Yvonne Wangũi Machira - Academia.edu (original) (raw)
Papers by Yvonne Wangũi Machira
PLOS Global Public Health
Region-specific laboratory reference intervals (RIs) are important for clinical trials and these ... more Region-specific laboratory reference intervals (RIs) are important for clinical trials and these data are often sparse in priority areas for research, including Africa. We reviewed data on RIs from Africa to identify gaps in the literature with a systematic review of PubMed for RI studies from Africa published ≥2010. Search focus included clinical analytic chemistry, hematology, immunological parameters and RIs. Data from adults, adolescents, children, pregnant women, and the elderly were included. We excluded manuscripts reporting data from persons with conditions that might preclude clinical trial participation in studies enrolling healthy volunteers. Of 179 identified manuscripts, 80 were included in this review, covering 20 countries with the largest number of studies in Ethiopia (n = 23, 29%). Most studies considered healthy, nonpregnant adults (n = 55, 69%). Nine (11%) studies included pregnant women, 13 (16%) included adolescents and 22 (28%) included children. Recruitment, s...
PLOS ONE, 2019
Background Sexual autonomy empowers women to set boundaries, take control of their bodies, preven... more Background Sexual autonomy empowers women to set boundaries, take control of their bodies, prevent sexually transmitted diseases and avoid unplanned pregnancy. A woman's ability to negotiate safer sex is crucial for her survival and that of her child. Sexual autonomy among East African women is vital to the elimination of the deaths of neonates, infants, and children. The aim of our study was to explore the association of sexual autonomy on neonatal, infant, and child mortality. Methodology This was a secondary analysis of demographic health survey (DHS) data on women of reproductive age (15-49 years) in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. Data on our outcome variables neonatal, infant, and under-five mortality which were in binary form was extracted from the database. Sexual autonomy was classified as a composite variable of "respondent can refuse sex," "respondent can ask partner to use condom," and "if spouse is justified in asking husband to use condom." Other sociodemographic, maternal, health system and paternal variables were included in the analysis. STATA version 14 was used for analysis. Proportions and frequencies were used to describe the three outcome variables and sociodemographic characteristics. Chi-square tests were used to compare associations between sexual autonomy and categorical variables. Adjusted hazard ratios were used to determine the association between sexual autonomy and independent variables.
The Pan African medical journal, 2012
Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably h... more Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably high in a decade. In 2007, the Ministry of Public Health and Sanitation adopted a community health strategy to reverse the poor health outcomes in order to meet Millennium Development Goals 4 and 5. It aims at strengthening community participation and its ability to take action towards health. The study aimed at evaluating the effectiveness of the strategy in improving maternal and neonatal health outcomes in Kenya. Between 2008 and 2010, the African Medical and Research Foundation implemented a community-based maternal and newborn care intervention package in Busia County using the community health strategy approach. An interventional, non-randomized pre-test post test study design was used to evaluate change in essential maternal and neonatal care practices among mothers with children aged 0 - 23 months. There was statistically significant (p < 0.05) increase in attendance of at leas...
BMC Women's Health
Background There is limited information on factors that influence oral pre-exposure prophylaxis (... more Background There is limited information on factors that influence oral pre-exposure prophylaxis (PrEP) uptake and adherence among adolescent girls and young women (AGYW). We conducted a qualitative methods study to explore experiences, facilitators and barriers of PrEP uptake and adherence to PrEP among AGYW at risk of Human Immunodeficiency Virus (HIV) infection in Kampala, Uganda. Methods This study was nested in a prospective cohort study that offered daily oral PrEP to AGYW. Between April 2019 and October 2020 we conducted in-depth interviews with 26 AGYW aged 14–24 years who had been offered or had been using PrEP for at least 6 months, including PrEP adherers (8), non-adherers (8) and those who had declined PrEP (10). After 12 months, follow-up interviews were conducted with 12 AGYW who had adhered to PrEP and those who had dropped it. Thematic analysis was conducted and data were further examined and categorized into the 5 constructs of the Socio-Ecological Model (SEM). Resul...
This policy note provides observations from a pilot that tested integration of social accountabil... more This policy note provides observations from a pilot that tested integration of social accountability mechanisms in healthcare delivery in Kenya between 2011 and 2013.
World Bank Group Health, Nutrition and Population (HNP) Discussion Papers, 2020
The burden of NCDs in Kenya is rising rapidly, and now accounts for more than 50 percent of all h... more The burden of NCDs in Kenya is rising rapidly, and now accounts for more than 50 percent of all hospital admissions, and nearly 30 percent of total deaths. Cancer is the second leading cause of NCD mortality in Kenya, with the incidence of cancer nearly doubling between 2008-2012. The illness affects Kenyans of all ages and socio-economic backgrounds, with an increasing risk of cancer as age progresses. Most cancer cases are diagnosed at an advanced stage when treatment options are limited, leading to poor prognosis and high fatality rates. This report uses a case study approach with focus group discussions and in-depth interviews to shed light on the patient journey, and better understand the direct and indirect costs families face; the difficult decisions and choices they need to make; and the socio-economic and psychological implications of having a family member afflicted by cancer. Key challenges identified include lack of awareness and poor knowledge of cancer; late health seeking behavior; inadequate health insurance coverage and gaps in the benefit package which limit access to critical diagnostic tests, treatments and drugs; and socio-cultural barriers, including stigma, fear and myths that impede patients from seeking care early. The main themes from the patient stories and focus group discussions, including the economic impact on patients and households are summarized and a series of recommendations to mitigate the cost of cancer to patients and families are proposed based on the findings from the case studies.
Plos One, 2019
Background Sexual autonomy empowers women to set boundaries, take control of their bodies, preve... more Background
Sexual autonomy empowers women to set boundaries, take control of their bodies, prevent sexually transmitted diseases and avoid unplanned pregnancy. A woman’s ability to negotiate safer sex is crucial for her survival and that of her child. Sexual autonomy among East African women is vital to the elimination of the deaths of neonates, infants, and children. The aim of our study was to explore the association of sexual autonomy on neonatal, infant, and child mortality.
Methodology
This was a secondary analysis of demographic health survey (DHS) data on women of reproductive age (15–49 years) in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. Data on our outcome variables neonatal, infant, and under-five mortality which were in binary form was extracted from the database. Sexual autonomy was classified as a composite variable of “respondent can refuse sex,” “respondent can ask partner to use condom,” and “if spouse is justified in asking husband to use condom.” Other sociodemographic, maternal, health system and paternal variables were included in the analysis. STATA version 14 was used for analysis. Proportions and frequencies were used to describe the three outcome variables and sociodemographic characteristics. Chi-square tests were used to compare associations between sexual autonomy and categorical variables. Adjusted hazard ratios were used to determine the association between sexual autonomy and independent variables.
Results
The sampled women were predominantly urban (75%; n = 5758) and poor (48.7%; n = 3702). A majority of those that experienced mortality (neonatal mortality 53.5%, infant mortality 54.3%, under-five mortality 55.7%) were young (under 20) at the time of their first child’s birth while their male partners were older. The multivariate analysis supports the beneficial effects of women’s sexual autonomy in East Africa. Women who exercised sexual autonomy experienced significantly lower rates of child mortality at all three stages: neonatal (NHR = 0.80, 95% CI: 0.68–0.94, p = 0.006), infant (IHR = 0.82, 95% CI: 0.72–0.93, p = 0.003), and under-five (UHR = 0.84, 95% CI: 0.75–0.94, p = 0.002), net of all other factors. Receiving antenatal care and using contraceptives also contributed significantly to lower child mortality rates.
Conclusion
Our findings suggest that sexual autonomy among East African women is an urgent priority that is crucial to the survival of neonates, infants, and children in East Africa. Women should be informed, empowered, and autonomous concerning their reproductive and sexual health.
Background: Kenya’s Medical Supply Chain (MSC) has been described as suffering from a “multiplici... more Background: Kenya’s Medical Supply Chain (MSC) has been described as suffering from a “multiplicity of parallel procurement systems, a complexity full of inefficiency and lack of clarity and synergy” [1]. The general objective of this study was to review the performance of the public MSC’s planning, budgeting, procurement and distribution of drugs and supplies (D&S) with a view to establishing strengths, weaknesses and opportunities in the system.
Design: The study adopted a qualitative formative case study design. The study sought to explore all unknown variables that affect effective and efficient delivery of health commodities against need based on epidemiological and other relevant data in Kajiado. The investigation involved collection of primary data through interviews as well as review of secondary data. Data collection sources were then triangulated to form findings on common themes.
Results: A total of 80 respondents, 69 (86%) from 14 health facilities in Kajiado and 11 (14%) national level Ministry and Kenya Medical Supplies Agency (KEMSA) staff and Development Partners were interviewed for the study. The study illustrated that at the County level, the available MSC-related resources are not sufficient and/or consistently supplied and neither is resource allocation guided by demographic and epidemiological profiling. Moreover, the existing personnel are not sufficient or adequately trained in the areas of governance and management, key to maximising D&S resources. Lack of stewardship of the MSC in Kenya is the key deterrent to an efficient and effective system. Inefficient parallel MSC systems have also created what one respondent described as a circus of a system. Government officials reported that not enough was being done by the relevant authorities to streamline the systems.
Recommendations: To enhance delivery of D&S, the Government should lead, and engage stakeholders, in implementing governance reforms that address the (1) the health policy framework through integration and regulation of the parallel supply chain systems at national and County levels; at County level, there is an urgent need to train health officials if they are expected to maximise the resources allocated to them, (2) with the MSC human resource (HR), a paradigm shift in work allocation should be considered to have more administrators, qualified and continuously trained in supply chain issues, (3) MSC processes and operations could be
improved through cross-linkages of the Health Management Information System (HMIS) and a Logistics Management Information System (LMIS) that would allow automated access, analysis and monitoring of demographic, epidemiological and economic data to enhance information used for decision making in costing resource allocation; the health Ministries and KEMSA should also institute accountability mechanisms that facilitate customer responsiveness and (4) rational drug use could be improved through sensitisation targeting both medical practitioners and patients to maximise on the resources provided.
Background and objectives: This study presents findings on the acceptability and feasibility of a... more Background and objectives: This study presents findings
on the acceptability and feasibility of an integrated nutrition,
agriculture and health intervention that delivers vitamin A
rich, orange fleshed sweet potato (OFSP), through antenatal
care services (ANC) with the goal of improving the health and
nutrition of pregnant women and their infants in Western Kenya.
Methods: We explored the feasibility and acceptability of
the intervention through 42 interviews with nurses, community
health extension workers (CHEW), vine multiplers (VM),
agriculture extension agents and district-level officials; and
24 focus group discussions with community health workers
(CHW), pregnant women, and their husbands. Qualitative data
was transcribed verbatim and analysed using NVivo 10.0. Content analysis was used to identify key topics, relational analysis to examine relationships between themes and respondents.
Results: Enhanced maternal and child health coupled with
food security were the most recognized benefits by respondents. Mothers felt their children were less susceptible to disease and more energetic; they and their partners also valued OFSPs’ shorter maturity and higher yields. Frontline health workers perceived higher ANC attendance and increased contact between mothers, their partners and children with the
health system. All implementers were motivated by enhanced
training, more effective nutrition messaging, tangible recommendations to improve dietary quality, community recognition, and ability to better serve their clients. CHWs emerged as key facilitators of implementation and outreach to mothers.
Challenges to implementation and uptake included mothers’
distance to ANC and VMs, misperceptions such as OFSP having
contraceptive properties, need for continuous community
sensitization, and increased workload without commiserate remuneration for CHWs and VMs.
Conclusions: Perceived benefits and motivating factors
among key stakeholders outweighed challenges of integrating
OFSP with ANC services. These findings contribute to other
evaluation activities that assess effectiveness, feasibility and acceptability of this integrated agriculture and health intervention.
Background: Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained un... more Background: Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably high in a decade. In 2007, the Ministry of Public Health and Sanitation adopted a community health strategy to reverse the poor health outcomes in order to meet Millennium Development Goals 4 and 5. It aims at strengthening community participation and its ability to take action towards health. The study aimed at evaluating the effectiveness of the strategy in improving maternal and neonatal health outcomes in Kenya.
Methods: Between 2008 and 2010, the African Medical and Research Foundation implemented a community-based maternal and newborn care intervention package in Busia County using the community health strategy approach. An interventional, non-randomized pre-test post test study design was used to evaluate change in essential maternal and neonatal care practices among mothers with children aged 0 - 23 months.
Results: There was statistically significant (p<0.05) increase in attendance of at least four antenatal care visits (39% to 62%), deliveries by skilled birth attendants (31% to 57%), receiving intermittent preventive treatment (23% to 57%), testing for HIV during pregnancy (73% to 90%) and exclusive breastfeeding (20% to 52%).
Conclusion: The significant increase in essential maternal and neonatal care practices demonstrates that, community health strategy is an appropriate platform to deliver community based interventions. The findings will be used by actors in the child survival community to improve current approaches, policies and practice in maternal and neonatal care.
Background: Malaria is a leading cause of morbidity and mortality in children younger than 5 year... more Background: Malaria is a leading cause of morbidity and mortality in children younger than 5 years in Kenya.
Within the context of planning for a vaccine to be used alongside existing malaria control methods, this study
explores sociocultural and health communications issues among individuals who are responsible for or influence
decisions on childhood vaccination at the community level.
Methods: This qualitative study was conducted in two malaria-endemic regions of Kenya–South Coast and Busia.
Participant selection was purposive and criterion based. A total of 20 focus group discussions, 22 in-depth
interviews, and 18 exit interviews were conducted.
Results: Participants understand that malaria is a serious problem that no single tool can defeat. Communities
would welcome a malaria vaccine, although they would have questions and concerns about the intervention.
While support for local child immunization programs exists, limited understanding about vaccines and what they
do is evident among younger and older people, particularly men. Even as health care providers are frustrated
when parents do not have their children vaccinated, some parents have concerns about access to and the quality
of vaccination services. Some women, including older mothers and those less economically privileged, see
themselves as the focus of health workers’ negative comments associated with either their parenting choices or
their children’s appearance. In general, parents and caregivers weigh several factors–such as personal opportunity
costs, resource constraints, and perceived benefits–when deciding whether or not to have their children
vaccinated, and the decision often is influenced by a network of people, including community leaders and health
workers.
Conclusions: The study raises issues that should inform a communications strategy and guide policy decisions
within Kenya on eventual malaria vaccine introduction. Unlike the current practice, where health education on
child welfare and immunization focuses on women, the communications strategy should equally target men and
women in ways that are appropriate for each gender. It should involve influential community members and
provide needed information and reassurances about immunization. Efforts also should be made to address
concerns about the quality of immunization services–including health workers’ interpersonal communication skills.
PLOS Global Public Health
Region-specific laboratory reference intervals (RIs) are important for clinical trials and these ... more Region-specific laboratory reference intervals (RIs) are important for clinical trials and these data are often sparse in priority areas for research, including Africa. We reviewed data on RIs from Africa to identify gaps in the literature with a systematic review of PubMed for RI studies from Africa published ≥2010. Search focus included clinical analytic chemistry, hematology, immunological parameters and RIs. Data from adults, adolescents, children, pregnant women, and the elderly were included. We excluded manuscripts reporting data from persons with conditions that might preclude clinical trial participation in studies enrolling healthy volunteers. Of 179 identified manuscripts, 80 were included in this review, covering 20 countries with the largest number of studies in Ethiopia (n = 23, 29%). Most studies considered healthy, nonpregnant adults (n = 55, 69%). Nine (11%) studies included pregnant women, 13 (16%) included adolescents and 22 (28%) included children. Recruitment, s...
PLOS ONE, 2019
Background Sexual autonomy empowers women to set boundaries, take control of their bodies, preven... more Background Sexual autonomy empowers women to set boundaries, take control of their bodies, prevent sexually transmitted diseases and avoid unplanned pregnancy. A woman's ability to negotiate safer sex is crucial for her survival and that of her child. Sexual autonomy among East African women is vital to the elimination of the deaths of neonates, infants, and children. The aim of our study was to explore the association of sexual autonomy on neonatal, infant, and child mortality. Methodology This was a secondary analysis of demographic health survey (DHS) data on women of reproductive age (15-49 years) in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. Data on our outcome variables neonatal, infant, and under-five mortality which were in binary form was extracted from the database. Sexual autonomy was classified as a composite variable of "respondent can refuse sex," "respondent can ask partner to use condom," and "if spouse is justified in asking husband to use condom." Other sociodemographic, maternal, health system and paternal variables were included in the analysis. STATA version 14 was used for analysis. Proportions and frequencies were used to describe the three outcome variables and sociodemographic characteristics. Chi-square tests were used to compare associations between sexual autonomy and categorical variables. Adjusted hazard ratios were used to determine the association between sexual autonomy and independent variables.
The Pan African medical journal, 2012
Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably h... more Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably high in a decade. In 2007, the Ministry of Public Health and Sanitation adopted a community health strategy to reverse the poor health outcomes in order to meet Millennium Development Goals 4 and 5. It aims at strengthening community participation and its ability to take action towards health. The study aimed at evaluating the effectiveness of the strategy in improving maternal and neonatal health outcomes in Kenya. Between 2008 and 2010, the African Medical and Research Foundation implemented a community-based maternal and newborn care intervention package in Busia County using the community health strategy approach. An interventional, non-randomized pre-test post test study design was used to evaluate change in essential maternal and neonatal care practices among mothers with children aged 0 - 23 months. There was statistically significant (p < 0.05) increase in attendance of at leas...
BMC Women's Health
Background There is limited information on factors that influence oral pre-exposure prophylaxis (... more Background There is limited information on factors that influence oral pre-exposure prophylaxis (PrEP) uptake and adherence among adolescent girls and young women (AGYW). We conducted a qualitative methods study to explore experiences, facilitators and barriers of PrEP uptake and adherence to PrEP among AGYW at risk of Human Immunodeficiency Virus (HIV) infection in Kampala, Uganda. Methods This study was nested in a prospective cohort study that offered daily oral PrEP to AGYW. Between April 2019 and October 2020 we conducted in-depth interviews with 26 AGYW aged 14–24 years who had been offered or had been using PrEP for at least 6 months, including PrEP adherers (8), non-adherers (8) and those who had declined PrEP (10). After 12 months, follow-up interviews were conducted with 12 AGYW who had adhered to PrEP and those who had dropped it. Thematic analysis was conducted and data were further examined and categorized into the 5 constructs of the Socio-Ecological Model (SEM). Resul...
This policy note provides observations from a pilot that tested integration of social accountabil... more This policy note provides observations from a pilot that tested integration of social accountability mechanisms in healthcare delivery in Kenya between 2011 and 2013.
World Bank Group Health, Nutrition and Population (HNP) Discussion Papers, 2020
The burden of NCDs in Kenya is rising rapidly, and now accounts for more than 50 percent of all h... more The burden of NCDs in Kenya is rising rapidly, and now accounts for more than 50 percent of all hospital admissions, and nearly 30 percent of total deaths. Cancer is the second leading cause of NCD mortality in Kenya, with the incidence of cancer nearly doubling between 2008-2012. The illness affects Kenyans of all ages and socio-economic backgrounds, with an increasing risk of cancer as age progresses. Most cancer cases are diagnosed at an advanced stage when treatment options are limited, leading to poor prognosis and high fatality rates. This report uses a case study approach with focus group discussions and in-depth interviews to shed light on the patient journey, and better understand the direct and indirect costs families face; the difficult decisions and choices they need to make; and the socio-economic and psychological implications of having a family member afflicted by cancer. Key challenges identified include lack of awareness and poor knowledge of cancer; late health seeking behavior; inadequate health insurance coverage and gaps in the benefit package which limit access to critical diagnostic tests, treatments and drugs; and socio-cultural barriers, including stigma, fear and myths that impede patients from seeking care early. The main themes from the patient stories and focus group discussions, including the economic impact on patients and households are summarized and a series of recommendations to mitigate the cost of cancer to patients and families are proposed based on the findings from the case studies.
Plos One, 2019
Background Sexual autonomy empowers women to set boundaries, take control of their bodies, preve... more Background
Sexual autonomy empowers women to set boundaries, take control of their bodies, prevent sexually transmitted diseases and avoid unplanned pregnancy. A woman’s ability to negotiate safer sex is crucial for her survival and that of her child. Sexual autonomy among East African women is vital to the elimination of the deaths of neonates, infants, and children. The aim of our study was to explore the association of sexual autonomy on neonatal, infant, and child mortality.
Methodology
This was a secondary analysis of demographic health survey (DHS) data on women of reproductive age (15–49 years) in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. Data on our outcome variables neonatal, infant, and under-five mortality which were in binary form was extracted from the database. Sexual autonomy was classified as a composite variable of “respondent can refuse sex,” “respondent can ask partner to use condom,” and “if spouse is justified in asking husband to use condom.” Other sociodemographic, maternal, health system and paternal variables were included in the analysis. STATA version 14 was used for analysis. Proportions and frequencies were used to describe the three outcome variables and sociodemographic characteristics. Chi-square tests were used to compare associations between sexual autonomy and categorical variables. Adjusted hazard ratios were used to determine the association between sexual autonomy and independent variables.
Results
The sampled women were predominantly urban (75%; n = 5758) and poor (48.7%; n = 3702). A majority of those that experienced mortality (neonatal mortality 53.5%, infant mortality 54.3%, under-five mortality 55.7%) were young (under 20) at the time of their first child’s birth while their male partners were older. The multivariate analysis supports the beneficial effects of women’s sexual autonomy in East Africa. Women who exercised sexual autonomy experienced significantly lower rates of child mortality at all three stages: neonatal (NHR = 0.80, 95% CI: 0.68–0.94, p = 0.006), infant (IHR = 0.82, 95% CI: 0.72–0.93, p = 0.003), and under-five (UHR = 0.84, 95% CI: 0.75–0.94, p = 0.002), net of all other factors. Receiving antenatal care and using contraceptives also contributed significantly to lower child mortality rates.
Conclusion
Our findings suggest that sexual autonomy among East African women is an urgent priority that is crucial to the survival of neonates, infants, and children in East Africa. Women should be informed, empowered, and autonomous concerning their reproductive and sexual health.
Background: Kenya’s Medical Supply Chain (MSC) has been described as suffering from a “multiplici... more Background: Kenya’s Medical Supply Chain (MSC) has been described as suffering from a “multiplicity of parallel procurement systems, a complexity full of inefficiency and lack of clarity and synergy” [1]. The general objective of this study was to review the performance of the public MSC’s planning, budgeting, procurement and distribution of drugs and supplies (D&S) with a view to establishing strengths, weaknesses and opportunities in the system.
Design: The study adopted a qualitative formative case study design. The study sought to explore all unknown variables that affect effective and efficient delivery of health commodities against need based on epidemiological and other relevant data in Kajiado. The investigation involved collection of primary data through interviews as well as review of secondary data. Data collection sources were then triangulated to form findings on common themes.
Results: A total of 80 respondents, 69 (86%) from 14 health facilities in Kajiado and 11 (14%) national level Ministry and Kenya Medical Supplies Agency (KEMSA) staff and Development Partners were interviewed for the study. The study illustrated that at the County level, the available MSC-related resources are not sufficient and/or consistently supplied and neither is resource allocation guided by demographic and epidemiological profiling. Moreover, the existing personnel are not sufficient or adequately trained in the areas of governance and management, key to maximising D&S resources. Lack of stewardship of the MSC in Kenya is the key deterrent to an efficient and effective system. Inefficient parallel MSC systems have also created what one respondent described as a circus of a system. Government officials reported that not enough was being done by the relevant authorities to streamline the systems.
Recommendations: To enhance delivery of D&S, the Government should lead, and engage stakeholders, in implementing governance reforms that address the (1) the health policy framework through integration and regulation of the parallel supply chain systems at national and County levels; at County level, there is an urgent need to train health officials if they are expected to maximise the resources allocated to them, (2) with the MSC human resource (HR), a paradigm shift in work allocation should be considered to have more administrators, qualified and continuously trained in supply chain issues, (3) MSC processes and operations could be
improved through cross-linkages of the Health Management Information System (HMIS) and a Logistics Management Information System (LMIS) that would allow automated access, analysis and monitoring of demographic, epidemiological and economic data to enhance information used for decision making in costing resource allocation; the health Ministries and KEMSA should also institute accountability mechanisms that facilitate customer responsiveness and (4) rational drug use could be improved through sensitisation targeting both medical practitioners and patients to maximise on the resources provided.
Background and objectives: This study presents findings on the acceptability and feasibility of a... more Background and objectives: This study presents findings
on the acceptability and feasibility of an integrated nutrition,
agriculture and health intervention that delivers vitamin A
rich, orange fleshed sweet potato (OFSP), through antenatal
care services (ANC) with the goal of improving the health and
nutrition of pregnant women and their infants in Western Kenya.
Methods: We explored the feasibility and acceptability of
the intervention through 42 interviews with nurses, community
health extension workers (CHEW), vine multiplers (VM),
agriculture extension agents and district-level officials; and
24 focus group discussions with community health workers
(CHW), pregnant women, and their husbands. Qualitative data
was transcribed verbatim and analysed using NVivo 10.0. Content analysis was used to identify key topics, relational analysis to examine relationships between themes and respondents.
Results: Enhanced maternal and child health coupled with
food security were the most recognized benefits by respondents. Mothers felt their children were less susceptible to disease and more energetic; they and their partners also valued OFSPs’ shorter maturity and higher yields. Frontline health workers perceived higher ANC attendance and increased contact between mothers, their partners and children with the
health system. All implementers were motivated by enhanced
training, more effective nutrition messaging, tangible recommendations to improve dietary quality, community recognition, and ability to better serve their clients. CHWs emerged as key facilitators of implementation and outreach to mothers.
Challenges to implementation and uptake included mothers’
distance to ANC and VMs, misperceptions such as OFSP having
contraceptive properties, need for continuous community
sensitization, and increased workload without commiserate remuneration for CHWs and VMs.
Conclusions: Perceived benefits and motivating factors
among key stakeholders outweighed challenges of integrating
OFSP with ANC services. These findings contribute to other
evaluation activities that assess effectiveness, feasibility and acceptability of this integrated agriculture and health intervention.
Background: Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained un... more Background: Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably high in a decade. In 2007, the Ministry of Public Health and Sanitation adopted a community health strategy to reverse the poor health outcomes in order to meet Millennium Development Goals 4 and 5. It aims at strengthening community participation and its ability to take action towards health. The study aimed at evaluating the effectiveness of the strategy in improving maternal and neonatal health outcomes in Kenya.
Methods: Between 2008 and 2010, the African Medical and Research Foundation implemented a community-based maternal and newborn care intervention package in Busia County using the community health strategy approach. An interventional, non-randomized pre-test post test study design was used to evaluate change in essential maternal and neonatal care practices among mothers with children aged 0 - 23 months.
Results: There was statistically significant (p<0.05) increase in attendance of at least four antenatal care visits (39% to 62%), deliveries by skilled birth attendants (31% to 57%), receiving intermittent preventive treatment (23% to 57%), testing for HIV during pregnancy (73% to 90%) and exclusive breastfeeding (20% to 52%).
Conclusion: The significant increase in essential maternal and neonatal care practices demonstrates that, community health strategy is an appropriate platform to deliver community based interventions. The findings will be used by actors in the child survival community to improve current approaches, policies and practice in maternal and neonatal care.
Background: Malaria is a leading cause of morbidity and mortality in children younger than 5 year... more Background: Malaria is a leading cause of morbidity and mortality in children younger than 5 years in Kenya.
Within the context of planning for a vaccine to be used alongside existing malaria control methods, this study
explores sociocultural and health communications issues among individuals who are responsible for or influence
decisions on childhood vaccination at the community level.
Methods: This qualitative study was conducted in two malaria-endemic regions of Kenya–South Coast and Busia.
Participant selection was purposive and criterion based. A total of 20 focus group discussions, 22 in-depth
interviews, and 18 exit interviews were conducted.
Results: Participants understand that malaria is a serious problem that no single tool can defeat. Communities
would welcome a malaria vaccine, although they would have questions and concerns about the intervention.
While support for local child immunization programs exists, limited understanding about vaccines and what they
do is evident among younger and older people, particularly men. Even as health care providers are frustrated
when parents do not have their children vaccinated, some parents have concerns about access to and the quality
of vaccination services. Some women, including older mothers and those less economically privileged, see
themselves as the focus of health workers’ negative comments associated with either their parenting choices or
their children’s appearance. In general, parents and caregivers weigh several factors–such as personal opportunity
costs, resource constraints, and perceived benefits–when deciding whether or not to have their children
vaccinated, and the decision often is influenced by a network of people, including community leaders and health
workers.
Conclusions: The study raises issues that should inform a communications strategy and guide policy decisions
within Kenya on eventual malaria vaccine introduction. Unlike the current practice, where health education on
child welfare and immunization focuses on women, the communications strategy should equally target men and
women in ways that are appropriate for each gender. It should involve influential community members and
provide needed information and reassurances about immunization. Efforts also should be made to address
concerns about the quality of immunization services–including health workers’ interpersonal communication skills.