Bioethics in Kenya: Who is Interested in Certificate Courses

Inadequate training in matters of ethics renders health care providers unprepared for dilemmas faced in public health, research, and clinical practice. Certificate course training offer opportunities to gain more knowledge and skills on all matter ethics. Over the past decade, the increase in research activities in Kenya has not been proportionate to training in ethics. The centre of Biomedical Ethics and Culture (CBEC), Kenya Medical Research Institute (KEMRI) Bioethics training Initiative (CK-BTI) is a Forgaty funded program for building capacity in research ethics for Kenya and Pakistan. This paper evaluates the characteristics of participants that attended the CK-BTI certificate level courses in Kenya between 2017 to 2021. This data was analysed for this paper and utilized information from the training application process. Between November 2017 and July 2021, a total of 1,359 applications were received and 457 (33.6%) trained. The target countries were Kenya and Pakistan but interest was drawn from Tanzania, Uganda, Nigeria, and Zambia. The continued interest in the certificate level ethics courses may imply a need to increase the number of ethics training offered within the East African region.

Assessment of Women’s Experience of Care during Childbirth for Quality Improvement at Level 5 Health Facilities in Bungoma County, Kenya

High maternal and newborn mortality is a pressing problem in developing countries. Poor treatment during childbirth contributes directly and indirectly to this problem. Many women experience disrespectful and abusive treatment during childbirth worldwide which violates their rights. In Kenya, 20% of women report having experienced some form of disrespect and abuse (D&A). Bungoma County is among the 15 counties with the worst maternal and newborn health statistics in Kenya. The maternal mortality rate is 382 per 100,000 live births and newborn deaths 32 per 1,000 live births, while skilled birth attendance is 41.4%. This study was motivated by the poor maternal and newborn indicators, rising incidences of D&A, limited formal research on respectful maternity care. The study aimed at assessing women’s experience of care during childbirth at Level 5 health facilities in Bungoma County. The specific objectives were to determine the women’s experiences of care during childbirth, to determine factors contributing to disrespect and abuse during childbirth and to identify strategies for addressing issues affecting respectful maternity care for promoting quality of maternal and newborn care. A cross-sectional descriptive study design was used. It involved 360 mothers. Analysis of quantitative data was done using SPSS. Descriptive statistics were presented in graphs, tables, frequencies and percentages. Qualitative data was analysed thematically. The prevalence of D&A was 42.2%, younger age and lower education aggravated D&A. Autonomy, privacy and confidentiality, and absence of birth companionship were major aspects of D&A. Health workforce shortage, inadequate supervision, space and beds, poor provider-patient relationships were factors leading to D&A. It was concluded that there is a need for increased incorporation of Respectful Maternity Care (RMC) in routine care, deploy more staff, avail equipment and supplies, and enhance support supervision. The study information intends to assist stakeholders in prioritising policy actions for improving the quality of maternal and newborn health outcomes and indicators.

The Demographics Behind the Courage to Tell for Survivors: Child Sexual Abuse Experiences in Kenya

Child Sexual Abuse (CSA) is both a global and national social issue, as well as an epidemic in various societies. Non-disclosure of CSA only worsens and extends survivors’ suffering, and CSA’s long-term effects can be devastating. Several studies have been done in the field of CSA and its health implications but rarely have previous studies addressed child sexual abuse disclosure (CSAD). The current study aimed at examining child factors of CSAD at Thika Level 5 Hospital (TL5H) in Kiambu County, Kenya. The study is a case study using a phenomenology approach where the primary data was collected from the sexual abuse survivors and caregivers using a mixed-method analysis. Interviews were conducted with 30 CSA survivors, 25 girls, and 5 boys: 5-17 years. The study utilised the convergent QUAL (investigative open-ended questions and storytelling) design with a Quan component (structured survey) to identify CSA survivors’ experiences while receiving medical treatment and therapeutic intervention at TL5H. Descriptive and thematic approaches were applied to analyse qualitative data that revealed survivors’ lived experiences with CSA. Informed by Bronfenbrenner’s Socio-Ecological Model (SEM), saliency analysis was applied to code the recurring and important themes from the data in order to identify which child factors. Survivors gave detailed accounts of types of threats and manipulation applied by perpetrators to stop them from disclosing abuse. Survivors said disclosing or not disclosing helped them cope with abuse trauma. Quantitative results revealed that 58% of the survivors who completed the disclosure process aged between 9-13 years, 83.3% were female, and 70% had achieved a lower level of education.

Microbial and Physicochemical Qualities of Septic Tank Wastewater: An Evaluation.

The physicochemical and microbial qualities of septic tank effluent samples from households within the study area were evaluated. Three replicate samples from Locations A, B, and C representing Agbor, Benin City, and Sapele regions of Delta and Edo States, Nigeria were collected from both the inlet tank (raw sewage) and the outlet chamber (semi-treated sewage) for physicochemical and microbiological analyses using standard methods. Results of the physicochemical analyses showed that pH values ranged from 6.5 – 7.7 across locations and in both the raw and semi-treated samples. Electrical conductivity (EC), Total suspended solid (TSS) and BOD was significantly higher (p>0.05) in the raw sewage (RS) than in the semi-treated (SS), while DO was higher (p>0.05) in the SS in all three locations sampled. Microbial analysis shows that total heterotrophic bacteria (THB) was highest in the RS in two locations. Microbial isolates from wastewater samples included Staphylococcus aureus, Proteus mirabilis, Escherichia coli, Pseudomonas aeruginosa, and Aspergillus niger. DO was low at an average of 3.20 and 3.73 mg/L in both chambers of the septic tank. Average BOD5 of 59.4 and 42.8 mg/L and COD average of 206.8 and 153.2 mg/L were reported for the RS and SS chambers. 0.3 was the value of the ratio of BOD5/COD for the RS and SS in the study. This infers that biodegradation was slow and inefficient in the septic tank system, and that modification of the design is recommended to increase retention time in the RS chamber

Perceived Demographic and Socio-Economic Factors Contributing to Poor Outcome of Neonatal Sepsis at Paediatric Unit Kenyatta National Hospital

Introduction: Globally sepsis is still a known case of high mortality and mobility rates among neonates. This is despite having been advances in healthcare quality. The World Health Organization estimates that more than 40% of deaths occurring among infants aged below five years happen during the neonatal phase and they result in 3.1 infant deaths annually. Objective: This study sought to establish the perceived demographic and socioeconomic status of poor outcomes of neonatal sepsis at Kenyatta national hospital paediatric unit. Methodology: This was a hospital-based descriptive cross-sectional study conducted in the Paediatric Unit of Kenyatta National Hospital. A total of 175 mothers of neonates with neonatal sepsis admitted in KNH selected using consecutive sampling methods were recruited into the study. A validated researcher-administered semi-structured questionnaire was used to collect the data. Descriptive statistics involved the calculation of measures of central tendencies like means, modes and medians between variables. Association between the study variables was estimated using both chi-square and odds ratio statistics at a 95% confidence interval. The study results were presented in tables, graphs and charts, as appropriate. Results: Maternal demographic factors associated with poor outcomes of neonatal sepsis included - younger or advanced maternal age (X2 = 4.735, df = 2, p = 0.031); low education level (X2 = 6.362, df = 1, p = 0.012) and short birth intervals of < 2 years (X2 = 5.108, df = 2, p = 0.023). Maternal socioeconomic factors associated with poor outcomes of neonatal sepsis included - low household income level (X2 = 6.163, df = 1, p = 0.014); large family sizes of ≥5 members (X2 = 4.844, df = 1, p = 0.028) and lack of a health insurance cover (X2 = 5.382, df = 1, p = 0.019). Conclusion: Various maternal demographics, maternal socio-economic were significant perceived determinants of poor outcomes of neonatal sepsis in Kenyatta National Hospital’s Paediatric Unit. Recommendations: The national government with the help of county governments and development partners should invest in community empowerment programs that aim to improve the socioeconomic status of caregivers and their households. In addition, further investments in the health care system are needed to make it more affordable to all and particularly to the low-income group.

