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Barriers to Quality Nursing Burn Care in Moi Teaching and Referral Hospital in Kenya
Get PDFBackground
The incidence of burns has significantly increased over the last decades. Although there is an extensive amount of literature on burns related injuries in Kenya, there is no evidence of studies which have examined barriers to quality nursing burn care in public health facilities in the country.
Objective
To examine factors hindering quality nursing burn care at Moi Teaching and Referral Hospital.
Material and Methods
Six variables were assessed namely nurse age, nursing responsibility, availability of consumables, pre and post-operative care, staffing and the equipment which is always working and in good condition.
Results
Availability of consumables negatively predicted barriers to quality nursing care among nurses who were currently working in the burn unit (t = -2.37; p = 0.02). And a positive predictor among those who had worked in the burn unit before (t = 2.00; p = 0.05). Equipment always working and in good condition was a positive predictor among nurses who had never worked in the burn unit (t = 2.38; p = 0.02).
Conclusion
Staffing, proper working equipment and availability of consumables are major barriers to the provision of quality nursing for burn patients.
1.0 Introduction
The incidence of burns has significantly increased over the last decades (1). Developing countries alone, account for nearly 95% of all documented cases, with the majority of the cases being reported in the poorest and remote areas in these regions (2,3). The stack reality is that it is becoming a major public health problem (1).
Unfortunately, these regions lack a surmountable amount of resources to reduce the incidence and the severity of injuries attributed to burns (3–5). These include a lack of trained staff and advanced equipment to manage burn injuries (4,5).
The distribution of burn injuries may differ significantly with gender, income, and age groups (6,7). However, the majority of these cases occur in domestic settings where cooking takes place (8). Fuels for lighting, heating and cooking are listed as the main contributors (9).
In Africa, burns remain a public health concern due to their high incidence and the inability of the region to manage the cases (1). It is estimated that 6.1 per 100,000 burns related deaths occur annually in Africa (10). Apart from death, other poor outcomes include long recuperation time and even paralysis (11,12).
About 32,633 burns were recorded in Kenya in 2010 (13). Although there is an extensive amount of literature on burns-related injuries in the country, there is no evidence of studies that have examined barriers to quality nursing burn care in public health facilities.
2.0 Materials and Methods
2.1 Study Design
The study was cross-sectional in design.
2.2 Study Site and Participants
The site was Moi Teaching and Referral Hospital (MTRH) the second-largest and the only national referral health facility outside the Kenyan capital, Nairobi. The 800-bed hospital has a 21bed burn unit. There were 23 patients admitted to the unit at the time of the study. The study targeted all the nurses who had been employed at the time on a full-time basis. A total of 195 nurses were randomly selected to participate in the study.
2.3 Data Collection Procedure
A semi-structured questionnaire was used to collect data. Four research assistants were recruited, trained, and engaged in administering the questionnaire. Data was conducted from May 2016 to December 2016.
2.4 Data analysis
Hierarchical regression was used to predict barriers to quality nursing burn care among nurses who were currently working in the burn unit, those who had previously worked in the unit, and those who had never worked in the burn unit. Six variables were assessed namely nurse age, nursing responsibility, availability of consumables, pre and post-operative care, staffing, and the conditions of the equipment.
2.5 Ethical Consideration
Moi University and MTRH Institutional Review and Ethics Committee (IREC) reviewed and approved the study. All nurses who participated in the study consented verbally and without coercion.
3.0 Results
3.1 Characteristics of the Nurses
The majority of the nurses were females (n = 124; 63.6%). The proportion of male and female nurses who had never worked in the burn unit differed slightly (47.3% vs. 49.0%). Most of the nurses who previously worked in the burn unit were males (n = 24; 64.9%) and vice versa for those currently stationed in the unit (n = 43; 62.7%).
