1.  Title: Constructive men's engagement in reproductive health: a training-of-trainers' manual. Couple communication and shared decisionmaking related to reproductive health. Author: Futures Group International. Health Policy Initiative; Care International. Keneya Ciwara; Mali. Ministere de la Sante. Division de la Sante Reproductive Source: Washington, D.C., Futures Group International, Health Policy Initiative, 2009 May. 26 p. (USAID Contract No. GPO-I-01-05-00040-00) Abstract: This curriculum was developed as part of a USAID | Health Policy Initiative, Task Order 1 project focused on building an enabling policy and institutional environment for constructive men's engagement (CME) in reproductive health in Mali. The project worked with the Ministry of Health and other partners in facilitating the process of creating national guidelines to integrate CME in family planning and reproductive health (FP / RH) and to improve women's and men's uptake of FP / RH services. The project brought together the assembly of a large, multisectoral group of stakeholders to develop, refine, and validate Mali's national guidelines in support of the national Reproductive Health Strategic Plan. The Minister of Health quickly approved the guidelines and signed them into effect on May 20, 2008. This document contains the manual used in the pilot workshops with relais communautaires. It is designed to enable community health educators to incorporate activities related to constructive men's engagement in reproductive health (CME-RH) in their daily work. This includes promoting dialogue among men and women to increase couple communication and shared decisionmaking related to FP / RH. As such, it can be adapted in other settings, based on local needs. Language: English Keywords: KENYA | MANUAL | TRAINING ACTIVITIES | COUPLES | DECISION MAKING | TRAINING OF TRAINERS | REPRODUCTIVE HEALTH | MEN'S INVOLVEMENT | INTERPERSONAL COMMUNICATION | WORKSHOPS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Training Programs | Education | Family Characteristics | Family and Household | Sociocultural Factors | Behavior | Health | Programs | Organization and Administration | Communication Document Number: 331535 |
| 2. Title: Overcoming barriers to treatment for children. Author: Population Council Source: Momentum. 2009 Jun;:[1] p. Abstract: Only 11 percent of HIV-positive children eligible for treatment in Kenya receive life-saving therapy. Through surveys, group discussions, and interviews with families and health workers, Council researchers identified barriers that prevent parents and caregivers from seeking treatment for HIV-infected children. Applying its research findings, the Council and the government of Kenya are supporting community-awareness activities to educate and assist caregivers, inform them of available services, and reduce stigma. The Council is also working with health facilities to improve counseling, support, and outreach services, and to provide Kenya's government with recommendations for improving pediatric HIV services so HIV-positive children across the country receive life-saving treatment. (Excerpts) Language: English Keywords: KENYA | SUMMARY REPORT | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | OBSTACLES | TREATMENT | UTILIZATION OF HEALTH CARE | HEALTH SERVICES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Organization and Administration | Medical Procedures | Medicine | Delivery of Health Care | Health Document Number: 331492 |
3.  Title: The quality of family planning services and client satisfaction in the public and private sectors in Kenya. Author: Agha S; Do M Source: International Journal For Quality In Health Care. 2009 Apr;21(2):87-96. Abstract: OBJECTIVE: To compare the quality of family planning services delivered at public and private facilities in Kenya. METHODS: Data from the 2004 Kenya Service Provision Assessment were analysed. The Kenya Service Provision Assessment is a representative sample of health facilities in the public and private sectors, and comprises data obtained from a facility inventory, service provider interviews, observations of client-provider interactions and exit interviews. Quality-of-care indicators are compared between the public and private sectors along three dimensions: structure, process and outcome. RESULTS: Private facilities were superior to public sector facilities in terms of physical infrastructure and the availability of services. Public sector facilities were more likely to have management systems in place. There was no difference between public and private providers in the technical quality of care provided. Private providers were better at managing interpersonal aspects of care. The higher level of client satisfaction at private facilities could not be explained by differences between public and private facilities in structural and process aspects of care. CONCLUSIONS: Formal private sector facilities providing family planning services exhibit greater readiness to provide services and greater attention to client needs than public sector facilities in Kenya. Consistent with this, client satisfaction is much higher at private facilities. Technical quality of care provided is similar in public and private facilities. Language: English Keywords: KENYA | RESEARCH REPORT | DATA ANALYSIS | CLIENTS | FAMILY PLANNING | SATISFACTION | PUBLIC SECTOR | PRIVATE SECTOR | QUALITY OF HEALTH CARE | HEALTH SERVICES | REPRODUCTIVE HEALTH | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Psychological Factors | Behavior | Macroeconomic Factors | Economic Factors | Health Services Evaluation | Delivery of Health Care | Health Document Number: 342098 |
| 4. Title: Assessment of family planning services in Kenya: Evidence from the 2004 Kenya Service Provision Assessment Survey. Author: Agwanda A; Khasakhala A; Kimani M Source: Calverton, Maryland, Macro International, MEASURE DHS, 2009 Jan. [51] p. (USAID Contract No. GPO-C-00-03-00002-00Kenya Working Papers No. 4) Based on further analysis of the 2004 Kenya Service Provision Assessment Survey. Abstract: This study focused on factors associated with the readiness of Kenyan health facilities to provide quality and appropriate care to family planning clientele; the degree to which health care providers foster informed selection of an appropriate contraceptive method; and the extent to which clients perceive services to be of high quality. Data was obtained from the 2004 Kenya Service Provision Assessment. The composite indicators scores for facility readiness were generally low and many facilities lacked simple items like visual aids, guidelines, towels, speculum, etc. There were marked differences in facility readiness by region, facility type, and managing authority. Provider service provision scores were generally high but the only important difference was by region. Client satisfaction was dependent on the facility type, managing authority, sex of the provider, and the waiting time to receive services. Clients were more likely to be satisfied with female rather than male providers. Clients were less satisfied in Nyanza, although the facilities were more ready with high-performing providers. In contrast, North Eastern Province had less ready facilities, but high client satisfaction and high provider performance. Health centre, clinics, and dispensaries need to be revamped to appropriate standards so as to include all basic elements of family planning service provision. North Eastern Province, with motivated workers, highly satisfied clients but poor facilities, deserves proper attention. Facilities in Nairobi need improvements in staff supervision and retraining. There is need to educate the clientele on the availability of appropriate services within the government facilities. Language: English Keywords: KENYA | RESEARCH REPORT | RECOMMENDATIONS | HEALTH SURVEYS | KAP SURVEYS | EVALUATION INDEXES | FAMILY PLANNING PERSONNEL CHARACTERISTICS | FAMILY PLANNING PERSONNEL EVALUATION | FAMILY PLANNING PROGRAM EVALUATION | PERCEPTION | HUMAN GEOGRAPHY | SATISFACTION | SEX FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health | Surveys | Sampling Studies | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Family Planning Personnel | Family Planning Programs | Family Planning | Psychological Factors | Behavior | Geography | Social Sciences | Science | Sociocultural Factors | Population Characteristics | Demographic Factors | Population Document Number: 329890 |
