Age assessment services in public dental health facilities in Kenya: burden and sources of referral (a cross-sectional study).

Introduction: the need for age assessment remains relevant due to unregistered births or lack of identification documents as a result of political and socioeconomic conflicts. Dentists play a significant role in age assessment. In order to establish the need for capacity building and collaboration, the study set out to determine the proportion of dental patients referred for age assessment and their sources of referral. Methods: a cross-sectional study, based on 5-year records (2014-2018) of dental patients and a selected sample of 316 patients who visited for age assessment in 2019-2020 in the same hospitals. The study centers were 8 county hospitals. Variables included gender, dental visits, health facility, and sources of referral. One-way Analysis of Variance (ANOVA) and Fisher´s Exact test were used to identify a significant association between variables. Results: from the records, 12,738 (5.7%) patients sought age assessment services. Females 6,410 (50.3%) and males 6,328 (49.7%) were nearly equal. There was a statistically significant difference in the average number of patients who required age assessment services from different facilities, p=0.000. The selected sample comprised of 186 (58.9%) and 130 (41.1%) males and females respectively. Sources of referral included; court of law (267, 84.5%), prior to acquiring identification documents (47, 14.9%), and others (2, 0.6%). Conclusion: an average of 5% of dental patients seek age assessment services signifying the need for sustained capacity building so as to ensure competent service delivery. The majority of the sampled patients were referrals from the court of law. Further research on how the dental fraternity can collaborate with the Judiciary to ensure justice in age disputes is recommended.

Prognostic factors influencing HIV-free survival among infants enrolled for HIV early infant diagnosis services in selected hospitals in Nairobi County, Kenya.

BACKGROUND: Despite being a preventable disease, pediatric HIV infection continues to be a public health concern due to the morbidity and mortality associated with the disease. Vertical transmission of HIV occurs when a mother living with HIV passes the virus to her baby during pregnancy, childbirth, or breastfeeding. Globally, the vertical transmission rate of HIV is 9% with sub-Saharan Africa accounting for 90% of these infections. In Kenya, the national vertical transmission rates of HIV stood at 11.5% by the end of 2018, with a target to reduce vertical transmission rates to below 5% and 2% in breastfeeding and non-breastfeeding infants respectively, by the end of 2021. OBJECTIVE: To determine the prognostic factors influencing HIV-free survival among infants enrolled for HIV early infant diagnosis (EID) services in selected hospitals in Nairobi County, Kenya. METHODS: A prospective cohort study design was adopted. HIV exposed infants were recruited at six weeks to determine HIV-free survival over 12 months follow up. Simple random sampling was used to select 166 infants and data were collected from the mothers using semi-structured interviewer-administered questionnaires. Log-rank tests were used to test for associations at the bi-variable level while Cox-proportional regression was used to analyze data at the multi-variable level, with the aid of STATA 14 software. Ethical approval was obtained from Kenya Medical Research Institute, Scientific Ethics Review Unit. RESULTS: The overall infant HIV incidence rate over one-year follow-up was 9 cases per 100 person-years (95% CI: 5.465-16.290). The failure event was defined as an infant with a positive PCR test during the study period with total failures being 13 (9.41%) over 12 months. Prognostic factors associated with poor infant HIV-free survival were young maternal age (18-24 years) and mothers with a recent HIV diagnosis of ≤ 2 years since a positive HIV diagnosis (HR 5.97 CI: 1.20, 29.58) and (HR 6.97 CI: 1.96, 24.76), respectively. CONCLUSION: Maternal prognostic factors associated with poor infant HIV-free survival were young maternal age (18-24 years) and recent maternal HIV diagnosis of ≤ 2 years since positive HIV diagnosis. The study recommended the development of an intervention package with more rigorous adherence counseling and close monitoring for young mothers, and mothers with recent HIV diagnoses.

Influence of hepatitis B virus co-infection on virological and immunological response to antiretroviral treatment among HIV patients attending comprehensive care clinics in Makueni County, Kenya.

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.

