An assessment of information communication technology content, context and process dimensions in public health facilities in Machakos and Nairobi Counties, Kenya

Objective: To establish the level of ICT related content, context and process dimensions vis- a- vis the upscaling of ICT in health care facilities in Nairobi and Machakos counties.Design: A cross sectional studySetting: Machakos and Nairobi counties levels 4-6 hospitalsSubjects: Seventy three (73) respondents drawn from the health facilities were interviewed.Results: ICT content variables studied were operations computerised, ICT facilities provided and breakdown-replacement protocol. Context variables included on-job ICT trainings, ICT training sponsorships by facility and presence of institutional ICT induction program. The process variables were staff involvement in design of ICT aspects and presence of ICT policy. Among contextual factors, presence of institutional induction training program on ICT was relatively high compared to ICT training on job and ICT training sponsorship offered by facility (χ= 28.15, d.f=2, p<0.001 at 95%CI). Under process dimensions, presence of ICT policy at facility was higher compared to staff involvement in design of ICT aspects (χ =15.03, d.f =2 and p<0.001). Among the content factors, the ICT facilities provided was relatively high in all the facilities compared to levels of services operations computerised and breakdownreplacement protocol (χ=18.4, d.f =6 and p<0.005). Under the challenges, reliability of ICT infrastructure posed the greatest challenge towards up scaling of ICT among the content factors (χ=10.79, d.f. = 4, p-value=0.029). Process factor related challenges also had major impact on up scaling of ICT i.e. less up scaling of ICT that was attributed to lack of support from hospital top management team (χ 9.44, d.f.=4 and p=0.005). Comparing levels 5 and 6 facilities, the context dimension; presence of institutional induction training on ICT was the main factor that affected both facilities equally in relation to up scaling of ICT (p-value=0.021). Comparing level 4 facilities to level 6, process and content dimensions were the main factors that determined ICT uptake specifically availability of ICT policies in the institutions (p=0.011) and the levels of services operations that have been computerized (p=0.010) respectively.Conclusion: The study findings showed that content and process dimensions were the major aspects that were critical for positive up scaling of ICT in public health facilities. These factors were setting-dependent on the classification of the facility levels, in this study the level 4 facilities had poor up scaling of ICT compared to level 5 and level 6. The specific key attributes included: Strong management involvement in ICT related matters (process dimensions), availability and implementation of an ICT policy especially among level 4(process dimension), presence of an institutional induction training program on ICT (context dimension), type of ICT support provided and its reliability (content dimension) and level of services operations computerized (content). The major challenges that hindered up scaling of ICT were reliability of ICT infrastructure under the content factors and lack of support from hospital top management team under the process related factors

Intermittent preventive treatment and bed nets uptake among pregnant women in Kenya

Background: Malaria in pregnancy is a preventable disease which results in poor pregnancy outcomes. The use of intermittent preventive treatment in pregnancy (IPTp) and long-lasting insecticide treated nets (LLINs) have been shown to reduce maternal malaria episodes.Objectives: To describe i) The proportion receiving first and second dose (IPTp1 and 2) in malaria endemic zones, ii) proportion receiving IPTp 1 and 2 stratified by coast and lake endemic zones iii) proportion receiving LLINs, stratified by coastal and lake endemic zones.Design: A retrospective descriptive study.Setting: Lake and Coast region malaria endemic zones.Subjects: Pregnant women.Results: IPTp2 dose during an ANC revisit fell by 29% between 2012 and 2015, with 76% receiving an IPTp2 in 2012 and only 47% receiving it in 2015. More pregnant women in Coastal endemic areas received IPTp2 compared to Lake, with 88% versus 73% in 2012, and 53% versus 44% in 2015, respectively.There was steady increase in bed net usage from 69% and 54% in 2012 to 96% and 95% in 2015 for lake and coast endemic zones respectively. The uptake of LLINs was 15% higher in the lake region compared to the coastal endemic region in 2012 and significantly declined over the five years to 6%, 7% and 1% in 2013, 2014 and 2015, respectively.Conclusion: Our study found that there has been a significant decline from 2012 through 2015, in the number of pregnant women in Kenya receiving recommended malaria prophylaxis in the regions of highest malaria burden. However, the coverage of LLIN has consistently improved over the same period

Long term study on the effect of mollusciciding with niclosamide in streamhabitats on the transmission of schistosomiasis mansoni after community-basedchemotherapy in Makueni District, Kenya

Background: Schistosoma mansoni infection is a persistent public health problem in many Kenyan communities. Although praziquantel is available, re-infection after chemotherapy treatment is inevitable, especially among children. Chemotherapy followed by intermittent mollusciciding of habitats of Biomphalaria pfeifferi, the intermediate host snail, may have longer term benefits, especially if timed to coincide with natural fluctuations in snail populations. Methods: In this cohort study, the Kambu River (Intervention area) was molluscicided intermittently for 4 years, after mass chemotherapy with praziquantel in the adjacent community of Darajani in January 1997. The nearby Thange River was selected as a control (Non-intervention area), and its adjacent community of Ulilinzi was treated with praziquantel in December 1996. Snail numbers were recorded monthly at 9–10 sites along each river, while rainfall data were collected monthly, and annual parasitological surveys were undertaken in each village. The mollusciciding protocol was adapted to local conditions, and simplified to improve prospects for widespread application. Results: After the initial reduction in prevalence attributable to chemotherapy, there was a gradual increase in the prevalence and intensity of infection in the non-intervention area, and significantly lower levels of re-infection amongst inhabitants of the intervention area. Incidence ratio between areas adjusted for age and gender at the first follow-up survey, 5 weeks after treatment in the non-intervention area and 4 months after treatment in the intervention area was not significant (few people turned positive), while during the following 4 annual surveys these ratios were 0.58 (0.39-0.85), 0.33 (0.18-0.60), 0.14 (0.09-0.21) and 0.45 (0.26-0.75), respectively. Snail numbers were consistently low in the intervention area as a result of the mollusciciding. Following termination of the mollusciciding at the end of 2000, snail populations and infections in snails increased again in the intervention area. Conclusion: The results of this study demonstrate that in the Kenyan setting a combination of chemotherapy followed by intermittent mollusciciding can have longer term benefits than chemotherapy alone

Spatial distribution and co-infection with urogenital and intestinal schistosomiasis among primary school children in Migori County, Kenya

Background: Schistosomiasis is the most prevalent helminthic infection in sub-Saharan Africa. School age children have the highest burden. Chronic schistosome infections in children can have irreversible effects lasting throughout adulthood.Objective: To determine the prevalence, intensity and distribution of urogenital and intestinal schistosomiasis among primary school children in Migori County, Kenya.Design: Descriptive cross-sectional study.Setting: Primary schools in Migori County, Kenya.Subjects: Children aged seven to fourteen years.Results: We enrolled 1,784 children with the ratio of female to males being 1:1. Their mean age was 11.4 years (standard deviation ± 1.6). The overall prevalence of infection was 26%, with urogenital and intestinal schistosomiasis being found in 9% and 20% of children, respectively. A trend of increasing prevalence with increasing age of children was observed. Boys had a 50% higher risk of being infected with schistosomiasis when compared to girls (adjusted odds ratio 1.5, 95% confidence interval 1.2-1.9). Intensities of schistosome infections did not vary significantly across gender and age. Nyatike Constituency had the highest prevalence of schistosomiasis (54%).Prevalence in schools ranged from 1.7 to 89%. Seven schools (23%) had a schistosomiasis prevalence of at least 50% while 12 (39%) schools had schistosomiasis prevalence of between 10 and 50%.Conclusion: Our study showed that schistosomiasis is endemic in the study area and represents a significant public health problem among school children. The area should be prioritised for interventions including mass deworming, public health education and sanitation improvement

Nightly Variation in Sleep Influences Self-efficacy for Adhering to a Healthy Lifestyle: A Prospective Study

Background: Self-efficacy, or the perceived capability to engage in a behavior, has been shown to play an important role in adhering to weight loss treatment. Given that adherence is extremely important for successful weight loss outcomes and that sleep and self-efficacy are modifiable factors in this relationship, we examined the association between sleep and self-efficacy for adhering to the daily plan. Investigators examined whether various dimensions of sleep were associated with self-efficacy for adhering to the daily recommended lifestyle plan among participants (N = 150) in a 12-month weight loss study. Method: This study was a secondary analysis of data from a 12-month prospective observational study that included a standard behavioral weight loss intervention. Daily assessments at the beginning of day (BOD) of self-efficacy and the previous night’s sleep were collected in real-time using ecological momentary assessment. Results: The analysis included 44,613 BOD assessments. On average, participants reported sleeping for 6.93 ± 1.28 h, reported 1.56 ± 3.54 awakenings, and gave low ratings for trouble sleeping (3.11 ± 2.58; 0: no trouble; 10: a lot of trouble) and mid-high ratings for sleep quality (6.45 ± 2.09; 0: poor; 10: excellent). Participants woke up feeling tired 41.7% of the time. Using linear mixed effects modeling, a better rating in each sleep dimension was associated with higher self-efficacy the following day (all p values <.001). Conclusion: Our findings supported the hypothesis that better sleep would be associated with higher levels of reported self-efficacy for adhering to the healthy lifestyle plan

Diameter Growth Performance Varies with Species Functional-Group and Habitat Characteristics in Subtropical Rainforests

We examined tree diameter growth in 20 plots subjected to various disturbance intensities (natural, low, moderate and intensive logging) in a bid to understand the general tree growth responses in relation to habitat characteristics in subtropical rainforests of north-eastern New South Wales, Australia. Species-specific regeneration strategy, maximum size and level of shade tolerance were used to classify species into 5 groups; emergent and shade tolerant main canopy (group 1), shade tolerant mid canopy (2), shade tolerant understoreys (3), moderate shade tolerant (4), and shade intolerant (5) tree species. Data series for trees >10 cm diameter at 1.3 m above the ground level (dbh) providing observations spanning over 36 years were used in multilevel regression analyses. The results showed that spatial and temporal effects in tree growth at the stand-level are a combination of the differences between species functional group compositions and environmental gradients. High growth responses were observed in the shade intolerant species while increasing level of shade tolerance and decreasing maximum size decreased trees growth rates. Tree growth increased with altitude on a large scale across regions, and with disturbance intensity on a small scale at the plot (stand) level. Increase in northness (south through flat to north facing sites) increased growth in species group 1 for trees < 67 cm dbh, but beyond this dbh threshold the opposite was true. These showed that saplings of species group 1 may require increased illumination to reach the forest canopy, but once in the canopy, low soil water availability may be limiting to tree growth in the north facing sites. Decrease in northness was associated with increased growth in species group 2 indicating that reduced illumination and improved soil moisture in the south facing sites were conducive for maximum growth in this species group. Maximum growth potential in species group 4 and 5 increased with decrease in eastness, suggesting that the increased afternoon solar radiation and temperature were conducive for high growth rates in these species. Although topographic gradient may determine the spatial and temporal variations in tree growth where growth appeared to increase from the crest down the slope into the creek, its effects on soil fertility and water availability, and interactions between these and other factors may make it difficult to discern clear growth patterns

Modeling the potential future distribution of anthrax outbreaks under multiple climate change scenarios for Kenya

The climate is changing, and such changes are projected to cause global increase in the prevalence and geographic ranges of infectious diseases such as anthrax. There is limited knowledge in the tropics with regards to expected impacts of climate change on anthrax outbreaks. We determined the future distribution of anthrax in Kenya with representative concentration pathways (RCP) 4.5 and 8.5 for year 2055. Ecological niche modelling (ENM) of boosted regression trees (BRT) was applied in predicting the potential geographic distribution of anthrax for current and future climatic conditions. The models were fitted with presence-only anthrax occurrences (n = 178) from historical archives (2011–2017), sporadic outbreak surveys (2017–2018), and active surveillance (2019–2020). The selected environmental variables in order of importance included rainfall of wettest month, mean precipitation (February, October, December, July), annual temperature range, temperature seasonality, length of longest dry season, potential evapotranspiration and slope. We found a general anthrax risk areal expansion i.e., current, 36,131 km2, RCP 4.5, 40,012 km2, and RCP 8.5, 39,835 km2. The distribution exhibited a northward shift from current to future. This prediction of the potential anthrax distribution under changing climates can inform anticipatory measures to mitigate future anthrax risk

Modeling the spatial distribution of anthrax in southern Kenya

Background Anthrax is an important zoonotic disease in Kenya associated with high animal and public health burden and widespread socio-economic impacts. The disease occurs in sporadic outbreaks that involve livestock, wildlife, and humans, but knowledge on factors that affect the geographic distribution of these outbreaks is limited, challenging public health intervention planning. Methods Anthrax surveillance data reported in southern Kenya from 2011 to 2017 were modeled using a boosted regression trees (BRT) framework. An ensemble of 100 BRT experiments was developed using a variable set of 18 environmental covariates and 69 unique anthrax locations. Model performance was evaluated using AUC (area under the curve) ROC (receiver operating characteristics) curves. Results Cattle density, rainfall of wettest month, soil clay content, soil pH, soil organic carbon, length of longest dry season, vegetation index, temperature seasonality, in order, were identified as key variables for predicting environmental suitability for anthrax in the region. BRTs performed well with a mean AUC of 0.8. Areas highly suitable for anthrax were predicted predominantly in the southwestern region around the shared Kenya-Tanzania border and a belt through the regions and highlands in central Kenya. These suitable regions extend westwards to cover large areas in western highlands and the western regions around Lake Victoria and bordering Uganda. The entire eastern and lower-eastern regions towards the coastal region were predicted to have lower suitability for anthrax. Conclusion These modeling efforts identified areas of anthrax suitability across southern Kenya, including high and medium agricultural potential regions and wildlife parks, important for tourism and foreign exchange. These predictions are useful for policy makers in designing targeted surveillance and/or control interventions in Kenya