Knowledge, attitude and practice of post exposure prophylaxis among female sex workers at Majengo, Nairobi

Background: HIV Post-exposure prophylaxis (PEP) is defined as the provision of a short course of antiretroviral drugs soon after a possible or confirmed HIV exposure to HIV negative persons. The aim is to allow a person’s immune system to provide protection against the virus and to prevent HIV from becoming established in someone’s body. However, its use in at*risk populations such as female sex workers has not been studied extensively. Objectives: The main objective of the study was to determine knowledge, attitude and practice in particular use of post exposure prophylaxis among the female sex workers. Study Design: Descriptive cross-sectional survey was carried out at the female sex worker clinic located at Majengo slums, Nairobi. Method: Consecutive sampling method was used to identify study population and 345 participants were sampled and interviewed using semi*structured questionnaire. Results: The average age of the participants was between (25*34years). The mean duration of prostitution was 10 years. The mean number of all type of sexual clients per week was 11.4 (CI: 10.6*12.2). Condom use was high among irregular clients (>90%) as compared to regular clients/boyfriends (6.8%). On sexual practice the study showed that vaginal sex was highly practiced among all sexual clients (90%). The study revealed that 75.7% of the participants had adequate knowledge on PEP. Though 71% of the participants had ever used PEP, majority (68.9%) did not complete the four weeks of treatment. Out of the participants who had ever used EP, 10.3% had used it due to rape and 65.3% condom burst (P<0.01) and 24.4% had used it because they either chose not to use condom or they were paid more not to use condoms The study demonstrated that side effects of drugs (57.4%) and fear of being known that they were using PEP (64.1%) positively affected the uptake of Post exposure prophylaxis. Conclusion: The study demonstrated that the participants adopted safer sexual behaviour which included condom use though more education is needed to use protection even with the boyfriends/regular clients. Most of the participants reported that the reason for PEP use as due to condom burst, there was need for health providers to do health education on proper condom use and the recommended lubricants including demonstration from time to time to avoid condom burst. The results also showed that the study participants rarely practiced risky sexual behaviour like anal sex. The study revealed that 23.4% of the participants had inadequate knowledge on PEP. The major constraint to PEP uptake was side effects and fear that other clients will know that they are on PEP hence there is need for more interventions on PEP in order to increase the level of awareness and adherence

Determinants of active trachoma among children aged 1-9 years in Ol Donyo Nyokie location, Kajiado County, Kenya

Objective: To determine the factors associated with active trachoma among children aged 1-9 years in Ol Donyo Nyokie, Kajiado County.Methods: This was a descriptive cross-sectional study which utilized both quantitative and qualitative techniques for data collection and was carried out at Ol Donyo Nyokie, Kajiado County. Sequential sampling procedure was used to select study participants. A total of 345 mothers together with their children were sampled. The random start was adopted using lottery method and then every 3rd household until a desired sample size of 345 had been achieved. In households with more than one child, one among them was selected by lottery method. Physical examination on the children’s eyes was done while their respective mothers participated in the questionnaire survey supported by observation checklist. Two Focus group discussions were also conducted among mothers and Key Informant interviews among healthcare providers. Results: The overall prevalence of active trachoma was found to be 15.7%. Stratified by age and sex, the younger age group (1-5) years had a 2.13-fold risk of getting active trachoma (χ2 (1) =5.93, p< 0.017; AOR=2.13 [95%: CI=1.15-3.96] compared to the older group (6-9) years. There was however no significant difference between males and females (P>0.05). In the final logistic regression model; Face washing frequency (P<0.001), child’s dirty face(P<0.005), water access >30 mins(P<0.006), mother’s level of education(P<0.017), age of child(P<0.021), monthly income(P<0.029), pit latrine ownership(P<0.039), open defecation(P<0.054) and pit latrine usage (P<0.055) were identified as the predictors of active trachoma. In the Focus Group Discussion, about three quarters (74%) of the mothers were aware of trachoma. Majority of the mothers who were aware of trachoma indicated that water was a major challenge in the area without which trachoma could not be eliminated. Majority of the respondents did not own pit latrines and few of them also disregarded their use. From the Key Informant Interviews most of the respondents confirmed that water, lack of formal education and poverty were the major problems facing the community in the study area.Conclusion: The prevalence was found to be high, which indicates that active trachoma is still a major public health concern in the study area. Poor socio-economic and environmental conditions exacerbate the suffering of the community and make it difficult to prevent and control trachoma. Enhancement of interventions, therefore, particularly of facial cleanliness and environmental sanitation should be addressed to ensure effective prevention and control of trachoma and to bring down the prevalence levels below the WHO threshold of (>10 % prevalence). Community participation in education and outreach services are also crucial.Keywords: Active trachoma, children 1-9 years, risk factors, control and prevention, Kenya.Afr J Health Sci. 2017; 30(2):77-8

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

Timing and Determinants of Tuberculosis Treatment Interruption in Nairobi County, Kenya

