A Qualitative Assessment of Participation in a Rapid Scale-Up, Diagonally-Integrated MDG-Related Disease Prevention Campaign in Rural Kenya

Background: Many countries face severe scale-up barriers toward achievement of MDGs. We ascertained motivational and experiential dimensions of participation in a novel, rapid, ‘‘diagonal’ ’ Integrated Prevention Campaign (IPC) in rural Kenya that provided prevention goods and services to 47,000 people within one week, aimed at rapidly moving the region toward MDG achievement. Specifically, the IPC provided interventions and commodities targeting disease burden reduction in HIV/ AIDS, malaria, and water-borne illness. Methods: Qualitative in-depth interviews (IDI) were conducted with 34 people (18 living with HIV/AIDS and 16 not HIVinfected) randomly selected from IPC attendees consenting to participate. Interviews were examined for themes and patterns to elucidate participant experience and motivation with IPC. Findings: Participants report being primarily motivated to attend IPC to learn of their HIV status (through voluntary counseling and testing), and with receipt of prevention commodities (bednets, water filters, and condoms) providing further incentive. Participants reported that they were satisfied with the IPC experience and offered suggestions to improve future campaigns. Interpretation: Learning their HIV status motivated participants along with the incentive of a wider set of commodities that were rapidly deployed through IPC in this challenging region. The critical role of wanting to know their HIV status combine

"Before we used to get sick all the time": perceptions of malaria and use of long-lasting insecticide-treated bed nets (LLINs) in a rural Kenyan community

<p>Abstract</p> <p>Background</p> <p>Malaria is a leading global cause of preventable morbidity and mortality, especially in sub-Saharan Africa, despite recent advances in treatment and prevention technologies. Scale-up and wide distribution of long-lasting insecticide-treated nets (LLINs) could rapidly decrease malarial disease in endemic areas, if used properly and continuously. Studies have shown that effective use of LLINs depends, in part, upon understanding causal factors associated with malaria. This study examined malaria beliefs, attitudes, and practices toward LLINs assessed during a large-scale integrated prevention campaign (IPC) in rural Kenya.</p> <p>Methods</p> <p>Qualitative interviews were conducted with 34 IPC participants who received LLINs as part of a comprehensive prevention package of goods and services. One month after distribution, interviewers asked these individuals about their attitudes and beliefs regarding malaria, and about their use of LLINs.</p> <p>Results</p> <p>Virtually all participants noted that mosquitoes were involved in causing malaria, though a substantial proportion of participants (47 percent) also mentioned an incorrect cause in addition to mosquitoes. For example, participants commonly noted that the weather (rain, cold) or consumption of bad food and water caused malaria. Regardless, most participants used the LLINs they were given and most mentioned positive benefits from their use, namely reductions in malarial illness and in the costs associated with its diagnosis and treatment.</p> <p>Conclusions</p> <p>Attitudes toward LLINs were positive in this rural community in Western Kenya, and respondents noted benefits with LLIN use. With improved understanding and clarification of the direct (mosquitoes) and indirect (e.g., standing water) causes of malaria, it is likely that LLIN use can be sustained, offering effective household-level protection against malaria.</p

Reproductive Intentions and Outcomes among Women on Antiretroviral Therapy in Rural Uganda: A Prospective Cohort Study

Background: Antiretroviral therapy (ART) may influence the biological, social and behavioral determinants of pregnancy in HIV-infected women. However, there are limited longitudinal data on the reproductive intentions and outcomes among women on ART in Africa. Methodology /Principal Findings: Using a prospective cohort design, we analyzed trends in desire for children and predictors of pregnancy among a cohort of 733 HIV-infected women in rural Uganda who initiated ART between May 2003 and May 2004 and were followed up in their homes until June 2006. Women answered in-depth social and behavioral questionnaires administered every quarter in year 1 after initiating ART, and every 6 to 12 months thereafter. Use of family planning methods was assessed at 18 and 24 months after starting ART. We tested for non-constant pregnancy incidence by using a shape parameter test from the Weibull distribution. We modeled repeated measurements of all variables related to the women’s desire for children over time using a generalized estimating equation (GEE) extension to the logistic regression model. Risk factors for pregnancy were examined using Cox proportional hazards model. 711 women eligible for the study were followed-up for a median time of 2.4 years after starting ART. During this time, less than 7 % of women reported wanting more children at any time point yet 120 (16.9%) women experienced 140 pregnancies and pregnancy incidence increased from 3.46 per 100 women-years (WY) in the first quarter to 9.5 per 100 WY at 24 months (p,0.0001). This wa

