C. Pruebas de simulación: Dentro de este tipo de ensayos, encaminados a conocer el comportamiento de un tensioactivo en condiciones ambientales reales,
5. ANÁLISIS DE RESULTADOS
5.3 Toxicidad en el proceso de biodegradación
Kilifi District, the site of the study, is in Coast Province bordering the Indian Ocean (figure 4.1). The nearest city is Mombasa, the second largest city in Kenya and its main sea port. The area is located 4° south o f the Equator and has mean daily temperatures of between 22°C and 30°C, with relative humidity o f approximately 70%. There are two main rainfall seasons per year: the long rains are between April and June and the short rains, between October and December. Malaria transmission follows the seasonal rainfall, with peak periods between June and August and December and January.
S U D A N A ./% ^ETHIOPIA L<ik< A A.# M rir S r i ll l FI VhI. UGANDA U K t i\ I DI[iACÀLGALU I SOM AH A 1ESE?T
,.Ei,:r,"\:.KENYA
Eldoret^ , S ^ '' ^ "m Cey ^ \ K i su m j ^ N j k u r u ' ■■■'■• A Ma do Gashi NyVi.t Vit.K^nyi '''*\AIRnRI HYANlA '.Lamu Indian A Ocean M om bisa TANZANIA ^ IFigure 4. 1: Map of Kenya showing Kilifi, the study site
The population projection in the Kilifi D istrict D evelopm ent Plan for 1999, the year the study com m enced, w as 812, 684 (G overnm ent o f K enya, 1997). T he projection for children in the 5-9 year age range w as 136, 799. T he population is skew ed to the yo u n g er age ranges: children in the 0-14 age group account for 49% o f the people in the district.
A griculture is the m ost im portant econom ic activity in the area, engag in g 70% o f the labour force, m ostly in the form o f sm all-scale subsistence farm s (G overnm ent o f K enya, 1997). T here is a pattern o f m ale m igration to M om basa for w ork: in consequence, w om en carry out m ost o f the crop cultivation. T he m ost im portant food crop is m aize, follow ed by cassava; coconuts and cashew nuts are the m ost im portant cash crops. T he rate o f food self-sufficiency is low: 70% o f households in C oast Province are unable to produce sufficient food crops to m eet even h a lf o f the household energy requirem ents (H oorw eg, et al., 1995).
T here are 323 prim ary schools in Kilifi D istrict, w ith a p u p il/teach er ratio o f 35:1. The D istrict has 40 secondary schools. The level o f fem ale enrolm ent in secondary schools is low at 38% . There is one school for children w ith hearing im pairm ents and
seven units for children with disabilities in various schools, one for children with visual impairments and six for children with leaming disabilities (Government of Kenya, 1997).
The infant mortality rate in the district is 100/1000, which is higher than the Kenyan national figure of 66/1000. Chronic malnutrition is consistently high: 50% of pre school children are classified as malnourished. Immunisation coverage is low due to traditional practices and beliefs (Government of Kenya, 1997). Formal health services are provided by Kilifi District Hospital, government dispensaries, private health clinics and community health workers, who are trained to supply subsidised drugs from home and to assess patients for referral to other facilities when necessary. However, over 60% of rural households are located more than 2 kilometres from the nearest health facility and 50% live a similar distance from a community health
worker (Molyneux, 1999). In consequence, the majority o f people rely on the
informal sector - local shops stocking antipyretics and antimalarials and waganga, or
traditional healers - for first-line healthcare.
The research unit, the coastal branch of the Kenya Medical Research Institute (KEMRI) is a collaborative programme with The Wellcome Trust, UK. An area comprising a 40km stretch of coastline north of Kilifi town, extending 30km inland has been under demographic and epidemiological surveillance since the early 1990s (Snow, et al., 1993b). The study area consists o f rural and peri-urban communities
with most of the population originating from the Mijikenda ethnic group. The
languages spoken by this group and used as the medium of assessment in this study will be described in Chapter Seven. The research unit is attached to Kilifi District Hospital, the main referral hospital, used by more than 80% o f a population of 80 000 in the study area. The clinical arm of the research unit comprises a 40-bed paediatric ward, staffed by two to three nurses and receiving 5000 admissions per year (12 per day). There is also a high dependency unit with seven beds, two nurses and a dedicated clinical laboratory. Thirty-seven percent of admissions and 10% o f deaths in 1999/2000 were due to malaria (Dr C Newton, personal communication).
4.4 Summary
Estimates suggest that the proportion of children with disabilities may be higher in resource-poor countries than in their richer counterparts. Areas such as Kilifi have few rehabilitative services for such children. The characterisation of developmental impairments associated with severe forms of malaria may assist in the future development of appropriate service provision.