Behavioral attitudes and preferences in cooking practices with traditional open-fire stoves in Peru, Nepal, and Kenya: implications for improved cookstove interventions.

Global efforts are underway to develop and promote improved cookstoves which may reduce the negative health and environmental effects of burning solid fuels on health and the environment. Behavioral studies have considered cookstove user practices, needs and preferences in the design and implementation of cookstove projects; however, these studies have not examined the implications of the traditional stove use and design across multiple resource-poor settings in the implementation and promotion of improved cookstove projects that utilize a single, standardized stove design. We conducted in-depth interviews and direct observations of meal preparation and traditional, open-fire stove use of 137 women aged 20-49 years in Kenya, Peru and Nepal prior in the four-month period preceding installation of an improved cookstove as part of a field intervention trial. Despite general similarities in cooking practices across sites, we identified locally distinct practices and norms regarding traditional stove use and desired stove improvements. Traditional stoves are designed to accommodate specific cooking styles, types of fuel, and available resources for maintenance and renovation. The tailored stoves allow users to cook and repair their stoves easily. Women in each setting expressed their desire for a new stove, but they articulated distinct specific alterations that would meet their needs and preferences. Improved cookstove designs need to consider the diversity of values and needs held by potential users, presenting a significant challenge in identifying a "one size fits all" improved cookstove design. Our data show that a single stove design for use with locally available biomass fuels will not meet the cooking demands and resources available across the three sites. Moreover, locally produced or adapted improved cookstoves may be needed to meet the cooking needs of diverse populations while addressing health and environmental concerns of traditional stoves

Childbirth is not a Sickness; A Woman Should Struggle to Give Birth : Exploring Continuing Popularity of Home Births in Western Kenya.

More than 95% of Kenyan women receive antenatal care (ANC) and only 62% access skilled delivery. To explore women‘s opinion on delivery location, 20 focus group discussions were conducted at an urban and rural setting in western Kenya. Participants included health care workers, traditional birth attendants (TBAs), and women who attended at least four ANC visits and delivered. Six in-depth interviews were also conducted with a combination of women who gave birth in a facility and at home. Discussions were digitally recorded and transcribed for analysis. Data was subjected to content analysis for deductive and inductive codes. Emergent themes were logically organized to address the study topic. Findings revealed that delivery services were sought from both skilled attendants and TBAs. TBAs remain popular despite lack of acknowledgement from mainstream health care. Choice of delivery is influenced by financial access, availability and quality of skilled delivery services, physical access, culture, ignorance about childbirth processes, easy access to familiar TBAs, fear of hospitals and hospital procedures, and social stigma. Appreciation of TBA referral role, quality maternity service, and reproductive health education can encourage facility deliveries. Formal and informal health workers should cooperate in innovative ways and ensure safe motherhood in Kenya.Keywords: Delivery decision; Traditional birth attendants; Skilled delivery; Focus group discussions; Keny

Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya

Abstract Background Estimately, 70–80% of cancer cases are diagnosed in late stages in Kenya with breast cancer being a common cause of mortality among women where late diagnosis is the major ubiquitous concern. Numerous studies have focused on epidemiological and health policy dynamics essentially underestimating the determining factors that shape people’s choices and cues to health care service uptake. The study sought to evaluate the knowledge, attitude and health seeking behavior towards breast cancer and its screening in a quest to explain why women present for prognosis and treatment when symptomatic pointers are in advanced stages, impeding primary prevention strategies. Methods Eight focus groups (6–10 members per group) and four key informant interviews were conducted among adult participants from rural and urban settings. Sessions were audio-recorded and transcribed. A thematic analysis of the data was based on the concepts of the health belief model. Data analysis was conducted using NVIVO10. Results Most women perceived breast cancer as a fatal disease and conveyed fear of having early screening. Rural women preferred self-prescribed medications and the use of alternative medicine for long periods before presenting for professional care on suspicion that the lump is cancerous. Accessibility to equipped health facilities, lack of information to establish effective follow-up treatment and low-income status were underscored as their major health seeking behavior barriers whereas, urban women identified marital status as their main barrier. Key informant interviews revealed that health communication programs emphasized more on communicable diseases. This could in part explain why there is a high rate of misconception and suspicion about breast cancer among rural and urban women in the study setting. Conclusions Creating breast cancer awareness alongside clear guidelines on accessing screening and treatment infrastructure is critical. It was evident, a diagnosis of breast cancer or lump brings unexpected confrontation with mortality; fear, pain, cultural barriers, emotional and financial distress. Without clear referral channels to enable those with suspicious lumps or early stage disease to get prompt diagnosis and treatment, then well-meaning awareness will not necessarily contribute to reducing morbidity and mortality

An examination of postpartum family planning in western Kenya: I want to use contraception but I have not been told how to do so

