Illness experiences of people living with HIV in Kenya: a case study of Kisumu County

Owino GEO. Illness experiences of people living with HIV in Kenya: a case study of Kisumu County. Bielefeld: University of Bielefeld Library; 2015.## Background to the Study More than thirty years after the onset of the global HIV pandemic, HIV continues to be both a huge public health burden and a social concern. By the end of 2013, an estimated 35 million people lived with HIV globally. Nearly 70% of people living with HIV (PLHIV) resided in Sub-Saharan Africa with Kenya accounting for an estimated 1.6 million over the same period. Despite highly active antiretroviral therapy (HAART) enhancing the chances for longer life, PLHIV still encounter multiple challenges including stigma and discrimination and livelihood insecurity. These difficulties notwithstanding, literature suggests that PLHIV struggle to innovate within their social spheres to find means of leading meaningful lives. However, little research has been done in Kenya from a phenomenological perspective to describe the lived experiences of PLHIV in the context of improved quality of life and longevity. ## Objective The main objective of this study was to provide a detailed phenomenological description of the illness experiences of PLHIV in Kisumu County of Kenya. The study inquired into how PLHIV in Kisumu County made sense of their HIV status, how being diagnosed HIV positive affected their lives and which coping strategies they adopted in order to adapt to a life with HIV. The study also researched into the difficulties that PLHIV faced in adapting to their new status. ## Theoretical Framework The study was guided by the symbolic interactionist and the chronic illness trajectory theories. Both theories are embedded in the interpretative tradition. The interpretivist tradition views meanings as products of the process of social interaction through which agents mutually interpret events and phenomena, thereby creating commonly negotiated meanings. According to symbolic interactionism, this interaction process is mediated by symbols, chiefly, a commonly shared language. ## Methodology The study adopted a qualitative research methodology. The hermeneutic phenomenological design was used to guide data collection, coding and analysis. Ethical approval was granted by the Kenyatta University Ethical Review Committee and the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). Data was collected through 49 in-depth interviews, (30 females and 19 males), eight (8) focus group discussions (FGDs) and six (6) key informant interviews. Data was digitally recorded, personally transcribed, deductively and inductively coded and analysed with the help of the MAXQDA qualitative data analysis software. Data is presented in form of quotations and interpretations of the researcher. ## Key Findings The study findings are presented in three parts, in chapters 3, 4, and 5 respectively. Each of these chapters deals with a specific domain as follows: being diagnosed HIV positive; effects of HIV on the lives of PLHIV and the coping strategies PLHIV adopted as well as the difficulties they faced. PLHIV got to know their status within four main circumstances: personal illness, spouse’s death or illness, antenatal care, and public health campaigns. The majority reported initially accepting their status and adopting positive living, although nearly all expressed some degree of fear, shock, and pain or sadness. Reconciliation to the diagnosis was mediated by psychosocial support, quest for health and longevity, the perception of high HIV prevalence and the present and future well-being of their children. The effects on social relationships involved stable, stigmatizing and discriminatory, improved and restructured interaction patterns. The effects on capacity to fulfill social obligations included retained, regained, and diminished capacity to work. The sense of self was perceived as either being stable, disrupted, or restored. Coping strategies adopted included receiving psychosocial and emotional support, practicing faith and religious beliefs, social engagement, adherence to medication and clinical appointments, livelihood enhancement, adoption of safe sexual behaviours, and abstinence from or minimizing the use of alcohol and other drugs. Difficulties faced included insecure livelihoods, stigma and discrimination, and inability to provide for their children’s education. ## Discussion People in Kisumu County were diagnosed HIV positive under a variety of circumstances and reacted in diverse ways in making sense of their diagnosis. The emotional and psychological reactions are a normal process that help people make sense of traumatic experiences. A number of conditions helped the participants reconcile with a positive HIV diagnosis. These included psychosocial support and counseling from patient support centers (PSC), families and support groups and the availability and accessibility of ART. PLHIV are creative agents who devise pragmatic mechanisms to live successfully with HIV amidst stigma, discrimination and morally judgmental attitudes. The coping strategies adopted have helped PLHIV to adapt well, and enabled them to continue with their social obligations, maintain their social relationships and retain relatively stable perceptions of self. PLHIV in Kisumu County are however still confronted by a number of difficulties that hamper their coping efforts. ## Conclusions and Recommendations PLHIV are able to cope and adapt well to the disruptions, contradictions and difficulties of living with HIV. However, for their coping to be adaptable, they need the psychosocial, emotional and material support of their families, communities, health providers and the wider society. It is therefore recommended that the design and implementation of policy and programmatic interventions should involve all stakeholders, including PLHIV. Other recommendations include provision of HIV-related information and education to the communities, review of the health education curriculum, ensuring sustainability of ART and provision of adequate health care resources

Improving early childhood development in the context of the nurturing care framework in Kenya: A policy review and qualitative exploration of emerging issues with policy makers

