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Drivers, decision making processes and outcomes of unsafe abortion in four districts of Siaya County, Kenya .
(2013-03-18) Osur, Joakim
Unsafe abortion is a major public health problem causing 13% and 30% of maternal deaths globally and in Kenya respectively. Despite this, the drivers of the practice in Kenyan communities are scarcely documented. Further, little is documented about the decision making process for women who chose unsafe abortion and whether social networks have a role on this. In addition, not much is known about the methods unsafe abortion providers use and the outcomes of the methods. The objectives of this study were, therefore, to determine the drivers of the practice; find out how social networks influence women's decisions to procure abortion; and determine outcomes of methods used in Siaya County. The study employed a mixture of quantitative and qualitative techniques including cross-sectional survey of 320 patients presenting to health facilities after attempted unsafe abortion; case studies of 8 women who had undergone unsafe abortions; one enquiry into unsafe abortion related death using Rashomon technique and in-depth interviews with 12 unsafe abortion providers and 21 key informants. The findings indicated that women procuring unsafe abortions were mostly below the age of 24 years (76%), in their first trimester of pregnancy (85%) and presenting to health facilities with incomplete abortion (87%). The most commonly reported drivers of unsafe abortion included inadequate infrastructure and equipment in health facilities with all facilities studied not having a full complement of recommended conditions. Only 5.5% of eligible health workers were competent and willing to provide termination of pregnancy services. At community level, unsafe abortions were associated with desire for a good life, pressure from social contacts, and the determination of unsafe abortion providers to give the service. Social networks were found to play a role in the woman's decision making process with 95% of the women consulting with their social networks before making a decision. These consultations led to 63% of women owning a decision to abort while the rest were either not sure or even felt compelled to abort. Logistic regression predictions showed that the man causing the pregnancy and the woman's mother were the most influential persons in cases of unsafe abortion. A case fatality rate of 0.3 per 1000 women aged 15 - 44 was recorded. Other severe complications included hemorrhage requiring blood transfusion and pelvic infection. A Chi square test revealed significant difference in the outcomes of unsafe abortion based on the methods used (X2 = 193, df = 30, p 0.05). Logistic regression predictions confirmed that the outcomes depended on methods used, genital tract injury, for example, being 30%, 120% and 370% more likely to occur with use of self -inserted gadgets, self- inserted medicine and gadget inserted by someone else respectively as compared to hemorrhage not requiring transfusion. It is recommended that the Ministries in charge of Health and NGOs running programs to reduce unsafe abortion prioritizes community involvement as a way of reducing unsafe abortion; give unsafe abortion providers capacity to counsel and refer patients to health facilities; and that the identified drivers of unsafe abortion are addressed comprehensively.
Effects of bednet use, topography and targeted vector control on malaria transmission in the highlands of Vihiga and Kakamega counties, Western Kenya
(2013-03-26) Atieli, Harrysone Etemesi
Insecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality. However, there is scanty information on actual usage of owned nets which varies among households. Such variations may limit the potential effect of nets and cause spatial heterogeneity on malaria transmission. Likewise there is limited information and utilization of topographic parameters such as the shape of the underlying valley ecosystem in identification of high-risk malaria foci to help enhance surveillance and targeted vector control activities in regions where they are most needed. The objective of this study was to determine the effect of ITNs use, topography and targeted vector control on malaria transmission. The study was done in; Iguhu, Mbale and Emutete in Vihiga and Kakamega counties, in malaria hypomeso-endemic highlands of western Kenya. All houses in study sites were geo-referenced and mapped. Using a randomized-repeated cross-sectional study design, residents of 300 households randomly selected from each site in Iguhu and Emutete were interviewed for ITN s ownership/usage, their houses sprayed for vector abundance and occupants screened of malaria during the dry and rainy seasons of 2009-2010. Association of topography and spatial distribution of malaria vectors and infections were determined between broad 'U'-shaped versus narrow 'V'-shaped valley ecosystems in the three sites. Baseline information from spatio-temporal data above was used to identify intense transmission areas for target vector control using Indoor Residual Spray (IRS) and Biological larviciding. Entomological and parasitological data were used for impact evaluation. Data was managed in excel spread sheets and analyzed by STATA software. Student t-test was done to determine differences in adult vectors and larval densities while Chi-square test was done to determine differences in occurrence of malaria infection prevalence. Univariate and multivariate' analysis of Turkey HSD test was done to determine the most predictive independent variable for the occurrence of larvae, adult vectors and malaria cases. Despite ITN ownership reaching more than 71%, usage was low at 56.3%. The proportion of non-adherence to ITN use was significantly higher during the dry season than rainy season, 46.6% vs. 32.9% in Iguhu (X2= 12.42, d.f = 1, P <0.001) and 53.4% vs. 41.8% in Emutete (X2 = 21.12, d.f = 1, P < 0.0001), respectively. Indoor resting female An. gambiae s.l. density was lower (43% t = 2.38, d.f = 167, P = 0.02) in houses with functional ITNs. Infection prevalence for all age groups was significantly lower by 30% among net users compared to non-net users during the rainy season (OR 0.72,95% CI 0.51-1.00, P < 0.05). Broad flat bottomed valleys had significantly high number of anopheles larvae per habitat (P=0.024 Tukey HSD test), indoor resting vector density (f-=5.7, P<0.000I) and malaria infections (t=9.96, P<0.000I) than narrow valleys ecosystem during both seasons. Targeted vector control was associated with up to 61.3% reduction in indoor resting vector densities although. the reduction/effect on malaria infection was not significant. The findings of this study highlight the wide gap between ITN ownership and usage and effect on malaria transmission. Likewise, it recognises the importance of topographic parameters on vector abundance and malaria transmission. Based on this study, there is need to sensitize households on sustained use of owned ITN s in order to optimize their role as a malaria control tool and the need to consider topographic parameters in identification of high-risk malaria foci and use of this in programmatic targeted vector control to fight malaria.
The inference of immunochromatographic test, microscopy and polymerase chain reaction in diagnosis of lymphatic filariasis in Tana Delta, Kenya
(2013-08-14) Kagai, James Mwaniki
The current diagnostictests for Wuchereriabancrofti infections are insensitive and logistically unsuitable in epidemiological studies and disease surveillance. Although needing refinement, potentially sensitive polymerase chain reaction (PCR) assays have been developed. The suitability of these assays as molecular epidemiological and surveillance tools has not been extensively studied. These assays can be used to estimate disease indices, such as vector infection rate and are important in estimation of the infection pattern in the suspect areas. The main objective of this work was to study W. bancrofti infections in an identified population in the Tana Delta district, using modified molecular assays. The Tana delta, situated along the Kenyan north coast lies in a potentially lymphatic filariasis endemic region but no data on the disease has been documented. This study improved and evaluated PCR assays in monitoring of W. bancrofti infections in humans and the vectors in the Tana Delta. Samples which included, blood, sputum and urine were collected from consenting participants along with mosquitoes which were collected from their homes. The mosquitoes were identified and examined for W. bancrofti infections. Observations from the study indicated that PCR assays had sensitivity and specificity above 84%. This study demonstrated that the W. bancrofti infections exist in the Northern part of the Kenyan coast with prevalence of 6.4% to 9.6% using traditional diagnostic tests and PCR assays respectively. The prevalence of W. bancrofti in mosquito vectors was 1.0% microfilariae by dissection and 1.6% by PCR mosquito assay. A relationship between LF prevalence in the population and vector prevalence was observed. Through a calculation of a factorש (Hebrewshin), the relationship could enable projection of LF prevalence in the population from the determined vector prevalence. The study suggests that this factor ש would be directly proportional to the disease prevalence in the population (p=0.005). By using the modified PCR assays which are both sensitive and specific (p<0.005), an end point (denoted as a prevalence of 0.1%) for the mass drugs administration (MDA) can be determined. The age group 11-20 years was found to be more enthused in participating in the study, with the best turn out of 31% compared to all other age groups (p=0.001). This group had the highest lymphatic filariasis prevalence too. The results from sputum and urine are comparable, suggesting that either of these samples may be used in LF surveillance studies. It is observed that whereas the molecular methods are sensitive and specific, the cost involved is high. The study therefore recommends the use of PCR assays in determination of end-point for MDA. Further, it is recommended that where a survey of lymphatic filariasis is required; 11-20 age group be used to represent the community.
Assessment of Heavy Metal Concentration in the Environment and Perceived Health Risks by the Community around Kadhodeki Dumpsite, Nairobi county
(2014-02-22) Njagi, Joan Murugi; Njagi, E.N.M.; Akungah, Daniel Nyagetiria; Afullo, A. T. O
Solid wastes constitute a disaster for human health and environmental degradation. Dumpsites in Kenyan urban settlements are used as sources of nutrient rich soils for cultivating crops without regard to the risks of perceived toxic heavy metal pollution from the wastes. Water sources near the dumpsites are used as domestic water source for the people living near such sites. This water is often contaminated by toxic heavy metals leaching from the dumpsite. Heavy metals are known to accumulate in the plants then passed to the humans through the food chain. Prolonged consumption of unsafe concentrations of heavy metals through foodstuffs may lead to the accumulation of heavy metals in the humans causing disruption of numerous biochemical processes. The aim of this study was to determine the level of heavy metals in the vegetables, soil and water samples collected around Kadhodeki dumpsite. The study also sought to assess the knowledge, attitude and perceptions of the health risks posed by the site to the residents of the village. Heavy metal determination samples collected was carried out using X- ray fluorescence (XRF) analytical method. A descriptive cross sectional survey was carried out to assess the knowledge, attitudes and perceptions of people living around the study area. The analytical data was subjected to statistical tests of significance using ANOVA and post hoc analysis by Tukeys test (P<0.05) to determine whether there was any significant difference between the study sites. Chi square was used to determine if there were associations between the study variables in the survey. The research found that the vegetables under study had low levels of essential metals Fe, Mn, Zn and Cu while they had higher levels of Ni, Co, V, and more than maximum allowable levels (MAL) of Hg and Pb. V, Mn, Cu, Ni, Hg concentrations in the soil were higher than MAL for agricultural soils while Fe, Zn were within the limits. The water was contaminated by high than allowed levels of Mn (366-856 μg/l) and Fe (5132-12402 μg/l) in drinking water while Zn (40-336 μg/l) was below the WHO limits. The people living in Kadhodeki village had inadequate knowledge about the health risks which was significantly associated with the level of education (χ2 = 20.86 df=1 P<0.01). A significant association between level of education and perception was also revealed (χ2=13.57, df=1, p<0.01). Insignificant associations between age and the number of years the participants had lived in the village were found for the variables of knowledge, attitude and perception. Health education to the people living in Kadhodeki village on the dangers posed by the vegetables grown around the dumpsite should be done to prevent further consumption of contaminated crops. Farmers growing edible crops around the site should be advised to stop doing so and instead encouraged to grow other crops which can provide some earning and at the same time reclaim the land.
Predictors of community health workers retention in service in Makueni County, Kenya
(2014-07-24) Kithuka, Peter Munyao; Ochieng, O.; Korir, Julius; Mwitari, J.
Globally, the reported attrition rates of Community Health Workers (CHWs) vary between 3.2% and 77% with high rates being associated with volunteer CHWs. In Kenya, retention rate is estimated at 67% while in Makueni it varies between 50% and 98%. The success of community programmes is often hampered by low retention rates which affects the sustainability of interventions and increases training costs, since it needs continuous replacement which makes the programme difficult to manage. The main objective of this study was to establish predictors of community health workers retention in service in Makueni County. The study used a crosssectional study design employing mixed methods of data collection incorporating researcher-administered questionnaires, Focus Group Discussions and Key Informant Interviews. The study population consisted of 2,800 CHWs commissioned by the Ministry of Health in Makueni County. Sample size of the study was 603 CHWs selected through Cluster sampling. 552 CHWs participated in the study. Purposive sampling was used to select participants for Focus Group Discussions and Key Informant Interviews. Quantitative data was subjected to descriptive, cross-tabulation and logistic regression analysis using SPSS version 20 software. Thematic analysis was done using Nvivo to gain an in-depth understanding of the study results and triangulate quantitative findings. Results showed that of the 552 CHWs interviewed, 87.7% were married, 78.2% were aged between 30-49 years, 68.1% were females, 59.6% had completed secondary level of education, 97.6% were Christians, 62% were subsistence farmers and 64% were residents in lowland zone. The retention rate among the study participants was 69.4%. Logistic regression results showed that the predictors of retention of CHWs in Makueni County included; financial incentives (p=0.000, OR= 129.477), provision of health updates (p=0.000, OR=4.489), belonging to a self-help group (p= 0.004, OR=2.555), provision of reporting tools (p=0.000. OR=0.022 and provision of essential medical kits (p=0.000, OR=4.768). In conclusion, there is need to review community health strategy implementation guidelines to harmonize provision of regular financial incentives, essential medical kits, reporting tools and health updates (through more comprehensive training programmes, refresher trainings and regular dissemination and sharing of new health information). The national and county government and partners of the community health strategy should also create effective mechanisms for livelihood support of CHWs such as establishing self-help groups as a sustainability measure for the community health strategy.
