BackgroundNomadic lifestyle has been shown to be a significant factor in low immunization coverage. However, other factors which might aggravate vaccination uptake in nomadic pastoralists are poorly understood. Our study aimed at establishing the relative influence of social demographics, missed opportunities, and geographical mobility on severe under vaccination in children aged less than two years living in a nomadic pastoralist community of Kenya.MethodsWe used cross-sectional analytical study design. An interviewer-administered questionnaire was used to obtain quantitative data from 515 mothers with children aged less than two years. Under vaccination was the sum the total number of days a delayed vaccine was given after the recommended age range for each vaccine. Severe under vaccination was defined as those children who remained under-vaccinated for more than six months. Geographical mobility was assessed as household members who had gone to live or herd elsewhere in the previous 12 months, missed opportunity included questions on whether a child visiting a health facility had missed being vaccinated, while social demographic data included household size and mothers social demographics.ResultsThree-quarters of the mothers had no formal education. One-third of the children had been taken to a health facility and missed being vaccinated. Forty percent of the households had moved in the previous 12 months. Prevalence of missed opportunity was 30.1%; 42.2% of children had not received any vaccines by their first birthday, and 24.1% of children were severely under vaccinated.No significant association was found between social demographics and under-vaccination. Variables associated with under-vaccination were; movement of the whole family, (p = .015), missed opportunity, (p = <.001), lack of vaccines, (p = (.002), and location of health facility, (p = <.001). Movement of women and children made a significant contribution (p = 0.006) to severe under-vaccination. Children in households where women and children had moved were nine times more likely to be severely under-vaccinated than in those households where there was no movement.ConclusionGeographic mobility of women and children was a key determinant of severe under vaccination among nomadic pastoralists in Kenya.

BackgroundReliability and validity of measurements are important for the interpretation and generalisation of research findings. Valid, reliable and comparable measures of health status of individuals are critical components of the evidence base for health policy. The need for sound information is especially urgent in the case of emerging diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics.Several successfully implemented health interventions have involved community health workers (CHWs) in reaching out to the community, and the Community Health Strategy is one such an intervention. The government of Kenya, through the Ministry of Public Health and Sanitation has rolled out the strategy as a way of improving health care at the household level. It involves CHWs collecting health status data at the household level, which is presented at community meetings in which the community discusses the results, identifies action areas, and plans activities for improving their health status.MethodsTen percent of all households visited by CHWs for data collection in different sites (rural and peri-urban) were systematically selected and visited a second time by technically trained research team members. The test-retest method was applied to establish reliability. The Kappa score was used to measure reliability, while sensitivity, specificity, and positive predictive values were used to measure validity.ResultsInter-observer agreement between the two sets of data in both sites was good; most indicators measured slight agreement. However, some indicators demonstrated greater discrepancies between the two data sets (e.g. measles immunization). Specificity measures were more stable in Butere (rural), which had more than 90% in all the indicators tested, compared to Nyalenda (peri-urban), which fluctuated between 50% and 90%. There were variable reliability results in the peri-urban site for the indicators measured, while the rural site presented more stable results. This is also depicted in the validity measures in both sites.ConclusionsThe paper concludes that there are convincing results that CHWs can accurately and reliably collect certain types of community data which has cost-saving implications, especially for resource poor settings.

Forty three percent (43%) of deliveries in Kenya takes place under the supervision of skilled attendants. But the Nyanza province in Western Kenya still registers lower proportions of facility deliveries (34 percent Contribution/ OriginalityThis study is one of very few studies which have investigated the opinions of mothers on the use of non-skilled maternal health care. Most papers have focused on the use of skilled attendants and have not effectively interrogated the opinions of women on why they specifically use non-skilled care.

Background: Fuels used for cooking are major sources of household air pollution, which lead to increased prevalence of upper respiratory tract infections and allergic conditions especially in children. The aim of present study was to investigate whether fuels used for cooking were risk factors for adenoid hypertrophy in children.Methods: Authors used a case-control study design where the exposure was cooking fuel and the disease was adenoid hypertrophy. Cases were children where a post nasal space x-ray showed enlargement of the adenoids. The controls were children with no adenoid hypertrophy or related diseases. The sample consisting of 112 children was hospital based. Parent-administrated questionnaires were used to collect information on cooking fuel.Results: Cooking gas and charcoal were associated adenoid hypertrophy. Adjusted odds ratio (OR) were 1.092 for charcoal and 3.516 for gas. Children in households where gas was predominantly used for cooking were three times more likely to have enlarged adenoids.Conclusions: Exposure to cooking gas which emits nitrogen dioxide was a primarily risk for adenoid hypertrophy. Larger community-based studies are recommended to come up with evidence that guides policy concerning use of household fuels and adenoid hypertrophy.