Health Facilities In Kenya Research Articles

Cesarean delivery and associated socioeconomic factors and neonatal survival outcome in Kenya and Tanzania: analysis of national survey data

ABSTRACT Background: The increasing trends in cesarean delivery are globally acknowledged. However, in many low-resource countries, socioeconomic disparities have created a pattern of underuse and overuse among lower and higher socioeconomic groups. The impact of rising cesarean delivery rates on neonatal survival is also unclear. Objective: To examine cesarean delivery and its associated socioeconomic patterns and neonatal survival outcome in Kenya and Tanzania. Methods: We employed binary logistic regression to analyze cross-sectional demographic and health survey data on neonates born in health facilities in Kenya (2014) and Tanzania (2016). Results: Cesarean delivery rates ranged from 5% among uneducated, rural Tanzanian women to 26% among educated urban women in Kenya to 37.5% among managers in urban Tanzania. Overall findings indicated higher odds of cesarean delivery among mothers from richest households, adjusted odds ratio (aOR) 1.4 (95% CI 1.2–1.8), those insured, aOR 1.6 (95% CI 1.3–1.9), highly educated, aOR 1.6 (95% CI 1.2–2.0) and managers aOR 1.7 (95% CI 1.3–2.2), compared to middle class, no insurance, primary education and unemployed, respectively. Overall, compared to normal births and while adjusting for maternal risk factors, cesarean delivery was significantly associated with neonatal mortality in Kenya and Tanzania, overall aOR 1.7 (95% CI 1.2–2.7). However, statistical significance ceased when fetal risk factors and number of antenatal care visits were further controlled for, aOR 1.6 (95% CI 0.9–2.6). Conclusion: Disproportionate access to cesarean delivery has widened in Kenya and Tanzania. Higher risks of cesarean-related neonatal deaths exist. Medically indicated or not, the safety and/or choice of cesarean delivery is best addressed on individual basis at the health-facility level. However, policy initiatives to eliminate incentives, improve equitable access and accountability to reduce unnecessary cesarean deliveries through well-informed decisions are needed. Efforts to prevent unintended pregnancies among adolescents as well as training of health workers and continuous research to improve neonatal outcomes are vital.

Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilities.

In 2016, Kenya conducted a study of missed opportunities for vaccination (MOV)-when eligible children have contact with the health system but are not fully vaccinated-to explore some of the reasons for persistent low vaccination coverage. This paper details the qualitative findings from that assessment. Using the World Health Organization MOV methodology, teams conducted focus group discussions among caregivers and health workers and in-depth interviews of key informants in 10 counties in Kenya. Caregivers of children <24 months of age visiting the selected health facilities on the day of the assessment were requested to participate in focus group discussions. Health workers were purposively sampled to capture a broad range of perspectives. Key informants were selected based on their perceived insight on immunization services at the county, sub-county, or health facility level. Six focus group discussions with caregivers, eight focus group discussions with health workers, and 35 in-depth interviews with key informants were completed. In general, caregivers had positive attitudes toward healthcare and vaccination services, but expressed a desire for increased education surrounding vaccination. In order to standardize vaccination checks at all health facility visits, health workers and key informants emphasized the need for additional trainings for all staff members on immunization. Health workers and key informants also highlighted the negative impact of significant understaffing in health facilities, and the persistent challenge of stock-outs of vaccines and vaccination-related supplies. Identified factors that could contribute to MOV include a lack of knowledge surrounding vaccination among caregivers and health workers, inadequate number of health workers, and stock-outs of vaccines or vaccination-related materials. In addition, vaccination checks outside of vaccination visits lacked consistency, leading to MOV in non-vaccinating departments. Qualitative assessments could provide a starting point for understanding and developing interventions to address MOV in other countries.

