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The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety. KEY MESSAGESThe East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.Collaborations have been established between researchers in North America and East African countries for these studies.Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.

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BACKGROUND: Cervical cancer is caused by oncogenic human papillomaviruses (HPV) and is one of the most common malignancies in women living in sub-Saharan Africa. Women infected with the human immunodeficiency virus (HIV) have a higher incidence of cervical cancer, but the full impact on HPV detection is not well understood, and associations of biological and behavioral factors with oncogenic HPV detection have not been fully examined. Therefore, a study was initiated to investigate factors that are associated with oncogenic HPV detection in Kenyan women. METHODS: Women without cervical dysplasia were enrolled in a longitudinal study. Data from enrollment are presented as a cross-sectional analysis. Demographic and behavioral data was collected, and HPV typing was performed on cervical swabs. HIV-uninfected women (n = 105) and HIV-infected women (n = 115) were compared for demographic and behavioral characteristics using t-tests, Chi-square tests, Wilcoxon sum rank tests or Fisher's exact tests, and for HPV detection using logistic regression or negative binomial models adjusted for demographic and behavioral characteristics using SAS 9.4 software. RESULTS: Compared to HIV-uninfected women, HIV-infected women were older, had more lifetime sexual partners, were less likely to be married, were more likely to regularly use condoms, and were more likely to have detection of HPV 16, other oncogenic HPV types, and multiple oncogenic types. In addition to HIV, more lifetime sexual partners was associated with a higher number of oncogenic HPV types (aIRR 1.007, 95% CI 1.007-1.012). Greater travel distance to the clinic was associated with increased HPV detection (aOR for detection of ≥ 2 HPV types: 3.212, 95% CI 1.206-8.552). Older age (aOR for HPV 16 detection: 0.871, 95% CI 0.764-0.993) and more lifetime pregnancies (aOR for detection of oncogenic HPV types: 0.706, 95% CI, 0.565-0.883) were associated with reduced detection. CONCLUSION: HIV infection, more lifetime sexual partners, and greater distance to health-care were associated with a higher risk of oncogenic HPV detection, in spite of ART use in those who were HIV-infected. Counseling of women about sexual practices, improved access to health-care facilities, and vaccination against HPV are all potentially important in reducing oncogenic HPV infections.

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The association of sunrays with skin damage have been known since medieval times. The description of the electromagnetic spectrum facilitated the identification of the ultraviolet light spectrum as being responsible for skin damage resulting from prolonged skin exposure. Sunscreens have been used since ancient civilizations with various measures to limit exposure to sun exposure being employed. Awareness of the risks associated with sunrays has been increasing in the last century, and as a result, the science, technologies, and formulation have advanced significantly. The use of sunscreen products continues rising as government health agencies seek to contain increasing cases of UV induced melanomas. Recreational sunbathing and artificial tanning have increased the risk for these diseases significantly. This review article sought to expound the scientific basis of sunscreen use, the classification, formulation, quality control and regulation across the different countries around the world. The literature review was conducted on Google scholar, PubMed, SCOPUS, Cochrane, BMJ, SCIELO among others.

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BACKGROUND: Our study objective was to determine the validity and reliability of the breast module of a cancer awareness measure (BCAM) among adult women in western Kenya. METHODS: The study was conducted between October and November 2012, following three breast cancer screening events. Purposive and systematic random sampling methods were used to identity 48 women for cognitive focus group discussions, and 1061 (594 who attended vs. 467 who did not attend screening events) for surveys, respectively. Face and psychometric validity of the BCAM survey was assessed using cognitive testing, factor analysis of survey data, and correlations. Internal reliability was assessed using Cronbach's alpha. RESULTS: Among survey participants, the overall median age was 34 (IQR: 26-44) years. Compared to those women who did not attend the screening events, women attendees were older (median: 35 vs. 32 years, p = 0.001) more often married (79% vs. 72%, p = 0.006), more educated (52% vs. 46% with more than an elementary level of education, p = 0.001), more unemployed (59% vs. 11%, p = 0.001), more likely to report doing breast self-examination (56% vs. 40%, p = 0.001) and more likely to report having felt a breast lump (16% vs. 7%, p = 0.001). For domain 1 on knowledge of breast cancer symptoms, one factor (three items) with Eigen value of 1.76 emerged for the group that did not attend screening, and 1.50 for the group that attended screening. For both groups two factors (factor 1 "internal influences" and factor 2 "external influences") emerged among domain 4 on barriers to screening, with varied item loadings and Eigen values. There were no statistically significant differences in the factor scores between attendees and non-attendees. There were significant associations between factor scores and other attributes of the surveyed population, including associations with occupation, transportation type, and training for and practice of breast self-examination. Cronbach's alpha showed an acceptable internal consistency. CONCLUSION: Certain subpopulations are less likely than others to attend breast screening in Kenya. A survey measure of breast cancer knowledge and perceived barriers to screening shows promise for use in Kenya for characterizing clinical and community population beliefs, but needs adaptation for setting, language and culture.

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Our objective was to assess the effectiveness of educational sessions that accompanied breast cancer screening events in three communities in western Kenya between October and November 2013. Five hundred and thirty-two women were recruited to complete a test of breast cancer-relevant knowledge and randomly allocated to 'pre-test' or 'post-test' groups that immediately preceded or followed participation in the educational sessions. The education was organized as a presentation by health professionals and focused mainly on causes of breast cancer, early and late cancer presentation signs, high-risk groups, screening methods to find early-stage breast cancer, self-breast exam procedures and treatment options for this disease. Participants were invited to ask questions and practice finding nodules in silicone breast models. The median age was 35 years (interquartile range: 28-45), and 86% had not undergone breast cancer screening previously. Many individual items in our test of knowledge showed statistically significant shifts to better-informed responses. When all items in the assessment questionnaire were scored as a 'test', on average there was a 2.80 point (95% CI: 2.38, 3.22) significant improvement in knowledge about breast cancer after the educational session. Our study provides evidence for the effectiveness of an educational strategy carefully tailored for women in these communities in Kenya.

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SETTING: A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya. OBJECTIVES: Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors. DESIGN: Retrospective cross-sectional study using routine programme data. RESULTS: During the study period, 2635 women delivered at the RMC: 50% were aged 16-24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births. CONCLUSION: This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions.

Contexte : Une structure de santé privée rurale, le Ruby Medical Centre (RMC), participant à un système de bons de traitement de Maternité sans risques destiné à des femmes pauvres du conté de Kiambu au Kenya.Objectifs : Entre 2007 et 2013, déterminer 1) le nombre de femmes qui ont accouché au RMC, leurs caractéristiques et le devenir de leur grossesse, et 2) le nombre ne bénéficiant que d'un paquet de soins anténataux (ANC) incomplets et les facteurs associés.Schéma : Etude rétrospective transversale basée sur les données recueillies en routine dans les programmes.Résultats : Au cours de la période d'étude, 2635 femmes ont accouché au RMC : 50% étaient âgées de 16 à 24 ans, 60% avaient été transférées d'autres structures et 59% avaient débuté les ANC au cours du 3e trimestre. De ces 2635 femmes, 1793 (68%) avaient un paquet d'ANC incomplet : 347 (13%) ont manqué les principaux tests sanguins, 312 (12%) n'ont pas eu de vaccination anti-tétanique et 1672 (65%) ont eu moins de quatre consultations. Un démarrage tardif et des ANC débutés ailleurs étaient associés à un paquet d'ANC incomplet. Un décès lié à la grossesse est survenu et le taux de mortinatalité a été de 10/1000 naissances.Conclusion : Cette première évaluation du système de bons de traitement dans les zones rurales du Kenya a mis en évidence des problèmes de qualité des ANC. En dépit de l'évolution favorable des grossesses, il est nécessaire d'accroitre les efforts pour faire venir les femmes enceintes plus tôt, offrir des ANC complets et un suivi plus cohérent et précis des indicateurs et des interventions de santé reproductive.

Marco de referencia: El Ruby Medical Centre (RMC) es un centro de atención de salud privado en zona rural, que participa en el sistema de cupones por una maternidad sin riesgo en el condado de Kiambu, en Kenia.Objetivos: Determinar entre el 2007 y el 2013: 1) la cantidad de mujeres cuyo parto se atendió en el RMC, las características de las mujeres y los desenlaces relacionados con el embarazo; y 2) el número de mujeres que recibieron una atención prenatal (ANC) incompleta y los factores asociados con esta situación.Métodos: Fue este un estudio transversal retrospectivo a partir de los datos del programa corriente.Resultados: Durante el período del estudio, se atendió el parto de 2635 mujeres en el RMC, el 50% de las cuales tenía entre 16 y 24 años de edad, el 60% acudió como remisión de otros centros de atención y el 59% había comenzado la ANC durante el tercer trimestre del embarazo. De las 2635 mujeres, 1793 recibieron una ANC incompleta (68%) a saber: en 347 no se practicaron los principales exámenes sanguíneos (13%); 312 no recibieron la vacuna con el toxoide antitetánico (12%); y 1672 acudieron a menos de cuatro citas de control (65%). Los factores asociados con una ANC incompleta fueron una presentación tardía al programa y el inicio de la ANC en un centro diferente. Se presentó un caso de mortalidad relacionada con el embarazo y la tasa de mortinatalidad fue de 10 por 1000 nacimientos.Conclusión: El presente estudio es la primera evaluación del sistema de cupones por una maternidad sin riesgo en la zona rural de Kenia y puso en evidencia problemas en materia de calidad de la ANC. Pese a los desenlaces favorables del embarazo, se precisan iniciativas que fomenten una presentación más temprana de las embarazadas al programa, la ANC integral, y una vigilancia más regular y exacta de los indicadores y las intervenciones en materia de salud reproductiva.

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This systematic review assessed the quantitative literature to determine whether orphans are more likely to experience physical and/or sexual abuse compared to non-orphans in sub-Saharan Africa (SSA). It also evaluated the quality of evidence and identified research gaps. Our search identified 10 studies, all published after 2005, from Zimbabwe, South Africa, Kenya and Uganda. The studies consisted of a total 17,336 participants (51% female and 58% non-orphans). Of those classified as orphans (n=7,315), 73% were single orphans, and 27% were double orphans. The majority of single orphans were paternal orphans (74%). Quality assessment revealed significant variability in the quality of the studies, although most scored higher for general design than dimensions specific to the domain of orphans and abuse. Combined estimates of data suggested that, compared to non-orphans, orphans are not more likely to experience physical abuse (combined OR=0.96, 95% CI [0.79, 1.16]) or sexual abuse (combined OR=1.25, 95% CI [0.88, 1.78]). These data suggest that orphans are not systematically at higher risk of experiencing physical or sexual abuse compared to non-orphans in sub-Saharan Africa. However, because of inconsistent quality of data and reporting, these findings should be interpreted with caution. Several recommendations are made for improving data quality and reporting consistency on this important issue.

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BACKGROUND: The efficacy of anti-retroviral Therapy (ART) depends on adherence to the prescribed regimen. However, lack of adherence leads to treatment failure and drug resistance among other negative outcomes. OBJECTIVE: To determine factors influencing adherence to ARVS among patients attending the Comprehensive Care Clinic (CCC) within Jomo Kenyatta University of Agriculture and Technology (JKUAT). DESIGN: A descriptive cross sectional study. SETTING: Comprehensive Care Clinic within JKUAT. SUBJECTS: Three hundred HIV positive patients, undergoing ART treatment and follow up at the JKUAT clinic for a minimum duration of one month before the study, were recruited. RESULTS: Of the 300 patients enrolled for the study (70% females and 30% males), 81% were adhering to ARV treatment. The factors that were significantly associated with adherence included; Support (encouragement and reminder to take drugs) (P = 0.025); the number of meals respondents took in a day (P = 0.001); pill burden (P = 0.002) and forgetfulness (P = 0.001). However, there was no significant relationship between adherence and age, marital status, education, employment status or time taken to travel to the clinic. CONCLUSION: This study concluded that, the observed level of sub-optimal adherence to ART (19%) is of public health concern. These patients are vulnerable to treatment failure and development of resistant viral strains. Consequently the modifiable factors (Support, Number of meals taken, pill burden, and forgetfulness, should be addressed to change the current tread.

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OBJECTIVE: To document the prevalence of malaria parasitaemia among the HIV infected febrile children in a malaria endemic area. DESIGN: A cross-sectional study. SETTING: An ambulatory paediatric HIV clinic in Western Kenya, between November 2011 and December 2012. SUBJECTS: A total of 245 febrile HIV infected children aged less than 14 years attending the HIV clinic in the Webuye level IV hospital were included in the study. A systematic sampling method was used. MAIN OUTCOMES: A blood sample was taken for malaria parasite testing. Presence or absence of malaria parasites was documented. Clinical and socio-demographic characteristics of the participants were also recorded. RESULTS: A total of 245 participants were recruited mean age being 5.53 years. Malaria prevalence was 81.9%. Most participants (97%) were on cotrimoxazole prophylaxis. Some of the factors found to be positively associated with malaria parasitaemia were; male sex, care taker category (parent), WHO stage 3 and 4 of HIV disease, and a high absolute CD4 count. However, only the caretaker association was statistically significant. CONCLUSION: The frequency of malaria parasitaemia among febrile HIV infected children is still high regardless of the high cotrimoxazole prophylaxis uptake. It is also noted that there is a shift in the age group of fever among children toward the older age group. This implies that policies may need to be relooked at to include the older age group in the aggressive malaria prevention measures to avoid losing on the already made gains.

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OBJECTIVES: To conduct clinical breast cancer screening in three sites in Western Kenya and explore community barriers to screening uptake. DESIGN: Cross-sectional study. SETTING: Western Kenya specifically, Mosoriot, Turbo, and Kapsokwony. SUBJECTS: Community members (18 years and older) who did not attend the screening events. OUTCOME MEASURE: The outcome measure was having heard about the breast cancer screening events. Both structured and open-ended questions were used for data collection. Item frequency, correlations, and content analyses were performed. RESULTS: A total of 733 community members were surveyed (63% women, median age 33 years, IQR = 26-43). More than half (55%) of respondents had heard about the screening but did not attend. The majority of those who had heard about this particular screening had knowledge of screening availability in general (45% vs. 25%, p < 0.001). Only 8.0% of those who heard and 6.0% of those who had not heard of the screening event had previously undergone clinical breast exam (p = 0.20). Reasons for not attending the screening event were personal factors, including busy schedule (41.0%), perceived low personal risk (12.7%), lack of transport (4.2%), as well as health facility factors such as poor publicity (14.4%) and long queues (8.7%). CONCLUSION: Barriers to breast cancer screening uptake were associated with inadequate publicity, perceived long waits at event and busy lives among community women.

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Background. The intestinal parasitic infections (IPIs) are globally endemic, and they constitute the greatest cause of illness and disease worldwide. Transmission of IPIs occurs as a result of inadequate sanitation, inaccessibility to potable water, and poor living conditions. Objectives. To determine a baseline prevalence of IPIs among children of five years and below at Webuye Health and Demographic Surveillance (HDSS) area in western Kenya. Methods. Cross-sectional survey was used to collect data. Direct saline and formal-ether-sedimentation techniques were used to process the specimens. Descriptive and inferential statistics such as Chi-square statistics were used to analyze the data. Results. A prevalence of 52.3% (417/797) was obtained with the male child slightly more infected than the female (53.5% versus 51%), but this was not significant (χ (2) = 0.482, P > 0.05). Giardia lamblia and Entamoeba histolytica were the most common pathogenic IPIs with a prevalence of 26.1% (208/797) and 11.2% (89/797), respectively. Soil-transmitted helminths (STHs) were less common with a prevalence of 4.8% (38/797), 3.8% (30/797), and 0.13% (1/797) for Ascaris lumbricoides, hookworms, and Trichuris trichiura, respectively. Conclusions. Giardia lamblia and E. histolytica were the most prevalent pathogenic intestinal protozoa, while STHs were less common. Community-based health promotion techniques are recommended for controlling these parasites.

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OBJECTIVES: To determine the prevalence of malnutrition among children admitted with acute diarrhoea disease at Moi Teaching and Referral Hospital and to establish the effect of malnutrition on duration of hospital stay. DESIGN: Prospective observational study. SETTING: Paediatric wards of Moi Teaching and Referral Hospital, Eldoret, Kenya. SUBJECTS: A total of 191 children aged 6 and 59 months admitted with acute diarrhoea disease, without chronic co-morbidities or visible severe malnutrition, were systematically enrolled into the study between November 2011 and March 2012. OUTCOME MEASURES: Nutritional status based on WHO WHZ scores taken at admission and duration of hospital stay. RESULTS: The mean age was 13.2 months with a male to female sex ratio of 1.16:1. Of all the children seen with acute diarrhoeal diseases, 43.9% had acute malnutrition (<-2 WHZ score), with 12% being severely malnourished (<-3 Z score). Average duration of hospital stay was 3.36 (SD=1.54) days. Among those with malnutrition the average duration of stay was 3.39 (SD=1.48) days while for those without malnutrition it was 3.21(SD=1.20) days, which was not statistically different. No death was reported. WHO weight for Height Z scores picked 12% of severe form of malnutrition missed out by Welcome Trust classification (weight for age). CONCLUSION: Routine anthrometry including weight for height identifies more children with malnutrition in acute diarrhoeal diseases. Presence of malnutrition did not affect duration of hospital stay.

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SETTING: Diabetes clinics in three hospitals in Western Kenya: Moi Teaching and Referral Hospital and two associated district hospitals. OBJECTIVE: To determine the proportion of diabetes patients with a history of tuberculosis (  TB), human immunodeficiency virus (HIV  ) infection and tobacco smoking. DESIGN: A descriptive study using routinely collected data from patient records in the three diabetes clinics. RESULTS: Of 1376 patients analyzed, 750 (55%) were female. The mean age of the patients in the clinics was 53.5 years (95%CI 52.2-54.8), with an average duration of diabetes of 8.1 years (95%CI 7.6-8.7). Of all patients, 5.6% reported a history of TB, similar to the frequency about 20 years earlier (1990) in Tanzania. Only 30% of the patients reported knowing their HIV status; 6% were HIV-positive. A history of tobacco smoking was reported by 3.8% of the patients. CONCLUSION: The HIV epidemic does not seem to have significantly changed the relationship between TB and diabetes mellitus (DM) in this cohort of diabetes patients. The frequency of HIV and TB in this special population was comparable to that in the general population, and only a small proportion of patients reported a history of tobacco smoking.

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OBJECTIVE: To determine whether there is a relationship between male involvement in maternal health and utilisation of skilled birth attendants (SBAs) after controlling for socio-demographic and maternal characteristics. DESIGN: Data from the Kenya Demographic and Health Survey (KDHS) conducted in 2008-09 were analysed. SETTING: Nationally representative survey in Kenya. SUBJECTS: The unit of analysis was couples who met the inclusion criteria of being married and having had a child in the three years before the survey. RESULTS: The adjusted odds ratio after controlling for other factors indicates that women whose husbands attended at least one ANC visit were more likely to have skilled birth attendance than those whose husbands did not attend any ANC visits [AOR, 1.9; 95 percent CI, 1.09-3.32]. Maternal characteristics that had a statistically significant association with delivery by an SBA included educational level, employment, number of ANC visits, and parity. The province where the couple resided also was statistically significant. CONCLUSION: In Kenya a male partner's participation, through attending ANC visits, is associated with a woman's use of an SBA during delivery.

