45 research outputs found
Neonatal Survival in Sub-Sahara: A Review of Kenya and South Africa
Introduction: The majority (99%) of the children who die during the first 4 weeks of life do so in
the poorer parts of the world, especially in sub-Saharan Africa and South Asia. In 2018, sub-Saharan
Africa had a neonatal mortality rate of 28 deaths per 1000 live births. The purpose of the review was
to explore and describe the trends of neonatal mortality within the two sub-Saharan countries.
Methods: We did a literature search in biomedical databases of data published, in English,
between Jan 1, 1975, and November 30, 2019. The databases included Scopus, Web of Science,
Science Direct, Cochrane Library, PUBMED, OVID and Google scholar. The keywords used in
the search: “Neonatal Survival”, “Sub-Sahara”, “Kenya” and “South Africa”.
Results: The search generated 2209 articles of which only 27 met the inclusion criteria. The
present study qualitatively analysed data. Data were presented and organized under two
thematic domains: 1) trends of national neonatal mortality rates in South Africa and Kenya
and 2) causes of neonatal mortality.
Conclusion: The current review results noted that in 2018, the neonatal mortality rate for
Kenya was 19.6 deaths per 1000 live births. The neonatal mortality rate has fallen gradually
from 35.4 deaths per 1000 live births in 1975. On the other hand, South Africa has had its
neonatal mortality rate fall from 27.9 deaths per 1000 live births in 1975 to 10.7 deaths per
1000 live births in 2018. Most neonatal deaths resulted in preterm birth complications
followed by intrapartum-related events for the two countries. Within the sub-Saharan region,
disparities exist as neonates born in South Africa are more likely to survive during the
neonatal period compared to Kenya.Health Studie
Determinants of High Neonatal Mortality Rates in Migori County Referral Hospital in Kenya
Background: Neonatal mortality is a significant public health problem worldwide. In Kenya, neonatal
mortality rates are unacceptably high within the sub-Saharan region. In 2017 the country had 20.9 deaths
per 1000 live births above the WHO target of 12 deaths per 1000 live births.
Purpose: The purpose of this study was to investigate the determinants of high neonatal mortality rates in
Migori County, Kenya. The neonatal mortality cases were utilised as the target population to the study.
Method: A quantitative, descriptive, cross-sectional, non-experimental research design was used. A
systematic sampling technique was employed to draw a sample of 201 archived neonatal cases out of 420
neonatal mortality medical records, which constituted the study population. Data were collected by means
of a developed questionnaire. The Statistical Package for Social Sciences (SPSS) Version 21 was used to
analyse data.
Results: The main findings revealed the leading determinants of neonatal mortality were early neonatal
period, prematurity, low birth weight, neonates with intrapartum complications and poor 1st Apgar score.
Obstetrical haemorrhage and HIV were the main maternal complications associated to neonatal mortalities,
while the leading direct causes of death in this study were birth asphyxia and sepsis.
Conclusions: To reduce mortalities, a multifaceted approach is needed to establish quality improvement in
neonatal intensive care and reduce preterm birth incidences in Migori County.Health Studie
Barriers to and Opportunities for Male Partner Involvement in Antenatal Care in Efforts to Eliminate Mother-to-child Transmission of Human Immuno-deficiency Virus in Kenya: Systematic Review
Introduction:
Men’s involvement in antenatal care (ANC) is intended to encourage husbands to support women’s care and associated interventions, including
prevention of mother-to-child transmission from pregnancy to delivery, and throughout the postnatal period. The present study aimed to
systematically review the barriers and opportunities for male partner involvement in antenatal care in efforts to eliminate mother-to-child
transmission of Human Immunodeficiency virus (HIV) in Kenya.
Methods:
A systematic search of articles was from the following databases; Scopus, Science Direct, PUBMED, OVID, and Google scholar. The reference
list of included studies was manually searched for possible additional eligible articles. The searches were conducted from May 2019 to April 2020.
Qualitative analysis was done and data were presented in thematic domains.
Results:
The search generated 2208 articles, of which only 19 met the inclusion criteria. The major findings were discussed under two thematic domains: 1)
Barriers: Knowledge, Social-cultural/economic factors, Institutional factors, and Age. 2) Opportunities: Skilled Birth Attendant, Human
Immunodeficiency virus-free infant and Human Immunodeficiency virus testing.
