Integrating men into the reproductive health equation: Acceptability and feasibility in Kenya

This study’s objective was to improve understanding of Kenyan men’s actual and potential roles as supportive partners in various phases of reproductive health (RH), to help in the design of strategies to encourage men’s greater participation in a variety of RH initiatives in Kenya. The results of the study clearly show that, to a larger extent than anticipated, men in Kenya already participate in women-centered RH services. Overall the institutional barriers seemed to be more overwhelming than the cultural barriers, given that one of the reasons frequently given for nonparticipation was fear of non-acceptance by the health providers. Based on the Population Council’s work on social context issues, including partnership, three potential levels for interventions have been developed: providing information on partnership for reproductive choice and health; building comfort and capacity among providers; and creating a space for partners. The results of this study indicate that there are opportunities for interventions at all three levels, although the space for partners may remain limited to consultations and outpatient care for at least the immediate future

Effect of malaria transmission reduction by insecticide-treated bed nets (ITNs) on the genetic diversity of Plasmodium falciparum merozoite surface protein (MSP-1) and circumsporozoite (CSP) in western Kenya

Abstract Background: Although several studies have investigated the impact of reduced malaria transmission due to insecticide-treated bed nets (ITNs) on the patterns of morbidity and mortality, there is limited information on their effect on parasite diversity. Methods: Sequencing was used to investigate the effect of ITNs on polymorphisms in two genes encoding leading Plasmodium falciparum vaccine candidate antigens, the 19 kilodalton blood stage merozoite surface protein-1 (MSP-1 19kDa ) and the Th2R and Th3R T-cell epitopes of the pre-erythrocytic stage circumsporozoite protein (CSP) in a large community-based ITN trial site in western Kenya. The number and frequency of haplotypes as well as nucleotide and haplotype diversity were compared among parasites obtained from children <5 years old prior to the introduction of ITNs (1996) and after 5 years of high coverage ITN use (2001). Results: A total of 12 MSP-1 19kDa haplotypes were detected in 1996 and 2001. The Q-KSNG-L and E-KSNG-L haplotypes corresponding to the FVO and FUP strains of P. falciparum were the most prevalent (range 32-37%), with an overall haplotype diversity of > 0.7. No MSP-1 19kDa 3D7 sequence-types were detected in 1996 and the frequency was less than 4% in 2001. The CSP Th2R and Th3R domains were highly polymorphic with a total of 26 and 14 haplotypes, respectively detected in 1996 and 34 and 13 haplotypes in 2001, with an overall haplotype diversity of > 0.9 and 0.75 respectively. The frequency of the most predominant Th2R and Th3R haplotypes was 14 and 36%, respectively. The frequency of Th2R and Th3R haplotypes corresponding to the 3D7 parasite strain was less than 4% at both time points. There was no significant difference in nucleotide and haplotype diversity in parasite isolates collected at both time points

Effect of malaria transmission reduction by insecticide-treated bed nets (ITNs) on the genetic diversity of Plasmodium falciparum merozoite surface protein (MSP-1) and circumsporozoite (CSP) in western Kenya

Background Although several studies have investigated the impact of reduced malaria transmission due to insecticide-treated bed nets (ITNs) on the patterns of morbidity and mortality, there is limited information on their effect on parasite diversity. Methods Sequencing was used to investigate the effect of ITNs on polymorphisms in two genes encoding leading Plasmodium falciparum vaccine candidate antigens, the 19 kilodalton blood stage merozoite surface protein-1 (MSP-119kDa) and the Th2R and Th3R T-cell epitopes of the pre-erythrocytic stage circumsporozoite protein (CSP) in a large community-based ITN trial site in western Kenya. The number and frequency of haplotypes as well as nucleotide and haplotype diversity were compared among parasites obtained from children <5 years old prior to the introduction of ITNs (1996) and after 5 years of high coverage ITN use (2001). Results A total of 12 MSP-119kDa haplotypes were detected in 1996 and 2001. The Q-KSNG-L and E-KSNG-L haplotypes corresponding to the FVO and FUP strains of P. falciparum were the most prevalent (range 32–37%), with an overall haplotype diversity of > 0.7. No MSP-119kDa 3D7 sequence-types were detected in 1996 and the frequency was less than 4% in 2001. The CSP Th2R and Th3R domains were highly polymorphic with a total of 26 and 14 haplotypes, respectively detected in 1996 and 34 and 13 haplotypes in 2001, with an overall haplotype diversity of > 0.9 and 0.75 respectively. The frequency of the most predominant Th2R and Th3R haplotypes was 14 and 36%, respectively. The frequency of Th2R and Th3R haplotypes corresponding to the 3D7 parasite strain was less than 4% at both time points. There was no significant difference in nucleotide and haplotype diversity in parasite isolates collected at both time points. Conclusion High diversity in these two genes has been maintained overtime despite marked reductions in malaria transmission due to ITNs use. The frequency of 3D7 sequence-types was very low in this area. These findings provide information that could be useful in the design of future malaria vaccines for deployment in endemic areas with high ITN coverage and in interpretation of efficacy data for malaria vaccines based on 3D7 parasite strains

Community-based AIDS Prevention and Care in Africa: Results of four action-research interventions in East and Southern Africa

The Community Counseling Aides (CCA) project operating with support from the National AIDS Control Programme (NACP) in Uganda, is a government initiative being carried out in collaboration with local communities. As the Ministry of Health seeks to develop local capacity to support and operate these efforts at the community level, it has identified the need to improve the skills of local project staff so that they may begin to assume the responsibility for monitoring and evaluating their own program performance. This is part of an overall strategy on the part of the Ugandan Government to decentralize control and allocation of resources within the health sector to the local level. The CCA project’s experience in carrying out the four interventions described in this report goes beyond validating what people are doing at the local level. It provides evidence of how much more effective grassroots organizations can be in carrying out their work if provided with simple but appropriate forms of technical assistance. Modest investments of time, expertise, and financial support, executed in a participatory fashion, can yield generous returns