Prevalence and risk factors for gender based violence during pregnancy in Kisumu county Kenya

Background: Gender Based Violence (GBV) is a pervasive and systemic public health problem affecting pregnant women but there is paucity of data on the magnitude of GBV during pregnancy and the factors associated with it in Kenya, particularly in areas where the prevalence of GBV in the general population is unacceptably high.Objectives: To determine the prevalence and factors associated with GBV during pregnancy in Kisumu County.Design: A cross sectional survey conducted between May and October 2016. Multivariate Logistic Regression was performed and the Odds Ratio (OR) at 95% Confidence Interval (CI) calculated to identify the factors associated with GBV.Setting: Two public primary health care facilities in each of the six sub counties in Kisumu County.Subjects: 691 eligible pregnant women attending antenatal care in the selected facilities responded to a questionnaire and were screened for GBV.Results: The mean and median age was 24.5 and 24 years respectively, and the age at sexual debut was 16.7 2.2 years. Thirty nine (39.2%) had experienced physical violence during the current pregnancy, perpetrated by an intimate partner (97%).Increased risk of violence was associated with having secondary level of education or more in the women OR=2.088,95% CI[1.147-3.802],occasional alcohol consumption by the intimate partner(IP) OR=2.843, 95%CI[1.519-4.059], witnessing violence as a child OR=3.380, 95%CI[2.427-6.046] and prior experience of physical OR=13.116,95%CI[7.976-21.569] or sexual violence OR=4.208,95% CI[2.603-6.803]. Male partner dominance in decision making, OR=5.930, 95%CI [3.998-8.797] and infidelity by the woman OR=3.442, 95% CI [1.696-9.686] or her IP, OR=9.906, 95% CI [6.088-16.119] were associated with increased violence. The belief in the social superiority of a man OR=3.949, 95%CI [2.044-7.631], man’s right to assert over a woman OR=3.163, 95%CI [1.930-5.185] and the belief that women should tolerate violence to save a relationship/marriage OR=9.493, 95% CI [5.746-5.681] were predictors of increased violence.Conclusion: A substantial proportion of pregnant women experience GBV in Kisumu County. The findings indicate the need for routine screening for GBV at ANC and the potential for initiation of interventions to mitigate the negative effects of violence for the affected women. Approaches targeting beliefs and strengthening of legal structures may be viable primary prevention options.

Family model of HIV care and treatment: a retrospective study in Kenya

<p>Abstract</p> <p>Background</p> <p>Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV-infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal.</p> <p>Methods</p> <p>A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV-positive members and to prevent new infections. Comprehensive family-centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach.</p> <p>Results</p> <p>Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV- positive partners among those tested: 71% and 89%, respectively.</p> <p>Conclusions</p> <p>The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement.</p

Disseminated Mycobacterium-Avium Infection Among Hiv-Infected Patients in Kenya

Previous studies from Africa have been unable to identify disseminated Mycobacterium avium complex (MAC) infection in patients with advanced human immunodeficiency virus (HIV) infection. We performed mycobacterial blood cultures and CD4 counts on 48 symptomatic adults with advanced HIV infection admitted to the hospital in Nairobi, Kenya over 4 weeks in 1992. Fourteen patients had mycobacteremia; these patients had significantly lower CD4 counts than the patients with negative cultures (14/mm vs. 85/mm; p < 0.01). Three patients (6%) were bacteremic with M. avium (mean CD4 count, 10/mm) and 11 (23%) were bacteremic with Mycobacterium tuberculosis complex (MTB) (mean CD4 count, 15/mm). Thus, M. avium bacteremia was detected significantly less frequently in the study population than MTB bacteremia (p = 0.04). The minimum rate for HIV-associated disseminated M. avium infection in patients admitted to the hospital in Nairobi was estimated to be approximately 1%. Patients with mycobacteremia died or were discharged home sick before the diagnosis was made. Disseminated M. avium does occur in adults with advanced HIV infection in sub-Saharan Africa, but is less common than disseminated MTB

Placebo found equivalent to amoxicillin for treatment of acute bronchitis in Nairobi, Kenya: a triple blind, randomised, equivalence trial

Background:Antibiotic treatment is not recommended for acute bronchitis in immunocompetent patients in industrialised countries. Whether these recommendations are relevant to the developing world and to immunocompromised patients is unknown.Design, setting and participants:Randomised, triple blind, placebo controlled equivalence trial of amoxicillin compared with placebo in 660 adults presenting to two outpatient clinics in Nairobi, Kenya, with acute bronchitis but without evidence of chronic lung disease.Main outcome measure:The primary study end point was clinical cure, as defined by a ⩾75% reduction in a validated Acute Bronchitis Severity Score by 14 days; analysis was by intention to treat with equivalence defined as ⩽8% difference between study arms.Results:Clinical cure rates in the amoxicillin and placebo arms were 81.7% and 84.0%, respectively (difference 2.3%, 95% CI −8.6% to 4.0%). Of 131 HIV infected subjects (19.8%), cure rates for those randomised to amoxicillin (77.2%) and placebo (83.8%) differed by 6.6% (95% CI −21.7% to 8.6%). Among HIV uninfected subjects, the difference in cure rates was 1.6% (95% CI −8.5% to 5.3%). Potential drug side effects were similar in the two arms. No subjects required hospitalisation or died.Conclusion:Antibiotic treatment of acute bronchitis is unhelpful, even in populations with a high prevalence of HIV infection

Impact of expanded antiretroviral use on incidence and prevalence of tuberculosis in children with HIV in Kenya

SettingAntiretroviral therapy (ART) reduces pulmonary tuberculosis (PTB) in human immunodeficiency virus (HIV) infected children. Recent ART recommendations have increased the number of children on ART.ObjectiveTo determine the prevalence and incidence of TB in HIV-infected children after the implementation of expanded ART guidelines.DesignA prospective cohort study including HIV-infected children aged 6 weeks to 14 years was conducted in Kenya. The primary outcome measure was clinically diagnosed TB. Study participants were screened for prevalent TB at enrollment using Kenya's national guidelines and followed at monthly intervals to detect incident TB. Predictors of TB were assessed using logistic regression and Cox proportional hazards regression.ResultsOf 689 participants (median age 6.4 years), 509 (73.9%) were on ART at baseline. There were 51 cases of prevalent TB (7.4%) and 10 incident cases, with over 720.3 child-years of observation (incidence 1.4 per 100 child-years). Months on ART (adjusted hazard ratio [aHR] 0.91, P = 0.003; aOR 0.91, P&lt; 0.001) and months in care before ART (aHR 0.87, P= 0.001; aOR 0.92, P &lt; 0.001) were protective against incident and prevalent TB.ConclusionsART was protective against TB in this cohort of HIV-infected children with high levels of ART use. Optimal TB prevention strategies should emphasize early ART in children