Knowledge and attitude as determinant factors in HIV care among pregnant women in Rachuonyo North, Homa-Bay County, Kenya

Background: Mothers knowledge and attitude on PMTCT is a highly effective intervention with enormous potential to enhance access and utilization of PMTCT services Objective: To assess knowledge, attitude and practices of HIV infected women on Prevention of mother to child transmission attending antenatal care clinics in Rachuonyo North, Homa- Bay County, Kenya. Design: A cross sectional study Setting: Twenty antenatal care clinics in Rachuonyo North, Homa-Bay County, Kenya Subjects: HIV infected pregnant women.Results: PMTCT coverage and utilization was 77%. Majority (71.2%, 95% CI: 66.7 – 75.7) of the respondents had positive health seeking behaviours. Approximately 65.5%, of respondents understood four prong approach of PMTCT whereas, 64.9% of the respondents attended ANC clinics > 4 visits which is standard with WHO. The reasons cited by respondents for PMTCT interventions included ARV prophylaxis with EBF (42.1%, 95% CI: 37.2 – 47.1) ARV prophylaxis with BM substitute (22.9%, 95% CI:18.9 - 27.3) among others. There was significant association between attitude on PMTCT and health seeking behaviour, (AOR = 1.57, 95%CI: 1.09 – 4.15) and p=0.004<0.05. Willingness to test for HIV had a significant association with attitude on PMTCT (AOR =1.90, 95% CI: 1.08 – 8.21) with p - value<0.001. Conclusion: There was significant association between attitude on PMTCT and health seeking behaviour. Knowledge on when MTCT occurs in pregnancy and delivery is critical and key determinant to influence access and utilization of PMTCT services. Accurate information on the PMTCT service access and utilization significantly addresses psychosocial support services

Factors associated with pneumonia in children under five (2-59 months) in Nairobi, Kenya

Introduction: Pneumonia the leading cause of mortality and morbidity in children under five in the world. Most deaths occur in Sub-Saharan Africa and South Asia. Objective: This study investigated factors associated with pneumonia at their first presentation in Mbagathi District Hospital, Nairobi County. Methods: We conducted a hospital based cross-sectional study at the pediatric department at Mbagathi District Hospital. All guardians of children between 2-59 months were recruited at the hospital causality and inpatient department. Pneumonia diagnosis was based on WHO definitions. Pneumonia was associated with fast breathing with or without chest in drawing. Severe pneumonia was defined as fast breathing with any danger signs. Systematic random sampling procedure was used to select study participants. A total of 384 guardians together with their children were sampled. Results: Childhood pneumonia was caused by a combination of exposure to risk factors related to the host, the environment and infection. Low level of education of guardians was associated with pneumonia in children p<0.0.5 (Wald= 8.358, df =3). Crowding was associated with pneumonia in children p<0.05 (OR 0.33, 95% CI, 0.11-0.95). Birth weight of children was significantly associated with pneumonia p<0.05 (OR 0.59, 95% CI 0.38-0.92). Conclusions: The prevalence of pneumonia in children is reducing, this due to the public health interventions in the households and the hospital facility. Poor environmental factors increase the suffering of the community and this makes it difficult to prevent and control pneumonia. Increased pneumococcal conjugate vaccine coverage in children could significantly reduce the burden of pneumonia in sub-Saharan African countries. Key words: Childhood pneumonia, streptococcus pneumoniae, under five (2-59 months), Acute lower Respiratory Infection (ALRI)

Characteristics and Health Outcomes of Patients with Road Traffic Injuries managed in Critical Care Unit at Kenyatta National Hospital: A One Year Retrospective Cohort Study

Road traffic accidents are rapidly increasing in developing countries due to rapid motorization. There is limited data on outcomes of patients admitted in critical care units in Kenya. The study aimed at assessing characteristics and health outcomes of patients with road traffic injuries managed in the critical care unit at Kenyatta National Hospital. A retrospective cohort study was conducted where 71 patients’ files were reviewed using a data collection sheet. Data was analyzed using SPSS version 21.0. Male to female ratio was 3.5:1. Mean age was 30 years. Motor vehicles and motor cycles accounted for 30.3% and 27.3% of injuries respectively. Head Injuries accounted for up to 97.5% of all injuries. Glasgow coma scale (GCS) on admission was below 8 among 81.7% of the patients. Low GCS was significantly associated with age below 40 years, p<0.02. The mean CCU stay was 18 days. Referrals were 69% (n=49) of the patients and was significantly associated with GCS below 8, p<0.01. GCS below 8 was strongly associated with Computerized tomography scan services, p<0.00.Mortality rate was 36.6% (n=26). The mean cost of management was ksh.450195.67. More resource allocation to county CCUs and enhanced evacuation can improve the outcomes of the patients

Factors associated with anti-retroviral treatment failure among HIV/AIDS patients in Kibera slums, Nairobi county

