1
|
Mokua SN, Ombogo L, Mathu D, Otambo P, Nyandieka L, Onteri SN, Mbuka SJ, Kariuki J, Ahmed I, Wanjihia V, Mutai J, Bukania Z. "For a man to go to hospital, then that would be his last option": A qualitative study exploring men's experiences, perceptions and healthcare needs in the implementation of Universal Health Coverage in Kenya. PLOS Glob Public Health 2024; 4:e0002925. [PMID: 38713655 DOI: 10.1371/journal.pgph.0002925] [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] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/16/2024] [Indexed: 05/09/2024]
Abstract
The achievement of Universal Health Coverage (UHC) requires equitable access and utilization of healthcare services across all population groups, including men. However, men often face unique barriers that impede their engagement with health systems which are influenced by a myriad of socio-cultural, economic, and systemic factors. Therefore, understanding men's perspectives and experiences is crucial to identifying barriers and facilitators to their healthcare-seeking behaviour under UHC initiatives. This qualitative study sought to explore men's perceptions, experiences, healthcare needs and potential strategies to inform an impartial implementation of Universal Health Coverage (UHC) in Kenya. The study employed a qualitative research design to investigate men's healthcare experiences in 12 counties across Kenya. Thirty focus group discussions involving 296 male participants were conducted. Men were purposively selected and mobilized through the support of health facility-in-charges, public health officers, and community health extension workers. Data was coded according to emergent views and further categorized thematically into three main domains (1) Perspectives and experiences of healthcare access (2) Socio-cultural beliefs and societal expectations (3) Desires and expectations of health systems. Findings revealed complex sociocultural, economic, and health system factors that influenced men's healthcare experiences and needs which included: masculinity norms and gender roles, financial constraints and perceived unaffordability of services, lack of male-friendly and gender-responsive healthcare services, confidentiality concerns, and limited health literacy and awareness about available UHC services. Our study has revealed a disconnect between men's needs and the current healthcare system. The expectations concerning masculinity further exacerbate the problem and exclude men further hindering men's ability to receive appropriate care. This data provides important considerations for the development of comprehensive and gender-transformative approaches challenging harmful masculine norms, pushing for financial risk protection mechanisms and gender-responsive healthcare delivery attuned to the unique needs and preferences of men.
Collapse
Affiliation(s)
- Sharon N Mokua
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lorraine Ombogo
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - David Mathu
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Prisca Otambo
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lilian Nyandieka
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Stephen N Onteri
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Schiller J Mbuka
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - James Kariuki
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Ismail Ahmed
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Violet Wanjihia
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Joseph Mutai
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| |
Collapse
|
2
|
Ahmed IA, Kariuki J, Mathu D, Onteri S, Macharia A, Mwai J, Otambo P, Wanjihia V, Mutai J, Mokua S, Nyandieka L, Echoka E, Njomo D, Bukania Z. Health systems' capacity in availability of human resource for health towards implementation of Universal Health Coverage in Kenya. PLoS One 2024; 19:e0297438. [PMID: 38289943 PMCID: PMC10826929 DOI: 10.1371/journal.pone.0297438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Kenya faces significant challenges related to health worker shortages, low retention rates, and the equitable distribution of Human Resource for Health (HRH). The Ministry of Health (MOH) in Kenya has established HRH norms and standards that define the minimum requirements for healthcare providers and infrastructure at various levels of the health system. The study assessed on the progress of Universal Health Coverage (UHC) piloting on Human Resource for Health in the country. METHODS The study utilized a Convergent-Parallel-Mixed-Methods design, incorporating both quantitative and qualitative approaches. The study sampled diverse population groups and randomly selected health facilities. Four UHC pilot counties are paired with two non-UHC pilot counties, one neighboring county and the second county with a geographically distant and does not share a border with any UHC pilot counties. Stratification based on ownership and level was performed, and the required number of facilities per stratum was determined using the square root allocation method. Data on the availability of human resources for health was collected using a customized Kenya Service Availability and Readiness Assessment Mapping (SARAM) tool facilitated by KoBo ToolKitTM open-source software. Data quality checks and validation were conducted, and the HRH general service availability index was measured on availability of Nurses, Clinician, Nutritionist, Laboratory technologist and Pharmacist which is a minimum requirement across all levels of health facilities. Statistical analyses were performed using IBM SPSS version 27 and comparisons between UHC pilot counties and non-UHC counties where significance threshold was established at p < 0.05. Qualitative data collected using focus group discussions and in-depth interview guides. Ethical approval and research permits were obtained, and written informed consent was obtained from all participants. RESULTS The study assessed 746 health facilities with a response rate of 94.3%. Public health facilities accounted for 75% of the sample. The overall healthcare professional availability index score was 17.2%. There was no significant difference in health workers' availability between UHC pilot counties and non-UHC pilot counties at P = 0.834. Public health facilities had a lower index score of 14.7% compared to non-public facilities at 27.0%. Rural areas had the highest staffing shortages, with only 11.1% meeting staffing norms, compared to 31.8% in urban areas and 30.4% in peri-urban areas. Availability of health workers increased with the advancement of The Kenya Essential Package for Health (KEPH Level), with all Level 2 facilities across counties failing to meet MOH staffing norms (0.0%) except Taita Taveta at 8.3%. Among specific cadres, nursing had the highest availability index at 93.2%, followed by clinical officers at 52.3% and laboratory professionals at 55.2%. The least available professions were nutritionists at 21.6% and pharmacist personnel at 33.0%. This result is corroborated by qualitative verbatim. CONCLUSION The study findings highlight crucial challenges in healthcare professional availability and distribution in Kenya. The UHC pilot program has not effectively enhanced healthcare facilities to meet the standards for staffing, calling for additional interventions. Rural areas face a pronounced shortage of healthcare workers, necessitating efforts to attract and retain professionals in these regions. Public facilities have lower availability compared to private facilities, raising concerns about accessibility and quality of care provided. Primary healthcare facilities have lower availability than secondary facilities, emphasizing the need to address shortages at the community level. Disparities in the availability of different healthcare cadres must be addressed to meet diverse healthcare needs. Overall, comprehensive interventions are urgently needed to improve access to quality healthcare services and address workforce challenges.
