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Impact of Tungiasis on School Age Children in Muranga County, Kenya

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Impact of Tungiasis on School Age Children in Muranga County, Kenya IMPACT OF TUNGIASIS ON SCHOOL AGE CHILDREN IN MURANGA COUNTY, KENYA. JOSEPHINE WANJIKU NGUNJIRI Research Thesis submitted in Fulfillment of the Requirement for the Award of a Degree of Doctor of Philosophy in Tropical and Infectious Diseases of The University of Nairobi. 2015 DECLARATION This research thesis is my original work and has not been presented for award of a degree in any other university. Josephine Wanjiku Ngunjiri Reg. No.W80/92621/2013 Signature…………………................Date…………………………… P.O Box 1881, Nyeri -Kenya The thesis has been submitted with our approval as the University supervisors. Dr. Peter N. Keiyoro Signature…………………................Date…………………………… Senior Lecturer: Biological sciences, School of continuing and Distance education University of Nairobi. P. O. Box 30197-01000, Nairobi Prof.Walter Mwanda Signature…………………................Date…………………………… Professor of Haematology : Institute of Tropical and Infectious Diseases, University of Nairobi,P. O Box 19676-00202, Kenyatta National Hospital University Campus Prof Jorg Heukelbach Signature…………………................Date…………………………… Department of Community Health, School of Medicine, Federal University of Ceará,Rua Prof. Costa Mendes 1608, 5. andar i Fortaleza CE 60430-140, Brazil ii Dedication This work is dedicated to my parents Mr.and Mrs.Ngunjiri, siblings Esther, Samuel and Teresa as well as my nephew Chris for their great support during my studies. Also to all the children in the Tungiasis endemic areas globally, this is in hope of their better future through acquisition of education. It is also hoped that these children will enjoy their childhood years free from burden of disease caused by Tungiasis. iii Acknowledgement I am grateful to the University of Nairobi Institute of Tropical and Infectious Diseases. I am very thankful to my supervisors Dr. Peter Keiyoro, Prof. Walter Mwanda and Prof. Jorg Heukelbach for their immense support, commitment, personal contributions, encouragement, guidance and close supervision during the study. To you I say a big thank you and may God bless you. I also wish to acknowledge funding from Kenyan Government through National Commission of Science, Technology and Innovation 5th call grant, 2014. I am thankful for the assistance from Daniel Kiirithio during the main data analysis phase, Lazarus Maina and Duncan Lenairoshi, community health workers especially Eunice Kiunga and Ann Wacera, parents and children who participated in the study. I appreciate the assistance provided by staff of Murang’a level 4 Hospital and Thika Hospital level 5 Records Departments during the desk top review of health records. I also appreciate the Institute of Health Metrics and Evaluation, University of Washington, USA for giving me an opportunity to attend the Global Burden of Disease Technical Training workshop in May, 2015 held in Greece. This offered a great learning and training experience in Global Burden of Disease metrics and methods of estimating burden of disease. iv Table of content DECLARATION ........................................................................................................................i Dedication................................................................................................................................ iii Acknowledgement ....................................................................................................................iv List of Figures........................................................................................................................ viii List of Tables ............................................................................................................................ix Operational definitions...............................................................................................................x List of abbreviations .............................................................................................................. xiii Abstract...................................................................................................................................xiv CHAPTER ONE:INTRODUCTION.........................................................................................1 1.1 Background of the study......................................................................................................1 1.2 Life cycle of Tunga penetrans .............................................................................................4 1.3 Problem statement................................................................................................................6 1.4 Significance of the study......................................................................................................8 1.5 Justification..........................................................................................................................9 1.6 Rationale of the study ........................................................................................................10 1.7 Objectives ..........................................................................................................................11 1.8 Research Questions............................................................................................................12 1.9 Research hypothesis...........................................................................................................12 1.10 Organization of the study.................................................................................................12 CHAPTER TWO:LITERATURE REVIEW...........................................................................14 2.1 Health Burden caused by Infectious Diseases ...................................................................14 2.2 Prevalence of Tungiasis and its sequelae...........................................................................14 2.3 Morbidity resulting from Tungiasis in endemic areas. ......................................................16 2.4 Mortality caused by Tungiasis...........................................................................................18 2.5 Disability Adjusted Life Years (DALYs) metric in quantifying burden of disease. .........20 2.6 Impact of health on acquisition of basic education............................................................24 2.7 Intervention measures used to address Tungiasis burden..................................................27 2.8 Theoretical frame work......................................................................................................29 2.9 Conceptual framework.......................................................................................................32 CHAPTER THREE:METHODOLOGY .................................................................................35 3.1 Study design.......................................................................................................................35 3.2 Study area...........................................................................................................................35 v 3.3 Study population ................................................................................................................37 3.4 Inclusion and exclusion criteria .........................................................................................37 3.5 Determination of Sample size and Sampling procedure....................................................38 3.6 Recruitment and consenting procedures ............................................................................40 3.7 Diagnosis of symptomatic Tungiasis among the children .................................................41 3.8 Prevalence of sequelae, health states and disease among age children .............................43 3.9 Morbidity caused by Tungiasis among children................................................................43 3.10 Mortality due Tungiasis among children. ........................................................................44 3.11 Determination of Disability Adjusted life years (DALYS) resulting from Tungiasis.....44 3.12 Determining variables of acquisition of basic education.................................................45 3.13 Quality assurance procedure............................................................................................46 3.13.1 Pre-testing of data collection instruments.....................................................................46 3.13.2 Reliability......................................................................................................................47 3.14 Data Collection Instruments ............................................................................................48 3.14.1 Questionnaires...............................................................................................................49 3.14.2 Observations .................................................................................................................50 3.14.3 Desk top Review guide .................................................................................................51 3.15 Data collection procedures...............................................................................................51 3.16 Ethical considerations ......................................................................................................52 3.17 Data management and statistical analysis........................................................................53
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