The East African health research journal最新文献

Background: Undergraduate nursing students in clinical practice have a higher risk of hepatitis B infection. The prevalence and factors associated with hepatitis B vaccination (HBV vaccine) uptake among nursing students remained unknown. This study examined the prevalence and factors associated with HBV vaccination among clinical nursing students.

Methodology: A sample of 229 undergraduate nursing students was enrolled in an analytical cross-sectional study. Sociodemographic data, status of vaccination, and beliefs about HBV infection and vaccination using domains of the health belief model (HBM) were collected in a face-to-face interview using a questionnaire. Descriptive statistics were used to summarise the participants' characteristics and prevalence of HBV vaccination. Multivariate logistic regression analysis was used to examine the association between sociodemographic factors and domains of the HBM model and HBV vaccination uptake.

Results: The prevalence of vaccination uptake was 25.8%. Sociodemographic factors associated with uptake of the HBV vaccine included being female (P =.031), being a final-year student (P =.013), and having knowledge of HBV (P =.049). As for HBM, two domains, perceived benefit [Adjusted Odds Ratio (AOR) = 1.40; 95% CI, 1.05 to 1.86; P=.022] and self-efficacy (AOR = 1.87, 95% CI, 1.12 to 3.11; P=.016), were significantly associated with HBV vaccine uptake.

Conclusion: HBV vaccination uptake among undergraduate clinical nursing students was low. Clinical experience, knowledge, perceived benefit, and self-efficacy were positively associated with HBV vaccine uptake. Interventions to improve these domains among BSc Nursing students should be promoted to improve vaccination uptake.

Introduction: Indoor Air Pollution (IAP) from biomass fuel is one of the major health threats globally. There is limited data on community awareness and perceptions of health conditions associated with IAP in urban informal settlements in sub-Saharan Africa. We explored community perceptions of IAP-associated health conditions, risk behaviors, and potential interventions to reduce IAP in urban informal settlements.

Methods: We used purposive sampling to recruit participants from households located in Mwanza urban informal settlements. We conducted 16 In-depth Interviews (IDIs), two Focused Group Discussions (FGDs), and four Key Informant Interviews (KIIs). Obtained data were then transcribed, translated, coded and analyzed thematically with Dedoose qualitative data analysis software.

Results: Majority of participants were unaware of the health conditions associated with IAP. Participants perceived biomass fuel from charcoal as a safe fuel compared to other known fuels (firewood and gas). Indoor biomass fuel use for cooking and use of rubber and plastic materials for fire lighting were the commonly practices and risk behaviors for IAP. Moreover, poverty is what guides the choice of fuel use for cooking.

Conclusion: Participants awareness health effects of biomass fuel was low, strategies to reduce poverty and health promotion on the health effects of IAP are urgently needed in the Mwanza urban informal settlements.

Background: Insufficient knowledge about COVID-19 and low socioeconomic status have been associated with distrustful attitudes towards vaccination against COVID-19.

Objective: The aim of this study was to explore determinants of COVID-19 vaccine uptake among the general population and health workers.

Methods: A cross sectional study was conducted in 16 councils which included; Milele, Mpanda, Newala, Simanjiro, Nanyumbu, Muleba, Longido, Ulanga, Igunga, Mbulu, Karatu, Mufindi, Mvomero, Kilolo and Tabora Town. A total of 427 health care workers and 1,907 individuals were sampled from health facilities and households. Structured questionnaires were used to collect the required information.

Results: Although the majority (93.2%) of health workers were vaccinated, 35.4% perceived their risk of getting COVID-19 infection as high. Self-reported uptake of COVID-19 vaccine was 42.4% among the general population. Significantly low proportion of the general population in Mufindi district council (7.5%) were vaccinated against COVID-19. Health workers' knowledge and perception on COVID-19 vaccination did not vary with socio-demographic factors. Among the general population, those who were separated/divorced (ARR: 0.8: 95% CI; 0.7 to 0.9), those who attained primary level of education (ARR: 0.8: 95% CI; 0.7 to 0.9), self-employed (ARR: 0.8: 95% CI; 0.7 to 0.9) and unemployed (ARR: 0.7: 95% CI; 0.6 to 0.8) were less likely to be vaccinated against COVID-19. Having positive attitude (ARR: 1.2: 95% CI; 1.1 to 1.5) and perception (ARR:1.8: 95% CI; 1.5 to 2.2), and knowledge on COVID-19 prevention (ARR: 3.0: 95% CI; 2.1to 4.4) increased the likelihood COVID-19 vaccine uptake. Prior experience of vaccination against other diseases (ARR:1.2: 95% CI; 1.0 to1.3), having history of chronic diseases (ARR:1.3: 95% CI; 1.2 to 1.4) and a family member who died of COVID-19 (ARR:1.3: 95% CI; 1.1to1.4) were also determinants of COVID-19 vaccine uptake.

