Donatien BEGUY - Profile on Academia.edu (original) (raw)

Papers by Donatien BEGUY

Journal of Urban Health, May 1, 2010

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.

Reproductive Health, 2015

Background: Several studies have demonstrated a link between young people's sexual behavior and l... more Background: Several studies have demonstrated a link between young people's sexual behavior and levels of parental monitoring, parent-child communication, and parental discipline in Western countries. However, little is known about this association in African settings, especially among young people living in high poverty settings such as urban slums. The objective of the study was to assess the influence of parental factors (monitoring, communication, and discipline) on the transition to first sexual intercourse among unmarried adolescents living in urban slums in Kenya. Methods: Longitudinal data collected from young people living in two slums in Nairobi, Kenya were used. The sample was restricted to unmarried adolescents aged 12-19 years at Wave 1 (weighted n = 1927). Parental factors at Wave 1 were used to predict adolescents' transition to first sexual intercourse by Wave 2. Relevant covariates including the adolescents' age, sex, residence, school enrollment, religiosity, delinquency, and peer models for risk behavior were controlled for. Multivariate logistic regression models were used to assess the associations of interest. All analyses were conducted using Stata version 13. Results: Approximately 6 % of our sample transitioned to first sexual intercourse within the one-year study period; there was no sex difference in the transition rate. In the multivariate analyses, male adolescents who reported communication with their mothers were less likely to transition to first sexual intercourse compared to those who did not (p < 0.05). This association persisted even after controlling for relevant covariates (OR: ≤0.33; p < 0.05). However, parental monitoring, discipline, and communication with their fathers did not predict transition to first sexual intercourse for male adolescents. For female adolescents, parental monitoring, discipline, and communication with fathers predicted transition to first sexual intercourse; however, only communication with fathers remained statistically significant after controlling for relevant covariates (OR: 0.30; 95 % C.I.: 0.13-0.68). Conclusion: This study provides evidence that cross-gender communication with parents is associated with a delay in the onset of sexual intercourse among slum-dwelling adolescents. Targeted adolescent sexual and reproductive health programmatic interventions that include parents may have significant impacts on delaying sexual debut, and possibly reducing sexual risk behaviors, among young people in high-risk settings such as slums.

Transitions to Adulthood in a High Fertility Context: the Case of Sub- Saharan Africa

This paper describes the challenges and opportunities of transitions to adulthood in high fertili... more This paper describes the challenges and opportunities of transitions to adulthood in high fertility settings, focusing on the case of sub-Saharan Africa, which has the most youthful population in the world. Current challenges in the region are high levels of youth unemployment and under-employment and low levels of education in terms of quality of education and access to education. Early marriage among girls is high in many sub-Saharan African countries, which limits their employment and education prospects. Youth in sub-Saharan Africa are also uniquely vulnerable to poor sexual and reproductive health outcomes, illustrated by early childbearing and the HIV epidemic among youth. The paper concludes with the policy prospects to address these challenges, including increased allocation of resources to support primary and secondary education, vocational training, and access to health services, particularly among the most vulnerable groups of youth.

Adverse life events and delinquent behavior among Kenyan adolescents: a cross-sectional study on the protective role of parental monitoring, religiosity, and self-esteem

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...

Global health action, 2014

Women continue to die in unacceptably large numbers around the world as a result of pregnancy, pa... more Women continue to die in unacceptably large numbers around the world as a result of pregnancy, particularly in sub-Saharan Africa and Asia. Part of the problem is a lack of accurate, population-based information characterising the issues and informing solutions. Population surveillance sites, such as those operated within the INDEPTH Network, have the potential to contribute to bridging the information gaps. To describe patterns of pregnancy-related mortality at INDEPTH Network Health and Demographic Surveillance System sites in sub-Saharan Africa and southeast Asia in terms of maternal mortality ratio (MMR) and cause-specific mortality rates. Data on individual deaths among women of reproductive age (WRA) (15-49) resident in INDEPTH sites were collated into a standardised database using the INDEPTH 2013 population standard, the WHO 2012 verbal autopsy (VA) standard, and the InterVA model for assigning cause of death. These analyses are based on reports from 14 INDEPTH sites, coveri...

