Voluntary medical male circumcision: Safety and satisfacion at Migori County Hospital

Background: The World Health Organization (WHO) recommended Voluntary Medical Male Circumcision (VMMC) as an HIV prevention option for men based on evidence showing a reduction in HIV acquisition of 50% to 60%. Based in this evidence, the rapid expansion of VMMC in sub Saharan Africa has raised concerns on the capacity of VMMC programs to provide sustainable high quality and safe VMMC services.Objective: To determine the rates and correlates of adverse events following VMMC among clients attending Migori County Hospital.Design: Descriptive cross sectional study Setting: Migori County Referral Hospital, Kenya.Subjects: Between November and December 2015, 138 men receiving VMMC services at Migori County hospital were interviewed during their follow up visits within 7 days following the procedure. We systematically sampled every third participant attending their follow up visit. Face to face interviews were conducted to obtain data on demographics and levels of satisfaction, and physical examination to determine any adverse events after circumcision. Fishers exact was used to test for correlates of adverse events among participants.Results: The mean age of participants was 22 years, Standard Deviation (SD) ±5) .About two-thirds (63.8%) had reached secondary level education, 26(18.8%) tertiary level, 23(16.7%) primary level and only 1(0.7%) had no education. The majority 100(72.5%) reported being aware of possible adverse events following male circumcision and almost all 135 (97.8%) participants reported having adhered to wound care instructions. The rate of mild and moderate adverse events was 58.7% and 2.9%, respectively. There was no severe adverse event reported. Bathing and not changing underpants was associated with adverse events. The Majority 137 (99.3%) of participants were highly satisfied with the circumcision procedure and the post-operative care services they received.Conclusion: These results imply that VMMC in this setting can be delivered safely and effectively with high client satisfaction

Abortion related stigma: a case study of abortion stigma in regions with high and low incidences of unsafe abortion

Background: Abortion accounts for 35% of maternal mortality in Kenya. Kenya has reported an increase in the rate of unsafe abortions from 32 to 48 per 1000 women of reproductive age in 2002 and 2012 respectively. During the same period, women presented in public health facilities with severe complications indicating that women were having unsafe abortions.Objective: To investigate the association between incidences of unsafe abortion and stigma attitudes and beliefs about abortion among community member’s in two counties located in regions with either high or low incidences of unsafe abortion.Design: A cross-sectional comparative study.Settings: General community members in Trans Nzoia and Machakos Counties.Subjects: Men and women of reproductive age in Trans Nzoia and Machakos Counties.Results: Respondents in Trans Nzoia County reported the highest full-scale abortion stigma levels (μ=55.4) compared to those from Machakos County (μ=53.07). The mean differences in SABAS scores for all the four subscales were significant for fear of contagion, exclusion and discrimination and Negative stereotyping (p-value <0.000). Incidence region, educational attainment and marital status were all significantly associated with stigmatising attitudes. Respondents in the 35-49 age group showed more stigmatising attitudes than younger respondents, and married individuals showed more stigmatising attitudes than single respondents, and lower education levels were associated with higher levels of stigma.Conclusions: Mean stigma scores for counties with high incidence of unsafe abortions were higher than those from regions with a low incidences of unsafe abortion. Male community members, those with lower levels of education were more likely to report higher levels of stigma at the community level. The majority of women seeking abortion were viewed negatively by general community members, and this could explain women’s decision to seek an unsafe abortion

Association between levels of pain and disability in patients with somatic and neurogenic low back pain at Mbagathi District Hospital in Nairobi County, Kenya

Background: Low Back Pain is a problem of public health importance in developed countries as well as developing ones including Kenya. Low Back Pain, sub-categorized into somatic and neurogenic pain manifests in different unknown levels which have enormous health and socio economic impact. In Kenya, information on levels of pain and disability and how the two affect each other remain scanty.Objective: To determine the relationship between levels of pain and disability among patients with somatic and neurogenic Low Back Pain at Mbagathi District Hospital in Nairobi County, Kenya.Design: A cross-sectional study.Setting: Mbagathi District Hospital from May 2016 to August 2016.Subjects: All consenting Low Back Pain patients referred for out-patient physiotherapy clinic at Mbagathi District HospitalResults: Out of 176 participants enrolled in the study, majority, (63.1%) were females compared to 36.9% who were males. The proportion of patients with somatic Low Back Pain was 72.7 %( n=128) compared to 27.3 % (n=48) that had neurogenic Low Back Pain. More than half, 55.7 % (n=98) of the participants had pain intensity of moderate level while the remainder, 44.3 %( n=78) presented with severe pain level. Most respondents, 60.8 %( n=107) had minimal disability level compared to 33.5 %( n=59), and 5.7 %( n=10) whose levels were moderate and severe disability respectively. Results showed significant association between severe pain and moderate and severe disability (P<0.001). Neurogenic pain was also significantly associated with severe and moderate disability (P=0.006).Conclusion: A great majority of patients attending out-patient physiotherapy clinic presented with somatic Low Back Pain whose disability level was Minimal. A smaller proportion of patients with neurogenic Low Back Pain had moderate and severe disability. Neurogenic pain posed the highest risk of moderate and severe disability

