Determinants of modern contraceptive use among sexually active men in Kenya

Background: Research in Kenya has focussed on family planning from women’s perspectives, with the aim of helping reduce the burden of unintended pregnancies. As such, the determinants of modern contraceptive use among sexually active women are well documented. However, the perspectives of men should be considered not only as women’s partners, but also as individuals with distinct reproductive histories and desires of their own. This study seeks to understand the determinants of modern contraceptive use among sexually active men, by exploring factors that are correlated with modern contraceptive use. Methods: The data source is the nationally representative 2014 Kenya Demographic and Health Survey (DHS) of men aged 15–54 years. The analysis is restricted to 9,514 men who reported being sexually active in the past 12 months prior to the survey, as they were likely to report either doing something or not to avoid or delay pregnancy. We use bivariate and multinomial logistic regression to assess factors that influence modern contraceptive use among sexually active men. Results: Findings from the bivariate and multinomial logistic regression indicate that region of residence, marital status, religion, wealth, interaction with a health care provider, fertility preference, number of sexual partners and access to media were all significantly associated with modern contraceptive use among sexually active men. Conclusion: Provider-client interaction as well as dissemination of information through mass media has the potential to increase knowledge and uptake of modern contraceptives. Similar efforts targeting segments of the population where contraceptive uptake is low are recommended

Female sex workers experiences of using contraceptive methods: a qualitative study in Kenya

Background: Female Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs)/HIV, unintended pregnancy, violence, sexual exploitation, stigma and discrimination. Female sex workers have unmet need for contraceptives and require comprehensive Sexual and Reproductive Health (SRH) prevention interventions. Existing programs pay little attention to the broad sexual and reproductive health and rights of these women and often focus on HIV and other STIs prevention, care and treatment while neglecting their reproductive health needs, including access to family planning methods. The aim of this study is, therefore, to explore the experiences of female sex workers with using existing contraceptive methods, assess individual and health facility-level barriers and document inter-partner relationship in the use of contraceptives. Methods: We focus on women aged 15–49, who reported current sex work, defined as ‘providing sexual services in exchange for money or other material compensation as part of an individual’s livelihood.’ Results: Findings reveal that while some FSWs know about modern contraceptives, others have limited knowledge or out rightly refuse to use contraceptives for fear of losing clients. The interaction with different client types act as a barrier but also provide an opportunity for contraceptive use among FSWs. Most FSWs recognize the importance of dual protection for HIV/STI and pregnancy prevention. However, myths and misconceptions, fear of being tested for HIV at the family planning clinic, wait time, and long queues at the clinics all act in combination to hinder uptake of contraceptives. Conclusions: We recommend a targeted approach to address the contraceptive needs of FSWs to help remove barriers to contraceptive uptake. We also support the introduction of counseling services to provide information on the benefits of non-barrier contraceptive methods and thereby enhance dual use for both pregnancy and STI/HIV preventio

Contraceptive method choice among women in slum and non-slum communities in Nairobi, Kenya

Background: Understanding women’s contraceptive method choices is key to enhancing family planning services provision and programming. Currently however, very little research has addressed inter and intra-regional disparities in women’s contraceptive method choice. Using data from slum and non-slum contexts in Nairobi, Kenya, the current study investigates the prevalence of and factors associated with contraceptive method choice among women. Methods: Data were from a cross-sectional quantitative study conducted among a random sample of 1,873 women (aged 15–49 years) in two non-slum and two slum settlement areas in Nairobi, Kenya. The study locations were purposively sampled by virtue of being part of the Nairobi Urban Health and Demographic Surveillance System. Bivariate and multivariate logistic regression were used to explore the association between the outcome variable, contraceptive method choice, and explanatory variables. Results: The prevalence of contraceptive method choice was relatively similar across slum and non-slum settlements. 34.3 % of women in slum communities and 28.1 % of women in non-slum communities reported using short-term methods. Slightly more women living in the non-slum settlements reported use of long-term methods, 9.2 %, compared to 3.6 % in slum communities. Older women were less likely to use short-term methods than their younger counterparts but more likely to use long-term methods. Currently married women were more likely than never married women to use short-term and long-term methods. Compared to those with no children, women with three or more children were more likely to report using long term methods. Women working outside the home or those in formal employment also used modern methods of contraception more than those in self-employment or unemployed. Conclusion: Use of short-term and long-term methods is generally low among women living in slum and non-slum contexts in Nairobi. Investments in increasing women’s access to various contraceptive options are urgently needed to help increase contraceptive prevalence rate. Thus, interventions that focus on more disadvantaged segments of the population will accelerate contraceptive uptake and improve maternal and child health in Kenya

