PHD-School of Public Health
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Item Effectiveness of Albendazole on Soil Transmitted Nematodes Among School Going Children in Kakamega County, Kenya(Kenyatta University, 2020-02) Ngonjo, Teresia WambuiSoil-Transmitted Nematodes (STNs) are roundworms transmitted through faecally contaminated soil. Globally, major STNs include Ascaris lumbricoides, Trichuris trichiura and hookworm (Necator americanus and Ancylostoma duodenale). School going children are mostly affected by STN infections. STNs cause malnutrition, intellectual retardation and cognitive deficits. They are distributed worldwide, Kenya included and they are of public health importance. Kenya has embarked on mass deworming programs since 2012.The study is entrenched in school mass deworming programs. Kakamega county has high edemicity of STNs and treatment using albendazole has been going on since 2009. The main objective of the study was to determine the effectiveness of a single 400 milligram dose of albendazole against STNs infections. A longitudinal study was conducted in selected public primary schools selected through random sampling from three randomly selected sub counties, Kakamega East, Kakamega Central and Kakamega South in Kakamega County, in Kenya. A structured checklist was used to establish demographics of the school pupils and schools’ WASH conditions. Kato Katz technique examined STN infections both at baseline and follow up survey. The prevalence of infection was determined as the percentage of children that tested positive for each STNs species to the total number of children examined. Intensity of infection was determined using Arithmetic mean of the number of eggs per gram of feaces. A total of 731 children in baseline from seven primary schools provided stools and were examined for STN infections. A post treatment survey was conducted after two weeks where total of 665 children were examined. Effectiveness of albendazole was analyzed using prevalence reduction and the fecal egg reduction rate (ERR). Data was analyzed using STATA version 12.0. Associations were assessed between WASH predictors and STNs; Infection prevalence of either gender or age group was analysed using Pearson chi-square test. Infection mean intensity was assessed using two sample independent t- test and significance for age group was assessed using ANOVA test. Prevalence of infections based on 95% CIs was calculated using binomial logistic regression. Arithmetic mean expressed mean egg counts and negative binomial regression model estimated mean intensity. At baseline, STNs prevalence was 44.0% (95% CI: 35.8 – 54.2). Common STN was Ascaris lumbricoides. 43.5%. The baseline STN mean intensity was 3674 eggs per gram. There was significant prevalence reduction of combined STN prevalence infection to 2.3% (PR=94.9%, P=0.001). STNs mean intensity was significantly reduced from 3674 epg to 59 epg (ERR=98.4%, P=0.001). Prevalence of T. trichiura significantly reduced, 0.8% to 0 (100%, P<0.001). Pupil latrine ratio was significantly associate with STN infection intensity (χ2 = 3.7333, df=1, p=0.047).Imroved water source was not significantly associated with both lower infection prevalence (χ2 = 0.875, df = 1, p=0.350) or intensity (χ2 = 0.1944, df = 1, p=0.659). Hand-wash facility with water and soap did not associate with both lower infection prevalence (χ2 =0.4667, p=0.495). In this study, mass treatment with Albendazole was highly effective on the STNs. These findings are important to Ministry of Health and Ministry of Education in assessing the national deworming guidelines and policies. Mass Deworming programmes be extended to communities to ensure all possible transmission focal points are covered.Item Treatment of Moderate Acute Malnutrition Using Plumpy Sup among Children Aged 6 to 59 Months in Turkana County, Kenya(Kenyatta University, 2022) Majwa, Philimon Omondi; Margaret Keraka; Sophie OcholaIn Kenya, 26% of children are moderately stunted, 11.4% severely stunted, 6.7% moderately underweight, 2.6% severely underweight, and 13.0% moderately wasted, with 2.5% severely. In Turkana County, 25.6% of children are moderately stunted, and 17.4% are moderately wasted. Plumpy Sup is used to treat moderate acute malnutrition through the supplementary feeding programme. With the increased reports of relapse and overstay of children aged 6 to 59 months in the supplementary feeding programme, there is limited documentation of the effectiveness of plumpy sup in a community-based programme in Turkana county. This prospective cohort study assessed the effectiveness of Plumpy sup in the management of moderate acute malnutrition among 300 children aged 6 to 59 months in Turkana central sub-county. The study employed stratified and multistage sampling, with data collected via desk review, key informant interviews, focused group discussions, and household interviews. Data on child morbidity status was collected using a two -week-day recall period, while a 24-hour dietary recall was used to collect data on the type and amount of food that the child consumed. Nutrient analysis was done using the Nutri-surv software in conjunction with the Kenya Food Consumption Table. Descriptive and inferential statistics were used to analyze the variables of interest. Survival analysis and log-rank test were used to establish the recovery rate of the children. At the 90th day, the mean energy intake, 556.1±56.9 kcal per day, of children aged six to 11months was below the recommended daily allowance of 675 to 806 kcal; Protein intake for children aged 6 to 11 months was 11.3±3.9 g per day; while Carbohydrate intake was 74.3±5.7 g per day, all below the recommended daily allowance. Morbidity prevalence was high (76.3% at baseline) at with 39.3% suffering from malaria, 21.7% from diarrhoea, and 7.7% from an eye infection.. Access to water and sanitation services from baseline to day 90 was statistically significant except for treatment with traditional herbs. The median day to recovery was 84 days for females and 70 days for males. The difference observed in recovery rate between males and females was not statistically significant. There was a significant relationship between caregivers’ socioeconomic status and the recovery rate of children on day one and day 42. There was no statistically significant difference in caregivers’ attitude on IYCF and recovery rate for all the days. There was no statistically significant association, all p>0.05, between the effectiveness of Plumpy sup and the morbidity status of the child. On factors affecting the effectiveness of Plumpy sup, a full model containing all predictors was statistically significant, χ2 (8, N=300) = 17.847, p=0.022; the model could distinguish between children who recovered and those who did not recover.