MST-Department of Public Health

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Acccess and Utilization of Artemether Lumefantrine as First Line Non-over the Counter Treatment for Malaria in Masii Division, Mwala District, Kenya
(2012-04-18) Kioko, Jonathan M.; Mwanzo, I.; Mbugi, J. P.
Prompt and appropriate case management has remained a major challenge in the fight against malaria in Kenya especially due to limited timely access to recommended drugs and development of resistance to drugs by malaria parasites among other reasons. As a result, Kenya changed from chloroquine to Sulphur-pyremethamine (SP) based drugs in late 90's and in April 2006 to Artemether Lumefantrine (AL) as the first line antimalarial drug which is an Artemisinin based Combination Therapy (ACT). The main difference between the current first line treatment drug and the former ones is that it is restricted from being dispensed by shopkeepers at community level. Since the introduction of this drug in April 2006, no study has been conducted to establish levels of communities' timely access to the drug. This study therefore explored health seeking behaviour of selected residents of Masii Division, Mwala District in order to establish how this restriction affected timely access and utilization of AL for malaria treatment. A cross sectional study design was adopted and multi-stage sampling technique used. A total of 350 respondents who had suffered from malaria since October 2007 (for ease of recalling) were sampled and interviewed. Qualitative data was collected through Focus Group Discussion (FGDs) sessions and summarized in tables for report compilation while quantitative data was analyzed using SPSS computer package. Out of the sampled respondents, 86.6% took or administered drugs to children when they suffered from malaria. The drugs/ treatment substances were sourced from medical facilities (76.6%), chemists/ pharmacies 14%, shops 5.7%, traditional healers / herbalists 4.3%, prepared / used drug remains at home 2.3%, borrowed drugs from neighbors 0.6%, from both health facility and herbalists 0.6% while 6.3% took no action. Association between seeking treatment from health facilities and utilizing AL for malaria treatment had strong statistical significance. Out of the 303 people who used drugs only 8.9% (27) took AL and adhered to prescription. Of those respondents who visited health facilities, slightly less than half (41.4%) got all the anti-malarial drugs. Majority (77.1 %) of the respondents reported to have at least one bed net in their households while the rest (22.9%) did not have. Access to health facilities was found to be average as 54.6% of the respondents took one hour or less to get to the nearest health facility. However, there was no statistically signi ficant association between access to health facilities and utilization of AL for malaria treatment. Only 5.7% of respondents knew the correct first line treatment for malaria. Knowledge of AL as the first line treatment for malaria and its utilization for malaria treatment had statistically significant association. In conclusion access and utilization of AL for malaria treatment was very low in the area and malaria continues to pose a major challenge to the community. There is therefore need for extensive awareness creation on signs and symptoms of malaria and promotion of AL utilization for malaria treatment in the community. Further, integrated malaria prevention approaches need to be embraced for effective reduction of malaria burden as there is no single magic bullet.
Access and quality of services in the prevention of mothers to child transmission of HIV in public health institutions in Thika district, Kenya
(2011-11-21) Gitau, David K.; Alloys S. S. Orago; Kabiru, Ephantus W.
PMTCT of HIV has become an important intervention for prevention and control of HIV and AIDS in developing countries. MTCT is the most significant source of HIV infection in children below the age of 15 years, with approximately 2.5 million living with HIV and AIDS worldwide. Sub-Sahara Africa contributes 2.2 million of those living with HIV and AIDS globally. The prevalence rate of HIV in adults aged 15-49 years was estimated at 5.1 % in Kenya in 2006 and in pregnant women attending ANC clinics in Thika district stood at 5%. Public health facilities are challenged to adequately offer PMTCT services due to various constraints leading to loss of intervention opportunities which contribute to the high prevalence of HIV and AIDS in children. The objectives of this study were to determine the level of access and quality of PMTCT services and factors that influenced both in Thika District. The study population comprised of women of child bearing age (15-49 years) attending MCH clinics who were interviewed at the exit. Quantitative data was collected using structured face to face interview schedule and questionnaire and qualitative data through observation checklist, FGDs and key informant interviews. SPSS and MS Excel computer softwares were used to manage data. Descriptive statistics was used and computation of derived values used in data analysis. PMTCT of HIV services are accessed through attending ANC clinics, visiting a VCT centre, at the maternity, and CCC. In the study, distance from home to health facilities was not associated with antenatal clinic attendance (x2 =.728; df =1; p>0.05). No relationship was established between clinic attendance and testing (x2 =1.370; df =1; p>0.05) and frequency of attendance and testing (x2=2.980; df =1; p>0.05). Uptake of testing was higher in urban than in rural health facilities (x2=14.436; df =3; p<0.05).Younger clients (1524) were more receptive to testing than older clients (x2=8.546; df =2; p<0.05). ARV prophylaxis is a core intervention in PMTCT of HIV. Nevirapine was the only ARV being offered to infected mothers and infants at health facilities in the district during the study period beside cotrimoxazole for prevention of OIs. Occasional shortages were reported. Breastfeeding is a proved mode of MTCT of HIV. Respondents who reported breast problems and were breastfeeding were (19) 54.3%. The HIV infected were less likely to breastfeed (x2=34.942; df =1; p<0.05) and were more likely to practice exclusive replacement feeding as compared to the uninfected women (x2=52.721; df =2; p<0.05). All study sites offered free FP services and resources were available. Any effective FP method together with the condom is recommended for the HIV infected. In this study, FP method use was found to be influenced by marital status and occupation. Those married adopted FP method use more than others (x2=39.059; df =4; p<0.05) and professionals used FP methods more than others. Knowledge of where to find PLWHA support groups was higher in those who were visited by a health worker or a PLWHA since delivery (x2=8.109; df =1; p<0.05). Women who had involved their spouses in VCT highly influenced them to seek for these services (x2 =67.156; df =2; p<0.05) and were more likely to know where to seek for emotional support (x2= 4.846; df =1; p<0.05). Overall access to services was 16.7% and quality 12.5%. Consistent, sustainable availability of basic resources and standardized and knowledge based provision of care and follow up services underlined the quality of PMTCT of HIV services. Conclusions point to the need for policy and practical interventions that focus on enhancing access and quality of these services. The results from this study will assist policy makers, service providers and the wider community in scaling up PMTCT of HIV services for greater access and better quality.
