Abstract : Background: About 21 million Kenyans use unsanitary or shared latrines while 5.6 million have no latrine at all and defecate in the open. Busia County was among the counties with the lowest (42%) sanitation coverage compared to National level of 49%, with more than half of the population defecating in the open. Diarrheal and cholera were among the top three diseases causing morbidity and mortality in the County, with cholera outbreaks frequently being reported. In December 2012, Kenya government and UNICEF jointly implemented a pilot Community-Led-Total Sanitation Intervention (CLTSI) in Busia County to tame poor sanitation. The CLTSI was to achieve total sanitation among Busia County households through sanitation behavior change. To assure sustainability of sanitation behavior change, there was need to identify the specific attributable value of CLTSI to beneficiaries of Busia County. This study aimed at evaluating the social-economic returns on investment (SROI) among household beneficiaries of CLTSI in Busia County. Methods: Quasi Experimental Stdy design was used to collect data before(baseline) and after (Outcome) for CLTSI implementation while multi stage-random sampling was used to sample 459 houselds from villages that CLTSI had been implemented and certified to have achieved total sanitation in Busia County. SROI methodology was used to establish Social-economic value added to residents of Busia County by CLTSI. Results: SROI value added to Busia County residents was KES 1: 10.5 meaning that every KES invested it created a Social-economic value of KEES 10.5 to Busia residents. Conclusion: That CLTSI should be rolled out Country wide with a view of improving level of sanitation and hygiene.

Keyword : Evaluation, Sanitation, Community Led-To Total Sanitation Intervention, Social-economic Returns on Investment

Abstract : Background: In December 2012, Kenya government and UNICEF jointly implemented a Community-Led-Total Sanitation Intervention (CLTSI) in Busia County to tame poor sanitation that was at 42% vs 49% National. The CLTSI was to achieve total sanitation among Busia County households through sanitation behavior change. Main aim of the study was to document the lessons learnt after implementation of CLTSI in Busia County. The study focused on the implementation process of the CLTSI to draw experiences. Documenting lessons learnt helped in understanding and improving implementation of CLTSI, accounting for success (or failure) and enhancing best practice of CLTSI management before countrywide rollout. Methods: Quasi experimental design was used while multi-stage and random sampling was used to sample respondents. A total of 35 (70%) of primary implementers of CLTSI participated in the study Structured questionnaire was used to collect the data. Results: Findings show that out of 35 facilitators who implemented CLTSI, only 25(71.4%) were trained on the rigours of CLTSI. Duration of training varied from 3 days 10 (28.6%) to 5 days 15 (42.9%) of which more than a half 21(60.0%) CLTSI facilitators felt training was inadequate. Challenges experienced during implementation of CLTSI included: time constraint 24 (68.6%), transport constraint 20(57.1%), inadequate skills 17(48.6%), poor community mobilization 35(100.0%), household illiteracy 29 (82.9%), financial constraint 18 (51.9%).Other reasons included hostile community, poor leadership 32 (91.4%). Conclusion: For the purposes of rolling up the CLTSI, some lessons learnt could be adopted in order to achieve total sanitation in the country. From our evaluation study, CLTSI was found to have impacted positively to the residents of Busia County.

Keyword : Lessons learnt, Community-Led-To Total Sanitation Intervention

Abstract : Background: Globally, dental caries is one of the most prevalent dental health problem that affects children. Its prevalence in Bureti division is not known.The objectives were to determine dental caries experience, prevalence and risk factors associated with dental caries among pre-school going children of Bureti Sub-County, Kericho County. Methods: The Study population was all pre-school going children aged 3-6 years. The study utilized cross sectional descriptive design that involved quantitative techniques. The teeth of the children was examined at that point in time by a qualified dentist and also their caregivers/paretns interviewed on oral health hygiene practices. The dmft scores was recorded. A proportionate stratified sampling technique was used to sample schools. Data was analysed using Stata version 12 and data presented in tables and graphs. Chi test was used to test for associations between outcome/dependent variables and independent variables. Regression analysis was done to establish significance of associations among dependent and independent variables. Results: The mean age of children was 53.22±17.29 months, with boys being majority (51.7%). The child age of starting brushing teeth was 3.5±0.94 years. Majority (63.88%) had dental caries. The mean dmft was 3.54±1.95 with the greatest component being decayed teeth (53.1%). Majority of the children (62.26%) brush teeth with tooth paste and brush at least once weekly (61.73%). The main risk factors for dental caries were mother’s occupation (OR=3.18), Eating of sugary foods (OR=2.49), lack of brushing (OR=3.08), bottle feeding (OR=7.17), and poor social demographics. Conclusion: The prevalence of dental caries was high (63.88%) and severe (mean dmft=3.54±1.9) which indicate high dental care treatment need. Consumption of sugary foods rich in cariogenic particles, poor social demographics of the caregivers, poor brushing of teeth, bottle feeding (p-value≤0.05) are associated with high dental caries prevalence and dental caries experience.

