charles obonyo - Academia.edu (original) (raw)
Papers by charles obonyo
Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusio... more Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusion may decrease short-term mortality, the risk of human immunodeficiency virus (HIV) transmission is considerable in Africa. We constructed a decision tree to weigh the short-term mortality benefit of transfusion against HIV infection risk. Probability estimates were derived from published studies. The base-case was a two-year-old child with a 13.5% mortality risk to be transfused with screened or unscreened blood (1% or 13% HIV contamination risk, respectively), with reduction of mortality to 5.5% by transfusion (odds ratio ϭ 2.7), and a 2.4% risk of fatal transfusion complications. A sensitivity analysis was performed to assess the influence of variation in these estimates. If a child developed acquired immunodeficiency syndrome, survival was weighed as one-tenth of normal survival. For the base-case, we found that transfusion with screened blood provided a survival benefit of 5%. In contrast, transfusion with unscreened blood decreased survival by 2%. Patients with a mortality risk Ͻ 5% derived no benefit from a transfusion with screened blood. Other important factors for the benefit of transfusion were the effectiveness of transfusion in reducing mortality and the risk of blood contamination. A blood transfusion was clearly beneficial if the mortality risk was high and the risk of contamination was low. Our findings can be used as a basis for a clinical transfusion policy that limits transfusions to situations in which they are likely to be beneficial. This will in turn optimize child survival and prevent unnecessary exposure of low risk children to the transfusion risks.
Frontiers in Public Health, Nov 24, 2022
Multi-sectoral stakeholder perspectives on the local population health and wellbeing in an urbani... more Multi-sectoral stakeholder perspectives on the local population health and wellbeing in an urbanizing area in Kenya.
Sustainability
The literature on urban travel behaviour in Africa is sparse, limiting our understanding of how u... more The literature on urban travel behaviour in Africa is sparse, limiting our understanding of how urban transport policies respond to human and planetary needs. We conducted a cross-sectional household telephone survey on 1334 participants, using a 24 h time-use diary, to investigate travel behaviour and barriers to active travel (walking and cycling) in Yaoundé, Cameroon. We found that two-thirds of all participants reported at least one trip; the median (IQR) numbers of trips per capita and per participant with trips were 2 (0–3) and 2 (2–3), respectively. The main trip modes were shared taxi (46%), walking (27%), private cars (11%), and motorcycle taxis (10%), with 25%, 56%, and 45% of all participants reporting the use of active, motorised, and public transport, respectively. The mean (IQR) trip duration was 48 (30–60) min; for participants who reported trips, the daily overall and active travel durations were 121 (60–150) and 28 (0–45) min, respectively. Women were less likely to...
Malaria Journal, 2022
Background The World Health Organization recommends quinine plus clindamycin as first-line treatm... more Background The World Health Organization recommends quinine plus clindamycin as first-line treatment of malaria in the first trimester of pregnancy and as a second-line treatment for uncomplicated falciparum malaria when artemisinin-based drug combinations are not available. The efficacy of quinine plus clindamycin was compared with that of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in children below 5 years of age. Methods An open-label, phase 3, randomized trial was conducted in western Kenya. Children aged 6–59 months with uncomplicated falciparum malaria were randomly assigned (1:1) via a computer-generated randomization list to receive 3 days of twice a day treatment with either oral quinine (20 mg/kg/day) plus clindamycin (20 mg/kg/day) or artemether-lumefantrine (artemether 20 mg, lumefantrine 120 mg) as one (for those weighing 5–14 kg) or two (for those weighing 15–24 kg) tablets per dose. The primary outcome was a PCR-corrected r...
