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

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

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

Integrating pediatric TB services into child healthcare services in Africa: study protocol for the INPUT cluster-randomized stepped wedge trial

Background Tuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB. The INPUT study is a stepped-wedge cluster-randomized intervention study aiming to assess the effectiveness of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age. Methods Two strategies will be compared: i) The standard of care, offering pediatric TB services based on national standard of care; ii) The intervention, with pediatric TB services integrated into child healthcare services: it consists of a package of training, supportive supervision, job aids, and logistical support to the integration of TB screening and diagnosis activities into pediatric services. The design is a cluster-randomized stepped-wedge of 12 study clusters in Cameroon and Kenya. The sites start enrolling participants under standard-of-care and will transition to the intervention at randomly assigned time points. We enroll children aged less than 5 years with a presumptive diagnosis of TB after obtaining caregiver written informed consent. The participants are followed through TB diagnosis and treatment, with clinical information prospectively abstracted from their medical records. The primary outcome is the proportion of TB cases diagnosed among children < 5 years old attending the child healthcare services. Secondary outcomes include: number of children screened for presumptive active TB; diagnosed; initiated on TB treatment; and completing treatment. We will also assess the cost-effectiveness of the intervention, its acceptability among health care providers and users, and fidelity of implementation. Discussion Study enrolments started in May 2019, enrolments will be completed in October 2020 and follow up will be completed by June 2021. The study findings will be disseminated to national, regional and international audiences and will inform innovative approaches to integration of TB screening, diagnosis, and treatment initiation into child health care services.publishedVersio

HIV-1 Drug Resistance Emergence among Breastfeeding Infants Born to HIV-Infected Mothers during a Single-Arm Trial of Triple-Antiretroviral Prophylaxis for Prevention of Mother-To-Child Transmission: A Secondary Analysis

Analysis of a substudy of the Kisumu breastfeeding trial by Clement Zeh and colleagues reveals the emergence of HIV drug resistance in HIV-positive infants born to HIV-infected mothers treated with antiretroviral drugs