| 5. Peer Reviewed Title: HIV prevalence and associated risk factors among individuals aged 13-34 years in rural western Kenya. Author: Amornkul PN; Vandenhoudt H; Nasokho P; Odhiambo F; Mwaengo D Source: Plos One. 2009 Jul;4(7):e6470. Abstract: From a demographic surveillance system, the authors selected a random sample of Asembo, Kenya residents ages 13–34 years, who were contacted at home and invited to a nearby mobile study site. From October 2003 to April 2004, consenting participants were interviewed on risk behavior and tested for HIV and HSV-2. HIV voluntary counseling and testing was offered. Of 2,606 eligible residents, 1,822 (70%) enrolled. Primary reasons for refusal included not wanting blood taken, not wanting to learn HIV status, and partner or parental objection. Females comprised 53% of 1,762 participants providing blood. Adjusted HIV prevalence was 15.4% overall: 20.5% among females and 10.2% among males. HIV prevalence was highest in women ages 25-29 years (36.5%) and men ages 30-34 years (41.1%). HSV-2 prevalence was 40.0% overall: 53% among females, 25.8% among males. In multivariate models stratified by gender and marital status, HIV infection was strongly associated with age, higher number of sex partners, widowhood, and HSV-2 seropositivity. Language: English Keywords: KENYA | RURAL AREAS | RESEARCH REPORT | SAMPLING STUDIES | HIV INFECTIONS | HERPES GENITALIS | PREVALENCE | RISK FACTORS | AGE FACTORS | SEX FACTORS | MIGRATION | VOLUNTARY COUNSELING AND TESTING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Geographic Factors | Population | Studies | Research Methodology | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Measurement | Health | Population Characteristics | Demographic Factors | Population Dynamics | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 339909 |
| 6. Peer Reviewed Title: Knowledge of HIV status, sexual risk behaviors and contraceptive need among people living with HIV in Kenya and Malawi. Author: Anand A; Shiraishi RW; Bunnell RE; Jacobs K; Solehdin N; Abdul-Quader AS; Marum LH; Muttunga JN; Kamoto K; Aberle-Grasse JM; Diaz T Source: AIDS. 2009 Jun 17; Abstract: BACKGROUND:: Several studies support the need for effective interventions to reduce HIV transmission risk behaviors among people living with HIV/AIDS (PLWHAs). DESIGN:: Cross-sectional nationally representative demographic health survey of Kenya (2003) and Malawi (2004-2005) that included HIV testing for consenting adults. METHODS:: We analyzed demographic health survey data for awareness of HIV status and sexual behaviors of PLWHAs (Kenya: 412; Malawi: 664). The analysis was adjusted (weighted) for the design of the survey and the results are nationally representative. FINDINGS:: Eighty-four percent of PLWHAs in Kenya and 86% in Malawi had sex in the past 12 months and in each country, 10% reported using condoms at last intercourse. Among sexually active PLWHAs, 86% in Kenya and 96% in Malawi reported their spouse or cohabiting partner as their most recent partner. In multivariate logistic regression models, married or cohabiting PLWHAs were significantly more likely to be sexually active and less likely to use condoms. Over 80% of PLWHAs were unaware of their HIV status. Of HIV-infected women, nearly three-quarters did not want more children either within the next 2 years or ever, but 32% in Kenya and 20% in Malawi were using contraception. INTERPRETATION:: In 2003-2005, majority of PLWHAs in Kenya and Malawi were unaware of their HIV status and were sexually active, especially married or cohabiting PLWHAs. Of HIV-infected women not wanting more children, few used contraception. HIV testing should be expanded, prevention programs should target married or cohabiting couples and family planning services should be integrated with HIV services. Language: English Keywords: KENYA | MALAWI | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | PERSONS LIVING WITH HIV/AIDS | AWARENESS | SEX BEHAVIOR | CONDOM USE | CONTRACEPTION | NEEDS | FERTILITY PREFERENCES | HIV/FP INTEGRATION | HIV TESTING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Africa, Southern | Demographic Surveys | Population Dynamics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Knowledge | Sociocultural Factors | Behavior | Risk Reduction Behavior | Family Planning | Economic Factors | Fertility | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341748 |
| 7. Peer Reviewed Title: Women's use of private and government health facilities for childbirth in Nairobi's informal settlements. Author: Bazant ES; Koening MA; Fotso JC; Mills S Source: Studies in Family Planning. 2009 Mar;40(1):39-50. Abstract: The private sector's role in increasing the use of maternal health care for the poor in developing countries has received increasing attention, yet few data exist for urban slums. Using household-survey data from 1,926 mothers in two informal settlements in Nairobi, Kenya, collected in 2006, we describe and examine the factors associated with women's use of private and government health facilities for childbirth. More women gave birth at private facilities located in the settlements than at government facilities, and one-third of the women gave birth at home or with the assistance of a traditional birth attendant. In multivariate models, women's education, ethnic group, and household wealth were associated with institutional deliveries, especially in government hospitals. Residents in the more disadvantaged settlement were more likely than those in the better-off settlement to give birth in private facilities. In urban areas, maternal health services in both the government and private sectors should be strengthened, and efforts made to reach out to women who give birth at home. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | REFUGEES | TRADITIONAL BIRTH ATTENDANTS | HOUSEHOLDS | CHILDBIRTH | REFUGEE CAMPS | UTILIZATION OF HEALTH CARE | PRIVATE SECTOR | GOVERNMENT PROGRAMS | HEALTH FACILITIES | DEMOGRAPHIC FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Population | Migrants | Migration | Population Dynamics | Health Personnel | Delivery of Health Care | Health | Family and Household | Sociocultural Factors | Pregnancy Outcomes | Pregnancy | Reproduction | Residence Characteristics | Population Distribution | Geographic Factors | Health Services | Macroeconomic Factors | Programs | Organization and Administration Document Number: 341077 |
| 8. Peer Reviewed Title: HIV infection, malnutrition, and invasive bacterial infection among children with severe malaria. Author: Berkley JA; Bejon P; Mwangi T; Gwer S; Maitland K; Williams TN; Mohammed S; Osier F; Kinyanjui S; Fegan G; Lowe BS; English M; Peshu N; Marsh K; Newton CR Source: Clinical Infectious Diseases. 2009 Aug 1;49(3):336-43. Abstract: BACKGROUND: Human immunodeficiency virus (HIV) infection, malnutrition, and invasive bacterial infection (IBI) are reported among children with severe malaria. However, it is unclear whether their cooccurrence with falciparum parasitization and severe disease happens by chance or by association among children in areas where malaria is endemic. METHODS: We examined 3068 consecutive children admitted to a Kenyan district hospital with clinical features of severe malaria and 592 control subjects from the community. We performed multivariable regression analysis, with each case weighted for its probability of being due to falciparum malaria, using estimates of the fraction of severe disease attributable to malaria at different parasite densities derived from cross-sectional parasitological surveys of healthy children from the same community. RESULTS: HIV infection was present in 133 (12%) of 1071 consecutive parasitemic admitted children (95% confidence interval [CI], 11%-15%). Parasite densities were higher in HIV-infected children. The odds ratio for admission associated with HIV infection for admission with true severe falciparum malaria was 9.6 (95% CI, 4.9-19); however, this effect was restricted to children aged 1 year. Malnutrition was present in 507 (25%) of 2048 consecutive parasitemic admitted children (95% CI, 23%-27%). The odd ratio associated with malnutrition for admission with true severe falciparum malaria was 4.0 (95% CI, 2.9-5.5). IBI was detected in 127 (6%) of 2048 consecutive parasitemic admitted children (95% CI, 5.2%-7.3%). All 3 comorbidities were associated with increased case fatality. CONCLUSIONS: HIV, malnutrition and IBI are biologically associated with severe disease due to falciparum malaria rather than being simply alternative diagnoses in co-incidentally parasitized children in an endemic area. Language: English Keywords: KENYA | RESEARCH REPORT | CONTROL GROUPS | MULTIVARIATE ANALYSIS | CHILDREN | MALARIA | SIGNS AND SYMPTOMS | HIV INFECTIONS | MALNUTRITION | BACTERIAL AND FUNGAL DISEASES | CASE FATALITY RATE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Viral Diseases | Nutrition Disorders | Infections | Death Rate | Mortality | Population Dynamics Document Number: 342633 |
