Skilled care through antenatal, delivery and postpartum period, is essential for the mother-newborn health. Migori County in the Nyanza region had 53.4% births aided by a skilled health professional compared to an average nationally of 61.8%, while the region averaged 65% in the 2014 Demographic and Health Survey. To address the comparatively lower uptake of skilled care, a maternal-infant community-level health interventional project was instituted. This study assessed the effectiveness and determinants of the integrated maternal- infant health intervention on uptake of skilled professional services through birth and postnatal among reproductive age women in Migori County. A quasi-experimental, posttest only nonequivalent groups design was applied in this study. A sample of 590 reproductive age women, who gave birth after January 2014 in Rongo and Migori sub-county, were included in the study. Data were collected using interviewer administered questionnaire and key informant guides. Utilization of postpartum and delivery services in a health facility were the two main outcome measures of the study. Descriptive statistics reporting proportions, Chi square and Fisher’s exact test at bivariate and odds ratio at multivariate analysis level were computed. The findings show a twenty seven percent (27.2%) increase in utilization of facility delivery for the intervention group, compared to 16.6% increase for the control (χ2= 9.0, P= 0.003). Participants who received the intervention had increased odds - AOR= 1.56, p=0.048, of having a health facility delivery and higher odds - AOR= 3.31, p=0.016, to using postpartum care services. Being in married union decreased the odds - AOR= 0.33, p=0.006, of seeking health facility delivery. Choice of health facility delivery was positively influenced by a mother having had attended at least four antenatal visits and having a birth companion (p=0,000), with ones mother as a birth companion (AOR 4.97, p=0.000). There were a higher proportion of complications necessitating attention by a health professional reported at 13.3% in the control group, compared to intervention at 2.9%. Having been sensitized on maternal-infant health by traditional birth assistant, cut down probability of uptake of delivery at health facility by 18.2 times (AOR= 0.055, p=0.017). At multivariate analysis, participants who had community health Volunteer referral for post natal care to a health facility, had greater odds - AOR= 2.72, p=0.039, of taking up the services, the odds declined for those taking between 30 to 60 minutes to health facility (AOR 0.166, p=0.002). From the key informants, lack of male partner support and ‘feeling experienced’ were cited as barriers to seeking skilled care at health facility. In conclusion, the intervention improved uptake of facility delivery and postpartum care. Availing health education and having ones mother as birth companion are two critical aspects that can improve uptake of skilled birth attendance and postpartum care. Study recommends appliance, and scaling up similar ‘community-level’ approaches in raising utilization of health facility care in the other Migori County, sub-Counties and in other places in Kenya where reduced uptake of SBA prevails. Further, more emphasis is needed on health education for the pivotal role played in influencing uptake of postnatal care.

Maternal anaemia is a significant contributor to pregnancy-related mortalities worldwide, and its aetiology has been linked to iron deficiency. To meet the increased nutritional demand in pregnancy, supplementation of iron and folic acid is vital. The supplements are provided freely to pregnant women during antenatal visits at public health facilities but their uptake in Kenya remain unacceptably low. We sought to identify the prevalence of self-reported Iron and Folic Acid supplementation (IFAs) adherence during pregnancy and its determinants among mothers seeking Maternal and Child Healthcare (MCH) 0-6 months post-delivery at Kakamega county hospital. To achieve this, an institution based cross-sectional study incorporating a mixed-method study design was conducted between May to August 2020. Both qualitative and quantitative data were collected. Quantitative data were collected through face-to-face interviews with eligible mothers of 0-6 months postdelivery using semi-structured questionnaires. Qualitative data were obtained through Key Informant Interviews (KIIs) with Community Health Volunteers (CHVs) and healthcare providers. During data collection, a systematic random sampling technique was used, and a total of 241 mothers of 0-6 months post-delivery were interviewed. The qualitative data collected were transcribed in Microsoft word 2016 and organized into themes using NVIVO 12. The quantitative data were analyzed using R statistical software version 3.5.2. The findings of the descriptive analysis, Chi-square tests and logistic regression were presented through tables and figures. Inferences were made at a 95% Confidence Interval (CI). The results showed a moderate adherence to IFAs (60.6%) during pregnancy among mothers seeking MCH at Kakamega county hospital. Some of the reasons for non-adherence stated by the respondents included: IFAs related side effects (41.3%), forgetfulness (37.3%) and bad smell of the supplements (10.3%). Higher IFAs adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts of low anaemia knowledge. Health system-related factors found to influence IFAs compliance positively were: having had pregnancy counselling before conception (OR=2.086, 95% CI: 1.071, 4.255; p<0.01) and having received education on IFAs during ANC visits (OR=2.372, 95% CI: 1.109, 5.218; p=0.028). Also, KIIs with CHVs linked IFAs adherence to socio-cultural factors such as strong religious beliefs, misconceptions and old age pregnancies. The study concluded that there is a moderate adherence to IFAs during pregnancy among mothers seeking MCH at Kakamega county hospital. The greatest impediments of IFAs compliance during pregnancy are IFAs related side effects, forgetfulness, and the bad smell of the IFAs tablets. We recommend that the MCH department of Kakamega county hospital intensify counselling on IFAs among all the mothers seeking ANC, especially on home-based remedies of IFAs related side effects. Supposedly, little incentives such as issuing a card or certificate to mothers who complete more than 4 ANC visits could boost ANC adherence.