Examining user fee reductions in public primary healthcare facilities in Kenya, 1997\u20132012: effects on the use and content of antenatal care

BackgroundIn 2004, The Kenyan government removed user fees in public dispensaries and health centers and replaced them with registration charges of 10 and 20 Kenyan shillings (2004 $US 0.13 and $0.25), respectively. This was termed the 10/20 policy. We examined the effect of this policy on the coverage, timing, source, and content of antenatal care (ANC), and the equity in these outcomes.MethodsData from the 2003, 2008/9 and 2014 Kenya Demographic and Health Surveys were pooled to investigate women’s ANC care-seeking. We conducted an interrupted time series analysis to assess the impact of the 10/20 policy on the levels of and trends in coverage for 4+ ANC contacts among all women; early ANC initiation and use of public facility-based care among 1+ ANC users; and use of public primary care facilities and receipt of good content, or quality, of ANC among users of public facilities. All analyses were conducted at the population level and separately for women with higher and lower household wealth.ResultsThe policy had positive effects on use of 4+ ANC among both better-off and worse-off women. Among users of 1+ ANC, the 10/20 policy had positive effects on early ANC initiation at the population-level and among better-off women, but not among the worse-off. The policy was associated with reduced use of public facility-based ANC among better-off women. Among worse-off users of public facility-based ANC, the 10/20 policy was associated with reduced use of primary care facilities and increased content of ANC.ConclusionsThis study highlights mixed findings on the impact of the 10/20 policy on ANC service-seeking and content of care. Given the reduced use of public facilities among the better-off and of primary care facilities among the worse-off, this research also brings into question the mechanisms through which the policy achieved any benefits and whether reducing user fees is sufficient for equitably increasing healthcare access.

The use of case advocates to manage child survivors of sexual violence in public health facilities in Kenya: A qualitative study exploring the perceptions of child survivors, care givers and health care providers

BackgroundThe uptake of and retention in health services by child survivors of violence (CSV) is a growing challenge, especially in sub-Saharan Africa. While lay health workers have been used in several settings to improve access to health services, there is limited literature on the use of such workers to support services for CSV. ObjectiveTo explore the acceptability of using trained lay health workers (case advocates) to provide basic information and escort CSV to various referral points within two public health facilities in Kenya. ParticipantsThe following participants were enrolled after giving their consent: CSV 14–18 years of age presenting for services along with their caregivers during the study; caregivers above age 18; and healthcare providers (HCPs) providing services for sexual violence at the two study sites. MethodsIn-depth interviews (14 with CSV and 27 with caregivers) and four focus group discussions (with 30 HCPs) were conducted. Data were transcribed in MSWord and analysed using a grounded theory analytical approach. ResultsCaregivers and CSV reported that the case advocates were useful in fast-tracking access to services, easing CSV movement through health facilities and helping CSV communicate their issues. HCPs reported improved timeliness and completeness of services due to the involvement of the case advocates. ConclusionThe use of case advocates to support CSV is acceptable to children, caregivers and HCPs. Task-sharing between case advocates and HCPs has the potential to improve the uptake of the various services offered to CSV, especially in resource-limited settings.

Utilization of Diagnostic Imaging in Dental and Maxillofacial Trauma in Selected Kenyan Hospitals

Background: Globally, much has changed in the imaging modalities available to investigate maxillofacial trauma. Nevertheless, the regional practice patterns are highly influenced by availability, affordability and accessibility of imaging services as well as competence in interpreting radiological images and the practice of defensive medicine. The aim was to assess the use of maxillofacial trauma imaging modalities as well as to document patterns of skeletal injuries at selected government-sponsored health facilities in Kenya. Material and Methods: A cross sectional study, done in three health facilities. Results: There were 137 (81.5%) males and 31 (18.5%) females with a mean of 27.73 ± 9.86 years. Commonest aetiology of trauma was interpersonal violence (80, 47.62%) and road traffic crashes (63, 37.50%). The total number of radiological examinations was 250 with a mean of 1.49 ± 0.99 examinations per patient. Plain film radiographs were more (210, 84%) than computed tomographic scans (39, 15.6%). Dental panoramic technique was the most (104, 61.9%) popular. Most participants experienced isolated fractures to the mandible (99, 58.9%) and midface (28, 16.7%). Conclusion: Dental panoramic radiography remained the imaging of choice for mandibular fractures which had the commonest occurrence. There is a shift from the traditional conventional skull radiography to computed tomography in the diagnosis of midfacial fractures. Judicious utilization and prompt provision of affordable services in dental panoramic and computed tomographic scanning at the study centers and other upcoming health facilities are paramount in ensuring timely diagnosis and management of maxillofacial injuries in Kenya.

