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Nigatu A, Abdureshid N, Abate S, Dagne I, Oumer A. Undernutrition and determinants among adolescent street children in DireDawa City, eastern Ethiopia: Vulnerability assessment. Nutrition 2024; 119:112307. [PMID: 38218049 DOI: 10.1016/j.nut.2023.112307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Adolescents go through rapid development and increased nutritional requirements that can put them at higher risk of undernutrition--a problem that can be highest among orphaned or street children. Evidence on nutritional risk and its contributing factors among this segment is lacking in the city of Dire Dawa, where many children are on the streets with limited access to proper care. The aim of this study was to identify determinants of undernutrition among street adolescents in Ethiopia. METHODS A community-based cross-sectional study was conducted with 358 street adolescents 12 to 19 y of age in Dire Dawa from January to February 2022. After conducting a preliminary survey and registering all available street children, a complete enumeration was made. For data collection, an interviewer-administered questionnaire was used along with anthropometric measurements using standard procedures. Height-for-age (HAZ) and body mass index (BMI) for age z scores were computed using World Health Organization (WHO) Anthroplus and statistical analysis was done using SPSS software version 26. Independent variables with P < 0.25 in bivariable analysis were included in multivariable logistic regression, and variables with P < 0.05 were considered statistically significant. A crude and adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. RESULTS Among 358 street adolescents, 44% (38.9-49.5) and 56% (50.8-61.4) were thin and stunted, respectively. Thinness among street children could be associated with a longer stay on the street (AOR, 1.65; 95% CI, 1.40-1.90), infrequent meal frequency (AOR, 1.32; 95% CI, 1.19-1.45), unprotected drinking water sources (AOR, 1.55; 95% CI, 1.40-1.71), alcohol drinking (AOR, 2.92; 95% CI, 1.51-4.32), inadequately diversified diet (AOR, 1.21; 95% CI, 1.06-1.36), and illness history (AOR, 1.34; 95% CI, 1.21-1.47). Moreover, odds of stunting were significantly associated with staying on the street (AOR, 1.32; 1.10-1.54), unsafe drinking water (AOR, 1.63; 95% CI, 1.13-2.66), smoking cigarettes (AOR, 1.54; 95% CI, 1.21-2.52), dietary diversity (AOR, 2.34; 95% CI, 1.43-3.82), and acute illness (AOR, 2.12; 95% CI, 1.31-5.23). CONCLUSION Thinness and stunting were prevalent among street children and are associated with infrequent meals, poor dietary diversity, substance abuse, unsafe water sources, and illness histories that could be targeted for multisectoral interventions.
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Affiliation(s)
- Abel Nigatu
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Neil Abdureshid
- Department of Midwifery, College of Medicine and Health Sciences, Dire-Dawa University, Dire-Dawa, Ethiopia
| | - Shambel Abate
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Imam Dagne
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Abdu Oumer
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia.
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Armoon B, Griffiths MD, Mohammadi R, Ahounbar E. The global distribution and epidemiology of alcohol and drug use among street-involved children and youth: a meta-analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:381-398. [PMID: 37310881 DOI: 10.1080/00952990.2023.2201872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/14/2023] [Accepted: 03/28/2023] [Indexed: 06/15/2023]
Abstract
Background: Street-involved children and youth (SICY) who work and live on/of the streets are more likely to inject drugs and engage in psychoactive substance use.Objectives: The present study aimed to identify the prevalence, distribution, sociodemographic determinants, and risk-taking associated with alcohol and drug use among SICY.Methods: Studies published in English related to alcohol and drug use among SICY were searched for from December 1 1985 to July 1 2022, on PubMed, Scopus, Cochrane, and Web of Science.Results: After full-text paper evaluation, 73 studies were included in the meta-analysis. Results indicated that lifetime prevalence rates were 44% (alcohol), 44% (crack), 33% (inhalants), 44% (solvents), 16% (tranquilizer/sedatives), 22% (opioids), and 62% (polysubstance use). The current prevalence rates were 40% (alcohol), 21% (crack), 20% (inhalants), 11% (tranquilizer/sedatives), and 1% (opioids). Also, life-time and current prevalence of alcohol and crack use, current prevalence of tranquilizer/sedative use, and life-time prevalence of polysubstance use were higher among older age groups. Life-time prevalence of tranquilizer/sedative use was lower among older age groups.Conclusions: The high prevalence of using alcohol, crack, and inhalants is a major issue because they are used extensively among different age groups, including minors. Such findings are beneficial for policymakers, health authorities, and professionals in developing programs aimed at minimizing inhalant use and other types of substance use harms among this group. It is important to accurately monitor this risk-exposed population to understand the mechanisms that might help protect them from high-risk substance use.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Armoon B, Griffiths MD, Mohammadi R. The Global Distribution and Epidemiology of Psychoactive Substance Use and Injection Drug Use Among Street-Involved Children and Youth: A Meta-Analysis. Subst Use Misuse 2023; 58:746-764. [PMID: 36924274 DOI: 10.1080/10826084.2023.2181036] [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] [Indexed: 03/18/2023]
Abstract
