Occupational risk factors of Low Back Pain among tea pickers and non-tea pickers in James Finlay (K) Ltd, Kericho County, Kenya

Low back pain (LBP) is a major public health problem in the world. It is estimated that 60% of all employees experience LBP at some point in their life during their employment career. It is also the most prevalent musculo-skeletal condition in rural communities in Kenya and it is estimated that 64% of the tea pickers are suffering from LBP in Kenya, of these, 29% had a history of back pain before they started picking tea. The study aimed at determining the prevalence and assessing the occupational risk factors of LBP among tea pickers and non-tea pickers in James Finlay (K) Limited tea estates in Kericho County. Data were collected using structured questionnaires. Bivariate, multivariate analysis and Pearson’s chi square (χ2) test was used to measure the associations. This study was a cross-sectional comparative study that sampled 454 adults (335 tea pickers and 119 non-tea pickers). The prevalence of LBP was found to be 45.4% (125/335) and 39.5% (47/119) among tea pickers and non-tea pickers respectively. The following characteristics were significant at bivariate level including age, parity and duration of work were found to be related to LBP among tea pickers and non-tea pickers (χ2=8.643; P=0.034 and χ2=6.013; p=0.049) respectively. However, the number of hours worked per day was significantly associated with LBP among tea pickers only (χ2=17.192; p=0.000).  Further, the number of kilograms of tea leaves picked and the number of kgs carried per day was also significantly associated with LBP (χ2=16.882; p=0.000 and χ2=15.978; p=0.001) respectively. There was also a significant association of LBP with carrying of heavy load and how one sharpened farm tools among the non tea pickers who reported to have suffered LBP (χ2=13.129; p=0.000 and χ2=4.125; p=0.042) respectively. However, age (p=0.0022; 95% CI -9.4-7); absenteeism from work (P=0.010; 95% CI 2.7-19.5), work duration per day (P=0.000; 95% CI 23.1-38.5), type of occupation (P=0.000; 95% CI 62.2-79.3) and the no. of Kgs (P=0.011; 95% CI -17.8-2.3) carried were found to contribute independently to LBP among tea pickers whereas absenteeism from work (P=0.000; 95% CI 11.9-29.1), work duration per day (P=0.000; 95% CI 69.8-86.8), alcohol uptake (P=0.008; 95% CI 3.2-20.7), heavy load carried (P=0.018; 95% CI 1.8-18.2) and work duration (P=0.002; 95% CI -14.3-3.2) among non-tea pickers were also found to contribute independently to LBP. The prevalence of LBP was found to be high among both tea and non-tea pickers. We recommend that there is need to consider reviewing tea picking policies for instance introduction of tea picking devices in order to alleviate occupational health hazards associated with tea picking. Key words: Low Back Pain, tea pickers, non-tea pickers.

Nutritional Status of Adolescent and Adult PLWHA on Anti-Retroviral Treatment, Attending Various Comprehensive Care Centres in Nairobi County, Kenya

Background: Maintaining nutritional needs of People Living with HIV and AIDS (PLWHA) who are on Anti-Retroviral Treatment (ART) helps to strengthen their immune system and optimize response to medical treatment. The main objective of this study was to assess the nutritional status PLWHA on ART and the associated factors. Methodology: This was a cross-sectional study where 454 adolescent and adult PLWHA on ART were randomly selected and consent obtained to join the study. Structured interviewer-administered questionnaires were used to gather data on their socio-economic characteristics, the types of food consumed in the last 24 hours and their Body Mass Index. The data was organized and analysed using SPSS version 17.0. Variables were categorized and Chi-square statistical test used to assess association where a p-value of less than or equal to 0.05 was considered statistically significant. Results: A total of 454 PLWHA were recruited into the study and 180 (39.6%) were males while 274 (60.4%) were females giving a Male: Female ratio of 1: 1.5. Over three quarters (77%) had attained secondary education and above. The main sources of income were employment (48.5%) and business (44.9%). The types of foods consumed were beans and beef for body building (proteins); Ugali (maize meal) and rice for energy (Carbohydrates); kales and cabbages (vegetables), bananas and pineapples (fruits) as protective foods. Over half (51.1%) were overweight/obese. Sources of income and the monthly earnings were significantly associated with the overweight/obesity. Conclusion: The PLWHAs’ sources of income and monthly earnings had statistical significance on their nutritional status (BMI) of being over-weight/obese. However, other factors such as: ART’s ability to decrease resting-energy expenditure and basal metabolic rate resulting in replenishment of muscle bulk and hence weight gain; or intentional over-eating to avoid the stigmatized weight loss which is often “associated” with being HIV positive may have had a part to play. Keywords: PLWHA; ART; Nutritional status (BMI); food groups and consumption; food availability, affordability and use

Adherence to Anti-Retroviral Treatment and Factors Associated with Optimal Adherence among Adolescent and Adult PLWHA Attending Comprehensive Care Centres in Selected Hospitals in Nairobi County

Background: Anti-retroviral therapy (ART) has saved many lives from imminent deaths among PLWHA. However, the success is pegged on optimal (>95%) adherence to the ART by the PLWHA. The main objective of this study was to determine the ART adherence level by the PLWHA and the factors associated with the adherence.Methods: This was a cross sectional descriptive study on 454 PLWHA, attending Comprehensive Care Centres (CCCs) in selected hospitals in Nairobi County. A structured questionnaire was used to collect data. The Data was analysed using SPSS version 17.0. Results: There were 180 (39.6%) males and 274 (60.4%) females in the study. Majority (53.3%) PLWHA were aged between 40 and 49 years. Only 265 (58.4%) had optimal adherence to ART and duration on the ART was found to be significantly associated with optimal adherence to ART drugs.Conclusion: Optimal adherence was far below the recommended (>95%) mark and duration on  ART was found to be significantly associated with optimal adherence. That is, the shorter the time one had been on ART, the more the chances of being more adherent. Most PLWHA blamed forgetfulness as the main reason for their failure to take the ART drugs as required. Since Anti-Retroviral Treatment is a lifelong process, targeted counselling including reminders (ringing of a bell in the phone) and formation of groups for calling each other for remembrance would suffice. Keywords: PLWHA; ART; optimal adherence; Forgetfulness

Village-Randomized Clinical Trial of Home Distribution of Zinc for Treatment of Childhood Diarrhea in Rural Western Kenya

<div><p>Background</p><p>Zinc treatment shortens diarrhea episodes and can prevent future episodes. In rural Africa, most children with diarrhea are not brought to health facilities. In a village-randomized trial in rural Kenya, we assessed if zinc treatment might have a community-level preventive effect on diarrhea incidence if available at home versus only at health facilities.</p><p>Methods</p><p>We randomized 16 Kenyan villages (1,903 eligible children) to receive a 10-day course of zinc and two oral rehydration solution (ORS) sachets every two months at home and 17 villages (2,241 eligible children) to receive ORS at home, but zinc at the health–facility only. Children’s caretakers were educated in zinc/ORS use by village workers, both unblinded to intervention arm. We evaluated whether incidence of diarrhea and acute lower respiratory illness (ALRI) reported at biweekly home visits and presenting to clinic were lower in zinc villages, using poisson regression adjusting for baseline disease rates, distance to clinic, and children’s age.</p><p>Results</p><p>There were no differences between village groups in diarrhea incidence either reported at the home or presenting to clinic. In zinc villages (1,440 children analyzed), 61.2% of diarrheal episodes were treated with zinc, compared to 5.4% in comparison villages (1,584 children analyzed, p<0.0001). There were no differences in ORS use between zinc (59.6%) and comparison villages (58.8%). Among children with fever or cough without diarrhea, zinc use was low (<0.5%). There was a lower incidence of reported ALRI in zinc villages (adjusted RR 0.68, 95% CI 0.46–0.99), but not presenting at clinic.</p><p>Conclusions</p><p>In this study, home zinc use to treat diarrhea did not decrease disease rates in the community. However, with proper training, availability of zinc at home could lead to more episodes of pediatric diarrhea being treated with zinc in parts of rural Africa where healthcare utilization is low.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00530829?term=NCT00530829&rank=1" target="_blank">NCT00530829</a></p></div

Baseline characteristics for participants in home zinc and comparison villages, western Kenya, February 2008–March 2009.

<p>*p value controls for cluster design by village.</p>†<p>Poorer household is defined as the lowest two quintiles using multiple component analysis.</p

Effect of home zinc on rate of sick visits to Lwak clinic, hospitalization, and mortality, western Kenya, from February 2008–March 2009, controlling for baseline rates of morbidity in home zinc and comparison villages.

<p>Intention-to-treat analysis includes all enrolled children. Rates are given as episodes per person-year.</p><p>*Pre-intervention period was October 2006 to November 2007.</p>†<p>While pre-intervention includes all children in the village of appropriate age, the intervention period only includes those enrolled in the home zinc study.</p>‡<p>Rate ratio is comparing rates between home zinc and comparison groups during the intervention period, adjusted for pre-intervention rates of same syndrome in the child’s village, distance of child’s compound to Lwak Hospital and child’s age.</p>¶<p>For primary outcome, intracluster correlation (ICC) = 0.027.</p

Trial profile.

<p>Village randomization and number of children enrolled at the initial enrollment in December 2007 and during the ongoing enrollment during the study period from February 2008–March 2009. Children and person-time contribution given for the analysis of clinic-based surveillance and household morbidity surveillance – see methods. PBIDS = Population-based Infectious Disease Surveillance.</p

Effect of intervention on drug use and healthcare use for various disease syndromes during the intervention period from household morbidity surveillance (HMS), western Kenya, February 2008–March 2009.

<p>*p-value calculation includes a random effect variable for village, and adjusts for pre-intervention rates of seeking care outside the home by village - F-test in SAS PROC GLIMMIX.</p>†<p>% given in table is the % of biweekly household visits with illness that resulted in medication use or care-seeking outside the home. Denominator for sought care was slightly lower than for medication use due to some missing data for that variable.</p>¶<p>For primary outcome, intracluster correlation (ICC) = 0.030.</p

Case definitions for major infectious disease syndromes from clinic and household morbidity surveillance (HMS) in Asembo, western Kenya.

<p>*Elevated respiratory rate for age based on WHO Integrated Management of Childhood Illness algorithm <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0094436#pone.0094436-Winch1" target="_blank">[14]</a>; <2 months, ≥60 breaths/minute; 2–11 months, ≥50 breaths/minute; 12–59 months, ≥40 breaths/minute.</p>†<p>IMCI danger signs are maternal report of convulsions, inability to drink or breastfeed, or vomiting everything, or on exam lethargy or unconsciousness <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0094436#pone.0094436-WHO1" target="_blank">[22]</a>.</p>‡<p>IMCI signs/symptoms of dehydration are the following: sunken eyes, slow skin pinch, restless/irritable behavior, drinking eagerly or not at all <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0094436#pone.0094436-WHO1" target="_blank">[22]</a>.</p