Exploring Health and Wellbeing in a Low-to-Middle Income Country: A Case Study of Kenya

The recent past has witnessed an increased interest in the concept of wellbeing both in academia and public policy. Governments and international organizations have developed a policy agenda with the broad goal of improving individual and collective wellbeing; positioning it as the desired outcome of, and the benchmark with which to evaluate social and economic progress, and the effectiveness of governments and their policies. The majority of such efforts have been conducted in Euro-American nations with limited efforts in developing countries. In the low-to-middle income countries where such efforts exist, they are based on experiences and indicators from the high-income western countries. As such, limited initiatives that aim to understand how wellbeing is conceptualized in time and place exist in low-to-middle income countries (LMICs) as societal progress in these resource-constrained areas are persistently assessed by econometric measures such as Gross Domestic Product (GDP). To address this gap, the present thesis explored indicators for constructing a healthy population index, an important domain of societal wellbeing in the context of LMICs. As part of the global index of wellbeing project, this thesis set out to understand how Kenyans socially construct their health and wellbeing across place, socio-demographic characteristics, and over their life-course. Using an explorative study design, the thesis employs the social constructionists’ perspectives and the eco-social theory to answer three specific research questions. First, the thesis responds to the question, what are the perceptions, meanings and determinants of societal health and wellbeing that matter most to Kenyans and are there differences and similarities by gender and region? Second, how do the youth (15-24 years), the middle-aged (25-49) and the seniors (≥50 years) in Kenya socially construct their health and wellbeing? Third and lastly, what are the indicators of a healthy population domain of wellbeing that matter in the context of Kenya and are there potential secondary data sets that could be used to evaluate progress in health over the past years and into the future? In answering these questions, this thesis adopted qualitative research methodologies – including in-depth interviews (IDIs) and focus group discussions (FGDs). The IDIs with representatives of youth groups (male and female), women, and men groups, representatives of Community-Based Organizations (CBO), and with policy makers (i.e., Member of County Assembly) were conducted to explore their work and lived experiences of health and wellbeing in their respective communities. Focus group discussions (FGDs) with lay participants were conducted to understand their perceptions, meanings, determinants and the social construction of societal health and wellbeing and to determine similarities and differences by gender and across place. The thesis also highlights the indicators of the healthy population domain that matter to Kenyans as revealed in the collected data and suggest potential data sources for evaluating progress. Using the constructs of embodiment and pathways of embodiment of the eco-social theory, the thesis provides a framework with which to map population health indicators for wellbeing assessment in the context of LMICs. The social constructionists’ viewpoint on the other hand, is employed in this thesis to explore the social production of knowledge about societal health and wellbeing. The findings reveal that concepts of healthy community and a good life (a proxy of wellbeing) are used interchangeably and are defined using similar concepts. Additionally, having a healthy community and a good life is shown to be dependent on the ability of the community to meet the basic needs for all its members. Specifically, six themes emerge as critical descriptors of a healthy community and a good life in Kenya: a) community health status and quality of healthcare; b) economic and living standard factors; c) social relationships; d) the state of the environment; e) political and governance issues; and f) cultural and societal values, beliefs, norms and practices which influence perceptions and meanings of population health and wellbeing. These contextual factors and the individual and immediate factors interact to create social hierarchies based on gender, age, social class, and regional power imbalances which limit accessibility to resources to certain groups of people. For example, the findings show that gender-based violence (GBV) is a key social determinant of health which disproportionally affects women because of the preexisting cultural structures that act to disempower them. Moreover, the findings reveal that the politics and governance structures – including real engagement in political decision-making, tribalism, corruption and electoral violence are important factors that propagate health inequalities in communities, thus influencing perceptions and meanings of health and wellbeing. Furthermore, the results of this thesis reveal that across their life-course, Kenyans adopt unique social constructs to explain their lived experiences of health and wellbeing. The youth (15-24 years) for example, consider themselves as – “bleeding bodies”, “untrustworthy bodies”, “culturally disadvantaged bodies” and “bodies at risk”. The middle-aged (25-49 years), on the other hand, construct health and wellbeing around issues of domestic violence, whereas the seniors (≥50 years) narrate how they embody distress associated with care for their children and grandchildren in contexts characterized by economic poverty and socio-cultural erosion. According to the participants’ narratives, the indicators for the healthy population domain range from health outcome indicators such as the prevalence and incidence rates for infectious diseases (e.g. HIV and the opportunistic diseases), non-communicable diseases (e.g. cancer, hypertension, diabetes and unintentional injuries), mortality rates as well as accessibility, effectiveness and acceptability of healthcare services, lifestyle and behavior, and indicators of public health programs. Theoretically, this study provides the wellbeing literature with a rudimentary framework premised on the social constructionists’ perspectives and the eco-social theory for understanding the healthy population indicators that matter in LMICs. In so doing, it highlights socially, geographically and culturally relevant indicators thus allowing for evidence-based policy and policy evaluation across time and space. For example, this research reveals that even though constructs around community health status and quality of healthcare services remain frequent descriptors of the health and wellbeing of populations, social and cultural inclusion, issues such as GBV, socio-cultural erosion and care responsibilities are some aspects of the community that need to be included in evaluation of progress in health and quality of life. This information is important in formulation of relevant health policies and interventions

