Factors influencing voluntary medical male circumcision among men aged 18-50 years in Kibera Division

Background: Voluntary Medical Male Circumcision (VMMC) is the surgical removal of all or part of the foreskin from the penis. It is done for medical reasons as it has been shown to reduce the risk of female to male transmission of HIV by up to 60%. It has also been associated with lower transmission of sexually transmitted infections. Voluntary Medical Male Circumcision services have been scaled up in countries with high prevalence, generalised heterosexual HIV epidemics and low rates of male circumcision. Kibera is inhabited by a multi-ethnic community with a sizeable number of un-circumcising ethnic groups.Objectives: To determine the uptake of voluntary medical male circumcision among men in Kibera Division and to identify factors associated with circumcision preference.Design: Descriptive cross-sectional study.Setting: Kibera Division of Nairobi County.Subjects: Simple random sampling was used to enrol 387 participants. A 42-item questionnaire was administered to the participants for determining the uptake of VMMC. It had three sub-sections: demographic characteristics, general knowledge about VMMC and AIDS and acceptability of VMMC, which collected data on the main outcome measures. Data captured was entered into EpiInfo and converted to Stata13 for validation and analysis. Bivariate statistics were generated for all the variables in accordance to the study questions. Categorical variables were analysed using chi-square tests, while the qualitative variables were analysed using the t-test. Multivariate logistic regression analysis was performed to identify factors associated with the acceptability of male circumcision.Results: The study analysed data for a sample of 341 individuals whose mean age was 31 years (95%= 31+-9.1) and 62% were married. A total of 54% of the respondents had completed secondary and tertiary level of education. The level of understanding about VMMC was above average. Fifty nine percent of the respondents (95% CI = 0.54 - 0.64) knew about VMMC. Of these, 31% had obtained information about VMMC from TV and radio. The most frequently mentioned reason for undergoing VMMC was prevention of HIV and sexually transmitted infections. The level of uptake of VMMC was high at 75%. The study established that the prefered age group for circumcision was during adolescence. Using multivariate logistic regression, the factors associated with uptake of VMMC were education level, medical and hygiene reasons for VMMC. Barriers for uptake were cost, pain and long recovery period after the operation.Conclusion: The uptake and acceptability of male circumcision is high among the general population in Kibera. Participant understanding of HIV and VMMC was also high. There is need for heightened awareness creation in educational institutes. This will specifically target young men before or shortly after their sexual debut when they may still be free of HIV and HSV-2 infections. Circumcision by medical providers should be increased in traditionally circumcising regions to reduce incidence of adverse events

Use of fine-scale stratigraphy and chemostratigraphy to evaluate conditions of deposition and preservation of a Triassic lagerstätte, south-central Virginia

The rich, fossiliferous Triassic sediments exposed in the Virginia Solite Quarry include a 34-mm-thick “insect layer” that is notable for detailed preservation of soft-bodied invertebrate and vertebrate remains. We describe this unique Konservat-Lagerstätte and use sedimentologic and geochemical analyses to interpret the environmental conditions necessary to preserve such delicate fossils. This work is among the first attempts to apply detailed geochemical/stratigraphic analysis to the study of Lagerstätten and we report on a 332-mm-thick section that includes the insect layer and the rocks immediately below and above it. Our analysis successfully constrains various aspects of the depositional and diagenetic history of the Lagerstätte and permits a detailed analysis of changing conditions prior to, during, and after deposition. Geochemical and sedimentologic analyses of the insect layer and surrounding lithologies reveal a change from siliciclastic-dominated layers (Unit 1) to dolomite-siliciclastic laminites above (Unit 2 and the insect layer), separated by a boundary dolostone layer that is traceable for over 200 m. We interpret this sedimentary shift as the initial stages in the transgression of a shallow, saline, alkaline rift-basin lake over lake margin deposits. The absence of bioturbation by plants and benthic organisms, as well as a lack of predation on the insects, is not explained by significant water depth, but is instead more reasonably considered a result of the chemistry of the water at the lake margin, affected by groundwater seeps, which provided F-, Mg-, and Ca-rich fluids. Although the initial conditions of preservation are remarkable, it is equally impressive that the fossils survived extensive diagenesis, e.g. dissolution of quartz and coarsening of dolomite