Adherence and Treatment Outcomes among Patients with Comorbidity of Depression and Other Mental Disorders attending Psychiatric Hospitals in Rwanda
(2014-08-18) Mutabazi, Michel
Mental disorders constitute a serious public health problem. Besides, the co-morbidities of mental disorders pose a major problem with regard to adherence and treatment outcomes. This pseudo-longitudinal study aimed to investigate adherence and treatment outcomes among patients with comorbidity of depression and other mental disorders attending psychiatric hospitals in Rwanda. A sample of 382 patients was selected using systematic random sampling from three neuropsychiatric sites. The first and second assessments of patients took place after two and four months from each date of recruitment respectively. Data was collected during interviews using validated semi- structured tools and scales and from medical records of patients and analyzed using SPSS. It was found that the point prevalence of comorbidity of depression and other mental or neurological disorders was 31.4%. Among these patients, 18.1% had comorbidity of depression and other mental disorders but without any neurological disorder and 12.3% had depression and other neurological disorders but without any other mental disorders and 1% had depression, other mental and neurological disorders. The mean perceived social support (31.4%) was low and some patients lacked the support they needed. The mean perceived social stress (11.5%) was also low but could have effects on specific patients who experienced it. The overall level of functioning among patients was 57±13.8 falling in the GAF interval of [51-60]. This means that on average patients had moderate symptoms or moderate impairments in functioning. The overall level of adherence to treatment was found to be 65.8%. This indicates that the patients did not adhere optimally to their treatment: only 32.5% of patients achieved optimal adherence (score ≥ 80%). This is a lower rate compared to developed countries. The t-tests and chi-square tests were undertaken. The significant factors (p<0.05) influencing (hindering or promoting) adherence to treatment were medication side effects, affordability of treatment regimen, poor fit between treatment requirements and patient’s lifestyles or daily routine, poor communication, attitudes of service providers, availability of appointment staff, comorbidity of depression and other disorders, being busy, forgetfulness, travelling, social support, problems in social environment, having relatives who were stressful to patients, having economic barriers to access healthcare services and stigmatization. A weak significant relationship between adherence to treatment and treatment o number of patients who adhere optimally to treatment in order to have better treatment outcomes.
Constructive Men’s Engagement (CME) in Enhancing Reproductive Health in Makindu and Mutitu Sub-Counties of Kenya.
(2014-09-01) Kimathi, George
Reproductive health problems are the leading cause of women's ill health and death worldwide. Approximately 99% of all maternal deaths occur in developing countries, with Sub-Saharan Africa registering a maternal mortality ratio of 1,000/100,000 live births. Maternal mortality in Kenya has continued to rise since 2003, from a ratio of 414 deaths per 100,000 live births to 488 deaths per 100,000 live births in 2009. Over 56% of deliveries in Kenya are attended by unskilled people and outside health facilities. Only 28% of women receive skilled care within the first 4 critical hours following delivery. Men play cardinal and dominant roles in reproductive health. However, increasing their participation has not always been achieved. The main objective of this study was to establish individual, programmatic and healthcare provider related determinants of Constructive Men’s Engagement (CME) in reproductive health, and explore their potential for improving women’s health. An interventional quasi-experimental design was applied with interventions to promote CME-RH being implemented in Makindu Sub-county for 12 months following baseline while Mutitu Sub-county served as a control site. A total of 968 men and 32 nurses participated with 484 men respondents being interviewed at baseline and end-term in both sites. Furthermore, 8 men and 10 women FGDs, in addition to 18 KII were undertaken. A GEM Scale for CME- RH was adapted and applied to establish CME-RH levels among respondents. Similarly, a Trainer of Trainers’ manual on CME-RH was also developed and used to facilitate fortnightly CME-RH sessions with groups of men in Makindu. SPSS Ver 19.1 was used for data management with Chi-square tests, correlation and regression statistics applied for analysis. At baseline, Makindu and Mutitu had 43.4% and 44.6% of men who had CME-RH respectively. However Makindu recorded 60.3%, while Mutitu had only 47.1% of men who were CME-RH compliant at post-test. On individual characteristics, education level OR= 2.095 (0.902- 4.839) p=0.004, age of respondent OR= 1.716 (1.328 -2.438) p<0.010, knowledge on the number of times a pregnant woman should attend ante-natal clinic OR =1.738 (1.239 - 2.925) p=0.008 and knowledge of conventional family planning methods OR= 0.733 (0.579 - 0.968) p=0.043 were identified as independent predictors of CME-RH. Spousal approval for use of family planning OR= 1.316 (0.06 - 2.296) p=0.002 as well as approval for access to FP services by young unmarried couples OR= 2.881 (1.783 - 5.271) p<0.001 were also significant. Programmatic independent predictors of CME-RH were identified as having male only RH meetings/trainings OR= 1.094 (0.766 - 1.703) p=0.015, lack of confidentiality among ANC/MCH staff OR=1.297 (0.793 - 2.237) p=0.016 and the perception that RH programs have done little to involve men OR=1.963 (1.289 - 2.19) p=0.003. The capacity of health care providers including their skills, competencies and attitude also greatly influenced CME-RH. This study recommends promotion of CME-RH to be prioritized while reproductive health programs should adopt a multi-sectoral approach in design and implementation. Trainings and health promotion meetings targeting men on RH matters should always be organized for men only. Ways must also be devised to ensure staff at ANC/MCH clinics observe confidentiality with regard to client information, while RH programs must engender men to play seminal roles as prevalent at household and community level. Research would be valuable to unravel cultural values and practices that could be harnessed to promote CME-RH in Kitui and Makueni Counties.
