IntroductionDespite extensive knowledge about effective tobacco control interventions, the prevalence of tobacco use in many middle- and low-income countries continues to rise. In these countries, public appreciation of levels of protection provided by laws and regulations on tobacco use and exposure to tobacco smoke is limited. After ratification of the Framework Convention on Tobacco Control, Kenya enacted the Tobacco Control Act, 2007, banning smoking in public places except in designated smoking areas.ObjectiveTo assess adherence to the Tobacco Control Act, 2007 by determining the presence of a workplace policy on tobacco use in bars and restaurants.MethodsA survey of 176 liquor licensed bars and restaurants in Nairobi County was carried out. Their managers were asked about the presence of a workplace policy governing smoking of tobacco, and observations made on provisions that determine adherence to the Tobacco Control Act, 2007.ResultsSmoking took place in almost all bars and restaurants (150 (85%)). Half the establishments (86 (49%)) had a workplace policy governing tobacco use among employees, although a difference between bars (11 (23%)) and restaurants (75 (58%)) was recorded (p<0.001). Establishments at which managers had lower levels of education were less likely to have a workplace policy (p<0.001) and less likely to have ‘no smoking’ signs and designated smoking areas (p<0.005).Conclusions and recommendationsKenya's implementation of the Tobacco Control Act, 2007 does not provide sufficient protection of patrons and workers in bars and restaurants. It is important to sensitise hospitality workers to the dangers of tobacco smoke. Bar and restaurants managers should have a minimum post-secondary education level. The Tobacco Control Act, 2007 requires strengthening to ensure that bars and restaurants have a smoke-free environment.
The use and abuse of antibiotics are directly related to the development of drug resistance, a global public health problem. Whereas the majority of research focus is on the use and misuse of antibiotics in drug resistance development, little is known about improper disposal, as a source of contamination in the environment that includes groundwater, especially in informal settlements. This study sought to determine antibiotic use and disposal in informal settlements in Kisumu, Kenya. A random cross-sectional sample of 447 households in selected informal settlements of Kisumu, Kenya was studied. A structured questionnaire was issued to persons heading households. The prevalence of antibiotic use was 43% (n = 193). Among these people, 74% (n = 144) had consulted a health worker in a healthcare facility for a prescription. Respondents did not always complete doses but kept the remainder for the next time they would become ill (54%). About 32% disposed of the remainder of the antibiotics in pit latrines and compost pits (10%) while 4% disposed through burning. Antibiotic use was fairly high despite a low level of awareness of the health effects of consuming water contaminated with antibiotics (35%) (n = 156); p = 0.03. Misuse and inappropriate disposal of antibiotics as identified may lead to a higher risk of antibiotic resistance, increasing the disease burden in the informal settlements.
High frequency of antibiotic detection in groundwater in informal settlements is attributed to increased usage and improper disposal, thus difficult to identify sources of antibiotic resistance in the environment, worsened by inadequate sanitation facilities and increased population density, particularly in developing-countries. Reliance on groundwater exposes them to pollutants and risk of antibiotic resistance, in addition to experiencing inequities in accessing vital services. Sulfamethoxazole and trimethoprim, used for prophylaxis by HIV/AIDS patients were tested in 49 groundwater sources in Kisumu, Kenya. Only Sulfamethoxazole (SMX) was found, with a detection frequency of 14.3% and concentrations ranging from below limit of quantification (LOQ) to 258.2 ng/L. Trimethoprim (TMP), marketed in combination with sulfamethoxazole, was not detected, owing to its high distribution coefficient (kPa7.12) and, generally, being a bigger molecule with modest water mobility and solubility. Furthermore, TMP ratio in cotrimoxazole is low (5:1), it is expected that mass loading will be lower, as well as influence of the study area’s hydrogeology, where soil is clayey with high porosity and permeability. Escherichia coli was recovered in 98% (n = 48) of water samples, with counts ranging from 16 to 8,850 MPN/100ml. Additionally, resistance to sulfamethoxazole was identified in 6% (n = 3) samples with Inhibition Zone Diameters of 0.8mm(resistant), 10.5mm (resistant), and 11.5mm (intermediate), but not among samples where SMX was detected. Antibiotic concentrations in water that can cause resistance are unknown because antibiotic-resistant E. coli was not found in water samples where sulfamethoxazole was identified, raising concerns about f environmental resistance spread. Concentration of SMX was lower in a previous research, which only collected water from one groundwater source, than the current study, which included additional samples (49). Presence of SMX and Escherichia coli resistance is of concern and necessitates greater attention and regular monitoring for potential contaminants and resistance trigger to avert potential risks to human health.
Background: Informal settlements across SSA have proliferated with increased urban population. Characterized by inadequate water supply, inhabitants resort to groundwater for domestic use. This happens oblivious of water contamination with emerging contaminants in form of antibiotics and their derivatives. Development of antibiotic resistant genes and antibiotic resistant bacteria, causes ill health, thus interventions that increase level of awareness of health effects of consuming water contaminated with antibiotics are requisite. This involves protecting human, animal and environmental in totality in a One-Health approach. This study sought to determine antibiotic use, disposal and level of awareness of health effects associated with consuming water contaminated with antibiotics.Methods: A cross-sectional study of a random sample of 447 households in selected informal settlements of Kisumu County, Kenya was conducted in September 2019. A structured questionnaire was generated based on research questions and administered to heads of households to assess, antibiotic use, disposal and level of awareness of health effects associated with consuming water contaminated with antibiotics. Data was entered and analyzed in SPSS version 20.Results: Level of awareness of health effects of consuming water contaminated with antibiotics was low, 35% (n=156), especially among households where a member had used an antibiotic within one month prior to the time of study; p=0.03. Groundwater was used by 99.8% (n=446) for various purposes, including drinking (9% (n=40)), cooking (18%(n=43)), washing utensils (79% (n=353)), clothes (96% (427)) and house (95% (421)). About half the households reported antibiotic use 43% (n=193). Among this, 74% (n=144) consulted a health worker in a healthcare facility for prescription. Respondents who had taken antibiotics did not always complete doses but reported to have kept the remainder for next time they would get sick (54%). About 32% disposed remainder of antibiotics in pit latrines, compost pits (10%) while 4% reported to have burnt them. Conclusion and recommendation:Groundwater is the major water source for domestic use in informal settlements. With low awareness of risks associated with consuming water contaminated with antibiotics, a looming public health concern due to antibiotic resistance necessitate attention to avert health effects that may lead to ill health.
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