School of Public Health

Prevalence and factors associated with modern contraceptive use among female adolescents aged 15-19 years in Kenya

Wed, 01 Jan 2025 00:00:00 GMT

Prevalence and factors associated with modern contraceptive use among female adolescents aged 15-19 years in Kenya Salat, Ednah Chepngeno Adolescent sexual and reproductive health (ASRH) contributes to the global burden of sexual ill health, with unmet needs persisting worldwide. Kenya's government reaffirms its commitment to increasing the contraceptive prevalence among adolescents aged 15-19 to 55% by 2025 from the current 10%. Only 43.8% of married and 36.9% of sexually active unmarried adolescents (15-19) used any method of contraception as of 2022 in Kenya. The objectives were; to determine the demographic and social characteristics (Age, education, marital status, parity, economic status), and prevalence of modern contraceptive use among female adolescents and to identify associated factors. The study utilized secondary data from Kenya's 2021 Performance Monitoring for Action (PMA) survey. The data extraction process focused on identifying and filtering female adolescents aged 15-19 who met specific inclusion criteria: sexually active, married or unmarried, and present during the survey period. After applying these criteria, the final weighted sample consisted of 344 respondents. Descriptive analyses were conducted to calculate the mean values and proportions for the relevant variables. Bivariate analysis was carried out to determine the association between outcome (modern contraceptive use) and exposure variables. All variables with a p-value>0.2 at the bivariate level were subjected to a multivariable binary logistic regression model. Stepwise backward elimination unconditional logistic regression was used to develop the final model. All variables with p-values >0.05 at a multivariable level were regarded as independently associated with modern contraceptives. According to the results of the 344 sexually active girls, 169 were using modern contraceptives, giving a prevalence of 49.1% (95% CI: 43.8- 54.4). The mean age was 17.8 years (SD+/-1.7), with the age group 18-19 years contributing 64.8% of the respondents, with a prevalence of 57.4%. Those who reported being married or staying with a partner as if married had 46.3% using modern contraceptives, while those with secondary and higher education had 51.9% using modern contraceptives. The odds of modern contraceptive use were 2.0 times higher among those adolescents aged 18-19 years (AOR 2.0, 95% CI, 1.21-3.45, p<0.005) compared to adolescents aged 15- 17 years. Those who reported having one child had 2.2 odds of using modern contraceptives compared to those who had never had a child before (AOR 2.2, 95% CI, 1.17-4.24, p<0.05). Other factors that were independently associated with modern contraceptive use include household wealth quantiles (AOR 4.9 CI 95%, 2.08-11.29, p<0.05) and the perception that the community’s view a few adolescents using modern contraceptives were promiscuous (AOR 0.4. 95% CI, 0.2-0.78, p<0.05). In conclusion Age, education, and economic resources have a positive impact on modern contraceptive use, while community perceptions have a negative influence. These factors are key in shaping the contraceptive behavior of adolescents in Kenya. Recommending this a targeted comprehensive approach encompassing education on sexual reproductive health, awareness-raising, and community engagement is paramount in empowering adolescents to make informed decisions about their reproductive health

Factors associated with mortality among severely ill covid-19 patients, Nairobi metropolis, Kenya

