Nutritional Status of Children Aged 6 to 59 Months in Community Based Education and Service Centres (Cobes) in Western Kenya

Protein-energy malnutrition remains a major global problem. In Kenya, the prevalence of stunting and underweight has remained stable for over a decade. In Western Kenya the prevalence has remained at 30% stunting, 20% underweight and 6% wasting. Community Based Education and Service (COBES) centres are annually used by Moi University College of Health Sciences for community diagnosis of various health problems including malnutrition. The objective was to determine the prevalence of malnutrition in children aged 5 to 59 months in selected COBES health centres in Western Kenya. Cross-sectional studies were carried out between March and May 2008 in 7 out of 15 COBES centres in Western Kenya. Cluster sampling technique was used with each health centre as the sampling unit. Anthropometric measurements were performed on all children aged 6-59 months within the households sampled. The sample size depended on the number of cases seen in the households within the period of study. A total of 70 households per Health Centre were sampled. Any child between 6 months and 59 months of age in each household was sampled for nutritional status assessment. Anthropometric measurements were done on a total of approximately 700 children in the seven Health Centres: (Stunting- HAZ<-2, Wasting-WHZ <-2, underweight –WAZ<-2 and MUAC, < 12.5mm). The nutritional status of the children was determined using the WHO recommended Zscore values as well as the Kenya Government Ministry of Health recommended charts based on anthropometric measurements . Analysis of the data was carried out using Epi-info 2000 computer software. Meteitei showed the highest malnutrition revalence (53% HAZ, 15% WHZ, 27% WAZ and 18.1 MUAC) whereas Chulaimbo showed the lowest prevalence (7% HAZ, 3% WAZ). The other centres showed mixed prevalence. The reason for high prevalence in Meteitei could not be immediately ascertained but one of the possibilities could be dependence on tea and sugarcane as major cash crops at the expense of food crops. Prevalence of malnutrition in Chulaimbo was the lowest probably due to mixed farming practised in the area or successful health education in the population. The nutritional status of the children studied was within the normal range in the rest of the Centres

Possible Biochemical Markers in Protein-Energy Malnutrition and Malaria in Children in Western Kenya

This study was carried out to determine possible biochemical markers in children suffering from Plasmodium falciparum malaria and Protein-Energy Malnutrition in a Hospital setting in Western Kenya. Spectrophotometric assays of selected biochemical parameters namely, albumin, total proteins, glucose, glutamate oxaloacetate transaminase, glutamate pyruvate transaminase and bilirubin, were determined. The assays were done on serum samples obtained from children < 5 years of age admitted to the paediatric ward as well as outpatient clinics at Webuye District Hospital and Moi Teaching and Referral Hospital in Western Kenya suffering from either or both of the two disease conditions. Plasma albumin levels showed 33% of the children to be below the normal range and 40% above normal; mean total protein concentration was 56.0 mg/l; mean glucose concentration was 65 mmol/l, glutamate oxaloacetate transaminase and glutamate pyruvate transaminase concentrations were 9.0 and 5.9 μl/l respectively. Total bilirubin was 0.3 mg/dl while mean concentration for creatinine was 0.75 mg/dl. The biochemical markers studied did not show any unusual values at the time of the assays, but serum glucose and albumin levels showed potential as diagnostic markers for the two disease conditions.Keywords: Biochemical markers, spectrophotometry, protein-energy malnutrition, Western KenyaEast and Central African Journal of Pharmaceutical Sciences Vol. 15 (2012) 18-2

Sensitivity and specificity of point-of-care circulating Cathodic antigen test before and after praziquantel treatment in diagnosing Schistosoma mansoni infection in adult population co-infected with human immunodeficiency virus-1, North-Western Tanzania.

BACKGROUND: The effect of Human Immunodeficiency Virus-1 (HIV-1) on CD4+ Th2 cells is hypothesized to affect parasitological diagnosis of Schistosoma mansoni using Kato Katz technique. Thus, the use of more sensitive technique such as Point-of-Care Circulating Cathodic Antigen (POC-CCA) test is recommended. However, the sensitivity of this diagnostic test in diagnosing S.mansoni infection and the usefulness of it in monitoring efficacy of praziquantel drug in presence of HIV-1 co-infection remains inconclusive. The Primary objective of the present study was to assess accuracy of the POC-CCA test in diagnosing S.mansoni infection before and after praziquantel treatment in adult population co-infected with HIV -1. METHODS: A prospective longitudinal study was conducted among individuals aged 15-55 years at Igalagala village, north-western Tanzania. At baseline and 4 weeks after treatment, a single stool and urine samples were collected from each participants. Kato Katz (KK) technique and Point-of-Care Circulating Cathodic Antigen tests were used for diagnosis of Schistosoma mansoni. RESULTS: At baseline, based on KK and POC-CCA, the prevalence of S.mansoni was 57.8% (95%CI: 52.9-62.4) and 87.5% (95%CI: 83.9-90.4). Based on KK technique and POC-CCA test, 3.6% and 5.7% of the study participants were co-infected with S.mansoni and HIV-1. At baseline, in the general population, the sensitivities of POC-CCA test using KK technique and combine gold standard were 96.3%(95%CI: 93.1-98.3) and 97.6%(95%CI:95.5-98.9) respectively. In the HIV-1 seropositive group, at baseline, the sensitivities of POC-CCA test using KK technique and combined gold standards, were 93.3%(95%CI:68.1-99.8) and 96%(95CI%:79.6-99.9). Four weeks after treatment, in general population, the sensitivities of POC-CCA test using KK technique and combined gold standards were 47.8%(95%CI:26.8-69.4) and 84.4%(95%CI:74.4-91.7). In the HIV-1 seropositive group, using KK technique, the sensitivity was 100% (95%CI:2.5-100). CONCLUSION: The sensitivity of POC-CCA in diagnosing S.mansoni infection was higher than KK technique in adult individuals likely to have low infection intensity and co-infected with HIV-1. However, its sensitivity decreases following praziquantel treatment but remained higher than Kato Katz technique. If the goal of the post-treatment is to identify uncured individuals, then POC-CCA test offers the best choice

Protein-Energy Malnutrition And Malaria Antibody Profiles In Pre-School Children In Western Kenya: A Potential Diagnostic Tool

Protein-energy malnutrition is a serious clinical condition with high prevalence in areas where Plasmodium falciparum is highly endemic such as western Kenya. There is a major need to determine the relationship between PEM and malaria antibody profiles especially in an area where malaria is endemic. The objective of this work, therefore, was to determine the association between PEM and specific malaria antibodies and the potential diagnostic value of the antibodies in children aged between 5 and 59 months. Cross- sectional surveys as well as analysis of sera for specific malaria antibodies were carried out at Asembo Division, Bondo District, Kisumu County, Nyanza Province. A total of sixty villages identified through random sampling with each household as the sampling unit were used for data collection. Two thousand, one hundred and twelve (2112) Children < 5 years of age were sampled in three successive cross- sectional surveys: The first survey included children < 3 years of age while the subsequent two surveys included children < 5 years of age. Anthropometric measurements were carried out followed by finger prick blood sample for assay of antibodies in sera of the study children. Statistical variables (Odds Ratio, at 95% CI) were determined using SPSS 11 and SAS computer packages. Both Multivariate and Bivariate analyses were carried out. Epi-info 2002 package was used to determine anthropometric variables. Demographic variables and malaria parasite counts were determined for all the children sampled. Circumsporozoite Surface Protein (CSP) IgG antibody was found to be significantly associated with stunting and underweight (p<0.05) but not with wasting. Liver Stage Antigen (LSA) IgG antibody was significantly associated with wasting only (p<0.05) while Merozoite Surface Protein (MSP) IgG antibody was not significantly associated with any malnutrition state. The mean concentration of CSP IgG was elevated in stunted, wasted and underweight in comparison to controls. Liverstage antigen 1 IgG was elevated in stunted children only as compared to controls, whereas MSP IgG was low in all PEM cases as compared to controls. Specific Plasmodium falciparum antibody profiles could accurately be used to determine the association between malaria and Protein-Energy Malnutrition

Nutritional Status Of Children Aged 6 T0 59 Months In Community Based Education And Service Centres (Cobes) In Western Kenya

Protein-energy malnutrition remains a major global problem. In Kenya, the prevalence of stunting and underweight has remained stable for over a decade. In Western Kenya the prevalence has remained at 30% stunting, 20% underweight and 6% wasting. Community Based Education and Service (COBES) centres are annually used by Moi University College of Health Sciences for community diagnosis of various health problems including malnutrition. The objective was to determine the prevalence of malnutrition in children aged 5 to 59 months in selected COBES health centres in Western Kenya. Cross-sectional studies were carried out between March and May 2008 in 7 out of 15 COBES centres in Western Kenya. Cluster sampling technique was used with each health centre as the sampling unit. Anthropometric measurements were performed on all children aged 6-59 months within the households sampled. The sample size depended on the number of cases seen in the households within the period of study. A total of 70 households per Health Centre were sampled. Any child between 6 months and 59 months of age in each household was sampled for nutritional status assessment. Anthropometric measurements were done on a total of approximately 700 children in the seven Health Centres: (Stunting- HAZ<-2, Wasting-WHZ <-2, underweight –WAZ<-2 and MUAC, < 12.5mm). The nutritional status of the children was determined using the WHO recommended Z- score values as well as the Kenya Government Ministry of Health recommended charts based on anthropometric measurements. Analysis of the data was carried out using Epi-info 2000 computer software. Meteitei showed the highest malnutrition prevalence (53% HAZ, 15% WHZ, 27% WAZ and 18.1 MUAC) whereas Chulaimbo showed the lowest prevalence (7% HAZ, 3% WAZ). The other centres showed mixed prevalence. The reason for high prevalence in Meteitei could not be immediately ascertained but one of the possibilities could be dependence on tea and sugarcane as major cash crops at the expense of food crops. Prevalence of malnutrition in Chulaimbo was the lowest probably due to mixed farming practised in the area or successful health education in the population. The nutritional status of the children studied was within the normal range in the rest of the Centres

