Substance use, abuse and risky sexual behaviour among students studying health related courses in a tertiary institution in western Kenya

Background: Substance abuse among university students in Kenya is currently a major public health concern. Drugs such as tobacco and alcohol are now widely and easily available in the universities. Colleges therefore form the main locus of substance abuse, with more than 40% of students already affected. Health care professionals are believed to be the lead in healthy practices but as well can be a serious source of safety lapses for patients if they engage in substance misuse. Although this is a very important subject area, studies regarding prevalence of substance abuse especially among students undertaking health related courses remain scant.Objective: The study sought to determine substance use/abuse and likely consequences among student studying health related courses at a tertiary institution.Study Setting: The study was conducted among students undertaking health related courses in the College of Health Sciences within a large tertiary learning institution in Western Kenya.Study Subjects: The College of Health Sciences has four main schools; Medicine, Nursing, Dentistry and Public Health. Two schools; school of Medicine and school of Nursing were picked using simple random sampling. Proportionate sampling was then applied to each group. In total, 376 students from both the Bachelor of Science in Nursing and medicine programs were interviewed using a pre-tested questionnaire.Results: The main substance commonly used and abused among students in the college of Health Sciences is alcohol. Other substances include; cigarettes, miraa and cannabis. About 37% of all the students interviewed had ever consumed alcohol. Of those who had taken alcohol, 35.6% were nursing students while 64.4% were medical students. More males (56.8%) than females (43.2%) drink alcohol. Factors associated with substance abuse include: gender; females are less likely to use/abuse substances compared to males (P;0.007, A.O.R; 0.518, C.I.0.373 - 0.908), religion; Muslim students are less likely to participate to use/abuse substances compared to other religions (P;0.005; A.O.R;0.173 C.I;0.046-0.504) and type of student residence; students renting rooms outside are more likely to use/abuse substances compared to their counterparts living in the hostels (P;0.158;A.O.R;4.58,C.I;0.556-22.955). There was a strong association between alcohol use and engagement in risky sexual behavior (X2=20.4, P: 0.001). Students who take alcohol are more likely to suffer other effects such as quarrels (16.8%), fights (12%), injuries (12.2%), loss of money/valuables (19.4%) and relationship problems.Conclusions: Substance use and consequently abuse among students at the college of Health sciences is moderately high and there is a potential for this vice increasing further. Behaviour change strategies should be designed to address this problem among students at the college of health sciences

Factors influencing uptake of family planning services among men in Kenya

Background: Utilisation of family planning services in Kenya remains quite low hence, the soaring population which has partly hampered achievement of the fifth Millennium Development Goal (MDG) as well as achievement of overall development goals for the entire country. Current reports indicate that male participation improves uptake of maternal healthcare and family planning services among women.Objective: To determine factors that influence male participation in family planning services in Kenya.Design: A retrospective studySetting: Nationally representative survey of Eight provinces in Kenya.Subjects: Married and single sexually active men.Results: From the adjusted logistic regression model after controlling for other factors, we found higher education AOR 1.59 (C.I: 0.767-3.299), employment AOR 1.67 (C.I: 1.127-2.496), Media as the source of information AOR 1.75 (C.I: 1.308-2.367), discussion with a health worker AOR 1.71 (C.I: 1.206 – 2.430), number of wives (one wife AOR 0.07 (C.I: 0.007-0.769), No more desire for children AOR 2.83 (C.I: 1.794-4.489) and the total number of children one has (1-4) AOR 2.55 (CI: 1.616 -4.029) as the main factors that influence male participation in family planning services.Conclusion: In Kenya, programmes intending to have men actively participate in family planning services should focus on addressing multiple factors which influence men’s participation in family planning services

Factors associated with workers’ exposure to occupational hazards at North Rift Jua Ka Li Enterprises in Eldoret Town, Kenya

