No abstract

Half a million women die annually from pregnancy related causes. In Kenya, maternal mortality ratio (MMR) remains high in spite of great efforts to improve maternal health care. We studied some factors linked to maternity in a rural community setting. A survey was conducted in the community living in Madiany division of Siaya County, Kenya. We randomly sampled 403 mothers of children under three years old. Variables of interest were antenatal care attendance (ANC), parity, distance from the health facility and women empowerment (autonomy). Nearly 94% of the mothers had at least one ANC visit and 48.6% had completed the recommended four or more ANC visits; about 65.7% initiated ANC at first trimester. Parity, distance to the health facility and autonomy were associated with ANC visits. Mothers with one child had a twice higher chance of at least four ANC visits than those with more than one child. Those living at most 60 minutes travel-time from the health facility were seven times more likely have early ANC initiation and five times more likely to have at least four ANC attendance than those living more than 60 minutes travel-time from the health facility. Autonomy was linked to early initiation of ANC visit. This may indicate that improving maternal care and achieving Millennium Development Goal (MDG) 5 target, it is important to improve coverage of health facilities and implement development programs that empower rural women.

BackgroundSubstance 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.MethodsA 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.ResultsBinary 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.ConclusionAltogether, 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.

IntroductionImmunization 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.MethodsThis 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.ResultsIntervention 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)].ConclusionCS 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.

No abstract

No abstract

Background: ANC provides the opportunity to detect and treat anomalies of pregnancy and access to preventive maternal and child healthcare. However, detailed information about the actual quality and content of ANC in practice is scanty, especially in developing countries. We analyzed the pattern and content of antenatal care service in Kenya in order to assess the quality of ANC. Methods: We used data from the 2008/9 KDHS, a nationally representative survey of women aged 15-49 years in Kenya. Proportion was used for description purpose while association was determined by bivariate and multivariate analysis in which odds ratio with a 95% confidence interval values were calculated. Results: About 50.9% of women sought ANC services either in health centers or dispensaries but these lower level health facilities had more content gaps. Multivariate analysis indicated that maternal age, regional residence, urban residence, wealth index, education and the media influenced ANC initiation and at least 4 ANC visits. There was a coverage gap existing in terms of iron-folate supplementation (66.1%), tetanus toxoid (66.5%), presumptive/preventive treatment for malaria with SP (38.7%) and education on pregnancy complication (44.3%). Nearly a third of women missed the screening for complication during pregnancy. Conclusion: Disparities exist in provision of ANC components, by type of facility attended, rural-urban and low versus higher income biases. Consequently vulnerable women attending ANC miss important care including screening for complication during pregnancy and labor. Efforts should be designed to improve on supplies to government health centers and dispensaries. Well stocked outreach village clinics with the requirements of a comprehensive antenatal care resource allocation should be used to eliminate service disparities. Government policy should help to increase media penetration amongst the masses and sensitize mothers on the importance of ANC.

Background: Kenya has a maternal mortality rate (MMR) of 362 women per 100,000, partly attributed to inadequate or lack of birth and emergency preparedness, including the individual birth plan. Moreover, a paucity of data on determinants of individual birth plan use hampers its promotion and utility against MMR. This study assessed the determinants of individual birth plan use among women attending the postnatal clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, Kenya. Methods: Hospital-based survey was conducted among 354 expectant women between November 2018 and February 2019. Data were collected using questionnaires and a Focus Group Discussion guide. A Logistic regression model was also used to determine factors associated with IBP utilization, where only p-value's <0.05 were considered significant. Textual data were analyzed thematically using NVIVO. Results: Most mothers (68.6%) had an individual birth plan. Determinants for having birth plans included client factors such as education, OR 8.93, p<0.001, occupation, OR=2.40, p=0.020, and parity, AOR=3.29, p=<0.034; knowledge of danger signs, AOR 8.1, p=0.001. Health facility factors included birth plan counseling, OR=3.45, p=0.013, emergency preparedness, OR=2.06, p=0.034, access to motorized transport such as a car, OR=3.8, p=0.035 or motorcycle, OR=2.7, p=0.006 and attending a clinic in a referral hospital, OR=5.8, p=0.003 Conclusion: This study has demonstrated most women utilize individual birth plans. However, they were ill-prepared for an emergency. Determinants of IBP use included client factors such as education level, employment status, parity, knowledge of danger signs, maternal attitude; and facility factors including counseling, attending a clinic in a referral hospital, the use of an automobile to reach the hospital, and hostility by the health care providers. Therefore, we recommend that prenatal counseling should emphasize emergency preparedness among pregnant women. There is a need to empower women through education and employment to enhance IBP utilization.