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Copyright of Critical African Studies is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The availability of labor-power is a critical element of all commodity chains. This is especially true of laborintensive production processes such as agriculture. The COVID-19 pandemic had a major impact on this, as well as on many other aspects of the economy and everyday life. The institutions of the modern world-system responded in various ways to the new situation influenced by COVID-19, taking measures to mitigate and avert the detrimental effects. This paper examines these responses and their impact on the availability of labor-power in the agricultural areas of Nakuru County, Kenya, and O'Higgins Region, Chile. By practically applying world-systems analysis, we shed light on the significance of institutions during periods of stagnation and their impact on the availability of labor-power in global commodity chains. This allows us to draw conclusions about the general impact of institutional responses to stagnation phases at the worker level. We show that the institutions studied responded in very different ways to the stagnation phase affected by COVID-19. As a result, O'Higgins Region experienced a labor-power shortage that Nakuru County had not, which may have a lasting impact on labor-power availability. [ABSTRACT FROM AUTHOR]

Background: Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions. Methods: A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted. Results: Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice. Conclusions: FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access. Plain language summary: Women's decisions to use family planning (FP) are influenced by social norms, the unwritten rules of appropriate actions within social networks, and are shaped by advice and information received from key influencers—important individuals who shape what is acceptable within social networks. The aim of this study was to understand how key influencers uphold and transmit information and norms about FP, and explore who women consult as they make FP decisions and why they consult these key influencers. We interviewed 16 women, 10 partners and 14 key influencers in peri-urban Nairobi, Kenya. We found that key influencers for decisions about FP included mothers, aunts, partners, friends and healthcare providers. In making a decision about FP use, women consulted key influencers based on who they deemed trustworthy to keep their FP use secret and described less trust to speak with men about FP in their social networks. Mothers understood the social risks of using FP and so could advise on its discreet use, and aunts were approachable sources of impartial information about FP. Although women identified partners as key decision makers, they were aware that power imbalances might affect final FP choices. Our findings underscore the importance of FP interventions working with women's social networks and to address social norms influencing women's decisions in using FP. Interventions to change FP norms should consider dynamics of secrecy, trust and emotional closeness that affect FP discussions among women's networks. [ABSTRACT FROM AUTHOR]

The health burden due to mental health has historically been underestimated with focus on communicable diseases and deaths and little consideration of disability and comorbidity effects of poor mental health. Recent data show increasing trends of mental health disorders as a share of global health burdens and vulnerability of adolescents. This paper aims to explore social determinants of mental health as experienced by adolescent girls, drawing attention to gendered risks during the COVID-19 pandemic. Semi-structured interviews with twenty-two adolescent girls in urban informal settlements in Kenya and Nigeria reveal unique environmental, socio-cultural, economic and educational factors that threatened their mental wellbeing. The pandemic exacerbated these determinants. An equitable recovery will require a consideration of not only disproportional mental health outcomes, but also social determinants that contribute to these outcomes. As more than half of the urban population in sub-Saharan Africa reside in informal settlements, this study has implications for youth-focused mental health interventions in these and similar settings. [ABSTRACT FROM AUTHOR]

Diarrhoea and malnutrition are major problems afflicting children in Kenya and other developing countries. This is detrimental to human capital development and child well-being. This paper aims at evaluating the potential impact of cash transfers on nutritional status and incidence of diarrhoea among children below five years and differentiated by gender in Kenya. Because the cash transfers are not randomly assigned, propensity score matching methods were applied to a nationally representative household survey to examine whether unconditional cash transfers aid child human capital development. We provide empirical evidence that children in cash transfer-receiving households differ from those in non-recipient households. Second, we show that the unconditional cash transfers have potential to influence human capital development. However, girls are generally in an underprivileged situation in Kenya. Whereas cash transfers reduced the incidence of diarrhoea and malnutrition for boys in cash transfer-receiving households, in the case of girls the impact of cash transfers was not significant in case of diarrhoea or it was significant but adversely affected nutritional status. These results are comparable to other evaluations of unconditional cash transfers around the world. The results suggest there is scope for cash transfer programmes to promote human capital development among vulnerable households. Consequently, there is a case for expanding the cash transfers and ensuring efficient and effective administrative structure for targeting, disbursement and accountability. [ABSTRACT FROM AUTHOR]

This paper examines how regulatory, owner-specific, firm-specific and support factors influence participation in domestic trade by Kenyan firms owned by men and women with a view to informing policy action. Data from the 2016 survey on micro, small, and medium enterprises supported empirical estimations. Two models were estimated using the probit regression. The first was on participation in domestic trade by firms owned by women, while the second was on participation in domestic trade by firms owned by men. I controlled endogeneity and heterogeneity using the control function approach. The findings revealed that firm size, access to credit, goodwill, firm registration status, and university education attainment were significant in influencing participation of Kenyan firms in domestic trade. The evidence indicates a need to mainstream gender issues in making of trade policy; and enforcement of laws guaranteeing women improved access to trade credit and property including land rights. Improving access to incubation and capacity building support among female-owned firms could drive growth, specialization, and knowledge accumulation for enhanced participation in trade. [ABSTRACT FROM AUTHOR]

Background: Addressing the unmet need for modern contraception underpins the goal of all family planning and contraception programs. Contraceptive discontinuation among those in need of a method hinders the attainment of the fertility desires of women, which may result in unintended pregnancies. This paper presents experiences of contraceptive use, reasons for discontinuation, and future intentions to use modern contraceptives. Methods: Qualitative data were collected in two rural counties in Kenya in 2019 from women with unmet need for contraception who were former modern contraceptive users. Additional data was collected from male partners of some of the women interviewed. In-depth interviews and focus group discussions explored previous experience with contraceptive use, reasons for discontinuation, and future intentionality to use. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach. Results: Use of modern contraception to prevent pregnancy and plan for family size was a strong motivator for uptake of contraceptives. The contraceptive methods used were mainly sourced from public health facilities though adolescents got them from the private sector. Reasons for discontinued use included side efects, method failure, peer infuence, gender-based violence due to covert use of contraceptives, and failure within the health system. Five rea- sons were provided for those not willing to use in the future: fear of side efects, cost of contraceptive services, family conficts over the use of modern contraceptives, reduced need, and a shift to traditional methods. Conclusion: This study expands the literature by examining reasons for contraceptive discontinuation and future intentionality to use among women in need of contraception. The results underscore the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social infuencers in family planning programs and services will help garner support for contraception, rather than focusing exclusively on women. The results of this study can inform implementation of family planning programs in Kenya and beyond to ensure they address the concerns of former modern contraception users. [ABSTRACT FROM AUTHOR]

