Clinical Outcomes Following Management of Adult Femoral Shaft Fractures by Surgery and Traction at Thika Level 5 Hospital

Objective: To compare the clinical outcomes of femoral shaft fractures managed surgically and conservatively by traction. Design: A prospective quasi experimental study at the Thika level 5 hospital. Methods: 148 adult patients who had sustained traumatic fractures of femur were prospectively enrolled and assigned into two treatment groups.69(46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%)patients were enrolled in group B and managed by skeletal traction. Patients were purposively assigned into group A after they were able to afford the implants into the surgica group and the rest into the conservative group. Clinical outcomes that were assessed in the wards and clinics included malunion rates, mobility and limb length discrepancy up to three months post discharge. Data was collected by history, physical examination and radiological evaluation using a standardized questionnaire. The data was compiled and analyzed using SPSS version 17. Persons’ chi square, odds ratio and logistic regression were used to measure associations, risk analysis and multivariate analysis. Results: No significant difference was noted between the two groups in terms of demographic data, fracture type and co;morbidities. Malunion rate of more than 5 degrees was seen in 11(15.9%) patients in group A compared to 34(43.1%) patients in group B (p< 0.001). Seven patients (10.1%) in group A had limb shortening greater than 2 cm compared to 20 patients(25.3%) in group B (P<0.011).Good functional outcomes were achieved in 38 patients (55.1%) who underwent surgery compared to 23 patients (29.1%) managed by traction (p< 0.004) Conclusion: The data indicates a better clinical outcome of managing femoral shaft fractures by surgery as compared to traction. It also indicates that clinicians in regional referral hospitals should be encouraged to use operative methods in femoral shaft fracture management primarily without delay. Keywords: fracture shaft femur, clinical outcome, malunion, functional outcome, limb shortenin

Cross-sectional study on effect of civil society organizations interventions on individuals infected with HIV in Busia County Kenya

Since the discovery of HIV in the early 1980s in Kenya, Civil Society Organizations have played a major role in its fight. The aim was to study effect of intervention on improved health, nutrition and income generation activities on individuals infected by HIV. A cross-sectional study was undertaken as a baseline with aquasi experimental study design to compare intervention and non intervention sites. Two hundred and seventeen (217) respondents out of which 69.1% were females and 30.9% males selected from four sub counties of Busia County. A structured questionnaire was administered to people infected with HIV in CSO intervention and non intervention sites. In depth interviews and Focus Group Discussions (FGDs) were performed using a guide. Structured forms guided the performance on clinical examination and anthropometry procedures. The Statistical Package for Social Scientist software was used to analyze quantitative data. Frequency distributions were calculated and visualized and Chi square test with odds ratios computed. NVIVO statistics software was used to analyze qualitative data. Audio and video recordings were transcribed verbatim, line by line coding used to manage discrete units of text, and data segments reviewed to illustrate people’s perspectives. A majority of respondents had primary level education (46.3%) and was self-employed (72.1%). HIV/AIDS awareness was high in both the non-intervention (84%) and intervention (79.8%) site, with access to information playing a major role in people’s understanding of HIV/AIDS (p<0.01). Majority of respondents (95.2%) in intervention and non-intervention (96.2%) sites had easy access to ARVs, with 48.1% sourcing drugs privately. Approximately 44.1% sourced ARVs therapy from government facilities with 30.3% from CSOs. Distance to health facilities was the main challenge for those accessing ARV drugs in intervention (22.0%) and non-intervention (39.7%) sites, (OR=2.3 (95%CI=1.2-4.5), p=0.01) was greater in the non-intervention sites. Lack of cash for transport (25% versus 27%) and weakness in the body (11% versus 16.4%) were other challenges as recorded. Most respondents (93.9%) had good ARV uptake, with 74% having reported no major health problems in the recent three months. Only 7% of respondents examined clinically had abnormal blood pressure. Mean body temperature was 36.43 degrees Celsius (std. dev. =0.734). Regarding weights classification, 13.7% of the respondents were underweight, 58.9% normal, 7.3% overweight, and 5% were obese and weights differed by gender (p<0.01) significantly. A large proportion (89.1% in intervention and 94.3% in non-intervention sites) of respondents was aware of good eating habits although they practiced poor eating patterns. In the morning, the trend was (71.9% and 62.4% in the intervention and non-intervention sites) respondents eat nothing. ‘Ugali’ (posho) and traditional vegetables was the most common type of food eaten during lunch (31.0% in intervention and 34.1% in the non-intervention site) and dinner (33.6% intervention and 25.1% in non-intervention sites). Fruits are hardly consumed by majority (42.1% and 45.3%). Provision of ARV (intervention (81.3%) and non-intervention sites (84.3%), (X2(df) =0.32(1), p=0.57) was the most common mode of support received. In focus groups discussion sessions, respondents mentioned of no direct financial benefits received from CSOs although many say they recognize what the government has done for them. In their discussion, it was revealed that CSOs initiate short term projects which do not last and when they wind up get compromise when projects end. This survey demonstrates the essential role played by implementing partners (CSOs) on improved health, nutrition and socio economic status. Influence on better access to medication, balanced diet, and economic change probably contributes to living a better and healthier life for those infected with HIV.Afr J Health Sci. 2017; 30(2):57-7

