Medicine and Health Sciences Commons^™

Screening For Tuberculosis In Pregnancy: Do We Need More Than A Symptom Screen? Experience From Western Kenya, R J. Kosgei, D Szkwarko, S Callens, P Gichangi, Marleen Temmerman, A-B Kihara, J J. Sitienei, E J. Cheserem, P M. Ndavi, A J. Reid, E J. Carter

Obstetrics and Gynaecology, East Africa

Objectives: 1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ⩾2 weeks’ duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya.

Design: Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya.

Results: Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26–35) and 26 years (IQR 24–31) in …

Conscientious Objection To Provision Of Legal Abortion Care, Brooke R. Johnson Jr, Eszter Kismödi, Monica V. Dragoman, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Despite advances in scientific evidence, technologies, and human rights rationale for providing safe abortion, a broad range of cultural, regulatory, and health system barriers that deter access to abortion continues to exist in many countries. When conscientious objection to provision of abortion becomes one of these barriers, it can create risks to women’s health and the enjoyment of their human rights. To eliminate this barrier, states should implement regulations for healthcare providers on how to invoke conscientious objection without jeopardizing women’s access to safe, legal abortion services, especially with regard to timely referral for care and in emergency cases when …

Primary Healthcare Providers’ Views On Improving Sexual And Reproductive Healthcare For Adolescents In Bolivia, Ecuador, And Nicaragua, Lina Jaruseviciene, Miguel Orozco, Marcia Ibarra, Freddy Cordova Ossio, Bernardo Vega, Nancy Auquilla, Joel Medina, Anna C. Gorter, Peter Decat, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved.

Methods: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology.

Results: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and …

Maternal Anaemia And Duration Of Zidovudine In Antiretroviral Regimens For Preventing Mother-To-Child Transmission: A Randomized Trial In Three African Countries, Benn K.D. Sartorius, Matthew F. Chersich, Mary Mwaura, Nicolas Meda, Marleen Temmerman, Marie Louise Newell, Timothy M. M. Farley, Stanley Luchters, The Kesho Bora Study Group

Obstetrics and Gynaecology, East Africa

Background: Although substantiated by little evidence, concerns about zidovudine-related anaemia in pregnancy have influenced antiretroviral (ARV) regimen choice for preventing mother-to-child transmission of HIV-1, especially in settings where anaemia is common.

Methods: Eligible HIV-infected pregnant women in Burkina Faso, Kenya and South Africa were followed from 28 weeks of pregnancy until 12–24 months after delivery (n = 1070). Women with a CD4 count of 200-500cells/mm3 and gestational age 28–36 weeks were randomly assigned to zidovudine-containing triple-ARV prophylaxis continued during breastfeeding up to 6-months, or to zidovudine during pregnancy plus single-dose nevirapine (sd-NVP) at labour. Additionally, two cohorts were …

Cryotherapy Following Visual Inspection With Acetic Acid And Lugol's Iodine (Via/Vili) In Khwisero, Western Kenya: Lesson From The Field Affecting Policy And Practice, Sammy Ngichabe, Patricia Muthaura, Christine W. Murungi, J. Muyoka, Elkanah Omenge, L Muchiri

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer can be prevented and mortality/morbidity reduced by early detection and referral. Developing countries are likely to benefit from more cost effective methods of screening and treatment. Visual inspection with acetic acid and Lugol`s iodine (VIA/VILI) offers a see and treat solution thus an affordable and efficient way to identify pre-malignant lesions. Immediate treatment with cryotherapy can be offered if pre-malignant lesions are found on visual inspection. Cryotherapy is a simple procedure that is curative for dysplasia; it is likely to benefit cervical dysplasia cases picked early in resource poor settings, however there are several factors that …

Ampath-Oncology: A Model For Comprehensive Cancer Care In Sub-Saharan Africa, R.M. Strother, F.C. Asirwa, N.B. Busakhala, E. Njiru, Elkanah Omenge, F. Njuguna, J. Carter, A. Mega, S. Mostert, G.J.L. Kaspers

Obstetrics and Gynaecology, East Africa

Increased awareness of cancer as a health crisis facing less developed healthcare systems has led to recent calls for increased investment in cancer care infrastructure in low resource settings. However, operational descriptions of well-functioning cancer care systems in resource-constrained settings are limited. AMPATH-Oncology is the result of collaboration between North American, European, and Kenyan partners to develop a comprehensive cancer care model that supports screening services, cancer treatment, and palliative care. This article describes the approach taken by the AMPATH-Oncology program to deliver cancer care in a resource-constrained setting. A review of other ‘high-income – low-income’ collaborative models identifies successful …

Managing Data For The International, Multicentre Intergrowth-21st Project, E O. Ohuma, L Hoch, C Cosgrove, H E. Knight, L Cheikh Ismail, L Juodvirsiene, A T. Papageorghiou, H Al-Jabri, M Domingues, P Gilli, N Kunnawar, N Musee, F Roseman, A Carter, M Wu, D G. Altman

Obstetrics and Gynaecology, East Africa

The INTERGROWTH-21st Project data management was structured incorporating both a centralised and decentralised system for the eight study centres, which all used the same database and standardised data collection instruments, manuals and processes. Each centre was responsible for the entry and validation of their country-specific data, which were entered onto a centralised system maintained by the Data Coordinating Unit in Oxford. A comprehensive data management system was designed to handle the very large volumes of data. It contained internal validations to prevent incorrect and inconsistent values being captured, and allowed online data entry by local Data Management Units, as well …

Human Resource Inequalities At The Base Of India's Public Health Care System, Saseendran Pallikadavath, Abhishek Singh, Reuben Ogollah, Tara Dean, William Stones

Obstetrics and Gynaecology, East Africa

This paper examines the extent of inequalities in human resource provision at India's Heath Sub-Centres (HSC)—first level of service provision in the public health system. ‘Within state’ inequality explained about 71% and ‘between state’ inequality explained the remaining 29% of the overall inter-HSC inequality. The Northern states had a lower health worker share relative to the extent of their HSC provision. Contextual factors that contributed to ‘between’ and ‘within’ district inequalities were the percentages of villages connected with all-weather roads and having primary schools. Analysis demonstrates a policy and programming need to address ‘within State’ inequalities as a priority.

The Objectives, Design And Implementation Of The Intergrowth-21st Project, Villar J, Altman D. G, Purwar M, Noble J. A, Knight H. E, Ruyan P, Ismail L. Cheikh, Barros F. C, Lambert A, Papageorghiou A. T, Maria Carvalho, Jaffer Y. A, Bertino E, Gravett M. G, Bhutta Z. A, Kennedy S. H

Obstetrics and Gynaecology, East Africa

INTERGROWTH-21st is a multicentre, multiethnic, populationbased project, being conducted in eight geographical areas (Brazil, China, India, Italy, Kenya, Oman, UK and USA), with technical support from four global specialised units, to study growth, health and nutrition from early pregnancy to infancy. It aims to produce prescriptive growth standards, which conceptually extend the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) to cover fetal and newborn life. The new international standards will describe: (1) fetal growth assessed by clinical and ultrasound measures; (2) postnatal growth of term and preterm infants up to 2 years of age; and (3) the relationship …

Implementation Of The Intergrowth-21st Project In Kenya, Maria Carvalho, Sudhir Vinayak, Roseline Ochieng, V Choksey, N Musee, W Stones, H E. Knight, L Cheikh Ismail

Obstetrics and Gynaecology, East Africa

The African site in the INTERGROWTH-21(st) Project was Parklands, a wealthy suburb of Nairobi, Kenya, with a largely middle-to-high socio-economic status population. There are three hospitals with obstetric units in Parklands, with approximately 4300 births per year. The Newborn Cross-Sectional Study (NCSS) sample was drawn from all three hospitals, covering 100% of births in this target population. The Fetal Growth Longitudinal Study (FGLS) sample was recruited from antenatal clinics serving these hospitals, using the eligibility criteria in the INTERGROWTH-21(st) protocol. Special activities to raise awareness of the study included securing media coverage and distributing leaflets in antenatal clinic waiting rooms. …

Coital Frequency And Condom Use In Monogamous And Concurrent Sexual Relationships In Cape Town, South Africa, Wim Delva, Fei Meng, Roxanne Beauclair, Nele Deprez, Marleen Temmerman, Alex Welte, Niel Hens

Obstetrics and Gynaecology, East Africa

Introduction: A decreased frequency of unprotected sex during episodes of concurrent relationships may dramatically reduce the role of concurrency in accelerating the spread of HIV. Such a decrease could be the result of coital dilution - the reduction in per-partner coital frequency from additional partners - and/or increased condom use during concurrency. To study the effect of concurrency on the frequency of unprotected sex, we examined sexual behaviour data from three communities with high HIV prevalence around Cape Town, South Africa.

Methods: We conducted a cross-sectional survey from June 2011 to February 2012 using audio computer-assisted self-interviewing to reconstruct one-year …

The Evolution Of Comprehensive Cancer Care In Western Kenya, R. M. Strother, F. C. Asirwa, N. B. Busakhala, E. Njiru, Elkanah Omenge, F. Njuguna, J. Skiles, J. Carter, A. Mega, G.J.L. Kaspers

Obstetrics and Gynaecology, East Africa

In the next 20 years, it is expected that 70% of incident cancers will be diagnosed in the developing world. There exist very few models of cancer care delivery in resource constrained settings. We present a model of cancer care delivery that developed as a result of a multi-institutional collaboration between high-income country academic medical centers and a Kenyan medical school and governmental referral hospital. Based on the infrastructure provided by a successful HIV care program, AMPATH-Oncology presently offers a range of clinical services across the continuum of care, including cervical cancer and breast cancer screening, palliative care, and oncology …

Characteristics, Sexual Behaviour And Risk Factors Of Female, Male And Transgender Sex Workers In South Africa, Marlise L. Richter, M. Chersich, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background. In South Africa, information on sex workers’ characteristics, sexual behaviour and health needs is limited. Current social, legal and institutional factors impede a safe working environment for sex workers and their clients.

Objectives. To describe characteristics and sexual behaviour of female, male and transgender sex workers, and assess their risk factors for unprotected sex.

Methods: Repeat cross-sectional surveys among sex workers were conducted in Hillbrow, Sandton, Rustenburg and Cape Town in 2010. Sex workers were interviewed once; any re-interviews were excluded from analysis. Unprotected sex was defined as any unprotected penetrative vaginal or anal sex with last two clients. …

Evaluating Audio Computer Assisted Self-Interviews In Urban South African Communities: Evidence For Good Suitability And Reduced Social Desirability Bias Of A Cross-Sectional Survey On Sexual Behaviour, Roxanne Beauclair, Fei Meng, Nele Deprez, Marleen Temmerman, Alex Welte, Wim Delva, Niel Hens

Obstetrics and Gynaecology, East Africa

Background: Efficient HIV prevention requires accurate identification of individuals with risky sexual behaviour. However, self-reported data from sexual behaviour surveys are prone to social desirability bias (SDB). Audio Computer-Assisted Self-Interviewing (ACASI) has been suggested as an alternative to face-to-face interviewing (FTFI), because it may promote interview privacy and reduce SDB. However, little is known about the suitability and accuracy of ACASI in urban communities with high HIV prevalence in South Africa. To test this, we conducted a sexual behaviour survey in Cape Town, South Africa, using ACASI methods.

Methods: Participants (n = 878) answered questions about their sexual relationships on …

Improving Quality Of Maternal And Newborn Care In Selected Districts In 3 Sub-Saharan Countries: Baseline Quality Assessment, Els Duysburgh, Wei-Hong Zhang, M. Ye, Adrian Williams, S. Massawe, A. Sie, J. Williams, R. Mpembeni, S. Loukanova, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: To measure pre-intervention quality of routine antenatal and childbirth care in rural districts of Burkina Faso, Ghana and Tanzania and to identify shortcomings.

Methods: In each country, we selected two adjoining rural districts. Within each district, we randomly sampled 6 primary healthcare facilities. Quality of care was assessed through health facility surveys, direct observation of antenatal and childbirth care, exit interviews and review of patient records.

Results: By and large, quality of antenatal and childbirth care in the six districts was satisfactory, but we did identify some critical gaps common to the study sites in all three countries. Counselling …

Limited Effectiveness Of Hiv Prevention For Young People In Sub-Saharan Africa: Studying The Role Of Intervention And Evaluation, Kristien Michielsen, Marleen Temmerman, Van Rossem

Obstetrics and Gynaecology, East Africa

On average, 2,500 young people (15-24 years) get -infected with HIV every day; 80% of which live in sub-Saharan Africa. Since no cure or vaccine is available, reducing sexual risk behaviour in this group is crucial in tackling the epidemic. The general objective of this doctoral study was to improve the effectiveness of HIV prevention interventions for young people in sub-Saharan Africa. First, we assessed the overall effectiveness of such interventions (systematic literature review, meta-analysis). Secondly, we evaluated a school-based peer-led HIV prevention interventions in Rwanda (longitudinal, non-randomized controlled trial), to get insight into how interventions are developed, implemented and …