1
|
Owiny MO, Ngare BK, Mugo BC, Rotich J, Mutembei A, Chepkorir K, Sitawa R, Obonyo M, Onono JO. Assessment of community perceptions and risk to common zoonotic diseases among communities living at the human-livestock-wildlife interface in Nakuru West, Kenya: A participatory epidemiology approach. PLoS Negl Trop Dis 2023; 17:e0011086. [PMID: 36701376 PMCID: PMC9904458 DOI: 10.1371/journal.pntd.0011086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/07/2023] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Zoonoses account for most of the emerging and re-emerging infections in Kenya and in other low to medium-income countries across the world. The human-livestock-wildlife interface provides a nexus where transmission and spread of these zoonotic diseases could occur among communities farming in these areas. We sought to identify perceptions of the community living near the Lake Nakuru National Park in Kenya. METHODS We used participatory epidemiology techniques (PE) involving Focus Group Discussion (FGD) among community members and Key Informant Interviews (KII) with the health, veterinary, and administration officers in July 2020. We used listing, pairwise matching, and proportional piling techniques during the FGDs in the randomly selected villages in the study area from a list of villages provided by the area government officers. Kruskal-Wallis test was used to compare the median scores between the zoonotic diseases, source of information, and response to disease occurrence. Medians with a z-score greater than 1.96 at 95% Confidence Level were considered to be significant. Content analysis was used to rank qualitative variables. RESULTS We conducted seven FGDs and four KIIs. A total of 89 participants took part in the FGDs with their ages ranging from 26 to 85 years. Common zoonotic diseases identified by participants included anthrax, rabies, and brucellosis. Anthrax was considered to have the greatest impact by the participants (median = 4, z>1.96), while 4/7 (57%) of the FGDs identified consumption of uninspected meat as a way that people can get infected with zoonotic diseases. Community Health Volunteers (Median = 28, z = 2.13) and the government veterinary officer (median = 7, z = 1.8) were the preferred sources of information during disease outbreaks. CONCLUSION The participants knew the zoonotic diseases common in the area and how the diseases can be acquired. We recommend increased involvement of the community in epidemio-surveillance of zoonotic diseases at the human-wildlife-livestock interface.
Collapse
Affiliation(s)
- Maurice Omondi Owiny
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
- * E-mail:
| | - Ben Kipchumba Ngare
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Bernard Chege Mugo
- Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Jacob Rotich
- Department of Health, County Government of Nakuru, Nakuru, Kenya
| | - Arithi Mutembei
- Department of Agriculture, Wajir County Government, Wajir, Kenya
| | | | - Rinah Sitawa
- Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Mark Obonyo
- Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Joshua Orungo Onono
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
2
|
Kigen HT, Boru W, Gura Z, Githuka G, Mulembani R, Rotich J, Abdi I, Galgalo T, Githuku J, Obonyo M, Muli R, Njeru I, Langat D, Nsubuga P, Kioko J, Lowther S. A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015. Pan Afr Med J 2020; 36:127. [PMID: 32849982 PMCID: PMC7422748 DOI: 10.11604/pamj.2020.36.127.19786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 06/03/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. Methods we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli. Results during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). Conclusion we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.
