African Health Sciences <p>African Health Sciences is an open access, free online, internationally refereed journal publishing original articles on research, clinical practice, public health, policy, planning, implementation and evaluation, in the health and related sciences relevant to Africa and the tropics. African Health Sciences acknowledges support provided by the African Health Journals Partnership Project that is funded by the US National Institutes of Health (through the National Library of Medicine and the Fogarty International Center) and facilitated by the Council of Science Editors.</p> <p>Indexed on MEDLINE/PUBMED; PUBMED CENTRAL; African Index Medicus; HINARI; Bioline; AJOL; Science Citation Index - Clarivate (Thompson Reuters)&nbsp;<strong>Impact factor (2018):</strong> <strong>0.842. CiteScore (2018): 0.99.</strong></p> <p>Other websites related to this journal include:&nbsp; <a title="" href="" target="_blank" rel="noopener"></a></p> <p>African Health Sciences encourages authors to now submit their papers online to the following website: <a title="" href="" target="_blank" rel="noopener"></a></p> Makerere University Medical School (Uganda) en-US African Health Sciences 1680-6905 <strong>A. </strong><strong>AFRICAN HEALTH SCIENCES OPEN ACCESS POLICY</strong><br /><p>While African Health Sciences has been freely accessible online there have been questions on whether it is Open Access or not. We wish to clearly state that indeed <strong>African Health Sciences is Open Access.</strong> There are key issues regarding Open Access needing clarification for avoidance of doubt:</p><ol><li><em>1. </em><em>Henceforth, papers in African Health Sciences will be published under the CC BY (Creative Commons Attribution License) 4.0 International. See details on </em><a href=""><em></em></a><em>)</em></li><li><em>2. </em><em>The copyright owners or the authors grant the 3<sup>rd</sup> party (perpetually and in advance) the right to disseminate, reproduce, or use the research papers in part or in full, format/medium as long as:</em></li></ol><ul><li><em>No substantive errors are introduced in the process</em></li><li><em>Attribution of authorship and correct citation details are given</em></li><li><em>The referencing details are not changed. </em></li></ul><p><em>Should the papers be reproduced in part, this must be clearly stated.</em></p><ol><li><em>3. </em><em>The papers will be freely and universally accessible online in an easily readable format such as XML in at least one widely recognized open access repository such as PUBMED CENTRAL.</em></li></ol><p><em>B. </em><strong>ABRIDGED LICENCE AGREEMENT BETWEEN AUTHORS AND <em>African Health Sciences</em></strong></p><p>I submitted my manuscript to <em>African Health Sciences</em> and would like to affirm that: <strong></strong></p><p><strong>1.0 </strong><strong> I am authorized by my co-authors to enter into these arrangements.</strong></p><p><strong>2.0 I </strong><strong>guarantee</strong><strong>, on behalf of self and co-authors:</strong><strong></strong></p><ul><li>That the paper is original, and has not been published in any other peer-reviewed journal; nor is it under consideration by other journal (s). It does not infringe existing copyright or any other person’s rights</li></ul><p> </p><ul><li>That we are/I am the sole author(s) of the paper and with authority to enter into this agreement. My granting rights to <em>African Health Sciences</em> is not in breach of any other obligation</li></ul><p> </p><ul><li>That the paper contains nothing unlawful, or libelous. Nor anything that would constitute a breach of contract, confidence or commitment given to secrecy, if published</li></ul><p> </p><ul><li>That I/we have taken care to ensure the integrity of the article.</li></ul><p>3.0 <strong> I and all co-authors, agree that</strong> the paper, if accepted for publication, shall be licensed under the <a href="" target="_self">Creative Commons Attribution License 4.0</a>. (see <a href=""></a>)</p> AFYA BORA CONSORTIUM FELLOWSHIP: a journey of success in Global Health Leadership Training <p>Nil.</p> Onesmus Gachuno Theresa Odero Esther Seloilwe David Urassa Edith Tarimo Damalie Nakanjako Nelson Sewankambo Ndeso S Atanga Edie G Halle-Ekane Yukari Manabe Kristin N Hosey Susan A Chapman Douglas J Wiebe Joachim Voss Gabrielle O’Malley Yohana Mashalla Margaret Ndegwa Jarim Omogi Carey Farquhar Judith N Wasserheit Copyright (c) 2021-05-23 2021-05-23 21 i ii 10.4314/ahs.v21i.1S Editor’s choice <p>Nil.