Malnutrition and cachexia among cancer out-patients in Nairobi, Kenya.

Cancer is the third leading cause of death in Kenya. However, there is scarce information on the nutritional status of cancer patients to guide in decision making. The present study sought to assess the risk of malnutrition, and factors associated with malnutrition and cachexia, among cancer out-patients, with the aim of informing nutrition programmes for cancer management in Kenya and beyond. This was a facility-based cross-sectional study performed at Kenyatta National Hospital and Texas Cancer Centre in Nairobi, Kenya. The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool (MUST). Diagnoses of malnutrition and cachexia were done using the European Society of Clinical Nutrition and Metabolism (ESPEN) and Fearon criteria, respectively. A total of 512 participants were assessed. Those at risk of malnutrition were 33·1 % (12·5 % at medium risk, 20·6 % at high risk). Prevalence of malnutrition was 13·4 %. The overall weight loss >5 % over 3 months was 18·2 % and low fat-free mass index was 43·1 %. Prevalence of cachexia was 14·1 % compared with 8·5 % obtained using the local criteria. Only 18·6 % participants had received any form of nutrition services. Age was a predictor of malnutrition and cachexia in addition to site of cancer for malnutrition and cigarette smoking for cachexia. The use of the MUST as a screening tool at the first point of care should be explored. The predictive value of current nutrition assessment tools, and the local diagnostic criteria for malnutrition and cachexia should be reassessed to inform the development of appropriate clinical guidelines and future capacity-building initiatives that will ensure the correct identification of patients at risk for timely care.

Collaboration between developing and developed countries and between developing countries in occupational health research and surveillance.

Collaborative occupational health and safety studies between counterparts in developing and developed countries and between developing countries have demonstrated their potential for improving occupational health and safety. Such collaboration in occupational health and safety is encouraged in the development of infrastructure in research empowerment and capacity building. This action includes the setting of priorities, the identification and documentation of problems, sponsorship, data bases and surveillance systems, technical support, methodology, publishing, research and training programs, controlled intervention, information exchange, and networking. Examples of priorities in occupational health and safety in the developing world include the informal sector (informally hired and independent workers), temporary work, pesticides, accidents, dusts, carcinogens, solvents, ergonomics, women and child labor, human immunodeficiency virus/acquired immunodeficiencey syndrome (HIV/AIDS), and transfer of hazardous materials and technologies. The sustainability of occupational health and safety structures and functions in the developing countries is a primary concern. Socioethical principles emphasize local, national, mutual and global gains. Examples of collaboration are given. Pervasive problems and strategies toward their solution are highlighted.

A survey on management perspectives of the state of workplace health and safety practices in Kenya.

A baseline survey was conducted in 1995 on management perspectives of occupational health and safety (OHS) structures and practices in Kenya. This was achieved by interviewing management and supervisory staff attending 1 week multi-disciplinary courses that were organized by the Federation of Kenya Employers (FKE) and the International Labour Office (ILO) at hotel venues in Kenya. The purpose of the survey was to gain some insight into work safety conditions in Kenya and to assess the potential for a new OHS manual to meet existing knowledge gaps. The manual was locally developed in 1993/4 by Kenyan OHS experts in collaboration with colleagues from the Swedish National Institute for Working Life. Results of the survey from 65 participants indicated that most workplace managers were not familiar with the Kenyan work safety legislation. Work injuries were largely attributable to working with dangerous machinery. Occupational diseases and HIV/AIDS were cited as other causes of workplace morbidity and mortality. Although most respondents (70%) were satisfied with their work safety conditions, only 37% said their workplaces were annually audited by labour inspectors while 45% said injured workers were not treated well by management. Many workplaces (65%) violated the mandatory legal requirement on the establishment of health and safety committees. The OHS resource person and course content were rated highly by most respondents (96%). The foregoing results provided the basis of a needs analysis for future OHS programs in Kenya.

The status of pesticide usage in East Africa

A descriptive epidemiologic study using pretested questionnaires was conducted in East Africa in 1989/90 and looked at various types of pesticides in current usage in the region especially with regard to their procurement; distribution and utilization. Hospital records were examined for reported cases of pesticide poisoning as well as assessing the knowledge and the awareness of health care providers on the recognition and potential of pesticide poisoning. The main pesticide importers in the region were the Ministries of Agriculture whereas distribution was dominated by co-operative unions. Although pesticide regulatory mechanisms existed; their weak structures enabled the importation and usage of pesticides no longer in use in the countries of origin. Incidents of abuse were noted; as in the use of organochlorine pesticides on food crops and reported poisoning cases in the district hospitals where Kenya and Tanzania reported 455 and 736 cases respectively. Though tentative; more than 40 per cent of the health care professionals interviewed could not recognise pesticide poisoning cases. Therefore to avert pesticide related morbidity and mortality in the region; pesticide regulatory bodies need strenghning while pesticide users; the general public and health care workers should be educated on pesticides