Traditional Birth Attendants and Childbirth in Kenya: A Case of Kitui West Sub County

The first objective of this research was to explore the role played by traditional birth attendants (TBAs) during pregnancy and childbirth. The second objective was to establish perspectives of pregnant women regarding the role played by TBAs during childbirth. Eight TBAs out of 12 were selected using simple random sampling technique. These 8 TBAs were drawn from the environs of 10 sampled health facilities. To calculate the sample size for the pregnant women to be interviewed about their perspectives towards TBAs from the 10 sampled health facilities , this formula was used, 1230 x 15/100=184.5 rounded up to 185. According to 2009 census, the population of women at child bearing age (15 – 49 years) was 1230 in Kitui West Sub-County (KNBS et al.; 2009). The final sample size for pregnant women was 187 as shown under the discussion on sampling techniques. An in depth individual interview guide was used to gather information from the 8 TBAs and 165 pregnant women. Unstructured interview guide was used to gather information from 22 respondents who formed focus group discussion (FGD). To make a meaning from the raw data, it was transcribed and emerging themes and patterns according the objective of the study were picked. The Chi-square test analysis showed that more than a half of the women preferred to deliver at home assisted by a TBA. (χ2=1.572; df=2; p=0.036) where p=0.05. This was confirmed by the fact that 37 percent out of 135 respondents who attended ANC clinic and 90 percent out of 30 respondents who did not attend ANC clinic delivered at home assisted by TBAs

‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya

Background: Obstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women’s health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing? Methods: We used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya. Emergent themes contributed to generation of substantive theory and a conceptual framework on the health seeking behaviour of fistula patients. Results: We recruited 121 participants aged 17 to 62 years whose treatment pathways are presented. Participants delayed health seeking, living with fistula illness after their first encounter with unresponsive hospitals. The health seeking trajectory is characterized by long episodes of staying home with illness for decades and consulting multiple actors. Staying with fistula illness entailed health seeking through seven key actions of staying home, trying home remedies, consulting with private health care providers, Non-Governmental organisations, prayer, traditional medicine and formal hospitals and clinics. Long treatment trajectories at hospital resulted from multiple hospital visits and surgeries. Seeking treatment at hospital is the most popular step for most women after recognizing fistula symptoms. Conclusions: We conclude that the formal health system is not responsive to women’s needs during fistula illness. Women suffer an illness with a chronic trajectory and seek alternative forms of care that are not ideally placed to treat fistula illness. The results suggest that a robust health system be provided with expertise and facilities to treat obstetric fistula to shorten women’s treatment pathways

Soybean farm-saved seed viability and vigor as influenced by agro-ecological conditions of Meru South Sub-County, Kenya

Objective: The experiment was conducted with the aim of assessing the soybean farm-saved seed viability and vigor as influenced by agro-ecological conditions of Meru South Sub-County, Kenya.Methodology and results: Within one month of harvest, soybean farm-saved-seed was randomly sampled from 30 households in February 2013 from areas representative of agro-ecological zones Upper Midlands II (Ann. Mean temp. (18.2-20.60C); Upper Midlands III (19.2-20.60C; Lower Midlands III (20.9-22.90C) and Lower Midlands IV (21-240C). Standard germination, electrical conductivity and moisture content tests were done according to ISTA rules (2007). Analysis of Variance was done using SAS (9.2) and means separated using LSD. Results revealed that seed moisture was lowest in the warmer LM4 (6.3%) than in the cooler LM3 (8%); UM3 (8.4%) and UM2 (10%). In addition, soybean seed from the cooler agro-ecologies - UM2 (94%), UM3 (86.6%) and LM3 (99.5%) had significantly higher germination than seed from the lower warmer LM4 (57%). Similarly, seed vigor was highest in the cooler UM2 (41.7 C/cm/g), UM3 (45.8C/cm/g) and LM3 (31.6C/cm/g) as shown by reduced seed leachates; indicative of better integrity of seed membranes than seed from the warmer LM4 (79.1C/cm/g). In addition, there was a strong negative correlation between electrical conductivity and germination, showing a faster deterioration due to leakage of electrolytes.Conclusions and applications of findings: The soybean farm-saved seed germination and vigor were significantly influenced by agro-ecological conditions. Considering that seed moisture content in the lower warmer agro-ecologies was significantly lower than those from higher cooler agro-ecologies the observed seed deterioration was attributable to the higher temperatures characteristic of lower altitudes agro-ecologies. Therefore, since the farm saved seed viability and vigor was better retained in the cooler higher agroecological zones (UM2, UM3 and LM3) of Meru South Sub-County, farmers should source better quality soybean seed from these areas. The results validate the need for ecological zoning of suitable areas for the production of high quality soybean seed in Kenya.Keywords: soybean farm-saved seed, agro-ecological zones, seed germination and vigo

