Prevalence and associated factors of hepatitis B virus among patients attending an STI health facility in Nairobi, Kenya

Objectives: The study aimed at determining the distribution of HBV infection, immunity status and associated factors among STI clinic attendees in Kenya.Study design: The study was a cross sectional descriptive study that followed a quantitative approach. It was conducted from April to June 2014. Questionnaires were used to collect data and from the consenting participants blood was drawn and screened for HBsAg, anti- HBV and anti-HBc serologySetting: The study was carried out at the STI clinic -specialized treatment Centre in Nairobi.Subjects: Systematic random sampling was used to enroll the subjects.200 consenting STI attendees aging between the ages of 18 to 60 years were recruited.Results: The mean age of the study subjects was 32.77 years (SD=8.638) and a median of 31 years. Among the 200 samples analyzed, the prevalence rates of HBsAg and anti- HBV were found to be 19/200 (9.5%) and 53/200 (26.5%) respectively. The major associated factors of hepatitis B transmission that were found to statistically significant among the study population were unprotected sex (p -value 0.004*<0.05), number of sexual partners (p-value 0.003<0.05) and those with genital ulcers (p-value <0.001). Majority of the study subjects had immunity from natural infection 53/200 (26.5%).Conclusion: Sexual mode of transmission of hepatitis B was found to be associated with HBV infection among the STI attendees in Kenya. HBV is a vaccine preventable infection and the results highlight the importance of HBV vaccination among STI clinic visiting patients and their clients/partners

Immunization coverage and its determinants among children aged 12 - 23 months in a peri-urban area of Kenya

Introduction: The institutionalization of strong immunization services over recent years has ensured that today more than 70% of the worlds' targeted population is reached. In Kenya, approximately 77% of children aged 12-23 months are fully vaccinated with some districts reporting even lower levels of coverage. However, low immunization coverage remains a challenge in low income and high population settings such as Kaptembwo Location, Nakuru district. Methods: A cross sectional community based survey was undertaken between January and March 2011. Cluster sampling method was employed. Data was collected using pretested interviewer guided structured questionnaires through house to house visits. Data was analyzed in SPSS using descriptive, bivariate and multivariate logistic regression to identify independent predictors of full immunization. Results: Complete immunization coverage was 76.6%. Coverage for specific antigens was; BCG (99.5%), OPV0 (97.6%), OPV 1(98.7%), OPV2 (96.6%), OPV3 (90.5%), Penta 1(98.9), Penta 2 (96.6%), Penta 3 (90.0%), Measles (77.4%). The drop-out rate between the first and third pentavalent vaccine coverage was 8.9%. Predictors of full immunization included number of children within the family, place of birth of the child, advice on date of next visit for growth monitoring and opinion on the health immunization services offered. Conclusion: Complete immunization coverage among children aged 12-23 months is still below target. Efforts to improve vaccination coverage must take into account the immunization determinants found in this study. There is need to focus on strengthening of awareness strategies.Pan African Medical Journal 2013; 14:

Factors Associated With Nutritional Status among Children with Visceral Leishmaniasis (Vl) Attending Kacheliba Subcounty Hospital, West Pokot County, Kenya

Visceral Leishmaniasis (VL) causes considerable morbidity and mortality in Kenya. However, data on the factors associated with nutritional status among children aged 5-12 years at Kacheliba Sub County Hospital is nonexistent. This study sought to determine factors associated with the nutritional status among children aged 5-12 years with visceral leishmaniasis, in West Pokot County. A descriptive cross-sectional design was employed involving both quantitative and qualitative approaches to data collection. Two hundred and three children aged 5-12years with VL were enrolled in the study. Data was analyzed using chi-square to test the association between the variables, odds ratio reression was used to test the multivariate relationships between various independent and dependent variables. WAZ and HAZ scores measures showed that malnutrition among these children there existed at 30.5% o. Factors such as the guardian age, sex, monthly income, the length of illness, number of children in the household as well as level of education influenced the prevalence of malnutrition among these children. The study also established that knowledge, attitude and practices of these guardians also influenced prevalence of malnutrition among the children. The study concluded that there was interplay between malnutrition and VL among children and recommended that detailed surveys to establish the prevalence of malnutrition among communities where VL is rampant and coming up with initiatives of ensuring food security was necessary

