Factors Influencing Roles Played by Church Leaders in Community Health Programmes’ Sustainability in Homa Bay District-Kenya

Introduction: Sustainability of community health programs in resource limited countries within sub Saharan Africa like Kenya, pose major challenges to most of the governments and the perceived benefiting communities. Churches around the world are involved in one way or another in various types of community development programs. Their involvement promotes sustainability of these programs. Key health indicators in Kenya have been worsening day by day for over decades. Though there is a reverse in most of the indicators, they still remain poor in regards to World Health Organization’s standards. Worse, sustainability of the on going programs remains one key observable challenge that seeks for synergistic partnership. Direct roles played by Church leaders in community Health programs in Homa-Bay District were not clearly understood. What influenced them to or not to play a role in these programs were also not known, yet there were adequate evidences which showed that sustainability of community health programs remained a challenge for decades. This caused a concern for investigation. The aim of the study was therefore to assess factors influencing the roles church leaders’ play in community health programs sustainability in Homa Bay District. It specifically looked at the roles played by church leaders in the design, implementation, monitoring and evaluation of the on going programs together with other partners, their unilateral roles in churches that promote sustainability of ongoing programs and also to determine institutional factors that influence the roles they play in Community Health Programs at the District. Methodology: The study was a cross-sectional exploratory study that employed qualitative approach of data collection. The study population were ordained church ministers, who were either priests or pastors together with their local lay leaders from Catholic, Seventh Day Adventist, Anglican Church of Kenya, Baptist and Full Gospel Churches in Homa Bay District. The findings of the study revealed that, Church leaders play very minimal roles in the programs and they vary from one church to another. What influences their roles were: -        The degree of support from overall church leaders to respective internal committees. -        Adapted policies by partners / church. -        The functionality level of relevant government coordinating structures in the District. In conclusion, church leaders are established to have minimal support to ongoing health programs due to inadequate sensitization and involvement by the government coordinating structures. So there is a need for government to strengthen its commitment towards sensitising church leadership to be involved actively and consistently among other partner

Spatial and temporal distribution of notified tuberculosis cases in Nairobi County, Kenya, between 2012 and 2016

Background: Tuberculosis (TB) is an infectious disease of major public health concern globally. The disease has showed space‐time variations across settings. Spatial temporal assessment can be used to understand the distribution and variations of TB disease.Objective: To determine the spatial and temporal distribution of notified TB cases in Nairobi County, Kenya, between 2012 and 2016Design: A cross sectional studySetting: Nairobi County, KenyaSubjects: Tuberculosis cases notified in Tuberculosis Information for Basic Units from 2012 to 2016Results: A total of 70,505 cases of TB were notified in Nairobi County between 2012 and 2016, with male to female ratio of 3:2 and HIV coinfection rate of 38%.The temporal analysis showed a declining trend of the notified cases. The spatial clusters showed stability in most areas while others varied annually during the study period. The space‐time analysis also detected the four most likely clusters or hotspots. Cluster 1 which covered the informal settlements of Kibera, Kawangware and Kangemi with 4,011observed cases against 2,977expected notified TB cases(relative risk (RR) 1.37, p<0.001). Further, Cluster 2 covered Starehe and parts of Kamukunji, Mathare, Makadara, Kibra and Dagoretti North Constituencies (RR 1.93, p<0.001; observed and expected cases were 4,206 and 2,242, respectively.Conclusion: This study identified high TB case notifications, declining temporal trends and clustering of TB cases in Nairobi. Evidence of clustering of TB cases indicates the need for focused interventions in the hotspot areas. Strategies should be devised for continuous TB surveillance and evidence based decision making

Client experiences with “Dynamic Choice Prevention,” a model for flexible patient‐centred HIV prevention delivery in rural Eastern Africa

IntroductionIdentifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models.MethodsIn-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.ResultsIndividuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.ConclusionsDiverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities-but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health

Intensity of Nematode Infection in Children Aged 3 to 5 Years Living in Mukuru Kwa Njenga Slum Settlement, Nairobi, Kenya

Background. The burden of nematode infections is high mostly in children below 5 years old, with clinical manifestations ranging from mild to painful symptoms due to severe infections that end up suppressing the immune system of the infected children. The occurrence of these infections is highest in areas of extreme poverty. This study evaluated the intensity of nematode infections and assessed the status of deworming in children aged 3 to 5 years living in Mukuru slum settlement, Nairobi County, Kenya. Methodology. A total of 172 children aged between 3 and 5 years were sampled across the 5 major villages of Mukuru Slum settlement: Kwa Njenga, Vietnum, Wapewape, Kwa Reuben, and Motomoto. Community health workers administered questionnaires on the deworming history of children. Stool samples were collected, macroscopically examined, and microscopically analysed using Kato-Katz technique to assess the intensity of infection. The intensities of nematode infections were expressed as eggs per gram (epg) of faeces. Results. The point prevalence of nematode infection among the 98 children in the 1st sampling was 25.5% with a mean infection intensity of 5424 epg, whereas among the 74 children sampled in 2nd sampling, 47.3% had nematode infection with a mean infection intensity of 12384 epg. The average nematode infection for the 172 participants was 34.9% with a mean intensity of 17808 epg. The highest number of children infected with nematodes was in the village of Wapewape where 34 participants were examined and 36.3% were infected with a mean intensity of 3216 epg. Kwa Reuben and Vietnum villages had the same prevalence values of 32.4% where 34 participants in each village had a mean intensity of 3624 epg and 4512 epg, respectively. In both samplings, more than 80% of children had been dewormed more than 6 months prior to the study. Ascaris lumbricoides was the only species of intestinal nematodes identified to be present in the stool samples of children in this study, whereas Trichuris trichiura and hookworm infections were found to be absent. The intensity of infection was not dependent on age or gender

Mesalazine in the initial management of severely acutely malnourished children with environmental enteric dysfunction : a pilot randomized controlled trial

Background: Environmental enteric dysfunction (EED) is an acquired syndrome of impaired gastrointestinal mucosal barrier function that is thought to play a key role in the pathogenesis of stunting in early life. It has been conceptualized as an adaptive response to excess environmental pathogen exposure. However, it is clinically similar to other inflammatory enteropathies, which result from both host and environmental triggers, and for which immunomodulation is a cornerstone of therapy. Methods: In this pilot double-blind randomized placebo-controlled trial, 44 children with severe acute malnutrition and evidence of EED were assigned to treatment with mesalazine or placebo for 28 days during nutritional rehabilitation. Primary outcomes were safety and acceptability of the intervention. Results: Treatment with mesalazine was safe: there was no excess of adverse events, evidence of deterioration in intestinal barrier integrity or impact on nutritional recovery. There were modest reductions in several inflammatory markers with mesalazine compared to placebo. Depression of the growth hormone – insulin-like growth factor-1 axis was evident at enrollment and associated with inflammatory activation. Increases in the former and decreases in the latter correlated with linear growth. Conclusions Intestinal inflammation in EED is non-essential for mucosal homeostasis and is at least partly maladaptive. Further trials of gut-specific immunomodulatory therapies targeting host inflammatory activation in order to optimize the growth benefits of nutritional rehabilitation and to address stunting are warranted. Funded by The Wellcome Trust

Poisoning patterns and factors associated with treatment outcomes among patients: A case study of Kiambu county hospitals, Kenya

Background Rising poisoning incidences worldwide, primarily in developing countries, remain ambiguous due to paucity of data and poison centres. This study evaluates patterns and factors causing poor outcomes in Kiambu County, Kenya. Methods A records-based retrospective cross-sectional study of poisoning cases who presented to nine facilities between June 2015 and July 2020 was conducted. The data collected was analysed through descriptive, bivariate, and multivariate logistic regression using STATA version 13. Results Kiambu county has a minimum prevalence of poisoning of 3.2%. A total of 434 cases were studied. Most cases (85.5%) resulted from acute exposures, with 75% being intentional. Pesticides (61.1%), paraffin (18.7%), alcohol (6.5%), and pharmaceutical drugs (4.4%) were the primary poisons used. 3.9% didn't fit these categories, while 5.5% remained unknown. Common presentations at admission were vomiting (35.3%) and unconsciousness (21.6%). Pesticides were responsible for 72.0% of deaths. Sequelae occurred in 7.8%, full but delayed recovery in 17.6%, and 6.0% died. The largest cluster of total cases was found in Thika town sub-county. It also contained the primary clusters of alcohol and pesticide poisoning. Being male (AOR 4.577, 95% CI [1.244–16.842]) was significantly associated with adverse outcomes. Regardless of the poison, the majority 78.8% made a full recovery. Conclusion Due to the lack of standardized poisoning data tools, patient records lack vital information reflecting the quality of care that the patient received, reflecting a lack of structures to collect, analyse and utilise poisoning data for decision making. This study underpins the need for the establishment of a PC in Kiambu county, Kenya

Improving care engagement for mobile people living with HIV in rural western Kenya.

BackgroundAntiretroviral therapy (ART) assures major gains in health outcomes among people living with HIV, however, this benefit may not be realized by all due to care interruptions. Mobile populations comprise a subgroup that is likely to have sub-optimal care engagement, resulting in discontinuation of ART. We sought to evaluate the barriers to care engagement among highly mobile individuals living with HIV and explore options aimed at improving engagement in care for this group.MethodsQualitative in-depth interviews were conducted in 2020 among a purposive sample of twelve persons living with HIV and eight health care providers in western Kenya, within a mixed methods study of mobility in communities participating in the SEARCH trial (NCT01864603). We explored the barriers to care engagement among mobile individuals living with HIV and explored different options aimed at enhancing care engagement. These included options such as a coded card containing treatment details, alternative drug packaging to conceal drug identity, longer refills to cover travel period, wrist bands with data storage capability to enable data transfer and "warm handoff" by providers to new clinics upon transfer. Data were inductively analyzed to understand the barriers and acceptability of potential interventions to address them.ResultsStigma and lack of disclosure, rigid work schedules, and unpredictability of travel were major barriers to care engagement for highly mobile individuals living with HIV. Additionally, lack of flexibility in clinic schedules and poor provider attitude were identified as health-system-associated barriers to care engagement. Options that enhance flexibility, convenience and access to care were viewed as the most effective means of addressing the barriers to care by both patients and providers. The most preferred option was a coded card with treatment details followed by alternative drug packaging to conceal drug identity due to stigma and longer refills to cover travel periods.ConclusionHighly mobile individuals living with HIV desire responsive, flexible, convenient and patient-centered care delivery models to enhance care engagement. They embraced simple health delivery improvements such as coded cards, alternative drug packaging and longer refills to address challenges of mobility