Costs and cost drivers of comprehensive sexual reproductive health services to female sex workers in Kenya.

BACKGROUND: Comprehensive sexual reproductive health (SRH) programs for female sex workers (FSW) offering clinical, behavioural, and structural interventions have contributed to declining rates of HIV in this population. However, data on costs and cost drivers is needed to support programs and their donors to better allocate resources, make an investment case for continued funding, and to identify areas of improvement in program design and implementation. We aimed to estimate the annual per-FSW costs of comprehensive services for a standalone FSW program in Kenya. METHODS: We implemented a top-bottom and activity-based costing study of comprehensive FSW services at two drop-in centres (DICs), Mtwapa and Kilifi town, in Kilifi County, Kenya. Service costs were obtained from routinely collected patient data during FSW scheduled and unscheduled visits using Kenyan Ministry of Health records. Costing data were from the program and organization's expenditure reports, cross checked against bank documents and supported by information from in-depth interviews. Data were collected retrospectively for the fiscal year 2019. We obtained approval from the AMREF Research Ethics Committee (AMREF-ESRC P862/2020). RESULTS: In 2019, the unit cost of comprehensive services was 105.93 USD per FSW per year, roughly equivalent to 10,593 Kenya shillings. Costs were higher at Mtwapa DICs compared to Kilifi town DIC; 121.90 USD and 89.90 USD respectively. HIV counselling and testing cost 63.90 USD per person, PrEP was 34.20 USD and family planning was 9.93 USD. Of the total costs, staff salaries accounted for about 60%. Adjusted for inflation, costs in 2024 would be approximately 146.60. CONCLUSION: Programs should strive to maximize the number of FSW served to benefit from economies of scale. Given that personnel costs contribute most to the unit costs, programs should consider alternative designs which reduce personnel and other costs.

Potassium iodate levels in processed edible salts available in retail shops throughout Kenya, 2013.

OBJECTIVE: Iodine-deficiency disorders, due to insufficiency of iodine in the diet, are a global public health problem. The Kenyan Food, Drugs and Chemical Substances Act stipulates that processed retail-available edible salts contain 50-84 mg of potassium iodate (KIO3) per kilogram of salt. The present study determined the status of KIO3 levels in commercial salts, for public health action.Design/Setting/SubjectsAs part of the Kenya Demographic and Health Survey 2013, field workers collected salt samples from seven different local manufacturers/packers across eight regions of the country and sent them to the National Public Health Laboratory (NPHL) for KIO3 titration analysis. RESULTS: A total of 539 samples were collected and analysed at NPHL. The samples had a mean KIO3 of 62 mg/kg. Thirty-three (6 %) samples had KIO3 of 84 mg/kg. CONCLUSIONS: The study found that 62 % of salts sampled met the Kenyan standards, 24 % were below the required limits and 13 % were above the recommended range. Continuous monitoring of edible salts at the retail level is important to detect brands not adhering to standards and trace them for remedy. However, governmental efforts should be directed to the quality control and quality assurance of the salt-manufacturing industries.

Prevalence and correlates of depressive disorders in commercially sexual exploited children: A cross-sectional study in Mombasa, Kenya.

BACKGROUND: Commercial sexual exploitation of children (CSEC) is a global concern and is among the common forms of sexual violence against children. In Kenya, about 32 % of girls and 16 % of boys experience sexual violence before the age of 18 years. While much has been written about the impact of child sexual exploitation, there's little on the prevalence of depressive disorders among CSE children. OBJECTIVES: This study was conducted to assess the prevalence and correlates of depressive disorders among CSE children in Mombasa, Kenya. PARTICIPANTS AND SETTING: The study was conducted among CSE children (10-17 years) in Mombasa County. METHODS: A cross-sectional study conducted between May 2021 and June 2022. A total of 409 CSE children were enrolled, using a case management approach. Data was collected using the child identification tool and the Patient Health Questionnaire (PHQ-9), at the first counselling session to determine the prevalence of depression levels. RESULTS: Of the 409 children, 367 (90 %) were girls while 42 (10 %) were boys. The mean age was 15 years (10-17) (SD = 1.4, t = 0.765). In 286 (70 %) 'Depression unlikely' was recorded, while 123 (30 %) 'Depression likelihood.' Prevalence of mild to severe depression was significantly higher in girls than boys (p = 0.002). Other determinants of depression were having a primary level of education (p = 0.03) and being an orphan. (p = 0.03). CONCLUSION: It is important to prioritize mental health interventions such as screening and early diagnosis of mental health among CSE children in order to prevent and manage both short and long term effects.

Laboratory and Field Evaluation of the Crystal VC-O1 Cholera Rapid Diagnostic Test.

Cholera is a severe acute, highly transmissible diarrheal disease which affects many low- and middle-income countries. Outbreaks of cholera are confirmed using microbiological culture, and additional cases during the outbreak are generally identified based on clinical case definitions, rather than laboratory confirmation. Many low-resource areas where cholera occurs lack the capacity to perform culture in an expeditious manner. A simple, reliable, and low-cost rapid diagnostic test (RDT) would improve identification of cases allowing rapid response to outbreaks. Several commercial RDTs are available for cholera testing with two lines to detect either serotypes O1 and O139; however, issues with sensitivity and specificity have not been optimal with these bivalent tests. Here, we report an evaluation of a new commercially available cholera dipstick test which detects only serotype O1. In both laboratory and field studies in Kenya, we demonstrate high sensitivity (97.5%), specificity (100%), and positive predictive value (100%) of this new RDT targeting only serogroup O1. This is the first field evaluation for the new Crystal VC-O1 RDT; however, with these high-performance metrics, this RDT could significantly improve cholera outbreak detection and improve surveillance for better understanding of cholera disease burden.