Conclusion: Uptake of COVID-19 vaccine among the general population was significantly low among individuals with primary level of education, self-employed, unemployed, and those who were divorced or separated. Individuals with comprehensive knowledge on COVID-19 vaccination, those with positive attitude and perception on COVID-19 vaccination, having history of chronic diseases, prior vaccination against other diseases, and having a family member who succumbed to COVID-19 increased the likelihood COVID-19 vaccine uptake among the general population. Provision of health education and implementation of socio-behavioural communication change interventions are necessary to equip the general population with appropriate knowledge to transform their negative attitude and perception on COVID-19 vaccination.

Background: Heart failure (HF) is a chronic progressive condition in which the heart is unable to pump enough blood to meet the body's need for blood and oxygen. Globally, about 64 million people are affected with HF. This study was undertaken to determine the magnitude and factors associated with potassium abnormalities in heart failure patients on diuretics in Tanzania.

Methods: This was a hospital based cross-sectional study conducted at Bugando Medical Centre's outpatient clinic. The selection of this hospital was driven by the significant presence of heart failure patients in the facility and the convenience for the researchers, who were stationed at this facility during the study period. All consenting adult patients aged 18 years and above that were attending the cardiac clinic and had met Framingham criteria for heart failure and were taking diuretics for at least one month were included.

Results: The prevalence of hypokalemia and hyperkalemia was found to be 4.3% And 19.3% respectively. The median (IQR) age was 61 (46-70) years and majority of them (52.8%) were females. most of the patients (87.7%) had New York Heart Association (NYHA) class III heart failure.

Conclusion: Factors associated with potassium abnormalities include medication use, kidney disease and more severe heart failure. Healthcare providers should ensure that all patients with these associated factors receive regular electrolyte testing. Electrolytes should be part of the baseline investigation to all patients with heart failure starting treatment, and should be closely monitored in every clinic visit for early detection of these abnormalities and possible intervention, including dose adjustments.

Background: During the COVID-19 lockdowns, healthcare services were disrupted and community-based health insurance (CBHI) schemes could not operate efficiently. This study assessed the level of client satisfaction with CBHI schemes, associated factors, and service provider perspectives in central Uganda.

Methods: This was an explanatory sequential mixed-methods (quantitative - qualitative) study that was conducted between March and September 2021. In the first phase, a cross-sectional study among the 365 clients of the CBHI schemes who were aged ≥18 years old. The participants were recruited consecutively as they reported to the healthcare facility. Quantitative data were collected at patient exit using a piloted semi-structured interviewer-administered questionnaire. In the second phase, qualitative data were collected through 11 key informant interviews. These data were analyzed using a deductive thematic analysis approach. Modified Poisson regression was used to assess factors associated with client satisfaction and a p-value ≤0.05 at a 95% confidence interval was considered to be statistically significant.

Findings: Of the total number of participants, 38.9% (142/365) were "satisfied" with the CBHI services. Less satisfaction was associated with secondary level of education or above (adjPR = 0.55, 95% CI: 0.36-0.85, P=.007); residing beyond 16 kilometers from the healthcare facility (adjPR = 0.68, 95% CI: 0.41-0.95, P=.014); staying on the scheme for over 3 years (adjPR = 0.71, 95% CI: 0.51-0.99, P=.046); and good knowledge about the CBHI (adjPR = 0.76, 95% CI: 0.58-0.99, P=.040). Irregular availability of healthcare workers and long waiting time affected client satisfaction.

Conclusions: Satisfaction was considerably low during the lockdown. Lockdowns due to pandemics interrupt healthcare services and subsequently affect the satisfaction of CBHI clients with scheme services. Scheme managers need to identify facilities that are closer to enrolees and invest in technologies that reduce waiting time in the healthcare facility.

