Occurrence of rift valley fever in cattle in Ijara district, Kenya.

Ijara district in Kenya was one of the hotspots of rift valley fever (RVF) during the 2006/2007 outbreak which led to human and animal deaths causing huge economic and public health losses. The main constraint in the control and prevention of RVF is inadequate knowledge on its occurrence during the interepidemic period. This study was aimed at understanding the occurrence of RVF in cattle in Ijara to enable the development of improved community-based disease surveillance, prediction, control and prevention. Six herds each 700-1000 cattle were identified with participatory involvement of locals and project technical team of the project. One animal per herd was tagged with global position system (GPS) collar to enable follow up. Sero-surveys were conducted periodically to understand the herd's movement through various ecological zones and risk of exposure to RVF virus. Sixty animals less than 3 years old from each herd were randomly selected each sampling time and sero-surveyed for RVF four times (September 2012, December 2012, February 2013 and May 2013) during the study period and along the nomadic movement route. The serum samples collected were subjected to RVF inhibition ELISA test to detect if there was exposure for RVF virus (RVFV). The RVF inhibition ELISA positive samples were subjected to IgM ELISA test to determine if the exposures were current or recent (within 14 days). The result of the survey indicated that 13.1% (183/1396) of cattle sero-surveyed had RVFV antibodies by inhibition ELISA test while 1.4% (18/1396) was positive for IgM ELISA test. The highest RVFV circulation was detected after herds pass through bony forest between Lamu and Ijara and Halei forested areas. These forested areas also had the highest IgM detections. The findings indicate that even limited rainfall was able to initiate RVFV circulation in Ijara region with highest circulation detected within forested areas with potential to become epidemic if rains persist with extensive flooding. There is need to carry out regular participatory disease surveillance in domestic animals and other host systems to identify risk locations in hotspot areas and carry out community awareness and focal vaccination campaigns against RVF for preparedness, prevention and control. Additionally, monitoring of environmental conditions in risky ecological zones to detect enhanced rainfall and flooding should be prioritized for preparedness.

Away-from-home drinking water consumption practices and the microbiological quality of water consumed in rural western Kenya.

A cross-sectional descriptive study was conducted to examine away-from-home drinking water consumption practices and the microbiological quality of water consumed in rural western Kenya. The study involved adults and schoolchildren. Data were collected using focus group discussions, questionnaire survey, observations, diaries and interviews. The findings suggest that away-from-home drinking water consumption is a common practice in the study area; however, the microbiological quality of the water consumed is poor. While some respondents perceive the water to be safe for drinking mainly because of the clear colour of the water, others are forced by circumstances to drink the water as it is owing to a lack of alternative safe sources. It is concluded that there is a need for new innovative approaches to address away-from-home drinking water consumption in resource-poor settings in order to complement and maximize the benefits of point-of-use water treatment at the household level.

The potential of schoolchildren as health change agents in rural western Kenya.

A prospective, quasi-experimental study was carried out in Bondo district in western Kenya to determine the potential of schoolchildren as health change agents in a rural community. A group of 40 schoolchildren were given health education using action-oriented and participatory approaches and their knowledge and practices as well as the influence on recipient groups consisting of peers at school and parents/guardians at home, were studied. The study, which used questionnaire surveys, involved a pre-test of knowledge about malaria, diarrhea and hygiene among the recipient groups. After the baseline surveys they underwent health communication training conducted by the 40 schoolchildren. An identical post-test questionnaire was administered to all participants at 4 and 14 months. Health-related practices were studied regularly through observation in schools and homes over 14 months. Significant improvement in knowledge was detected in all recipient groups. Behavioral changes were more evident among the children than among the adults. The impact of the project was reflected in concrete changes in the school environment as well as the home environments. The implications of the findings for health education projects and public health programs are outlined.

Planning for PPM-DOTS implementation in urban slums in Kenya: knowledge, attitude and practices of private health care providers in Kibera slum, Nairobi.

SETTING: Kibera, the largest slum in Nairobi, Kenya. OBJECTIVE: To determine the tuberculosis (TB) knowledge, attitude and practices (KAP) of private health care providers (PHCPs) to identify their training needs and willingness to participate in a National Leprosy and Tuberculosis Control Programme (NLTP) guided TB control effort in the slum. DESIGN AND METHODOLOGY: A cross-sectional survey. The KAP of PHCPs was assessed using an interviewer administered questionnaire. RESULTS: Of 75 PHCPs interviewed, the majority (96.0%) were paramedics; 51 (77.1%) did not consider sputum smear microscopy crucial in patients presenting with prolonged cough or when a chest X-ray was suggestive of TB; of 29 (38.7%) who indicated familiarity with the drugs used in TB treatment, 20 (58.5%) would have chosen the NLTP-recommended regimens for the treatment of the various types of TB; 16 (21.3%) PHCPs indicated that they treated TB, six (37.5%) of whom were not familiar with anti-tuberculosis drug regimens. All the PHCPs referred TB suspects to the public sector for diagnosis. CONCLUSION: This study reveals a significant gap in TB knowledge among the PHCPs in Kibera slum. However, given appropriate training and supervision, there is potential for public-private mix for DOTS implementation in this setting.

Changing concepts of health and illness among children of primary school age in Western Kenya.

This paper examines changes in children's concepts of health and illness following an action-oriented health education intervention in Bondo district of Western Kenya. The study is a feasibility study exploring a specific educational approach, and it combines elements of health education research and anthropological research. Forty primary schoolchildren aged 10-15 years of age underwent a 2-month intervention and were thereafter enrolled as health communicators in a longitudinal study for an additional period of 12 months. Data were collected before, during and after the intervention using in-depth interviews and the draw-and-write technique. Students' actions and their active participation were key elements in the intervention. Although the intervention from the beginning focused on two specific diseases (malaria and diarrhea), the students were involved in developing their own ideas and visions about which changes to make, which actions to carry out and which target groups to approach. Data showed that children had acquired new concepts of health, some of which incorporated elements of the old ones. More action-oriented health concepts were identified and a general change from an external locus of control towards an internal locus of control was found. The study concludes that students can modify and broaden their concepts of health and illness through action-oriented health education. Key factors are the development of students' ownership through active and participatory teaching and learning approaches.

An evaluation of Health Workers for Change in seven settings: a useful management and health system development tool.

This paper presents the findings of a multi-centre study assessing the impact of Health Workers for Change (HWFC) workshops in seven different primary care sites, based on the common core protocol described in this paper. The paper discusses a common methodology used by the studies, consisting of a triangulation of qualitative and quantitative methods. Such methodologies are inherently complex as they require comparisons across systems, sites and procedures. The studies were conducted in six sites in Africa and one site in Argentina. Generally, the intervention resulted either in positive change or in no change, except in the area of staff relationships where conflicts were more frequent after the intervention than before. This may reflect a willingness to confront problems or contentious issues. Implementing the HWFC workshops improved provider-client relations, facility level functioning and aspects of staff interrelationships, and had some impact at the system level. All studies indicated that overall health system development is essential for improved service provision including quality of care. The findings also indicated that this intervention complemented and could assist health sector reform efforts and can play a role in sensitizing health workers to gender issues. The paper concludes with a discussion of the robustness of the methodology used in the studies.

The health workers for change impact study in Kenya.

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

A study of risk factors for intestinal helminth infections using epidemiological and anthropological approaches.

This study. conducted in Kisumu District, Kenya, identified important risk factors for infection with intestinal helminths using traditional epidemiological methods. This was combined with a rapid assessment study using qualitative methods, which focused on sanitation practices and local illness perceptions. The multiple logistic regression analysis revealed that the absence of latrines was a significant predictor for hookworm infection with an odds ratio (OR) of 1.9. The analysis also revealed that households without soap had a 2.6 times higher risk of being infected with Ascaris lumbricoides compared with households where soap was available, and that the number of inhabitants living in a household was a significant predictor for infections with hookworms (OR=3.2). Furthermore, the presence of children of 5 years and under in the household was a predictor for infection with A. lumbricoides (OR=2.7), while the absence of this age group was a predictor for hookworm infection (OR=3.8). The qualitative part of the study revealed that people did not consider worms as a serious health threat, but as a nuisance. Among the population. latrines were seen as beneficial because they were believed to prevent disease, to provide privacy and to keep the environment free of faeces. Handwashing was done many times a day but usually not with soap, which was mainly used when bathing or washing the whole body. Many inhabitants in a household or the presence of children of 5 years and under were never mentioned as being a disadvantage, and these elements would therefore be difficult to include in a control strategy. Since the lack of latrines and of soap were identified as risk factors for infection, while latrines, soap and medicine were seen as assets by the population, it is suggested that helminth control interventions should be concentrated within these areas in this particular society.