Cultural values, parenting and child adjustment in Kenya.

Children's, mothers' and fathers' reports were used to assess whether mothers' and fathers' individualism, collectivism and conformity values are significantly related to parenting behaviours and child adjustment during middle childhood. A sample of 95 children, 95 mothers and 94 fathers was recruited from Kisumu, Kenya. Our results indicated that controlling for child gender and parents' education, mothers' and fathers' higher collectivism values were associated with higher expectations regarding children's family obligations. Children of mothers who were more individualistic perceived that less was required of them in terms of family obligations. Mothers' conformity values were associated with more maternal and paternal warmth, and higher maternal expectations regarding children's family obligations, controlling for child gender and mothers' education. Mothers' education was significantly associated with more maternal and paternal warmth, more parental knowledge solicitation and higher paternal expectations regarding children's family obligations. Fathers' and mothers' individualism was associated with lower expectations regarding children's family obligations. Fathers' individualism was positively correlated with knowledge solicitation and more rules/limit-setting. Fathers' higher conformity values were correlated with more maternal warmth, more paternal warmth, more knowledge solicitation and mothers' and fathers' higher expectations regarding children's family obligations.

The Burden of Elders: Anxiety, Depression, and Personal Networks in Two African Slums.

ABSTRACT: Although anxiety and depression have been central topics for scholars and clinicians in the United States, few studies have examined their correlates in sub-Saharan Africa and none have examined large urban slums. Using face-to-face interviews in two African cities, we analyze self-reported symptoms of anxiety and depression in a community-based sample (n = 495). Ordinary least squares regression was used to analyze a variety of demographic and social predictors including sex, child-rearing, marital status, education, income, age, and neighborhood for residents of Agbogbloshie (Accra, Ghana) and Kangemi (Nairobi, Kenya). Controlling for other factors, two personal network dimensions were significant. Total network size is positively associated with symptoms of anxiety and depression in Kenya but not in Ghana. However, one factor was predictive of symptoms of anxiety and depression in both locations: the reported percentage of ties with older persons. Higher levels of anxiety and depression are associated with a larger share of older individuals in one's personal network.

Competitive Performance of Kenyan Runners Compared to their Relative Body Weight and Fat.

Body fat values obtained with various measurement methods deviate substantially in many cases. The standardised brightness-mode ultrasound method was used in 32 Kenyan elite long-distance runners to measure subcutaneous adipose tissue thicknesses at an accuracy and reliability level not reached by any other method. Subcutaneous adipose tissue forms the dominating part of body fat. Additionally, body mass (m), height (h), sitting height (s), leg length, and the mass index MI1 =0.53m/(hs) were determined. MI1 considers leg length, which the body mass index ignores. MI1 values of all participants were higher than their body mass indices. Both indices for relative body weight were within narrow ranges, although thickness sums of subcutaneous adipose tissue deviated strongly (women: 20-82 mm; men: 3-36 mm). Men had 2.1 times more embedded fasciae in the subcutaneous adipose tissue. In the subgroup with personal best times below world record time plus 10%, no correlation between performance and body mass index was found, and there was also no correlation with sums of subcutaneous adipose tissue thicknesses. Within the data ranges found here, extremely low relative body weight or low body fat were no criteria for the level of performance, therefore, pressure towards too low values may be disadvantageous.

Associations Between Perceived Material Deprivation, Parents' Discipline Practices, and Children's Behavior Problems: An International Perspective.

This study investigated the association between perceived material deprivation, children's behavior problems, and parents' disciplinary practices. The sample included 1,418 8- to 12-year-old children and their parents in China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States. Multilevel mixed- and fixed-effects regression models found that, even when income remained stable, perceived material deprivation was associated with children's externalizing behavior problems and parents' psychological aggression. Parents' disciplinary practices mediated a small share of the association between perceived material deprivation and children's behavior problems. There were no differences in these associations between mothers and fathers or between high- and low- and middle-income countries. These results suggest that material deprivation likely influences children's outcomes at any income level.

Cross-cultural effects of parent warmth and control on aggression and rule-breaking from ages 8 to 13.

