Management in Action: Managing the HIV/AIDS Curriculum in Kenya

Curriculum management can only be effective when the curriculum content and expected learning outcomes are clearly stated for the actual implementers. The implementers on their side especially the teachers and the school administration must ensure that the stated contents, instructional methodologies and the time lines are followed appropriately. This paper examines the extent at which the HIV/AIDS curriculum is being implemented at the Secondary School level in Kenya. The key objectives were to identify the policy dimensions of HIV/AIDS education curriculum and to determine the level of implementation of HIV/AIDS education curriculum in public secondary schools. Structured questionnaire, observation and in-depth interviews were used for data collection from selected school students and the curriculum implementers. The study concluded that HIV/AIDS aspects are taught in public secondary schools through infusion and integration into carrier subjects, though not allocated any specific time in the curriculum. The level at which these aspects are taught is very low, and when taught lecture method, which is a rather passive way of teaching, is the predominant method employed by the teachers. It is recommended that the teachers should be more creative and devise other forums that would ensure that these aspects are amply taught. Also the teachers should collect and avail more learning materials to their learners, including use of the internet to supplement what is provided in the text books. Keywords:Management, HIV/AIDS Education, Healthcare Service

Risk factors of severe pneumonia among children aged 2-59 months in western Kenya: a case control study

Introduction Globally, pneumonia is the leading cause of death in children under the age of 5 years. In Kenya, it is the second leading cause of mortality, accounting for greater than 30,000 deaths in this age group annually. This study sought to identify risk factors for severe pneumonia in children under the age of five years. Methods We conducted a case control study. Cases were children aged 2 to59 months with severe pneumonia or very severe pneumonia and controls were those with non-severe pneumonia as defined by the integrated management of childhood illnesses classification. We administered structured questionnaires to mothers of participants to obtain data on socio-demographics, nutritional status and potential environmental risk factors. Data was analyzed using Epi Info; significance level was set at 0.05. Results We recruited 103 cases and 103 controls. The median age of cases was 14.0 (Range 3-58) months and of controls 14.0 (Range 2-54) months. Comorbidity (Odds Ratio = 3.8, Confidence Interval 1.4-10.6), delay in seeking treatment for three days or more (Odds Ratio = 2.3, Confidence Interval 1.2-4.2) and contact with upper respiratory tract infection (Odds Ratio = 2.7, Confidence Interval 1.1-6.5) were independent risk factors for severe pneumonia. Receiving antibiotics at home (Odds Ratio = 0.4, Confidence Interval 0.2-0.8) was protective. Conclusion Co-morbidity, contact with upper respiratory tract infection and delay in seeking treatment are risk factors for severe pneumonia. We recommend health education regarding appropriate health seeking and engaging community health workers in pneumonia prevention, control and treatment.Pan African Medical Journal 2012; 13:4

Prevalence and factors associated with percutaneous injuries and splash exposures among health-care workers in a provincial hospital, Kenya, 2010

Introduction: Accidental occupational exposure of healthcare workers to blood and body fluids after skin injury or mucous membrane contact constitutes a risk for transmission of blood-borne pathogens. Such pathogens include Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV). We conducted a study to determine the prevalence and associated factors for percutaneous injuries and splash exposures among health-care workers in Rift Valley provincial hospital. Methods: A cross-sectional study was carried out from October to November 2010. Self reported incidents, circumstances surrounding occupational exposure and post-exposure management were sought by use of interviewer administered questionnaire. Descriptive, bivariate and multiple logistic regression (forward stepwise procedure) analyses were performed. The level of significance was set at 0.05. Results: Twenty five percent of health-care workers interviewed (N=305) reported having been exposed to blood and body fluids in the preceding 12 months. Percutaneous injuries were reported by 19% (n=305) and splash to mucous membrane by 7.2%. Higher rates of percutaneous injuries were observed among nurses (50%), during stitching (30%), and in obstetric and gynecologic department (22%). Health workers aged below 40 years were more likely to experience percutaneous injuries (OR= 3.7; 95% CI=1.08-9.13) while previous training in infection prevention was protective (OR= 0.52; 95% CI=0.03-0.90). Forty eight percent (n=83) reported the incidents with 20% (n=83) taking PEP against HIV. Conclusion: Percutaneous injuries and splashes are common in Rift Valley Provincial hospital. Preventive measures remain inadequate. Health institutions should have policies, institute surveillance for occupational risks and enhance training of health care workers.Pan African Medical Journal 2013; 14:1

