Factors influencing uptake of family planning services among men in Kenya

Background: Utilisation of family planning services in Kenya remains quite low hence, the soaring population which has partly hampered achievement of the fifth Millennium Development Goal (MDG) as well as achievement of overall development goals for the entire country. Current reports indicate that male participation improves uptake of maternal healthcare and family planning services among women.Objective: To determine factors that influence male participation in family planning services in Kenya.Design: A retrospective studySetting: Nationally representative survey of Eight provinces in Kenya.Subjects: Married and single sexually active men.Results: From the adjusted logistic regression model after controlling for other factors, we found higher education AOR 1.59 (C.I: 0.767-3.299), employment AOR 1.67 (C.I: 1.127-2.496), Media as the source of information AOR 1.75 (C.I: 1.308-2.367), discussion with a health worker AOR 1.71 (C.I: 1.206 – 2.430), number of wives (one wife AOR 0.07 (C.I: 0.007-0.769), No more desire for children AOR 2.83 (C.I: 1.794-4.489) and the total number of children one has (1-4) AOR 2.55 (CI: 1.616 -4.029) as the main factors that influence male participation in family planning services.Conclusion: In Kenya, programmes intending to have men actively participate in family planning services should focus on addressing multiple factors which influence men’s participation in family planning services

Parental Perceptions about Pain and Pain Management Practices in Neonatal Units: A Review

Background: Pain management in neonates remains sub-optimal in sub-Saharan countries like Kenya due to lack of resources to procure pharmacological analgesics. There, however, exist low-cost, mother-driven pain management strategies such as breastfeeding and kangaroo care that can be used for pain relief in neonates in Kenya. Successful use of these interventions is depended on parents’ perception about neonatal pain and how well pain in neonates is managed during hospitalisation.Objective: To determine parents’ perception about pain and pain management practices in neonatal units.Data sources: MEDLINE, CINAHL, Embase and PsycINFO databases were searched  using the following key words: parent(s), perception(s), view(s), neonate, newborn, pain, procedural pain, management, and practices.Study selection : Studies published in peer-reviewed English journals that focused on acute procedural pain or acute persistent pain on neonates were included in the review.Data extraction : Two independent authors critically reviewed retrieved articles and extracted data on study sample, setting, design as well as key findings on parental perceptions about pain and pain  management practices.Data synthesis: A meta-synthesis approach involving a critical evaluation of convergences and  divergences of participants’ views about pain and pain management practices.Results: Of the 101 articles generated through the databases search, four met the inclusion criteria. Parents believe that neonates experienced a lot of pain during hospitalisation that is often not adequately treated and desire to be involved in the pain care of their neonates.Conclusion: The high frequency of pain experienced by neonates in the course of hospitalisation should serve as an impetus to involve parents in procedural pain management in neonatal units

Malaria parasitemia among asymptomatic infants seen in a malaria endemic region of western Kenya

Background: Sustainable Development Goal number three call for complete reversal in the incidence of malaria by 2030. Malaria however remains a health priority in sub-Saharan Africa, with children under five experiencing the highest morbidity and mortality. In clinical settings, management of malaria cases has primarily been  centred on case definition, giving minimal consideration to the asymptomatic  individuals who remain a major reservoir since they do not seek care. In malaria endemic areas, infants are likely to remain asymptomatic since they have partial immunity acquired from the mother.Objective: To determine the proportion of infants with positive parasitemia and  describe their clinical and demographic characteristics.Design: A cross-sectional study.Setting: Webuye District Hospital, Western Kenya.Subjects: Three hundred and eighty four infants.Results: Prevalence of malaria parasitemia among enrolled infants was 61%. Infants born to housewife mothers, born to mothers who attended ANC during pregnancy; those weaned late or with family history of sickle cell disease were more likely tohave malaria parasitemia with p-values of 0.031,0.015,0.007, and 0.025  respectively.Conclusion: Prevalence of malaria parasitemia among asymptomatic infants in  Webuye (Western Kenya) remains high

Factors associated with rota virus diarrhea in the post vaccine period as seen at Moi Teaching and Referral Hospital, Kenya

Objectives: To describe the prevalence and factors associated with rotavirus diarrhea in the post vaccine era.Design: Cross-sectional study.Setting: Moi Teaching and referral Hospital, Pediatric Emergency Department.Participants: Children ≤2 years with acute diarrhea illness. Data was collected onto an interviewer administered questionnaire and a Certest® rapid rotavirus stool antigen test done.Main outcome measures: Socio-demographic and clinical characteristics including: Age, Gender, Rotavirus antigen test results, level of dehydration and anthropometric measurements.Results: 311 participants with acute diarrhea were recruited, with 55.6% (173/311) being rotavirus positive. On bivariate analysis, age appropriate completion of routine vaccination (p=0.030), two doses of rotavirus vaccination (p=0.005) and nutrition status (p=0.009) were associated with a positive rotavirus test. On logistic regression, mild wasting (OR 2.581; CI 95% 1.068-6.236;p=0.035) and moderate wasting (OR 3.424; CI 95% 1.221-9.604;p=0.019) were associated with rotavirus positive diarrhea. Receiving two rotavirus vaccines (OR 0.151; CI 95% 0.032-0.709;p=0.017) and age appropriate completion of routine vaccination (OR 0.478; CI 95% 0.256-0.892;p=0.003) was protective. The peak rotavirus prevalence was during the dry season. Receiving one rotavirus vaccine, severe malnutrition and socio-demographic characteristics e.g. age, the child’s primary caregiver, overcrowding were not statistically significant. Although majority of the children with rotavirus positive diarrhea had non-severe dehydration (63%, 109/173) this was also not significant (OR 1.066; CI 95% 0.6695- 1.699;p=0.786).Conclusion: Prevalence of Rotavirus diarrhea is still high among the under twos in our set up. Two rotavirus vaccines are needed for full protection. Advocacy and public health interventions should intensify to improve the vaccine coverag

