Perceptions and Experiences of School Teachers During the Implementation of a School-Based Deworming Activity in Kenya

Background: Primary school teachers are key stakeholders in the success of school-based deworming activity as they are responsible for drug administration and provision of health education to the School-Age Children (SAC). In Kenya, the National School-Based Deworming Programme (NSBDP) for control of soil-transmitted helminths and schistosomiasis was initiated in the year 2012 in prioritised areas. By the year 2013, over 6 million SAC had been treated. The present study sought to assess the teachers’ perceptions and experiences of the school-based deworming activity in an effort to improve programme effectiveness.   Methods: Qualitative data were collected, using in-depth interviews, in 4 subcounties of the coastal region of Kenya. Using purposive selection, 1 primary school teacher from each of the 38 schools also purposively selected participated in the study. The data were audio-recorded, transcribed, coded and analysed manually by study themes which included: reason for being selected for training to administer drugs; perceptions of training content and duration; experiences during drug acquisition, administration and record-keeping and motivation to continue participating in the deworming of school-age children.   Results: Half of the teachers indicated that they were selected to administer drugs to children as they were responsible for school health matters. The duration and content of the training were considered sufficient, and no challenges were faced during drug acquisition. Challenges faced during drug administration included non-compliance and experience of side effects of the drugs. No major problems were experienced in record-keeping, although the teachers felt that the forms needed to be simplified. Improvement of the children’s health and class performance was reported as a source of motivation to the teachers to continue administering the drugs. Fellow teachers were reported to have given moral support while over half of the respondents indicated that parents did not provide much support.   Conclusion: Generally, teachers have positive experiences and perceptions of the deworming activity. There is, however, a need to involve all stakeholders especially the parents through the school board of management to help counter non-compliance and possibly support in providing meals to the children to help minimise side effects after drug consumption. Inadequate moral support and incentives are negative factors on the teachers’ motivation

Knowledge, practices and perceptions of trachoma and its control among communities of Narok County, Kenya

© 2016 The Author(s). Background: Trachoma is the leading infectious cause of blindness in the world. It is commonly found in cultural groups with poor hygiene. Trachoma control includes Surgery, Antibiotics, Facial cleanliness and Environmental Improvement (SAFE). Potentially blinding and active trachoma are monitored using trachomatous trichiasis (TT) in adults and trachoma inflammation-follicular (TF) in children aged 1-9 years respectively. A cross-sectional study to assess the knowledge, practices and perceptions of trachoma and its control was conducted in the endemic communities in Narok County. Methods: Qualitative methods were used for data collection. Using purposive sampling, 12 focus group discussions (FGDs) with single sex adult and young men and women groups of homogenous characteristics, 12 key informant interviews with opinion leaders and 5 in-depth interviews (IDIs) with trichiasis patients and 6 with persons who have undergone trichiasis surgery were conducted. Data was audio recorded, transcribed, coded and analyzed manually by study themes; knowledge, practices and perceptions of trachoma transmission, infection signs, prevention and control. Results: Majority of the community members had knowledge of trachoma and its transmission. The practices that contributed to transmission of infection included: failure to wash faces and bathe regularly, sharing of water basins and towels for face washing, traditional methods of trachoma treatment and dirty household environment. Due to socio-cultural perceptions, toilets were unacceptable and use of bushes for human waste disposal was common. Poor perceptions on disease susceptibility, flies on children's faces, latrine ownership and usage and separation of human and animal dwellings also played a role in the transmission of trachoma. Fear of loss of sight during surgery was a deterrent to its uptake and a desire to be able to see and take care of domestic animals promoted surgery uptake. Majority of the community members were appreciative of Mass Drug Administration (MDA) though side effect such as vomiting and diarrhoea were reported. Conclusion: Poor practices and related socio-cultural perceptions are important risk factors in sustaining trachoma infection and transmission. Community members require health education for behavior change and awareness creation about surgery, MDA and its potential side effects for elimination of trachoma in Narok County, Kenya. Trial registration: KEMRI SSC 2785. Registered 2 September 2014

Evaluation of copromicroscopy, multiplex-qPCR and antibody serology for monitoring of human ascariasis in endemic settings

