Assessment of common surgical conditions encountered by cal oficers based in rural hospitals in east Africa

No Abstract

Factors Affecting the Utilisation of Improved Ventilated Latrines Among Communities in Mtwara Rural District, Tanzania.

The Tanzania government, working in partnership with other stakeholders implemented a community-based project aimed at increasing access to clean and safe water basic sanitation and promotion of personal hygiene in Mtwara Rural District. Mid-term evaluation revealed that progress had been made towards improved ventilated latrines; however, there was no adequate information on utilisation of these latrines and associated factors. This study was therefore conducted to establish the factors influencing the utilisation of these latrines. A cross-sectional study was conducted among 375 randomly selected households using a pre-tested questionnaire to determine whether the households owned improved ventilated latrines and how they utilised them. RESULS: About half (50.5%) of the households had an improved ventilated latrine and households with earnings of more than 50,000 Tanzanian Shillings were two times more likely to own an improved latrine than those that earned less (AOR 2.1, 95% CI=1.1-4.0, p= 0.034). The likelihood of owning an improved latrine was reduced by more than 60 percent for female-headed households (AOR=0.38; 95% CI=0.20-0.71; p=0.002). Furthermore, it was established that all members of a household were more likely to use a latrine if it was an improved ventilated latrine (AOR=2.4; 95% CI=1.1-5.1; p= 0.024). Findings suggest adoption of strategies to improve the wellbeing of households and deploying those who had acquired improved ventilated latrines as resource persons to help train others. Furthermore, efforts are needed to increase access to soft loans for disadvantaged members and increasing community participation

Sexual risk taking among patients on antiretroviral therapy in an urban informal settlement in Kenya: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Our intention was to analyze demographic and contextual factors associated with sexual risk taking among HIV-infected patients on antiretroviral treatment (ART) in Africa's largest informal urban settlement, Kibera in Nairobi, Kenya.</p> <p>Methods</p> <p>We used a cross-sectional survey in a resource-poor, urban informal settlement in Nairobi; 515 consecutive adult patients on ART attending the African Medical and Research Foundation clinic in Kibera in Nairobi were included in the study. Interviewers used structured questionnaires covering socio-demographic characteristics, time on ART, number of sexual partners during the previous six months and consistency of condom use.</p> <p>Results</p> <p>Twenty-eight percent of patients reported inconsistent condom use. Female patients were significantly more likely than men to report inconsistent condom use (aOR 3.03; 95% CI 1.60-5.72). Shorter time on ART was significantly associated with inconsistent condom use. Multiple sexual partners were more common among married men than among married women (adjusted OR 4.38; 95% CI 1.82-10.51).</p> <p>Conclusions</p> <p>Inconsistent condom use was especially common among women and patients who had recently started ART, i.e., when the risk of HIV transmission is higher. Having multiple partners was quite common, especially among married men, with the potential of creating sexual networks and an increased risk of HIV transmission. ART needs to be accompanied by other preventive interventions to reduce the risk of new HIV infections among sero-discordant couples and to increase overall community effectiveness.</p

Long-Term Adherence to Antiretroviral Treatment and Program Drop-Out in a High-Risk Urban Setting in Sub-Saharan Africa: A Prospective Cohort Study

Seventy percent of urban populations in sub-Saharan Africa live in slums. Sustaining HIV patients in these high-risk and highly mobile settings is a major future challenge. This study seeks to assess program retention and to find determinants for low adherence to antiretroviral treatment (ART) and drop-out from an established HIV/ART program in Kibera, Nairobi, one of Africa's largest informal urban settlements.A prospective open cohort study of 800 patients was performed at the African Medical Research Foundation (AMREF) clinic in the Kibera slum. Adherence to ART and drop-out from the ART program were independent outcomes. Two different adherence measures were used: (1) “dose adherence” (the proportion of a prescribed dose taken over the past 4 days) and (2) “adherence index” (based on three adherence questions covering dosing, timing and special instructions). Drop-out from the program was calculated based on clinic appointment dates and number of prescribed doses, and a patient was defined as being lost to follow-up if over 90 days had expired since the last prescribed dose. More than one third of patients were non-adherent when all three aspects of adherence – dosing, timing and special instructions – were taken into account. Multivariate logistic regression revealed that not disclosing HIV status, having a low level of education, living below the poverty limit (US$ 2/day) and not having a treatment buddy were significant predictors for non-adherence. Additionally, one quarter of patients dropped out for more than 90 days after the last prescribed ART dose. Not having a treatment buddy was associated with increased risk for drop-out (hazard ratio 1.4, 95% CI = 1.0–1.9).These findings point to the dilemma of trying to sustain a growing number of people on life-long ART in conditions where prevailing stigma, poverty and food shortages threatens the long-term success of HIV treatment

