Prevalence and risk factors for gender based violence during pregnancy in Kisumu county Kenya

Background: Gender Based Violence (GBV) is a pervasive and systemic public health problem affecting pregnant women but there is paucity of data on the magnitude of GBV during pregnancy and the factors associated with it in Kenya, particularly in areas where the prevalence of GBV in the general population is unacceptably high.Objectives: To determine the prevalence and factors associated with GBV during pregnancy in Kisumu County.Design: A cross sectional survey conducted between May and October 2016. Multivariate Logistic Regression was performed and the Odds Ratio (OR) at 95% Confidence Interval (CI) calculated to identify the factors associated with GBV.Setting: Two public primary health care facilities in each of the six sub counties in Kisumu County.Subjects: 691 eligible pregnant women attending antenatal care in the selected facilities responded to a questionnaire and were screened for GBV.Results: The mean and median age was 24.5 and 24 years respectively, and the age at sexual debut was 16.7 2.2 years. Thirty nine (39.2%) had experienced physical violence during the current pregnancy, perpetrated by an intimate partner (97%).Increased risk of violence was associated with having secondary level of education or more in the women OR=2.088,95% CI[1.147-3.802],occasional alcohol consumption by the intimate partner(IP) OR=2.843, 95%CI[1.519-4.059], witnessing violence as a child OR=3.380, 95%CI[2.427-6.046] and prior experience of physical OR=13.116,95%CI[7.976-21.569] or sexual violence OR=4.208,95% CI[2.603-6.803]. Male partner dominance in decision making, OR=5.930, 95%CI [3.998-8.797] and infidelity by the woman OR=3.442, 95% CI [1.696-9.686] or her IP, OR=9.906, 95% CI [6.088-16.119] were associated with increased violence. The belief in the social superiority of a man OR=3.949, 95%CI [2.044-7.631], man’s right to assert over a woman OR=3.163, 95%CI [1.930-5.185] and the belief that women should tolerate violence to save a relationship/marriage OR=9.493, 95% CI [5.746-5.681] were predictors of increased violence.Conclusion: A substantial proportion of pregnant women experience GBV in Kisumu County. The findings indicate the need for routine screening for GBV at ANC and the potential for initiation of interventions to mitigate the negative effects of violence for the affected women. Approaches targeting beliefs and strengthening of legal structures may be viable primary prevention options.

The effects of water quality and sanitation on immunocompromised: A case study of people living with HIV/AIDS in Kibera slum, Kenya

Background: Closer inspection of the spread of HIV/AIDS and its implications on individuals, communities and societies reveals several significant linkages with water and sanitation. In the context of poverty, malnutrition, high prevalence of co-infections with other opportunistic diseases, and overburdened health systems, individuals may be more susceptible to acquiring HIV and less able to cope with HIV-related illnesses, both physically and economically.Objectives: To determine the effect of sanitation and water quality on people living with HIV/AIDS in Kibera slum.Design: A cross sectional study.Settings: The study was carried out in Kibera informal settlement in Nairobi, Kenya.Subject: Randomly recruited 369 adults living with HIV/AIDS in Kibera slumResults: Logistic regression analysis employed to predict the probability that a respondent living with HIV/AIDS in Kibera slum would be infected with diseases related to taking contaminated water and living in poor environmental sanitary conditions using the predictor variables and showed a significant partial effect, x2 (5, N = 369) = 73.912, p< 0.001.Conclusions: Safe drinking water was inaccessible to a majority of participants indicating a high risk of opportunistic diseases and high economic burden

Family practices that influence the uptake of the Intergrated Management of Childhood Illnesses (IMCI) strategy among mothers at the MCH/FP clinic at Pumwani Maternity Hospital, Kenya

Background: Since 1999 the Government of Kenya has introduced the Integrated Management of Childhood Illness (IMCI) in an attempt to reduce child mortality. The IMCI strategy, developed by WHO and UNICEF, aims to improve the management of childhood illness at the primary health care level. The aim of this study was to determine the family practices that influence the uptake of the IMCI strategy among mothers in the MCH/FP clinic at Pumwani Maternity Hospital. Methods: A cross sectional survey was conducted at Pumwani Maternity Hospital MCH/FP clinic. A sample size of 385 mothers at the MCH/FP clinic was interviewed for quantitative data. All independent variables identified to significantly associate with ‘uptake of IMCI’ at bivariate analysis was considered together in a multivariate analysis. SPSS version 22 was used for statistical analysis. Results: Out of the 385 respondents interviewed, 78.4% children were well, 74.3% were of normal weight and 88.6% had been fully immunized. At multivariate analysis, statistically significant predictor family practices of IMCI uptake were fever experience, cough experience, living in Nairobi and giving iron supplements to the children.Conclusion: The uptake of the IMCI strategy, though high, was not optimal. There were many children who were underweight, had illnesses and were not fully immunized. These findings highlight the need for continuous strengthening of the IMCI strategy in health facilities

