East African medical journal最新文献

Background: HIV diagnosis is the gateway to antiretroviral therapy. However, 20-50% of HIV-infected individuals are unaware of their HIV status, derailing epidemic control.

Objective: To increase awareness of HIV status and enrollment into HIV care & treatment (C&T) services through a national HIV testing services (HTS) rapid results initiative (RRI) campaign in Kenya.

Design: This cross-sectional analysis presents yield of undiagnosed people living with HIV (PLHIV) and their enrollment into HIV C&T resulting from HTS RRI implemented in July-August 2013 as an example of utilizing RRIs to catalyze achievement of UNAIDS targets.

Results: During the campaign 1,462,378 persons received HTS, of whom 220,902 (15%) were children (aged <15 years), 55,088 (7%) couples and 116,126 (8%) key populations. A total of 37,630 (2.6%) HIV+ individuals were identified. Among children who received HTS, 3,244 (1.5%) tested HIV positive, compared to 34,386 (2.8%) among adults. Of the eight regions in Kenya: Nyanza, Rift-valley and Nairobi contributed 73.3% of all HIV+ individuals identified. HTS at health facility settings yielded the highest proportion (69%) of HIV+ and key populations had the highest prevalence (4.8%). Of those infected, 29,851 (79.3%) were enrolled into HIV C&T. Sex, age and setting of HTS were significantly associated with enrollment into HIV C&T (p<0.0001).

Conclusion: National HTS campaigns have the potential of increasing knowledge of HIV status. Targeted provision of HTS at health facility settings, to key populations and high burden geographical regions would narrow the gap of undiagnosed PLHIV towards achieving UNIADS 90-90-90 targets for HIV epidemic control.

Objective: This study aimed to translate, determine the comprehensibility and examine the linguistic equivalence of a Luganda Oral Mucositis Daily Questionnaire (OMDQ MTS) among patients undergoing chemotherapy.

Design: This was a validation study design in which bilingual patients who were receiving chemotherapy at Uganda cancer institute and had experienced some sort of oral discomfort after the start of their treatment were asked to complete OMDQ MTS Luganda followed by the English version on the same visit. The tools were administered at least two hours apart and had different item order.

Results and conclusions: Fifty participants accepted to take part by completing both versions of OMDQ MTS data. All item mean score differences between the two versions were less than ±0.25. The Cronbach's α for the Luganda and English versions were 0.78 and 0.86 based on standardized items while Guttman's lambada 2 and 3 were 0.89 and 0.79 respectively. A translated Luganda version of OMDQ MTS is reliable and easy to understand. Thus, it has the potential in being used to monitor mucositis among patients undergoing chemotherapy.

Introduction: Africa bears the greatest burden of stillbirth and yet, there is a paucity of data from this setting. The aim of this study was to determine the association between quality of intrapartum care and fresh stillbirth in Nairobi, Kenya.

Methods and materials: This was a case control study in 4 tertiary public hospitals in Nairobi county from August 2018 to April 2019. Two hundred and fourteen women with stillbirths and 428 women with livebirths between 28-42 weeks were enrolled. Fifty-five (55) of the 214 women had fresh stillbirths and were included in this analysis. Information was obtained through interviews and data abstraction from the medical records. The exposure variables were sociodemographics, refferal status, intrapartum complications, partogram use and fetal heart rate monitoring. The two-sample t-test was used to compare continuous variables and Chi-square or Fisher's exact tests for categorical variables. The association between exposure and outcome variables was done using bivariate and multivariate analysis using logistic regression. Statistical significance was defined as a two-tailed p-value ≤ 0.05.

Results: Refferal (OR 3.4, 95 % CI 1.9-6.03, P=0.001); no use of a partogram (OR 4.7 95% CI 2.6-8.4, P=<0.001); no fetal heart rate monitoring per schedule (OR 2.2, 95% CI 1.1-4.7, P=0.03), caesarean (OR 1.7, 95% CI 1-3.34, P=0.05) or beech delivery (OR 18, 95% CI=3.2-103, P=0.001) were associated with fresh stillbirth.

Conclusion: Improving the referral system, intrapartum care and timely caesarean delivery can reduce the risk of fresh stillbirth.