The Impacts of Task Shifting on the Management and Treatment of Malnourished Children in Northern Kenya: A Cluster-Randomized Controlled Trial.

Treating children with acute malnutrition can be challenging, particularly regarding access to healthcare facilities during treatment. Task shifting, a strategy of transferring specific tasks to health workers with shorter training and fewer qualifications, is being considered as an effective approach to enhancing health outcomes in primary healthcare. This study aimed to assess the effectiveness of integrating the treatment of acute malnutrition by community health volunteers into integrated community case management in two sub-counties in northern Kenya (Loima and Isiolo). We conducted a two-arm non-inferiority cluster-randomized controlled trial across 20 community health units. Participants were children aged 6-59 months with uncomplicated acute malnutrition. In the intervention group, community health volunteers used simplified tools and protocols to identify and treat eligible children at home and provided the usual integrated community case management package. In the control group, community health volunteers provided the usual integrated community case management package only (screening and referral of the malnourished children to the health facilities). The primary outcome was recovery (MUAC ≥12.5 cm for two consecutive weeks). Results show that children in the intervention group were more likely to recover than those in the control group [73 vs. 50; risk difference (RD)=26% (95% CI 12 to 40) and risk ratio (RR)=2 (95% CI 1.2 to 1.9)]. The probability of defaulting was lower in the intervention group than in the control group: RD=-21% (95% CI -31 to -10) and RR=0.3 (95% CI 0.2 to 0.5). The intervention reduced the length of stay by about 13 days, although this was not statistically significant and varied substantially by sub-county. Integrating the treatment of acute malnutrition by community health volunteers into the integrated community case management program led to better malnutrition treatment outcomes. There is a need to integrate acute malnutrition treatment into integrated community case management and review policies to allow community health volunteers to treat uncomplicated acute malnutrition.

Knowledge, attitude and practices around breast cancer and screening services among women of reproductive age in Turbo sub-county, Kenya.

Background: Only 12% of Kenyan women use breast cancer (BC)screening programs. Early identification is critical for reducing the condition's associated morbidity and mortality. Unfortunately, few studies have been conducted on the screening program's implementation and the causes for the low usage rates in Turbo Sub-County, Kenya. The purpose of this study was to learn about women of reproductive age's (WRA) practices, attitudes, and knowledge regarding BC screening programs, as well as to investigate the potential association between lifestyle factors and BC screening service utilization. Methods: Mixed-method approaches were used in an analytical cross-sectional study design. The study included 317 participants selected randomly. An interviewer-administered questionnaire was used to collect quantitative data while focus group discussion (FGD) and key informant interview (KII) guides were used for collecting qualitative data. The Statistical Package for Social Sciences (SPSS) version 26 was used to manage quantitative data, whereas NVivo version 12 was used to analyze qualitative data. Chi-square, Fisher's exact test, and multiple logistic regression were used to assess the degree of relationship between BC screening service uptake and independent variables. The qualitative data was transcribed verbatim, and the transcripts were automatically coded to generate themes. Results: The participants' mean age was 30.14 (9.64). Breast cancer screening services were used by 10.21% of the population. Women who were aware of the signs and symptoms of BC were 71.5 times more likely to undergo screening than their counterparts. Similarly, those with positive attitudes toward BC and screening programs were 84 times more likely to get screened than those with negative attitudes. Breastfeeding increased the likelihood of BC screening by OR = 37 (95% CI: 0.00-0.32), physical activity by OR = 37 (95% CI: 0.00-0.25), and chronic illnesses by OR = 37 (95% CI: 0.00-0.17). Conclusion: Knowledge of signs and symptoms of BC and a positive attitude towards perceived barriers enhanced the probabilities of BC screening. Being physically active, breastfeeding, and having a chronic disease all increased the odds of BC screening uptake. To improve screening rates, it is necessary to provide sufficient information to those who are least likely to be screened.

Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya.

