RESUMEN
OBJECTIVES: To determine the current status of immunisation coverage in Western Kenya before intervention, to identify strengths and weaknesses of the existing programme in order to design educational interventions that could improve the services provided and find out the training needs of the mid-level managers of Kenya Expanded Programme of Immunisation. DESIGN: Cross-sectional descriptive study. SETTING: All thirty nine districts in Rift Valley, Western and Nyanza provinces. SUBJECTS: Mid-level managers of Kenya Expanded Programme on Immunisation in the 39 districts and the provinces. These included Provincial Logisticians, Provincial Medical Officers of Health, District Medical Officers of Health, District Public Health Nurses, District Records and Health Information Officers, District Disease Surveillance Officers, and District Public Health Officers. MAIN OUTCOME MEASURES: Number of staff trained on EPI, coverage rates and perceived training needs of the mid-level managers. RESULTS: A total of eighty eight mid-level managers participated in the interviews. Most of these were District Public Health Nurses (40.9%) and District Health Information and Records Officers (23.9%). Only 49 (25%) of the District Health Management Team members had undergone training at the supervisory level. Eighteen districts (43.6%) had no member of the District Health Management Team that had ever been trained at the supervisory level. Using rates of Pentavalent 1 and measles coverage, Nyanza Province had the highest immunisation dropout rate (Pentavalent 1--measles) whereas Rift Valley Province had the lowest. The annual cumulative coverage for all the provinces by antigen was 80% for Pentavalent 1 and 2 and 60% for measles. The most requested need for inclusion in the training curriculum was maintenance of the cold chain equipment. CONCLUSIONS: Most of the members in the study area have not been trained on Expanded Programme on Immunisation and may be ill-equipped to manage the complicated programmes needed to maximise delivery of services. The immunisation coverage in this area is low while the dropout rates are high. We therefore recommend that all the mid-level managers of Expanded Programme on Immunisation in this area be trained comprehensively through the Merck Vaccine Network--Africa programme using the World Health Organisation approved mid-level managers course.
Asunto(s)
Programas de Inmunización/organización & administración , Evaluación de Programas y Proyectos de Salud , Administración en Salud Pública/normas , Vacunación/estadística & datos numéricos , Vacunas/provisión & distribución , Estudios Transversales , Escolaridad , Encuestas de Atención de la Salud , Humanos , Capacitación en Servicio , Kenia , Administración en Salud Pública/educación , Refrigeración/instrumentación , Refrigeración/normas , Encuestas y Cuestionarios , Vacunas/normasRESUMEN
Phase I of the International Study of Asthma and Allergies in Childhood has provided valuable information regarding international prevalence patterns and potential risk factors in the development of asthma, allergic rhinoconjunctivitis and eczema. However, in Phase I, only six African countries were involved (Algeria, Tunisia, Morocco, Kenya, South Africa and Ethiopia). Phase III, conducted 5-6 years later, enrolled 22 centres in 16 countries including the majority of the centres involved in Phase I and new centres in Morocco, Tunisia, Democratic Republic of Congo, Togo, Sudan, Cameroon, Gabon, Reunion Island and South Africa. There were considerable variations between the various centres of Africa in the prevalence of the main symptoms of the three conditions: wheeze (4.0-21.5%), allergic rhinoconjunctivitis (7.2-27.3%) and eczema (4.7-23.0%). There was a large variation both between countries and between centres in the same country. Several centres, including Cape Town (20.3%), Polokwane (18.0%), Reunion Island (21.5%), Brazzaville (19.9%), Nairobi (18.0%), Urban Ivory Coast (19.3%) and Conakry (18.6%) showed relatively high asthma symptom prevalences, similar to those in western Europe. There were also a number of centres showing high symptom prevalences for allergic rhinoconjunctivitis (Cape Town, Reunion Island, Brazzaville, Eldoret, Urban Ivory Coast, Conakry, Casablanca, Wilays of Algiers, Sousse and Eldoret) and eczema (Brazzaville, Eldoret, Addis Ababa, Urban Ivory Coast, Conakry, Marrakech and Casablanca).
