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The 3rd Pan African Thoracic Society (PATS) Biennial Congress: Lessons Learnt to Advance Lung Health in Africa
(PATS, 2024-03) Kagima, Jacqueline; Irungu, Anne; Ongaya, Asiko; Miheso, Barbara; Chakaya, Jeremiah; Masekela, Refiloe
Lung health in Africa is of great public health concern. To exchange knowledge, communicate the latest scientific advances in lung health, build the capacity of young researchers, and provide a platform for networking of lung health stakeholders in Africa, the Pan African Thoracic Society (PATS), in partnership with the Respiratory Society of Kenya organized and held the 3rd Biennial PATS congress, from June 7–10, 2023 in Mombasa, Kenya. There were a total of 30 conference sessions, which included six skills building workshops, two research dissemination workshops, six plenary sessions, and five each of pediatric, adult, and thoracic surgery symposia. A total of 60 abstracts were presented, including 27 oral abstracts and 33 posters. A wide range of issues for lung health in Africa emerged. These include the emerging role of the environment, especially climate change and global warming, on lung health, the threat posed by the use of tobacco and other nicotine products in Africa, the high burden of lung infections, insecurity of medical oxygen supply systems, and high burden of chronic respiratory disease. In this paper, we summarize the proceedings of this conference and draw lessons that can be used to advance lung health in the African continent.
Abagusii Traditional Environmental Knowledge and HIV/AIDS Management: Implications for English Language Teaching
(International Ecolinguistics Association, 2021) Maroko, Geoffrey Mokua; Mokua, Gladys Nyamoita; Nyakundi, Augustus Onchari; Onyambu, Meshack Ondora
Multidisciplinary and multisectoral interventions are necessary for the management of chronic conditions such as HIV/AIDS. One such intervention is the promotion of socially responsible teaching. Anchored within an eclectic theoretical framework involving traditional environmental knowledge, the Sapir-Whorf Hypothesis, and Vygotsky’s theory of thought, language and culture, this paper analyses the link between Abagusii traditional environmental knowledge and management of HIV/AIDS. Seven groups of people living with HIV/AIDS were engaged in focus group discussions on the management of HIV/AIDS treatment adherence through sustainable production and use of natural products. The paper reveals that the Abagusii have rich ecological knowledge on the production and use of natural products, which could improve treatment outcomes of people living with HIV/AIDS. This ecological knowledge can be harnessed, documented and ploughed into ELT materials for English Language Teaching. A three-tier ELT framework comprising classroom activities, integrated tasks and practical actions could be adopted for teaching integrated English in interesting ways while at the same time restoring the environment, food sufficiency and health.
Antimicrobial Resistant Pattern among Foodhandlers in Nairobi (Kenya)
(2007) Otieno, Micheal Frederick; Hussein, Ahmed Abdulrahman; sharma, R. R.; kombe, Y.
Antibiotic resistance represents a serious problem for clinicians, veterinarians, community and government at large. This involves cost implications as far as treatment is concerned. Multiple drug resistance as a result of empirical treatment have rendered most drugs ineffective. In view of the above, this descriptive cross-sectional study, aimed at isolating resistant entero-bacteria E. coli from food-handlers working in both high and low budget hotels. Specimens in the form of stool were collected from 297 food-handlers in their respective hotels were considered and analyzed for resistant E. coli bacteria at KEMRI-Centre for Microbiological. Research (CMR), in Nairobi. Besides, questionnaires were administered in order to assess health-seeking behaviour of the study subjects prior to medical examination. Antibiotics used in this study were amoxicillin-clavulanic acid, co-trimoxazole,ampicillin tetracycline, kanamycin, gentamycin, cefuroxime and chloramphenicol. These antibiotics were chosen on the basis of their use in the management of enteric bacterial nfections. The results from high budget hotels (i.e. three, four hotels ( i. e two stars and below) indicates high frequency of resistance in both hotel categories was seen in co-trimoxazole.and five stars) and low budget resistance. The highest level of 66.3% in high budget hotels and 66.4% in low budget hotels. Resistance difference between high budget hotels and low budget hotels was not statistically significant (P=0.56681). This was followed by ampicillin showing resistance of 55% in high budget hotels and 46% in low budget hotels, (P=0.8235). Tetracycline showed a resistance level of 34% in high budget hotels and 58% in low budget hotels, (P=0.2835) and co-amoxyclav showed resistance of 37% in high budget hotels and 38% in low budget hotels, (P=0.5074). The P-value results clearly indicate no significant relationship between taking medication by food-handlers prior to medical examination and the pattern of antibiotic resistance. Comparatively, the resistance pattern for the antibiotics tested is somehow the same for low and high budget hotels, indicating that, irrespective of the hotel category, if those working in hotels are potential carriers of drug resistant E. coli, then the category of hotel is irrelevant and either has a potential of transmitting resistant E. coli.