Obstetric Complications in Two Major Urban Maternal and Child Clinics in Mogadishu Somalia: A Cross Sectional Study on Prevalence and Associated Factors

Somalia has the highest adult lifetime risk of maternal mortality of 1 in 18. Few pregnant women visit the antenatal care and have access emergency obstetric care services to detect and handle complications at childbirth. We assessed the cases of obstetric complications and associated factors in two major maternal and child clinic in urban areas of Mogadishu Somalia. This cross sectional study was conducted between 2015 and 2016 among women who had given birth at Banadir Maternity and Children Hospital and SOS Maternal and Child Clinic in Mogadishu Somalia. Participants’ information was collected through interviews and health records. Data were analyzed using bivariate and multivariable logistic regression to determine factors associated with being prepared, with statistically significant level at p < 0.05. A total of 203 out of 385 (52.7%) women had obstetric complications. This included 30% severe bleeding, 29.6% obstructed labor, 23.6% hypertensive disorder and 14.3% cases of sepsis. Employment status (OR 0.6, 95% CI 0.4 to 0.9) monthly income (OR 1.7, 95% CI 1.1 to 3.2), antenatal care attendance (OR 0.7, 95% CI 0.5 to 0.9), ANC initiation in the first trimester (OR 0.7, 95% CI 0.5 to 0.9), home delivery assisted by Traditional Birth Attendance (OR 1.7, 95% CI 1.7 to 2.4), worsening of past medical condition preceding the current birth (OR 1.6, 95% CI 1.2 to 2.3), current pregnancy termination (OR 1.9, 95% CI 1.1 to 3.4), vaginal delivery (OR 0.5, 95% CI 0.3 to 0.6), delivery assisted by a nurse (OR 0.4, 95% CI 0.3 to 0.6) were associated with obstetric complication. The high proportion of obstetric complication especially hemorrhage among women in Mogadishu Somalia, requires that women be monitored closely during pregnancy to reduce complications and death, in the absence of medical interventions. Economic empowerment, improved awareness of ANC, training of TBA would be key in reducing the obstetric complication in this region Keywords: Obstetric complications, prevalence and associated factors, two major urban maternal and child health clinic, Mogadishu Somalia

Barriers and Facilitators to Uptake of Prostate Cancer Screening in a Kenyan Rural Community

Background: Prostate cancer (PC) is curable with early detection, yet it remains a major public health problem globally and a leading  cause of mortality among men. The objective of the study was to explore the barriers and facilitators to the uptake of prostate cancer screening among men aged 40–69 years in a rural community in Kenya. Methods: We utilized an explorative qualitative design and purposive sampling to select participants. Six focus group discussions (FGDs)  and seven in-depth interviews were conducted among 59 men aged 40–69 years and key informants in Kiambu County, Kenya. Data was collected using a semi-structured guide and content analysis was done. Results: The facilitators of screening included experience of symptoms, proximity and prominence of cancer, accessibility, and advocacy. The barriers to screening included lack of knowledge, fatalistic beliefs, low risk perception, stigma, and male dominance factors. Conclusion: This study provides vital information for the development of interventions to enhance shared decision-making in regard to PC screening. Capacity building of clinicians, task shifting and provision of well-coordinated affordable culturally sensitive screening services should be explored. The concerted effort among policy makers and all health care workers to overcome the stated barriers to  screening is highly recommended. &nbsp

Epidemiologie und Bedeutung von Trypanosomosen, Helminthosen und durch Zecken übertragene Infektionen bei Rindern in Busia, Kenia

