Browsing by Subject "Kenya"
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Item Open Access A diminutive Pliocene guenon from Kanapoi, West Turkana, Kenya.(Journal of human evolution, 2019-10) Plavcan, J Michael; Ward, Carol V; Kay, Richard F; Manthi, Fredrick KAlthough modern guenons are diverse and abundant in Africa, the fossil record of this group is surprisingly sparse. In 2012 the West Turkana Paleo Project team recovered two associated molar teeth of a small primate from the Pliocene site of Kanapoi, West Turkana, Kenya. The teeth are bilophodont and the third molar lacks a hypoconulid, which is diagnostic for Cercopithecini. The teeth are the same size as those of extant Miopithecus, which is thought to be a dwarfed guenon, as well as a partial mandible preserving two worn teeth, previously recovered from Koobi Fora, Kenya, which was also tentatively identified as a guenon possibly allied with Miopithecus. Tooth size and proportions, as well as analysis of relative cusp size and shearing crest development clearly separate the fossil from all known guenons. Based on the Kanapoi material, we erect a new genus and species, Nanopithecus browni gen. et sp. nov. The small size of the specimen suggests either that dwarfing occurred early in the lineage, or at least twice independently, depending on the relationship of the new species with extant Miopithecus. Further, the distinctive habitat and geographic separation from Miopithecus suggests that the origin of small body size is not uniquely linked to the current habitat of Miopithecus, and possibly that relatives of extant Miopithecus were much more widely distributed in the past. This in turn argues caution in using extant biogeography in models of the origins of at least some guenons.Item Open Access A Life of One's Own: Women's Education and Economic Empowerment in Kenya(2011-05-04) Cannon, AislynnItem Open Access Accessibility, availability and affordability of anti-malarials in a rural district in Kenya after implementation of a national subsidy scheme.(Malar J, 2011-10-26) Smith, Nathan; Obala, Andrew; Simiyu, Chrispinus; Menya, Diana; Khwa-Otsyula, Barasa; O'Meara, Wendy PrudhommeBACKGROUND: Poor access to prompt and effective treatment for malaria contributes to high mortality and severe morbidity. In Kenya, it is estimated that only 12% of children receive anti-malarials for their fever within 24 hours. The first point of care for many fevers is a local medicine retailer, such as a pharmacy or chemist. The role of the medicine retailer as an important distribution point for malaria medicines has been recognized and several different strategies have been used to improve the services that these retailers provide. Despite these efforts, many mothers still purchase ineffective drugs because they are less expensive than effective artemisinin combination therapy (ACT). One strategy that is being piloted in several countries is an international subsidy targeted at anti-malarials supplied through the retail sector. The goal of this strategy is to make ACT as affordable as ineffective alternatives. The programme, called the Affordable Medicines Facility - malaria was rolled out in Kenya in August 2010. METHODS: In December 2010, the affordability and accessibility of malaria medicines in a rural district in Kenya were evaluated using a complete census of all public and private facilities, chemists, pharmacists, and other malaria medicine retailers within the Webuye Demographic Surveillance Area. Availability, types, and prices of anti-malarials were assessed. There are 13 public or mission facilities and 97 medicine retailers (registered and unregistered). RESULTS: The average distance from a home to the nearest public health facility is 2 km, but the average distance to the nearest medicine retailer is half that. Quinine is the most frequently stocked anti-malarial (61% of retailers). More medicine retailers stocked sulphadoxine-pyramethamine (SP; 57%) than ACT (44%). Eleven percent of retailers stocked AMFm subsidized artemether-lumefantrine (AL). No retailers had chloroquine in stock and only five were selling artemisinin monotherapy. The mean price of any brand of AL, the recommended first-line drug in Kenya, was $2.7 USD. Brands purchased under the AMFm programme cost 40% less than non-AMFm brands. Artemisinin monotherapies cost on average more than twice as much as AMFm-brand AL. SP cost only $0.5, a fraction of the price of ACT. CONCLUSIONS: AMFm-subsidized anti-malarials are considerably less expensive than unsubsidized AL, but the price difference between effective and ineffective therapies is still large.Item Open Access Assessing the Accuracy of a Point of Care Analyzer for Hyperlipidemia in Western Kenya(2014) Park, Paul HaeYongThe prevalence of hyperlipidemia, along with other non-communicable diseases, is on the rise in low- and middle-income countries. Given the resource-limited setting, a myriad of diagnostic challenges exist with traditional laboratory-based lipid tests, including mobility, timeliness, and laboratory infrastructure. Novel technology in the form of "point of care" devices seeks to overcome such barriers by providing immediate results without dependency on significant laboratory infrastructure. CardioChek PA (Polymer Technology Systems, Inc., Indianapolis, United States) is a point of care lipid measuring device and is readily available in Kenya. However, it has not been validated in this setting. In this study, I assess the accuracy of CardioChek PA with respect to standard laboratory-based testing, which is currently the gold standard.
