Exposure to violence, adverse life events and the mental health of adolescent girls in Nairobi slums.

INTRODUCTION: Mental health problems rank among the leading causes of disability among young people globally. Young people growing up in urban slums are exposed to adverse childhood experiences, violence, and other adversities. There is limited research on how exposure to violence and adverse life events influence adolescents' mental health in urban poor settings. This study examines the associations between exposure to violence, adverse life events and self-reported depression in the slums of Nairobi. METHODS: This study draws on data collected from 2106 adolescent girls aged 12-19 years who were interviewed in the third wave of the Adolescent Girls Initiative Kenya (AGI-K). Mental health was measured using the Patient Health Questionnaire (PHQ 9). Frequency distributions, bivariate chi-squared analysis and multi-variate regression models were computed to identify factors that are independently associated with depression. RESULTS: About 13.3% of girls had symptoms of depression based on PHQ 9, 22% reported physical or sexual violence in the past year and about 47% of girls reported exposure to adverse life events in the family in the past year. After adjusting for the effects of socio-demographic factors, exposure to physical violence (AOR = 2.926, 95% CI 2.175-3.936), sexual violence (AOR = 2.519, 95% CI 1.637-3.875), perception of neighborhood safety (AOR = 1.533, 95% CI 1.159-2.028) and experience of adverse life events (AOR = 1.326, 95% CI 1.002-1.753) were significantly associated with self-reported depression. The presence of social support moderated the relationship between violence and mental health by reducing the strength of the association between violence and mental health in this setting. CONCLUSION: Given the magnitude of violence victimisation, adverse life events and depressive symptoms, there is a need to design interventions that reduce exposure to violence and provide psychosocial support to adolescents exposed to adverse events in urban slums in Nairobi.

Maternal Education and Immunization Status Among Children in Kenya.

Child morbidity and mortality due to infectious diseases continues to be a major threat and public health concern worldwide. Although global vaccination coverage reached 90 % for diphtheria, tetanus and pertussis (DTP3) across 129 countries, Kenya and other sub-Saharan countries continue to experience under-vaccination. The purpose of this study was to examine the association between maternal education and child immunization (12-23 months) in Kenya. This study used retrospective cross-sectional data from the 2008-2009 Kenya Demographic and Health Survey for women aged 15-49, who had children aged 12-23 months, and who answered questions about vaccination in the survey (n = 1,707). The majority of the children had received vaccinations, with 77 % for poliomyelitis, 74 % for measles, 94 % for tuberculosis, and 91 % for diphtheria, whooping cough (pertussis), and tetanus. After adjusting for other covariates, women with primary, secondary, and college/university education were between 2.21 (p < 0.01) and 9.10 (p < 0.001) times more likely to immunize their children than those who had less than a primary education. Maternal education is clearly crucial in ensuring good health outcomes among children, and integrating immunization knowledge with maternal and child health services is imperative. More research is needed to identify factors influencing immunization decisions among less-educated women in Kenya.

Association between domestic violence and HIV serostatus among married and formerly married women in Kenya.

The prevalence of both domestic violence (DV) and HIV among Kenyan women is known to be high, but the relationship between them is unknown. Nationally representative cross-sectional data from married and formerly married (MFM) women responding to the Kenya Demographic and Health Survey 2008/2009 were analyzed adjusting for complex survey design. Multivariable logistic regressions were used to assess the covariate-adjusted associations between HIV serostatus and any reported DV as well as four constituent DV measures: physical, emotional, sexual, and aggravated bodily harm, adjusting for covariates entered into each model using a forward stepwise selection process. Covariates of a priori interest included those representing marriage history, risky sexual behavior, substance use, perceived HIV risk, and sociodemographic characteristics. The prevalence of HIV among MFM women was 10.7% (any DV: 13.1%, no DV: 8.6%); overall prevalence of DV was 43.4%. Among all DV measures, only physical DV was associated with HIV (11.9%; adjusted odds ratio: 2.01, p <.05). Efforts by the government and women's groups to monitor and improve policies to reduce DV, such as the Sexual Offences Act of 2006, are urgently needed to curb HIV, as are policies that seek to provide DV counseling and treatment to MFM women.

Delaying sexual debut as a strategy for reducing HIV epidemic in Kenya.

The study purpose was to determine the association between sexual debut and HIV sero-status, and factors contributing to a positive HIV sero-status. Retrospective cross-sectional data from the Kenya Demographic and Health Survey-2003 were used. Data on women aged 15-49 (n = 3,273) and men aged 15-54 (n = 2,917) accepting HIV testing were retained from three datasets. Stata version 10.1 was used for analyses, p < 0.05. Nine percent of women and 5% of men tested positive for HIV, of whom 46% and 49%, p < 0.001 were aged 16-21 respectively. After adjusting for confounding, women and men who had sexual debut aged 16-21 were 2.31 (95% CI: 1.52-3.51), p < 0.001 and 1.83 (95% CI: 1.07-3.13), p < 0.05 times more likely to test positive for HIV compared to those who never had sex respectively. Early sexual debut continues to be a major risk factor for acquiring HIV infection later in life, suggesting earlier interventions could have a major impact towards fighting the disease.

Effect of mother's education on child's nutritional status in the slums of Nairobi.

BACKGROUND: Malnutrition continues to be a critical public health problem in sub-Saharan Africa. For example, in East Africa, 48 % of children under-five are stunted while 36 % are underweight. Poor health and poor nutrition are now more a characteristic of children living in the urban areas than of children in the rural areas. This is because the protective mechanism offered by the urban advantage in the past; that is, the health benefits that historically accrued to residents of cities as compared to residents in rural settings is being eroded due to increasing proportion of urban residents living in slum settings. This study sought to determine effect of mother's education on child nutritional status of children living in slum settings. METHODS: Data are from a maternal and child health project nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). The study involves 5156 children aged 0-42 months. Data on nutritional status used were collected between October 2009 and January 2010. We used binomial and multiple logistic regression to estimate the effect of education in the univariable and multivariable models respectively. RESULTS: Results show that close to 40 % of children in the study are stunted. Maternal education is a strong predictor of child stunting with some minimal attenuation of the association by other factors at maternal, household and community level. Other factors including at child level: child birth weight and gender; maternal level: marital status, parity, pregnancy intentions, and health seeking behaviour; and household level: social economic status are also independently significantly associated with stunting. CONCLUSION: Overall, mothers' education persists as a strong predictor of child's nutritional status in urban slum settings, even after controlling for other factors. Given that stunting is a strong predictor of human capital, emphasis on girl-child education may contribute to breaking the poverty cycle in urban poor settings.

Association between education and domestic violence among women being offered an HIV test in urban and rural areas in Kenya.

The objective of this study was to examine the association between education and domestic violence among women being offered an HIV test in urban and rural areas in Kenya. A sample selection of women who experienced physical (n = 4,308), sexual (n = 4,309), and emotional violence (n = 4,312) aged 15 to 49 allowed for the estimation of the association between education and domestic violence with further analysis stratified by urban and rural residence. The main outcome of interest was a three-factor (physical, sexual, and emotional) measure for violence with the main predictor being education. Nearly half of all domestic violence, physical (46%), sexual (45%), and emotional (45%) occurred among women aged 15 to 29. After adjusting for confounding variables, women who resided in urban areas and had a postprimary/vocational/secondary and college/university education were 26% (OR = 0.74, 95% CI: [0.64, 0.86]), p < .001 and 22% (OR = 0.78, 95% CI: [0.66, 0.92]), p < .01 less likely to have experienced physical violence compared to those who had a primary education respectively. This was 17% (OR = 0.83, 95% CI: [0.73, 0.94]), p < .01 and 17% (OR = 0.83, 95% CI: [0.72, 0.96]), p < .05 less likely among women who resided in rural areas. A surprising finding was that women residing in rural areas with less than a primary education were 35% less likely to have experienced sexual violence (OR = 0.65, 95% CI: [0.43, 0.99]), p < .01 compared to those who had a primary education. These findings suggest that physical, sexual, and emotional violence were prevalent in Kenya among married and formerly married women. This study indicates that more research is needed to understand factors for HIV/AIDS among Kenyan women who have specifically tested positive for HIV or identified as AIDS-positive and the implications for women's health.

Communicating HIV/AIDS through African American churches in North Carolina: implications and recommendations for HIV/AIDS faith-based programs.

This study explores HIV/AIDS communication strategies among church leaders at predominately African American churches in a metropolitan city and surrounding areas in North Carolina. The church leaders contacted for the study are members of an interfaith-based HIV/AIDS program. The researchers used semi-standardized interviews to explore how church leaders address HIV/AIDS in the church. The findings indicate that the seven church leaders who participated in the study use a variety of communication channels to disseminate HIV/AIDS information for congregants and their surrounding communities, which include both interpersonal and mass media.