The East African health research journal最新文献

Background: Dietary Diversity (DD) is an important component of Infant and Young Child Nutrition (IYCN). Globally, it is recommended that children aged 6-23 months be fed on diverse diets as a public health measure in curbing malnutrition. In Kenya, stunting rates among children below the age of five years is 26% and diversifying of diets is still sub-optimal. The study sought to assess maternal factors associated with dietary diversity scores among children aged 6-23 months in Kwale County, where stunting stands at 29%.

Methods: A cross sectional study design was adopted and a random sample of 244 mothers with children aged 6-23 months, residing in locations under Health and Demographic System Surveillance (HDSS) program participated in the study.

Results: Mothers aged 17-68 years were interviewed. Children's DD scores ranged from 0 to 5 with a mean of 2.2±0.9, only 8.2% of the children met the Minimum Dietary Diversity score (MDDs) of 4 food groups or more in a day. A bivariate regression analysis to determine factors associated with children's dietary diversity scores showed significant positive relationship with mother's educational level (r=0.186, P<.000, α=.01), household wealth index (r=0.163, P<.000, α=.01) and the child's age (r=0.396, P<.004, α=.01).

Conclusion: The study concludes that mothers' level of education, households' wealth index and child's age are factors associated with dietary diversity scores of children. Higher dietary diverse scores were observed among older children in the study age categories, from wealthy families and under care of mothers with higher education levels. In the study area however, only 8.2% of children met the minimum dietary diversity score necessitating targeted nutrition education of mothers and implementation of economic development initiatives to boost availability and consumption of diverse diets. A consideration of child age specific interventions will also address nutritional needs and preferences at different stages.

Background: Reducing Neonatal Mortality (NM) is vital in decreasing mortality in children below 5 years. Uganda has reported a significant reduction in under 5 and infant mortality over the past decade while NM has stagnated at 27 deaths per 1,000 live births. The NMR of 34 deaths per 1,000 live births in Eastern Uganda is higher than the national rate.

Objective: To determine risk factors for neonatal mortality in rural Iganga district, Eastern Uganda.

Methods: A matched case-control study was conducted between February and July 2019 in Nakigo and Nakalama sub-counties of Iganga district. Cases (n=91) were neonates that died and the controls (n=182) were live neonates at 1 month. Data on maternal, social demographic and neonatal variables were collected from mothers of neonates at household level. Descriptive analysis was performed to determine the profile of study participants. Data was presented as mean (and standard deviation) for continuous variables, and frequencies with percentages for categorical variables. A conditional logistic regression was performed to calculate Odds Ratios and to establish factors that were independently associated with risk of neonatal Mortality.

Results: Giving birth to 5 or more children (AOR=2.88, 95% CI =1.25-6.63), attending less than 4 antenatal care visits (AOR= 2.27, 95% CI= 1.14-5.54), and giving birth to twins (AOR= 6.30, 95% CI=1.24-32.0) were the risk factors for neonatal mortality while delivering from health facilities was protective (AOR= 0.26, 95% CI= 0.12-0.56).

Conclusion: The risk factors for NM are: - giving birth to 5 or more children, attendance of less than 4 antenatal care visits and giving birth to twins. To reduce the risk of NM, the study re-emphasises the need to put more focus on neonatal care during pregnancy and child birth. The study findings can be utilised to determine priorities for reducing the risk of NM in rural settings.

Background: Only 11% of women use family planning in Pemba, Tanzania. Among them, 9% use modern family planning (FP). Inadequate use of modern FP in the area may result in rapid population increase and attendant negative impact on social and economic development in the country.

Methods: An exploratory descriptive study was conducted in Wete District, Pemba. Thirty-eight women aged between 20 to 49 years were conveniently recruited for the study. The saturation was achieved with 4 FGDs and thematic framework guided analysis of data.

Results: Modern FP methods are available and accessible in all government healthcare facilities in Pemba. However, some women perceived that modern FP are effective and others think they are ineffective in preventing pregnancy. Male dominancy, religious beliefs, polygamy, and the economy influence the low uptake of modern FP.

