PHD-Department of Public Health

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    Assesment of health-related fitness status of 6-9 year old primary shool pupils in Mukono and Wakiso Districts, Central Uganda
    (2011-08-10) Nsibambi, Constance Adron Nakayiza
    Despite a world-wide increase in health-related diseases and conditions among children, little information is known about the children's health-related fitness status in Uganda. Assessment of the fitness status of pupils aged between 6 and 9 years in Mukono and Wakiso districts in central Uganda was conducted using physical fitness testing. The study also determined their level of engagement in physical activities. A cross-sectional survey research design was used to assess four health-related fitness components. These were cardiovascular endurance using a 9-minute run test, body composition using BMI method, low back flexibility using the sit and reach test and abdominal muscular strength/ endurance using the sit up test. The target population comprised of 25,500 school children drawn from public and private schools. Four thousand pupils formed the sample for the study. The actual sample consisted of 1929 pupils with 922 day scholars and 1,007 in boarding schools. Data was analysed using frequencies, percentages, means and standard deviation and one way analysis of variance at 0.05 level of significance. The AAHPERD (1980) percentiles and the WHO (2007) CDC-BM1 for sex- age-growth charts percentiles to determine the fitness status of the pupils. The results showed that out of the 922 day scholars 250 (27.1%) had weak cardiovascular endurance, 27 (2.9%) were underweight, while 58 (6.3%) were overweight, 29 (3.1%) were obese; 707 (76.7%) had poor flexibility and 798 (86.5%) had weak abdominal muscles. On the other hand, out of the 1007 pupils in boarding schools 307 (30.5%) had weak cardiovascular endurance, 50 (5%) were underweight, while 79 (7.8%) were overweight, 50 (5%) were obese, 824 (81.8%) had poor flexibility and 814 (80.9%) had weak abdominal muscles. The results revealed significant differences in cardiovascular endurance, hody composition and abdominal muscular strength/endurance between day and boarding pupils (p>0.05) with day scholars having higher mean distance run scores, lower mean BMI scores and lower mean sit up scores. There were no significant differences in the mean sit and reach scores between day and boarding pupils. However, majority of pupils achieved the recommended standard for the cardiovascular endurance and normal body composition. There were also significant gender differences in all the health-related fitness components. The boys had higher mean distance run scores, lower mean BMI scores, lower mean sit and reach scores and higher mean sit up scores. This implies that more boys had better cardiovascular endurance, normal weight and better muscular strength/endurance than girls. On the other hand, more girls were flexible than boys. The study revealed that the pupils demonstrated poor health-related fitness status especially in abdominal muscular endurance and low back flexibility. The study also revealed that most pupils met the recommended 60 minutes of daily physical activity although the activities they engaged in were not appropriate enough to develop most of the health related fitness components. It is recommended that more physical activities that develop the health-related fitness should be integrated in the school curriculum and children need to engage in more active behaviours.
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    Assessment of risk behaviour and HIV prevalence among people who inject drugs in Nairobi county, Kenya
    (2014-08-18) Oguya, Francis Ochieng’
    Kenya is experiencing a mixed HIV epidemic with characteristics of both „generalised‟ epidemic among the mainstream population, and a „concentrated‟ epidemic among specific Most at Risk Populations including Injecting Drug Users (IDUs). The KNASP 2009-2013 recognizes that this group has a high potential to transmit HIV and present a lot of challenges for effective intervention because of overall lack of data on how to access them, their numbers and distribution. The objectives of the study were to document Injecting Drug Use Practices, assess the behaviours that predispose IDUs to risk of HIV infection, estimate the HIV prevalence among IDUs and determine the services available for HIV and AIDS prevention, care and treatment among IDUs in Nairobi county. Using a cross-sectional survey design on IDUs who had been injecting drugs for the last twelve months in Nairobi. The study used Respondent Driven Sampling methodology for its proven effectiveness in sampling hidden populations. Key Informant Interviews, Focus Group discussions and a structured questionnaire were used for data collection. The study was approved by the KNH/UoN Ethical Review Board. The study comprised 344 (322 men, 22 women) respondents from the eastern and western regions of Nairobi. Written and verbal informed consent was voluntary provided by all respondents. RDSAT software, MS Access, MS Excel and SAS were used for data management, presentation and statistical analyses. Statistical methodology comprised descriptive statistics, cross tabulations and Multivariate Logistic Regression on HIV status with other predictor variables. Chi squared tests were used to test significance at 0.05. The age range for study respondents were from 17 to 55 years. Although awareness of HIV was universal, their knowledge of HIV transmission and prevention ranged from limited and severely limited. The HIV prevalence for IDUs was determined to be 18.3% with women exhibiting higher prevalence (37%) compared to men (17%). Injecting drug use commenced early from 11 years and the age group exhibiting the highest HIV prevalence ranged between 15-29 years among both genders. Residential location (χ2 =19.2, 2df, p<0.0088) and sex of respondent (χ2 =25.1, 1df, p<0.0001) were found to be highly associated with HIV status. Significant behavioral variables were age at first drug injection (χ2 =11.4, 4df, p<0.04), Reason for starting to inject - a better high (χ2 =5.0, 1df, p<0.02), sharing needles and syringes (χ2 =8.9, 2df, p<0.01), Injecting with HIV positive person (χ2 =18.3, 2df, p<0.0001), Injecting with a female injector (χ2 =5.8, 2df, p<0.04). Significant risky sexual behaviours comprised Unprotected sex with multiple partners (χ2 =9.2, 3df, p<0.03), casual sex with HIV positive partners (χ2 =6.3, 2df, p<0.04) and transactional sex (χ2 =20.6, 6df, p<0.0021). The study found that specialised health and support services for IDUs were minimal or non-existent. HIV prevention, health management and drug treatment services for IDUs do not exist and may be contributory to the high HIV risk being experienced by this group. Due to risky injecting and sexual behaviours, HIV prevalence for IDUs was three times the national average. The findings in this study showed extensive vulnerability of IDUs to HIV infection and identified lack of knowledge and awareness of HIV transmission and prevention; lack of IDU friendly health and drug treatment services, antagonistic national policies and negative societal attitudes were the key associative factors. Based on this, the study recommends urgent, comprehensive and targeted intervention programs comprising of contextualized IEC and BCC interventions on risks associated with drug use; provision of free injecting equipment; national campaign to in school and out of school youths at risk of drug use; provision of free, convenient and IDU friendly medical treatment and drug treatment for IDU; HTC and ART treatment.
