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PubMed1998

Health care technology in public health institutions in Kenya.

OBJECTIVE: To highlight the role of technology in the practice of medicine and the delivery of health care in public hospitals, the problems encountered and suggested solutions. DESIGN: The article reviews the process of technology planning, acquisition, management and assessment. Analysis of results and observations leads to recommendation and suggestions. SETTING: Health care technology assessment in hospitals in Kenya and South Africa 1998. INSTITUTIONS: Twenty four hospitals in Kenya and 54 hospitals in South Africa. RESULTS: Technology assessment as a health policy instrument and planning tool has not gained recognition in Kenya; acquisition of health care equipment is not done on the basis of evidence from relative advantage outcome, cost of ownership or returns on investment; tender boards lack the technical expertise to make clinical and technical evaluations of health care equipment and; health care is compromised due to poor equipment acquisition. CONCLUSION: The planning, deployment, management and assessment of technology should be fully integrated into health policy and planning. Policy guidelines should include the regulation, control and utilisation of health care technologies.

Delivery of Health Care↗
PubMed2000

Effective tuberculosis control and health sector reforms in Kenya: challenges of an increasing tuberculosis burden and opportunities through reform.

During the period from 1980 to 1997, the annual number of new tuberculosis cases increased four-fold in Kenya, and had reached approximately 50,000 cases by 1998. During the same time period, the government per capita expenditure on health dropped from US$9.5 to US$3.5. Since 1983, Kenya has been decentralising financial responsibility and decision-making power to the districts. In addition, the late 1980s saw the introduction of cost-sharing schemes for most health services, excluding tuberculosis (TB) treatment. In the midst of these changes, a dual epidemic of TB and HIV/AIDS emerged, and is presently over-burdening the traditional public health system. In response, the National Leprosy and Tuberculosis Control Programme (NLTP) is seeking a wider network of service providers and new approaches to the prevention and treatment of TB in the country. The history of health sector reform in Kenya is summarised and the role of the NLTP in these reforms assessed. Recent approaches taken by the NLTP to sustain effective TB control, which draw on the environment of a changing and flexible health system, are expressed. Participation of the NLTP in components of health sector reform, particularly decentralisation, integration, financing through cost-sharing and public/private mix, are highlighted.

Acquired Immunodeficiency Syndrome↗
PubMed2000

What do family planning clients and university students in Nairobi, Kenya, know and think about emergency contraception?

Currently, emergency contraception is seldom used in Kenya. As part of a larger study designed to provide insight into the possible roles for the method in Kenya, we assessed the knowledge of and attitudes towards emergency contraception in two groups of potential users, and we focus on these data specifically in this paper. We interviewed clustered samples of clients at ten family planning clinics in Nairobi (n = 282) and conducted four focus group discussions with students at two universities in Kenya (n = 42). Results show that despite relatively low levels of awareness and widespread misinformation, when the method was explained, both clients and students expressed considerable interest, but also expressed some health and other concerns.

Adult↗
PubMed2001

HIV/AIDS: the knowledge, attitudes and behaviour of dentists in Nairobi, Kenya.

The purpose of this study was to assess dentists' knowledge of HIV/AIDS, as it affects them in their workplace, attitudes pertaining to universal precautions and treatment of patients with HIV/AIDS and their behaviour toward their patients. A descriptive cross-sectional survey was carried out. A 34-item questionnaire was delivered to a random sample of 145 dentists based in Nairobi, Kenya. The response rate was 72% (N = 105). Just over half the sample (53%) knew that the first AIDS patient in Kenya was reported in 1984. Ninety eight per cent knew that the main mode of transmission of HIV/AIDS in Kenya is heterosexual contact. All the respondents reported the use of gloves during clinical procedures and use of an autoclave for sterilisation of instruments was reported by more than 85%. Most dentists indicated a willingness to treat HIV/AIDS patients while those with dissenting views preferred that they be treated in dedicated clinics or academic teaching hospitals. Nearly half felt that the risk of HIV transmission in the clinic is high. The incongruity between perceived knowledge, reported practise and attitudes suggests that there is a need for continuing education courses to enable dentists to practice their profession with due care as regards patients with HIV/AIDS. In addition, courses on working with patients with HIV/AIDS should be offered so as to remove ignorance and fear. Results from this survey show that there is a fair level of knowledge as far as HIV/AIDS is concerned. The results also indicate that a greater compliance with universally accepted guidelines for infection control is needed, as it remains low for dentists working in the capital city of a country that records a rising number of new HIV/AIDS cases every day.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

PVO / NGO initiatives, Africa. Kenya AIDS League Group.

