Implementation challenges of free maternity services policy in Kenya: the health workers’ perspective

Introduction: Kenya implemented the policy of free maternity services to reduce maternal mortality and morbidity. For successful implementation of this policy, there is need to monitor the implementation progress, identify the challenges and mitigate them and determine better strategies for implementation based on emerging implementation issues. This study was carried out to determine the challenges facing policy implementation and strategies for better implementation.Methods: This was a cross-sectional descriptive study carried at the Rift Valley Provincial General Hospital (RVPGH) and Bondeni maternity. All the staff who work at Bondeni Maternity (including nursing officer in-charge) were included in the study. All the staff who work at the Maternity Unit of the RVPGH were included in the study, as well as the Medical Superintendent of the facility. A total of 110 respondents were sampled. A questionnaire and interview guide were used to collect data. Data was analyzed using SPSS software.Results: A response rate of 91% (n=100) was achieved. Major implementation challenges include inadequate supplies (86%), inadequate funding (38%), staff shortage (92%), lack of motivation among health workers (62%), overwhelming workload (89%) and abuse of services by clients (32%). Strategies for better implementation include employment of more staff, motivation of health workers, improvement in policy financing, training of health workers and provision of adequate supplies.Conclusion: Implementation of free maternity services policy in Kenya is facing challenges but there exists strategies, which, if implemented, will help address these challenges

Role of Guidance and Counselling in Managing Discipline Among Tertiary College Students in Western Region, Kenya

Management of discipline among students in tertiary colleges is one issue that many college administrators are grappling with almost on a daily basis. Cases of sexual pervasion, drug abuse, prostitution, bullying, vandalism and examination malpractice among others have become prevalent in learning institutions in Kenya. Administrators are known to be applying more of the traditional methods than guidance and counselling to ensure effective management of discipline with very minimal success. The purpose of this study was to investigate the role of guidance and counselling (G&C) in managing discipline among students in tertiary colleges in Western Region, Kenya. This study used a survey research design. The study had a population of 12,123 students and 39 G&C Coordinators. A sample size of 411 respondents comprising 375 students and 36 guidance and counselling coordinators were used. Data collection was done using two sets of questionnaires, one for G&C coordinators and another for students. The collected data was then analysed using both inferential and descriptive statistics with the aid of SPSS computer software for windows.The following were the findings of this study: - Management of discipline had not fully been entrusted to guidance and counselling as the most preferred method; when G&C was involved, 24% of the G&C coordinators participated in the disciplinary proceedings.One quarter of the G&C coordinators had no professional training in counselling. This study concluded that the number of colleges that had fully embraced G&C as an intervention measure to manage discipline among students was below average. It was established that guidance and counselling had played a key role in helping students to change their behaviour and improve in academic performance in the colleges where it was fully operational; Most colleges had clear G&C policy frameworks despite the fact that their G&C programmes were not in tandem with the policies. The study came up with the following recommendations:- All G&C coordinators must undertake a professional training in counselling; The number of counselling teachers per institution should be proportional to the student enrolment and should not have any teaching load; It should be made policy that Guidance and counselling becomes the first line of defense when addressing discipline issues among students and all G&C coordinators were supposed to be inducted about implementation of policy

Prenatal cervical cancer screening using visual inspection with acetic acid in a low resource setting

Purpose: Cervical cancer is one of the most common malignancies among women in low resource setting. The objective of this study was to assess the acceptability of prenatal cervical cancer screening using visual inspection with acetic acid (VIA) in a low resource setting. Methods: This was a cross-sectional study conducted at Moi Teaching and Referral Hospital. Over a period of 12 months, we enrolled 331 women who were attending antenatal care clinic with a gestation of age of less than 22 weeks. We screened them for cervical cancer by applying 5% acetic acid to the cervix (VIA Method). Visualization of aceto-white lesions was interpreted as a positive VIA test. A cervicography was obtained for independent review by two clinicians. A repeat VIA test or colposcopy and biopsy were recommended at 6 weeks postpartum for those with a positive VIA test. Results: Mean gestational age was 16 weeks. Seventy five percent of participants (n = 247) had used contraceptives, 31.1% (n = 103) had previously been screened for cervical cancer and 9.1% (n = 14) were HIV positive. The study clinician detected 11.3% VIA positive while first and second independent reviewers reported 22.5% and 7.7% VIA-positive results, respectively. About 85.7% of the participants did not experience any immediate adverse reaction as a result of the procedure. However, 3.8%, 38.4% and 0.7% experienced pain, burning sensation and bleeding respectively. Overall, 98.4% (n = 306) indicated that they would recommend the test, and 99% (n = 307) indicated that they would return for a repeat test 6 weeks postpartum. HIV status had no influence on VIA-positive rates (p = 0.909). Conclusion: The rate of VIA positive was 13.8% among the pregnant women. It is acceptable to use VIA to screen pregnant women for cervical cancer

Community Dialogue to Shift Social Norms and Enable Family Planning: An Evaluation of the Family Planning Results Initiative in Kenya

<div><p>Introduction</p><p>Use of family planning (FP) is powerfully shaped by social and gender norms, including the perceived acceptability of FP and gender roles that limit women’s autonomy and restrict communication and decision-making between men and women. This study evaluated an intervention that catalyzed ongoing community dialogues about gender and FP in Siaya county, Nyanza Province, Kenya. Specifically, we explored the changes in perceived acceptability of FP, gender norms and use of FP.</p><p>Methods</p><p>We used a mixed-method approach. Information on married men and women’s socio-demographic characteristics, pregnancy intentions, gender-related beliefs, FP knowledge, attitudes, and use were collected during county-representative, cross-sectional household surveys at baseline (2009; n₁₁ = 650 women; n₁₂ = 305 men) and endline (2012; n₂₁ = 617 women; n₂₂ = 317 men); exposure to the intervention was measured at endline. We assessed changes in FP use at endline vs. baseline, and fitted multivariate logistic regression models for FP use to examine its association with intervention exposure and explore other predictors of use at endline. In-depth, qualitative interviews with 10 couples at endline further explored enablers and barriers to FP use.</p><p>Results</p><p>At baseline, 34.0% of women and 27.9% of men used a modern FP method compared to 51.2% and 52.2%, respectively, at endline (p<0.05). Exposure to FP dialogues was associated with 1.78 (95% CI: 1.20–2.63) times higher odds of using a modern FP method at endline for women, but this association was not significant for men. Women’s use of modern FP was significantly associated with higher spousal communication, control over own cash earnings, and FP self-efficacy. Men who reported high approval of FP were significantly more likely to use modern FP if reporting high approval of FP and more equitable gender beliefs. FP dialogues addressed persistent myths and misconceptions, normalized FP discussions, and increased its acceptability. Public examples of couples making joint FP decisions legitimized communication and decision-making with spouses about FP especially for men; women described partner support as key enabler of FP use.</p><p>Conclusions</p><p>Our evaluation demonstrates that an intervention that catalyzes open dialogue about gender and FP can shift social norms, enable more equitable couple communication and decision-making and, ultimately, increase use of FP.</p></div

Key determinants of and use of family planning among women at endline.

<p>Key determinants of and use of family planning among women at endline.</p

Sample characteristics.

<p>Sample characteristics.</p

CARE’s Family Planning Results Initiative Theory of Change.

<p>This theory of change illustrates, from left to right, the activities undertaken as part of CARE’s Family Planning Results Initiative, the expected intermediate outcomes that will lead to improvements in three key determinants of family planning which, ultimately, increase use of family planning in the intervention community.</p

Changes in family planning use between baseline and endline.

<p>Changes in family planning use between baseline and endline.</p

Subcutaneous metastasis of cancer of the endometrium

Background: Cancer of the endometrium is the third most common gynecological malignancy after cancer of the cervix and ovary in Kenya. Subcutaneous metastasis is unusual site for endometrial cancer. Few cases of cutaneous and subcutaneous metastases from cancer of endometrium have been reported in the literature. The main areas of cutaneous and subcutaneous metastases are abdominal, perineal surfaces, skin and toes. Disseminated lesions are associated with hematogenous spread, while some occur via lymphatic spread or contiguity. Case Presentation: We present a case of a 45-year-old female, Para 5 + 0, who presented to our gynecologic oncology clinic in July 2017. The patient was referred from a peripheral health facility for chemotherapy following radical hysterectomy in May 2017 for endometrial cancer. Histology results of the specimen taken during surgery showed endometrial Ca stage 2, grade 3. The patient developed a swelling on the right leg 6 months after completion of 6 cycles of carboplatin and paclitaxel. Biopsy from the leg showed features consistent with metastatic endometrioid adenocarcinoma. The patient was started on pegylated liposomal doxorubicin. Local radiation of the metastatic subcutaneous lesion was also done. Conclusion: Cutaneous and subcutaneous metastases from cancer of the endometrium are rare. We recommend histologic evaluation of subcutaneous masses developing in patients with endometrial cancer or in those suspected to have endometrial cancer