies on insecticide treated bed nets especially after free mass distribution campaigns. To address this gap, a cross-sectional survey on ITNs was conducted in southern coastal Kenya after the 2006 mass distribution campaign. The study was conducted in Msambweni, Kwale and Kinango districts where malaria is endemic. The objective of this study was to determine insecticide treated bed nets ownership, use and maintenance behavior in Kwale, Msambweni and Kinango districts in Kenya. A total of 1176 households were selected, and quantitative data was collected using a questionnaire and inspection of nets. All data were entered into a database and analyzed for patterns and associations. The results have shown high (80%) coverage of bed nets (treated or untreated) and moderate use (64%). Cost and lack of money were the main barriers to net ownership. Household ownership of any net varied by district (χ2 = 104.225, p=001), Kinango District (94%) had the highest proportion of households that own bed nets. Discrepancies in use of nets were also noted among the three districts (p=0.001, F=37.050). Kinango District had the highest (3.86) mean number of people sleeping under net per household, followed by Msambweni District (3.3) and Kwale District (2.24). Sixty nine percent of the total nets inspected had more than 5 holes of >=2.7cm in diameter and were classified as damaged. Presence of intact (not damaged) nets varied by district (p=0.001, F=16.000). Kinango District had the highest (1.19) mean number of nets that were still intact per household followed by Kwale District (0.73) and Msambweni District (0.72). Appearance of holes diminished the useful life of 53% of nets by the end of one year of net use (χ2 = 7.9468, p=0.0188). Only a small percentage (21%) of the nets with holes were repaired (χ2 = 99.7408, P=0.001). The owners of a substantial (31%) number of nets did not adhere to the recommended washing frequency and this was not significantly associated with the condition of the net (χ2 =1.9097, p=3849). Sixty nine (69%) of the retreated nets were LLITNs (χ2 = 38.0734, P=0.001) indicating lack of knowledge as to which nets should be retreated. Eighteen percent of the total households surveyed misused their nets. Presence of net misuse was significantly associated with district of residence (χ2 =10.047, P=0.018). Majority (42%) of the misused nets were used as chicken shed. This study provides valuable information for the Ministry of Public Health and Sanitation and other Government units, NGO‘s and community groups in planning, execution and assessment of ITNs programmes. In view of the foregoing, it is recommended that universal distribution of LLITNs should be conducted at much shorter intervals. Evidence from this study demonstrates that physical deterioration of the nets seems to occur at a faster rate.
Access and utilization of immunization services among refugees in Eastleigh North section of Nairobi, Kenya
(2013-02-01) Wagacha, Burton John
Immunization has been shown to be one of the most cost effective health prevention and intervention against childhood morbidity and mortality. Over 30 million children especially from Sub-Sahara Africa are not reached each year with routine immunization. As a result, 1.5 million children under five years die each year from vaccine preventable diseases. Recent outbreak of Polio, Measles and pertusis in Kenya with index cases among refugees from neighbouring countries raises the possibility that their immunization coverage may be way below WHO standards of 90%. Additionally, refugees who live diffusely among urban population lack specific programmes targeting them with primary health interventions. For instance, in 2007 Immunization coverage in Kenya was 76% and in Nairobi it was 65%. However, Eastleigh area which hosts thousands of refugees recorded only coverage of 51 %. The purpose of this study, therefore, was to establish levels of access and utilization of immunization services among refugees in Eastleigh North. A descriptive crosssectional study design was used. A sample of 432 children of refugees living in Eastleigh North was selected. Informed consent was obtained from the guardian after explanation and clarification of study objectives. The data was collected using semistructured questionnaires, key informant interviews and visits to health facilities. The data was analyzed using Statistical Package for Social Scientist (SPSS version 16) and presented in frequency tables, bar graphs and pie charts. All the respondents were women either mothers or guardians to the children below 5 years. Of all the respondents interviewed, 39.6% had no formal education and overwhelming majority (97.2%) were once married. However, 46.8% of the respondents were in polygamous marriage. A high proportion, 95.4% of the respondents were of Somalia origin, 4.2% from Ethiopia while 0.5% was of Eritrean origin. About 60% of the respondents relied on remittances from relatives and friends abroad while 6.37% were doing business in Kenya. Among the 432 children studied, 53.5% were males and 46.5% were female below 60months old with a mean age of 30.1 months. The study established that there was significant statistical association between level of income (P=0.043), availability of services (P=0.004), cultural beliefs (P=0.002), communication barrier (P=0.020) and police harassment (P=0.04) and access and utilization of immunization services. The study also established that there was no significant statistical association between level of education (P=0.827), Knowledge on importance of immunization (P=0.472) and utilization of immunization services. The study concluded that complete immunization coverage for the children was 39%, which was way below WHO target of 90% and socio-cultural and economic and healthcare institutional and providers' factors hindered refugees' access and utilization of immunization services. The study recommended that Medical Officer of Health (MOH) at the Nairobi City Council to conduct catch-up immunization campaign in Eastleigh North. In addition, UN Refugee Agency and Department of Refugees Affairs to identify and issue identification documents to the unregistered refugees to curb police arrests and also enable refugees move freely, work and do business in Nairobi. The study also recommended that the MOH to establish program to sensitize refugees about the negative effect of the cultural beliefs and to increase staffing level in the facilities while ensuring that significant number of them speak Somali or hire Somali interpreters, because Somali language was the commonest mode of communication by refugees in the area. The study recommended further research to compare refugees and host community living in similar settings.
