Multimorbidity from chronic conditions among adults in urban slums : the AWI-Gen Nairobi site study findings

Background: In the era of double burden of infectious and non-communicable diseases in sub-Saharan Africa, the burden of multimorbidity is likely to be common. However, there is limited evidence on the burden and its associated factors in the sub-Saharan African context. Objective: The aim of this study was to determine the levels and identify determinants of multimorbidity from chronic conditions in two urban slums in Nairobi. Methods: Data collected from 2003 study participants aged 40–60 years in two urban slums of the Nairobi Urban Health and Demographic Surveillance System in 2015 were used. Using self-report, anthropometry and key biomarkers, data on 16 conditions including chronic diseases, behavioral disorders and metabolic abnormalities were gathered. Lifetime multimorbidity defined by the occurrence of at least two chronic conditions in an individual at any time during their life course was computed. Factors associated with lifetime multimorbidity were identified using multiple logistic regression. Findings: A total of 2,081 chronic conditions were identified among 1,302 individuals. While 701 (35.0%) had no chronic condition, single morbidity was reported in 726 (36.2%) of the study population. The overall prevalence of lifetime multimorbidity was 28.7%. The prevalence of dyads and triads of simultaneous occurrences of conditions (episodic multimorbidity) was 20.8% and 6.1%, respectively. Single morbidity was positively associated with gender and alcohol consumption; and negatively associated with employment. Women, older people, the unemployed, current smokers and current alcohol consumers had higher levels of lifetime multimorbidity in the study population. Interpretation: The findings of this study indicate that a considerable proportion of adults living in urban slums experience multimorbidity from chronic conditions. Further studies with a better rigor to establish temporal associations between socio-demographic factors and the occurrence of chronic conditions are needed to explore the impacts and implications on health status and health system

Can free open access resources strengthen knowledge-based emerging public health priorities, policies and programs in Africa? [version 1; referees: 2 approved]

Tackling emerging epidemics and infectious diseases burden in Africa requires increasing unrestricted open access and free use or reuse of regional and global policies reforms as well as timely communication capabilities and strategies. Promoting, scaling up data and information sharing between African researchers and international partners are of vital importance in accelerating open access at no cost. Free Open Access (FOA) health data and information acceptability, uptake tactics and sustainable mechanisms are urgently needed. These are critical in establishing real time and effective knowledge or evidence-based translation, proven and validated approaches, strategies and tools to strengthen and revamp health systems.  As such, early and timely access to needed emerging public health information is meant to be instrumental and valuable for policy-makers, implementers, care providers, researchers, health-related institutions and stakeholders including populations when guiding health financing, and planning contextual programs

Blood Pressure and Arterial Stiffness in Kenyan Adolescents With α+Thalassemia.

BACKGROUND: Recent studies have discovered that α-globin is expressed in blood vessel walls where it plays a role in regulating vascular tone. We tested the hypothesis that blood pressure (BP) might differ between normal individuals and those with α+thalassemia, in whom the production of α-globin is reduced. METHODS AND RESULTS: The study was conducted in Nairobi, Kenya, among 938 adolescents aged 11 to 17 years. Twenty-four-hour ambulatory BP monitoring and arterial stiffness measurements were performed using an arteriograph device. We genotyped for α+thalassemia by polymerase chain reaction. Complete data for analysis were available for 623 subjects; 223 (36%) were heterozygous (-α/αα) and 47 (8%) were homozygous (-α/-α) for α+thalassemia whereas the remaining 353 (55%) were normal (αα/αα). Mean 24-hour systolic BP ±SD was 118±12 mm Hg in αα/αα, 117±11 mm Hg in -α/αα, and 118±11 mm Hg in -α/-α subjects, respectively. Mean 24-hour diastolic BP ±SD in these groups was 64±8, 63±7, and 65±8 mm Hg, respectively. Mean pulse wave velocity (PWV)±SD was 7±0.8, 7±0.8, and 7±0.7 ms-1, respectively. No differences were observed in PWV and any of the 24-hour ambulatory BP monitoring-derived measures between those with and without α+thalassemia. CONCLUSIONS: These data suggest that the presence of α+thalassemia does not affect BP and/or arterial stiffness in Kenyan adolescents

Impact of telemonitoring approaches on integrated HIV and TB diagnosis and treatment interventions in sub-Saharan Africa: a scoping review

