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Background: In Low and Middle Income Countries (LMIC), including Kenya, undernutrition has been the most significant contributor to child morbidity and mortality. Knowledge and practices of mothers/caregivers have been identified as a key sustainable factor for consideration in determining the nutritional status of children. The study aim was to determine how caregiver knowledge and socio-economic status will impact on nutritional status of children under 5 years. Methods: This study was conducted in Kwale County, Kenya to assess at baseline maternal and child parameters. Seven hundred pairs; children and their primary caregivers were sampled at baseline. Results: A total of 681 households comprised of caregiver and index child pair, participated in the survey from the sampled 700. Knowledge scores of food functions, breastfeeding and complementary feeding were combined to assess caregivers nutritional knowledge with a maximum score of 24. The median score was 11 (IQR: 9 – 12) and ranged from 0 to 24. Those with scores of 12 and above (50% plus) were 230 (33.2%). Stunting was 29.8% and the level of under-weight was 16.4%. No significant association was found between nutritional knowledge of the caregivers and nutitional indicators of children under 5 years but there was significant differences (P= 0.002.) in the Knowledge score of caregivers between the five wealth quintiles. Conclusion: Most of the caregivers did not have any nutritional knowledge which was assessed as knowledge of food groups and sources and functions of different foods as well as knowledge in breastfeeding and complementary feeding.

Background Vector control is an essential component in prevention and control of malaria in malaria endemic areas. Insecticide treated nets is one of the standard tools recommended for malaria vector control. The objective of the study was to determine physical integrity and insecticidal potency of long-lasting insecticidal nets (LLINs) used in control of malaria vector in Kirinyaga County, Kenya. Method The study targeted households in an area which had received LLINs during mass net distribution in 2016 from Ministry of Health. A total of 420 households were sampled using systematic sampling method, where the household heads consented to participate in the study. A semi-structured questionnaire was administered to assess care and use while physical examination was used to determine integrity. Chemical concentration was determined by gas chromatography mass spectroscopy (GC-MS). Data analysis was done using Statistical Package for Social Sciences (SPSS) version 19. Results After 18 months of use, 96.9% (95% CI: 95.2–98.6%) of the distributed nets were still available. Regarding net utilization, 94.1% of household heads reported sleeping under an LLIN the previous night. After physical examination, 49.9% (95% CI: 43–52.8%) of the bed nets had at least one hole. The median number of holes of any size was 2[interquartile range (IQR) 1–4], and most holes were located on the lower part of the nets, [median 3 (IQR 2–5)]. Only 15% of the nets with holes had been repaired. The median concentration for α-cypermethrin was 7.15 mg/m2 (IQR 4.25–15.31) and 0.00 mg/g (IQR 0.00–1.99) for permethrin. Based on pHI, Chi-square test varied significantly with the manufacturer (X (6, N = 389) = 29.14, p = 0.04). There was no significant difference between nets with different number of washes (X2(2) = 4.55, p = 0.103). Conclusion More than three-quarters of the nets supplied had survived and insecticidal potency was adequate in vector control. Standard procedure for field evaluation of surface insecticidal content available to a mosquito after landing on a net to rest is recommended.

Additional file 8. Repeatability testing chromatogram 1

Additional file 11. Calibration curve

Additional file 2. Questionnaire

Additional file 4. Extraction efficiency chromatogram 2

Additional file 9. Repeatability testing chromatogram 2

Additional file 5. Extraction efficiency chromatogram 3

Additional file 6. Extraction efficiency chromatogram 4

Additional file 3. Extraction efficiency chromatogram 1

Additional file 7. Extraction efficiency chromatogram 5

Community-based nutritional intervention to improve the practice of dietary diversity and child nutrition by community health workers (CHWs) involving Nyumba Kumi as small neighborhood units (SNUs) in communities has not yet been explored. This study was conducted in two villages in rural Kenya between 2018 and 2019. In total, 662 participants (control vs. intervention: n = 339 vs. n = 323) were recruited. The intervention group received education on maternal and child nutrition and follow-up consultations. The custom-tailored educational guidelines were made based on Infant and Young Child Feeding and the mother and child health booklet. The educational effects on household caregivers&rsquo, feeding practice attitude and child nutritional status were analyzed using multiple linear regression. After the intervention, a total of 368 household caregivers (187 vs. 181) and 180 children (113 vs. 67) were analyzed separately. Between the groups, no significant difference was found in their background characteristics. This study successfully improved the dietary diversity score (&beta, = 0.54, p &lt, 0.01) and attitude score (&beta, = 0.29, 0.01). The results revealed that the interventions using CHWs and SNUs were useful to improve dietary diversity and caregivers&rsquo, attitudes toward recommended feeding. This research has the potential to be successfully applied in other regions where child undernutrition remains.