Tuberculosis (TB) treatment is a key pillar in the management and control of TB. Service delivery within the treatment facilities plays an important role in ensuring treatment adherence by TB patients. A prospective cohort study involving 25 health facilities, 25 facility in-charge officers and 291 patients diagnosed as new sputum smear positive (SM+) between December 2014 and July 2015 was undertaken. The aim of the study was to estimate the median time to treatment interruption, associated factors and overall predictors of non-adherence to TB treatment. A total of 19 (6.5%) treatment interruptions were observed. The median time to default was 56 [95% CI, 36-105] days. Treatment in a non-public facility [AOR=0.210, 95% CI (0.046-0.952)] and facilities perceived to have adequate number of health care workers to offer Directly Observed Therapy (DOT) [AOR=0.195, 95% CI (0.068-0.56)] showed a lower odds of treatment interruption whereas attainment of secondary level education [AOR=5.28, 95% CI (1.18-23.59)] indicated a higher odds of treatment interruption. Non-clinical aspects of health care service delivery influence patient adherence to TB treatment. Health seeking behavior of groups considered to be high risk for treatment interruption should be incorporated into the design and delivery of TB treatment

Community Knowledge and Perceptions on National School-Based De-Worming Programme

Objectives: To determine the community level of knowledge, attitude and perception of soil transmitted helminthes and the national school-based de-worming programme in selected villages of Busia County in Kenya. Design: A cross-sectional survey. Setting: Busia and Bunyala districts in Busia County. Subjects: A total of 384 participants were studied. Main outcome measures: Socio-demographic characteristics, then knowledge, causes and effects of Soil Transmitted Infections on health and education, prevention strategies, knowledge of national school-based de-worming programming, implementing strategies of the programme, benefits of the programme, community satisfaction and health seeking behaviour. Results: Eating the uncooked food as a cause for soil transmitted infections constituted 27.16% (63) followed by 16.38% (38) not using latrines, 15.95% (37) eating left over foods, 12.93% (30) eating cold food, 10.78% (25) eating not well cooked pork, 9.48% (22) eating contaminated soil, and 7.33% (17) changing of diet. One head teacher interviewed stated that “One can be able to notice if his/her child has worm infection if the child eats without getting satisfied, eating all the time and yet his belly is big.”Community Health Extension Worker in the FGD stated that: “During floods seasons most of the areas in Budalangi become flooded and all latrines are filled with water and the excreta start overflowing. Most of the residents don’t have shoes especially the children and therefore they are prone to the worm infection.”99.57% of the parents were aware of the national school based de-worming programme of which (92%) learnt about the programme after their children were de-wormed in their various schools. Seventy five percent (174) were satisfied about the programme; 65.1% (151) and 10.3% indicated that the programme improves the children’s health and student’s school performance respectively. Conclusion: Most of the parents do not have adequate knowledge on worms, their causes and signs and symptoms of the intestinal worms. Low educational levels and poverty levels also contribute to the lack of awareness on intestinal worms and putting the prevention measures across the board. The study also found out that the community perception towards the de-worming programme was good because the de-worming programme improved the children’s health and performance in education

National study to review existing policy documents and identification of upcoming priority national health policy issues in East African community partner states : Kenya country report

There is lack of clearly referenced verifiable evidence for selected approaches to health issues in Kenya. The paper provides a review of literature, further identifying policy gaps, and to confirm main actors in the primary healthcare sector. Priority areas requiring research evidence are: Health care financing and access; Human resources/personnel for the Health Sector with equitable distribution of health workers to rural and urban areas; government delinking from direct provision of healthcare to concentrate on policy formulation, stewardship and regulatory functions; Shifting from curative services to preventive services

Improved diagnosis of Ziehl-Neelsen smear negative tuberculosis using sodium hypochlorite sedementation method

No Abstract. East African Medical Journal Vol. 84 (10) 2007: pp. 455-45

Sero-prevalence of human cytomegalovirus infection and predisposing factors among HIV infected patients attending comprehensive care clinic at Kenyatta National Hospital, Kenya

Background: Human Cytomegalovirus (hCMV) is one of the opportunistic infections in HIV patients. During an active infection it's a common cause of Pneumonia, retinitis, gastro-intestinal disease, and hepatitis. It is significantly associated as a HIV disease co-factor. It does quicken HIV acquisition, disease progression and high mortality and morbidity in HIV patients. Currently there is scanty data on this disease in Kenya leading to lack of recognition on the magnitude especially in HIV patients.Objective:To determine the sero-prevalence and predisposing factors associated with hCMV infection among HIV infected individuals attending comprehensive care clinic (CCC) at Kenyatta National Hospital, Nairobi County, Kenya.Design: A cross sectional study.Setting: Kenyatta National Hospital.Subjects: A total of 400 consenting patients were systematically sampled from HIV comprehensive clinic of Kenyatta National Hospital between July and August 2015Results: A total of 400 HIV-infected individuals who were 18 years and above with an average age of 42.73 (SD, 9.5) years were screened for CMV infections. Of these, 246(61.5%) were female and 154(38.5%) were male. Of 400,398 (99.0%) were hCMV IgG sero-positive, 32 (8.0%) were hCMV IgM sero-positive. Age group between 19 and 28 years [OR= 4.8 95% CI: (1.4-16.4); P=0.012], never been married [OR= 4.3 95% CI: (1.3-14.5); p=0.020], never had children [OR=3.2 95% CI: (1.2-8.5); p=0.022] and use of highly active anti-retroviral therapy (HAARn [OR=3.5 95% CI: (1.2-10.3); p=0.031]were found to be significantly associated with CMV sero-positivity in bivariate analysis. In multivariate analysis, bothCD4 (p <0.001) and viral loads (p <0.001) were found to be significantly associated with CMV sero-positivity.Conclusion: The 99.0% sero-prevalence of hCMV in the HIV patient's calls for routine screening for hCMV infections in order to prevent neurological clinical manifestations associated with CMV in HIV patients. Human cytomegalovirus preventive measures may be necessary to decrease mortality and morbidity associated with hCMV infections