Cost effectiveness of using surgery versus skeletal traction in management of femoral shaft fractures at Thika level 5 hospital, Kenya

Introduction: A prospective quasi experimental study was undertaken at the Thika level 5 hospital. The study aimed to compare the costs of managing femoral shaft fracture by surgery as compared to skeletal traction. Methods: sixty nine (46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%) patients were enrolled in group B and managed by skeletal traction. Exclusion criteria included patients with pathological fractures and previous femoral fractures. Data was collected by evaluation of patients in patient bills using a standardized questionnaire. The questionnaire included cost of haematological and radiological tests, bed fees, theatre fees and physiotherapy costs. The data was compiled and analyzed using SPSS version 16. Person's chi square and odds ratios were used to measure associations and risk analysis respectively. Results: A higher proportion of patients (88.4%) in group A were hospitalized for less than one month compared to 20 patients (30.4%) in group B (p, 0.001).Total cost of treatment in group A was significantly lower than in group B. Nineteen (27.9%) patients who underwent surgery paid a total bill of Ksh 5000-7500 compared to 7(10.4%) who were treated  by traction. The financial cost benefit of surgery was further complimented by better functional outcomes. Conclusion: The data indicates a cost advantage of managing femoral shaft fracture by surgery compared to traction. Furthermore the longer hospital stay in the traction group is associated with more malunion, limb deformity and shortening.Key words: Fracture shaft femur, cost effectiveness, functional outcom

The Influence of Household Socio-Economic Characteristics and Awareness on Aflatoxin Contamination of Maize in Makueni County, Kenya

Background: Aflatoxicosis resulting from consumption of contaminated maize poses a significant public health problem in many countries including Kenya, and many people living in developing countries could be chronically exposed to aflatoxin through their diet. It is caused by Aflatoxins produced by fungus of species Aspergillusparasiticus and Aspergillus flavus found mainly in cereals and other foodstuffs.Objective: To determine socio-economic and aflatoxin awareness factors associated with aflatoxin contamination in household maize in Makueni County, Kenya.Design: A comparative descriptive analytical study.Setting: Kibwezi and Kilome sub-counties of Makueni County, Kenya.Subjects: Four hundred and fifty household heads or their representatives with maize in their household stores, comprising 225 from each study site.Results: Majority of the households’ main source of income was farming and most of them were poor, but level of awareness on aflatoxin was very high. The results further showed significant associations of some socio-economic characteristics and awareness with aflatoxin contamination of maize. Gender of  household head was significantly associated with proper maize storage. Age of respondent was found to be significantly associated with knowledge/awareness of aflatoxin and knowledge on signs of suspected aflatoxin contaminated maize. There was significant association between age of respondent and perception on whether altitude/climate affected aflatoxin contamination, level of education and  knowledge/awareness of aflatoxin. Level of education was significantly associated with Knowledge on  identification of contaminated maize as well as on Knowledge on signs of aflatoxin. Besides, level of education was significantly associated with proper ventilation, discoloration of maize, and maize in storage affected by pests/insects, and cleaning of maize prior to storage. There was also significant  association between occupation of respondent and proper maize storage. Income of house hold head was significantly associated with knowledge/awareness on aflatoxin. Knowledge/awareness of aflatoxin  problem was also significantly associated with placing of material underneath of maize during drying, cleaning of maize prior to storage, moldy condition of maize, aflatoxin content in maize and proper maize storage.Conclusion: These study findings imply that efforts to control and prevent aflatoxin contamination of maize should take into consideration socio-economic characteristics as well as aflatoxin awareness. Thus reducing poverty levels by raising income, education levels and awareness of the community will most likely have a profound impact on control of aflatoxin. There is need, therefore, for policy makers and stakeholders to promote household positive socio-economic factors and aflatoxin awareness in households. This can greatly contribute to reduction of aflatoxin contamination in maize

Out-Patient Prescribing Practices at Mbagathi District Hospital-Nairobi County

Objective: To assess medicine use practices by using WHO prescribing and patient care indicators in Mbagathi Hospital outpatient department. Design: A hospital based retrospective study. Setting: Mbagathi District Hospital outpatient department between 1st January to 30th June 2012. Main outcome measures: Measures used in this study included, total number of medicines in a prescription, proportion of medicines in the essential drug list, proportion in generic names, proportion with injectables and antibiotics and percentage actually dispensed. Results: Total number of drugs prescribed was 1,506. On average, each patient was prescribed 3.85 types of drugs. A total of 835 drugs were prescribed by generic name, accounting for 25.6% of total number of drugs prescribed (1,506). Out of 391 sampled prescriptions, 266 had antibiotics accounting for (68.0%). A relatively small proportion of the prescriptions, 9.5% had an injection. A total of 1,087 drugs were prescribed according to the essential drugs list or formulary, accounting for 72.2% of total number of drugs prescribed (1,506). Only 55.2% of total medicines prescribed were actually dispensed and the rest were out of stock. Conclusion: The prescribing practices in this study are not satisfactory, as suggested by polypharmacy, over prescription of antibiotics, prescribing by brand names and lack of awareness of essential drugs list

