Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 19.879
Filtrar
1.
BMC Health Serv Res ; 24(1): 597, 2024 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-38715044

RESUMEN

BACKGROUND: Globally, a fifth of the children continue to face chronic undernutrition with a majority of them situated in the Low- and Middle-Income Countries (LMIC). The rising numbers are attributed to aggravating factors like limited nutrition knowledge, poor feeding practices, seasonal food insecurity, and diseases. Interventions targeting behaviour change may reduce the devastating nutrition situation of children in the LMICs. OBJECTIVE: For the co-design of a Behaviour Change Communication (BCC) intervention for young children in rural Kenya, we aimed to identify the experiences, barriers, facilitators, and preferences of caregivers and stakeholders regarding nutrition and health counselling. DESIGN: We employed a qualitative study design and used a semi-structured interview guide. The in-depth interviews were recorded, transcribed, and analysed using content analysis, facilitated by the software NVivo. SETTING: Health and Demographic Surveillance System (HDSS) area in Siaya County, rural Kenya. PARTICIPANTS: We interviewed 30 caregivers of children between 6 and 23 months of age and 29 local stakeholders with experience in implementing nutrition projects in Kenya. RESULTS: Nutrition and health counselling (NHC) was usually conducted in hospital settings with groups of mothers. Barriers to counselling were long queues and delays, long distances and high travel costs, the inapplicability of the counselling content, lack of spousal support, and a high domestic workload. Facilitators included the trust of caregivers in Community Health Volunteers (CHVs) and counselling services offered free of charge. Preferences comprised (1) delivering of counselling by CHVs, (2) offering individual and group counselling, (3) targeting male and female caregivers. CONCLUSION: There is a disconnect between the caregivers' preferences and the services currently offered. Among these families, a successful BCC strategy that employs nutrition and health counselling should apply a community-based communication channel through trusted CHVs, addressing male and female caregivers, and comprising group and individual sessions.


Asunto(s)
Cuidadores , Consejo , Investigación Cualitativa , Población Rural , Humanos , Kenia , Cuidadores/psicología , Consejo/métodos , Lactante , Femenino , Masculino , Adulto , Entrevistas como Asunto
2.
BMC Pediatr ; 24(1): 326, 2024 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-38734617

RESUMEN

Preterm birth (< 37 weeks gestation) complications are the leading cause of neonatal mortality. Early-warning scores (EWS) are charts where vital signs (e.g., temperature, heart rate, respiratory rate) are recorded, triggering action. To evaluate whether a neonatal EWS improves clinical outcomes in low-middle income countries, a randomised trial is needed. Determining whether the use of a neonatal EWS is feasible and acceptable in newborn units, is a prerequisite to conducting a trial. We implemented a neonatal EWS in three newborn units in Kenya. Staff were asked to record infants' vital signs on the EWS during the study, triggering additional interventions as per existing local guidelines. No other aspects of care were altered. Feasibility criteria were pre-specified. We also interviewed health professionals (n = 28) and parents/family members (n = 42) to hear their opinions of the EWS. Data were collected on 465 preterm and/or low birthweight (< 2.5 kg) infants. In addition to qualitative study participants, 45 health professionals in participating hospitals also completed an online survey to share their views on the EWS. 94% of infants had the EWS completed at least once during their newborn unit admission. EWS completion was highest on the day of admission (93%). Completion rates were similar across shifts. 15% of vital signs triggered escalation to a more senior member of staff. Health professionals reported liking the EWS, though recognised the biggest barrier to implementation was poor staffing. Newborn unit infant to staff ratios varied between 10 and 53 staff per 1 infant, depending upon time of shift and staff type. A randomised trial of neonatal EWS in Kenya is possible and acceptable, though adaptations are required to the form before implementation.


Asunto(s)
Puntuación de Alerta Temprana , Estudios de Factibilidad , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Humanos , Kenia , Recién Nacido , Femenino , Masculino , Signos Vitales , Actitud del Personal de Salud , Recién Nacido de Bajo Peso
3.
PLoS One ; 19(5): e0303215, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38739597

RESUMEN

Despite improvement over recent decades, childhood vaccination uptake remains a concern across countries. The World Health Organization observed that over 25 million children missed out on one or more vaccines in 2021, with urban poor and other marginalized groups being the most affected. Given the higher risk of disease transmission and vaccine-preventable diseases (VPD) outbreaks across densely populated urban slums, identifying effective interventions to improve childhood vaccination in this vulnerable population is crucial. This study explored the behavioral and social factors influencing childhood vaccination uptake in urban informal settlements in Nairobi, Kenya. A grounded theory approach was employed to develop a theoretical account of the socio-behavioral determinants of childhood vaccination. Five focus group discussions (FGDs) were conducted with purposively sampled caregivers of children under five years of age residing in informal settlements. The Theory of Planned Behavior guided the structuring of the FGD questions. An iterative process was used to analyze and identify emerging themes. Thirty-nine caregivers (median age 29 years) participated in the FGDs. From the analysis, four main thematic categories were derived. These included attitude factors such as perceived vaccine benefits, cultural beliefs, and emotional factors including parental love. Additionally, subjective norms, like fear of social judgment, and perceived behavioral control factors, such as self-control and gender-based influences, were identified. Furthermore, a number of practical factors, including the cost of vaccines and healthcare providers attitude, also affected the uptake of vaccination. Various social, behavioral, cultural, and contextual factors influence caregiver vaccination decisions in urban poor settings. Community-derived and context-specific approaches that address the complex interaction between socio-behavioral and other contextual factors need to be tested and applied to improve the timely uptake of childhood vaccinations among marginalized populations.


