This document discusses several issues related to HIV/AIDS in Kenya:
- Kenya has one of the world's worst HIV/AIDS epidemics, with an estimated 1.5 million people living with HIV. While prevalence has declined, only about half of those eligible receive treatment.
- Access to antiretroviral treatment has increased in recent years but remains low for children. Post-exposure prophylaxis and voluntary medical male circumcision can help reduce transmission rates.
- Breastfeeding provides crucial health benefits for infants and mothers but introduces risks for HIV-positive mothers, requiring antiretroviral interventions to reduce transmission through breast milk. Proper support is needed for breastfeeding to succeed.
The 5-in-1 pentavalent vaccine is now available in all Gavi-supported countries at a record low price, but only 50% of the children are being reached. Learn more about the pentavalent success story – and the challenges that remain.
In Nigeria, every year an estimated 124,000 children under the age of 5 die because of diarrhea, mainly due to unsafe water, sanitation and hygiene. Lack of adequate water and sanitation are also major causes of other diseases, including respiratory infection and under-nutrition
This presentation includes causes of maternal mortality; impact of maternal mortality; maternal health issues in northern nigeria; opportunities and strategies.
The 5-in-1 pentavalent vaccine is now available in all Gavi-supported countries at a record low price, but only 50% of the children are being reached. Learn more about the pentavalent success story – and the challenges that remain.
In Nigeria, every year an estimated 124,000 children under the age of 5 die because of diarrhea, mainly due to unsafe water, sanitation and hygiene. Lack of adequate water and sanitation are also major causes of other diseases, including respiratory infection and under-nutrition
This presentation includes causes of maternal mortality; impact of maternal mortality; maternal health issues in northern nigeria; opportunities and strategies.
Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
Safe Motherhood Program in Nepal: Challenges and Way ForwardKusumsheela Bhatta
The safe motherhood programme is one of the priority programme of Nepal. The goal of the National Safe Motherhood Program is to reduce maternal and neonatal morbidity and mortality and to improve the maternal and neonatal health through preventive and promotive activities as well as by addressing avoidable factors that cause death during pregnancy, childbirth and postpartum period. This presentation incorporates historical context, introduction, major achievements, actors, what Went Well, what didn’t go well, limitations, challenges, way forward of Safe Motherhood Program in Nepal.
This is the program started to benefit the labour room and maternity cases in govt sector of health care. Quality of care is import in health sectors. Providing Safe birth to the pregnent aldy even at the pheripheral level is the main intenstion of the program
The level of prevention topic will help you to know about how to prevent any particular disease in humans. Level of prevention is categorized into four
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
This presentation discusses:
Why it is a Global Health Issue?
Difference between HIV and AIDS?
Signs and Symptoms
Routes of Transmission
Risk factors
Diagnosis
Prevention
Treatment
Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
Safe Motherhood Program in Nepal: Challenges and Way ForwardKusumsheela Bhatta
The safe motherhood programme is one of the priority programme of Nepal. The goal of the National Safe Motherhood Program is to reduce maternal and neonatal morbidity and mortality and to improve the maternal and neonatal health through preventive and promotive activities as well as by addressing avoidable factors that cause death during pregnancy, childbirth and postpartum period. This presentation incorporates historical context, introduction, major achievements, actors, what Went Well, what didn’t go well, limitations, challenges, way forward of Safe Motherhood Program in Nepal.
This is the program started to benefit the labour room and maternity cases in govt sector of health care. Quality of care is import in health sectors. Providing Safe birth to the pregnent aldy even at the pheripheral level is the main intenstion of the program
The level of prevention topic will help you to know about how to prevent any particular disease in humans. Level of prevention is categorized into four
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
This presentation discusses:
Why it is a Global Health Issue?
Difference between HIV and AIDS?
Signs and Symptoms
Routes of Transmission
Risk factors
Diagnosis
Prevention
Treatment
Dr. Laura Guay, the Foundation’s Vice President of Research, also conducted a journalist training today sponsored by the National Press Foundation, teaching reporters about some of the most misunderstood issues concerning HIV and children
Patient information to complete the Soap Note. See attachment .docxssuser562afc1
Patient information to complete the Soap Note. See attachment
Family Medicine 12: 16-year-old female with vaginal bleeding and UCG
User:
Beatriz Duque
Email:
[email protected]
Date:
August 28, 2020 8:38PM
Learning Objectives
The student should be able to:
Describe the essential features of a preconception consultation, including how to incorporate this content into any visit.
Discuss chlamydia screening.
Demonstrate the use of the HEEADSS adolescent-interviewing technique.
Recognize pregnancy: intrauterine, ectopic, and miscarriage.
Discuss options during an unplanned pregnancy.
Select initial prenatal labs.
Counsel a pregnant patient for healthy behavior, folic acid supplementation, and immunizations.
Outline normal progression of symptoms and physical exam findings during pregnancy.
Demonstrate the management of a miscarriage, including the medical and social follow-up.
Knowledge
Chlamydia: Epidemiology, Course of Disease, and Screening Recommendations
Epidemiology
Chlamydial infection is the most common sexually transmitted bacterial infection in the United States. In 2007, more than 1.1 million chlamydia cases were reported to the CDC. It is thought that another million cases of chlamydia remain unreported.
Course of disease
Chlamydia is often insidious and asymptomatic. In women, genital chlamydial infection may result in urethritis, cervicitis, pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain. Chlamydial infection during pregnancy is related to adverse pregnancy outcomes, including miscarriage, premature rupture of membranes, preterm labor, low birth weight, and infant mortality.
Screening recommendations
The USPSTF found fair evidence that nucleic acid amplification tests (NAATs) can identify chlamydial infection in asymptomatic men and women, including asymptomatic pregnant women, with high test specificity. In low prevalence populations, however, a positive test is more likely to be a false positive than a true positive, even with the most accurate tests available.
Qualities of a Good Screening Test
1. The condition should be an important health problem and the condition screened for must have a high prevalence in the population.
2. There should be a latent stage of the disease.
3. There should also be effective treatment for the condition being screened.
4. Facilities for diagnosis and treatment should be available.
5. There should be a test or examination for the condition.
6. The test should be acceptable to the population and the total cost of finding a case should be economically balanced in relation to medical expenditure as a whole. The potential benefits of early detection and treatment of a condition need to be weighed against many factors, including adverse side effects of the screening test, time and effort required (of both the patient and the health care system) to take the test, financial cost of the test, potential psychological and phys.
HIV positive mother and her bABY, RISK OF TRANSMISSION, ANTENATAL CARE, INTRA...LalrinchhaniSailo
Globally, an estimated 1.3 million women and girls living with HIV become pregnant each year. In the absence of intervention, the rate of transmission of HIV from a mother living with HIV to her child during pregnancy, labour, delivery or breastfeeding ranges from 15% to 45%. As such, identification of HIV infection should be immediately followed by an offer of linkage to lifelong treatment and care, including support to remain in care and virally suppressed and an offer of partner services.
In 2019, 85% of women and girls globally had access to antiretroviral therapy (ART) to prevent mother-to-child transmission (MTCT). However, high ART coverage levels do not reflect the continued transmission that occurs after women are initially counted as receiving treatment. Achieving retention in care and prevention of incident HIV infections in uninfected populations remain high priorities to reach global elimination targets. Since the global shift to, and accelerated rollout of, highly effective, simplified interventions based on lifelong ART for pregnant women living with HIV, virtual elimination of MTCT – also known as vertical transmission – has been shown to be feasible.
AIDS is the late stage of HIV infection that occurs when the body's immune system is badly damaged because of the virus. In the U.S., most people with HIV do not develop AIDS because taking HIV medicine as prescribed stops the progression of the disease.
AIDS is the disease caused by the damage that HIV does to your immune system. You have AIDS when you get dangerous infections or have a super low number of CD4 cells. AIDS is the most serious stage of HIV, and it leads to death over time.