Background: Globally, street-involved children and youth (SICY) who work and live on/of the streets are at higher risk of increased psychoactive substances and injecting drug use. Objectives: The present study aimed to identify the prevalence, distribution, sociodemographic factors, and risk-taking behaviors associated with psychoactive substances and injecting drug use among SICY. Methods: Studies in English published from December 1 1985 to July 1 2022, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on psychoactive substances and injecting drug use among SICY. The pooled-prevalence estimates were obtained using a robust fixed-effects model. Results: The most commonly reported life-time and current psychoactive substance was tobacco followed by cannabis, LSD/ecstasy, cocaine, methamphetamine, heroin and injection drug use. The results showed that life-time and current prevalence of methamphetamine and cannabis use, as well as life-time prevalence of cocaine, LSD/ecstasy, heroin, tobacco, and injecting drug use increased as age rose while current prevalence of cocaine and tobacco use decreased as age rose. SICY who were male, homeless, had parents who had died, had history of substance use among family members or best friends, had experienced violence, had casual sex partners, had a history of working in the sex trade, and had unprotected sex were all related to psychoactive substance use and injecting drug use. Conclusions: Research examining this population suffers from lack of studies, therefore, improving the knowledge for interventions aimed at reducing risk behaviors, particularly those related to the transmission of sexually transmitted infections such as HIV is of great importance.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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Asfaw Z, Mitiku M, Abebe HT, Atsbeha MT. A Community-Based Study of Level and Determinants of Substance Use: Findings from Children Experiencing Homelessness in Major Cities of Northern Ethiopia. Subst Abuse Rehabil 2022; 13:101-110. [DOI: 10.2147/sar.s381768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
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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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Jaguga F, Turissini M, Barasa J, Kimaiyo M, Araka J, Okeyo L, Kwobah E. A descriptive survey of substance use treatment facilities in Uasin Gishu County Kenya. BMC Health Serv Res 2022; 22:645. [PMID: 35568902 PMCID: PMC9107223 DOI: 10.1186/s12913-022-08051-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Substance use disorders are a major problem in Uasin Gishu County, Kenya. The objective of this study was to describe the existing resources within substance use treatment facilities in the County, with the aim of guiding policy and interventions. Methods This was a cross-sectional study. We collected data from six substance use treatment facilities within Uasin Gishu County between August and November 2021. We used a researcher-designed questionnaire to collect information on: availability of in-patient and out-patient services; facility ownership (private-for-profit vs government-run); bed capacity; mode of payment for services; cost of services; availability of medicines for substance use treatment; and staffing characteristics. Descriptive statistics were used to summarize the data. Results One facility was run by the National government and the rest were private-for-profit. Uasin Gishu County government had no substance use treatment facility of its own. The total number of beds available within the six facilities was 174 against a population of 1.1 million. All six facilities had stocked at least one medication for substance use disorder treatment. None of the facilities had buprenorphine, buprenorphine naloxone, or methadone. Out-of pocket was the most common mode of payment for services with patients paying using this mode in all the six facilities. Only one facility was accredited by the National Hospital Insurance Fund (NHIF). All facilities had at least one certified addiction counselor and at least one psychologist. Half of the facilities did not have a nurse and two did not have a doctor. The qualification held by most staff was addiction counseling with 41.3% of them having achieved this qualification. Conclusion The facilities were well staffed with psychologists and addiction counselors. Gaps were found as regards bed capacity, use of pharmacotherapy, insurance coverage and availability of nursing staff and doctors. We recommend that the County government in collaboration with key stakeholders invests in substance use treatment in order to address the high burden of substance use disorders in Uasin Gishu County.
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Affiliation(s)
- Florence Jaguga
- Moi Teaching & Referral Hospital, P.O. BOX 3-30100, Eldoret, Kenya.
| | - Matthew Turissini
- Department of Internal Medicine, Indiana University, Bloomington, USA
| | - Julius Barasa
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Mercy Kimaiyo
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Joash Araka
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Lily Okeyo
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Edith Kwobah
- Moi Teaching & Referral Hospital, P.O. BOX 3-30100, Eldoret, Kenya
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Lonnie E, Pooja S, Allison G, Reuben K, David A, Juddy W, Edith A, Paula B. Exploring patient-provider interactions and the health system's responsiveness to street-connected children and youth in Kenya: a qualitative study. BMC Health Serv Res 2021; 21:363. [PMID: 33874934 PMCID: PMC8056657 DOI: 10.1186/s12913-021-06376-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 04/12/2021] [Indexed: 12/30/2022] Open
Abstract
Background In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. Methods This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. Results Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. Conclusions This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06376-6.
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Affiliation(s)
- Embleton Lonnie
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada
| | - Shah Pooja
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK.,Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Gayapersad Allison
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Kiptui Reuben
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Ayuku David
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya.,Department of Behavioural Science, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Wachira Juddy
- Department of Behavioural Science, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Apondi Edith
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Braitstein Paula
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada. .,Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada. .,Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya. .,Moi University, College of Health Sciences, School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya.
