Generally, introduction of new tools is usually done without consultation of the end users. There has been need for evidence to support decision making in regard to acceptance and effective use of the new diagnostic tools. The East Africa Public Health Laboratories Networking Project through Kenya Medical Research Institute - Operational Research on Tuberculosis, undertook a study to evaluate new diagnostic TB tools which include the Xpert® MTB/RIF (GeneXpert), and the Light Emitting Diodes – Florescence Microscopy (LED-FM). These new tools were introduced in five East Africa Public Health Laboratories Networking - Operating Research Project satellite sites, by the Ministry of Health with support from World Bank since the year 2012.
To document user acceptability of new laboratory tuberculosis (TB) diagnostic tools in the EAPHLNP OR Project Satellite study sites in Kenya.
This was a descriptive study using a cross-sectional design. A non-probabilistic convenient sampling was used to identify laboratory respondents per site. Sixteen laboratory staff who had used the new TB diagnostic tools at the four satellite sites were included in the interviews. A questionnaire was used to collect information on user acceptability to utilize the new tuberculosis diagnostic tools. An in-depth interview guide was included in the discussions with key informants to document the perception of the laboratory staff towards the introduction of new diagnostic tools, infrastructure, procurement, turnround time and their future recommendations.
It was noted that user acceptability of new TB diagnostic tools revealed varying levels of acceptance for different attributes. All the laboratory staff (100%) indicated that they understood the concept of GeneXpert compared to 75.0 (95% CI: 53.8 - 96.2) % for LED-FM. In regard to LED, 9/16 (56.3%) respondents rated the tool as poor compared to GeneXpert. 12/16 (75%) of the respondents reported that LED-FM had a low turnaround time. A total of 14/16 (87.5%) respondents reported that, there was no clarity on the algorithm for use of GeneXpert. Participants reported that, with regard to safety of equipment, GeneXpert was better than ZN because, users were not exposed to fumes and was easy to operate. In addition, the staff reported experiencing difficulties in stain preparation for ZN, identification and differentiations of bacilli from artifacts. GeneXpert was reported to detect more TB cases than LED and ZN since it was able to amplify low volume / quantities of bacilli.
GeneXpert was reported to be more preferred diagnostic tool compared to LED-FM. However, both tools have challenges when used independently which can be effectively addressed through argumentation. Quality of service maybe improved when both tools are used.
Malindi Sub-County Hospital in Kilifi County, is one of Kenya’s World Bank (WB) funded East Africa Public Health Laboratories Networking (EAPHLN) Project, Satellite sites, implementing Tuberculosis (TB) Operational Research (OR) protocol. There is Limited literature available in public health journals on the impact of OR studies’ implementation on participating health care personnel.
To document experiences, achievements, challenges and lessons learnt by health care personnel participating in the implementation of TB Operational Research (OR) protocol at Malindi Sub-County Hospital a Satellite site in Kenya.
This was a descriptive qualitative study with a purposive data collection method using an in-depth interview guide capturing demographic information. That is, achievements, experiences and challenges of nine health care personnel who participated in the TB OR study from 2013 to 2015. Data transcription was processed using Microsoft word, Open and Auxiliary Coding collected by three investigators. The findings were presented thematically.
Key achievements reported by the respondents include; Refresher courses, Mentorship sessions, Participation in workshop and Seminars. During monitoring and evaluation exercises, participants learnt research skills and experienced knowledge growth through interactions with KEMRI senior scientists. Exposure to OR methodology activities, improved confidence, and work competence to participants. It was realistic that, GeneXpert test was the most user friendly followed by LED FM microscopy. Participants concurred on challenges encountered during enrolment of study respondents due to heavy workload involving routine and OR activities with inadequate personnel and minimal motivation. However, adherence to protocol for sorting out, routing and triaging coughers with effective referral to laboratories assured collection of quality samples and achievement of high percentage of sample size.
