Adherence of healthcare practitioners to the adolescent reproductive health and development policy at The Garissa Provincial General Hospital, Kenya

Background: Kenya’s policies relating to population, family planning (FP) and reproductive health (RH) receive weak/fluctuating levels of adherence. The Adolescent Reproductive Health and Development  (ARH&D) policy gives directives and actions to follow in meeting identified ends and goals in the  reproductive and developmental needs of the youth- majority of Kenya’s population (Ministry of  Health-Youth Friendly Services (MOH-YFS), National Coordination Agency for Population and Development(NCAPD), 2011).Objective: To evaluate adherence of healthcare practitioners (HCPs) to the Adolescent Reproductive Health and Development (ARH&D) policy at the Garissa Provincial General Hospital, Kenya (GPGH).Design: A cross sectional study.Setting: Garissa Provincial General Hospital, Kenya.Subjects: Comprised of 172 Healthcare practitioners (HCPs), including 88 nurses, 14 doctors and 17  clinical officers (COs) and 53 adolescent clients.Results: The HCP policy utilisation rate of the ARH&D which was 62.2% was influenced by religious  affiliation, age, frequency of supervision. Adolescent client satisfaction level was about 34%. Severity of infibulations has reduced in severity among the Somali people. Consanguineous marriages of under-age girls, drug addiction, poverty, HIV and AIDS and FP stigmatisation are still high in North Eastern Province.Conclusion: Adherence to the ARH&D policy was about 62% at the GPGH. There was no ideal set up for YFS. The adolescent satisfaction low was at about 34%. Infibulation has reduced. There were  shortcomings with the HCP characteristics, facility deficits, and service management hurdles

Pregnancy rates among female participants in phase 1 and phase 2A AIDS vaccine clinical trials in Kenya

Background: Female participants in AIDS candidate vaccine clinical trials must agree to use effective contraception to be enrolled into the studies, and for a specified period after vaccination, since the candidate vaccines’ effects on the embryo or foetus are unknown.Objectives: To review data on female participants’ pregnancy rates from phase I and IIA AIDS vaccine clinical trials conducted at the Kenya AIDS Vaccine Initiative (KAVI) and to discuss the challenges of contraception among female participants.Design: Descriptive observational retrospective study.Setting: KAVI clinical trial site, Kenyatta National Hospital and University of Nairobi, Kenya.Subjects: Thirty nine female participants were enrolled into these trials. They received family planning counselling and were offered a choice of different contraceptive methods, as per the protocols. All contraception methods chosen by the participants were offered at the study site at no cost to the participant.Results: Four women conceived during the study period when pregnancies were to be avoided. All four had opted for sexual abstinence as a contraceptive method, but reported having been coerced by their partners to have unprotected sexual intercourse.Conclusion: Abstinence is clearly not a reliable contraceptive option for women in developing-country settings. Effective female-controlled contraceptives, administered at the clinical trial site, may empower female participants to better control their fertility, leading to more complete clinical trial data

Partner notification for sexually transmitted infections in developing countries: a systematic review

<p>Abstract</p> <p>Background</p> <p>The feasibility and acceptability of partner notification (PN) for sexually transmitted infections (STIs) in developing countries was assessed through a comprehensive literature review, to help identify future intervention needs.</p> <p>Methods</p> <p>The Medline, Embase, and Google Scholar databases were searched to identify studies published between January 1995 and December 2007 on STI PN in developing countries. A systematic review of the research extracted information on: (1) willingness of index patients to notify partners; (2) the proportion of partners notified or referred; (3) client-reported barriers in notifying partners; (4) infrastructure barriers in notifying partners; and (5) PN approaches that were evaluated in developing countries.</p> <p>Results</p> <p>Out of 609 screened articles, 39 met our criteria. PN outcome varied widely and was implemented more often for spousal partners than for casual or commercial partners. Reported barriers included sociocultural factors such as stigma, fear of abuse for having an STI, and infrastructural factors related to the limited number of STD clinics, and trained providers and reliable diagnostic methods. Client-oriented counselling was found to be effective in improving partner referral outcomes.</p> <p>Conclusions</p> <p>STD clinics can improve PN with client-oriented counselling, which should help clients to overcome perceived barriers. The authors speculate that well-designed PN interventions to evaluate the impact on STI prevalence and incidence along with cost-effectiveness components will motivate policy makers in developing countries to allocate more resources towards STI management.</p

New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries.

As more new and improved vaccines become available, decisions on which to adopt into routine programmes become more frequent and complex. This qualitative study aimed to explore processes of national decision-making around new vaccine adoption and to understand the factors affecting these decisions. Ninety-five key informant interviews were conducted in seven low- and middle-income countries: Bangladesh, Cameroon, Ethiopia, Guatemala, Kenya, Mali and South Africa. Framework analysis was used to explore issues both within and between countries. The underlying driver for adoption decisions in GAVI-eligible countries was the desire to seize GAVI windows of opportunity for funding. By contrast, in South Africa and Guatemala, non-GAVI-eligible countries, the decision-making process was more rooted in internal and political dynamics. Decisions to adopt new vaccines are, by nature, political. The main drivers influencing decisions were the availability of funding, political prioritization of vaccination or the vaccine-preventable disease and the burden of disease. Other factors, such as financial sustainability and feasibility of introduction, were not as influential. Although GAVI procedures have established more formality in decision-making, they did not always result in consideration of all relevant factors. As familiarity with GAVI procedures increased, questioning by decision-makers about whether a country should apply for funding appeared to have diminished. This is one of the first studies to empirically investigate national processes of new vaccine adoption decision-making using rigorous methods. Our findings show that previous decision-making frameworks (developed to guide or study national decision-making) bore little resemblance to real-life decisions, which were dominated by domestic politics. Understanding the realities of vaccine policy decision-making is critical for developing strategies to encourage improved evidence-informed decision-making about new vaccine adoptions. The potential for international initiatives to encourage evidence-informed decision-making should be realised, not assumed