Effects of Unionization on Sugar Cane Farmers’ Income in Bukembe Zone, Bungoma County

Agriculture is the backbone of the Kenyan economy and the sugarcane production is a key subsector in the agricultural sector which employs over half- a million people in Kenya. While sugarcane farming was meant to be a source of income and wealth creation to the people of Western Kenya, the outcome have been worrying as many farmers remain impoverished while the sugarcane factories face a mirage of challenges and   has been in constant crisis. The role of financial capital as a factor of production to facilitate economic growth and development as well as the need to appropriately channel credit to rural areas for economic development of the poor rural farmers cannot be over emphasized. Credit (capital) is viewed as more than just another resource such as labour, land, equipment and raw materials but also determines access to all of the resources on which farmers depend.  The purpose of the study was to analyse effect of unionization on sugarcane farmers’ in income in Bukembe Zone, Bungoma County.  The study adopted the descriptive survey research design. The target population of the study was 384 sugarcane farmers. The sample population was 50 farmers. Data collection was done by means of semi-structured questionnaires, in-depth interviews and focus group discussions. Both qualitative and quantitative analysis was done through content analysis and descriptive statistics respectively. Frequency tables and charts were used to present the findings. The study results indicated there was a significant relationship between unionization and farmers’ income (p=0.000); there was a significant relationship between farmers’  characteristics and farmers’ income (p=0.002);there was a significant relationship between company related factors and farmers’ income (p=0.000) and that there was a significant relationship between environmental related factors and farmers’ income (p=0.001). The study concluded that famers’ income is determined by unionization, farmers’ characteristics, related company characteristics and environmental related factors. The study recommended that sugar companies’ policies should be aligned with sugarcane farmers’ needs in order to gain sugarcane farmers trust and that farmers should research on various environmental factors that affect growth of sugarcane and seek experts’ solutions. Keywords: Farmers’ Income, Unionisation

Knowledge and practice of exclusive breastfeeding among women with children aged between 9 and 12 months in Al-Sabah Children Hospital, Juba, South Sudan

Introduction: Breastfeeding is an important tool for preventing childhood illnesses, and obesity, and hypertension later on in life, and it reduces the cost of food for the family and the country. Appropriate practices that support exclusive breastfeeding in the first six months reduce childhood morbidity and mortality.Methodology: 384 mothers with children aged 9 to 12 months attending the immunization and paediatric outpatient clinics were interviewed. Statistical Package for Social Sciences (SPSS) was used for data handling. Descriptive statistics and univariate logistic regression were used to analyse the data.Results: The majority of mothers were aged between 21 – 25 years (43.5%), had 2 - 4 children (55.5%) and primary education (48.2%). Most mothers had started breastfeeding within the first hour of delivery (76.8%), and knew that breastfeeding was nutritious to the baby. Parity and mother`s level of education were significant factors associated with exclusive breastfeeding (p<0.05). There was no statistically significant association between occupation, age of the mother, mode of delivery and exclusive breastfeeding (p>0.05). There was no statistical difference in rate of exclusive breastfeeding in mothers attending the OPD and the immunization clinic (p value=0.09).Conclusion: Most mothers knew the benefits and definitions of exclusive  breastfeeding. The early measures supporting breastfeeding are well practiced. Parity and mothers` education significantly affected exclusive breastfeeding.Keys words: Exclusive breast feeding, child, nutritio

Strengthening capacity for monitoring and evaluation through short course training in Kenya

Background: Weak monitoring and evaluation (M&E) systems and limited supply of M&E human resources in Africa signal the need to strengthen M&E capacity. Objectives: This exploratory study evaluated the effect of short course training on professionals’ knowledge and skills in the areas of mixed methods research, systematic review and meta-analysis and general principles of M&E. Methods: A partially mixed concurrent dominant status design including quantitative (multilevel modelling and meta-analyses) and qualitative (thematic content analysis) components was employed to evaluate the impact of a 4-day short course training focusing on these areas. Results: Thirty-five participants participated in the training. Participants experienced an increase in knowledge in the three areas; however, average change in knowledge did not differ across participants’ employment settings. Participants’ self-stated objectives considered as SMART and belonging to a higher level in Bloom’s taxonomy were associated with change in knowledge. Based on comments made by participants, majority intended to apply what they learned to their work; clarity of content delivery was the most liked aspect of the training, and the use of more practical sessions was recommended as a way to improve the training. Conclusions: This study provides preliminary evidence of potential of the use of short course training as an approach to strengthening capacity in M&E in less-developed countries such as Kenya. It underscores the importance of participants’ self-stated objective(s) as an element to be considered in the enhancement of knowledge, attitudes and skills needed for acceptable capacity building in M&E

Preparing for COVID-19: Household food insecurity and vulnerability to shocks in Nairobi, Kenya

An understanding of the types of shocks that disrupt and negatively impact urban household food security is of critical importance to develop relevant and targeted food security emergency preparedness policies and responses, a fact magnified by the current COVID-19 pandemic. This gap is addressed by the current study which draws from the Hungry Cities Partnership (HCP) city-wide household food insecurity survey of Nairobi city in Kenya. It uses both descriptive statistics and multilevel modelling using General Linear Mixed Models (GLMM) to examine the relationship between household food security and 16 different shocks experienced in the six months prior to the administration of the survey. The findings showed that only 29% of surveyed households were completely food secure. Of those experiencing some level of food insecurity, more experienced economic (55%) than sociopolitical (16%) and biophysical (10%) shocks. Economic shocks such as food price increases, loss of employment, and reduced income were all associated with increased food insecurity. Coupled with the lack of functioning social safety nets in Nairobi, households experiencing shocks and emergencies experience serious food insecurity and related health effects. In this context, the COVID-19 pandemic is likely to have a major negative economic impact on many vulnerable urban households. As such, there is need for new policies on urban food emergencies with a clear emergency preparedness plan for responding to major economic and other shocks that target the most vulnerable. Copyright: © 2021 Onyango et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Migration, rural–urban connectivity, and food remittances in Kenya

This paper draws on data from a representative city-wide household food security survey of Nairobi conducted in 2017 to examine the importance of food remitting to households in contemporary Nairobi. The first section of the paper provides an overview of the urbanization and rapid growth of Nairobi, which has led to growing socio-economic inequality, precarious livelihoods for the majority, and growing food insecurity, as context for the more detailed empirical analysis of food security and food remittances that follows. It is followed by a description of the survey methodology and sections analyzing the differences between migrant and non-migrant households in Nairobi. Attention then turns to the phenomenon of food remitting, showing that over 50% of surveyed households in the city had received food remittances in the previous year. The paper then uses multivariate logistic regression to identify the relationship between Nairobi household characteristics and the probability of receiving food remittances from rural areas. The findings suggest that there are exceptions to the standard migration and poverty-driven explanatory model of the drivers of rural–urban food remitting and that greater attention should be paid to other motivations for maintaining rural–urban connectivity in Africa

Covid-19 and urban food security in Ghana during the third wave

While the effects of the COVID-19 pandemic on household food security have been documented, the intensity and forms of food insecurity in urban households in the Global South have not been adequately explored. This is despite the emerging consensus that impacts of the pandemic were more severe in urban than rural Africa. This paper addresses this knowledge gap by examining the relationship between pandemic precarity and food insecurity in Ghana’s urban areas during the COVID-19 pandemic in 2020. This study is based on the World Bank (WB) and Ghana Statistical Service (GSS) COVID-19 High-Frequency Phone Survey. Using a sub-sample of 1423 urban households, the paper evaluates household experiences of the pandemic. Our findings show that household demographic characteristics are not a major predictor of food insecurity. Economic factors, especially the impact of the pandemic on wage income and total household income, were far more important, with those most affected being most food insecure

Food insecurity and dietary deprivation: Migrant households in Nairobi, Kenya

The current study focuses on food consumption and dietary diversity among internal migrant households in Kenya using data from a city-wide household survey of Nairobi conducted in 2018. The paper examined whether migrant households are more likely to experience inferior diets, low dietary diversity, and increased dietary deprivation than their local counterparts. Second, it assesses whether some migrant households experience greater dietary deprivation than others. Third, it analyses whether rural-urban links play a role in boosting dietary diversity among migrant households. Length of stay in the city, the strength of rural-urban links, and food transfers do not show a significant relationship with greater dietary diversity. Better predictors of whether a household is able to escape dietary deprivation include education, employment, and household income. Food price increases also decrease dietary diversity as migrant households adjust their purchasing and consumption patterns

DETERMINING AUTOMATION EFFECT ON MARKET EFFICIENCY

The aim of this research was to better understand technology-induced market changes. The Nairobi Security Exchange was studied and the effects of an automation exercise carried out in 2006, was the research focus. Adoption of case study unraveled how automation impacts efficiency. Secondary data in form of monthly NSE-20 share index from January 2001- December 2011 and transformed into compounded monthly return was used. Run test was then applied. Too many runs indicate a tendency for high and low values to alternate; it was found that returns were normally distributed. As such, a normality test was conducted on the NSE using mean, skewness and kurtosis. Considering the mean and median, the two measures were close , and in almost all the years the skewness was close to zero (0) as well as the kurtosis close to three (3) all this shows that the data was normally distributed which confirmed that the market was weak form efficiency. Finally, t statistics showed that there was a statistical significant difference between manual and automation in the stock market performance during the year of transition, 2005 to 2006 a P value of 0.0006 when it was fully implemented, implying that there was a difference in the market performance before and after market automation. These findings are meant to provide an understanding of the automation implication undertaken by market authorities that’s CMA and NSE on the market performance. It will assist investors to develop strategies relating to their operational environment