Associations between female genital mutilation/cutting and early/child marriage: A multi-country DHS/MICS analysis

Over the last several decades, global efforts to end female genital mutilation/cutting (FGM/C) have intensified through the combined efforts of international and nongovernmental organizations (NGOs), governments, and religious and civil society groups. Evidence of the wider impacts of FGM/C and interventions for its abandonment is small but emerging. The practice of FGM/C has frequently been linked to a girl’s marriageability and is thought to be associated with child marriage, either directly, as a cause of early/child marriage, or vice versa, or indirectly, resulting from common causes. Evidence of the relationships between these two practices to inform programming and policy for abandonment interventions is limited at best, however. This study investigates the relationship between FGM/C and early/child marriage; investigates the possible correlates of early/child marriage; compares FGM/C practice across the region; and examines the correlates for FGM/C

Female genital mutilation/cutting in Kenya: Is change taking place? Descriptive statistics from four waves of Demographic and Health Surveys

Nationally representative survey data on female genital mutilation/cutting (FGM/C) in Kenya are available from four waves of Demographic and Health Surveys. These survey data provide a rich and detailed picture of when, where, and how FGM/C has been carried out, and trends in changes in the practice. National prevalence data from successive waves of surveys show a steady decrease in the prevalence of FGM/C among women aged 15–49. While the data reported here are descriptive, they provide useful insights on the progress of FGM/C abandonment at national and subnational levels. These findings are useful for policymakers in steering discussions on policies, but also for guiding where to target interventions especially given the large ethnic and religious diversity. Findings also highlight where there are large numbers of women living with FGM/C who may be in need of specialized health services

Exploring the association between FGM/C and early/child marriage: A review of the evidence

Female genital mutilation/cutting (FGM/C) has been frequently linked to marriageability and thought to be associated with child marriage, yet there is remarkably little rigorous research to clarify the relationship between these two practices to inform discussions and responses. Furthermore, trends are also shifting in the timing of FGM/C from adolescence to early childhood, and the implications this might have on the links between early/child marriage and FGM/C are not well understood. This review of current available evidence aims to assess the association between FGM/C and early/child marriage in contexts where both practices are carried out. The social and cultural norms that underpin both practices and thus their continuation may vary across cultures and countries and even change over time; the challenge is to understand how social norms will and could be changed to end harmful practices that affect the lives of girls and women

Exploring sources of variability in adherence to guidelines across hospitals in low-income settings: a multi-level analysis of a cross-sectional survey of 22 hospitals.

BACKGROUND: Variability in processes of care and outcomes has been reported widely in high-income settings (at geographic, hospital, physician group and individual physician levels); however, such variability and the factors driving it are rarely examined in low-income settings. METHODS: Using data from a cross-sectional survey undertaken in 22 hospitals (60 case records from each hospital) across Kenya that aimed at evaluating the quality of routine hospital services, we sought to explore variability in four binary inpatient paediatric process indicators. These included three prescribing tasks and use of one diagnostic. To examine for sources of variability, we examined intra-class correlation coefficients (ICC) and their changes using multi-level mixed models with random intercepts for hospital and clinician levels and adjusting for patient and clinician level covariates. RESULTS: Levels of performance varied substantially across indicators and hospitals. The absolute values for ICCs also varied markedly ranging from a maximum of 0.48 to a minimum of 0.09 across the models for HIV testing and prescription of zinc, respectively. More variation was attributable at the hospital level than clinician level after allowing for nesting of clinicians within hospitals for prescription of quinine loading dose for malaria (ICC = 0.30), prescription of zinc for diarrhoea patients (ICC = 0.11) and HIV testing for all children (ICC = 0.43). However, for prescription of correct dose of crystalline penicillin, more of the variability was explained by the clinician level (ICC = 0.21). Adjusting for clinician and patient level covariates only altered, marginally, the ICCs observed in models for the zinc prescription indicator. CONCLUSIONS: Performance varied greatly across place and indicator. The variability that could be explained suggests interventions to improve performance might be best targeted at hospital level factors for three indicators and clinician factors for one. Our data suggest that better understanding of performance and sources of variation might help tailor improvement interventions although further data across a larger set of indicators and sites would help substantiate these findings

Informal task-sharing practices in inpatient newborn settings in a low-income setting: A task analysis approach

Aim: To describe the complexity and criticality of neonatal nursing tasks and existing task-sharing practices to identify tasks that might be safely shared in inpatient neonatal settings. Design: We conducted a cross-sectional study in a large geographically dispersed sample using the STROBE guidelines. Methods: We used a task analysis approach to describe the complexity/criticality of neonatal nursing tasks and to explore the nature of task sharing using data from structured, self-administered questionnaires. Data was collected between 26th April and 22nd August 2017. Results: Thirty-two facilities were surveyed between 26th April and 22nd August, 2017. Nearly half (42%, 6/14) of the “moderately critical” and “not critical” (41%, 5/11) tasks were ranked as consuming most of the nurses' time and reported as shared with mothers respectively. Most tasks were reported as shared in the public sector than in the private-not-for-profit facilities. This may largely be a response to inadequate nurse staffing, as such, there may be space for considering the future role of health care assistants

Evaluation of treatment outcomes and associated factors among patients managed for tuberculosis in Vihiga County, 2012‐ 2015