Policies as they are written often mask the power relations behind their creation (Hull, 2008). As a result, not only are policies that appear neat on the page frequently messy in their implementation on the ground, but the messiness of implementation, and implementation science, often brings these hidden power relations to light. In this paper, we examine the process by which different data sources were generated within a programme meant to increase access to quality private healthcare for the poorest populations in Kenya, how these sources were brought and analyzed together to examine gender bias in the large-scale rollout of Kenya's National Hospital Insurance Fund (NHIF) beyond public hospitals and civil service employees, and how these findings ultimately were developed in real time to feed into the NHIF reform process. We point to the ways in which data generated for implementation science purposes and without a specific focus on gender were analyzed with a policy implementation analysis lens to look at gender issues at the policy level, and pay particular attention to the role that the ongoing close partnership between the evaluators and implementers played in allowing the teams to develop and turn findings around on short timelines. In conclusion, we discuss possibilities for programme evaluators and implementers to generate new data and feed routine monitoring data into policy reform processes to create a health policy environment that serves patients more effectively and equitably. Implementation science is generally focused on programmatic improvement; the experiences in Kenya make clear that it can, and should, also be considered for policy improvement. [ABSTRACT FROM AUTHOR]

Climate-induced migration is an increasingly pressing issue in many African regions, as rising temperatures and extreme weather events have caused the displacement of vulnerable populations. This is especially so in Eastern Africa and the Horn of Africa, particularly Kenya and Ethiopia, where extreme weather events have led to rangeland degradation, crop failures, water shortages, and food insecurity. Hence, there is a perceived need to understand these processes better. Against this background, this paper reports on a study investigating the processes associated with climate-induced migration in Kenya and Ethiopia. The research method used consisted of an expert-driven assessment approach, which assesses the causes of climate-induced migration in Kenya and Ethiopia and its human and social implications on local communities. Data were collected from 110 experts residing and working on climate and migration-related issues in Ethiopia and Kenya via e-mail, whose knowledge of the current situation has enabled the identification of some important trends. The results show that climate change is a primary trigger of migration both internally and externally. The high number of migrants, many of whom living within levels of poverty in their home areas is straining resources and services in the receiving regions. Their presence is also leading to increased competition for jobs and resources. Additionally, it has increased urban poverty, as many migrants have little access to living space and health care. This paper provides a welcome addition to the literature in that it lists the causes and implications of climate-induced migration and, by doing so, fosters a better understanding of the current crisis and its implications. The implications of this paper to the overall knowledge of climate change and migration are twofold. First, it highlights the need for governments, international organisations, and other stakeholders better to understand the complex linkages between climate change and migration. Secondly, it shows the usefulness of better recognising how climate change can drive migration and the other factors shaping the decision to migrate. The paper concludes by stating the urgent need for policies and programmes that support climate change-induced migrants. Also, it draws attention to the usefulness of promoting sustainable development in their origin countries and destinations, so that migration is not necessarily perceived as the only response to climate change. A further conclusion is that there is a perceived need for providing access to resources such as education, health care, and livelihood opportunities and establishing mechanisms to ensure a safe and dignified return for those who choose to do so. • Climate change is a significant driver for migration in Kenya and Ethiopia. • Droughts, conflicts, and crop failures are among the key drivers of migration. • Male migration is more prominent than a female one. • Limited access to productive resources leads to outmigration from rural areas. • Lockdowns associated with the COVID-19 pandemic did not cause any major migration. [ABSTRACT FROM AUTHOR]

Gender-based violence (GBV) is a violation of human rights and must be addressed as such. This paper examines whether donor practices align with a rights-based approach, using data from our comprehensive study of foreign funding flows related to GBV in Colombia, Kenya, and Uganda from 2010 to 2020. By analyzing data from 1,180 grants--and providing parallel analyses of the state of GBV, and GBV reporting and interventions in each country--we demonstrate donors' role in shaping GBV outcomes and their consequent duty to address policies and practices that violate rights. Accordingly, we propose changes in donor practices to promote realization of the right to freedom from violence. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, cases of gender-based violence (GBV) dramatically increased. While the Kenyan governmental bodies are held responsible for their inadequate response to this "national disaster of GBV", the role of the Kenyan churches is hardly criticized. The churches neither spoke out against this prevalent injustice, nor did they openly support the victims of GBV. Furthermore, it could be argued that churches, through their patriarchal structures and cultural and doctrinal teachings, have contributed to this disaster. This article is written from a woman's perspective and focused on the notion of vumilia, or perseverance, an important notion in the lived faith of women. Vumilia is the Kiswahili word for "persevere" or "endure." It appears that a gendered vumilia theology applied to gender relations, prevents churches from adequately addressing gender-based violence. Unless and until this vumilia theology is deconstructed and balanced with a liberation theology, the church's response to gender-based violence will be superficial and insufficient. In this article, the narrative method is used to bring about the ideas and experiences of women in two Kenyan churches, the Reformed Church of East Africa (RCEA) and the African Israel Nineveh Church (AINC), related to vumilia and its cultural and theological underpinnings. The article discusses the teachings of vumilia theology in these churches and their effects on women who suffer from gender-based violence. The paper also traces the resistance of church women, indicating the contours of a woman-affirming Christ-centered theology and spirituality. [ABSTRACT FROM AUTHOR]

As a white, Western-educated man, undertaking research in Kakuma refugee camp, Kenya, I encountered ethical dilemmas related to my privileged racial and gender status. These include power imbalances between researchers and refugees and conducting research in the face of human suffering. Through critical self-reflexivity, I analyze my own experiences to reveal the personal and professional vulnerabilities that researchers from high-income countries (HICs) may encounter when working in contexts where oppression and forced displacement are prominent. I conclude that researchers who work in contexts of forced migration must extend beyond the boundaries of procedural research ethics and include components of relational ethics. This involves close collaboration with refugee participants to develop more culturally relevant research ethics guidelines for refugee-specific populations. [ABSTRACT FROM AUTHOR]

Seed systems are essential to bring good genetic material to farmers. Women farmers, however, have benefited less than men farmers from seed systems in low and middle income countries. We identify factors that inhibit and promote women's success in seed businesses through three case studies of women's and men's entrepreneurship across seed-related value chains and country contexts: tilapia seed production in Ghana, marketing and trading of improved maize and sorghum seeds in Kenya, and chicken seed dissemination in Tanzania. Applying a gender lens, we use key informant interviews and focus group discussions to analyze women's and men's motivations to engage in seed businesses, the challenges they confront to start and build their enterprises, and prospects for sustainability and continued success. We use quantitative data to characterize the levels of empowerment of the agripreneurs sampled. For women, the results show that the social normative context of the sector is critical. Time flexibility and profitability are important considerations for women's engagement. Furthermore, across all three country cases, family and external support are frequently key to women's participation and success in seed agripreneurship. The article discusses the importance of government bodies, NGOs, and donors in challenging the normative context around gender resource gaps, as well as provide technical packages and training to develop business acumen. Supporting change of restrictive gender norms in non-threateningways - such as ICTs - is key. [ABSTRACT FROM AUTHOR]

Copyright of Critical African Studies is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Nutrition plays an important role in child survival and development. Treatment action in the management of child health and nutrition is influenced by perceptions of illness, and gender plays an important role. However, little is known about if and how moderate undernutrition is recognised among lay populations, or how local social norms and intra-household dynamics affect decisions to seek biomedical assistance for nutritional concerns. In this paper we describe how childhood nutritional problems are recognised and understood within rural households. We demonstrate how context influences local constructs of 'normal', and suggest the centrality of gender in the management of child health and nutrition in our research context.Methods: This qualitative study was undertaken in Kilifi County on the Kenyan Coast. A set of 15 households whose children were engaged in a community-based nutrition intervention were followed up over a period of twelve months. Over a total of 54 household visits, group and individual in-depth interviews were conducted with a range of respondents, supplemented by non-participant observations. Eight in-depth interviews with community representatives were also conducted.Results: Local taxonomies of childhood undernutrition were found to overlap with, but differ from, biomedical categories. In particular, moderate undernutrition was generally not recognised as a health problem requiring treatment action, but rather as routine and manageable, typically seasonal, weight-loss. Where symptoms were considered more serious and requiring remedial action, household management strategies were typically based on perceived aetiology of the illness. Additionally, gender emerged as a potentially central theme in childhood nutrition problems and related management. Women reported that they have primary responsibility for ensuring children's good health and nutritional status, and that they are often held accountable when their children are of sub-optimal health.Conclusion: Perceptions of child nutrition and illness and gendered roles within households influence treatment action, and engagement with nutrition interventions. Community-based nutrition interventions must recognise these complex realities. [ABSTRACT FROM AUTHOR]

This paper uses a translog cost function approach to study the farm-level demand for poultry feed in Kenya. The study estimates the demand elasticities of the three common types of poultry feed; mixed feed, grain, and leafy vegetables. The estimated model was used to obtain estimates of Marshallian demand elasticities for poultry feed in Kenya for male-headed and female-headed households. The elasticities reported can be used by researchers and policy analysts to evaluate policy effects of changes in feed demand quantities within the livestock economy in Kenya. Moreover, these parameters can provide more reliable estimates of the total change in feed demand than relying on subjective measures of elasticities. Furthermore, the results of this study are essential in enhancing gender equitable policy formulation. Our findings show that own price elasticities of demand for all the feed types are negative and less than unit in absolute value for the sample of farmers surveyed, indicating that the feed types are relatively inelastic. The cross-price elasticities indicate that vegetables and grain are compliments while the rest of the poultry feed types are substitutes. The results also show that there are substantial gender differences in feed demand and elasticities of feed demand with respect to feed prices. [ABSTRACT FROM AUTHOR]

Climate variability and its impacts affect different members of gender groups in households and society differently. Within the pastoral community, women are more vulnerable, being among the poorest of the poor, and they are expected to be highly susceptible to climate variability effects. This study assesses gender perceptions of climate variability among pastoral and agro-pastoral communities in Marsabit County, Kenya. Results were triangulated with the use of data-collection techniques, including focused group discussions, individual interviews and field observations. These methods were used to analyse whether there is a difference in factors that determine the community perceptions of climate variability and trends by gender among the Marsabit pastoralist community. In analysing the study's data, descriptive and inferential statistics were employed. The findings indicate that respondents' perceptions of climate variability in the study area varied by gender, marital status and ethnic groups. The study reveals an increased workload of 48% for women and 32% for men resulting from climate impacts on daily household activities. In addition, the study found that 63% of male respondents primarily take on the role of decision-makers for their families, while 38% primarily serve as providers. In addition, 29% of male participants are responsible for providing security and 17% for managing family concerns within the community. In contrast, 33% of the female respondents predominantly fulfil the role of household domestic managers. The analysis further reveals that 90.3% of female and 86.8% of male respondents have noticed a decrease in rain received over time in the past two decades. This was reported to cause a burden on the most vulnerable members of the community, particularly women, by requiring them to travel long distances in search of water for household use. Gender and age affect who can access and control natural resources and household goods. This, in turn, affects the ability of pastoral and agro-pastoral communities to adapt, make a living and do other social and economic activities. The study recommends that, for climate impact adaptation measures to work, the community needs to put strategies that consider the different strengths, weaknesses and vulnerabilities of pastoral women and youth. Enactment and enforcement of gender-proactive policies and legislation that promote gender equity at the county level is highly recommended. The study further recommends using conventional weather forecasting to fill in the gaps left by the Indigenous Technical Knowledge Predictions. As a result, this study suggests that the public should be involved in creating agro-weather and climate advisories to lower vulnerability, boost resilience, boost productivity and ultimately improve the ability to adapt to climate impacts. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Given the disparities in gender representation, efforts are needed to make engineering education more inclusive and attractive to young people. It is important that those entering engineering education are making this decision with sufficient understanding of what it means to be an engineer. This study explored how lower secondary education students from Ireland (n = 435), Kenya (n = 436), and Sweden (n = 361) stereotyped engineers, and their interest in becoming an engineer was examined. The Draw an Engineer Test was used to achieve this, and ordinal and logistic regression analyses were conducted to compare the effects of students' genders and country of schooling on the genders and concepts of their drawn engineers, and on their interest in becoming an engineer in the future. Results: A Sankey diagram illustrated significant complexity in the interaction between conceptions of engineering work and fields of engineering. Chi-square tests of association were used to examine the association between students depicting an engineer as either the same or a different gender to themselves and their interest in becoming an engineer. The results of these and the regression analyses indicate that young people's gender explains more variance in the gender of drawn engineers and the country they are studying in explains more variance in their conception of engineers. However, most variance was explained when both students' gender and country of study were considered together. Further, particularly for young females, drawing a female engineer as opposed to a male engineer was positively associated with increased interest in becoming an engineer. Conclusions: There is a need to develop a greater understanding of engineering in young people to ensure they have sufficient information to make decisions regarding related educational pursuits. National-level attempts are needed to present accurate depictions of engineering, and effort needs to be invested in ensuring that young females can identify as engineers. Higher educational access needs to be considered in future work examining future career interests. [ABSTRACT FROM AUTHOR]

