DSpace Collection:http://ir.mu.ac.ke:8080/jspui/handle/123456789/312024-03-29T15:50:45Z2024-03-29T15:50:45ZIncidence of malaria and vector characteristics in a high transmission region in rural western KenyaMangeni, Judith Nekesahttp://ir.mu.ac.ke:8080/jspui/handle/123456789/80732023-09-21T06:36:12Z2017-01-01T00:00:00ZTitle: Incidence of malaria and vector characteristics in a high transmission region in rural western Kenya
Authors: Mangeni, Judith Nekesa
Abstract: Malaria is still the leading cause of morbidity and mortality especially among children below five years of age in Kenya. Although current reports indicate declining prevalence of malaria in some parts of Africa, some reports paint a grim and opposite picture in some of the areas. In Kenya, some of the regions such as Bungoma County continue to experience persistently high prevalence of malaria all year round despite the scale up of control measures. This can be attributed to various plausible reasons among them local spatial variation in malaria risk (heterogeneity). Heterogeneity in malaria risk and transmission has been previously documented even on a very small scale. Spatial analysis of self reported fevers in the HDSS indicates clustering of fevers in some villages. The main objective for this study was therefore to determine whether there were actual differences in transmission of malaria in villages with higher than average fevers (fever hotspots) and villages with lower than average fevers as well as the risk factors by measuring malaria transmission indices for a period of one year. The information can be used for designing strategies for targeting malaria control measures to the local situation with the final aim of elimination of malaria in this area. Methodology: This was a prospective closed cohort study. The study was conducted in the Webuye Health and Demographic Surveillance Site (HDSS) located in Bungoma East Sub-County, a region which has had persistent and perennial malaria burden. Six villages (two in the fever coldspot and four in the fever hotspot) were selected for fixed entomological surveillance. One household was randomly selected in each of the villages to set up a window exit trap (WET) while two other households within the same village were selected for monthly mosquito monitoring using Pyrethrum Spray Catches (PSC). Parasitological surveillance was done for all household members in the same households where mosquito surveillance was set up as well as their immediate neighbours for a period of one year at quarterly intervals. A total of 400 participants in 72 households were followed up longitudinally and tested for malaria quarterly for the entire period. The person-month xi incidence rate of malaria was computed for one year. Risk factors for malaria in the fever hotspots and coldspots were computed using multi-level mixed effects modelling. A t-test was used to compare vector densities in the fever coldspots and fever hotspots as well as the incidence of malaria. ANOVA was used to test if there were significant differences in malaria incidence among the villages. Generalised estimating equation (GEE) was used to model factors associated with asymtomatic status. Linear regression was used to show the correlation between the vector densities and the incidence of malaria. Results: Although there was no statistically significant difference in the incidence of malaria infections between the fever hotspots and fever coldspots, those living in fever hotspots had almost one and half times increased risk of infection compared to those in the fever coldspots. There was marked and significant hetereogeneity in the incidence of malaria among the villages. Entomological risk factors such as increased larval sites and mosquito densities were mainly responsible for the observed differences in the incidence of malaria in both the fever hotspots and coldspots. Almost half (46.3%) of all the malaria infections were asymptomatic indicating a high prevelence of asymptomatic infections within the region. Malaria infections during the dry season (January) were less likely to be asymptomatic (A.O.R: 0.26, C.I: -2.289 - 0.400). Conclusions and Recommendations There is significant heterogeneity in the incidence of malaria among the villages correlating with entomological risk factors. There is need to target interventions based on the presenting local context in-order to increase their effectiveness. The high number of asymptomatic cases indicates the need to set up active malaria surveillance inorder to capture the asymptomatic individuals and treat them so as to reduce the parasite reservoir. Targeting the asymptomactic reservoir will reduce malaria infections further and therefore contribute towards the goal of elimination. Key words Malaria incidence, prevalence, hotspots, vector behavior, rural western Kenya.2017-01-01T00:00:00ZHigh maternal iron status, dietary iron intake and iron supplement use in pregnancy and risk of gestational diabetes mellitus: a prospective study and systematic reviewKhambalia, A. Z.Aimone, Ashley MarikoNagubandi, P.Roberts, C. L.McElduff, A.Morris, J. M.Powell, K. L.Tasevski, V.Nassar, N.http://ir.mu.ac.ke:8080/jspui/handle/123456789/65212022-07-18T09:43:05Z2016-01-01T00:00:00ZTitle: High maternal iron status, dietary iron intake and iron supplement use in pregnancy and risk of gestational diabetes mellitus: a prospective study and systematic review
Authors: Khambalia, A. Z.; Aimone, Ashley Mariko; Nagubandi, P.; Roberts, C. L.; McElduff, A.; Morris, J. M.; Powell, K. L.; Tasevski, V.; Nassar, N.
