Factors influencing immunisation coverage in Mathare Valley, Nairobi.

OBJECTIVE: To determine the factors that influence immunisation coverage. DESIGN: Cross section destrictive study. SETTING: Mathare valley slums in Central district of Nairobi, Kenya. SUBJECTS: Seven hundred and twelve children aged 12-23 months. RESULTS: Access to immunisation services was excellent at 95.6%. However, utilisation of immunisation services was found to be suboptimal as indicated by the low fully immunised child (FIC) percentage of 69.2% and the high drop out rate between the first and third Pentavalent vaccine coverage by card or history (12.0%). The immunisation status of the study population is significantly influenced by the maternal age (p-value < 0.001), ethnicity (p-value 0.009) and presence of child welfare card at home (p-value < 0.001). Factors that contribute to the low immunisation coverage include ignorance on need for immunisations and on return dates, fear of adverse events following immunisation, negative attitude of health care providers and missed opportunities. CONCLUSION: The immunisation coverage in the area is low. The immunisation services are accessible but utilisation is poor.

What do family planning clients and university students in Nairobi, Kenya, know and think about emergency contraception?

Currently, emergency contraception is seldom used in Kenya. As part of a larger study designed to provide insight into the possible roles for the method in Kenya, we assessed the knowledge of and attitudes towards emergency contraception in two groups of potential users, and we focus on these data specifically in this paper. We interviewed clustered samples of clients at ten family planning clinics in Nairobi (n = 282) and conducted four focus group discussions with students at two universities in Kenya (n = 42). Results show that despite relatively low levels of awareness and widespread misinformation, when the method was explained, both clients and students expressed considerable interest, but also expressed some health and other concerns.

Assessing community attitude towards home-based care for people with AIDS (PWAs) in Kenya.

This paper presents data on an assessment of community attitudes toward HIV/AIDS and home based care. The findings indicate that due to inadequate information about the disease and care expectations, people were ambivalent toward the sick and in some instances out-right rejection prevailed. This formed the basis for their preference for institutional based care as opposed to home based care. This was further compounded by the economic status of the household/family. Sheer poverty militates against providing adequate home care in as much as families may be willing to do so. It also confirms that one may perhaps be too taken in by the romanticized idea of unswerving community support. This may further relegate the burden to the primary unit, the family and especially the women who ultimately carry the load with limited resources. This emphasizes the need to initially share the issue with the community in order to work out the mechanisms that will lessen the burden of, and facilitate home care. Training in the care of AIDS patients is crucial yet lacking at the family and community level. Whereas care, counseling and social support are particularly important prerequisites for home-based care, these were conspicuously lacking. Very few caregivers had appropriate training and were worried about their lack of knowledge and yet they had to care for patients. It was evident that they lacked a framework that would provide the capacity to facilitate home care. Such a framework would bridge the gap between the noble concept of home-based care and the realities of home based care.

Emergency contraception in Nairobi, Kenya: knowledge, attitudes and practices among policymakers, family planning providers and clients, and university students.

To gauge knowledge, attitudes, and practices about emergency contraception in Nairobi, Kenya, we conducted a five-part study. We searched government and professional association policy documents, and clinic guidelines and service records for references to emergency contraception. We conducted in-depth interviews with five key policymakers, and with 93 family planning providers randomly selected to represent both the public and private sectors. We also surveyed 282 family planning clients attending 10 clinics, again representing both sectors. Finally, we conducted four focus groups with university students. Although one specially packaged emergency contraceptive (Postinor levonorgestrel tablets) is registered in Kenya, the method is scarcely known or used. No extant policy or service guidelines address the method specifically, although revisions to several documents were planned. Yet policymakers felt that expanding access to emergency contraception would require few overt policy changes, as much of the guidance for oral contraception is already broad enough to cover this alternative use of those same commodities. Participants in all parts of the study generally supported expanded access to emergency contraception in Kenya. They did, however, want additional, detailed information, particularly about health effects. They also differed over exactly who should have access to emergency contraception and how it should be provided.

PIP: A five-part study was conducted to gauge knowledge, attitudes, and practices about emergency contraception (EC) among policymakers, family planning providers and clients, and university students in Nairobi, Kenya. Government and professional association policy documents, and clinic guidelines and service records were searched for references to EC. In-depth interviews were conducted with 5 key policymakers, and with 93 family planning providers randomly selected to represent both the public and private sectors. Furthermore, 282 family planning clients attending 10 clinics were also surveyed and four focus groups were conducted with university students. Although one specially packaged EC was registered in Kenya, the method was scarcely known or used. No extant policy or service guidelines address the method specifically, although revisions to several documents were planned. Yet policymakers felt that expanding access to EC would require few overt policy changes, as much of the guidance for oral contraception was already broad enough to cover this alternative use of those same commodities. Participants in all parts of the study generally supported expanded access to EC in Kenya. They did, however, want additional detailed information, particularly on the health effects of EC. They also differed on who should have access to EC and how it should be provided.

Sexual behaviour in Kenya: implications for sexually transmitted disease transmission and control.

Sexual behaviour in Kenya in relation to STD transmission was investigated with a view to forming a basis for the more rational design of STD/HIV control interventions. Questionnaires were administered to a sample of 762 men and women attending eight health facilities in two urban centres. Equal numbers of STD patients (cases) and non-STD related clinic attenders (clinic controls) were selected, matched by gender and clinic. Another sample of 427 men and women was obtained from a random sampling of households in a slum area in Nairobi (community controls). Male STD patients who were unmarried, or married but living apart from their wives, reported a higher mean number of sex partners in the previous three months than did male clinic or community controls. Unmarried female STD patients reported a higher mean number of sex partners in the previous three months than did unmarried female clinic or community controls. Both male and female STD patients were more likely to report having been involved in commercial sex transactions in the previous three months than clinic or community controls. Considerable heterogeneity in sexual behaviour was apparent. In multivariate analysis, the most important predictor of STD acquisition for both men and women was the number of reported sex partners in the previous three months. In addition, for men only, marital status (unmarried, or married but living apart from their wives) and purchasing sex were significant predictors of being an STD patient. These data confirm the importance of commercial sex in STD transmission, and suggest that men play a bridging role between female sex workers and the general population of women.(ABSTRACT TRUNCATED AT 250 WORDS)

Health care-seeking behavior related to the transmission of sexually transmitted diseases in Kenya.

OBJECTIVES: The purpose of this study was to identify health-care seeking and related behaviors relevant to controlling sexually transmitted diseases in Kenya. METHODS: A total of 380 patients with sexually transmitted diseases (n = 189 men and 191 women) at eight public clinics were questioned about their health-care seeking and sexual behaviors. RESULTS: Women waited longer than men to attend study clinics and were more likely to continue to have sex while symptomatic. A large proportion of patients had sought treatment previously in both the public and private sectors without relief of symptoms, resulting in delays in presenting to study clinics. For women, being married and giving a recent history of selling sex were both independently associated with continuing to have sex while symptomatic. CONCLUSIONS: Reducing the transmission of sexually transmitted diseases in Kenya will require improved access, particularly for women, to effective health services, preferably at the point of first contact with the health system. It is also critical to encourage people to reduce sexual activity while symptomatic, seek treatment promptly, and increase condom use.

Family planning in Siaya district, western Kenya: an analysis of factors influencing fertility levels.

PIP: The use of family planning services in the Siaya district of Kenya is analyzed using data collected in 1988 on some 200 randomly selected women. The emphasis is on the factors affecting contraceptive acceptance.^ieng