SummaryThe practice of appropriate health seeking has a great potential to reduce the occurrence of severe and life-threatening child illnesses. We assessed the influence of socio-demographic, economic and diseaserelated factors in health care seeking for child illnesses among slum dwellers of Nairobi, Kenya. A survey round of the Nairobi Urban Demographic Surveillance System (NUDSS) generated information on 2-week child morbidity, illness symptoms, perceived illness severity and use of modern health services. During this round of data collection, interviewers visited a total of 15 174 households, where 3015 children younger than 5 years lived. Of the 999 (33.1%) children who were reported to have been sick, medical care of some sort was sought for 604 (60.5%). Lack of finances (49.6%) and a perception that the illness was not serious (28.1%) were the main reasons given for failure to seek health care outside the home. Health care seeking was most common for sick children in the youngest age group (0-11 months). Caretakers sought medical care more frequently for diarrhoea symptoms than for coughing and even more so when the diarrhoea was associated with fever. Perception of illness severity was strongly associated with health care seeking. Household income was significantly associated with health care seeking up to certain threshold levels, above which its effects stabilized. Improving caretaker skills to recognize danger signs in child illnesses may enhance health-seeking behaviour. Integrated Management of Child Illnesses (IMCI) programmes must be accessible free of charge to the urban poor in order to increase health care seeking and bring about improvements in child survival.
BackgroundThe linkage between the socio-economic inequality and HIV outcomes was analysed using data from a population-based household survey that employed multistage-stratified sampling. The goal is to help refocus attention on how HIV is linked to inequalities.MethodsA socio-economic index (SEI) score, derived using Multiple Correspondence Analysis of measures of ownership of durable assets, was used to generate three SEI groups: Low (poorest), Middle, and Upper (no so poor). Distribution of HIV outcomes (i.e. HIV prevalence, access to HIV/AIDS information, level of stigma towards HIV/AIDS, perceived HIV risk and sexual behaviour) across the SEI groups, and other background characteristics was assessed using weighted data. Univariate and multivariate logistic regression was used to assess the covariates of the HIV outcomes across the socio-economic groups. The study sample include 14,384 adults 15 years and older.ResultsMore women (57.5%) than men (42.3%) were found in the poor SEI [P<0.001]. HIV prevalence was highest among the poor (20.8%) followed by those in the middle (15.9%) and those in the upper SEI (4.6%) [P<0.001]. It was also highest among women compared to men (19.7% versus 11.4% respectively) and among black Africans (20.2%) compared to other races [P<0.001]. Individuals in the upper SEI reported higher frequency of HIV testing (59.3%) compared to the low SEI (47.7%) [P< 0.001]. Only 20.5% of those in poor SEI had “good access to HIV/AIDS information” compared to 79.5% in the upper SEI (P<0.001). A higher percentage of the poor had a stigmatizing attitude towards HIV/AIDS (45.6%) compared to those in the upper SEI (34.8%) [P< 0.001]. There was a high personal HIV risk perception among the poor (40.0%) and it declined significantly to 10.9% in the upper SEI.ConclusionsOur findings underline the disproportionate burden of HIV disease and HIV fear among the poor and vulnerable in South Africa. The poor are further disadvantaged by lack of access to HIV information and HIV/AIDS services such as testing for HIV infection. There is a compelling urgency for the national HIV/AIDS response to maximizing program focus for the poor particularly women.
Determinants of sexual activity and intentions for condom use were examined guided by the Attitude, Social influences, and Self-efficacy (ASE) model as a theoretical framework. A total of 561 in and out-of-school youth (15-24 years) in Addis Ababa completed a self-administered questionnaire. A third of them reported sexual intercourse in the past and half of the sexually active used condoms during recent intercourse. Being out-of-school, male, aged 20-24 years, alcohol use and khat (amphetamine-like substance) consumption predicted the likelihood of engagement in sexual activity. Of these variables, however, male sex was more associated with reported condom use during recent sexual intercourse. Self-efficacy, skills, and barriers predicted 23% of the variance in intentions to use condoms. Self-efficacy was also associated with past condom use. Psychosocial constructs predicted more variations in condom use intention for males than for females. In general, self-efficacy was found to be the strongest predictor of the constructs, whereas attitude and social influences were the weakest. The study implies that HIV/AIDS prevention programmes for young people in Ethiopia need to emphasize building assertive communication skills in sexual negotiations and condom use. Minimizing the gender gap in sexual relationships forms the cornerstone for such educational strategies.
Rapid urbanization and inequitable distribution of social services in African cities significantly contribute to the current deterioration of child health indicators in the region. Determinants of child morbidity and healthcare utilization among slum residents in Nairobi City, Kenya were assessed. Using a morbidity surveillance system, we visited 1691 households every 90 days for 9 months and registered 696 children below 5 years. 264 (37.9 per cent) children were reported to have been sick or injured at least once during the study period. A total of 447 illness episodes were reported among the 264 children (an average of 1.7 episodes per child). Cough, fever, diarrhea, skin problems and eye diseases made up the top five causes of morbidity. Child age below 1 year (OR=2.7; 95 per cent CI=1.33, 5.49) and having a working-mother (OR=2.0; 95 per cent CI=1.19, 3.31) were significantly associated with child morbidity report. About half of the mothers sought proper medical care for their sick children mostly from health institutions located outside the slum. Healthcare seeking within the slum heavily relied on informal private clinics. Working mothers sought medical care more often than non-working mothers (OR=0.29; 95 per cent CI=0.12, 0.7) and infants got priorities compared to older sick children (OR=0.2; 95 per cent CI=0.05, 0.83). We conclude that maternal engagement in non-formal low-paying jobs might in the long-run have a questionable gain in child survival among slum residents.
The study assessed and compared pregnancy and child health outcomes of teenage (aged less than 20 years) and adult (20-34 years of age) mothers. A total of 226 teenage and 205 adult mothers met the study criteria out of the 3,256 women in the reproductive age group (15-49 years) and 318 adolescent girls (12-14 years of age) covered by the Nairobi Cross-sectional Slums Survey (NCSS). The main comparison involved socio-demographic variables, events during pregnancy, obstetric outcome, child morbidity and mortality and care provided during an illness episode. Results showed that a significantly higher percentage of teenage mothers and their partners had lower educational achievement compared with adult mothers and their partners. They were more likely to be economically disadvantaged than the adult mothers. Teenage mothers and their parents were also less likely to have ever been married. The two groups of mothers were comparable in terms of the rate and timing of antenatal care visits, place of delivery, rate of operative deliveries, reported size of the baby at birth, child vaccination status and reported morbidity and health care practice during an illness episode. The index child was alive during the survey period for 89.4% of the teenage and 96.6% of the adult mothers (OR= 3.36; 95% CI =1.34, 8.79; P=0.004). Child survival rates in the two groups of mothers were found to be quite similar after controlled analysis for the influence of socio-economic factors. The study concluded that bad obstetric outcomes were not associated with maternal age.Although teenage and adult mothers were not significantly different on child health practices, children born to the former group died most frequently probably due to their poor socioeconomic achievements.
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