Depressive Disorders among Workers in the Selected Hotels in the Capital City of Kenya: A Cross Sectional Study on Prevalence and Correlates

Background: Depressive symptoms are potential outcomes of poorly functioning and demanding work environments. Such symptoms are frequent and cause considerable suffering for the employees as well as financial loss for the employers. As a major hub of tourist attraction and the current consistent terrorism threats, workers in hotel industries in Nairobi Kenya have significant pressure not only to deliver quality services but also are faced with declining tourist flow. Accordingly, studies of psychosocial working conditions and depressive symptoms in this industry are valuable. Objective: This study measured the levels of depressive disorders and associated correlates among workers in selected luxury hotel industries in Nairobi Kenya. Methods: This cross-sectional study, consented and enrolled 360 workers in selected hotels in Nairobi. A sociodemographic based questionnaire and a mental health screening tool; Patient Health Questionnaire (PHQ-9) were used to gather information relevant to this study. The data was analyzed for central tendencies as well as for any associations and correlations. Results: The mean age of the 360 respondents was 28.4 (SD± 4.98) years. The majority 84.2% were aged 20 to 30 years, 55.3% had secondary level education, 35.3% worked as waiters. Using the PHQ-9, 9.2% had major depressive disorder while 10% were categorized as other depressive disorders. In multivariate analysis, major depressive disorders were independently associated with staying in temporary housing (OR 0.1, 95% CI 0.03 to 0.6) and those whose adult household population was between 1 to 3 persons (OR 2.7, 95% CI 1.03 to 7). The other depressive disorders were independently associated with working in low end hotels (OR 5.3, 95% CI 1.2 to 22.7); having primary education level (OR 3.9, 95% CI 1.1 to 15.9); staying in temporary houses (OR 0.3, 95% CI 0.1 to 0.8); and with monthly income of 10,000 to 50,000 KSh (100 to 500USD). The Key informant interviews identified poor remuneration, management disregard to employees input, negative attitude from work and colleagues, hostile treatment by clients, employers and colleagues, long working hours, poor diet, domestic problems, political instabilities, pressure from family members and high standards of living as some of the factors contributing to work related depression. Conclusion: Cumulatively, significantly high proportion of hotel workers suffer from depressive disorders in Nairobi. If correlates such as socio-demographic and economic, influenced by working conditions are not tackled, workers in hotel industries in Nairobi are poised to record one of the highest levels of depressive disorders in Kenya. Keywords: Depressive disorders, Workers in selected hotels, Nairobi Kenya

Uptake and Emerging Issues Surrounding Hospital Deliveries Services. Perspective of One General Hospital Located in Arid and Insecure Garissa County of North Eastern Kenya

Background: Increasing the percentage of births delivered in health facilities is important for reducing the relatively high maternal mortality ratio in Kenya. Despite the increasing availability in awareness, affordability, modernization of formal obstetric care in Kenya, the majority of births in Garissa County still occur at home assisted by unskilled traditional birth attendants (TBAs). The objective of this study was to determine the factors affecting uptake of hospital delivery services by attending or receiving various services at Garissa Provincial General Hospital (GPGH).  Methodology: Data on place of delivery, reasons for place of delivery, and a range of potential explanatory factors affecting choice of place of delivery were collected by interviewer-led questionnaire among 338 women attending GPGH. Predictors of place of delivery were explored in an exploratory risk factor analysis using multiple logistic regression. Results: The mean age of the 338 women respondents was 27.03 (SD± 4.66) years, ranging from 17 to 48 years. The majority of the women, 71.6%, were aged between 21 to 30 years, 32.8% had tertiary level education, 86.1% were married, 62.4% attended the GPGH for antenatal care services, and 56.2% were currently pregnant. Three quarters (76.3%) had previously delivered at the GPGH. In multivariate analysis, women who were nulliparous (OR 0.2, 95% CI 0.09 to 0.6), delivered in the hospital in the last 2 years (OR 12.8, 95% CI 5.1 to 32.4) or 3 years ago (OR 13.1, 95% CI 4.9 to 34.4) or those who liked the cleanliness of the hospital (OR 1.9, 95% CI 1.1 to 3.7) and appreciated hospital due to availability of medical supplies (OR 1.8, 95% CI 1.1 to 3.3) were independently associated with utilization of the health facility.Conclusion: A high proportion of women from the county embraced hospital delivery. Among the factors positively affecting uptake of health services in the facility antenatal were hospital cleanliness, equipment and medical supply availability and improved privacy. Keywords: Hospital Delivery, Uptake and emerging issues, Garissa County of North Eastern Kenya

