Kenyan Women Research Articles

Doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections among Kenyan women using HIV pre-exposure prophylaxis: study protocol for an open-label randomized trial

BackgroundWomen in Africa face disproportionate risk of human immunodeficiency virus (HIV) acquisition, accounting for more than half of new infections in Africa and similarly face a disproportionate burden of sexually transmitted infections (STIs). Very high STI prevalence is being observed globally, especially among people taking pre-exposure prophylaxis (PrEP) for HIV prevention. Doxycycline post-exposure prophylaxis (dPEP) has been proposed as an STI prevention strategy to reduce chlamydia, syphilis, and possibly gonorrhea, and trials are ongoing among cisgender men who have sex with men (MSM) and transgender women who are taking PrEP in high-income settings. We designed and describe here the first open-label trial to determine the effectiveness of dPEP to reduce STI incidence among cisgender women.MethodsWe are conducting an open-label 1:1 randomized trial of dPEP versus standard of care (STI screening and treatment and risk-reduction counseling without dPEP) among 446 Kenyan women aged ≥ 18 and ≤ 30 years old women taking PrEP. Women are followed for 12 months, with quarterly STI testing, treatment, and adherence counseling. The primary trial outcome will be the combined incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, compared between the randomized groups. We will also assess dPEP acceptability, tolerability, safety, impact on sexual behavior, adherence, and occurrence of antimicrobial resistance (AMR) in N. gonorrhoeae and C. trachomatis isolates. Finally, we will estimate cost per incident STI case and complications averted accounting for nonadherence and benefits relative AMR or side effects.DiscussionThe results of this trial may have immediate implications for the global epidemic of STIs and sexual health. If effective, dPEP could put STI prevention into women’s hands. While dPEP may be able to prevent STIs, it carries important risks that could counter its benefits; global debate about the balance of these potential risks and benefits requires data to inform policy and implementation and our study aims to fill this gap.Trial registrationClinicalTrials.gov NCT04050540.

Prevalence and correlates of periodontitis among Kenyan women planning to conceive

BackgroundPeriodontitis has been associated with adverse pregnancy outcomes. Little is known about the burden and risk factors for periodontitis among reproductive age women in sub-Saharan Africa. This analysis aimed to determine the prevalence and correlates of periodontitis among Kenyan women planning to conceive.MethodsHIV-seronegative, reproductive-age women who were planning to conceive were enrolled and underwent a periodontal examination. Following the US Centers for Disease Control and Prevention clinical case definitions, the presence and severity of periodontitis was determined by establishing the level of clinical periodontal attachment loss and graded in three categories: no/mild, moderate, and severe. Secondary outcomes included the scores on the Gingival Index and Decayed, Missing, and Filled Teeth (DMFT) Index. Correlates of periodontitis were examined using univariable and multivariable logistic regression.ResultsOf the 647 women in the study, 84% (n = 541) had no/mild periodontitis, 15% (n = 97) had moderate periodontitis, and 1% (n = 9) had severe periodontitis. Mild gingivitis was present in 61% (n = 396) of women, while 27% (n = 176) had moderate gingivitis, and 1% (n = 9) had severe gingivitis. The majority (75%, n = 487) of women had a DMFT index in the very low range (score < 5). Periodontitis was observed in 12% (12/101) of nulliparous women compared to 13% (36/286) of women with one prior delivery (prevalence ratio [PR] 1.03, 95% confidence interval [95% CI] 0.57–1.96), 21% (36/170) of women with two prior deliveries (PR 1.78, 95% CI 0.97–3.26), and 24% (22/90) of women with 3 or more prior deliveries (PR 2.06, 95% CI 1.08–3.92).ConclusionThis study demonstrated a substantial prevalence of moderate-severe periodontitis among women planning to conceive in Kenya. These results highlight the need to address the oral care needs of reproductive age women, particularly those with multiple prior pregnancies.

