The healthcare system and client failures contributing to maternal mortality in rural Kenya

Background The global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government’s provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya. Methods An explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains. Results Identified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients’ ANC non-adherence. Conclusion In conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.Health Studie

Patient Retention and Adherence to Antiretrovirals in a Large Antiretroviral Therapy Program in Nigeria: A Longitudinal Analysis for Risk Factors

Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria.We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return >60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p < 0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml(3)) >350 and <100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100-200. The adjusted GEE analysis showed that patients aged <35 years (p = 0.005), who traveled for >2 hours to the clinic (p = 0.03), had total ART duration of >6 months (p<0.001), and CD4 counts >200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/family (p = 0.01) and were treated with tenofovir-containing regimens (p < or = 0.001) were more likely to be adherent.These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence

Kenya's Experience Towards Sustainable Human Settlements Delivery in Africa

Due to limited resources and for purposes of economic growth, some degree of concentration of activities and people inparticular places are deemed to be economically and technically vital for purposes of development planning. Such concentrationsof people and activities range from small villages, towns, municipalities to large cities and metropolis otherwise aggregatedas human settlements. However, it is imperative that well-articulated and proactive planning praxes have to be enacted forposterity and environmental harmony in the human settlements. As such, diverse sets of praxes to the human settlementdevelopment have evolved at different epochs in Kenyan history. The praxes are divergent in timing, scope and forms. Allthese have acted in concert to manifest dynamism in the human settlement development. On the one hand , conventionaldevelopment planning practice has not been able to cope with the pace of urban development and hence the emergence ofsprawling informal urban settlements in many of Africa's cities, Kenya included. On the other hand development planningpractice has not been ablle to cope with the pace of urban development and hence the emergence of sprawling informalsettlements in many of Africa's cities, Kenya included. This experience forms the context of this paper and progress further bydetailing in-depth strategies for attaining sustainable human settlement development in the light of informal settlements. KEY WORDS: Human Settlement, Sustainable Development, Urbanization, Growth Centres, Service Centres and Strategies Résumé En raison des ressources très limitées et aux fins de stimuler la croissance économique, une certaine concentration desactivités et de la population dans des endroits bien précis s'avère nécessaire puisque ces derniers sont appelés à jouer unrôle économiquement et techniquement vital dans la planification du développement. De telles concentrations de lapoupulation et d'activités partent des petits villages, des villes, des municipalités, de grandes villes jusqu'aux métropolesqui hébergent de grandes agglomérations humaines. Il est cependant impérieux que des actions bien articulées et proactivesen matière de planification soient officiellement décrétées pour faciliter leur validité postérieure et leur harmonieenvironnementale au sein des agglomérations humaines. En tant que tels, divers ensembles d'initiatives déstinés audéveloppement de l'habitat humain ont vu le jour à différentes époques, dans l'histoire du Kenya. Ces initiatives quidivergent quant à leur synchronisation, leur portée et leurs formes ont toutes servi à refléter le dynamisme dudéveloppement de l'agglomération humaine. Ainsi donc, les pratiques de planification du développement n'ont pas pu seconformer à l'allure du développement urbain et elles ont dans certains cas, conduit à une pullulation des agglomérationsspontanées dans des cités africaines, y compris le Kenya. Cet article part d'abord de l'expérience et des progrès enregistrés,pour ensuite déboucher aux stratégies détaillées qui peuvent donner lieu à un développement harmonieux et durable del'habitat humain, à la lumière de l'apparition des agglomérations spontanées. Mots-clés: habitat humain, développement durable, urbanisation, centres en plein essor, centres de fourniture des services, StrategiesDiscovery and Innovation Volume 15 Number1/2 June (2003) pp. 28-3

Plasmodium falciparum parasite prevalence in East Africa:Updating data for malaria stratification

The High Burden High Impact (HBHI) strategy for malaria encourages countries to use multiple sources of available data to define the sub-national vulnerabilities to malaria risk, including parasite prevalence. Here, a modelled estimate of Plasmodium falciparum from an updated assembly of community parasite survey data in Kenya, mainland Tanzania, and Uganda is presented and used to provide a more contemporary understanding of the sub-national malaria prevalence stratification across the sub-region for 2019. Malaria prevalence data from surveys undertaken between January 2010 and June 2020 were assembled form each of the three countries. Bayesian spatiotemporal model-based approaches were used to interpolate space-time data at fine spatial resolution adjusting for population, environmental and ecological covariates across the three countries. A total of 18,940 time-space age-standardised and microscopy-converted surveys were assembled of which 14,170 (74.8%) were identified after 2017. The estimated national population-adjusted posterior mean parasite prevalence was 4.7% (95% Bayesian Credible Interval 2.6–36.9) in Kenya, 10.6% (3.4–39.2) in mainland Tanzania, and 9.5% (4.0–48.3) in Uganda. In 2019, more than 12.7 million people resided in communities where parasite prevalence was predicted ≥ 30%, including 6.4%, 12.1% and 6.3% of Kenya, mainland Tanzania and Uganda populations, respectively. Conversely, areas that supported very low parasite prevalence (<1%) were inhabited by approximately 46.2 million people across the sub-region, or 52.2%, 26.7% and 10.4% of Kenya, mainland Tanzania and Uganda populations, respectively. In conclusion, parasite prevalence represents one of several data metrics for disease stratification at national and sub-national levels. To increase the use of this metric for decision making, there is a need to integrate other data layers on mortality related to malaria, malaria vector composition, insecticide resistance and bionomic, malaria care-seeking behaviour and current levels of unmet need of malaria interventions

Drivers of early marriage and teenage pregnancy in Kenya and Uganda during COVID-19 lockdown period: A systematic review

The present study aimed to explore the drivers of early marriage and teenage pregnancy in Kenya and Uganda during COVID-19 lockdown period. A systematic review design was adopted. The major online databases utilized were PubMed, Google Scholar, Uganda and Kenya Ministry of Health repositories, ScienceDirect, and Scopus. Studies that were originating from Kenya and Uganda that were publicly available in electronic format published from March 2020 to March 2022 were used. The thematic analysis identified major concepts that were drivers to the present research problem which were as follows: (1) school closure and (2) loss of income by parents. The COVID-19 containment measures introduced in the two countries were noted as major contributing factors. During the pandemic, lockdown led to school closures which meant the teenagers being idle at home with an increased opportunity to indulge in sexual risk behaviors. Schools have been noted to be a safe place protecting this vulnerable population. However, with their prolonged closure, the teenagers were exposed to sexual predators. Parents lost income, and this might have contributed to early marriages and teenagers' dependency on their sexual partners. Based on the reviewed evidence, the present study furthers the advocacy for the reduction of early marriages and teenage pregnancy, especially in the current COVID-19 pandemic era. The study calls upon the governments to intensify efforts toward the present research problem as the COVID-19 pandemic is eroding the earlier gains made within the regionHealth Studie

Biphasic MERS-CoV Incidence in Nomadic Dromedaries with Putative Transmission to Humans, Kenya, 2022–2023

Middle East respiratory syndrome coronavirus (MERS-CoV) is endemic in dromedaries in Africa, but camel-to-human transmission is limited. Sustained 12-month sampling of dromedaries in a Kenya abattoir hub showed biphasic MERS-CoV incidence; peak detections occurred in October 2022 and February 2023. Dromedary-exposed abattoir workers (7/48) had serologic signs of previous MERS-CoV exposure

Action and action-regulation in entrepreneurship: Evaluating a student training for promoting entrepreneurship

10.5465/amle.2012.0107Academy of Management Learning and Education14169-9