Mental health issues associated with the management of tuberculosis in Homabay, Busia and Kakamega Counties, Kenya.

BACKGROUND: Despite the implementation of patient-centred care, mental health issues remain a significant risk factor and comorbidity for Tuberculosis (TB) disease. Mental health issues being co-morbidities to TB are likely to increase the disease burden of the affected population. This study therefore investigated the prevalence and impact of mental health issues in Tuberculosis (TB) patients. METHODS: This cross-sectional study design used mixed methods in data collection. The study used structured questionnaires, key informant interviews and focus group discussions. 127 TB patients were purposively selected from a group of patients who previously recovered successfully, with a history of relapse or are currently on TB treatment in high-volume facilities in Homa Bay, Busia and Kakamega Counties. 30 Key informant interviews were conducted with Healthcare workers. Quantitative data analysis was done using STATA version 14. Thematic analysis was employed to analyze qualitative data using NVivo version 10. RESULTS: The findings showed that the most common mental health issues affecting TB patients were anxiety (66%) and depression (55%), which were commonly experienced during the presumptive stage of TB. Qualitative data revealed that stigma was the main barrier that hindered TB patients from accessing care. TB patients articulated the benefits of support structures ranging from positive encouragement, reminders on taking drugs, accompaniment to the clinic, and financial support in TB management. Furthermore, the study established that the majority of Health Care Workers (HCWs) were not prepared to handle TB patients' mental issues, a gap that is likely to impact the quality of care TB patients receive. CONCLUSION: The study established that mental health issues impact TB treatment outcomes. Healthcare systems should prioritize the integration of mental health care into TB programs to address the high prevalence of mental health issues among TB patients.

Voices from the Youth in Kenya Addressing Mental Health Gaps and Recommendations.

Studies including adolescents and young people (AYP) enhance the relevance of research results, benefit stakeholders, and inform future research. There exists a mental health gap in services for AYP living in low and middle-income countries. This study aims to identify mental health challenges faced by adolescents and young people in Kenya, develop practical recommendations to mitigate these issues, and reduce the mental health burden among this population. We convened an AYP-led meeting that involved 41 participants. The meeting objectives were to (1) identify efforts to support existing national and regional strategic priorities and review goals for addressing mental health needs among AYPs, (2) develop immediate action plans for strengthened mental health services, (3) review and strengthen country-level coordination mechanisms, and (4) identify how participating county experiences can inform mental health services in Kenya. Ministry of Health (MoH) officials from national and county levels, academic experts, and implementing partner agencies involved in mental health services participated in the meeting. The team, including AYP representatives, identified various mental health challenges among the AYA and recommended interventions aimed towards improving their mental health situation in the country. The challenges were clustered into three themes and comprehensively reviewed to establish the precipitating factors to mental health outcomes among AYPs in Kenya and provide recommendations. The themes included (1) legislative, (2) service provider/Ministry of Health, and (3) adolescent/individual-level factors. To bridge the mental health gap in the country and scale up mental health outcomes, the stakeholders recommended interventions within the context of the three clusters. The key suggestions included an increase in insurance financing, acceleration of community health interventions, the establishment of adolescent-friendly spaces, the training of adolescent youth champions, interactive service provision models, implementation of the existing mental health policies and structures, the development of comprehensive assessment tools, well equipped mental health departments in health facilities, the enhancement of telehealth services and digital villages, the mobilization of a functional mental health response team, and the development of a mental health database.

Hypertension and Associated Inflammatory Markers Among HIV-Infected Patients in Tanzania.

