8 research outputs found
Estimating Burden of Diarrhoea Associated with Water, Sanitation and Hygiene among the Under Fives in Residential Environs of Nairobi, Kenya
No full textThis study aimed to quantify the burden of childhood diarrhoea morbidity and mortality of the under five children in Nairobi city using household data and hospital records. The main objective of this study was to estimate the diarrhoea disease burden of children aged less than five years associated with Water, sanitation and hygiene in Nairobi using available mortality and morbidity information. The study used a cross-sectional, non interventional approach. For estimating childhood diarrhoea disease burden, the study area was categorized into four exposure residential environs with differentiated by WASH and SES characteristics. The delineation gave four residential environs namely ISLI, HDLI, MDHI and LDHI. The parameters considered included access to improved water and sanitation and diarrhoea (case fatality, incidence rate, incidence duration, and prevalence) so as to calculate DALYs. Also household hygiene knowledge and practice were assessed, sanitary inspections conducted and water samples collected that were analysed for total and faecal coliform counts, turbidity, and conductivity. Data obtained were subjected to relevant statistical tools including descriptive statistics, relative risk estimates, regression analysis, and multivariate methods. The results of the study show ISLI and HDLI environs were receiving significantly low and unreliable amounts of water (<201cd/person/day) as well as inadequate sanitary facilities. The results also revealed that the microbiological quality of water in ISLI and HDLI residential environs was generally poor due to poor water handling practices and poor sanitary conditions within the surroundings. Overall, household water storage showed a significantly higher contamination (33.2%) than household tap water supplies (4.7%). These factors influenced a high childhood diarrhoea burden observed in this study. For diarrhoea the study identified a distinct pattern of childhood morbidity. The annual Disability adjusted life years for children under the age of five years in Nairobi study area were approximately 106DALYs/1000 person years (ISLI=223; HDLI=98; MDHI=56 and LDHI=47). This means that children loose approximately 10% of their quality life to diarrhoea with ISLI and HDLI losing 22.3% and 9.8% respectively compared to 5.65 and 4.7% for MDHI and LDHI respectively. The diarrhoea patterns observed emphasized the role of socio-economic, educational, water supply and sanitation factors on diarrhoea morbidity and mortality in the Nairobi study area. Some of the most important factors that contributed to diarrhoea morbidity were parental education (p=0.013), household water consumption rates (p<0.001), household income (p=0.008), and access to sanitation facilities (p<0.001). The optimal WASH and SES conditions in this study were for MDHI. There is need therefore to improve children’s living conditions to match the MDHI residential environs for children’s diarrhoea and health outcomes to be significantly reduced. To this end, multi-stakeholder involvement and strengthening of the institutional mechanisms responsible for providing water and sanitation will be key to providing improved access to water and sanitation in the city of Nairobi especially in the ISLI and HDLI residential areas of Nairobi. This should be enhanced by legislating mandatory construction of improved ventilated pit latrines, focusing on improving sanitation aspect of water distribution points, and provide health promotion on the significance of household hygiene among others
Determinants of Postnatal Care Use in Kenya
No full textPregnancy related complications may result in maternal deaths post delivery especially in developing countries. Skilled deliveries and postnatal care (PNC) use in Kenya is low. The objective of this study was to identify the determinants of PNC use. Kenya Demographic and Health Survey (2008-09 KDHS) women’s data were analyzed. Overall data from 3,970 women were analyzed. Results indicate that 47 percent of the women received PNC services. Factors associated with PNC use are mothers’ age at delivery of the last child, 4+ ANC visits, urban residence, and skilled delivery. However, lack of education and unskilled delivery were associated with low use of PNC services (p <0.05). In conclusion, the use of PNC services is low at 47 percent although the main determinants for PNC use are amenable to intervention. Strengthening of maternal health services throughout the continuum of care and promoting the use of high quality services by pregnant women is recommended
SCHOOL HYGIENE PROMOTION APPROACHES AND THEIR INFLUENCE ON PUPIL\u27S HYGIENE PRACTICES IN PUBLIC PRIMARY SCHOOLS IN DAGORETTI, NAIROBI CITY COUNTY, KENYA
No full textPurpose: The purpose of this study was to examine hygiene promotion approaches that were being employed by public primary schools in Dagoretti North and South Sub Counties in Nairobi City County and whether the approaches influenced hygiene behaviors that were practiced by pupils.
Methodology: The study applied a descriptive cross-sectional design. Questionnaires were administered to 384 pupils with the aim of collecting data on hygiene knowledge and practices. A questionnaire was also used to collect data on hygiene promotion approaches from 32 school health teachers. Pupils\u27 demographic data was collected from school head teachers. Five key informant interviews were conducted with Nairobi City County public health and education officers and a staff from a non-governmental organization that was implementing school hygiene activities in Dagoretti South and North Sub Counties. Observation checklists were used to triangulate information on hygiene practices by pupils. Analysis was done using SPSS software.
Findings: Results indicate that 95.6% of the pupils practiced hand washing at critical times, 98.7% used the toilet while 85.4% safely disposed solid waste. The study reveals that water, sanitation and hygiene in schools approach is implemented by 31.3% of the school health teachers. There was a significant relationship between school health clubs approach and hand washing at critical times (p=0.04) and proper solid waste disposal (p=0.02). One way analysis of variance established that there is a significant difference among hygiene promotion approaches and pupils hygiene knowledge, F(5, 162) = 6.41, p <.05 Æž²p = 0.076.
Unique contribution to theory, practice and policy: The study establishes that different hygiene promotion approaches have the potential to influence hygiene practices and in particular, hand washing at critical times and proper solid waste disposal amongst pupils. The study recommends the use of school health clubs approach for hygiene promotion at public primary school
Individual Attributes Influencing Cervical Cancer Screening Services in Selected Health Facilities in Machakos County
No full textJournal ArticleIn Kenya, 51.2% of estimated women population of 11 million aged 15 years and older are at risk of developing
cervical cancer. Research shows that screening a woman even once between the ages of 35 and 40 years reduces her lifetime
risk of cervical cancer by 25–36%. However, the effective cervical cancer screening in developing countries is as low as
18.5%. Low levels of utilization of Cervical Cancer Screening Services (CCSS) among health care workers have been
documented. This study sought to determine the utilization of cervical cancer screening services by healthcare workers
(HCWs) in selected health facilities in Machakos County. It was also thought imperative to determine individual HCW
attributes influencing utilization of cervical cancer screening services in selected health care facilities in the county. The study
adopted a descriptive cross-sectional study design involving 271 female health workers drawn from all the level 4 and level 5
facilities within the county. Respondents were stratified according to level of facility and according to their cadres. Data was
collected via self-administered questionnaires and a facility assessment tool. Data analysis used SPSS version 21. Association
was subjected to binary logistic regression. Only 25% of HCWs had utilized cervical cancer screening services. HCWs who
had certificate (OR = 0.05, p-value < 0.01), diploma (OR = 0.04, p-value < 0.01) and degrees (OR = 0.09, p-value = 0.01) were
less likely to utilize CCSS as compared to HWCs who had attained graduate studies or higher. Also health workers aged 30
years and below (OR = 0.12, p-value = 0.01) and those aged between 31 and 40 years (OR = 0.30, p-value = 0.05) were less
likely to utilize CCSS as compared to healthcare workers who were aged more than 50 years. The study recommends
establishment of tailor-made sensitization programs on young female health care worker aimed at increasing their uptake of
CCSS services among these group
Effect of Phone Text Message Reminders on Compliance with Rabies Post-Exposure Prophylaxis following Dog Bites in Rural Kenya
No full textThe prompt administration of post-exposure prophylaxis (PEP) is one of the key strategies for ending human deaths from rabies. A delay in seeking the first dose of rabies PEP, or failure to complete the recommended dosage, may result in clinical rabies and death. We assessed the efficacy of short message system (SMS) phone texts in improving the adherence to scheduled PEP doses among bite patients in rural eastern Kenya. We conducted a single-arm, before-after field trial that compared adherence among bite patients presenting at Makueni Referral Hospital between October and December 2018 (control) and between January and March 2019 (intervention). Data on their demographics, socio-economic status, circumstances surrounding the bite, and expenditures related to the bite were collected. A total of 186 bite patients were enrolled, with 82 (44%) in the intervention group, and 104 (56%) in the control group. The odds of PEP completion were three times (OR 3.37, 95% CI 1.28, 10.20) more likely among patients who received the SMS reminder, compared to the control. The intervention group had better compliance on the scheduled doses 2 to 5, with a mean deviation of 0.18 days compared to 0.79 days for the control group (p = 0.004). The main reasons for non-compliance included lack of funds (30%), and forgetfulness (23%) on days for follow-up treatment, among others. Nearly all (96%, n = 179) the bite patients incurred indirect transport costs, at an average of USD 4 (USD 0–45) per visit. This study suggests that the integration of SMS reminders into healthcare service delivery increases compliance with PEP, and may strengthen rabies control and elimination strategies
Understanding national trends in COVID‐19 vaccine hesitancy in Canada – April 2020 to March 2021
No full textObjective: Key to reducing COVID‐19 morbidity and mortality and reducing the need for further lockdown measures in Canada and worldwide is widespread acceptance of COVID‐19 vaccines. Vaccine hesitancy has emerged as a key barrier to achieving optimal vaccination rates, for which there is little data among Canadians. This study examined rates of vaccine hesitancy and their correlates among Canadian adults. Methods: This study analyzed data from five age, sex and province‐weighted population‐based samples to describe rates of hesitancy between April 2020 and March 2021 among Canadians who completed online surveys as part of the iCARE Study, and various sociodemographic, clinical and psychological correlates. Vaccine hesitancy was assessed by asking: “If a vaccine for COVID‐19 were available today, what is the likelihood that you would get vaccinated?” Responses were dichotomized into ‘very likely’, ‘unlikely’, ‘somewhat unlikely’ (reflecting some degree of vaccine hesitancy) vs ‘extremely likely’ to get the vaccine, which was the comparator. Results: Overall, 15,019 respondents participated in the study. A total of 42.2% of respondents reported vaccine hesitancy over the course of the study, which was lowest during surveys 1 (April 2020) and 5 (March 2021) and highest during survey 3 (November 2020). Fully adjusted multivariate logistic regression analyses revealed that women, those aged 50 and younger, non‐Whites, those with high school education or less, and those with annual household incomes below the poverty line in Canada (i.e., $60,000) were significantly more likely to report being vaccine hesitant over the study period, as were essential and healthcare workers, parents of children under the age of 18, and those who do not get regular flu vaccines. Believing engaging in infection prevention behaviours (like vaccination) is important for reducing virus transmission and high COVID‐19 health concerns (being infected and infecting others) were associated with 77% and 54% reduction in vaccine hesitancy, respectively, and having high personal financial concerns (worried about job or income loss) was associated with 1.33 times increased odds of vaccine hesitancy. Conclusion: Results point to the importance of targeting vaccine efforts to women, younger people and socioeconomically disadvantaged groups, and that vaccine messaging should emphasize the benefits of getting vaccinated, and how the benefits (particularly to health) far outweigh the risks. Future research is needed to monitor ongoing changes in vaccine intentions and behaviour, as well as to better understand motivators and facilitators of vaccine acceptance, particularly among vulnerable groups. The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license
Attitudes towards vaccines and intention to vaccinate against COVID-19: a cross-sectional analysis - implications for public health communications in Australia
No full textObjective To examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study. Design and setting Cross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021. Participants Total of 1166 Australians from general population aged 18-90 years (mean 52, SD of 19). Main outcome measures Primary outcome: responses to question € If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?'. Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions. Results Seventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine. Conclusions Most Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor's recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates
How well do covariates perform when adjusting for sampling bias in online COVID-19 research? Insights from multiverse analyses
No full textCOVID-19 research has relied heavily on convenience-based samples, which-though often necessary-are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common statistical adjustments for demographic covariates successfully attenuate such bias. This registered study analysed responses to identical questions from three convenience and three largely representative samples (total N = 13,731) collected online in Canada within the International COVID-19 Awareness and Responses Evaluation Study (www.icarestudy.com). We compared samples on 11 behavioural and psychological outcomes (e.g., adherence to COVID-19 prevention measures, vaccine intentions) across three time points and employed multiverse-style analyses to examine how 512 combinations of demographic covariates (e.g., sex, age, education, income, ethnicity) impacted sampling discrepancies on these outcomes. Significant discrepancies emerged between samples on 73% of outcomes. Participants in the convenience samples held more positive thoughts towards and engaged in more COVID-19 prevention behaviours. Covariates attenuated sampling differences in only 55% of cases and increased differences in 45%. No covariate performed reliably well. Our results suggest that online convenience samples may display more positive dispositions towards COVID-19 prevention behaviours being studied than would samples drawn using more representative means. Adjusting results for demographic covariates frequently increased rather than decreased bias, suggesting that researchers should be cautious when interpreting adjusted findings. Using multiverse-style analyses as extended sensitivity analyses is recommended
