Despite being globally recommended as an effective intervention in tuberculosis (TB) prevention among people living with HIV, isoniazid preventive therapy (IPT) implementation remains suboptimal, especially in sub-Saharan Africa. This study explored the factors influencing the acceptability of IPT among healthcare providers in selected HIV clinics in Nairobi County, Kenya, a high HIV/TB burden country. The study was conducted in the HIV clinics of three purposefully selected public healthcare facilities in Nairobi County, Kenya between February 2017 and April 2017.
Results:
Provider acceptability of IPT was influenced by factors relating to the organizational context, provider training on IPT and their perception on its efficacy, length and clarity of IPT guidelines and standard operation procedures, as well as structural factors (policy, physical and work environment). Inadequate high-level commitment and support for the IPT programme by programme managers and policy-makers were found to be the major barriers to successful IPT implementation in our study context.
This study provides insight into the complexity of factors affecting the IPT implementation in Kenya. Ensuring optimal acceptability of IPT among healthcare providers will require an expanded depth of engagement by policy-makers and IPT programme managers with both providers and patients, as well as on-the-job design specific actions to support providers in implementation. Such high-level commitment and support are consequently essential for quality delivery of the intervention […]
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Non-communicable diseases (NCDs) currently constitute a serious threat to health worldwide, with the situation expected to worsen if concerted actions are not urgently taken. The World Health Organisation (WHO) identified population-based interventions addressing four NCD risk factors – tobacco use, harmful use of alcohol, unhealthy diet, and physical inactivity; also known as “best buys” – and proposes the use of multi-sectoral approaches (MSA) to engage the public, private, and non-profit sectors to implement these best buys. The African Population and Health Research Centre (APHRC) led Cameroon and five other African countries in a study to analyse how countries are addressing NCD prevention in order to best facilitate MSA for NCD prevention in Africa.
The aims of this study were to:
- Describe the development of policies in multiple sectors designed to address NCDs or best buys
- Through key stakeholder interviews and field observations of policy implementation in Cameroon, describe the status of implementation of current policy and perspectives on how to best implement MSA for NCD prevention in Cameroon
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This analysis of non-communicable diseases prevention policies in Africa (ANPPA) case study set out to analyse non-communicable disease (NCD) policies in South Africa. Its specific aims were to:
- Assess the state of implementation of NCD “best buy” interventions
- Generate evidence on the extent to which multi-sectoral action (MSA) is used in formulating and implementing policy guiding these interventions in South Africa
- Identify barriers to and facilitators of the formulation and implementation of NCD prevention and control policies in the country
- Contribute to the literature on multi-sectoral action relevance in formulating and implementing NCD prevention and control policies
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Universal Health Coverage (UHC) is high on the agenda as we celebrate World Health Day once again this year. Simply […]
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Despite myriad targets and 17 inter-related goals, the 2030 Sustainable Development agenda has, at its core, a single prevailing ambition: […]
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Poop. Shit. Feces. Small words – in any language – with unmatched potential to enable us engage all our senses. […]
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There is a growing burden of non-communicable diseases (NCDs) especially in low and middle-income countries. Major NCDs such as cardiovascular diseases, diabetes, cancers and chronic lung diseases share risk factors that include harmful use of alcohol, tobacco use, unhealthy diet and insufficient physical activity. The 2011 United Nations Political Declaration on NCDs recognized that actions to prevent and control NCDs require multi-sectoral action (MSA).
In Malawi, the extent to which non-health sectors are aware of NCD prevention, and their involvement in developing and implementing NCD-related policies, is not documented. The Analysis of NCDs Prevention Policies in Africa (ANPPA) research project, sought to explore and understand the current policy environment for prevention of NCDs in Malawi as a case study site among six sub-Saharan African (SSA) countries. The aim of the study was to generate evidence on the extent to which MSA plays a role in formulation and implementation of policies related to NCD preventive ‘best buy’ interventions, which are the World Health Organization’s (WHO) recommended measures to cost-effectively deliver the greatest benefit in reducing risk factors for NCDs. […]
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This Kenyan case study report is part of a broader study examining the existence of non-communicable disease prevention policies and the extent to which multi-sectoral approaches were applied in the policy development and implementation processes in five sub-Saharan African countries: Kenya, South Africa, Cameroon, Nigeria, and Malawi. In particular, the study focused on policies addressing the World Health Organization (WHO) “best buy” interventions for non-communicable disease (NCD) prevention. These interventions address the four major NCD risk factors, namely: tobacco use, harmful alcohol consumption, unhealthy diet, and physical inactivity.
A case study design was used to capture rich descriptions of major policies related to each risk factor. Data was collected through document reviews and key informant interviews with decision-makers from various sectors, then coded and analyzed with the aid of NVivo, a qualitative data analysis software. Analysis was guided by the policy triangle, which looked at the contextual factors influencing policy adoption, policy processes, and those involved in the processes. […]
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The Lancet Commission on the future of health in Sub-Saharan Africa is an optimistic lot. A report launched on September […]
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The aim of this paper is to provide empirical evidence of the effect of crop diversity on crop production and spillover effect. Based on the estimation of production functions with spatial concerns on an original and rich data set, results of the study suggest that crop diversity has a positive and significant effect on crop production. Its marginal contribution is substantial when rainfall is low in the agroecosystem. Furthermore, spatial dependence is a major issue and could be explained by topographic, climatic and agronomic constraints. […]
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This paper describes how a collaborative research involving health decision-makers, service providers, communities and research institutions provided a pathway for getting evidence into the design of Kenya’s community health strategy as part of wider health systems improvement.
The case study:
The process started with a review of community-based health care in the eastern Africa region, followed by pilot projects in western Kenya. More demand for evidence by national decision-makers arose when a window of opportunity emerged to develop a national community health strategy. The decision-makers were engaged in the follow-up studies to inform further development of the strategy. Challenges included competing work interests of the decision-makers, delays in getting research results, and financial modalities.
Conclusions:
Decision-makers can utilise locally generated research evidence to address a major health systems problem if they are engaged in the study from the beginning. Their continued engagement in the study can also lead to more resource mobilization for additional evidence generation. The involvement of influential development partners and strengthening decision-makers’ capacity in knowledge translation are also critical for effective research utilisation. […]
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As urbanization continues unabated in Kenya, the wellbeing of the urban poor – whose majority live in slum settlements – will increasingly drive national development indicators including Vision 2030, SDGs and FP2020 goals. It is therefore central to understand and identify ways to address the poor reproductive health outcomes among poor urban slum populations in the country.
Taking advantage of APHRC’s NCSS surveys conducted in 2000 and 2012 among a representative sample of slum households across Nairobi, we show that there has been a considerable increase in use of modern contraception among women in Nairobi slums, from 34% in 2000 to 53% in 2012, and a reduction in inequity in access through much higher increases among previously disadvantaged groups.
Using decomposition analysis techniques, we show that much of the observed increase is due to behavioral changes in the effect of fertility preferences on contraceptive use; and to compositional changes in woman’s education, child survival and exposure to FP information. This may be the result of efforts by the government of Kenya and its development partners to reduce the disparities in uptake and use of FP services through various programs and policies targeting the poor segments of the Kenyan population. […]
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This fact sheet presents new evidence from a study conducted in Nairobi, Mombasa and Homa Bay counties in 2015. Data were collected in 78 schools from teachers, principals and students in Forms 2 and 3, as well as from key informants involved with policy and program development and implementation. […]
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This paper explores the potential link between the sensitivity of willingness to pay (WTP) to the order of presenting bid amounts in contingent valuation questions (ordering effect) and respondent uncertainty. The resource being valued is a public project to protect salt marshes against the spread of an invasive aquatic plant in the Brest roadstead (France).
Valuation uncertainty is captured through a variant of payment card format where respondents are given the opportunity to report their WTP as either a single value (Option A) or an interval of values (Option B). The ordering effect is tested using both parametric models that ignore and control for the potential sample selection bias related to the choice between Option A and Option B, as well as non-parametric models.
The results suggest that (1) respondents place substantial WTP values on salt marsh conservation, and (2) the ordering effect is linked to respondent uncertainty since only uncertain respondents react differently to changes in the order of presenting bid amounts. Specifically, for uncertain respondents, putting bid amounts in ascending order yields lower welfare estimates than putting bid amounts in descending order or random order. Policy recommendations and options to deal with ordering effect are discussed. […]
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The African Population and Health Research Center, in collaboration with its consortium partners Marie Stopes Kenya, Family Health Options Kenya, the Great Lakes University of Kisumu, Centre for the Study of Adolescence, Forum for African Women Educationalists and Christian Health Association of Kenya implemented the expansion phase of a community-based family planning project in two large counties in western Kenya: Busia and Siaya. In 2012, when the current phase of the project started, Busia and Siaya districts (later counties), had an estimated total population of 1.7 million (739,000 in Busia and 915,000 in Siaya).
The objective of the project was to increase routine use of modern contraceptive methods among women of reproductive age by eight percentage points specifically by: 1) influencing switching from short to long-term methods, 2) increasing modern contraceptive rate on young/ low parity married women, 3) influencing men’s attitudes towards FP uptake and reducing desired family size and 4) influencing fertility intentions among women and men. […]
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Non-communicable diseases (NCDs) – largely the result of modifiable behavioral risks such as physical inactivity that gradually develop into physiological risks – are a main cause of morbidity and mortality worldwide. In Kenya, a nationally representative STEPwise survey of risk factors for NCDs established that 10.8% of Kenyans accumulated low levels of total physical activity. The goal of our analyses was to compare domains of self-reported physical activity in two Nairobi slums to national estimates. […]
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There is a growing concern worldwide regarding municipal solid waste generation. An estimated 11.2 billion tons of solid waste is collected worldwide every year. The increasing volume and complexity of waste associated with the modern economy and rapid urbanization pose a serious risk to ecosystems and human health. In Africa, the key drivers of solid waste generation are urbanization and sustained urban population growth. The management of the waste that is generated in urban areas and the risks associated with its handling are a major problem of confronting many cities in sub-Saharan Africa, including Dakar, the focus of the present study. […]
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There are no published data from specific regions of sub-Saharan Africa describing the clinical and pathological characteristics and molecular subtypes of invasive breast cancer by ethnic group. The purpose of this study was to investigate these characteristic s among the three major ethno-cultural groupings in Kenya.
The study included women with pathologically confirmed breast cancer diagnosed between March 2012 and May 2015 at 11 hospitals throughout Kenya. Sociodemographic, clinical, and reproductive data were collected by questionnaire, and pathology review and immunohistochemistry were performed centrally. […]
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Scaling up of integrated tuberculosis (TB)–human immunodeficiency virus (HIV) services remains sub-optimal in many resource-limited countries, including Ghana, where the two conditions take a heavy toll on the financial resources of health systems as well as infected persons. Previous studies have documented several implementation challenges towards TB–HIV service integration, but views of patients on integrated service delivery have not received commensurate research attention. This paper explored the experiences of 40 TB–HIV co-infected patients at different stages of treatment in Ghana. […]
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Within human services, client satisfaction is highly prioritised and considered a mark of responsiveness in service delivery. A large body of research has examined the concept of satisfaction from the perspective of service users. However, not much is known about how service providers construct client satisfaction. The purpose of this paper is to throw light on healthcare professionals’ perspectives on patient satisfaction, using tuberculosis (TB) clinics as a case study. […]
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In this paper, we reflect on our experiences of implementing a multipronged intervention to improve sexual and reproductive health outcomes. The project used family planning as its entry point and was implemented in two high fertility counties—Busia and Siaya in Kenya. The intervention, implemented by a seven-member consortium, involved: family planning services delivery; regular training of service providers to deliver high quality services; monitoring and evaluation; strengthening of commodity chain delivery and forecasting; school-based and out-of-school based sexuality education; and advocacy and stakeholder engagements at the community, county and national levels. […]
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This brief presents key findings of a two-year research study that compared implementation and impact of two social protection interventions for basic health care provision: the Community Health Plan (TCHP) in Nandi County, and the Kenyan National Free Maternity Services (FMS) and Free Primary Care (FPC) programs.
The study focused on analyzing impact in terms of reaching the poor and specific sub-groups, the quality of care, the health service utilization, and out-of-pocket expenditures. The study also focused on the associations between social protection interventions and inclusive economic growth. […]
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This fact sheet targeted at youth aged 15-19 years, highlights key components of comprehensive sexuality education and what it means for youth. It is based on the Assessing the Implementation of Sexuality Education Policies and Curricula report by APHRC and the Guttmacher Institute.
The study was conducted in three Kenyan sites: Nairobi, Homa Bay and Mombasa. This version is written in Swahili for easy understanding among those who live in Mombasa. […]
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This fact sheet targeted at youth aged 15-19 years, highlights key components of comprehensive sexuality education and what it means for youth. It is based on the Assessing the Implementation of Sexuality Education Policies and Curricula report by APHRC and the Guttmacher Institute.
The study was conducted in three Kenyan sites: Nairobi, Homa Bay and Mombasa. This version is written in Swahili for easy understanding among those who live in Mombasa. […]
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Cardiovascular diseases (CVDs) are the most common cause of non-communicable disease mortality in sub-Saharan African (SSA) countries. Gaps in knowledge of CVD conditions and their risk factors are important barriers in effective prevention and treatment. Yet, evidence on the awareness and knowledge level of CVD and associated risk factors among populations of SSA is scarce. This review aimed to synthesize available evidence of the level of knowledge of and perceptions towards CVDs and risk factors in the SSA region. […]
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