Sickle cell anaemia is an autosomal recessive blood disorder that has over the years been a big burden on healthcare in Kenya and Africa as a whole. The disease tends to be caused by a point mutation that occurs in the beta globin chain of red blood cells. The gene Adenine (A) is replaced by the gene Thyamine (T). This in turn causes an alteration of the amino acids from the hydrophilic Glutamic Acid to the hydrophobic Valine. This in turn causes the production of red blood cells that tend to sickle in hypoxic conditions, HbS. The production of this type of red blood cells is characterized by various complications. The symptoms include; anaemia, jaundice, stroke, bacterial infections, vaso occlusive crises, acute chest syndrome, splenic sequestration among others. Vaso occlusive crises is one of the major complications of the condition. This is whereby a patient experiences a substantial amount of pain in any body part. Most commonly in the back, chest or legs. This pain occurs when the sickled red blood cells block the flow of blood to certain tissues thus depriving them of oxygen. This in turn causes the body to initiate an inflammatory response so as to deal with the problem. The key strategy in the management of these patients is achieving a steady state. This refers to a situation whereby a patient has not experienced any illness or any vaso occlusive crises and has not received any blood transfusion in a duration of at least 3 consecutive months. In order to achieve this, sickle cell patients have to take a lifelong regimen of a drug named hydroxyurea (HU). This drug is not provided free and due to this and various other reasons, some patients within the Kenyan population have been found not to take this daily medication. Other various reasons such as a belief the drug would cause cancer, side effects felt from it and a lack of understanding of its purpose contributes to non-compliance to taking it. Sickle cell anaemia patients require routine laboratory analyses which include a full blood count. The full blood count is the test most utilized in the routine monitoring of these patients. However, there is no data that depicts the differences, if any, of the haematological parameters within the Kenyan sickle cell population and such data would lead to enhancing the management of these patients through hydroxyurea by both their clinicians and caregivers. The objective of this study was to compare the haematological parameters; haemoglobin levels (Hb), white blood cell (WBC) counts and Platelet (Plt) counts, of sickle cell patients in steady state, both those taking hydroxyurea and those not taking hydroxyurea. For this a comparative cross-sectional study was carried out at the Kenyatta National Hospital where 92 sickle cell patients in steady state were selected by systematic sampling. Of these, 46 patients were compliant to taking hydroxyurea and the other 46 patients were not taking hydroxyurea at all for a period not less than 3months. Upon giving consent, about 2ml of whole blood was collected from each participant and placed in vacutainers containing the anticoagulant Ethylene Diamine Tetra Acetic Acid. This blood was then evaluated for full blood counts, obtaining parameters including the white blood cell counts, haemoglobin levels and platelet counts. Demographic data was collected using a questionnaire, which was also used to collect data for screening of participants and collected data entered into a database. The student t test, two sample t test assuming unequal variance, was then used to assess the significance of difference between the respective means of the groups. A p value of less than or equal to 0.05 was considered statistically significant in this comparison. The mean haemoglobin level of the group of patients on hydroxyurea was found to be significantly higher compared to the mean haemoglobin level of the hydroxyurea naïve group. On the other hand, the mean white blood cell count of the group of patients on hydroxyurea was found to be significantly lower compared to the mean white blood cell count of the hydroxyurea naïve group. The mean platelet count of the group of patients on hydroxyurea was also found to be significantly lower compared to the mean platelet count of the hydroxyurea naïve group. In conclusion, a statistically significant difference between the haemoglobin, white blood cell counts and platelet counts was noted between the two groups. This included a higher mean in Hb in the group of patients on hydroxyurea and a lower mean in white blood cell count and platelet count. These findings lead to the conclusion that hydroxyurea has a significant impact on the haematological parameters of sickle cell patients. This impact is positive and it consequently leads to an overall positive impact on health status for sickle cell patients. Studies such as this can form a basis for further research on the mechanism of action of hydroxyurea on the blood parameters.

Delivery of safe water for human consumption is now considered a fundamental right. However, dwindling resources and faulty sanitation in Low and Middle- Income Countries makes the availability of safe water almost unattainable. It is therefore important to continuously evaluate the chemical and biological quality of drinking water. Failure to do so, people will be exposed to numerous water borne enteric diseases. Mombasa and the Coastal Region in general experience perennial water shortages. This cross-sectional study aimed to determine the frequency and characterization of Escherichia coli pathotypes from water samples collected from and wells in Mombasa County. One hundred and fifty-seven (157) water samples were collected from all four Sub Counties that is Mvita, Kisauni, Likoni and Changamwe Sub Counties using sterile techniques. Variables such chlorine treatment, distance to pit latrine, borehole or well covers, among others were recorded. The samples were then inoculated to double strength MacConkey broth and incubated at 370C for up to 48 hours. Positive results from the double strength MacConkey broth were compared to the 3 tube McCrady Most Probable Number table. The Escherichia coli were confirmed by Eijkman‟s test and antibiotic susceptibility carried out on confirmed isolates. The Escherichia coli were then molecularly characterized to determine the pathotypes using polymerase chain reaction. Out of 157 samples collected from around Mombasa County, one hundred and thirty-one (131) samples (83.4%) were contaminated by coliform bacteria. Of the contaminated samples, only 79 (60.3%) were confirmed to have E. coli. All the samples with E. coli tested (n = 77; 100%) were sensitive to Gentamicin, while all (n = 77; 100%) isolates were resistant to Ampicillin. Molecular characterization indicated that this study‟s isolates were typed as Enteroinvasive E. coli. These findings suggest that E. coli are major contaminants of water in wells and boreholes in Mombasa County. The E. coli showed a distribution of resistant and sensitivity patterns to commonly used antibiotics. The most dominant pathotype detected was Enteroinvasive E. coli.

Community participation is of paramount importance for the success of any community project. This study aimed at determining the level of community participation in rural health care services and the associated factors in enhancing community participation in Kakuyuni sub-location, in Machakos County. The planning and implementation of rural health care services, is dominated by the individual interests of their leaders or influenced by other local leaders, political leaders and facility in charges rather than the community itself. The objectives of this study were to; To determine at what level the community participates in rural health services, to determine the socio-demographic and community related factors that affect community participation in rural health services and to determine the challenges hindering community participation in rural health care in Kakuyuni Sub location, in Machakos County. An interviewer administered questionnaire which was both closed ended and open ended was used to collect data from 384 participants. A cross-sectional analytical study design was used to conduct this study. The quantitative data obtained was analysed using SPSS software version 24, and Chi square was used to determine significant results. The sociodemographic factors were analysed using descriptive statistics. To analyse the factors, cross tabulation and independent chi square (χ 2 ) tests were used with P values of 0.05 to determine the significant factors. The significant factors were then entered in for Binary Logistic Regression, and finally to multivariate r egression. The researcher found out that, 59 (15.4%), of the respondents were involved in needs assessment, 36 (9.4%) at implementation stage, 1.6% at monitoring and evaluation, and 1.3% were involved in all levels of rural health care. However, most 278 (72.4 %) of the respondents reported no involvement at any level of rural health care. The following factors were significantly affecting community participation towards rural health care services; length of stay in the area and community mobilization Some of the challenges hindering community participation in rural health care facility services included; lack of laws specifically governing implementation of community projects; majority of community members lacked knowledge on community participation 349 (90.9%) on when and where to participate in, lack of community empowerment, poor leadership in the community, lack proper representation and poor infrastructure, poor management systems and poor communication systems. In conclusion, Kakuyuni community members community participation in Kakuyuni Sub-location was low at 106 (27.6%). The study recommends that the community should be enlightened on community participation and their role in rural health care facility services, there is need for increased community mobilization and empowerment to the community members on community participation to ensure increased participation and more so in males and the need for Community leaders to be sensitized on governance, community empowerment and establishing good communication systems. All this together will make the community members to gain control of the program and decisions that shape their health care.

