Characteristics of newborns with surgical conditions, referred to and seen at a tertiary-level hospital in western Kenya

Background: World over, neonatal mortality contributes significantly to the under-five mortality rate, and 10% of neonatal deaths in low and middle-income countries (LMICs) are due to surgical conditions. The majority of surgical conditions are congenital malformations that are only amenable to surgical treatment in the neonatal period. In Kenya, specialized neonatal surgical care is only available in the two tertiary level hospitals in Eldoret and Nairobi. Since the majority of newborns with surgical conditions are born or seek initial care in the lower level health facilities, appropriate referral and transport to the tertiary-level hospitals determines the overall outcome of their treatment. Moreover, socio-demographic and clinical characteristics of newborns with surgical conditions are important determinants of the outcome of their care at the tertiary-level hospital.Study Objective: To describe the socio-demographic; clinical; and referral and transport characteristics of the newborns with surgical conditions, who were referred to and seen at Moi Teaching and Referral Hospital (MTRH).Study design: A hospital-based cross-sectional study was done on all newborns with surgical conditions referred, transported to and seen at the Newborn Unit.Study Setting: Moi Teaching and Referral Hospital, Eldoret, Kenya.Main Outcomes: Socio-demographic; clinical; and referral and transport characteristics of the newborns who met the inclusion criteria.Results: One-hundred and twenty-six newborns who met the inclusion criteria were recruited into the study between February 2018 and January 2019. The median age of the newborns at admission was 4.4 days (106.5 hours), and only 26 (20.6%) of their mothers had optimal antenatal care during pregnancy. The level of education and the occupation of their mothers had a significant association with the uptake of antenatal care during pregnancy (p-value = 0.000). The majority had congenital anomalies that were mainly gastroschisis (23.0%), hydrocephalus (18.3%), ano-rectal malformations (ARM) (14.3%) and Hirschsprung’s disease (14.3%). Most (96.0%) of the newborns were transported to MTRH using road ambulance, and 95.2% were escorted by trained medical personnel during transport.Conclusions: Congenital anomalies were the major surgical conditions seen in the newborns referred and transported to MTRH, and gastroschisis was the leading condition. The newborns had delay in accessing neonatal surgical care; and the majority of their mothers had poor antenatal care during pregnancy, despite the apparent high health-facility delivery

Modifiable factors associated with active pulmonary tuberculosis in a Kenyan prison

Objectives: To establish modifiable factors associated with active pulmonary tuberculosis (PTB) among prisoners.Design: Retrospective matched case-control study.Setting: Nakuru GK prison in Kenya.Subjects: A total of l44 subjects (48 cases and 96 controls) were recruited into the study. Cases were adult prisoners who had at least two initial sputum specimens being Acid Fast Bacilli-positive (AFB+) on direct smear microscopy and hence recruited to PTB WHO DOTS Programme. Controls were adults with no chronic cough and not on PTB treatment six months prior to the study.Results: Independent factors significantly associated with active PTB disease were: self reported HIV+ status (OR=11; 95%CI = 2.42-47.77), evidence of BCG vaccination (OR = 0.20; 95%CI = 0.05-0.60), contact with PTB case (OR = 7.0; 95%CI =1.17-38.23), unemployment (OR = 9.0; 95%CI = 1.84-43.97) and sharing linen (OR = 4.32; 95%CI = 1.08-17.29).Conclusions: Modifiable factors associated with active PTB in Nakuru G.K prison are: HIV status, BCG vaccination, PTB case contact, poverty and poor personal hygiene. We recommend HIV counselling and testing of all PTB patients, screening for TB upon prison entry and TB contact investigation and improving personal hygiene of prisoners

Attitudes and practices of caregivers on adherence to antiretroviral (ARV) Drugs among HIV-Infected children attending comprehensive care clinic in Kenyatta National Hospital

Background: Ensuring high level of adherence to anti-retroviral medication (ARV) is a priority in treating people living with HIV and AIDS. Adherence in children cannot be fully studied if we do not recognize the involvement of primary caregivers who largely determine how well and often the ARV medication is taken.Objective: To determine attitude and practices of the primary caregivers on adherence of ARV in HIV+ve children.Methods: A cross-sectional study involving primary caregivers of HIV +ve children. Interviewer administered questionnaires were used to collect data from 126 primary caregivers. The data was complemented with key informant in-depth interviews with the health workers at the Comprehensive Care Centre (CCC) and two focus group discussions (FGD) of the primary caregivers.Setting: Kenyatta National Hospital comprehensive care centre for HIV/AIDS.Results: Adherence of 97.2 % to antiretroviral drugs was reported. The primary caregivers reported various methods they used to remind them when to give the medication e.g. clock alarms. 99.2% of the caregivers were aware of the ARV side effects. Out of the 126 caregivers interviewed, 96% of them recommended that caregivers of HIV+ve children should know their HIV Status.Conclusion: This study has revealed that practices and attitude of the caregivers of HIV +ve primary caregivers of HIV+ve children influence the ARV adherence levels. Primary care givers are susceptible to or do suffer stress and HIV/AIDs Comprehensive Care Centres should consider establishment of pychosocial support groups. More studies and follow up especially in the rural settings for comparison with urban areas are recommended.Keywords: antiretroviral treatment, children, primary caregivers, adherenceAfr J Health Sci. 2013; 26:330-33

