NUTRITION STATUS AND ASSOCIATED MORBIDITY RISK FACTORS AMONG ORPHANAGE AND NON-ORPHANAGE CHILDREN IN SELECTED PUBLIC PRIMARY SCHOOLS WITHIN DAGORETTI, NAIROBI, KENYA.

BACKGROUND: Most of the nutritional surveys that have been carried out in Kenya have concentrated on children aged five years and below who are under the care of their parent(s). The HIV/AIDS, conflict, natural disasters, endemic diseases such as malaria and tuberculosis and rising poverty has claimed the health and lives of millions of productive adults, leaving their children orphaned and vulnerable. This has led to mushrooming of orphanages to take care of these orphans and vulnerable children in Kenya. OBJECTIVE: Compare the nutrition status and associated risk factors of primary school children living in orphanages and those not living in orphanages in selected public primary schools in Dagoretti Division, Nairobi. DESIGN: Descriptive cross sectional survey. SETTING: Four public primary schools in Dagoretti Division. Data were collected from school registers and directly questioning the students, parents/guardians or caretakers. SUBJECTS: Four hundred and sixteen, four to eleven year olds randomly selected orphanage and non-orphanage children who attended the same primary school. RESULTS: The orphanage children had a significantly higher rate of stunting and underweight (p < 0.05) than the non-orphanage children. The orphanage children had also a significantly higher rate of morbidity (p < 0.05) than the non-orphanage children. The orphanage children were more than three times more likely to take inadequate calories compared to the non-orphanage children. CONCLUSIONS: The main factors associated with the higher rate of malnutrition among orphanage children were high morbidity rate, inadequate amounts and diversity of foods served, low rates of vaccination and basic hygiene.

ROLES OF TRADITIONAL BIRTH ATTENDANTS AND PERCEPTIONS ON THE POLICY DISCOURAGING HOME DELIVERY IN COASTAL KENYA.

OBJECTIVES: To describe the roles of Traditional Birth Attendants (TBAs), to determine the perceptions of TBAs and Skilled Birth Attendants (SBAs) towards the policy discouraging home delivery by TBAs and to establish the working relationship between TBAs and SBAs in Kwale, Kenya. DESIGN: Community based cross-sectional study. SETTING: Mwaluphamba, Kinango and Golini locations of Kwale County, Kenya. SUBJECTS: Fifty eight participants were involved in the study. Interviews were conducted with 22 TBAs and 8 SBAs as well as 3 FGDs with 28 TBAs were carried out in July 2012. MAIN OUTCOME MEASURES: Roles of TBAs, policy awareness and support as well as the working relationship between TBAs and SBAs. RESULTS: Before delivery, the main role of TBAs was checking position of the baby in the womb (86%) while during delivery, the main role was stomach massage (64%). However, majority (95%) of the TBAs did not provide any after delivery. All SBAs and 59% of TBAs were aware of the policy while 88% SBAs and 36% of TBAs supported it. The working relationship between TBAs and SBAs mainly involved the referral of women to health facilities (HFs). Sometimes, TBAs accompanied women to the HF offering emotional support until after delivery. CONCLUSION: TBAs in Kwale have a big role to play especially during pregnancy and delivery periods. Awareness and support of the policy as well as the collaboration between SBAs and TBAs should be enhanced in Kwale.

Utilization of folic acid and iron supplementation services by pregnant women attending an antenatal clinic at a regional referral hospital in Kenya.

To determine utilization of iron and folic acid supplementation services among pregnant women in Kenya. A cross sectional study was conducted at Nyeri Hospital, a regional referral hospital in central Kenya. Women attending the antenatal clinic were selected through systematic sampling. A semi-structured questionnaire was administered to collect information on utilization of folic acid and iron supplementation services. Women who ingested folic acid or iron supplements for >4 days in a week were considered "highly compliant". The health worker in-charge of the antenatal clinic was interviewed about the frequency of supplement stock-outs during the past year. Haemoglobin concentration was measured directly from one drop of capillary blood and measured using portable HEMOCUE B-Hb photometer. Of the 381 women interviewed, only 23.6 % obtained antenatal care in the first trimester; 69.3 and 51.2 % received folic acid and iron supplements, respectively. However, only half (45-58 %) received any information about supplementation. Most women were initiated on folic acid (80.7 %) or iron (67.7 %) after 12 and 16 weeks of gestation, respectively, well after the recommended time period. However, more than 80 % of those who received folic acid and iron were highly compliant. Stock-outs were common at the facility. Of 361 women tested for Hb level, the prevalence of anaemia (Hb levels < 11 g/dl) was 7.8 %. Health workers need to better explain the importance of supplements to pregnant women. Women who come late to antenatal clinic miss opportunities to start supplementation early in pregnancy. Problems with supply chain management exacerbate the problem.

