Health seeking behavior, practices of TB and access to health care among TB patients in Machakos County, Kenya. A cross-sectional study

Despite efforts to implementation of the DOTS programme in Kenya since the year (1993) and achieving 100% coverage by the year 1996; new TB cases continue to emerge in communities, a significance of TB transmission. The success of the DOTS programne require total adherence to treatment for those infected with TB and appropriate control measures as stipulated in TB treatment guidelines, trained manpower to manage the infected patients and surveillance. The main objective of this study was to examine the health seeking behavior of TB patients, practices of TB and access to health care. A cross- sectional survey of TB patients was done in Athi-River, Machakos level 5 and Mutituni TB treatment health facilities in Machakos County. A pre-tested self administered questionnaire/ interviews was used to collect data. The data was analyzed by use of statistical package for social sciences (SPSS) version 16. Pearson Chi-Square analysis was used to determine the relationships between variables. Level of significance was fixed at 0.05 (p=0.05).The results of this study reveal TB is affecting  more males than females (60.4%).Most of the TB patients are young below 40 years accounting for (71.8%),  are poor and unemployed (65%).When the TB patient realized they were sick, most of them (81.4%) sought informal remedies from private practioners or self medicated. This delayed early opportunity to seek heath care for more than one month by (82%) of the respondents. Failure of the informal treatment and unbearable pains in advanced disease forced the majority (96.8%) to seek health care in designated TB treatment facilities. There is secrecy in TB status disclosure as (75.5%) declined to openly disclose. For those who disclosed (78%) was to a selected family member mainly to seek assistance (90.7%). Across age groups, educational level, marital status, disclosure of TB status was of no statistical significance p=0.462 and openness of status p=0.112 respectively as the majority remained secret. Health education received by (52.8%) in the TB clinics was observed to significantly influence clinic attendance p=0.014 and adherence to treatment p=0.008 as 78.5% attended regularly and 85.5% adhered respectively. Treatment in public facilities is free with the majority (89.9%) reporting attendance.  TB patients care in the community is  mainly by family members (74.8%), there is no follow up by heath workers and social support group is minimal at (11.4%).The ministry of health needs to address  control measures by initiating strict surveillance of TB, initiate community education on best practices of  TB and to distigmatize the disease. Key words Health seeking behavior of TB patients, practices of TB and access to health care in Machakos Count

Lay beliefs, practices of TB and HIV/AIDS among the community members living in Machakos County, Kenya: A cross sectional study

Knowledge of lay beliefs on existence, cause, mode of TB transmission, and the association of TB/HIV relationship are key entry point to initiate effective prevention and control of TB in communities. Misconceptions of this result to fear and stigma that can sustain TB transmission. The main objective of this study was to determine the study community beliefs of TB, its relationship with HIV/AIDS and to quantify prevention practices. A cross- sectional survey of community members was done in Athi-river and Central Divisions of Machakos County. A pre-tested self administered questionnaire and researcher assisted interviews was used to collect data. The data was analyzed by use of statistical package for social sciences (SPSS) version 16. Pearson Chi-Square analysis was used to determine the relationships between variables. Level of significance was fixed at 0.05 (p=0.05). The results of this study reveal a majority (90.6%) of the community is aware of the existence of TB and that 90.1% believe  it can be transmitted p<0.05 respectively. Misconceptions and lay beliefs on the cause and mode of TB disease transmission was prevalent with (90.8%) blaming these on unrelated factors such as smoking, poor hygiene, HIV/AIDS, hereditary and sharing eating utensils respectively. The community practices were discriminatory as they separated eating utensils of TB patients or isolated them as a way of preventing the disease spread which causes fear. A slight majority of the community (46.5%) believes TB is related to HIV/AIDS, a disease of stigma citing similarity of symptoms .The rest obseveve there is no relationship and said the symptoms and modes of transmission are different. The Ministry of health needs to urgently bridge this gap by disseminating health education on TB and TB/ HIV/AIDS relationships in the communities to demystify fear that result from misconceptions. Key words: Lay Beliefs and practices of TB & HIV/AIDS, Community of Machakos County Kenya

Effect of Legal and Technological Arrangements on Performance of Micro and Small Enterprises in Kenya

The purpose of technology is to improve productivity of enterprises and enhance the quality of goods produced by the firms to help them withstand local and international competition. When applied to micro and small enterprises, technology has proved to be the engine of economic growth amongst “Asian Tigers”. This paper aimed at investigating how legal and technological arrangements that micro and small enterprises (MSEs) have entered into enforce quality practices in their industry to improve performance of their businesses. It used training, purchase of equipment, franchising and sub-contracting as its independent variables while enterprise performance was its dependent variable. Both qualitative and quantitative research designs were used which was descriptive in nature. The target population for the study was MSEs in Embu district who received any form of technology between the years 2008 and 2010. The findings of the study revealed that dependent variables were a function of investment in technology. Consequently, these variables affect performance of MSEs which in turn influences the type of legal and technological arrangements that the MSEs adopt. At start-ups and early stages of business growth, there is very minimal investment in technology which results to adoption of lower levels of legal and technological arrangements and consequently to ineffective MSE performance. This is the situation in Kenya today and unless interventions are made to break this status quo, the study concluded that the MSEs are off the road to achievement of Kenya’s vision 2030. Key words; Micro and Small Enterprise Performance, Quality, Technology

An African dilemma : pastoralists, conservationists and tourists - reconciling conflicting issues in Kenya