Trends and determinants of Comprehensive HIV and AIDS knowledge among urban young women in Kenya

<p>Abstract</p> <p>Background</p> <p>Sub-Saharan Africa remains the region most heavily affected by HIV. In 2008, the region accounted for 67% of HIV infections worldwide, the region also accounted for 72% of the world's AIDS-related deaths in 2008. Young people aged 15-24 years accounted for an estimated 45% of the new HIV infections. In sub-Saharan Africa, Kenya is among countries affected by the HIV and AIDS pandemic which led to the declaration of AIDS as a national disaster in 1999. Given these scenario the study was undertaken to examine trends in HIV and AIDS comprehensive knowledge and identify the main correlates of comprehensive HIV and AIDS knowledge among Kenyan urban young women.</p> <p>Methods</p> <p>Data used was drawn from the 1993, 1998, 2003 and 2008/09 Kenya Demographic & Health Surveys. Logistic regression was used for analysis.</p> <p>Results</p> <p>While comprehensive HIV and AIDS knowledge is low among urban young women in Kenya, the results show a significant increase in comprehensive knowledge from 9% in 1993 to 54% in 2008/09. The strongest predictors for having comprehensive knowledge were found to be 1) education; 2) having tested for HIV; 3) knowing someone with HIV, and/or 4) having a small or moderate to great risk perception.</p> <p>Conclusion</p> <p>The response to HIV and AIDS can only be successful if individuals adopt behaviours that will protect against infection. Currently, efforts are underway in Kenya to ensure that young people have comprehensive knowledge. As evident from the results, comprehensive HIV and AIDS knowledge has increased over the 15 year period among urban young women from 9% in 1993 to 54% in 2008/09. Despite this improvement, a lot more needs to be done to attain the target of 90% threshold set by UNGASS. While both young women and men should be targeted with education on HIV prevention, concerted efforts should be directed at young women as many continue to get infected due to low levels of comprehensive HIV knowledge.</p

Modern contraceptive use among migrant and non-migrant women in Kenya

Background: Manifest socio-economic differences are a trigger for internal migration in many sub-Saharan settings including Kenya. An interplay of the social, political and economic factors often lead to internal migration. Internal migration potentially has significant consequences on an individual’s economic growth and on access to health services, however, there has been little research on these dynamics. In Kenya, where regional differentials in population growth and poverty reduction continue to be priorities in the post MDG development agenda, understanding the relationships between contraceptive use and internal migration is highly relevant. Methods: Using data from the 2008–09 Kenya Demographic and Health Survey (DHS), we analyze data from 5,905 women aged 15–49 years who reported being sexually active in the last 12 months prior to the survey. Bivariate and multivariate logistic regressions are fitted to predict correlates of contraceptive use in the presence of migration streams among other explanatory variables. Results: Modern contraceptive use was significantly higher among women in all migration streams (non-migrant urban (OR = 2.8, p \u3c 0.001), urban-urban (OR = 2.0, p \u3c 0.001), urban-rural (OR = 2.0, p \u3c 0.001), rural-urban (OR = 2.6, p \u3c 0.001), rural-rural (OR = 1.7, p \u3c 0.001), than non-migrant rural women. Conclusion: Women who internally migrate within Kenya, whether from rural to urban or between urban centres, were more likely to use modern contraception than non-migrant rural women. This phenomenon appears to be due to selection, adaption and disruption effects which are likely to promote use of modern contraceptives. Programmatically, the differentials in modern contraceptive use by the different migration streams should be considered when designing family planning programmes among migrant and non-migrant wome

Prevalence and predictors of HIV sero-discordance among cohabiting couples tested in northern Tanzania

