Prognostic awareness and prognostic information preferences among advanced cancer patients in Kenya

Background: Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information. Aim: To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya. Setting: Outpatient medical oncology and palliative care clinics and inpatient medical and surgical wards of Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. Methods: The authors surveyed 207 adults with advanced solid cancers. The survey comprised validated measures developed for a multi-site study of end-of-life care in advanced cancer patients. Outcome variables included prognostic awareness and preference for prognostic information. Results: More than one-third of participants (36%) were unaware of their prognosis and most (67%) preferred not to receive prognostic information. Increased age (OR = 1.04, 95% CI: 1.02, 1.07) and education level (OR: 1.18, CI: 1.08, 1.30) were associated with a higher likelihood of preference to receive prognostic information, while increased symptom burden (OR= 0.94, CI: 0.90, 0.99) and higher perceived household income levels (lower-middle vs low: OR= 0.19; CI: 0.09, 0.44; and upper middle- or high vs low: OR= 0.22, CI: 0.09, 0.56) were associated with lower odds of preferring prognostic information. Conclusion: Results reveal low levels of prognostic awareness and little interest in receiving prognostic information among advanced cancer patients in Kenya. Contribution: Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients.

Characterization of genital chlamydia amongst female sex workers in Nairobi, Kenya

Introduction: genital chlamydia, which is caused by diverse Chlamydia trachomatis genotypes, is largely asymptomatic. We aimed to identify C. trachomatis genotypes causing genital chlamydia among female sex workers attending a sex workers outreach program clinic in Nairobi, Kenya. Methods: this cross-sectional study was conducted between 18 April 2017 and 19 March 2021. Genitourinary complaints from eligible female sex workers were documented using a structured questionnaire. Endocervical swabs were collected for laboratory analysis. C. trachomatis plasmid DNA was extracted, PCR-amplified, and sequenced. Consensus sequences were generated and aligned with reference sequences to determine the C.trachomatis genotypes. Bivariate analysis was used to determine the association between genitourinary complaints and genital chlamydia. Results: endocervical swabs were collected from a total of 348 participants. Of these, 46 (13.2%) were positive for C. trachomatis. Most (297, 85.3%) of the participants presented with pelvic discharge with or without other symptoms. Fifteen (15, 4.3%) had abdominal pain and 3 (0.9%) had an itchy vulva. There was no statistically significant relationship between clinical presentation and genital chlamydia. Twenty-three samples were successfully sequenced. Each sequence was at least 90% identical to each of the 13 references C. trachomatis genotypes A, B, C, D, E, F, G, Ia, J, L1, L2, L2b and L3. Conclusion: we found no significant association between individual genitourinary complaints and genital chlamydia infection. The C. trachomatis genotypes circulating amongst female sex workers in Nairobi could be related to genotypes A, B, C, D, E, F, G, Ia, J, L1, L2, L2b, and L3.

Hematological Profiles of Eligible Blood Donors at Kenyatta National Hospital, Kenya

Aim:To determine hematological profile of eligible blood donors at Kenyatta National Hospital (KNH), Kenya.Study Design:Adopted a cross-sectional study.Place and Duration of Study:Kenyatta National Hospital, between March 2021 and August 2021.Methodology:This study recruited 202 eligible blood donors comprising of 173 males and 29 females aged 18-57 years. Blood samples (4ml) were drawn from donated units into ethylene diamine tetraacetic acid (EDTA) tube. Hematological parameters were estimated using a complete blood count (CBC) analyzer (Humacount 5D®). A total of eighteen hematological parameters were analyzed. These parametersincluded; red blood cell (RBC) count, hemoglobin concentration, RBC indices, white blood cell (WBC) count, absolute and differential WBC and platelet (PLT) count. Results were presented in medians and 95% interquartile ranges and compared using Mann–Whitney U test.Results:The median counts for all hematological parameters were within the accepted reference ranges for the adult urban population in Kenya. The median and interquartile range for total red cell count was 4.9×106/μL [0.74], hemoglobin level was 14.3g/dL[1.8], hematocrit was 44.9% [5.1], white blood count was 4.9×103/μL [1.4] and platelet was 234×103/L [64]. Among the red cell parameters analyzed, male donors had a significantly higher RBC count (P<0.001), hematocrit (P=0.001) and hemoglobin (P<0.001) than female donors. Among white blood cell parameters analyzed, only lymphocytes (P=0.011) were significantly higher in female donors than male donors. Platelet count (P<0.001) was also significantly higher in females than male donors.Conclusion:This study showed eligible donors at KNH had significant differences in red cell count, hematocrit, hemoglobin, lymphocytes and platelets between male and female donors. Additionally, it highlighted that some blood donors had hematological parameters belowand above the recommended reference ranges. These findings support the need to review the current donor recruitment criteria recommending the inclusion of complete blood count in screening.

