Assessment of Voluntary HIV Counseling and Testing Service utilization and VCT/HIV related knowledge and attitude towards VCT Among out of school youth in rural Nakuru County, Kenya: A cross sectional survey

Background: Voluntary HIV counseling and testing (VCT) is one of the key tools in the HIV/AIDS prevention and control programs in Kenya. But utilization of VCT services among out of school youth is low. The aim of this study was to assess voluntary HIV Counseling and Testing Service Utilization and VCT/HIV related knowledge and attitude towards VCT among out of school youth since though they are a risk group in Kenya they are less likely than other groups to be offered this service. A cross sectional study design was done among 369 out of school youth aged 18-35 drawn from three rural divisions of Nakuru County, Kenya, using proportionate and purposive sampling technique. Self-administered questionnaire was used to estimate the prevalence of VCT service utilization and to assess VCT/HIV related knowledge and attitude towards VCT among out of school youth. Data were entered and analyzed using SPSS version 11.5.The study sample consisted of 56.1% males and 43.9% females. The mean age for those who had utilized VCT was 24 for men and 23 for females. The majority of the out-of- school youth (62.6%) had not utilized VCT. Poor utilization of VCT services was found to be significantly associated with HIV/VCT related knowledge and negative attitude towards VCT. VCT utilization among out-of- school youth in Nakuru County was low. The major factors identified for increased VCT service utilization were high VCT/HIV related knowledge and positive   attitude towards VCT. HIV/AIDS prevention and control programs in Nakuru County should focus on the above areas. Key words: HIV testing, VCT utilization, Knowledge, Out of school youth, Nakuru Keny

Assessment of Voluntary HIV Counseling and Testing Service Utilization and Associated Health Service Related Factors Among Out of School Youth in Nakuru Kenya: A Cross Sectional Survey

Background: Voluntary HIV counseling and testing (VCT) is one of the key tools in the HIV/AIDS prevention and control programs in Kenya. But utilization of VCT services among out of school youth is low. The aim of this study was to investigate health service related factors associated with VCT utilization among out of school youth in a rural setting since though they are a risk group in Kenya they are less likely than other groups to be offered this service. A cross sectional study design was done among 369 out of school youth aged 18-35 drawn from three rural divisions of Nakuru County, Kenya, using proportionate and purposive sampling technique. Self-administered questionnaire was used to estimate the prevalence of VCT service utilization and to assess associated health service related factors. Data were entered and analyzed using SPSS version 11.5. The study sample consisted of 56.1% males and 43.9% females. The mean age for those who had utilized VCT was 24 for men and 23 for females. The majority of the out-of- school youth (62.6%) had not utilized VCT. Poor utilization of VCT services was found to be associated with perception of quality of VCT services. It was shown that VCT utilization was significantly associated with competence of VCT counselors and youth friendliness of the services. CT utilization among out-of- school youth in Nakuru County was low. The major factors identified for increased VCT service utilization were better perception of the quality of the VCT services, and more competence of the CVT counselors. Hence, HIV/AIDS prevention and control programs in Nakuru County should focus on the above areas. Keywords: HIV testing, VCT utilization, Stigma, Knowledge, Out of school youth, Nakuru, Keny

Assessment of Voluntary HIV Counseling and Testing Service Utilization and Associated Socio-demographic Factors Among Out of School Youth in Rural Nakuru County, Kenya: A Cross Sectional Survey

Voluntary HIV counseling and testing (VCT) is one of the key tools in the HIV/AIDS prevention and control programs in Kenya. But utilization of VCT services among out of school youth is low. The aim of this study was to assess Voluntary HIV Counseling and Testing Service utilization and associated socio-demographic factors among out of school youth, since though they are a risk group in Kenya; they are less likely than other groups to be offered this service. A cross sectional study design was done among 369 out of school youth, aged 18-35 years drawn from three rural divisions of Nakuru County, Kenya, using proportionate and purposive sampling technique. Self-administered questionnaire was used to estimate the prevalence of VCT service utilization and to assess associated socio-demographic factors among out of school youth. Data were entered and analyzed using SPSS version 11.5. The study sample consisted of 56.1% males and 43.9% females. The mean age for those who had utilized VCT was 24 for men and 23 for females. The majority of the out-of- school youth (62.6%) had not utilized VCT. It was shown that VCT utilization was significantly associated with the level of education, level of income and marital status. There was no significant association   between VCT utilization and age or gender. VCT utilization among out-of- school youth in Nakuru County was low. HIV/AIDS prevention and control programs in Nakuru County should focus on the above areas. Keywords: HIV testing, VCT utilization, Knowledge, Out of school youth, Nakuru Keny

Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley Mother Baby Hospital: A longitudinal case-series study

Background: Eclampsia, considered a serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods: This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results: During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0-40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1-2.0). Conclusion: There is no benefit of emergency caesarean section for women with eclampsia. Instead, it increases the risk of perinatal adverse outcomes, including the risk of admission to the newborn unit and perinatal death

Safety and immunogenicity of ChAdOx1 nCoV-19 (AZD1222) vaccine in adults in Kenya: a phase 1/2 single-blind, randomised controlled trial

Background: There are limited data on the immunogenicity of coronavirus disease 2019 (COVID-19) vaccines in African populations. Here we report the immunogenicity and safety of the ChAdOx1 nCoV-19 (AZD1222) vaccine from a phase 1/2 single-blind, randomised, controlled trial among adults in Kenya conducted as part of the early studies assessing vaccine performance in different geographical settings to inform Emergency Use Authorisation. Methods: We recruited and randomly assigned (1:1) 400 healthy adults aged ≥18 years in Kenya to receive ChAdOx1 nCoV-19 or control rabies vaccine, each as a two-dose schedule with a 3-month interval. The co-primary outcomes were safety, and immunogenicity assessed using total IgG enzyme-linked immunosorbent assay (ELISA) against SARS-CoV-2 spike protein 28 days after the second vaccination. Results: Between 28th October 2020 and 19th August 2021, 400 participants were enrolled and assigned to receive ChAdOx1 nCoV-19 (n=200) or rabies vaccine (n=200). Local and systemic adverse events were self-limiting and mild or moderate in nature. Three serious adverse events were reported but these were deemed unrelated to vaccination. The geometric mean anti-spike IgG titres 28 days after second dose vaccination were higher in the ChAdOx1 group (2773 ELISA units [EU], 95% CI 2447, 3142) than in the rabies vaccine group (61 EU, 95% CI 45, 81) and persisted over the 12 months follow-up. We did not identify any symptomatic infections or hospital admissions with respiratory illness and so vaccine efficacy against clinically apparent infection could not be measured. Vaccine efficacy against asymptomatic SARS-CoV-2 infection was 38.4% (95% CI -26.8%, 70.1%; p=0.188). Conclusions: The safety, immunogenicity and efficacy against asymptomatic infection of ChAdOx1 nCoV-19 among Kenyan adults was similar to that observed elsewhere in the world, but efficacy against symptomatic infection or severe disease could not be measured in this cohort. Pan-African Clinical Trials Registration: PACTR202005681895696 (11/05/2020

Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley mother baby hospital: a longitudinal case-series study

Background: Eclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods: This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results: During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0–40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1–2.0). Conclusion: There is no benefit of emergency caesarean section for women with eclampsia. This study showed that induction of labour and vaginal delivery can be successfully achieved in pregnant women with eclampsia. Maternal and perinatal mortality from eclampsia can be prevented through prompt and effective care