In Webuye, Kenya, two blood samples were collected from 246 subjects to simultaneously measure the lipid levels via both CardioChek PA and the gold standard. All subjects were adults, and geographic stratified sampling methods were applied. Statistical analysis of the novel device's accuracy was based on percent bias, which is the standardized approach established by the National Cholesterol Education Program (NCEP) of the National Institute of Health (NIH). The NCEP suggests that percent bias be ≤±3% for low-density lipoprotein (LDL) cholesterol, ≤±5% for high-density lipoprotein (HDL) cholesterol, ≤±5% for total cholesterol (TC), and ≤±4% for triglycerides (TG). Misclassification rates and absolute percent bias were also analyzed.
This study found the CardioChek PA analyzer to be substantially inaccurate for LDL cholesterol (-25.9% bias), HDL cholesterol (-8.2% bias), and TC (-15.9% bias). For TG, the CardioChek PA performed well with a percent bias of 0.03%. However, the TG absolute percent bias (27.7%) and proportion of patients outside of the NCEP range (85%) reflected substantial inaccuracy of measurements. Moreover, those patients at higher risk of complications from hyperlipidemia were most likely to be misclassified into a lower risk category. Thus, we conclude that CardioChek PA is inaccurate and not suitable for our clinical setting. Furthermore, the findings highlight the need to validate new diagnostic tools in the appropriate setting prior to scale up regardless of its potential for novel utility.
Item Open Access Asthma, Airflow Obstruction, and Eosinophilic Airway Inflammation Prevalence in Western Kenya: A Population-Based Cross-Sectional Study.(International journal of public health, 2023-01) Navuluri, Neelima; Lagat, David; Egger, Joseph R; Birgen, Elcy; Diero, Lameck; Murdoch, David M; Thielman, Nathan; Kussin, Peter S; Que, Loretta G; Paul, DevonObjectives: Determine the prevalence of airway disease (e.g., asthma, airflow obstruction, and eosinophilic airway inflammation) in Kenya, as well as related correlates of airway disease and health-related quality of life. Methods: A three-stage, cluster-randomized cross-sectional study in Uasin Gishu County, Kenya was conducted. Individuals 12 years and older completed questionnaires (including St. George's Respiratory Questionnaire for COPD, SGRQ-C), spirometry, and fractional exhaled nitric oxide (FeNO) testing. Prevalence ratios with 95% confidence intervals (CIs) were calculated. Multivariable models were used to assess correlates of airflow obstruction and high FeNO. Results: Three hundred ninety-two participants completed questionnaires, 369 completed FeNO testing, and 305 completed spirometry. Mean age was 37.5 years; 64% were women. The prevalence of asthma, airflow obstruction on spirometry, and eosinophilic airway inflammation was 21.7%, 12.3% and 15.7% respectively in the population. Women had significantly higher SGRQ-C scores compared to men (15.0 vs. 7.7). Wheezing or whistling in the last year and SGRQ-C scores were strongly associated with FeNO levels >50 ppb after adjusting for age, gender, BMI, and tobacco use. Conclusion: Airway disease is a significant health problem in Kenya affecting a young population who lack a significant tobacco use history.Item Open Access Blood pressure level impacts risk of death among HIV seropositive adults in Kenya: a retrospective analysis of electronic health records.(BMC Infect Dis, 2014-05-22) Bloomfield, Gerald S; Hogan, Joseph W; Keter, Alfred; Holland, Thomas L; Sang, Edwin; Kimaiyo, Sylvester; Velazquez, Eric JBACKGROUND: Mortality among people with human immunodeficiency virus (HIV) infection is increasingly due to non-communicable causes. This has been observed mostly in developed countries and the routine care of HIV infected individuals has now expanded to include attention to cardiovascular risk factors. Cardiovascular risk factors such as high blood pressure are often overlooked among HIV seropositive (+) individuals in sub-Saharan Africa. We aimed to determine the effect of blood pressure on mortality among HIV+ adults in Kenya. METHODS: We performed a retrospective analysis of electronic medical records of a large HIV treatment program in western Kenya between 2005 and 2010. All included individuals were HIV+. We excluded participants with AIDS, who were <16 or >80 years old, or had data out of acceptable ranges. Missing data for key covariates was addressed by inverse probability weighting. Primary outcome measures were crude mortality rate and mortality hazard ratio (HR) using Cox proportional hazards models adjusted for potential confounders including HIV stage. RESULTS: There were 49,475 (74% women) HIV+ individuals who met inclusion and exclusion criteria. Mortality rates for men and women were 3.8 and 1.8/100 person-years, respectively, and highest among those with the lowest blood pressures. Low blood pressure was associated with the highest mortality incidence rate (IR) (systolic <100 mmHg IR 5.2 [4.8-5.7]; diastolic <60 mmHg IR 9.2 [8.3-10.2]). Mortality rate among men with high systolic blood pressure without advanced HIV (3.0, 95% CI: 1.6-5.5) was higher than men with normal systolic blood pressure (1.1, 95% CI: 0.7-1.7). In weighted proportional hazards regression models, men without advanced HIV disease and systolic blood pressure ≥140 mmHg carried a higher mortality risk than normotensive men (HR: 2.39, 95% CI: 0.94-6.08). CONCLUSIONS: Although there has been little attention paid to high blood pressure among HIV+ Africans, we show that blood pressure level among HIV+ patients in Kenya is related to mortality. Low blood pressure carries the highest mortality risk. High systolic blood pressure is associated with mortality among patients whose disease is not advanced. Further investigation is needed into the cause of death for such patients.Item Open Access Bungoma County Woman’s Study: A Pilot Randomized Evaluation To Estimate The Impact Of A Screening and Referral Service On Contraceptive Use(2018) Augustine, Arun MathewBackground: An estimated 225 million women globally have an unmet family planning need, three-quarters of whom live in low and middle-income countries. Addressing this need requires new and innovative approaches, such as digital health solutions. We examined the impact of a new phone-based screening and referral service on the take-up of family planning as part of a pilot study to prepare for a full trial of the intervention.