AIDS is a syndrome, or range of symptoms, that may develop in time in a person with HIV who does not receive treatment. A person can have HIV without developing AIDS, but it is not possible to have AIDS without first having HIV.
HIV (human immunodeficiency virus) is a virus that attacks the body's immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome).
There is currently no effective cure. Once people get HIV, they have it for life.
But with proper medical care, HIV can be controlled. People with HIV who get effective HIV treatment can live long, healthy lives and protect their partners.
Physical dimension: Good physical fitness and confidence in one’s personal ability to take care of health problems.
Emotional: refers to both our emotional and mental states – that is, to our feelings and our thoughts.
Spiritual: Refers to individuals identify their own basic purpose in life; learn how to experience love, joy, peace, and fulfillment; and help themselves and others achieve their full potential.
Occupational: Deriving personal satisfaction from your vocation, that provides creativity and challenge.
Social: The ability to interact effectively with other people and the social environment, to develop satisfying interpersonal relationships, and to fulfill social roles.
Intellectual: Your ability to think and learn from life experience, your openness to ideas, and your capacity to question and evaluate information.
Environmental: The impact your world has on your well well-being.
2. Background Information
Kenya is home to one of the world’s harshest HIV and
AIDS epidemics.
An estimated 1.5 million people are living with HIV;
around 1.2 million children have been orphaned by
AIDS; and in 2009 80,000 people died from AIDS-
related illnesses.
Kenya’s HIV prevalence peaked during 2000 and,
according to the latest figures, has dramatically reduced
to around 6.3 percent.
This decline is thought to be partially due to an increase
in education and awareness, and high death rates.
3. Background contd..
Whilst many people in Kenya are still not being reached with
HIV prevention and treatment services, access to treatment is
increasing.
More than half of adults who need treatment are receiving it,
with around 100,000 additional adults on treatment in 2010
than in 2009.
In comparison, the number of children in need of
antiretroviral treatment that are receiving it is extremely low.
An estimated 170,000 children are eligible to receive
treatment, yet only around 1 in 5 have access to it. This
demonstrates Kenya still has a long way to go in providing
universal access to HIV treatment, prevention and care.
4. Access to ARVs and ART
In 2003 only 5 percent of people needing ART were
receiving antiretroviral therapy.
In 2006 Kenya’s President announced that
antiretroviral drugs would be provided for free in
public hospitals and health centres.
In 2007 treatment coverage was low at 42 percent
with only 172,000 on treatment.
Nevertheless, by 2009 the number of people
receiving antiretroviral therapy had significantly
increased to 336,980.
5. Access to ARVs and ART contd…
However, due to a 2010 change in WHO treatment
guidelines, which recommend starting treatment
earlier, the proportion of people eligible to receive
antiretroviral treatment remained at only 48
percent.
Under the previous guidelines, treatment coverage
would have been 65 percent.
By 2010, access to treatment had increased further
with 432,621 receiving treatment, around 61 percent
of those in need.
6. Access to ARVs and ART contd…
“Despite an increase in children accessing
treatment, the overall coverage for children remains
extremely low.”
Around half of those infected with tuberculosis (TB)
are co-infected with HIV in Kenya, although this
varies widely according to region. Antiretroviral
treatment for co-infected individuals has been found
to improve patient survival if it is administered as
soon as possible after TB treatment.
8. PEP
Post-exposure prophylaxis (PEP) is a special course of HIV
treatment that aims to prevent people from becoming infected
with HIV.
PEP is prescribed, in some instances, to people who have
potentially been exposed to the virus.
The treatment, which can be accessed from clinics and health
centers in many parts of the world, can prevent the virus from
becoming established in the body of someone who has been
exposed.
PEP is particularly important for people who have been
sexually assaulted or people who have been exposed to blood
through a needle injury or other accident at work
9. How does PEP work?
Post-exposure prophylaxis is an antiretroviral drug
treatment that is started immediately after someone
is exposed to HIV.
