Factors Associated with the Ebola Viral Disease Outbreak in Montserrado County, Liberia

The 2014 Ebola Virus Disease (EVD) outbreak went on record as the most distressing epidemic in the 41 years history of Ebola following its discovery in DRC and South Sudan. Liberia, one of the three nations at the epicentre of the EVD outbreak, grapples with poverty and is still recovering from civil war that ended in 2003, suffers a weak health system. Montserrado County in Liberia was one of the three counties that were hit hardest by the outbreak, the others being Lofa and Margibi. The primary objective of this study was to assess the aspects linked to the identification and response patterns with regards to the EVD outbreak in Montserrado County, Liberia. This was necessitated by the dire need for effective infectious disease detection and control. A cross-sectional design was adopted. Primary data was collected from nurses in Montserrado and further secondary data was abstracted from County health records. Montserrado recorded a case fatality rate of 44.7%. Analysis showed that the odds of females dying from EVD were 21% lower than for men. Age and location decreased odds to 16% though not at a statistically significant level. Longer time to detection meant higher chances of fatality; mean days to detection for those who recovered was 5.49±4.02 and 5.82±4.18 for fatalities. Lack of diagnostic capacity, fear, limited knowledge of the disease, and sociocultural beliefs presented as some of the key barriers to detection and response. There is need to improve the health system in Liberia, conduct more rigorous health education, strengthen disease surveillance, and break barriers to detection and response for better preparedness. Keywords: Ebola virus disease, outbreak, Montserrado, Liberi

Cervical cancer screening uptake among women in Naivasha

Background: About 86% of the cases of cervical cancer occur in developing countries. In Kenya, cervical cancer represents 21% of all cancers in women. With a development period as long as ten years, cervical cancer is possible to control through screening and treatment. Several projects in reproductive health have been offering cervical cancer screening using visual methods through visual inspection with acetic acid or visual inspection with Lugol’s iodine (VIA/VILI). Family planning counselling programs are a good opportunity to discuss the benefits of cervical cancer screening with gynaecological examination more easily accepted. The study looked at the outcomes in relation to screening.Methods: A total of 384 women aged 18 – 49 years were enrolled through systematic sampling in the descriptive cross sectional study. These were clients who attended the family planning clinic in June-July 2014. Participants answered questions from semi-structured questionnaires.Results: Participants who reported to have been screened for cervical cancer were 15.4%. Those screened during the study period were 2.3% and of these, 44.4% had positive VIA/VILI results. Age-group, residence, employment status and usual treatment centre were significant in relation to cervical cancer screening uptake.Conclusion: The availability of screening services in clinics that clients normally attend does not translate into high proportions in cervical cancer screening uptake. However, targeted screening will result in more positive cases being reported.Keywords: Cervical cancer screening uptake, VIA/VILI, family planning clinic, KenyaAfr J Health Sci. 2014; 29(1):13-2

Anti-thrombotic effect of Zingiber officinale (ginger) in sprague dawley rats

Background: The prevalence of thrombotic diseases is rising globally. Presently, stroke and ischemic heart disease account for 25% of all deaths. Use of anti-thrombotic drugs have proven effective in prevention of these ailments but might not be affordable especially in developing countries. They are also associated with undesirable side effects. This study sought to determine the anti-thrombotic effect of ginger since it is affordable, accessible and is widely used as a food enhancer and a medicinal herb.Methods: The current study employed an in-vivo experimental study design. Three groups Sprague dawley rats (N=5) were given different doses of methanolic extract of ginger for 30 days. Two other groups (N=5) which served as controls received 5% dimethyl sulfoxide and aspirin for the same duration. Measurement of bleeding time, platelet count, prothrombin time, activated partial thromboplastin time and thrombin time was done to assess the anti-thrombotic property.Results: There was a statistically significant difference in bleeding time (P=0.03) across the groups investigated. There was however no significant difference across the groups in platelet count, prothrombin time, activated partial thromboplastin time and thrombin time (P=˃0.05).Conclusion: This study demonstrates that methanolic extract of ginger possesses an anti-thrombotic property probably through inhibition of platelet function. Regular consumption of ginger may therefore confer protection against thrombotic diseases

Factors Associated with Cervical Cancer Screening Uptake in Naivasha District, Kenya

The objective was to determine and explore factors associated with cervical cancer screening uptake among women attending the family planning clinic at a public hospital in Naivasha District. A concurrent triangulation mixed study method was used. Using systematic sampling, 384 women aged 18-49 years of age were enrolled into the study. Data was collected through semi-structured questionnaires. After purposive sampling 7 key informant interviews and 2 focus group discussions were conducted using interview guides among women treated at the family planning clinic. Data from the quantitative study was analyzed for descriptive statistics, bivariate (unpaired student’s t-test, Chi-square) and multivariate analysis (Binary logistic regression analysis) while themes were used to analyze data from the qualitative study. Using multivariate analysis, employment status, usual treatment center, risk of cervical cancer, having heard of cervical cancer and knowing someone who had been screened were factors found to be significantly associated with cervical cancer screening uptake. Large number of clients, inadequate screening rooms, inadequate information and misconception of facts on cervical cancer screening were identified as common barriers to uptake of screening. Hospital talks were the most preferred source of getting information related to cervical cancer. In conclusion, policy makers should establish a comprehensive strategy that ensures programs in health facilities and outreaches educate those accessing their facilities well so as to increase cervical cancer screening uptake. Keywords: Cervical cancer screening; VIA/VILI; family planning clinic; Naivasha referral public hospital; Health access

Correlates of contraceptive use among HIV discordant couples in Kenya

Despite risks of HIV transmission to infants born of the HIV positive women, contraceptive use is uncommon among women in HIV discordant partnerships. The aim of this study was to determine the factors associated with contraceptive use in a clinical trial cohort of HIV serodiscordant couples based in Thika and Eldoret, Kenya. Data were analyzed from 481 HIV discordant couples enrolled in the Partners in Prevention HSV/HIV Transmission Study at the Thika and Eldoret sites. The primary study outcome was self-reported use of contraception other than condoms. Using a marginal longitudinal logistic model based on generalized estimating equations (GEE) approach we assessed the association of various demographic and behavioral factors with contraceptive use. At baseline the prevalence of non barrier contraceptive use among HIV positive and negative women was 24.3% and 25.7%, respectively. At month 12 of follow-up, the prevalence of contraceptive use was 44.4% among the HIV positive and 26% among the HIV negative women while at month 24, the prevalence of contraceptive use was 38.6% among the HIV positive and 18.2% among the HIV negative women. HIV positive women were more likely to report using contraception than HIV negative women (odds ratio (OR) 1.61 95% confidence interval (CI) 1.04-2.47). Additionally, being married (OR 2.4, 95% CI 1.2-5.0), attending Thika site clinic (OR 6.1, 95% CI 4.2-9.0), and having two or more children (OR 1.9, 95% CI 1.3-2.8) were significantly associated with use of non barrier contraceptives. Future programs should focus on interventions to increase contraceptive use among HIV serodiscordant couples, with a special emphasis on HIV negative women, unmarried women and women with few children

Prevalence and Factors Associated with Sexual Violence among Male Sex Workers (MSW) on Antiretroviral Therapy in Nairobi, Kenya

Background: Sexual violence is commonly thought of as an issue affecting primarily women and girls; however, stigma, discrimination, and violence are also expressed towards men who have sex with men (MSM), male sex workers (MSW), and transgender (TG) individuals. Our study examined the prevalence and predictors of Sexual Violence among Male Sex Workers in Kenya Methods: A cross-sectional survey was administered among 260 MSW living with HIV reached through a combination of chain referral and venue-based sampling in Kenya. Results: There is a high prevalence of sexual violence among MSW in this population 48.5% (n=126). Religious denomination; main source of income; duration on treatment; receiving gifts and materials in return for sex; and belonging to a group were significantly associated with sexual violence (p<0.005).At the multivariate analysis level; Respondents that received gifts and materials in return to sex were 2.1 times more likely to experience sexual violence compared to those that did not (CI: 1.1-4.9). Those who did not belong to a group were 1.8 times more likely to experience sexual violence (CI: 1.9-3.7). Conclusion: A better understanding of sexual violence among MSM/MSW/TG populations is necessary in order to develop clear and specific recommendations for future interventions targeting this issue

Establishing adherence–concentration–efficacy thresholds of TDF–FTC pre-exposure prophylaxis for HIV prevention in African women: a protocol for the Women TDF–FTC Benchmark Study