Producing routine malaria data: an exploration of the micro-practices and processes shaping routine malaria data quality in frontline health facilities in Kenya

BackgroundRoutine health information systems can provide near real-time data for malaria programme management, monitoring and evaluation, and surveillance. There are widespread concerns about the quality of the malaria data generated through routine information systems in many low-income countries. However, there has been little careful examination of micro-level practices of data collection which are central to the production of routine malaria data.MethodsDrawing on fieldwork conducted in two malaria endemic sub-counties in Kenya, this study examined the processes and practices that shape routine malaria data generation at frontline health facilities. The study employed ethnographic methods—including observations, records review, and interviews—over 18-months in four frontline health facilities and two sub-county health records offices. Data were analysed using a thematic analysis approach.ResultsMalaria data generation was influenced by a range of factors including human resource shortages, tool design, and stock-out of data collection tools. Most of the challenges encountered by health workers in routine malaria data generation had their roots in wider system issues and at the national level where the framing of indicators and development of data collection tools takes place. In response to these challenges, health workers adopted various coping mechanisms such as informal task shifting and use of improvised tools. While these initiatives sustained the data collection process, they also had considerable implications for the data recorded and led to discrepancies in data that were recorded in primary registers. These discrepancies were concealed in aggregated monthly reports that were subsequently entered into the District Health Information Software 2.ConclusionChallenges to routine malaria data generation at frontline health facilities are not malaria or health information systems specific; they reflect wider health system weaknesses. Any interventions seeking to improve routine malaria data generation must look beyond just malaria or health information system initiatives and include consideration of the broader contextual factors that shape malaria data generation.

Patient costs of diabetes mellitus care in public health care facilities in Kenya.

SummaryObjectiveTo estimate the direct and indirect costs of diabetes mellitus care at five public health facilities in Kenya.MethodsWe conducted a cross‐sectional study in two counties where diabetes patients aged 18 years and above were interviewed. Data on care‐seeking costs were obtained from 163 patients seeking diabetes care at five public facilities using the cost‐of‐illness approach. Medicines and user charges were classified as direct health care costs while expenses on transport, food, and accommodation were classified as direct non–health care costs. Productivity losses due to diabetes were classified as indirect costs. We computed annual direct and indirect costs borne by these patients.ResultsMore than half (57.7%) of sampled patients had hypertension comorbidity. Overall, the mean annual direct patient cost was KES 53 907 (95% CI, 43 625.4‐64 188.6) (US$ 528.5 [95% CI, 427.7‐629.3]). Medicines accounted for 52.4%, transport 22.6%, user charges 17.5%, and food 7.5% of total direct costs. Overall mean annual indirect cost was KES 23 174 (95% CI, 20 910‐25 438.8) (US$ 227.2 [95% CI, 205‐249.4]). Patients reporting hypertension comorbidity incurred higher costs compared with diabetes‐only patients. The incidence of catastrophic costs was 63.1% (95% CI, 55.7‐70.7) and increased to 75.4% (95% CI, 68.3‐82.1) when transport costs were included.ConclusionThere are substantial direct and indirect costs borne by diabetic patients in seeking care from public facilities in Kenya. High incidence of catastrophic costs suggests diabetes services are unaffordable to majority of diabetic patients and illustrate the urgent need to improve financial risk protection to ensure access to care.

Impact of the Introduction of Rotavirus Vaccine on Hospital Admissions for Diarrhea Among Children in Kenya: A Controlled Interrupted Time-Series Analysis.

BackgroundMonovalent rotavirus vaccine, Rotarix (GlaxoSmithKline), was introduced in Kenya in July 2014 and is recommended to infants as oral doses at ages 6 and 10 weeks. A multisite study was established in 2 population-based surveillance sites to evaluate vaccine impact on the incidence of rotavirus-associated hospitalizations (RVHs).MethodsHospital-based surveillance was conducted from January 2010 to June 2017 for acute diarrhea hospitalizations among children aged <5 years in 2 health facilities in Kenya. A controlled interrupted time-series analysis was undertaken to compare RVH pre– and post–vaccine introduction using rotavirus-negative cases as a control series. The change in incidence post–vaccine introduction was estimated from a negative binomial model that adjusted for secular trend, seasonality, and multiple health worker industrial actions (strikes).ResultsBetween January 2010 and June 2017 there were 1513 and 1652 diarrhea hospitalizations in Kilifi and Siaya; among those tested for rotavirus, 28% (315/1142) and 23% (197/877) were positive, respectively. There was a 57% (95% confidence interval [CI], 8–80%) reduction in RVHs observed in the first year post–vaccine introduction in Kilifi and a 59% (95% CI, 20–79%) reduction in Siaya. In the second year, RVHs decreased further at both sites, 80% (95% CI, 46–93%) reduction in Kilifi and 82% reduction in Siaya (95% CI. 61–92%); this reduction was sustained at both sites into the third year.ConclusionsA substantial reduction in RVHs and all-cause diarrhea was observed in 2 demographic surveillance sites in Kenya within 3 years of vaccine introduction.

Health Implications of Sexual Violence Among Survivors in Selected Health Facilities in Kenya: Are There Gender Disparities?

Health Implications of Sexual Violence Among Survivors in Selected Health Facilities in Kenya: Are There Gender Disparities?

Integrating Spiritual Care into Maternity Care at a University Teaching and Referral Hospital in Eldoret, Kenya: Challenges, Lessons and Way Forward

Spiritual needs of care seekers, families and caregivers are ignored in maternity care in health facilities in Kenya. The quality of care remains poor with unacceptable maternal and neonatal mortalities. The Clinical Pastoral Education (CPE) Project at the College of Health Sciences of Moi University Eldoret, Kenya, aimed to integrate spiritual care into maternity care at The Riley Mother and Baby Hospital of The Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, in order to provide holistic healthcare. In phase I, spiritual needs of mothers of neonates admitted to the Newborn Unit at the MTRH in Eldoret, Kenya, were assessed using a research protocol with modified North America validated tools (see Appendix) and unstructured interview guides. For phase II, hospital chaplains, trained using a Moi University post-graduate diploma curriculum for clinical pastoral education and care, were engaged as spiritual caregivers at the Hospital. In phase III, the same tools were used to re-assess spiritual needs after introducing spiritual care. This article presents challenges and progress made, lessons learnt from the CPE Project and knowledge gaps identified from the study. Baseline data showed lack of trained hospital chaplains and inadequate spiritual care at the Teaching and Referral hospital despite great need by patients, caregivers and families. Lack of precise definitions, theoretical and conceptual frameworks for spirituality in literature emerged as a challenge. The Kenya Chaplaincy Training Centre was initiated at the hospital to train hospital chaplains and healthcare providers who could provide spiritual care. A psychobiosocial conceptual framework, utility tools and a new theory for self-empowerment were proposed to address knowledge gaps in current literature.

Providers and women\u2019s perspectives on person-centered maternity care: a mixed methods study in Kenya

BackgroundGlobally, there has been increasing attention to women’s experiences of care and calls for a person-centered care approach. At the heart of this approach is the patient-provider relationship. It is necessary to examine the extent to which providers and women agree on the care that is provided and received. Studies have found that incongruence between women’s and providers’ perceptions may negatively impact women’s compliance, satisfaction, and future use of health facilities. However, there are no studies that examine patient and provider perspectives on person-centered care.MethodsTo fill this gap in the literature, we use cross-sectional data of 531 women and 33 providers in seven government health facilities in Kenya to assess concordance and discordance in person-centered care measures. Additionally, we analyze 41 in-depth interviews with providers from three of these facilities to examine why differences in reporting may occur. Descriptive statistical methods were used to measure the magnitude of differences between reports of women and reports of providers. Thematic analyses were conducted for provider surveys.ResultsOur findings suggest high discordance between women and providers’ perspectives in regard to person-centered care experiences. On average, women reported lower levels of person-centered care compared to providers, including low respectful and dignified care, communication and autonomy, and supportive care. Providers were more likely to report higher rates of poor health facility environment such as having sufficient staff. We summarize the overarching reasons for the divergence in women and provider reports as: 1) different understanding or interpretation of person-centered care behaviors, and 2) different expectations, norms or values of provider behaviors. Providers rationalized abuse towards women, did not allow a companion of choice, and blamed women for poor patient-provider communication. Women lacked assurance in privacy and confidentiality, and faced challenges related to the health facility environment. Providers attributed poor person-centered care to both individual and facility/systemic factors.ConclusionsImplications of this study suggests that providers should be trained on person-centered care approaches and women should be counseled on understanding patient rights and how to communicate with health professionals.

Risk Factors for Death in Children Aged 5-14 Years Hospitalised with Pneumonia: A Retrospective Cohort Study

Introduction: There were almost 1 million deaths in children aged between 5 and 14 years in 2017, and 98% occurred in low and middle-income countries. Pneumonia is estimated to account for 11% of deaths in this age group, yet there are no validated guidelines for pneumonia management in older children and data to support their development are limited. Aim: We sought to understand the magnitude of, and risk factors for mortality among children aged 5-14 years hospitalised with pneumonia in district-level health facilities in Kenya. Methods: We did a retrospective cohort study using routine data collected from an established clinical information network of 13 hospitals in Kenya. We reviewed records for children aged 5-14 admitted with pneumonia between March 1, 2014 and February 28, 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We also used existing WHO criteria (intended for under-5s) to define levels of severity and examined their performance in identifying those at increased risk of death. Results: There were 1832 children diagnosed with pneumonia during the study period. 145 (7·9%) died and there were proportionally more deaths in older children (10-14). In adjusted analyses, severe pallor (odds ratio (OR) 7.4), moderate pallor (OR 2.96), reduced consciousness (OR 4.18), older age (>9 years) (OR 2·48), inability to eat or drink (OR 1·91), HIV (OR 2·31) and severe malnutrition (OR 1·89) were significantly associated with mortality. The presence of clinical characteristics used by the WHO to define severe pneumonia was associated with death in univariate analysis (OR 2·86), but was poor in discriminating those at risk of death (sensitivity: 0·56, specificity: 0·68, and AUC: 0·62). Conclusion: Children over-5 are a neglected group with high inpatient pneumonia mortality. Our findings suggest that the paediatric WHO criteria for classification of severity miss important signs such as pallor, and do not appear to be a valid tool for risk assessment in this age group. While this work does not constitute formal evidence that utilising factors such as pallor would save lives, it does identify subgroups of patients at risk and areas on which to focus further research. Funding Statement: This study was supported by funds from a senior research fellowship awarded to ME by the Wellcome Trust. AA was supported by funds from a Wellcome Trust Strategic Award, the Initiative to Develop African Research Leaders (IDeAL) Wellcome Trust award, and a Wellcome Trust core grant awarded to the KEMRI–Wellcome Trust Research Programme. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval for the use of de-identified routine data was provided by the parent study of the CIN from the Kenya Medical Research Institute (KEMRI) National Ethical Review Committee. The Ministry of Health and participating hospitals gave their permission.

Can Changes in Service Delivery Models Improve Program Quality and Efficiency? A Closer Look at HIV Programs in Kenya and Uganda.

With the scale-up of antiretroviral treatment, many health facilities in low- and middle-income countries have implemented innovative practices targeted at overcoming operational challenges and delivering efficient quality HIV services. However, many of these practices remain largely unexplored as a means to better reach the global 90-90-90 targets. A study was conducted on selected facilities in districts of country programs supported by The Global Fund to Fight AIDS, Tuberculosis, and Malaria. The aims of the study were to understand how facilities seek to improve the delivery and uptake of HIV services and to examine what innovative practices might be contributing to their success. The study used a qualitative approach through observations, document reviews, and semistructured interviews with site management and clinical staff to identify service delivery innovations in 30 health facilities in Kenya and Uganda. Eleven innovative practices were observed along the HIV care cascade. These practices led to improvements in the quality of testing, treatment, and retention across the facilities. Effective human resource and data management processes also enabled the implementation of these innovative practices. Many facilities use innovative practices along the HIV care cascade to address bottlenecks and challenges. These have the potential to improve the quality and efficiency of service delivery and support the attainment of the 90-90-90 treatment targets. Replicating these practices would require further implementation research and a mind shift of donors, governments, and implementers from a metric of coverage to a stronger focus on efficiency and impact.

Spatial and socio-economic correlates of effective contraception among women seeking post-abortion care in healthcare facilities in Kenya.

IntroductionInformation, counseling, availability of contraceptives, and their adoption by post-abortion care (PAC) patients are central to the quality of PAC in healthcare facilities. Effective contraceptive adoption by these patients reduces the risks of unintended pregnancy and repeat abortion.MethodsThis study uses data from the Incidence and Magnitude of Unsafe Abortion Study of 2012 to assess the level and determinants of highly effective contraception among patients treated with complications from an unsafe abortion in healthcare facilities in Kenya. Highly effective contraception was defined as any method adopted by a PAC patient that reduces pregnancy rate by over 99%.ResultsGenerally, contraceptive counseling was high among all PAC patients (90%). However, only 54% of them received a modern family planning method—45% a short-acting method and 9% a long-acting and permanent method. Adoption of highly effective contraception was determined by patient’s previous exposure to unintended pregnancies, induced abortion and modern family planning (FP). Facility level factors associated with the uptake of highly effective contraceptives included: facility ownership, availability of evacuation procedure room, whether the facility had a specialized obstetric-gynecologist, a facility that also had maternity services and the number of FP methods available for PAC patients.Discussion and conclusionFor better adoption of highly effective FP, counseling of PAC patients requires an understanding of the patient’s past experience with contraception and their future fertility intentions and desires in order to meet their reproductive needs more specifically. Family planning integration with PAC can increase contraceptive uptake and improve the reproductive health of post-abortion care patients.

Training health care providers to provide PrEP for HIV serodiscordant couples attending public health facilities in Kenya

ABSTRACT To catalyse national scale up of PrEP for HIV serodiscordant couples in public health facilities in Kenya, the Partners Scale-Up Project, using a two-day case-based interactive curriculum, trained health care providers working in 24 high volume facilities in central and western Kenya on PrEP service delivery. Using a standardised test with questions about PrEP and antiretroviral-based HIV prevention we assessed gain in knowledge and confidence gain by comparing pre-and post-training test scores. We explored experiences of the training through key informant interviews after clinics started delivering PrEP. Of 716 health care providers trained, 235 (32.9%) were nurses, 144 (20.2%) were clinical officers and 155 (21.7%) were HIV counsellors. There was a significant improvement between the means of pre-test and post-test scores (61.7% (SD 17.4) vs 86.4% (SD 12.7) p < 0.001). The proportion of those who reported being ‘very comfortable’ providing care to HIV serodiscordant couples increased from 22.8% to 67.3% (p < 0.001). Key themes that training increasing both knowledge of PrEP and confidence to deliver PrEP to HIV serodiscordant couples emerged from interviews. This short, standardised training resulted in a substantial increase in knowledge of PrEP and in the confidence of the health providers to provide PrEP to HIV serodiscordant couples. Trial registration ClinicalTrials.gov NCT03052010

Patient costs of hypertension care in public health care facilities in Kenya.