The aim is to allow a person’s immune system a
chance to provide protection against the virus and to
prevent HIV from becoming established in
someone’s body.
It usually consists of a month long course of two or
three different types of the antiretroviral drugs that
are also prescribed as treatment for people living
with HIV.
10. Contd…
The World Health Organisation recommends
prescribing zidovudine and lamivudine as the
preferred regimen, stating that countries are
generally advised to use the same regimens as they
would for treating HIV.
The British HIV Association recommend a
combination of drugs called Truvada (tenofovir and
emtricitabine) and Kaletra (lopinavir and ritonavir).
11. Effectiveness of PEP
The conclusions from both human and animal trials
is widely recognized and as a result, a number of
countries have produced guidelines suggesting the
possible use of post-exposure prophylaxis in both
occupational circumstances (for example a health-
care worker who has been exposed in a hospital) and
non-occupational circumstances (for example a
person who has had unprotected sex).
They tend to suggest that, as it is not 100 percent
effective, post-exposure prophylaxis should only be
used as a very last resort.
12. Effectiveness contd…
In cases where PEP is used, there are various factors that can
affect its effectiveness.
Delayed initiation: In order for post-exposure prophylaxis to have a
chance of working, the medication needs to be taken as soon as
possible, and within 72 hours of exposure to HIV. Left any longer and it
is thought that the effectiveness of the treatment is severely diminished.
Resistant virus: The person who potentially transmitted HIV (the
‘source’) may have a drug-resistant HIV virus, which could make PEP
ineffective.
Adherence: It is very important that a person using PEP takes the
treatment exactly as prescribed by their doctor or health worker. The
side effects of the medication are a reason why some people find it
difficult to adhere to the full 28-day course of treatment properly.
13. Who can benefit from post-exposure prophylaxis?
People exposed to blood or bodily fluids at work
Victims of rape or sexual assault
People potentially exposed through needles
People who may have been exposed to HIV through
consensual sexual contact
14. Risks and side-effects
As with most antiretrovirals, post-exposure
prophylaxis can cause side effects such as:
Diarrhoea Headaches
Nausea / vomiting Fatigue.
Some of these side effects can be quite severe and it
is estimated that 1 in 5 people give up the treatment
before completion.
There is also the risk that taking PEP may cause a
person to develop drug resistance should the patient
become infected with HIV and need to be treated
with antiretrovirals
15. Other emerging issues
Discussion
What is HIV super-infection?
HIV and Gender vulnerability
HIV and Contraceptives in relation to increasing
vulnerability
17. What is VMMC?
VMMC (Voluntary medical adult male circumcision)
A medical intervention that reduces (does not
eliminate) risk of HIV infection among sexually
active, HIV uninfected men.
Three high-quality scientific studies showing that
male circumcision reduces the risk of getting HIV by
60%
18. Advantages of MC as an addition to existing
prevention interventions
Very good safety profile
One time intervention
Most importantly, it works (and saves lives)
Other potential advantages:
Can be delivered through existing health care system (after
enhancing capacity)
Likely to be benefits for partners of circumcised men
Other health benefits (reduce other STI and complications of
STI)
19. 2007 KAIS: Male circumcision and HIV
Province with the highest HIV prevalence (Nyanza) has the lowest MC level
Province with the second highest HIV prevalence (Nairobi) has second
lowest MC level
20. HIV 3 times more prevalent among uncircumcised
men than circumcised
Source: 2007 Kenya AIDS Indicator Survey
21. Rate of new HIV infection 3 times higher among men
not circumcised
0
1
1
2
2
3
3
4
4
5
5
Not circumcised Circumcised
Percentincidentinfections(%)
Source: 2007 Kenya AIDS Indicator Survey
22. For the avoidance of doubt!
Medical Adult Male Circumcision
is and shall remain
VOLUNTARY
24. Exclusive breastfeeding
WHO strongly recommends exclusive breastfeeding for
the first six months of life.
At six months, other foods should complement
breastfeeding for up to two years or more.