Background: The Jua kali industry relies on a steady stream of incoming scrap metal from industrial operations and individual scrap peddlers. Despite the progress made in the scrap metal industry, workers are still potentially exposed to hazards from ergonomic, noise, dusts, fumes, and powerful machinery especially those working in upcoming townsObjective: The main objective of the study was to assess factors associated with welders’ exposure to occupational hazards during their dutiesStudy Setting: The study was conducted at the North Rift Jua Kali Enterprises in Eldoret town. StudySubjects: The study targeted 140 welders who were already working in the North Rift Jua Kali Enterprises in Eldoret town , key informants including, official from NRJKE, labour officer and public health officer in charge of occupational safety and health (OSH).Methods: The study utilized a cross sec tional study design. Simple random sampling technique was employed to recruit the workers based on their employment numbers or registration numbers. In addition, purposive sampling technique was employed to select key informants including, official from NRJKE, labour officer and public health officer in charge of occupational safety and health (OSH).Results: Welding is predominantly a male dominated occupation 87(88.8%) Majority 36 (36.7%) of the welders were aged 26 35 years Most welders had at least some primary school education 43(4 3.9%)3.9%). Majority of the welders 83(84.7%) were employed as casuals. Factors associated with occurrence of occupational health hazards among welders in Eldoret are; age (X2 = 6.788 ; p <0 .00 1), education level (X2 = 2.048 ; p <0 .001) and level of awareness on use of PPEs (X2 = 0 .832 ; p <0 .00 1). The key informants indicated the level of working experience an d level of education.Conclusions: and recommendations Welding of metals in Eldoret is mainly done by young males who are usually employed on casual basis. The main factors associated with exposure to occupational hazards among the welders are age, level of education and level of awareness on use of PPEs. The re is need to target the younger welders with health awareness messages on using personal protective equipment’s in order to reduce exposure to occupational hazards

Client factors that contributes to non-adherence to the immunization schedule for children under five years of age in Chepsaita Location

Background: Worldwide about 29,000 children under the age of five die every day, mainly from preventable diseases. Every year around 8 million children in developing countries die before they reach their fifth birthday; many during the first year of life. By 2016, child mortality rate for Kenya was 49.2 deaths per 1,000 live births.Objective: The main objective of the study was to assess client factors that contributes to non-adherence to the immunization schedule for children under five years in Chepsaita location.Study Setting: This study was carried out in Chepsaita location , Turbo Sub county, in Uasin Gishu CountyStudy Subjects: The study population was all households with children aged below five years within Chepsaita location consisting of 300 households. The proxies were their mothers or caretakers found at home at the time of data collection. The health workers at the health centre who offer MCH services as well as community volunteers were included in the study as key informants.Methods: This study adopted a cross-sectional study design. Purposive and Snowball sampling techniques were used to select households. Further, the staff working at the immunization clinic were purposively selected for in-depth interview at the health facility.Results: A total of 172 households participated in this study. Majority of the respondents were from the age brackets of 35-39 years (22.7%) and 30-34 years (22.1%). Most of the participants were married (91.9%). Most of the mothers indicated their highest level of education as primary (53.5%). Majority of the study area residents were found to be protestants (64.5%). The immunization coverage rate according to the findings from the present study was 74.4%. Client factors associated with non-adherence to the immunisation schedule were; maternal age (X2 =48.611, P <0.001), education level (X2 = 50.351, P <0.001), Marital Status (X2 = 11.993, P <0.001), place of delivery (X2 =0.175, P<0.001), family size (X2 =5.307, P =0.021) and maternal knowledge about immunization (X2 =10.872, P <0.001).Conclusion: Adherence to immunization is still low in Chepsaita location. Client related factors associated with adherence to EPI immunization schedule for children under five years of age include; older maternal age, lower maternal education level, marital status, mother’s occupation and lower family monthly income, place of delivery, large family size and lower maternal level of knowledge on immunization.Recommendation: Based on the study findings, its recommended that mothers should be educated on importance of adherence to EPI immunization schedule for children under five years which it was found to be low in Chepsaita location. The study recommends the collaboration of national government, county government, community-based organization (CBOs), NGOs and other health sector actors to come up with sensitization campaigns on adherence to EPI immunization which will benefit all mothers

Prevalence, heterogeneity of asymptomatic malaria infections and associated factors in a high transmission region

Background: Although current reports have shown a reduction in malaria cases, the disease still remains a major public health problem in Kenya. In most endemic regions, the majority of infections are asymptomatic which means those infected may not even know and yet they remain infectious to the mosquitoes. Asymptomatic infections are a major threat to malaria control programs since they act as silent reservoirs for the malaria parasites.Objective: The study sought to determine the prevalence of asymptomatic malaria infections, whether they show heterogeneity spatially, across age groups and across time as well as their determinants in a high transmission region.Study Design: This was part of a larger prospective cohort study on malaria indices in the HDSS.Study Setting: The study was conducted in the Webuye Health and Demographic Surveillance Site in Bungoma East Sub-County.Study Subjects: Quarterly parasitological surveys were conducted for a cohort of 400 participants from randomly selected households located in known fever “hotspots” and “coldspots”. Follow-up of all the participants continued for a period of one year. Generalized estimating equations were used to model risk factors associated with asymptomatic parasitemia.Results: Of the total 321 malaria infections detected during the five cross-sectional surveys conducted over the period of one year, almost half (46.3%) of these were asymptomatic. Overall, most of the asymptomatic cases (67%) were in households within known fever “hotspots”. The proportion of infections that were asymptomatic in the coldspots were 73.1%, 31.8%, 13.3%, 55.6% and 48.2% during the first, second, third, fourth and fifth visits respectively. In the known fever “hotspots”, the proportion of infections without symptoms was 47.7%, 48.5%, 35%, 41.3% and 47.5% during the first, second, third, fourth and fifth visits respectively. Factors associated with asymptomatic malaria include; the village one lives: people living in village M were twice likely to be asymptomatic (A.O.R: 2.141, C.I: 0.03 - 1.488), age: children aged between 6 to 15 years were more than twice likely to be asymptomatic (A.O.R: 2.67, C.I. 0.434 - 1.533) and the season: infections during the dry season (January) were less likely to be asymptomatic (A.O.R: 0.26, C.I: -2.289 - 0.400).Conclusion: The prevalence of asymptomatic infections in this region is still very high. The highest proportion of asymptomatic infections was registered in a fever coldpspot village which may explain why the village is a fever coldspot in the first place. There is a need for active surveillance to detect the asymptomatic cases as well as treat them in-order to reduce the reservoir. Targeting interventions to the asymptomatic individuals will further reduce the transmission within this region

