BackgroundInterventions to reverse trends in malaria-related morbidity and mortality in Kenya focus on preventive strategies and drug efficacy. However, the pattern of use of anti-malarials in malaria-endemic populations, such as in western Kenya, is still poorly understood. It is critical to understand the patterns of anti-malarial drug use to ascertain that the currently applied new combination therapy to malaria treatment, will achieve sustained cure rates and protection against parasite resistance. Therefore, this cross-sectional study was designed to determine the patterns of use of anti-malarial drugs in households (n = 397) in peri-urban location of Manyatta-B sub-location in Kisumu in western Kenya.MethodsHousehold factors, associated with the pattern of anti-malarials use, were evaluated. Using clusters, questionnaire was administered to a particular household member who had the most recent malaria episode (within <2 weeks) and used an anti-malarial for cure. Mothers/caretakers provided information for children aged <13 years.ResultsStratification of the type of anti-malarial drugs taken revealed that 37.0% used sulphadoxine/pyrimethamine (SP), 32.0% artemisinin-based combined therapy (ACT), 11.1% anti-pyretics, 7.3% chloroquine (CQ), 7.1% quinine, 2.5% amodiaquine (AQ), while 3.0% used others which were perceived as anti-malarials (cough syrups and antibiotics). In a regression model, it was demonstrated that age (P = 0.050), household size (P = 0.047), household head (P = 0.049), household source of income (P = 0.015), monthly income (P = 0.020), duration of use (P = 0.029), dosage of drugs taken (P = 0.036), and source of drugs (P = 0.005) significantly influenced anti-malarial drug use. Overall, 38.8% of respondents used drugs as recommended by the Ministry of Health.ConclusionThis study demonstrates that consumers require access to correct and comprehensible information associated with use of drugs, including self-prescription. There is potential need by the Kenyan government to improve malaria care and decrease malaria-related morbidity and mortality by increasing drug affordability, ensuring that the recommended anti-malarial drugs are easily available in all government approved drug outlets and educates the local shopkeepers on the symptoms and appropriate treatment of malaria. Following a switch to ACT in national drug policy, education on awareness and behaviour change is recommended, since the efficacy of ACT alone is not sufficient to reduce morbidity and mortality due to malaria.

Trial designA pragmatic cluster randomised controlled trial.MethodsParticipants: Clusters were primary health care clinics on the Ministry of Health list. Clients were eligible if they were aged 18 and over. Interventions: Two members of staff from each intervention clinic received the training programme. Clients in both intervention and control clinics subsequently received normal routine care from their health workers. Objective: To examine the impact of a mental health inservice training on routine detection of mental disorder in the clinics and on client outcomes. Outcomes: The primary outcome was the rate of accurate routine clinic detection of mental disorder and the secondary outcome was client recovery over a twelve week follow up period. Randomisation: clinics were randomised to intervention and control groups using a table of random numbers. Blinding: researchers and clients were blind to group assignment.ResultsNumbers randomised: 49 and 50 clinics were assigned to intervention and control groups respectively. 12 GHQ positive clients per clinic were identified for follow up. Numbers analysed: 468 and 478 clients were followed up for three months in intervention and control groups respectively. Outcome: At twelve weeks after training of the intervention group, the rate of accurate routine clinic detection of mental disorder was greater than 0 in 5% versus 0% of the intervention and control groups respectively, in both the intention to treat analysis (p = 0.50) and the per protocol analysis (p =0.50). Standardised effect sizes for client improvement were 0.34 (95% CI = (0.01,0.68)) for the General Health Questionnaire, 0.39 ((95% CI = (0.22, 0.61)) for the EQ and 0.49 (95% CI = (0.11,0.87)) for WHODAS (using ITT analysis); and 0.43 (95% CI = (0.09,0.76)) for the GHQ, 0.44 (95% CI = (0.22,0.65)) for the EQ and 0.58 (95% CI = (0.18,0.97)) for WHODAS (using per protocol analysis). Harms: None identified.ConclusionThe training programme did not result in significantly improved recorded diagnostic rates of mental disorders in the routine clinic consultation register, but did have significant effects on patient outcomes in routine clinical practice.Trial registrationInternational Standard Randomised Controlled Trial Number Register ISRCTN53515024.

Introduction: This was a nested study in which 2011 data from a baseline study conducted by Great Lakes University of Kisumu, supported with funds from UNICEF Kenya, findings was analyzed and used to assess the role of demographic and personal characteristic associated with exclusive breast feeding as a way of checking the high mortality of under-5 children in Nyanza province. Methods: A multi-stage cluster sampling technique was used to select 3,200 households. Descriptive statistics were used to determine the coverage of exclusive breastfeeding practice. Frequencies were run using SPSS and Chi -square test was used to determine the association. Findings: The practice of exclusive breastfeeding in Siaya County is found at 29.9%; with unemployed mothers presenting at 36.1%, while working class mothers performed poorly at 21.4%. On demographic factors, marital status reported that polygamous had 33.0%. Single mothers reported 36.0%.On personal characteristics, the time taken to initiate breast milk to a baby had an association with exclusive breast feeding. Conclusion: Marital status, putting the child on breast milk has an association with exclusive breastfeeding.

Introduction: This was a nested study in which 2011 data from a baseline study conducted by Great Lakes University of Kisumu, supported with funds from UNICEF Kenya. Findings was analyzed and used to describe practices of exclusive breastfeeding among lactating mothers with children under-5 years of age in Nyanza province. Methods: A multi-stage cluster sampling technique was used to select 2,805 households. Descriptive statistics were used to determine the coverage of exclusive breastfeeding practice. Frequencies were run using SPSS and Chi -square test was used to determine the association. Findings: The practice of exclusive breastfeeding in Siaya County is found at 29.9%; with unemployed mothers presenting at 36.1%, while working class mothers performed poorly at 21.4%.On the level of education:-respondents on none level of education reported the highest at 46.2%, while post Secondary level reported the lowest at 26.1%.All had a p-value 0.008 significant at the 5% level. This could be due to connection that education has with employment. Conclusion: Source of income and level of education has an association with exclusive breastfeeding. Recommendation. Need for further research to find out why uneducated mothers breastfeed more than educated mothers.