Prevalence and Intensity of Single and Mixed Schistosoma mansoni and Schistosoma haematobium Infections in Primary School Children in Rachuonyo North District, Homabay County, Western Kenya

Objective: To determine the prevalence and intensity of single and mixed schistosomiasis infection among primary school children in Rachuonyo North District, Homabay County in western Kenya.Design: A descriptive cross sectional study.Setting: A parasitological survey involving six primary schools in  Rachuonyo North District, Homabay County.Subjects: Four hundred and seventy four(474) school children, seven to 15 years old. Each child provided a urine and stool sample for diagnosis of schistosome and soiltransmitted helminth infections. Urine samples were processed using the filtration technique and the sample examined by microscopy for Schistosoma haematobium ova. Stool samples were processed by the Kato-Katz technique and the sample examined by microscopy for ova of S. mansoni and soil-transmitted helminths.Results: Prevelance of S.haematobium was 37.6%, S.mansoni (12.2%), hookworm (14.6%), Ascaris lumbricoides (6.3%), Trichuris trichiura (5.3%) among the children in the participating schools. Overall, 78.6% of the children infected with S.haematobium had light infection (< 50eggs per 10 ml of urine) and the rest (21.4%) had heavy infection (.50 eggs per 10 ml of urine). On the hand, 75.9% of those with S.mansoni had lightinfection (one to 99 eggs per gram of stool (EPG), and the rest (24.1% ) had moderate infection intensities (100-399 (EPG).Conclusion: This is the first report in which both S.haematobium and S.mansoni are found together in the same geographic locality in high prevalence in the Lake Victoria region of western Kenya, with S. haematobium being the most predominant in some places. Rachuonyo North District becomes a new focus of mixed human schistosome infections in Kenya. The significant burden of schistosomiasis in this area highlightsthe need to include regular treatment for schistosomiasis in the national school based deworming programme especially now that the infection occurs in areas more than five kilometres away from the lake

Effects of nutritional support on growth and development of children receiving Anti-Retroviral Therapy (ART) in selected slums of Nairobi, Kenya

Background: Anti-retroviral therapy (ART) in infants and children has been proven effective. For optimal outcomes of ART, other factors such as the nutrition status of the patient, dietary patterns, treatment adherence, economic status and incidence of opportunistic infections are essential for effective therapeutic outcomes. Objective: To determine the effect of nutritional support on growth and development patterns of HIV-infected children aged 6-59 months, receiving ART in urban resourcepoor setting of Nairobi, Kenya. Study Design: Quasi experimental study design.Study Setting: Eight slum areas of Nairobi namely Kibera, Kawangware, Kangemi, Dagoretti, Mukuru, Dandora, Kariobangi and Mwiki Study Subjects: Two hundred and sixty (260) HIV-infected children (aged 6-59 months) on ART were randomly selected from eight comprehensive care centres (CCCs) and followed for a period of up to six months. Results: Nutritional support had significant effect on HAZ (P<0.05) and was protective against stuntedness of children (P=0.044; 95% CI, 0.20-0.98). However, the association between nutritional support and weight-for-age (WAZ) (P=0.477) or weight-for-height (WHZ) (P=0.924) were not significant. The WAZ improved for both the experimental and control groups by the end of the study. Additionally, the study showed that nutritional support was not significantly protective of children in experimental study arm from becoming underweight compared to controls (P=0.521; 95% CI, 0.51-3.70). Similarly, food support was not protective of children in experimental group from being wasted compared to controls (P=0.586; 95% CI, 0.54-2.94). The association between nutritional support and motor development was not significant (P=0.091). The CD4 cell counts between the study groups was not statistically different (P=0.087) and neither was disease incidence (P=0.166).Conclusion: Despite results indicating non-significant differences of four of the five parameters measured, the results show that growth and  development parameters of children in the experimental group had  improved. Given the food insecurity status in the experimental group, growth and development parameters of children improved and may have been worse had support not been provided. In light of this, the study recomends that interventions on nutritional support for HIV-infected chidren in limited resource settings should be implemented to cater for the short term acute shortages. Additionally, the appropiateness of support provided with regard to the formulation and content of food for the 6-59 months age group should always be considered for better outcomes

The effect of pre-lacteal feeding on full breastfeeding in Nairobi, Kenya

Objective: To assess the effect of pre-lacteal feeding on full breastfeeding in the first six months of life in selected hospitals, Nairobi Province. Pre-lacteal feeding has been internationally discouraged because of its negative effect on the duration of breastfeeding.Methods: A prospective cohort design was used with a sample of 692 mother-infant pairs recruited at birth and followed up until 6 months of age. The sample was drawn from five major hospitals in Nairobi. Data was analyzed using the SPSS computer software. Descriptive analysis was used on all variables. Chi-test was used for univariate analysis. Logistic regression analysis was used to determine the effect of pre-lacteal feeding on full breastfeeding.Results: Slightly more than half (58.8%) of the mothers were formally employed and their mean age was 28.3 ±4.9 years. The mean income was KES 26,360 ± 34,696. The mean birth weight of the infants was 3.24 ±0.43kg and 53.3% were males. The prevalence of pre-lacteal feeding was 26.8% (95% CI 23.5%-30.1%). The most common pre-lacteal feeds used at all hospitals were infant formula and glucose solution. There were significant (

Growth and Nutritional Status of the First Six Months of Life Among Selected Hospitals- Nairobi Province

Background: Exclusive breastfeeding for infants is recommended for the first six months for optimal health, development and growth. However, there is limited data on infant feeding practices and nutrition status of infants in Nairobi.Objective: To assess infant growth and nutritional status and compare with feeding practices in the first six months of life in selected hospitals, Nairobi Province.Design: Prospective cohort designSetting: Five major hospitals in Nairobi namely; The Aga Khan, Pumwani Maternity, Mater Misercordiae, St Mary’s Langata and Jamaa Hospitals.Subjects: A sample of 692 mother-infant pairs were recruited at birth and followed up until six months.Intervention: There was no direct experimental intervention, but there was observation of infant feeding practices, weight and height measurement was recorded every four weeks and determination of nutrition status of the infants for a period of six months.Main Outcome Measures: Nutritional status and infant feeding practices in the first six months.Results: Slightly more than half (58.8%) of the mothers were formally employed and the rest were self employed. The mean age of the mothers was 28.3 ±4.9 years. The mean income was KES 26,360 ± 34,696. The mean birth weight of infants was 3.24 ±0.43kg and 53.3% of all infants were male. Above 80% of infants were within normal weight based on weight for age Z-scores (WAZ) at 6, 10, 14 and 23 weeks. The prevalence of overweight based on WAZ was 9.5%, 11.6%, 11.9% and 11% at 6, 14, 19 and 23 weeks, respectively. There were no significant (P>0.05) differences in WAZ between infants on different feeding methods.Conclusions: There was no significant difference in weight or length gain among children that were fully breastfed in comparison to those who were given infant formula or had mixed feeding. However, there was concern over the proportion of overweight infants, as the condition may lead to long term health problems

Health Effects of Pesticide Exposure among Formulators, Repackers and Store Workers in Nairobi, Kenya

Though it is widely believed that adverse health effects occur among farm workers who handle pesticides, few studies have been done to quantify the extent to which pesticide formulators, re-packers and store workers are affected. The present study assessed the prevalence of signs and symptoms of illness due to pesticide exposure among factory workers in Nairobi Kenya using a descriptive cross- sectional study design on consenting factory workers. A questionnaire was administered enquiring about their biodata, work practices and occurrence of signs and symptoms associated with pesticide poisoning. Data was coded, entered into MS Access database and analyzed using SPSS version 11.5. Test for significance was done using chi-square to identify key variables associated with pesticide poisoning. Workers who had been in employment for less than one year reported a higher prevalence of signs and symptoms associated to pesticide poisoning such as burning skin (P = 0.004) and dizziness (P = 0.006). Workers who handled organochlorine pesticide had higher prevalence of burning of skin (P = 0.002), convulsions (P = 0.003), twitching (P = 0.004), painful swallowing (P = 0.004), dermatitis (P = 0.019) and headache (P = 0.028) among other pesticide exposure related symptoms. Workers who had handled pesticides for a longer period of time appeared to have less signs and symptoms of pesticide poisoning probably suggesting that long term exposure to pesticides either imparted some form of acquired immunity to pesticides or that their longer experience resulted in better risk perception and management. Keywords: pesticide, organochlorine, organophospate, formulator, poisoning