The effects of short-term zidovudine treatment on mother to child hiv-1Transmission
(2013-02-08) Rikia, Mwari Kibaya
Vertical transmission accounts for the majority of pediatrics HIV-1 infections. Immunological, obstetrical, co-infection with other diseases and maternal viral load are some of the factors that influence this mode of transmission. It is not clear which of these factors are important in determining whether a mother will infect her infant. The long-term treatment of mothers with Zidovudine (AZT) during pregnancy reduced the infection rate by 70%. However, drug resistance variants are generated and can be vertically transmitted during long-term treatment. In Kenya, the use of a short-term treatment reduces transmission by 67% but whether this treatment could induce drug but whether this treatment could induce drug resistance is not known. This study investaigated the induction and transmission of drug resistance variants during a short-term treatmen with AZT. part of pol (697bp) region encoding the reverse transcriptase of six HIV-1 isolates from positive mothers (three on AZT adn three untreated) and their infected infants was analyzed. Proviral DNA was amplified by nested PCR, the products cloned, sequenced and phylogenetically analyzed. Some natural points mutations at codons known to confer resistance to AZT were observed in some mothers' but none were transmitted to the infants. However in one case (BU025) of a child whose mother was on AZT, lysine was substituted for serine at codon 70 (K7OS) but, serine is not documented to confer any resistance to AZT. Selective transmission was observed in both treatment and non treatment groups (KSO51,KSOO6,BU025 and KSOO4), supported by high bootstrap values of 914,995,898 and 914 and 995 respectively. However multiple transmissions were also observed where the mothers population was heterogeneous and homogeneous in mother-child pairs KSOO4 ad BUO69 respectively. In mother -child pair KSO12, the infant's viral population clustered away fromthe mothers but the boostsrap value was low (421). Phylogenetic analysis revealed that four mothers were infected with HIV-1 subtype A and remaining two mothers were dually infected. Mother KSO12 was infected with two distinct subtype A viruses and the other mother KSOO4 with subtype A and D. The dually infected mothers trasmitted subtype A virus to their infants. In cases of mixed infection our results suggest that there is selective transmission of genotypes and/or phenotypes. None of the three mothers' on short-term AZT treatment transmitted resistant variants to their infants. In addition, there were no differences in the transmission patterns between the AZT treated and non-term AZT treatment for prevention of vertical transmission of HIV-1 is effective adn safe.