Adherence to antimalarial combination therapy with artemether-lumefantrine in childre below five years in Embu district, Kenya
(2011-11-03) Njeru, Elijah Mbiti
Malaria is a major public health challenge in Kenya especially among young children and pregnant women. It accounts for 30% of all outpatient attendances, 19% of all admissions and leads to 20% of all deaths in children aged below five years. Despite much effort to fight malaria, the efforts have been undermined by malaria parasites that develop resistance to the commonly available malaria drugs. Since a new antimalarial drug, Artemether - Lumefantrine (AL) was introduced in Kenya in the mid 2006, not much has been known about how this new drug has been used by patients. A descriptive cross sectional study was therefore carried out between April and May 2008 to assess adherence to AL in children below the age of five years in Embu District. Purposive and random sampling procedures were used to select the study site and subjects. Data was collected at the Embu Provincial General Hospital and in Gatunduri, Dallas and Itabua dispensaries where a total of 355 caregivers of children treated for malaria with AL were recruited, interviewed using a structured schedule and followed up on the third day of treatment. The results showed that though 73.5% of the caregivers had either good or very good knowledge on malaria, the knowledge on how to take AL had gaps and was inadequate. Whereas 97.5% and 88.2% could tell the correct amount of drug to give and correct schedule respectively, there were deficiencies and knowledge gaps in areas like preparation of AL for the children to take (78.7%), possible side effects (20.3%) and the dietary requirements that go along with AL use (63.9%). Further, the composite adherence was low (46.8%). There was a significant association between adherence and caregivers' knowledge on malaria (P< 0.001), knowledge on the AL dispensing instructions (P = 0.001), occupation of caregiver (P = 0.03), age of caregiver (P = 0.02), vomiting (P = 0.001) and the time the first dose was given (P = 0.001). The study concluded that adherence to AL was low in this setting and rejected the research hypothesis that adherence to AL was satisfactory among children aged below five years in Embu district. To address adherence, the study recommends education to the community to boost knowledge on malaria which was positively associated with adherence, re- training health workers on communication skills for effective counseling on disease and treatment issues and development of communication materials, reinforcing the requirement that all first doses of AL be administered at the health facility before the child left, the children under treatment for malaria with AL should be followed up after 2 days of treatment to monitor the response to treatment and sort out challenges that arose from treatment like replenishing the supply of AL if needed and that the health managers take up adherence to malaria treatment as an urgent challenge and address the factors that hamper adherence.
An analysis of the incidences and causes of road traffic accidents in kisii central district-Kenya
(2011-12-16) Osoro, Alfred Amenya
Road Traffic Accidents (R T As) are an emerging public health problem worldwide with over 1.2 million deaths and 10 million injured or crippled annually. Globally, road traffic accidents are the ninth leading contributor to the burden of disease and the tenth leading cause of death by injury. Deaths from injuries are projected to rise up to 8.4 million worldwide by 2020. In developing countries, accidents are common and yet remain underreported mainly due to inaccurate statistics on road deaths. In Kenya, over 3000 lives are lost and more than 3000 are left with serious disabilities annually due to RTAs. This study was undertaken to establish the incidence and causes of RTAs and their impact on public health in Kisii Central District - Kenya, as well as assess the effect of the new traffic amendment rules of November 2003 on the state of RTAs. A total of 393 respondents comprising of fifteen traffic police officers, fifty one motor vehicle drivers, two hundred ninety seven road users and thirty accident victims who were undergoing treatment at the time of the study were used for data collection. This was a cross-sectional study, which used questionnaires, interview schedules and focus group discussions to collect data. Among the nonmotorist road users, 65.7'% were males, while 34.3% were females. For the drivers, 90.2% were males while 9.8% were females (x ,2 = 98.412, (df' = 2, P =- 0.0005). Seventy-four point five percent of drivers had a previous history of RTAs while 25.5% had none. Vehicles causing traffic accident included matatus (73.4%), buses (13.3%), saloon cars (10%) and landrovers (3.3%). Contributory factors reported by road users included human errors (59.6%), defective roads (19.50'0) while twenty nine point nine percent were attributed to defective vehicles (x2 = 98.412, df = 2, P = 0.0005). Police records showed that RTAs were caused by: human errors (66.7%) defective vehicles (13.3%), and other road users (6.7%). Over-speeding, overtaking, overloading and police leniency was significantly associated with RTAs (x2 = 42.221, df = 3, P = 0.0003). Methods of preventing RTAs suggested by study participants included observing and enforcement of traffic rules (19.6%), avoiding over-speeding and overtaking carelessly (18.8%), avoiding overloading (17.1`%), stopping drunk driving (11.2%), designing and constructing good roads (6.6%) and training and retraining of drivers (3.6%) as significant factors which can help in the prevention of RTAs. The results of this study have shown that Matatus and buses are the leading categories of vehicles causing accidents in Kisii Central District. Factors contributing to these accidents include: human errors, defective vehicles, and bad reads. It is imperative that this information is availed to the public so that concerted effort is made by all stakeholders to curb road carnage. This study suggests that policy makers, development partners and insurance firms can use findings to formulate sound road policy, which can reduce mortality in our roads.
Assesment of the needs of orphaned and vulnerable children within central division, Mwingi District Kenya
(2011-11-17) Mwende, Patricia Nzilu
The number of Orphaned and Vulnerable Children in the world is expected to rise to 25 million by the year 2010. In Kenya, the number of orphans is expected to rise to 2 million by 2010. These children have limited access to physical, psychosocial and economic support thus making them among the most vulnerable of our society. A cross-sectional study was carried out to assess the needs of Orphaned and Vulnerable Children (OVC) within Central Division of Mwingi District, Kenya. A total of 400 orphans and 90 caregivers were included in the study. The study set out to determine the needs, factors influencing provision of needs and the constraints in the provision of needs of these children. Data was collected using pre-tested structured open-ended questionnaires for orphans and caregivers. SPSS was used for analysis and Chi-square test for goodness-of-fit was used to test for the relationship between variables. The results indicated that, 61.1% of the caregivers and 51.0% OVC were females. Most OVC (51.0%) were aged 11 to 15 years and 58.0% had been orphaned for over 3 years. Majority (36.7%) of the care givers were aged 41-50 years and 62.2% were unemployed. Majority (85.0%) of the OVC attended school with no significant difference between girls and boys in school attendance (p> 0.05). The reasons for not attending school were: lack of school uniforms, school levies, looking after other siblings and working in order to earn income to feed the family. Most OVC (42.0%) rarely or occasionally (41.0%) fell sick. The most prevalent disease condition was malaria (43.0%) and coughing (18.0%). The health seeking behaviour of the OVC was good with the majority (91.0%) attending hospital when sick while only (9.0%) did not. The reasons for lack of medical care were: lack of drugs in hospital (100.0%), lack of money for medical fee (87.5%) and overcrowding in the hospitals (87.5%). There was a significant relationship between gender and taking OVC for regular medical check up (P(0.05). Majority of the caregivers (94.4%) who did not take OVC for under their care for regular medical check up were females as compared to the males (77.1%). There was a significant association between lack of medical care for OVC and the care givers occupation, education level and the number of children in the household at (P<0.05). Physical needs of the OVC were food (77.0%), clothing (76.0%), and shelter (30.0%). Food needs of the OVC were met by relatives (52.0%), grandparents (36.0%), mothers (35.0%) and the government (30.0%). The psychosocial needs of the OVC were parental guidance (36.0%) love and affection (16.0%). There was a significant difference between the gender of OVC and the psychosocial needs at (p P<0.05). Over 26% of caregivers had children who had been discriminated. However OVC had mostly experienced discrimination in school (100.0%) and when playing with other children (58.3%) out of school. The findings of this study are important in the formulation of policies regarding orphaned and vulnerable children. In addition, this study will be of use to social service providers in planning, Implementation, monitoring and evaluation of effective service delivery to the orphaned and vulnerable children.
