Alcohol and Substance use vis a vis HIV Sexual Risk Behaviours among freshman students at a Kenyan University College; Focus for Interventions

The study was to evaluate the perception of freshman students at Kimathi University College of Technology towards HIV/AIDS, sexual behaviours and drug use. A cross sectional study with a probability, two stage sampling method was used.115 participated, 21.7% were female. Knowledge of HIV/AIDS was high, although behaviour did not reflect such. The number of participants that have engaged in sex is 57.9%, 65.1% of males. 45.5% state they do not use condoms. 48.3% having never been tested for HIV. Of these, 41.1% feel they have never been exposed to the virus. Participants who reported having consumed alcohol and other drugs were 27.2%, and 7.5% felt the use of drugs or alcohol increased the risk of sexually transmitted disease. Consumption of alcohol was significantly associated to having engaged in sex (p=0.003) and non use of condoms (p=0.015). Results show need for further intervention to change the attitude of the students. Keywords: Freshman, Alcohol, Substance abuse, HIV, Risk behavio

Challenges and Coping Strategies among Couples of Mixed HIV Status Presenting at a Large Comprehensive Care Centre in Eldoret, Kenya

This study was to determine challenges and coping strategies of HIV discordant couples seen at AMPATH Centre, Moi Teaching and Referral Hospital, Kenya. A cross sectional study design with consecutive sampling was used.384 participated. Challenges included; negotiation for sex (100%), need for children (94%) and blame for HIV infection. Females reported more abuse (65.4% against 34.6% for males). Highest incidence of abuse was reported among the unemployed HIV positive females. Coping strategies expressed included; abstinence (9%), condom use (74%), sleeping facing opposite sides in bed or separation of beds (11%) and living apart. A bivariate analysis of those participants who reported use of condom all the time and those who reported otherwise showed Age group, order of HIV testing and HIV status were significant while level of formal education of the participants and occupation were not. Negotiation for sex formed the greatest challenge while a combination of coping strategies was used. Keywords: HIV, Discordant couple, challenges, coping strategie

Socio-Demographic, Nutritional and Adherence as Determinants of Nevirapine Plasma Concentration among HIV-1 Patients from Two Geographically Defined Regions of Kenya

Background: Data are skewed on the role of Socio-demographic, nutritional and adherence related factors on the influence of nevirapine plasma concentrations among Kenyan population. This study rigorously determined these three factors on nevirapine plasma concentrations among HIV patients receiving HIV treatment in two regions known for high prevalence of HIV and long duration of ART uptake.Methods: Blood samples were collected from 377 consenting HIV adult patients receiving an NVP-based first-line ART regimen. A detailed sociodemographic questionnaire was administered. NVP plasma concentration was measured by liquid chromatography - tandem mass spectrometry (LC-MS/MS). Results: The majority (59.2%) of the patients were female, 72.2% were from western Kenya (predominantly Nilotic speaking community). The patients’ mean age was 41.6 (SD ± 11.5) years and the mean duration of ART was 5.1 (SD ± 4.8) years. The median BMI of the patients was 25 kg/m2 (IQR = 22.2 - 28.7 kg/m2). The majority 81.2% were receiving 3TC/NVP/TDF ART regimen, 30% had changed their initial ART regimen with 54.4% reporting missing taking current ARVs. Overall NVP plasma levels ranged from 4-44207 ng/mL (median 6213 ng/mL, IQR 3097–8606.5 ng/mL). There were 105 (25.5%) participants with NVP levels of <3100 ng/mL, associated with poor viral suppression. Multivariate linear regression analysis showed region of origin (adjusted β 976, 95% CI, 183.2 to 1768.82; p = 0.016), gender (adjusted β 670, 95% CI, 293.6 to 1634.2; p = 0.047), education level (adjusted β -39.0779, 95% CI, -39.07 to 1085.7; p = 0.068), initial ART regimen type (adjusted β = -548.1, 95% C = -904.2 to -192; p =0.003) and ARV uptake in the past 30 days (adjusted β = -1109, 95% C = -2135 to -83; p =0.034) remained independently associated with NVP plasma levels.Conclusion: NVP plasma concentration is highly heterogenous among Kenyan population with a significant proportion of patients reporting levels of <3100 ng/ml, correlated with poor viral suppression. The host pharmacoecologic factors, such as gender, age, weight, education level, region of origin (ethnicity), ART regimen type and adherence, are key in influencing NVP plasma concentration. Taking these factors into consideration, HIV treatment may be personalized to achieve optimal treatment success. Keywords: Nevirapine plasma concentration, host pharmacoecologic factors, HIV-1 patients in Kenya DOI: 10.7176/JHMN/81-05 Publication date:October 31st 202

