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Nanjala M.,African Medical and Research Foundation
Global journal of health science | Year: 2012

A cross-sectional study covering 380 male partners and their spouses was conducted in Busia district in Western Kenya to establish demographic, socio-economic and cultural factors that affect male partner participation in promoting deliveries by skilled attendants. The study showed a significant relationship between level of education (P=0.0000) and level of income (P=0.0004) of the male partner and his support for skilled delivery. Lack of knowledge by male partners of complications associated with delivery, cultural beliefs, high fees charged for deliveries at health facilities and "un-cooperative" health workers are major contributing factors to low male partner involvement in child birth activities. Improving the levels of education and income of male partners, addressing the cultural beliefs and practices, improving health care provider-client relationship and sensitizing men on complications associated with pregnancy and child birth can contribute significantly in enhancing male partner involvement in promoting deliveries by skilled attendants.

Mugisa M.,African Medical and Research Foundation
The Pan African medical journal | Year: 2012

Malaria is a leading killer disease in Uganda and it accounts for significant morbidity in pregnant women and children. Pregnant women are more susceptible to malaria, which causes adverse effects including abortion, low birth weight and maternal anaemia. Children with severe malaria frequently develop one of these symptoms including: severe anaemia, respiratory distress, Prostration, convulsions and cerebral malaria. Due to the severity of the disease there is need for multiple interventions to reduce the disease burden. African Medical and Research Foundation (AMREF) adopted community based approaches to improve malaria prevention. Behavioral change communication (BCC) was fundamental at every process of Project implementation. This paper shares AMREF's experience in using BCC strategies amidst other interventions in malaria prevention approaches involving use of insecticide treated nets and environment management. AMREF through a Malaria project (2007-2010) in Nakasongola district supported BCC activities through training, community mobilization, mass media, health promotion and advocacy. Program performance was measured through baseline and evaluation surveys in 2007 and 2010. The final project evaluation indicated improvement from baseline values as follows: knowledge on prevention of malaria among school children from 76.6% to 90%, under five children sleeping under bed net the previous night from 51% to 74.7%, and from 24% to 78% among pregnant women. Mobilization of malaria prevention interventions can be successful once BCC approaches are adequately planned and coordinated. Malaria prevention through BCC strategies are likely to be more effective with integration of other malaria interventions, and involvement of community based structures.

Over decades, evidence has accumulated to justify the concern that top-down approaches do not work and may result in lack of program ownership and sustainability. As a result, participatory approaches have increasingly become popular. An example of such an approach is hereby presented. Working with AMREF, Mkuranga district significantly gained experience and improved its community participatory approaches in health development. AMREF's model of Community Based Health Care (CBHC) approaches was used to implement integrated Water and Sanitation, Child Survival and Reproductive health programs. The project established functioning village health and water committees. A 45% increase in utilization of services was reported. Adequate nutrition status among children rose from 67.9% to 81%. Attendance of antenatal clinics rose from 35% to 70.2%. A total of 117 shallow wells, 21 boreholes and 25 rain water harvesting systems were established. Based on this experience, we conclude that in order to achieve the Millennium Development Goals (MDGs) and the National Poverty Reduction Strategy (Mkukuta) targets, building partnerships with communities who are the target beneficiaries is a prerequisite and CBHC approach is a fundamental towards attaining those goals. The model demonstrates that community participation is key to community empowerment, as well as community ownership and sustainability of health interventions.

Mboya B.,African Medical and Research Foundation
The Pan African medical journal | Year: 2012

Currently, Tanzania's HIV prevalence is 5.7%. Gender inequality and Gender Based Violence (GBV) are among factors fuelling the spread of HIV in Tanzania. This study was conducted to assess universal access to HIV prevention services among GBV survivors in Iringa and Dar-es-Salaam where HIV prevalence is as high as 14.7% and 9% respectively compared to a national average of 5.7%. In 2010, a mixed methods study using triangulation model was conducted in Iringa and Dar-es-Salaam regions to represent rural and urban settings respectively. Questionnaires were administered to 283 randomly selected survivors and 37 health providers while 28 in-depth interviews and 16 focus group discussions were conducted among various stakeholders. Quantitative data was analyzed in SPSS by comparing descriptive statistics while qualitative data was analyzed using thematic framework approach. Counseling and testing was the most common type of HIV prevention services received by GBV survivors (29%). Obstacles for HIV prevention among GBV survivors included: stigma, male dominance culture and fear of marital separation. Bribery in service delivery points, lack of confidentiality, inadequate GBV knowledge among health providers, and fear of being involved in legal matters were mentioned to be additional obstacles to service accessibility by survivors. Reported consequences of GBV included: psychological problems, physical trauma, chronic illness, HIV infection. GBV related stigma and cultural norms are obstacles to HIV services accessibility. Initiation of friendly health services, integration of GBV into HIV services and community based interventions addressing GBV related stigma and cultural norms are recommended.

Kimani B.,African Medical and Research Foundation
The Pan African medical journal | Year: 2012

Jigger infestation is an important but neglected public health problem. The study assessed the knowledge, attitude and practices of household members on jigger infestation, practices and control within Murang'a district, a rural location in Kenya. A cross-sectional descriptive study design was used. Structured interview schedules and observation checklist were used to collect quantitative data. A sample size of 271 household members was interviewed. Descriptive and inferential statistics were analyzed and odds ratios computed at 95% confidence interval to determine variables association. On knowledge, 70.1% acknowledged poor hygiene and sanitation contributes to jigger infestation while 16.6% identified jigger flea as the cause of jigger infestation. Over half (53.9%) reported jiggers are transmissible from person to person. Majority (94.8%) identified signs and symptoms of jigger infestation. Over a quarter (23.6%) reported an infested household member and 18.8% infested persons were confirmed during the study. Many (59.8%) held the opinion that, jigger infested persons are lazy, 26.2% reported they are poor and 12% reported they either have specific blood or are from certain families. Below half (48.7%) believed in myths and misconceptions on jiggers. Majority (90.8%) reported needles/pins were the mostly used jigger removal items followed by thorns 38.7%. About two thirds (62.0%) were not aware of communal jigger prevention and control activities. The Chi-square results showed that, the village, type of house floor and compound maintenance were significantly associated with jigger infestation (p<0.05). Knowledge on jigger infestation is high but this has not translated to jigger prevention and control in the area.

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