The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms.

Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal. Devices are implemented with guidance and training, mentorship, and community engagement. Sociodemographic and clinical data are collected from caregivers and records of enrolled sick children aged 0-59 months at study facilities, with phone follow-up on Day 7 (and Day 28 in the RCT). The primary outcomes assessed for the RCT are severe complications (mortality and secondary hospitalisations) by Day 7 and primary hospitalisations (within 24 hours and with referral); and, for the pre-post study, referrals and antibiotic. Secondary outcomes on other aspects of health status, hypoxaemia, referral, follow-up and antimicrobial prescription are also evaluated. In all countries, embedded mixed-method studies further evaluate the effects of the intervention on care and care processes, implementation, cost and cost-effectiveness. Pilot and baseline studies started mid-2021, RCT and post-intervention mid-2022, with anticipated completion mid-2023 and first results late-2023. Study approval has been granted by all relevant institutional review boards, national and WHO ethical review committees. Findings will be shared with communities, healthcare providers, Ministries of Health and other local, national and international stakeholders to facilitate evidence-based decision-making on scale-up.Study registration: NCT04910750 and NCT05065320

Incidence and Correlates of HIV-1 RNA Detection in the Breast Milk of Women Receiving HAART for the Prevention of HIV-1 Transmission

The incidence and correlates of breast milk HIV-1 RNA detection were determined in intensively sampled women receiving highly active antiretroviral therapy (HAART) for the prevention of mother-to-child HIV-1 transmission.Women initiated HAART at 34 weeks of pregnancy. Breast milk was collected every 2-5 days during 1 month postpartum for measurements of cell-associated HIV DNA and cell-free HIV RNA. Plasma and breast milk were also collected at 2 weeks, 1, 3 and 6 months for concurrent HIV-1 RNA and DNA measurements. Regression was used to identify cofactors for breast milk HIV-1 RNA detection.Of 259 breast milk specimens from 25 women receiving HAART, 34 had detectable HIV-1 RNA (13%, incidence 1.4 episodes/100 person-days 95% CI = 0.97-1.9). Fourteen of 25 (56%) women had detectable breast milk HIV-1 RNA [mean 2.5 log(10) copies/ml (range 2.0-3.9)] at least once. HIV-1 DNA was consistently detected in breast milk cells despite HAART, and increased slowly over time, at a rate of approximately 1 copy/10(6) cells per day (p = 0.02). Baseline CD4, plasma viral load, HAART duration, and frequency of breast problems were similar in women with and without detectable breast milk HIV-1 RNA. Women with detectable breast milk HIV-1 RNA were more likely to be primiparous than women without (36% vs 0%, p = 0.05). Plasma HIV-1 RNA detection (OR = 9.0, 95%CI = 1.8-44) and plasma HIV-1 RNA levels (OR = 12, 95% CI = 2.5-56) were strongly associated with concurrent detection of breast milk HIV-1 RNA. However, no association was found between breast milk HIV-1 DNA level and concurrent breast milk HIV-1 RNA detection (OR = 0.96, 95%CI = 0.54-1.7).The majority of women on HAART had episodic detection of breast milk HIV-1 RNA. Breast milk HIV-1 RNA detection was associated with systemic viral burden rather than breast milk HIV-1 DNA

Farmers’ Participation in Factory Contracted Services and its Effect on Profitability among Smallholder Sugarcane Farmers in Malava Sub-county in Kenya

Sugarcane crop is among the industrial crops that are major employers and contributors to the Kenyan economy. In a bid to attain self-sufficiency in sugar, Kenya has made remarkable efforts to develop sugarcane subsector. However, sugarcane productivity is still low compared to its potential yield. For a long time, this crop has been grown through contract farming. This study aimed at evaluating the effect of participation in factory contracted services on the profitability of smallholder farmers in Malava Sub-county in Western Kenya. Primary data were collected using structured questionnaires from a sample of 384 farmers using systematic random sampling and proportional sampling allocation techniques. Analysis of variance was applied to determine if there is a significant difference between profitability of contracted and non-contracted farmers. The effect of contracted services on profitability among contract farmers was analyzed by multiple linear regression. The results showed that contracted extension, labour and credit services have significant effect on farmers’ gross margins. Based on the results, the study recommended the Kenyan government to formulate policies that enhance provision of contracted extension, labour and credit services. The need for a review of the existing contract engagement terms among sugarcane farmers is also evident in this study