Survivors of Gender Based Violence in a major recovery Center in Nairobi, Kenya; a retrospective study on characteristic, prevalence, trends and correlates between 2006 and 2009

Background: Gender-based violence (GBV) is an endemic perpetrated mainly against women and children that results in physical, sexual or psycho-social harm. Globally about one in three women experience GBV in her lifetime while in Kenya about 50 % of women experience GBV in their lifetime, which is currently among the highest rates in the world. While various report exists highlighting various forms of GBV in Kenya, data are skewed on the trends and correlates of GBV in Kenya. Objective: This retrospective study characterized the survivors of GBV attending a major Gender Violence Recovery Center (GVRC) in Nairobi Kenya and evaluated the trends and factors associated with GBV between 2006 and 2009. Methods: This study, obtained permission from the hospital to retrieve data from past records of d 384 GBV survivors who were recruited from different parts of Kenya. A sociodemographic based questionnaire and Patient Health Questionnaire (PHQ-9) were used to gather information relevant to this study. The data was analyzed for central tendencies as well as for any associations and correlations. Results: The mean of the 384 GBV survivors was 19.79 (SD = 11.8; range 1-70) years while 90.4% of them were female. Among the survivors, 55.5% were single (never married before), 52.9% had primary and lower education level, while 70.6% were unemployed. Rape (46%) was the most common type of GBV. Other GBV types included defilement (26%), domestic/physical violence (17%), sexual violence and sodomy (4%). Of all the GBV, a quarter (39.3%) occurred at night (9 pm to 5am). The year 2007 and 2008 was marked by high level of GBV at 35.9% and 32.8% respectively while 96.2% occurred in the later months of year (October, November and December). Penetrative GBV was common among survivors who knew their perpetrator OR 0.7 (95% CI 0.6 to 0.9); in the years 2006 OR 1.9(95% CI 1.2 to 3.1), 2007 OR 1.7(95% CI 1.1 to 2.5) and 2008 OR 1.7(95% CI 1.2 to 3.6). Defilement was common among survivors who had primary level education OR 6.7 (95% CI 2.7 to 16.9), who knew their perpetrators OR 1.8 (95%CI 1.2 to 2.8), in the morning hours OR 2.7 (95% CI 1.5 to 4.9) and afternoon hours OR 3.9 (95% CI 2.2 to 6.8). Further, defilement was more common in the year 2006 OR 2.7 (95% CI 1.2 to 5.8). Domestic violence was likely to occur among survivors aged 30 to 40 years OR 1.9 (95% CI 1.1 to 3.6) and those who knew their perpetrators OR 41.2 (95%CI 5.7 to 300). Rape was common among survivors who were aged 19 to 29 years OR 2.3 (95% CI 1.6 to 3.3) or 30 to 40 years OR 2 (95% CI 4 to 2.9), female OR 4.7 (95% CI 1.8 to 12), those employed or in business OR 1.9 (95% CI 1.4 to 2.6) and lastly in the year 2007 OR 1.8 (95% CI 1.1 to 3.1) and 2008 OR 1.7 (95% CI 1.0 to 2.5). Sexual violence was common among survivors who know their perpetrators OR 0.4 (95% CI 0.2 to 0.9) and among survivors who reported the incidence within 72 hours OR 10.2 (95% CI 2.4 to 42). Sodomy occurred less among the female OR 0.01 (95% CI 0.1 to 0.2). Conclusion: Rape was more common form of GBV among the survivors and most of the GBV occurred in the later months of year in the years 2007 and early 2008 which were marked by post-election violence. Familiarity with perpetrators, female gender, and the younger age were disproportionately vulnerable to GBV. Strife of any nature are key predictors of GBV. Effective protection can be established only by preventing GBV, identifying risks and responding to survivors. Keywords: Survivors of Gender-based violence, Major GBV Recovery Center in Nairobi Kenya, trends and correlates between 2006 and 2009

Substance abuse among college youth in one of the largest transit hub in Machakos County Kenya; a cross sectional study on prevalence and associated factors