A randomized, open-label, comparative efficacy trial of artemether-lumefantrine suspension versus... more A randomized, open-label, comparative efficacy trial of artemether-lumefantrine suspension versus artemether-lumefantrine tablets for treatment of uncomplicated Plasmodium falciparum malaria in children in western Kenya
IntroductionLow household socioeconomic status is associated with unhealthy behaviours including ... more IntroductionLow household socioeconomic status is associated with unhealthy behaviours including poor diet and adverse health outcomes. Different methods leading to variations in SES classification has the potential to generate spurious research findings or misinform policy. In low and middle-income countries, there are additional complexities in defining household SES, a need for fieldwork to be conducted efficiently, and a dearth of information on how [1]classification could impact estimation of disease risk. MethodsUsing cross-sectional data from 200 households in Kisumu County, Western Kenya, we compared three approaches of classifying households into low, middle, or high SES: fieldworkers (FWs), Community Health Volunteers (CHVs), and a Multiple Correspondence Analysis econometric model (MCA). We estimated the sensitivity, specificity, and inter-rater reliability and misclassification of the three methods using MCA as a comparator. We applied an unadjusted generalized linear mo...
Nutrients, 2021
The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a re... more The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption (‘own livestock’) had lower odds of moderate or severe household...
Background: The global control strategy for schistosomiasis is the periodic administration of pra... more Background: The global control strategy for schistosomiasis is the periodic administration of praziquantel. Schistosomes have developed reduced susceptibility to praziquantel. Artemisinin-based drug combinations are promising alternatives to praziquantel, but it is unclear whether a single dose of an artemisinin-based drug combination is as effective and safe as praziquantel. We assessed the efficacy and safety of a single oral dose of artesunate plus sulfalene/pyrimethamine in the treatment of schistosomiasis. Methods: An exploratory, open-label randomized trial, was carried out in Rarieda sub-County, western Kenya to compare the efficacy of a single oral dose of artesunate plus sulfalene/pyrimethamine (12mg/kg of artesunate) to a standard single dose of praziquantel (40mg/kg) in the treatment of school children (aged 6 to 15 years) with S. mansoni infection. The primary outcomes were cure and egg reduction rates on day 28 after treatment in the per-protocol population.Results: A t...
The American Journal of Tropical Medicine and Hygiene, 1998
Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusio... more Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusion may decrease short-term mortality, the risk of human immunodeficiency virus (HIV) transmission is considerable in Africa. We constructed a decision tree to weigh the short-term mortality benefit of transfusion against HIV infection risk. Probability estimates were derived from published studies. The base-case was a two-year-old child with a 13.5% mortality risk to be transfused with screened or unscreened blood (1% or 13% HIV contamination risk, respectively), with reduction of mortality to 5.5% by transfusion (odds ratio ϭ 2.7), and a 2.4% risk of fatal transfusion complications. A sensitivity analysis was performed to assess the influence of variation in these estimates. If a child developed acquired immunodeficiency syndrome, survival was weighed as one-tenth of normal survival. For the base-case, we found that transfusion with screened blood provided a survival benefit of 5%. In contrast, transfusion with unscreened blood decreased survival by 2%. Patients with a mortality risk Ͻ 5% derived no benefit from a transfusion with screened blood. Other important factors for the benefit of transfusion were the effectiveness of transfusion in reducing mortality and the risk of blood contamination. A blood transfusion was clearly beneficial if the mortality risk was high and the risk of contamination was low. Our findings can be used as a basis for a clinical transfusion policy that limits transfusions to situations in which they are likely to be beneficial. This will in turn optimize child survival and prevent unnecessary exposure of low risk children to the transfusion risks.
American Journal of Public Health Research, 2014
Half a million women die annually from pregnancy related causes. In Kenya, maternal mortality rat... more Half a million women die annually from pregnancy related causes. In Kenya, maternal mortality ratio (MMR) remains high in spite of great efforts to improve maternal health care. We studied some factors linked to maternity in a rural community setting. A survey was conducted in the community living in Madiany division of Siaya County, Kenya. We randomly sampled 403 mothers of children under three years old. Variables of interest were antenatal care attendance (ANC), parity, distance from the health facility and women empowerment (autonomy). Nearly 94% of the mothers had at least one ANC visit and 48.6% had completed the recommended four or more ANC visits; about 65.7% initiated ANC at first trimester. Parity, distance to the health facility and autonomy were associated with ANC visits. Mothers with one child had a twice higher chance of at least four ANC visits than those with more than one child. Those living at most 60 minutes travel-time from the health facility were seven times more likely have early ANC initiation and five times more likely to have at least four ANC attendance than those living more than 60 minutes travel-time from the health facility. Autonomy was linked to early initiation of ANC visit. This may indicate that improving maternal care and achieving Millennium Development Goal (MDG) 5 target, it is important to improve coverage of health facilities and implement development programs that empower rural women.
