The Prevalence and Knowledge of Emergency Contraceptive Pills (ECP’s) among women in Kibera, Nairobi

Background: Emergency contraception (EC) refers to the use of certain contraceptive methods by women and girls to prevent pregnancy after unprotected sexual intercourse. Many women who have a need for emergency contraception do not use it. Usually, women simply do not know that it exists or, if they know, they do not know where to get it or how or when to use it.Young and unmarried women constitute a high risk group for unsafe abortions. It has been estimated that widespread use of emergency contraception may significantly reduce the number of abortion-related morbidity and mortality. The Consortium for Emergency has set a goal of making emergency contraceptive pills a standard part of reproductive health care worldwide. Objectives: The main objective of this study was to evaluate the prevalence, knowledge, attitudes and practises towards the uptake of emergency contraceptive pills by women in Kibera slum,Nairobi, Kenya Design: A Cross-sectional survey was conducted in Kibera, Nairobi Method: Multi stage sampling was used to determine the study population and 384 women were interviewed using a structured questionnaire. SPSS version 16 and STATA version 11 were used for statistical analyses. Results: The results were that the mean age of the women was 26 years with a standard deviation of 7.4. Majority of the women were married (52%). More than half (58%) reported to use a method of contraception. The prevalence of emergency contraceptive pill was found to be (23%).The findings of this study show that knowledge of emergency contraceptive pills was high (74%) meaning many women have heard about it. The main source of information of Emergency Contraceptive Pills (ECPs) was from friends and family (34%). However when it came to its usage, (37%) of the women thought that it would cause health problems if they used it, while (25%) were not familiar with the emergency contraceptive pill itself, hence were afraid of using it. The main reason for the women not using emergency contraceptives was because of misinformation (62%) followed by a lack of awareness (38%). Conclusion: This study found the prevalence of ECP to be 23% and that knowledge on ECP was adequate with more than half the women reporting to have heard of ECP. However awareness does not lead to use of ECP’s and the method is underused. The major constraint to ECP use was misinformation, with many women fearing that ECP might cause health problems or interfere with their fertility. Religion was also a constraint to ECP with only Protestants reporting its use.&nbsp

Bancroftian filariasis in Kwale District, Kenya

Objective: To determine the prevalence of Wuchereria bancrofti infection in an area designated for filariasis control trial.Design: A cross-sectional survey.Setting: Three villages in Kinango location, Kwale district, Coast Province, Kenya.Subjects/participants: Oral informed consent to participate was obtained from adults and parents or guardians of children below fifteen years of age.Main outcome measures: Microfilaraemia prevalences, microfilarial densities and clinical manifestations.Results: The overall prevalence of microfilaraemia in the population was 16.4%. The prevalence of microfilaraemia was age-dependent and the overall microfilarial density (MFD) was 69.4 mf/ml (geometric mean) and significantly higher in males (95.8 mf/ml) than in females (48.6 mf/ml) (p < 0.05). The prevalence of clinical signs of infection was also agedependent with elephantiasis being significantly higher in females (2.3%) than in males (0.9%) (p < 0.05). Among the males, the major clinical manifestation was hydrocele (10.4%).Conclusion: These findings show high prevalence of bancroftian filariasis in Kwale district and warrant similar studies followed by implementation of intervention measures to reduce transmission in all areas of endemicity in the Coast Province

Adherence to Anti-Retroviral Treatment and Factors Associated with Optimal Adherence among Adolescent and Adult PLWHA Attending Comprehensive Care Centres in Selected Hospitals in Nairobi County

Background: Anti-retroviral therapy (ART) has saved many lives from imminent deaths among PLWHA. However, the success is pegged on optimal (&gt;95%) adherence to the ART by the PLWHA. The main objective of this study was to determine the ART adherence level by the PLWHA and the factors associated with the adherence.Methods: This was a cross sectional descriptive study on 454 PLWHA, attending Comprehensive Care Centres (CCCs) in selected hospitals in Nairobi County. A structured questionnaire was used to collect data. The Data was analysed using SPSS version 17.0. Results: There were 180 (39.6%) males and 274 (60.4%) females in the study. Majority (53.3%) PLWHA were aged between 40 and 49 years. Only 265 (58.4%) had optimal adherence to ART and duration on the ART was found to be significantly associated with optimal adherence to ART drugs.Conclusion: Optimal adherence was far below the recommended (&gt;95%) mark and duration on  ART was found to be significantly associated with optimal adherence. That is, the shorter the time one had been on ART, the more the chances of being more adherent. Most PLWHA blamed forgetfulness as the main reason for their failure to take the ART drugs as required. Since Anti-Retroviral Treatment is a lifelong process, targeted counselling including reminders (ringing of a bell in the phone) and formation of groups for calling each other for remembrance would suffice. Keywords: PLWHA; ART; optimal adherence; Forgetfulness

Nutritional Status of Adolescent and Adult PLWHA on Anti-Retroviral Treatment, Attending Various Comprehensive Care Centres in Nairobi County, Kenya

Background: Maintaining nutritional needs of People Living with HIV and AIDS (PLWHA) who are on Anti-Retroviral Treatment (ART) helps to strengthen their immune system and optimize response to medical treatment. The main objective of this study was to assess the nutritional status PLWHA on ART and the associated factors. Methodology: This was a cross-sectional study where 454 adolescent and adult PLWHA on ART were randomly selected and consent obtained to join the study. Structured interviewer-administered questionnaires were used to gather data on their socio-economic characteristics, the types of food consumed in the last 24 hours and their Body Mass Index. The data was organized and analysed using SPSS version 17.0. Variables were categorized and Chi-square statistical test used to assess association where a p-value of less than or equal to 0.05 was considered statistically significant. Results: A total of 454 PLWHA were recruited into the study and 180 (39.6%) were males while 274 (60.4%) were females giving a Male: Female ratio of 1: 1.5. Over three quarters (77%) had attained secondary education and above. The main sources of income were employment (48.5%) and business (44.9%). The types of foods consumed were beans and beef for body building (proteins); Ugali (maize meal) and rice for energy (Carbohydrates); kales and cabbages (vegetables), bananas and pineapples (fruits) as protective foods. Over half (51.1%) were overweight/obese. Sources of income and the monthly earnings were significantly associated with the overweight/obesity. Conclusion: The PLWHAs’ sources of income and monthly earnings had statistical significance on their nutritional status (BMI) of being over-weight/obese. However, other factors such as: ART’s ability to decrease resting-energy expenditure and basal metabolic rate resulting in replenishment of muscle bulk and hence weight gain; or intentional over-eating to avoid the stigmatized weight loss which is often “associated” with being HIV positive may have had a part to play. Keywords: PLWHA; ART; Nutritional status (BMI); food groups and consumption; food availability, affordability and use

Value beyond function: Analyzing the perception of wheelchair innovations in Kenya

Innovations in the field of assistive technology are usually evaluated based on practical considerations related to their ability to perform certain functions. However, social and emotional aspects play a huge role in how people with disabilities interact with assistive products and services. Over a five months period, we tested an innovative wheelchair service provision model that leverages 3D printing and Computer Aided Design to provide bespoke wheelchairs in Kenya. The study involved eight expert wheelchair users and five healthcare professionals who routinely provide wheelchair services in their community. Results from the study show that both users and providers attributed great value to both the novel service delivery model and the wheelchairs produced as part of the study. The reasons for their appreciation went far beyond the practical considerations and were rooted in the fact that the service delivery model and the wheelchairs promoted core values of agency, empowerment and self-expression

User fees in private non-for-profit hospitals in Uganda: a survey and intervention for equity

BACKGROUND: In developing countries, user fees may represent an important source of revenues for private-non-for-profit hospitals, but they may also affect access, use and equity. METHODS: This survey was conducted in ten hospitals of the Uganda Catholic Medical Bureau to assess differences in user fees policies and to propose changes that would better fit with the social concern explicitly pursued by the Bureau. Through a review of relevant hospital documents and reports, and through interviews with key informants, health workers and users, hospital and non-hospital cost was calculated, as well as overall expenditure and revenues. Lower fees were applied in some pilot hospitals after the survey. RESULTS: The percentage of revenues from user fees varied between 6% and 89% (average 40%). Some hospitals were more successful than others in getting external aid and government subsidies. These hospitals were applying lower fees and flat rates, and were offering free essential services to encourage access, as opposed to the fee-for-service policies implemented in less successful hospitals. The wide variation in user fees among hospitals was not justified by differences in case mix. None of the hospitals had a policy for exemption of the poor; the few users that actually got exempted were not really poor. To pay hospital and non-hospital expenses, about one third of users had to borrow money or sell goods and property. The fee system applied after the survey, based on flat and lower rates, brought about an increase in access and use of hospital services. CONCLUSION: Our results confirm that user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible

What's normal? Oligosaccharide concentrations and profiles in milk produced by healthy women vary geographically.

Background: Human milk is a complex fluid comprised of myriad substances, with one of the most abundant substances being a group of complex carbohydrates referred to as human milk oligosaccharides (HMOs). There has been some evidence that HMO profiles differ in populations, but few studies have rigorously explored this variability.Objectives: We tested the hypothesis that HMO profiles differ in diverse populations of healthy women. Next, we examined relations between HMO and maternal anthropometric and reproductive indexes and indirectly examined whether differences were likely related to genetic or environmental variations.Design: In this cross-sectional, observational study, milk was collected from a total of 410 healthy, breastfeeding women in 11 international cohorts and analyzed for HMOs by using high-performance liquid chromatography.Results: There was an effect of the cohort (P 4 times higher in milk collected in Sweden than in milk collected in rural Gambia (mean ± SEM: 473 ± 55 compared with 103 ± 16 nmol/mL, respectively; P < 0.05), and disialyllacto-N-tetraose (DSLNT) concentrations ranged from 216 ± 14 nmol/mL (in Sweden) to 870 ± 68 nmol/mL (in rural Gambia) (P < 0.05). Maternal age, time postpartum, weight, and body mass index were all correlated with several HMOs, and multiple differences in HMOs [e.g., lacto-N-neotetrose and DSLNT] were shown between ethnically similar (and likely genetically similar) populations who were living in different locations, which suggests that the environment may play a role in regulating the synthesis of HMOs.Conclusions: The results of this study support our hypothesis that normal HMO concentrations and profiles vary geographically, even in healthy women. Targeted genomic analyses are required to determine whether these differences are due at least in part to genetic variation. A careful examination of sociocultural, behavioral, and environmental factors is needed to determine their roles in this regard. This study was registered at clinicaltrials.gov as NCT02670278

Key genetic variants associated with variation of milk oligosaccharides from diverse human populations

Human milk oligosaccharides (HMO), the third most abundant component of human milk, are thought to be important contributors to infant health. Studies have provided evidence that geography, stage of lactation, and Lewis and secretor blood groups are associated with HMO profile. However, little is known about how variation across the genome may influence HMO composition among women in various populations. In this study, we performed genome-wide association analyses of 395 women from 8 countries to identify genetic regions associated with 19 different HMO. Our data support FUT2 as the most significantly associated (P < 4.23-9 to P < 4.5-70) gene with seven HMO and provide evidence of balancing selection for FUT2. Although polymorphisms in FUT3 were also associated with variation in lacto-N-fucopentaose II and difucosyllacto-N-tetrose, we found little evidence of selection on FUT3. To our knowledge, this is the first report of the use of genome-wide association analyses on HMO

Variation in Human Milk Composition Is Related to Differences in Milk and Infant Fecal Microbial Communities.

Previously published data from our group and others demonstrate that human milk oligosaccharide (HMOs), as well as milk and infant fecal microbial profiles, vary by geography. However, little is known about the geographical variation of other milk-borne factors, such as lactose and protein, as well as the associations among these factors and microbial community structures in milk and infant feces. Here, we characterized and contrasted concentrations of milk-borne lactose, protein, and HMOs, and examined their associations with milk and infant fecal microbiomes in samples collected in 11 geographically diverse sites. Although geographical site was strongly associated with milk and infant fecal microbiomes, both sample types assorted into a smaller number of community state types based on shared microbial profiles. Similar to HMOs, concentrations of lactose and protein also varied by geography. Concentrations of HMOs, lactose, and protein were associated with differences in the microbial community structures of milk and infant feces and in the abundance of specific taxa. Taken together, these data suggest that the composition of human milk, even when produced by relatively healthy women, differs based on geographical boundaries and that concentrations of HMOs, lactose, and protein in milk are related to variation in milk and infant fecal microbial communities

Delivery Practices and Associated Factors among Mothers Seeking Child Welfare Services in Selected Health Facilities in Nyandarua South District, Kenya

<p>Abstract</p> <p>Background</p> <p>A measure of the proportion of deliveries assisted by skilled attendants is one of the indicators of progress towards achieving Millennium Development Goal (MDG) 5, which aims at improving maternal health. This study aimed at establishing delivery practices and associated factors among mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya to determine whether mothers were receiving appropriate delivery care.</p> <p>Methods</p> <p>A hospital-based cross-sectional survey among women who had recently delivered while in the study area was carried out between August and October 2009. Binary Logistic regression was used to identify factors that predicted mothers' delivery practice.</p> <p>Results</p> <p>Among the 409 mothers who participated in the study, 1170 deliveries were reported. Of all the deliveries reported, 51.8% were attended by unskilled birth attendants. Among the deliveries attended by unskilled birth attendants, 38.6% (452/1170) were by neighbors and/or relatives. Traditional Birth Attendants attended 1.5% (17/1170) of the deliveries while in 11.7% (137/1170) of the deliveries were self administered. Mothers who had unskilled birth attendance were more likely to have <3 years of education (Adjusted Odds ratio [AOR] 19.2, 95% confidence interval [CI] 1.7 - 212.8) and with more than three deliveries in a life time (AOR 3.8, 95% CI 2.3 - 6.4). Mothers with perceived similarity in delivery attendance among skilled and unskilled delivery attendants were associated with unsafe delivery practice (AOR 1.9, 95% CI 1.1 - 3.4). Mother's with lower knowledge score on safe delivery (%) were more likely to have unskilled delivery attendance (AOR 36.5, 95% CI 4.3 - 309.3).</p> <p>Conclusion</p> <p>Among the mothers interviewed, utilization of skilled delivery attendance services was still low with a high number of deliveries being attended by unqualified lay persons. There is need to implement cost effective and sustainable measures to improve the quality of maternal health services with an aim of promoting safe delivery and hence reducing maternal mortality.</p