Introduction: In sub-Saharan Africa where HIV/AIDS epidemic is  predominantly generalized, majority of HIV infections occur among heterosexual couples. The majority of people do not know their sero-status. Thus, utilisation of Couples' HIV Counselling and Testing (CHCT) services remain to be critical in preventing new infections. The objective was to establish prevalence and predictors of HIV sero-discordance among cohabiting couples presenting for CHCT services in northern Tanzania. Methods: A cross-sectional study inteveviewed 1,333 couples aged 18-49 years tested from 2005 to 2007 in Kilimanjaro and Arusha regions. A CHCT checklist was used to collect data from couples. Data were analyzed using STATA 10. Results: Generally, 220(16%) out of 1,333 couples were HIV sero-discordant. In sero-discordance unions, women were likely to be HIV positive than men (71% versus 29% respectively p&lt;0.001). HIV sero-discordant relationship was associated with age (35-45 years) for both men and women (Adjusted Odds Ratio (AOR): 2.3, 95% Confidence Interval (CI): 1.7-3.2) and (AOR: 2.6, 95% CI 1.9-3.7) respectively. Women with older men partners were less likely to be in HIV sero-discordance relationships (AOR: 0.5 95% CI 0.3-09). Arusha couples were likely to be HIV sero-discordant than those of Kilimanjaro (AOR: 2.3 95% CI 1.7-3.2). Couples living far away from CHCT centres were less likely to be sero-discordant than those live nearby (AOR: 0.4 95% CI 0.2-0.9). Conclusion: HIV sero-discordance prevalence is high among our participants. Thus, we recommend CHCT utilization should widely be promoted as entry point in treatment as prevention strategy in order to protect uninfected partners in HIV sero-discordance relationships.Pan African Medical Journal 2015; 2

Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study

Background: Young women in Kenya experience a higher risk of mistimed and unwanted pregnancy compared to older women. However, contraceptive use among youth remains low. Known barriers to uptake include side effects, access to commodities and partner approval. Methods: To inform a youth focussed behaviour change communication campaign, Population Services Kenya developed a qualitative study to better understand these barriers among young women. The study was carried out in Nyanza, Coast, and Central regions. Within these regions, urban or peri-urban districts were purposively selected based on having contraceptive prevalence rate close to the regional average and having a population with low socioeconomic profiles. In depth interviews were conducted with a sample of sexually active women aged 15–24, both users and non-users, that were drawn from randomly selected households. Results: All the respondents in the study were familiar with modern methods of contraception and most could describe their general mechanisms of action. Condoms were not considered as contraception by many users. Contraception was also associated with promiscuity and straying. Fear of side effects and adverse reactions were a major barrier to use. The biggest fear was that a particular method would cause infertility. Many fears were based on myths and misconceptions. Young women learn about both true side effects and myths from their social networks. Conclusion: Findings from this research confirm that awareness and knowledge of contraception do not necessarily translate to use. The main barriers to modern contraceptive uptake among young women are myths and misconceptions. The findings stress the influence of social network approval on the use of family planning, beyond the individual’s beliefs. In such settings, family planning programming should engage with the wider community through mass and peer campaign strategies. As an outcome from this study, Population Services Kenya developed a mass media campaign to address key myths and misconceptions among youth

Factors influencing place of delivery for women in Kenya: an analysis of the Kenya Demographic and Health Survey, 2008/2009

Background Maternal mortality in Kenya increased from 380/100000 live births to 530/100000 live births between 1990 and 2008. Skilled assistance during childbirth is central to reducing maternal mortality yet the proportion of deliveries taking place in health facilities where such assistance can reliably be provided has remained below 50% since the early 1990s. We use the 2008/2009 Kenya Demographic and Health Survey data to describe the factors that determine where women deliver in Kenya and to explore reasons given for home delivery. Methods Data on place of delivery, reasons for home delivery, and a range of potential explanatory factors were collected by interviewer-led questionnaire on 3977 women and augmented with distance from the nearest health facility estimated using health facility Global Positioning System (GPS) co-ordinates. Predictors of whether the woman’s most recent delivery was in a health facility were explored in an exploratory risk factor analysis using multiple logistic regression. The main reasons given by the woman for home delivery were also examined. Results Living in urban areas, being wealthy, more educated, using antenatal care services optimally and lower parity strongly predicted where women delivered, and so did region, ethnicity, and type of facilities used. Wealth and rural/urban residence were independently related. The effect of distance from a health facility was not significant after controlling for other variables. Women most commonly cited distance and/or lack of transport as reasons for not delivering in a health facility but over 60% gave other reasons including 20.5% who considered health facility delivery unnecessary, 18% who cited abrupt delivery as the main reason and 11% who cited high cost. Conclusion Physical access to health facilities through distance and/or lack of transport, and economic considerations are important barriers for women to delivering in a health facility in Kenya. Some women do not perceive a need to deliver in a health facility and may value health facility delivery less with subsequent deliveries. Access to appropriate transport for mothers in labour and improving the experiences and outcomes for mothers using health facilities at childbirth augmented by health education may increase uptake of health facility delivery in Kenya