Small ruminant production facets like decision-making, ownership, labour allocation, access to- and control over assets are gendered. This study investigates intra-household gender dynamics and practices around sheep and goat production among smallholder farmers in South East region of Kenya. A quantitative study was conducted on 358 dual-headed (married) households to generate gender-disaggregated data on ownership, decision-making and labour allocation around small ruminant production. Qualitative data was collected through focused group discussions to bring out the community perspectives. From the findings, the average number of small ruminants owned by the households as reported by men was slightly higher than women. The average number of small ruminants solely owned by men was significantly higher than by women. Men reported a relatively higher number of jointly owned small ruminants compared to women. More women than men reported that they could give as a gift, sell-off and slaughter jointly owned small ruminants without consulting their spouses. Small ruminants were considered the most important livestock asset in supporting a household's livelihood by relatively more women than men. Men had more decision-making autonomy over jointly owned small ruminants compared to women. Production tasks around small ruminants such as feeding, watering, selling milk and cleaning housing structures were mostly performed by the women. Qualitative data identified men as the de facto owners of small ruminants with a higher power position in making the important production decisions. The study offers three implications on the design of livestock interventions to empower women, the interventions should ensure that; 1) women are not just owners of livestock assets but also share power and decision-making rights in all aspects of production, 2) production labour is shared equitably between men and women and, 3) women access benefits from livestock production even when animals are owned by men. [ABSTRACT FROM AUTHOR]

Background: The prevalence of malaria parasites in adults in Africa is less well researched than in children. Therefore, a demographic surveillance site was used to conduct a household survey of adults in the malaria endemic area of Maseno division in Kisumu County near Lake Victoria. Methods: A random survey of 1,190 adults living in a demographic health surveillance site in a malaria endemic area of 70,805 population size was conducted, measuring presence of malaria parasites by slide microscopy. Data were analysed using STATA to calculate the prevalence of malaria and associated risk factors. Results: The adult prevalence of presence of malaria parasites in Maseno was 28% (95% CI: 25.4-31.0%). Gender was a significant sociodemographic risk factor in both univariate (OR 1.5, p = 0.005) and multivariate (OR 1.4, p = 0.019) analyses. Females were 50% more likely to have malaria than men. Conclusions: Presence of malaria parasites is common in the adult population of this endemic area, and the rate is greatly increased in women. The presence of such an adult pool of malaria parasites represents a key reservoir factor in transmission of parasites to children, and is relevant for plans to eradicate malaria. [ABSTRACT FROM AUTHOR]

Copyright of ÖZP - Österreichische Zeitschrift für Politikwissenschaft is the property of Oesterreichische Zeitschrift fur Politikwissenschaft and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Health workers' compliance with outpatient malaria case-management guidelines has been improving in Africa. This study examined the factors associated with the improvements. Methods: Data from 11 national, cross-sectional health facility surveys undertaken from 2010–2016 were analysed. Association between 31 determinants and improvement trends in five outpatient compliance outcomes were examined using interactions between each determinant and time in multilevel logistic regression models and reported as an adjusted odds ratio of annual trends (T-aOR). Results: Among 9,173 febrile patients seen at 1,208 health facilities and by 1,538 health workers, a higher annual improvement trend in composite "test and treat" performance was associated with malaria endemicity-lake endemic (T-aOR = 1.67 annually; p<0.001) and highland epidemic (T-aOR = 1.35; p<0.001) zones compared to low-risk zone; with facilities stocking rapid diagnostic tests only (T-aOR = 1.49; p<0.001) compared to microscopy only services; with faith-based/non-governmental facilities compared to government-owned (T-aOR = 1.15; p = 0.036); with a daily caseload of >25 febrile patients (T-aOR = 1.46; p = 0.003); and with under-five children compared to older patients (T-aOR = 1.07; p = 0.013). Other factors associated with the improvement trends in the "test and treat" policy components and artemether-lumefantrine administration at the facility included the absence of previous RDT stock-outs, community health workers dispensing drugs, access to malaria case-management and Integrated Management of Childhood Illness (IMCI) guidelines, health workers' gender, correct health workers' knowledge about the targeted malaria treatment policy, and patients' main complaint of fever. The odds of compliance at the baseline were variable for some of the factors. Conclusions: Targeting of low malaria risk areas, low caseload facilities, male and government health workers, continuous availability of RDTs, improving health workers' knowledge about the policy considering age and fever, and dissemination of guidelines might improve compliance with malaria guidelines. For prompt treatment and administration of the first artemether-lumefantrine dose at the facility, task-shifting duties to community health workers can be considered. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Ecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

