Ten years of the Kenya Adolescent Reproductive Health Project: What has happened?

This evaluation by the Population Council’s APHIA II Operations Research Project sought to find out whether the adolescent sexual and reproductive health (ASRH) and HIV/AIDS activities in Kenya had been sustained over a 10-year period when the project was replicated and scaled up to cover seven provinces in the country. The evaluation had three main objectives: 1) to determine the extent to which activities of the Kenya Adolescent Reproductive Health Program (KARHP) have continued at national, provincial, and district levels; 2) to determine whether desired sexual and reproductive health outcomes (knowledge, behavior, and practices) have been sustained among in- and out-of-school adolescents over time; and 3) to identify challenges experienced by various partners in sustaining the model. The results show that reproductive health knowledge and behavior improved among the adolescents. A significant increase was found in the proportions of adolescents who have delayed sexual debut and who reported safer sexual practices at first sex in comparison with an earlier survey. Although the survey suggests that the efforts to sustain KARHP/ASRH activities may have desirable behavioral outcomes among adolescents, there is a need to strengthen these activities to increase their effect, and to streamline coordination of ASRH activities by the different partners

Mainstreaming and scaling up the Kenya Adolescent Reproductive Health Project

From 1999–2003, FRONTIERS implemented a Global Agenda program of operations research (OR) projects to address the reproductive health (RH) needs of adolescents in four countries—Bangladesh, Kenya, Mexico, and Senegal. The project was implemented in two districts of Western Province in Kenya and was known as the Kenya Adolescent Reproductive Health Project (KARHP). The project supported a public sector, multisectoral intervention to enhance young people’s knowledge and behavior regarding HIV prevention and RH. Implemented jointly with PATH, this OR project demonstrated that such an intervention could be implemented by the public sector, that it was acceptable to communities, that its influence on RH and HIV/AIDS knowledge, attitudes, and behavior was understood, and that the type and amount of financial and other resources needed to implement each of the component activities was calculated. Based on the positive results, the feasibility, acceptability, effectiveness, and cost of the youth RH activities, and the interest of the government and communities, including peer educators, religious and civic leaders, and parents, the activities have been mainstreamed and scaled up in other districts and provinces in Kenya

Contributing towards efforts to abandon female genital mutilation/cutting in Kenya: A situation analysis

The Kenyan Ministry of Gender, Sports, Culture and Social Services, with support from UNFPA/Kenya, commissioned the Population Council to conduct a situation analysis of female genital mutilation/cutting (FGM/C) programs in Kenya, with the overall objective of documenting the current status of and trends in FGM/C programming and to help identify crucial elements that need to be prioritized for support. Results show marked declines in prevalence nationally between generations, suggesting a decline in the practice as well as trends toward “medicalization” in recent years. The practice still continues for different reasons, such as rite of passage, for marriageability, controlling sexuality, religious requirements, family honor, and for cultural and ethnic identity. Respondents were all in agreement that there is an urgent need for a National Coordinating Agency that could bring together all stakeholders working toward the abandonment of FGM/C in Kenya and offered suggestions about the role, structure, and responsibilities of such an agency

Multisectoral youth RH interventions: The scale-up process in Kenya and Senegal

As in many developing countries, young people in Kenya and Senegal (aged 10–20) account for about 25 percent of the population. To ensure their future contribution to their countries, it is of vital strategic importance to safeguard their welfare. Rapid social change in both countries exposes youth to sexual and reproductive health (RH) risks, including unintended pregnancy, sexually transmitted infections including HIV, and sexual violence. Beginning in 1999, the Population Council’s FRONTIERS program conducted operations research studies that tested the feasibility, acceptability, and cost of a public-sector, multisectoral intervention to enhance young people’s RH knowledge and behavior. Study findings showed improvement in young people\u27s RH behavior and knowledge, successful engagement of government ministries, and increased understanding of RH needs among communities. Communities and the participating ministries in Kenya and Senegal expressed interest in incorporating elements from these interventions into their routine operations. FRONTIERS and its local partners launched follow-up projects in both countries to adapt, expand, institutionalize, and scale up the activities. This brief describes the processes involved in institutionalizing and scaling up the multisectoral interventions

Sexual and reproductive health needs of adolescents perinatally infected with HIV in Uganda

In Uganda, HIV/AIDS treatment, care and support programs are still organized around either adult or pediatric care and fail to adequately address the needs of adolescents, specifically perinatally-infected adolescents. This study, implemented jointly by the Population Council\u27s Frontiers in Reproductive Health (FRONTIERS) program and the AIDS Support Organization (TASO), aimed to better understand the reproductive health and sexuality of this population group, and to identify anxieties or fears they have around entering social stages of adulthood. This study confirms that wide programmatic gaps exist in addressing the sexual and reproductive health needs of young people perinatally infected with HIV who are now growing into sexually active adolescents and adults

From pilot to program: Scaling up the Kenya Adolescent Reproductive Health Project

The Population Council’s Frontiers in Reproductive Health Program and the Program for Appropriate Technology in Heath collaborated with three Government of Kenya ministries—Education; Health; and Gender, Sports, Culture and Social Services—to design and implement the Kenya Adolescent Reproductive Health Project with the goals of: improving knowledge about reproductive health and encouraging a responsible and healthy attitude toward sexuality among adolescents, delaying the onset of sexual activity among younger adolescents, and decreasing risky behaviors among sexually active adolescents. Key findings from the pilot project showed that the three ministries could successfully implement these interventions with high participation among parents and youth. For these efforts to be sustainable, partners should be involved and willing to integrate activities within their respective programs, share costs, and create a favorable policy and legislative environment

A Systematic Review of Immunological Studies of Erythema Nodosum Leprosum.

Erythema nodosum leprosum (ENL) is a painful inflammatory complication of leprosy occurring in 50% of lepromatous leprosy patients and 5-10% of borderline lepromatous patients. It is a significant cause of economic hardship, morbidity and mortality in leprosy patients. Our understanding of the causes of ENL is limited. We performed a systematic review of the published literature and critically evaluated the evidence for the role of neutrophils, immune complexes (ICs), T-cells, cytokines, and other immunological factors that could contribute to the development of ENL. Searches of the literature were performed in PubMed. Studies, independent of published date, using samples from patients with ENL were included. The search revealed more than 20,000 articles of which 146 eligible studies were included in this systematic review. The studies demonstrate that ENL may be associated with a neutrophilic infiltrate, but it is not clear whether it is an IC-mediated process or that the presence of ICs is an epiphenomenon. Increased levels of tumor necrosis factor-α and other pro-inflammatory cytokines support the role of this cytokine in the inflammatory phase of ENL but not necessarily the initiation. T-cell subsets appear to be important in ENL since multiple studies report an increased CD4+/CD8+ ratio in both skin and peripheral blood of patients with ENL. Microarray data have identified new molecules and whole pathophysiological pathways associated with ENL and provides new insights into the pathogenesis of ENL. Studies of ENL are often difficult to compare due to a lack of case definitions, treatment status, and timing of sampling as well as the use of different laboratory techniques. A standardized approach to some of these issues would be useful. ENL appears to be a complex interaction of various aspects of the immune system. Rigorous clinical descriptions of well-defined cohorts of patients and a systems biology approach using available technologies such as genomics, epigenomics, transcriptomics, and proteomics could yield greater understanding of the condition

Integrating 3D Models with the Theatrical Design Process

The ability to visually communicate ideas is perhaps the most important skill that a designer can have. With recent advancements in technology, traditional forms of visual communication such as hand drawing and painting are being replaced by computer models and 3D rendering. Utilizing these technologies allows designers to not only communicate more efficiently, but also make discoveries about how the environment may interact with the audience and performers in a way that was previously not possible