Harmful Practices Related to Sexual and Reproductive Health Rights Affecting Young People Living with HIV/AIDS in Kenya

Globally several young people living with HIV/AIDS continue to suffer from various types of harmful practices related to Sexual and reproductive health rights (SRHR). This is in contravention of their SRHR fundamental human rights as enshrined in national, regional, and international laws and agreements. In Eastern and Southern Africa, an estimated 19.6 million people were living with HIV/AIDS as of 2017, and an extra 800,000 people were newly infected yearly.  This study aimed to discover the harmful practices in society related to sexual and reproductive health rights affecting young people living with HIV/AIDS in Kenya. This was a cross-sectional study involving a sample of 224 adolescents and young people from Nairobi City County and Homabay County in Kenya. The study used both qualitative and quantitative methods of data collection and analysis. Before the study commenced ethical approvals were acquired from the Kenyatta University Ethics and Review Committee, National Commission for Science, Technology and Innovation, County Governments, and selected County and Sub-County health facilities in Kenya. The study established that various harmful practices were directed at adolescent Young People living with HIV/AIDS. The harmful practices include stigma and discrimination (87.9%); physical abuse (53.5%); rape (50.5%); being barred from SRHR services (29.3%) and forced contraception (24.3%). Furthermore, it was noted that the perpetrators of harmful practices included relatives (73.7%); guardians (64.7%); boda-boda riders (51.5%); parents (38.4%); police officers (13.1%) and healthcare providers (11.1%). Since many harmful practices among AYP living with HIV/AIDS remain underreported, survivors of harmful practices should be encouraged to promptly report the vices to the relevant authority for action. The National and County governments should formulate regulatory and policy frameworks aimed at protecting adolescent young people living with HIV/AIDS from harmful vices. Keywords: Harmful practices, Sexual and reproductive health rights, young people living with HIV/AIDS DOI: 10.7176/JHMN/112-04 Publication date: December 31st 202

Caregivers’ Knowledge on Routine Growth Monitoring of Children Aged 9 Months in Nyamira County, Kenya

DOI: 10.7176/JHMN/72-05 Publication date:March 31st 2020 1. Introduction Growth monitoring is one of the services offered in Maternal Neonatal and Child Health (MNCH) Clinics in health facilities encompassing routine check-ups by health workers to examine whether a child is growing as expected. Other services provided in these clinics are not limited to; vitamin A supplementation, immunization, health education and counselling, minor ailment treatment, screening for nutritional and medical conditions for management and defaulter tracing and follow-ups (Debuo et al. 2017). Measuring the weight and length of children monthly reflects their growth pattern which is compared against WHO’s growth standards to ascertain whether a child is growing consistently, showing a growth concern or trending towards a growth problem that need to be addressed. A study conducted in Southern Ethiopia found out that 53 % of the caregivers had poor knowledge on growth monitoring (Daniel et al. 2017). Majority of them said they did not know what a growth chart entailed nor did they know how to interpret growth curves (Daniel et al. 2017). A study conducted in Ghana revealed that more than 40% of the caregivers lacked good knowledge on routine growth monitoring. This study found out that more than 30% of the caregivers did not understand the meaning of routine growth monitoring and only 18.7% of them were able to interpret the normal, static, upward and decline growth curves (Debuo et al. 2017). A study in Zambia established that majority (92%) of the caregivers of children aged between 0-59 months had knowledge on the importance of growth monitoring (Banda, 2012). Caregivers of children aged between 12-23 months in Zambia and Ethiopia were reported to have poor knowledge on feeding practices (Bilal et al. 2014, Banda, 2012). Daniel et al. (2014), Elana et al. (2009) and Roberfroid et al. (2005) found out that more than half of the caregivers were unable to understand and interpret the growth charts. Low comprehension on growth charts implies that healthcare providers do not educate caregivers using the growth chart (Gyampoh, 2012)

Pneumococcal Immunisation Coverage Among Infants Between 4-12 Months in Nyamira County, Kenya

