Prevalence of cervical cytology abnormalities among HIV infected women at Rwanda Military Hospital

Objectives: To establish the prevalence of cervical cytology abnormalities, determine the correlation between CD4+ cell count and abnormal Pap smear, determine the correlation between WHO-HIV staging and abnormal pap smear among HIV infected women attending HIV clinic at Rwanda Military Hospital.Design: Cross-sectional descriptive studySetting: Rwanda Military Hospital Kigali, RwandaSubjects: All HIV-positive women, 18-69 years who had been or were sexually active and were attending the HIV-clinic and consented to participate in the study.Results: Two hundred and ninety three women infected with HIV had cervical smear taken for cytology. Of the 293 women who were recruited for the study, cervical Squamous Intra epithelial Lesion (SIL) were present in 58 (20%). Of those with cervical SIL, 33 (56.89%) women had low-grade SIL, 15(25.86%) had Atypical Squamous Cells of Undetermined Significance (ASCUS), six (10.34%) had high-grade SIL, three (5.17%) had Squamous cell carcinoma ( SCC) and one (1.72%) had Atypical Glandular Cells of Undetermined Significance (AGUS). In the current study, use of ARV drugs was not associated with a reduction in the risk of cervical SILConclusion: A high prevalence of cervical SIL was found among HIV-infected women at Rwanda Military Hospital. Increased immune suppression was significantly associated with cervical SIL

Using arts‐based methods to develop service user led learning materials for social work education

Theories transmitted to students about professional practice in health and social care come traditionally from the perspective of practitioners, often as a heroic narrative, inevitably casting the service‐user in a passive role (Wiltshire, 2006). Post‐modern theorists like Foucault (1973) call this the authoritative 'gaze' that objectifies the user of public services, generating a power relationship between the professional and the service user. New perspectives are needed to redress this imbalance, drawing on the narratives of the service‐users themselves (Greenhalgh, 2006). Since 2007, a project led by service‐users at London South Bank University has been experimenting with new approaches to developing learning and teaching materials for social work education using opportunities afforded by the recent accreditation of awards within the General Social Care Council’s new Post Qualifying Framework. This paper outlines some of our experiences to date of experimenting with creative arts‐based approaches to facilitate the development of learning materials as ‘inherently creative acts’ (Sagan, 2007). This paper documents the experiences of a small group of service users and academics as we have all worked in different ways to co‐produce it using different mediums and media in order to contribute our views

‘Capacity for what? Capacity for whom?’ A decolonial deconstruction of research capacity development practices in the Global South and a proposal for a value-centred approach

Whilst North to South knowledge transfer patterns have been extensively problematised by Southern and decolonial perspectives, there is very little reflection on the practice of research capacity development (RCD), still strongly focused on technoscientific solutionism, yet largely uncritical of its underlying normative directions and power asymmetries. Without making transparent these normative and epistemological dimensions, RCD practices will continue to perpetuate approaches that are likely to be narrow, technocratic and unreflexive of colonial legacies, thus failing to achieve the aims of RCD, namely, the equitable and development-oriented production of knowledge in low- and middle-income societies. Informed by the authors’ direct experience of RCD approaches and combining insights from decolonial works and other perspectives from the margins with Science and Technology Studies, the paper undertakes a normative and epistemological deconstruction of RCD mainstream practice. Highlighting asymmetries of power and material resources in knowledge production, the paper’s decolonial lens seeks to aid the planning, implementation and evaluation of RCD interventions. Principles of cognitive justice and epistemic pluralism, accessibility enabled by systems thinking and sustainability grounded on localisation are suggested as the building blocks for more reflexive and equitable policies that promote research capacity for the purpose of creating social value and not solely for the sake of perpetuating technoscience

Sickle cell trait frequencies in blood donors and its effect among recepients in Bungoma County, Kenya

Sickle cell trait blood can cause complications in transfused patients.Objective: This study aimed at evaluating the prevalence of sickle cell trait among the blood donors and its impact in transfused patients in Bungoma County.Design: A cross sectional study targeting healthy blood donors and patients transfused with sickle cell trait blood in Bungoma County from January 2019 to January 2020.Participants: A total of 350 blood donors and 10 patients transfused with sickle cell trait blood were enrolled.Results: The sickle cell trait prevalence amongst the blood donor population in Bungoma County was deduced to be 14.28 %.White, red blood cell counts, haemoglobin, haematocrit, mean cell volume, mean cell haemoglobin and mean cell haemoglobin concentration parameters were not affected in patients transfused with sickle cell trait blood ( p = 0.466, 0.980, 0.787, 0.886, 0.971, 0.476 and 0.524).Also, liver function tests in the same patients was not affected ( p= 0.2193, 0.4678, 0.3052 and 0.7263) respectively for Alanine, Aspartate, Direct and Total Bilirubin levels respectively.Conclusion: There were no clinical abnormalities in patients transfused with sickle cell trait, however it was observed that acquired haemoglobin AS (Sickle cell trait) was detected among the transfused population

PREGNANCY OUTCOMES IN MOTHERS WITH ADVANCED HUMAN IMMUNODEFICIENCY VIRUS DISEASE

Objective: To determine the impact of HIV disease on immediate maternal and foetaloutcomes at the Kenyatta National Hospital, Nairobi, KenyaDesign: Prospective cohort study.Setting: Kenyatta National Hospital, Nairobi, Kenya, between September 2004 andApril 2005.Subjects: Sixty eight mothers with advanced HIV disease (WHO clinical stage 3 and4) and 68 HIV negative pregnant mothers.Results: Mothers with advanced HIV disease were more likely to be anaemic (55% vs.16% p<0.001), to have sexually transmitted diseases (56% vs. 15%, p=0.004), to havechorioamnionitis (14.8% vs. 2%, p=0.004), to develop preterm premature rupture ofmembranes (31 % vs. 9%, p<0.001), to have puerperal pyrexia (16% vs. 2%, p=0.032)an to die (5% vs. 0.5%, p=0.028) compared to HIV negative mothers. The meangestational age at deliver was lower in mothers with advanced HIV disease comparedto the seronegative counterparts (73% vs. 32%, delivery<37 weeks, p<0.00l). Infants ofmothers with advanced HIV disease compared to infants of seronegative mothers weremore likely to be low birth weight infants (58% vs. 21%, p<0.00l), stillborn (4% vs.2%, p=0.308) and to have low Apgar scores (28% vs. 12%, Apgar score < 4 at 5 minutesp=0.02). Perinatal sepsis and perinatal deaths were more common in infants born tomothers with advanced HIV disease compared to infants born to HIV negative mothers(8 vs. 3, p=0.003 and 14 vs. 5, p=0.025 respectively). External congenital anomalies weresimilar in the two groups (5.9% vs. 5.9%).Conclusion: Pregnancies complicated by advanced HIV disease are more likely to haveadverse outcomes, both maternal and foetal. Advanced HIV disease is associated withincreased risk of both maternal and fetal mortality. HIV infected mothers should becounselled on the increased pregnancy risks associated with advanced disease

Secrecy inhibits support:A grounded theory of community perspectives of women suffering from obstetric fistula, in Kenya

Aim: this study aimed to gain understanding of the views of community members in relation to obstetric fistula. Design and method: a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data. Setting: participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta. Interviews took place either in the home, place of work, or hospital. Findings: the core category (central concept) is ‘secrecy hinders support’. This was supported by three themes: ‘keeping fistula hidden’, ‘treatment being a lottery’ and ‘multiple barriers to support.’ These themes represent the complexities around exposure of individual fistula sufferers and the impact that lack of information and women's status can have on treatment. Keeping fistula secret reinforces uncertainties around fistula, which in itself fuels myths and ignorance regarding causes and treatments. Lack of openness, at an individual level, prevents support being sought or offered. Conclusions: A multi-layered strategy is required to support women with fistula. At a societal level, the status of women in LMIC countries needs elevation to a level that provides equity in health services. At a national level, laws need to protect vulnerable women from mistreatment as a direct result of fistula. Furthermore, resources should be available to ensure provision of timely management, as part of routine services. At community level, awareness and education is required to actively engage members to support women locally. Peer support before and after fistula repair may be beneficial, but requires further research

Understanding the lived experience of women before and after fistula repair: A qualitative study in Kenya

Objective: To gain understanding of the first-hand experience of women prior to and following repair of a vaginal fistula, to determine the most effective support mechanisms. Design: Qualitative phenomenological study using a series of in-depth semi-structured interviews at two time points: prior to fistula repair and 6 months post-surgery. Data were analysed thematically. Setting: Three fistula clinics in three districts in Kenya. Population: A purposive sample of 16 women suffering with vaginal fistula who were seeking fistula repair. Methods: Thrity-two semi-structured interviews were conducted. Results: The two main themes represented the women's journeys from social isolation to social reintegration. Women felt euphoric following fistula repair, believing that a 'miracle' had occurred. However, the 'post-miracle phase' demonstrated that the social and psychological impact of fistula leaves scars that are not easily healed, even when fistula repair is successful. Conclusion: Women's experiences of living with fistula have an impact beyond that which can be repaired solely by surgery. The findings from this study support the need for more active psychological assessment in the management of women with fistula, and the role of targeted psychological support in any package of care given in the post repair phase. The format of this support requires further study. Engagement by health professionals with the wider community could raise awareness of the causes of fistula, and provide support for significant others who may also be feeling vulnerable. It is likely that the collaborative efforts from health professionals and community members will provide the most effective support