Implementing an intensified mentorship approach towards accelerated medical laboratory accreditation in 10 counties in Kenya

Background: Despite Kenya's roll-out of the Strengthening Laboratory Management Towards Accreditation programme in 2010, most laboratories had not made significant or tangible improvements towards accreditation by 2016. In April 2016, the University of Maryland, Baltimore enrolled 27 facilities in the standard Strengthening Laboratory Management Towards Accreditation programme. Objective: This study aimed to describe and evaluate the implementation of an intensified mentorship strategy on laboratory accreditation. Methods: In October 2017, the University of Maryland, Baltimore implemented intensive mentorship in 27 hospital laboratories in Nairobi, Kiambu, Meru, Embu, Muranga, Nyeri, Laikipia, Nyandarua, Tharaka-Nithi, and Kirinyaga counties in Kenya. Laboratories were paired with competent mentors whose skills were matched to facility gaps. Baseline and follow-up assessments were done between April 2016 and March 2019 using the World Health Organization's Stepwise Laboratory Quality Improvement Process Towards Accreditation Checklist and overall scores of the 12 Quality System Essentials and star ratings (from zero to five, based on scores) used to evaluate the effectiveness of the intensified mentorship.Results: In September 2017, 14 laboratories scored zero stars, three scored one star, eight scored two stars, one scored three stars, and one laboratory was accredited. By March 2019, eight laboratories were accredited, five scored four stars, 10 scored three stars, three scored two stars, and only one scored one star. The average score change with the intensified approach was 81.5 versus 53.9 for the standard approach.Conclusion: The intensified mentorship strategy resulted in fast-tracked progress towards laboratory accreditation and can be adopted in similar resource-limited settings

Evaluation of the Knowledge, Attitudes and Prevention Practices with Regard to Cutaneous Leishmaniasis Caused by Leishmania aethiopica in Mount Elgon Focus, Kenya

Leishmaniasis has spread beyond the traditional areas of the Rift Valley and North Eastern provinces. There is more evidence of emergence and spread of leishmaniasisin Western Kenya. However, there is currently no comprehensive study on knowledge, attitude and prevention practices on leishmaniasis among the risk populations in the endemic Mount Elgon region of westernKenya. This has hindered the protocol for understanding the epidemiology of leishmaniasis.The descriptive survey design study was carried out from April to June, 2019 and it sought for information on KAP related to cutaneous leishmaniasis (C.L) in Mount Elgon region. Using stratified simple random sampling technique, a total of 340 household participants were selected in the study area. Structured questionnaire was used to collect the data. Regarding the responses given to knowledge, attitude and practice, a score of 1 was given for each right response and 0 for unsure responses. Data analysis was conducted using IBM SPSS version 23 statistical software. Descriptive statistics that include frequency and percentage were used to analyze the results. Out of 340 individuals were participated in our study 214 (62.9%) of the participants were males and 126 (37.1%) were females. The result of the present study in terms of knowledge showed that most of the respondents scored less than four items out of six correctly, hence described as having poor knowledge of CL.With regard to attitude respondents believed that CL was a problem in their area and had positive attitude towards the treatment of the disease. TheOriginal Research Article study also found out that majority of the respondents practiced well, as indicated by scoring positively in more than three items. In terms of plants used in the treatment of the disease,Olea europaea, Kigelia Africana, Terminial mollis, Croton macrostachyus, Tylosema fassoglense andBridella micrantha were mentioned. It was concluded that, people were less knowledgeable, had positive attitude towards the treatment especially using plant extracts could act as the basis for future research on alternative drugs against the disease