Conclusion: Modern FP methods are widely accessible for free in Wete Pemba; however, their low uptake is influenced by social-cultural and economic factors. Community-based education on the benefit of Modern FP will facilitate positive perceptions of using modern FP and increase its use by women in Wete Pemba.

Introduction: Cholera epidemic poses a global public health threat, heavily impacting the global economy and societies, with Africa and Asia particularly affected due to factors like; inadequate sanitation, contaminated water, and overcrowding. The associated high rates of morbidity and mortality strain productivity and healthcare costs while complicating control measures. Consequently, the World Health Organization's cholera control initiative and the Diarrhoeal Diseases Laboratory Network advocate for rapid responses to outbreaks and continuous environmental surveillance, since traditional cholera detection methods relying on phenotypic fingerprinting, although considered the gold standard, suffer from labour-intensiveness, time-consumption, and skill requirements. This results in inadequate surveillance and delayed treatment in remote areas lacking well-equipped laboratories.

Methods: A systematic review was conducted to evaluate the development and performance of cholera rapid diagnostic techniques for detecting cholera in clinical samples and for environmental surveillance purposes over the past decade.

Results: Twenty-four commercially produced diagnostics were identified in January 2011. Ten more were mentioned in the literature and yet did not provide enough relevant data due to suspected production withdrawal or fall-back. The vast bulk of tests were discovered to be based on antigen or antibody detection, with DNA accounting for a large proportion of the residual tests. This study revealed a plethora of diagnostic methods, some of which have not yet made it to the commercial market. Promising approaches, such as; Loop-mediated isothermal amplification (LAMP), ELISA, and simplified PCR protocols, are likely to play a significant role in future cholera screening. Findings are herein summarised in tables and figures.

Conclusion: Cholera epidemic continues to present a formidable global health challenge with economic and social repercussions. Traditional detection methods fall short in resource-limited areas, necessitating the exploration of advanced molecular techniques, like aptamers, to improve diagnosis, surveillance, and control measures, especially in regions vulnerable to cholera outbreaks.

Background: The 2019-20 Rwanda demographic health survey revealed an overall use of modern contraceptives of 58% but participants were not likely to use family planning in the postpartum period. Three quarters of participants intended to use contraception only after they had resumed menses and not breastfeeding. This study intended to measure post-abortion contraception uptake and to evaluate factors affecting immediate post abortion contraception uptake among patients consulting two public hospitals in Kigali, Rwanda.

Methods: This is an observational cross-sectional study of women admitted for abortion in 2 hospitals' obstetric units in Kigali; the University Teaching Hospital of Kigali (CHUK) and Muhima District Hospital (MH) from November 2019 to April 2020. Admission registry was accessed daily to determine abortion admissions. After informed consent, participants underwent a standardised interview prior to their discharge from respective hospital.

Results: There were 252 participants over 6 months; 88.5% were counselled for post-abortion contraception and 52% desired contraception prior to hospital discharge. Upon discharge, 70.2% of the study participants who wished immediate post abortion contraception received it before discharge and 29.8% had no contraception despite having expressed interest for immediate post abortion contraception. Being married and involving husband in choosing post-abortion contraception were significantly associated with use of post-abortion contraception.

Conclusion: Post-abortion contraception uptake in 2 large public hospitals in Kigali remains low. Being married and involving husband in choosing post-abortion contraception are positive factors associated with post-abortion contraception uptake while choosing a permanent contraception is associated with not receiving any contraception at the time of discharge from hospital. There is a need to consider prescribing an alternative interim methods of contraception to women desiring permanent sterilisation.

Background: Rapid advancement and penetration of mobile phone technology has made the devices indispensable professional, social, and networking tools. However, the impact of their use in the spread of multi-drug resistant diarrheal-causing bacteria is less understood.

Objective: The aim of this study was to determine the practices of mobile phone use among healthcare workers, paediatric patients' caretakers, and paediatric inpatients with diarrhoea at Kitale County Referral Hospital, and identify the associated risk of spread of bacteria, including multi-drug resistant strains on the mobile phones.

