Maternal morbidity in Kenya : Measurement, contributions and limitations of DHS data

Résumé En raison du manque d'information sur les complications liées à la grossesse et l'ac­couchement au Kenya et dans la plupart des pays d'Afrique subsaharienne, la morbidité maternelle continue d'être une dimension négligée de la santé maternelle, à la différence de la mortalité maternelle. Dans les années 1990, le programme des Enquête Démographique et de Santé (EDS) a collecté des données sur les complications liées à l'accouchement dans un peu moins de 40 pays en développement sur la base des déclarations des femmes. Ce type de données reste sous-utilisé. Cet ar­ticle analyse la prévalence de la morbidité maternelle auto-déclarée au Kenya ainsi que ses déterminants sur la base de l'EDS 1998, la seule enquête qui a recueilli ce type de données au Kenya. De plus, l'article discute brièvement des approches de la mesure de la morbidité maternelle dans les pays en développement, de leurs for­ces et de leurs limites. Il s'avère qu'au Kenya le travail prolongé est la complication la plus souvent déclarée en 1998, suivi de l'hémorragie. Des différences significati­ves entre régions sont observées pour l'hémorragie, la septicémie, et l'éclampsie. Les déclarations de morbidité maternelle sont significativement associées avec la parité, l'assistance à l'accouchement, le groupe ethnique et la province de résiden­ce. L'article conclut qu'en l'absence de systèmes d'état civil adéquats, la morbidité auto-déclarée reste l'approche la plus fiable pour recueillir l'information sur la mor­bidité maternelle au Kenya et en Afrique subsaharienne. Summary Due to lack of information on complications related to pregnancy and childbirth in Kenya and in most countries in sub-Saharan Africa, maternal morbidity continue to be a neglected dimension of maternal health, unlike maternal mortality. In the 1990s the DHS program collected data on complications related to childbirth in nearly 40 developing countries based on women’s reports. This type of data has been underutilized. This paper analyzes the prevalence of self-reported maternal morbidities in Kenya as well as their determinants using the 1998 Kenya Demogra­phic and Health Survey, the only survey that collected this kind of data in Kenya. The paper also briefly discusses the approaches used in the measurement of maternal morbidity in developing countries, their strengths and limitations. In Kenya it is found that prolonged labor was the most commonly reported complication followed by hemorrhage in 1998. Significant differences between regions are observ­ed in hemorrhage, sepsis, and eclampsia. Reports on maternal morbidity are significantly associated with parity, assistance at delivery, ethnicity, and province of resi­dence. The paper concludes that, because of the absence of adequate vital registration systems, self-reported morbidity remains the most viable approach to collect information on maternal morbidity in Kenya and in Sub-Saharan Africa

The Straight Talk Campaign in Uganda: Impact of mass media initiatives—Summary report

This Horizons study in Uganda found that exposure by adolescents to Straight Talk, a mass media initiative focused on adolescent sexual and reproductive health (ASRH), was associated with greater ASRH knowledge, a greater likelihood of having been tested for HIV, and more communication with parents about ASRH issues

ABC messages for HIV prevention in Kenya: Clarity and confusion, barriers and facilitators

The Horizons Program and FHI/IMPACT developed a collaborative research study to explore how adults and youth in Kenya define and perceive the ABC (abstinence/being faithful/consistent condom use) terms and behaviors. Additional objectives of the study were to identify attitudes and norms around the ABC behaviors that influence perceptions of them, and the role of important actors in transmitting messages about them. Findings highlight potential challenges in promoting each of the ABC behaviors, as well as some positive elements that can be built upon when developing programs. HIV prevention programs that incorporate ABC messages—both in Kenya and elsewhere—should consider a number of lessons highlighted in this study

Helping youth prevent HIV: An evaluation of the Straight Talk program in Uganda

Mass media initiatives are being implemented globally to provide information and foster HIV preventive behavior, however there has been limited evaluation of these efforts in sub-Saharan Africa. The Straight Talk (ST) program in Uganda has targeted youth with HIV and reproductive health (RH) information for over a decade. Evaluation results show positive associations between exposure to ST media and a number of key outcomes among youth, including sexual behavior, knowledge, and attitudes. In 2005–06, the Horizons Program conducted the first impact evaluation of the ST program in Uganda to document its effects on young people. This brief focuses on the findings of the adolescent survey. Overall, the study indicates that many Ugandan adolescents have benefited from ST products, and that greater exposure was associated with greater benefits. This includes less sexual activity among exposed males, and higher levels of HIV testing and RH knowledge among exposed youth. The ST program is using the results of the Horizons’ evaluation to strengthen the successful elements of its activities and address gaps

ABCs for HIV prevention in Kenya: Messages, beliefs, and barriers

A great deal of attention has been focused recently on promoting the “ABCs” of HIV prevention— abstinence or delaying sex, being faithful to one sexual partner or reducing the number of sexual partners, and consistently using condoms during sex. Yet even as programs that focus on the ABCs to prevent sexual HIV transmission are rolled out, questions remain about how well different groups in varied cultural contexts understand the terms, as well as how best to address challenges to adopting the ABC behaviors. The Horizons Program and FHI/IMPACT developed a collaborative research study in 2004 to explore how adults and youth in Kenya define and perceive the ABC terms and behaviors. Additional study objectives, noted in this research summary, were to identify attitudes and norms around the ABC behaviors that influence perceptions of them, and the role of important actors in transmitting messages about them. Findings highlight potential challenges in promoting each of the ABC behaviors, as well as some positive elements that can be built upon when developing programs

Beacon of hope: Evaluation of the Kenya Girl Guides Association HIV/AIDS program for school children

This Horizons report presents findings from an evaluation of the Kenya Girl Guides Participatory Peer Education Program for HIV and AIDS Prevention. The objective of the program was to train Girl Guide patrol leaders as peer educators, who in turn would communicate key information and concepts about such topics as HIV prevention, relationships, and self-esteem to other Girl Guides, and ultimately to their school peers. The results demonstrate that peer education conducted by Girl Guides is a feasible strategy for imparting HIV and AIDS education to school-going youth; however, such a program would need to be branded, strengthened, and appropriately resourced to attain positive results that extend beyond the Girl Guides to include their peers. The results also demonstrate that school girls in this study are operating in an environment where their male counterparts are more than seven times as likely to be sexually experienced, and may be exerting considerable pressure to have sex even on the strongest of girls. HIV risk-reduction programs directed at school girls may be more successful if they also address the risk behavior of school boys

Maternal mortality in Kenya : measures and determinants

Dans les trois dernières décennies, les chercheurs et la communauté internationale ont montré un intérêt accru pour la mortalité maternelle. Des objectifs et des stratégies ont été proposés pour réduire celle-ci au cours de diverses conférences internationales (Conférence de la Maternité Sans Risque à Nairobi en 1987, Conférence Internationale sur la Population au Caire en 1994 et particulièrement, Sommet du Millénaire à New York en l'an 2000). Alors que certains pays en développement ont réussi à atteindre les objectifs fixés, le Kenya se trouve confronté à l’un des plus grands défis auquel il ait dû faire face en matière de santé : réduire les niveaux toujours élevés de la mortalité maternelle. Comme dans la plupart des pays d’Afrique subsaharienne, au Kenya, les données de l'état civil qui pourraient fournir des informations fiables sur les décès maternels sont généralement incomplètes et les Enquêtes Démographiques et de Santé sont devenues la principale source d'information pour estimer à la fois la mortalité des adultes et la mortalité maternelle. A l’aide de ces enquêtes cette thèse vise à expliquer les niveaux élevés de la mortalité maternelle au Kenya entre 1986 et 2008. Par ailleurs, les EDS sont utilisées en même temps qu’une enquête sur les morbidités obstétricales réalisée dans un hôpital de Nairobi pour mesurer les morbidités obstétricales qui accroissent les risques de mortalité. Cette thèse combine les méthodes démographiques classiques et les modèles linéaires généralisés pour étudier les niveaux et les tendances de la mortalité maternelle, analyser les morbidités obstétricales et les déterminants individuels de l’une et des autres. Elle se penche également sur les facteurs contextuels, en particulier le système de santé du Kenya. Les niveaux de mortalité maternelle sont liés à l’accessibilité, la disponibilité et la qualité des services de santé maternelle, de même qu’ils sont liés aux comportements des femmes en matière de reproduction et de recours de soins de santé maternelle. Mais, ces comportements sont influencés par l’environnement socioculturel de la femme et cette thèse étudie l’ensemble de ces déterminants.In nearly the last three decades, an increased interest in maternal mortality has been taken by both researchers and the international community. Strategies and targets to reduce maternal mortality have been set during various International Conferences (The Safe Motherhood Conference in Nairobi in 1987, the International Conference on population in Cairo in 1994, and most importantly, the Millennium Summit in New York in the year 2000). While some developing countries have managed to meet the targets set, persistently high risks of maternal mortality remain one of the greatest health challenges that Kenya continue to face. Like in most sub-Saharan Africa countries, in Kenya, vital registration of births and deaths, that could reliably and continuously elicit information on maternal deaths, is usually incomplete. DHS sibling history data is the major source of information for both adult and maternal mortality. Using this data, this dissertation seeks to explain the persistently high levels of maternal mortality in Kenya between 1986 and 2008. A hospital based study is used to measure obstetric morbidities. This dissertation combines both classic demographic methods and generalized linear models to study levels and trends of maternal mortality, analyze obstetric morbidities and individual determinants of maternal mortality and morbidity. The Kenyan health system is considered as a contextual determinant of maternal mortality and morbidity in terms of availability, accessibility and quality of maternal health services. We find that the persistently high levels of maternal mortality are extremely related to the healthcare system, women’s reproductive and maternal healthcare seeking behavior, and that women’s’ behavior is highly linked to their socio cultural environment

Socio-economic and demographic factors influencing open defecation in Haiti: a cross-sectional study

Abstract Background Open defecation (OD) remains an important public health challenge in Haiti. The practice poses a significantly high risk of disease transmission. Considering these negative health consequences, this paper aims to identify socio-economic and demographic factors that influence OD practice among households in Haiti. Methods The study used secondary data from 13,405 households from the Haiti Demographic and Health Survey 2016-2017. Descriptive statistics and bivariate analysis were used to find the preliminary results. Further, multivariate analysis was performed to confirm the findings. Results Around one quarter (25.3%) of Haitian households still defecate in the open, almost 10% in urban areas, and nearly 36% in rural areas. Multivariate analysis revealed that the age and sex of the household head, household size, number of children aged 1-14 years old in the household, education level, wealth index, access to mass media, place of residence, and region were significant predictors of OD practice among households in Haiti. Conclusion To accelerate the elimination of OD by 2030 and therefore achieve sustainable open defecation-free status, the government of Haiti and its partners should consider wealth disparities among regions and mobilize mass media and community-based networks to raise awareness and promote education about sane sanitation practices. Furthermore, because the possibilities to build toilets differ between rural and urban areas, specific interventions must be spearheaded for each of these regions. The public program can subsidize individual toilets in rural areas with room to collect dry excreta for the preparation of fertilizers, while in urban areas collective toilets can be built in slums. Interventions should also prioritize households headed by women and young people, two underpriviledged socioeconomic groups in Haiti