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Substance Use among Homeless Reproductive Age People in Southern Ethiopia. Int J Reprod Med 2021; 2021:8272986. [PMID: 33816608 PMCID: PMC7987451 DOI: 10.1155/2021/8272986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 02/28/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Substance use by homeless reproductive age people may result to anxiety, involvement of risky sexual behaviors, and increasing the likelihood of unwanted pregnancy and sexually transmitted diseases (STDs). Therefore, this study assessed the magnitude of alcohol use, sexual intercourse after alcohol use, and its associated factors among homeless reproductive age people in southern Ethiopia. Methods Community-based cross-sectional study design was conducted among homeless reproductive age people. The snowball sampling technique was used to recruit 842 participants. Pretested and structured interviewer-administered questionnaire was used to collect the data. Data were entered into Epidata version 3.1 and exported to SPSS version 23 for analysis. Binary logistic regression was used to determine the association of independent variables with the outcome variables. Odds ratio with their 95% confidence interval and P value was used to identify the significant variables. Results More than half 423 (53.2%) of the respondents had taken a drink that contains alcohol in the last one year of the study period. Out of 324 khat chewers, 190 (58.64%) had sex after chewing khat. More than one-thirds, 323(38.4%) homeless people were smoking cigarette during the study period. Factors associated with alcohol use were age 19-25 years (AOR: 0.49; CI: 0.34, 0.72), ≥26 years (AOR: 0.40; CI: 0.25, 0.65), level of education (AOR: 0.61; CI: 0.39, 0.94), place of residence: major urban (AOR: 0.31; CI: 0.18, 0.51), small town (AOR: 0.38; CI: 0.23, 0.63), ever heard about STDs (AOR: 0.14; CI: 0.07, 027), and being a cigarette smoker (AOR: 2.67; CI: 1.94, 3.71). Conclusions In this study, significant percentage of respondents had taken a drink that contains alcohol. Age, level of education, place of residence, ever heard about STDs, and smoking cigarette were variables significantly associated with alcohol use. Awareness creation on the effect and outcome of substance use is recommended.
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Embleton L, Shah P, Amin Gayapersad A, Kiptui R, Ayuku D, Braitstein P. Identifying Strategies to Advance Health Equity through Action on Social Determinants of Health and Human Rights for Street-Connected Children and Youth in Kenya. Health Hum Rights 2020; 22:177-197. [PMID: 33390706 PMCID: PMC7762894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite the fact that street-connected children and youth (SCY) in low- and middle-income countries experience numerous social and health inequities, few evidence-based policies and interventions have been implemented to improve their circumstances. Our study analyzed strategies to advance health equity through action on the social determinants of health (SDH) for SCY in Kenya based on General Comment 21 of the United Nations Committee on the Rights of the Child. To identify policies and interventions, we analyzed archival newspaper articles and policy documents and elicited ideas from a diversity of social actors across Kenya. Our results identified three types of policies and interventions: repressive, welfare oriented, and child rights based. We then situated these strategies within the World Health Organization's conceptual framework on SDH inequities to understand their mechanism of impact on health equity. Our results demonstrate that a child rights approach provides a strong avenue for advancing health equity through action on the SDH for SCY in Kenya. As a result of these findings, we developed a checklist for policy makers and other stakeholders to assess how their policies and interventions are upholding human rights, addressing needs, and working to advance health equity for SCY.
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Affiliation(s)
- Lonnie Embleton
- Postdoctoral fellow at the Dalla Lana School of Public Health at the University of Toronto, Canada
| | - Pooja Shah
- PhD student in the Faculty of Public Health and Policy at the London School of Hygiene and Tropical Medicine, United Kingdom
| | - Allison Amin Gayapersad
- Postdoctoral fellow at the Dalla Lana School of Public Health at the University of Toronto, Canada
| | - Reuben Kiptui
- Research Coordinator at the Academic Model Providing Access to Healthcare in Eldoret, Kenya
| | - David Ayuku
- Professor of Clinical Psychology at the Moi University School of Medicine, Eldoret, Kenya
| | - Paula Braitstein
- Epidemiologist and Associate Professor at the Dalla Lana School of Public Health at the University of Toronto, Canada
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Embleton L, Shah P, Gayapersad A, Kiptui R, Ayuku D, Braitstein P. Characterizing street-connected children and youths' social and health inequities in Kenya: a qualitative study. Int J Equity Health 2020; 19:147. [PMID: 32859193 PMCID: PMC7455900 DOI: 10.1186/s12939-020-01255-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Street-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality. We theorize these health inequities are socially produced and result from systemic discrimination and a lack of human rights attainment. Therefore, we sought to identify and understand how SCY's social and health inequities in Kenya are produced, maintained, and shaped by structural and social determinants of health using the WHO conceptual framework on social determinants of health (SDH) and the Convention on the Rights of the Child (CRC) General Comment no. 17. METHODS This qualitative study was conducted from May 2017 to September 2018 using multiple methods including focus group discussions, in-depth interviews, archival review of newspaper articles, and analysis of a government policy document. We purposively sampled 100 participants including community leaders, government officials, vendors, police officers, general community residents, parents of SCY, and stakeholders in 5 counties across Kenya to participate in focus group discussions and in-depth interviews. We conducted a thematic analysis situated in the conceptual framework on SDH and the CRC. RESULTS Our findings indicate that SCY's social and health disparities arise as a result of structural and social determinants stemming from a socioeconomic and political environment that produces systemic discrimination, breaches human rights, and influences their unequal socioeconomic position in society. These social determinants influence SCY's intermediary determinants of health resulting in a lack of basic material needs, being precariously housed or homeless, engaging in substance use and misuse, and experiencing several psychosocial stressors, all of which shape health outcomes and equity for this population. CONCLUSIONS SCY in Kenya experience social and health inequities that are avoidable and unjust. These social and health disparities arise as a result of structural and social determinants of health inequities stemming from the socioeconomic and political context in Kenya that produces systemic discrimination and influences SCYs' unequal socioeconomic position in society. Remedial action to reverse human rights contraventions and to advance health equity through action on SDH for SCY in Kenya is urgently needed.
