Interpersonal Influences in the Scale-up of Male Circumcision Services in a Traditionally Non-circumcising Community in Rural Western Kenya

Promoting male circumcision (MC) is now recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men, and plans are underway to scale-up this intervention especially in non-circumcising communities, with generalized HIV pandemic. This qualitative study identifies and characterizes the role of social and interpersonal factors in the scale-up of MC services in a rural non-circumcising community in western Kenya. Twenty-four sex-specific focus group discussions were conducted with a purposive sample of Luo men and women (15-34 years). Peer and youth groups, girlfriends and women, parents, and cultural political, religious, school leaders were identified as key influences in the scale-up of MC services. The study concludes that social and interpersonal forces create opportunities and constraints for scaling up the MC intervention. Planners of MC projects should therefore harness the power of informal networks and social structures to enhance community engagement, motivate behaviour change and increase demand for MC services

Interpersonal Influences in the Scale-up of Male Circumcision Services in a Traditionally Non-circumcising Community in Rural Western Kenya

Promoting male circumcision (MC) is now recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men, and plans are underway to scale-up this intervention especially in non-circumcising communities, with generalized HIV pandemic. This qualitative study identifies and characterizes the role of social and interpersonal factors in the scale-up of MC services in a rural non-circumcising community in western Kenya. Twenty-four sex-specific focus group discussions were conducted with a purposive sample of Luo men and women (15-34 years). Peer and youth groups, girlfriends and women, parents, and cultural political, religious, school leaders were identified as key influences in the scale-up of MC services. The study concludes that social and interpersonal forces create opportunities and constraints for scaling up the MC intervention. Planners of MC projects should therefore harness the power of informal networks and social structures to enhance community engagement, motivate behaviour change and increase demand for MC services

Psychosocial Factors Influencing Promotion of Male circumcision for HIV Prevention in a Non-circumcising Community in Rural Western Kenya

Male circumcision (MC) is now recommended as an additional HIV preventive measure, yet little is known about factors that may influence its adoption, especially in non-circumcising communities with generalized HIV pandemic. This qualitative study explored factors influencing MC adoption in rural western Kenya. Twenty-four sex specific focus group discussions were conducted with a purposive sample of Luo men and women (15-34 years). Perceived barriers to circumcision were pain and healing complications, actual and opportunity costs, behavioral disinhibition, discrimination, cultural identity, and reduced sexual satisfaction; perceived facilitators were hygiene, HIV/STI risk reduction, ease in condom use, cultural integration, and sexual satisfaction. To enhance MC adoption, community education, and dialogue is needed to address the perceived fears

Measures adopted by indigent mothers in Kilifi County to tackle maternal health challenges during the COVID-19 pandemic

