BackgroundSuccessful treatment of tuberculosis (TB) involves taking anti-tuberculosis drugs for at least six months. Poor adherence to treatment means patients remain infectious for longer, are more likely to relapse or succumb to tuberculosis and could result in treatment failure as well as foster emergence of drug resistant tuberculosis. Kenya is among countries with high tuberculosis burden globally. The purpose of this study was to determine the duration tuberculosis patients stay in treatment before defaulting and factors associated with default in Nairobi.MethodsA Case-Control study; Cases were those who defaulted from treatment and Controls those who completed treatment course between January 2006 and March 2008. All (945) defaulters and 1033 randomly selected controls from among 5659 patients who completed treatment course in 30 high volume sites were enrolled. Secondary data was collected using a facility questionnaire. From among the enrolled, 120 cases and 154 controls were randomly selected and interviewed to obtain primary data not routinely collected. Data was analyzed using SPSS and Epi Info statistical software. Univariate and multivariate logistic regression analysis to determine association and Kaplan-Meier method to determine probability of staying in treatment over time were applied.ResultsOf 945 defaulters, 22.7% (215) and 20.4% (193) abandoned treatment within first and second months (intensive phase) of treatment respectively. Among 120 defaulters interviewed, 16.7% (20) attributed their default to ignorance, 12.5% (15) to traveling away from treatment site, 11.7% (14) to feeling better and 10.8% (13) to side-effects. On multivariate analysis, inadequate knowledge on tuberculosis (OR 8.67; 95% CI 1.47-51.3), herbal medication use (OR 5.7; 95% CI 1.37-23.7), low income (OR 5.57, CI 1.07-30.0), alcohol abuse (OR 4.97; 95% CI 1.56-15.9), previous default (OR 2.33; 95% CI 1.16-4.68), co-infection with Human immune-deficient Virus (HIV) (OR 1.56; 95% CI 1.25-1.94) and male gender (OR 1.43; 95% CI 1.15-1.78) were independently associated with default.ConclusionThe rate of defaulting was highest during initial two months, the intensive phase of treatment. Multiple factors were attributed by defaulting patients as cause for abandoning treatment whereas several were independently associated with default. Enhanced patient pre-treatment counseling and education about TB is recommended.

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Background/Aim: In 2005, the sub-county health management team identified a need for information to reduce the lack of skilled attendance at birth. This study assesses the determinants of birth preparedness among women who had given birth in the last 2 years in Tharaka Nithi County, Kenya. Methods: Stratified sampling was used to select 345 pregnant women for interview. Systematic sampling was used so that every 14th client attending a maternal/child health clinic in the sampled facilities was interviewed. A descriptive cross-sectional survey design was used. A chi-squared test and logistic regression were used to analyse the data. Results: Approximately 20% of the interviewed sample were prepared for birth on all six recommended aspects of birth preparedness. The most planned for aspect of birth was hospital birth expenses (74%), followed by place of birth (69%). The least prepared for aspect was transport to a health facility (35%). Conclusions: Higher level of education, higher income, salaried occupation and at least four antenatal care visits all increased the likelihood of being more prepared for birth. A history of stillbirth reduced the likelihood of birth preparedness. It is recommended that the Kenya Ministry of Health improve levels of birth preparedness through the provision of antenatal care.

INTRODUCTIONDespite a global decrease of maternal mortality by 44% in the past two decades, 99% of the global 830 women that die daily from preventable causes related to pregnancy and childbirth still occur in poor and rural communities in developing countries.1 Fortunately, the risk of death from a birth complication can be detected early and averted if a woman attends the minimum four quality antenatal clinic (ANC) visits often referred to as focused antenatal care (FANC). Methods:Descriptive cross-sectional design was used to study 326 postnatal mothers in three primary health facilities. Systematic sampling technique was used. We collected data using a researcher-administered structured questionnaire and focused group discussion. Quantitative data analysis was conducted using statistical package for Social Sciences (SPSS) version 20.0 and involved univariate and bivariate analysis. Chi-square were used to test the significance of the association between the dependent and independent variables (p<0.05). Qualitative data was analyzed by thematic content analysis. Results: IBP utilization was low 48.2% (95% CI (42.7%-58.6%) despite high ANC attendance. Identifying a blood donor was the least utilized component (25%