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PubMed2000

Using evidence to change antimalarial drug policy in Kenya.

Chloroquine resistance was first detected in Kenya in 1978 and escalated during the 1980s. Chloroquine remained the treatment of choice for uncomplicated malaria infections until revised guidelines were launched in 1998 despite a plethora of scientific evidence on failure. This review analyses the range and quality of the evidence base that was used to change the drug policy in Kenya from chloroquine to SP and examines the process of consensus building and decision making. Our review illustrates the difficulties in translating sensitivity data with gross geographical, temporal and methodological variations into national treatment policy. The process was complicated by limited options, unknown adverse effects of replacement therapies, cost, as well as limited guidance on factors pertinent to changing the drug policy for malaria. Although > 50% of the studies showed parasitological failures by 1995, there was a general lack of consensus on the principles for assessing drug failures, the inclusion criteria for the study subjects and the relative benefits of parasitological and clinical assessments. A change in international recommendations for assessment of drug efficacy in 1996 from parasitological to clinical response further perplexed the decisions. There is an urgent need for international standards and evidence-based guidelines to provide a framework to assist the process by which decision-makers in malaria-endemic countries can make rational choices for antimalarial drug policy change.

Antimalarials↗
PubMed2003

Health and nutritional status of orphans <6 years old cared for by relatives in western Kenya.

One of the consequences of the HIV/AIDS epidemic in sub-Saharan Africa is the increase in the number of orphans, estimated to have reached 6-11% of children <15 years old in 2000. Orphans who stay in their communities may be at increased risk for poor health due to reduced circumstances and loss of parental care. We have used data from a population-based study in rural western Kenya to compare basic health and nutritional indicators between non-orphaned children <6 years old and children who lost either or both of their parents. In June 2000, all children <6 years old who had been recruited for a cross-sectional survey in 60 villages of Rarieda Division, western Kenya, in June 1999 were invited to return for a follow-up survey. Basic demographic characteristics, including the vital status of the child's parents, and health histories were requested from all 1190 participants of the follow-up survey, along with a finger-prick blood sample for determination of malaria parasite status and haemoglobin (Hb) levels. Height-for-age (H/A) and weight-for-height (W/H) Z-scores were also calculated from anthropometric measurements. Overall, 7.9% of the children had lost one or both their parents (6.4% had lost their father, 0.8% had lost their mother and 0.7% had lost both parents). While there was no difference between orphans and non-orphans regarding most of the key health indicators (prevalence of fever and malaria parasitaemia, history of illness, Hb levels, H/A Z scores), W/H Z-scores in orphans were almost 0.3 standard deviations lower than those of non-orphans. This association was more pronounced among paternal orphans and those who had lost a parent more than 1 year ago. These results suggest that the health status of surviving orphans living in their community is similar to that of the non-orphan population, but longitudinal cohort studies should be conducted to determine better the overall impact of orphanhood on child health.

Child Welfare↗
PubMed2001

Epidemiology of parasitic gastrointestinal nematode infections of ruminants on smallholder farms in central Kenya.

In order to establish the infection pattern with gastrointestinal nematodes in ruminants in the central Kenya highlands, a study was carried out in 58 smallholder farms. The study involved monthly faecal examinations from sheep, goats and cattle and pasture sampling from eight communal grazing areas. Each month, six Dorper worm-free tracer lambs were introduced and four locally grazed cross-bred sheep were purchased for parasite recovery. The mean faecal egg counts (FEC) for cattle were low throughout the study period, whereas those for sheep and goats showed a seasonal pattern with high levels of infection occurring during the two main rainy seasons, especially in March, April and October. There were significant differences in egg counts over time and among farms. Haemonchus contortus was the most prevalent nematode in the tracer lambs whereas the previously exposed locally grazed sheep had significantly lower numbers of H contortus but significantly higher numbers of Trichostrongylus species The highest levels of infection in the tracer lambs occurred in November 1995 and January, May and June 1996. Based on this study, it is now possible to explore the possibility of using strategic treatments for the control of parasitic gastroenteritis in this area of Kenya.

