Effects Of HIV and Intestinal Parasites Co-Infection On Hematological Parameters Among Pregnant Women Attending Selected Health Facilities In Nyeri County, Kenya

 Introduction: Prevalence of HIV among women in Nyeri County increased from 2.5% in 2007 to 5.5 % in 2009 and 6.3% in 2013. The study aimed to determine effect of co-infection of HIV and intestinal parasites on hemogram among pregnant women attending health facilities in the County. Methodology: A comparative cross-sectional study was conducted among 130 participants. Interview schedule was used to collect data. Stool and blood samples were processed using standard procedures. Data was analyzed using SPSS. Results among 130 respondents 34% had intestinal protozoans infection. Results: Among 65 HIV positive respondents, 25% had Entamoeba Coli infection and 2% Iodamoeba butschlii. Among 65 HIV negative respondents, 38% had Entamoeba Coli, and 6% Iodamoeba butschlii infection. One HIV negative respondent had Hymenolepis nana infection. Co-infection of HIV and intestinal parasites had significant effect on WBC (p < 0.05), RBC (p < 0.05), Haemoglobin (p < 0.05) and haematocrit (p < 0.05). Conclusion: (i) Prevalence of co-infection of intestinal protozoan parasites and HIV was high(ii) Co-infection of HIV and intestinal protozoan parasites decreased WBC, RBC, haemoglobin and haematocrit. Recommendation: Routine screening for intestinal parasites during antenatal healthcare and more research to verify pathogenicity of Entamoeba Coli. Key words: HIV, Intestinal parasites, co-infection, pregnant women, hemogram

Health seeking behavior, practices of TB and access to health care among TB patients in Machakos County, Kenya. A cross-sectional study

Despite efforts to implementation of the DOTS programme in Kenya since the year (1993) and achieving 100% coverage by the year 1996; new TB cases continue to emerge in communities, a significance of TB transmission. The success of the DOTS programne require total adherence to treatment for those infected with TB and appropriate control measures as stipulated in TB treatment guidelines, trained manpower to manage the infected patients and surveillance. The main objective of this study was to examine the health seeking behavior of TB patients, practices of TB and access to health care. A cross- sectional survey of TB patients was done in Athi-River, Machakos level 5 and Mutituni TB treatment health facilities in Machakos County. A pre-tested self administered questionnaire/ interviews was used to collect data. The data was analyzed by use of statistical package for social sciences (SPSS) version 16. Pearson Chi-Square analysis was used to determine the relationships between variables. Level of significance was fixed at 0.05 (p=0.05).The results of this study reveal TB is affecting  more males than females (60.4%).Most of the TB patients are young below 40 years accounting for (71.8%),  are poor and unemployed (65%).When the TB patient realized they were sick, most of them (81.4%) sought informal remedies from private practioners or self medicated. This delayed early opportunity to seek heath care for more than one month by (82%) of the respondents. Failure of the informal treatment and unbearable pains in advanced disease forced the majority (96.8%) to seek health care in designated TB treatment facilities. There is secrecy in TB status disclosure as (75.5%) declined to openly disclose. For those who disclosed (78%) was to a selected family member mainly to seek assistance (90.7%). Across age groups, educational level, marital status, disclosure of TB status was of no statistical significance p=0.462 and openness of status p=0.112 respectively as the majority remained secret. Health education received by (52.8%) in the TB clinics was observed to significantly influence clinic attendance p=0.014 and adherence to treatment p=0.008 as 78.5% attended regularly and 85.5% adhered respectively. Treatment in public facilities is free with the majority (89.9%) reporting attendance.  TB patients care in the community is  mainly by family members (74.8%), there is no follow up by heath workers and social support group is minimal at (11.4%).The ministry of health needs to address  control measures by initiating strict surveillance of TB, initiate community education on best practices of  TB and to distigmatize the disease. Key words Health seeking behavior of TB patients, practices of TB and access to health care in Machakos Count

Improving the documentation of female genital mutilation or cutting (FGM/C) abandonment interventions and their evaluations

Female genital mutilation/cutting (FGM/C) is internationally recognized as a violation of human rights. Consequently, there have been extensive efforts to promote the abandonment of the practice. There is limited evidence on the impact of many of the efforts, in part because many interventions are implemented by small organizations with inadequate resources to document and evaluate their activities. The complex nature of FGM/C interventions, as with other interventions aimed at addressing violence against women and girls, also makes it difficult to adequately document what is done, how, when, and with what results. Nonetheless, it is important that implementing organizations make every effort to document and evaluate their interventions, and share the outcomes and lessons learned to ensure accountability and for others to learn from, adapt, replicate, and scale up successful interventions. In this Guidance Note, we provide guidance to help organizations that are implementing FGM/C abandonment interventions better document and report on their programmatic and evaluation activities

Lay beliefs, practices of TB and HIV/AIDS among the community members living in Machakos County, Kenya: A cross sectional study

