Effect of A Community Health Worker led Intervention on Skilled Birth Care in Rural Mwingi West Sub-County, Kenya: A Quasi Experimental Study.

Despite strong evidence that skilled birth care (SBC) significantly reduces maternal deaths, one in four babies worldwide are delivered without SBC. This has kept maternal mortality rates (MMR) high in sub-Saharan Africa and Kenya in particular. Kenya adopted Community Health Strategy (CHS) with the aim of improving community health services. The aim of this study was to evaluate the effect of CHS on SBC in Mwingi west sub-county, Kenya. A quasi experimental study design was conducted with 1 pretest and 2 post-test household surveys done in intervention and control sites. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents. Binary logistic regression analysis was used to estimate the odds of SBC utilization before and after the intervention In intervention site; SBC utilization significantly improved by 12.9% (57.9% vs. 70.5%) and women in end term survey were 1.6 times (Adj. OR=1.556, P <0.0001; 95%CI: 1.295-1.868) more likely to deliver under SBC compared to baseline. Compared to control, the proportion of women delivering under SBC in intervention site increased by 8.6%. To improve maternal and child health outcomes in Kenya, implementation of CHS should be fast tracked in all counties.

Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users.

BACKGROUND: Substance use is increasingly becoming prevalent on the African continent, fueling the spread of HIV infection. Although socio-demographic factors influence substance consumption and risk of HIV infection, the association of these factors with HIV infection is poorly understood among substance users on the African continent. The objective of the study was to assess socio-demographic and sexual practices that are associated with HIV infection among injection drug users (IDUs), non-IDUs, and non-drug users (DUs) at an urban setting of coastal Kenya. METHODS: A cross-sectional descriptive study was conducted among 451 adults comprising HIV-infected and -uninfected IDUs (n = 157 and 39); non-IDUs (n = 17 and 48); and non-DUs (n = 55 and 135); respectively at coastal, Kenya. Respondent driven sampling, snowball and makeshift methods were used to enroll IDUs and non-IDUs. Convenience and purposive sampling were used to enroll non-DUs from the hospital's voluntary HIV testing unit. Participant assisted questionnaire was used in collecting socio-demographic data and sexual practices. RESULTS: Binary logistic regression analysis indicated that higher likelihood of HIV infection was associated with sex for police protection (OR, 9.526; 95% CI, 1.156-78.528; P = 0.036) and history of sexually transmitted infection (OR, 5.117; 95% CI, 1.924-13.485; P = 0.001) in IDUs; divorced, separated or widowed marital status (OR, 6.315; 95% CI, 1.334-29.898; P = 0.020) in non-IDUs; and unemployment (OR, 2.724; 95% CI, 1.049-7.070; P = 0.040) in non-drug users. However, never married (single) marital status (OR, 0.140; 95% CI, 0.030-0.649; P = 0.012) was associated with lower odds for HIV infection in non-drug users. CONCLUSION: Altogether, these results suggest that socio-demographic and sexual risk factors for HIV transmission differ with drug use status, suggesting targeted preventive measures for drug users.

Community health worker interventions are key to optimal infant immunization coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya.

INTRODUCTION: Immunization is a powerful and cost-effective health intervention which averts an estimated 2 to 3 million deaths every year. Kenya has a high infant and under five mortality and morbidity rates. Increasing routine child immunization coverage is one way of reducing child morbidity and mortality rates in Kenya. Community Health Workers (CHWs) have emerged as critical human resources for health in developing countries. The Community Strategy (CS) is one of the CHW led interventions promoting Maternal and Child Health (MCH) in Kenya. This study sought to establish the effect of CS on infant vaccination Coverage (IVC) in Mwingi west sub-county; Kenya. METHODS: This was a pretest - posttest experimental study design with 1 pretest and 2 post-test surveys conducted in intervention and control sites. Mwingi west and Mwingi north sub-counties where intervention and control sites respectively. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents. RESULTS: Intervention site end-term evaluation indicated that; the CS increased IVC by 10.1% (Z =6.0241, P <0.0001), from a suboptimal level of 88.7% at baseline survey to optimal level of 98.8% at end term survey. Infants in intervention site were 2.5 times more likely to receive all recommended immunizations within their first year of life [(crude OR= 2.475, P<0.0001; 95%CI: 1.794-3.414) (adj. OR=2.516, P<0.0001; 95%CI: 1.796-3.5240)]. CONCLUSION: CS increased IVC in intervention site to optimal level (98.8%). To improve child health outcomes through immunization coverage, Kenya needs to fast-track nationwide implementation of the CS intervention.