Uptake of Isoniazid Preventive Therapy (IPT) and Its Associated Factors among People Living with HIV (PLWHIV) in Kajiado County, Kenya

Isoniazid Preventive Therapy (IPT) involves use of isoniazid by People Living with HIV (PLWHIV) who havelatent TB for a period not less than six months to prevent active TB infection. Despite the critical role of IPT in reducing HIV/TB co-infection related morbidity and deaths, not much has been done to examine why its full implementation has not been achieved and the probable solution. The objective of this study was to determine uptake of isoniazid preventive therapy and its associated factors among people living with HIV in Kajiado County, Kenya. Analytical Cross-sectional study was carried out in purposely selected four Hospitals. Two hundred and seventy two(272) study participants were recruited through systematic sampling with 100% response rate. Data were collected using structured questionnaires. Cross tabulation, bivariate and multivariate analysis was carried out to identify factors influencing IPT uptake. The study found out that IPT uptake was at 72%. Logistic regression analysis, established the existence of a significant positive association (p-value=0.000, βii=1.729) between patient knowledge among PLHIV and IPT uptake. A correlation analysis outcome shows the existence of a significant positive relationship (r=0.332, sig. =0.000) between patients knowledge and having ever used IPT at 0.01 level in a two tailed.The 72% of IPT uptake was sufficient. Patient knowledge factors had the highest influence on IPT amongst PLWHIV. The role of health care givers and health centers as IPT information disseminators and IPT knowledge source respectively, was invaluable in this study

Socioeconomic Factors and Cultural Practices Influencing the Resurgence of Bedbugs (Cimex hemipterus): A Case of Nakuru Town, Kenya

Bedbugs are parasitic insects that feed mostly on blood (human). Cimex hemipteruscommonly known as the Tropical bedbug resurge in warmer climates like Africa, Asia and America. Over the years bedbug infestation has remained a major public health concern among the residents of Nakuru Town Kenya. The purpose of this study was to determine socioeconomic factors and cultural practices that influence the resurgence of bedbugs in Nakuru Town, Kenya.This study adopted analytic epidemiological study design and used cross sectional descriptive survey for data collection. It was conducted in seven estates in Nakuru Town, Kenya with an estimated population of 32,856 in a period of seven months. Cluster sampling was used to sample the households in the estates with the study surveillance being done in four hundred and twenty two (422) households whereas 57% and 43% of the participants were male and female respectively The main source of income among the respondents was self-employment with only 27% of the participants being employed. According to the findings of this study 31% of the residents were earning between 5000 and 10000 with only 4% of their monthly income been allocated to healthcare.The current socioeconomic status among the residents of Nakuru Town is inhibiting the fight against bedbug elimination. Cultural beliefs like witchcraft are limiting the eradication of bedbugs and leads to the resurgence in some of the households.In conclusion, the current socioeconomic status among the residents of Nakuru Town is inhibiting the fight against bedbug elimination. The findings of this study will be used to inform the policy makers in the Nakuru County government on measures to be taken to improve the socioeconomic status of its residents so that in the future residents are empowered to eradicate the bedbugs.

A qualitative perinatal audit at a rural health facility in Eldoret, Kenya

Background: Objectives of the study were to ascertain the pattern of occurrence of perinatal mortality by applying the World Health Organization (WHO), International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period, ICD perinatal mortality (ICD-PM), following the introduction of a qualitative perinatal audit process at a rural health facility in Kenya.Methods: A single centre retrospective analysis demonstrating the application of the WHO, ICD-PM. Data pertaining to perinatal deaths for the period from 1st May 2017 to 31st August 2018 was obtained from Plateau Mission Hospital perinatal audit records.Results: There were 22 perinatal deaths during the study period, 17 were included in the study. The overall perinatal death rate was 11 per 1000 births. Antepartum deaths were as a consequence of fetal growth related problems (33.3%), infection (33.3%) or unexplained (33.3%) with pregnancy-related hypertensive disorders (gestational hypertension, pre-eclampsia and eclampsia) being the most frequent medical condition associated with the mortalities. Neonatal deaths (47.1%) were the most frequent in the study and were a consequence of low birth weight and prematurity (25.0%), Convulsions and disorders of cerebral status (25.0%). The maternal condition in most of these cases being complications of placenta, cord and membranes. Acute intrapartum events and were least in this setting accounting for 17.4% of deaths.Conclusions: The ICD-PM is generalizable and its use in perinatal death classification emphasises focus on both mother and baby. Our study showed the majority of perinatal deaths occurred in the early neonatal period & affected mostly preterm infants.

Status of healthcare waste management in small and medium sized healthcare facilities in Nakuru East Sub County, Kenya

Background: Health care waste (HCW) is unwanted materials produced from hospitals, laboratories and research centres. HCW is of public health importance because hazardous HCW carries significant health risks. If poorly handled, it can lead to significant public health crises. Consequently, guidelines for proper management of HCW have been legislated. Unfortunately, not all healthcare facilities adhere to the guidelines. Diseases spread by inadequately disposed HCW are becoming increasingly prevalent especially in developing nations. This study was therefore conducted to establish the status of HCW management in six purposefully selected healthcare facilities in Nakuru East Sub-County (NESC), Kenya.Methods: A cross sectional study design was used to conduct this study. Six healthcare facilities (HCFs) in NESC, Kenya were purposefully selected. The HCFs were selected based on level and patient volumes and categorised as small or medium sized. HCW from each of the HCFs was weighed and categorised. Observation checklists and interviews were used to determine techniques used in HCW management.Results: The total weekly weight of HCW was 187.65 kg (mean 31.3 kg). Small sized HCF produced 49.55 kg/week while medium sized HCFs produced 138.1 kg/week. Total weekly weight of general HCW was 143.7 kg (76.5%); 33.8 kg (18%) was infectious while 10.2 kg (5.4%) was sharps.Conclusions: Healthcare facilities in NESC produce significant quantities of HCW. General HCW was predominant, followed by infectious waste and sharps. A considerable proportion of the HCFs did not comply with the stipulated guidelines for safe management of HCW. Concerned authorities in all HCFs should be alert and proactive regarding proper management of HCW.

Citizen engagement in social health insurance purchasing, in selected counties in Kenya

Background: National hospital insurance fund (NHIF) uses capitation as a strategic purchasing model to provide primary care health services (PCHS). This study sought information on citizen knowledge of PCHS benefit package, NHIF communication to citizens, determination of citizen views and values, NHIF accountability to citizens, citizen choice of PCHS provider and how these factors influence citizen access to NHIF, PCHS.Methods: This was a cross sectional research conducted between March 2017 to March 2018. 426 patients were sampled from Nyandarua and Nakuru Counties.Results: 366 (93%) patients knew the PCHS benefit package, 226 (57%) said NHIF communication to them was adequate, 280 (71%) said NHIF does not take into account their view and values, 272 (69%) said NHIF is not accountable to them, 269 (68%) knew how to select an outpatient facility, 111 (28%) said they did not receive NHIF, PCHS. Multivariate logistics regression analysis of citizen engagement factors and access to PCHS, indicate that NHIF communication to citizens (p<0.05, OR=2.358, 95% CI [1.399-3.975]), purchaser accountability (p<0.05, OR=2.073, 95% CI [1.017-4.226]) and provider choice (p<0.05, OR=2.990, 95% CI [1.817-4.920]) added significantly to the regression model.Conclusions: There is inadequate engagement of citizens in NHIF decision making which may hinder access to NHIF PCHS, therefore NHIF should establish citizens’ needs and preference through public forums, elicit citizens’ feedback, act on complains when raised, inform citizens on how the capitation system works and NHIF should visit health facilities regularly to establish if patients are accessing PCHS.

