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Blake CE, Monterrosa EC, Rampalli KK, Khan ANS, Reyes LI, Drew SD, Dominguez-Salas P, Bukachi SA, Ngutu M, Frongillo EA, Iruhiriye E, Girard AW. Basic human values drive food choice decision-making in different food environments of Kenya and Tanzania. Appetite 2023; 188:106620. [PMID: 37271253 PMCID: PMC10423943 DOI: 10.1016/j.appet.2023.106620] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
Increased access to a variety of foods in low-and-middle-income countries (LMICs) has led to greater autonomy in food choice decision-making. Autonomy allows individuals to make decisions through negotiation of considerations in ways that are consistent with basic values. The aim of this study was to identify and describe how basic human values drive food choice in two diverse populations with transitioning food environments living in the neighboring East African countries of Kenya and Tanzania. Secondary data analysis was carried out on focus group discussions conducted with men and women in Kenya (n = 28) and Tanzania (n = 28) as part of prior studies on food choice. A priori coding based on Schwartz's theory of basic human values was conducted, followed by a narrative comparative analysis, which included review by original principal investigators. Values of conservation (security, conformity, tradition), openness to change (self-directed thought and action, stimulation, indulgence), self-enhancement (achievement, power, face), and self-transcendence (benevolence-dependability and -caring) were prominent drivers of food choice in both settings. Participants described how values were negotiated and highlighted existing tensions. For example, the value of tradition was cited as important in both settings but changing food contexts (e.g., new foods, diverse neighborhoods) increased prioritization of values like stimulation, indulgence, and self-directed thought and action. The application of a basic values framework was useful for understanding food choice in both settings. A focused understanding of how values drive food choice decision-making in the context of changing food availability in LMICs is essential for the promotion of sustainable healthy diets.
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Affiliation(s)
- Christine E Blake
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Eva C Monterrosa
- Global Alliance for Improved Nutrition, Rue de Varembé 7, 1202, Geneva, Switzerland.
| | - Krystal K Rampalli
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | | | - Ligia I Reyes
- Cornell University, Division of Nutritional Sciences, Ithaca, NY, 14853, USA.
| | - Shiny Deepika Drew
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Paula Dominguez-Salas
- Natural Resources Institute, University of Greenwich, London, UK; International Livestock Research Institute, Nairobi, Kenya.
| | - Salome A Bukachi
- Institute of Anthropology, Gender and African Studies (IAGAS), University of Nairobi, Kenya.
| | - Mariah Ngutu
- Institute of Anthropology, Gender and African Studies (IAGAS), University of Nairobi, Kenya.
| | - Edward A Frongillo
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Elyse Iruhiriye
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Amy Webb Girard
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Isanovic S, Constantinides SV, Frongillo EA, Bhandari S, Samin S, Kenney E, Wertheim-Heck S, Nordhagen S, Holdsworth M, Dominguez-Salas P, Ambikapathi R, Laar A, Patil CL, Kulkarni B, Bukachi SA, Ngutu M, Blake CE. How Perspectives on Food Safety of Vendors and Consumers Translate into Food-Choice Behaviors in 6 African and Asian Countries. Curr Dev Nutr 2023; 7:100015. [PMID: 37181131 PMCID: PMC10100931 DOI: 10.1016/j.cdnut.2022.100015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/30/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Consumption of unsafe foods increases morbidity and mortality and is currently an issue, particularly in low- and middle-income countries. Policy actions to ensure food safety are dominated by mitigation of biological and chemical hazards through supply-side risk management, lessening the degree to which consumer perspectives of food safety are considered. Objectives This study aimed to provide an in-depth understanding, from vendor and consumer perspectives, of how food-safety concerns of consumers translate into their subsequent food-choice behaviors in 6 diverse low- and middle-income countries. Methods Six Drivers of Food Choice projects (2016-2022) provided transcripts from 17 focus group discussions and 343 interviews conducted in Ghana, Guinea, India, Kenya, Tanzania, and Vietnam. Qualitative thematic analysis was used to identify emerging themes important to food safety. Results The analysis suggests that consumers constructed meaning about food safety through personal lived experience and social influences. Community and family members contributed knowledge about food safety. Concerns about food safety were influenced by reputations of and relationships with food vendors. Consumers' mistrust of food vendors was amplified by purposeful adulteration or unsafe selling practices and new methods used to produce food. Moreover, consumers were reassured of food safety by positive relationships with vendors; meals cooked at home; implementation of policies and following regulations; vendor adherence to environmental sanitation and food-hygiene practices; cleanliness of vendors' appearance; and vendors' or producers' agency to use risk mitigation strategies in production, processing, and distribution of food. Conclusions Consumers integrated their meanings, knowledge, and concerns about food safety to achieve assurance about the safety of their foods when making food-choice decisions. The success of food-safety policies hinges on consideration of consumers' food-safety concerns in their design and implementation, alongside actions to reduce risk in food supply.