Determinants of HIV positive status at first PCR test among toddlers seeking early infant diagnosis (EID) services in selected hospitals in Nairobi County, Kenya

Introduction: Early Infant Diagnosis (EID) is the practice of testing infants for HIV within the first 4­6 weeks of life or at the earliest opportunity possible so as to promptly link HIV-infected infants to healthcare and treatment. In the absence of timely HIV testing and Antiretroviral Therapy (ART) initiation, one-third of infants living with HIV die before their first birthday and more than half die before 2 years. Worldwide, Mother To Child Transmission (MTCT) rates accounted for 8.9% of all HIV infections by the end of 2015, with Sub-Saharan Africa accounting for 12% of these infections. In Kenya, MTCT infection rates were at 14%, accounting for 7% of all new infant infections globally by the same period. Objection: The objectives of this study was to establish the determinants of HIV positive status at first PCR Test among infants seeking EID services in some selected hospitals in the Nairobi County, Kenya. Materials and Methodology: A longitudinal cohort study employing a mixed-method approach was used. Quantitative data was collected from pairs of 163 mother-infant using interviewer administered, pre-tested, and semi-structured questionnaires. While qualitative data was collected using Focus Group Discussion (FGDs) guides, it was coded, cleaned and analyzed using STATA Version 14. Quantitative data was analyzed using Fisher's exact test (p= 0.1) and Poisson Regression (p= 0.05) at bivariate and multivariable levels respectively. Thematic analysis was undertaken for qualitative data. Results: The findings from the adjusted parsimonious model revealed that, three variables influenced the infant HIV status at first PCR test. The study participants who had been administered with ART during pregnancy had a lower risk (RR= 0.06) of getting HIV positive infants relative to those who hadn't received ARVs during pregnancy (95% CI 0.014, 0.213 p= 0.000). Respondents who had been initiated on ART during the first trimester had lower risk (RR= 0.1) of getting an HIV positive infant than respondents who were administered with ARVs in the third trimester (95% CI 0.014, 0.021, p= 0.001). Respondents on first-line regimen had a lower risk (RR= 0.04) of getting HIV infected infants compared to those who were on the second line regimen (95% CI 0.012, 0.114, p= 0.000) confirming all the three significant variables as protective factors. Conclusion: The study corroborate that, first line ART regimen administered before pregnancy or during the first trimester of pregnancy was effective in lowering the risk of getting an HIV positive infant. Pediatric HIV infection, disease progression is quite rapid and without prompt treatment, most infants might not survive their second birthday

Uptake of antenatal care services among women of reproductive age in Mandera County, Kenya

Background: Antenatal care is an opportunity for prevention and management of existing and potential causes of maternal and newborn mortality and morbidity. The new WHO antenatal care model, stipulates that, the first antenatal care visit takes place within the first trimester (gestational age of <12 weeks) and then, additional seven visits. Only 37% of women in Mandera County had utilized the recommended minimum four ANC visits. Objectives: There was need to assess the critical factors influencing the uptake of ANC in Mandera County Kenya, in order to enlighten stakeholders on the development of appropriate ANC Service Provision Program. This study took the intiative of bridging the gap. Methodology: The study adopted cross-sectional design using both quantitative and qualitative methods. Stratified and Sample random sampling were used to get a quantity of 348 respondents. Data was collected using questionnaire, FGDs and KIIs guides and Pearson's Chi-square test. Multivariate analysis using logistic regression was summarized to establish the strengths of the association. Odds Ratio (OR) and 95% Confidence Interval (CI) were used and threshold for statistical significance was set at p<0.05. Qualitative data was transcribed and analyzed thematically. Results: The proportion of women who utilized ANC was 83.0% and only 60.3% had attended recommended visits. Individual factors that influenced ANC uptake were; age, level of education, monthly income, gravida, parity and complications during pregnancy. Contextual factors that influenced ANC were; time taken to reach health facilities, source of maternal information and local discouragements. There was no significant relationship between Religion, marital status, age at first pregnancy with ANC uptake. Conclusion: The negative perception can change by; improving culturally sensitive ANC services accessibility by; increasing the number of female skilled health workers and reducing traveling time to the health facilities by conducting regular outreach services targeting villages with no close facility to pastoral communities. It will be important to strengthen CHVs' capacity to emphasize primary health care and accelerate progress towards UHC in the County. Provide health education and promotion targeting older mothers with high parity, women inclined to harmful cultural practices and their partners. In spite of a wide range of literature on ANC topics in most parts of Kenya, it was limited pertaining Mandera County. Recomandations: Meticulous understanding of local barriers and facilitating factors of ANC utilization is prerequisite for designing and implementing interventions that aim to improve ANC uptake. Well developed infrastructure is a basic need that falls in the category of basic wants for Mandera County

Khat use and psychotic symptoms in a rural Khat growing population in Kenya: a household survey.