| 9. Peer Reviewed Title: Comparison of CD4 cell count, viral load, and other markers for the prediction of mortality among HIV-1-infected Kenyan pregnant women. Author: Brown ER; Otieno P; Mbori-Ngacha DA; Farquhar C; Obimbo EM; Nduati R; Overbaugh J; John-Stewart GC Source: Journal of Infectious Diseases. 2009 May 1;199(9):1292-300. Abstract: BACKGROUND: There are limited data regarding the relative merits of biomarkers as predictors of mortality or time to initiation of antiretroviral therapy (ART). METHODS: We evaluated the usefulness of the CD4 cell count, CD4 cell percentage (CD4%), human immunodeficiency virus type 1 (HIV-1) load, total lymphocyte count (TLC), body mass index (BMI), and hemoglobin measured at 32 weeks' gestation as predictors of mortality in a cohort of HIV-1-infected women in Nairobi, Kenya. Sensitivity, specificity, positive predictive value (PPV), and area under the receiver operating characteristic (ROC) curve (AUC) were determined for each biomarker separately, as well as for the CD4 cell count and the HIV-1 load combined. RESULTS: Among 489 women with 10,150 person-months of follow-up, mortality rates at 1 and 2 years postpartum were 2.1% (95% confidence interval [CI], 0.7%-3.4%) and 5.5% (95% CI, 3.0%-8.0%), respectively. CD4 cell count and CD4% had the highest AUC value (>0.9). BMI, TLC, and hemoglobin were each associated with but poorly predictive of mortality (PPV, <7%). The HIV-1 load did not predict mortality beyond the CD4 cell count. CONCLUSIONS: The CD4 cell count and CD4% measured during pregnancy were both useful predictors of mortality among pregnant women. TLC, BMI, and hemoglobin had a limited predictive value, and the HIV-1 load did not predict mortality any better than did the CD4 cell count alone. Language: English Keywords: KENYA | RESEARCH REPORT | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | IMMUNOLOGIC FACTORS | BODY WEIGHT | HEMOGLOBIN LEVEL | RISK FACTORS | AIDS | MORTALITY | ANTIRETROVIRAL THERAPY | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Immunity | Immune System | Physiology | Biology | Hemic System | Health | Population Dynamics | HIV Document Number: 342360 |
| 10. Peer Reviewed Title: Engaging parliamentarians as advocates for women's health: findings from Kenya and Namibia. Author: Caffrey P; Weiss E; Wood L; Connor E; Orza L; Trasi R Source: Global Public Health. 2009;4(3):271-83. Abstract: Members of parliament (MPs) are well placed to promote national health policies that improve women's access to quality health care, including HIV services. To catalyse political will and leadership, the International Centre for Research on Women, Centre for the Study of AIDS at the University of Pretoria, International Community of Women Living with HIV/AIDS and Realising Rights: The Ethical Globalization Initiative, conducted the Parliamentarians for Women's Health project in select African countries. This paper focus on participatory community assessments - a methodology used by the project to improve MPs' understanding of women's health issues, particularly HIV/AIDS, and to increase their engagement with civil society in order to better represent women's health needs and concerns. In-depth interviews with eight MPs from Kenya and Namibia highlight the value of the assessments in identifying women's health problems and service gaps. The MPs reported that they undertook various activities after the assessments, including gathering more information about women's health from local communities, pushing for new parliamentary committees to be a platform for health issues, using the information from the assessments to inform policy, more carefully reviewing budget allocations and establishing relationships with civil society. Participatory methods can be used to meet political leaders' needs for information and communities' needs to influence policymaking that affects their lives. Language: English Keywords: KENYA | NAMIBIA | RESEARCH REPORT | GOVERNMENT OFFICIALS | WOMEN'S HEALTH | ADVOCACY | CIVIL SOCIETY | HEALTH POLICY | HIV PREVENTION | PARTICIPATION | WORKSHOPS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Africa, Southern | Administrative Personnel | Organization and Administration | Health | Communication | Economic Factors | Policy | Political Factors | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Social Behavior | Behavior | Education Document Number: 341393 |
| 11. Title: Individual- and community-level determinants of social acceptance of people living with HIV in Kenya: Results from a national population-based survey. Author: Chiao C; Mishra V; Sambisa W Source: Health and Place. 2009 Sep;15(3):742-750. Abstract: Using the 2003 Kenya Demographic and Health Survey, we investigated the influence of individual- and community-level factors on accepting attitudes toward people living with HIV (PLHIV) using three outcomes: (1) willingness to care for an infected household member, (2) willingness to buy vegetables from an infected vendor, and (3) willingness to allow an infected female teacher to continue teaching. In multilevel logistic regression models, we found that individuals who expressed greater acceptance of PLHIV were more likely to be male, older, more educated, high AIDS knowledge, and exposed to mass media. At the community level, differences in accepting attitudes were associated with community AIDS knowledge, community education, and community AIDS experience, but not for region, or place of residence. The findings suggest the important role of community factors in determining social acceptance of PLHIV. Programmatic strategies aimed at increasing these accepting attitudes should consider both individual- and community-level factors. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | DEMOGRAPHIC AND HEALTH SURVEYS | COMMUNITY | TEACHERS | PERSONS LIVING WITH HIV/AIDS | SOCIAL DISCRIMINATION | STIGMA | HIV INFECTIONS | PSYCHOSOCIAL FACTORS | ATTITUDES | FAMILY RELATIONSHIPS | ACCEPTANCE PROCESS | FOOD AND BEVERAGE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Education | Viral Diseases | Diseases | Social Problems | Sociocultural Factors | Behavior | Psychological Factors | Family Characteristics | Family and Household | Decision Making | Nutrition | Health Document Number: 341072 |
