Knowledge and attitude of women on the available PMTCT services at the antenatal clinic of the Coast Province General Hospital

Introduction: Several high profile events of the last decade have served as catalysts for the now widely  available prevention of mother-to-child transmission of HIV services. However, Kenya continues to face challenges in assuring that all women in need of PMTCT services receive the full package.Methods: Background: Methods: A cross sectional survey was undertaken. Systematic sampling method  was used for sample selection. Data was collected using pretested structured questionnaires. Data was  analyzed in SPSS and Epi Info using bivariate and multivariate logistic regression.Results: Approximately 75% of participants were seeking PMTCT services in CPGH for the first time, 71% knew of their HIV status. About 95% of participants were satisfied with privacy during testing. Clients who  had never delivered in CPGH had a significantly (pConclusion: Participants seeking PMTCT services had poor HIV knowledge; but reported positive experiences and good provider – client relationship. However for a successful PMTCT program in CPGH attention needs to be paid in the patient experiences as they seek other reproductive services

Health Seeking behavior; perspective of the Marginalized Somali Community in Garissa County, a Semi-Arid Region of North Eastern Kenya

Appropriate medical care seeking could prevent a significant number of deaths and complications due to ill health. Unfortunately, healthcare seeking behaviors (HSB) differs according to place, the affected, disease types, beliefs and the opportunities to seek care. These decisions are not isolated to individuals but are embedded in a broader household and social organizational decision process and the capacity to allow seeking of care. This descriptive cross-sectional community-based study used a multistage cluster sampling method to enrol consenting adults from different households located in the seven (7) sub-counties in Garissa County. The data were collected by interviewing 405 adult population and the answers reported in pretested structured questionnaires. Among the surveyed respondents, the mean age (±SD) was 35.17 (12.9) years, 68.1% had no formal education, 72.8% were female and 81.2% were married. Health care seeking during the latest illness was reported by three quarters of the respondents (n=293, 72.3%). The treatment or advice during the latest illness was sought by the majority in the Government / public hospitals (n=226, 55.5%), followed by in the private hospitals (n= 37, 9.1%) and among Traditional or homeopathic or spiritual healers (n = 28, 6.9%). In multivariate analysis, household headship, possession of health insurance, reasons for choosing preferred healthcare facility, durations prior to seeking treatment and the perceived three common illnesses in the community were associated with seeking treatment during the latest illness both in any of the healthcare facility and in the government/public hospitals. Gender, occupation and reasons for choosing preferred healthcare facility independently influenced seeking treatment during the latest illness both in any of the health facility and in private hospitals.  Durations prior to seeking treatment was the only independent factor associated with seeking treatment both in any of the healthcare facility and among Traditional or homeopathic or spiritual healers. During the latest illnesses among this marginalized population, appropriate health seeking behavior was significantly high with the majority preferring the government/public facilities. Gender, occupation, household headship, possession of health insurance, reasons for choosing preferred hospital, availability and the preference of current health facility, duration with illness and perceived illnesses in the community are the predictors of HSB. Improvement in education, health facilities and medical services in the community, introduction of community based integrated management of common community illness are imperative to improve HSB among the Somali community in this Semi-arid region of Kenya. Keywords: Health seeking, Latest illnesses, Somali community, Semi-arid County of Keny

Factors Associated with Uptake of Cervical Cancer Screening among Women Aged 18-49 Years in Njiru Sub-County, Nairobi Kenya

