A Proof-of-Principle Study in Rural Kenya

Tungiasis (sand flea disease) is a neglected tropical disease, prevalent in resource-poor communities in South America and sub-Saharan Africa. It is caused by an inflammatory response against penetrated female sand fleas (Tunga penetrans) embedded in the skin of the host. Although associated with debilitating acute and chronic morbidity, there is no proven effective drug treatment. By consequence patients attempt to remove embedded sand fleas with non-sterile sharp instruments, such as safety pins, a procedure that represents a health threat by itself. In this proof-of-principle study we compared the topical application of a mixture of two dimeticones of low viscosity (NYDA) to the topical application of a 0.05% solution of KMnO4 in 47 school children in an endemic area in rural Kenya. The efficacy of the treatment was assessed during a follow up period of seven days using viability signs of the embedded parasites, alterations in the natural development of lesion morphology and the degree of local inflammation as outcome measures. Seven days after treatment, in the dimeticone group 78% (95% CI 67–86%) of the parasites had lost all signs of viability as compared to 39% (95% CI 28–52%) in the KMnO4 group (p<0.001). In the dimeticone group 90% (95% CI 80–95%) of the penetrated sand fleas showed an abnormal development already after 5 days, compared to 53% (95% CI 40–66%; p<0.001) in the KMnO4 group. Seven days after treatment, signs of local skin inflammation had significantly decreased in the dimeticone group (p<0.001). This study identified the topical application of dimeticones of low viscosity (NYDA) as an effective means to kill embedded sand fleas. In view of the efficacy and safety of the topical treatment with dimeticone, the mechanical extraction of embedded sand fleas using hazardous instruments is no longer warranted

Fully immunized child:coverage, timing and sequencing of routine immunization in an urban poor settlement in Nairobi, Kenya

Median age of vaccination. Table S2a: Median age of vaccination (days) among non-FIC children aged 12–23 months. Table S2b: Median age of vaccination (days) among FIC children aged 12–23 months. (XLSX 17 kb

Blood Pressure and Arterial Stiffness in Kenyan Adolescents With α+Thalassemia.

BACKGROUND: Recent studies have discovered that α-globin is expressed in blood vessel walls where it plays a role in regulating vascular tone. We tested the hypothesis that blood pressure (BP) might differ between normal individuals and those with α+thalassemia, in whom the production of α-globin is reduced. METHODS AND RESULTS: The study was conducted in Nairobi, Kenya, among 938 adolescents aged 11 to 17 years. Twenty-four-hour ambulatory BP monitoring and arterial stiffness measurements were performed using an arteriograph device. We genotyped for α+thalassemia by polymerase chain reaction. Complete data for analysis were available for 623 subjects; 223 (36%) were heterozygous (-α/αα) and 47 (8%) were homozygous (-α/-α) for α+thalassemia whereas the remaining 353 (55%) were normal (αα/αα). Mean 24-hour systolic BP ±SD was 118±12 mm Hg in αα/αα, 117±11 mm Hg in -α/αα, and 118±11 mm Hg in -α/-α subjects, respectively. Mean 24-hour diastolic BP ±SD in these groups was 64±8, 63±7, and 65±8 mm Hg, respectively. Mean pulse wave velocity (PWV)±SD was 7±0.8, 7±0.8, and 7±0.7 ms-1, respectively. No differences were observed in PWV and any of the 24-hour ambulatory BP monitoring-derived measures between those with and without α+thalassemia. CONCLUSIONS: These data suggest that the presence of α+thalassemia does not affect BP and/or arterial stiffness in Kenyan adolescents

Tungiasis in 5-12 year olds and associated factors in Murang’a South district, Central Kenya.

Thesis, Master of Science in Public Health, Jomo Kenyatta University of Agriculture and Technology.Jomo Kenyatta University of Agriculture and Technolog

Predisposing factors of neonatal morbidity in Gicumbi District, Rwanda

https://doi.org/10.12032/life2020-0803-101Background: Rwanda has registered tremendous achievements in the health sector. However, neonatal morbidity remains high in some areas. This study aims to determine the prevalence and predisposing factors of neonatal morbidity in the Gicumbi District. Methods: The study was a retrospective, cross-sectional study. Overall population of interest comprised 349 neonates. Quantitative data were collected using a pre-tested data extraction tool which comprised of general characteristics of mothers and neonates, social factors, medical insurance and physiological factors. Results: The study found that the prevalence of neonatal morbidity is 28.4%. Bivariate analysis shows that 8 variables were statistically significant with neonatal morbidity. In multivariable analysis, factors identified as statistically associated with neonatal morbidity were mothers who did not have any antenatal care during pregnancy (AOR = 5.3; 95% CI = −1.313–22.118, P < 0.019). Conclusion: Prevalence of neonatal morbidity was significant among neonates born in Gicumbi District and mothers who did not have any antenatal care during pregnancy are most vulnerable. Thus, public health staff, leaders at the facility, and national level are advised to assess all barriers and enablers of Antenatal care coverage

Knowledge, Attitude and Practices towards Nutrition and Influencing Factors among Pregnant and Lactating Women in Kigeme Refugee Camp, Rwanda

This study aimed to determine the level of knowledge, attitude and practices towards nutrition and influencing factors among pregnant and lactating women. This was a descriptive cross-sectional study conducted in Kigeme refugee camp-Rwanda using both quantitative and qualitative methods. The questionnaires were distributed to 220 pregnant and lactating women that were randomly selected and conducted four focus groups discussion with pregnant and lactating women and to14 community health workers in order to determine the nutrition knowledge attitude and practices among pregnant and lactating women (0 to 6 month post-partum). SPSS 20.0 and thematic analysis was used to analyze gathered data. The results showed that more than half of participants 53.6% had high knowledge, while 46.4% had moderate knowledge. This was supported by the qualitative findings which confirmed that the participants had high nutrition knowledge. The level of attitude show that 67.2% has negative attitude while 32.7% has positive attitude; regarding nutrition practice, 71.8% had poor nutrition practice while 28.2% had good nutrition practice. After running multivariate analysis, the variables independently associated with practice towards nutrition were purchasing the food in the market as source of food (AOR=14.987; 95%CI=1.650-4.231; P=0.001) and attitude (AOR=18.896; 95%CI=2.674-10.537; P<0.001). The study concludes that the participants have high knowledge toward nutrition but most of them have negative attitude and poor nutrition practices. The poor nutrition attitudes influenced by limited source of food and attitude

Quality and Safety Management of Health Care Service Delivery among Public Hospitals in Rwanda: a Cross-Sectional Survey

DOI: 10.21106/ijtmrph.81Background or Objectives: Quality and safety of health care service delivery remain a challenge worldwide due to unsafe care, inappropriate practices, adverse events and medication errors that result in harm, disability and death of patients. This study examines the status of quality and safety management of health care service delivery in public hospitals in Rwanda. Methods: The study was a descriptive cross-sectional study. Overall population of interest comprised of 564 hospital managers from 47 hospitals. An online email-based questionnaire was used for data collection. Statistical analysis included bivariate, multivariable, and logistic regression analyses with significance at p<0.05. Data were analyzed using Statistical Package for social Sciences (SPSS) Software v.21. Results: The study sample population was 235 managers (5 persons from each hospital). Of the 235 responses received, 72.3% were from male managers and 27.7% were from female managers. The prevalence of adverse events among public hospitals in Rwanda is 0.007% (p=0.02, 95% CI: 0.017-0.023) with risk of incidents of 0.073%. In all, 98.7% of public hospitals reported incidents, and only 39.3% of them have regularly reported all types of incidents. The most common incidents were adverse drug event (25.3%), loss to follow-up/referrals (25%), and surgical site infection (20%). Rwanda has 0.043 (IQR: 0.032-0.060) doctors per 1,000 population. The country also has 0.25 (IQR: 0.18-0.33) nurses per 1,000 population. The 76.5% of respondents reported that variation of consultation time is between 10-15 minutes (p=0.003, 95% CI: 0.002-0.004) which is associated with 0.12% risk of incidents. The public hospitals have on average 44.25 ± 13.46 SD consultations per clinician per day. More than a half of respondents 54.3% (p=0.033, 95%CI: 0.029- 0.036) reported that 10-20% of treatment given to patients were not needed and are significantly associated with high risk of incidents. The public hospitals score Level 1(documentation) (p=0.016, 95%CI: 0.014-0.019) for quality health care services delivery and, over half score Level 2(implementation). They also score Level 1(documentation) (p: 0.209, 95%CI: 0.201-0.216) for safe health care, and approximately half of them score Level 2(implementation). Conclusion and Implications for Translation: The quality and safety of health care services should be a priority for health care professionals and healthcare systems. The culture of blame and punishment is a challenge across hospitals. Reassuring adverse events reporting and learning from errors need to be emphasized and prioritized in public hospitals

Drug-related problems among type II diabetes mellitus patients with hypertension: a cross-sectional study