Knowledge and practices towards rabies and determinants of dog rabies vaccination in households: a cross sectional study in an area with high dog bite incidents in Kakamega County, Kenya, 2013

Introduction: an estimated 55,000 people die from rabies annually. Factors promoting dog vaccination, estimates of vaccination coverage and knowledge on rabies are important for effective rabies control. We sought to establish these estimates at household (HH) level and whether rabies knowledge is associated with proper control practices. Methods: cross-sectional cluster survey with two-stage sampling was employed in Kakamega County to enroll HH members above 18 years. A set of questions related to rabies knowledge and practice were used to score participant response. Score above the sample mean was equated to adequate knowledge and proper practices respectively. Independent t-test was used to evaluate the differences of sample mean scores based on dog vaccination status. Bivariate analysis was used to associate knowledge to practices. Results: three hundred and ninety HHs enrolled and had a population of 754 dogs with 35% (n=119) HH having vaccinated dogs within past 12 months. Overall mean score for knowledge was 7.0 (±2.8) with range (0-11) and 6.3 (±1.2) for practice with range (0-8). There was a statistically significant difference in mean knowledge (DF=288, p<0.01) and practice (DF=283, p=0.001) of HH with vaccinated dogs compared to ones with unvaccinated dogs. Participants with adequate rabies knowledge were more likely to have proper health seeking practices 139 (80%) (OR=3.0, 95% CI=1.4-6.8) and proper handling practices of suspected rabid dog 327 (88%) (OR=5.4, 95% CI=2.7-10.6). Conclusion: rabies vaccination below the 80% recommended for herd immunity. Mass vaccination campaign needed. More innovative ways of translating knowledge into proper rabies control practice are warranted

Risk factors of severe pneumonia among children aged 2-59 months in western Kenya: a case control study

Introduction Globally, pneumonia is the leading cause of death in children under the age of 5 years. In Kenya, it is the second leading cause of mortality, accounting for greater than 30,000 deaths in this age group annually. This study sought to identify risk factors for severe pneumonia in children under the age of five years. Methods We conducted a case control study. Cases were children aged 2 to59 months with severe pneumonia or very severe pneumonia and controls were those with non-severe pneumonia as defined by the integrated management of childhood illnesses classification. We administered structured questionnaires to mothers of participants to obtain data on socio-demographics, nutritional status and potential environmental risk factors. Data was analyzed using Epi Info; significance level was set at 0.05. Results We recruited 103 cases and 103 controls. The median age of cases was 14.0 (Range 3-58) months and of controls 14.0 (Range 2-54) months. Comorbidity (Odds Ratio = 3.8, Confidence Interval 1.4-10.6), delay in seeking treatment for three days or more (Odds Ratio = 2.3, Confidence Interval 1.2-4.2) and contact with upper respiratory tract infection (Odds Ratio = 2.7, Confidence Interval 1.1-6.5) were independent risk factors for severe pneumonia. Receiving antibiotics at home (Odds Ratio = 0.4, Confidence Interval 0.2-0.8) was protective. Conclusion Co-morbidity, contact with upper respiratory tract infection and delay in seeking treatment are risk factors for severe pneumonia. We recommend health education regarding appropriate health seeking and engaging community health workers in pneumonia prevention, control and treatment.Pan African Medical Journal 2012; 13:4

Factors associated with biomedical waste management practices among healthcare personnel at Mbagathi county hospital, Nairobi Kenya

