Factors influencing voluntary medical male circumcision among men aged 18-50 years in Kibera Division

Background: Voluntary Medical Male Circumcision (VMMC) is the surgical removal of all or part of the foreskin from the penis. It is done for medical reasons as it has been shown to reduce the risk of female to male transmission of HIV by up to 60%. It has also been associated with lower transmission of sexually transmitted infections. Voluntary Medical Male Circumcision services have been scaled up in countries with high prevalence, generalised heterosexual HIV epidemics and low rates of male circumcision. Kibera is inhabited by a multi-ethnic community with a sizeable number of un-circumcising ethnic groups.Objectives: To determine the uptake of voluntary medical male circumcision among men in Kibera Division and to identify factors associated with circumcision preference.Design: Descriptive cross-sectional study.Setting: Kibera Division of Nairobi County.Subjects: Simple random sampling was used to enrol 387 participants. A 42-item questionnaire was administered to the participants for determining the uptake of VMMC. It had three sub-sections: demographic characteristics, general knowledge about VMMC and AIDS and acceptability of VMMC, which collected data on the main outcome measures. Data captured was entered into EpiInfo and converted to Stata13 for validation and analysis. Bivariate statistics were generated for all the variables in accordance to the study questions. Categorical variables were analysed using chi-square tests, while the qualitative variables were analysed using the t-test. Multivariate logistic regression analysis was performed to identify factors associated with the acceptability of male circumcision.Results: The study analysed data for a sample of 341 individuals whose mean age was 31 years (95%= 31+-9.1) and 62% were married. A total of 54% of the respondents had completed secondary and tertiary level of education. The level of understanding about VMMC was above average. Fifty nine percent of the respondents (95% CI = 0.54 - 0.64) knew about VMMC. Of these, 31% had obtained information about VMMC from TV and radio. The most frequently mentioned reason for undergoing VMMC was prevention of HIV and sexually transmitted infections. The level of uptake of VMMC was high at 75%. The study established that the prefered age group for circumcision was during adolescence. Using multivariate logistic regression, the factors associated with uptake of VMMC were education level, medical and hygiene reasons for VMMC. Barriers for uptake were cost, pain and long recovery period after the operation.Conclusion: The uptake and acceptability of male circumcision is high among the general population in Kibera. Participant understanding of HIV and VMMC was also high. There is need for heightened awareness creation in educational institutes. This will specifically target young men before or shortly after their sexual debut when they may still be free of HIV and HSV-2 infections. Circumcision by medical providers should be increased in traditionally circumcising regions to reduce incidence of adverse events

Occurrence of adverse drug reactions associated with highly active anti-retroviral therapy at Mbagathi District Hospital, Nairobi, Kenya

Background: Life-saving highly active anti-retroviral therapy (HAART) has been accompanied by the challenge of incident adverse drug reactions (ADRs). Locally generated data is scanty, inadequately documented, and therefore not available to inform revision of clinical protocols.Objective: To study and document the magnitude and type of ADRs associated with HAART over a 42 month period at Mbagathi District Hospital (MDH) Nairobi.Design: A retrospective cohort study.Setting: A high burdened HIV comprehensive care clinic based at the Mbagathi District Hospital in Nairobi, Kenya.Subjects: HIV infected patients receiving highly active anti-retroviral therapy (HAART)Results: Adverse drug reactions associated with HAART occurred in 63% of adult study subjects. Majority (91.4%) of the ADRs experienced were medium to long term conditions, namely peripheral neuropathy in 33.3%, lipodystrophy in 32.6%, hepatic toxicity in 24.4% and lactic acidemia in 4.1 % of patients. Furthermore, occurrence of all the ADRs was associated with increasing baseline age (p<0.0001). Gender differences were found in patients with lipodystrophy (p<0.001), and lactic acidemia (p=0.047),with a female preponderance.Conclusion: Adverse drug reactions were experienced by 63% patients on HAART. Majority of the ADRs were those commonly associated with the medium to long term use of stavudine and nevirapine. Despite the high frequency of ADRs, patient outcomes were favourable as there were no reported deaths or hospitalisations

The detection of antibodies against Schistosoma mansoni soluble egg antigens (SEA) and CEF6 in ELISA, before and after chemotherapy.

Circulating IgG antibody reactivity and excreted egg counts were investigated in 489 Kenyans given chemotherapy for schistosomiasis mansoni. Antibody reactivity was measured in ELISA, using either unfractionated aqueous soluble constituents of Schistosoma mansoni eggs (SEA) or CEF6 (a soluble fraction of S. mansoni eggs containing two cationic antigens) as the antigen source. Antibody reactivity for each antigen source was strongly associated with egg counts, both pre- and post-treatment. Approximately 6 months after chemotherapy, egg counts were zero in 84% of the subjects. The mean optical densities (OD) measured in the post-treatment ELISA were 60% (CEF6) or 45% (SEA) lower than the pre-treatment values, the reduction in the OD with CEF6 as antigen source being significantly greater than that observed with SEA (P <0.001). The usefulness of an assay for antibody reactivity in monitoring the effects of the treatment of schistosomiasis is discussed