Background: Pneumonia is the leading killer among all infectious diseases worldwide. Though treatable, it often results in high mortality and morbidity therefore putting pressure on available health resources. The best intervention for pneumonia is prevention through vaccination. Objective. To determine pneumococcal vaccine coverage among infants between 4-12 months in Nyamira County Methods: A cross sectional design was used in this study. Using questionnaires. Caregivers were interviewed and a checklist was used to review the vaccination records. Data was analyzed using descriptive statistics and inferential statistics. Results: The results indicated that coverage of 82.5% for PCV 10 vaccine is below the recommended 90%. Caregivers were predominantly female, 97% and in informal employment. Among the demographic factors of the cohort, level of education was found to be statistically significant with p values of 0.029 as calculated using Fischer’s Exact. Care Givers were asked whether they had other children that were below 5 years so as to determine whether their previous experience with their children made any impact on the vaccine coverage. This demographic factor was also found to be significant with a P value of 0.019 as calculated using Chi Square.  and the number of other children Caregivers had (besides the infant being studied) that were below 5 years were found to and respectively. Conclusion and Recommendations: Coverage of pneumococcal vaccine in Borabu Sub-County, Nyamira County was (82.5%), still below the internationally recommended target of 90%. Uptake of PCV 10 vaccine was found to be influenced by Knowledge about the PCV 10 vaccine, level of education of Caregivers and the age of children that Caregivers had who were below 5 years. The coverage of PCV 10 vaccine in Borabu Sub County in Nyamira County can be enhanced by increasing knowledge of Caregivers on PCV 10 vaccine and by increasing compliance to the vaccination schedule. This can be done through various channels such as use of mobile phone-based reminders and community sensitization campaigns. A study can be done to identify effective interventions for delivering health education about pneumococcal vaccine in rural populations. In addition, interventional studies may be done to test effectiveness of reminder systems on immunization uptake. Keywords: uptake, coverage, PCV 10, pneumococcal vaccine. DOI: 10.7176/JNSR/11-22-01 Publication date: November 30th 202

Knowledge, Perception and Level of Male Partner Involvement in Choice of Delivery Site among Couples at Coast Level Five Hospital, Mombasa County, Kenya

Involvement of males in reproductive health is an important step in reducing maternal and newborn deaths. A number of pregnant women attending Coast Level Five Hospital report waiting for their male partner to discuss and choose the delivery site. Although some do this when already in labour , there are no records on how many practice this and the influence of the couple knowledge and perception on male partner involvement in choice of delivery site. This descriptive cross-sectional study aimed at establishing the level of male partner involvement and influence of couple knowledge and perception on male involvement in choice of delivery site among women who delivered at this facility. Systematic sampling was used to select the participants. A semi-structured questionnaire and focus group discussion guide were used to collect data. Chi-square and binary logistic regression were used for statistical analysis. 40.6% of male partners were involved in choice of delivery site, women knowledge (χ2-19.256; df-1; p<0.001), women (χ2-11.347; df-1; p=0.001) and male partners’ perception (χ2-10.909; df-1; p=0.001) influenced male partner involvement. However, women knowledge was the only predictor of male involvement (OR-3.843; 95% CI, 2.082-7.092; P<0.001). Male partner involvement was low, empowering women and encouraging positive perception among women and male partners will enhance male partner involvement in choice of delivery site. The health workers in Mombasa should come up with health education and communication strategies to improve public knowledge and perception towards male involvement and ultimately improve the level of male partner involvement in choice of delivery site. Keywords: Coast Level Five Hospital, Male involvement, Choice of delivery site, Mombasa Kenya, Male partner, Knowledge and perception

Health Implications of Sexual Violence Among Survivors in Selected Health Facilities in Kenya: Are There Gender Disparities?

