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1.
PLoS Negl Trop Dis ; 14(4): e0008108, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32236091

RESUMO

Brucellosis is an important zoonotic disease globally, with particularly high burdens in pastoral settings. While the zoonotic transmission routes for Brucella spp. are well known, the relative importance of animal contact, food-handling and consumption practices can vary. Understanding the local epidemiology of human brucellosis is important for directing veterinary and public health interventions, as well as for informing clinical diagnostic decision making. We conducted a cross-sectional study in Ijara District Hospital, north-eastern Kenya. A total of 386 individuals seeking care and reporting symptoms of febrile illness were recruited in 2011. Samples were tested for the presence of Brucella spp. using a real-time PCR (RT-PCR) and results compared to those from the test for brucellosis used at Ijara District Hospital, the febrile Brucella plate agglutination test (FBAT). A questionnaire was administered to all participants and risk factors for brucellosis identified using logistic regression with an information theoretic (IT) approach and least absolute shrinkage and selection (LASSO). Sixty individuals were RT-PCR positive, resulting in a prevalence of probable brucellosis of 15.4% (95% CI 12.0-19.5). The IT and LASSO approaches both identified consuming purchased milk as strongly associated with elevated risk and boiling milk before consumption strongly associated with reduced risk. There was no evidence that livestock keepers were at different risk of brucellosis than non-livestock keepers. The FBAT had poor diagnostic performance when compared to RT-PCR, with an estimated sensitivity of 36.6% (95% CI 24.6-50.1) and specificity of 69.3% (95% CI 64.0-74.3). Brucellosis is an important cause of febrile illness in north-eastern Kenya. Promotion of pasteurisation of milk in the marketing chain and health messages encouraging the boiling of raw milk before consumption could be expected to lead to large reductions in the incidence of brucellosis in Ijara. This study supports the growing evidence that the FBAT performs very poorly in the diagnosis of brucellosis.

2.
PLoS One ; 14(10): e0212601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31589619

RESUMO

INTRODUCTION: Use of tobacco and its products are the single most preventable cause of death in the world. The objective of this study was to determine the prevalence of current tobacco use and identify associated factors among Rwandans aged 15-34 years. METHODS: This study involved secondary analysis of existing data from the nationally representative WHO STEPwise approach to Surveillance of non-communicable diseases (STEPS) conducted in 2013 to explore the prevalence of tobacco use and its associated factors in Rwanda. Data of 3,900 youth participants (15-34 years old) who had been selected using multistage cluster sampling during the survey was analyzed. The prevalence of current smoking along with socio-demographic characteristics of the sample were determined and multivariable logistic regression was employed to identify independent factors associated with current tobacco use. RESULTS: The prevalence (weighted) of current tobacco use (all forms) was 8% (95%CI: 7.08-9.01). The prevalence was found to be significantly higher among males, young adults aged 24-34, youth with primary school education or less, those from Southern province, people with income (work in public, private organizations and self-employed) and young married adults. However, geographical location i.e. urban (7%) and rural (8%) settings did not affect prevalence of tobacco use. Factors that were found to be associated with current tobacco use through the multivariate analysis included being male, aged 25 years and above, having an income, and residing in Eastern, Kigali City and Southern Province compared to Western province. CONCLUSION: The association between smoking and socio-demographic characteristics among Rwandan youth identified in this study provides an opportunity for policy makers to tailor future tobacco control policies, and implement coordinated, high-impact interventions to prevent initiation of tobacco use among the youth.