Cervical cancer remains a major public health concern in developing countries including Kenya, where it is currently ranked the highest cause of cancer deaths. Early detection of cervical cancer using Pap smear provides an appropriate way of prevention which, would in turn lead to a decrease in incidence and mortality. This study aimed at assessing the awareness, perceptions, reproductive and sexual practices influencing uptake of cervical cancer screening among women aged 18-49 years in Njiru Sub County, Nairobi County. Two hundred and forty seven women participated in this cross-sectional study. Data were collected using semi-structured questionnaires and focused group discussion (FGD). Data was analyzed using SPSS version 19.0. Descriptive statistics were used to give proportions and frequencies. Pearson’s chi square (χ2) was used to test for associations among variables and differences were considered statistically significant at p≤0.05. The mean age of the respondents was 30.7±1.18 years. Most (32%), of the respondents were aged 25-29 years. Majority (96.4%) of the respondents in this study were Christians and most (68%) of them were married. Approximately fifty percent of the study respondents had primary level education followed by secondary (38.9%), tertiary (8.9%) and no formal education 2.4%. About 46% of the respondents were self-employed. Approximately eighty five percent (211/247) of the study respondents were aware of cervical cancer and had commonly (36.4%) obtained their information from media followed by health talks (34.8 %). Of those who were aware 25.6% (54/211) reported cervical cancer to be caused by Human Papilloma Virus (HPV). Most 43.6% (41/94) of the respondents who had ever been screened perceived the cervical screening procedures as uncomfortable followed by 24.5% (23/94) who perceived it as embarrassing. Majority 52.1% (49/94) of those who had been screened reported to have not received any support from their partners. More than ninety percent 94.7% reported that cervical cancer screening was very useful in the prevention of cervical cancer. The factors associated with uptake of cervical cancer screening were awareness (p≤0.035), opinion about cervical screening (p≤0.000), cervical screening usefulness (p≤0.006), frequency of having cervical screening done (p≤0.000) and partner support (p≤0.000). There is need to improve public awareness by educating women on the risk factors associated with cervical cancer and benefits of cervical screening through health talks and promotions, mass media awareness. Health professionals and healthcare workers should take the opportunity to educate and encourage women attending health facilities for other health problems to undergo cervical cancer screening. There is need to include men in education on cervical cancer especially sexual partners/ spouses so that they can encourage their spouses/partners in terms of moral and material support to increase the uptake of cervical cancer screening. Keywords: cervical cancer, screening, uptake, awarenes

Prevalence and factors associated with percutaneous injuries and splash exposures among health-care workers in a provincial hospital, Kenya, 2010

Introduction: Accidental occupational exposure of healthcare workers to blood and body fluids after skin injury or mucous membrane contact constitutes a risk for transmission of blood-borne pathogens. Such pathogens include Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV). We conducted a study to determine the prevalence and associated factors for percutaneous injuries and splash exposures among health-care workers in Rift Valley provincial hospital. Methods: A cross-sectional study was carried out from October to November 2010. Self reported incidents, circumstances surrounding occupational exposure and post-exposure management were sought by use of interviewer administered questionnaire. Descriptive, bivariate and multiple logistic regression (forward stepwise procedure) analyses were performed. The level of significance was set at 0.05. Results: Twenty five percent of health-care workers interviewed (N=305) reported having been exposed to blood and body fluids in the preceding 12 months. Percutaneous injuries were reported by 19% (n=305) and splash to mucous membrane by 7.2%. Higher rates of percutaneous injuries were observed among nurses (50%), during stitching (30%), and in obstetric and gynecologic department (22%). Health workers aged below 40 years were more likely to experience percutaneous injuries (OR= 3.7; 95% CI=1.08-9.13) while previous training in infection prevention was protective (OR= 0.52; 95% CI=0.03-0.90). Forty eight percent (n=83) reported the incidents with 20% (n=83) taking PEP against HIV. Conclusion: Percutaneous injuries and splashes are common in Rift Valley Provincial hospital. Preventive measures remain inadequate. Health institutions should have policies, institute surveillance for occupational risks and enhance training of health care workers.Pan African Medical Journal 2013; 14:1

Uptake of Antenatal Care Services among Women of Reproductive Age in Mandera County, Kenya

