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Ombija S, Wao H, Esho T. Water, sanitation, and intimate partner violence: Insights from Kibra Slums, Nairobi. J Glob Health 2024; 14:04141. [PMID: 38939947 PMCID: PMC11211967 DOI: 10.7189/jogh.14.04141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Intimate partner violence (IPV) poses significant health and social challenges for women, particularly in slums characterised by limited access to basic amenities like water and sanitation facilities. This study aimed to investigate the association between accessibility of water, sanitation and hygiene (WASH) facilities and IPV among women in Kibra, Nairobi county, Kenya. Methods A cross-sectional study design utilising a modified Demographic Health and Survey questionnaire was conducted among women aged 15-49 in Kibra slums. Data on water and sanitation accessibility and IPV experiences were collected from 1068 participants. Quantitative analysis by use of logistic regression, was conducted to assess associations between WASH accessibility and IPV. Results Among the participants, 64.0% reported experiences of IPV. Women who had access to water inside household; adjusted odds ratio (AOR) = 0.44 (95% CI = 0.31-0.64) and sanitation AOR = 0.57 (95% CI = 0.37-0.88) had decreased odds of experiencing IPV whereas reliance on external water sources such as outside pipes AOR = 18.18 (95% CI = 8.62-38.33) or vendors AOR = 14.42 (95% CI = 6.88-30.24) had heightened IPV vulnerability. Conclusions Access to clean water and sanitation is associated with reduced likelihood of women experiencing IPV in slums whereas access to water outside household is associated with increased likelihood of experiencing IPV. Connecting households with water to improve access and construction of adequate sanitation facilities may protect women against intimate partner violence in slums.
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Affiliation(s)
| | - Hesborn Wao
- African Population and Health Research Centre (APHRC), Nairobi, Kenya
| | - Tammary Esho
- Amref International University (AMIU), Nairobi, Kenya
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Balakrishnan AK, Otieno S, Dzombo M, Plaxico L, Ukoh E, Obara LM, Brown H, Musyimi C, Lincoln C, Yang LS, Witte SS, Winter SC. Socio-ecological impacts of extreme weather events in two informal settlements in Nairobi, Kenya. Front Public Health 2024; 12:1389054. [PMID: 38887261 PMCID: PMC11180900 DOI: 10.3389/fpubh.2024.1389054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
Climate change is expected to profoundly impact health and coping and widen social and environmental inequalities. People living in informal settlements are especially vulnerable to climate change as they are often located in ecologically sensitive areas more susceptible to extreme weather events (EWEs), such as floods, droughts, and heat waves. Women residing in informal settlements are especially vulnerable to climate change and related EWEs because they are more likely to experience worse health-related impacts than men but are less likely to have access to health-related services. Despite this inequality, there is a dearth of research that focuses on the impacts of EWEs on women in informal settlements. This study aims to explore the multidimensional impacts of EWEs on the daily lives of women in informal settlements through the lens of socio-ecological theory. Study data is from six monthly surveys (1 September 2022-28 February 2023) collected from a probability sample of 800 women living in two of the largest informal settlements in Nairobi, Kenya. This data is part of an ongoing longitudinal study that uses community participatory methods to investigate the effects of climate change on health and wellbeing in informal settlements by a team of 16 community health volunteers who lead data collection and provide expertise in ongoing analysis. Findings show profound impacts on women's health and wellbeing across individual, micro-, meso-, exo-, and macrosystems. These include physical and mental health, financial disruptions, property issues, social impacts, and impacts on their surrounding physical environment, such as disrupted food or water access, poor air quality, drainage issues, and safety concerns. In addition, findings highlight the critical importance of the chrono- and biosphere systems in research focused on the impacts of climate change and related EWEs among climate-vulnerable communities and marginalized populations within them.
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Affiliation(s)
| | | | | | - LaNae Plaxico
- School of Social Work, Columbia University, New York, NY, United States
| | - Ebuka Ukoh
- School of Social Work, Columbia University, New York, NY, United States
| | - Lena Moraa Obara
- Rutgers, School of Social Work, The State University of New Jersey, New Brunswick, NJ, United States
| | - Haley Brown
- School of Social Work, Columbia University, New York, NY, United States
| | - Christine Musyimi
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Chloe Lincoln
- School of Social Work, Columbia University, New York, NY, United States
| | | | - Susan S. Witte
- School of Social Work, Columbia University, New York, NY, United States
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Cox J, Raimer-Goodman L, Gatwiri C, Elliott A, Goodman M. Partner Cooperation, Conflict, Maternal Mental Health, and Parenting Behaviors in Rural Kenya: Towards a Two-Generational Understanding of Gender Transformation Benefits. INTERNATIONAL JOURNAL ON CHILD MALTREATMENT : RESEARCH, POLICY AND PRACTICE 2023; 6:555-566. [PMID: 38333764 PMCID: PMC10852061 DOI: 10.1007/s42448-023-00156-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 02/10/2024]
Abstract
Increasing partner cooperation is an established approach to reducing intimate partner violence. This strategy, known in the literature as "gender transformation," benefits mental and physical health of women and men. Less is known about the potential for gender transformation strategies to improve the nurturing context for children. We hypothesize that increasing partner cooperation, a common benefit of community-based empowerment programs, would decrease child maltreatment through reducing intimate partner conflict and improving maternal mental health. This study utilizes cohort data from women (n = 400) participating in a combined group-based microfinance program to assess potential mechanisms by which partner cooperation at T1 (June 2018) predicts less children maltreatment at T2 (June 2019). As hypothesized, partner cooperation predicts less subsequent child maltreatment-frequency of neglect, corporal punishment, physical assault, and psychological abuse in the past month. This association is mediated completely by subsequent more partner cooperation and less intimate partner conflict, maternal loneliness, and depression. Implications of this study include potential for combining multiple development areas-women's empowerment, intimate partner cooperation, mental health, and child nurturing contexts. Future study should assess these pathways in a cluster-based randomized trial, and explore how findings may inform policy and practice where these domains are less integrated.
