Nutritional status of children admitted for diarrhoeal diseases in a referral hospital in western Kenya

Objectives: To determine the prevalence of malnutrition among children admitted with acute diarrhoea disease at Moi Teaching and Referral Hospital and to establish the effect of malnutrition on duration of hospital stay. Design: Prospective observational study. Setting: Paediatric wards of Moi Teaching and Referral Hospital, Eldoret, Kenya Subjects: A total of 191 children aged 6 and 59 months admitted with acute diarrhoea disease, without chronic co-morbidities or visible severe malnutrition, were systematically enrolled into the study between November 2011 and March 2012. Outcome Measures: Nutritional status based on WHO WHZ scores taken at admission and duration of hospital stay. Results:The mean age was 13.2 months with a male to female sex ratio of 1.16:1. Of all the children seen with acute diarrhoeal diseases, 43.9% had acute malnutrition ( Conclusion: Routine anthrometry including weight for height identifies more children with malnutrition in acute diarrhoeal diseases. Presence of malnutrition did not affect duration of hospital stay

Assessing researchers’ performance in developing countries : is Google Scholar an alternative?

This article compares the representation of 10 purposefully selected LIS researchers in South Africa in Google Scholar (GS), Thomson Scientific’s (herein referred to as ISI – Institute for Scientific Information) citation indexes, and Elsevier’s Scopus, in order to determine whether or not Google Scholar is an alternative tool for evaluating research in developing countries, particularly those situated in Sub-Saharan Africa. Three indicators, namely the number of publications, the number of citations and the h-index, were used to measure the similarity or dissimilarity between the three databases/ services in the coverage of South Africa’s LIS documents. The data was also subjected to a Pearson correlation analysis to examine the relationship between GS and ISI, GS and Scopus and ISI and Scopus. Results show that GS covers more publications and citations than ISI and Scopus. There is a stronger correlation between GS and Scopus than there is between GS and ISI. We conclude that GS is an alternative service, but should be cautiously used when evaluating research in developing countries. Areas for further research are also recommended.Information Scienc

Mangroves in peril: unprecedented degradation rates of peri-urban mangroves in Kenya

Marine ecosystems are experiencing unprecedented degradation rates higher than any other ecosystem on the planet, which in some instances are up to 4 times those of rainforests. Mangrove ecosystems have especially been impacted by compounded anthropogenic pressures leading to significant cover reductions of between 35 and 50% (equivalent to 1–2% loss pa) for the last half century. The main objective of this study was to test the hypothesis that peri-urban mangroves suffering from compounded and intense pressures may be experiencing higher degradation rates than the global mean (and/or national mean for Kenya) using Mombasa mangroves (comprising Tudor and Mwache creeks) as a case study. Stratified sampling was used to sample along 22 and 10 belt transects in Mwache and Tudor respectively, set to capture stand heterogeneity in terms of species composition and structure in addition to perceived human pressure gradients using proximity to human habitations as a proxy. We acquired SPOT (HRV/ HRVIR/ HRS) images of April 1994, May 2000 and January 2009 and a vector mangrove map of 1992 at a scale of 1:50 000 for cover change and species composition analysis. Results from image classification of the 2009 image had 80.23% overall accuracy and Cohen's kappa of 0.77, thus proving satisfactory for use in this context. Structural data indicate that complexity index (CI) which captures stand structural development was higher in Mwache at 1.80 compared to Tudor at 1.71. From cover change data, Tudor lost 86.9% of the forest between 1992 and 2009, compared to Mwache at 45.4%, representing very high hitherto undocumented degradation rates of 5.1 and 2.7% pa, respectively. These unprecedentedly high degradation rates, which far exceed not only the national mean (for Kenya of 0.7% pa) but the global mean as well, strongly suggest that these mangroves are highly threatened due to compounded pressures. Strengthening of governance regimes through enforcement and compliance to halt illegal wood extraction, improvement of land-use practices upstream to reduce soil erosion, restoration in areas where natural regeneration has been impaired, provision of alternative energy sources/building materials and a complete moratorium on wood extraction especially in Tudor Creek to allow recovery are some of the suggested management interventions

Distance from Home to Study Clinic and Risk of Follow-Up Interruption in a Cohort of HIV-1-Discordant Couples in Nairobi, Kenya

Background: Longitudinal studies of HIV-1-infected individuals or those at risk of infection are subject to missed study visits that may have negative consequences on the care of participants and can jeopardize study validity due to bias and loss of statistical power. Distance between participant residence and study clinic, as well as other socioeconomic and demographic factors, may contribute to interruptions in patient follow-up. Methods: HIV-1-serodiscordant couples were enrolled between May 2007 and October 2009 and followed for two years in Nairobi, Kenya. At baseline, demographic and home location information was collected and linear distance from each participant’s home to the study clinic was determined. Participants were asked to return to the study clinic for quarterly visits, with follow-up interruptions (FUI) defined as missing two consecutive visits. Cox proportional hazards regression was used to assess crude and adjusted associations between FUI and home-to-clinic distance, and other baseline characteristics. Results: Of 469 enrolled couples, 64% had a female HIV-1-infected partner. Overall incidence of FUI was 13.4 per 100 person-years (PY), with lower incidence of FUI in HIV-1-infected (10.8 per 100 PY) versus -uninfected individuals (16.1 per 100 PY) (hazard ratio [HR] = 0.66; 95% confidence interval [CI]: 0.50, 0.88). Among HIV-1-infected participants, those living between 5 and 10 kilometers (km) from the study clinic had a two-fold increased rate of FUI compared to those living <5 km away (HR = 2.17; 95% CI: 1.09, 4.34). Other factors associated with FUI included paying higher rent (HR = 1.67; 95% CI: 1.05, 2.65), having at least primary school education (HR = 1.96; 95% CI: 1.02, 3.70), and increased HIV-1 viral load (HR = 1.23 per log10 increase; 95% CI: 1.01, 1.51). Conclusions: Home-to-clinic distance, indicators of socioeconomic status, and markers of disease progression may affect compliance with study follow-up schedules. Retention strategies should focus on participants at greatest risk of FUI to ensure study validity

Economic value and latent demand for agricultural drought forecast: Emerging market for weather and climate information in Central-Southern Nigeria

Provision of weather and climate services are expected to improve the capacity for rural households’ preparedness and response plans to weather shocks. With increase in public investments in developing and communicating weather information on local scale in Nigeria, uncertainty in timescales that meet farmers’ needs and economic value of the information is still poorly understood. It is now a policy concern on whether farmers’ preferences and demands might increase its uptake. This study analyzed the economic value, latent demand, and emerging market of weather and climate information in Central-Southern Nigeria. Farm-level cross-sectional data reveals that 76% of the respondents were willing to pay for improved weather information and early warnings in taking climate smart decisions. Within farmers who showed positive responses, 86% would pay for sub-seasonal to seasonal weather information while 38% would pay for medium and short range weather information respectively. The economic value of sub-seasonal to seasonal weather information was estimated at N1600 ($3.60) per year per capita with total aggregated value of N1.3 billion ($2.9 m) yearly for the derived savannah area. Predictive total market value of N17.43billion ($39 m) would be obtained from improved weather information in Nigeria. Simulated results of 5$193,360) for service providers. Large farm size, good farm-income, mobile phone dissemination channels, and location-specific information were drivers of farmers’ uptake decisions of weather information in the dry savannah area. The huge emerging market for improved weather information should be developed into a public–private market to efficiently facilitate uptake and use in Nigeria

Knowledge and Acceptability of Pap Smears, Self-Sampling and HPV Vaccination among Adult Women in Kenya

ObjectivesOur study aimed to assess adult women’s knowledge of human papillomavirus (HPV) and cervical cancer, and characterize their attitudes towards potential screening and prevention strategies.MethodsWomen were participants of an HIV-discordant couples cohort in Nairobi, Kenya. An interviewer-administered questionnaire was used to obtain information on sociodemographic status, and sexual and medical history at baseline and on knowledge and attitudes towards Pap smears, self-sampling, and HPV vaccination at study exit.ResultsOnly 14% of the 409 women (67% HIV-positive; median age 29 years) had ever had a Pap smear prior to study enrollment and very few women had ever heard of HPV (18%). Although most women knew that Pap smears detect cervical cancer (69%), very few knew that routine Pap screening is the main way to prevent ICC (18%). Most women reported a high level of cultural acceptability for Pap smear screening and a low level of physical discomfort during Pap smear collection. In addition, over 80% of women reported that they would feel comfortable using a self-sampling device (82%) and would prefer at-home sample collection (84%). Nearly all women (94%) reported willingness to be vaccinated to prevent cervical cancer if offered at no or low cost.ConclusionsThese findings highlight the need to educate women on routine use of Pap smears in the prevention of cervical cancer and demonstrate that vaccination and self-sampling would be acceptable modalities for cervical cancer prevention and screening

Barriers to Antiretroviral Initiation in HIV-1–Discordant Couples

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

Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya

<p>Abstract</p> <p>Background</p> <p>Since 2000, peer-mediated interventions among female sex workers (FSW) in Mombasa Kenya have promoted behavioural change through improving knowledge, attitudes and awareness of HIV serostatus, and aimed to prevent HIV and other sexually transmitted infection (STI) by facilitating early STI treatment. Impact of these interventions was evaluated among those who attended peer education and at the FSW population level.</p> <p>Methods</p> <p>A pre-intervention survey in 2000, recruited 503 FSW using snowball sampling. Thereafter, peer educators provided STI/HIV education, condoms, and facilitated HIV testing, treatment and care services. In 2005, data were collected using identical survey methods, allowing comparison with historical controls, and between FSW who had or had not received peer interventions.</p> <p>Results</p> <p>Over five years, sex work became predominately a full-time activity, with increased mean sexual partners (2.8 versus 4.9/week; <it>P </it>< 0.001). Consistent condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; <it>P </it>< 0.001) as well as the likelihood of refusing clients who were unwilling to use condoms (OR = 4.9, 95%CI = 3.7–6.6). In 2005, FSW who received peer interventions (28.7%, 145/506), had more consistent condom use with clients compared with unexposed FSW (86.2% versus 64.0%; AOR = 3.6, 95%CI = 2.1–6.1). These differences were larger among FSW with greater peer-intervention exposure. HIV prevalence was 25% (17/69) in FSW attending ≥ 4 peer-education sessions, compared with 34% (25/73) in those attending 1–3 sessions (P = 0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498) in 2005 (<it>P </it>= 0.36).</p> <p>Conclusion</p> <p>Peer-mediated interventions were associated with an increase in protected sex. Though peer-mediated interventions remain important, higher coverage is needed and more efficacious interventions to reduce overall vulnerability and risk.</p