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PubMed1993

Perception of a schistosomiasis control project in rural Kenya by the beneficiaries.

A schistosomiasis control project was implemented in Mwea Rice Irrigation Scheme in Central Kenya between late 1983 and December 1988 by Kenya Medical Research Institute scientists in collaboration with the National Irrigation Board. The aim of the project was to control schistosomiasis through provision of alternative water sources, bath and laundry units, latrines, chemotherapy and health education. The community participated fully. Five years later in December 1988, 203 household heads were interviewed on their perception of the control project in terms of purpose, project ownership and management, benefits, continuity and their knowledge of schistosomiasis transmission cycle. 61% of the respondents were females and 39% males. 92% of them said that the purpose for the project was to treat, control and prevent bilharzia from spreading, and to promote good health. Slightly over 50% said that the project belonged to them but that they would have liked to be more involved in its management. 74% said that they are able to save time because the facilities are now nearer to them; whilst 79% felt that they were saving money because they did not have to buy drugs since they felt healthier. 99% said that they thought that bilharzia has been controlled, and 82% said that their children looked healthier. 95% said that they could see the project surviving for a long time period suggesting that it was self sustaining and they were willing to start a maintenance of facilities fund. Overall, the community appreciated the social, economic and health benefits derived from the control project.

Communicable Disease Control↗
PubMed1993

Growth of under five-year-old children in Kyeni, Kenya.

During a three-months period a cross-sectional study of the measurements of head circumference, mid-upper-arm circumference (MUAC) and weight was performed in 515 under five-year-old children in Kyeni, Kenya. Growth of Kyeni children seems to develop according to international standards for weight-for-age, MUAC-for-age and head circumference and for all parameters the average remains above minus 2 SD of the standard. Despite the presence of anthropometric malnutrition and downward trend in weight-for-age, MUAC-for-age and to a lesser degree the head circumference-for-age, the average growth of the Kyeni children in Kenya is within normal limits of international references.

Age Factors↗
PubMed1993

Evaluation of light traps for sampling anopheline mosquitoes in Kilifi, Kenya.

Anopheline mosquitoes were sampled inside houses, where residents slept under untreated bednets, by CDC light traps and human-biting catches to evaluate light traps as a means for determining human exposure to malaria vectors in Kilifi District, Kenya. Mosquitoes were sampled during 2 all-night collections by light traps and one all-night biting catch in a series of 262 houses. Collections yielded 1,721 Anopheles gambiae s.l. and 46 An. funestus, and 60.3% of the houses were negative for anophelines. There was a significant correlation in numbers of An. gambiae s.l. captured by light traps and human-biting collections (r = 0.64), but light traps were biased and underestimated An. gambiae s.l. abundance. This bias increased with increasing mosquito abundance. In addition, the proportion of An. gambiae s.l. infected by Plasmodium falciparum was 2.3-fold higher in light traps than in human-biting collections. Along the coastal zone of Kenya where vector abundance is low, light traps do not provide an adequate estimate of man-vector contact when such information is required at the household level in epidemiological studies of malaria parasite transmission.

Animals↗
PubMed1993

Epidemiology of cardiovascular diseases in Africa with special reference to Kenya: an overview.

At the beginning of this century, high blood pressure was virtually non-existent among the indigenous Kenyans. This phenomenon of normotension continued until the Second World War following which the Kenyan African began to exhibit progressive rise in blood pressure which was age-related. Similar changes were observed in Uganda at the same time. From about 25 years ago, high blood pressure became established in Kenya and the neighbouring countries, in particular Uganda. These trends have been observed in West Africa notably Ghana, Nigeria, Cote d'Ivoire and also in Cameroon and Zaire in the Central African region. Consumption of sodium salt and alcohol, psychological stress, obesity, physical inactivity and other dietary factors are thought to play important aetiologic role in the genesis of primary hypertension in the susceptible individuals. Low blood pressure communities still exist scattered all over the world, where blood pressure does not seem to rise with age. In Africa these have been observed in Kenya, Nigeria, Zaire and Kalahari Desert. They also exist in Pacific island, Australia, South America and elsewhere. Rural-urban migration coupled with acculturation and modernization trends have some relationship with the development of high blood pressure as observed in Kenyan and Ghanian epidemiologic studies.

Africa↗
PubMed1996

The consistent association between Epstein-Barr virus and Hodgkin's disease in children in Kenya.

