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PubMed2004

Strategic management of technology in public health sector in Kenya and South Africa.

OBJECTIVE: To investigate factors contributing to health care equipment problems and associated technological investments in public hospitals. DESIGN: The article reviews the processes of equipment planning, procurement and management. Analysis of results and observations from experts leads to recommendations and suggestions on good equipment management practices in public hospitals. It also provides recommendations for competitive utilisation of equipment in the public health sector. SETTINGS: Health care equipment management in Kenya and South Africa in 1999/2000. INSTITUTIONS: A total of 10 public equipment maintenance institutions, and 38 equipment maintenance experts participated in the survey. Majority of the participants were drawn from teaching hospitals. RESULTS: It is evident that the way health technology is managed in health care institutions directly affects the quality of treatment patients receive. Although strategic importance of technology in health care has been documented widely in scientific literature; equipment planning, procurement and management have not received the attention they deserve in the transformation of health care services in the two countries under the survey. CONCLUSIONS: The growing demand for more and better health care greatly expands the role of health care equipment in the delivery of health services. Kenya and South Africa have tried various strategies to improve access, quality and cost-efficiency in the health care delivery systems. However it is clear that the optimal method has yet to be found. Good management of health care equipment increases efficiency in health care services and enhances health outcomes.

Budgets↗
PubMed2004

Dietary intake, feeding and care practices of children in Kathonzweni division, Makueni District, Kenya.

OBJECTIVE: To determine and compare the socio-economic characteristics, childcare and feeding practices among children aged 6-59 months of households participating in a World Vision Kenya programme with non-participants. DESIGN: A comparative cross-sectional survey. SETTING: A World Vision Kenya project area (Kimundi and Yinthungu sub-locations) and a non-project area (Thavu and Yeekanga sub-locations) both in Kathonzweni division, Makueni district. STUDY POPULATION: A random sample of 320 children aged 6-59 months and their respective households. A sub-sample (n=60) was assessed for dietary intake. RESULTS: A significantly higher proportion of children in the non-project area (63.8%) than in the project area (37.5 %)(p=0.00) were introduced to complementary foods within the first three months. The first main food given to children in both areas was unenriched cereal porridge. In both areas, grandmothers were reported to be the main alternative caregivers though most of the mothers prepared food for the children while other caretakers did the actual feeding. CONCLUSION: No significant difference was noted in the childcare practices in the two areas contrary to what may have been expected since the programme aimed at promoting appropriate childcare and feeding practices hence the expected difference.

Breast Feeding↗
PubMed2004

Challenges in the epidemiological and clinical aspects of Burkitt's lymphoma in Kenya: linking evidence and experience.

BACKGROUND: In a series of 1005 cases of Burkitt's lymphoma studied for epidemiological and clinical characteristics, some features remain less obvious contrary to what is commonly held about this disease. OBJECTIVES: To use the case series to document the challenges in the epidemiological and clinical characteristics of Burkitt's lymphoma (BL) in Kenya. DESIGN: Cross sectional study involving clinical review of case series. SETTING: Kenyatta National Hospital and the seven provincial hospitals in Kenya during the period between 1986 and 1996. DATA SOURCES: Systematic review of the epidemiological and clinical features of the 1005 cases enrolled in the case study and review of reference lists of retrieved articles to identify original research dealing with the epidemiological and clinical features of Burkitt's lymphoma. DATA EXTRACTION: The investigators and research assistants screened both the case series and published information and data to yield relevant information. CONCLUSION: The majority of Burkitt's lymphoma cases between the age group three and nine years of age coincide with the established epidemiological and clinical characteristics. The adult BL cases and some childhood cases however do not conform entirely to the established characteristics. Therefore, making the diagnosis of Burkitt's lymphoma require that; geographical, demographical, clinical features as well as any underlying infections for instance, Human Immunodeficiency Virus be taken into consideration.

Age Factors↗
PubMed2005

Tuberculosis and oral Candida species surveillance in HIV infected individuals in Northern Kenya, and the implications on tuberculin skin test screening for DOPT-P.

