PHD-School of Health Sciences

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This collections contains bibliographic information and abstracts of PHD theses and dissertation in the School of Health Sciences held in Kenyatta University Library

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Determinants of adherence to anti-retroviral therapy and high risk behavior among HIV infected patients on treatment in Nairobi Province, Kenya.
(Kenyatta University, 2009-10) Oyore, J. P.
Anti-retroviral therapy (ART) has been successful in dramatically decreasing the morbidity and mortality caused by HIV infection. Levels of adherence in excess of 95% are required to ensure treatment success, adequate viral load suppression, improved immune status and slowing of the disease progression. It has also been reported that a lot of complacency during ART and feeling of reduced infectivity by the patients on ART could lead to high risk sexual behaviour and enhance transmission of HIV. To date there is very little scientific data on ART adherence, factors influencing it and any resultant high risk behaviour in Nairobi, Kenya. This was a non -interventional cross-sectional study using rapid appraisal techniques for collecting both qualitative and quantitative data. The main objective of this study was to determine the levels of adherence, factors influencing it and identify any resultant high-risk behavioural changes during ART among patients in selected treatment sites in Nairobi Province, Kenya. A combination of data collection tools was used to gather the information in this study including semi -structured questionnaires, adherence measurement tool and FGDs. Qualitative data was consolidated using data matrices. Analysis of qualitative data was done by triangulation based on major themes or constructs. Quantitative data was analyzed using the statistical package for social scientists (SPSS) version 16.0. Hypothesis testing was done using Chi-square and Kruskal-Wallis tests to test the significance of the categorical variables. T-tests and Mann U Whitney tests (non -parametric tests) were used to assess the differences between groups for continuous variables. Multistage sampling design was used since convenience sampling was used to determine the health facilities after which systematic sampling was used to select the patients to be interviewed. The results indicated that just about half ,216 (48%) of the PLWHA had accurate knowledge of what ARVs were and what they do to the body. There was a significant relationship between knowledge of ARVs and adherence with those having more accurate knowledge more likely to adhere (X2 = 106.432 df = 7, p :s 0.001). The composite adherence ART level of adherence from the three methods used among patients in Nairobi was found to be 85% with 43% of the patients not achieving optimal adherence. The major factors that were found to constrain adherence were costs (X2 = 306.02, df= 7, p:S0.001), lack of social support (X2 = 0.804, df= 7, p~O.997), side effects (X2 = 92.583, df= 7, p:S 0.00), distance to the facility, gender (X2 = 104.006, df= 7, p:S0.02) , CD4 count at start of treatment. The results also indicated that a good proportion 342 (76%) of the patients who had been on treatment for over six months had engaged in high risk HIV transmission behaviour by either having sexual intercourse without protection or with partners of unknown HIV status. Quality of care is affected by lack of adequate supply of drugs and training of health workers. These findings will help policy intervention towards improving access and adherence to ARV through carefully planned and evaluated interventions. Furthermore, it will lead to the improvement of the quality of medication discussions and care so that both patients and care providers receive and understand the information they need, enable patients to accurately assess their readiness to initiate and adhere to ARV, identify gaps between knowledge and actual practice both for health workers and PL WHA. The information will also be given to the PL WHA to enable them reduce the high risk sexual behaviour that may predispose them to HIV re-infection. Itis recommended that there should be more education and information provided to the patients prior to initiating ART so that they know the facts about ARVs. In conclusion, the study found that majority of patients on ART does not achieve optimum adherence levels and that 342 (76%) of patients on ARVs are engaging in risky sexual behaviour. The study also recommends more targeted counseling be provided by the care providers highlight the importance of adherence hence promoting adherence among the patients. There should also be improved education targeting the PLWHA to sensitize them and remind them that they are not free of HIV and AIDS v n af r b ing on tr atm nt and that th y would still t r -infected by other strains of HIV.
The swain-langley and McCoy blood group polymorphisms of complement receptor 1: role in severe plasmodium falciparum malaria
(Kenyatta University, 2009-11) Guyah, Bernard Ochieng'
Analyses of class and subclass antibody of circulating immune complexes in children with severe Plasmodium Falciparummalaria in endemic regions of Western Kenya
(Kenyatta University, 2010-06) Mibei, Erick Kipsang
Plasmodium falciparum infection is characterized by deadly complications such as severe malaria-associated anaemia (SMA) and cerebral malaria (CM).The exact mechanisms underlying pathogenesis of these severe forms of Plasmodium falciparum malaria are not fully understood yet they are associated with a lot of morbidity and mortalitv. Studies have shown a link between severe P. falciparum malaria and levels of circulating immune complexes (CIC) but the exact role of these CICs in the pathogenesis of severe P. falciparum malaria is still unclear. This study aimed to investigate the quantitative and qualitative differences in antibody classes and subclasses in serum immune complexes (lCs) between children with the severe forms of P. falciparum malaria and those with uncomplicated malaria as well as identifying the predominant P. falciparum antigens that contribute to IC formation in these clinical groups. A total of 75 children with SMA and 32 children with CM were enrolled from hospitals in western Kenya and matched with 74 and 52 control children respectively with uncomplicated symptomatic malaria. IC levels were measured using solid phase ELISA protocols and antibody classes and subclasses were identified using polyspecific sera for the classes or monoclonal antibodies for the subclasses. ICs were purified using polyethylene glycol (pEG) precipitation. The isolated ICs were dissociated by using an acidic buffer (Glycine- HCL pH 2.0). These were then electrophoresed on one-dimensional and two-dimensional polyacrylamide gel blotted by Western transfer and probed using human anti-F. falciparum antibodies. The study showed a general increase in levels of ICs as a result of P. falciparum infection in severe malaria cases and their symptomatic controls. Although IgG IC levels were elevated in children with severe malaria upon enrolment, children with CM had the highest levels of ICs for all the antibody classes. Conditional logistic regression showed a borderline association between IgG4-containing ICs and increased risk of SMA (OR = 3.11, 95% Cl 1.01 to 9.56, P = 0.05). Total IgG-containing ICs (OR = 2.58, 95% Cl 1.20 to 5.53, P < 0.(2) and IgE-containing ICs (OR = 3.27, OR 1.38 to 7.78, P < 0.01) were associated with increased risk of CM. Six specific P. falciparum antigens were found to be associated with severe malarial anaemia while another three antigens were associated with cerebral malaria when compared to their specific controls. While when SA and CM where compared together, a 91Kda antigen was highly associated with SA (P < 0.01), while a slightly lighter antigen of about 87 Kda was significantly associated with CM (P < 0.01). These findings have demonstrated quantitative and qualitative differences in ICs in children with SMA and CM and this underscores the potential mechanisms of the pathophysiology of the disease. Furthemore the findings of this study suggested having higher IgG4-containing ICs is a risk factor for SMA while higher IgG and also IgE-containing ICs are both associated with CM pathology. This suggest that although SMA and CM were characterized by high levels of ICs, the class and subclass make up of these KCsas well as the role that they play in each may be distinct. This study demonstrated an association between malaria antigens and severity of the disease hence there is need for full characterization of the parasite antigens. These findings may contribute to a better understanding of the role of different antibody classes and subclasses in protective or damaging mechanisms and may provide new insights into development of effective malaria control strategies and vaccine development.