SummaryBackgroundHypertension in low‐ and middle‐income countries, including Kenya, is of economic importance due to its increasing prevalence and its potential to present an economic burden to households. In this study, we examined the patient costs associated with obtaining care for hypertension in public health care facilities in Kenya.MethodsWe conducted a cross‐sectional study among adult respondents above 18 years of age, with at least 6 months of treatment in two counties. A total of 212 patients seeking hypertension care at five public facilities were interviewed, and information on care seeking and the associated costs was obtained. We computed both annual direct and indirect costs borne by these patients.ResultsOverall, the mean annual direct cost to patients was US$ 304.8 (95% CI, 235.7‐374.0). Medicines (mean annual cost, US$ 168.9; 95% CI, 132.5‐205.4), transport (mean annual cost, US$ 126.7; 95% CI, 77.6‐175.9), and user charges (mean annual cost, US$ 57.7; 95% CI, 43.7‐71.6) were the highest direct cost categories. Overall mean annual indirect cost was US$ 171.7 (95% CI, 152.8‐190.5). The incidence of catastrophic health care costs was 43.3% (95% CI, 36.8‐50.2) and increased to 59.0% (95% CI, 52.2‐65.4) when transport costs were included.ConclusionsHypertensive patients incur substantial direct and indirect costs. High rates of catastrophic costs illustrate the urgency of improving financial risk protection for these patients and strengthening primary care to ensure affordability of hypertension care.

Determinants of provider-initiated HIV testing and counselling uptake at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya

INTRODUCTION&#x0D; The HIV/AIDS burden persists in sub-Saharan Africa despite preventive efforts. In Kenya, the HIV prevalence in Kisumu county (19.9%) is triple the national rate (5.9%). Provider-initiated testing and counselling (PITC) is among the best strategies for HIV prevention. The model entails HIV testing of individuals presenting themselves to health facilities for routine medical services. Though introduced in most healthcare facilities in Kenya, the uptake of PITC and determinants of uptake have not been established. The main objective of this study was to establish the determinants of PITC uptake by patients seeking healthcare services at the Jaramogi Oginga Teaching and Referral Hospital.&#x0D; METHODS&#x0D; This was a cross-sectional study involving a systematic random sample of patients seeking services at the hospital.&#x0D; RESULTS&#x0D; Of 291 participants, 53% were females and 70% were aged between 18 and 35 years. Participants aged 36-45 years were less likely to accept PITC services than those aged 18-25 years (unadjusted odds ratio (uOR)=0.28, 95% CI [0.14-0.59]). Employment (uOR=1.81, 95% CI [1.09-3.01]) and having a friendly relationship with the provider (uOR=3.35, 95% CI [1.41-7.92]) were significantly associated with PITC uptake. Patients who reported having a friendly relationship with the staff were more likely to report PITC uptake (adjusted odds ratio (aOR) = 4.75, 95% CI [1.58-14.31]).&#x0D; CONCLUSION&#x0D; Interventions should encourage facilities to improve staff-patient relationships to increase uptake of PITC services.

Integration of Cervical Cancer Screening Services in the Routine Examinations Offered in the Kenyan Health Facilities: A Systematic Review

