Violet Kimani

Bed net use and associated factors in a rice farming community in Central Kenya

BackgroundUse of insecticide-treated nets (ITNs) continues to offer potential strategy for malaria prevention in endemic areas. However their effectiveness, sustainability and massive scale up remain a factor of socio-economic and cultural variables of the local community which are indispensable during design and implementation stages.MethodsAn ethnographic household survey was conducted in four study villages which were purposefully selected to represent socio-economic and geographical diversity. In total, 400 households were randomly selected from the four study villages. Quantitative and qualitative information of the respondents were collected by use of semi-structured questionnaires and focus group discussions.ResultsMalaria was reported the most frequently occurring disease in the area (93%) and its aetiology was attributed to other non-biomedical causes like stagnant water (16%), and long rains (13%). Factors which significantly caused variation in bed net use were occupant relationship to household head (χ2 = 105.705; df 14; P = 0.000), Age (χ2 = 74.483; df 14; P = 0.000), village (χ2 = 150.325; df 6; P = 0.000), occupation (χ2 = 7.955; df 3; P = 0.047), gender (χ2 = 4.254; df 1; P = 0.039) and education levels of the household head or spouse (χ2 = 33.622; df 6; P = 0.000). The same variables determined access and conditions of bed nets at household level. Protection against mosquito bite (95%) was the main reason cited for using bed nets in most households while protection against malaria came second (54%). Colour, shape and affordability were some of the key potential factors which determined choice, use and acceptance of bed nets in the study area.ConclusionThe study highlights potential social and economic variables important for effective and sustainable implementation of bed nets-related programmes in Sub-Saharan Africa.

Malaria vector control practices in an irrigated rice agro-ecosystem in central Kenya and implications for malaria control

BackgroundMalaria transmission in most agricultural ecosystems is complex and hence the need for developing a holistic malaria control strategy with adequate consideration of socio-economic factors driving transmission at community level. A cross-sectional household survey was conducted in an irrigated ecosystem with the aim of investigating vector control practices applied and factors affecting their application both at household and community level.MethodsFour villages representing the socio-economic, demographic and geographical diversity within the study area were purposefully selected. A total of 400 households were randomly sampled from the four study villages. Both semi-structured questionnaires and focus group discussions were used to gather both qualitative and quantitative data.ResultsThe results showed that malaria was perceived to be a major public health problem in the area and the role of the vector Anopheles mosquitoes in malaria transmission was generally recognized. More than 80% of respondents were aware of the major breeding sites of the vector. Reported personal protection methods applied to prevent mosquito bites included; use of treated bed nets (57%), untreated bed nets (35%), insecticide coils (21%), traditional methods such as burning of cow dung (8%), insecticide sprays (6%), and use of skin repellents (2%). However, 39% of respondents could not apply some of the known vector control methods due to unaffordability (50.5%), side effects (19.9%), perceived lack of effectiveness (16%), and lack of time to apply (2.6%). Lack of time was the main reason (56.3%) reported for non-application of environmental management practices, such as draining of stagnant water (77%) and clearing of vegetations along water canals (67%).ConclusionThe study provides relevant information necessary for the management, prevention and control of malaria in irrigated agro-ecosystems, where vectors of malaria are abundant and disease transmission is stable.

The unsystematic alternative: Towards plural health care among the Kikuyu of Central Kenya

Abstract The traditional medical care system exists and functions in Kenya along with the modern medical system forming a plural health care system. Although the oldest and the most widespread, the former is the least understood and least accepted in any formal way, by Kenyan authorities. This is mainly due to the fact that the system is fluid and unsystematic, lacking in any form a working code of ethics and conceptualised often along the basis of ethnic cultural beliefs and practices on illness and disease. The approach is by no means static. Included in this approach are ethnic traditions and values, folk knowledge, medical taxonomy, patterns and regulations of health-seeking behaviour, supportive social institutions and structures as well as personnel used in the delivery of restorative and preventive therapy.

Part 3: The making of an Urban Mganga: New trends in traditional medicine in urban Kenya

Abstract The need persists for traditional medical practitioners in countries where medical facilities are limited. In addition, their use in cities where such facilities are available shows that they are meeting a need. The beliefs of a group of forty‐eight urban Kenyan practitioners are described in general terms and the induction, training and practice of one is detailed. Emerging patterns of utilization are leading to coexistence. Many traditional practitioners are eager to foster this trend and to accept new ideas.

Attempts to coordinate the work of traditional and modern doctors in Nairobi in 1980

Abstract This brief report of an ongoing official effort to coordinate medical pluralism speaks directly to the issues of this section: the application of cultural analysis to medical practice and planning.