OUTPATIENT PRESCRIBING PRACTICES AT MBAGATHI DISTRICT HOSPITAL-NAIROBI COUNTY.

OBJECTIVE: To assess medicine use practices by using WHO prescribing and patient care indicators in Mbagathi Hospital outpatient department. DESIGN: A hospital based retrospective study. SETTING: Mbagathi District Hospital outpatient department between 1st January to 30th June 2012. MAIN OUTCOME MEASURES: Measures used in this study included, total number of medicines in a prescription, proportion of medicines in the essential drug list, proportion in generic names, proportion with injectables and antibiotics and percentage actually dispensed. RESULTS: Total number of drugs prescribed was 1,506. On average, each patient was prescribed 3.85 types of drugs. A total of 835 drugs were prescribed by generic name, accounting for 25.6% of total number of drugs prescribed (1,506). Out of 391 sampled prescriptions, 266 had antibiotics accounting for (68.0%). A relatively small proportion of the prescriptions, 9.5% had an injection. A total of 1,087 drugs were prescribed according to the essential drugs list or formulary, accounting for 72.2% of total number of drugs prescribed (1,506). Only 55.2% of total medicines prescribed were actually dispensed and the rest were out of stock. CONCLUSION: The prescribing practices in this study are not satisfactory, as suggested by polypharmacy, over prescription of antibiotics, prescribing by brand names and lack of awareness of essential drugs list.

GROWTH AND NUTRITIONAL STATUS OF THE FIRST SIX MONTHS OF LIFE AMONG SELECTED HOSPITALS--NAIROBI PROVINCE.

BACKGROUND: Exclusive breastfeeding for infants is recommended for the first six months for optimal health, development and growth. However, there is limited data on infant feeding practices and nutrition status of infants in Nairobi. OBJECTIVE: To assess infant growth and nutritional status and compare with feeding practices in the first six months of life in selected hospitals, Nairobi Province. DESIGN: Prospective cohort design SETTING: Five major hospitals in Nairobi namely; The Aga Khan, Pumwani Maternity, Mater Misercordiae, St Mary's Langata and Jamaa Hospitals. SUBJECTS: A sample of 692 mother-infant pairs were recruited at birth and followed up until six months. INTERVENTION: There was no direct experimental intervention, but there was observation of infant feeding practices, weight and height measurement was recorded every four weeks and determination of nutrition status of the infants for a period of six months. MAIN OUTCOME MEASURES: Nutritional status and infant feeding practices in the first six months. RESULTS: Slightly more than half (58.8%) of the mothers were formally employed and the rest were self employed. The mean age of the mothers was 28.3 ± 4.9 years. The mean income was KES 26,360 ± 34,696. The mean birth weight of infants was 3.24 ± 0.43 kg and 53.3% of all infants were male. Above 80% of infants were within normal weight based on weight for age Z-scores (WAZ) at 6, 10, 14 and 23 weeks. The prevalence of overweight based on WAZ was 9.5%, 11.6%, 11.9% and 11% at 6, 14, 19 and 23 weeks, respectively. There were no significant (P > 0.05) differences in WAZ between infants on different feeding methods. CONCLUSIONS: There was no significant difference in weight or length gain among children that were fully breastfed in comparison to those who were given infant formula or had mixed feeding. However, there was concern over the proportion of overweight infants, as the condition may lead to long term health problems.

FACTORS INFLUENCING VITAMIN A SUPPLEMENTATION AMONG MOTHERS OF CHILDREN UNDER FIVE YEARS OLD AT MBAGATHI DISTRICT HOSPITAL, KENYA.

BACKGROUND: Vitamin A supplementation is one of the best-proven and most costeffective interventions to improve vitamin A status and save children's lives. OBJECTIVE: To assess factors affecting practices and utilisation of Vitamin A supplementation services among mothers with children below five years attending Mbagathi District Hospital. DESIGN: Cross-sectional descriptive study. SETTING: Mbagathi District Hospital (MDH) Maternal and Child Health Clinic (MCH) and Paediatric Out Patient Department (POPD). SUBJECTS: Mothers attending MDH MCH and POPD. MAIN OUTCOME MEASURES: Utilisation, Practices and Awareness of vitamin A supplementation (VAS). RESULTS: A total of one hundred and fifty eight respondents were interviewed. About a half (52%) of the respondents had their children up to date with VAS while less than a half (43%) of the mothers had received vitamin A after delivery. Three quarters of the respondents'children had missed the vitamin A capsule because they were either not aware of schedule (41%) or had stopped coming to clinic (35%). This notwithstanding, 91% of the respondents neither encountered any problems when seeking VAS services nor had negative beliefs or superstitions about vitamin A. CONCLUSION: The main factors affecting utilisation of VAS services was lack of information and awareness among both health workers and mothers. These services are averagely well utilised at MDH though still below the National 80% coverage target.