Kenya is facing irreconcilable tensions by competing interests from conservationists, tourism developers and pastoralists. Concerns arising from the well-being of flora and, in particular, fauna by conservationists; tourists and commercial tourism; and the increasingly restricted use of traditional lands and herding animals by pastoralist indigenous communities, have populated the discourse of land use in Kenya. In this paper, we look into the varying perceptions of each group of stakeholders and seek to analyse the current narrative that gives priority to wildlife protection and the commercial exploitation of wildlife through high-end tourism development to the detriment of the rights and interests of pastoralism. As pastoral land becomes more appropriated, our analysis shows that the antagonistic relationship between conservationism, commercial tourism and pastoralism is likely to deteriorate. We therefore propose a more participatory model of tourism development that will allow pastoralist communities to have a voice in the process

Arterolane–piperaquine–mefloquine versus arterolane–piperaquine and artemether–lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Kenyan children: a single-centre, open-label, randomised, non-inferiority trial

Background: Triple antimalarial combination therapies combine potent and rapidly cleared artemisinins or related synthetic ozonides, such as arterolane, with two, more slowly eliminated partner drugs to reduce the risk of resistance. We aimed to assess the safety, tolerability, and efficacy of arterolane–piperaquine–mefloquine versus arterolane–piperaquine and artemether–lumefantrine for the treatment of uncomplicated falciparum malaria in Kenyan children. Methods: In this single-centre, open-label, randomised, non-inferiority trial done in Kilifi County Hospital, Kilifi, coastal Kenya, children with uncomplicated Plasmodium falciparum malaria were recruited. Eligible patients were aged 2–12 years and had an asexual parasitaemia of 5000–250 000 parasites per μL. The exclusion criteria included the presence of an acute illness other than malaria, the inability to tolerate oral medications, treatment with an artemisinin derivative in the previous 7 days, a known hypersensitivity or contraindication to any of the study drugs, and a QT interval corrected for heart rate (QTc interval) longer than 450 ms. Patients were randomly assigned (1:1:1), by use of blocks of six, nine, and 12, and opaque, sealed, and sequentially numbered envelopes, to receive either arterolane–piperaquine, arterolane–piperaquine–mefloquine, or artemether–lumefantrine. Laboratory staff, but not the patients, the patients' parents or caregivers, clinical or medical officers, nurses, or trial statistician, were masked to the intervention groups. For 3 days, oral artemether–lumefantrine was administered twice daily (target dose 5–24 mg/kg of bodyweight of artemether and 29–144 mg/kg of bodyweight of lumefantrine), and oral arterolane–piperaquine (arterolane dose 4 mg/kg of bodyweight; piperaquine dose 20 mg/kg of bodyweight) and oral arterolane–piperaquine–mefloquine (mefloquine dose 8 mg/kg of bodyweight) were administered once daily. All patients received 0·25 mg/kg of bodyweight of oral primaquine at hour 24. All patients were admitted to Kilifi County Hospital for at least 3 consecutive days and followed up at day 7 and, thereafter, weekly for up to 42 days. The primary endpoint was 42-day PCR-corrected efficacy, defined as the absence of treatment failure in the first 42 days post-treatment, of arterolane–piperaquine–mefloquine versus artemether–lumefantrine, and, along with safety, was analysed in the intention-to-treat population, which comprised all patients who received at least one dose of a study drug. The 42-day PCR-corrected efficacy of arterolane–piperaquine–mefloquine versus arterolane–piperaquine was an important secondary endpoint and was also analysed in the intention-to-treat population. The non-inferiority margin for the risk difference between treatments was −7%. The study is registered in ClinicalTrials.gov, NCT03452475, and is completed. Findings: Between March 7, 2018, and May 2, 2019, 533 children with P falciparum were screened, of whom 217 were randomly assigned to receive either arterolane–piperaquine (n=73), arterolane–piperaquine–mefloquine (n=72), or artemether–lumefantrine (n=72) and comprised the intention-to-treat population. The 42-day PCR-corrected efficacy after treatment with arterolane–piperaquine–mefloquine (100%, 95% CI 95–100; 72/72) was non-inferior to that after treatment with artemether–lumefantrine (96%, 95% CI 88–99; 69/72; risk difference 4%, 95% CI 0–9; p=0·25). The 42-day PCR-corrected efficacy of arterolane–piperaquine–mefloquine was non-inferior to that of arterolane–piperaquine (100%, 95% CI 95–100; 73/73; risk difference 0%). Vomiting rates in the first hour post-drug administration were significantly higher in patients treated with arterolane–piperaquine (5%, 95% CI 2–9; ten of 203 drug administrations; p=0·0013) or arterolane–piperaquine–mefloquine (5%, 3–9; 11 of 209 drug administrations; p=0·0006) than in patients treated with artemether–lumefantrine (1%, 0–2; three of 415 drug administrations). Upper respiratory tract complaints (n=26 for artemether–lumefantrine; n=19 for arterolane–piperaquine–mefloquine; n=23 for arterolane–piperaquine), headache (n=13; n=4; n=5), and abdominal pain (n=7; n=5; n=5) were the most frequently reported adverse events. There were no deaths. Interpretation: This study shows that arterolane–piperaquine–mefloquine is an efficacious and safe treatment for uncomplicated falciparum malaria in children and could potentially be used to prevent or delay the emergence of antimalarial resistance. Funding: UK Department for International Development, The Wellcome Trust, The Bill & Melinda Gates Foundation, Sun Pharmaceutical Industrie