RESUMO
Self-medication is very common especially in developing countries and is documented to be associated with many health risks including antibiotic resistance.Antibiotic resistance is shrinking the range of effective antibiotics and is currently listed as a global health problem.This study investigated the perceptions of self-medication with antimicrobials (SMWA) after community mobilization intervention amongthe households in Nyalenda B, an informal settlement, within Kisumu County, Kenya.This enabled the study to establish the magnitude of SMWA and the perceptions that persist given such intervention within the region. Data was collected through structured questionnaires administered to 380 households. Focus group discussions (FGDs) were also facilitated and targeted purposively-selected 30 CHVs. Descriptive and binary logistic regression analyses were used to determine the associationbetween socio-demographic characteristics and the perceptions influencing SMWA. The study established that 316 households had used antimicrobials of which 20.9% were self-medicating with antimicrobials.Age (OR=0.647, 95% CI=0.431, 0.973, P=0.037) is significantly related to SMWA, use of NHIF for outpatient services(OR=1.772, 95% CI=0.652, 2.887, P=0.133)and use of Universal Healthcare Services (OR=1.165, 95% CI=0.922, 1.472, P=0.201)may have contributed to SMWA reduction but not significantly as compared to other socio-demographic factors. Likewise, sources of information or advice on self-medication (OR=0.732, 95% CI=0.613, 0.873, P=0.001) and illness or symptoms of illness (OR=1.324, 95% CI=1.129, 1.554, P=0.001) may significantly influence SMWA as compared to other SMWA perceptions. Community mobilization using empowerment as a strategy and implemented through participatory learning and action is a successful method for reduction of SMWA level and development of SMWA perceptions with an experiential value especially when strengthened with structural modification. SMWA is a serious problem in developing countries and so such intervention should be prolonged and continuous to offer sustained changes in public perception and attitudes towards the misuse of antimicrobials
RESUMO
Background:Deaf adolescent children face greater challenges in accessing information, particularly on sexual and reproductive health (SRH) than those with other forms of disability. Parents therefore represent the first source of information for such children. However, the extent of this and systems of communication used by these parents remain largely unknown. Therefore, it is against thisbackdrop that we sought to study systems of parents communicating SRH issues to their children. Methods:A mixed method design was used to collect quantitative and qualitative data on the system of communication used by the sign-language illiterate parents respectively, their Original ResearchArticle perceptions on such discussions and the choice of system of communication. A sample size of 384 parent-child pairs was selected using systematic probability sampling for the quantitative component of the study. For the qualitative component, respondents were recruited using a purposive convenience sampling method which though non-representative, allowed the investigator to choose participants best suited for the intended objective.The study was carried out in ten schools; randomly selected from a sample frame comprising of a list of primary and secondary schools for deaf children within the former Nyanza region of western Kenya. Data was collected using anonymized questionnaires and Focus Group Discussions (FGDs).Results:Majority of the male parents 90 (23.4%) were in the age range of 51-60 years, while most female parents 134 (34.8%) were in the age category of 40-50 years. Nearly 70% (67%) of the children were in the age range of 15-19 years. Overall, use of picture came out as the main mode/format of communication (33%);with females using it more (23%) compared to males 12.3%. Lip-reading (children reading the lips of their parents), was principally used by male parents. 32(8.3%)parents falling within the age group 41-50 and 51-60 years felt that the information they had on SRH was inadequate. More so, in a qualitative interview, most parents were not satisfied that they had provided enough information to their children on matters of SRH due to communication barrier. Some of the emerging themes from the FGDs were: parents lack a proper approach of conveying SRH information to their deaf adolescent children, unresponsiveness/lack of interest by deaf adolescent children, wrong translation of information conveyed and insufficient time with their deaf adolescent children to pass across these messages.Conclusion: Children with hard hearing are less likely to get adequate information on SRH than their counterparts with no hearing impairment
RESUMO
Aim:This study sought to assess factors that influence adherence to malaria microscopy diagnosis in the treatment of out-patients in the hospital.Methods:From April to June 2018, a cross-sectional study was conducted. Semi-structured questionnaires were administered on clinicians and microscopists, while prescription practices of pharmacy personnel and clinicians were observed. To determine microscopy performance, systematically sampled thick blood smears, which had been used to diagnose malaria in out-patients were re-examined for presence or absence of malaria parasites by independent expert microscopists. Each thick blood smear was re-examined by two independent expert microscopists, and in case of discordant results a tie-breaker expert provided reference results for performance measures. Test validity and reliability were determined using Graph Pad Prism v5.01. Results:Three (30%) clinicians strictly (100%) adhered to malaria microscopy diagnosis during treatment of out-patients, had refresher training on malaria case management and were aware that the laboratory participates in national quality assurance (QA) scheme. At the pharmacy-level adherence tomicroscopy results during treatment was generally 100% and >98% for clinicians. However, 13 (11%) malaria false-positive participants still received Artemether-Lumefantrine. Of 375 selected blood slides, 118(31.5%) were read as positive at the health facility, while 105 (28%) were read as positive by the experts, (P <0.01). Overall, 96% of test results were concordant with expert reference. The overall inter-reader agreement between hospital diagnosis and experts microscopists was κ=0.91 (95% CI: 0.87-0.96). Sensitivity was; 99.1% (95% CI: 94.9-100), specificity; 95.2% (95% CI: 91.9-97.4), Positive Predictive Value; 89% (95% CI: 81.9-94) and Negative Predictive Value; 99.6 (95% CI: 97.9-100). Conclusion:Our results show commendable adherence to malaria microscopy during treatment of out-patients in Kisumu County Referral Hospital. Refresher training on malaria case management for clinician and awareness by clinicians that the hospital laboratory participates in national QA scheme had positive influence on the adherence to malaria microscopy during treatment of out-patients. Malaria microscopy test validity and reliability were commendable