Collapse
Affiliation(s)
- Ismail Adow Ahmed
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - James Kariuki
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - David Mathu
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Stephen Onteri
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Antony Macharia
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Judy Mwai
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Priscah Otambo
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Violet Wanjihia
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Joseph Mutai
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Sharon Mokua
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Lilian Nyandieka
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Elizabeth Echoka
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Doris Njomo
- Kenya Medical Research Institute Kenya, Eastern and Southern Africa Centre of International Parasite Control, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| |
Collapse
|
3
|
Thumbi SM, Muema J, Mutono N, Njuguna J, Jost C, Boyd E, Tewoldeberhan D, Mutua I, Gacharamu G, Wambua F, Allport R, Olesambu E, Osman AM, Souza D, Kimani I, Oyugi J, Bukania Z, Oboge H, Palmer GH, Yoder J. The Livestock for Health Study: A Field Trial on Livestock Interventions to Prevent Acute Malnutrition Among Women and Children in Pastoralist Communities in Northern Kenya. Food Nutr Bull 2023; 44:S119-S123. [PMID: 37850922 DOI: 10.1177/03795721231195427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Livestock-dependent communities in Africa's drylands disproportionately experience acute malnutrition, especially during drought seasons. We detail the design and implementation of the Livestock for Health (L4H) study aimed at determining the effect of providing livestock feed and nutritional counselling to prevent seasonal spikes of acute malnutrition. METHODS The L4H study employed a 3-arm cluster randomized controlled trial to compare households in pastoralist settings in northern Kenya receiving livestock feeds during critical dry periods, with or without nutritional counseling, with control households. Over 4 dry seasons, 2019 to 2021, the study collected data on household milk production, consumption patterns, mothers'/children's nutritional status, household socioeconomic status, herd dynamics, and human and animal health status every 6 weeks. RESULTS L4H recruited 1734 households, with 639, 585, and 510 households assigned to intervention arms 1 and 2 and control arm 3, respectively. From these households, 1734 women and 1748 children younger than 3 years were recruited. In total, 19 419 household visits were completed, obtaining anthropometric measures 9 times on average for each child and mother. Eighty-one households (5%) were lost from the study due to the mother's death, child's death, migration, and withdrawal for other reasons. DISCUSSION L4H's success in a challenging environment was possible due to strong community engagement, formative studies to inform trial design, collaboration with local authorities, and effective interdisciplinary collaboration. Subsequent manuscripts will report the study findings. TRIAL REGISTRATION The study was registered October 29, 2020, and is online at ClinicalTrials.gov (ID: NCT04608656).
Collapse
Affiliation(s)
- Samuel M Thumbi
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Immunology and Infection Research, University of Edinburgh
| | - Josphat Muema
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Nyamai Mutono
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Christine Jost
- Global Health Training, Advising, and Support Contract, Credence Management Solutions LLC, supporting the United States Agency for International Development (USAID) Bureau for Humanitarian Assistance
| | - Erin Boyd
- United States Agency for International Development's Bureau for Humanitarian Assistance (USAID/BHA), Washington, DC
| | | | - Immaculate Mutua
- Ministry of Health, Government of Marsabit County, Marsabit, Kenya
| | | | | | | | - Emmanuella Olesambu
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Abdal Monium Osman
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Darana Souza
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Irene Kimani
- United States Agency for International Development's Bureau for Humanitarian Assistance (USAID/BHA), Washington, DC
| | - Julius Oyugi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
| | - Harriet Oboge
- Center for Epidemiological Modelling and Analysis, University of Nairobi
- Feed the Future Innovation Lab for Animal Health, Washington State University
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, USA
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Jonathan Yoder
- Feed the Future Innovation Lab for Animal Health, Washington State University
- School of Economic Sciences, Washington state University, Pullman, USA
| |
Collapse
|
4
|
Onteri SN, Kariuki J, Mathu D, Wangui AM, Magige L, Mutai J, Chuchu V, Karanja S, Ahmed I, Mokua S, Otambo P, Bukania Z. Diabetes health care specific services readiness and availability in Kenya: Implications for Universal Health Coverage. PLOS Glob Public Health 2023; 3:e0002292. [PMID: 37756286 PMCID: PMC10529624 DOI: 10.1371/journal.pgph.0002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
Diabetes is a major cause of morbidity and mortality worldwide yet preventable. Complications of undetected and untreated diabetes result in serious human suffering and disability. It negatively impacts on individual's social economic status threatening economic prosperity. There is a scarcity of data on health system diabetes service readiness and availability in Kenya which necessitated an investigation into the specific availability and readiness of diabetes services. A cross sectional descriptive study was carried out using the Kenya service availability and readiness mapping tool in 598 randomly selected public health facilities in 12 purposively selected counties. Ethical standards outlined in the 1964 Declaration of Helsinki and its later amendments were upheld throughout the study. Health facilities were classified into primary and secondary level facilities prior to statistical analysis using IBM SPSS version 25. Exploratory data analysis techniques were employed to uncover the distribution structure of continuous study variables. For categorical variables, descriptive statistics in terms of proportions, frequency distributions and percentages were used. Of the 598 facilities visited, 83.3% were classified as primary while 16.6% as secondary. A variation in specific diabetes service availability and readiness was depicted in the 12 counties and between primary and secondary level facilities. Human resource for health reported a low mean availability (46%; 95% CI 44%-48%) with any NCDs specialist and nutritionist the least carder available. Basic equipment and diagnostic capacity reported a fairly high mean readiness (73%; 95% CI 71%-75%) and (64%; 95%CI 60%-68%) respectively. Generally, primary health facilities had low diabetic specific service availability and readiness compared to secondary facilities: capacity to cope with diabetes increased as the level of care ascended to higher levels. Significant gaps were identified in overall availability and readiness in both primary and secondary levels facilities particularly in terms of human resource for health specifically nutrition and laboratory profession.