Expression of fcyrilll, cr3 intracellular tumor necrosis factor-alpha and nitric oxide production by monocytes from children with plasmodium falciparum malaria
(2011-07-19) Ogonda, Adhiambo L.
Malaria is a major cause of childhood morbidity and mortality in tiub-Saharan Africa. Most of the mortality is the result of severe Plasmodium falciparum (P. falciparum) disease complications such as severe malarial anemia (SMA) and cerebral malaria (CM). A clear understanding of the factors that play a role in the pathogenesis of severe P. falciparum malaria is essential for the development of effective prophylactic and therapeutic measures. Malaria infection leads to formation of immune complexes (ICs) that can interact with monocyte/macrophages by binding to their surface Fc gamma and complement receptors. The interaction of ICs with Fe gamma receptor III (FcyRIII, CD16) on monocytes/macrophages results in stimulation leading to production of nitric oxide (NO) and the cytokine tumor necrosis factor-alpha (TNF-(X) which ire important factors implicated in the development of severe malaria. FcyRIIIA can also mediate phagocytosis of antibody-coated infected and uninfected red cells which could contribute to the development of severe anaemia. However, phagocytosis of opsonized ICs via complement receptor 3 (CR3, Mac-1, CD I Ib/CD18) suppresses pro-inflammatory monocyte functions such as NO production. Therefore, the expression levels of these receptors on monocytes/macrophages may influence degree of stimulation and determine individuals' susceptibility to severe malaria. This study examined the expression of FcyRIII and CR3 on monocytes of children with severe malarial anaemia, cerebral malaria, and their age and gender-matched uncomplicated malaria controls by flow cytometr y. Whole blood was obtained from the patients during the acute illness and after recovery from illness and stained with directly conjugated antibodies against CD14, FcyRIII/CD16 and CR3/CD1 lb followed by red cell lysis. In addition, monocytes were stimulated with BSA-anti-BSA immune complexes to determine the effect on the intracellular expression of TNF-a and NO by monocytes. The expression of FcyRIII on total CD16+ mono~cyte population and on the CD14+CD16+ monocyte subpopulation was highest in SMA vases and correlated negatively with the haematocrit levels. The expression of CR3 w CD14+CD16+ and CD14++CD16+ monocytes sub-populations was lowest in SMA ases and correlated positively with the haematocrit levels. The ability to produce N in response to IC correlated positively with age and was higher in the SMA than in ( VI group (P= 0.013) but there were no differences between these severe malaria groups 'A i th their age matched controls. Intracellular TNF-a expression by CD14+CD16+ id CD14++CD16+ monocytes in response to IC stimulation correlated positively with their FcyRIII expression levels. The concentration of total monocytes and their subpopulations was significantly higher in SMA cases than in all the other clinical groups and correlated inversely with haematocrit levels. These findings suggest that CD14+CD16+ and CD14++CD16± monocytes may be more mature and responsive to activation in SMA cases than in CM cases. Over expression of FcyRIII on monocytes in response to P. falciparum infection may be an important contributing factor to the development of severe malarial anaemia.
Determinants of adherence to Anti-Retroviral therapy and high risk behaviour among HIV infected patients on treatment in Nairobi province, Kenya
(2011-07-25) Oyore, J. P.
Anti-retroviral therapy (ART) has been successful in dramatically decreasing the morbidity and mortality caused by HIV infection. Levels of adherence in excess of 95°/, are required to ensure treatment success, adequate viral load suppression, improved immune status and slowing of the disease progression. It has also been reported that and feeling of reduced infectivity by the patients on ART could lead tonhance transmission of HIV. To date there is very little scientific data on ART adherence, factors influencing it and any resultant high risk behaviour in Nairobi, Kenya. cross-sectional study using rapid appraisal techniques for collecting both qualitative and quantitative cl.ita. The main objective of this study was to determine the levels of adherence, factors influencing it and identify any resultant high-risk behavioural changes during ART treatment sites in Nairobi Province, Kenya. A combination of data collection tormation in this study including semi -structured questionnaires, adherence measurement tool and FGD,. Qualitative data was consolidated using data matrices. Analysis of qualitative data was done by triangulation based on major themes or constructs. Quantitative data was analyzed using the statistical package for social scientists (SPSS) version 16.0. Hypothesis testing was done using Chi-square and Kruskal-Wallis tests to test the significance of the categorical variables. T-tests arametric tests) were used to assess the differences between groups for continuous variables. Multistage sampling design was used since convenience sampling was used to determine the health facilities alter which systematic sampling was used to select The results indicated that just about half ,216 (48%) of the PLWHA had accurate knowledge of what ARVs were and what they do to the body. There was a significant relationship between knowledge of ARVs and adhere (x2 imal adherence. The major fact((x2 rt= 0.804, df = 7, p<_0.997), side effects = 92.583, df = 7, p <_ 0.00), distance to the facility, gender 104.006, df =7, p<0.02) , CD4 count at start of treatment. The resproportion 342 (76%) of the patients who had been on treatment for over six months had engaged in high risk HIV transmission behaviour by either. having sexual intercourse without protection with partners of unknown HIV status. Quality of care is affected by lack of adequate supply of drugs and training of health workers. These findings will help policy intervention towards improving access and adherence to ARV through carefully planned and evaluated interventions. Furthermore, ii will lead to the improvement of the quality of medication discussions and care so that both patients and care providers receive and understand the information they need, enable patients to accurately as their readiness to initiate and adhere to ARV, identify gaps between knowledge and actual practice both for health workers and PLWHA. The information will althem reduce the high risk sexual behavior that may predispose them tded that there should be more education and information provided to the patients prior to initiating ART so that they know the facts about ARVs. In conclusion, the study found that majority of patients )n ART does not achieve optimum adherence levels and that 342 (76%) of patients on ARVs are engaging in risky sexual behaviour. The study also recommends more targeted counseling be provided by fie care providers highlight the importance of adherence hence promote. There should also be improved education targeting the PLWHA to sensitize them and remind then that they are not free of HIV and AIDS even after being on treatment and that they would still get re-infected by other Strains of HIV.
