African Journal of Health Sciences <p>The Journal of African Health Sciences has been in production and circulation since 1994.The Journal has been produced through the efforts of Kenya Medical Research Institute (KEMRI) and the African Forum for Health Sciences (AFHES).</p> <p>A lot of interest had been created in the Journal locally and internationally. The Journal was regularly patronized by scientist as one of the leading scientific publication in Africa.</p> <p>The Publications Committee, a committee comprised of the senior scientists that peruses all publications emanating from KEMRI, felt that it was essential to continue with the publication and circulation of the Journal as soon as possible. Therefore the Publications Committee formed a new team to revive the publication and circulation of the Journal and to ensure future sustainability of the Journal. The new team felt there is need for mechanism to fund the above activities towards revival of the Journal on behalf of the scientist.</p> <p>Other websites related to this journal: <a href="" target="_blank" rel="noopener"></a></p> Kenya Medical Research Institute en-US African Journal of Health Sciences 1022-9272 Editorial: Why Should Bringing Life on Earth Endanger the Lives of Mothers in Developing Countries? <p>No Abstract.</p> Hudson A. Lodenyo Copyright (c) 2021-07-06 2021-07-06 34 2 148 148 Socio-Demographic Factors Influencing Utilization of Obstetric Fistula Services among Women of Reproductive Age in Makueni County, Kenya <p><em>Obstetric fistula</em> refers to an abnormal hole that connects a woman’s vagina and bladder or vagina and rectum through which urine and/or fecal matter leaks continuously. The underlying causes of obstetric fistula include early marriages, teenage pregnancies, Female Genital Mutilation (FGM), assault and surgical trauma. It is estimated globally that more than half a million women of reproductive age die from complications related to pregnancy and childbirth. Out of this statistic, about 99 percent occur in Sub-Saharan Africa and Asia. This was a descriptive cross-sectional study which was conducted at Makueni County in eastern part of Kenya. This study sought to investigate the socio-demographic factors influencing utilization of Obstetric Fistula services among women of reproductive age in Makueni County.<br><strong>Materials and Methods:</strong> The study used both quantitative and qualitative data collection methods. Quantitative data was collected using semi-structured questionnaires administered by trained Research Assistants. A total of 389 questionnaires were considered fit representing a 92.18% response rate. Quantitative data was cleaned and entered into a Microsoft excel database before being analyzed by SPSS version 22.0. Descriptive statistics were presented using percentages, frequency tables, graphs and pie-charts. Inferential statistics were calculated to establish the association between study variables using chi-square tests done at 95% confidence interval and p-values of less than 0.05 considered statistically significant.<br><strong>Results:</strong>The results revealed that only 32% (95CI, 27% - 37%) of respondents utilized obstetric fistula services in which counseling was the most sought service at 44.4% (95%CI, 36% - 53%).Chi-square analysis showed that there was a significant statistical association between age (p=0.001), level of education (p=0.002), occupation (p=0.001), average monthly family income (p=0.011) and utilization of obstetric fistula services.<br><strong>Conclusion:</strong> The study concludes that there were low utilization rates, low knowledge levels and negative perceptions towards obstetric fistula services. The findings of this study would help relevant stakeholders in structuring programs and strategize on interventions related to creation of community awareness and thus improve the health seeking behaviors towards utilization of obstetric fistulae screening services. These results would also be of use to the Ministry of Health for purposes of health education and for policy formulation and implementation with regards to workable short-term and long-term obstetric fistulae interventions.