Caroline Kabiru - Academia.edu (original) (raw)
Papers by Caroline Kabiru
BMC Public Health, 2015
Background: Home management of uncomplicated malaria (HMM) is now integrated into the community c... more Background: Home management of uncomplicated malaria (HMM) is now integrated into the community case management of childhood illness (CCM), an approach that requires parasitological diagnosis before treatment. The success of CCM in resource-constrained settings without access to parasitological testing significantly depends on the caregiver's ability to recognise malaria in children under five years (U5), assess its severity, and initiate early treatment with the use of effective antimalarial drugs in the appropriate regimen at home. Little is known about factors that influence effective presumptive treatment of malaria in U5 by caregivers in resource-constrained malaria endemic areas. This study examined the factors associated with appropriate HMM in U5 by caregivers in rural Kassena-Nankana district, northern Ghana.
Journal of youth studies, 2010
While early sexual experiences are a key marker of the transition from childhood to adulthood, it... more While early sexual experiences are a key marker of the transition from childhood to adulthood, it is widely acknowledged that precocious initiation of sexual activity predisposes adolescents to negative health and psychological outcomes. Extant studies investigating adolescent sexuality in sub-Saharan Africa often rely on cross-sectional data lacking information on the social-psychological underpinnings of adolescent behavior. Through the theoretical lens of the protection-risk conceptual framework, this paper draws on two waves of longitudinal data collected from 2,134 adolescents to examine sociodemographic, psychosocial and behavioral predictors of transition to first sex among adolescents living in slum and non-slum settlements in urban Kenya. We employ logistic regression models to examine the effect of antecedent sociodemographic and risk and protective factors measured during the first wave of data collection on transition to first sex by the second wave. We observe that tran...
Child & youth services, Jan 16, 2012
Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adop... more Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adopt a protection-risk conceptual framework to examine resilience (academic achievement, civic participation, and avoidance of risk behaviors) among 1,722 never-married 12-19 year olds living in two Kenyan urban slums. We find stronger associations between explanatory factors and resilience among older (15-19 years) than younger (12-14 years) adolescents. Models for pro-social behavior and models for anti-social behavior emerge as key predictors of resilience. Further accumulation of evidence on risk and protective factors is needed to inform interventions to promote positive outcomes among youth situated in an ecology of adversity.
Journal of research on adolescence : the official journal of the Society for Research on Adolescence, 2013
We explore the concerns, challenges, aspirations, and expectations of sub-Saharan African youth, ... more We explore the concerns, challenges, aspirations, and expectations of sub-Saharan African youth, and investigate how these youth cope with neighborhood constraints to aspiration achievement. We draw on cross-sectional survey data from 4033 12-22 year olds (50.3% males) from two Kenyan urban slums and subsequent in-depth interviews conducted with a subset of 75 youth when they were 13-24 years old (45.3% male). We observe that despite the challenges characteristic of urban slums, some youth maintain high aspirations and try to achieve them through education, delinquency, residential mobility, and religion. We note that others adjust their aspirations to account for limited opportunities. Overall, our findings highlight positive youth agency and underscore the need to improve the quality of life in urban slums.
Child and adolescent psychiatry and mental health, 2014
Past research provides strong evidence that adverse life events heighten the risk of delinquent b... more Past research provides strong evidence that adverse life events heighten the risk of delinquent behavior among adolescents. Urban informal (slum) settlements in sub-Saharan Africa are marked by extreme adversity. However, the prevalence and consequences of adverse life events as well as protective factors that can mitigate the effects of exposure to these events in slum settlements is largely understudied. We examine two research questions. First, are adverse life events experienced at the individual and household level associated with a higher likelihood of delinquent behavior among adolescents living in two slums in Nairobi, Kenya? Second, are parental monitoring, religiosity, and self-esteem protective against delinquency in a context of high adversity? We used cross-sectional data from 3,064 males and females aged 12-19 years who participated in the Transitions to Adulthood Study. We examined the extent to which a composite index of adverse life events was associated with delinq...