Background: The standard diagnosis of Ascaris lumbricoides and other soil-transmitted helminth (STH) infections relies on the detection of worm eggs by copromicroscopy. However, this method is dependent on worm patency and shows only limited accuracy in low-intensity infection settings. We aimed to decipher the diagnostic accuracy of different antibodies using various Ascaris antigens in reference to copromicroscopy and quantitative PCR (qPCR), four months after national STH preventative chemotherapy among school children in western Kenya. Methodology: STH infection status of 390 school children was evaluated via copromicroscopy (Kato-Katz and mini-FLOTAC) and qPCR. In parallel, Ascaris-specific antibody profiles against larval and adult worm lysates, and adult worm excretory-secretory (ES) products were determined by enzyme-linked immunosorbent assay. Antibody cross-reactivity was evaluated using the closely related zoonotic roundworm species Toxocara cati and Toxocara canis. The diagnostic accuracy of each antibody was evaluated using receiver operating curve analysis and the correspondent area under the curve (AUC). Principal findings: Ascaris was the predominant helminth infection with an overall prevalence of 14.9% (58/390). The sensitivity of mini-FLOTAC and Kato-Katz for Ascaris diagnosis reached only 53.5% and 63.8%, respectively compared to qPCR. Although being more sensitive, qPCR values correlated with microscopic egg counts (R = -0.71, P<0.001), in contrast to antibody levels. Strikingly, IgG antibodies recognizing the ES products of adult Ascaris worms reliably diagnosed active Ascaris infection as determined by qPCR and microscopy, with IgG1 displaying the highest accuracy (AUC = 0.83, 95% CI: 0.75–0.91). Conclusion: IgG1 antibody responses against adult Ascaris-ES products hold a promising potential for complementing the standard fecal and molecular techniques employed for monitoring Ascaris infections. This is of particular importance in the context of deworming programs as the antibody diagnostic accuracy was independent of egg counts

Increasing coverage in mass drug administration for lymphatic filariasis elimination in an urban setting: a study of Malindi Town, Kenya.

Implementation of Mass Drug Administration (MDA) in urban settings is an obstacle to Lymphatic Filariasis (LF) elimination. No urban-specific guidelines on MDA in urban areas exist. Malindi district urban area had received 4 MDA rounds by the time the current study was implemented. Programme data showed average treatment coverage of 28.4% (2011 MDA), far below recommended minimum of 65-80%.To identify, design and test strategies for increased treatment coverage in urban areas, a quasi-experimental study was conducted in Malindi urban area. Three sub-locations with lowest treatment coverage in 2011 MDA were purposively selected. In the pre-test phase, 947 household heads sampled using systematic random method were interviewed for quantitative data. For qualitative data, 12 Focus Group Discussions (FGDs) with single sex adult and youth male and female groups and 3 with community drug distributors (CDDs) were conducted. Forty in-depth interviews with opinion leaders and self-administered questionnaires with District Public Health officers purposively selected were carried out. The quantitative data were analyzed using SPSS version 16 and statistical significance assessed by χ(2) test.The qualitative data were analyzed manually according to study's themes.The identified strategies were implemented prior to and during 2012 MDA in two sub-locations (experimental) while in the third (control), usual MDA strategies were applied. In the post-test phase, 2012 MDA coverage in experimental and control sub-locations was comparatively assessed for effect of the newly designed strategies on urban MDA. Results indicated improved treatment coverage in experimental sub-locations, 77.1% in Shella and 66.0% in Barani. Central (control) sub-location also attained high coverage, 70.4% indicating average treatment coverage of 71%.The identified strategies contributed to increased treatment coverage in experimental sites and should be applied in urban areas. Due to closeness of sites, spillover effects may have contributed to increased coverage in the control site

The role of personal opinions and experiences in compliance with mass drug administration for lymphatic filariasis elimination in Kenya.

