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.

Assessment of substance use among injured persons seeking emergency care in Nairobi, Kenya

ntroduction: Trauma is a leading cause of morbidity and mortality in Kenya. In many countries, substance use is common among patients presenting with injuries to an emergency center (EC). Objective: To describe the epidemiology of self-reported substance use among adult injured patients seeking ED care in Nairobi, Kenya. Methods: This prospective cross-sectional study, assessed patients presenting with injuries to the Kenyatta Na-tional Hospital ED in Nairobi, Kenya from March through June of 2021. Data on substance use, injury character-istics and ED disposition were collected. Substances of interest were alcohol, stimulants, marijuana, and opiates.The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) tool was used to characterize hazardous alcoholuse. Results: A total of 1,282 patients were screened for participation, of which 646 were enrolled. Among participants,322 (49.8%) reported substance use in the past month (AUDIT-C positive, stimulants, opiates, and/or marijuana). Hazardous alcohol use was reported by 271 (42.0%) patients who screened positive with AUDIT-C. Polysubstance use, (≥2 substances) was reported by 87 participants in the past month. Median time from injury to ED arrival was 13.1 h for all enrolees, and this number was significantly higher among substance users (median 15.4 h, IQR 5.5 - 25.5; p = 0.029). Conclusions: In the population studied, reported substance use was common with a substantial proportion of injured persons screening positive for hazardous alcohol use. Those with substance use had later presentations for injury care. These data suggest that ED programming for substance use disorder screening and care linkagecould be impactful in the study setting.

Perinatal Outcomes of Newborns by Women Presenting with Maternal Complications in Pregnancy at a County Referral Hospital in Lower Eastern Kenya

BACKGROUND Maternal complications during pregnancy and labor have been the leading cause of maternal and neonatal death globally. The aim of the study was to observe and compare the differences in the perinatal outcomes of newborns born to women with maternal complications to those born to women without complications. MATERIALS AND METHODS This was a prospective hospital-based paired cohort study. A total of 510 pregnant women were followed up and their newborns' outcomes recorded. 102 had complications and 408 did not have complications. RESULTS Thirteen percent (n=17) of women with complications and 9% (n=34) of women without complications were aged between 13 to 19 years. Forty five percent n=45 of the respondents were followed for maternal care related to fetus and amniotic cavity and possible delivery-related complications. CONCLUSION Teenagers and women aged above 34 years in pregnancy were at a higher risk of presenting with maternal complications. Women referred from hard to reach constituencies of the county were more likely to present with complications in pregnancy. Maternal care related to amniotic fluid cavity complications was the leading maternal complications in pregnancy followed by edema with proteinuria complications. RECOMMENDATIONS Governments and non-governmental organizations should put more emphasis on youth friendly services to reduce maternal complications associated with teenage pregnancy. There should also be more investment on infrastructure to make referral systems easy and avoid the second delay among women with maternal complications. African Journal of Health Sciences Volume 34, Issue No.4, July- August 2021 438 Moreover, women presenting with maternal complications in pregnancy at all levels of care should be closely followed up to avert cases of intra-uterine fetal deaths before and during labor.

Predictors of Adherence to Highly Active Antiretroviral Therapy among HIV Patients attending Selected Comprehensive Care Centres in Kericho County, Kenya