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    Associating genetic resistance to plasmodium falciparum malaria infection with ethnic groups residents of malaria endemic and non-endemic regions of Kenya
    (2011-08-11) Ayodo, George
    Malaria causes death of millions of people in sub-Saharan Africa and about 80% are children and women under 5 years of age. Infection has therefore exerted pressure on human genome and as a consequence clinical manifestations appear variable in endemic and non-endemic populations. Part of the reason for this epidemiological difference is hypothesized that over the last few thousand years, endemic populations have built up genetic resistance to severe malaria infection. To test this hypothesis, the study searched for evidence of natural selection in malaria exposed and unexposed populations by (a) carrying out a large-scale collection in Kenya of severe malaria cases and controls from the Luo ethnic group and also of population controls from the Masai and Kikuyu ethnic groups, (b) carrying out an association study at 10 genetic variants previously associated with malaria resistance, (b) studying frequency differences across populations to determine which of these variants have been subject to selection for malaria resistance in the past few thousand years, and (c) also studying haplotype and linkage disequilibrium patterns around malaria resistance genes to search for evidence of natural selection. In the Luo case-control samples, the previously described associations at CD36-GT (P value < 0.004) and HbAS (P value = 0.015) were replicated. Strikingly, there was unusually high frequency differentiation of the HbAS and CD36-GT variants in the exposed (Luo and Yoruba) vs. relatively unexposed (Kikuyu and Masai) populations compared to a panel of 1,454 randomly chosen markers that were studied in the same samples (P < 0.00036 and 0.00096 respectively). By statistically combining the case-control association and frequency differentiation statistics, the power of the association analysis was increased by several orders of magnitude (HbAS with P value < 0.0000 18 and CD36-GT with P value < 0.00043), which provides a potential tool for researchers to find risk factors for infectious disease in future. Further assessment o€ haplotype blocks flanking HbAS-T, CD36-G and ICAM-T suggested that exposed and un-exposed populations exhibit different haplotype block patterns, supporting the evidence of natural selection. CD 36GT appears to be under selection in both the Luo and Yoruba ethnic group, whereas HbAS is under selection in the Yoruba ethnic only but not in Luo ethnic groups. These results suggest Yoruba and Luo-perhaps because they are on different sides of the African continent-evolved different genetic response to malaria because they had been exposed to the disease for thousand years. This study has not only developed a novel method to identify malaria variants but has also provided an insight on the possibility of exploiting haplotype block patterns to map causal genes
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    Community integrated management of childhood illness: role of the "dialogue model" as an interactive communication tool
    (2011-08-15) Othero, Doreen Maloba
    Community Integrated Management of Childhood Illnesses (CIMCI) is one of the three components of the Integrated Management of Childhood Illness (IMCI) strategy, a holistic approach that aims at lowering Infant and child morbidity and mortality in developing countries. CIMCI targets changing household child care practices in order to enhance child survival. Implementation of CIMCI is majorly based on interactive communication between health service providers and mothers/caregivers of children aged below five years. The aim of this study was to test the effectiveness of the "Dialogue Model" as an interactive communication tool for implementing Community IMCI. The model was applied to 18 key household childcare practices that were identified to cause infant and child morbidity and mortality. A longitudinal comparative study was carried out in three out of the five divisions of Nyando district, Kenya. The study was done in six distinct phases. Both qualitative and quantitative approaches were used in data collection, analysis and presentation. Baseline quantitative data was collected using a semi-structured questionnaire that was administered to 930 randomly sampled mothers and caregivers. Qualitative data was collected through Key Informant Interviews and Focus Group Discussions. Quantitative data was analyzed using SPSS and Epi Info and generated frequencies, cross tabulations, ODDS Ratios and Chi-Square computations. Results of the baseline survey on key household childcare practices revealed that majority 481(77.0%) and 222(73.5%) of the mothers in the proposed intervention and control areas weaned their children before 4 months of age hence the strong correlation between weaning and prevalence of diarrhoea (CI 1.11-2.96 and 1.11-2.96) respectively. Only 64(10.2%) and 49(16.3%) of the children in the two study areas underwent growth monitoring after 9 months of age. A minority 91(14.6%) and 43(14.2%) of respondents in the proposed intervention and control areas confirmed that fathers' participated in the daily care of the children implying that the burden of routine childcare rests on the mothers. Treatment of drinking water was found to be minimal as only 199(31.8%) and 110(36.4%) respondents in the two study areas affirmed that their children drunk treated water. It was also established that only 196(31.4%) and 79(26.2%) of the mothers underwent HIV testing during pregnancy. Following training of health workers on the "Dialogue Model" majority 176(72.2%) of mothers/caregivers reported that health service providers spent at least 15 minutes examining their children, 181(74.0%) acknowledged having been counseled while 206(84.4%) received follow-up dates. Results following implementation of the "Dialogue Model" showed significant improvement in most of the household child care practices. Majority 430 (68.8%). of the children in the intervention area now undergo growth monitoring beyond 9 months unlike only 73(24.3%) in the control area. A large proportion 552(88.3%) of mothers in the intervention area is currently treating drinking water compared to 158(52.4%) in the control area. However, culture bound household practices such as fathers' participation in child care showed no improvement despite implementation of the "Dialogue Model". Similarly, HIV testing during pregnancy showed very minimal improvement. Prevalence of IMCI classified diseases such as measles, diarrhoea and aneamia showed significant reduction following implementation of the "Dialogue Model". The conclusion from this study was that the "Dialogue Model" was an effective tool for enhancing household child care practices and also improved communication between health workers and the mothers/caregivers. However, it was recommended that further research be done to establish another communication approach that could positively change culture bound household child care practices such as fathers' participation in routine childcare. To enhance uptake of HIV testing during pregnancy, there was need for change in the implementation policy so that male partners are involved in the counseling and testing process together with their female partners
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    Determinants of adherence to anti-retroviral therapy and high risk behavior among HIV infected patients on treatment in Nairobi Province, Kenya.
    (Kenyatta University, 2009-10) Oyore, J. P.
    Anti-retroviral therapy (ART) has been successful in dramatically decreasing the morbidity and mortality caused by HIV infection. Levels of adherence in excess of 95% are required to ensure treatment success, adequate viral load suppression, improved immune status and slowing of the disease progression. It has also been reported that a lot of complacency during ART and feeling of reduced infectivity by the patients on ART could lead to high risk sexual behaviour and enhance transmission of HIV. To date there is very little scientific data on ART adherence, factors influencing it and any resultant high risk behaviour in Nairobi, Kenya. This was a non -interventional cross-sectional study using rapid appraisal techniques for collecting both qualitative and quantitative data. The main objective of this study was to determine the levels of adherence, factors influencing it and identify any resultant high-risk behavioural changes during ART among patients in selected treatment sites in Nairobi Province, Kenya. A combination of data collection tools was used to gather the information in this study including semi -structured questionnaires, adherence measurement tool and FGDs. Qualitative data was consolidated using data matrices. Analysis of qualitative data was done by triangulation based on major themes or constructs. Quantitative data was analyzed using the statistical package for social scientists (SPSS) version 16.0. Hypothesis testing was done using Chi-square and Kruskal-Wallis tests to test the significance of the categorical variables. T-tests and Mann U Whitney tests (non -parametric tests) were used to assess the differences between groups for continuous variables. Multistage sampling design was used since convenience sampling was used to determine the health facilities after which systematic sampling was used to select the patients to be interviewed. The results indicated that just about half ,216 (48%) of the PLWHA had accurate knowledge of what ARVs were and what they do to the body. There was a significant relationship between knowledge of ARVs and adherence with those having more accurate knowledge more likely to adhere (X2 = 106.432 df = 7, p :s 0.001). The composite adherence ART level of adherence from the three methods used among patients in Nairobi was found to be 85% with 43% of the patients not achieving optimal adherence. The major factors that were found to constrain adherence were costs (X2 = 306.02, df= 7, p:S0.001), lack of social support (X2 = 0.804, df= 7, p~O.997), side effects (X2 = 92.583, df= 7, p:S 0.00), distance to the facility, gender (X2 = 104.006, df= 7, p:S0.02) , CD4 count at start of treatment. The results also indicated that a good proportion 342 (76%) of the patients who had been on treatment for over six months had engaged in high risk HIV transmission behaviour by either having sexual intercourse without protection or with partners of unknown HIV status. Quality of care is affected by lack of adequate supply of drugs and training of health workers. These findings will help policy intervention towards improving access and adherence to ARV through carefully planned and evaluated interventions. Furthermore, it will lead to the improvement of the quality of medication discussions and care so that both patients and care providers receive and understand the information they need, enable patients to accurately assess their readiness to initiate and adhere to ARV, identify gaps between knowledge and actual practice both for health workers and PL WHA. The information will also be given to the PL WHA to enable them reduce the high risk sexual behaviour that may predispose them to HIV re-infection. Itis recommended that there should be more education and information provided to the patients prior to initiating ART so that they know the facts about ARVs. In conclusion, the study found that majority of patients on ART does not achieve optimum adherence levels and that 342 (76%) of patients on ARVs are engaging in risky sexual behaviour. The study also recommends more targeted counseling be provided by the care providers highlight the importance of adherence hence promoting adherence among the patients. There should also be improved education targeting the PLWHA to sensitize them and remind them that they are not free of HIV and AIDS v n af r b ing on tr atm nt and that th y would still t r -infected by other strains of HIV.
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    Determinants of adherence to Anti-Retroviral therapy and high risk behaviour among HIV infected patients on treatment in Nairobi province, Kenya
    (2011-07-25) Oyore, J. P.
    Anti-retroviral therapy (ART) has been successful in dramatically decreasing the morbidity and mortality caused by HIV infection. Levels of adherence in excess of 95°/, are required to ensure treatment success, adequate viral load suppression, improved immune status and slowing of the disease progression. It has also been reported that and feeling of reduced infectivity by the patients on ART could lead tonhance transmission of HIV. To date there is very little scientific data on ART adherence, factors influencing it and any resultant high risk behaviour in Nairobi, Kenya. cross-sectional study using rapid appraisal techniques for collecting both qualitative and quantitative cl.ita. The main objective of this study was to determine the levels of adherence, factors influencing it and identify any resultant high-risk behavioural changes during ART treatment sites in Nairobi Province, Kenya. A combination of data collection tormation in this study including semi -structured questionnaires, adherence measurement tool and FGD,. Qualitative data was consolidated using data matrices. Analysis of qualitative data was done by triangulation based on major themes or constructs. Quantitative data was analyzed using the statistical package for social scientists (SPSS) version 16.0. Hypothesis testing was done using Chi-square and Kruskal-Wallis tests to test the significance of the categorical variables. T-tests arametric tests) were used to assess the differences between groups for continuous variables. Multistage sampling design was used since convenience sampling was used to determine the health facilities alter which systematic sampling was used to select The results indicated that just about half ,216 (48%) of the PLWHA had accurate knowledge of what ARVs were and what they do to the body. There was a significant relationship between knowledge of ARVs and adhere (x2 imal adherence. The major fact((x2 rt= 0.804, df = 7, p<_0.997), side effects = 92.583, df = 7, p <_ 0.00), distance to the facility, gender 104.006, df =7, p<0.02) , CD4 count at start of treatment. The resproportion 342 (76%) of the patients who had been on treatment for over six months had engaged in high risk HIV transmission behaviour by either. having sexual intercourse without protection with partners of unknown HIV status. Quality of care is affected by lack of adequate supply of drugs and training of health workers. These findings will help policy intervention towards improving access and adherence to ARV through carefully planned and evaluated interventions. Furthermore, ii will lead to the improvement of the quality of medication discussions and care so that both patients and care providers receive and understand the information they need, enable patients to accurately as their readiness to initiate and adhere to ARV, identify gaps between knowledge and actual practice both for health workers and PLWHA. The information will althem reduce the high risk sexual behavior that may predispose them tded that there should be more education and information provided to the patients prior to initiating ART so that they know the facts about ARVs. In conclusion, the study found that majority of patients )n ART does not achieve optimum adherence levels and that 342 (76%) of patients on ARVs are engaging in risky sexual behaviour. The study also recommends more targeted counseling be provided by fie care providers highlight the importance of adherence hence promote. There should also be improved education targeting the PLWHA to sensitize them and remind then that they are not free of HIV and AIDS even after being on treatment and that they would still get re-infected by other Strains of HIV.
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    Determinants of socio-cultural risks factors in HIV infections among the muslim community in Kenya
    (2011-08-11) Karama, Mohamed; Orago, A. S.; Moji, Kazuhiko
    HIV and AIDS continue to devastate many areas of the world. Africa and especially Sub Saharan Africa remains the epicenter for the pandemic. In Kenya despite declining prevalence, the incidence remain high. This is as a result of among others risk taking behaviours and resistance to change. Muslims form 25 to 30% of the population of Kenya and despite the low prevalence among them, little is known about their socio-cultural risk factors in relation to HIV infection. The aim of this study was therefore to determine the knowledge and perception of the Muslim on HIV and AIDS, to identify risk practices among them. This was a cross sectional study where both qualitative and quantitative data collection methods were used countrywide and during two national Muslim leaders consultative workshops and other workshops at the district levels. Focus group discussions, in-depth interviews with key informants and administration of a questionnaires for quantitative data on knowledge and attitude was undertaken. Data analysis included running frequencies for percentages and the use of chi-square to determine the difference in risk perceptions between males and females. There are about 2300 mosques 4800 madrassas (Muslim schools), 99 secular schools, 20 Muslim managed health facilities and about 1000 community organizations. There is an extensive Islamic teaching that can be useful in addressing HIV related problems. Knowledge levels measured as percentages of the community who got the right answers ranged between 38% to 97% with women being less informed but the difference is not significant (p=<0.06). Knowledge levels were superficial with less details on prevention and management of HIV. National average for perceived prevalence was 2.6% with Northern Kenya being lowest at less than 1 % and Nyanza being highest at average of 5.5% an indicator of recognition of HIV as problem for all Kenyans. Risk priorities varied between regions with the coast identifying tourism related risk and the Northern region identifying cultural practices including polygamy divorce and female circumcision as a possible risk practices. In Northern Kenya and the Coast, divorce rates and polygamous marriages were estimated to range between 15 and 30% and 10 to 30% respectively. The transport industry especially long distance truck drivers a preference for Muslim businessmen, taxis, and other public transport are of general concern countrywide. There was significant difference in the perception of risk between men and women (p =<0.001). There is need for more coordinated involvement of Muslims and the mainstreaming of HIV control and prevention within the physical and social infrastructure and the Islamic teachings. More research should be undertaken to better understand the implications of the risk practices in the spread of HIV in the Muslim community in Kenya. The results of this study helped in the development of a Muslim policy on HIV in Kenya
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    Development and application of a geo-medical information decision support system (geo medinfo) for malaria surveillance and risk modelling in Nyanza Province, Kenya
    (2011-08-04) Mogere, Nyaribo Stephen
    In sub-Saharan Africa, malaria is a leading cause of morbidity and mortality. Detailed knowledge of spatial variation of malaria epidemiology and associated risk factors is important for planning and evaluating malaria-control measures. This study therefore investigated an approach in the development and application of a GIS-based healthcare management system with abilities to incorporate climate-based risk predicators of malaria transmission in Nyanza Province. Two sites, Siaya district and Kisii Highlands were selected to implement this study. The PMIS was designed with capabilities to carry out both micro- and macro-levels spatial epidemiologic analyses of malarial transmission. Using Universal Modeling Language (UML) and Microsoft Visio 2003 health data classes, relationships, attributes and data types were modeled which formed the basis for customizing and design of the Patient Management Information System (PMIS). A tailor-made PMIS was then implemented to capture malarial data alongside patient care in Siaya District Hospital, a rural health facility in Nyanza Province, Kenya. A total of 822 malarial case households were tracked and mapped using the Global Positioning System (GPS) and entered into the PMIS. In addition, malaria monthly cases from a total of 127 health facilities in Kisii Highlands were obtained for the period between 1996 and 2005 alongside data on rainfall, Normalised Difference Vegetation Index (NDVI), temperature and Digital Elevation Model (DEM) as possible predicators of malarial risk in the study area. Spatial analyses results revealed that the average distance traveled by study participants to Siaya District Hospital (SDH) was 6km while the longest distance was about 13.15km. There was a significant positive correlation between distances of malaria case households to the health facility, proximity to water bodies and malarial outcomes at 0.05 level of significance (P<0.005). However, no significant differences (p<0.005) were found between malarial case households and controls with regard to proximity to local road network. Regression modelling of malarial transmission in the Kisii Highlands revealed associations between rainfall, NDVI, temperature and DEM and malaria cases in the three administrative districts of Nyamira, Kisii and Gucha. These factors had varied influence on malaria risk transmission with the DEM found to explain most of the malaria case variations in the study area. Geospatial risk models developed for malaria transmission predictions were validated using F-test. The study recommends further testing and validation of both PMIS and the spatial predictive malaria risk model in other parts of the country. The study concludes that it is feasible to develop GeoMedlnfo in broader health information sharing nationally, designed as a tool for improved diagnostics, planning and management programming of malarial surveillance system.
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    The effect of selenium intake in progression of asymptomatic hiv type 1 infected children in Nyamasaria Sub county Kisumu County Kenya
    (2015) Otieno, Samwel Boaz
    The prevalence of the Human-Immuno-deficiency Virus has been observed to be inversely related to selenium levels in foods. More recent Demographic Health Surveys have shown that despite the prevalence of HIV reducing by half in Kenya the prevalence in Kisumu County still remains twice the National prevalence, which suggests that there could be other factors involved in HIV epidemiology in the County. The hypothesis of this study was that selenium intake does not cause rapid progression of to AIDS from HIV infected children in Kisumu County. The main objective was to determine the effect the intake of yeast selenium on CD4 T cells and Weight for Age Z Score in HIV positive children (3-16 years). In this study a total of 68 HIV positive children were registered in the study to asses the efficacy of selenium. Yeast selenium (50μgm) was given to 34 children while the remaining 34 were put on a placebo.Blood samples and weight of the both groups were taken at 3 months intervals from 0, 3months and 6 months. The blood samples were analyzed by Enzyme Linked Immunosorbent Assay for CD4T cells while Weight for Age Z score was analyzed by Epi.Info version 3.4 and SPSS version16 for significance.In the study it was shown that children on selenium had progressive improvement of WAZ and which was significantly different at six months between children on selenium and the controls {F (5,12) = 5.758, P=0.006}.By using -2 standard deviations Z scores as a measure of cut-off, 15% boys and no girl on selenium was wasted at six months. Among the controls 64% of boys and 38% of girls were wasted at six months. The children on selenium had weight gain of up to 2.5 kilograms in six months. There was a significant mean increase CD4 T cell count at six months among the children on selenium,{ t( 1, N=30) = -2.943, p=0.006} compared to the matched controls {t =(1,N=30) =1.258 p= 0.0.0218}. CD4 T cell count increased among all age groups on test,3-5years (+ 267.1),5-8 years (+200.3) 9-15 years (+71.2) cells/mm3 . In matched controls a decrease was observed in all age categories, 3-5 years (-71),5-8 years (-125) and 9-13years (-10.1) cells/mm3 . There was no significant difference in CD4 T cell count between boys {F (2, 32) = 1.531 p= 0.232} and between girls {F (2, 49) = 1.040, p= 0.361} and between boys and girls {F (5, 81) = 1.379, p= 0.241} among the children on test. Similarly no significant difference was observed between boys and girls {F (5, 86) = 1.168, p= 0.332} in matched controls. In the test group there was a significant positive correlation between weight for age (WAZ), and CD4 T Cell Count p=0.007, R2= 0.252, F<0.05, β =252.23.There was a significant correlation observed between Weight for Z score and CD4 T cell count{ t( 2, N=27) = 2.94 p=0.007} with β = +252.23 and adjusted R² of 0.2016..In matched controls no significant correlation between weight for age Z-Score and CD4 T cell count change was observed at six months{ t (2, N=26) =0.08 p = 0.934} with β coefficient of +3.366 and adjusted R² =0.0337 .No positive correlation was observed among the children on selenium between CD4 T Cell count, and gender {t (2,27) = -0.69 p=0.0.495} with β coefficient of -138.23. Similarly in a matched control there was no significant correlation between CD4 T cell count and gender {t (2, N=26) = -0.90 p= -0.380} with β coefficient of -135.50.Majority (96.78%) of children on test either remained or progressed to WHO immunological stage I. It can be concluded that selenium intake slowed the rate of progression to AIDS from HIV positive patients as shown by increase in CD4 T cell count and further that there was no significant response between girls and boys. It is recommended that selenium be given as supplement to the HIV positive children on WHO clinical stage I to III as away of delaying progression to WHO stage IV.
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    Effect of Structured Caregiver Nutrition Education on Management of Pediatric Type 1 Diabetes in Uganda: A Cluster Randomized Trial
    (Kenyatta University, 2022) Bari, Ndahura Nicholas; Judith Kimiywe; Judith Munga; Ezekiel Mupere
    Nutrition education is a vital component in the successful management of diabetes among pediatric type 1 diabetes mellitus (T1DM) patients. However, in Uganda, no published study has been done to find out if nutrition education affects the nutrition knowledge of caregivers and the glycaemic and dietary outcomes of their children.This study, therefore, evaluated the effect of the provision of a structured nutrition education course to caregivers of children and adolescents with T1DM on their level of type 1 diabetes nutrition knowledge and their children’s glycaemic control, dietary intake and diversity (DDS) in Uganda. The study was a cluster-randomised controlled trial in which study participants were randomly assigned to two groups; a control group and an intervention group at a ratio of 1:1. The total sample size was 100 caregiver-child dyads. Data was collected at baseline and 3 months post-intervention. The participants in the control group continued to receive routine medical care, while those in the intervention group received routine medical care and attended a structured group nutrition education course. The intervention lasted 12 weeks, it consisted of eight face-to-face sessions lasting 45 minutes each. The primary outcome was glycated haemoglobin (HbA1c) and the secondary outcomes (caregivers’ level of nutrition knowledge, children’s DDS and mean adequacy ratio (MAR). Data was collected using researcher-administered questionnaires. The data was analysed using SPSSVersion 26. Descriptive statistics such as frequencies, percentages, mean, standard deviation and medianwere used to describe the demographic, socioeconomic, diabetes-related characteristics, nutrient and dietary adequacy from the 24-hour recall. Independent samples t-test, Mann–Whitney U-test, analysis of variance (ANOVA) and Kruskal-Wallis Htest were used to determine the differences in continuous variables between the study groups. A Chi-square test was used to test for associations among categorized variables between the study groups.Spearman’s rank correlation coefficient was used to test for an association between the caregiver’s T1DM nutrition knowledge and dietary intake indices. The baseline findings revealed that 87.6%of the caregivers had low T1DM nutrition knowledge and this was significantly different across the levels of education (Kruskal-Wallis Htest: p = 0.007). Most type 1 diabetic children and adolescents had a mean DDS of 5.5 with adequate carbohydrate and protein but were found to be at risk of essential fatty acid and micronutrient deficiencies. The children’s mean HbA1c, DDS and MAR after the intervention were HbA1c (intervention: 10.87 versus control: 10.86; p= 0.347), (intervention: 5.93 versus control: 5.26; p=0.006) and (intervention: 0.81 versus control: 0.77; p = 0.021) respectively. The intervention group had a higher mean type 1 diabetes nutrition knowledge score (45.14%) compared to the control group (33.73%). There was no significant difference in the children’s HbAlc levels following their caregiver’s participation in the structurednutrition education course (Wilcoxon signed-rank test: p = 0.748). However, there was a 0.7 % decrease in the children’s HbAlc levels in the intervention group 3 months after the intervention compared to a 0.1 increase in the control group. A significant positive correlation between the caregiver’s nutrition knowledge scores and nutrient adequacy ratios (NARs) of vitamin B6, biotin, folic acid, and iron were observed (Spearman’s rank correlation: p< 0.05). Based on the gaps in the existing nutrition education module, a nutrition education guide for caregivers of children with T1DM in Uganda was developed and used during the intervention. This study concluded that structured nutrition education for caregivers of paediatric T1D patients can improve their nutrition knowledge and their children’s overall dietary adequacy. Therefore, the study recommends the developed contextualized guide should be used to conduct nutrition education sessions with caregivers of children with T1DM.
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    Effects of Behavioural Change Communication on Hivand Aids Related High Risk Behaviour among Fishermen in Homabay and Siaya Counties, Kenya
    (Kenyatta University, 2023) Akobi, William Kala; John Paul Oyore; George Ochieng Otieno
    Risky sexual behaviors such as sexual concurrency, sexual networks (fish for sex exchange) and unprotected sex, have been reported as the main cause of STIs / HIV infections among the fisher folks. Behavioral Change mechanisms such as condom use, and abstinence are some of the interventions used in the prevention of transfer of infections from one person to another. In Kenya, studies are lacking on the effect of targeted behavioral change communication on the prevalence of risky behaviors among the fisher folks. Risky sexual behaviors increase the risk of contracting STIs which results into acute as well as long-term complications including infertility, fetal wastage, ectopic pregnancy, cancer, premature death and neonatal/infant infections. This was a cross-sectional, longitudinal descriptive and quasi-experimental study involving 246 randomly selected fisher folks in Mbita Homabay County and Usenge in Siaya County. This study used quasi-experimental design to assess the awareness level on risky sexual behavior among the fisher folks in Mbita, Homabay County and Usenge, Siaya County; with the aim of assessing the awareness level of the risky behavior among the fishermen, determining the prevalence alcohol and drug abuse and high risk behavior among the fisher folks; determining the role of circumcision in high risk behavior among the fisher folks; identifying the high risk behaviors among the fisher folks in Mbita, Homabay county and Usenge, Siaya County; determining the role of sexual networks and sexual concurrency as a risky sexual behavior among the fisher folks in Mbita, Homa Bay County and Usenge Siaya and to determine the effect of the behavior change communication on the risky sexual behavior among the fisherfolks in Mbita, Homabay County and Usenge, Siaya county. This was a three-tier study involving baseline, intervention and end line (evaluation). Qualitative data was collected using Focus Group Discussion and Key informant interviews while, quantitative data was collected using structured questionnaires. Descriptive statistics and inferential statistics were used in data analysis. Fishers exact test was used with a significant P>0.000. Various variables were influenced by behavior change communication strategies used. These includes use of condom every time of sexual encounter P>0.000, risk associated with non -condom use P>0.004, stopping using condom and fear of getting HIV/AIDS P>0.009, Sexual intercourse without condom use is dangerous P>0.000, whether remembering to use condom every time of sex is difficult P.0.000, whether they are keeping many sexual partners P.0.004, receiving fish /money in exchange for sex in last six months P.0.006. This study recommends further research on the emerging of the dynamic boda boda riders within the fishing industry beaches and its public health effect on industry as far as sexually transmitted infections and HIV spread is concerned and its public health outcome This mode of transport is popular within the fishing c ommunity.
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    Effects of Cash Transfer Programme for Orphans and Vulnerable Children on Livelihood Outcomes of Beneficiary Households in Meru County, Kenya
    (Kenyatta University, 2022) Festus, Eliud Mutwiri; Joan Kabaria -Muriithi; Christine Njuguna
    Studies have revealed that increasing levels of poverty aggravates the plight of vulnerable populations in developing countries making it imperative for governments to design cash transfer programmes to address the situation. Cash Transfer programmes are policies and programmes designed to cushion vulnerable people against poverty and vulnerability. Scholarly work suggest that Cash Transfer Programmes have positively contributed to improved livelihoods of underprivileged and vulnerable populations in most African countries, however, few studies have been done to determine their effects on beneficiary households in Kenya. Despite various efforts to improve the livelihood outcomes of beneficiary households in Kenya, indicators such as school enrolment and retention, access to affordable health services, wealth creation and ownership of assets show the possibility that beneficiaries of cash transfer programme are still suffering from poverty, vulnerability and social exclusion. This study sought to investigate the effects of Cash Transfer Programme for Orphans and Vulnerable Children (OVC) on livelihood outcomes of households in Tigania West Sub- County, Meru County. Specifically the study sought to: assess the relationship between socio-economic characteristics of households receiving cash transfer programme and livelihood outcomes; examine beneficiary households’ Awareness on the objectives of cash transfer programme for OVC and their livelihood outcomes; investigate the relationship between expenditure priorities and livelihood outcomes; explore the risks associated with the mode of payment of cash transfer programme for orphans and vulnerable children and their effects on livelihood outcomes and to develop a model of the relationship between cash transfer programme and livelihood outcomes. The study utilized mixed methods research design and targeted 1040 subjects with a sample of 281. The findings indicate that cash transfer programme had a positive impact on livelihood outcomes of beneficiary households and that there exists a positive relationship between the socio-economic characteristics of households receiving cash transfers for OVC and their livelihood outcomes, awareness of objectives of the cash transfer programme impacted negatively on the livelihood outcomes of beneficiary households. The expenditure priorities of households receiving cash transfers impacted their livelihood outcomes, while risks associated with the mode of payment had an explanatory strength on livelihood outcomes of beneficiary households. The study recommends that policy makers should review the existing policies on the cash transfer programmes to incorporate the assessment of households’ socio-economic characteristics prior to their enrolment into the programme. Policy implementers should disburse the cash Electronically or through bank accounts as the two modes of payment were found to have had the lowest associated risks and thus are the preferred mode of disbursement of cash transfers to OVC. The Government of Kenya and NGOs dealing with children’s issues should develop training programmes on awareness and expenditure modalities to promote effective utilization of cash transfer stipends among the beneficiaries.
