Adherence to Anti-Retroviral Treatment and Factors Associated with Optimal Adherence among Adolescent and Adult PLWHA Attending Comprehensive Care Centres in Selected Hospitals in Nairobi County

Background: Anti-retroviral therapy (ART) has saved many lives from imminent deaths among PLWHA. However, the success is pegged on optimal (>95%) adherence to the ART by the PLWHA. The main objective of this study was to determine the ART adherence level by the PLWHA and the factors associated with the adherence.Methods: This was a cross sectional descriptive study on 454 PLWHA, attending Comprehensive Care Centres (CCCs) in selected hospitals in Nairobi County. A structured questionnaire was used to collect data. The Data was analysed using SPSS version 17.0. Results: There were 180 (39.6%) males and 274 (60.4%) females in the study. Majority (53.3%) PLWHA were aged between 40 and 49 years. Only 265 (58.4%) had optimal adherence to ART and duration on the ART was found to be significantly associated with optimal adherence to ART drugs.Conclusion: Optimal adherence was far below the recommended (>95%) mark and duration on  ART was found to be significantly associated with optimal adherence. That is, the shorter the time one had been on ART, the more the chances of being more adherent. Most PLWHA blamed forgetfulness as the main reason for their failure to take the ART drugs as required. Since Anti-Retroviral Treatment is a lifelong process, targeted counselling including reminders (ringing of a bell in the phone) and formation of groups for calling each other for remembrance would suffice. Keywords: PLWHA; ART; optimal adherence; Forgetfulness

Nutritional Status of Adolescent and Adult PLWHA on Anti-Retroviral Treatment, Attending Various Comprehensive Care Centres in Nairobi County, Kenya

Background: Maintaining nutritional needs of People Living with HIV and AIDS (PLWHA) who are on Anti-Retroviral Treatment (ART) helps to strengthen their immune system and optimize response to medical treatment. The main objective of this study was to assess the nutritional status PLWHA on ART and the associated factors. Methodology: This was a cross-sectional study where 454 adolescent and adult PLWHA on ART were randomly selected and consent obtained to join the study. Structured interviewer-administered questionnaires were used to gather data on their socio-economic characteristics, the types of food consumed in the last 24 hours and their Body Mass Index. The data was organized and analysed using SPSS version 17.0. Variables were categorized and Chi-square statistical test used to assess association where a p-value of less than or equal to 0.05 was considered statistically significant. Results: A total of 454 PLWHA were recruited into the study and 180 (39.6%) were males while 274 (60.4%) were females giving a Male: Female ratio of 1: 1.5. Over three quarters (77%) had attained secondary education and above. The main sources of income were employment (48.5%) and business (44.9%). The types of foods consumed were beans and beef for body building (proteins); Ugali (maize meal) and rice for energy (Carbohydrates); kales and cabbages (vegetables), bananas and pineapples (fruits) as protective foods. Over half (51.1%) were overweight/obese. Sources of income and the monthly earnings were significantly associated with the overweight/obesity. Conclusion: The PLWHAs’ sources of income and monthly earnings had statistical significance on their nutritional status (BMI) of being over-weight/obese. However, other factors such as: ART’s ability to decrease resting-energy expenditure and basal metabolic rate resulting in replenishment of muscle bulk and hence weight gain; or intentional over-eating to avoid the stigmatized weight loss which is often “associated” with being HIV positive may have had a part to play. Keywords: PLWHA; ART; Nutritional status (BMI); food groups and consumption; food availability, affordability and use

Delivery Practices and Associated Factors among Mothers Seeking Child Welfare Services in Selected Health Facilities in Nyandarua South District, Kenya

<p>Abstract</p> <p>Background</p> <p>A measure of the proportion of deliveries assisted by skilled attendants is one of the indicators of progress towards achieving Millennium Development Goal (MDG) 5, which aims at improving maternal health. This study aimed at establishing delivery practices and associated factors among mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya to determine whether mothers were receiving appropriate delivery care.</p> <p>Methods</p> <p>A hospital-based cross-sectional survey among women who had recently delivered while in the study area was carried out between August and October 2009. Binary Logistic regression was used to identify factors that predicted mothers' delivery practice.</p> <p>Results</p> <p>Among the 409 mothers who participated in the study, 1170 deliveries were reported. Of all the deliveries reported, 51.8% were attended by unskilled birth attendants. Among the deliveries attended by unskilled birth attendants, 38.6% (452/1170) were by neighbors and/or relatives. Traditional Birth Attendants attended 1.5% (17/1170) of the deliveries while in 11.7% (137/1170) of the deliveries were self administered. Mothers who had unskilled birth attendance were more likely to have <3 years of education (Adjusted Odds ratio [AOR] 19.2, 95% confidence interval [CI] 1.7 - 212.8) and with more than three deliveries in a life time (AOR 3.8, 95% CI 2.3 - 6.4). Mothers with perceived similarity in delivery attendance among skilled and unskilled delivery attendants were associated with unsafe delivery practice (AOR 1.9, 95% CI 1.1 - 3.4). Mother's with lower knowledge score on safe delivery (%) were more likely to have unskilled delivery attendance (AOR 36.5, 95% CI 4.3 - 309.3).</p> <p>Conclusion</p> <p>Among the mothers interviewed, utilization of skilled delivery attendance services was still low with a high number of deliveries being attended by unqualified lay persons. There is need to implement cost effective and sustainable measures to improve the quality of maternal health services with an aim of promoting safe delivery and hence reducing maternal mortality.</p

Factors associated with non-adherence to highly active antiretroviral therapy in Nairobi, Kenya

