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The Impact of Post-Election Violence on HIV and Other Clinical Services and on Mental Health—Kenya, 2008
- Sapna Bamrah, Agneta Mbithi, Jonathan H. Mermin, Thomas Boo, Rebecca E. Bunnell, SK Sharif, Susan Temporado Cookson
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 1 / February 2013
- Published online by Cambridge University Press:
- 26 November 2012, pp. 43-51
- Print publication:
- February 2013
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Introduction
In December 2007, civil disruption and violence erupted in Kenya following national elections, displacing 350,000 people and affecting supply chains and services. The Kenyan government and partners were interested in assessing the extent of disruption in essential health services, especially HIV treatment.
MethodsA two-stage cluster sampling for patients taking antiretroviral therapy (ART) was implemented ten weeks after elections, March 10-21, 2008, at twelve health facilities providing ART randomly selected in each of the three provinces most affected by post-election disruption—Rift Valley, Nyanza, and Central Provinces. Convenience samples of patients with tuberculosis, hypertension, or diabetes were also interviewed from the same facilities. Finally, a convenience sampling of internally displaced persons (IDPs) in the three provinces was conducted.
ResultsThree hundred thirty-six IDPs in nine camps and 1,294 patients in 35 health facilities were interviewed. Overall, nine percent of patients reported having not returned to their routine health care facility; 9%-25% (overall 16%) reported a temporary inability for themselves or their children to access care at some point during January-February 2008. Less than 15% of patients on long-term therapies for HIV, tuberculosis, diabetes, or hypertension had treatment interruptions compared with 2007. The proportion of tuberculosis patients receiving a ≥45-day supply of medication increased from five percent in November 2007 to 69% in December 2007. HIV testing decreased in January 2008 compared with November 2007 among women in labor wards and among persons tested through voluntary counseling and testing services in Nyanza and Rift Valley Provinces. Patients and their family members witnessed violence, especially in Nyanza and Rift Valley Provinces (54%-59%), but few patients (2.5%-14%, 10% overall) personally experienced violence. More IDPs reported witnessing (80%) or personally experiencing (38%) violence than did patients. About half of patients and three-quarters of IDPs interviewed had anxiety or depression symptoms during the four weeks before the assessment. There was no association among patients between the presence of HIV, tuberculosis, diabetes, and hypertension and the prevalence of anxiety or depression symptoms.
ConclusionMore than 85% of patients in highly affected provinces avoided treatment interruptions; this may be in part related to practitioners anticipating potential disruption and providing patients with medications for an extended period. During periods of similar crisis, anticipating potential limitations on medication access and increased mental health needs could potentially prevent negative health impacts.
. ,Bamrah S ,Mbithi A ,Mermin JH ,Boo T ,Bunnell RE ,Sharif SK .Cookson ST The Impact of Post-Election Violence on HIV and Other Clinical Services and on Mental Health—Kenya, 2008 . Prehosp Disaster Med.2013 ;28 (1 ):1 -9
Longitudinal vitamin and homocysteine levels in normal pregnancy
- Rolf J. L. M. Cikot, Régine P. M. Steegers-Theunissen, Chris M. G. Thomas, Theo M. de Boo, Hans M. W. M. Merkus, Eric A. P. Steegers
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- Journal:
- British Journal of Nutrition / Volume 85 / Issue 1 / January 2001
- Published online by Cambridge University Press:
- 09 March 2007, pp. 49-58
- Print publication:
- January 2001
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Evidence of the impact of maternal nutritional status on pregnancy outcome is increasing. However, reference values for vitamin and homocysteine concentrations in maternal blood during normal pregnancy are scarce, and are lacking for the preconceptional period and early pregnancy. Thus, in a longitudinal study we evaluated vitamin and homocysteine concentrations in 102 nulliparous women with an uneventful singleton pregnancy and normal outcome not using supplements. The physiological changes in vitamin and homocysteine concentrations in blood were determined from the preconceptional period throughout pregnancy until 6 weeks post-partum. The vitamins evaluated comprised retinol, thiamin, riboflavin, pyridoxal 5′-phosphate, folate in serum and erythrocytes, vitamin B12 and α-tocopherol. The plasma homocysteine concentration was also measured, considering the essential roles of folate, vitamin B6 and vitamin B12 in homocysteine metabolism. The concentrations of retinol, thiamin, pyridoxal 5′-phosphate serum folate and vitamin B12 decreased during pregnancy. In contrast, the concentrations of riboflavin, α-tocopherol, and folate in erythrocytes increased or showed only minor changes. Homocysteine concentrations also remained approximately constant during pregnancy. These observations emphasize the importance of preconceptional and post-partum concentrations of vitamins in the evaluation of pregnancy-induced changes. These data have provided valuable reference values for vitamins and homocysteine before, during and after pregnancy in order to contribute to better diagnosis of maternal deficiencies and to study further the relationship between maternal vitamin status and adverse course and outcome of pregnancy.