Asunto(s)
Población Urbana , Vacunación , Humanos , Femenino , Masculino , Vacunación/psicología , Vacunación/estadística & datos numéricos , Adulto , Población Urbana/estadística & datos numéricos , Kenia , Preescolar , Investigación Cualitativa , Cuidadores/psicología , Lactante , Grupos Focales , Conocimientos, Actitudes y Práctica en Salud , Áreas de Pobreza , Pobreza , Padres/psicología
4.
PLoS One ; 19(5): e0302510, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38768112

RESUMEN

BACKGROUND: The increased prevalence of overweight and obesity, along with high diet diversity, is observed among higher socio-economic groups in Sub-Saharan Africa. One contributing factor to these observed variations is food choice motives. However, the role of these motives in explaining the observed differences has not been thoroughly explored in this context. OBJECTIVE: This study investigates whether there are significant differences in food choice motives among socio-economic groups and whether these variations can partly explain the socio-economic disparities in diet diversity and overweight and obesity outcomes. METHODS: This study utilizes cross-sectional data from four counties in Kenya: Kiambu, Murang'a, Uasin Gishu, and Nakuru. The survey employed a three-stage cluster sample design to gather data using structured questionnaires on food choice motives, diet diversity, and anthropometrics from 381 adults in 2022. The mediating effects of 8 food choice motives (health, mood, convenience, sensory appeal, natural content, price, weight control, and familiarity) were analyzed using the Karlson-Holm-Breen method. RESULTS: The results show that individuals with higher household incomes place greater importance on health, mood, sensory, and weight concerns. The probability of an overweight and obesity outcome increases by 19% for a standard deviation change in the asset score, and by 8% for a standard deviation change in the years of schooling. Sensory motives significantly mediated these relationships. Sensory motives explained 29% of the income-BMI association and 30% of the education-BMI relationship. Higher education was also associated with increased diet diversity (ß = 0.36, P < 0.001) mediated by higher health and sensory concerns. CONCLUSIONS: The findings suggest significant differences in food choice motives among socio-economic groups, which contribute to outcomes such as overweight and obesity. Therefore, educational and other policies aimed at reducing obesity should also address food choice motives, while considering the disparities among socio-economic segments within populations.


Asunto(s)
Dieta , Preferencias Alimentarias , Motivación , Obesidad , Factores Socioeconómicos , Humanos , Kenia/epidemiología , Obesidad/epidemiología , Obesidad/psicología , Femenino , Masculino , Preferencias Alimentarias/psicología , Adulto , Estudios Transversales , Persona de Mediana Edad , Adulto Joven , Conducta de Elección , Adolescente , Sobrepeso/epidemiología , Sobrepeso/psicología
5.
J Acquir Immune Defic Syndr ; 96(2): 121-129, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38771751

RESUMEN

BACKGROUND: The design of HIV prevention programs for adolescent girls and young women (AGYW) are informed by data on who is at highest risk and where they can be reached. Places (hotspots) associated with selling sex are an established outreach strategy for sex work (SW) programs but could be used to reach other AGYW at high risk. SETTING: This study took place in Mombasa, Kenya. METHODS: We conducted a cross-sectional, bio-behavioural survey among (N = 1193) sexually active AGYW aged 14-24 years recruited at hotspots. We compared HIV prevalence by subgroup (SW; transactional sex, TS; and non-transactional sex), stratified by hotspot type (venues and nonvenues). We examined whether associations between HIV prevalence and hotspot/subgroup remained after adjustment for individual-level risk factors, and estimated HIV prevalence ratio with and without adjustment for these individual-level factors. RESULTS: Overall HIV prevalence was 5.6%, 5.3% in venues and 7.3% in nonvenues. Overall SW HIV prevalence was 2-fold higher than among participants engaged in nontransactional sex. After adjusting for age and individual-level risk factors, HIV prevalence was 2.72 times higher among venue-based SWs (95% confidence interval: 1.56 to 4.85) and 2.11 times higher among nonvenue AGYW not engaged in SW (95% confidence interval: 0.97 to 4.30) compared with venue-based AGYW not engaged in SW. CONCLUSION: AGYW who sell sex remain at high risk of HIV across types of hotspots. The residual pattern of elevated HIV burden by AGWY subgroup and hotspot type suggests that unmeasured, network-level factors underscore differential risks. As such, hotspots constitute a "place" to reach AGYW at high risk of HIV.


Asunto(s)
Infecciones por VIH , Trabajo Sexual , Humanos , Adolescente , Femenino , Kenia/epidemiología , Infecciones por VIH/epidemiología , Adulto Joven , Estudios Transversales , Prevalencia , Trabajo Sexual/estadística & datos numéricos , Factores de Riesgo , Conducta Sexual , Trabajadores Sexuales/estadística & datos numéricos
6.
BMC Health Serv Res ; 24(1): 618, 2024 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-38730398