SpringerPlus, 2014
Dwellers of urban informal settlements in developing countries are consistently reported to be vi... more Dwellers of urban informal settlements in developing countries are consistently reported to be victims of high diarrhoea prevalence. Studies have frequently reported the association between high diarrhoea prevalence and other factors, such as poor living conditions, inadequate hygiene, and sanitation in these settings. However, little is known about the dynamics of diarrhoea prevalence in mountainous urban informal settlements similar to the Rwandan context. This study was conducted in the Matyazo cell of Huye town to review the prevalence and correlates of diarrhoea. A survey of 214 households and transect walks in the neighbourhoods were conducted during the rainy and dry seasons. Logistic regression was used to analyse the survey data while the thematic analysis technique was used to analyse qualitative data. Results indicated a substantial reduction of diarrhoea prevalence from the rainy to the dry season. It was also found that the prevalence was unequally distributed in the ne...
The Pan African medical journal, 2014
Global Health Action, 2014
Background: Maternal mortality is higher and skilled attendance at delivery is lower in the slums... more Background: Maternal mortality is higher and skilled attendance at delivery is lower in the slums of Nairobi (Kenya) compared to Ouagadougou (Burkina Faso). Lower numbers of public health facilities, greater distance to facilities, and higher costs of maternal health services in Nairobi could explain these differences. Objective: By comparing the use of maternal health care services among women with similar characteristics in the two cities, we will produce a more nuanced picture of the contextual factors at play. Design: We use birth statistics collected between 2009 and 2011 in all households living in several poor neighborhoods followed by the Nairobi and the Ouagadougou Health and Demographic Surveillances Systems (n 03,346 and 4,239 births). We compare the socioeconomic characteristics associated with antenatal care (ANC) use and deliveries at health facilities, controlling for demographic variables. Results: ANC use is greater in Nairobi than in Ouagadougou for every category of women. In Ouagadougou, there are few differentials in having at least one ANC visit and in delivering at a health facility; however, differences are observed for completing all four ANC visits. In Nairobi, less-educated, poorer, non-Kikuyu women, and women living in the neighborhood farther from public health services have poorer ANC and deliver more often outside of a health facility. Conclusions: These results suggest that women are more aware of the importance of ANC utilization in Nairobi compared to Ouagadougou. The presence of numerous for-profit health facilities within slums in Nairobi may also help women have all four ANC visits, although the services received may be of substandard quality. In Ouagadougou, the lack of socioeconomic differentials in having at least one ANC visit and in delivering at a health facility suggests that these practices stem from the application of well-enforced maternal health regulations; however, these regulations do not cover the entire set of four ANC visits.
International Perspectives on Sexual and Reproductive Health, 2013
It is generally believed that men and women misreport their sexual behaviors, which undermines th... more It is generally believed that men and women misreport their sexual behaviors, which undermines the ability of researchers, program designers and health care providers to assess whether these behaviors compromise individuals' sexual and reproductive health. Data on 1,299 recent sexual partnerships were collected in a 2007 survey of 1,275 men and women aged 18-24 and living in Kisumu, Kenya. Chi-square and t tests were used to examine how sample selection bias and selective partnership reporting may result in gender differences in reported sexual behaviors. Correlation coefficients and kappa statistics were calculated in further analysis of a sample of 280 matched marital and nonmarital couples to assess agreement on reported behaviors. Even after adjustment for sample selection bias, men reported twice as many partnerships as women (0.5 vs. 0.2), as well as more casual partnerships. However, when selective reporting was controlled for, aggregate gender differences in sexual behaviors almost entirely disappeared. In the matched-couples sample, men and women exhibited moderate to substantial levels of agreement for most relationship characteristics and behaviors, including type of relationship, frequency of sex and condom use. Finally, men and women tended to agree about whether men had other nonmarital partners, but disagreed about women's nonmarital partners. Both sample selection bias and selective partnership reporting can influence the level of agreement between men's and women's reports of sexual behaviors. Although men report more casual partners than do women, accounts of sexual behavior within reported relationships are generally reliable.