Development and delivery of evidence-based messages to reduce the risk of zoonoses in Nairobi, Kenya

This paper describes a trans-disciplinary process of co-generating and disseminating evidence-based messages for reducing the risk from cryptosporidiosis and other zoonoses in an urban community in Nairobi. Research findings about disease prevalence, risk factors and observed risky and risk-mitigating practices were analysed by a team comprising researchers, community members and local policy- and decision-makers. Using participatory planning, multiple strategies were developed for disseminating key information. We identified five vulnerable groups at higher risk of exposure to cryptosporidiosis and other cattle zoonoses with similar transmission pathways (women, children, elderly people, immunosuppressed people and male farm workers). For each group, targeted messages were developed. Good practices already in use, as were also practices as practices to improve environmental conditions. These messages were disseminated through printed material, in a workshop, through community campaigners and also an edutainment soap opera episode broadcast on Kenyan television. In conclusion, a participatory and trans-disciplinary process can help transform the findings of research into messages that are targeted, attractive and understandable.

Outcome mapping for fostering and measuring change in risk management behaviour among urban dairy farmers in Nairobi, Kenya

A study was undertaken to investigate and mitigate the risk from zoonotic Cryptosporidium associated with dairy farming in Dagoretti division, Nairobi, Kenya. Outcome mapping (OM), a relatively new tool for planning and evaluation, was used to foster and then monitor changes in farmer management of health risks. Elements of the OM framework, including the vision, mission and expected progress markers, were developed in participatory sessions and a set of progress markers was used for monitoring behaviour change in farmers participating in the project (the boundary partners). Behaviour change (the outcome challenge) was supported by a range of awareness and educational campaigns, working with strategic partners (extension agents and administrative leaders). The farmers the project worked with made considerable progress according to the markers; they demonstrated an understanding of cryptosporidiosis, established or maintained clean and well drained cattle sheds, and took conscious effort to reduce possible infection. Farmers who did not participate in the project (non-contact farmers) were found to be less advanced on the progress marker indicators. Non-contact farmers who carried out risk-reducing practices had done so independently of the project team. The administration leaders, as strategic partners, had a positive attitude towards the project and confidence in their ability to support project objectives. The study demonstrates the utility of OM in helping to identify and support behavioural change.

Agrochemicals pose health risks to coffee factory workers in Githuguri (Kenya)

In this century, the use of pesticides and fertilizers (agrochemicals) is indispensable because they are seen as a panacea for protecting crops from insects and diseases. However, the manner in which these agrochemicals are handled poses significant health risks to manufacturers, transporters, vendors and farmers. In Kenya, for example, coffee factory workers (specifically storekeepers) apportion the agrochemicals and sell them to the coffee farmers. The process of apportioning and other factors expose these workers to health risks. In order to evaluate the extent of the problem, a pilot study was undertaken in the Githuguri location. The results showed that lack of use of protective clothing, poor handling of agrochemicals and poorly designed storage facilities were very common. As a result, 95% of the workers interviewed reported a variety of agrochemical health related problems. In conclusion, the government and the public role regarding possible preventive measures were proposed.

Correlates of contraceptive use among HIV discordant couples in Kenya

Despite risks of HIV transmission to infants born of the HIV positive women, contraceptive use is uncommon among women in HIV discordant partnerships. The aim of this study was to determine the factors associated with contraceptive use in a clinical trial cohort of HIV serodiscordant couples based in Thika and Eldoret, Kenya. Data were analyzed from 481 HIV discordant couples enrolled in the Partners in Prevention HSV/HIV Transmission Study at the Thika and Eldoret sites. The primary study outcome was self-reported use of contraception other than condoms. Using a marginal longitudinal logistic model based on generalized estimating equations (GEE) approach we assessed the association of various demographic and behavioral factors with contraceptive use. At baseline the prevalence of non barrier contraceptive use among HIV positive and negative women was 24.3% and 25.7%, respectively. At month 12 of follow-up, the prevalence of contraceptive use was 44.4% among the HIV positive and 26% among the HIV negative women while at month 24, the prevalence of contraceptive use was 38.6% among the HIV positive and 18.2% among the HIV negative women. HIV positive women were more likely to report using contraception than HIV negative women (odds ratio (OR) 1.61 95% confidence interval (CI) 1.04-2.47). Additionally, being married (OR 2.4, 95% CI 1.2-5.0), attending Thika site clinic (OR 6.1, 95% CI 4.2-9.0), and having two or more children (OR 1.9, 95% CI 1.3-2.8) were significantly associated with use of non barrier contraceptives. Future programs should focus on interventions to increase contraceptive use among HIV serodiscordant couples, with a special emphasis on HIV negative women, unmarried women and women with few children.