Utilization of skilled birth attendants among women of reproductive age in Central District, Kitui County
(2013-03-14) Kanini, Caroline Mumbe
Skilled Birth Attendance is one of the most important interventions in reducing material mortality. With only 44% of deliveries assisted by skilled birth attendants in Kenya, the number of maternal deaths is significantly higher. The aim of this study was to identify factors determining utilization of skilled birth attendants in Central Division of Kitui North District. The specific objectives were to determine the proportion of Women of Reproductive Age (WRA) utilizing Skilled Birth Attendants (SBAs), to assess the socio-cultural factors influencing utilization of skilled birth attendants and to establish the barriers to utilization of skilled birth attendants by women of reproductive age in Central Division. This was a descriptive cross-sectional study utilizing quantitative and qualitative approaches targeting women of reproductive age group 15-49 years. Data was collected using interviewer administered questionnaire and focused group discussions for the child bearing age respondents who had delivered within the last one year preceding the study and interview guide for key informants. Chi-square was used to test the association between the research variables and odds ratio for the relationship between the dependent and independent variables under study. Data was analyzed using STATA 10.0 and presented in figures, tables, frequencies and numerations. The results showed antenatal attendance rate of 90.9% while proportion of deliveries attended by skilled attendant was at 41.4%. The following factors were found to influence utilization of SBAs in the study area: age (i=8.65(df=2), p=O.O 13). religion (OR 3.22, p=0.004), level of education (OR 2.43, p=0.05), partner's occupation (OR 0.533, p=0.029), parity (OR 0.26, p=0.002), residence (OR 4.07, p
Environmental and demographic factors influencing drug and substance abuse among secondary school students in Kisumu Town East, Kenya
(2013-03-19) Nyatuoro, Joshua Otieno
Drug abuse is a major public health problem among the youth worldwide especially in developingcountries. The accessibility, affordability, and consumption of abused drugs by the youths have attracted great concern among public health personnel. The impact of drug abuse in human health and well-being is substantial and its contribution ranges from medical, social, family, legal and economic problems which are created by its uncontrolled use. Thus, drug abuse-related problems among the youth cannot •be ignored. Evidence from around the world reveals that there is an upward trend in the misuse of psychoactive drugs among the youth. There is limited documented information on the extent of drug abuse among secondary school students Kisumu Town East, Kenya. The main objective of this study was to investigate environmental and demographic factors influencing drug and substance abuse among secondary school students in Kisumu Town East, Kenya. The findings of the study would be used to guide policy in the control and prevention of drug abuse in secondary schools. Descriptive cross-sectional study design was used in the study. Stratified sampling was used to determine the number of boys' schools, girls' schools and mixed schools to be selected. A total of eight schools were . sampled proportionately in the ratio of 1:1:6 (boys, girls and mixed) respectively. The study population in this study was students in public secondary schools in Kisumu Town East, Kenya. Systematic random sampling was used to select respondents proportionate to population size, the cluster and the school selected. A total of three hundred and .twenty nine students were sampled for this study. Among the respondents, one sixty seven were girls while boys were one hundred and sixty two. Data collection was done through administration of structured questionnaire. Cross tabulation was used to show interrelationship between the dependent and independent variables. Chi-square test was used to test the existence of relationships between the variables and odds ratio used to determine the strength of the risks on exposure (p<0.05 was considered statistically significant). The study found out that demographic factors influencing drug and substance abuse were gender (Odds ratio=l.90), mothers marital status at birth (p=O.03), number of siblings (p=O.01) and area of residence (p=0.02). Some family environmental factors influencing drug and substance abuse were mother's educational level and leisure time (p=O.Ol) family health (Odds ratio=2.70 and expectation from parents (Odds ratio=O.30). Some school environmental factors which influenced drug and substance abuse were distance to the nearest wine and spirit shop (Odds ratio=2.22), guest speakers (Odds ratio=O.62), school achievement (p=O.Ol), class repetition (Odds ratio=1.67), satisfaction with school (Odds ratio=O.45) and non students abuse in school (Odds ratio=1.89). The study recommended that the Ministry of Education should introduce clear policies on drug abuse prevention in learning institutions and formulate strategic plans which can promote academic achievements in schools as-a strategy in fighting drug abuse in schools.
Occupational risk factors contributing to injury by medical sharps among health workers at Kenyatta National Hospital, Nairobi, Kenya
(2013-03-21) Wafula, Kennedy Simiyu
Healthcare workers are at risk of medical sharps injuries, which according to the Kenya national policy on injection safety, 58% of healthcare workers have suffered these injuries. This study was conducted with the aim of establishing occupational risk factors contributing to injury by medical sharps among healthcare workers at Kenyatta National Hospital, Nairobi, Kenya. The objectives of this study were to; determine the frequency and severity of injuries from medical sharps; assess the risks due to exposure to medical sharps at the hospital, to ascertain the factors that contribute to occurrence of injury by medical sharps, and assess the measures in place to report, document, prevent, control, or manage injuries from medical sharps among health care workers. This descriptive cross sectional study was conducted between July and December 2010. A self administered questionnaire was distributed to 320 respondents from different job cadres of healthcare workers at the hospital who were selected proportionate to the sample frame. A checklist was used to observe medical sharps wastes management practices at the hospital. Focus group discussions were held with healthcare workers to obtain in-depth information on the root causes of medical sharps injuries at the hospital. Data were entered into MS Access database and analysis was done by use of Statistical Package for Social Sciences (SPSS), version 11.5. The study findings suggest that 44% of respondents were involved in medical sharps injury at the hospital. The majority of the injured respondents (91%) experienced medical sharps injuries between1-2 times, while few of the respondents (5%) experienced medical sharps injuries 3- 4 times within the past one year. Sixty two percent of injured respondents suffered moderate injuries which were characterized by skin puncture and some bleeding, while 33% of respondents suffered superficial injuries which were without any bleeding and 5% of respondents experienced severe injuries which were characterized by profuse bleeding. Many 75%of the injured respondents suffered a needle prick, 30% experienced a glove tear, while few 18% contracted upper respiratory tract infection, only 2% contracted pulmonary tuberculosis, and a paltry 0.3% of the respondents reported to be occupationally infected with Human Immunodeficiency virus, Hepatitis A and cellulites. The factors associated with medical sharps injury include; working in the critical care section (OR: 3.17, 95% CI: 1.4 7.2,p=O.OI),working in the job cadre of a nurse (OR: 1.85,95% CI: 1.16-2.95, p=0.01), and healthcare workers with education level of below diploma (OR: 1.85, 95% CI: 1.16-2.95, p=0.01).Seventy four percent of the respondents did not seek for post-exposure prophylaxis, while only 26% reported to have sought for post exposure prophylaxis. The research concluded that nurses were among healthcare workers at the highest risk of sharps injury, the critical care section presented more sharps injury risks than other sections at the hospital. Underreporting of medical sharps injury was common while many injured respondents did not seek for post exposure prophylaxis. There is need for adequate supply and use of safety engineered devices, safe disposal of medical sharps, better reporting and surveillance of sharps injury cases at the hospital.
Factors influencing adherence and satisfaction with the, quality of antiretroviral therapy and care services in Kisii District, Kenya
(2013-03-25) Osiemo, Stephen Angwenyi
Adherence to treatment and satisfaction with the quality of services is crucial in achieving optimal antiretroviral therapy (ART) outcomes. However, available evidence indicated that in sub-Saharan Africa only 77% of clients adhered to the recommended level of at least 95% that is needed to keep the viral load in the body at undetectable levels. On the other hand, the challenges of health management, infrastructure and technology continued to compromise the quality of health in Kenya. The general objective of this study was to assess the factors that influenced adherence and satisfaction with the quality of ART and care services at the Patient Support Centers in Kisii District. This was a descriptive cross-sectional study whose sample size was 363 respondents. The focus group discussion and structured questionnaire techniques were used to collect data from systematically selected respondents. The levels of adherence and satisfaction with ART and care services were measured using the ordinal scale. The study found that the level of adherence to ART and care drugs was 80.7% against 95% that is recommended. Distance, cost of services, location of PSC site and availability of drugs used for care were all found to be significant in influencing adherence (p < 0.001). It was also found that 72.7% of respondents were highly satisfied with the quality of ART and care services. Greeting as a measure of courtesy, privacy, disclosure of shared information, cleanliness and waiting time were the significant factors that influenced satisfaction with the quality of services (p < 0.001). It was concluded that besides the provision of free ART services, there were other significant factors like distance and waiting time that influenced adherence and satisfaction with the quality of services respectively. It was recommended that satellite Patient Support Centre sites be established at lower levels of service delivery and that all health providers be trained on quality health management.
Perception and Practices on Malaria Control among Pregnant Women in Machakos Central Division, Kenya
(Kenyatta University, 2013-05) Kyania, Martin Mulala
Malaria is endemic in Kenya. It is the most important cause of morbidity and mortality in children under five years of age. It accounts for 30% of outpatient visits and nearly 20% of admissions to health facilities here Kenya. In Machakos District, Malaria has been the top cause of morbidity and mortality particularly in children under 5 years and women in the reproductive age. Records from the Machakos District hospital show that malaria cases have been steadily increasing from a low of 151,181 in the year 2002 to a high of 435,987 in the year 2010. The main objective of the study was to establish the perception and practices of pregnant women on malaria control in Machakos Central Division. The research design used was a descriptive survey and the study was done at Machakos District Hospital. A sample of 384 pregnant women from the division was interviewed using an interview schedule. In addition three focus group discussions of eight respondents each were conducted. Results showed that factors that were found to influence perceptions and practices of pregnant mothers on malaria control were education (X2=8.J5!, df=J, p<0.004), occupation (l=4.029, df=l , p<0.045), believe that malaria can be treated/controlled through medical intervention (X2=!7.703, df=l , p
Effects of Psychosocial Support on Anti-retroviral Therapy Adherence and Clinical Outcomes of HIV Patients at Kwale and Machakos, Kenya