Labelling and Othering: (Re)Engaging Wangari Maathai’s Madwoman Tag in Unbowed: A Memoir

This article is an interpretive analysis of how Wangari Maathai’s autobiography Unbowed: A Memoir (2007) revises the author’s Otherness through theorising and practising intersectional environmentalism. The article argues that Unbowed becomes a space where Maathai’s struggle for environmental restoration and democracy intersects with her feminist agency. This article isolates Maathai’s practice of feminism as one that took cognisance of ecological justice to revise her Otherness, using it as a space enabling her to speak against societal injustice. To negotiate and, in effect, humanise the environment and use it as a locus for emancipating Kenyan women, Maathai reworks the label of madness attached to her and (re)uses it as a tag with some degree of privilege. Using literary criticism methodologies to engage Maathai’s autobiography, this article examines the implications of self-definition for those operating within liminal spaces. Of importance is how Maathai uses the madness label, aimed at silencing her, to create a hierarchy of privilege. The article concludes that through subtly agitating for ecological justice, Maathai found her voice to self-define herself, revising Otherness and liberating Wanjiku (the Kenyan poor). She does this by refocusing the hierarchies of subjectification embedded in the label “mad.”

Trajectories and predictors of perinatal depressive symptoms among Kenyan women: a prospective cohort study

There are gaps in understanding longitudinal patterns and predictors of perinatal depressive symptoms in sub-Saharan Africa. This study aimed to explore trajectories of depressive symptoms and associated factors from pregnancy to 9 months post partum among Kenyan women. In this prospective cohort study, we analysed data from the PrEP Implementation for Mothers in Antenatal Care (PrIMA) study in which HIV-negative women were enrolled in pregnancy and followed up to 9 months post partum in 20 public sector maternal-child health clinics in western Kenya. Pregnant women were eligible for enrolment if they were not infected with HIV, aged 15 years or older, and were able to provide consent. Eligible participants were screened and enrolled between Jan 15, 2018, and July 31, 2019, and followed up to 9 months post partum, with the last participant study visit conducted on Jan 15, 2021. Study nurses serially assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), intimate partner violence with the Hurt, Insult, Threaten, Scream scale, and social support with the Medical Outcomes Study scale. Generalised estimating equations were used to identify correlates of moderate-to-severe depressive symptoms (CESD-10 score ≥10) and group-based trajectory modelling identified discrete trajectories of perinatal depressive symptoms. Among 4447 participants in the main PrIMA study, 3555 had complete depressive symptom data in pregnancy and depressive symptom data post partum and were included in the primary analysis. Median age was 24·0 years (IQR 21·0-28·7), 1330 (38%) participants had low social support, and 278 (8%) reported intimate partner violence in pregnancy. All participants (100%) were female and all (100%) were of African Kenyan ethnicity. Prevalence of moderate-to-severe depressive symptoms was higher in pregnancy than post partum (870 [24·5%; 95% CI 23·1-25·9] vs 597 [6·8%; 15·6-18·1]; p<0·0001). Five patterns of depressive symptoms were identified; persistent moderate-to-severe depressive symptoms in pregnancy and post partum (295 [8·3%]), moderate-to-severe depressive symptoms in pregnancy that resolved post partum (139 [3·9%]), moderate-to-severe depressive symptoms that emerged post partum (40 [1·1%]), chronically mild symptoms (2709 [76·2%]), and no depressive symptoms (372 [10·5%]). Emergent moderate-to-severe depressive symptoms were associated with older age. Emergent, persistent, and resolving moderate-to-severe depressive symptoms were associated with intimate partner violence during pregnancy; and persistent and resolving moderate-to-severe depressive symptoms were associated with low social support and high HIV risk (all p<0·05). Moderate-to-severe depressive symptom risk was significantly increased with intimate partner violence (adjusted odds ratio 2·07 [95% CI 1·81-2·31]; p<0·0001), low social support (1·74 [1·56-1·95]; p<0·0001), and partner HIV-positive status (1·48 [1·22-1·78]; p<0·0001). 23·34% (95% CI 18·77-27·65) of cases of perinatal moderate-to-severe depressive symptoms were attributable to low social support. One third of women had perinatal moderate-to-severe depressive symptoms; nearly half of these had higher severity phenotypes of resolving, persistent, and emerging moderate-to-severe depressive symptoms that might require tailored interventions. Perinatal women with comorbid psychosocial stressors such as intimate partner violence and previous pregnancy loss should be prioritised for mental health services that augment social support within routine maternal-child health care. National Institutes of Health. For the Kiswahili translation of the abstract see Supplementary Materials section.

Perceptions of Police Among Kenyan Female Immigrants in the United States

We explored how highly educated and middle-class Kenyan female immigrants perceive their encounters with the police in the United States, including the decision to access the criminal justice system in response to their victimization. We found a positive correlation between perceptions of procedural justice and cooperation among Kenyan women immigrants. Conversely, prior victimization was inversely associated with help-seeking among these women. When Kenyan female immigrants perceived high police effectiveness in dealing with IPV, they were more likely to feel obligated to obey the U.S. police. Implications and recommendations for future research are discussed.

The role of education and income as protective factors against intimate partner violence and HIV exposure among Kenyan women

Introduction Intimate partner violence (IPV) is a public health problem that impacts approximately one in three women worldwide in their lifetime. The purpose of the study was to explore the lived experiences of women teachers and violence in Kenya. It also explores the intersection between intimate partner violence, HIV risk, and gender inequality. Method Data were collected through two focus groups of a total of 15 women teachers. We recruited women ages 21–44 from two geographically diverse urban and rural schools. The data were analyzed using a thematic analysis method to identify text themes and meaning patterns. Results Three contextual experiences emerged: socio-cultural influences of gender norms, masculinity and patriarchy; uneven power dynamics; and institutionalized gender inequality. Discussion Findings suggest that education alone is not sufficient to end GBV. Comprehensive and gender transformative governmental policy approaches are needed to mitigate GBV in Kenya.

The illusion of stable fertility preferences

Fertility preferences have long played a key role in models of fertility differentials and change. We examine the stability of preferences over time using rich panel data on Kenyan women’s fertility desires, expectations, actual fertility, and recall of desires in three waves over a nine-year period, when respondents were in their 20s. We find that although desired fertility is quite unstable, most women perceive their desires to be stable. Under hypothetical future scenarios, few expect their desired fertility to increase over time but, in fact, such increases in fertility desires are common. Moreover, when asked to recall past desires, most respondents report previously wanting exactly as many children as they desire today. These patterns of bias are consistent with the emerging view that fertility desires are contextual, emotionally laden, and structured by identity.

Efficacy of Single-Dose Human Papillomavirus Vaccination among Young African Women

BackgroundSingle-dose human papillomavirus (HPV) vaccination, if efficacious, would be tremendously advantageous, simplifying implementation and decreasing costs.MethodsWe performed a randomized, multicenter, double-blind, controlled trial of single-dose nonavalent (HPV 16/18/31/33/45/52/58/6/11 infection) or bivalent (HPV 16/18 infection) HPV vaccination compared with meningococcal vaccination among Kenyan women 15 to 20 years of age. Enrollment and 6-monthly cervical swabs and a month 3 vaginal swab were tested for HPV deoxyribonucleic acid (DNA). Enrollment sera were tested for HPV antibodies. The modified intent-to-treat (mITT) cohort comprised participants who had an HPV antibody-negative result at enrollment and an HPV DNA-negative result at enrollment and month 3. The primary outcome was incident persistent vaccine-type HPV infection by month 18.ResultsBetween December 2018 and June 2021, 2275 women were randomly assigned and followed. A total of 758 participants received the nonavalent HPV vaccine, 760 received the bivalent HPV vaccine, and 757 received the meningococcal vaccine; retention was 98%. Thirty-eight incident persistent infections were detected in the HPV 16/18 mITT cohort: one each among participants assigned to the bivalent and nonavalent groups and 36 among those assigned to the meningococcal group. Nonavalent vaccine efficacy (VE) was 97.5% (95% confidence interval [CI], 81.7 to 99.7%; P≤0.0001), and bivalent VE was 97.5% (95% CI, 81.6 to 99.7%; P≤0.0001). Thirty-three incident persistent infections were detected in the HPV 16/18/31/33/45/52/58 mITT cohort: four in the nonavalent group and 29 in the meningococcal group. Nonavalent VE for HPV 16/18/31/33/45/52/58 was 88.9% (95% CI, 68.5 to 96.1; P<0.0001). The rate of serious adverse events was 4.5% to 5.2% by group.ConclusionsOver the 18-month timeframe we studied, single-dose bivalent and nonavalent HPV vaccines were each highly effective in preventing incident persistent oncogenic HPV infection, similar to multidose regimens. (Funded by the National Institutes of Health, the Bill and Melinda Gates Foundation, and the University of Washington; ClinicalTrials.gov number, NCT03675256.)

