Perceptions of male partner involvement in antenatal care among pregnant women and nurses at a Sub-county Referral Hospital in Kenya

BACKGROUNDMen are important personalities in the family. They play great roles such as being breadwinners and decision- makers.They influence greatly on women's access to maternal health services. The study sought to gain an understanding of male involvement in that study area through focused group discussions among the pregnant women who attended the antenatal clinic. AIMTo determine the perception of pregnant women and nurses on male partner involvement in antenatal care. METHODOLOGYThe study was facility- based and adopted an exploratory qualitative approach. Three focus group discussions (FGDs) were conducted consisting of 6-8 participants each and lasting 20-30 minutes. Three key informant interviews (KIIs) were conducted among three nurses working at the antenatal clinic, each lasting for 20-30 minutes. The data was audio-recorded in Kiswahili and later transcribed verbatim then translated to English. RESULTSThe following themes emerged from the FGDs: low male involvement, positive view of men involved and being busy at work as the main factor for non-accompaniment. The themes emerging from the KIIs were; positive attitude towards male involvement, long waiting time at the antenatal clinic as the main reason for low male involvement. CONCLUSIONMost men were not involved in antenatal care. They cited unfriendly antenatal clinic environment such as crowded facilities with limited seats. Being busy at work and the long waiting hours at the centres was a major concern. RECOMMENDATIONMotivate more men to participate in antenatal care by prioritizing couples attending theclinic. Educate both women and men on the need for male partner involvement in antenatal care

Prevalence and Risk Factors Associated with Precancerous Cervical Cancer Lesions among HIV-Infected Women in Resource-Limited Settings

Objective. To assess the prevalence and identified associated risk factors for precancerous cervical cancer lesions among HIV-infected women in resource-limited settings in Kenya. Methods. HIV-infected women attending the ART clinic at the Nazareth Hospital ART clinic between June 2009 and September 2010. Multivariate logistic regression model with odds ratios and 95% confidence intervals (CI) were estimated after controlling for important covariates. Result. A total of 715 women were screened for cervical cancer. The median age of the participants was 40 years (range 18–69 years). The prevalence of precancerous lesions (CINI, CINII, CIN III, ICC) was 191 (26.7%). After controlling for other variables in logistic regression analysis, cervical precancerous lesions were associated with not being on ART therapy; whereby non-ART were 2.21 times more likely to have precancerous lesions than ART patients [(aOR) = 2.21, 95% CI (1.28–3.83)]. Conclusion. The prevalence of precancerous cervical lesions was lower than other similar settings. It is recommended that cancer screening of HIV-infected women should be an established practice. Availability and accessibility of these services can be done through their integration into HIV. Prompt initiation of HAART through an early enrollment into care has an impact on reducing the prevalence and progression of cervical precancerous lesions

Physical activity engagement in Eldoret, Kenya, during COVID-19 pandemic.

The World Health Organization (WHO) recommends that individuals of all ages participate in regular physical activity (PA) for optimal health and to support with the control of multiple non-communicable diseases. In Kenya however, involvement in PA across the general population is low and there is an increase in sedentary lifestyles in both rural and urban areas. An inverse relationship exists between socioeconomic status and involvement in PA. The novel COVID-19 ushered in associated control measures to limit the spread of the virus. These measures included staying at home, social distancing, and closure of physical spaces such as gyms, public parks, sports grounds, outdoor playing areas and schools. The impact was immediate, impacting patterns and routines of PA in Kenya. The primary aim of this study was to verify if COVID-19 affected PA prevalence and patterns amongst adults in Eldoret, Kenya. The secondary aim was to ascertain if the modification in behaviour is consistent amongst individuals from different socioeconomic backgrounds. We used a cross-sectional study to examine self-reported PA data amongst 404 participants. All participants were ≥18 years and resided in Eldoret, Kenya. Data were collected using a self-administered, structured questionnaire adapted from the WHO Global Physical Activity Questionnaire (WHO GPAQ). The characteristics of participants' is summarized using descriptive statistics, and bivariate analyses for measures of associations of variables was done using Chi-squared and Fishers exact tests. Binary logistic regressions were performed to adjust for the various factors and report associations between variables. The p-value considered for significant differences was set at <0.05. Participants in this study had mean age of 30.2±9.8 years. Almost 90% of the participants were not aware of the current WHO guidelines on PA, 9% stopped PA engagement after COVID-19 was first reported in Kenya, and only 25% continued regular PA. Less than half maintained PA intensity after the advent of COVID-19, with almost half reporting a drop. Males had a drop in time taken per PA session while females maintained session lengths after COVID-19 (p = 0.03). Males preferred gym-setup or mixed-type PA while females opted for indoor (home) aerobics before and after COVID-19 (p = 0.01, p = 0.02 respectively). Compared to males, females were less likely to achieve both vigorous- and moderate-intensity PA recommendations (p<0.01 and p = 0.02 respectively). Zone of residence was associated with participation in aerobic PA (p = 0.04; 95% CI = 0.02499-0.96086) and, similarly, level of education was associated with knowledge of WHO recommendations for PA (p = 0.01; 95% CI = -1.7544 - -0.2070). A majority of the urban population of Eldoret, Kenya and especially those with lower level of education are unaware of WHO recommendations for PA, and 30% of them have not engaged in any form of PA for many years. The majority that report involvement in PA do not achieve the WHO recommended threshold levels of PA. The results also indicated that COVID-19 has negatively affected intensity of PA, and that there has been an increase in time spent sitting/reclining amongst individuals in the higher socio-economic classes and specifically amongst females

Gender-age distribution of tuberculosis among suspected tuberculosis cases in western Kenya

Globally, tuberculosis (TB) continues to exact an unacceptably high toll of disease and death among children, particularly in the wake of the HIV epidemic. Kenya is ranked 13th among the 22 high-burden TB countries, and 5th in Africa. To determine the gender-age distribution of tuberculosis among TB suspects in western Kenya. In a cross-sectional study carried out at 10 hospitals in western Kenya, sputa from 872 TB suspects underwent microscopy and culture on solid and liquid media. The growth was identified using the Hains GenoType® Mycobacterium CM and GenoType® Mycobacterium AS kits. A questionnaire was used to collect demographic data. In total, 41.4% of the TB suspects were diagnosed with mycobacterial disease (95.8% TB cases and 4.2% NTM disease cases). Hence, 39.7% of the suspects were diagnosed with TB, 61.6% males and 38.4% females. A total of 263 (76%) of the 346 TB cases accepted to be tested for HIV infection and 41.8% (110/263) were co-infected (males, 55.5%; females, 44.5%). There was no significant difference in the TB-HIV co-infection rate between genders [OR = 1.006; 95% CI: 0.671-1.508; P = 0.979]. The majority (40.9%) of the TB/HIV cases were in the 25-34-year age bracket. In general, the prevalence of TB was significantly higher in males than females (&#967;2 = 10.67; P = 0.001), the majority (37.0%) being in the 25-34 age-group. Children below 15 years constituted 4.9% of the cases. A high prevalence of TB was observed in this study, males in the 25-34 age-group carrying the highest burden. There is need for more efforts and resources to increase knowledge and access TB and NTM syndromes care. [Med-Science 2018; 7(2.000): 252-6

The Prevalence and Associated Factors of Hypertension among HIV Patients

Background. The dual burden of cardiovascular diseases and Human Immunodeficiency Virus (HIV) in sub-Saharan Africa is of public health concern. Persons living with HIV are 1.5–2 times more likely to develop CVD risk factors compared to the noninfected individuals. Hypertension is a major risk factor leading to the rising CVD epidemic in SSA. However, the burden of hypertension among HIV patients in Kenya is not well documented. Objective. This study determined the prevalence and the associated factors of hypertension among HIV patients receiving regular care at Thika Level 5 Hospital Comprehensive Care Clinic (CCC), within metropolitan Nairobi, Kenya. Methods. The current cross-sectional study involved review of patients’ records/charts. Charts for adult patients seen in the last 6 months at Thika Level 5 Hospital CCC were included in the study. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on two different readings one month apart, while overweight/obesity was defined as body mass index (BMI) ≥ 25 kg/m2. Results. In a sample of 939 HIV patients, the majority, 68.8% (646), were female. The patients’ ages ranged from 18 to 84 years with a median age of 44 (IQR 37–51) years. The mean BMI was higher for females (25.8 kg/m2) compared to that of males (23.1 kg/m2). However, the prevalence of hypertension was higher among males (25.3%) compared to females (16.9%). Age >40 years (AOR = 2.80, p≤0.001), male sex (AOR = 2.10; p=0.04), history of alcohol consumption (AOR = 2.56, p≤0.001), and being overweight/obese (AOR = 2.77 p≤0.001) were significantly associated with hypertension. The antiretroviral (ARV) regimen and, additionally, the duration of antiretroviral therapy had no association with being hypertensive. Conclusion. The prevalence of hypertension is high among HIV patients. Traditional cardiovascular risk factors were associated with hypertension, but no association was observed with ART regime or duration of ARV use. There is a need to integrate hypertension management into regular HIV care

Health-seeking pathway and factors leading to delays in tuberculosis diagnosis in West Pokot County, Kenya: A grounded theory study.

BackgroundPatients' health-seeking behaviour can lead to delays in tuberculosis (TB) diagnosis, however little is known about the experiences and treatment pathways of patients diagnosed with TB in Kenya. The aim of this study is to explore the health seeking practices and factors contributing to delay in TB diagnosis.MethodsThis study was based on explorative qualitative research using a constructivist grounded theory approach. A total of 61 TB patients in the intensive phase of treatment were recruited as informants in the study. Six focus group discussions and 15 in-depth interviews were used to collect data. Data were analysed through three step coding using the grounded theory approach.ResultsParticipants adopted different treatment pathways as they sought care from a pluralistic health care system involving traditional healers, herbalists, private clinic, drug shops and the public health sector. The study revealed an explanatory model of factors leading to delay illustrated by the participant's expression "I suffered for a long time." The model is comprised of three categories that lead to delays, namely individual, social-cultural and structural factors.ConclusionThere is a need to improve timely diagnosis of TB through innovative approaches such as intensive case finding. Similarly, the health-care system should decentralize TB services as much as possible and offer free diagnostic services to increase accessibility

Assessing the effectiveness of alcohol and drug abuse awareness campaigns among University students in Kenya: a quasi-experimental study.