</p> <p>&nbsp;</p> Mary Maundu Mbinya Keraka Nyanchoka Margaret Maurice Onditi Kodhiambo Vincent Omwenga Matoke Copyright (c) 2021-07-06 2021-07-06 34 2 149 163 Radiologic Pattern of Uterine Leiomyoma among Rural Women Undergoing Routine Pelvic Ultrasonography in South-South Nigeria <p>Uterine leiomyomas are benign tumours of myometrial origin and are the most common solid uterine neoplasms in women and more prevalent among African women. The study was aimed at evaluating the radiologic pattern of uterine leiomyoma among rural women in South-South Nigeria.<br><strong>Materials and Methods</strong>: A descriptive study design was adopted with 1460 women in June 2017 and June 2018 in Degema and Bakana towns in Nigeria during a free medical care programme organised by the Kalabari National Association–USA. Real time grey scale ultrasonography using Sonolite Edge Portable Ultrasound machine fitted with 3.5MHz curvilinear transducer was used after obtaining informed consent. The collated results were analyzed using SPSS statistical software version 21.0 and presenting all in charts, tables, and figures. Eta correlation was used to evaluate association between variables.<br><strong>Results:</strong> The overall mean age (±standard deviation) of participants was 33.44+5.39years with a range of 18-56years and majority of participants were overweight 38.49% while 31.30% were obese. Majority of the leiomyomas were intramural constituting 47.60% followed by subserosal and submucosal constituting 28.63% and 23.77% respectively. Multiple leiomyomas were more common with majority of the masses found in the anterior wall of the uterus. Ovarian cyst was the most common co-existing pelvic lesion with leiomyoma.<br><strong>Conclusion:</strong> The radiologic pattern of uterine leiomyoma shows that intramural leiomyomas are commoner in all age groups and multiple leiomyomas more than solitary lesions. An uncommon teenage leiomyoma was seen in a 19-year-old.</p> Olukumni Yetunde Ijeruh Ebbi Donald Robinson Nengi Alazigha Alaro Meshack Lawson Wekhe Chidinma Copyright (c) 2021-07-06 2021-07-06 34 2 164 178 Determinants of Implementing a Community-Based Diagnosis and Monitoring System for Hypertension at Community Level in Malawi <p><strong>Introduction:</strong> Hypertension control and management remains a major public health challenge in low-and-middle-income countries including Malawi. In addition, health facility-based diagnosis and monitoring of hypertension in Malawi is hampered by lack of access to care, shortage of health professionals, fragmented services and extra cost especially for the poor. The purpose of this study was to explore the determinants of implementing a community-based system for hypertension at community level.<br><strong>Materials and Methods:</strong> Semi-structured interviews were conducted among 28 purposively selected community volunteers across 35 community sites in Lilongwe, Malawi. The tool was used to collect information about determinants of implementing community-based diagnosis at individual, health system and patient level. Data was analysed using thematic approach through pre-identified evolving themes. Ethical approval was granted by both Malawi and Ethics committee of the Medical Faculty of Heidelberg University.<br><strong>Results</strong>: A total of 28 community volunteers participated in the study, of which 24 (85.7%) were females and 4 (14.7%) were males. The determinants that affect diagnosis and monitoring at community level were categorized into three socio-ecological units of analysis: individual level (limited training on hypertension and other non-communicable diseases, lack of incentives, poor collaboration and communication difficulties); health systems level (drug shortage, inadequate infrastructure and equipment, lack of well-functioning referral system, and limited number of community volunteers) and patient-related determinants (adherence to medication, lack of appreciation and use of alternative remedies for hypertension).<br><strong>Conclusion</strong>: A socio-ecological perspective provided a useful framework to explore the interplay among multilevel and interactive factors that impact diagnosis and monitoring of hypertension at individual, health system and patient level. Planners and resource allocators could consider these factors during planning, implementation, and evaluation of community programs. Additionally, a holistic public health approach which builds upon community volunteer’s capacities and harnesses the community’s needs is paramount to improve hypertension control and monitoring at community level.<br><br></p> Elvis Safary Micrina Mwandeti Caroline Mtaita Veronica Shiroya Andreas Deckert Volker Winkler Florian Neuhann Copyright (c) 2021-07-06 2021-07-06 34 2 179 193 Socioeconomic Characteristics Associated with Nutrient Intake and Cardiovascular Disease Biomarkers among Women of Reproductive Age in Nairobi County, Kenya <p><strong>Introduction</strong>:Cardiovascular disease is one of the leading causes of mortality globally, more so in developing countries. The&nbsp; documentation on determinants and predictors for the cardiovascular disease biomarkers among women of reproductive age in Sub-Saharan Africa is limited, despite the growing burden of Non-Communicable Diseases. Major determinants of cardiovascular disease include socioeconomic characteristics and nutrient intake while predictors include body composition, hypertension and dyslipidemia. This study established associations between determinants and predictors for cardiovascular disease biomarkers among middle and upper middle-class women in Nairobi City County, Kenya.</p> <p><strong>Materials and Methods: </strong>A household based cross-sectional study was conducted among 250 women. A researcher administered&nbsp; questionnaire was used to collect data for three months. The determinants and predictors for the cardiovascular disease biomarkers were measured. Fasting venous blood samples were collected among 42 women. A p-value of less than 0.05 was considered significant.</p> <p><strong>Results:</strong> A third (34%) of the participants were employed in office work, accessed food from supermarket and fast-food outlets (60.8%) and were of upper middle class (41.2%), thus increasing risk to cardiovascular disease. Participants consumed more calorie dense foods and less fruits and vegetables characterized by nutrient intake. The mean intake of potassium (3377.35± 1825.59) and magnesium (1973± 22.48) were inadequate. The mean energy intake (2733.12± 999.55) was above recommended dietary reference of 2000 kilocalories. Almost half of the participants had elevated LDL-C (45.2%), low HDL-C (81%), obesity (41.6%), elevated WHR (63.2%), visceral fat (51.2%), SBP (33.2%) and DBP (45.6%). Nutrient intake was significantly associated with biomarkers for elevated LDL-C (χ<sup>2</sup>=4.54; p=0.033), total Cholesterol (χ<sup>2</sup>=4.20; p=0.040), WHR (χ<sup>2</sup>=6.05; P=0.014), SBP (χ<sup>2</sup>=14.47; p&lt;0.001) and DBP (χ2=16.07; p&lt;0.001).</p> <p><strong>Conclusion</strong>:The determinants for cardiovascular disease were more likely as predictors of biomarkers for cardiovascular disease among women of reproductive age.</p> <p><strong>Recommendation:</strong> We recommend that the Ministry of Health at County and national level and other stakeholders enact and support interventions that promote intake of low calorie dense foods, more fruits, vegetables, whole grains, pulses and physical activity to improve cardio metabolic health.<br><br></p> Matilda Obimbo Judith Kimiywe Irene Ogada Hudson Lodenyo Copyright (c) 2021-07-06 2021-07-06 34 2 194 208 Reliable Determination of Anaemia Prevalence, among 2175 Children Admitted to Campus University Hospital of Togo <p><strong>Introduction:</strong>&nbsp; Anaemia prevalence among children under 5 years old, in the world in 2011 according to WHO was at 62.8%. WHO-AFRO in 2015 stated that in most Africa countries, laboratory infrastructures and testing quality remain in budding stages. The purpose of this study was to ensure the accuracy of the haemoglobin test, for a reliable estimation of the anaemia prevalence among children with comparison of this prevalence to some previous national data.<br><strong>Materials and Methods:</strong> This retrospective descriptive study was performed from May 2017 to February 2018 on quality control and patient’s outcome registers, at the Campus University Hospital Laboratory. The accuracy of The Sysmex XN-1000® was evaluated by using the Clinical Laboratory Improvement Amendments criterion. The anaemia prevalence was assessed with WHO anaemia criteria.<br><strong>Results:</strong> The accuracy conformity rate of haemoglobin test was 100%. The prevalence of anaemia, ranging from 50.2% to 68.6%, was higher among children aged of 12 to 14. The highest prevalence of severe anaemia (22.8%) as well as moderate anaemia (29.1%) was observed among 5 to 11 years children.