</p> James K Tumwine Copyright (c) 2021-05-23 2021-05-23 21 iii iii 10.4314/ahs.v21i. Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary Hospital in Kenya <p><strong>Background:</strong> Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure.</p> <p><strong>Objective:</strong> To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya.</p> <p><strong>Methodology:</strong> A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet.</p> <p><strong>Results:</strong> A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load &lt;1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load &gt; 1000 copies/ ml p&lt;0.012.</p> <p><strong>Conclusion:</strong> The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years).</p> <p><strong>Keywords:</strong> Adolescents; HIV; Kenya; virologic suppression; young adults.</p> Patrick Mburugu Peter Muiruri Nelly Opiyo Justus Simba Jane Adunda Rosemary Kawira Onesmus Gachuno Copyright (c) 2021-05-23 2021-05-23 21 1 7 10.4314/ahs.v21i.2S Evaluation of quality of life and associated factors among HIV patients on antiretroviral therapy in North West region of Cameroon <p><strong>Background:</strong> There is evidence that Quality of Life (QoL) of People Living with HIV/AIDS (PLHIV) has a significant role in ART retention, treatment adherence, and survival. As a result, QoL is becoming increasingly important for policy- makers, program implementers, and researchers. However, factors associated with QoL, in a culturally diverse country like Cameroon are unknown.</p> <p><strong>Objective:</strong> We aimed to assess the QoL of PLHIV on ART and assess the extent to which physical, psychosocial, environ- mental, and spiritual factors drive QoL.</p> <p><strong>Method:</strong> A cross-sectional study was conducted among 394 PLHIV aged &gt;21 in North-West Cameroon from April to July 2019. Data were collected using WHO-QOL BREF questionnaire. Descriptive statistics, bivariate, and multivariate linear regression analyses were performed.</p> <p><strong>Results:</strong> Majority (34.5%) of participants were in the age range of 41-50, with 73% females. The average QoL of the re- spondents was “good” with mean score of 3.57 on 5 and 71.4% agreed to have satisfactory QoL. Bivariate regression anal- yses revealed that all six proposed predictors were significantly associated with QoL. Psychological factors made the greatest impact (β = 0.213; p&lt;0.003), followed by physical factors (β = 0.19; p&lt;0.001).</p> <p><strong>Conclusion:</strong> PLHIV fairly agreed to have good QoL. The QoL was driven by mainly psychological and physical factors and not level of independence. However, the mean score perceptions for the investigated domains were low. Mental health ser- vices should consider these predictors when designing strategies to improve the QoL of PLHIV. While this study provides useful insights, other possible drivers of QoL among PLHIV should be investigated.</p> <p><strong>Keywords:</strong> Quality of life and associated factors; HIV patients; antiretroviral therapy; Cameroon.</p> Anissette N Busi Marius Nsoh Moses O Otieno Sylvester A Ndeso Gregory E Halle-Ekane Copyright (c) 2021-05-23 2021-05-23 21 8 17 10.4314/ahs.v21i.3S Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub County Hospital, Homa Bay- Kenya <p><strong>Background:</strong> Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adoles- cents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance.</p> <p><strong>Objectives:</strong> To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression.</p> <p><strong>Methods:</strong> This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups.</p> <p><strong>Results:</strong> According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression χ2 (2) = 0.280, p = 0.869 (&gt; 0.05).</p> <p><strong>Conclusion:</strong> The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were signif- icant predictors of viral suppression, and therefore adherence to antiretroviral therapy.</p> <p><strong>Keywords:</strong> Adherence; clinic attendance; antiretroviral therapy; HIV; virologic suppression.