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1.
Infect Dis Poverty ; 9(1): 22, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32114985

RESUMEN

BACKGROUND: Lymphatic filariasis (LF), a neglected tropical disease (NTD) and leading cause of global disability, is endemic in 32 countries in Africa with almost 350 million people requiring regular drug administration, and only 16 countries achieving target coverage. Community Drug Distributors (CDDs) are critical for the success of NTD programs, and the distribution of medicines during mass drug administration (MDA) in Africa; however they could also be a weak link. The primary aim of this study is to explore and describe perceptions of CDDs during MDA for LF in Mvita sub-county in Mombasa county and Kaloleni sub-county in Kilifi county, Kenya; and provide recommendations for the effective engagement of communities and CDDs in low-resource settings. METHODS: In September 2018, we conducted six focus group discussions with community members in each sub-county, three with men aged 18-30, 31-50, and 51 years and above and three with women stratified into the same age groups. In each sub-county, we also conducted semi-structured interviews with nine community health extension workers (CHEWs), the national LF focal point, the county NTD focal points, and seven community leaders. Content analysis of the data was conducted, involving a process of reading, coding, and displaying data in order to develop a codebook. RESULTS: We found that several barriers and facilitators impact the engagement between CDDs and community members during MDA. These barriers include poor communication and trust between CDDs and communities; community distrust of the federal government; low community knowledge and perceived risk of LF, poor timing of MDA, fragmented supervision of CDDs during MDA; and CDD bias when distributing medicines. We also found that CDD motivation was a critical factor in their ability to successfully meet MDA targets. It was acknowledged that directly observed treatment and adequate health education were often not executed by CDDs. The involvement of community leaders as informal supervisors of CDDs and community members improves MDA. CONCLUSIONS: In order to achieve global targets around the elimination of LF, CDDs and communities must be effectively engaged by improving planning and implementation of MDA.


Asunto(s)
Agentes Comunitarios de Salud , Filariasis Linfática/tratamiento farmacológico , Filariasis Linfática/epidemiología , Filaricidas/uso terapéutico , Adulto , Agentes Comunitarios de Salud/organización & administración , Agentes Comunitarios de Salud/psicología , Femenino , Grupos Focales , Humanos , Kenia/epidemiología , Masculino , Administración Masiva de Medicamentos , Persona de Mediana Edad , Adulto Joven
3.
Environ Monit Assess ; 192(3): 167, 2020 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-32030474

RESUMEN

Mountains are the preferred sites for studying long-range atmospheric transportation and deposition of heavy metals, due to their isolation and steep temperature decrease that favors cold trapping and condensation of particulate forms of heavy metals. Any enrichment of heavy metals in mountains is presumed to primarily occur through atmospheric deposition. In this particular study, we assessed the status of 27 subsurface soils collected along two elevation gradients of Mt. Kenya using enrichment factors (EFs) as the ecological risk assessments. The collected soils were analyzed for total organic carbon, zinc (Zn), iron (Fe), manganese (Mn), and copper (Cu). The mean concentration of Mn, Fe, Zn, and Cu was 0.376 mg/kg, 47.6 mg/kg, 12.3 mg/kg, and 4.88 mg/kg in Chogoria and 0.560 mg/kg, 113 mg/kg, 12.7 mg/kg, and 2.70 mg/kg in Naro Moru respectively. These concentrations were below the US-EPA maximum permissible levels for soils, implying that the levels recorded had low toxicity. Meanwhile, the mean enrichment factors for Mn, Cu, and Zn were 0.447, 131, and 78.8 in Chogoria and 0.463, 38.9, and 53.0 in Naro Moru respectively. This implied that Zn and Cu in Chogoria sites were extremely enriched, while in Naro Moru, enrichment levels ranged from significant to extreme. However, Mn was found to have minimal enrichment in all the sites. Lower montane forest and bamboo zone recorded relatively high enrichment due to distance from source of pollution. Ericaceous zone also had high mean enrichment due to influence of wind which favors higher deposition at mid-elevations.