The Kenya AIDS League Group is a community based organization established in October 1994. Its main goals and objectives are to offer hardship funds for people living with HIV/AIDS and to create awareness of HIV/AIDS among the broader community. A team of 42 volunteers is engaged in information and education campaigns on HIV/AIDS. Project activities include counseling youth on STDs and visiting schools and homes to reach adolescents with HIV/AIDS prevention methods. On home visits, volunteers speak with both teenagers and their parents. Volunteers conduct outreach with groups of college students, social workers, sex workers, and street children. Income generation projects sponsored by the league are beginning to benefit people living with HIV/AIDS. For more information, please contact: Hillary S. Maloba, Kenya AIDS League Group, PO Box 731, Mumias, Kenya.

Acquired Immunodeficiency Syndrome↗
PubMed1998

HIV and Kenya's homosexuals.

According to UNAIDS, fewer than 5% of AIDS cases in Kenya are the result of sexual transmission of HIV between men. However, studies by AMREF of STDs among truck drivers show evidence of homosexual activity, especially between older men and boys aged 12-16 years. The studies are supported by anecdotal evidence which suggests that sex between men in Kenya is more common than generally believed. Statistics are hard to come by as homosexuality is a criminal offense. As society disapproves, homosexuals often manage to keep their sexuality a secret but unprotected sex with their wives and male partners increases the risk of HIV transmission. On the Kenyan coast, homosexuality is more accepted and there are "marriages" between men. Maina Kahindo of the Ministry of Health does not see this as a area needing urgent attention: "Taking into account other modes of transmission of HIV/AIDS, homosexuality is negligible and should not take up our resources and time." Also in Kenya, the Nakuru District Commissioner has been speaking at the opening of a 2-day workshop for youth. He announced that nearly 28% of the district's youth were infected with HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Surprising success in Kenya's FP programme.

Mrs. Margaret Gachara, Deputy Director of the Ministry's Family Health Division, explained that the strengths and weaknesses of the program have recently been examined using a new operations research approach, known as situation analysis. "If family planning was not working in Kenya, we had to know why in order to decide what to do about it. We began the study to find out where our weaknesses lay. To our surprise, we found that we were not weak, but moderately successful," she said. The Kenya Situation Analysis Study, conducted by the Health Ministry and the Population Council, revealed that contraceptive prevalence increased by 2%/year between 1984-89, from 17% to 27%. "That is quite acceptable by World Bank and WHO standards. Our total fertility rate has dropped from 7.9% to 6.7%, and in urban areas is down to 3.8%. We are now continuing with in-depth studies, but we expect to be able to say next year that our family planning program should have a moderately high rating, especially in terms of quality of care." Since the 1st results of the Analysis Study were published, family planning agencies in several other African, Asian and Latin American countries have requested similar studies. The Kenyan study showed that the Pill is the most popular method of contraception, used by about 80% of family planning acceptors. However, the use of injectable contraceptives has risen about 4-fold in recent years, from 0.5 to 1.8 million doses a year, Mrs. Gachara said. When the study was conducted, availability of injectable contraceptives was very poor and did not have strong logistical support. This has now been changed, and its use is going up very fast in rural areas. 1 of the reasons is that women who want to use contraception, but do not have support from their husbands, can have injection without their husbands knowing. Although the 3 monthly injectable initially had a very bad press and little Parliamentary support, research has shown that many of the fears were unfounded. Kenyan policy is to make the injectable available to women with 4 children and to those over 35. Guidelines have recently been changed, to require 1 live birth before injectables are offered, rather than 2. The government is also making efforts to promote the use of Noristerat, and a pilot program is currently underway to study implants. The situation analysis did reveal problems in a number of areas, and a list of recommendations has now been drawn up to improve the quality of care. The recommendations include improved supply of information on permanent contraceptive methods and on the side-effects of other contraceptives, a reduction in waiting times for family planning services and an increase in follow-up. "The future looks good for family planning in Kenya, but we have to match our services to contraceptive health benefits and to focus more on maternal health in its totality," Mrs. Gachara said.

Africa↗
PubMed1989

The nature and impact of population policy in Kenya.

This paper examined the existence and impact of population policy in Kenya. The findings show that Kenya has adopted an antinatalist population policy which also aims at promoting balanced population distribution. This policy is, however, not well-designed and integrated. The demographic targets are often not specified or vague; the program measures are limited; and the policy does not encompass most geographical areas and subpopulation in terms of needs and resource endowments. There is need to reformulate the existing population policy in Kenya and make it well-designed and more rigorous. The policy must have set demographic targets to be achieved within specified time periods. The program measures must be broadened to include a wider range of factors directly and indirectly implied in a population resource equation at the present and in the future. Such a policy will achieve controlled population growth and balanced population distribution.