Background: Antenatal care is an opportunity for prevention and management of existing and potential causes of maternal and newborn mortality and morbidity. The new WHO antenatal care model, stipulates that, the first antenatal care visit takes place within the first trimester (gestationalage of <12 weeks) and then, additional seven visits. Only 37% of women in Mandera County had utilized the recommended minimum four ANC visits.Objectives: There was need to assess the critical factors influencing the uptake of ANC in Mandera County Kenya, in order to enlighten stakeholders on the development of appropriate ANC Service Provision Program. This study took the intiative of bridging the gap.Methodology: The study adopted cross-sectional design using both quantitative and qualitative methods. Stratified and Sample random sampling were used to get a quantity of 348 respondents. Data was collected using questionnaire, FGDs and KIIs guides and Pearson’s Chi-square test. Multivariate analysis using logistic regression was summarized to establish the strengths of the association. Odds Ratio (OR) and 95% Confidence Interval (CI) were used and threshold for statistical significance was set at p<0.05. Qualitative data was transcribed and analyzed thematically.Results: The proportion of women who utilized ANC was 83.0% and only 60.3% had attended recommended visits. Individual factors that influenced ANC uptake were; age, level of education, monthly income, gravida, parity and complications during pregnancy. Contextual factors that influenced ANC were; time taken to reach health facilities, source of maternal information and local discouragements. There was no significant relationship  between Religion, marital status, age at first pregnancy with ANC uptake.Conclusion: The negative perception can change by; improving culturally sensitive ANC services accessibility by; increasing the number of female  skilled health workers and reducing traveling time to the health facilities by conducting regular outreach services targeting villages with no close  facility to pastoral communities. It will be important to strengthen CHVs' capacity to emphasize primary health care and accelerate progress towards UHC in the County. Provide health education and promotion targeting older mothers with high parity, women inclined to harmful culturalpractices and their partners. In spite of a wide range of literature on ANC topics in most parts of Kenya, it was limited pertaining Mandera County.Recomandations: Meticulous understanding of local barriers and facilitating factors of ANC utilization is prerequisite for designing and implementing interventions that aim to improve ANC uptake. Well developed infrastructure is a basic need that falls in the category of basic wants for Mandera County. Key words: Antenatal care (ANC), Mandera, FGDs, immunization

Dental caries and oral health practices among 12 year old children in Nairobi West and Mathira West Districts, Kenya

Background: Dental caries is a common disease in children which causes pain with resultant effect on various physiological and social functions. The main objective of the study was to determine the association between dental caries and oral health knowledge and practice among children in Nairobi West and Mathira West Districts. Methods: A cross-sectional study was conducted among 639 children aged 12 years attending public primary schools in Nairobi West and Mathira West districts between August 2009-February 2010. A questionnaire was used to determine the level of knowledge and practices employed. Oral screening was performed using World Health Organisation (WHO) recommended methods. Dental caries was measured using the Decayed, Missing, Filled Teeth (DMFT) index. Results: Nairobi West District had significantly higher caries prevalence of 37.5% than Mathira West District (24.0%). The DMFT in Nairobi West District was 0.76 ± 1.2, while in Mathira West District it was 0.36 ± 0.7. On multivariate analysis high consumption of soda was found to be a significant risk factor for dental caries in Nairobi West District(Odds Ratio (OR) = 3.0). In Mathira West District having an illiterate mother was a significant risk factor for dental caries (OR=4.3). Conclusion: Countrywide intensive oral health promotion should be carried out especially in urban areas, to reduce the higher prevalence of dental caries. The school health policy should be used to promote oral health by provision of oral health instructions and highlighting harmful dietary practices. Preventive practices such as regular dental checkups should be advocated and promoted in schools.Pan African Medical Journal 2012; 12:4

Environmental and occupational factors associated with chronic myeloid leukemia: a case-control study

Background: The relationship between chronic myeloid leukemia (CML) and a broad range of exposures to occupational and environmental factors known to cause leukemia in general is limited. CML is by and large incurable and treatment is just palliative and life prolonging, with high case fatality rate, even in the best centers. Furthermore treatment is very expensive. Identification of leukemogenic factors is therefore important if this can lead to simple public health interventions. Objective: The objective was to determine key environmental and occupational exposure factors that may be associated with CML. Methods: This was a case-control study involving CML cases enrolled in Glivec International Patient Assistance Program (GIPAP) clinics at the Nairobi Hospital and Aga Khan University Hospital and two control groups for each case, matched for age and sex: a family- and hospital-based control, was carried out. One hundred and eight cases with age and-gender-matched family- and hospital-based controls were recruited and a standard questionnaire was administered. Individual data on demographics, occupation, environment, and exposures to benzene and farm organochemical products were obtained. Clinical examination was carried out in control subjects. Statistical analysis was done using bivariate and multivariate analysis to look for associations between exposure factors and CML. Results: The median age at diagnosis of CML cases was 41.32 years with an age range of 8–81 years and a male to female ratio of 1.7:1. Most of our cases were concentrated in or around Nairobi. There was no significant correlation found for exposure to benzene or pesticides. Long duration of exposure to pesticides in the family control group was significantly associated (t-test, P = 0.017) with risk of CML. Conclusions: Associations between exposures to organic solvents like pesticides and CML were indicated but were not entirely consistent, although no associations with benzene products were found. Nevertheless, for almost all cases of Ph chromosome-positive CML, other explanations must be sought for

