Neuraminidase inhibitors: who, when, where?

Although the neuraminidase inhibitors (NIs), oseltamivir and zanamivir were first licensed in 1999, their clinical effectiveness is still hotly debated. Two rigorous systematic reviews and meta-analyses of the data from clinical trials conducted in community settings against relatively benign influenza, both suggest that reductions in symptom duration are extremely modest, under one day. Whilst one of these reviews could find no evidence of reductions in complications, the most recent review reported clinically meaningful and statistically significant reductions in the likelihood of requiring antibiotics (44%) and hospitalizations (63%) in adult patients with confirmed influenza, treated with oseltamivir. A further meta-analysis of observational data from the 2009 influenza A(H1N1) pandemic suggested that, in hospitalised patients, NIs significantly reduced mortality in adults by 25% overall, and by 62% if started within 48 hours of symptom onset, compared with no treatment. But, the effectiveness of NIs in children is far less clear. Taken together, these data suggest that NIs should be reserved for patients with influenza who are at high-risk of complications, or when clinically assessed found to be markedly unwell, or rapidly deteriorating. In such patients, treatment should be initiated empirically, as soon as possible, preferably with follow-on virological confirmation

Can subsidized early child care promote women’s employment? : evidence from Kenya

Women’s disproportionate child care responsibilities significantly impede their labor force participation. Subsidizing child care for women in poor urban settings can be a powerful mechanism to improve women's employment outcomes and reduce gender inequalities in Africa. To test whether child care obligations limit African women from engaging in paid work, researchers from McGill University and the African Population and Health Research Center (APHRC) conducted a randomized study that provided subsidized early child care (ECC) to selected mothers living in a slum area of Nairobi, Kenya

Violence, uncertainty, and resilience among refugee women and community workers: An evaluation of gender-based violence case management services in the Dadaab refugee camps.

Reports of gender-based violence (GBV) are common in camps for refugees and displaced populations. In the Dadaab refugee camps in north-eastern Kenya, the International Rescue Committee (IRC) and CARE International (CARE) implement programmes that aim to both respond to and prevent GBV. A cornerstone of this work has been to train refugees, known as refugee community workers, to deliver aspects of GBV prevention and response work in order to develop a broader implementation of traditional GBV outreach, community mobilisation, and case management. To date, there has been limited rigorous research on this broader GBV case management plus task sharing approach in the context of a refugee camp setting. To address this key gap in evidence, the London School of Hygiene and Tropical Medicine (LSHTM) and the African Population and Health Research Centre (APHRC), in collaboration with IRC and CARE, have sought to assess this model to understand its feasibility, acceptability, and influence among female survivors of GBV accessing care. Data for this study, funded by UK aid, were collected in the Dadaab refugee camps between 2014 and 2017, which coincided with a temporary decision to close the camp and repatriate Somali refugees. The research confirms the magnitude and complexity of the violence that women and girls experience in the camps in Dadaab. In the year leading up to this study, 47% of women accessing the GBV centres for case management reported experiencing intimate partner violence and 39% reported experiencing non-partner violence. In addition, the study highlights the specific risks, challenges, opportunities and rewards experienced by refugee community workers in their dual role of community members and GBV activists living side-by-side with survivors and perpetrators of violence. Solely related to their work as GBV caseworkers, one in three refugee community workers reported experiencing non-partner violence in the last 12 months. Despite this, 93% of refugee community workers stated their work was rewarding or extremely rewarding. The majority of women (82%) accessing services reported that their interactions with refugee community workers had a positive effect, and that working with them was useful. However, having refugees deliver services to their own community was not without its challenges, and survivors raised issues on confidentiality, mistranslations, and perceived biases on clan differences. The study also provides an insight into the importance of contextual factors in case management, and the impact of the announcement of the (now-delayed) camp closure in Dadaab. Priorities of both the camp population and service providers (GBV and referral services) shifted greatly during this time of uncertainty and affected when and how women were accessing services

Benchmarking food environment policies for the prevention of diet-related non-communicable diseases in Kenya: National expert panel’s assessment and priority recommendations

