Medicine and Health Sciences Commons^™

Too Hot To Thrive: A Qualitative Inquiry Of Community Perspectives On The Effect Of High Ambient Temperature On Postpartum Women And Neonates In Kilifi, Kenya., Adelaide Lusambili, Sari Kovats, Britt Nakstad, Veronique Filippi, Peter Khaemba, Nathalie Roos, Cherie Part, Stanley Luchters, Matthew Chersich, Jeremy Hess

Institute for Human Development

Objectives; To understand community perspectives on the effects of high ambient temperature on the health and wellbeing of neonates, and impacts on post-partum women and infant care in Kilifi.

Design; Qualitative study using key informant interviews, in-depth interviews and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (CHVs) (n = 22) and stakeholders from health and government ministries (n = 16).

Settings; We conducted our research in Kilifi County in Kenya’s Coast Province. The area is largely rural and during …

Mothers Get Really Exhausted!” The Lived Experience Of Pregnancy In Extreme Heat: Qualitative Findings From Kilifi, Kenya, Fiona Scorgie, Adelaide Lusambili, S. Luchters, Peter. Khaemba, Veronique Filippi, B. Nakstad, Jeremy Hess, Cathryn Birch, S. Kovats, M.F. Chersich

Institute for Human Development

Background: Palliative care (PC) can reduce symptom distress and improve quality of life for patients and their families experiencing life-threatening illness. While the need for PC in Kenya is high, PC service delivery and research is limited. Qualitative research is needed to explore potential areas for PC research and support needed to enable that research. This insight is critical for informing a national PC research agenda and mobilizing limited resources for conducting rigorous PC research in Kenya.

Objectives: To explore perceptions of priority areas for PC research and support needed to facilitate rigorous research from the perspective of Kenyan PC …

Phenotype And Genetic Analysis Of Data Collected Within The First Year Of Neurodev, Patricia Kipkemoi, Heesu Ally Kim, Bjorn Christ, Emily O’Heir, Jake Allen, Christina Austin-Tse, Samantha Baxter, Amina Abubakar, Charles Newton, Alicia Martin

Institute for Human Development

Genetic association studies have made significant contributions to our understanding of the etiology of neurodevelopmental disorders (NDDs). However, these studies rarely focused on the African continent. The NeuroDev Project aims to address this diversity gap through detailed phenotypic and genetic characterization of children with NDDs from Kenya and South Africa. We present results from NeuroDev’s first year of data collection, including phenotype data from 206 cases and clinical genetic analyses of 99 parent-child trios. Most cases met criteria for global developmental delay/intellectual disability (GDD/ID, 80.3%). Approximately half of the children with GDD/ID also met criteria for autism. Analysis of exome-sequencing …

Strategies For Improving Mental Health And Wellbeing Used By Adults Ageing With Hiv From The Kenyan Coast: A Qualitative Exploration, Peter Mwangala, Ryan G. Wagner, Charles R. Newton, Amina Abubakar

Institute for Human Development

Background: Physical and mental health problems are common among older adults living with HIV (OALWH). Adaptive coping strategies play a vital role in improving these adults' mental health and well-being despite the deleterious effects of HIV and ageing. However, in sub-Saharan Africa, limited evidence exists on the commonly utilized coping strategies in this population. We explore the coping strategies used by Kenyan OALWH to improve their mental health and wellbeing.

Methods: Semi-structured in-depth interviews were conducted between October and December 2019 with 56 participants: 34 OALWH (53% female), 11 healthcare providers (63% female) and 11 primary caregivers (73% female) in …

Navigating Life With Hiv As An Older Adult On The Kenyan Coast: Perceived Health Challenges Seen Through The Biopsychosocial Model, Patrick Mwangala, Ryan G. Wagner, Charles Newton, Amina Abubakar

Institute for Human Development

Objectives: This study explores the perceptions of adults living with HIV aged ≥50 years (recognized as older adults living with HIV—OALWH), primary caregivers and healthcare providers on the health challenges of ageing with HIV at Kilifi, a low literacy setting on the coast of Kenya.

Methods: We utilized the biopsychosocial model to explore views from 34 OALWH and 22 stakeholders on the physical, mental, and psychosocial health challenges of ageing with HIV in Kilifi in 2019. Data were drawn from semi-structured in-depth interviews, which were audio-recorded and transcribed. A framework approach was used to synthesize the data.

Results: Symptoms of …

A Qualitative Inquiry Of Experiences Of Hiv-Related Stigma And Its Effects Among People Living With Hiv On Treatment In Rural Kilifi, Kenya, Stanley Wechuli Wanjala, Moses Nyongesa, Rachael Mapenzi, Stanley Luchters, Amina Abubakar

Institute for Human Development

Background: The pervasiveness of HIV-related stigma and discrimination, and its consequences on HIV prevention and treatment, have been well documented. However, little is known about the lived experiences of HIV-related stigma and its effects among the general adult population living with HIV in rural African settings. This study set out to explore this knowledge gap.

Methods: From April to June 2018, we conducted in-depth interviews with a convenience sample of 40 adults living with HIV aged 18–58 years in Kilifi, Kenya. A semi-structured interview guide was used to explore experiences of HIV-related stigma and its impact on these adults. …

Using Social Practice Theory In Measuring Perceived Stigma Among Female Sex Workers In Mombasa, Kenya, Joseph Newton Guni, Stanley Wechuli Wanjala, Griffins Manguro, Caroline Gichuki, Megan Sc Lim, Minh D. Pham, Stanley Luchters, James Orwa

Institute for Human Development

Background Perceived stigma is a complex societal phenomenon that is harboured especially by female sex workers because of the interplay of a myriad of factors. As such, a precise measure of the contribution of different social practices and characteristics is necessary for both understanding and intervening in matters related to perceived stigma. We developed a Perceived Stigma Index that measures the factors that greatly contribute to the stigma among sex workers in Kenya, and thereby inform a framework for future interventions.

Methods Social Practice Theory was adopted in the development of the Perceived Stigma Index in which three social domains …

Delivering Health Services During Early Days Of Covid-19 Pandemic: Perspectives Of Frontline Healthcare Workers In Kenya’S Urban Informal Settlements, Vibian Angweny, Sabina Odero, Stephen Mulupi, Derrick Ssewanyana, Constance Shumba, Eunice Ndirangu, Amina Abubakar

Institute for Human Development

The COVID-19 pandemic has caused widespread disruptions to health, economic and social lives globally. This qualitative study explores frontline healthcare workers’ (HCWs) experiences delivering routine care in Kenya’s informal settlements during the early phases of the pandemic, amidst stringent COVID-19 mitigation measures. Thirteen telephone interviews were conducted with facility and community-based HCWs serving three informal settlements in Nairobi and Mombasa. Data were analyzed using the framework approach. Results indicate there were widespread fears and anxieties surrounding COVID-19 and its management. Secondly, access to facility-based care at the onset of the pandemic was reported to decline, with service availability hampered by …

Prevalence And Factors Associated With Mild Depressive And Anxiety Symptoms In Older Adults Living With Hiv From The Kenyan Coast, Patrick N. Mwangala, Carophine Nasambu, Ryan G. Wagner, Charles R. Newton, Amina Abubakar

Institute for Human Development

Introduction: Empirical research on the burden and determinants of common mental disorders (CMDs), especially depression and anxiety, among older adults living with HIV (OALWH) in sub-Saharan Africa is inadequate. To bridge the gap in Kenya we: (1) determined the prevalence of CMDs among OALWH on routine HIV care compared to HIV-negative peers; (2) investigated HIV status as an independent predictor of CMDs in older adults; and (3) investigated CMD determinants.

Methods: In a cross-sectional study conducted between 2020 and 2021, the prevalence of CMDs and associated determinants were investigated at the Kenyan coast among 440 adults aged ≥50 …

Strategies For Improving Mental Health And Well Being Used By Adults Ageing With Hiv: A Qualitative Exploration, Patrick N. Mwangala, Ryan G. Wagner, Charles R. Newton, Amina Abubakar

Institute for Human Development

Background: Physical and mental health problems are common among older adults living with HIV (OALWH). Adaptive coping strategies play a vital role in improving these adults' mental health and well-being despite the deleterious effects of HIV and ageing. However, in sub-Saharan Africa, limited evidence exists on the commonly utilized coping strategies in this population. We explore the coping strategies used by Kenyan OALWH to improve their mental health and wellbeing.

Methods: Semi-structured in-depth interviews were conducted between October and December 2019 with 56 participants: 34 OALWH (53% female), 11 healthcare providers (63% female) and 11 primary caregivers (73% female) in …

Views Of Nurses And Other Healthcare Workers On Interventions To Reduce Disrespectful Maternity Care In Rural Health Facilities In Kilifi And Kisii Counties, Kenya: Analysis Of A Qualitative Interview Study, Adelaide Lusambili, Jerim Obure, Stefania Wisofschi, Lucy Nyaga, Kennedy Mulama, Marleen Temmerman

Institute for Human Development

Objective There is an abundance of evidence illuminating the factors that contribute to disrespectful maternity care in sub-Saharan Africa. However, there is limited documented evidence on how some of the key influences on the mistreatment of women could be addressed. We aimed to document the perspectives of nurses and other healthcare workers on existing and potential strategies embedded at the health facility level to promote respectful delivery of healthcare for women during delivery and on what interventions are needed to promote respectful and equitable treatment of women receiving maternity care in rural Kenya.

Design, setting and participants We analysed relevant …

Hiv Virological Non-Suppression Is Highly Prevalent Among 18- To 24-Year-Old Youths On Antiretroviral Therapy At The Kenyan Coast, Moses K. Nyongesa, Mwaganyuma H. Mwatasa, Vincent A. Kagonya, Gabriel Mwambingu, Caroline Ngetsa, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development

Background: In sub-Saharan Africa, data on virologic outcomes of young people living with HIV (YLWH) enrolled on antiretroviral therapy (ART) remains scarce. In this study, we describe the prevalence of HIV virological non-suppression (VNS) and its associated factors among YLWH aged 18–24 years from the Kenyan coast.

Methods: Data were analyzed for 384 YLWH who participated in a larger cross-sectional study conducted between November 2018 and September 2019 in two counties at the Kenyan coast (Kilif and Mombasa). Descriptive statistics were used to summarize sample characteristics and logistic regression was used for statistical modeling of factors associated with …

Increased Condom Use Among Key Populations Using Oral Prep In Kenya: Results From Large Scale Programmatic Surveillance, Griffins O. Manguro, Abednego M. Musau, Daniel K. Were, Soud Tengah, Brian Wakhutu, Jason Reed, Marya Plotkin, Stanley Luchters, Peter Gichangi, Marleen Temmerman

Institute for Human Development

Background: Female sex workers (FSW) and men having sex with men (MSM) in Kenya have high rates of HIV infection. Following a 2015 WHO recommendation, Kenya initiated national scale-up of pre-exposure prophylaxis (PrEP) for all persons at high-risk. Concerns have been raised about PrEP users’ potential changes in sexual behaviors such adopting condomless sex and multiple partners as a result of perceived reduction in HIV risk, a phenomenon known as risk compensation. Increased condomless sex may lead to unintended pregnancies and sexually transmitted infections and has been described in research contexts but not in the programmatic setting. This study …

Measurement Characteristics And Correlates Of Hiv-Related Stigma Among Adults Living With Hiv: A Cross-Sectional Study From Coastal Kenya, Stanley W. Wanjala, Moses Nyongesa, Paul Mwangi, Agnes M. Mutua, Stanley Luchters, Charles R J C Newton, Amina Abubakar

Institute for Human Development

Objective We studied the psychometric properties of the 12-item short version of the Berger HIV stigma scale and assessed the correlates of HIV-related stigma among adults living with HIV on the Kenyan coast.

Design Cross-sectional study.

Setting Comprehensive Care and Research Centre in the Kilifi County Hospital.

Participants Adults living with HIV on combination antiretroviral therapy were recruited and interviewed between February and April 2018 (n=450).

Main outcome measures HIV-related stigma.

Results 450 participants with a median age of 43 years (IQR=36–50) took part in the study. Of these, 356 (79.1%) were female. Scale reliability and validity were high (alpha=0.80, …

Psychosocial And Mental Health Challenges Faced By Emerging Adults Living With Hiv And Support Systems Aiding Their Positive Coping: A Qualitative Study From The Kenyan Coast, Moses K. Nyongesa, Carophine Nasambu, Rachael Mapenzi, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development

Background: In sub-Saharan Africa, there is little data on the challenges faced by young people living with HIV tran- sitioning into adult life. Adapting the socio-ecological framework, this qualitative study investigated the challenges faced by emerging adults living with HIV from a rural Kenyan setting. Additionally, the study explored support systems that aid positive coping among these young adults.

Methods: In April 2018, in-depth interviews were conducted with a convenience sample of 22 young adults living with HIV (12 females), 18–24 years old, from rural Kilifi, coast of Kenya. Data were analyzed thematically using NVIVO 11 software.

Results …

Correlates Of Health-Related Quality Of Life In Primary Caregivers Of Perinatally Hiv Infected And Hiv Exposed Uninfected Adolescents At The Kenyan Coast, Patrick N. Mwangala, Derrick Ssewanyana, Paul Mwangi, Esther Chongwo, Carophine Nasambu, Vincent A. Kagonya, Gaia Scerif, Charles R. Newton, Amina Abubakar

Institute for Human Development

Background: Mothers and other primary caregivers play a crucial role in looking after perinatally HIV infected, and HIV exposed uninfected adolescents in sub-Saharan Africa. Day- to-day caregiving in the context of limited instrumen- tal support and added biomedical risk (HIV seropositivity) may expose these caregivers to adverse states of health. Unfortunately, very few studies have examined their health-related quality of life (HRQoL). Our study documents the HRQoL profile, and associated factors in primary caregivers of perinatally HIV infected, perinatally HIV exposed but uninfected and HIV unexposed/uninfected adolescents aged 12–17 years at the Kenyan Coast.

Methods: This was a …

Alcohol And Illicit Drug Use Among Young People Living With Hiv Compared To Their Uninfected Peers From The Kenyan Coast: Prevalence And Risk Indicators, Moses K. Nyongesa, Paul Mwangi, Michael Kinuthia, Amin S. Hassan, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development

Background: In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people.

Methods: Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). …

Mental Health During Covid-19 Pandemic Among Caregivers Of Young Children In Kenya’S Urban Informal Settlements. A Cross-Sectional Telephone Survey, Vibian Angweny, Margaret Kabue, Esther Chongwo, Adam Mabrouk, Ezra Too, Rachel Odhiambo, Carophine Nasambu, Joyce Marangu, Derrick Ssewanyana, Eunice Njoroge, Eunice Ombech, Mercy Mokaya, Emmanuel Obulemire, Anil Khamis, Amina Abubakar

Institute for Human Development

The emergence of COVID-19 has profoundly affected mental health, especially among highly vulnerable populations. This study describes mental health issues among caregivers of young children and pregnant women in three urban informal settlements in Kenya during the first pandemic year, and factors associated with poor mental health. A cross-sectional telephone survey was administered to 845 participants. Survey instruments included the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, COVID-19 Anxiety Scale, and questions on the perceived COVID-19 effects on caregiver wellbeing and livelihood. Data were analyzed using descriptive statistics, and univariate and multivariate analysis. Caregivers perceived COVID-19 as a threatening condition …

Correlates Of Health-Related Quality Of Life Among Adults Receiving Combination Antiretroviral Therapy In Coastal Kenya, Moses K. Nyongesa, Paul Mwangi, Stanley Wanjala, Agnes M. Mutua, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development

Background: Health-related quality of life (HRQoL) is an important metric of perceived wellbeing in people living with HIV/AIDS (PLWHA). However, research on HRQoL among PLWHA in sub-Saharan Africa is limited. This study investigates factors associated with HRQoL among PLWHA in Kilifi, coast of Kenya.

Methods: Between February and April 2018, 450 adults living with HIV and on combined antiretroviral therapy (cART) between 18 to 60 years were sequentially recruited from an HIV-specialized clinic. The Functional Assessment of HIV Infection (FAHI) questionnaire, previously adapted for assessing HRQoL in this setting, was slightly modified and administered to participants alongside other …

Prevalence And Correlates Of Depressive Symptoms Among Adults Living With Hiv In Rural Kilifi, Kenya, Moses K. Nyongesa, Paul Mwangi, Stanley W. Wanjala, Agnes M. Mutua, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development

Background: Published research on depression among people living with HIV/AIDS (PLWHA) from Africa is increasing, but data from Kenya remains scarce. This cross-sectional study measured the prevalence and correlates of depressive symptoms among PLWHA in rural Kilifi, on the Kenyan coast.

Methods: Between February and April 2018, we consecutively recruited and interviewed 450 adults living with HIV and on combination antiretroviral therapy (cART). Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9), with a positive depression screen defined as PHQ-9 score ≥ 10. Measures of psychosocial, health, and treatment characteristics were also administered.

Results: The overall prevalence of …