Collapse
Affiliation(s)
- Hudson Taabukk Kigen
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Waqo Boru
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Zeinab Gura
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - George Githuka
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Robert Mulembani
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Jacob Rotich
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Isack Abdi
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Tura Galgalo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.,African Field Epidemiology Network, Nairobi, Kenya
| | - Jane Githuku
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Raphael Muli
- Department of Health, County Government of Nairobi, Nairobi, Kenya
| | - Ian Njeru
- Ministry of Health, Nairobi, Kenya.,Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | - Daniel Langat
- Ministry of Health, Nairobi, Kenya.,Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | | | | | - Sara Lowther
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Analogbei T, Dear N, Reed D, Esber A, Akintunde A, Bahemana E, Adamu Y, Iroezindu M, Maganga L, Kiweewa F, Maswai J, Owuoth J, Ake JA, Polyak CS, Crowell TA, Falodun O, Song K, Milazzo M, Mankiewicz S, Schech S, Golway A, Mebrahtu T, Lee E, Bohince K, Hamm T, Parikh A, Hern J, Lombardi K, Imbach M, Eller L, Peel S, Malia J, Kroidl A, Kroidl I, Geldmacher C, Kafeero C, Nambuya A, Tegamanyi J, Birungi H, Mugagga O, Nassali G, Wangiri P, Nantabo M, Nambulondo P, Atwijuka B, Asiimwe A, Nabanoba C, Semwogerere M, Mwesigwa R, Jjuuko S, Namagembe R, Bagyendagye E, Tindikahwa A, Rwomushana I, Ssentongo F, Kibuuka H, Millard M, Kapkiai J, Wangare S, Mangesoi R, Chepkwony P, Bor L, Maera E, Kasembeli A, Rotich J, Kipkoech C, Chepkemoi W, Rono A, Kesi Z, Ngeno J, Langat E, Labosso K, Langat K, Kirui R, Rotich L, Mabwai M, Chelangat E, Agutu J, Tonui C, Changwony E, Bii M, Chumba E, Korir J, Sugut J, Gitonga D, Ngetich R, Kiprotich S, Rehema W, Ogari C, Ouma I, Adimo O, Ogai S, Okwaro C, Maranga E, Ochola J, Obambo K, Sing'oei V, Otieno L, Nyapiedho O, Sande N, Odemba E, Wanjiru F, Khamadi S, Chiweka E, Lwilla A, Mkondoo D, Somi N, Kiliba P, Mwaipopo M, Mwaisanga G, Muhumuza J, Mkingule N, Mwasulama O, Sanagare A, Kishimbo P, David G, Mbwayu F, Mwamwaja J, Likiliwike J, Muhumuza J, Mcharo R, Mkingule N, Mwasulama O, Mtafya B, Lueer C, Kisinda A, Mbena T, Mfumbulwa H, Mwandumbya L, Edwin P, Olomi W, Adamu Y, Akintunde A, Tiamiyu A, Afoke K, Mohammed S, Harrison N, Agbaim U, Adegbite O, Parker Z, Adelakun G, Oni F, Ndbuisi R, Elemere J, Azuakola N, Williams T, Ayogu M, Enas O, Enameguono O, Odo A, Ukaegbu I, Ugwuezumba O, Odeyemi S, Okeke N, Umeji L, Rose A, Daniel H, Nwando H, Nicholas E, Iyanda T, Okolo C, Mene V, Dogonyaro B, Olabulo O, Akinseli O, Onukun F, Knopp G. Predictors and Barriers to Condom Use in the African Cohort Study. AIDS Patient Care STDS 2020; 34:228-236. [PMID: 32396478 DOI: 10.1089/apc.2019.0302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Consistent condom use is an inexpensive and efficacious HIV prevention strategy. Understanding factors associated with condom use and barriers to use can inform strategies to increase condom uptake. The ongoing African Cohort Study prospectively enrolls adults at 12 clinical sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, participants are asked about condom use at last sex with a regular partner. Robust Poisson regression models were used to evaluate predictors of self-reported condom use. Participants who reported not using condoms were asked to provide reasons. From January 2013 to September 2019, 2482 participants reported having at least one regular sexual partner in the preceding 6 months. Of those, 1577 (63.5%) reported using a condom at last sex. Condom use was more common among older participants, males, HIV-infected participants, and those with an HIV-infected partner. Married participants, those with a partner of unknown HIV status, and those reporting alcohol use were less likely to report condom use at last sex. Condom use at last sex also varied significantly by clinical site. Partner disapproval or refusal to use a condom was a consistent driver of disparities in condom use among participants who were HIV infected, female, and aged 18-24 years. Effective HIV prevention programs should integrate condom education with the tools necessary to negotiate condom use with regular partners.