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Affiliation(s)
- L Embleton
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada
| | - P Shah
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - A Gayapersad
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
| | - R Kiptui
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - D Ayuku
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
- Department of Behavioural Science, School of Medicine, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - P Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada.
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada.
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya.
- Department of Medicine, School of Medicine, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya.
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Embleton L, Di Ruggiero E, Odep Okal E, Chan AK, Logie CH, Ayuku D, Braitstein P. Adapting an evidence-based gender, livelihoods, and HIV prevention intervention with street-connected young people in Eldoret, Kenya. Glob Public Health 2019; 14:1703-1717. [PMID: 31162989 PMCID: PMC6906550 DOI: 10.1080/17441692.2019.1625940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
Despite being highly vulnerable to acquiring HIV, no effective evidence-based interventions (EBI) exist for street-connected young people (SCY) in low- and middle-income countries (LMICs). Therefore, this paper describes the research process of adapting an existing EBI in Eldoret, Kenya using a modified ADAPT-ITT model with a young key population. From May to August 2018 we adapted the combined Stepping Stones and Creating Futures interventions. We used community-based participatory methods, focus group discussions, and working groups with four Peer Facilitators and 24 SCY aged 16-24 years. At the inception of this project, a matched-savings programme was integrated into the intervention to further address structural drivers of HIV. Numerous adaptations came forth through the participatory process. Engaging SCY in the adaptation process ensured the programme was responsive to their needs, relevant to the street context, and respected their right to participate in the research process.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, Faculty of Medicine, University of Toronto , Toronto , Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
| | - Evans Odep Okal
- Academic Model Providing Access to Healthcare , Eldoret , Kenya
| | - Adrienne K Chan
- Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada
- Dignitas International , Zomba , Malawi
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto , Canada
| | - David Ayuku
- Department of Behavioural Science, College of Health Science, Moi University , Eldoret , Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
- Academic Model Providing Access to Healthcare , Eldoret , Kenya
- College of Health Sciences, School of Medicine, Moi University , Eldoret , Kenya
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Roshanpajouh M, Mirkazemi R, Maleki Moghaddam M, Saravani M, Rahat Dahmardeh M, Asadi H, Rezazadeh M. Children addiction treatment and rehabilitation residential centers in Iran: report of a pilot study. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1675785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mohsen Roshanpajouh
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Psychiatry Institute), Iran University of Medical Sciences, Tehran, Iran
| | - Roksana Mirkazemi
- Farzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran, Iran
| | - Mahdieh Maleki Moghaddam
- Office of Children Program, Headquarters Welfare Organization of Sistan and Balouchestan Province, Zahedan, Iran
| | - Mohammad Saravani
- Department of Addiction Prevention, Welfare Organization of Sistan and Balouchestan Province, Zahedan, Iran
| | - Maasoumeh Rahat Dahmardeh
- Department of Addiction Prevention, Welfare Organization of Sistan and Balouchestan Province, Zahedan, Iran
| | - Hassan Asadi
- Department of Addiction Prevention, Welfare Organization of Sistan and Balouchestan Province, Zahedan, Iran
| | - Majid Rezazadeh
- Deputy of Development of Prevention, State Welfare Organization (SWO), Tehran, Iran
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Chairani R, Hamid AYS, Sahar J, Nurachmah E, Budhi TE. Strengthening resilience in families of street adolescents with embedding spiritual values. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abdurahman H, Adejumo O, Abdulmalik J. Prevalence of psychoactive substance use among male adolescents in Southwest Nigeria. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1604840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Haleem Abdurahman
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Olurotimi Adejumo
- Hertfordshire Partnership University, NHS Foundation Trust, Hertfordshire, UK
| | - Jibril Abdulmalik
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Galárraga O, Shah P, Wilson-Barthes M, Ayuku D, Braitstein P. Cost and cost-effectiveness of voluntary medical male circumcision in street-connected youth: findings from an education-based pilot intervention in Eldoret, Kenya. AIDS Res Ther 2018; 15:24. [PMID: 30497481 PMCID: PMC6264043 DOI: 10.1186/s12981-018-0207-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/08/2018] [Indexed: 01/06/2023] Open
Abstract
Background Voluntary medical male circumcision (VMMC) is a critical component of HIV prevention. VMMC policies have achieved initial targets in adult men yet continue to fall short in reaching younger men and adolescents. Setting We present the cost and scale-up implications of an education-based, VMMC intervention for adolescent street-connected males, for whom the street has become their home and/or source of livelihood. The intervention was piloted as part of the Engaging Street Youth in HIV Interventions Project in Eldoret, Kenya. Methods We used a micro-costing approach to estimate the average cost of a VMMC intervention in 116 street-connected youth. Average cost was estimated per individual and per cohort by dividing total cost per intervention by number of clients accessing the intervention over a 30-day period. Total average costs included direct and support procedure costs, educational costs, and direct research costs. Cost-effectiveness was measured in cost per DALYs averted over a 5 and 10-year period. Results The total cost of the intervention was $12,526 over the 30-day period, with an average cost per individual of $108. The direct VMMC procedure cost was approximately $9 per individual. Personnel costs contributed the greatest percentage to the total intervention cost (38.2%), with mentors and social workers representing the highest wage earners. Retreat-related and education costs contributed 51% and 13% respectively to the total average cost, with surgical equipment costs contributing less than 1%. At a cost of $108 per individual, the intervention averted 60166 DALYs in 5 years resulting in a cost per DALY averted of $267. Conclusion The VMMC intervention was highly cost-effective in Kenya, despite the additional costs incurred to reach SCY. Further scale-up may be warranted to effectively apply this intervention in comparable populations. Electronic supplementary material The online version of this article (10.1186/s12981-018-0207-x) contains supplementary material, which is available to authorized users.