Keyword : Dental Carries, Risk factors, Decayed teeth, Pre-school children

Abstract : Background: Postnatal care (PNC) is vital for the life of both mother and child as it reduces both marternal and infant morbidities and mortalities. However, in Kenya, PNC utilization is low (48%) but the cause is not known. Post-natal care –health seeking behavior among women oreproductive age in homa bay town Methods: A total of 377 mothers having children aged 6-8 weeks old participated in the study in which a community based cross sectional study using quantitative complemented by qualitative methods of data collection was employed. Quantitative data collection involved structured questionnaires administered to mothers proportionately and systematically randomly sampled. Qualitative data was collected through Key informant interview guide from 10 purposively selected health care providers and 11 lead community volunteers (CHVs). The SPSS version 17.0 and Chi square, Logistic regression and odds ratio were used for quantitative data analysis while thematic approach was used to analyse qualitative data to complement the findings. Results: Majority, 80% understood PNC and utilized such services within 6-8 weeks. About 81% of mother received information from skilled health workers. Majority,80% of women received immunization and was significant (χ² =12.635, p=0.027) to Utilization of PNC. Close 64% of women attended PNC services between two and three times. 67% mothers mentioned haemorrhage as the likely risk after delivery. Main attitude-related reason for low utilization of PNC service was lack of awareness (50.5%) of PNC, experience, expectation and perception that was significant (χ² =11.688, p=0.039) to access to PNC services. Majority who accessed PNC services expected physical examination (49.1%) and immunization of their babies (44.5%) and said the quality was good. On health seeking behaviours, 84% delivered in a health facility and 10.8% delivered home and was significant (χ² =11.354, p=0.003) to utilization of PNC. 89% accessed some form of PNC service was significant (χ² =21.515, p=0.000). There was a gap between knowing and understanding PNC as majority of the respondents had knowledge of PNC but attended twice and late between 4 and 6 weeks for purposes of immunization and sickness (hemorrhage). Conclusion: The study also revealed that positive attitude regarding reception by health providers, quality of service, expectation, experience and perception of PNC services increased utilization of PNC services.

Keyword : Post-Natal Care, Health seeking Behaviour, Knowledge, attitude, cultural beliefs

Abstract : BACKGROUND- Clavicle fractures were traditionally treated nonoperatively, but due to higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications there is an increasing trend for operative management. Plating and intramedullary nailing are the most popular surgical options Functional results after both the techniques proved to be superior compared with conservative treatment of DMCF in some recently reported prospective randomized studies. The aim of this study was to compare the clinical result ,functional outcome along with complications rate in minimally invasive antegrade TEN for the treatment of DMCF with that of 1/3rd tubular plating anteriorly. MATERIALS AND METHODS Prospective study was conducted between 2009 and 2016 in which 66 patients (49males and 17 females) with ota type b DMCFs underwent surgical fixation with antegrade TENs and 1/3rd tubular plate.They were randomized in two groups-one with TENS & other with plate fixation with 1/3rd tubular plate. Evaluation done by constant-murley shoulder outcome and dash scores at 6, 12 weeks, 3, 6, and 12 months to determine outcomes. RESULTS During analysis we have 34 pts in TENS group & 32 pts in plate group.There was no significant difference in union time,CONSTANT & DASH score. Lesser operating time,less blood loss,easier implant removal & minimal complication with no any case of deep infection seen in TENS group but shortening[>0.5 cm ]was noted in few cases.In plate group there were no major complications, only minor complications of superficial infection, deep infection,hypertrophied scarring without pain,limited shoulder motion with no case of shortening. CONCLUSION There is no significant difference regarding union [clinical and radiological] and stability.However TENS is preferable for treating simple displaced fracture of DMCFs in view of lesser morbidity,better cosmetic result,easier implant removal.Fixation with plate seems to be little more stable & its the implant of choice in comminuted fracture .

Keyword : Clavicle TENS 1/3rd tubular plate displaced

Abstract : Duplication cysts of the alimentary canal are rare congenital anomalies which can be present in any part of the GIT, from the oral cavity till the anal canal. The clinical presentation primarily depends on the location of the cyst. A large number of such lesions can be diagnosed prenatally using ultrasonography. The main treatment modality for enteric duplication cysts is surgery. Most commonly, these present with pain in abdomen, bleeding, and sometimes with obstruction, including intussusception. However, a significant number of these lesions are diagnosed incidentally. Here we are presenting a series of 3 cases showing the rare presentations of duplication cysts.  

Keyword : Duplication cyst; congenital anomaly; intraluminal; pediatric  

Abstract : Uropathogenic E. coli (UPEC) is the major cause of over 90% of urinary tract infections (UTIs). UTIs are the major common bacterial contaminations in health facilities and society settings. These infections require immediate medical attention as they cause discomfort to the diseased people. The cure of this disorder is complicated with the arrival of extended-spectrum β-lactamase (ESBL)-manufacturing pathogen. Therefore, the objective of this study is to determine the impact of two ancient antibiotics: Fosfomycin and Mecillinam. The experiment was conducted on diverse multidrug resilient clinical isolates. The challenges associated with the contaminations are compounded by the lack of appropriate chemotherapeutic agents. Several trials were conducted to investigate the vulnerability of clinical isolates like AmpC, + ESBL, TEME, and OXA 48. E.Coli is grown under intracellular and extracellular conditions of two longstanding antibiotics, namely Mecillinam and Fosfomycin. The antibiotics are viewed as disruptive against a range of Gram-negative bacteria. Our outcome demonstrates that these antibiotics show a lethal effect on some bacteria under study. Lastly, this investigation endorses the probable usage of both Mecillinam and Fosfomycin in the cure of these multidrug resistant microorganisms.

Keyword : Pathogen, antibiotics, ESBL positive strains, E.coli, Fosfomycin and Mecillinam