Collapse
Affiliation(s)
- Tope Analogbei
- Health Implementation Program, Nigerian Ministry of Defense, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Abuja, Nigeria
| | - Nicole Dear
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Domonique Reed
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Allahna Esber
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Akindiran Akintunde
- US Army Medical Research Directorate—Africa, Abuja, Nigeria
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
| | - Emmanuel Bahemana
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Mbeya, Tanzania
| | - Yakubu Adamu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Nairobi, Kenya
| | - Michael Iroezindu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Nairobi, Kenya
| | - Lucas Maganga
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- National Institute of Medical Research—Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Jonah Maswai
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Kenya Medical Research Institute, Nairobi, Kenya
- Henry Jackson Foundation MRI, Kericho, Kenya
| | - John Owuoth
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Kenya Medical Research Institute, Nairobi, Kenya
- Henry Jackson Foundation MRI, Kisumu, Kenya
| | - Julie A. Ake
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Christina S. Polyak
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Trevor A. Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Frawley A, Rotich J, Delong A, Menya D, Naanyu V, Horowitz C, Fuster V, Litzelman D, Kamano J, Vedanthan R. PS015 Hypertension Related Skills Retention Among Community Health Workers in Rural Western Kenya: Process Evaluation of the Lark Hypertension Study. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
5
|
Frawley A, Rotich J, Delong A, Menya D, Naanyu V, Horowitz C, Fuster V, Litzelman D, Kamano J, Vedanthan R. PM203 Hypertension Knowledge Retention Among Community Health Workers in Rural Western Kenya: Process Evaluation of the Lark Hypertension Study. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
6
|
George G, Rotich J, Kigen H, Catherine K, Waweru B, Boru W, Galgalo T, Githuku J, Obonyo M, Curran K, Narra R, Crowe SJ, O’Reilly CE, Macharia D, Montgomery J, Neatherlin J, De Cock KM, Lowther S, Gura Z, Langat D, Njeru I, Kioko J, Muraguri N. Notes from the Field: Ongoing Cholera Outbreak — Kenya, 2014–2016. MMWR Morb Mortal Wkly Rep 2016; 65:68-9. [DOI: 10.15585/mmwr.mm6503a7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
7
|
Talam NC, Gatongi P, Rotich J, Kimaiyo S. Factors affecting antiretroviral drug adherence among HIV/AIDS adult patients attending HIV/AIDS clinic at Moi Teaching and Referral Hospital, Eldoret, Kenya. East Afr J Public Health 2008; 5:74-78. [PMID: 19024414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine important factors that affect antiretroviral drug adherence among HIV/AIDS male and female adult patients (18 years and above) attending Moi Teaching and Referral Hospital, Eldoret, Kenya. METHODS A cross sectional study involving 384 HIV/AIDS adult patients attending Moi Teaching and Referral Hospital, Eldoret was conducted. These patients were on ARV drugs. They were investigated for factors that affected their drug adherence based on observing the timing of doses and keeping of clinic appointments for drug refills during the months of May, June and July 2005. Data were collected from the respondents using interviewer-administered questionnaires to patients and self-administered questionnaires by ten key informants (nurses and clinicians in charge of HIV/AIDS clinic) selected by purposive sampling. The key variables examined were demographic, other characteristics of the patients and adherence factors. Data were analysed using Statistical Package for Social Sciences (SPSS) version 10.0 for frequencies, cross-tabulations and Chi-Squared test and statistical significance set at p < 0.05. RESULTS Sixty-eight percent of the respondents on ARVs were females. 52.1% had secondary and post secondary education. They were aged between 18-63 years (mean age 36.1 +/- 8.5 years). Results showed that only 43.2% adhered to the prescribed time of taking drugs. The most commonly cited reasons for missing the prescribed dosing time by the patients were: Being away from home 68.8%, being too busy 58.9%, forgetting 49.0%, having too many medicines to take 32.6% and stigma attached to ARVs 28.9%. There was no significant difference between males and females based on timing of taking medications (chi2 = 2.9412, p = 0.0861). On the basis of keeping clinic appointments, all the respondents claimed to adhere to scheduled clinics. However, from hospital records, it was established that only 93.5% of the respondents kept clinic appointments. The most common reasons for poor adherence to clinic appointments were; Being away from home (50%), forgetting (50%), being too busy (50%), stigma (70%), feeling sick (80%) and changes in work routine (60%). CONCLUSION The key factors affecting adherence were; being away from home, being busy and forgetting. It was recommended that patients should be educated on the importance of strict adherence to the prescribed doses of ARVs as a suitable measure of intervention. Future research should explore multiple-target interventions to resolve the barriers to adherence.
