Maternal health in resource-poor urban settings: how does women's autonomy influence the utilization of obstetric care services?

Background: Despite various international efforts initiated to improve maternal health, morethan half a million women worldwide die each year as a result of complications arising frompregnancy and childbirth. This research was guided by the following questions: 1) How doeswomen's autonomy influence the choice of place of delivery in resource-poor urban settings? 2)Does its effect vary by household wealth? and 3) To what extent does women's autonomy mediatethe relationship between women's education and use of health facility for delivery?Methods: The data used is from a maternal health study carried out in the slums of Nairobi, Kenya.A total of 1,927 women (out of 2,482) who had a pregnancy outcome in 2004–2005 were selectedand interviewed. Seventeen variable items on autonomy were used to construct women's decisionmaking,freedom of movement, and overall autonomy. Further, all health facilities serving the studypopulation were assessed with regard to the number, training and competency of obstetric staff;services offered; physical infrastructure; and availability, adequacy and functional status of suppliesand other essential equipment for safe delivery, among others. A total of 25 facilities weresurveyed.Results: While household wealth, education and demographic and health covariates had strongrelationships with place of delivery, the effects of women's overall autonomy, decision-making andfreedom of movement were rather weak. Among middle to least poor households, all threemeasures of women's autonomy were associated with place of delivery, and in the expecteddirection; whereas among the poorest women, they were strong and counter-intuitive. Finally, thestudy showed that autonomy may not be a major mediator of the link between education and useof health services for delivery.Conclusion: The paper argues in favor of broad actions to increase women's autonomy both asan end and as a means to facilitate improved reproductive health outcomes. It also supports thecall for more appropriate data that could further support this line of action. It highlights the needfor efforts to improve households' livelihoods and increase girls' schooling to alter perceptions ofthe value of skilled maternal health care

Determinants of health care seeking for childhood illnesses in Nairobi slums

The practice of appropriate health seeking has a great potential to reduce the occurrence of severe and life-threatening child illnesses. We assessed the influence of socio-demographic, economic and disease-related factors in health care seeking for child illnesses among slum dwellers of Nairobi, Kenya. A survey round of the Nairobi Urban Demographic Surveillance System (NUDSS) generated information on 2-week child morbidity, illness symptoms, perceived illness severity and use of modern health services. During this round of data collection, interviewers visited a total of 15 174 households, where 3015 children younger than 5 years lived. Of the 999 (33.1%) children who were reported to have been sick, medical care of some sort was sought for 604 (60.5%). Lack of finances (49.6%) and a perception that the illness was not serious (28.1%) were the main reasons given for failure to seek health care outside the home. Health care seeking was most common for sick children in the youngest age group (0–11 months). Caretakers sought medical care more frequently for diarrhoea symptoms than for coughing and even more so when the diarrhoea was associated with fever. Perception of illness severity was strongly associated with health care seeking. Household income was significantly associated with health care seeking up to certain threshold levels, above which its effects stabilized. Improving caretaker skills to recognize danger signs in child illnesses may enhance health-seeking behaviour. Integrated Management of Child Illnesses (IMCI) programmes must be accessible free of charge to the urban poor in order to increase health care seeking and bring about improvements in child survival.<br/

Socioeconomic differentials between HIV caregivers and noncaregivers: is there a selection effect? A case of older people living in Nairobi City

This article seeks to investigate the association between caregiving to someone with an HIV-related illness and the socioeconomic status of the caregiver using a population-based survey of 1,587 older people living in Nairobi slums. Findings indicate significant differences in living arrangements, wealth, income, and expenditure between HIV caregivers and noncaregivers. HIV caregivers lived in larger households and were also more likely to live in households with a large number of children younger than the age of 15 years. Whereas a high proportion of HIV caregivers were ranked highly in terms of wealth status, differences in per capita income and expenditure were not significant when household size and other confounders were accounted for. The financial costs associated with caring for someone with a chronic illness and the reliance on family members with financial ability for material support, a common feature of African extended family systems, may account for the relative economic advantage of HIV caregiver