Reproductive tract infection (RTI) is a broad term that includes sexually transmitted infections (STIs) as well as other infections of the reproductive tract. STIs present a major burden of disease in Kenya’s population. They are among the most important causes of maternal and infant morbidity and mortality in Kenya. Serious complications attributable to STIs and RTIs include ectopic pregnancy, pelvic inflammatory disease, preterm labour, pregnancy loss, congenital infection, infertility, genital cancer HIV, and AIDS.
Data from the 2007 Kenya AIDS Indicator Survey (KAIS) indicated that the Herpes Simplex Virus-2 (HSV-2) prevalence rate among the general population (between the ages of 15 and 64 years) is 35 percent and that 81 percent of adults who are infected with HIV are also infected with HSV-2. The KAIS also showed that the prevalence of syphilis among the general population is about 2 percent, but it is higher among older adults between the ages of 50 and 64 years (4.4 percent males and 2.5 percent females). Moreover, among participants who were seropositive for syphilis, 17 percent also had HIV, 72 percent had HSV-2 and 16 percent had both HIV and HSV-2.
The Division of Reproductive Health (DRH) faces many structural and technical challenges with regard to prevention, treatment and management of RTIs and STIs. Many health facilities offer only syndromic management of STIs, and not all antenatal facilities offer screening and treatment of all STIs. Many health service providers need re-orientation toward managing RTIs and STIs and enhancement of skills to diagnose and treat them adequately. RTI/STI interventions have also not been thoroughly integrated into the wider reproductive health programmes.
DRH Activities to Prevent and Treat RTIs/STIs
DRH, in collaboration with the National AIDS and STIs Control Programme (NASCOP), National AIDS Control Council (NACC) and other partners, is working to revitalize and strengthen RTI and STI programmes at all levels nationally. Work is going on to comprehensively assess STI management and technical capabilities in Kenya.
DRH has been working on updating knowledge and enhancing the technical capacity of providers in STI detection and management, in part through the extensive dissemination of the National RTI Guidelines, which provides clear direction and sets uniform standards for managing RTIs and STIs in Kenya. Other tools and training guidelines on STI management are being updated and developed.
DRH is building on this experience to advocate with the Ministry of Public Health and Sanitation (MOPHS) and its development partners for placing a greater priority on RTIs and STIs in national policy development and resource allocation, and for ensuring that STIs are central components of Kenya’s health and community-based strategies. DRH is also generating national awareness and understanding of the importance of RTIs in reproductive health, particularly by integrating RTI/STI management into wider reproductive health programming for better and earlier detection of common STIs among clients.
Central to the RTI/STI revitalization campaign, DRH and its partners have re-established the National STI Technical Working Group. This group is made up of DRH and other MOPHS divisions, NACC, NASCOP and technical expert partners. Their mandate is to reset the research agenda and coordinate STI and RTI research and programme activities.
Human resources have been enhanced through providing additional technical capacity building to health care providers, many of whom had not received training in RTIs and STIs since the 1990s.
Cancers of Reproductive Organs
This program focuses on the prevention and control of cancers of reproductive organs in both women and men- namely cancer of the cervix, breast cancer and prostate cancer.
The existing policy documents in which statements are made with respect to these cancers are: The National Reproductive Health Policy (2007); The National Reproductive Health Strategy (2009-2015); and The National Cancer Control Strategy (2010-2015). Other documents that are currently being finalized are The National Guidelines for Prevention and Management of Cervical, Breast and Prostate Cancers, and The National Cervical Cancer Prevention Program Action Plan 2011-2015.
The National Guidelines for Prevention and Management of Cervical, Breast and Prostate Cancers provides a step-by-step overview on evidence-based service delivery processes (from primary prevention, screening, and management) that, if implemented, would result in prevention and control of these three cancers. In addition, the guidelines provide an overview of the management of the respective overt cancers. The guidelines also comprise an extensive section on palliative care for patients with overt cancer as well as behavior change communication (BCC) interventions. These include advocacy to enhance awareness, address myths and misconceptions, and create demand for enhanced health seeking behavior for cancer prevention and control services.
The National Cervical Cancer Prevention Program Action Plan 2011-2015 articulates strategies adopted by Kenya towards the prevention and control of cervical cancer. This program places particular emphasis on prevention and early treatment of these cancers. Integration of cancer screening and treatment into other service delivery sites such as maternal and child health and family planning clinics, out-patient departments and HIV comprehensive care centres is a key strategy to expanding access to these screening services.
The screening methods indicated for cervical cancers are the visual inspection methods such as Visual Inspection with Acetic Acid (VIA) followed by Visual Inspection with Lugols Iodine (VILI) at all levels of health care delivery. Other screening methods such as Pap smear and Human Papilloma Virus (HPV) testing can be used in health facilities where they are available. Emphasis for screening for cancer of breast is placed on clinical breast examinations, self-breast examinations, and regular mammograms. For prostate cancers, regular clinical examination and Prostatic Surface Antigen (PSA) tests are emphasized.
Key Policies, Strategies, Guidelines and Tools
To guide the provision of RTI/STI services in Kenya, DRH has developed several policies, strategies, service provider guidelines and tools. Read more.