Collapse
Affiliation(s)
- N C Talam
- Department of Epidemiology and Nutrition, School of Public Health, Moi University, P O Box 4606, Eldoret, Kenya.
| | | | | | | |
Collapse
|
8
|
Ayaya SO, Sitienei J, Odero W, Rotich J. Knowledge, attitudes, and practices of private medical practitioners on tuberculosis among HIV/AIDS patients in Eldoret, Kenya. ACTA ACUST UNITED AC 2005; 80:83-90. [PMID: 16167721 DOI: 10.4314/eamj.v80i2.8651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tuberculosis (TB) is one of the major communicable diseases afflicting mankind today. Its prevalence is increasing with increase in HIV infection. It is important that doctors be able to correctly diagnose and institute proper management of patients with TB. OBJECTIVES To determine the knowledge, attitudes, and practices (KAP) of private medical practitioners in Eldoret on the management of TB. DESIGN Cross-sectional descriptive qualitative study. SETTING Private medical practitioners' clinics and the outpatient departments of private hospitals in Eldoret town, western, Kenya. Eldoret is a cosmopolitan town 350-km north west of Nairobi. It is the main town in the north Rift Valley with such infrastructure as roads, international airport, and banks. SUBJECTS Private medical practitioners in Eldoret. RESULTS Fifty three out of 70 private doctors were interviewed. Of these 84.9% were male. Only 5.7% knew that sputum for AAFBs is collected on spot, early morning, and spot, whereas 69.8% and 13.2% said it should be collected on three and six consecutive early mornings respectively. Sputum and chest X-ray were the most common investigations used to diagnose TB. Few doctors knew that the clinical features considered as suspicious for TB in children were failure to thrive (FTT) (20.6%), contact with open TB case (12.8%), and cough for more than two or more weeks (7.8%). Others wrongly considered cough for four or more weeks (9.2%). Features correctly considered of diagnostic value by a few of the private doctors in paediatric TB were: chest X-ray (19.8%), FTT (8.7%), positive sputum for AAFBs (8.7%), and history of contact with TB case (8.7%). A small number of doctors based their diagnosis on chest X-ray (38%), AAFBs (19%), and Keith-Jones criteria (6.3%). There were 16 regimes mentioned and used for the treatment of TB. The NLTP recommended regimes such as 2RHZ/4RH, 2RHZE/6HE, 2RHZ/6HE and 2SHRZE/1RHZE/5HRE, were used by 9(19.6%), 2(4.3%), 0% and 0% of the doctors respectively. The rest used unrecommended regimes and no doctor used the re-treatment regime of 2SHRZE/1RHZE/5RHE. Similar regimes were used for the HIV as for the non-HIV-infected patients. None of the interviewees had appropriate knowledge on all the areas of diagnosis, treatment, case recording, and follow up. CONCLUSION Most doctors were not aware of the correct diagnosis and treatment of TB and many used unrecommended treatment regimes. They were generally unfamiliar with the recording system of TB cases. Most doctors did not know the definitions of the various re-treatment cases. Continuing medical education on clinical management of TB patients is needed for doctors in private practice.
Collapse
Affiliation(s)
- S O Ayaya
- Department of Child Health and Paediatrics, Faculty of Health Sciences, Moi University, PO Box 4600 Eldoret, Kenya
| | | | | | | |
Collapse
|
9
|
Ayaya SO, Esamai FO, Rotich J, Olwambula AR. Socio-economic factors predisposing under five-year-old children to Severe protein energy malnutrition at the Moi teaching and referral hospital, Eldoret, Kenya. ACTA ACUST UNITED AC 2004; 81:415-21. [PMID: 15622936 DOI: 10.4314/eamj.v81i8.9203] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Malnutrition is one of the leading causes of morbidity and mortality in children aged five years and below. Risk factors for severe protein energy malnutrition (PEM) have been identified as ignorance, family size, mothers and fathers education, poverty, residence, chronic infections, and congenital defects or malformations. The role of such social factors as the caretaker, extended family, homestead surroundings, and family cohesiveness have not been studied in Kenya. OBJECTIVE To determine the social and economic factors that predispose children to severe PEM as seen at the Moi Teaching and Referral Hospital (MTRH), Eldoret. DESIGN Prospective and case control study. SETTING The MTRH, Eldoret, Paediatric wards, outpatient and MCH clinics over a 12 month period (June 2001 to June 2002). SUBJECTS Sixty six children aged 3 to 36 months with severe PEM attending the MTRH outpatient clinics and those admitted in the Paediatric wards were age-matched with 66 controls. METHODS A standard pretested questionnaire was used to interview caretakers with severely malnourished children and age-matched controls. The children were weighed after interviewing the caretakers. The data was entered on a computer and analysed using the statistical package for social sciences (SPSS) programme. RESULTS The social risk factors for PEM were single mothers (Odds Ratio) OR 14.93, p= 0.00001), young mothers aged 15-25 years (OR 3.95, p= 0.00020), the child's living conditions such as living in a temporary house (OR 3.627 p= 0.00257), caretaker who was not married to the child's parent (OR 0.10, p= 0.00005) and not staying with both parents in the past six months (OR 0.28606, p=0.00101). The economic risk factors were father's lack of ownership of land (OR 0.401, p= 0.01732), cattle (OR 0.24, p=0.00022), not growing maize (OR 0.15, p=0.00013), not growing beans (OR 0.36, p=0.00484) and ownership of small piece of land by grandfather (OR 6.00, p= 0.02274). Other risk factors were incomplete immunization (OR 3.87, p= 0.00151) and female sex (p=0.03721). CONCLUSION Poverty, social conditions under which the child was living, sex of the child and incomplete immunizations were risk factors for the severe protein energy malnutrition.
