Geographic Variations in Antenatal Care Services in Sierra Leone

Despite antenatal care presenting opportunities to identify and monitor women at risk, use of recommended antenatal care services remains. Barriers preventing use of antenatal services vary between countries, and limited knowledge exists about the link between geographical settings and antenatal service use. The objective of this cross-sectional quantitative study was to explore geographical variations and investigate how social demographic characteristics affect use of antenatal care for women in Sierra Leone using the Andersen behavioral model. The data used were from the 2016 maternal death surveillance report of the whole counrty (N =706). Logistic regression analysis was used to determine the individual predictor effects on antenatal care, including geographical location, the age of women, marital status, parity, and institution of birth impact. Southern, Northern, and Eastern women had significantly lower odds of attending the recommended antenatal services compared to women in the Western region (OR = .517, p = .019; OR = .497, p = .021; OR = 0.014, p = .041, respectively). The odds of married women attending the recommended antenatal services was 7.3 times more than that of the single women (OR = 7.397). Also, significantly associated with less uptake of recommended antenatal visits was lower education level among women (OR = .517). This study will contribute to positive social change by highlighting inequities in antenatal care use among women, thus allowing for accurate targeting of health promotion programs and ultimately saving lives of mothers and children of Sierra Leone through more inclusive policies

Factors influencing Quality Management of Medication by Nurses at Kenyatta National Hospital Paediatric Wards. Nairobi, Kenya.

The main objective of this descriptive cross-sectional survey was to determine the factors influencing quality management of medication by nurses at Kenyatta National Hospital (KNH) paediatric medical wards. The study involved 80 nurses, 180 caretakers, four nurse managers and combined both qualitative and quantitative methods. Data gathering instruments included researcher administered questionnaires to a randomly sampled group of nurses and caretakers. Quantitative data analysis was done using descriptive and inferential statistics while qualitative data was analyzed manually. High workload (90%), language barrier (56%), absence of paediatric formulations (55%), multiple tasks (21%), lack of support (20%) and limited physical space (19%) were the main challenges that nurses encountered during drug administration.  There was only one nurse (1.25%) trained in pediatric nursing. Analysis revealed an association between quality drug administration and number of years worked in paediatric wards (fisher’s exact p < 0.05) and the attendance of continuing medical education (CME) (Fishers exact p < 0.05). According to the study findings, it was concluded that there are factors that influence quality of medication management and if not addressed, these can adversely affect the patient. Study recommendations were that more nurses be trained in paediatric nursing and deployed to their area of specialization to decrease the heavy workload and ensure quality medication administration. It is further recommended that standards of quality care and procedure manuals on medication management should be developed and made available to the health care workers. Keywords: Medication, Medication errors, Medication management, Nursing, Caregiver, Quality Medication management

The Effect of Audit Committees on the Performance of County Governments in Kenya

Purpose - The chief objective of this management research study was to determine the effect of county audit committees on the performance of county governments in Kenya. Methodology - This management research paper was based on a conceptual framework that elaborates this relationship theoretically based on the exploratory empirical studies. This management research paper uses three theories as the anchoring theories based on the research variables of county audit committees and performance. Thus, this research paper built an all-inclusive structure that answers the research question of whether county audit committees had an effect on the county government performance in Kenya. The study uses a purposive judgement sampling model. The target population was all 47 county governments in Kenya and the county audit committees was the preferred unit of analysis. Hypotheses were tested using regression analysis and Pearson’s Product Moment Correlation analysis. Descriptive statistics were computed for the study objectives on the main characteristics of the study variables. Findings - The findings revealed that there was a strong relationship between county audit committees and county government performance. Implications - The findings of this study give managers and policy makers in the county government an in-depth understanding of the best practices in the management of public sector establishments by the use of county audit committees to promote their performance. Value - This study significantly contributes to the understanding and use of theories and practice of the correlation between county audit committees and performance of organizations. The key terms are; audit committees, county and performance.

Delivery of an Ebola Virus-Positive Stillborn Infant in a Rural Community Health Center, Sierra Leone, 2015.

We report the case of an Ebola virus (EBOV) RNA-negative pregnant woman who delivered an EBOV RNA-positive stillborn infant at a community health center in rural Sierra Leone, 1 month after the mother's last possible exposure. The mother was later found to be immunoglobulins M and G positive indicating previous infection. The apparent absence of Ebola symptoms and not recognizing that the woman had previous contact with an Ebola patient led health workers performing the delivery to wear only minimal personal protection, potentially exposing them to a high risk of EBOV infection. This case emphasizes the importance of screening for epidemiological risk factors as well as classic and atypical symptoms of Ebola when caring for pregnant women, even once they have passed the typical time frame for exposure and incubation expected in nonpregnant adults. It also illustrates the need for health-care workers to use appropriate personal protection equipment when caring for pregnant women in an Ebola setting

Risk Factors Associated with Severity of Nongenetic Intellectual Disability (Mental Retardation) among Children Aged 2–18 Years Attending Kenyatta National Hospital

