CHALLENGES FACING THE FEEDING PROGRAMMES IN PRE-PRIMARY SCHOOLS IN DIFFICULT CIRCUMSTANCES IN KENYA

Good nutrition is critical in the realization of the potentials in children and in maximizing the benefits derived from educational investment. This article presents the findings from the investigation on the challenges experienced in the feeding programme in pre-primary schools in difficult circumstances in Kenya. The study determined the challenges in the feeding programme in pre-primary schools in Isiolo County, Kenya and also explored the possible strategies that could be put in place to mitigate the challenges. The dependent variable was the feeding programme while the independent variables were the challenges. The target population was all the 200 public pre-primary schools in Isiolo County. Purposive sampling was used to select the schools, headteachers, teachers and parents. Data was collected using questionnaires and observation schedule. Descriptive survey design was deemed appropriate for the study. Qualitative data obtained was transcribed, analyzed thematically and presented descriptively with verbatim quotes. The study established that the feeding programmes were dependent on the government and donor funding. The level of parental participation was low and the food provided was not balanced. More importantly that the major challenges were; shortage of water, food insecurity, inaccessibility, insecurity and harsh climatic conditions It was recommended that the government and all the stakeholders should develop possible measures to deal with finances and cost options.  Article visualizations

Risk Management in Financial Information Systems using Bayesian Networks

During the last 20 years many technological advances have inundated the entire spectrum of our everyday lives. None of these advances has had such an impact like the IT revolution which can only compare with the Industrial Revolution of the 18th Century. The advent and acceptance of Information Technology as the norm rather the exception has seen this sector move from a tedious and cumbersome manually managed and run sector, to an almost paperless industry that is almost entirely dependent on Information Systems. With the growth of the dependency on IT, the impact of risk concerns on the development and exploitation of information systems has also increased exponentially. Within the financial services industry, risk management involves assessing and quantifying business risks, then taking measures to control or reduce them. These methods are generally built around a well structured process. However, the product coming from the different risk management steps is still largely informal, and often not analytical enough. This lack of formality hinders the automation of the management of risk-related information. Furthermore, these risk management system focuses on specific phases of the software life cycle, without recognizing that risks in one stage can have an impact on other stages. This necessitates the proposed study in order to propose a generic approach that may be deployed to mitigate risks from the early stages of financial information systems development for daily financial institution operations until the post-implementation phases. This paper proposes a new approach for performing a risk analysis study of financial information systems. It is aimed at developing a generic approach for Risk Analysis and Management applicable from the early phases of information system development unlike in the existing models which are applied after the development process. It can be utilized for identifying and valuating the assets, threats, and vulnerabilities of the information system, followed by a graphical modeling of their interrelationships using Bayesian Networks. The proposed approach will exploit the results of the risk analysis for developing a Bayesian Network model, which presents concisely all the interactions of the undesirable events for the system. Based on “what–if” studies of system operation, the Bayesian Network model identifies and prioritizes the most critical events. Keywords: Riks, risk management, Bayesian Network mode

Prevalence and Risk Factors for Perineal Trauma among Women at a Teaching and Referral Hospital in Kenya

Perineal trauma is classified according to the degree of structures involved or according to the depth of the injury. Mild perineal trauma is very common following vaginal delivery. Risk factors for perineal trauma include primiparity, precipitate labour, instrumental deliveries, pushing techniques and birth positions. Perineal trauma is associated with significant short-term and long-term complications. The objective of the study was to determine the prevalence and risk factors for perineal trauma among women at teaching and referral hospital in western Kenya. A cross-sectional study was carried out at the teaching hospital between April and May 2015. Two hundred and nine women who had come to deliver at the facility were consented to participate in the study. A structured checklist was used to obtain data from the women and make observations as skilled care givers attended to deliveries. All analyses were performed at 95% level of confidence. Two hundred and nine (209) deliveries were observed. Majority of the women, 76 (36.40%), were in the 20-24 age group. Ninety seven (46.10%) of them were para 0. Eighty one (38.8%) of the women sustained various types of perineal trauma. Supine position during delivery was the most preferred position, in 201 (96.2%), of the women. Age of the mother, parity, infant birth weight, and history of previous trauma, were statistically significant, associated with trauma in the univariate analysis (p=0.013; p=0.000; p= 0.010; p= 0.033) respectively. Adjusting for other factors, the odds of sustaining perineal trauma increased with increased birth weight (OR 2.878; p= 0.005) and decreased with increasing parity (OR 0.037; p=0.000). The prevalence of perineal tears as revealed by the study was 38.8%. This study recommended evidence based practice during labour and delivery in order to improve pelvic floor outcomes as well as reduce operative deliveries and long term morbidities. Key words: Perineal trauma, Risk factors, Prevalence, Women DOI: 10.7176/JHMN/65-09 Publication date: August 31st 201