Anti-thrombotic effect of Zingiber officinale (ginger) in sprague dawley rats

Background: The prevalence of thrombotic diseases is rising globally. Presently, stroke and ischemic heart disease account for 25% of all deaths. Use of anti-thrombotic drugs have proven effective in prevention of these ailments but might not be affordable especially in developing countries. They are also associated with undesirable side effects. This study sought to determine the anti-thrombotic effect of ginger since it is affordable, accessible and is widely used as a food enhancer and a medicinal herb.Methods: The current study employed an in-vivo experimental study design. Three groups Sprague dawley rats (N=5) were given different doses of methanolic extract of ginger for 30 days. Two other groups (N=5) which served as controls received 5% dimethyl sulfoxide and aspirin for the same duration. Measurement of bleeding time, platelet count, prothrombin time, activated partial thromboplastin time and thrombin time was done to assess the anti-thrombotic property.Results: There was a statistically significant difference in bleeding time (P=0.03) across the groups investigated. There was however no significant difference across the groups in platelet count, prothrombin time, activated partial thromboplastin time and thrombin time (P=˃0.05).Conclusion: This study demonstrates that methanolic extract of ginger possesses an anti-thrombotic property probably through inhibition of platelet function. Regular consumption of ginger may therefore confer protection against thrombotic diseases

Acute Phase Response of Albumin and Haptoglobin in Experimental Infection of the Olive Baboon, Papio Anubis, with Schistosoma Mansoni

Following infection of baboons with Schistosoma mansoni cercariae, a rapid four-fold increase in mean  serum haptoglobin concentrations was observed. These concentrations dropped to near pre-infection levels  following curative treatment of the infected animals with praziquantel. On challenge of the animals with a  second cercarial dose, haptoglobin concentrations demonstrated a more gradual increase that did not attain  the heights of the initial infection. Albumin concentrations displayed an inversely disproportionate relationship  to those of haptoglobin and decreases were much less pronounced. Whereas albumin was not a  sensitive indicator of schistosomiasis mansoni, haptoglobin proved to be useful in detecting the acute infection  and in determining prognosis of the disease in the olive baboon.

KENYAN PURPLE TEA ANTHOCYANINS ABILITY TO CROSS THE BLOOD BRAIN BARRIER REINFORCING BRAIN ANTIOXIDANT CAPACITY IN MICE

Studies on antioxidants as neuroprotective agents have been hampered by the impermeability of the blood brain barrier (BBB) to many compounds. However, previous studies have shown that a group of tea ( Camellia sinensis ) flavonoids, the catechins, are brain permeable and neuroprotective. Despite this remarkable observation, there exists no data on the bioavailability and pharmacological benefits of tea anthocyanins (ACNs) in the brain tissue. This study investigated the ability of Kenyan purple tea ACNs to cross the BBB and boost the brain antioxidant capacity. Mice were orally administered with purified and characterised Kenyan purple tea ACNs or a combination of Kenyan purple tea ACN\u2019s and coenzyme-Q10, at a dose of 200 mg kg-1 body weight in an experiment that lasted for 15 days. Twenty four hours post the last dosage of antioxidants, CO2 was used to euthenise the mice. Then the brain was excised and used for various biochemical analyses. Kenyan purple tea ACNs significantly (P<0.05) raised brain Glutathione (GSH) levels, implying a boost in brain antioxidant capacity. Notably, ACN metabolites were detected in brain tissue of ACN fed mice. This is the first demonstration that Kenyan purple tea ACNs can cross the BBB, reinforcing the brain\u2019s antioxidant capacity. Hence, there is need to study ACNs as suitable candidates for dietary supplements that could support antioxidant capacity in the brain and have potential to provide neuroprotection in neurodegenerative conditions.Les \ue9tudes sur les antioxydants comme agents neuroprotecteurs ont \ue9t\ue9 handicap\ue9es par l\u2019imperm\ue9abilit\ue9 de la barri\ue8re de sang du cerveau (BBB) \ue0 plusieurs produits. Par ailleurs, les \ue9tudes ant\ue9rieurs ont montr\ue9 qu\u2019un groupe de flavono\uefdes du th\ue9 ( Camellia sinensis ) , les cat\ue9chines, permettent la perm\ue9abilit\ue9 du cerveau et prot\ue8gent les nerfs. Malgr\ue9 cette observation importante, il n\u2019ya pas de donn\ue9es sur la biodisponibilit\ue9 et les vertus pharmacologiques des anthocyanines du th\ue9 (ACNs) dans le tissue du cerveau. Cette \ue9tude a \ue9valu\ue9 l\u2019aptitude des anthocyanines du th\ue9 pourpre du Kenya de traverser le BBB et am\ue9liorer la capacit\ue9 antioxydante du cerveau. Des rats \ue9taient oralement administr\ue9s des anthocianines du th\ue9 pourpre purifi\ue9s et caract\ue9ris\ue9s ou une combinaison des ACNs avec le coenzyme-Q10, \ue0 une dose de 200 mg kg-1 de poids vif dans un essai d\u2019une dur\ue9e de 15 jours. Vingt quatre heures apr\ue8s le dernier dosage d\u2019antioxydants, le CO2 \ue9tait utilis\ue9 pour euthanasier les rats. Ensuite, le cerveau \ue9tait excis\ue9 et soumis \ue0 diverses analyses biochimiques. Les ACNs ont augment\ue9 significativement (P<0.05) les niveaux du Glutathione (GSH) du cerveau,,ce qui implique une am\ue9lioration de la capacit\ue9 antioxydante du cerveau. Remarquablement, les m\ue9tabolites ACN \ue9taient d\ue9tect\ue9s dans le tissu des rats nourris aux ACNs. Ceci est la premi\ue8re d\ue9monstration que les anthocyanines (ACNs) du th\ue9 pourpre Kenyan peuvent franchir la barri\ue8re h\ue9mato-enc\ue9phalique (BHE), renfor\ue7ant ainsi la capacit\ue9 antioxydante du cerveau. Ainsi, le besoin s\u2019impose de les \ue9tudier comme des candidats appropri\ue9s pour les aliments de suppl\ue9ment qui pourraient renforcer la capacit\ue9 antioxydante dans le cerveau et avoir le potentiel d\u2019offrir la neuroprotection dans les conditions neurod\ue9g\ue9n\ue9ratrices

In vitro antileishmanial activity and phytochemical analysis of Carissa edulis against Leishmania major

Background: However, there is need to carry out scientific studies in order to confirm the medicinal properties of many plants used traditionally. Carissa edulis Forskk. (Gentiales: Apocynaceae) used by local communities for the treatment of various diseases has showed antiviral, antibacterial and antiprotozoal properties although there are no studies demonstrating its antileishmanial activity. Objective: To investigate in vitro antileishmanial activity of extracts of Carissa edulis on promastigote and amastigote forms of Leishmania major. Methodology: Solvent extraction of the stem parts of C. edulis was performed using water, methanol, petroleum ether, dichloromethane and ethyl acetate. Minimum inhibitory concentration (MIC), anti-amastigote and nitric oxide production assays were carried out to demonstrate antileishmanial activity of C. edulis extracts against the two forms of L. major parasite species: promastigote and amastigote. The extracts were also screened for phytochemical constituents present. Cytotoxicity assay was then done to assess their safe use as herbal medicinal products. Results: The C. edulis petroleum ether extract showed the strongest antileishmanial activity against L. major promastigotes (MIC=625μg/ml) with the water, dichloromethane and ethyl acetate extracts recording the weakest activity (MIC=2500μg/ml). The successive methanol extract reduced the number L. major amastigotes by 88.29% compared to the negative control (RPMI). The water (13.37μM), petroleum ether (12.93μM) and successive methanol extracts (12.82μM) produced nitrite values lower than the standard drugs Pentostam® (14.35μM) and Amphotericin B (14.13μM). Discussion: All C. edulis extracts have potential antileishmanial activity against L. major. Preliminary phytochemical screening of these extracts showed presence of alkaloids, terpenoids, phenols, anthraquinones and saponins. These phytochemicals were previously reported to have antileishmanial activity. Therefore, the plant extracts could offer an opportunity to develop cheaper antileishmanial alternatives to the more expensive pentavalent antimonials. Key words: C. edulis, L. major, promastigote, amastigot

Animal-related factors associated with moderate-to-severe diarrhea in children younger than five years in western Kenya: A matched case-control study

Background Diarrheal disease remains among the leading causes of global mortality in children younger than 5 years. Exposure to domestic animals may be a risk factor for diarrheal disease. The objectives of this study were to identify animal-related exposures associated with cases of moderate-to-severe diarrhea (MSD) in children in rural western Kenya, and to identify the major zoonotic enteric pathogens present in domestic animals residing in the homesteads of case and control children. Methodology/Principal findings We characterized animal-related exposures in a subset of case and control children (n = 73 pairs matched on age, sex and location) with reported animal presence at home enrolled in the Global Enteric Multicenter Study in western Kenya, and analysed these for an association with MSD. We identified potentially zoonotic enteric pathogens in pooled fecal specimens collected from domestic animals resident at children’s homesteads. Variables that were associated with decreased risk of MSD were washing hands after animal contact (matched odds ratio [MOR] = 0.2; 95% CI 0.08–0.7), and presence of adult sheep that were not confined in a pen overnight (MOR = 0.1; 0.02–0.5). Variables that were associated with increased risk of MSD were increasing number of sheep owned (MOR = 1.2; 1.0–1.5), frequent observation of fresh rodent excreta (feces/urine) outside the house (MOR = 7.5; 1.5–37.2), and participation of the child in providing water to chickens (MOR = 3.8; 1.2–12.2). Of 691 pooled specimens collected from 2,174 domestic animals, 159 pools (23%) tested positive for one or more potentially zoonotic enteric pathogens (Campylobacter jejuni, C. coli, non-typhoidal Salmonella, diarrheagenic E. coli, Giardia, Cryptosporidium, or rotavirus). We did not find any association between the presence of particular pathogens in household animals, and MSD in children. Conclusions and significance Public health agencies should continue to promote frequent hand washing, including after animal contact, to reduce the risk of MSD. Future studies should address specific causal relations of MSD with sheep and chicken husbandry practices, and with the presence of rodents

Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa

Abstract Background Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods. Methods We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients. Results Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects. Conclusions The intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally