Kenya has registered over 300,000 cases of COVID-19 and is a high-burden tuberculosis country. Tuberculosis diagnosis was significantly disrupted by the pandemic. Access to timely diagnosis, which is key to effective management of tuberculosis and COVID-19, can be expanded and made more efficient through integrated screening. Decentralized testing at community level further increases access, especially for underserved populations, and requires robust systems for data and process management. This study delivered integrated COVID-19 and tuberculosis testing to commercial motorbike (Bodaboda) riders, a population at increased risk of both diseases with limited access to services, in four counties: Nairobi, Kiambu, Machakos and Kajiado. Testing sheds were established where riders congregate, with demand creation carried out by the Bodaboda association. Integrated symptom screening for tuberculosis and COVID-19 was conducted through a digital questionnaire which automatically flagged participants who should be tested for either, or both, diseases. Rapid antigen-detecting tests (Ag-RDTs) for COVID-19 were conducted onsite, while sputum samples were collected and transported to laboratories for tuberculosis diagnosis. End-to-end patient data were captured using digital tools. 5663 participants enrolled in the study, 4946 of whom were tested for COVID-19. Ag-RDT positivity rate was 1% but fluctuated widely across counties in line with broader regional trends. Among a subset tested by PCR, positivity was greater in individuals flagged as high risk by the digital tool (8% compared with 4% overall). Of 355 participants tested for tuberculosis, 7 were positive, with the resulting prevalence rate higher than the national average. Over 40% of riders had elevated blood pressure or abnormal sugar levels. The digital tool successfully captured complete end-to-end data for 95% of all participants. This study revealed high rates of undetected disease among Bodaboda riders and demonstrated that integrated diagnosis can be delivered effectively in communities, with the support of digital tools, to maximize access.
COVID-19 , Off-Road Motor Vehicles , Humans , Kenya/epidemiology , Cross-Sectional Studies , COVID-19/diagnosis , COVID-19/epidemiology , Motorcycles
Background: Stroke care requires a patient-centred, evidence-based and culturally appropriate approach for better patient clinical outcomes. Quality of life necessitates precise measuring using health-related quality measures that are self-reported and language appropriate. However, most of the self-reported measures were devised in Europe and therefore not considered contextually appropriate in other settings, more so in Africa. Objectives: Our study aimed to produce a Swahili version by translating and adapting the stroke-specific quality of life (SSQOL) scale among people with stroke in Kenya. Method: We used a questionnaire translation and cross-cultural adaptation. The pre-validation sample of 36 adult participants was drawn from 40 registered people with stroke, from the Stroke Association of Kenya (SAoK). Quantitative data were collected using both English and Swahili versions of the SSQOL scale. The mean, standard deviation (s.d.) and overall scores were calculated and are presented in tables. Results: The back translation revealed a few inconsistencies. Minor semantic and equivalence alterations were done in the vision, mood, self-care, upper extremity function and mobility domains by the expert review committee. Respondents indicated that all questions were well-understood and captured. The stroke onset mean age was 53.69 years and the standard deviation was 14.05. Conclusion: The translated version of the Swahili SSQOL questionnaire is comprehensible and well-adapted to the Swahili-speaking population. Clinical implication: The SSQOL has the potential to be a useful outcome measure for use in Swahili-speaking patients with stroke.
Introduction: male partner involvement in antenatal care (ANC) contributes to improved maternal health outcomes, but has been wanting in sub-Saharan Africa. We investigated the prevalence and factors associated with male involvement in ANC. Methods: this was a cross-sectional survey conducted in November and December 2019 in Kitui East sub-county, Kenya. We recruited men above 18 years whose spouses had given birth 12-months prior to the study. Data were collected at the household level using an interviewer-administered questionnaire. Male involvement was defined as provision of physical, psycho-social, decision-making, and financial support, which was measured through twelve questions. Factor scores of the twelve questions were generated by fitting a Rasch model. Participants who scored at least 75% were involved. Bivariate and multivariate logistic regression models were fitted to identify the independent predictors of male involvement. Results: a total of 300 participants were interviewed. The mean age was 36.7 years (SD=±7.6), 52.3% had primary level education, 64.3% had between 1-3 children, 44.6% were 5 years older than their spouses, while 37.3% earned between $50-$100 per month. The prevalence of male involvement in ANC was 61% (95%C.I: 55.7%, 66.3%) and was positively associated with previous ANC attendance by the spouse (AOR= 4.96, 95% CI: 2.37, 10.38, p<0.001), having 1-2 and 3-4 children (AOR= 4.57, 95% CI: 1.70, 12.31, p=0.003 and AOR= 4.84, 95% CI: 1.59, 14.79, p=0.006) respectively. On the contrary, participants who lacked knowledge on the minimum ANC visits (AOR= 0.37, 95% CI: 0.17, 0.83, p=0.016), unplanned pregnancy (AOR=0.22, 95% CI: 0.10, 0.48, p<0.001), and individual financial decision-making (AOR= 0.42, 95% CI: 0.21, 0.89, p=0.023) were less likely to be involved. Conclusion: more than half of the participants reported involvement in ANC, which was significantly associated with previous ANC experience and having less than four children. Empowering men with knowledge on ANC and joint decision-making with their spouses is imperative in order to improve male involvement.