Asthma control and factors associated with control among children attending clinics at a national referral hospital in western Kenya

Background: Asthma control is the extent to which the various manifestations of asthma have been reduced or removed by treatment. In developing countries including Kenya, many children continue to visit hospitals with acute symptoms of asthma, which is a pointer to poor control.Objectives: To determine the level of asthma control and factors associated with the observed control among children at a national referral hospital.Design: Cross-sectional studySetting: Moi Teaching and Referral Hospital, Eldoret, Kenya paediatric clinics.Subjects: A total of 166 asthmatic children aged 6-11 years and their parents/caretakers were enrolled between August 2016 and October 2017.Main Outcome: Level of control using childhood asthma control test (c-ACT)Results: The median age of enrolled children was 8.17 years with males being the majority, 94 (56.6%). Using c-ACT, 92 (55.4%, 95%CI: 47.52, 63.10) had well controlled asthma at baseline. At univariate analysis, having a medical insurance cover (p=0.034), dry season (p=0.036), and parental perception of asthma control (p=0.002) were significantly associated with good control of asthma. Acceptance that a child had asthma was associated with poor control of asthma, p=0.046. On multivariate logistic regression, a perception of a well-controlled child by the parent/caretaker correlated well with good control of asthma.Conclusion: About half of the children in this set up have good control of asthma with the observed status of control being affected by parental/caretaker perception on asthma

Iodine status and sources of dietary iodine intake in Kenyan women and children

In 2009, the Government of Kenya adopted a mandatory iodine standard for all ediblesalt of 30-50 mg/kg with potassium iodate as a required fortificant. To assess the new standard, iodine nutrition measurements were included in the Kenya National Micronutrient Survey (KNMS) in 2011. Spot urine samples were obtained from 951 school-age children (SAC, 5 - 14y of age) and 623 non-pregnant women (NPW, 15 – 49y), together with 625 salt samples from their households. Because salt is the major dietary source of iodine as well as sodium in Kenya, sodium concentrations were measured in the same urine samples. Using the iodine and sodium data, the report introduces a novel regression technique to apportion the urinary iodine concentrations (UIC) in both survey groups to the key sources of iodine intake, namely, naturally present (native) iodine content, iodized salt in processed foods and iodized household salt. The salt iodine (SI) content in Kenya’s households (mean 40.3 mg/kg, SD 19.4 mg/kg) showed high-quality iodized salt supply. The SI content in 94.9% of households was ≥15 mg/kg. Median UIC findings in SAC (208 μg/L) and NPW (167 μg/L) indicated adequate iodine nutrition. Although variations in UIC values existed by age, gender (only in SAC), residence type, household wealth index, and region, median UIC findings were within the accepted optimum range in virtually all sub-categories. The findings do not suggest the need for change in Kenya’s universal salt iodization (USI) strategy or adjustment of the current salt iodine standard. Partitioning of UIC values by dietary sources of iodine intake in each survey group attributed ± 35% to native dietary iodine content, ± 45% to processed food and ± 20% to household salt. The UIC levels from native iodine intake alone (60.8 μg/L and 65.3 μg/L in SAC and NPW, respectively) fell below the threshold for iodine deficiency, which supports the inference that the current USI strategy in Kenya is effective in preventing iodine deficiency. The results from regression analysis indicate that the iodine intakes of SAC and NPW can be explained mainly, and in the same way, by their urinary sodium concentrations (UNaC) and the SI contents in salt from their households. The spot UNaC data do not accurately represent salt intake estimates but the mean UNaC findings may be useful for analyzing future changes in salt supply and use from efforts to reduce the salt intake of Kenya’s population.Keywords: Universal Salt Iodization, Dietary Iodine Sources, Population Iodine Status, Keny