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Embleton L, Ayuku D, Makori D, Kamanda A, Braitstein P. Causes of death among street-connected children and youth in Eldoret, Kenya. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:19. [PMID: 29764412 PMCID: PMC5952842 DOI: 10.1186/s12914-018-0160-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/07/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Street-connected young people carry a disproportionate burden of morbidities, and engage in a variety of practices that may heighten their risk of premature mortality, yet there are currently no reports in the literature on the rates or risk factors for mortality among them, nor on their causes of death. In low- and middle-income countries they are frequently in situations that violate their human rights, likely contributing to their increased burden of morbidities and vulnerability to mortality. We thus sought to describe the number of deaths annually, causes of death, and determine the number of deaths attributable to HIV among street-connected young people aged 0 to 30 years in Eldoret, Kenya. METHODS Eldoret, Kenya has approximately 1900 street-connected young people. We collected data on deaths occurring from October 2009 to December 2016 from Moi Teaching and Referral Hospital records, Academic Model Providing Access to Healthcare HIV program records, and utilized verbal autopsies when no records were available. Descriptive analyses were conducted stratified by sex and age category, and frequencies and proportions were calculated to provide an overview of the decedents. We used logistic regression to assess the association between underlying cause of death and sex, while controlling for age and location of death. RESULTS In total there were 100-recorded deaths, 66 among males and 34 among females; 37% of were among those aged ≤18 years. HIV/AIDS (37%) was the most common underlying cause of death, followed by assault (36%) and accidents (10%) for all decedents. Among males, the majority of deaths were attributable to assault (49%) and HIV/AIDS (26%), while females primarily died due to HIV/AIDS (59%). CONCLUSION Our results demonstrate a high number of deaths due to assault among males and HIV/AIDS among males and females. Our findings demonstrate the need for studies of HIV prevalence and incidence among this population to characterize the burden of HIV, particularly among young women given the higher number of deaths attributed to HIV/AIDS among them. Most deaths were preventable and require the urgent attention of service providers and policymakers to implement programs and services to prevent premature mortality and uphold children's rights.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - David Ayuku
- College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | | | | | - Paula Braitstein
- College of Health Sciences, School of Medicine, Department of Medicine, Moi University, Eldoret, Kenya. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Regenstrief Institute Inc., Indianapolis, USA. .,Fairbanks School of Public Health, Indiana University, Indianapolis, USA. .,Division of Epidemiology, 155 College Street, Toronto, ON, M5T 3M, Canada.
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Embleton L, Ott MA, Wachira J, Naanyu V, Kamanda A, Makori D, Ayuku D, Braitstein P. Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya. BMC Med Ethics 2015; 16:89. [PMID: 26687378 PMCID: PMC4684915 DOI: 10.1186/s12910-015-0084-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 12/15/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY's specific vulnerabilities in LMIC. METHODS As part of three interrelated research projects in western Kenya, we created procedures to address SCCY's vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report. RESULTS Substantial community engagement provided input on SCCY's participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation. CONCLUSIONS Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity.
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Affiliation(s)
- L Embleton
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - M A Ott
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - J Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - V Naanyu
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya.
| | - A Kamanda
- Moi Teaching and Referral Hospital, Eldoret, Kenya.
| | - D Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - D Ayuku
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya.
| | - P Braitstein
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Fairbanks School of Public Health, Department of Epidemiology, Indiana University, Indianapolis, IN, USA.
- Regenstrief Institute, Inc., Indianapolis, IN, USA.
- Division of Epidemiology, 155 College Street, Toronto, M5T 3M7, ON, Canada.