Full list of author information is available at the end of the articletolerability of both drugs ... more Full list of author information is available at the end of the articletolerability of both drugs were assessed by caregiver questionnaire.
Background: World Health Organisation recommends quinine plus clindamycin as first-line treatment... more Background: World Health Organisation recommends quinine plus clindamycin as first-line treatment of malaria in the first trimester of pregnancy and as a second-line treatment for uncomplicated falciparum malaria when artemisinin-based drug combinations are not available. We compared the efficacy of quinine plus clindamycin with that of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in children below 5 years of age. Methods: An open-label, phase 3, randomised trial was conducted in western Kenya. Children aged 6-59 months with uncomplicated falciparum malaria were randomly assigned (1:1) via a computer-generated randomization list to receive 3 days of twice a day treatment with either oral quinine (20mg/kg/day) plus clindamycin (20mg/kg/day) or artemether-lumefantrine tablets (artemether 20mg, lumefantrine 120mg). The primary outcome was a PCR-corrected rate of adequate clinical and parasitological response (ACPR) on day 28 in the per-protoco...
Background Access to healthy food is considered a key determinant of dietary behavior, and there ... more Background Access to healthy food is considered a key determinant of dietary behavior, and there is mixed evidence that living near a supermarket is associated with a healthier diet. In Africa, supermarkets may contribute to the nutrition transition by offering both healthy and unhealthy foods and by replacing traditional food sellers. In Kisumu, Kenya, a planned hypermarket (ie, a supermarket combined with a department store) will form the basis for a natural experimental evaluation. Objective The aim of this study is to explore the impacts of a new hypermarket on food shopping practices, dietary behaviors, physical activity patterns, and body composition among local residents and to identify concurrent changes in the local foodscape. We also aim to explore how impacts and associations vary by socioeconomic status. Methods We employ a mixed methods, longitudinal study design. Two study areas were defined: the hypermarket intervention area (ie, Kisumu) and a comparison area with no ...
IntroductionThe nutritional transition is fuelling a concerning rise in Non-Communicable Diseases... more IntroductionThe nutritional transition is fuelling a concerning rise in Non-Communicable Diseases (NCDs) in Low and Middle-Income Countries (LMICs). These countries lack strong health infrastructure capable of supporting the long-term and expensive medical treatment for those living with NCDs. It is important to identify stakeholders involved in influencing food retail and dietary choices as part of a population-level strategy to reduce the burden of NCDs in LMICs. The aim of this study is to explore stakeholder perspectives on the impacts of new and existing food retail on local diets in Kenya.MethodsRegulatory and local community stakeholders from Kisumu and Homabay Counties of Western Kenya in this study responded to a semi-structured, open-ended interview schedule. We sought their perspectives on the impact of a proposed new mall and supermarket in Kisumu and existing supermarkets in Homabay on local dietary practices. Digital voice recorders captured the responses, which were t...
Introduction: Non-communicable diseases have risen markedly over the last decade. A phenomenon th... more Introduction: Non-communicable diseases have risen markedly over the last decade. A phenomenon that was mainly endemic in high income countries has now visibly encroached in low and middle-income settings. A major contributor to this is a shift towards unhealthy dietary behavior. The aim of this study was to examine the complex interplay between individual characteristics and the environment to understand how these influenced food choices and practices in Western Kenya.Methods: This study used semi-structured guides to conduct focus group discussions with both male and female members of the community, capturing various socioeconomic groups, from Kisumu and Homabay Counties to further understand their perspective on influences of dietary behavior. Narratives were obtained using digital voice recorders, transcribed verbatim and translated to English. Data analysis adopted an exploratory and inductive analysis approach. Coded responses were analyzed using NVIVO 12 PRO software.Results:...
