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Maternal healthcare is a global agenda. Kenya introduced free maternity services (FMS) in 2013 to allow women to give birth for free in all government public health facilities. The introduction of FMS was timely due to the high maternal mortality rate in Kenya. FMS was also introduced to fulfil the Jubilee Party government's elections campaign promises. It is, however, not known how primary beneficiaries and health providers perceived the FMS roll-out following the presidential directive in 2013. This article aims to explore the roles of political contestations in FMS as a social protection scheme in Kenya. In this qualitative ethnographic study in Kilifi County, we interviewed the mothers who utilised FMS and the health workers who implemented the policy. The data gathered was analysed contextually and thematically. The prevailing narrative from the health services professionals and the mothers who participated in our study is that FMS is 'the president's thing' and has a clear political orientation; it is seen as deceiving the public in two ways: first by shrouding political interests, and second by adding to the burden of women, as delivery was not free – all the other services and medication before and after birth came at a cost. Health workers feel helpless and frustrated and, in most cases, they have to cope with meagre resources to ensure safe births. In some cases, quality of care is compromised due to supply-side constraints. This article shows how social protection has been used to gain political mileage and has not considered the local needs of the maternal healthcare system. [ABSTRACT FROM AUTHOR]

Medical male circumcision has been shown to reduce the risk of heterosexual transmission of HIV infection in men by up to 60% in three randomised controlled trials. However, not much anthropological literature exists to provide a holistic understanding of sexual behaviour among migrating fishermen who have been circumcised. This qualitative study used cultural ecology theory and anthropological methods to develop a more holistic understanding of Luo fishermen's sexual behaviour after circumcision when they migrate (wimbo) to islands in western Kenya. Results from focus-group discussions show that duringwimbothere is a deviation from community norms governing sexual expression, influenced by the belief that circumcision provides protection against HIV infection. Through the exchange of sex for fish, circumcised men access new sexual partners in the destination beaches and engage in risky sexual behaviours without any HIV prevention measures. The processes and practices associated withwimbomay therefore help explain why rates of HIV infection are increasing among fisherfolk despite new interventions to combat HIV. These results have relevant implications for HIV-related intervention and policy in sub-Saharan Africa. [ABSTRACT FROM PUBLISHER]

Urban and rural areas have distinctive health problems, which require consideration. To examine sociocultural features of cholera and its community context, a semi-structured explanatory model interview based on vignettes depicting typical clinical features of cholera was used to interview 379 urban and rural respondents in Western Kenya. Findings included common and distinctive urban and rural ideas about cholera, and its prevention and treatment. The three most commonly perceived causes among urban and rural respondents collectively were drinking contaminated water, living in a dirty environment and lacking latrines. However, a dirty environment and flies were more prominently perceived causes among urban respondents. Rural respondents were less likely to identify additional symptoms and more likely to identify biomedically irrelevant perceived causes of cholera. Oral rehydration therapy was the most frequently reported home treatment. Health facilities were recommended unanimously at both sites. For prevention, rural respondents were more likely to suggest medicines, and urban respondents were more likely to suggest health education and clean food. Findings indicate community priority, demand for and potential effectiveness of enhanced efforts to control cholera in Western Kenya, and they suggest strategies that are particularly well suited for control of cholera in urban and rural areas. [ABSTRACT FROM PUBLISHER]

Large-scale surveys have reported that about 55% of orphans worldwide are adolescents. In Kenya, the majority of HIV-infected adolescents are females. The current study used the anthropological methods of in-depth case studies to analyse how migratory life situations of individual female adolescent orphans in the Luo community of Western Kenya may increase their exposure to HIV. The study shows that the ability of the female adolescent orphans to adopt risk-preventive behaviour in relation to HIV is determined by a range of factors beyond their control of individual sexual behaviour. Although analysis of a single case study limits generalisation of the findings, the results provide insights into the reason for sex differentials in HIV infection rates among adolescents as reported in some large-scale surveys. The paper recommends that HIV prevention strategies for adolescents should examine the specific life situations of female orphans by focusing on the impacts of HIV and AIDS and poverty on the protective role of the family. It also recommends that keeping female adolescent orphans in school or in vocational training can be an effective HIV prevention strategy for them. [ABSTRACT FROM AUTHOR]