3.
Influenza Other Respir Viruses ; 12(1): 38-45, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29197152

RESUMO

BACKGROUND: Estimates of influenza-associated hospitalization are severely limited in low- and middle-income countries, especially in Africa. OBJECTIVES: To estimate the national number of influenza-associated severe acute respiratory illness (SARI) hospitalization in Rwanda. METHODS: We multiplied the influenza virus detection rate from influenza surveillance conducted at 6 sentinel hospitals by the national number of respiratory hospitalization obtained from passive surveillance after adjusting for underreporting and reclassification of any respiratory hospitalizations as SARI during 2012-2014. The population at risk was obtained from projections of the 2012 census. Bootstrapping was used for the calculation of confidence intervals (CI) to account for the uncertainty associated with all levels of adjustment. Rates were expressed per 100 000 population. A sensitivity analysis using a different estimation approach was also conducted. RESULTS: SARI cases accounted for 70.6% (9759/13 813) of respiratory admissions at selected hospitals: 77.2% (6783/8786) and 59.2% (2976/5028) among individuals aged <5 and ≥5 years, respectively. Overall, among SARI cases tested, the influenza virus detection rate was 6.3% (190/3022): 5.7% (127/2220) and 7.8% (63/802) among individuals aged <5 and ≥5 years, respectively. The estimated mean annual national number of influenza-associated SARI hospitalizations was 3663 (95% CI: 2930-4395-rate: 34.7; 95% CI: 25.4-47.7): 2637 (95% CI: 2110-3164-rate: 168.7; 95% CI: 135.0-202.4) among children aged <5 years and 1026 (95% CI: 821-1231-rate: 11.3; 95% CI: 9.0-13.6) among individuals aged ≥5 years. The estimates obtained from both approaches were not statistically different (overlapping CIs). CONCLUSIONS: The burden of influenza-associated SARI hospitalizations was substantial and was highest among children aged <5 years.


Assuntos
Hospitalização , Influenza Humana/complicações , Influenza Humana/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Lactente , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Fatores de Risco , Ruanda/epidemiologia , Vigilância de Evento Sentinela , Adulto Jovem
4.
Emerg Infect Dis ; 23(13)2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29155658

RESUMO

More than ever, competent field epidemiologists are needed worldwide. As known, new, and resurgent communicable diseases increase their global impact, the International Health Regulations and the Global Health Security Agenda call for sufficient field epidemiologic capacity in every country to rapidly detect, respond to, and contain public health emergencies, thereby ensuring global health security. To build this capacity, for >35 years the US Centers for Disease Control and Prevention has worked with countries around the globe to develop Field Epidemiology Training Programs (FETPs). FETP trainees conduct surveillance activities and outbreak investigations in service to ministry of health programs to prevent and control infectious diseases of global health importance such as polio, cholera, tuberculosis, HIV/AIDS, malaria, and emerging zoonotic infectious diseases. FETP graduates often rise to positions of leadership to direct such programs. By training competent epidemiologists to manage public health events locally and support public health systems nationally, health security is enhanced globally.


Assuntos
Fortalecimento Institucional , Epidemiologia/educação , Saúde Global/educação , Vigilância em Saúde Pública , Saúde Pública/educação , Surtos de Doenças , Métodos Epidemiológicos , Epidemiologia/organização & administração , Humanos , Administração em Saúde Pública , Vigilância em Saúde Pública/métodos , Estados Unidos , Recursos Humanos
5.
BMJ Glob Health ; 2(1): e000121, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28588996

RESUMO

It is increasingly clear that resolution of complex global health problems requires interdisciplinary, intersectoral expertise and cooperation from governmental, non-governmental and educational agencies. 'One Health' refers to the collaboration of multiple disciplines and sectors working locally, nationally and globally to attain optimal health for people, animals and the environment. One Health offers the opportunity to acknowledge shared interests, set common goals, and drive toward team work to benefit the overall health of a nation. As in most countries, the health of Rwanda's people and economy are highly dependent on the health of the environment. Recently, Rwanda has developed a One Health strategic plan to meet its human, animal and environmental health challenges. This approach drives innovations that are important to solve both acute and chronic health problems and offers synergy across systems, resulting in improved communication, evidence-based solutions, development of a new generation of systems-thinkers, improved surveillance, decreased lag time in response, and improved health and economic savings. Several factors have enabled the One Health movement in Rwanda including an elaborate network of community health workers, existing rapid response teams, international academic partnerships willing to look more broadly than at a single disease or population, and relative equity between female and male health professionals. Barriers to implementing this strategy include competition over budget, poor communication, and the need for improved technology. Given the interconnectedness of our global community, it may be time for countries and their neighbours to follow Rwanda's lead and consider incorporating One Health principles into their national strategic health plans.

6.
Pan Afr Med J ; 26: 72, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28451049

RESUMO

INTRODUCTION: Hepatitis B virus infection is a major public health problem worldwide and in Africa. This would be the first ever documented study on epidemiology of Hepatitis B infections in the newly formed Republic of South Sudan. This study was designed to estimate the sero-prevalence of Hepatitis B virus infection amongst pregnant women attending antenatal services in Juba. METHODS: A cross-sectional study was conducted among pregnant women attending antenatal clinic services in Juba Teaching Hospital, in the period between December 2012 and March 2013. Any pregnant woman, attending antenatal care services at Juba Teaching Hospital, was included if she was a resident of Juba County for at least 1 year before pregnancy. A Hepatitis B case was defined as any women participating in the study and was found to be positive for HbsAg and confirmed by ELISA. RESULTS: This study documented that the prevalence of Hepatitis B surface antigen (HBsAg) among pregnant women attending ANC in Juba was 11% (31 out of the 280 samples). Other samples tested were indeterminate (36%), naturally immune (27.1%), susceptible (23%) and the remaining 1.8% was immune due to vaccination. Significant risk factors for Hepatitis B infection were loss of partner (OR 4.4 and CI of 1.4-13.9) and history of Jaundice (OR 1.7 and CI of 1.2-2.1). CONCLUSION: These study findings show that only 29% of infants in Juba county are born to immune mothers (naturally or vaccine induced). The remaining 70% of babies would be at risk of infection, if a birth dose of Hepatitis B is not provided. We therefore recommended introduction of Hepatitis B Vaccine birth dose into routine infants' vaccination series to eliminate this risk.


Assuntos
Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Hepatite B/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Vacinas contra Hepatite B/administração & dosagem , Hospitais de Ensino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Sudão do Sul/epidemiologia , Adulto Jovem
7.
Am J Trop Med Hyg ; 95(2): 452-6, 2016 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-27352876

RESUMO

In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1-5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6-9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0-11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10-0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks.


Assuntos
Bartonella quintana/isolamento & purificação , Surtos de Doenças , Ftirápteros/microbiologia , Rickettsia prowazekii/isolamento & purificação , Febre das Trincheiras/epidemiologia , Tifo Epidêmico Transmitido por Piolhos/epidemiologia , Adolescente , Adulto , Animais , Bartonella quintana/patogenicidade , Estudos de Casos e Controles , Coinfecção , Humanos , Incidência , Masculino , Razão de Chances , Centros de Reabilitação , Rickettsia prowazekii/patogenicidade , Fatores de Risco , Ruanda/epidemiologia , Análise de Sobrevida , Febre das Trincheiras/diagnóstico , Febre das Trincheiras/mortalidade , Febre das Trincheiras/transmissão , Tifo Epidêmico Transmitido por Piolhos/diagnóstico , Tifo Epidêmico Transmitido por Piolhos/mortalidade , Tifo Epidêmico Transmitido por Piolhos/transmissão
8.
Pan Afr Med J ; 25: 234, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28293350

RESUMO

INTRODUCTION: The World Health Organization (WHO) promotes the Directly Observed Treatment (DOT) strategy as the standard to increase adherence to Tuberculosis (TB) medication. However, cases of retreatment and Multi Drug Resistant continue to be reported in many parts of Kenya. This study sought to determine the factors influencing the completion of tuberculosis medication among TB patients in Embu County, Kenya. METHODS: A descriptive cross-sectional study was conducted on a population of tuberculosis patients under DOT attending selected TB treatment clinics in Embu County, in Kenya. One hundred and forty TB patients interviewed within a period of 3 months. Data were analyzed using SPSS version 17.0 and included Bivariate and Multivariate Analysis. The level of significance was p≤ 0.05. RESULTS: The male and female participants were 61.4% and 38.6% respectively. The mean age of the respondents was 35±31.34-39.3 years. For the majority (52%) of the participants, the highest level of education was primary education. The unemployed participants formed the highest number of the respondent in the study (73%). The majorities (91.4%0) of the respondents were under the home-based DOT strategy (91.4%, 95% C.I: 85.5-95.5). Bivariate analysis using Chi-square showed that the level of education (p=0.003), patients feeling uncomfortable during supervision (p=0.01), and knowledge regarding the frequency of taking medication (p=0.004) were all significantly associated with knowledge regarding the importance of completion of medication. However, none of these factors was significant after multivariate analysis. CONCLUSION: Most participants did not know the importance of completion of medication. TB programs should come up with better ways to educate TB patients on the importance of supervision and treatment completion during the treatment of TB. The education programs should focus on influencing the attitudes of patients and creating awareness about the importance of treatment completion. The TB programs should be designed towards eliminating the factors influencing the completion of TB medication.


Assuntos
Antituberculosos/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação , Tuberculose/tratamento farmacológico , Adulto , Estudos Transversais , Terapia Diretamente Observada , Feminino , Humanos , Quênia , Masculino , Análise Multivariada , Organização Mundial da Saúde
9.
J Water Health ; 13(3): 714-25, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26322757

RESUMO

Populations living in informal settlements with inadequate water and sanitation infrastructure are at risk of epidemic disease. In 2010, we conducted 398 household surveys in two informal settlements in Nairobi, Kenya with isolated cholera cases. We tested source and household water for free chlorine residual (FCR) and Escherichia coli in approximately 200 households. International guidelines are ≥0.5 mg/L FCR at source, ≥0.2 mg/L at household, and <1 E. coli/100 mL. In these two settlements, 82% and 38% of water sources met FCR guidelines; and 7% and 8% were contaminated with E. coli, respectively. In household stored water, 82% and 35% met FCR guidelines and 11% and 32% were contaminated with E. coli, respectively. Source water FCR≥0.5 mg/L (p=0.003) and reported purchase of a household water treatment product (p=0.002) were associated with increases in likelihood that household stored water had ≥0.2 mg/L FCR, which was associated with a lower likelihood of E. coli contamination (p<0.001). These results challenge the assumption that water quality in informal settlements is universally poor and the route of disease transmission, and highlight that providing centralized water with ≥0.5 mg/L FCR or (if not feasible) household water treatment technologies reduces the risk of waterborne cholera transmission in informal settlements.


Assuntos
Cólera , Surtos de Doenças , Água Potável/microbiologia , Purificação da Água/métodos , Qualidade da Água , Cloro , Cólera/epidemiologia , Cólera/prevenção & controle , Escherichia coli/isolamento & purificação , Humanos , Quênia , Medição de Risco
10.
J Epidemiol Glob Health ; 5(1): 33-9, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25700921

RESUMO

Medical students have limited exposure to field epidemiology, even though will assume public health roles after graduation. We established a 10-week elective in field epidemiology during medical school. Students attended one-week didactic sessions on epidemiology, and nine weeks in field placement sites. We administered pre- and post-tests to evaluate the training. We enrolled 34 students in 2011 and 2012. In 2011, we enrolled five of 24 applicants from a class of 280 medical students. In 2012, we enrolled 18 of 81 applicants from a class of 360 students; plus 11 who participated in the didactic sessions only. Among the 34 students who completed the didactic sessions, 74% were male, and their median age was 24 years (range: 22-26). The median pre-test score was 64% (range: 47-88%) and the median post-test score was 82% (range: 72-100%). Successful completion of the field projects was 100%. Six (30%) students were not aware of public health as a career option before this elective, 56% rated the field experience as outstanding, and 100% reported it increased their understanding of epidemiology. Implementing an elective in field epidemiology within the medical training is a highly acceptable strategy to increase awareness for public health among medical students.


Assuntos
Educação de Graduação em Medicina/métodos , Epidemiologia/educação , Estudantes de Medicina , Adulto , Currículo , Feminino , Humanos , Quênia , Masculino , Saúde Pública/educação , Faculdades de Medicina , Recursos Humanos , Adulto Jovem
11.
Pan Afr Med J ; 18: 60, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-26113894

RESUMO

INTRODUCTION: Neural tube defects such as anencephaly, spina bifida, and encephalocele are congenital anomalies of the central nervous system. Data on the prevalence of neural tube defects in Kenya are limited. This study characterizes and estimates the prevalence of spina bifida and encephalocele reported in a referral hospital in Kenya from 2005-2010. METHODS: Cases were defined as a diagnosis of spina bifida or encephalocele. Prevalence was calculated as the number of cases by year and province of residence divided by the total number of live-births per province. RESULTS: From a total of 6,041 surgical records; 1,184 (93%) had reported diagnosis of spina bifida and 88 (7%) of encephalocele. Estimated prevalence of spina bifida and encephalocele from 2005-2010 was 3.3 [95% Confidence Interval (CI): 3.1-3.5] cases per 10,000 live-births. The highest prevalence of cases were reported in 2007 with 4.4 (95% CI: 3.9-5.0) cases per 10,000 live-births. Rift Valley province had the highest prevalence of spina bifida and encephalocele at 6.9 (95% CI: 6.3-7.5) cases per 10,000 live-births from 2005-2010. CONCLUSION: Prevalence of spina bifida and encephalocele is likely underestimated, as only patients seeking care at the hospital were included. Variations in regional prevalence could be due to referral patterns and healthcare access. Implementation of a neural tube defects surveillance system would provide a more thorough assessment of the burden of neural tube defects in Kenya.


Assuntos
Encefalocele/epidemiologia , Defeitos do Tubo Neural/epidemiologia , Disrafismo Espinal/epidemiologia , Feminino , Humanos , Recém-Nascido , Quênia/epidemiologia , Masculino , Vigilância da População , Prevalência , Estudos Retrospectivos
12.
Pan Afr Med J ; 19: 10, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25815092

RESUMO

INTRODUCTION: Rabies is a fatal viral infection, resulting in >55,000 deaths globally each year. In August 2011, a young orphaned zebra at a Kenyan safari lodge acquired rabies and potentially exposed >150 tourists and local staff. An investigation was initiated to determine exposures among the local staff, and to describe animal bite surveillance in the affected district. METHODS: We interviewed lodge staff on circumstances surrounding the zebra's illness and assessed their exposure status. We reviewed animal bite report forms from the outpatient department at the district hospital. RESULTS: The zebra was reported bitten by a dog on 31(st) July 2011, became ill on 23(rd)August, and died three days later. There were 22 employees working at the lodge during that time. Six (27%) had high exposure due to contact with saliva (bottle feeding, veterinary care) and received four doses of rabies vaccine and one of immune-globulin, and 16 (73%) had low exposure due to casual contact and received only four doses of rabies vaccine. From January 2010 to September 2011, 118 cases of animal bites were reported in the district; 67 (57%) occurred among males, 65 (57%) in children <15 years old, and 61 (52%) were inflicted in a lower extremity. Domestic and stray dogs accounted for 98% of reported bites. CONCLUSION: Dog bites remains the main source of rabies exposure in the district, but exposure can result from wildlife. This highlights the importance of a one health approach with strong communication between wildlife, veterinary, and human health sectors to improve rabies prevention and control.


Assuntos
Mordeduras e Picadas/epidemiologia , Vacinas Antirrábicas/administração & dosagem , Raiva/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Cães , Equidae , Feminino , Humanos , Lactente , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Raiva/transmissão , Estudos Retrospectivos , Adulto Jovem
13.
Pan Afr Med J ; 15: 109, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24244795

RESUMO

INTRODUCTION: Cholera is a disease caused by the bacterium Vibrio cholera and has been an important public health problem since its first pandemic in 1817. Kenya has had numerous outbreaks of cholera ever since it was first detected there during 1971. In August 2010 an outbreak of cholera occurred in Kuria West District spreading to the neighboring Migori District. We conducted an investigation in order to determine the magnitude of the problem and institute control measures. METHODS: In order to update the line lists we reviewed records in Migori and Kuria district hospitals and conducted active case search in the community between 30th August and 6th September 2010. Data was analyzed using Epi-Info 3.5.2. RESULTS: A total of 114 cases and with 10 deaths (Case Fatality Rate = 9%) were documented. The index case was an 80 years old woman from Mabera Division who had hosted a cultural marriage ceremony a day before the outbreak. The mean age of case patients was 34.5 years (Standard Deviation=23.4) with a range 5 to 80 years. Females accounted for 61.4% of cases; people aged 10-39 years accounted 46.9%, those 40-69 years accounted for 29.2% and those above 70 years accounted for 9.7% of the cases. Sixty percent of deaths occurred among patients aged 50 years and over, case fatality rate was highest in this age group (16.7%) followed by those aged 40-49 years (12.5%), 20-29 years (10%) and 10-19 years (4.8%). The outbreak was confirmed within 2 weeks of onset after one (16.7%) of the six samples taken tested positive for V. cholera (serotype Inaba). CONCLUSION: High case fatality rate and late laboratory confirmation was noted in this outbreak. There was urgent need to capacity build the districts on cholera case management, outbreak management, and equip the Migori District Hospital laboratory to allow prompt confirmation.


Assuntos
Cólera/mortalidade , Surtos de Doenças/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
J Infect Dis ; 208 Suppl 1: S69-77, 2013 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-24101648

RESUMO

BACKGROUND: Cholera remains endemic in sub-Saharan Africa. We characterized the 2009 cholera outbreaks in Kenya and evaluated the response. METHODS: We analyzed surveillance data and estimated case fatality rates (CFRs). Households in 2 districts, East Pokot (224 cases; CFR = 11.7%) and Turkana South (1493 cases; CFR = 1.0%), were surveyed. We randomly selected 15 villages and 8 households per village in each district. Healthcare workers at 27 health facilities (HFs) were surveyed in both districts. RESULTS: In 2009, cholera outbreaks caused a reported 11 425 cases and 264 deaths in Kenya. Data were available from 44 districts for 6893 (60%) cases. District CFRs ranged from 0% to 14.3%. Surveyed household respondents (n = 240) were aware of cholera (97.5%) and oral rehydration solution (ORS) (87.9%). Cholera deaths were reported more frequently from East Pokot (n = 120) than Turkana South (n = 120) households (20.7% vs. 12.3%). The average travel time to a HF was 31 hours in East Pokot compared with 2 hours in Turkana South. Fewer respondents in East Pokot (9.8%) than in Turkana South (33.9%) stated that ORS was available in their village. ORS or intravenous fluid shortages occurred in 20 (76.9%) surveyed HFs. CONCLUSIONS: High CFRs in Kenya are related to healthcare access disparities, including availability of rehydration supplies.


Assuntos
Cólera/epidemiologia , Cólera/mortalidade , Epidemias/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
15.
BMC Pregnancy Childbirth ; 13: 56, 2013 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-23448615

RESUMO

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.


Assuntos
Parto Obstétrico/efeitos adversos , Trabalho de Parto/fisiologia , Complicações do Trabalho de Parto/etiologia , Transtornos Puerperais/etiologia , Fístula Vaginal/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Incidência , Quênia/epidemiologia , Modelos Logísticos , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Transtornos Puerperais/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Fístula Vaginal/epidemiologia
16.
Pan Afr Med J ; 14: 10, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23504245

RESUMO

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.