Barriers to antiretroviral initiation in HIV-1-discordant couples.
(JAIDS Journal of Acquired Immune Deficiency Syndromes, 2011-11-01) Gatuguta, A.; Guthrie, B. L.; Choi, R. Y.; Liu, A. Y.; Mackelprang, R. D.; Rositch, A. F.; Bosire, R.; Manyara, L.; Kiarie, J. N.; Farquhar, C.
BACKGROUND: In Kenya and much of sub-Saharan Africa, nearly half of all couples affected by HIV are discordant. Antiretroviral therapy (ART) slows disease progression in HIV-1-infected individuals and reduces transmission to uninfected partners. We examined time to ART initiation and factors associated with delayed initiation in HIV-1-discordant couples in Nairobi. METHODS: HIV-1-discordant couples were enrolled and followed quarterly for up to 2 years. Clinical staff administered questionnaires and conducted viral loads and CD4 counts. Participants with a CD4 count meeting ART criteria were referred to a nearby US President's Emergency Plan for AIDS Relief-funded treatment center. Barriers to ART initiation among participants with a CD4 count eligible for ART were assessed by Cox regression. RESULTS: Of 439 HIV-1-infected participants (63.6% females and 36.4% males), 146 met CD4 count criteria for ART during follow-up. Median time from meeting CD4 criteria until ART initiation was 8.9 months, with 42.0% of eligible participants on ART by 6 months and 63.4% on ART by 1 year. The CD4 count at the time of eligibility was inversely associated with time to ART initiation (hazard ratio = 0.49, P < 0.001). Compared with homeowners, those paying higher rents started ART 48% more slowly (P = 0.062) and those paying lower rents started 71% more slowly (P = 0.002). CONCLUSIONS: Despite access to regular health care, referrals to treatment centers, and free access to ART, over one-third of participants with an eligible CD4 count had not started ART within 1 year. Factors of lower socioeconomic status may slow ART initiation, and targeted approaches are needed to avoid delays in treatment initiation.
The challenges fraughting isoniazid prophylaxis as a child tuberculosis prevention strategy in high burden settings in Nairobi, Kenya
(Kenyatta University School of Medicine, 2015) Okwara, F.N.; Oyore, J.P.; Were, F.
Background: Paediatric Tuberculosis (TB) is rapidly becoming a major public health concern among the urban poor. Though contacts' tracing and Isoniazid Prophylaxis Therapy (lPT) is an effective prevention strategy, its benefits have not been realized in many resource poor settings. Barriers to its uptake have not been fully elucidated. Objectives: To evaluate the challenges that fraught the implementation of' contact tracing and IPT, as a TB prevention strategy in children in household contact with adults with TB from informal settlements in Nairobi, Kenya. Metbodology: A prospective longitudinal multicenter cohort study was done, where 366 recently diagnosed TB smear positive source cases were asked to enroll their child contacts for IPT. Consent was sought. Structured standard questionnaire was used to get information on source case TB treatment, socio-demographics, TB knowledge and perceptions. Baseline screening was done to exclude those with TB and/or other chronic illnesses. Contacts were then put on daily isoniazid for 6 months and followed up monthly for one year for new TB disease. Adherence, safety and challenges were monitored. Focused group discussions and key informant interviews were used to provide secondary data. Results: All the 366 source cases interviewed were on first line anti- TB treatment. IPT acceptability was 87.3%. A total of 428 child contacts were screened, but 14(3.2%) had TB disease hence excluded. Compliance rates were 93% (95% CI 90.1 - 96.2%) and 85% (95% CI 80.2%- 88%) after 1'1and 6th months respectively. Challenges reported included; side effects in 22%, programmatic concerns in 86%, drug related issues in 70.1 %, and various health system challenges. The leading programmatic challenge was too many hospital visits (65.2%) and the drug related challenge was difficulty in administering tablets to children (44.3%). IPT completion rate was 368 out of 414 (88.8%). By endpoint, IPT failure was documented in 6( 1.6%), hence the relative risk of new TB disease in contacts on IPT was 0.49 (95% CI 0.21 -0.86). Conclusion: IPTwas an effective and safe child TB prevention strategy in informal settlements, but it's implementation had been hampered by relatively low acceptability, sub-optimal adherence, programmatic challenges, and high defaulting rates and by limited benefits realized.