Wed, 01 Jan 2025 00:00:00 GMT

Factors associated with mortality among severely ill covid-19 patients, Nairobi metropolis, Kenya Muendo, Charles Mulwa Background: Severe Coronavirus Disease 2019 (COVID-19) occurs in about 20% of hospitalized patients. Many of these patients have comorbidities and are the main contributors for COVID-19 mortality. The most common underlying conditions include hypertension, diabetes, and chronic lung disease. Objectives: To describe socio-demographic factors of severe COVID-19 patients; determine the clinical, laboratory, and radiological characteristics and outcomes of severe COVID-19 disease; and evaluate the predictors of mortality for severely ill COVID-19 patients. Methods: A cross-sectional study in Nairobi Metropolis was conducted between September and December 2021. Patient information was collected from the inpatient registers of selected hospitals with COVID-19 isolation centers. This included demographic and clinical information, presenting signs and symptoms, laboratory and radiological findings during hospitalization, and case management. A severe COVID- 19 patient was defined as any COVID-19 patient with any of the following: oxygen saturation <94% in room air, respiratory rate >30 breaths/minute, and any signs of respiratory distress such as difficulty in breathing, or rapid breathing, confusion, reduced blood pressure, low blood oxygen, and tiredness. Mortality (case) was defined as any patient with severe COVID-19 infection who died, as recorded and reported by the hospital. Non-case was defined as any patient who survived a severe COVID-19 infection. Means and medians were calculated for continuous variables, and frequencies and proportions for categorical variables. Chi-square and multivariable binary logistic regression compared exposure factors with disease outcome. The study proposal was approved by Moi University Institutional Research Ethics Committee (IREC). Results: Total abstracted records were for 818 patients; 500 (61%) severe patients (153 non-survivors, 347 survivors). The analysis involved 150 non-survivors and 150 survivors. Males were 66.8%, and a mean age of 53.29 years ± 17.7. Sixty-four (64.3) percent presented with difficulty breathing, cough 63.7%, while 33.3% had a fever. Patients with Peripheral Oxygen Saturation (SPO2) of ≤94% were 39.9% at admission, rising to 90.0% during isolation. Patients with underlying diabetes were 29.3%, while hypertension/heart disease was 28.3%. Patients that developed acute respiratory distress syndrome (ARDS) were 26.0%. Patients put on oxygen therapy were 28.3%, mechanical ventilation 19.3%, and ICU admissions were 3.7%. Factors significantly associated with death were: hypertension (OR-3.5, 95% CI- 1.34–9.45, p-value- 0.011); ARDS (OR- 8.9, 95% CI- 3.05–26.14, p-value- <0.001); severe disease at admission (OR- 18.7, 95% CI- 5.24–67.15, p-value <0.001); and failure to receive oxygen treatment (OR- 17.5, 95% CI- 5.54–55.32, p-value <0.001). Conclusion: The results highlighted that advanced age, hypertension, hypoxia at admission, and lack of oxygen therapy were independently associated with increased risk of death. These findings are consistent with international evidence, yet they also reflect unique health system challenges within the Kenyan context. Recommendation: We recommend that the government of Kenya, through the Ministry of Health, should: enhance early risk stratification and triage, scale up oxygen supply and infrastructure, expand intensive care capacity, and improve management of non-communicable diseases, among others.

The factors associated with the uptake of intermittent preventive treatment of Malaria in pregnancy in Nambale Sub-County Hospital, Kenya

Thu, 01 Jan 2026 00:00:00 GMT

The factors associated with the uptake of intermittent preventive treatment of Malaria in pregnancy in Nambale Sub-County Hospital, Kenya Angute, Collins Omondi Background: Malaria remains a significant public health problem globally, with highest morbidity and mortality reported in sub Saharan Africa. In 2022, there were 12.7 million (36%) cases of Malaria in Pregnancy (MiP) in Sub Saharan Africa and 27% were reported from East Africa. In Kenya, there were a total of 4,080,441 malaria cases and 5% MiP cases. Busia County in Western Kenya reported 341,886 malaria cases and 22% MiP cases. WHO recommends administering intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) as preventive treatment for malaria in pregnancy (MIP) in malaria-endemic zones to prevent MiP. Objectives: To determine proportion of pregnant women of nine months’ pregnancy utilizing IPTp-SP 3 and to describe sociodemographic, health facility and individual factors influencing utilization of IPTp-SP 3 among pregnant women of nine months’ pregnancy attending antenatal care at Nambale Sub-County Hospital in Busia County. Methods: This was a cross-sectional study that employed consecutive sampling whereby, pregnant women of nine months, aged between 14-49 years were interviewed, using the interviewer- administered questionnaires on Kobo-collect. The dependent variable was the uptake of three doses of IPTp-SP, with sociodemographic, health facility and individual factors as the independent variables. A Descriptive of factors was done, Chi square test was used in bivariate analysis to determine association between independent variables and dependable variables, variable with p value of ≤0.2, were subjected to multivariable logistic regression analysis to identify variables with p value of ≤0.05 associated with utilization of IPTp-SP among pregnant women. Results: A total of 384 pregnant women were interviewed. Their median age was 25 years (range of 14 – 49 years), 68% (262/384) were married and 90% (348/384) of all the participants resided in rural areas. More than half of the participants, 60% (232/384) utilized IPTp SP3. Awareness of use and the benefits of IPTp was reported by 93% (256/384) of participants. Majority of the respondents, 67% (258/384) were unemployed, and 47% (182/384) had secondary education as their highest level of education. In the bivariate analysis, participant age 21-30 years {cOR=2.34, 95% CI=1.4–3.7}, belief that >3 doses of IPTp prevented MiP {cOR=3.09, 95% CI=1.5–6.2}and participant having attained tertiary education {cOR=2.71, 95% CI=1.4–5.1} were associated with uptake of three or more doses of IPTp by the participants. On multivariable logistics regression analysis, attendance of ANC at least 4 times {aOR=8.42, 95% CI=4.4–16.0} and participants taking IPTp-SP for the first time at 14-17 gestation weeks {aOR=7.79, 95% CI=3.2 18.7} were factors independently associated with optimal utilization of IPTp (IPTp-SP3). Conclusion: A sub-optimal IPTp-SP 3 utilization (60%) way below WHO target recommendation of 80%. More than four ANC attendance with the first IPTp-SP uptake beginning 14-17 gestation weeks were independently associated with optimal utilization of IPTp (IPTp-SP3). Recommendation: Pregnant women attending ANC at the facility should ensure that they attend ANC at least four times and take at least three doses of IPTp for maximum protection against malaria in pregnancy. Enhanced risk communication and community engagement by the community health volunteers on IPTp-SP awareness and importance. Key Words: FELTP, IPTp-SP, Kenya, Malaria, Pregnancy, WHO