Collapse
Affiliation(s)
- Stephen N. Onteri
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - James Kariuki
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - David Mathu
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Antony M. Wangui
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Lucy Magige
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Joseph Mutai
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Vyolah Chuchu
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Sarah Karanja
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Ismail Ahmed
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Sharon Mokua
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Priscah Otambo
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| |
Collapse
|
5
|
Muema J, Mutono N, Kisaka S, Ogoti B, Oyugi J, Bukania Z, Daniel T, Njuguna J, Kimani I, Makori A, Omulo S, Boyd E, Osman AM, Gwenaelle L, Jost C, Thumbi SM. The impact of livestock interventions on nutritional outcomes of children younger than 5 years old and women in Africa: a systematic review and meta-analysis. Front Nutr 2023; 10:1166495. [PMID: 37485389 PMCID: PMC10358768 DOI: 10.3389/fnut.2023.1166495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Nutrition-sensitive livestock interventions have the potential to improve the nutrition of communities that are dependent on livestock for their livelihoods by increasing the availability and access to animal-source foods. These interventions can also boost household income, improving purchasing power for other foods, as well as enhance determinants of health. However, there is a lack of synthesized empirical evidence of the impact and effect of livestock interventions on diets and human nutritional status in Africa. Objective To review evidence of the effectiveness of nutrition-sensitive livestock interventions in improving diets and nutritional status in children younger than 5 years old and in pregnant and lactating women. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of published studies reporting on the effect of livestock interventions on maternal and child nutrition in Africa. Data were extracted, synthesized, and summarized qualitatively. Key outcomes were presented in summary tables alongside a narrative summary. Estimation of pooled effects was undertaken for experimental studies with nutritional outcomes of consumption of animal-source foods (ASFs) and minimum dietary diversity (MDD). Fixed effects regression models and pooled effect sizes were computed and reported as odds ratios (ORs) together with their 95% confidence intervals (CI). Results After the screening, 29 research papers were included in the review, and of these, only 4 were included in the meta-analysis. We found that nutrition-sensitive livestock interventions have a significant positive impact on the consumption of ASFs for children < 5 years (OR = 5.39; 95% CI: 4.43-6.56) and on the likelihood of meeting minimum dietary diversity (OR = 1.89; 95% CI: 1.51-2.37). Additionally, the impact of livestock interventions on stunting, wasting, and being underweight varied depending on the type of intervention and duration of the program/intervention implementation. Therefore, because of this heterogeneity in reporting metrics, the pooled estimates could not be computed. Conclusion Nutrition-sensitive livestock interventions showed a positive effect in increasing the consumption of ASFs, leading to improved dietary diversity. However, the quality of the evidence is low, and therefore, more randomized controlled studies with consistent and similar reporting metrics are needed to increase the evidence base on how nutrition-sensitive livestock interventions affect child growth outcomes.
Collapse
Affiliation(s)
- Josphat Muema
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
| | - Nyamai Mutono
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Stevens Kisaka
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Brian Ogoti
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Irene Kimani
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Anita Makori
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Sylvia Omulo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
| | - Erin Boyd
- United States Agency for International Development’s Bureau for Humanitarian Assistance, Washington, DC, United States
| | - Abdal Monium Osman
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Luc Gwenaelle
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Christine Jost
- United States Agency for International Development’s Bureau for Humanitarian Assistance, Washington, DC, United States
- Global Health Support Initiative III, Social Solutions International, Washington, DC, United States
| | - SM Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
- South African Center for Epidemiological Modelling and Analysis, Stellenbosch, South Africa
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
6
|
Wachira C, Ogallo W, Okwako S, Remy SL, Bukania Z, Njeru MK, Mwangi M, Mokua S, Omwanda W, Ressler D, Walcott-Bryant A. Analysis of user interactions with a digital health wallet for enabling care continuity in the context of an ongoing pandemic. J Am Med Inform Assoc 2023; 30:674-682. [PMID: 36645248 PMCID: PMC10018250 DOI: 10.1093/jamia/ocad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/28/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The onset of COVID-19 and related policy responses made it difficult to study interactive health informatics solutions in clinical study settings. Instrumented log and event data from interactive systems capture temporal details that can be used to generate insights about care continuity during ongoing pandemics. OBJECTIVE To investigate user interactions with a digital health wallet (DHW) system for addressing care continuity challenges in chronic disease management in the context of an ongoing pandemic. MATERIALS AND METHODS We analyzed user interaction log data generated by clinicians, nurses, and patients from the deployment of a DHW in a feasibility study conducted during the COVID-19 pandemic in Kenya. We used the Hamming distance from Information Theory to quantify deviations of usage patterns extracted from the events data from predetermined workflow sequences supported by the platform. RESULTS Nurses interacted with all the user interface elements relevant to triage. Clinicians interacted with only 43% of elements relevant to consultation, while patients interacted with 67% of the relevant user interface elements. Nurses and clinicians deviated from the predetermined workflow sequences by 42% and 36%, respectively. Most deviations pertained to users going back to previous steps in their usage workflow. CONCLUSIONS User interaction log analysis is a valuable alternative method for generating and quantifying user experiences in the context of ongoing pandemics. However, researchers should mitigate the potential disruptions of the actual use of the studied technologies as well as use multiple approaches to investigate user experiences of health technology during pandemics.
