Use of insecticide treated bed nets among pregnant women in Kilifi District, Kenya

Background: Malaria is one of the most serious public health problems in Kenya. Pregnant women are among the groups with the highest risk of malaria. Use of insecticide treated bed nets (ITNs) is a cost-effective method of controlling malaria. Despite this, there is low utilisation of ITNs among pregnant women in Kilifi district which is an endemic malaria zone.Objective: To determine knowledge, attitude and practice on the use of ITNs in the prevention of malaria among pregnant women in Kilifi district.Design: A descriptive cross-sectional study. Setting: The district hospital and the five health centres in Kilifi district Subjects: Two hundred and twenty pregnant women attending antenatal clinics (ANC)between October and December 2007.Results: Knowledge on malaria illness and ITNs was high with majority of pregnant women having adequate level of knowledge (86.9%). There was significant association between level of education and adequate knowledge (P-value=0.010). Good attitude on ITNs use was low. There was no association between good attitude and any of the socio-demographic variables. The majority of pregnant women attending ANC owned ITNs (75.4%). ITNs usage was high (70.5%). There was significant association between religion and good practice (p-value=0.050). Although adequate level of knowledge on malaria and protective role of ITNs was high, there was no association between knowledge with practice and attitude.Conclusion: Before any malaria preventive intervention is implemented in an area, different socio-cultural factors must be considered when behavioural interventions for malaria control are designed and implemented. Targeted health education should be disseminated to the community to remove stigma and misconceptions associated with ITNs. Community concerns and fears should be addressed

Malaria “hotspots” within a larger hotspot; what’s the role of behavioural factors in fine scale heterogeneity in western Kenya?

Background: Malaria remains a major public health problem in Kenya accounting for the highest morbidity and mortality especially among children. Previous reports indicate that infectious agents display heterogeneity in both space and time and malaria is no exception. Heterogeneity has been shown to reduce the effectiveness of interventions. Previous studies have implicated genetic (both human and parasite) and environmental factors as mainly responsible for variation in malaria risk. Human behaviour and its potential risk for contributing to variation in malaria risk has not been extensively explored.Objective: To determine if there were behavioural differences between the people living in hotspots (high malaria burden) and coldspots (low malaria burden) within a geographically homogeneous and high malaria transmission region.Design: A prospective closed cohort study.Setting: The study was conducted in the Health and Demographic Surveillance Site in Bungoma East sub-County.Subjects: A total of 400 people in randomly selected households in both the fever hotspots and cold spots were tested for malaria at quarterly intervals using malaria rapid diagnostic tests (RDTs).Results: Significant heterogeneity in malaria incidence and prevalence was observed between villages. Incidence of malaria was significantly higher in the hotspots (high malaria burden areas) compared to the coldspots (low malaria burden) (49 episodes per 1000 person months compared to 26/1000, ttest p < 0.001). The incidence also varied significantly among the individual villages by season (P: 0.0071). Knowledge on malaria therapy was significantly associated with whether one was in the cold spot or hotspot (P: 0.033). Behavioural practices relating to ITN use were significantly associated with region during particular seasons (P: 0.0001 and P: 0.0001 respectively).Conclusion: There is marked and significant variation in the incidence of malaria among the villages creating actual hotspots of malaria within the larger hotspot. There is a significant difference in malaria infections between the hotspots and cold spots. Knowledge on malaria therapy and behavioural factors such as ITN use may contribute to the observed differences during some seasons

Prevalence, heterogeneity of asymptomatic malaria infections and associated factors in a high transmission region

Background: Although current reports have shown a reduction in malaria cases, the disease still remains a major public health problem in Kenya. In most endemic regions, the majority of infections are asymptomatic which means those infected may not even know and yet they remain infectious to the mosquitoes. Asymptomatic infections are a major threat to malaria control programs since they act as silent reservoirs for the malaria parasites.Objective: The study sought to determine the prevalence of asymptomatic malaria infections, whether they show heterogeneity spatially, across age groups and across time as well as their determinants in a high transmission region.Study Design: This was part of a larger prospective cohort study on malaria indices in the HDSS.Study Setting: The study was conducted in the Webuye Health and Demographic Surveillance Site in Bungoma East Sub-County.Study Subjects: Quarterly parasitological surveys were conducted for a cohort of 400 participants from randomly selected households located in known fever “hotspots” and “coldspots”. Follow-up of all the participants continued for a period of one year. Generalized estimating equations were used to model risk factors associated with asymptomatic parasitemia.Results: Of the total 321 malaria infections detected during the five cross-sectional surveys conducted over the period of one year, almost half (46.3%) of these were asymptomatic. Overall, most of the asymptomatic cases (67%) were in households within known fever “hotspots”. The proportion of infections that were asymptomatic in the coldspots were 73.1%, 31.8%, 13.3%, 55.6% and 48.2% during the first, second, third, fourth and fifth visits respectively. In the known fever “hotspots”, the proportion of infections without symptoms was 47.7%, 48.5%, 35%, 41.3% and 47.5% during the first, second, third, fourth and fifth visits respectively. Factors associated with asymptomatic malaria include; the village one lives: people living in village M were twice likely to be asymptomatic (A.O.R: 2.141, C.I: 0.03 - 1.488), age: children aged between 6 to 15 years were more than twice likely to be asymptomatic (A.O.R: 2.67, C.I. 0.434 - 1.533) and the season: infections during the dry season (January) were less likely to be asymptomatic (A.O.R: 0.26, C.I: -2.289 - 0.400).Conclusion: The prevalence of asymptomatic infections in this region is still very high. The highest proportion of asymptomatic infections was registered in a fever coldpspot village which may explain why the village is a fever coldspot in the first place. There is a need for active surveillance to detect the asymptomatic cases as well as treat them in-order to reduce the reservoir. Targeting interventions to the asymptomatic individuals will further reduce the transmission within this region