Highly Active Antiretroviral Therapy (HAART) is undoubtedly the only proven remedy known to improve the health outcomes and reduce AIDS-related mortality. However, just like other chronic diseases, HIV presents significant challenges in achieving and maintaining adherence to medication. The effectiveness of HAART solely depends on adherence. For maximum medication benefits, a nearperfect adherence levels of >95% is required yet data from different studies indicate that few, if any patients have achieved perfect adherence. The main objective of the study was to the determine predictors of adherence to Highly Active Antiretroviral Therapy among HIV patients attending selected comprehensive care centres in Kericho County. MATERIALS AND METHODS A descriptive cross-sectional study was adopted, involving 280 HIV patients (≥ 15 years) on HAART from three selected Comprehensive Care Centres in Kericho County, Kenya. Quantitative and qualitative data were collected using interviewer administered semi-structured questionnaires and key informant interviews, respectively. Purposive sampling was used to select the three health facilities while systematic sampling was used for participant selection. Adherence was measured using viral load. Data was analyzed using SPSS version 25. Logistic regression analysis was used to determine the association between adherence to HAART and various independent variables. Results were considered to be significant at p < 0.05). RESULTS AND CONCLUSION Seventy six percent (76%) of the respondents had optimal adherence while 24% had sub-optimal adherence. More females than males were on treatment. Use of HAART alternatives was a risk factor for sub-optimal adherence (p=0.011). Having someone/tool to remind of when to take medication and disclosure of HIV positive status to spouse were found to significantly promote adherence to HAART with p=0.034) and p=0.048, respectively. African Journal of Health Sciences Volume 34, Issue No.4, July- August 2021 465 RECOMMENDATIONS Several studies have been done on the socio-demographic and socio-economic factors associated with adherence to HAART. Findings from this study indicate that attitudes and practices towards HAART have significant effects on adherence hence more research should be done on attitudes and practice aspects of adherence

Prevalence of vitamin D deficiency in exclusively breastfed infants at a tertiary healthcare facility in Nairobi, Kenya

ABSTRACT Objective: To determine the prevalence of vitamin D deficiency (VDD) in exclusively breastfed infants at the Aga Khan University Hospital Nairobi, Kenya (AKUHN). The relationships between 25-hydroxyvitamin D; 25OHD, parathyroid hormone (PTH), maternal vitamin D supplementation, and sunlight exposure were also determined. Subjects and methods: Blood from 98 infants was assayed for 25OHD, calcium, phosphate, and PTH. Socio-demographic and clinical characteristics were analyzed using descriptive statistics and inferential analysis (p < 0.05). Results: The prevalence of VDD (25OHD <12 ng/mL), vitamin D insufficiency (VDI, 25OHD 12-20 ng/mL) and vitamin D sufficiency (VDS, 25OHD >20 ng/mL) was 11.2% (95% CI 8.0%-14.4%), 12.2% (95% CI 8.9%-15.5%), and 76.5% (95% CI 72.3%-80.8%) respectively. There was no difference in the mean age, head circumference, length, or weight of infants in VDD, VDI, and VDS groups. PTH was elevated when 25OHD was <12 ng/mL and normal when 25OHD was between 12-20 ng/mL. 25OHD and PTH were normal in infants whose mothers received vitamin D supplements. Infants who received <30 minutes/day of exposure to sunlight were 5 times more likely to have VDI than infants who received ≥30 minutes/day (p = 0.042). Conclusions: The prevalence of VDD in exclusively breastfed infants at AKUHN is low. The current national policy that recommends exclusive breastfeeding of infants in the first 6 months of life appears to be effective in staving off vitamin D deficiency but those infants with < 30 minutes sunlight exposure may benefit from low dose supplemental vitamin D during times of low sunlight exposure.

Antiulcerogenic effects of selected African nightshades (Solanum nigrum Linn. ) genotypes on the rat stomach: a morphologic and morphometric study / Efectos antiulcerogénicos de genotipos seleccionados de solanáceas Africanas (Solanum nigrum Linn. m) en el estómago de ratas: un estudio morfológico y morfométrico

Solanum nigrum (SLN), commonly known as African nightshade, is used as a vegetable as well as in the management and treatment of various ailments including gastric ulcers. We analyzed, both grossly and microscopically using H&E, Masson's trichrome and PSA staining methods, the protective effects of aqueous leaf extracts of three Kenyan SLN genotypes namely S. scabrum (SSB), S. sarrachoides (SSR) and S. villosum (SVL) on ethanol-induced gastric lesions in rats. There was evidence of gastro-protection by all the three genotypes with the SSB showing the highest ulcer inhibition score (76.37 %) followed by SSR (72.51 %) and SVL (63.30 %). SLN-pretreated rats showed less areas of gastric mucosal surface erosion. Additionally in the pretreated animals, the depth of the ulcers were markedly reduced, reaching only the gastric pit region except in those treated with SVL where the ulcers penetrated slightly more deeply to affect the gastric glands. Compared with controls, the mean microscopic ulcer index decreased 5.07, 3.55 and 2.37-fold in rats pretreated with SSB, SSR and SVL extracts respectively. Results of this work show extracts of the three SLN genotypes to have antiulcerogenic potential but at varied strengths, thus confirming earlier reports that phytoconstituents and hence the efficacy of a medicinal plant may be influenced by genetic factors.

