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BackgroundUnmarried women who report less recent sexual intercourse (>30 days from survey enumeration) are largely excluded from global health monitoring and evaluation efforts. This study investigated level and contextual factors in modern contraceptive utilization and unmet need within this overlooked female subpopulation in Kenya from 2014 to 2019.MethodsThis study analyzed data from the Performance Monitoring and Accountability (PMA) survey in Kenya, a nationally representative survey of female respondents, to understand the level and contextual factors for family planning utilization and unmet need within female subgroups including married, unmarried sexually active (defined as sexual intercourse within 30 days of survey enumeration), and unmarried with less recent sexual intercourse (defined as sexual intercourse 1-12 months prior to survey enumeration). The analysis included multilevel regression modeling to assess correlates on outcomes of modern contraceptive prevalence rate (mCPR), unmet need, and recent emergency contractive pill (ECP) use, which is a unique PMA question: "Have you used emergency contraception at any time in the last 12 months?".ResultsCumulatively, the surveys enumerated 19,161 women and this weighted analysis included 12,574 women aged 15-49 from three female subgroups: 9,860 married women (78.4%), 1,020 unmarried sexually active women (8.1%), and 1,694 unmarried women with less recent sexual intercourse (13.5%). In 2019, while controlling for covariates, unmarried women with less recent sexual intercourse exhibited statistically significant differences (p-valueConclusionIn Kenya, unmarried women with less recent sexual intercourse exhibited significantly different contraceptive utilization, unmet need, and recent emergency contraceptive use. Moreover, changes over time in key family planning indicators were asymmetrical by female subgroup. This study identifies an important monitoring gap regarding unmarried women with less recent sexual intercourse. Evidence dissemination by the global measurement community for these unmarried women is exceedingly scarce; therefore, developing an inclusive research agenda and actionable information about these marginalized women is needed to enable targeted planning and equitable service delivery.

Multidrug-resistant tuberculosis (MDR TB) in Africa may be more prevalent than previously appreciated. Factors leading to development of drug resistance need to be understood to develop appropriate control strategies for national programs. We gathered estimates of MDR TB rates for 39 of 46 countries in Africa. The relationship between MDR TB rates and independent factors was analyzed by using correlation and linear regression models. Our findings indicate that drug resistance surveys in Africa are critically needed. MDR TB rates must be assessed in countries without these surveys. In countries that have conducted a drug resistance survey, a new survey will determine evolution of drug resistance rates. We found no correlation between high MDR rates and TB incidence, HIV/TB co-infection rates, or year of introduction of rifampin. Results show that the retreatment failure rate was the most predictive indicator for MDR TB. Current category II drug regimens may increase MDR TB.

INTRODUCTION: Ziehl-Neelsen (ZN) bright-field microscopy is time-consuming, with poor sensitivity, even under optimal conditions. Introduction of Primo StariLED fluorescent microscopy (FM) may improve TB case finding at referral hospitals in Rwanda.The study aimed to determine the acceptability and effectiveness of iLED in a low resource setting. METHODS: between June 2009 and May 2010, the Rwandan TBProgramand National Reference Laboratorycarried out demonstration studies with iLED at a referral hospital in the capital,Kigali, and a rural district hospital in Nyamata, takingconventional FM as Gold Standard. RESULTS: agreement between the iLED and rechecking at the Reference Laboratory were deemed �almost perfect� (kappa = 0.81-1.00) across three of four site-phase combinations. The exception was Nyamata District Hospital during the validation phase, which was deemed �substantial�agreement (kappa = 0.61-0.80). However, the 100% concordance at both demonstration sites during the continuation phase shows technicians' rapid command of the new iLED microscope in a relatively short time. The lower overall positivity rate obtained in the rural clinicis not related to the performance of the microscope (or technicians), but is attributable to a significant increase in total number of patients and samples screened through active case finding. CONCLUSIONS: laboratory technicians demonstrated high acceptance ofiLED. Additionally, fluorescent microscopy reduces the time necessary for examination by more than half. The high level of agreement between iLED and FMduring implementation in both sites provides initial evidence for iLED to replace current methods.