Prevalence and risk factors of smoking among secondary school students in Nairobi

Objectives: To determine the prevalence of smoking and investigate factors that may influence smoking behaviour in secondary school students in Nairobi. Design: Cross-sectional survey in which a self-administered questionnaire was issued to the students. Setting: Sampled public and private secondary schools in Nairobi. Participants: All the students in the selected secondary schools were included in the study. Results: Five thousand, three hundred and eleven(74. 1%) secondary school students were covered. There were 3658 boys and 1653 girls in the study. The mean age was 16.7 years SD ± 1.48. The study covered 3065(77.3%) and 2246 (70. 1%) of the public and private school students respectively. A total of 1709 (32.2%) were ever-smokers. The overall rate of eversmoking by gender among the students was 38.6% of males and 17.9% of the females. Experimentation with smoking started at five years and regular smoking at 10 years but majority of students (72.2%) started at between age 12 and 16 years. Parents' and teachers' smoking habits influenced initiation of smoking by young children while peer pressure, advertising and type of school influenced older children to smoking. About 67% of the eversmokers stopped the habit giving various reasons. There was a strong relationship between age of smoking initiation and stoppage. Majority of the students smoked either to enhance their personalities or for stimulation. Most students smoked less than five cigarettes per day. General shops, kiosks and cigarette stalls which sell cigarettes in both packets and single sticks were the main source to students. Students smoked mostly in the evening and at night. Most student smokers were not discouraged by health warnings on the cigarette packets and awareness of the dangers of smoking. Enforceable legislation that would ban advertising and make smoking illegal was the main recommendation from the students. Conclusions: Smoking is a problem among Kenyan students. The habit starts quite early in life. Peer pressure, advertising, type of school and age influenced smoking among the students. Banning the sale of cigarettes in single sticks is recommended. Anti-smoking campaigners and specially trained school teachers should encourage attitude shaping among school children towards self confidence and adequacy. (E Afr Med J:2003 80(4): 207-212

TOBACCO CONSUMPTION AMONG PRIMARY SCHOOL TEACHERS IN NAIROBI

Objective: To determine the extent, pattern and the attendant risk factors of cigarettesmoking and tobacco consumption among primary school teachers in Nairobi.Design: A descriptive cross-sectional study.Setting: The study was carried out among randomly selected Nairobi City Council primaryschools in 1996.Participants: All the teachers in the selected primary schools were included in the study.Results: Out of 910 teachers contacted, 813 responded (a response rate of 89.3 %). A total of800 teachers completed the questionnaire correctly and are the subject of the presentanalysis. Fifty per cent of male and three per cent of female teachers were cigarette smokersat the time of the study. The median age for starting to smoke was between 15 and 24 years.At this age, the teachers were secondary school and tertiary college students. It was observedthat the age of smoking initiation seems to determine the individual's smoking status laterin life.Conclusion: Since 57% of smokers started smoking during their secondary school days,secondary school students seem to be at a higher risk of initiating smoking. It is thereforeimportant to target them for smoking control initiatives before they start the habit. Anumber of smokers were willing to quit smoking but did not know how to go about it.External assistance is therefore required for them to achieve their wish. It is also importantto emphasise the need by the relevant authorities to initiate programmes for anti-smokingeducation in secondary schoolsand colleges in the country

PREVALENCE AND RISK FACTORS OF SMOKING AMONG SECONDARY SCHOOL STUDENTS IN NAIROBI

ABSTRACTObjectives: To determine the prevalence of smoking and investigate factors that mayinfluence smoking behaviour in secondary school students in Nairobi.Design: Cross-sectional survey in which a self-administered questionnaire was issued to thestudents.Setting: Sampled public and private secondary schools in Nairobi.Participants: All the students in the selected secondary schools were included in the study.Results: Five thousand, three hundred and eleven(74. 1%) secondary school students werecovered. There were 3658 boys and 1653 girls in the study. The mean age was 16.7 years SD± 1.48. The study covered 3065(77.3%) and 2246 (70. 1%) of the public and private schoolstudents respectively. A total of 1709 (32.2%) were ever-smokers. The overall rate of eversmokingby gender among the students was 38.6% of males and 17.9% of the females.Experimentation with smoking started at five years and regular smoking at 10 years butmajority of students (72.2%) started at between age 12 and 16 years. Parents’ and teachers’smoking habits influenced initiation of smoking by young children while peer pressure,advertising and type of school influenced older children to smoking. About 67% of the eversmokersstopped the habit giving various reasons. There was a strong relationship betweenage of smoking initiation and stoppage. Majority of the students smoked either to enhancetheir personalities or for stimulation. Most students smoked less than five cigarettes per day.General shops, kiosks and cigarette stalls which sell cigarettes in both packets and singlesticks were the main source to students. Students smoked mostly in the evening and at night.Most student smokers were not discouraged by health warnings on the cigarette packets andawareness of the dangers of smoking. Enforceable legislation that would ban advertising andmake smoking illegal was the main recommendation from the students.Conclusions: Smoking is a problem among Kenyan students. The habit starts quite early inlife. Peer pressure, advertising, type of school and age influenced smoking among thestudents. Banning the sale of cigarettes in single sticks is recommended. Anti-smokingcampaigners and specially trained school teachers should encourage attitude shaping amongschool children towards self confidence and adequacy

