Mothers In Kenya Research Articles

Corrigendum to “Perinatal care and breastfeeding education during the COVID‐19 pandemic: Perspectives from Kenyan mothers and healthcare workers”

Corrigendum to “Perinatal care and breastfeeding education during the COVID‐19 pandemic: Perspectives from Kenyan mothers and healthcare workers”

Sociodemographic predictors of parenting stress among mothers in socio-economically deprived settings in rural and urban Kenya and Zambia

Parental stress occurs when parenting demands exceed the resources available to cope with parenting. Previous research has identified household wealth, educational level, marital status, age, and number of dependent children as predictors of parental stress. However, limited evidence exists from sub-Saharan Africa. This study investigated the sociodemographic predictors of parenting stress among mothers in Kenya and Zambia. This cross-sectional study utilised baseline secondary data from parenting intervention programs implemented in Kisumu County (rural Kenya), Nairobi County (Urban Kenya), and Chisamba District (rural Zambia). Out of 913 caregivers recruited for the parenting program, 844 with complete data were included in the analysis. The mean age was 1.0 (SD = 0.7) years. Parental stress was measured using the Parental Stress Score (PSS) tool and demographic questionnaires were used to collect demographic information. Mean PSS were compared across study sites, and a multiple linear regression model was used to examine associations between sociodemographic predictors (household income, educational level, marital status, maternal age, child age, and number of children aged < 5 years) and PSS, adjusting for clustering and other predictors. From the results, the mean PSS in rural Kenya was 37.6 [SD = 11.8], in urban Kenya was 48.4 [SD = 4.2], and in rural Zambia was 43.0 [SD = 9.1]. In addition, the significant association between PSS and mothers’ income and educational level was only observed in Kenyan study sites (income: Kenya rural β = -0.40, p < 0.001**; Kenya urban, β = − 0.33, p = .02*; Zambia rural, β = − 0.01, p = 0.7) education: Kenya rural, β = − 0.25, p = .005**; Kenya urban, β = − 0.14, p = 0.07; Zambia rural, β = 0.04, p = 0.3). However, marital status, mother’s age, child’s age, and the number of children below five years were not associated with PSS. The results revealed that mothers’ income and education level were negatively associated with PSS, indicating that higher socioeconomic status can buffer the effects of parental stress.Trial registration Pan African Clinical Trials Registry (https://pactr.samrc.ac.za/) database (ID Number: PACTR20180774832663 Date: 26/July/2018; (ID number: PACTR201905787868050 Date: 06/May/2019.

Harnessing Kenyan Mothers Knowledge to Counter Violent Extremism: A Contribution to Feminist Philosophical Approaches

The capturing of the knowledge of Kenyan mothers can improve the effectiveness of countering violent extremism efforts. This is because African women possess power and agency within their societies that contributes to their knowledge. This paper analyses the knowledge and experience of mothers whose sons joined the al Shabaab violent extremist organisation in Somalia as a contribution to African feminist epistemology. It interrogates the epistemological representation of African women in violent extremism practice from a knowledge production perspective. The paper explores the contribution of mothers of al-Shabaab recruits to African feminist epistemology on approaches to address violent extremism. Through an African feminist narratological approach, the paper contributes to the reclamation of African women’s place in knowledge production. The paper coins an African feminist grounded theory, ‘Nafsi African feminism’ that denotes that African women’s knowledge is based on a convergence of their power and vulnerabilities borne out of their lived experiences. Through its study findings, utilising the NVivo data analysis software to thematise, the paper reveals that the knowledge of mothers of al Shabaab recruits touches on institutions, processes, structures, and systems including sociology, political science, education, religion, and health. The paper concludes by calling for the reclamation and capturing of African feminist epistemology to contribute to a holistic and effective approach to addressing violent extremism.

