1
|
Angwa LM, Ouma C, Okoth P, Nyamai R, Kamau NG, Mutai K, Onono MA. Acceptability, adherence, and clinical outcomes, of amoxicillin dispersible tablets versus oral suspension in treatment of children aged 2-59 Months with pneumonia, Kenya: A cluster randomized controlled trial. Heliyon 2020; 6:e03786. [PMID: 32322742 PMCID: PMC7160563 DOI: 10.1016/j.heliyon.2020.e03786] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 01/13/2023] Open
Abstract
Amoxicillin dispersible tablet (DT) is now recommended by the WHO as a first-line drug for the treatment of pneumonia in children below 5 years. The study aim was to compare acceptability, adherence and clinical outcome of amoxicillin DT and amoxicillin oral suspension (OS) in the treatment of children aged 2–59 months with pneumonia in Kenya. We conducted a two-arm cluster randomized controlled trial and utilized quantitative methods. The community unit was the unit of randomization. Children aged 2–59 months with pneumonia were enrolled and treated with either amoxicillin DT or OS. Acceptability was defined as the perception of taste of medication as the same or better compared to other medicines and expression of willingness of caregivers to use DT/OS in future, adherence was measured based on the dose, frequency, and duration of treatment, and clinical outcome as complete resolution of symptoms without change of antibiotic treatment. Equivalence was defined as a difference of ≤8% between study arms. We found high levels of acceptability among both DT (93.9%) and OS (96.1%) arms (difference 2.3%, 90% CI -2.6-7.3). The objective measure of adherence on day four and the overall objective measure were significantly higher among children on DT compared to children on OS (88.7% vs. 41.5% (difference 47.2%, 90% CI 31.0–63.3) & 83.5% vs. 39% (difference 44.5%, 90% CI 27.9–60.9), respectively). Cure rates were high in both arms (DT (99.5%), OS (98.1%), difference 1.4%, 90% CI -0.2-3.2). There is reported better adherence to Amoxicillin DT compared to OS and equivalence in acceptability and clinical outcomes.
Collapse
Affiliation(s)
- Linet M Angwa
- Department of Clinical Medicine, Kabarak University, Kenya
| | - Collins Ouma
- Department of Biomedical Sciences and Technology, Maseno University, Kenya
| | | | | | - Nyawira G Kamau
- Institute of Tropical Medicine, Jomo Kenyatta University, Kenya
| | | | | |
Collapse
|
2
|
Barbara B, Joseph O, Mevis O, Mutai K. Assessing the Feasibility of Adapting a School-Based HIV Prevention Intervention to Include Voluntary Male Medical Circumcision and Vaccination for Human Papilloma Virus Prevention. East Afr Health Res J 2020; 4:108-112. [PMID: 34308227 PMCID: PMC8279225 DOI: 10.24248/eahrj.v4i1.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 05/20/2020] [Indexed: 12/05/2022] Open
Abstract
In 2012, there were 2,454 cases and 1,676 deaths from cervical cancer in Kenya. Human Papilloma Virus (HPV) is responsible for 99% of all cervical cancers. National cervical cancer prevention guidelines recommend HPV vaccination among HPV-naïve pre-adolescent girls' prior to onset of sexual activity preferably through school-based interventions. Similarly, Voluntary Male Medical Circumcision (VMMC) programs also reduce sexually transmitted infections like HIV, and ideally should also be conducted prior to the onset of sexual activity. The Families Matter! Program (FMP) is a school-based evidence-based HIV prevention intervention for parents and guardians of pre-adolescents aimed to enhance protective parenting practices in order to reduced sexual risk-taking among adolescents. In this paper we describe how we will recruit a cohort of 55 parent-child dyads in a primary school in Kisumu County then implement and evaluate an adapted FMP program that incorporates VMMC promotion and HPV vaccination in conjunction. It is anticipated that the intervention will enhance parental-child communication about sexual matters, promote safe sexual practices and uptake of biomedical prevention interventions and overall reproductive health among the pre-adolescents
Collapse
Affiliation(s)
- Burmen Barbara
- Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Obunga Joseph
- Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Omollo Mevis
- Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Kennedy Mutai
- Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| |
Collapse
|
3
|
Burmen B, Mutai K, Malika T. Isoniazid Preventative Therapy uptake for child household contacts of tuberculosis index cases, Kisumu County, Kenya, 2014-2015. J Public Health Afr 2019; 10:827. [PMID: 31285812 PMCID: PMC6589639 DOI: 10.4081/jphia.2019.827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 02/19/2018] [Indexed: 11/22/2022] Open
Abstract
Isoniazid Preventative Therapy (IPT) is recommended for children aged less than 5 years that have been in contact with an open case of TB, and screen negative for TB, to prevent the risk of TB progression. We examined IPT uptake among child household contacts of TB index cases, within a TB case detection study, in a high TB burden region. A cross-sectional study involving all IPT-eligible children drawn from a TB case detection study was done in Kisumu County, Kenya between 2014 and 2015. By linking a subset of the study database to the TB program IPT register, we described Child contacts as initiated on IPT and TB index cases as having child contacts initiated on IPT based on whether their names or their child contacts names respectively, were found in the IPT register. Logistic regression analysis was used to describe index and contact characteristics associated with IPT initiation. Of 555 TB index cases recruited into the study, 243 (44%) had a total of 337 IPT-eligible child contacts. Forty-seven (19%) index cases that had child contacts initiated on IPT; they were more likely to have been diagnosed with smear positive TB compared to those who were diagnosed with smear negative TB (OR 5.1, 95%CI 1.1-23.2; P=0.03) and to reside in rural Kisumu compared to those in urban Kisumu (OR 3.3, 95% CI 1.6-6.8; P<0.01). The 51 (15%) child contacts that were initiated on IPT were more likely to be were first degree relatives of the index case compared to those who were not (OR 2.6, 95% CI 1.2-5.5; P=0.02) and to reside in rural Kisumu compared to those in urban Kisumu (OR 2.6, 95% CI 1.2-5.1; P<0.01). IPT initiation, which is influenced by index and contact characteristics, is suboptimal. The TB program should provide health worker training, avail appropriate pediatric TB diagnostic tools, job aids and monitoring tools, and ensure continuous supply of medication, and to facilitate IPT implementation. Additionally, targeted health education interventions should be formulated to reach those who are unlikely to accept IPT.
Collapse
Affiliation(s)
- Barbara Burmen
- Kenya Medical Research Institute/Center for Global Health Research, Kisumu
- Maseno University, Maseno
| | - Kennedy Mutai
- Kenya Medical Research Institute/Center for Global Health Research, Kisumu
| | - Timothy Malika
- National Tuberculosis, Leprosy and Lung Diseases Program, Kisumu County, Kenya
| |
Collapse
|
4
|
Onono M, Abdi M, Mutai K, Asadhi E, Nyamai R, Okoth P, Qazi SA. Community case management of lower chest indrawing pneumonia with oral amoxicillin in children in Kenya. Acta Paediatr 2018; 107 Suppl 471:44-52. [PMID: 30570795 DOI: 10.1111/apa.14405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/30/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022]
Abstract
AIM To determine the accuracy and effectiveness of community health workers (CHWs) when compared to trained nurses for management of pneumonia in Kenyan children. METHODS In Homabay County in western Kenya, children 2-59 months of age with lower chest indrawing pneumonia were identified, classified and treated by CHWs with oral amoxicillin (90 mg/kg per day) for five days at home. Trained nurses visited the child within 24 hours to verify diagnosis; and on day 4 and 14 to assess treatment outcomes. RESULTS CHWs identified 1906 children with lower chest indrawing pneumonia. There was an 88.7% concordance in classification and treatment for lower chest indrawing pneumonia by CHWs compared to nurses. Children with moderate malnutrition (OR 1.68; 95% CI: 1.22-2.30), comorbidities such as diarrhoea or malaria (OR 1.55; 95% CI: 1.32-1.81) or an additional day of delay in care seeking (OR 1.06; 95% CI: 1.02-1.10) were more likely to have an incorrect classification of lower chest indrawing by the CHW. Comorbidity (OR 1.66; 95% CI: 1.12-2.48) and fast breathing (OR 4.66; 95% CI: 1.26-17.27) were significantly associated with treatment failure on day 14. CONCLUSION CHWs can correctly manage lower chest indrawing pneumonia even in high-mortality settings, such as western Kenya, in sub-Saharan Africa.
Collapse
Affiliation(s)
| | | | | | | | - Rachel Nyamai
- Maternal, Newborn, Child and Adolescent Health Unit; Ministry of Health Kenya; Nairobi Kenya
| | | | - Shamim Ahmad Qazi
- Department of Maternal, Newborn, Child and Adolescent Health; World Health Organization; Geneva Switzerland
| |
Collapse
|
5
|
Burmen B, Mutai K, Malika T. Isoniazid preventative therapy uptake for child household contacts of TB index cases, Kisumu County, Kenya, 2014-2015. J Public Health Afr 2018. [DOI: 10.4081/jphia.2018.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Isoniazid Preventative Therapy (IPT) is recommended for children aged less than 5 years that have been in contact with an open case of TB and screen negative for TB to prevent the risk of TB progression. We examined IPT uptake among child household contacts of TB index cases within a TB case detection study in a high TB burden region. Methods A cross-sectional study involving all IPT eligible children drawn from a TB case detection study was done in Kisumu County, Kenya between 2014 and 2015. By linking a subset study database to the TB program IPT register, we described Child contacts as ‘initiated on IPT’ and TB index cases as ‘having child contacts initiated on IPT’ based on whether their names or their child contacts names respectively, were found in the IPT register. Logistic regression analysis was used to describe index and contact characteristics associated with IPT initiation Results Of 555 TB index cases into the study, 243 (44%) had a total of 337 IPT-eligible child household contacts. Forty-seven (19%) index cases that had child contacts initiated on IPT; they were more likely to have been diagnosed with smear positive TB compared to those who were diagnosed with smear negative TB (OR 5.1, 95% CI 1.1-23.2; p=0.03) and to reside in rural Kisumu compared to those in urban Kisumu (OR 3.3, 05% CI 1.6-6.8; p<0.01). The 51 (15%) child contacts that were initiated on IPT were more likely to be were first degree relatives of the index case compared to those who were not (OR 2.6, 95% CI 1.2-5.5; p=0.02) and to reside in rural Kisumu compared to those in urban Kisumu (OR 2.6, 95% CI 1.2-5.1; p<0.01). Conclusion IPT initiation, which is influenced by index and contact characteristics, is suboptimal. The TB program should provide health worker training, avail appropriate pediatric TB diagnostic tools and continuous supply of medication, and job aids and monitoring tools to facilitate IPT implementation. Additionally, targeted health education interventions should be formulated to reach those who are unlikely to accept IPT.
Collapse
|
6
|
Sokwalla S, Joshi M, Amayo E, Mecha J, Acharya K, Mutai K. Quality of sleep and risk for obstructive sleep apnoea in ambulant individuals with type 2 diabetes mellitus at a tertiary referral hospital in Kenya: a cross-sectional, comparative study. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
7
|
Burmen B, Obunga J, Mutai K. Disclosure status and disclosure intentions among HIV positive persons in rural western Kenya, 2011–2012. Cogent Medicine 2017. [DOI: 10.1080/2331205x.2017.1291096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- B. Burmen
- HIV Implementation Science and Services (HISS), Kenya Medical Research Institute/Centers for Global Health Research, (KEMRI, CGHR), Busia Road, P.O. Box 1578-40100, Kisumu, Kenya
| | - J. Obunga
- HIV Implementation Science and Services (HISS), Kenya Medical Research Institute/Centers for Global Health Research, (KEMRI, CGHR), Busia Road, P.O. Box 1578-40100, Kisumu, Kenya
| | - K. Mutai
- HIV Implementation Science and Services (HISS), Kenya Medical Research Institute/Centers for Global Health Research, (KEMRI, CGHR), Busia Road, P.O. Box 1578-40100, Kisumu, Kenya
| |
Collapse
|
8
|
Mutai K, Gruber BA, Leonard NJ. Synthetic spectroscopic models. Intramolecular stacking interactions between indole and connected nucleic acid bases. Hypochromism and fluorescence. J Am Chem Soc 1975; 97:4095-4104. [PMID: 1159212 DOI: 10.1021/ja00847a038] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
9
|
|