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    The effects of HIV testing and counselling on behaviour change in the prevention of HIV among the military population in Kenya
    (Kenyatta University, 2012-02) Elmi, Ltcol Mohamed Yussuf
    HIV testing and counselling (HTC) is an important prevention intervention whose aim is to enable an individual know his/her HIV sero-status and is also an entry point to treatment, care and support. Kenya in the new KNASP (2009/13) envisions an HIV free society through universal access to HIV services such as knowledge of HIV status by 2015, where 80% of the Kenyan population would have been counselled and tested. In order to achieve the national universal access targets, utilization of HTC services should increase everywhere throughout the country including the Kenya military. However, HTC services remain underutilized with only 50% of Kenyan between the ages of 15 and 64 years possessing knowledge of their HIV status and up to 83% of those infected with HIV do not know their HIV status. AIDS is currently the leading cause of death globally in the military, accounting for more than half of in-service and post service mortality in some countries. Such attrition causes loss of continuity at command level and within the ranks, increasing recruitment and training costs for replacements, and generally contributes to reduction in military preparedness, internal stability and external security. HIV and AIDS is one of the worst epidemics with most far reaching health and developmental consequences the world has ever seen. In Kenya, HIV and AIDS was declared a national disaster in 1999. Kenya continues to have a severe, generalized and concentrated HIV epidemic and the estimated HIV prevalence in adults aged between 15 and 49 years was about 7.1% in 2007 reducing marginally to 6.3% in 2008/2009. Throughout the world, the military personnel are the most vulnerable population to HIV and AIDS including sexually transmitted diseases. This is due to demographic factors such as their population being predominantly youthful with highly mobile and sexually active males. Access to alcohol tends to exacerbate risky sexual behaviour and hence increased vulnerability to contracting HIV. Despite the military being a high risk group, no previous study has investigated the effects of HIV testing and counselling as a .prevention intervention in Kenya. A descriptive, retrospective and prospective cross sectional study was conducted in the Kenyan military between 2003 and 2006 to evaluate the effect of voluntary counselling and testing as a tool for behaviour change among military personnel in 7 barracks in Kenya. A total of 320 respondents were interviewed and 6 FGDs were held the latter consisting of 60 participants in total. The findings revealed that more males than female respondents participated in the study and that over 79% of them were aged between 18 and 40 years. There was a remarkable increase in the utilization of HTC services from 9% in 2003 to 58.8% in 2006. A number of respondent-related factors including sex, age, marital status, occupation, level of education, concurrent partnerships, STI and knowledge of partners HIV status were identified to promote positive sexual behaviour change. Several factors were significantly associated with utilization ofHTC as a behaviour change strategy at 95% confidence level. These included knowledge of partner's HIV status (X2 = 1.867, P > 0.010), occupation of males (l =2.583, P > 0.011), and engagement in risky sexual behaviour (X2 = 2.049, P > 0.017). The findings also showed that at 95% confidence interval, marital status (l = 2.651, P > 0.024) and knowledge of partners' HIV status cl =1.685, P > 0.047) were significantly associated with the utilization of HTC and PMTCT services as a behaviour change strategy. The findings from retrospective records indicated that the HIV prevalence in the Kenyan military personnel had declined from 13% in 2002 to 5.3% in 2007 as was also a decline in STI cases among the same population. This study indicated that there was a significant behaviour change in the military and a deeper understanding of the effects of HTC as strategic tools in HIV prevention.
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    Evaluation of Compliance to Food SAafety Standards Amongst Food Handlers in Selected Hospitals in Kenya
    (2013-08-15) Nyamari, J. M.
    Food borne diseases presents a widespread and growing public health problem both in developed and developing countries including Kenya. Diseases spread through food still remain a common and persistent problem resulting in appreciable morbidity and occasional mortality. Food hygiene in hospital poses peculiar problems, particularly given the presence of patients who could be more vulnerable than healthy individuals to microbiological risks. Kitchen environment and food handlers play an important role in ensuring food safety throughout the chain of production, processing and preparation; the common involvement of food handlers who are not specifically trained in food hygiene and HACCP and kitchen environments that do not meet food safety standard is a cause of concern. The objectives of this study were to assess the levels of compliance to food hygiene standards in selected hospitals in Kenya; to determine perceived barriers to implementing food safety practices amongst food handlers, and to evaluate the effectiveness of food safety training on food safety knowledge and practices among hospital food handlers. The main aim was to provide baseline data for implementing food safety standards and in hospital food services in order to enhance compliance. This study utilized a quasi-experimental study design. Through a simple random stratified sampling, 42 hospitals (22 interventional group and 20 control group) were selected for the study with a total of 343 food handlers (129 interventional group and 141 control groups). All hospitals were evaluated on their compliance to food hygiene standards; Nine FGDs having food handlers from both interventional groups and control groups were undertaken to determine barriers to implementing food safety practices. Pre and post-training assessments were conducted on knowledge and behavior related to three key food safety practices; personal hygiene, food hygiene and environmental hygiene. The study identified gaps with regard to status of the hospital kitchen, status and storage of equipments, some aspects of personal hygiene and sanitation and vector control. The following were identified in all FGDs; lack of food safety training, poor working conditions, rapid turnover, lack of sufficient equipments, lack of water, lack of recognition by the hospital management and insufficient supervision as the major barriers influencing non compliance to food safety standards. Overall food handlers knowledge scores increased from 50.6 ±16.5 pre- training to 76.4 ±15.5 post training (P<0.05), and reported practices scores increased from 101.3±11.6 pre-training to 105.3±12.2 post training (P<0.05) in the intervention group. However, when each practice was examined independently significant changes were not observed, results indicate that training can improve knowledge and behavior, but knowledge alone does not always improve behavior. The findings of this study highlight the importance of regular inspection of hospital kitchens; providing health education in food and personal hygiene to food handlers and incorporation of the same in existing guidelines and policies for food establishments.
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    Factors influencing prenatal health status of women attending prenatal clinics in selected low income areas
    (2012-01-03) Ondigi, Alice N.
    This study is designed to investigate the factors influencing prenatal health status among women attending prenatal clinics in selected low income areas of Nairobi, Kenya. The main purpose is therefore to establish the prental health status of pregnant women in low income areas and how this has contributed toward the healthy development of the unborn baby. Literature reviewed indicates that there is an increase in both maternal and infant mortality rates among low income women, and the most affected are women living in urban slums of Nairobi, Kenya. The literature further indicates that accessibility in terms of escalating costs of obtaining adequate health care and poor infrastructure are among the main factors that lead to poor prenatal status of the expectant women. However, based on the Safe Motherhood conceptual framework, there is need to improve the health status of the expectant women. Variables attributed to prenatal health status that this study addressed include: prenatal health conditions as a dependent variable, while age, level of education, number of visits attended, number of children, attitude of the pregnant women toward their pregnancy, partner support, family and community support, problems experienced and quality of prenatal health care offered at the clinic as independent variables. This study considered these variables to be influencing the prenatal health status of pregnant women in Kenya. Four administrative divisions from the eastern from the eastern part of Nairobi, Kenya were purposively selected. These four administrative divisions were: Mathare, Makadara, Starehe and Embakasi. The sample population of 170 pregnant women who ranged from 15-40 years was drawn from the six clinics randomly chosen from the four areas where the majority of low income people live. The findings of this study therefore, indicated that number of children per respondent, and number of prenatal visits attended was negatively correlated with prenatal health conditions. The hypotheses were tested using regression analysis and the associated t-tests. The two variables including partner support were included in the regression equation as the main predictors of prenatal health status. Since good prenatal health conditions aim to improve birth outcomes, it is therefore important for the Government to take measures to improve infrastructure, encourage expectant women to take measures to improve infrastructure, encourage expectant women to attend prenatak clinics earlier in their pregnancies, and promote women's perceptions, family and the surrounding community
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    Influence of child care practices on malaria severity in children under five years of age in Mbeere district of Eastern province, Kenya
    (2011-08-09) Mwaniki, P. Kabanya
    Malaria, a blood parasitic disease is a leading cause of mortality and morbidity particularly among children and pregnant women because they are most at risk in many developing countries, especially those in Sub-Saharan Africa. Most of the deaths due to malaria could be averted if care-takers recognized the signs and symptoms of malaria and instituted appropriate measures W ithout delay. Early recognition followed by correct management is a key strategy for malaria control in endemic areas. The effectiveness of this strategy requires an understanding of careseeking patterns including the actions the care-takers initiate in response to an episode of childhood febrile illness since they greatly influence the severity of the disease. A health facility-based descriptive cross-sectional study was carried out in Mbeere District (a malaria endemic area), where caretakers seeking treatment for their children aged under-five years who tested positive for malaria parasites were recruited into the study. The main objective was to determine health care practices during the illness and their effect on the severity of the illness. A questionnaire was used to collect primary qualitative data from caretakers. Additional qualitative data was obtained through focus group discussions with women groups in each of the study sites. The data was entered using Epi-Info interface and analysis done using the Statistical Package for Social Sciences (SPSS) version 12.0 software. Pearson's chisquare test of independence was used to determine level of associations at 95% confidence interval. The results established that the children had been unwell for mainly (X days prior to health facility visit. The mean duration of illness for the children was 2.1 (S.D \ days. On diagnosis and classification of the illness at the health facility, 23.9% of all children seen had complicated malaria, 74.3% had uncomplicated malaria while 1.7% were not classified. There was no significant difference in severity of malaria among the different age groups of children (x = 2.32, p=0.67). Analysis of actions taken at home showed that 81.3% of the caretakers had taken one or more actions at home while 18.7% never took any action. The action of giving drugs was the most common (64.1%) followed by removal of excessive clothing (16.5%). Although caretakers were not able to accurately identify the specific drugs they gave to the sick children, they were able to report that the drugs were for a specific sign or symptom like drug to reduce fever. pain, drugs to treat malaria etc. Only 8% of the respondents reported having given an antimalarial drug at home. The variation on the caretakers' immediate action was also noted to be associated with the levels of education of the individual caretaker particularly in giving a drug (x2 = 15.900, P < 0.05), more fluids to the child (X = 4.322, P < 0.05) and doing nothing on first notice (x2 = 15.924, P < 0.05). All the caretakers with college education gave drugs on first notice that the child was unwell. There was also a significant association between caretakers' religion and occupation with the severity of malaria (x2 = 8.62, p = 0.01; x2 = 50.2, p=0.001) respectively. Among the Akorino sect, a significant 48.1% of the caretakers and slightly more than half (56.6%) of those in semi-skilled labour had their children diagnosed with complicated malaria. The association between feeding practices and severity of malaria was also significant. Among caretakers who gave food and fluids less Frequently during the illness 25.8% and 34.7% of the children had complicated malaria (p=0.42 and 0.001) respectively.