Many sub-Saharan African countries have experienced various challenges that threaten the quality of health services offered to the population. The COVID-19 pandemic disrupted access to healthcare services in many countries as they grappled with implementing measures to curb its spread. The consequences of COVID-19 have been catastrophic for maternal and newborn health. There is a dearth of information on expectant mothers’ negotiation mechanisms to access maternal health services during COVID-19 in Kenya. This rapid qualitative study draws data from purposefully selected 15 mothers who were either pregnant or had newborn babies during the COVID-19 pandemic in Kilifi county in Kenya. Data were analyzed thematically and presented in a textual description. Women used the following alternatives to access maternal health: giving birth at the homes of traditional birth attendants (TBAs), substituting breastfeeding with locally available food supplements, relying on limited resources and neighbours for delivery and local savings and rotating credit associations. This study shows that urgent measures are needed to provide high quality maternal and child health services during and after the COVID-19 pandemic. These include but are not limited to developing special interventions for the pregnant women for any emergency and establishing trust between communities and individuals through the TBAs.De nombreux pays d'Afrique subsaharienne ont connu divers défis qui menacent la qualité des services de santé offerts à la population. La pandémie de COVID-19 a perturbé l'accès aux services de santé dans de nombreux pays alors qu'ils s'efforçaient de mettre en oeuvre des mesures pour freiner sa propagation. Les conséquences du COVID-19 ont été catastrophiques pour la santé maternelle et néonatale. Il y a un manque d'informations sur les mécanismes de négociation des femmes enceintes pour accéder aux services de santé maternelle pendant la COVID-19 au Kenya. Cette étude qualitative rapide tire des données de 15 mères délibérément sélectionnées qui étaient enceintes ou qui ont eu des nouveau-nés pendant la pandémie de COVID-19 dans le comté de Kilifi au Kenya. Les données ont été analysées thématiquement et présentées dans une description textuelle. Les femmes ont utilisé les alternatives suivantes pour accéder à la santé maternelle: accoucher au domicile des accoucheuses traditionnelles (AT), remplacer l'allaitement par des compléments alimentaires disponibles localement, compter sur des ressources et des voisins limités pour l'accouchement et sur les associations locales d'épargne et de crédit rotatif. Cette étude montre que des mesures urgentes sont nécessaires pour fournir des services de santé maternelle et infantile de haute qualité pendant et après la pandémie de COVID-19. Celles-ci incluent, mais sans s'y limiter, le développement d'interventions spéciales pour les femmes enceintes pour toute urgence et l'établissement de la confiance entre les communautés et les individus par le biais des AT.De nombreux pays d'Afrique subsaharienne ont connu divers défis qui menacent la qualité des services de santé offerts à la population. La pandémie de COVID-19 a perturbé l'accès aux services de santé dans de nombreux pays alors qu'ils s'efforçaient de mettre en oeuvre des mesures pour freiner sa propagation. Les conséquences du COVID-19 ont été catastrophiques pour la santé maternelle et néonatale. Il y a un manque d'informations sur les mécanismes de négociation des femmes enceintes pour accéder aux services de santé maternelle pendant la COVID-19 au Kenya. Cette étude qualitative rapide tire des données de 15 mères délibérément sélectionnées qui étaient enceintes ou qui ont eu des nouveau-nés pendant la pandémie de COVID-19 dans le comté de Kilifi au Kenya. Les données ont été analysées thématiquement et présentées dans une description textuelle. Les femmes ont utilisé les alternatives suivantes pour accéder à la santé maternelle: accoucher au domicile des accoucheuses traditionnelles (AT), remplacer l'allaitement par des compléments alimentaires disponibles localement, compter sur des ressources et des voisins limités pour l'accouchement et sur les associations locales d'épargne et de crédit rotatif. Cette étude montre que des mesures urgentes sont nécessaires pour fournir des services de santé maternelle et infantile de haute qualité pendant et après la pandémie de COVID-19. Celles-ci incluent, mais sans s'y limiter, le développement d'interventions spéciales pour les femmes enceintes pour toute urgence et l'établissement de la confiance entre les communautés et les individus par le biais des AT.Wellcome Trust, the Netherlands Organization for Scientific Research-WOTRO Science for Global Development, the Josephine de Karman scholarships and French Institute for Research in Africa.https://www.ajol.info/index.php/ajrhhj2023Centre for the Advancement of Scholarshi

Non-adherence to antiretroviral treatment among migrating fishermen in western Kenya’s islands : a rapid qualitative study

This article was written as a product of 2022 September Summer School at the University of Pretoria and as part of a Wellcome Trust funded project Reimagining Reproduction: Making babies, making kin and citizens in Africa.Fishing communities in many Sub-Saharan African countries are a high-risk population group disproportionately affected by the HIV epidemic. The association of migration with HIV and AIDS in sub-Saharan Africa is well documented. Frequent mobility, high consumption of alcohol, multiple sexual partners, transactional and commercial sex, poor health infrastructure and limited access to health services are reported among the main factors shaping the HIV epidemic in fishing communities. Moreover, studies have been conducted in sub-Saharan Africa on adherence to antiretroviral treatment (ART) among fishers; however, non-adherence to ART remains poorly understood among migrating fishermen in the western Kenya islands. This qualitative study investigated factors contributing to non-adherence among fishermen in the western Kenya islands. This study utilised 51 in-depth interviews and six focus group discussions to highlight factors contributing to non-adherence to ART by mobile fishermen. Data were analysed using a contextualised thematic analysis. Results show that migration, alcohol consumption and ART sharing contributed to non-adherence. Adherence to ART is a powerful predictor of survival for individuals living with HIV and AIDS. The Kenyan government can use lessons from this study to target fishermen to achieve the UNAIDS 2025 recommendations on people-centred and context-specific service responses to AIDS as this would move Kenya closer to the 90% reduction in annual infections by 2030. This article contributes to a deeper understanding of how and why fishermen from the islands in western Kenya struggle to adhere to treatment even though they can access ARTs through the public health care system. Longitudinal studies should be conducted to explore how the factors associated with non-adherence correlate with other key health outcomes such as drug resistance.http://www.www.tandfonline.com/toc/raar202024-11-28hj2024Centre for the Advancement of ScholarshipSDG-03:Good heatlh and well-beingSDG-11:Sustainable cities and communitie