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OBJECTIVE: To determine the diagnostic usefulness of tuberculosis (TB) symptom screening to detect active pulmonary TB among human immunodeficiency virus (HIV) infected pregnant women in two PMTCT (prevention of mother-to-child transmission) clinics in western Kenya that are supported by the United States Agency for International Development-Academic Model Providing Access to Healthcare partnership. DESIGN: Cross-sectional study. Participants were interviewed for TB symptoms with a standardized questionnaire (cough >2 weeks, fever, night sweats, weight loss or failure to gain weight). Those with cough submitted sputum specimens for smear microscopy for acid-fast bacilli and mycobacterial culture. Women at >14 weeks gestation underwent shielded chest radiography (CXR). RESULTS: Of 187 HIV-infected women, 38 (20%) were symptom screen-positive. Of these, 21 had a cough for >2 weeks, but all had negative sputum smears and mycobacterial cultures. CXRs were performed in 26 symptomatic women: three were suggestive of TB (1 miliary, 1 infiltrates and 1 cavitary). Of 149 women with a negative symptom screen, 100 had a CXR and seven had a CXR suggestive of TB (1 cavitary, 2 miliary and 4 infiltrates). CONCLUSION: This study did not support the utility of isolated symptom screening in identification of TB disease in our PMTCT setting. CXR was useful in identification of TB suspects in both symptomatic and asymptomatic women.

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OBJECTIVE: To determine risk factors for death in HIV-infected African patients on anti-retroviral therapy (ART). DESIGN: Retrospective Case-control study. SETTING: The MOH-USAID-AMPATH Partnership ambulatory HIV-care clinics in western Kenya. RESULTS: Between November 2001 and December 2005 demographic, clinical and laboratory data from 527 deceased and 1054 living patients receiving ART were compared to determine independent risk factors for death. Median age at ART initiation was 38 versus 36 years for the deceased and living patients respectively (p<0.0148). Median time from enrollment at AMPATH to initiation of ART was two weeks for both groups while median time on ART was eight weeks for the deceased and fourty two weeks for the living (p<0.0001). Patients with CD4 cell counts <100/mm3 were more likely to die than those with counts >100/mm3 (HR=1.553. 95% CI (1.156, 2.087), p<0.003). Patients attending rural clinics had threefold higher risk of dying compared to patients attending clinic at a tertiary referral hospital (p<0.0001). Two years after initiating treatment fifty percent of non-adherent patients were alive compared to 75% of adherent patients. Male gender, WHO Stage and haemoglobin level <10 grams% were associated with time to death while age, marital status, educational level, employment status and weight were not. CONCLUSION: Profoundly immunosuppressed patients were more likely to die early in the course of treatment. Also, patients receiving care in rural clinics were at greater risk of dying than those receiving care in the tertiary referral hospital.

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OBJECTIVES: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya. DESIGN: A retrospective descriptive study. SETTING: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya. SUBJECTS: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya. INTERVENTIONS: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART). MAIN OUTCOME MEASURES: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed. RESULTS: Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment was four years (0-14.2 years), 51% girls, 25% paternal orphans, 10% total orphans and 13% maternal orphans. At enrollment, 25% had weight-for-Age Z scores (WAZ) > or = -1 and 21% had WAZ scores < or = 3. Orphaned children had worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO clinical stage 3 and 4, 56% were WHO clinical stages 1 and 2 with 19% missing clinical staging at enrollment. Cough (25%), gastroenteritis (21%), fever (15%), pneumonia (10%) were the commonest presenting features. Twenty six per cent had been diagnosed with tuberculosis and only 25% started on cotrimoxazole preventive therapy (CPT). Median CD4% at enrollment was 16% (0-64%); latest recorded values were 22% (0-64). Sixty four per cent were on cART (cART+), median age at start was 5.4 (014.4 years). The median initial CD4% among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART (cART-). Median CD4% for cART+ improved to 22% (0-59); whereas cART- was 23% (0-64) at last appointment. During the period of follow-up, one fifth (19%) of children on cART were lost to follow-up compared to slightly over one third (37%) for those not on cART. Thirty four percent were hospitalised; 41% diagnosed with pneumonia. Six per cent of 4017 were confirmed dead. CONCLUSIONS: HIV-infected children were enrolled in care early in childhood. Orphanhood was prevalent in these children as were gastroenteritis, fever, pneumonia and advanced immuno-suppression. Orphans were more likely to be severely malnourished. Only a quarter of children were put on cotrimoxazole preventive therapy. Children commenced on cART late but responded well to treatment. Loss to follow-up was less prevalent among those on cART.

