Indepth Healthy Transition to Adulthood study

The Kilifi – Dodowa Workshop 27 th Evasius Bauni – 28 th May 2014

1200 1000 800 600 400 200 0 The Kemri-wellcome Trust Research Programme 1989 Norbert Peshu Kevin Marsh Charles Newton Bob Snow DSS 2000 Malaria Bacterial disease Neurology Genetics Social science Public health 2013 Malaria Bacterial disease Neurology Genetics Social science Public health Resp disease HIV TB Malnutrition Sickle disease NCD

The

Kilifi HDSS

Epidemiology Demography Department

Kilifi HDSS Viral Epidemiology & Control

Evasius Bauni James Nokes

Human Genetic Factors

Tahreni Bwanaali

Invasive Bacterial Diseases

Tom Williams

Cluster Support and management

Anthony Scott

GPS Receivers

Integrated Surveillance Systems

Vital status/migration 270,000 population Home visits every 3-4 months Clinical case recording ~4,000 inpatients/y Integrated with DSS on admission Laboratory data From inpatient and research studies linked on DSS IDNO

Kilifi IHTAS Staff

• • • • • • • • • Evasius Bauni George Mochamah David Walumbe Carolyne Ndila Christopher Nyundo David Amadi Gideon Nyutu Boniface Jibendi Michael Kinuthia • • • • • • • • • Mark Otiende Alex Mutuku John Ojal Jackline Wafula Pauline Mwatsuma Paul Musumba Francis Kombe Charles Syengo Elina Kaulu

IHTAS sub-studies

• • • • • • On-line stakeholders questionnaire Stakeholders workshop Focus –group discussions Indepth-interviews with stakeholders Systematic literature review (health intervetions) Systematic literature review (health problems) • • • • • Systematic literature review (why young people do not use health services) Mapping health facilities Analysing existing data Identifying pilot sites IHTAS phase 2

What is the problem? What health interventions are in place?

• • • • •

What is the problem?

Substance abuse Unprotected sex leading to unwanted pregnancies, abortion, STIs and HIV Accidents and injuries, sexual violence, bullying Early marriages and, homosexuality Nutrition • • • • • •

Health Interventions

Provision of health information (15) Screening HIV (5) TB (1) Child rights (2) Reproductive health services/YFS (4) Economic empowerment (3) Malaria control(1)

What is the problem? Systematic Literature Review

Interventions N Impact Anti-helminthic Hygiene Malaria prevention Nutrition Reproductive health Voluntary male circumcision Other 3 7 5 4 10 Signifi Mod 2 1 4 3 1 1 2 7 1 3 Insignif 0 2 1 1 0 2 4 2 2 0 2 0 0

Age-sex structure and population density

• • • • • • • • Population: 270,000 (2012 2013 r29) 34,000 HH, 900km2 Males: 47% Children <5 years: 19% Children 5 -14years: 30% 10-24 years: 33% Adults 15 – 49 years:39% Elderly ≥50+: 12%

What do we know? The 10-24 profile

b) Health facility survey (n=80) a) Popn characteristics %

33

Total Population (10-24yrs) Education status Out of school All Pregnancies 10-24 yrs 13-19 yrs

60 41 26

c) Hospital admissions d) Causes of death

Females Pregnancy related disorders Infectious & Parasitic Genitourinary System Injuries Blood disorders Digestive System Males Mental and behavioral Nervous System Respiratory System Poisoning by drugs other 10-14 15-18 19-24 HIV/AIDS related death Malaria Injuries Pneumonia Pulmonary tuberculosis Maternal causes of death other ot her 10-14 15-18 19-24 Injuries HIV/AIDS related death Pneumonia Malaria Pulmonary tuberculosis Maternal causes of death other other

Oct 2013 Dec 2013

Timelines

Data collection Compiling results and writing July – December 2014 January-March 2015 Jan-June 2014 April – May 2015 What we know Proposal to fill the gaps What we want to know Writing and submitting trial proposal

Acknowledgements

• IHTAS Staff & Stakeholders Kilifi • Kemri-Wellcome Trust Research Programme • Ministry of health • Dodowa & LSHTM Collaborators • Hewlett Foundation

www.kilifi-ihtas.com