Global Health Action, 2014

View metadata, citation and similar papers at core.ac.uk provided by Horizon / Pleins textes Back... more View metadata, citation and similar papers at core.ac.uk provided by Horizon / Pleins textes Background: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. Design: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided persontime denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1Á4 year and 5Á14 year age groups. Results: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. Conclusions: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes underdocumented, rates. External causes of death are a significant childhood problem in some settings.

Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Global Health Action, 2014

Global Health Action, 2014

Global Health Action, 2013

Background: Migration is difficult to measure because it is highly repeatable. Health and Demogra... more Background: Migration is difficult to measure because it is highly repeatable. Health and Demographic Surveillance Systems (HDSSs) provide a unique opportunity to study migration as multiple episodes of migration are captured over time. A conceptual framework is needed to show the public health implications of migration. Objective/design: Research conducted in seven HDSS centres [International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network], published in a peer-reviewed volume in 2009, is summarised focussing on the ageÁsex profile of migrants, the relation between migration and livelihoods, and the impact of migration on health. This illustrates the conceptual structure of the implications of migration. The next phase is described, the Multi-centre Analysis of the Dynamics In Migration And Health (MADIMAH) project, consisting of workshops focussed on preparing data and conducting the analyses for comparative studies amongst HDSS centres in Africa and Asia. The focus here is on the (standardisation of) determinants of migration and the impact of migration on adult mortality. Results: The findings in the volume showed a relatively regular age structure for migration among all HDSS centres. Furthermore, migration generally contributes to improved living conditions at the place of origin. However, there are potential negative consequences of migration on health. It was concluded that there is a need to compare results from multiple centres using uniform covariate definitions as well as longitudinal analysis techniques. This was the starting point for the on-going MADIMAH initiative, which has increased capacity at the participating HDSS centres to produce the required datasets and conduct the analyses. Conclusions: HDSS centres brought together within INDEPTH Network have already provided strong evidence of the potential negative consequences of migration on health, which contrast with the beneficial impacts of migration on livelihoods. Future comparative evidence using standardised tools will help design policies for mitigating the negative effects, and enhancing the positive effects, of migration on health.

International Journal of Epidemiology, 2014

The Kombewa Health and Demographic Surveillance System (HDSS) grew out of the Kombewa Clinical Re... more The Kombewa Health and Demographic Surveillance System (HDSS) grew out of the Kombewa Clinical Research Centre in 2007 and has since established itself as a platform for the conduct of regulated clinical trials, nested studies and local disease surveillance. The HDSS is located in a rural part of Kisumu County, Western Kenya, and covers an area of about 369 km 2 along the northeastern shores of Lake Victoria. A dynamic cohort of 141 956 individuals drawn from 34 718 households forms the HDSS surveillance population. Following a baseline survey in 2011, the HDSS continues to monitor key population changes through routine biannual household surveys. The intervening period between setup and baseline census was used for preparatory work, in particular Global Positioning System (GPS) mapping. Routine surveys capture information on individual and households including residency, household relationships, births, deaths, migrations (in and out) and causes of morbidity (syndromic incidence and prevalence) as well as causes of death (verbal autopsy). The Kombewa HDSS platform is used to support health research activities, that is clinical trials and epidemiological studies evaluating diseases of public health importance including malaria, HIV and global emerging infectious diseases such as dengue fever. Formal data request and proposed collaborations can be submitted at

Population, Space and Place, 2012

Building on African migration as a household survival strategy; urban-rural linkages as critical ... more Building on African migration as a household survival strategy; urban-rural linkages as critical for migrants' continued engagement with origin communities; reintegration in case of return; and safety net for supplementing precarious urban incomes; we examine the role of family ties in rural origin linkages among 1,693 older migrants living in Nairobi informal settlements. Despite the grim of slum residence, 80% of older migrants in Nairobi slums maintained contact with their rural origin homes during a full year of observation. Family-related factors, especially members of the nuclear family residing in rural origin, explained 45% of explained linkages. Religion, ethnicity, land ownership at origin, and current health and economic statuses are other key predictors. The patterns and reasons of linkages are consistent with migrants' positive contributions to the upkeep of rural origin households. Our findings are well-anchored in the larger continental literature that has shown the urban migrant as not a 'disembedded individual' but instead part of rural origin collectives. Against the weakness of state safety net system, the study sheds crucial light on the enduring importance of sociocultural networks in people's everyday lives, particularly the importance of family ties for older migrants. To the extent that poor health status, being aged 60 years or older, and long duration of residence in the slums, which are predictors of low propensities to maintain contacts with rural origin, are also indicators of diminished social engagement, policy interventions among the urban poor may need to include efforts to enhance rural origin reintegration of the mostaged individuals.

Transition into first sex among adolescents in slum and non-slum communities in Nairobi, Kenya

Journal of Youth Studies, 2010

Journal of Urban Health, 2010

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.

Journal of Urban Health, 2011

The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up in Korogocho and... more The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up in Korogocho and Viwandani slum settlements to provide a platform for investigating linkages between urban poverty, health, and demographic and other socioeconomic outcomes, and to facilitate the evaluation of interventions to improve the wellbeing of the urban poor. Data from the NUHDSS confirm the high level of population mobility in slum settlements, and also demonstrate that slum settlements are long-term homes for many people. Research and intervention programs should take account of the duality of slum residency. Consistent with the trends observed countrywide, the data show substantial improvements in measures of child mortality, while there has been limited decline in fertility in slum settlements. The NUHDSS experience has shown that it is feasible to set up and implement long-term health and demographic surveillance system in urban slum settlements and to generate vital data for guiding policy and actions aimed at improving the wellbeing of the urban poor. KEYWORDS Urban slum, Health and demographic surveillance system, Health and demographic indicators, Korogocho, Viwandani, Nairobi, Kenya. Africa's capacity to closely monitor key demographic events is curtailed by lack of vital registration systems, which would help account for all births, deaths, and population movements. Understanding patterns, spatial dimensions, and trends in these key demographic events would be very vital for the planning of health, social, and related services. Population-based Health and Demographic Surveillance Systems (HDSSs) were designed to fill this important data gap. The HDSS involves the prospective followup on a well-defined population living in a clearly circumscribed geographic area. 1 The HDSS records and monitors changes in vital health and demographic events relating to the population under surveillance. In addition to collecting these health and S200 Zulu is with the African Institute for Development Policy (AFIDEP),

Overview of migration, poverty and health dynamics in Nairobi City's slum settlements

Journal of Urban Health, 2011

Journal of Urban Health, 2010

Between 60% and 70% of Nairobi City's population live in congested informal settlements, commonly... more Between 60% and 70% of Nairobi City's population live in congested informal settlements, commonly referred to as slums, without proper access to sanitation, clean water, health care and other social services. Children in such areas are exposed to disproportionately high health hazards. This paper examines the impact of mother and child migration on the survival of more than 10,000 children in two of Nairobi's informal settlements-Korogocho and Viwandani-between July 2003 and June 2007, using a two-stage semi-parametric proportional hazards (Cox) model that controls for attrition and various factors that affect child survival. Results show that the slum-born have higher mortality than non-slum-born, an indication that delivery in the slums has long-term health consequences for children. Children born in the slums to women who were pregnant at the time of migration have the highest risk of dying. Given the high degree of circular migration, factors predisposing children born in the slums to recent migrant mothers to higher mortality should be better understood and addressed.

Journal of Urban Health, 2011

Young people living in poor urban informal settlements face unique challenges as they transition ... more Young people living in poor urban informal settlements face unique challenges as they transition to adulthood. This exploratory paper uses retrospective information from the baseline survey of a 3-year prospective study to examine the timing and sequencing of four key markers (first sex, marriage, birth, and independent housing) of the transition to adulthood among 3,944 adolescents in two informal settlements in Nairobi city, Kenya. Event history analysis techniques are employed to examine the timing of the events. Results indicate that there is no significant gender difference with regard to first sexual debut among adolescents. For many boys and girls, the first sexual experience occurs outside of marriage or other union. For males, the sequencing of entry begins with entry into first sex, followed by independent housing. Conversely, for females, the sequencing begins with first sex and then parenthood. Apart from sexual debut, the patterns of entry into union and parenthood do not differ much from what was observed for Nairobi as a whole. The space constraints that typify the two slums may have influenced the pattern of leaving home observed. We discuss these and other findings in light of their implications for young people's health and well-being in resource-poor settings in urban areas.