Tobacco consumption among primary school teachers in Nairobi

(East African Medical Journal: 2001 78(3): 119-123

Tuberculosis transmission in Kenya: results of the third National Tuberculin Survey

Kenya, a country with a high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) infection. To assess the prevalence of TB infection, bacille Calmette-Guérin (BCG) coverage and the annual risk of tuberculosis infection (ARTI), and to compare estimates with previous findings. A sample of primary school children aged 6-14 years from the same study districts sampled in previous surveys were tuberculin skin tested using the Mantoux method from September 2004 to July 2007. The prevalence of TB infection was estimated by the mirror method, with the mode at 17 mm. Of the 94 771 registered children, 76 676 (80.9%) completed the survey investigations, 12 107 (15.8%) of whom had no BCG scar. The prevalence of TB infection was estimated at 10.2%, with a corresponding ARTI of 1.1%. The ARTI obtained from the current survey is comparable to that of the 1994-1996 survey and higher than that of the 1986-1990 survey. The BCG coverage was comparable with the 1994-1996 survey and higher than in the 1986-1990 survey. TB transmission in Kenya has remained the same over the last decade, which suggests that activities undertaken by the TB control programme have been sufficient to hold TB transmission steady, but insufficient to reduce i

Tuberculosis re-treatment outcomes within the public service in Nairobi, Kenya

Objectives: This study was undertaken to describe treatment outcomes in patients started on a re-treatment drug regimen, assess the quality of follow up procedures and the adequacy of the currently advocated re-treatment drug regimen in Nairobi, Kenya. Design: A retrospective study. Setting: Mbagathi District Hospital (MDH), Nairobi, a public hospital that serves as the Tuberculosis (Tb) referral centre for Nairobi. Materials and methods: The Tb register at the MDH was used to identify patients who were on the re-treatment regimen for Tb. Case records for these patients were then retrieved. From these sources, information on age, sex, HIV status, previous and current tuberculosis disease and drug regimens, adherence to treatment and treatment outcomes, was obtained. Descriptive statistics was used to analyse the data. Results: Of the total of 4702 patients registered at the MDH between 1996 and 1997, 593 (12.6%) were patients with either recurrent Tb, returning to treatment after default or had failed initial treatment. Of the 593 patients, case records were unavailable for 168 and 17 were children below the age of ten in whom the diagnosis of Tb was uncertain making a total of 185 patients who were excluded from the study. Of the remaining 408 patients, 77 (18.9%) were cured, 61 (15.0%) completed treatment without confirmation of cure, two (0.5%) defaulted, six (1.5%) died and 262 (64.2%) had no outcome information. There were no treatment failures. Treatment success defined as cure or treatment completion was achieved in 94.5% of the 146 patients in whom outcome data were available. HIV positive patients had a statistically significant poorer success rate (34/40, 85%) when compared with HIV negative patients (104/106, 94%), p=0.004. Mycobacterium tuberculosis culture and drug susceptibility testing, was not done. Conclusion: The high number of patients with no treatment outcome information at the MDH is worrying, as these patients may harbour drug resistant bacilli and reflects an inadequate follow up service for Tb re-treatment in Nairobi. However, where treatment outcomes could be assessed, the currently advocated re-treatment regimen achieved a high success rate. These observations point to an urgent need to improve Tb documentation and follow up procedures within the public service in Nairobi in order to forestall the emergence and spread of drug resistant Tb. (East African Medical Journal: 2002 79(1): 11-15

Tuberculosis and the HIV epidemic: increasing annual risk of tuberculous infection in Kenya, 1986-1996.

OBJECTIVES: The purpose of this study was to assess the impact of the increased incidence of tuberculosis (TB) due to HIV infection on the risk of TB infection in schoolchildren. METHODS: Tuberculin surveys were carried out in randomly selected primary schools in 12 districts in Kenya during 1986 through 1990 and 1994 through 1996. Districts were grouped according to the year in which TB notification rates started to increase. HIV prevalence in TB patients and changes in TB infection prevalence were compared between districts. RESULTS: Tuberculous infection prevalence rates increased strongly in districts where TB notification rates had increased before 1994 (odds ratio = 3.1, 95% confidence interval = 2.3, 4.1) but did not increase in districts where notification rates had increased more recently or not at all. HIV prevalence rates in TB patients were 50% in districts with an early increase in notification rates and 28% in the other study districts. CONCLUSIONS: Countries with an increasing prevalence of HIV infection will need additional resources for TB control, not only for current patients but also for the patients in additional cases arising from the increased risk of TB infection