Women's Health Commons^™

Impact Of Point-Of-Care Ultrasound Use On Patient Referral Decisions In Rural Kenya: A Mixed Methods Study., Grace Wanjiku, Gregory Bell, Sonja Kapadia, Benjamin Wachira

Emergency Medicine, East Africa

Background: Point-of-care ultrasound (POCUS) is recognized as a key imaging modality to bridge the diagnostic imaging gap in Low- and Middle-Income Countries (LMICs). POCUS use has been shown to impact patient management decisions including referral for specialist care. This study explored the impact of POCUS use on referral decisions among trained healthcare providers working in primary rural and peri-urban health facilities in Kenya.

Methods: A concurrent mixed methods approach was used, including a locally developed survey (N=38) and semistructured interviews of POCUS trained healthcare providers (N=12). Data from the survey was descriptively analyzed and interviews were evaluated through the framework …

Challenges And Opportunities For Improving Access To Adolescent And Youth Sexual And Reproductive Health Services And Information In The Coastal Counties Of Kenya: A Qualitative Study., Evaline Chepchirchir Langat, Abdu Mohiddin, Flaura Kidere, Anisa Omar, Job Akuno, Violet Naanyu, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: Globally, adolescents and youth experience high unmet need for sexual and reproductive health (SRH) information and services. In Kenya, evidence shows that more than half of teenage pregnancies are unintended and that half of all new HIV infections occur in people ages 15-24-year-olds, with the majority of those being female. The coastal counties in Kenya record a relatively high adolescent pregnancy rate and higher rates of unmet need for contraception for all women of reproductive age compared to the national average. This study focused on gaining a deeper understanding of the existing challenges to and opportunities for accessing SRH …

Too Hot To Thrive: A Qualitative Inquiry Of Community Perspectives On The Effect Of High Ambient Temperature On Postpartum Women And Neonates In Kilifi, Kenya., Adelaide Lusambili, Sari Kovats, Britt Nakstad, Veronique Filippi, Peter Khaemba, Nathalie Roos, Cherie Part, Stanley Luchters, Matthew Chersich, Jeremy Hess

Institute for Human Development

Objectives; To understand community perspectives on the effects of high ambient temperature on the health and wellbeing of neonates, and impacts on post-partum women and infant care in Kilifi.

Design; Qualitative study using key informant interviews, in-depth interviews and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (CHVs) (n = 22) and stakeholders from health and government ministries (n = 16).

Settings; We conducted our research in Kilifi County in Kenya’s Coast Province. The area is largely rural and during …

Sars-Cov-2 Seroprevalence In Pregnant Women In Kilifi, Kenya From March 2020 To March 2022, Angela Koech, Geoffrey Omuse, Alex Mugo, Isaac Mwaniki, Joseph Mutunga, Moses Mukhanya, Onesmus Wanje, Grace Mwashigadi, Geoffrey Katana, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: Seroprevalence studies are an alternative approach to estimating the extent of transmission of SARS-CoV-2 and the evolution of the pandemic in different geographical settings. We aimed to determine the SARS-CoV-2 seroprevalence from March 2020 to March 2022 in a rural and urban setting in Kilifi County, Kenya.

Methods: We obtained representative random samples of stored serum from a pregnancy cohort study for the period March 2020 to March 2022 and tested for antibodies against the spike protein using a qualitative SARS-CoV-2 ELISA kit (Wantai, total antibodies). All positive samples were retested for anti-SARS-CoV-2 anti-nucleocapsid antibodies (Euroimmun, ELISA kits, NCP, …

Determinants Of Preconception Care Among Pregnant Women In An Urban And A Rural Health Facility In Kenya: A Qualitative Study, Joan Okemo, Dorothy Kamya, Mukaindo Mwaniki, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Preconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could con- tribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in rural areas. Little is known regarding PCC use in Kenya that could help in addressing this shortfall. This study aimed to qualitatively assess the determinants of PCC in urban and rural settings in Kenya.

Methods: A qualitative approach was …

Implementation Process Brief: Integrated Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Charlotte E. Warren, Aparna Jain, Melsa Lutomia, Jane Loech, Elizabeth Washika

Reproductive Health

Enabling women living with HIV to use contraception effectively can decrease unintended pregnancies and in turn reduce maternal mortality and vertical transmission of HIV. This brief describes the implementation process and intervention tested under the Evidence Project for delivering integrated FP and HIV services at the community level in Kenya. It outlines the implementation steps, best practices, and lessons learned of an intervention that was tested within the existing community health structure. Community health volunteers were trained to offer FP as part of their routine services to women living with HIV, and community health units were prepared to sustain those …

Using Demographic And Health Surveys In The Campaign To End Fgm/C: A Kenyan Example, Dennis Matanda, Caroline W. Kabiru

Reproductive Health

In order to design effective interventions to end female genital mutilation/cutting (FGM/C), we need to map where FGM/C is practiced and what factors influence it. Data from the Demographic and Health Surveys (DHS), nationally representative surveys conducted in low- and middle-income countries every five years, give us the opportunity to explore how FGM/C is influenced by both individual and community-level factors. Where FGM/C prevalence is not uniform, various research and analysis techniques can be used to improve estimates and draw further information from DHS data. This brief shares insights from two studies carried out in Kenya using DHS data collected …

Associations Between Fgm/C And Hiv In Ethiopia, The Gambia, Kenya, And Sierra Leone: A Limited Analysis Of Demographic And Health Survey Data, Yetunde A. Noah Pinheiro, Zhuzhi Moore, David Gathara

Reproductive Health

Studies investigating the association between male circumcision and HIV have demonstrated the protective effect of male circumcision. In some settings, FGM/C and male circumcision are considered “equivalent” procedures. This working paper presents findings of a study that investigates the effect of FGM/C on the likelihood of HIV infection for women in practicing communities in Ethiopia, Gambia, Kenya, and Sierra Leone.

Quality Of Antenatal Care And Its Relationship With Women’S Intended Use Of Their Anc Facility For Delivery: A National Cross-Sectional Study In Kenya, Jisoo Kim

Electronic Thesis and Dissertation Repository

Maternal deaths have been one of the leading causes of deaths in sub-Saharan Africa. Delivering at an institution can prevent the majority of maternal deaths in developing countries. A national cross-sectional survey of Kenya was used to determine if the quality of antenatal care (ANC) provided to women is associated with their intention to deliver at the same facility. Multilevel mixed-effects logistic regression was used to examine this relationship. Quality of ANC variables assessed in this study were not significantly associated with women’s intention to deliver at the same facility. Mothers preferred to deliver at hospitals, rather than clinics/dispensaries. ANC …

Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance

Reproductive Health

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the …

What Do We Know About The Hiv Risk Characteristics Of Adolescent Girls And Young Women In Kenya? Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

The Population Council is conducting implementation science research in Kenya to build needed evidence to inform community-based, girl-centered interventions. DREAMS programs in Kenya are implementing a core package of interventions in the highest HIV-burden areas to address HIV risk among adolescent girls and young women (AGYW)—a population in which AIDS is the leading cause of death in the region. This brief summarizes key findings from a survey of 1,778 AGYW, more than half of whom are enrolled in DREAMS programming.

Progress And Priorities For Reproductive, Maternal, Newborn, And Child Health In Kenya: A Countdown To 2015 Country Case Study, Emily C. Keats, Anthony Ngugi, William Macharia, Nadia Akseer, Emma Nelima Khaemba, Zaid Ahmad Bhatti, Arjumand Rizvi, John Tole, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.
Methods: We did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 …

Women's Perceptions And Experiences Of Family Planning By Contraceptive Methods In Kenya And Bangladesh: Preliminary Results, Kazuyo Machiyama, Joyce Mumah, Caroline W. Kabiru, George Odwe, Francis Obare, Fauzia Akhter Huda, John C. Cleland, John B. Casterline

Reproductive Health

No abstract provided.

Method-Specific Attributes That Influence Choice Of Future Contraception Among Married Women In Nairobi’S Informal Settlements, Joyce Mumah, John B. Casterline, Kazuyo Machiyama, Marylene Wamukoya, Caroline W. Kabiru, John C. Cleland

Reproductive Health

No abstract provided.

The Nia Project: Baseline Survey Instruments, Karen Austrian

Poverty, Gender, and Youth

This document includes all of the Nia Project baseline survey instruments used to collect data in Kenya, providing a multidimensional description of a sample of the participating girls and the schools they attend. The Project is one of the first randomized controlled trials to explore the role of sanitary pad distribution and reproductive health education—individually and in combination—to improve girls’ educational and sexual and reproductive health outcomes. The study collected data from 3,489 girls from 140 schools in three rural Kilifi subcounties: Magarini, Kaloleni, and Ganze.

The Nia Project—Brief, Eunice N. Muthengi, Emily Farris, Karen Austrian

Poverty, Gender, and Youth

This brief provides highlights from the Nia Project conducted in Kenya. The study found that while gaps exist in girls’ capabilities, particularly knowledge and attitudes related to menstruation and reproductive health, the Nia Project has the potential to bridge those gaps. The Project is one of the first randomized controlled trials to explore the role of sanitary pad distribution and reproductive health education—individually and in combination—to improve girls’ educational and sexual and reproductive health outcomes. The findings of this study will make a critical contribution to filling an evidence gap in the field of menstrual health and hygiene management, and …

The Nia Project: Baseline Report, Eunice N. Muthengi, Emily Farris, Karen Austrian

Poverty, Gender, and Youth

The onset of puberty and menarche is a particularly vulnerable time for girls, when external pressures are exacerbated by their lack of knowledge of their bodies, their rights, and the implications of their decisions, and by their inability to manage puberty and adolescence safely and comfortably with appropriate menstrual health and hygiene management (MHM) products. Although several programs have previously been developed to address girls’ MHM needs globally, few have been evaluated, and where evidence does exist the results have been mixed. In collaboration with ZanaAfrica, the Population Council is evaluating the Nia Project, a set of interventions for adolescent …

Reasons For Unmet Need For Family Planning, With Attention To The Measurement Of Fertility Preferences In Kenya And Bangladesh, Joyce Mumah, Kazuyo Machiyama, Caroline W. Kabiru, George Odwe, Francis Obare, Fauzia Akhter Huda, John B. Casterline, John C. Cleland

Reproductive Health

No abstract provided.

Predictors Of Infant Age At Enrollment In Early Infant Diagnosis Services In Kenya., Kathy Goggin, Catherine Wexler, Niaman Nazir, Vincent S. Staggs, Brad Gautney, Vincent Okoth, Samoel A Khamadi, Andrea Ruff, Michael Sweat, An-Lin Cheng, Sarah Finocchario-Kessler

Manuscripts, Articles, Book Chapters and Other Papers

Despite the importance of early detection to signal lifesaving treatment initiation for HIV+ infants, early infant diagnosis (EID) services have received considerably less attention than other aspects of prevention of mother to child transmission care. This study draws on baseline data from an on-going cluster randomized study of an intervention to improve EID services at six government hospitals across Kenya. Two logistic regressions examined potential predictors of "on time" (infant ≤6 weeks of age) vs. "late" (≥7 weeks) and "on time" versus "very late" (≥12 weeks) EID engagement among 756 mother-infant pairs. A quarter of the infants failed to get …

Pharmacy Workers In Kenya Need Training And Support On Medical Abortion Information And Referrals To Prevent Unsafe Service Provision, Jesse Njunguru, A. Finnie, Katharine Footman, Wilson Liambila, Kate Reiss

Reproductive Health

Despite the centrality of pharmacists in the provision of abortion services in Kenya, little is known about their medical abortion (MA) knowledge, attitudes, or practices. This policy brief reports on a study that set out to bridge this gap in the evidence. The report concludes that comprehensive training for pharmacy workers could improve the quality of MA provision and referrals, and help pharmacy workers identify opportunities to simultaneously provide clients with information on contraception and STI prevention. Such efforts would be in line with current Kenyan government policies to reduce the public health burden caused by the prevalence of unsafe …

Adolescent Sexual And Reproductive Health Situation: Insights From The 2014 Kenya Demographic And Health Survey, Francis Obare, George Odwe, Harriet Birungi

Reproductive Health

The 2015 Kenya National Adolescent Sexual and Reproductive Health Policy recognized the importance of addressing adolescent sexual and reproductive health (SRH) needs for achieving the country’s development goals. Although estimates from the 2014 Kenya Demographic and Health Survey (DHS) show the country registered improvements in key reproductive, maternal, and child health outcomes, adolescent outcomes likely remain poor given the challenges associated with adequately addressing their sexual and reproductive health needs. This report presents findings of further analysis of the 2014 Kenya DHS on key SRH outcomes among adolescent girls and boys 15 to 19 years old in Kenya. Understanding the …

Introducing Contraceptive Methods In Low-Resource Settings: New Opportunities In Kenya, Population Council

Reproductive Health

This factsheet outlines the Delivering Contraceptive Vaginal Rings project, awarded by USAID to the Population Council in October 2013 to foster the introduction of two contraceptive methods. The objectives of this project are to: 1) improve availability and affordability of a three-month Progesterone Vaginal Ring for postpartum breastfeeding women, and 2) facilitate regulatory approval and introduction of a one-year contraceptive vaginal ring containing Nestorone® and ethinyl estradiol—a long-acting method for non-breastfeeding women that is in the late stages of development. The factsheet identifies milestones achieved and new opportunities in Kenya to implement activities in the year ahead.

Adolescent Girls Initiative-Kenya: Qualitative Report, Eunice N. Muthengi, Karen Austrian, Amanda Landrian, Benta Abuya, Joyce Mumah, Caroline W. Kabiru

Poverty, Gender, and Youth

The Adolescent Girls Initiative-Kenya (AGI-K) is currently delivering multisectoral interventions, targeting violence prevention, education, health, and wealth creation, to adolescent girls aged 11–14 in two marginalized areas of Kenya. This report provides a brief overview of the research design and intervention components being delivered in AGI-K, and presents findings from the first round of qualitative data collection intended to highlight the strengths and weaknesses of the implementation processes thus far. The findings provide important information about the perceived effects of the program from a diverse set of respondents. Overall, beneficiaries, their parents/guardians, and other key stakeholders value the program and …

Kenya: Helping Adolescent Mothers Remain In School Through Strengthened Implementation Of School Re-Entry Policies, Esther Lwanga Walgwe, Nancy Termini Lachance, Harriet Birungi, Chi-Chi Undie

Reproductive Health

By applying robust evidence, securing the support of decisionmakers, and engaging stakeholders, STEP UP enabled national and local decisionmakers to better understand the consequences of unintended pregnancy for adolescent girls’ schooling in Homa Bay County, Kenya. STEP UP is playing an important role in informing the implementation of policies within the Kenyan educational sector that will improve educational opportunities for school-age mothers. Through early stakeholder engagement, strong partnerships, the support of implementers and policymakers, effective communication and dissemination strategies, decisionmaker capacity, and the dedication of the adolescent mothers themselves, evidence generated by STEP UP was successfully utilized by key stakeholders. …

Addressing Intimate Partner Violence And Power In Relationships In Hiv Testing Services: Results Of An Intervention Piloted In Nairobi, Kenya, Nicole Haberland, Charity Ndwiga, Katharine Mccarthy, Margaret Makanyengo, Rose Kosgei, Cecilia Choi, Julie Pulerwitz, Sam Kalibala

HIV and AIDS

The overarching goal of this study was to pilot an approach to HIV testing services (HTS) that addresses intimate partner violence (IPV) and sexual relationship power (SRP) inequalities, and explores the intervention’s potential for improving uptake and retention of antiretroviral therapy and prevention of mother-to-child transmission services. The project was implemented in Kenyatta National Hospital’s (KNH) antenatal care (ANC) clinic, and examined intermediate indicators of effect, as well as operational issues around incorporating attention to IPV in hospital procedures, especially in high-volume, high-need settings like KNH’s. The findings from this study suggest that providing some minimal IPV/SRP counseling to all …

Kenya Adolescent Sexual And Reproductive Health Policy, Ministry Of Health Kenya

Reproductive Health

This document is a review and revision of the National Adolescent Sexual and Reproductive Health Policy of Kenya, which involved in-depth consultations with a wide range of stakeholders through literature review, interviews, consultative meetings, and reviews of the various drafts. Many changes took place at the national and international levels that needed to be taken into account as the policy was reviewed, including the Constitution of Kenya (2010) with its attendant devolved governance structure as well as demographics, and social, economic, and technological environment. The government has made concerted efforts as part of Vision 2030 to respond to adolescents and …

Promoting Respectful Maternity Care Resource Package—Implementing Respectful Maternity Care In Kenya, Population Council

Reproductive Health

The Respectful Maternity Care (RMC) Resource Package was developed by the Heshima project as part of the USAID Translating Research into Action (TRAction) project. The resource package is designed to be used by program managers, supervisors, trainers, technical advisors, and others who organize or facilitate RMC training workshops on sexual and reproductive health as well as skills training in emergency obstetric and newborn care. The resource package provides experienced facilitators with background information, materials, instructions, and tips for promoting respectful care in reproductive, maternal, and newborn health services in both facilities and communities. The resource package also includes tools for …

Contraceptive Use And Fertility Intentions Among Women Living With Hiv In Kenya And Swaziland, Integra Initiative

Reproductive Health

At the end of 2013, an estimated 35 million people were living with HIV, and sub-Saharan Africa was disproportionately affected. With major efforts directed at expanding access to life-saving antiretroviral therapy in sub-Saharan Africa, many people are living longer with HIV, leading productive and sexually active lives. Unintended pregnancies and the potential of vertical transmission are some of the challenges faced by women living with HIV. Understanding the fertility preferences and reproductive decisions of these women is vital for informing efforts to enable them to achieve these desires effectively and safely. The “Steps to Integration” series provides a guide on …

Promoting Respectful Maternity Care Resource Package—Alternative Dispute Resolution: Resolving Incidents Of Disrespect And Abuse, Population Council

Reproductive Health

Alternative Dispute Resolution (ADR) is a process whereby an independent and impartial third party facilitates negotiation between disputing parties, in this case to resolve incidents of disrespect and abuse (D&A) in a health care setting. In Kenya, ADR was originally used to settle land disputes and inheritance issues at the community level. The voluntary ADR mechanism brings the aggrieved parties together with an opportunity to solve problems in a locally acceptable way. ADR supports both providers’ and clients’ rights and obligations by ensuring each side is heard. This Respectful Maternity Care (RMC) resource provides guidance on the sequence of steps …

Promoting Respectful Maternity Care Resource Package—Debriefing Sessions: Caring For The Carers, Population Council

Reproductive Health

Caring for the Carers is an activity aimed at reducing work-related stress—a major driver of disrespect and abuse (D&A) during facility-based childbirth. Pregnancy, labor, and delivery are expected to be joyous moments for the mother, her family, and the service providers. However, this is not always the case due to maternal complications or even death. Maternity units often have high workloads. This, coupled with lack of professional support for staff and providers, and poor governance and leadership, may lead to work-related stress. These critical incidents can accumulate and contribute to staff stress and emotional exhaustion, which ultimately prevents provision of …