HIV-related stigma is a frequently cited barrier to HIV testing and care engagement. A nuanced understanding of HIV-related stigma is critical for developing stigma-reduction interventions to optimize HIV-related outcomes. This qualitative study documented HIV-related stigma across eight communities in east Africa during the baseline year of a large HIV test-and-treat trial (SEARCH, NCT: 01864603), prior to implementation of widespread community HIV testing campaigns and efforts to link individuals with HIV to care and treatment. Findings revealed experiences of enacted, internalized and anticipated stigma that were highly gendered, and more pronounced in communities with lower HIV prevalence; women, overwhelmingly, both held and were targets of stigmatizing attitudes about HIV. Past experiences with enacted stigma included acts of segregation, verbal discrimination, physical violence, humiliation and rejection. Narratives among women, in particular, revealed acute internalized stigma including feelings of worthlessness, shame, embarrassment, and these resulted in anxiety and depression, including suicidality among a small number of women. Anticipated stigma included fears of marital dissolution, verbal and physical abuse, gossip and public ridicule. Anticipated stigma was especially salient for women who held internalized stigma and who had experienced enacted stigma from their partners. Anticipated stigma led to care avoidance, care-seeking at remote facilities, and hiding of HIV medications. Interventions aimed at reducing individual and community-level forms of stigma may be needed to improve the lives of PLHIV and fully realize the promise of test-and-treat strategies. [ABSTRACT FROM AUTHOR]

Background: In many African settings, gender strongly influences household treatment-seeking and decision-making for childhood illnesses. While mothers are often the primary engagers with health facilities, their independence in illness-related decisions is shaped by various factors. Drawing on a gender lens, we explored treatment-seeking pathways pre- and post-hospital admission for acutely ill young children living in low income settlements in Nairobi, Kenya; and the gendered impact of child illness both at the household and health system level. Methods: Household members of 22 children admitted to a public hospital were interviewed in their homes several times post hospital discharge. In-depth interviews covered the child's household situation, health and illness; and the family's treatment-seeking choices and experiences. Children were selected from an observational cohort established by the Childhood Acute Illness and Nutrition (CHAIN) Network. Results: Treatment-seeking pathways were often long and complex, with mothers playing the key role in caring for their children and in treatment decision-making. Facing many anxieties and dilemmas, mothers often consulted with significant influencers - primarily women - particularly where illnesses were prolonged or complex. In contrast to observations in rural African contexts, fathers were less prominent as influencers than (often female) neighbours, grandparents and other relatives. Mothers were sometimes blamed for their child's condition at home and at health facilities. Children's illness episode and associated treatment-seeking had significant gendered socio-economic consequences for households, including through mothers having to take substantial time off work, reduce their working hours and income, or even losing their jobs. Conclusion: Women in urban low-income settings are disproportionately impacted by acute child illness and the related treatment-seeking and recovery process. The range of interventions needed to support mothers as they navigate their way through children's illnesses and recovery include: deliberate engagement of men in child health to counteract the dominant perception of child health and care as a 'female-domain'; targeted economic strategies such as cash transfers to safeguard the most vulnerable women and households, combined with more robust labour policies to protect affected women; as well as implementing strategies at the health system level to improve interactions between health workers and community members. [ABSTRACT FROM AUTHOR]

There has been a growing interest in laws governing resources particularly land in reference to gender in Africa. Law reforms in relation to land have produced potentially useful regulations and espoused egalitarian land rights. However, the backdrop to these reforms contains a scene of land disputes, resistance to laws, violence against women and poor enforcement leading to injustices to women with a pervasive effect on families in vulnerable communities. Using focused ethnographic research methods, the writer investigated women’s land rights between November 2015 and August 2016. In-depth interviews, focus group discussions, review of archival records and observations were utilised. The study found that in contexts of prolonged livelihood vulnerabilities, as in the case of the Luo people of south-western Kenya, women seeking refuge from livelihood difficulties employ two strategies to anchor their security. They migrate from marital homes to fishing villages and also lay claim to marital land, which is held by men according to customary laws. These strategies produce social dilemmas and risky manoeuvering. Statutory land laws that are enacted to mitigate land related conflicts undermine the existing customary land laws that advantage men. Therefore, women’s land claims, and statutory land laws that espouse equality in land ownership, destabilise men’s sense of masculinity. By drawing on the experiences of women, I show the intersection between land laws, enduring injustices and gender relations in a context of strained livelihoods. [ABSTRACT FROM AUTHOR]

Copyright of Arxiu d'Etnografia de Catalunya is the property of Universitat Rovira I Virgili and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Soil degradation, a serious environmental problem in many developing countries, often necessitates the use of fertilizers to improve crop yields. However, smallholders usually do not have sufficient information about their soil nutrient levels to make profit‐maximizing decisions about fertilizer usage. We conducted two‐round experimental auctions to determine whether providing information and fertilizer recommendations from inexpensive soil testing kits to farmers in western Kenya affected their behavior and ability to optimize their input choices. We auctioned organic and inorganic agricultural inputs, dividing farmers into information treatments, and analyzed the data using double and triple difference estimations. We find that providing soil information has significant effects on farmers' willingness to pay for inputs. We then use Monte Carlo simulations to show that there is potential for high net benefits to farmers from individualized soil tests. These results suggest that soil testing can be a cost‐effective method to increase food security in the region. [ABSTRACT FROM AUTHOR]