We investigated whether bidirectional associations between parental warmth and behavioral control and child aggression and rule-breaking behavior emerged in 12 cultural groups. Study participants included 1,298 children (M = 8.29 years, standard deviation [SD] = 0.66, 51% girls) from Shanghai, China (n = 121); Medellín, Colombia (n = 108); Naples (n = 100) and Rome (n = 103), Italy; Zarqa, Jordan (n = 114); Kisumu, Kenya (n = 100); Manila, Philippines (n = 120); Trollhättan/Vänersborg, Sweden (n = 101); Chiang Mai, Thailand (n = 120); and Durham, NC, United States (n = 111 White, n = 103 Black, n = 97 Latino) followed over 5 years (i.e., ages 8-13). Warmth and control were measured using the Parental Acceptance-Rejection/Control Questionnaire, child aggression and rule-breaking were measured using the Achenbach System of Empirically-Based Assessment. Multiple-group structural equation modeling was conducted. Associations between parent warmth and subsequent rule-breaking behavior were found to be more common across ontogeny and demonstrate greater variability across different cultures than associations between warmth and subsequent aggressive behavior. In contrast, the evocative effects of child aggressive behavior on subsequent parent warmth and behavioral control were more common, especially before age 10, than those of rule-breaking behavior. Considering the type of externalizing behavior, developmental time point, and cultural context is essential to understanding how parenting and child behavior reciprocally affect one another.

Opportunities and peer support for aggression and delinquency during adolescence in nine countries.

This study tested culture-general and culture-specific aspects of adolescent developmental processes by focusing on opportunities and peer support for aggressive and delinquent behavior, which could help account for cultural similarities and differences in problem behavior during adolescence. Adolescents from 12 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States) provided data at ages 12, 14, and 15. Variance in opportunities and peer support for aggression and delinquency, as well as aggressive and delinquent behavior, was greater within than between cultures. Across cultural groups, opportunities and peer support for aggression and delinquency increased from early to mid-adolescence. Consistently across diverse cultural groups, opportunities and peer support for aggression and delinquency predicted subsequent aggressive and delinquent behavior, even after controlling for prior aggressive and delinquent behavior. The findings illustrate ways that international collaborative research can contribute to developmental science by embedding the study of development within cultural contexts.

Mothers' beliefs about indigenous and traditional food affordability, availability and taste are significant predictors of indigenous and traditional food consumption among mothers and young children in rural Kenya.

OBJECTIVE: To examine mothers' and young children's consumption of indigenous and traditional foods (ITF), assess mothers' perception of factors that influence ITF consumption, and examine the relationship between perceived factors and ITF consumption. DESIGN: Longitudinal study design across two agricultural seasons. Seven-day FFQ utilized to assess dietary intake. Mothers interviewed to assess their beliefs about amounts of ITF that they or their young children consumed and on factors that influence ITF consumption levels. SETTING: Seme sub-County, Kenya. PARTICIPANTS: Mothers with young children. RESULTS: Less than 60 % of mothers and children consumed ITF at time of assessment. Over 50 % of the mothers reported that their ITF consumption amounts and those of their children were below levels that mothers would have liked for themselves or for their young children. High cost, non-availability and poor taste were top three reasons for low ITF consumption levels. Mothers who identified high cost or non-availability as a reason for low levels of ITF consumption had significantly lower odds of consuming all ITF except amaranth leaves. Mothers who identified poor taste had significantly lower odds of consuming all ITF except green grams and groundnuts. Similar relationships were noted for young children's ITF consumption levels. CONCLUSIONS: A majority of the mothers reported that they and their children did not consume as much ITF as the mothers would have liked. Further studies should examine strategies to improve availability and affordability of ITF, as well as develop recipes that are acceptable to mothers and children.

Is there a "complementary feeding cultural core" in rural Kenya? Results from ethnographic research in five counties.

This investigation used data from focused ethnographic studies in five rural counties in Kenya to determine whether the concept of "special foods for infants and young children" exists in the different ethnic groups in these areas as an identifiable component of cultural beliefs and knowledge, as well as in practice, and whether they can be characterized as a "complementary feeding cultural core." The concept of "cultural core foods" refers to the set of foods that have a central role in diets of a population and, as a consequence, also have significant social and emotional components. We used the ethnographic cognitive mapping technique of "free listing" and a qualitative 24-hr recall of infants and young children (IYC) intake, with probing, to obtain data on caregivers' beliefs and behaviours. The results show that an IYC cultural food core can be identified in all of the counties. A related finding that supports the argument for an "IYC cultural core" with respect to appropriate foods for IYC is the clear cognitive consensus within sites about its content, although in practice, food insecurity and food shortage constrain household abilities to put their beliefs into practice. We conclude that interventions to improve IYC feeding in rural Kenya that build on the concept of "IYC cultural core foods" will be congruent with basic cultural ideas about managing IYC feeding and could take advantage of this cultural feature.

