1
|
Prentice-Mott G, Odhiambo A, Conners EE, Mwaki A, Blackstock AJ, Oremo J, Akelo O, Eleveld A, Quick R, Murphy J, Berendes DM. Evaluation of SaTo pans as a new latrine technology in Kisumu County healthcare facilities, Kenya. Trop Med Int Health 2023; 28:881-889. [PMID: 37940633 PMCID: PMC10886420 DOI: 10.1111/tmi.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Innovations to improve public sanitation facilities, especially in healthcare facilities (HCFs) in low-income countries, are limited. SaTo pans represent novel, largely untested, modifications to reduce odour and flies and improve acceptability of HCF sanitation facilities. We conducted a pilot project to evaluate acceptability, cleanliness, flies and odour within latrines in 37 HCFs in Kisumu, Kenya, randomised into intervention (SaTo pan modifications) and control arms by sub-county and HCF level. METHODS At baseline (pre-intervention) and endline (>3 months after completion of SaTo pan installations in latrines in intervention HCFs), we surveyed users, cleaners and in-charges, observed odour and cleanliness, and assessed flies using fly tape. Unadjusted difference-in-difference analysis compared changes from baseline to endline in patient-reported acceptability and observed latrine conditions between intervention and control HCFs. A secondary assessment compared patient-reported acceptability following use of SaTo pan versus non-SaTo pan latrines within intervention HCFs. RESULTS Patient-reported acceptability of latrines was higher following the intervention (baseline: 87%, endline: 96%, p = 0.05). However, patient-reported acceptability was also high in the control arm (79%, 86%, p = 0.34), and the between-arm difference-in-difference was not significant. Enumerator-observed odour declined in intervention latrines (32%-14%) compared with controls (36%-51%, difference-in-difference ratio: 0.32, 95% confidence interval: 0.12-0.84), but changes in flies, puddling of urine and visible faeces did not differ between arms. In the secondary assessment, fewer intervention than control latrines had patient-reported flies (0% vs. 26%) and odour (18% vs. 50%), and reported satisfaction was greater. Most cleaners reported dropholes and floors were easier to clean in intervention versus controls; limited challenges with water for flushing were reported. CONCLUSIONS Our results suggest SaTo pans may be acceptable by cleaners and users and reduce odour in HCF sanitation facilities, though challenges exist and further evaluation with larger sample sizes is needed.
Collapse
Affiliation(s)
- Graeme Prentice-Mott
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Erin E Conners
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alex Mwaki
- EIS Service, Safe Water and AIDS Project, Kisumu, Kenya
| | - Anna J Blackstock
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jared Oremo
- EIS Service, Safe Water and AIDS Project, Kisumu, Kenya
| | - Oscar Akelo
- EIS Service, Safe Water and AIDS Project, Kisumu, Kenya
| | - Alie Eleveld
- EIS Service, Safe Water and AIDS Project, Kisumu, Kenya
| | - Robert Quick
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Murphy
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David M Berendes
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Zulaika G, Nyothach E, van Eijk AM, Wang D, Opollo V, Obor D, Mason L, Chen T, Kerubo E, Oyaro B, Mwaki A, Eleveld A, Ngere I, Fwaya E, ter Kuile FO, Kwaro D, Phillips-Howard PA. Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls in western Kenya: a cluster randomised controlled trial. EClinicalMedicine 2023; 65:102261. [PMID: 37860578 PMCID: PMC10582356 DOI: 10.1016/j.eclinm.2023.102261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
Background High rates of sexual and reproductive health (SRH) harms and interrupted schooling are global challenges for adolescent girls, requiring effective interventions. We assessed the impact of menstrual cups (MCs) or cash transfers conditioned on school attendance (CCTs), or both, on SRH and schooling outcomes in western Kenya. Methods In this cluster-randomised Cups or Cash for Girls (CCG) trial, adolescent girls in Forms two and three at 96 secondary schools in Siaya County (western Kenya) were randomised to receive either CCT, MC, combined CCT and MC, or control (1:1:1:1) for an average of 30 months. The CCT intervention comprised 1500KES (US$15 in 2016) via a cash card each school trimester. All four treatment groups received puberty and hygiene training. Assenting girls with parent or guardian consent who were post-menarche, not pregnant, area residents, not boarding, and had no disabilities precluding participation were eligible. Socio-behavioural risk factors and incidence of HIV and herpes simplex virus type 2 (HSV-2) were measured annually. School retainment and adverse events were monitored throughout. The primary outcome comprised a composite of incident HIV, HSV-2 and/or all-cause school dropout by school exit examination. The primary analysis was by intention-to-treat (ITT) using generalised linear mixed models, controlling for a priori selected baseline covariates. The trial is registered with ClinicalTrials.gov, NCT03051789. Findings Between February 28, 2017 and June 30, 2021, 4137 girls (median age 17.1 [interquartile range (IQR): 16.3-18.0]) were enrolled and followed annually until completion of secondary school (median 2.5 years [IQR: 2.4-2.7]); 4106 (99.3%) contributed to the ITT analysis. No differences in the primary composite outcome between intervention and control groups were seen (MC: 18.2%, CCT: 22.1%, combined: 22.1%, control: 19.6%; adjusted risk ratio [aRR]: 0.97, 95% confidence interval 0.76-1.24; 1.14, 0.90-1.45; and 1.13, 0.90-1.43, respectively). Incident HSV-2 occurred in 8.6%, 13.3%, 14.8%, and 12% of the MC, CCT, combined and control groups, respectively (MC: RR: 0.67, 0.47-0.95, p = 0.027; aRR: 0.71, 0.50-1.01, p = 0.057; CCT: aRR: 1.02, 0.73-1.41, p = 0.92; combined aRR: 1.16, 0.85-2.58, p = 0.36). Incident HIV was low (MC: 1.2%, CCT: 1.5%, combined: 1.0%, and control: 1.4%; aRR: 0.88, 0.38-2.05, p = 0.77, aRR: 1.16, 0.51-2.62, p = 0.72, aRR: 0.80, 0.33-1.94, p = 0.62, respectively). No intervention decreased school dropout (MC: 11.2%, CCT: 12.4%, combined: 10.9%, control: 10.5%; aRR: 1.16, 0.86-1.57; 1.23, 0.91-1.65; and 1.06, 0.78-1.44, respectively). No related serious adverse events were seen. Interpretation MCs, CCTs, or both, did not protect schoolgirls against a composite of deleterious harms. MCs appear protective against HSV-2. Studies of longer follow-up duration with objective measures of health impact are needed in this population. Funding Department of Health and Social Care, the Foreign, Commonwealth & Development Office, the Medical Research Council and Wellcome.