Solanum nigrum (SLN), comúnmente conocida como la solanácea africana, se usa como vegetal, para el tratamiento de diversas dolencias incluyendo las úlceras gástricas. Analizamos de forma macro y microscópica, de forma macroscópica y microscópica, utilizando para ello tinciones de H&E, tricrómico de Masson y PSA los efectos protectores de extractos acuosos de hojas de tres genotipos SLN de Kenia: S. scabrum (SSB), S. sarrachoides (SSR) and S. villosum (SVL) en lesiones gástricas inducidas por etanol en ratas. Hubo evidencia de gastroprotección por parte de los tres genotipos con el SSB mostrando el puntaje más alto de inhibición de la úlcera (76,37 %) seguido de SSR (72,51 %) y SVL (63,30 %). Las ratas tratadas previamente con SLN mostraron menos áreas de erosión de la superficie de la mucosa gástrica. Además, en los animales pretratados, la profundidad de las úlceras se redujo notablemente, llegando solo a la región del fondo gástrico, excepto en aquellos tratados con SVL donde las úlceras penetraron un poco más profundamente para afectar las glándulas gástricas. En comparación con los controles, el índice medio de úlcera microscópica disminuyó 5,07, 3,55 y 2,37 veces en ratas pretratadas con extractos de SSB, SSR y SVL, respectivamente. Los resultados de este trabajo muestran que los extractos de los tres genotipos de SLN tienen potencial antiulcerogénico en diferentes concentraciones, lo que confirma informes anteriores que los fitoconstituyentes y la eficacia de una planta medicinal pueden estar influenciados por factores genéticos.

Outcomes and effects of homeopathic treatment of malaria in Kenya, a multi-centre study

Background InKenya malaria is the leading cause for illness and death; homeopathy is used for many years to treat this disease. A previous study in Ghana in 1996, showed comparable effects of homeopathy and chloroquine. MethodsIn three studies we documented homeopathic treatment in a retrospective qualitative study, a prospective single arm study, and a comparison between one cohort receiving homeopathic treatment and the other artemether.ResultsIn the qualitative retrospective study (2014) (n=54), we related typicalmalaria and individual symptoms, with remedy prescriptions and affected organs. Principal Component Analysis (PCA) showed, that specific remedies were prescribed for patterns of affected organs.In the prospective study (2014) (n=70),the primary outcome was the parasitological status at the first follow up (median 8 days), secondary outcome was the quality of life measure with Outcome Related to Impact on Daily Life. In the third study, of the group (n=79) (b) exposed to homeopathy, n=6 (a) were still parasite-positive after one week, in the control (co-artem) group of n=35 (c) no patient was positive (d). The odds ratio was 5.8068 (95% CI 0.3183 ­105.8794), with z = 1.187 and P = 0.2352. The difference was not statistically significant; homeopathic remedies and coartem tablets had similar effect for uncomplicated malaria in that region.Co-morbidity was treated with different remedies.ConclusionHomeopathic treatment can be used as a valuable option, also when other treatments are ineffective by microbial resistance, not indicated (as in pregnancy) and financially not affordable.(AU)

The HIV/AIDS pandemic in Kenya: an investigation into the perceptions of Kenyans toward people living with HIV/AIDS and government programmes