Conclusion:
The review notes that the main barriers to male partner involvement in antenatal care in efforts to eliminate mother-to-child transmission of Human
Immunodeficiency virus in Kenya include; socio-cultural factors, the low maternal-child health education by the male partner, and institutional
factors. It further provides insight on the opportunities associated with male partner involvement in antenatal care/prevention of mother-to-child
transmission, which includes; having Human Immunodeficiency virus-free infants and increased, skilled birth deliveries. The review strongly calls
out for sustainable initiatives to incorporate males into the antenatal care/prevention of mother to child transmission programs.Health Studie
Leveraging Farmer Field Days to Provide Family Planning and Other Health Services in Rural Kenya
Background: Access to family planning (FP) and other reproductive health (RH) services is difficult in much of rural Africa. Distance to health facilities, staff shortages, stock-outs, and other barriers impede the uptake and continued use of contraception. One way to improve FP access in rural areas is to deliver FP services at non-health events. FHI and Land O’Lakes collaborated to assess a model for providing health services through existing farmer-education events. This study examined the introduction of Family Planning/Reproductive Health services through Land O’Lakes-supported dairy cooperatives. Methods: The study was conducted at seven events in Central and Rift Valley provinces between August and December 2010. Typical field days draw attendees from across the dairy sector: farmers, processors, development partners and officials from the Ministry of Livestock Development and the Kenya Dairy Board. At each study site, local Land O Lakes and dairy cooperative staff helped to incorporate a “family health camp” where attendees could consult with clinicians. The package included FP services, child immunizations, antenatal care, sexually transmitted infection screening and treatment, and HIV counseling and testing. All women, 18 to 49 years old, who received services from an on-site provider, were invited to participate in a survey about the health camp and the offered services. A total of 319 women were interviewed. Key findings: Use of health services at the seven field days was high; more than 80% of the 2,344 attendees received consultations. The services provided most frequently during the field-days were non-reproductive health exams (66%), FP counseling (18%), and HIV counseling and testing (13%). Of the women interviewed, 40% were affiliated with a dairy cooperative. One-quarter of current FP users acquired additional supplies of contraceptives at the event. Knowledge contributions: This study contributes to the scant data regarding the provision of health services in the non-health sector. . This model provides a convenient way for rural people to access health services. Key Words: FP services, non-health sector, rural area, farmer
Experiences of Former Markers of Undergraduate Assignments and Examinations at A University: A Case Study
Purpose
The present study explored experiences of former markers of undergraduate assignments and examinations at the
University of South Africa (Unisa).
Methodology
Qualitative method of research was used to gather data. Colaizzi’s method (1978) was used to analyze and interpret
data. The article’s frame of reference was informed by Mezirow’s transformative learning theory which is aligned to
critical theory (Mezirow 2009).
Findings
Findings were based on the following: Demographic information, markers’ experiences in marking assignments and
exam books, content knowledge, markers’ meetings, duration of marking assignments and examination books as well
as students support, and suggestions are the themes that emerged from the data that was gathered.
Originality
It is recommended that the university must develop a policy for external markers for marking assignments and
examinations of undergraduate program. All E-tutors must be trained to support students after the official closure of
registration and before examinations are set. All markers must be trained - through a markers’ guide - to mark
assignments and examination books.Teacher Educatio
Experiences of adolescents and youth with HIV testing and linkage to care through the Red Carpet Program (RCP) in Kenya
Adolescents and youth living with HIV (AYLHIV) experience worse health outcomes compared to adults. We aimed to understand the experiences of AYLHIV in care in the youth-focused Red-Carpet program in Kenya to assess the quality of service provision and identify programmatic areas for optimization. We conducted focus group discussions among 39 AYLHIV (15–24 years) and structured analysis into four thematic areas. Within the HIV testing theme, participants cited fear of positive results, confidentiality and stigma concerns, and suggested engaging the community and youth in HIV testing opportunities. Within the HIV treatment adherence theme, participants cited forgetfulness, stigma, adverse side effects, lack of family support, and treatment illiteracy as barriers to adherence. Most participants reported positive experiences with healthcare providers and peer support. In terms of the HIV status disclosure theme, AYLHIV cited concerns about their future capacity to conceive children and start families and discussed challenges with understanding HIV health implications and sharing their status with friends and partners. Youth voices informing service implementation are essential in strengthening our capacity to optimize the support for AYLHIV within the community, at schools and healthcare facilities.</p
Optimizing Linkage to Care and Initiation and Retention on Treatment of Adolescents with Newly Diagnosed HIV Infection.
Objective: Unsuccessful linkage to care and treatment increases adolescent HIV-related morbidity and mortality. This study evaluated the effect of a novel adolescent and youth Red Carpet Program (RCP) on the timing and outcomes of linkage to care.
Design: A prepost implementation evaluation of the pilot RCP program.
Settings: Healthcare facilities (HCFs) and schools in Homa Bay County, Kenya.
Study participants: HIV-infected adolescents (15–19 years) and youth (20–21 years).
Interventions: RCP provided fast-track peer-navigated services, peer counseling, and psychosocial support at HCFs and schools in six Homa Bay subcounties in 2016. RCP training and sensitization was implemented in 50 HCFs and 25 boarding schools.
Main outcome measures: New adolescent and youth HIV diagnosis, linkage to and retention in care and treatment.