Medical care is vital for life and health, but the waste generated from medical activities presents a problem to human health. Mbagathi county hospital generate 210-341kg infectious and highly infectious waste per day. Lack of work place guideline in many hospitals in developing countries, the implementation of biomedical waste regulations is still below the recommended threshold. This study determined factors associated with biomedical waste management practices among healthcare personnel in Mbagathi county hospital, in Nairobi Kenya. This descriptive cross sectional study used quantitative technique to gather relevant data. Purposive sampling was used to have 195 healthcare personnel as a study subject. Quantitative data were collected using structured questionnaires and analysed using Statistical Package for Social Scientists version 20. A descriptive analysis was used to summary the data and association between variable were tested using chi-square, multivariate and bivariate statistical test. P-values were considered significant at < 0.05. Among the surveyed healthcare personnel, the mean age (±SD) was 31.9 (7.5) years, (86.2%) had tertiary level education and (48.7%) were nurses. A significant voluminous of waste are generated: (96.9%) sharps, (91.3%) pharmaceutical, (90.3%) pathological, (81%) kitchen, (68.7%) incineration ash while the least produced waste reported (64.6%) radioactive wastes. Significant number of study participants (22.6%) had inadequate knowledge on biomedical waste management, with score of ≤ 50%. The nurses scored significantly more with regards to the knowledge on biomedical waste management compared to other healthcare personnel (P =0.001). 31% of study participant did not know when to seal safety bins. 28.2 %, 3.1% of the study participants disagreed and strongly disagreed respectively on management of the biomedical waste at the facility (P=0.005). Out of 195 of study participants, 6.7% had not agreed on recommended practices related to biomedical waste management at the hospital (P =0.001). Waste generated at various departments are source of infection that healthcare personnel and patient are exposed to and variation of knowledge among healthcare personnel is an indication of inadequacy as far as biomedical waste management is concerned. Periodic sensitization of staff using existing friendly channel to convey messages, environmental and occupation health unit to be incorporated in all curriculum for early exposure so as to address concern arising from biomedical waste management in health facility. Keywords: Biomedical waste management, Knowledge, attitude and practice, County Hospital, Capital City of Kenya

Determinants of vaccination coverage among pastoralists in north eastern Kenya

Background: Vaccination is the most cost-effective, highest-impact health intervention to reduce the morbidity and mortality of Vaccine Preventable Diseases (VPDs). Despite success in Kenya implementing the Expanded Programme on Immunisation, VPDs remain prevalent in pastoralist communities. Pastoralism was defined as raising any livestock other than fowl; nomadism was defined by seasonal movement ofanimals for grazing.Objective: To examine the roles of geographic access and Knowledge, Attitudes, and Practices (KAPs) on vaccination coverage among settled and nomadic pastoralist households (HHs).Design: A cross-sectional study.Setting: Lagdera Sub-county, Garissa County, North Eastern, Kenya.Subject: Twelve mothers were selected for interview per cluster. We used a structured instrument to survey pastoralist mothers with children aged 0–59 months old.Results: A total of 476 eligible mothers were interviewed with 725 children; 241 mothers (50.6%) belonged to nomadic HHs while 235 (49.4%) belonged to settled HHs. Forty percent of nomadic mothers stated that vaccination was “very important” compared to 87.2% of mothers from settled HHs. Nearly 60% of mothers from nomadic HHs had never vaccinated all their children in comparison to 7.2% of mothers from settled pastoralist. The main reason for non-vaccination among mothers from nomadic HHs was “hospital or clinic was too far away” (78.6%).Analysis of the collected data revealed steep distance decay in the level of vaccine utilisation.Conclusion: Nomadic pastoralist exhibited very low vaccination coverage than their settled counterpart.This, in turn, calls for proper policy measures for addressing these inequities

Factors Associated with Uptake of Cervical Cancer Screening among Women Aged 18-49 Years in Njiru Sub-County, Nairobi Kenya

Cervical cancer remains a major public health concern in developing countries including Kenya, where it is currently ranked the highest cause of cancer deaths. Early detection of cervical cancer using Pap smear provides an appropriate way of prevention which, would in turn lead to a decrease in incidence and mortality. This study aimed at assessing the awareness, perceptions, reproductive and sexual practices influencing uptake of cervical cancer screening among women aged 18-49 years in Njiru Sub County, Nairobi County. Two hundred and forty seven women participated in this cross-sectional study. Data were collected using semi-structured questionnaires and focused group discussion (FGD). Data was analyzed using SPSS version 19.0. Descriptive statistics were used to give proportions and frequencies. Pearson’s chi square (χ2) was used to test for associations among variables and differences were considered statistically significant at p≤0.05. The mean age of the respondents was 30.7±1.18 years. Most (32%), of the respondents were aged 25-29 years. Majority (96.4%) of the respondents in this study were Christians and most (68%) of them were married. Approximately fifty percent of the study respondents had primary level education followed by secondary (38.9%), tertiary (8.9%) and no formal education 2.4%. About 46% of the respondents were self-employed. Approximately eighty five percent (211/247) of the study respondents were aware of cervical cancer and had commonly (36.4%) obtained their information from media followed by health talks (34.8 %). Of those who were aware 25.6% (54/211) reported cervical cancer to be caused by Human Papilloma Virus (HPV). Most 43.6% (41/94) of the respondents who had ever been screened perceived the cervical screening procedures as uncomfortable followed by 24.5% (23/94) who perceived it as embarrassing. Majority 52.1% (49/94) of those who had been screened reported to have not received any support from their partners. More than ninety percent 94.7% reported that cervical cancer screening was very useful in the prevention of cervical cancer. The factors associated with uptake of cervical cancer screening were awareness (p≤0.035), opinion about cervical screening (p≤0.000), cervical screening usefulness (p≤0.006), frequency of having cervical screening done (p≤0.000) and partner support (p≤0.000). There is need to improve public awareness by educating women on the risk factors associated with cervical cancer and benefits of cervical screening through health talks and promotions, mass media awareness. Health professionals and healthcare workers should take the opportunity to educate and encourage women attending health facilities for other health problems to undergo cervical cancer screening. There is need to include men in education on cervical cancer especially sexual partners/ spouses so that they can encourage their spouses/partners in terms of moral and material support to increase the uptake of cervical cancer screening. Keywords: cervical cancer, screening, uptake, awarenes