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Oppong Asante K. Exploring age and gender differences in health risk behaviours and psychological functioning among homeless children and adolescents. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2015. [DOI: 10.1080/14623730.2015.1088739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Goldblatt A, Kwena Z, Lahiff M, Agot K, Minnis A, Prata N, Lin J, Bukusi EA, Auerswald CL. Prevalence and Correlates of HIV Infection among Street Boys in Kisumu, Kenya. PLoS One 2015; 10:e0140005. [PMID: 26461494 PMCID: PMC4604137 DOI: 10.1371/journal.pone.0140005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Despite their perceived vulnerability to HIV, East African street youth have been neglected in HIV prevention research. We examined HIV seroprevalence and correlates of HIV infection in a sample of male street youth in Kisumu, Kenya. Methods We enrolled a street-recruited sample of 13–21 year old street youth. Participants completed a survey followed by voluntary HIV counseling and testing. Survey items included demographics, homelessness history, survival activities, sexual behavior and substance use. We examined the relationship between predictor variables, markers of coercion and marginalization and HIV. Results The sample included 296 males. Survival activities included garbage picking (55%), helping market vendors (55%), begging (17%), and working as porters (46%) or domestic workers (4%). Forty-nine percent of participants reported at least weekly use of alcohol and 32% marijuana. Forty-six percent of participants reported lifetime inhalation of glue and 8% fuel. Seventy-nine percent of participants reported lifetime vaginal sex, 6% reported lifetime insertive anal sex and 8% reported lifetime receptive anal sex. Twelve (4.1%; 95% CI: 2.3–7.0) participants tested positive for HIV. Of those, all had been on the street for at least one year and all had engaged in vaginal sex. Occupations placing youth at particular risk of coercion by adults, including helping market vendors (prevalence ratio (PR) = 8.8; 95% CI: 1.2–67.5) and working as domestic workers (PR = 4.6; 95% CI: 1.1–19.0), were associated with HIV infection. Both insertive anal sex (PR = 10.2; 95% CI: 3.6–29.4) and receptive anal sex (PR = 3.9; 95% CI: 1.1–13.4) were associated with HIV infection. Drug use, begging, and garbage picking were not associated with HIV infection. Conclusions Although HIV prevalence in our sample of street youth is comparable to that of similarly-aged male youth in Nyanza Province, our findings highlight behavioral factors associated with HIV infection that offer opportunities for targeted prevention among street youth in East Africa.
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Affiliation(s)
- Ariella Goldblatt
- University of California, Berkeley–University of California at San Francisco Joint Medical Program, UC Berkeley School of Public Health, Berkeley, California, United States of America
| | - Zachary Kwena
- Center for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Maureen Lahiff
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Alexandra Minnis
- School of Public Health, University of California, Berkeley, California, United States of America
- Women's Global Health Imperative, RTI International, San Francisco, California, United States of America
| | - Ndola Prata
- Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, California, United States of America
| | - Jessica Lin
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Elizabeth A. Bukusi
- Center for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Colette L. Auerswald
- University of California, Berkeley–University of California at San Francisco Joint Medical Program, UC Berkeley School of Public Health, Berkeley, California, United States of America
- * E-mail:
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Oppong Asante K, Meyer-Weitz A, Petersen I. Mental Health and Health Risk Behaviours of Homeless Adolescents and Youth: A Mixed Methods Study. CHILD & YOUTH CARE FORUM 2015. [DOI: 10.1007/s10566-015-9335-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Winston SE, Chirchir AK, Muthoni LN, Ayuku D, Koech J, Nyandiko W, Carter EJ, Braitstein P. Prevalence of sexually transmitted infections including HIV in street-connected adolescents in western Kenya. Sex Transm Infect 2015; 91:353-9. [PMID: 25714102 PMCID: PMC4518741 DOI: 10.1136/sextrans-2014-051797] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/07/2014] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The objectives of this study were to characterise the sexual health of street-connected adolescents in Eldoret, Kenya, analyse gender disparity of risks, estimate the prevalence of sexually transmitted infections (STIs), and identify factors associated with STIs. METHODS A cross-sectional study of street-connected adolescents ages 12-21 years was conducted in Eldoret, Kenya. Participants were interviewed and screened for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus-2, syphilis and HIV. Descriptive statistics and logistic regression were used to identify factors associated with having any STI. RESULTS Of the 200 participants, 81 (41%) were female. 70.4% of females and 60.5% of males reported sexual activity. Of those that participated in at least one STI test, 28% (55/194) had ≥1 positive test, including 56% of females; 14% (28/194) had >1 positive test. Twelve females and zero males (6% overall, 14.8% of females) were HIV positive. Among females, those with HIV infection more frequently reported transactional sex (66.7% vs. 26.1%, p=0.01), drug use (91.7% vs. 56.5%, p=0.02), and reported a prior STI (50.0% vs. 14.7%, p<0.01). Having an adult caregiver was less likely among those with HIV infection (33.3% vs. 71.0%, p=0.04). Transactional sex (AOR 3.02, 95% CI (1.05 to 8.73)), a previous STI (AOR 3.46 95% CI (1.05 to 11.46)) and ≥2 sexual partners (AOR 5.62 95% (1.67 to 18.87)) were associated with having any STI. CONCLUSIONS Street-connected adolescents in Eldoret, Kenya are engaged in high-risk sexual behaviours and females in particular have a substantial burden of STIs and HIV. There is a need for STI interventions targeted to street-connected youth.