Sexual based violence (SBV) is a serious public health problem with profound impact on physical, social and mental health, both immediately and many years after the assault. The global statistics on sexual assault against women indicates that, at least one in every three (34%) has been beaten and/or coerced into sex. A World Health Organisation (WHO) multi-country study reports that between 16% and 59% women from Africa had ever experienced sexual violence. In Kenya, about 24% of women have been raped at least once. Nairobi women Hospital alone receives an average of 230 survivors per month, with approximately 45% being children, 49% women and 6% men respectively. The main aim of this study was to investigate the gender disparities in health implications of SBV among survivors in three health facilities in Kenya. This was a cross-sectional study involving 236(84.3%) female and 44(15.7%) male survivors were enrolled in the study. The study established that sexual based violence resulted into health consequences (76.8%) including psychological trauma 143(51%), physical injuries 75(27%), STIs 38(14%), gynaecological disorders 35(12%), Human Immunodeficiency Virus (HIV) 32(11%), gastrointestinal disorders 21(7%) and unwanted pregnancies 17(6%). The results showed that females and males who developed health complications were not significantly different (χ2=0.223; df=1; p= 0.637). Males were more likely to suffer from psychological trauma, physical injuries and gastrointestinal injuries compared to females (OR= 1.2, CI= 0.6- 2.2; OR= 0.2, CI= 0.1- 5.0; and OR= 0.7, CI= 0.4- 1.5). On the hand, the study established that females were more likely to suffer from Sexually Transmitted Infection (STIs) (OR= 1.4, CI= 0.3- 6.0), gynaecological disorders (OR= 1.5, CI=0.5- 4.5), HIV (OR= 1.9, CI= 0.6- 6.6), and unwanted pregnancies (OR= 2.3, CI= 0.7- 8.1) compared to males. There is an urgent need to deal with the problems of SBV by preventing and stopping it. There should be a collaborative approach between all the stakeholders including the community, ministries of Medical Services and Public Health & Sanitation, private and non-governmental organization in dealing with sexual based violence and health implications resulting from it. Keywords: Sexual based violence, health implications, survivors, males DOI: 10.7176/JHMN/66-03 Publication date:September 30th 201

Task Shifting/Sharing on Contraceptive Counselling Services between Midwives and Physicians A Randomized Control Trial in Kisumu County, Kenya

Introduction: Unsafe abortion, led to 120,000 Kenyan women receiving Post Abortion Care (PAC) in 2012. 70% of those women, had not used  contraceptives before pregnancy. The aim of the study was to determine if post abortion contraceptive counselling could be shared between  physicians and midwives in Kisumu County, Kenya. Methodology: A total of 128 women were included in this cohort study that was nested in a larger randomized controlled trial, whereby women  sought PAC at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and Kisumu County Hospital (KCH) from October 2015 to September 2017. The 128 women were randomly assigned to a midwife or a physician for contraceptive counselling. Then a follow up after 7–10 days or three months. Associated factors for contraceptive uptake, contraceptive method choice, adherence, and satisfaction level, were analyzed using chi square, Fishers exact test , IBM SPSS Statistics for Windows, Version 22.0. Results: In the study, there was no difference between midwives (98.5%) and physicians (93.5%) in providing contraceptive counselling to post abortion women. 95.3% of the participants accepted while 4.7% did not accept use of contraceptives. The most commonly used contraceptive  method after counselling was hormonal injection at 39%. After 3-months follow-up 79.7% retained the chosen contraceptive method while 20.3% had changed the usual type of contraception and 3.9% had stopped using contraceptives. Among the respondents who still used a method, 96.1% were satisfied with the chosen methods, with no difference between midwifes and physicians (p=0.799). Parity had significant influence on contraceptive uptake and adherence (p= 0.000.). Conclusion: Post abortion seeking women were satisfied with contraceptive counselling they received regardless of whether the provider was a  midwife or a physician. The result emphasizes that physicians task sharing of contraceptive counselling with midwives is conceivable, with possibilityfor physicians focusing on more complicated cases. Keywords: Contraceptive counselling, Contraceptive uptake, Post Abortion Women, Midwives, Physicians, Kenya

Post Abortion Women’s Perception On Contraceptive Counselling Provided By Service Providers: A Qualitative Study In Kisumu County, Kenya

Background: Contraceptive Counselling is the process in which service providers engage with Patients to help them identify a suitable  contraceptive method and in a follow up interaction until the effectiveness of the process is achieved. Establish good rapport between the service providers and the recipients. Contraceptive uptake among post abortion patients is affected by the perception the women have on contraceptive counselling by the service providers. Contraceptive knowledge is high and its usage is low among post abortion patients. Aim: The main aim of this study was to explore how patients seeking post abortion care perceived contraceptive counselling provided by service providers in Kisumu County, Kenya. Methodology: A sample of 20 post abortion patiens participated in the In-depth interviews where open ended questions with probes were used to collect data. The interviews were conducted in two facilities, Jaramogi Oginga Odinga Teaching and Referral Hospital and Kisumu East DistrictHospital (Kisumu County Hospital) (both in Kisumu County, Kenya). The interviews were recorded and verbally transcribed. NVivo version 11 was used to sort out the data. Thematic analysis was used to analyse data. The sorted data was coded and structured in nine themes with regard to quality of care in contraceptive services. Choice of contraceptive method, information provided to recepients, interpersonal relationship, continuityand follow up, technical competence, affordability of contraceptive services, partner preference, myths and misconceptions, suggestions and concerns was emphasized. Results: The patients were able to obtain information about the various methods of contraception enabling them to make informed choices as a result of the discussions with the service providers. The good interpersonal relationship of the service providers with the respondents establishedgood rapport and reduced the stigma. Respondents were now able to revisit clinics after abortion without fear and contraceptives provided free of charge after discussions with the respondents who felt comfortable using them. Partners were important in contraceptive decision making, suchthat those who had partners found it easy to decide. Conclusion: The Respondents perceived contraceptive counselling positively indicating the friendliness of the service providers that made them feel confident with the contraceptive counselling and comfortable to discuss abortion with them. Respondents did not like the term abortion because itdemoralized them. Keywords: Contraceptive counselling, Contraceptive experience, Missed  Opportunities, Contraceptive Uptake, Physicians and Midwives, Post  Abortion Car

Factors influencing diarrheal prevalence among children under five years in Mathare Informal Settlement, Nairobi, Kenya

Globally, diarrhoea is the second major cause of death among children under five years. The aim of the study was to establish factors influencing diarrhoeal prevalence among children under five years in Mathare Informal Settlement. Cross-sectional survey was used. Data was collected from 1st July to 1st August 2019 among primary care- givers (PCGs) of children under five years in Mathare Informal Settlement, in Nairobi, Kenya. This urban informal settlement in Kenya was purposively sampled. Simple random sampling was used to select the households and the respondents. P0.05 was considered as statistically significant. A total of 324 primary caregivers selected from 324 households were included in the study. Fifty six point seventeen percent of the respondents were aged 25-31 years old. Prevalence of diarrhoea among children was 18.7%. Sex, relationship of the primary caregivers, number of people and children in the households were found to be statisti- cally significant with diarrhoea prevalence with p=0.008, p0.001, p0.001, p0.001 respectively. One hundred and seventy one (52.78%) primary caregivers had no formal education. primary caregivers disposed of the child’s faeces in garbage in 38.89% of the cases. Education level of the primary caregivers, renting, presence of flies, fae- ces, and open garbage near or within the compound were found to be associated with diarrhoea prevalence with p0.001, p=0.024, p0.001, p0.001 respectively. Several factors were found to be associated with diarrhoeal prevalence among children under five years

MALE INVOLVEMENT IN HOME CARE FOR HIV PATIENTS IN KENYA

MEN INVOLVEMENT IN HOME CARE FOR HIV PATIENTS IN KENYA HIV and AIDS remain a health and development challenge in Kenya with 5.9% prevalence. Home-based care emerged. There is low men involvement, little training, and advocacy. Women bear the burden. The objective was to establish the influence of training and advocacy on socio-cultural factors related to men involvement in home-based care