Malaria drug resistance is a global public health concern. Though parasite mutations have been associated with resistance, other factors could influence the resistance. A robust surveillance system is required to monitor and help contain the resistance. This study established the role of travel and gender in dispersion of chloroquine resistant genotypes in malaria epidemic zones in Kenya. A total of 1,776 individuals presenting with uncomplicated malaria at hospitals selected from four malaria transmission zones in Kenya between 2008 and 2014 were enrolled in a prospective surveillance study assessing the epidemiology of malaria drug resistance patterns. Demographic and clinical information per individual was obtained using a structured questionnaire. Further, 2 mL of blood was collected for malaria diagnosis, parasitemia quantification and molecular analysis. DNA extracted from dried blood spots collected from each of the individuals was genotyped for polymorphisms in Plasmodium falciparum chloroquine transporter gene (Pfcrt 76), Plasmodium falciparum multidrug resistant gene 1 (Pfmdr1 86 and Pfmdr1 184) regions that are putative drug resistance genes using both conventional polymerase chain reaction (PCR) and real-time PCR. The molecular and demographic data was analyzed using Stata version 13 (College Station, TX: StataCorp LP) while mapping of cases at the selected geographic zones was done in QGIS version 2.18. Chloroquine resistant (CQR) genotypes across gender revealed an association with chloroquine resistance by both univariate model (pD0:027) and by multivariate model (p D 0:025), female as reference group in both models. Prior treatment with antimalarial drugs within the last 6 weeks before enrollment was associated with carriage of CQR genotype by multivariate model (pD0:034). Further, a significant relationship was observed between travel and CQR carriage both by univariate model (pD0:001) and multivariate model (p D 0:002). These findings suggest that gender and travel are significantly associated with chloroquine resistance. From a gender perspective, males are more likely to harbor resistant strains than females hence involved in strain dispersion. On the other hand, travel underscores the role of transport network in introducing spread of resistant genotypes, bringing in to focus the need to monitor gene flow and establish strategies to minimize the introduction of resistance strains by controlling malaria among frequent transporters. [ABSTRACT FROM AUTHOR]

This study sought to examine gender effect of entrepreneurial orientation on dairy farming career resilience in Kenya. Specifically, the study examined the moderating role of gender on the relationship between future orientation (FO), market orientation (MO), risk-taking orientation (RO), social orientation (SO) and entrepreneurial resilience of dairy agripreneurs in Kenya. We surveyed 682 respondents; 480 males and 202 female dairy agripreneurs in Murang'a County, Kenya using a cross-sectional study design. Data was collected using semi-structured questionnaire using personal interview. Data were analysed using partial least square-structural equation modelling PLS-SEM and multi-group analysis (MGA). Results show significant gender differences across the agripreneurial orientations. The direct effects relationships indicate that future, market and risk-taking orientation of female agripreneurs had a positive and significant impact on agripreneurial resilience (AR). While, for male agripreneurs, future and market orientation had a positive and significant impact on AR; but social orientation had a negative impact on AR. Gender moderates the entrepreneurial orientation-agripreneurial career resilience relationship whereby female agripreneurs had statistically significant higher risk-taking propensity of (β = 0.189, p = 0.06) compared to their male counterparts (β = 0.054, p = 0.06). [ABSTRACT FROM AUTHOR]

This article presents a case study of research in Dadaab, Kenya to highlight some of the relevant challenges encountered while conducting gender-based violence research in humanitarian settings. A longitudinal mixed-methods design was used to evaluate a comprehensive case-management intervention in the refugee complex near the border of Kenya and Somalia. We present an overview of both expected and unexpected challenges during preparation and implementation of the research, adaptations made to the research design, and lessons learned for future research in similar contexts. Some of the key challenges were attributed to the highly securitized and remote environment of Dadaab refugee camp, like many refugee camp settings, which created limitations for sampling designs, interview locations, and also created particular burdens for the research team members conducting interviews. In addition to the camp environment, the dynamic nature of events and trends in the camp setting created barriers to follow-up with longitudinal cohort participants as well as uncertainty on how to plan for future implementation of research design phases in response to camp changes. Conducting research in humanitarian settings requires a flexible approach to accommodate the challenges that can impact both service delivery and research activities. The discussion presented in this article contributes to the evolving practical guidance on conducting research in humanitarian settings. [ABSTRACT FROM AUTHOR]

Purpose: To date, there has been insufficient focus on age and sex differences in studies of violence amongst adolescents and young adults in low- and middle-income countries. As adolescence is a formative period during which experiencing violence can have both short- and long-term consequences, we aim to investigate experiences of violence by age and sex across five countries. Methods: Incidences of past-year violence victimization were estimated by sex across two-year age bands (13–24 years) using Violence Against Children Survey datasets from Cambodia, Haiti, Kenya, Malawi, and Tanzania. Analyses were conducted separately for each country. The presence of an association with age and each type of violence was identified using logistic regressions separately by sex. Sex was then added to the models as an interaction term and adjusted Wald tests were used to assess differences between males and females in age effects. Results: Risk of physical violence by both an adult caregiver and a community member decreased with age for both sexes in all countries. In contrast, risk of IPV increased with age for both sexes in all countries. Although some countries displayed a steeper increase in risk of IPV and sexual violence with age for males, females face higher overall levels of risk for these forms of violence. Conclusion: Findings highlight how adolescents’ and young adults’ risk of violence changes with age and type of violence. The analysis underscores the importance of collecting violence data disaggregated by age and sex to best inform policies and programming. Implications and contributions: We analyzed five Violence Against Children Surveys (VACS) and found age effects for physical, sexual, and intimate partner violence for adolescents 13–24 years old. Age effects for sexual violence are stronger among females than males. Future policies targeting adolescents should consider how age and gender influence risk of violence. [ABSTRACT FROM AUTHOR]

Women comprise a significant proportion of the health workforce globally but remain under-represented in the higher professional categories. Concern about the under-representation of women in health leadership positions has resulted in increased research on the topic, although this research has focused primarily on high-income countries. An improved understanding of the career trajectories and experiences of healthcare leaders in low- and middle-income countries (LMICs), and the role of gender, is therefore needed. This qualitative case study was undertaken in two counties in coastal Kenya. Drawing on the life-history approach, 12 male and 13 female healthcare leaders were interviewed between August 2015 and July 2016 on their career progression and related experiences. Although gender was not spontaneously identified as a significant influence, closer exploration of responses revealed that gendered factors played an important role. Most fundamentally, women's role as child bearers and gendered societal expectations including child nurturing and other domestic responsibilities can influence their ability to take up leadership opportunities, and their selection and appointment as leaders. Women's selection and appointment as leaders may also be influenced by positive discrimination policies (in favour of women), and by perceptions of women and men as having different leadership styles (against women, who some described as more emotive and reactive). These gendered influences intersect in relatively invisible ways with other factors more readily identified by respondents to influence their progression and experience. These factors included: professional cadre, with doctors more likely to be selected into leadership roles; and personal and professional support systems ranging from family support and role models, through to professional mentorship and continuing education. We discuss the implications of these findings for policy, practice and research, including highlighting the need for more in-depth intersectionality analyses of leadership experience in LMICs. [ABSTRACT FROM AUTHOR]