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Affiliation(s)
- Sejla Isanovic
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shilpa V. Constantinides
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shiva Bhandari
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sharraf Samin
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Emma Kenney
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sigrid Wertheim-Heck
- Environmental Policy Group, Department of Social Sciences, Wageningen University, Wageningen, the Netherlands
| | | | - Michelle Holdsworth
- Montpellier Interdisciplinary Center on Sustainable Agri-food Systems, University of Montpellier, French Agricultural Research Centre for International Development, International Center for Advanced Mediterranean Agronomic Studies, Mediterranean Agronomic Institute of Montpellier, French National Institute for Agricultural Research, Institut Agro, French National Research Institute for Sustainable Development, Montpellier, France
| | - Paula Dominguez-Salas
- Natural Resources Institute, University of Greenwich, London, United Kingdom
- International Livestock Research Institute, Nairobi, Kenya
| | - Ramya Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, USA
- Department of Global Development, Cornell University, Ithaca, NY, USA
| | - Amos Laar
- University of Ghana, Department of Population, Family and Reproductive Health, School of Public Health, Accra, Ghana
| | - Crystal L. Patil
- Department of Human Development Nursing Science, University of Illinois–Chicago, Chicago, IL, USA
| | - Bharati Kulkarni
- Division of Reproductive Biology, Maternal and Child Health and Nutrition, Indian Council of Medical Research, V. Ramalingaswami Bhawan, New Delhi, India
| | - Salome A. Bukachi
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Mariah Ngutu
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Christine E. Blake
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Bukachi SA, Ngutu M, Muthiru AW, Lépine A, Kadiyala S, Domínguez-Salas P. Gender and sociocultural factors in animal source foods (ASFs) access and consumption in lower-income households in urban informal settings of Nairobi, Kenya. J Health Popul Nutr 2022; 41:30. [PMID: 35818082 PMCID: PMC9275060 DOI: 10.1186/s41043-022-00307-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background Gender shapes household decision-making and access for nutritious diets, including animal source foods (ASFs) that impact on child health and nutrition status. However, research shows that the poorest households in the urban informal settlements of Nairobi have low ASFs consumption. This study was conducted to explore further from a qualitative perspective the gender, sociocultural factors affecting household ASF consumption this study. Methods To explore further on the topic of study, an exploratory qualitative study was carried out to establish the factors that influence access, allocation and consumption of animal source foods (ASFs) by households in urban informal settings of Nairobi. Nineteen focus group discussions with men and women were conducted to enable in-depth exploration of ASFs consumption. Results Gender influences decision-making of household ASFs dietary intake. Gendered power dynamics prevail with men as breadwinners and household heads often determining the food access and consumption of ASFs. Women are increasingly accessing short-term waged-based incomes in urban informal settings and now play a role in food and nutrition security for their households. This enforces the idea that women’s decision-making autonomy is an important aspect of women empowerment, as it relates to women’s dietary diversity and subsequently, better household nutritional status. As evidenced in this study, if a woman has bargaining power based on accessing incomes to support their household food needs, she will not jeopardize food security. The mobile digital money platform was key in enabling access to resources to access food. Use of trust to access food on credit and purchasing smaller packaged quantities of food were also enablers to access of food/ASFs.