Child maltreatment, social capital, maternal mental health and duration of program involvement: Assessment from a community-based empowerment program in Kenya.

Multisystem, multi-level interventions are required to enable resilient, nurturing environments for children facing adversity. This study assesses parenting behavior associated with participation in a community-based, adapted microfinance program, and mediated by program-affiliated social capital, maternal depression and self-esteem among Kenyan women. Participants in the intervention, Kuja Pamoja kwa Jamii (KPJ, Swahili for "Come Together to Belong"), gather weekly to engage in trainings and group-based microfinance. Groups selected for the study had participated in the program for 0-15 months at the time of the first interview. Women (n = 400) completed surveys in June 2018 and June 2019. Measures included duration of program exposure, group-affiliated social capital (i.e. trust, belonging, cohesion, and expectation of mutual benefit), depression, self-esteem, and conflict tactics. We used regression analyses and generalized structural equation models to explore associations between program exposure, social capital, psychosocial variables and child maltreatment. Each standard deviation increase in duration of program exposure decreased odds of child physical abuse by 40% and child neglect by 35%. Each standard deviation in the social capital index predicted a significant reduction in odds of child physical abuse (aOR: 0.67), and child neglect (aOR: 0.71). Self-esteem and depression fully mediated observed associations between social capital and child maltreatment. Findings recommend further investigation of the potential for adapted microfinance programs to deliver parenting interventions, improve mental health and foster resilience-enabling social capital. A randomized control trial is required to validate the potential of the assessed intervention to improve parenting behaviors and supportive social conditions.

Predictors of adverse pregnancy outcomes among Kenyan women with HIV on antiretroviral treatment in pregnancy.

The aim of this study was to understand predictors of adverse pregnancy outcomes (APOs) among women on antiretroviral treatment (ART). A longitudinal cohort. Participants from the Mobile WAChX trial were evaluated for APOs, including stillbirth (fetal death at ≥20 weeks' gestation), preterm birth (PTB, livebirth at <37 weeks' gestation,) and neonatal death (NND, ≤28 days after live birth). Predictors were determined by univariable and multivariable Cox proportional hazards and log-binomial models. Among 774 women included, median age was 27 years and 29.0% had unsuppressed HIV viral load (>1000 copies/ml) at enrollment. Half (55.1%) started ART prepregnancy, 89.1% on tenofovir-based regimens. Women with depression had a higher risk of stillbirth (adjusted hazard ratio [aHR] 2.93, 95% confidence interval (95% CI) 1.04-8.23), and women with lower social support score had higher risk of late stillbirth (aHR 11.74, 2.47-55.86). Among 740 livebirths, 201 (27.2%) were preterm and 22 (3.0%) experienced NND. PTB was associated with unsuppressed maternal viral load (adjusted prevalence ratio [aPR] 1.28, 95% CI 1.02-1.61), intimate partner violence (IPV) in pregnancy (aPR 1.94, 95% CI 1.28-2.94), and history of any sexually transmitted infection (STI) (aPR 1.63, 95% CI 1.06-2.51). NND was associated with PTB (aPR 2.53, 95% CI 1.10-5.78) and STI history (aPR 4.25, 95% CI 1.39-13.06). Most associations retained significance in the subgroup of women with viral suppression. Maternal viremia during pregnancy predicted PTB as did IPV, lower education, and STI history, while psychosocial stressors predicted stillbirth. Implementing mental health services, ART adherence, partner support, and routine STI screening and treatment could reduce APOs among women with HIV in sub-Saharan Africa settings.

The Role of Women and Men in Land Use and Property Rights in Mt. Elgon Region

Gender mainstreaming is a strategy employed to end discrimination against a particular gender and promote equality between men and women using inclusive policies and laws. The Kenyan Government has made great progress in enacting laws aimed at achieving equal benefits and protection of the law in respect to property rights over land. Unfortunately, enforcement remains challenging. With a focus on land ownership and use in Mt. Elgon region, this article seeks to evaluate the impact of gender mainstreaming policies and legal structures, which have been established to help Kenyan women attain equal land rights. The region is an area in the Western part of Kenya near the border with Uganda. It provides an interesting look into land dispute resolution because, apart from being a resource-rich area, it has experienced significant violence related to land use between the years 2006 to 2008, from state and non-state actors. The study concludes that harmful traditional beliefs and cultural practices influence the role gender plays in the access women and men have to land use and property right. Keywords: patrimony, global political economy, gendered political economy, property rights, land rights, gender mainstreaming DOI: 10.7176/JLPG/119-08 Publication date: March 31 st 2022

Socio-Economic Factors and Table Banking Loans Default Levels Among Women Groups in Machakos County, Kenya

Defaulting on a loan happens when one fails to make sufficient payments for an extended period. Lenders will deem a loan in default when the borrower haven’t paid the minimum required payment for a certain number of months as detailed in the loan contract. Loan defaults can happen with any type of loan, table banking being one of them. In Kenya as in most developing countries, table banking has been recognized and accepted by development agencies and the government as effective tool for economic development poverty alleviation and industrialization. It’s a proven method for women to spearhead their finances and experience economic perks through organized and calculated means. However, despite of their important role many of these table banking programs have collapsed because of problems in repayment. The general study objective was to investigate the effect of social economic factors on Table Banking loans default among Women in Machakos county, Kenya. The specific objectives were to determine the relationship between level of income, literacy level, borrowing experience as well as household demand and Table Banking loans default level among Women in Machakos County, Kenya. The study design was descriptive with a target population consisting of 22,500 women contained in all the 1500 women groups in Machakos County. A sample size of 384 women group members was selected through simple random sampling technique. Primary data on the selected women from the women groups were collected using structured questionnaires. The response rate was 342 women representing 89 percent. Data was analyzed using frequency distribution, chi-square tests and regression analysis. It was disclosed that there was a negative but significant association between level of income, literacy level, borrowing experience and household demand and table banking loan default level by women in women groups. Demographic factors also had a negative but significant relationship with table banking loan default level among women in women groups in Machakos County. For practice the study recommended that: Firstly, women should engage in extra financial activities to increase their income level. Secondly the uptake of loans should be with the reason of income generation and not necessarily meeting the households’ needs. This will ensure that the loans taken will be regenerated to assure repayment in time and minimize defaulting of the table banking loans. Thirdly the government should enhance entrepreneurship and financial management trainings including incorporating it through formal education. This study focused on socio-economic factors influence on women's default table banking loans, therefore, other influential factors and disciplines should be studied to useful to reduce the defaulting of table banking loans. The study was limited in Machakos County. Low biasness can be attained for all the Kenyan women groups, therefore, a study focusing on other locations and larger spheres of the population of the study should be done, that is, in county, regional and national levels.

Abstract P1-02-13: Tumour infiltrating lymphocytes (TILs) and immune composition in breast cancer patients from Kenya: Spatial distributions and associations with risk factors and tumour characteristics