Prevalence and Associated Risk Factors of Soil-Transmitted Helminthiases among Primary School-going Children in Rarieda, Siaya County-Kenya

Background and Aim: It is certain that without readily available water in sufficient quantity, and free of pathogens, man's progress is tremendously hindered. In Muyuka, Cameroon, though there exist public taps littered “here and there”, the population most often find themselves fetching water from nearby streams raising to surface the question of sustainability of the available water systems which was the aim of this study.Methods:This was a cross-sectional, analytic study targeting household heads and water committee members in the rural communities of Muyuka. Three communities were randomly selected and from each, five quarters were randomly selected. In the quarters, convenience sampling technique was used for the household heads while snowball sampling technique was used to get the water committee members. An interviewer administered questionnaire was used and data analyzed using R.Results:A total of 371 persons participated in the study. The average number of years lived in the community was 22.08 (SD=10.61) and ranged from 10 to 66. Only 13.00% of the participant didn’t see the water system as challenging while 81.5% finds it to be severely problematic. Utilization of water averaged far less than the 50L/person/day and the situation worsened as the household size increased. Close to half (49.6%) of participants did not participate at any stage in the development of the water system. According to the participants, water systems breaks down averagely 3 times in a year and last for about 67 days before being repaired. Water committee members reported difficulties in accessing spare parts and inadequacy in their training.Conclusion:Frequent breakdown of the water schemes compounded by the unavailability of spare parts and hence delays in repairs, and in expansion, user dissatisfaction and unwillingness to pay their bills; inadequacy in training of water committee members, has resulted in poor sustainability of the water system

Assessment of Levels of Nutrients in Selected ALVs at Different Harvesting Stages and Locations of Production in Western Kenya

Proper nutrition contributesto declines under-five mortality rates and improves the productivity of adults.Addressing nutritional problems requires adequate information on the diets of individuals and populations. African leafy vegetables (ALVs) are widely consumed and often harvested at different stages after planting with the help of different communities. Four ALVs namely Vigna unguiculata, Amaranthus hybridus, Cleome gynandraand Solanum scabrumare commonly grown vegetables in western Kenya, their potentials have not been evaluated to supply the nutrients. However, nutritional values may vary depending on the species, harvesting stage and location of production. The effects of species, harvesting stages and location of production on the nutritional valueof selected ALVs were evaluated. The trials were laid out in a randomized complete block design in three replicates in Busia, Kisumu, andLela. Leaves were sampled at different harvesting stages and analyzed for N, P, K, Na, Ca, Mg, Mn, Fe, andZn levels. Amaranthus hybridushad significantly (P≤0.05) higher levels ofP,Ca,Zn, Mn, andNa.TheN, P,K, Ca,Mg, Zn and Fe levelssignificantly (P≤0.05) increased then decreased with harvesting stage.The levels of nutrients significantly (P≤0.05) varied with location of production except forNa. The ALVs from Kisumu site hadsignificantly(P≤0.05) higher levels of N, P, K, Ca, Mg and Zn, ALVs from Lela site had higher levels of Mn and Na while ALVs from Busia site had higher levels of Fe. Amaranthus hybridusis a better contributor of-ofP, Ca, Zn, Mn, andNa. The Fe, Mg and Zn levels were above the Recommended Dietary Allowance and may be used to alleviate deficiencies associated with such nutrients. Harvesting the ALVs at the stage the nutrients attain their optimum levels is recommended. There is a needfor the developmentof regional food composition tables for all ALVs in Kenya.