African Journal of Reproductive Health, 2007
Drawing on nationally representative data collected from Burkinabé, Ghanaian, Malawian, and Ugand... more Drawing on nationally representative data collected from Burkinabé, Ghanaian, Malawian, and Ugandan adolescents, this study examines differences among four groups of never married, 15-19 year olds: primary abstainers (sexually inexperienced), secondary abstainers (last sex more than 12 months prior to the survey), recent abstainers (sexually active in last year but not in the last 3 months), and sexually active (had sexual intercourse in the last 3 months). The percentage of primary abstinent adolescents ranged from 42% (Malawian males) to 85% (Ghanaian males). In general, a greater proportion of females than males were primary abstainers. Primary abstainers were younger than sexually experienced adolescents. Current involvement in a romantic relationship was a significant predictor of sexual status with primary abstainers being the least likely to be romantically involved. Overall, findings suggest that adolescents' gender, prior sexual experiences and contextual circumstances, such as romantic partnerships, should be considered when designing abstinence promotion programs. (Afr J Reprod Health 2007; 11[3]:111-132) RÉSUMÉ Facteurs liés à l'abstinence sexuelle chez les adolescents dans quatre pays d'Afrique subsaharienne En se fondant sur les données à représentation nationale recueillies auprès des adolescents burkinabe, ghanéens, malawiens et ougandais, cette étude examine les différences entre quatre groupes d'adolescents qui n'ont pas été jamais mariés, âgés de 15-19 ans: les abstentionnistes primaires (sexuellement inexpérimentés), les abstentionnistes secondaires (le dernier rapport sexuel compte plus de 12 mois avant l'enquête), les abstentionnistes récents (sexuellement actifs au cours de l'année passée mais pas au cours de trois derniers mois) et sexuellement actifs (ont eu des rapports sexuels au cours de trois dernier mois). Le pourcentage des adolescents de la catégorie de l'abstinence primaire variait de 42% (les mâles malawiens) à 85% (les mâles ghanéens). En général, une plus grande proportion de femelles par rapport aux mâles étaient des abstentionnistes primaires. Les abstentionnistes primaires étaient plus jeunes que les adolescents sexuellement expérimentés. L'implication actuelle dans un rapport romantique est un indice significatif de la situation sexuelle chez les abstentionnistes primaires qui ont la moindre possibilité d'être impliqués romantiquement. Dans l'ensemble, les résultats montrent que le genre des adolescents, les expériences sexuelles antérieures et les circonstances contextuelles, telles les associations romantiques, doivent être prises en considération pour la conception des programmes de la promotion de l'abstinence. (Rev Afr Santé Reprod 2007; 11[3]:111-132).
Child and Adolescent Psychiatry and Mental Health, 2010
BACKGROUND: Consumption of alcohol is associated with acute and chronic adverse health outcomes. ... more BACKGROUND: Consumption of alcohol is associated with acute and chronic adverse health outcomes. There is a paucity of studies that explore the determinants of alcohol use among adolescents in sub-Saharan Africa and, in particular, that examine the effects of adverse childhood experiences on alcohol use. METHODS: The paper draws on nationally-representative data from 9,819 adolescents aged 12-19 years from Burkina
Journal of Urban Health, 2011
Adolescent involvement in problem behaviors can compromise health, development, and successful tr... more Adolescent involvement in problem behaviors can compromise health, development, and successful transition to adulthood. The present study explores the appropriateness of a particular theoretical framework, Problem Behavior Theory, to account for variation in problem behavior among adolescents in informal settlements around a large, rapidly urbanizing city in sub-Saharan Africa. Data were collected from samples of never married adolescents of both sexes, aged 12-19, living in two Nairobi slum settlements (N=1,722). Measures of the theoretical psychosocial protective and risk factor concepts provided a substantial, multi-variate, and explanatory account of adolescent problem behavior variation and demonstrated that protection can also moderate the impact of exposure to risk. Key protective and risk factors constitute targets for policies and programs to enhance the health and well-being of poor urban adolescents in sub-Saharan Africa.