PREVALENCE of psychiatric morbidity in a community sample in Western Kenya

Background:About 25% of the worldwide population suffers from mental, neurological and substance use disorders but unfortunately, up to 75% of affected persons do not have access to the treatment they need. Data on the magnitude of the mental health problem in Kenya is scarce. The objectives of this study were to establish the prevalence and the socio-demographic factors associated with mental and substance use disorders in Kosirai division, Nandi County, Western Kenya. Methods:This was a cross sectional descriptive study in which participants were selected by simple random sampling. The sampling frame was obtained from a data base of the population in the study area developed during door-to-door testing and counseling exercises for HIV/AIDS. Four hundred and twenty consenting adults were interviewed by psychologists using the Mini International Neuropsychiatric Interview Version 7 for Diagnostic and Statistical Manual 5th Edition and a researcher-designed social demographic questionnaire. Results:One hundred and ninety one (45%) of the participants had a lifetime diagnosis of at least one of the mental disorders. Of these, 66 (15.7%) had anxiety disorder, 53 (12.3%) had major depressive disorder; 49 (11.7%) had alcohol and substance use disorder. 32 (7.6%) had experienced a psychotic episode and 69 (16.4%) had a life-time suicidal attempt. Only 7 (1.7%) had ever been diagnosed with a mental illness. Having a mental condition was associated with age less than 60 years and having a medical condition. Conclusion:A large proportion of the community has had a mental disorder in their lifetime and most of these conditions are undiagnosed and therefore not treated. These findings indicate a need for strategies that will promote diagnosis and treatment of community members with psychiatric disorders. In order to screen more people for mental illness, we recommend further research to evaluate a strategy similar to the home based counseling and testing for HIV and the use of simple screening tools

Prevalence of lifestyle cardiovascular risk factors and estimated framingham 10-year risk scores of adults with psychotic disorders compared to controls at a referral hospital in Eldoret, Kenya

Introduction: Lifestyle factors such as smoking, alcohol use, suboptimal diet, and inadequate physical activity have been associated with increased risk of cardiovascular diseases. There are limited data on these risk factors among patients with psychosis in low- and middle-income countries. Objectives: This study aimed to establish the prevalence of lifestyle cardiovascular risk factors, and the 10-year cardiovascular risk scores and associated factors in patients with psychosis compared to controls at Moi Teaching and Referral Hospital in Eldoret, Kenya. Methods: A sample of 297 patients with schizophrenia, schizoaffective disorder, or bipolar mood disorder; and 300 controls matched for age and sex were included in this analysis. A study specific researcher-administered questionnaire was used to collect data on demographics, antipsychotic medication use, smoking, alcohol intake, diet, and physical activity. Weight, height, abdominal circumference, and blood pressure were also collected to calculate the Framingham 10-year Cardiovascular Risk Score (FRS), while blood was drawn for measurement of glucose level and lipid profile. Pearson’s chi-squared tests and t-tests were employed to assess differences in cardiovascular risk profiles between patients and controls, and a linear regression model was used to determine predictors of 10-year cardiovascular risk in patients. Results: Compared to controls, patients with psychosis were more likely to have smoked in their lifetimes (9.9% vs. 3.3%, p = 0.006) or to be current smokers (13.8% vs. 7%, p = 0.001). Over 97% of patients with psychosis consumed fewer than five servings of fruits and vegetables per week; 78% engaged in fewer than three days of vigorous exercise per week; and 48% sat for more than three hours daily. The estimated 10-year risk of CVD was relatively low in this study: the FRS in patients was 3.16, compared to 2.93 in controls. The estimated 10-year cardiovascular risk in patients was significantly associated with female sex (p = 0.007), older patients (p \u3c 0.001), current tobacco smoking (p \u3c 0.001), and metabolic syndrome (p \u3c 0.001). Conclusion: In the setting of Eldoret, there is suboptimal physical exercise and intake of healthy diet among patients with psychosis and controls. While the estimated risk score among patients is relatively low in our study, these data may be useful for informing future studies geared towards informing interventions to promote healthy lifestyles in this population