Comparing Elastic-Degenerate Strings: Algorithms, Lower Bounds, and Applications

An elastic-degenerate (ED) string T is a sequence of n sets T[1], . . ., T[n] containing m strings in total whose cumulative length is N. We call n, m, and N the length, the cardinality and the size of T, respectively. The language of T is defined as L(T) = {S1 · · · Sn : Si ∈ T[i] for all i ∈ [1, n]}. ED strings have been introduced to represent a set of closely-related DNA sequences, also known as a pangenome. The basic question we investigate here is: Given two ED strings, how fast can we check whether the two languages they represent have a nonempty intersection? We call the underlying problem the ED String Intersection (EDSI) problem. For two ED strings T1 and T2 of lengths n1 and n2, cardinalities m1 and m2, and sizes N1 and N2, respectively, we show the following: There is no O((N1N2)1−ϵ)-time algorithm, thus no O ((N1m2 + N2m1)1−ϵ)-time algorithm and no O ((N1n2 + N2n1)1−ϵ)-time algorithm, for any constant ϵ > 0, for EDSI even when T1 and T2 are over a binary alphabet, unless the Strong Exponential-Time Hypothesis is false. There is no combinatorial O((N1 + N2)1.2−ϵf(n1, n2))-time algorithm, for any constant ϵ > 0 and any function f, for EDSI even when T1 and T2 are over a binary alphabet, unless the Boolean Matrix Multiplication conjecture is false. An O(N1 log N1 log n1 + N2 log N2 log n2)-time algorithm for outputting a compact (RLE) representation of the intersection language of two unary ED strings. In the case when T1 and T2 are given in a compact representation, we show that the problem is NP-complete. An O(N1m2 + N2m1)-time algorithm for EDSI. An Õ(N1ω−1n2 + N2ω−1n1)-time algorithm for EDSI, where ω is the exponent of matrix multiplication; the Õ notation suppresses factors that are polylogarithmic in the input size. We also show that the techniques we develop have applications outside of ED string comparison

A transition of atmospheric emissions of particles and gases from on-road heavy-duty trucks

The transition, in extent and characteristics, of atmospheric emissions caused by the modernization of the heavy-duty on-road fleet was studied utilizing roadside measurements. Emissions of particle number (PN), particle mass (PM), black carbon (BC), nitrogen oxides (NOx), carbon monoxide (CO), hydrocarbon (HC), particle size distributions, and particle volatility were measured from 556 individual heavy-duty trucks (HDTs). Substantial reductions in PM, BC, NOx, CO, and to a lesser extent PN were observed from Euro III to Euro VI HDTs by 99 %, 98 %, 93 %, and 57 % for the average emission factors of PM, BC, NOx, and CO, respectively. Despite significant total reductions in NOx emissions, the fraction of NO2 in the NOx emissions increased continuously from Euro IV to Euro VI HDTs. Larger data scattering was evident for PN emissions in comparison to solid particle number (SPN) for Euro VI HDTs, indicating a highly variable fraction of volatile particle components. Particle size distributions of Euro III to enhanced environmentally friendly vehicle (EEV) HDTs were bimodal, whereas those of Euro VI HDTs were nucleation mode dominated. High emitters disproportionately contributed to a large fraction of the total emissions with the highest-emitting 10 % of HDTs in each pollutant category being responsible for 65 % of total PM, 70 % of total PN, and 44 % of total NOx emissions. Euro VI HDTs, which accounted for 53 % of total kilometres driven by Swedish HDTs, were estimated to only contribute to 2 %, 6 %, 12 %, and 47 % of PM, BC, NOx, and PN emissions, respectively. A shift to a fleet dominated by Euro VI HDTs would promote a transition of atmospheric emissions towards low PM, BC, NOx, and CO levels. Nonetheless, reducing PN, SPN, and NO2 emissions from Euro VI HDTs is still important to improve air quality in urban environments

