Barriers to Interpersonal Communication as a Tool for Improving the Uptake of Voluntary Medical Male Circumcision in Siaya County, Kenya

Despite its acknowledged importance in health management, particularly when dealing with such sensitive issues that transcend the boundaries of health as sexuality, stigma and discrimination, there is little research on the efficacy of interpersonal communication (IPC) in health programmes in Kenya. Consequently, little is documented on barriers to IPC in the implementation of health interventions. We examined specific potential barriers to IPC as an integral device in the implementation of the voluntary medical male circumcision (VMMC) programme in Siaya, Kenya. We used a mixed-methods sequential cross-sectional research design, and the multi-stage sampling technique – combining purposive and chain referral sampling procedures to arrive at the desired samples. Two questionnaires were administered on 370 male residents of Bondo and Rarieda in Siaya; and on 35 implementers of the programme in the two sub-counties. Further, we interviewed five managers from the implementing agencies. We used descriptive and inferential statistics to analyse quantitative data, and presented the findings through text and tables, while qualitative data were analysed through the description, analysis and interpretation process. The findings show time constraints as a significant barrier chiefly from the viewpoint of the operational staff, who admitted lacking time for meaningful interactions with their clients to fully explain issues raised for desired mutual understanding. Culture, in its various forms, has a significant negative cross-cutting bearing on provider-client interactions, while provider-client language difference, coupled with service providers’ attitude and jargons had a potential negative effect on the VMMC programme’s final outcome, at least from the clients’ perspective. We recommend full integration of IPC in healthcare management. Communication training should be accorded its due prominence, both in terms of scope and depth, in all heath training institutions. We further vouch for service provider cultural competence to enhance understanding. IPC can play a crucial role in healthcare management in Kenya due to its ability to facilitate important provider-client transaction, particularly in the largely oral rural resource-deprived populations, which lack adequate access to mass communication media. This study has discussed a raft of potential barriers to IPC, and provides significant insights to planners and managers of management of health programmes and interventions. Keywords: Siaya, Kenya; healthcare; interpersonal communication; barriers; cultural nuances; voluntary male circumcision. DOI: 10.7176/JHMN/72-10 Publication date:March 31st 202

The Significance of Livelihood Support Projects to Health Communication Strategies in Resource-deprived Settings: A Look at the Medical Male Circumcision Programme in Siaya County, Kenya

Behaviour change communicators and health experts often assume that individual beliefs and perceptions hold the key to explaining health behaviours, thereby ignoring the extraneous constraints that obtain in the individual’s environment. Access to basic resources, such as food clothing and shelter, can be central to developing an understanding for health transactions, particularly in severely resource-deprived populations found in rural and informal urban dwellings, where basic survival at times overrides all other considerations. In such situations, specific livelihood improvement programmes targeting the intended beneficiaries and other key players in a given health intervention could be an incentive for the adoption and uptake of the intervention. This study examined the possible effects of socio-economic incentives to complement communication campaigns to improve the uptake of voluntary medical male circumcision (VMMC) for the prevention of HIV/AIDS in Siaya County of Kenya. Using multi-stage sampling, we purposively selected two sub-counties, Bondo and Rarieda, from where, using the snowball technique, we drew a sample of 370 male residents aged 18 to 49 years, mainly from the fish landing areas of the two sub-counties. We conducted two focus group discussions with men and women residents, besides in-depth interviews with five managers of the programme. Results were drawn from direct and indirect questions touching on socio-economic issues covered in the qualitative and quantitative research instruments and from anecdotal evidence. We found that, besides conventional prevention and treatment programmes, combating HIV/AIDS through VMMC in low-income populations requires reasonable investment in economic assistance to the intended beneficiaries of VMMC and those with the potential to influence their decision. These activities should be integrated in the wider programme implementation spectrum with clear structures that serve as entry points for health message delivery points. Keywords: Siaya, Kenya, healthcare, circumcision, interpersonal communication, livelihood enhancement. DOI: 10.7176/RHSS/10-12-06 Publication date:June 30th 202

Factors Associated with Choice of Infant Feeding Practices among HIV-1 Positive Post-natal Clinic Attendees in Tharaka Nithi County

Background: Feeding practices for HIV-exposed infants plays a key role in determining the risk of morbidity and mortality. Infected mothers’ choice of infant feeding is influenced by many factors within the community hence challenging their decisions. We sought to determine factors associated with choice of HIV exposed infant feeding practices in the region. Methods: Two hundred and forty nine HIV infected mothers were systematically recruited.  Data on infant HIV status was obtained from facility records. Respondents were interviewed using a semi-structured questionnaire. Focus group discussions and key informant interviews were carried out to support primary data. Analysis was done using SPSS version 16.0. Logistic regression was used to determine association of factors that influenced choice of infant feeding practice. Results: Of the 249 respondents, 98% chose exclusively breastfeeding during prenatal counseling but majority did not sustain beyond 2 months, while replacement feeding was least practiced (2%) postnatal. Major factors that influenced feeding practices were mother’s education (OR 2.637; CI: 1.088-6.388), non-health care workers advise (OR 3.053; CI: 1.706-5.463), not belonging to support groups (OR 2.804; CI: 1.620-4.854) rejection of health care workers support (OR 3.386; CI: 1.937-5.919). Conclusion: Although exclusive breastfeeding was the preferred feeding choice among the respondents immediately after birth, it was not sustained beyond the second month of the infant’s life. Increased contact of HIV positive women with health care workers and professionals through promotion of trust in community health workers, attendance of ANC and delivery in hospital should be promoted.  Education efforts should also target non health care persons who influence feeding practices to reduce stigma among HIV positive mothers. Keywords:  Infant feeding practices; Stigm

Prevalence and Factors Associated with Sexual Violence among Male Sex Workers (MSW) on Antiretroviral Therapy in Nairobi, Kenya

Background: Sexual violence is commonly thought of as an issue affecting primarily women and girls; however, stigma, discrimination, and violence are also expressed towards men who have sex with men (MSM), male sex workers (MSW), and transgender (TG) individuals. Our study examined the prevalence and predictors of Sexual Violence among Male Sex Workers in Kenya Methods: A cross-sectional survey was administered among 260 MSW living with HIV reached through a combination of chain referral and venue-based sampling in Kenya. Results: There is a high prevalence of sexual violence among MSW in this population 48.5% (n=126). Religious denomination; main source of income; duration on treatment; receiving gifts and materials in return for sex; and belonging to a group were significantly associated with sexual violence (p<0.005).At the multivariate analysis level; Respondents that received gifts and materials in return to sex were 2.1 times more likely to experience sexual violence compared to those that did not (CI: 1.1-4.9). Those who did not belong to a group were 1.8 times more likely to experience sexual violence (CI: 1.9-3.7). Conclusion: A better understanding of sexual violence among MSM/MSW/TG populations is necessary in order to develop clear and specific recommendations for future interventions targeting this issue

Development of immunoassays for detection of Human Immunodeficiency Virus based on Consensus env gp41 Immunodominant Region Peptide from HIV-1 infections in Kenya

Background: Human Immunodeficiency Virus (HIV) is characterized by high rates of genetic variability in vivo that could affect the performance of the HIV antibody-based detection kits. Objective: This study aimed at developing immunoassays for HIV based on Consensus env gp41 Immunodominant region (IDR) from HIV infections in Kenya. Methods: HIV RNA was extracted from 91 samples collected from 5 regional blood transfusion centers in Kenya. The RNA was reverse transcribed, sequenced in the env gp41-Immunodominant Region (IDR) and the Consensus sequence generated used to synthesize corresponding peptide. The Global HIV envgp41-IDR Consensus peptide was obtained from the literature and also synthesized. The two peptides were used to separately develop HIV immunoassays based on Enzyme-linked Immunosorbent Assay (ELISA) and Lateral Flow Assay (LFA) platforms and the performance of developed assays was evaluated. The same HIV env gp41 IDR peptides were used to develop ELISA-based immunoassays for determination HIV Incidence / Recency. Results: The study did not find significant difference between the performance of the immunoassays that were developed with Consensus env gp41-IDR peptide (Kenya) and those developed using Consensus env gp41-IDR peptide (Global). However, the study found a significant difference between the performance of HIV ELISA for HIV Incidence testing that was developed with Consensus envgp41-IDR peptide (Kenya) and that which was developed using Consensus envgp41-IDR peptide (Global) with the former displaying superior performance. Conclusions: The developed immunoassays demonstrated that both Consensus env gp41-IDR peptides (Kenya and Global) could be used to develop HIV immunoassays but Consensus env gp41-IDR peptide (Kenya) could be more suitable for development of HIV Incidence assays in Kenya. Keywords: HIV, Consensus sequence, env gp41-Immunodominant Region, Immunoassay

Survey on prevalence and risk factors on HIV-1 among pregnant women in North-Rift, Kenya: a hospital based cross-sectional study conducted between 2005 and 2006

<p>Abstract</p> <p>Background</p> <p>The HIV/AIDS epidemic in Kenya is a major public-health problem. Estimating the prevalence of HIV in pregnant women provides essential information for an effective implementation of HIV/AIDS control measures and monitoring of HIV spread within a country. The objective of this study was to determine the prevalence of HIV infection, risk factors for HIV/AIDS and immunologic (lymphocyte profile) characteristics among pregnant women attending antenatal clinics in three district hospitals in North-Rift, Kenya.</p> <p>Methods</p> <p>Blood samples were collected from pregnant women attending antenatal clinics in three district hospitals (Kitale, Kapsabet and Nandi Hills) after informed consent and pre-test counseling. The samples were tested for HIV antibodies as per the guidelines laid down by Ministry of Health, Kenya. A structured pretested questionnaire was used to obtain demographic data. Lymphocyte subset counts were quantified by standard flow cytometry.</p> <p>Results</p> <p>Of the 4638 pregnant women tested, 309 (6.7%) were HIV seropositive. The majority (85.1%) of the antenatal attendees did not know their HIV status prior to visiting the clinic for antenatal care. The highest proportion of HIV infected women was in the age group 21–25 years (35.5%). The 31–35 age group had the highest (8.5%) HIV prevalence, while women aged more than 35 years had the lowest (2.5%).</p> <p>Women in a polygamous relationship were significantly more likely to be HIV infected as compared to those in a monogamous relationship (p = 0.000). The highest HIV prevalence (6.3%) was recorded among antenatal attendees who had attended secondary schools followed by those with primary and tertiary level of education (6% and 5% respectively). However, there was no significant relationship between HIV seropositivity and the level of education (p = 0.653 and p = 0.469 for secondary and tertiary respectively). The mean CD4 count was 466 cells/mm³(9–2000 cells/mm³). Those that had less than 200 cells/mm³accounted for 14% and only nine were on antiretroviral therapy.</p> <p>Conclusion</p> <p>Seroprevalence of HIV was found to be consistent with the reports from the national HIV sentinel surveys. Enumeration of T-lymphocyte (CD4/8) should be carried out routinely in the antenatal clinics for proper timing of initiation of antiretroviral therapy among HIV infected pregnant women.</p

Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis

BackgroundCOVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting results. ObjectiveThe aim of this study was to examine the relationship between pregnancy status and the clinical COVID-19 severity characterized by the cytokine storm through a systematic review and meta-analysis. MethodsWe searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing the COVID-19 severity cytokine storm outcome were included. COVID-19 severity characterized by a cytokine storm was described using parameters such as intensive care unit admission, invasive mechanical ventilation, mechanical ventilation, hospital admission, pro- and anti-inflammatory cytokine levels, consolidation on chest computed tomography scan, pulmonary infiltration, extreme fevers as characteristic of a cytokine storm, syndromic severity, higher neutrophil count indicative of a cytokine storm, and severe COVID-19 presentation. ResultsA total of 17 articles including data for 840,332 women with COVID-19 were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 with a cytokine storm (random-effects model odds ratio [OR] 2.47, 95% CI 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1%) and 24,352 (3.1%) among pregnant and nonpregnant women with COVID-19, respectively. The fixed-effects model also showed a correlation between pregnancy status and severe COVID-19 with a cytokine storm (OR 7.41, 95% CI 7.02-7.83; P<.001). Considerable heterogeneity was found among all pooled studies (I²=98%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I²=29 %, P=.19), and the funnel plot revealed no publication bias. The subanalysis between single-center and multicenter studies demonstrated similar heterogeneity (I2=72% and 98%, respectively). Sensitivity analysis on each subgroup revealed that pregnancy was significantly related to severe COVID-19 with a cytokine storm from single-center studies (fixed-effects model OR 3.97, 95% CI 2.26-6.95; P<.001) with very low heterogeneity (I²=2%, P=.42). ConclusionsBeing pregnant is clearly associated with experiencing a severe course of COVID-19 characterized by a cytokine storm. The COVID-19 pandemic should serve as an impetus for further research on pregnant women diagnosed with COVID-19 to map out the salient risk factors associated with its severity. Trial RegistrationPROSPERO CRD42021242011; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242011