Substance abuse amongst university students is a major public health concern. There is paucity of literature on the effectiveness of the existing interventions aimed at reducing substance abuse in middle and low income countries. This study was done to determine the effectiveness of alcohol and drug abuse awareness campaigns on behaviour change among first year undergraduate students. This was a quasi-experimental study. Baseline survey involving 473 first year undergraduate students from two public universities in the coastal region of Kenya was done. The Universities were then allocated to either experimental or control group. Intervention of awareness campaigns were carried out in one of the University for a period of one year after which an end-line surveys involving 387 students was done. Data was collected using self-administered questionnaires. The study showed high prevalence of substance use with alcohol being the most commonly used substance at both baseline and end-line surveys. Despite the intervention being in one University, the prevalence of drug use increased from 38.9% to 48.9% in the control University and 31.3 % to 55.2% in the intervention University. The problem of substance abuse is enormous among university students. Information awareness campaigns against substance abuse alone are not effective in reducing uptake of substance use among university students.There is need to devise more effective strategies to control substance abuse. [Med-Science 2017; 6(3.000): 464-70

Burden of stigma among tuberculosis patients in a pastoralist community in Kenya: A mixed methods study.

BackgroundTuberculosis (TB) stigma remains a barrier to early diagnosis and treatment completion. Increased understanding of stigma is necessary for improved interventions to minimise TB stigma and its effects. The purpose of this study is to quantitatively measure TB stigma and to explore qualitatively its manifestation among TB patients in a rural Kenyan community.MethodsThis hospital based study using explanatory sequential mixed methods approach was conducted in 2016. In the quantitative part of the study, a questionnaire containing socio-demographic characteristics and scales measuring perceived TB stigma and experienced TB stigma, was administered to 208 adult pulmonary TB patients receiving treatment in West Pokot County. Respondents with high stigma were purposively selected to take part in in-depth interviews and focus group discussions. The qualitative data were collected through 15 in-depth interviews and 6 focus group discussions with TB patients. Descriptive and bivariate analysis was done for the quantitative data while the thematic analysis was done for qualitative data.ResultsThe internal consistency reliability coefficients were satisfactory with Cronbach alphas of 0.87 and 0.86 for the 11-item and 12-item stigma measurement scale. The investigation revealed that TB stigma was high. The key drivers of TB stigma were the association of TB with HIV/AIDS and the fear of TB transmission. TB stigma was exemplified through patients being isolated by others, self-isolation, fear to disclose TB diagnosis, association of TB with human immunodeficiency virus (HIV) and lack of social support. Being a woman was significantly associated with high levels of both experienced stigma (p = 0.007) and perceived stigma (p = 0.005) while age, marital status, occupation and the patient's religion were not.ConclusionThere is a need to implement stigma reduction interventions in order to improve TB program outcomes

Treatment outcomes and associated epidemiological characteristics among patients hospitalized with COVID-19 in critical care and isolation wards at a tertiary hospital in Kiambu County, Kenya

Background: COVID-19 was a novel infection whose outcomes were not well established to be associated with any factors during the start of the pandemic that it caused globally. Objective: To establish epidemiological characteristics associated with mortality among patients hospitalized with covid-19 at a tertiary hospital in Kiambu County Kenya Methods: This was a retrospective Analytical cross-sectional study done at Avenue Hospital Isolation and Intensive care wards. Polymerase chain reaction (PCR) positively identified Covid-19 adult patients who were admitted were recruited into the study. The mortality rate from COVID-19 infection and epidemiological characteristics associated with the mortalities among the COVID-19 hospitalized patients were the measures of outcomes being investigated. Results: A total of 154 patients were recruited in the study. Almost two thirds of the patients had comorbidities (n=96; 62.3%). Out of 154 patients, 23.4% (n=36) died and 76.6% n= (118) were discharged alive. Kaplan Meier statistics revealed, the median survival time was 22 days (95% CI: 16.626 - 27.374) among patents who died. The epidemiological factor predicting death of a patient after adjusting for odds was increase in age (AOR: 1.138; 95% CI: 1.009 - 1.285; p-value- 0.036). Conclusion and Recommendations: Majority of the patients admitted with COVID-19 were discharged alive compared to those with mortalities. The mortalities which occurred were associated with an increase in age among the patients. The study recommends healthcare professionals to prioritize older demographic patients diagnosed with COVID-19 during triage and routine care