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OBJECTIVE: To determine the length of delays from onset of symptoms to initiation of treatment of pulmonary tuberculosis (PTB). DESIGN: Cross-sectional study. SETTING: Chest/TB clinic, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. SUBJECTS: Newly diagnosed smear positive pulmonary tuberculosis (PTB) patients. RESULTS: Two hundred and thirty patients aged between 12 and 80 (median; 28.5) years were included in the study. They comprised 148 (64.3%, median 30 years) males and 82 (35.7%, median 28 years) females. One hundred and two (44%) came from urban and 128 (56%) came from rural setting covering a median distance of 10 (range 0-100) kilometres and paying Kshs 20 (range 0-200) to facility. Cough was the commonest symptom reported by 228 (99.1%) of the patients followed by chest pain in 214 (80%). The mean patient delay was 11 +/- 17 weeks (range: 1-78 weeks) with no significant difference between males and females, the mean system delay was 3 +/- 5 weeks (range: 0-39 weeks). The median patient, health systems and total delays were 42, 2, and 44 days respectively for all the patients. Marital status, being knowledgeable about TB, distance to clinic and where help is sought first had significant effect on patient delay. CONCLUSION: Patient delay is the major contributor to delay in diagnosis and initiation of treatment of PTB among our patients. Therefore TB control programmes in this region must emphasise patient education regarding symptoms of tuberculosis and timely health seeking behaviour.

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OBJECTIVES: To determine the prevalence, risk factors and antibiotic sensitivity of streptococcus pneumoniae carried in the upper respiratory tract of children. DESIGN: A cross-sectional study on consecutive clients. SETTING: Maternal Child Health Clinic (MCH) at Moi Teaching and Referral Hospital (MTRH) in western Kenya. SUBJECTS: Seventy eight of children attending Maternal Child Health Clinic between March 10th 2003 and July 11th 2003. MAIN OUTCOME MEASURES: Upper airway carriage status, ventilation, housing, age, illness, sensitivity patterns. RESULTS: Fifty six percent were boys; the median age was six months (range 1-42 months). Streptococcus pneumoniae carriage rate was in 28 (35.9%) cases. Fifty two percent of S. pneumoniae were resistant to penicillin, 25% to ampicillin and 78% to cotrimoxazole. There was significant association between the type of floor with pneumococcal carriage (p = 0.009) with people living in earth floor houses being five times more likely to be pneumococcal carriers as compared to those living in cement floor houses. CONCLUSIONS: A significant resistance of S. pneumoniae to penicillin, ampicillin and cotrimoxazole was found. Earth floored houses may increase susceptibility to upper airway S. pneumoniae carriage. RECOMMENDATION: Similar studies should be conducted in other parts of Kenya in order to learn about susceptibility patterns and associated risk factors, including floor type, in the country and tailor better treatment regimens.

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OBJECTIVES: To examine the frequency of street food consumption of people living in low-income settlements in Nairobi and the role of street foods in their daily diet and to reveal why people consume street foods rather than home-prepared foods. SETTING, SUBJECTS AND METHODS: A cross-sectional descriptive study was done with 1011 households and in-depth interviews with a subsample of 73 households in two selected areas in Nairobi: Korogocho, a low-income slum area and Dandora, a low-middle-income area. RESULTS: The frequency of street food consumption was higher in Korogocho than in Dandora (3.6 vs 2.0 days per week; P<0.001). Street food consumption did not differ between different types of households, with the exception of household size. Employment status of the household head and street food consumption were related (P<0.001): consumption frequency of 3.7 days per week when irregularly or unemployed, 2.9 days/week when self-employed and 2.1 days/week when regularly employed. Furthermore, where an adult woman with primarily a domestic role was present, street food consumption was less (2.55 days per week when present vs 2.95 when not present; P<0.05). CONCLUSIONS: Street foods play an important role in the diet of poor households in Nairobi, in particular for breakfast and snacks, because they are cheap and convenient. The frequency of street food consumption is determined by a combination of at least four factors: level of household income; regularity of income; household size; and time available to prepare meals. SPONSORSHIP: The project is financed by the Netherlands Foundation for the Advancement of Tropical Research (WOTRO), filenumber WV 96-153.

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