Development and application of a geo-medical information decision support system (geo medinfo) for malaria surveillance and risk modelling in Nyanza Province, Kenya
(2011-08-04) Mogere, Nyaribo Stephen
In sub-Saharan Africa, malaria is a leading cause of morbidity and mortality. Detailed knowledge of spatial variation of malaria epidemiology and associated risk factors is important for planning and evaluating malaria-control measures. This study therefore investigated an approach in the development and application of a GIS-based healthcare management system with abilities to incorporate climate-based risk predicators of malaria transmission in Nyanza Province. Two sites, Siaya district and Kisii Highlands were selected to implement this study. The PMIS was designed with capabilities to carry out both micro- and macro-levels spatial epidemiologic analyses of malarial transmission. Using Universal Modeling Language (UML) and Microsoft Visio 2003 health data classes, relationships, attributes and data types were modeled which formed the basis for customizing and design of the Patient Management Information System (PMIS). A tailor-made PMIS was then implemented to capture malarial data alongside patient care in Siaya District Hospital, a rural health facility in Nyanza Province, Kenya. A total of 822 malarial case households were tracked and mapped using the Global Positioning System (GPS) and entered into the PMIS. In addition, malaria monthly cases from a total of 127 health facilities in Kisii Highlands were obtained for the period between 1996 and 2005 alongside data on rainfall, Normalised Difference Vegetation Index (NDVI), temperature and Digital Elevation Model (DEM) as possible predicators of malarial risk in the study area. Spatial analyses results revealed that the average distance traveled by study participants to Siaya District Hospital (SDH) was 6km while the longest distance was about 13.15km. There was a significant positive correlation between distances of malaria case households to the health facility, proximity to water bodies and malarial outcomes at 0.05 level of significance (P<0.005). However, no significant differences (p<0.005) were found between malarial case households and controls with regard to proximity to local road network. Regression modelling of malarial transmission in the Kisii Highlands revealed associations between rainfall, NDVI, temperature and DEM and malaria cases in the three administrative districts of Nyamira, Kisii and Gucha. These factors had varied influence on malaria risk transmission with the DEM found to explain most of the malaria case variations in the study area. Geospatial risk models developed for malaria transmission predictions were validated using F-test. The study recommends further testing and validation of both PMIS and the spatial predictive malaria risk model in other parts of the country. The study concludes that it is feasible to develop GeoMedlnfo in broader health information sharing nationally, designed as a tool for improved diagnostics, planning and management programming of malarial surveillance system.
Analyses of class and subclass antibody of circulating immune complexes in children with severe plasmodium Falciparum malaria in endemic regions of Western kenya
(2011-08-04) Mibei, Erick Kipsang
Plasmodium falciparum infection is characterized by deadly complications such as severe malaria-associated anaemia (SMA) and cerebral malaria (CM)The exact mechanisms underlying pathogenesis of these severe forms of Plasmodium falciparum malaria are not fully understood yet they are associated with a lot of morbidity and mortality. Studies have shown a link between severe P. falciparum malaria and levels of circulating immune complexes (CIC) but the exact role of these CICs in the pathogenesis of severe P. falciparum malaria is still unclear. This study aimed to investigate the quantitative and qualitative differences in antibody classes and subclasses in serum immune complexes (ICs) between children with the severe forms of P. falciparum malaria and those with uncomplicated malaria as well as identifying the predominant P. falciparum antigens that contribute to IC formation in these clinical groups. A total of 75 children with SMA and 32 children with CM were enrolled from hospitals in western Kenya and matched with 74 and 52 control children respectively with uncomplicated symptomatic malaria. IC levels were measured using solid phase ELISA protocols and antibody classes and subclasses were identified using polyspecific sera for the classes or monoclonal antibodies for the subclasses. ICs were purified using polyethylene glycol (PEG) precipitation. The isolated ICs were dissociated by using an acidic buffer (GlycineHCL pH 2.0). These were then electrophoresed on one-dimensional and two-dimensional polyacrylamide gel blotted by Western transfer and probed using human anti-P. falciparum antibodies. The study showed a general increase in levels of ICs as a result of P. falciparum infection in severe malaria cases and their symptomatic controls. Although IgG IC levels were elevated in children with severe malaria upon enrolment, children with CM had the highest levels of ICs for all the antibody classes. Conditional logistic regression showed a borderline association between IgG4-contaning ICs and increased risk of SMA (OR = 3.11, 95% CI 1.01 to 9.56, P = 0.05). Total IgGcontaining ICs (OR = 2.58, 95% CI 1.20 to 5.53, P < 0.02) and IgE-containing ICs (OR 3.27, OR I .38 to 7.78, P < 0.01) were associated with increased risk of CM. Six specific falciparum antigens were found to be associated with severe malarial anaemia while another three antigens were associated with cerebral malaria when compared to their specific controls. While when SA and CM where compared together, a 91Kda antigen was highly associated with SA (P < 0.01), while a slightly lighter antigen of about 87 Kda was significantly associated with CM (P < 0.01). These findings have demonstrated quantitative and qualitative differences in ICs in children with SMA and CM and this underscores the potential mechanisms of the pathophysiology of the disease. Furthemore the findings of this study suggested having higher IgG4-containing ICs is a risk factor for SMA while higher IgG and also IgE-containing ICs are both associated with CM pathology. This suggest that although SMA and CM were characterized by high levels of ICs, the class and subclass make up of these IlCs as well as the role that they play in each may be distinct. This study demonstrated an association between malaria antigens and severity of the disease hence there is need for full characterization of the parasite antigens. These findings may contribute to a better understanding of the role of different antibody classes and subclasses in protective or damaging mechanisms and may provide new insights into development of effective malaria control strategies and vaccine development.
Influence of child care practices on malaria severity in children under five years of age in Mbeere district of Eastern province, Kenya
(2011-08-09) Mwaniki, P. Kabanya
Malaria, a blood parasitic disease is a leading cause of mortality and morbidity particularly among children and pregnant women because they are most at risk in many developing countries, especially those in Sub-Saharan Africa. Most of the deaths due to malaria could be averted if care-takers recognized the signs and symptoms of malaria and instituted appropriate measures W ithout delay. Early recognition followed by correct management is a key strategy for malaria control in endemic areas. The effectiveness of this strategy requires an understanding of careseeking patterns including the actions the care-takers initiate in response to an episode of childhood febrile illness since they greatly influence the severity of the disease. A health facility-based descriptive cross-sectional study was carried out in Mbeere District (a malaria endemic area), where caretakers seeking treatment for their children aged under-five years who tested positive for malaria parasites were recruited into the study. The main objective was to determine health care practices during the illness and their effect on the severity of the illness. A questionnaire was used to collect primary qualitative data from caretakers. Additional qualitative data was obtained through focus group discussions with women groups in each of the study sites. The data was entered using Epi-Info interface and analysis done using the Statistical Package for Social Sciences (SPSS) version 12.0 software. Pearson's chisquare test of independence was used to determine level of associations at 95% confidence interval. The results established that the children had been unwell for mainly (X days prior to health facility visit. The mean duration of illness for the children was 2.1 (S.D \ days. On diagnosis and classification of the illness at the health facility, 23.9% of all children seen had complicated malaria, 74.3% had uncomplicated malaria while 1.7% were not classified. There was no significant difference in severity of malaria among the different age groups of children (x = 2.32, p=0.67). Analysis of actions taken at home showed that 81.3% of the caretakers had taken one or more actions at home while 18.7% never took any action. The action of giving drugs was the most common (64.1%) followed by removal of excessive clothing (16.5%). Although caretakers were not able to accurately identify the specific drugs they gave to the sick children, they were able to report that the drugs were for a specific sign or symptom like drug to reduce fever. pain, drugs to treat malaria etc. Only 8% of the respondents reported having given an antimalarial drug at home. The variation on the caretakers' immediate action was also noted to be associated with the levels of education of the individual caretaker particularly in giving a drug (x2 = 15.900, P < 0.05), more fluids to the child (X = 4.322, P < 0.05) and doing nothing on first notice (x2 = 15.924, P < 0.05). All the caretakers with college education gave drugs on first notice that the child was unwell. There was also a significant association between caretakers' religion and occupation with the severity of malaria (x2 = 8.62, p = 0.01; x2 = 50.2, p=0.001) respectively. Among the Akorino sect, a significant 48.1% of the caretakers and slightly more than half (56.6%) of those in semi-skilled labour had their children diagnosed with complicated malaria. The association between feeding practices and severity of malaria was also significant. Among caretakers who gave food and fluids less Frequently during the illness 25.8% and 34.7% of the children had complicated malaria (p=0.42 and 0.001) respectively.
Prevalence of sexually transmitted diseases, HIV/AIDS among female sex workers and acceptability of intravaginal ring in Mukuru, Nairobi, Kenya
(2011-08-10) Nyanchera, Wakasiaka Sabina; Mbithi, J. J. N.; Anzala, O.; Priddy, F.
Human Immunodeficiency Syndrome (HIV and AIDS) has escalated into a humanitarian and developmental crisis. Out of 33.2 million people living positive worldwide, majority (22.5 million) live in Sub Saharan Africa (UNAIDS 2008). Gender roles and responsibilities in African communities bring forth inequalities which often reduce the power of women in negotiating for safer sex. In many African communities, women are care givers. They are expected to care for the spouse, children and the extended family. However, when a woman is infected with HIV, she may be divorced, denied access to family inheritance and care. This prospective cohort study recruited one hundred female sex workers in Mukuru informal settlement in the period between October 2005 to May 2008. The aim of this study was to recruit and characterize individuals for future efficacy clinical trials for HIV Vaccines and Microbicides. Part of the clinical site requirements for such trials is that cohorts must have documented high risk behaviour, high STI prevalence and high retention rates. In order to establish baseline Sexually Transmitted Infections (STI) burden in the community, health care providers were interviewed regarding common STI they treat. Health care providers were asked about their views regarding acceptability of an intravaginal ring which may be used to deliver Microbicides when they become available. Data was analyzed using Statistical Package for Social Sciences (SPSS). Results indicate that Female Sex Workers (FSVV) in the cohort are at a higher risk of contracting STI. Majority FSW (67%) were young, with a mean age of 28. Literacy levels were low with 45% reporting no formal schooling. On average, FSW had three clients per day with the earliest sex debut being 9 years. Almost half (53%) said they used condoms sometimes with primary partners. At baseline HIV prevalence was 11.3%, this is higher than the national prevalence which stands at (7.4%). Vaginal discharge symptoms and Pelvic inflammatory disease were the most common STI seen. Out of 75 symptomatic patients, 30 (40%) reported having vaginal sex in the same period. Only 4% 'reported anal sex during the symptomatic period. Diagnosis of Trichomoniasis correlated significantly with income of more than 200 Kenya shillings per week. In multivariate analysis, diagnosis of STI (Chlamydia, gonorrhea, Trichomoniasis or syphilis) was strongly associated with alcohol use (OR=3.35, P=0.002). Intravaginal rings were well accepted by majority of health care providers who asked for more information regarding the rings and Microhicides. Recruitment, characterization and establishment of this cohort provide an opportunity to access Vaccine and Microbicides strategy for HIV prevention especially for women.
Assesment of health-related fitness status of 6-9 year old primary shool pupils in Mukono and Wakiso Districts, Central Uganda
(2011-08-10) Nsibambi, Constance Adron Nakayiza
Despite a world-wide increase in health-related diseases and conditions among children, little information is known about the children's health-related fitness status in Uganda. Assessment of the fitness status of pupils aged between 6 and 9 years in Mukono and Wakiso districts in central Uganda was conducted using physical fitness testing. The study also determined their level of engagement in physical activities. A cross-sectional survey research design was used to assess four health-related fitness components. These were cardiovascular endurance using a 9-minute run test, body composition using BMI method, low back flexibility using the sit and reach test and abdominal muscular strength/ endurance using the sit up test. The target population comprised of 25,500 school children drawn from public and private schools. Four thousand pupils formed the sample for the study. The actual sample consisted of 1929 pupils with 922 day scholars and 1,007 in boarding schools. Data was analysed using frequencies, percentages, means and standard deviation and one way analysis of variance at 0.05 level of significance. The AAHPERD (1980) percentiles and the WHO (2007) CDC-BM1 for sex- age-growth charts percentiles to determine the fitness status of the pupils. The results showed that out of the 922 day scholars 250 (27.1%) had weak cardiovascular endurance, 27 (2.9%) were underweight, while 58 (6.3%) were overweight, 29 (3.1%) were obese; 707 (76.7%) had poor flexibility and 798 (86.5%) had weak abdominal muscles. On the other hand, out of the 1007 pupils in boarding schools 307 (30.5%) had weak cardiovascular endurance, 50 (5%) were underweight, while 79 (7.8%) were overweight, 50 (5%) were obese, 824 (81.8%) had poor flexibility and 814 (80.9%) had weak abdominal muscles. The results revealed significant differences in cardiovascular endurance, hody composition and abdominal muscular strength/endurance between day and boarding pupils (p>0.05) with day scholars having higher mean distance run scores, lower mean BMI scores and lower mean sit up scores. There were no significant differences in the mean sit and reach scores between day and boarding pupils. However, majority of pupils achieved the recommended standard for the cardiovascular endurance and normal body composition. There were also significant gender differences in all the health-related fitness components. The boys had higher mean distance run scores, lower mean BMI scores, lower mean sit and reach scores and higher mean sit up scores. This implies that more boys had better cardiovascular endurance, normal weight and better muscular strength/endurance than girls. On the other hand, more girls were flexible than boys. The study revealed that the pupils demonstrated poor health-related fitness status especially in abdominal muscular endurance and low back flexibility. The study also revealed that most pupils met the recommended 60 minutes of daily physical activity although the activities they engaged in were not appropriate enough to develop most of the health related fitness components. It is recommended that more physical activities that develop the health-related fitness should be integrated in the school curriculum and children need to engage in more active behaviours.
