Factors influencing cervical cancer screening in a Kenyan Health Facility: a mixed qualitative and quantitative study

Background: Cervical cancer is the commonest cause of cancer-related morbidity and mortality among women in developing countries in sub-Saharan Africa. Screening for cervical cancer among HIV infected women is crucial as they are more at risk of developing the disease and progressing faster once infected with Human Papilloma Virus (HPV).Methods: We aimed to determine the factors affecting the utilization of cervical cancer screening among HIV infected women above 18 years of age at Kenyatta National Hospital by conducting a cross-sectional mixed quantitative and qualitative methods study. Descriptive and inferential analysis was carried out on quantitative data to determine significant associations with cervical cancer utilization. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising.Results: Three hundred and twenty eight of the total 387 women enrolled reported they had been advised by their health providers to go for screening. However, only 179 (46%) reported cervical cancer screening.  Women were more likely to report cervical cancer screening if recommendation by a staff was made (p <0.001), and prior to joining KNH CCC (p <0.001). Qualitatively the main barrier to screening included fear of screening due to concerns about excessive pain or bleeding, lack of proper communication on screening procedures and long waiting timeConclusions: The utilization of cervical cancer screening services was low despite high rates of health care recommendation. The women were more likely to utilize the service if recommendation from the health care worker was made, and if they had ever screened before

Cotrimoxazole prophylaxis impact on Cd4+ cells & infection reduction in HAART naïve HIV infected adults in our urban population, Kenya

Background: The study was undertaken to explore and generate information on the morbidity patterns in HAART Naïve HIV infected adults on oral Cotrimoxazole prophylaxis (CTXp) attending Mbagathi and Kenyatta National Hospitals, comprehensive care centres.Methods: A qualitative , retrospective study design of mixed methods was used which comprised; Clinical data extraction and Secondary data analysis of 450 personal medical records that existed and which met inclusion criteria based on age, baseline CD4+ cells ≥ 350 count, non-pregnant, absence of active TB and on  CTXp for duration of six months at the time of enrollment.Results: The study showed that patients in both Mbagathi district and Kenyatta National hospitals comprehensive care centres (CCC) had at baseline CD4+ cells range; 350-600 and later at 12 months CD4+ cells range; 400-1500. Patients of younger age, when given CTXp, had a consistent high CD4+ cells count (above 1000 CD4+ cells count) while those of older age had CD4+ levels that were fluctuating. The median age was 31 years. In over 50% documentation, common infections were frequent and patients treated with essential antimicrobial drugs. We observed that CTXp prophylaxis may have reduced severity of infections and this could also have supported up to 60% of the resolved infections. The self-reported adherence to CTXp was observed as part of quality monitored care.Conclusion: The findings of this study support work in a number of literature in other studies done outside Kenya on CTXp not associated with a worsened progression of HIV disease. Stockouts should be avoided due to public health implications. Further studies may be done to find out what potential CTXp has on HIV infected Kenyan patients with serious threat of bacterial infections in conjunction with the customized highly active antiretroviral therapy (HAART)

Risk factors for human brucellosis in northern Tanzania

Little is known about the epidemiology of human brucellosis in sub-Saharan Africa. This hampers prevention and control efforts at the individual and population levels. To evaluate risk factors for brucellosis in northern Tanzania, we conducted a study of patients presenting with fever to two hospitals in Moshi, Tanzania. Serum taken at enrollment and at 4–6 week follow-up was tested by Brucella microagglutination test. Among participants with a clinically compatible illness, confirmed brucellosis cases were defined as having a ≥ 4-fold rise in agglutination titer between paired sera or a blood culture positive for Brucella spp., and probable brucellosis cases were defined as having a single reciprocal titer ≥ 160. Controls had reciprocal titers &lt; 20 in paired sera. We collected demographic and clinical information and administered a risk factor questionnaire. Of 562 participants in the analysis, 50 (8.9%) had confirmed or probable brucellosis. Multivariable analysis showed that risk factors for brucellosis included assisting goat or sheep births (Odds ratio [OR] 5.9, 95% confidence interval [CI] 1.4, 24.6) and having contact with cattle (OR 1.2, 95% CI 1.0, 1.4). Consuming boiled or pasteurized dairy products was protective against brucellosis (OR 0.12, 95% CI 0.02, 0.93). No participants received a clinical diagnosis of brucellosis from their healthcare providers. The under-recognition of brucellosis by healthcare workers could be addressed with clinician education and better access to brucellosis diagnostic tests. Interventions focused on protecting livestock keepers, especially those who assist goat or sheep births, are needed

Risk factors for human acute leptospirosis in northern Tanzania

Introduction: Leptospirosis is a major cause of febrile illness in Africa but little is known about risk factors for human infection. We conducted a cross-sectional study to investigate risk factors for acute leptospirosis and Leptospira seropositivity among patients with fever attending referral hospitals in northern Tanzania. Methods: We enrolled patients with fever from two referral hospitals in Moshi, Tanzania, 2012–2014, and performed Leptospira microscopic agglutination testing on acute and convalescent serum. Cases of acute leptospirosis were participants with a four-fold rise in antibody titers, or a single reciprocal titer ≥800. Seropositive participants required a single titer ≥100, and controls had titers &#60;100 in both acute and convalescent samples. We administered a questionnaire to assess risk behaviors over the preceding 30 days. We created cumulative scales of exposure to livestock urine, rodents, and surface water, and calculated odds ratios (OR) for individual behaviors and for cumulative exposure variables. Results: We identified 24 acute cases, 252 seropositive participants, and 592 controls. Rice farming (OR 14.6), cleaning cattle waste (OR 4.3), feeding cattle (OR 3.9), farm work (OR 3.3), and an increasing cattle urine exposure score (OR 1.2 per point) were associated with acute leptospirosis. Conclusions: In our population, exposure to cattle and rice farming were risk factors for acute leptospirosis. Although further data is needed, these results suggest that cattle may be an important source of human leptospirosis. Further investigation is needed to explore the potential for control of livestock Leptospira infection to reduce human disease

Socio-Economic and Institutional Constraints to Accessing Credit among Smallholder Farmers in Nyandarua District, Kenya

Amongst the challenges faced by smallholder farmers in production is inaccessibility to credit. This study sought to identify household socio-economic and institutional constraints influencing access to credit among smallholder farmers in Nyandarua District. The study used a Logit model. Both quantitative and qualitative data were acquired from primary and secondary sources. Primary data was collected using questionnaires through a survey design. A sample of 164 smallholder farmers was selected using stratified, multi-stage random sampling techniques. Data was analyzed using descriptive statistics and maximum likelihood method using Statistical Package for Social Sciences (SPSS). The study established that socio-economic constraints such as age, gender, household size, farm income, collateral and awareness are critical determinants of access to credit. The study also established that institutional requirements such as costs involved in operating / maintaining bank accounts, loan requirements and transaction costs involved in the credit process influenced access to credit. The study concludes that household socio-economic characteristics and institutional requirements influence access to credit. Key recommendations made include the need by government to deal with bureaucracies involved in land registration to benefit majority of smallholder farmers who remain insecure in the land they use without proof of ownership and also to make easier the registration of lease certificates for those who do not own land and use land on leasehold tenure system. Financial institutions should also put in place less stringent credit requirements and reduce credit costs especially interest rates to make credit more affordable. Keywords: socio-economic and institutional constraints, credit access, smallholder farmers, logit model

Analysis of Farmers’ Perceptions of the Effects of Climate Change in Kenya: the Case of Kyuso District

A cross-sectional analysis was carried out to evaluate how farmers in Kyuso District have perceived climate change. Data was collected from 246 farmers from six locations sampled out through a multistage and simple random sampling procedure. The logistic regression analysis was carried out to assess factors influencing farmers’ perceptions of climate change. The analysis revealed that 94% of farmers in Kyuso District had a perception that climate was changing.  In this regard, age of the household head, gender, education, farming experience, household size, distance to the nearest input/output market, access to irrigation water, local agro-ecology, access to information on climate change, access to extension services, off farm income and change in temperature and precipitation were found to have significant influence on the probability of farmers to perceive climate change. Since the level of perception to climate change revealed by the study was found to be high (94%), the study suggests that more policy efforts should thus be geared towards helping farmers to adapt to climate change. Key words: Climate change, Perceptions, Logistic regression, Kyuso District

Assessment of Farmers’ Adaptation to the Effects of Climate Change in Kenya: the Case of Kyuso District

The study was carried out to assess how farmers in Kyuso District have adapted to the effects of climate change. Survey data was collected from 246 farmers from six locations that were sampled out through a multistage and simple random sampling procedure. The probit regression model was fitted into the data in order to assess factors influencing farmers’ adaptation to the effects of climate change. The analysis revealed that 85% of the farmers had adapted in various ways to the effects of climate change. In this regard, the age of the farmer, gender, education, farming experience, farm income, access to climate information, household size, local agro-ecology, distance to input/output market, access to credit, access to water for irrigation, precipitation and temperature were found to have significant influence on the probability of farmers to adapt to climate change. The study suggests that more policy efforts should thus be geared towards helping all the farmers in the district to adapt to climate change. Key words: climate change, adaptation, probit regression model, Kyuso District

Good immune restitution but unsatisfactory viral suppression in children on ART in a remote Western Kenya area

Mexico AIDS Conference 200

Safeguarding Intangible Cultural Heritage: a photobook of traditional foodways of the Isukha and East Pokot communities of Kenya

This photobook presents the results of traditional foodways documentation conducted in Isukha and East Pokot communities of Kenya within the project ‘Safeguarding traditional foodways of two communities in Kenya’ executed by UNESCO Nairobi Office. The documentation was undertaken between 2008-2012 largely by pupils of primary schools in Isukha and East Pokot. The pupils received great assistance from their teachers, local project coordinators and the project team mainly consisting of staff from National Museums of Kenya, Bioversity International and the Department of Culture

Safeguarding Intangible Cultural Heritage: traditional foodways of the Isukha community of Kenya

This document presents the results of documentation of traditional foodways conducted in the Isukha community of Kenya within the project ‘Safeguarding traditional foodways of two communities in Kenya. The documentation was undertaken between 2010-2012 largely by pupils of two primary schools– Muraka and Shihuli assisted by their teachers, a local project coordinator and the project team mainly consisting of staff from National Museums of Kenya, Bioversity International and the Department of Culture