Background: This paper explores telemonitoring approaches as a promising real time and contextual strategy in improving HIV and TB interventions, quality access and uptake, retention, adherence and coverage impact in endemic and epidemic prone-regions. Methods: A scoping review design was applied to synthesize telemonitoring HIV and TB information indexed in peer reviewed journal hubs to identify relevant articles pertaining to telemonitoring as a proxy surrogate method in reinforcing sustainability of HIV/TB prevention and treatment in sub-Saharan Africa. The following research indexing hubs were used for the search: Medline, Embase, Global Health, PubMed, MeSH PsycInfo, Scopus and Google Scholar. The articles selected were used to foster evidence of telemonitoring/mhealth diagnosis, treatment of HIV and TB prevention and control approaches. Results: We found telemonitoring approaches as a convenient and sustained proxy-method of HIV and TB risk reduction strategies including early diagnosis and prompt quality clinical outcomes. This has shown to significantly contribute in decreasing health systems/patients cost, long waiting time in clinics, hospital visits, travels and time off/on from work. Conclusion: Telemonitoring/mhealth (electronic phone text/video/materials messaging) adoption, integration, acceptability, access and uptake are crucial in monitoring and improving HIV and TB uptake, retention, adherence and coverage in both local and national interventions programs. Improved integrated HIV and TB telemonitoring sustainability hold great promises in health systems strengthening including patient early centered diagnosis and care delivery, uptake and retention in medications/ services and improvement of patients’ quality of life

Invigorating Health Strategy in an Integrated Design Process

Healthy buildings are gaining crucial significance in construction and one health setting for promoting occupants’ health. However, the traditional design process for healthy buildings presents limitations with no specific guidelines. In contrast, the integrated design process (IDP) has proven to be effective in realizing high-performance buildings. However, the IDP shortfall of not having robust health strategy (HS) capability is a concern of interest. Thus, we posit further advancement of IDP in the context of incorporating HS in the prevailing IDP guidelines with a sequential iterative procedure. Moreover, a conceptual framework aimed at invigorating the implementation of HS in all IDP stages is proposed. The strategies within IDP that would reinforce achieving healthy building by addressing building process implementation are highlighted. The (IDP + HS) iterative framework herein advanced is intended to aid neophyte and experienced building professionals to reflect about the process of achieving healthy building while optimizing IDP for one’s health invigoration in construction industry

Challenges and opportunities of optimal breastfeeding in the context of HIV option B+ guidelines

Abstract Background In 2013, the World Health Organization released a new set of guidelines widely known as Option B+. Prior to that there were guidelines released in 2010. Option B+ recommends lifelong antiretroviral treatment for all pregnant and breastfeeding women living with Human Immunodeficiency Virus. The study aimed at investigating challenges and opportunities in implementing Infant and Young Child Feeding in the context of Prevention of Mother To Child Transmission (PMTCT) guidelines among HIV positive mothers of children aged 0–24 months. The study also examined implications presented by implementing the 2013 PMTCT consolidated guidelines in the transition phase from the 2010 approach in Zambia. Methods A mixed methods approach was employed in the descriptive cross sectional study utilizing semi structured questionnaires and Focused Group Discussions. Further, data was captured from the Health Information Management System. Results During the PMTCT transition, associated needs and challenges in institutionalizing the enhanced guidelines from option A and B to option B+ were observed. Nonetheless, there was a decline in Mother to Child Transmission (MTCT) of HIV rates with an average of 4%. Mothers faced challenges in complying with optimal breastfeeding practices owing to lack of community support systems and breast infections due to poor breast feeding occasioned by infants’ oral health challenges. Moreover, some mothers were hesitant of lifelong ARVs. Health workers faced programmatic and operational challenges such as compromised counseling services. Conclusion Despite the ambitious timelines for PMTCT transition, the need to inculcate new knowledge and vary known practice among mothers and the shift in counseling content for health workers, the consolidated guidelines for PMTCT proved effective. Some mothers were hesitant of lifelong ARVs, rationalizing the debated paradigm that prolonged chemotherapy/polypharmacy may be a future challenge in the success of ART in PMTCT. Conflicting breast feeding practices was a common observation across mothers thus underpinning the need to strongly invigorate Infant and Young Child Feeding information sharing across the continuum of heath care from facility level to community and up to the family; for cultural norms, practices and attitudes enshrined within communities play a vital role in child care

Dietary diversity and nutritional status of children aged 6–59 months from rural fishing and non-fishing communities in Zambia

Low-quality complementary foods combined with inappropriate feeding practices put children under the age of five in developing countries at high risk for undernutrition. This study explored dietary diversity, fish consumption patterns and nutritional status of children in Luapula, a rural province in Zambia, where households rely on capture fisheries for their livelihoods. In the cross-sectional study, households with children aged 6–59 months were enrolled in the study. A semi-structured questionnaire was utilised to collect socioeconomic characteristics, dietary intake and anthropometric data. Descriptive statistics and bivariate associations were conducted. 23% of children aged 6–23 months met the minimum dietary diversity. About 49% and 41% of the children were fed on fresh small pelagic fish and large dried fish once to twice a week, respectively. Imbilya (Serranochromis mellandi), Chisense (Poecilothrissa moeruensis), and amatuku (Tilapia sparrmanii) were the most preferred fish species due to their availability and affordability. Only 3.5% of children consumed porridge to which fish powder had been added. There was a significant difference in the height for age z scores of children in the two communities (χ2= 12.404; p = 0.002, d.f = 2). Low dietary diversity was observed across the fishing and non-fishing communities and less than half of the children consumed fish despite proximity of the study sites to one of the largest water bodies in Zambia. Better nutrition outcomes were observed among children in capture fisheries dependent households. Nutrition education in growth monitoring and promotion centres should address the issue of adequacy of diets with regard to frequency and diversity

