Research Unit: Health and Wellbeing

Objective:

We sought to identify factors associated with linear growth among under-5 children in two urban informal settlements in Nairobi.

Design:

We used longitudinal data for the period 2007–2012 from under-5 children recruited in the two sites between birth and 23 months and followed up until they reached 5 years of age. We fitted a generalized linear model on height-for-age Z-scores using the generalized estimating equations method to model linear growth trajectories among under-5 children. Known for its flexibility, the model provides strong parameter estimates and accounts for correlated observations on the same child.

Setting:

Two urban informal settlements in Nairobi, Kenya.

Participants:

Under-5 children and their mothers.

Results:

The findings show that child weight at birth, exclusive breastfeeding and immunization status were key determinants of linear growth among under-5 children. Additionally, maternal characteristics (mother’s age, marital status) and household-level factors (socioeconomic status, size of household) were significantly associated with child linear growth. There were biological differences in linear growth, as female children were more likely to grow faster than males. Finally, the model captured significant household-level effects to investigate further.

Conclusions: 

Findings from the study point to the need to improve the targeting of child health programs directed at the urban poor population in Nairobi. Specific modifiable determinants of child linear growth, particularly child weight at birth, exclusive breastfeeding, immunization status and mother’s background characteristics, should be considered when designing interventions aiming at addressing child health inequities in these settings. […]

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Background

With a human immunodeficiency virus (HIV) prevalence of 2.1% among 15–24-year-olds, opportunities for further integration of sexual and reproductive health (SRH) and HIV prevention services for young people in Uganda exist. We examine a range of factors that contribute to variance in risky sexual behavior among young Ugandans.

Methods

A cross-sectional, nationally representative household survey was conducted between February and March 2016. The questionnaire used assessed knowledge, attitudes, and practices related to SRH among young people aged 10–24 years. A composite indicator was constructed to assess risky sexual behavior, defined as being involved in sexual relations under the influence of alcohol or drugs, engaging in sexual activities without a condom, and having multiple sexual partners in the 6 months preceding the survey. Exploratory analysis was conducted to provide descriptive statistics. Logistic regression was conducted to determine the factors associated with risky sexual behavior. This analysis focuses on the sub-category aged 15–24 years, comprised of 2725 respondents.

Results

Knowledge levels of family planning (FP), sexually transmitted infections (STIs) and HIV across all respondents were high (above 82%). Self-reported perceived risk of STIs and pregnancy was consistently higher among 20–24-year-old respondents, with 61.5% feeling at risk of STIs compared to 46.2% of 15–19-year-olds. A total of 22.7% of respondents reported having been involved in risky sexual behavior. Factors associated with risky sexual behavior among the 15–19 years group included gender, single orphanhood, casual work, schooling status, FP knowledge and self-perceived risk of STIs/HIV. For the 20–24-year-old respondents, significantly associated factors included gender, educational level, relationship to head of household, place of residence, and self-perceived risk of pregnancy.

Conclusions

Despite high general SRH/HIV knowledge and perceived risk of pregnancy and HIV, risky sexual behavior among young Ugandans remains high. Effectiveness gaps in the integrated SRH/HIV response for young people should be addressed and targeted interventions focused on holistic prevention at individual level through information, risk awareness, and skill development should be combined with interventions targeting social structures affecting individual behavior. […]

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Background

Zambia, with its women having five children on average, is one of the countries in sub-Saharan African with the highest fertility rates. As the country works on expanding its reproductive health programs, this analysis sought to understand factors behind the current utilization of injectable, long-acting and permanent methods (iLAPMs) of contraception.

Methods

Cross-sectional secondary data drawn from the Zambia Demographic and Health Surveys (ZDHS) were used. This included married women aged 15–49 for the years 1992 (n = 620), 1996 (n = 1176), 2001/02 (n = 1483), 2007 (n = 1665) and 2013/14 (n = 4394). Frequencies, cross-tabulations, and logistic regression were used to analyze levels and differentials in use of iLAPMs.

Results

Except for the variables “religion” and “region”, the rest of the independent variables show significance on the use of iLAPMs, at varying levels. “Desire for children” is the strongest predictor of use of iLAPMs as it was significant at all the five data points. This is followed by “age”, although it was not significant in 2007. “Education of the woman and partner” and “number of living children” were also significant, but only for two out of the five data collection points. “Ethnicity”, “type of residence”, “heard about FP in last 12 months”, and “main decision maker on woman’s health” were only significant for one out of the five data points.

Conclusion

This study has established that women’s desire for children is the main factor influencing use of iLAPMs in Zambia. Women who still want to have children are less likely to use iLAPMs even though the odds of using these methods among these women increased between 1992 and 2014. This indicates that most of this increase is due to the desire by these women to space births rather than stop having children. The 2013/2014 data also suggest an increase in access to iLAPMs among the less privileged women i.e. those in rural areas and those with low levels of education. This trend appears to have stemmed from the scaling up of family planning programs to cover rural communities. Greater effort should be invested in family planning programs that reach all categories of women. […]

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Many countries in sub-Saharan Africa have poor solid waste management systems, putting people living near dumpsites at higher risk of disease infections. Good risk perception could enhance individual- and community-level protection and prevention efforts. The objective of this study was to examine the levels and determinants of perceived health risk associated with exposure to solid waste dumpsites in Kenya. The level of risk was measured on a five-point Likert scale. The results showed that about 27% and 42% of the study population in Nairobi and Mombasa, respectively, perceive that they have little or no health risk from the nearby dumpsites. Study site, family size and wealth index were associated with risk perception in the multivariate analysis. A sizable proportion (42%) of the population living near dumpsites has lower risk perception. Health promotion interventions are needed to enhance risk awareness and perception in these communities. […]