Fertilin beta peptides inhibit sperm binding to zona-free eggs in a homologous baboon in vitro fertilization system.

This study developed a baboon in vitro fertilization system that can be used in testing defined gamete antigens for fertility effects. A laparoscopic procedure that proved very valuable in retrieving eggs from female baboons for in vitro studies was developed. On average, 30 +/- 5 (SD) eggs were harvested per female baboon per cycle. Micromolar quantities of hexapeptides or a 28 aa residue peptide, all corresponding to fertilin beta disintegrin domain, competitively inhibited the binding of zona-free baboon eggs by baboon sperm in vitro. This study demonstrated that fertilin beta has a required role in baboon fertilization.

Vasectomy: preliminary report on 25 cases.

Preliminary data on 25 men who underwent vasectomy for contraception between June 1986 and May 1988 at the Marie Stopes Clinic--Nairobi is presented. The majority (76.0%) of the subjects were aged between 25 and 39 years. 68.0% had 4 living children or less. Professionals including lecturers, lawyers, teachers, engineers etc, formed 88.0% of the total. Three clients(12.0%) had documented complications; one had aseptic wound, one had haematoma and the last one had a failed vasectomy. All were treated successfully. Complications of vasectomy and the need for follow-up of vasectomised men are discussed.

PIP: Preliminary data on 25 men who underwent vasectomy for contraception between June 1986 and May 1988 at the Marie Stopes Clinic - Nairobi is presented. The majority (76%) of the subjects were aged between 25 and 39 years. 68.0% had 4 living children or less. Professionals including lecturers, lawyers, teachers, and engineers formed 88.0% of the total. 3 clients (12.0%) had documented complications; one had aseptic wound, one had hematoma, and the last one had a failed vasectomy. All were treated successfully. Other complications that may occur include orchitis, epididymitis, disturbed sexual function, granuloma, and antibody or arterio-venous fistula formation. Follow-up is a necessary process since patients may not return, even if there is a problem. In this study only 4 (16.9%) of the men reported back after 6 weeks. The other 3 (12.0%) returned because of their complications.

Nutrition status and associated factors among children in public primary schools in Dagoretti, Nairobi, Kenya.

BACKGROUND: Malnutrition among school-age children is due to inadequacies in one or more of the three main preconditions for good nutrition: food, care and health. Children stunted at school age are likely to have been exposed to poor nutrition since early childhood. Interventions for school age children can supplement efforts to reduce levels of stunting in the preschool years. OBJECTIVE: To assess the nutrition status and associated risk factors of children in selected public primary schools in Dagoretti Division, Nairobi. METHODS: Descriptive cross sectional design was used. 208 students aged 4-11years of both gender were randomly selected from four public primary schools in Dagoretti Division. Data was collected from school registers and directly questioning the students, parents /guardians. RESULTS: Among the children surveyed, 24.5% were stunted, 14.9% underweight and 9.7% were wasted. There were more boys than girls who were stunted. Breakfast contributed 10.2% of the daily energy intake. Few children consumed foods from more than four food groups. Incidence of diarrhea, colds/coughs increased the risk of stunting and underweight. CONCLUSION: Consumption of food which is inadequate in required calories and from less than four varieties of food groups by the children were important predictors of malnutrition.

Vitamin A supplementation awareness among mothers of children under five years old at Mbagathi District Hospital, Nairobi, Kenya.

BACKGROUND: Vitamin A deficiency is one of the leading micro-nutrient deficiencies of public health importance in Kenya. Provision of vitamin A supplements every six months is an inexpensive, safe, quick and effective way to improve vitamin A status and save children's lives. OBJECTIVES: To determine vitamin A supplementation awareness, attitudes and beliefs among mothers of children under five years old attending Mbagathi District Hospital. DESIGN: Cross sectional study. SETTING: Mbagathi District Hospital (MDH) Maternal and Child Health Clinic (MCH) and Paediatric Out Patient Department (POPD). PARTICIPANTS: Mothers attending MDH MCH and POPD. DATA COLLECTION: Both quantitative and qualitative data using questionnaires, in-depth interviews and focus group discussions. SAMPLING: A systematic random sampling where every alternate client was recruited and questionnaires administered to make 158 respondents. Key informants were purposively chosen for in-depth interviews and focus group discussions. RESULTS: Ninety four percent of the respondents reported having heard about vitamin A, major source of information being the health worker (82%). While 58% of the respondents were aware that the recommended schedule for VAS for children is every 6 months, almost half (49%) of respondents were aware vitamin A was given to mothers. Most of the respondents were positive and supportive of VAS. There were no negative beliefs or attitudes mentioned. However, majority (66%) had never discussed about Vitamin A with other mothers/people. Only 18% of the respondents believed VAD was associated with eye problems/blindness. Most mothers did not believe there was a specific consequence of VAD. Majority (64%) of the respondents did not believe there were any possible hindrances to taking their children for VAS. CONCLUSION: Mothers were positive and supportive of VAS, major source of information being the health worker but there was lackof information and awareness among both health workers and mothers.