Recent studies have suggested that Epstein-Barr virus (EBV) may play a role in the etiology of Hodgkin's disease (HD). In a previous study, we used a latent membrane protein 1 (LMP1)-specific antibodies to examine archival material from 74 British children with HD and found 50% of cases to be positive. It is known that there are geographic and ethnic variations in the incidence of HD. We have investigated LMP1 status in formalin-fixed, paraffin wax-embedded lymph nodes with HD involvement from 53 children and 48 adults from Kenya using immunohistochemical staining. We also developed sensitive and specific in vitro gene amplification protocols for examining the EBV strain type in such material using several combinations of primers derived from the EBNA 2 and EBNA 3 coding regions. LMP1 positivity was present in 100% of the pediatric cases (two lymphocyte-predominant, 25 nodular sclerosis, 16 mixed cellularity, 5 lymphocyte depletion, and 5 unclassified) and in 66% of the adult cases (two of three lymphocyte-predominant, 26 of 39 nodular, sclerosis, two of two mixed cellularity, and two of four lymphocyte depletion). Tests to type the EBV strain were undertaken in 25 EBV-positive pediatric cases. A combination of type-specific polymerase chain reactions for EBNA 2 and EBNA 3C genes indicated that seven patients had type 1, eight had type 2, and 10 had dual infections with both types. Five cases with dual infections were further investigated using a sensitive in situ hybridization for the EBV-encoded, small nuclear nonpolyadenylated RNAs (EBERs). EBER transcripts were detected in Reed-Sternberg and Hodgkin cells and in occasional infiltrating lymphocytes. These observations indicate that in Kenya EBV is consistently associated with pediatric cases of HD, and that biopsies from a number of such cases appear to carry both type 1 and type 2 viral sequences.

Adolescent↗
PubMed1996

Some emerging issues on the malaria problem in Kenya.

Malaria in Kenya has been characterised by marked variability in its epidemiology, partly reflecting the obstacles and progress made in the control strategies. The impact of anti-vector activities in the 1970s and before have been observed for variable lengths of time afterwards. Malaria has re-emerged in areas previously with little or no transmission. The recovery of infective Anopheles gambiae vector in higher altitudes affirms the potential for transmission in areas where epidemics have been known to occur. Morbidity and mortality patterns in the otherwise endemic lowlands have become increasingly severe, an observation which would be attributed to the increasing inefficacy of chloroquine. Efforts to promote personal protection suffer substantial setbacks in sustainability inspite of apparent acceptability. There are indications that the mosquito vector susceptibility to permethrin and other insecticides will now require continual monitoring in order to detect development of significant resistance. In this communication, we review some emergent issues in malaria transmission in Kenya and the potential for control as adduced from historical and contemporary perspectives.

Altitude↗
PubMed1996

Induced abortion in Kenya: its determinants and associated factors.

In a study involving 1077 women who were admitted and treated for incomplete abortion and its related problems at eight hospitals (seven district and one mission hospitals) in six of the eight provinces of Kenya, between October 1988 and March 1989, 169 (15.7%) had illegally induced unsafe abortion, based on their own history and clinical findings. The illegally induced unsafe abortions were common among both rural and urban dwellers, and women from almost all social and economic strata were involved. However, they were more common among the youth (< 25 year olds), school girls, those with high formal education, in formal employment, and not currently married. Majority (90.4%), of the induced group said their pregnancies were unwanted, as compared to only 29.1% of the non-induced (p < 0.05). The main determining factor for termination of pregnancy amongst these women appeared to be the fact that it was unwanted and/or unplanned, either because of inappropriate timing, the type of man responsible, the relationship itself and the social and economic implications thereof. This is contributed to by poor contraceptive use inspite of very good awareness, and/or desire to use. There is urgent need to integrate abortion care and related services into the overall reproductive health care and as a part of the broader safe motherhood initiative in Kenya. In addition it is necessary to revise the legal provisions on abortion so as to make them more relevant. Appropriate management of adolescent fertility, should be undertaken with the aim of reducing the extent of illegally induced unsafe abortion with attendant sequealae.

Abortion, Illegal↗
PubMed1996

Field evaluation of arthropod repellents, deet and a piperidine compound, AI3-37220, against Anopheles funestus and Anopheles arabiensis in western Kenya.