Determinants of Contraceptives Uptake among Adolescents’ Girls Aged 14-19 Years in Homa Bay County

Introduction. Adolescents are individuals aged between 10-19 years. This phase is characterised by rapid growth, sexual maturation, and sexual exploration. These behaviours expose sexually active adolescent girls to a greater risk of unintended pregnancies, unsafe abortion, and sexually transmitted infections. This study aimed to assess the determinants of contraceptives uptake among adolescent girls in Homa Bay County in Kenya with specific objectives assessing the level of awareness, uptake as well as evaluating the factors affecting the sexual & reproductive health service provision to adolescent girls in the region. Result: A cross-sectional survey was done targeting 385 girls and 32 health facilities. The response rate was 100%, with the level of knowledge on contraceptives at 97.6%. The main sources of knowledge on contraceptives were from teachers in schools (30%), peers (17.2%) and media. 70% of the respondents were in a heterosexual relationship of which 58.6% preferred male condom use as their contraceptive method of choice, while the use of pills was the least at 0.6%. The majority (57.9%) of the girls did not practice safer sex exposing them to a higher risk of Sexually transmitted infections and unintended pregnancies. Discussions: The level of contraceptive uptake significantly varied from one sub-county to the other (p < 0.005), with the sub-counties in the Islands of Lake Victoria such as Suba sub-counties having up to 80% lesser chance of their girls using any form of contraceptives (OR = 0.2; CI: 0.2–0.8). Major barriers were the fear of side effects (51.8%) and self-stigmatisation (13.4 %). Health facilities were the main source of contraceptives (77.1%); however, the study noted a lack of youth-friendly services that would favour increased access. Further, there was a complete lack of knowledge on adolescent sexual and reproductive health policies and procedures among the girls (39.6%). Conclusion: Misinformation, cultural perception on the use of contraceptives among adolescents, and lack of youth-friendly services in health facilities are key drivers to the underutilisation of contraceptives by adolescent girls in Homabay county. Adolescents from the island stand a higher risk of non-utilisation of contraceptives compared to their mainland counterparts. Recommendations: There is a need for strengthened youth-friendly comprehensive sexual health education and services in all health facilities with more emphasis on risk reduction interventions and sensitisation of young girls on the available policies. Mechanisms should be availed, specifically to reach the “hard to reach” adolescent populations in the islands.

Evaluation of Some Toxic Heavy Metals in Rice and Beans Samples Cultivated in Yobe State, Nigeria

Grains have become an integral part of the human diet due to their nutritional values, thus any form of contamination especially by heavy metals is of great concern. This research evaluated the level of Cadmium, Chromium, Lead and Mercury in the commonly consumed foods (Rice and Beans) across Yobe State, North-eastern Nigeria. A composite sample from each of the three Senatorial Zones was collected from farm harvests and designed as ZAR, ZAB, ZBR, ZBB, ZCR and ZCB for Zone A Rice, Zone A Beans, Zone B Rice, Zone B Beans, Zone C Rice and Zone C Beans respectively. The metal Concentration was determined using atomic absorption spectroscopy (AAS). Results in mg/Kg across the local governments indicates respective ranges for Hg, Pb, Cd, and Cr of 0.30 - 4.04, 0.16 - 0.92, 0.03 - 0.05 and 0.02- 0.52 in Rice, 0.14-3.73, 0.05-0.33, 0.05-0.07 and 0.00-0.14 in beans. Comparison of the results showed that with the exception of mercury, all metals are within the tolerable ranges set by International Standard Tolerable Limits and European Regulatory Standard. Potential hazards may be speculated because the detected levels are on the higher side of the tolerable ranges. A higher level of mercury in samples collected from Zone C might be associated with the reported cases of chronic kidney diseases from those areas.

Understanding the Role of Health Workers in the LF Elimination Program in Kenya: Challenges Faced and Suggestions for Improved Program Performance

The Kenyan Ministry of Health and its partners through the Division of Vector-Borne and Neglected Tropical Diseases, is in charge of the Lymphatic Filariasis Mass Drug Administration programme. This is implemented through the national, county, and sub-county neglected tropical diseases coordinators. The current study sought to understand the roles, challenges faced and suggestions of how program performance can be improved by the community health extension workers, county and sub-county neglected tropical diseases coordinators. Two wards of the Kaloleni sub-county; Kilifi County were purposively selected. In 2015, Kaloleni and Kayafungo wards had a treatment coverage of 58% and 54% respectively; 62% and 39% respectively in 2016, all below the recommended minimum treatment coverage of 65%. Qualitative data was collected through sixteen in-depth interviews with community health extension workers and two semi-structured interviews with the county and sub-county neglected tropical diseases coordinators. Data were analysed by QSR NVIVO version 10 according to identified themes. The study results show the various roles in planning and implementation of the program include; supply chain management; health information education communication and records management; health workforce training and management, leadership and governance, and service delivery. Challenges faced included insufficiency of drugs supplied and information education communication materials, the inadequacy of community drug distributors selected and trained, poor facilitation for training and supervision of community drug distributors, limited duration of the mass drug administration, and delayed reporting due to poor network coverage. The results of this study show that the community health extension workers, county and sub-county neglected tropical diseases coordinators are not fully involved in program leadership and governance, a role that is taken up at the national level. They should be involved in all the stages of the mass drug administration program to create ownership to improve the program performance