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Ogolla KO, Chemuliti JK, Ngutu M, Kimani WW, Anyona DN, Nyamongo IK, Bukachi SA. Women’s empowerment and intra-household gender dynamics and practices around sheep and goat production in South East Kenya. PLoS One 2022; 17:e0269243. [PMID: 35925935 PMCID: PMC9352016 DOI: 10.1371/journal.pone.0269243] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Small ruminant production facets like decision-making, ownership, labour allocation, access to- and control over assets are gendered. This study investigates intra-household gender dynamics and practices around sheep and goat production among smallholder farmers in South East region of Kenya. A quantitative study was conducted on 358 dual-headed (married) households to generate gender-disaggregated data on ownership, decision-making and labour allocation around small ruminant production. Qualitative data was collected through focused group discussions to bring out the community perspectives. From the findings, the average number of small ruminants owned by the households as reported by men was slightly higher than women. The average number of small ruminants solely owned by men was significantly higher than by women. Men reported a relatively higher number of jointly owned small ruminants compared to women. More women than men reported that they could give as a gift, sell-off and slaughter jointly owned small ruminants without consulting their spouses. Small ruminants were considered the most important livestock asset in supporting a household’s livelihood by relatively more women than men. Men had more decision-making autonomy over jointly owned small ruminants compared to women. Production tasks around small ruminants such as feeding, watering, selling milk and cleaning housing structures were mostly performed by the women. Qualitative data identified men as the de facto owners of small ruminants with a higher power position in making the important production decisions. The study offers three implications on the design of livestock interventions to empower women, the interventions should ensure that; 1) women are not just owners of livestock assets but also share power and decision-making rights in all aspects of production, 2) production labour is shared equitably between men and women and, 3) women access benefits from livestock production even when animals are owned by men.
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Affiliation(s)
- Kennedy O. Ogolla
- Biotechnology Research Institute, The Kenya Agricultural Livestock Research Organization, Kikuyu, Kenya
- * E-mail:
| | - Judith K. Chemuliti
- Biotechnology Research Institute, The Kenya Agricultural Livestock Research Organization, Kikuyu, Kenya
| | - Mariah Ngutu
- Department of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Winnie W. Kimani
- Biotechnology Research Institute, The Kenya Agricultural Livestock Research Organization, Kikuyu, Kenya
| | - Douglas N. Anyona
- Department of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | | | - Salome A. Bukachi
- Department of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
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Drew S, Blake C, Monterrosa E, Rampalli K, Khan ANS, Reyes L, Bukachi S, Ngutu M, Frongillo E, Iruhiriye E, Girard A, Dominguez-Salas P. How Schwartz’ Basic Human Values Influence Food Choices in Kenya and Tanzania. Curr Dev Nutr 2022. [PMCID: PMC9193813 DOI: 10.1093/cdn/nzac059.007] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To identify and describe how values drive food choice of vulnerable consumers in two East African countries, Kenya and Tanzania. Methods Secondary data analysis was conducted on focus group discussions from studies in Kenya and Tanzania. A codebook was developed based on Schwartz's theory of basic human values. A priori coding was conducted in NVivo 12 followed by a narrative comparative analysis, which included review by original principal investigators. Results Values of conservation (security, conformity, tradition), openness to change (self-directed thought and action, stimulation, indulgence), self-enhancement (achievement, power, face), and self-transcendence (benevolence dependability and caring) were prominent drivers of food choice in both settings. While tradition was an important value in food choice, new social situations and food environments rendered reprioritization, especially pertaining to youth and animal source foods. Openness to change values were readily cited, especially in peri-urban Kenya with many new foods and diverse neighborhoods. Values of independent thought and action were drivers of mothers’ food choices for families. Benevolence security and caring were drivers choices for child feeding and selecting trustworthy food vendors. Many participants described how values existed in tension. For example, changes in livelihood led to a reprioritization of values like stimulation or indulgence over tradition. Conclusions Values were important drivers of food choice in both settings, particularly for meat. Future efforts to promote healthy, sustainable diets will require policy and broad consumer support to succeed. Examining the values that drive food choice in different contexts is necessary especially to minimize unintended consequences, controversy, and perhaps opposition in the implementation of policies and programs. Funding Sources UK Government's Foreign, Commonwealth, and Development Office and the Bill & Melinda Gates Foundation; the views expressed do not necessarily reflect the UK Government's official policies.
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Bukachi SA, Ngutu M, Muthiru AW, Lépine A, Kadiyala S, Domínguez-Salas P. Consumer perceptions of food safety in animal source foods choice and consumption in Nairobi's informal settlements. BMC Nutr 2021; 7:35. [PMID: 34261518 PMCID: PMC8281509 DOI: 10.1186/s40795-021-00441-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background Animal-source foods (ASFs) are high-quality nutrient-dense products key to reducing stunting and micronutrient deficiencies. However, their consumption among the poorest households in urban informal settlements is low. Several drivers beyond price, including health considerations have been reported to drive ASF choice and consumption among consumers. This current study explores consumer perceptions of food safety associated with animal source foods (ASFs) consumption in urban informal settlements with a view to unpacking the health considerations driving their choice and consumption. Methods Coupled households with children 6–59 months formed the study sample. The Food Environments Working Group (FEWG) Framework of the Agriculture and Nutrition for Health academy (ANH) was used to guide the study which utilized qualitative methods namely, 60 in-depth interviews (IDIs), 19 focus group discussions, and 19 key informant interviews (KIIs) complemented by unstructured observations. Data were transcribed and analysed according to emerging themes. Results Consumer perceptions of food safety are driven by concerns about food production, processing, handling, storage and the health risks associated with consumption of the ASFs. For all the ASFs, lack of traceability of source, unhygienic environments in which they were sold and health risks around consuming too much or improperly cooked products were key perceptions from the community. To mitigate against food safety risks, consumers used strategies such as boiling the ASFs, purchasing their products from trusted retailers, avoiding vendors in unhygienic environments and reducing the amount and frequency of consumption of ASFs or totally avoiding their consumption. These consumer perceptions are increasingly influencing the ASFs choice and consumption in low-income populations besides other drivers. Notably, given limited incomes that influence their purchasing power and the need for nutritious diets that included ASFs, the dilemma of quality vis-a-vis quantity persists and consumers still accessed and consumed these ASF products to supplement their diets. Conclusions To enhance food safety for ASFs, as well as assure consumer access to safe ASFs from informal markets, there is need to contextualize the value chain as informed by consumer perceptions on food safety as these influence their ASFs choice and consumption.
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Affiliation(s)
- Salome A Bukachi
- Institute of Anthropology, Gender and African Studies, University of Nairobi (UoN), Nairobi, Kenya.
| | - Mariah Ngutu
- Institute of Anthropology, Gender and African Studies, University of Nairobi (UoN), Nairobi, Kenya
| | - Ann W Muthiru
- Institute of Anthropology, Gender and African Studies, University of Nairobi (UoN), Nairobi, Kenya
| | - Aurélia Lépine
- Institute for Global Health, University College London (UCL), London, UK
| | | | - Paula Domínguez-Salas
- International Livestock Research Institute (ILRI), Nairobi, Kenya.,Natural Resources Institute, University of Greenwich, London, UK
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Ngure K, Vusha S, Mugo N, Emmanuel-Fabula M, Ngutu M, Celum C, Baeten JM, Heffron R. "I never thought that it would happen … " Experiences of HIV seroconverters among HIV-discordant partnerships in a prospective HIV prevention study in Kenya. AIDS Care 2016; 28:1586-1589. [PMID: 27264119 DOI: 10.1080/09540121.2016.1191610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 10/21/2022]
Abstract
In spite of access to behavioral and biomedical HIV prevention strategies, HIV transmission occurs. For HIV-serodiscordant couples, prevention programs can be tailored to address individual and couples' needs to preserve their relationship while minimizing HIV risk. Programs for serodiscordant couples may benefit from learning from experiences of couples who transmit HIV. We conducted 20 individual in-depth interviews with 10 initially HIV-serodiscordant couples who transmitted HIV during prospective follow-up at a peri-urban research site in Thika, Kenya. Data were analyzed inductively to identify situations that led to prevention failure and coping mechanisms. Inconsistent condom use driven by low HIV risk perception and alcohol use often preceded seroconversion while persistent blame frequently hindered couples' communication soon after seroconversion. In this emerging era of antiretroviral-based HIV prevention, couples' counseling can capitalize on opportunities to foster a supportive environment to discuss initiation and adherence to time-limited pre-exposure prophylaxis and lifelong antiretroviral therapy, in addition to strategies to reduce alcohol use, diffuse blame, and use condoms.