Background: The introduction and scale up of anti-retroviral therapy (ART) has reduced HIV-related morbidity and mortality, this advantage will however be eroded if factors associated with anti-retroviral treatment failure are not identified and well addressed.Objective: To determine factors associated with anti-retroviral treatment failure among adult HIV/AIDS patients in Kibera slums, Nairobi county.Design: Descriptive cross-sectional studySetting: AMREF-Kibera community based Health CentreSubjects: Adult HIV/AIDS patients who have been on ART for six months and above.Results: It was clear that knowledge, attitudes and practices have a significant effect on anti-retroviral treatment failure with 86 % of the respondents agreeing that herbal medicine can be used as an alternative to ART while 75 % agreed that one does not need ART if they do not have AIDS. Poor adherence practices was also observed with the main reason of missing medication being due to stigma 81% followed by pill burden 78% and side effects 75%. The odds of ART failure were 1.09 times higher for those with poor knowledge about the purpose of ART drugs (ART Drugs are to Cure HIV AIDS). The odds of ART failure were 1.183 times higher for those with poor attitude (ART is a waste of Time). The odds of ART failure were 1.468 times higher for those with poor practices. The odds of ART Failure were 1.559 times higher for those with poor adherence practices as opposed to those with good adherence practices.Conclusion: Inadequate knowledge and poor attitudes towards ART in addition to poor adherence practices were associated with anti-retroviral treatment failure. The study therefore recommends that there is an urgent need to educate HIV/AIDS patients on ART and good adherence practices to avoid anti-retroviral treatment failure

Timing and Determinants of Tuberculosis Treatment Interruption in Nairobi County, Kenya

Tuberculosis (TB) treatment is a key pillar in the management and control of TB. Service delivery within the treatment facilities plays an important role in ensuring treatment adherence by TB patients. A prospective cohort study involving 25 health facilities, 25 facility in-charge officers and 291 patients diagnosed as new sputum smear positive (SM+) between December 2014 and July 2015 was undertaken. The aim of the study was to estimate the median time to treatment interruption, associated factors and overall predictors of non-adherence to TB treatment. A total of 19 (6.5%) treatment interruptions were observed. The median time to default was 56 [95% CI, 36-105] days. Treatment in a non-public facility [AOR=0.210, 95% CI (0.046-0.952)] and facilities perceived to have adequate number of health care workers to offer Directly Observed Therapy (DOT) [AOR=0.195, 95% CI (0.068-0.56)] showed a lower odds of treatment interruption whereas attainment of secondary level education [AOR=5.28, 95% CI (1.18-23.59)] indicated a higher odds of treatment interruption. Non-clinical aspects of health care service delivery influence patient adherence to TB treatment. Health seeking behavior of groups considered to be high risk for treatment interruption should be incorporated into the design and delivery of TB treatment

Determinants of active trachoma among children aged 1-9 years in Ol Donyo Nyokie location, Kajiado County, Kenya

Objective: To determine the factors associated with active trachoma among children aged 1-9 years in Ol Donyo Nyokie, Kajiado County.Methods: This was a descriptive cross-sectional study which utilized both quantitative and qualitative techniques for data collection and was carried out at Ol Donyo Nyokie, Kajiado County. Sequential sampling procedure was used to select study participants. A total of 345 mothers together with their children were sampled. The random start was adopted using lottery method and then every 3rd household until a desired sample size of 345 had been achieved. In households with more than one child, one among them was selected by lottery method. Physical examination on the children’s eyes was done while their respective mothers participated in the questionnaire survey supported by observation checklist. Two Focus group discussions were also conducted among mothers and Key Informant interviews among healthcare providers. Results: The overall prevalence of active trachoma was found to be 15.7%. Stratified by age and sex, the younger age group (1-5) years had a 2.13-fold risk of getting active trachoma (χ2 (1) =5.93, p< 0.017; AOR=2.13 [95%: CI=1.15-3.96] compared to the older group (6-9) years. There was however no significant difference between males and females (P>0.05). In the final logistic regression model; Face washing frequency (P<0.001), child’s dirty face(P<0.005), water access >30 mins(P<0.006), mother’s level of education(P<0.017), age of child(P<0.021), monthly income(P<0.029), pit latrine ownership(P<0.039), open defecation(P<0.054) and pit latrine usage (P<0.055) were identified as the predictors of active trachoma. In the Focus Group Discussion, about three quarters (74%) of the mothers were aware of trachoma. Majority of the mothers who were aware of trachoma indicated that water was a major challenge in the area without which trachoma could not be eliminated. Majority of the respondents did not own pit latrines and few of them also disregarded their use. From the Key Informant Interviews most of the respondents confirmed that water, lack of formal education and poverty were the major problems facing the community in the study area.Conclusion: The prevalence was found to be high, which indicates that active trachoma is still a major public health concern in the study area. Poor socio-economic and environmental conditions exacerbate the suffering of the community and make it difficult to prevent and control trachoma. Enhancement of interventions, therefore, particularly of facial cleanliness and environmental sanitation should be addressed to ensure effective prevention and control of trachoma and to bring down the prevalence levels below the WHO threshold of (>10 % prevalence). Community participation in education and outreach services are also crucial.Keywords: Active trachoma, children 1-9 years, risk factors, control and prevention, Kenya.Afr J Health Sci. 2017; 30(2):77-8