Abstract Background: The immune landscape of breast cancer in patients from Sub Saharan Africa is understudied and findings are mainly extrapolated from studies in Caucasians and African Americans. Given the prognostic value of Tumour Infiltrating Lymphocytes (TILs) in breast cancer subtypes, the paucity of specific TIL marker data among BC patients from Africa, and the limited data on TIL spatial heterogeneity, our aim was to describe the distribution of TILs within the intratumoral stroma and the leading/invasive edge stroma, and evaluate their association across BC subtypes with established risk factors in Kenyan women with BC. Methods: Visual quantification of overall TILs within the intratumoral stroma (sTILs) and the stroma at the leading edge/invasive edge of the tumour (LE-TILs) were performed on Haematoxylin and Eosin stained whole slide sections of pathologically confirmed breast cancer based on the guidelines of the International TIL working group. Tissue Microarrays (TMAs) of tumour were also were constructed and stained with immunohistochemistry for CD3, CD4, CD8, CD68, CD20 and Fox P3. The TMA slides were scanned on the Aperio Digital pathology slide scanner, imported into the Aperio, assigned a template, segmented and annotated before analysis using a nuclear algorithm. Linear and logistic regression models were used to assess the associations between risk factors and tumor features with IHC markers and total TILs, after adjusting for other covariates. Results: A total of 226 invasive breast cancer cases were included in the final analysis for TILs and immune cell markers. The mean age at diagnosis of these breast cancer patients was 48.3 years. The distribution of the BC molecular subtypes defined by IHC markers was 56.2%, 16.8%, 9.3%, and 17.7 % (luminal A, luminal B, HER2-enriched, and TN breast cancers, respectively). On the whole we found that LE TIL proportions were higher than sTIL (41.3% versus 15% for TILs ≥30 and 19.3% and 4.4% for TILs ≥50 respectively). After adjusting for other tumor characteristics, we found higher TILs associated with high KI67 and high grade (for both sTIL and LE-TIL), TNBC (for sTIL only), and HER2 status, luminal B subtype, and smaller tumor size (&amp;lt;4 cm) (for LE-TIL only). Both sTILs and LE-TILs were predominantly composed of CD3, CD8 and CD68 with a much smaller contribution of CD4 and CD20. The percent positive cells for Fox3 were markedly lower compared to other IHC markers for both sTILs and LE-TILs. Conclusions: Our findings with regards to enrichment of TILs in more aggressive breast cancers are similar to what has been previously published. The distinct associations between intratumoral stroma and leading edge TIL measures for some factors highlight the importance of spatial TIL evaluations in future studies. Our findings add to the body of knowledge regarding TILs and TIL subtypes in breast cancer, which underscore the need to conduct studies specific to African populations. Citation Format: Shahin Sayed, Xiaohong R Yang, Dhirendra Govender, Breast Health Study group. Tumour infiltrating lymphocytes (TILs) and immune composition in breast cancer patients from Kenya: Spatial distributions and associations with risk factors and tumour characteristics [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-02-13.

Dr Tatu Kamau vs The Attorney General and Others: problems and prospects in Kenya’s 2021 High Court ruling to uphold the Prohibition of Female Genital Mutilation Act 2011 - a reply to ‘The prosecution of Dawoodi Bohra women’ by Richard Shweder

‘[The] average third world woman leads an essentially truncated life based on her feminine gender (read: sexually constrained) and being “third world” (read: ignorant, poor, uneducated, tradition-bound, domestic, family-oriented, victimized, etc.). This, I suggest, is in contrast to the (implicit) self-representation of Western women as educated, modern, as having control over their own bodies and sexualities, and the freedom to make their own decisions’ (Mohanty, 2003: 337). Not much has changed regarding Western views of the ‘third world woman’ in the 37 years since Chandra Mohanty made these remarks – this is especially so when it comes to the heated topic of female circumcision, female genital cutting or what opponents refer to as female genital mutilation among African and Muslim women. In Richard Shweder’s (2022) conclusion of the target article, he outlines four key considerations that justify male circumcision and argues that these factors ought to also determine the acceptability of female circumcision in liberal democracies: (1) the practice is broadly supported by the communities that uphold them; (2) the practice is motivated by the fundamental principle of gender equality; (3) the practice is not more physically invasive than what is legally allowed for male circumcision; and (4) there is scant evidence of harm. Shweder (2022) points out that all four conditions are consistent with the practice of khatna – a mild, barely visible form of female circumcision among the Dawoodi Bohra. In this response article, we consider these four standards in our discussion of Kenya’s High Court ruling this year to uphold the Prohibition of Female Genital Mutilation Act 2011. It first describes the legal context for challenging the constitutionality of the Act and outlines the key provisions within the Kenyan Constitution and its Bill of Rights that the plaintiff identified in her petition, focusing especially on the rights of Kenyan women to bodily autonomy and cultural expression. It then delves into the complex symbolic, cultural and socio-religious nuances of gender-inclusive circumcision rituals, citing various case studies in our reflection on the four points Shweder proposes for legitimising female circumcision.

Fear, faith and finances: health literacy experiences of English and Swahili speaking women newly diagnosed with breast and cervical cancer.