Perceptions on donated human milk and human milk banking in Nairobi, Kenya.

Donor human milk (DHM) is recomended as the best alternative when use of mothers' own milk is not a feasible option. Kenya has not yet established human milk banks (HMBs) for provision of safe DHM, which is free from any physical, chemical, microbiological contaminants or pathogens. This study aimed to establish the perceptions on donating and using DHM, and establishing HMBs in Kenya. Qualitative data were collected through 17 focus group discussions, 29 key informant interviews, and 25 in-depth interviews, with women of childbearing age, community members, health workers, and policy makers. Quantitative interviews were conducted with 868 mothers of children younger than 3 years. Descriptive analysis of quantitative data was performed in STATA software, whereas qualitative interviews were coded using NVIVO and analysed thematically. Majority of them had a positive attitude towards donating breast milk to a HMB (80%) and feeding children on DHM (87%). At a personal level, participants were more willing to donate their milk to HMBs (78%) than using DHM for their own children (59%). The main concerns on donation and use of DHM were personal dislikes, fear of transmission of diseases including HIV, and hygiene concerns. Ensuring safety of DHM was considered important in enhancing acceptability of DHM and successful establishment of the HMBs. When establishing HMBs, Kenya must take into consideration communication strategies to address the main concerns raised regarding the quality and safety of the DHM. The findings will contribute to the development of HMB guidelines in Kenya and other African contexts.

Parenting, culture, and the development of externalizing behaviors from age 7 to 14 in nine countries.

Using multilevel models, we examined mother-, father-, and child-reported (N = 1,336 families) externalizing behavior problem trajectories from age 7 to 14 in nine countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States). The intercept and slope of children's externalizing behavior trajectories varied both across individuals within culture and across cultures, and the variance was larger at the individual level than at the culture level. Mothers' and children's endorsement of aggression as well as mothers' authoritarian attitudes predicted higher age 8 intercepts of child externalizing behaviors. Furthermore, prediction from individual-level endorsement of aggression and authoritarian attitudes to more child externalizing behaviors was augmented by prediction from cultural-level endorsement of aggression and authoritarian attitudes, respectively. Cultures in which father-reported endorsement of aggression was higher and both mother- and father-reported authoritarian attitudes were higher also reported more child externalizing behavior problems at age 8. Among fathers, greater attributions regarding uncontrollable success in caregiving situations were associated with steeper declines in externalizing over time. Understanding cultural-level as well as individual-level correlates of children's externalizing behavior offers potential insights into prevention and intervention efforts that can be more effectively targeted at individual children and parents as well as targeted at changing cultural norms that increase the risk of children's and adolescents' externalizing behavior.

When Diabetes Confronts HIV: Biological Sub-citizenship at a Public Hospital in Nairobi, Kenya.

This article investigates how international donor policies cultivate a form of biological sub-citizenship for those with diabetes in Kenya. We interviewed 100 patients at a public hospital clinic in Nairobi, half with a diabetes diagnosis. We focus on three vignettes that illustrate how our study participants differentially perceived and experienced living with and seeking treatment and care for diabetes compared to other conditions, with a special focus on HIV. We argue that biological sub-citizenship, where those with HIV have consistent and comprehensive free medical care and those with diabetes must pay out-of-pocket for testing and treatment, impedes diabetes testing and treatment. Once diagnosed, many are then systematically excluded from the health care system due to their own inability to pay. We argue that the systematic exclusion from international donor money creates a form of biological sub-citizenship based on neoliberal economic policies that undermine other public health protections, such as universal primary health care.

To Keep this Disease from Killing You: Cultural Competence, Consonance, and Health among HIV-positive Women in Kenya.

The HIV/AIDS crisis continues in sub-Saharan Africa, where nearly 70% of infections are found. Despite recent efforts to supply antiretroviral therapy to those infected, most are not receiving medication and are forced to rely on self-management to remain healthy. In Kenya, many of those infected are women living in extreme poverty. This article presents the findings of research among poor women in Nairobi that examined the relationship between knowledge of a cultural model of self-managing HIV/AIDS, cultural consonance, and health. This biocultural study expands on earlier findings showing that knowledge of the model (competence) is a significant predictor of health by examining here how behavior consistent with that knowledge (consonance) affects health outcomes, as measured by CD4 counts, perceived stress, depressive symptoms, and recent illnesses.

Self-managing HIV/AIDS: cultural competence and health among women in Nairobi, Kenya.

Despite recent efforts to supply antiretroviral therapy, many in Africa are not receiving medication, instead relying on self-management in their attempts to remain healthy. In Kenya, the majority of those infected are women who are below the extreme poverty level. Building on research demonstrating a link between knowledge of HIV/AIDS management and the length of time HIV-positive women have lived in Nairobi, this article uses a cognitive anthropological approach that conceives of culture as shared models and explores the relationship between how well women know a cultural model of self-managing HIV/AIDS and health among women who are not receiving biomedical treatment. Outcomes include reported perceived stress, depressive symptoms, and recent illness episodes. Here, this association of competence in the shared cultural model and health among women living in extremely marginal economic conditions is explored from a biocultural perspective to better understand this relationship. Knowledge of the model is a significant predictor of better overall health even after controlling for age, education, income, marital status, internal locus of control, and how long women have known that they are HIV-positive. This article adds to the HIV/AIDS literature by quantitatively linking health to cultural knowledge among an HIV-positive population. It also contributes to the cultural consensus literature by demonstrating health benefits of cultural knowledge.

Evaluation of Measles-Mumps-Rubella Vaccination Among Newly Arrived Refugees.

OBJECTIVES: To assess US availability and use of measles-mumps-rubella (MMR) vaccination documentation for refugees vaccinated overseas. METHODS: We selected 1500 refugee records from 14 states from March 2013 through July 2015 to determine whether overseas vaccination records were available at the US postarrival health assessment and integrated into the Advisory Committee on Immunization Practices schedule. We assessed number of doses, dosing interval, and contraindications. RESULTS: Twelve of 14 (85.7%) states provided data on 1118 (74.5%) refugees. Overseas records for 972 (86.9%) refugees were available, most from the Centers for Disease Control and Prevention's Electronic Disease Notification system (66.9%). Most refugees (829; 85.3%) were assessed appropriately for MMR vaccination; 37 (3.8%) should have received MMR vaccine but did not; 106 (10.9%) did not need the MMR vaccine but were vaccinated. CONCLUSIONS: Overseas documentation was available at most clinics, and MMR vaccinations typically were given when needed. Further collaboration between refugee health clinics and state immunization information systems would improve accessibility of vaccination documentation.

Narrating sexual identities in Kenya: "Choice," value, and visibility.

This article examines the discursive construction of female same-sex sexual identities in Nairobi. We identify the discursive forces of "choice," devaluation, and invisibility as influential within Kenyan media representations of lesbian, gay, bisexual, transgender, and intersex citizens. Using creative focus groups and participant observation, we demonstrate how same-sex attracted women in Nairobi resist and rearticulate these discursive forces to assert their identity and agency as individuals and as a queer community.

Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study.

BACKGROUND: Hypertension, the leading global risk factor for mortality, is characterized by low treatment and control rates in low- and middle-income countries. Poor linkage to hypertension care contributes to poor outcomes for patients. However, specific factors influencing linkage to hypertension care are not well known. OBJECTIVE: To evaluate factors influencing linkage to hypertension care in rural western Kenya. DESIGN: Qualitative research study using a modified Health Belief Model that incorporates the impact of emotional and environmental factors on behavior. PARTICIPANTS: Mabaraza (traditional community assembly) participants (n = 242) responded to an open invitation to residents in their respective communities. Focus groups, formed by purposive sampling, consisted of hypertensive individuals, at-large community members, and community health workers (n = 169). APPROACH: We performed content analysis of the transcripts with NVivo 10 software, using both deductive and inductive codes. We used a two-round Delphi method to rank the barriers identified in the content analysis. We selected factors using triangulation of frequency of codes and themes from the transcripts, in addition to the results of the Delphi exercise. Sociodemographic characteristics of participants were summarized using descriptive statistics. KEY RESULTS: We identified 27 barriers to linkage to hypertension care, grouped into individual (cognitive and emotional) and environmental factors. Cognitive factors included the asymptomatic nature of hypertension and limited information. Emotional factors included fear of being a burden to the family and fear of being screened for stigmatized diseases such as HIV. Environmental factors were divided into physical (e.g. distance), socioeconomic (e.g. poverty), and health system factors (e.g. popularity of alternative therapies). The Delphi results were generally consistent with the findings from the content analysis. CONCLUSIONS: Individual and environmental factors are barriers to linkage to hypertension care in rural western Kenya. Our analysis provides new insights and methodological approaches that may be relevant to other low-resource settings worldwide.

Positive parenting and children's prosocial behavior in eight countries.

BACKGROUND: Research supports the beneficial role of prosocial behaviors on children's adjustment and successful youth development. Empirical studies point to reciprocal relations between negative parenting and children's maladjustment, but reciprocal relations between positive parenting and children's prosocial behavior are understudied. In this study reciprocal relations between two different dimensions of positive parenting (quality of the mother-child relationship and the use of balanced positive discipline) and children's prosocial behavior were examined in Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States. METHODS: Mother-child dyads (N = 1105) provided data over 2 years in two waves (Mage of child in wave 1 = 9.31 years, SD = 0.73; 50% female). RESULTS: A model of reciprocal relations between parenting dimensions, but not among parenting and children's prosocial behavior, emerged. In particular, children with higher levels of prosocial behavior at age 9 elicited higher levels of mother-child relationship quality in the following year. CONCLUSIONS: Findings yielded similar relations across countries, evidencing that being prosocial in late childhood contributes to some degree to the enhancement of a nurturing and involved mother-child relationship in countries that vary widely on sociodemographic profiles and psychological characteristics. Policy and intervention implications of this study are discussed.

Taking Turns or Not? Children's Approach to Limited Resource Problems in Three Different Cultures.

Some problems of resource distribution can be solved on equal terms only by taking turns. We presented such a problem to 168 pairs of 5- to 10-year-old children from one Western and two non-Western societies (German, Samburu, Kikuyu). Almost all German pairs solved the problem by taking turns immediately, resulting in an equal distribution of resources throughout the game. In the other groups, one child usually monopolized the resource in Trial 1 and sometimes let the partner monopolize it in Trial 2, resulting in an equal distribution in only half the dyads. These results suggest that turn-taking is not a natural strategy uniformly across human cultures, but rather that different cultures use it to different degrees and in different contexts.

Similarities and Differences in Maternal Responsiveness in Three Societies: Evidence From Fiji, Kenya, and the United States.

The first relationship between an infant and her caregiver, typically the mother, lays the foundation for cognitive, social, and emotional development. Maternal responsiveness and affect mirroring have been studied extensively in Western societies yet very few studies have systematically examined these caregiving features in non-Western settings. Sixty-six mother-infant dyads (7 months, SD = 3.1) were observed in a small-scale, rural island society in Fiji, a village in Kenya, and an urban center in the United States. Mothers responded similarly to infant bids overall, but differences were found across societies in the ways mothers selectively respond to affective displays. This has implications for understanding early emotion socialization as well as understanding variation in infant social ecologies across the globe.

Stigmatizing attitudes toward mental illness among primary school children in Kenya.

BACKGROUND: Literature describing stigmatizing attitudes towards people with mental illness by children in the developing world is lacking. Children's mental health issues in the Kenyan context are especially pertinent due to the increased likelihood of exposure to risk factors and the high prevalence of mental disorders. The objective of the current study was to examine socio-demographic factors associated with the endorsement of stigmatizing attitudes towards people with mental illness among Kenyan school children. METHODS: We analyzed cross-sectional survey data from 4585 primary school-aged children in standards one through seven in the Eastern Province of Kenya. We examined relationships between the endorsement of stigmatizing attitudes and age, gender, district, religion, being in the standard appropriate for one's age, and parental employment status. RESULTS: Stigma scores decreased with increasing age (ß = -0.83; 95 % CI = -0.99 to -0.67). Boys had higher stigma scores compared to girls (ß = 1.55; 95 % CI = 0.86-2.24). Students from the rural district had higher average stigma scores as compared to those from the peri-urban district (ß = 1.14; 95 % CI = 0.44-1.84). Students who were not in the standard appropriate for their age had lower stigma scores than those who were in the standard typical for their age (ß = -1.60; 95 % CI = -2.43 to -0.77). CONCLUSIONS: Stigmatizing attitudes toward the mentally ill exist among primary school children in Kenya; thus, anti-stigma interventions are needed, and our findings highlight particular subgroups that could be targeted.