The perceived impact of climate change on mental health and suicidality in Kenyan high school students.

BACKGROUND: Climate change has psychological impacts but most of the attention has been focused on the physical impact. This study was aimed at determining the association of climate change with adolescent mental health and suicidality as reported by Kenyan high school students. METHODS: This was a cross sectional study with a sample size of 2,652. The participants were high school students selected from 10 schools in 3 regions of Kenya. A questionnaire was used to assess climate change experiences, mental health problems, and suicidality of the youth. Data were analyzed descriptively and with logistic regression to determine various associations of the different variables and the predictors of the various scores of SDQ and suicidality at 95% CI. RESULTS: Significant differences were observed between gender and two of the threats of climate change - worry and being afraid as subjectively experienced by the participants. Females were more worried and afraid of climate change than males. On univariate and multivariate logistic regression, we found that various experiences of climate change were significantly associated with various scores of SDQ and much fewer of the experiences predicted SDQ scores. The same pattern was reflected in suicidality. CONCLUSION: Climate change appears to be associated with mental health concerns and suicidality according to Kenyan high school students' reports with gender differences in some associations.

Integrating Adolescent Mental Health into HIV Prevention and Treatment Programs: Can Implementation Science Pave the Path Forward?

Adolescent mental health (AMH) is a critical driver of HIV outcomes, but is often overlooked in HIV research and programming. The implementation science Exploration, Preparation, Implementation, Sustainment (EPIS) framework informed development of a questionnaire that was sent to a global alliance of adolescent HIV researchers, providers, and implementors working in sub-Saharan Africa with the aim to (1) describe current AMH outcomes incorporated into HIV research within the alliance; (2) identify determinants (barriers/gaps) of integrating AMH into HIV research and care; and (3) describe current AMH screening and referral systems in adolescent HIV programs in sub-Saharan Africa. Respondents reported on fourteen named studies that included AMH outcomes in HIV research. Barriers to AMH integration in HIV research and care programs were explored with suggested implementation science strategies to achieve the goal of integrated and sustained mental health services within adolescent HIV programs.

Prevalence and characteristics of metabolic syndrome and its components among adults living with and without HIV in Nigeria: a single-center study.

BACKGROUND: Persons living with HIV (PLHIV) now live longer due to effective combination antiretroviral therapy. However, emerging evidence indicates that they may be at increased risk for some cardiometabolic disorders. We compared the prevalence of metabolic syndrome (MetS) and its component disorders between persons living with and without HIV in Nigeria. METHODS: This was a cross-sectional analysis of baseline data from a prospective cohort study of non-communicable diseases among PLHIV along with age- and sex-matched persons without HIV (PWoH) at the University of Abuja Teaching Hospital Nigeria. We collected sociodemographic and clinical data, including anthropometric measures and results of relevant laboratory tests. MetS was defined using a modification of the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) criteria. RESULTS: Of the 440 PLHIV and 232 PWoH, women constituted 50.5% and 51.3% respectively. The median age of the PLHIV was 45 years while that of the PWoH was 40 years. The prevalence of MetS was 30.7% (95% CI: 26.4%, 35.2%) and 22.8% (95% CI: 17.6%, 28.8%) among the PLHIV and PWoH respectively (P = 0.026). Independent associations were found for older age (P < 0.001), female sex (P < 0.001), family history of diabetes (P < 0.001), family history of hypertension (P = 0.013) and alcohol use (P = 0.015). The prevalence of component disorders for PLHIV versus PWoH were as follows: high blood pressure (22.3% vs 20.3%), prediabetes (33.8% vs 21.1%), diabetes (20.5% vs 8.2%), high triglycerides (24.5% vs 17.2%), low HDL-Cholesterol (51.1% vs 41.4%), and abdominal obesity (38.4% vs 37.1%). Adjusting for age and sex, prediabetes, diabetes, and low HDL-Cholesterol were significantly associated with HIV status. Duration on antiretroviral therapy, protease inhibitor-based regimen, CD4 count, and viral load were associated with some of the disorders mostly in unadjusted analyses. CONCLUSION: We found a high burden of MetS and its component disorders, with significantly higher prevalence of dysglycemia and dyslipidemia among PLHIV as compared to PWoH. Integration of strategies for the prevention and management of MetS disorders is needed in HIV treatment settings.