The HIV/AIDS pandemic is compounded by the continued stigmatization of the virus/disease and of people living with HIV/AIDS (PLWHA). Employing structuration theory, this study sought to examine the perceptions of Kenyans toward their government's efforts to curtail HIV/AIDS as well as their attitudes toward PLWHA. Data for this study were collected using an open-ended online survey. In total, 103 participants (25.3%) completed the survey. We used snowball sampling to select prospective participants known to the researcher; they were sent a link to the survey via email or direct message on a social networking site like Facebook or WhatsApp, and were asked to share the survey with people in their social circles. Data were analysed using thematic analysis. Findings revealed that some participants had confidence in the Kenyan government's efforts to address the HIV/AIDS pandemic, while others showed no confidence in government-led initiatives. Consistent with previous research, this study found that stigma towards HIV/ AIDS and PLWHA still exists. Practical and theoretical implications of the findings are discussed

The impact of an inclusive education intervention on learning outcomes for girls with disabilities within a resource-poor setting

Background: Despite a global commitment to the right to education for persons with disabilities, little is known about how to achieve inclusive education in practice, particularly in low- and middle-income countries (LMICs), where the majority of the world's people with disabilities reside. Moreover, although exclusion from education is magnified by intersecting gender and socioeconomic inequalities, there is especially little knowledge regarding what approaches to inclusive education are effective amongst girls with disabilities living in resource-poor settings. Objectives: The objective of this article was to assess the impact of an inclusive education intervention led by a non-governmental organisation (NGO) on the educational attainment of girls with disabilities in the resource-poor Lakes region of Kenya. Method: A quasi-experimental design was employed, where the literacy and numeracy educational attainment of the intervention and control groups was compared over two time points a year apart (Time 1 and Time 2; total matched N = 353). During this period, activities pertaining to six core components of a holistic inclusive education model were implemented. Results: Relative to the control group, girls with disabilities in the intervention group reported a greater increase in literacy and numeracy attainment, adjusted for grade and level of functional difficulty. Conclusion: Findings suggest that the intervention was successful in engendering additional improvements in the educational attainment of girls with disabilities from the resource-poor Lakes region of Kenya. Results highlight both the applicability of NGO-led interventions in settings, where national implementation of inclusive education is constrained, and the potential of taking such interventions to scale

Development of self-help groups for caregivers of children with disabilities in Kilifi, Kenya: process evaluation

Background: Caring for a child with disabilities in a resource-poor setting brings many challenges to the caregiver. We examined the development of self-help groups for caregivers in a rural part of Kenya. Objectives: To conduct a process evaluation on the development of self-help groups during a 10-month set-up period, focusing on implementation and mechanisms associated with their functional status. Methods: Using a realist evaluation design, we set up 20 self-help groups for 254 caregivers. An evaluation was conducted to investigate implementation and mechanisms of impact. Implementation focused on caregiver registration, community group support and monitoring visit compliance. Data were collected from group registers, records of meetings and field notes. Mechanisms of impact employed a framework of strengths­weaknesses­opportunities­threats to review the groups at the end of the 10-month set-up period. Results: Recruitment resulted in registration of 254 participants to 18 groups ­ two groups disbanded early. Post-evaluation included 11 active and 7 inactive groups. Compliance with the monitoring visits was consistent across the active groups. All groups engaged in 'merry-go-round' activities. The active groups were characterised by strong leadership and at least one successful income generation project; the inactive had inconsistent leadership and had dishonest behaviour both within the group and/or externally in the community. Mediators associated with functional status included the following: available literacy and numeracy skills, regular meetings with consistent attendance by the members, viable income generating projects, geographical proximity of membership and strong leadership for managing threats. Conclusion: Self-help groups have the potential to progress in resource-poor settings. However, critical to group progression are literacy and numeracy skills amongst the members, their geographical proximity, regular meetings of the group, viable income generating projects and strong leadership

Determinants of HIV positive status at first PCR test among toddlers seeking early infant diagnosis (EID) services in selected hospitals in Nairobi County, Kenya

