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