Risk factors for severe acute malnutrition among children aged 6-59 months admitted at Lubango Pediatric Hospital, Angola

Background: The 4th Millennium Development Goal (MDG) is to reduce the mortality rates among underfives by two thirds between 1990 and 2015. Efforts to prevent child deaths need to be stepped up in order to meet that target but the challenge is how to reduce morbidity and mortality among children with SAM. In SSA, the nutritional and health situation is worsening. The hospital case fatality rates(CFR) for SAM remain high due to faulty case management in resource-poor settings. Despite the improved understanding of the clinical management of SAM, the CFR among admitted children in SSA has remained between 20- 30%. This study sought to determine the social demographic and clinical risk factors associated with severe acute malnutrition among children admitted at Lubango Pediatric Hospital. Methods: This was a case-control design where cases were compared with age and sex -matched controls with weight for height. Data was collected using an interviewer administered structured questionnaire, with caregivers as respondents: Clinical history and examination was conducted by a trained clinician eliciting duration of illness and categorizing symptoms such as fever and cough among others. The Nutritional status of the child was determined using anthropometric measurement. A pre- HIV test counselling was done to the care takers and the ones who gave consent, an HIVantibody test was conducted to the child using Determine and unigold HIV rapid test followed by a post-test counselling for both the HIV positive and negative children. For children who had been admitted the same year, the files were found for confirmation of the diagnosis of the previous admission(s).Results: The significant predictors of severe malnutrition were family order, HIV test results, previous history of admission with diarrhea and malnutrition, duration of breast feeding and number of previous admissionsConclusion: The burden of severe malnutrition is still high among children admitted in hospital. There is need to strengthen breast feeding campaigns and family planning strategies. Further clinicians need to be proactive in assessing the risk of malnutrition in HIV positive children and children with recurrent admissions especially with malnutrition and diarrhea

Assessment of factors associated with the uptake of Provider initiated HIV counselling and testing (PITC) among clients at Kenyatta National Hospital Accident and Emergency Department, Nairobi, Kenya

HIV/AIDS has contributed to a high proportion of morbidity and mortality among people around the globe. Without proper care and treatment many more people will continue to perish, hence, to curb this, proper preventive measure needs to be put in place, for instance HIV testing and counseling. Despite the importance of this step, most HIV. infected patients are unaware of their HIV status. To improve the HIV status awareness, provider.initiated counseling and testing (PITC) was introduced. This study aimed to assess factors associated with PITC uptake. A cross sectional hospital.based survey of patients visiting Kenyatta National Hospital Accident and Emergency Department was carried out between August 2010 and November 2010. The survey comprised of 340 participants. A high proportion (96.2%) of the patients accepted to test for HIV. There was a significant association between PITC uptake and informal employment (P = 0.006), HIV risk behaviors (p = 0.04), decision to allow their children play with HIV positive children (p = 0.018), and fearing HIV test (P < 0.001). Having informal employment, HIV risk behaviours and not fearing to test for HIV was significantly associated with PITC uptake. More studies need to be carried out to identify barriers to PITC uptake. Keywords: PITC, risk behaviours, HIV/AIDS, Stigma, discriminatio