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Affiliation(s)
- Jessica Cox
- University of Texas Medical Branch, Marvin Graves, 301 University Blvd, Galveston, TX 77552, USA
| | - Lauren Raimer-Goodman
- University of Texas Medical Branch, Marvin Graves, 301 University Blvd, Galveston, TX 77552, USA
| | | | - Aleisha Elliott
- University of Texas Medical Branch, Marvin Graves, 301 University Blvd, Galveston, TX 77552, USA
| | - Michael Goodman
- University of Texas Medical Branch, Marvin Graves, 301 University Blvd, Galveston, TX 77552, USA
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Gayawan E, Uzobo E, Ononokpono DN, Aladeniyi OB, Dake FAA. Intimate partner violence and malnutrition among women of reproductive age in Western Africa: A geostatistical analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002354. [PMID: 37939021 PMCID: PMC10631639 DOI: 10.1371/journal.pgph.0002354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
Intimate partner violence (IPV) is a public health issue, and the experience varies among population sub-groups in Africa. In the West African sub-region, IPV perpetrated against women remains high and is exacerbated by the pertaining cultural milieu. It affects women's health, wellbeing, and nutritional status. We examined the association between women's lifetime experiences of physical, sexual, and emotional IPV and undernutrition by quantifying the association at smaller geographical settings in West African countries. We used a bivariate probit geostatistical technique to explore the association between IPV and undernutrition, combining data from the latest Demographic and Health Survey conducted in ten Western African countries. Bayesian inference relies on Markov chain Monte Carlo simulation. The findings demonstrate spatial clustering in the likelihood of experiencing IPV and being underweight in the regions of Mali, Sierra Leone, Liberia and neighboring Cote d'Ivoire, Ghana, Togo, Benin, Cameroon, and Nigeria. The pattern of clustering was somewhat similar when physical violence was combined with underweight and emotional violence combined with underweight. The findings also indicate protective effects of education, wealth status, employment status, urban residence, and exposure to mass media. Further, the likelihood of experiencing IPV and the likelihood of being underweight or thin declined with age and age-gap between the woman and her partner. The findings provide insight into the location-specific variations that can aid targeted interventions, and underscore the importance of empowering women holistically, in the domains of education, socio-economic and socio-cultural empowerment, in addressing women's vulnerability to IPV and malnutrition (underweight and thinness). Furthermore, IPV prevention programmes will need to address gender inequality and cultural factors such as male dominance that may heighten women's risk of experiencing IPV.
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Affiliation(s)
- Ezra Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria
| | - Endurance Uzobo
- Department of Sociology, Niger Delta University, Wilberforce Island, Amassoma, Nigeria
| | | | | | - Fidelia A. A. Dake
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
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5
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Winter SC, Johnson L, Dzombo MN. Sanitation-related violence against women in informal settlements in Kenya: a quantitative analysis. Front Public Health 2023; 11:1191101. [PMID: 37841717 PMCID: PMC10574432 DOI: 10.3389/fpubh.2023.1191101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Approximately 3.6 billion people around the world do not have access to safe sanitation options. Those lacking access are not only at risk of diarrheal disease, other tropical diseases, and parasitic infections, they are at greater risk of experiencing violence, particularly women and girls. The burden of lack of access to safe sanitation is disproportionately experienced by women in informal settlements in lower- and middle-income countries, where violence rates tend to be higher and access to sanitation lower. Women lacking access to safe toilets often have to walk long distances to access a facility or open site or use shared toilet facilities, which increase their vulnerability to violence. Methods We explore the prevalence and multilevel factors associated with women's experiences, observations, and exposure to stories about past-year sanitation-related violence in a probability sample of 550 women in a large informal settlement in Nairobi, Kenya using chi-square tests and multivariate logistic regressions. Results Findings suggest that social/community engagement and social/cultural beliefs are important considerations for hearing about and observing sanitation-related violence, but less so experiences of sanitation-related violence. Alternatively, individual-level and technological factors may be critical factors in actual experiences of violence. Discussion Sanitation-related violence and creating an environment of safety in which women can take care of their sanitation-related needs in ways that also protect them, their families, and their communities is critical for meeting sanitation-related development agendas and goals such as Sustainable Development Goal 6.2 to achieve access to adequate and equitable sanitation and hygiene for all by 2030.
