Fertility Problems and Fertility Care in Sub-Saharan Africa: The Case of Kenya

Having children is important to most people. Nevertheless, fertility care for involuntarily childless couples is not a high priority for governments in developing countries. Governments and Non-governmental Organizations (NGOs) in these countries give more urgency and money to programs which support contraception and safe abortions, because of concerns, for example, about population growth and life-threatening diseases such as HIV/AIDS. In highly pronatalist countries, however, the consequences of having fertility problems can have an enormous negative impact on the life and well-being of involuntarily childless couples. The focus of this chapter will be on infertility, fertility problems and involuntary childlessness in Kenya. In this chapter we describe the findings of a mixed method study among men and women with fertility problems that was carried out in Kenya in 2016. The following themes are addressed: knowledge of fertility problems, the need to have children, rejections from society because of not having a child, fertility-related quality of life, loneliness versus support and sharing, and fertility treatment (considerations and experiences)

Population-Based Assessment of Hypertension Epidemiology and Risk Factors among HIV-Positive and General Populations in Rural Uganda

BACKGROUND:Antiretroviral therapy scale-up in Sub-Saharan Africa has created a growing, aging HIV-positive population at risk for non-communicable diseases such as hypertension. However, the prevalence and risk factors for hypertension in this population remain incompletely understood. METHODS:We measured blood pressure and collected demographic data on over 65,000 adults attending multi-disease community health campaigns in 20 rural Ugandan communities (SEARCH Study: NCT01864603). Our objectives were to determine (i) whether HIV is an independent risk factor for hypertension, and (ii) awareness and control of hypertension in HIV-positive adults and the overall population. RESULTS:Hypertension prevalence was 14% overall, and 11% among HIV-positive individuals. 79% of patients were previously undiagnosed, 85% were not taking medication, and 50% of patients on medication had uncontrolled blood pressure. Multivariate predictors of hypertension included older age, male gender, higher BMI, lack of education, alcohol use, and residence in Eastern Uganda. HIV-negative status was independently associated with higher odds of hypertension (OR 1.2, 95% CI: 1.1-1.4). Viral suppression of HIV did not significantly predict hypertension among HIV-positives. SIGNIFICANCE:The burden of hypertension is substantial and inadequately controlled, both in HIV-positive persons and overall. Universal HIV screening programs could provide counseling, testing, and treatment for hypertension in Sub-Saharan Africa