In addition:
Breastfeeding should begin within an hour of birth;
Breastfeeding should be "on demand", as often as
the child wants day and night; and
Bottles or pacifiers should be avoided.
25. Health benefits for infants
Breast milk is the ideal food for newborns and
infants. It gives infants all the nutrients they need
for healthy development.
It is safe and contains antibodies that help protect
infants from common childhood illnesses - such
as diarrhoea and pneumonia, the two primary
causes of child mortality worldwide.
Breast milk is readily available and affordable,
which helps to ensure that infants get adequate
sustenance.
26. Benefits for mothers
Breastfeeding also benefits mothers. The practice
when done exclusively is associated with a natural
(though not fail-safe) method of birth control (98%
of protection in the first 6 months after birth).
It reduces risks of breast and ovarian cancer later in
life, helps women return to their pre-pregnancy
weight faster, and lowers rates of obesity.
27. Long-term benefits for children
Beyond the immediate benefits for children,
breastfeeding contributes to a lifetime of good health.
Adults who were breastfed as babies often have lower
blood pressure and lower cholesterol, as well as lower
rates of overweight, obesity and type-2 diabetes.
There is evidence that people who were breastfed
perform better in intelligence tests.
28. Why not infant formula?
Infant formula does not contain the antibodies found
in breast milk. When infant formula is not properly
prepared, there are some risks arising from the use of
unsafe water and unsterilized equipment or the
potential presence of bacteria in powdered formula.
Malnutrition can result from over-diluting formula
to "stretch" supplies.
Further, frequent feedings maintain the breast milk
supply. If formula is used but becomes unavailable, a
return to breastfeeding may not be an option due to
diminished breast milk production.
29. HIV and breastfeeding
An HIV-infected mother can pass the infection to her infant
during pregnancy, delivery and through breastfeeding.
Antiretroviral (ARV) drug interventions to either the mother
or HIV-exposed infant reduces the risk of transmission of HIV
through breastfeeding.
Together, breastfeeding and ARV interventions have the
potential to significantly improve infants' chances of surviving
while remaining HIV uninfected.
WHO recommends that when HIV-infected mothers
breastfeed, they should receive ARVs and follow WHO
guidance for breastfeeding and complementary feeding.
30. Regulating breast-milk substitutes
An international code to regulate the marketing of
breast-milk substitutes was adopted in 1981. It calls
for:
All formula labels and information to state the
benefits of breastfeeding and the health risks of
substitutes;
No promotion of breast-milk substitutes;
No free samples of substitutes to be given to
pregnant women, mothers or their families; and
No distribution of free or subsidized substitutes to
health workers or facilities.
31. Support for mothers is essential
Breastfeeding has to be learned and many women
encounter difficulties at the beginning. Nipple pain,
and fear that there is not enough milk to sustain the
baby are common.
Health facilities that support breastfeeding - by
making trained breastfeeding counselors available to
new mothers - encourage higher rates of the practice.
To provide this support and improve care for
mothers and newborns, there are now more than 20
000 "baby-friendly" facilities in 152 countries thanks
to a WHO-UNICEF initiative.
32. Work and breastfeeding
Many mothers who return to work abandon
breastfeeding partially or completely because they do
not have sufficient time, or a place to breastfeed,
express and store their milk.
Mothers need a safe, clean and private place in or
near their work to continue breastfeeding.
Enabling conditions at work can help, such as paid
maternity leave, part-time work arrangements,
facilities for expressing and storing breast milk, and
breastfeeding breaks.
33. The next step: phasing in new foods
To meet the growing needs of babies at six months of age,
complementary foods should be introduced as they continue to
breastfeed. Foods for the baby can be specially prepared or
modified from family meals. WHO notes that:
Breastfeeding should not be decreased when starting
complementary feeding;
Complementary foods should be given with a spoon or cup,
not in a bottle;
Foods should be clean, safe and locally available; and
Ample time is needed for young children to learn to eat solid
foods.