Animal Husbandry↗
PubMed2002

Maxillofacial injuries caused by terrorist bomb attack in Nairobi, Kenya.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

Adolescent↗
PubMed1982

[A report on two year of ophthalmological work in Kenya (author's transl)].

After two years' work as lecturers in ophthalmology at the University of Nairobi we report on our experiences in both teaching as well as outpatient and inpatient-care at the Kenyatta National Hospital. Special emphasis is given to the socio-economical background of the public health service in Kenya, to point out the special aspects of day-to-day medical work as well as the different needs of a postgraduate program in ophthalmology in this country. The main purpose of our work, supported by the Federal German Ministry of Economic Cooperation, Munich University Eye Clinic and many other organizations, was to train ophthalmologists in their own country. Finally, medical research programs currently in progress and concerning special aspects of tropical ophthalmology are reported on. These studies are designed to help find a solution of the problem of blindness, which is briefly analysed, and which is much more urgent in Kenya than in Western Europe.

Education, Medical↗
PubMedDate not supplied

Road traffic injuries in Kenya: magnitude, causes and status of intervention.

Road traffic crashes exert a huge burden on Kenya's economy and health care services. Current interventions are sporadic, uncoordinated and ineffective. This report offers a descriptive analysis of secondary data obtained from a variety of published literature and unpublished reports. Over three thousand people are killed annually on Kenyan roads. A four-fold increase in road fatalities has been experienced over the last 30 years. More than 75% of road traffic casualties are economically productive young adults. Pedestrians and passengers are the most vulnerable; they account for 80% of the deaths. Buses and matatus are the vehicles most frequently involved in fatal crashes. Characteristics of crashes vary considerably between urban and rural settings: pedestrians are more likely to be killed in urban areas, whereas passengers are the majority killed on intercity highways that transverse rural settings. Road safety interventions have not made any measurable impact in reducing the numbers, rates and consequences of road crashes. Despite the marked increase in road crashes in Kenya, little effort has been made to develop and implement effective interventions. Impediments to road traffic injury prevention and control include ineffective coordination, inadequate resources and qualified personnel, and limited capacity to implement and monitor interventions. There is need to improve the collection and availability of accurate data to help in recognising traffic injury as a priority public health problem, raising awareness of policymakers on existing effective countermeasures and mobilizing resources for implementation. Establishment of an effective lead agency and development of stakeholder coalitions to address the problem are desirable.

Accidents, Traffic↗
PubMed1980

The isolation and identification of leishmanial parasites from domestic dogs in the Machakos District of Kenya, and the possible role of dogs as reservoirs of kala-azar in East Africa.

Two out of 288 sick and emaciated dogs from homesteads in the Machakos District of Kenya, where human kala-azar cases existed, were found to be infected with leishmaniasis. The leishmanial strain isolated from one of the dogs was characterized enzymologically and serologically and found to be identical with strains isolated from human kala-azar cases and Phlebotomus martini. The significance of these findings is discussed in terms of the general epidemiology of visceral leishmaniasis in Kenya.

Animals↗
PubMed1987

The Saradidi, Kenya, rural health development programme: retrospective demographic analysis.

A census was done in Saradidi, Kenya from 1980 to 1982 as part of a community-based health development programme. The population was 42,755 (excluding 39 persons of unknown age or sex); 17.1% were less than five years old, 46.9% were below age 15, 4.7% were age 65 years or older and 19.7% were women in the reproductive years (age 15 to 44 years). The sex ratio was 86 males per 100 females due principally to migration of adult males for work. The mean number of persons per household was 4.0 and the mean village population was 764. The singulate mean age of marriage for men was 27.0 years and for women 19.9 years; 0.8% of adult men had never married. Only 0.1% of women by age 50 had never been married. Men were significantly more likely than women to be married to more than one spouse, divorce and separation was higher among men, and by age 50 about one-third of women were widows. Men had more years of formal education than women and young people of both sexes more than older people; 73.1% of men and 96.1% of women 60 years and more had never attended school. Infant mortality rates estimated indirectly ranged between 139 and 155 by area. A strong association was found between increasing education of the mother and decreased reported mortality of children. The total fertility of 6.2 was high but lower than the national average possibly because of the high rates of polygamy and primary infertility and the long periods of amenorrhoea and breast feeding which occurred after delivery. This area continues to have one of the highest levels of infant and child mortality in Kenya as well as relatively high fertility and a population with a very young age structure. This implies a continued very rapid rate of population growth which will make more difficult in the future the problems of delivering effective health services and overcoming poverty. A vigorous programme directed toward improving health is indicated which must include family planning.

Community Health Services↗
PubMed1987

Changes in sources of treatment occurring after inception of a community-based malaria control programme in Saradidi, Kenya.

To determine the changes in source of antimalarial treatment and perceptions about malaria after the initiation of a community-based malaria control programme in Saradidi, Kenya, two identical surveys were carried out; one in March 1982 (before the programme began in May 1982) and the other in December 1984. Three areas were involved: areas A and B had antimalarial treatment provided by village health helpers (VHH's) and area C had VHH's who did not provide treatment. Two groups of randomly selected women age 15 to 59 years were interviewed: 45 in survey 1 and 92 in survey 2. A decided change in the source of malaria treatment was observed. In the first survey, 52.9% of the respondents from areas A and B combined purchased antimalarial medicine from shops; other sources were government health facilities, mission clinics, and the Saradidi community clinic. By the second survey, 85.2% of the respondents in areas A and B obtained treatment from the VHH's; no significant change occurred in area C. In both surveys the leading reasons given for people purchasing drugs from shops was that the distance to health facilities was great, that no transport was available and that shops were open when emergencies occurred. The shopkeeper frequently advised which drug to take and the dosage as well as selling the drugs. For family illnesses of unknown aetiology most people (82.2% in survey 1 and 97.8%, in survey 2) went to a hospital or clinic. These results demonstrate that the malaria control programme in Saradidi has influenced both the source of antimalarials and the attitudes people have about malaria. In Saradidi, Kenya people chose to obtain antimalarial treatment and advice from community health workers.

Adolescent↗
PubMed1994

Phlebotomine sandflies of Kenya (Diptera: Psychodidae). III. The identification and distribution of species of the subgenus Larroussius.

The six species of phlebotomine sandflies of the subgenus Larroussius recorded in Kenya are Phlebotomus aculeatus, P. elgonensis, P. guggisbergi, P. longipes, P. orientalis and P. pedifer. Five are proven vectors of leishmaniasis in that country or elsewhere. Males of all six can be identified by the morphology of the aedeagus or the number and position of the hairs on the inner surface of the coxite. Additional features separating some of the species are the sizes of the palpal and antennal segments. The females have usually been considered difficult or impossible to distinguish. A comparison of the base of the spermathecal ducts is made and it is shown that all six can be identified by this character alone. A map of Kenya is given, showing the presently known distribution of the six Larroussius species. Further surveys are necessary in parts of the country that have not been systematically surveyed.

Animals↗
PubMed1993

Disease research in the wildlife-livestock interface in Kenya.

Selected results of wildlife disease research in Kenya are given against the background of the socio-economic conflict in the wildlife/livestock interface. An attempt is made to rank the three areas of conflict between wildlife and livestock: feeding competition, disease control and predation. Disease survey results reveal the lack of wildlife reservoirs, with the exception of some important problem areas. Research on trypanosomiasis identifies a variety of adaptations evolved in wild Bovidae. The most striking result is the isolation of serum proteins from buffalo with trypanocidal activity against all common species of trypanosomes. The importance of wild Bovidae as reservoir hosts for theileriosis of livestock is discussed. The African buffalo presents the only known reservoir host of economic importance. The use of parasite stocks derived from buffalo has been effective to immunize cattle under field conditions in spite of the presence of an unknown number of antigenic types. The occurrence of common antigens indicated by successful immunization in the field was also confirmed by the recognition of common antigenic epitopes by cloned cytotoxic T cells. These results are encouraging for the plans afoot for large scale immunizations in Kenya. The co-existence of livestock and wildlife is threatened by declining profits and increasing costs for wildlife production and the absence of a general policy to encourage the full economic use of wildlife in areas where it competes with livestock.