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Affiliation(s)
- Susanna E Winston
- Division of Pediatric Infectious Diseases, Rhode Island Hospital/Hasbro Children's Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | | | - Lauryn N Muthoni
- Moi Teaching and Referral Hospital, Eldoret, Kenya Aga Khan University Hospital, Nairobi, Kenya
| | - David Ayuku
- Department of Behavioral Sciences, Moi University, School of Medicine, College of Health Sciences, Eldoret, Kenya
| | - Julius Koech
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya Department Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya
| | - E Jane Carter
- Department of Pulmonary and Critical Care, The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA Department of Medicine, Moi University, School of Medicine, College of Health Sciences, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya Department of Medicine, Moi University, School of Medicine, College of Health Sciences, Eldoret, Kenya Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA Division of Epidemiology, University of Toronto, Dalla Lana School of Public Health, Toronto, Canada Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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Oppong Asante K, Meyer-Weitz A, Petersen I. Correlates of psychological functioning of homeless youth in Accra, Ghana: a cross-sectional study. Int J Ment Health Syst 2015; 9:1. [PMID: 25587353 PMCID: PMC4292989 DOI: 10.1186/1752-4458-9-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on homeless youth has shown that this population is at high risk for various mental health problems. Previous studies conducted among homeless young adults in Ghana have focused primarily on economic, social and cultural causes of homelessness, their engagement in risky sexual behaviours and the prevalence of STI including HIV/AIDS. We are therefore not fully informed of the prevalence of psychological symptoms and their associated factors. The aim of the study was to determine the association between psychological functioning and social and health risk behaviours among a sample of homeless youth in Ghana. METHODS A cross-sectional survey of a convenience sample of 227 (122 male and 105 female) homeless youth was conducted in Ghana in 2013. An interviewer-administered questionnaire was used to collect data due to low level of literacy among the study population. Pearson-moment correlation coefficient (r) and multiple standard regression models were fitted to analyse the data. RESULTS Approximately 87% of the participants in this study exhibited moderate to severe psychosocial symptoms. Specifically, emotional, conduct, hyperactivity and peer relationship problems among the participants were 69%, 74%, 54% and 89% respectively. Overall psychosocial functioning was predicted by stigma (self-stigma and experienced stigma), violent behaviours and suicidal ideation. Substance use and perceived resilience were significantly associated with emotional problems. CONCLUSION There is a need for holistic interventions to help improve the psychological and social functioning of homeless youth. Such programmes should strengthen socio-emotional coping strategies in street youth as well as address contextual risk factors such as stigma and discrimination by the public.
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Affiliation(s)
- Kwaku Oppong Asante
- />Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4041 South Africa
- />Department of Psychology, Regent University College of Science & Technology, Accra, Ghana
| | - Anna Meyer-Weitz
- />Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4041 South Africa
| | - Inge Petersen
- />Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4041 South Africa
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Oppong Asante K, Meyer-Weitz A, Petersen I. Substance use and risky sexual behaviours among street connected children and youth in Accra, Ghana. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:45. [PMID: 25428774 PMCID: PMC4258041 DOI: 10.1186/1747-597x-9-45] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 11/16/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research on street children and youth has shown that this population is at high risk for substance use. Though risky sexual behaviours have been investigated and widely reported among street youth in resource constrained-settings, few studies have explored the relationship between substance use and other risk behaviours. This study was therefore conducted to examine the association between substance use and risky sexual behaviours among homeless youth in Ghana. METHOD A cross-sectional survey of a convenient sample of 227 (122 male and 105 female) street connected children and youth was conducted in Ghana in 2012. Using self-report measures, the relationship between substance use and risky sexual behaviours was examined using logistic regression. RESULTS Substance use was relatively high as 12% and 16.2% reported daily use of alcohol and marijuana respectively. There were age and sex differences in substance use among the sample. As compared to males, more females had smoked cigarettes, used alcohol and marijuana. While alcohol use decrease with age, marijuana use on the other hand increases with age. Results from multivariate analysis revealed that having ever drunk alcohol and alcohol use in the past one month were independently associated with all the four indices of risky sexual behaviour (ever had sex, non-condom use, multiple sexual partners and survival sex). Both marijuana use and smoking of cigarettes were associated with having ever had sex, multiple sexual partners and survival sex. Other drug use was independently associated with non-condom use. CONCLUSION Substance use seems to serve as a possible risk factor for sexual risk behaviours among homeless youth. Harm reduction interventions are needed to prevent street children and youth from engaging in substance use and risky sexual behaviours. Such programmes should pay special attention to females and younger children who are highly susceptible to the adverse conditions on the street.
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Affiliation(s)
- Kwaku Oppong Asante
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban 4041, South Africa.
