Abortion related stigma: a case study of abortion stigma in regions with high and low incidences of unsafe abortion

Background: Abortion accounts for 35% of maternal mortality in Kenya. Kenya has reported an increase in the rate of unsafe abortions from 32 to 48 per 1000 women of reproductive age in 2002 and 2012 respectively. During the same period, women presented in public health facilities with severe complications indicating that women were having unsafe abortions.Objective: To investigate the association between incidences of unsafe abortion and stigma attitudes and beliefs about abortion among community member’s in two counties located in regions with either high or low incidences of unsafe abortion.Design: A cross-sectional comparative study.Settings: General community members in Trans Nzoia and Machakos Counties.Subjects: Men and women of reproductive age in Trans Nzoia and Machakos Counties.Results: Respondents in Trans Nzoia County reported the highest full-scale abortion stigma levels (μ=55.4) compared to those from Machakos County (μ=53.07). The mean differences in SABAS scores for all the four subscales were significant for fear of contagion, exclusion and discrimination and Negative stereotyping (p-value <0.000). Incidence region, educational attainment and marital status were all significantly associated with stigmatising attitudes. Respondents in the 35-49 age group showed more stigmatising attitudes than younger respondents, and married individuals showed more stigmatising attitudes than single respondents, and lower education levels were associated with higher levels of stigma.Conclusions: Mean stigma scores for counties with high incidence of unsafe abortions were higher than those from regions with a low incidences of unsafe abortion. Male community members, those with lower levels of education were more likely to report higher levels of stigma at the community level. The majority of women seeking abortion were viewed negatively by general community members, and this could explain women’s decision to seek an unsafe abortion

Abortion-related stigma and unsafe abortions: perspectives of women seeking abortion care in Machakos and Trans-Nzoia Counties, Kenya

Background: The rate of unsafe abortions in Kenya increased from 32 per 1000 women of reproductive age in 2002 to 48 per 1000 women in 2012-- one of the highest in Sub- Saharan Africa. Abortion-related stigma has been linked to high levels of unsafe abortions.Objective: To explore the perspectives of women seeking abortion services in public and private health facilities in regions with high as well as low incidence of unsafe abortions in Kenya on abortion-related stigma.Design: A comparative qualitative study.Setting: Selected public and private health facilities offering post abortion care services in Machakos and Trans Nzoia CountiesSubjects: Women seeking abortion related services in private and public health facilities in Machakos and Trans Nzoia Counties.Results: Abortion-related stigma manifested in various forms including verbal abuse such as ridicule and name calling, isolation, physical abuse and denial of services. The stigma was in form of self-stigma, from the community and from health providers. Due to stigma, women preferred to seek information on abortion only from trusted friends and close relatives, regardless of their reliability so as to keep abortion confidential. Private facilities were reported as the main facilities where women could get an abortion confidentially, but costly compared to public facilities. As a result, women who could not afford private facilities chose to self-induce and present in a health facility to seek post abortion (PAC) care as the only way to access services, regardless of the dangers. Young single women seeking abortion services reported higher levels of stigma from health providers compared to older married women. Perception that abortion was illegal in Kenya perpetuated stigma and prevented women from seeking safe abortion services due to fear of being arrested.Conclusion: Stigma associated with abortion is a major barrier to women seeking and receiving safe, comprehensive abortion care. Therefore, understanding abortion-related stigma is a critical step to designing measures to address barriers to women accessing safe reproductive health services

Voluntary medical male circumcision: Safety and satisfacion at Migori County Hospital

Background: The World Health Organization (WHO) recommended Voluntary Medical Male Circumcision (VMMC) as an HIV prevention option for men based on evidence showing a reduction in HIV acquisition of 50% to 60%. Based in this evidence, the rapid expansion of VMMC in sub Saharan Africa has raised concerns on the capacity of VMMC programs to provide sustainable high quality and safe VMMC services.Objective: To determine the rates and correlates of adverse events following VMMC among clients attending Migori County Hospital.Design: Descriptive cross sectional study Setting: Migori County Referral Hospital, Kenya.Subjects: Between November and December 2015, 138 men receiving VMMC services at Migori County hospital were interviewed during their follow up visits within 7 days following the procedure. We systematically sampled every third participant attending their follow up visit. Face to face interviews were conducted to obtain data on demographics and levels of satisfaction, and physical examination to determine any adverse events after circumcision. Fishers exact was used to test for correlates of adverse events among participants.Results: The mean age of participants was 22 years, Standard Deviation (SD) ±5) .About two-thirds (63.8%) had reached secondary level education, 26(18.8%) tertiary level, 23(16.7%) primary level and only 1(0.7%) had no education. The majority 100(72.5%) reported being aware of possible adverse events following male circumcision and almost all 135 (97.8%) participants reported having adhered to wound care instructions. The rate of mild and moderate adverse events was 58.7% and 2.9%, respectively. There was no severe adverse event reported. Bathing and not changing underpants was associated with adverse events. The Majority 137 (99.3%) of participants were highly satisfied with the circumcision procedure and the post-operative care services they received.Conclusion: These results imply that VMMC in this setting can be delivered safely and effectively with high client satisfaction

'Tweaking' the model for understanding and preventing maternal and neonatal morbidity and mortality in low income countries : "inserting new ideas into a timeless wine skin"

Background: Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care. Discussion: The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries Conclusion: In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in LICS

Prevalence and causes of ocular morbidity in Mbeere District, Kenya. Results of a population-based survey.