Africa↗
PubMed2002

Strategic control of gastrointestinal nematodes of sheep in the highlands of central Kenya.

The effectiveness of anthelmintic treatments given 3 weeks after the onset of rains to control gastrointestinal nematodes in sheep in the highlands of central Kenya was investigated. The study was carried out on a farm situated approximately 85 km north west of Nairobi in Nyandarua District of central Kenya. In May 1999, 35 Corriedale ram lambs aged between 8 and 10 months were eartagged, weighed and given albendazole at 3.8 mg/kg body mass. The animals were then allocated to three treatment groups. Three weeks after onset of both the short and long rains' season in November 1999 and April 2000 respectively, lambs in groups 1 and 2 were dewormed. Lambs in group 1 were given closantel at 10 mg/kg body mass in November and closantel plus albendazole at 3.8 mg/kg body mass in April. Lambs in group 2 were given albendazole at 3.8 mg/kg body mass on both occasions, while lambs in group 3 were maintained as the untreated controls. Nematode eggs per gram of faeces (epg) for lambs in the control group were significantly higher (P < 0.05) than in the treated groups beginning from November, when the strategic treatments started. The levels of epg did not differ significantly between the two treated groups. Body mass for the treated groups was significantly higher (P< 0.05) than for the control group from January 2000 until the experiment was terminated. The rainfall received in the study area in 2000 during the long rain season was inadequate and only occurred for a short period. The amount of herbage on pastures was therefore not adequate and all the study animals started losing mass from June 2000 until the experiment was terminated. The cumulative mass gain and amount of wool produced by the treated lambs during the study period did not differ significantly. There was therefore no difference in using either of the two drugs. It is concluded that, strategic anthelmintic treatments of sheep at the start of the wet season in the highlands of central Kenya is effective in controlling gastrointestinal nematodes. To prevent high levels of re-infection during the season of the long rains (April to June), it is recommended that, during this season, a second treatment be given 5-6 weeks after the first one or at the start of the dry season.

Albendazole↗
PubMed2000

Vitamin A deficiency in pre-school children in Kenya.

OBJECTIVE: To determine the prevalence of vitamin A in pre-school children in Kenya. DESIGN: Cross-sectional survey. SETTING: Fourteen districts randomly selected from the eight provinces in Kenya. SUBJECTS: Six thousand four hundred and twenty five pre-school children (3298 boys and 3127 girls) aged 6-72 months in 27 clusters randomly selected from fourteen districts. MAIN OUTCOME MEASURES: Serum retinol levels and xerophthalmia were determined using High Pressure Liquid Chromatography (HPLC) and ophthalmological assessment respectively. RESULTS: The mean serum retinol was 0.84 mmol/l +/- 0.58 SD. The mean serum retinol by sex was 0.82 +/- 0.51 SD and 0.87 +/- 65 SD (p=0.005) for boys and girls respectively. Over seven per cent of the children were severely vitamin A deficient (<0.35 mmol/l) and 32.9% had marginal vitamin A deficiency (0.70 mmol/l). In the age group six to eleven months, 11.2% and 40.7% of the children were severely and marginally vitamin A deficient, respectively. Clinical examination results indicated that 0.1% of children had corneal xerosis (X2), and one per cent of the children had Bitot's spots (XIB). Geographically, the results show that the problem is most prevalent in Kwale, Mombasa, Kitui, Baringo, Kisumu, Kisii, Bungoma, Garissa and Mandera. CONCLUSION: This survey demonstrated that regardless of the assessment method used, vitamin A deficiency is a significant public health problem in Kenya which requires urgent interventions. The group at highest risk was children aged six to twenty three months. Boys were at more risk than girls.

Age Factors↗
PubMed2000

Intestinal obstruction at a provincial hospital in Kenya.

OBJECTIVE: To determine the presentation, aetiological pattern, management and outcome of intestinal obstruction at the Central Provincial General Hospital, Nyeri, Kenya. DESIGN: A descriptive retrospective study. SETTING: Surgical Department, Central Provincial General Hospital, Nyeri, Kenya. SUBJECTS: All patients who were admitted and operated on for intestinal obstruction in the surgical department of the above hospital between January 1992 and May 1999. RESULTS: A total of 139 patients were studied. There were 102 males and 37 females giving a male:female ratio of 2.8:1. The age range was two days to 85 years with the majority (43.2%) of the patients being in the age group 0-10 years. Vomiting and abdominal pain were the commonest symptoms while abdominal distension and abdominal tenderness were the leading signs. Abount seventy of the patients had any form of investigation with plain abdominal x-ray being the leading investigation. Sigmoid volvulus, external herniae, adhesions and bands and ileo-colic intussusception were the commonest causes of bowel obstruction. About a third (32.4%) of the patients were found to have gangrenous gut. Sixty three complications were recorded in 47 patients, with the leading complication being death (17.3%) followed by wound infection (14.4%). CONCLUSION: Five leading causes of intestinal obstruction in Nyeri, Kenya, are: sigmoid volvulus, external herniae, adhesions and bands, ileocolic intussusception and small bowel volvulus.