<br><strong>Conclusion:</strong> The Sysmex XN-1000® provides accurate haemoglobin test results. The anaemia prevalence in 2018 among children admitted to Campus University hospital and the previous ones are still high.<br>&nbsp;</p> Kafui C. Kouassi Micheline A.H.N Tettekpoe Agboka Sogbéli Hounogbe Karou S. Damintoti Copyright (c) 2021-07-06 2021-07-06 34 2 209 217 Stroke Survivors’ Knowledge of Risk Factors for Stroke and their Post-Stroke Care Seeking Experiences: A cross-sectional study in rural southwestern Uganda <p><strong>Introduction</strong>: Stroke is a major cause of morbidity and mortality globally. The aim of this study was to examine the stroke survivors’ knowledge of the risk factors for stroke, stroke warning signs and post stroke care seeking behaviour and signs of stroke in rural southwestern Uganda.</p> <p><strong>Materials and Methods:</strong> A mixed methods cross-sectional study was conducted from October 2018 to February 2019, with 25 stroke survivors in a general population cohort. Questionnaire were administered with 25 people and in-depth interviews conducted with 10 people. Descriptive statistics and thematic content analysis were applied to the quantitative and qualitative data, respectively.</p> <p><strong>Results:</strong> Participants described stroke as: a persistent numbness of a particular body part; a condition due to witchcraft; a sexually transmitted infection (‘obulwadde bw’obukaba’); a disease parents get when a daughter engages in pre-marital sex in their home (‘obuko’). The participants reported that their awareness of their own hypertension and diabetes increased post-stroke. Participants also reported that their smoking prevalence decreased in the post-stroke period. Participants reported experiencing persistent headaches and numbness but did not associate them with stroke. Participants responding to the questionnaire described post-stroke care as biomedical (19/25), traditional (13/25) and for rehabilitation (10/25). The participants also described delays in seeking medical care because either they did not know what to do, or they thought the stroke was a self-limiting brief episode or that they required alternative treatment to biomedical care.</p> <p><strong> Conclusion:</strong> Misconceptions around the causes of stroke, and poor care seeking behaviour suggests a need for health education to improve community knowledge about risk factors and warning signs of stroke to help reduce incidence and improve post stroke treatment outcomes.<br><br></p> Dominic Bukenya Janet Seeley Robert Newton Fatuma Ssembajja Julius Kamwesiga Lena von Koch Gunilla Eriksson Susanne Guidetti Copyright (c) 2021-07-06 2021-07-06 34 2 218 229 Prevalence of Optimal Breastfeeding and Maternal and Child Health Care Service-Related Factors Associated with Optimal Breastfeeding in Dollow District, Somalia <p><strong>Backgroup</strong>: Breast milk is the ideal food for physical and mental growth and development of all infants. It contains all essential nutrients including carbohydrates, essential fats, proteins, minerals, and immunological factors. Exclusive breastfeeding (EBF) means providing only breast milk to the infants; no other liquids or solids including water, except oral rehydration solution or drops/syrups of vitamins, minerals, or medicines within the first six months of birth. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life with continued breastfeeding for 2 years or beyond and timely introduction of safe, appropriate, and nutritionally adequate complementary foods. Optimal breastfeeding includes exclusive breastfeeding for the first six months and continued breastfeeding for up to two years and beyond. Somalia has some of the worst maternal health indicators in the world. This study sought to establish the prevalence of optimal breastfeeding and maternal and child health service-related factors associated with optimal breastfeeding in Dollow District, Somalia.<br><strong>Materials and Methods:</strong> This study adopted a descriptive cross-sectional study. This study was conducted in Dollow district in Gedo region of Jubaland state. The sample size was calculated using the formula advanced by Mugenda (2003). A sample of 426 participants were involved in the study. This study targeted women with children aged between 0 to 36 months in Dollow district, Somalia. Purposive and systematic sampling methods were employed. Data was collected using research assistant administered questionnaire. Ethical approval was sought from the University of Eastern African Baraton.