PURPOSE: Ocular morbidity (OM) describes any eye disease regardless of resultant visual loss. Ocular morbidity may affect large numbers of people in low income countries and could lead to many episodes of care. However there is limited evidence about the prevalence of ocular morbidity or resulting health-seeking behavior. This study in Mbeere District, Kenya, set out to explore both these issues. METHODS: A cross-sectional household survey was conducted in 2011. Trained teams moved from house to house examining and questioning residents on ocular morbidity and health-seeking behavior. Data were collected on standardized proformas and entered into a database for analysis. RESULTS: 3,691 people were examined (response rate 91.7%). 15.52% (95% CI 13.86-16.92) had at least one ocular morbidity in at least one eye. The leading cause was presbyopia which affected 25.11% (95% CI 22.05-28.45) of participants over 35 and increased with age. Other leading causes of OM were conditions that affected the lens (32.58%) and the conjunctiva (31.31%). No association was found between educational attainment or employment and OM. 9.63% (7.87-11.74) self-reported an ocular morbidity in the previous six months and 45.94% (95% CI 37.1-55.04) stated that they had sought treatment for the condition. CONCLUSION: A large number of people were affected by an ocular morbidity in this survey. Most of these people could potentially be managed in their own communities through primary care services (e.g. those with presbyopia). Further work is required to understand the best way of providing an effective, equitable service for ocular morbidity

Quality Of Antenatal Care In Rural Southern Tanzania: A Reality Check.

Counselling on the danger signs of unpredictable obstetric complications and the appropriate management of such complications are crucial in reducing maternal mortality. The objectives of this study were to identify gaps in the provision of ANC services and knowledge of danger signs as well as the quality of care women receive in case of complications. The study took place in the Rufiji District of Tanzania in 2008 and was conducted in seven health facilities. The study used (1) observations from 63 antenatal care (ANC) sessions evaluated with an ANC checklist, (2) self-assessments of 11 Health workers, (3) interviews with 28 pregnant women and (4) follow-up of 12 women hospitalized for pregnancy-related conditions.Blood pressure measurements and abdominal examinations were common during ANC visits while urine testing for albumin or sugar or haemoglobin levels was rare which was often explained as due to a lack of supplies. The reasons for measuring blood pressure or abdominal examinations were usually not explained to the women. Only 15/28 (54%) women were able to mention at least one obstetric danger sign requiring medical attention. The outcomes of ten complicated cases were five stillbirths and three maternal complications. There was a considerable delay in first contact with a health professional or the start of timely interventions including checking vital signs, using a partograph, and detailed record keeping. Linking danger signs to clinical and laboratory examination results during ANC with the appropriate follow up and avoiding delays in emergency obstetric care are crucial to the delivery of coordinated, effective care interventions

Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission

Background. The epidemiology of congenital malaria was investigated in a hospital-based malaria surveillance study in Papua, Indonesia

Health systems strengthening to arrest the global disability burden: Empirical development of prioritised components for a global strategy for improving musculoskeletal health

Introduction Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health. Methods Design: mixed-methods, three-phase design. Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response. Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci. Phase 3: informed by phases 1-2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions. Results Phase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action. Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model. Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening. Conclusion An empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives

Past and present dynamics of sorghum and pearl millet diversity in Mount Kenya region

Crop populations in smallholder farming systems are shaped by the interaction of biological, ecological, and social processes, occurring on different spatio temporal scales. Understanding these dynamics is fundamental for the conservation of crop genetic resources. In this study, we investigated the processes involved in sorghum and pearl millet diversity dynamics on Mount Kenya. Surveys were conducted in ten sites distributed along two elevation transects and occupied by six ethnolinguistic groups. Varieties of both species grown in each site were inventoried and characterized using SSR markers. Genetic diversity was analyzed using both individual- and population-based approaches. Surveys of seed lot sources allowed characterizing seed-mediated gene flow. Past sorghum diffusion dynamics were explored by comparing Mount Kenya sorghum diversity with that of the African continent. The absence of structure in pearl millet genetic diversity indicated common ancestry and/or important pollen- and seed-mediated gene flow. On the contrary, sorghum varietal and genetic diversity showed geographic patterns, pointing to different ancestry of varieties, limited pollen-mediated gene flow, and geographic patterns in seed-mediated gene flow. Social and ecological processes involved in shaping seed-mediated gene flow are further discussed