Adolescent↗
PubMed2003

Psychiatric morbidity among children and young persons appearing in the Nairobi Juvenile Court, Kenya.

OBJECTIVES: To estimate the prevalence and pattern of psychiatric disorders among children and young persons appearing in the Nairobi juvenile court, Kenya. DESIGN: A point prevalence survey. SETTING: The Nairobi Juvenile Court, Kenya. SUBJECTS: Ninety (sixty-four males and twenty-six females) children and young persons aged 8 to 18 years classified as criminal offenders, group I (60), and those for protection and discipline, group II (30), were selected. METHOD: A socio-demographic questionnaire, reporting questionnaire for children (RQC), follow-up interview for children (FIC), present state examination (PSE) and clinical interview were administered to the subjects. International Classification of Diseases, 10th Edition (ICD-10) diagnostic criteria were used. RESULTS: The crude psychiatric morbidity (CPM) rate was 44.4%. ICD-10 documented psychiatric disorders detected in those with CPM were conduct disorders 45%, mixed disorders of conduct and emotion 20%, emotional disorders with onset specific to childhood 20%, mood disorders 12.5% and hyperkinetic disorders 2.5%. CONCLUSION: This study has shown a high presence of psychiatric morbidity in children and young persons appearing in the Nairobi Juvenile Court. These juveniles need and would benefit from mental treatment as recommended in section 18 of Cap 141 of the laws of Kenya; The Children's and Young Persons Act.

Adolescent↗
PubMed1954

The dissemination of 17D yellow fever vaccine in Africans in Kenya in relation to the interpretation of results of protection-test surveys.

The extent of dissemination of 17D yellow fever vaccine among the population of Kenya, especially among Africans, is estimated, largely from information in the records of the Kenya Medical Department. The total recorded vaccinations of Africans between 1941 and 1951 amount to about 379,000, representing 7.2% of the African population in 1948; it is, however, possible that the actual number of vaccinations is considerably higher. At Mombasa, 78,000 persons of races other than Africans were given routine inoculation over the same period.After a study of the economy of use of vaccine, the author discusses the protection-test surveys performed before 1951 and during that year in relation to the dissemination of vaccine. It is tentatively concluded that natural infection of man with yellow fever is rare in both Kenya and Tanganyika.

Humans↗
PubMed1961

A tuberculosis survey in Kenya.

The Government of Kenya, wanting to assess the extent of the tuberculosis problem in the Colony and Protectorate as an essential preliminary to a control programme, requested the assistance of WHO in carrying out a survey. The purpose was to establish the over-all prevalence for Kenya of tuberculous infection and pulmonary tuberculosis.From a population of about six million people, 8700 were selected at random for tuberculin testing, chest X-ray and bacteriological examination.The results of examination of this small sample indicate that among the 3.5 million Africans aged 10 years and over there are approximately 110 000 cases and suspected cases of pulmonary tuberculosis, and that 3% of the children aged 0-4 years and 13% of those aged 5-9 are infected.The problem of tuberculosis control in Kenya is undoubtedly a big one, the population being scattered over vast areas. However, the excellent co-operation of the population throughout the present survey suggests that mass control measures might meet with considerable success.

Child↗
PubMed2004

Outbreak of aflatoxin poisoning--eastern and central provinces, Kenya, January-July 2004.

In May 2004, CDC Kenya, trainees of the CDC-supported Field Epidemiology and Laboratory Training Program (FELTP) in Kenya, the World Health Organization, and CDC were invited by the Kenya Ministry of Health (KMOH) to participate in the investigation of an outbreak of jaundice with a high case-fatality rate (CFR) in the districts of Makueni and Kitui, Eastern Province. Preliminary laboratory testing of food collected from the affected area revealed high levels of aflatoxin, suggesting that the outbreak was caused by aflatoxin poisoning, as was a previous outbreak in the same area in 1981. In the United States, aflatoxin concentrations are limited to 20 parts per billion (ppb), a level also adopted by Kenyan authorities. The 2004 outbreak resulted from widespread aflatoxin contamination of locally grown maize, which occurred during storage of the maize under damp conditions. Urgent replacement of the aflatoxin-contaminated maize with noncontaminated maize proved to be a critical intervention; however, as of July 21, a limited number of new cases continued to be detected. This report summarizes the preliminary results of the outbreak investigation. Aflatoxin poisoning likely will continue to be a public health problem until culturally appropriate storage methods for dry maize are implemented by the local population. In addition, enhanced surveillance for human aflatoxin poisoning and testing of commercially sold maize for aflatoxin levels will lead to long-term improvements in public health.