Digital media and maternal healthcare among young women in Kenya: Use, patterns, and perspectives

This study aimed to examine the relationship between digital media use and maternal health care utilization among young pregnant mothers in Kenya. Using a mixed methods approach combining questionnaires and focus group discussions (FGDs), data were collected from pregnant women and new mothers aged 19–35 years in Nairobi. Using Microsoft Excel Data Analysis ToolPak Ver. 2016, primary data were statistically analyzed, while FGD data were subjected to thematic analysis and narrative interpretation. Findings revealed that 88% of participants preferred internet searches for information, 92% used different digital media during pregnancy, 56% used pregnancy apps, and 9% abstained from digital media for maternal health information. The study concludes that, in addition to the continued importance of traditional sources of information, digital media have a significant impact on the use of maternal health services. It recommends that health care providers actively usedigital media, especially apps, as educational tools to disseminate reliable information to young pregnant women and new mothers in Kenya. It also recommends that planners and policymakers incorporate digital media into maternal health interventions to increase their effectiveness.

Using bottom-up evaluation to build community practice-based evidence and strengthen community-engaged research

ABSTRACT Non-governmental organizations (NGOs) play a critical role in mitigating social problems by creating innovative interventions to address unmet community needs, particularly in low- and middle-income countries. These community-generated interventions are rarely evaluated or recognized within the prevention science lexicon that informs evidence-based practice, but bottom-up evaluation (BUE) offers researchers an approach to help reverse this trend. This paper illustrates BUE processes using evaluation of an NGO-created intervention for HIV-positive single mothers in Kenya as a case example. The participatory BUE study involved three phases: (1) viability assessment via qualitative participant interviews; (2) evaluation preparation and NGO capacity-building; and (3) effectiveness evaluation. Qualitative interview data revealed 24 intervention outcomes most impactful to participants’ lives and confirmed intervention viability. Participatory mapping identified key program outcomes for inclusion in the evaluation instrument, which was developed collaboratively with program staff. Effectiveness evaluation findings suggest that the intervention improved the health, psychosocial wellbeing, and economic security of single mothers facing the dual challenges of HIV/AIDS and extreme poverty. As illustrated in this study, bottom-up evaluation offers social work researchers an approach that can center voices of intervention participants, build community practice-based evidence, and strengthen community-engaged research in alignment with social work priorities and values.

A Case Control Study to Assess Factors Associated with HIV Mother to Child Transmission in Kenya

Background: With the proposal that people with undetectable serum viral loads of HIV cannot transmit, there is a large gap, either due to viral discordance or transcytosis, that would be explaining the persistent 4 to 7 percent vertical transmission of HIV to infants by Kenyan mothers. Therefore, we looked for factors that predispose mothers with HIV to transmit the disease to their children so that policy can be generated for their screening to be conducted if they fit the specified criteria that identifies them as a high-risk group. Methods: Through access to the National Database providing HIV treatment services country wide, we looked for the presence of the available factors from MTCT cases and assessed their association with increased risk of vertical transmission. The factors assessed were mother’s blood plasma viral load (BPVL), geographic location of the mother and child (associated with specific higher and lower socioeconomic status), gender of the baby being born, time age after birth with confirmation of Mother to Child Transmission (MTCT), method of feeding chosen by mothers, age of the mothers, and the regimen of Highly Active Anti Retro Viral treatment (HAART) that the mother and child had been given. Results: Mixed breast feeding posed a much higher risk, mothers of a younger age posed a higher risk, residents of some areas were at higher risks, of note the town of Lamu in Kenya. The at birth stat administration of Niverapin with Zidovudin (NVP+AZT) to the baby was very effective against the transmission, in comparison to any of the other interventions, and having an UD BPVL led to a six-fold reduction the risk of MTCT. Conclusion: There are factors that are associated with a higher risk of vertical transmission from pregnant and lactating UD BPVL mothers which warrant implementation of more stringent policy in their case to achieve Elimination of MTCT(EMTCT) in Kenya. Other factors that were not in the available records and the ones found to have an impact need to be investigated with more accuracy through a prospective study.

A Continual Pre-training Approach to Tele-Triaging Pregnant Women in Kenya

Access to high-quality maternal health care services is limited in Kenya, which resulted in ∼36,000 maternal and neonatal deaths in 2018. To tackle this challenge, Jacaranda Health (a non-profit organization working on maternal health in Kenya) developed PROMPTS, an SMS based tele-triage system for pregnant and puerperal women, which has more than 350,000 active users in Kenya. PROMPTS empowers pregnant women living far away from doctors and hospitals to send SMS messages to get quick answers (through human helpdesk agents) to questions about their medical symptoms and pregnancy status. Unfortunately, ∼1.1 million SMS messages are received by PROMPTS every month, which makes it challenging for helpdesk agents to ensure that these messages can be interpreted correctly and evaluated by their level of emergency to ensure timely responses and/or treatments for women in need. This paper reports on a collaborative effort with Jacaranda Health to develop a state-of-the-art natural language processing (NLP) framework, TRIM-AI (TRIage for Mothers using AI), which can automatically predict the emergency level (or severity of medical condition) of a pregnant mother based on the content of their SMS messages. TRIM-AI leverages recent advances in multi-lingual pre-training and continual pre-training to tackle code-mixed SMS messages (between English and Swahili), and achieves a weighted F1 score of 0.774 on real-world datasets. TRIM-AI has been successfully deployed in the field since June 2022, and is being used by Jacaranda Health to prioritize the provision of services and care to pregnant women with the most critical medical conditions. Our preliminary A/B tests in the field show that TRIM-AI is ∼17% more accurate at predicting high-risk medical conditions from SMS messages sent by pregnant Kenyan mothers, which reduces the helpdesk’s workload by ∼12%.

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers.

The impact of the COVID-19 pandemic on breastfeeding (BF) practices in low- and middle-income countries (LMICs) is not well understood.Modifications in BF guidelines and delivery platforms for breastfeeding education during the COVID-19 pandemic are hypothesised to have affected BF practices. We aimed to understand the experiences with perinatal care, BF educationand practice among Kenyan mothers who delivered infants during the COVID-19 pandemic.We conducted in-depth key informant interviews with 45 mothers who delivered infants between March 2020 and December 2021, and 26 health care workers (HCW) from four health facilities in Naivasha, Kenya.While mothers noted that HCWs provided quality care and BF counselling, individual BF counselling was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID-19 safety protocols. Mothers stated that some HCW messages emphasised the immunologic importance of BF. However, knowledge among mothers about the safety of BF in the context of COVID-19 was limited, with few participants reporting specific counselling or educational materials on topics such as COVID-19 transmission through human milk and the safety of nursing during a COVID-19 infection. Mothers described COVID-19-related income loss and lack of support from family and friends as the major challenge to practising exclusive breastfeeding (EBF) as they wished or planned. COVID-19 restrictions limited or prevented mothers' access to familial support at facilities and at home, causing them stress and fatigue. In some cases, mothers reported job loss, time spent seeking new means of employmentand food insecurity as causes for milk insufficiency, which contributed to mixed feeding before 6 months.The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages about the importance of practising EBF were provided, altered HCW education delivery methods, reduced social supportand food insecurity limit EBF practices for mothers in this context.

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers

A role for worm cutl-24 in background- and parent-of-origin-dependent ER stress resistance

BackgroundOrganisms in the wild can acquire disease- and stress-resistance traits that outstrip the programs endogenous to humans. Finding the molecular basis of such natural resistance characters is a key goal of evolutionary genetics. Standard statistical-genetic methods toward this end can perform poorly in organismal systems that lack high rates of meiotic recombination, like Caenorhabditis worms.ResultsHere we discovered unique ER stress resistance in a wild Kenyan C. elegans isolate, which in inter-strain crosses was passed by hermaphrodite mothers to hybrid offspring. We developed an unbiased version of the reciprocal hemizygosity test, RH-seq, to explore the genetics of this parent-of-origin-dependent phenotype. Among top-scoring gene candidates from a partial-coverage RH-seq screen, we focused on the neuronally-expressed, cuticlin-like gene cutl-24 for validation. In gene-disruption and controlled crossing experiments, we found that cutl-24 was required in Kenyan hermaphrodite mothers for ER stress tolerance in their inter-strain hybrid offspring; cutl-24 was also a contributor to the trait in purebred backgrounds.ConclusionsThese data establish the Kenyan strain allele of cutl-24 as a determinant of a natural stress-resistant state, and they set a precedent for the dissection of natural trait diversity in invertebrate animals without the need for a panel of meiotic recombinants.

