What Does the Informal Sector Know about Health Insurance?

SHOPS is implementing a behavior change communication campaign in Nairobi, Kenya, targeted at informal sector workers earning $5 - $15 per day. The objective is to change their attitudes and perceptions towards health insurance which can improve financial access to HIV care and other needed health services. This formative research was gathered through focus group discussions and a household survey of informal sector workers earning $5 - $15 per day. The focus groups and the survey collected information on the target population’s knowledge of basic health insurance concepts, attitudes toward insurance companies and existing health insurance products, household priorities, and health seeking practices. This evidence is informing the behavior change campaign to make sure that is tailored to appeal to the motivations of informal sector workers, especially those who are likely to need HIV services. The presentation was made by Agnes Gatome-Munyua at a meeting with members of the Association of Kenyan Insurers in November 2014.

Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics, and other therapies in India and Kenya

The objective of this study was to investigate the clinical characteristics of children who died from diarrhea in low- and middle-income countries, such as the duration of diarrhoea, comorbid conditions, care-seeking behavior and oral rehydration therapy use. The study included verbal autopsy data on children who died from diarrhea between 2000 and 2012 at seven sites in Bangladesh, Ethiopia, Ghana, India, Pakistan, Uganda and the United Republic of Tanzania, respectively. Data came from demographic surveillance sites, randomized trials and an extended Demographic and Health Survey. The type of diarrhea was classified as acute watery, acute bloody or persistent and risk factors were identified. Deaths in children aged 1 to 11 months and 1 to 4 years were analyzed separately. Findings revealed that the proportion of childhood deaths due to diarrhea varied considerably across the seven sites from less than 3% to 30%. Among children aged 1–4 years, acute watery diarrhea accounted for 31–69% of diarrheal deaths, acute bloody diarrhea for 12–28%, and persistent diarrhea for 12–56%. Among infants aged 1–11 months, persistent diarrhea accounted for over 30% of diarrheal deaths in Ethiopia, India, Pakistan, Uganda and the United Republic of Tanzania. At most sites, more than 40% of children who died from persistent diarrhea were malnourished. Persistent diarrhea remains an important cause of diarrheal death in young children in low- and middle-income countries. Research is needed on the public health burden of persistent diarrhea and current treatment practices to understand why children are still dying from the condition.

Community Case Management of Childhood Diarrhea in a Setting with Declining Use of Oral Rehydration Therapy: Findings from Cross-Sectional Studies among Primary Household Caregivers, Kenya, 2007

We sought to determine factors associated with appropriate diarrhea case management in Kenya. We conducted a cross-sectional survey of caregivers of children < 5 years of age with diarrhea in rural Asembo and urban Kibera. In Asembo, 61% of respondents provided oral rehydration therapy (ORT), 45% oral rehydration solution (ORS), and 64% continued feeding. In Kibera, 75% provided ORT, 43% ORS, and 46% continued feeding. Seeking care at a health facility, risk perception regarding death from diarrhea, and treating a child with oral medications were associated with ORT and ORS use. Availability of oral medication was negatively associated. A minority of caregivers reported that ORS is available in nearby shops. In Kenya, household case management of diarrhea remains inadequate for a substantial proportion of children. Health workers have a critical role in empowering caregivers regarding early treatment with ORT and continued feeding. Increasing community ORS availability is essential to improving diarrhea management.

Health Seeking Behaviour of Mothers of Under-Five-Year-Old Children in the Slum Communities of Nairobi, Kenya

Prompt and appropriate health seeking is critical in the management of childhood illnesses. This paper examines the health seeking behaviour in under-five child morbidity. It explores in detail actions taken by 28 mothers when their children become sick. Sixty-two in-depth interviews with mothers were conducted from four study communities. The mothers were identified from a demographic surveillance system. The interviews were tape-recorded, transcribed and thematically analysed. The study shows that mothers classify childhood illnesses into four main categories: (1) not serious—coughs, colds, diarrhoea; (2) serious but not life-threatening—malaria; (3) sudden and serious—pneumonia; and (4) chronic and therefore not requiring immediate action—malnutrition, tuberculosis, chronic coughs. This classification is reflected in the actions taken and time it takes to act. Shops are used as the first source of healthcare, and when the care moves out of the home, private health facilities are used more compared to public health facilities, while even fewer mothers consult traditional healers. Consequently we conclude that there is a need to train mothers to recognize potentially life-threatening conditions and to seek appropriate treatment promptly. Drug vendors should be involved in intervention programs because they reach many mothers at the critical time of health seeking.