Determinants of health inequalities among adults in Korogocho informal settlement, Nairobi, Kenya
(2014-09-12) Eboreime-oikeh, Imesidayo Omua
Dearth of actionable evidence of the magnitude, determinants, and mediators of health inequalities in deprived communities has hampered efforts to eliminate invidious health inequalities. The objectives of this study, which set out to bridge the knowledge gap, were to assess the magnitude of health inequalities, identify the determinants of health inequalities, and determine which material, psychosocial, and behavioral factors mediate health inequalities in Korogocho, an informal settlement in Nairobi, capital city of Kenya. Eligible, consenting adults were selected from each of Korogocho informal settlement's nine villages, for this cross-sectional, field-based study, through multi-stage mixed cluster sampling. The independent variables comprised demographic, socioeconomic, and environmental determinants while the mediating variables were material, psychosocial, and behavioral factors. Differences in the prevalence of the dependent variables: self-rated health status and self-reported chronic health conditions, were the indicators of health inequalities. Health inequalities were measured in three dimensions: health disadvantage, health gap, and social health gradient using prevalence difference, odds ratio, and concentration curves respectively. Complementary qualitative data were collected from six focus group discussions and key informant interviews. The study population comprised 719 adults aged 25 to 59 years, mean age 34.20 ± 8.68 years with 188 (26.1%) males. Ngomongo village respondents had the highest prevalence of poor self-rated health status (44.3%) while Grogan B village respondents had the highest prevalence (29.7%) of self-reported chronic health conditions. Compared to Korogocho informal settlement, Ngomongo village (Odds ratio [OR], 2.22; 95% CI, 1.44 to 3.44; P = 0.0003) and Kisumu Ndogo village (OR, 1.76; 95% CI, 1.06 to 2.93; P = 0.029) respondents suffered significant health disadvantage. Varying magnitudes of health gaps and gradients were detected in the villages except in Highridge village where the magnitude of health inequalities was not statistically significant. Social health gradients were most marked within Gitathuru and Kisumu Ndogo villages but not across Korogocho informal settlement. From binary logistic regression, older age (45 to 59 years), female gender, lack of access to health care, and village of residence were the significant determinants of health inequalities. Significant mediators of health inequalities were alcohol intake, lack of voluntary physical exercise, having multiple, concurrent sexual partners, and unprotected sex. Mediators contributed between 10.5% and 14% in females and between 30.3% and 40.4% in males, to health inequalities. The qualitative interviewees attributed ill-health mainly, to environmental pollution, poor sanitation, and poverty. To conclude, despite mass deprivations and concentrated poverty, disaggregated data showed significant magnitudes of health inequalities within and across some villages of Korogocho informal settlement. Most of the identified determinants and mediators of health inequalities were socially constructed and therefore remediable. This study provides needed policy-relevant evidence, which is based on local priorities and should help stakeholders to target policies and design interventions such as social protection, gender mainstreaming, environmental regeneration, and health promotion to eliminate health inequalities and hence leverage aggregate population health. Future large scale, longitudinal studies that incorporate life-courses perspectives are recommended to further validate the findings of this study in other deprived communities in Africa and globally.
Effects of HIV-Intestinal Parasites Co-Infection on Selected Hematological Parameters among Pregnant Women in Selected Health Facilities in Nyeri County, Kenya
(Kenyatta University, 2014-10-09) Nyambura, Anthony Wanjohi; Kabiru, Ephantus W.; Gicheru, Michael
Pregnancy places extreme stress on the haematological system and understanding of the physiological changes that result is obligatory in order to interpret any need for therapeutic intervention. Iron deficiency is the most common cause of anaemia in pregnancy. Intestinal parasitic infections increase anaemia in pregnant women. The results are low pregnancy weight gain and intra uterine development retardation (IUDR), followed by low birth weight (LBW), with its associated greater risk of infection and higher perinatal mortality rates. On the other hand HIV and AIDS is one of leading cause of mortality worldwide. HIV damage a person's body by destroying specific blood cells including CD4 T cells which are crucial to helping the body fight diseases resulting to AIDS. Sub-Saharan Africa is the region most affected by both HIV and intestinal parasites disease burdens. In Kenya, HIV infection remains a major public health problem where women are most affected. Studies have documented the effects of parasite infection on haemoglobin among pregnant women. Effects of HIV infection on haemoglobin level have been documented as well. However, there is paucity of data on effect of HIV - Intestinal parasite co-infection on haematological changes among pregnant women in Kenya. The co-infection is likely to aggravate the haematological changes. Therefore, this study aims to establish the prevalence of co-infection with HIV and intestinal parasites, the effect of HIV -Intestinal parasites co-infection on haemoglobin, red blood cells, white blood cells, platelets and CD4 cells; management practices of the co-infection and challenges encountered by health facilities during management. A cross sectional study will be conducted where a sample population of 344 pregnant women in selected health facilities in Nyeri County will participate. Structured interviewer administered questionnaires will be used to collect quantitative data. Qualitative data will be collected using six focused group discussions among pregnant women and key informant interviews among health care providers. Stool and blood samples will be analysed in the laboratory using standard procedures. The data collected will be managed and analysed using SPSS for windows (version 20). The information generated will inform policy development to address the problem of HIV and intestinal parasites co-infection among pregnant women.
Effectiveness of Isoniazid Prophylaxis in Prevention of Tuberculosis in Child Household Contacts of Adults With Pulmonary Tuberculosis in Nairobi County, Kenya
(Kenyatta University, 2015) Okwara, F. N.
Sub-Saharan Africa continues to document high burden of pediatric TB, driven by the HIV epidemic. The urban poor are at highest risk of infection. Infected children experience rapid disease progression and severer disease. Contacts‟ tracing and isoniazid prophylaxis is an effective prevention strategy, but has been administered inconsistently in most resource poor countries. Perceived obstacles have been sub-optimal effectiveness in view of continuous transmission and re-infections, as well as adherence and safety concerns. The objectives of this study was to evaluate the effectiveness of IPT in preventing TB related morbidity in children in household contact with adults with TB from informal settlements in Nairobi. A prospective longitudinal cohort study was done. Child contacts of recently diagnosed PTB smear-positive adults were enrolled. Recruitment started in December 2011 to July 2013. Consent was sought. A structured questionnaire was used to get information on source case TB treatment, socio-demographic characteristics and TB knowledge. Contacts underwent baseline clinical evaluations to exclude TB disease using clinical algorithms. TST, microscopy and histology were done whenever indicated. Contacts with chronic illnesses were excluded. A blood sample was obtained at baseline for liver enzymes assays and for PCR for HIV DNA. Contacts were then put on isoniazid for 6 months and followed up monthly for 1 year for new TB infection, and compliance and adverse events monitored. Qualitative data was provided by 2FGD and KIIs. Data was analyzed using SPSS. IPT acceptability was 320 out of 366(87.3%) of eligible source cases. Most (96%) were from poor social backgrounds, and 83.4% had below tertiary level of education. All source cases were on first line anti-TB treatment. Of 428 contacts screened, 6.3% were HIV positive. The baseline prevalence of latent TB was 92 (22.2%), while 14 (3.2%) had TB disease. IPT completion rate was 368 of 414 (88.8%). Overall compliance rate was 89%. IPT failure was documented in 6 (1.6%) cases, the relative risk of new TB disease in contacts on IPT was 0.49 (95% CI 0.21 -0.86). IPT effectiveness in preventing TB in exposed contacts was 50%. On multivariate logistic regression of factors influencing IPT failure, only weight faltering of contact was significant (p= 0.005). The leading programmatic challenges reported were too many hospital visits (65.2%) and difficulties in administering tablets to children (44.3%). Side effects were documented in 22.2%, mainly skin rash (12.5%), but significant hepatotoxicity occurred in only 3(0.08%). In conclusion, child TB is prevalent in exposed contacts in informal settlings. Contact screening and IPT is an effective, acceptable and safe child TB prevention strategy for exposed child contacts in these settings, however its implementation is fraught by various social and programmatic challenges minimizing overall benefits realized. Therefore, there is need to prioritize these children in informal settlements in TB screening programs. Furthermore, linkage of IPT strategy to nutrition interventions programs, and the provision of minimal adherence support to households could greatly optimize overall effectiveness attained.