Collapse
Affiliation(s)
- S O Ayaya
- Department of Child Health and Paediatrics, Faculty of Health Sciences, Moi University, Eldoret, Kenya
| | | | | | | |
Collapse
|
10
|
Ayaya SO, Esamai FO, Rotich J, Liechty E. Perinatal mortality in the Special Care Nursery of Moi Teaching and Referral Hospital, Eldoret, Kenya. East Afr Med J 2004; 81:555-61. [PMID: 15868963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES To determine the mortality rate and causes of death of all infants admitted to the Special Care Nursery (SCN) of a tertiary referral hospital in rural Kenya. DESIGN Prospective and Cross-sectional study SETTING Special Care Nursery, Moi Teaching and Referral Hospital, Eldoret, Kenya. SUBJECTS All infants admitted to the Special Care Nursing (SCN). MAIN OUTCOME MEASURES Survival status at seven postnatal days; major causes of mortality and morbidity. RESULTS Three hundred and thirty five babies were studied between February and September 1999. Out of these 167 (49.9%) were male. There were 50 (15%) preterm and 124 (37.3%) low birth weight babies. There were 198 (76.2%) appropriate for gestational age (AGA), 46 (17.7%) small for gestational age and 16 (6.2%) large for gestational age babies. The seven day mortality rate of infants admitted to the Special Care Nursery was 66 (19.7%). Birth asphyxia and respiratory distress accounted for most deaths. Infants who were admitted primarily because the mother remained under general anesthesia generally did well. Logistic factors, including inadequate training for neonatal resuscitation in ward cadre of staff, unavailability of trained paediatricians and obstetricians, and inadequate operating theatre supplies were all found to delay treatment and likely to increase mortality. CONCLUSION Morbidity and mortality of infants born at the MTRH remain high. The most common cause of mortality remains birth asphyxia. Some causative factors, such as lack of resources or personnel, are logistic and could be rectified. Antenatal care had a significant positive impact on both morbidity and mortality.
Collapse
Affiliation(s)
- S O Ayaya
- Department of Child Health and Paediatrics, Faculty of Health Sciences, Moi University, PO Box 6121, Eldoret, Kenya
| | | | | | | |
Collapse
|
11
|
Williams LS, Rotich J, Qi R, Fineberg N, Espay A, Bruno A, Fineberg SE, Tierney WR. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology 2002; 59:67-71. [PMID: 12105309 DOI: 10.1212/wnl.59.1.67] [Citation(s) in RCA: 294] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Hyperglycemia at the time of acute ischemic stroke has been linked to worse outcome in both human and animal studies. OBJECTIVE To describe the prevalence and severity of hyperglycemia on hospital admission among acute ischemic stroke patients, to examine the independent relationship of admission hyperglycemia to all-cause mortality, and to document the inpatient management of hyperglycemia. METHODS Patients hospitalized with acute ischemic stroke at one hospital from July 1993 to June 1998 (n = 656) were identified. Demographic data, diagnoses, and blood glucose (BG) values were retrieved from the electronic medical record system. Admission stroke severity, fingerstick BG results, and new diabetes diagnoses were obtained by chart review. Hyperglycemia was defined as admitting random serum BG > or = 130 mg/dL. Hazard ratios (HR) for 30-day, 1-year, and 6-year mortality were calculated using multivariable Cox regression models. RESULTS Hyperglycemia at admission to hospital was present in 40% of patients with acute stroke. Patients with hyperglycemia were more often women and more likely to have prior diagnoses of diabetes and heart failure. Almost all of these patients remained hyperglycemic during their hospital stay (mean BG = 206 mg/dL), and 43% received no inpatient hypoglycemic drugs. Hyperglycemic patients had longer hospital stay (7 vs 6 days, p = 0.015) and higher inpatient hospital charges ($6,611 vs $5,262, p < 0.001). Hyperglycemia independently increased the risk for death at 30 days (HR 1.87, p < or = 0.01), 1 year (HR 1.75, p < or = 0.01), and 6 years after stroke (HR 1.41, p </= 0.01). CONCLUSIONS Admitting hyperglycemia was common among patients with acute ischemic stroke and was associated with increased short- and long-term mortality and with increased inpatient charges. Inpatient blood glucose management was suboptimal in this hospital. A trial of intensive treatment of hyperglycemia should be considered.
Collapse
Affiliation(s)
- L S Williams
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis 46202, USA.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
BACKGROUND Perinatal morbidity (PNM) is highest in the developing countries including Kenya. Studies on the perinatal morbidity in Moi Teaching and Referral Hospital (MTRH) have not been carried out. Furthermore, factors associated with PNM are unknown at the MTRH. OBJECTIVE To establish the causes and incidence of perinatal morbidity at the MTRH NewBorn Unit (NBU). DESIGN A retrospective study using case notes. SETTING The NBU of the MTRH in Eldoret, Kenya. SUBJECTS Babies who were admitted to the MTRH's Newborn Unit from January to December 1997. RESULTS The perinatal morbidity was 667 per 1000 babies admitted to the NBU. The most common reason for admission was mother under anaesthesia. The most common cause of morbidity was asphyxia. The mean maternal age was 24 years. The mean level of education was 1.7 years. More than fifty five per cent of the mothers were housewives. The mean birthweight was 2.75 kg (+/- 0.9 SD), 55.9% had normal birthweight, 37% were low birthweight and three per cent were large babies. The mean duration of stay in the NBU was 3.8 days. CONCLUSION Most of the admissions were Caesarean section babies who did not require admission. Younger mothers were more likely to have babies with neonatal sepsis, convulsions, pneumonia and asphyxia.
Collapse
Affiliation(s)
- S O Ayaya
- Department of Child Health and Paediatrics, Faculty of Health Sciences, Moi University, P.O. Box 4606, Eldoret, Kenya
| | | | | | | |
Collapse
|
13
|
Esamai F, Ayuo P, Owino-Ongor W, Rotich J, Ngindu A, Obala A, Ogaro F, Quoqiao L, Xingbo G, Guangqian L. Rectal dihydroartemisinin versus intravenous quinine in the treatment of severe malaria: a randomised clinical trial. East Afr Med J 2000; 77:273-8. [PMID: 12858920 DOI: 10.4314/eamj.v77i5.46632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the clinical efficacy and safety of rectal dihydroartemisinin (DATM--Cotecxin) and intravenous quinine in the treatment of severe malaria in children and adults. SETTING Moi Teaching and Referral Hospital, Eldoret, Kenya between July and November 1998. PATIENTS A total of sixty seven patients aged two to sixty years with severe malaria were studied. DESIGN This was an open randomised comparative clinical trial. OUTCOME MEASURES These were parasite clearance time, fever clearance time, efficacy and the side effect profile of the two drugs. RESULTS The two groups were comparable on admission on the clinical and laboratory parameters. The parasite clearance time was shorter in the rectal DATM group than quinine group. There was no statistical difference on the fever clearance time and cure rates in the two groups. The adverse reaction profile was better with rectal DATM than with quinine, tinnitus observed more in the quinine group. CONCLUSION Rectal DATM is faster in parasite clearance than quinine and is a safe and convenient alternative to quinine in the treatment of severe malaria.
Collapse
Affiliation(s)
- F Esamai
- Department of Child Health and Paediatrics, Faculty of Health Sciences, Moi University, P.O. Box 4606, Eldoret, Kenya
| | | | | | | | | | | | | | | | | | | |
Collapse
|