Community understanding of pneumonia in Kenya

Effective management of pneumonia demands active participation by the caretaker to facilitate early seeking of appropriate health care and adequate compliance to home care messages. This would only be possible if the caretakers’ perception of pneumonia is appropriate. This study aims to determine community’s perception of childhood pneumonia in a suburb of Nairobi.

The objective of this study is to determine community perception of childhood pneumonia through a cross sectional study utilizing qualitative ethnographic methodology.  The participants included six key informants for in-depth interview and eight groups for focus group discussions from the study community.

Pneumonia was perceived to be the most serious childhood illness. There was a great deal of diversity of Kikuyu phrases for chest-in drawing. There was no term for rapid breathing. Chest in-drawing, fever, difficult in breathing, startling at night and convulsions were perceived as features of pneumonia. Chest in-drawing, fever and convulsions were indicative of severe disease.

It was concluded that the caretakers perceived severe pneumonia as outlined in the IMCI guidelines. Non-severe pneumonia was not perceived for what it should be. Inappropriate knowledge on causes of pneumonia and signs of non severe pneumonia are likely to interfere with compliance with home care messages.

Mother's health seeking behaviour during child illness in a rural western Kenya community

In most developing countries, the health of the children is strongly dependant on maternal healthcare behaviour. The study describes the prevalence of illness among preschool children in a rural sugarcane growing community and the mother’s health seeking behavior.

The objectives of the study were to document the presence of illness among preschool children at household level in a rural community in Western Kenya and also determine the mother’s health seeking behavior during the course of these illnesses.

This was an observational cross-sectional community survey using interview schedules, key informants and focus group discussions and Makunga Rural Health Center in Kakamega District western Kenya. Descriptive statistics were used in data analysis.

Fifty two percent of the children had had at least one illness a week prior to the survey. Fever was the most commonly reported symptom with 48% of the cases. A third (32.4%) of the mothers purchased and administered drugs to their sick children without seeking medical attention. The most commonly reported reasons for this behavior were: the government health facilities were at a distance, the services are poor and inability to afford services at the private hospitals and clinics.

Intervention programmes focusing on diversification of income sources, maternal education and community based mobile clinics are likely to contribute towards improved health of children in this and any other rural sugarcane growing community.

Who is to blame? Perspectives of caregivers on barriers to accessing healthcare for the under-fives in Butere District, Western Kenya

Kenya, like many developing nations, continues to experience high childhood mortality in spite of the many efforts put in place by governments and international bodies to curb it. This study sought to investigate the barriers to accessing healthcare services for children aged less than five years in Butere District, a rural district experiencing high rates of mortality and morbidity despite having relatively better conditions for child survival.

Exit interviews were conducted among caregivers seeking healthcare for their children in mid 2007 in all the 6 public health facilities. Additionally, views from caregivers in the community, health workers and district health managers were sought through focus group discussions (FGDs) and key informant interviews (KIs).

Three hundred and ninety-seven respondents were surveyed in exit interviews while 45 respondents
participated in FGDs and KIs. Some practices by caregivers including early onset of child bearing, early supplementation, and utilization of traditional healers were thought to increase the risk of mortality and morbidity, although reported rates of mosquito net utilization and immunization coverage were high. The healthcare system posed barriers to access of healthcare for the under fives, through long waiting time, lack of drugs and poor services, incompetence and perceived poor attitudes of the health workers. FGDs also revealed wide-spread concerns and misconceptions about health care among the caregivers.

Caregivers’ actions were thought to influence children’s progression to illness or health while the healthcare delivery system posed recurrent barriers to the accessing of healthcare for the under-fives. Actions on both fronts are necessary to reduce childhood mortality.