Malaria “hotspots” within a larger hotspot; what’s the role of behavioural factors in fine scale heterogeneity in western Kenya?

Background: Malaria remains a major public health problem in Kenya accounting for the highest morbidity and mortality especially among children. Previous reports indicate that infectious agents display heterogeneity in both space and time and malaria is no exception. Heterogeneity has been shown to reduce the effectiveness of interventions. Previous studies have implicated genetic (both human and parasite) and environmental factors as mainly responsible for variation in malaria risk. Human behaviour and its potential risk for contributing to variation in malaria risk has not been extensively explored.Objective: To determine if there were behavioural differences between the people living in hotspots (high malaria burden) and coldspots (low malaria burden) within a geographically homogeneous and high malaria transmission region.Design: A prospective closed cohort study.Setting: The study was conducted in the Health and Demographic Surveillance Site in Bungoma East sub-County.Subjects: A total of 400 people in randomly selected households in both the fever hotspots and cold spots were tested for malaria at quarterly intervals using malaria rapid diagnostic tests (RDTs).Results: Significant heterogeneity in malaria incidence and prevalence was observed between villages. Incidence of malaria was significantly higher in the hotspots (high malaria burden areas) compared to the coldspots (low malaria burden) (49 episodes per 1000 person months compared to 26/1000, ttest p < 0.001). The incidence also varied significantly among the individual villages by season (P: 0.0071). Knowledge on malaria therapy was significantly associated with whether one was in the cold spot or hotspot (P: 0.033). Behavioural practices relating to ITN use were significantly associated with region during particular seasons (P: 0.0001 and P: 0.0001 respectively).Conclusion: There is marked and significant variation in the incidence of malaria among the villages creating actual hotspots of malaria within the larger hotspot. There is a significant difference in malaria infections between the hotspots and cold spots. Knowledge on malaria therapy and behavioural factors such as ITN use may contribute to the observed differences during some seasons

Malaria “hotspots” within a larger hotspot; what’s the role of behavioural factors in fine scale heterogeneity in western Kenya?

Background: Malaria remains a major public health problem in Kenya accounting for the highest morbidity and mortality especially among children. Previous reports indicate that infectious agents display heterogeneity in both space and time and malaria is no exception. Heterogeneity has been shown to reduce the effectiveness of interventions. Previous studies have implicated genetic (both human and parasite) and environmental factors as mainly responsible for variation in malaria risk. Human behaviour and its potential risk for contributing to variation in malaria risk has not been extensively explored.Objective: To determine if there were behavioural differences between the people living in hotspots (high malaria burden) and cold spots (low malaria burden) within a geographically homogeneous and high malaria transmission region.Design: A prospective closed cohort study.Setting: The study was conducted in the Health and Demographic Surveillance Site in Bungoma East sub-County.Subjects: A total of 400 people in randomly selected households in both the fever hotspots and cold spots were tested for malaria at quarterly intervals using malaria rapid diagnostic tests (RDTs).Results: Significant heterogeneity in malaria incidence and prevalence was observed between villages. Incidence of malaria was significantly higher in the hotspots (high malaria burden areas) compared to the cold spots (low malaria burden) (49 episodes per 1000 person months compared to 26/1000, t test p < 0.001). The incidence also varied significantly among the individual villages by season (P: 0.0071). Knowledge on malaria therapy was significantly  associated with whether one was in the cold spot or hotspot (P: 0.033). Behavioural practices relating to ITN use were significantly associated with region during particular seasons (P: 0.0001 and P: 0.0001 respectively).Conclusion: There is marked and significant variation in the incidence of malaria among the villages creating actual hotspots of malaria within the larger hotspot. There is a significant difference in malaria infections between the hotspots and cold spots. Knowledge on malaria therapy and behavioural factors such as ITN use may contribute to the observed differences during some seasons