Introduction: Early Infant Diagnosis (EID) is the practice of testing infants for HIV within the first 4­6 weeks of life or at the earliest opportunity possible so as to promptly link HIV-infected infants to healthcare and treatment. In the absence of timely HIV testing and Antiretroviral Therapy (ART) initiation, one-third of infants living with HIV die before their first birthday and more than half die before 2 years. Worldwide, Mother To Child Transmission (MTCT) rates accounted for 8.9% of all HIV infections by the end of 2015, with Sub-Saharan Africa accounting for 12% of these infections. In Kenya, MTCT infection rates were at 14%, accounting for 7% of all new infant infections globally by the same period. Objection: The objectives of this study was to establish the determinants of HIV positive status at first PCR Test among infants seeking EID services in some selected hospitals in the Nairobi County, Kenya. Materials and Methodology: A longitudinal cohort study employing a mixed-method approach was used. Quantitative data was collected from pairs of 163 mother-infant using interviewer administered, pre-tested, and semi-structured questionnaires. While qualitative data was collected using Focus Group Discussion (FGDs) guides, it was coded, cleaned and analyzed using STATA Version 14. Quantitative data was analyzed using Fisher's exact test (p= 0.1) and Poisson Regression (p= 0.05) at bivariate and multivariable levels respectively. Thematic analysis was undertaken for qualitative data. Results: The findings from the adjusted parsimonious model revealed that, three variables influenced the infant HIV status at first PCR test. The study participants who had been administered with ART during pregnancy had a lower risk (RR= 0.06) of getting HIV positive infants relative to those who hadn't received ARVs during pregnancy (95% CI 0.014, 0.213 p= 0.000). Respondents who had been initiated on ART during the first trimester had lower risk (RR= 0.1) of getting an HIV positive infant than respondents who were administered with ARVs in the third trimester (95% CI 0.014, 0.021, p= 0.001). Respondents on first-line regimen had a lower risk (RR= 0.04) of getting HIV infected infants compared to those who were on the second line regimen (95% CI 0.012, 0.114, p= 0.000) confirming all the three significant variables as protective factors. Conclusion: The study corroborate that, first line ART regimen administered before pregnancy or during the first trimester of pregnancy was effective in lowering the risk of getting an HIV positive infant. Pediatric HIV infection, disease progression is quite rapid and without prompt treatment, most infants might not survive their second birthday

A qualitative study on alcohol and drug abuse among undergraduate (University Students) in the coastal region of Kenya

BACKGROUND: Substance use poses a significant threat to the health, social and economic fabric of families, communities and nations. In Kenya, alcohol and drug abuse has been identified as a hindrance to education, development and by extension, to national development. Alcohol and drug abuse has been associated with crime and indiscipline e.g. poor class attendance, poor performance, school dropout and destructive strikes that lead to damage the institution property or even death. Alcohol and drug abusers are also likely to lower their morals and engage in risky sexual activities that can lead to sexually transmitted diseases including HIV infection and AIDS. OBJECTIVES: The aim of this study therefore was to explore on the perceptions and the magnitude of substance abuse among undergraduate (University students) in the two public Universities in the coastal region of Kenya. Also find amicable solutions to curb the menace that can destroy the future of a generation aged between 18­29 years at the peak of their life. METHODOLOGY: This was a qualitative study involving undergraduate (University students), dean of students and counsellors from Pwani University and Technical University of Mombasa. Focus Group Discussions(FGDs) and Key informant interviews were used to collect data. The number of KIIs was guided by data saturation. Thematic analysis was done by identifying, coding, and categorizing patterns or themes found in the data. RESULTS: The problem of alcohol and substance abuse among undergraduate students was a reality. The commonly abused substances were alcohol, miraa (khat), marijuana (cannabis) and cigarettes. Some of the factors predisposing students to abuse drugs were; easy accessibility to drugs, peer pressure, availability of funds, excess freedom, male gender, stress, not being active in religious activities, poor parenting and the African culture that uphold substances such as alcohol as an acceptable social drink. Participants noted that alcohol and drug abuse had led to various negative effects. The major ones affecting the students being poor performance, risky sexual behaviour, and mental disturbances. Participants suggested that Universities ought to intensify awareness campaigns to sensitize students against substance use. CONCLUSION: The commonly abused substances were alcohol, marijuana, miraa (Khat) and tobacco. Alcohol and drug abuse has left a negative impact among undergraduates (university students). The main consequences being; discontinuation of studies, mental disturbances and risky sexual activities. All stakeholders must take action creating awareness among students on the negative effects of substance abuse. Universities should set up programs with an aim to curb substance abuse in the institutions of higher learning. The government should reinforce the set laws and regulations and deal with trafficking of illicit substances into the country

Uptake of antenatal care services among women of reproductive age in Mandera County, Kenya

Background: Antenatal care is an opportunity for prevention and management of existing and potential causes of maternal and newborn mortality and morbidity. The new WHO antenatal care model, stipulates that, the first antenatal care visit takes place within the first trimester (gestational age of <12 weeks) and then, additional seven visits. Only 37% of women in Mandera County had utilized the recommended minimum four ANC visits. Objectives: There was need to assess the critical factors influencing the uptake of ANC in Mandera County Kenya, in order to enlighten stakeholders on the development of appropriate ANC Service Provision Program. This study took the intiative of bridging the gap. Methodology: The study adopted cross-sectional design using both quantitative and qualitative methods. Stratified and Sample random sampling were used to get a quantity of 348 respondents. Data was collected using questionnaire, FGDs and KIIs guides and Pearson's Chi-square test. Multivariate analysis using logistic regression was summarized to establish the strengths of the association. Odds Ratio (OR) and 95% Confidence Interval (CI) were used and threshold for statistical significance was set at p<0.05. Qualitative data was transcribed and analyzed thematically. Results: The proportion of women who utilized ANC was 83.0% and only 60.3% had attended recommended visits. Individual factors that influenced ANC uptake were; age, level of education, monthly income, gravida, parity and complications during pregnancy. Contextual factors that influenced ANC were; time taken to reach health facilities, source of maternal information and local discouragements. There was no significant relationship between Religion, marital status, age at first pregnancy with ANC uptake. Conclusion: The negative perception can change by; improving culturally sensitive ANC services accessibility by; increasing the number of female skilled health workers and reducing traveling time to the health facilities by conducting regular outreach services targeting villages with no close facility to pastoral communities. It will be important to strengthen CHVs' capacity to emphasize primary health care and accelerate progress towards UHC in the County. Provide health education and promotion targeting older mothers with high parity, women inclined to harmful cultural practices and their partners. In spite of a wide range of literature on ANC topics in most parts of Kenya, it was limited pertaining Mandera County. Recomandations: Meticulous understanding of local barriers and facilitating factors of ANC utilization is prerequisite for designing and implementing interventions that aim to improve ANC uptake. Well developed infrastructure is a basic need that falls in the category of basic wants for Mandera County

Impact of traffic, poverty and facility ownership on travel time to emergency care in Nairobi, Kenya

Background: In many low and middle-income countries (LMICs), timely access to emergency healthcare services is limited. In urban settings, traffic can have a significant impact on travel time, leading to life-threatening delays for time-sensitive injuries and medical emergencies. In this study, we examined travel times to hospitals in Nairobi, Kenya, one of the largest and most congested cities in the developing world. Methods: We used a network approach to estimate average minimum travel times to different types of hospitals (e.g. ownership and level of care) in Nairobi under both congested and uncongested traffic conditions. We also examined the correlation between travel time and socioeconomic status. Results: We estimate the average minimum travel time during uncongested traffic conditions to any level 4 health facility (primary hospitals) or above in Nairobi to be 4.5 min (IQR 2.5­6.1). Traffic added an average of 9.0 min (a 200% increase). In uncongested conditions, we estimate an average travel time of 7.9 min (IQR 5.1­10.4) to level 5 facilities (secondary hospitals) and 11.6 min (IQR 8.5­14.2) to Kenyatta National Hospital, the only level 6 facility (tertiary hospital) in the country. Traffic congestion added an average of 13.1 and 16.0 min (166% and 138% increase) to travel times to level 5 and level 6 facilities, respectively. For individuals living below the poverty line, we estimate that preferential use of public or faith-based facilities could increase travel time by as much as 65%. Conclusion: Average travel times to health facilities capable of providing emergency care in Nairobi are quite low, but traffic congestion double or triple estimated travel times. Furthermore, we estimate significant disparities in timely access to care for those individuals living under the poverty line who preferentially seek care in public or faith-based facilities

Building focused cardiac ultrasound capacity in a lower middle-income country: a single centre study to assess training impact

Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agree-ment between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training pro-gramme locally. Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were as-sessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa > 0.6 indicative of good inter-rater agreement. Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties. Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives

Purchasing reforms and tracking health resources, Kenya

As low- and middle-income countries undertake health financing reforms to achieve universal health coverage, there is renewed interest in making allocation of pooled funds to health-care providers more strategic. To make purchasing more strategic, countries are testing different provider payment methods. They therefore need comprehensive data on funding flows to health-care providers from different purchasers to inform decision on payment methods. Tracking funding flow is the focus of several health resource tracking tools including the System of Health Accounts and public expenditure tracking surveys. This study explores whether these health resource tracking tools generate the type of information needed to inform strategic purchasing reforms, using Kenya as an example. Our qualitative assessment of three counties in Kenya shows that different public purchasers, that is, county health departments and the national health insurance agency, pay public facilities through a variety of payment methods. Some of these flows are in-kind while others are financial transfers. The nature of flows and financial autonomy of facilities to retain and spend funds varies considerably across counties and levels of care. The government routinely undertakes different health resource tracking activities to inform health policy and planning. However, a good source for comprehensive data on the flow of funds to public facilities is still lacking, because these activities were not originally designed to offer such insights. We therefore argue that the methods could be enhanced to track such information and hence improve strategic purchasing. We also offer suggestions how this enhancement can be achieved

Registration of antimicrobials, Kenya, Uganda and United Republic of Tanzania, 2018

Objective. To determine the proportion of essential and non-essential antimicrobial medicines that are registered on the drug registers in Kenya, Uganda and United Republic of Tanzania.Methods We categorized all antimicrobials on the national drug registers and essential medicines lists of the three countries using the British National Formulary. We also categorized all antibiotics according to the World Health Organization access, watch and reserve (AWaRe) classification. We calculated the proportions of essential and non-essential antimicrobials that were registered by antimicrobial class and AWaRe classification. Findings In 2018, Kenya had 2105 registered antimicrobials, Uganda had 1563 and the United Republic of Tanzania had 1327. Of these medicines, 1353 (64.3%) were non-essential in Kenya, 798 (51.1%) in Uganda and 706 (53.2%) in the United Republic of Tanzania. Kenya had 160 antimicrobials on its national essential medicines lists, Uganda had 187 and the United Republic of Tanzania had 182; of these, 33 (20.7%), 50 (26.7%) and 52 (28.6%) were not registered, respectively. High proportions of antimycobacterial and antiparasitic medicines were not registered. Of essential access antibiotics, 14.3% (4/28) were not registered in Kenya, 8.6% (3/35) in Uganda and 20.5% (8/39) in the United Republic of Tanzania, nor were 25.0% (3/12) of watch antibiotics in Kenya, 14.3% (2/14) in Uganda and 19.1% (4/21) in the United Republic of Tanzania. Conclusion Suboptimal registration of essential antimicrobials and over-registration of non-essential antimicrobials may encourage inappropriate use, especially since non-essential antimicrobials do not appear on national treatment guidelines. Countries should prioritize registration of the antimicrobial medicines on their essential medicines lists

Clinical neonatal hypoxic ischemic injury: Cranial ultrasound spectrum of findings in neonates admitted to a Newborn Unit in Nairobi, Kenya

