MST-School of Health Sciences

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

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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.
Acute Viral Respiratory Infections in Intensive Care Unit and Ventilator Support Patients in Moi Teaching and Referral Hospital, Uasin-Gishu County, Kenya.
(Kenyatta University, 2022) Kipsang, K. Amos; Washingtone Arodi; Marion Burugu
Acute respiratory tract infections (ARTIs) are among the five most common causes of morbidity and mortality globally, accounting for approximately 3.9 million deaths annually. Most of these deaths occur among young children in developing countries Mechanical ventilation supports the breathing system but does not change any pre-existing condition. Associated challenges include viral and bacterial infections. The prevalence of these infections is high, however these infections mimic bacterial infections. There is no documentation of these infections in many healthcare facilities In Africa. This study aimed at assessing the prevalence rates of Influenza virus, HRV, RSV, HPIV, hMPV, Human Adenovirus and HCoV in study subjects on ventilator support as well as those on critical care in the intensive care unit. The study was done at MTRH in Uasin Gishu County. Samples were collected from April 2017 to August 2017. 200 samples of bronchoalveolar lavage were collected. The samples were then transported to KEMRI Nairobi at 2-8°C for analysis. The RNA/DNA of the viruses was detected using real time PCR and multiplex PCR. Data analysis as well as coding and entry were done using statistical package for social studies (SPSS). The results were log-transformed to obtain equal distribution. The results were also expressed as mean±standard deviation. The results were then compared with respect to whether in ICU or on mechanical ventilation as well age using ANOVA with Bonferroni’s post-test using GenStat Release 14.1 (PC/Windows). Presentation of the data was done using graphs, pie charts and tables/figures. The samples that tested positive for Influenza A virus, HPIV-1, HPIV-2, HPIV-3, RSV, Adenovirus, HRV Human Metapneumovirus and HCoV was 33 (16.5%) 12 (6%), 8 (4%), 11 (5.5%), 19 (9.5%), 5(2.5%), 42(21%), 22 (11%) and 9(4.5%) respectively. However significant difference in viral infection among study participants in the intensive care unit and those on ventilator support in the different age groups of the patients analyzed was noted. There was noted difference among the patients in different age categories based on whether in ICU or ventilator support by Influenza A Virus, HPIV-1, HRV and hMPV viral infections at P-Value ≤0.05. Highest infection means were indicated in age group >65 for Influenza A Virus, HPIV-1 and HRV and age group <5 for hMPV in both ICU and those on ventilator support. Lowest infection means were also observed only in age group 20-34 for Influenza A Virus HPIV-1, HRV and Human metapneumovirus in the intensive care unit and also those on ventilator support. There were 34 cases of multiple viral infections. 20 cases were in those on ventilator support while 14 cases were present in those in the intensive care unit. It is evident that these infections are common in patients in ICU and those under ventilator support at MTRH. It is also clear that these infections are common in the various age categories. Those below 5 years and those above 50 years have higher prevalence of majority of the infections in comparison to other age groups. Surveillance for viral respiratory infections should be improved in order to implement treatment and also understand seasonality of these viruses and other new respiratory viruses. Co-infections should be closely monitored especially in mechanical ventilation in order to understand the impact of ventilator support on infection rates by these viruses. More studies needs to be done focusing on nosocomial respiratory viral infections.
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.
Antibiotic Susceptibility Patterns of Bacteria Isolated from Wards, Operating Room and Post-Operative Wound Infections among Patients Attending Mama Lucy Hospital, Kenya.