RESUMEN

BACKGROUND: In Africa, the delivery of HIV pre-exposure prophylaxis (PrEP) at public healthcare clinics is challenged by understaffing, overcrowding, and HIV-associated stigma, often resulting in low PrEP uptake and continuation among clients. Giving clients the option to refill PrEP at nearby private pharmacies, which are often more convenient and have shorter wait times, may address these challenges and improve PrEP continuation. METHODS: This mixed methods study used an explanatory sequential design. At two public clinics in Kiambu County, Kenya, clients ≥ 18 years initiating PrEP were given the option to refill PrEP at the clinic where they initiated for free or at one of three nearby private pharmacies for 300 Kenyan Shillings (~ $3 US Dollars). The providers at these pharmacies (pharmacists and pharmaceutical technologists) were trained in PrEP service delivery using a prescribing checklist and provider-assisted HIV self-testing, both with remote clinician oversight. Clients were followed up to seven months, with scheduled refill visits at one, four, and seven months. The primary outcomes were selection of pharmacy-based PrEP refills and PrEP continuation. Following pilot completion, 15 in-depth interviews (IDIs) with clients who refilled PrEP were completed. We used descriptive statistics and thematic analysis to assess study outcomes. RESULTS: From November 2020 to November 2021, 125 PrEP clients were screened and 106 enrolled. The majority (59%, 63/106) of clients were women and the median age was 31 years (IQR 26-38 years). Over 292 client-months of follow-up, 41 clients (39%) refilled PrEP; only three (3%) at a participating pharmacy. All clients who completed IDIs refilled PrEP at clinics. The reasons why clients did not refill PrEP at pharmacies included: a preference for clinic-delivered PrEP services (i.e., pre-existing relationships, access to other services), concerns about pharmacy-delivered PrEP services (i.e., mistrust, lower quality care, costs), and lack of knowledge of this refill location. CONCLUSIONS: These findings suggest that clients who initiate PrEP at public clinics in Kenya may have already overcome barriers to clinic-delivered PrEP services and prefer PrEP access there. To reach new populations that could benefit from PrEP, a stand-alone model of pharmacy-delivered PrEP services may be needed. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04558554 [registered: June 5, 2020].


Asunto(s)
Infecciones por VIH , Farmacias , Profilaxis Pre-Exposición , Humanos , Kenia , Infecciones por VIH/prevención & control , Masculino , Femenino , Profilaxis Pre-Exposición/métodos , Adulto , Farmacias/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico , Adulto Joven
7.
BMJ Open ; 14(5): e082011, 2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38697765

RESUMEN

BACKGROUND: Kenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)), sought to address this challenge. This study examines the quality of care (QoC) across the continuum of maternal care under the LMP in Kenya. METHODS: We conducted a convergent parallel mixed-methods study across multiple levels of the Kenyan health system, involving key informant interviews with national stakeholders (n=15), in-depth interviews with county officials and healthcare workers (HCWs) (n=21), exit interview survey with mothers (n=553) who utilised the LMP delivery services, and focus group discussions (n=9) with mothers who returned for postnatal visits (at 6, 10 and 14 weeks). Quantitative data were analysed descriptively, while qualitative data were analysed thematically. All the data were triangulated at the analysis and discussion stage using a framework approach guided by the QoC for maternal and newborns. RESULTS: The results showed that the expanded FMP enhanced maternal care access: geographical, financial and service utilisation. However, the facilities and HCWs bore the brunt of the increased workload and burnout. There was a longer waiting time for the initial visit by the pregnant women because of the enhanced antenatal care package of the LMP. The availability and standards of equipment, supplies and infrastructure still posed challenges. Nurses were multitasking and motivated despite the human resources challenge. Mothers were happy to have received care information; however, there were challenges regarding respect and dignity they received (inadequate food, over-crowding, bed-sharing and lack of privacy), and they experienced physical, verbal and emotional abuse and a lack of attention/care. CONCLUSIONS: Addressing the negative aspects of QoC while strengthening the positives is necessary to achieve the Universal Health Coverage goals through better quality service for every woman.


Asunto(s)
Servicios de Salud Materna , Atención Posnatal , Calidad de la Atención de Salud , Humanos , Kenia , Femenino , Embarazo , Adulto , Servicios de Salud Materna/normas , Atención Posnatal/normas , Continuidad de la Atención al Paciente , Recién Nacido , Atención Prenatal/normas , Política de Salud , Investigación Cualitativa , Atención Perinatal/normas , Grupos Focales , Adulto Joven
8.
Pan Afr Med J ; 47: 101, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38766565

RESUMEN

Introduction: motorcycles continue to be a popular mode of transport in Kenya. However, the related injuries cause significant morbidity and mortality and remain to be a major and neglected public health issue. This raised the crucial need for hospital preparedness in managing morbidities and in reducing mortalities. This formed the basis of this paper which aims to document the challenges and opportunities in the healthcare system in handling motorcycle accidents in a Kenyan border town in Busia County. Methods: we drew data from an exploratory qualitative study that was carried out in 2021. All six referral hospitals purposively included in the study. The study targeted a total of 25 top level facility managers as key informants on the facility level opportunities and challenges in handling motorcycle accidents. Descriptive data were analyzed using SPSS version 20. Results: the hospitals were not well prepared to handle motorcycle accidents. The major challenges were understaffing in critical care services; inadequate/lack of equipment to handle motorcycle injuries; inadequate/lack of infrastructure i.e. surgical wards, emergency rooms, inadequate space, functional theatre; lack/inadequate supplies; overstretched referral services arising from the hinge burden of motorcycle accidents in the area; inadequate specialized personnel to provide trauma/care services; mishandling of cases at the site of accident; inability of victims to pay related bills; inappropriate identification of victims at the facility; lack/inadequate on-job training. Some opportunities that currently exist include health system interventions which are not limited to employment of more professionals, improvement of infrastructure, provision of equipment and increase of budgetary allocation. Conclusion: the study reveals vast challenges that are faced by hospitals in managing patients. This calls for the government to step in and capitalize on the proposed opportunities by the health managers to be able to manage morbidities and bring down mortalities due to motorcycle accidents.