Cervical cancer is the second most common cancer among women and the leading cause of deaths among women worldwide. In Kenya, uptake of screening services is at 3.2% below the targeted of 70%. Therefore, there is need to study the factors that lead to low uptake of the screening services. One way of increasing the uptake of the screening services is its integration with other routine services, thus leading to a reduction in morbidity and mortality rates associated with the disease. The objective of this study was to review and examine the importance of integrating cervical cancer screening services in the routine examinations offered in the Kenyan health facilities. A retrospective study design was adopted by this study. The review of articles, journals, strategic plans was done from the year 2012 to 2017. Data sources included Medline, PMC, Library, Pubmed, Google scholar, cancer prevention plans and strategies. About 28 data sources were reviewed with 78.5% indicating that increased knowledge and creation of awareness on cervical cancer would greatly improve the utilization of the screening services. More than 87% of the information collected among published work in Kenya demonstrated that knowledge on importance cervical cancer screening is inadequate. The primary results of this study suggest that all women of reproductive age (WRA) should undergo cervical cancer screening as a routine service. An integration approach should be adopted, to enhance knowledge on cervical cancer and the importance of screening, causes, preventive and treatment options. The study recommends that, the Government of Kenya through the Ministry of health should include cervical cancer screening as a routine procedure for all WRA.

Prevalence and Capacity of Cancer Diagnostics and Treatment: A Demand and Supply Survey of Health-Care Facilities in Kenya.

The cancer incidence burden is expected to rise to over 85% in sub-Saharan Africa by 2030.1 This alarming trend underscores the need to develop evidence-based interventions that can effectively handle this volatile epidemic. The evidence generation entails the collection of adequate information on burden, pattern, and prevalence of cancer relative to capacity to promote effective decision-making. Accordingly, this study documents the prevalence and types of cancer in Kenya (demand side) and to determine the diagnostic and treatment capacity of the various health facilities to handle cancer cases (supply side). To investigate demand and supply factors for cancer control, the study surveyed 7 of the 47 counties in Kenya during 2013 to 2014. It sampled 1048 patients with cancer records and 12 health-care facilities. The study found that the most frequent age for female patients was at age 52, while for men was at age 62. The most prevalent cancer in women was breast cancer and cancer of the cervix, while for men was cancer of the esophagus and prostate. It was also found that children and rural populations were more vulnerable than it was thought, hence defying the local perception that cancer inflicts only adults and those in urban areas. Accessing cancer screening and treatment was one of the major hurdles as most cancer care services in Kenya were concentrated within a 5-km radius of each other in Nairobi. The limited capacity with respect to diagnosis and treatment has implications to issues of access, proximity, and availability. It is critical that policy makers and practitioners closely review the current public and individual perceptions about the cancer problems and mitigation strategies.

Simplifying the ShangRing technique for circumcision in boys and men: use of the no-flip technique with randomization to removal at 7 days versus spontaneous detachment.

To assess safety of the no-flip ShangRing male circumcision technique and to determine clinical course and safety of spontaneous detachment (i.e., allowing the device to fall off), we conducted a case series of no-flip ShangRing circumcision combined with a randomized controlled trial of removal 7 days postcircumcision versus spontaneous detachment at two health facilities in Kenya. The primary outcome was the safety of the no-flip technique based on moderate and severe adverse events (AEs) during the procedure and through 42-day follow-up. A main secondary outcome was clinical course and safety of spontaneous detachment. Two hundred and thirty males 10 years and older underwent no-flip circumcision; 114 randomized to 7-day removal and 116 to spontaneous detachment. All circumcisions were successfully completed. Overall 5.3% (6/114) of participants in the 7-day group and 1.7% (2/116) in the spontaneous group had an AE; with no differences when compared to the 3% AE rate in historical data from African studies using the original flip technique (P = 0.07 and P = 0.79, respectively). Overall 72.4% (84/116) of participants in the spontaneous group wore the ShangRing until it detached. Among the remaining (27.6%; 32/116), the ring was removed, primarily at the participants' request, due to pain or discomfort. There was no difference in AE rates (P = 0.169), visit day declared healed (P = 0.324), or satisfaction (P = 0.371) between randomization groups. The median time to detachment was 14.0 (IQR: 7–21, range: 5–35) days. The no-flip technique and spontaneous detachment are safe, effective, and acceptable to boys and men 10 years and older. Phimosis and penile adhesions do not limit successful ShangRing circumcision with the no-flip technique.