A large proportion of nurses reported having undergone in-service training in burn management (n = 171; 87.7%). However, about half of those who had undergone such training had never worked with burn patients before (n = 93; 47.7%). Interestingly, most of these nurses were approaching the legal retirement age (62.0%). See Table 1.
Table 1: Characteristics of the nurses
3.2 Condition of the patients in the burn unit
Close to two-thirds of the patients in the burn unit were adults (n = 17; 73.9%). About 60.9% (n = 14) of the patients were males. Most of the injuries were either work-related (n = 11; 47.8%) or due to domestic violence (n = 8; 34.7%). The majority of the injuries were third-degree burns caused by electric faults, open fires, scalds, and corrosive substances (n = 16; 69.6%). Overall, scalds were the main cause of the burns (n = 13; 56. 5%). The mean hospital stay was 34.4 days. The majority of the patients rated their condition as improved (n = 16; 69. 6%).
3.3 Barriers to the provision of quality burn care
The hierarchical regression predicted a significant portion of barriers to quality nursing burn care among the three categories of nurses (r2= .68 for the nurses currently working in the burn unit, r2 = .63 for those who have ever worked in the burn unit, and r2 = .45 for those who have never worked in the burn unit).
Nursing responsibility, specifically post-operative care, was a consistent barrier to the provision of quality nursing burn care. Pre-operative care positively predicted barriers to the provision of quality nursing burn care among nurses who had never worked in the unit. After controlling for nursing responsibility, staffing consistently predicted barriers to the provision of quality nursing burn care across the three categories.
The influence of the nurses’ level of education across the three categories was less consistent. It was affected by the nurses’ ages which were highly correlated with barriers to the provision of quality nursing burn care (r2= 0.68, p < .05for nurses who are currently working in the burn care, r2 = 0.56, p < .001for those who have ever worked in the burn unit and r2 = 0.60, p < .001 for those who have never worked in the burn unit).
A hierarchical regression with and without the age of the nurse revealed that age was not a suppressor variable. It was therefore removed from the model. Thereafter, staffing positively predicted barriers to the provision of quality nursing burn care. Availability of consumables negatively predicted barriers to quality nursing care among nurses who were currently working in the burn unit (t = -2.37; p = 0.02). And a positive predictor among those who had worked prior in the burn unit (t = 2.00; p = 0.05). Equipment always working and in good condition was a positive predictor among nurses who had never worked in the burn unit (t = 2.38; p = 0.02).
Table 2: Hierarchical regression without nurses’ age for predictors of barriers to quality burn care
* p < .05, ** p < .001
4.0 Discussion
As the study was ongoing, a section of the media reported overcrowding in the MTRH wards (14). The study observed the same in the burn unit which had an excess of two patients. And this could be attributed to the large catchment area of the hospital which spans 23 counties and the neighboring countries in East and Central Africa (15).
However, sharing a hospital bed is a health risk as it may be a precursor to nosocomial infections. It is also demeaning as it denies the patients their needed privacy. And for this reason, the hospital should take necessary measures to ensure the unit is decongested.
One way to do this is to increase the burn unit bed capacity and if need be, refer non-critical cases to other facilities. Prevention of scalds at the household level could prove more helpful. As scalds are the leading causes of burn injuries among burn patients seen at the facility and this was also reported by Lelei et al. (16) and Odondi et al. (17).
However, the number of injuries attributed to scalds was lower in our study compared to the two studies (16,17). This may be attributed to the differences in the studied population. Unlike this study whose primary focus was on the patients admitted to the burn unit, the two studies targeted burn patients in both the outpatient and inpatient departments.
In terms of staffing, the study observed that the same number of nurses assigned to the 21 patients was managing the additional patients. This increased patient-nurse ratio leads to job dissatisfaction (18). It is also a recipe for burnout and prolonged recuperation (18,19). And contribute to increasing mortality (18). Ultimately, this may prolong in-hospital stays as was seen in the study. And which was longer than that reported by Lelei et al. (16) and Odondi et al. (17).
In order to safeguard against burnout, staffing is critical as it may also offer a multi-specialized team to cater to different levels of nursing (19). This may be easy to achieve in MTRH as it has a high number of nurses who have been trained in burn management. However, most of these skills remain underutilized. And most probably, may go to waste considering that most of the trained nurses were approaching the legal retirement age.
Lastly, postoperative care has a significant impact on the recovery of a burn patient after surgery (20). But this is a demanding task that needs specialized treatment equipment and which should be in good working conditions (21). And this calls for their maintenance to enable them to function well throughout their lifespan. However, the cost of doing so should be low and cost-effective (19). Alongside the equipment, the availability of consumables such as dressing materials must be taken into consideration. Otherwise, all these may affect the quality of burn management.
5.0 Conclusion
The study observed that staffing, proper working equipment, and availability of consumables are major barriers to the provision of quality nursing for burn patients.
References
Wong JM, Nyachieo DO, Benzekri NA, Cosmas L, Ondari D, Yekta S, et al. Sustained high incidence of injuries from burns in a densely populated urban slum in Kenya: An emerging public health priority. Burns J Int Soc Burn Inj. 2014 Sep;40(6):1194–200.
Sasor SE, Chung KC. Upper Extremity Burns in the Developing World: A Neglected Epidemic. Hand Clin. 2019 Nov 1;35(4):457–66.
Ahuja RB, Bhattacharya S. Burns in the developing world and burn disasters. BMJ. 2004 Aug 21;329(7463):447–9.
Atiyeh B, Masellis A, Conte C. Optimizing Burn Treatment in Developing Low- and Middle-Income Countries with Limited Health Care Resources (Part 1). Ann Burns Fire Disasters. 2009 Sep 30;22(3):121–5.
Stokes MAR, Johnson WD. Burns in the Third World: an unmet need. Ann Burns Fire Disasters. 2017 Dec 31;30(4):243–6.
Blom L, Klingberg A, Laflamme L, Wallis L, Hasselberg M. Gender differences in burns: A study from emergency centres in the Western Cape, South Africa. Burns. 2016 Nov 1;42(7):1600–8.
Ali SA, Hamiz-ul-Fawwad S, Al-Ibran E, Ahmed G, Saleem A, Mustafa D, et al. Clinical and demographic features of burn injuries in karachi: a six-year experience at the burns centre, civil hospital, Karachi. Ann Burns Fire Disasters. 2016 Mar 31;29(1):4–9.
Sadeghi Bazargani H, Arshi S, Ekman R, Mohammadi R. Prevention-oriented epidemiology of burns in Ardabil Provincial Burn Centre, Iran. Burns. 2011 May 1;37(3):521–7.
Sharma NP, Duke JM, Lama BB, Thapa B, Dahal P, Bariya ND, et al. Descriptive Epidemiology of Unintentional Burn Injuries Admitted to a Tertiary-Level Government Hospital in Nepal: Gender-Specific Patterns. Asia Pac J Public Health. 2015 Jul 1;27(5):551–60.
World Health Organization. A WHO plan for burn prevention and care [Internet]. World Health Organization; 2008 [cited 2022 Apr 29]. 23 p.
Weissman O, Weissman O, Farber N, Berger E, Grabov Nardini G, Zilinsky I, et al. Hypoglossal nerve paralysis in a burn patient following mechanical ventilation. Ann Burns Fire Disasters. 2013 Jun 30;26(2):86–9.
Stiles CE, McLawhorn MM, Nosanov LB, Paul JL, Shupp JW. Burn Injuries in Patients with Paralysis: A National Perspective on Injury Patterns and Outcomes. J Burn Care Res Off Publ Am Burn Assoc. 2017 Dec 27;39(1):15–20.
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Otieno J. The Star [Internet]. Report lays bare mess in country’s referral hospitals. 2019 [cited 2022 Apr 30]. Available from: https://www.the-star.co.ke/news/2019-05-10-report-lays-bare-mess-in-countrys-referral-hospitals/
MTRH. Moi Teaching and Referral Hospital [Internet]. 2018 [cited 2022 Apr 30]. Available from: http://www.mtrh.go.ke/about-us
Lelei LK, Chebor AK, Mwangi HR. Burns injuries among in-patients at Moi Teaching and Referral Hospital, Eldoret, Kenya. Ann Afr Surg [Internet]. 2011 [cited 2022 Apr 30];8.
Odondi RN, Shitsinzi R, Emarah A. Clinical patterns and early outcomes of burn injuries in patients admitted at the Moi Teaching and Referral Hospital in Eldoret, Western Kenya. Heliyon. 2020 Mar 20;6(3):e03629.
Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA. 2002 Oct 23;288(16):1987–93.
Bettencourt AP, McHugh MD, Sloane DM, Aiken LH. Nurse Staffing, the Clinical Work Environment, and Burn Patient Mortality. J Burn Care Res Off Publ Am Burn Assoc. 2020 Aug;41(4):796.
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Acknowledgments
Our gratitude goes to all the nurses who participated in the study.
Author Contributions
All the authors participated in the writing of the manuscript. The three authors formulated the study, and collected, and analyzed the data.
Competing Interest
The author has no competing interests
Socio-Demographic Characteristics Associated with Self-Induced Abortion with Misoprostol in Uasin Gishu County
Get PDFoai:ojs2.hizarticles.com:article/2BackgroundThere are attempts to increase community access to misoprostol in Kenya. However, several factors may hinder such health-seeking behaviour. And to date, there are no documented evidence examining individual-level factors that may influence self-administration of the drug in Uasin Gishu County or any other part of Kenya.
ObjectiveThis study examined the socio-demographic characteristics associated with self-induced abortion with misoprostol among women presenting themselves with abortion-related complications in public health facilities in Uasin Gishu County in Kenya.
Material and MethodsFrom the sample, the study identified women who had induced their pregnancy with misoprostol. The association between self-induced abortion and the socio-demographic variables was then analysed using the Pearson Chi-square test. Significant variables were subjected to regression analysis after controlling for confounding. Odds Ratio (OR) with confidence interval(CI) was used where possible to ascertain the extent of the association.
ResultsThe prevalence of self-induced abortion with misoprostol in the County was 25.6% (137). Women who had not completed primary school were .292 times more likely to self-induce their pregnancy with misoprostol, (OR, .292; 95% CI = .10, .83; p = 0.021).
1.0 Introduction
Abortion is outlawed in Kenya and is only permitted if the pregnancy threatens the life of the mother or the unborn baby (1). However, the outlawing of abortion does not hinder many women from seeking or illegally inducing their pregnancies (2). And for so many women, surgical methods remain their preferred choice (3). However, surgical procedures are expensive (4). Fear, stringent laws, and stigmatization surrounding abortion issues make surgical procedures inaccessible to many women (5).
Misoprostol provides a ‘better’ alternative to women who find it difficult to access surgical ‘routes’ (2). The drug is relatively affordable, readily available, and easy to administer (6,7). It also reduces the high risks of infections and reproductive tract injuries attributable to inadequate surgical procedures (8). Making it an ideal choice for women seeking clandestine abortions, especially in settings where abortion is restricted or outlawed (6,9).
The number of trained health workers capable of administering misoprostol has increased tremendously in Kenya (8). Following the approval of misoprostol and its inclusion in the National Essential Medicine List (10). There are also attempts to increase community access to misoprostol through community distribution (7).
This call is supported by documented evidence that has shown that women can safely administer the pill with minimum or no medical supervision (6,9). However, several factors may hinder such health-seeking behavior. These include the woman’s age, marital status, parity, education level, and employment status (11). To date, there is no documented evidence that has examined how these factors influence the self-administration of misoprostol in Kenya.