Barriers to accessibility and utilization of HIV testing and counseling services in Tanzania: experience from Angaza Zaidi programme

Introduction: While HIV testing and counseling (HTC) services remain to be amongst the effective strategies in slowing HIV transmission, its accessibility and uptake in Tanzania is low. In 2011, 50% of adults have been ever tested and received their results. We conducted this study to assess barriers to accessibility and utilization of HTC services in Tanzania. Methods: A mixed methods study was conducted using both quantitative and qualitative approaches. Data were collected in in 9 regions of Tanzania in 2012. Twelve (12) in-depth interviews, 8 Focus Group Discussions and 422 clients were approached for data collection. Quantitative data were entered and analysed using SPSS, proportions were compared using chi-square test. Qualitative data, content analysis approach was used. Results: Overall 422 exit clients were enrolled into the study, 4.9% clients reported spending &gt;2 hours at the HTC centre before they were attended (p&lt;0.0001). Of the 422 clients in our study 5.7 % received HIV testing before getting HIV counseling (p=0.0001). Of those clients who received counseling, 21.8% of reported counseling to be done in a group (p=0.0001). Majority of study participants reported that the counselling sessions were private, with sufficient information, and interactive (p&lt;0.0001). Mobile services clinics, the Post Test Clubs and couple counselling and testing were effective approaches in stimulating demand for and use of HTC services. Conclusion: Findings show that coverage of HTC was high, however long waiting time and lack of confidentiality impeded its accessibility and utilization. We recommend increase of staff and adherence to counselling ethics to safeguard clients' privacy.Pan African Medical Journal 2016; 2

Is 'Opt-Out HIV Testing' a real option among pregnant women in rural districts in Kenya?

PMTCT allows people living with HIV to actualize childbearing. However, it also complicates motherhood, as the medical consequences and public health implications of non-adherence to PMTCT service recommendations disrupt socio-cultural expectations of childbearing and parenthood. This thesis aimed to study childbearing and adherence to PMTCT interventions focusing on how women living with HIV realize motherhood in Kenya. We sought to answer how women on ART experience motherhood and how motherhood aggravate adherence to PMTCT services Methods: A quantitative cross sectional study (I) with a questionnaire survey conducted among pregnant women at their first visit to antenatal clinic to study consent to HIV testing and three qualitative studies analyzed with content analysis (II and IV) and narrative structuring (III) were included. Qualitative interviews were performed with women living with HIV who were pregnant, recently delivered and those actively planning a pregnancy to explore views and experiences when seeking a pregnancy (II), the reasoning and deciding about adherence to PMTCT (III) and how motherhood interferes with HIV treatment (IV). Results: ‘Striving for motherhood’ was the overriding theme describing the desire of women on ART to be parents while negotiating the challenges of living with HIV (IIV). Children improve women’s position in society and are a sign of a happy and fulfilled life (II-IV). Of 900 pregnant women surveyed at their first visit to antenatal care clinic, only 17% understood that HIV testing is optional (I). Making an informed decision to decline HIV testing was associated with knowing that testing was optional (OR=5.44, 95%CI 3.44-8.59), not having a stable relationship with the child’s father (OR=1.76, 95%CI 1.02-3.03), and not having discussed HIV testing with a partner before the ANC visit (OR=2.64 95%CI 1.79-3.86). Socio-economic affluence and residence influence behaviors such as no condom use, non-disclosure of HIV infection, use of traditional medicine simultaneously with ART, home delivery and stigma and discrimination from partners, family and community, all of which undermine adherence to PMTCT services (II-IV). Structural shortcomings in PMTCT result in the lack of antiretroviral HIV medicines, practice of mixed infant feeding and missed appointments (I, III, IV). Conclusion: Motherhood is achieved at the cost of striving to balance socio-cultural expectations of childbearing that also conceals their HIV infection at the cost of nonadherence to PMTCT recommendations. Being infected with HIV does not remove the desire of motherhood and related socio-cultural demands. It is important to acknowledge the significance childbearing among women infected with HIV to improve adherence. Women with chronic illness such as HIV-infection who are dependent on continuous medication and health check-ups struggle to balance the desire for children with the needs related to their illness and the expectations of being a ‘good mother’

Assessment Of Common Surgical Conditions Encountered By Medical Officers Based In Rural Hospitals In East Africa.

Background: Medical officers and specialists based in rural hospitals must have skills and knowledge to handle the most common emergency and elective surgical problems in their catchment population. The aim of this study was to assess the common surgical problems faced by medical officers in rural hospitals in Kenya and Tanzania that are supported by AMREF specialist outreach services and CCM-Comitato Collaborazione Medica surgeons and to assess how such training may be provided. Methods: This study covered 31 rural district, Church, NGO and overnment Hospitals in East Africa. A cross-sectional survey using self-administered open-ended questionnaire was used. Forty-two questionnaires were administered to medical officers in charge of the hospitals. The data received was entered in EPlNFO and analysed using SPSS to show the frequency of distribution of different variables. Results: Of the 31 hospitals, 84% had 50 - 200 beds and 1-3 doctors; 40% had less than two : Most (80%) had outpatients load of 10,000 -30,000 per year and inpatients load of 3,000-10,000 per year;79% of the hospital carried out 500-2000 deliveries per year. A third (35%) of the hospitals had no anaesthetist. Between 200-400 patients per year required emergency and elective surgery in 50% of hospitals. Common emergency surgical conditions and procedures were Ectopic pregnancy, Caesarean section, strangulated hernia, appendectomy and bowel resection. Hernia repair, Hydrocelectomy, Hysterectomy, prostatectomy and appendectomy were the commonest elective procedures. A total of 79% of rural based medical officers preferred a combination of on-the-job training by visiting specialists and training at a referral facility as the best method to improve their surgical skills so as to competently deal with major surgical problems in their area. The majority (85%) of the respondents preferred that training should take 6-12 months. Medical officers, supported by periodic visits by specialists to perform complicated elective surgery and refresher training, can adequately manage majority of surgical problems in&apos; rural areas. Conclusion: 1. There is need for a critical review of the current institution-based surgical training for rural based medical officers. 2. There is shortage of health workers who can administer safe anaesthesia in rural hospitals 3. Medical officers prefer combined approach to surgical training, on-the-job training by visiting specialist and institution-based training for a short period 6-12 months

"I will not let my HIV status stand in the way." Decisions on motherhood among women on ART in a slum in Kenya- a qualitative study

Abstract Background The African Medical Research Foundation antiretroviral therapy program at the community health centre in Kibera counsels women to wait with pregnancy until they reach the acceptable level of 350 cells/ml CD4 count and to discuss their pregnancy intentions with their health care providers. A 2007 internal assessment showed that women were becoming pregnant before attaining the 350 cells/ml CD4 count and without consulting health care providers. This qualitative study explored experiences of intentionally becoming pregnant among women receiving highly active antiretroviral therapy (HAART). Methods Nine pregnant women, six newly delivered mothers and five women wanting to get pregnant were purposefully selected for in-depth interviews. Content analysis was used to organize and interpret the women's experiences of becoming pregnant. Results Women's choices for pregnancy could be categorized into one overarching theme 'strive for motherhood' consisting of three sub-themes. A child is thought of as a prerequisite for a fulfilled and happy life. The women accepted that good health was required to bear a pregnancy and thought that feeling well, taking their antiretroviral treatment and eating nutritious food was enough. Consulting health care providers was perceived as interfering with the women's decisions to get pregnant. Becoming pregnant as an HIV-infected woman was, however, complicated by the dilemmas related to disclosing HIV infection and discussing pregnancy intentions with their partners. Conclusions Motherhood is important to women on antiretroviral treatment. But they seemed to lack understanding of the relationship between a high CD4 cell count and a low chance of transmission of HIV to offspring. Better education about the relationship of perceived good physical health, low CD4 cell count and the risk of mother to child transmission is required. Women want to control the domain of childbearing but need enough information to make healthy choices without risking transmission.</p