Cost effectiveness of using surgery versus skeletal traction in management of femoral shaft fractures at Thika level 5 hospital, Kenya

Introduction: A prospective quasi experimental study was undertaken at the Thika level 5 hospital. The study aimed to compare the costs of managing femoral shaft fracture by surgery as compared to skeletal traction. Methods: sixty nine (46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%) patients were enrolled in group B and managed by skeletal traction. Exclusion criteria included patients with pathological fractures and previous femoral fractures. Data was collected by evaluation of patients in patient bills using a standardized questionnaire. The questionnaire included cost of haematological and radiological tests, bed fees, theatre fees and physiotherapy costs. The data was compiled and analyzed using SPSS version 16. Person's chi square and odds ratios were used to measure associations and risk analysis respectively. Results: A higher proportion of patients (88.4%) in group A were hospitalized for less than one month compared to 20 patients (30.4%) in group B (p, 0.001).Total cost of treatment in group A was significantly lower than in group B. Nineteen (27.9%) patients who underwent surgery paid a total bill of Ksh 5000-7500 compared to 7(10.4%) who were treated  by traction. The financial cost benefit of surgery was further complimented by better functional outcomes. Conclusion: The data indicates a cost advantage of managing femoral shaft fracture by surgery compared to traction. Furthermore the longer hospital stay in the traction group is associated with more malunion, limb deformity and shortening.Key words: Fracture shaft femur, cost effectiveness, functional outcom

Effect of Civil Society Organizations on Health, Nutrition and Economic Status of People Living with HIV/ AIDS in Busia County, Kenya

 Introduction: Civil Society Organizations (CSOs) play a major role in HIV/AIDS response. Despite their massive effort to promote health care, nutrition and socio-economic empowerment to people living with the disease, documented data on the impact and value of their interventions remain scanty. Globally, people infected with HIV/AIDS by 2018 were estimated to be 37.9 millions recording 1.1 million mortalities in that year. HIV prevalence rate in Kenya was at 4.9% among the general population of ages 15-64 years [2]. In other reports, the national HIV prevalence was at 4.5% while males and females aged 15 to 24 years at 5.2% in 2018. Busia County had HIV prevalence rate of 7.7% in the same year [1]. Aim: The objective of this study was to determine the effect of CSOs interventions on health, nutrition and economic status of people living with HIV/AIDS in Busia County. Materials And Methodology: A quasi-experimental study design was done with structured and non-structured questionnaires administered to two hundred and twenty (220) participants at baseline and end line by registered CSOs with other facilitators. All permanent male and female residents infected with HIV aged between 15 and 64 years from comprehensive patient attendance lists obtained from the Ministry of Health (MoH) facilities qualified for the study. All respondents signed informed consent forms prior to participation. Qualitative in-depth data was obtained through focus group discussions(FGDs) from key informant interviews. Results: No statistically significant differences were reported due to gender, household size and education level recorded in both sites at baseline and end line. Access to HIV/AIDS information was higher in CSOs intervention sites (89.5%) than in non - intervention (73.2%) sites at end line. Respondents in the intervention group had a significant improvement in sourcing Antiretroviral (ARVs) drugs especially from private facilities (P<0.05) but no scientific difference in access to health care services between sites after CSOs intervention. Respondents receiving support for Income Generating Activities (IGA) reduced by 2.1% in the intervention sites at end line. Respectively those in non-intervention sites increased by 4.1%. The negative 6.2% Net Effect of Intervention (NEI) reported was nonetheless not statistically significant (OR=0.98 (95% CI=0.42- 1.5), p=0.48). Organizations such as Reproductive Health Initiatives' impact was reported despite others' existence lacked evidence from which to establish their impact of CSOs intervention. Initiation of home based care, Chama support and income generating projects to improve on the source of economic status for PLWHA were programs that supported the government in providing quality services. However, the programs they implement some possibly a duplication of health-related services, were primarily skewed on donor interest because of dependency [10]. Conclusion: CSOs intervention did not have a significant effect on access to HIV/AIDS information, access to health care services, their morbidity patterns, food intake and nutritional status as well as on economic status and income generating activities. This could be due to reports that, some implementing organizations lacked adequate documentation (comprehensive database, reliable and consistent data), eventually, often failing to monitor and evaluate projects they initiated. Recommendations:CSOs should work in collaboration with the government to develop sustainable interventions aimed at empowering PLWHA in improving their livelihood not only in Busia County but also across the Country. Access to ARVs from the nearest health facility will reduce suffering especially from opportunistic infections. Keywords: Civil Society Organizations, HIV/AIDS, People Living with HIV/AIDS(PLWHA