Child undernutrition is a persistent challenge in arid and semi-arid areas due to low and erratic rainfall, recurrent droughts and food insecurity. In these settings, caregivers face several challenges in accessing health services for sick and/or malnourished children, including long distances to health facilities, harsh terrain, and lack of money to pay for transportation costs to the health facilities, leading to low service coverage and sub-optimal treatment outcomes. To address these challenges and optimize treatment outcomes, the World Health Organization recommends utilizing community health volunteers (CHVs) to manage acute malnutrition in the community. This study explored the perceptions of community members regarding acute malnutrition treatment by CHVs in Turkana and Isiolo counties in Kenya. The study utilized a cross-sectional study design and included a purposive sample of caregivers of children, CHVs, officers who trained and supervised CHVs and community leaders in the intervention area. Focus group discussions and key informant interviews were used to explore perceptions towards the management of acute malnutrition by CHVs. Generally, caregivers and CHVs perceived the intervention to be beneficial as it readily addressed acute malnutrition treatment needs in the community. The intervention was perceived to be acceptable, effective, and easily accessible. The community health structure provided a platform for commodity supply and management and CHV support supervision. This was a major enabler in implementing the intervention. The intervention faced operational and systemic challenges that should be considered before scale-up.

Has the double burden of malnutrition reached pupils in rural western Kenya?

BACKGROUND: Undernutrition and overnutrition have been considered separate challenges caused by the distinct factors in distinct settings. The double burden of malnutrition is defined as the coexistence of both undernutrition and overnutrition, which has now spread globally, especially in low- and middle-income countries. In Kenya, the double burden of malnutrition is present in the capital city but the situation in rural areas currently remains unknown. The aim of this study was therefore to analyze nutritional status in rural Kenya. METHODS: Data from height and weight measurements conducted by teachers in the third term of school year 2013 were collected from primary schools. Teachers were trained by experts before starting the measurements. The Z-scores of height-for-age, weight-for-age, and body mass index-for-age were calculated using AnthroPlus, and nutritional status was defined according to the World Health Organization guidelines. RESULTS: Data analyzed from 7,447 pupils (3,763 boys and 3,684 girls) showed that 12.4% were stunted and 7.8% were underweight among those ≤120 months old, and 11.7% were thin among those >120 months old. Boys were more likely to be stunted than girls. Boys were more likely to be underweight and girls were more likely to be overweight in the older age group. CONCLUSION: The double burden of malnutrition was not found, and undernutrition was still common among schoolchildren in the study area. However, it is important to monitor nutritional status due to adverse effects of rapid urbanization. Height and weight measurements in schools may be useful for monitoring the nutritional status of schoolchildren.

Examining the appropriateness and reliability of the strategy of the Kenyan Comprehensive School Health Program.

The Kenyan government established the Kenyan Comprehensive School Health Program (KCSHP) on the basis of Kenyan National School Health Policy. A KCSHP pilot project was carried out in eight primary schools in Mbita Sub-County of Homa Bay County in the Nyanza Region from 2012 to 2017. This pilot project provided health facilities and support for evaluation with a school health checklist, and organized teacher training on health education, a child health club, and school-based health check-ups. The present study aimed to examine the appropriateness and reliability of the strategy of the second KCSHP pilot project in Kenya. We analyzed data from self-administered questionnaires targeted at pupils in seventh-grade in the eight primary schools. The questionnaire consisted of questions on health-related knowledge, attitudes and practices, self-evaluated physical and mental health status, self-awareness of health control, subjective happiness, recognition on the importance of learning about health in school, absenteeism, and sense of school belongingness. The project contributed to improving health-related knowledge, attitudes and practices, self-evaluated health status, sense of school belongingness, recognition on the importance of learning about health in school, self-awareness of health control, and absenteeism. On the contrary, subjective happiness did not improve significantly.

Implementation of Kenyan comprehensive school health program: improvement and association with students' academic attainment.

There is growing evidence supporting the effectiveness of a comprehensive school health program. However, implementation in developing countries is a challenge. Furthermore, the available information on the association between a comprehensive school health program and students' academic attainment is limited. In Kenya, a project to verify the effects of a comprehensive school health program was carried out in Mbita sub-county, Homa Bay County from September 2012 to August 2017. This study aimed to clarify the improvement of school health during the project years and the association between school health and students' academic attainment. Primary schools in Mbita sub-county were selected as study sites. We assessed 44 schools' scores on a school health checklist developed from the Kenyan Comprehensive School Health Program, the students' mean score on the Kenya Certificate of Primary Education (KCPE), and absenteeism during the project years (2013-16). The mean school health checklist score (n = 44 schools) was 135.6 in 2013, 169.9 in 2014, 158.2 in 2015 and 181.3 in 2016. The difference of the mean score between 2013 and 2016 was significant. In addition, correlation analysis showed a significant association between mean KCPE score in the project years and school health checklist score (Pearson's coefficient was 0.43, p = 0.004). The results of this study suggest improvements of school health by the implementation of the Kenyan Comprehensive School Health Program and students' academic attainment.