Determinants of Postnatal Care Use in Kenya

Pregnancy related complications may result in maternal deaths post delivery especially in developing countries. Skilled deliveries and postnatal care (PNC) use in Kenya is low. The objective of this study was to identify the determinants of PNC use. Kenya Demographic and Health Survey (2008-09 KDHS) women’s data were analyzed. Overall data from 3,970 women were analyzed. Results indicate that 47 percent of the women received PNC services. Factors associated with PNC use are mothers’ age at delivery of the last child, 4+ ANC visits, urban residence, and skilled delivery. However, lack of education and unskilled delivery were associated with low use of PNC services (p <0.05). In conclusion, the use of PNC services is low at 47 percent although the main determinants for PNC use are amenable to intervention. Strengthening of maternal health services throughout the continuum of care and promoting the use of high quality services by pregnant women is recommended

Risk Assessment of Aflatoxin and Fumonisin in Fish Feeds, Kenya: A Review

Fish is a protein source and constitutes other significant nutrients that have been crucial to human health. Aquaculture in Kenya has grown faster than any other food production sector, with fish feeds being prepared from different cereal products commonly contaminated by Mycotoxins. But controlling the growth of fungi that cause mycotoxin has been a challenge due to conditions that enable their development. With fish contamination primarily ignored, there is still high consumption of fish being propagated by improved and increased aquacultural activities. There have been various qualitative and quantitative assessments on Aflatoxin and Fumonisin in animal feed and food with little focus on fish feed which might be the most significant risk factor for cancer development. Kenya's high occurrence warranted the current review, which describes sources of fish feeds, conditions for mould growth, exposure of fish too contaminated feeds, decontamination of fish feed and feed ingredients, effects of Fumonisin and Aflatoxin on fish and human, risk characterization and management strategies. This review provides a platform and insights to novice researchers to pave the way for future research in the area. Keywords: Mycotoxins; Aflatoxins; Fumonisin; Uasin Gishu; Kisumu. DOI: 10.7176/JBAH/11-10-05 Publication date:May 31st 202

Accessibility, availability and affordability of anti-malarials in a rural district in Kenya after implementation of a national subsidy scheme

<p>Abstract</p> <p>Background</p> <p>Poor access to prompt and effective treatment for malaria contributes to high mortality and severe morbidity. In Kenya, it is estimated that only 12% of children receive anti-malarials for their fever within 24 hours. The first point of care for many fevers is a local medicine retailer, such as a pharmacy or chemist. The role of the medicine retailer as an important distribution point for malaria medicines has been recognized and several different strategies have been used to improve the services that these retailers provide. Despite these efforts, many mothers still purchase ineffective drugs because they are less expensive than effective artemisinin combination therapy (ACT). One strategy that is being piloted in several countries is an international subsidy targeted at anti-malarials supplied through the retail sector. The goal of this strategy is to make ACT as affordable as ineffective alternatives. The programme, called the Affordable Medicines Facility - malaria was rolled out in Kenya in August 2010.</p> <p>Methods</p> <p>In December 2010, the affordability and accessibility of malaria medicines in a rural district in Kenya were evaluated using a complete census of all public and private facilities, chemists, pharmacists, and other malaria medicine retailers within the Webuye Demographic Surveillance Area. Availability, types, and prices of anti-malarials were assessed. There are 13 public or mission facilities and 97 medicine retailers (registered and unregistered).</p> <p>Results</p> <p>The average distance from a home to the nearest public health facility is 2 km, but the average distance to the nearest medicine retailer is half that. Quinine is the most frequently stocked anti-malarial (61% of retailers). More medicine retailers stocked sulphadoxine-pyramethamine (SP; 57%) than ACT (44%). Eleven percent of retailers stocked AMFm subsidized artemether-lumefantrine (AL). No retailers had chloroquine in stock and only five were selling artemisinin monotherapy. The mean price of any brand of AL, the recommended first-line drug in Kenya, was $2.7 USD. Brands purchased under the AMFm programme cost 40$0.5, a fraction of the price of ACT.</p> <p>Conclusions</p> <p>AMFm-subsidized anti-malarials are considerably less expensive than unsubsidized AL, but the price difference between effective and ineffective therapies is still large.</p

Does Anti-malarial Drug Knowledge Predict Anti-malarial Dispensing Practice in drug outlets? A Survey of Medicine Retailers in Western Kenya.

Background Malaria is a major cause of morbidity and mortality in Kenya, where it is the fifth leading cause of death in both children and adults. Effectively managing malaria is dependent upon appropriate treatment. In Kenya, between 17 to 83 percent of febrile individuals first seek treatment for febrile illness over the counter from medicine retailers. Understanding medicine retailer knowledge and behaviour in treating suspected malaria and dispensing anti-malarials is crucial. Methods To investigate medicine retailer knowledge about anti-malarials and their dispensing practices, a survey was conducted of all retail drug outlets that sell anti-malarial medications and serve residents of the Webuye Health and Demographic Surveillance Site in the Bungoma East District of western Kenya. Results Most of the medicine retailers surveyed (65%) were able to identify artemether-lumefantrine (AL) as the Kenyan Ministry of Health recommended first-line anti-malarial therapy for uncomplicated malaria. Retailers who correctly identified this treatment were also more likely to recommend AL to adult and paediatric customers. However, the proportion of medicine retailers who recommend the correct treatment is disappointingly low. Only 48% would recommend AL to adults, and 37% would recommend it to children. It was discovered that customer demand has an influence on retailer behaviour. Retailer training and education were found to be correlated with anti-malarial drug knowledge, which in turn is correlated with dispensing practices. Medicine retailer behaviour, including patient referral practice and dispensing practices, are also correlated with knowledge of the first-line anti-malarial medication. The Kenya Ministry of Health guidelines were found to influence retailer drug stocking and dispensing behaviours. Conclusion Most medicine retailers could identify the recommended first-line treatment for uncomplicated malaria, but the percentage that could not is still too high. Furthermore, knowing the MOH recommended anti-malarial medication does not always ensure it is recommended or dispensed to customers. Retailer training and education are both areas that could be improved. Considering the influence that patient demand has on retailer behaviour, future interventions focusing on community education may positively influence appropriate dispensing of anti-malarials

Geochemistry and health data to inform public health outcomes in western Kenya

Environmental geochemistry data can reveal spatial differences in dietary intake with implications for health status. For example, soil and subsequently crop chemistry data is influenced by changes in soil type, pH, geology and geographical features (amongst other factors). Specific soil and food composition data can support estimates of dietary mineral supplies (Watts et al. 2019, 2021a). However, additional metrics can supplement the understanding of links between geochemistry and health in Western Kenya. Here we present a summary of data from a survey of soil and crops, but will focus in particular on the private drinking water and urines as an estimate of nutritional status or exposure to potentially harmful elements collected across 20 Counties in Western Kenya. We discuss the potential for interpreting health metrics, including: food dietary estimates, drinking water and biomonitoring data (urine – Watts et al. 2020; 2021b). Comparisons between these metrics will be discussed, along with the limitations in interpreting these data. These datasets were presented to stakeholders from each of the 20 Counties in June 2022 to provide feedback on data outcomes and to co-design the data delivery to assist in dissemination. Stakeholders included the leaders of agriculture and public health offices in each County government office and from academia. This second point of discussion will raise the importance of information flow back and the challenges in doing so e.g. mis-/over-interpretation of data, opportunities to incorporate into decision making and the stimulation of new research. In particular, the value of undertaking a multi-disciplinary research project to encourage stakeholders to plan intervention strategies with a multi-disciplinary consideration

Iodine status in western Kenya: a community-based cross-sectional survey of urinary and drinking water iodine concentrations

Spot urinary iodine concentrations (UIC) are presented for 248 individuals from western Kenya with paired drinking water collected between 2016 and 2018. The median UIC was 271 µg L−1, ranging from 9 to 3146 µg L−1, unadjusted for hydration status/dilution. From these data, 12% were potentially iodine deficient ( 300 µg L−1). The application of hydration status/urinary dilution correction methods was evaluated for UICs, using creatinine, osmolality and specific gravity. The use of specific gravity correction for spot urine samples to account for hydration status/urinary dilution presents a practical approach for studies with limited budgets, rather than relying on unadjusted UICs, 24 h sampling, use of significantly large sample size in a cross-sectional study and other reported measures to smooth out the urinary dilution effect. Urinary corrections did influence boundary assessment for deficiency–sufficiency–excess for this group of participants, ranging from 31 to 44% having excess iodine intake, albeit for a study of this size. However, comparison of the correction methods did highlight that 22% of the variation in UICs was due to urinary dilution, highlighting the need for such correction, although creatinine performed poorly, yet specific gravity as a low-cost method was comparable to osmolality corrections as the often stated ‘gold standard’ metric for urinary concentration. Paired drinking water samples contained a median iodine concentration of 3.2 µg L−1 (0.2–304.1 µg L−1). A weak correlation was observed between UIC and water-I concentrations (R = 0.11)

