Mothers’ knowledge of mother-to-child transmission of HIV and infant feeding practices in Juba, South Sudan

Introduction: While exclusive breastfeeding for the first six months of life is recommended for HIV-infected mothers, this may not be practiced fullyin South Sudan; exclusive formula feeding, which is the best alternative to breastfeeding, may not be practical.Objective: To assess the knowledge of mother-to-child transmission of HIV (MTCT) and practices of feeding infants in the first six months of life among HIV-infected mothers attending Antiretroviral Therapy Centres in Juba Teaching Hospital (JTH) and Juba Military Hospital (JMH).Method: A cross-sectional study in which 304 HIV-infected mothers with children aged 6-18 months were interviewed between October and  December 2016 using structured questionnaires. Key informant interviews (KIIs) and focus group discussions (FGDs) were also conducted using interview guides. Quantitative data was analysed using Statistics Package for Social Sciences software. Chi-square test was used to test the presence of significant association between the variables and the association is statistically significant when the p-value is < 0.05. Multiple logistic regression analysis was used to identify which predictor variables have major effect on the dependent variable. Qualitative data was transcribed in English and summarized according to the key themes, and the information obtained was used to supplement and interpret the findings of the quantitative data.Results: Only 120 (40%) of the HIV-infected mothers had a good knowledge of MTCT; 213 mothers (70.1%) practiced mixed feeding, 70 (23.0%)  practiced exclusive breastfeeding and 20 (6.6%) practiced exclusive formula feeding. The factors that were found to have a positive effect on choice of infant feeding methods were having more than one child (odds ratio = 0.303, 95% Confidence interval: 0.161-0.571, p = 0.001) and participation in the prevention of motherto-child transmission of HIV programme (PMTCT) (odds ratio = 2.260, 95% Confidence interval: 1.251-4.084, p = 0.007). Stigma (p = 0.248) and mothers’ knowledge of MTCT (p = 0.072) were not statistically significantly associated with the mothers’ infant feeding practices.Conclusion: Knowledge of MTCT is low. Mixed feeding before six months of age is predominant among the HIV-infected mothers. It is thereforerecommended that HIV-infected mothers receive adequate information from counsellors regarding MTCT and exclusive breastfeeding for the first six monthsof an infant’s life.  Key words: Knowledge, infant feeding, HIV-infected mothers, Juba

Enhancing the use of emergency contraception in a refugee setting: Findings from a baseline survey in Kakuma refugee camps, Kenya

In August 1992, the International Rescue Committee (IRC) at the request of the United Nations, the United Nations High Commission for Refugees, and the Kenyan Government, initiated a primary health care program in the Kakuma Refugee Camp. Since then, the population of the camp has continued to grow, and activities have moved from a crisis to a maintenance phase. In January 1997, IRC assumed the additional responsibility of the camp hospital, bringing the entire health sector under their management. IRC\u27s programs focus on maintaining and improving public health and promoting self-reliance, particularly of the most vulnerable communities. This project focuses on emergency contraception as an aspect of the reproductive health (RH) needs of refugee women and men of reproductive age. The project will especially target the large adolescent community currently resident in the camp. The objective is to contribute to the improved quality of RH services for refugees and the local Turkana population in Kakuma through operations research on the introduction of emergency contraception. This report presents findings from the baseline survey

Nurturing Medical Professionalism in the Surgical Community

Introduction: The teaching of professionalism worldwide is changing for effectiveness. Our aim was to explore the reflection of the surgical teaching community in a Kenyan context on how professionalism can be effectively inculcated through the socio-cultural concept of activity theory.Methods: A sequential mixed-methods study was conducted among clinicians and students within the surgical community of the University of Nairobi from March to December 2014. . Individual interviews and focusgroup- discussions were conducted using grounded theory methods. A survey of the resultant views was performed through a pre-determined questionnaire which utilized a 4-point Likert scale for response ranging from “strongly agree” to “strongly disagree”. Factor analysis was used to analyze the responses to the survey. Internal reliability was determined by Cronbach’s α.Results: Four themes emerged from the interviews; change of values, regulation, enabling environment and formal curriculum. In the survey, the participants strongly agreed with strengthening mentorship (77.5%) and a teaching facility (74.7%) with a rewarding or recognition (69.5%). The reliability test of the items showed a Cronbach’s α of 0.827.Conclusion: This study demonstrates that the participants would like to see a different and transforming path in inculcating professionalism through changing values and enabling environment among others.Key words: Nurturing, Medical professionalism, Surgical communit

Young people’s perception of sexual and reproductive health services in Kenya

Background Addressing the Sexual and Reproductive Health (SRH) needs of young people remains a big challenge. This study explored experiences and perceptions of young people in Kenya aged 10–24 with regard to their SRH needs and whether these are met by the available healthcare services. Methods 18 focus group discussions and 39 in-depth interviews were conducted at health care facilities and youth centres across selected urban and rural settings in Kenya. All interviews were tape recorded and transcribed. Data was analysed using the thematic framework approach. Results Young people’s perceptions are not uniform and show variation between boys and girls as well as for type of service delivery. Girls seeking antenatal care and family planning services at health facilities characterise the available services as good and staff as helpful. However, boys perceive services at health facilities as designed for women and children, and therefore feel uncomfortable seeking services. At youth centres, young people value the non-health benefits including availability of recreational facilities, prevention of idleness, building of confidence, improving interpersonal communication skills, vocational training and facilitation of career progression. Conclusion Providing young people with SRH information and services through the existing healthcare system, presents an opportunity that should be further optimised. Providing recreational activities via youth centres is reported by young people themselves to not lead to increased uptake of SRH healthcare services. There is need for more research to evaluate how perceived non-health benefits young people do gain from youth centres could lead to improved SRH of young people

Views and Experiences of Mucosal Sampling in HIV Clinical Research among Kenyan Volunteers

HIV transmission predominantly occurs across mucosal surfaces. Efforts to find an effective and efficacious HIV vaccine, requires understanding the various mechanisms of sexual HIV transmission including immune responses to various HIV vaccine candidates along the mucosal pathways.  In this paper, we describe the experiences of health volunteers in three Phase 1 HIV vaccines trials and an observation study that comprised of high- risk and low risk healthy participants with regard to the collection of rectal, cervical and seminal mucosal samples. The paper emanates from a study that examined the views and experiences of volunteers in participating in HIV clinical research, at the KAVI-Institute of Clinical Research, Nairobi, Kenya. The study followed a mixed methods phenomenological research approach with a dominant qualitative strand. In the first phase, quantitative data was collected via a survey questionnaire involving 116 volunteers that helped identify 28 volunteers for the qualitative phase.  Quantitative data were analyzed using SPPS while qualitative data was transcribed verbatim, thematic themes identified for coding and entered into Atlas ti for analysis. Participants had a mean age of 28.5 ± 5.7 years (range 20–51 years). There were more males (n =85) than females (n= 31). In general, volunteers expressed mixed reactions towards the collection and use of mucosal samples. Both none-consenting and consenting volunteers cited invasiveness of their privacy.Also reported were experiences of physical and psychological discomforts, with men terming the collection of semen via masturbation as unnatural and contravening individuals’ religious and cultural beliefs. The findings reveal a knowledge gap among community members with use of mucosal samples and modes of collection

Exploring Partnerships between Academia and Disabled Persons’ Organisations: Lessons Learned from Collaborative Research in Africa

In this article, we discuss how our academic research on disability and international development in five African countries has benefited hugely from active collaboration with advocates, practitioners, and policymakers, ultimately ensuring that research evidence is used to inform policy and practice. Whilst building such partnerships is seen as good practice, it is particularly important when working on disability issues, as the clarion call of the disability movement, ‘nothing about us without us’, attests. This is not just a slogan. Without the active and critical engagement of disabled people – as researchers, participants, advocates – the evidence gathered would not have the same impact. This article discusses experiences from research in Liberia, Kenya, Uganda, Sierra Leone, and Zambia. It highlights the challenges and opportunities such partnerships can bring in achieving the goals of leaving no one behind and doing nothing without the active engagement and inclusion of persons with disabilities.Department for International Development (DFID)Economic and Social Research Council (ESRC

<i>“It Is Too Much for Us”:</i> Direct and Indirect Costs of Disability Amongst Working-Aged People with Disabilities in Dhaka, Bangladesh and Nairobi, Kenya

Globally, people with disabilities face a heightened risk of poverty. Drivers of poverty include exclusion from work and other livelihood activities (indirect costs) and disability-related direct costs–such as for rehabilitation, personal assistance and assistive devices–that are required for participation and functioning. This research explores sources of direct and indirect costs, their impact and mitigation strategies using 42 in-depth interviews with working-aged people with disabilities in Nairobi, Kenya and Dhaka, Bangladesh. This research finds that people with disabilities and their households face high direct costs, such as for healthcare, assistive devices, transportation and accommodations at school and work, and indirect costs, such as un- and underemployment and lower salaries when working. Many direct costs were unmet, or covered through out-of-pocket spending, although social protection in Kenya was also an important strategy. Unmet direct costs frequently led to higher future indirect costs. Direct and indirect costs could cause financial strain, decreased participation, health and wellbeing, particularly when unaddressed. Challenges mitigating costs included not just insufficient income, but also lack of decision-making power within the household and insufficient information on and poor availability of needed goods, services and opportunities–factors which should be considered in the design of interventions

Who is to blame? Perspectives of caregivers on barriers to accessing healthcare for the under-fives in Butere District, Western Kenya

<p>Abstract</p> <p>Background</p> <p>Kenya, like many developing nations, continues to experience high childhood mortality in spite of the many efforts put in place by governments and international bodies to curb it. This study sought to investigate the barriers to accessing healthcare services for children aged less than five years in Butere District, a rural district experiencing high rates of mortality and morbidity despite having relatively better conditions for child survival.</p> <p>Methods</p> <p>Exit interviews were conducted among caregivers seeking healthcare for their children in mid 2007 in all the 6 public health facilities. Additionally, views from caregivers in the community, health workers and district health managers were sought through focus group discussions (FGDs) and key informant interviews (KIs).</p> <p>Results</p> <p>Three hundred and ninety-seven respondents were surveyed in exit interviews while 45 respondents participated in FGDs and KIs. Some practices by caregivers including early onset of child bearing, early supplementation, and utilization of traditional healers were thought to increase the risk of mortality and morbidity, although reported rates of mosquito net utilization and immunization coverage were high. The healthcare system posed barriers to access of healthcare for the under fives, through long waiting time, lack of drugs and poor services, incompetence and perceived poor attitudes of the health workers. FGDs also revealed wide-spread concerns and misconceptions about health care among the caregivers.</p> <p>Conclusion</p> <p>Caregivers' actions were thought to influence children's progression to illness or health while the healthcare delivery system posed recurrent barriers to the accessing of healthcare for the under-fives. Actions on both fronts are necessary to reduce childhood mortality.</p