RP-Department of Community Health
Permanent URI for this collection
Browse
Browsing RP-Department of Community Health by Issue Date
Now showing 1 - 20 of 172
Results Per Page
Sort Options
Item Mothers' knowledge on malaria and vector management strategies in Nyamira District, Kenya.(East Afr Med J, 200-09) Osero, O.J.S.; Otieno, Micheal Frederick; Orago, A. S.BACKGROUND: Maternal knowledge on malaria and vector control measures are important because they enable mothers make an informed choice on the method of malaria control to use for their children under five years. OBJECTIVE: To determine the mothers' knowledge on malaria and vector control measures particularly use of insecticide treated nets. DESIGN: Cross sectional, descriptive study. SETTING: Eight health centres in Nyamira District, Kenya. SUBJECTS: Four hundred mothers bringing their children aged five years and below to the child health clinics. RESULTS: Mothers had a problem of defining malaria. Majority of them (91.8%) recognised mosquitoes as causing malaria. About 30% associated malaria with dirt, dirty compounds, dirty food/utensils, unboiled water and uncooked food. Many mothers identified basic malaria symptoms such as headache (70%), fever (68.8%), cold (65%), body or joint pain (65.5%) and abdominal pain/ vomiting (0.5%). Mothers (40.8%)were less knowledgeable on most vulnerable groups to malaria. A large number of mothers (55.5%) used nothing to protect themselves and their children under five years from mosquito bites. The radio (69%) tuned in the local language, played a very important role in the mothers' knowledge about the use of mosquito nets and insecticide treated nets. CONCLUSION: By virtue of the fact that majority of mothers (91.8%) recognised that mosquitoes caused malaria, it was an indicator that they were knowledgeable of its existence. Mothers were also informed of most of the malaria vector control measures particularly use of bed nets and insecticide treated nets. However, the general usage of those measures was very low.Item Topography as a modifier of breeding habitats and concurrent vulnerability to malaria risk in the western Kenya highlands(Parasites & Vectors, 201-12) Mwanzo, I.; Atieli, H.E.; Zhou, G.; Lee, M.; Kweka, E. J.; Afrane, Y.; Githeko, A.K.; Yan, G.BACKGROUND: Topographic parameters such as elevation, slope, aspect, and ruggedness play an important role in malaria transmission in the highland areas. They affect biological systems, such as larval habitats presence and productivity for malaria mosquitoes. This study investigated whether the distribution of local spatial malaria vectors and risk of infection with malaria parasites in the highlands is related to topography. METHODS: Four villages each measuring 9 Km2 lying between 1400-1700 m above sea level in the western Kenya highlands were categorized into a pair of broad and narrow valley shaped terrain sites. Larval, indoor resting adult malaria vectors and infection surveys were collected originating from the valley bottom and ending at the hilltop on both sides of the valley during the rainy and dry seasons. Data collected at a distance of ≤ 500 m from the main river/stream were categorized as valley bottom and those above as uphill. Larval surveys were categorized by habitat location while vectors and infections by house location. RESULTS: Overall, broad flat bottomed valleys had a significantly higher number of anopheles larvae/dip in their habitats than in narrow valleys during both the dry (1.89 versus 0.89 larvae/dip) and the rainy season (1.66 versus 0.89 larvae/dip). Similarly, vector adult densities/house in broad valley villages were higher than those within narrow valley houses during both the dry (0.64 versus 0.40) and the rainy season (0.96 versus 0.09). Asymptomatic malaria prevalence was significantly higher in participants residing within broad than those in narrow valley villages during the dry (14.55% vs. 7.48%) and rainy (17.15% vs. 1.20%) season. Malaria infections were wide spread in broad valley villages during both the dry and rainy season, whereas over 65% of infections were clustered at the valley bottom in narrow valley villages during both seasons. CONCLUSION: Despite being in the highlands, local areas within low gradient topography characterized by broad valley bottoms have stable and significantly high malaria risk unlike those with steep gradient topography, which exhibit seasonal variations. Topographic parameters could therefore be considered in identification of high-risk malaria foci to help enhance surveillance or targeted control activities in regions where they are most needed.Item Risk of transfusion malaria in Nairobi.