In addition to Intra-household resource allocations and internal dynamics of decision-making, gendered perceptions on household food security play a critical role in households' nutritional status, especially in developing countries. However, evidence on the role of gender-based perceptions on households' food security and related implications on the households' nutritional status is limited. This study examines the determinants of gender-disaggregated household food security perceptions among smallholder farming households. We used two panels of data from households in eastern and western Kenya and employ the House hold Food Insecurity Access Scale to measure perceptions of household food insecurity, and the random effects generalized ordered probit model to evaluate the determinants of security perceptions across gender. The results reveal that the factors that influence food security perceptions vary across gender. The education level of household head and the number of relatives were negatively associated with female perceptions of household food insecurity, whereas the household dependency ratio was positively associated with female perceptions of household food insecurity. In contrast, age and gender of household head were positively correlated with male perception of household food insecurity. The findings suggest that gender matters in household food security perceptions and that the determinants of the food security perceptions vary across gender. [ABSTRACT FROM AUTHOR]

Copyright of Review of African Political Economy is the property of Review of Political Economy (ROAPE) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Malaria remains a major health and development challenge in the sub-Saharan African economies including Kenya, yet it can be prevented. Technologies to prevent malaria are available but are not universally adopted by male- and female-headed households. The study thus, examined the role of gender in malaria prevention, examining adoption behaviour between male- and female-headed households in Kenya. Methods: The study uses a recent baseline cross-section survey data collected from 2718 households in parts of western and eastern Kenya. Two separate models were estimated for male- and female-headed households to determine if the drivers of adoption differ between the two categories of households. Results: The findings from the study show that: access to public health information, residing in villages with higher experience in malaria prevention, knowledge on the cause and transmission of malaria significantly increase the number of practices adopted in both male- and female-headed households. On the other hand, formal education of the household head and livestock units owned exhibited a positive and significant effect on adoption among maleheaded households, but no effect among female-headed households. Conclusions: The findings from thus study suggest that universal policy tools can be used to promote uptake of integrated malaria prevention practices, for female- and male-headed households. [ABSTRACT FROM AUTHOR]

Background: Repeat household surveys are useful to assess change in prevalence over time, but there have been no repeat surveys of common mental disorder (CMD) in Kenya, or indeed sub-Saharan Africa. Therefore a repeat household survey of CMD and its associated risk factors was conducted in Maseno area, Kisumu county in Kenya, using a demographic surveillance site as the sample frame, in order to test the hypotheses that (a) the prevalence of CMD would increase between 2004 and 2013 due to the intervening political, social and economic pressures; (b) as in 2004, there would be no gender difference in prevalence of CMD. Methods: One thousand one hundred ninety households were selected, and 1158 adult participants consented to be interviewed with a structured epidemiological assessment while 32 refused to participate in the study interviews, giving a response rate of 97.3 %. Results: The study found that the overall prevalence of CMD in 2013 was 10.3 %. However, there were significantly higher rates of having any CMD in 2013 if one was female (OR 6.2, p < 0.001), divorced/widowed (OR 2.5, p < 0.003), aged over 60 (OR 2.3, p = 0.052), either self-employed (OR 3.3 p < 0.001) or employed (OR 3.3, p < 0.001), or belonged to the lowest asset quintile (OR 2.5, p = .0.004) after adjusting for other variables significant at the bivariate level. The overall prevalence in 2013 was consistent with that found in 2004, despite intervening political and community turbulence. However, this apparent consistency masks the development of a striking difference in prevalence between the genders. Over the decade 2004-13, the prevalence for men dropped from 10.9 to 3.8 % (P = 0.001) and the prevalence for women increased from 10.8 to 17.5 % (p = 0.001). Conclusion: Common mental disorders continue to pose a significant public health burden in Kenya, and gender related vulnerability merits further research and is relevant for health worker training. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to describe the physical, social, and psychological initiation practices of street connected children and youths, in Eldoret, western Kenya. Methods: This qualitative study was conducted from August 2013 to February 2014. A total of 65 SCCY aged 11-24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth atMoi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside "bases/ barracks"; 3) Street youth community-based organizations. In-depth interviews and focus group discussions were used to collect data. All data were audio recorded, transcribed, translated to English, and a content analysis performed. Results: The overall median age was 18 years (IQR 14-20.5 years) and 69.2 % of participants were male. None had gone beyond primary level of education. The majority (81.5 %) reported to be sexually active. The street community had well-defined structures and rules that were protective of members and ensured survival on the streets. To be fully accepted children had to go through an initiation ritual that had important gender differences. Common rituals between males and females included interrogation, smearing of black soot, and payment of tax. Ritual practices unique to boys were physical abuse, theft of personal possessions, volatile substance use, being forced to eat garbage, and sodomy among the physically weak. Rituals unique to girls were being forced to 'become a wife or sexual partner', rape, and gang rape. Physical and psychological abuse during initiation was normalized and there were no clear mechanisms of dealing with these forms of abuse. Conclusion: There were important gender differences in the initiation practices of SCCY. Normalization of physical and psychological abuse during initiation contributes to the high health risks faced by these SCCY. Appropriate interventions need to be developed in collaboration with SCCY. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Market-based development efforts frequently create opportunities to generate income from goods previously produced and consumed within the household. Production within the household is often characterized by a gender and age division of labor. Market development efforts to improve well-being may lead to unanticipated outcomes if household production decisions are noncooperative. We develop and test models of household decision making to investigate intrahousehold decision making in a nomadic pastoral setting from Kenya. Our results suggest that household decisions are contested, with husbands using migration decisions to resist wives' ability to market milk. [ABSTRACT FROM AUTHOR]