Prenatal Care , Spouses , Adult , Child , Cross-Sectional Studies , Female , Humans , Kenya/epidemiology , Male , Pregnancy , Prevalence
BACKGROUND: Chronic pain is a common clinical symptom and has a high socio-economic and health burden on patients, clinicians and the healthcare sector. Globally, clinicians continue to exhibit limited knowledge, negative attitudes and misconceptions about chronic pain, raising public health concerns. OBJECTIVE: Our study aimed to determine the level of knowledge, attitudes and practices of clinicians towards assessment and management of patients with chronic pain in a tertiary hospital. METHODS: This cross-sectional study at a tertiary care hospital in Kenya adopted a census method to recruit participants (n = 240). A questionnaire containing 77 items derived from the Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ) and the Knowledge and Attitudes Survey regarding Pain (KASRP) was used to collect data. The questionnaire had three parts. Part A had six items to determine information on demographic characteristics. Part B and C had 54 and 23 items, respectively, that determined information on knowledge, attitudes and practice of clinicians managing chronic pain. Data were analysed using SPSS Version 24. RESULTS: Response rate was 83.3% (n = 153). Only 9% (n = 14) of the respondents were believed to have adequate knowledge and positive attitudes; 62% (n = 95) used best practice for cognitive/behavioural management of chronic pain. Few (9% n = 14) used best practice in the assessment and measurement of chronic pain. CONCLUSION: There is inadequate knowledge, attitudes and practices amongst clinicians regarding assessment and management of chronic pain. Future research is needed in a wider population to compare these results. CLINICAL IMPLICATION: It may motivate clinicians to improve their level of knowledge, attitudes and practices for pain management, hence improving poor chronic pain outcome.
BACKGROUND: Healthcare practitioners are required to integrate clinical experience with the best research evidence for the benefit of the patient. OBJECTIVE: Determine the attitudes, perceptions and barriers regarding evidence-based practice (EBP) in sports physiotherapy in Kenya. METHOD: A quantitative crosssectional study was conducted among licensed physiotherapists in the Republic of Kenya through a self-administered questionnaire. Associations between selected sociodemographic characteristics (gender, age, training, experience, specialisation) and attitudes, perceptions and barriers were determined using a Chi-square test. RESULTS: A 55.9% (n = 391) response rate was recorded. A positive attitude towards EBP was reported by 94.6% (n = 370) of the respondents. The most obvious areas of agreement with attitude-and perception-related statements were that 'EBP is important in that patients can receive the best possible treatment' (95.9%; n = 375), and that it is important that 'evidence-based guidelines related to work exist' (84.6%; n = 331). There were no significant associations between the demographic characteristics (gender p = 0.104 [X 2 = 2.638;1]; age p = 0.495 [X 2 = 2.393;3]; training p = 0.590 [X 2 = 4.644;6]; experience p = 0.980 [X 2 = 0.426;4] and specialisation p = 0.649 [X 2= 0.207;1]); and attitudes and perceptions regarding EBP. Insufficient time was highlighted by 57.8% (n = 226) of the respondents as one of the 'most important barriers'. CONCLUSION: Although physiotherapists presented with strong positive attitudes towards EBP in sports physiotherapy, barriers were identified which could hinder the implementation of EBP in sports physiotherapy. CLINICAL IMPLICATIONS: Barriers to applying EBP in sports physiotherapy may lead to inferior quality of care for athletes while addressing these barriers is crucial.
[This corrects the article DOI: 10.4102/sajp.v76i1.1430.].
BACKGROUND: Despite improved immunological and viral load control, the prevalence of HIV/AIDS-related peripheral neuropathy among survivors on highly active antiretroviral therapy (HAART) is rising globally raising public health concerns. OBJECTIVES: To determine the prevalence and clinical characteristics of peripheral neuropathy amongst persons on HAART attending Comprehensive Care Clinics in Busia County, Kenya. METHOD: This cross-sectional descriptive quantitative study utilised purposive sampling and included 289 adults living with HIV/AIDS. Data collection was undertaken using the Clinical HIV Associated Neuropathy Tool (CHANT) and analysed using the Statistical Package for the Social Sciences version 25.0. RESULTS: Of people on HAART, 68.17% (197 amongst 289) had peripheral neuropathy. The majority were female 76.8% (n = 222), 38.1% (n = 110) were between 41 and 50, and 35% (n = 101) were widowed. The most common primary symptom was reduced right foot big toe vibration (76.8%, n = 222). There was a strong positive relationship (r = 0.621, P = 0.000) between foot vibration and illness. There was a statistically significant influence of demographic characteristics of persons on HAART on PN as they accounted for 98.5% of the variance (R 2 = 0.985). CONCLUSION: Peripheral neuropathy is prevalent and is significantly influenced by socio-demographic characteristics of persons on HAART-PN. Early diagnosis and exercise guidance by physiotherapists is key in forestalling severe symptoms, disability and poor quality of life. CLINICAL IMPLICATIONS: There is need to screen persons living with HIV on HAART for PN to establish their medical, physiotherapy and rehabilitation needs. Early diagnosis will encourage healthcare workers to start interventions to prevent progression of impairment, onset of disability and decrease in quality of life. Therefore, adaptation of PN screening tools and physiotherapeutic interventions should be considered.
