Urinary Schistosomosis in Patients of Rural Medical Health Centers in Kwale County, Kenya.

Urinary schistosomosis is a serious public health problem prevalent in low-income rural regions of sub-Saharan Africa, including coastal part of Kenya. Praziquantel administration to school-aged children is the prevailing tool of schistosomosis control in these regions. The aim of our study was to find out if this control strategy can lead to interruption of parasite trasmission and disease elimination. During February and March 2018, the occurrence of urinary schistosomosis in volunteers of primary health care facilities in Kwale County, Kenya was examined and the occurrence of infected intermediate hosts Bulinus globosus in local water resources was monitored. Participants completed a questionnaire concerning source of water for household purposes, type of housing and health status and were asked to provide urine samples. Diagnosis of urinary schistosomosis was established by detection of Schistosoma haematobium eggs in urine specimens microscopically, using filtration method. Infected B. globosus snails were detected using cercaria shedding tests. From the hemolymph of snails, prepatent period of infection was identified by polymerase chain reaction (PCR). The presence of urinary schistosomosis was detected in 15.07 % (69 out of 451) of study participants. Cercaria shedding test was positive in 2 particular sites of river Pengo and Tsanganyiko. Genetic material (haemolymph) of 68 B. globosus snails tested by DraI PCR revealed 7 Schistosoma spp. positive samples. Six of seven DraI positive snails were infected by S. haematobium, as it was detected by Sh110/SmS1 PCR. The study revealed, that the disease was still present in the region studied and the transmission was not interrupted. The rate of infection was significantly influenced by the water supplies used for household purposes and the type of housing.

Relationship between dietary patterns and stunting in preschool children: a cohort analysis from Kwale, Kenya.

OBJECTIVES: Stunting is a significant cause of poor cognitive performance and lower school achievement. Stunting is observed among pre-school children in several areas in Africa; however, not all children are affected, and children with and without stunting are seen in the same communities. Therefore, this study aimed to identify nutritional and other factors that prevent stunting that may exist in local communities. STUDY DESIGN: This is a prospective cohort study. METHODS: Data were extracted from the Health and Demographic Surveillance System conducted in Kwale County, Kenya. The cohort consisted of all households with children less than five years old, within a radius of 2.2 km from a local health centre. A dietary pattern (DP) survey with a semi-quantitative food frequency questionnaire was conducted on caretakers of children who were voluntary participated from the cohort between June 2012 and August 2012. Using cluster analysis, the children were assigned to a DP group. Logistic regression analysis was applied to calculate the adjusted odds ratios (aORs) of DPs for stunting controlling for other factors. RESULTS: In total, 402 children were included in the analysis. By cluster analysis, three DPs were identified: protein-rich DP; traditional DP; and traditional DP complemented by breastfeeding. The aOR of a child becoming stunted from a normal height during the study period among children who received a traditional DP compared with those who had a protein-rich DP was 2.78 (95% confidence interval [CI]: 1.02-7.55). However, the aOR for children who were already stunted at the start of the study and had a traditional DP was 1.49 (95% CI: 0.82-2.72). Increased aORs of stunting were observed among children aged over 12 months compared with children aged 6-11 months, and the effects of DPs were modified by age in months from 12 to 35 months; however, the effects were near the null value for children over 36 months of age, although these were not statistically significant. CONCLUSIONS: We found that the traditional DP showed a higher risk for stunting compared with the protein-rich DP, and the most vulnerable age range for stunting was between 12 and 35 months. Interventions to prevent stunting should focus on providing 12- to 35-month-old children with locally available, protein-rich foods.

ROLES OF TRADITIONAL BIRTH ATTENDANTS AND PERCEPTIONS ON THE POLICY DISCOURAGING HOME DELIVERY IN COASTAL KENYA.

OBJECTIVES: To describe the roles of Traditional Birth Attendants (TBAs), to determine the perceptions of TBAs and Skilled Birth Attendants (SBAs) towards the policy discouraging home delivery by TBAs and to establish the working relationship between TBAs and SBAs in Kwale, Kenya. DESIGN: Community based cross-sectional study. SETTING: Mwaluphamba, Kinango and Golini locations of Kwale County, Kenya. SUBJECTS: Fifty eight participants were involved in the study. Interviews were conducted with 22 TBAs and 8 SBAs as well as 3 FGDs with 28 TBAs were carried out in July 2012. MAIN OUTCOME MEASURES: Roles of TBAs, policy awareness and support as well as the working relationship between TBAs and SBAs. RESULTS: Before delivery, the main role of TBAs was checking position of the baby in the womb (86%) while during delivery, the main role was stomach massage (64%). However, majority (95%) of the TBAs did not provide any after delivery. All SBAs and 59% of TBAs were aware of the policy while 88% SBAs and 36% of TBAs supported it. The working relationship between TBAs and SBAs mainly involved the referral of women to health facilities (HFs). Sometimes, TBAs accompanied women to the HF offering emotional support until after delivery. CONCLUSION: TBAs in Kwale have a big role to play especially during pregnancy and delivery periods. Awareness and support of the policy as well as the collaboration between SBAs and TBAs should be enhanced in Kwale.