Consortium for Advanced Research Training in Africa (CARTA) Report: Year 3

This report presents learning from the African Institution initiative’s experiences to date, with a particular focus on the third year of activity. Its audience is both the consortia funded under the initiative and the Wellcome Trust. The report is an annual (interim deliverable) of the evaluation and learning project, and is in this context a ‘living document’. As such, the report aims to provide an evaluation resource that can enable each consortium to reflect on individual progress and priorities going forward. […]

Read More…

DATA DOCUMENTATION – ORAL HIV SELF TESTING PROJECT

HIV/AIDS remains a leading cause of morbidity and mortality in sub-Saharan Africa. HIV disproportionately affects women and youth aged 15-24 years. The majority of those living with HIV/AIDS (69%) as well as the largest proportion of new infections (72%) are in sub-Saharan Africa. The percentage of the general population who are aware of their HIV status is less than 20%, a factor that may explain the large numbers in new infections each year relative to other regions of the world. In response to preliminary findings indicating relatively high approval and potential acceptance of oral HIV self-testing, this study aimed to assess and quantify perceived social harms and abuses that may arise from widespread availability of oral HIV testing kits and to describe possible actions to prevent these harms and abuses. Using both qualitative and quantitative approaches, the study explored potential social harms and abuses that could emanate from self-testing and assessed potential strategies to mitigate these harms and abuses. Information on approaches to mitigate these harms and abuses was also collected. The results of this study are expected to inform the design, development and implementation of HIV prevention and control strategies aimed at promoting the safe use of oral HIV self-testing kits as an alternative to conventional avenues of HIV testing.

To request the project data sets please email us at: datarequests@aphrc.org […]

Read More…

TRANSITIONS TO ADULTHOOD IN A HIGH FERTILITY CONTEXT: THE CASE OF SUB-SAHARAN AFRICA

Sub-Saharan Africa (SSA) is projected to experience the highest population growth rate of any subregion in the next three decades (United Nations, 2013). Rapid population growth in this region is a major challenge due largely to the inability of the economies of many countries to absorb the large number of adults in productive ages. The large population of children and young people in the region means that drastic measures are urgently needed to ensure that the educational, employment, and social needs of the youthful population are met. Failure to address these needs means that many young people’s ability to contribute meaningfully to the economy will be severely curtailed with adverse consequences to regional development. […]

Read More…

REPRODUCTIVE HEALTH AND FAMILY PLANNING FINANCING IN KENYA. A MAPPING OF THE RESOURCE FLOWS

Reproductive Health and Family planning related policy making, budgeting and planning by governments and other stakeholders at country level would benefit tremendously if quality periodic reports that compare the health sector funding needs with the allocation of resources (domestic and external), actual expenditure and distribution of resources as well as projected availability of resources (domestic and external) are made available on regular basis. […]

Read More…

REPRODUCTIVE HEALTH FINANCING IN KENYA: AN ANALYSIS OF NATIONAL COMMITMENTS, DONOR ASSISTANCE, AND THE RESOURCES TRACKING PROCESS

Understanding the flow of resources at the country level to reproductive health is essential for effective financing of this key component of health. This paper gives a comprehensive picture of the allocation of resources for reproductive health in Kenya and the challenges faced in the resource-tracking process. Data are drawn from Kenyan budget estimates, reproductive health accounts, and the Resource Flows Project database and compare budgets and spending in 2005–06 with 2009–10. Despite policies and programmes in place since 1994, services for family planning, maternity care and infant and child health face serious challenges. […]

Read More…

UNINTENDED PREGNANCY: MAGNITUDE AND CORRELATES IN SIX URBAN SITES IN SENEGAL

Abstract

Background:

In Senegal, unintended pregnancy has become a growing concern in public health circles. It has often been described through the press as a sensational subject with emphasis on the multiple infanticide cases as
a main consequence, especially among young unmarried girls. Less scientific evidence is known on this topic, as fertility issues are rarely discussed within couples. In a context where urbanization is strong, economic insecurity is
persistent and the population is globalizing, it is important to assess the magnitude of unintended pregnancy among urban women and to identify its main determinants.

Methods:

Data were collected in 2011 from a representative sample of 9614 women aged 15–49 years in six urban sites in Senegal. For this analysis, we include 5769 women who have ever been pregnant or were pregnant at the time of the survey. These women were asked if their last pregnancy in the last two years was ‘wanted ’then’ , ‘wanted later’ or ‘not wanted’. Pregnancy was considered as unintended if the woman responded ‘wanted later’ or ‘not wanted’. Descriptive analyses were performed to measure the magnitude of unintended pregnancies, while multinomial logistic regression models were used to identify factors associated with the occurrence of unintended pregnancy. The analyses were performed using Stata version 12. All results were weighted.

Results:

The results show that 14.3% of ever pregnant women reported having a recent unintended pregnancy. The study demonstrates important distinctions between women whose last pregnancy was intended and those whose last pregnancy was unintended. Indeed, this last group is more likely to be poor, from a young age (< 25 years) and multiparous. In addition, it appears that low participation of married women in decision-making within the couple (management of financial resources) and the lack of discussion on family planning issues are associated with greater experience of unintended pregnancy.

Conclusion:

This study suggests a need to implement more targeted programs that guarantee access to family planning for all women in need. In urban areas that are characterized by economic insecurity, as in Senegal, it is important to consider strategies for promoting communication within couples on fertility issues. […]

Read More…

MINISTRY OF EDUCATION TO REDUCE THE INCIDENCE OF SEXUAL HARASSMENT AND VIOLENCE AMONG GIRLS ATTENDING HIGH SCHOOLS IN KENYA BY 2015

Sexual violence and harassment in schools is a public health problem. It is detrimental to girls’ psychosomatic health; a fact that has been expressed by students, educators, and community officials throughout the last decade. Sexual violence is “…any sexual act, attempted sexual act, unwanted sexual comments or advances, or acts of trafficking women’s sexuality using coercion, threats of harm or physical force, by any person regardless of relationship to the survivor, in any setting, including but not limited to home and work.” […]

Read More…

CLOSING THE PERFORMANCE GAP IN STUDENT LEARNING OUTCOMES BETWEEN PRIVATE AND PUBLIC SCHOOLS

In developing countries, school enrolment has increased tremendously over the past 10 years. For instance, between 2003 and 2008, primary school enrolment rates in sub-Saharan Africa increased by 18% with a number of countries recording gross enrolment rates above 100%. Despite these gains, learning outcomes have been declining raising fears that children are simply going through the school system with minimal learning. […]

Read More…

STATUS REPORT ON THE SEXUAL AND REPRODUCTIVE HEALTH OF ADOLESCENTS LIVING IN URBAN SLUMS IN KENYA

Young people face numerous health challenges during their transition to adulthood. These challenges include, among others, limited access to sexual and reproductive health (SRH) information and services. Unmet SRH needs among adolescents may contribute to sexually transmitted infections (STIs), including HIV, and unintended pregnancies. Adolescent pregnancies are associated with several adverse outcomes, such as miscarriage, unsafe abortion, obstructed labor, and other complications, which can result in long-term morbidity and even death. Additionally, poor sexual and reproductive health outcomes can especially impact the status of young women, as they may face stigma from the community as well as diminished educational and employment opportunities. The long-term impacts of unmet SRH are also felt at population level, as high prevalence of HIV and high fertility rates place strains on communities and nations. As the world undergoes rapid urbanization, these strains will be increasingly felt in urban populations. […]

Read More…

INCIDENCE AND COMPLICATIONS OF UNSAFE ABORTION IN KENYA: KEY FINDINGS OF A NATIONAL STUDY

Unsafe abortion is defined by the World Health Organization (WHO) as a procedure for terminating pregnancy, carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. Under the 2010 Kenyan constitution, abortion may be granted to a pregnant woman or girl, when in the opinion of a trained health professional, she needs emergency treatment or her life or health is in danger. Nevertheless, unsafe abortion remains a leading cause of maternal morbidity and mortality in Kenya. The treatment of complications of unsafe abortion also consumes significant health systems resources. In this report, we document findings from a recent nationwide study of the incidence of induced abortion and severity of complications of unsafe abortion in Kenya. The study was conducted in 2012 among a nationally-representative sample of Levels II to VI public and private health facilities. The Abortion Incidence Complications Methodology (AICM) and the Prospective Morbidity Methodology (PMM) were used as well-established and complementary approaches to estimate abortion incidence and the severity of unsafe abortion complications in Kenya. […]

Read More…

THE ASSOCIATION OF UNWANTED PREGNANCY AND SOCIAL SUPPORT WITH DEPRESSIVE SYMPTOMS IN PREGNANCY: EVIDENCE FROM RURAL SOUTHWESTERN ETHIOPIA

Depression in pregnancy has adverse health outcomes for mothers and children. The magnitude and risk factors of maternal depression during pregnancy is less known in developing countries. This study examines the association between pregnancy intention, social support and depressive symptoms in pregnancy in Ethiopia.

Data for this study comes from a baseline survey conducted as part of a community- based cohort study that involved 627 pregnant women from a Demographic Surveillance Site (DSS) in Southwestern Ethiopia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms during pregnancy. Data on depressive symptoms, pregnancy intention, social support and other explanatory variables were gathered using an interviewer-administered structured questionnaire. The association between independent variables and depressive symptom during pregnancy was assessed using multivariable logistic regression. […]

Read More…

RISK FACTORS FOR SUBOPTIMAL ANTIRETROVIRAL THERAPY ADHERENCE IN HIV-INFECTED ADOLESCENTS IN GABORONE, BOTSWANA: A PILOT CROSS-SECTIONAL STUDY

Objective:

Little is known about factors associated with suboptimal antiretroviral treatment (ART) adherence among adolescents in Sub-Saharan Africa. Our objective was to determine the level of ART adherence and predictors of non-adherence among human immunodeficiency virus (HIV)-infected adolescents at the Botswana-Baylor Children’s Clinical Centre of Excellence in Gaborone, Botswana. Methods: In a cross-sectional study, 82 HIV-infected adolescents receiving ART and their caregivers were administered a structured questionnaire. The patient’s clinical information was retrieved from medical records. Outcome measures included excellent pill count ART adherence (.95%) and virologic suppression (HIV viral load ,400 copies/mL). Multivariate logistic regression analysis was performed to identify independent predictors of ART non-adherence. Results: The overall median (interquartile range) ART adherence was 99% (96.5–100) (N = 82). Seventy-six percent of adolescents had excellent pill count ART adherence levels and 94% achieved virologic suppression. Male adolescents made up 65% of the non-adherent group (P = 0.02). Those who displayed suboptimal ART adherence were more likely to report having ever missed ART doses due to failure to pick up medication at the pharmacy (30.0% versus 9.7%, P = 0.03). In the multivariate logistic regression model, male sex (odds ratio [OR] 3.29, 95% confidence interval [CI] 1.13–9.54; P = 0.03) was the only factor which was independently associated with suboptimal ART adherence. […]