AN ASSESSMENT OF THE EFFECT OF GENDERED DECISION-MAKING AND ACCESS TO INSTITUTIONAL SUPPORT SERVICES ON MAIZE PRODUCTION EFFICIENCY IN KENYA

The need to effectively integrate gender in agriculture is a topical issue in research and policy debates. Previous studies have shown that women in Sub-Saharan Africa (SSA) face challenges in accessing productive resources such as land, and this reduces their productivity compared to men. Most of these studies, however, have analyzed male-headed versus female-headed households, and this approach fails to take into account the women who are in male-headed households, for example. Moreover, the combined effect of gendered decision-making and access to institutional support services on agricultural productivity and efficiency has not received adequate focus in empirical work. The main objective of this study was to assess the effect of intra-household decision-making and access to institutional support services (group membership, credit, extension, agricultural training forums) on maize production efficiency in Kenya. Using primary data collected from Bungoma and Meru counties, a multivariate probit model was applied to analyze factors affecting men’s and women’s participation in decision-making, while stochastic frontier production functions were used to estimate technical efficiency. Findings indicate that men and women do not have equal roles in household decision-making and access to institutional support services. Women had higher group membership while men had higher education levels, access to agricultural training forums and were found to be more likely to contribute to decisions on input and labour use. Extension, mobile phone use and credit had a positive effect on efficiency. Based on these results, the study recommends implementation of gender-based interventions such as agricultural training forums for women, as well as providing incentives that encourage men to join and contribute productively to agricultural development groups. This will ensure fairness in access to resources and improved efficiency

AN ASSESSMENT OF THE EFFECT OF GENDERED DECISION-MAKING AND ACCESS TO INSTITUTIONAL SUPPORT SERVICES ON MAIZE PRODUCTION EFFICIENCY IN KENYA

The need to effectively integrate gender in agriculture is a topical issue in research and policy debates. Previous studies have shown that women in Sub-Saharan Africa (SSA) face challenges in accessing productive resources such as land, and this reduces their productivity compared to men. Most of these studies, however, have analyzed male-headed versus female-headed households, and this approach fails to take into account the women who are in male-headed households, for example. Moreover, the combined effect of gendered decision-making and access to institutional support services on agricultural productivity and efficiency has not received adequate focus in empirical work. The main objective of this study was to assess the effect of intra-household decision-making and access to institutional support services (group membership, credit, extension, agricultural training forums) on maize production efficiency in Kenya. Using primary data collected from Bungoma and Meru counties, a multivariate probit model was applied to analyze factors affecting men’s and women’s participation in decision-making, while stochastic frontier production functions were used to estimate technical efficiency. Findings indicate that men and women do not have equal roles in household decision-making and access to institutional support services. Women had higher group membership while men had higher education levels, access to agricultural training forums and were found to be more likely to contribute to decisions on input and labour use. Extension, mobile phone use and credit had a positive effect on efficiency. Based on these results, the study recommends implementation of gender-based interventions such as agricultural training forums for women, as well as providing incentives that encourage men to join and contribute productively to agricultural development groups. This will ensure fairness in access to resources and improved efficiency

Interview and participant characteristics: qualitative assessment of the integrated public health prevention campaign against HIV, malaria, and diarrheal disease, Lurambi, Kenya.

<p>Interview and participant characteristics: qualitative assessment of the integrated public health prevention campaign against HIV, malaria, and diarrheal disease, Lurambi, Kenya.</p

Characteristics motivating participation and satisfaction: qualitative assessment of the integrated public health prevention campaign against HIV, malaria, and diarrheal disease, Lurambi, Kenya.