</p> William N Tanyi Onesmus Gachuno Theresa Odero Carey Farquhar David Kimosop Allan Mayi Copyright (c) 2021-05-23 2021-05-23 21 18 24 10.4314/ahs.v21i.4S Short report: knowledge and perceptions of health workers that strengthen adherence for paediatric and adolescent clients on the intensive adherence counselling program in Kampala, Uganda. A qualitative study <p><strong>Background:</strong> Health care workers (HWs) support HIV positive children and adolescents with detectable HIV viral loads on the intensive adherence counselling (IAC) program to achieve viral suppression through individual adherence counselling. Low re-suppression rates of 23% showed low program effectiveness in fifteen public health facilities.</p> <p><strong>Objectives:</strong> We set out to determine the knowledge and perceptions of HWs that support this program to improve its effectiveness.</p> <p><strong>Methods:</strong> We conducted a qualitative study where five HWs that oversee clinical care for children on ART were interviewed about the program. Data on their knowledge of the program, and perceptions on why it was not effective was collected. Thematic analysis using the inductive approach was used. Transcripts were read, coded and emergent themes determined.</p> <p><strong>Results:</strong> Five HWs participated and all were knowledgeable about the program. Two themes emerged as barriers to IAC program effectiveness, patient factors and health system factors. Patient factors were failure to attend appointments, failure to change adherence practices, and lack of consent. Health system factors were work overload, delay in getting results and drug stock outs.</p> <p><strong>Conclusion:</strong> HWs are knowledgeable about the IAC program and client specific barriers should be addressed to improve viral suppression for children.</p> <p><strong>Keywords:</strong> Intensive adherence counselling; health care worker barriers.</p> Esther Nasuuna Joanita Kigozi Alex Muganzi Nelson Sewankambo Damalie Nakanjako Copyright (c) 2021-05-23 2021-05-23 21 25 28 10.4314/ahs.v21i.5S Predictors of antiretroviral therapy interruptions and factors influencing return to care at the Nkolndongo Health District, Cameroon <p>Background: Antiretroviral therapy is a lifelong commitment that requires consistent intake of tablets to optimize health outcomes, attain and maintain viral suppression. Objective: We aimed to elicit predictors of treatment interruption amongst PLHIV and identify motivating factors influ- encing return to care. Method: We conducted a cross-sectional study using a mixed-method approach in four hospitals in Yaoundé. Sociodemo- graphic and clinical data were collected from ART registers. Using purposeful sampling, thirteen participants were enrolled for interviews. Quantitative data were analyzed using Epi-Info and Atlas-TI for qualitative analysis. Ethical clearance ap- proved by CBCHS-IRB. Results: A total of 271 participants records were assessed. The mean age was 33 years (SD±11years). Private facilities CASS and CMNB registered respectively 53 (19.6%) and 14 (5.2%) participants while CMA Nkomo and IPC had 114 (42.1%) and 90 (33.2%) participants. Most participants (75.3%) were females [OR 1.14; CI 0.78-1.66] compare with males. 78% had no viral load test results. Transport cost and stigmatization constituted the most prominent predictors of treatment interruption (47.5%) and (10.5%) respectively. Belief in the discovery of an eminent HIV cure and the desire to raise offspring motivated 30% and 61%, respectively to resume treatment. Conclusion: Structural barriers like exposed health facility, and dispensing ARVs in open spaces stigmatizes clients and increases odds of attrition. Attrition of patients on ART will be minimized through implementation of client centered ap- proaches like multiplying proxy ART pick points, devolving stable clients to community ARV model.</p> <p>Keywords: ART interruption; attrition; return to care; predictors; motivating factors; Cameroon.</p> Marius Nsoh Katayi E Tshimwanga Busi A Ngum Avelina Mgasa Moses O Otieno Bokwena Moali Nathanael Sirili Ndeso S Atanga Gregory Edie Halle-Ekane Copyright (c) 2021-05-23 2021-05-23 21 29 38 10.4314/ahs.v21i.6S Retention of pediatric patients in care: a study of the Kibera Community Health Center HIV/AIDS Program <p><strong>Background:</strong> In 2011, 3.4 million children were living with HIV worldwide1.