Factors influencing utilisation of wellness centre services among men who have sex with men in Tumaini wellness centres, Kisumu and Awendo towns, Kenya

Background: Men who have sex with men (MSM) are a crucial and marginalised at risk population for HIV in Africa but have not in the past been given a lot of attention. Like other areas of Africa, homosexuality is illegal in Kenya and hence most gay and other same-sex practicing Kenyans live in highly stigmatising and discriminatory settings, which put them at risk of emotional and/or physical harm.Objective:To determine factors influencing utilisation of Wellness Centre services by Men who have Sex with Men inTumaini Wellness Centres in Kisumu and Awendo towns.Design:A retrospective Cohort Study.Setting: TumainiWellness centre in Kisumu and Awendo towns between 2012 and 2015.Subjects:Three hundred and fifty three Men who have sex with men who had been enrolled in the Wellness Centre in Kisumu City and Awendo town between 2012 and 2015.Results:The study used consecutive sampling to select a sample size of 198 MSM. However, the study obtained 353 responses, which gives a response rate of more than 100%. The association between current utilization of Wellness Center services andindependent variables (uptake of STI screening service, condom uptake, uptake of Alcohol and Drug use and uptake of Risk reduction counselling) were assessed by use of chi-square. The results show that the factors influencing Screening for STIs in wellness centres include marital status (p=0.0398), Town of residence (p=0.002), knowledge on the correct use of the condom (p=0.016), HTC counselling (p=0.013) and receiving of results (p=0.013). In addition, factor influencing condom distribution in the wellness centres include knowledge on the correct use of condoms (p=0.0001), consistent use of condoms (p=0.001), negotiating of condom use with regular partner and casual partner (p=0.001) and alcohol influence (p=0.016). The study also established that factors that significantly influence uptake of alcohol and drug use screening services were drug use in the past 30 days (p=0.017) and HTC counselling (p=0.039). It was also established that HTC counselling (p=0.001), receiving of HIV results (p=0.0013) and negotiation for condom use with regular partner and casual partners (p=0.008) influence the uptake of risk reduction counselling were age of the MSM.Conclusion: Age of MSM, knowledge on condom use, Alcohol use and HTC results are some of the factors that influence uptake of Wellness Centre Services. This study recommends that governmental organisations such as NASCOP should setup wellness centres that cater for high risk groups like men who have sex with men to offer treatment and specialised counselling as part of HTS and STI services that is confidential and sensitive to the needs of men who have sex with men. In addition, both governmental and non-governmental organizations should increase the coverageof HTC by establishing more MSM friendly centres. In addition, the governmental and non-governmental organisations should seek to integrate HTC services and STIs screening in wellness centres

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

Accelerated nitridation and oxidation by plasma on polyethylene

Glow discharges of oxygen and nitrogen were applied to low density polyethylene thin films in order to study accelerated oxidation and nitridation in the polymer. The studies were focused on the morphologic, crystalline and hydrophilic evolution promoted by plasma exposure. The particular chemical characteristics of the gases and the constant impact of high-energy particles on the surfaces produced different types of erosion. Oxygen plasmas produced the release of fragments from the polymeric surface which created fibered textures and nitrogen plasmas resulted in folded morphologies of nano and micro dimensions on polyethylene. The plasmas of both gases increased and decreased the crystallinity in the polymers, between 33% and 57%, with similar tendencies, differing only in the percentage of crystallinity. The plasma exposure produced a decrease in the contact angles of water on polyethylene in the first 30 min of plasma, from 70% in the untreated polymers, to 45% and 35% as a consequence of the polar groups added to the surface

Accessibility of esssential medicines for non-communicable diseases in a devolved government in Kenya – the case for trans Nzoia county of western Kenya

Objective: The study sought to determine the accessibility (affordability and physical access) to essential medicines for the four major non communicable in Trans-Nzoia County.Design: The design was a descriptive cross-sectional study carried out for three months among outpatients with non-communicable diseases.Setting: The study was conducted in five hospitals within Trans Nzoia County western Kenya using qualitative and quantitative methods.Participants and interventions: Patients and key informant personnel were interviewed. Secondary documents from the health facility were reviewed. The sample size used was 320 participants attending the medical outpatient clinics.Data obtained was analyzed using descriptive and inferential statistics. The level of significance was p = 0.05.Results: The study found the essential medicines for non-communicable diseases to be affordable on the basis of minimum daily wage calculation at 0.309 days’ wages, in contrast with the majority participant (78%) reported the medicines not affordable. Medicines for management of chronic obstructive pulmonary disease were found to be most costly with affordability rating of 0.449 days’ wages. Health facilities where participants received essential medicines for non-communicable diseases were geographically accessible with most participants at 92% using 1 hour or less to get to the facility. Cost of transport means was found to be 0.52 days’ wages constituting an impediment to accessibility.Conclusion: With an epidemiological change in Kenya from communicable diseases to non-communicable diseases, there is need for renewed focus on access to essential medicines for these conditions as reflected by the formation of division of non-communicable disease in the ministry of Health. Based on the study findings, there is need to increase healthcare funding by the county governments for purchase of essential medicines for non-communicable diseases to improve accessibility and affordability by the general population

Dielectric study of the phase diagram of the poly(γ‐benzyl‐L‐glutamate)/dimethylformamide system

The phase diagram for solutions of poly(γ‐benzyl‐L‐glutamate) in dimethylformamide has been investigated over the entire composition and temperature ranges with dielectric spectroscopy. The dielectric response in this system is dominated by ionic mobility, and phase transitions have been detected as changes in the ionic conductivity. The phase boundaries, determined by dielectric spectroscopy, are consistent with earlier published results obtained by a combination of optical microscopy observations and nuclear magnetic resonance and differential scanning calorimetry studies.A. Dereszewska acknowledges the support of the Donostia International Physic Center and a scholarship from the Spanish Government through the Ministerio de Asuntos Exteriores. A. Alegria acknowledges the support of the Basque Country Government (project 9/UPV 00206.215‐13568/2001) and the Spanish Ministry of Science and Technology (project MAT 2001/0070).Peer reviewe