Background. Many of the nongenetic causal risk factors of intellectual disability (ID) can be prevented if they are identified early. There is paucity on information regarding potential risk factors associated with this condition in Kenya. This study aimed to establish risk factors associated with severity of nongenetic intellectual disability (ID) among children presenting with this condition at Kenyatta National Hospital (KNH). Methods. A hospital-based cross-sectional study was conducted over the period between March and June 2017 in pediatric and child/youth mental health departments of Kenyatta National Hospital (KNH), Kenya. It included children aged 2–18 years diagnosed with ID without underlying known genetic cause. Results. Of 97 patients with nongenetic ID, 24% had mild ID, 40% moderate, 23% severe-profound, and 10% unspecified ID. The mean age of children was 5.6 (±3.6) years. Male children were predominant (62%). Three independent factors including “labor complications” [AOR = 9.45, 95% CI = 1.23–113.29, P=0.036], “admission to neonatal intensive care unit” [AOR = 8.09, 95% CI = 2.11–31.07, P=0.002], and “cerebral palsy” [AOR = 21.18, CI = 4.18–107.40, P≤0.001] were significantly associated with increased risk of severe/profound nongenetic ID. Conclusion. The present study findings suggest that perinatal complications as well as postnatal insults are associated with increased risk of developing severe-profound intellectual disability, implying that this occurrence may be reduced with appropriate antenatal, perinatal, and neonatal healthcare interventions

Assessment of parents' perception of quality of pediatric oncology inpatient care at Kenyatta National Hospital

Objective: Adequate knowledge of parents' perception of quality of pediatric cancer care helps to identify the areas of care improvement which would contribute to disease outcome in regard to the quality of life and satisfaction with the care provided. The aim of the study was to assess the parents' perception of the quality of Pediatric Oncology Inpatient Care at Kenyatta National Hospital. Methods: A cross-sectional descriptive quantitative and qualitative study was undertaken using a pretested semi-structured questionnaire and a focused group discussion guide. Assessment of parents' perception of quality of care was done in relation to the institution's structures and care delivery processes. These included the ward environment, resources for cancer treatment, care processes, service providers, and parents' knowledge empowerment. Participants were systematically selected. Parents' perception was defined as satisfaction or dissatisfaction with the care provided. Data were analyzed using SPSS version 20.0 (Armonk, NY: IBM Corp.) and presented as frequencies and percentages. Chi-square was used to test the significant association between variables. Level of significance was set at a P ≤ 0.05. Results: A total of 107 respondents were interviewed and 57.9% were satisfied with the overall quality of care they received. The determinants of overall satisfaction in this study were found to be related to resources for cancer treatment (odds ratio [OR] =3.10; 95% confidence interval [CI] =1.39–6.90; P = 0.005), care delivery processes (OR = 2.87; 95% CI = 1.28–6.43; P = 0.009), and the ward environment (OR = 2.59; 95% CI = 1.17–5.74; P = 0.018). Conclusions: The parents were moderately satisfied with the oncology care services their children received. The gaps identified in service delivery included those related to the availability of the required resources for efficient care delivery and also educational as well as psychosocial needs of the parents

Changes in sexual behaviour among HIV-infected women in west and east Africa in the first 24 months after delivery

Objective: Describe changes in sexual behaviour and determinants of unsafe sex among HIV-infected women in the 24 months after delivery. Design: Cohort analysis nested within a prevention of mother-to-child transmission trial in Burkina Faso (n = 339) and Kenya (n = 432). Methods: Women were followed during pregnancy and until 12–24 months after delivery. At each visit, structured questionnaires were administered about sexual activity and condom use, and risk-reduction counselling and condoms were provided. Results: At study entry, a median 2 months after HIV testing (interquartile range = 1–4), 411/770 (53.4%) of women reported partner disclosure, increasing to 284/392 (71.9%) at the final visit. Although most partners were supportive following disclosure, between 5 and 10% of disclosed women experienced hostile or unsupportive partner responses during follow-up visits. At each visit, about a third of sexually active women reported unsafe sex (unprotected sex with HIV-uninfected or unknown status partner). In multivariable logistic regression, unsafe sex was 1.70-fold more likely in Kenyan than in Burkinabe women [95% confidence interval (95% CI) = 1.14–2.54], and in those with less advanced HIV disease or aged 16–24 years. Compared with women who disclosed their status to partners and others, unsafe sex was over six-fold higher in nondisclosers (95% CI = 3.31–12.11), the effect size reducing with increasing disclosure. Conclusion: HIV-infected women who recently delivered have a high potential for further HIV transmission, especially as HIV discordance is common in Africa. Longitudinal care for women, including positive-prevention interventions, is needed within new services providing antiretroviral prophylaxis during breastfeeding – this repeated interface with services could focus on reducing unsafe sex. Much remains unknown about how to facilitate beneficial disclosure

Replication Data for: Prevalence of SARS-CoV-2 Antibodies from a one-year National Serosurveillance of Kenyan Blood Transfusion Donors

These data contain anonymised residual donor serum samples used for screening of transfusion transmissible infections collected at the KNBTS regional centres which has been used to compute standardised SARS-CoV-2 seroprevalence by age, sex and region using KNBS population as the standard population