Asunto(s)
Accidentes de Tránsito , Motocicletas , Heridas y Lesiones , Humanos , Kenia/epidemiología , Heridas y Lesiones/terapia , Heridas y Lesiones/epidemiología , Hospitales , Atención a la Salud/organización & administración , Atención a la Salud/normas , Investigación Cualitativa
9.
Trials ; 25(1): 331, 2024 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-38773658

RESUMEN

BACKGROUND: Self-monitoring of glucose is an essential component of type 1 diabetes (T1D) management. In recent years, continuous glucose monitoring (CGM) has provided an alternative to daily fingerstick testing for the optimisation of insulin dosing and general glucose management in people with T1D. While studies have been conducted to evaluate the impact of CGM on clinical outcomes in the US, Europe and Australia, there are limited data available for low- and middle-income countries (LMICs) and further empirical evidence is needed to inform policy decision around their use in these countries. METHODS: This trial was designed as a pragmatic, parallel-group, open-label, multicentre, three-arm, randomised (1:1:1) controlled trial of continuous or periodic CGM device use versus standard of care in people with T1D in South Africa and Kenya. The primary objective of this trial will be to assess the impact of continuous or periodic CGM device use on glycaemic control as measured by change from baseline glycosylated haemoglobin (HbA1c). Additional assessments will include clinical outcomes (glucose variation, time in/below/above range), safety (adverse events, hospitalisations), quality of life (EQ-5D, T1D distress score, Glucose Monitoring Satisfaction Survey for T1D), and health economic measures (incremental cost-effectiveness ratios, quality adjusted life years). DISCUSSION: This trial aims to address the substantial evidence gap on the impact of CGM device use on clinical outcomes in LMICs, specifically South Africa and Kenya. The trial results will provide evidence to inform policy and treatment decisions in these countries. TRIAL REGISTRATION: NCT05944731 (Kenya), July 6, 2023; NCT05944718 (South Africa), July 13, 2023.


Asunto(s)
Automonitorización de la Glucosa Sanguínea , Glucemia , Diabetes Mellitus Tipo 1 , Hemoglobina Glucada , Estudios Multicéntricos como Asunto , Ensayos Clínicos Pragmáticos como Asunto , Humanos , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/diagnóstico , Automonitorización de la Glucosa Sanguínea/instrumentación , Kenia , Glucemia/metabolismo , Glucemia/análisis , Glucemia/efectos de los fármacos , Hemoglobina Glucada/metabolismo , Hemoglobina Glucada/análisis , Sudáfrica , Calidad de Vida , Control Glucémico/instrumentación , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Ciencia de la Implementación , Insulina/administración & dosificación , Insulina/uso terapéutico , Resultado del Tratamiento , Análisis Costo-Beneficio , Monitoreo Continuo de Glucosa
10.
Glob Health Action ; 17(1): 2345970, 2024 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-38774927

RESUMEN

BACKGROUND: The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services. OBJECTIVES: We investigated the pandemic's impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania. METHODS: A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February-April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access. RESULTS: We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (p < 0.001) in Kenya and 5.6% (p = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05-2.34]; p = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22-0.58]; p < 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33-0.79]; p = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14-2.88]; p = 0.011). CONCLUSIONS: COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes.


Main findings: The COVID-19 pandemic disrupted diabetes care in Kenya and Tanzania resulting in changes in place and frequency of blood glucose testing, medication prescribed (less oral hypoglycaemics and more insulin), fewer health facility visits and more difficulty accessing healthcare providers.Added knowledge: This study quantifies the impact of the COVID-19 pandemic on diabetes care in Kenya and Tanzania, and describes the factors associated with care disruption in both countries.Global health impact for policy and action: Evidence on diabetes care disruption is useful in making plans and policies responsive to the needs of diabetes patients during pandemics or related emergency situations.


Asunto(s)
COVID-19 , Diabetes Mellitus Tipo 2 , Accesibilidad a los Servicios de Salud , Humanos , Kenia/epidemiología , Tanzanía/epidemiología , COVID-19/epidemiología , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/epidemiología , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Adulto , Anciano , SARS-CoV-2 , Atención a la Salud/organización & administración , Pandemias
11.
BMC Pregnancy Childbirth ; 24(1): 359, 2024 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-38745117