Breast and cervical cancer are among the leading causes of cancer-related deaths globally. In Kenya, delayed presentation and diagnosis contribute to breast and cervical cancer mortality. The Kenyan government acknowledges the cancer burden with estimated 39,000 new cases diagnosed and 27,000 deaths per annum. Mortality can be reduced if cancer is diagnosed early and with appropriate treatment. Health Literacy (HL) about cancer screening, diagnosis and treatment is important in reducing mortality, but there is little understanding about HL levels, experiences of patients diagnosed with breast and cervical cancer and the contexts in which they make decisions. In this study, health literacy is defined as the degree to which individuals have the capacity to obtain, communicate, process and understand basic health information and services needed to make appropriate health decisions. This exploratory qualitative study investigated the HL experiences of accessing and using health information in women with any stage of breast or cervical cancer presenting at the Aga Khan University Hospital (private) or Kenyatta National Hospital (public) in Nairobi, Kenya. Data were gathered through semi-structured interviews from a purposive sample of 18 women. Interviews were transcribed verbatim, and the Consolidated criteria for reporting qualitative studies guidelines guided data analysis. The findings may aid development of patient education tools and determine effective ways of communicating cancer-related health information to improve the knowledge and health-seeking behaviours of Kenyan women. This project identified sociocultural beliefs and factors that influence how women understand information provided by healthcare professionals. Themes that arose included but were not limited to: fear, despair and agony at diagnosis, faith, social support, side effects, cancer-related stigma and financial burden of cancer as a barrier to getting information.

Cryotherapy and LEEP are Effective Treatment for CIN Lesions in HIV+ and HIV- Women in Western Kenya

Cervical cancer is the third most common cancer worldwide and the most common cancer among Kenyan women, with an age-standardized incidence rate of 33.8% in 2018. Cervical intraepithelial neoplasia (CIN) caused by human papillomavirus (HPV) in HIV+ women is over twice as likely to progress in severity compared to HIV- women. Conflicting reports exist as to the efficacy of cryotherapy or loop electrosurgical excision procedure (LEEP) as treatment for CIN among HIV+ women. This study assesses the results of cryotherapy or LEEP for CIN among HIV+ compared to HIV- women in Western Kenya.

Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study.

ObjectiveTo determine the contribution of specific contraceptive side effects to method switch and modern‐method discontinuation among Kenyan women.DesignA prospective cohort study.SettingFive counties in Western Kenya.ParticipantsWomen aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities.MethodsPatient‐reported adverse effect symptoms, method switch and discontinuation were reported through weekly text message‐based surveys for 24 weeks.Main outcome measurementsPrevalence, hazards ratio (HR).ResultsAmong 825 women, 44% were using implants, 43% injectables, 7% an intrauterine device and 6% oral contraceptive pills at enrolment. Most (61%) women were continuing a method used in the previous month. During the 24‐week follow up, incidence of contraceptive switch was 61.3 per 100 person‐years (95% confidence interval [CI] 52.4–71.8) and incidence of discontinuation was 38.5 per 100 person‐years (95% CI 31.6–47.0). On average, one‐quarter (prevalence [Pr] 0.24, 95% CI 0.22–0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95% CI 0.13–0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95% CI 1.22–4.57). Risk of all‐modern method discontinuation was higher among women experiencing irregular bleeding (aHR 2.39, 95% CI 1.20–4.77), weight changes (aHR 2.72, 95% CI 1.47–4.68) and sexual side effects (aHR 2.42, 95% CI 1.40–4.20).ConclusionsAddressing irregular bleeding, weight changes and sexual side effects through development of new products that minimise these specific side effects and anticipatory counseling may reduce method‐related discontinuation.Tweetable abstractBleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects.

Vaginal washing behaviour and fecundability among Kenyan women in a prospective preconception cohort.

Intravaginal washing, practised by a significant proportion of women globally, is associated with acquisition of human immunodeficiency virus (HIV), sexually transmitted infections and bacterial vaginosis (BV). A single prior study among women in the United States found that vaginal washing was associated with lower fecundability. To examine the association between vaginal washing and fecundability among Kenyan women. HIV-negative Kenyan women who were trying to conceive and reported no history of infertility care-seeking were followed prospectively for incident pregnancy for up to six months. At monthly visits, participants reported the first day of last menstrual period, sexual behaviour, vaginal washing behaviour, underwent pregnancy testing and provided vaginal swabs for detection of BV by Gram stain (Nugent score ≥7). Discrete time proportional probability models were used to estimate fecundability ratio (FR) and 95% confidence interval (CI) comparing menstrual cycles when women reported vaginal washing to menstrual cycles when no vaginal washing was reported. Four hundred and fifty-eight women contributed 1,376 menstrual cycles and 255 pregnancies. At enrolment, a third (35.2%, 161 of 458) of participants reported vaginal washing with the majority using water only (73.9%, 119 of 161). After adjustment for age, frequency of unprotected intercourse and study site, vaginal washing in the prior four weeks was associated with a 29% lower fecundability (adjusted FR [aFR] 0.71, 95% CI 0.53, 0.94), which did not change after further adjustment for BV at the visit prior to each pregnancy test (aFR 0.71, 95% CI 0.54, 0.95). Periconceptual vaginal washing may reduce fecundability. Potential mechanisms include vaginal washing-associated changes in the vaginal microbiota, inflammation, disruption of cervical mucus and effects on sperm function. Vaginal washing has no known health benefits, and cessation may improve women's likelihood of conceiving.