Background: Tuberculosis (TB) treatment outcomes are used to evaluate program and patient success. Despite this, factors driving and sustaining high rates of poor TB treatment outcomes in Vihiga County are not well understood.Objective: To evaluate treatment outcomes and associated factors among patients managed for TB in Vihiga County between 2012 and 2015.Design: Descriptive cohort study.Setting: Vihiga County.Subjects: Notified TB patients >15years who were on drug susceptible TB treatment.Results: Of the 3288 eligible patients more than half were male 1961 (60%), 85% were from the public sector while 23% were over 45years. Among the TB patients, 2865 (87%) were successfully treated, 299 (9%) died and 124 (4%) had other poor treatment outcomes. On multivariate analysis, advancing age (Adjusted Odds Ratio (AOR) 3.3, 95% CI2.03‐5.38, P<0.001), HIV positive (AOR1.78, 95% CI1.27‐2.49, P0.001), previously treated (AOR1.78, 95% CI1.2‐2.49, P<0.001) and unknown HIV status (AOR 2.11, 95% CI 1.21‐3.68, P 0.008) increased the risk of death. TB patients with positive sputum results during initiation of treatment (AOR=0.68, CI=0.50‐0.94, P‐value 0.018) and those with normal body mass index (BMI) (AOR 0.37, 95% CI 0.24‐0.58, P<0.001), were less likely to die.Conclusion: While higher BMI and bacteriological confirmation reduced the risk of death, advancing age, unknown HIV status, HIV positive, being a previously treated TB case increased the risk of death. We recommend early and accurate diagnosis of TB cases, TB/HIV integration and active involvement of community health volunteers in TB management

Characterising Kenyan hospitals' suitability for medical officer internship training: a secondary data analysis of a cross-sectional study

Objective To characterise the capacity of Kenya internship hospitals to understand whether they are suitable to provide internship training for medical doctors. Design A secondary data analysis of a cross-sectional health facility assessment (Kenya Harmonized Health Facility Assessment (KHFA) 2018). Setting and population We analysed 61 out of all 74 Kenyan hospitals that provide internship training for medical doctors. Outcome measures Comparing against the minimum requirement outlined in the national guidelines for medical officer interns, we filtered and identified 166 indicators from the KHFA survey questionnaire and grouped them into 12 domains. An overall capacity index was calculated as the mean of 12 domain-specific scores for each facility. Results The average overall capacity index is 69% (95% CI 66% to 72%) for all internship training centres. Hospitals have moderate capacity (over 60%) for most of the general domains, although there is huge variation between hospitals and only 29 out of 61 hospitals have five or more specialists assigned, employed, seconded or part-time-as required by the national guideline. Quality and safety score was low across all hospitals with an average score of 40%. As for major specialties, all hospitals have good capacity for surgery and obstetrics-gynaecology, while mental health was poorest in comparison. Level 5 and 6 facilities (provincial and national hospitals) have higher capacity scores in all domains when compared with level 4 hospitals (equivalent to district hospitals). Conclusion Major gaps exist in staffing, equipment and service availability of Kenya internship hospitals. Level 4 hospitals (equivalent to district hospitals) are more likely to have a lower capacity index, leading to low quality of care, and should be reviewed and improved to provide appropriate and well-resourced training for interns and to use appropriate resources to avoid improvising

Informal task-sharing practices in inpatient newborn settings in a low-income setting-A task analysis approach.

Aim: To describe the complexity and criticality of neonatal nursing tasks and existing task-sharing practices to identify tasks that might be safely shared in inpatient neonatal settings. Design: We conducted a cross-sectional study in a large geographically dispersed sample using the STROBE guidelines. Methods: We used a task analysis approach to describe the complexity/criticality of neonatal nursing tasks and to explore the nature of task sharing using data from structured, self-administered questionnaires. Data was collected between 26th April and 22nd August 2017. Results: Thirty-two facilities were surveyed between 26th April and 22nd August, 2017. Nearly half (42%, 6/14) of the "moderately critical" and "not critical" (41%, 5/11) tasks were ranked as consuming most of the nurses' time and reported as shared with mothers respectively. Most tasks were reported as shared in the public sector than in the private-not-for-profit facilities. This may largely be a response to inadequate nurse staffing, as such, there may be space for considering the future role of health care assistants

Comparable outcomes among trial and nontrial participants in a clinical trial of antibiotics for childhood pneumonia: a retrospective cohort study.

OBJECTIVES: We compared characteristics and outcomes of children enrolled in a randomized controlled trial (RCT) comparing oral amoxicillin and benzyl penicillin for the treatment of chest indrawing pneumonia vs. children who received routine care to determine the external validity of the trial results. STUDY DESIGN AND SETTING: A retrospective cohort study was conducted among children aged 2-59 months admitted in six Kenyan hospitals. Data for nontrial participants were extracted from inpatient records upon conclusion of the RCT. Mortality among trial vs. nontrial participants was compared in multivariate models. RESULTS: A total of 1,709 children were included, of whom 527 were enrolled in the RCT and 1,182 received routine care. History of a wheeze was more common among trial participants (35.4% vs. 11.2%; P < 0.01), while dehydration was more common among nontrial participants (8.6% vs. 5.9%; P = 0.05). Other patient characteristics were balanced between the two groups. Among those with available outcome data, 14/1,140 (1.2%) nontrial participants died compared to 4/527 (0.8%) enrolled in the trial (adjusted odds ratio, 0.7; 95% confidence interval: 0.2-2.1). CONCLUSION: Patient characteristics were similar, and mortality was low among trial and nontrial participants. These findings support the revised World Health Organization treatment recommendations for chest indrawing pneumonia

Risk factors for death among children aged 5-14 years hospitalised with pneumonia: a retrospective cohort study in Kenya.

INTRODUCTION: There were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5-14 years hospitalised with pneumonia in district-level health facilities in Kenya. METHODS: We did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5-14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death. RESULTS: 1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62). CONCLUSION: Children >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population