| 12. Peer Reviewed Title: Trends in primary and secondary abstinence among Kenyan youth. Author: Chiao C; Mishra V Source: AIDS Care. 2009 Jul;Calverton, Maryland, Macro International, Demographic and Health Research Division, MEASURE DHS, 2007 Nov. 21(7):881-892. 15 p. (DHS Working Papers No. 36USAID Contract No. GPO-C-00-03-00002-00) Abstract: The authors used data from Kenya Demographic and Health Surveys in 1993, 1998, and 2003 to examine 10-year trends in primary and secondary abstinence among never-married youth ages 15–24 and to explore the role of HIV prevention knowledge, schooling, and contextual factors in affecting their abstinence behaviors. Their analysis shows that both primary and secondary abstinence levels have risen in the past 10 years, with the abstinence levels higher among females than among males. Logistic regression models indicate that knowledge that abstinence can prevent HIV infection was positively associated with the likelihood of practicing abstinence. However, knowledge that condom use can prevent HIV infection was associated with lower abstinence practice. In-school youth were more likely to abstain from sex than those working. Effects of the contextual variables were only significant on the likelihood of primary abstinence among female youth. Language: English Keywords: KENYA | TECHNICAL REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | DATA ANALYSIS | YOUTH | ADOLESCENTS | STUDENTS | PRIMARY SCHOOLS | SECONDARY SCHOOLS | ABSTINENCE | HIV INFECTIONS | TRANSMISSION | HIV PREVENTION | KNOWLEDGE | CONDOM USE | BEHAVIOR | SEX EDUCATION | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Research Methodology | Age Factors | Population Characteristics | Education | Schools | Family Planning, Behavioral Methods | Family Planning | Viral Diseases | Diseases | Infections | Sociocultural Factors | Risk Reduction Behavior | Program Evaluation | Programs | Organization and Administration Document Number: 322987 |
| 13. Title: Daily trimethoprim-sulfamethoxazole prophylaxis rapidly induces corresponding resistance among intestinal Escherichia coli of HIV-infected adults in Kenya. Author: Chiller TM; Polyak CS; Brooks JT; Williamson J; Ochieng B; Shi YP; Ouma P; Greene C; Hamel M; Vulule J; Bopp C; Slutsker L; Mintz E Source: Journal of the International Association of Physicians in AIDS Care. 2009 May-Jun;8(3):165-9. Abstract: BACKGROUND: Trimethoprim-sulfamethoxazole (TMP-SMZ) has been recommended by World Health Organization (WHO) as daily prophylaxis for Africans with AIDS to prevent opportunistic infections. Daily TMP-SMZ may reduce its susceptibility to commensal intestinal Escherichia coli (E coli), increasing the burden of TMP-SMZ-resistant pathogens. METHODS: Participants received either daily TMP-SMZ (CD4 <350 cells/mm(3)) or daily multivitamins (MVIs; CD4 > or =350 cells/mm(3)) for 6 months. Stool was collected at baseline, 2 weeks, 2 months, and 6 months. A random E coli was tested for susceptibility. RESULTS: Baseline prevalence of TMP-SMZ resistance ranged from 71% to 81% and was not different across CD4 strata. At 2 weeks, prevalence of TMP-SMZ-resistant E coli increased significantly from 78% to 98% (P < .001) among persons taking daily TMP-SMZ and did not change among persons taking MVIs. CONCLUSIONS: Daily prophylaxis with TMP-SMZ induced in vivo resistance to the drug after 2 weeks. Empiric therapy for diarrhea with agents other than TMP-SMZ should be considered for HIV-infected persons receiving daily TMP-SMZ prophylaxis. Language: English Keywords: KENYA | RESEARCH REPORT | STATISTICAL STUDIES | PERSONS LIVING WITH HIV/AIDS | ADULTS | BACTERIAL AND FUNGAL DISEASES | ANTIBIOTICS | DRUG RESISTANCE | PREVALENCE | DIARRHEA | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement Document Number: 342456 |
| 14. Peer Reviewed Title: Estimating inequalities in ownership of insecticide treated nets: does the choice of socio-economic status measure matter? Author: Chuma J; Molyneux C Source: Health Policy and Planning. 2009 Mar;24(2):83-93. Abstract: Research on the impact of socio-economic status (SES) on access to health care services and on health status is important for allocating resources and designing pro-poor policies. Socio-economic differences are increasingly assessed using asset indices as proxy measures for SES. For example, several studies use asset indices to estimate inequities in ownership and use of insecticide treated nets as a way of monitoring progress towards meeting the Abuja targets. The validity of different SES measures has only been tested in a limited number of settings, however, and there is little information on how choice of welfare measure influences study findings, conclusions and policy recommendations. In this paper, we demonstrate that household SES classification can depend on the SES measure selected. Using data from a household survey in coastal Kenya (n = 285 rural and 467 urban households), we first classify households into SES quintiles using both expenditure and asset data. Household SES classification is found to differ when separate rural and urban asset indices, or a combined asset index, are used. We then use data on bednet ownership to compare inequalities in ownership within each setting by the SES measure selected. Results show a weak correlation between asset index and monthly expenditure in both settings: wider inequalities in bednet ownership are observed in the rural sample when expenditure is used as the SES measure [Concentration Index (CI) = 0.1024 expenditure quintiles; 0.005 asset quintiles]; the opposite is observed in the urban sample (CI = 0.0518 expenditure quintiles; 0.126 asset quintiles). We conclude that the choice of SES measure does matter. Given the practical advantages of asset approaches, we recommend continued refinement of these approaches. In the meantime, careful selection of SES measure is required for every study, depending on the health policy issue of interest, the research context and, inevitably, pragmatic considerations. Language: English Keywords: KENYA | RESEARCH REPORT | LOW INCOME POPULATION | SOCIOECONOMIC STATUS | EXPENDITURES | BED NETS | MALARIA PREVENTION | HEALTH STATUS INDEXES | HEALTH POLICY | HEALTH SERVICES | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Social Class | Socioeconomic Factors | Economic Factors | Financial Activities | Parasite Control | Public Health | Health | Malaria | Parasitic Diseases | Diseases | Policy | Political Factors | Sociocultural Factors | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration Document Number: 331225 |
| 15. Peer Reviewed Title: Association of attitudes and beliefs towards antiretroviral therapy with HIV-seroprevalence in the general population of Kisumu, Kenya. Author: Cohen CR; Montandon M; Carrico AW; Shiboski S; Bostrom A; Obure A; Kwena Z; Bailey RC; Nguti R; Bukusi EA Source: PLoS One. 2009;4(3):e4573. Abstract: BACKGROUND: Since antiretroviral therapy (ART) became available in the developed world, the prevalence of unprotected sex and the incidence of sexually transmitted infections (STIs) and HIV have increased. We hypothesized that a similar phenomenon may be occurring in sub-Saharan Africa concomitant with the scale-up of HIV treatment. METHODS: We conducted a general population-based survey in Kisumu, Kenya. Participants completed an interview that included demographics as well as ART-related attitudes and beliefs (AB) and then underwent HIV serological testing. Exploratory and confirmatory factor analyses of AB about ART indicated two factors: 1) ART-related risk compensation (increased sexual risk taking now that ART is available); and 2) a perception that HIV is more controllable now that ART is available. Logistic regression was used to determine associations of these factors with HIV-seroprevalence after controlling for age. FINDINGS: 1,655 (90%) of 1,844 people aged 15-49 contacted, including 749 men and 906 women, consented to participate in the study. Most participants (n = 1164; 71%) had heard of ART. Of those who had heard of ART, 23% believed ART was a cure for HIV. ART-related risk compensation (Adjusted (A)OR = 1.45, 95% CI 1.16-1.81), and a belief that ART cures HIV (AOR = 2.14, 95% CI 1.22-3.76) were associated with an increased HIV seroprevalence in men but not women after controlling for age. In particular, ART-related risk compensation was associated with an increased HIV-seroprevalence in young (aged 15-24 years) men (OR = 1.56; 95% CI 1.12-2.19). CONCLUSIONS: ART-related risk compensation and a belief that ART cures HIV were associated with an increased HIV seroprevalence among men but not women. HIV prevention programs in sub-Saharan Africa that target the general population should include educational messages about ART and address the changing beliefs about HIV in the era of greater ART availability. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | STATISTICAL REGRESSION | PERSONS LIVING WITH HIV/AIDS | ATTITUDES | BELIEFS | HIV INFECTIONS | PREVALENCE | DEMOGRAPHIC FACTORS | ANTIRETROVIRAL THERAPY | RISK BEHAVIOR | SEX BEHAVIOR | SEX FACTORS | KNOWLEDGE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Viral Diseases | Diseases | Psychological Factors | Behavior | Culture | Sociocultural Factors | Measurement | Population | HIV | Population Characteristics Document Number: 331237 |