Predictive geochemical mapping using machine learning in western Kenya

Digital soil mapping techniques represent a cost-effective method for obtaining detailed information regarding the spatial distribution of chemical elements in soils. Machine learning (ML) algorithms using random forest (RF) models have been developed for classification, pattern recognition and regression tasks, they are capable of modelling non-linear relationships using a range of datasets, identifying hierarchical relationships, and determining the importance of predictor variables. In this study, we describe a framework for spatial prediction based on RF modelling where inverse distance weighted (IDW) predictors are used in conjunction with ancillary environmental covariates. The model was applied to predict the total concentration (mg kg−1) and assess the prediction uncertainty of 56 elements, soil pH and organic matter content using 466 soil samples in western Kenya; the results of iodine (I), selenium (Se), zinc (Zn) and soil pH are highlighted in this work. These elements were selected due to contrasting biogeochemical cycles and widespread dietary deficiencies in sub-Saharan Africa, whilst soil pH is an important parameter controlling soil chemical reactions. Algorithm performance was evaluated determining the relative importance of each predictor variable and the model's response using partial dependence profiles. The accuracy and precision of each RF model were assessed by evaluating out-of-bag predicted values. The models R2 values range from 0.31 to 0.64 whilst CCC values range from 0.51 to 0.77. The IDW predictor variables had the greatest impact on assessing the distribution of soil properties in the study area, however, the inclusion of ancillary environmental data improved model performance for all soil properties. The results presented in this paper highlight the benefits of ML algorithms which can incorporate multiple layers of data for spatial prediction, uncertainty assessment and attributing variable importance. Additional research is now required to ensure health practitioners and the agri-community utilise the geochemical maps presented here for assessing the relationship between environmental geochemistry, endemic diseases and preventable micronutrient deficiency

Behavioral attitudes and preferences in cooking practices with traditional open-fire stoves in Peru, Nepal, and Kenya: implications for improved cookstove interventions.

Global efforts are underway to develop and promote improved cookstoves which may reduce the negative health and environmental effects of burning solid fuels on health and the environment. Behavioral studies have considered cookstove user practices, needs and preferences in the design and implementation of cookstove projects; however, these studies have not examined the implications of the traditional stove use and design across multiple resource-poor settings in the implementation and promotion of improved cookstove projects that utilize a single, standardized stove design. We conducted in-depth interviews and direct observations of meal preparation and traditional, open-fire stove use of 137 women aged 20-49 years in Kenya, Peru and Nepal prior in the four-month period preceding installation of an improved cookstove as part of a field intervention trial. Despite general similarities in cooking practices across sites, we identified locally distinct practices and norms regarding traditional stove use and desired stove improvements. Traditional stoves are designed to accommodate specific cooking styles, types of fuel, and available resources for maintenance and renovation. The tailored stoves allow users to cook and repair their stoves easily. Women in each setting expressed their desire for a new stove, but they articulated distinct specific alterations that would meet their needs and preferences. Improved cookstove designs need to consider the diversity of values and needs held by potential users, presenting a significant challenge in identifying a "one size fits all" improved cookstove design. Our data show that a single stove design for use with locally available biomass fuels will not meet the cooking demands and resources available across the three sites. Moreover, locally produced or adapted improved cookstoves may be needed to meet the cooking needs of diverse populations while addressing health and environmental concerns of traditional stoves

Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial

BACKGROUND: Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and delays in seeking care are associated with increased mortality. Thus, a critical component of hypertension management is to optimize linkage and retention to care. METHODS/DESIGN: This study investigates whether community health workers, equipped with a tailored behavioral communication strategy and smartphone technology, can increase linkage and retention of hypertensive individuals to a hypertension care program and significantly reduce blood pressure among them. The study will be conducted in the Kosirai and Turbo Divisions of western Kenya. An initial phase of qualitative inquiry will assess facilitators and barriers of linkage and retention to care using a modified Health Belief Model as a conceptual framework. Subsequently, we will conduct a cluster randomized controlled trial with three arms: 1) usual care (community health workers with the standard level of hypertension care training); 2) community health workers with an additional tailored behavioral communication strategy; and 3) community health workers with a tailored behavioral communication strategy who are also equipped with smartphone technology. The co-primary outcome measures are: 1) linkage to hypertension care, and 2) one-year change in systolic blood pressure among hypertensive individuals. Cost-effectiveness analysis will be conducted in terms of costs per unit decrease in blood pressure and costs per disability-adjusted life year gained. DISCUSSION: This study will provide evidence regarding the effectiveness and cost-effectiveness of strategies to optimize linkage and retention to hypertension care that can be applicable to non-communicable disease management in low- and middle-income countries. TRIAL REGISTRATION: This trial is registered with (NCT01844596) on 30 April 2013