Lessons learned from implementing the Non-Communicable Diseases Kit in a humanitarian emergency: an operational evaluation in Sudan.

Non-communicable diseases (NCDs) are a major global health concern, and their management is particularly challenging in humanitarian contexts where healthcare resources are limited. The WHO Non-Communicable Diseases Kit (WHO-NCDK) is a health system intervention targeted at the primary healthcare (PHC) level and designed to provide essential medicines and equipment for NCDs management in emergency settings, meeting the needs of 10 000 people for 3 months. This operational evaluation aimed to assess the effectiveness and utility of the WHO-NCDK in two PHC facilities in Sudan and identify key contextual factors that may influence its implementation and impact. Using a cross-sectional mixed-methods observational approach that combined quantitative and qualitative data, the evaluation found that the kit played a critical role in maintaining continuity of care when other supply chain solutions were disrupted. However, contextual factors such as local communities' unfamiliarity with healthcare facilities, the national integration of NCDs into PHC, and the existence of monitoring and evaluation systems were identified as important considerations for enhancing the WHO-NCDK's utility and usefulness. The evaluation suggests that the WHO-NCDK can be an effective intervention in emergency settings, provided that contextual factors such as local needs, facility capacity and healthcare worker capacity are considered before kit deployments.

Prevalence and correlates of cervical squamous intraepithelial lesions among HIV-infected and uninfected women in Central Kenya.

INTRODUCTION: cervical intraepithelial neoplasia the precursor of cervical cancer occurs with increased frequency in women infected with human immunodeficiency virus (HIV). This study aimed at determining the prevalence and correlates of abnormal cervical cytology among HIV-infected women and compare to the uninfected women. METHODS: a cross-sectional study conducted among HIV-infected and uninfected women enrolled in a HIV study in Central Kenya. All women had baseline Pap smear examination assessed using Bethesda system. Bivariate and multivariate logistic regression methods were employed to assess the correlates of cervical squamous epithelial lesions (CSIL). RESULTS: a total 480 women had an acceptable baseline smear, 373 (78%) were HIV-infected. Median age was 30.2 years [IQR 25.4-35.5]. Overall prevalence of CSIL was 37% (176/480) with the prevalence of low grade squamous intraepithelial lesion (LSIL), atypical squamous cells undetermined significance (ASCUS), high grade squamous intraepithelial lesions (HSIL) and atypical glandular cells (AGC) were 17%, 14%, 4% and 2% respectively. HIV-infected women had a higher prevalence of CSIL at 42% as compared to HIV-uninfected women at 19%. HIV infection was the predictor associated with development of CSIL at multivariate analysis and specifically, HIV-infected women were 3 times (AOR 3.1, 95% CI: 1.8 - 5.4, p<0.005) more likely to have CSIL than HIV-uninfected women. The age 35 - 44 years was protective to developing CSIL (AOR 0.45, 95% CI: 0.24 - 0.87, p=0.018). CONCLUSION: cervical squamous epithelial lesions is a major problem among Kenyan women. HIV infection confers a higher risk to development of CSIL. Cervical cancer screening should be an established practice in HIV programs.