`Keeping Healthy in the Backseat': How Motherhood Interrupted HIV Treatment in Recently Delivered Women in Kenya

Although there is a large body of literature related to the experiences of motherhood and aspects of the change that it brings about; how the experience of motherhood affects the healthcare of women with chronic illness is less documented. This study explores how motherhood in newly delivered HIV-infected mothers in Kenya interrupted their antiretroviral treatment (ART). Qualitative interviews were performed with 26 mothers on ART in a rural or urban area. The data were organised and interpreted using content analysis. The study found that adherence to ART was influenced by contextual differences in socio-cultural expectations and family relationships. Urban life enabled women to make decisions on their own and to negotiate challenges that were often unpredictable. Women in rural areas knew what was expected of them and decisions were normally not for them to make alone. The women in Busia and Kibera had difficulties combining adherence with attaining the socio-cultural definition of good mothering. Lack of support from health providers and weak healthcare systems contributed to inadequate stocks of HIV drugs and inaccessibility of HIV-related care. From the data; we developed the main theme `keeping healthy in the backseat' and the two sub-themes `regaining self-worth through motherhood' and `mother first - patient later.' We suggest that motherhood is context-specific and follows socio-cultural practises; which made it difficult for the women in Kenya to follow ART instructions. There is a need to reassess HIV-related services for mothers on ART in order to give them a better chance to stay on treatment and satisfy their aspiration to be `good mothers.' Contextspecific HIV-treatment policies are necessary for ensuring adherence and successful treatment outcomes

Trachoma control using the who adopted "safe with azithromycin".

OBJECTIVE: To report on and share the experiences, accomplishments and lessons learnt by African Medical and Research Foundation (AMREF), Sight Savers International (SSI), University of Nairobi (UON) and the Ministry of Health (MOH) during implementation of a three year Shompole trachoma control pilot study using azithromycin. The target of the project was to reduce the prevalence of active and potentially blinding trachoma by 50% by the year 2005. DESIGN: Community based survey. SETTING: Shompole location, Magadi division, Kajiado district of the Rift Valley Province of Kenya. SUBJECTS: Five hundred and twenty six randomly selected households from 166 manyattas (bomas/ homesteads) proportionately distributed in all the 13 villages of the four sub-locations of Shompole location were visited. Nine hundred and ninety eight children (1-9 years) and 898 adults (215 years) were examined for active trachoma (TF) and potentially blinding trachoma (TT) respectively. RESULTS: The prevalence of active trachoma (TF) in children has dropped from 46.4% in 2002 to 16.0% in 2006 and that of potentially blinding trachoma (TT) from 4.5% to 1.7% in the same period. Women have more TT than men. Out of the 15 cases of TT reported in the survey, only two were recurrences. The prevalence of active trachoma (TF) is higher in boys than girls, p=0.044. The proportion of children with clean faces has not changed but the proportion of children with many (>5) flies has drastically reduced from 48.0% in 2002 to 6.0% in 2006. The community holds strong negative believes about pit latrines. The project is sustainable. CONCLUSIONS: This project has positively influenced eye care policy locally and globally. The targets for "SA" components of SAFE were achieved while "FE" components were partially achieved. RECOMMENDATIONS: The ongoing scale up of the project to cover the whole of Kajiado district is justified. Formative study and review of the project's health promotion strategy is necessary. Collaboration and joint planning with neighbouring endemic districts of Kenya and Tanzania should be encouraged because of the nomadic nature of the Maasai who are the project beneficiaries.

The prevalence of hepatitis C virus antibodies in renal patients, blood donors and patients with chronic liver disease in Kenya.

We tested serum samples from four categories of patients with nephrological problems (nephrotic syndrome, stable chronic renal failure, haemodialysis patients and renal transplant recipients), patients with chronic liver disease and volunteer blood donors for the presence of antibody to hepatitis C virus (HCV). Screening was done by second-generation enzyme linked immunosorbent assay (ELISA) and confirmation with second-generation recombinant immunoblot assay (RIBA). Of all the renal patients, only 6.3% of the transplant patients tested positive for anti-HCV, while in patients with chronic liver disease anti-HCV was detected in 2.6% of the patients with chronic hepatitis and in none with liver cirrhosis or hepatocellular carcinoma. This finding of low prevalence in these patient groups was not in keeping with findings in studies done elsewhere. Our anti-HCV prevalence of 0.9% in blood donors was comparable to that found in Europe, USA and Taiwan. We recommend that the low prevalence of anti-HCV in some of our high risk groups should not lead to complacence and hence further studies are necessary to evaluate the infectivity of anti-HCV positive patients and the potential for cross infection.

Treatment of gonorrhea with single-dose thiamphenicol in Kenya.

The efficacy of a single 2.5-g dose of thiamphenicol against infection with penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) or non-penicillinase-producing strains (non-PPNG) was studied in a two-phase clinical trial in Nairobi. The first phase included men who had had a urethral discharge for less than seven days, were infected with either PPNG or non-PPNG, and had not received previous treatment. The second phase included men with PPNG infections that had not responded to treatment with penicillin. The overall cure rate (determined by follow-up examinations and cultures three and ten days after treatment) was 90.6% in the first phase of the study and 92.1% in the second phase. A second 2.5-g dose of thiamphenicol was administered to four of the six patients in the second phase whose cultures yielded gonococci after the initial dose; the infections of all four patients were cured. The results of disk diffusion tests of gonococcal isolates did not correlate well with the outcome of treatment.