Changing mother's hygiene and sanitation practices in resource constrained communities: case study of Turkana District, Kenya.

Lack of adequate sanitation, hygiene and safe portable water are serious global health problems that contribute to deaths of many children under the age of 5 years annually, mainly due to diarrhoeal diseases. This study was set out to determine the extent to which sanitation and hygiene promotion influenced mothers' and children's health in Turkana District; one of the arid Northern frontier Districts of Kenya. A repeat cross-sectional study design with multi-stage sampling method was used. A total of 300 mothers were randomly sampled for interviews in a baseline survey carried out in 2007 and in a post-intervention survey carried out in 2008. Data were collected using questionnaires and analyzed using SPSS for frequencies, cross tabulations and regression amongst other tests. Significant improvements were observed in hand washing practice, presence of hand washing soap at household and refuse pit ownership. In Kakuma Division the proportion of those who washed hands regularly increased from 48.8 to 91.3 % (χ(2) = 7.28, P = 0.122), in Lodwar Central, those who wash hands regularly increased from 85.5 to 89.9 % (χ² = 10.85, P = 0.028) while in Lokichogio, the proportions increased from 77.5 to 93.8 % (χ² = 15.56, P = 0.004). For hand washing soap at household, there was an increase in proportion of those who wash hands with soap from 65 to 78 % (χ² = 3.87, P = 0.049) within the group with no formal education. There was significant reduction of diarrhoea prevalence in children aged less than 5 years. Sanitation and hygiene promotion based on community participatory approaches can lead to significant reduction of diarrhoea in children.

Effects of hygiene and sanitation interventions on reducing diarrhoea prevalence among children in resource constrained communities: case study of Turkana District, Kenya.

Worldwide, lack of access to safe drinking water together with inadequate sanitation and hygiene is an overwhelming contributor to approximately 4 billion cases of illness annually. This study was set out to understand the effects of hygiene and sanitation interventions on targeted health outcomes including diarrhoeal prevalence in children's of Turkana District, Kenya. The interventions undertaken included capacity building and empowerment approach to trigger communities to demand hygiene and sanitation facilities. Three hundred mothers were randomly sampled in a baseline survey carried out in 2007 and in a post-intervention survey carried out in 2008 (a repeat cross-sectional study design). Specimens were collected for microbiological tests of key diarrhoea related pathogens. Overall, Faecal coliform counts per 100 ml sample had significant variations between 2007 and 2008; in Kakuma, reduced from 88 to 30.2 colony units (P = 0.005), Lodwar Central where the number reduced from 91 to 17.3 units (P = 0.003), and in Lokichogio Division, the number reduced from 63.8 to 23.6 units (P = 0.006). From the 230 stool samples examined, the proportion of children from whom infectious pathogens of Proteus spp. was isolated reduced from 16 to 7 % while Escherichia coli reduced from 54 to 41 %. Overall, prevalence of diarrhoea related microbes in children aged <5 years reduced from 91.3 % in 2007 to 78.3 % after intervention (2008). It is notable that sanitation and hygiene promotion leads to significant reduction of diarrhoea prevalence in children aged <5 years. Its application should therefore be up-scaled in resource constrained areas.

Modifiable factors associated with active pulmonary tuberculosis in a Kenyan prison.

OBJECTIVES: To establish modifiable factors associated with active pulmonary tuberculosis (PTB) among prisoners. DESIGN: Retrospective matched case-control study. SETTING: Nakuru GK prison in Kenya. SUBJECTS: A total of 144 subjects (48 cases and 96 controls) were recruited into the study. Cases were adult prisoners who had at least two initial sputum specimens being Acid Fast Bacilli-positive (AFB+) on direct smear microscopy and hence recruited to PTB WHO DOTS Programme. Controls were adults with no chronic cough and not on PTB treatment six months prior to the study. RESULTS: Independent factors significantly associated with active PTB disease were: self reported HIV+ status (OR=11; 95% CI = 2.42-47.77), evidence of BCG vaccination (OR = 0.20; 95% CI = 0.05-0.60), contact with PTB case (OR = 7.0; 95% CI = 1.17-38.23), unemployment (OR = 9.0; 95% CI = 1.84-43.97) and sharing linen (OR = 4.32; 95%CI = 1.08-17.29). CONCLUSIONS: Modifiable factors associated with active PTB in Nakuru G.K prison are: HIV status, BCG vaccination, PTB case contact, poverty and poor personal hygiene. We recommend HIV counselling and testing of all PTB patients, screening for TB upon prison entry and TB contact investigation and improving personal hygiene of prisoners.

Hydrological modelling of snail dispersal patterns in Msambweni, Kenya and potential resurgence of Schistosoma haematobium transmission.

Urinary schistosomiasis is an important source of human morbidity in Msambweni, Kenya, where the intermediate host snail, Bulinus nasutus is found in ponds and water pools. In the past, aquatic habitats in the area have been studied separately; however, recent collections of B. nasutus snails and shells indicated that many of these ponds are in fact connected during and following sufficient rains. Satellite imagery and a geographical information system (GIS) were used to survey the main water courses and potential drainage routes, to locate potential source populations of snails and to determine probable snail dispersal routes. The 2 water bodies implicated as being the most important Schistosoma haematobium transmission foci in the area were found to differ in their degree of connectivity to other B. nasutus source habitats. One pond becomes connected even after normal rains, while the other pond requires prolonged rains or flooding to become connected with source habitats. Consequently, the transmission foci differ in their susceptibility to snail population control measures. Spatially explicit dispersal models that consider the spatial and temporal patterns of connectivity between aquatic habitats will contribute to improved snail surveillance and more focused control for urinary schistosomiasis at a local level.

A comparative study of different albendazole and mebendazole regimens for the treatment of intestinal infections in school children of Usigu Division, western Kenya.

A clinical trial to compare the effectiveness of 4- and 6-mo repeated treatment with albendazole 600 mg (Zentel, SmithKline Beecham) or mebendazole 600 mg (Vermox, Janssen) on geohelminth infections was carried out on children in 6 primary schools; the study included 1,186 children, ages 4 to 19 yr. Kato-Katz examination was performed on stool samples before and after treatment. Overall, albendazole produced better cure rates and egg reduction rates for geohelminths. The cure rates for albendazole were 92.4% for hookworm infection, 83.5% for Ascaris lumbricoides, and 67.8% for Trichuris trichiura. Mebendazole given either 2 or 3 times in a year had cure rates of 50 and 55.0% (respectively) for hookworm, 79.6 and 97.5% for A. lumbricoides, and 60.6 and 68.3% for T. trichiura infection. The geometric mean intensity of hookworm eggs per gram (epg) of stool decreased by 96.7% after albendazole treatment compared with 66.3 and 85.1%, respectively, for 2 or 3 doses of mebendazole (P < 0.05) over the same period. Reductions in epg for A. lumbricoides and T. trichiura were comparable for both drugs. Our results indicate that treatment with albendazole at a 6-mo interval was more effective than mebendazole regimens and may be the best choice for use in the control of the 3 geohelminths.

Prevalence and familial aggregation of schistosomal liver morbidity in Kenya: evaluation by new ultrasound criteria.

Severe periportal fibrosis is not an inevitable consequence of infection with Schistosoma mansoni. Genetic predisposition may be a deciding factor in the development of disease. To assess the contribution of genetic factors in the severity of hepatic fibrosis, the degree of familial aggregation was determined in a Kenyan population. Schistosomal fibrosis was identified with hepatic ultrasound and newly proposed World Health Organization criteria, which include both qualitative and quantitative observations. These 2 aspects of the criteria correlated well with one another. The peak prevalence of ultrasound proven fibrosis trailed 5-10 years behind peak prevalence of infection and declined sharply after age 50 years. This pattern was consistent with either resolution of severe fibrosis over 10-20 years or early death of those severely affected. Genetic predisposition appears to be a weak factor in the development of severe disease in this population, since no household or familial aggregation could be identified.

Evidence against rapid emergence of praziquantel resistance in Schistosoma haematobium, Kenya.

We examined the long-term efficacy of praziquantel against Schistosoma haematobium, the causative agent of urinary schistosomiasis, during a school-based treatment program in the Msambweni area of Coast Province, Kenya, where the disease is highly endemic. Our results, derived from treating 4,031 of 7,641 children from 1984 to 1993, indicate substantial year-to- year variation in drug efficacy. However, the pattern of this variation was not consistent with primary or progressive emergence of praziquantel resistance. Mathematical modeling indicated that, at current treatment rates, praziquantel resistance will likely take 10 or more years to emerge.

Dynamics and control of Schistosoma haematobium transmission in Kenya: an overview of the Msambweni Project.

Ecologic modeling of Schistosoma transmission in endemic communities has suggested that antiparasite therapy targeted at the most heavily infected segment of the human population (i.e., school-age children) should have a significant impact on local parasite transmission. Our 1984-1991 experience with age-targeted therapy in the Msambweni area of Kenya has shown an overall decrease in area transmission within 1-2 years following initiation of annual treatment of school-age groups. Snail monitoring confirmed a continuing but variable reduction of vector infection rates. However, subgroup analysis showed significant differences in transmission suppression between more developed coastal villages with piped-water kiosks and villages with only limited access to safe water supplies. Villages without piped water were marked by higher initial prevalences of S. haematobium infection, greater prevalence among adults, longer and more frequent contact with high-risk water sources, and persistently high transmission despite compliance with parasitologic screening or drug therapy. We conclude that targeted therapy had a significant impact on S. haematobium transmission in some areas, but that more extensive or more prolonged coverage is necessary to reduce the rate of new infection in high-risk villages. Defining field-use algorithms, based on decision analysis of economic and ecologic parameters, should provide effective guidelines for selective versus mass treatment in expanded control areas.

Age-targeted chemotherapy for control of urinary schistosomiasis in endemic populations.

Severity of urinary tract morbidity increases with intensity and duration of Schistosoma haematobium infection. We assessed the ability of yearly drug therapy to control infection intensity and reduce S. haematobium-associated disease in children 5-21 years old in an endemic area of Kenya. In year 1, therapy resulted in reduced prevalence (66% to 22%, P < 0.001) and intensity of S. haematobium infection (20 to 2 eggs/10 mL urine), with corresponding reductions in the prevalence of hematuria (52% to 19%, P < 0.001). There was not, however, a significant first-year effect on prevalence of urinary tract abnormalities detected by ultrasound. Repeat therapy in years 2 and 3 resulted in significant regression of hydronephrosis and bladder abnormalities (41% to 6% prevalence, P < 0.01), and further reductions in proteinuria. Repeat age-targeted therapy was associated with decreased prevalence of infection among young children (< 5 yr) entering into the targeted age group. Two years after discontinuation of therapy, intensity of S. haematobium infection and ultrasound abnormalities remained suppressed, but hematuria prevalence began to increase (to 33% in 1989). Reinstitution of annual therapy in 1989 and 1990 reversed this trend. We conclude that annual oral therapy provides an effective strategy for control of morbidity due to S. haematobium on a population basis, both through regression of disease in treated individuals, and prevention of infection in untreated subjects.