A field evaluation of the repellents N,N-diethyl-3-methylbenzamide (deet) and 1-(3-cyclohexen-1-yl-carbonyl)-2-methylpiperidine (AI3-37220, a piperidine compound) was conducted against Anopheles funestus and An. arabiensis in Kenya. Both repellents provided significantly more protection (P < 0.001) than the ethanol control. AI3-37220 was significantly more effective (P < 0.001) than deet in repelling both species of mosquitoes. After 9 h, 0.1 mg/cm2 of AI3-37220 provided 89.8% and 71.1% protection against An. arabiensis and An. funestus, respectively. Deet provided > 80% protection for only 3 h, and protection rapidly decreased after this time to 60.2% and 35.1% for An. arabiensis and An. funestus, respectively, after 9 h. Anopheles funestus was significantly less sensitive (P < 0.001) to both repellents than An. arabiensis. The results of this study indicate that AI3-37220 is more effective than deet in repelling anopheline mosquitoes in western Kenya.

Adult↗
PubMed1996

Acceptability and discontinuation of Depo-Provera, IUCD and combined pill in Kenya.

This paper reports on a prospective study conducted between June 1990 and June 1992 to determine method acceptability, user satisfaction and continuation rates for three highly effective and reversible contraceptive methods currently available in Kenya: the CuT 380A (IUCD), the injectable, Depo-Provera and the low-dose oral contraceptive pill, Microgynon. A non-randomised sample of volunteer participants was used. One thousand and seventy-six users were followed up for a period of one year or up to the time of discontinuation of the method, whichever came earlier. Analysis revealed method specific differences in users' characteristics. The OC users were younger and had fewer children than the IUCD or Depo-Provera users. The Depo-Provera users were older, and had the largest family sizes. Many OC users (almost 40%) were single, while almost three-quarters of IUCD and Depo-Provera users were married. IUCD users were also more educated compared to OC and Depo-Provera users. Survival analysis was used to calculate cumulative life table discontinuation rates by method for the 12 month period. Discontinuation rates were highest for OC users (80%) and lowest for IUCD users (20%) and intermediate for Depo-Provera users (39%). Ninety percent of OC and Depo-Provera users and 86% of IUCD users said they were satisfied with their respective methods. While OCs are among the most popular family planning methods in Kenya, they are also one of the most problematic, while IUCD has the fewest compliance problems. Service providers need to address the issue of high discontinuation rates among the young OC users.

Adolescent↗
PubMed1997

Chloroquine versus pyrimethamine/sulphadoxine in the treatment of uncomplicated P. falciparum malaria in northern Kenya.

The response of P. Falciparum to chloroquine (CQ) and pyrimethamine-sulphadoxine (PSD) in vivo was investigated in 173 indigenous uncomplicated malaria patients at Sololo Hospital, Moyale district in northern Kenya. All the patients were symptomatic and parasitaemic. They were divided in two age groups (children < 10 years, adults > 10 years). They were randomly assigned to receive either CQ or PSD standard treatment and then followed up at 7 and 14 days. In the child group, out of 91 patients enrolled, 65 (71.4%) completed the seven-day study; among these 38 (17 females and 21 males with mean age of 41.9 months) were treated with CQ and 27 (11 females and 16 males with mean age 39.1 months) with PSD. Parasites were significantly (p < 0.001) more resistant to CQ (18/38, 47.4%) than PSD (0/27, 0%). In the adult group, out of 82 patients enrolled, 54 (65.9%) completed the 7-day-study, and among these 27 (10 females and 17 males with mean age of 22.5 years) were treated with CQ and 27 (11 females and 16 males with mean age of 23.2 years) with PSD. Parasites were significantly (p = 0.01) more resistant to CQ (7/20, 25.9%) than PSD (0/27, 0%). Overall, considering the 119 patients who completed the follow-up, the resistance of P. falciparum was significantly higher (p < 0.001) to CQ (25/65, 38.5%) than to PSD (0/54, 0%). Out of the 94 patients with negative slide at day 7, fifty seven came at the control of the day 14 (30 children and 27 adults). Among them, 22 were in CQ group and five were found positive (22.7%), while the 35 patients in PSD group all tested negative (p = 0.006). The resistance to CQ in the children group was 25% (p = 0.05) and 20% in the adult group (p = 0.13). We conclude that the significant parasitological resistance to CQ in the area under study questions the continued use of CQ as first line antimalarial treatment. On the contrary, PSD can still be considered a very effective drug against P. falciparum in northern Kenya.

Adolescent↗
PubMed1997

An evaluation of surveillance of malaria at primary health care level in Kenya.