Knowledge of lay beliefs on existence, cause, mode of TB transmission, and the association of TB/HIV relationship are key entry point to initiate effective prevention and control of TB in communities. Misconceptions of this result to fear and stigma that can sustain TB transmission. The main objective of this study was to determine the study community beliefs of TB, its relationship with HIV/AIDS and to quantify prevention practices. A cross- sectional survey of community members was done in Athi-river and Central Divisions of Machakos County. A pre-tested self administered questionnaire and researcher assisted interviews was used to collect data. The data was analyzed by use of statistical package for social sciences (SPSS) version 16. Pearson Chi-Square analysis was used to determine the relationships between variables. Level of significance was fixed at 0.05 (p=0.05). The results of this study reveal a majority (90.6%) of the community is aware of the existence of TB and that 90.1% believe  it can be transmitted p<0.05 respectively. Misconceptions and lay beliefs on the cause and mode of TB disease transmission was prevalent with (90.8%) blaming these on unrelated factors such as smoking, poor hygiene, HIV/AIDS, hereditary and sharing eating utensils respectively. The community practices were discriminatory as they separated eating utensils of TB patients or isolated them as a way of preventing the disease spread which causes fear. A slight majority of the community (46.5%) believes TB is related to HIV/AIDS, a disease of stigma citing similarity of symptoms .The rest obseveve there is no relationship and said the symptoms and modes of transmission are different. The Ministry of health needs to urgently bridge this gap by disseminating health education on TB and TB/ HIV/AIDS relationships in the communities to demystify fear that result from misconceptions. Key words: Lay Beliefs and practices of TB & HIV/AIDS, Community of Machakos County Kenya

Tracing change in female genital mutilation/cutting: Shifting norms and practices among communities in Narok and Kisii counties, Kenya

In Kenya, there has been a steady and marked decline in the prevalence of female genital mutilation/cutting (FGM/C) but there is great variance in the prevalence of FGM/C across the country, with prevalence remaining high among certain ethnic groups such as Somali, Samburu, Kisii, and the Maasai. The objectives of this study were: 1) to explore whether and how unprogrammed factors or programmed FGM/C interventions (alternative rites of passage, legal and policy measures, religious-oriented approaches, promotion of girls’ education, intergenerational dialogues, use of rescue centers, and other undocumented approaches) influence community values deliberation in Narok and Kisii counties; 2) to assess what changes in FGM/C norms and practices have occurred in Narok and Kisii counties, and identify factors motivating these changes; and 3) to identify barriers to FGM/C abandonment in these key “hot spots,” and assess how, in light of empirical findings and theoretical models of behavior, intervention efforts might be optimized and coordinated to accelerate abandonment. The study clearly shows that norms and practices of FGM/C are not static even in these study areas. While there might not be widespread abandonment yet, people are reassessing norms and traditions in light of the current social climate. These changes may provide a useful starting point for intervention programs that seek to create dialogue and critical reflection on the practice of FGM/C in an effort to accelerate its abandonment

Using Demographic and Health Surveys in the campaign to end FGM/C: A Kenyan example

In order to design effective interventions to end female genital mutilation/cutting (FGM/C), we need to map where FGM/C is practiced and what factors influence it. Data from the Demographic and Health Surveys (DHS), nationally representative surveys conducted in low- and middle-income countries every five years, give us the opportunity to explore how FGM/C is influenced by both individual and community-level factors. Where FGM/C prevalence is not uniform, various research and analysis techniques can be used to improve estimates and draw further information from DHS data. This brief shares insights from two studies carried out in Kenya using DHS data collected in 1998, 2003, 2008, and 2014. The brief presents lessons learned and suggestions for the way forward

Exploring the nature and extent of normative change in FGM/C in Somaliland

More than 200 million girls and women alive today have undergone FGM/C across 30 countries in Africa, Asia, and the Middle East. While most affected countries have adopted legal frameworks prohibiting FGM/C, these have been varyingly effective in preventing the practice or significantly accelerating its abandonment. The success of programmatic interventions to address FGM/C has also been variable. One possible reason for the limited success of these initiatives is the neglect of the collectively held social norms underpinning the practice’s continuation. This study, conducted in 30 villages in Somaliland, aimed to investigate: 1) if the norms associated with FGM/C are consistent with a social coordination norm; 2) which norms—if any—are associated with different stages of readiness to change; 3) how, to what extent, and by whom the norms and practices are being contested or altered; and 4) if the stages of readiness to change are associated with gender, location (rural/urban), and generational differences

Shifts in female genital mutilation/cutting in Kenya: Perspectives of families and health care providers

Despite compelling reasons and efforts to eradicate female genital mutilation/cutting (FGM/C) in Kenya, the practice has persisted, albeit with some changes. This study sought to understand the shifts in FGM/C among families and healthcare providers from selected Kenyan communities that practice FGM/C. Our findings highlight similarities and differences across three distinct Kenyan communities. FGM/C appears to persist through two models: first, shifts (changes) in the practice, notably cutting at a younger age, lesser cutting; and second, through stability and consistency with minimal change. The two diverse models appear to rely on and sustain social norms that support FGM/C in these communities. The study findings highlight several possible avenues for leveraging positive change, outlined in this report, which also includes future research needs

Contraceptive Adoption, Discontinuation, and Switching among Postpartum Women in Nairobi's Urban Slums.

Unmet need for contraception is highest within 12 months post-delivery, according to research. Using longitudinal data from the Nairobi Urban Health and Demographic Surveillance System, we assess the dynamics of contraceptive use during the postpartum period among women in Nairobi's slums. Results show that by 6 months postpartum, 83 percent of women had resumed sexual activity and 51 percent had resumed menses, yet only 49 percent had adopted a modern contraceptive method. Furthermore, almost half of women discontinued a modern method within 12 months of initiating use, with many likely to switch to another short-term method with high method-related dissatisfaction. Women who adopted a method after resumption of menses had higher discontinuation rates, though the effect was much reduced after adjusting for other variables. To reduce unmet need, effective intervention programs are essential to lower high levels of discontinuation and encourage switching to more effective methods