The main strategy adopted for Lymphatic Filariasis (LF) elimination globally is annual mass drug administration (MDA) for 4 to 6 rounds. At least 65% of the population at risk should be treated in each round for LF elimination to occur. In Kenya, MDA using diethylcarbamazine citrate (DEC) and albendazole data shows declining compliance (proportion of eligible populations who receive and swallow the drugs) levels (85%-62.8%). The present study's aim was to determine the role of personal opinions and experiences in compliance with MDA.This was a retrospective cross-sectional study conducted between January and September 2009 in two districts based on December 2008 MDA round. In each district, one location with high and one with low compliance was selected. Through systematic sampling, nine villages were selected and interviewer-based questionnaires administered to 965 household heads or adult representatives also systematically sampled. The qualitative data were generated from opinion leaders, LF patients with clinical signs and community drug distributors (CDDs) all purposively selected and interviewed. Sixteen focus group discussions (FGDs) were also conducted with single-sex adult and youth male and female groups. Chi square test was used to assess the statistical significance of differences in compliance with treatment based on the records reviewed. The house-to-house method of drug distribution influenced compliance. Over one-quarter (27%) in low compared to 15% in high compliance villages disliked this method. Problems related to size, number and taste of the drugs were more common in low (16.4%) than in high (14.4%) compliance villages. Reasons for failure to take the drugs were associated with compliance (p<0.001). The reasons given included: feeling that the drugs were not necessary, CDD not visiting to issue the drugs, being absent and thinking that the drugs were meant for only the patients with LF clinical signs. A dislike for modern medicine prevailed more in low (6.7%) than in high (1.2%) compliance villages. Experience of side effects influenced compliance (P<0.001). The common side effects experienced included giddiness, fever, headache and vomiting. Social support, alcohol and substance use were not associated with compliance in both types of villages (p>0.05).Community sensitization on treatment, drugs used, their regimen and distribution method involving all leaders should be strengthened by the Programme Implementers. The communities need to be made aware of the potential side effects of the drugs and that health personnel are on standby for the management of side effects in order to build confidence and increase the compliance levels

Safety, efficacy and acceptability of praziquantel in the treatment of Schistosoma haematobium in pre-school children of Kwale County, Kenya.

BACKGROUND:The recommended strategy for control of schistosomiasis is preventive chemotherapy with praziquantel (PZQ). Pre-school children (PSC) are excluded from population treatment programs. In high endemic areas, these children are also at risk, and require treatment with PZQ. The Government of Kenya initiated the National School-Based Deworming Programme (NSBDP) where PSC in Early Childhood Development Education (ECDE) Centers are only eligible for treatment with albendazole (ABZ) but not with PZQ. METHODOLOGY/PRINCIPAL FINDINGS:400 PSC were enrolled, from 10 randomly selected ECDE Centers in Kwale County, Kenya where children were treated with crushed PZQ tablets mixed with orange juice, at a single dose of 40 mg/kg. Adverse events were assessed 24 hours post-treatment through questionnaires administered to the parents or guardians. Acceptability was determined by observing if the child spat and/ or vomited all or part of the PZQ dose immediately after treatment. Efficacy was assessed by examining urine samples for Schistosoma haematobium eggs in the 5 weeks post-treatment follow-up. Children testing negative for S. haematobium during the follow-up were considered cured. Egg reduction rate (ERR) was calculated as the decrement in the infection intensity (group's geometric mean egg counts per 10 ml of urine) following treatment expressed as a proportion of the pre-treatment infection intensity. Before treatment, 80 out of the 400 children enrolled in the study tested positive for S. haematobium (20.0% (95% confidence interval (CI) 16.4-24.2%). Of these, 41 had infections of heavy intensity (51.3%) while the rest (48.7%) were of light intensity. Five weeks post-treatment, 10 children who had heavy intensity infection were diagnosed with S. haematobium (prevalence: 2.5% (95% CI 1.5-4.9%). Infection intensities decreased significantly from 45.9 (95% CI: 31.0-68.0) eggs/ 10 ml urine to1.4 (95% CI: 1.1-1.7) eggs/ 10 ml urine during pre-and post-treatment respectively. The ERR was 96.9%. There were no severe adverse events during follow up 24 hours post treatment. Treatment tolerability among the 400 children was high as none of the children spat and/ or vomited as observed in this study. CONCLUSION/SIGNIFICANCE:The study revealed that crushed PZQ is safe and effective in the treatment of urogenital schistosomiasis in this age group. It is therefore recommended that PZQ should be administered to the PSC in Kwale County

Addressing barriers of community participation and access to mass drug administration for lymphatic filariasis elimination in Coastal Kenya using a participatory approach.

