Home > Kenya > 2008 & 2009 Urban health studies – African Population & Health Research Centre

2008 & 2009 Urban health studies – African Population & Health Research Centre

Below are citations and abstracts to 6 urban health studies by the African Population and Health Research Centre that were published in 2008 or 2009. Entries are arranged by publication date:

1 – Malar J. 2009 Jul 15;8:160

Fever treatment in the absence of malaria transmission in an urban informal settlement in Nairobi, Kenya.

Ye Y, Madise N, Ndugwa R, Ochola S, Snow RW.

African Population and Health Research Centre, Nairobi, Kenya. yyazoume@aphrc.org

BACKGROUND: In sub-Saharan Africa, knowledge of malaria transmission across rapidly proliferating urban centres and recommendations for its prevention or management remain poorly defined. This paper presents the results of an investigation into infection prevalence and treatment of recent febrile events among a slum population in Nairobi, Kenya.

METHODS: In July 2008, a community-based malaria parasite prevalence survey was conducted in Korogocho
slum, which forms part of the Nairobi Urban Health and Demographic Surveillance system. Interviewers visited 1,069 participants at home and collected data on reported fevers experienced over the preceding 14 days and details on the treatment of these episodes. Each participant was tested for malaria parasite presence with Rapid Diagnostic Test (RDT) and microscopy. Descriptive analyses were performed to assess the period prevalence of reported fever episodes and treatment behaviour.

RESULTS: Of the 1,069 participants visited, 983 (92%) consented to be tested. Three were positive for Plasmodium falciparum using RDT; however, all were confirmed negative on microscopy. Microscopic examination of all 953 readable slides showed zero prevalence. Overall, from the 1,004 participants who have data on fever, 170 fever episodes were reported giving a relatively high period prevalence (16.9%, 95% CI:13.9%-20.5%) and higher among children below five years (20.1%, 95%CI:13.8%-27.8%). Of the fever episodes with treatment information 54.3% (95%CI:46.3%-62.2%) were treated as malaria using mainly sulphadoxine-pyrimethamine or amodiaquine, including those managed at a formal health facility. Only four episodes were managed using the nationally recommended first-line treatment, artemether-lumefantrine.

CONCLUSION: The study could not demonstrate any evidence of malaria in Korogocho, a slum in the centre
of Nairobi. Fever was a common complaint and often treated as malaria with anti-malarial drugs. Strategies, including testing for malaria parasites to reduce the inappropriate exposure of poor communities to expensive anti-malarial drugs provided by clinical services and drug vendors, should be a priority for district planners.

2: Reprod Health. 2009 Jun 16;6:9.

Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services?

Fotso JC, Ezeh AC, Essendi H.

African Population and Health Research Center (APHRC), Nairobi, Kenya. jcfotso@aphrc.org.

BACKGROUND: Despite various international efforts initiated to improve maternal health, more than half a million women worldwide die each year as a result of complications arising from pregnancy and childbirth. This research was guided by the following questions: 1) How does women’s autonomy influence the choice of place of delivery in resource-poor urban settings? 2) Does its effect vary by household wealth? and 3) To what extent does women’s autonomy mediate the relationship between women’s education and use of health facility for delivery?

METHODS: The data used is from a maternal health study carried out in the slums of Nairobi, Kenya. A total of 1,927 women (out of 2,482) who had a pregnancy outcome in 2004-2005 were selected and interviewed. Seventeen variable items on autonomy were used to construct women’s decision-making, freedom of movement, and overall autonomy. Further, all health facilities serving the study population were assessed with regard to the number, training and competency of obstetric staff; services offered; physical infrastructure; and availability, adequacy and functional status of supplies and other essential equipment for safe delivery, among others. A total of 25 facilities were surveyed.

RESULTS: While household wealth, education and demographic and health covariates had strong relationships
with place of delivery, the effects of women’s overall autonomy, decision-making and freedom of movement were rather weak. Among middle to least poor households, all three measures of women’s autonomy were associated with place of delivery, and in the expected direction; whereas among the poorest women, they were strong and counter-intuitive. Finally, the study showed that autonomy may not be a major mediator of the link between education and use of health services for delivery.

CONCLUSION: The paper argues in favor of broad actions to increase women’s autonomy both as an end and as a means to facilitate improved reproductive health outcomes. It also supports the call for more appropriate data that could further support this line of action. It highlights the need for efforts to improve
households’ livelihoods and increase girls’ schooling to alter perceptions of the value of skilled maternal health care.

3: BMC Public Health. 2009 May 27;9:153.

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

Kyobutungi C, Ezeh AC, Zulu E, Falkingham J.

African Population & Health Research Center, Nairobi, Kenya. ckyobutungi@aphrc.org

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.

METHODS: Data were collected from residents of the Nairobi Urban Health and Demographic Surveillance
area aged 50 years and above on 1st October 2006. Health status was assessed using the short SAGE (Study on Global AGEing and Adult Health) form and two outcome measures–self-rated health and a composite health score–were generated. To assess HIV/AIDS affected status, respondents were asked: Have you personally been affected by HIV/AIDS? If yes, a follow up question: “How have you been personally affected by HIV/AIDS?” was asked. Ordinallogistic regression was used in models with self-rated health and linear regression in models with the health score.