Determinants of socio-cultural risks factors in HIV infections among the muslim community in Kenya
(2011-08-11) Karama, Mohamed; Orago, A. S.; Moji, Kazuhiko
HIV and AIDS continue to devastate many areas of the world. Africa and especially Sub Saharan Africa remains the epicenter for the pandemic. In Kenya despite declining prevalence, the incidence remain high. This is as a result of among others risk taking behaviours and resistance to change. Muslims form 25 to 30% of the population of Kenya and despite the low prevalence among them, little is known about their socio-cultural risk factors in relation to HIV infection. The aim of this study was therefore to determine the knowledge and perception of the Muslim on HIV and AIDS, to identify risk practices among them. This was a cross sectional study where both qualitative and quantitative data collection methods were used countrywide and during two national Muslim leaders consultative workshops and other workshops at the district levels. Focus group discussions, in-depth interviews with key informants and administration of a questionnaires for quantitative data on knowledge and attitude was undertaken. Data analysis included running frequencies for percentages and the use of chi-square to determine the difference in risk perceptions between males and females. There are about 2300 mosques 4800 madrassas (Muslim schools), 99 secular schools, 20 Muslim managed health facilities and about 1000 community organizations. There is an extensive Islamic teaching that can be useful in addressing HIV related problems. Knowledge levels measured as percentages of the community who got the right answers ranged between 38% to 97% with women being less informed but the difference is not significant (p=<0.06). Knowledge levels were superficial with less details on prevention and management of HIV. National average for perceived prevalence was 2.6% with Northern Kenya being lowest at less than 1 % and Nyanza being highest at average of 5.5% an indicator of recognition of HIV as problem for all Kenyans. Risk priorities varied between regions with the coast identifying tourism related risk and the Northern region identifying cultural practices including polygamy divorce and female circumcision as a possible risk practices. In Northern Kenya and the Coast, divorce rates and polygamous marriages were estimated to range between 15 and 30% and 10 to 30% respectively. The transport industry especially long distance truck drivers a preference for Muslim businessmen, taxis, and other public transport are of general concern countrywide. There was significant difference in the perception of risk between men and women (p =<0.001). There is need for more coordinated involvement of Muslims and the mainstreaming of HIV control and prevention within the physical and social infrastructure and the Islamic teachings. More research should be undertaken to better understand the implications of the risk practices in the spread of HIV in the Muslim community in Kenya. The results of this study helped in the development of a Muslim policy on HIV in Kenya
Associating genetic resistance to plasmodium falciparum malaria infection with ethnic groups residents of malaria endemic and non-endemic regions of Kenya
(2011-08-11) Ayodo, George
Malaria causes death of millions of people in sub-Saharan Africa and about 80% are children and women under 5 years of age. Infection has therefore exerted pressure on human genome and as a consequence clinical manifestations appear variable in endemic and non-endemic populations. Part of the reason for this epidemiological difference is hypothesized that over the last few thousand years, endemic populations have built up genetic resistance to severe malaria infection. To test this hypothesis, the study searched for evidence of natural selection in malaria exposed and unexposed populations by (a) carrying out a large-scale collection in Kenya of severe malaria cases and controls from the Luo ethnic group and also of population controls from the Masai and Kikuyu ethnic groups, (b) carrying out an association study at 10 genetic variants previously associated with malaria resistance, (b) studying frequency differences across populations to determine which of these variants have been subject to selection for malaria resistance in the past few thousand years, and (c) also studying haplotype and linkage disequilibrium patterns around malaria resistance genes to search for evidence of natural selection. In the Luo case-control samples, the previously described associations at CD36-GT (P value < 0.004) and HbAS (P value = 0.015) were replicated. Strikingly, there was unusually high frequency differentiation of the HbAS and CD36-GT variants in the exposed (Luo and Yoruba) vs. relatively unexposed (Kikuyu and Masai) populations compared to a panel of 1,454 randomly chosen markers that were studied in the same samples (P < 0.00036 and 0.00096 respectively). By statistically combining the case-control association and frequency differentiation statistics, the power of the association analysis was increased by several orders of magnitude (HbAS with P value < 0.0000 18 and CD36-GT with P value < 0.00043), which provides a potential tool for researchers to find risk factors for infectious disease in future. Further assessment o€ haplotype blocks flanking HbAS-T, CD36-G and ICAM-T suggested that exposed and un-exposed populations exhibit different haplotype block patterns, supporting the evidence of natural selection. CD 36GT appears to be under selection in both the Luo and Yoruba ethnic group, whereas HbAS is under selection in the Yoruba ethnic only but not in Luo ethnic groups. These results suggest Yoruba and Luo-perhaps because they are on different sides of the African continent-evolved different genetic response to malaria because they had been exposed to the disease for thousand years. This study has not only developed a novel method to identify malaria variants but has also provided an insight on the possibility of exploiting haplotype block patterns to map causal genes
Isolation of recurrent mycobacteium isolates from sputum smear negative relapse at the central reference tuberculosis laboratory in Nairobi, Kenya
(2011-08-15) Wahogo, Josephine N; Orago, Alloys S.S.; Kabiru, Ephantus W.
Pregnant women have increased susceptibility to malaria infection. In these women, malaria parasites are frequently found sequestered in the placental intervillous spaces, a condition referred to as placental malaria (PM). Placental malaria threatens the health of the mother and the child's life by causing intrauterine growth retardation, abortions, still births and reduction in gestational age. An estimated 24 million pregnant women in SubSaharan Africa are at risk. Mechanisms responsible for increased susceptibility in pregnant women are not fully understood. Baboons are susceptible to Plasmodium knowlesi and have similar host pathogen interactions and reproductive physiology similar to humans, making them attractive for the development as a model for studying mechanisms underlying development of placental malaria. This study exploited the susceptibility of baboons to Plasmodium knowlesi infection to develop a non-human primate (baboon) model for studying PM. The main objective of the study was to demonstrate PM and characterize immunological mechanisms underlying the pathogenesis of PM in baboons infected with Plasmodium knowlesi. The pregnancies of three time mated adult female baboons and their gestational levels (one in its second trimester and two in their third trimester) were confirmed by ultrasonography. On the 150th day of gestation, the pregnant baboons were infected with Plasmodium knowlesi H strain parasites together with four non pregnant controls. Peripheral parasitaemia development was monitored on a daily basis from two days post inoculation. Collection of sera, plasma, mononuclear cells and haematological samples was done on a weekly basis. Peripheral blood mononuclear cells (PBMC) were stimulated in culture with concanavalin A and P. knowlesi antigens and their proliferation quantified. Sera cytokine and immunoglobulin concentrations were measured by ELISA using respective enzyme conjugated antibodies. Two pregnant baboons aborted (one on day 6 and the other on day 7 post infection) and cesarean section was only done on one baboon. Smears prepared from placental blood demonstrated the presence Plasmodium knowlesi parasites in all the sampled placentas. On average, the pregnant baboons had more than 29 fold higher placental parasitaemia than simultaneous peripheral parasitaemia. This shows that Plasmodium knowlesi preferentially sequesters in the baboon placenta just like Plasmodium falciparum does in humans. Two baboons that had high placental parasitaemia experienced abortion, which is a sequele of human placental malaria. Results indicate that PM in this model is associated with significant (P < 0.05) suppression of immunoglobulin G, Interferon gamma, and interleukin 6 responses. Tumour necrosis factor alpha responses were significantly upregulated (P < 0.05) while immunoglobulin M, interleukin 10, interleukin 12, interleukin 4 and PBMC proliferation responses did not differ from controls (P > 0.05). These data are consistent with some findings from human studies, showing the feasibility of this model for studying mechanisms underlying placental malaria. The study has contributed valuable data to be used in further studies and the development of preventative, control and therapeutic measures against PM in women
Community integrated management of childhood illness: role of the "dialogue model" as an interactive communication tool
(2011-08-15) Othero, Doreen Maloba
Community Integrated Management of Childhood Illnesses (CIMCI) is one of the three components of the Integrated Management of Childhood Illness (IMCI) strategy, a holistic approach that aims at lowering Infant and child morbidity and mortality in developing countries. CIMCI targets changing household child care practices in order to enhance child survival. Implementation of CIMCI is majorly based on interactive communication between health service providers and mothers/caregivers of children aged below five years. The aim of this study was to test the effectiveness of the "Dialogue Model" as an interactive communication tool for implementing Community IMCI. The model was applied to 18 key household childcare practices that were identified to cause infant and child morbidity and mortality. A longitudinal comparative study was carried out in three out of the five divisions of Nyando district, Kenya. The study was done in six distinct phases. Both qualitative and quantitative approaches were used in data collection, analysis and presentation. Baseline quantitative data was collected using a semi-structured questionnaire that was administered to 930 randomly sampled mothers and caregivers. Qualitative data was collected through Key Informant Interviews and Focus Group Discussions. Quantitative data was analyzed using SPSS and Epi Info and generated frequencies, cross tabulations, ODDS Ratios and Chi-Square computations. Results of the baseline survey on key household childcare practices revealed that majority 481(77.0%) and 222(73.5%) of the mothers in the proposed intervention and control areas weaned their children before 4 months of age hence the strong correlation between weaning and prevalence of diarrhoea (CI 1.11-2.96 and 1.11-2.96) respectively. Only 64(10.2%) and 49(16.3%) of the children in the two study areas underwent growth monitoring after 9 months of age. A minority 91(14.6%) and 43(14.2%) of respondents in the proposed intervention and control areas confirmed that fathers' participated in the daily care of the children implying that the burden of routine childcare rests on the mothers. Treatment of drinking water was found to be minimal as only 199(31.8%) and 110(36.4%) respondents in the two study areas affirmed that their children drunk treated water. It was also established that only 196(31.4%) and 79(26.2%) of the mothers underwent HIV testing during pregnancy. Following training of health workers on the "Dialogue Model" majority 176(72.2%) of mothers/caregivers reported that health service providers spent at least 15 minutes examining their children, 181(74.0%) acknowledged having been counseled while 206(84.4%) received follow-up dates. Results following implementation of the "Dialogue Model" showed significant improvement in most of the household child care practices. Majority 430 (68.8%). of the children in the intervention area now undergo growth monitoring beyond 9 months unlike only 73(24.3%) in the control area. A large proportion 552(88.3%) of mothers in the intervention area is currently treating drinking water compared to 158(52.4%) in the control area. However, culture bound household practices such as fathers' participation in child care showed no improvement despite implementation of the "Dialogue Model". Similarly, HIV testing during pregnancy showed very minimal improvement. Prevalence of IMCI classified diseases such as measles, diarrhoea and aneamia showed significant reduction following implementation of the "Dialogue Model". The conclusion from this study was that the "Dialogue Model" was an effective tool for enhancing household child care practices and also improved communication between health workers and the mothers/caregivers. However, it was recommended that further research be done to establish another communication approach that could positively change culture bound household child care practices such as fathers' participation in routine childcare. To enhance uptake of HIV testing during pregnancy, there was need for change in the implementation policy so that male partners are involved in the counseling and testing process together with their female partners
Consistency of stools as an indicator of type of intestinal parasites harboured by patients with abdominal pain at Kenyatta National hospital, Nairobi, Kenya
(2011-12-02) Githigaro, Peter Mathenge
Abdominal pain is a common problem reported to clinicians for various ailments. Hospital records in Kenya show that high percentage of patients suffers from abdominal pain. Among the causes of abdominal pain are intestinal parasites. Intestinal parasites include protozoa and helminthes living in the intestine of animals and human. They are among the most common infections in developing countries. About 3.5 billion people worldwide are infected with intestinal parasites without considering those with abdominal pain. There are many people living with intestinal parasites without knowing. The impact of these parasites on public health has been under estimated, although they cause considerable morbidity and mortality. The main objective of this study was to determine whether consistency of stool could be used as an indicator of type of intestinal parasites causing abdominal pain in a patient. Patients being investigated for intestinal parasitic infections in the clinical laboratory were interviewed and a sample size of 400 patients suffering from abdominal pain selected. Stools of patients were macroscopically examined to determine their consistency; both direct saline and formal-ether concentration methods were used to identify parasitic agents. Stool specimens with eggs of Taenia species were stained and eggs differentiated to species using modified Ziehl-Neelsen stain technique. Harada-Mori culture technique was done on positive stools with hookworm looking like eggs in order to differentiate the worm species. Data was analyzed, and association among stool consistency, age groups, sex and intestinal parasites were tested using chi-square. Of the 400 patients 164(42.0%) had acute abdominal pain, 181(45.3°/x) had chronic abdominal pain and 55(13.8%) had recurrent abdominal pain. The consistency of stools from those patients were 218(54.5%) formed, 95(23.8%) soft, 78(19.5%) loose and 9(2.3%) watery. Stools from 79(19.75%) patients had inclusions; those with pus cells were 44(11.0%), mucus 33(8.25%), blood 23(:5.75%) and yeast cells 15(3.75%). The results show 27.5% of patients complaining of abdominal pain had intestinal parasitic infections. The most prevalent helminth was hookworm (2.5%) while the most prevalent protozoan was Blastocystis hominis (10.75°/). The study show stools from patients complaining of acute abdominal pain had higher amount of water than stools from patients with ether chronic or recurrent abdominal pain (x2=47.3, df=6, P=0.000). Patient's complains of different duration of abdominal pain was not related to presence of intestinal parasitic agents in stools (x2=72.55, df 64, P=0.207). There was no association between intestinal parasitic infections and consistency of stools (x2=0.000, df 3, P=1.000). Patients of 36-40 years age group had the highest number 50% of parasitic infection eases than any other age group (x2=38.52, df=10, P<0.001). The findings from this study provide a general awareness among KNH practicing physicians the need of laboratory diagnosis of stools, in confirming clinical findings when treating patients with abdominal pain.
Anti-leishmanial activity of acacia mellifera (leguminosae: momosoideae) against leishmania Major
(2011-12-02) Mburu, Faith Wambui
Leishmaniasis is a major group of parasitic diseases in the tropical regions. Their public health importance requires integrated measures in order to ensure effective control of the disease. Chemotherapy is the mainstay of control with pentavalent antimomal agents still widely used as the drugs of choice. However. these drugs are associated with many undesired effects, which include renal and cardiac toxicity. nlyalgia, anthralgia. pancreatitis, gastrointestinal problems. cardiac arrhythmia and sudden death. I he antimonials are also very expensive, and require a long period of administration. Subsequently. the search for compounds with possible antileishmanial activity is growing. A lot of locus is currently being given to natural products. It has long been known that plants are a rich source of compounds with potential medicinal uses. ,Acacia mellifera subsp. mellifera is a recognized medicinal plant used for conditions such as malaria pneumonia, sterility, stomach problems and primary stages of syphilis. However_ limited information is Available on its isolated metabolites. The main objective of this study was to determine whether A. mellifera has any antileisllnlanial activities. To achieve this. the stem bark and leaves of .A. mellifera were extracted using methanol and dichloromethane then extracts evaluated against Leishmania major promastigotes and alnastigotes in limo. Further fractionation on dichloromethane extracts yielded nine fractions designated as fractions I-IX. The effects of extracts as well as fractions were evaluated both in cell free media and using infected macrophages. To evaluate the immunostimulatorv activities of the extracts, production of nitric oxide in supernatants from macrophages stimulated with extracts was detected by Griess test. All tests were done in triplicate. Statistical analyses of the results obtained were done by analysis of variance. chi-square and Kluskal-Wallis test. Results revealed that extracts containing a combination of methanol and dichloromethane had the highest activity against L. major promastigotes in cell-free culture. 100%) mortality was observed on promastigotes cultured with 5mg/ml of the methanol and dichloromethane crude extracts. The methanol and dichloromethane stem bark extracts, however. did not inhibit the transformation of L. major alnastigotes into promastigotes (P>0.05). The stem bark methanol extract had the lowest infection rate of 41.35%. Infection rates of' the extracts compared to a positive control had a difference (x2 =13.89; df=9: P>0.05). The fractions of dichloromethane had a statistically significant difference in their infection rates (F=6.827: df=4.15: P<0.01). Fraction VII had the lowest infection rates of 30% at 250mg/ml and also the lowest IC50 of' 54.19pg/ml. Close in its activity were fractions Vlll and IX. Results for immunostimulatory activity among the fractions of dichloromethane indicated that there was no significant production of nitric oxide (P>0.05). These results suggest another possible mechanism of action of the fractions other than through stimulation of nitric oxide production. A comparison of the immunostimulatory effects between the methanol and dichloromethane indicated production of nitric oxide by the methanol extract. There was a difference (H4,4,4,4= 14.04: P<0.05). The results from this study demonstrate that Acacia mellifera indeed has activity against Leishmania major parasites. This is a major contribution toward attainment of the Millenium Development Goal that seeks to combat disease.
Factors influencing prenatal health status of women attending prenatal clinics in selected low income areas
(2012-01-03) Ondigi, Alice N.
This study is designed to investigate the factors influencing prenatal health status among women attending prenatal clinics in selected low income areas of Nairobi, Kenya. The main purpose is therefore to establish the prental health status of pregnant women in low income areas and how this has contributed toward the healthy development of the unborn baby. Literature reviewed indicates that there is an increase in both maternal and infant mortality rates among low income women, and the most affected are women living in urban slums of Nairobi, Kenya. The literature further indicates that accessibility in terms of escalating costs of obtaining adequate health care and poor infrastructure are among the main factors that lead to poor prenatal status of the expectant women. However, based on the Safe Motherhood conceptual framework, there is need to improve the health status of the expectant women. Variables attributed to prenatal health status that this study addressed include: prenatal health conditions as a dependent variable, while age, level of education, number of visits attended, number of children, attitude of the pregnant women toward their pregnancy, partner support, family and community support, problems experienced and quality of prenatal health care offered at the clinic as independent variables. This study considered these variables to be influencing the prenatal health status of pregnant women in Kenya. Four administrative divisions from the eastern from the eastern part of Nairobi, Kenya were purposively selected. These four administrative divisions were: Mathare, Makadara, Starehe and Embakasi. The sample population of 170 pregnant women who ranged from 15-40 years was drawn from the six clinics randomly chosen from the four areas where the majority of low income people live. The findings of this study therefore, indicated that number of children per respondent, and number of prenatal visits attended was negatively correlated with prenatal health conditions. The hypotheses were tested using regression analysis and the associated t-tests. The two variables including partner support were included in the regression equation as the main predictors of prenatal health status. Since good prenatal health conditions aim to improve birth outcomes, it is therefore important for the Government to take measures to improve infrastructure, encourage expectant women to take measures to improve infrastructure, encourage expectant women to attend prenatak clinics earlier in their pregnancies, and promote women's perceptions, family and the surrounding community
Mother-to-child transmission of HIV type-1: Mechanisms of cellular immunity associated with chemoprophylactic intervention
(2012-01-03) Makokha, Ernest Pancras
Normal pregnancy and pregnancy complicated with HIV infection are associated with decreased immune responses. Decreased immune responses manifested in reduced maternal CD4+ T cell counts have been associated with risk of having a child infected with HIV - which risk ranges between 25 and 45% (without intervention) in sub-Saharan Africa. Zidovudine (AZT), which has been the prophylactic drug of choice for MTCT since 1994, reportedly increases on immune reconstitution in pregnancy and the risk of MTCT are still not very clearly knwon. A prospective, observational cohort study of women with and without HIV-1 infection was conducted in 7 rural health centres in Western Kenyan Districts of Busia, Siaya, Bondo and Kisumu. The study participants included 110 HIV-1 infected women ( with their index infants) as well as 311 HIV -1 seronegative women as controls. The participants were enrolled at 16 weeks gestation and followed up through pregnancy and postnatally to determine quantitative changes of CD4+ and CD8+ T cells using immunocytmetric methods. For the HIV-seropositive women, the profiles of CD4+ and CD8+ T cells were evaluated in relation to maternal AZT chemoprophylaxis and the index infant HIV infection status. Specimen collection was done at 26 and 36 weeks of pregnancy, 3 and 6 months postpartume and 3 months intervals thereafter until 2 years postpartum. Early diagnosis of HIV-1 among infants was performed by genetic amplification of HIV-specific genes using polymerase chain reaction (PCR). Only women and infants (born to HIV-postive mothers) whose consecutive data was available after collection according to study protocol met the criteria for the present analysis. HIV seronegative and seropositive women were similar with respect to their age groups and mean ages (HIV + ; 22.8 and 22.5 years) (p>0.005). However , sero-positive women had low entry CD4+ T cells (413-cells /ul) compared to sero-negative ones (829 cells/ul)(p<0.001). In HIV-sero-negative women, CD4+T cell levels remained fairly stable during pregnancy and postpartum, though not significantly. However, among the seropostitive women, CD4+T cell levels increased steadily during pregnancy and reduced towards early antepartum levels (600 cell /ul) late after delivery. For the CD8+ T cell profiles, the two categories had an early increase and a relatively stable or moderately increasing levels postpartum. When CD4+ T cell counts of HIV-1 infected women given AZT were assayed at week 24 of gestation through pregancy to 10 weeks postpartum and stratified by HIV-1 infection status of the child, there was a general increase of cells in response to AZT paired t-test comparisons of CD4+ T cell changes in the two categories of HIV-infected women (HIV transmitters and non-transmitters) before and after AZT administration showed that the CD4+ T cell increase in response to AZT was significantly associated with lack of transmission of HIV-1 to child (P=0.035). Whereasa it is expected that HIV-1 infection and pregnancy play a role in reducing immunity, the present study demostrates that a rise in the CD4+ T cell counts following short AZT regimen now widely in resource-weak countries, may be evidence of active suppression of replication of replication of HIV. On the strength of these findings, HIV-infected women who want to have children may be assured that pregancy will not cause significant progression of their disease. It is, however, recommended that such women be given a regimen of antiretrovirals (ARVs) to help reduce the risk of MTCT of HIV-1