Collapse
Affiliation(s)
| | | | | | | | - Zipporah Bukania
- Centre for Public Health—Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Mercy Karimi Njeru
- Centre for Public Health—Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Moses Mwangi
- Centre for Public Health—Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Sharon Mokua
- Centre for Public Health—Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | | | | |
Collapse
|
7
|
Codjia P, Kutondo E, Kamudoni P, Munga J, Ahluwalia A, Sharma I, de Jong Y, Amolo T, Maina-Gathigi L, Mwenda V, Chaudhry H, Bukania Z. Mid-term evaluation of Maternal and Child Nutrition Programme (MCNP II) in Kenya. BMC Public Health 2022; 22:2191. [PMID: 36443721 PMCID: PMC9702643 DOI: 10.1186/s12889-022-14627-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Kenya is faced with a triple burden of malnutrition which is multi-faceted with health and socio-economic implications. Huge geographical disparities exist, especially, in the arid and semi-arid lands exacerbated by inadequate resource allocation to the nutrition sector and challenges in multi-sectoral coordination and nutrition governance. UNICEF’s Maternal and Child Nutrition Programme is a four-year (2018–2022) resilience-building, multi-sectoral program focused on pregnant and lactating women, mothers of children under five years and children under five years. The objective of the mid-term evaluation was to establish the relevance, effectiveness, efficiency, and sustainability of the programme. Methods The field evaluation conducted between June and July 2021, adopted a concurrent mixed-methods approach, where qualitative information was gathered through 29 key informant interviews and 18 focus group discussions (6 FGDs per population group; women of reproductive age, adolescent girls and men). Quantitatively, data were obtained through desk review of secondary data from programme reports, budgets, and project outputs where descriptive analysis was undertaken using Excel software. Qualitative information was organized using Nvivo software and analyzed thematically. Results The findings provide evidence of the relevance of the Maternal and Child Nutrition Programme II to the nutrition situation in Kenya and its alignment with the Government of Kenya and donor priorities. Most planned programme targets were achieved despite operating in a COVID-19 pandemic environment. The use of innovative approaches such as family mid-upper arm circumference, integrated management of acute malnutrition surge model, Malezi bora and Logistic Management Information Management System contributed to the realization of effective outputs and outcomes. Stringent financial management strategies contributed toward programme efficiencies; however, optimal utilization of the resources needs further strengthening. The programme adopted strategies for strengthening local capacity and promoting ownership and long-term sustainability. Conclusion The programme is on track across the four evaluation criteria. However, a few suggestions are recommended to improve relevance, effectiveness, efficiency, and sustainability. A formal transition strategy needs to be developed in consultation with multi-stakeholder groups and implemented in phases. UNICEF Nutrition section should explore a more integrated programming mode of delivery through joint initiatives with other agencies under the Delivery as One UN agenda, along the more gender transformative approaches with more systematic involvement of males and females in gender-based discussions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14627-2.
Collapse
|
8
|
Muema J, Oboge H, Mutono N, Makori A, Oyugi J, Bukania Z, Njuguna J, Jost C, Ogoti B, Omulo S, Thumbi SM. Sero - epidemiology of brucellosis in people and their livestock: A linked human - animal cross-sectional study in a pastoralist community in Kenya. Front Vet Sci 2022; 9:1031639. [PMID: 36467641 PMCID: PMC9716101 DOI: 10.3389/fvets.2022.1031639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/03/2022] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Brucellosis is associated with massive livestock production losses and human morbidity worldwide. Efforts to control brucellosis among pastoralist communities are limited by scarce data on the prevalence and risk factors for exposure despite the high human-animal interactions in these communities. This study simultaneously assessed the seroprevalence of brucellosis and associated factors of exposure among pastoralists and their livestock in same households. METHODS We conducted a cross-sectional study in pastoralist communities in Marsabit County - Kenya. A total of 1,074 women and 225 children participated and provided blood samples. Blood was also drawn from 1,876 goats, 322 sheep and 189 camels. Blood samples were collected to be screened for the presence of anti-Brucella IgG antibodies using indirect IgG Enzyme-Linked Immunosorbent Assay (ELISA) kits. Further, Individual, household and herd-level epidemiological information were captured using a structured questionnaire. Group differences were compared using the Pearson's Chi-square test, and p-values < 0.05 considered statistically significant. Generalized mixed-effects multivariable logistic human and animal models using administrative ward as the random effect was used to determine variables correlated to the outcome. RESULTS Household-level seropositivity was 12.7% (95% CI: 10.7-14.8). The individual human seroprevalence was 10.8% (9.1-12.6) with higher seroprevalence among women than children (12.4 vs. 3.1%, p < 0.001). Herd-level seroprevalence was 26.1% (23.7-28.7) and 19.2% (17.6-20.8) among individual animals. Goats had the highest seroprevalence 23.1% (21.2 - 25.1), followed by sheep 6.8% (4.3-10.2) and camels 1.1% (0.1-3.8). Goats and sheep had a higher risk of exposure OR = 3.8 (95% CI 2.4-6.7, p < 0.001) and 2.8 (1.2-5.6, p < 0.007), respectively relative to camels. Human and animal seroprevalence were significantly associated (OR = 1.8, [95%CI: 1.23-2.58], p = 0.002). Herd seroprevalence varied by household head education (OR = 2.45, [1.67-3.61, p < 0.001]) and herd size (1.01, [1.00-1.01], p < 0.001). CONCLUSIONS The current study showed evidence that brucellosis is endemic in this pastoralist setting and there is a significant association between animal and human brucellosis seropositivity at household level representing a potential occupational risk. Public health sensitization and sustained human and animal brucellosis screening are required.
Collapse
Affiliation(s)
- Josphat Muema
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
| | - Harriet Oboge
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
| | - Nyamai Mutono
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Centre for Epidemiological Modeling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Anita Makori
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Centre for Epidemiological Modeling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Christine Jost
- United States Agency for International Development's Bureau for Humanitarian Assistance (USAID/BHA), Washington, DC, United States
- Global Health Support Initiative III, Social Solutions International, Washington, DC, United States
| | - Brian Ogoti
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Centre for Epidemiological Modeling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Sylvia Omulo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program - Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
| | - S. M. Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
- South African Center for Epidemiological Modeling Analysis, Stellenbosch, South Africa
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
9
|
Muema J, Nyamai M, Wheelhouse N, Njuguna J, Jost C, Oyugi J, Bukania Z, Oboge H, Ogoti B, Makori A, Fernandez MDP, Omulo S, Thumbi S. Endemicity of Coxiella burnetii infection among people and their livestock in pastoral communities in northern Kenya. Heliyon 2022; 8:e11133. [PMID: 36303929 PMCID: PMC9593183 DOI: 10.1016/j.heliyon.2022.e11133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Coxiella burnetti can be transmitted to humans primarily through inhaling contaminated droplets released from infected animals or consumption of contaminated dairy products. Despite its zoonotic nature and the close association pastoralist communities have with their livestock, studies reporting simultaneous assessment of C. burnetti exposure and risk-factors among people and their livestock are scarce. Objective This study therefore estimated the seroprevalence of Q-fever and associated risk factors of exposure in people and their livestock. Materials and methods We conducted a cross-sectional study in pastoralist communities in Marsabit County in northern Kenya. A total of 1,074 women and 225 children were enrolled and provided blood samples for Q-fever testing. Additionally, 1,876 goats, 322 sheep and 189 camels from the same households were sampled. A structured questionnaire was administered to collect individual- and household/herd-level data. Indirect IgG ELISA kits were used to test the samples. Results Household-level seropositivity was 13.2% [95% CI: 11.2–15.3]; differences in seropositivity levels among women and children were statistically insignificant (p = 0.8531). Lactating women had higher odds of exposure, odds ratio (OR) = 2.4 [1.3–5.3], while the odds of exposure among children increased with age OR = 1.1 [1.0–1.1]. Herd-level seroprevalence was 83.7% [81.7–85.6]. Seropositivity among goats was 74.7% [72.7–76.7], while that among sheep and camels was 56.8% [51.2–62.3] and 38.6% [31.6–45.9], respectively. Goats and sheep had a higher risk of exposure OR = 5.4 [3.7–7.3] and 2.6 [1.8–3.4], respectively relative to camels. There was no statistically significant association between Q-fever seropositivity and nutrition status in women, p = 0.900 and children, p = 1.000. We found no significant association between exposure in people and their livestock at household level (p = 0.724) despite high animal exposure levels, suggesting that Q-fever exposure in humans may be occurring at a scale larger than households. Conclusion The one health approach used in this study revealed that Q-fever is endemic in this setting. Longitudinal studies of Q-fever burden and risk factors simultaneously assessed in human and animal populations as well as the socioeconomic impacts of the disease and further explore the role of environmental factors in Q-fever epidemiology are required. Such evidence may form the basis for designing Q-fever prevention and control strategies.
Collapse
Affiliation(s)
- Josphat Muema
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya,Washington State University Global Health Program – Kenya, Nairobi, Kenya,Feed the Future Innovation Lab for Animal Health, Washington State University, USA,Corresponding author.
| | - Mutono Nyamai
- Washington State University Global Health Program – Kenya, Nairobi, Kenya,Feed the Future Innovation Lab for Animal Health, Washington State University, USA,Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | | | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Christine Jost
- United States Agency for International Development's Bureau for Humanitarian Assistance (USAID/BHA), Washington, DC, USA,Global Health Support Initiative III, Social Solutions International, Washington DC, USA
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Harriet Oboge
- Washington State University Global Health Program – Kenya, Nairobi, Kenya,Feed the Future Innovation Lab for Animal Health, Washington State University, USA
| | - Brian Ogoti
- Washington State University Global Health Program – Kenya, Nairobi, Kenya,Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Anita Makori
- Washington State University Global Health Program – Kenya, Nairobi, Kenya,Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | | | - Sylvia Omulo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya,Feed the Future Innovation Lab for Animal Health, Washington State University, USA,Paul G. Allen School for Global Health, Washington State University, Pullman, USA
| | - S.M. Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya,Feed the Future Innovation Lab for Animal Health, Washington State University, USA,Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya,Paul G. Allen School for Global Health, Washington State University, Pullman, USA,South African Center for Epidemiological Modelling Analysis, South Africa,Institute of Immunology and Infection Research, University of Edinburgh, UK
| |
Collapse
|
10
|
Muema J, Oyugi J, Bukania Z, Nyamai M, Jost C, Daniel T, Njuguna J, Thumbi SM. Impact of livestock interventions on maternal and child nutrition outcomes in Africa: A systematic review and meta-analysis protocol. AAS Open Res 2021; 4:1. [PMID: 34761161 PMCID: PMC8552048 DOI: 10.12688/aasopenres.13150.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
The challenge of undernutrition (stunting and wasting) still remains a major health concern in children below 5 years of age in Africa, with the continent accounting for more than one third of all stunted children and more than one quarter of all wasted children globally. Despite the growing evidence on the role of agriculture interventions in improving nutrition, empirical evidence on the impact of livestock intervention on nutrition in Africa is scant. This review is aimed at determining whether livestock interventions are effective in reducing undernutrition in children below five years of age and in pregnant and lactating women in Africa. The review will be conducted according to PRISMA guidelines. Major electronic databases will be searched and complemented with grey and non-indexed literature from google and google scholar, and expert consultation for additional articles and reports. PICO criteria will be used while employing search strategies including MeSH, Boolean search operators and truncation/wildcard symbol to narrow or broaden the search. Articles on effect of livestock interventions on maternal and child nutrition conducted in Africa that meet the set inclusion criteria will be included in the review after critical appraisal by two independent reviewers. A standardized form will be used to extract data from included studies. The extracted data will be summarized and synthesized both qualitatively and quantitatively and key outcomes presented. Evidence generated from the systematic review and meta-analysis will be important for guiding nutrition sensitive livestock interventions and policies on nutrition programming, specifically on how to leverage on livestock interventions to reduce the burden of undernutrition.
Collapse
Affiliation(s)
- Josphat Muema
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University, Global Health Program - Kenya, Nairobi, Kenya
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mutono Nyamai
- Washington State University, Global Health Program - Kenya, Nairobi, Kenya
- Wangari Maathai Institute of Peace and Environmental studies, University of Nairobi, Nairobi, Kenya
| | - Christine Jost
- United States Agency for International Development’s office for U.S Disaster Assistance, Washington, DC, USA
| | | | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Samuel Mwangi Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University, Global Health Program - Kenya, Nairobi, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute,, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, USA
| |
Collapse
|
11
|
Muema J, Oyugi J, Bukania Z, Nyamai M, Jost C, Daniel T, Njuguna J, Thumbi SM. Impact of livestock interventions on maternal and child nutrition outcomes in Africa: A systematic review and meta-analysis protocol. AAS Open Res 2021; 4:1. [PMID: 34761161 PMCID: PMC8552048 DOI: 10.12688/aasopenres.13150.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 04/04/2024] Open
Abstract
The challenge of undernutrition (stunting and wasting) still remains a major health concern in children below 5 years of age in Africa, with the continent accounting for more than one third of all stunted children and more than one quarter of all wasted children globally. Despite the growing evidence on the role of agriculture interventions in improving nutrition, empirical evidence on the impact of livestock intervention on nutrition in Africa is scant. This review is aimed at determining whether livestock interventions are effective in reducing undernutrition in children below five years of age and in pregnant and lactating women in Africa. The review will be conducted according to PRISMA guidelines. Major electronic databases will be searched and complemented with grey and non-indexed literature from google and google scholar, and expert consultation for additional articles and reports. PICO criteria will be used while employing search strategies including MeSH, Boolean search operators and truncation/wildcard symbol to narrow or broaden the search. Articles on effect of livestock interventions on maternal and child nutrition conducted in Africa that meet the set inclusion criteria will be included in the review after critical appraisal by two independent reviewers. A standardized form will be used to extract data from included studies. The extracted data will be summarized and synthesized both qualitatively and quantitatively and key outcomes presented. Evidence generated from the systematic review and meta-analysis will be important for guiding nutrition sensitive livestock interventions and policies on nutrition programming, specifically on how to leverage on livestock interventions to reduce the burden of undernutrition.
Collapse
Affiliation(s)
- Josphat Muema
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University, Global Health Program - Kenya, Nairobi, Kenya
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mutono Nyamai
- Washington State University, Global Health Program - Kenya, Nairobi, Kenya
- Wangari Maathai Institute of Peace and Environmental studies, University of Nairobi, Nairobi, Kenya
| | - Christine Jost
- United States Agency for International Development’s office for U.S Disaster Assistance, Washington, DC, USA
| | | | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Samuel Mwangi Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University, Global Health Program - Kenya, Nairobi, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute,, Nairobi, Kenya
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, USA
| |
Collapse
|
12
|
Po JYT, Bukania Z, Muhammad L, Hickey GM. Associations between Maternal Participation in Agricultural Decision-Making and Child Nutrition in Semiarid Kenya. Journal of Hunger & Environmental Nutrition 2020. [DOI: 10.1080/19320248.2019.1617214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- June Yee Tsun Po
- Department of Natural Resource Sciences, McGill University, Sainte-Anne-de-Bellevue, Q.C., Canada
| | | | - Lutta Muhammad
- Kenya Agricultural and Livestock Research Organization, Nairobi, Kenya
| | - Gordon M. Hickey
- Department of Natural Resource Sciences, McGill University, Sainte-Anne-de-Bellevue, Q.C., Canada
| |
Collapse
|
13
|
Oyando R, Njoroge M, Nguhiu P, Sigilai A, Kirui F, Mbui J, Bukania Z, Obala A, Munge K, Etyang A, Barasa E. Patient costs of diabetes mellitus care in public health care facilities in Kenya. Int J Health Plann Manage 2019; 35:290-308. [PMID: 31621953 PMCID: PMC7043382 DOI: 10.1002/hpm.2905] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/05/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To estimate the direct and indirect costs of diabetes mellitus care at five public health facilities in Kenya. METHODS We conducted a cross-sectional study in two counties where diabetes patients aged 18 years and above were interviewed. Data on care-seeking costs were obtained from 163 patients seeking diabetes care at five public facilities using the cost-of-illness approach. Medicines and user charges were classified as direct health care costs while expenses on transport, food, and accommodation were classified as direct non-health care costs. Productivity losses due to diabetes were classified as indirect costs. We computed annual direct and indirect costs borne by these patients. RESULTS More than half (57.7%) of sampled patients had hypertension comorbidity. Overall, the mean annual direct patient cost was KES 53 907 (95% CI, 43 625.4-64 188.6) (US$ 528.5 [95% CI, 427.7-629.3]). Medicines accounted for 52.4%, transport 22.6%, user charges 17.5%, and food 7.5% of total direct costs. Overall mean annual indirect cost was KES 23 174 (95% CI, 20 910-25 438.8) (US$ 227.2 [95% CI, 205-249.4]). Patients reporting hypertension comorbidity incurred higher costs compared with diabetes-only patients. The incidence of catastrophic costs was 63.1% (95% CI, 55.7-70.7) and increased to 75.4% (95% CI, 68.3-82.1) when transport costs were included. CONCLUSION There are substantial direct and indirect costs borne by diabetic patients in seeking care from public facilities in Kenya. High incidence of catastrophic costs suggests diabetes services are unaffordable to majority of diabetic patients and illustrate the urgent need to improve financial risk protection to ensure access to care.
Collapse
Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Martin Njoroge
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter Nguhiu
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Antipa Sigilai
- Centre for Geographic Medicine Research, Kenya Medical Research Institute, KiIifi, Kenya
| | - Fredrick Kirui
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jane Mbui
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Andrew Obala
- Medical Microbiology, Moi University, Eldoret, Kenya
| | - Kenneth Munge
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Anthony Etyang
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Geographic Medicine Research, Kenya Medical Research Institute, KiIifi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
14
|
Etyang AO, Sigilai A, Odipo E, Oyando R, Ong'ayo G, Muthami L, Munge K, Kirui F, Mbui J, Bukania Z, Mwai J, Obala A, Barasa E. Diagnostic Accuracy of Unattended Automated Office Blood Pressure Measurement in Screening for Hypertension in Kenya. Hypertension 2019; 74:1490-1498. [PMID: 31587589 PMCID: PMC7069390 DOI: 10.1161/hypertensionaha.119.13574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. Despite increasing adoption of unattended automated office blood pressure (uAOBP) measurement for determining clinic blood pressure (BP), its diagnostic performance in screening for hypertension in low-income settings has not been determined. We determined the validity of uAOBP in screening for hypertension, using 24-hour ambulatory BP monitoring as the reference standard. We studied a random population sample of 982 Kenyan adults; mean age, 42 years; 60% women; 2% with diabetes mellitus; none taking antihypertensive medications. We calculated sensitivity using 3 different screen positivity cutoffs (≥130/80, ≥135/85, and ≥140/90 mm Hg) and other measures of validity/agreement. Mean 24-hour ambulatory BP monitoring systolic BP was similar to mean uAOBP systolic BP (mean difference, 0.6 mm Hg; 95% CI, −0.6 to 1.9), but the 95% limits of agreement were wide (−39 to 40 mm Hg). Overall discriminatory accuracy of uAOBP was the same (area under receiver operating characteristic curves, 0.66–0.68; 95% CI range, 0.64–0.71) irrespective of uAOBP cutoffs used. Sensitivity of uAOBP displayed an inverse association (P<0.001) with the cutoff selected, progressively decreasing from 67% (95% CI, 62–72) when using a cutoff of ≥130/80 mm Hg to 55% (95% CI, 49–60) at ≥135/85 mm Hg to 44% (95% CI, 39–49) at ≥140/90 mm Hg. Diagnostic performance was significantly better (P<0.001) in overweight and obese individuals (body mass index, >25 kg/m2). No differences in results were present in other subanalyses. uAOBP misclassifies significant proportions of individuals undergoing screening for hypertension in Kenya. Additional studies on how to improve screening strategies in this setting are needed.
Collapse
Affiliation(s)
- Anthony O Etyang
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme (A.O.E., A.S., E.O., G.O.)
| | - Antipa Sigilai
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme (A.O.E., A.S., E.O., G.O.)
| | - Emily Odipo
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme (A.O.E., A.S., E.O., G.O.)
| | - Robinson Oyando
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya (R.O., K.M., E.B.)
| | - Gerald Ong'ayo
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme (A.O.E., A.S., E.O., G.O.)
| | - Lawrence Muthami
- Centre for Public Health Research (L.M., Z.B., J.M.), Kenya Medical Research Institute, Nairobi
| | - Kenneth Munge
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya (R.O., K.M., E.B.)
| | - Fredrick Kirui
- Centre for Clinical Research (F.K., J.M.), Kenya Medical Research Institute, Nairobi
| | - Jane Mbui
- Centre for Clinical Research (F.K., J.M.), Kenya Medical Research Institute, Nairobi
| | - Zipporah Bukania
- Centre for Public Health Research (L.M., Z.B., J.M.), Kenya Medical Research Institute, Nairobi
| | - Judy Mwai
- Centre for Public Health Research (L.M., Z.B., J.M.), Kenya Medical Research Institute, Nairobi
| | | | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya (R.O., K.M., E.B.)
| |
Collapse
|
15
|
Opiyo RO, Nyasulu PS, Olenja J, Zunza M, Nguyen KA, Bukania Z, Nabakwe E, Mbogo A, Were AO. Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya: a mixed-methods survey. Ren Replace Ther 2019. [DOI: 10.1186/s41100-019-0237-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis.
Methods
A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a QUAN + qual paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected using a structured, self-reported questionnaire using Open Data Kit “Collect software” while qualitative data were collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and NVIV0 12 for qualitative data was conducted. The dependent variable, “adherence to diet prescription” was analyzed as a binary variable. P values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic regression models respectively. Qualitative data were thematically analyzed.
Results
Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently associated with adherence to diet prescriptions were “flexibility in the diets” (AOR 2.65, 95% CI 1.11–6.30, P 0.028), “difficulties in following diet recommendations” (AOR 0.24, 95% CI 0.13–0.46, P < 001), and “adherence to limiting fluid intake” (AOR 9.74, 95% CI 4.90–19.38, P < 0.001).
Conclusions
For patients with chronic kidney disease on hemodialysis, diet prescriptions with less restrictions and requiring minimal extra efforts and resources are more likely to be adhered to than the restrictive ones. Patients who adhere to their fluid intake restrictions easily follow their diet prescriptions. Prescribed diets should be based on the individual patient’s usual dietary habits and assessed levels of challenges in using such diets. Additionally, diet adherence messages should be integrated with fluid limitation messages. Further research on understanding patients’ adherence to fluid restriction is also suggested.
Collapse
|
16
|
Oyando R, Njoroge M, Nguhiu P, Kirui F, Mbui J, Sigilai A, Bukania Z, Obala A, Munge K, Etyang A, Barasa E. Patient costs of hypertension care in public health care facilities in Kenya. Int J Health Plann Manage 2019; 34:e1166-e1178. [PMID: 30762904 PMCID: PMC6618067 DOI: 10.1002/hpm.2752] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 11/09/2022] Open
Abstract
Background Hypertension in low‐ and middle‐income countries, including Kenya, is of economic importance due to its increasing prevalence and its potential to present an economic burden to households. In this study, we examined the patient costs associated with obtaining care for hypertension in public health care facilities in Kenya. Methods We conducted a cross‐sectional study among adult respondents above 18 years of age, with at least 6 months of treatment in two counties. A total of 212 patients seeking hypertension care at five public facilities were interviewed, and information on care seeking and the associated costs was obtained. We computed both annual direct and indirect costs borne by these patients. Results Overall, the mean annual direct cost to patients was US$ 304.8 (95% CI, 235.7‐374.0). Medicines (mean annual cost, US$ 168.9; 95% CI, 132.5‐205.4), transport (mean annual cost, US$ 126.7; 95% CI, 77.6‐175.9), and user charges (mean annual cost, US$ 57.7; 95% CI, 43.7‐71.6) were the highest direct cost categories. Overall mean annual indirect cost was US$ 171.7 (95% CI, 152.8‐190.5). The incidence of catastrophic health care costs was 43.3% (95% CI, 36.8‐50.2) and increased to 59.0% (95% CI, 52.2‐65.4) when transport costs were included. Conclusions Hypertensive patients incur substantial direct and indirect costs. High rates of catastrophic costs illustrate the urgency of improving financial risk protection for these patients and strengthening primary care to ensure affordability of hypertension care.