OBJECTIVE: To determine the pattern of opportunistic infections such as TB and Candida species in HIV infected patients in Northern Kenya. DESIGN: Cross-sectional study. SETTING: Five health facilities in Moyale (n=224), Mandera (n=121) and Turkana Kakuma; (n=83), Lopiding; (n=94) districts during different periods in 2003. SUBJECTS: Five hundred and fifty two patients. RESULTS: In total 94 (18%) patients were found to be HIV positive (Moyale=42, Mandera=13, Turkana; Kakuma=8, Lopiding=31). Only 65 of 94 HIV positive patients provided saliva samples. Of these, 11 (17%) were TB smear positive and 19 (29.2%) were colonized by oral Candida species. The Candida isolates were as follows; Co-infection of Candida species and TB (n=4), C. albicans only (n=12), C. tropicalis only (n=1), C. albicans and C. glabarata (n=1) and C. albicans, C. glabarata and C. tropicalis. co-infection (n=1). CONCLUSION: The findings provides an important insight into the differences in mucosal susceptibility to bacteria (TB) infection and fungal (Candida species) colonization during HIV immunosuppression, based on collected blood, sputum and saliva specimens. Further studies are needed to elucidate the comparative transmission dynamics and pathogenetic mechanisms of these opportunistic infections-in different regions of Kenya. Such studies would improve the efficiency of directly observed preventive therapy programme (DOPT-P) whose implementation involves screening by tuberculin skin testing.

Candidiasis, Oral↗
PubMed2005

New enzymatic assay, parasite lactate dehydrogenase, in diagnosis of malaria in Kenya.

BACKGROUND: The unique ability of plasmodial lactate dehydrogenase p(LDH) to utilise 3-acetyl pyridine dinucleotide (APAD) in lieu of NAD as a coenzyme in the conversion of pyruvate to lactate, led to the development of a biochemical assay for the detection of plasmodial parasitaemia. Researchers have reported that p(LDH) activity of plasmodia could be used as an assessment of parasitaemia since human red blood cells do not utilise APAD in the metabolism of glucose. OBJECTIVE: To use p(LDH) for field and clinical diagnosis of malaria in endemic regions of Kenya. DESIGN: Prospective field and clinical study. SETTING: Kisumu District Hospital and Walter Reed malaria laboratory in Kenya. SUBJECTS: The study subjects were of three different categories: the healthy non-infected individuals staying out of malaria endemic region (controls group 1), the nonparasitaemic and parasitaemic non- symptomatic healthy individuals living in endemic region {both field study group 2}, the non-parasitaemic and parasitaemic symptomatic individuals living in endemic region {both clinical study group 3}. RESULTS: In the clinical studies, thin smear microscopy gave the highest sensitivity as 75.6% for plasma, while the highest specificity was 71.4%. For red blood cells, the highest sensitivity was 78.4% while specificity was 80%. In the field trials, the highest sensitivity was 89% using thin smear microscopy whereas the specificity was 45% for plasma cut off using thick smear. For red blood cells, the highest sensitivity was 79% while specificity was 66.7%. CONCLUSION: The variations in sensitivity and specificity of this assay in comparison to microscopy is a strong indication that p(LDH) may be measuring even the sequestered parasites that cannot be visualised by microscopy. The results of this study validates the use of p(LDH) as an alternative objective test for malaria diagnosis against microscopy.

Adolescent↗
PubMed2005

Self reported alcohol use in an urban traffic trauma population in Kenya.

BACKGROUND: Kenya has a soaring rate of road traffic fatalities. Available evidence suggests significant alcohol-relatedness to trauma. We know little about the prevalence of alcohol-related injuries in Nairobi. OBJECTIVE: To determine the extent and pattern of alcohol use in subjects admitted following road traffic accident. DESIGN: A descriptive hospital based survey. SETTING: Kenyatta National Hospital (KNH)- a university affiliated hospital in Nairobi, Kenya. RESULTS: The overall incidence of alcohol use was 26.3%. This was higher in males (29.6%) than females (9.1%). Use was 24.4%, 31.0%, 28.6% and 13.6% in the 16-25, 26-35, 36-45 and 46-55 age groups respectively. The mean ages, pre-hospital times and ISS were similar for the AUG and NAUG. The incidence of males, weekend injuries, night collisions, and pedestrian involvement was 94.4%, 69.4%, 41.7%, 77.8% in the AUG and 83.2%, 35.6%, 19.8% and 61.4% in the NAUG respectively. The incidence of head and extremity injuries in AUG was 27.8% and 50% respectively compared to 11.9% and 66.3% in the NAUG. Treatment costs were higher for the NAUG. CONCLUSIONS: The results suggest a high incidence and potential alcohol-relatedness to road trauma in Nairobi. The study calls for objective evaluation of the extent, interactions and effects of this modifiable trauma factor.