<p>Characteristics motivating participation and satisfaction: qualitative assessment of the integrated public health prevention campaign against HIV, malaria, and diarrheal disease, Lurambi, Kenya.</p

Barriers to ART adherence among school students living with HIV in Kenya

HIV has transformed from a serious acute illness with high rates of morbidity and mortality to a fairly easily managed chronic disease. However, children and adolescents living with HIV are yet to achieve similar improvement in their HIV care outcomes compared to adults. There have been a number of studies assessing the reasons for slower improvement in these age categories, mainly focusing on health systems, drug- and familyrelated barriers to ART adherence in children. We sought to explore school-related barriers to adherence through in-depth interviews with students living with HIV (SLHIV) aged 13–17 years who had fully disclosed their HIV status in western Kenya. Data was analysed using NVivo 8™. The study found that stigmatisation in the form of negative discussions and alienation, fear of unintended disclosure (due to the drug packaging and lack of privacy while taking their pills) were barriers to ART adherence among these SLHIV. Other barriers included challenges with drug storage while in school and the complexity of coordinating school and clinic-related activities and a lack of structured support systems in schools. In addition to hindering their adherence to ART, these barriers resulted in negative emotions (anger, sadness, frustration) and affected school performance. This study found fairly serious barriers to ART adherence among SLHIV, which calls for structured communication and coordinated support between government ministries of health and education in Kenya

Sexual risk behaviors, mental health outcomes and attitudes supportive of wife-beating associated with childhood transactional sex among adolescent girls and young women: Findings from the Uganda Violence Against Children Survey.

Compared to young men, Ugandan young women are disproportionately impacted by HIV. Childhood transactional sex may contribute to this disparity. Using data from the 2015 Uganda Violence Against Children Survey, we used logistic regression models to assess the association between childhood transactional sex and negative outcomes. Among 18-24-year-old young women who had sex prior to 18 (n = 982), those who ever engaged in transactional sex had 5.9 times [adjusted odds ratio (AOR); confidence interval (CI): 1.6-22.2] higher odds of having multiple sexual partners in the past year; 5.2 times (AOR; CI: 2.1-12.9) higher odds of infrequent condom use in the past year; 3.0 times (AOR; CI: 1.2-7.9) higher odds of hurting themselves intentionally; and 3.2 times (AOR; CI: 1.3-7.7) higher odds of having attitudes justifying spousal abuse than young women who never engaged in transactional sex. Interventions for transactional sex and HIV in Uganda should consider prioritizing prevention, harm-reduction and continued investment in adolescent girls' and young women's futures

Sexual Violence Prevalence and Related Pregnancy Among Girls and Young Women: A Multicountry Analysis

This study aims to quantify the prevalence of forced sex, pressured sex, and related pregnancy among adolescent girls and young women in five low- and middle-income countries. Nationally representative, cross-sectional household surveys were conducted in Haiti, Malawi, Nigeria, Zambia, and Uganda among girls and young women aged 13 to 24 years. A stratified three-stage cluster sample design was used. Respondents were interviewed to assess prevalence of sexual violence, pregnancy related to the first or most recent experience of forced or pressured sex, relationship to perpetrator, mean age at sexual debut, mean age at pregnancy related to forced or pressured sex, and prevalence of forced/coerced sexual debut. Frequencies, weighted percentages, and weighted means are presented. The lifetime prevalence of forced or pressured sex ranged from 10.4% to 18.0%. Among these adolescent girls and young women, the percentage who experienced pregnancy related to their first or most recent experience of forced or pressured sex ranged from 13.2% to 36.6%. In three countries, the most common perpetrator associated with the first pregnancy related to forced or pressured sex was a current or previous intimate partner. Mean age at pregnancy related to forced or pressured sex was similar to mean age at sexual debut in all countries. Preventing sexual violence against girls and young women will prevent a significant proportion of adverse effects on health, including unintended pregnancy. Implementation of strategies to prevent and respond to sexual violence against adolescent girls and young women is urgently needed