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Affiliation(s)
- Kenneth Ngure
- a School of Public Health , Jomo Kenyatta University of Agriculture and Technology , Juja , Kenya.,b Department of Global Health , University of Washington , Seattle , WA , USA
| | - Sophie Vusha
- c Partners in Health Research and Development , Nairobi , Kenya
| | - Nelly Mugo
- b Department of Global Health , University of Washington , Seattle , WA , USA.,d Center for Clinical Research , Kenya Medical Research Institute , Nairobi , Kenya
| | | | - Mariah Ngutu
- c Partners in Health Research and Development , Nairobi , Kenya
| | - Connie Celum
- b Department of Global Health , University of Washington , Seattle , WA , USA.,e Department of Epidemiology , University of Washington , Seattle , WA , USA.,f Department of Medicine , University of Washington , Seattle , WA , USA
| | - Jared M Baeten
- b Department of Global Health , University of Washington , Seattle , WA , USA.,e Department of Epidemiology , University of Washington , Seattle , WA , USA.,f Department of Medicine , University of Washington , Seattle , WA , USA
| | - Renee Heffron
- b Department of Global Health , University of Washington , Seattle , WA , USA.,c Partners in Health Research and Development , Nairobi , Kenya
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Ngure K, Heffron R, Curran K, Vusha S, Ngutu M, Mugo N, Celum C, Baeten JM. I Knew I Would Be Safer. Experiences of Kenyan HIV Serodiscordant Couples Soon After Pre-Exposure Prophylaxis (PrEP) Initiation. AIDS Patient Care STDS 2016; 30:78-83. [PMID: 26836236 DOI: 10.1089/apc.2015.0259] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) for HIV-uninfected persons is highly efficacious for HIV prevention. Understanding how people at risk for HIV will use PrEP is important to inform PrEP scale-up and implementation. We used qualitative methods to gather insights into couples' early experiences with PrEP use within the Partners Demonstration Project, an open-label implementation study evaluating integrated delivery of PrEP and antiretroviral therapy (ART). PrEP is offered to HIV uninfected partners until the HIV-infected partner initiates and sustains ART use (i.e., PrEP as a "bridge" to ART initiation and viral suppression). From August 2013 to March 2014 we conducted 20 in-depth dyadic interviews (n = 40) with heterosexual HIV serodiscordant couples participating at the Thika, Kenya study site, exploring how couples make decisions about using PrEP for HIV prevention. We developed and applied deductive and inductive codes to identify key themes related to experiences of PrEP initiation and use of time-limited PrEP. Couples reported that PrEP offered them an additional strategy to reduce the risk of HIV transmission, meet their fertility desires, and cope with HIV serodiscordance. Remaining HIV negative at follow-up visits reinforced couples' decisions and motivated continued adherence to PrEP. In addition, confidence in their provider's advice and client-friendly services were critical to their decisions to initiate and continue use of PrEP. Strategies for wide-scale PrEP delivery for HIV serodiscordant couples in low resource settings may include building capacity of health providers to counsel on PrEP adoption while addressing couples' concerns and barriers to adoption and continued use.
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Affiliation(s)
- Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kenya
- Department of Global Health, University of Washington, Seattle, Washington
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Kathryn Curran
- Department of Global Health, University of Washington, Seattle, Washington
| | - Sophie Vusha
- Center for Clinical Research, Kenya Medical Research Institute, Kenya
| | - Mariah Ngutu
- Center for Clinical Research, Kenya Medical Research Institute, Kenya
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, Washington
- Center for Clinical Research, Kenya Medical Research Institute, Kenya
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
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Abstract
Cervical cancer is the most frequent cancer among women aged between 15 years and 44 years in Kenya, resulting in an estimated 4,802 women being diagnosed with cervical cancer and 2,451 dying from the disease annually. It is often detected at its advanced invasive stages, resulting in a protracted illness upon diagnosis. This qualitative study looked at the illness trajectories of women living with cervical cancer enrolled for follow-up care at Kenyatta National Hospital cancer treatment center and the Nairobi Hospice, both in Nairobi county, Kenya. Using the qualitative phenomenological approach, data were collected through 18 in-depth interviews with women living with cervical cancer between April and July 2011. In-depth interviews with their caregivers, key informant interviews with health care workers, and participant observation field notes were used to provide additional qualitative data. These data were analyzed based on grounded theory’s inductive approach. Two key themes on which the data analysis was then anchored were identified, namely, psychosocial challenges of cervical cancer and structural barriers to quality health care. Findings indicated a prolonged illness trajectory with psychosocial challenges, fueled by structural barriers that women were faced with after a cervical cancer diagnosis. To address issues relevant to the increasing numbers of women with cervical cancer, research studies need to include larger samples of these women. Also important are studies that allow in-depth understanding of the experiences of women living with cervical cancer.
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Affiliation(s)
- Mariah Ngutu
- Institute of Anthropology, Gender and African Studies (IAGAS), University of Nairobi, Nairobi, Kenya
| | - Isaac K Nyamongo
- Institute of Anthropology, Gender and African Studies (IAGAS), University of Nairobi, Nairobi, Kenya
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