A system approach to improving maternal and child health care delivery in Kenyan communities and primary care facilities: baseline survey on maternal health

Background: Maternal, fetal and neonatal mortality are 10 to 100 fold higher in many low-income compared to high-income countries. Reasons for these discrepancies include limited antenatal care and delivery outside health facilities.Objectives: The study aimed at conducting a baseline survey to assess the current levels of maternal health indicators in six counties in Western Kenya.Methods: This was a cross sectional study conducted targeting women residing in Uasin-Gishu, ElgeyoMarakwet, TransNzoia, Bungoma, Busia and Kakamega counties who had given birth five years prior to the interview. Socio-demographic and maternal indicators were collected using forms adopted from KDHS 2009. Interviews were conducted in the homesteads between December 2015 and June 2016.Results: A total of 6257 women participated in the study, median age 27 years IQR 23-32. Majority of the women had post-primary level of education, were married and 40% were members of an income-generating activity. 56.8% were using modern family planning method, 49% attended WHO recommended four plus antenatal clinic visits and only 20% attended in the first trimester. Majority, 85% had their most recent delivery in a health facility.Conclusion: Findings suggest that women are not attending recommended four plus antenatal clinic visits and even those that attend are few are during the first trimester.Keywords: System approach, maternal and child health care, Kenyan communities

Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley Mother Baby Hospital: A longitudinal case-series study

Background: Eclampsia, considered a serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods: This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results: During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0-40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1-2.0). Conclusion: There is no benefit of emergency caesarean section for women with eclampsia. Instead, it increases the risk of perinatal adverse outcomes, including the risk of admission to the newborn unit and perinatal death

Low back pain among primary school teachers in Rural Kenya: Prevalence and contributing factors

Background: Low back pain (LBP) has been recognised as a common occupational problem with a high prevalence among work-related musculoskeletal disorders. Although there appears to be a high prevalence of LBP among school teachers, there is inadequate information on the prevalence and predisposing factors of LBP among primary school teachers in rural Western Kenya. Aim: To determine the prevalence, factors associated with LBP and physical disability caused by LBP. Setting: The setting was public schools in rural Western Kenya selected by simple random sampling method. Methods: A cross-sectional study was conducted among primary teachers from public schools using a self-administered questionnaire. The questionnaire included information on LBP, demographic data, occupational and psychosocial factors and disability score. The 12-month prevalence, associated factors and LBP disability were analysed. Results: The 12-month self-reported prevalence of LBP among primary teachers was 64.98%, with close to 70% of them reporting minimal disability. The logistic regression analysis showed that female gender (odds ratio [OR]: 1.692, p < 0.02) was associated with LBP and high supervisor support (OR: 0.46, p < 0.003) was negatively associated with LBP. Conclusion: The prevalence of LBP among primary school teachers in rural Western Kenya is 64.98%, with the majority of them reporting minimal disability. The identified risk factors were female gender and low supervisor support. The presence of work-related psychosocial risk factors in this study suggests a comprehensive approach in evaluation and management of LBP. Preventive measures should be in place to prevent and reduce the progression of LBP disability

Knowledge and perceptions on childhood asthma among care-takers of children with asthma at a National Referral Hospital in Western Kenya: a descriptive study

Background: Identifying knowledge gaps in asthma self-management and identifying existing myths is an important step in determining appropriate health education and demystifying the myths so as to enhance asthma control.Objective: To identify existing knowledge gaps and perceptions among the caregivers of asthmatic children.Methods: A cross sectional study was done among caretakers of asthmatic children aged 6-11 years at Moi Teaching and Referral Hospital. Data on knowledge and perceptions among caretakers was collected using a questionnaire.  Results: A total of 116 caretakers were recruited of whom 71.6% were mothers. Although 60% of the caretakers had asthma medications at home, only a third felt their children were asthmatic. Eighty four (72.4%) had basic asthma knowledge. Syrups were preferred to inhalers by 70.7%, with 64.7% believing that inhalers were for the very sick. Only 36 (31%) felt preventer medications in asthma were necessary. Acceptance of asthma as a diagnosis and presence of asthma drugs were significantly associated with better knowledge of asthma, p-values 0.015 and 0.009 respectively.Conclusion: Most caregivers perceive syrups to be better despite having good basic knowledge on asthma. There is need to address asthma perceptions among caretakers in resource poor settings which is likely to improve control.  Keywords: Childhood asthma, care-takers, Western Kenya