Assessment of cold chain management practices in immunisation centres in Kacheliba division, Pokot County, Kenya

Background: Immunisation contributes significantly to the achievement of MDGs. It is one of the eight elements and success stories of primary health care. Proper utilisation of Immunisation services is associated with improved child health outcomes. The WHO targets Immunisation coverage of 90% for urban areas and 80% for rural areas.Objectives: To assess the cold chain management practices that could affect  potency of vaccines and its utilisation by under five year old children in Kacheliba Division.Design: A cross-sectional descriptive study.Setting: All health facilities in Kacheliba Division, Kenya.Subjects: Parents/guardians of under-five year old children and all the health facility level within Kacheliba Division.Results: Seven (87.5%) health facilities reported that they collect vaccines at intervals of more than one month. Four (50%) health institution were located 20 kilometers from the local vaccine store - Kacheliba District Hospital. Kacheliba District Hospital gets their vaccine stocks from Eldoret KEMSA depot, an estimated 90 kilometers away. Completely melted ice packs during transportation of vaccine were encountered only in one (12.5%) centre- Kacheliba mobile dispensary. Major source of power for the refrigerators was the gas (75%), and electricity (28.6%). During electricity power block out, the right temperature intervals were then generated using gas. It was found that all the eight health facilities did not have a stand by biomedical technician who maintains and repair refrigerators. Furthermore there was no budgetary allocation for the refrigerators maintenance and repair among all the health facilities. Problems related to cold chain were observed in all the eight facilities in Kacheliba Division. Inadequate air circulation was seen in seven (87.5%) facilities, water bottles were kept inside the cold boxes and fridges in three (37.5%) facilities, Food and drinks were kept in cold boxes and fridges in 4(50%) facilities and vaccines were not kept in proper compartment in three (37.5%) facilities.Conclusion: The cold chain management practices among health facilities in Kacheliba Division of Pokot County were not upto the standards set by the Kenya Extended Programmeme on Immunisation (KEPI)) Guidelines. Cold chain  management should be improved through continuous medical educational  programmemes and sufficient budgetary allocation

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

Malaria Parasitaemia among Febrile Children Infected with Human Immunodeficiency Virus in the Context of Prophylactic Cotrimoxazole as Standard of Care: A Cross- Sectional Survey in Western Kenya

Objective: To document the prevalence of malaria parasitaemia among the HIV infected febrile children in a malaria endemic area. Design: A cross-sectional study. Setting: An ambulatory paediatric HIV clinic in Western Kenya, between November 2011 and December 2012. Subjects: A total of 245 febrile HIV infected children aged less than 14 years attending the HIV clinic in the Webuye level IV hospital were included in the study. A systematic sampling method was used. Main outcomes: A blood sample was taken for malaria parasite testing. Presence or absence of malaria parasites was documented. Clinical and socio-demographic characteristics of the participants were also recorded. Results: A total of 245 participants were recruited mean age being 5.53 years. Malaria prevalence was 81.9%. Most participants (97%) were on cotrimoxazole prophylaxis. Some of the factors found to be positively associated with malaria parasitaemia were; male sex, care taker category (parent), WHO stage 3 and 4 of HIV disease, and a high absolute CD4 count. However, only the caretaker association was statistically significant. Conclusion: The frequency of malaria parasitaemia among febrile HIV infected children is still high regardless of the high cotrimoxazole prophylaxis uptake. It is also noted that there is a shift in the age group of fever among children toward the older age group. This implies that policies may need to be relooked at to include the older age group in the aggressive malaria prevention measures to avoid losing on the already made gains

Asthma control and factors associated with control among children attending clinics at a national referral hospital in western Kenya