Pesticide applicators’ knowledge, attitudes and practices of pesticide use and exposure in floriculture farms in Naivasha, Kenya

Thu, 01 Jan 2026 00:00:00 GMT

Pesticide applicators’ knowledge, attitudes and practices of pesticide use and exposure in floriculture farms in Naivasha, Kenya Muniu, Samuel Kimani Introduction: Pesticides are widely used in agriculture to boost yields and reduce pest related losses. Global pesticide use has doubled since 1990, reaching 3.70 million tonnes in 2022, with Africa's usage rising by 185% over the same period. However, Africa saw a slight decline from 210,000 tonnes in 2021 to 209,000 tonnes in 2022, with most pesticides imported. In Kenya, use peaked at 6,228 tonnes in 2020 before falling to 5,083 in 2022. A study in Naivasha found 141 pesticides in 20 horticultural farms, 4.3% classified by WHO as highly hazardous (Mburu et al., 2013). These statistics highlight that pesticides are still in use, yet their usage poses significant health risks to pesticide applicators working in floriculture farms due to occupational exposure. Despite continued pesticide reliance and health risks for workers, little research explores knowledge, attitudes, and practices (KAP) related to pesticide exposure, particularly in Naivasha’s floriculture industry. Objective: The study aimed to identify pesticide applicators’ knowledge of safe pesticide use and the potential health risks associated with exposure in floriculture farms. Secondly, it examined pesticide applicators’ attitudes towards pesticide use, safety measures, and their perceived risks in floriculture farms. Thirdly, it evaluated the practices of pesticide applicators regarding protective measures, handling, and application of pesticides in floriculture farms. Methods: A cross-sectional study conducted in May and June 2014 involving 168 pesticide applicators from floriculture farms in Naivasha, selected using multistage sampling. Data collection involved an interviewer-administered questionnaire. Ethical approval was obtained. Informed consent was secured from all participants prior to data collection. Data were analyzed using statistical methods: knowledge (0–23) was categorized using the Benjamin Bloom’s scale, attitudes (0–39) as positive/negative, and risky behaviours (0–26) with scores above 15 indicating higher risk. Descriptive statistics summarized findings, while Mann-Whitney and Kruskal-Wallis tests examined socio-demographic associations (p < 0.05). The Kolmogorov-Smirnov test assessed the normality of KAP scores. Results: All study participants were male, with an average age of 29; most (84.5%) were married, and half had attained post-primary education. Although 60.1% had high knowledge and 75% had positive attitudes toward safe pesticide use, 97.6% participated in risky practices. While higher knowledge (2[2] = 14.539, p = 0.001) and positive attitudes (U = 3092, p = 0.023) were significantly associated with reduced risky practices, they were not sufficient alone to ensure safe practices. Instead, the study found that older age (U = 1676, p < 0.001), being married (U = 2731, p < 0.001), higher educational levels (U = 2280, p < 0.001), and increased experience with pesticide usage (U = 1760.5, p < 0.001) were also significantly linked to safer behaviour. Conclusion: Effective pesticide safety requires more than knowledge and positive attitudes. Addressing key demographic factors like age, education, and experience is crucial to reduce risky practices. Recommendations: To improve pesticide safety in floriculture farms, stakeholders should provide training, raise awareness, and enforce protective measures. Educating pesticide applicators on health risks, promoting responsible attitudes, and ensuring proper equipment use will reduce hazardous exposure