Implementing the OR TB study in Malindi Sub-County Hospital was informative experience to the participating health care personnel on appropriate use of existing TB diagnostic tools. Provision of human resource in OR studies is essential to address the challenge of heavy workload that would otherwise disrupt smooth implementation of OR activities.
Spot and morning sputum samples are used in the diagnosis of Pulmonary Tuberculosis (TB). There are no guidelines currently for a choice of two sputum samples to be used in determining optimal performance of a diagnostic tool. Performance has been determined using one of the four approaches of choice of sputum samples in different studies with varying results. The choices include; (a) Final diagnosis based on both spot and morning sample results, whereby the patient is the unit of analysis (point-of-care) [1,3] (b) Spot sample results (c) Morning sample results  (d) Pooled results of spot and morning samples 
Whereby the sample is the unit of analysis (laboratory based) respectively, this study was to determine the appropriate choice of sputum sample(s) for optimal performance of TB diagnostic tools in Kenya.
A cross-sectional study was conducted between February 2013 and October 2016 in nine selected public health, facilities in Kenya. People presumed to have TB aged 18 years and above visiting the facilities and eligible for the study were enrolled after consenting. Spot and early morning samples were collected over two consecutive days. Samples were analysed using Ziehl Neelsen (ZN), Light Emitting Diode-Fluorescent Microscopy (LED-FM).LED-FM and GeneXpert. Lowenstein Jensen LJ Culture was used as the gold standard. TB Positivity, Sensitivity and Specificity were determined using IBM-SPSS statistical software.
There was significantly high TB identification with LJ culture, using final diagnosis based on both spot and morning sample results compared to separate samples. There was significantly higher incremental detection benefit with GeneXpert than with ZN and FM microscopy. However, there was no significant difference in sensitivities and specificities within the four approaches for choice of sputum sample used.
The findings provide evidence on the need to develop guidelines on choice of sputum samples to be used for accurate TB detection and validation of TB diagnostic tools.
Throat Cancer refers to cancer involving structures of the throat. These include the larynx and the pharynx. Risk factors for cancer of the throat are varied and many but some are listed below.
Contraceptive Counselling is the process in which service providers engage with Patients to help them identify a suitable contraceptive method and in a follow up interaction until the effectiveness of the process is achieved. Establish good rapport between the service providers and the recipients.
Contraceptive uptake among post abortion patients is affected by the perception the women have on contraceptive counselling by the service providers. Contraceptive knowledge is high and its usage is low among post abortion patients.
The study objective was to investigate the natural selection and genetic variability of HEVs and to identify HEV serotypes in circulation among children below 5 years old with diarrhea in an informal settlement(Kibera) in Kenya.
A sample of 20 post abortion patiens participated in the In-depth interviews where open ended questions with probes were used to collect data. The interviews were conducted in two facilities, Jaramogi Oginga Odinga Teaching and Referral Hospital and Kisumu East District Hospital (Kisumu County Hospital) (both in Kisumu County, Kenya). The interviews were recorded and verbally transcribed. NVivo version 11 was used to sort out the data. Thematic analysis was used to analyse data. The sorted data was coded and structured in nine themes with regard to quality of care in contraceptive services. Choice of contraceptive method, information provided to recepients, interpersonal relationship, continuity and follow up, technical competence, affordability of contraceptive services, partner preference, myths and misconceptions, suggestions and concerns was emphasized.
The patients were able to obtain information about the various methods of contraception enabling them to make informed choices as a result of the discussions with the service providers. The good interpersonal relationship of the service providers with the respondents established good rapport and reduced the stigma. Respondents were now able to revisit clinics after abortion without fear and contraceptives provided free of charge after discussions with the respondents who felt comfortable using them. Partners were important in contraceptive decision making, such that those who had partners found it easy to decide.
The Respondents perceived contraceptive counselling positively indicating the friendliness of the service providers that made them feel confident with the contraceptive counselling and comfortable to discuss abortion with them. Respondents did not like the term abortion because it demoralized them.