Malaria “hotspots” within a larger hotspot; what’s the role of behavioural factors in fine scale heterogeneity in western Kenya?

Background: Malaria remains a major public health problem in Kenya accounting for the highest morbidity and mortality especially among children. Previous reports indicate that infectious agents display heterogeneity in both space and time and malaria is no exception. Heterogeneity has been shown to reduce the effectiveness of interventions. Previous studies have implicated genetic (both human and parasite) and environmental factors as mainly responsible for variation in malaria risk. Human behaviour and its potential risk for contributing to variation in malaria risk has not been extensively explored.Objective: To determine if there were behavioural differences between the people living in hotspots (high malaria burden) and cold spots (low malaria burden) within a geographically homogeneous and high malaria transmission region.Design: A prospective closed cohort study.Setting: The study was conducted in the Health and Demographic Surveillance Site in Bungoma East sub-County.Subjects: A total of 400 people in randomly selected households in both the fever hotspots and cold spots were tested for malaria at quarterly intervals using malaria rapid diagnostic tests (RDTs).Results: Significant heterogeneity in malaria incidence and prevalence was observed between villages. Incidence of malaria was significantly higher in the hotspots (high malaria burden areas) compared to the cold spots (low malaria burden) (49 episodes per 1000 person months compared to 26/1000, t test p < 0.001). The incidence also varied significantly among the individual villages by season (P: 0.0071). Knowledge on malaria therapy was significantly  associated with whether one was in the cold spot or hotspot (P: 0.033). Behavioural practices relating to ITN use were significantly associated with region during particular seasons (P: 0.0001 and P: 0.0001 respectively).Conclusion: There is marked and significant variation in the incidence of malaria among the villages creating actual hotspots of malaria within the larger hotspot. There is a significant difference in malaria infections between the hotspots and cold spots. Knowledge on malaria therapy and behavioural factors such as ITN use may contribute to the observed differences during some seasons

Treatment of shigella infections: why sulfamethoxazole-trimethoprim, tetracyclines and ampicillin should no longer be used

Background: Bloody diarrhoea results in high morbidity and mortality especially in developing countries with shigellosis being the main cause of acute bloody diarrhoea. The use of appropriate antimicrobial agents in the treatment of acute diarrheal disease shortens the duration of illness and bacterial shedding leading to a reduction in morbidity and mortality. Treatment options for many infections are becoming limited due to globally emerging antibiotic resistance. Globally, resistance of shigella species to trimethoprim-sulfamethoxazole (TMP-SMX), tetracyclines and ampicillin has been reported with subsequent recommendations of not using these antimicrobial drugs for empirical therapy of acute bloody diarrhoea.Objective: To establish the antimicrobial susceptibility patterns and antimicrobial drug use for treatment of shigella species in patients with acute bloody diarrhoea.Design: A hospital based case control study.Setting: Six health facilities, three in Kilifi County and three in Nairobi County.Subject: A total of 284 stool specimens were collected from patients who fitted the standard cases definition for acute bloody diarrhoea.Results: Eighty (28.2%) bacterial isolates were recovered from 284 stool samples collected from cases presenting with acute bloody diarrhoea of which 67 (83.8%) were Shigella species, nine (11.3%) were Enteroinvassive Escherichia coli isolates, three (3.8%) were Salmonella Typhi and one (1.3%) were Yersinia enterocolitica. Shigella isolates had high resistance to sulfamethoxazole-trimethoprim (97%), tetracycline (83.6%) ampicillin (58.2%) and chloramphenicol (20.9%). The isolates showed low resistance to nalidixic (4.5%) and ciprofloxacin (3.0%) while there was no resistance to ceftriaxone. The most common multidrug resistance pattern detected in Shigella strains combined sulfamethoxazole-trimethoprim, amoxicillin/ampicillin and tetracyclines.Antibiotic prescriptions were given to 243(85.6%) of the patients presenting with acute bloody diarrhoea. Among these, 94 (38.7%) were given prescriptions for ciprofloxacin, 53 (21.8%) for sulfamethaxazole-trimethiprin and 36(14.8%) for Tetracyclines. Chloramphenicol, amoxicillin/ampicillin, nalidixic acid and ceftriaxone were prescribed to 10.7 %, 3.7%, 2.9% and 0.4% of the patients respectively. A total of 123 (51%) received antibiotics which were ranked to have high resistance (sulfamethoxazole-trimethoprim, tetracyclines ampicillin and chloramphenicol).Conclusion: The high rates of antimicrobial resistance among the commonly prescribed antimicrobials such as sulfamethoxazole-trimethoprim, tetracycline, ampicillin and chloramphenicol is of major concern. Despite recommendations discouraging the empirical use of sulfamethoxazole-trimethoprim, tetracycline, ampicillin and chloramphenicol for treatment of acute bloody diarrhoea, more than half of the patients with acute bloody diarrhoea were still treated with these antibiotics.There is need to train health care workers on the proper management of acute bloody diarrhoea and the importance of adhering to the clinical guidelines