Since the prioritization of Lymphatic Filariasis (LF) elimination in 1997, progress has been made in reducing disease transmission and burden. Validation of elimination through Transmission Assessment Surveys (TAS) in implementation units (IUs) that have received at least 5 rounds of mass drug administration (MDA) and achieved minimum threshold of 65% treatment coverage is required. There are IUs that do not qualify for TAS due to achievement of low treatment coverage. This study sought to identify barriers of community participation and access to MDA, develop and test strategies to be recommended for improved uptake. Two wards in Kaloleni sub-county, Kilifi county with an average treatment coverage of 56% in 2015, 50.5% in 2016 were purposively sampled and a quasi-experimental study conducted. Through systematic random sampling, 350 (pre-intervention) and 338 (post-intervention) household heads were selected and interviewed for quantitative data. For qualitative data, 16 Focus Group Discussions (FGDs) with purposively selected community groups were conducted. Participatory meetings were held with county stakeholders to agree on strategies for improved community participation in MDA. The quantitative data were analyzed using STATA version 14.1, statistical significance assessed by chi square test and qualitative data by QSR NVIVO version 10. The identified strategies were tested in experimental sites during the 2018 MDA and the usual MDA strategies applied in control sites. The results showed an increase in community participation and access to MDA in both sites 80.6% (pre-intervention), 82.9% (post-intervention). The proportion of participants who considered the treatment as necessary significantly (p = 0.001) increased to 96.2% from 88.3% and significantly dropped for those with drug swallowing problems associated with: size (p<0.001), number (p<0.027) and taste (p = 0.001). The implemented strategies may have contributed to increased participation and access to MDA and should be applied for improved treatment uptake. Health education on disease aetiology and importance of drug uptake in all rounds is key to program's success

Research Dissemination Strategies Used by Kenya Medical Research Institute Scientists

Background:&nbsp;Dissemination of research findings is acknowledged as an important component of any research process. Implementation of research findings into practice or policy is necessary for improving outcomes in the targeted community. Given the context and dynamic environment in which researchers operate, there is need to find out existing gaps in terms of disseminating research findings to key stakeholders. The objective of this study was to investigate the health research dissemination strategies used by Kenya Medical Research Institute (KEMRI) researchers. &nbsp; Methods:&nbsp;This was a mixed-method study employing concurrent sequence (use of both qualitative and quantitative) methods of data collection. The study was conducted in KEMRI’s 10 centres spread in 3 geographical areas: Kisumu, Kilifi, and Nairobi counties. Potential respondents were identified through purposive sampling. Three inter-related data collection methods were employed in this study. These methods included key informant interviews with: (a) MoH officials from county government; (b) KEMRI researchers; and (c) key KEMRI departments, namely Corporate Affairs and the library. Additionally, secondary sources of information, such as scientific reports, KEMRI annual reports, and financial statements, were also reviewed. &nbsp; Results:&nbsp;Publication of papers in peer-reviewed journals was mentioned as the most common method of dissemination of research findings. Scientists published in 353 peer-reviewed journals (or publishing houses) between the years 2002 and 2015.&nbsp; Over 92.7% of these publications were in international peer-reviewed journals. Conferences and workshops were also mentioned. In the absence of a centralised electronic KEMRI publication database, the research team extracted and collated a publication lists from KEMRI annual reports and financial statements. This was limiting since it did not have an exhaustive list of all publications by KEMRI scientists. Only 3 respondents mentioned having written policy briefs or engaged the media as part of dissemination channels. The media representatives cited the use of social media (Facebook and Twitter) as another channel that KEMRI scientists could exploit. Challenges in dissemination included lack of knowledge on research translation leading to poor synthesis of research outputs as well as selective reporting by the media. &nbsp; Conclusion:&nbsp;Publications in peer-reviewed journals was the most preferred channel of communicating scientific outputs. Conferences and writing of policy briefs were the other sources of dissemination. We recommend that KEMRI dissemination channels should go well beyond simply making research available through the traditional vehicles of journal publications and scientific conference presentations but establish institutional mechanism which would facilitate extracting the main messages or key implications derived from research results and communicating them to stakeholders in attractive ways that would encourage them to factor the research implications into their work

Implementation challenges and opportunities for improved mass treatment uptake for lymphatic filariasis elimination: Perceptions and experiences of community drug distributors of coastal Kenya.