Clinical Outcomes Following Management of Adult Femoral Shaft Fractures by Surgery and Traction at Thika Level 5 Hospital

Objective: To compare the clinical outcomes of femoral shaft fractures managed surgically and conservatively by traction. Design: A prospective quasi experimental study at the Thika level 5 hospital. Methods: 148 adult patients who had sustained traumatic fractures of femur were prospectively enrolled and assigned into two treatment groups.69(46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%)patients were enrolled in group B and managed by skeletal traction. Patients were purposively assigned into group A after they were able to afford the implants into the surgica group and the rest into the conservative group. Clinical outcomes that were assessed in the wards and clinics included malunion rates, mobility and limb length discrepancy up to three months post discharge. Data was collected by history, physical examination and radiological evaluation using a standardized questionnaire. The data was compiled and analyzed using SPSS version 17. Persons’ chi square, odds ratio and logistic regression were used to measure associations, risk analysis and multivariate analysis. Results: No significant difference was noted between the two groups in terms of demographic data, fracture type and co;morbidities. Malunion rate of more than 5 degrees was seen in 11(15.9%) patients in group A compared to 34(43.1%) patients in group B (p< 0.001). Seven patients (10.1%) in group A had limb shortening greater than 2 cm compared to 20 patients(25.3%) in group B (P<0.011).Good functional outcomes were achieved in 38 patients (55.1%) who underwent surgery compared to 23 patients (29.1%) managed by traction (p< 0.004) Conclusion: The data indicates a better clinical outcome of managing femoral shaft fractures by surgery as compared to traction. It also indicates that clinicians in regional referral hospitals should be encouraged to use operative methods in femoral shaft fracture management primarily without delay. Keywords: fracture shaft femur, clinical outcome, malunion, functional outcome, limb shortenin

Effect of Civil Society Organizations on Health, Nutrition and Economic Status of People Living with HIV/ AIDS in Busia County, Kenya

 Introduction: Civil Society Organizations (CSOs) play a major role in HIV/AIDS response. Despite their massive effort to promote health care, nutrition and socio-economic empowerment to people living with the disease, documented data on the impact and value of their interventions remain scanty. Globally, people infected with HIV/AIDS by 2018 were estimated to be 37.9 millions recording 1.1 million mortalities in that year. HIV prevalence rate in Kenya was at 4.9% among the general population of ages 15-64 years [2]. In other reports, the national HIV prevalence was at 4.5% while males and females aged 15 to 24 years at 5.2% in 2018. Busia County had HIV prevalence rate of 7.7% in the same year [1]. Aim: The objective of this study was to determine the effect of CSOs interventions on health, nutrition and economic status of people living with HIV/AIDS in Busia County. Materials And Methodology: A quasi-experimental study design was done with structured and non-structured questionnaires administered to two hundred and twenty (220) participants at baseline and end line by registered CSOs with other facilitators. All permanent male and female residents infected with HIV aged between 15 and 64 years from comprehensive patient attendance lists obtained from the Ministry of Health (MoH) facilities qualified for the study. All respondents signed informed consent forms prior to participation. Qualitative in-depth data was obtained through focus group discussions(FGDs) from key informant interviews. Results: No statistically significant differences were reported due to gender, household size and education level recorded in both sites at baseline and end line. Access to HIV/AIDS information was higher in CSOs intervention sites (89.5%) than in non - intervention (73.2%) sites at end line. Respondents in the intervention group had a significant improvement in sourcing Antiretroviral (ARVs) drugs especially from private facilities (P<0.05) but no scientific difference in access to health care services between sites after CSOs intervention. Respondents receiving support for Income Generating Activities (IGA) reduced by 2.1% in the intervention sites at end line. Respectively those in non-intervention sites increased by 4.1%. The negative 6.2% Net Effect of Intervention (NEI) reported was nonetheless not statistically significant (OR=0.98 (95% CI=0.42- 1.5), p=0.48). Organizations such as Reproductive Health Initiatives' impact was reported despite others' existence lacked evidence from which to establish their impact of CSOs intervention. Initiation of home based care, Chama support and income generating projects to improve on the source of economic status for PLWHA were programs that supported the government in providing quality services. However, the programs they implement some possibly a duplication of health-related services, were primarily skewed on donor interest because of dependency [10]. Conclusion: CSOs intervention did not have a significant effect on access to HIV/AIDS information, access to health care services, their morbidity patterns, food intake and nutritional status as well as on economic status and income generating activities. This could be due to reports that, some implementing organizations lacked adequate documentation (comprehensive database, reliable and consistent data), eventually, often failing to monitor and evaluate projects they initiated. Recommendations:CSOs should work in collaboration with the government to develop sustainable interventions aimed at empowering PLWHA in improving their livelihood not only in Busia County but also across the Country. Access to ARVs from the nearest health facility will reduce suffering especially from opportunistic infections. Keywords: Civil Society Organizations, HIV/AIDS, People Living with HIV/AIDS(PLWHA

Cross-sectional study on effect of civil society organizations interventions on individuals infected with HIV in Busia County Kenya

Since the discovery of HIV in the early 1980s in Kenya, Civil Society Organizations have played a major role in its fight. The aim was to study effect of intervention on improved health, nutrition and income generation activities on individuals infected by HIV. A cross-sectional study was undertaken as a baseline with aquasi experimental study design to compare intervention and non intervention sites. Two hundred and seventeen (217) respondents out of which 69.1% were females and 30.9% males selected from four sub counties of Busia County. A structured questionnaire was administered to people infected with HIV in CSO intervention and non intervention sites. In depth interviews and Focus Group Discussions (FGDs) were performed using a guide. Structured forms guided the performance on clinical examination and anthropometry procedures. The Statistical Package for Social Scientist software was used to analyze quantitative data. Frequency distributions were calculated and visualized and Chi square test with odds ratios computed. NVIVO statistics software was used to analyze qualitative data. Audio and video recordings were transcribed verbatim, line by line coding used to manage discrete units of text, and data segments reviewed to illustrate people’s perspectives. A majority of respondents had primary level education (46.3%) and was self-employed (72.1%). HIV/AIDS awareness was high in both the non-intervention (84%) and intervention (79.8%) site, with access to information playing a major role in people’s understanding of HIV/AIDS (p<0.01). Majority of respondents (95.2%) in intervention and non-intervention (96.2%) sites had easy access to ARVs, with 48.1% sourcing drugs privately. Approximately 44.1% sourced ARVs therapy from government facilities with 30.3% from CSOs. Distance to health facilities was the main challenge for those accessing ARV drugs in intervention (22.0%) and non-intervention (39.7%) sites, (OR=2.3 (95%CI=1.2-4.5), p=0.01) was greater in the non-intervention sites. Lack of cash for transport (25% versus 27%) and weakness in the body (11% versus 16.4%) were other challenges as recorded. Most respondents (93.9%) had good ARV uptake, with 74% having reported no major health problems in the recent three months. Only 7% of respondents examined clinically had abnormal blood pressure. Mean body temperature was 36.43 degrees Celsius (std. dev. =0.734). Regarding weights classification, 13.7% of the respondents were underweight, 58.9% normal, 7.3% overweight, and 5% were obese and weights differed by gender (p<0.01) significantly. A large proportion (89.1% in intervention and 94.3% in non-intervention sites) of respondents was aware of good eating habits although they practiced poor eating patterns. In the morning, the trend was (71.9% and 62.4% in the intervention and non-intervention sites) respondents eat nothing. ‘Ugali’ (posho) and traditional vegetables was the most common type of food eaten during lunch (31.0% in intervention and 34.1% in the non-intervention site) and dinner (33.6% intervention and 25.1% in non-intervention sites). Fruits are hardly consumed by majority (42.1% and 45.3%). Provision of ARV (intervention (81.3%) and non-intervention sites (84.3%), (X2(df) =0.32(1), p=0.57) was the most common mode of support received. In focus groups discussion sessions, respondents mentioned of no direct financial benefits received from CSOs although many say they recognize what the government has done for them. In their discussion, it was revealed that CSOs initiate short term projects which do not last and when they wind up get compromise when projects end. This survey demonstrates the essential role played by implementing partners (CSOs) on improved health, nutrition and socio economic status. Influence on better access to medication, balanced diet, and economic change probably contributes to living a better and healthier life for those infected with HIV.Afr J Health Sci. 2017; 30(2):57-7

