Care-seeking dynamics among patients with diabetes mellitus and hypertension in selected rural settings in Kenya

Diabetes mellitus and hypertension are two common non-communicable diseases (NCDs) that often coexist in patients. However, health-seeking behaviour in patients with diabetes mellitus or hypertension has not been extensively studied especially in low- and middle-income countries. This study aimed to examine care-seeking dynamics among participants diagnosed with diabetes and/or hypertension across nine counties in rural Kenya. We conducted a cross-sectional study among adults diagnosed with diabetes and/or hypertension through face-to-face interviews. Of the 1100 participants, 69.9% had hypertension, 15.5% diabetes while 14.7% had both. The mean age of the respondents was 64 years. The majority of the respondents (86%) were on allopathic treatment. Hospital admission, having a good self-rated health status and having social support for illness, were positively associated with appropriate health-seeking behaviour while use of alcohol and pharmacy or chemist as source of treatment were negatively associated with appropriate health-seeking behaviour. Our study found a high prevalence of appropriate health-seeking behaviour among respondents with the majority obtaining care from government facilities. The results are evidence that improving public health care services can promote appropriate health-seeking behaviour for non-communicable diseases and thus improve health outcomes

Strengthening Community Health Strategy in Kenya through Public Private Partnership –Implementation Research

Community health workers play a vital role in the overburdened health systems of low and middle income countries. By supporting basic health system activities at the community level such as education on health related issues, health promotion and providing referrals to the nearest health facilities, they form a link between the communities and the peripheral health system. Despite the wide utilization of community health programs to extend the reach of inadequate health care systems characterized by shortage of health workers, a lot of implementation challenges exist and pose a threat to the sustainability of these programs. The overall objective of this study was to evaluate a community health worker program implemented in rural parts of Kenya through a public private partnership and thus provide context specific evidence on effectiveness and sustainability. The study utilized different methods to assess various components of the program including cross-sectional studies to assess uptake of maternal and child health services, health seeking behaviour for patients diagnosed with diabetes and hypertension and a case control design assessing risk reduction for diarhoea or respiratory infections following a hygiene education intervention. The work highlights evidence on the effectiveness of the program in prevention of infectious diseases, promoting well being of pregnant mothers and children and supporting patients with chronic diseases and ensuring they are retained in care. The work also highlights gaps that close to community initiatives can fill improving knowledge levels and encouraging uptake of health services

Sputum volume predicts sputum mycobacterial load during the first 2 weeks of antituberculosis treatment

CITATION: Karinja, M. N., Esterhuizen, T. M., Friedrich, S. O. & Diacon, A. H. 2015. Sputum volume predicts sputum mycobacterial load during the first 2 weeks of antituberculosis treatment. Journal of Clinical Microbiology, 53:1087–1091, doi:10.1128/JCM.02379-14.The original publication is available at http://jcm.asm.orgDisease severity in patients with pulmonary tuberculosis is associated with mycobacterial sputum load. To ascertain whether reduced sputum production during treatment is a useful clinical sign of improvement, we analyzed the mycobacterial loads of 5,552 sputum samples collected from 439 newly diagnosed sputum smear-positive tuberculosis patients who participated in six 14-day studies of antituberculosis treatment. Sputum volumes were categorized as low (10 ml), and mycobacterial load was measured by the time to positivity in liquid culture and the CFU counts on solid culture. The association of sputum volume with mycobacterial load was estimated with multiple linear regression models adjusted for repeated measures. The predictor variables were sputum volume category, treatment day, specific study , and the interaction of sputum volume category and treatment day. Mycobacterial load was significantly associated only with the day on treatment and sputum volume, which tended to decrease with ongoing treatment. With the volume held constant, each day on treatment decreased the log CFU by 0.082 (P < 0.001) and increased the time to positivity (TTP) by 1.04 h (P < 0.001). From low to medium and from medium to large sputum volumes, the log CFU/ml increased by 0.265 (P < 0.003) and 0.490 (P < 0.001), respectively, and the TTP decreased by 1.17 h (P < 0.001) and 1.30 h (P < 0.001), respectively, for a given day of treatment. The variability of the sputum load measurements increased with the day of treatment and lower sputum volumes. The significant association of sputum volume and mycobacterial load validates decreasing sputum production as a clinical sign of improvement during early antituberculosis treatment.http://jcm.asm.org/content/53/4/1087.abstract?sid=abd756b8-1fb2-4832-b2aa-ed3570d4c583Publisher's versio

Risk reduction of diarrhea and respiratory infections following a community health education program - a facility-based case-control study in rural parts of Kenya

Abstract Background Diarrheal and acute respiratory infections remain a major cause of death in developing countries especially among children below 5 years of age. About 80% of all hospital attendances in Kenya can be attributed to preventable diseases and at least 50% of these preventable diseases are linked to poor sanitation. The purpose of this study was to assess the impact of a community-based health education program, called Familia Nawiri, in reducing the risk of diarrhea and respiratory infections among people living in three rural Kenyan communities. Methods Cases were defined as patients attending the health facility due to diarrhea or a respiratory infection while controls were patients attending the same health facility for a non-communicable disease defined as an event other than diarrhea, respiratory infection. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a logistic regression model to assess the risk of diarrheal or respiratory infection in association with exposure to the health education program. Results There were 324 cases and 308 controls recruited for the study with 57% of the cases and 59% of the controls being male. Overall, 13% of cases vs. 20% of control patients were exposed to the education program. Participants exposed to the program had 38% lower odds of diarrhea and respiratory infections compared to those not exposed to the program (adjusted OR 0.62, 95% CI 0.41–0.96). A similar risk reduction was observed for participants in the study who resided in areas with water improvement initiatives (adjusted OR 0.65, 95% CI 0.47–0.90). Variables in the adjusted model included water improvement projects in the area and toilet facilities. Conclusion Findings from this study suggest participants exposed to the education program and those residing in areas with water improvement initiatives have a reduced risk of having diarrhea or respiratory infection