Anne Khasakhala

Decomposing Kenyan socio-economic inequalities in skilled birth attendance and measles immunization

IntroductionSkilled birth attendance (SBA) and measles immunization reflect two aspects of a health system. In Kenya, their national coverage gaps are substantial but could be largely improved if the total population had the same coverage as the wealthiest quintile. A decomposition analysis allows identifying the factors that influence these wealth-related inequalities in order to develop appropriate policy responses. The main objective of the study was to decompose wealth-related inequalities in SBA and measles immunization into their contributing factors.MethodsData from the Kenyan Demographic and Health Survey 2008/09 were used. The study investigated the effects of socio-economic determinants on [1] coverage and [2] wealth-related inequalities of SBA utilization and measles immunization. Techniques used were multivariate logistic regression and decomposition of the concentration index (C).ResultsSBA utilization and measles immunization coverage differed according to household wealth, parent’s education, skilled antenatal care visits, birth order and father’s occupation. SBA utilization further differed across provinces and ethnic groups. The overall C for SBA was 0.14 and was mostly explained by wealth (40%), parent’s education (28%), antenatal care (9%), and province (6%). The overall C for measles immunization was 0.08 and was mostly explained by wealth (60%), birth order (33%), and parent’s education (28%). Rural residence (−19%) reduced this inequality.ConclusionBoth health care indicators require a broad strengthening of health systems with a special focus on disadvantaged sub-groups.

Factors influencing union formation in Nairobi, Kenya

Using retrospective data from the Urban Integration Survey conducted in 2001 in Nairobi, Kenya, on a sample of 955 women and men aged 25-54, this paper compares factors influencing entry into union formation for men and women. The analysis uses event history methods, specifically Cox Proportional Hazards regression, stratified by age cohort and run separately by sex. The results indicate that delay in union formation is more pronounced for women than for men. Cohabitation without formal marriage is the prominent form of union, especially among the younger generation, and appears to have increased. For men, the timing of union is more dependent upon human capital acquisition than on cultural factors. These findings show that the marriage search model, which was first applied in Western countries, can also hold in cities of developing countries. Nonetheless, neither the search model nor the integration or the independence models apply to womens union formation, which very few exogenous factors can explain.

FACTORS ASSOCIATED WITH RISKY SEXUAL BEHAVIOUR AMONG OUT-OF-SCHOOL YOUTH IN KENYA

This paper examines factors that may predispose unmarried and unemployed out-of-school youth to risky sexual behaviour. Data for analysis were derived from the Behaviour Surveillance Survey carried out in Kenya in late 2002. A total of 6129 male and female unmarried and unemployed out-of-school youth in the age range 15-24 years were successfully interviewed. However, for this paper only a sample of 3961 comprising sexually experienced youth in the 12 months preceding the survey was used. Methods of analysis included descriptive statistics and multinomial logistic regression. Results for males indicate that factors associated with low and high risk were whether they had fathered a child, district of residence and frequency of alcohol use, while current age and age at first sexual debut stood out for those with low risk alone. For females the district of residence and age of partner at sexual debut were the factors that predisposed them to low-risk sexual behaviour, while for high risk the district of residence, current age and ever being pregnant were significant. The results indicate that for these youth, contextual and probably social factors appear to be the main determinants of risky sexual behaviour for both males and females. The findings also support those of other studies that link risky sexual behaviour among youth, especially males, to alcohol consumption. Programmes for intervention therefore need to focus on these aspects. There is also a need for studies that can look at district-specific factors for more focused interventions.

Factors Influencing Couples’ Unmet Need for Contraception in Kenya

Many studies on unmet need have been women-based with some passing inferences made for men and couples yet reproductive decisions are not made by women alone, but are dyadic in nature. This paper examines couple’s unmet need for contraception in Kenya by using the married couple as the unit of analysis, rather than the individual man or woman. The paper specifically estimates couple’s unmet need and identifies factors that have influenced this. The data used is from the matched couple data derived from the Kenya Demographic and Health Survey, 1998 (KDHS). Only fecund couples in monogamous unions are included in the analysis. The results give the total couple’s unmet need of 16.5 percent (which is 7.5 percent lower than the level of unmet need for currently married women and 3.7 percent higher than the Bankole-Ezeh estimate of couples’ unmet need, using 1993 KDHS). About 7 percent of this accounted for unmet need for limiting while 9.8 percent accounted for unmet need for spacing. In terms of factors influencing couple’s unmet needs, region of residence, ethnicity, number of living children and couples’ discussion of and other reproductive health issues, were the most significant predictors of couples’ unmet need. In order to reduce the unmet need, region specific programs should be emphasized and that couple’s should be encouraged to make joint decisions on reproductive health issues.

Mortality Decline in Kenya: A Reexamination of Recent Under-Five Mortality Estimate

This study examined the extent of birth displacement and its effect on the under-five mortality estimates in Kenya. Using data from 2003 and 2008/09 Kenya Demographic and Health Surveys, we evaluate the variability of birth displacement by region and place of residence based on the survival status of the child. We compute birth ratios for children born in the 5th calendar year preceding each survey and note the possible effect on under-five mortality estimates. Results show that under-five mortality estimates in 2008/09 survey are smaller than that of a similar period in 2003 survey by 17 percent. Overall, birth ratios for the 5th calendar year were below 100 percent suggesting presence of birth displacement. However, there was no variance in the displacement between surviving and dead children, hence modest impact on the under-five mortality rate. Evidence suggests that the remarkable decline in the under-five mortality rate recorded in 2008/09 is a function of both overestimation of mortality rate in 2003 survey and underestimation in 2008/09 survey. We recommend that data from more than one source be used to interpret under-five mortality decline and further research should be conducted linking the observed mortality decline to the delivery of known effective interventions.

Mainstreaming HIV Interventions into Education Systems

The HIV epidemic continues to threaten the achievement of national developmental agendas and, by extension, the Millennium Development Goals, including the goals for education. The United Nation’s 2011 Political Declaration on HIV and AIDS set the ambitious target of halving by 2015 the percentages of young people below 15 years who had sexual intercourse (UNAIDS 2011). This and related goals are to be achieved largely by expanding access to children aged less than 15 years to information and education for the improvement of life skills. This strategy was based on the premise that education is a ‘window of hope’ and a social ‘vaccine’ against HIV since it equips individuals with knowledge necessary for survival (Hargreaves and Boler 2006; World Bank 2002). According to UNICEF (2002), the education sector shoulders the task of finding lasting solutions that mitigate the impacts of the HIV pandemic.