Deckblatt-Impressum Dedication Contents Abbreviations Introductiion Overall objective Literature review Materials and methods Results Discussion Conclusions Summary Zusammenfassung References Annexes Acknowledgement SelbständigkeitserklärungThe overall objective of this study was to identify and assess the disease risk factors constraining cattle productivity in Busia District, western Kenya, through a cross-sectional and a longitudinal disease survey. During the cross-sectional disease study (November 2002), the prevalence of infections with trypanosomes, tick-borne disease parasites in cattle and faecal egg counts in calves were determined in the six divisions of Busia District. Results of the questionnaire indicated that farmers considered trypanosomosis, TBDs and helminthosis as the major constraints to productivity in cattle. Using the BCT, four types of trypanosome infections were detected (T. vivax, T. congolense, T. brucei as well as mixed infections) and the overall mean trypanosome prevalence in cattle was 4.7% (95% CI = 4.0-5.6). Trypanosome prevalence in cattle was significantly (p < 0.05) higher in Budalang i and Funyula divisions than in other divisions. Adults and young stock had significantly higher trypanosome infections than calves. Free grazed and free grazed/tethered cattle had significantly higher trypanosome infections than either tethered or stall-fed animals. The overall mean prevalence of Anaplasma, Babesia and Theileria parasites in cattle was 16.4%, 4.8% and 6.9%, respectively. The prevalences of Babesia and Theileria parasites were significantly lower in Matayos and Township divisions than in other divisions. The risk of infections with Anaplasma and Babesia was significantly higher in adults and young stock than in calves but this did not apply for infections with Theileria parasites. There were significantly more calves (70%) with high FEC compared to those (30%) shedding moderate to low numbers of faecal eggs. Compared to the other divisions, the risk of trypanosome and helminth infection was higher in Budalang i and Funyula. The ages of animals and husbandry practices were significantly associated with the risk of infections with trypanosomes, helminths and TBD-parasites. Based on the findings of the cross-sectional study, a longitudinal survey was designed in Budalang i and Funyula divisions. Hence, 200 ear-tagged local Zebu and exotic/crossbred cattle stratified by breed and age, were purposively sampled from each division. Consequently, a total of 400 head of cattle (120 heifers, 120 calves and 160 adults) was selected. The animals were randomly assigned to 4 trial groups consisting of 50 (20 adults, 15 heifers and 15 calves) animals per group. Group I consisted of control animals, while Group II had animals treated prophylactically with isometamidium chloride at 1 mg/kg bw. Group III consisted of animals treated with albendazole 10mg/kg bw and Group IV had animals treated with albendazole at 10mg/kg bw and prophylactically with isometamidium chloride at 1 mg/kg. All treatments were repeated every three months during the 9-month follow-up study period. The mean hazard ratio of new trypanosome infections in Budalang i and Funyula Divisions indicated that, untreated control animals were consistently at the highest risk of new infections followed by albendazole and then ISMM-treated animals. The risk of new trypanosome infections was lowest in the albendazole/ISMM treated animals. Results also revealed that the trypanosome infection rates of G. pallidipes were significantly higher than those of G. fuscipes implying that G. pallidipes had a higher vectorial capacity for animal trypanosomosis than G. fuscipes. With regard to infections with Anaplasma spp, treated animals, and local Zebus were significantly at a lower risk of infection compared to other animals. The risk of infection with Anaplasma and Babesia parasites also increased with age. For the infection with Theileria parasites, exotic/crossbred cattle had a significantly higher risk of infection than local Zebus. The shedding of FEC was significantly reduced by albendazole treatment. Calves had significantly higher FEC than any other age group. In addition, free grazed animals were also shedding significantly higher numbers of eggs than tethered and stall-fed animals. There were significantly more cows and heifers shedding trematode eggs than calves. It was found that, trypanosome- and helminth-infections significantly reduced PCV of infected cattle. Single or combined albendazole and ISMM treatments resulted in significant improvements of PCV values. Trypanosome- and helminth-infections also significantly depressed weight gains in calves although helminth- infections were a much more important factor. Trypanosome- and helminth- infections were significantly associated with mortality in cattle. In calves however, helminth-infections were correlated with more deaths compared to trypanosome-infections. Abortions and stillbirths were restricted to untreated and albendazole treated cattle, implying that trypanosome infection significantly increased the rate of abortion in pregnant cows. It can therefore be concluded that, trypanosome- and helminth-infections significantly constrain cattle productivity in Busia District, and that approaches to cost-effective disease management should avoid dealing with each disease in isolation, but rather employ an integrated approach.Eine ökonomische Rinderhaltung wird im südlichen Afrika durch zahlreiche Tierkrankheiten erschwert. Das Hauptziel der vorliegenden Arbeit waren die Identifizierung und Bewertung von Krankheitsrisiken, die sich besonders negativ auf eine profitable Rinderproduktion auswirken. Zu diesem Zweck wurden eine Querschnittsuntersuchung und eine Langzeitstudie in dem im westlichen Kenia liegenden Bezirk Busia durchgeführt. Bei der Querschnittsuntersuchung im November 2002 wurden die Prävalenz von Nagana (Trypanosomosis) und durch die Zeckenbefall bedingten Parasitosen bestimmt. Ausserdem wurden die Ei- Ausscheidungen (EPG) durch Nematoden und Trematoden (unter besonderer Berücksichtigung von Kälbern) quantifiziert. Diese Untersuchung erstreckte sich auf alle sechs Verwaltungsbezirke von Busia. Eine Auswertung vorab verteilter Fragebögen kam zu dem Ergebnis, dass die Bauern Nagana, zeckenbedingte Erkrankungen und durch Infektionen mit Helminthen verursachte Krankheiten als Haupthindernisse für eine profitable Rinderhaltung bewerteten. Bei der Untersuchung ergab sich, dass die Nagana durch drei Trypanosomenarten (T. brucei, T. congolense und T. vivax) sowie durch deren Mischinfektionen verursacht wurde. Die durchschnittliche Prävalenz betrug 4,7% (95% Konfidenzintervall = 4,0 5,6). In zwei Verwaltungsbezirken (Funyula und Budalang´i) war die Prävalenz signifikant (p < 0,05) höher als bei den Kälbern in den übrigen Bezirken. Kälber hatten signifikant weniger Trypanosomeninfektionen als Jungrinder (1-3 Jahre) und erwachsene Tiere. Ein signifikant geringeres Infektionsrisiko wurde bei Stallhaltung und/oder Anpflocken der Tiere beobachtet. Die durchschnittlichen Prävalenzen für Infektionen mit Anaplasmen, Babesien und Theilerien betrugen 16,4, 4,8 beziehungsweise 6,9%. Im Vergleich zu den übrigen Verwaltungsbezirken wurden bei Tieren in Matayos und Township signifikant weniger Infektionen mit Babesien und Theilerien diagnostiziert. Mit zunehmendem Alter gab es einen signifikanten Anstieg der Infektionsrate bei Anaplasmen und Babesien; dies galt jedoch nicht für Theilerien. Ungefähr 70% aller untersuchten Kälber hatten hohe EPG- Werte, während die übrigen 30% nur mässige oder niedrige EPG- Werte aufwiesen. Alter und/oder Managementsysteme korrelierten signifikant mit dem Infektionsrisiko für Trypanosomen, Helminthen und durch Zeckenbefall bedingte Erkrankungen. Die neun Monate dauernde Langzeitstudie wurde in Funyula und Budalang´i durchgeführt, wo das Infektionsrisiko mit Trypanosomen signifikant höher als in allen anderen Regionen war. In jedem der beiden Verwaltungsbezirke wurden 200 Rinder verschiedener Rassen (Zebu, exotisches Milchvieh sowie deren Kreuzungsprodukte) mit Ohrmarken gekennzeichnet. Diese wurden in vier Gruppen zu jeweils 50 Rindern (20 erwachsene Tiere, 15 Färsen, 15 Kälber) aufgeteilt. Die erste Gruppe wurde als Kontrolle geführt; bei der zweiten wurden alle Tiere in Abständen von drei Monaten prophylaktisch mit Isometamidium (1mg/kg KGW) behandelt. Die Tiere der dritten Gruppe erhielten zeitgleich eine Behandlung mit Albendazol (10mg/kg KGW), während bei der vierten Gruppe sowohl Isometamidium als auch Albendazol in den angegebenen Dosierungen verwendet wurden. Die Analyse des mittleren Infektionsrisikos ergab, dass die Tiere aus der Kontrollgruppe das höchste Risiko einer Neuinfektion mit Trypanosomen hatten, gefolgt von den mit Albendazol behandelten Tieren. Die gleichzeitig mit Albendazol und Isometamidium behandelten Tiere wiesen das geringste Infektionsrisiko auf. Bei den Sektionen von Tsetsefliegen ergab sich, dass G. pallidipes eine signifikant höhere vektorielle Kapazität als G. fuscipes aufwies. Behandelte Rinder und lokale Zebus hatten ein signifikant geringeres Risiko mit Anaplasmen als alle anderen Tiere. Das Risiko von Infektionen mit Anaplasmen und Babesien stieg mit zunehmendem Alter. Milchviehrassen und deren Kreuzungsprodukte hatten ein signifikant höheres Infektionsrisiko für Theilerien. Die EPG-Werte waren bei Kälbern signifikant höher als bei allen anderen Altersgruppen. Tiere mit freiem Weidegang hatten signifikant höhere Ei-Ausscheidungen als aufgestallte oder angepflockte Tiere. Durch Behandlung mit Albendazol wurde die Ei- Ausscheidung signifikant reduziert. Kühe und Färsen hatten signifikant höhere Ausscheidungen von Trematodeneiern. Infektionen mit Trypanosomen und Helminthen führten zu einem signifikanten Abfall des Hämatokritwertes. Albendazol- und Isometamidiumbehandlungen allein oder in Kombination resultierten in signifikanten Verbesserungen des Hämatokrit. Infektionen mit Trypanosomen und/oder Helminthen hatten auch einen signifikanten, negativen Einfluss auf die Gewichtsentwicklung, wobei Infektionen mit Helminthen sich besonders negativ auswirkten. Es bestand eine signifikante Korrelation zwischen Mortalitätsrate und Infektionen mit Trypanosomen bzw. Helminthen. Infektionen mit Helminthen führten zu besonders vielen Todesfällen bei Kälbern. Aborte oder Totgeburten wurden bei unbehandelten oder nur mit Albendzol behandelten Kühen registriert, was den Schluss zulässt, das Trypanosomeninfektionen die Hauptursache waren. Infektionen mit Nagana und/oder Helminthen wirken sich also besonders negativ auf die Produktivität der Rinder aus. Die Bekämpfung nur eines Problems würde unter diesen Umständen nicht zu einer nachhaltigen Verbesserung führen. Es werden deshalb integrative Ansätze zur gleichzeitigen Bekämpfung der Hauptprobleme empfohlen

Timing and Determinants of Tuberculosis Treatment Interruption in Nairobi County, Kenya

Tuberculosis (TB) treatment is a key pillar in the management and control of TB. Service delivery within the treatment facilities plays an important role in ensuring treatment adherence by TB patients. A prospective cohort study involving 25 health facilities, 25 facility in-charge officers and 291 patients diagnosed as new sputum smear positive (SM+) between December 2014 and July 2015 was undertaken. The aim of the study was to estimate the median time to treatment interruption, associated factors and overall predictors of non-adherence to TB treatment. A total of 19 (6.5%) treatment interruptions were observed. The median time to default was 56 [95% CI, 36-105] days. Treatment in a non-public facility [AOR=0.210, 95% CI (0.046-0.952)] and facilities perceived to have adequate number of health care workers to offer Directly Observed Therapy (DOT) [AOR=0.195, 95% CI (0.068-0.56)] showed a lower odds of treatment interruption whereas attainment of secondary level education [AOR=5.28, 95% CI (1.18-23.59)] indicated a higher odds of treatment interruption. Non-clinical aspects of health care service delivery influence patient adherence to TB treatment. Health seeking behavior of groups considered to be high risk for treatment interruption should be incorporated into the design and delivery of TB treatment

Correlates for cardiovascular diseases among diabetic/hypertensive patients attending outreach clinics in two Nairobi slums, Kenya