Beacon of hope: Evaluation of the Kenya Girl Guides Association HIV/AIDS program for school children

This Horizons report presents findings from an evaluation of the Kenya Girl Guides Participatory Peer Education Program for HIV and AIDS Prevention. The objective of the program was to train Girl Guide patrol leaders as peer educators, who in turn would communicate key information and concepts about such topics as HIV prevention, relationships, and self-esteem to other Girl Guides, and ultimately to their school peers. The results demonstrate that peer education conducted by Girl Guides is a feasible strategy for imparting HIV and AIDS education to school-going youth; however, such a program would need to be branded, strengthened, and appropriately resourced to attain positive results that extend beyond the Girl Guides to include their peers. The results also demonstrate that school girls in this study are operating in an environment where their male counterparts are more than seven times as likely to be sexually experienced, and may be exerting considerable pressure to have sex even on the strongest of girls. HIV risk-reduction programs directed at school girls may be more successful if they also address the risk behavior of school boys

The quality of antenatal care in rural Tanzania: what is behind the number of visits?

Background: Antenatal care (ANC) provides an important opportunity for pregnant women with a wide range of interventions and is considered as an important basic component of reproductive health care.Methods: In 2008, severe maternal morbidity audit was established at Saint Francis Designated District Hospital (SFDDH), in Kilombero district in Tanzania, to ascertain substandard care and implement interventions. In addition, a cross-sectional descriptive study was carried out in 11 health facilities within the district to assess the quality of ANC and underlying factors in a broader view.Results: Of 363 severe maternal morbidities audited, only 263 (72%) ANC cards were identified. Additionally, 121 cards (with 299 ANC visits) from 11 facilities were also reviewed. Hemoglobin and urine albumin were assessed in 22% - 37% and blood pressure in 69% - 87% of all visits. Fifty two (20%) severe maternal morbidities were attributed to substandard ANC, of these 39 had severe anemia and eclampsia combined. Substandard ANC was mainly attributed to shortage of staff, equipment and consumables. There was no significant relationship between assessment of essential parameters at first ANC visit and total number of visits made (Spearman correlation coefficient, r = 0.09; p = 0.13). Several interventions were implemented and others were proposed to those in control of the health system.Conclusions: This article reflects a worrisome state of substandard ANC in rural Tanzania resulting from inadequate human workforce and material resources for maternal health, and its adverse impacts on maternal wellbeing. These results suggest urgent response from those in control of the health system to invest more resources to avert the situation in order to enhance maternal health in this country. © 2012 Nyamtema et al.;

SARS-CoV-2 seroprevalence in pregnant women in Kilifi, Kenya from March 2020 to March 2022

Background: Seroprevalence studies are an alternative approach to estimating the extent of transmission of SARS-CoV-2 and the evolution of the pandemic in different geographical settings. We aimed to determine the SARS-CoV-2 seroprevalence from March 2020 to March 2022 in a rural and urban setting in Kilifi County, Kenya. Methods: We obtained representative random samples of stored serum from a pregnancy cohort study for the period March 2020 to March 2022 and tested for antibodies against the spike protein using a qualitative SARS-CoV-2 ELISA kit (Wantai, total antibodies). All positive samples were retested for anti-SARS-CoV-2 anti-nucleocapsid antibodies (Euroimmun, ELISA kits, NCP, qualitative, IgG) and anti-spike protein antibodies (Euroimmun, ELISA kits, QuantiVac; quantitative, IgG). Results: A total of 2,495 (of 4,703 available) samples were tested. There was an overall trend of increasing seropositivity from a low of 0% [95% CI 0–0.06] in March 2020 to a high of 89.4% [95% CI 83.36–93.82] in Feb 2022. Of the Wantai test-positive samples, 59.7% [95% CI 57.06–62.34] tested positive by the Euroimmun anti-SARS-CoV-2 NCP test and 37.4% [95% CI 34.83–40.04] tested positive by the Euroimmun anti-SARS-CoV-2 QuantiVac test. No differences were observed between the urban and rural hospital but villages adjacent to the major highway traversing the study area had a higher seroprevalence. Conclusion: Anti-SARS-CoV-2 seroprevalence rose rapidly, with most of the population exposed to SARS-CoV-2 within 23 months of the first cases. The high cumulative seroprevalence suggests greater population exposure to SARS-CoV-2 than that reported from surveillance data

Highly Effective Therapy for Maternal Malaria Associated With a Lower Risk of Vertical Transmission

Background. The epidemiology of congenital malaria was investigated in a hospital-based malaria surveillance study in Papua, Indonesia