Urban Setting In Kenya Research Articles

Comparative Analysis of Avian Malaria Prevalence in Rural Vs. Urban Settings in Kenya

Purpose: To aim of the study was to analyze the comparative analysis of avian malaria prevalence in rural vs. urban settings in Kenya. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study found that avian malaria was more prevalent in urban areas, likely due to higher mosquito populations and altered land use patterns that facilitate vector breeding. In contrast, rural areas exhibited lower prevalence, attributed to more extensive natural habitats that support diverse bird species and reduce mosquito density. Additionally, environmental factors such as temperature and humidity were found to play crucial roles in disease transmission, with urban settings experiencing more favorable conditions for mosquito proliferation. Unique Contribution to Theory, Practice and Policy: Ecological niche theory, urban heat island effect & environmental determinants of health theory may be used to anchor future studies on comparative analysis of avian malaria prevalence in rural vs. urban settings in Kenya. Implement targeted vector control measures in urban areas to reduce mosquito breeding sites and manage environmental factors contributing to higher avian malaria prevalence. Formulate and implement policies that address the intersection of urbanization and wildlife health.

Determinants of diarrheal disease in children undergoing complementary feeding in a low-income urban setting in Kenya.

This study aimed to identify and characterise the determinants influencing the occurrence of diarrheal diseases in children aged 6-24 months undergoing complementary feeding within a low-income urban community in Kenya. This study followed a cross-sectional design and recruited caregivers of children aged 6-24 months from 302 households. The dependent variable was the 2-week diarrhoea prevalence among children, with independent variables including sociodemographic characteristics, child immunisation and feeding status, and water and sanitation facilities. Data analysis was performed using SPSS. Descriptive statistics and logistic regression analyses were used to assess associations between independent variables and the occurrence of diarrheal diseases. The majority of caregivers were female (n = 282, 93.4%), aged 25-34 years (n = 156, 51.7%), had attained secondary school education (n = 154, 51%), were unemployed (n = 162, 53.6%), and earned Ksh 10,000 (USD 100) or less. 296 (98%) indexed children were fully vaccinated against rotavirus. Most households used improved drinking water sources (n = 272, 90.1%). Most caregivers did not regularly wash their hands with soap and water (n = 225, 74.5%). The 2-week diarrhoea prevalence among children was 34.1% (103/302), with 69.9% (72/103) of these cases seeking care at a healthcare facility. Logistic regression analysis revealed that children of caregivers earning Ksh 20,000 and below (aOR = 2.9[1.3-6.5], p = 0.01), and those from households using unimproved sanitation facilities (aOR = 1.9 [CI 1-3.4], p = 0.042), had significantly higher odds of having diarrhoea. The study found a high prevalence of diarrhoea in Kenyan children aged 6-24 months, with caregiver income and household sanitation facilities significantly impacting the occurrence of the disease. The study suggests integrated approaches, including education, income generation, hygiene, and improved nutrition, to address the burden of diarrheal disease.

Enabling Adherence to Treatment (EAT): a pilot study of a combination intervention to improve HIV treatment outcomes among street-connected individuals in western Kenya