<p>Abstract</p> <p>Background</p> <p>Antiretroviral therapy (ART) requires high-level (> 95%) adherence. Kenya is rolling out ART access programmes and, issue of adherence to therapy is therefore imperative. However, published data on adherence to ART in Kenya is limited. This study assessed adherence to ART and identified factors responsible for non adherence in Nairobi.</p> <p>Methods</p> <p>This is a multiple facility-based cross-sectional study, where 416 patients aged over 18 years were systematically selected and interviewed using a structured questionnaire about their experience taking ART. Additional data was extracted from hospital records. Patients were grouped into adherent and non-adherent based on a composite score derived from a three questions adherence tool developed by Center for Adherence Support Evaluation (CASE). Multivariate regression model was used to determine predictors of non-adherence.</p> <p>Results</p> <p>Overall, 403 patients responded; 35% males and 65% females, 18% were non-adherent, and main (38%) reason for missing therapy were being busy and forgetting. Accessing ART in a clinic within walking distance from home (OR = 2.387, CI.₉₅= 1.155-4.931; <it>p = </it>0.019) and difficulty with dosing schedule (OR = 2.310, CI.₉₅= 1.211-4.408, <it>p = </it>0.011) predicted non-adherence.</p> <p>Conclusions</p> <p>The study found better adherence to HAART in Nairobi compared to previous studies in Kenya. However, this can be improved further by employing fitting strategies to improve patients' ability to fit therapy in own lifestyle and cue-dose training to impact forgetfulness. Further work to determine why patients accessing therapy from ARV clinics within walking distance from their residence did not adhere is recommended.</p

Questionnaire Survey on the Occurrence of Risk factors for Toxoplasma gondii infection amongst Farmers in Thika District, Kenya

A survey was conducted to determine the occurrence of risk factors for Toxoplasma gondii infection amongst farmers in Thika District, Kenya. Interviews were conducted in a total of 385 households using a structured questionnaire. The water consumed at household level originated from taps (74.3%), rivers or streams (15.1%), wells (5.4%) and boreholes (5.2%). A number of households (46.8%) consumed water without boiling or applying any form of treatment. All respondents washed vegetables before cooking, whilst 99.0% washed fruits before eating. Boiled milk was preferred by 99.5% of the farmers. The majority (85.2%) consumed beef more often, whilst 1.6% consumed pork. The majority (98.7%) consumed thoroughly cooked meat. Meat was preserved by 17% of farmers. Only four farmers (1.2%) who practised mixed farming used gloves when handling livestock manure. Five farmers (1.6%) reported the occurrence of abortion in ruminants and pigs on their farms within the last two years before the study. Almost half (44.9%) of the households owned cats, which were kept mainly as pets (79.8%) and for deterring rodents (20.2%). The majority of households (91.3%) fed the cats on leftovers, whilst 8.1% fed cats with raw offal. Sixteen households (9.2%) provided housing for cats. Only five households (2.8%) had litter boxes, but none of the households with litter boxes used gloves when cleaning them out. Disposal of cat faeces was done mainly by women (55.5%). Only one farmer (0.3%) had some knowledge about toxoplasmosis, but was not aware of the transmission mechanism. The study highlights the need for public health education to raise awareness of risk factors for toxoplasmosis

Long Term School Based Deworming against Soil-Transmitted Helminths Also Benefits the Untreated Adult Population: Results from a Community-Wide Cross Sectional Survey

Background. Soil-transmitted helminths (STH) are a public health problem in Kenya. The primary control strategy for these infections is preventive chemotherapy (PC) delivered through school based deworming (SBD) programs. The World Health Organization (WHO) recommends the inclusion of other at-risk groups in the PC. The untreated groups in endemic areas have been shown to act as reservoirs for STH transmission. Few field based studies have focused on the possible benefits of SBD to the untreated groups in the community. This study sought to determine the levels of STH among all age groups in a community where SBD has been going on for more than 10 years. Methods. This was a cross sectional study where 3,292 individuals, ranging from 2 to 98 years, were enrolled. Stool samples were analyzed using duplicate Kato Katz thick smear technique for presence of STH eggs. Statistical analysis was conducted using STATA software 14.0 (Stata corporation). Results. Out of the total 3,292 stool samples analyzed, only 13 were positive for any STH. Of these, 12 were infected with Trichuris trichiura and one case was of hookworm. There was no Ascaris lumbricoides infection detected. Of the 13 STH infections, seven of the infections were of school going age (6-18 years), 5 were of preschool age (). More male (61.5%) than female were infected with STH. Conclusion. This study shows very low prevalence of STH among all age groups in Mwea, suggesting that long term SBD may also be benefitting the untreated groups in the community and thus the potential to achieve STH elimination in such endemic areas

Human studies on probiotics and endogenous lactic acid bacteria in the urogenital tract

Every minute of every day more and more children die of diarrheal diseases and women, and girls become infected by HIV An estimated 7,000 women become infected each day. While many valiant efforts are being made to address these issues, until now they have proved to be markedly ineffective. The notion that lactic acid bacteria, formulated into food or dietary supplements, could have a role to play in slowing the morbidity and mortality associated with HIV/AIDS and gastroenteritis, is built upon sound clinical findings and scientific investigations, yet no international efforts have been placed in this approach, to date. We hereby summarize the reasons why such efforts should be made, provide an example of one model being set up in sub-Saharan Africa, and challenge the international community to consider the potential benefits of probiotics, especially for communities not reached by governmental and nongovernmental agencies. Copyright © 2005 by Lippincott Williams & Wilkins

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P &lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally