Aetiology and implications of domestic injuries in the elderly.

This study was conducted in ten major city hospitals and twelve city council health clinics in Nairobi. Hospital records covering the period 1986 to 1990 were reviewed. Information on age, sex, occupation, type and cause of injury, the management and outcome of treatment was extracted from the records. This article focuses on the elderly, aged 55 years and above. The results indicate that falls inside the house accounted for most (69%) of the injuries. This was followed by accidental cuts (27%) and injuries resulting from domestic violence (26%). The main types of injuries recorded were open wounds (56%), followed by head injuries (24%) and fractures (21%). Most of the injuries (more than 63%) occurred in the low income areas (mainly Mathare and Eastlands). These injuries have implications on care for the elderly and on the cost to the individual, the health facilities and the nation. The results indicate that domestic injuries are a common occurrence among the elderly and there is need to focus on prevention and cost-effective case management strategies.

Factors that determine utilization of modern contraceptives in East, Central and southern Africa.

A cross-sectional study to determine modern contraceptives utilization among women aged between 15 and 19 years was performed between September and October, 1991 in 5 countries of East Central and Southern Africa. The study involved both rural and urban area of Kenya, Uganda, Mauritius, Swaziland and Zambia. A total of 4513 women were interviewed of whom 2418 (53.6%) were from the urban areas while 2096 (46.4% were from the rural areas. The percentage distribution of contraceptive users was 33.2% in urban and 48.9% in rural areas. The proportion of users of traditional/natural contraception was 38.5%. Overall the prevalence of contraceptive use was 29.5%. Thus the natural/traditional methods were most popular in the region. The user rate of modern contraceptive methods ranged from 6.8% for Zambia to 60% for Mauritius. The study revealed that contraceptive prevalence rates were higher among women in urban areas (60%) than in rural areas (40%). The main factors influencing contraceptive use in order of importance included distance from residence to clinics, level of education attained, parity, marital status, approval by husbands/boyfriends and knowledge of family planning methods. Contraceptive use was highest in the age group of 20 to 34 years while it was lowest among young women aged 15-19 years.

Pattern of Schistosoma mansoni infection after intervention in Mwea irrigation scheme in Kenya.

A longitudinal study of Schistosoma mansoni reinfection rate was carried out in an endemic area of Kenya, after intervention. Intervention measures applied involved chemotherapy, community mobilization to effect change in water contact habits and faecal disposal. This paper focuses on S. mansoni reinfection pattern over a two-year period. The age group 5-19 years showed an increasing trend of reinfection as compared to the 30-59 years age group. More than 50% in the 5-19 year age group had been reinfected by twelve months of follow-up. They were also responsible of 91% of all the egg-load and 83% of all the infections at the end of the study period. Since majority of the 5-19 year age group comprises school children, there is an urgent need of including issues related to schistosomiasis in the school curriculum especially in the endemic areas.

PIP: Schistosomiasis is a parasitic disease caused by blood flukes which live in the mesenteric and/or vesical veins of humans over a life span of several years. Cercariae are released by infected intermediate snail hosts into fresh water whose larvae then penetrate the skin of man when the individual contacts infected fresh water. Schistosomiasis is debilitating, setting in slowly and causing concern in its chronic stages. Chronic infection results in complications such as liver fibrosis and portal hypertension for Schistosoma mansoni and ureteric obstruction, bacterial infection, and cancer of the bladder for S. haematobium. In endemic areas, children have the highest prevalence and intensity of infection due to their more extensive contact with water relative to adults. Chemotherapy helps to control the disease, but population immigration, untreated pregnant women and very young children, and the selectiveness of control strategies make reinfection inevitable. This paper reports findings on the rate of reinfection with S. mansoni in Kirinyaga district, Kenya, between September 1983 and December 1988, after a prevention and control intervention. Schistosomiasis is endemic in that area of Kenya. Measures applied during the intervention included chemotherapy and community mobilization to effect change in water contact habits and faecal disposal. Individuals aged 5-19 years showed an increasing trend of reinfection compared to individuals aged 30-59 years, with more than 50% of subjects in the 5-19 year old age group being reinfected by twelve months of follow-up. The young age group also accounted for 91% of the egg-load and 83% of all infections at the end of the study period. The majority of the 5-19 year old age group comprises school children. An urgent need therefore exists to cover schistosomiasis-related issues in schools.

Childhood accidents in an urban community in Kenya.

A retrospective study was conducted over a twenty-month period from March 1991 to October 1992. The purpose of the study was to determine the types and causes of domestic accidents/injuries in the city of Nairobi. A total of 9,648 case files were perused and out of this figure 52% or 5009 records belonged to persons aged below 18 years. The male:female ratio was 1.6:1. Burns were identified as the most prevalent type of injury (37%) followed by cuts/wounds (24.9%) and body swellings (4.9%). The main causes of these accidents were: fire, falls inside and outside the house and cutting implements. These results are only an index to a problem that has been given little prominence in the field of public health.