Dental caries and oral health practices among 12 year old children in Nairobi West and Mathira West Districts, Kenya

Background: Dental caries is a common disease in children which causes pain with resultant effect on various physiological and social functions. The main objective of the study was to determine the association between dental caries and oral health knowledge and practice among children in Nairobi West and Mathira West Districts. Methods: A cross-sectional study was conducted among 639 children aged 12 years attending public primary schools in Nairobi West and Mathira West districts between August 2009-February 2010. A questionnaire was used to determine the level of knowledge and practices employed. Oral screening was performed using World Health Organisation (WHO) recommended methods. Dental caries was measured using the Decayed, Missing, Filled Teeth (DMFT) index. Results: Nairobi West District had significantly higher caries prevalence of 37.5% than Mathira West District (24.0%). The DMFT in Nairobi West District was 0.76 ± 1.2, while in Mathira West District it was 0.36 ± 0.7. On multivariate analysis high consumption of soda was found to be a significant risk factor for dental caries in Nairobi West District(Odds Ratio (OR) = 3.0). In Mathira West District having an illiterate mother was a significant risk factor for dental caries (OR=4.3). Conclusion: Countrywide intensive oral health promotion should be carried out especially in urban areas, to reduce the higher prevalence of dental caries. The school health policy should be used to promote oral health by provision of oral health instructions and highlighting harmful dietary practices. Preventive practices such as regular dental checkups should be advocated and promoted in schools.Pan African Medical Journal 2012; 12:4

Risk factors associated with postpartum haemorrhage at Juba Teaching Hospital, South Sudan, 2011

Objective: To study risk factors associated with post partum haemorrhage (PPH) in Juba Teaching Hospital, South Sudan.Method: An unmatched case control study was conducted in which 44 cases and 88 controls were involved, from September to December 2011. Data were collected using a structured questionnaire in face to face interviews, and analyzed using Epi-info 3.5.3 statistical programme to determine if there was a correlation.Results: Maternal demographic and obstetric characteristics were found to be associated with the risk of bleeding during Bivariate analysis. However, age was found to confound emergency admission, uterotonic use (Oxytocin and Misoprostol) use and delivery type; the latter being modified, in the development of post partum haemorrhage.Conclusion: These results indicate that active management of the third stage of labour (AMTSL) and prompt intervention reduced the risk of developing PPH. Understanding the factors that cause PPH will allow us to better strengthen and effect pre-delivery and emergency obstetric care which may help us reduce maternal mortality due to post partum haemorrhage

Investigation to determine staff exposure and describe animal bite surveillance after detection of a rabid zebra in a safari lodge in Kenya, 2011

Introduction: Rabies is a fatal viral infection, resulting in >55,000 deaths globally each year. In August 2011, a young orphaned zebra at a Kenyan safari lodge acquired rabies and potentially exposed >150  tourists and local staff. An investigation was initiated to determine exposures among the local staff, and to describe animal bite surveillance in the affected district.Methods: We interviewed lodge staff on circumstances surrounding the zebra's illness and assessed  their exposure status. We reviewed animal bite report forms from the outpatient department at the district hospital. Results: The zebra was reported bitten by a dog on 31st July 2011, became ill on  23rdAugust, and died three days later. There were 22 employees working at the lodge during that time. Six (27%) had high  exposure due to contact with saliva (bottle feeding, veterinary care) and received four doses of rabies  vaccine and one of immune-globulin, and 16 (73%) had low exposure due to casual contact and received only four doses of rabies vaccine. From January 2010 to September 2011, 118 cases of animal bites were reported in the district; 67 (57%) occurred among males, 65 (57%) in children <15 years old, and 61  (52%) were inflicted in a lower extremity. Domestic and stray dogs accounted for 98% of reported bites.Conclusion: Dog bites remains the main source of rabies exposure in the district, but exposure can  result from wildlife. This highlights the importance of a one health approach with strong communication between wildlife, veterinary, and human health sectors to improve rabies prevention and control.Key words: Rabies, outbreak, epidemiology, East Africa 

