Cervical cancer screening uptake among women in Naivasha

Background: About 86% of the cases of cervical cancer occur in developing countries. In Kenya, cervical cancer represents 21% of all cancers in women. With a development period as long as ten years, cervical cancer is possible to control through screening and treatment. Several projects in reproductive health have been offering cervical cancer screening using visual methods through visual inspection with acetic acid or visual inspection with Lugol’s iodine (VIA/VILI). Family planning counselling programs are a good opportunity to discuss the benefits of cervical cancer screening with gynaecological examination more easily accepted. The study looked at the outcomes in relation to screening.Methods: A total of 384 women aged 18 – 49 years were enrolled through systematic sampling in the descriptive cross sectional study. These were clients who attended the family planning clinic in June-July 2014. Participants answered questions from semi-structured questionnaires.Results: Participants who reported to have been screened for cervical cancer were 15.4%. Those screened during the study period were 2.3% and of these, 44.4% had positive VIA/VILI results. Age-group, residence, employment status and usual treatment centre were significant in relation to cervical cancer screening uptake.Conclusion: The availability of screening services in clinics that clients normally attend does not translate into high proportions in cervical cancer screening uptake. However, targeted screening will result in more positive cases being reported.Keywords: Cervical cancer screening uptake, VIA/VILI, family planning clinic, KenyaAfr J Health Sci. 2014; 29(1):13-2

Factors Associated with Cervical Cancer Screening Uptake in Naivasha District, Kenya

The objective was to determine and explore factors associated with cervical cancer screening uptake among women attending the family planning clinic at a public hospital in Naivasha District. A concurrent triangulation mixed study method was used. Using systematic sampling, 384 women aged 18-49 years of age were enrolled into the study. Data was collected through semi-structured questionnaires. After purposive sampling 7 key informant interviews and 2 focus group discussions were conducted using interview guides among women treated at the family planning clinic. Data from the quantitative study was analyzed for descriptive statistics, bivariate (unpaired student’s t-test, Chi-square) and multivariate analysis (Binary logistic regression analysis) while themes were used to analyze data from the qualitative study. Using multivariate analysis, employment status, usual treatment center, risk of cervical cancer, having heard of cervical cancer and knowing someone who had been screened were factors found to be significantly associated with cervical cancer screening uptake. Large number of clients, inadequate screening rooms, inadequate information and misconception of facts on cervical cancer screening were identified as common barriers to uptake of screening. Hospital talks were the most preferred source of getting information related to cervical cancer. In conclusion, policy makers should establish a comprehensive strategy that ensures programs in health facilities and outreaches educate those accessing their facilities well so as to increase cervical cancer screening uptake. Keywords: Cervical cancer screening; VIA/VILI; family planning clinic; Naivasha referral public hospital; Health access

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

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 (>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 (>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

Effects of Mega Dose Micronutrient Supplementation On Serum Zinc, Retinol and Immune Status of Adult Males and Females Diagnosed with and Without HIV, Malaria and TB in Western Kenya – An Unpublished Perspective as at The Year 2004

Background: The role of micronutrients in management of HIV/AIDS, malaria and TB remains poorly understood worldwide. Objectives: To assess differences in mega dose nutritional management between HIV-seronegative and seropositive adult males and females diagnosed with HIV at Voluntary Testing and Counseling Centers (VCT) in Western Kenya. Methods: This was a randomized controlled study in which 90 subjects were recruited on the basis of an HIV-seropositive result from a voluntary and counseling center (VCT) using rapid HIV test kits. They were evaluated at baseline and every 4 weeks for 3 months to establish their clinical, biochemical and immunological status. After 12 weeks, 74 clients were still in the study, 9 were lost to follow-up while 7 had died. Of the 74 who completed the study, confirmation of baseline HIV status by ELIZA revealed that 63 were HIV-seropositive while 11 were HIV-seronegative despite losing spouses to HIV/AIDS. Correlations between parameters at baseline, during and after intervention were determined; Spearman’s Rho Coefficients indicating the level of significance. Group means were used to compare continuous data while categorical data was compared using Chi-Square. Results: Significant reductions in the clinical manifestation of disease were noted in the cohort after intervention for 12 weeks. Despite the large and different micronutrient dosages used between the two study arms, the only difference by arm of intervention was in the serum vitamin E level at 4 weeks which was much higher in arm 1 than it was in arm 2 of the study (p = 0.005). This might have been occasioned by the significant repletion of zinc in both arms, probably because use of citric acid in both arms improved zinc up-take from the supplements, food and/or reserves enabling other nutrients to be appropriately restored in both arms, these supporting the decision to pool the study arms and compare differences by HIV-seronegative and seropositive, notwithstanding the small sample sizes recruited but which nonetheless were our study limitation. Independent of the intervention arms, reduction of viral load by more than 0.5 log10 copies/ml correlated with higher baseline optical densities of HIV antibodies (P = 0.016) and higher baseline viral loads (p = 0.0001). A lower optical density of HIV antibodies at baseline correlated with higher serum zinc levels at 12 weeks (p = 0.008) and a lower Body Mass Index (BMI) at baseline (p = 0.029). Independent of the arm of study, a significant increase in CD4 cells counts post intervention correlated with lower baseline viral loads (p = 0.010), lower baseline NK cell counts (p = 0.007

Khat use and psychotic symptoms in a rural Khat growing population in Kenya: a household survey

Background:Khat is an amphetamine like psychostimulant chewed by over 10 million people globally. Khat use is thought to increase the risk of psychosis among its chewers. The evidence around this however remains inconclusive stemming from the scanty number of studies in this area and small study sample sizes. We undertook a large household survey to determine the association between psychotic symptoms and khat chewing in a rural khat growing and chewing population in Kenya. Methods:For this cross-sectional household survey, we randomly selected 831 participants aged 10 years and above residing in the Eastern region of Kenya. We used the psychosis screening questionnaire (PSQ) to collect information on psychotic symptoms and a researcher designed sociodemographic and clinical questionnaire to collect information on its risk factors. We used descriptive analysis to describe the burden of khat chewing and other substance use as well as rates and types of psychotic symptoms. Using a univariate and multivariate analyses with 95% confidence interval, we estimated the association between khat chewing and specific psychotic symptoms. Results:The prevalence of current khat chewing in the region was at 36.8% (n = 306) with a male gender predominance (54.8%). At least one psychotic symptom was reported by 16.8% (n = 168) of the study population. Interestingly, psychotic symptoms in general were significantly prevalent in women (19.5%) compared to men (13.6%) (p = 0.023). Khat chewing was significantly associated with reported strange experiences (p = 0.024) and hallucinations (p = 0.0017), the two predominantly reported psychotic symptoms. In multivariate analysis controlling for age, gender, alcohol use and cigarette smoking, there was a positive association of strange experiences (OR, 2.45; 95%CI, 1.13–5.34) and hallucination (OR, 2.08; 95% C.I, 1.06–4.08) with khat chewing. Of note was the high concurrent polysubstance use among khat chewers specifically alcohol use (78.4%) and cigarette smoking (64.5%). Conclusions:Psychotic symptoms were significantly elevated in khat users in this population. Future prospective studies examining dose effect and age of first use may establish causality

ケニア沿岸部における新たな地域密着型栄養教育プログラムによる食事の多様性と推奨される給餌方法に対する態度の向上-介入研究

長崎大学学位論文 [学位記番号]博（医歯薬）甲第1342号 [学位授与年月日]令和3年3月22

Contextually appropriate communication strategies for COVID-19 prevention in Kenya border regions: evidence from a mixed methods observational study in Busia and Mandera counties

Kenya has long and porous borders with its neighbouring countries. These regions, predominantly inhabited by highly mobile rural communities with strong cross-border cultural ties, present major challenges in managing movement of people and COVID-19 preventive measures. Our study sought to assess knowledge of COVID-19 prevention behaviours, how these varied by socioeconomic (SEC) factors and the challenges of engagement and implementation, in two border counties of Kenya. We conducted a mixed methods study using a household e-survey (Busia, N=294; Mandera, N=288; 57% females, 43% males), and qualitative telephone interviews (N=73: Busia 55; Mandera 18) with policy actors, healthcare workers, truckers and traders, and community members. Interviews were transcribed, English translated and analysed using the framework method. Associations between SEC (wealth quintiles, educational level) and knowledge of COVID-19 preventive behaviours were explored using Poisson regression. Participants were mostly educated to primary school level (54.4% Busia, 61.6% Mandera). Knowledge of COVID-19 prevention varied by behaviour: hand washing-86.5%, use of hand sanitiser-74.8%, wearing a face mask-63.1%, covering the mouth when sneezing or coughing-56.3% and social distancing-40.1%. Differences in knowledge by area, educational level and the wealth index were marked, greatest for Mandera, the less educated and the poor. Interviews with stakeholders revealed challenges in health messaging, psychosocial and socioeconomic factors, lack of preparedness for truck border crossings, language barrier, denial and livelihood insecurity as key challenges to engagement with and implementation of COVID-19 prevention behaviours in the border regions. The influence of SEC disparities and border dynamics on knowledge and engagement with COVID-19 prevention behaviours calls for contextually appropriate risk communication strategies that are cognisant of community needs and local patterns of information flow. Coordinating response measures across border points is crucial in winning communities' trust and maintaining essential economic and social activities. [Abstract copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

Adult population as potential reservoir of NTD infections in rural villages of Kwale district, Coastal Kenya: implications for preventive chemotherapy interventions policy

<p>Abstract</p> <p>Background</p> <p>Neglected tropical diseases (NTDs) are major public health problems in developing countries where they contribute to suffering of populations living in poor settings. As part of a research project started in September 2009 in Kwale district, Coast Region, Kenya, a baseline cross-sectional survey was conducted in 5 rural villages to provide information on the status of NTDs, including urinary schistosomiasis, soil-transmitted helminthiasis (STH), and lymphatic filariasis. This paper presents the results of a parasitological investigation among adults in the study villages.</p> <p>Methods</p> <p>A total of 599 adults in the 5 study villages were tested for NTD infections in urine, stool and blood. The presence of <it>Schistosoma haematobium </it>infection was determined by the urine filtration method. The presence of STH in stool was determined by Kato-Katz method while filarial antigenaemia was determined using immunochromatographic (ICT) test.</p> <p>Results</p> <p>The study revealed high prevalence of hookworm (41.7%) and schistosomiasis (18.2%) infections among adults in the study villages. Of the 599 individuals examined, 50.1% had one or more helminthic infections. There was low level of polyparasitism with helminthic NTDs in the study population with 9.5% and 1.7% of the participants having two and three infections, respectively.</p> <p>Conclusions</p> <p>In the current study, hookworm and schistosomiasis infections were identified as important infections among adults living in areas of high endemicity for these infections. Thus, if this section of the population is left untreated it may remain an important potential reservoir and a source of re-infection for school-age children treated in school deworming programmes. Therefore, there is a need to design novel strategies for preventive chemotherapy interventions that could allow inclusion of adults in an effort to reduce force of infection in high endemic communities.</p

Major and minor surgery output at district level in Kenya: review and issues in need of further research

Major and minor surgery is a service of great importance both for the people in need and for health workers and managers trying to develop a comprehensive primary health care service. While in highly industrialised countries some 5000 - 9000 major operations are performed per 100,000 people per year, the rates in East Africa in the early 1990s were in the range of 70-500. In our study all surgical operations performed at hospitals and clinics in Meru district during 12 months in 1990-1991 were listed on record forms including age, sex and home address of patients, and type of operation. Totally 3,415 major operations were recorded, corresponding to 263/100,000 people (88 for males and 434 for females), and the most common major operations were caesarean section, tubal ligation, explorative laparotomy, eye/lens removal and hernia repair. Assuming that the basic need in eastern Africa is about 1,000 major operations/100,000/year it appears that only 7-50% of this basic need was available in this rural area. The epidemiological basis for such estimates is however rather weak and the information systems are unsatisfactory. More accurate data are required both on descriptive epidemiology and on surgical service output as a basis for planning. Comparisons are difficult due to poorly standardised epidemiology and output indicators. We examine, from a health planning perspective, four possible methods of quantifying the major surgery output: (a) the annual number of major operations per 100 hospitals beds; (b) the number per 1000 inpatient admissions; (c) the number per 10,000 new out-patient consultations; and (d) the annual number per 100,000 catchment area population. The mean number per 100 beds was 310 with a range from 452 to 140; the mean number per 1000 admissions was 74 ranging from 88 to 31, the number per 10,000 new outpatient visits was 96 ranging from 188 to 55, and the mean number per 100,000 catchment area population was 263 for the entire district with a range from 383 to 119 among the five hospitals. We conclude that option (1) and (2) are useful and implementable, (3) is less useful but implementable, and option (4) is potentially very useful but not easily implementable until a catchment area population definition is agreed. Minor surgery is even less well investigated, and there are hardly any studies at all from low-income countries. Our data from Meru demonstrate that the one-year output in a population of 1.3 million people was 26,858 (2,066/100,000 people/year) of which about 82% were done at the hospitals in the area. The smaller clinics did on average only 1.8-6.4 minor operations per month. The basic need for minor surgery in these areas has not been estimated, so the unmet need must be considered unknown. Further research is recommended in the following areas: epidemiological estimates of surgical service need in eastern Africa, critical review of the health information systems with regard to surgery, quality of major and minor surgery services especially in rural areas, reasons for low surgical output at small clinics; possible remedies. [Afr. J. Health Sci. 2002; 9: 17-25