Methods: This pilot study tested the procedures for a randomized encouragement trial. We recruited 112 women with an unmet need for family planning from local markets in Western Kenya, conducted an eligibility screening, and randomized half of the women to receive an encouragement to try the investigational intervention. Four months after sending an encouraging to the treatment group, we attempted to conduct a follow-up survey with all enrolled participants.
Results: The encouragement sent via text message to the treatment group led to differential rates of intervention uptake between the treatment and control groups, but take-up among the group was lower than anticipated (33.9% vs 1.8% in the control group). Study attrition was also substantial. We obtained follow-up data from 44.6% of enrolled participants. Among those in the treatment group who tried the intervention, however, the instrumental variables estimate of the Local Average Treatment Effect was an increase of 41 percentage points in the probability of contraceptive take-up.
Conclusion: This randomized encouragement design and study protocol is feasible but requires modifications to the encouragement and follow-up data collection procedures. The investigational intervention appears to have a positive impact on contraceptive take-up among women with an unmet need despite a number of contextual challenges.
Item Open Access Business Plan for Sustainable Ethanol Cooking Fuel in Developing World(2014-04-24) Zhou, Kerui; Shi, WenjingEthanol cooking fuel has great promise in developing countries, especially in South Asia and Africa, because it can yield significant economic, environmental and health benefits. This business plan aims to find a clean and ideal solution to promote ethanol cooking fuel and stoves cost-effectively for a representative developing country—Kenya. This plan compares the biological features of a couple of potential feedstock of ethanol and chooses sweet sorghum because of its great adaptability to semi-arid climate and short harvesting cycle. Next, by assessing the technical and economical feasibility of a local small-scale ethanol plant and bringing forward integrated solutions throughout the entire supply chain from the feedstock production to the retail of ethanol fuel products, this business plan indicates that ethanol cooking fuel and stoves can substitute prevalent fuel-wood and three-stone fire cost-effectively. The local production of ethanol can yield income benefits to local farmers by purchasing local feedstock, healthy benefits to local residents, especially women and children, and job-creating benefits to local communities by involving retailers, delivers and farmers into this business. Besides, if the investor further takes carbon credit generated from ethanol plant, byproducts of ethanol production and potential government subsidies or financial incentive policies into consideration, the profitability of this business could be improved additionally.Item Open Access Catarrhine hallucal metatarsals from the early Miocene site of Songhor, Kenya.(Journal of human evolution, 2017-07) Patel, Biren A; Yapuncich, Gabriel S; Tran, Cassandra; Nengo, Isaiah OSonghor is an early Miocene fossil locality in Kenya known for its diverse primate assemblage that includes catarrhine species belonging to the genera Kalepithecus, Limnopithecus, Dendropithecus, Rangwapithecus, and Proconsul. Expeditions to Songhor since the 1930s have recovered unassociated catarrhine postcranial remains from both the fore- and hindlimbs, including multiple elements from the feet. In this study, we describe KNM-SO 31233, a complete left hallucal metatarsal (Mt1), along with several other fragmentary Mt1 specimens (KNM-SO 1080, 5129, 5141, 22235). These fossils were compared to extant catarrhines and platyrrhines, as well as available fossil Miocene catarrhine Mt1s. Morphometric data were obtained from 3D surface renderings and subjected to a number of analyses to assess their phenetic affinity with the comparative sample, make predictions of body mass, and to infer their functional morphology. The size and shape of the Songhor Mt1s are diverse, exhibiting a large robust morph (KNM-SO 5141) similar in size but not in shape to extant African apes, medium-sized morphs (KNM-SO 1080, 5129 and 22235), and a smaller, slender one (KNM-SO 31233) that has a shape resembling arboreal quadrupedal leaping monkeys and suspensory atelines and hylobatids. KNM-SO 31233 is unlike other known fossil Mt1s, and in general, none of the Songhor Mt1s resembled any single extant anthropoid clade or species. The morpho-functional diversity of Songhor Mt1s is consistent with an extensive morphological and phylogenetic catarrhine diversity in the early part of the Miocene epoch.Item Open Access Cervical cancer precursors and hormonal contraceptive use in HIV-positive women: application of a causal model and semi-parametric estimation methods.