Factors influencing high prevalence of Fresh Still Births in Mbagathi County Hospital, Nairobi - Kenya

Background: The annual global burden of stillbirths is approximately 2.6 million, 98% of which occur in Sub Saharan Africa. In 2016, approximately 24 still births per month occurred in Mbagathi County Hospital (MCH) representing a 33.3% increase from 2015. A third of these were Fresh Still Births (FSBs). Objectives: To establish factors influencing increase in FSB among women delivering at MCH. Methodology: The study was conducted at MCH postnatal ward. A descriptive cross sectional study design was employed. Forty three respondents with FSBs were consecutively sampled. Clearance to conduct the study was sought from Ethics Review Committee, MCH and respondents. Researcher administered questionnaires were used for data collection over two months. Descriptive data involved calculation of measures of central tendency. Findings were presented in tables, graphs and narrative. Results: A majority of the respondents were less than 20 years old, had low education level and were unemployed. Also the biggest proportion had preterm deliveries; prolonged premature rupture of membranes, had medical conditions and attended antenatal care less than four times. Most of the FSBs had complications and were delivered preterm. The facility had inadequate staffing, lacked prompt triaging equipment, and rarely used partograph to monitor labor. Conclusion: Maternal, fetal and hospital related factors influenced high prevalence of FSB. Recommendations: Improve uptake of focused antenatal care among women. Need for girl child empowerment in line with Sustainable Development Goal 5. Improve midwife to patient ratio, develop protocol regarding triaging and labor monitoring. Avail hospital equipment for proper maternity care

Extent to which Visual Inspection with Acetic Acid Screening Guidelines are Adhered to in Selected Health Facilities in Embu County, Kenya before and after Intervention

Cervical cancer is one of the few diseases that reflect global inequities. In low and middle income countries, its incidence is nearly twice as high and its death rates three times as high compared to high income countries. Programs must focus on changing these trends. Visualizing with acetic acid encompasses the following: First, the health Care provider (HCP) does vaginal examination using a speculum, then dilute (3-5%) acetic acid (vinegar) is applied to the cervix. The presence of abnormal tissue often temporarily appears white when exposed to vinegar and then cervical color changes are observed with a naked eye. The outcome of Visual inspection with acetic acid is very subjective and depends with the level of skill of health care provider as well as availability of procedure supplies and adhering to Via procedure guidelines. The aim of this study was to determine the Extent to which Visual Inspection with acetic acid guidelines are adhered to in selected health facilities in Embu county prior to intervention and after intervention. An intervention study design was used. In particular, fourteen health care providers who were the initial study respondents were taken through an intensive VIA training for two days didactic and a four days clinical practice with guidance of preceptors. The facilities where respondents were recruited from were selected using a purposeful sampling method. Prior to intervention, a baseline data was taken that included use of questionnaires and observational checklist to determine adherence to VIA guidelines. The health care providers were then followed up for a period of four months where by 434 women were screened. The study area was Embu County in Kenya and the target population was the health services providers who provided VIA services in government facilities. The data was collected through self-administered questionnaires and observational checklists. In addition, secondary data was obtained from the health facility records and KDHS 2014. For data analysis, quantitative techniques of analysis were used. This study established that, despite all the respondents having some form of prior training on cervical cancer screening using VIA/VILLI, positivity rate was low before intervention. Cervical cancer screening guidelines were poorly adhered to prior to training compared to improved adherence after training. After intervention, healthcare providers were able to make the correct diagnosis and identify precancerous lesions. Cervical cancer screening uptake also scaled up. Baseline positivity was 0.8% and after training it was 14.1%. The study Concludes and Recommends that based on the key findings of this study, the MOH VIA training guidelines and curriculum should be revised to accommodate clinical practice for at least 4 days after 2 days didactic training with use of preceptors and cervical images

Male infertility: A retrospective review of laboratory charts at a tertiary teaching hospital in Nairobi City County

Background: Globally, approximately 50 million couples experience one form of infertility, and 10 million cases of subfertility have been reported in sub-Saharan Africa. Infertility is characterized by a lack of clinical conception among couples who live together for more than one year with regular coitus, without the use of contraception. Factors related to fertility vary by sex and geographical region. These factors include age, lifestyle, infectious diseases, and genetic disorders. In African culture, children are considered a simple inheritance and a measure of masculinity, so efforts are needed to address the growing problem of male infertility in this context. Objective: To determine the prevalence of male infertility among adult men seeking semen analysis services in a tertiary teaching hospital in Nairobi, Kenya. Methods: This was a cross-sectional study that involved a retrospective review of archived electronic data in the hospital information system. These data were from male patients who visited the laboratory with a request for semen analysis between January 2016 and December 2020. A checklist was used to extract data related to sociodemographic factors and laboratory results (age, seminal volume, and diagnosis). Results: The average age of the male clients seen during the review period was 36±8 years, with the majority aged 31–40 years n= 996 (46.7%). The youngest was 21 years old, and the oldest was 70 years old. The total prevalence of seminal abnormalities was 1628 (77%) of the 2131 electronic data that was reviewed. Only 502 (23%) of the patients had a normal seminal diagnosis. Most clients exhibited at least one form of seminal abnormalities, such as asthenospermia 913 (43%), oligospermia 441 (21%), and azoospermia 272 (13%). There was a statistically significant association between age and seminal abnormality (X 2 = 31.393, P=.013). A significant association was also found between seminal volume and abnormalities (X 2 = 94.538, P=.000). Conclusion: Our findings showed that there were some seminal abnormalities among Kenyan men in Nairobi County. More effort is required to identify the cause of this increase in seminal abnormalities. Initiation of health interventions to reduce this burden of infertility may be necessary

Health service factors influencing uptake of cervical visual inspection with acetic acid in selected health facilities in Embu County, Kenya

Background: Cervical cancer is the second most common cancer among females in developing countries. Despite widespread screening efforts for cancer of the cervix and training on VIA/VILLI, deaths due to cervical cancer remain high. This study aimed to determine Health Service Provider factors influencing the uptake of cervical cancer screening by VIA in selected health facilities in Embu County, Kenya. Methodology: Data were collected from 14 healthcare providers who were the initial study respondents from 7 purposively selected health facilities. Data collection tools were self-administered questionnaires and structured interviews for key informants. Additional secondary data were obtained from the health facility records and KDHS 2014. For data analysis, both quantitative and qualitative techniques of analysis were applied. Results: Lack of awareness creation on VIA, lack of skills to do VIA, lack of supplies for VIA, cost and fear of speculum examination by women were some factors leading to low uptake of cervical cancer screening. Conclusions and Recommendations: Increasing awareness of VIA needs to be done such as through recruitment of male champions for cervical cancer screening to mobilize and participate in awareness campaigns. Moreover, there needs to be an increase in the number of health care providers trained in VIA and cryotherapy and creating a pool of trainers of other health service providers. Additionally, the provision of VIA supplies needs to be ensured and VIA services offered free of charge. MOH and county governments\u27 departments of health should ensure support supervision at least once per quarter to the health care workers trained on VIA

History of HIV and AIDS in Kenya: Evolution and Contemporary Issues

Kenya is at the cusp of attaining HIV epidemic control. With a four-decade old epidemic, that at its height ravaged the country with devastating effects at all levels, the foreseeable end is indeed a momentous feat. Yet, as we forge into the future, it would be remiss of us to fail to honor the work and lives of all who in some way contributed to the gains that we see today.The epidemic now calls for a new way of thinking. The challenge is different; and that is to end AIDS as a public health threat sustainably. Written by five authors who served as front line health workers during the height of the HIV epidemic and continue to be involved in the response, this book will appeal to many a reader. Policy makers, educationalists, students, scientists, anthropologists, historians, faith and lay communities will all resonate with the book. By providing a historical chronology of events in Kenya\u27s HIV response, myths and misconceptions, scientific and programmatic advances, the authors provide useful insights into the past, contemporary issues and provide a sneak preview to what the future holds.https://ecommons.aku.edu/books/1170/thumbnail.jp