Assessment of the Prevalence of Chlamydia trachomatis Infection in Donated Blood at Regional Blood Transfusion Centre, Eldoret, Kenya

Aim:To detect Chlamydia trachomatisin donated blood at Regional Blood Transfusion center, Eldoret.Methodology:A random selection blood sample was done for this study for a period of one month from July 24th2017 to August 24th2017. Blood bags were numbered 1-87 and picked amongst unnumbered blood bags by each donor in order of donation. The samples obtained were subjected to centrifugation and serum used in the immunoassay test by using the Chlamydia trachomatisIgG/IgM Elisa test kit.Results:This study showed that C. trachomatiswas present in 8% (7 samples) of the blood samples analyzed and 92% were found to be negative.Conclusion:With 8% of the samples testing positive for Chlamydia trachomatisthisindicated that some of the blood donated to the Regional Transfusion Center is contaminated

DNA Analysis of Ralstonia solanacearum Based on 270-bp PCR-amplified Fragment from the Lowlands and Highlands of Kenya

Aims: Bacterial wilt, caused by Ralstonia solanacearum, is a devastating disease resulting in tremendous losses of economic crops such as plants in the Solanaceae. Studies have shown that R. solanacearum is spreading from the lowlands to the highlands. This has seen increased need for understanding the genetic diversity of R. solanacerum strains common in these areas as a basis for better strategies in their control. Methodology: Sixty-nine bacteria isolates obtained from various wilting plant hosts (Tomato, capsicum and potato) from 11 different sites in Nyeri, Nyahururu, Kirinyaga, Kiambu, Nakuru Murang’a and Embu were subjected to molecular analysis. Results: All the bacteria isolates were confirmed to be R. solacearum following PCR amplification of about 270-bp fragment using specific primers OLI 1-F and Y2-R. Based on the targeted 16 S rDNA sequences using primers OLI 1 and Y2, the 69 bacteria isolates had 98 to 100% identity with other DNA sequences for R. solanacearum isolates deposited in the NCBI database. Analysis of genetic differentiation showed there were total of 26 haplotypes from the 11 studied populations. The total number of segregating sites in all populations was 225. Conclusion: Through this study, it was realized that the main causative agent of bacterial wilt in potatoes, tomatoes and capsicum grown in the lowland and highland regions in Kenya is R. solanacearum. The isolates are in two main groups (Cluster A and B) that represent mainly the phylotypes I and II respectively.

Influence of Farmer-Driven Composting Technology on Below and Above Ground Biology of Common Bean in Western Kenya

Composts are rich in nutrients especially carbon, nitrogen, phosphorus and potassium. These nutrients enhance the colonization of plants by beneficial endophytic and rhizosphere microbes. Therefore, a field experiment was conducted on MMUST farm to determine the effect of farmer-produced composts soil biota and above ground pests on bean plant within Western Kenya. five farmer-produced composts with varying plant and animal waste ingredients (FPC1, FPC2, FPC3, FPC4, FPC5), DAP fertilizer and controls. Each of the resulting 14 treatment combinations comprised of twin plots (3 m × 2 m) for the two bean varieties, each having n = 40 plants per variety, spaced at 50 cm × 15 cm, replicated in 3 blocks (24 m × 14 m) in a randomized block design. Rhizobium root nodules, rhizosphere fungal and bacterial populations (CFU 10-g of soil) where higher in the compost-treatments than in DAP, while soil nematode populations were low. Therefore, the present study concluded that farmer-produced composts in Western Kenya improve below and above ground of common bean.