Farmers’ Participation in Factory Contracted Services and its Effect on Profitability among Smallholder Sugarcane Farmers in Malava Sub-county in Kenya

Sugarcane crop is among the industrial crops that are major employers and contributors to the Kenyan economy. In a bid to attain self-sufficiency in sugar, Kenya has made remarkable efforts to develop sugarcane subsector. However, sugarcane productivity is still low compared to its potential yield. For a long time, this crop has been grown through contract farming. This study aimed at evaluating the effect of participation in factory contracted services on the profitability of smallholder farmers in Malava Sub-county in Western Kenya. Primary data were collected using structured questionnaires from a sample of 384 farmers using systematic random sampling and proportional sampling allocation techniques. Analysis of variance was applied to determine if there is a significant difference between profitability of contracted and non-contracted farmers. The effect of contracted services on profitability among contract farmers was analyzed by multiple linear regression. The results showed that contracted extension, labour and credit services have significant effect on farmers’ gross margins. Based on the results, the study recommended the Kenyan government to formulate policies that enhance provision of contracted extension, labour and credit services. The need for a review of the existing contract engagement terms among sugarcane farmers is also evident in this study

Farmers’ Participation in Factory Contracted Services and its Effect on Profitability among Smallholder Sugarcane Farmers in Malava Sub-county in Kenya

Sugarcane crop is among the industrial crops that are major employers and contributors to the Kenyan economy. In a bid to attain self-sufficiency in sugar, Kenya has made remarkable efforts to develop sugarcane subsector. However, sugarcane productivity is still low compared to its potential yield. For a long time, this crop has been grown through contract farming. This study aimed at evaluating the effect of participation in factory contracted services on the profitability of smallholder farmers in Malava Sub-county in Western Kenya. Primary data were collected using structured questionnaires from a sample of 384 farmers using systematic random sampling and proportional sampling allocation techniques. Analysis of variance was applied to determine if there is a significant difference between profitability of contracted and non-contracted farmers. The effect of contracted services on profitability among contract farmers was analyzed by multiple linear regression. The results showed that contracted extension, labour and credit services have significant effect on farmers’ gross margins. Based on the results, the study recommended the Kenyan government to formulate policies that enhance provision of contracted extension, labour and credit services. The need for a review of the existing contract engagement terms among sugarcane farmers is also evident in this study

Incidence of depressive symptoms among sexually abused children in Kenya

Abstract Background Children who experience sexual abuse undergo various negative psychosocial outcomes such as depressive symptoms. Unfortunately, not many studies have been conducted on the incidence of depressive symptoms among sexually abused children in Kenya. This study sought to ascertain the incidence of depressive symptoms among children who have experienced sexual abuse in Kenya. Methods This was a longitudinal study design. It was conducted at Kenyatta National Teaching and Referral Hospital and Nairobi Women’s Hospitals in Kenya. One hundred and ninety-one children who had experienced sexual abuse and their parents/legal guardians were invited to participate in the study. The study administered the Becks Depression Inventory and the Child Depression Inventory to the children. Results The incidence of depressive symptoms after 1 month of sexual abuse revealed that amongst children who were below 16 years old, 14.6% had minimal-mild depressive symptoms while 85.4% had moderate-severe depressive symptoms. In comparison, children who were 16 years or older, 6.4% had minimal-mild depressive symptoms while 93.6% had moderate-severe depressive symptoms. Children below 16 years old whose parents were separated were found to have depressive symptoms (p < 0.001) as well as those who were presented early for medical care (p < 0.004), while children aged 16 years and above who were abused by strangers were more likely to have depressive symptoms (p < 0.024) and those who were not attending school (p < 0.002). Conclusion Sexual abuse of children is world-wide and the Kenyan situation is comparable. Being the victim of sexual abuse as a child has major psychological and emotional sequlae which need to be addressed in Kenya. Children who experience sexual abuse have very high incidence of developing depressive symptoms. All the sexually abused children studied suffered from depressive symptoms and a large majority suffered from major depressive symptoms that should be promptly and effectively addressed to ameliorate psychological suffering among children

Types of cancers in categories.

Types of cancers in categories.</p

Associations between sociodemographic characteristics and choice of country.

Associations between sociodemographic characteristics and choice of country.</p

Reasons given for choice of country for cancer treatment.

Reasons given for choice of country for cancer treatment.</p