Search

Despite the notable gains that have been realized in reversing perinatal, neonatal, and childhood morbidity and mortality, insignificant actions on birth defects undermine the desired outcomes. A yearly upward trend of birth defects (44.04-205.28 per 100,000 livebirths) between 2014 and 2018 attributed to known genetic, unknown multifactorial inheritance, and socio-demographic environmental factors, with an estimated unit economic cost of $ 1,139.73 for outpatient services was observed in Kiambu County, Kenya. Thus, interventions anchored on social health insurance would suffice., Competing Interests: The authors declare no competing interests., (Copyright: George Nyadimo Agot et al.)

Introduction: major external structural birth defects (MESBDs) are known to exert an enormous economic burden on individuals and health services; however, they have been vastly underprioritized as a public health problem in settings where cost analyses are limited. This study aimed at conducting a cost analysis of outpatient services for MESBDs in selected hospitals in Kiambu County, Kenya., Methods: a cross-sectional descriptive survey was conducted in four hospitals selected for providing outpatient corrective and rehabilitative services to the under-fives. An ingredient approach was used to gather data retrospectively on the cost drivers for castings, bracings, and tendonectomies from healthcare providers' perspectives for a one-year time horizon from January 1 st , 2018, to December 31 st , 2018. Prevalence-based morbidity data were extracted from outpatient occupational therapy clinic registers, whereas staff time was gathered through face-to-face inquiries. Associated cost drivers of 349 cases were quantified, valued using prevailing market prices, and categorized as recurrent costs. The unit economic costs were calculated as average costs, expressed in U.S. dollars, and inflated to the U.S. dollar Consumer Price Index from January 2018 to December 2018., Results: the unit economic cost of all the cases was estimated at $1,139.73; $1,143.51 for neural tube defects (NTDs), $1,143.05 for congenital talipes equinovarus (CTEV), and $1,109.81 for congenital pes planus., Conclusion: the highest economic burden of MESBDs was associated with NTDs, and CTEV, respectively. We recommend further research to estimate the economic costs of MESBDs among school-going pupils to inform the equitable allocation of resources for health and childhood developmental programs., Competing Interests: The authors declare no competing interests., (Copyright: George Nyadimo Agot et al.)

Background: Although major external structural birth defects continue to occur globally, the greatest burden is shouldered by resource-constrained countries with no surveillance systems. To our knowledge, many studies have been published on risk factors for major external structural birth defects, however, limited studies have been published in developing countries. The objective of this study was to identify risk factors for major external structural birth defects among children in Kiambu County, Kenya. Methods: A hospital-based case-control study was used to identify the risk factors for major external structural birth defects. A structured questionnaire was used to gather information retrospectively on maternal exposure to environmental teratogens, multifactorial inheritance, and sociodemographic-environmental factors during the study participants' last pregnancies.  Descriptive analyses (means, standard deviations, medians, and ranges) were used to summarize continuous variables, whereas categorical variables were summarized as proportions and percentages in frequency tables. Afterward, logistic regression analyses were conducted to estimate the effects of the predictors on the odds of major external structural birth defects in the country. Results: Women who conceived when residing in Ruiru sub-county (adjusted odds ratio [aOR]: 5.28; 95% CI: 1.68-16.58; P<0.01), and Thika sub-county (aOR: 0.27; 95% CI; 0.076-0.95; P =0.04); and preceding siblings with history of birth defects (aOR: 7.65; 95% CI; 1.46-40.01; P =0.02) were identified as the significant predictors of major external structural birth defects in the county. Conclusions: These findings pointed to MESBDs of genetic, multifactorial inheritance, and sociodemographic-environmental etiology. Thus, we recommend regional defect-specific surveillance programs, public health preventive measures, and treatment strategies to understand the epidemiology and economic burden of these defects in Kenya. We specifically recommend the integration of clinical genetic services with routine reproductive health services because of potential maternal genetic predisposition in the region., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Agot GN et al.)

Introduction: major external structural birth defects are typical and have been associated with childhood morbidity, mortality and lifelong resource-intensive disabilities. These defects continue to occur; however, they are yet to be recognized as public health problems in Kenya. The objective of this study was to estimate the prevalence of major external structural birth defects in Kiambu County in Kenya, 2014-2018., Methods: a cross-sectional study design was adopted; a retrospective review of medical records was conducted between 2014 and 2018 abstracting 873 birth defects. Following a predetermined inclusion criterion, a five-year prevalence numerator of 362 cases was determined, whereas, a five-year prevalence denominator of 299,854 cases of registered live-births was obtained from the birth registrar. Annual prevalence estimates of 29 sub-groups and 6 groups of these defects were calculated as the number of cases (numerator) divided by the number of live-births (denominator). Associated 95% binomial exact confidence intervals were also computed and expressed per 100,000 live-births., Results: defects of the musculoskeletal system, the central nervous system, orofacial, genital organs, eye and anus were observed. Defects of the musculoskeletal system were the most prevalent, ranging from 22.98 (95% CI: 11.87-40.13) to 116.9 (95% CI: 92.98-145.08) per 100,000 live-births. Defects of the central nervous system followed ranging between 13.40 (95% CI: 5.39-27.61) and 32.79 (95% CI: 20.79-49.19) per 100,000 live-births., Conclusion: despite musculoskeletal system defects being the most common group, hypospadias; a defect of the male genital organ was the most prevalent among the sub-group of these defects., Competing Interests: The authors declare no competing interests., (Copyright: George Nyadimo Agot et al.)

