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Purpose: To assess the health facility factors associated with low birth weight at Thika Level Five Hospital in Kiambu County, Kenya. Methodology: Cross sectional convergent design was employed. The target group composed of mothers who delivered in the hospital during the study period (July-August, 2019). A sample was obtained from all willing mothers. Sample size was determined using the Cochran formula assuming a proportion (p) of 16.4% of low birth weight. Desired sample size was 210 mothers which was adjusted to 215 participants. Independent variables included: medical equipment and supplies, medical personnel and accessibility of health facility. Dependent variable was LBW which was classified further as very LBW, extremely LBW. The primary focus was first to identify LBW which was then categorized according to the standard classification. Quantitative and qualitative data were collected and analyzed using logistic regression and NVivo respectively. Findings: Accessibility to a health facility OR= 0.45, p=0.04, CL [0.21-0.97] was associated with very low birth weight. The mothers (FGDs) indicated that there were challenges at the laboratory; some health workers were not good; and ANC counselling sessions were inadequate. Health workers who were Key Informants (KI) reported inadequacy of resources and suggested campaigns to reach mothers in order to attend ANC early and a provision of a preconception centre at the Hospital. Unique contribution to theory, practice and policy: Inaccessibility of a health facility by pregnant mothers is a risk factor for very low birth weight neonates. ANC guidelines to be revised to cater for the concerns of mothers. Preconception centres should be established in hospitals.

Background Globally, individuals who do not possess authentic documentation of date of birth may require age assessment before accessing certain rights or facing legal consequences. The determination of age requires customization and a systematic multidisciplinary approach. Hence, professional and human rights organizations have established relevant guidelines. In Kenya, there is lack of a documented local policy on age assessment; nevertheless, the dentists working in public hospitals often receive patients for age assessment. In order to improve on local practices, there is need to investigate current age assessment procedures. Therefore, the objective of this study was to look at the age assessment methods in use currently. Methods The study design was cross-sectional. Data was collected prospectively from new patients who visited eight (8) selected public dental health facilities for age assessment during the study period 2019–2020.Patients were sampled through convenience sampling from randomly selected hospitals. Study variables included gender, estimated age and age assessment methods. The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 20. The statistical significance was tested by Chi-square test. Results The study included 316 patients, 186(58.9%) males and 130(41.1%) females. The average age was 19.42 ± 12.33 years, with a range of 1.5–79 years. There were significantly (Χ2(7) = 39.883, p = 0.000) more children (248,78.5%) than adults (68,21.5%). The age was assessed through examination of presented documents, social history and review of eruption patterns. There was significant use of dental panoramic radiographs (210,66.5%) to review root formation (Χ2(7) = 164.991, p = 0.000). Unspecified tooth maturity tables were used to deduce the dental age. Conclusion Age assessment was mostly indicated for children aged 18 years and below. Both non-medical and medical methods were applied in age assessment though devoid of any structured processes. Observation of eruption patterns and use of dental panoramic images to assess developing teeth were utilized in most patients. The dental age was assessed through the use of unspecified tooth maturity tables. There is need for further training on application and limitations of age estimation methods as well as development of a national protocol so as to ensure equality and provision of evidence based age assessment services.

Substance abuse amongst university students is a major public health concern. There is paucity of literature on the effectiveness of the existing interventions aimed at reducing substance abuse in middle and low income countries. This study was done to determine the effectiveness of alcohol and drug abuse awareness campaigns on behaviour change among first year undergraduate students. This was a quasi-experimental study. Baseline survey involving 473 first year undergraduate students from two public universities in the coastal region of Kenya was done. The Universities were then allocated to either experimental or control group. Intervention of awareness campaigns were carried out in one of the University for a period of one year after which an end-line surveys involving 387 students was done. Data was collected using self-administered questionnaires. The study showed high prevalence of substance use with alcohol being the most commonly used substance at both baseline and end-line surveys. Despite the intervention being in one University, the prevalence of drug use increased from 38.9% to 48.9% in the control University and 31.3 % to 55.2% in the intervention University. The problem of substance abuse is enormous among university students. Information awareness campaigns against substance abuse alone are not effective in reducing uptake of substance use among university students.There is need to devise more effective strategies to control substance abuse. [Med-Science 2017; 6(3.000): 464-70]

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.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.

