Assessment of factors associated with the uptake of Provider initiated HIV counselling and testing (PITC) among clients at Kenyatta National Hospital Accident and Emergency Department, Nairobi, Kenya

HIV/AIDS has contributed to a high proportion of morbidity and mortality among people around the globe. Without proper care and treatment many more people will continue to perish, hence, to curb this, proper preventive measure needs to be put in place, for instance HIV testing and counseling. Despite the importance of this step, most HIV. infected patients are unaware of their HIV status. To improve the HIV status awareness, provider.initiated counseling and testing (PITC) was introduced. This study aimed to assess factors associated with PITC uptake. A cross sectional hospital.based survey of patients visiting Kenyatta National Hospital Accident and Emergency Department was carried out between August 2010 and November 2010. The survey comprised of 340 participants. A high proportion (96.2%) of the patients accepted to test for HIV. There was a significant association between PITC uptake and informal employment (P = 0.006), HIV risk behaviors (p = 0.04), decision to allow their children play with HIV positive children (p = 0.018), and fearing HIV test (P < 0.001). Having informal employment, HIV risk behaviours and not fearing to test for HIV was significantly associated with PITC uptake. More studies need to be carried out to identify barriers to PITC uptake. Keywords: PITC, risk behaviours, HIV/AIDS, Stigma, discriminatio

Cost effectiveness of using surgery versus skeletal traction in management of femoral shaft fractures at Thika level 5 hospital, Kenya

Introduction: A prospective quasi experimental study was undertaken at the Thika level 5 hospital. The study aimed to compare the costs of managing femoral shaft fracture by surgery as compared to skeletal traction. Methods: sixty nine (46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%) patients were enrolled in group B and managed by skeletal traction. Exclusion criteria included patients with pathological fractures and previous femoral fractures. Data was collected by evaluation of patients in patient bills using a standardized questionnaire. The questionnaire included cost of haematological and radiological tests, bed fees, theatre fees and physiotherapy costs. The data was compiled and analyzed using SPSS version 16. Person's chi square and odds ratios were used to measure associations and risk analysis respectively. Results: A higher proportion of patients (88.4%) in group A were hospitalized for less than one month compared to 20 patients (30.4%) in group B (p, 0.001).Total cost of treatment in group A was significantly lower than in group B. Nineteen (27.9%) patients who underwent surgery paid a total bill of Ksh 5000-7500 compared to 7(10.4%) who were treated  by traction. The financial cost benefit of surgery was further complimented by better functional outcomes. Conclusion: The data indicates a cost advantage of managing femoral shaft fracture by surgery compared to traction. Furthermore the longer hospital stay in the traction group is associated with more malunion, limb deformity and shortening.Key words: Fracture shaft femur, cost effectiveness, functional outcom

Clinical Outcomes Following Management of Adult Femoral Shaft Fractures by Surgery and Traction at Thika Level 5 Hospital

Objective: To compare the clinical outcomes of femoral shaft fractures managed surgically and conservatively by traction. Design: A prospective quasi experimental study at the Thika level 5 hospital. Methods: 148 adult patients who had sustained traumatic fractures of femur were prospectively enrolled and assigned into two treatment groups.69(46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%)patients were enrolled in group B and managed by skeletal traction. Patients were purposively assigned into group A after they were able to afford the implants into the surgica group and the rest into the conservative group. Clinical outcomes that were assessed in the wards and clinics included malunion rates, mobility and limb length discrepancy up to three months post discharge. Data was collected by history, physical examination and radiological evaluation using a standardized questionnaire. The data was compiled and analyzed using SPSS version 17. Persons’ chi square, odds ratio and logistic regression were used to measure associations, risk analysis and multivariate analysis. Results: No significant difference was noted between the two groups in terms of demographic data, fracture type and co;morbidities. Malunion rate of more than 5 degrees was seen in 11(15.9%) patients in group A compared to 34(43.1%) patients in group B (p< 0.001). Seven patients (10.1%) in group A had limb shortening greater than 2 cm compared to 20 patients(25.3%) in group B (P<0.011).Good functional outcomes were achieved in 38 patients (55.1%) who underwent surgery compared to 23 patients (29.1%) managed by traction (p< 0.004) Conclusion: The data indicates a better clinical outcome of managing femoral shaft fractures by surgery as compared to traction. It also indicates that clinicians in regional referral hospitals should be encouraged to use operative methods in femoral shaft fracture management primarily without delay. Keywords: fracture shaft femur, clinical outcome, malunion, functional outcome, limb shortenin