p16INK4a/Ki-67 dual stain cytology for cervical cancer screening in Thika district, Kenya

Background: The identification of suited early detection tests is one among the multiple requirements to reduce cervical cancer incidence in developing countries. Methods: We evaluated p16INK4a/Ki-67 dual-stain cytology in a screening population in Thika district, Kenya and compared it to high-risk human papillomavirus (HR-HPV) DNA testing and visual inspection by acetic acid (VIA) and Lugol’s iodine (VILI). Results: Valid results for all tests could be obtained in 477 women. 20.9 % (100/477) were tested positive for HR-HPV DNA, 3.1 % (15/477) had positive VIA/VILI and 8.2 % (39/477) positive p16INK4a/Ki-67 cytology. Of 22 women that showed up for colposcopy and biopsy, 6 women were diagnosed with CIN3 and two with CIN2. All women with CIN2/3 were negative in VIA/VILI screening and positive by HR-HPV DNA testing. But HPV was also positive in 91.7 % (11/12) of women with normal histology. p16INK4a/Ki-67 cytology was positive in all 6 women with CIN3, in one of the two CIN2 and in only 8.3 % (1/12) of women with normal histology. Conclusions: p16INK4a/Ki-67 cytology is an interesting test for further studies in developing countries, since our findings point to a lower fraction of false positive test results using p16INK4a/Ki-67 cytology compared to HPV DNA testing in a Kenyan screening population. VIA/VILI missed all histology-proven CIN2/3

Prospective Changes in Serum Levels of Some Proinflammatory Cytokines and Erythropoietin among Anaemic HIV-infected Patients Attending Kenyatta National Hospital Comprehensive Care Centre

Between 70 to 80% of HIV infected patients develop anaemia which is a major complication in advanced HIV infection. The multifactorial etiology of the HIV-associated anaemia requires extensive studies on its unique pathophysiology as a step towards improving therapeutic options and disease management.The objective of this study is to monitor changes in serum levels of erythropoietin (Epo), Tumor necrosis factor-alpha (TNF-α), Interleukin-6 (IL-6), C-Reactive Protein (CRP) and anaemia in HIV infected patients over six months’ period. This study is Longitudinal descriptive study and it was conducted at Kenyatta National Hospital, Kenyatta National Hospital can be considered as Comprehensive Care Centre.The study used one hundred and eighty-four (184) seropositive adults aged 18 to 60 years.The results shows that Blood cells exhibited pathologies ranging from: Rouleaux formation, round macrocytes, microcytic hypochromic cells and target cells in frequencies that decreased with increase in CD4+ cells. Normochromic, macrocytic normochromic and dimorphic anaemias were observed. Bicytopenia (erythrocytopenia and leucopenia), reactive thrombocytosis with giant platelets, neutrophil and eosinophil hypersegmentations were also observed. Persistent increase in Epo and CRP levels were demonstrated among subjects throughout the study period. Increases in TNF-α levels without corresponding increase in IL-6 levels were observed. Persistence anaemia in presence of high Epo levels is suggestive of hyposensitivity to Epo by erythroid precursors. Asynchronized increases in TNF-α and IL- 6 levels may have deprived the duo the synergy required to effectively inhibit Epo production further facilitating the escalating levels of Epo observed. High levels of CRP observed indicate enhanced inflammation processes associated with HIV infection. Iron studies to rule out the role of iron-restricted erythropoiesis in the development microcytic, dimorphic anaemias and the granulocytic hypersegmentations noted are recommended. Studies on the possibility of Epo hyposensitivity derailing the effectiveness of recombinant human Epo in the management of HIV – associated anaemia are recommended.