Asunto(s)
Cobre , Manganeso , Metales Pesados , Contaminantes del Suelo , Zinc , Cobre/análisis , Monitoreo del Ambiente , Kenia , Manganeso/análisis , Suelo , Contaminantes del Suelo/análisis , Tanzanía , Zinc/análisis
4.
J Environ Manage ; 260: 110133, 2020 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-32090829

RESUMEN

Community-based wildlife conservation (CBWC) programmes have been a pervasive paradigm in the conservation circles since the 1970s. The key elements of such programmes are that local communities are given ownership rights or custodianship and management responsibilities over wildlife, and that they gain social and economic benefits from conservation of the resources. However, to date, there have been only a few studies that offer in-depth analyses of the interplay between governance processes and livelihood impacts of CBWC programmes. Here, I conducted key informant interviews and focus group discussions in five wildlife conservancies in the Maasai Mara ecosystem in Kenya to address the following questions: i) What are the perceived impacts of the wildlife conservancies on livelihoods of the local people? ii) To what extent are the wildlife conservancies governed in relation to the principles of environmental governance? I assessed impacts on livelihoods by applying the Sustainable Livelihoods Framework to explore perceived conservancy-related benefits and costs (i.e. perceived changes in social, financial, human, physical, and natural capitals). I assessed governance by asking the respondents whether the following eight principles of environmental governance were applied: legitimacy, transparency, accountability, inclusiveness, fairness, integration, capability, and adaptability. Perceived benefits of participating in wildlife co-management were identified as: enhanced income from gainful employment and new business opportunities, membership to cooperative societies and participation in community work (e.g. school bursary and feeding programmes), enhanced social relations, improved access to credit and health facilities, enhanced physical infrastructure (schools, roads and bridges), improved physical security and coordinated sharing of provisioning ecosystem services like pasture and water. The principles of legitimacy, inclusiveness, and integration had reportedly been well implemented in wildlife co-management. However, the institutional mechanisms for sharing resources within the conservancies lacked transparency, accountability, and fairness, and tended to favour those who were politically connected to the leadership of the conservancies. Moreover, most of the conservancies had weak systems and few resources to facilitate delivery on responsibilities (i.e. had low capability), and had some costs associated with human-wildlife conflicts. For an improved co-management of wildlife to be achieved in these conservancies, local institutions should be reconfigured to allow active participation by conservancy landowners in decision-making, information sharing, and equitable access to conservancy-related benefits.


Asunto(s)
Conservación de los Recursos Naturales , Ecosistema , Animales , Animales Salvajes , Política Ambiental , Humanos , Kenia
5.
BMC Ecol ; 20(1): 13, 2020 02 27.
Artículo en Inglés | MEDLINE | ID: mdl-32103743

RESUMEN

BACKGROUND: A long-term experiment at two trial sites in Kenya has been on-going since 2007 to assess the effect of organic and conventional farming systems on productivity, profitability and sustainability. During these trials the presence of significant numbers of termites (Isoptera) was observed. Termites are major soil macrofauna and within literature they are either depict as 'pests' or as important indicator for environmental sustainability. The extent by which termites may be managed to avoid crop damage, but improve sustainability of farming systems is worthwhile to understand. Therefore, a study on termites was added to the long-term experiments in Kenya. The objectives of the study were to quantify the effect of organic (Org) and conventional (Conv) farming systems at two input levels (low and high) on the abundance, incidence, diversity and foraging activities of termites. RESULTS: The results showed higher termite abundance, incidence, activity and diversity in Org-High compared to Conv-High, Conv-Low and Org-Low. However, the termite presence in each system was also dependent on soil depth, trial site and cropping season. During the experiment, nine different termite genera were identified, that belong to three subfamilies: (i) Macrotermitinae (genera: Allodontotermes, Ancistrotermes, Macrotermes, Microtermes, Odontotermes and Pseudocanthotermes), (ii) Termitinae (Amitermes and Cubitermes) and (iii) Nasutitiermitinae (Trinervitermes). CONCLUSIONS: We hypothesize that the presence of termites within the different farming systems might be influenced by the types of input applied, the soil moisture content and the occurrence of natural enemies. Our findings further demonstrate that the organic high input system attracts termites, which are an important, and often beneficial, component of soil fauna. This further increases the potential of such systems in enhancing sustainable agricultural production in Kenya.


Asunto(s)
Isópteros , Agricultura , Animales , Biodiversidad , Kenia , Agricultura Orgánica , Suelo
6.
Environ Monit Assess ; 192(2): 118, 2020 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-31950287

RESUMEN

Analysis of elemental concentration in soil and water was carried out in Ortum to ensure safe utilization of soil and water resources for agriculture, industrial, and household purposes. Elemental analysis of soil and water was done using the EDXRF spectrometer and the inductively coupled plasma - optical emission spectrometry (ICP-OES), respectively. A total of 59 soil samples from different locations and depth and 10 water samples were collected from Ortum using purposive sampling method. The results of the mean elemental composition of 13 elements Ni (ppm), Cu (ppm), Zn (ppm), Pb (ppm), K (%w), Ca (%w), Fe (%w), Ti (%w), Mn (ppm), Rb (ppm), Sr (ppm), Zr (ppm), and Nb (ppm) in soils were 58.11, 46.91, 73.49, 22.20, 3.83, 24.39, 1.72, 7.73, 1529.74, 60.98, 442.26, 410.63, and 29.36, respectively, and the mean of 19 elements Ni, Cu, Pb, Zn, Ag, Al, As, Ba, Ca, Cd, Co, Cr, Fe, K, Mg, Mn, Mo, Na, and Se in water samples in (mg/l) were 0.037, 0.0014, 0.0005, 0.0042, 0.0030, 0.021, 0.0080, 0.12, 73.81, 0.00023, 0.0036, 0.00276, 0.0040, 6.11, 38.18, 0.00023, 0.0032, 46.87, and 0.0026, respectively. The average elemental concentration in soils was within the world average range. The mean concentration of Cu, Zn, and Pb in soil reduced with increase in depth while that of Ni increased with increase in depth. The average metal pollution indices in soils, geoaccumulation index (Igeo) potential ecological risk index (Ei), and synthesized potential ecological risk index (Er) were evaluated and found to be - 0.40, 4.92, and 19.69, respectively. According to the classification index, the results show that the soil in Ortum is moderately polluted, and the risk associated with the measured elemental concentration of Ni, Zn, Cu, and Pb in the soils is low. The elemental concentrations in water samples was lower than the recommended permissible limits except for Calcium (Ca) in borehole water with an average of 90.80 mg/l against the permissible levels of 75 mg/l (WHO, 2011). The pH for water samples was found to range from 6.60 to 7.71 with an average of 7.07 which is within the acceptable range of pH 6.5 to pH 8.5 as recommended by WHO, 2011. The study found out that elemental concentration in soil and water samples from Ortum were withing the world average values and that the soil and water in Ortum is safe for use in agriculture and domestic purposes.


Asunto(s)
Monitoreo del Ambiente , Contaminantes Ambientales/análisis , Metales Pesados/análisis , Agricultura , Ecología , Contaminación Ambiental/análisis , Contaminación Ambiental/estadística & datos numéricos , Industrias , Kenia , Medición de Riesgo , Suelo/química , Contaminantes del Suelo/análisis
7.
High Blood Press Cardiovasc Prev ; 27(1): 61-82, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31981085

RESUMEN

INTRODUCTION: Metabolic syndrome (MetS) is a risk factor for cardiovascular-related morbidity and mortality. Although the risk factors for MetS are well documented, differences in gender-based demographics among Kenyan adults with central obesity are lacking. AIM: Determine gender differences in the pattern of socio-demographics relevant to metabolic syndrome among Kenyan adults with central obesity at a mission hospital, Nairobi. METHODS: A cross-sectional baseline survey involving adults (N = 404) with central obesity aged 18-64 years, as part of a community-based lifestyle intervention study. Respondents were systematically sampled using the International Diabetes Federation definition for MetS. Lifestyle characteristics, anthropometric, clinical and biochemical markers were measured and analyzed using SPSS. RESULTS: High (87.2%) MetS prevalence associated with advanced age in males (p < 0.001) and females (p = 0.002) was observed. MetS was likely among divorced/separated/widowed (p = 0.021) and high income males (p = 0.002) and females (p = 0.017) with high income. Unemployed males (p = 0.008) and females with tertiary education (p = 0.019) were less likely to have MetS. Advanced age was likely to lead to high blood pressure, fasting blood glucose and triglycerides (p < 0.05). Males were more likely (p = 0.026) to have raised triglycerides, while females (p < 0.001) had low high density lipoproteins. CONCLUSION: A high prevalence of MetS associated with social and gender differences among Kenyan adults with central obesity. These underscore the need to look beyond the behavioral and biological risks and focus on every nuance of gender differences in addressing MetS and CVDs.


Asunto(s)
Disparidades en el Estado de Salud , Hospitales , Estilo de Vida , Síndrome Metabólico/epidemiología , Obesidad Abdominal/epidemiología , Determinantes Sociales de la Salud , Factores Socioeconómicos , Adolescente , Adulto , Factores de Edad , Anciano , Estudios Transversales , Escolaridad , Empleo , Femenino , Humanos , Renta , Kenia/epidemiología , Masculino , Estado Civil , Síndrome Metabólico/diagnóstico , Persona de Mediana Edad , Obesidad Abdominal/diagnóstico , Prevalencia , Factores de Riesgo , Factores Sexuales , Adulto Joven
8.
PLoS One ; 15(1): e0220274, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31978098

RESUMEN

The nutritional and economic potentials of livestock systems are compromised by the emergence and spread of antimicrobial resistance. A major driver of resistance is the misuse and abuse of antimicrobial drugs. The likelihood of misuse may be elevated in low- and middle-income countries where limited professional veterinary services and inadequately controlled access to drugs are assumed to promote non-prudent practices (e.g., self-administration of drugs). The extent of these practices, as well as the knowledge and attitudes motivating them, are largely unknown within most agricultural communities in low- and middle-income countries. The main objective of this study was to document dimensions of knowledge, attitudes and practices related to antimicrobial use and antimicrobial resistance in livestock systems and identify the livelihood factors associated with these dimensions. A mixed-methods ethnographic approach was used to survey households keeping layers in Ghana (N = 110) and Kenya (N = 76), pastoralists keeping cattle, sheep, and goats in Tanzania (N = 195), and broiler farmers in Zambia (N = 198), and Zimbabwe (N = 298). Across countries, we find that it is individuals who live or work at the farm who draw upon their knowledge and experiences to make decisions regarding antimicrobial use and related practices. Input from animal health professionals is rare and antimicrobials are sourced at local, privately owned agrovet drug shops. We also find that knowledge, attitudes, and particularly practices significantly varied across countries, with poultry farmers holding more knowledge, desirable attitudes, and prudent practices compared to pastoralist households. Multivariate models showed that variation in knowledge, attitudes and practices is related to several factors, including gender, disease dynamics on the farm, and source of animal health information. Study results emphasize that interventions to limit antimicrobial resistance should be founded upon a bottom-up understanding of antimicrobial use at the farm-level given limited input from animal health professionals and under-resourced regulatory capacities within most low- and middle-income countries. Establishing this bottom-up understanding across cultures and production systems will inform the development and implementation of the behavioral change interventions to combat antimicrobial resistance globally.


Asunto(s)
Antibacterianos/efectos adversos , Granjas , Conocimientos, Actitudes y Práctica en Salud , Ganado/microbiología , Crianza de Animales Domésticos , Animales , Bovinos , Pollos/microbiología , Agricultores/psicología , Ghana , Humanos , Kenia , Ovinos/microbiología , Encuestas y Cuestionarios , Tanzanía , Zambia , Zimbabwe
9.
Food Chem ; 312: 126030, 2020 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-31911353

RESUMEN

This study developed comprehensive quantification methods for major nutritive and antinutritive phytochemical aglycones in edible African nightshade leaves, an underutilized food resource in the sub-Saharan area. A simultaneous hydrolysis and extraction method was developed using methanol with 2 M sulfuric acid with incubation at 65 °C for 60 min. UHPLC-QqQ-MS/MS methods were developed and validated for hydrolysis optimization and for quantification of eight major aglycones of polyphenols, alkaloids and sapogenins in 20 differently sourced nightshade leaves, comprising two African species Solanum scabrum and S. nigrum, and from two distinct cultivation sites, one in New Jersey, US and the other in Kenya Eldoret. Variation in species, accessions and cultivation environment played an important role in affecting the phytochemical profile. Total antinutritive alkaloids and sapogenins in all nightshade leaves were evaluated and found to be safe for consumption. This work provides evidence that the consumption of African nightshade leaves as a nutrient rich leafy green vegetable is safe and can contribute to food security and nutritional improvement in the sub-Saharan area.


Asunto(s)
Alcaloides/análisis , Polifenoles/análisis , Saponinas/análisis , Solanum/química , Cromatografía Líquida de Alta Presión/métodos , Glicosilación , Hidrólisis , Kenia , Análisis Multivariante , Hojas de la Planta/química , Espectrometría de Masas en Tándem
12.
Int J Gynaecol Obstet ; 148(1): 27-34, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31544243

RESUMEN

OBJECTIVE: Despite the recognized importance of person-centered care, very little information exists on how person-centered maternity care (PCMC) impacts newborn health. METHODS: Baseline and follow-up data were collected from women who delivered in government health facilities in Nairobi and Kiambu counties in Kenya between August 2016 and February 2017. The final analytic sample included 413 respondents who completed the baseline survey and at least one follow-up survey at 2, 6, 8, and/or 10 weeks. Data were analyzed using descriptive, bivariate, and multivariate statistics. Logistic regression was used to assess the relationship between PCMC scores and outcomes of interest. RESULTS: In multivariate analyses, women with high PCMC scores were significantly less likely to report newborn complications than women with low PCMC scores (adjusted odds ratio [aOR] 0.39, 95% confidence interval [CI] 0.16-0.98). Women reporting high PCMC scores also had significantly higher odds of reporting a willingness to return to the facility for their next delivery than women with low PCMC score (aOR 12.72, 95% CI 2.26-71.63). The domains of Respect/Dignity and Supportive Care were associated with fewer newborn complications and willingness to return to a facility. CONCLUSION: PCMC could improve not just the experience of the mother during childbirth, but also the health of her newborn and future health-seeking behavior.


Asunto(s)
Servicios de Salud Materna/organización & administración , Atención Dirigida al Paciente/métodos , Resultado del Embarazo/epidemiología , Adulto , Femenino , Humanos , Recién Nacido , Kenia , Servicios de Salud Materna/estadística & datos numéricos , Madres/psicología , Oportunidad Relativa , Atención Dirigida al Paciente/estadística & datos numéricos , Embarazo , Encuestas y Cuestionarios
13.
Sci Total Environ ; 709: 135344, 2020 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-31874341

RESUMEN

Child exposure to fecal-oral pathogens occurs through several transmission pathways. However, the relative importance of different exposure points for pathogen transmission both inside and outside households is not well understood. We conducted a cross-sectional study in the urban slum of Kibera in Nairobi, Kenya, collecting 237 environmental samples from 40 households from source water, stored drinking water, caregiver hands, child hands, household surfaces, soil, standing water, open drainage ditches, and streams. We quantified the fecal indicator Escherichia coli and the enteric pathogens of adenovirus, Campylobacter jejuni, Shigella spp./enteroinvasive E. coli (EIEC), and Vibrio cholerae. At least one enteric pathogens was detected in 13% of household stored water, 47% of hand, 46% of table surface, 26% of plate surface, 75% of floor surface, 96% of soil, 56% of standing water, 77% of drainage ditch, and 100% of stream samples despite all households having access to a toilet or latrine. Our results provide evidence that children may be exposed to enteric pathogens from several exposure points, that domestic hygiene practices related to water treatment and child handwashing were associated with reduced pathogen detection in this setting, but household table and floor cleaning practices were not, that ownership or presence of chickens in the compound was associated with increased detection of C. jejuni inside households and on soil, that there were interactions among different transmission pathways for enteric pathogens, and that there were differential correlations between E. coli and enteric pathogens for different pathogens and environmental sample types. Additionally, V. cholerae was detected at several exposure points during a cholera outbreak. Overall, these results suggest that interventions that can disrupt many transmission pathways may be needed to reduce enteric pathogen exposure in this urban slum setting.


Asunto(s)
Ríos , Suelo , Animales , Pollos , Niño , Estudios Transversales , Escherichia coli , Heces , Humanos , Kenia , Saneamiento , Agua
14.
Int J Med Inform ; 133: 104006, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31706230

RESUMEN

BACKGROUND: Use of routine HIV programme data for surveillance is often limited due to inaccuracies associated with patient misclassification which can be addressed by unique patient identification.We assessed the feasibility and acceptability of integrating an iris recognition biometric identification system into routine HIV care services at 4 sites in Kenya. METHODS: Patients who had recently tested HIV-positive or were engaged in care were enrolled. Images of the iris were captured using a dual-iris camera connected to a laptop. A prototype iris biometric identification system networked across the sites, analysed the iris patterns; created a template from those patterns; and generated a 12-digit ID number based on the template. During subsequent visits, the patients' irises were re-scanned, and the pattern was matched to stored templates to retrieve the ID number. RESULTS: Over 55 weeks 8,614 (98%) of 8,794 new patients were assigned a unique ID on their first visit. Among 6,078 return visits, the system correctly re-identified patients' IDs 5,234 times (86%). The false match rate (a new patient given the ID of another patient) was 0·5% while the generalized false reject rate (re-scans assigned a new ID) was 4·7%. Overall, 9 (0·1%) agreed to enrol but declined to have an iris scan. The most common reasons cited for declining an iris scan were concerns about privacy and confidentiality. CONCLUSION: Implementation of an iris recognition system in routine health information systems is feasible and highly acceptable as part of routine care in Kenya. Scale-up could improve unique patient identification and tracking, enhancing disease surveillance activities.


Asunto(s)
Identificación Biométrica , Infecciones por VIH , Registros , Adulto , Estudios de Factibilidad , Femenino , Sistemas de Información en Salud , Humanos , Iris , Kenia , Masculino , Persona de Mediana Edad
15.
Nat Commun ; 10(1): 5615, 2019 12 09.
Artículo en Inglés | MEDLINE | ID: mdl-31819062

RESUMEN

Novel interventions that leverage the heterogeneity of parasite transmission are needed to achieve malaria elimination. To better understand spatial and temporal dynamics of transmission, we applied amplicon next-generation sequencing of two polymorphic gene regions (csp and ama1) to a cohort identified via reactive case detection in a high-transmission setting in western Kenya. From April 2013 to July 2014, we enrolled 442 symptomatic children with malaria, 442 matched controls, and all household members of both groups. Here, we evaluate genetic similarity between infected individuals using three indices: sharing of parasite haplotypes on binary and proportional scales and the L1 norm. Symptomatic children more commonly share haplotypes with their own household members. Furthermore, we observe robust temporal structuring of parasite genetic similarity and identify the unique molecular signature of an outbreak. These findings of both micro- and macro-scale organization of parasite populations might be harnessed to inform next-generation malaria control measures.


Asunto(s)
Malaria/epidemiología , Malaria/transmisión , Parásitos/fisiología , Análisis Espacio-Temporal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Haplotipos/genética , Humanos , Kenia/epidemiología , Persona de Mediana Edad , Parásitos/genética , Plasmodium falciparum/genética , Plasmodium falciparum/fisiología , Adulto Joven
16.
Environ Monit Assess ; 192(1): 18, 2019 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-31820117

RESUMEN

The occurrence of 17 antibiotics belonging to sulfonamides, ß-lactams, macrolides and aminoglycosides classes, and trimethoprim in raw hospital wastewater, wastewater treatment plant (WWTP), and surface water was determined. Residual antibiotics were quantified by LC/MS/MS. Residues of antibiotics in hospital wastewater were 3-10 times higher than that detected in WWTP and surface water. Trimethoprim, spectinomycin, ampicillin, and oxacillin were detected in all the sampled water. Sulfamethoxazole was detected at the highest concentration of 20.6, 7.8, and 6.8 µg L-1 in hospital wastewater, WWTP and in surface water, respectively. Other detected sulfonamides were sulfamethazine, sulfadiazine, and sulfanilamide at a concentration range of 0.4-15.7 µg L-1. Detected trimethoprim ranged from 0.4-6.6 µg L-1, the rest of the detected antibiotics were up to 1.0 µg L-1. The speciation of the sulfonamides at pH values relevant to sampled water was evaluated by use of pKa values. These compounds existed largely as anionic and neutral species indicating high mobility as these speciation forms are less sorbed in environmental matrices. Continuous monitoring of antibiotics residues in wastewater, surface water, and other environmental matrices is very important due to their adverse health and environmental effects. The information is useful in designing strategies for antibiotics pollution control and also in policy formulation.


Asunto(s)
Antibacterianos/análisis , Monitoreo del Ambiente , Eliminación de Residuos Líquidos , Contaminantes Químicos del Agua/análisis , Cromatografía Liquida , Agua Dulce/química , Kenia , Macrólidos , Sulfonamidas , Espectrometría de Masas en Tándem , Aguas Residuales/química , Agua
17.
BMC Public Health ; 19(1): 1700, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31852536

RESUMEN

BACKGROUND: The rate of tobacco use among people with mental illness is nearly twice that of the general population. Psychotropic medications for tobacco cessation are relatively expensive for most Kenyans. Behavioral counseling and group therapy are effective lower cost strategies to promote tobacco cessation, yet have not been studied in Kenya among individuals with concomitant mental illness. METHODS/DESIGN: One hundred tobacco users with mental illness who were part of an outpatient mental health program in Nairobi, Kenya were recruited and allocated into intervention and control groups of the study (50 users in intervention group and 50 users in control group). Participants allocated to the intervention group were invited to participate in 1 of 5 tobacco cessation groups. The intervention group received the 5As (Ask, Advise, Assess, Assist and Arrange) and tobacco cessation group behavioral intervention, which included strategies to manage cravings and withdrawal, stress and anxiety, and coping with depression due to withdrawal; assertiveness training and anger management; reasons to quit, benefits of quitting and different ways of quitting. Individuals allocated to the control group received usual care. The primary outcome was tobacco cessation at 24 weeks, measured through cotinine strips. Secondary outcomes included number of quit attempts and health-related quality of life. DISCUSSION: This study will provide evidence to evaluate the efficacy and safety of a tobacco cessation group behavioral intervention among individuals with mental illness in Kenya, and to inform national and regional practice and policy. TRIAL REGISTRATION: Trial registration number: NCT04013724. Name of registry: ClinicalTrials.gov. URL of registry: https://register.clinicaltrials.gov Date of registration: 9 July 2019 (retrospectively registered). Date of enrolment of the first participant to the trial: 5th September 2017. Protocol version: 2.0.


Asunto(s)
Terapia Conductista/métodos , Análisis Costo-Beneficio/estadística & datos numéricos , Consejo/métodos , Calidad de Vida/psicología , Cese del Hábito de Fumar/métodos , Cese del Uso de Tabaco/psicología , Tabaquismo/terapia , Adulto , Anciano , Anciano de 80 o más Años , Terapia Conductista/economía , Consejo/economía , Femenino , Humanos , Kenia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cese del Hábito de Fumar/economía , Cese del Uso de Tabaco/estadística & datos numéricos
18.
19.
PLoS One ; 14(12): e0226133, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31856196

RESUMEN

INTRODUCTION: Young people worldwide are often reticent to access family planning services from public health facilities: instead, they choose to get contraception from private, retail pharmacies. In Kenya, certain contraceptives are available in pharmacies: these include injectables, which can be dispensed but not administered, according national guidelines. However, Kenya struggles with enforcement of its pharmacy regulations and addressing illegal activity. Therefore, in this qualitative study, we assessed private pharmacies as an existing source of injectable contraception for young Kenyans (age 18-24), and investigated the perceived quality of service provision. METHODS: This study used: focus group discussions (6) with young community members; in-depth interviews (18) with youth who had purchased contraception from pharmacies; key informant interviews with pharmacy personnel and pharmacy stakeholders (25); and a mystery shopper (visiting 45 pharmacies). RESULTS: The study found that for injectable contraception, private pharmacies had expanded to service provision, and pharmacy personnel's roles had transcended formal or informal training previously received-young people could both purchase and be injected in many pharmacies. Pharmacies were perceived to lack consistent quality or strong regulation, resulting in young clients, pharmacy personnel, and regulators being concerned about illegal activity. Participants' suggestions to improve pharmacy service quality and regulation compliance focused on empowering consumers to demand quality service; strengthening regulatory mechanisms; expanding training opportunities to personnel in private pharmacies; and establishing a quality-based 'brand' for pharmacies. DISCUSSION: Kenya's recent commitments to universal health coverage and interest in revising pharmacy policy provide an opportunity to improve pharmacy quality. Multi-pronged initiatives with both public and private partners are needed to improve pharmacy practice, update and enforce regulations, and educate the public. Additionally, the advent of self-administrable injectables present a new possible role for pharmacies, and could offer young clients a clean, discreet place to self-inject, with pharmacy personnel serving as educators and dispensers.


Asunto(s)
Anticoncepción/estadística & datos numéricos , Regulación Gubernamental , Farmacéuticos/legislación & jurisprudencia , Adolescente , Anticoncepción/psicología , Servicios de Planificación Familiar/legislación & jurisprudencia , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Grupos Focales , Política de Salud , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Inyecciones , Kenia , Masculino , Calidad de la Atención de Salud , Adulto Joven
20.
PLoS One ; 14(12): e0226426, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31856245

RESUMEN

BACKGROUND: Despite the high burden of adverse adolescent sexual and reproductive health (SRH) outcomes, it has remained a low political priority in Kenya. We examined factors that have shaped the lack of current political prioritization of adolescent SRH service provision. METHODS: We used the Shiffman and Smith policy framework consisting of four categories-actor power, ideas, political contexts, and issue characteristics-to analyse factors that have shaped political prioritization of adolescent SRH. We undertook semi-structured interviews with 14 members of adolescent SRH networks between February and April 2019 at the national level and conducted thematic analysis of the interviews. FINDINGS: Several factors hinder the attainment of political priority for adolescent SRH in Kenya. On actor power, the adolescent SRH community was diverse and united in adoption of international norms and policies, but lacked policy entrepreneurs to provide strong leadership, and policy windows were often missed. Regarding ideas, community members lacked consensus on a cohesive public positioning of the problem. On issue characteristics, the perception of adolescents as lacking political power made politicians reluctant to act on the existing data on the severity of adolescent SRH. There was also a lack of consensus on the nature of interventions to be implemented. Pertaining to political contexts, sectoral funding by donors and government treasury brought about tension within the different government ministries resulting in siloed approaches, lack of coordination and overall inefficiency. However, the SRH community has several strengths that augur well for future political support. These include the diverse multi-sectoral background of its members, commitment to improving adolescent SRH, and the potential to link with other health priorities such as maternal health and HIV/AIDS. CONCLUSION: In order to increase political attention to adolescent SRH in Kenya, there is an urgent need for policy actors to: 1) create a more cohesive community of advocates across sectors, 2) develop a clearer public positioning of adolescent SRH, 3) agree on a set of precise approaches that will resonate with the political system, and 4) identify and nurture policy entrepreneurs to facilitate the coupling of adolescent SRH with potential solutions when windows of opportunity arise.


Asunto(s)
Prioridades en Salud , Política , Salud Reproductiva , Salud Sexual , Adolescente , Femenino , Política de Salud , Humanos , Kenia , Masculino , Formulación de Políticas
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