<br><strong>Results:</strong> The prevalence of exclusive breastfeeding in Dollow district was found to be 27.6%, while the prevalence of optimal breastfeeding was low at 19.1%. Maternal and child health related factors that were significantly associated with the practice of optimal breast-feeding included delivery under skilled birth care (OR=4.058, 95%CI of OR=1.688-9.760, P&lt;0.05), taking child to growth monitoring clinics (OR=15.680, 95%CI of OR=4.875-50.437, P&lt;0.05), and seeking postpartum care (OR=1.939, 95%CI of OR=1.237-3.037, P&lt;0.05).<br><strong>Conclusion and Recommendations:</strong> Both Exclusive and Optimal Breastfeeding practices were extremely low. To improve optimal breastfeeding practices, the government of Somalia and development partners need to promote interventions that create income generating activities among women of reproductive age and promote access to nutrition education. The government of Somalia and its development partners need to improve uptake of maternal and child health services which include ANC, post-partum care and child growth monitoring. Evidence in this study has shown that uptake of these MCH services is positively associated with practice of optimal breastfeeding.<br><br></p> Abdiwali Mohamed Mohamud Japheth Mativo Nzioki Cheptoek Muhamud Copyright (c) 2021-07-06 2021-07-06 34 2 230 239 Neuropsychological Changes in Tuberculosis Patients following Treatment: A preliminary study <p><strong>Introduction:</strong> Tuberculosis (TB) is reported to lead to significant neuropsychological problems such as depression and anxiety in addition to poor quality of life. These problems may impact adherence to treatment and disease outcomes. In the present preliminary study we assessed the effects of TB treatment on the neuropsychological profile of newly diagnosed smear-positive TB patients<br><strong>Materials and Methods:</strong> Repeated measures design was adopted. Participants were administered neuropsychological tests and quality of life measures at diagnosis and at month six after treatment.<br><strong>Results:</strong> Significant improvement was observed on the Immediate (Pre-test Mean = 18.5, SD= 9.2, Post-test M= 30.0, SD= 23.2) t(21) = -2.38, p= .027) and Delayed (Pre-test Mean = 4.7, SD= 2.9, Post-test M= 6.6, SD= 2.4), t(21) = -4.98, p&lt; .001) recall of the California Verbal Learning Test (CVLT) Short Form, Further, on the Brief Symptom Inventory (BSI), psychological distress significantly decreased after treatment compared to the initial testing (pre-test M= .709, SD= .601, post-test M= .322, SD= .423), t (20) = 2.41, p= .026 (two-tailed).<br><strong>Conclusion:</strong> Neuropsychological functioning among TB patients was impacted positively by anti-tuberculous medications.&nbsp; Neuropsychological assessment should be considered an integral part of treatment and management of TB patients.<br><br></p> Ernest Yorke Kelvin Acquaye Nora Nkornu Vincent Boima Ida Dzifa Dey Vincent Ganu Maame-Boatemaa Amissah-Arthur Dela Fiagbe C. Charles Mate-Kole Copyright (c) 2021-07-06 2021-07-06 34 2 240 249 Common Periodontal Diseases and Socio-Cultural Factors Associated with Occurrence of Periodontal Disease among Women of Reproductive Age Seeking Health Care in Banadir Hospital, Mogadishu Somalia <p><strong>Introduction:</strong> According to the World Health Organisation (WHO) oral health refers to a state of being free from oral or facial pain, oral infection, sores, periodontal disease, tooth loss and other diseases that inhibit the capacity to chew, bite, smile and speak. Dental and oral health is an essential part of systemic health and well-being. Poor oral hygiene can lead to dental cavities and gum disease, and has also been linked to heart disease, cancer, and diabetes. Oral diseases virtually affect the entire population, but it has not been made a priority. Hence oral diseases have been termed as a “neglected epidemic‟. Globally, the prevalence of dental caries among adults is nearly 100% and prevalence of severe periodontitis is 15-20%. Due to the collapse of the central government of Somalia since 1991, the health system also collapsed including oral health care and no surveys done since then. However, non-official reports suggest that oral health service utilization in Benadir region and Somalia in general is poor, as most patients only attend dental clinics with advanced stages of decayed teeth which can only be extracted. The objective of this study was to establish the social cultural and lifestyle factors associated with occurrence of Periodontal Disease among women of reproductive age attending Benadir Hospital in Mogadishu Somalia.