Collapse
Affiliation(s)
- Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Valarie Opollo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - David Obor
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Emily Kerubo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Boaz Oyaro
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Alex Mwaki
- Safe Water and AIDS Project (SWAP), Kisumu, Kenya
| | - Alie Eleveld
- Safe Water and AIDS Project (SWAP), Kisumu, Kenya
| | - Isaac Ngere
- Washington State University Global Health Program, Nairobi, Kenya
| | | | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Daniel Kwaro
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | |
Collapse
|
3
|
Berendes D, Martinsen A, Lozier M, Rajasingham A, Medley A, Osborne T, Trinies V, Schweitzer R, Prentice-Mott G, Pratt C, Murphy J, Craig C, Lamorde M, Kesande M, Tusabe F, Mwaki A, Eleveld A, Odhiambo A, Ngere I, Kariuki Njenga M, Cordon-Rosales C, Contreras APG, Call D, Ramay BM, Ramm RES, Paulino CJT, Schnorr CD, Aubin MD, Dumas D, Murray KO, Bivens N, Ly A, Hawes E, Maliga A, Morazan GH, Manzanero R, Morey F, Maes P, Diallo Y, Ilboudo M, Richemond D, Hattab OE, Oger PY, Matsuhashi A, Nsambi G, Antoine J, Ayebare R, Nakubulwa T, Vosburgh W, Boore A, Herman-Roloff A, Zielinski-Gutierrez E, Handzel T. Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19. PLOS Water 2022; 1:e0000027. [PMID: 38410139 PMCID: PMC10896259 DOI: 10.1371/journal.pwat.0000027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices-for example, hand hygiene-are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.
Collapse
Affiliation(s)
- David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea Martinsen
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matt Lozier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anu Rajasingham
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexandra Medley
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taylor Osborne
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Victoria Trinies
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CDC Foundation, Atlanta, Georgia, USA
| | - Ryan Schweitzer
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Graeme Prentice-Mott
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caroline Pratt
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention
| | - Jennifer Murphy
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina Craig
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Maureen Kesande
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Fred Tusabe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Alex Mwaki
- Safe Water and AIDS Project, Kisumu, Kenya
| | | | | | | | | | | | | | - Douglas Call
- Washington State University, Pullman, Washington, USA
| | | | | | | | | | - Michael De Aubin
- Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Devan Dumas
- Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Kristy O Murray
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nicholas Bivens
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Anh Ly
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Ella Hawes
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Adrianna Maliga
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Gerhaldine H Morazan
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | | | - Francis Morey
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | - Peter Maes
- UNICEF, Kinshasa, Democratic Republic of Congo
| | | | | | | | | | | | | | - Gertrude Nsambi
- Department of Hygiene and Public Health, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | | | | | - Waverly Vosburgh
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy Boore
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy Herman-Roloff
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Emily Zielinski-Gutierrez
- Division of Global Health Protection, Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Tom Handzel
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Straily A, Kavere EA, Wanja D, Wiegand RE, Montgomery SP, Mwaki A, Eleveld A, Secor WE, Odiere MR. Evaluation of the Point-of-Care Circulating Cathodic Antigen Assay for Monitoring Mass Drug Administration in a Schistosoma mansoni Control Program in Western Kenya. Am J Trop Med Hyg 2021; 106:303-311. [PMID: 34749308 PMCID: PMC8733502 DOI: 10.4269/ajtmh.21-0599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
The WHO guidelines for monitoring and evaluating Schistosoma mansoni control programs are based on the Kato-Katz (KK) fecal examination method; however, there are limitations to its use, particularly in low prevalence areas. The point-of-care urine circulating cathodic antigen (POC-CCA) assay has emerged as a useful tool for mapping schistosomiasis prevalence, but its use in monitoring and evaluating control programs has not been evaluated. Before POC-CCA can be used for these programs, it must be determined how previous guidance based on the KK method can be translated to the POC-CCA assay; furthermore, its performance in different endemicity settings must be evaluated. Urine and stool specimens were collected from students attending public primary schools in western Kenya before mass treatment with praziquantel at baseline (51 schools), year 1 (45 schools), year 2 (34 schools), and year 3 (20 schools). Prevalence and infection intensity were determined by the KK method and POC-CCA assay. Changes in prevalence and intensity were compared within the strata of schools grouped according to the baseline prevalence determined by the KK method (0–10%, > 10–20%, > 20%). The prevalence determined by the POC-CCA assay was higher than that determined by the KK method at all time points for all strata. The prevalence determined by the KK method decreased from baseline to 2 and 3 years, as did infection intensity (with one exception). A corresponding decrease was not always replicated by the POC-CCA assay results. The POC-CCA assay did not perform as expected, and the concordance of results of the two tests was poor. Furthermore, there are emerging concerns regarding the specificity of the POC-CCA assay. Therefore, it is impossible to translate historical data and programmatic guidelines based on the KK method results to the POC-CCA assay.