Cross-sectional study on effect of civil society organizations interventions on individuals infected with HIV in Busia County Kenya

Since the discovery of HIV in the early 1980s in Kenya, Civil Society Organizations have played a major role in its fight. The aim was to study effect of intervention on improved health, nutrition and income generation activities on individuals infected by HIV. A cross-sectional study was undertaken as a baseline with aquasi experimental study design to compare intervention and non intervention sites. Two hundred and seventeen (217) respondents out of which 69.1% were females and 30.9% males selected from four sub counties of Busia County. A structured questionnaire was administered to people infected with HIV in CSO intervention and non intervention sites. In depth interviews and Focus Group Discussions (FGDs) were performed using a guide. Structured forms guided the performance on clinical examination and anthropometry procedures. The Statistical Package for Social Scientist software was used to analyze quantitative data. Frequency distributions were calculated and visualized and Chi square test with odds ratios computed. NVIVO statistics software was used to analyze qualitative data. Audio and video recordings were transcribed verbatim, line by line coding used to manage discrete units of text, and data segments reviewed to illustrate people’s perspectives. A majority of respondents had primary level education (46.3%) and was self-employed (72.1%). HIV/AIDS awareness was high in both the non-intervention (84%) and intervention (79.8%) site, with access to information playing a major role in people’s understanding of HIV/AIDS (p<0.01). Majority of respondents (95.2%) in intervention and non-intervention (96.2%) sites had easy access to ARVs, with 48.1% sourcing drugs privately. Approximately 44.1% sourced ARVs therapy from government facilities with 30.3% from CSOs. Distance to health facilities was the main challenge for those accessing ARV drugs in intervention (22.0%) and non-intervention (39.7%) sites, (OR=2.3 (95%CI=1.2-4.5), p=0.01) was greater in the non-intervention sites. Lack of cash for transport (25% versus 27%) and weakness in the body (11% versus 16.4%) were other challenges as recorded. Most respondents (93.9%) had good ARV uptake, with 74% having reported no major health problems in the recent three months. Only 7% of respondents examined clinically had abnormal blood pressure. Mean body temperature was 36.43 degrees Celsius (std. dev. =0.734). Regarding weights classification, 13.7% of the respondents were underweight, 58.9% normal, 7.3% overweight, and 5% were obese and weights differed by gender (p<0.01) significantly. A large proportion (89.1% in intervention and 94.3% in non-intervention sites) of respondents was aware of good eating habits although they practiced poor eating patterns. In the morning, the trend was (71.9% and 62.4% in the intervention and non-intervention sites) respondents eat nothing. ‘Ugali’ (posho) and traditional vegetables was the most common type of food eaten during lunch (31.0% in intervention and 34.1% in the non-intervention site) and dinner (33.6% intervention and 25.1% in non-intervention sites). Fruits are hardly consumed by majority (42.1% and 45.3%). Provision of ARV (intervention (81.3%) and non-intervention sites (84.3%), (X2(df) =0.32(1), p=0.57) was the most common mode of support received. In focus groups discussion sessions, respondents mentioned of no direct financial benefits received from CSOs although many say they recognize what the government has done for them. In their discussion, it was revealed that CSOs initiate short term projects which do not last and when they wind up get compromise when projects end. This survey demonstrates the essential role played by implementing partners (CSOs) on improved health, nutrition and socio economic status. Influence on better access to medication, balanced diet, and economic change probably contributes to living a better and healthier life for those infected with HIV.Afr J Health Sci. 2017; 30(2):57-7

Effect of Civil Society Organizations on Health, Nutrition and Economic Status of People Living with HIV/ AIDS in Busia County, Kenya

 Introduction: Civil Society Organizations (CSOs) play a major role in HIV/AIDS response. Despite their massive effort to promote health care, nutrition and socio-economic empowerment to people living with the disease, documented data on the impact and value of their interventions remain scanty. Globally, people infected with HIV/AIDS by 2018 were estimated to be 37.9 millions recording 1.1 million mortalities in that year. HIV prevalence rate in Kenya was at 4.9% among the general population of ages 15-64 years [2]. In other reports, the national HIV prevalence was at 4.5% while males and females aged 15 to 24 years at 5.2% in 2018. Busia County had HIV prevalence rate of 7.7% in the same year [1]. Aim: The objective of this study was to determine the effect of CSOs interventions on health, nutrition and economic status of people living with HIV/AIDS in Busia County. Materials And Methodology: A quasi-experimental study design was done with structured and non-structured questionnaires administered to two hundred and twenty (220) participants at baseline and end line by registered CSOs with other facilitators. All permanent male and female residents infected with HIV aged between 15 and 64 years from comprehensive patient attendance lists obtained from the Ministry of Health (MoH) facilities qualified for the study. All respondents signed informed consent forms prior to participation. Qualitative in-depth data was obtained through focus group discussions(FGDs) from key informant interviews. Results: No statistically significant differences were reported due to gender, household size and education level recorded in both sites at baseline and end line. Access to HIV/AIDS information was higher in CSOs intervention sites (89.5%) than in non - intervention (73.2%) sites at end line. Respondents in the intervention group had a significant improvement in sourcing Antiretroviral (ARVs) drugs especially from private facilities (P<0.05) but no scientific difference in access to health care services between sites after CSOs intervention. Respondents receiving support for Income Generating Activities (IGA) reduced by 2.1% in the intervention sites at end line. Respectively those in non-intervention sites increased by 4.1%. The negative 6.2% Net Effect of Intervention (NEI) reported was nonetheless not statistically significant (OR=0.98 (95% CI=0.42- 1.5), p=0.48). Organizations such as Reproductive Health Initiatives' impact was reported despite others' existence lacked evidence from which to establish their impact of CSOs intervention. Initiation of home based care, Chama support and income generating projects to improve on the source of economic status for PLWHA were programs that supported the government in providing quality services. However, the programs they implement some possibly a duplication of health-related services, were primarily skewed on donor interest because of dependency [10]. Conclusion: CSOs intervention did not have a significant effect on access to HIV/AIDS information, access to health care services, their morbidity patterns, food intake and nutritional status as well as on economic status and income generating activities. This could be due to reports that, some implementing organizations lacked adequate documentation (comprehensive database, reliable and consistent data), eventually, often failing to monitor and evaluate projects they initiated. Recommendations:CSOs should work in collaboration with the government to develop sustainable interventions aimed at empowering PLWHA in improving their livelihood not only in Busia County but also across the Country. Access to ARVs from the nearest health facility will reduce suffering especially from opportunistic infections. Keywords: Civil Society Organizations, HIV/AIDS, People Living with HIV/AIDS(PLWHA

Factors associated with low levels of birth & death registration in Kieni East district of the Central Province of Kenya

Objective: To determine the factors associated with low levels of registration of births and deaths in Kieni East district.Methods: This was a cross-sectional study that adopted a convergent parallel mixed method design. The qualitative study was conducted through in-depth interviews held with District Civil Registrar and Assistant Chiefs. The quantitative study was conducted through a semi-structured questionnaire administered to 373 randomly selected heads of households.Results: Registration of births was found to be significantly associated to the mother’s level of educational attainment, age of the child, attendance to early childhood education, and the income level of the household head, while the Age of the deceased predicted death registration. The level of awareness on the need to register events was high; however, knowledge of the required duration for registration, the process of registration and the importance of registration was found lacking. Costs associated with registration and lack of property to inherit were the most cited reasons for failure to register birth and death occurrences respectively. Certain segments of the residents of the district were internally displaced persons of the 2007 post election violence who were facing challenges in the acquisition of the registration documents and replacement of lost registration documents.Conclusion: The study identified potential areas of intervention in improving birth and death registration in the district.Afr J Health Sci. 2013; 26:272-29

Treatment of shigella infections: why sulfamethoxazole-trimethoprim, tetracyclines and ampicillin should no longer be used

Background: Bloody diarrhoea results in high morbidity and mortality especially in developing countries with shigellosis being the main cause of acute bloody diarrhoea. The use of appropriate antimicrobial agents in the treatment of acute diarrheal disease shortens the duration of illness and bacterial shedding leading to a reduction in morbidity and mortality. Treatment options for many infections are becoming limited due to globally emerging antibiotic resistance. Globally, resistance of shigella species to trimethoprim-sulfamethoxazole (TMP-SMX), tetracyclines and ampicillin has been reported with subsequent recommendations of not using these antimicrobial drugs for empirical therapy of acute bloody diarrhoea.Objective: To establish the antimicrobial susceptibility patterns and antimicrobial drug use for treatment of shigella species in patients with acute bloody diarrhoea.Design: A hospital based case control study.Setting: Six health facilities, three in Kilifi County and three in Nairobi County.Subject: A total of 284 stool specimens were collected from patients who fitted the standard cases definition for acute bloody diarrhoea.Results: Eighty (28.2%) bacterial isolates were recovered from 284 stool samples collected from cases presenting with acute bloody diarrhoea of which 67 (83.8%) were Shigella species, nine (11.3%) were Enteroinvassive Escherichia coli isolates, three (3.8%) were Salmonella Typhi and one (1.3%) were Yersinia enterocolitica. Shigella isolates had high resistance to sulfamethoxazole-trimethoprim (97%), tetracycline (83.6%) ampicillin (58.2%) and chloramphenicol (20.9%). The isolates showed low resistance to nalidixic (4.5%) and ciprofloxacin (3.0%) while there was no resistance to ceftriaxone. The most common multidrug resistance pattern detected in Shigella strains combined sulfamethoxazole-trimethoprim, amoxicillin/ampicillin and tetracyclines.Antibiotic prescriptions were given to 243(85.6%) of the patients presenting with acute bloody diarrhoea. Among these, 94 (38.7%) were given prescriptions for ciprofloxacin, 53 (21.8%) for sulfamethaxazole-trimethiprin and 36(14.8%) for Tetracyclines. Chloramphenicol, amoxicillin/ampicillin, nalidixic acid and ceftriaxone were prescribed to 10.7 %, 3.7%, 2.9% and 0.4% of the patients respectively. A total of 123 (51%) received antibiotics which were ranked to have high resistance (sulfamethoxazole-trimethoprim, tetracyclines ampicillin and chloramphenicol).Conclusion: The high rates of antimicrobial resistance among the commonly prescribed antimicrobials such as sulfamethoxazole-trimethoprim, tetracycline, ampicillin and chloramphenicol is of major concern. Despite recommendations discouraging the empirical use of sulfamethoxazole-trimethoprim, tetracycline, ampicillin and chloramphenicol for treatment of acute bloody diarrhoea, more than half of the patients with acute bloody diarrhoea were still treated with these antibiotics.There is need to train health care workers on the proper management of acute bloody diarrhoea and the importance of adhering to the clinical guidelines

Commonly cited incentives in the community implementation of the emergency maternal and newborn care study in western Kenya

Background: Mortality of mothers and newborns is an important public health problem in low-income countries. In the rural setting, implementation of community based education and mobilization are strategies that have sought to reduce these mortalities. Frequently such approaches rely on volunteers within each community. Objective: To assess the perceptions of the community volunteers in rural Kenya as they implemented the EmONC program and to identify the incentives that could result in their sustained engagement in the project. Method: A community-based cross sectional survey was administered to all volunteers involved in the study. Data were collected using a self-administered supervision tool from all the 881 volunteers. Results: 881 surveys were completed. 769 respondents requested some form of incentive; 200 (26%) were for monetary allowance, 149 (19.4%) were for a bicycle to be used for transportation, 119 (15.5%) were for uniforms for identification, 88 (11.4%) were for provision of training materials, 81(10.5%) were for training in Home based Life Saving Skills (HBLSS), 57(7.4%) were for provision of first AID kits, and 39(5%) were for provision of training more facilitators, 36(4.7%) were for provision of free medication. Conclusion: Monetary allowances, improved transportation and some sort of identification are the main incentives cited by the respondents in this context

Determination of seasonal rainfall variability, onset and cessation in semi-arid Tharaka district, Kenya

The study quantified rainfall variability for March–May (MAM) and October–December (OND) seasons in Tharaka district, Kenya. The parameters analysed were inter-annual variability of seasonal rainfall, onset and cessation using daily rainfall data in three agro-ecological zones’ stations. Percentage mean cumulative method was used to determine onset and cessation, and seasonal variability was estimated using rainfall variability indices. Although both seasons are highly variable, OND has been persistently below mean over time while MAM shows high within-season variability. Despite the near uniformity in the mean onset and cessation dates, the former is highly variable on an inter-annual scale. The two rainfall seasons are inherently dissimilar and therefore require specific cropping in agro-ecological zone LM4 and LM4-5. It is possible that farmers in IL5 are missing an opportunity by under-utilising MAM rainfall. The results should be incorporated in implications of climate variability and vulnerability assessment in semi-arid Tharaka district