Method: Questionnaires were administered to research participants and swabs were collected from mobile phones of consenting healthcare workers and paediatric patients' caretakers for further analysis. Stool samples were also collected from paediatric study participants diagnosed with gastroenteritis. Culture was done following standard microbiological procedures. Isolate identification, antibiotic susceptibility profile, and MDR phenotypes were tested using the Vitek 2 Compact microbiology analyzer. Gram-negative MDR isolates were then screened for selected carbapenemase genes using multiplex real-time PCR.

Results: Only 38% of healthcare workers sanitize their handsets during or after work. The most common mobile phone bacterial isolate was Enterococcus faecalis (28.95%) followed by Staphylococcus aureus (18.42%). 58% of stool sample isolates were Vibrio cholera 01 serotype followed by Escherichia coli 0157.H7 (20%). Methicillin-resistant Staphylococcus aureus (43%) and Vancomycin Resistant Enterococcus (6%). BlaVIM was the most commonly detected gene from five isolates, including Vibrio cholera 01.

Conclusion: The most common pathogen circulating on the mobile phones of healthcare workers and patients' caretakers at Kitale County Hospital is Enterococcus faecalis.

Introduction: Endometriosis is characterised by endometrial tissue outside the endometrial cavity. The implantation sites may be pelvic or extrapelvic in nature. Umbilical endometriosis is a rare type of cutaneous endometriosis, accounting for 0.5-1% of extrapelvic endometriosis cases. Current literature on umbilical endometriosis is absent in the Tanzanian population.

Case report: A 30-year-old woman with prior caesarean deliveries presented with a 3-year history of umbilical swelling, cyclical pain, and menses-related bleeding. Examination revealed a firm brown umbilical lesion measuring 5×4 centimetres (cm). Wide excisional biopsy was performed. Histopathological examination confirmed endometriosis and ruled out malignancy. The postoperative follow-up revealed no signs of recurrence.

Conclusions: This case report highlights the need for high clinical vigilance and comprehensive differential diagnosis, especially for recurring and cyclical abdominal symptoms. Despite resource limitations, accurate diagnosis and appropriate treatment can result in the successful management of this rare condition. The report emphasises the urgency for clinicians to boost awareness, promote research, and advocate for better resources to ensure optimal patient outcomes.

Introduction: The introduction of Hepatitis B vaccination in the general community requires understanding the factors that determines its uptake. This is specifically essential for planning, implementation and evaluation of the effectiveness of the program. This study investigated the uptake and associated factors of Hepatitis B Vaccination among clients attending Budwale Health Center in Eastern Uganda.

Methods: Facility based cross-sectional study was conducted from July to December, 2022. Interviewer administered questionnaire was used to collect data from 403 respondents who were aged 18 years and above attending a government health facility. Data was analyzed using SPSS version 20. Vaccination uptake was determined by descriptive statistics, measures of association were done using modified Poisson regression to estimate the association between the factors and vaccination uptake. Scores on knowledge questions were categorized using bloom's cut off point into good knowledge (>80%), moderate knowledge (60-79%) and poor knowledge (< 60 %).

Results: Vaccination uptake was at 68.7% which is the recommended 90% required to achieve herd immunity. Slightly above half of the participants (51.8%) and 35.7% had moderate and good and knowledge about HBV vaccination and infection respectively. Age category (28-37 years) were more likely to be vaccinated than other age categories. PR=1.21 95% CI: (1.025, 1.418) P=0. 024. Clients who had moderate knowledge were more likely to be vaccinated compared to those with poor knowledge PR=2.81, 95%CI: (1.830, 4.306) P=0.001. The study also found that the cost of vaccines, presence of health workers, distance of health facilities from the home, long waiting queues and occupational risks were the main reasons for low uptake of vaccine.

Conclusion and recommendation: The uptake of HB vaccination was moderate among the studied group which was influenced by individual factors such as knowledge on HB as well as health services access factors. Therefore, due attention should be given to filling the knowledge gaps through education and sensitization, and addressing the barriers to accessing vaccination services.

