Factors that Hinder Parents from the Communicating of Sexual Matters with Adolescents in Rwanda

Parent-adolescent communication about sexual matters is one of the means that encourages adolescents to adopt responsible sexual behaviour. However, parents do not discuss sexual matters with adolescents and those who discuss to some extent; little information about sexuality is provided. This study, was, therefore aimed to find out the factors that hindered parents from communicating with their adolescent children on sexual matters. A descriptive, cross sectional study employing both quantitative and qualitative approaches was utilized. Simple random sampling was used to select households of parents/caretakers with adolescents and face to face interviews were used to collect data in February 2011. Out of 388 respondents, majority (81%) reported that they do not discuss sexual matters with the adolescents due to socio-demographic, cultural, individual and socio-environmental factors/barriers. Being male (p=0.04), parents’ age over 44 years (OR< 1 at 95% CI), lower levels of education (≤primary) and income (farming and remittance) was significantly associated with “not communicating” sexual matters with the adolescents (p<0.05). These findings strengthen the need for continued sensitization of parents/caretakers to involve themselves in discussing sexual matters with the adolescents. Furthermore, guidance of parents/caretakers on how to approach the subject of sexuality and sustenance of discussions with the adolescents is paramount.Key words: Communication, Sexual matters, Parents/ Caretakers, Adolescent

Integrated community case management in a peri-urban setting: a qualitative evaluation in Wakiso District, Uganda.

Integrated community case management (iCCM) strategies aim to reach poor communities by providing timely access to treatment for malaria, pneumonia and diarrhoea for children under 5 years of age. Community health workers, known as Village Health Teams (VHTs) in Uganda, have been shown to be effective in hard-to-reach, underserved areas, but there is little evidence to support iCCM as an appropriate strategy in non-rural contexts. This study aimed to inform future iCCM implementation by exploring caregiver and VHT member perceptions of the value and effectiveness of iCCM in peri-urban settings in Uganda.A qualitative evaluation was conducted in seven villages in Wakiso district, a rapidly urbanising area in central Uganda. Villages were purposively selected, spanning a range of peri-urban settlements experiencing rapid population change. In each village, rapid appraisal activities were undertaken separately with purposively selected caregivers (n = 85) and all iCCM-trained VHT members (n = 14), providing platforms for group discussions. Fifteen key informant interviews were also conducted with community leaders and VHT members. Thematic analysis was based on the 'Health Access Livelihoods Framework'.iCCM was perceived to facilitate timely treatment access and improve child health in peri-urban settings, often supplanting private clinics and traditional healers as first point of care. Relative to other health service providers, caregivers valued VHTs' free, proximal services, caring attitudes, perceived treatment quality, perceived competency and protocol use, and follow-up and referral services. VHT effectiveness was perceived to be restricted by inadequate diagnostics, limited newborn care, drug stockouts and VHT member absence - factors which drove utilisation of alternative providers. Low community engagement in VHT selection, lack of referral transport and poor availability of referral services also diminished perceived effectiveness. The iCCM strategy was widely perceived to result in economic savings and other livelihood benefits.In peri-urban areas, iCCM was perceived as an effective, well-utilised strategy, reflecting both VHT attributes and gaps in existing health services. Depending on health system resources and organisation, iCCM may be a useful transitional service delivery approach. Implementation in peri-urban areas should consider tailored community engagement strategies, adapted selection criteria, and assessment of population density to ensure sufficient coverage

EFFECT OF COVI-SOUP ON CD4 CELL COUNT AND HAEMOGLOBIN AMONG PATIENTS WITH DIABETES TYPE II AND HYPERTENSION IN KAKAMEGA COUNTY, KENYA: A RANDOMIZED CONTROL TRIAL

Type II diabetes mellitus (DM) and hypertension (HTN) diseases are part of the world’s challenges in achieving sustainable development goals. Cases of type II diabetes mellitus and hypertension diseases in low and middle-income countries are becoming a concern. Type II diabetes mellitus is an inflammatory disease. When there is inflammation the immune system is triggered and haemoglobin level is affected. While there have been numerous strategies to address the issue, these efforts have not been sufficient to guarantee a reduction in disease severity. This was an experimental study conducted in Kakamega County, Kenya. It employed a randomized control trial approach, with two groups: treatment and control. Systematic random sampling was used in identifying participants and simple randomization was used to allocate the respondent to the intervention groups. Sample sizes of 34 (treatment group) and 30 (control group) were used to produce quantitative data. This study evaluated the effect of COVI-soup on haemoglobin (Hb) and cluster of differentiation 4 (CD4) cell count of patients living with both type II diabetes mellitus and hypertension. The treatment group received COVI-soup (a soup composed of butternut squash, ginger, garlic, sunflower pepper, chia seeds and turmeric) while the control group was on a rice soup. Statistical Packages for Social Science (SPSS) version 20 was used in the data analysis. A paired student t-test was used to determine the effect of COVI-soup on Hb and CD4 cell count. There was a positive effect in CD4 cell count in the treatment group (P =0.001) whereas there was no significant effect in the control group (P =0.267). The mean change in CD4 cell count in the treatment group was 97 cells/ul and in the control 75 cells/ul. There was a positive effect (increase) on hemoglobin levels in the treatment group (p=0.0001) whereas there was no significant effect in the control group (p =0.126). The hemoglobin mean change in the treatment group was 3.9 g/dl and in the control 0.5 g/dl. Therefore, COVI-soup had a positive effect on hemoglobin and CD4 cell count levels among patients with both hypertension and type II diabetes mellitus

Effective training-of-trainers model for the introduction of continuous positive airway pressure for neonatal and paediatric patients in Kenya

Background: Continuous positive airway pressure (CPAP) is a relatively low-cost technology which can improve outcome in neonatal and paediatric patients with respiratory distress. Prior work in a lower middle-income country demonstrated degradation of CPAP skills and knowledge after the initial training. Aims: To determine if a training-of-trainers (ToT) curriculum can decrease gaps in skills and knowledge between first-generation (trained by a United States physician and nurse) and second-generation healthcare providers (trained by local trainers) in Kenya, and to describe the usage pattern, outcome and safety in patients who received CPAP following the trainings. Methods: The first day of training entailed didactic and simulation sessions. On the second day participants were taught how to train others to use CPAP. First- and second-generation healthcare providers were tested on their skills and knowledge. Unpaired t-tests were used to test for equivalence. Prospective data on CPAP usage was collected following the initial trainings. Results: 37 first-generation healthcare providers (16 nurses; 21 physicians, medical/clinical officers) were trained as trainers and 40 second-generation healthcare providers (19 nurses, 21 physicians, medical/clinical officers) trained by first-generation healthcare providers were available for skills and knowledge testing. There were no statistically significant differences between first- and second-generation healthcare providers’ skills (90%, 95% CI 87–93 vs 89%, 95% CI 86–92) or knowledge scores (91%, 95% CI 88–93 vs 90%, 95% CI 88–93). A total of 1111 patients were placed on CPAP mostly by nurses (61%), prematurity/acute respiratory distress syndrome was the most common indication, nasal injury/bleeding (2%) was the most common reported adverse event, and the overall mortality rate was 24%. Conclusion: The ToT model was successful, nurses initiated CPAP most commonly, prematurity with acute respiratory distress syndrome was the most common indication, and adverse events were uncommon.</p