Contribution of Completed Modified World Health Organization Partograph on Maternal and Foetal Mortality Reduction in Health Facilities in Makueni County, Kenya
(Science Publishing Group, 2019) Muthusi, Urbanus Mutiso; Nyamoita, Mokua Gladys; Macharia, Stephen
Background: Maternal and foetal mortality is one of the major health problem facing low income countries as compared to the high income countries. This burden is mostly felt in sub Saharan Africa and Southeast Asia where 99% of the global burden of maternal death is found. The World Health Organization (WHO) promotes partograph use in the monitoring and management of mothers in labour enabling timely decision-making regarding interventions to be undertaken. Objective: To assess the relationship between complete modified world health organization partograph and maternal and foetal outcomes in health facilities in Makueni County, Kenya Methods: This was a cross sectional study design. The study used a structured questionnaire to collect data from the partographs retrospectively. Data analysis was done using SPSS version 20.0 and chisquare tests were used to assess the relationship of variables. The cut off point for the level of significance was 0.05. Phi and Cramer’s V test was used to determine the strength of association Findings: Descriptive statistics and frequency tables were used to describe the extent to which the partograph was used. The use of partograph had effects on both foetal and maternal outcomes. The study established method of delivery had a significance association with foetal monitoring (foetal heart rate, liquor, and moulding), labour progress monitoring (descent, contractions and cervical dilatation) and referral monitoring at α = 0.05. The study also found significant association between foetal outcome and contraction, gravidity, parity, foetal heart rate and moulding at α = 0.05. Conclusion: There is a significant association between maternal, foetal outcomes and labour progress and partograph completeness in Makueni County. The study therefore recommends increased mobilization and routine check by supervisors to ensure partographs are filed on time and hospitals to embrace training programme to enable midwifery care-providers acquire relevant skills to complete partographs during the labour process.
The Demographics Behind the Courage to Tell for Survivors: Child Sexual Abuse Experiences in Kenya
(East African Nature and Science Organization, 2021) Wamuyu, Eunice Menja; Kathuri-Ogola, Lucy; Muriithi, Joan Kabaria; Swindle, Taren
Child Sexual Abuse (CSA) is both a global and national social issue, as well as an epidemic in various societies. Non-disclosure of CSA only worsens and extends survivors’ suffering, and CSA’s long-term effects can be devastating. Several studies have beendone in the field of CSA and its health implications but rarely have previous studies addressed child sexual abuse disclosure (CSAD). The current study aimed at examining child factors of CSAD at Thika Level 5 Hospital (TL5H) in Kiambu County, Kenya. The study is a case study using a phenomenology approach where the primary data was collected from the sexual abuse survivors and caregivers using a mixed-method analysis. Interviews were conducted with 30 CSA survivors, 25 girls, and 5 boys: 5-17 years. The study utilised the convergent QUAL (investigative open-ended questions and storytelling) design with a Quan component (structured survey) to identify CSA survivors’ experiences while receiving medical treatment and therapeutic intervention at TL5H. Descriptive and thematic approaches were applied to analyse qualitative data that revealed survivors’ lived experiences with CSA. Informed by Bronfenbrenner’s Socio-Ecological Model (SEM), saliency analysis was applied to code the recurring and important themes from the data in order to identify which child factors. Survivors gave detailed accounts of types of threats and manipulation applied by perpetrators to stop them from disclosing abuse. Survivors said disclosing or not disclosing helped them cope with abuse trauma. Quantitative results revealed that 58% of the survivors who completed the disclosure process
Detection and Management of Adverse Drug Reactions Related to Antiretroviral Drugs among HIV/AIDS Patients in Kiambu Sub-County, Kenya
(African Journals Online, 2013) Nderitu, F. W.; Gikonyo, N. K.; Sinei, K. A.