RESUMEN

BACKGROUND: Respectful Maternal and Neonatal Care (RMNC) maintains and respects a pregnant person's dignity, privacy, informed choice, and confidentiality free from harm and mistreatment. It strives for a positive pregnancy and post-pregnancy care experiences for pregnant people and their families, avoiding any form of obstetric violence. Though RMNC is now widely accepted as a priority in obstetric care, there is a gap in resources and support tools for healthcare wproviders to clearly understand the issue and change long-established practices such as non-humanized caesarean sections. MSI Reproductive Choices (MSI) manages 31 maternities across 7 countries with a zero-tolerance approach towards disrespectful maternity care and obstetric violence. MSI developed and implemented a hybrid training package, which includes an online module and 1-day in-person workshop that allows healthcare providers to explore their beliefs and attitudes towards RMNC. It leverages methodologies used in Values-Clarification-Attitudes-Transformation (VCAT) workshops and behaviour change approaches. METHODS: The impact of this training intervention was measured from the healthcare providers' and patients' perspectives. Patient experience of (dis)respectful care was collected from a cross-sectional survey of antenatal and postnatal patients attending MSI maternities in Kenya and Tanzania before and following the RMNC training intervention. Healthcare providers completed pre- and post-workshop surveys at day 1, 90 and 180 to measure any changes in their knowledge, attitudes and perception of intended behaviours regarding RMNC. RESULTS: The results demonstrate that healthcare provider knowledge, attitudes and perceived RMNC practices can be improved with this training interventions. Patients also reported a more positive experience of their maternity care following the training. CONCLUSION: RMNC is a patient-centred care priority in all MSI maternities. The training bridges the gap in resources currently available to support changes in healthcare wproviders' attitudes and behaviours towards provision of RMNC. Ensuring health system infrastructure supports compassionate obstetric care represents only the first step towards ensuring RMNC. The results from the evaluation of this RMNC provider training intervention demonstrates how healthcare provider knowledge and attitudes may represent a bottleneck to ensuring RMNC that can be overcome using VCAT and behaviour change approaches.


Asunto(s)
Actitud del Personal de Salud , Personal de Salud , Respeto , Humanos , Kenia , Tanzanía , Femenino , Embarazo , Adulto , Estudios Transversales , Personal de Salud/educación , Personal de Salud/psicología , Servicios de Salud Materna/normas , Recién Nacido , Relaciones Profesional-Paciente , Adulto Joven
12.
BMC Med Educ ; 24(1): 534, 2024 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-38745243

RESUMEN

BACKGROUND: Midwifery education is under-invested in developing countries with limited opportunities for midwifery educators to improve/maintain their core professional competencies. To improve the quality of midwifery education and capacity for educators to update their competencies, a blended midwifery educator-specific continuous professional development (CPD) programme was designed with key stakeholders. This study evaluated the feasibility of this programme in Kenya and Nigeria. METHODS: This was a mixed methods intervention study using a concurrent nested design. 120 randomly selected midwifery educators from 81 pre-service training institutions were recruited. Educators completed four self-directed online learning (SDL) modules and three-day practical training of the blended CPD programme on teaching methods (theory and clinical skills), assessments, effective feedback and digital innovations in teaching and learning. Pre- and post-training knowledge using multiple choice questions in SDL; confidence (on a 0-4 Likert scale) and practical skills in preparing a teaching a plan and microteaching (against a checklist) were measured. Differences in knowledge, confidence and skills were analysed. Participants' reaction to the programme (relevance and satisfaction assessed on a 0-4 Likert scale, what they liked and challenges) were collected. Key informant interviews with nursing and midwifery councils and institutions' managers were conducted. Thematic framework analysis was conducted for qualitative data. RESULTS: 116 (96.7%) and 108 (90%) educators completed the SDL and practical components respectively. Mean knowledge scores in SDL modules improved from 52.4% (± 10.4) to 80.4% (± 8.1), preparing teaching plan median scores improved from 63.6% (IQR 45.5) to 81.8% (IQR 27.3), and confidence in applying selected pedagogy skills improved from 2.7 to 3.7, p < 0.001. Participants rated the SDL and practical components of the programme high for relevance and satisfaction (median, 4 out of 4 for both). After training, 51.4% and 57.9% of the participants scored 75% or higher in preparing teaching plans and microteaching assessments. Country, training institution type or educator characteristics had no significant associations with overall competence in preparing teaching plans and microteaching (p > 0.05). Qualitatively, educators found the programme educative, flexible, convenient, motivating, and interactive for learning. Internet connectivity, computer technology, costs and time constraints were potential challenges to completing the programme. CONCLUSION: The programme was feasible and effective in improving the knowledge and skills of educators for effective teaching/learning. For successful roll-out, policy framework for mandatory midwifery educator specific CPD programme is needed.


Asunto(s)
Estudios de Factibilidad , Partería , Humanos , Partería/educación , Kenia , Nigeria , Femenino , Adulto , Evaluación de Programas y Proyectos de Salud , Competencia Clínica , Masculino
13.
Sci Rep ; 14(1): 11037, 2024 05 14.
Artículo en Inglés | MEDLINE | ID: mdl-38745063

RESUMEN

This study aimed to determine the degree of family relations and associated socio-demographics characteristics, clinical/physical and mental disorders in type 2 diabetes mellitus in a Kenyan diabetes clinic. This study was part of a large multicentre study whose protocol and results had been published. It took place at the outpatient diabetes clinic at a County Teaching and Referral Hospital in South East Kenya involving 182 participants. We used a socio-demographic questionnaire, the Hamilton Depression (HAM-D) and PHQ-9 rating scales for depression, the MINI International Neuropsychiatric Interview (MINI; V5 or V6) for DSM-5 diagnoses, the WHO-5 Well-being scale and Problem Areas in Diabetes Scale (PAID). We extracted from the notes all physical conditions. We enquired about similar conditions in 1st and 2nd degree relatives. Descriptive, Chi-square test, Fisher's exact test, one way ANOVA, and Multinomial logistic regression analysis were conducted to test achievements of our specific aims. Of the 182 patients who participated in the study, 45.1% (82/182) reported a family history of diabetes. Conditions significantly (p < 0.05) associated with a degree of family history of diabetes were retinopathy, duration of diabetes (years), hypertension, and depressive disorder. On average 11.5% (21/182) scored severe depression (≥ 10) on PHQ-9 and 85.2% (115/182) scored good well-being (≥ 13 points). All DSM-5 psychiatric conditions were found in the 182 patients in varying prevalence regardless of relations. In addition, amongst the 182 patients, the highest prevalence was poor well-being on the WHO quality of life tool. This was followed by post-traumatic disorders (current), suicidality, and psychotic lifetime on DSM-5. The least prevalent on DSM-5 was eating disorders. Some type 2 diabetes mellitus physical disorders and depression have increased incidence in closely related patients. Overall, for all the patients, the prevalence of all DSM-5 diagnoses varied from 0.5 to 9.9%.


