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"Languages, Mixed Kenya."
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Does Africa Need a Rotten Kin Theorem? Experimental Evidence from Village Economies
This article measures the economic impacts of social pressure to share income with kin and neighbours in rural Kenyan villages. We conduct a lab experiment in which we randomly vary the observability of investment returns to test whether subjects reduce their income in order to keep it hidden. We find that women adopt an investment strategy that conceals the size of their initial endowment in the experiment, though that strategy reduces their expected earnings. This effect is largest among women with relatives attending the experiment. Parameter estimates suggest that women anticipate that observable income will be \"taxed\" at a rate above 4%; this effective tax rate nearly doubles when kin can observe income directly. At the village level, we find an association between the willingness to forgo expected return to keep income hidden in the laboratory experiment and worse economic outcomes outside the laboratory.
Journal Article
Preferences for and acceptability of long-acting HIV prevention products among pregnant and lactating women accessing health services in Kenya: a mixed method cross-sectional analysis
Background
Increased risk of HIV acquisition during pregnancy and lactation among women is evident, necessitating their inclusion in the evaluation of new HIV prevention interventions. Pregnant and postpartum women specifically face challenges with oral PrEP associated with stigma, and the burden of using other tablets. Long-acting products may address challenges related to oral PrEP, however, there is limited data on product-specific preferences and acceptability among pregnant and lactating women.
Methods
We conducted a mixed-method study to assess the preferences and acceptability of long-acting PrEP modalities either under development or already established among pregnant and lactating women. We conducted quantitative surveys (
n
= 434) and in-depth interviews (
n
= 80) in central and western Kenya. We used descriptive statistics and categorical variables to summarize frequencies and proportions. Inductive and deductive content analytic approaches were used for in-depth interviews.
Results
The median age of respondents was 25 years (IQR 19.3–31.0). Majority were married (263/434, 61%), had completed high school (222/434, 51%), with no condoms use in the prior 3 months (348/434, 80%). The most preferred PrEP formulations were injectable (251/434, 57%) and implantable (175/434, 40%) options. Participants who preferred injectable PrEP had 8.56 times higher odds of considering ease of use as a reason. (aOR = 8.56, 95% CI [3.81–20.48]) and 3.71 odds of choosing perceived discreteness (aOR = 3.71, 95% CI (1.57–9.97)) as their preference reasons. Participants who preferred Implant for HIV prevention had 2.31 odds of considering it due to perceived effectiveness in preventing HIV as a preference reason (aOR = 2.31, 95% CI (1.21—4.66)) and 2.53-fold of considering discreteness as a preference reason (aOR = 2.53, 95% CI (1.46—4.59)). From the in-depth interviews, women reported prospective acceptability due to the perceived convenience of LA products, perceived effectiveness, reduced cost, improved privacy, and reduced stigma. Women had concerns regarding the safety and efficacy of the products during pregnancy and lactation.
Conclusion
Acceptability of LA products underscores the importance of considering the unique needs of pregnant and breastfeeding women in the development of future prevention interventions
.
Aligning preferences and needs would enhance the uptake and adherence outcomes of HIV prevention products.
Journal Article
What’s the Story on Agriculture? Using Narratives to Understand Farming Households’ Aspirations in Meru, Kenya
In the limited research on farming aspirations, little attention has been paid to the narratives which frame and shape them, and the ways in which the aspirations of those who farm intersect with the goals of extension services. Drawing on multimethod research conducted in Meru County, Kenya, we demonstrate how aspirations are not only situated within a consideration of personal circumstances, but are shaped in crucial ways by networks of relations and by the perceived possibilities afforded by material and cultural resources. We further highlight the accounts of state extension agents that link a lack of engagement with the desires and needs of those who farm to the failure of agricultural development initiatives. We argue that an engagement with aspirations opens up a route to understanding the obstacles and potentialities that matter to those who farm and, as such, might enable more responsive development initiatives centred on the perceptions and desires of those who farm.
Journal Article
Factors influencing mothers’ decisions regarding obstetrical care in Western Kenya: a mixed-methods study
Background
Siaya County in Western Kenya has one of the highest maternal mortality rates in Kenya. We sought to elucidate factors that influence mothers’ decisions regarding where to seek obstetrical care, to inform interventions that seek to promote effective use of obstetric services and reduce maternal mortalities. To guide our research, we used the “Three Delays Model”, focusing on the first delay—seeking care. While interventions to reduce maternal mortalities have focused on addressing delays in accessing and receiving care, context-specific data on drivers of the first delay are scarce.
Methods
We used a mixed-method study to assess how maternal decision-making of birth location is influenced by personal, contextual, and cultural factors. We conducted structured interviews with women aged 14 years or older living in Siaya, Bondo, and Yala, rural districts in Western Kenya. We then conducted focus group interviews with a subset of women to elucidate this question: How do drivers of the first delay (i.e., seeking care) affect the decision to seek home versus hospital delivery, potentially negatively influencing maternal mortality.
Results
Three hundred and seven women responded to the surveys, and 67 women (22%) from this group participated in focus group interviews. Although we focused on type 1 delays, we discovered that several factors that impact type 2 and type 3 delays directly contribute to type 1 delays. Our findings highlighted that factors influencing women’s decisions to seek care are not simply medical or cultural but rather contextual, involving many elements of life, particularly in rural communities.
Conclusions
It is imperative to address multiple-level factors that influence women’s decisions to seek care and have in-hospital deliveries. To curtail maternal mortality in rural Western Kenya and comparable settings, targeted interventions must take into consideration these important influencers.
Journal Article