The Antibacterial, Antioxidant and Phytochemical Composition of Combretum tanaense (J. Clark) Root Extracts

Aims: To evaluate the antibacterial, antioxidant and phytochemical composition of Combretum tanaense extracts. Study Design: Laboratory-experimental design was used in this study. Place and Duration of Study: Fresh roots of Combretum tanaense were obtained from Mount Kenya University botanical garden in Thika (Kiambu County-Kenya). The study was carried out between November 2017 and February 2018 at Mount Kenya University Biochemistry and Pharmacognosy laboratories. Methodology: Duplicate voucher specimens were prepared and deposited at the East Africa herbarium housed at the National Museums of Kenya and Mount Kenya University herbarium. Extraction of total extracts of C. tanaense roots was conducted according to standard procedures. Agar well diffusion and 2-2-diphenyl picryl hydrazyl (DPPH) assay methods were used to evaluate antibacterial and free radical scavenging activities of the extracts. All assays were performed in triplicate. Antibacterial data was presented as a mean zone of inhibition ± SEM while free radical scavenging activities were expressed regarding IC50. Phytochemical screening was carried out using standard procedures to ascertain the presence or absence of various phytochemical groups in the test plant. Results: The current study indicated that Combretum tanaense root extracts had antibacterial activities against the selected gram-positive and gram-negative bacterial strains. The highest activity was recorded against gram-negative bacteria (Haemophilus influenza) by exhibiting inhibition zones of 13.32±0.15 mm and 12.82±0.36 mm for methanol and water extracts respectively. Antioxidant activities for both methanol and water extracts were ten times higher compared to that of standard (L-ascorbic acid). The extracts were found to have saponins, phenols including tannins and glycosides. Conclusion: Extracts of Combretum tanaense have compounds that exhibit antibacterial and antioxidant activities. From the results obtained, the ability of the extracts to inhibit bacterial growth and scavenge for free radicals was due to the presence of phenolic compounds and will be attributed to the healing properties of this plant. This study recommends further studies including toxicity and isolation of active compounds for the development of products with pharmaceutical value.

Aproximación etnográfica al concepto de salud y enfermedad en la tribu turkana: proyecto para la mejora de la salud de los nómadas del Triángulo de Ilemi, Kenia / An ethnographic approach to the concepts of health and disease in the Turkana tribe: a project to improve the health of the nomads of the Ilemi Triangle, Kenya

RESUMEN El objetivo de este artículo es ofrecer una aproximación a la cultura de la tribu turkana del Triángulo de Ilemi, al noroeste de Kenia, en especial al modo en el que los miembros de este grupo étnico nómada entienden y dan forma a su propio constructo de salud y enfermedad. Se basa en un estudio etnográfico llevado a cabo en julio y agosto de 2014, en el que se realizaron observación participante en 15 aldeas de la tribu turkana, entrevistas informales y entrevistas en profundidad, con la colaboración de dos traductoras de la tribu y un enfermero. Se tomaron registros escritos, de video y de audio, los que se transcribieron para su posterior análisis. Entre los principales resultados de este estudio cabe destacar que tanto el concepto de salud como el de enfermedad distan mucho del enfoque occidental que a priori traen los proyectos externos y es probable que la falta de adherencia al seguimiento terapéutico de dichos proyectos esté relacionada con el desconocimiento cultural de ambos constructos por parte del equipo profesional.

ABSTRACT This paper aims to provide a broad view of the Turkana tribe of the Ilemi Triangle in northwestern Kenya, especially regarding the way the members of this nomadic ethnic group understand and shape their own construct of health and disease. It is based in an ethnographic study carried out in July and August 2014, including participant observation of 15 villages of the Turkana tribe, formal interviews and in-depth interviews carried out with the collaboration of two translators of the tribe and a nurse. Field notes as well videos and audio records were captured and transcribed for later analysis. Among the primary results of this study, it should be highlighted that the concepts of both health and disease differ greatly from the western approach that external projects bring with them a priori and it is likely that the lack of adherence to these projects is related to the scant cultural knowledge regarding such constructs on the part of the health professionals.

Knowledge of Primary Health Care Providers in Nairobi East District, Kenya, Regarding HIV-related Oral Facial and Other Common Oral Diseases and Conditions.