Home management of diarrhea among underfives in a rural community in Kenya: household perceptions and practices

Diarrheal disease is a major cause of morbidity and mortality among under-fives especially in rural and peri-urban communities in developing countries. Home management of diarrhea is one of the key household practices targeted for enhancement in the Community Integrated Management of Childhood Illness (C-IMCI) strategy.

The aim of this study was to determine the perceptions of mothers/caregivers regarding the causes of diarrhea among under-fives and how it was managed in the home before seeking help from Community Health Workers or health facilities.

A household longitudinal study was conducted in Nyando district, Kenya in 2004-2006 adopting both qualitative and quantitative approaches. A total of 927 mothers/caregivers of under-fives participated in the study. The main outcomes measured were perceived causes of childhood diarrhoea, action taken during diarrhea, fluid intake, recognition of signs of dehydration, feeding during convalescence, adherence to treatment and advice.

A majority of the respondents 807 (87.1%) reported that their children had suffered from diarrhea within the last 2 weeks before commencement of the study. Diarrhea was found to contribute to 48% of child mortality in the study area. Perceived causes of diarrhea were: unclean water 524 (55.6%), contaminated food 508 (54.9%), bad eye 464 (50.0%), false teeth 423 (45.6%) and breast milk 331 (35.8%). More than 70% of mothers decreased fluid intake during diarrhea episodes. The mothers perceived wheat flour, rice water and selected herbs as anti-diarrheal agents. During illness, 239 (27.8%) of the children were reported not to have drunk any fluids at all, 487 (52.5%) drunk much less and only 93 (10.0%) were reported to have drunk more than usual. A significant 831 (89.6%) withheld milk including breast milk with the notion that it enhanced diarrhea.

Based on these findings, there is need to develop and implement interactive communication strategies for the health workers and mothers to address perceptions and misconceptions and facilitate positive change in the household practice on management of diarrhea among under-fives.

Market analysis of the ORS and zinc markets in Kenya

PSI/Kenya commissioned this report to inform the programmatic strategies relevant to the reduction of under 5 years old morbidity and mortality in Kenya through the increased use of ORS and zinc per WHO recommendations.  Data was collected in a period of two weeks through 15 face to face in-depth interviews with pharmaceutical manufacturers, distributors, UNICEF, WHO, and other stakeholders as well as visits to the trade in and around Nairobi.

The study found that although there is a considerable supply of ORS on the market that complies with WHO regulations, there is a limited demand for ORS (and zinc) due to lack of information from caregivers as well as from health providers.  Recommendations for future programming include: increasing knowledge and self-efficacy amongst caregivers, increasing availability of zinc and ORS through the public and private sector, and increasing health professionals' recommendation of ORS and zinc.

Mothers' Knowledge, Attitudes and Practices Regarding Acute Respiratory Infections in Children in Baringo District, Kenya

Control of actue respiratory infections (ARI) is a major public health problem in developing countries.  Implementation of case management protocols requires participation of the community to reduce morbidity and mortality from ARI.  Health education programmes can only be effective when designed to take into account the prevailing knowledge, attitudes and practices (KAP) of the community towards ARI in their children.

The objective of the study was to determine the KAP of mothers regarding ARI in their children aged less than five years.  To reach this objective a community based cross-sectional survey was completed in the Baringo District in Kenya.  Mothers with children aged 0-5 years were recruited following stratified random sampling in three areas of Baringo District to represent low, medium and high potential areas based on agricultural productivity.  A mixed structured and unstructured questionnaire was adminsitered to each of the respondent mothers by the investigator; with the help of an interpreter where necessary.

A total of 309 mothers were interviewed.  Their mean age was 31.5 years (range 16-51) and 34% had no formal education.  Only 18% of mothers described pneumonia satisfactorily.  60.2% knew that measles is preventable by immunisation.  87.1% of the mothers said they would seek health centre services for severe ARI.  Formal education had a positive influence on the KAP of the mothers.

The study revealed that the mothers had good knowledge of mild forms of ARI but not the sever forms.  Their attititude to ARI was appropriate but subsequent practices were not.  Low utilisation of health services for moderate ARI may result in continued high mortality because of delayed identification of seriously ill children.