Background: Fruits are essential for good health and they form a major component of human diet. They are vital energy contributors that are depended upon all levels of human as food supplement or nutrients. Although they have all these benefits, when there are not handled with good hygiene they can transmit parasitic infections especially intestinal parasitic infections in the world including Rwanda. The study was conducted to determine the parasitological patterns on fruits purchased in "Huye complex market and Rango local market" in southern province of Rwanda.

Objective: To assess and identify the parasitological patterns on fruits purchased in Huye complex market and Rango local market in Southern Province of Rwanda.

Methodology: A cross-sectional study was designed and 188 fruits were sampled from Huye complex market and Rango local market then washed by using normal saline and the suspension was centrifuged and the sedimentation was examined on a microscope. Data was analysed using Statistical Package for Social Sciences (SPSS) version 23.0 and MS Excel.

Results: The overall prevalence of all parasites obtained from the fruits was 52.65%, whereby the prevalence of all parasites in Rango local and Huye complex markets was 66.63% and 44.7%, respectively. The frequency of identified parasites' contamination was Ascaris Lumbricoides 44.44%, cysts of Giardia lamblia 24.24%, eggs of Trichuris trichura 10.1%, cysts of Entamoeba coli 17.17% and Entamoeba histolytica 4.04%.

Conclusion: The level of fruits contamination by pathogenic parasites remain high, hence regular health education on hygiene of fruit have to be increased to the population and continuous monitoring on sellers of fruits is required.

Background: Preconception care (PCC) is the provision of health interventions to women and couples before conception occurs and is valuable in promoting healthy maternal, birth, and neonatal health outcomes. In Africa, more so in Kenya, maternal and neonatal health indicators have remained poor. The key constraint limiting progress is the gap between what is needed and what exists in terms of skills and availability of human resources & infrastructures in the face of increased demand. This gap was yet to be measured for PCC in Kenya, more so in Kisumu County.

Methods: Using a cross-sectional design, this study specifically sought to determine the rate of self-reported PCC provision and to illustrate how it is influenced by health provider characteristics. Structured interviews were conducted with health providers (n=476) to ascertain their knowledge, perceptions and practice of PCC care. The significance of the differences in means was determined by the Student's t test and linear regression were used to show the relationship between the health provider characteristics and the PCC provision rate.

Results: Self-reported PCC provision was estimated at 39%. There was a significant difference in the mean for cadres {nurses (M=70.04, SD=8.951) and non-nurses (M=71.90, SD=8.732); t (473) =-2.23, P=.026)}, years of experience up to 5 years (M=72.04, SD=8.417) and more than 5 years (M=69.89, SD=9.283); t (465) =2.63, P=.009, the mean provision per level (M=60.21, SD=4.902; t (26)=-5.06, P<.001) and type of service (M=69.36, SD=4.924; t (26) =4.63, P<.001). A significant regression model was found, and the model statistics were F (2,464) =5.97, P=.003, R2=.03. Only cadre (b=0.01, t (464) =2.23, P=.026) and years of experience (b=-0.13, t (464) =-2.79, P=.005) were significant determinants of PCC provision. The health workers felt PCC was an important service whose provision was low due to inadequate human capital investment.

Conclusion: Self-reported provision of PCC by health workers was relatively low and was influenced by the cadre of health workers and their years of experience. It specifically demonstrated the importance of various aspects of human capital, i.e., knowledge, perceptions, competence and adequacy of training in the provision of this care. Furthermore, it showed that the nursing cadre has a higher probability of providing this care. Investing in on-the-job training for health providers, especially nurses, and providing care in primary health facilities in rural areas can improve PCC service delivery.

Background: Urogenital infections pose a considerable public health threat, as almost half of women will experience urinary and reproductive system infections at some point in their lives. However, the urogenital infection burden is often not clear in some regions. Nevertheless, the misuse of antimicrobial agents, including self-prescription, has increased widespread antimicrobial resistance, limiting treatment benefits. Therefore, this study aimed to identify the various urogenital infections, associated risk factors, and profile the bacterial isolates, and assess their antibiotic resistance among women attending Mwingi Hospital.

Methods: A cross-sectional study was conducted on 322 women aged between the ages of 15 to 44 years. Urine and high vaginal swabs were collected from all participants and analyzed within 6 hours. Microscopic examination on wet mounts was done, bacterial isolation was done and those with significant growth were confirmed and subjected to antimicrobial susceptibility testing using specific media. Descriptive statistics were used in expressing the infection frequencies and antimicrobial resistance. Odds ratios were used to determine the risk of urogenital infection. The level of significance was considered at a P value of less than 0.05.

Results: Among the 322 women, 45.3% (146) had a urogenital infection, with bacteria being the primary cause (26.4%). The infections included UTI (22.7%), Candidiasis (15.2%), Trichomoniasis (3.7%), Gonorrhea (2.5%), and Bacterial vaginitis (1.2%). Antibiotic use was 32.9%, with only 2.8% receiving a microbiological diagnosis before antibiotic use. The overall antibiotic resistance was 53%, with the lowest resistance observed against penicillin and combinations (31.4%) and 3rd Cephalosporins (39.4%). The highest resistance was observed against nalidixic acid (74.8%) and cotrimoxazole (62.6%).

Conclusion: Women attending Mwingi Hospital are commonly affected by various urogenital infections. Antibiotic use without microbiological diagnosis was observed. Among the antibiotics tested, 3^rd generation cephalosporins and penicillin combination agents were noted as the most effective in treating bacterial urogenital infections, while nalidixic acid and cotrimoxazole were ineffective. Improved diagnosis and targeted treatments are necessary to prevent further development of antibiotic resistance.

Background: Anaemia is a global public health indicator of both poor nutrition and poor health. Besides, it stands as a silent signal of mal-aligned health system across the entire human lifespan. Globally, the importance of anaemia is most pronounced among children. This study was conceived to assess severity and morphological characteristics of anaemia among children aged from 6 to 59 months old in Temeke, Dar es Salaam, Tanzania.

Methods: We designed a cross sectional, clinics-based analytical study. Children aged 6 to 59 months with anaemia were the target population. Severity and morphological characteristics of anaemia were the main outcome variables. Data were collected using a pre-designed questionnaire. Data were summarised using median and inter-quartile range (continuous variables) or frequency and proportions (categorical variables). Chi-square tests were applied to assess association between categorical variables. Alpha level of 5% was used as a limit of type 1 error in findings. Written informed consent was sought from mother of each child prior to inclusion into the study.

Results: We successfully recruited and analysed 250 children. Participants median age was 17.5 (IQR: 9 - 34) months (females, n=112, 44.8%). Point prevalence of anaemia (Hb<12 g/dL) was 66.8%. Among anemic children (n=167), about 19%, 63% and 18% had mild, moderate and severe anaemia respectively. A direct linear association between MCV and MCHC was observed among anemic children (n=167, Spearman's rank ´Y= 0.86, P=.000). There was a significant association between prevalence and severity of anaemia among studied children (LR χ² (corrected) = 229.5, df=3). Majority (n=121, 72%) of the studied children had normocytic normochromic anaemia.

Conclusion: Majority of under-fives in attendance at outpatient clinics in Temeke were anemic. Normochromic normocytic anaemia was the most prevalent variant of anaemia in this study population.

Background: Lack of insight into the community's knowledge, attitude and practice (KAP) regarding schistosomiasis stands as a significant obstacle in controlling the disease in endemic regions. Understanding communities' KAP is crucial for designing and implementing appropriate disease control measures. The present study was conducted to assess community's KAP on shistosomiasis in Pujini, Pemba.

Methods: A total of 328 respondents aged 7 to 79 years were selected from schools and the general community using systematic random sampling method. Data collection was conducted using questionnaires, face-to-face interviews and Focus Group Discussion (FGD) to capture communities' KAP and personal experiences and participants' demographic characteristics.

Results: Most participants demonstrated awareness of schistosomiasis, including its transmission, symptoms and preventive measures, although they struggled to distinguish between urogenital and intestinal schistosomiasis. The majority displayed positive attitudes toward the disease, yet over half of them (59.1%) believed that the disease could not re-occur after initial treatment. Notably, older people were significantly less knowledgeable than their younger counterparts (ƴ² = 41.982, df = 5, p = <.05) while farmers were also significantly more knowledgeable than other occupational groups like fishermen, livestock keepers and house wives (ƴ² = 36.194, df = 4, p = .003).

Conclusion: Community's knowledge about schistosomiasis decreased with increasing age likely due to low levels of education among adults and their poor attendance to health education meetings and campaigns. Despite positive attitudes and awareness toward schistosomiasis, a significant portion of the population continue to be engaged in risky activities such as water contact and poor sanitation practices. Efforts to enhance knowledge, foster positive attitudes, and encourage good practices remains crucial for the successful control and eventual elimination of schistosomiasis.