Background: There is little information on stroke morbidity in Kenya to inform health care planning. The disability-adjusted life-years (DALYs) are a time-based measure of health status that incorporates both disability and mortality. Methods: This was a multicenter prospective study in Kenya’s public tertiary hospitals conducted in 2015–2017. Data on sex, age, and global disability outcome were collected and used to calculate the sum of years of life lost prematurely due to stroke (YLL), the years of healthy life lost due to disability (YLD), and the DALYs. Results: Up to 719 adult stroke patients participated in the study. The peak age group for stroke was 60–64 years, with ischemic stroke accounting for 56.1% of the stroke cases. After 1-year follow-up, the YLD were 2,402.50, YLL were 5,335.99, and the DALYs were 7,738.49. YLD contributed 31% of the total DALYs. The DALYs varied by sex (male: 2,835.79; female: 4,902.70 years) and by stroke type (ischemic stroke: 4,652.98; hemorrhagic stroke: 3,085.51). The young age group (< 45 years) bore a greater burden accounting for 35.6% of the total DALYs. Conclusion: The YLD, YLL, and DALYs observed reinforce the need for targeted prevention of risk factors and comprehensive stroke care initiatives in Kenya.

Background: About 86% of the cases of cervical cancer occur in developing countries. In Kenya, cervical cancer represents 21% of all cancers in women. With a development period as long as ten years, cervical cancer is possible to control through screening and treatment. Several projects in reproductive health have been offering cervical cancer screening using visual methods through visual inspection with acetic acid or visual inspection with Lugol’s iodine (VIA/VILI). Family planning counselling programs are a good opportunity to discuss the benefits of cervical cancer screening with gynaecological examination more easily accepted. The study looked at the outcomes in relation to screening.Methods: A total of 384 women aged 18 – 49 years were enrolled through systematic sampling in the descriptive cross sectional study. These were clients who attended the family planning clinic in June-July 2014. Participants answered questions from semi-structured questionnaires.Results: Participants who reported to have been screened for cervical cancer were 15.4%. Those screened during the study period were 2.3% and of these, 44.4% had positive VIA/VILI results. Age-group, residence, employment status and usual treatment centre were significant in relation to cervical cancer screening uptake.Conclusion: The availability of screening services in clinics that clients normally attend does not translate into high proportions in cervical cancer screening uptake. However, targeted screening will result in more positive cases being reported.Keywords: Cervical cancer screening uptake, VIA/VILI, family planning clinic, KenyaAfr J Health Sci. 2014; 29(1):13-24

Serum ferritin concentration is the preferred biomarker to assess population iron status in the absence of inflammation. Interpretation of this biomarker is complicated in populations with a high burden of infection, however, because inflammation increases serum ferritin concentration independently of iron status. We aimed to compare estimates of iron status of Kenyan pregnant women, with circulating ferritin concentrations adjusted for inflammation using newly proposed methods by the BRINDA project, or using previously proposed adjustment methods. We re-analyzed data from pregnant Kenyan women living in a rural area where malaria is highly endemic (n = 470) or in an urban area (n = 402). As proposed by the BRINDA group, we adjusted individual ferritin concentration by internal regression for circulating concentrations of C-reactive protein (CRP) and &alpha, 1-acid glycoprotein (AGP). Other adjustment methods comprised: (a) arithmetic correction factors based on CRP or AGP, (b) exclusion of subjects with inflammation (CRP &gt, 5 mg/L or AGP &gt, 1 g/L), and (c) higher ferritin cut-off value (&lt, 30 &mu, g/L). We additionally adjusted for Plasmodium infection as appropriate. Lastly, we assessed iron status without adjustment for inflammation. All correction methods increased prevalence of iron deficiency compared to the unadjusted estimates. This increase was more pronounced with the internal regression correction method. The iron deficiency prevalence estimate increased from 53% to 87% in rural Kisumu study and from 30% to 41% in the urban Nairobi study after adjusting for inflammation (CRP and AGP) using the BRINDA internal regression method. When we corrected for both inflammation and Plasmodium infection using the regression correction, it resulted in lower prevalence estimates compared to uninfected women. Application of linear regression methods to adjust circulating ferritin concentration for inflammation leads to markedly decreased point estimates for ferritin concentration and increased estimates for the prevalence of iron deficiency in pregnancy.