Novel sources of drought tolerance from landraces and wild sorghum relatives

Sorghum (Sorghum bicolor [L.] Moench) is the fifth most important cereal crop worldwide and second aftermaize (Zeamays L.) in Kenya. It is an important food security crop in arid and semi-arid lands, where its production potential is hampered by drought. Drought tolerance can be measured by a plant’s ability to resist premature senescence, often described as stay-green. This study was carried out with the objective of identifying novel stay-green trait among wild and landrace genotypes of sorghum. Forty-four sorghum genotypes that included 16 improved, nine landraces, and 17 wild relatives of sorghum alongside known stay-green sources, B35 and E36-1, were evaluated under well-watered and water-stressed conditions in an alpha-lattice design of three replications. Data was collected on plant height (PHT), flag leaf area (FLA), panicle weight (PWT), 100-seed weight (HSW), relative chlorophyll content (RCC), number of green leaves at maturity (GLAM), days to 50% flowering (DFL), and grain yield (YLD). Genetic diversity was determined using diversity arrays technology (DArT) sequencing and quality control (QC) markers were generated using a java script. Lodoka, a landrace, was the most drought-tolerant genotype, recorded the highest numbers of RCC and GLAM, and outperformed B35 and E36-1 in yield under water-stress and well-watered conditions. The RCC was highly correlated with GLAM (r = .71) and with yield-related traits, HSW (r = .85), PWT (r = .82), and YLD (r = .78). All traits revealed high heritability (broad-sense) ranging from 60.14 to 98.4% for RCC and DFL, respectively. These results confirm earlier reports that wild relatives and landraces are a good source of drought tolerance alleles

A grounded theory of regaining normalcy and reintegration of women with obstetric fistula in Kenya

Abstract Background Obstetric fistula is a reproductive health problem causing immense suffering to 1% of women in Kenya that is formed as sequelae of prolonged obstructed labour. It is a chronic illness that disrupts women lives, causing stigma and isolation. Fistula illness often introduces a crisis in women’s life begetting feelings of shame and serious disruption to their social, psychological, physical and economic lives, in addition to dealing with moral and hygiene challenges. Currently, women undergo free of charge surgery at vesicovaginal fistula (VVF) camps held in national referral hospitals and dedicated fistula centres generating a significant pool of women who have undergone surgery and are ready to regain normal lives. Objective The purpose of this study was to explore experiences of women immersing back into communities and their return to normalcy after surgery in three VVF repair centres in Kenya. We set out to answer the question: what strategies improve obstetric fistula patients’ reintegration process? Methods We used grounded theory methodology to capture the reintegration and regaining normalcy experiences of women after surgery. Narrative interviews were held with 60 women during community follow-up visits in their homes after 6–19 months postoperatively. Grounded theory processes of theoretical sampling, repeated measurement; constant comparative coding in three stage open, axial and selective coding; memoing, reflexivity and positionality were applied. Emergent themes helped generate a grounded theory of reintegration and regaining normalcy for fistula patients. Results To regain normal healthy lives, women respond to fistula illness by seeking surgery.. After surgery, four possible outcomes of the reintegration process present; reintegration fully or partially back into their previous communities, not reintegrated or newly integrating away from previous social and family settings. The reintegration statuses point to the diversity outcomes of care for fistula patients and the necessity of tailoring treatment programs to cater for individual patient needs. Conclusion The emerging substantive theory on the process of reintegration and regaining normalcy for fistula patients is presented. The study findings have implications for fistula care, training and policy regarding women’s health, suggesting a model of care that encompasses physical, social, economic and psychological aspects of care after surgery and discharge

Additional file 1: of ‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya

Narrative guide. The set of questions used to guide the narrative interviews with the study participants. (DOCX 64 kb