RESUMEN
BACKGROUND: Nomadic lifestyle has been shown to be a significant factor in low immunization coverage. However, other factors which might aggravate vaccination uptake in nomadic pastoralists are poorly understood. Our study aimed at establishing the relative influence of social demographics, missed opportunities, and geographical mobility on severe under vaccination in children aged less than two years living in a nomadic pastoralist community of Kenya. METHODS: We used cross-sectional analytical study design. An interviewer-administered questionnaire was used to obtain quantitative data from 515 mothers with children aged less than two years. Under vaccination was the sum the total number of days a delayed vaccine was given after the recommended age range for each vaccine. Severe under vaccination was defined as those children who remained under-vaccinated for more than six months. Geographical mobility was assessed as household members who had gone to live or herd elsewhere in the previous 12 months, missed opportunity included questions on whether a child visiting a health facility had missed being vaccinated, while social demographic data included household size and mothers social demographics. RESULTS: Three-quarters of the mothers had no formal education. One-third of the children had been taken to a health facility and missed being vaccinated. Forty percent of the households had moved in the previous 12 months. Prevalence of missed opportunity was 30.1%; 42.2% of children had not received any vaccines by their first birthday, and 24.1% of children were severely under vaccinated. No significant association was found between social demographics and under-vaccination. Variables associated with under-vaccination were; movement of the whole family, (p = .015), missed opportunity, (p = <.001), lack of vaccines, (p = (.002), and location of health facility, (p = <.001). Movement of women and children made a significant contribution (p = 0.006) to severe under-vaccination. Children in households where women and children had moved were nine times more likely to be severely under-vaccinated than in those households where there was no movement. CONCLUSION: Geographic mobility of women and children was a key determinant of severe under vaccination among nomadic pastoralists in Kenya.
Asunto(s)
Etnicidad/estadística & datos numéricos , Agricultores/estadística & datos numéricos , Migrantes/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Lactante , Kenia , Masculino , Madres/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
BACKGROUND: The aim of this study was to determine cultural factors associated with prostate cancer screening intent among adult Kenyan African men. METHODS: A cross-sectional quantitative study with an analytic design was carried out in a randomly selected sample of 155 adult men aged 25-98 years living in a rural community in Kenya. Constructs from the Theory of Planned Behaviour were used to guide this study. A 5 -point Likert scale was used to assess fatalistic beliefs, fear, perceived benefits, and family influence. A structured questionnaire was used to collect quantitative data at the household level. RESULTS: Only 2.4% of the study participants had been screened for prostate cancer. About 2/3rd (64%) of the participants felt that they were at risk of getting prostate cancer; 44% intended to be screened within the following 6 months. Mean scores on a 5-point Likert scale indicated: strong beliefs in the benefits of prostate screening (4.2 (±SD .8), men aged over 40 were not perceived to be at risk of getting prostate cancer (1.3 ± .6), relatively high fatalistic beliefs of prostate cancer screening (3.6 (±SD .8), high degree of fear or apprehension of prostate cancer screening (3.2 (±SD 1.2), and a high level of influence of family members in prostate cancer screening (3.9 (±SD 1.0). The Wald criterion demonstrated that only family influence made a significant contribution to the intent to screen for prostate cancer (p = 0.031). Age, education, marital status, fatalism, fear, and benefit of screening were not associated with the intent to screen for prostate cancer. CONCLUSIONS: Strong beliefs of the benefits of prostate screening tended to be surpassed by relatively high fatalistic beliefs and fear or apprehension in prostate cancer screening. The family plays an important role in influencing decision making related to prostate cancer screening in Africans.
Asunto(s)
Características Culturales , Detección Precoz del Cáncer/psicología , Intención , Neoplasias de la Próstata/prevención & control , Población Rural , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Humanos , Kenia , Masculino , Persona de Mediana Edad , Población Rural/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Antiretroviral (ARV) adherence of ≥ 95% is recommended for suppressing HIV. However, studies have shown that the ≥ 95% recommended level is rarely achieved. OBJECTIVE: This cross-sectional community-based study sought to assess factors contributing to ARV drug adherence among adults living with HIV or AIDS. SETTING: The study was conducted in a rural community in Machakos County, Kenya. METHODS: The questions used for the study were adapted from the Patient Medicine Adherence Questionnaire (PMAQ), a tool grounded in the Health Belief Model. Adherence to ARV was measured using self-reports and pill counts. The perception social support was measured with a 5-point Likert scale, whereas the type and the number of side effects experienced were recorded using 'yes' and 'no' questions. We used the chi-square test to test associations and binary logistic regression to assess factors explaining dose adherence to ARV. RESULTS: The levels of adherence of 86% using self-reports were significantly higher (p < 0.001) than the pill count of 58.6%. The immediate family was rated high in providing social support (3.7 ± 0.6) followed by social support groups (3.1 ± 0.8). A binary logistic regression analysis was conducted to predict ARV adherence (adherent, non-adherent) using social support, side effects and marital status as explanatory variables. The Wald criterion demonstrated that marital status (p = 0.019) and burden of side effects (p ≤ 0.001) made a significant contribution to the prediction of ARV adherence. CONCLUSION: The burden of side effects and being a divorcee are primary predictors of ARV adherence.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Infecciones por VIH/tratamiento farmacológico , Estado Civil , Cumplimiento de la Medicación , Población Rural , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/efectos adversos , Actitud , Estudios Transversales , Divorcio , Familia , Femenino , VIH , Humanos , Kenia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Autoinforme , Apoyo SocialRESUMEN
We explored constraints of implementing AIDS education in public schools in Kenya. Sixty interviews with teachers and 60 focus group discussions with students were conducted in 21 primary and nine secondary schools. System/school-level constraints included lack of time in the curriculum, limited reach of secondary-school students (because AIDS education is embedded in biology, which is not compulsory), and disapproval of openness about sex and condoms by the Ministry of Education and parents. Alternative strategies to teach about AIDS had their own constraints. Teachers lacked training and support and felt uncomfortable with the topic. They were not used to interactive teaching methods and sometimes breached confidentiality. Teachers' negative attitudes constrained students from seeking information. Training interventions should be provided to teachers to increase their self-confidence, foster more positive attitudes, and stimulate interactive teaching methods. The Ministry of Education needs to have a clear policy toward the promotion of condoms.