Use of mobile phone short text message service to enhance cervical cancer screening at the thika level 5 hospital, Kiambu County, Kenya
(2015) Wanyoro, Anthony Karanja
Cervical cancer is a major public health problem among adult women especially in developing countries and its control is of paramount importance. Organized screening programmes have led to a large decline in cervical cancer incidence and mortality in developed countries. In Kenya very few women at risk have regular repeat cervical cancer screening and there exists no effective recall mechanism to enhance scheduled screening. The Short Message Service (SMS) Text may be used as a recall tool to enhancing cervical cancer screening in developing countries such as Kenya where other communication means may not be easily available. This blinded randomized controlled trial where participants were recruited from among eligible women attending the general female outpatient clinic at Thika Level 5 hospital; randomly allocated to an intervention (SMS text reminders) arm and a control (no SMS) study aimed to determine the influence of using SMS text reminders in enhancing adherence to scheduled repeat screening for cervical cancer. Data was collected using interview guide and analyzed using STATA version 11. Categorical variables were summarized by frequencies and proportions while continuous variables were summarized by means, medians and standard deviations. Chi square test was used to establish the relationship between categorical variables while logistical regression analysis was conducted to evaluate the influence of the independent variables on adherence to scheduled screening while using the SMS reminders. The mean age of the participants was 38.8 ± 10.8, most were married and of low socio- economic status. Only 20% of the eligible women attending the general outpatient’s clinic had ever been screened with only 8.8% having had regular screening. A total of 7.4% of the study population had abnormal cytological smears of which 3.2% were invasive cancer. It was found that 67.1% of participants in the intervention arm and 20.3% in the control arm re-attended to rescreening at end line as scheduled. The participants who received SMS text reminders were 8 times more likely to adhere to scheduled rescreening than those who did not (OR 8.02; CI 95% 4.69-13.73; p-<0.001). The age group 30-34 years, participants those whose spouses were employed and those who used public transport to access the hospital were significantly associated with return to scheduled screening after sending SMS text reminders (OR 2.24 P<0.005); (OR 2.2 P<0.05); (OR3.29 P< 0.005) respectively. On multiple logistical analyses having owned a mobile phone for more than two years was found to be more important in influencing re-attendance if one was educated above secondary school level. It was concluded that many women attending the general outpatient’s clinic were not screened and almost 10% of such women had abnormal cervical lesions including cervical cancer. Screening such women and reminding them of the next screening dates increases their chances of adherence to scheduled screening by up to 8 times when compared to those not reminded. The study recommended that the Short Text Message Service (SMS) reminders should be integrated into the cervical cancer screening programmes and cervical cancer screening services should be integrated in the female general outpatient clinic
The effect of selenium intake in progression of asymptomatic hiv type 1 infected children in Nyamasaria sub county Kisumu County Kenya
(2015) Otieno, Samwel Boaz
The prevalence of the Human-Immuno-deficiency Virus has been observed to be inversely related to selenium levels in foods. More recent Demographic Health Surveys have shown that despite the prevalence of HIV reducing by half in Kenya the prevalence in Kisumu County still remains twice the National prevalence, which suggests that there could be other factors involved in HIV epidemiology in the County. The hypothesis of this study was that selenium intake does not cause rapid progression of to AIDS from HIV infected children in Kisumu County. The main objective was to determine the effect the intake of yeast selenium on CD4 T cells and Weight for Age Z Score in HIV positive children (3-16 years). In this study a total of 68 HIV positive children were registered in the study to asses the efficacy of selenium. Yeast selenium (50μgm) was given to 34 children while the remaining 34 were put on a placebo.Blood samples and weight of the both groups were taken at 3 months intervals from 0, 3months and 6 months. The blood samples were analyzed by Enzyme Linked Immunosorbent Assay for CD4T cells while Weight for Age Z score was analyzed by Epi.Info version 3.4 and SPSS version16 for significance.In the study it was shown that children on selenium had progressive improvement of WAZ and which was significantly different at six months between children on selenium and the controls {F (5,12) = 5.758, P=0.006}.By using -2 standard deviations Z scores as a measure of cut-off, 15% boys and no girl on selenium was wasted at six months. Among the controls 64% of boys and 38% of girls were wasted at six months. The children on selenium had weight gain of up to 2.5 kilograms in six months. There was a significant mean increase CD4 T cell count at six months among the children on selenium,{ t( 1, N=30) = -2.943, p=0.006} compared to the matched controls {t =(1,N=30) =1.258 p= 0.0.0218}. CD4 T cell count increased among all age groups on test,3-5years (+ 267.1),5-8 years (+200.3) 9-15 years (+71.2) cells/mm3 . In matched controls a decrease was observed in all age categories, 3-5 years (-71),5-8 years (-125) and 9-13years (-10.1) cells/mm3 . There was no significant difference in CD4 T cell count between boys {F (2, 32) = 1.531 p= 0.232} and between girls {F (2, 49) = 1.040, p= 0.361} and between boys and girls {F (5, 81) = 1.379, p= 0.241} among the children on test. Similarly no significant difference was observed between boys and girls {F (5, 86) = 1.168, p= 0.332} in matched controls. In the test group there was a significant positive correlation between weight for age (WAZ), and CD4 T Cell Count p=0.007, R2= 0.252, F<0.05, β =252.23.There was a significant correlation observed between Weight for Z score and CD4 T cell count{ t( 2, N=27) = 2.94 p=0.007} with β = +252.23 and adjusted R² of 0.2016..In matched controls no significant correlation between weight for age Z-Score and CD4 T cell count change was observed at six months{ t (2, N=26) =0.08 p = 0.934} with β coefficient of +3.366 and adjusted R² =0.0337 .No positive correlation was observed among the children on selenium between CD4 T Cell count, and gender {t (2,27) = -0.69 p=0.0.495} with β coefficient of -138.23. Similarly in a matched control there was no significant correlation between CD4 T cell count and gender {t (2, N=26) = -0.90 p= -0.380} with β coefficient of -135.50.Majority (96.78%) of children on test either remained or progressed to WHO immunological stage I. It can be concluded that selenium intake slowed the rate of progression to AIDS from HIV positive patients as shown by increase in CD4 T cell count and further that there was no significant response between girls and boys. It is recommended that selenium be given as supplement to the HIV positive children on WHO clinical stage I to III as away of delaying progression to WHO stage IV.
Epidemiology of tuberculosis and human immunodeficiency virus co-infection, clinical presentations and impact on immunohaematological parameters in Mombasa county, Kenya.
(Kenyatta University, 2015-01) Ayieko, Yonge Shadrack; Otieno, Michael F.; Sharma, Rekha R.