Effects of Agricultural Commercialization on Food Crop Input Use and Productivity in Kenya

The objective of this report is to analyze the effects of smallholder commercialization on food crop input use and productivity in rural Kenya. The main research issues were: (1) To examine the determinants of smallholder fertilizer use on food crops, with a focus on the effects of household and regional agricultural commercialization; (2) To examine the determinants of food crop productivity, again with a focus on the effects of commercialization; and (3) To discuss the implications of the findings for policy and additional research necessary to improve the contribution of cash cropping to rural food productivity growth and food security. A main premise of the paper is that the effects of commercialization are not uniform and cannot be generalized. The effects are hypothesized to differ both according to differences in the institutional/contractual arrangements between firms and smallholders, management decisions, and the level of credit and extension support provided to smallholders by the various private and parastatal firms involved in promoting smallholder cash crops.food security, food policy, food crop productivity, food crop input, Crop Production/Industries, Productivity Analysis, Downloads May 2008 - July 2009: 78, Q18,

Effects of Agricultural Commercialization on Food Crop Input Use and Productivity in Kenya

Crop Production/Industries, Downloads July 2008 - July 2009: 23,

Household access to safe water, sanitation and hygiene in Kajiado County, Kenya

A cross-sectional study was carried out in Kajiado central, East, West and south sub-counties with women aged 18 to 49 years. Survey targeted 768 women of reproductive age. National access to safe water in Kenya is currently at 63% while sanitation lags behind at only 30%. From the survey, access to safe water was found to be 62.3% compared to county average of 66.2%. More than half of the households (59.2%) do not have access to a toilet facility with 98.4% of those without access to a toilet defecating in the bush (Open defecation). Hand washing practice was found to be at 95.3%. However, only 40.3% of the respondents use appropriate hand washing facilities. Access to safe water in the county is still low compared to the national averages. The survey revealed that communities in the county get their water from unsafe sources

Response of cowpea genotypes to Alectra vogelii parasitism in Kenya

Cowpea is popular in Eastern Kenya where it is attractive to farmers because of its high economic value and the belief that it does not require many external inputs. Farmers are however discouraged to grow the crop in this region due to massive attack by a parasitic weed Alectra vogelii (Benth). Yield losses due to A. vogelii have being estimated to range from 50 to 100% in Mbeere, Kitui and Makueni districts. No single method however is available to farmers in these regions in control of the parasitic weed. Combining several control methods, as in the management of Striga spp in Western Kenya should be a sustainable option. Field studies were conducted in 2010 and 2011 at Kenya Agricultural Research Institute (KARI), Kiboko farm to determine the response of 143 cowpea genotypes to Alectra infestation. The aim for the study was to identify resistant genotypes that could be used in breeding programme. Significant differences were observed amongst cowpea genotypes in days to first Alectra emergence, number of Alectra shoots emerged at 6, 8, 10 and 12 week after planting and grain yield. Cowpea genotypes Kir/Nya-005 and Mbe/Mach-022 showed complete resistance to  Alectra while Ken-Kunde, M66 and K80 (all commercial varieties) supported the highest number of Alectra shoots. Grain yield loss in the three susceptible varieties was 80, 79 and 50% respectively. On the other hand, Sia/Cia-004, Mbe/Mach-014 and Kib-006 had high grain yields despite the high number of Alectra shoots present. There was a strong correlation (r = -0.57) between grain yield and number of Alectra shoots emerged at 12 weeks after planting. A significant negative (r = -0.37) correlation was also obtained between pod number per plant and number of emerged Alectra shoots at 12 weeks after planting. This negative correlation proves the high accumulation dry matter in the cowpea roots at the expense of the pods thus decreasing grain yield. This information showed that there is sufficient genetic variability in the cowpea genotypes studied, which can be exploited in breeding improved cowpea varieties for resistance to A. vogelii in Kenya. A great progress towards developing improved cowpea variety that meets farmer’s preferences with durable resistance to A. vogelii can be achieved if the genes from the resistant and tolerant local cowpea cultivars identified in this study could be introgressed into the adapted susceptible improved varieties. This will increase the potential impact of adoption of resistant cowpea varieties in the zones.Key words: Cowpea, Alectra vogelii, Resistance/tolerance and grain yield