Background: Young population is at high risk of acquiring sexually transmitted infections including hepatitis B virus, and thus the key target group for intervention. University students are reported to have inadequate knowledge concerning HBV. This study aimed to generate information on students' knowledge and attitudes surrounding HBV preventive practices.

Methodology: A cross-sectional study was conducted in three Tanzanian universities in Moshi town of the northern Tanzanian region of Kilimanjaro. A total of 283 students were interviewed regarding their knowledge, attitudes, and practices regarding Hepatitis B Virus infection. Bloom's cut-off of 80% was used throughout to determine whether respondents had appropriate Knowledge, Attitudes, and Practices (KAP). Chi-squared test was used to measure independent associations between observed KAP levels with any demographic risk factors, with a P value of 0.05 as the cut-off for statistical significance.

Results: There was a fairly good knowledge about HBV among students among the three universities such that; 22.3%, 33.9% and 43.8% of the students had good, moderate and poor knowledge about HBV, respectively. While 46.3% of the students showed neutral attitude towards HBV, 29.3% and 24.4% had positive and negative attitudes, respectively. Only 6.0% of the students had good practices for HBV whereas 21.6% and 72.4 showed moderate and poor practices respectively. With regards to good knowledge, associated demographic factors included: Being single (P=.007); Having a master's degree (P=.039) and being a student at MWECAU (P=.001). Being single and being a student at MWECAU were also independently associated with positive attitude to HBV (P=.007) and (.001), respectively. No demographic factor was associated with HBV practices.

Conclusions: The overall knowledge regarding HBV was fairly good among students from the three universities. Neutral attitude towards HBV demonstrated by the studied students may indicate stigma against HBV carriers. Notwithstanding the positive knowledge and the moderate attitude about HBV, there was an apparent poor practice towards HBV prevention especially vaccination and screening. Our findings, underscore the need to bridge the prominent gap between knowledge and practices among the high-risk youth in universities and schools by up scaling sensitization campaigns on preventive practices against HBV and other related viruses.

Background: Low uptake of modern contraceptives among adolescents remains a serious public health concern with over 20 million adolescents in need of modern contraceptives are not using any. In Tanzania where the adolescent fertility rate is 112 per 1000, only 15.2% of adolescents are using modern contraceptives. Contraceptive use stands out to be one of the key interventions to reduce the burden of adolescent pregnancy which is high in the country at 22%. There is little information on factors associated with modern contraceptive use among out of school adolescents, who are at an increased risk of adolescent pregnancies.

Objective: To determine the prevalence and factors associated with modern contraceptive use among out of school adolescent girls in Moshi municipality, Kilimanjaro region.

Methodology: This was a population based cross-sectional study, conducted in Moshi municipality in Kilimanjaro region 2 wards; Majengo and Njoro. The wards were randomly selected out of the 21 wards in the region. Household survey was conducted in the wards and adolescents aged 10 to 19 years who were out of school and consented and or assented to participate in the study were recruited. Data was collected using Kobo Collect ^TM on an Android device. Data was analysed using SPSS version 20. To determine the factors associated with modern contraceptive use, crude and adjusted analysis using logistic regression analysis was done.

Results: A total of 298 out-of-school adolescents were enrolled, with a median age of 19 (IQR 17-19) years. The prevalence of ever use of modern contraceptives among 154 sexually active adolescents was 51%, and 35% were current users of the methods. Two of common methods ever used were; injectables (27.3%) and male condoms (3.2%) respectively. Factors independently associated with ever use of modern contraceptives were; being married or cohabiting (aOR: 5.7) and having 2 or more sexual partners in the past 12 months (aOR: 5.9).

Conclusion: Ever and current use of modern contraceptives among out-of-school adolescents were reported at 51% and 35% respectively. Respondent's marital status and number of sexual partners was associated with ever use of modern methods. Strengthening of adolescent-friendly SRH services outside facility setting is needed given very few are currently using a modern method. Further, through inter-sectoral collaboration interventions to keep adolescent girls at school should be strengthened.