(PLoS One, 2014) Leslie, Hannah H; Karasek, Deborah A; Harris, Laura F; Chang, Emily; Abdulrahim, Naila; Maloba, May; Huchko, Megan JOBJECTIVE: To demonstrate the application of causal inference methods to observational data in the obstetrics and gynecology field, particularly causal modeling and semi-parametric estimation. BACKGROUND: Human immunodeficiency virus (HIV)-positive women are at increased risk for cervical cancer and its treatable precursors. Determining whether potential risk factors such as hormonal contraception are true causes is critical for informing public health strategies as longevity increases among HIV-positive women in developing countries. METHODS: We developed a causal model of the factors related to combined oral contraceptive (COC) use and cervical intraepithelial neoplasia 2 or greater (CIN2+) and modified the model to fit the observed data, drawn from women in a cervical cancer screening program at HIV clinics in Kenya. Assumptions required for substantiation of a causal relationship were assessed. We estimated the population-level association using semi-parametric methods: g-computation, inverse probability of treatment weighting, and targeted maximum likelihood estimation. RESULTS: We identified 2 plausible causal paths from COC use to CIN2+: via HPV infection and via increased disease progression. Study data enabled estimation of the latter only with strong assumptions of no unmeasured confounding. Of 2,519 women under 50 screened per protocol, 219 (8.7%) were diagnosed with CIN2+. Marginal modeling suggested a 2.9% (95% confidence interval 0.1%, 6.9%) increase in prevalence of CIN2+ if all women under 50 were exposed to COC; the significance of this association was sensitive to method of estimation and exposure misclassification. CONCLUSION: Use of causal modeling enabled clear representation of the causal relationship of interest and the assumptions required to estimate that relationship from the observed data. Semi-parametric estimation methods provided flexibility and reduced reliance on correct model form. Although selected results suggest an increased prevalence of CIN2+ associated with COC, evidence is insufficient to conclude causality. Priority areas for future studies to better satisfy causal criteria are identified.Item Open Access Characteristics of Women Who Attend Cervical Cancer Screening and Follow-Up in Community Health Campaigns Versus Home Visits in Rural Western Kenya(2023) Hendrickson, KaylaBackground: Cervical cancer is a preventable disease with a disproportionate burden in Sub-Saharan Africa. In Kenya, cervical cancer is the leading cause of cancer-related death in women. In line with WHO recommendations, Kenya is offering screening to women between the ages of 30 and 65 years old; however, rates of screening uptake are far below desired levels due to economic, logistical, and social barriers. This study is phase 2 of a two-part trial exploring implementation strategies for HPV-testing using self-collected specimens. Drawing on lessons from phase 1, we offered HPV-testing through community health campaigns (CHCs) in rural communities followed by linking HPV-positive women to facility-based treatment. Methods: Target communities were enumerated before the CHCs to identify women in the age range of 30-65 years old and who were not pregnant. Women were educated about cervical cancer by community health volunteers and told of when and where the CHC would be happening. At the CHC, participants were consented, given a brief demographics survey, and instructed on how to self-collect cervical specimens for HPV-testing. Participants were later contacted via SMS messaging, phone calls, or home visits with their results. Women who were enumerated but did not attend the fair were visited at home and offered testing. Those who tested as HPV-positive were linked to their nearest health center for preventative treatment. Descriptive statistics and logistic regression were used to analyze the demographic characteristics of women who came to the CHC and women who sought treatment compared with those who didn’t. Results: A total of 3299 women were screened for HPV, an estimated target population reach of 77%. The average HPV positivity rate was 16.7% across both the CHCs and the mop up. Of the 551 women who were HPV positive, 278 of them (50.5%) sought treatment. Characteristics associated with screening at the CHC included being encouraged to come by someone the woman knows, having completed primary school, some secondary school or attending college and above, working in the labor, professional, academic professions, having heard of cervical cancer before, working outside the home, and having missed work to attend screening. Women who came to the CHC had 25% greater odds of seeking treatment compared to women screened in home visits. Characteristics associated with seeking treatment included having tested for cervical cancer before and having missed work to attend screening. Having heard of cervical cancer before was also associated with seeking treatment, but with less precise estimates. Conclusion: Social support for seeking care and knowledge of cervical cancer are associated with women attending community health campaigns that offer self-collected HPV-testing. Other demographics have weak or null associations with care-seeking behavior in this context, suggesting the CHC model with enhanced linkage to care methods could be a way to overcome some of the social and logistical barriers women face for accessing preventative treatment. However, at a treatment linkage rate of only 50%, more work needs to be done to further understand the barriers to care in this context.
Item Restricted Clinical characteristics and 12-month outcomes of patients with valvular and non-valvular atrial fibrillation in Kenya.(PLoS One, 2017) Temu, Tecla M; Lane, Kathleen A; Shen, Changyu; Ng'ang'a, Loise; Akwanalo, Constantine O; Chen, Peng-Sheng; Emonyi, Wilfred; Heckbert, Susan R; Koech, Myra M; Manji, Imran; Vatta, Matteo; Velazquez, Eric J; Wessel, Jennifer; Kimaiyo, Sylvester; Inui, Thomas S; Bloomfield, Gerald SBACKGROUND: Atrial fibrillation (AF) is a major contributor to the global cardiovascular disease burden. The clinical profile and outcomes of AF patients with valvular heart diseases in sub-Saharan Africa (SSA) have not been adequately described. We assessed clinical features and 12-month outcomes of patients with valvular AF (vAF) in comparison to AF patients without valvular heart disease (nvAF) in western Kenya. METHODS: We performed a cohort study with retrospective data gathering to characterize risk factors and prospective data collection to characterize their hospitalization, stroke and mortality rates. RESULTS: The AF patients included 77 with vAF and 69 with nvAF. The mean (SD) age of vAF and nvAF patients were 37.9(14.5) and 69.4(12.3) years, respectively. There were significant differences (p<0.001) between vAF and nvAF patients with respect to female sex (78% vs. 55%), rates of hypertension (29% vs. 73%) and heart failure (10% vs. 49%). vAF patients were more likely to be taking anticoagulation therapy compared to those with nvAF (97% vs. 76%; p<0.01). After 12-months of follow-up, the overall mortality, hospitalization and stroke rates for vAF patients were high, at 10%, 34% and 5% respectively, and were similar to the rates in the nvAF patients (15%, 36%, and 5%, respectively). CONCLUSION: Despite younger age and few comorbid conditions, patients with vAF in this developing country setting are at high risk for nonfatal and fatal outcomes, and are in need of interventions to improve short and long-term outcomes.Item Open Access Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study.(Global health action, 2018-01) Olwanda, Easter; Shen, Jennifer; Kahn, James G; Bryant-Comstock, Katelyn; Huchko, Megan JImproving patient flow and reducing over-crowding can improve quality, promptness of care, and patient satisfaction. Given low utilization of preventive care in low-resource countries, improved patient flows are especially important in these settings.Compare patient flow and provider efficiency between two cervical cancer screening strategies via self-collected human papillomavirus (HPV).We collected time and motion data for patients screened for cervical cancer in 12 communities in rural Migori County, Kenya as part of a larger cluster randomized trial. Six communities were randomized to screening in community health campaigns (CHCs) and six to screening at government clinics. We quantified patient flow: duration spent on each active stage of screening and wait times, and the number of patients arriving at CHCs and clinics each hour of the day. In addition, for four CHCs, we collected time and motion data for providers, and measured provider efficiency as a ratio of active (service delivery) time to total time spent at the clinic.Total duration of screening visits, at CHCs and clinics was 42 and 87 minutes, respectively (p < 0.001 for difference). Total active time lasted longer at CHCs, with a mean of 28 minutes per patient versus 15 minutes at clinics, largely due to differences in duration for group education (p < 0.001). Wait time for registration at clinics was 36 minutes, explaining most of the difference between settings, but sometimes incorporated other health services.There is a substantial difference in patient flow at clinics compared to CHCs. Shorter duration at CHCs suggests that the model is favorable for patients in limiting time spent on screening. Future cervical cancer screening programs designed for scale-up should consider how this advantage may enhance satisfaction and uptake. For clinic-based screening programs, efforts could be made towards reducing registration wait times.Item Open Access Conceptualization of Health Among United Methodist Church Clergy in Western Kenya(2012) Georggi, Nicole AAbstract
INTRODUCTION
Clergy are a dynamic group of the population: they point people to God, navigate social and spiritual waters, provide advice and guidance, and teach and visit parishioners. Research has shown that caregivers often neglect their health to tend to the health and well-being of others. Because of their unique role in society, the health and well-being of the clergy themselves is an important subject of research. While clergy health is a growing topic of interest in the Western world, very little is known. The few studies conducted on the health of clergy have found that in some areas, this group is less healthy than the general population due to their hectic schedules, lacking social support, and job-related stressors. With the exception of the United States, Canada, and Great Britain, almost nothing has been studied internationally regarding clergy health. In Africa, religion is known to play an important role in the daily life of its inhabitants; however, the overall well-being of clergy including mental, spiritual, and physical health remains under-studied. To date, nothing has been reported regarding the health of pastors in Kenya. This exploratory study sought to better understand how United Methodist Church (UMC) clergy in Western Kenya conceptualize health and how that relates to their health seeking behaviors.