Access to Workplace Supports is Positively Associated with Exclusive Breastfeeding among Formally Employed Mothers in Kenya

Mothers in low-income settings who work in agricultural employment are challenged to meet breastfeeding (BF) recommendations. Recent legislation in Kenya mandates maternity leave and workplace supports, yet the relation of these benefits with BF practices is poorly understood. We evaluated the associations with workplace-provided BF supports and BF practices among formally employed mothers in Kenya. The availability of supports was hypothesized to be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). We conducted repeated cross-sectional surveys among formally employed mothers at 1-4 d and 6, 14, and 36 wk (to estimate 24 wk) postpartum in Naivasha, Kenya. We used logistic regression adjusted for maternal age, education, physical burden of work, HIV status, and income to evaluate associations between workplace supports and EBF practices. Among formally employed mothers (n=564), those who used onsite workplace childcare were more likely to practice EBF than those who used community- or home-based childcare at both 6 wk (95.7% compared with 82.4%, P=0.030) and 14 wk (60.6% compared with 22.2%, P<0.001; adjusted OR: 5.11; 95% CI: 2.3, 11.7). Likewise, at 14 wk among mothers who currently used daycare centers, a higher proportion of mothers who visited daycare centers at or near workplaces practiced EBF (70.0%) than of those not visiting daycare centers (34.7%, P=0.005). EBF prevalence was higher among mothers with access to workplace private lactation spaces than among mothers without such spaces (84.6%compared with 55.6%, P=0.037), and among mothers who lived in workplace housing than those without onsite housing (adjusted OR: 2.06, 95% CI: 1.25, 3.41). Formally employed mothers in Kenya who have access to and use workplace-provided BF supports were more likely to practice EBF than mothers who lacked these supports. As the Kenya Health Act is implemented, lactation rooms, onsite housing and daycare, and transportation to visit children can all support BF and EBF among employed mothers.

Reconstructing the Traditional Roles of Contemporary Muslim Mothers in Kenya

There is a constant struggle for women who aspire to be good Muslim mothers at the same time have a positive impact on their society as professionals. These women do acknowledge and understand their unique position in the upbringing of children and prioritise motherhood responsibility over their other ambitions in life. There are those who prioritise their education and career over motherhood and others believe that Muslim women are not ideally supposed to be working outside the house. The Muslim society is experiencing all types of impurities ranging from drug addiction, corruption, homosexuality, lesbianism, alcoholism, homicides, and mass poverty to destitution. Could this be as a result of Muslim women going out to work and delegating their responsibility at home? Or how can they make the best out of their position at home as mothers and outside as professionals to help change society? In what ways can they balance and get out of their stereotypical roles and contribute positively to the wellbeing of the whole society? This article will discuss motherhood institutions from the daily experiences of mothers; homestay, working, older, and the modern generation. It will also try to find out whether they can balance being a mother and a career person and what impact this will have on Muslim society

Maintaining Continuity of Care for Expectant Mothers in Kenya During the COVID-19 Pandemic: A Study of MomCare.

In Kenya, early coronavirus disease (COVID-19) modeling studies predicted that disruptions in antenatal care and hospital services could increase indirect maternal and neonatal deaths and stillbirths. As the Kenyan government enforced lockdowns and a curfew, many mothers-to-be were unable to safely reach hospital facilities, especially at night. Fear of contracting COVID-19, increasing costs of accessing care, stigma, and falling incomes forced many expectant mothers to give birth at home. MomCare, which primarily serves communities in remote areas and urban slums, links mothers-to-be with payers and health care providers, following a standardized pregnancy program based on World Health Organization guidelines at a predetermined cost and quality. Expectant mothers gain access to care through a mobile wallet on their feature phone (voice, text, and basic internet), and providers are paid after appropriate care is given. Within the first 3 weeks of the pandemic in Kenya, the following services were added to the MomCare bundle: emergency ambulance services during curfew hours, extended bed allowances to encourage early care, phone calls to check on mothers approaching their delivery dates and to promote the generation of a birth plan, SMS messages to inform mothers of open facilities and COVID-19 protocols, and training for clinic staff in managing COVID-19 patients and infection prevention. We compare data collected through the MomCare platform during the 6 months before the first confirmed COVID-19 case in Kenya (September 2019-February 2020) with data collected during the 6 months that followed. This study shows that care-seeking behaviors (enrollment, antenatal/postnatal care, skilled deliveries) increased for mothers-to-be enrolled in MomCare during the COVID-19 lockdowns, while quality of care and outcomes were maintained. Public health practitioners can promote interactive, patient-driven technology like MomCare to augment traditional responses, quickly linking payments with patients and providers in times of crisis.

Characterizing the extent human milk folate is buffered against maternal malnutrition and infection in drought‐stricken northern Kenya

AbstractObjectivesFolate is an essential nutrient fundamental to human growth and development. Human milk maintains high folate content across the maternal folate status range, suggesting buffering of milk folate with prioritized delivery to milk at the expense of maternal depletion. We investigated whether and how the extent of this buffering may diminish under prolonged nutritional and/or disease stress, while taking into consideration infants' varying vulnerability to malnutrition‐related morbidity/mortality.MethodsA cross‐sectional study analyzed milk specimens from northern Kenyan mothers (n = 203), surveyed during a historic drought and ensuing food shortage. Multiple regression models for folate receptor‐α (FOLR1) in milk were constructed. Predictors included maternal underweight (BMI &lt; 18.5), iron‐deficiency anemia (hemoglobin &lt;12 g/dl and dried‐blood‐spot transferrin receptor &gt;5 mg/L), folate deficiency (hyperhomocysteinemia, homocysteine &gt;12 or 14 μmol/L), inflammation (serum C‐reactive protein &gt;5 mg/L), infant age and sex, and mother‐infant interactions.ResultsIn adjusted models, milk FOLR1 was unassociated with maternal underweight, iron‐deficiency anemia and inflammation. FOLR1 was positively associated with maternal folate deficiency, and inversely associated with infant age. There was interaction between infant age and maternal underweight, and between infant sex and maternal folate deficiency, predicting complex changes in FOLR1.ConclusionsOur results suggest that mothers buffer milk folate against their own nutritional stress even during a prolonged drought; however, the extent of this buffering may vary with infant age, and, among folate‐deficient mothers, with infant sex. Future research is needed to better understand this variability in maternal buffering of milk folate and how it relates to folate status in nursing infants.

Distinct Antibody Responses to Endemic Coronaviruses Pre- and Post-SARS-CoV-2 Infection in Kenyan Infants and Mothers.

Pre-existing antibodies that bind endemic human coronaviruses (eHCoVs) can cross-react with SARS-CoV-2, which is the betacoronavirus that causes COVID-19, but whether these responses influence SARS-CoV-2 infection is still under investigation and is particularly understudied in infants. In this study, we measured eHCoV and SARS-CoV-1 IgG antibody titers before and after SARS-CoV-2 seroconversion in a cohort of Kenyan women and their infants. Pre-existing eHCoV antibody binding titers were not consistently associated with SARS-CoV-2 seroconversion in infants or mothers; however, we observed a very modest association between pre-existing HCoV-229E antibody levels and a lack of SARS-CoV-2 seroconversion in the infants. After seroconversion to SARS-CoV-2, antibody binding titers to the endemic betacoronaviruses HCoV-OC43 and HCoV-HKU1, and the highly pathogenic betacoronavirus SARS-CoV-1, but not the endemic alphacoronaviruses HCoV-229E and HCoV-NL63, increased in the mothers. However, eHCoV antibody levels did not increase following SARS-CoV-2 seroconversion in the infants, suggesting the increase seen in the mothers was not simply due to cross-reactivity to naively generated SARS-CoV-2 antibodies. In contrast, the levels of antibodies that could bind SARS-CoV-1 increased after SARS-CoV-2 seroconversion in both the mothers and infants, both of whom were unlikely to have had a prior SARS-CoV-1 infection, supporting prior findings that SARS-CoV-2 responses cross-react with SARS-CoV-1. In summary, we found evidence of increased eHCoV antibody levels following SARS-CoV-2 seroconversion in the mothers but not the infants, suggesting eHCoV responses can be boosted by SARS-CoV-2 infection when a prior memory response has been established, and that pre-existing cross-reactive antibodies are not strongly associated with SARS-CoV-2 infection risk in mothers or infants.

Analysis of the Effects of the Home Environment Systems on Secondary School Re-Admission among Student Mothers in Marani Sub-County, Kisii County, Kenya

The challenges of motherhood coupled with the coming of new roles and identities for student mothers remain pervasive and have conspired to continue constraining girls from participating in education. The consequences of becoming pregnant are many. The study explored the extent to which student-mothers receive emotional and social support both at home and at school in adjusting and coping with their dual roles as mothers and students. The study was conducted at Marani Sub-County of Kisii County. The study employed a descriptive survey design and the target population was 779, while the sample size was 234. The stratified sampling technique was used to select the school teenage mothers, while the census method was applied for both principals and teacher counsellors since they were few. Pilot testing of the research instruments was undertaken to ascertain both validity and reliability so as to guard against the threats of ambiguities and biases. This was done by subjecting the instruments to subject matter experts as well as trying them out within field conditions. Reliability was ascertained via the test-retest method. Data were collected from respondents by the use of special designed questionnaires and interview schedules. The information obtained was analysed by the use of descriptive statistics such as counting frequencies and mean. Qualitative data for teacher counsellors were analysed using the themes method. Data were presented in tables and figures. The process by which data was analysed started with coding, scoring, and screening for errors. Then data were entered into the SPSS program, after which data exploration and cleaning were done before starting to mine information. This is because the accuracy of any conclusions depends on the accuracy of the data to yield inferences. The findings of the study indicated that the home and school environments, as well as emotional support, were influencing secondary school re-entry among student mothers in Kenya. Further, the study shows student mothers can be motivated to re-join school to improve their future life. The research therefore recommended that the government and other stakeholders need to put psychosocial systems in place for the readmission of secondary school student mothers so as to put their livelihood back on track.

Nutrient-Dense Moringa oleifera Leaf Supplementation Increases Human Milk Output in Western Kenyan Mothers

ObjectivesWe aim to evaluate the impact of moringa leaf powder on maternal and infant nutrition, milk output, and intestinal health.MethodsThis was a single-blinded cluster-randomized controlled trial of 20g of moringa in corn porridge versus porridge alone taken daily for 3 months by exclusively breastfeeding women of term infants (>36 weeks gestational age) enrolled within 30 days of birth in Kisumu, Kenya. At enrollment and exit, we collected 24-hour pumped milk output, milk, maternal and infant fecal and capillary samples, and Hemoglobin by HemoCue©. We performed monthly infant and maternal anthropometrics. We will perform biosample analysis for markers of vitamin A and iron status, IGF-1, and inflammatory markers; milk/fecal microbiome; milk composition; and intestinal inflammation/markers of environmental enteric dysfunction. Data is analyzed via IBM SPSS v.27 with univariate and multivariate analysis for primary and secondary outcomes.ResultsN = 50 mother-infant pairs (infants 44% female). Most infants were appropriate for gestational age (GA) (27, 54%) with 19 (38%) large for GA and 1 small for GA. Mothers’ were initially 14% wasted (MUAC < 23cm), with MUAC 26.2 ± 2.7cm overall, n = 49. Wasting resolved in all. Maternal 24-hour milk output did not differ at enrollment between clusters (502.5,303.8–896.3, n = 24 vs. 525.0,363.8–693.8 mL, n = 24; p = 1.0) but did increase dramatically at exit in the cluster receiving moringa (control: 648.81 ± 324.1, n = 21 vs. intervention: 981.09 ± 368.3 mL, n = 23; p = 0.003). Infant growth (average daily weight gain, total weight gain, WLZ, WAZ, or LAZ) and maternal MUAC and BMI did not differ between clusters at enrollment or exit. Maternal and infant hemoglobin (hgb) did not differ between clusters at enrollment; maternal anemia (hgb < 11 g/dL) trended higher in the control at enrollment (40% vs. 12.5%, n = 49, p = 0.05); at exit this difference resolved. Infant hgb was higher at exit in the intervention group (11.3 ± 0.8 vs. 10.7 ± 1.0, p = 0.02). No participants experienced adverse effects.Conclusions20g daily moringa leaf powder for three months increases maternal milk output but has no impact on growth in a sample of Kenyan infants and mothers with a low rate of initial undernutrition.Funding SourcesThis research was funded by an NIH K award and an NIH BIRCWH Award as well as early investigator startup funds from the University of Kentucky.

Preliminary Effectiveness of Group Interpersonal Psychotherapy for Young Kenyan Mothers With HIV and Depression: A Pilot Trial.