Characteristics of Lassa Fever Outbreak in Ondo State, Nigeria, Year 2019

Background: Lassa fever (LF) is an acute viral haemorrhagic illness of a 2–21-day incubation period that occurs in West Africa. It is endemic in Nigeria and peaks during the first 12 weeks of the year. On January 22, 2019, the Nigeria Centre for Disease Control (NCDC) declared an outbreak of LF following an upsurge of LF cases in the country. A total of 213 confirmed cases including 41 deaths were reported from sixteen states including Ondo State. A multi-sectoral national rapid-response-team (RRT) was deployed to Ondo State to characterise the outbreak, assess its determinants, and institute control measures. Methods: An Emergency Operations Center (EOC) was activated to coordinate activities. We defined a suspected case as anyone with one or more of the following symptoms: malaise, fever, headache, sore throat, cough, vomiting and either history of contact with rodents, or a probable or confirmed LF case in the past 21 days, or any person with inexplicable bleeding between January 1, 2019, to February 26, 2019, in Ondo State. A confirmed case was any suspected case with laboratory confirmation. We conducted active case search, collected data using the LF case investigation form and reviewed the existing line list. We conducted contact tracing in hospitals and affected Local Government Areas (LGA). Data was analysed using and Epi info 7.0. Results: We identified 287 LF suspected cases in 6 LGAs; 118 were confirmed with 21 deaths (case fatality rate: 17.8%). The mean age was 39.2 ±20 years with a male-to-female ratio of 1.3:1. Of the 1,269 contacts line-listed, 20 became symptomatic, while 14 (70.0%) were confirmed positive. The secondary attack rate was 1.1%. Conclusion: The confirmed cases were more of primary cases, hence the need to focus more on reducing rodent-to-human transmission of LF. We recommend continuous education on community and health facility infection prevention control, contact tracing and enforcement of environmental sanitation measures across the state to mitigate future outbreaks

The Potential of O’nyong-nyong Virus Strain SG650 Murine Monoclonal Antibodies for Detection of O’nyong-nyong and Chikungunya Viruses

O’nyong-nyong virus (ONNV) and Chikungunya virus (CHIKV) are antigenically related alphaviruses responsible for febrile illnesses common to the tropics and associated with relatively high morbidity and mortality. Murine monoclonal antibodies (mAbs) targeting alphaviruses like Chikungunya have been developed and used to make commercially available kits. However, few studies have been conducted to develop antibodies specific to ONNV and no commercial kits are available for use in endemic regions where outbreak potential is high. We demonstrate the potential of in-house generated monoclonal antibodies against ONNV to detect both ONNV and CHIKV. The objective of this study was to generate mAbs using hybridoma technology, characterize the developed mAbs, determine their specificity against selected alphaviruses and check their diagnostic potential using an indirect IgG enzyme-linked immunosorbent assay (ELISA) and focus neutralization assay (FRNT50). BALB/c mice were immunized with ONNV purified proteins from ONNV infectious culture fluid. After four rounds of booster injections, the mice were sacrificed, spleen cells harvested and fused with parental myeloma cells then cultured in selective media and the successful hybrid clones with antibody-producing ability purified to yield the desired mAbs. Five monoclonal antibodies targeting the ONNV E1 protein of isotypes IgG2a/kappa, IgG2b/kappa and IgM/kappa (P1B12, P1E9, P1G11, P1B4 and P1G6) demonstrated a potential to detect both ONNV and CHIKV isolates by indirect IgG ELISA but no potential for neutralization of the viruses by FRNT50. This study demonstrates the potential efficacy of in-house serological tools as an alternative in the absence of commercial assays in screening and diagnosis of ONN and CHIK viruses which are often co-circulating. It is our recommendation that this work may be pursued further to design and optimize ELISA assays, using the developed mAbs, for the detection of both ONN and CHIK viruses in the research laboratory set-up