Heroin shortage in Coastal Kenya: A rapid assessment and qualitative analysis of heroin users' experiences

INTRODUCTION

While relatively rare events, abrupt disruptions in heroin availability have a significant impact on morbidity and mortality risk among those who are heroin dependent. A heroin shortage occurred in Coast Province, Kenya from December 2010 to March 2011. This qualitative analysis describes the shortage events and consequences from the perspective of heroin users, along with implications for health and other public sectors.

METHODS

As part of a rapid assessment, 66 key informant interviews and 15 focus groups among heroin users in Coast Province, Kenya were conducted. A qualitative thematic analysis was undertaken in Atlas.ti. to identify salient themes related to the shortage.

RESULTS

Overall, participant accounts were rooted in a theme of desperation and uncertainty, with emphasis on six sub-themes: (1) withdrawal and strategies for alleviating withdrawal, including use of medical intervention and other detoxification attempts; (2) challenges of dealing with unpredictable drug availability, cost, and purity; (3) changes in drug use patterns, and actions taken to procure heroin and other drugs; (4) modifications in drug user relationship dynamics and networks, including introduction of risky group-level injection practices; (5) family and community response; and (6) new challenges with the heroin market resurgence.

CONCLUSIONS

The heroin shortage led to a series of consequences for drug users, including increased risk of morbidity, mortality and disenfranchisement at social and structural levels. Availability of evidence-based services for drug users and emergency preparedness plans could have mitigated this impact.

NASOPHARYNGEAL ANGIOFIBROMAS IN KENYA

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NASOPHARYNGEAL CANCER IN KENYA: CLINICAL AND ENVIRONMENTAL ASPECTS

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NASOPHARYNGEAL CANCER IN KENYA: PATHOLOGY

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THE INFLUENCE OF TEMPERATURE ON THE SUCCESSION OF REDIAL AND CERCARIAL GENERATIONS OF FASCIOLA GIGANTICA IN A SNAIL HOST

Experiments on the larval development of Fasciola gigantica carried out under natural conditions have shown that at temperatures of 16° C. or less the rediae did not produce cercariae. The first-generation rediae, developed from the sporocyst, and all the rediae of subsequent generations produced only daughter rediae and did not change over to the production of cercariae as long as the low temperatures of the cold season lasted.

As soon as the cold season ended and the temperature of the water in the aquaria containing the infected snails rose to a mean maximum of 20° C. all the rediae switched from redial to cercarial production.

INTENSIVE NITROGEN MUSTARD THERAPY WITH ABDOMINAL AORTIC OCCLUSION IN NASOPHARYNGEAL CARCINOMA

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EVIDENCE IN FAVOUR OF A LOW DOSE FOR THE TUBERCULIN TEST

In an attempt to solve the problem of whether a high or a low dose should be used for tuberculin testing a new method of statistical analysis is presented. It consists in tabulating the frequency of tuberculin "positive" children in households where the adults are tuberculin "positive" and tuberculin "negative" respectively; these frequencies are compiled for a wide range of arbitrarily chosen limits between "positive" and "negative" reactions. Values for these statistics have been obtained from data collected in Kenya; they strongly suggest that the reactors to the low-dose test are those infected with tubercle bacilli and the non-reactors to this test are the uninfected. However, a more detailed analysis is possible and this paper demonstrates that statistics of the type described may be used for testing the plausibility of a specific hypothesis about the patterns of tuberculin reactions among infected and uninfected persons. By testing a number of different hypotheses, the most plausible was found to be that the tuberculin sensitivities of infected and uninfected persons correspond to those of the reactors and the non-reactors to the low-dose test respectively. On the basis of the data presented it thus appears that the low-dose test is better suited than the high-dose test for distinguishing between infected and uninfected persons.