Introduction: The Nurturing Care Framework (NCF) describes “nurturing care” as the ability of nations and communities to support caregivers and provide an environment that ensures children's good health and nutrition, protects them from threats, and provides opportunities for early learning through responsive and emotionally supportive interaction. We assessed the extent to which Kenyan government policies address the components of the NCF and explored policy/decision makers' views on policy gaps and emerging issues.Methods: A search strategy was formulated to identify policy documents focusing on early childhood development (ECD), health and nutrition, responsive caregiving, opportunities for early learning and security and safety, which are key components of the NCF. We limited the search to policy documents published since 2010 when the Kenya constitution was promulgated and ECD functions devolved to county governments. Policy/decision-maker interviews were also conducted to clarify emerging gaps from policy data. Data was extracted, coded and analyzed based on the components of the NCF. Framework analysis was used for interview data with NCF being the main framework of analysis. The Jaccard's similarity coefficient was used to assess similarities between the themes being compared to further understand the challenges, successes and future plans of policy and implementation under each of the NCF domains.Results: 127 policy documents were retrieved from government e-repository and county websites. Of these, n = 91 were assessed against the inclusion criteria, and n = 66 were included in final analysis. The 66 documents included 47 County Integrated Development Plans (CIDPs) and 19 national policy documents. Twenty policy/decision-maker interviews were conducted. Analysis of both policy and interview data reveal that, while areas of health and nutrition have been considered in policies and county level plans (coefficients >0.5), the domains of early learning, responsive caregiving and safety and security face significant policy and implementation gaps (coefficients ≤ 0.5), particularly for the 0–3 year age group. Inconsistencies were noted between county level implementation plans and national policies in areas such as support for children with disabilities and allocation of budget to early learning and nutrition domains.Conclusion: Findings indicate a strong focus on nutrition and health with limited coverage of responsive caregiving and opportunities for early learning domains. Therefore, if nurturing care goals are to be achieved in Kenya, policies are needed to support current gaps identified with urgent need for policies of minimum standards that provide support for improvements across all Nurturing Care Framework domains

Nutrient enrichment of pineapple waste using Aspergillus niger and Trichoderma viride by solid state fermentation

The enrichment by microbial fermentation of agro industrial waste to alleviate their nutritional problems has been proposed but the nutritional value of the subsequent feed for animal consumption has not been fully elucidated. This study investigates whether solid state fermentation of pineapple waste using the fungi Aspergillus niger and Trichoderma viride could improve its nutrient content. Results show that fermentation of pineapple waste by solid state fermentation using the fungi A. niger and T. viride significantly (P < 0.05) enriches the nutrient content of the waste, particularly increasing the crude protein and ash content while lowering the crude fiber content. The most significant nutrient enrichment was recorded at 72 h of fermentation using A. niger and at 96 h of fermentation using T. viride. Indiscernible changes were noted in the mineral content of pineapple waste (PW). Dry matter increased significantly (P < 0.05) as fermentation progressed with the highest values recorded at 96 h. This study establishes no significant differences (P > 0.05) in the fermentation abilities of the two fungi, A. niger and T. viride. Fermented pineapple waste may be a potential supplement in compounding animal feed provided that it is acceptable and highly digestible.Keywords: Agro industrial waste, crude fiber, crude protein

Improving early childhood development in the context of the nurturing care framework in Kenya: A policy review and qualitative exploration of emerging issues with policy makers

Introduction: The Nurturing Care Framework (NCF) describes “nurturing care” as the ability of nations and communities to support caregivers and provide an environment that ensures children's good health and nutrition, protects them from threats, and provides opportunities for early learning through responsive and emotionally supportive interaction. We assessed the extent to which Kenyan government policies address the components of the NCF and explored policy/decision makers' views on policy gaps and emerging issues.  Methods: A search strategy was formulated to identify policy documents focusing on early childhood development (ECD), health and nutrition, responsive caregiving, opportunities for early learning and security and safety, which are key components of the NCF. We limited the search to policy documents published since 2010 when the Kenya constitution was promulgated and ECD functions devolved to county governments. Policy/decision-maker interviews were also conducted to clarify emerging gaps from policy data. Data was extracted, coded and analyzed based on the components of the NCF. Framework analysis was used for interview data with NCF being the main framework of analysis. The Jaccard's similarity coefficient was used to assess similarities between the themes being compared to further understand the challenges, successes and future plans of policy and implementation under each of the NCF domains.  Results: 127 policy documents were retrieved from government e-repository and county websites. Of these, n = 91 were assessed against the inclusion criteria, and n = 66 were included in final analysis. The 66 documents included 47 County Integrated Development Plans (CIDPs) and 19 national policy documents. Twenty policy/decision-maker interviews were conducted. Analysis of both policy and interview data reveal that, while areas of health and nutrition have been considered in policies and county level plans (coefficients >0.5), the domains of early learning, responsive caregiving and safety and security face significant policy and implementation gaps (coefficients ≤ 0.5), particularly for the 0–3 year age group. Inconsistencies were noted between county level implementation plans and national policies in areas such as support for children with disabilities and allocation of budget to early learning and nutrition domains.  Conclusion: Findings indicate a strong focus on nutrition and health with limited coverage of responsive caregiving and opportunities for early learning domains. Therefore, if nurturing care goals are to be achieved in Kenya, policies are needed to support current gaps identified with urgent need for policies of minimum standards that provide support for improvements across all Nurturing Care Framework domains.</p