BackgroundStreet-connected individuals (SCI) in Kenya experience barriers to accessing HIV care. This pilot study provides proof-of-concept for Enabling Adherence to Treatment (EAT), a combination intervention providing modified directly observed therapy (mDOT), daily meals, and peer navigation services to SCI living with HIV or requiring therapy for other conditions (e.g. tuberculosis). The goal of the EAT intervention was to improve engagement in HIV care and viral suppression among SCI living with HIV in an urban setting in Kenya.MethodsThis pilot study used a single group, pre/post-test design, and enrolled a convenience sample of self-identified SCI of any age. Participants were able to access free hot meals, peer navigation services, and mDOT 6 days per week. We carried out descriptive statistics to characterize participants’ engagement in EAT and HIV treatment outcomes. We used McNemar’s chi-square test to calculate unadjusted differences in HIV outcomes pre- and post-intervention among participants enrolled in HIV care prior to EAT. We compared unadjusted time to initiation of antiretroviral therapy (ART) and first episode of viral load (VL) suppression among participants enrolled in HIV care prior to EAT vs. concurrently with EAT using the Wilcoxon rank sum test. Statistical significance was defined as p < 0.05. We calculated total, fixed, and variable costs of the intervention.ResultsBetween July 2018 and February 2020, EAT enrolled 87 participants: 46 (53%) female and 75 (86%) living with HIV. At baseline, 60 out of 75 participants living with HIV (80%) had previously enrolled in HIV care. Out of 60, 56 (93%) had initiated ART, 44 (73%) were active in care, and 25 (42%) were virally suppressed (VL < 1000 copies/mL) at their last VL measure in the 19 months before EAT. After 19 months of follow-up, all 75 participants living with HIV had enrolled in HIV care and initiated ART, 65 (87%) were active in care, and 44 (59%) were virally suppressed at their last VL measure. Among the participants who were enrolled in HIV care before EAT, there was a significant increase in the proportion who were active in HIV care and virally suppressed at their last VL measure during EAT enrollment compared to before EAT enrollment. Participants who enrolled in HIV care concurrently with EAT had a significantly shorter time to initiation of ART and first episode of viral suppression compared to participants who enrolled in HIV care prior to EAT. The total cost of the intervention over 19 months was USD $57,448.64. Fixed costs were USD $3623.04 and variable costs were USD $63.75/month/participant.ConclusionsThis pilot study provided proof of concept that EAT, a combination intervention providing mDOT, food, and peer navigation services, was feasible to implement and may support engagement in HIV care and achievement of viral suppression among SCI living with HIV in an urban setting in Kenya. Future work should focus on controlled trials of EAT, assessments of feasibility in other contexts, and cost-effectiveness studies.

Sociolinguistic Competence of a Trilingual at Age Five

Being Trilingual is no longer a strange phenomenon as it may have been sometime back. In fact, in urban settings in Kenya, children are learning English as a third language (L3) rather than a second language (L2). Canale and Swain (1980) propose that communicative competence comprises four language competencies, namely: Linguistic, Sociolinguistic, Strategic, and Discourse competencies Of concern in this study is the sociolinguistic competence of trilingual children at age five. Purposive sampling and snowballing were used to select six children: three boys and three girls. Data were collected through a conversational technique where the children were prompted to express themselves in three languages: English, Kiswahili, and their Mother Tongue. It was found that the children exhibited three main sociolinguistic competencies: code-mixing, use of colloquial Kiswahili, and use of politeness forms. Lexical code-mixing was the commonest and the children code-mixed two languages in their utterances. The findings of this study reveal that Kenyan children are on the path of trilingualism at age five, and it affirms the current language in education policy, which encourages the use of three languages at different levels of education. These findings are relevant to language policymakers today and in the future.

Carotid intima media thickness (CIMT) in adults in the AWI-Gen Nairobi site study: Profiles and predictors

BackgroundCarotid intima media thickness (CIMT) is used as a marker of subclinical and asymptomatic atherosclerotic vascular disease. Increased CIMT is associated with future cerebrovascular and cardiovascular events. There is limited data on the profile and correlates of CIMT in Africa. The aim of this study was to describe the profile and correlates of CIMT in apparently normal younger-age adults in an urban setting in Kenya. MethodsThis study used population-based data collected from 2003 adults between the ages of 40 and 60 years in two slums of Nairobi as part of a genetic study. CIMT was measured using LOGIQ e (GE Healthcare, CT, USA) ultrasound on both left and right carotid arteries, whereby maximum, mean, and minimum values were recorded. Age- and sex-specific CIMT measurements were calculated and their association with basic sociodemographic, behavioral and body composition indicators were investigated. ResultsThe median (IQR) CIMT were 0.58 (0.51, 0.66) and 0.59 (0.53, 0.66) in men and women, respectively. About 16% of the study population had CIMT greater than 0.7mm, the cut off for higher CIMT. Nearly 60% had CIMT values ≥75th percentile. Age, current use of alcohol, systolic blood pressure, subcutaneous fat thickness, pulse rate and pulse pressure were found to be the main predictors of CIMT in our study population. ConclusionThis study provided population-based reference values and predictors for CIMT for an adult population living in urban poor settings in Kenya. Future studies need to consider biochemical and genetic predictors of CIMT in this population.

Patterns and predictors of elevated blood pressure and hypertension among primary school children in urban Kenya.

We examined the prevalence of elevated blood pressure (BP) and hypertension among 390 primary school children of different socioeconomic status (SES) in two urban settings in Kenya and explored the association between children's BP status and their sociodemographic characteristics, dietary behaviours and overweight/obesity status. Children's BP and anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on the children's dietary behaviours. An average of three BP readings was used to calculate BP percentiles by age, sex and height. BMI-for-age z-scores, waist-circumference-to-height ratio and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between BP and sociodemographic characteristics, dietary behaviours and overweight/obesity. About 9% of the school children had elevated BP and 33% had stage 1 hypertension. Among overweight children, the proportion of children with elevated BP was 1.85-fold greater and the proportion of children with hypertension was 1.83-fold greater compared with children with healthy body weight. Similar patterns of significant associations were seen among obese children, children with central obesity and children with high total skinfold values. The proportion of children with hypertension was 1.42-fold greater among children with high frequency of consumption of chips/crisps compared with children with lower frequency of consumption. These results increase our understanding BP patterns and determinants among school children in Kenya and can help inform noncommunicable disease prevention efforts.

Patterns and Predictors of Elevated Blood Pressure Among Primary School Children in Two Urban Settings in Kenya

ObjectivesWe conducted a cross-sectional study to examine the prevalence of elevated blood pressure (BP) among primary school children of different socio-economic status in two urban settings in Kenya and explored the association between elevated BP and children’s dietary behaviors and overweight/obesity status. MethodsThe research study was conducted in Nairobi and Kisumu cities in Kenya. Three public schools, catering to children from households at low, medium and high socio-economic status were purposively selected to participate in the study in each city. Data was collected among children within the ages of 10–12 years enrolled in grades 4–6 at each school. Certified clinicians read children’s BP readings using an aneroid sphygmomanometer and age-appropriate child BP cuffs. Trained enumerators measured children’s weights, heights, waist circumferences and skinfolds. We calculated children’s BP percentiles, BMI-for-age percentiles, waist circumference-for-height ratio (WHtR) and total skinfold values as recommended. Parents, with the help of their respective children, completed questionnaires on children’s consumption of fruits, vegetables, red meats and processed meats, fries/crisps, fried/baked wheat products, confectioneries and beverages. Complete data were available for 390 children. We utilized prevalence ratio regression analysis to examine the association between children’s BP and dietary practices and obesity. ResultsOver, 20% of the school children had pre-hypertension and 14% had hypertension, giving an overall elevated BP prevalence of 34%. Overweight and obese children were significantly more likely to have elevated BP and hypertension compared to children with healthy BMI-for-age percentiles. Children with WHtR > 0.5 and children with high total skinfold values were significantly more likely to have elevated BP and hypertension compared to children with lower waist circumference and skinfold values. Children who consumed high amounts of fries/crisps were significantly more likely to have elevated BP compared to children who consumed lower amounts. ConclusionsThis study increases our understanding BP patterns and determinants among school children in Kenya, and informs non-communicable disease prevention efforts. Funding SourcesSaff Family.

Association between Primary School Children’s Unhealthful Behaviors and Overweight/Obesity: A Cross-Sectional Analysis in Urban Kenya

We examined patterns of unhealthful dietary, PA and sleep behaviors among primary school children of different socio-economic status (SES) in two urban settings in Kenya and explored the association between these behaviors and overweight/obesity among the children. Data was collected on 390 children, aged 10-12 years, who attended public primary schools in two cities. Children’s anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on children’s dietary, physical activity, and sleep behaviors. Body-mass-index-for-age z-scores, waist-circumference-to-height ratio, and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between socio-economic/demographic characteristics, unhealthful behaviors and overweight/obesity. Overall, 21% of the children were overweight or obese and 9% had abdominal obesity. Prevalence of unhealthful behaviors varied significantly by child’s age, gender, school income levels, city, and frequency of consumption of restaurant foods. Children who consumed less than recommended amount of fruit servings had 1.68 times the risk of being overweight/obese, 2.49 times the risk of having abdominal obesity and 1.47 times the risk of having high total skinfold values compared to children with adequate fruit intake. Children with high frequency of consumption of red/processed meats had 1.50 times the risk of being overweight/obesity compared to children with less-frequent consumption. We found rather high prevalence of unhealthful behaviors among primary school children in Kenya, identified their determinants, and the association between specific behaviors and overweight/obesity. These results can guide childhood obesity prevention measures in Kenya and neighboring countries.

Challenges Faced by House-Hold Contacts of Pulmonary Tuberculosis Patients In An Urban Setting In Nairobi, Kenya

Close contacts of active pulmonary tuberculosis (PTB) patients are at higher risk of infection as the confirmed cases remain highly infectious before and while in the early stages of treatment. This work highlights the encounters and perspectives of household contacts (HHCs) of PTB patients in an urban setting in Kenya, with a focus on accessibility to health services, interactions within the community, and the risk of infection at home. A multimethod study design involving descriptive cross-sectional analysis and informal interviews was used. The study participants were recruited from tuberculosis (TB) isolation wards and outpatient clinics of Mbagathi County Hospital in Nairobi, Kenya. Data was collected using structured questionnaires and informal interviews. Results revealed improved access to treatment by PTB patients. However, the global goal of eliminating TB infections by minimizing latent tuberculosis reactivation remains a challenge in this population primarily because most of the HHCs lacked knowledge on diagnosis and treatment of latent tuberculosis infection (LTBI). Most participants were residents of informal settlements in Nairobi characterized by small and poorly planned housing structures with poor waste management systems. In most houses, the living space doubled as cooking and sleeping area. There was therefore a high exposure of spouses, children and other persons living with the patients. We recommend that further education be provided to HHCs to increase awareness on available testing and preventive treatment for LTBI, and infection prevention practices at the household level. Furthermore, additional resources should be offered to economically disadvantaged patients to support their social and treatment needs.

Food Environment in and around Primary School Children's Schools and Neighborhoods in Two Urban Settings in Kenya.

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low-, medium- and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 km of the schools and the school children’s neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels and inform public health interventions aimed at promoting healthy food environments in Kenya.

Conducting qualitative research during COVID-19: reflections on methods and challenges when interviewing marginalized refugee women

This reflective opinion article arises from our experience conducting interviews with refugee women attending ante-natal and post-natal services in an urban setting in Kenya in the context of COVID‑19. First, we explain the research context in light of the study objectives. We reflect on the methodological challenges we faced, including researcher’s positionality, and argue that conducting research within the refugee context during the pandemic is unique, therefore research design must reconsider inclusive methodologies tailored to the uniqueness of refugees’ experience in order to obtain useful data. Second, we discuss these challenges in light of our experiences and the implications for addressing the gaps we identified, with particular emphasis on the ways in which professionals working with refugee communities in the context of a pandemic can build trust and obtain meaningful and uncompromised data. Lastly, we provide recommendations for researchers conducting similar research.

Predictors of presumptive treatment of uncomplicated malaria among children in private retail outlets in Kenya: mixed effects logistic regression modelling

Background: The health seeking behavior in Kenya raises concerns in malaria case management at the private sector. Adherence to the national guidelines for the diagnosis, treatment and prevention of malaria is key in management of the disease. Presumptive treatment remains a major challenge in Kenya, especially in the private sector, with major gaps in literature identified on predictors of this treatment. Mixed-effects regression modelling considers county clustering, is more accurate in prediction and is more efficient and flexible. Methods: The study design was a cross-sectional, nationally representative, retail outlet survey secondary data analysis. The study populations included the health care providers in the retail outlets sampled randomly in both the rural and urban settings in Kenya. The primary outcome of interest was the proportion of health care providers who treated patients presumptively. Multivariable analysis was conducted for the significant variables, adjusting for clustering at the county level to determine the predictors of presumptive treatment. The best fitting model was examined using the Akaike Information Criterion (AIC). Results: Out of the 333 health care providers who treated patients, 190 (57%) treated patients presumptively. From the mixed effects logistic regression model, the predictors of presumptive treatment of uncomplicated malaria were case management training (AOR = 0.44; 95% CI = (0.18 – 1.09)), asked signs or symptoms (AOR = 0.19; 95% CI = (0.10 - 0.37)) and results presented (AOR = 0.08 95% CI = (0.03 - 0.19)). Conclusions: Presumptive treatment of uncomplicated malaria remains a challenge in the private retail sector. Malaria case management training and health care providers asking of signs and symptoms and results presented predicts presumptive treatment. To address the issue of presumptive treatment of Malaria, strengthening of malaria case management training is key for health care providers in the private sector.

‘Sometimes I feel like the other life on heroin was better’: transitioning experiences towards methadone, and HIV prevention implications in Urban Kenya

In 2014 methadone as part of Medically Assisted Therapy (MAT) was introduced in Kenyan public health facilities as part of a comprehensive approach to HIV prevention and treatment. This paper explores the transition experiences for people moving from the use of heroin to MAT. The paper reports on a qualitative study conducted in an urban setting in Kenya in 2015. Findings show that transitioning from the use of heroin to methadone can both be a liberating and disempowering experience. While study participants were reportedly pleased with the life changes brought about by methadone, they struggled with negotiating the transition from an ‘old life’ of heroin use to methadone. Tensions were navigating the 'new life' on methadone and the 'old life' on heroin. These tensions generate new forms of social exclusion, as well as feelings of uncertainty and ambivalence. A particular effect of this challenging transition is how new forms of risk and vulnerability for HIV are created even whilst others are attended to. MAT programs need to attend to the dynamics described to address the risk of HIV posed by a ‘new life’ and the broader tensions involved in transitioning from the use of heroin to methadone.

School effectiveness and academic performance in low-resourced urban settings in Kenya

ABSTRACT The paper examines the link between school effectiveness and academic performance among primary schools in Nairobi city, Kenya. Data are from 1120 teachers spread in 89 primary schools. Using multivariate regression analysis, the school effectiveness correlates and school academic performance are investigated. Results show existence of a latent variable that strongly explains academic performance even after accounting for covariates. This implies that poor parents in urban poor neighbourhoods choose to enrol their children in schools perceived to be effective; and, investment on strategies that enhance school effectiveness could go a long way to improve school academic performance.

P1946Hypertension prevalence, awareness, treatment and control and 10-year estimated CVD risk in East and West Africa: pooled analysis of data from 4 African countries

Abstract Background Though the prevalence of hypertension is rising in Sub-Saharan Africa, few studies have characterized the epidemiology and management of hypertension across many heterogeneous communities. We assessed prevalence, awareness, treatment and control of hypertension and estimated the 10-year cardiovascular risk across six sites in East and West Africa. Methods Between June and August 2018, we conducted household-based surveys in 6 rural, semi-urban and urban settings in Kenya, Nigeria, Tanzania and Uganda to enroll community-dwelling adults (aged &gt;18 years) collect data including age, gender, smoking, anthropometric measures, health insurance, utilization of health care facilities. We defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use. We used country specific Globorisk prediction equations to estimate 10-year CVD risk. Results A total 3,150 participants with a mean age of 40 years (SD 15), 61% of whom were women, 8% had ever smoked, and 33% were overweight/obese. About 23.7% (95% CI 22.2, 25.2) of the entire sample had hypertension, of whom 60.6% (56.8, 64.3) were diagnosed. Among diagnosed, 61.7% (57.2, 66.1) were taking antihypertensives, and 27.7% (22.7, 33.1) had controlled BP. The prevalence of hypertension was 38.6% in Ikire-Nigeria, 25.1% Ukonga-Tanzania, 23.3% in Oyo-Nigeria, 21.6% in Okpok-Nigeria, 20.4% in Soroti-Uganda, and 9.7% in Viwandani-Kenya. The overall median estimated 10-yr CVD risk was low 4.6% IQR (2.3, 9.6) and 8.6% had 10-yr CVD risk &gt;10%. (Figure 1) Conclusion Among African adults aged &gt;18 years, nearly a quarter have hypertension, three in 5 being treated, and fewer than three in ten had BP under control. The low number of people in control is ubiquitous in all sites and warrants greater prevention strategies, better screening and more effective and affordable treatment options than what is currently available.

"It's like these CHCs don't exist, are they featured anywhere?": Social network analysis of community health committees in a rural and urban setting in Kenya.

BackgroundIn Kenya, Community Health Committees (CHC) were established to enhance community participation in health services. Their role is to provide leadership, oversight in delivery of community health services, promote social accountability and mobilize resources for community health. CHCs form social networks with other actors, with whom they exchange health information for decision-making and accountability. This case study aimed to explore the structure of a rural and an urban CHC network and to analyze how health-related information flowed in these networks. Understanding the pathways of information in community settings may provide recommendations for strategies to improve the role and functioning of CHCs.MethodsIn 2017, we conducted 4 focus group discussions with 27 community discussants and 10 semi-structured interviews with health professionals in a rural area and an urban slum. Using social network analysis, we determined the structure of their social networks and how health related information flowed in these networks.ResultsBoth CHCs were composed of respected persons nominated by their communities. Each social network had 12 actors that represented both community and government institutions. CHCs were not central actors in the exchange of health-related information. Health workers, community health volunteers and local Chiefs in the urban slum often passed information between the different groups of actors, while CHCs hardly did this. Therefore, CHCs had little control over the flow of health-related information. Although CHC members were respected persons who served in multiple roles within their communities, this did not enhance their centrality. It emerged that CHCs were often left out in the flow of health-related information and decision-making, which led to demotivation. Community health volunteers were more involved by other actors such as health managers and non-governmental organizations as a conduit for health-related information.ConclusionSocial network analysis demonstrated how CHCs played a peripheral role in the flow of health-related information. Their perception of being left out of the information flow led to demotivation, which hampered their ability to facilitate community participation in community health services; hence challenging effective participation through CHCs.

Depression, injecting drug use, and risky sexual behavior syndemic among women who inject drugs in Kenya: a cross-sectional survey

BackgroundInjecting drug use (IDU) is a key driver of the HIV epidemic particularly when individuals experience psychosocial conditions and risky sexual behavior in a syndemic manner. This study sets out to assess evidence of a syndemic pattern of psychosocial conditions (IDU, depression, intimate partner violence (IPV)) on one the hand and risky sexual behavior on the other while accounting for the socio-economic disadvantage among women who inject drugs (WWID) in low-income urban settings in Kenya.MethodsUsing a cross-sectional study design, this study recruited 306 WWIDs from two sites in Nairobi between January 2017 and July 2017. Multiple methodologies including descriptive analyses of co-occurrences of psychosocial conditions at the individual level, standard logistic regression analyses to examine relationships and interactions within and between psychosocial conditions and risky sexual behavior, and classification trees algorithm for predictive modeling via machine learning were employed.ResultsThe prevalence of the psychosocial conditions was as follows: IDU, 88%; depression, 77.1%; and IPV, 84%. The prevalence of risky sexual behavior was 69.3%. IDU and depression were related to each other (P < 0.05) and each of them with risky sexual behavior (P < 0.05). The highest 2-way and 3-way co-occurrence of conditions were reported in IDU and depression (72%) and in IDU, depression, and risky sexual behavior (62%), respectively, indicating clustering of the conditions at the individual level. Further, each additional psychosocial condition (IDU and depression) was associated with sixfold odds (P = 0.000) of having risky sexual behavior suggesting a dose-response relationship. Logistic regression analyses incorporating multiplicative interactive effects returned three significant variables (P < 0.05): IDU*depression interaction effect, “Age when delivered the first child,” and “Income.” Classification tree modeling represented a 5-level interaction analysis with IDU and depression predicted to have the highest influence on risky sexual behavior.ConclusionFindings provide possible evidence of a syndemic pattern involving IDU, depression, and risky sexual behavior suggesting the need for an integrated approach to the implementation of harm reduction interventions among WWID in low-income urban settings in Kenya. This work highlights the need for further studies to authenticate the findings and to characterize pathways in the syndemic development in WWID.