Impact of asymptomatic plasmodium falciparum infection on the risk of subsequent matic malaria in a longitudinal cohort in Kenya

Background: Asymptomatic Plasmodium falciparum infections are common in sub-Saharan Africa, but their effect on subsequent symptomaticity is incompletely understood. Methods: In a 29-month cohort of 268 people in Western Kenya, we investigated the association between asymptomatic P. falciparum and subsequent symptomatic malaria with frailty Cox models. Results: Compared to being uninfected, asymptomatic infections were associated with an increased 1-month likelihood of symptomatic malaria [adjusted Hazard Ratio (aHR):2.61, 95%CI:2.05–3.33], and this association was modified by sex, with females [aHR:3.71, 95%CI:2.62–5.24] at higher risk for symptomaticity than males [aHR:1.76, 95%CI:1.24–2.50]. This increased symptomatic malaria risk was observed for asymptomatic infections of all densities and in people of all ages. Long-term risk was attenuated but still present in children under 5 [29-month aHR:1.38, 95%CI:1.05–1.81]. Conclusions: In this high-transmission setting, asymptomatic P. falciparum can be quickly followed by symptoms and may be targeted to reduce the incidence of symptomatic illness

Exposure to Diverse Plasmodium falciparum Genotypes Shapes the Risk of Symptomatic Malaria in Incident and Persistent Infections: A Longitudinal Molecular Epidemiologic Study in Kenya

Background: Repeated exposure to malaria infections could protect against symptomatic progression as people develop adaptive immunity to infections acquired over time. Methods: We investigated how new, recurrent, and persistent Plasmodium falciparum infections were associated with the odds of developing symptomatic compared with asymptomatic malaria. Using a 14-month longitudinal cohort in Western Kenya, we used amplicon deep sequencing of 2 polymorphic genes (pfama1 and pfcsp) to assess overlap of parasite genotypes (represented by haplotypes) acquired within an individual's successive infections. We hypothesized infections with novel haplotypes would increase the odds of symptomatic malaria. Results: After excluding initial infections, we observed 534 asymptomatic and 88 symptomatic infections across 186 people. We detected 109 pfcsp haplotypes, and each infection was classified as harboring novel, recurrent, or persistent haplotypes. Incident infections with only new haplotypes had higher odds of symptomatic malaria when compared with infections with only recurrent haplotypes [odds ratio (OR): 3.24; 95% confidence interval (CI), 1.20-8.78], but infections with both new and recurrent haplotypes (OR: 0.64; 95% CI: 0.15-2.65) did not. Assessing persistent infections, those with mixed (persistent with new or recurrent) haplotypes (OR: 0.77; 95% CI: 0.21-2.75) had no association with symptomatic malaria compared with infections with only persistent haplotypes. Results were similar for pfama1. Conclusions: These results confirm that incident infections with only novel haplotypes were associated with increased odds of symptomatic malaria compared with infections with only recurrent haplotypes but this relationship was not seen when haplotypes persisted over time in consecutive infections

Level of awareness and factors associated with exposure to occupational health hazards among street cleaners in Eldoret Town, Uasin Gishu County

Objective: Street cleaners are unprotected from a range of health hazards in their day-to-day activities of removing harmful pollutants from the streets. The main aim of this study was to assess the level of awareness and factors associated with exposure to occupational health hazards among street cleaners in Eldoret Town, Uasin Gishu County.Setting: The study was conducted in Eldoret town, Uasin Gishu County.Design: The study adopted a cross sectional survey research design.Participants: The study’s participants were street cleaners. Since the target population was small, census design was adopted. Data were collected using questionnaires. Data analysis was done using both descriptive and inferential statistics.Results: The study targeted 70 street workers who all of them participated in the study. This gave a response rate of 100%. Study results revealed that 55(78.6%) of the respondents were exposed to health hazards daily. Further, majority 52(74.3%) of street cleaners were not aware of administrative procedures regarding the management of hazard exposure. In addition, 55(78.5%) of street cleaners are not aware of well-developed preventive maintenance programs. The main factor associated with exposure to hazards is level of education (ꭓ2=21.417, df=8, ‘p=0.000).Conclusions: The study concluded that the level of awareness on health hazards and prevention measures among street cleaners in Eldoret town, was low. The level of education is associated with exposure to these health hazards. There is need for training of cleaners on the personal protective equipment usage and its importance so as to promote awareness and reduce occupational hazard