(2013-07-19) Machera, Tom Marwa
The effects of psychosocial support on ART adherence and clinical outcomes following an HIV diagnosis have been well documented in western countries where linkages between HIV-related treatment and psychosocial support programs are well established, little is known about those who become engaged with such services in countries of the world where comprehensive HIV-related care and prevention systems are continuing to develop. The aim of the study was to understand how patients’ psychosocial factors might affect antiretroviral treatment adherence and other clinical outcomes and to identify key components of support, including the social and economic aspects necessary for promoting optimal adherence. The objective of this study was to investigate the effects of psychosocial support on ART adherence and clinical outcomes of HIV patients enrolled at Kwale and Machakos district hospitals. This was a cross sectional study which was carried out at Machakos and Kwale HIV Comprehensive Care Clinics (CCC).Two different types of structured questionnaires were administered; one on the HIV positive clients/patients enrolled on care at the CCC and their past six months and over records reviewed by looking at the CCC patient blue card (abstraction). Data was collected using pre-tested questionnaire which were administered to each of the 440 clients/patients selected randomly from a population of 2820 clients/patients on care at the CCC. Individual in-depth interviews and focus group discussions were conducted with CCC managers and support group leaders to collect qualitative data. SPSS was used to conduct data analysis, descriptive statistics to examine the frequency. The study findings showed that patients linked to HIV support groups were able to adhere to ART optimally (Chi-square=20.7, p=0.000 and 93.8, p=0.000 in Kwale and Machakos respectively) and had better clinical outcomes compared to those who were not, among the clinical outcomes that the study investigated were opportunistic infection relapses and new OIs (t=-2.928, p= 0.004), weight outcomes (t=2.170, p-value=0.031) and failing of the first line ARVs regimen (Chi-square 8.74, p=0.003 and Chi- square 40.15, p=0.000 respectively). The study data indicated that there were no statistically significant relationships between occupation and adherence level including clinical outcomes of the linked and non linked patients. The study used t-test and Chi-square tests to establish if there was a difference in clinical outcomes such as opportunistic infections, gain in body weight and ART adherence between the linked and non linked patients. Linked patients had better clinical outcomes and optimum ART adherence compared to non linked patients. There is need to encourage formation of HIV psychosocial support groups at the community level, these support groups should be linked to health facilities’ HIV comprehensive care clinics to complement the continuum of care between facilities and the community. The Ministry of Health and other stakeholders should encourage formation of HIV psychosocial support groups, including addressing their sustainability and further support through income generating activities.
Factors that Influence the uptake of Breast Cancer Screening among Women of Reproductive Age in Mosocho Division, Kisii Central District, Kenya.
(2013-07-22) Macheneri, Paul
Every year breast cancer kills approximately 40,000 women globally (American Cancer society, 2006). Globally, breast cancer incidence is on the rise, especially in developing countries and from 2000-2006, breast cancer was the most diagnosed cancer among women in Kenya and 80% - 90% of those women presented with stage 3 and 4 of the disease. In order to more effectively promote breast preventive medical care programs, it is important to identify the key determinants of women’s behavior regarding their decisions to engage in screening. The aim of this study was to identify the factors that influence the uptake of breast examination and screening for cancer among women in the division. The Health belief model formed the basis for this study and Cross -sectional survey research design was used in the study. Data was collected using interviewer administered questionnaires, a key informant interview and a focus group discussion. The study targeted women of reproductive age (15 – 49 years) randomly sampled from 245 households within Mosocho division. The households from the 5 locations were systematically sampled and the data obtained analyzed using both descriptive and inferential statistics. Descriptive statistics included frequency charts and tables while inferential statistics included the use of Pearson’s chi-square () and Correlation analysis. The statistical package for social sciences (SPSS) was used to compute the statistics. Fifty five point nine percent of the respondents had never undertaken any form of breast screening in the last two years. The breast screening uptake was lowest among women aged 30 – 39 years (17.2%) and among women with middle college level of education (6.0%). This research found significant associations between SECDs, psychosocial factors, institutional factors and women’s level of knowledge about breast cancer with breast screening uptake. Women with lower socioeconomic status were found to be less likely to undertake screening services. Institutional characteristics such as breast health education and guidance by nurses were found to be significant and positively associated with screening uptake among the women. The study findings will help the ministries of health and education to formulate policies that are directed at promotion of early breast health seeking behavior among the women and generate information on the role of MCH clinics in creating awareness of breast 12 screening to reduce the incidence of late breast cancer. This analysis also provides evidence about the extent of utilization of breast cancer preventive care among women in a developing country and gives guidance on promoting early breast cancer screening among women.

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