Efficiency and factors influencing efficiency of Community Health Strategy in providing Maternal and Child Health services in Mwingi District, Kenya: An expert opinion perspective

Introduction: Community Health Strategy (CHS) is a new Primary Health Care (PHC) model in Kenya, designed to provide PHC services in Kenya.In 2011, CHS was initiated in Mwingi district as one of the components of APHIA plus kamili program. The objectives of this study was to evaluatethe efficiency of the CHS in providing MCH services in Mwingi district and to establish the factors influencing efficiency of the CHS in providing MCHservices in the district. Methods: this was a qualitative study. Fifteen Key informants were sampled from key stakeholders. Sampling was done using purposive and maximum variation sampling methods. Semi-structured in-depth interviews were used for data collection. Data was managed and analyzed using NVIVO.  Framework analysis and quasi statistics were used in data analysis. Results: expert opinion data indicated that the CHS was efficient in  providing MCH services. Factors influencing efficiency of the CHS in  provision of MCH services were: challenges facing Community Health Workers (CHWs), Social cultural and economic factors influencing MCH in the district, and motivation among CHWs.Conclusion: though CHS was found to be efficient in providing MCH  services, this was an expert opinion perspective, a quantitative Cost Effectiveness Analysis (CEA) to confirm these findings is recommended. To improve efficiency of the CHS in the district, challenges facing CHWs and Social cultural and economic factors that influence efficiency of the CHS in the district need to be addressed

Socio-cultural factors influencing male involvement in home-based care for people living with HIV and AIDS in Maseno Division, Western Kenya

Background: Home-based care has emerged as an effective method of providing costeffective and compassionate care to those infected with HIV and AIDS. Traditionally, women have been in the forefront in the provision of care for those infected with HIV and AIDS. However, there was low male involvement in home-based care services and little research has been done.Objective: To investigate socio-cultural factors that influence male involvement in home-based HIV and AIDS care in Western Kenya.Design: Cross-sectional, descriptive study.Setting: Maseno division Western Kenya.Subjects: Two hundred and fourty eight (248) caregivers selected fromregistered support groups in Maseno Division, Western Kenya.Results: Overall, 29% of the caregivers were male, 75% took care of close relatives and 59.7% of the respondents had not received formal training on home-based care. Those respondents who had no employment indicated low levels of male involvement than those who had employment (χ2=17.18, p=0.001). Male caregivers performed fewer nursing activities such as changing soiled beddings (μ =1.97, SD=0.95) compared to the general activities like buy and carry food home (μ=2.95, SD=1.15). Respondents who had high number patients were statistically more likely to report lower levels of male involvement than those who had lower number of patients χ2=61.69, p= 0.025. Although 92% agreed that men should be involved in care giving, over 50% said that it is taboo for men to cook or fetch water, that care giving is for women, and the men who participate in housework are considered weak or bewitched. Male involvement in home-based care variables were negatively correlated with socio-cultural variables. For example, there was a significant strong negative relationship between taboo for married man to cook with men cook and feed HIV patients (r =- 0.69, P=0.01). Conclusion: Full participation of males’ in HIV home care is hindered by the current socio-cultural constraints. There is need to address it through health education using context-specific and culturally-sensitive messages

The ZmRCP-1 promoter of maize provides root tip specific expression of transgenes in plantain

Background Bananas and plantains (Musa spp.) provide 25 % of the food energy requirements for more than 100 million people in Africa. Plant parasitic nematodes cause severe losses to the crop due to lack of control options. The sterile nature of Musa spp. hampers conventional breeding but makes the crop suitable for genetic engineering. A constitutively expressed synthetic peptide in transgenic plantain has provided resistance against nematodes. Previous work with the peptide in potato plants indicates that targeting expression to the root tip improves the efficacy of the defence mechanism. However, a promoter that will provide root tip specific expression of transgenes in a monocot plant, such as plantain, is not currently available. Here, we report the cloning and evaluation of the maize root cap-specific protein-1 (ZmRCP-1) promoter for root tip targeted expression of transgenes that provide a defence against plant parasitic nematodes in transgenic plantain. Results Our findings indicate that the maize ZmRCP-1 promoter delivers expression of β-glucuronidase (gusA) gene in roots but not in leaves of transgenic plantains. In mature old roots, expression of gusA gene driven by ZmRCP-1 becomes limited to the root cap. Invasion by the nematode Radopholus similis does not modify Root Cap-specific Protein-1 promoter activity. Conclusions Root cap-specific protein-1 promoter from maize can provide targeted expression of transgene for nematode resistance in transgenic plantain

Characteristics Of Caregivers And Households Practicing Bottle-Feeding In Kisumu East District

There is documented evidence of increased risk of infant mortality in formula-fed versus breast- fed infants and young children. The potential danger especially in resource-poor settings with poor water and sanitation conditions is well known. In reducing risks associated with the sanitation of feeding equipment, bottle-feeding is often discouraged with cup and spoon promoted as better alternatives. To determine the characteristics of caregivers and households with bottle-fed young under-twos in a rural community of Kisumu East district, a cross-sectional descriptive survey using a structured questionnaire was carried out. The data were analyzed using SPSS version 17.0. Frequencies for non-continuous data were obtained and the relationship between the background variables and the bottle-feeding of the infant/child was established through the chi-square test. A total of 494 caregivers with young ones, under-twos, were interviewed. The findings from the study showed that of the 406 respondents addressing questions on bottle-feeding the previous night prior to the survey, 91 (22.4%) were practicing infant bottle-feeding. Answers to the question “who assisted the mother during delivery”, revealed that 88 children were bottle-fed, 38(43.2%) of whom were delivered under skilled attendance while out of the 314 children not bottle-fed, 145 (46.2%) were delivered under skilled attendance. Some of the indicators found to be significantly different included: main source of household income which was found to be significantly associated (p=0.044) with bottle-feeding, child’s age was significantly (P =0.008) different with respect to bottle-feeding and breast-feeding initiation after birth was significantly (p = 0.004) associated with bottle-feeding. The tendency to bottle-feed was lower among those with complete immunization status compared to those with incomplete immunization. This association with immunization indicates that facility delivery coupled with faithfulness in visits throughout the immunization schedule, promotes contact with the health facility staff and potentially has a significant role in promoting good infant and child feeding practices. In conclusion, infant/young child bottle-feeding is still a public health issue in resource-poor settings. Promotion of safe infant/young child feeding practices for improving nutritional and health status of children especially in the resource-poor settings should be advocated especially where bottle-feeding is still in high use. There is need for community-based strategies to bring about a change that addresses the current prevalence of bottle-feeding found in the study area