Mapping potential Anopheles gambiae s.l. larval distribution using remotely sensed climatic and environmental variables in Baringo, Kenya.

Anopheles gambiae s.l. (Diptera: Culicidae) is responsible for the transmission of the devastating Plasmodium falciparum (Haemosporida: Plasmodiidae) strain of malaria in Africa. This study investigated the relationship between climate and environmental conditions and An. gambiae s.l. larvae abundance and modelled the larval distribution of this species in Baringo County, Kenya. Mosquito larvae were collected using a 350-mL dipper and a pipette once per month from December 2015 to December 2016. A random forest algorithm was used to generate vegetation cover classes. A negative binomial regression was used to model the association between remotely sensed climate (rainfall and temperature) and environmental (vegetation cover, vegetation health, topographic wetness and slope) factors and An. gambiae s.l. for December 2015. Anopheles gambiae s.l. was significantly more frequent in the riverine zone (P < 0.05, r = 0.59) compared with the lowland zone. Rainfall (b = 6.22, P < 0.001), slope (b = - 4.81, P = 0.012) and vegetation health (b = - 5.60, P = 0.038) significantly influenced the distribution of An. gambiae s.l. larvae. High An. gambiae s.l. abundance was associated with cropland and wetland environments. Effective malaria control will require zone-specific interventions such as a focused dry season vector control strategy in the riverine zone.

The treatment pathways followed by cases of human African trypanosomiasis in western Kenya and eastern Uganda.

Although early diagnosis and treatment are key factors in the effective control of human African trypanosomiasis (HAT), many cases of the disease delay taking appropriate action, leading to untold suffering. As a better understanding of treatment-seeking behaviour should help in identifying the obstacles to early diagnosis and effective treatment, the treatment pathways followed by 203 former HAT cases in western Kenya and eastern Uganda have recently been explored. About 86% of the HAT cases had utilized more than two different healthcare options before being correctly diagnosed for HAT, with about 70% each using more than three different health facilities. Only about 8% of the cases reported that they had been correctly diagnosed the first time they sought treatment. Just over half (51%) of the HAT cases had been symptomatic for >2 months before being correctly diagnosed for HAT, and such time lags in diagnosis contributed to 72% of the cases receiving their first appropriate treatment only in the late stage of the disease. The likelihood of a correct diagnosis increased with the time the case had been symptomatic. These observations indicate an urgent need to build the diagnostic capacity of the primary healthcare facilities in the study area, so that all HAT cases can be identified and treated in the early stage of the disease.

An ethnographic study of cervical cancer among women in rural Kenya: is there a folk causal model?

This article assesses knowledge, attitudes, and practices regarding cervical cancer among rural women of Kenya. One hundred and sixty women (mean age 37.9 years) who sought various health care services at Tigoni subdistrict hospital, Limuru, Kenya, were interviewed using a semistructured questionnaire. In addition, three focus group discussions (25 participants) were held, five case narratives recorded, and a free list of cervical cancer risk factors obtained from a group of 41 women respondents. All women were aged between 20 and 50 years. About 40% knew cervical cancer, although many still lack factual information. A history of sexually transmitted diseases (61.5%), multiple sexual partners (51.2%), and contraceptive use (33%) were identified as risk factors. Other factors mentioned include smoking, abortion, and poor hygiene standards. High parity, early sexual debut, and pregnancy were not readily mentioned as risk factors. We propose a folk causal model to explain the link between these factors and cervical cancer. Lack of knowledge constrains utilization of screening services offered at the clinics. Consequently, respondents support educating women as a way to tackling issues on cervical cancer. It is recommended that an integrated reproductive health program that addresses comprehensively women's health concerns be put in place.

Health care switching behaviour of malaria patients in a Kenyan rural community.

Patients ordinarily use multiple sources of health care. This study reveals the transitions patients in a rural region of Gusii, Kenya are likely to make beyond the homestead in their search for alternatives to combat malaria. Malaria is a very common health problem in the region resulting in enormous human and economic losses. Data on health care seeking behaviour were collected over a 10-month period. The primary data for this paper is from malaria-focused ethnographic interviews with 35 adults (18 women and 17 men). Results show that patients are more likely to start with self-treatment at home as they wait for a time during which they observe their progress. This allows them to minimise expenditure incurred as a result of the sickness. They are more likely to choose treatments available outside the home during subsequent decisions. The decisions include visiting a private health care practitioner, a government health centre or going to a hospital when the situation gets desperate. Knowledge and duration of sickness, the anticipated cost of treatment. and a patient's judgement of the intensity of sickness determine their choice of treatment.

Home case management of malaria: an ethnographic study of lay people's classification of drugs in Suneka division, Kenya.

Lay people in malaria-affected regions frequently have to choose from many over-the-counter malaria management drugs, requiring them to be able to identify these medications and distinguish between them. Lay people make these distinctions at two levels - age of the patient and the whether he or she has fever, pain or malaria. Sometimes decisions are based on incorrect information given by friends and relatives, causing prolonged suffering to the patient, exacerbating chloroquine resistance and leading to resistance to the sulfodoxine/pyrymethamine drugs now recommended as first-line treatment in Kenya.