Additional file 1: Appendix S1. A PDF file with a detailed dataset for intra- and inter-group Adherence rates, before the adoption of Universal test and Treat (UTT) and after UTT adoption; found at https://doi.org/10.6084/m9.figshare.5760219.v1 .

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

Summary Background Cardiovascular diseases are the second leading cause of morbidity and mortality in Kenya. However, there is limited clinico-epidemiological data on stroke to inform decision making. This study sought to establish stroke distribution patterns and characteristics in patients seeking care at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH), with the ultimate aim of establishing the first national stroke registry in Kenya. Methods This was a prospective multicentre cohort study among stroke patients. The study used a modified World Health Organisation STEP-wise approach to stroke surveillance tool in collecting data on incidence, major risk factors and mortality rate. The Cochran’s Mantel–Haenszel chisquared test of conditional independence was used with p-value set at 0.05. Results A total of 691 patients with confirmed stroke were recruited [KNH 406 (males: 40.9%; females: 59.1%); MTRH 285 (males: 44.6%; females: 55.4%)] and followed over a 12-month period. Overall, ischaemic stroke accounted for 55.6% of the stroke cases, with women being the most affected (57.5%). Mortality rate at day 10 was 18.0% at KNH and 15.5% at MTRH, and higher in the haemorrhagic cases (20.3%). The most common vascular risk factors were hypertension at 77.3% (males: 75.7%; females: 78.5%), smoking at 16.1% (males: 26.6%; females: 8.3%) and diabetes at 14.9% (males: 15.7%; females: 14.4%). Ischaemic stroke was conditionally independent of gender after adjusting for age. Conclusions To our knowledge this is the first pilot demonstration establishing a stroke registry in sub-Saharan Africa and clearly establishes feasibility for this approach. It also has utility to both inform and potentially guide public policy and public health measures on stroke in Kenya. Important and unexpected observations included the preponderance of women affected by cerebrovascular disease and that cigarette smoking was the second most common risk factor. The latter, over time, will further impact on the clinico-epidemiological profile of cerebrovascular disease in Kenya.

Hemoglobin and ferritin are important biomarkers of iron status but are both altered by inflammation. We used the inflammation biomarkers C-reactive protein (CRP) and alpha1-acid glycoprotein (AGP) to adjust hemoglobin and ferritin concentrations to clarify interpretation of iron status. Apparently healthy adults who tested positive twice for HIV but who had not reached stage IV or clinical AIDS were randomly allocated to receive a food supplement (n = 17 and 21) or the food plus a micronutrient capsule (MN; 10 men and 34 women, respectively) containing 30 mg iron/d. Hemoglobin, ferritin, CRP, and AGP concentrations were measured at baseline and 3 mo and subjects were divided into 4 groups (reference, no inflammation; incubating, raised CRP; early convalescence, raised AGP and CRP; and late convalescence, raised AGP). Correction factors (the ratios of the median for the reference group over each inflammatory group) improved the consistency of the ferritin but not the hemoglobin results. After correction, ferritin (but not hemoglobin) increased in both men (48 microg/L; P = 0.02) and women (12 microg/L; P = 0.04) who received MN but not in the food-only group. However, hemoglobin did improve in subjects who showed no inflammation both at baseline and mo 3 (P = 0.019), but ferritin did not increase in this group. In conclusion, ferritin concentrations were more closely linked to current inflammation than hemoglobin; hence, correction by inflammation biomarkers improved data consistency. However, low hemoglobin concentrations were the consequence of long-term chronic inflammation and improvements in response to MN supplements were only detected in subjects with no inflammation.

Introduction: Prevention of Mother to child transmission (PMTCT) of HIV for a long time has been implemented as standalone programs. Recently, there has been increasing awareness and discussion on possible benefits of integrating Sexual and Reproductive Health (SRH) and PMTCT services to reduce mother to child transmission of HIV. Aims and objectives: To identify barriers to PMTCT uptake and assesses challenges experienced in integration of PMTCT with SRH services. Material and methods: The study employed mixed methods of study design and three stage cluster sampling strategy to recruit 340 HIV positive postnatal mothers. Twelve key informants were purposively selected from all selected study facilities. A structured questionnaire and a focus group discussion guide were used to obtain information from postnatal HIV infected mothers on barriers to PMTCT uptake. Key informants interview guides (KIIs) were used to obtain information from hospitals administrators and PMTCT staff on barriers to effective intergration of SRH and PMTCT services. Data collected using questionnaires was analysed using Statistical Package for Social Sciences (SPSS) version 17. Qualitative data from key informants was analysed using Microsoft office excel. Observation and results: Lack of partners support, stigma and discrimination were reported as the main hindrances to PMTCT uptake. Inadequate staffing and lack of specialized training was reported as a barrier to PMTCT and SRH services integration. Conclusion: Barriers to PMTC integration with SRH programme can be eliminated by addressing shortage of staff, equipping staff with specialized knowledge and skills on SRH and PMTCT.

Background Neglected tropical diseases (NTDs) are major public health problems in developing countries where they contribute to suffering of populations living in poor settings. As part of a research project started in September 2009 in Kwale district, Coast Region, Kenya, a baseline cross-sectional survey was conducted in 5 rural villages to provide information on the status of NTDs, including urinary schistosomiasis, soil-transmitted helminthiasis (STH), and lymphatic filariasis. This paper presents the results of a parasitological investigation among adults in the study villages. Methods A total of 599 adults in the 5 study villages were tested for NTD infections in urine, stool and blood. The presence of Schistosoma haematobium infection was determined by the urine filtration method. The presence of STH in stool was determined by Kato-Katz method while filarial antigenaemia was determined using immunochromatographic (ICT) test. Results The study revealed high prevalence of hookworm (41.7%) and schistosomiasis (18.2%) infections among adults in the study villages. Of the 599 individuals examined, 50.1% had one or more helminthic infections. There was low level of polyparasitism with helminthic NTDs in the study population with 9.5% and 1.7% of the participants having two and three infections, respectively. Conclusions In the current study, hookworm and schistosomiasis infections were identified as important infections among adults living in areas of high endemicity for these infections. Thus, if this section of the population is left untreated it may remain an important potential reservoir and a source of re-infection for school-age children treated in school deworming programmes. Therefore, there is a need to design novel strategies for preventive chemotherapy interventions that could allow inclusion of adults in an effort to reduce force of infection in high endemic communities.

Plasma zinc is an important biomarker of zinc status, but the concentration is depressed by inflammation.Apparently healthy adults, who tested positive twice for human immunodeficiency virus (HIV) but who had not reached stage IV or clinical AIDS, were randomly allocated to receive a food supplement (n=17 and 21) or the food plus a micronutrient capsule (MN; n=10 men and n=33 women) containing 15 mg zinc/day. We used the inflammation biomarkers, C-reactive protein (CRP) and alpha1-acid glycoprotein (AGP), to identify subjects with and without inflammation and determine the effect of inflammation on the response of plasma zinc concentrations to the MN and food supplements.There were no differences between men and women either in plasma zinc or in the responses to the supplements and their data were combined. Plasma zinc was lower in those with inflammation than without. Repeated measures analysis of variance (ANOVA) showed that inflammation blocked increases in plasma zinc, and there was an approximate 10% increase in plasma zinc concentration in response to the MN supplement (P=0.023) in those without inflammation. Subgroup analysis showed mean changes in plasma zinc of 0.95 and -0.83 micromol/l (P=0.031) in response to the MN and food treatments, respectively, in those without inflammation at both time points.Inflammation seems to block any increase in plasma zinc after MN supplement and it is important to identify those without inflammation to determine the effectiveness of a zinc supplementation program.

Inflammation influences the assessment of nutritional status. For example, inflammation reduces plasma retinol concentrations and vitamin A deficiency is overestimated. Conversely inflammation increases plasma ferritin concentrations and Fe deficiency is underestimated. Blood samples were obtained from 163 free-living HIV-1-infected adults, not on continuous medication, anti-retroviral drugs or micronutrients, not unwell and who had not reached WHO stage IV of HIV/AIDS. We used four markers of inflammation, C-reactive protein (CRP), alpha1-acid glycoprotein (AGP), alpha1-antichymotrypsin and erythrocyte sedimentation rate but mainly CRP and AGP were used to separate the subjects into four groups: 'healthy' where both CRP and AGP were normal; 'incubation phase' where CRP was elevated; 'early convalescence' where AGP and CRP were elevated and 'late convalescence' where only AGP was elevated. Correction factors were calculated to remove the influence of inflammation from each biomarker and group where inflammation was present and the data are shown before and after recalculation. The correction increased median plasma retinol concentrations of the whole group from 1.16 to 1.33 micromol/l, comparable with values (mean 1.29 micromol/l) in HIV-negative Kenyan women. Median ferritin concentrations fell by about 50% in both sexes and the number of women with plasma ferritin concentrations < or = 12 microg/l increased from eleven to twenty. The correction also increased plasma carotenoids and Hb but not alpha-tocopherol concentrations. We suggest that the method described to remove the influence of inflammation from nutritional biomarkers should be generally applicable in apparently healthy people and prevents discarding valuable data because of mild inflammation. The method does now need to be tested in other populations.

Major and minor surgery is a service of great importance both for the people in need and for health workers and managers trying to develop a comprehensive primary health care service. While in highly industrialised countries some 5000 - 9000 major operations are performed per 100,000 people per year, the rates in East Africa in the early 1990s were in the range of 70-500. In our study all surgical operations performed at hospitals and clinics in Meru district during 12 months in 1990-1991 were listed on record forms including age, sex and home address of patients, and type of operation. Totally 3,415 major operations were recorded, corresponding to 263/100,000 people (88 for males and 434 for females), and the most common major operations were caesarean section, tubal ligation, explorative laparotomy, eye/lens removal and hernia repair. Assuming that the basic need in eastern Africa is about 1,000 major operations/100,000/year it appears that only 7-50% of this basic need was available in this rural area. The epidemiological basis for such estimates is however rather weak and the information systems are unsatisfactory. More accurate data are required both on descriptive epidemiology and on surgical service output as a basis for planning. Comparisons are difficult due to poorly standardised epidemiology and output indicators. We examine, from a health planning perspective, four possible methods of quantifying the major surgery output: (a) the annual number of major operations per 100 hospitals beds; (b) the number per 1000 inpatient admissions; (c) the number per 10,000 new out-patient consultations; and (d) the annual number per 100,000 catchment area population. The mean number per 100 beds was 310 with a range from 452 to 140; the mean number per 1000 admissions was 74 ranging from 88 to 31, the number per 10,000 new outpatient visits was 96 ranging from 188 to 55, and the mean number per 100,000 catchment area population was 263 for the entire district with a range from 383 to 119 among the five hospitals. We conclude that option (1) and (2) are useful and implementable, (3) is less useful but implementable, and option (4) is potentially very useful but not easily implementable until a catchment area population definition is agreed. Minor surgery is even less well investigated, and there are hardly any studies at all from low-income countries. Our data from Meru demonstrate that the one-year output in a population of 1.3 million people was 26,858 (2,066/100,000 people/year) of which about 82% were done at the hospitals in the area. The smaller clinics did on average only 1.8-6.4 minor operations per month. The basic need for minor surgery in these areas has not been estimated, so the unmet need must be considered unknown. Further research is recommended in the following areas: epidemiological estimates of surgical service need in eastern Africa, critical review of the health information systems with regard to surgery, quality of major and minor surgery services especially in rural areas, reasons for low surgical output at small clinics; possible remedies. [Afr. J. Health Sci. 2002; 9: 17-25 ]