</p> <p><strong>Materials and Methods:</strong> This was a descriptive cross-sectional study conducted in Benadir region in South-Eastern Somalia. The study was conducted among women in their reproductive age between 15-49 years residing in Benadir region and attending Benadir Hospital for ANC and outpatient care. Sample size was determined as 422 using the Fisher (1998) formula. Systematic sampling method was used for data collection.</p> <p><strong>Results:</strong> The prevalence of periodontal disease among women of reproductive age attending Benadir Hospital in Mogadishu is 82%. Sociocultural and lifestyle factors found to be influencing occurrence of periodontal disease among these women were smoking tobacco (OR=22.60, 95%CI=3.071-166.29., P&lt;0.05), drinking alcohol (OR=3.399, 95% CI of OR=1.123-10.396, P&lt;0.05), chewing miraa (OR=1.926, 95%CI=1.093-3.396, P&lt;0.05) and taking soft drinks regularly (OR=2.010, 95%CI of OR=1.150-3.510, P&lt;0.05).</p> <p><strong>Conclusion and Recommandation:</strong> To help reduce the burden of periodontal disease in Mogadishu, health promotion officers need to focus more on emphasizing on lifestyle changes such as reduction in alcohol intake, reduction of uptake of sugary drinks, not chewing miraa or smoking tobacco to bring down prevalence of periodontal diseases among women in Mogadishu.</p> <p><strong>Keywords:</strong> Sociocultural and Lifestyle Factors, Periodontal Disease, Women, Benadir Hospital, Mogadishu</p> Mohamed Hussein Haji Mumin Japheth Mativo Nzioki Mary Kerich Copyright (c) 2021-07-06 2021-07-06 34 2 250 260 Procurement and Management of Pharmaceutical Supplies at the Siaya County Referral Hospital <p><strong>Introduction:</strong> Pharmaceuticals are integral in-patient care and consume significant institutional and national health expenditure. Pharmaceutical management practices worldwide adopt a centralized, decentralized or mixed approach, to varied outcomes. In Kenya, the Ministry of Health (MOH) alludes to frequent stock-outs, poor procurement and storage practices, inconsistent treatment guidelines, and the use of counterfeit drugs as shortcomings in streamlining patient care and improving health outcomes. The aim of this study was to evaluate the logistical management of pharmaceutical supplies in Siaya County Referral Hospital (SCRH).<br><strong>Materials and Methods</strong>: This was a cross-sectional study. Purposive sampling was done for key-informant interviews (KII). Chart review utilized hospital inventory data for the preceding quarter. Ms Excel was used to analyse the inventory data and the qualitative data was reported and manually analysed thematically.<br><strong>Results</strong>: SCRH has three pharmacies, a drug and therapeutic commission (DTC), an essential drug list (EDL) but is without a formulary or quality assurance department, even though procurement, flow and storage of medicines adheres to set national guidelines. Kenya Medical Supplies Agency (KEMSA) supplies 73.9% of the drugs while direct hospital purchases account for 17.4%. Most drug consumption occurs in the outpatient department (73.5%) and tablets constitute the largest portion of formulations consumed (64.3%). Finally, consumption is less than supply for all the individual drug types.<br><strong>Conclusion:</strong> The facility adheres to national guidelines of procuring and handling pharmaceuticals. Notable shortcomings include the inadequate staffing, lack of a hospital formulary, quality assurance department and an inactive drugs and therapeutic commission (DTC). Also, significant shortfalls in tracer medication exist due to inconsistent delivery timelines by KEMSA.</p> <p><strong>&nbsp;</strong></p> Derrick Omoga Oloo Copyright (c) 2021-07-06 2021-07-06 34 2 261 276