Collapse
Affiliation(s)
- Anne Straily
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alex Mwaki
- Safe Water and AIDS Project, Kisumu, Kenya
| | | | - William E Secor
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maurice R Odiere
- Safe Water and AIDS Project, Kisumu, Kenya.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| |
Collapse
|
5
|
Murray AL, Napotnik JA, Rayner JS, Mendoza A, Mitro B, Norville J, Faith SH, Eleveld A, Jellison KL, Lantagne DS. Evaluation of consistent use, barriers to use, and microbiological effectiveness of three prototype household water treatment technologies in Haiti, Kenya, and Nicaragua. Sci Total Environ 2020; 718:134685. [PMID: 31839311 DOI: 10.1016/j.scitotenv.2019.134685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
Household water treatment (HWT) can improve drinking water quality and reduce diarrheal disease. New HWT technologies are typically evaluated under ideal conditions; however, health gains depend on consistent, effective household use, which is less often evaluated. We conducted four evaluations of three prototype HWT technologies: two filters and one electrochlorinator. Evaluations consisted of a baseline survey, HWT distribution to households (ranging from 60 to 82), and four visits (ranging from 1 week-14 months after distribution). Each visit included a survey, observation of treated water presence (confirmed use), and microbiological analysis of treated and untreated samples for E. coli. Consistent use was defined as the proportion of total visits with confirmed use. Overall, confirmed use declined 2.54% per month on average, and 2-72% of households demonstrated 100% consistent use. Consistent use was positively associated with baseline HWT knowledge and practice and belief that drinking water was unsafe, and negatively associated with technological problems. Reported barriers to use were behavioral, such as forgetting or when outside the home, and technological failures. Technologies demonstrated 68-96% E. coli reductions, with 18-70% of treated samples having detectable E. coli. Results highlight the importance of household use evaluations within prototype HWT technology design cycles, the need for standard evaluation metrics, and difficulties in achieving both consistent use and microbiological effectiveness with HWT technologies.
Collapse
Affiliation(s)
- Anna L Murray
- Tufts University Department of Civil and Environmental Engineering, 200 College Avenue Medford, MA, 02155, USA.
| | - Julie A Napotnik
- Lehigh University Department of Civil and Environmental Engineering, 13 East Packer Avenue Bethlehem, PA, 18015, USA
| | - Justine S Rayner
- Tufts University Department of Civil and Environmental Engineering, 200 College Avenue Medford, MA, 02155, USA
| | - Antonia Mendoza
- Fundación Tierra, Avenida del Parque, San Juan del Sur, Nicaragua
| | - Brittany Mitro
- Tufts University Department of Civil and Environmental Engineering, 200 College Avenue Medford, MA, 02155, USA
| | - Joshua Norville
- Tufts University School of Medicine, Department of Public Health and Community Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
| | - Sitnah H Faith
- Safe Water and AIDS Project, P.O. Box 3323, Kisumu, Kenya
| | - Alie Eleveld
- Safe Water and AIDS Project, P.O. Box 3323, Kisumu, Kenya
| | - Kristen L Jellison
- Lehigh University Department of Civil and Environmental Engineering, 13 East Packer Avenue Bethlehem, PA, 18015, USA
| | - Daniele S Lantagne
- Tufts University Department of Civil and Environmental Engineering, 200 College Avenue Medford, MA, 02155, USA
| |
Collapse
|
6
|
Batura N, Skordis J, Palmer T, Odiambo A, Copas A, Vanhuyse F, Dickin S, Eleveld A, Mwaki A, Ochieng C, Haghparast-Bidgoli H. Cost-effectiveness of conditional cash transfers to retain women in the continuum of care during pregnancy, birth and the postnatal period: protocol for an economic evaluation of the Afya trial in Kenya. BMJ Open 2019; 9:e032161. [PMID: 31699743 PMCID: PMC6858100 DOI: 10.1136/bmjopen-2019-032161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION A wealth of evidence from a range of country settings indicates that antenatal care, facility delivery and postnatal care can reduce maternal and child mortality and morbidity in high-burden settings. However, the utilisation of these services by pregnant women, particularly in low/middle-income country settings, is well below that recommended by the WHO. The Afya trial aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased utilisation of these services in rural Kenya and thus retain women in the continuum of care during pregnancy, birth and the postnatal period. This protocol describes the planned economic evaluation of the Afya trial. METHODS AND ANALYSIS The economic evaluation will be conducted from the provider perspective as a within-trial analysis to evaluate the incremental costs and health outcomes of the cash transfer programme compared with the status quo. Incremental cost-effectiveness ratios will be presented along with a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Sensitivity analyses will be undertaken to explore uncertainty and to ensure that results are robust. A fiscal space assessment will explore the affordability of the intervention. In addition, an analysis of equity impact of the intervention will be conducted. ETHICS AND DISSEMINATION The study has received ethics approval from the Maseno University Ethics Review Committee, REF MSU/DRPI/MUERC/00294/16. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference. TRIAL REGISTRATION NUMBER NCT03021070.