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

Background: Visceral Leishmaniasis (Kala-azar) is a serious disease caused by species of the parasitic protists Leishmani and transmitted by Phlebotomus sandflies . It is classified as a neglected disease yet it is a public health problem, a debilitating disease causing an estimated 500,000 new cases each year, and a tenth of these patients will die in the endemic areas. Objective: To assess the knowledge, attitude, perception and the behaviour of the community towards kala-azar in Loima Sub-County of Turkana County, Kenya. Methods: Descriptive cross- sectional research design was employed and the study was conducted between October, 2015 and June, 2016. Cluster random sampling technique was used to identify study subjects in the purposively selected Loima area. A sample size of 341 respondents who were household heads or adult members were randomly sampled. Data collection was done using pretested structured questionaires, interviews, focus group discussions and observations; entered into Statistical Package for Social Sciences (SPSS) version 17.0 for analysis and presentation done using both quantitative and qualitative approaches. The chi – square test with 95 CI was used to compare the association between variables. P-value of less than 0.005 was considered as a level of significance. Results: The key factors influencing knowledge, attitude, perception and behaviour towards the disease in the community and with significant association include:Age ((OR=0.6; 95%CI= (0.1-1.0), p=0.113) ,gender(OR=0.6; 95%CI= (0.2-0.8), p=0.011), educational level (OR=1.1; 95%CI= (0.4-1.6), p=0.0341, socio-economic status, housing (OR=1.6; 95%CI= (1.0-3.0), p=0.024 ), behaviour of resting or sitting near termite mounds 70%(n=191) (OR=0.6; 95%CI= (0.1-2.1), p=0.0043)) and lack of proper knowledge on transmission of disease. Also, human practices such as deforestation and hunting 52%(n=32), and dancing at night (Edong’a -64.8%(n=167), when the sand flies are active. Conclusion: The study concludes that kala-azar is endemic in the area and though the community is aware of its existence, the residents have different of beliefs about the transmission. The study recommends the need for enhanced general health education and awareness on the transmission cycle of kala-azar. Community empowerment and participation should be emphasized as well as structural development plans that include sand fly management strategies and control methods that would ensure the removal of breeding and resting sites of the vectors within human habitation.

Contexte La relation entre la leucemie myeloide chronique (LMC) et de nombreuses expositions differentes a des facteurs environnementaux et professionnels connus pour causer une leucemie de maniere generale est limitee. Dans l’ensemble, la LMC est incurable et le traitement ne constitue qu’une solution palliative permettant de prolonger la vie, avec un taux de letalite tres eleve, meme dans les meilleurs centres. En outre, son traitement est extremement onereux. L’identification des facteurs leucemogenes est par consequent importante si elle permet de recourir a de simples interventions de sante publique.

Background. Maternal mortality has continued to escalate in Kenya inspite of all the efforts being made by the government, non-governmental organization and the community. The purpose of the study was to establish the antecedent factors predisposing women to maternal death using the three delays model. Methodology: Retrospective 72 maternal death cases which occurred between January 01, 2009 and June 30, 2010 were reviewed by an independent gynecologist/obstetrician. Interviews were conducted with kins of the deceased women using a confidential questionnaire for female death based on distal as well as proximal factors that may have had a bearing on maternal death. Health care workers were likewise interviewed using a formulated questionnaire to assess the ability and readiness of the hospital to offer emergency obstetric care. Results: A record of 72 maternal deaths occurred during the study period thus between January 1, 2009 and June 30. 2010. Out of 72, 42 maternal deaths were as a result of direct obstetric complications which include hemorrhage, post-partum sepsis, pre-eclampsia and abortion. Post partum hemorrhage was the most common complication which contributed to maternal deaths. Again out of 72 maternal deaths, 33 were as a result of indirect causes with peritonitis, heart disease, HIV/AIDS, anemia, and convulsive disorder respectively. Delayed access to transport, lack of money for user fees, and hospital distance were challenges that led to delay in accessing care. Hospital experiences included; delay in service provision by staff, delayed quality emergency obstetric care and delayed care while at the hospital, unavailability of blood for transfusion, and lack of money for drugs, were reported as major challenges which attributed to maternal death. Conclusion: The study suggests maternal mortality occurs as a result of lack of access to quality healthcare facility poor health seeking behavior and poor socio-economic factors.

The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this regard, the health system requires strengthening to respond to the rising cases of infection, drug resistance and quality of life lost while continuing to seek interventions that improve adherence to medication and case detection among those infected. Methods: This study sought to determine factors that are associated with sputum positivity after intensive phase of chemotherapy in people with tuberculosis. It was a retrospective case-control study conducted in Rhodes chest clinic, a City Council health unit in Nairobi that specializes in treatment of chest infections. The participants were sampled from clinic attendants who had completed two months of intensive phase TB chemotherapy and met inclusion criteria. Results: Seventy participants of whom 25 (36%) were sputum positive at the end of two (2) months intensive phase were included in the study. Skipping medication doses was significantly associated with sputum positivity (p = 0.01). Patients who were sputum positive at the end of the two-month period were more likely to have taken longer time before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 - 12) and 4 (3 - 8) weeks respectively although this difference was not significant (p = 0.09). Patients who had not disclosed their infection status had a two-fold possibility of remaining sputum positive at the end of intensive phase. Conclusion: Early diagnosis and treatment of TB, and adherence to medication were important factors that affect sputum conversion during intensive phase of TB treatment. Therefore, public health practitioners should advise patients to seek prompt diagnosis and treatment of signs and symptoms of tuberculosis.

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.

The study aimed to describe the effect of an oral health education intervention on oral hygiene status and gingival inflammation among persons with HIV attending two comprehensive healthcare centres in Nairobi, Kenya. This was a quasi-experimental study of 195 participants (with 102 in the intervention group, and 93 serving as the control group) who were selected using stratified random sampling. The data were collected at baseline, at three months (review 1), and at six months (review 2) using an interviewer-administered World Health Organization clinical examination form. The prevalence of plaque among the participants in the intervention decreased from 70.6% to 18.6%, with a significant decrease in their mean plaque score, from 0.89 to 0.15. The prevalence of gingival inflammation in the intervention group decreased from 58.2% to 12.7%, with a significant decrease in the mean gingival score, from 0.66 to 0.11. No significant change in degree of oral hygiene and gingival inflammation was observed among the non-intervention group. There was a strong association between the change in the mean gingival score and the change in the mean plaque score between baseline and at six months for the intervention group. The regression analysis yielded a coefficient of determination (r2) of 0.76; therefore, 76% of the variation in change in gingival score was explained by the variables in the equation. Only the change in mean plaque score was a significant predictor of the change in gingival score.

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.

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 p16INK4a/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 p16INK4a/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. p16INK4a/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: p16INK4a/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 p16INK4a/Ki-67 cytology compared to HPV DNA testing in a Kenyan screening population. VIA/VILI missed all histology-proven CIN2/3.

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 14 months 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 6–9 months, 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 14 months, 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.

Introduction nbsp Acute Respiratory Infections ARI is the most common causes of both illness and mortality nbsp Objectives nbsp This study aimed to identify the aetiology of acute respiratory illnesses in subjects from selected health facilities in Nakuru Country in Kenya nbsp Method nbsp This was a case control study which recruited parents or guardians with children less than years of age who visited the selected health facilities with suspected ARI Controls were matched for age and sex Throat and nasopharyngeal swabs were collected from the children to isolation and detection of bacterial and viral agents respectively A questionnaire was used to obtain socio demographic information from the study subjects Logistic regression analysis was used to identify the factors associated with ARI agents nbsp Results nbsp Bacteria were isolated in of sampled patients with nbsp Streptococcus nbsp pyogenes nbsp andStreptococcus nbsp viridans being the most predominant At least one ARI respiratory associated virus in of the specimen collected from the children with nbsp Influenza A nbsp nbsp RSV and nbsp Influenza B nbsp being more common Mixed infections were present in of the sampled children The clinical predictors of bacterial isolation were fever high respiratory rate cough and stridor while high respiratory rate and cough were more associated with viral detection nbsp Conclusion nbsp The study revealed that influenza viruses and nbsp Streptococcus nbsp pyogenes nbsp are the major viral and bacterial etiologies of ARI respectively in this study population Mixed infections are also common among the study subjects

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.Key words: Fracture shaft femur, cost effectiveness, functional outcome

Background: Visceral Leishmaniasis (Kala-azar) is a serious disease caused by species of the parasitic protists Leishmania. It can affect humans living in parts of the tropics and sub-tropics and is transmitted by Phlebotomus sandflies. It is classified as a neglected disease yet it is a public health problem, a debilitating disease causing an estimated 500,000 new cases each year, and a tenth of these patients will die in the predisposed areas. Objective: To assess the exposure factors associated with kala-azar in Loima sub-county of Turkana County, Kenya. Methods: Descriptive cross- sectional research design was employed and the study was conducted between October, 2015 and June, 2016. Cluster random sampling technique was used to identify study subjects in the purposively selected Loima Sub-county. A sample size of 341 respondents who were household heads or adult members and health facility workers were randomly sampled. Data collection was done using pretested structured questionaires, interviews, focus group discussions and observations; entered into Statistical Package for Social Sciences (SPSS) version 17.0 for analysis. Presentation of data was done using both quantitative and qualitative approaches. Results: The key exposure factors to the disease in the community include: Age, gender, educational level, socio-economic status, housing, presence of large amount of termite mounds all over the area 60.1%(n=205),inaccessibility to health services, varying health-seeking behaviour and lack of proper knowledge on transmission of disease. Also, human activities such as deforestation and hunting 52%(n=32), resting or sitting near termite mounds 70%(n=191) and dancing at night (Edong’a -64.8%(n=167), when the sand flies are active. There was a significant association between age ((OR=0.7; 95%CI= (0.4-1.1), p=0.135) and exposure to kala-azar, gender (OR=0.6; 95%CI= (0.4-0.9), p=0.012),education level (OR=1.2; 95%CI= (0.1-1.4), p=0.0501)), housing (OR=1.8; 95%CI= (1.0-3.1), p=0.029 ),presence of large amount of termite mounds (OR=0.6; 95%CI= (0.2-2.0), p=0.0045) and resting or sitting near termite-mounds (OR=0.6; 95%CI= (0.1-2.1), p=0.0043)).Conclusion: The study concludes that kala-azar is prevalent in the area and though the community is aware of its existence, the residents have different beliefs about transmission. The study recommends the need for enhanced general health education and awareness on the transmission cycle of kala-azar. Community empowerment and participation should be emphasized as well as structural development plans that include sand fly management strategies and control methods that would ensure the removal of breeding and resting sites of the vectors within human habitation. In addition, integrated disease surveillance and response to be implemented to avert the disease situation.

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.

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.Pan African Medical Journal 2012; 12:42

Udgivelsesdato: 1993-Dec This study compares the results of a full mouth examination with the results of examining only the CPITN selection of 10 index teeth 17/16, 11, 26/27, 47/46, 31 and 36/37 for estimates of prevalence and severity of the conditions assessed with the CPITN, i.e. gingival bleeding, dental calculus, pockets 4-5 mm deep and pockets 6+ mm deep. The mean number of sextants recorded with bleeding or with calculus was generally overestimated when examinations were based on the CPITN selection of index teeth, whereas the mean number of sextants with pockets, whether moderate or deep, were generally underestimated. Similarly, the prevalence of pockets, whether moderate or deep, was underestimated in virtually all age groups while the prevalence of calculus was overestimated in all age groups and the prevalence of bleeding was overestimated among persons below 30 yr of age. We conclude that the partial recording approach of the CPITN methodology is reasonably well suited for identifying persons who are relatively healthy according to the hierarchy of the CPITN parameters. There is, however, a considerable risk that persons presenting with the more severe conditions, i.e. pockets, will be overlooked if only partial recordings are performed.

This study investigates the relationship between CPITN findings and the prevalence and severity of periodontal attachment loss in a rural Kenyan population comprising 1131 persons aged 15-65 years. All persons were examined for calculus, gingival bleeding, pocket depths and attachment loss levels on 4 sites of each tooth present. Recordings of bleeding, calculus and pocket depths were used to compute CPITN scores based on the 10 index teeth originally proposed, and these CPITN scores were subsequently related to the attachment loss findings derived from the full-mouth assessment. In most cases, persons with a CPITN scoreor = 1 did not have attachment lossor = 4 mm. However, among 40+ year-old persons with CPITN score 2 over 90% had attachment lossor = 4 mm and over 50% of the 50+ year-olds with CPITN score 3 had attachment lossor = 6 mm. Less than 20% of the 15-29 year-olds with CPITN score 3 had attachment lossor = 6 mm, and usually the attachment loss levels ranged between 0 and 3 mm. Beyond the age of 35 years over 10% of the sextants with CPITN score 0 had attachment lossor = 4 mm. Below the age of 35 years more than one third of all sextants with CPITN score 3 had attachment loss levelsor = 3 mm. Thus, the CPITN findings overestimate both prevalence and severity of periodontal attachment loss among the younger age groups and underestimate these parameters among elderly subject.