Collapse
Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Martin Njoroge
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peter Nguhiu
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Fredrick Kirui
- Clinical Unit, KEMRI Centre for Clinical Research, Nairobi, Kenya
| | - Jane Mbui
- Clinical Unit, KEMRI Centre for Clinical Research, Nairobi, Kenya
| | - Antipa Sigilai
- Epidemiology and Demography, KEMRI Centre for Geographic Medicine Research, Coast, Kilifi, Kenya
| | - Zipporah Bukania
- Public health nutrition, maternal and child health unit, KEMRI Centre for Public Health Research, Nairobi, Kenya
| | - Andrew Obala
- Medical Microbiology and Parasitology, Moi University, Eldoret, Kenya
| | - Kenneth Munge
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Anthony Etyang
- Epidemiology and Demography, KEMRI Centre for Geographic Medicine Research, Coast, Kilifi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
17
|
van der Haar F, Knowles J, Bukania Z, Camara B, Pandav CS, Mwai JM, Toure NK, Yadav K. New Statistical Approach to Apportion Dietary Sources of Iodine Intake: Findings from Kenya, Senegal and India. Nutrients 2018; 10:nu10040430. [PMID: 29596369 PMCID: PMC5946215 DOI: 10.3390/nu10040430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/13/2018] [Accepted: 03/27/2018] [Indexed: 01/13/2023] Open
Abstract
Progress of national Universal Salt Iodization (USI) strategies is typically assessed by household coverage of adequately iodized salt and median urinary iodine concentration (UIC) in spot urine collections. However, household coverage does not inform on the iodized salt used in preparation of processed foods outside homes, nor does the total UIC reflect the portion of population iodine intake attributable to the USI strategy. This study used data from three population-representative surveys of women of reproductive age (WRA) in Kenya, Senegal and India to develop and illustrate a new approach to apportion the population UIC levels by the principal dietary sources of iodine intake, namely native iodine, iodine in processed food salt and iodine in household salt. The technique requires measurement of urinary sodium concentrations (UNaC) in the same spot urine samples collected for iodine status assessment. Taking into account the different complex survey designs of each survey, generalized linear regression (GLR) analyses were performed in which the UIC data of WRA was set as the outcome variable that depends on their UNaC and household salt iodine (SI) data as explanatory variables. Estimates of the UIC portions that correspond to iodine intake sources were calculated with use of the intercept and regression coefficients for the UNaC and SI variables in each country’s regression equation. GLR coefficients for UNaC and SI were significant in all country-specific models. Rural location did not show a significant association in any country when controlled for other explanatory variables. The estimated UIC portion from native dietary iodine intake in each country fell below the minimum threshold for iodine sufficiency. The UIC portion arising from processed food salt in Kenya was substantially higher than in Senegal and India, while the UIC portions from household salt use varied in accordance with the mean level of household SI content in the country surveys. The UIC portions and all-salt-derived iodine intakes found in this study were illustrative of existing differences in national USI legislative frameworks and national salt supply situations between countries. The approach of apportioning the population UIC from spot urine collections may be useful for future monitoring of change in iodine nutrition from reduced salt use in processed foods and in households.
Collapse
Affiliation(s)
- Frits van der Haar
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Jacky Knowles
- Large Scale Food Fortification Initiative, Global Alliance for Improved Nutrition, 1211 Geneva, Switzerland.
| | - Zipporah Bukania
- Center for Public Health Research, Kenya Medical Research Institute, 00202 Nairobi, Kenya.
| | - Boubacar Camara
- Comité Scientifique de l'Ecole Doctorale, Université Cheikh Anta Diop de Dakar, B.P. 5005 Dakar-Fann, Sénégal.
| | - Chandrakant S Pandav
- All India Institute of Medical Sciences, Iodine Global Network, New Delhi 110029, India.
| | - John Maina Mwai
- Ministry of Health, Nutrition and Dietetics Unit, P.O. Box 43319-00100, Nairobi, Kenya.
| | - Ndeye Khady Toure
- Cellule de Lutte contre la Malnutrition, B.P. 45001 Dakar-Fann, Sénégal.
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
| |
Collapse
|
18
|
Opanga Y, Kaduka L, Bukania Z, Mutisya R, Korir A, Thuita V, Mwangi M, Muniu E, Mbakaya C. Nutritional status of cancer outpatients using scored patient generated subjective global assessment in two cancer treatment centers, Nairobi, Kenya. BMC Nutr 2017; 3:63. [PMID: 32153843 PMCID: PMC7050868 DOI: 10.1186/s40795-017-0181-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/28/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022] Open
Abstract
Background Malnutrition is a universal problem in cancer patients renowned as an important factor for increased morbidity, decreased quality of life and high mortality. Early diagnosis of malnutrition risk through nutrition screening followed by comprehensive and timely interventions reduces mortality associated with malnutrition. The Scored Patient-Generated Subjective Global Assessment (PGSGA) method has been proved efficient in identifying cancer patients with nutrition challenges and guiding appropriate interventions. However this tool has not been adopted in management of cancer patients in Kenya. The aim of the study was to assess and describe nutrition status of cancer outpatients receiving treatment at Kenyatta National Hospital Hospital (KNH) and Texas Cancer Centre (TCC). Methods The study adopted a hospital based descriptive cross sectional study. Cancer outpatients with confirmed stage 1–4 cancers, physically stable, aged 18 years and above and receiving cancer treatment were recruited and assessed using Scored PGSGA tool. Proportions, measures of central tendency and pearsons’ chi-square test were used in statistical analysis. Results Among the 471 participants assessed, 71.8% were female and 28.2% male. Most participants had stage 2, 3 and 4 cancers at 27.2%, 27.2% and 24.3% respectively. Highest proportion of participants had breast (29.7%) and female genital cancers (22.9%). Sixty nine percent of participants were well nourished (SGA-A), 19.7% moderately malnourished (SGA-B) and 11.3% severely malnourished (SGA-C) and this difference was statistically significant. The mean PGSGA score was 6.76 (SD 5.17). Based on the score, 33.8% of participants required critical nutrition care, 34.8% symptoms management, 14.2% constant nutrition education and pharmacological intervention while 17.2% required routine assessments and reassurance. More (m;54.7%, f; 45.3%) males than females were severely malnourished(SGA-C) and this was statistically significant (P < 0.001).Prevalence of severe malnutrition was highest among participants with digestive organ cancers (49.1%) followed by those with lip cancer (17%) and the least prevalence reported in those with Karposi Sarcoma (0%). Most of stage 4 participants were moderately (37.5%) and severely (29.4%) malnourished. Conclusions The Scored Patient-Generated Subjective Global Assessment is able to identify cancer patients both at risk of malnutrition and those severely malnourished. It also provides a guideline on the appropriate nutrition intervention hence an important tool in nutrition management of cancer patients.
Collapse
Affiliation(s)
- Yvonne Opanga
- 1School of Public Health, Moi University, P.O. Box 24405-00100, Nairobi, Kenya
| | - Lydia Kaduka
- 2Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Zipporah Bukania
- 2Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Richard Mutisya
- 2Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ann Korir
- 3Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Veronica Thuita
- 4Department of Nutrition, Kenyatta National Hospital, Nairobi, Kenya
| | - Moses Mwangi
- 2Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Erastus Muniu
- 2Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | |
Collapse
|