There remains a dearth of data regarding the association between chronic inflammation and hypertension (HTN) in sub-Saharan Africa, a region that accounts for >70% of the global burden of HIV infection. Therefore, we assessed the levels of biomarkers among HIV+ individuals and its associations with HTN in Tanzania. A cross-sectional study was conducted at one of the largest clinics in Tanzania and data from 261 HIV+ patients were analyzed. Standardized tools were used to collect data. Blood pressure was measured using Omron® M2 blood pressure monitor. Enzyme-linked immunosorbent assay was used to test for inflammatory markers [C-reactive protein (CRP), interleukin (IL)-6, IL-18, soluble tumor necrosis factor receptor type I (sTNFRI), sTNFRII]. Bivariate and multivariable analysis was conducted to examine association between the biomarkers and HTN. We further conducted age-sex-alcohol-adjusted models to control for any confounders. The prevalence of HTN was 43% with a high prevalence reported in female (70%) participants and those older than 55 years of age (77%). Being women, older than 55 years of age, married, and being overweight was associated with HTN. The highest correlations were observed between TNR2 and CRP (ɤ = 0.13, P = 0.044), and TNR2 and IL-18 (ɤ = 0.13, P = 0.034). Participants who had elevated CRP levels were 2 times more likely to experience HTN in the age-adjusted model [odds ratio (OR) = 3.5, 95% confidence interval (CI) = 1.1-11.3], age-sex-adjusted model (OR = 3.3, 95% CI = 1.0-10.9), and the full model (OR = 2.9, 95% CI = 0.8-10.0). Our study shows that high CRP levels are significantly associated with the higher prevalence of HTN notwithstanding all other markers, which showed a positive association with HTN despite not being significant. These findings point to the importance of creating awareness, education, and screening for HTN among HIV patients in high epidemic countries. More rigorous studies are needed to know the exact pathway mechanisms of inflammation in HIV patients.

Impact of the First Wave of the COVID-19 Pandemic on HIV/AIDS Programming in Kenya: Evidence from Kibera Informal Settlement and COVID-19 Hotspot Counties.

The study sought to determine the impact of COVID-19 on HIV/AIDS programming in the Kibera informal settlement and COVID-19 hotspot counties during the first wave of the pandemic. The study was conducted in two phases. The first phase entailed the analysis of HIV care and treatment secondary data (2018-2020) from the Kenya Health Information System. In the second phase, a prospective cohort study was conducted among people living with HIV in the Kibera informal settlement. A total of 176 participants aged 18 years and above accessing HIV services at selected healthcare facilities in Kibera were randomly sampled from facility electronic medical records and followed up for three months. Socio-demographics and contact details were abstracted from the records and telephone interviews were conducted with consenting participants. Results from the retrospective review of HIV program data indicated a 56% (p < 0.000, 95% CI: 31.3%-62.8%) reduction in uptake of HIV services. Clients starting antiretroviral therapy (ART) reduced significantly by 48% (p < 0.001, 95% CI: 35.4%-77%) in hotspot counties. However, pre-exposure prophylaxis uptake increased significantly by 24% (p < 0.019, 95% CI: 4%-49%). In Kibera, 14% reported missing medications at the onset of the COVID-19 pandemic because of lack of food (38%) and government measures (11%), which affected ART access; 11% did not access health facilities due to fear of contracting COVID-19, government regulations and lack of personal protective equipment. Socioeconomic factors, food insecurity and government measures affected uptake of HIV/AIDS services; hence, the need for scaling up measures to increase access to HIV/AIDS services during the onset of pandemics.

The impact of community led alternative rite of passage on eradication of female genital mutilation/cutting in Kajiado County, Kenya: A quasi-experimental study.

INTRODUCTION: In Kenya, Female Genital Mutilation/Cutting (FGM/C) is highly prevalent in specific communities such as the Maasai and Somali. With the intention of curtailing FMG/C prevalence in Maasai community, Amref Health Africa, designed and implemented a novel intervention-community-led alternative rite of passage (CLARP) in Kajiado County in Kenya since 2009. The study: a) determined the impact of the CLARP model on FGM/C, child early and forced marriages (CEFM), teenage pregnancies (TP) and years of schooling among girls and b) explored the attitude, perception and practices of community stakeholders towards FGM/C. METHODS: We utilised a mixed methods approach. A difference-in-difference approach was used to quantify the average impact of the model with Kajiado as the intervention County and Mandera, Marsabit and Wajir as control counties. The approach relied on secondary data analysis of the Kenya Demographic and Health Survey (KDHS) 2003, 2008-2009 and 2014. A qualitative approach involving focus group discussions, in-depth interviews and key informant interviews were conducted with various respondents and community stakeholders to document experiences, attitude and practices towards FGM/C. RESULTS: The CLARP has contributed to: 1) decline in FGM/C prevalence, CEFM rates and TP rates among girls by 24.2% (p<0.10), 4.9% (p<0.01) and 6.3% (p<0.01) respectively. 2) increase in girls schooling years by 2.5 years (p<0.05). Perceived CLARP benefits to girls included: reduction in teenage marriages and childbirth; increased school retention and completion; teenage pregnancies reduction and decline in FGM/C prevalence. Community stakeholders in Kajiado believe that CLARP has been embraced in the community because of its impacts in the lives of its beneficiaries and their families. CONCLUSION: This study demonstrated that CLARP has been positively received by the Maasai community and has played a significant role in attenuating FGM/C, CEFM and TP in Kajiado, while contributing to increasing girls' schooling years. CLARP is replicable as it is currently being implemented in Tanzania. We recommend scaling it up for adoption by stakeholders implementing in other counties that practice FGM/C as a rite of passage in Kenya and across other sub Saharan Africa countries.

Using Friendship Ties to Understand the Prevalence of, and Factors Associated With, Intimate Partner Violence Among Adolescents and Young Adults in Kenya: Cross-Sectional, Respondent-Driven Survey Study.

BACKGROUND: Optimization of innovative approaches is required for estimating the intimate partner violence (IPV) burden among adolescents and young adults (AYA). Further investigation is required to identify risk and protective factors associated with IPV among AYA. There remain significant gaps in understanding these factors among this vulnerable population. OBJECTIVE: The goal of our study was to determine the prevalence of IPV among an urban population of AYA and to identify factors associated with IPV among AYA. METHODS: A cross-sectional study design utilizing respondent-driven sampling was adopted. The study was conducted among 887 AYA, aged 15 to 24 years, residing in Nairobi, Kenya. Data were collected through a phone-based survey using the REACH (Reaching, Engaging Adolescents and Young Adults for Care Continuum in Health)-AYA app. Questions on behavioral and psychosocial factors were adopted from different standardized questionnaires. Descriptive, bivariate, and multivariable statistics were used to describe the characteristics of the study sample. RESULTS: Of the 887 participants, a higher proportion were male (540/887, 60.9%) compared to female (347/887, 39.1%). The prevalence of IPV was 22.3% (124/556). IPV was associated with being unsure if it was okay for a boy to hit his girlfriend, living in a home with physical violence or abuse, and being bullied (P=.005). The likelihood of experiencing IPV was higher among respondents whose friends and family members used alcohol (odds ratio [OR] 1.80, 95% CI 1.09-2.98) and among those who had repeated a class at school in the past two years (OR 1.90, 95% CI 1.11-3.23). Respondents who visited a health facility or doctor for reproductive health services were 2 times more likely to experience IPV (OR 2.23, 95% CI 1.40-3.70). Respondents who had used illicit drugs were 2 times more likely to experience IPV (OR 4.31, 95% CI 2.64-7.04). The probability of experiencing IPV decreased by 63% (OR 0.37, 95% CI 0.16-0.85) among respondents who refused to have sex with someone who was not prepared to use a condom. CONCLUSIONS: IPV remains a significant public health priority because of its impact to society. Our results are in congruence with other similar studies. Efforts toward incorporating appropriate IPV core measures into the comprehensive care package for every AYA seeking health services should be explored. Programs need to address constellations of risk and protective factors linked to IPV in an effort to prevent its occurrence.

Neonatal, infant, and child mortality among women exposed to intimate partner violence in East Africa: a multi-country analysis.