METHODS
This study partnered with religion and public health researchers at Moi University in Eldoret, Kenya, and utilized qualitative methodology to gather information on the conceptualization of health among UMC clergy in Western Kenya. One hour in-depth oral interviews with seven clergy and two Associate District Superintendents and four focus group discussions were conducted with a total of 52 United Methodist Church clergy in Nyanza Province, Kenya in June and July 2012.
ANALYSIS
All transcripts were entered into QSR International's NVivo 10 qualitative data analysis software and coded. Two members of the research team coded an in-depth oral interview and focus group transcription to ensure replicability. A combination of Grounded Theory (GT) analysis and Interpretative Phenomenological Analysis (IPA) was used to interpret the data.
CONCLUSION
UMC clergy define health holistically as the complete well-being of a person in their mind, body, and spirit. Indigenous cultural traditions are still present within the UMC; pastors and parishioners will seek care from a magician rather than a medical doctor if they believe the disease stems from evil spirits. Religious beliefs relate to health seeking behavior in one of two ways: first, clergy believe God alone heals, and thereby view medical seeking behavior as unnecessary and second, clergy believe God alone heals, but view the doctor as a permitted conduit of healing. This knowledge learned from this exploratory study may help inform future interventions.
Item Open Access Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya.(PLoS One, 2017) Masika, Wechuli Geoffrey; O'Meara, Wendy Prudhomme; Holland, Thomas L; Armstrong, JaniceINTRODUCTION: The clinical features of UTI in young children may not localize to the urinary tract and closely resemble other febrile illnesses. In malaria endemic areas, a child presenting with fever is often treated presumptively for malaria without investigation for UTI. Delayed or inadequate treatment of UTI increases the risk of bacteremia and renal scarring in young children and subsequently complications as hypertension and end stage renal disease in adulthood. METHODS: A cross-sectional study was carried out in a hospital in western Kenya. Inpatients and outpatients 2 months to five years with axillary temperature ≥37.5°C and no antibiotic use in the previous week were enrolled between September 2012 and April 2013. Urine dipstick tests, microscopy, and cultures were done and susceptibility patterns to commonly prescribed antibiotics established. UTI was defined as presence of pyuria (a positive urine dipstick or microscopy test) plus a positive urine culture. RESULTS: A total of 260 subjects were recruited; 45.8% were female and the median age was 25months (IQR: 13, 43.5). The overall prevalence of UTI was 11.9%. Inpatients had a higher prevalence compared to outpatients (17.9% v 7.8%, p = 0.027). UTI co-existed with malaria but the association was not significant (OR 0.80, p = 0.570). The most common organisms isolated were Escherichia coli (64.5%) and Staphylococcus aureus (12.9%) and were sensitive to ciproflaxin, cefuroxime, ceftriaxone, gentamycin and nitrofurantoin but largely resistant to more commonly used antibiotics such as ampicillin (0%), amoxicillin (16.7%), cotrimoxazole (16.7%) and amoxicillin-clavulinate (25%). CONCLUSION: Our study demonstrates UTI contributes significantly to the burden of febrile illness in young children and often co-exists with other infections. Multi-drug resistant organisms are common therefore choice of antimicrobial therapy should be based on local sensitivity pattern.Item Open Access Environmental influences and habitat associations of reticulated giraffes as revealed by camera traps(2021-04-28) Egna, NicoleCamera trapping has been used in recent years as a means of assessing species population size and distributions, habitat use, and behavior, thus facilitating knowledge and protection of wildlife and natural ecosystems. One disadvantage of camera trapping is recording false absences, whereby the species is present but not detected by the camera. Dynamic occupancy modeling can be used as an accurate method to address this bias and produce reliable estimates of site occupancy, colonization rates, and extinction rates. These metrics are critical for applications in long-term monitoring programs and meta-population studies and can contribute to species conservation efforts. This study utilizes camera trapping images from Loisaba Conservancy, Laikipia, Kenya between 2016 and 2017. The objectives of this study are threefold: (1) to utilize dynamic occupancy modeling to assess the habitat and environmental correlates influencing the probability of reticulated giraffe occurrence at camera trap sites, (2) to assess whether the presence of livestock displaces giraffe, and (3) to assess the habitat and environmental covariates that impact the presence or absence of giraffe at camera trap sites. This study found that the most significant predictor of declining giraffe presence was year, potentially as a result of the severe drought Kenya experienced in 2017. I also present evidence that giraffes do avoid locations that have recently been occupied by livestock. Understanding the environmental influences and habitat associations of reticulated giraffes is critical for providing information about population changes over time and the factors driving those changes. Thus, this information will increase ecological knowledge of the reticulated giraffe and subsequently aid in their conservation.Item Open Access Examining Mosquito Biting Patterns and the Efficacy of Insecticide-Treated Bed Nets in Preventing Mosquito Bites in Webuye, Kenya.(2017) Evans, Daniel RowlandBackground: Despite widespread access and use of insecticide-treated bed nets (ITN) in Bungoma County in Kenya, there has been little reduction in malaria infection rates. It has been hypothesized that this gap between theoretical and actual ITN efficacy is caused by improper use of ITNs, poor physical condition of ITNs, or insecticide resistance in local mosquitos. This study aims to examine potential factors that affect the efficacy of the ITNs in Western Kenya.
