Factors Associated With Uptake of Skilled Attendants’ Services During Child Delivery In Garissa Town, Kenya

Objective: To identify the factors that are associated with uptake of skilled delivery services during child delivery among women of reproductive age in Garissa town.Design: Cross sectional study.Setting: Garissa townSubject: Three hundred and thirty four women aged 15-49 years who had had at least one delivery in their lifetime were asked about the type of delivery services they had during their last child delivery.Results: The study found that 47% of the last deliveries women were attended by skilled persons and the rest of the deliveries were provided by TBAs. The predictors of skilled delivery uptake in this study were found to be; having knowledge on skilled delivery service providers (AOR = 17.2; 95% CI: 1.05 – 281.12; p = 0.046), child deliveries numbering one to three (AOR = 116.95; 95% CI: 26.68 – 512.64; p = 0.001) and four to six (AOR = 16.75; 95% CI: 4.44 – 62.87; p = 0.001), presence of previous delivery complication (AOR = 11.71; 95% CI: 3.96 – 34.60; p = 0.001), disapproval of TBA services (AOR = 27.19; 95% CI: 6.67 – 110.76; p = 0.001), lack of preference for gender of skilled delivery service provider (AOR = 6.51; 95% CI: 1.08 – 39.37; p = 0.041), and positive view on service related factors such as time to nearest facility (AOR = 3.91; 95% CI: 1.24 – 12.34; p = 0.020), hygiene (AOR = 5.03; 95% CI: 1.49 – 17.05; p = 0.009) and operation time of health facility (AOR = 4.67; 95% CI: 1.59 – 13.76; p = 0.005).Conclussion: The findings show that cultural and maternal factors as well as quality of services at facility level play major role in determining uptake of skilled services among women in Garissa as compared to social  demographic and economic factors

Prevalence and intensity of intestinal parasitic infections and factors associated with transmission among school going children

Objective: To determine the prevalence and intensity of intestinal parasitic infections and factors associated with transmission among primary school going children.Design: Cross-sectional descriptive study.Setting: Muthithi Location situated in Murang’a County, Kenya.Subjects: Multi-stage sampling was used to select 418 children. Stool specimens were examined using Kato-katz technique to determine the number of helminthes eggs per gram of stool and formol ether concentration technique to detect the different protozoan cysts. Data were analysed using Statistical Package format (SPSS version 20.0). Pearson’s Chi-square test was used to establish the association between categorical variables. Multivariate analysis was used to determine the factors associated with the infections.Results: The study established that 53.8% (225 out of 418) were infected with one or more of intestinal parasite. Five species of helminthes were identifiedwith prevalence of 11.5%; the predominant helminth parasite identified was Ascaris lumbricoides 9.1% (38 cases). Intestinal protozoan identified in this population was Entamoeba histolytica with prevalence of 42.3% (177 cases). The factors established to be independently associated with presence of intestinal parasitic infection were: age 11-15 years P<0.001, use of plain water for hand washing P<0.05, eating food without spoon P<0.05, consuming raw vegetables P<0.001, untrimmed finger nails P<0.001 and source of drinking water [river P<0.001 and mixed sources (river, well and tap) P<0.05].Conclusion: This study revealed that intestinal parasites still pose a public health problem to school going children. Despite lack of school based deworming programme in this area, treatment combined with health education and other interventions in school age children is recommended as a way of controlling transmission

Reverse Transcriptase Inhibitors Drug Resistance Mutations in Drug-Naive HIV Type 1 Positive Kenyan Individuals

Objective: To evaluate the extent of HIV-1 drug resistance among drug naïve Kenyan individuals.Design: Cross-sectional study.Setting: Kenya Medical Research Institute HIV laboratory Nairobi, Kenya.Subjects: A total of seventy eight HIV-1 positive drug naïve subjects randomised from five Kenyan provincial hospitals between April and June 2004.Results: A major non-nucleoside reverse transcriptase (NNRTI) an associated mutation was found in one patient (1.3%). NNRTI associated resistance mutations were present at amino acid codon sites G98A (2.56%); K103E (1.3%) and L100F (3.57%) prevalences. Baseline resistance may compromise the response to standard NNRTI-based first-line ART in 1.3 % of the study subjects.Conclusion: This indicates in general, that drug resistance among HIV-1 positive drug naïve individual is at low thresholds (1.3%) but the problem could be more serious than reported here. Continuous resistance monitoring is therefore warranted to maintain individual and population-level ART effectiveness

New indirect immunofluorescence assay as a confirmatory test for human immunodeficiency virus type 1

Background: Screening of blood and blood products for human immunodeficiency virus (HIV) is routinely performed using the enzyme-linked immunosorbent assay (ELISA), and the results confirmed by Western blot (WB). However, western blot is expensive and mostly performed in developed countries. A technique more superior or comparable to WB and adaptable to developing countries must be sought. In an effort to identify such a technique, this study determined the efficiency of indirect immunofluorescence assay (IFA) to detect antibodies to HIV-1. Objective: To determine the accuracy and sensitivity of an in-house immunofluorescence assay (IFA) to detect antibodies to HIV-1 in plasma. Design: A comparative study to evaluate the performance of indirect immunofluorescence assay (IFA) and western blot (WB) techniques in the detection of antibodies to HIV-1. Setting: Kenya Medical Research Institute, Centre for Virus Research. The study was conducted between June and December 2001. Methods: The evaluation of IFA as a technique for detecting antibodies to HIV-1 utilized a total of 400 samples. For these samples, IFA was compared with ELISA and particle agglutination (PA) (manuscript under preparation). Of the 400 samples, there were discrepant results in the three assays in only 36 samples. IFA was compared with Western blot (WB) to confirm the true HIV-1 serostatus in these 36 plasma specimens. The IFA technique used acetone-fixed HIV-1 infected MOLT-4 cells in one spot on a Teflon coated slide and uninfected MOLT-4 cells alone in a second spot to asses non-specific fluorescence. Western blot was performed according to the instructions of the manufacturer. Results: The sensitivity and specificity of IFA based on 36 plasma specimens tested was 71.4% and 100% respectively. All samples that were HIV seronegative by WB were also HIV seronegative by IFA. However, two (5.6%) samples were HIV seronegative by IFA but seropositive by WB. Conclusion: The data obtained show that IFA can be used as a primary confirmatory test in Kenya. East African Medical Journal Vol. 81 No. 5 May 2004: 222-22