Secrecy inhibits support:A grounded theory of community perspectives of women suffering from obstetric fistula, in Kenya

Aim: this study aimed to gain understanding of the views of community members in relation to obstetric fistula. Design and method: a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data. Setting: participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta. Interviews took place either in the home, place of work, or hospital. Findings: the core category (central concept) is ‘secrecy hinders support’. This was supported by three themes: ‘keeping fistula hidden’, ‘treatment being a lottery’ and ‘multiple barriers to support.’ These themes represent the complexities around exposure of individual fistula sufferers and the impact that lack of information and women's status can have on treatment. Keeping fistula secret reinforces uncertainties around fistula, which in itself fuels myths and ignorance regarding causes and treatments. Lack of openness, at an individual level, prevents support being sought or offered. Conclusions: A multi-layered strategy is required to support women with fistula. At a societal level, the status of women in LMIC countries needs elevation to a level that provides equity in health services. At a national level, laws need to protect vulnerable women from mistreatment as a direct result of fistula. Furthermore, resources should be available to ensure provision of timely management, as part of routine services. At community level, awareness and education is required to actively engage members to support women locally. Peer support before and after fistula repair may be beneficial, but requires further research

Students’ experiences of using the partograph in Kenyan labour wards

Background: Previous research has demonstrated the likely benefits of partograph use in low-resourced settings. However, the challenges of completing a partograph are also reported. The objective of this study was to examine students’ views and experiences of partograph use to gain understanding of the realities of using this tool in the labour ward. Methods: In a qualitative study, 51 student nurses, undertaking their maternity placement at a university in Nairobi, Kenya, participated in five focus group discussions. Data were audio recorded, transcribed verbatim and analysed thematically. Results: Four main themes emerged from the analyses: challenges to ‘doing the right thing’; theory-practice disconnectedness; negative role models; and retrospective recording. Conclusions: The results provide insight into the challenges faced by students when practising in the labour ward environment. A more effective approach to partograph training and implementation should be adopted to support students. However, student midwife training is unlikely to be implemented into practice unless the qualified team supports their learning. Given that the partograph had little status in the labour ward, change may only happen when senior health professionals (midwives and obstetricians) lead by example. Further research is required to explore the views of obstetricians and qualified midwives on partograph use. Appropriate implementation strategies also warrant further investigation

PARTNER NOTIFICATION IN THE MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS IN NAIROBI, KENYA

ABSTRACTObjective: To assess utilization of partner notification as a tool in prevention and controlof Sexually transmitted infections in Nairobi City Council clinics.Design: A cross-sectional study carried out between April and September 2000.Setting: Nairobi City Council health clinics were stratified into eight administrativedivisions and a total of 16 out of 54 primary health clinics with at least four STIs patientsper day were selected. A standard questionnaire was administered to every fourth patientwith clinical diagnosis of STIs who gave consent on exist. Sexual partners referred byindex cases during the five day period from each clinic were also enrolled into the study.An additional questionnaire was administered to HCP who were managing STIs patientsand their sex partners.Results: Of 407 STIs patients recruited between April and September 2000, 20.6% wereprimary and 2% were secondary referrals giving an average referral rate of 23%.Respondents with multiple sex partners were less likely to refer their partners comparedto those who had one partner (17.9% vs 82.1%, p&lt;0.005). Counseling of STI patientson the importance of partner referral was more effective than issuing referral cardsalone (72.8% vs 56.8% % p= &lt;0.006). Barriers to partner notification included partnersbeing out of town (44.6%) fear of quarrels and violence from partners (32.5%) andcasual partners (15.1%) whose sex partners were unknown.Conclusion: Counseling and understanding of STIs patients on the need to treat all sexualpartners is pivotal to the success of partner referral

Understanding the complexities of unexplained stillbirth in sub‐Saharan Africa: a mixed‐methods study

Objective: To understand the complexities surrounding unexplained stillbirth for the development and implementation of culturally acceptable interventions to underpin care in Tanzania and Zambia. Design: Mixed-methods. Setting: Tertiary, secondary and primary care facilities in Mansa, Zambia and Mwanza, Tanzania. Sample: Quantitative; 1997 women giving birth at two tertiary care facilities (one in each country). Qualitative; 48 women and 19 partners from tertiary, secondary and primary care facilities. Methods: Case review using data from a 2000 consecutive case record target. Qualitative interviews with a purposive sample of women and partners, using a grounded theory approach. Results: A total of 261 stillbirths were recorded; Tanzania rate 16%, Zambia 10%, higher than previous country estimates of 2.24% and 2.09%, respectively. Women in both countries who reported a previous stillbirth were more likely to have stillbirth (RR (95% CI): 1.86 (1.23 – 2.81)). Cause of death was unexplained in 28% of cases. Qualitative findings indicated that not knowing what caused the baby to be stillborn prevented women from grieving. This was compounded by poor communication skills of health professionals who displayed little empathy and skill when counselling bereaved families. Conclusion: Stillbirth risk in both facilities was far higher than national data, with women reporting a previous stillbirth at higher risk. Women want to know the cause of stillbirth and exploration of appropriate investigations in this setting is required. Providing health professionals with support and ongoing training is key to improving the experiences of women and future care. Funding: National Institute for Health Research. Keywords: Stillbirth, autopsy, communication, grief, sub-Saharan Africa, mixed-methods