BACKGROUND: Substance abuse among college students is a growing problem confronting Kenya today. Substance abuse in this population predicts substance related problems in later life. This study is a buildup of limited data evaluating the cases of substance abuse and associated factors among college students situated in the environment of a major transit point for trucks along Nairobi-Mombasa highway in Machakos County Kenya. METHOD: This descriptive cross-sectional survey used Self-Administered WHO Model Core Questionnaire, Focus group discussions (FGD) and Key Informant Interviews (KII) to gather information on the use of various drugs among students in colleges within Mlolongo transit point along Nairobi-Mombasa highway. Data were analyzed using bivariate and multivariable logistic regression to determine factors associated with being prepared, with statistically significant level at p < 0.05. RESULTS: Out of the 152 college students who consented, 53.9% were female verses 46.1% males. Their mean age was 21.26 (SD 2.43) years with 46.7% of them aged between 18 to 20 years. About 42 (27.6%) students were abusing different substances. Among them 66.7% were abusing alcohol, 19% Miraa and 14% tobacco. Marital status (OR 0.12, 95% CI 0.02 to 0.8), student’s belief (OR 0.4, 95%CI 0.12 to 0.7) emotional effect (OR 2.9, 95% CI 1.55 to 5.7) and stimulation of moods (OR 4.5, 95% CI 2.1 to 10.2) influenced use of substance. CONCLUSION: The prevalence of substance use among Mlolongo college students is high. Addressing youthful factors such as demography, beliefs, and emotional needs which greatly influence substance abuse. The role of the truck transit point in the peddling, purchase and usage among the youth must be carefully evaluated. Keywords: Substance abuse; Prevalence and associated factors; College students; largest transit hub in Machakos County Kenya

Socio-Demographic, Nutritional and Adherence as Determinants of Nevirapine Plasma Concentration among HIV-1 Patients from Two Geographically Defined Regions of Kenya

Background: Data are skewed on the role of Socio-demographic, nutritional and adherence related factors on the influence of nevirapine plasma concentrations among Kenyan population. This study rigorously determined these three factors on nevirapine plasma concentrations among HIV patients receiving HIV treatment in two regions known for high prevalence of HIV and long duration of ART uptake.Methods: Blood samples were collected from 377 consenting HIV adult patients receiving an NVP-based first-line ART regimen. A detailed sociodemographic questionnaire was administered. NVP plasma concentration was measured by liquid chromatography - tandem mass spectrometry (LC-MS/MS). Results: The majority (59.2%) of the patients were female, 72.2% were from western Kenya (predominantly Nilotic speaking community). The patients’ mean age was 41.6 (SD ± 11.5) years and the mean duration of ART was 5.1 (SD ± 4.8) years. The median BMI of the patients was 25 kg/m2 (IQR = 22.2 - 28.7 kg/m2). The majority 81.2% were receiving 3TC/NVP/TDF ART regimen, 30% had changed their initial ART regimen with 54.4% reporting missing taking current ARVs. Overall NVP plasma levels ranged from 4-44207 ng/mL (median 6213 ng/mL, IQR 3097–8606.5 ng/mL). There were 105 (25.5%) participants with NVP levels of <3100 ng/mL, associated with poor viral suppression. Multivariate linear regression analysis showed region of origin (adjusted β 976, 95% CI, 183.2 to 1768.82; p = 0.016), gender (adjusted β 670, 95% CI, 293.6 to 1634.2; p = 0.047), education level (adjusted β -39.0779, 95% CI, -39.07 to 1085.7; p = 0.068), initial ART regimen type (adjusted β = -548.1, 95% C = -904.2 to -192; p =0.003) and ARV uptake in the past 30 days (adjusted β = -1109, 95% C = -2135 to -83; p =0.034) remained independently associated with NVP plasma levels.Conclusion: NVP plasma concentration is highly heterogenous among Kenyan population with a significant proportion of patients reporting levels of <3100 ng/ml, correlated with poor viral suppression. The host pharmacoecologic factors, such as gender, age, weight, education level, region of origin (ethnicity), ART regimen type and adherence, are key in influencing NVP plasma concentration. Taking these factors into consideration, HIV treatment may be personalized to achieve optimal treatment success. Keywords: Nevirapine plasma concentration, host pharmacoecologic factors, HIV-1 patients in Kenya DOI: 10.7176/JHMN/81-05 Publication date:October 31st 202

Family planning utilization and correlates; perspective of women aged 15-49 years from Mandera County of North Eastern Kenya