Prevalence of cystic echinococcosis in livestock slaughtered in selected abattoirs of Laikipia West Sub-County, Kenya

Background: Cystic echinococcosis (CE) is a neglected, emerging and reemerging zoonotic disease caused by the larval stage of the dog tapeworm of the genus Echinococcus. It causes great public health and economic concerns wherever it occurs. CE is endemic in Kenya and most studies done in the country focused on two loci; Turkana and Maasai communities. The prevalence of CE has not been documented in Laikipia County which is located between two CE hot spot areas in Kenya.Objectives: To estimate the prevalence of CE in livestock slaughtered in abattoirs of Laikipia west Sub CountyDesign: A cross-sectional studySetting: Three selected abattoirs in Laikipia west Sub CountySubjects: All cattle, sheep and goats slaughtered in the selected abattoirs between October and December, 2015.Main outcome measures: Species, sex, CE status, and originResults: A total of 339 cattle, 1396 sheep and 478 goats were examined for presence of hydatid cysts in both the thoracic and abdominal cavities during postmortem meat inspection. Overall prevalence was 3.3% and individual species’ prevalence was 11.8%, 1.5% and 2.3% in cattle, sheep and goats respectively. Most (99.1 %) slaughter animals originated from the study area. Forty-three percent (31/72) of the CE positive animals had fertile cysts and 87.1% of them originated from the study area.Conclusion: The results show a significantly higher prevalence of CE in cattle with most slaughter animals and those with fertile cysts originating from the study area. Possible implications for public health and the livestock economy require immediate control measures

Antiulcerogenic effect of Capparis cartillaginea decne on indomethacin induced gastric ulcer in wistar rats

Background: Peptic ulcer disease is a non-malignant, mucosal lesion of the stomach or duodenum. The mucosal defect reaches the muscularis mucosa and sometimes, beyond causing life threatening complications, including haemorrhage, perforations, gastrointestinal obstruction and malignancy.Methods: The animals were pre-treated with omeprazole 20 mg/kg and 300 mg/kg of Capparis cartillaginea decne orally for 14 days. On the 15th day, ulcers were induced using indomethacin 30 mg/kg and 4 hours post ulcer induction, they were sacrificed. Ulcer index, pH, total acidity and volume were determined.Results: Extensive lesions were seen in indomethacin ulcerated rats with mean ulcer score of (1.260±0.18). In comparison, there were minimal areas of erosion on animals pre-treated with omeprazole (0.14±0.025) and plant extracts (0.280±0.097). Indomethacin-induced ulcer treated animals showed the highest volume of gastric juice output (3.14±0.21 ml), whereas the animals pre-treated with omeprazole had lower gastric juice output (2.20±0.2 9ml). This was comparable to animals pre-treated with the plant extract (1.80±0.13 ml). The pH was high in animals pre-treated with omeprazole (5.02±0.53). This was also seen in animals pre-treated with the extract (4.82±0.31). This was in comparison to the low pH seen in indomethacin ulcerated animals (2.20±0.16). Indomethacin-induced ulcer treated animals showed high levels of total acidity (88.64±1.71 mEq/L). Whereas the animals pre-treated with omeprazole had lower total acidity (55.26±3.77 mEq/L), which was also mirrored in animals pre-treated with the plant extracts (61.44±2.42 mEq/L).Conclusions: The extracts of Capparis cartillaginea decne showed anti-ulcer effect on indomethacin induced ulcers in Wistar rats