Community drug distributors (CDDs) who are volunteers have the responsibility of awareness creation, household census, drug distribution and record-keeping and are thus key stakeholders in the campaign for Lymphatic Filariasis (LF) elimination. Taking into account their experiences and perceptions is important for a successful elimination campaign. We conducted a qualitative study in 2018 to identify implementation challenges and opportunities for improved mass drug administration (MDA) uptake based on the CDDs perceptions and experiences. Within a larger study that used mixed methods quasi-experimental design, we collected qualitative data from two wards in Kaloleni Sub-County of Kilifi County which was purposively selected owing to its low, 56% and 50.5% treatment coverage in 2015 and 2016 respectively. Focus group discussions (FGDs) (n = 8) and in-depth interviews (IDIs) (n = 8) with CDDs, IDIs (n = 22) with opinion leaders and IDIs (n = 8) with health workers were conducted and the data analyzed by QSR NVIVO version 10 according to thematic areas. The results showed that based on the perceptions and experiences of the CDDs, several challenges: communities' refusal to take the drugs; absenteeism during MDA; non-adherence to CDDs selection criteria; inadequacy in number of CDDs engaged during the campaign and training provided; insufficiency of drugs issued to CDDs; lack of CDDs supervision and low motivation negatively impact on MDA uptake. Opportunities to address the challenges included: awareness creation on MDA, health education on LF and observation of hygiene during drug administration, increased duration of awareness creation and drug administration, adherence to CDDs selection criteria and putting into consideration the vastness of an area and population density while deploying CDDs. Other opportunities include: improved CDDs training and scheduling; issuing of enough drugs to CDDs to meet the communities' demand and improved supervision and motivation of CDDs. Addressing the challenges highlighted is an important step of maximizing MDA uptake. The opportunities presented need to be considered by the NTD program personnel, the county health personnel and the community while planning the implementation of MDA campaigns

The adverse effects of albendazole and praziquantel in mass drug administration by trained schoolteachers

Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) conducted stool examinations for soil transmitted helminthiases (STH) and Schistosoma mansoni , among school children in Mwea Division, Central Kenya where both infections are endemic. Mass drug administrations (MDAs) were then conducted in 2004 and 2005 using schoolteachers trained on how to administer treatment, physically and psychologically prepare the children to take the medication, have them eat before treatment, handle minor and refer serious side effects to local health facilities. Local health workers were on standby to help manage severe side effects. This study examined side effects of the drugs and the teachers’ preparedness to handle the children when such effects occurred. No serious side effects requiring referral to the health centre occurred and the minor ones observed were temporal. In 2005 children in Mwea schools were treated with albendazole 400mg and praziquantel 40mg/kg body weight while those of Ndia, a neighboring division treated with only albendazole 400mg since there was low S.mansoni prevalence. Monitoring of side effects was done in two schools of Ndia and in three of Mwea through a questionnaire distributed to grade three pupils a week after treatment. Of 73 pupils from Mwea, 49.7% reported incidences of stomachache, vomiting/nausea, headache and dizziness whereas 39.2% of 186 from Ndia experienced incidences of cough, stomachache and headache. This shows that more pupils from Mwea, (albendazole and praziquantel) than from Ndia (albendazole alone) experienced minor side effects. These results show that both drugs have temporary, minor side effects, which can be managed by trained schoolteachers by ensuring that the school children do not swallow the drugs on an empty stomach and rest immediately after swallowing the drugs but should be closely monitored by health personnel. In this study, one trained schoolteacher could administer treatment to three hundred children in one day, which makes the approach cost effective and should be adopted nationally