Background: Asthma control is the extent to which the various manifestations of asthma have been reduced or removed by treatment. In developing countries including Kenya, many children continue to visit hospitals with acute symptoms of asthma, which is a pointer to poor control.Objectives: To determine the level of asthma control and factors associated with the observed control among children at a national referral hospital.Design: Cross-sectional studySetting: Moi Teaching and Referral Hospital, Eldoret, Kenya paediatric clinics.Subjects: A total of 166 asthmatic children aged 6-11 years and their parents/caretakers were enrolled between August 2016 and October 2017.Main Outcome: Level of control using childhood asthma control test (c-ACT)Results: The median age of enrolled children was 8.17 years with males being the majority, 94 (56.6%). Using c-ACT, 92 (55.4%, 95%CI: 47.52, 63.10) had well controlled asthma at baseline. At univariate analysis, having a medical insurance cover (p=0.034), dry season (p=0.036), and parental perception of asthma control (p=0.002) were significantly associated with good control of asthma. Acceptance that a child had asthma was associated with poor control of asthma, p=0.046. On multivariate logistic regression, a perception of a well-controlled child by the parent/caretaker correlated well with good control of asthma.Conclusion: About half of the children in this set up have good control of asthma with the observed status of control being affected by parental/caretaker perception on asthma

Characteristics of HIV-infected adolescents enrolled in a disclosure intervention trial in western Kenya

Knowledge of one's own HIV status is essential for long-term disease management, but there are few data on how disclosure of HIV status to infected children and adolescents in sub-Saharan Africa is associated with clinical and psychosocial health outcomes. We conducted a detailed baseline assessment of the disclosure status, medication adherence, HIV stigma, depression, emotional and behavioral difficulties, and quality of life among a cohort of Kenyan children enrolled in an intervention study to promote disclosure of HIV status. Among 285 caregiver-child dyads enrolled in the study, children's mean age was 12.3 years. Caregivers were more likely to report that the child knew his/her diagnosis (41%) compared to self-reported disclosure by children (31%). Caregivers of disclosed children reported significantly more positive views about disclosure compared to caregivers of non-disclosed children, who expressed fears of disclosure related to the child being too young to understand (75%), potential psychological trauma for the child (64%), and stigma and discrimination if the child told others (56%). Overall, the vast majority of children scored within normal ranges on screenings for behavioral and emotional difficulties, depression, and quality of life, and did not differ by whether or not the child knew his/her HIV status. A number of factors were associated with a child's knowledge of his/her HIV diagnosis in multivariate regression, including older age (OR 1.8, 95% CI 1.5-2.1), better WHO disease stage (OR 2.5, 95% CI 1.4-4.4), and fewer reported caregiver-level adherence barriers (OR 1.9, 95% CI 1.1-3.4). While a minority of children in this cohort knew their HIV status and caregivers reported significant barriers to disclosure including fears about negative emotional impacts, we found that disclosure was not associated with worse psychosocial outcomes

Morbidity and mortality in HIV - infected children admitted at Moi Teaching and Referral Hospital in Western Kenya

Background: HIV-infected children are at higher risk of opportunistic infections that could result in hospitalisation. The outcomes of hospitalisation are variable and depend on the admission diagnosis, the patients’ immune status and whether or not the patient is on anti-retroviral drugs.Objective: To describe the characteristics and causes of hospitalisation and mortality for HIV infected children admitted to Moi Teaching and Referral hospital in western Kenya.Design: a retrospective study of prospectively collected data.Setting: The paediatric wards of Moi Teaching and Referral Hospital (MTRH). A Kenyan National Referral Hospital.Subjects: HIV-infected children admitted the paediatric wards.Interventions: Treatment with combination anti-retroviral therapy (cART), treatment of common opportunistic infections.Main outcome measures: Demographic and clinical data, including diagnosis, immune status, and treatment with combination anti-retroviral therapy (cART), were extracted from hospital admission records of HIV-infected children registered with the USAIDAcademic Model Providing Access to Healthcare (AMPATH) partnership. We conducted descriptive statistical analyses and used chi-square and fisher’s exact tests to assess for associations between categorical variables and each of the independent variables.Results: Between December 2006 and May 2009, 396 HIV-infected children were admitted to MTRH. Median age at admission was 2.0 years (range 0-15); 236 (59%) were male; 36 (15%) of available 236 orphan status entries were orphaned; 198 (73%) were in CDC categories B and C and 61 (16%) of available 386 had been on ART. Among 108 patients with documented immunologic status, the mean CD4 cell percentage was 16% (SD 10.8). Among the 396 children, 104 (15%) were diagnosed with pneumonia, 92 (14%) with gastroenteritis, 36 (9%) with tuberculosis and 37 (9%) with malaria. Deaths occurred in 28(7%) of the patients. The median duration of hospitalisation was seven days (range 1- 516) for discharged patients and six days (range 0-72) for those who died. A significantly higher percentage of the children who were not previously enrolled in AMPATH died, signifying 14 (15%) mortality among this population of admitted patients, p = 0.0017. Of those who died, (17%) were diagnosed with pneumonia and 22 (79%) of them were not on cART.Conclusion: The common diagnoses at hospitalisation included pneumonia, gastroenteritis, malaria and tuberculosis. Higher mortality occurred among those diagnosed with pneumonia and those not previously enrolled in the HIV care programme. Aggressive treatment and prevention of the most prevalent diseases and early enrollment into HIV care are recommended for HIV-infected children. A follow-up study to investigate the pathological causes of death in this population is recommended