Background: Unmet need for modern family planning methods is an important health issue for women. The purpose of this study was to evaluate family planning awareness, utilization and associated factors among women aged 15-49 years from Mandera County, an arid part of North Eastern Kenya. Methods: This cross sectional study randomly enrolled 117 eligible women from April to September 2015. Data was collected using structured questionnaire, key informant interviews (KII) and focused group discussions (FGD) guides. Up to 36 FDGs were conducted among women in health, leadership, education and religious sectors. 12 KIIs among influential and knowledgeable members of the county were also conducted to gather qualitative data. STATA version 11 was used for qualitative data analysis. The thematic content analysis was used to analyze qualitative data. Results: The mean age of the 117 women who responded was 29.9 (SD± 9.8) years. About 79.5% of these 117 women were aware of contraceptive and family planning methods mainly through family and friends (52.1%). Of the 41.9% who reported using family planning (FP) methods, 26.5% used condoms. In multivariate analysis, women who were from either the Northern (OR 4.3, 95% CI 1.1 to 18.2), Southern (OR 7.5, 95% CI 1.7 to 33.4) or Eastern of Madera County (OR 4.7, 95% CI 1.1 to 20.8); had either secondary (OR 11.1, 95% CI 2.7 to 46.1) or tertiary (OR 11.9, 95% CI 2.6 to 55.9) level of education; were employed (OR 4.3, 95% CI 1.2 to 19.1); used either condoms (OR 5.7, 95% CI 1.3 to 24.5) or hormonal family planning methods (OR 5.8, 95% CI 1.4 to 25.2) were independently associated with utilization of FP. The FGD and KII confirms the low level of utilization of FP. These discussions identified location of origin, awareness, income, employment, religion and cultural practices as some of the factors limiting the utilization of FP. Conclusion: Remarkably, a high proportion of women from Mandera County; an arid, region in the North Eastern Kenya, were aware and embraced FP. If deterrents such as socio-cultural, lack of education and awareness are tackled, this region is poised to record one of the highest up take of modern family planning methods in Kenya. Keywords: Family Planning, Utilization, Women of Reproductive Age

Epidemiology of bacterial Septicemia among children under five in Mbita Subcounty, South Nyanza, Kenya

Background: Septicaemia is a major cause of mortality and morbidity, especially in sub-Saharan Africa leading to complications marked by bodily inflammation referred as sepsis. This is a systemic disease associated with presence of pathogenic microorganisms (viral, parasitic and bacterial) or their toxins in the blood. Bacterial septicaemia is the most fatal and prevalent in hospitalised cases. Globally, 76% of children under five years die due to septicaemia. In East Africa a mortality rate of 40% have been reported. In Kenya, South Nyanza regions have reported higher morbidity and mortality cases among children. We hypothesis that apart from immunosuppressive diseases, septicaemia could contribute significantly to this prevalence in the region. Methods: Blood samples were obtained from 248 children whose guardian consented and a detailed sociodemographic questionnaire was administered. Bacterial isolation and characterization were done using the automated BACTEC 9240 system. Results: The mean age of the participants was 27.9 (SD ±20.7) months. The majority (30.6%) were aged between 1 to 12 months, 50.8% were males, 58.9% had body temperatures above 37.6 OC while only 8.1% were HIV seropositive. The mean white blood cells (WBC) of the participants were 17720.9 (SD 8929.1) cells/ml with 5.2% had leucopenia. A total of 84 of the 248 (33.9%) of the children had septicaemia with the majority (28.6%) caused by Staphylococcus epidermidis followed by Staphylococcus aureus and Escherichia coli each at 13.1%. Bacteria that were reported singly included Salmonella Paratyphi B, Citrobacter freundii, Gemella morbillorum, Klebsiella pneumoniae, Lactococcus lactis cremoris, Pantoea spp, and Pseudomonas putida. In multivariate regression analysis, female gender (OR 0.6; 95% confidence interval (CI) 0.4 to 0.9), co-infection with malaria (OR 2.7; 95% CI 1.1 to 6.7) and gastrointestinal disorders (OR 2.9, 95% CI 1.3 – 7.3) were independently associated with bacterial septicemia infection. Conclusion: Significantly higher proportion of the children in this region are infected with septicaemia. Majority of the cases were caused by Gram positive bacteria. Age and other c-infection contribute significantly to septicaemia infection in this region. Rapid testing and etiological characterisation of children with suspected symptoms of septicaemia is key in this region in order to institute appropriate treatment and management. Keywords: bacterial Septicemia, Epidemiology, Children under five, South Nyanza, Kenya DOI: 10.7176/JNSR/10-10-06 Publication date:May 31st 202

Bacterial Vaginosis Associated with Increased Risk of Female-to-Male HIV-1 Transmission: A Prospective Cohort Analysis among African Couples

In a prospective study, Craig Cohen and colleagues investigate the association between bacterial vaginosis and the risk of female-to-male HIV-1 transmission

Socio-demographic characteristics.

Socio-demographic characteristics.</p

S1 File -

(DOCX)</p