Accidents, Traffic↗
PubMed2005

Vitamin a deficiency and anaemia in young children living in a malaria endemic district of western Kenya.

BACKGROUND: Vitamin A deficiency makes children vulnerable to infections and influences the outcome of various infections. In 1993 vitamin A deficiency was found to be a public health problem in Bungoma district of western Kenya. OBJECTIVE: To determine the prevalence of vitamin A deficiency, anaemia and malaria parasitaemia and to correlate these with haemoglobin, ferritin and acute phase response. DESIGN: A cross-sectional study. SETTING: Bungoma district of western Kenya. SUBJECTS: Three hundred and three children aged one to three years were studied. MAIN OUTCOME MEASURES: Serum retinol, haemoglobin, serum ferritin, alpha-1 acid glycoprotein, C-reactive protein and malaria parasite density. RESULTS: Twentynine percent of the children had severe vitamin A deficiency, 92% had anaemia (haemoglobin less than 10 g/dl) 24(7%) of these were severely anaemic while 76% had malaria parasitaemia. There was no significant difference in the retinol levels of children with malaria parasitaemia and those without malaria parasitaemia (P = 0.6). Retinol levels were significantly lower among children with high C-reactive protein (P < 0.001). Malaria parasitaemia negatively correlated with haemoglobin (r = -0.13, P < 0.05) and C-reactive protein (r = 0.21, P < 0.01). There was no difference in haemoglobin level of children with normal serum retinol and those with low serum retinol (P = 0.16). Ferritin did not differ significantly among children with normal haemoglobin and those with low haemoglobin (P = 0.13). CONCLUSION: Vitamin A deficiency and anaemia are a public health problem among the children studied. The high prevalence of vitamin A deficiency may have resulted from acute phase response induced by infections.

Age Factors↗
PubMed2005

Mother's health seeking behaviour during child illness in a rural western Kenya community.

BACKGROUND: In most developing countries, the health of the children is strongly dependant on maternal healthcare behaviour. The study describes the prevalence of illness among preschool children in a rural sugarcane growing community and the mother's health seeking behavior. OBJECTIVES: To document the presence of illness among preschool children at household level in a rural community in Western Kenya and also determine the mother's health seeking behavior during the course of these illnesses. METHODS: This was an observational cross-sectional community survey using interview schedules, key informants and focus group discussions and Makunga Rural Health Center in Kakamega District western Kenya. Descriptive statistics were used in data analysis. RESULTS: Fifty two percent of the children had had at least one illness a week prior to the survey. Fever was the most commonly reported symptom with 48% of the cases. A third (32.4%) of the mothers purchased and administered drugs to their sick children without seeking medical attention. The most commonly reported reasons for this behavior were: the government health facilities were at a distance, the services are poor and inability to afford services at the private hospitals and clinics. CONCLUSION: Intervention programmes focusing on diversification of income sources, maternal education and community based mobile clinics are likely to contribute towards improved health of children in this and any other rural sugarcane growing community.

Adult↗
PubMed1999

Mycobacterium avium-related epizootic in free-ranging lesser flamingos in Kenya.

An epizootic in free-ranging lesser flamingos (Phoeniconaias minor) in Kenya resulted in more than 18,500 deaths from August through mid-November 1993. Disease was concentrated along the shores of Rift Valley Lakes Bogoria and Nakuru (Kenya) and did not involve any of the other avian or mammalian species frequenting the lakes. Coincidental to the outbreak was a bloom of algae on Lake Bogoria, toxins from which were first suspected to be causative. Discrete necrotic and granulomatous lesions were often noted in spleen and liver, and Mycobacterium avium serovar I was isolated from both organs. Escherichia coli and Pseudomonas aeruginosa also were often recovered in pure culture from liver. Gross and histopathological evaluation of the cases disclosed signs of acute sepsis and also chronic, potentially life-threatening lesions of mycobacteriosis, primarily involving the spleen and liver. Lesions typical for algae toxicosis were not seen in any birds. Deaths were attributed to septicemia complicated in those affected, by mycobacteriosis.

Animals↗
PubMed1998

Perception of risk, sexual behaviour and STD/HIV prevalence in western Kenya.

OBJECTIVE: To determine the feasibility and acceptability of collecting data on sexual practices, knowledge, attitudes and perception of risk with regard to HIV and STD infection in two clinic populations. DESIGN: A cross sectional survey carried out between June and July 1992. SETTING: An urban and a rural health centre in western Kenya. SUBJECTS: One hundred and sixty women attending Maternal Child Health (MCH) and Family Planning Clinics (FP). INTERVENTIONS: Screening STDs including N. gonorrhoea, C. trachomatis, T. vaginalis and syphilis. In addition subjects were interviewed about sexual practices, knowledge, attitudes and perception of risk with regard to HIV and STD infection. RESULTS: The presence of any STD including HIV was detected in 36.2% of women at the urban clinic and 21.2% of women at the rural clinic. The demographics of the two populations were similar with respect to age but were significantly different for several variables including marital status, ethnicity and education. Knowledge of STDs and HIV was nearly universal in both clinic populations with > 96% of patients being aware of the existence of such diseases. 76.3% of women at the urban clinic felt they could get an STD as compared to 48.8% at the rural clinic (p < 0.02). This awareness of vulnerability among the urban population was also seen for HIV. CONCLUSION: It appears to be feasible to conduct studies of sexual practices and perceptions of risk for STD/HIV acquisition in women attending health centres in Kenya.

Adult↗
PubMed1998

Alcohol-related road traffic injuries in Eldoret, Kenya.

OBJECTIVE: To establish the extent of alcohol involvement in motor vehicle crashes occurring in Eldoret in western Kenya. DESIGN: A descriptive hospital-based study. SETTING AND SUBJECTS: Crash-involved patients aged 16 years and above presenting for treatment in all hospitals located in Eldoret town over a period of six months. METHODS: Casualties were enrolled consecutively. A questionnaire eliciting demographics and crash circumstances was administered. Blood alcohol concentration (BAC) was evaluated either by breath tests or venous blood sample analysis in consenting casualties presenting within 10 hours of the crash. BAC levels of 5 mg% and greater were taken as a positive test; patients registering BAC levels equal to or greater than 50 mg% were considered as being intoxicated. RESULTS: Of the 188 patients evaluated, 23.4% were BAC positive and 12.2% were intoxicated. Males were twice as likely as females to have been drinking prior to the crash (26.4% versus 13.6%; p = 0.08). Significantly greater proportions of night-time and weekend crashes involved intoxicated subjects (p = 0.02 and p = 0.03, respectively). Motor vehicle drives were the most affected by alcohol (60%), whereas pedestrians (33.3%), passengers (16%) and pedal cyclists (8.3%) were involved to a lesser extent. In comparison to passengers, drivers were eight times more likely to have been drinking (OR = 7.9, p = 0.04). CONCLUSIONS: Alcohol is a contributing factor in a substantial proportion of traffic crashes occurring in western Kenya. Policy response and specific interventions for discouraging driving under the influence of alcohol, including the establishment and enforcement of a legal BAC limit are needed.

Accidents, Traffic↗
PubMed1999

Altitude: a determinant for tuberculosis in Kenya?

OBJECTIVE: To determine to what extent tuberculosis incidence is associated with altitude. METHODS: Notification rates were obtained from all 41 districts in Kenya in the period 1988-1990; the mean altitude of each district was estimated. Data on indicators of socio-economic status such as literacy rate and infant mortality rate were obtained from the 1989 census, as well as data on other potential confounders such as urbanisation and median household size. RESULTS: The notification rate of new smear-positive tuberculosis was 32/100000 overall, varying between districts from 5 to 222/100000. Notification rates steeply reduced with increasing altitude (r = -0.71; 95% confidence interval [CI] -0.51 to -0.83). At altitudes of 1000 m or more the notification rates were less than 30% of those in districts at altitudes below 500 m, also after adjustment for confounding. CONCLUSION: Tuberculosis incidence in Kenya decreases strongly with increasing altitude. If the association is not due to unknown confounding factors, a range of potential biological explanations needs to be explored.

Altitude↗
PubMed1999

Menstruation requirements as a barrier to contraceptive access in Kenya.

BACKGROUND: In many countries, non-menstruating women are routinely denied contraceptive services even when pregnancy can easily be ruled out. OBJECTIVE: To determine whether menstruation requirements in Kenya constitute a barrier to access for potential family planning clients. DESIGN: Prospective and retrospective observational study. SETTING: Nine family planning clinics in western Kenya. SUBJECTS: Women presenting as new clients at Ministry of Health family planning clinics. INTERVENTIONS: Researchers used prospective tracking and retrospective record reviews to compare the menstrual status of women presenting for family planning services with that of women who received methods in family planning clinics. MAIN OUTCOME MEASURES: Dichotomous outcomes (menstruating versus non-menstruating women). RESULTS: During the eight-week period that tally sheets were used in the one hospital and eight health centres, 45% of the 760 women presenting for services as new clients were not menstruating (clinic range = 19%-70%). In contrast, information from clinic registers and client records in the same nine clinics showed that the (weighted) proportion of registered new clients who were menstruating was 85% (n = 102). We estimated that 78% of non-menstruating women (35% of all potential new clients) were sent away without services. CONCLUSION: For most women turned away, it is likely that pregnancy could be ruled out easily with a history and an examination. Menstruation as a pre-condition for provision of contraception wastes valuable resources and denies women their right to contraception.

Ambulatory Care Facilities↗
PubMed1999

Clinical presentation and diagnosis of cerebral malaria in children in the highlands of western Kenya.

BACKGROUND: The clinical presentation of cerebral malaria in children in the highlands has not been documented. OBJECTIVE: To describe the presentation of cerebral malaria in the age group one to twelve years. DESIGN: Prospective study conducted from May to September 1997, the rainy season during which malaria occurs in epidemics in the highlands of Kenya. SETTING: Paediatric wards of the Moi Teaching and Referral Hospital, Eldoret which is the Teaching Hospital for Moi University and the referral centre for surrounding districts of Western Kenya, with an altitude of over 2000 metres above sea level. PATIENTS: Twenty three consecutive children aged one to twelve years with cerebral malaria as defined by the WHO were studied. All children were treated with the standard quinine regimen for cerebral malaria. RESULTS: Majority of the children were six to ten years of age with 95.7% having a normal weight for age. 91.3%, 89.5% and 72.2% had fever, headache and convulsions respectively. 68.1% had a short duration of illness (less than three days) with only 9.5% presenting with hypoglycaemia. Severe anaemia was not observed but 72% had mild to moderate anaemia. Hyperparasitaemia (parasite counts greater than 100,000 per microlitre) was found in majority of the cases. CONCLUSION: Cerebral malaria presentation in the highlands is similar to that among non-immune populations and is an acute fulminant illness presenting with coma, hyperparasitaemia, fever and convulsions in children with normal nutritional status.

Altitude↗
PubMed1999

Cutaneous basal cell carcinoma in Kenya.

BACKGROUND: Primary basal cell carcinoma(BCC) of the skin is the commonest tumour in Caucasians. Its incidence and mode of presentation in Kenyan Africans are unknown. OBJECTIVE: To study the incidence and mode of presentation of BCC in Kenya. DESIGN: A thirty year retrospective study (1968-1997) of all BCCs documented in the Kenya Cancer Registry (KCR), and a case report of one patient seen at Kenyatta National Hospital (KNH), Nairobi. RESULTS: Seventy four BCCs were recorded in thirty five Caucasians and thirty nine Africans. The race-specific mean annual incidence rates per million population were 58.5 and 0.065 for Caucasians and Africans, respectively. Clinical presentation in both racial groups was similar. CONCLUSION: BCC is a rare malignant tumour in Kenyan Africans but its mode of clinical presentation is similar to that in Caucasians.

Adolescent↗
PubMed1999

HIV sero-prevalence among tuberculosis patients in Kenya.