Determinants of inequality in health care seeking for childhood illnesses : Insights from Nairobi informal settlements

An in-depth understanding of patterns of inequities in healthcare seeking among the urban residents is critical in identifying appropriate interventions strategies. The study evaluates determinants of inequality in health care seeking for childhood illnesses among informal settlement residents in Nairobi, Kenya. Methods: Data from the second Nairobi Cross-Sectional Slum Survey (NCSS 2012) was examined. The inequality in seeking health care for childhood diarrhea as the prototype illness was assessed using concentration index (CI). The wealth index based on the household possessions and amenities was used as a measure for socioeconomic status. Results: A total of 2 027 qualified women were included in this study. About 16.6% of children born of younger mothers aged < 20 years had diarrhea and a similar proportion of children (16.3%) was observed among mothers who were unemployed. The CI of −0.026 on health care seeking for diarrhea among children points to significant inequality among the urban poor (95% confidence interval: −0.028 to −0.023). Conclusion: Occupation of parents, age of mothers, ethnicity, marital status and children's age were major determinants with regard to disease outcome and to a broader extent inequality in health care seeking for childhood illnesses. Enhanced bottom top community health invigoration strategies in health information awareness and services access would be instrumental

Interlinkage among cardio-metabolic disease markers in an urban poor setting in Nairobi, Kenya

Introduction: The main cardio-metabolic diseases – mostly cardiovascular diseases such as stroke and ischemic heart disease – share common clinical markers such as raised blood pressure and blood glucose. The pathways of development of many of these conditions are also interlinked. In this regard, a higher level of co-occurrence of the main cardio-metabolic disease markers is expected. Evidence about the patterns of occurrence of cardio-metabolic markers and their interlinkage in the sub-Saharan African setting is inadequate. Objective: The goal of the study was to describe the interlinkage among common cardio-metabolic disease markers in an African setting. Design: We used data collected in a cross-sectional study from 5,190 study participants as part of cardiovascular disease risk assessment in the urban slums of Nairobi, Kenya. Five commonly used clinical markers of cardio-metabolic conditions were considered in this analysis. These markers were waist circumference, blood pressure, random blood glucose, total blood cholesterol, and triglyceride levels. Patterns of these markers were described using means, standard deviations, and proportions. The associations between the markers were determined using odds ratios. Results: The weighted prevalence of central obesity, hypertension, hyperglycemia, hypercholesterolemia, and hypertriglyceridemia were 12.3%, 7.0%, 2.5%, 10.3%, and 17.3%, respectively. Women had a higher prevalence of central obesity and hypercholesterolemia as compared to men. Blood glucose was strongly associated with central obesity, blood pressure, and triglyceride levels, whereas the association between blood glucose and total blood cholesterol was not statistically significant. Conclusions: This study shows that most of the common cardio-metabolic markers are interlinked, suggesting a higher probability of comorbidity due to cardio-metabolic conditions and thus the need for integrated approaches

Ethical, legal and societal considerations on Zika virus epidemics complications in scaling-up prevention and control strategies

Abstract Much of the fear and uncertainty around Zika epidemics stem from potential association between Zika virus (ZIKV) complications on infected pregnant women and risk of their babies being born with microcephaly and other neurological abnormalities. However, much remains unknown about its mode of transmission, diagnosis and long-term pathogenesis. Worries of these unknowns necessitate the need for effective and efficient psychosocial programs and medical-legal strategies to alleviate and mitigate ZIKV related burdens. In this light, local and global efforts in maintaining fundamental health principles of moral, medical and legal decision-making policies, and interventions to preserve and promote individual and collectiveHuman Rights, autonomy, protection of the most vulnerable, equity, dignity, integrity and beneficence that should not be confused and relegated by compassionate humanitarian assistance and support. This paper explores the potential medical and ethical-legal implications of ZIKV epidemics emergency response packages and strategies alongside optimizing reproductive and mental health policies, programs and best practice measures. Further long-term cross-borders operational research is required in elucidating Zika-related population-based epidemiology, ethical-medical and societal implications in guiding evidence-based local and global ZIKV maternal-child health complications related approaches and interventions. Core programs and interventions including future Zika safe and effective vaccines for global Zika immunization program in most vulnerable and affected countries and worldwide should be prioritized