Introduction:&nbsp;cardiovascular diseases (CVD) are the leading cause of death in the world. Over 80% of CVD related deaths occur in low- and middle-income countries (LMICs). Diabetes and hypertension, whose prevalence in Kenya is on the rise, are major risk factors for CVD. Despite this, studies indicate that awareness on the management of risk factors for CVD among diabetic/hypertensive patients in African populations is generally low. The aim of the study was to determine the risk factors for CVD among diabetic and/or hypertensive patients attending diabetes and hypertension management clinics in Korogocho and Viwandani slums of Nairobi. Methods:&nbsp;data were collected using questionnaires administered to 206 diabetic/hypertensive patients attending the clinics between July 2010 and February 2011. A review of these patients' medical records was done to determine the history of CVD outcomes such as hypertensive heart diseases, stroke and peripheral arterial diseases. Results:&nbsp;majority (66.5%) of the study participants were females mainly in the 51-65 age category. The study findings revealed that 73 (33.4%) respondents had CVD outcomes. In addition, 41.8% of the respondents were not aware of the causes of diabetes/hypertension. Age category 51-65 years had the highest (43.8%) number of respondents with CVD. Sex of the respondents and awareness of the link between hypertension and CVD were significantly associated with CVD outcomes (p&lt;0.05) among the respondents. Conclusion:&nbsp;measures to improve awareness levels among patients at high risk of CVD outcomes are needed to complement other measures to reduce CVD risk among such patients

The reporting of adverse drug reactions by healthcare providers in Kenya

Background: Spontaneous and consistent reporting is the cornerstone of adverse drug reaction (ADR) reporting. Under reporting is an enormous obstacle to effective pharmacovigilance (PV).Objective: To determine factors affecting ADR reporting by healthcare providers in selected hospitals in Kirinyaga County, Kenya.Methods: A cross-sectional study was conducted in four selected hospitals. A pretested self-administered questionnaire was utilised to collect data. Stratified sampling was used to recruit 224 healthcare providers. Statistical Package for Social Sciences (SPSS) version 23 analysed data. The Chi-squared test was used to determine association. Binary logistic regression assessed strength of association. Outcomes were considered significant at p-values of &lt;0.05.Results: Of 224 questionnaires distributed 215 were completed, 159 (74%) healthcare providers had not reported ADRs to the Pharmacy and Poisons Board (PPB) within the last 3 months. In total, 92 (42.8%) healthcare providers knew about reporting guidelines; 194 (90.2%) were not trained in ADR reporting. Those aware of the reporting guidelines and those trained were more likely to report ADRs. Continuing medical education was the preferred source of information about ADRs. The main barriers to ADR reporting include inadequate training, delayed feedback, not knowing where or to whom to report, lack of a PV centre in the county and inadequate&nbsp; access to ADR forms and guidelines.Conclusion: ADR reporting among healthcare providers could be improved. Age, profession, level of education, knowledge and&nbsp; training affected ADR reporting. Healthcare provider centred training and promotion of ADR reporting tools are necessary to boost ADR reporting and increase patient safety. Keywords: adverse drug reaction; spontaneous reporting; healthcare provider; pharmacovigilance, Kenya

Why are Neonates Dying? Socioeconomic and Proximate Determinants of Neonatal Mortality among Stable Low-Birth-Weight (LBW) Infants in Kenya

Background: Neonatal mortality rates are very high in Kenya, like the rest of Sub-Saharan Africa. The sustainable development goals aim to reduce the current 21 neonatal deaths per 1,000 live births to below 12 deaths per 1,000 live births. The rate of decline in Neonatal mortality in many countries is very slow compared to other childhood mortality rates. The objective of this study was to determine the socioeconomic and proximate determinants of neonatal mortality in Kenya. Methodology: A cohort study was carried out at Pumwani Maternity hospital, Thika Level 5 hospital and Machakos Level 5 hospital in Kenya with a sample of 343 stable LBW infants (≤2000g). Informed by the concepts of the Mosley and Chen (1984) analytical framework, several socioeconomic and proximate characteristics were included in the study. Cross tabulations and multiple logistic regression analyses were done to determine the relationships between the determinants and neonatal mortality. Results: The mean birth weight was 1492.6 g (SD=275.3) and mean gestational age was 30.3 weeks. Most infants (59.8%, N=343) were female. Incidence of neonatal mortality was 8.5% (n=340). Household income, birth complications, birth weight, gestational age and multiple births were significant determinants of neonatal mortality among the LBW infants weighing £2000 grams. Conclusion and recommendations: The findings affirm the Mosley and Chen (1984) analytical framework on determinants of neonatal survival. The study provides useful information on determinants of neonatal mortality that is relevant to the Kenyan context and applicable to other low income countries. Keywords: neonatal survival; neonatal mortality; socioeconomic determinants; proximate determinants; low-birth-weight infant