Assessment of Retrospective and Current Substance Use in Women Who Inject Drugs in Low-Income Urban Settings in Kenya

Women who inject drugs (WWIDs) continue to experience challenges that accumulate their risk to HIV transmission and other co-morbidities. However, data that conceptually link diverse substance use dimensions in WWIDs are lacking particularly in developing countries. We assessed retrospective and current substance use among 306 WWIDs in low-income urban settings in Kenya using mixed methods. Descriptive analyses were performed on quantitative data while qualitative narratives revealed insights from quantitative findings. The mean age of the study participants was 17 (range 11, 30) years. Out of the 306 WWIDs 57% commenced with substance use by combining both licit and illicit drugs. Intimate sexual partners including spouses and casual sex partners introduced seventy-four percent of WWIDs to substance use. Majority of the WWIDs (39.9%) commenced with 2- way substance combination with bhang and cigarette having the highest usage. However, 4-way substance combinations containing heroin, cigarette, bhang, valium, Rohypnol had the highest frequency (12.8%) at the time of the survey. Varied routes of heroin administration were mentioned including injection, smoking and sniffing as separate routes and as 2-way or 3-way mode combinations of these. To inform policies targeting the health and rights of girls and women in low income settings, this study recommends urgent upstream policies targeting the girl adolescent life in form of a multifunctional package composed of identifying girls at risk, substance use interventions, sexual health education, improved educational attainment, and progressive social policies that target low social economic status in the adolescent phase. Harm reduction programs in Kenya should target people who use heroin through both injection and non-injection modes of administration.

Magnitude and predictors of normal-weight central obesity– the AWI-Gen study findings

ABSTRACTBackground: Normal-weight central obesity is associated with higher mortality than general obesity as defined by body mass index, particularly in the absence of central fat distribution.Objective: The aim of this study was to examine the magnitude and predictors of normal-weight central obesity in an urban informal settlement setting in Kenya.Methods: We used data from the AWI-Gen study, a cross-sectional survey targeting randomly selected consenting adults between the ages of 40–60 in two urban informal settlements of Nairobi between 2014 and 2016. Central obesity was determined using waist circumference, waist to hip ratio, visceral fat thickness, and subcutaneous fat thickness. General obesity was determined using body mass index (BMI).Results: About 20.0% of participants in the study had general obesity. The prevalence of central obesity as measured by waist circumference was 52.0%, by waist-to-hip ratio was 53.5%, by visceral fat thickness was 32.4% and by subcutaneous fat thickness was 49.2%. The prevalence of normal-weight central obesity in the study population was highest when measured by waist to hip ratio (38.1%) and lowest when measured by visceral fat thickness (18.1%). Factors associated with normal-weight central obesity as assesses by waist circumference were being female, of older age, and in full-time employment. Older age was associated with normal-weight central obesity as assessed by waist to hip ratio.Conclusion: The findings highlight a significant prevalence of normal-weight central obesity among adults in a poor urban setting in Kenya, pointing to women as a key target group for focused interventions. Longitudinal studies are needed to establish whether there is a link between normal-weight central obesity and mortality in such settings as has been found in other settings.

Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population

BackgroundPerson-centered reproductive health care is recognized as critical to improving reproductive health outcomes. Yet, little research exists on how to operationalize it. We extend the literature in this area by developing and validating a tool to measure person-centered maternity care. We describe the process of developing the tool and present the results of psychometric analyses to assess its validity and reliability in a rural and urban setting in Kenya.MethodsWe followed standard procedures for scale development. First, we reviewed the literature to define our construct and identify domains, and developed items to measure each domain. Next, we conducted expert reviews to assess content validity; and cognitive interviews with potential respondents to assess clarity, appropriateness, and relevance of the questions. The questions were then refined and administered in surveys; and survey results used to assess construct and criterion validity and reliability.ResultsThe exploratory factor analysis yielded one dominant factor in both the rural and urban settings. Three factors with eigenvalues greater than one were identified for the rural sample and four factors identified for the urban sample. Thirty of the 38 items administered in the survey were retained based on the factors loadings and correlation between the items. Twenty-five items load very well onto a single factor in both the rural and urban sample, with five items loading well in either the rural or urban sample, but not in both samples. These 30 items also load on three sub-scales that we created to measure dignified and respectful care, communication and autonomy, and supportive care. The Chronbach alpha for the main scale is greater than 0.8 in both samples, and that for the sub-scales are between 0.6 and 0.8. The main scale and sub-scales are correlated with global measures of satisfaction with maternity services, suggesting criterion validity.ConclusionsWe present a 30-item scale with three sub-scales to measure person-centered maternity care. This scale has high validity and reliability in a rural and urban setting in Kenya. Validation in additional settings is however needed. This scale will facilitate measurement to improve person-centered maternity care, and subsequently improve reproductive outcomes.