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Sheira LA, Wekesa P, Cohen CR, Weke E, Frongillo EA, Mocello AR, Dworkin SL, Burger RL, Weiser SD, Bukusi EA. Impact of a livelihood intervention on gender roles and relationship power among people with HIV. AIDS 2024; 38:95-104. [PMID: 37788108 PMCID: PMC10842405 DOI: 10.1097/qad.0000000000003742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To evaluate the impact of an agricultural livelihood intervention on gender role conflict and sexual relationship power among people with HIV (PWH) in western Kenya. DESIGN Study participants were enrolled in Shamba Maisha , a cluster randomized controlled trial of an agricultural intervention conducted among PWH across 16 health facilities during 2016-2020. Intervention participants received a water pump, seeds, and agricultural and financial training; control participants received standard of HIV care. METHODS We assessed men's views on masculinity and gender roles via the validated gender role conflict score (GRCS; range 18-78, higher = greater gender role conflict). We measured gender power imbalances among women via the validated Sexual Relationship Power Scale (SRPS), which combines subscales of relationship control and decision-making dominance (range 1-4, higher = female holds more power). We compared changes over the study period by arm using longitudinal multilevel difference-in-difference linear regression models accounting for clustering of facilities using the intention-to-treat cohort. RESULTS We enrolled 720 participants (366 intervention, 354 control); 2-year retention was 94%. Median age was 40 and approximately 55% of participants were female. Among men, after 24-months the decrease in GRCS scores was 4.3 points greater in the intervention than the control arm ( P < 0.001). Among women, the intervention resulted in 0.25 points greater increase in the SRPS compared to the control arm ( P < 0.001). CONCLUSIONS Shamba Maisha resulted in less gender role conflict in men and greater sexual relationship power for women. Agricultural livelihood interventions may be a powerful tool to improve gender power imbalances, which may subsequently mitigate poverty and food insecurity.
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Affiliation(s)
- Lila A Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, Washington, USA
| | - Rachel L Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
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Suchman L, Gitome S, Nyando M, Kwena ZA, Wekesa P, Okumu S, Ndunyu L, Okoli C, Tijani A, Jegede A, Idiodi I, Nmadu G, Dimowo S, Maluwa A, Atuyambe L, Birabwa C, Alitubeera P, Kaudha B, Kayego A, Jumbe T, Mtalimanja I, Vallin J, Sinha E, Phillips BS, Amongin D, Bukusi E, Holt K, Kamanga M, Liu J, Malata A, Omoluabi E, Waiswa P. Many Cooks in the Kitchen: Iterating a Qualitative Analysis Process Across Multiple Countries, Sites, and Teams. Glob Health Sci Pract 2023; 11:e2300143. [PMID: 38050043 PMCID: PMC10749643 DOI: 10.9745/ghsp-d-23-00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/24/2023] [Indexed: 12/06/2023]
Abstract
Establishing and proving methodological rigor has long been a challenge for qualitative researchers where quantitative methods prevail, but much published literature on qualitative analysis assumes a relatively small number of researchers working in relative proximity. This is particularly true for research conducted with a grounded theory approach. Different versions of grounded theory are commonly used, but this methodology was originally developed for a single researcher collecting and analyzing data in isolation. Although grounded theory has evolved since its development, little has been done to reconcile this approach with the changing nature and composition of international research teams. Advances in technology and an increased emphasis on transnational collaboration have facilitated a shift wherein qualitative datasets have been getting larger and the teams collecting and analyzing them more diverse and diffuse. New processes and systems are therefore required to respond to these conditions. Data for this article are drawn from the experiences of the Innovations for Choice and Autonomy (ICAN) Research Consortium. ICAN aims to understand how self-injectable contraceptives can be implemented in ways that best meet women's needs in Kenya, Uganda, Malawi, and Nigeria. We found that taking a structured approach to analysis was important for maintaining consistency and making the process more manageable across countries. However, it was equally important to allow for flexibility within this structured approach so that teams could adapt more easily to local conditions, making data collection and accompanying analysis more feasible. Meaningfully including all interested researchers in the analysis process and providing support for learning also increased rigor. However, competing priorities in a complex study made it difficult to adhere to planned timelines. We conclude with recommendations for both funders and study teams to design and conduct global health studies that ensure more equitable contributions to analysis while remaining logistically feasible and methodologically sound.
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Affiliation(s)
- Lauren Suchman
- University of California San Francisco, San Francisco, CA, USA.
| | - Serah Gitome
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - Sarah Okumu
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | | | | | | | | | - Alfred Maluwa
- Malawi University of Science and Technology, Limbe, Malawi
| | - Lynn Atuyambe
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Betty Kaudha
- Makerere University School of Public Health, Kampala, Uganda
| | - Agnes Kayego
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Janelli Vallin
- University of California San Francisco, San Francisco, CA, USA
| | - Elena Sinha
- University of California San Francisco, San Francisco, CA, USA
| | - Beth S Phillips
- University of California San Francisco, San Francisco, CA, USA
| | - Dinah Amongin
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Kelsey Holt
- University of California San Francisco, San Francisco, CA, USA
| | | | - Jenny Liu
- University of California San Francisco, San Francisco, CA, USA
| | - Address Malata
- Malawi University of Science and Technology, Limbe, Malawi
| | | | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda
- Karolinska Institute, Stockholm, Sweden
- Busoga Health Forum, Jinja, Uganda
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Onono MA, Frongillo EA, Sheira LA, Odhiambo G, Wekesa P, Conroy AA, Cohen CR, Bukusi EA, Weiser SD. Links between Household-Level Income-Generating Agricultural Intervention and the Psychological Well-Being of Adolescent Girls in Human Immunodeficiency Virus-Affected Households in Southwestern Kenya: A Qualitative Inquiry. J Nutr 2023; 153:3595-3603. [PMID: 37863268 PMCID: PMC10739770 DOI: 10.1016/j.tjnut.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Adolescent girls may experience poor psychological well-being, such as social isolation, shame, anxiety, hopelessness, and despair linked to food insecurity. OBJECTIVES This study aimed to investigate the experiences with and perceived effects of a household-level income-generating agricultural intervention on the psychological well-being of adolescent girls in human immunodeficiency virus (HIV)-affected households in southwestern Kenya. METHODS We conducted 62 in-depth interviews with HIV-affected adolescent girls and caregiver dyads in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in Shamba Maisha (NCT01548599), a multisectoral agricultural and finance intervention trial aimed to improve food security and HIV health indicators. Participants were purposively sampled to ensure diversity in terms of age and location. Data were audiotaped, transcribed, translated, and uploaded into Dedoose (Sociocultural Research Consultants, LLC) software for management. Data were analyzed thematically based on reports from Dedoose. RESULTS We found evidence that a household-level structural intervention aimed at increasing food and financial security among persons living with HIV can contribute to better psychological well-being among adolescent girls residing in these households. The intervention also affected: 1) reduction of social isolation, 2) reduction of shame and stigma, 3) increased attendance and concentration in school, 4) improved caregiver mental health, and 5) reduced parental aggression and improved household communication. These associations were reported more commonly among those in the intervention arm than the control arm. CONCLUSIONS This study extends existing research by demonstrating how multisectoral structural interventions delivered at a household level can improve the psychological well-being of adolescents. We recommend that future research test livelihood interventions designed specifically for adolescent girls that integrate food-security interventions with other elements to address the social and psychological consequences of food insecurity holistically. This trial was registered at clinicaltrials.gov as NCT03741634.
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Affiliation(s)
- Maricianah A Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States.
| | - Lila A Sheira
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, United States
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Amy A Conroy
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States
| | - Craig R Cohen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, United States
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Odhiambo JA, Weiser SD, Frongillo EA, Burger RL, Weke E, Wekesa P, Bukusi EA, Cohen CR. Comparing the effect of a multisectoral agricultural intervention on HIV-related health outcomes between widowed and married women. Soc Sci Med 2023; 330:116031. [PMID: 37390805 PMCID: PMC10645573 DOI: 10.1016/j.socscimed.2023.116031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Widowed women make up 18-40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and mortality. We compared the effectiveness of a multisectoral climate adaptive agricultural livelihood intervention (called Shamba Maisha) on food insecurity, and HIV related health outcomes among widowed and married women living with HIV in western Kenya. METHODS We implemented Shamba Maisha (NCT02815579) using a cluster-randomized control trial design. The intervention arm received an US$175 in-kind loan to purchase a micro-irrigation pump, seeds, and fertilizer, and received eight training sessions on sustainable agriculture and financial management. Study outcomes were measured every 6 months over a 24-month follow-up period and trends in outcomes assessed using multilevel mixed-effects models. RESULTS The trial enrolled 232 (61.5%) married and 145 (38.5%) widowed women. Widowed women (mean age 42.8 ± 8.4 years) were older than married women (35.8 ± 9.0 years) (p < 0.01). Almost all widowed women (97.2%) self-identified as household heads compared to 10.8% of married women. Comparing widowed vs married women, reduction in food insecurity (-3.13, 95%CI -4.42, -1.84 vs. -3.08, 95%CI -4.15, -2.02), depressive symptoms (-0.21, 95%CI -0.36, -0.07 vs. -0.19, 95%CI -0.29, -0.08), internalized stigma (-0.33, 95%CI -0.55, -0.11 vs. -0.38, 95%CI -0.57, -0.19), and anticipated stigma (-0.46 95%CI -0.65, -0.28 vs. -0.35, 95%CI -0.50, -0.21) was similar for both groups. In contrast, improvements in social support (-2.22, 95%CI -3.85, -0.59 vs. -4.00, 95%CI -5.16, -2.84; p = 0.08) and reduction in enacted stigma (0.01, 95%CI -0.06, 0.08 vs. -0.14, 95%CI -0.20, -0.09; p < 0.01) were weaker for widowed than married women. CONCLUSIONS Our study is among the first comparing the effect of a livelihood intervention on HIV health outcomes among widowed and married women. Widowed women experienced similar benefits as married women on individual-level outcomes, but weaker benefit on outcomes dependent on their external environment like enacted stigma and social support. Future trials and programs targeting widowed women should bolster stigma reduction and social support.
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Affiliation(s)
- Jackline A Odhiambo
- School of Public Health and Community Development, Maseno University, Maseno, Kenya; Nyanam Widows Rising, Kisumu, Kenya.
| | - Sheri D Weiser
- Department of Medicine, University of California San Francisco, CA, USA
| | | | - Rachel L Burger
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, CA, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, CA, USA
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Suchman L, Omoluabi E, Kramer J, Vallin J, Sedlander E, Gitome S, Wekesa P, Kwena Z, Granovsky R, Kayego A, Kaudha B, Atuyambe L, Amongin D, Alitubeera P, Tijani A, Okoli C, Jegede A, Kamanga M, Nyando M, Ndunyu L, Holt K. Analyzing fast and slow: Combining traditional and rapid qualitative analysis to meet multiple objectives of a complex transnational study. Front Sociol 2023; 8:961202. [PMID: 36818663 PMCID: PMC9931144 DOI: 10.3389/fsoc.2023.961202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 01/06/2023] [Indexed: 06/18/2023]
Abstract
Much of the methodological literature on rapid qualitative analysis describes processes used by a relatively small number of researchers focusing on one study site and using rapid analysis to replace a traditional analytical approach. In this paper, we describe the experiences of a transnational research consortium integrating both rapid and traditional qualitative analysis approaches to develop social theory while also informing program design. Research was conducted by the Innovations for Choice and Autonomy (ICAN) consortium, which seeks to understand how self-injection of the contraceptive subcutaneous depot medroxyprogesterone acetate (DMPA-SC) can be implemented in a way that best meets women's needs, as defined by women themselves. Consortium members are based in Kenya, Uganda, Malawi, Nigeria, and the United States. Data for the ICAN study was collected in all four countries in sub-Saharan Africa. In order to both illuminate social phenomena across study sites and inform the program design component of the study, researchers developed tools meant to gather both in-depth information about women's contraceptive decision-making and data targeted specifically to program design during the formative qualitative phase of the study. Using these two bodies of data, researchers then simultaneously conducted both a traditional qualitative and rapid analysis to meet multiple study objectives. To complete the traditional analysis, researchers coded interview transcripts and kept analytical memos, while also drawing on data collected by tools developed for the rapid analysis. Rapid analysis consisted of simultaneously collecting data and reviewing notes developed specifically for this analysis. We conclude that integrating traditional and rapid qualitative analysis enabled us to meet the needs of a complex transnational study with the added benefit of grounding our program design work in more robust primary data than normally is available for studies using a human-centered design approach to intervention development. However, the realities of conducting a multi-faceted study across multiple countries and contexts made truly "rapid" analysis challenging.
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Affiliation(s)
- Lauren Suchman
- University of California, San Francisco, San Francisco, CA, United States
| | | | - Julia Kramer
- University of California, San Francisco, San Francisco, CA, United States
| | - Janelli Vallin
- University of California, San Francisco, San Francisco, CA, United States
| | - Erica Sedlander
- University of California, San Francisco, San Francisco, CA, United States
| | - Serah Gitome
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Rachel Granovsky
- University of California, San Francisco, San Francisco, CA, United States
| | - Agnes Kayego
- Makerere University School of Public Health, Kampala, Uganda
| | - Betty Kaudha
- Makerere University School of Public Health, Kampala, Uganda
| | - Lynn Atuyambe
- Makerere University School of Public Health, Kampala, Uganda
| | - Dinah Amongin
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | | | - Martha Kamanga
- Malawi University of Science and Technology, Limbe, Malawi
| | | | | | - Kelsey Holt
- University of California, San Francisco, San Francisco, CA, United States
| | - The ICAN Research ConsortiumHoltKelseyLiuJenny X.BukusiElizabethGitomeSerahOmoluabiElizabethMalataAddressWaiswaPeterKwenaZacharyNdunyuLouisaWekesaPaulineOkumuSarahIdiodiIvanOkoliChiomaTijaniAminatJegedeAyobamboNmaduGraceDimowoShakedeKamangaMarthaNyandoMandayachepaMtalimanjaInnocenciaJumbeTamandaniAtuyambeLynnAmonginDinahAlitubeeraPhoebeBirabwaCatherineKayegoAgnesKaudhaBettyPhillipsBethSuchmanLaurenVallinJanelliChallaSnehaKramerJuliaSedlanderEricaWilliamsLaKia
- University of California, San Francisco, San Francisco, CA, United States
- AkenaPlus Health, Abuja, Nigeria
- Kenya Medical Research Institute, Nairobi, Kenya
- Makerere University School of Public Health, Kampala, Uganda
- Malawi University of Science and Technology, Limbe, Malawi
- Maseno University, Kisumu, Kenya
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Daniel AK, Dworkin SL, McDonough A, Hatcher AM, Burger RL, Weke E, Wekesa P, Bukusi EA, Owino G, Odhiambo G, Thirumurthy H, Getahun M, Weiser SD, Cohen CR. The Impact of Land Tenure Security on a Livelihood Intervention for People Living with HIV in Western Kenya. AIDS Behav 2023; 27:245-256. [PMID: 35930199 PMCID: PMC9851924 DOI: 10.1007/s10461-022-03760-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Few studies have explored land access, a structural driver of health, and women's participation in livelihood interventions to improve food security and HIV outcomes. This qualitative study, embedded within Shamba Maisha (NCT02815579)-a randomized controlled trial (RCT) examining the impact of a multisectoral intervention among farmers living with HIV in western Kenya-sought to explore the influence of perceived access to and control of land on agricultural productivity, investments, and benefits. Thirty in-depth interviews (IDIs) were conducted with purposively sampled men and women, 3 to 6 months after receiving intervention inputs; data were deductively and inductively coded and analyzed. Farming practices and participation in Shamba Maisha were dependent on land tenure and participants' perceived strength of claim over their land, with participants who perceived themselves to be land insecure less likely to make long-term agricultural investments. Land tenure was influenced by a number of factors and posed unique challenges for women which negatively impacted uptake and success in the intervention. Data underscore the importance of secure land tenure for the success of similar interventions, especially for women; future interventions should integrate land security programming for improved outcomes for all.
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Affiliation(s)
- Afkera K Daniel
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA.
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington, Bothell, Bothell, WA, USA
| | - Annie McDonough
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Abigail M Hatcher
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Rachel L Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - George Owino
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Harsha Thirumurthy
- Department of Medical Ethics and Heath Policy, Perelman School of Medicine, Philadelphia, PA, USA
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
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Rickman RR, Lane CE, Collins SM, Miller JD, Onono M, Wekesa P, Nichols AR, Foster SF, Shiau S, Young SL, Widen EM. Body Composition Trajectories During the First 23 Months of Life Differ by HIV Exposure Among Infants in Western Kenya: A Prospective Study. J Nutr 2023; 153:331-339. [PMID: 36913469 PMCID: PMC10196592 DOI: 10.1016/j.tjnut.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/29/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Infants who are HIV-exposed and uninfected have suboptimal growth patterns compared to those who are HIV-unexposed and uninfected. However, little is known about how these patterns persist beyond 1 year of life. OBJECTIVES This study aimed to examine whether infant body composition and growth trajectories differed by HIV exposure during the first 2 years of life among Kenyan infants using advanced growth modeling. METHODS Repeated infant body composition and growth measurements (mean: 6; range: 2-7) were obtained from 6 weeks to 23 months in the Pith Moromo cohort in Western Kenya (n = 295, 50% HIV-exposed and uninfected, 50% male). Body composition trajectory groups were fitted using latent class mixed modeling (LCMM) and associations between HIV exposure and growth trajectories were examined using logistic regression analysis. RESULTS All infants exhibited poor growth. However, HIV-exposed infants generally grew suboptimally than unexposed infants. Across all body composition models except for the sum of skinfolds, HIV-exposed infants had a higher likelihood of belonging to the suboptimal growth groups identified by LCMM than the HIV-unexposed infants. Notably, HIV-exposed infants were 3.3 times more likely (95% CI: 1.5-7.4) to belong to the length-for-age z-score growth class that remained at a z-score of < -2, indicating stunted growth. HIV-exposed infants were also 2.6 times more likely (95% CI: 1.2-5.4) to belong to the weight-for-length-for-age z-score growth class that remained between 0 and -1, and were 4.2 times more likely (95% CI: 1.9-9.3) to belong to the weight-for-age z-score growth class that indicated poor weight gain besides stunted linear growth. CONCLUSIONS In a cohort of Kenyan infants, HIV-exposed infants grew suboptimally compared to HIV-unexposed infants beyond 1 year of age. These growth patterns and longer-term effects should be further investigated to support the ongoing efforts to reduce early-life HIV exposure-related health disparities.
