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

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

Change and Continuity in Kin-Based Support Systems for Widows and Orphans among the Luo in Western Kenya

No Abstract Available African Sociological Review 8, (1), 2004, pp. 139-15

“This is Our Home”:Notions of Home and Childhood Vulnerability in Western Kenya

Luo orphaned children derive their conceptualization of home from historical ideologies of patrilineal kinship and the local discourses of belonging situated within properly constituted marriage. Contrary to older literature that presents home as a domestic spatial arrange-ment, orphans understand home as a relational pathway that safeguards growth. We show that orphans use their notion of home to express feel-ings of vulnerability and apply their agency against adult-initiated foster-age practices. The article contributes to an enhanced understanding of Luo sociality and promotes a dynamic anthropology of relationships and child anthropology by unpacking the facets of childhood vulnerability. Our analysis points to analytic themes of contradictions and paradox in Luo kinship values in relation to child support and ambivalence in how children’s agency is exercised in fosterage arrangements.</p

Ethical dilemmas of social science research on AIDS and orphanhood in Western Kenya

This paper is based on the experiences drawn from a long-term social science research programme on the impact of the AIDS pandemic on orphanhood in western Kenya. It discusses the ethical dilemma of maintaining a delicate balance between research ethics, the expectations of the study population and negotiating the community's vested interests in a health related research project in a low-income society. I argue that informed consent and the intended benefits of the study to the participants continue to be major challenges facing the justification of social research with people affected by or living with AIDS in low-income societies. The paper underscores the importance of community feedback sessions as a way of enhancing chances of acceptability of research efforts and obtaining informed consent. It further shows how community feedback sessions contribute to local knowledge of the problem being studied, creating opportunities for advocacy. This discussion adds to the existing ethical debate on the wider contexts within which research on vulnerable people affected by AIDS is conducted by arguing that research practice is inseparable from epistemological concerns of knowledge production. I suggest that ethnographers should enhance efforts to innovatively design action research projects to serve the twin purposes of data collection and deal with ethical challenges that are experienced when doing long-term research on vulnerable groups.Kenya Research ethics HIV/AIDS Informed consent Orphanhood Social science research Children Ethnography

Perception of Cervical Cancer Patients on their Financial Challenges in Western Kenya

Abstract Background The number of cervical cancer cases is reported to increase among women of reproductive age in the recent past with patients facing challenges with care and management of the illness. However, little is known about the financial challenges these patients undergo in contexts such as western Kenya. This study assessed financial challenges and sources of financial assistance for cervical cancer patients in western Kenya. Methods A cross-sectional study involving 334 cervical cancer patients was conducted in Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu from September 2014 to February 2015. Structured questionnaire, in-depth interview guide and key informant interview guide were used to collect data. Quantitative data was analyzed using Statistical Package for Social Scientists (SPSS) Version 20 at a statistical significance of P ≤ 0.05, descriptive statistics and crosstabulations were performed. For qualitative data, the responses were transcribed verbatim and the content was then analyzed by searching for emerging themes on the financial challenges faced by cervical cancer patients. Qualitative data was presented in textual form with verbatim reports for illustrations. Results The key financial challenges from the study were costs of medication 291 (87%), cost of travel 281 (84%) and cost of diagnostic tests 250 (75%). Other costs incurred by the patients were cost of cloths and wigs 91 (27%), and cost of home and child care 80 (24%). Most 304 (91%) of the cervical cancer patients admitted and referred to JOOTRH did not have insurance cover and only 30 (9%) had National Hospital Insurance Fund cover which catered for only bed component of inpatient costs. Results showed that no patient received any assistance from well-wishers. Only a few received assistance from charity organizations 43 (13%), friends 91 (27%) and colleagues 31 (9%). Some patients received some assistance from relatives 32 (10%) and church 32 (10%). Conclusion Cervical cancer patients experience several financial challenges yet only few of them had insurance cover which catered for only bed component of inpatient costs. There is a need for the Kenyan health care system to develop mechanisms for provision of financial support for cervical cancer patients