Assuntos
Patógenos Transmitidos pelo Sangue , Líquidos Corporais , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Recursos Humanos em Hospital/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Política Organizacional , Prevalência , Amostragem , Inquéritos e Questionários , Centros de Atenção Terciária/estatística & dados numéricos , Viroses/epidemiologia , Viroses/prevenção & controle , Viroses/transmissão , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/prevenção & controle , Adulto Jovem
17.
Matern Child Health J ; 17(3): 441-7, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22569943

RESUMO

To determine prevalence and factors associated with intimate partner violence (IPV) among pregnant women seeking antenatal care. This was a cross-sectional study conducted at Kisumu District Hospital, Kenya amongst randomly selected pregnant women. A structured questionnaire was used to collect data. Participants self-reported about their own IPV experience (lifetime, 12 months prior to and during index pregnancy) and associated risk factors. Data were analyzed using Epi-info. The mean age of the 300 participants was 23.7 years. One hundred and ten (37 %) of them experienced at least one form of IPV during pregnancy. Psychological violence was the most common (29 %), followed by sexual (12 %), and then physical (10 %). Women who experienced IPV during pregnancy were more likely to have witnessed maternal abuse in childhood (aOR 2.27, 95 % CI = 1.05-4.89), been in a polygamous union (aOR 2.48, 95 % CI = 1.06-5.8), been multiparous (aOR 1.94, 95 % CI = 1.01-3.32) or had a partner who drank alcohol (aOR 2.32, 95 % CI = 1.21-4.45). Having a partner who attained tertiary education was protective against IPV (aOR 0.37, 95 % CI = 0.16-0.83). We found no association between HIV status and IPV. IPV is common among women seeking antenatal care at Kisumu District Hospital. Health care providers should be alerted to the possibility of IPV during pregnancy in women who witnessed maternal abuse in childhood, are multiparous, polygamous, have a partner who drinks alcohol or has low level education. Screening for IPV, support and referral is urgently needed to help reduce the burden experienced by pregnant women and their unborn babies.


Assuntos
Relações Interpessoais , Gestantes , Parceiros Sexuais , Maus-Tratos Conjugais/estatística & dados numéricos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos Transversais , Feminino , Hospitais de Distrito , Humanos , Lactente , Quênia/epidemiologia , Pessoa de Meia-Idade , Gravidez , Prevalência , Fatores de Risco , Parceiros Sexuais/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
18.
Pan Afr Med J ; 12: 93, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23077714

RESUMO

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.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tuberculose/terapia , Adulto , Fatores Etários , Estudos Transversais , Escolaridade , Feminino , Humanos , Quênia , Modelos Logísticos , Masculino , Análise Multivariada , Fatores Sexuais , Fatores de Tempo , Tuberculose/epidemiologia
19.
Pan Afr Med J ; 12: 42, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22891100

RESUMO

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.


Assuntos
Cárie Dentária/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Higiene Bucal , Criança , Estudos Transversais , Feminino , Humanos , Quênia , Masculino
20.
Emerg Infect Dis ; 18(6): 925-31, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22607971

RESUMO

Numerous outbreaks of cholera have occurred in Kenya since 1971. To more fully understand the epidemiology of cholera in Kenya, we analyzed the genetic relationships among 170 Vibrio cholerae O1 isolates at 5 loci containing variable tandem repeats. The isolates were collected during January 2009-May 2010 from various geographic areas throughout the country. The isolates grouped genetically into 5 clonal complexes, each comprising a series of genotypes that differed by an allelic change at a single locus. No obvious correlation between the geographic locations of the isolates and their genotypes was observed. Nevertheless, geographic differentiation of the clonal complexes occurred. Our analyses showed that multiple genetic lineages of V. cholerae were simultaneously infecting persons in Kenya. This finding is consistent with the simultaneous emergence of multiple distinct genetic lineages of V. cholerae from endemic environmental reservoirs rather than recent introduction and spread by travelers.


Assuntos
Cólera/epidemiologia , Cólera/microbiologia , Vibrio cholerae/genética , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Surtos de Doenças , Genes Bacterianos , Genótipo , Humanos , Lactente , Quênia/epidemiologia , Pessoa de Meia-Idade , Repetições Minissatélites , Tipagem de Sequências Multilocus , Filogenia , Filogeografia , Adulto Jovem
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