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    The influence of health education on the health care seeking behaviour of primary school pupils: a case of Kangundo D.E.B. primary school, Machakos district, Kenya
    (2012-02-06) Muia, D. M.
    This study investigated the influence of health education on primary school pupil's health care seeking behaviour in Kangundo DEB Primary School, Machakos District, Kenya. The study was premised on the emerging realization that individuals' actions continue to determine their health status. Health education appears to empower individuals to take responsibility for their health and that of others. Again, health education is increasingly being seen as a cost-effective way of enhancing preventive health care. This is in consideration of the diminishing financial resources available to most individuals and governments to commit to health care services. The theoretical premise of the study was that human actions are purposive. Human actions are often a result of careful consideration. The assumption of this study was that learning enables one to make informed choices of action to be taken, depending on the circumstances, which inform his/her worldview. Hence the need for health education to be programmed in such a manner that it enhances the learners’ capacity and competence to take appropriate health action. Accordingly, the study's broad objective was to establish whether and to what extent health education improved the health behaviour of primary school pupils in terms of taking appropriate health care seeking behaviour. This was a qualitative study. In-depth interviews, guided by semi-structured checklist questions, were carried out with key-informants. These included ten pupils, three teachers, two parents, two health officials, and one curriculum development specialist. Additional data was generated through focused group discussions (FGDs), observations, free listing and drawings. Triangulation of sources of data as well as tools of data collection enhanced the data collection process as well as validated data. Qualitative data analysis involved transcription and reconstruction of interviews as well as pattern coding of the emerging issues and themes. Presentation, discussion of data and conclusions were drawn from the emerging issues and themes. The study found that health education enhanced pupils' awareness of their health status. Informants reported that as a result of health education, they were able to practice such health behaviour as regular washing of hands, washing of fruits before eating, keeping the home and compound clean, brushing teeth, not sharing clothes and combs and avoiding unprotected sex. The study however found that while health education could be said to enhance the health awareness and capacity for appropriate health care seeking behaviour among pupils, nevertheless, there was a gap between awareness and action. Various factors made it difficult for pupils to practice what they were taught in health education. For example, water was not readily available when needed for washing hands or fruits. Boiling water for drinking was not routinely done due to lack of time as well as shortage of wood fuel. Some of the teacher based constraints to application of health education included failure by teachers to be good role models; overload on teachers as well as the examination oriented way of teaching which made it difficult for pupils to translate what they learnt in health education into appropriate health care seeking behaviour. The school environment as well as the neighbourhood often presented a picture contrary to what pupils learnt in health education. Existence of dirty latrines in the school, the Kangundo hospital dump, and uncollected garbage in Kangundo Town market were some examples. Again, traditional beliefs and practices with regard to health care also led to a dilemma on the part of pupils with regard to what they were to follow: the health education defined practices or traditional prescriptions? In the main, however, the study concluded that health education influenced pupils' health care seeking behaviour. It also concluded that those enabling factors that enhanced health education teaching and learning needed to be reinforced. These were factors like teaching and learning materials, the health and the learning environments. While the study demonstrated that knowledge by itself need not lead to action, the study also concluded that environmental factors largely determined the extent to which the health education generated knowledge and skills would be translated into appropriate health care seeking behaviour. The study recommended that there was need to improve the way health education was taught. That is, to re-assess the overload on teachers, the resources available and also to downplay the examination orientation in teaching and learning and emphasize the lasting value of health education. The study also recommended that an enabling environment should be created both in school and outside the school, so that pupils see that what they learnt in school was applicable in the outside world. This calls for community wide health education. The study therefore recommended that the Ministry of Health enhance its health education outreach services through giving in-service training to health education teachers. The Ministry of Health personnel should recognize and utilize the potential inherent in primary school pupils to learn and enhance health education among themselves and the wider community. The study further recommended that Kenya Institute of Education (KIE) produce durable and long lasting teaching and learning aids as it was found that, for one, teachers did not have the time to develop them in school. Secondly, the school did not have the required resources to avail to teachers for the development of teaching and learning aids. Teachers also need to be trained on cost-saving and innovative methods of improvising on teaching and learning aids. Since language was found to be a major constraint in the teaching and learning of health education, the study recommended the need to strengthen the teaching and learning of English in Kenyan schools. Lastly, the study made recommendations on areas for further research. Such areas for further research would include how to institutionalize health education in schools and society so that meaningful health practices become routine. The issue of why some people chose risky health practices and behaviour despite their knowledge of the consequences of such action needs to be investigated.