Examining characteristics, knowledge and regulatory practices of specialized drug shops in Sub-Saharan Africa: a systematic review of the literature.

BACKGROUND: Specialized drug shops such as pharmacies and drug shops are increasingly becoming important sources of treatment. However, knowledge on their regulatory performance is scarce. We set out to systematically review literature on the characteristics, knowledge and practices of specialized drug shops in Sub-Saharan Africa. METHODS: We searched PubMed, EMBASE, WEB of Science, CAB Abstracts, PsycINFO and websites for organizations that support medicine policies and usage. We also conducted open searches using Google Scholar, and searched manually through references of retrieved articles. Our search included studies of all designs that described characteristics, knowledge and practices of specialized drug shops. Information was abstracted on authors, publication year, country and location, study design, sample size, outcomes investigated, and primary findings using a uniform checklist. Finally, we conducted a structured narrative synthesis of the main findings. RESULTS: We obtained 61 studies, mostly from Eastern Africa, majority of which were conducted between 2006 and 2011. Outcome measures were heterogeneous and included knowledge, characteristics, and dispensing and regulatory practices. Shop location and client demand were found to strongly influence dispensing practices. Whereas shops located in urban and affluent areas were more likely to provide correct treatments, those in rural areas provided credit facilities more readily. However, the latter also charged higher prices for medicines. A vast majority of shops simply sold whatever medicines clients requested, with little history taking and counseling. Most shops also stocked popular medicines at the expense of policy recommended treatments. Treatment policies were poorly communicated overall, which partly explained why staff had poor knowledge on key aspects of treatment such as medicine dosage and side effects. Overall, very little is known on the link between regulatory enforcement and practices of specialized drug shops. CONCLUSIONS: Evidence suggests that characteristics and practices of specialized drug shops differ across rural and urban locations, and that these providers are highly responsive to client demand. However, there is a dearth in knowledge on how regulatory enforcement influences their characteristics and practices, and what strategies can be employed to strengthen the governance of the retail pharmaceutical sector

Predictors of Extra-Marital Partnerships among Women Married to Fishermen along Lake Victoria in Kisumu County, Kenya

BACKGROUND: The vulnerability of women to HIV infection makes establishing predictors of women's involvement in extra-marital partnerships critical. We investigated the predictors of extra-marital partnerships among women married to fishermen. METHODS: The current analyses are part of a mixed methods cross-sectional survey of 1090 gender-matched interviews with 545 couples and 12 focus group discussions (FGDs) with 59 couples. Using a proportional to size simple random sample of fishermen as our index participants, we asked them to enrol in the study with their spouses. The consenting couples were interviewed simultaneously in separate private rooms. In addition to socio-economic and demographic data, we collected information on sexual behaviour including extra-marital sexual partnerships. We analysed these data using descriptive statistics and multivariate logistic regression. For FGDs, couples willing to participate were invited, consented and separated for simultaneous FGDs by gender-matched moderators. The resultant audiofiles were transcribed verbatim and translated into English for coding and thematic content analysis using NVivo 9. RESULTS: The prevalence of extra-marital partnerships among women was 6.2% within a reference time of six months. Factors that were independently associated with increased likelihood of extra-marital partnerships were domestic violence (aOR, 1.45; 95% CI 1.09–1.92), women reporting being denied a preferred sex position (aOR, 3.34; 95% CI 1.26–8.84) and spouse longer erect penis (aOR, 1.34; 95% CI 1.00–1.78). Conversely, women's age – more than 24years (aOR, 0.33; 95% CI 0.14–0.78) and women's increased sexual satisfaction (aOR, 0.92; 95% CI 0.87–0.96) were associated with reduced likelihood of extra-marital partnerships. CONCLUSION: Domestic violence, denial of a preferred sex positions, longer erect penis, younger age and increased sexual satisfaction were the main predictors of women's involvement in extra-marital partnerships. Integration of sex education, counselling and life skills training in couple HIV prevention programs might help in risk reduction