Anti-politics and free maternal health services in Kilifi County, Kenya

Maternal healthcare is a global agenda. Kenya introduced free maternity services (FMS) in 2013 to allow women to give birth for free in all government public health facilities. The introduction of FMS was timely due to the high maternal mortality rate in Kenya. FMS was also introduced to fulfil the Jubilee Party government’s elections campaign promises. It is, however, not known how primary beneficiaries and health providers perceived the FMS roll-out following the presidential directive in 2013. This article aims to explore the roles of political contestations in FMS as a social protection scheme in Kenya. In this qualitative ethnographic study in Kilifi County, we interviewed the mothers who utilised FMS and the health workers who implemented the policy. The data gathered was analysed contextually and thematically. The prevailing narrative from the health services professionals and the mothers who participated in our study is that FMS is ‘the president’s thing’ and has a clear political orientation; it is seen as deceiving the public in two ways: first by shrouding political interests, and second by adding to the burden of women, as delivery was not free – all the other services and medication before and after birth came at a cost. Health workers feel helpless and frustrated and, in most cases, they have to cope with meagre resources to ensure safe births. In some cases, quality of care is compromised due to supply-side constraints. This article shows how social protection has been used to gain political mileage and has not considered the local needs of the maternal healthcare system.The Wellcome Trust, Dutch Research Council-WOTRO Science supported part of this work, a Josephine de Karman scholarship from the University of Bern and the Nairobi-based French Institute for Research in Africa.https://www.tandfonline.com/loi/cast202025-02-07hj2024Centre for the Advancement of ScholarshipNon

Local perspectives on policy implementation of free maternity health services in Kenya: Implications for universal health coverage.

Kenya introduced free maternity services (FMS) in 2013 to enable all pregnant women to give birth for free in all government public health facilities. Currently, Kenya is rolling out universal health coverage (UHC), which has been acknowledged as a priority goal for every health system and part of the 'Big Four Agenda' for sustainable national development in Kenya. FMS is one of the core services in Kenya, but since its launch, it is not clear whether the decentralized approach chosen to implement FMS is leading to UHC. This nine-month ethnographic study in Kilifi County, Kenya, was conducted between March-July 2016 and February-July 2017. A narrative approach to analysis was applied. In this article, we interrogate local perceptions of participation during the crafting and implementation of FMS. Findings show that FMS was detached from local realities, and this was a major inadequacy of the top to bottom approach. FMS did not consider local power relations and bargaining power which are requisites during policy formulation and implementation. The participants expressed desire for more localized control over resources from the national government. The findings suggest that as UHC is rolled out in Kenya, consultation of local stakeholders at the grassroots by the state departments would likely improve maternal healthcare outcomes. Such consultations must take into consideration differences in bargaining power and local power relations. Borrowing from the basic tenets of the recent anthropological theorization of constitutionality, this article proposes a bottom to top approach that leverages and integrates local views during policy-making process to create trust, a sense of ownership and accountability.Le Kenya a introduit des services de maternité gratuits (FMS) en 2013 pour permettre à toutes les femmes enceintes d'accoucher gratuitement dans tous les établissements de santé publique du gouvernement. Actuellement, le Kenya déploie la couverture sanitaire universelle (CSU), qui a été reconnue comme un objectif prioritaire pour chaque système de santé et fait partie du « Big Four Agenda » pour le développement national durable au Kenya. Le FMS est l'un des services de base au Kenya, mais depuis son lancement, il n'est pas clair si l'approche décentralisée choisie pour mettre en œuvre le FMS mène à la CSU. Cette étude ethnographique de neuf mois dans le comté de Kilifi, au Kenya, a été menée entre mars-juillet 2016 et février-juillet 2017. Une approche narrative de l'analyse a été appliquée. Dans cet article, nous interrogeons les perceptions locales de la participation lors de l'élaboration et de la mise en œuvre du FMS. Les résultats montrent que le FMS était détaché des réalités locales, ce qui constituait une insuffisance majeure de l'approche du haut vers le bas. Le FMS n'a pas pris en compte les relations de pouvoir locales et le pouvoir de négociation qui sont indispensables lors de la formulation et de la mise en œuvre des politiques. Les participants ont exprimé le souhait d'un contrôle plus localisé des ressources par le gouvernement national. Les résultats suggèrent qu'à mesure que la CSU est déployée au Kenya, la consultation des parties prenantes locales à la base par les départements de l'État améliorerait probablement les résultats des soins de santé maternelle. Ces consultations doivent tenir compte des différences de pouvoir de négociation et des relations de pouvoir locales. Empruntant aux principes de base de la récente théorisation anthropologique de la constitutionnalité, cet article propose une approche ascendante qui exploite et intègre les points de vue locaux au cours du processus d'élaboration des politiques pour créer la confiance, un sentiment d'appropriation et de responsabilité