Abstract: Aim
High iron measured using dietary intake and biomarkers is associated with Type 2 diabetes. It is uncertain whether a similar association exists for gestational diabetes mellitus. The aim of this systematic review was to conduct a cohort study examining first trimester body iron stores and subsequent risk of gestational diabetes, and to include these findings in a systematic review of all studies examining the association between maternal iron status, iron intake (dietary and supplemental) and the risk of gestational diabetes.
Methods
Serum samples from women with first trimester screening were linked to birth and hospital records for data on maternal characteristics and gestational diabetes diagnosis. Blood was analysed for ferritin, soluble transferrin receptor and C–reactive protein. Associations between iron biomarkers and gestational diabetes were assessed using multivariate logistic regression. A systematic review and meta-analysis, registered with PROSPERO (CRD42014013663) included studies of all designs published in English from January 1995 to July 2015 that examined the association between iron and gestational diabetes and included an appropriate comparison group.
Results
Of 3776 women, 3.4% subsequently developed gestational diabetes. Adjusted analyses found increased odds of gestational diabetes for ferritin (OR 1.41; 95% CI 1.11, 1.78), but not for soluble transferrin receptor (OR 1.00; 95% CI 0.97, 1.03) per unit increase of the biomarker. Two trials of iron supplementation found no association with gestational diabetes. Increased risk of gestational diabetes was associated with higher levels of ferritin and serum iron and dietary haem iron intakes.
Conclusions
Increased risk of gestational diabetes among women with high serum ferritin and iron levels and dietary haem iron intakes warrants further investigation.2016-01-01T00:00:00ZGeo-spatial patterns and associated risks of iron deficiency and infection among young Ghanaian children: implications for the safety of iron supplementation in malaria endemic areasAimone, Ashley Marikohttp://ir.mu.ac.ke:8080/jspui/handle/123456789/65202022-07-18T08:51:50Z2016-01-01T00:00:00ZTitle: Geo-spatial patterns and associated risks of iron deficiency and infection among young Ghanaian children: implications for the safety of iron supplementation in malaria endemic areas
Authors: Aimone, Ashley Mariko
Abstract: Background: The safety and effectiveness of iron supplementation in malaria endemic areas
may partly depend on host iron status; however, current methods for assessing iron deficiency
risk tend to be confounded by infection and are infeasible to implement at a population level.
Determining the geographical patterns of iron status and infection may provide a practical
alternative means of identifying high risk populations for whom integrated anaemia and
infection control programs are needed.
Objective: Determine the geo-spatial factors associated with iron status and infection risk among
1943 Ghanaian children (6-35 months of age) before and after participating in a randomized iron
home-fortification trial.
Methods: Secondary spatial analyses of iron status and infection outcomes were conducted. Iron
status was defined as serum ferritin concentration corrected for inflammation (C-reactive
protein, CRP) using a regression-based method. Malaria and non-malaria infection outcomes
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were defined using four combinations of inflammation (CRP >5 mg/L) and malaria parasitaemia
(with and without reported history of fever or concurrent axillary temperature >37.50 C).
Analyses were performed using a geographical information system (GIS) and generalized linear
geostatistical modelling with a Matern spatial correlation function.
Results: After adjusting for demographic characteristics such as age, sex, and maternal
education, none of the geo-spatial factors included in the iron status models (including
elevation, and distance to a health facility) demonstrated associations at baseline or endline;
however, there was significant residual spatial variation across the study area. Conversely,
malaria parasitaemia at baseline was associated with greater distance to a health facility and
lower elevation. These relationships did not remain at endline, nor when infection was defined
using CRP only. Mapping the model outputs showed defined low-risk areas that tended to
cluster around villages, particularly near the District centre.
Conclusions: In a malaria endemic area, geographical location may play a role in the risk of iron
deficiency and infection among children. Iron home-fortification likely alters the spatial risk
profile of malaria and non-malaria infection in this setting, though additional research is needed
to confirm the direction of these relationships2016-01-01T00:00:00ZImpact of community health workers on nutritional status and cognitive development of children aged less than two years in Kisumu And Migori Counties, KenyaSawe, Carolinehttp://ir.mu.ac.ke:8080/jspui/handle/123456789/64752022-06-28T11:45:30Z2020-01-01T00:00:00ZTitle: Impact of community health workers on nutritional status and cognitive development of children aged less than two years in Kisumu And Migori Counties, Kenya
Authors: Sawe, Caroline
Abstract: Globally, child malnutrition and poor cognition issues of public health importance. Sub Saharan
Africa records the highest levels of malnutrition with 39% of children being stunted, 4%
underweight and 10% wasted while in Kenya, 26% are stunted, 4% wasted and 11% underweight.
Most growth faltering in children occurs after the six months of life when exclusive breastfeeding
has been stopped, exposure to diseases is high and demand for nutritional needs increases due to
rapid growth and development. Nutrition in the first 1,000 days of life is key in child’s ability to
grow but after the second year of life, malnutrition can be been linked to reduced cognitive
outcomes, poverty, low human capita, reduced school and work performance. Compared to
developed nations, there is limited documented data on the relationship between child nutritional
status and cognitive development in developing countries. Kenyan Government integrated
Community Health Workers into the health system through the Health Community Strategy
program whose main aim was to ensure improved nutritional status and cognitive development
among all children. But since its launch in 2007, there has been limited studies on the effectiveness
of CHWs yet that finding could be key in upscaling the program. In 2013, World Vision trained
the CHWs in the Health Strategy program and used them to implement the Timed and Targeted
Counselling nutrition intervention in Kisumu County. The trained CHWs delivered key nutritional
messages on nutritional status and cognitive development at a particular time during child’s growth
as they engaged and counseled caretakers on health status of their children from time of delivery
until child was two years old. CHWs in Migori County which was the comparative group did not
receive any specialized training from World Vision on timed and targeted counseling. Trained
CHWs have the potential of improving the nutritional status and cognitive development among
children. The objective of this study was to establish the impact of CHWs on the nutritional status and cognitive development of children in Katito in Kisumu County with a comparison at Kegonga
Ntimaru in Migori County. Quasi experimental study design was used with secondary baseline
data obtained from World Vision database and endline data collected and analyzed. WHO Z scores
computed child’s underweight, overweight, stunting and wasting status while Bayleys Scale of
Infant Development Kit assessed the Cognitive scores of children with categories computed using
the Bayleys composite score. Food Frequency questionnaire collected data on dietary intake and
nutrient inadequacies were computed based on the Recommend Daily Allowances. Qualitative
data collected information on the perception of CHWs’ knowledge on nutritional status and child
cognition. STATA 13.1 and NVivo 7.0 analyzed quantitative qualitative data respectively.
Descriptive statistics summarized data into frequencies, means and standard deviation. Chi-square
and independent sample t-test assessed the relationship between two variables while Multinomial
logistic regression analyzed the relationship among variables. The level of significance was set at
p<0.05. At baseline, there was no significant difference in the levels of underweight and
overweight (chi2=8.73, p=0.068), wasting (chi2=0.25, p=0.885) and stunting (chi2=2.79, p=0.25)
among children at Katito and Kegonga Ntimaru sites. After three years of intervention
implementation at Katito, the prevalence of underweight reduced by 21.6%, overweight increased
by 8.3% (chi2=21.55, p<0.001) and wasting reduced by 26% (chi2=22.54, p<0.001). Only 61%
and 48% of children were exclusively breastfed in Katito and Kegonga Ntimaru respectively. A
total of 43% of children in Katito and 50% at Kegonga had inadequate iron sources from their
diets. Only 5% and 34% of the children had cognitive scores that were below average at Katito
and Kegonga Ntimaru respectively (Chi2=15.8537, p<0.001). The CHWs were perceived to be
knowledgeable on child nutritional status but had little knowledge on key foods for child cognition.
In Katito, it was found that exclusive breastfeeding was linked to child underweight and overweight status (Chi2=27.13, p=0.04) while stunting was linked to duration of breastfeeding
(Chi2=16.72, p=0.033). Children with cognitive scores that were above average had 8 times less
Relative Risks of being underweight compared to those with scores that were below average [RRR:
0.194: 95% CI: 0.06-0.624; p=0.0006] while those who were exclusively breastfed had 0.02 times
more Relative Risks of being severely wasted compared to those who breastfed for 3 months
[RRR: 0.028: 95% CI: 0.05-2.64; p=0.03]. The presence of CHWs led to reduced prevalence of
underweight but increased the overweight status of same population thus concluding that double
burden of malnutrition is already existing in communities with children at early age at higher risk.
This study recommends the use of CHWs to implement nutrition interventions and that
interventions to focus on child overweight. Further research on nutritional outcomes and cognitive
development at early age of growth is also recommended. Nutrition interventions to target this age
period as is the window period of opportunity2020-01-01T00:00:00Z