High-resolution bathymetries and shorelines for the Great Lakes of the White Nile basin

This article is licensed under a Creative Commons Attribution 4.0 International License.HRBS-GLWNB 2020 presents the first open-source and high-resolution bathymetry, shoreline, and water level data for Lakes Victoria, Albert, Edward, and George in East Africa. For each Lake, these data have three primary products collected for this project. The bathymetric datasets were created from approximately 18 million acoustic soundings. Over 8,200 km of shorelines are delineated across the three lakes from high-resolution satellite systems and uncrewed aerial vehicles. Finally, these data are tied together by creating lake surface elevation models collected from GPS and altimeter measures. The data repository includes additional derived products, including surface areas, water volumes, shoreline lengths, lake elevation levels, and geodetic information. These data can be used to make allocation decisions regarding the freshwater resources within Africa, manage food resources on which many tens of millions of people rely, and help preserve the region’s endemic biodiversity. Finally, as these data are tied to globally consistent geodetic models, they can be used in future global and regional climate change models.ECU Open Access Publishing Support Fun

Reviewing the literature on access to prompt and effective malaria treatment in Kenya: implications for meeting the Abuja targets

<p>Abstract</p> <p>Background</p> <p>Effective case management is central to reducing malaria mortality and morbidity worldwide, but only a minority of those affected by malaria, have access to prompt effective treatment.</p> <p>In Kenya, the Division of Malaria Control is committed to ensuring that 80 percent of childhood fevers are treated with effective anti-malarial medicines within 24 hours of fever onset, but this target is largely unmet. This review aimed to document evidence on access to effective malaria treatment in Kenya, identify factors that influence access, and make recommendations on how to improve prompt access to effective malaria treatment. Since treatment-seeking patterns for malaria are similar in many settings in sub-Saharan Africa, the findings presented in this review have important lessons for other malaria endemic countries.</p> <p>Methods</p> <p>Internet searches were conducted in PUBMED (MEDLINE) and HINARI databases using specific search terms and strategies. Grey literature was obtained by soliciting reports from individual researchers working in the treatment-seeking field, from websites of major organizations involved in malaria control and from international reports.</p> <p>Results</p> <p>The review indicated that malaria treatment-seeking occurs mostly in the informal sector; that most fevers are treated, but treatment is often ineffective. Irrational drug use was identified as a problem in most studies, but determinants of this behaviour were not documented. Availability of non-recommended medicines over-the-counter and the presence of substandard anti-malarials in the market are well documented. Demand side determinants of access include perception of illness causes, severity and timing of treatment, perceptions of treatment efficacy, simplicity of regimens and ability to pay. Supply side determinants include distance to health facilities, availability of medicines, prescribing and dispensing practices and quality of medicines. Policy level factors are around the complexity and unclear messages regarding drug policy changes.</p> <p>Conclusion</p> <p>Kenya, like many other African countries, is still far from achieving the Abuja targets. The government, with support from donors, should invest adequately in mechanisms that promote access to effective treatment. Such approaches should focus on factors influencing multiple dimensions of access and will require the cooperation of all stakeholders working in malaria control.</p

Knowledge, attitudes and practices on sexual and reproductive health issues of students at university of Nairobi

Objective: To investigate factors associated with occurrence of unwanted pregnancies and uptake of sexual and reproductive health information and services.Design: Cross sectional descriptiveSetting: Students’ hostels University of Nairobi.Subjects or participants: Students of University of Nairobi.Interventions: Focus group discussionMain outcome measures: Health issues; Unwanted pregnancies; Information on RH and abortion.Results and conclusion: On health problems, STIs, HIV/AIDS, alcohol and drug abuse were mentioned. On unwanted pregnancies, these were common and were generally terminated. Methods of termination mentioned included drinking concentrated tea leaves and other concoctions, overdosing with tablets from the chemist and taking misoprostol. On information on RH and abortion the requested information was on sexuality and not abortion. On sources of the information, the university clinic and academic sources were mentioned. On persons providing information and support to students, student leaders, the university clinic and lecturers were the preferred. Main barriers to receiving information from the school clinic included negative attitudes and poor practices of nurses. An assessment of the health problems facing the students be done and services structured to be responsive to the problems. Multidisciplinary fora for discussing sexual and reproductive health matters be set up. A retraining and reorientation of university health workers in particular the nurses be done periodicall

Risk factors for infection and disease with the malaria parasite in children less than five years of age in Kisumu District Nyanza Province Kenya

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