Collapse
Affiliation(s)
- Neha Batura
- Institute for Global Health, University College London, London, UK
| | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
| | - Tom Palmer
- Institute for Global Health, University College London, London, UK
| | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | - Sarah Dickin
- Stockholm Environment Institute, Stockholm, Sweden
| | | | - Alex Mwaki
- Safe Water and AIDS Project, Kisumu, Kenya
| | | | | |
Collapse
|
7
|
Zulaika G, Kwaro D, Nyothach E, Wang D, Zielinski-Gutierrez E, Mason L, Eleveld A, Chen T, Kerubo E, van Eijk A, Pace C, Obor D, Juma J, Oyaro B, Niessen L, Bigogo G, Ngere I, Henry C, Majiwa M, Onyango CO, Ter Kuile FO, Phillips-Howard PA. Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls: study protocol of a cluster-randomised controlled trial in western Kenya. BMC Public Health 2019; 19:1317. [PMID: 31638946 PMCID: PMC6805471 DOI: 10.1186/s12889-019-7594-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Adolescent girls in sub-Saharan Africa are disproportionally vulnerable to sexual and reproductive health (SRH) harms. In western Kenya, where unprotected transactional sex is common, young females face higher rates of school dropout, often due to pregnancy, and sexually transmitted infections (STIs), including HIV. Staying in school has shown to protect girls against early marriage, teen pregnancy, and HIV infection. This study evaluates the impact of menstrual cups and cash transfer interventions on a composite of deleterious outcomes (HIV, HSV-2, and school dropout) when given to secondary schoolgirls in western Kenya, with the aim to inform evidence-based policy to improve girls’ health, school equity, and life-chances. Methods Single site, 4-arm, cluster randomised controlled superiority trial. Secondary schools are the unit of randomisation, with schoolgirls as the unit of measurement. Schools will be randomised into one of four intervention arms using a 1:1:1:1 ratio and block randomisation: (1) menstrual cup arm; (2) cash transfer arm, (3) cups and cash combined intervention arm, or (4) control arm. National and county agreement, and school level consent will be obtained prior to recruitment of schools, with parent consent and girls’ assent obtained for participant enrolment. Participants will be trained on safe use of interventions, with all arms receiving puberty and hygiene education. Annually, the state of latrines, water availability, water treatment, handwashing units and soap in schools will be measured. The primary endpoint is a composite of incident HIV, HSV-2, and all-cause school dropout, after 3 years follow-up. School dropout will be monitored each term via school registers and confirmed through home visits. HIV and HSV-2 incident infections and risk factors will be measured at baseline, mid-line and end-line. Intention to treat analysis will be conducted among all enrolled participants. Focus group discussions will provide contextual information on uptake of interventions. Monitoring for safety will occur throughout. Discussion If proved safe and effective, the interventions offer a potential contribution toward girls’ schooling, health, and equity in low- and middle-income countries. Trial registration ClinicalTrials.gov NCT03051789, 15th February 2017.