We explore how seed systems enhance access to seeds, and information for climate-change adaptation in farming communities in Kenya, Tanzania and Uganda, as well as how gender-driven roles and institutional dynamics influence the process. Men and women farmers equally experience climate-change related effects, including drought, short rainy seasons and increased pest and disease incidence. Our study relies on exploratory data analysis of 1001 households surveyed in four sites in 2016. Farmers surveyed preferred early-maturing, heat-tolerant, high-yielding, and pest- and disease-resistant varieties, all important climate-adaptive traits. Seed systems of the focus crops studied are largely informal—overall, 68% women and 62% men use their own seed, indicating women's higher reliance on 'informal' seed and information sources. Only 21% of respondents reported interacting with seed experts who are affiliated with formal organizations. Both formal and informal organizations play a key role in providing access to climate-adapted seed/information, with access for men and women varying across the countries studied. There is a need to support further development of those connections, building on existing social networks. We conclude that inclusive and gender-responsive context- and country-specific seed interventions will ensure equitable outcomes, increase women's empowerment and strengthen both formal and informal seed systems for more effective climate-change adaptation. [ABSTRACT FROM AUTHOR]

This study analyzes the factors that influence the probability and extent of the adoption of mungbean production technologies in Tanzania, Kenya and Uganda, using multivariate probit and Poisson regression models. The results show that the probability and extent of the adoption of mungbean production technologies are influenced by gender of the household, household size, farm size, livestock size, household assets, access to extension services and access to credit. The study suggests that policy interventions that aimed at targeting women farmers, increasing household asset and information dissemination, such as field demonstrations and training programs, are crucial in enhancing technology adoption among smallholder farmers. [ABSTRACT FROM AUTHOR]

Rift Valley fever (RVF) is a zoonotic disease of great public health and economic importance transmitted by mosquitoes. The main method of preventing the disease is vaccination of susceptible livestock before outbreaks occur. Studies on RVF vaccines have focused on the production processes, safety, and efficacy standards but those on uptake and adoption levels are rare. This study sought to understand the barriers faced by men and women farmers in the uptake of livestock vaccines to inform strategies for optimizing the use of vaccines against RVF in East Africa. The cross-sectional qualitative study utilized the pairwise ranking technique in sex disaggregated focus group discussions to identify and rank these barriers. Results indicate that men and women farmers experience barriers to vaccine uptake differentially. The barriers include the direct and indirect cost of vaccines, distances to vaccination points, availability of vaccination crushes, intra-household decision making processes and availability of information on vaccination campaigns. The study concludes that vaccine provision does not guarantee uptake at the community level. Hence, these barriers should be considered while designing vaccination strategies to enhance community uptake because vaccine uptake is a complex process which requires buy-in from men and women farmers, veterinary departments, county/district and national governments, and vaccine producers. [ABSTRACT FROM AUTHOR]

Background: Despite being a priority population for HIV prevention and harm reduction programs, the sexual and reproductive health (SRH) needs of women who inject drugs are being overlooked. Furthermore, models for providing integrated SRH, HIV, and harm reduction services for women who inject drugs are rare. This article reports the development of community-based outreach services that integrated family planning and other SRH interventions with HIV and harm reduction services for this population in coastal Kenya. Methods: Using mixed-methods implementation research, a qualitative baseline needs assessment was conducted with women who inject drugs and harm reduction stakeholders using a combination of in-depth interviews and focus group discussions. The qualitative data from participants was subjected to thematic analysis using Nvivo. Based on the baseline needs assessment, integration of SRH into existing HIV and harm reduction services was implemented. After two years of implementation, an evaluation of the program was conducted using a combination of qualitative interviews and review of quantitative service delivery records and other program documents. The process, impacts, and challenges of integrating SRH into a community-based HIV prevention and harm reduction program were identified. Results: This article highlights: 1) low baseline utilization of family planning services among women who inject drugs, 2) improved utilization and high acceptability of outreach-based provision of SRH services including contraception among this population, 3) importance of training, capacity strengthening, technical support and financial resourcing of community-based organizations to integrate SRH into HIV prevention and harm reduction services, and 4) the value of beneficiary involvement, advocacy, and collaboration with other partners in the planning, designing and implementing of SRH interventions for women who inject drugs. Conclusions: Women who inject drugs in this study had low utilization of family planning and other SRH services, which can be improved through the integration of contraceptive and other SRH interventions into existing outreach-based HIV prevention and harm reduction programs. This integration is acceptable to women who inject drugs, and is programmatically feasible. For successful integration, a rights-based beneficiary involvement, coupled with sustainable technical and financial capacity strengthening at the community level is essential. [ABSTRACT FROM AUTHOR]

Background: Health inequity has mainly been linked to differences in economic status, with the poor facing greater challenges accessing healthcare than the less poor. To extend financial coverage to the poor and vulnerable, Kenya has therefore implemented several pro-poor health policy reforms. However, other social determinants of health such as gender and disability also influence health status and access to care. This study employed an intersectional approach to explore how gender disability and poverty interact to influence how poor women in Kenya benefit from pro-poor financing policies that target them. Methods: We applied a qualitative cross-sectional study approach in two purposively selected counties in Kenya. We collected data using in-depth interviews with women with disabilities living in poverty who were beneficiaries of the health insurance subsidy programme and those in the lowest wealth quintiles residing in the health and demographic surveillance system. We analyzed data using a thematic approach drawing from the study's conceptual framework. Results: Women with disabilities living in poverty often opted to forgo seeking free healthcare services because of their roles as the primary household providers and caregivers. Due to limited mobility, they needed someone to accompany them to health facilities, leading to greater transport costs. The absence of someone to accompany them and unaffordability of the high transport costs, for example, made some women forgo seeking antenatal and skilled delivery services despite the existence of a free maternity programme. The layout and equipment at health facilities offering care under pro-poor health financing policies were disability-unfriendly. The latter in addition to negative healthcare worker attitudes towards women with disabilities discouraged them from seeking care. Negative stereotypes against women with disabilities in the society led to their exclusion from public participation forums thereby limiting their awareness about health services. Conclusions: Intersections of gender, poverty, and disability influenced the experiences of women with disabilities living in poverty with pro-poor health financing policies in Kenya. Addressing the healthcare access barriers they face could entail ensuring availability of disability-friendly health facilities and public transport systems, building cultural competence in health service delivery, and empowering them to engage in public participation. [ABSTRACT FROM AUTHOR]