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1.
Pan Afr Med J ; 38: 126, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33912296

RESUMEN

Introduction: human papilloma virus (HPV) which is preventable is the main cause of cervical cancer and it targets mostly young adolescents. The study was to determine the practice desire, attitude and knowledge of mothers of adolescent girls on HPV vaccination in Western Kenya. Methods: this was a descriptive cross-sectional study design. Data was obtained using semi-structured questionnaires and analyzed using both descriptive and inferential statistics at 95% confidence level using the SPSS software version 22. A p-value ≤ 0.05 was considered statistically significant. Results: ninety five percent of the mothers had intentions to vaccinate their daughters and also had a positive attitude and their response to HPV vaccination was significantly lower than those without intentions p=0.02, 95% CI, OR=0.48 (0.90-0.89). Vaccination against HPV was low at 9.4% with a mean age of 34 years. Our results found a high level of cervical cancer awareness (85.0%), HPV and vaccine awareness respectively (62.0%, and 64.0%). "Vaccination of my daughters will prompt early sexual activity and the cost of HPV vaccination being a barrier to vaccination" had a statistically significant influence on the practice of vaccination. Negative attitude to daughters´ early onset of sexual activity significantly reduced up take while positive attitude to cost of HPV vaccine significantly increased up take of HPV vaccination with p value of 0.007 and 0.04 respectively. Conclusion: awareness of HPV and HPV vaccine prevention is low among mothers of adolescent girls in Western Kenya. There was a positive attitude and high desire towards the use of HPV vaccination therefore a need for awareness, policy and unify efforts to reduce cervical cancer burden.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Madres/estadística & datos numéricos , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Intención , Kenia , Persona de Mediana Edad , Núcleo Familiar , Conducta Sexual/psicología , Encuestas y Cuestionarios , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/virología , Vacunación/psicología
2.
Environ Sci Technol ; 55(9): 6052-6064, 2021 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-33826310

RESUMEN

Many sanitation interventions suffer from poor sustainability. Failure to maintain or replace toilet facilities risks exposing communities to environmental pathogens, yet little is known about the factors that drive sustained access beyond project life spans. Using data from a cohort of 1666 households in Kwale County, Kenya, we investigated the factors associated with changes in sanitation access between 2015 and 2017. Sanitation access is defined as access to an improved or unimproved facility within the household compound that is functional and in use. A range of contextual, psychosocial, and technological covariates were included in logistic regression models to estimate their associations with (1) the odds of sustaining sanitation access and (2) the odds of gaining sanitation access. Over two years, 28.3% households sustained sanitation access, 4.7% lost access, 17.7% gained access, and 49.2% remained without access. Factors associated with increased odds of households sustaining sanitation access included not sharing the facility and presence of a solid washable slab. Factors associated with increased odds of households gaining sanitation access included a head with at least secondary school education, level of coarse soil fragments, and higher local sanitation coverage. Results from this study can be used by sanitation programs to improve the rates of initial and sustained adoption of sanitation.


Asunto(s)
Saneamiento , Cuartos de Baño , Composición Familiar , Humanos , Kenia , Suelo
3.
Pan Afr Med J ; 38: 72, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33889238

RESUMEN

Introduction: over 1.5 million children die from vaccine-preventable diseases yearly. To avert these deaths and improve their livelihood, vaccine availability is important. The study assessed the availability of the vaccine, injection accessories and the associated factors in public health facilities in Nairobi City County and provided valuable data to contribute to improving healthcare infrastructure, stock management and vaccine distribution. Methods: a descriptive cross-sectional study was conducted in 68 randomly selected public health facilities at Nairobi City County in Kenya. Data was collected using a researcher-administered structured questionnaire and more information abstracted from the Vaccines management tools. The analysis was carried out using STATA version 14. Results: most facilities had experienced vaccines and accessories stock out at the time of the study and in the preceding twelve months. The most affected vaccines were tetanus (88%), measles-rubella (81%) and oral polio (79%). The causes of stockouts were rationing (82%), unavailability at the depot (93%), lack of transport (55%) and poor forecasting (50%). The majority (91%) of the facilities used the public transport system and only 1% had reliable government utility vehicles for delivery of vaccines and other logistics. Those near the vaccine depots preferred walking. Conclusion: the public health facilities in Nairobi City County experienced frequent stockouts of vaccines and accessories thereby exposing the residents to vaccine-preventable diseases.