Asunto(s)
Biomarcadores , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/epidemiología , Kenia/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Trastornos Mentales/epidemiología , Trastornos Mentales/diagnóstico , Depresión/epidemiología
14.
PLoS One ; 19(5): e0301833, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38748656

RESUMEN

Violence against children in schools harms the affected children, limits their learning and educational attainment, and extends its harms to families and the broader communities. However, to date, comparable cross-country data on violence against children in schools has not been available. We utilize the Violence Against Children and Youth Surveys (VACS) to estimate school-related violence against children in seven countries (Honduras, Kenya, Malawi, Nigeria, Tanzania, Uganda, and Zambia). Leveraging the unique comparability of the surveys, we are able to estimate both physical and sexual violence experienced in childhood and adolescence among youth aged 13-24. Where possible, we also disaggregate by gender and perpetrator type. Overall, within our sample seven countries, we find that 12.11-44.63% of females and 14.28-53.85% of males experienced at least one form of violence. Males experience higher levels of school-related violence and a significant portion of this is due to experiencing physical violence perpetrated by male classmates.


Asunto(s)
Instituciones Académicas , Humanos , Masculino , Femenino , Instituciones Académicas/estadística & datos numéricos , Adolescente , Estudios Transversales , Prevalencia , Adulto Joven , Violencia/estadística & datos numéricos , Kenia/epidemiología , Uganda/epidemiología , Nigeria/epidemiología , Tanzanía/epidemiología , Encuestas y Cuestionarios , Malaui/epidemiología , Zambia/epidemiología , Niño , Maltrato a los Niños/estadística & datos numéricos
15.
PLoS One ; 19(5): e0302744, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38748751

RESUMEN

BACKGROUND: Mental disorders account for nine percent of the overall global burden of disease and are among the top ten leading causes of disability. Mental illness and tuberculosis share risk factors including poverty, overcrowding, stigma, poor nutrition, substance use and retro-viral disease co-infection. Presence of mental illness in tuberculosis delays health-seeking, affects drug adherence, increases cost of treatment, prolongs disease duration, lowers quality of life, and increases mortality. Early diagnosis, linkage, and treatment of psychiatric morbidity among patients with tuberculosis would improve outcomes for both. This study thus aimed to determine the prevalence and factors associated with psychiatric morbidity among patients on treatment for tuberculosis at a low- middle- income country. METHODS: A cross-sectional study carried out at the tuberculosis clinic at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. 367 participants on TB treatment were interviewed using Mini-International Neuropsychiatric Interview (MINI) tool. The key outcome was presence of psychiatric illness. Pearson's Chi-square and logistic regression were used to assess relationships at bivariate and multivariate level respectively. RESULTS: Majority of the respondents were male (61.3%) and overall median age was 33 years. About half of participants (48.5%) had at least one psychiatric illness. Common disorders were alcohol use disorder (30.3%), depression (23.4%), substance use disorder (12.8%) and suicidality (8.2%). Odds of 'any psychiatric illness' were increased by being male (aOR = 1.92; P = 0.04), being separated or divorced (aOR = 6.86; P = 0.002), using alcohol (aOR = 3.2; P<0.001), having been previously treated for tuberculosis (aOR = 2.76; P = 0.01), having other medical comorbidities (aOR = 4.2; P = 0.004) and family history of mental illness (aOR = 2.4; P = 0.049). CONCLUSION: Almost half of the patients on treatment for tuberculosis had at least one psychiatric illness. Introduction of protocols for screening for mental illness and integration of mental health services with tuberculosis care would aid prompt diagnosis, referral, and quality of care.


Asunto(s)
Trastornos Mentales , Centros de Atención Terciaria , Tuberculosis , Humanos , Masculino , Kenia/epidemiología , Femenino , Adulto , Tuberculosis/epidemiología , Tuberculosis/tratamiento farmacológico , Trastornos Mentales/epidemiología , Estudios Transversales , Persona de Mediana Edad , Adulto Joven , Prevalencia , Adolescente , Factores de Riesgo
16.
BMJ Glob Health ; 9(5)2024 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-38749511

RESUMEN

INTRODUCTION: There are no published data on the long-term impact of invasive group B Streptococcus disease (iGBS) on economic costs or health-related quality of life (HRQoL) in low-income and middle-income countries. We assessed the impact of iGBS on healthcare utilisation, costs and HRQoL in Argentina, India, Kenya, Mozambique and South Africa. METHODS: Inpatient and outpatient visits, out-of-pocket (OOP) healthcare payments in the 12 months before study enrolment, and health-state utility of children and caregivers (using the EuroQol 5-Dimensions-3-Level) were collected from iGBS survivors and an unexposed cohort matched on site, age at recruitment and sex. We used logistic or Poisson regression for analysing healthcare utilisation and zero-inflated gamma regression models for family and health system costs. For HRQoL, we used a zero-inflated beta model of disutility pooled data. RESULTS: 161 iGBS-exposed and 439 unexposed children and young adults (age 1-20) were included in the analysis. Compared with unexposed participants, iGBS was associated with increased odds of any healthcare utilisation in India (adjusted OR 11.2, 95% CI 2.9 to 43.1) and Mozambique (6.8, 95% CI 2.2 to 21.1) and more frequent healthcare visits (adjusted incidence rate ratio (IRR) for India 1.7 (95% CI 1.4 to 2.2) and for Mozambique 6.0 (95% CI 3.2 to 11.2)). iGBS was also associated with more frequent days in inpatient care in India (adjusted IRR 4.0 (95% CI 2.3 to 6.8) and Kenya 6.4 (95% CI 2.9 to 14.3)). OOP payments were higher in the iGBS cohort in India (adjusted mean: Int$682.22 (95% CI Int$364.28 to Int$1000.16) vs Int$133.95 (95% CI Int$72.83 to Int$195.06)) and Argentina (Int$244.86 (95% CI Int$47.38 to Int$442.33) vs Int$52.38 (95% CI Int$-1.39 to Int$106.1)). For all remaining sites, differences were in the same direction but not statistically significant for almost all outcomes. Health-state disutility was higher in iGBS survivors (0.08, 0.04-0.13 vs 0.06, 0.02-0.10). CONCLUSION: The iGBS health and economic burden may persist for years after acute disease. Larger studies are needed for more robust estimates to inform the cost-effectiveness of iGBS prevention.


Asunto(s)
Países en Desarrollo , Calidad de Vida , Infecciones Estreptocócicas , Humanos , Masculino , Femenino , Niño , Mozambique , Infecciones Estreptocócicas/economía , Preescolar , Lactante , Adolescente , Kenia , Adulto Joven , India , Estudios de Cohortes , Streptococcus agalactiae , Aceptación de la Atención de Salud/estadística & datos numéricos , Sudáfrica , Argentina , Costos de la Atención en Salud/estadística & datos numéricos
17.
Indian J Med Ethics ; IX(2): 109-114, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38755766

RESUMEN

BACKGROUND: The Covid-19 pandemic led to an unprecedented impact on many sectors globally including research. We assessed the impact of the Covid-19 pandemic on the research portfolio, and on the approval turnaround time for research protocols submitted to the Scientific and Ethics Review Unit (SERU), at the Kenya Medical Research Institute (KEMRI). METHODS: We compared research protocols submitted between October 01, 2019 and March 31, 2020 (Period 1), to those submitted between April 1 and September 30, 2020 (Period 2). A document review tool was used to extract data from the 198 research protocols reviewed and approved over the two periods. RESULTS: In the two periods under review, the single largest percentage of protocols (89/198, 45.4%) involved infectious and parasitic diseases, and the single largest percentage of study designs was cross-sectional (75/198, 38%). Before the pandemic, the median time taken to review KEMRI-linked protocols was 87 days and for non-KEMRI linked protocols it was 121 days. During the pandemic, approval turnaround time dropped for both KEMRI and non-KEMRI protocols to 66 days and 92 days, respectively, due to the streamlined processes at the KEMRI SERU. CONCLUSION: The research portfolio was minimally affected by the pandemic. The adoption of email submission, and faster-than-usual processing and review protocols during the pandemic reduced the approval turnaround time.


Asunto(s)
Academias e Institutos , COVID-19 , Investigación , Investigación/estadística & datos numéricos , Protocolos Clínicos , Tiempo , Kenia , Academias e Institutos/estadística & datos numéricos
18.
Psychooncology ; 33(5): e6345, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38708858

RESUMEN

OBJECTIVES: Childhood cancer survivors' social reintegration may be hampered in low and middle-income countries. The nature and extent of social challenges and prejudices that survivors encounter in such settings are largely unknown. This study explores caregivers' perspectives on social reintegration and stigmatization of Kenyan childhood cancer survivors. METHODS: Caretakers of childhood cancer survivors (<18 years) were interviewed using mixed-methods questionnaires during home or clinic visits between 2021 and 2022. Stigma was assessed with an adjusted Social Impact Scale and risk factors were investigated. RESULTS: Caretakers of 54 survivors (median age 11 years) were interviewed. Families' income (93%) decreased since start of treatment. Caretakers (44%) often lost their jobs. Financial struggles (88%) were a burden that provoked conflicts within communities (31%). School fees for siblings became unaffordable (52%). Families received negative responses (26%) and were left or avoided (13%) by community members after cancer disclosure. Survivors and families were discriminated against because the child was perceived fragile, and cancer was considered fatal, contagious, or witchcraft. Survivors repeated school levels (58%) and were excluded from school activities (19%) or bullied (13%). Performance limitations of daily activities (p = 0.019), male sex (p = 0.032), solid tumors (p = 0.056) and a short time since treatment completion (p = 0.047) were associated with increased stigma. Caretakers recommended educational programs in schools and communities to raise awareness about cancer treatment and curability. CONCLUSIONS: Childhood cancer survivors and their families experienced difficulties with re-entry and stigmatization in society. Increasing cancer and survivorship awareness in schools and communities should facilitate social reintegration and prevent stigmatization.


Asunto(s)
Supervivientes de Cáncer , Cuidadores , Estigma Social , Humanos , Supervivientes de Cáncer/psicología , Supervivientes de Cáncer/estadística & datos numéricos , Kenia , Masculino , Femenino , Niño , Cuidadores/psicología , Adolescente , Encuestas y Cuestionarios , Adulto , Neoplasias/psicología , Preescolar , Persona de Mediana Edad
19.
Front Cell Infect Microbiol ; 14: 1382228, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38698904

RESUMEN

Background: Tick-borne pathogen (TBP) surveillance studies often use whole-tick homogenates when inferring tick-pathogen associations. However, localized TBP infections within tick tissues (saliva, hemolymph, salivary glands, and midgut) can inform pathogen transmission mechanisms and are key to disentangling pathogen detection from vector competence. Methods: We screened 278 camel blood samples and 504 tick tissue samples derived from 126 camel ticks sampled in two Kenyan counties (Laikipia and Marsabit) for Anaplasma, Ehrlichia, Coxiella, Rickettsia, Theileria, and Babesia by PCR-HRM analysis. Results: Candidatus Anaplasma camelii infections were common in camels (91%), but absent in all samples from Rhipicephalus pulchellus, Amblyomma gemma, Hyalomma dromedarii, and Hyalomma rufipes ticks. We detected Ehrlichia ruminantium in all tissues of the four tick species, but Rickettsia aeschlimannii was only found in Hy. rufipes (all tissues). Rickettsia africae was highest in Am. gemma (62.5%), mainly in the hemolymph (45%) and less frequently in the midgut (27.5%) and lowest in Rh. pulchellus (29.4%), where midgut and hemolymph detection rates were 17.6% and 11.8%, respectively. Similarly, in Hy. dromedarii, R. africae was mainly detected in the midgut (41.7%) but was absent in the hemolymph. Rickettsia africae was not detected in Hy. rufipes. No Coxiella, Theileria, or Babesia spp. were detected in this study. Conclusions: The tissue-specific localization of R. africae, found mainly in the hemolymph of Am. gemma, is congruent with the role of this tick species as its transmission vector. Thus, occurrence of TBPs in the hemolymph could serve as a predictor of vector competence of TBP transmission, especially in comparison to detection rates in the midgut, from which they must cross tissue barriers to effectively replicate and disseminate across tick tissues. Further studies should focus on exploring the distribution of TBPs within tick tissues to enhance knowledge of TBP epidemiology and to distinguish competent vectors from dead-end hosts.


Asunto(s)
Babesia , Camelus , Ehrlichia , Theileria , Garrapatas , Animales , Kenia/epidemiología , Camelus/parasitología , Camelus/microbiología , Theileria/aislamiento & purificación , Theileria/genética , Babesia/aislamiento & purificación , Babesia/genética , Ehrlichia/aislamiento & purificación , Ehrlichia/genética , Garrapatas/microbiología , Garrapatas/parasitología , Enfermedades por Picaduras de Garrapatas/microbiología , Enfermedades por Picaduras de Garrapatas/epidemiología , Enfermedades por Picaduras de Garrapatas/parasitología , Anaplasma/aislamiento & purificación , Anaplasma/genética , Rickettsia/aislamiento & purificación , Rickettsia/genética , Coxiella/aislamiento & purificación , Coxiella/genética , Hemolinfa/microbiología , Hemolinfa/parasitología , Glándulas Salivales/microbiología , Glándulas Salivales/parasitología
20.
Sci Rep ; 14(1): 9993, 2024 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-38693201

RESUMEN

Termites are widely distributed globally and serve as a valuable food source in many countries. However, information on the myriad nutritional benefits of processed termite products in African markets remain largely unexploited. This study evaluated the phytochemicals, fatty acids, amino acids, minerals, vitamins and proximate composition of the edible winged termites (Macrotermes spp.) from three major Counties of Kenya. A total of 9 flavonoids, 5 alkaloids, and 1 cytokinin were identified. The oil content varied from 33 to 46%, exhibiting significant levels of beneficial omega 3 fatty acids, such as methyl (9Z,12Z,15Z)-octadecatrienoate and methyl (5Z,8Z,11Z,14Z,17Z)-eicosapentaenoate, ranging from 82.7-95.1 to 6.3-8.1 µg/g, respectively, across the different regions. Four essential and cereal-limiting amino acids lysine (1.0-1.3 mg/g), methionine (0.08-0.1 mg/g), leucine (0.6-0.9 mg/g) and threonine (0.1-0.2 mg/g), were predominant. Moreover, termites had a rich profile of essential minerals, including iron (70.7-111.8 mg/100 g), zinc (4.4-16.2 mg/100 g) and calcium (33.1-53.0 mg/100 g), as well as vitamins A (2.4-6.4 mg/kg), C (0.6-1.9 mg/kg) and B12 (10.7-17.1 mg/kg). The crude protein (32.2-44.8%) and fat (41.2-49.1%) contents of termites from the various Counties was notably high. These findings demonstrated the promising nutrients potential of winged termites and advocate for their sustainable utilization in contemporary efficacious functional food applications to combat malnutrition.


Asunto(s)
Aminoácidos , Isópteros , Valor Nutritivo , Animales , Aminoácidos/análisis , Minerales/análisis , Vitaminas/análisis , Ácidos Grasos/análisis , Fitoquímicos/análisis , Kenia , África , Humanos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA