Effect of a lay counselor delivered integrated maternal mental health and early childhood development group-based intervention in Siaya County, Kenya: A quasi-experimental longitudinal study.

BACKGROUND: Maternal mental health is linked to early childhood development; yet there is a gap in evidence-based interventions for low-resource settings. This study estimates the impact of 'Integrated Mothers and Babies Course and Early Childhood Development' (iMBC/ECD), a cognitive-behavioral, group-based intervention, on maternal depression and early childhood social-emotional development in Siaya County, Kenya. METHODS: This quasi-experimental study enrolled 417 pregnant women and mothers of children under age 2 across two sub-counties in Siaya County. The intervention area had 193 women in 23 groups implementing iMBC/ECD and the control area had 224 women in 30 groups exposed to ECD only content. Mother/index child dyads were followed for two years. To estimate the causal treatment effect from the non-randomized design, we implemented the propensity score weighting method with inverse probability weights. RESULTS: At baseline, 10.2% of participants endorsed moderate/severe depressive symptoms. At 14-months post-intervention, 7.4% endorsed moderate/severe depression. Overall, iMBC/ECD intervention did not have a significant impact on reducing maternal depression or improving children's social and emotional development. However, sub-group analyses revealed that iMBC/ECD was associated with lowered depressive symptoms among women with no/low education, four or more children and/or no experience of intimate partner violence in the past year. Women with high program attendance (more than half of 14 sessions) also experienced consistently fewer depressive symptoms compared to those with lower attendance. LIMITATIONS: Non-randomized study, sub-group analyses are exploratory. CONCLUSIONS: The iMBC/ECD program may have the potential to improve maternal mental health and early child development for more targeted vulnerable populations.

Our women must return home: institutionalized patriarchy in colonial central Nyanza district, 1945-1963.

Colonial policies and practices were very instrumental in the creation of the Luo Diaspora. This Diaspora extended far beyond the physical and cultural boundaries of Central Nyanza as was constituted by the colonial administration. To colonial officials, this Diaspora represented "detribalized natives" responsible for social decay and immorality in the colonial townships. Similarly, to the male elders in the rural areas, this Diaspora was an affront towards destabilizing tribal authority and sanctions, which governed Luo moral order, Luo marriage, and Luo identity as it existed prior to colonialism. This article uses patriarchy as an analytical framework to understand how male elders and colonial officials collaborated to assert control over young women under suspicion of prostitution. The article argues that the Ramogi African Welfare Association (RAWA) was a post-war patriarchal institution which was used by male elders, with the encouragement of the colonial officials, to intimidate, harass and repatriate young women seeking wage employment within the emerging colonial townships. In this article, I use archival and field data gathered from Central Nyanza between 1999 and 2002 to illustrate how institutionalized patriarchy threatened many women and young girls seeking to migrate to colonial towns in order to exploit the limited economic and social opportunities that colonialism provided.

Daniel arap Moi and the politics of HIV and AIDS in Kenya, 1983-2002.

The contrasting outcomes to HIV/AIDS prevention and mitigation processes in sub-Saharan Africa have not been adequately investigated or explained. Specifically, few scholars have attempted to root the responses to HIV and AIDS within the socio-economic and political realities of those countries severely impacted by the disease. This article seeks to explain the ambivalent political response to HIV and AIDS in Kenya in the context of the neopatrimonial leadership of former president Daniel arap Moi, between 1983, when the disease was first identified, and 2002, when Moi finally left office. The article relies on rigorous interpretation and corroboration of secondary and primary data collected between 2004 and 2006. The findings suggest that the slow and inadequate response to HIV and AIDS in Kenya during Moi's presidency was primarily dictated by the need to maintain the structures of his neopatrimonial leadership.