Tuberculosis still represents an important global public health threat and it is one of the world‘s leading causes of death and HIV/AID has substantially altered the epidemiology of the infection especially in Sub-Saharan Africa. Most of death due TB and TB-HIV co-infection could be averted if clinicians recognized the signs and symptoms of the two diseases and instituted appropriate measures without delay. The magnitude of TB and TB-HIV co-infection is increasing despite progress made in the ART/DOTs control programs. There is no adequate knowledge on TB-HIV coinfection and effect on immune system since immunohaematological cell counts are not routinely carried out on TB patients. This hospital and laboratory based descriptive cross-sectional study was carried in Mombasa County. The main objective was to determine the magnitude of TB and TB-HIV co-infection and their relationship with clinical markers. Sputum from five hundred tuberculosis suspects were examined for AFB and cultured on solid and liquid media. Drug susceptibility test was done using BACTEC MGIT 960 incubator. Blood samples from tuberculosis suspects were screened for human immunodeficiency virus. Complete blood cell count was done using Sysmex Kx-2 and CD4+T cells analysed using FACS count flow cytometer. A questionnaire was used to collect demographic and medical history of the tuberculosis suspects. The data was entered in MS Excel 8.0 and analysed using Epi-Info 6.04b and statistical package for social sciences (SPSS) version 16.0 software. Pearson‘s chi-square test of independence was used to determine level of associations between TB-HIV co-infection and clinical outcomes. Student t test was used to test differences of means between two or more groups and Odds ratio to assess risk factors related to outcomes. Results showed tuberculosis prevalence was 42.0% and it was significantly higher in females (45.9%) than males 38.7% (P<0.05). Two hundred and two patients (96.2%) had pulmonary tuberculosis and eight (3.8%) extra-pulmonary tuberculosis. Smear positivity rate was 81.1% and culture positives 100%. Tuberculosis recurrence rate was 14.3% and was significantly associated with HIV infection (p<0.05). The majority of the TB cases (38.6%) were aged between 25-34 years (OR=58; CI; 0.340.94; p<0.05). Tuberculosis-HIV co-infection rate was 37.1% and it was not significantly associated with gender (P>0.05). Clinical features of chronic dry cough, fever, night sweats and weight loss were common in both TB and TB-HIV co-infected patients. Tuberculosis patients had higher CD4+T cell counts (474.5±198.8 cells/mm3) than co-infected patients (276.44±142.71) (t=5.6,df=461,p<0.05) but lower than reference group (1054.9 ± 156.1 cells/mm3, t=34.6, df=485, p<0.05). HIV/AIDS patients had significantly higher body mass index (19.9±2.2 kg/m2) than tuberculosis HIV/AIDS co-infected patients (BMI 18.8±2.7, t=0.70, df=58, p<0.05). The mean packed cell volume in TB-HIV co-infected patients was (32.31±4.8%) lower than TB patients without HIV/AIDS (34.21±4.4%) and the control group (36.41±4.2%). A high rate of drug resistance was observed in isoniazid (17.6%) and rifampicin (2.1%). Eight patients had multi-drug resistant-TB (4.8%). Any type of drug resistance in TBHIV co-infection patients was 19.1% suggesting a positive correlation (p<0.05). The high prevalence of tuberculosis and high co-infection in this study underscores the need for more efforts and resources to increase knowledge and access health care. There is also need to improve drug susceptibility testing to all newly diagnosed tuberculosis patients in all health facilities to monitor drug resistance. Immunohaematological indices (CD4 count, FBC and ESR) be performed routinely to monitor both TB and TB-HIV co-infection patients.
Determinants of Utilization of Hospital Delivery among Post-Natal Mothers in Thika and Kangundo Hospitals, Kenya
(Kenyatta University, 2015-01-22) Kabue, Priscillah Njeri
Maternal mortality rate due to pregnancy-related complications remains high at 488 per 100,000 live births in Kenya. If mothers are treated appropriately and in a timely manner, in a hospital almost all women who develop pregnancy-related complications can be saved from death and disability. The purpose of study was to assess why hospital deliveries in Kenya have remained low despite government strategies on improving health system and human resources. The objective of the study was to assess the determinants of utilization of hospital delivery and the rating of the health care services among postnatal mothers in Thika and Kangundo District Hospitals which are in Kiambu and Machakos Counties respectively. In view of this a cross- sectional study was conducted with an aim of establishing the factors that determine utilization of hospital during delivery. The study population was composed of eight hundred post natal mothers from Thika and Kangundo Districts attending Maternal Child Health Clinics who had delivered less than one year ago. Structured questionnaires and interviews were used to collect the data. In addition, Focus Group Discussions were conducted in each District and Key informants interviewed. Quantitative data was analyzed using SPSS for windows version 16 and data presented in form of tables and bar charts. The qualitative data from the focus group and Key informants was transcribed and a summary written. From the study Client oriented factors that were found to be associated with hospital delivery in both Kangundo and Thika included occupation (p = 0.028, p = 0.007), having money to go to the hospital (p = 0.000, p = 0.00), short distance from the health facility (p = 0.001, p = 0.029), and client having delivered in the hospital before (p = 0.000, p = 0.000) respectively among others. On binary regression Client oriented factors that predicted place of delivery in Kangundo were education level, previous delivery in a hospital and number of antenatal clinic attendance while in Thika they included client view of health worker, previous delivery in a hospital and economic factors. Health facility oriented factors that were associated with hospital delivery in Kangundo were lack of privacy (p = 0.000) while in Thika the manner in which the mother was handled by the health care worker (p = 0.001) and whether the mother received expected care (p =0.017). Rating of the health care services in terms of acceptability was average with only half of respondents feeling that the services were acceptable in both hospitals. In terms of accessibility 74% could access the hospital through matatus. In terms of availability time taken to be attended was rated above average while availability of health facilities and services required was below average in both districts. Quality of care during delivery was rated high in both districts with 72% of the respondents being assisted during head delivery but in terms of infection control this was above average. The research concludes that mothers do not utilize the health facility for delivery in both areas because of cost of the services, distance from the hospital, negative attitude of the health workers, lack of privacy and poor quality of care. Information generated by this study will be recommended to the policy makers in the Ministries of Health for use in addressing the challenges facing hospital delivery therefore promoting it leading to reduction in maternal morbidity and mortality.
Information and communication technology adoption in HIV and aids comprehensive care centers in Nairobi county, Kenya
(Kenyatta University, 2015-04) Kibaara, Rucha Kenneth; Ochieng Otieno; Michael Gicheru; Andre Yitambe
In the last decade, information and communication technology (ICT) has offered huge potential to answer many of the challenges that HIV and AIDS Comprehensive Care Centres (CCCs) face in provision of quality services in Nairobi County, Kenya. The objective of the study was to investigate health workers and patients‟ ICT adoption status, indentify their perceptions about ICT, determine factors that influence ICT adoption and determine the real predictors of ICT adoption status of health workers in HIV and AIDS CCCs in Nairobi County. This was a cross sectional descriptive study. Participants (N = 196) consisted of health workers drawn through proportionate stratified random sampling from twenty eight HIV and AIDS CCCs from both public and private hospitals in the study area. Questionnaires from 183 (93%) respondents were correctly filled and returned. Data analysis reflected 183 respondents. Data was collected from the health workers using questionnaires and also from the patients attending HIV and AIDS CCCs through focus group discussion (FGDs). The collected data was analyzed quantitatively and qualitatively. Quantitative data was analyzed with the use of Predictive Analytic Software (PAS) Version 19. Inferential and descriptive statistics were used. Qualitative data was analyzed by use of content analysis. The results showed that most (57%) of health workers had not adopted ICT. Results indicated that there is significant relationship between respondents status of ICT adoption and type of CCC (χ² = 0.117; df = 1; p = 0.032) with those from private CCCs more likely to adopt compared to those from public ones. The findings revealed that majority (77%) of health workers have positive perception of ICT drivers and ICT contributors (68%). Findings showed that most (47%) respondents with positive perceptions were more likely to adopt ICT. The results also showed significant relationship between adoption and health workers‟ perceptions of ICT access, personalization, security, site aesthetics, flexibility and optimism. Chi-square results at 0.05 probability error revealed significant relationship between adoption and factors of ICT training, quality of systems, information intensity, management support, technological resources, financial resources, complexities, compatibility, affordability, information security, image of facility, competitive pressure and patients‟ pressure. Multiple Regression results showed that the perception predictors were ICT access, personalization and information security. Findings showed that some of the factors that predict adoption status are ICT quality of systems (χ² = 0.000; df = 1; p = 0.000), information intensity (χ² = 19.422; df = 4; p = 0.001), financial resources (χ² = 0.395; df = 1; p = 0.030), technological resources (χ² = 0.395; df = 1; p = 0.030) and patients‟ pressure (χ² = 0.006; df = 1; p = 0.037). The study recommends policies that will help the management of CCCs improve ICT infrastructure and capacity building in order to optimize ICT adoption by health workers. It also recommends enactment of laws and regulations which will favour factors that influence ICT adoption and the actual predictors. This will lead to improved services that will be effective and efficient in HIV and AIDS Comprehensive Care Centers.
Predictors of HIV and Pulmonary TB Infections among Injection Drug Users in Mombasa County, Kenya
(Kenyatta University, 2015-09) Budambula, Valentine
Association of functionality and nutritional status of elderly persons: a comparison between institutionalized and non – institutionalized elderly in Nairobi County, in Kenya
(Kenyatta University, 2015-10) Mugo, Wairimu Judy
Malnutrition has been recognized as a common problem among the elderly persons and is associated with certain diseases and impaired functioning, but less is known about its relationship with nutrition intake and nutritional care among the elderly residents. This study determined the association of functionality and nutritional status of the Institutionalized elderly and compared with that of the elderly living with their family or community members. It also compared the functionality of the two categories of elderly men and women, and determined the extent to which functional independence impacts on the nutritional status of the elderly in the Nairobi County, Kenya. The Mini Nutritional Assessment questionnaire and the Modified Barthel Index were used to measure the nutritional status and functionality of the elderly. One Questionnaire was administered to the social welfare officer in each of the sampled institutions and a similar questionnaire administered to the care-giver of the elderly in the community to collect information on Institutions and Non- Institutional characteristics that relate to nutritional status and functionality of the elderly. Two hundred and seventy elderly men and women who met the inclusion criteria were sampled, 135 from 4 Institutions and 135 from Gumba, Kariobangi, Huruma and Kawangware divisions. Data were coded and entered using EPI Info version 9 and were analyzed using SPSS version 17. The participants were randomly selected and the response rate was 98.5% for the Non-Institutionalized elderly and 96.5% for the elderly living in the Institutions of the elderly. There was a significant relationship between gender and MUAC (2 = 12.745, df = 2, p = 0.002) with the mean MUAC measure among women (0.77  4.13) being higher than that of men (0.75  0.388), t = 4.446, df = 268, p = 0.714. There were more overweight non-institutionalized elderly (20.5%) compared to those in the institutions of the elderly (14.7%). There was a significant relationship between MUAC measure and CC (2 = 68.563, df = 2, p = 0.001), with the mean MUAC measure being higher (0.76  0.401) and mean measure of CC being 0.72  0.448, f = 45.28, df = 1, p = < 0.001. Eighty eight percent of the Institutionalized elderly consume 3 or more meals per day compared to 54.8% of the non-institutionalized elderly. There were more totally dependent elderly at Institutions (13.6%), compared to 3% who were Non-institutionalized. Functionality level was found to correlate positively with self-view of health status (r = + 0.133, p = 0.046) and the intake of 3 or more prescription drugs per day (r = + 0.139, p = 0.034). Body mass index of the elderly was found to correlate negatively to Calf Circumference (r = - 0.156, p = 0.027) and Stair Climbing (r = - 0.148, p = 0.025). Protein intake was found to correlate positively to the consumption of fruits and vegetables (r = +0.139, p = 0.029). Nutritional status of the elderly was found to correlate with functional ability. National and County governments should make and implement policies that would promote the nutritional status and functionality of the institutionalized and Non-institutionalized elderly.
Effects of Public Health Interventions on Intestinal Parasitic Infections among School-Going Children in Murang’a County, Kenya
(Kenyatta University, 2016-06) Muiruri-Gitahi, Mary G. Wangui
Intestinal parasitic infections have been found to form at least a quarter of all human infections globally. School-going children are the worst affected by these infections as it impairs their growth and cognitive development. Following the WHO recommendation, the Government of Kenya rolled out a school deworming programme under the School Health Programme in 2009. The study was embedded in the School Health Programme. The main objective of the study was to investigate the effects of public health interventions against intestinal parasitic infections among school going children in Murang’a County. It was a quasi-experimental study with schools assigned to intervention and control groups. The schools were selected through multi-stage sampling. Data was collected in three phases: baseline, intervention and post intervention evaluation. A total of 446 pupils from six primary schools provided stool samples for examination of intestinal parasitic infections. Structured interview guides and observation were used to collect more information on school sanitation, pupils’ hygiene practices and their level of knowledge of intestinal parasites. Qualitative data was collected through Key Informants Interviews and observations of school sanitation and hygiene practices compared with School Health Policy. Installation of tippy taps, provision of soap and water, and health education were some of the public health interventions which were implemented in intervention group. A post intervention evaluation was conducted to determine the effect of these interventions. Data was analyzed using SPSS version 20. Association of variables was tested using chi-square while t-test was used to compare means. At the baseline phase the overall prevalence of intestinal protozoan infections was 51.2% and 55.1% in the intervention and control group respectively. Prevalence of intestinal helminthic infections was 12% and 16.5% in intervention and control groups respectively. A comparison of mean percentage of infected pupils at baseline revealed that there was no statistically significant difference in the prevalence of intestinal parasites between intervention and control groups (t =0.32, P = 0.37). Level of knowledge of intestinal parasites was 52.3% and 48.8% in the intervention and control group respectively. The difference between the two was not statistically significant (2= 3.4, df = 5, P=0.13). There was a statistically significant relationship between protozoan infections and school sanitation (2= 10.3, df = 1, P = 0.001). Association between helminthic infections and school sanitation was also found to be significant (2= 2.4, df = 1, P=0.01). Key informants interview revealed that there were no health clubs at schools through which health promotion would be propagated among the pupils. After intervention a comparison of mean percentage of infected pupils revealed that there was a statistically significant reduction in intestinal protozoan infections in intervention group from 55.1% to 6.0% (t=12.6, P=0.001). There was also a statistically significant reduction in the prevalence of helminthic infections in the intervention group from 12.4% to 0.0% (t = -3.78, P<0.001). This has led to the conclusion that public health interventions influenced the reduction of the prevalence of intestinal parasites. The findings of this study are useful to the ministry of Education in formulating policies that will shape the future of the School Health Programme in Kenya. There is a suggestion to conduct a community based study to rule out the infections from the home environment.
Health burden of wildlife induced injuries among the Maasai cattle herders in Kajiado County, Kenya
(Kenyatta University, 2016-11) Makau, Isaac Kasilu
Wildlife induced injuries are a major but neglected emerging public health problem which contributes significantly to high mortality and morbidity among cattle herders. The objectives of the study were to determine the health burden of wildlife induced injuries, to identify the risk factors and establish the risk indices associated with wildlife induced injuries and to determine the protective measures adopted to mitigate wildlife induced injuries among the Maasai cattle herders in Kajiado Central and Loitokitok sub-counties. The study adopted a descriptive cross-sectional study design and mixed methods where quantitative and qualitative data were collected. Multi-stage sampling method was used. A total of 262 respondents were sampled for this study. The data collection tools used in this study included researcher administered questionnaires, Focus Group Discussions (FGDs) and key informant interviews (KIIs). Questionnaire was pre-tested be to ensure validity and reliability. Quantitative raw data from the field was checked for errors and completeness, through editing of responses. The cleaned data was exported to Statistical Package for Social Sciences (SPSS) software version 22 and Disability-Adjusted Life Years (DALYs) software for analysis. Descriptive statistical analysis was used to reveal the distribution of tendencies in the sample data. Descriptive statistics namely frequency tables and percentages were used to describe, organize and summarize the study findings. Chi-square test was used to establish if associations existed between study variables. A pvalue of ≤ 0.05 was considered significant. Multivariate Analysis of Variance (MANOVA) was used to the association between risk factors and wildlife induced injuries. Multiple Discriminant Function Analysis (MDFA) was used to determine the linear relationship between variables. Study findings show that wildlife induced injuries accounted for a total of 3,352 DALYs among cattle herders in Kajiado Central and Loitokitok sub-counties. Of this, 1,988 DALYs resulted in male Maasai cattle herders and 1,364 DALYs resulted in female Maasai cattle herders which indicate that male Maasai cattle herders lost more healthy years of life due to cattle herding than female Maasai cattle herders. Overall evidence generated from the study will be used to influence policy and direct focus on interventions geared towards addressing public health issues of significance to the poor Maasai cattle herders.
The Effects of Using Oral HIV Self-Testing Kits on Uptake of Male Partner Testing Among Pregnant Women in Selected Counties In Kenya
(Kenyatta University, 2018) Machera, Tom Marwa
Adult HIV prevalence peaked at 14% in Kenya in the mid-nineties and has since continued to drop and thereafter stabilized at below 5% since 2014 due mainly to a scale up of various evidence based HIV interventions including HIV care and treatment, PMTCT, VMMC, HTS among other. HIV-testing and counselling (HTC) is a very effective strategy in getting those infected with HIV into care and treatment and in making appropriate referrals to other HIV support services. Kenya has adopted a number of strategies including Provider initiated testing and counselling (PITC), outreach testing and counselling and home based testing and counselling. Women are more likely to be tested for HIV (79.8%) than their male counterparts (62.5%) are. Other strategies that have proved effective are integration of HTC in antenatal care and reproductive health services. The Kenya AIDS Indicator Survey (KAIS) of 2012 showed that up to 6.5% of pregnant women in Kenya were living with HIV, and that each year, close to about 45,000 infants becomes infected with HIV through mother-to-child transmission of HIV (MTCT). PMTCT is offered as part of routine ANC for pregnant women, alongside other important services such as HTC, linkages to care and treatment, and helps to prevent infant exposure to HIV during pregnancy, delivery and breastfeeding. However, many approaches to promote male involvement in HIV counselling and testing during ANC services, such as having male-only clinics on special days or evening clinics have been tried without much success. ANC in Kenya have the potential of being key entry points to HTC not only for pregnant women, but also their partners. This study was designed as randomized controlled trial (RCT) with three study arms, where 475 study participants were to be rolled randomly into each arm. The study participants were women attending ANC clinic for the first time in their current pregnancy. Fourteen (14) study sites were selected randomly from 180HIV testing, care and treatment sites in Eastern and Central regions of Kenya. The aim of the study was to determine if provision of oral HIV home testing kits would increase male partner testing rates, self-testing acceptability rates and identify operational challenges experienced by the ANC mothers when providing test kits to their male partners. Data was collected using pre-tested questionnaire which were administered to each of the 1217 women and 1133 men randomized into the three study arms. Four focus group discussions were conducted for females whose partners tested and those who never tested. Data analysis was done using SPSS and “R” statistical software and descriptive statistics used to examine the frequency and analysis of variance. The equivalence t-test showed a statistically significant differences (p-value=0.01, n=737, df= 2) between arm one and two while arm three was superior to arm 2 with significantly higher testing rates (P-value<0.001,n=758,df=2).Men who got the two intervention (special letter and a test kit)were 5.08 times more likely to test compared to men who got the special letter alone when controlling for age, employment, education and if the couples discussed HIV testing)The study presented a new understanding and dynamics of self-testing among men while also bringing about health impact for their pregnant partners, because it did not require men to go to ANC clinics in person. In arm three (those who got two interventions), over 80%of the men took HIV test compared to only 37.0 %in arm two (those who got one intervention; a card with HIV prevention messages alone) and 28.3%in arm one (standard package, a letter given to the ANC mother inviting her male spouse to come to the clinic, this is the current practice in Kenya). Men who discussed HIV testing with their wives were twelve times more likely to test for HIV compared to men who did not discuss HIV testing with their wives. This findings will inform HIV programs and policy makers on the best way to improve low testing rates among partners of ANC clients and also demonstrates how self-testing may provide males who are not currently reached by HTS an opportunity to test in private.

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