Field efficacy and acceptability of PermaNet® 3.0 and OlysetNet® in Kinshasa, Democratic Republic of the Congo.

BACKGROUND & OBJECTIVES: Insecticide resistance in mosquitoes at Kinshasa may jeopardize the efficacy and usage of long-lasting insecticidal nets (LLINs). Entomological impact, user acceptance and bioefficacy of a combination LLIN (PermaNet® 3.0) and a standard LLIN (OlysetNet®) were evaluated at two sites in Kinshasa characterized by high densities of either Anopheles gambiae s.s. (Kindele) or Culex spp (Kimbangu). METHODS: Insecticide susceptibility (permethrin, deltamethrin, bendiocarb, propoxur and DDT) was determined via tube tests and bottle assays. Entomological impact of unwashed and washed LLINs and untreated nets was assessed via Latin square, based on rotation of nets and their users through selected houses at each site. User acceptability was evaluated through interviews using a questionnaire and net bioefficacy was measured via cone bioassays with field-derived An. gambiae s.s. RESULTS: The An. gambiae s.s. population from Kindele was resistant to DDT and permethrin with mortality rate of 27.3 and 75.8%, respectively, and kdr mutations (L1014F) plus suspected metabolic resistance. The Culex spp population was resistant to all five insecticides tested. No differences in entomological indices were observed for the five net treatments, but bioefficacy against An. gambiae was significantly higher for unwashed and washed PermaNet 3.0 (100 and 71% mortality) than for OlysetNet (56 and 36%). Householders reported a good sleep most often when using unwashed and washed PermaNet (94 and 88%) and least often with unwashed OlysetNet (46%). INTERPRETATION & CONCLUSION: High bioefficacy via cone bioassays against an An. gambiae s.s. population with kdr and suspected metabolic resistance was observed with PermaNet 3.0. Lower biting rates and a higher chance of a good night of sleep were reported when using PermaNet 3.0 compared to OlysetNet.

Who is to blame? Perspectives of caregivers on barriers to accessing healthcare for the under-fives in Butere District, Western Kenya.

BACKGROUND: Kenya, like many developing nations, continues to experience high childhood mortality in spite of the many efforts put in place by governments and international bodies to curb it. This study sought to investigate the barriers to accessing healthcare services for children aged less than five years in Butere District, a rural district experiencing high rates of mortality and morbidity despite having relatively better conditions for child survival. METHODS: Exit interviews were conducted among caregivers seeking healthcare for their children in mid 2007 in all the 6 public health facilities. Additionally, views from caregivers in the community, health workers and district health managers were sought through focus group discussions (FGDs) and key informant interviews (KIs). RESULTS: Three hundred and ninety-seven respondents were surveyed in exit interviews while 45 respondents participated in FGDs and KIs. Some practices by caregivers including early onset of child bearing, early supplementation, and utilization of traditional healers were thought to increase the risk of mortality and morbidity, although reported rates of mosquito net utilization and immunization coverage were high. The healthcare system posed barriers to access of healthcare for the under fives, through long waiting time, lack of drugs and poor services, incompetence and perceived poor attitudes of the health workers. FGDs also revealed wide-spread concerns and misconceptions about health care among the caregivers. CONCLUSION: Caregivers' actions were thought to influence children's progression to illness or health while the healthcare delivery system posed recurrent barriers to the accessing of healthcare for the under-fives. Actions on both fronts are necessary to reduce childhood mortality.

The prevalence of anxiety and depression symptoms and syndromes in Kenyan children and adolescents.

BACKGROUND: Community studies on children and adolescents in Western settings suggest prevalence rates of anxiety and depressive symptoms that require intervention. AIM: To establish equivalent prevalence rates in a Kenyan (developing country) situation Method: Self-administered questionnaires for socio-demographic data, three Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV)-based instruments for anxiety symptoms and syndromes in children, one instrument for depression and one culture sensitive instrument for depression and anxiety were administered in three different sets to 3 775 randomly sampled students drawn from a stratified sample of 34.7% of all public secondary schools in Nairobi, Kenya. RESULTS: The prevalence rates of anxiety and depression symptoms and syndromes varied widely depending on sex and age and also on the emphasis of the different instruments used, and also according to the cut-off points for the various syndromes and instruments. Clinical diagnostic scores for depression were recorded in 43.7% of all the students. Using the cut-off points for the Multidimensional Anxiety Scale for Children (MASC), anxiety was recorded in 12.9% of all students. Nearly half (40.7%) of the respondents who completed the Short Leyton Obsessional Inventory for Children and Adolescents had positive scores for obsessive disorder, 81.1% were positive for compulsive disorder and an average of 69.1% had positive scores for both obsessive and compulsive disorders combined. Amongst those who completed the Ndetei-Othieno-Kathuku (NOK) scale for Depression and Anxiety, 49.3% had positive scores for moderate to severe anxiety with or without depression. The Screen for Child Anxiety Related Disorders - Revised (SCARED-R) yielded high levels (50-100%) for the different syndromes, with obsessive-compulsive disorder at 99.3%, just below separation anxiety and school phobia at 100%. Suicidal thoughts and plans were prevalent at 4.9-5.5%. CONCLUSION: Anxiety and depression were found at prevalence rates no less than is found in the West. This calls for appropriate clinical practices and policies.