Correlates of Sedentary Time Among Children and Adolescents in Ethiopia: A Cross-Sectional Study.

PURPOSE: To assess the correlates of sedentary time among children and adolescents in Ethiopia. METHODS: The study was conducted in representative samples of children and adolescents in the capital city of Ethiopia, Addis Ababa. Multivariable logistic regression models were used to determine associations of sedentary time and predictor variables. RESULTS: The mean sedentary time was 4.61 (95% confidence interval [CI], 4.35-4.86) hours per day. Overall, the prevalence of high sedentary time (>3 h/d) was 68.2% (95% CI, 64.2-72.2). Results of multivariable logistic regression analyses showed a statistically significant association between high sedentary time and female household head (adjusted odds ratio [AOR] = 0.50; 95% CI, 0.32-0.80), literate mothers (AOR = 1.98; 95% CI, 1.26-3.11), child attending public school (AOR = 1.79; 95% CI, 1.12-2.85), children who belonged to the poor and rich household wealth tertiles compared with medium wealth tertile (AOR = 2.30; 95% CI, 1.42-3.72 and AOR = 2.04; 95% CI, 1.14-3.65, respectively), and those families that did not have adequate indoor play space for children (AOR = 0.45; 95% CI, 0.29-0.72). CONCLUSION: The study found that time spent sedentary was high in the study area as compared with other studies of similar settings. Several modifiable factors were identified that can be targeted in interventions to reduce sedentary time in the study setting.

Association of maternal psychological distress with children with overweight/obesity in Ethiopia.

BACKGROUND: Poor maternal mental health is a major risk factor for adverse offspring health outcomes, including overweight/obesity status. Maternal mental distress is highly prevalent and associated with parenting practices influencing child weight. To date, there is little information documented in Ethiopia on maternal mental distress and children with overweight/obesity status. This study examined the association between maternal mental distress and children with overweight/obesity among mother-child dyads in Addis Ababa, Ethiopia. METHODS: An observational population-based cross-sectional study was conducted among mother-child dyads in representative samples in Addis Ababa, Ethiopia. Maternal mental distress was measured using the Self-Reporting Questionnaire (SRQ)-20. Child/adolescent overweight/obesity was defined as more than 1 SD above the median World Health Organization (WHO) growth reference. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The prevalence of maternal mental distress and children with overweight/obesity was estimated to be 10.1% and 28.8%, respectively. After adjusting for confounders, including maternal education, maternal occupation, average monthly household income, maternal body mass index (BMI) and the number of household members/family size, maternal psychological distress was not associated with offspring overweight/obesity status (adjusted OR [aOR] = 0.54; 95% CI: 0.25, 1.14). CONCLUSIONS: There is no evidence of an association between maternal psychological distress and children with overweight/obesity. This lack of association might be attributable to our cross-sectional study design. Future epidemiologic studies, particularly those using prospectively collected data, are warranted to examine better the effects of maternal psychological distress on offspring body weight.

Prevalence and determinants of maternal healthcare utilisation among young women in sub-Saharan Africa: cross-sectional analyses of demographic and health survey data.

BACKGROUND: Maternal health constitutes high priority agenda for governments across the world. Despite efforts by various governments in sub-Saharan Africa (SSA), the sub-region still records very high maternal mortality cases. Meanwhile, adequate utilization of maternal healthcare (antenatal care [ANC], skilled birth attendance [SBA], and Postnatal care [PNC]) plays a vital role in achieving improved maternal health outcomes. We examined the prevalence and determinants of maternal healthcare utilization among young women in 28 sub-Saharan African countries using data from demographic and health surveys. METHODS: This was a cross-sectional study of 43,786 young women aged 15-24 years from the most recent demographic and health surveys of 28 sub-Saharan African countries. We adopted a multilevel logistic regression analysis in examining the determinats of ANC, SBA, and PNC respectively. The results are presented as adjusted Odds Ratios (aOR) for the logistic regression analysis. Statistical significance was set at p < 0.05. RESULTS: The prevalence of maternal healthcare utilisation among young women in SSA was 55.2%, 78.8%, and 40% for ANC, SBA, and PNC respectively with inter-country variations. The probability of utilising maternal healthcare increased with wealth status. Young women who were in the richest wealth quintile were, for instance, 2.03, 5.80, and 1.24 times respectively more likely to utilise ANC (95% CI = 1.80-2.29), SBA (95% CI = 4.67-7.20), and PNC (95% CI = 1.08-1.43) than young women in the poorest wealth quintile. Young women who indicated having a barrier to healthcare utilisation were, however, less likely to utilise maternal healthcare (ANC: aOR = 0.83, 95% CI = 0.78-0.88; SBA: aOR = 0.82, 95% CI = 0.75-0.88; PNC: aOR = 0.88, 95% CI = 0.83-0.94). CONCLUSION: While SBA utilisation was high, we found ANC and PNC utilisation to be quite low among young women in SSA with inter-country variations. To accelerate progress towards the attainment of the Sustainable Development Goal (SDG) targets on reducing maternal mortality and achieving universal health coverage, our study recommends the adoption of interventions which have proven effective in some countries, by countries which recorded low maternal healthcare utilisation. The interventions include the implementation of free delivery services, training and integration of TBAs into orthodox maternal healthcare, improved accessibility of facilities, and consistent public health education. These interventions could particularly focus on young women in the lowest wealth quintile, those who experience barriers to maternal healthcare utilisation, uneducated women, and young women from rural areas.

Mental health symptoms and inflammatory markers among HIV infected patients in Tanzania.

BACKGROUND: HIV and mental disorders are predicted to be the leading causes of illness worldwide by the year 2030. HIV-infected patients are at increased risk of developing mental disorders which are significantly associated with negative clinical outcomes and propagation of new HIV infections. There is little evidence that links inflammation to development of mental disorders among HIV patients. Therefore, the main objective of this study was to evaluate if mental health symptoms were associated with biomarkers of inflammation in HIV infected subjects. METHODS: A cross-sectional study was conducted in Dar es Salam, Tanzania from March to May 2018. Standardized tools were used to collect data based on the World Health Organisation's (WHO) stepwise approach for non-communicable diseases (NCD) surveillance. A total of 407 HIV+ patients on antiretroviral therapy were recruited. The WHO stepwise approach for NCD surveillance was used to collect data together with anthropometric measurements. Mental health symptoms were determined based on self-reported thoughts of helplessness, suicide ideation, depression, despair, discouragement, and feelings of isolation. Enzyme-linked immunosorbent assay was used to test for inflammatory markers:- C-reactive protein (CRP), Iinterleukin-6 (IL-6), interleukin-18 (IL-18), soluble tumour necrosis factor receptor-I (sTNFR-I), and soluble tumour necrosis factor receptor-II (sTNFR-II). Bivariate and multi-variate analysis was conducted to examine the association between biomarkers and mental health symptoms. RESULTS: The prevalence of self-reported mental health symptoms was 42% (n = 169). Participants with self-reported symptoms of mental health had elevated CRP, were less likely to walk or use a bicycle for at least 10 minutes, were less likely to participate in moderate-intensity sports or fitness activities, and had poor adherence to HIV treatment (p < 0.005). CRP remained significant in the sex adjusted, age-sex adjusted, and age-sex-moderate exercise adjusted models. In the fully adjusted logistic regression model, self-reported mental health symptoms were significantly associated with a higher quartile of elevated CRP (OR 4.4; 95% CI 1.3-5.9) and sTNFR-II (OR 2.6; 95% CI 1.4-6.6) and the third quartile of IL-18 (OR 5.1;95% CI 1.5-17.5) as compared with those reporting no mental health symptoms. The significance of sTNFR-II and IL-18 in the fully adjusted model is confounded by viral load suppression rates at the sixth month. CONCLUSION: High CRP and sTNFR II were important contributors to the prevalence of mental health symptoms. This study is among the minimal studies that have examined mental health issues in HIV, and therefore, the findings may offer significant knowledge despite the potential reverse causality. Regardless of the nature of these associations, efforts should be directed toward screening, referral, and follow-up of HIV patients who are at-risk for mental health disorders.

Continuous quality improvement (CQI) Institutionalization to reach 95:95:95 HIV targets: a multicountry experience from the Global South.

BACKGROUND: Scaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets. This paper describes the experiences and outcomes related to implementing CQI processes to help reach these targets, with particular focus on clinical and programmatic settings in 6 countries from the global south. METHODS: The HIV program at the University of Maryland, Baltimore (UMB) implemented an adapted CQI model in Kenya, Tanzania, Botswana, Zambia, Nigeria and Rwanda that included the following steps: (1) analysing the problem to identify goals and objectives for improvement; (2) developing individual changes or 'change packages', (3) developing a monitoring system to measure improvements; and (4) implementing and measuring changes through continuous 'plan-do-study-act' (PDSA) cycles. We describe country-level experiences related to implementing this adaptive design, a collaborative learning and scale-up/sustainability model that addresses the 95:95:95 global HIV targets via a CQI learning network, and mechanisms for fostering communication and the sharing of ideas and results; we describe trends both before and after model implementation. RESULTS: Our selected country-level experiences based on implementing our CQI approach resulted in an increased partner testing acceptance rate from 21.7 to 48.2 % in Rwanda, which resulted in an increase in the HIV testing yield from 2.1 to 6.3 %. In Botswana, the overall linkage to treatment improved from 63 to 94 %, while in Kenya, the viral load testing uptake among paediatric and adolescent patients improved from 65 to 96 %, and the viral load suppression improved from 53 to 88 %. CONCLUSIONS: Adopting CQI processes is a useful approach for accelerating progress towards the attainment of the global 95:95:95 HIV targets. This paper also highlights the value of institutionalizing CQI processes and building the capacity of Ministry of Health (MoH) personnel in sub-Saharan Africa for the effective quality improvement of HIV programs and subsequent sustainability efforts.

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.

Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017.

BACKGROUND: The global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years. METHODS: We used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury. RESULTS: Globally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change. CONCLUSIONS: While road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented.

C - reactive protein and interleukin - 6 levels among human immunodeficiency virus -infected patients with dysglycemia in Tanzania.

BACKGROUND: Chronic inflammation has been associated with dysglycemia among people living with HIV (PLHIV). There is however, limited data regarding this phenomenon in sub-Sahara Africa (SSA). Therefore we assessed the levels of C-reactive protein (CRP) and Interleukin 6 (IL-6) on a cohort of PLHIV and its associations with dysglycemia in Tanzania. METHODS: We conducted a cross-sectional study at the Infectious Disease Clinic (IDC) in Tanzania from March to May 2018. Purposive sampling was used to identify participants who had an undetectable viral load, were on 1st line anti-retroviral therapy (ART) and had an overnight fast. The WHO stepwise approach for non-communicable disease (NCD) surveillance was used to collect data. Fasting blood glucose and blood glucose after 75 g oral glucose load was measured, and Enzyme-linked immunosorbent assay (ELISA) was used to test for inflammatory markers (IL-6 and CRP). Associations were explored using the Chi square test and binary logistic regression was performed to estimate the odds ratios. A p-value less than 0.05 was considered statistically significant. RESULTS: A total of 240 participants were enrolled. Forty two percent were overweight/obese (> 25 kg/m2), 89% had a high waist to height ratio. The median ART duration was 8(5-10) years. The prevalence of dysglycemia among our cohort of PLHIV was 32%. High CRP was associated with a 2.05 increased odds of having dysglycemia OR 2.05 (1.15-3.65) (p = 0.01). Taking stavudine was associated with a 1.99 odds of having dysglycemia OR 1.99 (1.04-3.82) (p = 0.03).We did not find a significant association between IL-6 and dysglycemia. CONCLUSION: High CRP and taking stavudine were significantly associated with dysglycemia among PLHIV with undetectable viral load.

Developing national strategies for reaching men with HIV testing services in Tanzania: results from the male catch-up plan.

BACKGROUND: According to the 2016-2017 Tanzania HIV Impact Survey, 55% of men diagnosed with HIV during the survey self-reported that they were unaware of their HIV status. As a response, the Government of Tanzania launched a Test and Treat campaign in June 2018 with a focus on reaching men and developed the 2018-2020 Male Catch-Up plan. This article reports (1) the enablers and barriers of HIV testing services (HTS) uptake among men (2) and describes the strategies that were proposed as part of the Male Catch-Up Plan to address some of these barriers. METHOD: Qualitative in-depth interviews were conducted with 23 men in Dar es Salaam to explore HTS enablers and barriers. To develop the Male Catch-Up Plan strategies, a desk review of published studies, and analyses of national implementers of HIV/AIDS interventions were conducted. An additional 123 interviews were also carried out with key implementers of HIV/AIDS interventions, healthcare workers, secondary school boys and members of the community in Iringa and Tanga. RESULTS: Enablers of HTS included the desire to check one's health, high HIV risk perception, wanting to protect oneself if tested negative, and being encouraged by their sexual partners. Barriers of HTS were fear of a positive test result, and low HIV risk perception. Proposed strategies from the Male Catch-Up Plan to address these barriers included non-biomedical and biomedical approaches. Non-biomedical strategies are social and cultural approaches to promote an enabling environment to encourage health seeking behavior, safe behavior, and providing peer education programs and social marketing to promote condoms. Biomedical approaches consisted of expanding targeted HIV testing, HIV self-testing, and integrating HIV services with other health services. CONCLUSION: A number of barriers contribute to the low uptake of HTS among men in Tanzania. National strategies have been developed to address these HTS barriers and guide the national Test and Treat campaign focusing on increasing HTS uptake among men.

Prostate and Colorectal Cancer Screening Uptake among US and Foreign-Born Males: Evidence from the 2015 NHIS Survey.

Research suggests that prostate and colorectal cancers disproportionately affect men in the US, but little is known about the determinants of prostate-specific antigen (PSA) and colorectal cancer (CRC) screening uptake among US and foreign-born males. The purpose of this study was to investigate what factors influence prostate and colorectal cancer screening uptake among US-native born and foreign-born men. Using the 2015 National Health Interview Survey, we conducted bivariate and multivariate analyses to highlight factors associated with the uptake of prostate and colorectal cancer screening among US-native born and foreign-born men. The sample size consisted of 5651 men respondents, with the mean age of 59.7 years (SD = 12.1). Of these, more than two-fifths (42%) were aged 50-64 years old. With respect to race/ethnicity, the sample was predominantly non-Hispanic Whites (65.5%), 863 (15.6%) Hispanics, and 710 (12.4%) Blacks. Our analysis found higher rates of both US-born and foreign-born men aged 65 years or older, who had either a PSA or CRC screening tests than those aged <65 years. Results of the general multivariate model suggest that men under 50 years old, US-born and foreign-born alike, are statistically significantly less likely to have prostate or colorectal cancer screenings than men aged 65 years or above. This study highlights the influencing factors that encourage or discourage PSA and CRC screening uptake between US-native born and foreign-born men. The results of this inquiry provide an evidence-based blueprint for policymakers and interventionists seeking to address prostate and colorectal cancer among men.

Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi Kenya.

BACKGROUND: We examine the uptake of HIV Testing and Counselling (HTC) and linkage into care over one year of providing HTC through community and health facility testing modalities among people living in Kibera informal urban settlement in Nairobi Kenya. METHODS: We analyzed program data on health facility-based HIV testing and counselling and community- based testing and counselling approaches for the period starting October 2013 to September 2014. Univariate and bivariate analysis methods were used to compare the two approaches with regard to uptake of HTC and subsequent linkage to care. The exact Confidence Intervals (CI) to the proportions were approximated using simple normal approximation to binomial distribution method. RESULTS: Majority of the 18,591 clients were tested through health facility-based testing approaches 72.5 % (n = 13485) vs those tested through community-based testing comprised 27.5 % (n = 5106). More clients tested at health facilities were reached through Provider Initiated Testing and Counselling PITC 81.7 % (n = 11015) while 18.3 % were reached through Voluntary Counselling and Testing (VCT)/Client Initiated Testing and Counselling (CITC) services. All clients who tested positive during health facility-based testing were successfully linked to care either at the project sites or sites of client choice while not all who tested positive during community based testing were linked to care. The HIV prevalence among all those who were tested for HIV in the program was 5.2 % (n = 52, 95 % CI: 3.9 %-6.8 %). Key study limitation included use of aggregate data to report uptake of HTC through the two testing approaches and not being able to estimate the population in the catchment area likely to test for HIV. CONCLUSION: Health facility-based HTC approach achieved more clients tested for HIV, and this method also resulted in identifying greater numbers of people who were HIV positive in Kibera slum within one year period of testing for HIV compared to community-based HTC approach. Linking HIV positive clients to care proved much easier during health facility- based HTC compared to community- based HTC.

Epidemiology of Cervical Squamous Intraepithelial Lesions in HIV Infected Women in Kenya: a cross-Sectional Study.

Cervical cancer is the second most common cancer among women worldwide. Infection with the human immunodeficiency virus (HIV) and its related immunosuppression are associated with an increased risk of prevalent, incident, and persistent squamous intraepithelial lesions (SILs) of the cervix. The objective of the study was to describe the prevalence and predictors of high-risk HPV and cervical cancer to support the need for strengthening cervical cancer screening programs for HIV infected women in Kenya. A cross sectional study was conducted in a hospital in Central Kenya, Kiambu district. The study population constituted of HIV positive women attending the ART treatment clinic. A total of 715 HIV positive women initiated on Antiretroviral Therapy (ART) were enrolled in this study. About 359 (52.1%) were less than 40 years of age and 644 (90.3%) of the patients were widowed. About 642 (92.6%) of the HIV infected women were in follow-up period of ≥ 1 year. The outcome/prognosis of the patients undergoing ICC was 3 cured, 5 good and 4 poor respectively. In a multivariable ordinal logistic regression analysis showed that for a one-unit decrease of CD4, we expect 1.23 log odds of increasing the severity of cervical cancer (B = 1.23, P < 0.0 15), given that all of the other variables in the model are held constant. In conclusion screening of all HIV infected women, who are under HIV care and treatment, enrolling patients on HAART with higher CD4 counts is recommended to see the net effect of HAART response.

Methods and associations of suicidality in Kenyan high school students: clinical and public health implications.

BACKGROUND: Most evidence on suicidal thoughts, plans and attempts comes from Western countries; prevalence rates may differ in other parts of the world. AIMS: This study determined the prevalence of suicidal thoughts, plans and attempts in high school students in three different regional settings in Kenya. METHOD: This was a cross-sectional study of 2652 high school students. We asked structured questions to determine the prevalence of various types of suicidality, the methods planned or effected, and participants' gender, age and form (grade level). We provided descriptive statistics, testing significant differences by chi-squared and Fisher's exact tests, and used logistic regression to identify relationships among different variables and their associations with suicidality. RESULTS: The prevalence rates of suicidal thoughts, plans and attempts were 26.8, 14.9 and 15.7%, respectively. These rates are higher than those reported for Western countries. Some 6.7% of suicide attempts were not associated with plans. The most common method used in suicide attempts was drinking chemicals/poison (18.8%). Rates of suicidal thoughts and plans were higher for older students and students in urban rather than rural locations, and attempts were associated with female gender and higher grade level - especially the final year of high school, when exam performance affects future education and career prospects. CONCLUSION: Suicidal thoughts, plans and attempts are prevalent in Kenyan high school students. There is a need for future studies to determine the different starting points to suicidal attempts, particularly for the significant number whose attempts are not preceded by thoughts and plans.

Can palliative care integrated within HIV outpatient settings improve pain and symptom control in a low-income country? A prospective, longitudinal, controlled intervention evaluation.

A high burden of pain, symptoms and other multidimensional problems persist alongside HIV treatment. WHO policy indicates palliative care as essential throughout the disease course. This study aimed to determine whether palliative care delivered from within an existing HIV outpatient setting improves control of pain and symptoms compared to standard care. A prospective, longitudinal controlled design compared patient outcomes at an outpatient facility that introduced palliative care training to clinicians and stocked essential palliative care drugs, to outcomes of a cohort of patients at a similar HIV care facility with no palliative care, in Tanzania. Inclusion criteria were clinically significant pain or symptoms. Patients were followed from baseline fortnightly until week 10 using validated self-report outcome measures. For the primary pain outcome, the required sample size of 120 patients was recruited. Odds of reporting pain reduced significantly more at intervention site (OR=0.60, 95% CI 0.50-0.72) than at control (OR=0.85, 95% CI 0.80-0.90), p=0.001. For secondary outcomes, longitudinal analysis revealed significant difference in slope between intervention and control, respectively: Medical Outcomes Study-HIV (MOS-HIV) physical score 1.46 vs. 0.54, p=0.002; MOS-HIV mental health 1.13 vs. 0.26, p=0.006; and POS total score 0.84 vs. 0.18, p=0.001. Neither baseline CD4 nor antiretroviral therapy (ART) use was associated with outcome scores. These data are the first to report outcomes evaluating integrated HIV outpatient palliative care in the presence of ART. The data offer substantive evidence to underpin the existing WHO clinical guidance that states an essential role for palliative care alongside HIV treatment, regardless of prognosis.

Assessment of community mobilization and home-based HIV counselling and testing offered by health facilities in rural Uganda.

Home-based HIV counselling and testing (HBHCT) and community mobilization have been proven to be effective in increasing the number of people linked to HIV care and treatment. An assessment was conducted in 18 health facilities in Uganda to evaluate the availability and extent of home based testing services and community mobilization activities in underserved communities. The performance of the health facilities was assessed using a checklist with indicators of HBHCT and community mobilization. While most of the health facilities (72.2%) had active community mobilization, only 12.2% had HBHCT services and this might have affected universal access to HIV prevention, care and treatment. The health facilities did not accompany their intensive community mobilization activities with HBHCT yet this provided the ideal entry point and opportunity to improve linkage to HIV treatment and care.

Association between dietary Intake, eating behavior, and childhood obesity among children and adolescents in Ethiopia.

Introduction: The upsurge of overweight/obesity (OW/OB) among children and adolescents is as a result of complex interactions between lifestyle behaviours and socioeconomic factors. The objective of this study was to determine socioeconomic and sociodemographic factors, dietary intake and eating behaviours of children and adolescents in Ethiopia and their association with OW/OB. Methods: A cross-sectional study was conducted among 632 children and adolescents-parent dyads. To identify overweight/obese among children and adolescents, body mass index-for-age Z-scores by sex and age relative to WHO 2007 reference was calculated using WHO AnthroPlus software. A multivariable logistic regression model fitted to determine the adjusted associations between the outcome and the predictors selected from the bivariate analyses. Data analysis was carried out using STATA V.15.0. Results: The proportion of participants with low, medium and high dietary diversity scores was 7.28%, 22.5%, and 70.2%, respectively. Participants aged 13-18 years were less likely to be overweight or obese [adjusted OR (aOR) = 0.40; 95%CI: 0.26, 0.64] to those aged 5-12 years. Children in a family with the richest or highest socioeconomic status (SES) were more likely to be overweight or obese than those in families with the poorest or lowest status. Children and adolescents who consumed soft drinks (sugar-sweetened beverages) four or more times per week [aOR = 3.24; 95%CI: 1.13, 7.95] were more likely to be overweight or obese to those who did not consume soft drinks. Conclusions: The study identified factors such as younger age (<12 years), high SES and consumption of soft drinks as key contributors to overweight and obesity among children and adolescents. Therefore, interventions targeting behavioural prevention and reduction of overweight and obesity among children and adolescents should be cognizant of the above factors during implementation in order to achieve desired outcomes, further guided by exploratory qualitative studies to identify public perceptions and attitudes affecting dietary practices.