BACKGROUND: Family medicine (FM) was introduced in Kenya in 2005. Up to date (August 2019), 42 family physicians have graduated from Kenyan Universities. AIM: The aim of the study was to establish the current state of FM in Kenya and identify areas for more research and actions to support and improve FM in Kenya. SETTING: Interviews were conducted at the different work sites of the participants, four of them in hospitals, one at a University and one in a hotel where a FM conference was held. METHODS: An online questionnaire (response rate = 56%) and six semi-structured interviews were conducted amongst family physicians who completed their studies in Kenya. However, the focus was on the interviews. RESULTS: Family physicians have different ideas of how FM should look like ideally, but all agree that family physicians should be team leaders of a primary healthcare team, taking care of a defined population. Lack of policies, low numbers of family physicians and the misunderstanding of FM by all stakeholders are the major challenges. Sixty-four percent of the participants work in rural areas, and 77% perceive their current work as FM. CONCLUSION: Family medicine must be defined and properly promoted. Various areas have been identified that require further research: assessing required number of family physicians, reasons and solutions for the low number of family physicians, funding possibilities, and research the most suitable definition of a Kenyan family physician.

ABSTRACT Objective To establish the correlation between intestinal parasitism in children younger than 6 years old and their dwelling in environmental protected areas without aqueduct service, in the neighborhood El Codito, in Bogotá, Colombia. Materials and Methods A cross-sectional study was done with 144 children between the ages of 4 and 70 months. Socio-demographic data were collected by surveying parents, and fecal samples were taken from the children to identify parasites. Descriptive measures were calculated for the variables by population type (parasitized and non-parasitized), establishing significant differences. Using a binary multivariate logistic regression, the correlation between intestinal parasitism and aqueduct was determined, adjusting the other studied variables. Results The prevalence of intestinal parasitism was 38.9%. The lack of aqueduct service was associated with intestinal parasitism (OR=31.25) after adjusting for other studied variables, which included affiliation to the subsidized health insurance regime compared with the contributory regime (OR= 1.49), home pets (OR= 2.58), mothers with professional jobs compared to mothers with non-professional jobs (OR=0.05), and dwelling in a rented room when compared with own dwelling (OR= 6.62). Conclusions Children under the age of 6 living in protected areas without water service were more likely to suffer from intestinal parasitism. It is known that preserving protected areas to protect the environment is of great importance, but if the settlement of populations in these territories is not prevented in time, the population living there is subject to adverse conditions which violate human dignity.

RESUMEN Objetivos Establecer la relación entre parasitismo intestinal en niños menores de 6 años y vivienda en áreas de protección ambiental, sin servicio de acueducto, en El Codito -Bogotá, Colombia. Métodos Estudio de corte transversal que incluyó 144 niños entre los 4 y 70 meses de edad. Se recolectaron datos sociodemográficos encuestando a los padres y se tomaron muestras fecales de los niños. Se calcularon medidas descriptivas de las variables por tipo de población (parasitada y no parasitada) estableciendo diferencias estadísticamente significativas. Utilizando una regresión logística binomial multivariada se determinó la relación entre parasitismo intestinal y servicio de acueducto, controlando por las demás variables estudiadas. Resultados Se encontró una prevalencia de parasitismo intestinal de 38,9%. La falta de servicio de acueducto estuvo asociada a parasitismo (OR=31,25) ajustando por las demás variables estudiadas. Otras variables asociadas a parasitismo fueron: afiliación al régimen de salud subsidiado al compararla con el contributivo (OR=1,49), presencia de animales en la vivienda (OR=2,58), madres con oficio técnico-profesional al compararlas con madres con oficios no calificados (OR=0,05) y vivienda en habitación rentada al compararla con vivienda propia (OR=6,62). Conclusiones Los niños menores de 6 años viviendo en áreas protegidas sin servicio de acueducto presentaron con mayor frecuencia parasitismo intestinal. Si bien es claro que el establecimiento de áreas protegidas para preservar el medio ambiente es esencial, si no se previene el asentamiento de poblaciones en estos territorios a tiempo, la población que habita en los mismos está sujeta a condiciones adversas que atentan contra la dignidad humana.

RESUMEN Objetivos Establecer la relación entre parasitismo intestinal en niños menores de 6 años y vivienda en áreas de protección ambiental, sin servicio de acueducto, en El Codito -Bogotá, Colombia. Métodos Estudio de corte transversal que incluyó 144 niños entre los 4 y 70 meses de edad. Se recolectaron datos sociodemográficos encuestando a los padres y se tomaron muestras fecales de los niños. Se calcularon medidas descriptivas de las variables por tipo de población (parasitada y no parasitada) estableciendo diferencias estadísticamente significativas. Utilizando una regresión logística binomial multivariada se determinó la relación entre parasitismo intestinal y servicio de acueducto, controlando por las demás variables estudiadas. Resultados Se encontró una prevalencia de parasitismo intestinal de 38,9%. La falta de servicio de acueducto estuvo asociada a parasitismo (OR=31,25) ajustando por las demás variables estudiadas. Otras variables asociadas a parasitismo fueron: afiliación al régimen de salud subsidiado al compararla con el contributivo (OR=1,49), presencia de animales en la vivienda (OR=2,58), madres con oficio técnico-profesional al compararlas con madres con oficios no calificados (OR=0,05) y vivienda en habitación rentada al compararla con vivienda propia (OR=6,62). Conclusiones Los niños menores de 6 años viviendo en áreas protegidas sin servicio de acueducto presentaron con mayor frecuencia parasitismo intestinal. Si bien es claro que el establecimiento de áreas protegidas para preservar el medio ambiente es esencial, si no se previene el asentamiento de poblaciones en estos territorios a tiempo, la población que habita en los mismos está sujeta a condiciones adversas que atentan contra la dignidad humana.

ABSTRACT Objective To establish the correlation between intestinal parasitism in children younger than 6 years old and their dwelling in environmental protected areas without aqueduct service, in the neighborhood El Codito, in Bogotá, Colombia. Materials and Methods A cross-sectional study was done with 144 children between the ages of 4 and 70 months. Socio-demographic data were collected by surveying parents, and fecal samples were taken from the children to identify parasites. Descriptive measures were calculated for the variables by population type (parasitized and non-parasitized), establishing significant differences. Using a binary multivariate logistic regression, the correlation between intestinal parasitism and aqueduct was determined, adjusting the other studied variables. Results The prevalence of intestinal parasitism was 38.9%. The lack of aqueduct service was associated with intestinal parasitism (OR=31.25) after adjusting for other studied variables, which included affiliation to the subsidized health insurance regime compared with the contributory regime (OR= 1.49), home pets (OR= 2.58), mothers with professional jobs compared to mothers with non-professional jobs (OR=0.05), and dwelling in a rented room when compared with own dwelling (OR= 6.62). Conclusions Children under the age of 6 living in protected areas without water service were more likely to suffer from intestinal parasitism. It is known that preserving protected areas to protect the environment is of great importance, but if the settlement of populations in these territories is not prevented in time, the population living there is subject to adverse conditions which violate human dignity.

Introducción: Infecciones parasitarias intestinales (IPI) son enfermedades tropicales desatendidas, a pesar de que su prevalencia es alta en muchos países en desarrollo. El impacto en la salud pública de los IPI es importante, especialmente para los niños debido al efecto negativo sobre el crecimiento y el desarrollo. Objectivos: Este estudio examina la prevalencia y factores de riesgo de IPI en niños preescolares de barrios en riesgo, incluidos los de las familias desplazadas. Materiales y Métodos: estudio transversal entre 239 niños preescolares de dos barrios vulnerables de Bogotá. Se recogieron muestras fecales y se examinaron microscópicamente utilizando dos técnicas (directa y Ritchie). Se aplicó cuestionario para indagar factores relacionados con el parasitismo intestinal. Resultados: Se encontró una prevalencia de 26,4% de parásitos intestinales patógenos (Giardia duodenalis, Blastocystis spp, Trichuris trichiura, Ascaris lumbricoides y Hymenolepis nana). La regresión logística resultó en cuatro factores de riesgo: hermanos ≤5 años (OR 2.33 [1.077-5.021]), los perros callejeros (OR 2.91 [0.867-9.767]), los ocupantes de la casa (OR 2.57 [1.155-5.706]) y el sexo del niño/a (OR 2.17 [1.022-4.615]). Discusión: La presencia del IPI en los niños preescolar es un problema de salud importante en Bogotá y que debe abordarse. Una alta prevalencia de protozoos se encontró comparado con helmintos. La implementación de políticas que aborden los factores de riesgo podría ser un primer paso en la disminución de la prevalencia del IPI. El antecedente de desplazamiento no cambio ni el tipo de parásito ni la prevalencia de parasitismo.

Introduction: Intestinal parasitic infections (IPIs) are neglected tropical diseases, even though their prevalence is high in many developing countries. The public health impact of IPIs is substantial, in particular for children due to the negative effect on growth and development. Objectives: This study examines the prevalence and risk factors of IPIs in preschool-children from at-risk neighborhoods, including those from internally displaced families. Materials and Methods: A cross-sectional study among 239 preschool-children from two vulnerable neighborhoods in Bogotá. Fecal samples were collected and microscopically examined (direct and Ritchie technique) and data regarding related factors was obtained through a questionnaire. Results: A prevalence of 26.4% for pathogenic parasites (Giardia duodenalis, Blastocystis spp, Trichuris trichiura, Ascaris lumbricoides, and Hymenolepis nana) was found. Logistic regression resulted in four risk factors: siblings ≤5 years (OR 2.33 [1.077-5.021]), stray dogs (OR 2.91 [0.867-9.767]), household members (OR 2.57 [1.155-5.706]) and child's sex (OR 2.17 [1.022-4.615]). Discussion: IPI presence in preschool children is an important health issue in Bogotá which should be addressed. A high protozoan prevalence was found compared to helminthes. Implementing policies addressing risk factors could be a first step in decreasing IPI prevalence