BackgroundOral pre-exposure prophylaxis (PrEP) using co-formulated emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) is a potent HIV prevention method for men and women, with its efficacy highly dependent on adherence. A pivotal HIV efficacy study combined with a directly observed pharmacological study defined the thresholds for HIV protection in men who have sex with men (MSM), which are the keys to PrEP promotion and development of new PrEP agents. For African women at risk for HIV and belonging to a priority group considered due to disproportionately high incident HIV infections, the variable adherence in PrEP clinical trials and the limited pharmacologic data have resulted in a lack of clarity about the PrEP adherence required for HIV protection. We propose a study to quantify the adherence–concentration–efficacy thresholds of TDF/FTC PrEP among African cisgender women to inform decisions about optimal PrEP dosing and adherence for HIV protection.MethodsWe randomized 45 low-risk HIV-uninfected African women, aged 18–30 years old, to directly observe the TDF/FTC PrEP of two, four, or seven doses per week for 8 weeks. A complementary age-matched pregnant women cohort at high risk of HIV, who will receive seven doses per week, was recruited (N = 15) with the primary aim of establishing benchmark concentrations in dried blood spots and peripheral blood mononuclear cells. Plasma, whole blood (WB), urine, hair, vaginal fluid, and vaginal tissue (non-pregnant women only) were archived for future testing. Drug concentrations were measured using methods validated for each biological matrix. Pharmacokinetic models were fitted to drug concentrations to quantify concentration–adherence thresholds. To define the drug concentrations associated with HIV protection, we applied the newly defined thresholds from the primary pharmacologic trial to the subset of women randomized to TDF/FTC or TDF in the Partners PrEP Study with the drug concentration assessed in plasma and WB samples. Multiple imputation was used to construct a data set with drug concentrations at each visit when an HIV test was performed for the entire cohort, replicating the work for MSM.DiscussionThe proposed study generated the first African women-specific TDF–PrEP adherence–concentration–efficacy thresholds essential for guiding the accurate interpretation of TDF/FTC PrEP programs and clinical trials of novel HIV prevention products using TDF/FTC as an active control. Clinical Trial RegistrationClinicalTrials.gov, identifier (NCT05057858)

Attitudes Toward Menstrual Suppression Among Cyclic and Continuous Contraceptive Vaginal Ring Users in Kenya

Objective: Multipurpose prevention technologies (MPTs) are developmental dual-purpose options that would provide women with a contraceptive as well as a prevention modality aimed at sexually transmitted infections. The contraceptive vaginal ring (CVR) has many properties that makes it an ideal MPT candidate. The objective of this study is to understand women’s attitudes towards menstrual suppression, a potential side effect of using a CVR, and how to address these attitudes for MPT vaginal rings in development. Materials and methods: We analyzed data derived from a subset of cohort study participants (n=45) in Thika, Kenya between January 2016- December 2018. The primary study enrolled 121 women 18-40 years with bacterial vaginosis and randomized them to cyclic or continuous CVR use for eight months. During the 6-month follow-up, a questionnaire eliciting attitudes towards menstrual suppression was administered. Responses to the menstrual suppression questionnaire between participants in the cyclic and continuous CVR use groups were compared. Likert-scale responses were summed to create a menstrual suppression attitude summary score, and a hierarchical cluster analysis was conducted to identify similarities in response patterns among all participants. Results: Totally 81.8% of continuous CVR users believed that one was less likely to get pregnant after using hormonal medication to suppress menses, compared to 47.8% of cyclic CVR users (P=0.02), and were more worried it would cause long-term health effects (86.4% vs 60.9%, p = 0.05). The menstrual suppression attitude summary score ranged from 8 to 42, with lower scores indicating negative attitudes. The summary score identified three distinct clusters. When asked if menstrual suppression effects long-term health; 100% of Cluster 3 was worried compared to 80.8% of Cluster 2 and 46.2% of Cluster 1 (p = 0.03). The average summary score among Cluster 3 (Mean = 14.8, SD = 4.6) was lower (p < 0.001) and women were more worried about discomfort during sex (p=0.05) as well as their sexual partners feeling the ring (p=0.02). Conclusion: Women are more likely to have negative attitudes if they believe menstrual suppression hinders future reproductive health. Education on cycle control and fertility could mitigate negative attitudes and improve uptake of CVRs