Childhood Mortality in Kenya: An examination of trends and determinants in the late 1980s to mid 1990s

After Independence in the early 1960s, child mortality in Kenya fell rapidly. Until around 1980, the under 5 mortality rate (U5MR), the probability of dying by age 5, fell at an annual rate of about 4 percent per annum. This rate of decline slowed in the early 1980s, to about 2 per cent per annum. Recent data from the 1998 Kenya Demographic and Health Survey showed that, far from declining, the U5MR increased by as much as 25 percent from the late 1980s to the mid 1990s. This adverse trend coincided with a number of other adverse trends: stagnation in growth of per capita income, declining levels of immunization, falling school enrolment, and the emergence of an HIV/AIDS epidemic. On a more positive note, fertility fell by about 30 percent from the mid 1980s to the mid 1990s. Controversy surrounds the factors responsible for the increase in child mortality in the 1990s, and the objective of this paper is to clarify the situation. Data from the 1993 and 1998 DHSs have been merged into a single data set, and multivariate analysis used to examine the factors associated with mortality risks in childhood. Dummy variables were used to represent different three-year time periods, from 1984-86 to 1996-98. Socioeconomic controls, including mother¹s education, an indicator of household wealth, urban/rural residence, and indicators of health service utilization, plus controls for reproductive dynamics such as age of mother at the birth, birth order, sex and preceding birth interval, were developed. In addition, an indicator of the HIV epidemic, the prevalence of HIV in the district of birth at the time of each child¹s birth, was developed. With no controls, the models confirmed an increase in mortality of about 25 percent. Including socioeconomic and biodemographic controls tended to strengthen the upward trend in mortality; in other words, had there been no changes in these factors, child mortality would have been expected to decline. Introducing controls for health variables immunization, pregnancy and delivery care, prevalence of childhood diseases and maternal and child malnutrition ­ also did not alter the underlying trends substantially. Thus rising child mortality could not be explained by socioeconomic, biodemographic or health status factors. Including the prevalence of HIV in the models, however, changed the underlying trends fundamentally, from sharp increase to monotonic decline. Although models of this sort cannot demonstrate causation, only association, the HIV epidemic appears to be the most probable cause of the recent increases in child mortality in Kenya. Of the health variables, the only one found to be significantly protective was immunization coverage

Childhood Sexual Abuse Among University Students in Tanzania

Objectives: There are no prevalence data for childhood sexual abuse among Tanzanian university students. This investigation addressed this paucity. The nature of sexual abuse was also investigated. Method: Participants (N= 487) from a university in Tanzania completed a questionnaire which assessed abusive childhood sexual experiences, gathering information about age of victim, duration of abuse, perpetrators, amount of force or persuasion involved, and potential causes of child sexual abuse. A number of individuals were also interviewed about their experiences. Results: The overall prevalence rate for child sexual abuse was 27.7%, with rates being higher for females than for males. The average age of the victim when abuse occurred was 13.8 years. Perpetrators were generally unidentified by respondents; nonetheless, a surprisingly high proportion of female perpetrators was noted. There was a considerable amount of force or persuasion involved in the abusive behavior: betrayal of trust, bribes and physical force were cited frequently. Poverty and superstition were the primary explanations given for child sexual abuse. Conclusion: The study provides evidence for the existence of child sexual abuse in Tanzania. Poverty feeds the “sugar daddy/mammy” phenomenon and combined with various forms of superstition is an important factor in child sexual abuse in Tanzania

Acceptability and sustainability of the WHO focused antenatal care package in Kenya

The objectives of this study were to assess the Kenyan Ministry of Health’s capacity to adapt focused antenatal care (ANC) at the service delivery level so that it can be sustained, and to examine the extent to which adaptation of the package has increased coverage and quality of key ANC services and the overall quality of care received by pregnant women. The study showed that focused ANC is acceptable to both clients and providers and the approach has also received tremendous support from both the government and health development partners. However, the sustainability of the focused ANC package is contingent upon availability of funding, availability of a minimum level of equipment and supplies, competent providers, and a clear policy direction. The study recommends further consultation with key actors (such as pre-service training institutions and professional bodies) to ensure institutionalization and standardization of focused ANC; community mobilization to create awareness about the new services being offered; reorganizing service delivery and client flow within clinics to reduce client waiting time; and training providers in the concept of focused ANC

FACTORS AFFECTING ACCESS TO MATERIAL HEALTH CARE IN KENYA: A CASE STUDY OF MACHAKOS COUNTY

The purpose of this study was to establish the factors affecting access to material health care in Kenya with reference to Machakos County as case study, there are many factors that influence health and health care seeking. Although many of these factors are similar across populations, exactly how they interact and influence the actions of people is often unique to a population in the context of the environment they live in. The study will add to the body of literature and researches shall be able to use this research study as a reference to what they will do in future not forgetting that it will be used as a source of literature review to their studies. This study adopted a descriptive research design. The populations of this study were the staff of Machakos County. Stratified Random Sampling method was used to select a sample of 300 respondents. The study used both primary and secondary data. Primary data was collected with semi-structured questionnaire. The questionnaires were personally administered by the researcher to the respondents. Secondary data was collected from other already existing sources and previous research. This will be through reading relevant literature available in the library, various documents, publications and reports including, journals, and magazines. Descriptive statistics such as mean, standard deviation and frequency distribution will be used to analyses the data. Data presentation was done by the use of charts, graphs, percentages and frequency tables. Inferential statistics were used in drawing conclusions. Maternal health services need to continuously sensitize to the community so that the number of pregnant mothers delivered in health facility increased to attain the National target and reduced maternal morbidity and mortality. Based on these findings, increase the utilization of health facility for delivery by improving education among girls, increase accessibility to health facility and promote early booking and regular visits to ANC by women have been recommended

Assessing knowledge, attitude and practices of male condom use among male employees fifty years and older at a diamond mining company in Namibia

Magister Public Health - MPHBackground: The HIV / AIDS pandemic have been characterized as the greatest natural challenge ever to confront humanity and one of the great moral causes of our time (World Bank, 2007). Although, the HIV and AIDS pandemic is a global problem, some regions of the world, notably sub-Saharan Africa are hardly hit by the pandemic. Namibia is one of the sub-Saharan African countries which are badly affected by the HIV and AIDS pandemic. It is estimated that about 360 000 Namibians were infected with HIV by 2010. This translates to a national HIV prevalence of (18.8%). The National HIV and AIDS Response Department has designed various interventions and strategies to curb the spread of the HIV. Promotion of male condoms promotion is one of the key strategies being advocated. If used consistently and correctly, male condoms are regarded as an effective preventive tool of HIV transmission. However, changing individual’s sexual behaviors and lifestyle to make condom use part of their sexual life seems to be the challenge. In Namibia most of the research in the area of HIV and AIDS were done among the youth and population aged between 15 – 49 years. Hence, this study looks at older men as a neglected population. Aim: The aim of the current study was to assess knowledge, attitudes and practices of condom use among male employees age 50 (fifty) years and older at a mining company in Southern Namibia. Methodology: A descriptive, cross-sectional survey utilizing quantitative research approach was applied. Data was collected through face-to-face interviewing male employees, age fifty years and older, while at work at the Mine Area 1 (MA1). Data was captured in excel and imported into SPSS version 16.0. Chi-square test was used to determine the association between KAP variables and the socio-demographic characteristics of the respondents. The level of statistical significance was set at 0.05. Results: Among 105 respondents (males, mean age 54.5 years), more than half lived in the singe sex male hostels. Knowledge about condom use was good but there remained a significant number of the respondents whose knowledge was insufficient. A high percentage of the respondents suggested that HIV positive individuals should always use condom every time they have sexual intercourse. Conclusion: This study showed that respondents are not at a high risk of contracting HIV infection due to lack of knowledge on condom use though some of them possessed insufficient knowledge. Thus, to minimize the likelihood of HIV infection targeted interventions including peer education programmes were suggested, and working with the community in the area. Moreover, a more comprehensive knowledge attitude and practice study among mine employees from various sections of the mine would be beneficial to identify the level of risk within the total employee population

Differences in characteristics of women who initiate antenatal care early and late in two slums of Nairobi, Kenya

ABSTRACT Background: About 90% of women in Kenya report at least one antenatal care (ANC) visit yet maternal mortality rate remains high at 414 per 100,000 live births. Only 40% of childbirths occur in health facilities. A previous study of Nairobi slums in 2000 indicated that only 10.3% of women initiated ANC visits in the first trimester. High incidence of maternal deaths in Kenya especially among the very poor has been attributed to inadequate emergency obstetrical care. Decreasing numbers of women are initiating ANC within the first trimester and this may be affecting the ability of the health system to identify and cater for women whose health conditions can be effectively managed through ANC. This study aimed to determine the proportion of women initiating ANC in the first and last trimesters and the background characteristics associated with these women in two slums of Nairobi, Kenya. It also sought to determine if timing of initial ANC visit was associated with number of visits and choice of place of delivery in a slum setting. Materials and methods: This research report is a secondary data analysis of the World Bank funded Maternal Health Project conducted between 1st April and 30th June, 2006 by the African Population and Health Research Center. Participants were women 12 to 54 years, enumerated in the Nairobi Urban Health Demographic Surveillance System living in two slums of Nairobi, who had a pregnancy outcome between January 2004 and December 2005. Women 15 to 49 years were included in this analysis. Analysis of the data was done using STATA 9.2. Findings: Only 7.3% of women initiated ANC in the first trimester, with 52% making four or more visits. In the third trimester 22% of women initiated ANC. Although 97% of women reported receiving their first ANC from a skilled health professional, only 48.4% delivered in well equipped health care facilities. The median number of months pregnant at first ANC was six and median number of visits was four. Women who were most likely to initiate early ANC had secondary school or higher level of education (p=0.055) and were in a union (p=0.008). The least likely to initiate care in the first trimester were of minority ethnicity (0.011) and high parity (p=0.019). As educational level and wealth status rise, the likelihood of late ANC initiation declines. Women living with unemployed partners were less likely to initiate care in the first trimester compared to those living with employed partners (OR 0.2, p=0.046). Only women with educated partners initiated care during the first trimester. Women who initiated ANC in the first trimester were more likely to have 4 visits and more likely to deliver in appropriate facilities than those who initiated care in the third trimester. Those who initiated care to obtain an ANC card were less likely to have 4 visits than those who initiated care to verify that pregnancy was normal (OR 0.5, p=0.000). Women who initiated care in first trimester were 1.5 and 5.0 times more likely to deliver in good health facilities than those who initiated care in third trimester (p=0.040) and those who had no ANC (p=0.000), respectively. Conclusion: Women in Korogocho and Viwandani may have better chances of delivering in appropriate facilities if they have low parity and secondary level education. The presence of a partner with a means of steady income may also make it easier for women to access delivery care in good facilities. Interventions to improve the level of educational attainment among women and provide affordable family planning are necessary to increase early ANC attendance and subsequently delivery in well equipped facilities

Nutritional Status and Malaria: An Ancillary Study to the Asembo Bay Cohort Project

Malaria and malnutrition remain major causes of morbidity and mortality among children under five. The associations between 1) malnutrition and subsequent asymptomatic parasitemia or clinical malaria and 2) multiple malaria infections and subsequent growth, were assessed among 18,028 visits from 1,182 children 30 months and younger using data from the Asembo Bay Cohort Project (ABCP). ABCP was a longitudinal study that collected information on children under five from 1992 to 1996 in an intense malaria transmission area of western Kenya. Infants were enrolled at birth and followed until loss to follow up, death, the end of the study, or five years of age. Anthropometric measures and blood specimens were obtained at monthly intervals. Anthropometric measures included calculated Z-scores for height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ). Clinical malaria (parasitemia with fever) and asymptomatic parasitemia (parasites without fever) were assessed with thick and thin blood films. Multinomial and linear generalized estimating equation models were used to estimate odds ratios for the association between malnutrition and malaria outcomes, and differences in mean Z-score following a one episode increase in cumulative malaria infection. Missing observations were accounted for through a combination of multiple imputation and inverse probability weighting. Stunting and underweight showed a modest association with subsequent asymptomatic parasitemia. The prevalence odds ratios for asymptomatic parasitemia increased from 1.07 (0.89, 1.29) to 1.35 (1.03, 1.76) as stunting severity increased from mild to severe, and the prevalence odds ratio increased from 1.16 (1.02, 1.33) to 1.35 (1.09, 1.66) as underweight increased from mild to moderate. Given the association between malnutrition and asymptomatic parasitemia, testing asymptomatic malnourished children for malaria should be considered. The association between cumulative malaria and malnutrition varied with age. An increase in cumulative malaria was associated with a limited decrease in subsequent mean HAZ and WHZ among children under 18 months. Among children 24-30 months, cumulative malaria was associated with a limited increase in mean HAZ. Multiple malaria infections may lead to consistent diversion and loss of nutrients, resulting in a decrease in subsequent mean HAZ and WAZ in very young children.Doctor of Philosoph

Utilization of health and medical services: factors influencing health care seeking behaviour and unmet health needs in rural areas of Kenya

There are many factors that influence health and health care seeking. Although many of these factors are similar across populations, exactly how they interact and influence the actions of people is often unique to a population in the context of the environment they live in. The current study, a population-based cross sectional survey, identifies three specific geographically diverse populations in rural areas of Kenya, to gain information regarding overall influences on health care seeking, and also information specific to each geographical area to directly target the health needs of the individual population living there. Participants of the survey were interviewed for personal information and details regarding their activities in response to their health and ill-health. The subsequent data was then analysed to determine which factors affected the use of health and medical services within the study areas and whether the study participants believed their health needs were being met