Enteric pathogens occur in high concentrations in untreated sewage water. In areas where untreated sewage water is used to irrigate agricultural land for cultivation of horticultural crops, it may pose a health risk to consumers, farm workers, handlers of the produce, and possibly, the community that lives within the vicinity of wastewater irrigated land. A cross-sectional survey, targeting 446 school children aged 6-12 years was conducted in 5 public primary schools in Njiru Sub-County, on the eastern side of Nairobi County. The objectives of the study were to determine the prevalence, intensity, and risk factors associated with the presence of intestinal parasitic infections (IPIs) in the study area. Fecal samples were collected from children whose parents or guardians had consented to their participation in the study. Ova and parasite detection was performed using both the formal-ether concentration and the Kato-Katz procedures. The intensity of infection was classified as light, moderate and heavy. Risk factors associated with the presence of IPIs such as education level of parents/guardians, hand washing habits, source of water for household use were assessed using a questionnaire, which was administered to parents/guardians. The overall prevalence of intestinal parasites was 37%, (95%CI 32.5-41.7%) with protozoan infections accounting for 26.7% and helminth infections, 15.1%. Entamoeba histolytica/dispar (39%) and Giardia duodenalis (8.1%) occurred in moderate to heavy intensities. Other protozoan parasites present were Entamoeba coli (2%), and Pentatrichomonas hominis (<1%).The most common helminth parasites were Ascaris lumbricoides (14.8%) and Trichuris trichiura (12.8%) with many children having light intensities of infection. Other common helminth infections present were hookworm (8.5%) and Schistosoma mansoni (5.8%). Other parasites detected were Enterobius vermicularis (4.3%), Hymenolepis nana (3.4%), Taenia species (1.6%), Diphyllobothrium latum (0.2%), Fasciola hepatica (0.2%) and Hymenolepis dimunita (0.2%). Children whose parents or guardians had primary education only (LR test=10.11, df=4, P=0.0386) and those who used the river as their main water source (P=0.027), were more likely to become infected. IPIs were common among the children in the Njiru area. Further investigations are needed to determine the impact of these infections on the children living in this locality. School-based interventions are recommended for control of these infections in the area.

The field of miRNA biology is tremendously growing, moreover, their roles of regulating a wide array of cell function is extensive. The importance of miRNAs in development has become nearly ubiquitous, with miRNA contributing to development of most cells and organs. Although miRNAs are clearly interwoven into known regulatory networks that control cell development, the specific modalities by which they intersect are often quite distinct in different organism. In insect species miRNA involved in development has been well study in Drosphila spp and Anopheles spp. However, information concerning possible developmental role of miRNAs in tsetse is limited. Hence, the aim of the study is to identify and characterize miRNA genes in the developmental cycle of G. pallidipes. Firstly, the small RNAs from the five developmental stages (larvae, pupae, teneral adults, non-teneral adults and gravid females) were sequenced using next generation sequencing technology. A total of 157 miRNAs were identified, which included 99 known tsetse miRNAs, 46 miRNAs conserved in other insects, and 12 novel miRNAs that had not been reported in any species. Moreover, we identified 93 miRNA genes that were differentially expressed by sex and/or in specific developmental stages. Hence, the 5550 target genes for the differentially expressed genes were identified using miRanda and RNAhyrid. Functional annotations using Blast2GO yielded KEGG pathways: Purine metabolism (n = 183), Thiamine metabolism (n = 163), Biosynthesis of antibiotics (n = 55), Aminoacyl-tRNA biosynthesis (n = 16), Pyruvate metabolism (n = 13), Pyrimidine metabolism (n = 12), Glycerophospholipid metabolism (n = 12), Amino sugar and nucleotide sugar metabolism (n = 11) and cysteine and methionine metabolism (n = 11). Also, gene ontology including, cellular process (n = 1464), metabolic process (n = 1383), cell part (n = 790), organelle (n = 609), membrane (n = 588), biological regulation (n = 467), localization (n = 398), response to stimulus (n= 285), cellular component organization or biogenesis (n = 222), and signalling (n = 218). The finding offers miRNA genes involved in the regulation of critical physiological functions specific towards G. pallidipes development, which could eventually guide other scientist in the use of miRNA genes as a combination of novel approaches and the available technique to combat tsetse-borne diseases.