RESULTS: About 18% of respondents reported being affected by HIV/AIDS in at least one way, although less than 1% reported being infected with HIV. Nearly 60% of respondents reported being in good health, 27% in fair health and 14% in poor health. The overall mean health score was 70.6 (SD: 13.9) with females reporting worse health outcomes than males. Respondents directly or indirectly affected by HIV/AIDS reported worse health outcomes than those not affected: mean health score: 68.5 and 71.1 respectively (t = 3.21, p = 0.0007), and an adjusted odds ratio of reporting poor health of 1.42 (95%CI: 1.12-1.80).

CONCLUSION: Poor health outcomes among older people affected by HIV/AIDS highlight the need for policies that target them in the fight against HIV/AIDS if they are to play their envisaged care giving and other traditional roles.

4: Matern Child Health J. 2009 Jan;13(1):130-7.

What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya.

Fotso JC, Ezeh A, Madise N, Ziraba A, Ogollah R.

African Population and Health Research Center (APHRC), P.O. Box 10787, 00100 GPO, Nairobi, Kenya. jcfotso@aphrc.org

OBJECTIVES: The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health
facilities.

METHODS: The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable.

RESULTS: Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy “wantedness”, and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women.

CONCLUSION: Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.

5: J Urban Health. 2008 May;85(3):428-42.

Provision and use of maternal health services among urban poor women in Kenya: what do we know and what can we do?

Fotso JC, Ezeh A, Oronje R.

Population Dynamics and Reproductive Health, African Population and Health Research Center (APHRC), Nairobi, Kenya. jcfotso@aphrc.org

In sub-Saharan Africa, the unprecedented population growth that started in the second half of the twentieth century has evolved into unparalleled urbanization and an increasing proportion of urban dwellers living in slums and shanty towns, making it imperative to pay greater attention to the health problems of the urban
poor. In particular, urgent efforts need to focus on maternal health. Despite the lack of reliable trend data on maternal mortality, some investigators now believe that progress in maternal health has been very slow in sub-Saharan Africa. This study uses a unique combination of health facility- and individual-level data collected in the slums of Nairobi, Kenya to: (1) describe the provision of obstetric care in the Nairobi informal settlements; (2) describe the patterns of antenatal and delivery care, notably in terms of timing, frequency, and quality of care; and (3) draw policy implications aimed at improving maternal health among the rapidly growing urban poor populations. It shows that the study area is deprived of public health services, a finding which supports the view that low-income urban residents in developing countries face significant obstacles in
accessing health care. This study also shows that despite the high prevalence of antenatal care (ANC), the proportion of women who made the recommended number of visits or who initiated the visit in the first trimester of pregnancy remains low compared to Nairobi as a whole and, more importantly, compared to rural
populations. Bivariate analyses show that household wealth, education, parity, and place of residence were closely associated with frequency and timing of ANC and with place of delivery. Finally, there is a strong linkage between use of antenatal care and place of delivery. The findings of this study call for urgent
attention by Kenya’s Ministry of Health and local authorities to the void of quality health services in poor urban communities and the need to provide focused and sustained health education geared towards promoting use of obstetric services.

6: Popul Health Metr. 2008 Mar 10;6:1.

The burden of disease profile of residents of Nairobi’s slums: Results from a Demographic Surveillance System.

Kyobutungi C, Ziraba AK, Ezeh A, Yé Y.

African Population & Health Research Center, P,O Box 10787, GPO 00100, Nairobi, Kenya. ckyobutungi@aphrc.org.

BACKGROUND: With increasing urbanization in sub-Saharan Africa and poor economic performance, the growth of slums is unavoidable. About 71% of urban residents in Kenya live in slums. Slums are characteristically unplanned, underserved by social services, and their residents are largely underemployed and poor. Recent research shows that the urban poor fare worse than their rural counterparts on most health indicators, yet much about the health of the urban poor remains unknown. This study aims to quantify the burden of mortality of the residents in two Nairobi slums, using a Burden of Disease approach and data
generated from a Demographic Surveillance System.

METHODS: Data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected between January 2003 and December 2005 were analysed. Core demographic events in the NUHDSS including deaths are updated three times a year; cause of death is ascertained by verbal autopsy and cause of death is assigned according to the ICD 10 classification. Years of Life Lost due to premature mortality (YLL) were
calculated by multiplying deaths in each subcategory of sex, age group and cause of death, by the Global Burden of Disease standard life expectancy at that age.

RESULTS: The overall mortality burden per capita was 205 YLL/1,000 person years. Children under the age of five years had more than four times the mortality burden of the rest of the population, mostly due to pneumonia and diarrhoeal diseases. Among the population aged five years and above, HIV/AIDS and
tuberculosis accounted for about 50% of the mortality burden.

CONCLUSION: Slum residents in Nairobi have a high mortality burden from preventable and treatable conditions. It is necessary to focus on these vulnerable populations since their health outcomes are comparable to or even worse than the health outcomes of rural dwellers who are often the focus of most interventions.

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