Background: In the Kenya primary health care (PHC) setting where most patients, including nearly 1.4 million HIV-infected people, seek medical care, PHC providers are expected to identify and manage HIV-related oral diseases during general consultations. This study aimed to assess the current knowledge of clinical officers and nurses in Nairobi East district of Kenya regarding HIV-related oral diseases and conditions. Design and Methods: A 40-item questionnaire was used in interviewing all 57 PHC providers in 2 administrative divisions in the district in a cross-sectional survey. Assessed categories were: knowledge about HIV-related oral lesions, clinical appearance of HIV-suspected conditions, knowledge about oro-pharyngeal candidiasis (OPC), general dental knowledge, common appearances of OPC, knowledge about periodontitis, causes of dental caries, frequency of general oral examinations and past training in oral health topics. The first 4 categories were confirmed as sub domains, with Cronbach’s alpha of 0.57, 0.54, 0.59 and 0.45 respectively. Results: All 57 PHC providers (15 clinical officers and 42 nurses) completed the questionnaire (response rate 100%). PHC providers did not routinely perform oral examinations. Their knowledge about HIV-related oral health topics and general oral health was found to be generally inadequate. Recommendations: A training module on HIV-related oro-facial lesions for Nairobi PHC providers, incorporating a practical session covering oral examinations, is recommended; especially in this high HIV-prevalence environment.

Predictors of Low Body Mass Index Among Patients with Smear Positive Pulmonary Tuberculosis in Kenya.

Aim: To determine the predictors of low body mass index (BMI) among tuberculosis (TB) cases in three high TB/HIV burden provinces in Kenya. Study Design: Cross-sectional survey, July 2010 to May 2011. Study Setting: Three high TB/HIV burden provinces in Kenya. Study Population: Notified new smear positive TB cases on anti-TB treatment. Sample Size: 1,298 Data Collection: Structured questionnaire. Data Analysis: The association of nutritional status (normal versus low BMI) is tested using a chi square for categorical variables while student t-test was used for continuous variables. Explanatory factors that were significantly associated with nutritional status (p value <0.05) were subjected to a logistic regression. HIV status was considered a priori risk factor in the multivariate model. Results: Of the participants, 57% (734/1298) and 43% (564/1298) had normal and low BMI respectively. There was no significant difference (p-value 0.71) by HIV status between normal BMI and low BMI. Employment, water source and HIV status were identified as significant predictors of low BMI in smear positive TB cases. Adjusting for all other factors in the multivariate model, lack of employment with the base being having an employment, was significantly found to have increased odds of low BMI of 1.8 times (95% CI 1.39 -2.26; p value <0.001). HIV status was not found to be a significant predictor of low BMI in TB cases. Conclusion: Lack of employment is a predictor of low BMI in TB cases in Kenya. Nutritional status does not differ by HIV status.

Exploring the Opinions of Parents and Teachers about Young People Receiving Puberty and Sex Education in Rural Kenya: A Qualitative Study.

In Kenya, one of the most significant public health concerns is the spread of HIV. Additionally, 13,000 girls drop out of school every year due to pregnancy. Although the Kenyan Ministry of Education and other independent organisations have tried to implement various means of developing puberty and sexual health education for young people, the situation is not improving. Aims: To explore the opinions of teachers and parents in rural Kenya about delivering puberty and sex education and to identify their perceptions of barriers to young people accessing this education. Study Design: Qualitative study. Place and Duration of Study: Rural Nyanza Province, Western Kenya between January and March 2013. Methodology: semi-structured interviews with 19 teachers and 30 parents following a topic guide to explore their opinions about what young people need to learn about sex education and perceived barriers to accessing that education. The interviews were transcribed and subjected to Framework analysis. Results: Analysis revealed a lack of continuity in teacher training for sex education and discrepancies in what is being taught in schools. It also highlighted internal contradictions in teachers’ and parents’ views about some aspects of sex education, particularly the emphasis on abstinence and negative attitudes towards contraception. Conclusion: Strategies for improvement may include a full evaluation of the formal sex education curriculum and retraining where necessary to ensure consistency in the sexual health messages that are delivered to young people. Additionally, parents and wider rural communities may need to be better supported in their ways of discussing puberty and sexual health with their children.