Barriers to Access and Utilization of Maternal and Infant Health Services in Migori, Kenya

Barriers to accessing and utilizing maternal and infant services hinder the progress of achieving the Millenium Development Goals 4 and 5, consequently improving maternal and infant health is an international priority.Maternal and infant mortality is highest in developing countries where several barriers to access and utilization of health care exist. This was a study of an on-going Maternal and Infant Survival to Health care Advancement (MAISHA) project to identify barriers to access and utilization of maternal and infant health services in Migori County, Kenya among 446 women of reproductive age. This was a cross sectional study which employed bothqualitative and quantitative methods. Data was collected using Interviewer - administered questionnaires, Key Informant Interview guides and Focus Group Discussion guides.Barriers to access of the services included socio-economic, cultural barriers and lack of up – to date training among the staff. Success in improving access and utilization of these services requires concerted efforts. Keywords:Barriers, Access, Utilization, Maternal and infant health, Maternal and infant mortality

Assessment of Patient Satisfaction with Nursing Care at a Large Public Referral Hospital in Kenya

Patient satisfaction with nursing care is known to predict patient outcomes. Nursing care offered by the largest single technical group in any hospital, is known to often determine the overall quality of care offered. This study hence examined the extent to which patients at a Referral hospital in Western Kenya are satisfied with the nursing care they receive. A cross sectional exit survey of discharged patients using a self-administered patient questionnaire was used. 274 patients participated, of which 65.6% were female. 94.1% had formal education with 59.1% reporting that this was their maiden visit to the hospital. Overall, 87% of patients felt satisfied with nursing care received. Most (81.8%) of the patients interviewed felt they had been promptly attended to, with a further 71.6% rating the nurses as competent and knowledgeable in their clinical care. The ward in which the patient had been admitted and the number of days a patient had spent in hospital were found to be significantly associated with reporting of overall satisfaction with nursing care (p=0.037 & 0.03 respectively). Since nursing care is determinant of patient outcomes during hospitalization, clinical care administrators should often emphasize on the Nurses’ technical competence and interpersonal relationships throughout patient care. Prompt quality nursing care should be prioritized to match with patient expectations in each hospital units and ensure patient satisfaction through reduction of length of stay in hospital. Key words: Assessment, patient satisfaction, nursing car

Immunogenicity and safety of fractional doses of 17D-213 yellow fever vaccine in HIV-infected people in Kenya (YEFE): a randomised, double-blind, non-inferiority substudy of a phase 4 trial

Background Evidence indicates that fractional doses of yellow fever vaccine are safe and sufficiently immunogenic for use during yellow fever outbreaks. However, there are no data on the generalisability of this observation to populations living with HIV. Therefore, we aimed to evaluate the immunogenicity of fractional and standard doses of yellow fever vaccine in HIV-positive adults. Methods We conducted a randomised, double-blind, non-inferiority substudy in Kilifi, coastal Kenya to compare the immunogenicity and safety of a fractional dose (one-fifth of the standard dose) versus the standard dose of 17D-213 yellow fever vaccine among HIV-positive volunteers. HIV-positive participants aged 18–59 years, with baseline CD4+ T-cell count of at least 200 cells per mL, and who were not pregnant, had no previous history of yellow fever vaccination or infection, and had no contraindication for yellow fever vaccination were recruited from the community. Participants were randomly assigned 1:1 in blocks (variable block sizes) to either a fractional dose or a standard dose of the 17D-213 yellow fever vaccine. Vaccines were administered subcutaneously by an unblinded nurse and pharmacist; all other study personnel were blinded to the vaccine allocation. The primary outcome of the study was the proportion of participants who seroconverted by the plaque reduction neutralisation test (PRNT50) 28 days after vaccination for the fractional dose versus the standard dose in the per-protocol population. Secondary outcomes were assessment of adverse events and immunogenicity during the 1-year follow-up period. Participants were considered to have seroconverted if the post-vaccination antibody titre was at least 4 times greater than the pre-vaccination titre. We set a non-inferiority margin of not less than a 17% decrease in seroconversion in the fractional dose compared with the standard dose. This study is registered with ClinicalTrials.gov, NCT02991495. Findings Between Jan 29, 2019, and May 17, 2019, 303 participants were screened, and 250 participants were included and vaccinated; 126 participants were assigned to the fractional dose and 124 to the standard dose. 28 days after vaccination, 112 (96%, 95% CI 90–99) of 117 participants in the fractional dose group and 115 (98%, 94–100) of 117 in the standard dose group seroconverted by PRNT50. The difference in seroconversion between the fractional dose and the standard dose was –3% (95% CI –7 to 2). Fractional dosing therefore met the non-inferiority criterion, and non-inferiority was maintained for 1 year. The most common adverse events were headache (n=31 [12%]), fatigue (n=23 [9%]), myalgia (n=23 [9%]), and cough (n=14 [6%]). Reported adverse events were either mild (182 [97%] of 187 adverse events) or moderate (5 [3%]) and were self-limiting. Interpretation Fractional doses of the 17D-213 yellow fever vaccine were sufficiently immunogenic and safe demonstrating non-inferiority to the standard vaccine dose in HIV-infected individuals with CD4+ T cell counts of at least 200 cells per mL. These results provide confidence that fractional dose recommendations are applicable to populations with high HIV prevalence. Funding Wellcome Trust, Médecins Sans Frontières Foundation, and the UK Department for International Development