Factors associated with low birth weight among neonates born at Olkalou District Hospital, Central Region, Kenya

Introduction: ninety-two percent of Low Birth Weight(LBW) infants are born in developing countries, 70% in Asia and 22% in Africa. WHO and UNICEF estimate LBW in Kenya as11% and 6%by 2009 Kenya Demographic Health Survey. The same survey estimated LBW to be 5.5% in Central Province, Kenya. Data in Olkalou hospital indicated that prevalence of LBW was high. However, factors giving rise to the problem remained unknown.Methods: a cross-sectional analytic study was therefore conducted to  estimate prevalence and distribution and determine the factors associated with LBW in the hospital.LBW was defined as birth of a live infant less than 2500g.We collected data using a semi-structured questionnaire and review of health records. A total 327 women were randomly selected from  500mothers.Data was managed using Epi Info 3.3.2.Results: the prevalence of LBW was 12.3% (n=40). The mean age of  mothers was 25.6±6.2 years. Mean birth weight was 2928±533 grams.There were 51.1% (n=165) male neonates and 48.9% (n=158) females. The following factors were significantly associated with LBW:LBW deliveryin a previous birth (OR=4.7, 95%C.I.=1.53-14.24), premature rapture of membranes (OR=2.95, 95%C.I.=1.14-7.62), premature births (OR=3.65,95%C.I.=1.31-10.38), and female newborn (OR=2.32,  95%C.I.=1.15-4.70). On logistic regression only delivery of LBW baby in a previous birth (OR=5.07, 95%C.I.=1.59-16.21) and female infant  (OR=3.37, 95%C.I.=1.14-10.00)were independently associated with LBW. Conclusion: prevalence of LBW in the hospital was higher than national estimates. Female infant and LBW baby in a previous birth are  independent factors. Local prevention efforts are necessary to mitigate the problem. Population-based study is necessary to provide accurate  estimates in the area

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 (

Environmental lead pollution and contamination in food around Lake Victoria, Kisumu, Kenya

Exposure to lead (Pb) through food, water, or contaminated air has adverse health impacts that are particularly severe in children. Many countries have outlawed the use of leaded petrol, and enacted policies and regulations limiting lead pollution, and lead levels in foods. However, African countries, including Kenya, have generally been slow in adopting policies and regulatory structures concerning lead pollution. The main objective of this study was to determine lead contamination levels in the environment around Kisumu (Kenya). Lead content in samples of tap water and other surface water ranged from 140 to 260, and 140 to 690 (μg/g), respectively. All the tap water samples had lead content above10 μg/g, the maximum WHO limit for lead in drinking water. The lead content in vegetables and fish ranged between 0.0 to 2.9 and 1.0 to 3.3 (μg/g), respectively. All the fish samples had lead levels above the WHO maximum limit of 0.2 (μg/g). Lead content in soil samples ranged from 0.2 to 3.9 (μg/g). These results indicate that there is considerable risk of lead poisoning from drinking water and eating some foods from these sites.Key words: Lead, pollution, environment, food safety

Infant feeding knowledge and practices among lactating mothers in Kwale County, Kenya

Background: Lactating mother’s knowledge on infant feeding and its practices are key determinants of children’s nutritional status and future food habits. In Kenya, stunting rates among children below five years is 26 %. Objective: To assess infant feeding knowledge and practices among lactating mothers in Kwale County where stunting stands at 29%.Design: A cohort study. Setting: Maternal and Child Health clinics or respective households.Subjects: Lactating mothers who were part of the baseline survey.Results: One hundred and ninety-seven lactating mothers were interviewed. Most mothers (65.3%) had knowledge of breastfeeding within the first hour and majority (91.8%), gave colostrum to the newly born. Majority (84%) had no knowledge on expressing a mother’s milk for later use. Complementary feeds had been introduced by 48.2% of which more than a quarter gave before six months. Maize meal porridge was the common weaning food in addition to mother’s milk. There was a significant relationship between: breast feeding advice given during antenatal care and use of colostrum (r = 0.165, N = 197, p = 0.021); breastfeeding initiation and pre-lacteal feeding (r = - 0.264, N = 197, p = 0.0001); parity and place of birth (r = 0.184, N = 197, p = 0.001) as well as pre- lacteal feeding and use of colostrum (r = - 0.289, N = 197, p = 0.0001).Conclusion: There was poor knowledge of preservation of mother’s milk and dietary diversity during complementary feeding. There is need for an intervention to empower mothers on best practices for optimal growth and development of infants