Patients with type II diabetes mellitus (T2DM) and hypertension (HTN) are at increased threat for long experiencing various problems related to medicine as they frequently received different medications for managing their condition. Recently, there were no studies done locally on drug-related problems (DRPs) among T2DM patients with HTN. Thus, this study aims to assess the DRPs among T2DM patients with HTN admitted at Kibuye Referral Hospital (KRH). DRPs were drug safety problems, drug ef-fectiveness problems and other drug problems. Methods: A retrospective cross-sectional study involved patients' files with T2DM and HTN, who were admitted at KRH from January 2013 to December 2017. The identification and classification of DRPs were based on pharmaceutical care network Europe (PCNE) classification system version 8.02. A simple random sampling technique was used to choose study par¬ticipants from the target population. Data that met inclusion and exclusion criteria were analyzed using STATA version 13. The Fisher exact test (bivariate analysis) and logistic regression (multivariate) were used to test association and p-value ≤ 0.05 was considered as statistically significant. An adjusted odd ra¬tio (AOR) with a confidence interval (CI) of 95% was determined using binary logistic regression. Results: Findings revealed that the prevalence of DRPs was 81.29% (313/385) and most of them each patient had at least two DRPs (69.05%). The patients aged above 55 years old were more likely to develop DRPs than those with age below 35 years (AOR = 1.2; P = 0.02; 95% CI: 0.2–2.3). Nevertheless, there was no significant association between DRPs and middle age (between 35 and 54 age of old). The patients who consumed more than or equal to 5 drugs were 2.4 times more likely to develop DRPs than those who took the number of medicines less than 5 (AOR = 15.4; P < 0.001; 95% CI: 8.8–26.8). Also, traditional medicines use ((AOR = 1.9; P = 0.016; 95% CI: 1.1–3.5) and having drug-related complication (AOR = 2.4; P < 0.001; 95% CI: 1.9–3) had shown significant associations. The total causes of DRPs identified were 1626 and most causes of DRPs were arisen from drug use (45.01%) and prescribing (37.83%). The drug/ dose selections were the most frequent causes of DRPs (36.97%). Conclusion: Since the prevalence of DRPs were relatively high, various factors influencing DRPs were established and most causes of DRPs were arising from drug use & drug prescribing among T2DM patients with HTN. Early detection needed to enhance patient’s life quality. Conducting studies in other hospitals needed to establish the national planning of DRPs to eradicate DRPs among patients T2DM with HTN

The influence of health technology on principal-agent relationship: a study of virtual doctor consultations in Rwanda

Use of technology in health care delivery is considered as one solution to speed up the health care delivery in underserved areas. Because of this, a number of health technologies have been brought into play, such as providing virtual doctor consultations. The idea of Principal-Agent relationship has turned out to be generally acknowledged in health economics. The health insurance market appears to fit into the standard Principal-Agent relationship that is described by a principal (poorly educated individual) and an agent (educated person), who endeavour to boost their utility capacities. In Rwanda, the health services are openly regulated while yet third part, payer, health insurance, for example, Rwanda Social Security Board (RSSB) and other private insurance providers dominate the buying of human services. Therefore, this study focused on assessing the influence of health technology on principal-agent relationship focusing on the virtual doctor consultation. This exploratory study utilised a qualitative approach to gather primary data. The qualitative data was collected using Key Informant Interview (KII) guide and Focus Group Discussions (FGD) guide. Collected data from both the FGDs and KIIs were analysed using Atlas.ti version 8.4 software after a proper transcription of the recorded data. The study findings suggested some challenges and numerous opportunities brought by health technology particularly virtual doctor consultations in Rwanda. Challenges include lack of interoperability of software leading to data concerns like data ownership, data access and data security, lack of stable infrastructure and a high cost of infrastructure development, differences in health care packages at different levels of treatment, scepticism especially with old people, literacy levels, smartphone penetration and cost of internet. Opportunities include cost saving, time saving, convenience, confidentiality, accessibility and proper utilization and distribution of the scarce healthcare workforce especially general practitioners (GPs). Moreover, induced demand due to encouragement and due to convenience of the service was identified by the study. However, as it would be anticipated that induced demand is a big concern for the insurance institutions, it was found not to be as major as anticipated patients are prompted to utilize health services at an early stage of illness, which makes the cost lower. Finally, the study identified that information asymmetry that exist between the agent and principal was found to be huge and of a great concern especially the regulators who have no information on where the information for patients is kept and what it is used for. The study recommends proper integration, incentives alignment, proper identification of the technology and cost effectiveness analysis for proper incorporation of health technologies in the health system

A multi-institutional, cross-sectional study on disclosure of HIV status to sexual partner(s) and associated factors among people living with HIV/AIDS attending selected hospitals in Kigali, Rwanda

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20200405Background: In Sub-Saharan Africa, human immunodeficiency virus (HIV) remains a public health problem. There is need for evidence-based interventions to curb new infections. HIV status disclosure, especially to sexual partner(s) remains a critical step towards reducing viral transmission across sexual partners. Methods: A hospital-based cross-sectional study, conducted at HIV clinics of three selected hospitals. Systematic random sampling was employed to sample 384 people living with HIV/AIDS (PLWH). A pre-tested self-administered questionnaire was used to collect data. Results: Of the participants, 66% of the participants reported HIV positive status disclosure, with only 46% of these having disclosed to their sexual partner. Logistic regression analysis identified age (p value 0.035; AOR 0.94), being satisfied with counselling (p value 0.017; AOR 0.24), gender (p value 0.030; AOR 5.51) and education (p value 0.041; AOR 2.14) as factors associated with having disclosed HIV status. Being younger, satisfaction with counselling, being female and having attained at least secondary education were all associated with higher odds of HIV status disclosure. Conclusions: Based on the findings of the current study, it can be concluded that there is need to improve rates of HIV status disclosure among PLWH in Kigali, Rwanda. The current study findings have provided baseline information for the local health authorities, health care providers, policy makers and other scholars working in HIV epidemic control. The local health authorities can use this as a guide to develop a programme aimed to address the issue of non-disclosure of HIV status in Kigali City and hence help control the incessant spread of HIV infection