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Glennah Kerubo, Evans Amukoye, Stefan Niemann, Samuel Kariuki
BACKGROUND: Anti-tuberculosis drug resistance is an emerging health problem in Kenya and especially in slums. Slum environments create a conducive environment for the spread of tuberculosis (TB) due to high population density and lack of basic amenities such as decent housing, access to clean water, lack of drainage and basic sanitation. Furthermore, ineffective health services in crowded and poorer populations, poor patient compliance, a large pool of untreated cases, delayed diagnosis and inappropriate treatment regimens are likely to favour selection and spread of drug resistant Mycobacterium tuberculosis (Mtb) strains in such settings, however, precise data on this problem are only sparsely available...
October 19, 2016: BMC Infectious Diseases
T Tony Trinh, Nelly Yatich, Richard Ngomoa, Christine J McGrath, Barbra A Richardson, Samah R Sakr, Agnes Langat, Grace C John-Stewart, Michael H Chung
BACKGROUND: Disclosure of HIV serostatus can have significant benefits for people living with HIV/AIDS. However, there is limited data on whether partner disclosure influences ART treatment response. METHODS: We conducted a retrospective cohort study of newly diagnosed, ART-naïve HIV-infected adults (>18 years) who enrolled at the Coptic Hope Center in Nairobi, Kenya between January 1st 2009 and July 1st 2011 and initiated ART within 3 months. Analysis was restricted to adults who reported to have either disclosed or not disclosed their HIV status to their partner...
2016: PloS One
D E Pelster, B Gisore, J Goopy, D Korir, J K Koske, M C Rufino, K Butterbach-Bahl
Greenhouse gas (GHG) emission measurements from livestock excreta in Africa are limited. We measured CH and NO emissions from excreta of six Boran () and six Friesian () steers near Nairobi, Kenya. The steers were fed one of three diets (T1 [chaffed wheat straw], T2 [T1 + Meissner - 0.2% live weight per day], and T3 [T1 + calliandra - 0.4% live weight every 2 d]). The T1 diet is similar in quality to typical diets in the region. Calliandra is a leguminous fodder tree promoted as a feed supplement. Fresh feces and urine were applied to grasslands and emissions measured using static chambers...
September 2016: Journal of Environmental Quality
K J Karimi, R Ayah, T Olewe
INTRODUCTION: Despite extensive knowledge about effective tobacco control interventions, the prevalence of tobacco use in many middle- and low-income countries continues to rise. In these countries, public appreciation of levels of protection provided by laws and regulations on tobacco use and exposure to tobacco smoke is limited. After ratification of the Framework Convention on Tobacco Control, Kenya enacted the Tobacco Control Act, 2007, banning smoking in public places except in designated smoking areas...
2016: BMJ Open
Jessica Cohen, Ginger Golub, Margaret E Kruk, Margaret McConnell
Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these "active" patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the "slums" of) Nairobi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received...
September 22, 2016: Preventive Medicine
Anjuli D Wagner, Cyrus M Wachira, Irene N Njuguna, Elizabeth Maleche-Obimbo, Kenneth Sherr, Irene W Inwani, James P Hughes, Dalton C Wamalwa, Grace C John-Stewart, Jennifer A Slyker
OBJECTIVES: Few routine systems exist to test older, asymptomatic children for HIV. Testing all children in the population has high uptake but is inefficient, while testing only symptomatic children increases efficiency but misses opportunities to optimize outcomes. Testing children of HIV-infected adults in care may efficiently identify previously undiagnosed HIV-infected children before symptomatic disease. METHODS: HIV-infected parents in HIV care in Nairobi, Kenya were systematically asked about their children's HIV status and testing history...
September 19, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Geoffrey Omuse, Kristien Nel Van Zyl, Kim Hoek, Shima Abdulgader, Samuel Kariuki, Andrew Whitelaw, Gunturu Revathi
BACKGROUND: Staphylococcus aureus (S. aureus) has established itself over the years as a major cause of morbidity and mortality both within the community and in healthcare settings. Methicillin resistant S. aureus (MRSA) in particular has been a major cause of nosocomial infections resulting in significant increase in healthcare costs. In Africa, the MRSA prevalence has been shown to vary across different countries. In order to better understand the epidemiology of MRSA in a setting, it is important to define its population structure using molecular tools as different clones have been found to predominate in certain geographical locations...
2016: Annals of Clinical Microbiology and Antimicrobials
Sophie M Goudet, Elizabeth W Kimani-Murage, Frederick Wekesah, Milka Wanjohi, Paula L Griffiths, Barry Bogin, Nyovani J Madise
OBJECTIVE: Children in slums are at high risk of undernutrition, which has long-term negative consequences on their physical growth and cognitive development. Severe undernutrition can lead to the child's death. The present paper aimed to understand the causes of undernutrition in children as perceived by various groups of community members in Nairobi slums, Kenya. DESIGN: Analysis of ten focus group discussions and ten individual interviews with key informants...
September 20, 2016: Public Health Nutrition
Jason Zingsheim, Dustin Bradley Goltz, Alexandra G Murphy, Teresa Mastin
This article examines the discursive construction of female same-sex sexual identities in Nairobi. We identify the discursive forces of "choice," devaluation, and invisibility as influential within Kenyan media representations of lesbian, gay, bisexual, transgender, and intersex citizens. Using creative focus groups and participant observation, we demonstrate how same-sex attracted women in Nairobi resist and rearticulate these discursive forces to assert their identity and agency as individuals and as a queer community...
September 16, 2016: Journal of Lesbian Studies
Kristjana H Ásbjörnsdóttir, James P Hughes, Dalton Wamalwa, Agnes Langat, Jennifer A Slyker, Hellen Moraa Okinyi, Julie Overbaugh, Sarah Benki-Nugent, Kenneth Tapia, Elizabeth Maleche-Obimbo, Ali Rowhani-Rahbar, Grace John-Stewart
BACKGROUND: Virologic and immunologic responses to antiretroviral treatment (ART) in infants may differ from older children due to immunologic, clinical or epidemiologic characteristics. METHODS: Longitudinal ART responses were modeled and compared in HIV-infected infants and children enrolled in cohorts in Nairobi, Kenya. Participants were enrolled soon after HIV diagnosis, started on ART, and followed for two years. Viral load decline was compared between infant and child cohorts using a nonlinear mixed effects model and CD4% reconstitution using a linear mixed effects model...
September 6, 2016: AIDS
Charles Njuguna, Ian Njeru, Elizabeth Mgamb, Daniel Langat, Anselimo Makokha, Dismas Ongore, Evan Mathenge, Samuel Kariuki
BACKGROUND: Shigellosis is the major cause of bloody diarrhoea worldwide and is endemic in most developing countries. In Kenya, bloody diarrhoea is reported weekly as part of priority diseases under Integrated Disease Surveillance and Response System (IDSR) in the Ministry of Health. METHODS: We conducted a case control study with 805 participants (284 cases and 521 controls) between January and December 2012 in Kilifi and Nairobi Counties. Kilifi County is largely a rural population whereas Nairobi County is largely urban...
2016: BMC Infectious Diseases
Badeia Jawhari, Louanne Keenan, David Zakus, Dave Ludwick, Abraam Isaac, Abdullah Saleh, Robert Hayward
OBJECTIVE: Rapid urbanization has led to the growth of urban slums and increased healthcare burdens for vulnerable populations. Electronic Medical Records (EMRs) have the potential to improve continuity of care for slum residents, but their implementation is complicated by technical and non-technical limitations. This study sought practical insights about facilitators and barriers to EMR implementation in urban slum environments. METHOD: Descriptive qualitative method was used to explore staff perceptions about a recent open-source EMR deployment in two primary care clinics in Kibera, Nairobi...
October 2016: International Journal of Medical Informatics
Julie A Tippens
The global increase in refugee migration to urban areas creates challenges pertaining to the promotion of refugee health, broadly conceived. Despite considerable attention to trauma and forced migration, there is relatively little focus on how refugees cope with stressful situations, and on the determinants that facilitate and undermine resilience. This article examines how urban Congolese refugees in Kenya promote psychosocial well-being in the context of structural vulnerability. This article is based on interviews (N = 55) and ethnographic participant observation with Congolese refugees over a period of 8 months in Nairobi in 2014...
August 25, 2016: Qualitative Health Research
Michael Baiocchi, Benjamin Omondi, Nickson Langat, Derek B Boothroyd, Jake Sinclair, Lee Pavia, Munyae Mulinge, Oscar Githua, Neville H Golden, Clea Sarnquist
DESIGN: The study's design was a cluster-randomized, matched-pairs, parallel trial of a behavior-based sexual assault prevention intervention in the informal settlements. METHODS: The participants were primary school girls aged 10-16. Classroom-based interventions for girls and boys were delivered by instructors from the same settlements, at the same time, over six 2-h sessions. The girls' program had components of empowerment, gender relations, and self-defense...
August 25, 2016: Prevention Science: the Official Journal of the Society for Prevention Research
Michael Muthamia, Kenneth Owino, Paul Nyachae, Margaret Kilonzo, Mercy Kamau, Jane Otai, Mark Kabue, Nelson Keyonzo
BACKGROUND: Long-acting reversible contraceptives (LARCs) are safe and highly effective, and they have higher continuation rates than short-acting methods. Because only a small percentage of sexually active women in Kenya use LARCs, the Tupange project implemented a multifaceted approach to increase uptake of LARCs, particularly among the urban poor. The project included on-site mentoring, whole-site orientation, commodity security, quality improvement, and multiple demand-promotion and service-provision strategies, in the context of wide method choice...
August 11, 2016: Global Health, Science and Practice
Victor Makanjuola, Yomi Esan, Bibilola Oladeji, Lola Kola, John Appiah-Poku, Benjamin Harris, Caleb Othieno, Leshawndra Price, Soraya Seedat, Oye Gureje
BACKGROUND: Most cultures in sub-Saharan Africa subscribe to the belief that the root cause of psychosis is supernatural. Individuals in the community who hold a religiomagical explanatory model of causation have been shown to exhibit more stigmatizing attitudes towards people with psychosis. Self-stigma among individuals with psychosis is less frequently studied. METHOD: We used a mixed-method approach, consisting of key informant's interviews to elicit information on explanatory models of causation of psychosis and questionnaire assessment of internalized stigma with an adapted version of the Scale for Internalized Stigma of Mental Illness...
August 4, 2016: Social Psychiatry and Psychiatric Epidemiology
Clea Sarnquist, Jake Sinclair, Benjamin Omondi Mboya, Nickson Langat, Lee Paiva, Bonnie Halpern-Felsher, Neville H Golden, Yvonne A Maldonado, Michael T Baiocchi
Purpose To evaluate the effect of behavioral, empowerment-focused interventions on the incidence of pregnancy-related school dropout among girls in Nairobi's informal settlements. Method Retrospective data on pregnancy-related school dropout from two cohorts were analyzed using a matched-pairs quasi-experimental design. The primary outcome was the change in the number of school dropouts due to pregnancy from 1 year before to 1 year after the interventions. Results Annual incidence of school dropout due to pregnancy decreased by 46% in the intervention schools (from 3...
July 10, 2016: Health Education & Behavior: the Official Publication of the Society for Public Health Education
David A S Smith, Ian J Gordon, Walther Traut, Jeremy Herren, Steve Collins, Dino J Martins, Kennedy Saitoti, Piera Ireri, Richard Ffrench-Constant
Sexually antagonistic selection can drive both the evolution of sex chromosomes and speciation itself. The tropical butterfly the African Queen, Danaus chrysippus, shows two such sexually antagonistic phenotypes, the first being sex-linked colour pattern, the second, susceptibility to a male-killing, maternally inherited mollicute, Spiroplasma ixodeti, which causes approximately 100% mortality in male eggs and first instar larvae. Importantly, this mortality is not affected by the infection status of the male parent and the horizontal transmission of Spiroplasma is unknown...
July 27, 2016: Proceedings. Biological Sciences
Martin Kavao Mutua, Elizabeth Kimani-Murage, Nicholas Ngomi, Henrik Ravn, Peter Mwaniki, Elizabeth Echoka
BACKGROUND: More efforts have been put in place to increase full immunization coverage rates in the last decade. Little is known about the levels and consequences of delaying or vaccinating children in different schedules. Vaccine effectiveness depends on the timing of its administration, and it is not optimal if given early, delayed or not given as recommended. Evidence of non-specific effects of vaccines is well documented and could be linked to timing and sequencing of immunization...
2016: Tropical Medicine and Health
Samuel Oji Oti, Steven van de Vijver, Gabriela B Gomez, Charles Agyemang, Thaddaeus Egondi, Catherine Kyobutungi, Karien Stronks
OBJECTIVE: To describe the processes, outcomes and costs of implementing a multi-component, community-based intervention for hypertension among adults aged > 35 years in a large slum in Nairobi, Kenya. METHODS: The intervention in 2012-2013 was based on four components: awareness-raising; improved access to screening; standardized clinical management of hypertension; and long-term retention in care. Using multiple sources of data, including administrative records and surveys, we described the inputs and outputs of each intervention activity and estimated the outcomes of each component and the impact of the intervention...
July 1, 2016: Bulletin of the World Health Organization
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