‘It is our Dirty Little Secret’: An Ethnographic Study of the Flying Toilets in Kibera Slums, Nairobi

Using the case study of the Kibera slums, this paper takes a medical anthropological approach to discuss and explain the untold and common practice among the urban poor in developing countries that is informally known as the ‘Flying Toilets’. This paper seeks to inform those working within the public health sector about such practices, but also to serve as a platform that can serve health promotion strategies and approaches geared toward such practices. International and local experts working in the discipline of water and sanitation and public health continue to miss the mark toward the improvement and promotion of health because of such secret informal practices as the Flying Toilets. For progress to occur, such practices must be understood and eradicated. Specifically, it cannot be assumed that an indicator such as community and family connection to a public sewer, a septic system, simple latrine or a ventilated improved latrine, as postulated by UNICEF and WHO, automatically improves sanitation. Demographic size/patterns, behaviour, and historical factors must be considered in light of all these variables. The Flying Toilet as a public hazard will be discussed in the political, historical, and economic context affecting the residents of the Kibera slums. In the context of this paper, we will interrogate the causes, organization, and the effects of the Flying ToiletsESR

Challenges for cancer care during COVID-19 pandemic in Kenya: Policy implications

Cancer accounts for roughly 7 percent of Kenyan mortality, making it the country\u27s third leading cause of death [1]. Available statistics indicate that 70–80 percent of cancer cases in Kenya are first diagnosed only in later stages [2]. Despite its high prevalence and the care needed to treat late-stage cancer, Kenya has few facilities and qualified healthcare workers (HCWs) that are dedicated to cancer treatment. In periods of a pandemic like COVID-19, both patients and HCWs may be at an additional risk of contracting the disease if tailored measures and strategies are not implemented for continuity of services

Positionality, Access to the Social Space and Place of Research: Narratives from Research in Low Middle Income Settings

Research on positionality and accessing field work for researchers studying their own communities in Lower Middle-Income Countries (LMICs) is scant. The majority of the literature on this topic emanates from High-Income Countries (HICs). Drawing on ethnographic field work conducted in Kenya and Pakistan, the authors have explored ways in which dialectic relationships between the researcher and participants in various social spaces (SSs) within the place of research (PoR) influences access to the field and data quality. The authors analysed reflective narratives from their fieldwork using Gibbs’s Reflective Cycle (GRC). The findings show that, accessing field work in LMICs where the research agenda is not fully developed with respect to funding and government support presents not only social and practical issues concerning the fieldwork but also ethical dilemmas. SSs in a PoR are powerful in determining both access to the field and data quality. For researchers returning from HICs to study the communities of their origin, being a native does not grant automatic access to research spaces. Gender and power dynamics are not only crucial for accessing the communities which are studied and from which data are collected but can also bring a degree of bias to the data collected. This paper sheds light on issues around positionality, access and doing field work in these contexts. The findings show the complex context in which research is conducted and how positionality is contested. This paper is useful for professionals from LMICs, early career researchers and professionals working in international development

Not enough traction: Barriers that aspiring researchers from low- and middle-income countries face in global health research

There is a growing concern of low representation of researchers from low-middle-income countries (LMICs) in the publication of global health research in high-impact peer-reviewed journals. Nobody denies that researchers from the developing world generally face several obstacles to publishing their research. In this viewpoint, we share some of the barriers we have observed from our experience working in both academia and global health practice in low and middle-income countries such as limited opportunities for research funding, gender disparities, and language barriers. Beyond presenting the barriers, we also provide some pragmatic solutions to addressing these barriers through increased research financing, capacity building, gender equity and inclusion, and editorial support. Most importantly, we call for setting a new level of ambition in redressing the imbalances and actualizing the leadership and emergence of a veritable critical mass of LMICs researchers

Long-Term health related quality of life following uterine fibroid embolization in a predominantly black african population: A retrospective cohort study

Uterine Fibroid Embolization (UFE) is one of the effective options available for treatment of symptomatic uterine fibroids with documented improvement in the quality of life and reduction in symptoms. The study assessed long-term quality of life post-uterine fibroid embolization in a mostly black population, noting scanty local or African research on this topic despite evidence suggesting a higher fibroid burden among black women. This retrospective study examined patients who underwent UFE from 2009 to 2014. Participants completed online demographic and UFS-QOL surveys. Statistical tests included Wilcoxon signed rank tests for HRQOL score differences and Pearson correlation for associations between independent factors and outcomes like quality of life and symptom severity. Data from 77 participants showed a median follow-up of eight years post-UFE. Median health-related quality of life significantly improved from baseline, with a median score of 88.6 (62.9 - 98.3). Symptom severity score also decreased significantly from baseline (54.7 to 21.9, p \u3c 0.001). Additionally, 31.1% reported follow-up fibroid treatments, 14.3% had major repeat procedures, and 22% reported pregnancies post-UFE, with 13% having children thereafter.

Honour based violence as a global public health problem: a critical review of literature

Purpose : 'Honour' Based Violence (HBV), a form of Gender Based Violence (GBV), has received increasing interest from media, human rights organisations, academics and public. A significant increase in the occurrence and reporting of HBV in many parts of the world and its detrimental impact on health and wellbeing of women, girls, communities and wider society; marks it a major public health concern. However, awareness and recognition of HBV in field of public health is low in many countries and there is little known about its nature, roots and distribution. Aim : The aim was to analyse existing literature to understand what is HBV; how it is understood, its nature and distribution. Methods : The literature was searched using the Scopus database and a series of search terms related to HBV, gender based violence and health and wellbeing. Findings : Definition of HBV and its forms is varied across cultures. There is a lack of consensus on how HBV can be identified over other forms of violence and no explicit theoretical perspectives have been sufficiently developed to deepen our understanding of HBV. Although findings from the review suggest that HBV forms and patterns may be regionally distinct, causes emanate from gender based and socio-economic inequalities. Value of findings : Findings from the review highlight the complexity of tackling HBV in a globalised world. Findings also provide insights on how public health model can be used to analyse causes and prevention of HBV. Further, a non-culturalised, unprejudiced and inclusive definition is required to flag-up and record HBV cases. Keywords : Honour-based violence, female genital mutilation, gender-based violence, public health, honour killin

Knowledge, attitudes and beliefs toward polypharmacy among older people attending Family Medicine Clinic, Nairobi, Kenya

Background Life expectancy has increased over the last century among older people, particularly those aged over 60 years. Aging is associated with increased disability, multiple chronic conditions, and increased use of health services managed with polypharmacy. There are few studies on polypharmacy and aging in sub-Saharan Africa, and it is unclear what older people know and their attitudes toward polypharmacy. This paper presents findings from a study that aimed to understand older people’s knowledge, attitudes and beliefs about polypharmacy. Methods A qualitative study using in-depth interviews of 15 patients aged 60 years and older who were taking more than five medications per day. The study was conducted at the Family Medicine Clinic (FMC), Aga Khan University Hospital, Nairobi. Data were analyzed using NVivo 12 software. Result Majority of participants had a good understanding of their underlying health conditions, but they did not know the specific names of the medications they were taking. Participants had diverse attitudes toward polypharmacy, with both positive and negative perceptions. Although adverse side effects were reported, participants remained positive because they believed these medicines were beneficial. Religion, faith and living healthy lifestyles were perceived to contribute to their positive attitude toward polypharmacy. Stigma and the cost of medication were reported as barriers. Conclusion This study provides valuable insights into the complexities of polypharmacy in older people. It highlights the importance of patient education, fostering strong patient-provider relationships, de-stigmatization, and improving medication affordability and accessibility. Further research could explore the polypharmacy of older people attending public institutions in rural Kenya

