Dataset Information

HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey.

ABSTRACT:

Background

The proportion of older people is increasing worldwide. Globally, it is estimated that older people (those 60 years or older) constitute more than 11% of the population. As the HIV/AIDS pandemic rages in sub-Saharan Africa (SSA), its impact on older people needs closer attention given the increased economic and social roles older people have taken on as a result of increased mortality among adults in the productive age groups. Few studies have looked at older people and their health in SSA or indeed the impact of HIV/AIDS on their health. This study aims to assess the effect of being directly or indirectly affected by HIV/AIDS on the health of older people in two Nairobi slums.

Methods

Data were collected from residents of the Nairobi Urban Health and Demographic Surveillance area aged 50 years and above on 1st October 2006. Health status was assessed using the short SAGE (Study on Global AGEing and Adult Health) form and two outcome measures--self-rated health and a composite health score--were generated. To assess HIV/AIDS affected status, respondents were asked: Have you personally been affected by HIV/AIDS? If yes, a follow up question: "How have you been personally affected by HIV/AIDS?" was asked. Ordinallogistic regression was used in models with self-rated health and linear regression in models with the health score.

Results

About 18% of respondents reported being affected by HIV/AIDS in at least one way, although less than 1% reported being infected with HIV. Nearly 60% of respondents reported being in good health, 27% in fair health and 14% in poor health. The overall mean health score was 70.6 (SD: 13.9) with females reporting worse health outcomes than males. Respondents directly or indirectly affected by HIV/AIDS reported worse health outcomes than those not affected: mean health score: 68.5 and 71.1 respectively (t = 3.21, p = 0.0007), and an adjusted odds ratio of reporting poor health of 1.42 (95%CI: 1.12-1.80).

Conclusion

Poor health outcomes among older people affected by HIV/AIDS highlight the need for policies that target them in the fight against HIV/AIDS if they are to play their envisaged care giving and other traditional roles.

SUBMITTER: Kyobutungi C

PROVIDER: S-EPMC2694783 | biostudies-literature | 2009 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey.

Kyobutungi Catherine C Ezeh Alex C AC Zulu Eliya E Falkingham Jane J

BMC public health 20090527

<h4>Background</h4>The proportion of older people is increasing worldwide. Globally, it is estimated that older people (those 60 years or older) constitute more than 11% of the population. As the HIV/AIDS pandemic rages in sub-Saharan Africa (SSA), its impact on older people needs closer attention given the increased economic and social roles older people have taken on as a result of increased mortality among adults in the productive age groups. Few studies have looked at older people and their ...[more]

PMID: 19473488

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Project description:BACKGROUND: It has been almost a decade since HIV was declared a national disaster in Kenya. Antiretroviral therapy (ART) provision has been a mainstay of HIV treatment efforts globally. In Kenya, the government started ART provision in 2003 with significantly scale-up after 2006. This study aims to demonstrate changes in population-level HIV mortality in two high HIV prevalence slums in Nairobi with respect to the initiation and subsequent scale-up of the national ART program. METHODS: We used data from 2070 deaths of people aged 15-54 years that occurred between 2003 and 2010 in a population of about 72,000 individuals living in two slums covered by the Nairobi Urban Health and Demographic Surveillance System. Only deaths for which verbal autopsy was conducted were included in the study. We divided the analysis into two time periods: the "early" period (2003-2006) which coincides with the initiation of ART program in Kenya, and the "late" period (2007-2010) which coincides with the scale up of the program nationally. We calculated the mortality rate per 1000 person years by gender and age for both periods. Poisson regression was used to predict the risk of HIV mortality in the two periods while controlling for age and gender. RESULTS: Overall, HIV mortality declined significantly from 2.5 per 1,000 person years in the early period to 1.7 per 1,000 person years in the late period. The risk of dying from HIV was 53 percent less in the late period compared to the period before, controlling for age and gender. Women experienced a decline in HIV mortality between the two periods that was more than double that of men. At the same time, the risk of non-HIV mortality did not change significantly between the two time periods. CONCLUSIONS: Population-level HIV mortality in Nairobi's slums was significantly lower in the approximate period coinciding with the scale-up of ART provision in Kenya. However, further studies that incorporate ART coverage data in mortality estimates are needed. Such information will enhance our understanding of the full impact of ART scale-up in reducing adult mortality among marginalized slum populations in Kenya.

Project description:ObjectivesTo determine the prevalence of cardiovascular disease (CVD) risk factors and explore associations with high-sensitivity cardiac troponin I (hscTnI) and high-sensitivity C-reactive protein (hsCRP) in people living with HIV (PLHIV) in Kenya.DesignPilot cross-sectional study.SettingData were collected from community HIV clinics across two sites in Nairobi, Kenya, from July 2019 to May 2020.ParticipantsConvenience sample of 200 PLHIV (≥30 years with no prior history of CVD).Outcome measuresPrevalence of cardiovascular risk factors and its association with hsTnI and hsCRP levels.ResultsAcross 200 PLHIV (median age 46 years, IQR 38-53; 61% women), the prevalence of hypercholesterolaemia (total cholesterol >6.1 mmol/L) and hypertension were 19% (n=30/199) and 30% (n=60/200), respectively. Smoking and diabetes prevalence was 3% (n=5/200) and 4% (n=7/200). HscTnI was below the limit of quantification (<2.5 ng/L) in 65% (n=109/169). High (>3 mg/L), intermediate (1-3 mg/L) and low (<1 mg/L) hsCRP levels were found in 38% (n=75/198), 33% (n=65/198) and 29% (n=58/198), respectively. Framingham laboratory-based risk scores classified 83% of PLHIV at low risk with 12% and 5% at intermediate and high risk, respectively. Older age (adjusted OR (aOR) per year increase 1.05, 95% CI 1.01 to 1.08) and systolic blood pressure (140-159 mm Hg (aOR 2.96; 95% CI 1.09 to 7.90) and >160 mm Hg (aOR 4.68, 95% CI 1.55 to 14) compared with <140 mm Hg) were associated with hscTnI levels. No associations were observed between hsCRP and CVD risk factors.ConclusionThe majority of PLHIV-using traditional risk estimation systems-have a low estimated CVD risk likely reflecting a younger aged population predominantly consisting of women. Hypertension and hypercholesterolaemia were common while smoking and diabetes rates remained low. While hscTnI values were associated with increasing age and raised blood pressure, no associations between hsCRP levels and traditional cardiovascular risk factors were observed.

Project description:BackgroundHIV infection is a significant independent risk factor for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information has suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA.ObjectiveThe aim of this study was to investigate willingness to receive COVID-19 vaccination among a national sample of PLWHA in China.MethodsThis cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18 to 65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBOs) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aORs), which involved one of the independent variables of interest and all significant background variables. Path analysis was also used in the data analysis.ResultsOut of 10,845 PLWHA approached by the CBOs, 2740 completed the survey, and 170 had received at least one dose of the COVID-19 vaccine. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (1470/2570, 57.2%). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR 1.11, 95% CI 1.09-1.12; P<.001), negative attitudes (aOR 0.96, 95% CI 0.94-0.97; P<.001), perceived support from significant others (perceived subjective norm; aOR 1.53, 95% CI 1.46-1.61; P<.001), and perceived behavioral control (aOR 1.13, 95% CI 1.11-1.14; P<.001). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR 1.99, 95% CI 1.65-2.40; P<.001), CBO staff (aOR 1.89, 95% CI 1.51-2.36; P<.001), friends and/or family members (aOR 3.22, 95% CI 1.93-5.35; P<.001), and PLWHA peers (aOR 2.38, 95% CI 1.85-3.08; P<.001) was associated with higher willingness to receive COVID-19 vaccination. The overall opinion supporting COVID-19 vaccination for PLWHA on the internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR 1.59, 95% CI 1.31-1.94; P<.001). Path analysis indicated that interpersonal-level variables were indirectly associated with willingness to receive COVID-19 vaccination through perceptions (β=.43, 95% CI .37-.51; P<.001).ConclusionsAs compared to PLWHA in other countries and the general population in most parts of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. The internet and social media as well as interpersonal communications may be major sources of influence on PLWHA's perceptions and willingness to receive COVID-19 vaccination.

Project description:BackgroundChild exposure to lead from informal used lead-acid battery (ULAB) recycling operations is a serious environmental health problem, particularly in developing countries.ObjectivesWe investigated child exposure to lead in the vicinities of ULAB recycling operations in the Dandora, Kariobangi and Mukuru slums in Nairobi between January and August 2015.MethodsTop soil (n = 232) and floor dust (n = 322) samples were collected from dwelling units (n = 120) and preparatory schools (n = 44) and analyzed using an inductively coupled plasma-optical emission spectrometer at the Mines and Geological Department Laboratory in the Ministry of Mining, Nairobi. From the obtained lead levels in soil and house dust, child blood lead levels were subsequently predicted using the Integrated Exposure Uptake Biokinetic Model for Lead in Children (IEUBK), Windows version.ResultsLead loadings in all the floor dust samples from the Dandora, Kariobangi and Mukuru slums exceeded the United States Environmental Protection Agency (USEPA) guidance value for lead on floors with a range of 65.2 - 58,194 μg/ft2. Control floor dust samples recorded lower lead loadings compared to the Dandora, Kariobangi and Mukuru slums. Lead concentration in 70.7% of the soil samples collected from waste dumps, industrial sites, residential areas, playgrounds and preparatory schools in Dandora, Kariobangi and Mukuru exceeded the respective USEPA guidance values for lead in soils. Lead concentration in 100% of control soil samples were below the respective USEPA limits. The IEUBK model predicted that nearly 99.9% of children ≤ 7 years old living near informal ULAB recycling operations in Dandora, Kariobangi and Mukuru were at risk of being lead poisoned, with predicted blood lead levels (BLL) above the Centers for Disease Control (CDC) reference value for blood lead. A total of 99.9% of exposed children living in the Mukuru slums are likely to have BLL above 34 μg/dL.ConclusionsThere is a need for coordinated efforts to decrease lead emissions from informal battery recycling in Nairobi slums and to remediate existing soils, particularly around battery workplaces and dumpsites. The BLL of local children should be clinically tested and appropriate intervention measures taken.

Dataset Information

HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey.

Background

Methods

Results

Conclusion

Publications

HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey.

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