(East Afr Med J., 1987-12) Kabiru, Ephantus W.; Kaviti, JNItem Female labour participation in agricultural production and the implications for nutrition and health in rural Africa(Elsevier, 1992-04) Lado, C.The broad objectives of this paper are: firstly, to examine the initial impact of colonialism on food production by women, by considering their role and activity patterns within the household in terms of rights, obligations, exchanges, allocation of resources and responsibilities and the division of labour in the selected African Societies of the Luo, Kikuyu and Luhya (Kenya), Ewe and Kusasi (Ghana), Mandinka (The Gambia), Yoruba (Nigeria) and Azande (Sudan). These ethnic groups used as examples were mainly selected on the basis of their predominance and availability of data in these countries lying in the Sub-Saharan Africa having similar historical roots of the British colonial policies. Secondly, some of the possible social, economic and biological effects or implications on the changes in rural women's work in the chosen case studies in Africa are elucidated. It has been hypothesized that the development process in rural Africa has marginalized women (with varying degrees) in the subsistence sector, reducing their productivity and control over resources; and that women's total work burden has relatively increased, a phenomenon which can be understood as an integral process of capital penetration and accumulation. These changes may have significant implications for nutrition and health affecting the overall levels of food production. Although the selected illustrations do not represent the full range of possibilities in Sub-Saharan Africa, the data on the gender roles and workpatterns and the different changing ways do indicate that the women's role in food production has profound implications for socio-economic development in general and nutrition and health in particular with much wider applicability. In fact no such cross-sectional study has been conducted in rural Africa. It is generally concluded that any consideration of women's agricultural production should not neglect the structural bases of their inequality, and the policies can be inadequate if they overlook the relationship between the subsistence and commercial sectors and the women's role in each. In effect, the relative and absolute losses in women's food production and incomes bear immediately on the food crisis of many of the Sub-Saharan African countries, and that the current policies for the food crisis are likely to fail unless there is an improvement of the data base in women's and men's specific food production activities, processing and marketing for use in policy formulation and implementation. Indeed, the integration of women into the development process should be sensitive to and cognizant of their needs, contributions and potentials in Sub-Saharan Africa.Item Bloodfeeding behavior of Anopheles gambiae s.l. and Anopheles funestus in Kilifi District, Kenya.(J Am Mosq Control Assoc., 1993-06) Mbogo, C. M.; Kabiru, Ephantus W.; Muiruri, S. K.; Nzovu, J. M.; Ouma, J. H.; Githure, J. I.; Beier, J. C.Blood meal samples were tested by ELISA for 534 Anopheles gambiae s.l. and 76 Anopheles funestus collected from 25 sites in Kilifi District, Kenya. Human IgG was detected in 94.4% of the An. gambiae s.l. and in 90.8% of the An. funestus. No samples were positive for cow and only a few were positive for goat. Both species fed predominantly on humans irrespective of host availability. At these sites on the Kenyan coast, the high degree of human-feeding by malaria vectors contributes to the efficiency of malaria parasite transmission and the high incidence of severe malaria.Item Low-level Plasmodium falciparum transmission and the incidence of severe malaria infections on the Kenyan coast.(Am J Trop Med Hyg., 1993-08) Mbogo, C.N.; Snow, R.W; Kabiru, Ephantus W.; Ouma, J. H.; Githure, J.I.; Marsh, K.; Beier, J.C.The transmission of Plasmodium falciparum was studied in relation to the incidence of severe malaria infections at Sokoke and Kilifi town, Kilifi District, Kenya. Intensive mosquito sampling during a one-year period yielded Anopheles gambiae s.l., An. funestus, and An. coustani. Anopheles gambiae s.l. was the predominant vector, comprising 87.9% and 97.9% of the total anophelines collected in Sokoke and Kilifi town, respectively. The proportion of An. gambiae s.l. with P. falciparum sporozoite infections was 4.1% (20 of 491) in Sokoke and 2.2% (3 of 138) in Kilifi town; no infections were detected in An. funestus or in An. coustani. Entomologic inoculation rates indicated that residents were exposed to only 8.0 infective bites per year in Sokoke and 1.5 in Kilifi town. Transmission was detected during only six months in Sokoke and three months in Kilifi town despite low-level, year-round vector activity. The yearly incidence of severe P. falciparum infections in children, 1-4 years of age was 24.1 per 1,000 in Sokoke and 4.2 per 1,000 in Kilifi town. Monthly patterns of transmission corresponded closely with the incidence of severe infections. At these sites on the coast of Kenya, the spatial and temporal incidence of severe malaria infections is associated with low-level P. falciparum transmission by vector populationsItem Utilisation of antenatal and maternity services by mothers seeking child welfare services in Mbeere District, Eastern Province, Kenya.(Kenya Medical Association, 2002) Mwaniki, P.K.; Kabiru, Ephantus W.; Mbugua, G.G.Background: Utilisation of antenatal and maternity services is an important maternal health indicator. Increasing the proportion of mothers who are cared for in health facilities during pregnancy, childbirth and puerperium reduces the health risks to mothers and their children. Objective: To determine the utilisation of antenatal and maternity services by mothers of Mbeere District bringing their children to the child welfare clinic. Design: Cross-sectional, descriptive study. Setting: Four rural health centres in Mbeere district. Subjects: Two hundred mothers bringing their children aged one year and below to the child welfare clinic between September and December 2000. Results: The proportion of mothers who utilised health facilities for antenatal and maternity services was 97.5% and 52%, respectively. Utilisation of health facilities for maternity services was significantly influenced by number of children and distance to health facility in that, as number of children increased, utilisation of maternity services reduced (chi2=8.99; p=0.027; df=1). Mothers living less than 5 km to a health facility utilised the services better than those living 5 km and beyond (chi2=7.57; p=0.0059; df=1). Among the reasons given by the mothers (individual respondents and through Focus Group Discussions) regarding dissatisfaction with the services offered included shortage of drugs and essential supplies, lack of commitment by staff, poor quality of food and lack of cleanliness in the health facilities. Conclusion: Coverage for antenatal services was high among mothers during their last pregnancy. However, only about half of the mothers interviewed utilised health facilities for maternity services (labour and delivery). The major constraints experienced by the mothers as they sought for the services (as reported by individual respondents and through Focus Group Discussions) included lack of transport, lack of money for transport and hospital fee and delay in admission to health facility once mothers report in labour. Lack of satisfaction with quality of care given could be the major demotivating factor in the use of health facilities for maternity services.Item Food Security Problems in Borabu Division, Nyamira District(2004) Keraka, M.This paper highlights the food security problems in Borabu Division, Nyamira District. It focuses on the concept of the relationship between population growth and land use. Secondly, it examines the influence of changing patterns of land ownership on land use and its impact on food availability. Thirdly, the paper investigates the impact of population growth on land use highlighting such issues as land devoted to food crop production, pasture and cash crop. The paper further examines the impact o~ male out-migration on land use. Finally, the paper highlights some of the major problems associated with land use for instance, labour shortages, lack of credit facilities, type of farm implements used, overutilization of land, limited extension services, and extinction of indigenous crops. Last but not least the paper endeavours to come up with valid conclusions and recommendations regarding these problems. The data for this paper was derived from observations as a member of the Abagusii community, an intensive review of recent studies carried out in the area, and some key informants. This information has been critically examined in this paper hence it gives us a clear picture of the problems of food production in this part of Nyamira DistrictItem Role of child health clinics in promoting use of insecticide-treated nets among children under five years in Nyamira district, Kenya.(East Afr Med J., 2006-08) Osero, O.J.S.; Otieno, Micheal Frederick; Orago, A. S.BACKGROUND: Maternal child health clinics are the ideal places to meet and sensitise all the mothers with children under five years on the use of insecticide-treated nets in the prevention of malaria. OBJECTIVE: To determine whether child health clinics are promoting the use of insecticide-treated nets in malaria prevention among children. DESIGN: Cross-sectional, descriptive study. SETTING: Eight health centres in Nyamira District. SUBJECTS: Four hundred mothers bringing their children aged five years and below to the child health clinics between August and October 2003. RESULTS: Two hundred and eighty four mothers (71%) had not received any information on the use of insecticide-treated nets while at the MCH clinics. Only 50% of the clinics had bed nets/ITNs posters mounted on their premises. Out of those clinics with posters, only in 50% of them had bed net posters seen. Very few mothers (36.2%) had seen the bed net/ITNs posters. None of the healthcare providers used bed net/ITNs posters to educate the mothers. None of the insecticide-treated net leaflets were issued. CONCLUSION: Despite the fact that maternal child health clinics were well placed in promoting the use of insecticide-treated nets to the mothers who brought their under five year children, very little was being done to this effect. MCH clinics need to be more aggressive in motivating mothers to use insecticide-treated nets.Item Malaria vector control practices in an irrigated rice agro-ecosystem in central Kenya and implications for malaria control(Malaria Journal, 2008) Ng'ang'a, Peter Njoroge; Shililu, Josephat; Jayasinghe, Gayathri; Kimani, Violet; Kabutha, Charity; Kabuage, Lucy W.; Kabiru, Ephantus W.; Githure, John; Mutero, CliffordBackground Malaria transmission in most agricultural ecosystems is complex and hence the need for developing a holistic malaria control strategy with adequate consideration of socio-economic factors driving transmission at community level. A cross-sectional household survey was conducted in an irrigated ecosystem with the aim of investigating vector control practices applied and factors affecting their application both at household and community level. Methods Four villages representing the socio-economic, demographic and geographical diversity within the study area were purposefully selected. A total of 400 households were randomly sampled from the four study villages. Both semi-structured questionnaires and focus group discussions were used to gather both qualitative and quantitative data. Results The results showed that malaria was perceived to be a major public health problem in the area and the role of the vector Anopheles mosquitoes in malaria transmission was generally recognized. More than 80% of respondents were aware of the major breeding sites of the vector. Reported personal protection methods applied to prevent mosquito bites included; use of treated bed nets (57%), untreated bed nets (35%), insecticide coils (21%), traditional methods such as burning of cow dung (8%), insecticide sprays (6%), and use of skin repellents (2%). However, 39% of respondents could not apply some of the known vector control methods due to unaffordability (50.5%), side effects (19.9%), perceived lack of effectiveness (16%), and lack of time to apply (2.6%). Lack of time was the main reason (56.3%) reported for non-application of environmental management practices, such as draining of stagnant water (77%) and clearing of vegetations along water canals (67%). Conclusion The study provides relevant information necessary for the management, prevention and control of malaria in irrigated agro-ecosystems, where vectors of malaria are abundant and disease transmission is stable.Item Distribution of mosquito larvae within the paddy and its implication in larvicidal application in Mwea rice irrigation scheme, Central Kenya.(International Centre for Insect Physiology and Ecology, 2008-03) Mwangangi, J.M; Muturi, E. J.; Shililu, J. I.; Jacob, B.; Kabiru, Ephantus W.; Mbogo, C.M.; Githure, J.I.; Novak, R.J.Distribution of mosquito larvae in inundated rice fields is poorly known despite its profound implications in implementation of vector control programs. Based on oviposition behavior of gravid females and biotic and abiotic conditions of the rice field, distribution of mosquito larvae within the paddy may vary greatly. As a guide to implementation of mosquito vector control program targeting the aquatic stages in the rice fields in Mwea, studies were conducted to determine the distribution of mosquito larvae within the paddy. Twenty-eight cages measuring 50 cm3 were distributed randomly within the paddy during the transplanting stage of the rice growth cycle, and were examined twice per week up to the flowering stage to determine mosquito oviposition pattern. A total of 17,218 mosquito larvae were collected at the periphery and a further 17,570 at the center of the paddy. These comprised 7,461 larvae from the genus Anopheles and 27,327 from genus Culex. The number of pupae collected at the periphery was 1,004 and 1.5 times greater than the number collected at the center. Significantly higher counts of Anopheles larvae were collected at the center (1.00 +/- 0.11) than at the periphery (0.55 +/- 0.05) of the paddy during transplanting stage, but the difference was not significant during the tillering stage. In contrast, significantly higher numbers of Culex larvae were collected from the periphery (3.09 +/- 0.39) than at the center (2.81 +/- 0.24) of the paddy. More pupae were also collected at the center than at the periphery of the paddy. These findings indicate the distribution of Anopheles and Culex larvae in rice fields to be nonrandom; however, for successful achievement of an integrated vector control program targeting the diverse mosquito fauna occurring in rice fields, there is need to target the whole paddy for larvicidal application.Item The risk of pathogenic intestinal parasite infections in Kisii Municipality, Kenya(BMC Public Health, 2008-07-14) Nyarango, R. M.; Aloo, P. A.; Kabiru, Ephantus W.; Nyanchongi, B. O.Background: Intestinal parasitic infections are among the most common Infections worldwide.Various epidemiological studies indicate that the prevalence of intestinal parasites is high especially in developing countries, although in many of these, the environmental risk factors have not been clearly elucidated. The