Asunto(s)
Dermatitis Atópica/epidemiología , Encuestas Epidemiológicas , Hipersensibilidad Respiratoria/epidemiología , Adolescente , África/epidemiología , Comorbilidad , Femenino , Humanos , Internacionalidad , Masculino , Prevalencia , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Malnutrition is one of the leading causes of morbidity and mortality in children aged five years and below. Risk factors for severe protein energy malnutrition (PEM) have been identified as ignorance, family size, mothers and fathers education, poverty, residence, chronic infections, and congenital defects or malformations. The role of such social factors as the caretaker, extended family, homestead surroundings, and family cohesiveness have not been studied in Kenya. OBJECTIVE: To determine the social and economic factors that predispose children to severe PEM as seen at the Moi Teaching and Referral Hospital (MTRH), Eldoret. DESIGN: Prospective and case control study. SETTING: The MTRH, Eldoret, Paediatric wards, outpatient and MCH clinics over a 12 month period (June 2001 to June 2002). SUBJECTS: Sixty six children aged 3 to 36 months with severe PEM attending the MTRH outpatient clinics and those admitted in the Paediatric wards were age-matched with 66 controls. METHODS: A standard pretested questionnaire was used to interview caretakers with severely malnourished children and age-matched controls. The children were weighed after interviewing the caretakers. The data was entered on a computer and analysed using the statistical package for social sciences (SPSS) programme. RESULTS: The social risk factors for PEM were single mothers (Odds Ratio) OR 14.93, p= 0.00001), young mothers aged 15-25 years (OR 3.95, p= 0.00020), the child's living conditions such as living in a temporary house (OR 3.627 p= 0.00257), caretaker who was not married to the child's parent (OR 0.10, p= 0.00005) and not staying with both parents in the past six months (OR 0.28606, p=0.00101). The economic risk factors were father's lack of ownership of land (OR 0.401, p= 0.01732), cattle (OR 0.24, p=0.00022), not growing maize (OR 0.15, p=0.00013), not growing beans (OR 0.36, p=0.00484) and ownership of small piece of land by grandfather (OR 6.00, p= 0.02274). Other risk factors were incomplete immunization (OR 3.87, p= 0.00151) and female sex (p=0.03721). CONCLUSION: Poverty, social conditions under which the child was living, sex of the child and incomplete immunizations were risk factors for the severe protein energy malnutrition.
Asunto(s)
Trastornos de la Nutrición del Niño/etiología , Desnutrición Proteico-Calórica/etiología , Distribución por Edad , Estudios de Casos y Controles , Causalidad , Mortalidad del Niño , Trastornos de la Nutrición del Niño/diagnóstico , Trastornos de la Nutrición del Niño/epidemiología , Preescolar , Países en Desarrollo , Composición Familiar , Hospitales de Enseñanza , Humanos , Lactante , Kenia/epidemiología , Estado Civil , Edad Materna , Morbilidad , Padres/educación , Pobreza , Estudios Prospectivos , Desnutrición Proteico-Calórica/diagnóstico , Desnutrición Proteico-Calórica/epidemiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Padres Solteros , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVES: To determine the mortality rate and causes of death of all infants admitted to the Special Care Nursery (SCN) of a tertiary referral hospital in rural Kenya. DESIGN: Prospective and Cross-sectional study SETTING: Special Care Nursery, Moi Teaching and Referral Hospital, Eldoret, Kenya. SUBJECTS: All infants admitted to the Special Care Nursing (SCN). MAIN OUTCOME MEASURES: Survival status at seven postnatal days; major causes of mortality and morbidity. RESULTS: Three hundred and thirty five babies were studied between February and September 1999. Out of these 167 (49.9%) were male. There were 50 (15%) preterm and 124 (37.3%) low birth weight babies. There were 198 (76.2%) appropriate for gestational age (AGA), 46 (17.7%) small for gestational age and 16 (6.2%) large for gestational age babies. The seven day mortality rate of infants admitted to the Special Care Nursery was 66 (19.7%). Birth asphyxia and respiratory distress accounted for most deaths. Infants who were admitted primarily because the mother remained under general anesthesia generally did well. Logistic factors, including inadequate training for neonatal resuscitation in ward cadre of staff, unavailability of trained paediatricians and obstetricians, and inadequate operating theatre supplies were all found to delay treatment and likely to increase mortality. CONCLUSION: Morbidity and mortality of infants born at the MTRH remain high. The most common cause of mortality remains birth asphyxia. Some causative factors, such as lack of resources or personnel, are logistic and could be rectified. Antenatal care had a significant positive impact on both morbidity and mortality.
Asunto(s)
Hospitales de Enseñanza/estadística & datos numéricos , Mortalidad Infantil , Salas Cuna en Hospital/estadística & datos numéricos , Causas de Muerte , Estudios Transversales , Femenino , Humanos , Recién Nacido , Kenia/epidemiología , Masculino , Estudios ProspectivosRESUMEN
BACKGROUND: The street children phenomenon is an increasing problem in most cosmopolitan cities of the world including Eldoret, which is a fast growing town. With the growth of the town so is the increasing number of street children. It is therefore important to have baseline data on their health problems. OBJECTIVE: To determine the health problems of street children in Eldoret. DESIGN: A prospective and descriptive study. SETTING: Eldoret Town, Kenya. SUBJECTS: Eldoret street children aged 5-21 years. Type 1 street children were the "on" the street children who spent most of their time on the streets but went home in the evenings, type 2 were the "of" the street children who spent all their time in the streets and had severed their links with their families and did not have a home to go to, type 3 were abandoned children staying in a shelter and type 4 were normal primary school children. RESULTS: One hundred and ninety one children were studied. There were 38, 47, 56 and 50 types 1, 2, 3 and 4 children, respectively. The most common symptom was cough (28.9%) while frequent diagnosis was upper respiratory tract infection (URTI) (12.1%) followed by skin disease (50.9%) as the leading disease category. The common drug of addiction was cigarette (37.6%) and none of the school children was taking any drug of addiction. The prevalence of disease was 467 per 1000 children. Type 2 street children had the highest prevalence of disease (833 per 1000 children). Shelter children had the least disease prevalence (474 per 1000). Factors determining prevalence of disease were the same as in normal children. The malnutrition rate was high with 31.1% and 41.9% of the children being stunted and underweight, respectively. Type 3 children had the highest rate of malnutrition with 51.8% and 64.3% being stunted and underweight. CONCLUSION: Street children have a high incidence of childhood diseases. Factors determining occurrence of disease among street children are as in normal children. Respiratory and skin diseases were the leading causes of morbidity. Drug abuse was rampant among the street children but none of the school children abused any drug. Sexually transmitted infections were not prevalent. Most of the shelter children were malnourished. RECOMMENDATIONS: The government of Kenya should provide free health care for street children in public hospitals. Further studies should be carried out on the prevalence of sexually transmitted diseases based on laboratory testing and on the causes of the injuries suffered by the street children. The reasons for the poor nutritional status of the shelter children should be analysed and appropriate measures taken.
Asunto(s)
Estado de Salud , Jóvenes sin Hogar/estadística & datos numéricos , Enfermedades Respiratorias/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Niño , Preescolar , Jóvenes sin Hogar/clasificación , Humanos , Kenia/epidemiología , Prevalencia , Estudios ProspectivosRESUMEN
OBJECTIVE: To establish the factors that determine the levels of immunisation coverage among children under five years in Mathare Valley. DESIGN: A cross-sectional study describing the situation at a point in time. SETTING: Mathare Valley slum with a population of 50,000 people in the city of Nairobi. SUBJECTS: The study population was mothers with children under five years in Mathare Valley and had been resident there for a period not less than five years prior to the study. OUTCOME MEASURES: Level of immunisation coverage among children in the study population and the factors that contribute to the low immunisation coverage. RESULTS: Knowledge on immunisation was high with 90% of the respondents able to define immunisation. The attitude on immunisation was positive (74.4%) and immunisation coverage stood at 62.2%. Age, level of education, attitude and knowledge on immunisation among the residents were significant determinants of immunisation coverage. CONCLUSION: Immunisation coverage was lower than the national average in Mathare Valley. Advanced mother's age, low level of education and relative lack of knowledge on immunisation were responsible for the low coverage.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Inmunización/estadística & datos numéricos , Servicios de Salud del Niño , Preescolar , Estudios Transversales , Escolaridad , Femenino , Humanos , Lactante , Recién Nacido , Kenia , Masculino , Edad Materna , Encuestas y CuestionariosRESUMEN
BACKGROUND: Perinatal morbidity (PNM) is highest in the developing countries including Kenya. Studies on the perinatal morbidity in Moi Teaching and Referral Hospital (MTRH) have not been carried out. Furthermore, factors associated with PNM are unknown at the MTRH. OBJECTIVE: To establish the causes and incidence of perinatal morbidity at the MTRH NewBorn Unit (NBU). DESIGN: A retrospective study using case notes. SETTING: The NBU of the MTRH in Eldoret, Kenya. SUBJECTS: Babies who were admitted to the MTRH's Newborn Unit from January to December 1997. RESULTS: The perinatal morbidity was 667 per 1000 babies admitted to the NBU. The most common reason for admission was mother under anaesthesia. The most common cause of morbidity was asphyxia. The mean maternal age was 24 years. The mean level of education was 1.7 years. More than fifty five per cent of the mothers were housewives. The mean birthweight was 2.75 kg (+/- 0.9 SD), 55.9% had normal birthweight, 37% were low birthweight and three per cent were large babies. The mean duration of stay in the NBU was 3.8 days. CONCLUSION: Most of the admissions were Caesarean section babies who did not require admission. Younger mothers were more likely to have babies with neonatal sepsis, convulsions, pneumonia and asphyxia.
Asunto(s)
Mortalidad Infantil , Enfermedades del Recién Nacido/epidemiología , Embarazo de Alto Riesgo , Adulto , Puntaje de Apgar , Peso al Nacer , Femenino , Edad Gestacional , Hospitales de Enseñanza , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/mortalidad , Kenia/epidemiología , Tiempo de Internación , Masculino , Edad Materna , Embarazo , Estudios Retrospectivos , Factores SocioeconómicosRESUMEN
Asthma is a common chronic childhood disease yet not much is known about factors that determine its outcome. Cigarette smoke has been associated with lung cancer in adults but its effects on children has hitherto been underestimated and not well studied. Cigarette smoke has been noted through various research studies to influence the development and or the exacerbation of asthma in childhood. Furthermore the prevalence of childhood asthma is higher among the children of smoking parents, more so when both parents are smokers as compared to those of non-smoking parents. Corroborative evidence indicates elevated urine cotinine levels amongst children of smoking parents than those of non-smoking parents. There is a corresponding increase in prevalence and exacerbation of asthma symptoms among children with raised urine cotinine levels than those with low levels. The presence of other risk factors increases the risk of development and exacerbation of bronchial asthma in children exposed to tobacco smoke than those not exposed. Cigarette smoking is on the increase, especially in developing countries due to aggressive advertising and exportation by the tobacco industry from developed countries. International legislation is needed to regulate the production and exportation of tobacco products. However, this may be resisted by the influential tobacco industry and may not get the support from the developing countries due to economic gains from the sale of tobacco products. This scenario poses major health problems for the developing countries in the future.
Asunto(s)
Asma/etiología , Protección a la Infancia , Exposición a Riesgos Ambientales/efectos adversos , Contaminación por Humo de Tabaco/efectos adversos , Adulto , Asma/epidemiología , Niño , Países en Desarrollo , Humanos , Prevalencia , Índice de Severidad de la Enfermedad , Fumar/epidemiología , Prevención del Hábito de FumarRESUMEN
A randomised controlled trial was carried out to determine the relative efficacy of four commonly used antimalarial drugs in children aged three to twelve years presenting with uncomplicated malaria at the Eldoret District Hospital, Kenya. One hundred and eighty eight children were studied between July 1993 and July 1994. There were no significant baseline differences between treatment groups with respect to age, sex, weight, ethnicity, haemoglobin, white blood cell (WBC) counts, parasite counts, previous exposure to malaria and prior treatment. Of the 188 patients, eleven were lost to follow-up while twelve were discontinued from the study due to poor clinical response. Most of the latter (eight out of twelve) were in the chloroquine group. By day seven, there were significant differences (p = 0.004) in parasite clearance between groups. There were no significant statistical differences between the groups (p = 0.12) with regard to the fever clearance time. However, there was a significant statistical difference (p = 0.00003) between the treatment groups in the cure rates. Halofantrine was the most efficacious drug with 82% of the cases cured followed by fansidar(R)(62%), amodiaquine (55%) and chloroquine (29%). RI and RII resistance were observed in all the treatment groups, i.e. halofantrine (18%), fansidar (38%), amodiaquine (45%) and chloroquine (67%) while RIII resistance was only observed in the chloroquine group(3%).