Asunto(s)
Instituciones de Salud/estadística & datos numéricos , Programas de Inmunización , Vacunación/estadística & datos numéricos , Vacunas/provisión & distribución , Niño , Estudios Transversales , Femenino , Humanos , Kenia , Masculino , Salud Pública , Encuestas y Cuestionarios , Enfermedades Prevenibles por Vacunación/prevención & control
4.
Pan Afr Med J ; 38: 84, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33889250

RESUMEN

Methadone maintenance treatment is reported as cost-effective in treatment of opioid use disorder. Estimated cost of providing methadone varies widely in different regions but there is no data regarding cost of methadone treatment in Kenya. The aim of this study was to estimate the cost of methadone maintenance treatment at a methadone maintenance treatment clinic in Nairobi, Kenya from the perspective of the government, implementing partner and the clients. Data was collected for the period of February 2017 to September 2018 for 700 enrolled clients. The cost of providing methadone treatment was estimated as the sum of salaries, laboratory test, methadone and other commodities costs. The outcome was daily cost of methadone per client. The costs are given in Kenya Shillings (Ksh). The cost of treating one client is approximately Ksh. 149 (US$1.49) per day which amounts to Ksh 4500 (US$ 45) per month. This is from the estimated direct costs such as salaries which accounted for 86.4%, methadone 9.6%, tests and other consumables at 4%. The estimated average dose per patient per day is 60mg.This excludes indirect costs such as capital and set up cost, maintenance cost, training, drug import and distribution and other bills. The findings of this study show that the estimate cost of providing methadone at Nairobi, Kenya is comparable to that in other centers. This can help to inform policy makers on continued provision of methadone treatment in the country.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Metadona/economía , Tratamiento de Sustitución de Opiáceos/economía , Trastornos Relacionados con Opioides/rehabilitación , Instituciones de Atención Ambulatoria/economía , Análisis Costo-Beneficio , Costos de los Medicamentos , Humanos , Kenia , Metadona/administración & dosificación , Tratamiento de Sustitución de Opiáceos/métodos , Trastornos Relacionados con Opioides/economía , Salarios y Beneficios/economía
5.
Pan Afr Med J ; 38: 103, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33889269

RESUMEN

Introduction: the effect of hepatitis B virus (HBV) infection on the natural history of human immunodeficiency virus (HIV) disease remains uncertain. Therefore, this study was conducted to determine the association of HBV co-infections with CD4 count and viral load levels in response to antiretroviral treatment among HIV patients attending comprehensive care clinics in Makueni County (Kenya). Methods: this was a prospective case-control study among patients seeking HIV services in three hospitals of Makueni County (Kenya). Newly diagnosed HIV mono-infected patients (controls) and HIV/HBV co-infected (cases), 18 years and above who had not started antiretrovirals (ARVs) participated. A total of 258 patients gave informed consent and participated. HIV mono-infected (controls) produced 129 while HIV/HBV (cases) gave 129 participants. P-values ≤ 0.05 were considered significant. Results: the majority (164, 63%) of the study participants were females for both arms of the study. The mean age of the participants was 31±0.402 years and majority of them were between the age of 26-30years old. At the beginning and end of the study the mean viral load for HIV/HBV co-infected individuals was (30169 and 1731) copies/ml while that of CD4 count was (327 and 459) cells/ul, and that of HIV mono-infected was (21860 and 1689) copies/ml and CD4 count of (421 and 437) cells/ul respectively. After enrolling them into antiretroviral therapy (ART) treatment and after six months of follow-up there was significant drop in viral load and significant increase in CD4 count for both groups at p<0.001 using logistic regression. Conclusion: HIV patients co-infected with hepatitis B virus had high viral load and low CD4 count compared to HIV monoinfected patients however with introduction of ARVs there was improvement in both groups with the highest noticed among the HIV/HBV co-infected patients.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Hepatitis B/complicaciones , Adulto , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Coinfección , Femenino , Estudios de Seguimiento , Infecciones por VIH/virología , Hepatitis B/epidemiología , Humanos , Kenia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Carga Viral , Adulto Joven
6.
Glob Health Sci Pract ; 9(1): 177-186, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33795368

RESUMEN

There is an urgent need for data to inform coronavirus disease (COVID-19) pandemic response efforts. At the same time, the pandemic has created challenges for data collection, one of which is interviewer training in the context of social distancing. In sub-Saharan Africa, in-person interviewer training and face-to-face data collection remain the norm, requiring researchers to think creatively about transitioning to remote settings to allow for safer data collection that respects government guidelines. Performance Monitoring for Action (PMA, formerly PMA2020) has collected both cross-sectional and longitudinal data on key reproductive health measures in Africa and Asia since 2013. Relying on partnerships with in-country research institutes and cadres of female interviewers recruited from sampled communities, the project was well-positioned to transition to collecting data on COVID-19 from the onset of the pandemic. This article presents PMA's development of a remote training system for COVID-19 surveys in the Democratic Republic of the Congo, Kenya, and Nigeria, including challenges faced and lessons learned. We demonstrate that remote interviewer training can be a viable approach when data are critically needed and in-person learning is not possible. We also argue against systematic replacement of in-person trainings with remote learning, instead recommending consideration of local context and a project's individual circumstances when contemplating a transition to remote interviewer training.


Asunto(s)
Recolección de Datos , Educación a Distancia , Educación Profesional/métodos , Pandemias , Investigadores/educación , Investigación/educación , Adolescente , Adulto , África del Sur del Sahara , Control de Enfermedades Transmisibles , República Democrática del Congo , Femenino , Humanos , Internet , Kenia , Nigeria , Salud Reproductiva , Encuestas y Cuestionarios , Adulto Joven
7.
BMJ Glob Health ; 6(4)2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33853843

RESUMEN

INTRODUCTION: We estimated unit costs for COVID-19 case management for patients with asymptomatic, mild-to-moderate, severe and critical COVID-19 disease in Kenya. METHODS: We estimated per-day unit costs of COVID-19 case management for patients. We used a bottom-up approach to estimate full economic costs and adopted a health system perspective and patient episode of care as our time horizon. We obtained data on inputs and their quantities from data provided by three public COVID-19 treatment hospitals in Kenya and augmented this with guidelines. We obtained input prices from a recent costing survey of 20 hospitals in Kenya and from market prices for Kenya. RESULTS: Per-day, per-patient unit costs for asymptomatic patients and patients with mild-to-moderate COVID-19 disease under home-based care are 1993.01 Kenyan shilling (KES) (US$18.89) and 1995.17 KES (US$18.991), respectively. When these patients are managed in an isolation centre or hospital, the same unit costs for asymptomatic patients and patients with mild-to-moderate disease are 6717.74 KES (US$63.68) and 6719.90 KES (US$63.70), respectively. Per-day unit costs for patients with severe COVID-19 disease managed in general hospital wards and those with critical COVID-19 disease admitted in intensive care units are 13 137.07 KES (US$124.53) and 63 243.11 KES (US$599.51). CONCLUSION: COVID-19 case management costs are substantial, ranging between two and four times the average claims value reported by Kenya's public health insurer. Kenya will need to mobilise substantial resources and explore service delivery adaptations that will reduce unit costs.


Asunto(s)
/economía , Manejo de Caso , Costos de la Atención en Salud , Humanos , Kenia/epidemiología , Pandemias
8.
Artículo en Inglés | MEDLINE | ID: mdl-33806590

RESUMEN

Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors require urgent policy attention. This specifically includes the lack of safe MHM spaces which threaten the health and dignity of women and girls.


Asunto(s)
Higiene , Pobreza , República Democrática del Congo , Países en Desarrollo , Etiopía , Femenino , Ghana , Conocimientos, Actitudes y Práctica en Salud , Humanos , India , Indonesia , Kenia , Menstruación , Nigeria , Uganda
9.
Pan Afr Med J ; 38: 51, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33854680

RESUMEN

Introduction: delayed diagnosis of Mycobacterium tuberculosis infection leads to accelerated individual to individual transmission. This study evaluated this aspect of delayed diagnosis among patients visiting Isiolo level four hospital in northern Kenya. Methods: this was a cross-sectional cohort study conducted during January, 2018-January, 2019 with systematically sampled 172 tuberculosis (TB) patients. Epidemiological and clinical characteristics were abstracted from records to serve as independent variables. Outcome variable was delayed diagnosis dichotomised into < 21 or > 21 days and treated as a binary outcome. Pre-tested interviewer-administered questionnaires, focused group discussions, and key informant interview guides were used to collect relevant information. Results: most (n=89, 57.8%) of the TB diagnosis fell in the category of > 21 day delay. Overall, among all patients, delay in days constituted a median of 27.6, a mean of 37.3 ± 57 days (range 0-414 days). Factors associated with delayed diagnosis (happening > 21 days) included (i) use of dispensary and private health facilities, (OR=4.3, 95% CI: 1.44,13.14; P=0.009) and (OR= 4.9, 95% CI: 1.64, 14.73; P=0.004), respectively (ii) Self-employed individuals (OR=21.7, 95% CI: 2.47,190.93; P=0.006) and employed individuals (OR=9.9, 95% CI: 1.14, 85.80; P=0.038) (iii) secondary-level education (OR=0.03, 95% CI: 0.01,0.21; P=0.000) and tertiary education (OR=0.033, 95% CI: 0.01, 0.23; P=0.001). Conclusion: delayed diagnosis of TB was found to be associated with health-seeking behaviour of TB patients, proxied by diagnosis facility, occupation, and education levels in our study area. Curtailment of local transmission of M. tuberculosis needs intensified health promotion and education in affected communities complemented with active case findings.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Tuberculosis/diagnóstico , Adolescente , Adulto , Niño , Estudios de Cohortes , Estudios Transversales , Diagnóstico Tardío , Escolaridad , Femenino , Humanos , Kenia , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Factores de Tiempo , Tuberculosis/transmisión , Adulto Joven
10.
Pan Afr Med J ; 38: 120, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33912290

RESUMEN

Introduction: anthrax is endemic in some parts of Kenya causing mortalities in livestock and morbidity in humans. On January 20th, 2018, news media reported suspected anthrax in a remote southern Kenyan village after villagers became ill following consumption of meat from a dead cow that was confirmed, by microscopy, to have died of anthrax. We assessed community knowledge, attitude and practices (KAP) to identify intervention gaps for anthrax prevention. Methods: we conducted a KAP survey in randomly selected households (HHs) in villages from selected wards. Using multi-stage sampling approach, we administered structured questionnaire to persons aged ≥15 years to collect KAP information from February 11th-21st, 2018. From a set of questions for KAP, we scored participants' response as "1" for a correct response and "0" for an incorrect response. Univariate analysis and Chi-square tests were performed to explore determinants of KAP. Concurrently, we gathered qualitative data using interview guides for thematic areas on anthrax KAP from key informant interviews and focus group discussions. Qualitative data were transcribed in Ms Word and analyzed along themes by content analysis. Results: among 334 respondents: 187/334 (56%) were male; mean age, 40.7±13.6 years; 331/334 (99.1%) had heard of anthrax and 304/331 (91.8%) knew anthrax to be zoonotic. Transmission was considered to be through eating dead-carcasses by 273/331 (82.5%) and through contact with infected tissue by 213/331 (64.4%). About 59% (194/329) regularly vaccinated their livestock against anthrax, 53.0% (174/328) had slaughtered or skinned a dead-animal and 59.5% (195/328) practiced home slaughter while 52.9% (172/325) treated sick-animals by themselves. Sex (p≤0.001), age (p=0.007) and livestock-rearing years (p≤0.001) were significantly associated with knowledge and practice. Conclusion: there were differences in knowledge and practices towards anthrax by age-group and sex. Enhanced public health education and targeted interventions by relevant government agencies is recommended.


Asunto(s)
Vacunas contra el Carbunco/administración & dosificación , Carbunco/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Zoonosis/prevención & control , Adulto , Factores de Edad , Anciano , Animales , Carbunco/epidemiología , Carbunco/veterinaria , Femenino , Grupos Focales , Educación en Salud , Humanos , Kenia/epidemiología , Ganado , Masculino , Persona de Mediana Edad , Factores Sexuales , Encuestas y Cuestionarios , Adulto Joven , Zoonosis/epidemiología
11.
Nat Commun ; 12(1): 1939, 2021 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-33850143

RESUMEN

The KNM-ER 2598 occipital is among the oldest fossils attributed to Homo erectus but questions have been raised about whether it may derive from a younger horizon. Here we report on efforts to relocate the KNM-ER 2598 locality and investigate its paleontological and geological context. Although located in a different East Turkana collection area (Area 13) than initially reported, the locality is stratigraphically positioned below the KBS Tuff and the outcrops show no evidence of deflation of a younger unit, supporting an age of >1.855 Ma. Newly recovered faunal material consists primarily of C4 grazers, further confirmed by enamel isotope data. A hominin proximal 3rd metatarsal and partial ilium were discovered <50 m from the reconstructed location where KNM-ER 2598 was originally found but these cannot be associated directly with the occipital. The postcrania are consistent with fossil Homo and may represent the earliest postcrania attributable to Homo erectus.


Asunto(s)
Fósiles , Hominidae/anatomía & histología , Animales , Femenino , Hominidae/clasificación , Humanos , Ilion , Kenia , Masculino , Paleontología
12.
BMC Oral Health ; 21(1): 154, 2021 03 24.
Artículo en Inglés | MEDLINE | ID: mdl-33761927

RESUMEN

BACKGROUND: This study aimed to determine the present oral health status of the rural Kenyan elderly population and to investigate whether oral health status is associated with the perceived general health. METHODS: A total of 131 individuals aged 65 years and over in Mbita Constituency, Homa Bay County in Kenya were randomly selected and visited at home. The home visit study, which was conducted from 2014 to 2016, included oral examination by a dentist and administration of a self-reporting questionnaire. The number of teeth present and functional tooth unit (FTU) points were calculated using the dental chart. Perceived general health, subjective masticatory ability, and self-reported periodontal symptoms were collected using a questionnaire sheet. Fisher's exact test and nonparametric test were used to determine the difference in percentage and means. The odds ratio of good general health based on the participants' masticatory satisfaction was calculated by logistic analysis. RESULTS: Satisfactory mastication was dependent on the number of teeth present, FTU points, and self-reported "gum bleeding" and "tooth mobility". Furthermore, satisfactory mastication was associated with perceived general health status independent of sex and age. The adjusted odds ratio of good perceived general health was 2.29 (95% confidence interval 1.05-4.99) for participants who had the subjective masticatory ability. CONCLUSION: Among the Kenyan elderly population, satisfactory mastication was related to the number of teeth present, FTU points, and self-reported periodontal symptoms. Furthermore, satisfactory mastication was associated with perceived general health status independently.


Asunto(s)
Masticación , Salud Bucal , Anciano , Estado de Salud , Humanos , Kenia/epidemiología , Encuestas y Cuestionarios
13.
Environ Int ; 152: 106485, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33689906

RESUMEN

BACKGROUND: Exposure to polycyclic aromatic hydrocarbons (PAHs) is a risk factor for esophageal squamous cell carcinoma (ESCC) in high-incidence areas of China, Iran and Brazil, but PAH assessments have not been conducted in East Africa, another ESCC hot spot. OBJECTIVE: To evaluate demographic or lifestyle factors associated with the PAH biomarker concentrations in the study population, and whether PAH metabolite concentrations showed any associations with esophageal precancerous lesions. METHODS: We recruited a community-based sample of 289 asymptomatic adults from a rural area of Kenya and performed Lugol's chromoendoscopy to detect esophageal squamous dysplasia (ESD); participants completed a questionnaire and provided a spot urine specimen. We analyzed urine for seven hydroxylated metabolites of naphthalene, fluorene, phenanthrene, and pyrene at the U.S. National Center for Environmental Health, and compared creatinine-corrected PAH metabolite concentrations with questionnaire data and the presence of ESD. RESULTS: PAH metabolite concentrations among never tobacco users in these rural Kenya residents were 2.4-28.1 times higher than those reported from never tobacco users in Iran, Brazil and the USA. Female sex, cooking indoors, having no post-primary education, and age <50, but not tobacco use, were positively and significantly associated with PAH metabolite concentrations. Almost all participants used wood as cooking fuel. Nine participants had advanced ESD. Adjusted logistic regression showed a significant association between 2-hydroxynaphthalene (OR = 4.19, 95%CI: 1.01-17.47) and advanced ESD. All other PAH metabolites had positive but non-significant associations with advanced ESD. CONCLUSIONS: Urinary PAH metabolite concentrations among never tobacco users are markedly higher in this group from Kenya than in other populations and are associated with indoor cooking with wood on open, unvented stoves. These metabolite concentrations were also associated with the presence of advanced esophageal dysplasia. Our findings underline the importance of assessing alternative cooking conditions to reduce PAH exposure in this population.


Asunto(s)
Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Hidrocarburos Policíclicos Aromáticos , Adulto , Brasil , Carcinógenos , China , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/etiología , Femenino , Humanos , Irán , Kenia/epidemiología , Hidrocarburos Policíclicos Aromáticos/análisis , Madera/química
14.
Artículo en Inglés | MEDLINE | ID: mdl-33671293

RESUMEN

Monitoring the safety of medicines used in public health programs (PHPs), including the neglected tropical diseases (NTD) program, is a WHO recommendation, and requires a well-established and robust pharmacovigilance system. The objective of this study was to assess the pharmacovigilance systems within the NTD programs in Ethiopia, Kenya, Rwanda, and Tanzania. The East African Community Harmonized Pharmacovigilance Indicators tool for PHPs was used to interview the staff of the national NTD programs. Data on four components, (i) systems, structures, and stakeholder coordination; (ii) data management and signal generation; (iii) risk assessment and evaluation; and (iv) risk management and communication, were collected and analyzed. The NTD programs in the four countries had a strategic master plan, with pharmacovigilance components and mechanisms to disseminate pharmacovigilance information. However, zero individual case safety reports were received in the last 12 months (2017/2018). There was either limited or no collaboration between the NTD programs and their respective national pharmacovigilance centers. None of the NTD programs had a specific budget for pharmacovigilance. The NTD program in all four countries had some safety monitoring elements. However, key elements, such as the reporting of adverse events, collaboration with national pharmacovigilance centers, and budget for pharmacovigilance activity, were limited/missing.


Asunto(s)
Enfermedades Desatendidas , Farmacovigilancia , Etiopía , Humanos , Kenia/epidemiología , Enfermedades Desatendidas/tratamiento farmacológico , Enfermedades Desatendidas/epidemiología , Rwanda/epidemiología , Tanzanía/epidemiología
15.
Artículo en Inglés | MEDLINE | ID: mdl-33672237

RESUMEN

Neglected Tropical Diseases (NTDs) trap individuals in a cycle of poverty through their devastating effects on health, wellbeing and social-economic capabilities that extend to other axes of inequity such as gender and/or ethnicity. Despite NTDs being regarded as equity tracers, little attention has been paid toward gender dynamics and relationships for gender-equitable access to NTD programs in sub-Saharan Africa (SSA). This paper examines the impact of NTDs on women's health and wellbeing in SSA using Kenya as a case study. This research is part of a larger research program designed to examine the impact of NTDs on the health and wellbeing of populations in Kenya. Thematic analysis of key informants' interviews (n = 21) and focus groups (n = 5) reveals first that NTDs disproportionately affect women and girls due to their assigned gender roles and responsibilities. Second, women face financial and time constraints when accessing health care due to diminished economic power and autonomy. Third, women suffer more from the related social consequences of NTDs (that is, stigma, discrimination and/or abandonment), which affects their health-seeking behavior. As such, we strongly suggest a gender lens when addressing NTD specific exposure, socio-economic inequities, and other gender dynamics that may hinder the successful delivery of NTD programs at the local and national levels.


Asunto(s)
Enfermedades Desatendidas , Salud de la Mujer , Prestación de Atención de Salud , Femenino , Humanos , Kenia/epidemiología , Enfermedades Desatendidas/epidemiología , Pobreza
16.
Artículo en Inglés | MEDLINE | ID: mdl-33673712

RESUMEN

Despite the well-documented health benefits of recreational sports, few opportunities exist in lower- and middle-income countries for adult women to participate in recreational physical activities. An explanatory sequential mixed methods approach was used to explore associations between an innovative soccer program for adult women and self-reported health status. Cross-sectional survey data were collected in 2018-2019 from 702 women in the Nikumbuke Project, a health and literacy program in southeastern rural Kenya, followed by focus group discussions with 225 women who also participated in the Project's soccer program. Quantitative findings suggest that women who participated in soccer had 67% greater odds of reporting good or excellent health than their non-soccer playing peers. Thematic analysis of qualitative data indicated that women credited soccer with less pain, fatigue, and stress, as well as weight loss and reduced dependence on medicine for hypertension, pain, and sleep problems. Women equated health benefits with greater ease and efficiency in completing chores, reduced worries, youthful energy, male-like strength, and pleased husbands. Soccer programs for adult women may be particularly effective interventions in settings where access to health care is limited and where lack of opportunity to engage in physical aerobic activity increases women's risks for poor health outcomes.


Asunto(s)
Población Rural , Salud de la Mujer , Adulto , Estudios Transversales , Femenino , Grupos Focales , Humanos , Kenia , Masculino
17.
Nat Commun ; 12(1): 1742, 2021 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-33741975

RESUMEN

A highly protective vaccine will greatly facilitate achieving and sustaining malaria elimination. Understanding mechanisms of antibody-mediated immunity is crucial for developing vaccines with high efficacy. Here, we identify key roles in humoral immunity for Fcγ-receptor (FcγR) interactions and opsonic phagocytosis of sporozoites. We identify a major role for neutrophils in mediating phagocytic clearance of sporozoites in peripheral blood, whereas monocytes contribute a minor role. Antibodies also promote natural killer cell activity. Mechanistically, antibody interactions with FcγRIII appear essential, with FcγRIIa also required for maximum activity. All regions of the circumsporozoite protein are targets of functional antibodies against sporozoites, and N-terminal antibodies have more activity in some assays. Functional antibodies are slowly acquired following natural exposure to malaria, being present among some exposed adults, but uncommon among children. Our findings reveal targets and mechanisms of immunity that could be exploited in vaccine design to maximize efficacy.


Asunto(s)
Inmunidad Humoral , Malaria/inmunología , Malaria/prevención & control , Receptores de IgG/inmunología , Esporozoítos/inmunología , Adulto , Anciano , Anticuerpos Antiprotozoarios/inmunología , Niño , Femenino , Humanos , Kenia , Vacunas contra la Malaria/inmunología , Masculino , Persona de Mediana Edad , Monocitos/inmunología , Neutrófilos/inmunología , Fagocitosis/inmunología , Plasmodium falciparum/inmunología , Receptores de IgG/metabolismo , Células THP-1 , Adulto Joven
18.
BMJ Glob Health ; 6(3)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33758014

RESUMEN

We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN's aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practical problems of service delivery, drive improvements in quality and test interventions. By including multiple routine settings in research, we aimed to promote generalisability of findings and demonstrate potential efficiencies derived from LHS. We illustrate the nature and range of research CIN has supported over the past 7 years as a form of LHS. Clinically, this has largely focused on common, serious paediatric illnesses such as pneumonia, malaria and diarrhoea with dehydration with recent extensions to neonatal illnesses. CIN also enables examination of the quality of care, for example that provided to children with severe malnutrition and the challenges encountered in routine settings in adopting simple technologies (pulse oximetry) and more advanced diagnostics (eg, Xpert MTB/RIF). Although regular feedback to hospitals has been associated with some improvements in quality data continue to highlight system challenges that undermine provision of basic, quality care (eg, poor access to blood glucose testing and routine microbiology). These challenges include those associated with increased mortality risk (eg, delays in blood transfusion). Using the same data the CIN platform has enabled conduct of randomised trials and supports malaria vaccine and most recently COVID-19 surveillance. Employing LHS principles has meant engaging front-line workers, clinical managers and national stakeholders throughout. Our experience suggests LHS can be developed in low and middle-income countries that efficiently enable contextually appropriate research and contribute to strengthening of health services and research systems.


Asunto(s)
Servicios de Salud del Niño/normas , Prestación de Atención de Salud/normas , Accesibilidad a los Servicios de Salud/normas , Investigación sobre Servicios de Salud , Mejoramiento de la Calidad , /epidemiología , Niño , Preescolar , Países en Desarrollo , Diarrea/epidemiología , Diarrea/prevención & control , Humanos , Lactante , Recién Nacido , Kenia/epidemiología , Malaria/epidemiología , Malaria/prevención & control , Pandemias , Neumonía/epidemiología , Neumonía/prevención & control
19.
Emerg Infect Dis ; 27(4): 1201-1205, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33754992
20.
BMJ Open ; 11(3): e042749, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33658260

RESUMEN

OBJECTIVES: COVID-19 may spread rapidly in densely populated urban informal settlements. Kenya swiftly implemented mitigation policies; we assess the economic, social and health-related harm disproportionately impacting women. DESIGN: A prospective longitudinal cohort study with repeated mobile phone surveys in April, May and June 2020. PARTICIPANTS AND SETTING: 2009 households across five informal settlements in Nairobi, sampled from two previously interviewed cohorts. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes include food insecurity, risk of household violence and forgoing necessary health services due to the pandemic. Gender-stratified linear probability regression models were constructed to determine the factors associated with these outcomes. RESULTS: By May, more women than men reported adverse effects of COVID-19 mitigation policies on their lives. Women were 6 percentage points more likely to skip a meal versus men (coefficient: 0.055; 95% CI 0.016 to 0.094), and those who had completely lost their income were 15 percentage points more likely versus those employed (coefficient: 0.154; 95% CI 0.125 to 0.184) to skip a meal. Compared with men, women were 8 percentage points more likely to report increased risk of household violence (coefficient: 0.079; 95% CI 0.028 to 0.130) and 6 percentage points more likely to forgo necessary healthcare (coefficient: 0.056; 95% CI 0.037 to 0.076). CONCLUSIONS: The pandemic rapidly and disproportionately impacted the lives of women. As Kenya reopens, policymakers must deploy assistance to ensure women in urban informal settlements are able to return to work, and get healthcare and services they need to not lose progress on gender equity made to date.


Asunto(s)
Control de Enfermedades Transmisibles/legislación & jurisprudencia , Equidad de Género , Pandemias , Femenino , Política de Salud , Humanos , Kenia/epidemiología , Estudios Longitudinales , Masculino , Estudios Prospectivos , Determinantes Sociales de la Salud
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