Results: Within 6 months of program rollout, 559 adolescents and youths (481 women; 78 men) were newly diagnosed with HIV (15–19 years n = 277; 20–21 years, n = 282). The majority (n = 544; 97.3%) were linked to care, compared to 56.5% at preimplementation (P \u3c 0.001). All (100.0%; n = 559) adolescents and youths received peer counseling and psychosocial support, and the majority (n = 430; 79.0%) were initiated on treatment. Compared to preimplementation, the proportion of adolescents and youths who were retained on treatment increased from 66.0 to 90.0% at 3 months (P \u3c 0.001), and from 54.4 to 98.6% at 6 months (P \u3c 0.001).
Conclusion: Implementation of RCP was associated with significant improvement in linkage to and early retention in care among adolescent and youth. The ongoing study will fully assess the efficacy of this linkage-to-care approach
Effectiveness, safety and acceptability of Sino-implant (II) during the first year of use: Results from Kenya and Pakistan
Background: Sino-implant (II) is a two-rod subcutaneous contraceptive implant used up to 4 years, containing 150 mg of levonorgestrel. We conducted two observational studies of Sino-implant (II) to evaluate its performance in routine service delivery settings.Methods: We enrolled 1326 women age 18-44 who had Sino-implant (II) inserted at clinics in Pakistan and Kenya. Women were followed-up using either an active or passive follow-up scheme in each study. Study outcomes were: one-year cumulative pregnancy and discontinuation rates; rates of insertion and removal complications; adverse event and side effect rates; reasons for discontinuation; and implant acceptability and satisfaction with clinic services.Results: A total of 754 women returned for at least one follow-up visit. The overall Pearl pregnancy rate was 0.4 per 100 woman-years [95% confidence interval (CI) 0.1, 0.9] resulting from 1 confirmed post-insertion pregnancy in Kenya and 4 in Pakistan. Country-specific Pearl rates were 0.2 (95% CI 0.0, 0.9) in Kenya and 0.6 (95% CI 0.2, 1.6) in Pakistan. The total cumulative 12-month probability of removal was 7.6% (95% CI 6.1, 9.1), with country-specific removal probabilities of 3.7% in Kenya (95% CI 2.1, 5.3) and 10.8% in Pakistan (95% CI 8.5, 13.2). Four serious adverse events occurred in Kenya and none occurred in Pakistan; one SAE (an ectopic pregnancy) was possibly related to Sino-implant (II). Most women in both countries said they would recommend the implant to others.Conclusion: The results from these studies reveal high effectiveness and favorable safety and acceptability during the first year of use of Sino-implant.Implication: The favorable Sino-implant (II) findings from Kenya and Pakistan provide further evidence from disparate regions that Sino-implant (II) is safe, effective and acceptable during routine service delivery
Advanced HIV disease in Homa Bay County, Kenya:Characteristics of newly-diagnosed and antiretroviral therapy-experienced clients
Advanced HIV disease (AHD) remains a significant burden, despite the widespread use of antiretroviral therapy (ART) programs. Individuals with AHD are at a high risk of death even after starting ART. We characterized treatment naïve and treatment experienced clients presenting with AHD in western Kenya to inform service delivery and program improvement. We conducted a retrospective study using routinely collected program data from October 2016 to September 2019 for AHD clients in eight facilities in Homa Bay County, Kenya. Demographic and clinical data were abstracted from the medical records of AHD clients, defined as HIV-positive clients aged ≥ 5 years with documented CD4 count < 200 cells/mm3 and/or WHO clinical stage II/IV. Associations were assessed using Pearson's chi-square and Mann-Whitney Rank-Sum tests at 5% level of significance. Of the 19,427 HIV clients at the eight facilities, 6649 (34%) had a CD4 count < 200 cells/mm3 or a WHO III/IV stage. Of these, 1845 were randomly selected for analysis. Over half (991) of participants were aged 45 + years and 1040 (56%) were female. The median age was 46.0 years (interquartile range: 39.2-54.5); 1553 (84%) were in care at county and sub-county hospitals; and 1460 (79%) were WHO stage III/IV at enrollment. At ART initiation, 241 (13%) had tuberculosis, 192 (10%) had chronic diarrhea, and 94 (5%) had Pneumocystis jiroveci pneumonia. At the time of data collection, 89 (5%) participants had died and 140 (8%) were lost to follow-up. Eighteen percent (330) of participants were ART-experienced (on ART for ≥ 3 months). The proportions of ART-experienced and -naïve clients regarding age, sex and marital status were similar. However, a higher proportion of ART-experienced clients received care at primary care facilities, (93(28%) vs. 199 (13%); P < .001); were WHO stage 3/4 at AHD diagnosis, 273 (84%) vs. 1187 (79%) (P = .041); and had died or been LTFU, (124 (38%) vs. 105 (7%); P < .001). With increasing prevalence of patients on ART, the proportion of AHD treatment-experienced clients may increase without effective interventions to ensure that these patients remain in care.</p
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