Methods: In order to assess the aforementioned aim, a longitudinal observational study was conducted. The study enrolled 9 households and performed weekly data and mosquito collections. Data and sample collection was conducted over an 8-week duration, from June 2016 to July 2016.
Results: The study found high ITN usage in the study households (99.3% coverage), a negative association between the number of mosquitoes collected and time, a high proportion of blood fed mosquitoes (0.409), and statistically significant associations with the proportion of blood fed mosquitos and twelve different predictor variables. Conclusion: This study shows that it is feasible to examine factors reducing ITN efficacy in the area and lays down a potential template to be scaled up to examine these factors more specifically.
Item Open Access Experiences of Lay Counselors Providing a Family-Based Therapy in Kenya: A Focus on Identity, Stress, Burnout, Motivation, and Self-Efficacy(2019) Wall, Jonathan TaylorAs health systems continue to implement task shifting models to overcome health access barriers and inequity, it is critical to understand the experiences of lay individuals in these new roles. This is particularly true for lay counselors who provide mental health services. This study sought to understand lay counselor experiences through the lens of identity, stress, motivation, burnout, and self-efficacy. Semi-structured interviews and focus group discussions were conducted with three groups of lay counselors with varying levels of counseling experience from a family therapy program in Eldoret, Kenya. Using thematic analysis, emergent themes were explored to characterize counselor experiences and inform task shifting implementation improvements. Such research provides crucial insight so that future interventions can improve support of lay providers.
Item Open Access Factors associated with isolated right heart failure in women: a pilot study from western Kenya.(Glob Heart, 2014-06) Lagat, David K; DeLong, Allison K; Wellenius, Gregory A; Carter, E Jane; Bloomfield, Gerald S; Velazquez, Eric J; Hogan, Joseph; Kimaiyo, Sylvester; Sherman, Charles BBACKGROUND: Small observational studies have found that isolated right heart failure (IRHF) is prevalent among women of sub-Saharan Africa. Further, several risk factors for the development of IRHF have been identified. However, no similar studies have been conducted in Kenya. OBJECTIVE: We hypothesized that specific environmental exposures and comorbidities were associated with IRHF in women of western Kenya. METHODS: We conducted a case-control study at a referral hospital in western Kenya. Cases were defined as women at least 35 years old with IRHF. Control subjects were similarly aged volunteers without IRHF. Exclusion criteria in both groups included history of tobacco use, tuberculosis, or thromboembolic disease. Participants underwent echocardiography, spirometry, 6-min walk test, rest/exercise oximetry, respiratory health interviews, and human immunodeficiency virus (HIV) testing. Home visits were performed to evaluate kitchen ventilation, fuel use, and cook smoke exposure time, all surrogate measures of indoor air pollution (IAP). A total of 31 cases and 65 control subjects were enrolled. Surrogate measures of indoor air pollution were not associated with IRHF. However, lower forced expiratory volume at 1 s percent predicted (adjusted odds ratio [AOR]: 2.02, 95% confidence interval [CI]: 1.27 to 3.20; p = 0.004), HIV positivity (AOR: 40.4, 95% CI: 3.7 to 441; p < 0.01), and self-report of exposure to occupational dust (AOR: 3.9, 95% CI: 1.14 to 14.2; p = 0.04) were associated with IRHF. In an analysis of subgroups of participants with and without these factors, lower kitchen ventilation was significantly associated with IRHF among participants without airflow limitation (AOR: 2.63 per 0.10 unit lower ventilation, 95% CI: 1.06 to 6.49; p = 0.04), without HIV (AOR: 2.55, 95% CI: 1.21 to 5.37; p = 0.02), and without occupational dust exposure (AOR: 2.37, 95% CI: 1.01 to 5.56; p = 0.05). CONCLUSIONS: In this pilot study among women of western Kenya, lower kitchen ventilation, airflow limitation, HIV, and occupational dust exposure were associated with IRHF, overall or in participant subgroups. Direct or indirect causality requires further study.Item Open Access Improving rational use of ACTs through diagnosis-dependent subsidies: Evidence from a cluster-randomized controlled trial in western Kenya.