Assessment of factors determining the choice of birth attendant in Kisau division, Makueni district, Kenya
(2011-08-09) Mutea, Nduku Lilian
The Kenya Demographic Health Survey (KDHS) 2008 showed that maternal mortality in Kenya is estimated at 488/100,000 live births, and that pregnancy related complications are the leading cause of death (27%) among women of childbearing age (CBS, 2008). Although 92% of women receive antenatal care at least once during pregnancy, a skilled attendant assists only 44% of mothers during childbirth. Therefore, the purpose of this study was to assess the factors determining the choice of birth attendant in Kisau Division, Makueni District. The specific objectives of the study were to: establish the level of utilization of Skilled Birth Attendants (SBAs) and Traditional Birth Attendants (TBAS) in the study population, examine the effects of socio-economic and demographic characteristics on choice of birth attendant, establish the role of TBAS in choice of a birth attendant and determine strategies that can be used to improve skilled birth attendance in the study population. The study adopted a descriptive survey design and the eligible respondents were women who had delivered in the previous 12 months. All women who delivered in health facilities and at homes in the previous 12 months were listed down in a sequential order from the latest to the oldest date of delivery, using records from the health facilities, chiefs, assistant chiefs, Community Health Workers (CHWs) and TBAs. Systematic random sampling method was used to identify participants for the study. Data was collected using interview schedules and Focus Group Discussions (FGD). CHWs, TBAs, religious leaders and the provincial administration assisted the researcher in tracking the study participants in their homes. A total of 315 women from Kisau division were interviewed, and 3 focus group discussions composed of health professionals, TBAs and local opinion leaders conducted. Secondary data was also obtained from health facility records in the study population. Data analysis was done using descriptive statistics and by applying Statistical Package for Social Sciences (SPSS). Data was then organized and presented by use of tables, bar graphs, pie charts and prose forms. The study established that majority of women (52.7%) in the study population delivered with TBAs assistance, and that utilization of SBAs was low (42.9%). A Chi-square test to establish if there was a relationship between household income and choice of birth attendant generated x2 =4.229 and a P value of 0.004 at 3 degree of freedom. Education level was also found to be a determinant of choice of birth attendant as the chi square test generated x2 =9.886 and a P value of 0.001 at 2 degree of freedom. The study also established a relationship between distance to health facility and women's choice of birth attendant. The chi square test generated x2 =2.905 and a P value of 0.001 at 2 degree of freedom. The study established that higher utilization of TBAs was because they (TBAs) lived closer to the women, charged lesser fees and allowed different modalities of payment, including payment in kind. SBA utilization was mainly due to perceived safety for both mother and baby. The study also established that TBAs and husbands to married women influenced the women's' decision on choice of birth attendant. The study recommends that government and other stakeholders introduce intense awareness programmes on the benefits of skilled birth attendance and reinforce the policy or, free maternity services at lower levels. The government should also bring maternity services closer to the community and support empowerment of girls and women through education.
Assessment of factors influencing adherence to antiretroviral therapy at Nyeri provincial hospital in Central Kenya.
(2011-08-10) Sumbi, Muthiani Victor
The Nyeri Provincial General Hospital (PGH) was one of the five pilot sites at which the Government of Kenya started providing antiretroviral therapy (ART) to HIV-infected patients in 2003. At this hospital, as in the other pilot sites, there was an increasing number of patients requiring a switch from first line to second line ART drug regimens due to treatment failure. There was little information available on levels of adherence to ART as well as the factors that influence adherence among patients to guide adherence promotion strategies and thus reduce the incidence of virologic and treatment failure. The objective of this study was to assess factors that influence adherence to ART at Nyeri PGH. The study was retrospective and cross-sectional. Two hundred and twenty nine patients were selected from a total of 705 patients who had been active on ART for at least one year and who were on solid drug dosage forms. Stratified random sampling was used to obtain the same relative proportions of adults, paediatrics, male and female respondents in the sample population as in the study population. Semi-structured interview schedules were used to obtain demographic information and patients' views on various dimensions of ART services at the hospital. Pill count data of patients collected over a period covering 3 clinic appointments was used to determine the percentage adherence levels of the patients to ART. For 13% of the patients for whom pill count data was not available, pharmacy refill dates were used to estimate adherence levels. Univariate analysis of various factors was undertaken to examine the odds of adherence and non-adherence to ART with respect to the various factors. Response values and categories were assigned to questions. Patient responses on ART services at the hospital were grouped into four categories: ART Acceptability, ART Accessibility, ART Affordability and ART Availability. The response scores were aggregated per statement and averaged to get mean scores for each category. The mean scores for each category of questions were subjected to correlation analysis to check for the influence of patients' views on their adherence level to ART. The mean adherence rate for all the patients was 92.7% ± 8.5%. The number of patients exhibiting optimal adherence (greater than 95%) to ART was 125, representing 55% of the total patients interviewed. 197 (86%) of the patients exhibited greater than 85% adherence to ART. Only 11 (5%) of the patients sampled had less than 75% adherence to ART. Being busy with household chores and job-related tasks (39%) as well as travelling (21%) were cited by the respondents as the most important factors affecting adherence. Occupation of patient was found to influence adherence with employed patients exhibiting a higher rate of non-optimal adherence (Odds Ratio of non-optimal adherence: 2.64, 95% Cl, 1.3863 to 4.8708, P < 0.005). Age, gender, level of education, marital status and knowledge of HIV disease were not found to significantly affect adherence. On correlation analysis, patients' views on ART availability and ART acceptability were significantly correlated with percentage adherence to ART (Spearman's r = -0.157, P < 0.05 and Spearman's r = 0.255, P < 0.01 respectively). Based on the adherence levels established in this study showing that about 14% of the study population was at an elevated risk of virologic failure, there is urgent need to institute measures to identify those patients with non-optimal adherence to ART and work out strategies to improve their adherence. Particular effort should be made to prepare practical medication taking plans for employed patients initiating ART therapy.
Assessment of factors influencing the nutritional status of under fives living with HIV / AIDS: a case of Lea Toto programme, Nairobi - Kenya
(2011-11-07) Matuli, J.
Factors that influence the nutritional status of under fives living with HIV/AIDS were assessed through a descriptive survey. These factors included feeding practices, health and socio-economic characteristics. The study was carried out at the Lea Toto Programme situated at Kangemi, Nairobi. Purposive sampling was used to select the under fives. Stratified random sampling was done according to age and gender then random sampling done to obtain a proportionate number from each stratum and a sample of ninety children out of a total of two hundred obtained. Data was obtained by use of a semi-structured interview schedule and taking of anthropometric measurements. Data analysis was done by use of the statistical package of social sciences (SPSS) and Epi Info. ANOVA, Pearson's Product Moment Correlation, Chi-square and t-test were used in analysis. Result revealed that sixty of the children were stunted, fourty five were underweight and eighteen were wasted. Foods consumed frequently by the children were carbohydrates in nature. No exclusive breastfeeding was practiced. Fifty six of the children were breastfed for more than two years. 89 babies were weaned on porridge. A (x2) test revealed that there was no significant relationship between stunting and underweight and the number of meals taken by the children but a relationship existed between wasting and number of meals An independent t-test showed a significant difference between underweight and wasting and whether children were breastfed or not. Fourty one of the children had succumbed to diarrhea within one week. Other opportunistic infections include anorexia, Tuberculosis and pneumonia. A (x2) test revealed a relationship between duration of living with HIV/AIDS and nutritional status. There was no relationship between frequency of occurrence of nausea and vomitting and nutritional status. Sixty two of the guardians had attained primary education and five college education Income was little and irregular An ANOVA test showed no significant difference in stunting, wasting and underweight and income A post-hoc test showed a significant difference between stunting and income. Dietary intake of children living with HIV/AIDS was inadequate due to low purchasing power of the guardians as a result of little income. These children ailed from opportunistic infections, which weakened their immune system. It is recommended that the government, donor agencies, nutritionists, and health institutions should work hand in hand to enhance the nutritional status of children living with HIV/AIDS.
An assessment of knowledge, Attitude and practice on abortion among female patients in Nairobi: a case study of Kenyatta National Hospital and Marie Stopes Clinic
(2011-12-05) Mbugua, Margaret Wangari; Ng'ang'a, Z. W.; Kamau, Reuben Koigi
Abortion is a social stigmatizing and ostracization issue as well as an important reproductive health problem associated with high morbidity and mortality. Each year 3.7 million pregnancies are terminated in Africa, with 200,000 deaths occurring from complications associated with unsafe abortions. In Kenya abortion is illegal. Women carry out abortions using unsafe methods and therefore suffer post-abortal complications. No documented studies have been carried out to determine knowledge, attitude and practice on abortion among female patients suffering from complications associated with abortion, and those seeking abortion services. A descriptive cross-sectional study was carried out among patients admitted at KNH and those patients seeking abortion services at Marie Stopes family planning clinic (Eastleigh), in Nairobi. The study recruited 286 respondents, 92 from KNII and 194 from MS, proportionate and only those who had an abortion. Respondents were interviewed using structured open and closed-ended questionnaires for quantitative data. The questionnaires were pre-tested at KNH for clarification. Two focus group discussions were held with HCP for qualitative data, 1 fgd was held at MS with 10 KECN, five KECN from gynecological ward of KNH and five from FP clinic of MS. While the second fgd took place at gynecological ward of KNH for KRCHN, five from MS and live from KNH. All the HCP had worked in those areas for more than a year. The discussions were monitored by the researcher while the proceedings and tape recording were managed by the research assistant. Data was collected 3 days per every week for four months, then was processed using SPSS and analyzed using the chi-square test to determine associations between variables. The results of the study showed that most of the respondents (60.1%) were single, (32.7%) married. Majority of respondents (54.1%) had secondary education while (3.5%) had no formal education, (55.0%) were protestants, (30.5%) Catholics (12.1%) Muslims and (2.4%) atheist. Majority of respondents had first sexual intercourse at mean age of 19 years, (SD =2.46), number of sexual partners mean 1.89 = 2, (SD = 1.03), age at first pregnancy mean 21.34 years. (SD=2.77), number of times respondents aborted mean 1.32, (SD=0.73), 48.3% respondents reported that poverty and economic constraints were the factors that led to termination of pregnancies. The respondents had poor knowledge on emergency contraceptives (mean score 1.0385) (SD=0.8048), which was a contributing factor to unwanted pregnancies, (34.6%) had poor knowledge on complications related to abortion that contributed to admissions for treatment, had association between knowledge of abortion and level of education (p=.031), 62.5% respondents had poor knowledge on methods of terminating pregnancies, (mean score 0.41, SD=.60), that explained why women suffered complications related to induced abortion. There was a significant statistical relationship between where abortions were performed between respondents at KNI-I and Marie Stopes (p=0.000), 40.6% respondents reported that doctors were the main providers, religion had no statistical significance with abortion practice (p=0.132). After procuring abortion 74.6%, respondents felt satisfied while 3.6% felt depressed, 62.4% respondents perceived HCP as concerned people, majority of HCP appreciated respondents who practiced abortion while minority maintained that abortion was an illegal unethical and immoral practice. Conclusion, the study observed a high incidence of abortion practice despite respondents negative attitude, on daily basis an average of 15 pregnancies were terminated at Marie Stopes and 7 patients were admitted with abortion related complications at KNH. Recommendations, are that the findings of this study will be of value to Ministry of Health and other interested parties such as NGOs in drawing policies to address abortion issues, and in improving reproductive health programs through intensified health education.
Assessment of knowledge, Attitude and practices regarding tuberculosis among adolescents in Kiswani- Mombasa district Kenya
(2011-07-15) Yonge, Shadrack A; Otieno, F.M.; Sharma, Rekha R.
Tuberculosis is a chronic infectious disease which is still a global health hazard. With the emergence of new more effective drugs, tuberculosis was expected to be completely eradicated; but global reports show results to the contrary. It seems that, in addition to drug regimens, individual health and social factors should be taken into consideration. This is not achievable except by increasing the knowledge and creating a positive attitude towards the disease. The aim of this study was to evaluate the level of knowledge, attitude and preventive practices of adolescents' in high school regarding tuberculosis. A cross-sectional study design was carried out in Kisauni Division, Mombasa District among the urban and sub-urban secondary schools. Qualitative data was obtained from key informant interviews while quantitative data was obtained from pre-tested structured questionnaires. A stratified of 384 respondents were used for the study. Descriptive statistics were used to summarize and analyze the data using the statistical package for social sciences (SPSS). Differences between independent and dependent variables were compared using Pearson's Chi-square and regression coefficient with the level of significance of p-values less than 0.05 (p<0.05 considered statistically significant. Some results were presented inform of tables, bar charts and pie charts. This study showed that 93.3% of the respondents had heard about T.B and medical workers were an important source of information. Knowledge about symptoms and transmission of T.B was 63.3%. Age was significantly associated with knowledge of T.B (x2=18.07; p<0.05; df=4). Knowledge of TB did not vary significantly by education level or gender (x2=0.4087; p>0.05; df=1). Tendency to discriminate TB patients was evident as 72.6% of the respondents opined to isolate TB patients from the family. Attitude towards TB patients did not vary significantly by age and gender. There was a positive relationship between the attitude and knowledge of adolescents towards TB. 50.3% of the respondents were on the opinion that TB can treated through directly observed treatments (DOTS). Mode of DOT delivery was significantly associated with knowledge (Z=9; p<0.05). Attitude towards DOT providers did not vary significantly by age or gender (x =6.553; p>0.05; df=5). Knowledge of tuberculosis (TB) had positive correlation with confidence in preventive practices (r=0.226, p<0.05) and behaviour change (r=0.274, p<0.05). Attitude had a positive correlation with beliefs of susceptibility to T.B (r=0.141; p<0.05) but negative correlations with preventive practices (r=-0.124; p<0.05) and behavioural change (r=-0.153, p<0.05). Considering the direct correlation of attitude and knowledge and also the important role of attitude in preventive behaviours, increasing the knowledge of adolescents about tuberculosis seems to be essential. This aim can be achieved by scheduling programs for general education of all students of the country in this regard. Establishing adolescents committees in the district by the Kenya government to prevent and control tuberculosis and other infectious diseases is of paramount. A national survey on the Kenyan adolescents who are in secondary schools knowledge of and attitudes towards tuberculosis should be conducted. More research is also needed on older adolescents to investigate their knowledge of TB changes as they mature and gain more exposure and knowledge
Assessment of knowledge, attitude and practices towards malaria prevention and control among primary school childrean in Busia district, Kenya
(2012-01-09) Odenyo, Thadeus Obadha; Orago, A. S.; Otieno, M.; Otieno, Syprine
Malaria is endemic in Busia District in Western Province Kenya. In the year 2003 malaria was incriminated for 50.0 % all cause mortality in the district. Malaria is on the rise in spite of available effective and proven tools. Conventional malaria prevention and control efforts have hitherto failed to strike an epidemiological breakthrough. Involvement of children in malaria prevention and control has not yet been attempted in the district. The overwhelming need for innovative approaches to defeat malaria has increasingly become an overwhelming priority. This study used; structured questionnaires among 649 pupils. 16 guided interviews among pupils. In-depth interviews among science teachers and focus group discussions among stake holders in the malaria sector to gather information on malaria. The objective of this study was to assess the knowledge, attitudes and practices of the pupils in Busia district. Results show that 94.1% of the pupils had knowledge on malaria transmission. These findings were better than results from studies in other endemic areas. Use of mosquito nets (55.0%) and ownership (93.8%) had a significant statistical difference (p<0.001). There was a significant statistical difference between chemotherapy use (99.7%)and compliance with prescribed dosage (45.0%, P<0.001). Chemoprophylaxis use was dependent on age (p<0.001) class of pupil (p<0.001). Having been taught about malaria in class (p<0.001) number of malaria bouts (p<0.001) and compliance with prescribed dosage (p<0.001). Use of Mosquito nets significantly improved with scaling-up of net coverage (p<0.001). Radio ownership significantly influenced chemotherapy use (p<0.001). Perception on visiting a health facility positively influenced health facility visits (p<0.001). Perceptions on mosquito net use positively influenced net use (p<0.001). The teacher interview results show that there is lack of malaria education in the primary school curriculum. Focus group discussions findings show that there is lack of collaboration among the malaria sector players. In conclusion, many respondents had knowledge on malaria etiology. Consequently. Concomitantly fewer bouts of malaria were reported. However varied and dynamic environmental factors hampered diametrical gains from practices. It is recommended that policy formulation on malaria be directed towards information. education and communication; monitoring and evaluation and intersectoral collaboration.
Assessment of nutritional and health interventions on HIV infected children under five years in Mathare North Health Centre, Nairobi
(2012-04-18) Lubeka, Crippina Buyanzi; Judith Kimiywe; Orinda, G. O.; Kimiywe, Judith
About 33.4 million people were living with HIV as of 2008 globally; 2.1 million ofthem were children under 15 years, and about 15.7 million were women. In certain parts of the world, HIV infection has significantly affected child survival. The World Health Report 2005 estimated that HIV infection contributed 3% to the global mortality among children younger than 5 years of age in 2005. According to UNAIDS and WHO 2004, there were more than 1.3 million people infected with HIV and AIDS in Kenya; and more than 100,000 children below the age of 15 years. In the recent years, growth, nutrition and metabolism of HIV infected children have received increased attention, as it has been recognized that HIV infected children generally do not grow as well as their uninfected counterparts. According to the 2005-2010 Kenyan National HIV/AIDS Strategic Plan, the government identified good nutrition as a key component of the national response to the HIV I AIDS epidemic. This study therefore sought to establish the effectiveness of nutritional and health interventions on the health and nutritional status of HIV infected children in Mathare. Respondents to the study included mothers of HIV positive children under five years seeking medical care at Mathare health centre, as well as staff offering services to the caregivers. The objectives of the study were to establish the sociodemographic and socio-economic status among care-givers of HIV infected children, identify nutrition and health interventions in place at Mathare health centre and the proportion of population accessing these interventions, determine the nutrition and health status of the HIV infected children attending clinic at Mathare health centre, assess the relationship between health and nutrition interventions, health status and nutrition status. Data was collected using a structured questionnaire administered on mothers and staff at the facility. These were then entered and analysed by Statistical Package for Social Sciences version 12.q. Descriptive statistics used to summarize the sample population included percentages, frequency distributions and charts. Chi-square was used to determine the relationship between categorical variables namely up-take of health and nutrition interventions versus nutrition status and presence of illnesses. From the study fmdings, marital status, mother's education and income level were the main factors that influenced access to interventions. The interventions at Mathare health centre include: nutritional counselling, micro-nutrient supplementation, food by prescription, immunization, ART and provision of prophylaxis. Twenty two percent of children in the study were stunted, eleven percent wasted while nineteen percent of the children were underweight. The most frequent illnesses and symptoms in the area were diarrhoea (38%), loss of appetite (29%), cold (28%) followed by cough and fever respectively. There was a significant relationship between nutritional counselling and nutrition status of children, there was also a relationship between food by prescription and nutrition status. Up-take of prophylaxis and ART showed a significant relationship with presence of illness but not with nutrition status. There was significant relationship between nutritional counselling and nutrition status. Nutritional counselling is cheap compared to provision of ART and therefore it can be extended that all children may receive as it is cheap yet it has shown to be effective.
Assessment of outcomes of HIV-exposed infants enrolled in prention of mother to child transmission (PMTCT) of HIV follow up care in Embu District, Kenya
(2012-11-30) Masini, Enos Okumu; Okello-Agina, Bonventure Michael; Simbauni, Jemimah
HIV infection transmitted from an infected mother to her child during pregnancy, labour, delivery and breastfeeding is known as mother-to-child transmission (MTCT). HIV infection through this route has become a major killer of children globally. In Kenya, there were about 141,000 HIV- exposed infants in 2007 with 22,000 of them getting HIV infected. Though the PMTCT services have been at the forefront of HIV prevention among HIV -exposed infants since 1998, outcomes of these infants in Kenya are rarely documented. This leaves an important PMTCT intervention aimed at eliminating peadiatric HIV largely unmeasured. The purpose of this study was to therefore establish the outcomes achieved among HIV -exposed infants enrolled in the PMTCT as a way of evaluating the efficacy of the program in Embu District. This was done through a descriptive retrospective study by reviewing HIV -exposed infants' registers in four health facilities in Embu District. The study population comprised HIV -exposed infants enrolled in PMTCT follow-up care in the district. Descriptive statistics used were proportions of HIV -exposed infants who received antiretroviral drugs for PMTCT, underwent early infant diagnosis of HIV, were HIV -positive, were lost-to-follow-up and were deceased. Analytic statistics calculated were the relative risk (RR) of HIV transmission and the RR of mortality associated with antiretroviral prophylaxis for PMTCT. The RR of loss-to-follow up among the infants associated with their HIV status was also calculated. The study found that the median infant age of enrolment into the follow-up care was 7 weeks. The uptake rate of infant and maternal antiretroviral prophylaxis was 8l. 7% and 86.8% respectively. Some 87.7% of the HIV -exposed infants underwent the first early infant diagnosis test for HIV at a median age of 8 weeks. The percentage of HIV -exposed infants who had early infant diagnosis of HIV conducted within the recommended six weeks of age was only 32%, while those who had it conducted by 12 weeks of age was 56% . Only 11.5% of the HIV -positive infants were put on paediatric highly active antiretroviral therapy (HAART) during the period of follow-up. The HIV transmission rate, when the first early infant diagnosis test for HIV was conducted, was 7%. For those infants whose mothers received antiretroviral prophylaxis for PMTCT, HIV transmission was reduced by 92% compared to those who did not (RR [95% CI] 0.08[0.03-0.14]). The cumulative HIV transmission rate at the end of follow-up was 7.3%. For those HIV-exposed infants who received ARV prophylaxis at birth, HIV transmission reduced by 90% by the end of follow-up compared to those who did not receive (RR [95% CI] 0.096 [0.087-0.109]). Cumulative infant mortality rate by the end of the 18-month follow-up was 14.8%; the median time of death' was 4 months. Although not statistically significant, there was a 54% mortality reduction among HIV- exposed who received ARV prophylaxis compared to those who did not (RR [95% CI] 0.46 [0.13- 1.09]). HIV -exposed and infected infants had 53.8% mortality compared to a lower 13.1 % mortality rate among the HIV -exposed but negative infants. Cumulative loss-to-follow-up rate among the HIV-exposed infants was 14.8%. HIV-exposed and infected infants were 14 times more likely to be lost to follow-up than those who were uninfected (RR [95% CI] 14.0 [2.4-18.9]). The 18-month HIV -free survival was 68%. These results show that the PMTCT program in Embu District reduced mother-to-child transmission of HIV and improved the HIV-free survival of the HIV-exposed infants. However, late enrolment of the infants, delay in conducting early infant diagnosis of HIV, poor uptake of peadiatric HAART and loss-to-follow-up posed a threat to successful program implementation. The study recommends measures to facilitate early conduction of infant HIV virologic diagnosis, eliminate missed opportunities in ARV prophylaxis for PMTCT, further reduce MTCT, improve peadiatric HAART uptake and reduce the high loss-to-follow-up.
An assessment of the impact of health compaigns against female genital mutilation in west pokot district, Kenya
(2011-12-08) Lokurosia, Jackline Chepkech
An estimated two million girls worldwide are at risk of experiencing genital mutilation every year of which the majority are young girls in 28 African countries. In Kenya, the practice is prevalent with 38% of women aged 15-49 years reporting being circumcised. The practice is nearly universal among the Kisii (97%) and Maasai (89%) and very common among Kalenjin (62%), Taita/Taveta (59%), Embu/Mere (54%), and to lesser extent among the Kikuyu (43%), Kamba (33%), and Mjikenda/Swahili (12%). Female Genital Mutilation causes irreversible, life-long health risks for girls and women, at the time of operation, during menstruation, consummation of marriage and during childbirth. The purpose of the study is to evaluate the impact of health campaigns on the community's practice of female circumcision through education, awareness campaigns and advocacy for alternative rites of passage. Simple random sampling technique was used to identify study subjects in the two purposively selected divisions namely, Chepareria (intervention site) and Sigor (control site). A total of 750 participants was randomly sampled comprising 375 household heads from each study site. Structured questionnaires, focus group discussions and interview guides were used to collect data on knowledge, attitudes and perceptions of the community on FGM and anti-FGM advocacy activities. The data collected were processed and analyzed using the computer Statistical Package for Social Sciences (SPSS). Chi-square test for independence was used to establish associations in health knowledge, attitude and perception of anti-Female Genital Mutilation advocacy activities. The student t-test was also used to determine the differences between mean ages in the two study sites. The results of the study indicate differences in the knowledge of health risks, attitudes and practices of Female Genital Mutilation between the study sites. For instance, it was found out that the prevalence of female circumcision was significantly higher in the control site than in the intervention site 222.279; df 2; p<0.001). The result also showed that awareness of the health and social implication of the procedure on women was significantly higher among the respondents in the intervention site (x2 = 99.8192; df =3; p<0.001). This could be attributed to their participation in the anti -FGM campaigns. The results also revealed that awareness of anti-FGM advocacy activities (x2=32.1963, df = 1, p<0.001) and participation (x2 _ 49.230; df = 1; p<0.05) were statistically significant between the study sites. Similarly, awareness of the alternative rite of passage ((x2= 188.140; df = 1, p<0.001), involvement ((x2 = 21.890; df = 4; p<0.001) and adoption (x2= 13.040; df = 1, p<0.001) showed significant difference. This reveals that more households in intervention site participate in anti-FGM activities than those in control site. Future plans to circumcise daughters ((x2 26.580; df = 1; p = <0.001) and willingness to stop the practice (x2 26.860; df == 2; p<0.001) also showed a significant difference indicating that families in the intervention site were abandoning the practice. The study concludes that exposure to and dissemination of information on the social, psychological and health risks of the practice on girls and women has impacted on the community's beliefs and practices about FGM. The study recommends that campaigns against female circumcision should be integrated in the social and economic development initiatives that particularly focus on women's empowerment.
Association between HIV status and socio-demographic characteristics of clients seeking Voluntary Counselling and Testing (VCT) services in selected sites in Kenyated sites in Kenya
(2011-11-24) Gathuya, Samuel Wambugu
Several studies have shown that some demographic factors such as gender play an important role in the transmission of HIV. Recent studies have also shown some association between male circumcision and HIV/AIDS as well as other social factors such as casual sex and condom use during high risk sex. However, although substantial data on socio-demographic variables are collected during voluntary counselling and testing sessions, it is not known how those factors correlate with client's HIV result, which would be important in informing HIV/AIDS programming. The main objective of this study was, to determine the association between sociodemographic characteristics of VCT clients and their HIV test results in selected sites in Kenya between 2002 and 2006. Analytic study design was applied. A retrospective study of 79,338 VCT client records and 17 Key Informant interviews with VCT site managers was undertaken. Records were considered for review if the client was above 18 years of age and had undergone full VCT and signed a consent form. Convenient sampling technique was used to select VCT sites. The VCT clients' records were entered into Epi Info 2002 computer software program and analysed using Statistical Software for Social Scientists (SPSS) and Microsoft Excel. Chi square test of association between HIV and socio-demographic characteristics was used. Results were considered significant when p value was less than 0.05. The results revealed that a little over half of the clients were males (52.6% vs 47.3%) (2 = 39859, df=l, P=0.000), majority of them in the age group of 25-49 years (57%). The clients' average age was 28 years (SD +/-8.6). Most of the clients were single (42.1 %) or in monogamous relationships (43.8%) and nearly 3 out of 10 were in skilled occupation. Clients' with secondary education accounted for 44.9% of the total. Nearly three-quarters (72.5%) of clients had sexual practices in the past and condom use with nonsteady partners among the sexually active was low (20.1%). Prevalence of HIV infection was significantly higher among women than men; 19.5% and 9.4% (2 = 1685.77, P=0.000), higher among those with low or no education (2 =998.76, df =3, P =0.000) and varied with occupation levels. Clients with skilled occupation were less likely to be infected compared to those in unskilled occupation (2 = 1720, df=4, P=0.000). High prevalence of HIV was observed among those who have ever been in marital relationships, the less educated, the unemployed clients and also among clients who had started sex and who never used condoms. Generally, the findings suggest that HIV affects people of low socioeconomic status and who were exposed to high risk sexual practices. Considering the prevailing high level of HIV infection rate among VCT clients, stakeholders implementing HIV/AIDS programs need to design appropriate HIV prevention programs targeting people in marital or cohabiting relationships, less educated, unemployed and clients who are exposed to high risk sexual behavior that fuel spread of HIV
Barriers to child nutrition security in food secure households : a study of Mjini village in Bungoma, Kenya
(2011-12-05) Echoka, Elizabeth; Orago, A. S.
Background: Food security is a key determinant of nutritional security. However, studies indicate that there are households that are food secure but still experience malnutrition, especially in children aged under five years of age. Objective: The study was undertaken to establish barriers to child nutrition security in food secure households. Methods: A cross-sectional study was conducted in Mjini village in Bungoma. A representative sample of some one hundred and seventy (170) food secure households with children aged 6-59 months was selected using multi stage sampling. Data was collected using an interview schedule, anthropometry, observation checklist and focus group discussions (FGD). Bivariate analysis using Pearson's chi-square and binary logistic regression analysis was used in data analysis. Results. The following were found to threaten children's nutritional security in food secure households. Lack of knowledge on frequency of feeding (60% vs. 38%, p=0.016, OR=2.5), and on the 3 major foods groups (52% vs.25.6%, p=0.006, OR=3.13), inadequate breastfeeding (48% vs. 13%, p=0.008, OR=6.2), untimely weaning (74% vs. 44%, p=0.001, OR=3.6), feeding child <3 times (59% vs.35%, p=0.009, OR=2.2), lack of stimulation when feeding child (47% vs. 18%, p=0.001, OR=4), lack of deworming (90% vs. 75%, p=0.004, OR=2.9), poor environmental sanitation (79% vs. 44%, p=0.001, OR=4.9), storing cooked food uncovered (74% vs. 18%, p=0.001, OR=6.8), feeding child with dirty hands (59% vs. 18%, p=0.001, OR=6.4) and diarrhoeal morbidity. Conclusion: Food availability alone is insufficient to assure nutrition security. It may have a limited effect on the nutritional well being of infants and children. Proper and sustained education of caregivers on care practices through multifaceted educational programmes dealing with behaviour/ attitude change and an evaluation and redesign of nutrition education are recommended.
Barriers to exclusive breastfeeding and nutritional status of non-exclusively breastfed infants in Eldoret municipality, Kenya
(2011-11-03) Wanyonyi, Mary Nekesa; Judith Waudo; Simbauni, Jemimah
Despite its many advantages, the benefits of breast milk have been widely unknown to mothers. In many of the world's developing countries, water and other liquids are added to the baby's diet in the first months of life risking infection from harmful bacteria and other pathogens. In Kenya only 13% of children below six months are exclusively breastfed. High infant mortality rates associated with diarrhoea, acute respiratory infections and poor responses to vaccinations result from lack of exclusive breastfeeding. It has been estimated that exclusive breastfeeding for the first six months of life could reduce infant mortality rate by a remarkable 13%. Globally, the practice of mixed feeding is a major public health concern. This study aimed at assessing the practicability of WHO recommendations on exclusive breastfeeding by establishing barriers to the practice. Descriptive survey method was used. The study was carried out in Eldoret Municipality. The study population was selected using simple random sampling. The sample size was 296 mothers of children aged 0-6 months. Data were collected through the administration of questionnaires and structured interview schedules and analyzed using Statistical Package for Social Sciences and EPI Info. Chi-square statistic was used to test the null hypothesis. Anthropometric measures were used to assess the nutritional status of infants. Out of the 296 infants, only 15.5% were breastfed exclusively. The mean age of exclusively breastfed infants was 1.8 months as 36% of the infants were introduced to other foods by 2 months. Maternal knowledge of exclusive breastfeeding was low. According to the mothers' understanding, exclusive breastfeeding periods in months were as follows; 0-2 (51%), 2-4 (16%), 4-6 (10%) and other ages (23%). Malnutrition cases of underweight were 2.7%, wasting 9.3% and stunting 6.9 %. The major hindrance to exclusive breastfeeding was mothers' perception of insufficient breast milk production. The null hypothesis was rejected as there were many factors that hindered EBF practice, P = 0.004. These findings will form a basis of designing effective strategies to address barriers to exclusive breastfeeding.
Barriers to HIV testing among TB patients: a case of Machakos district, Kenya
(2011-12-05) Ng'iela, Ronald
Human Immunodeficiency Virus infection (HIV) is fuelling tuberculosis (TB) infection tremendously and changing the pattern of this bacterial disease drastically that even good control programs are not sufficient in containing TB where HIV prevalence is high. The Centres for Diseases Control (CDC) recommended universal HIV testing among all patients presenting with AIDS-defining illness including TB for access to comprehensive care and thus, standard care. Four (4) major health facilities offering TB services in Machakos, a rural district in Kenya, East of Nairobi city were used to study the pattern of offer of HIV counseling and testing, the decline to receive the test and the awareness levels of TB/HIV association among TB patients. This was a cross-sectional study using a researcher-administered questionnaire to collect data. The main objective of the study was to determine the reasons for low uptake of HIV testing among TB patients. A questionnaire was administered to each of the sampled 312 TB patients consecutively on exit after service delivery. Machakos District was purposively chosen for this study because it has a high TB burden in Kenya and was one of the only 2 pilot districts that the CDC was supporting for universal HIV DTC in Kenya. Despite the CDC recommendations, in this study it was found that only 73% of TB patients were offered the HIV testing and that only 65% were eventually tested for HIV infection in Machakos District. It was observed that the main reasons for not being tested were failure by the health care providers to offer the service (59%), stigma (24.3%) and denial (8.4%). Patients from the rural set up were more unlikely to be offered the HIV test (22.6% vs. 8.6% among urban). In this study 65% of TB patients preferred HIV testing within the TB clinic and 79% felt it was their responsibility to take drugs and do not need to be supervised (DOTS). The cost of accessing ARVs in Machakos hospital was a major finding that promoted "opt - out". There was a significant association between facilities that were far from the administrative centre with less experienced staff in TB work and ' low offer for HIV testing among TB patients (25%), x = 76.916, df 3, p <_ 0.0001. Among those not offered, a significant 70 % of the respondents would have preferred DTC at the TB clinic although the health care workers did not promptly offer the opportunity (x2 = 20.736, df 3, p <_ 0.0001). A significant proportion of dually infected did not disclose their HIV status to their partners, only disclosing the TB infection, but overall there was more disclosure for HIV status than TB among the respondents (98% vs. 96%). Analysis of data was done using SPSS and Chi-square was used to test for association among variables. Correlation was used to determine the strength of the association. Level of significance was set at 0.05 and p values less than this were considered significant. From this study we concluded that the health care givers only perceive stigma and all TB patients should have been offered opportunity for HIV testing and given the right to "opt-out" if they were not ready. The findings from this study shall assist the health care providers and the NLTP to improve the standard of care to the dually infected by addressing the weaknesses. Key Words: "Opt-out", offer, decline, stigma, universal testing, comprehensive care, standard care.
Barriers to safe obstetric practices in prevention of mother to child HIV transmission in Kibera slums, Nairobi, Kenya
(2011-11-25) Ojowi, Lize Apondi; Owino, P. O.; Okello-Agina, Bonventure Michael
Mother to child transmission of HIV accounts for 90% of pediatric HIV/AIDS cases worldwide. Prevention of mother to child transmission of HIV (PMTCT) could curb the increasing rate of pediatric HIV/AIDS. A substantial proportion of perinatally acquired HIV-1 infection occurs at or near delivery, which suggest that obstetrical factors have an important influence on transmission. PMTCT interventions should target appropriate management of HIV positive pregnant women, which could reduce transmission of HIV from mothers to their infants. Safer obstetrical practices available in the hospitals such as use of elective cesarean section have been shown to reduce the risk of transmission by 50% and by 80% when combined with antiretroviral therapy. Access to these safe obstetric services remains a big problem in resource-constrained settings. This study assessed how level of income, level of knowledge on mother to child transmission of HIV (MTCT) and PMTCT, attitude of health workers as perceived by HIV positive mothers and adequacy of information given by health workers affected hospital delivery among HIV positive mothers involved in a community based PMTCT program in Kibera. A cross sectional study was carried out in which pre-tested questionnaires were administered to 146 HIV positive mothers in Kibera. Overall, 56.2 % delivered in the hospital while 43.8 delivered out of the hospital. Traditional birth attendants assisted 28.8 % while friends and relatives assisted 11.6 % and 5.5 % were not assisted. 69.5 % knew of their HIV status when they were pregnant, while 30.5 % knew their HIV status before pregnancy. Bivariate analysis showed that level of income, level of knowledge and attitude of health workers towards HIV positive mothers were significantly associated with hospital delivery (p = 0.003, p = 0.008 and p = 0.024 respectively). There was no significant association between being given information on ways of HIV transmission and prevention and hospital delivery (p = 0.142). Multivariate logistic regression showed that level of income was the most significant determinant and hence barrier to hospital delivery. These findings show that PMTCT programmes should focus more on addressing the financial barrier to accessing PMTCT services which includes hospital delivery. More education on ways and prevention of MTCT as well as the potential risks of home delivery should be given to HIV positive mothers. Emphasis should also be on giving adequate training to health workers aimed at improving their attitude towards HIV positive mothers. Traditional birth attendants should also be integrated in the programmes because of the crucial role they play in obstetric care in this area. This is evidenced by the big percentage (28 %) of mothers who sought their assistance during delivery.
Barriers to the uptake of cataract surgical services in Merti division, Isiolo, Kenya
(2011-12-30) Mohammed, Liban A.; Simbauni, Jemimah; Waswa, James Kisaka
The immense burden of blindness is prevalent in rural communities of developing countries, which are characterized by a high backlog of unoperated cataract and increasing incidence of cataract due to the ageing population. The factors that hinder people from accessing such sight-restoring services remain a major challenge for all eyecare professionals with a public health perspective. A cross-sectional descriptive study was carried out in all the six locations of Merti Division in Isiolo District of Eastern Province of Kenya. This study was aimed at identifying the barriers to the uptake of cataract surgical services where neither general eye-care services nor the cataract surgical services are available. Out of the 717 eye patients examined at rural health facilities, 98 (14%) operable cataract cases (vision less than 6/60 in one or both eyes) were detected by the use of the Snellen's Chart-E and a torch. More females (63; 64.3%) than males (35; 35.7%) attended the clinics during the screening exercise although statistically there was no significant difference between the sexes of the patients in different locations (x2 =4.643; df =5; P = 0.461). There was a significant number of the elderly (78; 80%) patients in attendance than the young adults (x˛ = 160.041; df = 3 ; P<0.001). Most patients with cataract significantly (x2 = 268.735; df = 5; P < 0.001) stayed at home for over two years (76; 78%) without seeking cataract surgical intervention. The number of cataract patients from Merti Division who received surgery at Isiolo Eye Unit within one month after booking were only 15 (15.3%) as compared to those who did not turn up for surgery (83; 84.7%). Out of the 15 who received surgery, 6 (40%) were males and 9 (60%) were females. This was made possible because of the support they got from the relatives (11; 11.2%) and the availability of funds to meet the cost (4; 4.1%). The respondents who did not turn up for cataract surgery when they were re-visited at their locations by the researcher gave the reasons as having nobody to take them to the hospital (23; 23.5%), generally unable to afford the cost of travel, meals and accommodation (22; 22.4%), nobody to leave behind to look after the homestead and property (6; 6.1%) and one patient did not get consent from the husband (1.0°19). The other hindering factors were the lack of knowledge of existence and services at Isiolo Eye Unit (64; 65.31 %) and the poor road network which was rough (33; 33.7%) and far (63; 64.3%). The burden of cataract blindness in Merti Division can be addressed through three-tier system where the full cost of surgery can be met by those who can afford; subsidized cost for the poor and free for the very poor. Effective cataract outreach programme is encouraged to enhance early detection, prompt referral and surgical intervention for the cataract patients. This effort requires intersectoral collaboration between all the stakeholders and the Ministry of Health. Cataract is not preventable, but sight restoration by surgery is the panacea to cataract blindness.