objective of this study was to determine the risk of pathogenic intestinal parasites infections in Kisii Municipality. Methods: Random sampling was used in the selection of the study samples. Stool parasitological profiles of food handlers were done by direct smear and formalin-ethyl acetate sedimentation method. Both vegetable and meat samples were examined for the presence of intestinal parasites. The storage and meat handling practices of the various butcheries were observed. Results: Types of samples examined for occurrence of intestinal parasites includes, a total of 84 vegetable, 440 meat and 168 stool samples. Fifty five (65.5%) vegetable,334 (75.9%) meat and 69 (41.1%) of the stool samples were found positive for intestinal parasites indicating a high overall risk (66.18%) for intestinal parasite infections. Of the parasites detected, the most common parasites infesting the foodstuffs and infecting the food handlers were Ascaris lumbricoides and Entamoeba histolytica. Parasites were significantly less likely to be present on meat that was refrigerated during display than meat that was displayed at ambient temperature. Conclusion: There is a high risk of infection with intestinal parasites in the sampled Municipal markets. About half of the food handlers surveyed (41.1 %) at the Municipal Hospital had one or more parasitic infections. Furthermore, meat (65.5%) and vegetables (75.9%) sold at the Municipal market were found to be contaminated with parasites hence the inhabitants requires a need for education on food safety, good distribution practices and improvement on sanitary conditions.Item Clinical competence of nursing graduates in Kenya(African Journal of Midwifery and Women's Health, 2009-04) Kabiru, Ephantus W.; Chege, Margaret Njambi; Karani, Anna; Derese, AnsellmeThe objective was to compare the clinical competence of nurse graduates of two curricula tracts. At the time of the study Kenya Medical Training College (KMTC) had an innovative skillslab-integrated curriculum for Kenya registered community health nurses trained in Nairobi and a traditional lecture-based curriculum for those trained elsewhere. 288 nurse graduates were recruited for the study. Two clinical skills were randomly selected for evidence-based performance. Indicators of competence were identified through Delphi study. Approval to conduct the study was obtained from Ministries of Health and Education and joint University of Nairobi, Kenyatta National Hospital Ethics and Research Committee. Data were collected through evidence-based performance, in-depth interviews and focus group discussions (FGDs). Data input and analysis were done using Excel Version 2003-97. There was significant difference (_2=65.988, p<0.001) in performance between graduates of the two methodologies. Those of the skillslab-based curriculum were described as critical thinkers. Those of the control group were described as better ward managers. The skillslab graduates consistently scored higher in all indicators of competence and across the components of nursing expertise.Item Use of insecticide treated nets among caregivers of children under five years in Makueni District, Kenya.(East African Medical Journal, 2009-07) Mwanzo, I.J.; Malusha, J.M.; Yitambe, A.; Mbugi, J.P.BACKGROUND: Insecticide treated nets (ITNs) have been identified as a key strategy in addressing malaria problem among young children and pregnant women. Their utilisation among under fives, however, have been found to be low in some areas. OBJECTIVE: To identify factors affecting net utilisation (sleeping under insecticide treated net) among caregivers of under fives in Makueni District in Kenya. DESIGN: A cross-sectional, descriptive study. SETTING: Eight sub-locations in Wote division Makueni district. SUBJECTS: Four hundred caregivers of children aged five years and below. RESULTS: The results indicated that 88.5% of caregivers were aware of ITNs. The proportion of households with children below five years that owned mosquito net were found to be 46.2%, and only 32.0% had at least a treated net. Slightly more than half of treated nets were used by under fives (52.2%) compared to 47.8% used by children over five years including adults. The main reason cited by majority of caregivers as a hindrance to net utilisation was lack of treated nets in households (72.3%). Utilisation of ITNs by under five children was found to be positively associated with knowledge of ITNs (p = 0.024), marital status (p = 0.018) and occupation (p = 0.043). CONCLUSION: Utilisation of ITNs by under fives was low despite high level of awareness among caregivers. Factors such as awareness of ITNs, marital status and occupation significantly affected ITNs utilisation. Although the government with support from other stakeholders has recently embarked on large scale distribution of nets in high risky districts, more interventions from various stakeholders are needed to increase availability and accessibility of subsidised permanently treated nets, including interventions to address non-compliance to proper utilisation of nets. There is also need for intensive education emphasising on their proper and consistent use. Scaling up proper use of ITNs along with other initiatives can contribute significantly in reducing malaria.Item Anopheles larval abundance and diversity in three rice agro-village complexes Mwea irrigation scheme, central Kenya(Malaria Journal, 2010) Mwangangi, J. M.; Shililu, J.; Kabiru, Ephantus W.; Muturi, E. J.; Muriu, S.; Jacob, B.; Mbogo, C. M.; Githure, J.; Novak, R. J.BACKGROUND: The diversity and abundance of Anopheles larvae has significant influence on the resulting adult mosquito population and hence the dynamics of malaria transmission. Studies were conducted to examine larval habitat dynamics and ecological factors affecting survivorship of aquatic stages of malaria vectors in three agro-ecological settings in Mwea, Kenya. METHODS: Three villages were selected based on rice husbandry and water management practices. Aquatic habitats in the 3 villages representing planned rice cultivation (Mbui Njeru), unplanned rice cultivation (Kiamachiri) and non-irrigated (Murinduko) agro-ecosystems were sampled every 2 weeks to generate stage-specific estimates of mosquito larval densities, relative abundance and diversity. Records of distance to the nearest homestead, vegetation coverage, surface debris, turbidity, habitat stability, habitat type, rice growth stage, number of rice tillers and percent Azolla cover were taken for each habitat. RESULTS: Captures of early, late instars and pupae accounted for 78.2%, 10.9% and 10.8% of the total Anopheles immatures sampled (n = 29,252), respectively. There were significant differences in larval abundance between 3 agro-ecosystems. The village with 'planned' rice cultivation had relatively lower Anopheles larval densities compared to the villages where 'unplanned' or non-irrigated. Similarly, species composition and richness was higher in the two villages with either 'unplanned' or limited rice cultivation, an indication of the importance of land use patterns on diversity of larval habitat types. Rice fields and associated canals were the most productive habitat types while water pools and puddles were important for short periods during the rainy season. Multiple logistic regression analysis showed that presence of other invertebrates, percentage Azolla cover, distance to nearest homestead, depth and water turbidity were the best predictors for Anopheles mosquito larval abundance. CONCLUSION: These results suggest that agricultural practices have significant influence on mosquito species diversity and abundance and that certain habitat characteristics favor production of malaria vectors. These factors should be considered when implementing larval control strategies which should be targeted based on habitat productivity and water management.Item The Influence of Gender-Related Factors on Access to Antiretroviral Therapy in Nairobi, Kenya(East and Central African Journal of Pharmaceutical Sciences, 2010) Kamau, Richard T.; Mwanzo, Isaac O.; Gikonyo, Nicholas K.This is a research report of a study set out to investigate the influence of gender related factors on access to antiretroviral therapy. The results showed that the number of females visiting ART clinics was twice that of males, and in the 18-26 years age bracket, females were 3 times more affected by HIV/AIDS than males. The marital status carried a 5-fold risk of carrying the AIDS virus while women were twice as likely to be infected by their husbands as compared to men getting the virus from their wives. The findings indicate that the lower the formal education, the higher the chances of carrying the virus. The findings suggest men had a significant advantage over women on access to ARVs. The clinic schedules precluded about 10% of the patients from access. Social stigma was low (approx. 10%) within spouses, and very high (approx. 90%) outside the institution of marriage. Women bore the larger burden of the stigma. In addition, the results suggest that gender segregated clinics would have no influence on the number of patients attending the clinicsItem Community Perceptions and Response to Flood Risks in Nyando District, Western Kenya(Journal of Disaster Risk Studies, 2010-06) Nyakundi, Hellen; Mogere, Stephen; Mwanzo, Isaac; Yitambe, AndreIn Kenya, the ability of local people to resist the impact of disasters has not been given adequate attention. A descriptive cross sectional study sought to investigate community perceptions and responses to flood risks in low and high risk areas of the Nyando District, Western Kenya. A total of 528 households, six government officials and five project managers of Community Based Organizations (CBOs) and Non Governmental Organizations (NGOs) were interviewed. Additionally, seven Focus Group Discussions (FGDs) involving three women, two male and two teacher groups were conducted. Data were analysed using the Statistical Package for the Social Sciences (SPSS) Program. The Chi-square test was used to de- termine associations and differences between variables. In the study, 83% of the respondents were aware of Traditional Flood Knowledge (TFK) and 80% acknowledged its use. Perception of the risk is influenced by several variables, most notably past experience of major floods and having survived them. Residents in the high risk areas had significantly higher levels of awareness and use of traditional flood knowledge. They were more aware of the nature of the flood related health risks they were exposed to and appeared better prepared for future flood risk. They were, however, more dependent on external aid. On the other hand, residents living in the low risk area reported better success with their response mechanisms.Item Microgeographic variations in Burkitt's lymphoma incidence correlate with differences in malnutrition, malaria and Epstein–Barr virus(British Journal of Cancer, 2010-11-23) Sumba, P. O.; Kabiru, Ephantus W.; Namuyenga, E.; Fiore, N.; Otieno, Richard O.; Moormann, A. M .; Orago, A. S.; Rosenbaum, P. F.; Rochford, R.Background: Endemic Burkitt's lymphoma (eBL) has been associated with Epstein–Barr virus (EBV) and holoendemic Plasmodium falciparum malaria. But recent evidence suggests that other risk factors are involved. Methods: We hypothesised that selenoprotein glutathione peroxidase (GPx), a surrogate of nutritional status, is an important biomarker for eBL risk. We measured plasma GPx, anthropometric markers of malnutrition, EBV viral loads and malaria parasitaemia in children aged 1–9 years (n=258) from two locations in Nyanza Province, Kenya, with higher-than-expected and lower-than-expected incidence of eBL. The study participants were malaria asymptomatic children from the community. Results: Children from eBL high-incidence areas had significantly lower GPx levels, high EBV viral load and more evidence of chronic malnutrition than children from eBL low-incidence areas (all P<0.001). Additionally, GPx levels were significantly lower in children with the highest EBV viral load and for those with P. falciparum infections (P=0.035 and P=0.004, respectively). Conclusions: These results suggest that selenium deficiency may be a risk factor for eBL.Item The Enhancement of East African Universities Contribution Towards the Attainment of Millenium Development Goal-5 Improving Maternal Health(Save the mothers.org, 2011) Ssonko, M.; Angina B. M. O.; Namuyonga, F.; Nakabembe, E.; Kakembo, F.`; Muyonga, F.; Kakembo, F.Item Factors associated with default from treatment among tuberculosis patients in nairobi province, Kenya: A case control study(BioMed Central, 2011) Muture, B.N.; Keraka, M.; Kimuu, P. K.; Kabiru, Ephantus W.; Ombeka, V.O.; Oguya, F.Background: Successful treatment of tuberculosis (TB) involves taking anti-tuberculosis drugs for at least six months. Poor adherence to treatment means patients remain infectious for longer, are more likely to relapse or succumb to tuberculosis and could result in treatment failure as well as foster emergence of drug resistant tuberculosis. Kenya is among countries with high tuberculosis burden globally. The purpose of this study was to determine the duration tuberculosis patients stay in treatment before defaulting and factors associated with default in Nairobi. Methods: A Case-Control study; Cases were those who defaulted from treatment and Controls those who completed treatment course between January 2006 and March 2008. All (945) defaulters and 1033 randomly selected controls from among 5659 patients who completed treatment course in 30 high volume sites were enrolled. Secondary data was collected using a facility questionnaire. From among the enrolled, 120 cases and 154 controls were randomly selected and interviewed to obtain primary data not routinely collected. Data was analyzed using SPSS and Epi Info statistical software. Univariate and multivariate logistic regression analysis to determine association and Kaplan-Meier method to determine probability of staying in treatment over time were applied. Results: Of 945 defaulters, 22.7% (215) and 20.4% (193) abandoned treatment within first and second months (intensive phase) of treatment respectively. Among 120 defaulters interviewed, 16.7% (20) attributed their default to ignorance, 12.5% (15) to traveling away from treatment site, 11.7% (14) to feeling better and 10.8% (13) to sideeffects. On multivariate analysis, inadequate knowledge on tuberculosis (OR 8.67; 95% CI 1.47-51.3), herbal medication use (OR 5.7; 95% CI 1.37-23.7), low income (OR 5.57, CI 1.07-30.0), alcohol abuse (OR 4.97; 95% CI 1.56- 15.9), previous default (OR 2.33; 95% CI 1.16-4.68), co-infection with Human immune-deficient Virus (HIV) (OR 1.56; 95% CI 1.25-1.94) and male gender (OR 1.43; 95% CI 1.15-1.78) were independently associated with default. Conclusion: The rate of defaulting was highest during initial two months, the intensive phase of treatment. Multiple factors were attributed by defaulting patients as cause for abandoning treatment whereas several were independently associated with default. Enhanced patient pre-treatment counseling and education about TB is recommended.