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Affiliation(s)
- Rachel R Rickman
- Department of Nutritional Sciences, University of Texas, Austin, TX, USA
| | - Charlotte E Lane
- International Initiative for Impact Evaluation Inc (3ie), Washington, DC, USA
| | - Shalean M Collins
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Joshua D Miller
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | | | - Pauline Wekesa
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Amy R Nichols
- Department of Nutritional Sciences, University of Texas, Austin, TX, USA
| | - Saralyn F Foster
- Department of Nutritional Sciences, University of Texas, Austin, TX, USA
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Elizabeth M Widen
- Department of Nutritional Sciences, University of Texas, Austin, TX, USA; Department of Women's Health and Pediatrics, Dell Pediatric Research Institute, University of Texas, Austin, TX, USA.
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Carter EJ, Mungai B, Njoroge T, Masese A, Szkwarko D, Angala P, Ronoh A, Owuor K, Masini E, Kamene M, Wekesa P. Finding the missing children for TB care and prevention in Kenya. Int J Tuberc Lung Dis 2022; 26:1144-1150. [PMID: 36447323 DOI: 10.5588/ijtld.22.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
SETTING: One hundred high TB burden facilities in nine counties in Kenya.OBJECTIVES: 1) To increase uptake of TB preventive therapy (TPT) among child contacts aged <5 years, and 2) to increase TB diagnosis in children aged <15 years presenting to health facilities for routine care.DESIGN: For objective 1, a clinic-based child contact management strategy incorporating transport/healthcare cost reimbursement, monitoring and evaluation tools, and healthcare worker education was utilized. For objective 2, community health screeners were established in pediatric outpatient departments to perform verbal screening, flagging symptomatic children for further evaluation.RESULTS: Over 15 months, identification of 8,060 individuals diagnosed with bacteriologically confirmed TB led to 2,022 child contacts. Of these, 1,848 (91%) were evaluated; 149 (8%) were diagnosed with TB disease, leaving 1,699 (92%) eligible for TPT; 1,613 (95%) initiated TPT and 1,335 (83%) completed TPT. In outpatient settings, 140,444 children were screened; 54,236 (39%) had at least two TB symptoms; 2,395 (4%) were diagnosed with TB diseaseCONCLUSION: Health system strengthening supporting a clinic-based child contact management program increased the number of children initiating TPT. Systematic screening in outpatient clinics can lead to increased TB case notifications; however, optimal screening tools and clearer diagnostic pathways for the evaluation of these children are needed.
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Affiliation(s)
- E J Carter
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - B Mungai
- Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - T Njoroge
- Centre for Health Solutions-Kenya, Nairobi, Kenya, Kenyatta National Hospital, Othaya, Kenya
| | - A Masese
- Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - D Szkwarko
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA, Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA
| | - P Angala
- Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - A Ronoh
- Kenya Division of National Tuberculosis, Leprosy and Lung Disease Program (DNTLDP), Nairobi, Kenya
| | - K Owuor
- Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - E Masini
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland, Stop TB Partnership, Geneva, Switzerland
| | - M Kamene
- Kenya Division of National Tuberculosis, Leprosy and Lung Disease Program (DNTLDP), Nairobi, Kenya
| | - P Wekesa
- Centre for Health Solutions-Kenya, Nairobi, Kenya
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9
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Cohen CR, Weke E, Frongillo EA, Sheira LA, Burger R, Mocello AR, Wekesa P, Fisher M, Scow K, Thirumurthy H, Dworkin SL, Shade SB, Butler LM, Bukusi EA, Weiser SD. Effect of a Multisectoral Agricultural Intervention on HIV Health Outcomes Among Adults in Kenya: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2246158. [PMID: 36508217 PMCID: PMC9856331 DOI: 10.1001/jamanetworkopen.2022.46158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
Importance Food insecurity and HIV health outcomes are linked through nutritional, mental health, and health behavior pathways. Objective To examine the effects of a multisectoral agriculture and livelihood intervention on HIV viral suppression and nutritional, mental health, and behavioral outcomes among HIV-positive adults prescribed antiretroviral therapy (ART). Design, Setting, and Participants This cluster randomized clinical trial was performed in 8 pairs of health facilities in Kenya. Participants were 18 years or older, living with HIV, and receiving ART for longer than 6 months; had moderate to severe food insecurity; and had access to arable land and surface water and/or shallow aquifers. Participants were followed up every 6 months for 24 months. Data were collected from June 23, 2016, to June 13, 2017, with follow-up completed by December 16, 2019. Data were analyzed from June 25 to August 31, 2020, using intention-to-treat and per-protocol methods. Interventions A loan to purchase a human-powered irrigation pump, fertilizer, seeds, and pesticides combined with the provision of training in sustainable agriculture and financial literacy. Main Outcomes and Measures The primary outcome was the relative change from baseline to the end of follow-up in viral load suppression (≤200 copies/mL) compared between study groups using difference-in-differences analyses. Secondary outcomes included clinic attendance, ART adherence, food insecurity, depression, self-confidence, and social support. Results A total of 720 participants were enrolled (396 women [55.0%]; mean [SD] age, 40.38 [9.12] years), including 366 in the intervention group and 354 in the control group. Retention included 677 (94.0%) at the 24-month visit. HIV viral suppression improved in both groups from baseline to end of follow-up from 314 of 366 (85.8%) to 327 of 344 (95.1%) in the intervention group and from 291 of 353 (82.4%) to 314 of 333 (94.3%) in the control group (P = .86). Food insecurity decreased more in the intervention than the control group (difference in linear trend, -3.54 [95% CI, -4.16 to -2.92]). Proportions of those with depression during the 24-month follow-up period declined more in the intervention group (from 169 of 365 [46.3%] to 36 of 344 [10.5%]) than the control group (106 of 354 [29.9%] to 41 of 333 [12.3%]; difference in trend, -0.83 [95% CI, -1.45 to -0.20]). Self-confidence improved more in the intervention than control group (difference in trend, -0.37 [95% CI, -0.59 to -0.15]; P = .001), as did social support (difference in trend, -3.63 [95% CI, -4.30 to -2.95]; P < .001). Conclusions and Relevance In this cluster randomized trial, the multisectoral agricultural intervention led to demonstrable health and other benefits; however, it was not possible to detect additional effects of the intervention on HIV clinical indicators. Agricultural interventions that improve productivity and livelihoods hold promise as a way of addressing food insecurity and the underpinnings of poor health among people living with HIV in resource-limited settings. Trial Registration ClinicalTrials.gov Identifier: NCT02815579.
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Affiliation(s)
- Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi
| | | | - Lila A. Sheira
- Department of Medicine, University of California, San Francisco
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Adrienne Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi
| | | | - Kate Scow
- Department of Land, Air and Water Resources, University of California, Davis
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Shari L. Dworkin
- School of Nursing and Health Studies, University of Washington-Bothell, Bothell
| | - Starley B. Shade
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Lisa M. Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs
| | - Elizabeth A. Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi
| | - Sheri D. Weiser
- Department of Medicine, University of California, San Francisco
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10
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Foster S, Rickman R, Nichols A, Collins S, Miller J, Onono M, Wekesa P, Young S, Widen E. Dietary Diversity in Infancy Is Associated with Linear Growth in The Second Year of Life. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11
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Wekesa P, McLigeyo A, Owuor K, Mwangi J, Ngugi E. Survival probability and factors associated with time to loss to follow-up and mortality among patients on antiretroviral treatment in central Kenya. BMC Infect Dis 2022; 22:522. [PMID: 35668350 PMCID: PMC9171980 DOI: 10.1186/s12879-022-07505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retention of patients who are receiving antiretroviral therapy (ART) remains a challenge especially in the setting of rapid expansion of HIV services. Retention in care remains vital to the HIV care continuum, and has been associated with viral suppression and improved survival. This study aimed to ascertain survival rates, time to loss to follow-up (LTFU) or mortality events and factors associated with time to LTFU or mortality among patients enrolled on antiretroviral therapy at health facilities in central Kenya. METHODS This was a retrospective cohort study among patients initiated on ART between 2004 and 2012 in central Kenya. Demographic characteristics, clinical characteristics and outcomes data were analyzed using Stata version 15.1. Competing risks regression analysis and cummulative incidence functions were used to estimate survival. RESULTS A total of 31,346 patients were included, of whom 65.6% were female, 76.0% were aged between 20 and 50 years old, and 38.9% were diagnosed at WHO stage III. At 36 months, overall retention was 68.8%, LTFU was 27.1%, and mortality was 4.1%. The total person-years of follow up was 74,986. The incidence rate of LTFU was 9.99 per 100 person years for a total of 9383.25 person-years of follow up. The mortality rate was 1.25 per 100 person years for a total of 875.5 person-years among those who died. The median time to LTFU was 11 months (IQR 3-22) while median time to death was 3 months (IQR 0-13). Men, unmarried patients, patients presenting with advanced HIV, not on TB treatment, and enrolled into the HIV program in later cohorts, had a shorter time to mortality and LTFU. CONCLUSION Our study demonstrated evidence of scale-up of HIV treatment programs in central Kenya. While most patients were enrolled at an advanced WHO clinical stage, overall 36-month mortality remained low, but occurred earlier during follow-up. Cohort LTFU at 36-months reduced in later years with the losses occurring within the 1st year of follow-up. Predictors of early mortality and LTFU included being male, single, separated or divorced, advanced WHO clinical stage, and among patients not on TB treatment.
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Affiliation(s)
- P Wekesa
- Centre for Health Solutions - Kenya, Nairobi, Kenya.
| | - A McLigeyo
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - K Owuor
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - J Mwangi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - E Ngugi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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12
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Angala P, Dlodlo RA, Wanjala S, Mamo G, Mugambi-Nyaboga L, Onyango Okoth E, Macharia S, Maina M, Wachira S, Owuor K, Masini E, Wekesa P, Carter EJ, Mungai B. TB training in Kenya: building capacity for care and prevention. Public Health Action 2022; 12:40-47. [DOI: 10.5588/pha.21.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Devolution of healthcare services in Kenya resulted in a large number of newly recruited tuberculosis (TB) coordinators. We describe a unique collaboration between a national tuberculosis program (NTP), a local, and an international non-governmental organization to
build human resource capacity in TB care and prevention.METHODS: From 2016 to 2021, the Kenya Division of National Tuberculosis, Leprosy and Lung Disease Program, Centre for Health Solutions-Kenya, and the International Union Against Tuberculosis and Lung Disease developed and conducted
a series of 7-day training courses. A key focus of training was the introduction of TBData4Action, an approach involving the local use of routinely available data to strengthen decision-making and support supervision.RESULTS: Implementation outcomes included training 331 (96%) coordinators
out of 344, representing all 47 counties, 37 national officers and 21 other stakeholders using the country-tailored curriculum, including hands-on group work by county teams and field practicals. Thirty-five national facilitators were identified and mentored as local faculty. Training costs
were reduced by 75% compared with international alternatives.CONCLUSION: The collaboration resulted in the training of the majority of the coordinators in a standardized approach to TB care. A sustainable approach to capacity building in local data use was found feasible; the model
could be adapted by other NTPs.
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Affiliation(s)
- P. Angala
- Centre for Health Solutions – Kenya, Nairobi, Kenya, Department of Business Administration, Maseno University, Kisumu, Kenya
| | - R. A. Dlodlo
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S. Wanjala
- Centre for Health Solutions – Kenya, Nairobi, Kenya
| | - G. Mamo
- Centre for Health Solutions – Kenya, Nairobi, Kenya
| | | | - E. Onyango Okoth
- Ministry of Health - Division of National Tuberculosis, Leprosy and Lung Disease Program, Nairobi, Kenya
| | - S. Macharia
- Ministry of Health - Division of National Tuberculosis, Leprosy and Lung Disease Program, Nairobi, Kenya
| | - M. Maina
- United States Agency for International Development/Kenya and East Africa, Nairobi, Kenya
| | - S. Wachira
- Centre for Health Solutions – Kenya, Nairobi, Kenya
| | - K. Owuor
- Centre for Health Solutions – Kenya, Nairobi, Kenya
| | - E. Masini
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland, Stop TB Partnership, Geneva, Switzerland
| | - P. Wekesa
- Centre for Health Solutions – Kenya, Nairobi, Kenya
| | - E. J. Carter
- International Union Against Tuberculosis and Lung Disease, Paris, France, Alpert Medical School at Brown University-Providence, RI, USA
| | - B. Mungai
- Centre for Health Solutions – Kenya, Nairobi, Kenya
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13
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Nagata JM, Miller JD, Cohen CR, Frongillo EA, Weke E, Burger R, Wekesa P, Sheira LA, Mocello AR, Otieno P, Butler LM, Bukusi EA, Weiser SD, Young SL. Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya. AIDS Behav 2022; 26:549-555. [PMID: 34373987 PMCID: PMC8813828 DOI: 10.1007/s10461-021-03410-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 12/21/2022]
Abstract
Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0-51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI -3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, Box 0110, San Francisco, CA, 94158, USA.
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
| | - Joshua D Miller
- Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lila A Sheira
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Phelgona Otieno
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa M Butler
- Institute for Collaboration On Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
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14
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Wekesa P, McLigeyo A, Owuor K, Mwangi J, Isavwa L, Katana A. Temporal trends in pre-ART patient characteristics and outcomes before the test and treat era in Central Kenya. BMC Infect Dis 2021; 21:1007. [PMID: 34565337 PMCID: PMC8474838 DOI: 10.1186/s12879-021-06706-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Retention of patients who did not initiate antiretroviral therapy (ART) has been persistently low compared to those who initiated ART. Understanding the temporal trends in clinical outcomes prior to ART initiation may inform interventions targeting patients who do not initiate ART immediately after diagnosis. METHODS A retrospective cohort analysis of known HIV-infected patients who did not initiate ART from healthcare facilities in Central Kenya was done to investigate temporal trends in characteristics, retention, and mortality outcomes. The data were sourced from the Comprehensive Care Clinic Patient Application Database (CPAD) and IQ care electronic patient-level databases for those enrolled between 2004 and 2014. RESULTS A total of 13,779 HIV-infected patients were assessed, of whom 30.7% were men.There were statisitically significant differences in temporal trends relating to marital status, WHO clinical stage, and tuberculosis (TB) status from 2004 to 2014. The proportion of widowed patients decreased from 9.1 to 6.0%. By WHO clinical stage at enrollment in program, those in WHO stage I increased over time from 8.7 to 43.1%, while those in WHO stage III and IV reduced from 28.5 to 10.8% and 4.0 to 1.1% respectively. Those on TB treatment during their last known visit reduced from 8.3 to 3.9% while those with no TB signs increased from 58.5 to 86.8%. Trends in 6 and 12 month retention in the program, loss to follow-up (LTFU) and mortality were statistically significant. At 6 months, program retention ranged between 36.0% in 2004 to a high of 54.1% in 2013. LTFU at 6 months remained around 50.0% for most of the cohorts, while mortality at 6 months was 7.5% in 2004 but reduced to 3.8% in 2014. At 12 months, LTFU was above 50.0% across all the cohorts while mortality rate reached 3.9% in 2014. CONCLUSION Trends in pre ART enrollment suggested higher enrollment among patients who were women and at earlier WHO clinical stages. Retention and mortality outcomes at 6 and 12 months generally improved over the 11 year follow-up period, though dipped as enrollment in asymptomatic disease stage increased.
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Affiliation(s)
- P Wekesa
- Centre for Health Solutions - Kenya, Nairobi, Kenya.
| | - A McLigeyo
- Centre for Health Solutions - Kenya, Nairobi, Kenya.
| | - K Owuor
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - J Mwangi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - L Isavwa
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - A Katana
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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15
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Miller JD, Frongillo EA, Weke E, Burger R, Wekesa P, Sheira LA, Mocello AR, Bukusi EA, Otieno P, Cohen CR, Weiser SD, Young SL. Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya. J Nutr 2021; 151:1656-1664. [PMID: 33709134 PMCID: PMC8243794 DOI: 10.1093/jn/nxab030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/04/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. OBJECTIVES We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. METHODS Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. RESULTS Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). CONCLUSIONS Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.
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Affiliation(s)
- Joshua D Miller
- Department of Anthropology, Northwestern
University, Evanston, IL, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior,
University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Lila A Sheira
- Department of Medicine, University of California San
Francisco, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Phelgona Otieno
- Centre for Clinical Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California San
Francisco, San Francisco, CA, USA
| | - Sera L Young
- Department of Anthropology, Northwestern
University, Evanston, IL, USA
- Institute for Policy Research, Northwestern
University, Evanston, IL, USA
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16
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Alvarez GG, Miller JD, Santoso MV, Wekesa P, Owuor PM, Onono M, Young SL. Prevalence and Covariates of Food Insecurity Across the First 1000 Days Among Women of Mixed HIV Status in Western Kenya: A Longitudinal Perspective. Food Nutr Bull 2021; 42:319-333. [PMID: 34011176 DOI: 10.1177/0379572121999024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Food insecurity (FI) is common globally and can have lifelong consequences. However, few studies have longitudinally examined how FI varies across gestation and the postpartum period ("the first 1000 days"); none have explored this in sub-Saharan Africa or in the context of HIV. OBJECTIVE To assess the prevalence and covariates of FI in the first 1000 days among Kenyan women. METHODS All pregnant women attending 7 clinics in western Kenya (n = 1247) were screened for HIV and FI (Individual Food Insecurity Access Scale) between September 2014 and June 2015. A subset of women (n = 371) was recruited into an observational cohort study and surveyed 11 times through 2 years postpartum (NCT02974972, NCT02979418). Data on FI, sociodemographics, and health were repeatedly collected. Severe FI was modeled using multilevel, mixed-effects logistic regressions (n = 346). RESULTS Of the 1247 pregnant women screened, 76.5% were severely food insecure in the prior month. Further, the prevalence of severe FI was higher among women living with HIV than those without (82.6% vs 74.6%, P < .05). In the cohort, the odds of being severely food insecure decreased monotonically after delivery. Each point higher on the Center for Epidemiologic Studies-Depression scale was associated with 1.08 times greater odds of being severely food insecure (95% CI: 1.05-1.10); each point higher on the Duke/UNC Functional Social Support Scale was associated with 0.97 lower odds of severe FI (95% CI: 0.94-0.99). CONCLUSIONS Severe FI is prevalent during the first 1000 days in western Kenya. Services to mitigate the far-reaching consequences of this modifiable risk should be considered.
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Affiliation(s)
- Gloria G Alvarez
- Gerald J. And Dorothy R. Friedman School of Nutrition Science and Policy, 1810Tufts University, Boston, MA, USA.,* Gloria G. Alvarez and Joshua D. Miller contributed equally to the manuscript
| | - Joshua D Miller
- Department of Anthropology, 3270Northwestern University, Evanston, IL, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, NC, USA.,* Gloria G. Alvarez and Joshua D. Miller contributed equally to the manuscript
| | - Marianne V Santoso
- Department of Anthropology, 3270Northwestern University, Evanston, IL, USA
| | | | | | | | - Sera L Young
- Department of Anthropology, 3270Northwestern University, Evanston, IL, USA.,Institute for Policy Research, 3270Northwestern University
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17
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Hatcher AM, Weiser SD, Cohen CR, Hagey J, Weke E, Burger R, Wekesa P, Sheira L, Frongillo EA, Bukusi EA. Food Insecurity and Intimate Partner Violence Among HIV-Positive Individuals in Rural Kenya. Am J Prev Med 2021; 60:563-568. [PMID: 33012622 PMCID: PMC7987870 DOI: 10.1016/j.amepre.2020.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Intimate partner violence and food insecurity are both structural drivers of HIV acquisition, care, and treatment, but little is known about how the 2 conditions intersect in the lives of those already living with HIV. METHODS This study examined cross-sectional baseline data (collected in January 2016-December 2017) from an ongoing trial in southwestern Kenya. Trained interviewers asked enrolled participants living with HIV aged 18-60 years about household food insecurity (using the Household Food Insecurity Access Scale), intimate partner violence (using an adapted WHO multicountry study instrument), and sociodemographics. Negative binomial regression was used to examine the association between food insecurity and partner violence victimization (among women) or perpetration (among men). Secondary data were analyzed in August 2019-March 2020. RESULTS Of 720 participants, more than half of women reported experiencing intimate partner violence (57.6%) and most men reported perpetrating it (58.4%). Participants reporting any partner violence had higher Household Food Insecurity Access Scale scores (21.8) compared with those reporting no violence (21.3, p=0.02). Each categorical change in food insecurity (mild, moderate, severe) was associated with a 41% increased risk of an additional partner violence episode. In models controlling for relationship status, wealth, season of interview (lean versus not lean), and baseline physical health, each 1-point increase in food insecurity was associated with a 6% higher risk of violence victimization among women and 4% greater risk of men perpetrating partner violence. CONCLUSIONS This study highlights the interconnected nature of intimate partner violence and food insecurity among women and men living with HIV. This relationship suggests that enhancing food security may be a useful intervention strategy to prevent intimate partner violence and improve HIV-related health outcomes.
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Affiliation(s)
- Abigail M Hatcher
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California; Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Jill Hagey
- Department of Medicine, Duke University, Durham, North Carolina
| | - Elly Weke
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Pauline Wekesa
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lila Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California; Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, Washington; Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
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18
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Nagata JM, Anicete LM, Cohen CR, Frongillo EA, Burger RL, Wekesa P, Weke E, Weiser SD, Bukusi EA. Presence of Older Adolescents in the Household is Associated with Depressive Symptoms Among Women Living with HIV in Kenya. AIDS Behav 2020; 24:3574-3578. [PMID: 32533394 PMCID: PMC7669667 DOI: 10.1007/s10461-020-02942-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of this study was to determine the association between the number of adolescents in a household and depressive symptoms among adult caregivers living with HIV. We examined cross-sectional baseline data among adults enrolled in the Shamba Maisha multisectoral agricultural intervention (n = 705) in the Nyanza region of Kenya (NCT02815579). Each additional adolescent 15-19 years in a household was associated with a 1.35 (95% CI 1.06-1.71) higher odds of depressive symptoms among women, but not men, adjusting for potential confounders. Interventions to support the mental health of adults living with HIV may target women caring for dependent adolescents 15-19 years.
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Affiliation(s)
- Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Lynhea M Anicete
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Rachel L Burger
- Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
| | | | - Elly Weke
- Family AIDS Care and Education Services, Kisumu, Kenya
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth A Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
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Wang M, Miller JD, Collins SM, Santoso MV, Wekesa P, Okochi H, Onono M, Weiser S, Gandhi M, Young SL. Social Support Mitigates Negative Impact of Food Insecurity on Antiretroviral Adherence Among Postpartum Women in Western Kenya. AIDS Behav 2020; 24:2885-2894. [PMID: 32212069 PMCID: PMC7483232 DOI: 10.1007/s10461-020-02839-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Food insecurity (FI), low social support, and low health-related quality of life (HRQoL) are associated with self-reported nonadherence to antiretroviral therapy (ART) among postpartum women, but these relationships have not been evaluated using objective adherence indicators. Hair samples were therefore analyzed among 83 postpartum Kenyan women living with HIV on efavirenz and nevirapine ART drug regimens in an observational cohort (NCT02974972). FI (0-27), social support (0-40), and HRQoL (8-40) in the prior month were also assessed. In multivariable models, each point increase in FI and decrease in HRQoL were associated with a 45.1% (95% CI: -64.3%, -15.6%) and 10.5% decrease (95% CI: 1.0%, 22.1%) in hair ART drug concentrations respectively, when social support was held constant. A significant interaction between social support and FI (β = 0.02, p = 0.017) indicated that greater social support was predicted to mitigate the negative impacts of FI on ART adherence. Addressing these modifiable barriers could improve ART adherence during this critical period.
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Affiliation(s)
- Mira Wang
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA
| | - Joshua D Miller
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA
| | - Shalean M Collins
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA
| | - Marianne V Santoso
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA
| | - Pauline Wekesa
- Family Aids Care and Education Services (FACES), Kenya Medical Research Institute, Kisumu, Kenya
| | - Hideaki Okochi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Maricianah Onono
- Family Aids Care and Education Services (FACES), Kenya Medical Research Institute, Kisumu, Kenya
| | - Sheri Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sera L Young
- Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL, 60208, USA.
- Institute for Policy Research, Northwestern University, Evanston, IL, 60208, USA.
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20
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McDonough A, Weiser SD, Daniel A, Weke E, Wekesa P, Burger R, Sheira L, Bukusi EA, Cohen CR. "When I Eat Well, I Will Be Healthy, and the Child Will Also Be Healthy": Maternal Nutrition among HIV-Infected Women Enrolled in a Livelihood Intervention in Western Kenya. Curr Dev Nutr 2020; 4:nzaa032. [PMID: 32270133 PMCID: PMC7127924 DOI: 10.1093/cdn/nzaa032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Food insecurity remains a major obstacle to achieving health and well-being for individuals living with HIV in western Kenya. Studies have shown that pregnant women are vulnerable to experiencing food insecurity worldwide, with significant consequences for both maternal and child health. The Shamba Maisha cluster randomized controlled trial in western Kenya (which means "farming for life" in Swahili) tested the effects of a multisectoral livelihood intervention consisting of agricultural and finance trainings, farm inputs, and a loan on health and food security among 746 farmers living with HIV in Kisumu, Homa Bay, and Migori Counties. OBJECTIVES We conducted a qualitative substudy within the Shamba Maisha trial to understand the experiences and perspectives of pregnant women living with HIV enrolled in the trial. METHODS Thirty women who had experienced a pregnancy during the Shamba Maisha study period, comprising 20 women in the intervention arm and 10 women in the control arm, completed in-depth interviews using a semistructured interview guide. RESULTS Intervention participants interviewed noted improvements in maternal nutrition compared with previous pregnancies, which they attributed to the livelihood intervention. Key identified pathways to improved nutrition included improved access to vegetables, increased variety of diet through vegetable sales, and improved nutritional awareness. Women in the intervention arm also perceived increased weight gain compared with prior pregnancies and increased strength and energy throughout pregnancy. CONCLUSIONS Livelihood interventions represent a promising solution to alleviate food insecurity for pregnant women in order to improve maternal and child health outcomes.This trial was registered at clinicaltrials.gov as NCT02815579.
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Affiliation(s)
- Annie McDonough
- San Francisco School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Afkera Daniel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lila Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
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21
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Onono M, Odhiambo GO, Congo O, Waguma LW, Serem T, Owenga MA, Wekesa P. Narratives of Women Using a 24-Hour Ride-Hailing Transport System to Increase Access and Utilization of Maternal and Newborn Health Services in Rural Western Kenya: A Qualitative Study. Am J Trop Med Hyg 2020; 101:1000-1008. [PMID: 31549608 PMCID: PMC6838568 DOI: 10.4269/ajtmh.19-0132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Between 1990 and 2015, Kenya had a 0.9% annual reduction in maternal mortality, one of the lowest reductions globally. This slow decline was linked to the relatively low utilization of delivery services. We designed a mobile phone-enhanced 24-hour transport navigation system coupled with personalized and interactive gestation-based text messages (MAccess) to address maternal child health service utilization. The primary purpose of this analysis is to explore the ways in which pregnant and postnatal women made decisions regarding care-seeking for pregnancy and childbirth services, the processes of getting care from home to the hospital as well their perceptions on how the MAccess intervention affected their pregnancy and childbirth care-seeking and utilization experience. We conducted semistructured, individual interviews with 18 postpartum women. Participants were purposively sampled. Interviews were audiotaped, transcribed, and analyzed using thematic analysis. For participants in this study, all three delays interacted in a complex manner to affect women's utilization of pregnancy and childbirth services. Even though women were aware of the benefits of skilled birth attendance, other health system factors such as opening hours, or health workers' attitudes still deterred women from delivering in health facilities. The MAccess innovation was highly acceptable to women throughout pregnancy and childbirth and helped them navigate the complex and layered individual, infrastructural, and health system factors that put them at risk of adverse maternal and newborn outcomes. These findings emphasize that an integrated approach, which addresses all delays simultaneously, is important for reducing perinatal morbidity and mortality.
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Affiliation(s)
- Maricianah Onono
- Kenya Medical Research Institute, Center for Microbiology Research, Kar Geno Research and Policy Hub, Kisumu, Kenya
| | - Gladys Ombonya Odhiambo
- Kenya Medical Research Institute, Center for Microbiology Research, Kar Geno Research and Policy Hub, Kisumu, Kenya
| | - Ouma Congo
- Kenya Medical Research Institute, Center for Microbiology Research, Kar Geno Research and Policy Hub, Kisumu, Kenya
| | - Lawrence Wandei Waguma
- Kenya Medical Research Institute, Center for Microbiology Research, Kar Geno Research and Policy Hub, Kisumu, Kenya
| | - Titus Serem
- Kenya Medical Research Institute, Center for Microbiology Research, Kar Geno Research and Policy Hub, Kisumu, Kenya
| | - Mildred Anyango Owenga
- Kenya Medical Research Institute, Center for Microbiology Research, Kar Geno Research and Policy Hub, Kisumu, Kenya
| | - Pauline Wekesa
- Kenya Medical Research Institute, Center for Microbiology Research, Kar Geno Research and Policy Hub, Kisumu, Kenya
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22
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Wang M, Miller J, Collins S, Santoso M, Wekesa P, Onono M, Gandhi M, Young S. Increased Social Support Mitigates the Negative Impact of Food Insecurity on Antiretroviral Adherence Among Postpartum Women in Western Kenya (P04-126-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz051.p04-126-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Antiretroviral (ARV) adherence is a strong predictor of improved health outcomes and treatment effectiveness among persons living with HIV. Food insecurity and low social support are have been demonstrated to predict reported nonadherence among pregnant women, but the relationship has not been evaluated using an objective indicator of adherence. Therefore, we explored the impacts of social support and food insecurity on ARV adherence using ARV drug concentrations in hair among postpartum Kenyan women living with HIV.
Methods
Hair samples were collected from 83 HIV + women, a subset from an observational pregnancy cohort study (NCT02974972), on Efavirenz (n = 58) and Nevirapine (n = 25)-based ARVs at nine months postpartum. Hair ARV concentrations were log transformed to approximate a normal distribution. Food insecurity [Individual Food Insecurity Access Scale (IFIAS, 0–27)], social support (Perceived Social Support Scale, 0–40), and quality of life (Short Form 8 Health Survey, 0–40] were recalled for the prior month. These covariables, along with sociodemographic characteristics, were included in a multivariable linear regression model (P < 0.2) and eliminated using a backward stepwise approach (P < 0.1).
Results
Mean IFIAS score was 10.0 (± 5.2). Lower food insecurity and greater quality of life were significantly associated with higher hair ARV concentrations. Each point increase in IFIAS and decrease in quality of life was associated with a 13.4% decrease (95%CI: −0.23, −0.05) and 15.7% decrease (95%CI: 0.06, 0.23) in hair levels, respectively. Social support was not significantly associated with ARV adherence in bivariate analysis, but did buffer against the negative impacts of food insecurity on ARV adherence in the final multivariable model (Figure 1).
Conclusions
This study demonstrates that low food insecurity is significantly associated with higher ARV adherence among postpartum women using an objective biomarker, and that social support can buffer the negative effect of food insecurity on adherence. Interventions addressing these modifiable barriers to ARV adherence should be explored to improve adherence among HIV + postpartum women.
Funding Sources
The study was supported by the National Institute of Mental Health and the National Institute of Allergy and Infectious Diseases.
Supporting Tables, Images and/or Graphs
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Affiliation(s)
| | - Josh Miller
- Department of anthropology, Northwestern University
| | | | | | | | | | | | - Sera Young
- Department of Anthropology, Institute for Policy Research, Northwestern University
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Onono MA, Wahome S, Wekesa P, Adhu CK, Waguma LW, Serem T, Owenga MA, Ong'wen P. Effects of an expanded Uber-like transport system on access to and use of maternal and newborn health services: findings of a prospective cohort study in Homa Bay, Kenya. BMJ Glob Health 2019; 4:e001254. [PMID: 31179030 PMCID: PMC6528775 DOI: 10.1136/bmjgh-2018-001254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/13/2019] [Accepted: 04/19/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Kenya's progress towards reducing maternal and neonatal deaths is at present 'insufficient'. These deaths could be prevented if the three delays, that is, in deciding to seek healthcare (delay 1), in accessing formal healthcare (delay 2) and in receiving quality healthcare (delay 3), are comprehensively addressed. We designed a mobile phone enhanced 24 hours Uber-like transport navigation system coupled with personalised and interactive gestation-based text messages to address these delays. Our main objective was to evaluate the impact of this intervention on women's adherence to recommended antenatal (ANC) and postnatal care (PNC) regimes and facility birth. METHODS We conducted a prospective cohort study. Women were eligible to participate in the study if they were 15 years or older and less than 28 weeks gestation. We defined cases as those who received the standard of care plus the intervention and the control group as those who received the standard of care only. For analysis, we used logistic regression analysis and report crude and adjusted OR (aOR) and 95 % CI. RESULTS Cases (women who received the intervention) had five times higher odds of having four or more ANC visits (aOR=4.7, 95% CI 3.20 to 7.09), three times higher odds of taking between 30 and 60 min to reach a health facility for delivery (aOR=3.14, 95% CI 2.37 to 4.15) and four times higher odds of undergoing at least four PNC visits (aOR=4.10, 95% CI 3.11 to 5.36). CONCLUSION An enhanced community-based Uber-like transport navigation system coupled with personalised and interactive gestation-based text messages significantly increased the utilisation of ANC and PNC services as well as shortened the time taken to reach an appropriate facility for delivery compared with standard care.
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Affiliation(s)
- Maricianah Atieno Onono
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Samuel Wahome
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline Wekesa
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Catherine Kidiga Adhu
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lawrence Wandei Waguma
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Titus Serem
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Mildred Anyango Owenga
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
| | - Patricia Ong'wen
- Center for Microbiology Research—Kar Geno Research and Policy Hub, Kenya Medical Research Institute, Kisumu, Kenya
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Mmeje O, Njoroge B, Wekesa P, Murage A, Ondondo RO, van der Poel S, Guzé MA, Shade SB, Bukusi EA, Cohan D, Cohen CR. Empowering HIV-infected women in low-resource settings: A pilot study evaluating a patient-centered HIV prevention strategy for reproduction in Kisumu, Kenya. PLoS One 2019; 14:e0212656. [PMID: 30840672 PMCID: PMC6402674 DOI: 10.1371/journal.pone.0212656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 02/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Female positive/male negative HIV-serodiscordant couples express a desire for children and may engage in condomless sex to become pregnant. Current guidelines recommend antiretroviral treatment in HIV-serodiscordant couples, yet HIV RNA viral suppression may not be routinely assessed or guaranteed and pre-exposure prophylaxis may not be readily available. Therefore, options for becoming pregnant while limiting HIV transmission should be offered and accessible to HIV-affected couples desiring children. METHODS A prospective pilot study of female positive/male negative HIV-serodiscordant couples desiring children was conducted to evaluate the acceptability, feasibility, and effectiveness of timed vaginal insemination. Eligible women were 18-34 years with regular menses. Prior to timed vaginal insemination, couples were observed for two months, and tested and treated for sexually transmitted infections. Timed vaginal insemination was performed for up to six menstrual cycles. A fertility evaluation and HIV RNA viral load assessment was offered to couples who did not become pregnant. FINDINGS Forty female positive/male negative HIV-serodiscordant couples were enrolled; 17 (42.5%) exited prior to timed vaginal insemination. Twenty-three couples (57.5%) were introduced to timed vaginal insemination; eight (34.8%) achieved pregnancy, and six live births resulted without a case of HIV transmission. Seven couples completed a fertility evaluation. Four women had no demonstrable tubal patency bilaterally; one male partner had decreased sperm motility. Five women had unilateral/bilateral tubal patency; and seven women had an HIV RNA viral load (≥ 400 copies/mL). CONCLUSION Timed vaginal insemination is an acceptable, feasible, and effective method for attempting pregnancy. Given the desire for children and inadequate viral suppression, interventions to support safely becoming pregnant should be integrated into HIV prevention programs.
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Affiliation(s)
- Okeoma Mmeje
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Betty Njoroge
- Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research, Nairobi, Kenya
| | - Pauline Wekesa
- Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research, Nairobi, Kenya.,Research Care and Treatment Program (RCTP)-Family AIDS Care & Education Services (FACES), Kisumu, Kenya
| | - Alfred Murage
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Raphael O Ondondo
- Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research, Nairobi, Kenya.,Research Care and Treatment Program (RCTP)-Family AIDS Care & Education Services (FACES), Kisumu, Kenya.,Masinde Muliro University of Science and Technology (MMUST), Kakamega, Kenya
| | - Sheryl van der Poel
- WHO/HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Geneva, Switzerland
| | - Mary A Guzé
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Starley B Shade
- Department of Medicine, Division of Prevention Services, University of California, San Francisco, San Francisco, CA, United States of America
| | - Elizabeth A Bukusi
- Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research, Nairobi, Kenya.,Research Care and Treatment Program (RCTP)-Family AIDS Care & Education Services (FACES), Kisumu, Kenya
| | - Deborah Cohan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States of America.,Research Care and Treatment Program (RCTP)-Family AIDS Care & Education Services (FACES), Kisumu, Kenya
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25
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Collins SM, Mbullo Owuor P, Miller JD, Boateng GO, Wekesa P, Onono M, Young SL. 'I know how stressful it is to lack water!' Exploring the lived experiences of household water insecurity among pregnant and postpartum women in western Kenya. Glob Public Health 2018; 14:649-662. [PMID: 30231793 DOI: 10.1080/17441692.2018.1521861] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
There is rapidly evolving literature on water insecurity in the general adult population, but the role of water insecurity during the vulnerable periods of pregnancy and postpartum, or in the context of HIV, has been largely overlooked. Therefore, we conducted an exploratory study, using Go Along interviews, photo-elicitation interviews, and pile sorts with 40 pregnant and postpartum Kenyan women living in an area of high HIV prevalence. We sought to (1) describe their lived experiences of water acquisition, prioritisation, and use and (2) explore the consequences of water insecurity. The results suggest that water insecurity is particularly acute in this period, and impacts women in far-reaching and unexpected ways. We propose a broader conceptualisation of water insecurity to include consideration of the consequences of water insecurity for maternal and infant psychosocial and physical health, nutrition, and economic well-being.
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Affiliation(s)
- Shalean M Collins
- a Department of Anthropology , Northwestern University , Evanston , IL , USA
| | | | - Joshua D Miller
- a Department of Anthropology , Northwestern University , Evanston , IL , USA
| | - Godfred O Boateng
- a Department of Anthropology , Northwestern University , Evanston , IL , USA
| | | | | | - Sera L Young
- a Department of Anthropology , Northwestern University , Evanston , IL , USA.,c Institute for Policy Research , Northwestern University , Evanston , IL , USA
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26
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Widen EM, Tsai I, Collins SM, Wekesa P, China J, Krumdieck N, Miller JD, Weiser SD, Onono M, Young SL. HIV infection and increased food insecurity are associated with adverse body composition changes among pregnant and lactating Kenyan women. Eur J Clin Nutr 2018; 73:474-482. [PMID: 30185898 DOI: 10.1038/s41430-018-0285-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Body composition changes markedly during reproduction. In sub-Saharan Africa, impacts of HIV infection on body composition across pregnancy and lactation in the context of Option B+ antiretroviral therapy are unknown. Therefore, we sought to evaluate the role of HIV infection on body composition during pregnancy and lactation among Kenyan women. SUBJECTS/METHODS A cohort of pregnant women (n = 333; 50.5% HIV+, receiving ART) were enrolled at seven clinics in western Kenya. Two prenatal (mean ± SD: 23.6 ± 4.4 and 33.4 ± 2.0 weeks gestation) and three postpartum (6, 14, and 36 weeks) measurements included: individual-level food insecurity, height, weight, fat mass (FM), and fat-free mass (FFM) by bioimpedance analysis (BIA), mid-upper arm circumference (MUAC), and triceps skinfold (TSF), allowing for AMA (arm muscle area) and AFA (arm fat area) derivation. Multivariable longitudinal regression models were used to relate HIV to body composition changes. RESULTS In longitudinal models, HIV-infected women had lower weight (ß = -3.0 kg, p = 0.003), fat mass (ß = -1.5 kg, p = 0.02), fat-free mass (ß = -1.5 kg, p = 0.01), TSF (ß = -2.6 mm, p < 0.001), AFA (ß = -3.9 cm3, p < 0.001), and MUAC (ß = -1.0 cm, p = 0.001), but not AMA (p = 0.34), across all observations. Food insecurity was inversely associated with AMA and MUAC postpartum (AMA ß-range = -0.47 to -0.92 cm3; MUAC ß-range = -0.09 to -0.15 cm, all p < 0.05). CONCLUSIONS HIV infection was associated with lower weight, fat mass, fat-free mass, TSF, AFA, and MUAC values during pregnancy and lactation, while food insecurity was intermittently associated with body composition. This suggests that pregnant and lactating women living with HIV and food insecurity could benefit from nutritional support.
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Affiliation(s)
- Elizabeth M Widen
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Irene Tsai
- School of General Studies, Columbia University, New York, NY, USA
| | - Shalean M Collins
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | | | - Joy China
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Joshua D Miller
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Sheri D Weiser
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA. .,Institute for Policy Research, Northwestern University, Evanston, IL, USA.
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27
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Boateng GO, Collins SM, Mbullo P, Wekesa P, Onono M, Neilands TB, Young SL. A novel household water insecurity scale: Procedures and psychometric analysis among postpartum women in western Kenya. PLoS One 2018; 13:e0198591. [PMID: 29883462 PMCID: PMC5993289 DOI: 10.1371/journal.pone.0198591] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/22/2018] [Indexed: 11/18/2022] Open
Abstract
Our ability to measure household-level food insecurity has revealed its critical role in a range of physical, psychosocial, and health outcomes. Currently, there is no analogous, standardized instrument for quantifying household-level water insecurity, which prevents us from understanding both its prevalence and consequences. Therefore, our objectives were to develop and validate a household water insecurity scale appropriate for use in our cohort in western Kenya. We used a range of qualitative techniques to develop a preliminary set of 29 household water insecurity questions and administered those questions at 15 and 18 months postpartum, concurrent with a suite of other survey modules. These data were complemented by data on quantity of water used and stored, and microbiological quality. Inter-item and item-total correlations were performed to reduce scale items to 20. Exploratory factor and parallel analyses were used to determine the latent factor structure; a unidimensional scale was hypothesized and tested using confirmatory factor and bifactor analyses, along with multiple statistical fit indices. Reliability was assessed using Cronbach’s alpha and the coefficient of stability, which produced a coefficient alpha of 0.97 at 15 and 18 months postpartum and a coefficient of stability of 0.62. Predictive, convergent and discriminant validity of the final household water insecurity scale were supported based on relationships with food insecurity, perceived stress, per capita household water use, and time and money spent acquiring water. The resultant scale is a valid and reliable instrument. It can be used in this setting to test a range of hypotheses about the role of household water insecurity in numerous physical and psychosocial health outcomes, to identify the households most vulnerable to water insecurity, and to evaluate the effects of water-related interventions. To extend its applicability, we encourage efforts to develop a cross-culturally valid scale using robust qualitative and quantitative techniques.
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Affiliation(s)
- Godfred O. Boateng
- Department of Anthropology, Northwestern University, Evanston, Illinois, United States of America
| | - Shalean M. Collins
- Department of Anthropology, Northwestern University, Evanston, Illinois, United States of America
| | - Patrick Mbullo
- Department of Anthropology, Northwestern University, Evanston, Illinois, United States of America
| | | | | | - Torsten B. Neilands
- Department of Medicine, Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Sera L. Young
- Department of Anthropology, Northwestern University, Evanston, Illinois, United States of America
- Institute for Policy Research, Northwestern University, Evanston, Illinois, United States of America
- * E-mail:
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Dumas SE, Maranga A, Mbullo P, Collins S, Wekesa P, Onono M, Young SL. "Men Are in Front at Eating Time, but Not When It Comes to Rearing the Chicken": Unpacking the Gendered Benefits and Costs of Livestock Ownership in Kenya. Food Nutr Bull 2017; 39:3-27. [PMID: 29226708 DOI: 10.1177/0379572117737428] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Livestock can promote resilience in low-income communities through a number of pathways. Livestock development programs seek to amplify these benefits but often fail to consider the costs to intended beneficiaries or the effect of prevailing gender norms. OBJECTIVE To explore perceptions of livestock ownership among female smallholder livestock keepers in Nyanza Region, Kenya, and unpack how the distribution of livestock benefits and investments varies by gender within households. METHODS We used multiple ethnographic techniques, including Photovoice, a photo-elicitation interview method, focus group discussions, and pile sorts, with female smallholder livestock owners (n = 18) participating in an ongoing cohort study. Transcripts were coded using a combination of a priori constructs and grounded theory. RESULTS We found that livestock benefited households by providing financial security, food security, social benefits, and human time and labor savings. However, these benefits largely promoted long-term household resilience rather than immediate gains. Livestock ownership also had major costs to household time and labor, which were overwhelmingly borne by women and children. Despite this investment, women had limited livestock ownership rights, decision-making power, control over income, or access to meat. CONCLUSIONS Our findings suggest that livestock ownership requires significant investments of household time and labor, which disproportionately burden women. Prevailing gender inequalities may therefore constrain the net benefit of livestock ownership for many women and their households in some contexts. Livestock development programs must assess both program benefits and costs at multiple levels to ensure that women's participation in livestock production leads to improved individual and household outcomes.
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Affiliation(s)
- Sarah E Dumas
- 1 Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Abena Maranga
- 2 College of Arts and Sciences, Cornell University, Ithaca, NY, USA
| | - Patrick Mbullo
- 3 Kenya Medical Research Institute (KEMRI), Center for Microbiology Research, Nairobi, Kenya
| | - Shalean Collins
- 4 Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.,5 Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Pauline Wekesa
- 3 Kenya Medical Research Institute (KEMRI), Center for Microbiology Research, Nairobi, Kenya
| | - Maricianah Onono
- 3 Kenya Medical Research Institute (KEMRI), Center for Microbiology Research, Nairobi, Kenya
| | - Sera L Young
- 4 Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.,5 Department of Anthropology, Northwestern University, Evanston, IL, USA
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Miller J, Fiorella K, Wekesa P, Boateng G, Collins S, Young S. An inquiry into a recent paper on pica in western Kenya. NFS Journal 2017. [DOI: 10.1016/j.nfs.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Krumdieck NR, Collins SM, Wekesa P, Mbullo P, Boateng GO, Onono M, Young SL. Household water insecurity is associated with a range of negative consequences among pregnant Kenyan women of mixed HIV status. J Water Health 2016; 14:1028-1031. [PMID: 27959881 PMCID: PMC5210218 DOI: 10.2166/wh.2016.079] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Water insecurity (WI) is a serious and worsening problem worldwide, but its role in health outcomes among people living with HIV or pregnant women is unknown. We assessed experiences of WI in a cohort of 323 pregnant Kenyan women of mixed HIV status. The majority (77.7%) had at least one experience of WI in the previous month; it was associated with negative economic, nutrition, disease, and psychosocial outcomes. A standardized cross-culturally valid household WI scale would facilitate assessment of the prevalence and consequences of WI, and increased attention to WI could reveal an overlooked, but modifiable, cause of adverse HIV outcomes.
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Affiliation(s)
| | - Shalean M Collins
- Program in International Nutrition, Cornell University, Ithaca, NY 14853, USA and Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853, USA E-mail:
| | - Pauline Wekesa
- Kenya Medical Research Institute, Centre for Microbiology Research, Mbagathi Road, Nairobi, Kenya
| | - Patrick Mbullo
- Kenya Medical Research Institute, Centre for Microbiology Research, Mbagathi Road, Nairobi, Kenya
| | - Godfred O Boateng
- Program in International Nutrition, Cornell University, Ithaca, NY 14853, USA and Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853, USA E-mail:
| | - Maricianah Onono
- Kenya Medical Research Institute, Centre for Microbiology Research, Mbagathi Road, Nairobi, Kenya
| | - Sera L Young
- Program in International Nutrition, Cornell University, Ithaca, NY 14853, USA and Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853, USA E-mail: ; Department of Anthropology, Northwestern University, Evanston, IL 60208, USA
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Mmeje O, Njoroge B, Wekesa P, Guzé MA, Shade S, Cohen CR. P17.31 Timed vaginal insemination as a safer conception method for hiv-serodiscordant couples in kisumu, kenya. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Onono M, Blat C, Miles S, Steinfeld R, Wekesa P, Bukusi EA, Owuor K, Grossman D, Cohen CR, Newmann SJ. Impact of family planning health talks by lay health workers on contraceptive knowledge and attitudes among HIV-infected patients in rural Kenya. Patient Educ Couns 2014; 94:438-41. [PMID: 24316053 PMCID: PMC4530318 DOI: 10.1016/j.pec.2013.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 11/13/2013] [Accepted: 11/19/2013] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To determine if a health talk on family planning (FP) by community clinic health assistants (CCHAs) will improve knowledge, attitudes and behavioral intentions about contraception in HIV-infected individuals. METHODS A 15-min FP health talk was given by CCHAs in six rural HIV clinics to a sample of 49 HIV-infected men and women. Effects of the health talk were assessed through a questionnaire administered before the health talk and after completion of the participant's clinic visit. RESULTS Following the health talk, there was a significant increase in knowledge about contraceptives (p<.0001), side-effects (p<.0001), and method-specific knowledge about IUCDs (p<.001), implants (p<.0001), and injectables (p<.05). Out of 31 women and 18 men enrolled, 14 (45%) women and 6 (33%) men intended to try a new contraceptive. Participant attitudes toward FP were high before and after the health talk (median 4 of 4). CONCLUSION A health talk delivered by CCHAs can increase knowledge of contraception and promote the intention to try new more effective contraception among HIV-infected individuals. PRACTICE IMPLICATIONS FP health talks administered by lay-health providers to HIV-infected individuals as they wait for HIV services can influence FP knowledge and intention to use FP.
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Affiliation(s)
- Maricianah Onono
- Kenya Medical Research Institute (KEMRI), Family Aids Care and Education Services (FACES), Kisumu, Kenya.
| | - Cinthia Blat
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Sondra Miles
- Department of Internal Medicine, University of California, San Francisco, USA
| | - Rachel Steinfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Pauline Wekesa
- Kenya Medical Research Institute (KEMRI), Family Aids Care and Education Services (FACES), Kisumu, Kenya
| | - Elizabeth A Bukusi
- Kenya Medical Research Institute (KEMRI), Family Aids Care and Education Services (FACES), Kisumu, Kenya
| | - Kevin Owuor
- Kenya Medical Research Institute (KEMRI), Family Aids Care and Education Services (FACES), Kisumu, Kenya
| | - Daniel Grossman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA; Ibis Reproductive Health, Oakland, CA, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Sara J Newmann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
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