Animals↗
PubMed2002

The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya.

Compelling epidemiological evidence showing a significant association between lack of male circumcision and HIV infection has prompted calls for consideration of male circumcision interventions as a strategy for reducing HIV prevalence in highly affected areas where circumcision is little practiced and transmission is predominantly heterosexual. Little is known about whether male circumcision interventions would be acceptable or feasible in traditionally non-circumcisng areas of Africa. This study assesses the acceptability of male circumcision in the Luo, a large, traditionally non-circumcising ethnic group in western Kenya. Separate focused group discussions with adult Luo men and women and semi-structured interviews with clinicians were conducted in Nyanza Province, Kenya. The primary barriers to acceptance of male circumcision were cultural identification, fear of pain and excessive bleeding and cost. The main facilitators were association of male circumcision with better hygiene and reduced risk of infection. Both men and women were eager for promotion of genital hygiene and male circumcision, and they desired availability of circumcision clinical services in the Province's health facilities. Clinicians lacked the knowledge and resources to offer safe circumcision counselling and services. If results from this study are valid for other areas of sub-Saharan Africa, acceptability of male circumcision as a means to reduce STDs and HIV is higher than previously suspected. Further studies are needed in other regions to assess the feasibility of introducing acceptable male circumcision information and services to reduce HIV transmission.

Adolescent↗
PubMedDate not supplied

Entomophagy among the Luo of Kenya: a potential mineral source?

Primary objective To determine the iron, zinc, and calcium content in different insects commonly eaten among the Luo of Kenya. Research design A cross-sectional design was chosen for the study in order to determine the insects eaten and their mineral content during a specific season.Methods and procedures Five different insect species were identified and collected with the help of local informants in the Nyang'oma sublocation of the Bondo district in western Kenya, and were analysed for iron, zinc and calcium contents. Main outcomes and results The iron content ranged from 18 to 1562 mg/100 g dry matter, the zinc content from 8 to 25 mg/100 g, and the calcium content from 33 to 341 mg/100 g in five different insects, onyoso mammon (ant), oyala (termite), ogawo (termite), agaor (termite), onjiri mammon (cricket). Conclusions Insect eating could prove to be a valuable measure to combat, especially, iron and zinc deficiency in developing countries.

Aged↗
PubMedDate not supplied

A theoretically based evaluation of HIV/AIDS prevention campaigns along the trans-Africa highway in Kenya.

Print HIV/AIDS prevention campaign materials (e.g., posters, pamphlets, stickers) from 10 public health organizations in Kenya were evaluated according to the Extended Parallel Process Model (EPPM), a health behavior change theory based on the fear appeal literature, at various sites along the Trans-Africa Highway in Kenya. Three groups each of commercial sex workers (CSWs), truck drivers (TDs) and their assistants (ASSTs), and young men (YM) who live and work at the truck stops participated in focus group discussions where reactions to the campaign materials were gathered according to this theoretical base. Reactions to campaign materials varied substantially, according to the poster or pamphlet viewed. Overall, most participants wanted more detailed information about (a) the proper way to use condoms, (b) ideas for how to negotiate condom use with reluctant partners, and (c) accurate information on symptoms of AIDS and what to do once one contracted HIV. Both quantitative and qualitative analyses of the campaign materials are reported.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Premarital childbearing in northwest Kenya: challenging the concept of illegitimacy.

A number of African countries, including Kenya, have experienced a marked rise in births among unmarried women. In Western countries, reproduction outside of marriage is assumed to be illegitimate and a social problem. One hypothesis used to explain the increasing incidence of premarital fertility in Africa is a breakdown of traditional social controls by the extended family over the sexual behavior of adolescents. A competing hypothesis suggests that unmarried women use sexual relations to achieve goals such as marriage. Among Turkana pastoralists of northwest Kenya, we find a pattern of premarital birth that fits either hypothesis only loosely. Premarital fertility among the Turkana is both widespread and culturally acceptable, with over 30 per cent of women having at least one child prior to marriage. Although women with premarital births initiate childbearing on average one year earlier than women with only marital births, women's marital status does not influence the length of the interval between first and second births. Marriage among the Turkana is not a social trigger for the onset and continuation of reproduction or a means to legitimate reproduction. Marital status of the parents simply determines the custody of a child. In a premarital birth, the father pays a set fee to the mother's family, and the custody of the child remains permanently with the mother's family. If the parents later marry, the father must purchase custody of the child by another fee at that time. Since the Turkana have experienced few effects of modernization, the existence of such a practice suggests that cultural factors must be taken into account before assessing premarital fertility in Africa as a social problem.

Adolescent↗
PubMedDate not supplied

Reproductive change in Zimbabwe and Kenya: the role of the proximate determinants in recent fertility trends.

This study examines trends in proximate determinants of fertility in Zimbabwe and Kenya. Findings from the four Demographic and Health Surveys conducted in these countries show that the dramatic fall in fertility in these countries is consistent with the underlying trends in the most important proximate determinants of fertility. In Zimbabwe, contraceptive use far exceeds other proximate determinants in influencing fertility levels and trends. The results show that the fertility inhibiting effects of contraception are more important than the effects of postpartum infecundability, marriage patterns, or sterility. The results also show that contraceptive use has its greatest suppressing effects in the middle and younger age groups. However, in Kenya, the dominant fertility inhibiting effect is postpartum infecundability, with contraception coming in second.

Adolescent↗
PubMedDate not supplied

The effects of infant deaths on the risk of subsequent birth: a comparative analysis of DHS data from Ghana and Kenya.

This paper examines the conditions under which there might be a strong or weak relationship between childhood mortality and fertility at the micro level. The premise is that as a society undergoes transition during which a conscious effort is made to space and limit birth, the effect associated with infant death on the risk of subsequent birth reduces. Using the 1998 DHS data from Ghana and Kenya, our multivariate hazard models show that women who have experienced infant deaths tend to have a higher risk of subsequent births than those without any infant deaths at all parities studied in both countries. In a comparative context, however, the magnitude of the effect associated with infant death was weaker in Kenya at all parities, corroborating the hypothesis that the effect indeed reduces in the course of transition. Besides infant deaths, other demographic, socioeconomic and sociocultural factors were also found to associate with the risk of births. The limitations and policy implications of the findings are discussed.

Adolescent↗
PubMed2001

Antimicrobial-resistant bacterial diarrhea in rural western Kenya.

Bacterial diarrheal diseases cause substantial morbidity and mortality in sub-Saharan Africa, but data on the epidemiology and antimicrobial susceptibility patterns of enteric bacterial pathogens are limited. Between May 1997 and April 1998, a clinic-based surveillance for diarrheal disease was conducted in Asembo, a rural area in western Kenya. In total, 729 diarrheal specimens were collected, and 244 (33%) yielded >or=1 bacterial pathogen, as determined by standard culture techniques; 107 (44%) Shigella isolates, 73 (30%) Campylobacter isolates, 45 (18%) Vibrio cholerae O1 isolates, and 33 (14%) Salmonella isolates were identified. Shigella dysenteriae type 1 accounted for 22 (21%) of the Shigella isolates. Among 112 patients empirically treated with an antimicrobial agent and whose stool specimens yielded isolates on which resistance testing was done, 57 (51%) had isolates that were not susceptible to their antimicrobial treatment. Empiric treatment strategies for diarrheal disease in western Kenya need to be reevaluated, to improve clinical care.

Adolescent↗