Nutrition performance in primary health care in Kisumu district
(2012-01-04) Wagah, Akinyi Margaret
The present picture in the nutrition space in Kenya indicates that trends in nutritional status of the under five-year-old children have significantly deteriorated after initial improvement in 1982. National statistics indicate that one out of every three children in Kenya is not growing and developing as expected for their age (UNICEF, 1999). Similarly, one in every five children in Nyanza does not live to see its fifth birthday (KDHS, 1993). It has also been documented that a staggering 115,000 under five year olds are denied their right to survival each year (GOK/UNICEF, 1998). It is in the light of the foregoing that this current study was undertaken to establish the nutritional performance in Primary Health Care (PHC) in Nyanza with special reference to Kisumu District. The district has apparently been one of the PHC model regions in the country. The study aimed at accomplishing the following objectives: 1. Establish the nutritional status of the under five-year-old children in the study community. 2. Determine the relationship between the nutritional status and the incidence of infections amongst the under five years olds. 3. Identify how PHC has responded to meeting the food security needs of the study communities. 4. Determine a trend analysis in nutritional status of the under five-year-olds between 1982-2000. 5. Examine the effectiveness of nutrition education programmes with a view to charting out innovative strategies for change. This study made use of both qualitative and quantitative approaches to data collection. The method of sampling used was multi-stage. The study population consisted of the following categories of people, namely: household members, under five-year-old children, women groups, non governmental organizations, government ministries handling nutrition issues, and mothers attending health care centres. In total, seven hundred and fifty respondents participated in the study. Data collected were processed and analyzed both qualitatively and quantitatively according to the objectives of the study. Frequency distribution of samples, cross tabulations was utilized to analyze quantitative data. Both quantitative and qualitative data were thus combined foe an in-depth analysis of sampled data and conclusions drawn. The study found out that despite the implementation of PHC in the Kisumu Primary Health Care region, the district depicts adverse infant/child health and nutrition problems thus calling for special attention. Overall, 31.1 percent of the children were stunted. The highest prevalence of stunting was found among the age group 12-23 months old. This suggests that this age group should be targeted for interventions. Similarly, 15.2 percent were established to be underweight while 9.1 percent were wasted. It was equally evidenced from the study that a network of nutrition risk factors interacted to influence the child's nutritional status amongst some of which were noted to be; poverty, access to health care, the incidence of infectious diseases, parental demographic factors, the HIV/AIDS, caring capacity of the mothers and the food security status. Almost all the variables in the data set had significant effect on the child's nutritional status. Nutrition education did not appear to cause substantial behavioural change. One reason why nutrition education had not succeeded in impacting change was that messages were not well-formulated and that there was an over-emphasis on "do 's and don 'ts". It was therefore recommended that community-based participation in the formulation of concepts and messages should form an indispensable part of future nutrition education programs. In the meanwhile, if nutrition education and intervention programs are to make significant changes towards influencing health-changing behaviours, then multi-sectoral and multi-dimensional approaches are deemed necessary. Nutrition programming therefore needs to be integrative and holistic in nature. In view of the above findings, this study concluded that the provision of PHC has been inadequate both in impact and sustainability and that a new paradigm shift is essential. It is in this light that integration of Human Development Approach (HDA) in nutritional development is deemed feasible in producing sustainable effects
The effects of HIV testing and counselling on behaviour change in the prevention of HIV among the military population in Kenya
(Kenyatta University, 2012-02) Elmi, Ltcol Mohamed Yussuf
HIV testing and counselling (HTC) is an important prevention intervention whose aim is to enable an individual know his/her HIV sero-status and is also an entry point to treatment, care and support. Kenya in the new KNASP (2009/13) envisions an HIV free society through universal access to HIV services such as knowledge of HIV status by 2015, where 80% of the Kenyan population would have been counselled and tested. In order to achieve the national universal access targets, utilization of HTC services should increase everywhere throughout the country including the Kenya military. However, HTC services remain underutilized with only 50% of Kenyan between the ages of 15 and 64 years possessing knowledge of their HIV status and up to 83% of those infected with HIV do not know their HIV status. AIDS is currently the leading cause of death globally in the military, accounting for more than half of in-service and post service mortality in some countries. Such attrition causes loss of continuity at command level and within the ranks, increasing recruitment and training costs for replacements, and generally contributes to reduction in military preparedness, internal stability and external security. HIV and AIDS is one of the worst epidemics with most far reaching health and developmental consequences the world has ever seen. In Kenya, HIV and AIDS was declared a national disaster in 1999. Kenya continues to have a severe, generalized and concentrated HIV epidemic and the estimated HIV prevalence in adults aged between 15 and 49 years was about 7.1% in 2007 reducing marginally to 6.3% in 2008/2009. Throughout the world, the military personnel are the most vulnerable population to HIV and AIDS including sexually transmitted diseases. This is due to demographic factors such as their population being predominantly youthful with highly mobile and sexually active males. Access to alcohol tends to exacerbate risky sexual behaviour and hence increased vulnerability to contracting HIV. Despite the military being a high risk group, no previous study has investigated the effects of HIV testing and counselling as a .prevention intervention in Kenya. A descriptive, retrospective and prospective cross sectional study was conducted in the Kenyan military between 2003 and 2006 to evaluate the effect of voluntary counselling and testing as a tool for behaviour change among military personnel in 7 barracks in Kenya. A total of 320 respondents were interviewed and 6 FGDs were held the latter consisting of 60 participants in total. The findings revealed that more males than female respondents participated in the study and that over 79% of them were aged between 18 and 40 years. There was a remarkable increase in the utilization of HTC services from 9% in 2003 to 58.8% in 2006. A number of respondent-related factors including sex, age, marital status, occupation, level of education, concurrent partnerships, STI and knowledge of partners HIV status were identified to promote positive sexual behaviour change. Several factors were significantly associated with utilization ofHTC as a behaviour change strategy at 95% confidence level. These included knowledge of partner's HIV status (X2 = 1.867, P > 0.010), occupation of males (l =2.583, P > 0.011), and engagement in risky sexual behaviour (X2 = 2.049, P > 0.017). The findings also showed that at 95% confidence interval, marital status (l = 2.651, P > 0.024) and knowledge of partners' HIV status cl =1.685, P > 0.047) were significantly associated with the utilization of HTC and PMTCT services as a behaviour change strategy. The findings from retrospective records indicated that the HIV prevalence in the Kenyan military personnel had declined from 13% in 2002 to 5.3% in 2007 as was also a decline in STI cases among the same population. This study indicated that there was a significant behaviour change in the military and a deeper understanding of the effects of HTC as strategic tools in HIV prevention.

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