Adolescent↗
PubMed2005

Evaluation criteria for the district health management information systems: lessons from the Ministry of Health, Kenya.

BACKGROUND: The District Health Management Information Systems (DHMISs) were established by the Ministry of Health (MoH) in Kenya more than two decades ago. Since then, no comprehensive evaluation has been undertaken. This can partly be attributed to lack of defined criteria for evaluating them. OBJECTIVE: To propose evaluation criteria for assessing the design, implementation and impact of DHMIS in the management of the District Health System (DHS) in Kenya. METHODS: A descriptive cross-sectional study conducted in three DHSs in Kenya: Bungoma, Murang'a and Uasin Gishu districts. Data was collected through focus group discussions, key informant interviews, and documents' review. The respondents, purposely selected from the Ministry of Health headquarters and the three DHS districts, included designers, managers and end-users of the systems. RESULTS: A set of evaluation criteria for DHMISs was identified for each of the three phases of implementation: pre-implementation evaluation criteria (categorised as policy and objectives, technical feasibility, financial viability, political viability and administrative operability) to be applied at the design stage; concurrent implementation evaluation criteria to be applied during implementation of the new system; and post-implementation evaluation criteria (classified as internal - quality of information; external - resources and managerial support; ultimate - systems impact) to be applied after implementation of the system for at least three years. CONCLUSIONS: In designing a DHMIS model there is need to have built-in these three sets of evaluation criteria which should be used in a phased manner. Pre-implementation evaluation criteria should be used to evaluate the system's viability before more resources are committed to it; concurrent (operational) - implementation evaluation criteria should be used to monitor the process; and post-implementation evaluation criteria should be applied to assess the system's effectiveness.

Biomedical Technology↗
PubMed1992

Breast cancer in Kenya: a histopathologic and epidemiologic study.

During 1981-1985, 417 cases of breast cancer were seen at the Department of Human Pathology, Kenyatta National Hospital, Nairobi, Kenya. During this period, 8041 cases of cancer were reported. Cancer of the breast accounted for 5% of all malignancies in Kenya and only second in number to cancer of the cervix. The incidence rate in females was 1.08 per 100,000 person-years. The incidence was low because the rural Kenyans have difficult access to the oncology facilities in Nairobi. The age specific incidence rates decreased after menopause. This is also found in other African countries but is in contrast with North America and Europe, where there is a rise after menopause. Young age of the first pregnancy, many pregnancies and a low fat content of the diet may contribute to the low incidence in post menopausal women. The distribution of the histological types was the same in Kenya with predominance of premenopausal cases and in the western world with predominance of postmenopausal cases. Invasive ductal carcinoma was the most common cancer type. Poorly differentiated tumours were common. This is probably explained by the fact that most patients seek medical help at a late state with advanced cancer. Only two cases of non-invasive intraductal carcinoma were found and in cases where lymphnodes were removed 88% had metastases.

Adolescent↗
PubMed2006

Partnerships creating postgraduate family medicine in Kenya.

Culminating a decade-long process, the first family medicine residency program in Kenya, among the first in Africa outside Nigeria and South Africa, was launched in 2005. Three diverse stakeholders are collaborating in their individual and joint missions: Moi University Faculty of Health Sciences (MUFHS), educating medical students to serve rural Kenyans; the Institute of Family Medicine (Infa-Med), a church hospital-based non-governmental organization aiming to introduce family medicine in Kenya; and the Ministry of Health (MoH), working to create an efficient government health care workforce for 32 million Kenyans. MUFHS brings central facilities, enthusiastic academic leadership, and long-term vision. Infa-Med contributes start-up resources, expatriate family medicine faculty, and well-established hospitals for training. MoH is giving political support to the new specialty as well as scholarships to MoH medical officers entering the 3-year residency program leading to the degree of Master of Medicine in Family Health. Among the lessons learned through this process are the importance of melding the missions of all partners, of integrating clinical with community care of the underserved, and of deriving curriculum from African and international evidence on how to marshal available resources to meet Kenya's national needs. Opportunities continue for internal and international collaboration.

Cooperative Behavior↗