Therefore, this study sought to examine the socio-demographic characteristics associated with self-induced abortion with misoprostol among women presenting themselves with abortion-related complications in public health facilities in Uasin Gishu County in Kenya.
2.0 Material and Methods
2.1 Study Area
Specifically, it targeted public health facilities classified as level III and above.
2.2 Study Population
All women who presented themselves in the targeted health facilities with induced abortion-related complications were recruited.
2.3 Study Design
The cross-sectional study took two months from 1st December 2017 to 31st January 2018.
2.4 Sampling Procedure
Of the 19 health facilities, eight (42.1%) agreed to participate in the study. Five were classified as level III facilities (n = 5; 31%), two-level as IV (n = 2; 100%), and one was a level VI facility (n = 1; 100%). All the patients who participated in the study consented in writing.
2.4.3 Inclusion Criteria
Only patients residing in the County and those managed as per the National Post Abortion Care (PAC) Guidelines (12) were recruited.
2.4.4 Exclusion Criteria
Any patient identified as having had spontaneous abortion or miscarriage was excluded.
2.5 Data Collection Procedure
Data collectors were trained in the administration of the questionnaires one week before the commencement of data collection. The data collectors used the waiting time in the waiting bay to inform the patients about the ongoing study and seek consent from individual patients.
Apart from the socio-demographic characteristics of the patients reported in this study, the team also took records of the reproductive and clinical histories, diagnosis, treatment and clinical procedures undertaken, post-abortion contraception, and management of outcomes. The findings of these outcomes are reported elsewhere.
From the sample, the study identified women who had induced their pregnancy with misoprostol. The study defined self-induced abortion with misoprostol as follows. The patient or someone without medical knowledge bought misoprostol tablets without a prescription with a view to assisting the patient to terminate her pregnancy. Alternatively, the patient did not visit any registered health facility licensed to dispense misoprostol for consultation. The study relied on self-reporting by the patient.
2.6 Data Collection Tools
Data was collected using a pre-tested interviewer-administered questionnaire. The study adopted the questionnaire from a nearly similar previous study (13,14). It then underwent modification to obtain a final and workable questionnaire that was used in this study.
2.7 Data Management and Analysis
The collected data were collected on a daily basis and then summarized in tables. And at the end of every week, the summarised sheet from different study sites was validated and compiled. The association between self-induced abortion and the socio-demographic variables was then analyzed using the Pearson Chi-square test. Significant variables were subjected to regression analysis after controlling for confounding. Odds Ratio (OR) with confidence interval (CI) was used where possible to ascertain the extent of the association.
2.8 Ethical Consideration
The study sought ethical review and consideration from Moi University College of Health Sciences and MTRH IREC. It received provisional approval on 11th April 2017 and full approval on 16th June 2017 (FAN: IREC 1987). The researchers also sought permission from the facility. All responses were anonymous and confidential.
Participation was also purely voluntary after the patients had consented in writing. In the case of underage participants, the research team sought consent from their parents or guardians. No patient was victimized, denied health services, or discriminated against for refusing to participate in the study.
3.0 Results
3.1 Recruitment Process of the Study Participants
One thousand three hundred and seventeen patients sought PAC services from the eight participating health facilities during the study period. This figure represented 36.0% of 3,659 women who visited the gynecology and obstetrics clinic from 1st December 2017 to 31st January 2018. Of the 1,317 patients, 19 (1.4%) had a miscarriage, 39 (3.0%) had a spontaneous abortion, and 618 (46.9%) were not residents of Uasin Gishu County. The 676 patients were, therefore, excluded from the study as per the exclusion criteria.
The researchers approached the remaining 641 (48.7%) patients. And 489 (76.2%) patients consented to the study. Of the 489 patients, 463 (94.7%) completed the health facility assessment, 5 (1.0%) withdrew from the study citing legal and personal reasons, and 21 (4.3%) provided incomplete data. The uncompleted data included the refusal to disclose the reproductive history and the method used to terminate the pregnancy.
The findings reported herein are of the 463 patients who completed the assessment. This number represented 72.2% of the 641 patients who met the inclusion criteria. And it represented 94.7% of the 489 patients who consented to the study. Most of these patients sought PAC services from Level VI facilities (n = 301, 65.0%). Figure 1 summarises the recruitment process of the 463 patients.
Figure 1: Recruitment process of the study participants
3.2 Prevalence of Self-Induced Abortion with Misoprostol
Of the 463 patients, 137 (25.6%) had self-induced their pregnancies with misoprostol. The remaining 326 (70.4%) used other methods. Four had exerted pressure on their abdomen to expel the fetus (1.2%), 161 overdosed or self-prescribed themselves medicines other than misoprostol (49.4%), while 13 inserted sharp objects in their vaginas to try and “open up” their uterus (4.0%). The remaining 50 had taken ‘harmful’ chemicals like livestock hormonal growth medicines, e.t.c (15.3%), and 98 had visited a medical practitioner who prescribed some medicinal products or performed some procedures to end the pregnancy (30.1%).
3.3 Socio-demographic Characteristics of the Clients
The sociodemographic variables were first cross-tabulated using the Pearson chi-square test. No significant association was established between self-induced abortion with misoprostol and the age of the patient, χ2 (5, N = 463) = 1.58, p = .904; the place where the patient resided, χ2 (1, N = 463) = .14, p = .704; religion, χ2 (3, N = 463) = 4.51, p = .211 and the occupation of the patient, χ2 (4, N = 463) = 1.29, p = .864. However, the patient level of education was found to be associated with self-induced abortion with misoprostol, χ2 (6, N = 463) = 16.03, p = .014. The variable was therefore entered into binary regression to ascertain if any of the seven levels of education under study might predict higher odds of self-induced abortion with misoprostol.
Table1: Socio-demographic Characteristics of the Client
*Significant value, p ≤ .05 at 95% C.I.
In comparison to the patients who were educated up to the university level, women who had not completed primary school were .292 times more likely to self-induce their pregnancy with misoprostol, (OR, .292; 95% CI = .10, .83; p = 0.021). It was noted that women educated to college level (mid-level), (OR, .635; 95% CI = .34, 1.19; p = 0.155), those who had completed secondary (OR, .537; 95% CI = .28, 1.04; p = .063) or primary education (OR, .36, 95% CI = .11, 1.17; p = .089), those who had not completed secondary school (OR, 1.31, 95% CI = .68, 2.53; p = .423), or had no formal education (OR, .55, 95% CI = .28, 1.06; p = .074) were not likely to self-induce their pregnancies with misoprostol. See Table 2.
Table 2: Binary regression analysis of the education level of the patients
*Significant at 95% C.I.
4.0 Discussions
4.1 Recruitment Process of the Study Participants
Abortion is illegal in Kenya and is only permitted to a certain extent by the law (15,16). The restrictive laws and the social stigma surrounding abortion issues more often compel many women to seek abortion services outside their communities (17). This finding was not unique to this study. Considering that, about half (46.9%) of all the patients identified to have induced their abortions resided outside Uasin Gishu County.
Interestingly, the majority of these patients sought PAC services from higher-level facilities. Most probably due to the perceived notion by many Kenyans that these facilities are well-equipped and have well-trained and specialized healthcare personnel (18). And this translates to quality medical services. On the contrary, lower-level facilities have equal capabilities to offer PAC services just like their higher-level facilities (14).
Therefore, the Government and other stakeholders in the health sector should strive to educate the public that they can still obtain the same kind of PAC services in the higher-level facilities as the lower ones. This move will help to ease the number of patients flocking level VI facilities in search of PAC.
4.2 Prevalence of Self-Induced Abortion with Misoprostol
This study reported a low number of women who had used misoprostol to terminate their pregnancies. This study reported a low number of women who had used misoprostol to terminate their pregnancies. This figure is a comparison to those reported in other countries like Ghana (11) and the United States (19). However, there is a likelihood that our study underreported the proportion of self-induced abortion with misoprostol.
Misoprostol has a high success rate of about 80 percent and fewer cases of complications arising from the use of the drug (20). Thus, a large proportion of women who might have self-induced their pregnancy with the pill may not have developed complications. Hence, they did not need to visit a health facility. It is also possible that some might have developed complications but did not seek treatment. Either out of fear, stigmatization, or considering their injuries mild to warrant any treatment. Or they treated their injuries at home by self-medication.
It is, therefore, possible that the previous media reports that raised concerns over the increasing number of self-induced abortions with misoprostol in the country may be accurate (21). However, what is worrying is the high number of unsafe abortions reported in our study. And it is a trend that seems to have refused to dwindle over the past years (14,22). Therefore, there is a need to sensitize the public about safe abortion methods like the usage of misoprostol.
4.3 Factors Associated with Self-Induced Abortion with Misoprostol
This study reported an association between patients’ education and self-induced abortion with misoprostol. A finding that is similar to a study conducted in Ghana (11). However, contrary to our study which found that women with no basic education are more likely to self-induce their pregnancy with misoprostol, the finding of the study in Ghana was actually the opposite. Similarly, unlike the study in Ghana, this study did not find age, religion, and occupation to be associated with self-induced abortion with misoprostol.
There were scarcities of similar studies which we could use to compare our findings. We, therefore, recommend further studies in this area. We believe that doing so will help shed more light on the facilitators and barriers to the uptake of this critical health-seeking behavior. These findings may help in designing interventions geared towards improving the self-use of misoprostol at the community level.
5.0 Conclusions
The prevalence of self-induced abortion with misoprostol was relatively low. The study also observed that women who had not completed primary school were more likely to self-induce their pregnancy with misoprostol.
References
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Coeytaux F, Hessini L, Ejano N, Obbuyi A, Oguttu M, Osur J, et al. Facilitating women’s access to misoprostol through community-based advocacy in Kenya and Tanzania. Int J Gynecol Obstet. 2014 Apr 1;125(1):53–5.
Osur J, Baird TL, Levandowski BA, Jackson E, Murokora D. Implementation of misoprostol for postabortion care in Kenya and Uganda: A qualitative evaluation. Glob Health Action. 2013;6(1):1–12.
Bello FA, Fawole B, Oluborode B, Awowole I, Irinyenikan T, Awonuga D, et al. Trends in misoprostol use and abortion complications: A cross-sectional study from nine referral hospitals in Nigeria. PLoS ONE [Internet]. 2018 Dec 31 [cited 2020 Sep 13];13(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312220/
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Competing Interests
The authors declare that they have no competing interests.
Acknowledgment
Our heartfelt appreciation goes to the patients who participated in this study.
Kenya needs to watch the incidence of leptospirosis
No full textLeptospirosis has received little attention from public health practitioners. And there is a likelihood that the spread and prevalence of the disease are high due scarcities of studies related to leptospirosis. As Kenya increases the acreage under rice, the country should monitor the incidences of leptospirosis. This is because evidence shows that the disease is prevalent in rice growing areas and as its transmission differs with rice cultivation practices.
Introduction
Leptospirosis is a bacterial disease that attacks both man and animals. Transmission of Leptospiral bacteria may occur via direct contact with infected live or dead animals or exposure to urine, water or soil contaminated with the bacteria. The disease is fatal and can result in death.
Data shows that about 1 million people across the globe are infected with the disease annually. About a third to a half of these cases were severe. Leptospirosis is slowly becoming a re-emerging disease globally. Lately, several countries have reported outbreaks in various parts of the world.
Distribution of leptospirosis in Kenya
In Kenya, the disease has received little attention from public health practitioners. And there is a likelihood that the spread and prevalence of the disease are high due scarcities of studies related to leptospirosis. However, the few available studies have shown a high prevalence of the disease in Nyandarua and Turkana.
Nyandarua is a wet region, and Leptospira spp is known to be endemic in wet areas. On the other hand, the high temperatures prevalent in Turkana favour the survival of the bacteria. The disease killed six students and 12 Kenyans in total after the outbreak of the disease in 2004. The 2004 outbreak was not the only outbreak in the country.
Kenya reported the first case of leptospirosis in 1944. Since then, Kenya has conducted few studies in this area. It has led to less awareness of the disease among Kenyans and little scientific interest in leptospirosis. Available studies in the country have focused their attention on pigs and rodents.
Recent research in Garissa and Tana River showed that nearly half of the sampled rodents tested positive for leptospiral bacteria. Conspicuously, the two regions house the Hola and Bura irrigation schemes.
Expansion of rice fields in the country
It is no doubt that the population of Kenya has doubled in the last three decades. Out of the country's desire to improve food security and feed its rapidly growing population, Kenyans have turned several previously arid and semi-arid lands (ASAL) into agricultural lands. Some into irrigated farmlands, while into ranches for cattle, sheep, goats and camels.
Scientific studies have shown that increased or intense agricultural activities may increase the number of synanthropic rodents. In 2022, Kenya announced plans to increase the acreage of land under irrigation. An ambitious goal outlined in Vision 2030 and spearheaded by the National Irrigation Authority.
Kenya wants to avoid overreliance on rain-fed agriculture, which has become unreliable due to erratic weather changes. The Government has launched several mega dams since it announced the plan early this year. Constructions of many others are underway, while some are awaiting commissioning.
For instance, in February 2022, the Government commenced the construction of the Mwache Irrigation dam in Kwale County. The dam will supply 186,000m3 of water for domestic use and irrigation of 2,600 acres of land in its environs. And on Oct 15 2022, President Dr William Ruto commissioned the Thiba dam in Kirinyanga County. The dam will boost the production of rice by 10,000 acres.
During its launch, the president announced a further plan to increase rice production in the Mwea Irrigation scheme by 86,000 metric tonnes. Before 2015, Kenya had only seven irrigation schemes. These schemes are Hola and Bura in Tana River, Ahero and West Kano in Kisumu, Bunyala in Siaya and Busia, Mwea in Kirinyanga and Pekerra in Baringo. However, the Government has launched several other projects like the Galana Kulalu Irrigation Scheme.
Kenya needs to watch the incidence of leptospirosis
While these are noble initiatives, they could also be a source of vector-borne disease. Some diseases that thrive well under irrigated farmlands include Leptospirosis, Bilharzia due to water snails and malaria as the areas provide fertile breeding grounds for mosquitoes, only to mention a few.
As Kenya increases the acreage under rice, the country should monitor the incidences of leptospirosis. Evidence shows that the disease is prevalent in rice-growing areas, and its transmission differs with rice cultivation practices. For instance, using animals like water buffaloes in cultivating the paddies may increase the risk of transmission.
There is a possibility that the rains may wash the bacteria into these rice paddies and, therefore, contaminate the soil. Contaminated soils are a good reservoir for the disease, and walking barefoot on such soils may encourage disease transmission. Most irrigation schemes are in areas with favourable climatic conditions ideal for the flourishing of different types of Leptospira.
These include high rainfall, humid conditions, low concentration of human waste, alkaline PH, sediments in water, warm climatic conditions and high moisture content in the soil. With the increase in the number of irrigation schemes and particularly the rice paddies in the country, there is a need to understand the epidemiology of the Leptospira spp in irrigation schemes in Kenya. Such studies will help reduce the risk of transmission and the future outbreak of the disease