Correlates of Stillbirths at Nyeri Provincial General Hospital, Kenya, 2009-2013: A Retrospective Study

Background: Death of a baby in-utero is a very devastating event to the mother and the family. Most stillbirths occur during labor and birth with other deaths occurring during the antenatal period. Millions of families experience stillbirths, yet these deaths remain uncounted, and policies have not been clearly stipulated to address this issue. The aim of the study was to identify the possible causes of stillbirths as recorded in the medical records. Methods: A retrospective study looking at medical records of women who experienced stillbirths between 1st January 2009 and 31st December 2013 at Nyeri Provincial General Hospital, Kenya. The hospital records containing cases of stillbirths were retrieved and data abstraction forms were used to collect data and information. Results: Both fresh and macerated stillbirths were equally common. The stillbirth rate was 12.2 per 1,000 births. There was signifi cant association between stillbirths and the clients who were referred and reason for referral, (p=0.029) and (p=0.005), respectively. The number of ANC visits during pregnancy was also signifi cant (p=0.05). Mode of delivery and the reason for cesarean section were signifi cantly associated with stillbirths, (p=0.003) and (p=0.032), respectively. The type of labor and delivery complications experienced was associated with stillbirths (p= 0.022). Conclusion and Global Health Implications: There were several factors associated with stillbirths thus efforts should be made to establish approaches aimed at prevention. Addressing the causes of stillbirths will contribute to reduction of perinatal mortality. Key words: Stillbirths • Medical Records • Labor • Delivery • Referral • Nyeri • Kenya Copyright © 2016 Cheptum et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Perception about traditional birth attendants by men and women of reproductive age in rural Migori County, Kenya

Background: Skilled birth attendance, a proven way of reducing maternal and perinatal mortality has remained low in low resource settings. Traditional Birth Attendants (TBAs) have continued to be culturally and socially accepted in many societies despite their limitation in handling childbirth complications. The study objective was to assess the perception of traditional birth attendants (TBAs) by the men and women of reproductive age in rural Migori. Methodology: This was a qualitative study carried out in four villages in Migori County, Nyanza region which involved married women of child bearing age and married men. Separate focus group discussions (FGDs) were done for men and women, where one FGD was conducted per group in each village. Content analysis was done after coding and categorizing data into thematic areas. Results: The findings indicated varied perceptions of men and women about the TBAs. Themen appreciated the services of TBAs mainly because of financial reasons while women enjoyed their friendly attitude and welfare services. The community was well aware of the risks of delivering with a TBA, however, they still opted for their services for reasons such as availability, accessibility and their friendly attitude. Conclusion: The men and women of reproductive had varied perceptions, both positive and negative about the traditional birth attendants. The TBAs still have a role to play in the community. Keywords: Traditional birth attendants, Skilled birth attendance, Community perception, Home delivery, Maternal mortalit

Asymptomatic Plasmodium infection and cognition among primary schoolchildren in a high malaria transmission setting in Uganda.

Asymptomatic parasitemia is common among schoolchildren living in areas of high malaria transmission, yet little is known about its effect on cognitive function in these settings. To investigate associations between asymptomatic parasitemia, anemia, and cognition among primary schoolchildren living in a high malaria transmission setting, we studied 740 children enrolled in a clinical trial in Tororo, Uganda. Parasitemia, measured by thick blood smears, was present in 30% of the children. Infected children had lower test scores for abstract reasoning (adjusted mean difference [AMD] -0.6, 95% confidence interval [CI] -1.01 to -0.21) and sustained attention (AMD -1.6 95% CI -2.40 to -0.81) compared with uninfected children. There was also evidence for a dose-response relationship between parasite density and scores for sustained attention. No associations were observed between anemia and either test of cognition. Schoolchildren in high transmission settings may experience cognitive benefits, from interventions aimed at reducing the prevalence of asymptomatic parasitemia