BACKGROUND: Khat is an amphetamine like psychostimulant chewed by over 10 million people globally. Khat use is thought to increase the risk of psychosis among its chewers. The evidence around this however remains inconclusive stemming from the scanty number of studies in this area and small study sample sizes. We undertook a large household survey to determine the association between psychotic symptoms and khat chewing in a rural khat growing and chewing population in Kenya. METHODS: For this cross-sectional household survey, we randomly selected 831 participants aged 10 years and above residing in the Eastern region of Kenya. We used the psychosis screening questionnaire (PSQ) to collect information on psychotic symptoms and a researcher designed sociodemographic and clinical questionnaire to collect information on its risk factors. We used descriptive analysis to describe the burden of khat chewing and other substance use as well as rates and types of psychotic symptoms. Using a univariate and multivariate analyses with 95% confidence interval, we estimated the association between khat chewing and specific psychotic symptoms. RESULTS: The prevalence of current khat chewing in the region was at 36.8% (n = 306) with a male gender predominance (54.8%). At least one psychotic symptom was reported by 16.8% (n = 168) of the study population. Interestingly, psychotic symptoms in general were significantly prevalent in women (19.5%) compared to men (13.6%) (p = 0.023). Khat chewing was significantly associated with reported strange experiences (p = 0.024) and hallucinations (p = 0.0017), the two predominantly reported psychotic symptoms. In multivariate analysis controlling for age, gender, alcohol use and cigarette smoking, there was a positive association of strange experiences (OR, 2.45; 95%CI, 1.13-5.34) and hallucination (OR, 2.08; 95% C.I, 1.06-4.08) with khat chewing. Of note was the high concurrent polysubstance use among khat chewers specifically alcohol use (78.4%) and cigarette smoking (64.5%). CONCLUSIONS: Psychotic symptoms were significantly elevated in khat users in this population. Future prospective studies examining dose effect and age of first use may establish causality.

Associations of Interleukin-1 Polymorphisms with Chronic Periodontitis in Two Different Kenyan Ethnic Groups: A Case Control Study.

OBJECTIVE: The aim of this study was to investigate the association between IL-1ß and IL-1α isoforms with chronic periodontitis in two Kenyan ethnic groups, Taitas and Swahilis. METHODS: A case-control study in which participants were assessed for dental plaque, gingival inflammation, pocket depth and gingival recession after informed consent. Buccal swab samples were obtained and deoxyribonucleic acid was isolated from the swabs using QIAamp DNA purification protocol followed by polymerase chain reaction amplification using specific primers to IL-1 α rs1800587 (-889) and rs17561 (+4845) and IL-1ß (rs16944 (-511) and rs11443624 (+3954). Restriction fragment length polymorphisms were recorded and association with clinical data was assessed. RESULTS: Three hundred and ninety participants were recruited; four loci (-511, -889, +3953 and +4845) were analyzed per subject, equivalent to 1560 analysis events. No deviation from Hardy Weinberg equilibrium 1df was observed. Frequency of allele 2 at IL-1ß +3954 was associated with chronic periodontitis in Taitas (OR = 1.94, 95% CI = 1.01 - 3.70, p = 0.045), whereas frequency of allele 1 at IL-1α -889 was associated with chronic periodontitis in Swahilis (OR = 3.16, 95% CI = 1.644 - 6.083, p less than 0.001). Allele 1 at locus IL-1α -889 was also associated with mild, (OR = 5.2, 95% CI = 1.445 - 18.71, p = 0.005), moderate (OR = 4.51, 95% CI = 2.08 - 9.79, p less than 0.001) and severe disease (OR = 2.19, 95% CI = 1.013 - 4.738, p = 0.042) in Swahilis. Haplotype 3 (allele 1 at all four loci) was significantly associated with chronic periodontitis in Taitas (OR = 2.4, 95% CI = 1.1 - 5.14, p = 0.022) and Swahilis (OR = 4.2, 95%CI = 1.35 - 13.3, p = 0.008). CONCLUSIONS: This study has shown that in the African population of Bantu origin, the two polymorphisms associated with chronic periodontitis are IL-1ß +3954 in Taitas and IL-1α-889 in Swahilis. Additionally, haplotype 3 was associated with chronic periodontitis in both ethnic groups.

Food-Handling Practices and Environmental Factors Associated With Food Contamination Among Street Food Vendors in Nairobi County, Kenya: A Cross-Sectional Study.

BACKGROUND: Lack of adequate sanitation and refuse disposal facilities are among the factors found to contribute to food contamination among street food vendors. Most vending facilities are near crowded places, such as bus terminals or markets to attract consumers, and the few basic amenities, such as toilets, are inadequate. The objective of the study was to determine which sanitation practices were associated with food contamination in Githurai and Gikomba markets in Nairobi County. METHODOLOGY: Using a cross-sectional study design, we systematically randomly sampled 149 street food vendors and used questionnaires to interview them and make observations. RESULTS: A significant negative association was observed between access to a toilet facility and food contamination (P<.001), with a decreased risk of occurrence of food contamination observed where vendors had access to a toilet facility (OR 0.095; 95% confidence interval [CI], 0.039-0.227). Accessibility of running water around the toilet facility was negatively associated with food contamination (P<.001), with vendors who reported access to running water having a lower occur-rence of food contamination (15.9%) compared with those who had no access to running water (30%). Presence of pests/rodents was significantly associated with food contamination (P<.001), with vendors who reported presence of pests/rodents having a 5.9-fold risk (OR 5.921; 95% CI, 2.831-12.383) of contaminated food. Access to fresh running water while preparing food, hand washing before handling food, and use of an apron were the food-handling practices that were negatively associated with food contamination (P<.005). Use of a head cover, hand washing after handling raw food, and the way food was served and stored had no statistically significant association with food contamination (P>.05). CONCLUSIONS: Access to a toilet facility and availability of running water within the toilet facility decreased the likelihood of food contamination. The presence of pests/rodents had a positive association with food contamination. There is a need for more basic amenities, especially toilets and water facilities, within these markets, as well as sensitisation on pest control.

Folate deficiency and utilization of folic acid fortified flour among pregnant women attending antenatal clinic at Pumwani Maternity Hospital, Kenya, 2015.

INTRODUCTION: in 2012, the Government of Kenya amended the Food, Drug and Chemical Substances Act to make the fortification of maize and wheat flour with folic acid mandatory. We assessed folate deficiency, awareness and use of folic acid fortified flour among pregnant women receiving antenatal care (ANC) at a clinic at Pumwani Maternity Hospital, Kenya, 2015. METHODS: we conducted a cross-sectional survey at Pumwani Maternity Hospital between October and November 2014. We enrolled pregnant women who received ANC and interviewed them using a semi-structured questionnaire after obtaining informed consent. Blood samples were collected from all study participants and serum folate level was analyzed by electrochemiluminescence immunoassay. Folate deficiency was defined as serum folate of < 10nmols/L and borderline folate deficiency was defined as serum folate of between 10nmols/L and 15nmols/L. RESULTS: among the 247 study participants, two (1%) had folate deficiency. One hundred and seventy-nine (73.4%) had heard about folic acid, but only 56 (23%) had heard about folic acid fortified flour. Overall, 198 (80%) study participants consumed fortified brands of maize flour and 205 (84%) consumed fortified brands of wheat flour; only four (2%) and two (1%) of study participants consumed specific brands of maize and wheat flour respectively because they were fortified. CONCLUSION: the prevalence of folate deficiency was low and this may have been because of the availability of fortification programs. Although there was limited knowledge of fortified flour, utilization was high. The Kenyan Ministry of Health should enforce implementation of the legislation on maize flour and wheat flour fortification by all milling industries.

Effects of mother related factors on perinatal outcomes-a study of mothers seeking antenatal care at public and non-public health facilities in Kisii County, Kenya.

The study sought to determine clientlevel and facility-level factors that affect perinatal outcomes among women attending comparable public (government owned) and non-public health facilities (non-government owned) in Kisii County-Kenya in the context of free maternity care. A total of 365 pregnant mothers recruited in 4 health facilities during their ANC visit and followed up to 2 weeks post-delivery but only 287 attended all follow-up visits. Study subjects were recruited proportionate to number of deliveries each of the facilities had conducted in the preceding 6 months. The dependent variable was perinatal outcome; independent variables were demographic and clinical factors. Analysis was done using χ2, logistic regression, paired t and McNemar's tests. Maternal BMI and a mother's parity were statistically correlated with perinatal outcome (χ2= 8.900, d.f =3, P=0.031 and (χ2= 13.232, d.f =4, P=0.039) respectively. Mothers with 1 parity were 4.5 times more likely to have normal perinatal outcomes (OR =4.5, 95% CI 2.25-14.29, P=0.012). There was a significant relationship between a mother's knowledge of pregnancy-related issues and the baby's weight (t=-67.8 d.f. 213 P<0.001). Mothers' knowledge on pregnancy issues and spousal involvement influences perinatal outcomes. Dietary Diversity Score (DDS) of a mother does not have a direct influence on the outcome of a pregnancy. There is need to focus on maternal factors that affect perinatal outcomes besides free maternity care.

Effects of mother related factors on perinatal outcomes-a study of mothers seeking antenatal care at public and non-public health facilities in Kisii County, Kenya

The study sought to determine client level and facility-level factors that affect perinatal outcomes among women attending comparable public (government owned) and non-public health facilities (non-government owned) in Kisii County-Kenya in the context of free maternity care. A total of 365 pregnant mothers recruited in 4 health facilities during their ANC visit and followed up to 2 weeks post-delivery but only 287 attended all follow-up visits. Study subjects were recruited proportionate to number of deliveries each of the facilities had conducted in the preceding 6 months. The dependent variable was perinatal outcome; independent variables were demographic and clinical factors. Analysis was done using χ2, logistic regression, paired t and McNemar's tests. Maternal BMI and a mother's parity were statistically correlated with perinatal outcome (χ2= 8.900, d.f =3, P=0.031 and (χ2= 13.232, d.f =4, P=0.039) respectively. Mothers with 1 parity were 4.5 times more likely to have normal perinatal outcomes (OR =4.5, 95% CI 2.25-14.29, P=0.012). There was a significant relationship between a mother's knowledge of pregnancy-related issues and the baby's weight (t=-67.8 d.f. 213 P<0.001). Mothers' knowledge on pregnancy issues and spousal involvement influences perinatal outcomes. Dietary Diversity Score (DDS) of a mother does not have a direct influence on the outcome of a pregnancy. There is need to focus on maternal factors that affect perinatal outcomes besides free maternity care

p16(INK4a)/Ki-67 dual stain cytology for cervical cancer screening in Thika district, Kenya.

BACKGROUND: The identification of suited early detection tests is one among the multiple requirements to reduce cervical cancer incidence in developing countries. METHODS: We evaluated p16(INK4a)/Ki-67 dual-stain cytology in a screening population in Thika district, Kenya and compared it to high-risk human papillomavirus (HR-HPV) DNA testing and visual inspection by acetic acid (VIA) and Lugol's iodine (VILI). RESULTS: Valid results for all tests could be obtained in 477 women. 20.9 % (100/477) were tested positive for HR-HPV DNA, 3.1 % (15/477) had positive VIA/VILI and 8.2 % (39/477) positive p16(INK4a)/Ki-67 cytology. Of 22 women that showed up for colposcopy and biopsy, 6 women were diagnosed with CIN3 and two with CIN2. All women with CIN2/3 were negative in VIA/VILI screening and positive by HR-HPV DNA testing. But HPV was also positive in 91.7 % (11/12) of women with normal histology. p16(INK4a)/Ki-67 cytology was positive in all 6 women with CIN3, in one of the two CIN2 and in only 8.3 % (1/12) of women with normal histology. CONCLUSIONS: p16(INK4a)/Ki-67 cytology is an interesting test for further studies in developing countries, since our findings point to a lower fraction of false positive test results using p16(INK4a)/Ki-67 cytology compared to HPV DNA testing in a Kenyan screening population. VIA/VILI missed all histology-proven CIN2/3.

Detecting DNA viruses in oral fluids: evaluation of collection and storage methods.

Storing saliva for nucleic acid diagnostics is problematic in resource-constrained settings. DNA Genotek's OMNIgene™·DISCOVER kit aims to stabilise microbial DNA at room temperature. We evaluate this for long-term storage, determining DNA quantity/purity and human herpesvirus 8 (HHV-8) load as indicator. Viral loads and DNA degradation were assayed over 14months in HHV-8-negative saliva spiked with cell-associated and cell-free virus and saliva collected fresh frozen and into kits from 10 HIV-positive patients. Viral loads remained constant for 6-9months, yielding high quantities of DNA: subsequent losses were ≤48%. Patient samples, frozen or kit stored, produced pure DNA of comparable concentration. Higher HHV-8 detection in frozen saliva resulted from losses during ethanol precipitation using kits. After 14months, DNA degradation was significant in frozen saliva, but that in kits had integrity similar to fresh samples. Storing frozen saliva is detrimental. This kit is well suited for collection, long-term storage, and assay of viral DNA in resource-constrained settings.

Diagnostic challenges of oral and cutaneous Kaposi's sarcoma in resource-constrained settings.

OBJECTIVES: Kaposi's sarcoma (KS), caused by HHV-8, is the most frequent HIV-associated malignancy worldwide and remains a major scourge in Sub-Saharan Africa. KS is also endemic in much of Africa. There is a risk of misdiagnosis based solely on clinical appearance and haematoxylin and eosin (H&E) staining, especially with other reactive and neoplastic vascular proliferations which occur in the mouth. This study examined oral and cutaneous biopsies from clinically diagnosed lesions of KS in Kenya, using histopathology supplemented with immunohistochemistry (IHC) and polymerase chain reaction (PCR) for HHV-8 as confirmation of diagnosis. METHODS: Biopsies of 49 lesions (28 oral, 21 cutaneous) previously diagnosed as 'KS' were re-examined by H&E staining and IHC targeting HHV-8 LANA-1. Positive controls were sections from embedded BCBL-1 cell lines. Negative controls were from three different HHV-8-negative biopsies. Confirmation of HHV-8 immunohistochemistry was sought by PCR and by determining the HHV-8 ORFK1 subtype. RESULTS: Whilst most cases were confirmed, 12 oral and 4 cutaneous lesions displayed clinical and histological features of KS but were negative to HHV-8 IHC. These oral lesions were re-diagnosed as pyogenic granulomata (n = 6), deep mycosis (n = 1), inflamed mucosa (n = 2) or 'uncertain but not KS' (n = 3). Whilst PCR is usually helpful in differentiating HHV-8 disease, all samples were HHV-8 PCR positive, with identical sequences, suggesting cross-contamination of samples in the original pathology laboratories. CONCLUSION: HHV-8 IHC is essential for the correct diagnosis of KS, but due to the high level of contamination in resource-poor settings, PCR is inadvisable.

Knowledge and attitude of women on the available PMTCT services at the antenatal clinic of the Coast Province General Hospital.

INTRODUCTION: Several high profile events of the last decade have served as catalysts for the now widely available prevention of mother-to-child transmission of HIV services. However, Kenya continues to face challenges in assuring that all women in need of PMTCT services receive the full package. METHODS: A cross sectional survey was undertaken. Systematic sampling method was used for sample selection. Data was collected using pretested structured questionnaires. Data was analyzed in SPSS and Epi Info using bivariate and multivariate logistic regression. RESULTS: Approximately 75% of participants were seeking PMTCT services in CPGH for the first time, 71% knew of their HIV status. About 95% of participants were satisfied with privacy during testing. Clients who had never delivered in CPGH had a significantly (p<0.001) higher odds compared to those who had previously delivered in CPGH and had their first PMTCT visit. participants who had never lost a pregnancy in CPGH and were in the hospital for the first time were 3 times likely to seek PMTCT services compared to those who had lost a pregnancy in CPGH. There was a significant association between family planning use before pregnancy and first PMTCT. CONCLUSION: Participants seeking PMTCT services had poor HIV knowledge; but reported positive experiences and good provider-client relationship. However for a successful PMTCT program in CPGH attention needs to be paid in the patient experiences as they seek other reproductive services.

