An exploration of opportunities and challenges facing cervical cancer managers in Kenya

BACKGROUND: Kenya like other developing countries is low in resource setting and is facing a number of challenges in the management of cervical cancer. This study documents opportunities and challenges encountered in managing cervical cancer from the health care workers’ perspectives. A qualitative study was conducted among cervical cancer managers who were defined as nurses and doctors involved in operational level management of cervical cancer. The respondents were drawn from four provincial hospitals and the only two main National public referral hospitals in Kenya. Twenty one [21] nurse managers and twelve [12] medical doctors were interviewed using a standardized interview guide. The responses were audio recorded, transcribed verbatim and the content analyzed in emerging themes. FINDINGS: Four themes were identified. Patient related challenges included a large number of patients, presenting in the late stage of disease, low levels of knowledge on cancer of the cervix, low levels of screening and a poor attitude towards screening procedure. Individual health care providers identified a lack of specialised training, difficulty in disclosure of diagnosis to patients, a poor attitude towards cervical cancer screening procedure and a poor attitude towards cervical cancer patients. Health facilities were lacking in infrastructure and medical supplies. Some managers felt ill-equipped in technological skills while the majority lacked access to the internet. Mobile phones were identified as having great potential for improving the management of cervical cancer in Kenya. CONCLUSION: Kenya faces a myriad of challenges in the management of cervical cancer. The peculiar negative attitude towards screening procedure and the negative attitude of some managers towards cervical cancer patients need urgent attention. The potential use of mobile phones in cervical cancer management should be explored

Virtual reality and serious gaming in re-engineering clinical teaching: A review of literature of the experiences and perspectives of clinical trainers

Re-engineer clinical teaching through innovative approaches such as virtual reality (VR) and Serious Gaming (SG) may increase patient safety. While several studies have focused on the experiences and perceptions of learners about VR and SG, few have if any have focused on the instructors. We reviewed and appraised published evidence to establish the experiences and intention to adopt VR and SG in clinical teaching. Relevant articles were sourced from five databases (PubMed/Medline, Informit, +A Education, ProQuest-ERIC, and CINHAL-EBSCO host). Experiences of clinical trainers were reported using the technological, pedagogical, and content knowledge (TPACK) model. The intention to adopt VR and SG was synthesized using the Technology Adoption Model (TAM). Clinical trainers had a positive attitude towards VR and SG. Those with longer professional experience were less likely to adopt VR and SG, while more experienced trainers were more likely to benefit from VR and SG. VR and SG are practical pedagogies for clinical instruction, but training is required for novice users. Cost-benefit analysis of VR and SG as clinical training approaches is needed

Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa

Background: Cervical cancer is the second most common female reproductive cancer after breast cancer with 84% of the cases in developing countries. A high uptake of human papilloma virus (HPV) vaccination and screening, and early diagnosis leads to a reduction of incidence and mortality rates. Yet uptake of screening is low in Sub-Saharan Africa and there is an increasing number of women presenting for treatment with advanced disease. Nine women in their twenties die from cervical cancer in Kenya every day. This paper presents the biopsychosocial risk factors that impact on cervical cancer knowledge among Kenyan women aged 15 to 24 years. The findings will highlight opportunities for early interventions to prevent the worrying prediction of an exponential increase by 50% of cervical cancer incidences in the younger age group by 2034. Methods: Data from the 2014 Kenya Demographic and Health Survey (KDHS) was analysed using complex sample logistic regression to assess biopsychosocial risk factors of knowledge of cervical cancer among young women aged 15 to 24 years (n = 5398). Findings: Close to one third of the participants were unaware of cervical cancer with no difference between participants aged 15–19 years (n = 2716) and those aged 20–24 years (n = 2691) (OR = 1; CI = 0.69–1.45). Social predisposing factors, such as lack of education; poverty; living further from a health facility; or never having taken a human immunodeficiency virus (HIV) test, were significantly associated with lack of awareness of cervical cancer (p<0.001). Young women who did not know where to obtain condoms had an OR of 2.12 (CI 1.72–2.61) for being unaware of cervical cancer. Psychological risk factors, such as low self-efficacy about seeking medical help, and an inability to refuse unsafe sex with husband or partner, perpetuated the low level of awareness about cervical cancer (p<0.001). Conclusions: A considerable proportion of young women in Kenya are unaware of cervical cancer which is associated with a variety of social and psychological factors. We argue that the high prevalence of cervical cancer and poor screening rates will continue to prevail among older women if issues that affect young women’s awareness of cervical cancer are not addressed. Given that the Kenyan youth are exposed to HPV due to early sexual encounters and a high prevalence of HIV, targeted interventions are urgently needed to increase the uptake of HPV vaccination and screening

Stakeholder perceptions of current practices and challenges in priority setting for non-communicable disease control in Kenya: a qualitative study

Objective To explore the stakeholders’ perceptions of current practices and challenges in priority setting for non-communicable disease (NCD) control in Kenya.Design A qualitative study approach conducted within a 1-day stakeholder workshop that followed a deliberative dialogue process.Setting Study was conducted within a 1-day stakeholder workshop that was held in October 2019 in Nairobi, Kenya.Participants Stakeholders who currently participate in the national level policymaking process for health in Kenya.Outcome measure Priority setting process for NCD control in Kenya.Results Donor funding was identified as a key factor that informed the priority setting process for NCD control. Misalignment between donors’ priorities and the country’s priorities for NCD control was seen as a hindrance to the process. It was identified that there was minimal utilisation of context-specific evidence from locally conducted research. Additional factors seen to inform the priority setting process included political leadership, government policies and budget allocation for NCDs, stakeholder engagement, media, people’s cultural and religious beliefs.Conclusion There is an urgent need for development aid partners to align their priorities to the specific NCD control priority areas that exist in the countries that they extend aid to. Additionally, context-specific scientific evidence on effective local interventions for NCD control is required to inform areas of priority in Kenya and other low-income and middle-income countries. Further research is needed to develop best practice guidelines and tools for the creation of national-level priority setting frameworks that are responsive to the identified factors that inform the priority setting process for NCD control

Self-reported use of internet by cervical cancer clients in two National Referral Hospitals in Kenya

Abstract Background Cervical cancer remains a devastating disease in Kenya accounting for more than 2000 deaths each year. Lack of information on cervical cancer prevention and management has been attributed to the apathy among women in seeking health interventions. Use of internet-based and mobile e-health tools could increase information access among cervical cancer patients. The objective of the study was; to establish the extent of use of mobile phones and internet by cervical cancer patients in accessing information related to cancer treatment and management.; find out the characteristics of patients associated with internet use and identify barriers faced by the patients in internet use. A cross sectional descriptive survey of 199 cervical patients visiting the two main referral hospitals in Kenya was done. A structured questionnaire was used to collect data. Findings The average length of illness was 2.43 years (SD ± 3.0). Only 7.5 %( n=15) reported to having used the internet as a source of information. 92.5 %( n=184) did not use internet. With Multiple options, 70.9% did not know how to use a computer, 29.2% did not have access to a computer, 14.6% lacked the money to use computers at the local cyber cafe while other barriers identified accounted for 11.1%. Patients reported that the internet had an important role in the management of cancer of the cervix in health education (17.6%), online consultation (14.6%), booking of patients (13.6%), referrals (8.5%) and collecting data (7%). The 96.5% of the respondents who had access to a mobile phone, recommended mobile phones for health education messages (31.7%), reminder alerts for medication (29.7%) and booking appointments (21.6%). There was a statistically significant association between income of the patients and internet use (p = 0.026) in this study. Conclusions There is low level use of the internet by cervical cancer clients attended in Public referral facilities in Kenya. This was attributed to; lack of knowledge on how to use computers and lack of access to a computer. High level of access to mobile phones was reported. This is an indicator of great potential for use of mobile phones in the management of cervical cancer through short messaging services (sms), without internet connectivity. There is even greater potential to internet use through web access via mobile phones.</p

The health and economic impact and cost effectiveness of interventions for the prevention and control of overweight and obesity in Kenya: a stakeholder engaged modelling study

Abstract Background The global increase in mean body mass index has resulted in a substantial increase of non-communicable diseases (NCDs), including in many low- and middle-income countries such as Kenya. This paper assesses four interventions for the prevention and control of overweight and obesity in Kenya to determine their potential health and economic impact and cost effectiveness. Methods We reviewed the literature to identify evidence of effect, determine the intervention costs, disease costs and total healthcare costs. We used a proportional multistate life table model to quantify the potential impacts on health conditions and healthcare costs, modelling the 2019 Kenya population over their remaining lifetime. Considering a health system perspective, two interventions were assessed for cost-effectiveness. In addition, we used the Human Capital Approach to estimate productivity gains. Results Over the lifetime of the 2019 population, impacts were estimated at 203,266 health-adjusted life years (HALYs) (95% uncertainty interval [UI] 163,752 − 249,621) for a 20% tax on sugar-sweetened beverages, 151,718 HALYs (95% UI 55,257 − 250,412) for mandatory kilojoule menu labelling, 3.7 million HALYs (95% UI 2,661,365–4,789,915) for a change in consumption levels related to supermarket food purchase patterns and 13.1 million HALYs (95% UI 11,404,317 − 15,152,341) for a change in national consumption back to the 1975 average levels of energy intake. This translates to 4, 3, 73 and 261 HALYs per 1,000 persons. Lifetime healthcare cost savings were approximately United States Dollar (USD) 0.14 billion (USD 3 per capita), USD 0.08 billion (USD 2 per capita), USD 1.9 billion (USD 38 per capita) and USD 6.2 billion (USD 124 per capita), respectively. Lifetime productivity gains were approximately USD 1.8 billion, USD 1.2 billion, USD 28 billion and USD 92 billion. Both the 20% tax on sugar sweetened beverages and the mandatory kilojoule menu labelling were assessed for cost effectiveness and found dominant (health promoting and cost-saving). Conclusion All interventions evaluated yielded substantive health gains and economic benefits and should be considered for implementation in Kenya

Additional file 1 of The health and economic impact and cost effectiveness of interventions for the prevention and control of overweight and obesity in Kenya: a stakeholder engaged modelling study

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Additional file 2 of The health and economic impact and cost effectiveness of interventions for the prevention and control of overweight and obesity in Kenya: a stakeholder engaged modelling study

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