As less than twenty five per cent of persons suffering from malaria seek formal treatment in most of sub-Saharan Africa, Facility-based morbidity statistics are inadequate for monitoring malaria control programmes. This explorative study assessed whether a health centre equipped with a microscope and trained personnel could monitor malaria transmission within its catchment area. The study was conducted at Chemase Health Centre in Nandi District in Kenya, an area holoendemic for malaria with Anopheles gambiae as the main vector and Plasmodium falciparum as the commonest cause of malaria. From first August to 31 October 1991, first seven children under five years of age on each working day accompanied by their mothers to the maternal and child health clinic were studied. A general examination was performed by a Registered Clinical Officer (Medical Assistant) and thin and thick blood smears made, stained with Giemsa stain and examined for malaria parasites by a Medical Laboratory Technologist. Mothers were interviewed by enrolled community nurses on antimalarial measures they were using in their homes. Four hundred and fifty five children mostly under five years of age, consisting of 48.1% males and 51.9% females, were studied. Malaria parasites were present in 209 (45.9%) blood smears of the children. The percentage of blood smears positive for malaria parasites was high in children below 36 months of age. There was a tendency for low percentage of blood smears positive for malaria in children whose mothers reported using mosquito nets or insecticide sprays. The study did not interrupt the routine of the health centre. Periodic monitoring of new malaria illnesses. and percentage of blood smears positive for malaria parasites in children aged 0 to 35 months should be introduced into health centre practice in Kenya. This catchment area approach could be used to monitor malaria control programmes as well as predicting malaria epidemics.

Age Distribution↗
PubMed1997

Ageing and poverty in rural Kenya: community perception.

Poverty is widespread among rural African elderly and associated with poor health and unsatisfactory access to health care. The purpose of this study was to determine community perception of the poorest in a community in rural Kenya, more specifically to identify factors considered by community members as associated with poverty in their midst. There is need to protect the aged members of the society from payment for health care and to include them in decision-making process. This study was undertaken in seven sites in Kisumu and Homa Bay districts in western Kenya where the Bamako Initiative was first launched, in 1987, calling on UNICEF and WHO to help accelerate the implementation of primary health care at district level, giving priority to women and children. Two household interview baseline surveys comprising 210 and 87 households, respectively, corroborated by the more qualitative approaches of participatory rural appraisal (PRA) and focus group discussions were conducted. This article analyses the importance of ageing as perceived by the communities as a factor associated with poverty.

Aged↗
PubMed1997

Median age at menopause in a rural population of western Kenya.

This was a cross sectional descriptive study to discuss the median age of menopause in a rural area of Western Kenya. The broad objective of the study was to describe the demographic and biophysical characteristics of the study population and determine the age of menopause. A review of the current and medieval records shows average age of menopause has remained relatively constant at 50 years in contrast to the receeding age of menarche. A total of 1078 women aged between 40-60 years were interviewed. The majority (98.8%) were from one ethnic group, the Luhya. Of the 1078 women, 880 (81.4%) were married and 198 (18.6%) were single. The average number of children per woman was 7.74. Most of the women (75.1%) had attained primary school education. Their husbands were unskilled workers in 30.1% of the cases. The mean weight and height of the women was 60.74 kg and 161.1 cm respectively. Using methods of probit analysis, the median and modal age of menopause was found to be 48.28 years in this group of western Kenya women. If generalised for the whole country, these results suggest that an average Kenyan woman lives for over ten years beyond menopause. It is recommended that more attention should be given to the special health problems of postmenopausal population.

Adult↗
PubMed1997

Drinking and driving in an urban setting in Kenya.

A roadside alcohol prevalence survey of drivers randomly selected from the general traffic was conducted in Eldoret, Kenya. Blood alcohol concentration (BAC) data obtained by a breath test in 90% of the sample (n = 479) was analysed by demographic and travel characteristics. 19.9% had a positive breath test (BAC > or = 5 mg%), 8.4% had BACs greater than 50 mg%, and 4% exceeded 80 mg%. A greater proportion of males (20%) had been drinking compared to females (12.5%): all drivers with high BACs (> or = 50 mg%) were males. The likelihood of having consumed alcohol was greater in motorists aged 25 years and above (20.4%) than in younger drivers aged 16-24 years (15.4%), their mean BACs were also more elevated (57 mg% versus 31 mg%). In comparison to operators of public service vehicles (PSV), people driving personal cars were more than twice as likely to have been drinking: with 21.9% being BAC positive against 10.8% (OR = 2.3; 95% CI, 1.0 to 6.3, p = 0.05). Educated individuals with skilled careers tended to indulge in drink-driving to a greater extent than professional drivers (operators of public transport, taxi and heavy goods vehicles), with BAC prevalence rates of 23.7% and 15.5%, respectively. Other circumstances influencing the probability of drink-driving were number of vehicle occupants, distance to destination, road location, time of the night and whether it was a weekend or weekday. These findings are discussed in relation to the potential for promotion of relevant deterrent measures, including the establishment of an appropriate BAC legal limit for drivers in Kenya.