Medico-social and socio-demographic factors associated with maternal mortality at Kenyatta National Hospital, Nairobi, Kenya.

PIP: To identify the most significant determinants of maternal mortality in Kenya, a prospective study involving 49,335 deliveries occurring at Kenyatta National Hospital from January 1978-87 was conducted. There were 156 maternal deaths in this series, for a maternal mortality rate of 3.2/1000 deliveries. The 5 most frequent causes of death were abortion (24%), hypertensive disease of pregnancy (13%), sepsis (13%), anemia (10%), and cardiac disease (7%). 24% of women who died were age 19 years or under, 27% were 20-24 years, 23% were 25-29 years, and 11% were 30-34 years. The largest percentage (24%) of deaths involved nulliparous women; 16% were to women of parity 5 and above. 28% of the women who died were single, and single women contributed the majority of deaths from abortion. 66% of the women who died had received no prenatal care. The proportion of avoidable deaths was 19% among clinic attenders compared to 29% among non-attenders. Overall, age, parity, and marital status--traditionally regarded as the key factors associated with maternal mortality--vary in their impact, given the cause of death and medical services received. The assumption that high parity is associated with maternal mortality was not confirmed in this study due to the significant number of deaths from abortion that involved single, nulliparous women. In addition, many women who died were in the optimum age group for childbearing, but were more prone to suffer from anemia, hypertension, ectopic pregnancy, and cardiac disease than women over 30 years old. Overall, 126 deaths were considered avoidable. Contributory factors were slowness of surgical management of emergencies, prolonged confinement of women with cardiac disease, and a lack of emergency supplies of blood and drugs for complicated deliveries.^ieng

Female surgical contraception in Kenya-- the Kenyatta National Hospital experience.

PIP: Surgical contraception is regarded as the most effective and widely used method of contraception today in the world. Female sterilization (FS) is currently more popular particularly in Africa, as compared to male sterilization. Compared to other parts of the world, Kenya has one of the lowest acceptancy rates for FS. It is suggested that age, parity, marital status and religions contribute to this low rate. 1,551 FS procedures performed at Kenyatta National Hospital (KNH) between January 1981 and December 1985 are studied. Of the 2 widely employed techniques for FS, minilaparatomy and laparoscopy, the latter was more favored at KNH during the study period, accounting for 48.9% of the cases. The peak parity was in the range of 6-8. Many sterilizations were performed on women in the age group of 30-34 (40.8%). Given the current early marriage age for girls in Kenya (16-18), the high parity and the age of sterilization would make this method demographically ineffective. Marital consideration for provision of this service contributed to the high parity among the single women in the study. For improved acceptance rate and wider application of surgical contraception in Kenya, it is suggested that the use of local anesthesia, service delivery points on an outpatient basis, public education and dramatic counseling, and above all, liberal attitude of service providers and administrators to such factors as age, parity and marital status are essential.^ieng

A review of the medical aspects of adolescent fertility in Kenya.

PIP: In 1990, the annual population growth rate in Kenya was 3.8%, among the highest rates world wide. The ever growing adolescent fertility rate (111-152/1000 from 1969-1989) contributed to this rapid growth. Further repeat pregnancies among adolescents remained high in the 1980's and ranged from 20%-28.6%, depending on the survey. Even though overall prevalence of pregnancy fell 15.4% between 1978-1984, it remained the same for the 15-19 year old group. Teenage births have made up at least 35% of total deliveries. 1985 data revealed that even though adolescents represent 11-35% of the total obstetric population, problems ranked high among them: 38% of all eclampsia cases and high maternal mortality (102/100,000 vs. 57/100,000 older mothers). Studies showed that adolescents are sexually active, are ignorant about contraception, and do not use contraception. Yet contraceptive and family planning services are free in Kenya. Nevertheless the teenagers are at high risk of an unwanted pregnancy, sexually transmitted diseases (STDs), and AIDS. In the early 1980s, Kenyatta National Hospital reported 53% of 74.1% of septic abortion cases being single women were between 14-20 years old. Similar results emerged from other studies. Health professionals believed these results to be underestimated, however. In the 1980s, 33% of all adolescents between 13-15 years old in a rural area had gonorrhea. In Kenyatta, 36% of pregnant 15-24 year olds had at least 1 STD while,e only 16% of those 24 years old did. Further, teenagers are especially vulnerable to psychological problems when they 1st learn of their pregnancy. Health services should be geared to meet the specific needs of adolescents, such as contraception education and antenatal services.^ieng