Family practices that influence the uptake of the Intergrated Management of Childhood Illnesses (IMCI) strategy among mothers at the MCH/FP clinic at Pumwani Maternity Hospital, Kenya

Background: Since 1999 the Government of Kenya has introduced the Integrated Management of Childhood Illness (IMCI) in an attempt to reduce child mortality. The IMCI strategy, developed by WHO and UNICEF, aims to improve the management of childhood illness at the primary health care level. The aim of this study was to determine the family practices that influence the uptake of the IMCI strategy among mothers in the MCH/FP clinic at Pumwani Maternity Hospital. Methods: A cross sectional survey was conducted at Pumwani Maternity Hospital MCH/FP clinic. A sample size of 385 mothers at the MCH/FP clinic was interviewed for quantitative data. All independent variables identified to significantly associate with ‘uptake of IMCI’ at bivariate analysis was considered together in a multivariate analysis. SPSS version 22 was used for statistical analysis. Results: Out of the 385 respondents interviewed, 78.4% children were well, 74.3% were of normal weight and 88.6% had been fully immunized. At multivariate analysis, statistically significant predictor family practices of IMCI uptake were fever experience, cough experience, living in Nairobi and giving iron supplements to the children.Conclusion: The uptake of the IMCI strategy, though high, was not optimal. There were many children who were underweight, had illnesses and were not fully immunized. These findings highlight the need for continuous strengthening of the IMCI strategy in health facilities

Factors associated with late presentation of suspected tuberculosis cases to tuberculosis management facilities: The case in Dagoretti district, Nairobi, Kenya

Background: Tuberculosis is a highly contagious disease accounting for a high number of deaths in the developing countries; its control can beeffectively achieved if individuals with the disease receive adequate and timely treatment. The objective of this study was to determine the factorsassociated with late presentation of suspects to tuberculosis management facilities in Dagoretti district in Nairobi, Kenya.Methods: A cross sectional study was conducted on patients aged 18 years and above attending TB clinics in Dagoretti District, Nairobi Kenya. A total of 426 TB suspects were interviewed. The study covered 8 clinics in Dagoretti district. Analysis was done using SPSS version 16.0 and Epi info version 6, this included Chi Square for Bivariate analysis and Binary Logistic Regression for Multivariate Analysis.Results: Out of the 426 tuberculosis suspects, 248 (58.2%) suspects had delayed in seeking medical care. In Bivariate analysis male gender (P=0.039, O.R=1.51; 95% Confidence Interval; 1.00- 2.27), level of education (Primary class 5-8) (P=0.001, O.R= 2.06; 95% C.I 1.34-3.19) and place of first medical care (drug store) (P= 0.013, O.R=1.63; 95% C.I 1.09-2.46) were all significantly associated with late presentation. After multivariate logistic regression, gender (P=0,019, OR=1.6), level of education (p=0.029, OR=1.26) and place of first medical care (P= 0.01 OR=1.27), were found to be significantly associated with late presentation. Conclusion: This study shows that age, level of education and place of first medical care are the factors associated with late presentation of suspects to tuberculosis management facilities.Key words: Tuberculosis, late presentation, management, suspects, participants, respondents, Keny

Factors associated with low levels of birth & death registration in Kieni East district of the Central Province of Kenya

Objective: To determine the factors associated with low levels of registration of births and deaths in Kieni East district.Methods: This was a cross-sectional study that adopted a convergent parallel mixed method design. The qualitative study was conducted through in-depth interviews held with District Civil Registrar and Assistant Chiefs. The quantitative study was conducted through a semi-structured questionnaire administered to 373 randomly selected heads of households.Results: Registration of births was found to be significantly associated to the mother’s level of educational attainment, age of the child, attendance to early childhood education, and the income level of the household head, while the Age of the deceased predicted death registration. The level of awareness on the need to register events was high; however, knowledge of the required duration for registration, the process of registration and the importance of registration was found lacking. Costs associated with registration and lack of property to inherit were the most cited reasons for failure to register birth and death occurrences respectively. Certain segments of the residents of the district were internally displaced persons of the 2007 post election violence who were facing challenges in the acquisition of the registration documents and replacement of lost registration documents.Conclusion: The study identified potential areas of intervention in improving birth and death registration in the district.Afr J Health Sci. 2013; 26:272-29

A Qualitative Study on Alcohol and Drug Abuse among Undergraduate (University Students) in The Coastal Region of Kenya

BACKGROUND: Substance use poses a significant threat to the health, social and economic fabric of families, communities and nations. In Kenya, alcohol and drug abuse has been identified as a hindrance to education, development and by extension, to national development. Alcohol and drug abuse has been associated with crime and indiscipline e.g. poor class attendance, poor performance, school dropout and destructive strikes that lead to damage the institution property or even death. Alcohol and drug abusers are also likely to lower their morals and engage in risky sexual activities that can lead to sexually transmitted diseases including HIV infection and AIDS. OBJECTIVES: The aim of this study therefore was to explore on the perceptions and the magnitude of substance abuse among undergraduate (University students) in the two public Universities in the coastal region of Kenya. Also find amicable solutions to curb the menace that can destroy the future of a generation aged between 18–29 years at the peak of their life. METHODOLOGY: This was a qualitative study involving undergraduate (University students), dean of students and counsellors from Pwani University and Technical University of Mombasa. Focus Group Discussions(FGDs) and Key informant interviews were used to collect data. The number of KIIs was guided by data saturation. Thematic analysis was done by identifying, coding, and categorizing patterns or themes found in the data. RESULTS: The problem of alcohol and substance abuse among undergraduate students was a reality. The commonly abused substances were alcohol, miraa (khat), marijuana (cannabis) and cigarettes. Some of the factors predisposing students to abuse drugs were; easy accessibility to drugs, peer pressure, availability of funds, excess freedom, male gender, stress, not being active in religious activities, poor parenting and the African culture that uphold substances such as alcohol as an acceptable social drink. Participants noted that alcohol and drug abuse had led to various negative effects. The major ones affecting the students being poor performance, risky sexual behaviour, and mental disturbances. Participants suggested that Universities ought to intensify awareness campaigns to sensitize students against substance use. CONCLUSION: The commonly abused substances were alcohol, marijuana, miraa (Khat) and tobacco. Alcohol and drug abuse has left a negative impact among undergraduates (university students). The main consequences being; discontinuation of studies, mental disturbances and risky sexual activities. All stakeholders must take action creating awareness among students on the negative effects of substance abuse. Universities should set up programs with an aim to curb substance abuse in the institutions of higher learning. The government should reinforce the set laws and regulations and deal with trafficking of illicit substances into the country. Keywords: Alcohol and drug abuse, substance abuse, undergraduate students, qualitative study, Keny