The objective of this study was to establish the detection, prevalence and management of various adverse drug reactions associated with antiretroviral drugs occurring in patients attending Comprehensive Care Centre (CCC) of Kiambu District Hospital. The study was a cross sectional survey where the patients included were those attending the CCC on a monthly basis. The results revealed that 65.2% of the patients had experienced symptoms suggestive of adverse drug reactions (ADRs). Of these, 67.2% did not associate the symptoms to the medicines they were taking but rather to the AIDS syndrome. The most prominent reaction was peripheral neuropathy at 0.395 (0.344-0.447 at 95% confidence interval) while the least common was hepatotoxicity. Whereas 71.5% could tell the frequency of the daily dosage, 92.1% did not know the names of the medicines they were taking but could describe them by shape and colour. There was a significant association between occurrence and reporting of ADRs and age (P<0.001), weight (P=0.001), marital status (P=0.016), occupation (P<0.001), religious participation (P<0.001) and education level (P<0.001). Although the health care providers displayed adequate knowledge in management of these reactions, they complained of inadequacy of the current reporting tool (MOH 257) in capturing ADRs. The patients were ill equipped in recognising the ADRs.
Determinants of Adherence to Anti-Retroviral Therapy and High Risk Behaviour among HIV Infected Patients on Treatment in Nairobi Province, Kenya.
(2015) Oyore, J. P.
Determinants of Focused Antenatal Care Uptake among Women in Tharaka Nithi County, Kenya
(Hindawi Publishing Corporation, 2017) Gitonga, Eliphas
Background. The health status of women is an important indicator of the overall economic health and well-being of a country. Maternal health is closely linked with the survival of newborns. For every woman who dies, about thirty others suffer lifelong injuries. Focused antenatal care is one of the interventions to reducematernalmorbidity andmortality. It recommends four targeted visits during pregnancy within which essential services are offered. The aim of the study was to assess the determinants of uptake of focused antenatal care among women inTharaka Nithi County, Kenya. Methods. This was a descriptive cross-sectional survey. Stratified sampling was used to select the health facilities while systematic sampling was used to select the respondents. Chi square, Fisher’s exact test, and logistic regression were used to analyse the data. Results. The level of uptake of focused antenatal care was slightly more than half (52%). The determinants of uptake of focused antenatal care are level of education, type of employment, household income, parity, and marital status of the pregnant women. Conclusion. Despite high attendance of at least one antenatal visit in Kenya, the uptake of focused antenatal care is proportionally low.
Determinants of health facility delivery among women in Tharaka Nithi county, Kenya
(African Field Epidemiology Network, 2016) Gitonga, Eliphas; Muiruri, Felarmine
Introduction: Kenya records a high maternal mortality ratio 362 maternal deaths per 100 000 live births. Tharaka Sub County has poor transport infrastructure, low levels of socio-economic status and long distances to health facilities. Secondary to these factors, delivering in a health facility is a challenge. Delivering in a health facility is one of the strategies to avert maternal death through skilled birth attendance. The aim of the study was to evaluate the determinants of health facility delivery among women in Tharaka Nithi County. Methods: the study design was descriptive cross sectional survey. Semi structured questionnaires were used for data collection. Stratified sampling was used to select the facilities. Systematic sampling was used to select the respondents. The sample size was 345. Descriptive statistics, chi square, Fishers exact and logistic regression were used in analysis. Results: majority (79%) of the respondents delivered in health facilities. Health facility deliveries were highest (80%) among women aged 20-34 years and among those who attended level 4 facilities for ante natal care (88.3%). Health facility deliveries were lowest among women with five or more births. Health facility deliveries were higher among those who attended at least 4 ante natal visits (87.2%) and having individual birth plans (90%). The likelihood of health facility deliveries was increased by increase in level of education (1.6 times), household income (2.4 times), attending a higher level facility ante natally (1.4 times), birth preparedness (3 times), attending at least 4 ante natal visits (2.9 times) but was decreased by an increase in parity (0.5 times). Conclusion: the determinants of place of delivery are maternal age, level of education, household income, parity, attendance of ante natal care four or more times and birth preparedness.
Determinants OF HIV-vct utilization among secondary schools teachers in Thika District, Kenya.
(2011) Keraka, M.; Marita, Enock Oburi; Mwanzo, I
Background: HIV/AIDS is a global health problem whose emergence has introduced new dimensions to health care delivery worldwide including Voluntary Counselling and Testing (VCT). Despite its proven benefits, high knowledge of VCT and its availability, its uptake is varied and often poor. It is commonly argued that teachers in Sub-Saharan African (SSA) countries have relatively high HIV prevalence rates than the general population. AIDS is claiming teachers more quickly than they can be trained in many countries and is the leading cause of death among teachers in the SSA countries. Objective: To identify determinants of HIV-VCT uptake amongst secondary schools teachers. Method: A cross-sectional survey involving 246 secondary school teachers randomly selected in Thika district, central Kenya. Results: HIV-VCT utilization among secondary school teachers was 30.5%. The younger and less experienced teachers were more likely to utilize HIV-VCT services than the older and more experienced ones (Likelihood ratio, P = 0.004). Private school teachers were more likely to utilize HIV-VCT services than those of the public schools (OR = 2.356, 95% CI limit, 1.082-5.128). Teachers who were scared by the HIV prevalence in their area were three times less likely to utilize HIV-VCT services (OR = 0.312, 95% CI, 0.104- 0.936). The teachers who had not sought HIV-VCT service were less likely to perceive HIV-VCT services as beneficial (Likelihood ratio, P =0.027). Various factors were identified as barriers to HIV-VCT uptake; most of them were post test implicated. A number of factors that made some teachers to seek HIV-VCT services were also identified; HIV/AIDS awareness campaigns and urges ‘to know status’ were most cited factors. Conclusion: Although HIV-VCT utilization among secondary school teachers was higher than that of the general public, at 30.5% was still low. Various factors were found to influence HIV-VCT uptake
Development of an algorithm of haematologic parameters as surrogate markers for CD4 cell count in resource-limited settings
(Academic Journals, 2016) Agwata, D.K.; Ongus, J.; Mbugua, A.; Maturi, P.; Nyamari, J.; Uwamungu, S.
Total Lymphocyte Count (TLC) has been previously evaluated as a surrogate for CD4 counts in the management of HIV especially in resource-limited settings with varying results. This study developed a clinical algorithm of TLC and other significant haematologic parameters to raise the predictive value of TLC in classifying subjects with CD4 count <350 cells/mm3. Total samples of 215 HIV-seropositive ARVnaïve patients were studied. The Beckman Counter was used for Complete Blood count (CBC), Beckton Dickinson FACS count for CD4 count, and Westergren method for Erythrocyte Sedimentation Rate (ESR). The variables retained as the most significant predictors (at p<0.05) were TLC<2000 cells/mm3 (sensitivity 71.5%, specificity 73.4%, PPV 69.1%, NPV 78.3%), Hb < 12 g/dl (sensitivity 59.8%, specificity 56.2%, PPV 63.3%, NPV 71%) and ESR>30 mm/h(sensitivity 57%, specificity 71%, PPV 66%, NPV 68%). A three-step algorithm of TLC <2000 cells/mm3, Hb<12 g/dl, and ESR>30 mm/h for predicting CD4 count<350 cells/mm3 yielded sensitivity 66%, specificity 82%, PPV 72%, NPV 77% (area under curve AUC 0.79). This algorithm had a higher predictive accuracy making it a better tool than the use of TLC alone in monitoring disease progression in resource-limited settings
Effect of a Health Communication Strategy on Uptake of Cervical Cancer Screening in Isiolo County, Kenya
(Canadian Center of Science and Education, 2023) Linus, Agnes Muthoni; Wanyoro, Anthony; Gitahi, Mary Muiruri
Background: To assess the effect of a health communication strategy on women’s community-level uptake of cervical cancer screening in Isiolo County. Purpose: to determine the effect of a health communication strategy on women’s community-level uptake of cervical cancer screening in Isiolo County. Methodology: The study adopted a community-based cluster randomized trial design. Multi-stage sampling was used to derive the sample size. There were 444 women overall, varying in age from 15 to 65 years. Community Health Volunteers disseminated health information to the intervention arm of study and referred participants to link health facilities for screening. An interviewer-administered questionnaire was used for data collection. The research was done between February and August of 2022. Findings: At baseline, the study findings showed that 18.2% of respondents had ever been screened. Reasons for not screening included: fear (12%); feeling healthy (17%) among others. At post-intervention, the cervical cancer screening uptake among the respondents in the intervention arm was found to have increased from 18.2% to 45.9%, while that of the control arm remained at 18%. Respondents in the study’s intervention arm had a 3.867 higher chances of being screened than respondents in the control arm (OR 3.849, CI.1.802- 8.223, P<0.001) Conclusion: At baseline, the screening uptake for cancer of the cervix was low. The existing communication strategies in Isiolo County were limited in addressing cervical cancer. Targeted health communication on cervical cancer screening by Community Health Volunteers, subsequently cervical cancer screening uptake post intervention
Empirical investigation on the contents of the patients informed consent forms for medical imaging services in the government hospitals in Nairobi City County, Kenya.
(I nternational Academic Journal of Health, Medicine and Nursing (IAJHMN), 2020) Koi, Victoria Otysula; Yitambe, Andrea; Warutere, Peterson
Informed consent is a requirement by the law to allow patients to make decisions with respect to their health and well-being. It is an ethical and legal requirement that patients seeking medical imaging services should give an informed consent prior to seeking treatment with respect from healthcare providers. However, the extent of usage of the informed consent process vary across medical procedures. The study therefore seeks to assess the contents of the patients Informed Consent Forms for medical imaging services in the government hospitals in Nairobi City County, Kenya. The study adopted a descriptive cross-sectional study design. The study specifically focused on administration of informed consent, contents of the patients Informed Consent Forms and modes of informed consent used among patients for medical imaging services. Imaging departments in Kenyatta National hospital, Mbagathi, Mama Lucy, National spinal injury and National Mathare Hospitals in Nairobi City County were chosen as the area of study. Patients in the imaging departments of the selected hospitals were recruited for study. The sample size selected was 307 respondents. The respondents were selected using systematic random sampling at a predetermined interval of 3. Collected data was coded for analysis by use of SPSS. Analysis was conducted on descriptive and inferential statistics. Frequency tables, pie-charts and graphs were used to present the quantitative data. Inferential statistics were done using Chi Square tests to determine the association between study variables at 95% confidence interval (p<0.05). The ethical considerations were strictly followed during data collection. It was further revealed that age (χ2=3.782; df= 4; p=0.016;), level of education (χ2=3.89; df= 4; p=0.030), revelation of reason for referral (χ2=26.081; df=1; p=0.001), provision of right to refuse or defer imaging (χ2=33.468; df= 1; p=0.001), giving consent for treatment (χ2=70.733; df=1; p=0.001), decision making for wellbeing (χ2=12.056; df=1; p=0.001), pre-operative counseling (χ2=9.533; df=1; p=0.002), cases of negligence from clinicians (χ2=22.414; df=1; p=0.001), understanding information provided by clinicians (χ2=4.394; df=1; p=0.036), adaptation of informed consent doctrine meeting physicians and patients (χ2=7.648; df=1; p=0.006), performance of diagnosis from patients’ past medical history (χ2=9.788; df=1; p=0.002), advice on alternative treatment options available (χ2=8.065; df=1; p=0.005), disclosure of information by practitioners (χ2=19.406; df=1; p=0.001) and physical examination done before medication (χ2=9.006; df=1; p=0.003) were significantly associated with informed consent administration among respondents. The study concludes majority of the domains of the contents of informed consent had a significant statistical association with administration of informed consent among respondents. These research findings provide a great insights and information to leaders, managers, law makers, governing and oversight authorities in decision making, policy formulation, strategic planning and regulation in a context specific to provide a conducive environment for practicing medical imaging procedures in an ethical and legal manner.
Environmental Covariates of Anopheles Arabiensis in a Rice Agroecosystem in Mwea, Central Kenya
(2007) Mwangangi, J. M.; Muturi, E. J.; Shililu, J. I.; Muriu, S.; Jacob, B.; Kabiru, Ephantus W.; Mbogo, C. M.; Githure, J. I.; Novak, R. J.
Water quality of aquatic habitats is an important determinant of female mosquito oviposition and successful larval development. This study examined the influence of environmental covariates on Anopheles arabiensis mosquito abundance in the Mwea Irrigation Scheme, Central Province of Kenya, prior to implementation of a malaria vector control program. Experimental rice plots were used to examine the environmental covariates responsible for regulating abundance and diversity of the aquatic stages of malaria vectors. Mosquito larval sampling and water quality analysis were done weekly from the flooding stage to the rice maturation stage. Sampling for mosquito larvae was conducted using standard dipping technique. During each larval collection, environmental covariates such as pH, temperature, conductivity, salinity, dissolved oxygen, water depth, and rice stage were measured. Anopheles arabiensis larval density was highest between 1 wk before transplanting and 4 wk after transplanting with peaks at weeks 0, 3, and 8. The fluctuation in values of the various environmental covariates showed characteristic patterns in different rice growth phases depending on the changes taking place due to the agronomic practices. Using a backward linear regression model, the factors that were found to be associated with abundance of An. arabiensis larvae at any of the rice growing phases included the following: dissolved oxygen, pH, turbidity, water depth, rice height, number of rice tillers, salinity, conductivity, and temperature. The environmental covariates associated with abundance of An. arabiensis were associated with early vegetative stage of the rice growth. For effective control of developmental stages of mosquito larvae, the application of larvicides should be done at the vegetative stage and the larvicides should persist until the beginning of the reproductive stage of the rice.
Evaluation of the Health-related Quality of Life of Children in Schistosoma Haematobium-endemic Communities in Kenya: a Cross-sectional Study.
(PLOS Neglected Tropical Diseases:, 2013-03-07) Terer, Carolyn Chebet; Mutuku, F. M.; Bustinduy, A. L.; Magtanong, R. V.; Muhoho, N.; Mungai, P. L.; Muchiri, E. M.; Kitron, U.; King, C. H.
BACKGROUND: Schistosomiasis remains a global public health challenge, with 93% of the ~237 million infections occurring in sub-Saharan Africa. Though rarely fatal, its recurring nature makes it a lifetime disorder with significant chronic health burdens. Much of its negative health impact is due to non-specific conditions such as anemia, undernutrition, pain, exercise intolerance, poor school performance, and decreased work capacity. This makes it difficult to estimate the disease burden specific to schistosomiasis using the standard DALY metric. METHODOLOGY/PRINCIPAL FINDINGS: In our study, we used Pediatric Quality of Life Inventory (PedsQL), a modular instrument available for ages 2-18 years, to assess health-related quality of life (HrQoL) among children living in a Schistosoma haematobium-endemic area in coastal Kenya. The PedsQL questionnaires were administered by interview to children aged 5-18 years (and their parents) in five villages spread across three districts. HrQoL (total score) was significantly lower in villages with high prevalence of S. haematobium (-4.0%, p<0.001) and among the lower socioeconomic quartiles (-2.0%, p<0.05). A greater effect was seen in the psychosocial scales as compared to the physical function scale. In moderate prevalence villages, detection of any parasite eggs in the urine was associated with a significant 2.1% (p<0.05) reduction in total score. The PedsQL reliabilities were generally high (Cronbach alphas ≥0.70), floor effects were acceptable, and identification of children from low socioeconomic standing was valid. CONCLUSIONS/SIGNIFICANCE: We conclude that exposure to urogenital schistosomiasis is associated with a 2-4% reduction in HrQoL. Further research is warranted to determine the reproducibility and responsiveness properties of QoL testing in relation to schistosomiasis. We anticipate that a case definition based on more sensitive parasitological diagnosis among younger children will better define the immediate and long-term HrQoL impact of Schistosoma infection.
Expanding Access to Maternal, Newborn and Primary Healthcare Services through Private-Community-Government Partnership Clinic Models in Rural Kenya: the Ubuntu-Afya Kiosk Model
(BMC Health Services Research, 2019) Gatakaa, Hellen; Ombech, Elizabeth; Omondi, Rogers; Otiato, James; Waringa, Vincent; Okomo, Gordon; Muga, Richard; Ndiritu, Moses; Gwer, Samson
Background: Fifteen counties contribute 98.7% of the maternal and newborn morbidity and mortality in Kenya. The dismal maternal and newborn (MNH) outcomes in these settings are mostly attributable to limited access to skilled MNH services. Public health services are stretched and limited in reach, and many social programmes are not sustainably designed. We implemented a network of 16 self-sustaining community medical centres (Ubuntu-Afya Kiosks) in Homa Bay County, to facilitate access to MNH and other primary health services. We investigated the effect of these centres on MNH access indicators over a 2-year period of initial implementation. Methods: We conducted a baseline and end-line survey in June 2016 and May 2018 respectively, in 10 community health units (CHU) served by Ubuntu-Afya Kiosks. We targeted women of child bearing age, ensuring equal sample across the 10 CHUs. The surveys were powered to detect a 10% increase in the proportion of women who deliver under a skilled birth attendant from a perceived baseline of 55%. Background characteristics of the respondents were compared using Fisher’s exact test for the categorical data. STATA ‘svy’ commands were used to calculate confidence intervals for the proportions taking into account the clustering within CHU. Results: The coverage of antenatal care during previous pregnancy was 99% at end-line compared to 81% at baseline. Seventy one percent of mothers attended at least four antenatal care visits, compared to 64% at baseline. The proportion of women who delivered under a skilled birth attendant during previous pregnancy was higher at end-line (90%) compared to baseline (85%). There was an increase in the proportion of women who had their newborns examined within 2 day of delivery from 74 to 92% at end-line. A considerable proportion of the respondents visited private clinics at end-line (31%) compared to 3% at baseline. Conclusions: Ubuntu-Afya Kiosks were associated with enhanced access to MNH care, with significant improvements observed in newborn examination within 2 days after delivery. More women sought care from private clinics at end-line compared to baseline, indicating potential for private sector in supporting health service delivery gaps in under-served settings.
Factors Influencing Behaviour Change for the Prevention of the Spread of HIV/AIDS among Students in Githunguri Division, Githunguri District, Kiambu County, Kenya
(International Journal of Social Science, 2012-08) Ndegwa, I. N.; Wanderi, P. M.; Mwisukha, A.
The Human Immunodeficiency Virus (HIV) continues to spread in most countries of the world including Kenya. Since HIV / AIDS has no cure yet, behavior change has been fronted as the most likely scientific basis for the reduction in HIV prevalence. The virus is spread mainly by behaviors such as sexual behavior and drug taking that are generally private and sometimes difficult to discuss openly. This study looked at behavior change for the prevention of the spread of the Human Immunodeficiency virus (HIV) among students in Githunguri Division, Kiambu East District, Kenya. It was a descriptive survey. Out of the 28 public secondary schools in Githunguri Division, seven of them were randomly selected using the stratified sampling method, while one school was purposively selected as it was the only one of its kind, making a total population of 8 schools as the study population. Data was collected using a questionnaire. A pilot study was carried out to determine the feasibility of the research instrument. Descriptive and inferential statistics (chi-square at a significance level of 0.05) were utilized for analysis of data. Behavior change had occurred as 56% of the respondents had abstained from having sex as compared to 36% of the respondents who had not abstained. Out of the 36% of the respondents who had engaged in sex, 50.8% of them had used condoms as compared to 49.2% of the respondents who had not used condoms. Females reported an average of 1.48 sexual partners, while the male respondents reported an average of 2.03. Behavior change was influenced by religion, knowledge of HIV / AIDS, influence from HIV / AIDS prevention methods and gender. The study further revealed that there was a significant relationship between gender and HIV / AIDS, with more males engaging in risky sexual behavior placing them at risk of contracting HIV. HIV prevention efforts had a significant influence on behavior change for the spread of HIV / AIDS among students. The study recommends the need to have prevention efforts that focus more on males so as to enhance their behavior change as nationally, some 400,000 students graduate from secondary schools every year. These young people represent a key cohort for behavior change communication and character formation.
Factors that Influence Sexual Reproductive Health Knowledge among Adolescent Girls with Disabilities in Kiambu County
(frican Journal of Midwifery and Women's Health, 2023) Kimani, Eunice W.; Nyamari, Jackim; Nyamu, Florence
Background/Aims Problems related to sexual health can have adverse effects on the overall health of adolescent girls, including those living with a physical disability. Improving sexual and reproductive health knowledge among this population can enable them to make informed decisions in relation to their sexual health. However, the sociodemographic characteristics that influence knowledge in this population have not been explored. This study investigated the influence of sociodemographic characteristics on the sexual and reproductive health knowledge of adolescent girls living with physical disabilities in Kiambu County, Kenya. Methods A cross-sectional mixed method study was conducted among 144 purposively selected adolescent girls aged 10–19 years old living with physical disabilities. A semi-structured questionnaire was used to gather data on participants’ sociodemographic characteristics and their sexual and reproductive health knowledge. Odds ratios and logistic regression was used to analyse the data. Results One in five (20.8%) of the participants had already had a sexual experience, and only 24.3% of participants had good sexual and reproductive health knowledge. The majority of the participants (54.9%) had low socioeconomic status, which was the only factor significantly associated with level of knowledge (odds ratio=4.91, P=0.021). Conclusions Socioeconomic status is a major determinant of sexual and reproductive health knowledge among adolescent girls living with disabilities. Measures must be put in place to economically empower the families of these girls, to facilitate improved knowledge and thus ensure their sexual health and wellbeing. Implications for practice Education interventions are needed that are tailored to adolescent girls living with disabilities to promote reproductive health in this population.

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