(Kenyatta University, 2021) Auna, Amulioto Johnstone; Margaret Muturi; Scholastica Mathenge
Surgical site infections are a worldwide problem in the field of surgery contributing to increased mortality and morbidity. However, despite advances in the control of surgical site infections, the risk of acquiring these infections has not fully been eliminated due to the emergence and spread of resistant bacteria pathogens. In Kenya, there were scanty published reports on the antibiogram of surgical site infection pathogens lurking in the hospitals. The objective of this research was to determine the prevalence and antibiotic susceptibility patterns of bacteria isolated from the wards, operating room, and surgical site infections among patients attending Mama Lucy Hospital. This was a cross-sectional descriptive study of patients with post-operative wound infections in the hospital wards. Purposive sampling was employed and a total of 126 samples collected. Of these, 58 came from surgical site infected patients and 68 were obtained from predefined areas of the wards and operating room of the facility. The samples were processed through Gram stain, culture, and an array of biochemical tests. Subsequently, antibiotic susceptibility tests by Kirby bauer disc diffusion technique were performed on the isolated bacteria. Data collected was analyzed using a statistical package for the social sciences (SPSS) version 20 and chi-square (p<0.05). A total of 137 bacteria were isolated from the culture positive swabs, 78 of these came from the wound pus swabs while 59 were recovered from the hospital surface swabs. Among the SSI bacteria, Staphylococcus aureus (28.2%) was the preponderant bacteria followed by E.coli (15.4%). In the wards and operating room, the main bacterial contaminant was Staphylococcus aureus. Based on the sensitivity report, all the SSI bacteria isolates were sensitive to Chloramphenicol (69.2%). Wherease the environmental bacteria isolates had sensitivity to Ciprofloxacin (86.4%), Doxycycline (88.1%), Chloramphenicol (93.2%) and Vancomycin (100%). Majority of the environmental isolates were highly resistant to Ampicillin/cloxacillin. In conclusion, the most prevalent SSI bacteria was Staphylococcus aureus, while Chloramphenicol was seen as the best drug for treating SSI at the hospital. The facility therefore needs to identify the most frequent bacteria associated with SSI. In addition, they need to monitor the bacteria that frequently contaminate the wards and operating room. The current antibiogram profile will help policy makers in the healthcare sector and the current setting to improve the current local guidelines on antibiotic prophylaxis for treatment of surgical site infection. The profiling will also assist in monitoring bacteria resistance trends within the institution and the country. Information generated from the hospital environment will help the infection control team at the current set-up to improve on the prevention of healthcare associated infections by carrying out active monitoring of hospital contaminants.
Antibiotic Susceptibility Profile of Enteric Bacterial Isolates from Stool in Children below Five Years with Diarrhoeal Disease in Muranga County, Kenya
(Kenyatta University, 2019-06) Mbuthia, Oliver Waithaka
Diarrhoea is a major cause of morbidity and mortality in developing countries. Bacterial agents are among pathogens implicated to cause diarrhoea in children and are of major concern in public health. Antibiotic use has paradoxically led to bacterial resistance and the situation continues to worsen. The main objective of the study, therefore, was to determine enteric bacterial isolates and their susceptibility to antibiotics from diarrhoeal stool samples among children below five years in Murang`a County. A hospital-based cross-sectional study approach was applied to 163 randomly selected diarrhoeal stool samples from children below five years in Murang`a and Muriranja`s hospitals. Enteric bacterial pathogens were cultured and identified using polymerase chain reaction and biochemical methods. A questionnaire was used to collect information from the guardian. Statistical analyses were performed using STATA v.13. Fisher’s exact test was used to check for evidence of relationship (p<0.05). Regression model analysis was used to estimate the association between pathogenic bacterial isolates and demographic, clinical, and hygienic factors. There were nearly equal distributions in gender 86(52.8%) female vs. 77(47.2%) male, the majority (35.6%) aged within 1 day - 12 months. Clinically, 153(93.9%) had a fever, while 117(71.8%) had a nutritional problem. A total of 188 enteric bacterial isolates belonging to 11 genera were recovered from stool samples of children under investigation. Predominant bacteria from stool samples was nonpathogenic Escherichia coli 85(43.8%), while 13(7.0%) E. coli were positive for virulence genes, including 8(4.3%) positive for both LT and STp Shiga-like or Enterotoxigenic E. coli, 3(1.6%) for eae Enteropathogenic E. coli and 2(1.1%) for Enteroaggregative E. coli gene. Others included: Salmonella 21(10.8%), Pseudomonas 14(7.2%), Shigella 14(7.2%), Klebsiella 12(6.2%), Aeromonas 8(4.1%), Enterobacter 7(3.6%), Proteus 8(4.1%), Citrobacter 3(1.6%), Yersinia 2(1.1%) and Vibrio species 1(0.5%). Children between 1 day - 12 months (OR 0.3, 95% CI 0.1-0.8) were more likely to be infected with pathogenic bacteria than those between 49-60 months. Enteric bacterial isolates were highly diverse in female and among those aged 49-60 months. Female participants (OR 1.8, 95% CI 1.1-3.4) were nearly twice likely to be infected with pathogenic bacteria. Those who presented with watery stool (OR 0.4, 95% CI 0.2-0.9) or mucoid stool (OR 0.3, 95% CI 0.2-0.7) remained associated with pathogenic bacterial infection but less likely to be infected compared to those who presented with watery-blood stained stools. Piped water and storing water with a lid were associated with a less bacterial infection. Almost all the isolates were resistant to Ampicillin, Amoxicillin, Chloramphenicol, Ciprofloxacin, Ceftriaxone, Kanamycin and Cotrimoxazole. Bacterial identification and subsequent antibiotic susceptibility testing from stool samples should be scaled up to confirm and guide therapeutic use thereby minimizing bacterial resistance
Antifungal Activities of Camellia Sinensis Crude Extract on Selected Pathogenic and Mycotoxic Fungi
(2014-02-26) Sigei, Erolls Cheruiyot; Muturi, Margret; Bii, Christine
Human fungal infections pose serious medical issues. Up to now, more than a hundred thousand fungal species are considered as natural contaminants. During the last decade, the incidence of superficial and deep mycotic infections has continued to increase explosively. There is a general consensus among researchers, clinicians and pharmaceutical companies that new, potent, effective and safe antifungal drugs are needed. Majority of work has been conducted on Camellia sinensis extracts against bacterial agent’s activity but little work for antifungal activity. In this study, in vitro antifungal activities of Camellia sinensis crude extracts compared with azole group of compounds on selected pathogenic and mycotoxic fungi were determined. That was done by evaluating the difference in antifungal activities of green and black tea crude extracts having a concentration of 100mg mL-1. Quantitative bioassay was done using disc diffusion method and Minimum Inhibition Concentration was done using broth dilution methods. The fungal isolates used for bioactivity testing were yeasts; Candida famata, C. lusitaniae, C. tropicalis ATCC 750, C. parapsilosis ATCC 22019, C. glabrata ATCC 24433, C. krusei ATCC 6258 and Cryptococcus neoformans ATCC 66031; and moulds, Trichophyton mentagrophytes, Microsporum gypseum, Fusarium monilliforme, Aspergillus spp and Penicillium chrysogeneum. ATCC standard fungal strains and clinical isolates were included. Green tea crude extract showed stronger inhibitory effect against the fungal strains tested than black tea crude extract. There was a significant difference in zone of inhibitions (T=4.09, P<0.05). Zone of inhibition exhibited by green tea crude extracts (11.92±0.00mm) were higher than black tea crude extracts (8.14±0.56mm). The pattern of activity by tea crude extracts against ATCC standard fungal strains and clinical isolates strains were similar. C. famata, C. lusitaniae, C. tropicalis ATCC 750 and dermatophyte, T. mentangrophyte were inhibited by green tea crude extract (IZD≥15mm). Clinical isolates of Candida albicans (strain 4 and strain 5); Cryptococcus neoformans (strain 3, 5 and 12), showed susceptibility to Camellia sinensis green crude extracts. The MIC of Camellia sinensis crude extracts against fungal isolates tested ranged from 50 mg mL-1 to 1.6 mg mL-1. Hot green tea crude extract (mean MIC 12.25mg mL-1) had a higher MIC on clinical fungal isolates than cold green tea crude extract (Mean MIC 12.167 mg mL-1). The concentrates of aqueous Camellia sinensis crude extracts showed synergistic activity with conventional antifungal drug. However, level of synergism differed as observed in difference in inhibitory effect. The difference in inhibitory effect was significant (P<0.05). The crude tea extract restored the activity of lower concentration of antifungal, Fluconazole below MIC to susceptible breakpoints. Generally, the MFC (Minimum Fungicidal Concentration) of Mixture crude extracts were slightly higher as compared to that of green tea crude extract. These results are suggestive that addition of milk to blend the crude extracts altered the bioactive ingredients resulting to higher concentration for its MFC as compared to crude extracts alone. The studies on Camellia sinensis crude extracts (green and black) have shown remarkable antifungal activity against different strains of fungi and highlighted its significance to humans as potential health products.
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 Kisauni-Mombasa District, Kenya.
(2009-06) Yonge, S.A.
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=l). 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 (X2=9; ~<0.05). Attitude towards DOT providers did not vary significantly by age or gender (t =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 behavioral change (r=-0.153, p<0.05). Considering the direct correlation of attitude and knowledge and also the important role of attitude in preventive behaviors, 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 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.
Assessment of the pharmaceutical manufacturing industry in Kenya to forecast local production sufficiency
(2017-10) Vugigi, Sarah Kadesa
The World Health Organization’s global strategy on public health aims to support Member States to improve access to essential medicines. The desire of Kenya Government to implement this is expressed by formulation of Kenya National Pharmaceutical Policy (2010) which encourages local production of essential medicines for self-sufficiency. The pharmaceutical manufacturing industry in Kenya is engaged in production of various types of dosage forms but its capacity and capability to produce essential medicines for Kenyans have not been determined. The aim of this study was to assess the pharmaceutical manufacturing industry in Kenya to forecast local production sufficiency. This was attained by evaluating the manufacturing capability, production capacities and compliance with international marketing authorization standard of the Kenyan pharmaceutical industry. The 24 licensed manufacturers of medicines for human use were assessed. Data was collected on the current drug situation in Kenya by scanning Pharmacy and Poisons Board database to determine range of products that are registered in Kenya. Local pharmaceutical manufacturer’s product lists, Kenya Essential Medicines list and pharmaceutical tender lists of three major procurers in Kenya (Kenya Medical Supplies Authority, Kenyatta National Hospital and Mission for Essential Drugs and Supplies) were examined to establish the proportion of products which was manufactured locally. Prices competitiveness and market share of local products were evaluated and subsequently, pharmaceutical equivalents of 150 locally manufactured essential medicines were determined. Data on production capacity for 5 years (2010-2014) and compliance of facilities with good manufacturing practices standard and other prerequisites of marketing authorization was obtained using a structured questionnaire. Results showed that solid dosage forms were majority (54.9 %) of local products and sterile preparations were minority (2.7 %). Locally manufactured products accounted for 14.5 % of registered and 21.5 % of retained products. Local firms manufactured 38.4 % of products listed as essential medicines and 55.6 %, 24.5 % and 21.8 %, respectively, of pharmaceutical products procured by Kenya Medical Supplies Authority, Kenyatta National Hospital and Mission for Essential Drugs and Supplies. The overall percentage of local pharmaceutical equivalents was 32.5 % for registered products. There was no variation between mean prices of local and imported pharmaceutical equivalents. Scatter diagrams demonstrated that imported pharmaceutical products comprised both low and highly priced brands. The overall utilized production capacity (two shifts) was 21.5 %; tablets (24.1 %), capsules (12.8 %), liquids (25.3 %), dry syrups (21.8 %), external preparations (21.3 %) and oral rehydration salts (23.6 %). This study projected the year for self-sufficiency in non sterile medicines produced in the local industry as 2043. Good manufacturing practices standard was satisfactory at 11 facilities while the rest were striving to achieve compliance. Research and development of new products was limited in most facilities with 1 % of the workforce deployed in this department. It is concluded from this study that Kenya depends heavily on imported drugs for her essential medicines needs. Majority of local products were less competitive than imported products and production capacity was underutilized. Majority of manufacturers adhered to current good manufacturing practice standards but were inadequate in research. This study recommends augmentation of research and development by the local pharmaceutical industry to generate new products. In addition, substantial government support is required to propel the industry to improve product range, product competitiveness and production capacity utilization.

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