Postpartum family planning (FP) in Kenya is low due to inadequate sensitization and awareness among women, particularly in rural areas. This paper identifies most widely used types of FP, intent and unmet needs among women, FP counseling and barriers to FP uptake. Focus group discussions with providers, traditional birth attendants (TBAs) and mothers, as well as in-depth interviews identify key themes including preferred postpartum FP, limits to existing FP counseling and barriers to FP uptake. Postpartum FP is common including injectable contraceptives, oral contraceptives, coils, condoms, and calendar methods. FP counseling is provided by peers, friends, TBAs and formal health providers. FP practices are associated with family support, literacy, access to FP information, side effects, costs and religion. In conclusion, changes in service provision and education could encourage increase in postpartum FP use in Kenya.La planification familiale du post-partum (PF) au Kenya est faible en raison de la sensibilisation insuffisante et la sensibilisation des femmes, en particulier dans les zones rurales. Ce document identifie les types les plus répandus de la PF, l'intention et les besoins non satisfaits chez les femmes, la consultation de la PF et les obstacles à l'adoption de la PF. Des discussions à groupe cible avec les prestataires de services, les accoucheuses traditionnelles (AT) et des mères, ainsi que des entrevues en profondeur dégagent les principaux thèmes, y compris la PF du post-partum préféré, les limites de la consultation de la PF en cours et les obstacles à l'adoption de la PF. La PF du Post-partum est commune, y compris les contraceptifs injectables, les contraceptifs oraux, les bobines, les préservatifs et les méthodes de calendrier. La consultation de la PF est prodiguée par des pairs, les amis, les accoucheuses traditionnelles et les prestataires officiels de santé. Les pratiques de la PF sont associées avec le soutien de la famille, l'alphabétisation, l'accès à l'information sur la PF, les effets secondaires, les coûts et la religion. En conclusion, les changements dans la prestation de services et de l'éducation pourraient encourager la hausse de l’utilisation de la PF du postpartum au Kenya

An examination of postpartum family planning in western Kenya: “I want to use contraception but I have not been told how to do so”

Postpartum family planning (FP) in Kenya is low due to inadequate sensitization and awareness among women, particularly in rural areas. This paper identifies most widely used types of FP, intent and unmet needs among women, FP counseling and barriers to FP uptake. Focus group discussions with providers, traditional birth attendants (TBAs) and mothers, as well as in-depth interviews identify key themes including preferred postpartum FP, limits to existing FP counseling and barriers to FP uptake. Postpartum FP is common including injectable contraceptives, oral contraceptives, coils, condoms, and calendar methods. FP counseling is provided by peers, friends, TBAs and formal health providers. FP practices are associated with family support, literacy, access to FP information, side effects, costs and religion. In conclusion, changes in service provision and education could encourage increase in postpartum FP use in Kenya.La planification familiale du post-partum (PF) au Kenya est faible en raison de la sensibilisation insuffisante et la sensibilisation des femmes, en particulier dans les zones rurales. Ce document identifie les types les plus répandus de la PF, l'intention et les besoins non satisfaits chez les femmes, la consultation de la PF et les obstacles à l'adoption de la PF. Des discussions à groupe cible avec les prestataires de services, les accoucheuses traditionnelles (AT) et des mères, ainsi que des entrevues en profondeur dégagent les principaux thèmes, y compris la PF du post-partum préféré, les limites de la consultation de la PF en cours et les obstacles à l'adoption de la PF. La PF du Post-partum est commune, y compris les contraceptifs injectables, les contraceptifs oraux, les bobines, les préservatifs et les méthodes de calendrier. La consultation de la PF est prodiguée par des pairs, les amis, les accoucheuses traditionnelles et les prestataires officiels de santé. Les pratiques de la PF sont associées avec le soutien de la famille, l'alphabétisation, l'accès à l'information sur la PF, les effets secondaires, les coûts et la religion. En conclusion, les changements dans la prestation de services et de l'éducation pourraient encourager la hausse de l’utilisation de la PF du postpartum au Kenya

Additional file 3: of Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya

Perceived barriers to early breast cancer screening uptake and treatment as mentioned by FGD participants. (DOCX 18 kb

Additional file 1: of Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya

Interview guide for the focus group discussions and in-depth interviews (key informants) (DOCX 44 kb

Additional file 2: of Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya

Map of the study areas. (DOCX 2073 kb

A randomized clinical trial of a group cognitive-behavioral therapy to reduce alcohol use among human immunodeficiency virus-infected outpatients in western Kenya

Background and aims: Culturally relevant and feasible interventions are needed to address limited professional resources in sub-Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder. This study tested the efficacy of a cognitive-behavioral therapy (CBT) intervention to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. Design: Randomized clinical trial. Setting: A large HIV outpatient clinic in Eldoret, Kenya, affiliated with the Academic Model Providing Access to Healthcare collaboration. Participants: A total of 614 HIV-infected outpatients [312 CBT; 302 healthy life-styles (HL); 48.5% male; mean age: 38.9 years; mean education 7.7 years] who reported a minimum of hazardous or binge drinking. Intervention and comparator: A culturally adapted six-session gender-stratified group CBT intervention compared with HL education, each delivered by paraprofessionals over six weekly 90-minute sessions with a 9-month follow-up. Measurements: Primary outcome measures were percentage of drinking days (PDD) and mean drinks per drinking day (DDD) computed from retrospective daily number of drinks data obtained by use of the time-line follow-back from baseline to 9 months post-intervention. Exploratory analyses examined unprotected sex and number of partners. Findings: Median attendance was six sessions across condition. Retention at 9 months post-intervention was high and similar by condition: CBT 86% and HL 83%. PDD and DDD marginal means were significantly lower in CBT than HL at all three study phases. Maintenance period, PDD - CBT = 3.64 (0.696), HL = 5.72 (0.71), mean difference 2.08, 95% confidence interval (CI) = 0.13 - 4.04; DDD - CBT = 0.66 (0.96), HL = 0.98 (0.098), mean difference = 0.31, 95% CI = 0.05 - 0.58. Risky sex decreased over time in both conditions, with a temporary effect for CBT at the 1-month follow-up. Conclusions: A cognitive-behavioral therapy intervention was more efficacious than healthy lifestyles education in reducing alcohol use among HIV-infected Kenyan outpatient drinkers