Read More…

SPATIAL VARIATION OF VOLATILE ORGANIC COMPOUNDS AND CARBON MONOXIDE IN BLANTYRE CITY, MALAWI

This study assessed variations of ambient volatile organic compounds and carbon monoxide (CO) levels in Blantyre City, Malawi. Volatile organic compounds and carbon monoxide measurement was done using the Multi-Gas Monitor between August and December, 2010. Rapid urbanization and lack of standard enforcement on air pollution as well as lack of data on pollutant levels in the city prompted this study. The study focused on methane volatile organic compounds and non-methane volatile compounds besides carbon monoxide. Results of the analysis showed that non-methane volatile compound levels were highest at public bus terminuses with 12.40 ± 0.83 ppm, and lowest for industrial locations (2.16 ± 0.09 ppm). However, all points registered zero (0.00) ppm for methane volatile organic compounds. Similarly, mean levels of carbon monoxide were highest at public bus terminuses with 10.92 ± 0.74 ppm, and lowest for industrial locations (1.11 ± 0.13 ppm). With the exception of Ginnery Corner, all the sampling points had levels of both parameters within the air quality standards. The study revealed a spatial and diurnal variation of the pollutants in all sampling points. It further revealed that the sources of these pollutants are diverse with vehicular emissions being the main source for Masauko Chipembere highway. […]

Read More…

STATISTICAL MODELING OF SOCIAL RISK FACTORS FOR SEXUALLY TRANSMITTED DISEASES AMONG FEMALE YOUTHS IN NIGERIA

Introduction:

Sexually transmitted diseases (STDs) are preventable, but the social risks factors connected to them are often not understood, particularly by female youths. There has been a dearth of information on the identification of social risk factors influencing STDs among female youths in Nigeria, hence we conducted this study. Methodology: This retrospective cross-sectional study utilized the Nigeria Demographic and Health Survey, 2008. It focused on female youths aged 15-24 (n=7,736) who ever had sexual intercourse. Data was analyzed using Chi-square and logistic regression models. Results: The mean age of the respondents was 20.2±2.5years. More female youths aged between 20 and 24 years contracted STDs in the last 12 months (2.5%) than those between the ages of 15 and 19 months (1.4%). A year prevalence of STDs among female youths in Nigeria was 2.1%. Socio-demographic factors such as age, education, wealth index, marital status, shared toilet, residence, contraceptive use, and total life-time number of sexual partners were found to be associated risk factors for contracting STDs (p<0.05). Controlling for potential confounding variables at the fifth iteration, the identified predictors of contracting STDs were wealth index, total lifetime number of sexual partners, awareness of HIV/AIDS, and shared toilet facility (p<0.05). Conclusions: The data confirmed the considerable impact of wealth index and awareness of HIV/AIDS as important predictors of STDs acquisition. Providing free condoms, along with teaching the importance of abstinence and improving knowledge of HIV/AIDS, can help to reduce the risk of STDs transmission. [...]

Read More…

PERSPECTIVES ON THE ROLE OF STAKEHOLDERS IN KNOWLEDGE TRANSLATION IN HEALTH POLICY DEVELOPMENT IN UGANDA

Stakeholder roles in the application of evidence are influenced by context, the nature of the evidence, the policy development process, and stakeholder interactions. Past research has highlighted the role of stakeholders in knowledge translation (KT) without paying adequate attention to the peculiarities of low-income countries. Here we identify the roles, relations, and interactions among the key stakeholders involved in KT in Uganda and the challenges that they face. […]

Read More…

NON-ATTENDANCE FOR OUT-PATIENT PHYSIOTHERAPY: EVALUATION PREDICTION AND PHYSIOTHERAPISTS’ PERCEPTION-A CROSS SECTIONAL STUDY

Non-attendance constitutes significant challenge at outpatient physiotherapy clinics. This study sought to estimate the rate of non-attendance for out-patient physiotherapy, to identify patients at risk of missing an appointment using a prediction model and to assess the perceptions of physiotherapists on factors influencing patient’s non-attendance. Materials and Methods: A 3-year retrospective audit of a Nigerian teaching hospital out-patient physiotherapy clinic was carried out. 1069 case charts were reviewed but only 930 were found valid for analysis. Data were gleaned on socio-demographic variables (age, sex, month of appointment and location of residence), referrer and diagnosis. The cross-sectional part of the study involved 60 consenting physiotherapists from selected hospitals from south-west, Nigeria. An adapted questionnaire was used to elicit perceived factors for patients’ non-attendance. Descriptive statistics of percentages were used to summarize data. Inferential statistics of logistic regression was used to obtain the predictive model for non-attendance at 0.05 alpha level. […]

Read More…

REHABILITATION OF BACK EXTENSOR MUSCLES’ INHIBITION IN PATIENTS WITH LONG-TERM MECHANICAL LOW-BACK PAIN

Long-term mechanical low-back pain (LBP) results in inhibition and atrophy of the deep segmental muscles such as multifidus and overactivity of the longer superficial muscles of the trunk with resultant decreased dynamic activity and increased fatiguibility [1–4]. Long-term mechanical LBP is more difficult to treat [5–7] and treatment outcomes give variable results [8–10] and it consequently results in both physical and psychological deconditionings that trap the patient in a vicious circle characterized with decreased physical performance, exacerbated nociceptive sensations, depression, impaired social functioning, and work disability [11]. […]

Read More…

PRACTICE, KNOWLEDGE AND PERCEPTIONS OF ANTENATAL CARE SERVICES AMONG PREGNANT WOMEN AND NURSING MOTHERS IN SOUTHWEST NIGERIA

High maternal death in Nigeria is a concern to public health practitioners. Knowledge and perception of antenatal care (ANC) by pregnant women and nursing mothers are important in usage of ANC facilities. This study bridged existing gap in inadequate report of perception and knowledge about ANC services. We conducted cross-sectional study among 460 randomly selected pregnant women and nursing mothers in Okitipupa local government area and used questionnaire to collect data on antenatal issues. ANC Knowledge was measured using point scores. We analyzed the data using descriptive statistics and Chi-square test (α=5.0%). Almost two third of respondents (64.1%) had negative perception about ANC. ANC know-ledge of about 15% was good, 61.1% moderate and 58(12.9%) was low. Age, husbands’ education level, place of ANC ser-vice, sources of information about ANC were significantly associated to knowledge and perceptions of ANC. Knowledge and utilization of ANC were high, but perception was inadequate. […]

Read More…

RISK FACTORS IN THE TRANSMISSION OF TUBERCULOSIS IN NAIROBI : A DESCRIPTIVE EPIDEMIOLOGICAL STUDY

Tuberculosis is an infectious disease with an estimated 1.45 million deaths every year. Many patients get infected as a result of ignorance of the risk factors that contribute to disease transmission. A descriptive epidemiological study was conducted on 258 patients presenting with pulmonary tuberculosis. Patients’ sputa were collected for laboratory analysis and patients were required to respond to a structured questionnaire on risk factors for transmission. Data among stratified groups were compared using bivariate analysis. Statistical significance was considered at p < 0.05. [...]

Read More…

FACTORS ASSOCIATED WITH NOT TESTING FOR HIV AND CONSISTENT CONDOM USE AMONG MEN IN SOWETO, SOUTH AFRICA

Besides access to medical male circumcision, HIV testing, access to condoms and consistent condom use are additional strategies men can use to prevent HIV acquisition. We examine male behavior toward testing and condom use. Objective: To determine factors associated with never testing for HIV and consistent condom use among men who never test in Soweto.Methods: A cross-sectional survey in Soweto was conducted in 1539 men aged 18–32 years in 2007. Data were collected on socio-demographic and behavioral characteristics to determine factors associated with not testing and consistent condom use. […]

Read More…

HUMAN FACTORS AFFECTING THE QUALITY OF ROUTINELY COLLECTED DATA IN SOUTH AFRICA

Evaluations that have looked at the people aspect of the health information system in South Africa have only focused on the availability of human resources and not on competence or other behavioural factors.

Using the Performance of Routine Information System Management (PRISM) tool that assumes relationships between technical, behavioural and organizational determinants of the routine information processes and performance, this paper highlights some behavioural factors affecting the quality of routinely collected data in South Africa.

In the context of monitoring maternal and child health programmes, data were collected from 161 health information personnel in 58 health facilities and 2 district offices from 2 conveniently sampled health districts. A self-administered questionnaire was used to assess confidence and competence levels of routine health information system (RHIS) tasks, problem solving and data quality checking skills, and motivation. […]

Read More…