Comparing sociocultural features of cholera in three endemic African settings

Cholera mainly affects developing countries where safe water supply and sanitation infrastructure are often rudimentary. Sub-Saharan Africa is a cholera hotspot. Effective cholera control requires not only a professional assessment, but also consideration of community-based priorities. The present work compares local sociocultural features of endemic cholera in urban and rural sites from three field studies in southeastern Democratic Republic of Congo (SE-DRC), western Kenya and Zanzibar.; A vignette-based semistructured interview was used in 2008 in Zanzibar to study sociocultural features of cholera-related illness among 356 men and women from urban and rural communities. Similar cross-sectional surveys were performed in western Kenya (n = 379) and in SE-DRC (n = 360) in 2010. Systematic comparison across all settings considered the following domains: illness identification; perceived seriousness, potential fatality and past household episodes; illness-related experience; meaning; knowledge of prevention; help-seeking behavior; and perceived vulnerability.; Cholera is well known in all three settings and is understood to have a significant impact on people's lives. Its social impact was mainly characterized by financial concerns. Problems with unsafe water, sanitation and dirty environments were the most common perceived causes across settings; nonetheless, non-biomedical explanations were widespread in rural areas of SE-DRC and Zanzibar. Safe food and water and vaccines were prioritized for prevention in SE-DRC. Safe water was prioritized in western Kenya along with sanitation and health education. The latter two were also prioritized in Zanzibar. Use of oral rehydration solutions and rehydration was a top priority everywhere; healthcare facilities were universally reported as a primary source of help. Respondents in SE-DRC and Zanzibar reported cholera as affecting almost everybody without differentiating much for gender, age and class. In contrast, in western Kenya, gender differentiation was pronounced, and children and the poor were regarded as most vulnerable to cholera.; This comprehensive review identified common and distinctive features of local understandings of cholera. Classical treatment (that is, rehydration) was highlighted as a priority for control in the three African study settings and is likely to be identified in the region beyond. Findings indicate the value of insight from community studies to guide local program planning for cholera control and elimination

Sociocultural determinants of anticipated oral cholera vaccine acceptance in three African settings : a meta-analytic approach

Controlling cholera remains a significant challenge in Sub-Saharan Africa. In areas where access to safe water and sanitation are limited, oral cholera vaccine (OCV) can save lives. Establishment of a global stockpile for OCV reflects increasing priority for use of cholera vaccines in endemic settings. Community acceptance of vaccines, however, is critical and sociocultural features of acceptance require attention for effective implementation. This study identifies and compares sociocultural determinants of anticipated OCV acceptance across populations in Southeastern Democratic Republic of Congo, Western Kenya and Zanzibar.; Cross-sectional studies were conducted using similar but locally-adapted semistructured interviews among 1095 respondents in three African settings. Logistic regression models identified sociocultural determinants of OCV acceptance from these studies in endemic areas of Southeastern Democratic Republic of Congo (SE-DRC), Western Kenya (W-Kenya) and Zanzibar. Meta-analytic techniques highlighted common and distinctive determinants in the three settings.; Anticipated OCV acceptance was high in all settings. More than 93 % of community respondents overall indicated interest in a no-cost vaccine. Higher anticipated acceptance was observed in areas with less access to public health facilities. In all settings awareness of cholera prevention methods (safe food consumption and garbage disposal) and relating ingestion to cholera causation were associated with greater acceptance. Higher age, larger households, lack of education, social vulnerability and knowledge of oral rehydration solution for self-treatment were negatively associated with anticipated OCV acceptance. Setting-specific determinants of acceptance included reporting a reliable income (W-Kenya and Zanzibar, not SE-DRC). In SE-DRC, intention to purchase an OCV appeared unrelated to ability to pay. Rural residents were less likely than urban counterparts to accept an OCV in W-Kenya, but more likely in Zanzibar. Prayer as a form of self-treatment was associated with vaccine acceptance in SE-DRC and W-Kenya, but not in Zanzibar.; These cholera-endemic African communities are especially interested in no-cost OCVs. Health education and attention to local social and cultural features of cholera and vaccines would likely increase vaccine coverage. High demand and absence of insurmountable sociocultural barriers to vaccination with OCVs indicate potential for mass vaccination in planning for comprehensive control or elimination