OBJECTIVE: To determine HIV seroprevalence among tuberculosis patients and the burden of HIV attributable tuberculosis among notified patients in Kenya. DESIGN: A cross-sectional anonymous unlinked HIV seroprevalence survey. SETTING: Tuberculosis diagnostic clinics of the National Leprosy Tuberculosis Programme in 19 districts. SUBJECTS: One thousand nine hundred and fifty-two newly notified tuberculosis patients. INTERVENTIONS: Selection and registration of eligible subjects followed by obtaining 5 ml of full blood for haemoglobin testing and separation of serum for HIV testing by ELISA. MAIN OUTCOME MEASURES: HIV seroprevalence per district and burden of HIV attributable tuberculosis among tuberculosis patients. RESULTS: A total of 1,952 eligible patients were enrolled. The weighted seroprevalence in the sample was 40.7% (range 11.8-79.6% per district). The seroprevalence was significantly higher among females and patients with sputum-smear negative tuberculosis. Chronic diarrhoea, female sex, oral thrush and a negative sputum were independent risk factors for HIV infection. The Odds ratio for HIV infection in female tuberculosis patients aged 15-44 years, was 5.6 (95% CI 4.5-6.9) compared with ante-natal clinic attenders. The population attributable risk was 0.22 in 1994. CONCLUSION: The HIV epidemic has had a profound impact on the tuberculosis epidemic in Kenya and explains about 41% of the 94.5% increase of registered patients in the period 1990-1994 and 20% of all registered patients in 1994. Repetition of the survey with inclusion of a more representative control group from the general population may provide a more accurate estimation of the burden of HIV attributable tuberculosis.

AIDS-Related Opportunistic Infections↗
PubMed1999

Prevalence of malnutrition in Kenya.

BACKGROUND: Prevalence of malnutrition among pre-school children can be used to determine the need for nutrition surveillance, nutritional care, or appropriate nutritional intervention programmes. Such data also indicate the target groups and where interventions are required. OBJECTIVE: To determine the at risk groups, extent and magnitude, and regional distribution of malnutrition. DESIGN: A cross sectional study. SETTING: The survey was conducted in 14 districts representative of the eight provinces of Kenya. SUBJECTS: Six thousand, four hundred and nineteen children (3294 males and 3125 females) aged six to 72 months selected using the cluster sampling technique from eight provinces were studied. MAIN OUTCOME MEASURES: Anthropometric measures of height/length and weight were used to do the assessment. RESULTS: The prevalence of stunting, wasting and underweight were 37%, 6% and 27% respectively. Stunting was highest among the 12-23 months age group (44.8%). A statistically significant difference (p = < 0.005) was found between boys and girls with regard to stunting. This difference was more remarkable when the two were stratified by age group where 29% of the boys were stunted compared to 20% of the girls. Geographically, it was found that there exists great regional disparities with a low (22.6%) in Kiambu and a high (56.5%) in Kwale districts. CONCLUSION: These results show that malnutrition is still a serious public health problem in Kenya and requires urgent attention. The problem since the first survey in 1977 shows an upward trend, suggesting deterioration over the years. Well thought out and targeted intervention programmes are long overdue. The results of this survey and others emphasize the importance of having a well established surveillance system which would ensure necessary and timely action.

Age Distribution↗
PubMed1999

Effects of translocation on hematologic parameters of free-ranging black rhinoceros (Diceros bicornis michaeli) in Kenya.

Management of the endangered black rhinoceros (Diceros bicornis michaeli) in Africa frequently involves translocation. These procedures are not without risk, and protocols must be critically examined. Hematologic analyses can be used to evaluate the effects of translocation on animal health. Hematologic data obtained during routine translocation of free ranging black rhinoceros (n = 74) in Kenya between 1991 and 1995 were examined, and subsets of data from rhinoceros (n = 43) that were translocated to different regions of Kenya were compared. All animals showed an increase in total blood protein. Animals transported for longer periods and to lower altitude zones with higher ambient temperatures and trypanosomiasis developed anemia and showed neutrophilia, lymphopenia (males), and eosinopenia. The changes in packed cell volume (PCV), hemaglobin, and neutrophils were more marked in females, and the PCV drop was more significant in subadults. The red cell changes were most probably pathologic, involving the loss of red cells from circulation through sequestration or hemorrhage. The changes in white cell parameters are consistent with the effect of endogenous corticosteroids as a result of stress. Transport and confinement stress might lead to gastric ulceration with hemorrhage. In many animals, exposure to trypanosomes contributes to anemia.

Anemia↗