A qualitative enquiry of health care workers’ narratives on knowledge and sources of information on principles of Respectful Maternity Care (RMC)

Research from sub-Saharan Africa indicate that many women experience varied forms of disrespectful maternity care, which amount to a violation of their rights and dignity. Notably, there is little research that sheds light on health care workers (HCWs) training and knowledge of principles of respectful maternity care (RMC). Formulating appropriate interventional strategies to promote the respectful provision of services for women during pregnancy, childbirth, and postpartum period requires an understanding of the current state of knowledge and sources of information on respectful maternity care among HCWs. This paper reports findings from a qualitative study that examined the knowledge and sources of information on the Respectful Maternity Care Charter among HCWs in rural Kisii and Kilifi counties in Kenya. Between January and March 2020, we conducted 24 in-depth interviews among HCWs in rural Kisii and Kilifi health facilities. Data were analyzed using a mixed deductive and inductive thematic analysis guided by Braun’s [2006] six stages of analysis. We found that from the seven globally accepted principles of respectful maternity care, at least half of the HCWs were aware of patients right to consented care, confidentiality and privacy, and the right to non-discriminatory care based on specific attributes. Knowledge of the right to no physical and emotional abuse, abandonment of care, and detentions in the facilities was limited to a minority of health care workers but only after prompting. Sources of information on respectful maternity care were largely limited to continuous medical and professional training and clinical mentorship. The existing gap shows the need for training and mentorship of HCWs on the Respectful Maternity Care Charter as part of pre-service medical and nursing curricula and continuing clinical education to bridge this gap. At the policy level, strategies are necessary to support the integration of respectful maternity care into pre-service training curricula

Views of nurses and other healthcare workers on interventions to reduce disrespectful maternity care in rural health facilities in Kilifi and Kisii counties, Kenya: analysis of a qualitative interview study

Objective There is an abundance of evidence illuminating the factors that contribute to disrespectful maternity care in sub-Saharan Africa. However, there is limited documented evidence on how some of the key influences on the mistreatment of women could be addressed. We aimed to document the perspectives of nurses and other healthcare workers on existing and potential strategies embedded at the health facility level to promote respectful delivery of healthcare for women during delivery and on what interventions are needed to promote respectful and equitable treatment of women receiving maternity care in rural Kenya. Design, setting and participants We analysed relevant data from a qualitative study based on in-depth interviews with 24 healthcare workers conducted between January and March 2020, at health facilities in rural Kilifi and Kisii counties, Kenya. The facilities had participated in a project (AQCESS) to reduce maternal and child mortality and morbidity by improving the availability and the use of essential reproductive maternal and neonatal child health services. The participants were mostly nurses but included five non-nurse healthcare workers. We analysed data using NVivo V.12, guided by a reflective thematic analysis approach. Results Healthcare workers identified four interconnected areas that were associated with improving respectful delivery of care to women and their newborns. These include continuous training on the components of respectful maternity care through mentorships, seminars and organised training; gender-responsive services and workspaces; improved staffing levels; and adequate equipment and supplies for care. Conclusions These findings demonstrate some of the solutions, from the perspectives of healthcare workers, that could be implemented to improve the care that women receive during pregnancy, labour and delivery. The issues raised by healthcare workers are common in sub-Saharan African countries, indicating the need to create awareness at the policy level to highlight the challenges identified, potential solutions, and application or implementation in different contexts

Community-driven data revolution is feasible in developing countries: experiences from an integrated health information and surveillance system in Kenya

Over the period of the Millennium Development Goals (2000-15), it became clear that there was a pressing need and an increasing capacity for a ‘data revolution’ to inform the global health development agenda. In most developing countries, data on key indicators were collected through laborious and retrospective surveys that were as much as five years out-of-date, or through passive reporting systems that relied on routinely generated health facility data. Gaps in the primary data were filled by modelled estimates, which often relied on inadequate assumptions