(PLoS medicine, 2018-07-17) Prudhomme O'Meara, Wendy; Menya, Diana; Laktabai, Jeremiah; Platt, Alyssa; Saran, Indrani; Maffioli, Elisa; Kipkoech, Joseph; Mohanan, Manoj; Turner, Elizabeth LBACKGROUND:More than half of artemisinin combination therapies (ACTs) consumed globally are dispensed in the retail sector, where diagnostic testing is uncommon, leading to overconsumption and poor targeting. In many malaria-endemic countries, ACTs sold over the counter are available at heavily subsidized prices, further contributing to their misuse. Inappropriate use of ACTs can have serious implications for the spread of drug resistance and leads to poor outcomes for nonmalaria patients treated with incorrect drugs. We evaluated the public health impact of an innovative strategy that targets ACT subsidies to confirmed malaria cases by coupling free diagnostic testing with a diagnosis-dependent ACT subsidy. METHODS AND FINDINGS:We conducted a cluster-randomized controlled trial in 32 community clusters in western Kenya (population approximately 160,000). Eligible clusters had retail outlets selling ACTs and existing community health worker (CHW) programs and were randomly assigned 1:1 to control and intervention arms. In intervention areas, CHWs were available in their villages to perform malaria rapid diagnostic tests (RDTs) on demand for any individual >1 year of age experiencing a malaria-like illness. Malaria RDT-positive individuals received a voucher for a discount on a quality-assured ACT, redeemable at a participating retail medicine outlet. In control areas, CHWs offered a standard package of health education, prevention, and referral services. We conducted 4 population-based surveys-at baseline, 6 months, 12 months, and 18 months-of a random sample of households with fever in the last 4 weeks to evaluate predefined, individual-level outcomes. The primary outcome was uptake of malaria diagnostic testing at 12 months. The main secondary outcome was rational ACT use, defined as the proportion of ACTs used by test-positive individuals. Analyses followed the intention-to-treat principle using generalized estimating equations (GEEs) to account for clustering with prespecified adjustment for gender, age, education, and wealth. All descriptive statistics and regressions were weighted to account for sampling design. Between July 2015 and May 2017, 32,404 participants were tested for malaria, and 10,870 vouchers were issued. A total of 7,416 randomly selected participants with recent fever from all 32 clusters were surveyed. The majority of recent fevers were in children under 18 years (62.9%, n = 4,653). The gender of enrolled participants was balanced in children (49.8%, n = 2,318 boys versus 50.2%, n = 2,335 girls), but more adult women were enrolled than men (78.0%, n = 2,139 versus 22.0%, n = 604). At baseline, 67.6% (n = 1,362) of participants took an ACT for their illness, and 40.3% (n = 810) of all participants took an ACT purchased from a retail outlet. At 12 months, 50.5% (n = 454) in the intervention arm and 43.4% (n = 389) in the control arm had a malaria diagnostic test for their recent fever (adjusted risk difference [RD] = 9 percentage points [pp]; 95% CI 2-15 pp; p = 0.015; adjusted risk ratio [RR] = 1.20; 95% CI 1.05-1.38; p = 0.015). By 18 months, the ARR had increased to 1.25 (95% CI 1.09-1.44; p = 0.005). Rational use of ACTs in the intervention area increased from 41.7% (n = 279) at baseline to 59.6% (n = 403) and was 40% higher in the intervention arm at 18 months (ARR 1.40; 95% CI 1.19-1.64; p < 0.001). While intervention effects increased between 12 and 18 months, we were not able to estimate longer-term impact of the intervention and could not independently evaluate the effects of the free testing and the voucher on uptake of testing. CONCLUSIONS:Diagnosis-dependent ACT subsidies and community-based interventions that include the private sector can have an important impact on diagnostic testing and population-wide rational use of ACTs. Targeting of the ACT subsidy itself to those with a positive malaria diagnostic test may also improve sustainability and reduce the cost of retail-sector ACT subsidies. TRIAL REGISTRATION:ClinicalTrials.gov NCT02461628.
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