Cultivable vaginal Lactobacillus is not associated with fecundability in Kenyan women attempting to conceive

To examine the association between cultivable vaginal Lactobacillus and fecundability in Kenyan women attempting nonmedically assisted conception. Prospective preconception cohort. Nairobi and Mombasa, Kenya. Women trying to conceive who reported ≤3 months of pre-enrollment conception attempt time. Cultivable Lactobacillus (primary), Lactobacillus morphotypes on Gram stain (secondary). Participants reported the first day of their last menstrual period and recent sexual behavior, underwent pregnancy testing, and provided vaginal specimen samples for Lactobacillus culture and Gram stain at ≤6 monthly preconception visits. The outcome was fecundability-the per-menstrual cycle probability of pregnancy. Associations between cultivable Lactobacillus and Lactobacillus morphotypes on Gram stain at the visit before each pregnancy test and fecundability were estimated using proportional probabilities models to generate fecundability ratios (FRs). A total of 458 women contributed 1,376 menstrual cycles. At enrollment, 65.3% (n = 299) of participants had cultivable Lactobacillus, 47.4% (n = 217) had cultivable hydrogen peroxide producing Lactobacillus, and 64.6% (n = 296) had Lactobacillus detected on Gram stain. In unadjusted analysis, there was no association between cultivable Lactobacillus at the prior visit and fecundability (FR, 0.92; 95% CI, 0.73-1.16); results were similar after adjustment for age, frequency of condomless sex, and study site (adjusted FR, 0.92; 95% CI, 0.72-1.18). Lactobacillus on Gram stain at the visit prior was associated with modestly higher fecundability (adjusted FR, 1.18; 95% CI, 0.92-1.51). Cultivable Lactobacillus was not associated with fecundability, although Lactobacillus morphotypes detected on Gram stain were somewhat associated with increased fecundability. The relationship between vaginal Lactobacillus and fecundity may be species-specific.

A community-based approach to cervical cancer prevention in western Kenya: An AMPATH feasibility project.

Objectives:Centralized programs have been ineffective in reducing the burden of cervical cancer among Kenyan women. A community-based pilot study was initiated to screen Kenyan women for cervical cancer and to vaccinate their children against human papillomavirus (HPV).Methods:Women were educated about cervical cancer prevention at community meetings. Women then provided self-collected vaginal swabs for oncogenic HPV testing using the Roche Cobas Assay. All women were then referred to the local clinic for Visual Inspection with Acetic Acid (VIA). Women were offered the quadrivalent HPV vaccine for their children if and when it became available for the study.Results:Women in western Kenya were invited to participate in community meetings. A total of 200 women were enrolled: 151 (75.5%) were HIV-uninfected and 49 (24.5%) were HIV-infected; the median age for all women was 42 years. High-risk (HR)-HPV types were detected in 49 of swabs from all 200 participants (24.5%) including 20.5% of HIV-uninfected women and 36.7% of HIV-infected women (P = .022). VIA was performed on 198 women: 192 had normal examinations and six had abnormal examinations. Five cervical biopsies revealed two cases of CIN 2 and one CIN 3. Although all mothers were willing to have their children (N = 432) vaccinated, the HPV vaccine could not be delivered to Kenya during the study period.Conclusions:Kenyan women were willing to attend community meetings to learn about prevention of cervical cancer, to provide self-collected vaginal swabs for HPV testing, to travel to the Webuye Clinic for VIA following the collection of swabs, and to have their children vaccinated against HPV. HR-HPV was prevalent, especially in HIV-infected women. As a result of this pilot study, this community-based strategy to prevent cervical cancer will be continued in western Kenya.