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    Mother-to-child transmission of HIV type-1: Mechanisms of cellular immunity associated with chemoprophylactic intervention
    (2012-01-03) Makokha, Ernest Pancras
    Normal pregnancy and pregnancy complicated with HIV infection are associated with decreased immune responses. Decreased immune responses manifested in reduced maternal CD4+ T cell counts have been associated with risk of having a child infected with HIV - which risk ranges between 25 and 45% (without intervention) in sub-Saharan Africa. Zidovudine (AZT), which has been the prophylactic drug of choice for MTCT since 1994, reportedly increases on immune reconstitution in pregnancy and the risk of MTCT are still not very clearly knwon. A prospective, observational cohort study of women with and without HIV-1 infection was conducted in 7 rural health centres in Western Kenyan Districts of Busia, Siaya, Bondo and Kisumu. The study participants included 110 HIV-1 infected women ( with their index infants) as well as 311 HIV -1 seronegative women as controls. The participants were enrolled at 16 weeks gestation and followed up through pregnancy and postnatally to determine quantitative changes of CD4+ and CD8+ T cells using immunocytmetric methods. For the HIV-seropositive women, the profiles of CD4+ and CD8+ T cells were evaluated in relation to maternal AZT chemoprophylaxis and the index infant HIV infection status. Specimen collection was done at 26 and 36 weeks of pregnancy, 3 and 6 months postpartume and 3 months intervals thereafter until 2 years postpartum. Early diagnosis of HIV-1 among infants was performed by genetic amplification of HIV-specific genes using polymerase chain reaction (PCR). Only women and infants (born to HIV-postive mothers) whose consecutive data was available after collection according to study protocol met the criteria for the present analysis. HIV seronegative and seropositive women were similar with respect to their age groups and mean ages (HIV + ; 22.8 and 22.5 years) (p>0.005). However , sero-positive women had low entry CD4+ T cells (413-cells /ul) compared to sero-negative ones (829 cells/ul)(p<0.001). In HIV-sero-negative women, CD4+T cell levels remained fairly stable during pregnancy and postpartum, though not significantly. However, among the seropostitive women, CD4+T cell levels increased steadily during pregnancy and reduced towards early antepartum levels (600 cell /ul) late after delivery. For the CD8+ T cell profiles, the two categories had an early increase and a relatively stable or moderately increasing levels postpartum. When CD4+ T cell counts of HIV-1 infected women given AZT were assayed at week 24 of gestation through pregancy to 10 weeks postpartum and stratified by HIV-1 infection status of the child, there was a general increase of cells in response to AZT paired t-test comparisons of CD4+ T cell changes in the two categories of HIV-infected women (HIV transmitters and non-transmitters) before and after AZT administration showed that the CD4+ T cell increase in response to AZT was significantly associated with lack of transmission of HIV-1 to child (P=0.035). Whereasa it is expected that HIV-1 infection and pregnancy play a role in reducing immunity, the present study demostrates that a rise in the CD4+ T cell counts following short AZT regimen now widely in resource-weak countries, may be evidence of active suppression of replication of replication of HIV. On the strength of these findings, HIV-infected women who want to have children may be assured that pregancy will not cause significant progression of their disease. It is, however, recommended that such women be given a regimen of antiretrovirals (ARVs) to help reduce the risk of MTCT of HIV-1
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    Nutrition performance in primary health care in Kisumu district
    (2012-01-04) Wagah, Akinyi Margaret
    The present picture in the nutrition space in Kenya indicates that trends in nutritional status of the under five-year-old children have significantly deteriorated after initial improvement in 1982. National statistics indicate that one out of every three children in Kenya is not growing and developing as expected for their age (UNICEF, 1999). Similarly, one in every five children in Nyanza does not live to see its fifth birthday (KDHS, 1993). It has also been documented that a staggering 115,000 under five year olds are denied their right to survival each year (GOK/UNICEF, 1998). It is in the light of the foregoing that this current study was undertaken to establish the nutritional performance in Primary Health Care (PHC) in Nyanza with special reference to Kisumu District. The district has apparently been one of the PHC model regions in the country. The study aimed at accomplishing the following objectives: 1. Establish the nutritional status of the under five-year-old children in the study community. 2. Determine the relationship between the nutritional status and the incidence of infections amongst the under five years olds. 3. Identify how PHC has responded to meeting the food security needs of the study communities. 4. Determine a trend analysis in nutritional status of the under five-year-olds between 1982-2000. 5. Examine the effectiveness of nutrition education programmes with a view to charting out innovative strategies for change. This study made use of both qualitative and quantitative approaches to data collection. The method of sampling used was multi-stage. The study population consisted of the following categories of people, namely: household members, under five-year-old children, women groups, non governmental organizations, government ministries handling nutrition issues, and mothers attending health care centres. In total, seven hundred and fifty respondents participated in the study. Data collected were processed and analyzed both qualitatively and quantitatively according to the objectives of the study. Frequency distribution of samples, cross tabulations was utilized to analyze quantitative data. Both quantitative and qualitative data were thus combined foe an in-depth analysis of sampled data and conclusions drawn. The study found out that despite the implementation of PHC in the Kisumu Primary Health Care region, the district depicts adverse infant/child health and nutrition problems thus calling for special attention. Overall, 31.1 percent of the children were stunted. The highest prevalence of stunting was found among the age group 12-23 months old. This suggests that this age group should be targeted for interventions. Similarly, 15.2 percent were established to be underweight while 9.1 percent were wasted. It was equally evidenced from the study that a network of nutrition risk factors interacted to influence the child's nutritional status amongst some of which were noted to be; poverty, access to health care, the incidence of infectious diseases, parental demographic factors, the HIV/AIDS, caring capacity of the mothers and the food security status. Almost all the variables in the data set had significant effect on the child's nutritional status. Nutrition education did not appear to cause substantial behavioural change. One reason why nutrition education had not succeeded in impacting change was that messages were not well-formulated and that there was an over-emphasis on "do 's and don 'ts". It was therefore recommended that community-based participation in the formulation of concepts and messages should form an indispensable part of future nutrition education programs. In the meanwhile, if nutrition education and intervention programs are to make significant changes towards influencing health-changing behaviours, then multi-sectoral and multi-dimensional approaches are deemed necessary. Nutrition programming therefore needs to be integrative and holistic in nature. In view of the above findings, this study concluded that the provision of PHC has been inadequate both in impact and sustainability and that a new paradigm shift is essential. It is in this light that integration of Human Development Approach (HDA) in nutritional development is deemed feasible in producing sustainable effects
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    Prevalence of sexually transmitted diseases, HIV/AIDS among female sex workers and acceptability of intravaginal ring in Mukuru, Nairobi, Kenya
    (2011-08-10) Nyanchera, Wakasiaka Sabina; Mbithi, J. J. N.; Anzala, O.; Priddy, F.
    Human Immunodeficiency Syndrome (HIV and AIDS) has escalated into a humanitarian and developmental crisis. Out of 33.2 million people living positive worldwide, majority (22.5 million) live in Sub Saharan Africa (UNAIDS 2008). Gender roles and responsibilities in African communities bring forth inequalities which often reduce the power of women in negotiating for safer sex. In many African communities, women are care givers. They are expected to care for the spouse, children and the extended family. However, when a woman is infected with HIV, she may be divorced, denied access to family inheritance and care. This prospective cohort study recruited one hundred female sex workers in Mukuru informal settlement in the period between October 2005 to May 2008. The aim of this study was to recruit and characterize individuals for future efficacy clinical trials for HIV Vaccines and Microbicides. Part of the clinical site requirements for such trials is that cohorts must have documented high risk behaviour, high STI prevalence and high retention rates. In order to establish baseline Sexually Transmitted Infections (STI) burden in the community, health care providers were interviewed regarding common STI they treat. Health care providers were asked about their views regarding acceptability of an intravaginal ring which may be used to deliver Microbicides when they become available. Data was analyzed using Statistical Package for Social Sciences (SPSS). Results indicate that Female Sex Workers (FSVV) in the cohort are at a higher risk of contracting STI. Majority FSW (67%) were young, with a mean age of 28. Literacy levels were low with 45% reporting no formal schooling. On average, FSW had three clients per day with the earliest sex debut being 9 years. Almost half (53%) said they used condoms sometimes with primary partners. At baseline HIV prevalence was 11.3%, this is higher than the national prevalence which stands at (7.4%). Vaginal discharge symptoms and Pelvic inflammatory disease were the most common STI seen. Out of 75 symptomatic patients, 30 (40%) reported having vaginal sex in the same period. Only 4% 'reported anal sex during the symptomatic period. Diagnosis of Trichomoniasis correlated significantly with income of more than 200 Kenya shillings per week. In multivariate analysis, diagnosis of STI (Chlamydia, gonorrhea, Trichomoniasis or syphilis) was strongly associated with alcohol use (OR=3.35, P=0.002). Intravaginal rings were well accepted by majority of health care providers who asked for more information regarding the rings and Microhicides. Recruitment, characterization and establishment of this cohort provide an opportunity to access Vaccine and Microbicides strategy for HIV prevention especially for women.