Implementing One Health as an integrated approach to health in Rwanda

It is increasingly clear that resolution of complex global health problems requires interdisciplinary, intersectoral expertise and cooperation from governmental, non-governmental and educational agencies. ‘One Health’ refers to the collaboration of multiple disciplines and sectors working locally, nationally and globally to attain optimal health for people, animals and the environment. One Health offers the opportunity to acknowledge shared interests, set common goals, and drive toward team work to benefit the overall health of a nation. As in most countries, the health of Rwanda's people and economy are highly dependent on the health of the environment. Recently, Rwanda has developed a One Health strategic plan to meet its human, animal and environmental health challenges. This approach drives innovations that are important to solve both acute and chronic health problems and offers synergy across systems, resulting in improved communication, evidence-based solutions, development of a new generation of systems-thinkers, improved surveillance, decreased lag time in response, and improved health and economic savings. Several factors have enabled the One Health movement in Rwanda including an elaborate network of community health workers, existing rapid response teams, international academic partnerships willing to look more broadly than at a single disease or population, and relative equity between female and male health professionals. Barriers to implementing this strategy include competition over budget, poor communication, and the need for improved technology. Given the interconnectedness of our global community, it may be time for countries and their neighbours to follow Rwanda's lead and consider incorporating One Health principles into their national strategic health plans

Tobacco use and associated factors among Rwandan youth aged 15-34 years: Findings from a nationwide survey, 2013.

IntroductionUse of tobacco and its products are the single most preventable cause of death in the world. The objective of this study was to determine the prevalence of current tobacco use and identify associated factors among Rwandans aged 15-34 years.MethodsThis study involved secondary analysis of existing data from the nationally representative WHO STEPwise approach to Surveillance of non-communicable diseases (STEPS) conducted in 2013 to explore the prevalence of tobacco use and its associated factors in Rwanda. Data of 3,900 youth participants (15-34 years old) who had been selected using multistage cluster sampling during the survey was analyzed. The prevalence of current smoking along with socio-demographic characteristics of the sample were determined and multivariable logistic regression was employed to identify independent factors associated with current tobacco use.ResultsThe prevalence (weighted) of current tobacco use (all forms) was 8% (95%CI: 7.08-9.01). The prevalence was found to be significantly higher among males, young adults aged 24-34, youth with primary school education or less, those from Southern province, people with income (work in public, private organizations and self-employed) and young married adults. However, geographical location i.e. urban (7%) and rural (8%) settings did not affect prevalence of tobacco use. Factors that were found to be associated with current tobacco use through the multivariate analysis included being male, aged 25 years and above, having an income, and residing in Eastern, Kigali City and Southern Province compared to Western province.ConclusionThe association between smoking and socio-demographic characteristics among Rwandan youth identified in this study provides an opportunity for policy makers to tailor future tobacco control policies, and implement coordinated, high-impact interventions to prevent initiation of tobacco use among the youth

Risk factors associated with postpartum haemorrhage at Juba Teaching Hospital, South Sudan, 2011

Objective: To study risk factors associated with post partum haemorrhage (PPH) in Juba Teaching Hospital, South Sudan. Method: An unmatched case control study was conducted in which 44 cases and 88 Controls were involved, from September to December 2011. Data was collected using a structured questionnaire in face to face interviews, and analyzed using Epi-info 3.5.3 statistical programme to determine if there was a correlation. Results: Maternal demographic and obstetric characteristics were found to be associated with the risk of bleeding during Bivariate analysis. However, age was found to confound emergency admission, uterotonic use (Oxytocin and Misoprostol) use and delivery type, the latter being modified, in the development of post partum haemorrhage. Conclusion: These results indicate that active management of the third stage of labour (AMTSL) and prompt intervention reduced the risk of developing PPH. Understanding the factors that cause PPH will allow us to better strengthen and effect pre delivery and emergency obstetric care which may help us reduce maternal mortality due to post partum haemorrhage