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This article explores older peoples’ perceptions of menopause and sexuality in old age. The research was exploratory, consisting of 12 vignette-based focus group discussions and 18 face-to-face semistructured interviews among older Yoruba men and women (60+). Findings revealed menopause as a biopsychosocial marker of aging that provides gendered spaces for women to abstain from or suppress their sexual desires and avoid a folk pregnancy- oyun iju(folk fibroid). Older men construe menopause and sexual refusals from their wives as opportunities for extramarital relations. Thus, both older men and women have differentiated perceptions and dispositions toward menopause, which have implications for their sexual health and well-being. […]

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Long acting reversible and permanent contraception (LARPs) offer promising opportunities for addressing the high and growing unmet need for modern contraception and helps to reduce unintended pregnancies and abortion rates in sub-Saharan Africa (SSA). This study examines the contextual factors that influence the use of long acting reversible and permanent contraception among married and fecund women in Ethiopia. […]

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Je, sauti ya picha ni nini? Sauti ya picha ni mbinu imara ya utafiti ambayo inategemea matumizi ya kamera na watu wa jamii kuchunguza hadithi, uzoefu au mawazo kuhusu jambo fulani ambalo linawaathirii. Washiriki wanaweza pia kuandika maandishi mafupi ili kupeana maelezo zaidi, changamoto wanazopitia na pia kama njia za kutafuta suluhu. Picha hutumika kama sauti ambayo inaweza eleza ujumbe flani, kwa maneno au bila maneno, and mara nyingi ielezee jambo gumu kwa njia sahihi. Maonyesho ya picha huruhusu washiriki kuandika na kurekodi matukio na hali zinazowazingira, na pia kuwawezesha kutafakari juu ya changamoto au hali wanazokumbana nazo. Pia wanaweza kutengeza mbinu zakuwasiliana na washika dau. […]

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Recent trends in global vaccination coverage have shown increases with most countries reaching 90% DTP3 coverage in 2008, although pockets of under vaccination continue to persist in parts of sub-Saharan Africa particularly in the urban slums. The objectives of this study were to determine the vaccination status of children aged between 12-23 months living in two slums of Nairobi and to identify the risk factors associated with incomplete vaccination. Methods: The study was carried out as part of a longitudinal Maternal and Child Health study undertaken in Korogocho and Viwandani slums of Nairobi. These slums host the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) run by the African Population and Health Research Centre (APHRC). All women from the NUHDSS area who gave birth since September 2006 were enrolled in the project and administered a questionnaire which asked about the vaccination history of their children. For the purpose of this study, we used data from 1848 children aged 12-23 months who were expected to have received all the WHO-recommended vaccinations. The vaccination details were collected during the first visit about four months after birth with followup visits repeated thereafter at four month intervals. Full vaccination was defined as receiving all the basic childhood vaccinations by the end of 24 months of life, whereas up-to-date (UTD) vaccination referred to receipt of BCG, OPV 1-3, DTP 1-3, and measles vaccinations within the first 12 months of life. All vaccination data were obtained from vaccination cards which were sighted during the household visit as well as by recall from mothers. Multivariate models were used to identify the risk factors associated with incomplete vaccination. […]

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The objective of the study was to determine the spatial variation in modern contraceptive use and unmet need for family planning across the counties of Kenya and to examine whether the spatial patterns were associated with inequalities in physical access to health facilities. Data were obtained from the 2008-2009 Kenya Demographic and Health Survey and linked to the location of health facilities in the country. Multivariate logistic regression was used to examine the influence of distance to the nearest health facility and health facility density, in addition to other covariates, on modern ontraceptive use and unmet need. Overall, the prevalence of modern contraceptive use and unmet need among women aged 15-49 in Kenya was 42.1% and 19.7% respectively. Among the respondents who lived more than 5 km from the nearest health facility modern contraceptive use was significantly less likely compared to women resident 5 km or less from the nearest health facility. Women from counties with higher health facility density were 53% more likely to use modern contraceptives compared to women in counties with low health facility density. Distance and health facility density in the county were not significantly associated with unmet need. Physical access to health facilities is an important determinant of modern contraceptive use and unmet need in Kenya. Strategies should be developed in underserved counties to mitigate the challenge of distance to health facilities, such as delivering services by outreach and mobile facilities. […]

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Abstract

The study examines the relationship between orphanhood status and nutritional status and food security among children living in the rapidly growing and uniquely vulnerable slum settlements in Nairobi, Kenya. The study was conducted between January and June 2007 among children aged 6–14 years, living in informal settlements of Nairobi, Kenya. Anthropometric measurements were taken using standard procedures and z scores generated using the NCHS/WHO reference. Data on food security were collected through separate interviews with children and their caregivers, and used to generate a composite food security score. Multiple regression analysis was done to determine factors related to vulnerability with regards to food security and nutritional outcomes. The results show that orphans were more vulnerable to food insecurity than non-orphans and that paternal orphans were the most vulnerable orphan group. However, these effects were not significant for nutritional status, which measures long-term food deficiencies. The results also show that the most vulnerable children are boys, those living in households with lowest socioeconomic status, with many dependants, and female-headed and headed by adults with low human capital (low education). This study provides useful insights to inform policies and practice to identify target groups and intervention programs to improve the welfare of orphans and vulnerable children living in urban poor communities. […]

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