"Before we used to get sick all the time": perceptions of malaria and use of long-lasting insecticide-treated bed nets (LLINs) in a rural Kenyan community

<p>Abstract</p> <p>Background</p> <p>Malaria is a leading global cause of preventable morbidity and mortality, especially in sub-Saharan Africa, despite recent advances in treatment and prevention technologies. Scale-up and wide distribution of long-lasting insecticide-treated nets (LLINs) could rapidly decrease malarial disease in endemic areas, if used properly and continuously. Studies have shown that effective use of LLINs depends, in part, upon understanding causal factors associated with malaria. This study examined malaria beliefs, attitudes, and practices toward LLINs assessed during a large-scale integrated prevention campaign (IPC) in rural Kenya.</p> <p>Methods</p> <p>Qualitative interviews were conducted with 34 IPC participants who received LLINs as part of a comprehensive prevention package of goods and services. One month after distribution, interviewers asked these individuals about their attitudes and beliefs regarding malaria, and about their use of LLINs.</p> <p>Results</p> <p>Virtually all participants noted that mosquitoes were involved in causing malaria, though a substantial proportion of participants (47 percent) also mentioned an incorrect cause in addition to mosquitoes. For example, participants commonly noted that the weather (rain, cold) or consumption of bad food and water caused malaria. Regardless, most participants used the LLINs they were given and most mentioned positive benefits from their use, namely reductions in malarial illness and in the costs associated with its diagnosis and treatment.</p> <p>Conclusions</p> <p>Attitudes toward LLINs were positive in this rural community in Western Kenya, and respondents noted benefits with LLIN use. With improved understanding and clarification of the direct (mosquitoes) and indirect (e.g., standing water) causes of malaria, it is likely that LLIN use can be sustained, offering effective household-level protection against malaria.</p

Overnight interbank markets and the determination of the interbank rate: a selective survey

Overnight interbank markets provide critical facilities for the banking system to manage, pool and redistribute its cash reserves. We provide a selective survey of the literature on overnight interbank markets. We outline the typical structure of overnight markets, including the networking relationships involved, as an indispensable prerequisite for a clear understanding of the workings of these markets. We review the theoretical and empirical studies on the determination of the overnight rate, and in that context discuss the implications of the 2007–08 financial crisis. We summarise key issues for further research

Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana

Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates.\ud Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries

Assessing access barriers to tuberculosis care with the tool to Estimate Patients' Costs: pilot results from two districts in Kenya

<p>Abstract</p> <p>Background</p> <p>The poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya.</p> <p>Methods</p> <p>The Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions.</p> <p>Results</p> <p>A total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8) and indirect (opportunity; USD 294.2) costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach.</p> <p>Conclusions</p> <p>The Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and gender-related impacts. The Tool helps to identify and tackle bottlenecks in access to TB care, especially for the poor. Reducing delays in diagnosis, decentralization of services, fully integrated TB/HIV care and expansion of health insurance coverage would alleviate patients' economic constraints due to TB.</p

Quality of Water the Slum Dwellers Use: The Case of a Kenyan Slum

As a result of rapid urbanization in a context of economic constraints, the majority of urban residents in sub-Saharan Africa live in slums often characterized by a lack of basic services such as water and sewerage. Consequently, the urban poor often use inexpensive pit latrines and at the same time may draw domestic water from nearby wells. Overcrowding in slums limits the adequate distance between wells and pit latrines so that micro-organisms migrate from latrines to water sources. Sanitary practices in these overcrowded slums are also poor, leading to contamination of these wells. This study sought to assess sanitary practices of residents of a Kenyan urban slum and fecal contamination of their domestic water sources. This cross-sectional study involved 192 respondents from Langas slum, Kenya. Forty water samples were collected from the water sources used by the respondents for laboratory analysis of coliforms. Of these 40 samples, 31 were from shallow wells, four from deep wells, and five from taps. Multiple-tube fermentation technique was used to enumerate coliform bacteria in water. The study found that most people (91%) in the Langas slum used wells as the main source of domestic water, whereas the rest used tap water. Whereas most people used pit latrines for excreta disposal, a substantial percentage (30%) of children excreted in the open field. The estimated distance between the pit latrines and the wells was generally short with about 40% of the pit latrines being less than 15 m from the wells. The main domestic water sources were found to be highly contaminated with fecal matter. Total coliforms were found in 100% of water samples from shallow wells, while 97% of these samples from shallow wells were positive for thermotolerant coliforms. Three out of the four samples from deep wells were positive for total coliforms, while two of the four samples were positive for thermotolerant coliforms. None of the samples from taps were positive for either total or thermotolerant coliforms. Because the presence of thermotolerant coliforms in water indicates fecal contamination, facilitated by the proximity between the wells and pit latrines, the study suggests that the pit latrines were a major source of contamination of the wells with fecal matter. However, contamination through surface runoff during rains is also plausible as indiscriminate excreta disposal particularly by children was also common. Owing to the fecal contamination, there is a high possibility of the presence of disease pathogens in the water; thus, the water from the wells in Langas may not be suitable for human consumption. To address this problem, treatment of the water at community or household level and intensive behavioral change in sanitary practices are recommended. Efforts should be made to provide regulated tap water to this community and to other slums in sub-Saharan Africa where tap water is not accessible. However, more sampling of different water sources is recommended

FinAccess Household Survey 2015

The Kenya FinAccess household survey measures access to and demand for financial services among adults in a nationally representative survey. The 2015 FinAccess sample is nationally representative based on the KNBS NASSEP V national household sampling frame. The target sample is 10,008 interviews from 834 clusters across Kenya (14 households will be targeted in each cluster). On respondent per household (+16 years) was selected randomly. Estimates from the 2015 FinAccess sample are representative to 13 sub-regional county clusters. Additional information can be found here: http://fsdkenya.org/dataset/finaccess-retail-2015