Udgivelsesdato: 1993-Dec In order to study the validity of the hierarchical principle of the CPITN we used data originating in a cross-sectional study of periodontal disease in a random sample comprising 1131 Kenyans aged 15-65 yr to determine, for each tooth present in each individual, the absence or presence of gingival bleeding, of dental calculus, of a pocket of 4-5 mm or a pocket of 6+ mm, such that each tooth had a separate recording for bleeding, calculus, pocket 4-5 mm and pocket 6+ mm. According to the hierarchical principle of CPITN a tooth with pockets as the most severe finding is assumed positive also for calculus and bleeding, and a tooth with calculus as the most severe finding is assumed positive also for bleeding. Our analysis showed that calculus as the most severe finding of a tooth overestimates the occurrence of bleeding by up to 18%, depending on age of the individuals and the set of teeth examined. Pockets as the most severe finding in a tooth overestimates the occurrence of bleeding by up to 13%, and overestimates calculus by up to 54%, most pronounced in the younger age groups. The effect of these overestimations on prevalence and severity estimates was the most pronounced for the severity measures, particularly regarding the severity of bleeding, whereas prevalence estimates remained relatively unaffected. Undoubtedly, this result should be seen in the light of a very high prevalence and severity of both bleeding and calculus in this population.

In Nairobi (Kenya) 334 women prostitutes of whom 80.5% were HIV-1 positive, were examined for oral mucosal lesions; 15.6% of seropositive, and 4.6% of seronegative, women had oral mucosal lesions, predominantly oral candidiasis. In the seropositives, 8.6% had erythematous, 1.1% had hyperplastic candidiasis, and 0.4% had hairly leukoplakia as the only oral lesions; 0.4% had a combination of erythematous and hyperplastic candidiasis, and 1.5% had combinations of pseudomembranous and erythematous candidiasis in the presence of hairly leukoplakia. Of the 211 seropositive women for whom we knew the first date on which a positive serologic test was obtained, the likelihood of developing an oral mucosal lesion was found to be dependent on the duration of seropositivity. The low incidence of oral mucosal lesions in this population may be due to the relatively recent acquisition of HIV-1 infection.

To describe the causes and determinants of maternal mortality among women of reproductive age seeking healthcare services at Kisii General Hospital.Descriptive retrospective study.Kisii General Hospital which is a Level-5 Referral Hospital.Seventy-two women who had died as a result of pregnancy and childbirth related conditions who had sought obstetric services at Kisii General Hospital.Majority 51(70.8%) of deceased did not go to hospital promptly, due to; lack of transport 22 (30.6%), lack of money 17 (23.6%), and hospital distance 8 (11.1%). About 43 (60%) of those who died were between 15-25 years of age. Hospital experiences included; delay in service provision by staff 14 (19.4%), unavailability of blood for transfusion 6 (8.3%), and lack of money for drugs 12 (16.7%). Complications which led to maternal mortality were mainly; postpartum sepsis, bleeding, hypertension and cardiovascular conditions.Lack of lack of transport, inability to pay, delayed care seeking and lack of emergency obstetrics were the major challenges. Postpartum sepses, bleeding and pre-eclampsia were the leading complications that led to death.

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 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.

Results Prevalence of tungiasis was 57% (218/385; 95% CI=51.7%-61.6%). Itching (89.1%) was the most common associated symptom, followed by pain upon pressure (67.3%), sleep disturbance (58.2%) and walking difficulties (53%). In multivariate logistic regression analysis the following independent factors were identified to be associated with tungiasis: living in houses with an earthen floors (adjusted OR=3.84; 95%IC: 2.09-7.06), walking barefooted (OR=3.28; 1.78-6.04), having a common resting place outside the house (OR=2.36; 1.01-5.51) and presence of rats on the compound (OR=1.69; 1.03-2.75).