Introduction: Unhealthy food environments drive the increase of diet-related non-communicable diseases (NCDs). Objective: We aimed to examine healthy food environment policies in Kenya and identify priorities for future action. Methods: Using the Healthy Food Environment Policy Index (Food-EPI) we collected evidence on the extent of government action to create healthy food environments across 13 policy and infrastructure support domains and 43 related good practice indicators between 2017 and 2018. A panel of 15 national experts rated the extent of government action on each indicator compared to the policy development cycle and international best practice respectively. Based on gaps found, actions to improve food environments in Kenya were identified and prioritized. Results: In the policy development cycle, 16/43 (37%) of good practice policy indicators were judged to be in ‘implementation’ phase, including: food composition targets, packaged foods’ ingredient lists/nutrient declarations; systems regulating health claims; restrictions on marketing breast milk substitutes; and school nutrition policies. Infrastructure support actions in ‘implementation’ phase included: food-based dietary guidelines; strong political support to reduce NCDs; comprehensive NCD action plan; transparency in developing food policies; and surveys monitoring nutritional status. Half (22/43) of the indicators were judged to be ‘in development’. Compared to international best practice, the Kenyan Government was judged to be performing relatively well (‘medium’ implementation) in one policy (restrictions on marketing breast milk substitutes) and three infrastructure support areas (political leadership; comprehensive implementation plan; and ensuring all food policies are sensitive to nutrition). Implementation for 36 (83.7 %) indicators were rated as ‘low’ or ‘very little’. Taking into account importance and feasibility, seven actions within the areas of leadership, food composition, labelling, promotion, prices and health-in-all-policies were prioritized. Conclusion: This baseline assessment is important in creating awareness to address gaps in food environment policy. Regular monitoring using Food-EPI may contribute to addressing the burden of diet-related NCDs in Kenya

Gender-based violence and its association with mental health among Somali women in a Kenyan refugee camp: a latent class analysis

BACKGROUND: In conflict-affected settings, women and girls are vulnerable to gender-based violence (GBV). GBV is associated with poor long-term mental health such as anxiety, depression and post-traumatic stress disorder (PTSD). Understanding the interaction between current violence and past conflict-related violence with ongoing mental health is essential for improving mental health service provision in refugee camps. METHODS: Using data collected from 209 women attending GBV case management centres in the Dadaab refugee camps, Kenya, we grouped women by recent experience of GBV using latent class analysis and modelled the relationship between the groups and symptomatic scores for anxiety, depression and PTSD using linear regression. RESULTS: Women with past-year experience of intimate partner violence alone may have a higher risk of depression than women with past-year experience of non-partner violence alone (Coef. 1.68, 95% CI 0.25 to 3.11). Conflict-related violence was an important risk factor for poor mental health among women who accessed GBV services, despite time since occurrence (average time in camp was 11.5 years) and even for those with a past-year experience of GBV (Anxiety: 3.48, 1.85-5.10; Depression: 2.26, 0.51-4.02; PTSD: 6.83, 4.21-9.44). CONCLUSION: Refugee women who experienced past-year intimate partner violence or conflict-related violence may be at increased risk of depression, anxiety or PTSD. Service providers should be aware that compared to the general refugee population, women who have experienced violence may require additional psychological support and recognise the enduring impact of violence that occurred before, during and after periods of conflict and tailor outreach and treatment services accordingly

Comparative study of physical activity patterns among school children in Kenya and Canada: Results from the ISCOLE Project

Abstract Examination of the timing and patterns of daily activity are crucial in understanding when children accumulate the highest levels of physical activity. The objectives of this study were to examine moderate-to-vigorous physical activity (MVPA) patterns accrued by time of day among Kenyan children, and compare activity patterns in Kenya to those of Canadian children. Physical activity and body weights of participating children were measured by accelerometry and anthropometry, while supplementary self-report data were captured by questionnaires. Data were collected as part of a larger International Study of Childhood Obesity, Lifestyle and Environment (ISCOLE) in Nairobi for ISCOLE-Kenya and in the Ottawa Region for ISCOLE-Canada. A total of 555 Kenyan and 541 Canadian children 9 to 11 years were included in the analyses. In Kenya, boys, under/healthy weight, and children attending public (lower socioeconomic status (SES)) schools were found to have significantly higher MVPA levels compared to girls, overweight/obese, and children attending private (higher SES) schools respectively. MVPA on weekdays was higher than on weekend-days. Activity profiles among Kenyan and Canadian children were very similar; however, Kenyan children had significantly higher MVPA and lower sedentary time on weekend-days. MVPA patterns among urban Kenyan children were largely similar to those of urban Canadian children when assessed by sex, BMI category, and weekday/weekend days. However, in the Kenyan sample, unlike in many higher income countries, lower SES was associated with higher MVPA