The authors adopted a task-sharing strategy in which lay health workers delivered group interpersonal psychotherapy (IPT-G) in primary care clinics in Nairobi, Kenya, to young mothers with HIV and depression. The study examined the acceptability, feasibility, and effectiveness of IPT-G in improving depression and antiretroviral therapy adherence. Twenty-four mothers (ages 18-24 years and 6-12 weeks postpartum) participated. The women were randomly assigned to IPT-G or to a waitlist. Eight lay providers administered the IPT-G sessions across 8 weeks. The primary outcome was pre- to postintervention change in depression scores as measured on the Edinburgh Postnatal Depression Scale. The secondary outcome was antiretroviral therapy adherence. All waitlist participants subsequently received the intervention, and a secondary outcome, within-group analysis, was conducted and included those participants. Participants' median age was 23.0 years, 17 (71%) lived with a partner, and 19 (79%) had fewer than two children. The intervention group had a mean±SD depression score of 15.9±4.3 at baseline and 6.8±7.0 postintervention. For the waitlist control group, the mean score was 17.3±5.9 at baseline and 13.2±6.6 at the first follow-up. Waitlist participants had significantly greater mean depression scores than did intervention group participants at the first follow-up (after the intervention group's 8-week IPT-G) (β=6.42, 95% confidence interval=1.17 to 11.66, p=0.017). No difference was observed between groups in antiretroviral therapy adherence. This study provides preliminary evidence that IPT-G led by community health workers may have benefits for postpartum depression among young mothers with HIV.

Treatment of maternal depression in low‐income women: A feasibility study from Kilifi, Kenya

To test the feasibility and acceptability of a group psychosocial intervention called Learning Through Play (LTP) plus Culturally adapted Cognitive Behaviour Therapy (CaCBT) for depressed Kenyan mothers with children aged 0-36months. This study was a single-arm mixed methods feasibility study to test an integrated parenting intervention for postnatal depression in a low-income rural area of Fumbini village in Kilifi District of Kenya. Women between the ages of 18 and 45years with children up to 3years were screened for depression using the Patient Health Questionnaire (PHQ-9). Those scoring above 10 on PHQ-9 were interviewed using the Revised Clinical Interview Schedule (CIS-R) to confirm the diagnosis of depression. Assessments were carried out at baseline and at the end of the intervention (3months), followed by qualitative interviews with 12 women. Qualitative interviews were analysed using thematic analysis from a socio-constructionist theoretical lens. The LTP Plus was both feasible and acceptable with high satisfaction among the participants. Qualitative results showed that the women perceived the intervention as beneficial in reducing the symptoms of depression, coping with stress and negative emotions. The results also indicated a reduction in scores on PHQ-9, GAD-7 with an increase in perceived social support, health-related quality of life and an improvement in mothers' knowledge about child development at the end of the intervention. This study represents the first feasibility research on integrated parenting intervention in Kenya. The results indicated that culturally adapted LTP plus CaCBT is feasible and acceptable in a low-income setting of Kenya. There is now a need to study the clinical and cost-effectiveness of LTP plus CaCBT in an appropriately powered larger randomised control trial, with a longer follow-up period.

Change in Caregivers' Attitudes and Use of Corporal Punishment Following a Legal Ban: A Multi-Country Longitudinal Comparison.

We examined whether a policy banning corporal punishment enacted in Kenya in 2010 is associated with changes in Kenyan caregivers' use of corporal punishment and beliefs in its effectiveness and normativeness, and compared to caregivers in six countries without bans in the same period. Using a longitudinal study with six waves of panel data (2008-2016), mothers (N = 1086) in Colombia, Italy, Jordan, Kenya, Philippines, Thailand, and United States reported household use of corporal punishment and beliefs about its effectiveness and normativeness. Random intercept models and multi-group piecewise growth curve models indicated that the proportion of corporal punishment behaviors used by the Kenyan caregivers decreased post-ban at a significantly different rate compared to the caregivers in other countries in the same period. Beliefs of effectiveness of corporal punishment were declining among the caregivers in all sites, whereas the Kenyan mothers reported increasing perceptions of normativeness of corporal punishment post-ban, different from the other sites. While other contributing factors cannot be ruled out, our natural experiment suggests that corporal punishment decreased after a national ban, a shift that was not evident in sites without bans in the same period.