A cross-sectional study on the association between varied social support modalities and glycemic levels amongst diabetic patients residing in Machakos County, Kenya.

Introduction: diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. While there's increasing evidence that social support from caregivers improves health outcomes in chronic illness management, the potential associations of the different types of social support and glycemic control among Type II diabetes clients have largely been ignored in Kenya. This cross-sectional study sought to establish the association between tangible, emotional, and informational social support and glycemic levels among clients diagnosed with Type II diabetes in Machakos County, Kenya. Methods: semi-structured interviews were conducted with 726 randomly selected Type II diabetes clients enrolled in diabetes care and treatment programs in government-owned public health facilities in Masinga and Matungulu sub-counties, Machakos, Kenya. Descriptive statistics and multinomial logistic regression were conducted to elucidate any associations. Results: seventy-three percent (73%) of the respondents were female, and 27% were male, with the majority (77.9%) being above 50 years and having lived with diabetes for over 3 years (61.5%). Opportunities for social support existed, with 62% of the respondents living with more than 2 persons above 18 in their households. From the Random Blood Glucose test analysis, 38.9% of the clients had high glycemic levels, partly because the majority (66.9%) of the respondents did not practice good diabetes self-management practices at the time of the study. While all three types of social support were reported as provided, only 30.6% reported receiving adequate social support. An association was found between social support and glycemic levels with respondents receiving adequate informational- P<0.05, OR 1.92, emotional -P<0.05, OR 3.7, and tangible support -P<0.05, OR 4.1 more likely to have better glycemic control than those with inadequate support. Conclusion: clients receiving adequate informational, emotional, and tangible social support were 2, 4, and 4 times, respectively, likely to have better glycemic control than those with inadequate support. Of the three types of social support, tangible support was most needed. Ultimately, a greater understanding of these interactions through longitudinal studies is required to identify solutions and optimize glycaemic control for diabetes clients in Kenya and beyond.

Spatial distribution of sexual network locations used by long-distance truck drivers along the Northern Corridor highway, Kenya.

BACKGROUND: In Kenya, long-distance truck drivers (LDTDs) using the Northern Corridor highway have a high prevalence of HIV and other sexually transmitted infections (STIs) due to their risky sexual networks. However, the spatial distribution of the sexual network locations used by LDTDs is not well understood. Consequently, healthcare stakeholders have found it difficult to provide spatially targeted HIV/STI interventions among LDTDs. Thus, the study sought to establish the spatial distribution of sexual network locations used by LDTDs along the Northern Corridor highway, to inform efficient distribution and use of limited HIV/STI-prevention resources. METHODS: A cross-sectional study design was used. The study adopted a systematic sampling technique. 296 LDTDs were interviewed using interviewer-administered questionnaires at the Mlolongo weighbridge in Kenya. The LDTDs listed their history of sexual interactions and highway stopovers used during the week preceding data collection. Geospatial modelling techniques, using R statistical software packages for spatial mapping, were employed. Shapefiles were created and overlaid over a map of Kenya using R statistical software to create maps of sexual networks. RESULTS: Forty-two highway stopovers used by LDTDs were spatially distributed along the highway, from the Kenya coast to the Kenya-Uganda border. In general, LDTDs' sexual network hotspots were restricted to the outskirts of major cities along the Northern Corridor highway (Nairobi, Mombasa and Nakuru) as well as the Kenya-Uganda international border. CONCLUSIONS: On the Northern Corridor highway, stopovers situated proximal to major urban areas, as well as those at international border points, frequently serve as sexual network hotspots among LDTDs and their sexual partners. Thus, healthcare stakeholders should improve access to HIV/STI-prevention services targeted for LDTDs at the sexual network hotspots identified in this study.

Determinants of microbial contamination of cooked foods hawked in Tharaka Nithi County, Kenya: a cross-sectional study.

Introduction: hawking of cooked foods is an important socio-economic activity. However, hawked cooked foods are prone to contamination, especially by pathogenic microorganisms. Methods: this was a cross-sectional study of 151 cooked food hawkers and 151 cooked food samples, one sample each from every respondent. Data was collected through questionnaires, observation checklists, laboratory processes, and key informant interviews. Quantitative data were analyzed using SPSS, while qualitative data were analyzed using the thematic network analysis technique. Results: adjusted multinomial logistic regression revealed increased odds of microbial contamination in cooked foods hawked by persons with primary-level education (adjusted odds ratio) AOR = 9.278, 95% confidence interval (CI) 2.292, 37.548; p = 0.003), persons earning a profit of Ksh. ≤500.00 (AOR = 4.046, 95% CI 1.825, 8.969; p = 0.001), and in areas infested with rodents (AOR = 6.386, 95% CI 1.877, 21.724; p = 0.003). However, cooked foods hawked by males (AOR = 0.338, 95% CI 0.133, 0.856; p = 0.022), persons trained on food safety (AOR = 0.216, 95% CI 0.064, 0.733; p = 0.014), persons wearing outer garments (AOR = 0.399, 95% CI 0.196, 0.812; p = 0.011), and by persons who stored their garbage in a municipal receptacle or a standard dust bin (AOR = 0.13, 95% CI 0.041, 0.410; p = 0.000) recorded reduced risk of contamination. Conclusion: hawker´s characteristics, food handling practices, and the condition of the hawking station are important determinants of microbial contamination of cooked foods hawked in Tharaka Nithi County. Targeted interventions need to be developed and implemented to prevent related foodborne diseases.

Demographic, occupational and societal risk exposures to physical injuries in a rural community in Western Kenya: a 12-week longitudinal study.

OBJECTIVE: We studied factors associated with the weekly occurrence of physical injuries in a rural setting to determine injury-related burden and risk exposures. DESIGN: Prospective cohort study. SETTING: Suna-West subcounty, Migori County, Western Kenya. PARTICIPANTS: 390 study participants (subjects) cluster sampled from 92 households, recruited and followed up for 12 weeks, between August and October 2019. METHODS: We collected data weekly on occurrence of injuries, individual-level and household-level independent variables using a standard interviewer-administered questionnaire adapted from the WHO survey tool for injuries. Analyses related occurrence of injuries and independent variables using a multilevel Poisson regression model, adjusting for age and sex. OUTCOME MEASURES: Quantifying injury-related burden and patterns by demographic, occupational and societal risk exposures. RESULTS: We documented 44 injuries, coming from 38 subjects dwelling in 30 of the 92 study households. On average, each study subject and household experienced 1.2 and 1.5 episodes of injuries across the 12 study weeks. Open wounds and bruises were the most frequent injuries commonly reported among middle-aged (18-54 years) and young (5-17 years) subjects at 32.2 and 7.6 episodes per 1000-person week, respectively. The common cause of injuries among young, middle-aged and old subjects (>54 years) were falls, road accidents and person-related assault or being hit by an object, each at 15.2, 18.9, and 11.4 episodes per 1000-person week, respectively. Subjects not domesticating animals (incidence rate ratio (IRR)=7.6, 95% CI 1.4 to 41.7) and those making a visit outside the local subcounty of residence (IRR=2.2, 95% CI 1.5 to 3.1) were at higher risk of reporting injuries. CONCLUSION: We provide evidence of a higher burden of physical injuries associated with demographic, occupational and societal risk exposures with the most injuries resulting from falls. Further studies could better define granular characteristics constituting these factors.

Assessment of delayed tuberculosis diagnosis preceding diagnostic confirmation among tuberculosis patients attending Isiolo County level four hospital, Kenya.

INTRODUCTION: delayed diagnosis of Mycobacterium tuberculosis infection leads to accelerated individual to individual transmission. This study evaluated this aspect of delayed diagnosis among patients visiting Isiolo level four hospital in northern Kenya. METHODS: this was a cross-sectional cohort study conducted during January, 2018-January, 2019 with systematically sampled 172 tuberculosis (TB) patients. Epidemiological and clinical characteristics were abstracted from records to serve as independent variables. Outcome variable was delayed diagnosis dichotomised into < 21 or > 21 days and treated as a binary outcome. Pre-tested interviewer-administered questionnaires, focused group discussions, and key informant interview guides were used to collect relevant information. RESULTS: most (n=89, 57.8%) of the TB diagnosis fell in the category of > 21 day delay. Overall, among all patients, delay in days constituted a median of 27.6, a mean of 37.3 ± 57 days (range 0-414 days). Factors associated with delayed diagnosis (happening > 21 days) included (i) use of dispensary and private health facilities, (OR=4.3, 95% CI: 1.44,13.14; P=0.009) and (OR= 4.9, 95% CI: 1.64, 14.73; P=0.004), respectively (ii) Self-employed individuals (OR=21.7, 95% CI: 2.47,190.93; P=0.006) and employed individuals (OR=9.9, 95% CI: 1.14, 85.80; P=0.038) (iii) secondary-level education (OR=0.03, 95% CI: 0.01,0.21; P=0.000) and tertiary education (OR=0.033, 95% CI: 0.01, 0.23; P=0.001). CONCLUSION: delayed diagnosis of TB was found to be associated with health-seeking behaviour of TB patients, proxied by diagnosis facility, occupation, and education levels in our study area. Curtailment of local transmission of M. tuberculosis needs intensified health promotion and education in affected communities complemented with active case findings.

Frequency of sexual interactions and associated factors among long-distance truck drivers operating along the Northern Corridor Highway, Kenya.

INTRODUCTION: harsh working conditions among long-distance truck drivers (LDTDs) expose them to risky sexual interactions while on transit. As a result, the risky sexual interactions among the LDTDs place them at a high risk of contracting human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). This study sought to assess the sexual interactions and associated factors among the LDTDs in Kenya. METHODS: two hundred ninety-six (296) LDTDs were interviewed using interviewer-administered questionnaires. A systematic sampling technique was adopted. The number of sexual acts reported by the respondents was used to generate an ordered outcome variable (frequency of sexual interactions), in the order of; no sexual acts (zero), one to three sexual acts (1), and four to six sexual acts (2). Association between the predictor variables and the outcome variable was analysed using ordered logistic regression analysis in R statistical software. RESULTS: the mean age of the study participants was 38.4 years, with the youngest being 24 years and the oldest 57 years. Slightly above half of the participants (52.4%) reported no sexual interactions, while the rest (47.6%) had sexual interactions with either casual or regular sexual partners on the week preceding the survey. Age, the number of weeks spent on a transit journey, and drug use were independently associated with the frequency of sexual interactions among LDTDs involved in the study. CONCLUSION: the frequencies of sexual interactions are likely to be higher among the younger LDTDs, those who spent more than one week on transit, and those who use alcohol and khat, hence a high exposure risk to HIV/STIs among them.