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Affiliation(s)
| | - Laura Johnson
- School of Social Work, Temple University, Philadelphia, PA, United States
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6
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Mottelson J. On the impact of urban planning in contexts with limited enforcement of building and planning regulations: A study of the urban form of planned and unplanned informal settlements in Maputo, Mozambique. PLoS One 2023; 18:e0292045. [PMID: 37768935 PMCID: PMC10538724 DOI: 10.1371/journal.pone.0292045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND More than one billion people live in informal settlements under precarious conditions. Urban planning is considered an important instrument to mitigate compromised living conditions in informal settlements. However, limited studies have investigated the long-term impact of urban planning in contexts with limited capacity to enforce building and planning regulations. The purpose of this study is to assess the long-term impact of urban planning on the development of sustainable urban form in contexts characterized by unregulated urban development. METHODS The study conducted geospatial surveys of three urban areas in Maputo, Mozambique covering adjacent planned and unplanned settlements that were established more than 40 years ago and subsequently developed with limited enforcement of building and planning regulations. High-resolution maps were produced and six urban form metrics were computed for the planned and unplanned areas respectively, providing the basis for quantitative and qualitative comparative analysis. RESULTS Although the study found signs of street encroachment and appropriation of the public space in the planned areas, the study found higher levels of built densities, higher proportions of public space, and higher average street widths in all planned areas compared to the respective neighboring unplanned areas. Furthermore, the statistical analysis consistently showed large effect sizes (Cohen's d > 0.8) of urban planning on indicators of compact city development and access conditions. CONCLUSION The results underscore that planning of street fabrics and plot layouts can enhance compact city development, improve transportation conditions, and increase the feasibility of investments in infrastructure in contexts with limited capacity to administer the urban growth.
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Affiliation(s)
- Johan Mottelson
- Institute of Architecture, Urbanism and Landscape, Royal Danish Academy, Copenhagen, Denmark
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Hassan R, Sanders T, Gichuna S, Campbell R, Mutonyi M, Mwangi P. Informal settlements, Covid-19 and sex workers in Kenya. URBAN STUDIES (EDINBURGH, SCOTLAND) 2023; 60:1483-1496. [PMID: 37273499 PMCID: PMC10230289 DOI: 10.1177/00420980211044628] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper highlights the challenges faced by female sex workers living and working in the urban informal settlements in Nairobi, Kenya, during the Covid-19 outbreak and the aftermath of the pandemic. Using data collected through phone interviews during the immediate crisis, we document the experiences of urban poor sex workers, illustrating the acute problems they faced, including precarious housing with the reality of eviction and demolition. The paper highlights the ramifications of the Covid-19 crisis for the sex industry and predominantly women working within this informal, illegal economy. Through our empirical data we illustrate how the nature of selling sex has changed for sex workers in this context, increasing risks of violence including police abuses. We argue that examining the Covid-19 crisis through the lens of one the most marginalised populations graphically highlights how the pandemic has and will continue to deepen pre-existing structural urban inequalities and worsen public health outcomes among the urban poor. Sex worker communities are often located at the intersections of structural inequalities of gender, class, race and nation and the socio-spatial fragmentations of how they live make them some of the most vulnerable in society. We close with comments in relation to sexual citizenship, exclusionary state practices and the feminisation of urban poverty.
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Affiliation(s)
| | | | | | | | - Mercy Mutonyi
- Bar Hostess Empowerment and Support Programme, Kenya
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Wambiya EOA, Gourlay AJ, Mulwa S, Magut F, Mthiyane N, Orindi B, Chimbindi N, Kwaro D, Shahmanesh M, Floyd S, Birdthistle I, Ziraba A. Impact of DREAMS interventions on experiences of violence among adolescent girls and young women: Findings from population-based cohort studies in Kenya and South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001818. [PMID: 37163514 PMCID: PMC10171651 DOI: 10.1371/journal.pgph.0001818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/16/2023] [Indexed: 05/12/2023]
Abstract
DREAMS aims to reduce HIV incidence among adolescent girls and young women (AGYW) by tackling drivers of HIV risk including gender-based violence. We evaluate the impact of DREAMS on recent experiences of violence perpetuated by men against AGYW. AGYW cohorts were randomly selected from demographic platforms in South Africa (rural KwaZulu-Natal) and Kenya (Nairobi informal settlements and rural Gem sub-county). AGYW aged 13-22 years were enrolled in 2017 (Nairobi, KwaZulu-Natal) or 2018 (Gem), with annual follow-up to 2019. We described proportions of AGYW who self-reported experiences of violence perpetrated by males in the 12 months preceding the interview, overall and by form (physical, sexual, emotional). We investigated associations with DREAMS (invitation to participate during 2017-2018) through multivariable propensity score-adjusted logistic regression and estimated the causal effect of DREAMS on experiences of violence, under counter-factual scenarios in which all versus no AGYW were DREAMS beneficiaries. Among 852, 1018 and 1712 AGYW followed-up in 2019 in Nairobi, Gem and KZN, respectively, proportions reporting any violence in 2019 were higher in Nairobi (29%) than Gem (18%) and KwaZulu-Natal (19%). By sub-type, emotional and physical violence were more frequently reported than sexual violence. We found no evidence of an impact attributable to DREAMS on overall levels of violence, in any setting. Nor was there evidence of impact on sub-types of violence, with one exception: an increase in physical violence in Nairobi if all, versus no, AGYW were DREAMS beneficiaries (16% vs 11%; +5% difference [95% CI: +0.2%, +10.0%]). Experiences of gender-based violence were common among AGYW, especially in urban settings, and DREAMS had no measurable impact on reducing violence within three years of implementation. Violence prevention programming that reaches more men and the broader community, sustained for longer periods, may yield greater gains in violence reduction than AGYW-focused programming. Additionally, more investment in implementation research is needed to bridge trial-based study findings from efficacy to population-level effectiveness.