BMC Public Health, 2015
Background: Home management of uncomplicated malaria (HMM) is now integrated into the community c... more Background: Home management of uncomplicated malaria (HMM) is now integrated into the community case management of childhood illness (CCM), an approach that requires parasitological diagnosis before treatment. The success of CCM in resource-constrained settings without access to parasitological testing significantly depends on the caregiver's ability to recognise malaria in children under five years (U5), assess its severity, and initiate early treatment with the use of effective antimalarial drugs in the appropriate regimen at home. Little is known about factors that influence effective presumptive treatment of malaria in U5 by caregivers in resource-constrained malaria endemic areas. This study examined the factors associated with appropriate HMM in U5 by caregivers in rural Kassena-Nankana district, northern Ghana.
Journal of youth studies, 2010
While early sexual experiences are a key marker of the transition from childhood to adulthood, it... more While early sexual experiences are a key marker of the transition from childhood to adulthood, it is widely acknowledged that precocious initiation of sexual activity predisposes adolescents to negative health and psychological outcomes. Extant studies investigating adolescent sexuality in sub-Saharan Africa often rely on cross-sectional data lacking information on the social-psychological underpinnings of adolescent behavior. Through the theoretical lens of the protection-risk conceptual framework, this paper draws on two waves of longitudinal data collected from 2,134 adolescents to examine sociodemographic, psychosocial and behavioral predictors of transition to first sex among adolescents living in slum and non-slum settlements in urban Kenya. We employ logistic regression models to examine the effect of antecedent sociodemographic and risk and protective factors measured during the first wave of data collection on transition to first sex by the second wave. We observe that tran...
Child & youth services, Jan 16, 2012
Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adop... more Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adopt a protection-risk conceptual framework to examine resilience (academic achievement, civic participation, and avoidance of risk behaviors) among 1,722 never-married 12-19 year olds living in two Kenyan urban slums. We find stronger associations between explanatory factors and resilience among older (15-19 years) than younger (12-14 years) adolescents. Models for pro-social behavior and models for anti-social behavior emerge as key predictors of resilience. Further accumulation of evidence on risk and protective factors is needed to inform interventions to promote positive outcomes among youth situated in an ecology of adversity.
Journal of research on adolescence : the official journal of the Society for Research on Adolescence, 2013
We explore the concerns, challenges, aspirations, and expectations of sub-Saharan African youth, ... more We explore the concerns, challenges, aspirations, and expectations of sub-Saharan African youth, and investigate how these youth cope with neighborhood constraints to aspiration achievement. We draw on cross-sectional survey data from 4033 12-22 year olds (50.3% males) from two Kenyan urban slums and subsequent in-depth interviews conducted with a subset of 75 youth when they were 13-24 years old (45.3% male). We observe that despite the challenges characteristic of urban slums, some youth maintain high aspirations and try to achieve them through education, delinquency, residential mobility, and religion. We note that others adjust their aspirations to account for limited opportunities. Overall, our findings highlight positive youth agency and underscore the need to improve the quality of life in urban slums.
Child and adolescent psychiatry and mental health, 2014
Past research provides strong evidence that adverse life events heighten the risk of delinquent b... more Past research provides strong evidence that adverse life events heighten the risk of delinquent behavior among adolescents. Urban informal (slum) settlements in sub-Saharan Africa are marked by extreme adversity. However, the prevalence and consequences of adverse life events as well as protective factors that can mitigate the effects of exposure to these events in slum settlements is largely understudied. We examine two research questions. First, are adverse life events experienced at the individual and household level associated with a higher likelihood of delinquent behavior among adolescents living in two slums in Nairobi, Kenya? Second, are parental monitoring, religiosity, and self-esteem protective against delinquency in a context of high adversity? We used cross-sectional data from 3,064 males and females aged 12-19 years who participated in the Transitions to Adulthood Study. We examined the extent to which a composite index of adverse life events was associated with delinq...