The recommended strategy for control of schistosomiasis is preventive chemotherapy with praziquantel (PZQ). Pre-school age children (PSAC) are excluded from population treatment programs. In high endemic areas, these children are also at risk, and require treatment with PZQ. The Government of Kenya initiated the National School-Based Deworming Programme (NSBDP) where PSAC in Early Childhood Development (ECD) Centres are only eligible for treatment with albendazole (ABZ) but not with PZQ. Four hundred PSAC were enrolled, from 10 randomly selected ECD Centers in Kwale County, Kenya where children were treated with crushed PZQ tablets mixed with fruit juice, at a single dose of 40 mg/kg. Treatment efficacy was assessed by examining urine samples for Schistosoma haematobium eggs in the 5 weeks’ post-treatment follow-up. Children testing negative for S. haematobium during the follow-up were considered cured. Egg reduction rate (ERR) was calculated as the decrement in the infection intensity (group’s geometric mean egg counts per 10 ml of urine) following treatment, expressed as a proportion of the pre-treatment infection intensity. Twenty-four hours’ post-treatment, adverse effects were assessed through questionnaires administered to the parents or guardians.Treatment acceptability was determined by observing if the child spat and/ or vomited all or part of the PZQ dose immediately after treatment.Before treatment, 80 out of the 400 children enrolled in the study tested positive for S. haematobium (20.0% (95% confidence interval (CI) 16.4 - 24.2%). Of these, 41 (51.3%) had infections of heavy intensity while the rest (48.7%) were of light intensity. Five weeks’ post-treatment, 10 children who had heavy intensity infection were diagnosed with S. haematobium (prevalence: 2.5% (95% CI 1.5 - 4. 9%). Infection intensities decreased significantly from 45.9% (95% CI: 31.0 - 68.0) eggs/ 10 ml urine to1.4% (95% CI: 1.1 - 1.7) eggs/ 10 ml urine during pre-and post-treatment respectively. The ERR was 96.9%. 330 out of the 400 children recruited inthe study were assessed for AEs 24 hours post treatment. One experienced dizziness, one experienced a headache, four had abdominal pain/discomfort, two had nausea and two experienced itching. None of the children vomited. While six respondents took no action when their child experienced an adverse event, one gave food, two gave milk and the other one made the child to rest. Treatment tolerability among the 400 children was high as none of the children spat and/ or vomited as observed in this study. The study revealed that crushed PZQ is safe and effective in the treatment of urogenital schistosomiasis in this age group. The study recommends the Government of Kenya to consider having the PSAC children treated with PZQ as they have a high S. haematobium burden.