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Affiliation(s)
- Elvis Omondi Achach Wambiya
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Annabelle J. Gourlay
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Mulwa
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Faith Magut
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Nondumiso Mthiyane
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Benedict Orindi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Center for Geographic Medicine Research, Kilifi, Kenya
| | - Natsayi Chimbindi
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Daniel Kwaro
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Maryam Shahmanesh
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Sian Floyd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Isolde Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abdhalah Ziraba
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
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Asencios-Gonzalez ZB, Vara-Horna AA, Brad McBride J. Intimate Partner Violence Against Women and Labor Productivity: The Mediating Role of Morbidity. Violence Against Women 2023:10778012231163572. [PMID: 36950730 DOI: 10.1177/10778012231163572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
This study determines that morbidity presents a mediating impact between intimate partner violence against women and labor productivity in terms of absenteeism and presenteeism. Partial least squares structural equation modeling (PLS-SEM) was used on a nationwide representative sample of 357 female owners of micro-firms in Peru. The resulting data reveals that morbidity is a mediating variable between intimate partner violence against women and absenteeism (β = 0.213; p < .001), as well as between intimate partner violence against women and presenteeism (β = 0.336; p < .001). This finding allows us to understand how such intimate partner violence against women negatively affects the workplace productivity in the context of a micro-enterprise, a key element in many economies across the world.
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Affiliation(s)
- Zaida B Asencios-Gonzalez
- Research Institute in Administrative Sciences and Human Resources at San Martín de Porres University (USMP), Lima, Peru
| | - Arístides A Vara-Horna
- Research Institute in Administrative Sciences and Human Resources at San Martín de Porres University (USMP), Lima, Peru
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Winter S, Musyimi C, Mutiso V, Ndetei D. Depressive symptoms and associated social and environmental factors among women living in informal settlements in Nairobi, Kenya. Glob Public Health 2023; 18:2200499. [PMID: 37054444 DOI: 10.1080/17441692.2023.2200499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower - and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18-75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict.
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Affiliation(s)
- Samantha Winter
- School of Social Work, Columbia University, New York, NY, USA
| | - Christine Musyimi
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Victoria Mutiso
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David Ndetei
- African Mental Health Research and Training Foundation, Nairobi, Kenya
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Winter S, Johnson L, Obara LM, Nair D. Exploring Non-partner Violence in Informal Settlements in Nairobi, Kenya. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP2017-NP2047. [PMID: 35524345 DOI: 10.1177/08862605221097444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Violence against women is a serious public health and human rights concern and can take many forms. Intimate partner violence (IPV) is the subject of the majority of research focused on violence against women around the world; yet the health consequences of non-partner violence (NPV) can be just as serious. There is a critical gap in literature focused on NPV and the co-occurrence of NPV and IPV in sub-Saharan Africa, particularly in informal settlements. The unique historical, political, social, geo-spatial, physical, and built environment in informal settlements-often characterized as places with high rates of crime and violence-may be important in understanding NPV and co-occurrence of NPV and IPV in these communities, but more research is needed. The purpose of this study was to explore NPV in a large informal settlement in Nairobi, Kenya including its relationship to IPV, correlates, and common perpetrators of NPV in this setting. Data from 552 household-level surveys collected from women in a large informal settlement in Nairobi in 2018 were used in this study. Descriptive statistics and penalized maximum likelihood logistic regressions were used to examine the association between IPV and NPV, correlates, and perpetrators of NPV. Findings showed a strong, positive association between past-year IPV and NPV-highlighting a critical area for future study in IPV, NPV, and poly-victimization research. Results corroborated some findings from existing NPV research, but yielded important new information about correlates and perpetrators of NPV in informal settlements. NPV and poly-victimization have serious health consequences for women in any context, but women in informal settlements also face a number of structural economic, social, political, and environmental challenges that affect their health and wellbeing and may exacerbate the health consequences of violence perpetrated against them. Thus, more research into NPV and poly-victimization in informal settlements is critical.
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Affiliation(s)
- Samantha Winter
- School of Social Work, 139058Columbia University, New York, NY, USA
| | - Laura Johnson
- School of Social Work, 6558Temple University, Philadelphia, PA, USA
| | - Lena M Obara
- School of Social Work, 242612Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Divya Nair
- School of Social Work, 139058Columbia University, New York, NY, USA
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Hassan R, Bhatia A, Zinke-Allmang A, Shipow A, Ogolla C, Gorur K, Cislaghi B. Navigating family planning access during Covid-19: A qualitative study of young women's access to information, support and health services in peri-urban Nairobi. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100031. [PMID: 34927130 PMCID: PMC8665648 DOI: 10.1016/j.ssmqr.2021.100031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 01/12/2023]
Abstract
The COVID-19 response has profoundly affected women's access to family planning services in Kenya. While prior studies have shown how the COVID-19 response created barriers to accessing family planning (FP) services, less is known about how the pandemic affected the normative influence that partners, peers, and health providers exert on women's FP choices. In this qualitative study, we interviewed 16 women (aged 18-25 years), 10 men in partnerships with women, and 14 people in women's social networks across 7 low-income wards in Nairobi, Kenya. Our findings suggest that COVID-19 response measures changed the contexts of normative influence on FP: financial insecurity, increased time at home with husbands or parents, and limited access to seek the support of health workers, friends, and other people in their social network affected how women negotiated FP access and use within their homes. Our study underscores the importance of ensuring FP is an essential service in a pandemic, and of developing health programs that change norms about FP to address the gendered burden of negotiating FP during COVID-19 and beyond.
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Affiliation(s)
- Rahma Hassan
- University of Nairobi, Kenya,Corresponding author
| | - Amiya Bhatia
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, UK
| | - Anja Zinke-Allmang
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, UK
| | - Amy Shipow
- Busara Center for Behavioral Economics, Kenya
| | | | | | - Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, UK
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Multiple aspects of energy poverty are associated with lower mental health-related quality of life: A modelling study in three peri-urban African communities. SSM - MENTAL HEALTH 2022; 2:100103. [PMID: 36688234 PMCID: PMC9792378 DOI: 10.1016/j.ssmmh.2022.100103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 02/01/2023] Open
Abstract
Objective Over 900 million people in sub-Saharan Africa (SSA) live in energy poverty, relying on cooking polluting fuels (e.g. wood, charcoal). The association between energy poverty and mental/physical health-related quality of life (HRQoL) among women in SSA, who are primarily tasked with cooking, is unknown. Methods Females (n = 1,150) from peri-urban Cameroon, Kenya and Ghana were surveyed on their household energy use and mental/physical health status using the standardized Short-Form 36 (SF-36) questionnaire. Random effects linear regression linked household energy factors to SF-36 mental (MCS) and physical component summary (PCS) scores. A binary outcome of 'likely depression' was derived based on participants' MCS score. Random effects Poisson regression with robust error variance assessed the relationship between household energy factors and odds of likely depression. Results The prevalence of likely depression varied by a factor of four among communities (36%-Mbalmayo, Cameroon; 20%-Eldoret, Kenya; 9%-Obuasi, Ghana). In the Poisson model (coefficient of determination (R2) = 0.28), females sustaining 2 or more cooking-related burns during the previous year had 2.7 (95%CI:[1.8,4.1]) times the odds of likely depression as those not burned. Females cooking primarily with charcoal and wood had 1.6 times (95%CI:[0.9,2.7]) and 1.5 times (95%CI:[0.8,3.0]) the odds of likely depression, respectively, as those primarily using liquefied petroleum gas. Women without electricity access had 1.4 (95%CI:[1.1,1.9]) times the odds of likely depression as those with access. In the MCS model (R2 = 0.23), longer time spent cooking was associated with a lower average MCS score in a monotonically increasing manner. In the PCS model (R2 = 0.32), women injured during cooking fuel collection had significantly lower (-4.8 95%CI:[-8.1,-1.4]) PCS scores. Conclusion The burden of energy poverty in peri-urban communities in SSA extends beyond physical conditions. Experiencing cooking-related burns, using polluting fuels for cooking or lighting and spending more time cooking are potential risk factors for lower mental HRQoL among women.
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Winter SC, Aguilar NJ, Obara LM, Johnson L. "Next, it will be you": Women's Fear of Victimization and Precautionary Safety Behaviors in Informal Settlement Communities in Nairobi, Kenya. Violence Against Women 2022; 28:2966-2991. [PMID: 34859703 DOI: 10.1177/10778012211045718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Around one billion people live in informal settlements globally, including over half of Nairobi, Kenya's 3 million residents. The purpose of this study was to explore women's fear of victimization within Mathare, an informal settlement in Nairobi, Kenya and how fear of victimization influences women's behaviors. Fifty-five in-depth interviews were conducted with women in 2015-2016. A modified grounded theory approach guided data collection and analysis. Findings suggest fear of victimization is a serious concern in informal settlements, but women have found ways to adapt their behaviors to cope and to continue to function and protect their children despite fearing victimization.
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Affiliation(s)
| | - Nathan J Aguilar
- School of Social Work, 5798Columbia University, New York, NY, USA
| | - Lena M Obara
- School of Social Work, 242612Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Laura Johnson
- School of Social Work, 16043Temple University, Philadelphia, USA
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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Bahati C, Rukundo G, Nyirahabimana N, Izabayo J, Niyonsenga J, Sezibera V. The prevalence of mental disorders among intimate partner violence exposed and non-exposed Rwandans: Findings from a national cross-sectional survey. Psychiatry Res 2022; 310:114465. [PMID: 35219265 DOI: 10.1016/j.psychres.2022.114465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/25/2022]
Abstract
Despite mounting evidence indicating an increased risk of long-term mental disorders in Rwanda's general population, little is still known about the national prevalence of mental disorders among victims of intimate partner violence (IPV) in a post-conflict setting. The aim of this study was to compare the prevalence of mental disorders among IPV exposed and non-exposed individuals in Rwanda. This was a cross-sectional study based on secondary data from the 2018 Rwanda Mental Health Survey. The sample consisted 20,381 participants selected nationwide, from 7,124 households (age range: 14-65 years), of which 3,759 Rwandans were exposed to IPV (18.4%) and 16,622 were non-exposed to IPV (81.6%). Participants were screened for IPV exposure and common mental disorders, and data was analyzed using the SPSS version 25 software. The results showed that the rate of any mental disorder was substantially higher in the group exposed to IPV than the non-exposed, at 32.4% and 11.7% respectively. These results highlight that among Rwandans diagnosed with severe mental disorders, participants with a history of IPV exposure present with increased odds of mental disorders prevalence and severity. Therefore, people seeking mental health care should also be screened for their IPV exposure and offered appropriate interventions.
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Affiliation(s)
- Claire Bahati
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda.
| | - Gilbert Rukundo
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda; Swiss Tropical and Public Health Institute
| | | | - Josias Izabayo
- Centre for Mental Health, College of Medicine and Health Sciences
| | - Japhet Niyonsenga
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda; Mental Health & Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda
| | - Vincent Sezibera
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda; Centre for Mental Health, College of Medicine and Health Sciences
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Coll CVN, Santos TM, Devries K, Knaul F, Bustreo F, Gatuguta A, Houvessou GM, Barros AJD. Identifying the women most vulnerable to intimate partner violence: A decision tree analysis from 48 low and middle-income countries. EClinicalMedicine 2021; 42:101214. [PMID: 34988411 PMCID: PMC8712229 DOI: 10.1016/j.eclinm.2021.101214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Primary prevention strategies are needed to reduce high rates of intimate partner violence (IPV) in low- and middle-income countries (LMICs). The effectiveness of population-based approaches may be improved by adding initiatives targeted at the most vulnerable groups and tailored to context-specificities. METHODS We applied a decision-tree approach to identify subgroups of women at higher risk of IPV in 48 LMICs and in all countries combined. Data from the most recent Demographic and Health Survey carried out between 2010 and 2019 with available information on IPV and sociodemographic indicators was used. To create the trees, we selected 15 recognized risk factors for IPV in the literature which had a potential for targeting interventions. Exposure to IPV was defined as having experienced physical and/or sexual IPV in the past 12 months. FINDINGS In the pooled decision tree, witnessing IPV during childhood, a low or medium empowerment level and alcohol use by the partner were the strongest markers of IPV vulnerability. IPV prevalence amongst the most vulnerable women was 43% compared to 21% in the overall sample. This high-risk group included women who witnessed IPV during childhood and had lower empowerment levels. These were 12% of the population and 1 in 4 women who experienced IPV in the selected LMICs. Across the individual national trees, subnational regions emerged as the most frequent markers of IPV occurrence. INTERPRETATION Starting with well-known predictors of IPV, the decision-tree approach provides important insights about subpopulations of women where IPV prevalence is high. This information can help designing targeted interventions. For a large proportion of women who experienced IPV, however, no particular risk factors were identified, emphasizing the need for population wide approaches conducted in parallel, including changing social norms, strengthening laws and policies supporting gender equality and women´s rights as well as guaranteeing women´s access to justice systems and comprehensive health services. FUNDING Bill and Melinda Gates Foundation (Grant INV-010051/OPP1199234), Wellcome Trust (Grant Number: 101815/Z/13/Z) and Associação Brasileira de Saúde Coletiva (ABRASCO).
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Affiliation(s)
- Carolina V N Coll
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Corresponding author at: International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.
| | - Thiago M Santos
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Karen Devries
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Felicia Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL 33146, United States
| | | | - Anne Gatuguta
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | | | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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18
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Winter SC, Johnson L, Obara LM. Neighborhood Cohesion, Perceptions of Disorder, and the Geography of Women's Fear of Crime in Informal Settlements in Nairobi, Kenya. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 68:385-401. [PMID: 34109649 DOI: 10.1002/ajcp.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Fear of crime is more pervasive and harder to address than crime itself and can cause physical and psychological health complications, particularly for women. Fear of crime is not always grounded in direct exposure to crime. Instead, it may be more directly linked to social cohesion and/or perceptions of neighborhood disorder, but little is known about these associations in informal settlements. This paper sought to explore these relationships in Mathare-a large informal settlement in Nairobi, Kenya. Using responses from surveys with 550 women in Mathare, we conducted regression, mediation, and moderated mediation analyses to investigate relationships between neighborhood disorder, fear of crime, and neighborhood cohesion and explore how these associations vary across geographic spaces (villages). Findings suggest that women's perceptions of neighborhood disorder are associated with fear of crime; neighborhood cohesion partially mediates the relationship between perceptions of neighborhood disorder and fear of crime; women's fear of crime varies by village; and the mediating role of neighborhood cohesion also varies by village. Efforts to build and strengthen social cohesion in informal settlements may help to reduce women's fear of crime, but more research is needed to explore under what conditions and in what spaces interventions are the most effective.