Fatal non-transport injuries in Nairobi, Kenya.

Records from the office of the Registrar of Births and Deaths in Nairobi, Kenya, were studied with the aim of determining the magnitude of fatalities due to injuries sustained in the living environment. This information covered the period between 1986 and 1990. Data were collected over a one month period from 3rd July 1991 to 9th August 1991. The information which was collected from the death certificates included type of injury resulting in death, age and sex of the victim. The results from a total of 944 records revealed that males suffered more deaths than females (M:F ratio was 2.67:1). The most commonly occurring type of injury resulting in death was burns (22.5%). This was followed by drowning (18.1%), head injuries (18%) and suicide by hanging (12%). Stab wounds and poisoning (excluding food poisoning) each accounted for 6% of the total deaths, inhalation of vomit (5.2%) and crush injuries due to falling from a height (3.8%). Bullet wounds, asphyxia due to choking, abortion and electrocution each contributed less than 3% of total deaths. The age bracket with the highest number of deaths was between 20 years to 39 year's (51.4%) while infants and children 0-4 years alone contributed 16% of the total deaths. Since non-transport fatalities are common in all age groups, health education programmes must target both children and the adult population.

Accidents involving adults in the home environment in Nairobi, Kenya.

Hospital records covering the period between 1986 and 1990 obtained from 10 major city hospitals and 12 City Council Health clinics were reviewed and information on age, sex, occupation, type and cause of injury and its management was extracted. Also extracted was information on outcome of treatment. This paper deals only with information related to persons aged 18 years and above. The results show that out of 9648 hospital records reviewed, 48% were adult cases, with a male to female ratio of 1.5:1. Age group 18-35 years constituted more than 70% of all the cases, declining markedly with increasing age. The slums and low income group residential areas contributed 63% of the cases. The main types of injuries attended to were open wounds (34%), burns (13%), swellings (7%), lacerations and bruises (6%), bites and limb injuries (5%), respectively. The results show that there is a clear case for a community operational research project with a strong accident prevention component.

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.

PIP: In December, 1988, a medical student and field workers interviewed 203 household heads (61% females and 39% males) in Thiba, a village in the Mwea Rice Irrigation Scheme in Kirinyaga District in central Kenya, as part of an evaluation of the schistosomiasis (bilharzia) control project implemented between late 1983 and December, 1988. Specifically, researchers wanted to know the perceptions of the people that the project served. The project consisted of health education and a water and health committee, which managed the construction of pit latrines, handpump shallow wells, and laundry and bath units. Most everyone (92% and 96%) understood that the project aimed to treat, control, and prevent bilharzia from spreading and to reduce bilharzia morbidity, respectively. Only 53% thought that the project belonged to the community. The remaining heads believed the project belonged to the Kenya Medical Research Institute, Ministry of Health, or a combination of the community, supervisor, and field workers. 74% reported that they saved time because the facilities were nearby. 80% believed that they were saving money because they did not need to buy drugs, since they felt healthier than they did before project implementation. 82% thought that their children appeared healthier, mainly due to the provision of potable water and bathrooms near the well sites. Almost everyone (99%) believed that the control project controlled schistosomiasis. 70% considered their workload to be easier because of the reduced distances to water sources and easy-to-operate pumps that their children could use. More than 90% thought that the project could survive in the long term, if the entire community were trained to maintain the facilities and provided spare parts. This suggested that the project was self sustaining. More than 90% knew the cause of bilharzia, how it is transmitted, its treatment, and how to prevent and control it. In conclusion, the community recognized the socioeconomic and health benefits of the control project.

Involvement of a community in schistosomiasis control: a Kenyan experience.

This paper illustrates how community participation was achieved in a study that was carried out between 1983-1988 whose general objective was to reduce the transmission of schistosomiasis in a rice irrigation scheme in Kenya. A community of 2,219 people was mobilized through health education, to effect changes in behaviour regarding water contact, water use and faecal disposal. Health education, alternative water sources, latrines and mass chemotherapy with praziquantel were the schistosomiasis control strategies utilized in this study. By the end of 2 years, the canals were cleared of their thick vegetation, water, sanitation, bathing and washing facilities were constructed, water contact with infective waters was reduced, faecal contamination of water was reduced, the people's knowledge on schistosomiasis increased and the rate and intensity of schistosomiasis infection was reduced. The study demonstrated that it is possible to fully involve the community in disease control efforts.

Relationship between nurses opinion on nursing care for HIV infected/AIDS patients and socio-economic factors in Nyeri District; Kenya

The main objective of the study was to relate the attitudes of nursing staff towards HIV positive and AIDS patients to the nurses' age; sex; religious affiliation and marital status. 211 nurses were randomly selected for the study form all health centres and the only District hospital in Nyeri; Kenya. Information was collected using a self-administered questionnaire; with the help and/or supervision of the investigators. There was statistically significant relationship between marital status of the nurses and the need to keep the HIV status of the patient confidential. 69 of the nurses said that it was not necessary to observe confidentiality for a number of reasons. Out of the 31 of those who said taht confidentiality was necessary; 83 were married. Nurses' expressed fear of contracting AIDS through casual contact did not have a significant relationship with christian denomination to which they were affiliated. 32 of the nurses said that one could get AIDS through casual contact. Other parameters are presented and discussed in this paper. It is evident that nurses need to be more enlightened on AIDS facts in order to improve on the quality of nursing care for HIV/AIDS patients

Hypertension in Kitui district: a comparative study between urban and rural populations.

This study was conducted in 1986, with the objective of finding out whether high blood pressure is a problem in the urban and rural populations of Kitui, and the risk factors that may be contributing to the problem. 360 people were visited at home and work places and their blood pressure, were taken in the sitting position under field conditions. A questionnaire on age, sex, marital status, occupation, smoking, miraa chewing and alcohol consumption and the number of people in the household was administered to every study subject, after which their heights and weights were recorded. Prevalence was found to be 6.4%. There was no difference in the occurrence of hypertension between the urban and rural populations. The relationship between the occurrence of hypertension and other parameters is presented and discussed in this paper.

Social characteristics and sexual behaviour of women at high risk of HIV infection in a town in Central Province of Kenya.

Forty seven women food handlers who were considered to be at high risk of HIV infection in Thika town of Central Province of Kenya were studied. The women were interviewed individually for information related to their social characteristics and sexual behaviour. The study showed that 91% were bar attendants, 58% had less than 7 years of formal education and 95% were either unmarried or divorced. All the women had at least one child. One of them practised anal sex but the rest practised vaginal sex. Their opinions on condom use revealed that they lacked knowledge on the advantages of condom use. Certain issues have been raised by this study, which call for in depth studies or incorporation into ongoing studies.

PIP: Researchers from the Kenya Medical Research Centre in Nairobi, Kenya interviewed 250 women food handlers who attended a routine medical exam in Thika town in Central Province to learn social characteristics and sexual behavior of women at high risk of acquiring HIV in urban areas. They only included the 47 who charged for sex. 1 researcher spoke with them later in their local dialect. All but 2 were bar attendants. 96% of their clients were nationals and none reported foreigners. 85% were not originally from Thika town and 51% of these came from the neighboring district of Muranga. 51% of these high risk women had lived in Thika town from 1 monthw5 years. 36.2% had 6-7 years of schooling and only 1 had 12 years. 85% reported to not have reached the level of education they wanted to reach. 49% of these said they did not reach the desired level due to insufficient funds and 19% became pregnant and left school. Age of menarche corresponded with the age when the 47 women left school. 85% had 1-4 children. Moreover 43% had had at least 1 abortion. 53% had been divorced and 45% never had a husband. 60% reported having used at least 1 form of contraceptive. Yet none of these women had used condoms. Some of the reasons for not using them included not knowing the advantages of using condoms, no need to use then, and no sexual pleasure. Only 1 reported having both vaginal and anal sex. 36% had 2 partners/week. 66% said that they go to different parts of Kenya at least once a month. Most of these trips resulted in an overnight stay. 81% had been circumcised and 83% had pierced ears. These results demonstrated a strong need for AIDS and sexually transmitted disease prevention education for high risk women.

Oral rehydration therapy and social marketing in rural Kenya.

In just a few years, oral rehydration therapy (ORT) has become the standard treatment to reduce infant diarrhoeal disease mortality in the developing world. The paper describes an ORT intervention campaign in a rural area in Western Kenya (Kakamega District). After about a year of careful preparation, the campaign was launched in January 1986 and compared the use of a value-added product (flavoured sachets) sold through private outlets in addition to primary care distribution of an unflavoured sachet in an experimental cell (Bukura Division). In a control cell (Novakholo Division), only unflavoured sachets were distributed free of charge through primary health care facilities. Using local perceptions of diarrhoeal disease management, the campaign in the experimental cell was carefully designed and mass communication techniques employed and adapted accordingly. Outcome assessments of the campaign, which lasted until March 1987, included the overall ORT utilisation over time. Changes in perceptions towards diarrhoeal disease management, direct assessments of mixing a 'safe and effective' solution accurately and other relevant process parameters were evaluated. Comparing several recent ORT intervention projects, the paper concludes that a combination of a commercial approach and mass communication techniques can further ORS use. If a proper incentive system for shopkeepers is installed and message design and ORS product are fully tailored to the perception and preferences of the target population, the commercial availability of ORS will create an extra demand of the product. However, this will not replace distribution of ORS salts delivered free of charge through primary care sources.