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Nyothach E.,Kenya Medical Research Institute | Odhiambo F.O.,Kenya Medical Research Institute | Eleveld A.,Safe Water and AIDS Project | Vulule J.,Kenya Medical Research Institute | And 4 more authors.
PLoS ONE | Year: 2013

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. Source


Silk B.J.,Scientific-Atlanta | Silk B.J.,National Center for Immunization and Respiratory Diseases | Sadumah I.,Health Integrated | Patel M.K.,Scientific-Atlanta | And 11 more authors.
BMC Public Health | Year: 2012

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 <2years of age in households using upesi jiko (48%) or three-stone stoves (49%) (p=0.88); children 2-5years 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 18months; 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 (<22years) 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 projects 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. © 2012 Silk et al.; licensee BioMed Central Ltd. Source


Suchdev P.S.,Emory University | Suchdev P.S.,Centers for Disease Control and Prevention | Ruth L.,Centers for Disease Control and Prevention | Obure A.,Kenya Medical Research Institute | And 11 more authors.
Food and Nutrition Bulletin | Year: 2010

Background. In 2007, the US Centers for Disease Control and Prevention partnered with local Kenyan institutions to implement the Nyando Integrated Child Health and Education Project, an effectiveness study that used social marketing and a community-based distribution program to promote the sale of Sprinkles and other health products. Objective. To describe monitoring of wholesale sales, household demand promotional strategies, and perceived factors influencing Sprinkles sales among vendors. Methods. Ongoing quantitative and qualitative monitoring of Sprinkles sales began in May 2007 in 30 intervention villages. Data sources included baseline and follow-up cross-sectional surveys; office records of Sprinkles sales to vendors; biweekly household monitoring of Sprinkles use; and qualitative data collection, including vendor focus groups and key informant interviews. Results. A total of 550 children aged 6 to 35 months were enrolled at baseline, and 451 were available at 12-month follow-up. During this period, nearly 160,000 sachets were sold wholesale to vendors, with variability in sales influenced by the social, political, and economic context. Vendors living closer to the wholesale office purchased more Sprinkles, so a second office was opened closer to remote vendors. On average, 33% of households purchased Sprinkles during household monitoring visits. Training sessions and community launches were important for community support and raising awareness about Sprinkles. Vendor incentives motivated vendors to sell Sprinkles, and consumer incentives promoted purchases. Conclusions. Sprinkles program monitoring in Kenya was critically important for understanding sales and distribution trends and vendor perceptions. Understanding these trends led to strategic changes to the intervention over time. © 2010, The United Nations University. Source


Suchdev P.S.,Centers for Disease Control and Prevention | Suchdev P.S.,Emory University | Shah A.,Emory University | Jefferds M.E.D.,Centers for Disease Control and Prevention | And 5 more authors.
Maternal and Child Nutrition | Year: 2013

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 sachetsweek-1 in 2008, 1.6 sachetsweek-1 in 2009 and 1.1 sachetsweek-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. © 2012 Blackwell Publishing Ltd. Source


Foote E.M.,University of Washington | Sullivan K.M.,Emory University | Ruth L.J.,Centers for Disease Control and Prevention | Oremo J.,Safe Water and AIDS Project | And 3 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2013

Although anemia in preschool children is most often attributed to iron deficiency, other nutritional, infectious, and genetic contributors are rarely concurrently measured. In a population-based, cross-sectional survey of 858 children 6 - 35 months of age in western Kenya, we measured hemoglobin, malaria, inflammation, sickle cell, a- thalassemia, iron deficiency, vitamin A deficiency, anthropometry, and socio-demographic characteristics. Anemia (Hb < 11 g/dL) and severe anemia (Hb < 7 g/dL) prevalence ratios (PRs) for each exposure were determined using multivariable modeling. Anemia (71.8%) and severe anemia (8.4%) were common. Characteristics most strongly associated with anemia were malaria (PR: 1.7; 95% confidence interval [CI] = 1.5-1.9), iron deficiency (1.3; 1.2-1.4), and homozygous a-thalassemia (1.3; 1.1-1.4). Characteristics associated with severe anemia were malaria (10.2; 3.5-29.3), inflammation (6.7; 2.3-19.4), and stunting (1.6; 1.0 -2.4). Overall 16.8% of anemia cases were associated with malaria, 8.3% with iron deficiency, and 6.1% with inflammation. Interventions should address malaria, iron deficiency, and non-malarial infections to decrease the burden of anemia in this population. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene. Source

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