SpringerPlus, 2014
Dwellers of urban informal settlements in developing countries are consistently reported to be vi... more Dwellers of urban informal settlements in developing countries are consistently reported to be victims of high diarrhoea prevalence. Studies have frequently reported the association between high diarrhoea prevalence and other factors, such as poor living conditions, inadequate hygiene, and sanitation in these settings. However, little is known about the dynamics of diarrhoea prevalence in mountainous urban informal settlements similar to the Rwandan context. This study was conducted in the Matyazo cell of Huye town to review the prevalence and correlates of diarrhoea. A survey of 214 households and transect walks in the neighbourhoods were conducted during the rainy and dry seasons. Logistic regression was used to analyse the survey data while the thematic analysis technique was used to analyse qualitative data. Results indicated a substantial reduction of diarrhoea prevalence from the rainy to the dry season. It was also found that the prevalence was unequally distributed in the ne...
The Pan African medical journal, 2014
Global Health Action, 2014
Background: Maternal mortality is higher and skilled attendance at delivery is lower in the slums... more Background: Maternal mortality is higher and skilled attendance at delivery is lower in the slums of Nairobi (Kenya) compared to Ouagadougou (Burkina Faso). Lower numbers of public health facilities, greater distance to facilities, and higher costs of maternal health services in Nairobi could explain these differences. Objective: By comparing the use of maternal health care services among women with similar characteristics in the two cities, we will produce a more nuanced picture of the contextual factors at play. Design: We use birth statistics collected between 2009 and 2011 in all households living in several poor neighborhoods followed by the Nairobi and the Ouagadougou Health and Demographic Surveillances Systems (n 03,346 and 4,239 births). We compare the socioeconomic characteristics associated with antenatal care (ANC) use and deliveries at health facilities, controlling for demographic variables. Results: ANC use is greater in Nairobi than in Ouagadougou for every category of women. In Ouagadougou, there are few differentials in having at least one ANC visit and in delivering at a health facility; however, differences are observed for completing all four ANC visits. In Nairobi, less-educated, poorer, non-Kikuyu women, and women living in the neighborhood farther from public health services have poorer ANC and deliver more often outside of a health facility. Conclusions: These results suggest that women are more aware of the importance of ANC utilization in Nairobi compared to Ouagadougou. The presence of numerous for-profit health facilities within slums in Nairobi may also help women have all four ANC visits, although the services received may be of substandard quality. In Ouagadougou, the lack of socioeconomic differentials in having at least one ANC visit and in delivering at a health facility suggests that these practices stem from the application of well-enforced maternal health regulations; however, these regulations do not cover the entire set of four ANC visits.
International Perspectives on Sexual and Reproductive Health, 2013
It is generally believed that men and women misreport their sexual behaviors, which undermines th... more It is generally believed that men and women misreport their sexual behaviors, which undermines the ability of researchers, program designers and health care providers to assess whether these behaviors compromise individuals' sexual and reproductive health. Data on 1,299 recent sexual partnerships were collected in a 2007 survey of 1,275 men and women aged 18-24 and living in Kisumu, Kenya. Chi-square and t tests were used to examine how sample selection bias and selective partnership reporting may result in gender differences in reported sexual behaviors. Correlation coefficients and kappa statistics were calculated in further analysis of a sample of 280 matched marital and nonmarital couples to assess agreement on reported behaviors. Even after adjustment for sample selection bias, men reported twice as many partnerships as women (0.5 vs. 0.2), as well as more casual partnerships. However, when selective reporting was controlled for, aggregate gender differences in sexual behaviors almost entirely disappeared. In the matched-couples sample, men and women exhibited moderate to substantial levels of agreement for most relationship characteristics and behaviors, including type of relationship, frequency of sex and condom use. Finally, men and women tended to agree about whether men had other nonmarital partners, but disagreed about women's nonmarital partners. Both sample selection bias and selective partnership reporting can influence the level of agreement between men's and women's reports of sexual behaviors. Although men report more casual partners than do women, accounts of sexual behavior within reported relationships are generally reliable.
African Journal of Reproductive Health, 2007
Drawing on nationally representative data collected from Burkinabé, Ghanaian, Malawian, and Ugand... more Drawing on nationally representative data collected from Burkinabé, Ghanaian, Malawian, and Ugandan adolescents, this study examines differences among four groups of never married, 15-19 year olds: primary abstainers (sexually inexperienced), secondary abstainers (last sex more than 12 months prior to the survey), recent abstainers (sexually active in last year but not in the last 3 months), and sexually active (had sexual intercourse in the last 3 months). The percentage of primary abstinent adolescents ranged from 42% (Malawian males) to 85% (Ghanaian males). In general, a greater proportion of females than males were primary abstainers. Primary abstainers were younger than sexually experienced adolescents. Current involvement in a romantic relationship was a significant predictor of sexual status with primary abstainers being the least likely to be romantically involved. Overall, findings suggest that adolescents' gender, prior sexual experiences and contextual circumstances, such as romantic partnerships, should be considered when designing abstinence promotion programs. (Afr J Reprod Health 2007; 11[3]:111-132) RÉSUMÉ Facteurs liés à l'abstinence sexuelle chez les adolescents dans quatre pays d'Afrique subsaharienne En se fondant sur les données à représentation nationale recueillies auprès des adolescents burkinabe, ghanéens, malawiens et ougandais, cette étude examine les différences entre quatre groupes d'adolescents qui n'ont pas été jamais mariés, âgés de 15-19 ans: les abstentionnistes primaires (sexuellement inexpérimentés), les abstentionnistes secondaires (le dernier rapport sexuel compte plus de 12 mois avant l'enquête), les abstentionnistes récents (sexuellement actifs au cours de l'année passée mais pas au cours de trois derniers mois) et sexuellement actifs (ont eu des rapports sexuels au cours de trois dernier mois). Le pourcentage des adolescents de la catégorie de l'abstinence primaire variait de 42% (les mâles malawiens) à 85% (les mâles ghanéens). En général, une plus grande proportion de femelles par rapport aux mâles étaient des abstentionnistes primaires. Les abstentionnistes primaires étaient plus jeunes que les adolescents sexuellement expérimentés. L'implication actuelle dans un rapport romantique est un indice significatif de la situation sexuelle chez les abstentionnistes primaires qui ont la moindre possibilité d'être impliqués romantiquement. Dans l'ensemble, les résultats montrent que le genre des adolescents, les expériences sexuelles antérieures et les circonstances contextuelles, telles les associations romantiques, doivent être prises en considération pour la conception des programmes de la promotion de l'abstinence. (Rev Afr Santé Reprod 2007; 11[3]:111-132).
Child and Adolescent Psychiatry and Mental Health, 2010
BACKGROUND: Consumption of alcohol is associated with acute and chronic adverse health outcomes. ... more BACKGROUND: Consumption of alcohol is associated with acute and chronic adverse health outcomes. There is a paucity of studies that explore the determinants of alcohol use among adolescents in sub-Saharan Africa and, in particular, that examine the effects of adverse childhood experiences on alcohol use. METHODS: The paper draws on nationally-representative data from 9,819 adolescents aged 12-19 years from Burkina
Journal of Urban Health, 2011
Adolescent involvement in problem behaviors can compromise health, development, and successful tr... more Adolescent involvement in problem behaviors can compromise health, development, and successful transition to adulthood. The present study explores the appropriateness of a particular theoretical framework, Problem Behavior Theory, to account for variation in problem behavior among adolescents in informal settlements around a large, rapidly urbanizing city in sub-Saharan Africa. Data were collected from samples of never married adolescents of both sexes, aged 12-19, living in two Nairobi slum settlements (N=1,722). Measures of the theoretical psychosocial protective and risk factor concepts provided a substantial, multi-variate, and explanatory account of adolescent problem behavior variation and demonstrated that protection can also moderate the impact of exposure to risk. Key protective and risk factors constitute targets for policies and programs to enhance the health and well-being of poor urban adolescents in sub-Saharan Africa.