Collapse
Affiliation(s)
- Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Daniel Kwaro
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Emily Zielinski-Gutierrez
- Center for Global Health, Division of Global Health HIV and TB, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Alie Eleveld
- Safe Water and AIDS Project (SWAP), Kisumu, Kenya
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Emily Kerubo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Annemieke van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Cheryl Pace
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - David Obor
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Jane Juma
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Boaz Oyaro
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Louis Niessen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Carl Henry
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Maxwell Majiwa
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Penelope A Phillips-Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| |
Collapse
|
8
|
Ochieng CA, Haghparast-Bidgoli H, Batura N, Odhiambo A, Shannon G, Copas A, Palmer T, Dickin S, Noel S, Fielding M, Onyango S, Odera S, Eleveld A, Mwaki A, Vanhuyse F, Skordis J. Conditional cash transfers to retain rural Kenyan women in the continuum of care during pregnancy, birth and the postnatal period: protocol for a cluster randomized controlled trial. Trials 2019; 20:152. [PMID: 30823886 PMCID: PMC6397480 DOI: 10.1186/s13063-019-3224-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 01/28/2019] [Indexed: 11/25/2022] Open
Abstract
Background Antenatal care (ANC), facility delivery and postnatal care (PNC) are proven to reduce maternal and child mortality and morbidity in high-burden settings. However, few pregnant rural women use these services sufficiently. This study aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased contact between pregnant women or women who have recently given birth and the formal healthcare system in Kenya. Methods The intervention tested is a conditional cash transfer to women for ANC health visits, a facility birth and PNC visits until their newborn baby reaches 1 year of age. The study is a cluster randomized controlled trial in Siaya County, Kenya. The trial clusters are 48 randomly selected public primary health facilities, 24 of which are in the intervention arm of the study and 24 in the control arm. The unit of randomization is the health facility. A target sample of 7200 study participants comprises pregnant women identified and recruited at their first ANC visit over a 12-month recruitment period and their subsequent newborns. All pregnant women attending one of the selected trial facilities for their first ANC visit during the recruitment period are eligible for the trial and invited to participate. Enrolled mothers are followed up at all health visits during their pregnancy, at facility delivery and for a number of visits after delivery. They are also contacted at three additional time points after enrolling in the study: 5–10days after enrolment, 6 months after the expected delivery date and 12 27 months after birth. If they have not delivered in a facility, there is an additional follow-up 2 wees after the expected due date. The impact of the conditional cash transfers on maternal healthcare services and utilization will be measured by the trial’s primary outcomes: the proportion of all eligible ANC visits made during pregnancy, delivery at a health facility, the proportion of all eligible PNC visits attended, the proportion of referrals attended during the pregnancy and the postnatal period, and the proportion of eligible child immunization appointments attended. Secondary outcomes include; health screening and infection control, live birth, maternal and child survival 48 h after delivery, exclusive breastfeeding, post-partum contraceptive use and maternal and newborn morbidity. Data sources for the measurement of outcomes include routine health records, an electronic card-reader system and telephone surveys and focus group discussions. A full economic evaluation will be conducted to assess the cost of delivery and cost effectiveness of the intervention and the benefit incidence and equity impact of trial activities and outcomes. Discussion This trial will contribute to evidence on the effectiveness and cost-effectiveness of conditional cash transfers in facilitating health visits and promoting maternal and child health in rural Kenya and in other comparable contexts. Trial registration ClinicalTrials.gov, NCT03021070. Registered on 13 January 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3224-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Caroline A Ochieng
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Hassan Haghparast-Bidgoli
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Neha Batura
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Aloyce Odhiambo
- Safe Water and AIDS Project (SWAP), P.O. Box 3323, Kisumu, 40100, Kenya
| | - Geordan Shannon
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Andrew Copas
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Tom Palmer
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Sarah Dickin
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Stacey Noel
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Matthew Fielding
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Sangoro Onyango
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Sarah Odera
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden
| | - Alie Eleveld
- Safe Water and AIDS Project (SWAP), P.O. Box 3323, Kisumu, 40100, Kenya
| | - Alex Mwaki
- Safe Water and AIDS Project (SWAP), P.O. Box 3323, Kisumu, 40100, Kenya
| | - Fedra Vanhuyse
- Stockholm Environment Institute, Linnegatan 87D, Box 24218, 10451, Stockholm, Sweden.
| | - Jolene Skordis
- UCL Institute for Global Health, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| |
Collapse
|
9
|
Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, Eleveld A, Mannell J. Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet 2019; 393:560-569. [PMID: 30739691 DOI: 10.1016/s0140-6736(18)33135-0] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 11/25/2022]
Abstract
The purpose of this Review is to provide evidence for why gender equality in science, medicine, and global health matters for health and health-related outcomes. We present a high-level synthesis of global gender data, summarise progress towards gender equality in science, medicine, and global health, review the evidence for why gender equality in these fields matters in terms of health and social outcomes, and reflect on strategies to promote change. Notwithstanding the evolving landscape of global gender data, the overall pattern of gender equality for women in science, medicine, and global health is one of mixed gains and persistent challenges. Gender equality in science, medicine, and global health has the potential to lead to substantial health, social, and economic gains. Positioned within an evolving landscape of gender activism and evidence, our Review highlights missed and future opportunities, as well as the need to draw upon contemporary social movements to advance the field.
Collapse
Affiliation(s)
- Geordan Shannon
- Centre for Gender and Global Health, Institute for Global Health, University College London, London, UK.
| | - Melanie Jansen
- Paediatric Intensive Care Unit and Centre for Children's Health Ethics and Law, Children's Health Queensland, Brisbane, QLD, Australia
| | | | - Carlos Cáceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angelica Motta
- Centro de Investigación Interdisciplinaria en Sexualidad, Sida y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Jenevieve Mannell
- Centre for Gender and Global Health, Institute for Global Health, University College London, London, UK
| |
Collapse
|
10
|
Alexander KT, Zulaika G, Nyothach E, Oduor C, Mason L, Obor D, Eleveld A, Laserson KF, Phillips-Howard PA. Do Water, Sanitation and Hygiene Conditions in Primary Schools Consistently Support Schoolgirls' Menstrual Needs? A Longitudinal Study in Rural Western Kenya. Int J Environ Res Public Health 2018; 15:ijerph15081682. [PMID: 30087298 PMCID: PMC6121484 DOI: 10.3390/ijerph15081682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 11/16/2022]
Abstract
Many females lack access to water, privacy and basic sanitation—felt acutely when menstruating. Water, sanitation and hygiene (WASH) conditions in schools, such as access to latrines, water, and soap, are essential for the comfort, equity, and dignity of menstruating girls. Our study was nested within a cluster randomized controlled pilot feasibility study where nurses provided menstrual items to schoolgirls. We observed the WASH conditions of 30 schools from June 2012–October 2013 to see if there were any changes in conditions, to compare differences between study arms and to examine agreement between observed and teacher-reported conditions. Data came from study staff observed, and school teacher reported, WASH conditions. We developed scores for the condition of school facilities to report any changes in conditions and compare outcomes across study arms. Results demonstrated that soap availability for students increased significantly between baseline and follow-up while there was a significant decrease in the number of “acceptable” latrines. During the study follow-up period, individual WASH indicators supporting menstruating girls, such as locks on latrine doors or water availability in latrines did not significantly improve. Advances in WASH conditions for all students, and menstrual hygiene facilities for schoolgirls, needs further support, a defined budget, and regular monitoring of WASH facilities to maintain standards.
Collapse
Affiliation(s)
- Kelly T Alexander
- Liverpool School of Tropical Medicine, Liverpool L35QA, UK.
- Cooperative for Assistance and Relief Everywhere (CARE), 151 Ellis St NE, Atlanta, GA 30303, USA.
| | - Garazi Zulaika
- Liverpool School of Tropical Medicine, Liverpool L35QA, UK.
| | | | - Clifford Oduor
- Kenya Medical Research Institute, Kisumu 1578-40100, Kenya.
| | - Linda Mason
- Liverpool School of Tropical Medicine, Liverpool L35QA, UK.
| | - David Obor
- Kenya Medical Research Institute, Kisumu 1578-40100, Kenya.
| | - Alie Eleveld
- Safe Water and AIDS Programme, Kisumu 3323-40100, Kenya.
| | - Kayla F Laserson
- Kenya Medical Research Institute, Kisumu 1578-40100, Kenya.
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | |
Collapse
|
11
|
Phillips-Howard PA, Nyothach E, Ter Kuile FO, Omoto J, Wang D, Zeh C, Onyango C, Mason L, Alexander KT, Odhiambo FO, Eleveld A, Mohammed A, van Eijk AM, Edwards RT, Vulule J, Faragher B, Laserson KF. Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural Western Kenya. BMJ Open 2016; 6:e013229. [PMID: 27881530 PMCID: PMC5168542 DOI: 10.1136/bmjopen-2016-013229] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Conduct a feasibility study on the effect of menstrual hygiene on schoolgirls' school and health (reproductive/sexual) outcomes. DESIGN 3-arm single-site open cluster randomised controlled pilot study. SETTING 30 primary schools in rural western Kenya, within a Health and Demographic Surveillance System. PARTICIPANTS Primary schoolgirls 14-16 years, experienced 3 menses, no precluding disability, and resident in the study area. INTERVENTIONS 1 insertable menstrual cup, or monthly sanitary pads, against 'usual practice' control. All participants received puberty education preintervention, and hand wash soap during intervention. Schools received hand wash soap. PRIMARY AND SECONDARY OUTCOME MEASURES Primary: school attrition (drop-out, absence); secondary: sexually transmitted infection (STI) (Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoea), reproductive tract infection (RTI) (bacterial vaginosis, Candida albicans); safety: toxic shock syndrome, vaginal Staphylococcus aureus. RESULTS Of 751 girls enrolled 644 were followed-up for a median of 10.9 months. Cups or pads did not reduce school dropout risk (control=8.0%, cups=11.2%, pads=10.2%). Self-reported absence was rarely reported and not assessable. Prevalence of STIs in the end-of-study survey among controls was 7.7% versus 4.2% in the cups arm (adjusted prevalence ratio (aPR) 0.48, 0.24 to 0.96, p=0.039), 4.5% with pads (aPR=0.62; 0.37 to 1.03, p=0.063), and 4.3% with cups and pads pooled (aPR=0.54, 0.34 to 0.87, p=0.012). RTI prevalence was 21.5%, 28.5% and 26.9% among cup, pad and control arms, 71% of which were bacterial vaginosis, with a prevalence of 14.6%, 19.8% and 20.5%, per arm, respectively. Bacterial vaginosis was less prevalent in the cups (12.9%) compared with pads (20.3%, aPR=0.65, 0.44 to 0.97, p=0.034) and control (19.2%, aPR=0.67, 0.43 to 1.04, p=0.075) arm girls enrolled for 9 months or longer. No adverse events were identified. CONCLUSIONS Provision of menstrual cups and sanitary pads for ∼1 school-year was associated with a lower STI risk, and cups with a lower bacterial vaginosis risk, but there was no association with school dropout. A large-scale trial on menstrual cups is warranted. TRIAL REGISTRATION ISRCTN17486946; Results.
Collapse
Affiliation(s)
- Penelope A Phillips-Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Jackton Omoto
- Siaya District Hospital, Ministry of Health, Siaya, Kenya
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | - Clement Zeh
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
- Centers for Disease Control and Prevention (CDC)-Kenya, Kisumu, Kenya
| | - Clayton Onyango
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
- Centers for Disease Control and Prevention (CDC)-Kenya, Kisumu, Kenya
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | - Kelly T Alexander
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | - Frank O Odhiambo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Alie Eleveld
- Safe Water and AIDS Project (SWAP), Kisumu, Kenya
| | - Aisha Mohammed
- Division of Reproductive Health, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Anna M van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | | | - John Vulule
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Brian Faragher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), UK
| | - Kayla F Laserson
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
12
|
Mason L, Laserson K, Oruko K, Nyothach E, Alexander K, Odhiambo F, Eleveld A, Isiye E, Ngere I, Omoto J, Mohammed A, Vulule J, Phillips-Howard P. Adolescent schoolgirls' experiences of menstrual cups and pads in rural western Kenya: a qualitative study. ACTA ACUST UNITED AC 2015. [DOI: 10.3362/1756-3488.2015.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Kayla Laserson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, US
| | - Kelvin Oruko
- KEMRI/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | | | | | - Frank Odhiambo
- KEMRI/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | | | - Emily Isiye
- District Education Office, Gem District, Sawagongo, Siaya County, Kenya
| | - Isaac Ngere
- District Medical Office, Gem District, Yala, Siaya County, Kenya
| | - Jackton Omoto
- Department of Obstetrics and Gynaecology, Siaya District Hospital, Ministry of Health, Siaya, Kenya
| | - Aisha Mohammed
- Division of Reproductive Health, Ministry of Public Health and Sanitation, Kenya
| | - John Vulule
- KEMRI/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | | |
Collapse
|
13
|
Mason L, Nyothach E, Alexander K, Odhiambo FO, Eleveld A, Vulule J, Rheingans R, Laserson KF, Mohammed A, Phillips-Howard PA. 'We keep it secret so no one should know'--a qualitative study to explore young schoolgirls attitudes and experiences with menstruation in rural western Kenya. PLoS One 2013; 8:e79132. [PMID: 24244435 PMCID: PMC3828248 DOI: 10.1371/journal.pone.0079132] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/18/2013] [Indexed: 11/18/2022] Open
Abstract
Background Keeping girls in school offers them protection against early marriage, teen pregnancy, and sexual harms, and enhances social and economic equity. Studies report menstruation exacerbates school-drop out and poor attendance, although evidence is sparse. This study qualitatively examines the menstrual experiences of young adolescent schoolgirls. Methods and Findings The study was conducted in Siaya County in rural western Kenya. A sample of 120 girls aged 14–16 years took part in 11 focus group discussions, which were analysed thematically. The data gathered were supplemented by information from six FGDs with parents and community members. Emergent themes were: lack of preparation for menarche; maturation and sexual vulnerability; menstruation as an illness; secrecy, fear and shame of leaking; coping with inadequate alternatives; paying for pads with sex; and problems with menstrual hygiene. Girls were unprepared and demonstrated poor reproductive knowledge, but devised practical methods to cope with menstrual difficulties, often alone. Parental and school support of menstrual needs is limited, and information sparse or inaccurate. Girls’ physical changes prompt boys and adults to target and brand girls as ripe for sexual activity including coercion and marriage. Girls admitted ‘others’ rather than themselves were absent from school during menstruation, due to physical symptoms or inadequate sanitary protection. They described difficulties engaging in class, due to fear of smelling and leakage, and subsequent teasing. Sanitary pads were valued but resource and time constraints result in prolonged use causing chafing. Improvised alternatives, including rags and grass, were prone to leak, caused soreness, and were perceived as harmful. Girls reported ‘other girls’ but not themselves participated in transactional sex to buy pads, and received pads from boyfriends. Conclusions In the absence of parental and school support, girls cope, sometimes alone, with menarche in practical and sometimes hazardous ways. Emotional and physical support mechanisms need to be included within a package of measures to enable adolescent girls to reach their potential.
Collapse
Affiliation(s)
- Linda Mason
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, United Kingdom
- * E-mail:
| | - Elizabeth Nyothach
- Kenya Medical Research Institute/Center for Disease Control Research and Public Health Collaboration, Kisumu, Nyanza Province, Kenya
| | - Kelly Alexander
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, United Kingdom
| | - Frank O. Odhiambo
- Kenya Medical Research Institute/Center for Disease Control Research and Public Health Collaboration, Kisumu, Nyanza Province, Kenya
| | - Alie Eleveld
- Safe Water and AIDS Project, Kisumu, Nyanza Province, Kenya
| | - John Vulule
- Kenya Medical Research Institute/Center for Disease Control Research and Public Health Collaboration, Kisumu, Nyanza Province, Kenya
| | - Richard Rheingans
- Centre for African Studies, University of Florida, Gainesville, Florida, United States of America
| | - Kayla F. Laserson
- Kenya Medical Research Institute/Center for Disease Control Research and Public Health Collaboration, Kisumu, Nyanza Province, Kenya
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aisha Mohammed
- Division of Reproductive Health, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | | |
Collapse
|
14
|
Suchdev PS, Shah A, Jefferds MED, Eleveld A, Patel M, Stein AD, Macdonald B, Ruth L. Sustainability of market-based community distribution of Sprinkles in western Kenya. Matern Child Nutr 2013; 9 Suppl 1:78-88. [PMID: 23167586 DOI: 10.1111/j.1740-8709.2012.00450.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To evaluate the sustainability of market-based community distribution of micronutrient powders (Sprinkles(®), Hexagon Nutrition, Mumbai, India.) among pre-school children in Kenya, we conducted in August 2010 a follow-up survey, 18 months after study-related marketing and household monitoring ended. We surveyed 849 children aged 6-35 months randomly selected from 60 study villages. Nutritional biomarkers were measured by fingerstick; demographic characteristics, Sprinkles purchases and use were assessed through household questionnaires. We compared Sprinkles use, marketing efforts and biomarker levels with the data from surveys conducted in March 2007, March 2008 and March 2009. We used logistic regression to evaluate associations between marketing activities and Sprinkles use in the 2010 survey. At the 2010 follow-up, 21.9% of children used Sprinkles in the previous 7 days, compared with 64.9% in 2008 (P < 0.001). Average intake was 3.2 sachets week(-1) in 2008, 1.6 sachets week(-1) in 2009 and 1.1 sachets week(-1) in 2010 (P < 0.001). Factors associated with recent Sprinkles use in 2010 included young age [6-23 months vs. 24-35 months, adjusted odds ratio (aOR) = 1.5, P = 0.02], lowest 2 quintiles of socio-economic status (aOR = 1.7, P = 0.004), household attendance at trainings or launches (aOR = 2.8, P < 0.001) and ever receiving promotional items including free Sprinkles, calendars, cups and t-shirts (aOR = 1.7, P = 0.04). In 2010, there was increased prevalence of anaemia and malaria (P < 0.001), but not iron deficiency (P = 0.44), compared with that in 2008. Sprinkles use in 2010 was associated with decreased iron deficiency (P = 0.03). Sprinkles coverage reduced after stopping household monitoring and reducing marketing activities. Continued promotion and monitoring of Sprinkles usage may be important components to sustain the programme.
Collapse
Affiliation(s)
- Parminder S Suchdev
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Silk BJ, Sadumah I, Patel MK, Were V, Person B, Harris J, Otieno R, Nygren B, Loo J, Eleveld A, Quick RE, Cohen AL. A strategy to increase adoption of locally-produced, ceramic cookstoves in rural Kenyan households. BMC Public Health 2012; 12:359. [PMID: 22591643 PMCID: PMC3490857 DOI: 10.1186/1471-2458-12-359] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 04/20/2012] [Indexed: 11/29/2022] Open
Abstract
Background Exposure to household air pollutants released during cooking has been linked to numerous adverse health outcomes among residents of rural areas in low-income countries. Improved cookstoves are one of few available interventions, but achieving equity in cookstove access has been challenging. Therefore, innovative approaches are needed. To evaluate a project designed to motivate adoption of locally-produced, ceramic cookstoves (upesi jiko) in an impoverished, rural African population, we assessed the perceived benefits of the cookstoves (in monetary and time-savings terms), the rate of cookstove adoption, and the equity of adoption. Methods The project was conducted in 60 rural Kenyan villages in 2008 and 2009. Baseline (n = 1250) and follow-up (n = 293) surveys and a stove-tracking database were analyzed. Results At baseline, nearly all respondents used wood (95%) and firepits (99%) for cooking; 98% desired smoke reductions. Households with upesi jiko subsequently spent <100 Kenyan Shillings/week on firewood more often (40%) than households without upesi jiko (20%) (p = 0.0002). There were no significant differences in the presence of children <2 years of age in households using upesi jiko (48%) or three-stone stoves (49%) (p = 0.88); children 2–5 years of age were less common in households using upesi jiko versus three-stone stoves (46% and 69%, respectively) (p = 0.0001). Vendors installed 1,124 upesi jiko in 757 multi-family households in 18 months; 68% of these transactions involved incentives for vendors and purchasers. Relatively few (<10%) upesi jiko were installed in households of women in the youngest age quartile (<22 years) or among households in the poorest quintile. Conclusions Our strategy of training of local vendors, appropriate incentives, and product integration effectively accelerated cookstove adoption into a large number of households. The strategy also created opportunities to reinforce health messages and promote cookstoves sales and installation. However, the project’s overall success was diminished by inequitable and incomplete adoption by households with the lowest socioeconomic status and young children present. Additional evaluations of similar strategies will be needed to determine whether our strategy can be applied equitably elsewhere, and whether reductions in fuel use, household air pollution, and the incidence of respiratory diseases will follow adoption of improved cookstoves.
Collapse
Affiliation(s)
- Benjamin J Silk
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, 1600 Clifton Road, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|