Introduction: Birth asphyxia causes significant neurologic injury and neurodevelopmental delay in children. Cranial ultrasound (CUS) can be used for the diagnosis, early intervention, and prognostication of birth asphyxia. We determined the CUS findings among term neonates with clinical birth asphyxia and correlated sonographic findings with the modified Sarnat clinical grade.Materials and Methods: We conducted a prospective cross-sectional analytical study in Kenyatta National Hospital New Born Unit (KNH NBU) between June 2018 and October 2018. Term babies, older than 24 h with clinical birth asphyxia, were recruited and CUS was performed. Statistical analysis was done using proportions, means, and frequencies. Chi-square tests were used to assess correlation between imaging findings and the clinical Sarnat grading of asphyxia.Results: Periventricular deep white matter echogenicity and thalamus and/or basal ganglia deep gray matter was reported in 56.4% and 31.1%, respectively. Only 4.4% had cortical gray matter. Normal CUS findings were reported in 40.0% of the neonates. Prolonged labor and meconium-stained liquor were the predominant risk factors for perinatal asphyxia, seen in 58% of the neonates. Prolonged labor was independently reported in 43% of the neonates. Moderate and severe Sarnat grades correlated with abnormal sonographic changes of hypoxic ischemic encephalopathy (HIE) (Grades 2­8) (P = 0.038). There was a trend toward HIE severity with worsening Sarnat stages (trend test P= 0.039). Abnormal resistive indices (<0.5 and >0.8) were strongly associated with the presence of HIE brain changes (P = 0.003).Conclusion: The correlation between birth asphyxia severity and CUS was more robust in Doppler evaluation of the deep cerebral arteries

Organisational management of hospital blood transfusion services in Nairobi County, Kenya: Evidence of implementation

Background: The World Health Organization in 2002 recommended implementation of a quality system for national blood programmes to ensure adequate and safe blood products to patients. Key elements of the quality system include organisational management, standards, documentation, training and assessment.Objectives: The aim of this study was to describe the extent to which organisational management, which is the first element of a quality system, has been implemented in hospitals in Nairobi County, Kenya.Methods: A descriptive, cross-sectional study design was used. Sixty health workers were selected as respondents from 15 hospitals that provide blood transfusion services in Nairobi County. The data collection period was from June to August 2015 and the data were analysed in 2016.Results: Faith-based hospitals had the lowest level of organisational management implementation (33.3%), private hospitals had 42.5%, whereas government hospitals had the highest implementation (60%). The extent of implementation was based on performance of the senior management team, overall rated by the respondents at 40.1%, establishment of hospital transfusion committees in nine (60%) of the hospitals and appointment of key staff ­ quality officers in three (20%) hospitals and blood transfusion specialists in six (40%) hospitals. These key staff were instrumental in steering the quality system and ensuring sound blood transfusion practices.Conclusion: The implementation of quality management systems in hospital blood transfusion services can be improved through commitment from senior management teams, who should provide the necessary resources for employment of key staff and establish and empower hospital transfusion committees to guide the blood transfusion services

Low back pain among primary school teachers in rural Kenya: prevalence and contributing factors

Background: Low back pain (LBP) has been recognised as a common occupational problem with a high prevalence among work-related musculoskeletal disorders. Although there appears to be a high prevalence of LBP among school teachers, there is inadequate information on the prevalence and predisposing factors of LBP among primary school teachers in rural Western Kenya.Aim: To determine the prevalence, factors associated with LBP and physical disability caused by LBP.Setting: The setting was public schools in rural Western Kenya selected by simple random sampling method.Methods: A cross-sectional study was conducted among primary teachers from public schools using a self-administered questionnaire. The questionnaire included information on LBP, demographic data, occupational and psychosocial factors and disability score. The 12-month prevalence, associated factors and LBP disability were analysed.Results: The 12-month self-reported prevalence of LBP among primary teachers was 64.98%, with close to 70% of them reporting minimal disability. The logistic regression analysis showed that female gender (odds ratio [OR]: 1.692, p < 0.02) was associated with LBP and high supervisor support (OR: 0.46, p < 0.003) was negatively associated with LBP.Conclusion: The prevalence of LBP among primary school teachers in rural Western Kenya is 64.98%, with the majority of them reporting minimal disability. The identified risk factors were female gender and low supervisor support. The presence of work-related psychosocial risk factors in this study suggests a comprehensive approach in evaluation and management of LBP. Preventive measures should be in place to prevent and reduce the progression of LBP disability