Journal of 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. Aspirations and concerns; Urban Context; Sub-Saharan Africa Almost 60% of the populations of most countries in sub-Saharan Africa are young people aged below 25 (United Nations, 2011). Although these young people are by no means a homogenous group, many are growing up in contexts characterized by rapid urbanization, weak economies, limited educational opportunities, high unemployment rates, pervasive poverty, and other socio-cultural transformations resulting from globalization . The realities of the socio-economic environment in which these youth are growing up, thus, may place significant constraints on their development. However, as Sommer (2010, p. 318) notes, "…while most urban youth in Africa are

Journal of Biosocial Science, 2013

SummaryThe contribution of adolescents' childbearing to total fertility rates in many sub-Sah... more SummaryThe contribution of adolescents' childbearing to total fertility rates in many sub-Saharan African countries is higher than in other parts of the world. In this paper, data collected from 897 female adolescents aged 15–19 years are analysed to investigate patterns and determinants of entry into motherhood in two informal settlements in Nairobi, Kenya, using Kaplan–Meier estimates and Cox regression models. About 15% of these adolescents have had a child. The findings show that marriage, being out of school and having negative models in peer, family and school contexts are associated with early childbearing among females aged 15–17 years. For adolescents aged 18–19 years, school attendance considerably delays entry into motherhood while marriage hastens its timing. Furthermore, older adolescents with high levels of social controls (parental monitoring or perceived peer orientation to or approval of prosocial behaviours) and individual controls (high religiosity and positiv...

Inconsistencies in Self-Reporting of Sexual Activity Among Young People in Nairobi, Kenya

Journal of Adolescent Health, 2009

Journal of Urban Health, May 1, 2010

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.

Reproductive Health, 2015

Background: Several studies have demonstrated a link between young people's sexual behavior and l... more Background: Several studies have demonstrated a link between young people's sexual behavior and levels of parental monitoring, parent-child communication, and parental discipline in Western countries. However, little is known about this association in African settings, especially among young people living in high poverty settings such as urban slums. The objective of the study was to assess the influence of parental factors (monitoring, communication, and discipline) on the transition to first sexual intercourse among unmarried adolescents living in urban slums in Kenya. Methods: Longitudinal data collected from young people living in two slums in Nairobi, Kenya were used. The sample was restricted to unmarried adolescents aged 12-19 years at Wave 1 (weighted n = 1927). Parental factors at Wave 1 were used to predict adolescents' transition to first sexual intercourse by Wave 2. Relevant covariates including the adolescents' age, sex, residence, school enrollment, religiosity, delinquency, and peer models for risk behavior were controlled for. Multivariate logistic regression models were used to assess the associations of interest. All analyses were conducted using Stata version 13. Results: Approximately 6 % of our sample transitioned to first sexual intercourse within the one-year study period; there was no sex difference in the transition rate. In the multivariate analyses, male adolescents who reported communication with their mothers were less likely to transition to first sexual intercourse compared to those who did not (p < 0.05). This association persisted even after controlling for relevant covariates (OR: ≤0.33; p < 0.05). However, parental monitoring, discipline, and communication with their fathers did not predict transition to first sexual intercourse for male adolescents. For female adolescents, parental monitoring, discipline, and communication with fathers predicted transition to first sexual intercourse; however, only communication with fathers remained statistically significant after controlling for relevant covariates (OR: 0.30; 95 % C.I.: 0.13-0.68). Conclusion: This study provides evidence that cross-gender communication with parents is associated with a delay in the onset of sexual intercourse among slum-dwelling adolescents. Targeted adolescent sexual and reproductive health programmatic interventions that include parents may have significant impacts on delaying sexual debut, and possibly reducing sexual risk behaviors, among young people in high-risk settings such as slums.

Transitions to Adulthood in a High Fertility Context: the Case of Sub- Saharan Africa

This paper describes the challenges and opportunities of transitions to adulthood in high fertili... more This paper describes the challenges and opportunities of transitions to adulthood in high fertility settings, focusing on the case of sub-Saharan Africa, which has the most youthful population in the world. Current challenges in the region are high levels of youth unemployment and under-employment and low levels of education in terms of quality of education and access to education. Early marriage among girls is high in many sub-Saharan African countries, which limits their employment and education prospects. Youth in sub-Saharan Africa are also uniquely vulnerable to poor sexual and reproductive health outcomes, illustrated by early childbearing and the HIV epidemic among youth. The paper concludes with the policy prospects to address these challenges, including increased allocation of resources to support primary and secondary education, vocational training, and access to health services, particularly among the most vulnerable groups of youth.

Adverse life events and delinquent behavior among Kenyan adolescents: a cross-sectional study on the protective role of parental monitoring, religiosity, and self-esteem

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...

Global health action, 2014

Women continue to die in unacceptably large numbers around the world as a result of pregnancy, pa... more Women continue to die in unacceptably large numbers around the world as a result of pregnancy, particularly in sub-Saharan Africa and Asia. Part of the problem is a lack of accurate, population-based information characterising the issues and informing solutions. Population surveillance sites, such as those operated within the INDEPTH Network, have the potential to contribute to bridging the information gaps. To describe patterns of pregnancy-related mortality at INDEPTH Network Health and Demographic Surveillance System sites in sub-Saharan Africa and southeast Asia in terms of maternal mortality ratio (MMR) and cause-specific mortality rates. Data on individual deaths among women of reproductive age (WRA) (15-49) resident in INDEPTH sites were collated into a standardised database using the INDEPTH 2013 population standard, the WHO 2012 verbal autopsy (VA) standard, and the InterVA model for assigning cause of death. These analyses are based on reports from 14 INDEPTH sites, coveri...

Global Health Action, 2014

View metadata, citation and similar papers at core.ac.uk provided by Horizon / Pleins textes Back... more View metadata, citation and similar papers at core.ac.uk provided by Horizon / Pleins textes Background: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. Design: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided persontime denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1Á4 year and 5Á14 year age groups. Results: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. Conclusions: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes underdocumented, rates. External causes of death are a significant childhood problem in some settings.

Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Global Health Action, 2014

Global Health Action, 2014

Global Health Action, 2013

Background: Migration is difficult to measure because it is highly repeatable. Health and Demogra... more Background: Migration is difficult to measure because it is highly repeatable. Health and Demographic Surveillance Systems (HDSSs) provide a unique opportunity to study migration as multiple episodes of migration are captured over time. A conceptual framework is needed to show the public health implications of migration. Objective/design: Research conducted in seven HDSS centres [International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network], published in a peer-reviewed volume in 2009, is summarised focussing on the ageÁsex profile of migrants, the relation between migration and livelihoods, and the impact of migration on health. This illustrates the conceptual structure of the implications of migration. The next phase is described, the Multi-centre Analysis of the Dynamics In Migration And Health (MADIMAH) project, consisting of workshops focussed on preparing data and conducting the analyses for comparative studies amongst HDSS centres in Africa and Asia. The focus here is on the (standardisation of) determinants of migration and the impact of migration on adult mortality. Results: The findings in the volume showed a relatively regular age structure for migration among all HDSS centres. Furthermore, migration generally contributes to improved living conditions at the place of origin. However, there are potential negative consequences of migration on health. It was concluded that there is a need to compare results from multiple centres using uniform covariate definitions as well as longitudinal analysis techniques. This was the starting point for the on-going MADIMAH initiative, which has increased capacity at the participating HDSS centres to produce the required datasets and conduct the analyses. Conclusions: HDSS centres brought together within INDEPTH Network have already provided strong evidence of the potential negative consequences of migration on health, which contrast with the beneficial impacts of migration on livelihoods. Future comparative evidence using standardised tools will help design policies for mitigating the negative effects, and enhancing the positive effects, of migration on health.

International Journal of Epidemiology, 2014

The Kombewa Health and Demographic Surveillance System (HDSS) grew out of the Kombewa Clinical Re... more The Kombewa Health and Demographic Surveillance System (HDSS) grew out of the Kombewa Clinical Research Centre in 2007 and has since established itself as a platform for the conduct of regulated clinical trials, nested studies and local disease surveillance. The HDSS is located in a rural part of Kisumu County, Western Kenya, and covers an area of about 369 km 2 along the northeastern shores of Lake Victoria. A dynamic cohort of 141 956 individuals drawn from 34 718 households forms the HDSS surveillance population. Following a baseline survey in 2011, the HDSS continues to monitor key population changes through routine biannual household surveys. The intervening period between setup and baseline census was used for preparatory work, in particular Global Positioning System (GPS) mapping. Routine surveys capture information on individual and households including residency, household relationships, births, deaths, migrations (in and out) and causes of morbidity (syndromic incidence and prevalence) as well as causes of death (verbal autopsy). The Kombewa HDSS platform is used to support health research activities, that is clinical trials and epidemiological studies evaluating diseases of public health importance including malaria, HIV and global emerging infectious diseases such as dengue fever. Formal data request and proposed collaborations can be submitted at

Population, Space and Place, 2012

Building on African migration as a household survival strategy; urban-rural linkages as critical ... more Building on African migration as a household survival strategy; urban-rural linkages as critical for migrants' continued engagement with origin communities; reintegration in case of return; and safety net for supplementing precarious urban incomes; we examine the role of family ties in rural origin linkages among 1,693 older migrants living in Nairobi informal settlements. Despite the grim of slum residence, 80% of older migrants in Nairobi slums maintained contact with their rural origin homes during a full year of observation. Family-related factors, especially members of the nuclear family residing in rural origin, explained 45% of explained linkages. Religion, ethnicity, land ownership at origin, and current health and economic statuses are other key predictors. The patterns and reasons of linkages are consistent with migrants' positive contributions to the upkeep of rural origin households. Our findings are well-anchored in the larger continental literature that has shown the urban migrant as not a 'disembedded individual' but instead part of rural origin collectives. Against the weakness of state safety net system, the study sheds crucial light on the enduring importance of sociocultural networks in people's everyday lives, particularly the importance of family ties for older migrants. To the extent that poor health status, being aged 60 years or older, and long duration of residence in the slums, which are predictors of low propensities to maintain contacts with rural origin, are also indicators of diminished social engagement, policy interventions among the urban poor may need to include efforts to enhance rural origin reintegration of the mostaged individuals.

Transition into first sex among adolescents in slum and non-slum communities in Nairobi, Kenya

Journal of Youth Studies, 2010

Journal of Urban Health, 2010

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.

Journal of Urban Health, 2011

The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up in Korogocho and... more The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up in Korogocho and Viwandani slum settlements to provide a platform for investigating linkages between urban poverty, health, and demographic and other socioeconomic outcomes, and to facilitate the evaluation of interventions to improve the wellbeing of the urban poor. Data from the NUHDSS confirm the high level of population mobility in slum settlements, and also demonstrate that slum settlements are long-term homes for many people. Research and intervention programs should take account of the duality of slum residency. Consistent with the trends observed countrywide, the data show substantial improvements in measures of child mortality, while there has been limited decline in fertility in slum settlements. The NUHDSS experience has shown that it is feasible to set up and implement long-term health and demographic surveillance system in urban slum settlements and to generate vital data for guiding policy and actions aimed at improving the wellbeing of the urban poor. KEYWORDS Urban slum, Health and demographic surveillance system, Health and demographic indicators, Korogocho, Viwandani, Nairobi, Kenya. Africa's capacity to closely monitor key demographic events is curtailed by lack of vital registration systems, which would help account for all births, deaths, and population movements. Understanding patterns, spatial dimensions, and trends in these key demographic events would be very vital for the planning of health, social, and related services. Population-based Health and Demographic Surveillance Systems (HDSSs) were designed to fill this important data gap. The HDSS involves the prospective followup on a well-defined population living in a clearly circumscribed geographic area. 1 The HDSS records and monitors changes in vital health and demographic events relating to the population under surveillance. In addition to collecting these health and S200 Zulu is with the African Institute for Development Policy (AFIDEP),

Overview of migration, poverty and health dynamics in Nairobi City's slum settlements

Journal of Urban Health, 2011

Journal of Urban Health, 2010

Between 60% and 70% of Nairobi City's population live in congested informal settlements, commonly... more Between 60% and 70% of Nairobi City's population live in congested informal settlements, commonly referred to as slums, without proper access to sanitation, clean water, health care and other social services. Children in such areas are exposed to disproportionately high health hazards. This paper examines the impact of mother and child migration on the survival of more than 10,000 children in two of Nairobi's informal settlements-Korogocho and Viwandani-between July 2003 and June 2007, using a two-stage semi-parametric proportional hazards (Cox) model that controls for attrition and various factors that affect child survival. Results show that the slum-born have higher mortality than non-slum-born, an indication that delivery in the slums has long-term health consequences for children. Children born in the slums to women who were pregnant at the time of migration have the highest risk of dying. Given the high degree of circular migration, factors predisposing children born in the slums to recent migrant mothers to higher mortality should be better understood and addressed.

Journal of Urban Health, 2011

Young people living in poor urban informal settlements face unique challenges as they transition ... more Young people living in poor urban informal settlements face unique challenges as they transition to adulthood. This exploratory paper uses retrospective information from the baseline survey of a 3-year prospective study to examine the timing and sequencing of four key markers (first sex, marriage, birth, and independent housing) of the transition to adulthood among 3,944 adolescents in two informal settlements in Nairobi city, Kenya. Event history analysis techniques are employed to examine the timing of the events. Results indicate that there is no significant gender difference with regard to first sexual debut among adolescents. For many boys and girls, the first sexual experience occurs outside of marriage or other union. For males, the sequencing of entry begins with entry into first sex, followed by independent housing. Conversely, for females, the sequencing begins with first sex and then parenthood. Apart from sexual debut, the patterns of entry into union and parenthood do not differ much from what was observed for Nairobi as a whole. The space constraints that typify the two slums may have influenced the pattern of leaving home observed. We discuss these and other findings in light of their implications for young people's health and well-being in resource-poor settings in urban areas.

Journal of 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. Aspirations and concerns; Urban Context; Sub-Saharan Africa Almost 60% of the populations of most countries in sub-Saharan Africa are young people aged below 25 (United Nations, 2011). Although these young people are by no means a homogenous group, many are growing up in contexts characterized by rapid urbanization, weak economies, limited educational opportunities, high unemployment rates, pervasive poverty, and other socio-cultural transformations resulting from globalization . The realities of the socio-economic environment in which these youth are growing up, thus, may place significant constraints on their development. However, as Sommer (2010, p. 318) notes, "…while most urban youth in Africa are

Journal of Biosocial Science, 2013

SummaryThe contribution of adolescents' childbearing to total fertility rates in many sub-Sah... more SummaryThe contribution of adolescents' childbearing to total fertility rates in many sub-Saharan African countries is higher than in other parts of the world. In this paper, data collected from 897 female adolescents aged 15–19 years are analysed to investigate patterns and determinants of entry into motherhood in two informal settlements in Nairobi, Kenya, using Kaplan–Meier estimates and Cox regression models. About 15% of these adolescents have had a child. The findings show that marriage, being out of school and having negative models in peer, family and school contexts are associated with early childbearing among females aged 15–17 years. For adolescents aged 18–19 years, school attendance considerably delays entry into motherhood while marriage hastens its timing. Furthermore, older adolescents with high levels of social controls (parental monitoring or perceived peer orientation to or approval of prosocial behaviours) and individual controls (high religiosity and positiv...

Inconsistencies in Self-Reporting of Sexual Activity Among Young People in Nairobi, Kenya

Journal of Adolescent Health, 2009