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Sorber R, Winston S, Koech J, Ayuku D, Hu L, Hogan J, Braitstein P. Social and economic characteristics of street youth by gender and level of street involvement in Eldoret, Kenya. PLoS One 2014; 9:e97587. [PMID: 24827584 PMCID: PMC4020866 DOI: 10.1371/journal.pone.0097587] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 04/21/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Street-connected youth are a neglected and vulnerable population, particularly in resource-constrained settings. The development of interventions and supports for this population requires insight into how they live. This study describes the social and economic characteristics of a convenience sample of street youth (SY) in Eldoret, Kenya. METHODS Participants were eligible if they were aged 12-21, living in Eldoret, spending days only (part-time), or nights and days on the street (full-time) and able and willing to consent or assent. Data were collected using a standardized interview conducted in English or Kiswahili. Binary dependent variables were having been arrested and/or jailed, and first priority for spending money (food vs. other). Nominal categorical dependent variables included major source of support, and major reason for being street-involved. Multivariable analysis used logistic regression models to examine the association of gender and level of street-involvement with social and economic factors of interest adjusting for age and length of time on the street. Data were analyzed using SAS 9.3. RESULTS Of the 200 SY enrolled, 41% were female, mean age of 16.3 years; 71% were on the street full-time, and 29% part-time. Compared with part-time SY, full-time SY were more likely to have been arrested (Adjusted Odds Ratio [AOR]: 2.33, 95% Confidence Interval [95%CI]:1.01-5.35), name food as their first spending priority (AOR: 2.57, 95%CI:1.03-6.45), have left home due to violence (AOR: 5.54, 95%CI: 1.67-18.34), and more likely to report friends on the street as a major source of support (AOR: 3.59, 95% CI: 1.01-12.82). Compared with females, males were more likely to have ever been arrested (AOR: 2.66, 95%CI:1.14-6.18), and to have ever been jailed (AOR: 3.22, 95%CI:1.47-7.02). CONCLUSIONS These results suggest a high degree of heterogeneity and vulnerability among SY in this setting. There is an urgent need for interventions taking into consideration these characteristics.
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Affiliation(s)
- Rebecca Sorber
- School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Susanna Winston
- Department of Pediatrics, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, United States of America
- Rhode Island Hospital-Hasbro Youth's Hospital, Providence, Rhode Island, United States of America
| | | | - David Ayuku
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Liangyuan Hu
- Department of Biostatistics, Brown University, Providence, Rhode Island, United States of America
| | - Joseph Hogan
- AMPATH Consortium, Eldoret, Kenya
- Department of Biostatistics, Brown University, Providence, Rhode Island, United States of America
| | - Paula Braitstein
- School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- AMPATH Consortium, Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
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26
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Embleton L, Mwangi A, Vreeman R, Ayuku D, Braitstein P. The epidemiology of substance use among street children in resource-constrained settings: a systematic review and meta-analysis. Addiction 2013; 108:1722-33. [PMID: 23844822 PMCID: PMC3776018 DOI: 10.1111/add.12252] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/11/2013] [Accepted: 05/13/2013] [Indexed: 11/30/2022]
Abstract
AIMS To compile and analyze critically the literature published on street children and substance use in resource-constrained settings. METHODS We searched the literature systematically and used meta-analytical procedures to synthesize literature that met the review's inclusion criteria. Pooled-prevalence estimates and 95% confidence intervals (CI) were calculated using the random-effects model for life-time substance use by geographical region as well as by type of substance used. RESULTS Fifty studies from 22 countries were included into the review. Meta-analysis of combined life-time substance use from 27 studies yielded an overall drug use pooled-prevalence estimate of 60% (95% CI = 51-69%). Studies from 14 countries contributed to an overall pooled prevalence for street children's reported inhalant use of 47% (95% CI = 36-58%). This review reveals significant gaps in the literature, including a dearth of data on physical and mental health outcomes, HIV and mortality in association with street children's substance use. CONCLUSIONS Street children from resource-constrained settings reported high life-time substance use. Inhalants are the predominant substances used, followed by tobacco, alcohol and marijuana.
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Affiliation(s)
- Lonnie Embleton
- College of Health Sciences, Department of Medicine, Moi University, Eldoret, Kenya
| | - Ann Mwangi
- College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | - Rachel Vreeman
- College of Health Sciences, School of Medicine, Department of Pediatrics, Moi University, Eldoret, Kenya
- School of Medicine, Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - David Ayuku
- College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- College of Health Sciences, Department of Medicine, Moi University, Eldoret, Kenya
- School of Medicine, Department of Medicine, Indiana University, Indianapolis, IN, USA
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada and
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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27
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Embleton L, Atwoli L, Ayuku D, Braitstein P. The journey of addiction: barriers to and facilitators of drug use cessation among street children and youths in Western Kenya. PLoS One 2013; 8:e53435. [PMID: 23326428 PMCID: PMC3541137 DOI: 10.1371/journal.pone.0053435] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/28/2012] [Indexed: 11/19/2022] Open
Abstract
This mixed-methods study examined barriers to and facilitators of street children’s drug use cessation in Eldoret, Kenya utilizing a cross-sectional survey and focus group discussions with a community-based sample of street-involved children and youth. The primary objective of this study was to describe factors that may assist or impede cessation of drug use that can be utilized in developing substance use interventions for this marginalized population. In 2011, 146 children and youth ages 10–19 years, classified as either children on the street or children of the street were recruited to participate in the cross-sectional survey. Of the 146 children that participated in the survey 40 were invited to participate in focus group discussion; 30 returned voluntarily to participate in the discussions. Several themes were derived from children’s narratives that described the barriers to and facilitators of drug cessation. Specifically, our findings reveal the strength of the addiction to inhalants, the dual role that peers and family play in substance use, and how the social, cultural, and economic context influence or impede cessation. Our findings demonstrate the need to integrate community, family and peers into any intervention in addition to traditional medical and psychological models for treatment of substance use dependence.
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Affiliation(s)
- Lonnie Embleton
- Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Lukoye Atwoli
- Department of Mental Health, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - David Ayuku
- Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
- * E-mail:
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