BACKGROUND: Most neonatal, infant, and child deaths occur in low- and middle-income countries (LMICs), where incidence of intimate partner violence (IPV) is highest in the world. Despite these facts, research regarding whether the two are associated is limited. The main objective was to examine associations between IPV amongst East African women and risk of death among their neonates, infants, and children, as well as related variables. METHODS: Analysis was conducted on data drawn from the Demographic and Health Surveys (DHS) conducted by ICF Macro/MEASURE DHS in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. The analytical sample included 11,512 women of reproductive age (15-49 years). The outcome variables, described by proportions and frequencies, were the presence or absence of neonatal, infant, and under-five mortality. Our variable of interest, intimate partner violence, was a composite variable of physical, sexual, and emotional abuse; chi-square tests were used to analyze its relationship with categorical variables. Adjusted odds ratios (aOR) were also used in linking sexual autonomy to independent variables. RESULTS: Children born to women who experienced IPV were significantly more likely to die as newborns (aOR = 1.3, 95% confidence interval [CI]: 1.4-2.2) and infants (aOR = 1.9, 95% CI: 1.6-2.2), and they were more likely to die by the age of five (aOR = 1.5, 95% CI: 1.01-1.55). Socioeconomic indicators including area of residence, wealth index, age of mother/husband, religion, level of education, employment status, and mass media usage were also significantly associated with IPV. After regression modelling, mothers who were currently using contraceptives were determined less likely to have their children die as newborns (aOR = 0.5, 95% CI: 0.3-0-7), as infants (aOR = 0.5, 95% CI: 0.3-06), and by age five (aOR = 0.4, 95% CI: 02-0.6). CONCLUSION: Understanding IPV as a risk indicator for neonatal, infant, and child deaths can help in determining appropriate interventions. IPV against women should be considered an urgent priority within programs and policies aimed at maximizing survival of infants and children in East Africa and the wellbeing and safety of their mothers.

Is sexual autonomy a protective factor for neonatal, child, and infant mortality? A multi-country analysis.

BACKGROUND: Sexual autonomy empowers women to set boundaries, take control of their bodies, prevent sexually transmitted diseases and avoid unplanned pregnancy. A woman's ability to negotiate safer sex is crucial for her survival and that of her child. Sexual autonomy among East African women is vital to the elimination of the deaths of neonates, infants, and children. The aim of our study was to explore the association of sexual autonomy on neonatal, infant, and child mortality. METHODOLOGY: This was a secondary analysis of demographic health survey (DHS) data on women of reproductive age (15-49 years) in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. Data on our outcome variables neonatal, infant, and under-five mortality which were in binary form was extracted from the database. Sexual autonomy was classified as a composite variable of "respondent can refuse sex," "respondent can ask partner to use condom," and "if spouse is justified in asking husband to use condom." Other sociodemographic, maternal, health system and paternal variables were included in the analysis. STATA version 14 was used for analysis. Proportions and frequencies were used to describe the three outcome variables and sociodemographic characteristics. Chi-square tests were used to compare associations between sexual autonomy and categorical variables. Adjusted hazard ratios were used to determine the association between sexual autonomy and independent variables. RESULTS: The sampled women were predominantly urban (75%; n = 5758) and poor (48.7%; n = 3702). A majority of those that experienced mortality (neonatal mortality 53.5%, infant mortality 54.3%, under-five mortality 55.7%) were young (under 20) at the time of their first child's birth while their male partners were older. The multivariate analysis supports the beneficial effects of women's sexual autonomy in East Africa. Women who exercised sexual autonomy experienced significantly lower rates of child mortality at all three stages: neonatal (NHR = 0.80, 95% CI: 0.68-0.94, p = 0.006), infant (IHR = 0.82, 95% CI: 0.72-0.93, p = 0.003), and under-five (UHR = 0.84, 95% CI: 0.75-0.94, p = 0.002), net of all other factors. Receiving antenatal care and using contraceptives also contributed significantly to lower child mortality rates. CONCLUSION: Our findings suggest that sexual autonomy among East African women is an urgent priority that is crucial to the survival of neonates, infants, and children in East Africa. Women should be informed, empowered, and autonomous concerning their reproductive and sexual health.

Stroke distribution patterns and characteristics in Kenya's leading public health tertiary institutions: Kenyatta National Hospital and Moi Teaching and Referral Hospital.

BACKGROUND: Cardiovascular diseases are the second leading cause of morbidity and mortality in Kenya. However, there is limited clinic-epidemiological data on stroke to inform decision making. This study sought to establish stroke distribution patterns and characteristics in patients seeking care at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH), with the ultimate aim of establishing the first national stroke registry in Kenya. METHODS: This was a prospective multicentre cohort study among stroke patients. The study used a modified World Health Organisation STEP-wise approach to stroke surveillance tool in collecting data on incidence, major risk factors and mortality rate. The Cochran's Mantel-Haenszel chisquared test of conditional independence was used with p-value set at 0.05. RESULTS: A total of 691 patients with confirmed stroke were recruited [KNH 406 (males: 40.9%; females: 59.1%); MTRH 285 (males: 44.6%; females: 55.4%) ] and followed over a 12-month period. Overall, ischaemic stroke accounted for 55.6% of the stroke cases, with women being the most affected (57.5%). Mortality rate at day 10 was 18.0% at KNH and 15.5% at MTRH, and higher in the haemorrhagic cases (20.3%). The most common vascular risk factors were hypertension at 77.3% (males: 75.7%; females: 78.5%), smoking at 16.1% (males: 26.6% females: 8.3%) and diabetes at 14.9% (males: 15.7%; females: 14.4%). Ischaemic stroke was conditionally independent of gender after adjusting for age. CONCLUSION: To our knowledge this is the first pilot demonstration establishing a stroke registry in sub-Saharan Africa and clearly establishes feasibility for this approach. It also has utility to both inform and potentially guide public policy and public health measures on stroke in Kenya. Important and unexpected observations included the preponderance of women affected by cerebrovascular disease and that cigarette smoking was the second most common risk factor. The latter, over time, will further impact on the clinico-epidemiological profile of cerebrovascular disease in Kenya.

Nutritional status of cancer outpatients using scored patient generated subjective global assessment in two cancer treatment centers, Nairobi, Kenya.

BACKGROUND: Malnutrition is a universal problem in cancer patients renowned as an important factor for increased morbidity, decreased quality of life and high mortality. Early diagnosis of malnutrition risk through nutrition screening followed by comprehensive and timely interventions reduces mortality associated with malnutrition. The Scored Patient-Generated Subjective Global Assessment (PGSGA) method has been proved efficient in identifying cancer patients with nutrition challenges and guiding appropriate interventions. However this tool has not been adopted in management of cancer patients in Kenya. The aim of the study was to assess and describe nutrition status of cancer outpatients receiving treatment at Kenyatta National Hospital Hospital (KNH) and Texas Cancer Centre (TCC). METHODS: The study adopted a hospital based descriptive cross sectional study. Cancer outpatients with confirmed stage 1-4 cancers, physically stable, aged 18 years and above and receiving cancer treatment were recruited and assessed using Scored PGSGA tool. Proportions, measures of central tendency and pearsons' chi-square test were used in statistical analysis. RESULTS: Among the 471 participants assessed, 71.8% were female and 28.2% male. Most participants had stage 2, 3 and 4 cancers at 27.2%, 27.2% and 24.3% respectively. Highest proportion of participants had breast (29.7%) and female genital cancers (22.9%). Sixty nine percent of participants were well nourished (SGA-A), 19.7% moderately malnourished (SGA-B) and 11.3% severely malnourished (SGA-C) and this difference was statistically significant. The mean PGSGA score was 6.76 (SD 5.17). Based on the score, 33.8% of participants required critical nutrition care, 34.8% symptoms management, 14.2% constant nutrition education and pharmacological intervention while 17.2% required routine assessments and reassurance. More (m;54.7%, f; 45.3%) males than females were severely malnourished(SGA-C) and this was statistically significant (P < 0.001).Prevalence of severe malnutrition was highest among participants with digestive organ cancers (49.1%) followed by those with lip cancer (17%) and the least prevalence reported in those with Karposi Sarcoma (0%). Most of stage 4 participants were moderately (37.5%) and severely (29.4%) malnourished. CONCLUSIONS: The Scored Patient-Generated Subjective Global Assessment is able to identify cancer patients both at risk of malnutrition and those severely malnourished. It also provides a guideline on the appropriate nutrition intervention hence an important tool in nutrition management of cancer patients.