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Public Health in Africa: What is New—The Context, The Gains, the Losses, The Renewed Public Health, and the Way Forward
(International Society of Nephrology, 2005) Kaseje, Dan; Juma, Pamela A. ; Oindo, Missie
Congenital Malformations among Newborns in Kenya
(African Journal of Food Agriculture, Nutrition and Development, 2009) Muga, R. O.; Mumah, S. C. J.; Juma, Pamela A.
Available literature suggests that congenital malformations are a major cause of prenatal infant deaths and postnatal physical defects [1, 2]. Therefore, a study was conducted to determine the patterns and incidence of congenital malformations at birth in newborns in Kenya and thereby analyze associated predisposing factors in their mothers. This single cross-sectional survey adopted the quasi-experimental study design to investigate a total of 7,355 consecutive births at the maternity unit of Kenyatta National Referral Hospital over a period of uninterrupted 12 months beginning 8th September to 7th September of the following year. Data collection involved clinical examination of the malformed newborns for final diagnosis using a standard proforma. The study included a control group of new born babies selected systematically among babies who were born during the same study period but had no recognizable defects at birth (n=210). These included normal babies delivered immediately after the malformed newborns. The experimental group comprised the malformed babies (n=207). Mothers were also interviewed for demographic information and data on life style and behavioral risk factors. In this paper only the results of the experimental group are described. A total of 207 malformations were documented. Results showed overall incidence of externally discernible malformations of 28.1 per 1000 total births (28.1/1000). The incidence of major malformations was 15/1000 births. Malformations of musculoskeletal system were the most frequently observed, accounting for 33.9% of all the major malformations, followed by malformations of the central nervous system (28.6%). Polydactyl was the most common single malformation with an incidence of 10/1000 total births. Neural tube defects (with an overall incidence of 4.6/1000 births) and chromosomal disorders were also common. On the overall, congenital malformations occurred in proportions that were comparable to other findings in Africa and other parts of the world. These findings highlight the need for stepping up nutritional prevention efforts, for instance, folic acid supplements; strengthening surveillance to monitor trends; and the establishment of a genetic centre in Kenya in order to strengthen local capacity for chromosomal studies, prenatal diagnosis, and genetic counseling on these complex issues.
People are Creating Policy up There, they are not Coming Down': Nurses' Views on The Expansion of Routine Provider-Initiated HIV Testing and Counselling in Nairobi, Kenya.
(eCommons, 2009) Ndirangu, Wambui Eunice; Evans, Catrin
In this report, we present selected findings from an exploratory piece of qualitative research on HIV testing that was undertaken in 2007-2008 with nurses in Nairobi, Kenya. At the same time, we share our own story of how this research came about and how NHIVNA research funding was able to lay the foundations for a larger study that will hopefully give voice to patients and HIV nurses in Nairobi and will develop HIV nursing research capacity in the country.
The Importance of HIV Specialist Services for African Women Living with HIV in Nottingham: Results of a Qualitative Study
(eCommons, 2009) Ndirangu, Wambui Eunice; Evans, Catrin
his article reports the results of a qualitative study of the experiences of African women living with HIV in Nottingham, UK. Globally, sub-Saharan Africa is the region most severely affected by the HIV pandemic [1]. This pattern is also reflected in the UK where African migrants make up 27% of those diagnosed with HIV despite the fact that they constitute less than 1% of the population [2–4]. Healthcare staff play a central role in meeting the prevention and care needs of people living with HIV/AIDS [5]. In contexts of increasing migration, health workers are called upon to recognise the diverse cultural, social, economic and political histories of their patients, and to understand how these interface with their current living situation, including their HIV-related health and treatment needs [6]. Relatively little research has been conducted to investigate the health experiences of migrant populations living with HIV in the UK, or on their patterns of access to, and utilisation of, HIV treatment and care [7]. Findings from the available, but limited, studies indicate that African migrants tend to present later than other population groups for HIV testing and treatment [8]. This is attributed to a number of obstacles to seeking or accessing care, including individual/community characteristics (such as AIDS-associated stigma, lack of perceived risk and denial), and factors associated with service and welfare provision in the host country – such as perceived discrimination, language and cultural differences, financial constraints and uncertain legal/immigration status [8–10]. Migrant African communities in the UK have traditionally congregated in London, where a large range of HIV specialist medical and communitybased services are available, and where material and social resources can be accessed through existing social networks. It is estimated that 81% of HIV-infected Africans live in London [4]. This situation is slowly changing however, attributed in part to the Government’s policy of ‘dispersal’ whereby, since 1999, asylum seekers have been ‘dispersed’ to locations across the country. Questions have been raised as to whether HIV services outside the capital are able to provide specialist care that is appropriate and accessible for African migrant groups. Very little research has been done, however, to explore the HIV NURSING • SPRING 2009 experiences of HIV-positive Africans living outside London [10–12].
Experiences of African Immigrant Women Living with HIV in the U.K.: Implications for Health Professionals.
(J Immigrant Minority Health, 2009) Ndirangu, Wambui Eunice; Catrin, Evans
In the U.K. immigrant women from Africa constitute an increasingly large proportion of newly diagnosed cases of HIV. A significant minority of these are refugees and asylum seekers. Very little is known about their experiences of living with HIV/AIDS, their psychosocial needs or their views of health care provision. This paper reports the results of a qualitative study that explored these issues by interviewing eight African women living with HIV in the British city of Nottingham. Women’s ability to live positively with HIV was found to be strongly shaped by their migration history, their legal status, their experience of AIDS-related stigma and their Christian faith. Significantly, health services were represented as a safe social space, and were highly valued as a source of advice and support. The findings indicate that non-judgemental, personalised health care plays a key role in encouraging migrant African women to access psychosocial support and appropriate HIV services.
A Review of Leishmaniasis in Eastern Africa.
(Elsevier, 2009-03) Ngure, Peter Kamau; Ng'ang'a, Zipporah W.; Rukunga, Geoffrey; Kimutai, Albert; Tonui, Willy K.
The review presents the epidemiology of leishmaniasis in the Eastern Africa region. We searched PUB MED and MEDLINE with several key words-namely, “leishmaniasis”;“cutaneous”, “diffuse cutaneous”, “mucosal”, and “visceral leishmaniasis”; “kala azar”, and “post kala azar dermal leishmaniasis”, -for recent clinical and basic science articles related to leishmaniasis in countries in the Eastern Africa region. Poverty, wars, conflicts and migration have significantly aggravated leishmaniases in Eastern Africa. Of particular concern is the increasing incidence of Leishmania-HIV co-infection in Ethiopia where 20∼40% of the persons affected by visceral leishmaniasis are HIV-co-infected. Sudan has the highest prevalence rate of post kala-azar dermal leishmaniasis(PKDL) in the world, a skin complication of visceral leishmaniasis(VL) that mainly afflicts children below age ten. In view of its spread to previously non-endemic areas and an increase in imported cases, leishmaniasis in Eastern Africa should be considered a health emergency.
Implementing Routine Provider Initiated HIV Testing in Public Healthcare Facilities in Kenya: A Qualitative Descriptive Study of Nurses’ Experiences.
(AIDS Care., 2011) Ndirangu, Wambui Eunice; Catrin, Evans
Routine 'provider-initiated testing and counselling' (PITC) for HIV has been implemented amidst concern over how consent, confidentiality and counselling (the 3C’s) can be maintained in underresourced health care settings. In Kenya, PITC has been rolled out since 2005, HIV prevalence is 7.1% and over 86% of adults have not been tested. Kenyan nurses are the main cadre implementing PITC but little is known about their experiences of incorporating HIV testing into everyday practice and the challenges faced in maintaining the 3’Cs within their work environments. This study aimed to explore these issues and adopted a qualitative multi-method design using a convenience sampling approach. Two focus group discussions (total n=12) and 13 in-depth individual interviews were For Peer Review Only undertaken with nurses from 11 different public health care facilities in Nairobi and its surrounding areas (including in- and out-patient settings). Data were analysed thematically. Nurses identified a range of personal, client and health system challenges in the everyday application of PITC. These included: (i) the contradictions of normalising a highly stigmatised disease and the difficulty of providing client centred care within a routinised and target oriented work culture; (ii) the challenge of dealing with ethically complex client situations in which the principles of the 3C’s could be difficult to uphold; and, (iii) lack of time, resources, space and recognition within workplace environments (especially in-patient settings) that, likewise, led to problems with maintaining the 3C’s. In-patient nurses in particular identified problems associated with testing in a multi-disciplinary context, suggesting that other health professionals appeared to routinely flout the PITC guidelines. In conclusion, this study shows that the process of translating policy into practice is invariably complex and that more research is needed to explore PITC practices, particularly in in-patient settings. Nurses require supervision and support to negotiate the challenges and to fulfil their roles effectively.
A Randomized Trial of Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine In The Treatment of Uncomplicated Malaria among Children in Western Kenya
(Malaria Journal, 2013) Onyango, Peter; McMorrow, Meredith; Otieno, Kephas; Agarwal, Aarti; Odero, Christopher; Williamson, John; Kariuki, Simon; Kachur, Stephen Patrick; Slutsker, Laurence; Desai, Meghna
Background: Artemether-lumefantrine (AL) was adopted as first-line treatment for uncomplicated malaria in Kenya in 2006. Monitoring drug efficacy at regular intervals is essential to prevent unnecessary morbidity and mortality. The efficacy of AL and dihydroartemisinin-piperaquine (DP) were evaluated for the treatment of uncomplicated malaria in children aged six to 59 months in western Kenya. Methods: From October 2010 to August 2011, children with fever or history of fever with uncomplicated Plasmodium falciparum mono-infection were enrolled in an in vivo efficacy trial in accordance with World Health Organization (WHO) guidelines. The children were randomized to treatment with a three-day course of AL or DP and efficacy outcomes were measured at 28 and 42 days after treatment initiation. Results: A total of 137 children were enrolled in each treatment arm. There were no early treatment failures and all children except one had cleared parasites by day 3. Polymerase chain reaction (PCR)-uncorrected adequate clinical and parasitological response rate (ACPR) was 61% in the AL arm and 83% in the DP arm at day 28 (p = 0.001). PCR-corrected ACPR at day 28 was 97% in the AL group and 99% in the DP group, and it was 96% in both arms at day 42. Conclusions: AL and DP remain efficacious for the treatment of uncomplicated malaria among children in western Kenya. The longer half-life of piperaquine relative to lumefantrine may provide a prophylactic effect, accounting for the lower rate of re-infection in the first 28 days after treatment in the DP arm.
Ethical Challenges that Arise at The Community Interface of Health Research: Village Reporters’ Experiences in Western Kenya.
(Developing World Bioethics, 2013) Onyango, Peter; Chantler, Tracey; Otewa, Faith; Okoth, Ben; Odhiambo, Frank; Parker, Michael; Geissler, Wenzel Paul
Community Engagement (CE) has been presented by bio-ethicists and scientists as a straightforward and unequivocal good which can minimize the risks of exploitation and ensure a fair distribution of research benefits in developing countries. By means of ethnographic fieldwork undertaken in Kenya between 2007 and 2009 we explored how CE is understood and enacted in paediatric vaccine trials conducted by the Kenyan Medical Research Institute and the US Centers for Disease Control (KEMRI/CDC). In this paper we focus on the role of paid volunteers who act as an interface between villagers KEMRI/CDC. Village Reporters’ (VRs) position of being both with the community and with KEMRI/CDC is advantageous for the conduct of trials. However it is also problematic in terms of exercising trust, balancing allegiances and representing community views. VRs role is shaped by ambiguities related to their employment status and their dual accountability to researchers and their villages. VRs are understandably careful to stress their commitment to self-less community service since it augments their respectability at community level and opens up opportunities for financial gain and self-development. Simultaneously VRs association with KEMRI/CDC and proximity to trial participants requires them to negotiate implicit and explicit expectations for material and medical assistance in a cultural setting in which much importance is placed on sharing and mutuality. To ensure continuity of productive interactions between VRs, and similar community intermediaries, and researchers, open discussion is needed about the problematic aspects of relational ethics, issues concerning undue influence, power relations and negotiating expectations.
Utilization of Stadardized Cervical Cancer Screening Services among Health Care Workers in Selected Health Facilities in Machakos County-Kenya.
(Kenyatta University, 2014) Nzioka, Agnes Wavinya
Cancer of the cervix is the second most common reproductive tract cancer among women globally and the leading cause of death in developing countries with large inequalities in utilization of standardized cervical cancer screening services. Standardized cervical cancer screening services utilization among health care workers is equally uneven and rarely documented in developing countries. In Kenya, cervical cancer accounts for 8-20% of all cancer cases and this is projected to double by 2020.Kenya's Cervical cancer screening services coverage is haphazard with standardized cervical cancer screening services only found in designated sites .The main objective of this study will be to assess the utilization of standardized cervical cancer screening services among health care workers in selected health facilities in Machakos County. This study will be descriptive cross- sectional in design. Reconnaissance survey was done to identify health facilities offering standardized cervical cancer screening services in Machakos County.Only 5 out of 157 health facilities offer standardized cervical cancer screening services, All these five health facilities will be selected for the study due to small sample size.Cluster sampling will be done to sample different group/cadres of health care workers in those selected health facilities Random sampling will be used to select individual participants for the study Study population will be female health care workers aged 18-65 years working in the selected health facilities in Machakos County whereby a sample size of 316 respondents will be randomly selected for this study. Study objectives will be ;to establish the proportion of health care workers utilizing cervical cancer screening services in selected health facilities in Machakos County, to determine individual attributes influence on utilization of cervical cancer screening services among the health care workers in selected health facilities in Machakos County, to establish service provider attributes' influence on utilization of cervical cancer screening services among health care workers in selected health facilities in Machakos County, to find out facility attributes influence on utilization of cervical cancer screening services among health care workers in selected health facilities in Machakos County Inclusion criteria will be health care workers aged 18-65 years working in selected health facilities in Machakos County willing to participate in this study. Exclusion criteria will be eligible health care workers who will be out of the health facility, or terminally ill, at the time of data collection Research instruments to be used will be Self administered questionnaires Qualitative data will be coded appropriately and then categorized as per emerging themes. The quantitative data will be cleaned and coded then entered into SPSS version 17.0 program for data management. The study outcome will be to improve early screening utilization rates and quality of life among female health care workers, and contribute to the body of knowledge. Feedback and recommendations will be given to stake holders to include the hospitals' administration, the health care workers in Machakos County. Research findings will further inform the national program to corroborate the findings of the current study, and work towards planning successful interventions specifically tailored to this population.
Policy Challenges Facing Integrated Community Case Management in Sub-Saharan Africa
(Tropical Medicine and International Health, 2014-07) Cliff, Julie; Bennett, Sara; George, Asha; Rodriguez, Daniela; Shearer, Jessica; Diallo, Brahima; Konate, Mamadou; Dalglish, Sarah L.; Juma, Pamela A.; Namakhoma, Ireen; Banda, Hastings; Chilundo, Baltazar; Mariano, Alda
objective To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. methods Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. results Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. conclusions iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies.
Kenyan Nurses Involvement in National Policy Development Processes
(Nursing Research and Practice, 2014-10) Spitzer, Denise; Juma, Pamela A.; Edwards, Nancy
The aim of this study was to critically examine how nurses have been involved in national policy processes in the Kenyan health sector. The paper reports qualitative results from a larger mixed method study. National nonnursing decision-makers and nurse leaders, and provincial managers as well as frontline nurse managers from two Kenyan districts were purposefully selected for interviews. Interviews dealt with nurses' involvement in national policy processes, factors hindering nurses' engagement in policy processes, and ways to enhance nurses' involvement in policy processes. Critical theory and feminist perspectives guided the study process. Content analysis of data was conducted. Findings revealed that nurses' involvement in policy processes in Kenya was limited. Only a few nurse leaders were involved in national policy committees as a result of their positions in the sector. Critical analysis of the findings revealed that hierarchies and structural factors as well as nursing professional issues were the primary barriers constraining nurses' involvement in policy processes. Thus, there is need to address these factors both by nurses themselves and by nonnursing decision makers, in order to enhance nurses engagement in policy making and further the contribution to quality of services to the communities.
Why Do Women Choose Private Over Public Facilities For Family Planning Services? A Qualitative Study of Post-Partum Women in An Informal Urban Settlement in Kenya
(BMC Health Services Research, 2015) Harper, Cynthia C.; Keesara, Sirina R.; Juma, Pamela A.
Background: Nearly 40 % of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied. Methods: We conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n = 61) to explore decision-making about contraceptive use after delivery, including facility choice. Results: When seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality. Conclusion: Women believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care.
Integrated Community Case Management for Childhood Illnesses: Explaining Policy Resistance in Kenya
(Health Policy and Planning, 2015) Bennett, Sara; Juma, Pamela A.; Owuor, Karen
Background: There has been a re-emphasis recently on community health workers to provide child health care services including integrated community case management for childhood illness (iCCM). This research analysed iCCM policy development in Kenya and in particular the types of decision-making criteria used by Kenyan policy-makers in considering whether to advance iCCM policy. Method: Data were collected through document reviews (n¼41) and semi-structured interviews (n¼19) with key stakeholders in iCCM policy including government officials, development partners, bilateral donors, and civil society organizations. Initial analysis was guided by the policy triangle with further analysis of factors affecting policy decision-making drawing upon a simple framework developed by Grindle and Thomas (Policy makers, policy choices and policy outcomes: the political economy of reform in developing countries. 1989; Policy Sci 22:213–48.). Findings: Policy development for iCCM has been slow in Kenya, compared with other Sub-Saharan African countries. At the time of the study, the Government had just completed the Community Health Training Manual which incorporated iCCM as a module, but this was the only formal expression of iCCM in Kenya. We found technical considerations, notably concerns about community health workers dispensing antibiotics to be a key factor slowing iCCM policy development, but this also overlapped with bureaucratic considerations, such as how the development of community health worker cadres may affect clinicians, as well as initial concerns about how an integrated approach might affect vertically oriented programs. International actors through agreements such as the Millennium Development Goals helped to get child survival onto the national policy agenda and such actors were active promoters of iCCM policy change. However international funders had not committed funding to scale-up iCCM policy, and this probably constrained their influence over iCCM policy debate. Conclusion: Kenyan actors’ concerns about iCCM underline the importance of adapting global policies to local conditions, and also generating local evidence to inform decision-making.
Evidence-Informed Policymaking in Practice: Country-Level Examples of Use of Evidence for iCCM Policy
(Health Policy and Planning, 2015-03) Bennett, Sara; Rodrıguez, Daniela C.; Shearer, Jessica; Mariano, Alda RE; Juma, Pamela A.; Dalglish, Sarah L.
Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. As countries move to adopt iCCM, it becomes important to understand how this growing evidence base is viewed and used by national stakeholders. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and uses Carol Weiss’ models of research utilization to further explain the use of evidence in these contexts. A documentary review and in-depth stakeholder interviews were conducted as part of retrospective case studies in each study country. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organization and United Nations Children’s Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. In terms of country-specific findings, Niger demonstrated both Interactive and Political models of research utilization by using iCCM to capitalize on the existing health infrastructure. Both Mozambique and Kenya exhibit Problem-Solving research utilization with different outcomes. Furthermore, the persistent quest for additional evidence suggests a Tactical use of research in Kenya. Results presented here indicate that while evidence from research studies and other contexts can be critical to policy development, local evidence is often needed to answer key policymaker questions. In the end, evidence may not be enough to overcome resistance if the policy is viewed as incompatible with national goals.
Women’s Attitudes Towards Receiving Family Planning Services From Community Health Workers in Rural Western Kenya
(African Health Sciences, 2015-03) Mukiira, Carol; Juma, Pamela A.; Mutombo, Namuunda
Background: Kenya ranks among the countries in Africa with high fertility rates. In order to reverse the trends in high fertility rates, there is need to increase uptake of family planning services particularly by use of community health workers (CHWs) in providing these services in rural areas. Objective: To describe the perceptions of women towards family planning service provision by CHWs in four rural districts of Western Kenya. It is based on baseline survey data from a three-year, rural community-based family planning project funded by The David and Lucile Packard Foundation. Methods: A cross-sectional baseline survey was conducted in Western Kenya. The data presented is part of a broader the broader survey . A survey questionnaire was administered to 1,997 women (15-49 years) but only 963 cases were valid for our analyses. Results: The findings revealed that only a third of the respondents exhibited high approval for Family Planning services from CHWs. Only four out of the thirteen variables explored showed significance on attitudes towards family planning services from CHWs. These are age, level of education, knowledge about family planning benefits and districts. Conclusion: Women’s perception towards family planning services delivered by CHWs in Western region in Kenya is quite low. To improve the demand and supply for family planning services in this region, there is need to invest a substantial amount of effort into sensitization of women on the relevance of CHWs in providing family planning services.
Effectiveness of Ng’adakarin Bamocha model in improving access to ante-natal and delivery services among nomadic pastoralist communities of Turkana West and Turkana North Sub-Counties of Kenya
(Pan African Medical Journal, 2015-04-23) Jillo, Ali Jillo; Ofware, Peter Obonyo; Njuguna, Susan; Mwaura-Tenambergen, Wanja
Introduction: Access to maternal and child health care services among the nomadic pastoralists community in Kenya and African continent in general is unacceptably low. In Turkana, only 18.1% of the women had seen a nurse or a midwife for antenatal care during pregnancy while only 1.3% of pregnant women reported delivery at health facilities in 2005. Ng’adakarin BAMOCHA model, based on migratory routes of the Turkana pastoralists and container clinics was adopted in 2007 to improve access to maternal and child health services by the nomads. Methods: A crosssectional study design was used to establish the effectiveness of Ng’adakarin BAMOCHA model on accessibility and uptake of ante-natal care and delivery services. A total of 360 households and 400 households were interviewed for pre-intervention and post-intervention respectively. The study compared the pre-intervention and post-intervention findings. Structured questionnaires and focus group discussion were used for data collection. Results: There was no improvement in the fourth ante-natal care visits between pre-intervention and post-intervention groups at 119(51.5%) and 111(41.9%) respectively (p<0.05). Knowledge of the community on the importance of ANC visits improved from 60%-72% with significance level of p<0.05. There was a significant increase 6%-17% of deliveries under a skilled health worker (p<0.05). TBA assisted deliveries increased from 7.5%- 20.2% with a p<0.05.There was significant reduction in home deliveries from 89.5%-79.5% with a p<0.05. Conclusion: The Ng’adakarin Bamocha model had a positive effect on the improving maternal health care among the nomadic pastoralist community in Turkana.
Altogether Now ... Understanding the Role of International Organizations in ICCM Policy Transfer
(Health Policy and Planning, 2015-07) Bennett, Sara; Dalglish, Sarah L; Juma, Pamela A. ; Rodrı´guez, Daniela C
Introduction Policy transfer theories explain how policy ideas move across time and geography and offer an approach to understanding waves of policy change, a common phenomenon in global health. Four primary mechanisms for the transfer of policies from global to national levels are posited: learning, coercion, socialization and competition. Methods We used six concurrent country case studies of policy change for child survival followed by a global study to analyse (1) mechanisms for policy transfer and (2) the roles of international organizations in promoting policy transfer. Our six country cases drew upon early adopters of integrated Community Case Management of Childhood Illness policy (Malawi, Niger), as well as countries that were slower to adopt due either to practical implementation challenges (Mozambique, Mali) and/or policy resistance (Burkina Faso, Kenya). In total, 145 semi-structured interviews and 283 document reviews were conducted across the six country cases, and 25 semi-structured interviews and 72 document reviews for the global study. Results Three of the four diffusion mechanisms (learning, coercion and socialization) were important in these cases, but not competition. Multiple strategies were employed by multilateral organizations to support policy transfer, such as regional meetings or academic publications, frequently serving multiple diffusion mechanisms simultaneously (e.g. both learning and socialization). In just one country case, funding conditionalities were used to press for policy change. The emphasis of policy transfer mechanisms varied between early and later adopters. Early adopters, for example, were more likely to engage in learning. International multilateral organizations were active policy transfer agents, and national policy-makers perception of them as “trusted partners” made them well suited for this role. However, on occasion their role became more that of advocates than neutral facilitators. Conclusions International actors use multiple synergistic channels to promote uptake of global health policies in low- and middle-income countries, and tailor strategies employed to country contexts.
Utilization of Day Surgery Services at Upper Hill Medical Centre and the Karen Hospital in Nairobi: the Influence of Medical Providers, Cost and Patient Awareness
(The Pan African Medical Journal, 2015-09) Odhiambo, Mildred Adhiambo; Njuguna, Susan; Waireri-Onyango, Rachel; Mulimba, Josephat; Ngugi, Peter Mungai
Introduction: Health systems face challenges of improving access to health services due to rising health care costs. Innovative services such as day surgery would improve service delivery. Day surgery is a concept where patients are admitted for surgical procedures and discharged the same day. Though used widely in developed countries due to its advantages, utilization in developing countries has been low. This study sought to establish how utilization of day surgery services was influenced by medical providers, patient awareness and cost among other factors. Methods: The study design was cross sectional with self administered questionnaires used to collect data. Data analysis was done by using statistical package for social science (SPSS) and presented as frequencies, percentages and Spearman's correlation to establish relationship among variables. Results: Medical providers included doctors, their employees and medical insurance providers. Most doctors were aware of day surgery services but their frequency of utilization was low. Furthermore, medical insurance providers approved only half of the requests for day surgery. Doctors' employees were aware of the services and most of them would recommend it to patients. Although, most patients were not aware of day surgery services those who were aware would prefer day surgery to in patient. Moreover, doctors and medical insurance providers considered day surgery to be cheaper than in patient. Conclusion: The study showed that medical providers and patient awareness had influence over day surgery utilization, though, cost alone did not influence day surgery utilization but as a combination with other factors.
Analysis of Non-Communicable Disease Prevention Policies in Five Sub-Saharan African Countries: Study Protocol
(Archives of Public Health, 2016) Oti, Samuel; Juma, Pamela A.; Mohamed, Shukri F.; Wisdom, Jennifer; Kyobutungi, Catherine
Background: The burden of non-communicable diseases (NCDs) and their risk factors is increasing in sub-Saharan Africa, and there have been calls for adopting a multi-sectoral approach in developing policies and programs to address this burden. Evidence exists largely from high-income countries on the success (and lack thereof) of multi-sectoral approach in improving population level health outcomes. In sub-Saharan Africa, there is limited research on the application and success of multi-sectoral approach in the formulation and implementation of policies aimed at prevention of non-communicable diseases. Therefore, this protocol describes a study that aims to primarily generate evidence on the extent to which multi-sectoral approach has been applied in developing policies to prevent non-communicable disease in six countries in sub-Saharan Africa –Kenya, Malawi, Nigeria, Cameroon, Togo and South Africa. Methods/Design: The study applies a multiple case study design. Data will be collated mainly through document reviews and key informant interviews with the relevant decision makers in various sectors. In each country, a detailed case study analysis will be undertaken of any policy/policies developed, adopted and implemented, aimed at implementing the World Health Organization recommended “best buys” for non-communicable disease prevention. These case studies will be conducted by research teams in each country; each team includes a senior research fellow supported by a doctoral student, and research assistants. Discussion: Uptake of the evidence generated from the case studies will be ensured by systematic engagement with policy makers in each country throughout the research process. Ultimately, a forum of experts will be convened to generate actionable recommendations on the use of multi-sectoral approach in non-communicable disease prevention policies in the region.

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