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Affiliation(s)
| | - Laura Johnson
- School of Social Work, Temple University, Philadelphia, PA, USA
| | - Lena Moraa Obara
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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The prevalence and correlates of depression before and after the COVID-19 pandemic declaration among urban refugee adolescents and youth in informal settlements in Kampala, Uganda: A longitudinal cohort study. Ann Epidemiol 2021; 66:37-43. [PMID: 34785396 PMCID: PMC8590831 DOI: 10.1016/j.annepidem.2021.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 12/27/2022]
Abstract
Purpose There is scant research examining urban refugee youth mental health outcomes, including potential impacts of the COVID-19 pandemic. We examine prevalence and ecosocial risk factors of depression in the periods before and after the COVID-19 pandemic declaration among urban refugee youth in Kampala, Uganda. Methods Data from a cohort of refugee youth (n = 367) aged 16–24 years were collected in periods before (February 2020) and after (December 2020) the WHO COVID-19 pandemic declaration. We developed crude and adjusted generalized estimating equation logistic regression models to examine demographic and ecosocial factors (food insecurity, social support, intimate partner violence) associated with depression, and include time-ecosocial interactions to examine if associations differed before and after the pandemic declaration. Results The prevalence of depression was high, but there was no significant difference before (27.5%), and after (28.9%) the pandemic declaration (P = .583). In adjusted models, food insecurity (aOR: 2.54; 95% CI: 1.21–5.33) and experiencing violence (aOR: 2.53; 95% CI: 1.07–5.96) were associated with increased depression, and social support was associated with decreased depression (aOR: 0.85; 95% CI: 0.81–0.89). Conclusions These findings highlight the urgent need for interventions to address chronic depression, food insecurity, and ongoing effects of violence exposure among urban refugee youth in Kampala.
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Angwenyi V, Kabue M, Chongwo E, Mabrouk A, Too EK, Odhiambo R, Nasambu C, Marangu J, Ssewanyana D, Njoroge E, Ombech E, Mokaya MM, Obulemire EK, Khamis A, Abubakar A. Mental Health during COVID-19 Pandemic among Caregivers of Young Children in Kenya's Urban Informal Settlements. A Cross-Sectional Telephone Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10092. [PMID: 34639394 PMCID: PMC8508326 DOI: 10.3390/ijerph181910092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022]
Abstract
The emergence of COVID-19 has profoundly affected mental health, especially among highly vulnerable populations. This study describes mental health issues among caregivers of young children and pregnant women in three urban informal settlements in Kenya during the first pandemic year, and factors associated with poor mental health. A cross-sectional telephone survey was administered to 845 participants. Survey instruments included the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, COVID-19 Anxiety Scale, and questions on the perceived COVID-19 effects on caregiver wellbeing and livelihood. Data were analyzed using descriptive statistics, and univariate and multivariate analysis. Caregivers perceived COVID-19 as a threatening condition (94.54%), affecting employment and income activities (>80%). Caregivers experienced discrimination (15.27%) and violence (12.6%) during the pandemic. Levels of depression (34%), general anxiety (20%), and COVID-19 related anxiety (14%) were highly prevalent. There were significant associations between mental health outcomes and economic and socio-demographic factors, violence and discrimination experiences, residency, and perceptions of COVID-19 as a threatening condition. Caregivers high burden of mental health problems highlights the urgent need to provide accessible mental health support. Innovative and multi-sectoral approaches will be required to maximize reach to underserved communities in informal settlements and tackle the root causes of mental health problems in this population.
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Affiliation(s)
- Vibian Angwenyi
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Margaret Kabue
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Esther Chongwo
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Adam Mabrouk
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Ezra Kipngetich Too
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Rachel Odhiambo
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Carophine Nasambu
- Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi P.O. Box 230-80108, Kenya;
| | - Joyce Marangu
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Derrick Ssewanyana
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON M5T 3L9, Canada
| | - Eunice Njoroge
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Eunice Ombech
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Mercy Moraa Mokaya
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Emmanuel Kepha Obulemire
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
| | - Anil Khamis
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
- Institute of Education, University College London, 20 Bedford Way, London WC1H 0AL, UK
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (M.K.); (E.C.); (A.M.); (E.K.T.); (R.O.); (J.M.); (D.S.); (E.N.); (E.O.); (M.M.M.); (E.K.O.); (A.K.); (A.A.)
- Neurosciences Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, Kilifi P.O. Box 230-80108, Kenya;
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Lambert JE, Denckla C. Posttraumatic stress and depression among women in Kenya's informal settlements: risk and protective factors. Eur J Psychotraumatol 2021; 12:1865671. [PMID: 34992747 PMCID: PMC8725741 DOI: 10.1080/20008198.2020.1865671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Approximately 56% of Kenya´s population resides in informal settlements (UN-Habitat, 2016). Female residents experience a range of psychosocial stressors including chronic poverty and high rates of interpersonal violence. Despite evidence that this population has some of the worst physical health outcomes in the country (APHRC, 2014), few studies have evaluated their mental health status and its correlates. Objective: The purpose of this study was to identify risk and protective factors associated with mental health problems (posttraumatic stress & depression) among women living in informal settlements in Kenya. Hypothesized risk factors included economic stress, a history of experiencing childhood abuse and sexual violence, as well as partner-perpetrated psychological and physical abuse. Hypothesized protective factors were supportive relationships with family members and friends and having a sense community connection. Method: Local community health workers were trained to collect data via individual interviews using validated measures. Participants were recruited using systematic random sampling in two informal settlements in Nakuru County. We used path analysis to test the hypothesized model among a sample of 301 women. Results: The model had an excellent fit (χ2 = 13.391, df = 8, p =.099; GFI =.99; CFI =.99; RMSEA =.05) and explained 25% of the variance in PTSS and 28% of the variance in depression. All predictor variables except support from friends were statistically significant in the expected direction. Specifically, economic stress, childhood abuse, sexual violence, as well as physical and psychological abuse from one´s partner had significant positive associations with PTSS and depression. Having supportive family members and a sense of being part of the community had significant negative associations with symptoms. Conclusions: Results highlight the importance of addressing intimate partner and other forms of interpersonal violence in these settings and hold implications for tailoring interventions for this marginalized population.
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Affiliation(s)
- Jessica E. Lambert
- International Rehabilitation Department, DIGNITY- Danish Institute Against Torture, Copenhagen, Denmark
| | - Christy Denckla
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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22
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Decker MR, Wood SN, Kennedy SR, Hameeduddin Z, Tallam C, Akumu I, Wanjiru I, Asira B, Omondi B, Case J, Clough A, Otieno R, Mwiti M, Perrin N, Glass N. Adapting the myPlan safety app to respond to intimate partner violence for women in low and middle income country settings: app tailoring and randomized controlled trial protocol. BMC Public Health 2020; 20:808. [PMID: 32471469 PMCID: PMC7260790 DOI: 10.1186/s12889-020-08901-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a leading threat to women's health and safety globally. Women in abusive relationships make critical decisions about safety and harm reduction while weighing multiple competing priorities, such as safety of children, housing and employment. In many low- and middle-income countries (LMIC), IPV prevention and response services are limited and women lack access to safety planning resources. In high-resource settings, an interactive safety decision aid app (myPlan) has been found valuable in reducing decisional conflict and empowering women to take action in accordance with their safety priorities. This paper describes 1) the community-participatory formative process used to adapt the myPlan app content, interface, and implementation for the Kenya context, and 2) the randomized clinical trial study protocol for efficacy evaluation of myPlan Kenya. METHODS A community-participatory formative process engaged service providers and stakeholders, as well as IPV survivors for adaptation, followed by an in-depth pilot and final refinements. A randomized clinical trial design will then be used to determine efficacy of the myPlan Kenya app compared to standard care among women reporting IPV or fear of partner and living in an urban settlement. myPlan Kenya app provides and solicits information on a) relationship health; b) safety priorities; and c) severity of relationship violence. Based on the woman's inputs, the evidence-based algorithm developed for myPlan Kenya generates a tailored safety plan. Outcome measures are assessed at baseline, immediate post-intervention, and 3-month post-baseline. Difference-in-differences analysis compares primary (e.g. safety preparedness, safety behavior, IPV), and secondary outcomes (e.g. resilience, mental health, service utilization, self-blame) across timepoints by group. DISCUSSION Formative phase revealed high feasibility and acceptability of a technology-based intervention for safety planning in this LMIC setting. This phase generated essential refinements to myPlan Kenya app readability, content and implementation, including increased visualization of messaging, and implementation via community health volunteers (CHVs). The resulting trial will be the first to evaluate efficacy of a community-partnered technology-based IPV intervention in a LMIC. Our adaptation process and trial results will inform researchers and interventionists to integrate multiple data sources to adapt IPV intervention content and interface in settings where technology-based interventions for IPV are novel and literacy is limited. TRIAL REGISTRATION Pan African Clinical Trial Registry approval received 25 April 2018 (PACTR201804003321122); retrospectively registered.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA. .,Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | - Zaynab Hameeduddin
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | - Irene Akumu
- Ujamaa-Africa, Mashinani Department, Nairobi, Kenya
| | | | - Ben Asira
- Ujamaa-Africa, Mashinani Department, Nairobi, Kenya
| | | | - James Case
- Johns Hopkins School of Nursing, Baltimore, USA
| | | | | | - Morris Mwiti
- Ujamaa-Africa, Mashinani Department, Nairobi, Kenya
| | | | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Center for Global Health, Johns Hopkins University, Baltimore, USA
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23
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Kimani J, Adhiambo J, Kasiba R, Mwangi P, Were V, Mathenge J, Macharia P, Cholette F, Moore S, Shaw S, Becker M, Musyoki H, Bhattacharjee P, Moses S, Fowke KR, McKinnon LR, Lorway R. The effects of COVID-19 on the health and socio-economic security of sex workers in Nairobi, Kenya: Emerging intersections with HIV. Glob Public Health 2020; 15:1073-1082. [DOI: 10.1080/17441692.2020.1770831] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Joshua Kimani
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Sex Worker Outreach Program (SWOP), Nairobi, Kenya
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | | | | | - Peninah Mwangi
- Bar Hostess Empowerment and Support Programme (BHESP), Nairobi, Kenya
| | | | - John Mathenge
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - Pascal Macharia
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - Francois Cholette
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Samantha Moore
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
| | - Souradet Shaw
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
| | - Marissa Becker
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
- National AIDS and STI Control Programme (NASCOP), Ministry of Health, Nairobi, Kenya
| | - Helgar Musyoki
- National AIDS and STI Control Programme (NASCOP), Ministry of Health, Nairobi, Kenya
| | - Parinita Bhattacharjee
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Stephen Moses
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
| | - Keith R. Fowke
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Lyle R. McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)
| | - Robert Lorway
- Institute for Global Public Health (IGPH), University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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