Adult↗
PubMed1998

Gender differences in the schooling experiences of adolescents in low-income countries: the case of Kenya.

Although a growing proportion of young people is spending some time in school between puberty and marriage, little research on education in developing countries has been focused on adolescent issues. This article examines the school environment in Kenya and the ways it can help or hinder adolescents. Gender differences are considered with a view toward illuminating some factors that may present particular obstacles or opportunities for girls. Using both qualitative and quantitative data, 36 primary schools in rural areas in three districts of Kenya are studied. These schools are chosen to reflect the spectrum of school quality in the country. The focus in this study is on primary schools because the majority of adolescents in school attend primary school. In these schools, where considerable variation in performance and parental educational status is found, disorganization coexists with strict punishment, minimal comforts are lacking, learning materials are scare, learning is by rote, and sex education is not provided. In the primary-school-leaving exam, girls' performance is poorer than that of boys. Teachers' attitudes and behavior reveal lower expectations for adolescent girls, traditional assumptions about gender roles, and a double standard about sexual activity.

Adolescent↗
PubMed1996

Rapid assessment of drug abuse in Kenya.

A country-wide needs assessment study undertaken in 1994 by the Government of Kenya and the United Nations International Drug Control Programme (UNDCP) revealed that drug abuse has permeated all strata of Kenyan society, youth and young adults being the most affected groups. The traditional cultural values and discipline of African society prescribed the circumstances under which drugs and intoxicants could be obtained, used and consumed. Perhaps as a result of the erosion of the powers of censure and control at the family and community levels, fewer stigmas are associated today with the use of intoxicants (especially alcohol and tobacco). One of the main recommendations of the study is that the Government of Kenya should set up specific demand reduction programmes to enlighten and educate the public on the problem of drug abuse. The need for a reassessment of government policy on the treatment of addicts is stressed, and it is suggested that the establishment of non-stigmatizing treatment and rehabilitation centres should be considered. Intersectoral collaboration between different government departments and non-governmental organizations is also proposed.

Adolescent↗
PubMed1998

Health worker performance after training in integrated management of childhood illness--Western Province, Kenya, 1996-1997.

Each year, approximately 12 million children die in developing countries before age 5 years; 70% of these deaths are caused by respiratory infections, diarrhea, malaria, measles, and malnutrition, alone or in combination. In 1994, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) developed the Integrated Management of Childhood Illness (IMCI) guidelines, which call for non-physician health workers (HWs) to evaluate every sick child presenting to a first-level health facility (HF) for each of these conditions, regardless of the child's presenting complaint(s). Even though IMCI is being incorporated into the national health-care programs of many developing countries, little is known about HW performance after IMCI training. To measure the level of performance achieved and maintained by IMCI-trained HWs, during 1996-1997 CDC, the Kenya-Finland Primary Health Care Program, and the Ministry of Health of Kenya prospectively evaluated the level of performance achieved by IMCI-trained HWs at the end of training (EOT) and the level of performance maintained during the first 3 months post-training (1-3MPT) with monthly or bimonthly clinical supervision. This report summarizes the results of this evaluation, which indicate that HWs achieved reasonably high performance levels managing ill children with mild and moderate disease classifications but performed at a much lower level when managing severely ill children at EOT.

Algorithms↗
PubMed1992

Clinical course and molecular characterization of a compound heterozygote for sickle hemoglobin and hemoglobin Kenya.

We describe a 25-year-old black woman who presented with a long history of anemia requiring transfusions during childhood and adolescence. Molecular analysis revealed her to be a compound heterozygote for the sickle mutation and the approximately 22.7 kb deletion associated with hemoglobin Kenya. This patient's clinical course was more severe than previously reported for the Hb S/Hb Kenya genotype, a probable consequence of concomitant iron deficiency.

Adult↗