DETERMINANTS OF IMMUNISATION COVERAGE AMONG CHILDREN IN MATHARE VALLEY, NAIROBI

Objective: To establish the factors that determine the levels of immunisation coverage amongchildren under five years in Mathare Valley.Design: A crars-sectional study describing the situation at a point i n time.Setting: Mathare Valley slum with a population of 50,000 people in the city of NairobiSubjects: The study population was mothers with children under five years in MathareValley and had been resident there for a period not less than five yt ars prior to the study.Outcome measures: Level of immunisation coverage among children in the study populationand the factors that contribute to the low immunisation coverage.Results: Knowledge on immunisation was high with 90% of the reslmndents able to defineimmunisation. The attitude on immunisation was positive (74.4'6) and immunisationcoverage stood at 62.2%. Age, level of education, attitude and know1 edge on immunisaiionamong the residents were sigdicant determinants of immunisation coverage.Conclusion: Immunisation coverage was lower than the national aver age in Mathare Valley.Advanced mother's age, low level of education and relative lackof know ledge on immunisationwere responsible for the low coverage

PERINATAL MORBIDITY AT THE MOI TEACHING AND REFERRAL HOSPITAL, ELDORET

Background: Perinatal morbidity (PNM) is highest in the developing countries includingKenya. Studies on the perinatal morbidity in Moi Teaching and Referral Hospital (MTRH)have not been carried out. Furthermore, factors associated with PNM are unknown at theMTRH.Objective: To establish the causes and incidence of perinatal morbidity at the MTRHNewBorn Unit (NBU).Design: A retrospective study using case notes.Setting: The NBU of the MTRH in Eldoret, Kenya.Subjects: Babies who were admitted to the MTRH's Newborn Unit from January toDecember 1997.Results: The perinatal morbidity was 667 per 1000 babies admitted to the NBU. The mostcommon reason for admission was mother under anaesthesia. The most common cause ofmorbidity was asphyxia. The mean maternal age was 24 years. The mean level of educationwas 1.7 years. More than fifty five per cent of the mothers were housewives. The meanbirthweight was 2.75 kg (B.9 SD), 55.9 % had normal birthweight, 37 % were low birthweightand three per cent were large babies. The mean duration of stay in the NBU was 3.8 days.Conclusion: Most of the admissioas were Caesarean section babies who did not requireadmission. Younger mothers were more likely to have babies with neonatal sepsis,convulsions,pneumonia and asphyxia

TRAINING NEEDS FOR MID-LEVEL MANAGERS AND IMMUNISATION COVERAGE IN WESTERN KENYA

ABSTRACTObjectives: To determine the current status of immunisation coverage in Western Kenya beforeintervention, to identify strengths and weaknesses of the existing programme in order to designeducational interventions that could improve the services provided and find out the training needsof the mid-level managers of Kenya Expanded Programme of Immunisation.Design: Cross-sectional descriptive study.Setting: All thirty nine districts in Rift Valley, Western and Nyanza provinces.Subjects: Mid-level managers of Kenya Expanded Programme on Immunisation in the 39 districtsand the provinces. These included Provincial Logisticians, Provincial Medical Officers of Health,District Medical Officers of Health, District Public Health Nurses, District Records and HealthInformation Officers, District Disease Surveillance Officers, and District Public Health Officers.Main outcome measures: Number of staff trained on EPI, coverage rates and perceived trainingneeds of the mid-level managers.Results: A total of eighty eight mid-level managers participated in the interviews. Most of thesewere District Public Health Nurses (40.9%) and District Health Information and Records Officers(23.9%). Only 49 (25%) of the District Health Management Team members had undergone training atthe supervisory level. Eighteen districts (43.6%) had no member of the District Health ManagementTeam that had ever been trained at the supervisory level. Using rates of Pentavalent 1 and measlescoverage, Nyanza Province had the highest immunisation dropout rate (Pentavalent 1 – measles)whereas Rift Valley Province had the lowest. The annual cumulative coverage for all the provincesby antigen was 80% for Pentavalent 1 and 2 and 60% for measles. The most requested need forinclusion in the training curriculum was maintenance of the cold chain equipment.Conclusions: Most of the members in the study area have not been trained on Expanded Programmeon Immunisation and may be ill-equipped to manage the complicated programmes needed tomaximise delivery of services. The immunisation coverage in this area is low while the dropoutrates are high. We therefore recommend that all the mid-level managers of Expanded Programmeon Immunisation in this area be trained comprehensively through the Merck Vaccine Network- Africa programme using the World Health Organisation approved mid-level managers course

The impact of the method of consent on response rates in the ISAAC time trends study

BACKGROUND: Centres in Phases I and III of the International Study of Asthma and Allergies in Childhood (ISAAC) programme used the method of consent (passive or active) required by local ethics committees. METHODS: Retrospectively, relationships between achieved response rates and method of consent for 13-14 and 6-7-year-olds (adolescents and children, respectively), were examined between phases and between English and non-English language centres. RESULTS: Information was obtained for 113 of 115 centres for adolescents and 72/72 centres for children. Both age groups: most centres using passive consent achieved high response rates (>80% adolescents and >70% children). English language centres using active consent showed a larger decrease in response rate. Adolescents: seven centres changed from passive consent in Phase I to active consent in Phase III (median decrease of 13%), with five centres showing lower response rates (as low as 34%). Children: no centre changed consent method between phases. Centres using active consent had lower median response rates (lowest response rate 45%). CONCLUSION: The requirement for active consent for population school-based questionnaire studies can impact negatively on response rates, particularly English language centres, thus adversely affecting the validity of the data. Ethics committees need to consider this issue carefully. © 2010 The Union

Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma

Background Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. Methods The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013–2014. One of the questions was: “Has a national asthma strategy been developed in your country for the next five years? For children? For adults?”. Results Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p < 0.001). Interpretation In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy. © 2017 SEICA

Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma

Background Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. Methods The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013–2014. One of the questions was: “Has a national asthma strategy been developed in your country for the next five years? For children? For adults?”. Results Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p < 0.001). Interpretation In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy. © 2017 SEICA