Communicating about sex: adolescents and parents in Kenya.

PIP: To guide the development of adolescent reproductive health programs in Kenya, a national IEC survey was conducted with 1476 adolescents 15-19 years of age and 2894 of their parents. The survey was conducted in 1994 by the Johns Hopkins University Population Communication Services, in collaboration with the Kenyan National Council for Population Development and the Central Bureau of Statistics. Both parents and children were most likely to report having discussed school, future careers, and alcohol/drug use during the year preceding the survey; topics least likely to be discussed included boy-girl relationships, acquired immunodeficiency syndrome (AIDS), sexual relations, abortion, contraception, and puberty. Mothers were more likely to discuss reproductive health issues with their children than fathers. Both male and female adolescents indicated they would be most comfortable discussing sexual matters with their same-sex siblings, friends, and health care workers. Over 75% of children and adults were supportive of school-based family life education programs. In many cases, parents lacked correct information about reproductive health issues. Interventions designed to facilitate parent-child communication include a weekly call-in radio program, a comic book that encourages teens to talk to their parents, and a booklet for parents suggesting ways of initiating discussions on sexual issues.^ieng

[Integration of STD services. How to reach and involve men and women]. / Integration des services MST. Comment toucher et impliquer les hommes et les femmes.

PIP: In Kenya, a sexually transmitted disease (STD) program implemented in 10 medical centers in Nairobi allows nurses to diagnose syphilis based on symptoms, have blood tests conducted to confirm syphilis, prescribe treatment, and provide counseling. About 5% of pregnant women in Kenya have syphilis but do not know that they are infected or are afraid to seek sexually transmitted disease treatment in health centers. This program tests all pregnant women for syphilis during the prenatal examination. Once syphilis is confirmed, the nurse educates the pregnant woman about syphilis and tells her that syphilis poses a risk to her baby and that she can be treated for syphilis. The nurse must also emphasize the need to treat the pregnant woman's sexual partner. Even though most women agree that the partner must be informed, many fear that the partner will react violently. Each pregnant woman with syphilis receives several partner notification cards asking the partner to go to a health center. The card does not mention syphilis. Once at the center, the man is told that his partner has syphilis. He is told that syphilis can affect the baby. Usually, the men are concerned about the baby. The men receive education on condom use and sexual practices because they have more control and initiative in sexual activity matters. Even though the men and women are advised to abstain from sexual intercourse for a week after treatment, some men have difficulty following this advice. The nurse discusses options relevant to both sexes (e.g., condom use with all partners). It is difficult for women to propose condom use because these decisions are to be made by the men. Women can learn how to use a condom and how to persuade her partner to use the condom. Some women sleep in a separate room or return to their family if their partner insists on sexual intercourse. Almost all pregnant women involved in the project were successfully treated and their partners were informed. More than 50% of the partners were successfully treated. The nurses are pleased with the program.^ieng

Syphilis control in pregnancy: decentralization of screening facilities to primary care level, a demonstration project in Nairobi, Kenya.

A decentralized syphilis control program in pregnant women was implemented in nine Nairobi City Council antenatal clinics between July 1992 and August 1993, whereby pregnant women were screened for syphilis, treated before leaving the clinic if RPR seroreactive, and counselled on the importance of partner treatment and sexual abstinence during treatment in order to protect their unborn babies from getting congenital syphilis. A total of 13,131 pregnant women were screened for syphilis (RPR test), 87.3% of seroreactive women were treated on site and 50% of partners returned to the clinic and were treated. The prevalence of RPR reactivity was 6.5%. Based on other data the program could theoretically have prevented 413 cases of congenital syphilis at a cost of approximately 50 USD per prevented case. This demonstration project shows that decentralized prevention of congenital syphilis in antenatal clinics by nurses is feasible and inexpensive and should receive priority in resource allocation in reproductive health and child survival programs.