Promoting Respectful Maternity Care: A training guide for facility-based workshops—Participant\u27s guide

This guide was produced as part of the Respectful Maternity Care (RMC) Resource Package. The Resource Package was designed to support health facility managers, health care providers, and communities in confronting disrespect and abuse (D&A) during facility-based childbirth and to promote respectful maternity care. The Resource Package includes a facilitator’s guide (facility-based workshops), facilitator’s guide (community-based workshops), participant’s guide, community flipchart, tools, and program briefs. Workshop objectives outlined in the Participant’s Guide: Outline current status of maternal and neonatal health in relation to respectful care. Discuss key RMC concepts, terminology, legal and rights-based approaches related to respectful maternity care and the RMC Resource Package. Demonstrate knowledge and use of VCAT theory and practice. Discuss selected evidence-based strategies that reduce D&A. Discuss participants’ role in promoting RMC. Develop action plans to support the implementation of RMC interventions at various levels of health (e.g., policy, program, regional/county, subcounty, facility, and community)

Promoting Respectful Maternity Care: A training guide for community-based workshops—Community facilitator\u27s guide

This guide was produced as part of the Respectful Maternity Care (RMC) Resource Package. The Resource Package was designed to support health facility managers, health care providers, and communities in confronting disrespect and abuse (D&A) during facility-based childbirth and to promote respectful maternity care. The Resource Package includes a facilitator’s guide (facility-based workshops), facilitator’s guide (community-based workshops), participant’s guide, community flipchart, tools, and program briefs. The Community Facilitator’s Guide, designed to be used by facilitators to promote respectful maternity care at the community level, can be adapted to educate a variety of stakeholders in community settings (i.e., Community Health Extension Workers, Community Health Workers, society leaders, legal aid officers). The Guide highlights key practical points to enable participants to act as resource persons regarding the rights and obligations of childbearing women, and as advocates of respectful maternity care including how to conduct an Alternative Dispute Resolution mechanism

Respectful Maternity Care Resource Package

The Respectful Maternity Care Resource Package is a set of manuals, tools, and resources to ensure high-quality, respectful maternal and newborn health services. The resources help program managers, health workers, and technical advisors set up workshops and trainings for facility-based providers and community health workers. The workshops provide practical, low-cost, and easily adaptable strategies to improve respectful care. The Respectful Maternity Care Resource Package was developed by the Heshima project as part of the USAID Translating Research into Action (TRAction) project. ------ Training facility-based health providers Facilitator’s guide Orientation slide deck Participant’s guide Training community health workers Facilitator’s guide Orientation slide deck Flip chart Additional resources Implementing respectful maternity care in Kenya Debriefing sessions: Caring for the carers Alternative dispute resolution: Resolving incidents of disrespect and abuse Maternity open days: Clarifying misconceptions about facility-based birt

Socio-cultural practices on the use of beetle grubs as food and feed in western Kenya

Abstract We examined the socio-cultural practices on the use of beetle grubs as food and feed in western Kenya by interviewing 211 randomly selected households and conducting seven focus group discussions in Bungoma, Kakamega, Busia, and Trans Nzoia counties. The grubs were used as food and feed in ~ 39% and 78% of the households, respectively. The perceived benefits of the grubs for human consumption were nutritiousness and no linkage to allergies. The grubs were perceived to enhance animal weight gain and increase poultry egg laying. They were also perceived to recycle nutrients from organic waste, and clean the environment. Toasting and roasting were the dominant methods of preparing the grubs. Lack of knowledge on the grub nutritional benefits and stigma were key deterrents to their consumption. About 66% of the respondents expressed willingness to farm the grubs if the market and rearing protocols are available. Almost 98% of the respondents lacked knowledge of the beetle biology, indicating limited capacity to conserve them. The practices on the use of beetle grubs as food and feed differed across counties and by gender, age, marital status and education level. Strategies for sustainable use of the grubs as food and feed have been proposed and new research directions highlighted

Impact of "test and treat" recommendations on eligibility for antiretroviral treatment: Cross sectional population survey data from three high HIV prevalence countries.

BACKGROUND:Latest WHO guidelines recommend starting HIV-positive individuals on antiretroviral therapy treatment (ART) regardless of CD4 count. We assessed additional impact of adopting new WHO guidelines. METHODS:We used data of individuals aged 15-59 years from three HIV population surveys conducted in 2012 (Kenya) and 2013 (Malawi and South Africa). Individuals were interviewed at home followed by rapid HIV and CD4 testing if tested HIV-positive. HIV-positive individuals were classified as "eligible for ART" if (i) had ever been initiated on ART or (ii) were not yet on ART but met the criteria for starting ART based on country's guidelines at the time of the survey (Kenya-CD4< = 350 cells/μl and WHO Stage 3 or 4 disease, Malawi as for Kenya plus lifelong ART for all pregnant and breastfeeding women, South Africa as for Kenya plus ART for pregnant and breastfeeding women until cessation of breastfeeding). FINDINGS:Of 18,991 individuals who tested, 4,113 (21.7%) were HIV-positive. Using country's ART eligibility guidelines at the time of the survey, the proportion of HIV-infected individuals eligible for ART was 60.0% (95% CI: 57.2-62.7) (Kenya), 73.4% (70.8-75.8) (South Africa) and 80.1% (77.3-82.6) (Malawi). Applying WHO 2013 guidelines (eligibility at CD4< = 500 and Option B+ for pregnant and breastfeeding women), the proportions eligible were 82.0% (79.8-84.1) (Kenya), 83.7% (81.5-85.6) (South Africa) and 87.6% (85.0-89.8) (Malawi). Adopting "test and treat" would mean a further 18.0% HIV-positive individuals (Kenya), 16.3% (South Africa) and 12.4% (Malawi) would become eligible. In all countries, about 20% of adolescents (aged 15-19 years), became eligible for ART moving from WHO 2013 to "test and treat" while no differences by sex were observed. CONCLUSION:Countries that have already implemented 2013 WHO recommendations, the burden of implementing "test and treat" would be small. Youth friendly programmes to help adolescents access and adhere to treatment will be needed

Distribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi)

International audienceBackground: Despite substantial progress in antiretroviral therapy (ART) scale up, some people living with HIV (PLHIV) continue to present with advanced HIV disease, contributing to ongoing HIV-related morbidity and mortality.Objective: We aimed to quantify population-level estimates of advanced HIV from three high HIV prevalence settings in Sub-Saharan Africa.Methods: Three cross-sectional surveys were conducted in (Ndhiwa (Kenya): September-November 2012), (Chiradzulu (Malawi): February-May 2013) and (Eshowe (South Africa): July-October 2013). Eligible individuals 15-59 years old who consented were interviewed at home followed by rapid HIV test and CD4 count test if tested HIV-positive. Advanced HIV was defined as CD4 < 200 cells/µl. We used logistic regression to identify patient characteristics associated with advanced HIV.Results: Among 18,991 (39.2% male) individuals, 4113 (21.7%) tested HIV-positive; 385/3957 (9.7% (95% Confidence Interval [CI]: 8.8-10.7)) had advanced HIV, ranging from 7.8% (95%CI 6.4-9.5) Chiradzulu (Malawi) to 11.8% (95%CI 9.8-14.2) Ndhiwa (Kenya). The proportion of PLHIV with advanced disease was higher among men 15.3% (95% CI 13.2-17.5) than women 7.5% (95%CI 6.6-8.6) p < 0.001. Overall, 62.7% of all individuals with advanced HIV were aware of their HIV status and 40.3% were currently on ART. Overall, 65.6% of individuals not on ART had not previously been diagnosed with HIV, while only 29.6% of those on ART had been on ART for ≥6 months. Individuals with advanced HIV disease were more likely to be men (adjusted Odds Ratio [aOR]; 2.1 (95%CI 1.7-2.6), and more likely not to be on ART (aOR; 1.7 (95%CI 1.3-2.1).Conclusion: In our study, about 1 in 10 PLHIV had advanced HIV with nearly 40% of them unaware of their HIV status. However, a substantial proportion of patients with advanced HIV were established on ART. Our findings suggest the need for a dual focus on alternative testing strategies to identify PLHIV earlier as well as improving ART retention

A Computational Drug Repositioning Approach for Targeting Oncogenic Transcription Factors

Mutations in transcription factor (TF) genes are frequently observed in tumors, often leading to aberrant transcriptional activity. Unfortunately, TFs are often considered undruggable due to the absence of targetable enzymatic activity. To address this problem, we developed CRAFTT, a computational drug-repositioning approach for targeting TF activity. CRAFTT combines ChIP-seq with drug-induced expression profiling to identify small molecules that can specifically perturb TF activity. Application to ENCODE ChIP-seq datasets revealed known drug-TF interactions, and a global drug-protein network analysis supported these predictions. Application of CRAFTT to ERG, a pro-invasive, frequently overexpressed oncogenic TF, predicted that dexamethasone would inhibit ERG activity. Dexamethasone significantly decreased cell invasion and migration in an ERG-dependent manner. Furthermore, analysis of electronic medical record data indicates a protective role for dexamethasone against prostate cancer. Altogether, our method provides a broadly applicable strategy for identifying drugs that specifically modulate TF activity

Oral amoxicillin versus benzyl penicillin for severe pneumonia among kenyan children: a pragmatic randomized controlled noninferiority trial.

BACKGROUND: There are concerns that the evidence from studies showing noninferiority of oral amoxicillin to benzyl penicillin for severe pneumonia may not be generalizable to high-mortality settings. METHODS: An open-label, multicenter, randomized controlled noninferiority trial was conducted at 6 Kenyan hospitals. Eligible children aged 2-59 months were randomized to receive amoxicillin or benzyl penicillin and followed up for the primary outcome of treatment failure at 48 hours. A noninferiority margin of risk difference between amoxicillin and benzyl penicillin groups was prespecified at 7%. RESULTS: We recruited 527 children, including 302 (57.3%) with comorbidity. Treatment failure was observed in 20 of 260 (7.7%) and 21 of 261 (8.0%) of patients in the amoxicillin and benzyl penicillin arms, respectively (risk difference, -0.3% [95% confidence interval, -5.0% to 4.3%]) in per-protocol analyses. These findings were supported by the results of intention-to-treat analyses. Treatment failure by day 5 postenrollment was 11.4% and 11.0% and rising to 13.5% and 16.8% by day 14 in the amoxicillin vs benzyl penicillin groups, respectively. The most frequent cause of cumulative treatment failure at day 14 was clinical deterioration within 48 hours of enrollment (33/59 [55.9%]). Four patients died (overall mortality 0.8%) during the study, 3 of whom were allocated to the benzyl penicillin group. The presence of wheeze was independently associated with less frequent treatment failure. CONCLUSIONS: Our findings confirm noninferiority of amoxicillin to benzyl penicillin, provide estimates of risk of treatment failure in Kenya, and offer important additional evidence for policy making in sub-Saharan Africa. CLINICAL TRIAL REGISTRATION: NCT01399723

Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study

Background Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals.Methods Continuously collected routine patients’ data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0–13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals.Findings During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0–28 days), but they accounted for 66% of the deaths in the age group 0–13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000–1499 g and 1500–1999 g.Interpretation The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (&gt;95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight