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Kenneth Munge, Stephen Mulupi, Edwine W Barasa, Jane Chuma
BACKGROUND: Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low- and middle-income countries (LMICs), and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospital Insurance Fund (NHIF) as a case study. METHODS: We applied a principal-agent relationship framework, which identifies three pairs of principal-agent relationships (government-purchaser, purchaser-provider, and citizen-purchaser) and specific actions required within them to achieve strategic purchasing...
July 18, 2017: International Journal of Health Policy and Management
Courtney L Boudreau, Howard Kress, Roger W Rochat, Kathryn M Yount
INTRODUCTION: Sexual violence (SV) against children is a global health and human rights issue that can have short and long-term consequences for health and wellbeing. Disclosing SV increases the likelihood that children can access health and protective services and receive psychosocial support. Research in high-income countries has found that child SV survivors are more likely to disclose when they are girls/women, experience fewer SV events, and experience SV perpetrated by a stranger...
February 16, 2018: Child Abuse & Neglect
Kerry A Thomson, Barbara Telfer, Patricia Opondo Awiti, Jane Munge, Mathew Ngunga, Anthony Reid
Within the first year of implementation, 43% of women who tested HIV positive at their first antenatal care visit were no longer retained and being followed in the free prevention of mother to child transmission (PMTCT) of HIV program offered by the Kenyan Ministry of Health and Médecins Sans Frontières in the informal settlement of Kibera, Nairobi. This study aimed to explore barriers to enrolling and remaining engaged in PMTCT services throughout the pregnancy and postpartum periods. Qualitative data from 31 focus group discussions and 35 in-depth interviews across six stakeholder groups that included women, men, and PMTCT service providers were analyzed...
2018: PloS One
Godfrey Bwire, Mohammad Ali, David A Sack, Anne Nakinsige, Martha Naigaga, Amanda K Debes, Moise C Ngwa, W Abdullah Brooks, Christopher Garimoi Orach
BACKGROUND: Despite advance in science and technology for prevention, detection and treatment of cholera, this infectious disease remains a major public health problem in many countries in sub-Saharan Africa, Uganda inclusive. The aim of this study was to identify cholera hotspots in Uganda to guide the development of a roadmap for prevention, control and elimination of cholera in the country. METHODOLOGY/PRINCIPLE FINDINGS: We obtained district level confirmed cholera outbreak data from 2011 to 2016 from the Ministry of Health, Uganda...
December 2017: PLoS Neglected Tropical Diseases
Anna J Rogers, Eliud Akama, Elly Weke, Justin Blackburn, George Owino, Elizabeth A Bukusi, Patrick Oyaro, Zachary A Kwena, Craig R Cohen, Janet M Turan
INTRODUCTION: Repeat HIV testing during the late antenatal period is crucial to identify and initiate treatment for pregnant women with incident HIV infection to prevent perinatal HIV transmission and keep mothers alive. In 2012, the Kenya Ministry of Health adopted international guidelines suggesting that pregnant women be offered retesting three months after an initial negative HIV test. Our objectives were to determine the current rate of antenatal repeat HIV testing; identify successes, missed opportunities and factors associated with retesting; and estimate the incidence of HIV during pregnancy...
December 2017: Journal of the International AIDS Society
Benjamin Daniels, Amy Dolinger, Guadalupe Bedoya, Khama Rogo, Ana Goicoechea, Jorge Coarasa, Francis Wafula, Njeri Mwaura, Redemptar Kimeu, Jishnu Das
Introduction: The quality of clinical care can be reliably measured in multiple settings using standardised patients (SPs), but this methodology has not been extensively used in Sub-Saharan Africa. This study validates the use of SPs for a variety of tracer conditions in Nairobi, Kenya, and provides new results on the quality of care in sampled primary care clinics. Methods: We deployed 14 SPs in private and public clinics presenting either asthma, child diarrhoea, tuberculosis or unstable angina...
2017: BMJ Global Health
V Muthee, A F Bochner, S Kang'a, G Owiso, W Akhwale, S Wanyee, N Puttkammer
INTRODUCTION: Electronic medical record (EMR) systems can yield many benefit; however, facilities need to meet certain requirements before they are able to successfully implement an EMR. We evaluated the feasibility and utility of conducting EMR readiness assessments (ERAs) to assess readiness of public facilities in Kenya for deployment of an EMR. METHOD: I-TECH supported the Ministry of Health to deploy KenyaEMR, an HIV/AIDS care and treatment EMR developed using the OpenMRS platform, at over 300 healthcare facilities in Kenya...
January 2018: International Journal of Medical Informatics
Mumbo Hazel Miseda, Samuel Odhiambo Were, Cirindi Anne Murianki, Milo Peter Mutuku, Stephen N Mutwiwa
BACKGROUND: Globally, there is an acute shortage of human resources for health (HRH), and the greatest burden is borne by low-income countries especially in sub-Saharan Africa and some parts of Asia. This shortage has not only considerably constrained the achievement of health-related development goals but also impeded accelerated progress towards universal health coverage (UHC). Like any other low-income country, Kenya is experiencing health workforce shortage particularly in specialized healthcare workers to cater for the rapidly growing need for specialized health care (MOH Training Needs Assessment report (2015))...
December 1, 2017: Human Resources for Health
Helen Smith, Charles Ameh, Pamela Godia, Judith Maua, Kigen Bartilol, Patrick Amoth, Matthews Mathai, Nynke van den Broek
Maternal death surveillance and response (MDSR) constitutes a quality improvement approach to identify how many maternal deaths occur, what the underlying causes of death and associated factors are, and how to implement actions to reduce the number of preventable stillbirths and maternal and neonatal deaths. This requires a coordinated approach, ensuring both national- and district-level stakeholders are enabled and supported and can implement MDSR in a "no name, no blame" environment. This field action report from Kenya provides an example of how MDSR can be implemented in a "real-life" setting by summarizing the experiences and challenges faced thus far by maternal death assessors and Ministry of Health representatives in implementing MDSR...
September 27, 2017: Global Health, Science and Practice
Edwin Onyango Ochomo, Harrysone Atieli, Sussy Gumo, Collins Ouma
BACKGROUND: Globally, cervical cancer is the fourth most frequent cancer in women, with an estimated 530,000 new cases in 2012, representing 7.5% of all female cancer deaths. Of the estimated more than 270,000 deaths from cervical cancer every year, more than 85% occur in less developed regions. In sub-Saharan Africa, 34.8 new cases of cervical cancer are diagnosed per 100,000 women annually, and 22.5/100,000 women die from the disease. Despite the magnitude of this problem, Kenya still has a screening rate of 3...
September 25, 2017: BMC Health Services Research
Jefitha Karimurio, Hillary Rono, Doris Njomo, John Sironka, Catherine Kareko, Michael Gichangi, Ernest Barasa, Alice Mwangi, Kefa Ronald, Francis Kiio
INTRODUCTION: The World Health Organization recommends TT surveys to be conducted in adults aged 15+ years (TT 15 survey) and certifies elimination of TT as a public health problem when there is less than 1 unknown case per 1,000 people of all ages. There is no standard survey method to accurately confirm this elimination prevalence threshold of 0.1% because rare conditions require large and expensive prevalence survey samples. The aim of this study was to develop an accurate operational research method to measure the total backlog of TT in people of all ages and detect when the elimination threshold is achieved...
2017: Pan African Medical Journal
T Gerrits, F Van Rooij, T Esho, W Ndegwa, J Goossens, A Bilajbegovic, A Jansen, B Kioko, L Koppen, S Kemunto Migiro, S Mwenda, H Bos
Infertility is a highly prevalent reproductive health condition in the global South, which often has a devastating impact on the people concerned. Yet, thus far it hardly received any attention from policy makers, Non-Governmental Organizations (NGOs) or donors working in the field of Sexual and Reproductive Health and Rights (SRHR). For this reason we have set up a project to increase knowledge and awareness about infertility and childlessness among those stakeholders and organizations and to generate insight into (possible) interventions in this field...
March 2017: Facts, Views & Vision in ObGyn
Liz Grant, Julia Downing, Emmanuel Luyirika, Mairead Murphy, Liz Namukwaya, Fatia Kiyange, Mackuline Atieno, Emilly Kemigisha-Ssali, Jenny Hunt, Kaly Snell, Scott A Murray, Mhoira Leng
BACKGROUND: The WHO is calling for the integration of palliative care in all health care settings globally. METHODS: A 3.5-year program was implemented in 12 government hospitals, three each in Kenya, Rwanda, Uganda and Zambia. A four-pillared approach of advocacy, staff training, service delivery strengthening and international and regional partnership working was utilized. A baseline assessment was undertaken to ascertain needs, and 27 indicators were agreed to guide and evaluate the intervention...
June 2017: Journal of Global Health
Kristie L Ebi, Mariam Otmani Del Barrio
BACKGROUND: There is limited published evidence of the effectiveness of adaptation in managing the health risks of climate variability and change in low- and middle-income countries. OBJECTIVES: To document lessons learned and good practice examples from health adaptation pilot projects in low- and middle-income countries to facilitate assessing and overcoming barriers to implementation and to scaling up. METHODS: We evaluated project reports and related materials from the first five years of implementation (2008-2013) of multinational health adaptation projects in Albania, Barbados, Bhutan, China, Fiji, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Philippines, Russian Federation, Tajikistan, and Uzbekistan...
June 20, 2017: Environmental Health Perspectives
Mitsuru Toda, Ian Njeru, Dejan Zurovac, David Kareko, Shikanga O-Tipo, Matilu Mwau, Kouichi Morita
Outbreaks of epidemic diseases pose serious public health risks. To overcome the hurdles of sub-optimal disease surveillance reporting from the health facilities to relevant authorities, the Ministry of Health in Kenya piloted mSOS (mobile SMS-based disease outbreak alert system) in 2013-2014. In this paper, we report the results of the qualitative study, which examined factors that influence the performances of mSOS implementation. In-depth interviews were conducted with 11 disease surveillance coordinators and 32 in-charges of rural health facilities that took part in the mSOS intervention...
2017: PloS One
Kathy Moscou, Jillian C Kohler
BACKGROUND: The Kenyan government has sought to address inadequacies in its National Pharmaceutical Policy and the Pharmacy and Poisons Board's (PPB) medicines governance by engaging with global actors (e.g. the World Health Organization). Policy actors have influenced the way pharmacovigilance is defined, how challenges are understood and which norms are requisite to address drug safety issues. In this paper, we investigate the relationship between specific modes of engagement among global (exogenous) and domestic actors at the national and sub-national level to identify the positive or negative effect on pharmacovigilance and pharmacogovernance in Kenya...
March 23, 2017: Globalization and Health
Craig R Cohen, Daniel Grossman, Maricianah Onono, Cinthia Blat, Sara J Newmann, Rachel L Burger, Starley B Shade, Norah Bett, Elizabeth A Bukusi
OBJECTIVES: To determine if integration of family planning (FP) and HIV services led to increased use of more effective contraception (i.e. hormonal and permanent methods, and intrauterine devices) and decreased pregnancy rates. DESIGN: Cohort analysis following cluster randomized trial, when the Kenya Ministry of Health led integration of the remaining control (delayed integration) sites and oversaw integrated services at the original intervention (early integration) sites...
2017: PloS One
Jeremiah Laktabai, Adriane Lesser, Alyssa Platt, Elisa Maffioli, Manoj Mohanan, Diana Menya, Wendy Prudhomme O'Meara, Elizabeth L Turner
INTRODUCTION: There are concerns of inappropriate use of subsidised antimalarials due to the large number of fevers treated in the informal sector with minimal access to diagnostic testing. Targeting antimalarial subsidies to confirmed malaria cases can lead to appropriate, effective therapy. There is evidence that community health volunteers (CHVs) can be trained to safely and correctly use rapid diagnostic tests (RDTs). This study seeks to evaluate the public health impact of targeted antimalarial subsidies delivered through a partnership between CHVs and the private retail sector...
March 20, 2017: BMJ Open
Sammy M Njenga, Henry M Kanyi, Faith M Mutungi, Collins Okoyo, Hadley S Matendechero, Rachel L Pullan, Katherine E Halliday, Simon J Brooker, C Njeri Wamae, Joyce K Onsongo, Kimberly Y Won
BACKGROUND: Lymphatic filariasis (LF) is a debilitating disease associated with extensive disfigurement and is one of a diverse group of diseases referred to as neglected tropical diseases (NTDs) which mainly occur among the poorest populations. In line with global recommendations to eliminate LF, Kenya launched its LF elimination programme in 2002 with the aim to implement annual mass drug administration (MDA) in order to interrupt LF transmission. However, the programme faced financial and administrative challenges over the years such that sustained annual MDA was not possible...
February 22, 2017: Parasites & Vectors
T Volkmann, D Okelloh, J Agaya, K Cain, B Ooko, T Malika, D Burton
Leveraging an existing community health strategy, a contact tracing intervention was piloted under routine programmatic conditions at three facilities in Kisumu County, Kenya. Data collected during a 6-month period were compared to existing programmatic data. After implementation of the intervention, we found enhanced programmatic contact tracing practices, noting an increase in the proportions of index cases traced, symptomatic contacts referred, referred contacts presenting to a facility for tuberculosis screening, and eligible contacts started on isoniazid preventive therapy...
December 21, 2016: Public Health Action
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