| 16. Title: Immune responses to measles and tetanus vaccines among Kenyan human immunodeficiency virus type 1 (HIV-1)-infected children pre- and post-highly active antiretroviral therapy and revaccination. Author: Farquhar C; Wamalwa D; Selig S; John-Stewart G; Mabuka J; Majiwa M; Sutton W; Haigwood N; Wariua G; Lohman-Payne B Source: Pediatric Infectious Disease Journal. 2009 Apr;28(4):295-9. Abstract: BACKGROUND:: HIV-1-infected children have lower response rates after measles and tetanus immunization than uninfected children. We determined the extent to which highly active antiretroviral therapy (HAART) augments vaccine immunity and promotes responses to revaccination. METHODS:: Previously immunized, antiretroviral-naive HIV-1-infected children were evaluated for immunity against measles and tetanus. After 6 months on HAART, children meeting CD4% criteria (>15%) who were persistently antibody negative were revaccinated and immunity was reassessed. RESULTS:: At enrollment, among 90 children with mean age of 4.9 years, 67% had negative measles IgG and 22% negative tetanus IgG. Among 62 children completing 6 months on HAART, 17 (40%) of 43 without protective measles IgG converted and 10 (53%) of 19 positive children lost measles responses (P = 0.3). Children who lost responses had significantly lower measles antibody concentrations than those who remained measles IgG positive during follow-up (7.1 vs. 20.3 mg/mL; P = 0.003). Three (23%) of 13 children negative for tetanus IgG spontaneously seroconverted on HAART, while 15 (31%) of 49 children lost tetanus antibody (P = 0.008). There was a nonsignificant trend for an association between spontaneous measles seroconversion and lower baseline HIV-1 viral load (P = 0.06). Tetanus seroconversion was associated with older age (P = 0.03). After revaccination, positive responses were observed in 78% and 75% of children reimmunized against measles and tetanus, respectively. CONCLUSIONS:: After 6 months of HAART, more than half of previously immunized children still lacked positive measles antibody. With increased use of HAART in pediatric populations, revaccination against measles and tetanus should be considered to boost response rates and immunization coverage. Language: English Keywords: KENYA | RESEARCH REPORT | CHILDREN | PERSONS LIVING WITH HIV/AIDS | MEASLES | HIV INFECTIONS | VACCINATION | ANTIRETROVIRAL THERAPY | TETANUS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Immunization | Primary Health Care | Health Services | Delivery of Health Care | Health | HIV | Infections Document Number: 341232 |
| 17. Peer Reviewed Title: The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. Author: Feikin DR; Nguyen LM; Adazu K; Ombok M; Audi A; Slutsker L; Lindblade KA Source: Tropical Medicine and International Health. 2009 Jan;14(1):54-61. Abstract: OBJECTIVE: To explore the impact of distance on utilisation of peripheral health facilities for sick child visits in Asembo, rural western Kenya. METHODS: As part of a demographic surveillance system (DSS), censuses of all households in the Asembo population of 55,000 are conducted three times a year, data are collected at all outpatient pediatric visits in seven DSS clinics in Asembo, and all households are GIS-mapped and linkable to a child's unique DSS identification number. Between May 1, 2003 and April 30, 2004, 3501 clinic visits were linked to 2432 children among 10,973 DSS-resident children < 5 years of age. RESULTS: Younger children and children with more severe illnesses travelled further for clinic visits. The median distance travelled varied by clinic. The rate of clinic visits decreased linearly at 0.5 km intervals up to 4 km, after which the rate stabilised. Using Poisson regression, controlling for the nearest DSS clinic for each child, socio-economic status and maternal education, and accounting for household clustering of children, for every 1 km increase in distance of residence from a DSS clinic, the rate of clinic visits decreased by 34% (95% CI, 31-37%) from the previous kilometer. CONCLUSION: Achieving equity in access to health care for children in rural Kenya will require creative strategies to address a significant distance-decay effect in health care utilisation. Language: English Keywords: KENYA | RESEARCH REPORT | DEMOGRAPHIC SURVEYS | STATISTICAL REGRESSION | RURAL POPULATION | CHILDREN | DISTANCE | HEALTH FACILITIES | UTILIZATION OF HEALTH CARE | HUMAN GEOGRAPHY | SOCIOECONOMIC STATUS | EDUCATIONAL STATUS | AGE FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Population Dynamics | Demographic Factors | Population | Data Analysis | Research Methodology | Population Characteristics | Youth | Geographic Factors | Delivery of Health Care | Health | Health Services | Geography | Social Sciences | Science | Sociocultural Factors | Socioeconomic Factors | Economic Factors Document Number: 330260 |
| 18. Peer Reviewed Title: What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya. Author: Fotso J; Ezeh A; Madise N; Ziraba A; Ogollah R Source: Maternal and Child Health Journal. 2009 Jan;13(1):130-7. Abstract: Objectives: The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and "appropriate" health facilities. Methods: The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either "inappropriate" or "appropriate". Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Results: Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy "wantedness", and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Conclusion: Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | SLUMS | URBAN POPULATION | WOMEN IN DEVELOPMENT | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | PROGRAM ACCESSIBILITY | QUALITY OF HEALTH CARE | CHILDBIRTH | EDUCATIONAL STATUS | PROMOTION | ANTENATAL CARE | MULTIPARITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Population Characteristics | Demographic Factors | Economic Development | Economic Factors | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Health Services Evaluation | Pregnancy Outcomes | Pregnancy | Reproduction | Socioeconomic Status | Socioeconomic Factors | Marketing | Parity | Fertility Measurements | Fertility | Population Dynamics Document Number: 308031 |
| 19. Title: HIV/AIDS knowledge and behaviour: have information campaigns reduced HIV infection? The case of Kenya. Author: Frolich M; Vazquez-Alvarez R Source: African Development Review. 2009 Apr;21(1):86-146. Abstract: AIDS continues to have a devastating effect on developing countries, particularly in sub-Saharan Africa. The lack of a proven effective vaccine to stop HIV transmission has led to much of public policy putting an emphasis on information campaigns in order to reduce HIV-prevalence. In this paper we examine the impact of HIV/AIDS-knowledge from two sides. First, we examine to what extent the campaigns have been successful at inducing the expected behavioural change with regards to HIV-related attitudes. Second, we examine the impact of HIV/AIDS knowledge on HIV status. The basic policy issue can be expressed as follows: even if individuals have acquired sufficient and necessary information on the basic facts about AIDS, factors such as innate risk attitudes or cultural background could undermine the effects of the campaigns. Using the Kenya Demographic and Health Survey (2003) we elicit empirical evidence on the relation between declared HIV/AIDS-knowledge, behavioural attitudes related to HIV/AIDS situations and the relation between knowledge and observed HIV-status. Overall, our empirical findings suggest that information campaigns have been effective at equipping the adult population in Kenya with the required knowledge to avoid becoming HIV-positive. However, when HIV-status is measured objectively we find that the relation between correctly declared attitudes and actual behaviour is only statistically significant for females who have arrived into sexuality late enough to benefit from such campaigns: it is for these females that the impact of the information campaigns has been to statistically reduce the probability of becoming HIV positive, as intended. In the case of males we find that there is no statistical relation between either knowledge or timing of the information campaigns and a positive HIV status. Nevertheless, another important finding refers to the selection bias induced by males who are sampled randomly but decline to take the HIV test. The consequences of this bias are twofold; first, the estimated policy parameters for males should be interpreted with caution, but more importantly, estimating the population level HIV-prevalence for Kenyan males based on the DHS implies underestimating the true and unknown prevalence rate. Our analysis controls for individual characteristics, selection bias and endogeneity effects, thus allowing us to make inferences for the full population and with regards to policy implementation. Language: English Keywords: KENYA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | HIV INFECTIONS | AIDS | PREVALENCE | KNOWLEDGE | ATTITUDES | INFORMATION | CAMPAIGNS | PROGRAM EFFECTIVENESS | BEHAVIOR | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Viral Diseases | Diseases | Measurement | Research Methodology | Sociocultural Factors | Psychological Factors | Communication Programs | Communication | Program Evaluation | Programs | Organization and Administration Document Number: 341877 |
| 20. Peer Reviewed Title: Adherence to anti retroviral therapy (ART) during Muslim Ramadan fasting. Author: Habib AG; Shepherd JC; Eng MK; Babashani M; Jumare J; Yakubu U; Gebi UI; Saad M; Ibrahim H; Blattner WA Source: AIDS and Behavior. 2009 Feb;13(1):42-45. Abstract: Annual fasting during the month of Ramadan is observed in Muslim countries, some of which have widespread HIV infection. We studied treatment adherence and customary practices among 142 fasting 'FT' and 101 nonfasting 'NFT' patients on anti-retroviral therapy (ART) in Nigeria. Adherence on ART among FT and NFT patients was similar during Ramadan, 96% and 98%, and ever since commencement of ART, 80% and 88%, respectively. FT patients altered their typical daily behaviors by advancing morning and delaying evening doses thereby prolonging dosing intervals, eating heavier meals pre-dawn and on breakfast at sunset (78%), and changing or reducing their sleeping and waking times (40%). This preliminary study suggests that adherence and drug taking frequency appear uncompromised in FT HIV infected patients on ARVs. Language: English Keywords: ETHIOPIA | KENYA | NIGERIA | SOMALIA | SOUTH AFRICA | TANZANIA | UGANDA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | ISLAM | HIV | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | RELIGION | CULTURE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Africa, Western | Africa, Southern | HIV Infections | Viral Diseases | Diseases | Sociocultural Factors | Behavior Document Number: 330156 |
| 21. Title: Analyzing the cost-effectiveness of interventions to benefit orphans and vulnerable children: evidence from Kenya and Tanzania. Author: Hutchinson P; Thurman TR Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2009 Apr. 26 p. (SR-09-51USAID Cooperative Agreement No. GPO-A-00-03-00003-00) Abstract: To provide insight on the success of programs providing services to orphans and vulnerable children (OVC), this paper analyzes cost-effectiveness of four programs in Kenya and Tanzania by comparing intervention costs to program outcomes. These results provide some evidence that investments in OVC programs-particularly (1) school-based HIV education and counseling for children and (2) savings and internal lending committees for guardians-can help improve the well-being of OVCs at a fairly low cost per beneficiary. Language: English Keywords: KENYA | TANZANIA | RESEARCH REPORT | ORPHANS AND VULNERABLE CHILDREN | HIV INFECTIONS | PSYCHOSOCIAL FACTORS | ANTIRETROVIRAL THERAPY | EDUCATION | HEALTH SERVICES | TREATMENT | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Behavior | HIV | Delivery of Health Care | Health | Medical Procedures | Medicine Document Number: 339996 |
| 22. Peer Reviewed Title: Performance of clinical algorithms for HIV-1 diagnosis and antiretroviral initiation among HIV-1-exposed children aged less than 18 months in Kenya. Author: Inwani I; Mbori-Ngacha D; Nduati R; Obimbo E; Wamalwa D; John-Stewart G; Farquhar C Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Apr 15;50(5):492-8. Abstract: BACKGROUND: Ninety percent of HIV-1-infected children live in sub-Saharan Africa. In the absence of diagnosis and antiretroviral therapy, approximately 50% die before 2 years. METHODS: We evaluated sensitivity and specificity of clinical algorithms for diagnosis of HIV-1 infection and antiretroviral therapy initiation among HIV-1-exposed children aged less than 18 months. Children were identified with routine HIV-1 testing and assessed using 3 sets of criteria: (1) Integrated Management of Childhood Illnesses (IMCI), (2) World Health Organization Presumptive Diagnosis (WHO-PD) for HIV-1 infection, and (3) CD4 T-lymphocyte cell subsets. HIV-1 infection status was determined using DNA polymerase chain reaction testing. FINDINGS: A total of 1418 children (median age 5.4 months) were screened for HIV-1 antibodies, of whom 144 (10.2%) were seropositive. Of these, 134 (93%) underwent HIV-1 DNA testing and 80 (60%) were found to be HIV-1 infected. Compared with HIV-1 DNA testing, sensitivity and specificity of the IMCI criteria were 19% and 96% and for WHO-PD criteria 43% and 88%, respectively. Inclusion of severe immune deficiency determined by CD4% improved sensitivity of IMCI and WHO-PD criteria to 74% and 84%, respectively; however, specificity declined to 43% and 41%, respectively. INTERPRETATION: Diagnosis of HIV-1 infection among exposed children less than 18 months in a high-prevalence resource-limited setting remains a challenge, and current recommended algorithms have low sensitivity. This underscores the need for rapid scale-up of viral assays for early infant diagnosis. Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | INFANT | HIV | EXAMINATIONS AND DIAGNOSES | EXPOSURE | LABORATORY PROCEDURES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Risk Factors | Laboratory Examinations and Diagnoses Document Number: 331222 |
| 23. Peer Reviewed Title: The persistence and challenges of homebirths: perspectives of traditional birth attendants in urban Kenya. Author: Izugbara C; Ezeh A; Fotso JC Source: Health Policy and Planning. 2009 Jan;24(1):36-45. Abstract: Through an analysis of focus group discussion data, we examine Kenyan traditional birth attendants' (TBAs) accounts of the persistence of homebirths and the key challenges they present. TBAs associated the continued demand for homebirths with the wide-ranging character and quality of their services. They did not consider their lack of formal training on matters of pregnancy and birthing to be a particular challenge to their work. Rather, they identified the non-cooperative and disrespectful attitudes of their counterparts in hospital settings as the most important issue. Further efforts are needed to make TBAs realize how much better their services could become if they adopted more modern ways of assisting in deliveries, unlearnt their belief in the superiority of their particular type of practice, and understood how their lack of formal training is a key issue. Language: English Keywords: KENYA | RESEARCH REPORT | FOCUS GROUPS | TRADITIONAL BIRTH ATTENDANTS | CHILDBIRTH | OBSTACLES | QUALITY OF HEALTH CARE | MATERNAL HEALTH | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Health Personnel | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Organization and Administration | Health Services Evaluation | Program Evaluation | Programs Document Number: 330475 |
| 24. Title: Correlates of condom use among male high school students in Nairobi, Kenya. Author: Kabiru CW; Orpinas P Source: Journal of School Health. 2009 Sep;79(9):425-32. Abstract: This study examined sociodemographic, behavioral, and psychosocial characteristics of three groups of adolescent males: those who use condoms consistently, those who use them sporadically, and non-condom users. The sample consisted of 931 sexually experienced male high school students in Nairobi, Kenya. Cross tabulations and general linear models were used to test the relation between each explanatory variable and condom user group. Fifty-three percent of respondents reported having used condoms. Compared with nonusers and sporadic users, consistent users engaged in sexual intercourse for the first time at an older age and reported higher condom use self-efficacy, more positive peer attitudes toward safe sex, and stronger attitudes toward condom use. Compared with sporadic and consistent users, nonusers reported fewer sexual partners, less substance use, and more frequent intercourse with nonromantic partners. Sporadic users, compared with the other two groups, had more sexual partners and stronger attitudes that support that males and females have separate roles. The three groups did not differ in HIV/AIDS knowledge. All groups perceived their risk of contracting an STI as low, and this perception did not differ by condom use. Differences in participants' age by group were minimal. Language: English Keywords: KENYA | RESEARCH REPORT | DATA ANALYSIS | STUDENTS | SECONDARY SCHOOLS | REPRODUCTIVE HEALTH | RISK BEHAVIOR | CHILD HEALTH | ADOLESCENT HEALTH | RISK FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Education | Schools | Health | Behavior Document Number: 342558 |
| 25. Title: Factors associated with sexual activity among high-school students in Nairobi, Kenya. Author: Kabiru CW; Orpinas P Source: Journal of Adolescence. 2009;32(4):1023-1039. Abstract: This study examined sociodemographic, behavioral, and psychosocial factors associated with heterosexual activity among a sample of 3,556 male and female high school students in Nairobi, Kenya. Approximately 50% of the males and 11% of females reported having had sexual intercourse at least once in their lifetime with a significant proportion reporting multiple sexual partnerships. Sexual activity was associated with various factors including religiosity, perceived parental attitudes towards sex, living arrangements, and school characteristics. However, the pattern of association differed for males and females. Results suggest that adolescents may benefit from sex education programs addressing multiple factors that may predispose adolescents to sexual activity, and that take into account gender differences. Language: English Keywords: KENYA | RESEARCH REPORT | STUDENTS | SECONDARY SCHOOLS | ADOLESCENTS | SEX BEHAVIOR | RISK BEHAVIOR | HIV INFECTIONS | AIDS | NEEDS | SEX EDUCATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Education | Schools | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Viral Diseases | Diseases | Economic Factors Document Number: 339858 |
| 26. Peer Reviewed Title: Misclassification of first-line antiretroviral treatment failure based on immunological monitoring of HIV infection in resource-limited settings. Author: Kantor R; Diero L; Delong A; Kamle L; Muyonga S; Mambo F; Walumbe E; Emonyi W; Chan P; Carter EJ; Hogan J; Buziba N Source: Clinical Infectious Diseases. 2009 Aug 1;49(3):454-62. Abstract: BACKGROUND: The monitoring of patients with human immunodeficiency virus (HIV) infection who are treated with antiretroviral medications in resource-limited settings is typically performed by use of clinical and immunological criteria. The early identification of first-line antiretroviral treatment failure is critical to prevent morbidity, mortality, and drug resistance. Misclassification of failure may result in premature switching to second-line therapy. METHODS: Adult patients in western Kenya had their viral loads (VLs) determined if they had adhered to first-line therapy for >6 months and were suspected of experiencing immunological failure (ie, their CD4 cell count decreased by 25% in 6 months). Misclassification of treatment failure was defined as a 25% decrease in CD4 cell count with a VL of <400 copies/mL. Logistic and tree regressions examined relationships between VL and 4 variables: CD4 T cell count (hereafter CD4 cell count), percentage of T cells expressing CD4 (hereafter CD4 cell percentage), percentage decrease in the CD4 T cell count (hereafter CD4 cell count percent decrease), and percentage decrease in the percentage of T cells expressing CD4 (hereafter CD4% percent decrease). RESULTS: There were 149 patients who were treated for 23 months; they were identified as having a 25% decrease in CD4 cell count (from 375 to 216 cells/microL) and a CD4% percent decrease (from 19% to 15%); of these 149 patients, 86 (58%) were misclassified as having experienced treatment failure. Of 42 patients who had a 50% decrease in CD4 cell count, 18 (43%) were misclassified. In multivariate logistic regression, misclassification odds were associated with a higher CD4 cell count, a shorter duration of therapy, and a smaller CD4% percent decrease. By combining these variables, we may be able to improve our ability to predict treatment failure. CONCLUSIONS: Immunological monitoring as a sole indicator of virological failure would lead to a premature switch to valuable second-line regimens for 58% of patients who experience a 25% decrease in CD4 cell count and for 43% patients who experience a 50% decrease in CD4 cell count, and therefore this type of monitoring should be reevaluated. Selective virological monitoring and the addition of indicators like trends CD4% percent decrease and duration of therapy may systematically improve the identification of treatment failure. VL testing is now mandatory for patients suspected of experiencing first-line treatment failure within the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya, and should be considered in all resource-limited settings. Language: English Keywords: KENYA | RESEARCH REPORT | CLASSIFICATION | STATISTICAL REGRESSION | ADULTS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | IMMUNOLOGICAL EFFECTS | MONITORING | ANTIRETROVIRAL DRUGS | TIME FACTORS | DRUG RESISTANCE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Age Factors | Population Characteristics | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Immunity | Immune System | Physiology | Biology | Evaluation | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics Document Number: 342630 |
| 27. Title: Survey on prevalence and risk factors on HIV-I among pregnant women in North-Rift, Kenya: a hospital based cross-sectional study conducted between 2005 and 2006. Author: Kiptoo M; Mpoke S; Ng'ang'a Z; Mueke J; Okoth F; Songok E Source: BMC International Health and Human Rights. 2009 Apr 30;9(10):6 p. Abstract: Background: The HIV/AIDS epidemic in Kenya is a major public-health problem. Estimating the prevalence of HIV in pregnant women provides essential information for an effective implementation of HIV/AIDS control measures and monitoring of HIV spread within a country. The objective of this study was to determine the prevalence of HIV infection, risk factors for HIV/AIDS and immunologic (lymphocyte profile) characteristics among pregnant women attending antenatal clinics in three district hospitals in North-Rift, Kenya. Methods: Blood samples were collected from pregnant women attending antenatal clinics in three district hospitals (Kitale, Kapsabet and Nandi Hills) after informed consent and pre-test counseling. The samples were tested for HIV antibodies as per the guidelines laid down by Ministry of Health, Kenya. A structured pretested questionnaire was used to obtain demographic data. Lymphocyte subset counts were quantified by standard flow cytometry. Results: Of the 4638 pregnant women tested, 309 (6.7%) were HIV seropositive. The majority (85.1%) of the antenatal attendees did not know their HIV status prior to visiting the clinic for antenatal care. The highest proportion of HIV infected women was in the age group 21-25 years (35.5%). The 31-35 age group had the highest (8.5%) HIV prevalence, while women aged more than 35 years had the lowest (2.5%). Women in a polygamous relationship were significantly more likely to be HIV infected as compared to those in a monogamous relationship (p = 0.000). The highest HIV prevalence (6.3%) was recorded among antenatal attendees who had attended secondary schools followed by those with primary and tertiary level of education (6% and 5% respectively). However, there was no significant relationship between HIV seropositivity and the level of education (p = 0.653 and p = 0.469 for secondary and tertiary respectively). The mean CD4 count was 466 cells/mm3 (9-2000 cells/mm3). Those that had less than 200 cells/mm3 accounted for 14% and only nine were on antiretroviral therapy. Conclusion: Seroprevalence of HIV was found to be consistent with the reports from the national HIV sentinel surveys. Enumeration of T-lymphocyte (CD4/8) should be carried out routinely in the antenatal clinics for proper timing of initiation of antiretroviral therapy among HIV infected pregnant women. Language: English Keywords: KENYA | RESEARCH REPORT | SURVEYS | PREGNANT WOMEN | HIV INFECTIONS | PREVALENCE | RISK FACTORS | VOLUNTARY COUNSELING AND TESTING | QUESTIONNAIRES | ANTENATAL CARE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Sampling Studies | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Measurement | Health | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Maternal Health Services | Maternal-Child Health Services | Primary Health Care Document Number: 341881 |
| 28. Peer Reviewed Title: HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey. Author: Kyobutungi C; Ezeh AC; Zulu E; Falkingham J Source: BMC Public Health. 2009 May 27;9(1):153. Abstract: ABSTRACT: BACKGROUND: The proportion of older people is increasing worldwide. Globally, it is estimated that older people (those 60 years or older) constitute more than 11% of the population. As the HIV/AIDS pandemic rages in sub-Saharan Africa (SSA), its impact on older people needs closer attention given the increased economic and social roles older people have taken on as a result of increased mortality among adults in the productive age groups. Few studies have looked at older people and their health in SSA or indeed the impact of HIV/AIDS on their health. This study aims to assess the effect of being directly or indirectly affected by HIV/AIDS on the health of older people in two Nairobi slums. METHODS: Data were collected from residents of the Nairobi Urban Health and Demographic Surveillance area, who on 1st October 2006, were 50 years and older. Health status was assessed using the short SAGE (Study on Global AGEing and Adult Health) form and two outcome measures - self-rated health and a composite health score - were generated. To assess HIV/AIDS affected status, respondents were asked: Have you personally been affected by HIV/AIDS? If yes, a follow up question: "How have you been personally affected by HIV/AIDS?" was asked. Ordinal logistic regression was used in models with self-rated health and linear regression in models with the health score. RESULTS: About 18% of respondents reported being affected by HIV/AIDS in at least one way, although less than 1% reported being infected with HIV. Nearly 60% of respondents reported being in good health, 27% in fair health and 14% in poor health. The overall mean health score was 70.6 (SD: 13.9). Females reported worse health outcomes than males. Respondents directly or indirectly affected by HIV/AIDS reported worse health outcomes than those not affected: mean health score: 68.5 and 71.1 respectively (t=3.21), and an adjusted odds ratio of reporting "poor health" of 1.42 (95%CI: 1.12-1.80). CONCLUSION: Poor health outcomes among older people affected by HIV/AIDS highlight the need for policies that target them in the fight against HIV/AIDS if they are to play their envisaged care giving and other traditional roles. Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | STATISTICAL REGRESSION | KAP SURVEYS | HEALTH SURVEYS | OLDER ADULTS | SLUMS | PERSONS LIVING WITH HIV/AIDS | HEALTH STATUS INDEXES | SEX FACTORS | SELF-PERCEPTION | AIDS | HIV INFECTIONS | HEALTH POLICY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Surveys | Sampling Studies | Studies | Health | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Viral Diseases | Diseases | Perception | Psychological Factors | Behavior | Policy | Political Factors | Sociocultural Factors Document Number: 341484 |
| 29. Peer Reviewed Title: HIV-1 RNA dysregulates the natural TLR response to subclinical endotoxemia in Kenyan female sex-workers. Author: Lester RT; Yao XD; Ball TB; McKinnon LR; Omange WR; Kaul R; Wachihi C; Jaoko W; Rosenthal KL; Plummer FA Source: PloS One. 2009;4(5):e5644. Abstract: BACKGROUND: Subclinical endotoxemia has been reported in HIV-1 infected persons and may drive systemic immune activation and pathogenesis. Proinflammatory responsiveness to endotoxin (LPS) is mediated by Toll-like receptor 4 (TLR4). We therefore examined the association between plasma LPS levels, HIV RNA, and TLR4 expression and cytokine responses in the blood of HIV infected and uninfected participants in a cohort of female sex-workers in Kenya. METHODOLOGY/PRINCIPAL FINDINGS: Ex vivo plasma and peripheral blood mononuclear cells (PBMC) were assessed for LPS and TLR mRNA, respectively. The effects of HIV single stranded RNA, a TLR8 ligand, on TLR4 and LPS signaling were further assessed in short term PBMC culture. Both HIV uninfected and infected subjects frequently had low detectable LPS levels in their plasmas. Significantly increased LPS levels were associated with chronic HIV-1 infection, both treated and untreated, but not with other acute or semi-chronic conditions reported. In HIV-uninfected subjects, TLR4 mRNA expression levels correlated inversely with plasma LPS levels, suggesting chronic endotoxin 'tolerance' in vivo. A similar effect of reduced TLR4 mRNA was seen in short term PBMC culture after stimulation with LPS. Interestingly, the apparent in vivo tolerance effect was diminished in subjects with HIV infection. Additionally, pre-stimulation of PBMC with LPS lead to proinflammatory (TNF-alpha) tolerance to subsequent LPS stimulation; however, pre-treatment of PBMC with HIV single-stranded RNA40, could enhance TLR4-mediated LPS responsiveness in vitro. CONCLUSIONS/SIGNIFICANCE: Thus, dysregulation of endotoxin tolerance by HIV-1 RNA may exacerbate HIV chronic immune activation and pathogenesis. Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | SEX WORKERS | WOMEN | HIV INFECTIONS | AIDS | IMMUNOLOGICAL EFFECTS | SIGNS AND SYMPTOMS | LABORATORY PROCEDURES | ANTIRETROVIRAL THERAPY | IMMUNE SYSTEM | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Sex Behavior | Behavior | Demographic Factors | Population | Viral Diseases | Diseases | Immunity | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Document Number: 342162 |
| 30. Peer Reviewed Title: Kenyan in-School Youths' Level of Understanding of Abstinence, Being Faithful, and Consistent Condom Use Terms: Implications for HIV-Prevention Programs. Author: Lillie T; Pulerwitz J; Curbow B Source: Journal of Health Communication. 2009 Apr-May;14(3):276-92. Abstract: Kenyan in-school youth ages 13-19 years (N = 1,375) were surveyed before an HIV-prevention intervention was implemented. As part of the survey, students wrote their definitions of the terms "abstinence," "being faithful," and "consistent condom use." These definitions were qualitatively analyzed by determining recurrent themes, developing a codebook, and having two coders code the responses. The entire definition was assigned an overall code of fully comprehended, partly comprehended, did not comprehend, or no response in comparison to the conventional definition of the term. Overall, 48% fully comprehended abstinence, 20% fully comprehended being faithful, and 7% fully comprehended consistent condom use. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | ADOLESCENTS | STUDENTS | ABSTINENCE, BE FAITHFUL, CONDOM USE | HIV PREVENTION | KNOWLEDGE | ABSTINENCE | CONDOM USE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | |