Interpersonal Influences in the Scale-up of Male Circumcision Services in a Traditionally Non-circumcising Community in Rural Western Kenya

Promoting male circumcision (MC) is now recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men, and plans are underway to scale-up this intervention especially in non-circumcising communities, with generalized HIV pandemic. This qualitative study identifies and characterizes the role of social and interpersonal factors in the scale-up of MC services in a rural non-circumcising community in western Kenya. Twenty-four sex-specific focus group discussions were conducted with a purposive sample of Luo men and women (15-34 years). Peer and youth groups, girlfriends and women, parents, and cultural political, religious, school leaders were identified as key influences in the scale-up of MC services. The study concludes that social and interpersonal forces create opportunities and constraints for scaling up the MC intervention. Planners of MC projects should therefore harness the power of informal networks and social structures to enhance community engagement, motivate behaviour change and increase demand for MC services

Interpersonal Influences in the Scale-up of Male Circumcision Services in a Traditionally Non-circumcising Community in Rural Western Kenya

Promoting male circumcision (MC) is now recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men, and plans are underway to scale-up this intervention especially in non-circumcising communities, with generalized HIV pandemic. This qualitative study identifies and characterizes the role of social and interpersonal factors in the scale-up of MC services in a rural non-circumcising community in western Kenya. Twenty-four sex-specific focus group discussions were conducted with a purposive sample of Luo men and women (15-34 years). Peer and youth groups, girlfriends and women, parents, and cultural political, religious, school leaders were identified as key influences in the scale-up of MC services. The study concludes that social and interpersonal forces create opportunities and constraints for scaling up the MC intervention. Planners of MC projects should therefore harness the power of informal networks and social structures to enhance community engagement, motivate behaviour change and increase demand for MC services

Networked Spaces: Benefits of Mobile Phones in the Treatment and Referral Process within iCCM

Kenya is still lagging behind regional and global averages in child mortality rates despite the fact that substantial progress has been made in reducing child mortality through child health programs since 1990. Furthermore, Kenya like other developing countries faces constraints in health system performance and access to services in hard-to-reach areas. Studies on the use of mobile phones in iCCM have mainly focused on malaria and neglected other common childhood illnesses, yet there is evidence to show the potential for the integration of mobile phones in iCCM to address the challenges of reducing under-five child morbidity and mortality due to common childhood illnesses. This paper aims to assess the informal uses of mobile phones in community case management of childhood illnesses in Nyaguda sub-location, Western Kenya. Ethnographic study design was employed. The study population consisted of 25 CHVs trained and supervised in ICCM and having access to basic mobile phones, selected caregivers, KIIs with Nyaguda dispensary incharge, CHEW Nyaguda sub-location, a clinical officer and matron in-charge of MCH at Bondo sub-County hospital, FGDs with caregivers, community health workers, CHEWs within the intervention sites of iCCM and Bondo sub-county health management team. Data collection methods included; in-depth interviews, KIIs, FGDs, and direct observation.  Data was analyzed through latent content analysis by theoretically relating the emerging themes from the texts as per the specific objectives. Ethical standards were followed by obtaining informed consent and respecting confidentiality.  This study found that the integration of mobile phone within iCCM opened further the existing and new spaces of care hence improving the healthcare system and health policy. Keywords:  iCCM, Informal uses, Mobile phones, Health worker

Psychosocial Factors Influencing Promotion of Male circumcision for HIV Prevention in a Non-circumcising Community in Rural Western Kenya

Male circumcision (MC) is now recommended as an additional HIV preventive measure, yet little is known about factors that may influence its adoption, especially in non-circumcising communities with generalized HIV pandemic. This qualitative study explored factors influencing MC adoption in rural western Kenya. Twenty-four sex specific focus group discussions were conducted with a purposive sample of Luo men and women (15-34 years). Perceived barriers to circumcision were pain and healing complications, actual and opportunity costs, behavioral disinhibition, discrimination, cultural identity, and reduced sexual satisfaction; perceived facilitators were hygiene, HIV/STI risk reduction, ease in condom use, cultural integration, and sexual satisfaction. To enhance MC adoption, community education, and dialogue is needed to address the perceived fears

Exploring the Care Relationship between Grandparents/Older Carers and Children Infected with HIV in South-Western Uganda: Implications for Care for Both the Children and Their Older Carers

The care of children orphaned by HIV/AIDS in sub-Saharan Africa is often undertaken by grandparents, yet little is known about the care relationship between grandparent and grandchild. Our aim was to examine this relationship to understand the needs and responsibilities of both the HIV positive child and older carer and the nature of the relationship, and to assess the implications for care for the children and the older carers. A qualitative study was conducted with 40 purposively sampled children (13–17 years) and their older carers (50 years and above). Participants were recruited from two clinics in south-western Uganda. Up to three semi-structured interviews were held with each participant. Data were analysed using a thematic framework approach. We found that the care relationship was mostly reciprocal: HIV positive children depended on carers for basic and health needs and carers counted on the children for performing tedious household tasks. The relationship was also characterised by challenges, sometimes causing tension between child and carer. We conclude that: (1) interventions targeting HIV positive children need to also address the needs of older carers, and (2) carers and children would benefit from psychosocial support and social protection

Socio-cultural determinants of anticipated acceptance of an oral cholera vaccine in Western Kenya

Determinants of anticipated acceptance of an oral cholera vaccine (OCV) were studied in urban and rural communities of Western Kenya. An explanatory model interview administered to 379 community residents assessed anticipated vaccine acceptance at various prices from no cost to full-cost recovery, socio-cultural features of cholera and social characteristics. Nearly all (99%) residents indicated willingness to accept a no-cost OCV, 95% at a price of US$0·8, 73$ 4·2 and 59% at US$ 8·4. Logistic regression models analysed socio-cultural determinants of anticipated OCV acceptance. Prominence of non-specific symptoms for cholera was negatively associated with acceptance. A cholera-specific symptom (thirst), self-help referring to prayer, income and education were positively associated. In the high-cost model, education was no longer significant and reliance on herbal treatment was a significant determinant of vaccine non-acceptance. Findings suggest high motivation for OCVs, if affordable. Socio-cultural determinants are better predictors of anticipated acceptance than socio-demographic factors alon

Measures adopted by indigent mothers in Kilifi County to tackle maternal health challenges during the COVID-19 pandemic

Many sub-Saharan African countries have experienced various challenges that threaten the quality of health services offered to the population. The COVID-19 pandemic disrupted access to healthcare services in many countries as they grappled with implementing measures to curb its spread. The consequences of COVID-19 have been catastrophic for maternal and newborn health. There is a dearth of information on expectant mothers’ negotiation mechanisms to access maternal health services during COVID-19 in Kenya. This rapid qualitative study draws data from purposefully selected 15 mothers who were either pregnant or had newborn babies during the COVID-19 pandemic in Kilifi county in Kenya. Data were analyzed thematically and presented in a textual description. Women used the following alternatives to access maternal health: giving birth at the homes of traditional birth attendants (TBAs), substituting breastfeeding with locally available food supplements, relying on limited resources and neighbours for delivery and local savings and rotating credit associations. This study shows that urgent measures are needed to provide high quality maternal and child health services during and after the COVID-19 pandemic. These include but are not limited to developing special interventions for the pregnant women for any emergency and establishing trust between communities and individuals through the TBAs.De nombreux pays d'Afrique subsaharienne ont connu divers défis qui menacent la qualité des services de santé offerts à la population. La pandémie de COVID-19 a perturbé l'accès aux services de santé dans de nombreux pays alors qu'ils s'efforçaient de mettre en oeuvre des mesures pour freiner sa propagation. Les conséquences du COVID-19 ont été catastrophiques pour la santé maternelle et néonatale. Il y a un manque d'informations sur les mécanismes de négociation des femmes enceintes pour accéder aux services de santé maternelle pendant la COVID-19 au Kenya. Cette étude qualitative rapide tire des données de 15 mères délibérément sélectionnées qui étaient enceintes ou qui ont eu des nouveau-nés pendant la pandémie de COVID-19 dans le comté de Kilifi au Kenya. Les données ont été analysées thématiquement et présentées dans une description textuelle. Les femmes ont utilisé les alternatives suivantes pour accéder à la santé maternelle: accoucher au domicile des accoucheuses traditionnelles (AT), remplacer l'allaitement par des compléments alimentaires disponibles localement, compter sur des ressources et des voisins limités pour l'accouchement et sur les associations locales d'épargne et de crédit rotatif. Cette étude montre que des mesures urgentes sont nécessaires pour fournir des services de santé maternelle et infantile de haute qualité pendant et après la pandémie de COVID-19. Celles-ci incluent, mais sans s'y limiter, le développement d'interventions spéciales pour les femmes enceintes pour toute urgence et l'établissement de la confiance entre les communautés et les individus par le biais des AT.De nombreux pays d'Afrique subsaharienne ont connu divers défis qui menacent la qualité des services de santé offerts à la population. La pandémie de COVID-19 a perturbé l'accès aux services de santé dans de nombreux pays alors qu'ils s'efforçaient de mettre en oeuvre des mesures pour freiner sa propagation. Les conséquences du COVID-19 ont été catastrophiques pour la santé maternelle et néonatale. Il y a un manque d'informations sur les mécanismes de négociation des femmes enceintes pour accéder aux services de santé maternelle pendant la COVID-19 au Kenya. Cette étude qualitative rapide tire des données de 15 mères délibérément sélectionnées qui étaient enceintes ou qui ont eu des nouveau-nés pendant la pandémie de COVID-19 dans le comté de Kilifi au Kenya. Les données ont été analysées thématiquement et présentées dans une description textuelle. Les femmes ont utilisé les alternatives suivantes pour accéder à la santé maternelle: accoucher au domicile des accoucheuses traditionnelles (AT), remplacer l'allaitement par des compléments alimentaires disponibles localement, compter sur des ressources et des voisins limités pour l'accouchement et sur les associations locales d'épargne et de crédit rotatif. Cette étude montre que des mesures urgentes sont nécessaires pour fournir des services de santé maternelle et infantile de haute qualité pendant et après la pandémie de COVID-19. Celles-ci incluent, mais sans s'y limiter, le développement d'interventions spéciales pour les femmes enceintes pour toute urgence et l'établissement de la confiance entre les communautés et les individus par le biais des AT.Wellcome Trust, the Netherlands Organization for Scientific Research-WOTRO Science for Global Development, the Josephine de Karman scholarships and French Institute for Research in Africa.https://www.ajol.info/index.php/ajrhhj2023Centre for the Advancement of Scholarshi

The Impact of a Community-based Pilot Health Education Intervention for Older People as Caregivers of Orphaned and Sick Children as a Result of HIV and AIDS in South Africa

The increasing HIV and AIDS epidemic in South Africa poses a substantial burden to older people, in particular older women who mainly provide care for sick adult children and their grandchildren who have become orphaned and rendered vulnerable by the death or illness of their parents. In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge. The results provided valuable information upon which the development of future interventions may be based and psychosocial and structural needs of the older caregivers may be addressed by relevant stakeholders

The orphaning experience: descriptions from Ugandan youth who have lost parents to HIV/AIDS

The HIV/AIDS epidemic has continued to pose significant challenges to countries in Sub-Saharan Africa. Millions of African children and youth have lost parents to HIV/AIDS leaving a generation of orphans to be cared for within extended family systems and communities. The experiences of youth who have lost parents to the HIV/AIDS epidemic provide an important ingress into this complex, evolving, multi-dimensional phenomenon. A fundamental qualitative descriptive study was conducted to develop a culturally relevant and comprehensive description of the experiences of orphanhood from the perspectives of Ugandan youth. A purposeful sample of 13 youth who had lost one or both parents to HIV/AIDS and who were affiliated with a non-governmental organization providing support to orphans were interviewed. Youth orphaned by HIV/AIDS described the experience of orphanhood beginning with parental illness, not death. Several losses were associated with the death of a parent including lost social capitol, educational opportunities and monetary assets. Unique findings revealed that youth experienced culturally specific stigma and conflict which was distinctly related to their HIV/AIDS orphan status. Exploitation within extended cultural family systems was also reported. Results from this study suggest that there is a pressing need to identify and provide culturally appropriate services for these Ugandan youth prior to and after the loss of a parent(s)