Cancer screening is known to reduce cancer morbidity and mortality, but this disease still remains to be one of the leading causes of cancer deaths in Kenya because of low screening uptake. This study, therefore, aimed at examining psychological, social and behavioral factors associated with the uptake of cancer screening services in Masinga sub-county, Machakos county, Kenya. Mixed method research design was used: case-control with systematic sampling method for quantitative data; and phenomenological approach with purposive sampling method for qualitative data. Quantitative data was collected using an interviewer-administered questionnaire and analyzed using SPSS version 26.0. Chi square/Fishers exact, Odds Ratios, T test and Mann-Whitney U tests were used to determine significance of the association between outcome and independent variables. Focus group discussions (FGDs) were used to collect qualitative data which was analyzed thematically. The data was presented using frequency polygons, tables and narratives. Confidence level was 95%. Data was gathered from a sample of 42 cases (screened [male- prostate, esophageal and colorectal; female- breast, cervical and esophageal]) and 116 controls (never been screened). Health belief model constructs, cognitive well-being, stress, autonomy and general self-efficacy were used as psychological variables. Social variables assessed were social network and social exclusion. Behavioral factors assessed encompassed knowledge on cancer screening (cues to action) and the effect they had on uptake of cancer screening, determinants of health seeking behaviors with regard to screening uptake, facilitators and barriers to screening and knowledge on preventive behaviors to cancer development. Qualitative data from nine FGDs were collected to enrich the quantitative data. Mantel-Haenszel test revealed that uptake of cancer screening is associated with cognitive well-being [OR .440 at 95% C.I .338- .572, p <0.001], autonomy [awareness of self (OR .172 at 95% C.I .049- .602, p .006 ), perceived choice (OR .119 at 95% C.I .048- .300, p <0.001)], general self-efficacy [OR .727 at 95% C.I .638- .828, p <0.001], increased perceived stress [OR .768 at 95% C.I .620- .951, p .016], perceived susceptibility (OR 2.758 at 95% C.I 1.155-6.585, p .022), perceived severity (OR 5.720 at 95% C.I 1.835-17.832, p .003), perceived benefits (OR 2.217 at 95% C.I 1.087-4.520, p .029). Also, for social factors, screening uptake was associated with decreased social exclusion [OR 1.785 at 95% C.I 1.390-2.291, p<0.001] and better social network [(Emotional loneliness OR 5.791 at 95% C.I 1.384-24.225, p .016) (Social loneliness OR .200 at 95% C.I .114- .351, p <0.001)]. This study established strong association between psychosocial factors and cancer screening uptake. Generally, there was poor knowledge on behaviors that contribute to cancer among the controls compared to cases. Based on the findings, special emphasis should be directed at increasing awareness, perception and dispelling the myths surrounding cancer and cancer screening at all community primary care points through well-designed health education programs.

Cardio Pulmonary Resuscitation refers to a sequential chain of measures taken to save and maintain the quality of life of a patient following cardiac arrest. The process involves recognition of absent breathing and circulation, basic life support with chest compressions and rescue breathing, and post resuscitative care. Effective cardiopulmonary resuscitation improves the patients’ outcomes hence reducing mortality related to cardiac arrest. The determinants of effective cardiopulmonary resuscitation (CPR) among health care workers are not well researched in African countries. The study sought to examine the knowledge, skills, and institutional factors that determine effective cardiopulmonary resuscitation among health care providers at Nakuru County hospital. The study adopted an analytic cross-sectional design; incorporated quantitative study tools. The study was carried out at Nakuru County Hospital. A census sampling technique was adopted to select 175 respondents who participated in the study. Data was collected using questionnaires and checklists. Data analysis was done using SPSS computer software, version 24 for descriptive analysis to generate frequencies, percentages, and tabulations. Chi-square tests and multiple regression analysis were done to determine the significant association between variables. Ethical approval was obtained from National Commission for Science, Technology, and Innovation (NACOSTI). Permission to collect data was also sought from Nakuru County Hospital administration. Informed consent was sought from the respondents before data was obtained. Majority, 54.3% (n=88) of the respondents had low knowledge of cardiopulmonary resuscitation. The majority 70.9% (n=112) did not have a BLS/ACLS certificate. According to the findings, 55.1% (n=87) and 51.9% (N=81) indicated that they did not have all the necessary resources for CPR. There was a significant relationship (p<0.001) between CPR knowledge and CPR practice. Among institutional factors, having a BLS/ACLS certificate (p=0.003), a refresher course in the last 2 years (p<0.001) and necessary resources (p=0.014) were significant. Respondents who had a BLS/ACLS certificate and those who had a refresher course in the last 2 years and those who indicated that necessary resources were 3.4, 2.9, and 3.1 times more likely to have good CPR practice. The poor practice of cardiopulmonary resuscitation among health care workers at Nakuru County Hospital is attributable to low CPR knowledge. Institutional factors also influenced effective CPR. More emphasis should be placed on continuous professional development and supervision be done after training. The hospital managers to enact a policy ensuring all health care workers possess a valid BLS/ACLS certificate.