Cost effectiveness of using surgery versus skeletal traction in management of femoral shaft fractures at Thika level 5 hospital, Kenya.

INTRODUCTION: A prospective quasi experimental study was undertaken at the Thika level 5 hospital. The study aimed to compare the costs of managing femoral shaft fracture by surgery as compared to skeletal traction. METHODS: Sixty nine (46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%) patients were enrolled in group B and managed by skeletal traction. Exclusion criteria included patients with pathological fractures and previous femoral fractures. Data was collected by evaluation of patients in patient bills using a standardized questionnaire. The questionnaire included cost of haematological and radiological tests, bed fees, theatre fees and physiotherapy costs. The data was compiled and analyzed using SPSS version 16. Person's chi square and odds ratios were used to measure associations and risk analysis respectively. RESULTS: A higher proportion of patients (88.4%) in group A were hospitalized for less than one month compared to 20 patients (30.4%) in group B (p, 0.001).Total cost of treatment in group A was significantly lower than in group B. Nineteen (27.9%) patients who underwent surgery paid a total bill of Ksh 5000-7500 compared to 7(10.4%) who were treated by traction. The financial cost benefit of surgery was further complimented by better functional outcomes. CONCLUSION: The data indicates a cost advantage of managing femoral shaft fracture by surgery compared to traction. Furthermore the longer hospital stay in the traction group is associated with more malunion, limb deformity and shortening.

Prevalence and factors associated with percutaneous injuries and splash exposures among health-care workers in a provincial hospital, Kenya, 2010.

INTRODUCTION: Accidental occupational exposure of healthcare workers to blood and body fluids after skin injury or mucous membrane contact constitutes a risk for transmission of blood-borne pathogens. Such pathogens include Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV). We conducted a study to determine the prevalence and associated factors for percutaneous injuries and splash exposures among health-care workers in Rift Valley provincial hospital. METHODS: A cross-sectional study was carried out from October to November 2010. Self reported incidents, circumstances surrounding occupational exposure and post-exposure management were sought by use of interviewer administered questionnaire. Descriptive, bivariate and multiple logistic regression (forward stepwise procedure) analyses were performed. The level of significance was set at 0.05. RESULTS: Twenty five percent of health-care workers interviewed (N=305) reported having been exposed to blood and body fluids in the preceding 12 months. Percutaneous injuries were reported by 19% (n=305) and splash to mucous membrane by 7.2%. Higher rates of percutaneous injuries were observed among nurses (50%), during stitching (30%), and in obstetric and gynecologic department (22%). Health workers aged below 40 years were more likely to experience percutaneous injuries (OR=3.7; 95% CI=1.08-9.13) while previous training in infection prevention was protective (OR=0.52; 95% CI=0.03-0.90). Forty eight percent (n=83) reported the incidents with 20% (n=83) taking PEP against HIV. CONCLUSION: Percutaneous injuries and splashes are common in Rift Valley Provincial hospital. Preventive measures remain inadequate. Health institutions should have policies, institute surveillance for occupational risks and enhance training of health care workers.

Factors associated with obstetric fistulae occurrence among patients attending selected hospitals in Kenya, 2010: a case control study.

BACKGROUND: In Kenya, about 3000 fistula cases are estimated to occur every year with an incidence of 1/1000 women. This study sought to identify risk factors associated with developing obstetrics fistula in order to guide implementation of appropriate interventions. METHODS: An unmatched case control study was conducted in three major hospitals in Kenya between October and December 2010. Cases were patients who had fistula following delivery within the previous five years. Controls were systematically selected from women who attended obstetrics and gynecology clinics at these hospitals, and did not have present or past history of fistula. Odds ratio was used as measure of association with their corresponding 95% confidence interval. Factors with p value of <0.1 were included into forward additive logistic regression model to generate adjusted odds ratios. RESULTS: Seventy cases and 140 controls were included in the study. Independent risk factors associated with obstetrics fistula included duration of labour of >24 hours (OR = 4.7, 95% CI = 2.4 -9.2), seeking delivery services after 6 hours of labour onset (OR = 6.9, 95% CI = 2.2-21.3), taking more than 2 hours to reach a health facility (OR = 5.7, 95% CI = 2.9 -11.5), having none or primary education (OR = 9.6, 95% CI = 3.3 -27.9) and being referred to another facility for emergency obstetrics services (OR = 8.6, 95% CI = 2.7 -27). CONCLUSIONS: Risk factors for developing obstetrics fistula were delays in care seeking including delay in making decision to seek delivery servers after six hours of labour onset, taking more than two hours to reach a health facility, labour duration of more than 24 hours and having no formal or primary education. Efforts geared at strengthening all levels of the health system to reduce delays in access to emergency obstetric care are needed.

Factors associated with late presentation of suspected tuberculosis cases to tuberculosis management facilities: The case in Dagoretti district, Nairobi, Kenya.

BACKGROUND: Tuberculosis is a highly contagious disease accounting for a high number of deaths in the developing countries; its control can be effectively achieved if individuals with the disease receive adequate and timely treatment. The objective of this study was to determine the factors associated with late presentation of suspects to tuberculosis management facilities in Dagoretti district in Nairobi, Kenya. METHOD: A cross sectional study was conducted on patients aged 18 years and above attending TB clinics in Dagoretti District, Nairobi Kenya. A total of 426 TB suspects were interviewed. The study covered 8 clinics in Dagoretti district. Analysis was done using SPSS version 16.0 and Epi info version 6, this included Chi Square for Bivariate analysis and Binary Logistic Regression for Multivariate Analysis. RESULTS: Out of the 426 tuberculosis suspects, 248 (58.2%) suspects had delayed in seeking medical care. In Bivariate analysis male gender (P = 0.039, O.R = 1.51; 95% Confidence Interval; 1.00- 2.27), level of education (Primary class 5-8) (P = 0.001, O.R= 2.06; 95% C.I 1.34-3.19) and place of first medical care (drug store) (P= 0.013, O.R = 1.63; 95% C.I 1.09-2.46) were all significantly associated with late presentation. After multivariate logistic regression, gender (P = 0,019, OR = 1.6), level of education (p = 0.029, OR = 1.26) and place of first medical care (P= 0.01 OR = 1.27), were found to be significantly associated with late presentation. CONCLUSION: This study shows that age, level of education and place of first medical care are the factors associated with late presentation of suspects to tuberculosis management facilities.

Dental caries and oral health practices among 12 year old children in Nairobi West and Mathira West Districts, Kenya.

BACKGROUND: Dental caries is a common disease in children which causes pain with resultant effect on various physiological and social functions. The main objective of the study was to determine the association between dental caries and oral health knowledge and practice among children in Nairobi West and Mathira West Districts. METHODS: A cross-sectional study was conducted among 639 children aged 12 years attending public primary schools in Nairobi West and Mathira West districts between August 2009-February 2010. A questionnaire was used to determine the level of knowledge and practices employed. Oral screening was performed using World Health Organisation (WHO) recommended methods. Dental caries was measured using the Decayed, Missing, Filled Teeth (DMFT) index. RESULTS: Nairobi West District had significantly higher caries prevalence of 37.5% than Mathira West District (24.0%). The DMFT in Nairobi West District was 0.76 ± 1.2, while in Mathira West District it was 0.36 ± 0.7. On multivariate analysis high consumption of soda was found to be a significant risk factor for dental caries in Nairobi West District(Odds Ratio (OR) = 3.0). In Mathira West District having an illiterate mother was a significant risk factor for dental caries (OR = 4.3). CONCLUSION: Countrywide intensive oral health promotion should be carried out especially in urban areas, to reduce the higher prevalence of dental caries. The school health policy should be used to promote oral health by provision of oral health instructions and highlighting harmful dietary practices. Preventive practices such as regular dental checkups should be advocated and promoted in schools.