Globalization and Health
Background Non-communicable diseases (NCDs) are the leading cause of death globally. While upstre... more Background Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub-Saharan Africa and the Caribbean are therefore the focus regions for a novel global health partnership to address upstream determinants of NCDs. Partnership The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthen...
BACKGROUND The increasing burden of non-communicable diseases (NCDs), which are prevalent in low ... more BACKGROUND The increasing burden of non-communicable diseases (NCDs), which are prevalent in low and middle income countries (LMICs), is largely attributed to modifiable behavioural risk factors such as poor/unhealthy diets and insufficient physical activity (PA). The adolescent stage–recently defined as 10-24 years of age–is an important formative phase of life and offers an opportunity to reduce NCD risk across the life course and for future generations. This protocol describes a portfolio of projects within the Global Diet and Activity Research (GDAR) Network, which aims to support the prevention of non-communicable diseases (NCD), including cardiovascular diseases, type 2 diabetes, and cancers in low and middle income countries (LMICs), with a specific focus on Kenya, Cameroon, South Africa and Jamaica. OBJECTIVE To utilise a convergent mixed methods design to explore exposures in the household, neighbourhood, school, and the journey from home to school, that may influence diet ...
BACKGROUND Access to healthy food is considered a key determinant of dietary behaviour and there ... more BACKGROUND Access to healthy food is considered a key determinant of dietary behaviour and there is mixed evidence that living near a supermarket is associated with a healthier diet. In Africa, supermarkets may contribute to the nutrition transition by offering both healthy and unhealthy foods; and by replacing traditional food sellers. In Kisumu, Kenya, a planned hypermarketThe aim of the study is to explore the impacts of the new hypermarket on food shopping practices, dietary behaviours, physical activity patterns and body composition in local residents, and to identify concurrent changes in the local foodscape. We also aim to explore how impacts and associations vary by socioeconomic status. (supermarket combined with department store) will form the basis for a natural experimental evaluation. OBJECTIVE The aim of the study is to explore the impacts of the new hypermarket on food shopping practices, dietary behaviours, physical activity patterns and body composition in local res...
Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusio... more Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusion may decrease short-term mortality, the risk of human immunodeficiency virus (HIV) transmission is considerable in Africa. We constructed a decision tree to weigh the short-term mortality benefit of transfusion against HIV infection risk. Probability estimates were derived from published studies. The base-case was a two-year-old child with a 13.5% mortality risk to be transfused with screened or unscreened blood (1% or 13% HIV contamination risk, respectively), with reduction of mortality to 5.5% by transfusion (odds ratio ϭ 2.7), and a 2.4% risk of fatal transfusion complications. A sensitivity analysis was performed to assess the influence of variation in these estimates. If a child developed acquired immunodeficiency syndrome, survival was weighed as one-tenth of normal survival. For the base-case, we found that transfusion with screened blood provided a survival benefit of 5%. In contrast, transfusion with unscreened blood decreased survival by 2%. Patients with a mortality risk Ͻ 5% derived no benefit from a transfusion with screened blood. Other important factors for the benefit of transfusion were the effectiveness of transfusion in reducing mortality and the risk of blood contamination. A blood transfusion was clearly beneficial if the mortality risk was high and the risk of contamination was low. Our findings can be used as a basis for a clinical transfusion policy that limits transfusions to situations in which they are likely to be beneficial. This will in turn optimize child survival and prevent unnecessary exposure of low risk children to the transfusion risks.
Frontiers in Public Health, Nov 24, 2022
Multi-sectoral stakeholder perspectives on the local population health and wellbeing in an urbani... more Multi-sectoral stakeholder perspectives on the local population health and wellbeing in an urbanizing area in Kenya.
Sustainability
The literature on urban travel behaviour in Africa is sparse, limiting our understanding of how u... more The literature on urban travel behaviour in Africa is sparse, limiting our understanding of how urban transport policies respond to human and planetary needs. We conducted a cross-sectional household telephone survey on 1334 participants, using a 24 h time-use diary, to investigate travel behaviour and barriers to active travel (walking and cycling) in Yaoundé, Cameroon. We found that two-thirds of all participants reported at least one trip; the median (IQR) numbers of trips per capita and per participant with trips were 2 (0–3) and 2 (2–3), respectively. The main trip modes were shared taxi (46%), walking (27%), private cars (11%), and motorcycle taxis (10%), with 25%, 56%, and 45% of all participants reporting the use of active, motorised, and public transport, respectively. The mean (IQR) trip duration was 48 (30–60) min; for participants who reported trips, the daily overall and active travel durations were 121 (60–150) and 28 (0–45) min, respectively. Women were less likely to...
Malaria Journal, 2022
Background The World Health Organization recommends quinine plus clindamycin as first-line treatm... more Background The World Health Organization recommends quinine plus clindamycin as first-line treatment of malaria in the first trimester of pregnancy and as a second-line treatment for uncomplicated falciparum malaria when artemisinin-based drug combinations are not available. The efficacy of quinine plus clindamycin was compared with that of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in children below 5 years of age. Methods An open-label, phase 3, randomized trial was conducted in western Kenya. Children aged 6–59 months with uncomplicated falciparum malaria were randomly assigned (1:1) via a computer-generated randomization list to receive 3 days of twice a day treatment with either oral quinine (20 mg/kg/day) plus clindamycin (20 mg/kg/day) or artemether-lumefantrine (artemether 20 mg, lumefantrine 120 mg) as one (for those weighing 5–14 kg) or two (for those weighing 15–24 kg) tablets per dose. The primary outcome was a PCR-corrected r...
A randomized, open-label, comparative efficacy trial of artemether-lumefantrine suspension versus... more A randomized, open-label, comparative efficacy trial of artemether-lumefantrine suspension versus artemether-lumefantrine tablets for treatment of uncomplicated Plasmodium falciparum malaria in children in western Kenya
IntroductionLow household socioeconomic status is associated with unhealthy behaviours including ... more IntroductionLow household socioeconomic status is associated with unhealthy behaviours including poor diet and adverse health outcomes. Different methods leading to variations in SES classification has the potential to generate spurious research findings or misinform policy. In low and middle-income countries, there are additional complexities in defining household SES, a need for fieldwork to be conducted efficiently, and a dearth of information on how [1]classification could impact estimation of disease risk. MethodsUsing cross-sectional data from 200 households in Kisumu County, Western Kenya, we compared three approaches of classifying households into low, middle, or high SES: fieldworkers (FWs), Community Health Volunteers (CHVs), and a Multiple Correspondence Analysis econometric model (MCA). We estimated the sensitivity, specificity, and inter-rater reliability and misclassification of the three methods using MCA as a comparator. We applied an unadjusted generalized linear mo...
Nutrients, 2021
The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a re... more The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption (‘own livestock’) had lower odds of moderate or severe household...
Background: The global control strategy for schistosomiasis is the periodic administration of pra... more Background: The global control strategy for schistosomiasis is the periodic administration of praziquantel. Schistosomes have developed reduced susceptibility to praziquantel. Artemisinin-based drug combinations are promising alternatives to praziquantel, but it is unclear whether a single dose of an artemisinin-based drug combination is as effective and safe as praziquantel. We assessed the efficacy and safety of a single oral dose of artesunate plus sulfalene/pyrimethamine in the treatment of schistosomiasis. Methods: An exploratory, open-label randomized trial, was carried out in Rarieda sub-County, western Kenya to compare the efficacy of a single oral dose of artesunate plus sulfalene/pyrimethamine (12mg/kg of artesunate) to a standard single dose of praziquantel (40mg/kg) in the treatment of school children (aged 6 to 15 years) with S. mansoni infection. The primary outcomes were cure and egg reduction rates on day 28 after treatment in the per-protocol population.Results: A t...
The American Journal of Tropical Medicine and Hygiene, 1998
Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusio... more Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusion may decrease short-term mortality, the risk of human immunodeficiency virus (HIV) transmission is considerable in Africa. We constructed a decision tree to weigh the short-term mortality benefit of transfusion against HIV infection risk. Probability estimates were derived from published studies. The base-case was a two-year-old child with a 13.5% mortality risk to be transfused with screened or unscreened blood (1% or 13% HIV contamination risk, respectively), with reduction of mortality to 5.5% by transfusion (odds ratio ϭ 2.7), and a 2.4% risk of fatal transfusion complications. A sensitivity analysis was performed to assess the influence of variation in these estimates. If a child developed acquired immunodeficiency syndrome, survival was weighed as one-tenth of normal survival. For the base-case, we found that transfusion with screened blood provided a survival benefit of 5%. In contrast, transfusion with unscreened blood decreased survival by 2%. Patients with a mortality risk Ͻ 5% derived no benefit from a transfusion with screened blood. Other important factors for the benefit of transfusion were the effectiveness of transfusion in reducing mortality and the risk of blood contamination. A blood transfusion was clearly beneficial if the mortality risk was high and the risk of contamination was low. Our findings can be used as a basis for a clinical transfusion policy that limits transfusions to situations in which they are likely to be beneficial. This will in turn optimize child survival and prevent unnecessary exposure of low risk children to the transfusion risks.
American Journal of Public Health Research, 2014
Half a million women die annually from pregnancy related causes. In Kenya, maternal mortality rat... more Half a million women die annually from pregnancy related causes. In Kenya, maternal mortality ratio (MMR) remains high in spite of great efforts to improve maternal health care. We studied some factors linked to maternity in a rural community setting. A survey was conducted in the community living in Madiany division of Siaya County, Kenya. We randomly sampled 403 mothers of children under three years old. Variables of interest were antenatal care attendance (ANC), parity, distance from the health facility and women empowerment (autonomy). Nearly 94% of the mothers had at least one ANC visit and 48.6% had completed the recommended four or more ANC visits; about 65.7% initiated ANC at first trimester. Parity, distance to the health facility and autonomy were associated with ANC visits. Mothers with one child had a twice higher chance of at least four ANC visits than those with more than one child. Those living at most 60 minutes travel-time from the health facility were seven times more likely have early ANC initiation and five times more likely to have at least four ANC attendance than those living more than 60 minutes travel-time from the health facility. Autonomy was linked to early initiation of ANC visit. This may indicate that improving maternal care and achieving Millennium Development Goal (MDG) 5 target, it is important to improve coverage of health facilities and implement development programs that empower rural women.
Full list of author information is available at the end of the articletolerability of both drugs ... more Full list of author information is available at the end of the articletolerability of both drugs were assessed by caregiver questionnaire.
Background: World Health Organisation recommends quinine plus clindamycin as first-line treatment... more Background: World Health Organisation recommends quinine plus clindamycin as first-line treatment of malaria in the first trimester of pregnancy and as a second-line treatment for uncomplicated falciparum malaria when artemisinin-based drug combinations are not available. We compared the efficacy of quinine plus clindamycin with that of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in children below 5 years of age. Methods: An open-label, phase 3, randomised trial was conducted in western Kenya. Children aged 6-59 months with uncomplicated falciparum malaria were randomly assigned (1:1) via a computer-generated randomization list to receive 3 days of twice a day treatment with either oral quinine (20mg/kg/day) plus clindamycin (20mg/kg/day) or artemether-lumefantrine tablets (artemether 20mg, lumefantrine 120mg). The primary outcome was a PCR-corrected rate of adequate clinical and parasitological response (ACPR) on day 28 in the per-protoco...
Background Access to healthy food is considered a key determinant of dietary behavior, and there ... more Background Access to healthy food is considered a key determinant of dietary behavior, and there is mixed evidence that living near a supermarket is associated with a healthier diet. In Africa, supermarkets may contribute to the nutrition transition by offering both healthy and unhealthy foods and by replacing traditional food sellers. In Kisumu, Kenya, a planned hypermarket (ie, a supermarket combined with a department store) will form the basis for a natural experimental evaluation. Objective The aim of this study is to explore the impacts of a new hypermarket on food shopping practices, dietary behaviors, physical activity patterns, and body composition among local residents and to identify concurrent changes in the local foodscape. We also aim to explore how impacts and associations vary by socioeconomic status. Methods We employ a mixed methods, longitudinal study design. Two study areas were defined: the hypermarket intervention area (ie, Kisumu) and a comparison area with no ...
IntroductionThe nutritional transition is fuelling a concerning rise in Non-Communicable Diseases... more IntroductionThe nutritional transition is fuelling a concerning rise in Non-Communicable Diseases (NCDs) in Low and Middle-Income Countries (LMICs). These countries lack strong health infrastructure capable of supporting the long-term and expensive medical treatment for those living with NCDs. It is important to identify stakeholders involved in influencing food retail and dietary choices as part of a population-level strategy to reduce the burden of NCDs in LMICs. The aim of this study is to explore stakeholder perspectives on the impacts of new and existing food retail on local diets in Kenya.MethodsRegulatory and local community stakeholders from Kisumu and Homabay Counties of Western Kenya in this study responded to a semi-structured, open-ended interview schedule. We sought their perspectives on the impact of a proposed new mall and supermarket in Kisumu and existing supermarkets in Homabay on local dietary practices. Digital voice recorders captured the responses, which were t...
Introduction: Non-communicable diseases have risen markedly over the last decade. A phenomenon th... more Introduction: Non-communicable diseases have risen markedly over the last decade. A phenomenon that was mainly endemic in high income countries has now visibly encroached in low and middle-income settings. A major contributor to this is a shift towards unhealthy dietary behavior. The aim of this study was to examine the complex interplay between individual characteristics and the environment to understand how these influenced food choices and practices in Western Kenya.Methods: This study used semi-structured guides to conduct focus group discussions with both male and female members of the community, capturing various socioeconomic groups, from Kisumu and Homabay Counties to further understand their perspective on influences of dietary behavior. Narratives were obtained using digital voice recorders, transcribed verbatim and translated to English. Data analysis adopted an exploratory and inductive analysis approach. Coded responses were analyzed using NVIVO 12 PRO software.Results:...
Globalization and Health
Background Non-communicable diseases (NCDs) are the leading cause of death globally. While upstre... more Background Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub-Saharan Africa and the Caribbean are therefore the focus regions for a novel global health partnership to address upstream determinants of NCDs. Partnership The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthen...
BACKGROUND The increasing burden of non-communicable diseases (NCDs), which are prevalent in low ... more BACKGROUND The increasing burden of non-communicable diseases (NCDs), which are prevalent in low and middle income countries (LMICs), is largely attributed to modifiable behavioural risk factors such as poor/unhealthy diets and insufficient physical activity (PA). The adolescent stage–recently defined as 10-24 years of age–is an important formative phase of life and offers an opportunity to reduce NCD risk across the life course and for future generations. This protocol describes a portfolio of projects within the Global Diet and Activity Research (GDAR) Network, which aims to support the prevention of non-communicable diseases (NCD), including cardiovascular diseases, type 2 diabetes, and cancers in low and middle income countries (LMICs), with a specific focus on Kenya, Cameroon, South Africa and Jamaica. OBJECTIVE To utilise a convergent mixed methods design to explore exposures in the household, neighbourhood, school, and the journey from home to school, that may influence diet ...
BACKGROUND Access to healthy food is considered a key determinant of dietary behaviour and there ... more BACKGROUND Access to healthy food is considered a key determinant of dietary behaviour and there is mixed evidence that living near a supermarket is associated with a healthier diet. In Africa, supermarkets may contribute to the nutrition transition by offering both healthy and unhealthy foods; and by replacing traditional food sellers. In Kisumu, Kenya, a planned hypermarketThe aim of the study is to explore the impacts of the new hypermarket on food shopping practices, dietary behaviours, physical activity patterns and body composition in local residents, and to identify concurrent changes in the local foodscape. We also aim to explore how impacts and associations vary by socioeconomic status. (supermarket combined with department store) will form the basis for a natural experimental evaluation. OBJECTIVE The aim of the study is to explore the impacts of the new hypermarket on food shopping practices, dietary behaviours, physical activity patterns and body composition in local res...