Injection safety knowledge and practices among clinical health care workers in Garissa provincial general hospital

Background: The World Health Organization estimates that approximately 16 billion injections are administered in developing countries annually. Injection safety is therefore critical in preventing occupational exposure and infection from blood borne pathogens, hence prevention is a vital part of any comprehensive plan for protecting health workers, patients and maintaining a safe environment.Objective: To determine the knowledge and practice of injection safety among clinical healthcare workers at the Garissa Provincial General Hospital.Design: A cross-sectional descriptive study.Setting: The Garissa provincial General Hospital from September 2011 to July 2012.Results: Injection safety knowledge was high with a score of 12.65 (SD ± 2.3) out of the total of 16 items. Appropriate injection safety practices were reported by most of the respondents. The level of knowledge was not significantly associated with respondents’ demographic characteristics(p>0.05), but was significantly associated with hand washing practice(p<0.05).Inferences were made on an appropriate injection safety practices like non-recapping of needles, hand washing and proper waste management. Drug administration practice varied in the different departments (p=0.043) and recapping of needles was significantly associated with training (p=0.047), designation (p=0.02) and area of deployment (p=0.017).Conclusion: Knowledge on injection safety was high but reported and observed practices were below the set standard. Risky practices such as recapping used syringes, re-use of disposable syringes and overfilling of sharp boxes were observed. There was insufficient provision of injection safety equipment, Poor waste handling and inadequate personal protective gear. Over prescription of unnecessary injections was widespread

Effect of curing time on selected properties of soil stabilized with fly ash, marble dust and waste sand for road sub-base materials

The properties of sub-base filling materials in highway construction are essential, as they can determine the performance of the road in service. Normally, the existing materials are removed and replaced with new materials that have adequate load-bearing capacity. Rising environmental concern and new environmental legislations have made construction professionals consider other methods. These methods include stabilizing the existing materials with other additives to improve their performance. Additives can be waste materials generated by different industries. In this work, the existing excavated soil is stabilized with waste materials. The wastes consisted of fly ash, marble dust and waste sand. The percentage addition of waste materials was 5%, 10%, 15% and 20% (by mass) of the existing soil. The soil/waste specimens were cured for 1, 7, 28, 56, 90 and 112 days before testing. Testing included the dry unit weight and unconfined compressive strength ( qu) as well as X-ray diffraction analysis and scanning electron microscopy observation. Also, the California Bearing Ratio values were obtained and are reported in this investigation. The results showed that the qu values increased with the increase in waste materials content. Also, there is tendency for the dry unit weight to increase with the increase in waste materials

Low HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa

BACKGROUND: Young Southern African women have the highest HIV incidence globally. Pregnancy doubles the risk of HIV acquisition further, and maternal HIV acquisition contributes significantly to the paediatric HIV burden. Little data on combination HIV prevention interventions during pregnancy and lactation are available. We measured HIV incidence amongst pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa. METHODS: A cohort study that included HIV-uninfected pregnant women was performed. Lay community- based workers provided individualized HIV prevention counselling and performed three-monthly home and clinic-based individual and couples HIV testing. Male partners were referred for circumcision, sexually transmitted infections or HIV treatment as appropriate. Kaplan-Meier analyses and Cox's regression were used to estimate HIV incidence and factors associated with HIV acquisition. RESULTS The 1356 women included (median age 22.5 years) received 5289 HIV tests. Eleven new HIV infections were detected over 828.3 person-years (PY) of follow-up, with an HIV incidence rate of 1.33 infections/100 PY (95% CI: 0.74±2.40). Antenatally, the HIV incidence rate was 1.49 infections/100 PY (95% CI: 0.64±2.93) and postnatally the HIV incidence rate was 1.03 infections/100 PY (95% CI: 0.33±3.19). 53% of male partners received HIV testing and 66% of eligible partners received referral for circumcision. Women within known serodiscordant couples, and women with newly diagnosed HIV-infected partners, adjusted hazard ratio (aHR) = 32.7 (95% CI: 3.8±282.2) and aHR = 126.4 (95% CI: 33.8±472.2) had substantially increased HIV acquisition, respectively. Women with circumcised partners had a reduced risk of incident HIV infection, aHR = 0.22 (95% CI: 0.03±1.86). CONCLUSIONS: Maternal HIV incidence was substantially lower than previous regional studies. Community-based combination HIV prevention interventions may reduce high maternal HIV incidence in resource-poor settings. Expanded roll-out of home-based couples HIV testing and initiating pre-exposure prophylaxis for pregnant women within serodiscordant couples is needed in Southern Africa