We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the 'Optimizing the Response of Prevention: HIV Efficiency in Africa' (ORPHEA) project, we collected retrospective data from government and non-governmental health facilities for 2011-12. We used multi-stage sampling to determine a sample of health facilities by type, ownership, size and interventions offered totalling 144 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time-motion observation methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Multivariate regression methods were used to analyse predictors of log-transformed average costs. Average costs were $7 and $79 per HTC and PMTCT client tested, respectively; and $66 per VMMC procedure. Results show evidence of economies of scale for PMTCT and VMMC: increasing the number of clients per year by 100% was associated with cost reductions of 50% for PMTCT, and 45% for VMMC. Task shifting was associated with reduced costs for both PMTCT (59%) and VMMC (54%). Costs in hospitals were higher for PMTCT (56%) in comparison to non-hospitals. Facilities that performed testing based on risk factors as opposed to universal screening had higher HTC average costs (79%). Lower VMMC costs were associated with availability of male reproductive health services (59%) and presence of community advisory board (52%). Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision., (© The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

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.

Objective: To assess the effect of oral health education on knowledge and oral health seeking behaviour of persons living with HIV/AIDS (PLWHA)., Methods: Quasi-experimental study design conducted among 195 Persons living with HIV/AIDS attending two Comprehensive Care Centres (CCC) at the Kenyatta National Hospital (intervention group) and Mbagathi district hospital (non-intervention group) in Nairobi Kenya. The participants were selected using systematic random sampling method and data collected using a questionnaire. Data was collected at baseline, at three months (review 1) and at six months (review 2)., Results: There was a significant change in oral health knowledge for KNH participants. However, no significant change in oral knowledge was recorded for MDH participants. The proportion of participants who brushed their teeth at least twice a day increased significantly from 52% to 88% for KNH. The proportion of those who had brushed the previous evening increased from 47% to 83.2%. There was no significant change in the proportion brushing at least twice a day among the non-intervention group. There was a significant association between change in knowledge and change to brushing at least twice a day among the intervention group., Conclusion: Oral health education led to improved oral health knowledge and oral hygiene practices among PLWHA.

Rotavirus infection is the single most common cause of acute gastroenteritis in children under five years of age. The costs of care and treatment for rotavirus gastroenteritis are high. The objective was to compute average cost of care for children admitted with rotavirus gastroenteritis. A survey was conducted in children admitted with a diagnosis of acute gastroenteritis in Nairobi, Kenya. These were recruited and followed up till discharge or death. The costs they incurred were collected and the average costs were calculated. We concluded that rotavirus gastroenteritis leads to considerable resource utilization in health care settings and the society., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: The study aims to determine the resource gaps in the delivery of MEHSP at the district health system., Design: Cross sectional survey., Setting: District health system, Coast Province, Kenya., Subjects: A sample of 11 district health system facilities., Results: Resource gaps analysis shows that service provision is sensitive to dominant inputs (availability of buildings, equipment, personnel, drugs and non-pharmaceuticals) at all levels of care. Targeting of the resources in respect of the important inputs is poor at all levels as demonstrated by the wide range of excess and shortages of inputs. The mismatch may have adverse effects on both quantity and quality of services., Conclusion: A deliberate policy for targeting of finances for the important inputs needs to be developed to ensure optimisation of their combinations for minimization of mismatch of resources.

Objective: Lead exposure has been associated with intellectual impairment in children in a number of international studies. Prevalence of elevated blood lead levels (eBLL > or = 10ug/dL) of between 5 - 15% has been reported among in Nairobi (UNEP, 2006). However, little is known about potential environmental exposure for eBLLs among children in Kibera, Nairobi., Methods: A descriptive, cross-sectional study of children drawn from Kibera slums who presented at Yes to kids (Y2K) programme of VIPS Health Services at Woodley, Nairobi between June and August 2007 was carried out. The study assessed potential correlates of eBLLs in 387 children aged 6 to 59 months and had lived in Kibera slums since birth. Sampling was purposive. The factors examined were age, sex, breastfeeding history, respondent's education and occupation, type of house walls, sources of drinking water and kales, and awareness of lead poisoning among respondents. Potential risk factors such exposure to paint, contaminated playgrounds, glazed pottery, cosmetics and para-occupational as well as living near lead industry and pica behavior were also examined. Potential environmental sources of lead such as drinking water, soil and kales were analyzed for lead levels., Results: Seven percent (n = 27, N = 387) had BLLs above 10ug/dl. BLL > or = 10ug/dl was associated with non-permanent housing (p = 0.812), playing on potentially lead contaminated grounds (p = 0.627) and pica behavior (p = 0.439). Low risk parental occupation (p = 0.001) and Kales sourced from the market/kiosks (p = 0.001) were significantly associated with BLL > or = 10ug/dl. Soil lead levels (Soil Pb) ranged from 3,000 to 90,000ug/kg, which was very high compared to WHO acceptable range of 100 - 200ug/kg. There was weak linear association (r2 = 0.0160) between Soil Pb and mean BLLs for a given village. There were no detectable levels of lead in kales and tap water., Conclusions: The study found about 7% (N = 387) of the children tested had eBLL > or = 10ug/dl in an area with very high soil lead levels (range in Kibera slums: 3,365 - 89,570ug/kg; WHO allowable range: 100 - 120ug/kg), raising a health flag that must be addressed using the multi-sectoral approach and further studies. It's important to note that the study design and its inherent limitations could have masked true picture of childhood lead poisoning in Kibera slums, Nairobi.

During the decade and a half after Alma Ata hundreds of projects were started in developing countries to implement the principles of PHC and start community based health care programs in the rural areas of developing countries. Until the past five years urban health was not seen as a special health problem. Population pressure in the rural areas has created shortages of land, food and employment opportunities. These forces have generated major population movements to the urban centres. The population movements have encouraged unprecedented expansion of urban centres. This sudden concentration of large populations in small geographical areas has resulted in the urban health crises of the developing world. The poor who live in the slum areas have no access to adequate health services, they experience frequent epidemics of communicable diseases like cholera, they live within a heavily polluted environment, and their children have very poor health because they are not immunized and are malnourished. The paper agrees with approaches which have been championed by development agencies to address the urban health crises. These approaches propose the reorientation of urban health systems to include adoption of PHC for urban health programs, intersectoral collaboration and extra budgetary support. The paper argues for further strengthening of the reorientation approach by adjusting the development planning model. It is proposed that the urban plan be integrated into the national development plan so that emerging urban health crises can receive special attention in resource allocation.

This paper studies the problem of malaria control in irrigation and non-irrigation areas in Kenya. Empirical results show that in both areas, households' level of awareness of malaria as a health problem, including its cause, was very high. However, attempts to trace the direct effects of malaria upon income or upon agricultural production were not statistically important. This does not imply that malaria has no consequence on household welfare. It is possible that the model equations were mis-specified--aggregate variables (total family size, total family income) and failure to quantify land in the production relationships may have contributed to these results. In addition, poor separation of malaria as a disease, from malaria as an infection, may have underestimated the effect of the disease on production. Thirdly, labour substitution (hiring or within-family substitution) was not measured in this early study, but was taken into account in subsequent research. Finally, labour requirements in the annual crop production schedules and the co-relation between these labour requirements and the pattern of adult morbidity were not longitudinally monitored. Cross-section data would bias the findings, particularly in those areas where the peak transmission season is short, where the crop grown does not require major labour input during this transmission season, and where acquisition of immunity would reduce the clinical impact of malaria upon adult labour. These vulnerabilities in the specification of the model and the data collected, probably affect the results obtained. Our empirical work raises a number of interesting and important questions which should be taken into account in future research.

This paper describes the methodology and presents preliminary results of an economic appraisal of a community based health care project in Kenya. Community health workers, trained for 12 weeks and deployed in two locations in Kenya's Western Province, act as first contact providers of basic health care and promoters of selected health, sanitation and nutrition practices. A Cost Benefit Analysis has been undertaken using the Willingness to Pay approach to compare the costs of the project and its benefits. The benefits are in the form of more easily accessible basic health care and are measured as consumer surplus accruing to the community. Gain in consumer surplus is consequent on the fall of average user costs and rise in utilisation of the project established points of first contact with primary health care. The argument for the economic viability of the project is validated by the large Net Present Value and Benefit Cost Ratio obtained for the whole of the project area and for the two locations separately. Although the evaluation technique used faces the problem of valuation of community time, aggregation of health care services at all points of first contact and the partial nature of cost benefit analysis evaluations, the results are strongly in favour of decentralisation of primary health care on similar lines in the rest of the country.

Essential drug schemes in the Third World countries face many problems. These include dependency on imported drugs in the face of chronic shortages of foreign exchange, inadequate manpower and technical capability for selection and procurement of drugs, competition between generic and brand drugs, weak local drug procurement and distribution systems and inability to commence local manufacturing even in situations where there may exist comparative advantage. Many of these problems relate to each other and are compounded by the domination of the pharmaceutical industry by multinational firms. Third World countries are in a very weak position in the international pharmaceutical industry. It is suggested that the essential drug situation would improve in Third World countries if certain strategies and policies were adopted. These include: intensification of personnel training in pharmaceuticals, deliberate use of generic drugs rather than brand name drugs, the involvement of the public sector in the procurement and distribution of drugs, buying drugs in bulk, changing drug prescription and consumption practices through continuous education, changing or instituting regulations to guard against unfavourable patents and commencing domestic production of essential drugs where this is not in conflict with the principle of comparative advantage.