Health status of people of slums in Nairobi, Kenya

The objective of this study was to describe the health status of people living in the slums of Nairobi. It was designed as a cross-sectional study based on data from visitors at a clinic at Trnava University located in Mukuru slum in Nairobi. There were about 16,000 visits registered at Mary Immaculate Clinic of Trnava University in Nairobi during 2 years of operation. A random 5% sample was drawn from the paper-card database of this clinic to assess basic characteristics and health complaints of visitors. Both self-reported health complaints and diagnoses written by physicians were used to assess health status of participants. More females with average age (by slum) ranging from 20.46 to 21.30 years than males with average age ranging from (by slum) 15.86 to 19.49 years are the visitors of the clinic. The major self-reported health complaints of visitors were cough, abdominal pain, and headache for both sexes. The most frequent diagnoses were consequently virosis, acute respiratory infections, and bronchitis. Differences in health complaints by slums were observed and are described herein. The major health complaints and diagnoses in addition to the differences in health complaints and diagnoses by slum show that environmental conditions can have major influences on health status. Therefore, environmental improvements are important in the improvement of health status. A very high prevalence of respiratory complaints and gastrointestinal problems signify that improvements in air pollution reduction, drinking water provision, and waste management in slums can lead to more significant and sustainable improvements in health status than just simple treatment. This fact should be taken into account when planning future relief programs.     

Women,poverty and adverse maternal outcomes in Nairobi,Kenya

Background  

The link between poverty and adverse maternal outcomes has been studied largely by means of quantitative data. We explore poor urban Kenyan women's views and lived experiences of the relationship between economic disadvantage and unpleasant maternal outcomes.     

HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey

Background  

The proportion of older people is increasing worldwide. Globally, it is estimated that older people (those 60 years or older) constitute more than 11% of the population. As the HIV/AIDS pandemic rages in sub-Saharan Africa (SSA), its impact on older people needs closer attention given the increased economic and social roles older people have taken on as a result of increased mortality among adults in the productive age groups. Few studies have looked at older people and their health in SSA or indeed the impact of HIV/AIDS on their health. This study aims to assess the effect of being directly or indirectly affected by HIV/AIDS on the health of older people in two Nairobi slums.     

Health care-seeking behaviour of HIV-infected mothers and male partners in Nairobi,Kenya

Health care-seeking behaviours of HIV-infected mothers in sub-Saharan Africa are poorly characterised and typically focus on individual health conditions rather than overall health. We conducted a qualitative study to understand how HIV-infected mothers, their male partners and their HIV-exposed infants seek medical services. We performed 32 in-depth interviews (17 female, 15 male) and four focus group discussions among HIV-infected post-partum women and their male partners in Nairobi, Kenya. We used a grounded theory approach to explore the paths followed for health-related concerns. Female participants reported that willingness to be tested for HIV influences whether women sought antenatal care and the type of facility they preferred for childbirth. The need for medical care outside regular clinic hours and securing safe transportation at night were also significant barriers to seeking care. Most men sought services from traditional healers and chemists before HIV diagnosis, and at governmental facilities afterwards. Both men and women sent infants to traditional healers for non-medical conditions such as bewitching and massage but rarely for medical conditions. Strategies to reduce HIV-related stigma and fears in antenatal and maternity settings, increase access to care after-hours and improve linkage to HIV care for men early in their infection are needed.     

Breastfeeding among teenage and adult mothers in Brazil

OBJECTIVE: To estimate the prevalence of breastfeeding among teenage (younger than 20 years old) and adult mothers of six-month-old children and to identify factors associated with weaning. METHODS: A cross-sectional study of a sample of 237 teenage mothers and 239 adult mothers living in the city of Montes Claros, Brazil, whose babies were six-month-old at the time of the interview was carried out. Mothers answered a questionnaire at home. To assess factors associated with weaning, univariate, Mantel-Haenszel, and multiple logistic regression analyses were performed. RESULTS: Breastfeeding prevalence in children aged 6 months was 71.3% among teenage mothers and 77.4% among adult mothers (crude OR=1.38; p=0.128), but after adjusting for control variables the role of adolescence added considerable weight to weaning. Factors associated with weaning were: marital status, mother's occupation after delivery (both showed interaction with teenage years), difficulty to breastfeeding in the first days after delivery, and exclusive breastfeeding at the time of hospital discharge. CONCLUSIONS: The observed interactions with teenage in regard to weaning suggest that motherhood in this age group has unique features that should be further investigated.     

South African teachers' responses to teenage pregnancy and teenage mothers in schools

South African law forbids excluding pregnant teenagers from school and permits young parents to continue with their schooling. However, the existence of progressive policy and law does not by itself ensure that pregnant teenagers and young parents remain in school or experience as little disruption to their studies as possible. Two of the factors influencing the experiences that pregnant girls and young parents have are the attitudes and practices of teachers. We explore how teachers in diverse South African secondary schools respond to young women's pregnancy and parenting. Teachers' responses are situated within a complex set of meanings invoking sexuality (and sexual censure), gender, class and race. We argue that many teachers view teenage pregnancy and parenting as social problems – a domain of sexual shame with negative effects and disruptive to the academic life of the school (including teachers and other learners). Teachers do not monolithically subscribe to such negativity and, in the context of changing policy and gender equality, there are glimmers of hope. Without much support, training or any formal school-based support, many teachers show care and concern for pregnant women and young parents, providing some hope for better experiences of schooling.     

Risk of poor pregnancy outcomes: Is it higher among multiparous teenage mothers?

It is commonly believed that pregnancy outcomes for multiparous teenage mothers are worse than those for teenage women experiencing a first birth. This article, based on a review of the literature, finds that when teenage mothers having a second birth are compared with those having a first birth, the second births often have worse outcomes. However, when the first and second birth to the same mother are compared, teenagers follow the pattern of older women, i.e., the second births usually have better outcomes than the first. This difference is probably due to selection bias.     

Teenage children of teenage mothers: psychological, behavioural and health outcomes from an Australian prospective longitudinal study

In many industrialised countries teenage pregnancy and teenage parenthood have in recent years been identified as social and public health problems that need to be tackled. A number of studies have looked at various outcomes for teenage mothers and their offspring, and many report a strong association with poverty for the mother both before and after having a child. Few studies, however, adequately control for socioeconomic circumstances when examining health and related outcomes. Most studies have focused on perinatal outcomes in the offspring with few looking at later health and development. In Australia, where the rate of teenage pregnancy is relatively high compared to other comparable countries, teenage pregnancy is a not prominent policy concern. As such, Australia offers the opportunity to study the outcomes of teenage parenthood in a country where there may be less stigma than in countries that portray teenage parenthood as a major health and/or social problem. This paper reports findings from the Mater-University Study of Pregnancy (MUSP) and its outcomes, a prospective study of women, and their offspring, who received antenatal care at a major public hospital (Mater Misericordiae Hospital) in South Brisbane, Australia, between 1981 and 1984. We have examined the associations of maternal age (< or =18 years (n=460) versus >18 years (n=4800)) at first antenatal visit with offspring psychological, behavioural and health characteristics when the offspring--the teenage children of teenage mothers--were aged 14 years. Multiple logistic regression was used to determine the effect of maternal and family characteristics on associations between maternal age and childhood outcomes at age 14. Results show that the 14 year old offspring of mothers who were aged 18 years and younger compared to those who were offspring of older mothers were more likely to have disturbed psychological behaviour, poorer school performance, poorer reading ability, were more likely to have been in contact with the criminal justice system and were more likely to smoke regularly and to consume alcohol. However, maternal age was not associated with health outcomes in their offspring at age 14 years. Indicators of low socioeconomic position and maternal depression were also associated with poorer psychological, cognitive and behavioural outcomes among 14 year olds. In addition children from poorer socioeconomic backgrounds and whose mothers were depressed were more likely to have self-reported poor health, asthma, to have been admitted to hospital twice or more since birth and to be bed-wetters at age 14. The associations between maternal age and psychological distress, school performance, and smoking and alcohol use were all largely explained by socioeconomic factors, maternal depression, family structure and maternal smoking. These findings confirm that not all teenage mothers and their offspring have adverse outcomes, and that many if not the majority have good outcomes.     

Implanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy

Background

This study was conducted to compare the incidence of repeat teenage pregnancy over a 24-month period postpartum among users of Implanon, the combined oral contraceptive pill (COCP) or depot medroxyprogesterone acetate (DMPA) and barrier methods or nothing (barrier/none). Contraceptive continuation rates 24 months postpartum for Implanon and COCP/DMPA were also compared.

Study Design

A prospective cohort study was conducted. Comparison groups were postpartum teenagers (12-18 years old) who self-selected Implanon (n=73), COCP/DMPA (n=40) and barrier/none (n=24). Questionnaires were used to gather data at recruitment and postpartum at 6 weeks and then 3 monthly intervals for 2 years.

Results

At 24 months postpartum, 48 (35%) teenagers had conceived. Implanon users became pregnant later than other contraceptive groups (p=.022), with mean time to first repeat pregnancy of 23.8 months [95% confidence interval (CI), 22.2-25.5], compared to 18.1 months (95% CI, 15.1-20.7) for COCP/DMPA and 17.6 months (95% CI, 14.0-21.3) for barrier/none. Implanon users were more likely to continue their use at 24 months than COCP/DMPA (p<.001) users. The mean duration for Implanon users was 18.7 months (95% CI, 17.0-20.3) compared to 11.9 months (95% CI, 9.5-14.3) for COCP/DMPA.

Conclusion

Teenagers who choose Implanon are significantly less likely to become pregnant and were found to continue with this method of contraception 24 months postpartum compared to those who choose COCP or DMPA and barrier methods or nothing.     

Characteristics,medical management and outcomes of survivors of sexual gender-based violence,Nairobi, Kenya

Setting:

Médecins Sans Frontières Clinic for sexual gender-based violence (SGBV), Nairobi, Kenya.

Objectives:

Among survivors of SGBV in 2011, to describe demographic characteristics and episodes of sexual violence, medical management, pregnancy and human immunodeficiency virus (HIV) related outcomes.

Design:

Retrospective review of clinical records and SGBV register.

Results:

Survivors attending the clinic increased from seven in 2007 to 866 in 2011. Of the 866 survivors included, 92% were female, 34% were children and 54% knew the aggressor; 73% of the assaults occurred inside a home and most commonly in the evening or at night. Post-exposure prophylaxis for HIV was given to 536 (94%), prophylaxis for sexually transmitted infections to 731 (96%) and emergency contraception to 358 (83%) eligible patients. Hepatitis B and tetanus toxoid vaccinations were given to 774 survivors, but respectively only 46% and 14% received a second injection. Eight (4.5%) of 174 women who underwent urine pregnancy testing were positive at 1 month. Of 851 survivors HIV-tested at baseline, 96 (11%) were HIV-positive. None of the 220 (29%) HIV-negative individuals who returned for repeat HIV testing after 3 months was positive.

Conclusion:

Acceptable, good quality SGBV medical care can be provided in large cities of sub-Saharan Africa, although further work is needed to improve follow-up interventions.     

Hospital-based perinatal outcomes and complications in teenage pregnancy in India

Teenage pregnancy is a worldwide problem bearing serious social and medical implications relating to maternal and child health. A cross-sectional observational study was undertaken to compare the different sociodemographic characteristics and perinatal outcomes of teenage primigravida mothers with those of adult primigravida mothers in a tertiary-care hospital in eastern India. A sample of 350 each in cases and comparison group comprised the study subjects. Data were collected through interviews and by observations using a pretested and predesigned schedule. Results revealed that the teenage mothers had a higher proportion (27.7%) of preterm deliveries compared to 13.1% in the adult mothers and had low-birthweight babies (38.9% vs 30.4% respectively). Stillbirth rate was also significantly higher in teenage deliveries (5.1% vs 0.9% respectively). The teenage mothers developed more adverse perinatal complications, such as preterm births, stillbirths, neonatal deaths, and delivered low-birthweight babies, when compared with those of the adult primigravida mothers. Teenage pregnancy is still a rampant and important public-health problem in India with unfavourable perinatal outcomes and needs to be tackled on a priority basis.     

Syphilis prevention in pregnancy: an opportunity to improve reproductive and child health in Kenya

Infection with maternal syphilis during pregnancy is a seriouscondition with dramatic impact on pregnancy outcome, includingperinatal wastage and congenital syphilis. Primary preventionof congenital syphilis by antenatal case-detection and treatmentof infected mothers is feasible and cost-effective. Yet theimplementation of syphilis prevention activities is not effectivein many third world countries, due to logistic and managerialobstacles. This paper describes the achievements and the constraints ofthe antenatal syphilis prevention programme in Nairobi, Kenya.The structural and technical problems and alternative strategiesfor the realization of an effective congenital syphilis preventionprogramme in an urban third world setting are discussed.     

Smoking and pregnancy outcome: trends among black teenage mothers in Missouri.

OBJECTIVES. The purpose of this study is to analyze the smoking changes that have occurred among pregnant Black teenagers in Missouri. The study also examines changes in Black teenage pregnancy outcomes in relation to smoking behavior changes. METHODS. This analysis used computerized data files from the 1978 to 1990 Missouri birth certificates to acquire information on smoking during pregnancy for 41,544 Black teenagers and 105,170 White teenagers. All Missouri births with smoking history were included in the study. RESULTS. During the study period, the rate for Blacks who smoked during pregnancy decreased from 37% in 1978 to less than 22% in 1990. A large part of this reduction is attributable to Black teenagers, whose smoking-during-pregnancy rate declined from 35.8% to 7.2%. Additionally, the Black teenage-specific low-birthweight rate decreased by 13.6% over the study period, possibly influenced by the decrease in smoking. CONCLUSIONS. The results indicate that a major norm has changed in smoking status among pregnant Black teenagers. Understanding the reasons behind this change could assist smoking cessation and other health promotion efforts.     

Beyond biomedical and comorbidity approaches: Exploring associations between affinity group membership,health and health seeking behaviour among MSM/MSW in Nairobi,Kenya

ABSTRACT

We explored general health and psychosocial characteristics among male sex workers and other men who have sex with men in Nairobi, Kenya. A total of 595 MSM/MSW were recruited into the study. We assessed group differences among those who self-reported HIV positive (SR-HIVP) and those who self-reported HIV negative (SR-HIVN) and by affinity group membership. Quality of life among SR-HIVP participants was significantly worse compared to SR-HIVN participants. Independent of HIV status and affinity group membership, participants reported high levels of hazardous alcohol use, harmful substance use, recent trauma and childhood abuse. The overall sample exhibited higher prevalence of moderate to severe depressive symptoms compared to the general population. Quality of life among participants who did not report affinity group membership (AGN) was significantly worse compared to participants who reported affinity group membership (AGP). AGN participants also reported significantly lower levels of social support. Membership in affinity groups was found to influence health seeking behaviour. Our findings suggest that we need to expand the mainstay biomedical and comorbidity focused research currently associated with MSM/MSW. Moreover, there are benefits to being part of MSM/MSW organisations and these organisations can potentially play a vital role in the health and well-being of MSM/MSW.