Estimation of body weight of Maasai Zebu calves and their crosses with Sahiwal and Boran in Kajiado District, Kenya

EVALUATION DU POIDS VIF DES VEAUX DE ZEBU MAASAI ET DE LEURS CROISEMENTS AVEC LE SAHIWAL ET LE BORAN DANS LE DISTRICT DE KAJIADO AU KENYA Résumé Une étude, menée en vue d'identifier les variables de veau qui pouvaient être utilisées pour concevoir une équation simple de régression linéaire afin d'évaluer le poids vif des veaux dans les systèmes pastoraux, est décrite. L'étude, qui a été conduite entre novembre 2000 et mars 2001, utilisait 232 veaux de moins de 10 mois appartenant à 23 ménages Maasai dans le district de Kajiado. L'équation de régression linéaire obtenue était beaucoup affectée par des facteurs tels que la circonférence thoracique, le sexe, l'état corporel et la race. Le coefficient global de détermination était de 92%. Le coefficient de corrélation entre le poids vif constaté et le poids vif envisagé était positif et très élevé. Il a été conclu que le sexe, la conformation, la circonférence thoracique et la race sont des paramètres utiles pour prévoir le poids vif des veaux dans le système pastoral de production chez les Maasai. Summary A study that was carried out to identify calf variables that could be used to develop a simple linear regression equation for estimating body weight of calves in pastoral systems is described. The study which was carried out between November 2000 and March 2001 used 232 calves less than 10 months old from 23 Maasai households in Kajiado District. The linear regression equation obtained was significantly affected by factors such as heart girth, sex, body condition score and breed. The overall coefficient of determination was 92.0%. The correlation coefficient between the observed and the predicted body weight was positive and highly significant. It was concluded that sex, body condition, heart girth and breed are useful predictors of body weight of calves in the Maasai pastoral production system. Bull Anim. Hlth. Prod. Afr. (2004) 53, 35-4

HIV-uninfected Kenyan adolescent and young women share perspectives on using pre-exposure prophylaxis during pregnancy

To optimize scale-up of pre-exposure prophylaxis (PrEP) for pregnant women at risk of HIV in high HIV burden settings, implementation strategies must be developed that account for perceptions of PrEP in this unique population. Semistructured focus group discussions were conducted with 68 HIV-uninfected Kenyan pregnant and postpartum women without prior PrEP knowledge or experience. A qualitative descriptive analysis was performed, using a constant comparison approach, to identify key themes related to the values and rationale impacting potential PrEP use in pregnancy. Median age was 19.5 years and participants were either pregnant or had 1–2 children. Almost all (96%) were married or had a steady partner. Women felt pregnancy was a time of high HIV risk because they desired sex less frequently, which may lead their partners to have outside partnerships. This made PrEP an attractive HIV prevention option for themselves and their infants. Although women believed male partner behaviors influenced their HIV risk, many women perceived that male partners would react negatively, including becoming physically violent, if they discovered that women used PrEP. Clinicians were identified as potential facilitators of PrEP use who could explain PrEP to male partners on behalf of pregnant women. Women said that community-level stigma against HIV and potential for conflating PrEP with antiretroviral therapy (ART) would necessitate that PrEP use be discreet. Our results indicate the importance of addressing risk perception of women, concerns of male partners, HIV stigma, and benefits of PrEP for HIV prevention as programs are developed for pregnant women

Gender-Specific Combination HIV Prevention for Youth in High-Burden Settings: The MP3 Youth Observational Pilot Study Protocol.

BACKGROUND: Nearly three decades into the epidemic, sub-Saharan Africa (SSA) remains the region most heavily affected by human immunodeficiency virus (HIV), with nearly 70% of the 34 million people living with HIV globally residing in the region. In SSA, female and male youth (15 to 24 years) are at a disproportionately high risk of HIV infection compared to adults. As such, there is a need to target HIV prevention strategies to youth and to tailor them to a gender-specific context. This protocol describes the process for the multi-staged approach in the design of the MP3 Youth pilot study, a gender-specific, combination, HIV prevention intervention for youth in Kenya. OBJECTIVE: The objective of this multi-method protocol is to outline a rigorous and replicable methodology for a gender-specific combination HIV prevention pilot study for youth in high-burden settings, illustrating the triangulated methods undertaken to ensure that age, sex, and context are integral in the design of the intervention. METHODS: The mixed-methods, cross-sectional, longitudinal cohort pilot study protocol was developed by first conducting a systematic review of the literature, which shaped focus group discussions around prevention package and delivery options, and that also informed age- and sex- stratified mathematical modeling. The review, qualitative data, and mathematical modeling created a triangulated evidence base of interventions to be included in the pilot study protocol. To design the pilot study protocol, we convened an expert panel to select HIV prevention interventions effective for youth in SSA, which will be offered in a mobile health setting. The goal of the pilot study implementation and evaluation is to apply lessons learned to more effective HIV prevention evidence and programming. RESULTS: The combination HIV prevention package in this protocol includes (1) offering HIV testing and counseling for all youth; (2) voluntary medical circumcision and condoms for males; (3) pre-exposure prophylaxis (PrEP), conditional cash transfer (CCT), and contraceptives for females; and (4) referrals for HIV care among those identified as HIV-positive. The combination package platform selected is mobile health teams in an integrated services delivery model. A cross-sectional analysis will be conducted to determine the uptake of the interventions. To determine long-term impact, the protocol outlines enrolling selected participants in mutually exclusive longitudinal cohorts (HIV-positive, PrEP, CCT, and HIV-negative) followed by using mobile phone text messages (short message service, SMS) and in-person surveys to prospectively assess prevention method uptake, adherence, and risk compensation behaviors. Cross-sectional and sub-cohort analyses will be conducted to determine intervention packages uptake. CONCLUSIONS: The literature review, focus groups, and modeling indicate that offering age- and gender- specific combination HIV prevention interventions that include biomedical, behavioral, and structural interventions can have an impact on HIV risk reduction. Implementing this protocol will show the feasibility of delivering these services at scale. The MP3 Youth study is one of the few combination HIV prevention intervention protocols incorporating youth- and gender-specific interventions in one delivery setting. Lessons learned from the design of the protocol can be incorporated into the national guidance for combination HIV prevention for youth in Kenya and other high-burden SSA settings

Specific vaginal bacteria are associated with an increased risk of Trichomonas vaginalis acquisition in women

Background. While bacterial vaginosis has been associated with an increased risk of Trichomonas vaginalis (TV) acquisition, it is unknown whether other characteristics of the vaginal microbiota, including the presence of key bacterial species, influence a woman's risk of TV acquisition. Methods. The vaginal microbiota before 25 unique episodes of TV infection involving 18 women was compared to that of 50 controls who remained uninfected. TV was detected by transcription-mediated amplification. Vaginal microbiota were quantified using broad-range polymerase chain reaction analysis and taxon-specific quantitative PCR of the 16S ribosomal RNA gene. Results. TV acquisition was significantly associated with the presence of Prevotella amnii (risk ratio [RR], 2.21; 95% confidence interval [CI], 1.12-4.38; P = .02) and Sneathia sanguinegens (RR, 2.58; 95% CI, 1.00-6.62; P = .049). When adjusted for menstrual phase, the association between P. amnii and TV acquisition remained similar (adjusted RR, 2.11; 95% CI, 1.03-4.33; P = .04), but the association between S. sanguinegens and TV acquisition was attenuated (adjusted RR, 2.31; 95% CI, .86-6.23; P = .10). Conclusions. Key vaginal bacterial species may contribute to the susceptibility to TV acquisition. Understanding how these bacterial species increase a woman's risk of TV acquisition could help to guide the development of novel strategies to reduce women's risk of TV infection

Perceived social influences on women’s decisions to use medications not studied in pregnancy: a qualitative ethical analysis of PrEP implementation research in Kenya

Implementation research ethics can be particularly challenging when pregnant women have been excluded from earlier clinical stages of research given greater uncertainty about safety and efficacy in pregnancy. The evaluation of HIV pre-exposure prophylaxis (PrEP) during pregnancy offered an opportunity to understand important ethical considerations and social influences shaping women’s decisions to participate in evaluation of PrEP and investigational drugs during pregnancy. We conducted interviews with women (n=51), focus groups with male partners (5 FGDs), interviews with health providers (n=45), 4 FGDs with pregnant/postpartum adolescents and 4 FGDs with young women. Data were analyzed using thematic content analysis, including ethical aspects of the data. Our study reveals that women navigate a complex network of social influences, expectations, support, and gender roles, not only with male partners, but with clinicians, family, and friends when making decisions about PrEP or other drugs that lack complete safety data during pregnancy