</p> <p><strong>Objectives:</strong> Describe the characteristics of pediatric patients enrolled into the HIV program at the Kibera community health center between January 2012 and March 2013. Determine the proportion of enrolled paediatric patients lost to follow up. Determine the correlates associated with retention and loss to follow up.</p> <p><strong>Methods:</strong> The study was a retrospective cohort study of program data of all pediatric patients enrolled into the HIV pro- gram in the facility between January 2012 and March 2013. The data was analyzed using SPSS.</p> <p><strong>Results:</strong> Of the 100 pediatric patients enrolled during the study period, 79 and 21 were HIV negative and positive respec- tively. Only 4 (5%) of the HIV exposed Infants and 11 (52%) of the HIV positive children were started on ART within the study period. The retention rate of the children at 3 months was 87% while the retention at both 12 and 15 months was 79%. There was an association between the mother or guardian disclosing their status and the retention of the child (p-value 0.026).</p> <p><strong>Conclusion:</strong> The disclosure of the HIV status by parent/guardian to the child was associated with better retention of the children in the program.</p> <p><strong>Keyword:</strong> Pediatric patients in care; Kibera community health center; HIV/AIDS.</p> Sara K Muli-Kinagwi Meshack Ndirangu Onesmus Gachuno Samuel Muhula Copyright (c) 2021-05-23 2021-05-23 21 39 43 10.4314/ahs.v21i.7S Safe birth matters: facilitators and barriers to uptake of the WHO safe childbirth checklist tool in a Tanzania Regional Hospital <p><strong>Background:</strong> The World Health Organization (WHO) developed the Safe Birth Checklist (SCC) to facilitate best practices in safe birthing practices. The SCC is utilizing existing evidence-based WHO guidelines and recommendations which has combined those into a single and practical bedside tool. The SCC is the first checklist-based intervention to target the pre- vention of maternal and neonatal deaths.</p> <p><strong>Objective:</strong> The objective of this project was to pilot-test the World Health Organization Safe Childbirth Checklist with Maternity Regional Hospital in, Tanzania.</p> <p><strong>Study Design and Methods:</strong> Retrospective analysis on 35 charts were completed to identify presence or absence of docu- mentation aligned with evidenced based checklist items. Staff training, end user observations and focus group discussions were utilized to elicit feedback about the tool and the process. Descriptive statistics and manual content analysis were used to analyze the rate of uptake and ownership over the checklist. The Checklist is broken down into four sections or time points (that are considered natural pause points in the care of laboring women). The four different pause points are admission, delivery, post-partum, and discharge.</p> <p><strong>Results:</strong> We trained 26 participants out of 32 staff how to use the SCC. Delivery time point had the lowest at SCC comple- tion rate at 39% compared to discharge having the highest completion rate at 93%. There was variation in completion rate of the checklist items at each time point. Checklist items at the beginning of each time point were completed between 94% and 100% of the time with the latter checklist list items completed between 29% and 57% of the time.</p> <p><strong>Conclusion:</strong> This project was able to identify facilitators and potential barriers to the successful uptake of the Safe Child- birth Checklist in Shinyanga Regional Hospital. Based on these findings, the MOH have opportunities to utilize those find- ings in the scale-up of the implementation of the checklist and future evaluation activities.</p> <p><strong>Keywords:</strong> Safe birth matters; WHO safe childbirth checklist tool; Tanzania Regional Hospital.</p> Joycelyn Thomas Joachim Voss Edith Tarimo Copyright (c) 2021-05-23 2021-05-23 21 44 50 10.4314/ahs.v21i.8S Health care workers experiences in emergency obstetric care following implementation of an in-service training program: case of 2 Referral Hospitals in Botswana <p><strong>Background:</strong> Maternal mortality rate remains a challenge in many developing countries.</p> <p><strong>Objectives:</strong> This study explored experiences of Health Care Workers on Emergency Obstetrics Care (EMOC) in-service training and its effect on maternal mortality.</p> <p><strong>Methods:</strong> Descriptive qualitative study design was conducted using in-depth interviews and focus group discussions. Par- ticipants were EMOC trained midwives and doctors purposively selected from the 2 referral hospitals in the country. Data were transcribed verbatim, coded, and analysed using Grounded Theory approach.</p> <p><strong>Results:</strong> Four themes emerged including training, EMOC implementation, maternal death factors and EMOC prioritisation. The duration of training was viewed inadequate but responsiveness to and confidence in managing obstetric emergencies improved post EMOC training. Staff shortage, HCWs non-adherence and negative attitude to EMOC guidelines; delays in instituting interventions, inadequate community involvement, minimal or no health talk to women and their partners and communities on sexual reproductive matters and non-prioritisation of EMOC by authorities were concerns raised.</p> <p><strong>Conclusion:</strong> Strengthening health education at health facility levels, stakeholders’ involvement; and prioritising EMOC in-service training are necessary in reducing the national maternal mortality.</p> <p><strong>Keywords:</strong> Maternal mortality; health care workers; EMOC, in-service training.</p> Ludo Nkhwalume Yohana Mashalla Copyright (c) 2021-05-23 2021-05-23 21 51 58 10.4314/ahs.v21i.9S Uptake and outcomes of early infant male circumcision services in four counties in Western Kenya <p><strong>Background:</strong> Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%.</p> <p><strong>Objectives:</strong> To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised.</p> <p><strong>Methods:</strong> A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program.</p> <p><strong>Results:</strong> A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of facilities offering EIMC while Migori had the lowest proportion. Uptake of EIMC was low at 17.4% for all male infants born, far less than the anticipated target of 40%. Average adverse event rates were 0.3%.</p> <p><strong>Conclusion:</strong> EIMC uptake remains low in this region of Kenya due to small number of health facilities offering the service. The proportion of circumcised early male infants born at the target health facilities is below the national target of 40% even though the rate of adverse events among those circumcised is acceptable.</p> <p><strong>Keywords:</strong> Adverse event; circumcision; early male infant; uptake; western Kenya.</p> Thomas Okwaro Andale Onesmus Gachuno Theresa Odero Mary Awuor Copyright (c) 2021-05-23 2021-05-23 21 59 63 10.4314/ahs.v21i.10S The utility of a modified W.H.O. TB screening tool among children at a Botswana child welfare clinic <p><strong>Background:</strong> In high TB/HIV settings, the increased risk for TB amongst children exposed to HIV has been established through biomedical tests. Screening HIV exposed children for TB can improve early childhood TB detection and treatment.</p> <p><strong>Objective:</strong> This study assessed the utility of a modified World Health Organization (WHO) tool by including HIV variables, to determine TB exposure amongst HIV exposed children presenting to a “Well Child” Clinic (CWC).</p> <p><strong>Methods:</strong> Clinical data were obtained from medical records and/or from the caregivers of children presenting to CWC. Data was analyzed to explore factors associated with positive screening for TB, including being exposed to HIV and current HIV status.</p> <p><strong>Results:</strong> Five percent (55/1100) screened reported a close TB contact and 21% (n=231) had positive TB symptom screen. History of close TB contact was a risk factor for positive screening for TB symptoms (OR 1.89 CI 1.05-3.4) while being HIV negative was protective (OR 0.3, Cl 0.19-0.62). HIV exposure was associated with increased risk of TB exposure (OR 2.9 CI 1.61-5.19).</p> <p><strong>Conclusion:</strong> Integrating HIV variables in the existing WHO screening tool for childhood TB can be useful in early detec- tion and treatment of TB in HIV exposed children in resource limited settings.</p> <p><strong>Keywords:</strong> Childhood TB screening; HIV Exposure screening; TB/HIV integration.</p> Wame Dikobe Mooketsi Molefi Bornapate Nkomo Botshelo Kgwaadira Boingotlo Gasenelwe Esther Seloilwe Yohanna Mashalla Tonya-Ascortt- Mills Copyright (c) 2021-05-23 2021-05-23 21 64 71 10.4314/ahs.v21i.11S