tag:theconversation.com,2011:/institutions/african-population-and-health-research-center-2107/articlesAfrican Population and Health Research Center2024-01-29T13:07:49Ztag:theconversation.com,2011:article/2183872024-01-29T13:07:49Z2024-01-29T13:07:49ZKenya’s healthcare workers abuse a third of teen mums from informal settlements – study<p>Adolescent pregnancy is a global public health concern: in <a href="https://data.unicef.org/topic/child-health/adolescent-health/">2022</a>, about 13% of girls and young women gave birth before the age of 18. </p>
<p>Compared with women in their early 20s, adolescents are more <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70179-7/fulltext?__scoop_post=9ef44560-18a4-11e5-90a9-001018304b75&__scoop_topic=1749219">susceptible</a> to maternal deaths. Pregnancy-related complications are among the leading causes of <a href="https://esaro.unfpa.org/en/topics/adolescent-pregnancy#:%7E:text=Early%20childbearing%2C%20high%20fertility%20rates,women%2020%20years%20and%20above.">death</a> among Africa’s adolescent girls. </p>
<p>Babies born to adolescent mothers in low- to middle-income countries also face an increased risk of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195731">neonatal deaths</a>, and pre-term and underweight birth. </p>
<p>These risks make it vital that pregnant girls feel comfortable seeking healthcare.</p>
<p>Adolescent pregnancy is an issue in Kenya, too, where <a href="https://data.unicef.org/topic/child-health/adolescent-health/">15%</a> of adolescent girls become mothers before the age of 18. Girls from the <a href="https://link.springer.com/content/pdf/10.1186/s12905-022-01986-6.pdf">poorest households</a> are more likely to become mothers than girls from the richest households. </p>
<p>As specialists in medical sociology and public health, we conducted a <a href="https://gh.bmj.com/content/bmjgh/8/11/e013268.full.pdf">survey</a> in 2022 of adolescent mothers in an informal settlement in Kenya. About a third reported that they had been abused by health providers during childbirth. The study found that abusive treatment <a href="https://gh.bmj.com/content/bmjgh/8/11/e013268.full.pdf">discouraged</a> these girls from seeking future maternity care at healthcare facilities. </p>
<p>This matters for several reasons. One is that <a href="https://bmcpregnancychildbirth.biomedcentral.com/counter/pdf/10.1186/1471-2393-13-18.pdf">facility-based childbirths</a> have a lower neonatal mortality rate than home childbirths. Maternal deaths are also lower when births occur in health facilities than at home. </p>
<h2>Young mothers in Kenya</h2>
<p>Our study site, Korogocho, is an informal settlement on the outskirts of Nairobi. About 200,000 people live there. It is overcrowded, with poor infrastructure and limited access to water and sanitation. Crime rates are high and residents are often exposed to violence and social unrest.</p>
<p>The study focused on 491 adolescent girls ranging in age from 14 to 19 years, who had a biological child at the time of the interviews.</p>
<p>Data were analysed to estimate the scale of abuse of girls during childbirth in health facilities. In total 32.2% of adolescent mothers suffered abuse from health providers during childbirth. </p>
<p>1.) Physical abuse was reported by 7.5% of participants. </p>
<p>To assess physical abuse, we asked girls if health workers punched, kicked, slapped, gagged, or hit them with an instrument, physically tied them to a bed, forcefully held them down to the bed, or had forceful downward pressure placed on their abdomen before the baby came out.</p>
<p>2.) Among those interviewed, 26.7% reported verbal abuse. </p>
<p>We assessed verbal abuse by asking girls if they were shouted at or screamed at, insulted, scolded, mocked, or had negative comments made about their physical appearance (such as cleanliness, private parts or weight), the baby’s physical appearance, and their sexual activity. </p>
<p>3.) Of the participants 15.1% claimed they had been the victims of stigma and discrimination.</p>
<p>Experience of stigma and discrimination was assessed by asking participants if health workers made negative comments to them regarding their ethnicity, race, tribe or culture, religion, age, marital status, education and literacy level, economic circumstances, and HIV status. </p>
<p>4.) One in 10 girls reported neglect and abandonment during childbirth. Neglect and abandonment were assessed by asking girls if staff members were present or not during admission and when the baby came out. </p>
<p>5.) Detainment was assessed by asking girls if they or their babies were held at the facility against their will because of their inability to pay fees. About 17% of the girls reported detainment. </p>
<p>Unsurprisingly, and consistent with a previous <a href="https://gh.bmj.com/content/bmjgh/5/Suppl_2/e003688.full.pdf">study</a> conducted among females within the reproductive age (15-49 years), we found that girls who were abused were less likely to:</p>
<ul>
<li><p>report being satisfied with the care received</p></li>
<li><p>intend to use the facility for future births</p></li>
<li><p>be willing to recommend the facility to others.</p></li>
</ul>
<h2>Ways forward</h2>
<p>Pregnant girls endure societal stigma and discrimination. These attitudes filter into the healthcare system and healthcare workers need to be trained properly to counter the shame that pregnant girls endure. </p>
<p>These adolescents also need to be informed about their rights to respectful care. </p>
<p>There are small scale interventions in some parts of <a href="https://www.ghspjournal.org/content/early/2023/04/03/GHSP-D-22-00169">Nigeria</a> and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0125267">Ghana</a> that show the potential to strengthen health systems to be more responsive to the needs of adolescents.</p>
<p>Until the mistreatment and abuse of adolescent girls is highlighted and addressed, professional care for pregnant girls will not be attained.</p><img src="https://counter.theconversation.com/content/218387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Kabiru receives funding from the Swedish International Development Cooperation Agency (Sida) through a grant to the African Population and Health Research Center for the Challenging the Politics of Social Exclusion project (Sida Contribution No. 12103). She also receives funding from the International Development Research Centre (IDRC) for the Action to empower adolescent mothers in Burkina Faso and Malawi to improve their sexual and reproductive health project (Grant No. 109813-001). The views expressed herein do not necessarily represent those of IDRC or its Board of Governors or Sida.</span></em></p><p class="fine-print"><em><span>Anthony Idowu Ajayi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Adolescent girls are more at risk during childbirth. Stigma and abuse by healthcare workers makes them less likely to seek medical care, putting their lives further in danger.Anthony Idowu Ajayi, Research Scientist, African Population and Health Research CenterCaroline W. Kabiru, Senior Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2164502023-11-15T14:30:06Z2023-11-15T14:30:06ZHealth risks at home: a study in six African countries shows how healthy housing saves children’s lives<p>Housing is a critical social determinant of health. The World Health Organization (WHO) <a href="https://iris.who.int/bitstream/handle/10665/276001/9789241550376-eng.pdf?sequence=22">defines healthy housing</a> as a shelter that supports physical, mental and social wellbeing. </p>
<p>The WHO has developed <a href="https://iris.who.int/bitstream/handle/10665/276001/9789241550376-eng.pdf?sequence=1">guidelines</a> outlining the attributes of healthy housing. These include structural soundness, as well as access to a local community that enables social interactions. Healthy housing protects inhabitants from the effects of disasters, pollution, waste and extreme heat or cold. It provides a feeling of home, including a sense of belonging, security and privacy. </p>
<p>Health risks in the home environment are important to think about because of the amount of time people spend there. In countries where unemployment levels are high or where most work is home based, people spend <a href="https://iris.who.int/bitstream/handle/10665/276001/9789241550376-eng.pdf?sequence=23">more than 70% of their time indoors</a>. Children especially spend a large amount of time at home, which exposes them to any health risks in the home environment.</p>
<p>We are researchers from the African Population and Health Research Center with an interest in urbanisation and population dynamics. We recently set out to <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03992-5">study the link between housing and children’s health</a>. We found that healthy housing generally lowered the chances of children falling ill with three diseases that we tracked: diarrhoea, acute respiratory illnesses and fever. </p>
<p>The impacts of housing quality extend beyond health and can have significant implications for education and subsequent economic outcomes, particularly for children. </p>
<h2>The research</h2>
<p><a href="https://www.brookings.edu/articles/can-rapid-urbanization-in-africa-reduce-poverty-causes-opportunities-and-policy-recommendations/">Rapid urbanisation and population growth</a> in Africa have pushed many people into informal settlements. Sub-Saharan Africa has <a href="https://blogs.afdb.org/fr/inclusive-growth/urbanization-africa-191">65%</a> of the world’s slum dwellers. This population generally lives in poor housing that lacks access to clean water, sanitation and hygiene services. The structures are overcrowded. They tend to have leaking roofs and damp walls, floors and foundations. They may also have indoor pollution, compromising the health of millions of people.</p>
<p>We set out to <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03992-5">evaluate</a> the relationship between healthy housing and the likelihood of children falling sick across six African countries: Burkina Faso, Cameroon, Ghana, Kenya, Nigeria and South Africa.</p>
<p>We studied the incidence of diarrhoea, acute respiratory illness and fever among children under the age of five. These three conditions can have severe consequences for child health and wellbeing. </p>
<p>Diarrhoea and acute respiratory infections are <a href="https://academic.oup.com/inthealth/advance-article/doi/10.1093/inthealth/ihad046/7210800">leading causes</a> of disease and deaths in children aged below five worldwide. Diarrhoea accounted for <a href="https://data.unicef.org/topic/child-health/diarrhoeal-disease/">9%</a> of all deaths among children under five in 2019. Acute respiratory illnesses caused about <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3147">20%</a> of deaths among children in this age group. The burden of under-five deaths linked to diarrhoea and respiratory illnesses like pneumonia is <a href="https://childmortality.org/wp-content/uploads/2023/01/UN-IGME-Child-Mortality-Report-2022.pdf#page=4">higher</a> for children in developing countries than those in developed regions. </p>
<p>We selected the six countries in our study because they provided data on the three diseases we tracked. They also allow for a comparative analysis across African countries. Our study used the latest available demographic and health survey data at the time of our research: Burkina Faso (2010), Cameroon (2011), Ghana (2014), Kenya (2014), Nigeria (2018) and South Africa (2016). We sampled data on 91,096 children aged under five.</p>
<h2>The findings</h2>
<p>Our study found that healthy housing was <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03992-5/tables/2">generally associated with reduced odds</a> of contracting the three illnesses we considered: diarrhoea, acute respiratory illness and fever. Our definition of healthy housing considered several attributes, including sanitation, drinking water sources and housing characteristics. </p>
<p>Homes that protect occupants from the elements, ensure access to adequate space and reduce overcrowding help keep children healthy. Homes that use cleaner cooking and lighting fuels reduce household air pollution, which leads to lower chances of respiratory infections.</p>
<p>Children living in healthy housing had fewer incidences of fever in all countries apart from South Africa. Here, children living in the healthiest homes are twice as likely to have fever than those living in unhealthy homes.</p>
<p>Fever is an indication of an underlying infection that could be viral or bacterial. Such infections are common in South Africa. In addition, the main causes of fevers among children under five are <a href="https://www.hindawi.com/journals/grp/2023/1906782/">diarrhoea and acute respiratory illnesses</a>. Among the countries included in the analysis, South Africa had the highest proportion of young mothers (aged below 25) and never-married mothers. This increases the chances that these mothers are engaged in work outside the home, leading to the early introduction of complementary feeding. This has been shown to increase the incidence of diarrhoea. These results call for addressing the causes of diarrhoea and respiratory illnesses by, for instance, ensuring South African homes have access to clean drinking water, adequate sanitation and clean energy for cooking.</p>
<p>While healthy housing is crucial, it’s not the sole determinant of a child’s health. Other factors, such as a sense of community, environmental exposure, parental education, income levels, healthcare access, and maternal and child-level factors <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03992-5/tables/3">also contribute to the overall health status of children</a>. For instance, we found that children in Burkina Faso who were not breastfed had higher chances of getting diarrhoea than those who were breastfed despite the condition of their housing. This tracks with studies that have documented that breastfeeding has a <a href="https://doi.org/10.3389/fped.2023.1086999">protective role</a> over gastrointestinal and respiratory tract infections among children. </p>
<h2>What next</h2>
<p>From our findings, parents can improve the wellbeing of their children by implementing simple strategies. This includes ensuring they use clean energy for cooking to reduce indoor air pollution and consequently reduce the incidence of acute respiratory illnesses. Similarly, using clean drinking water, hand washing and improving sanitation can help reduce cases of diarrhoea. </p>
<p>Bold but nuanced policy and programme government-level interventions can also help address the incidence of diseases affecting children under five in Africa. This requires efforts that go beyond just addressing the issue of housing to working with complementary sectors, like health, urban planning, environment and education.</p><img src="https://counter.theconversation.com/content/216450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hellen Gitau received funding from Wellcome Trust for this Complex Urban System for Sustainability and Health study. </span></em></p><p class="fine-print"><em><span>Blessing Mberu received funding from Wellcome Trust for this Complex Urban System for Sustainability and Health study. </span></em></p><p class="fine-print"><em><span>Kanyiva Muindi received funding from Wellcome Trust for this Complex Urban System for Sustainability and Health study. </span></em></p><p class="fine-print"><em><span>Samuel Iddi received funding from Wellcome Trust for this Complex Urban System for Sustainability and Health study.</span></em></p>The impact of housing quality extends beyond health to education and subsequent economic outcomes, particularly for children.Hellen Gitau, Research officer, African Population and Health Research CenterBlessing Mberu, Head of Urbanisation and Wellbeing, African Population and Health Research Center, African Population and Health Research CenterKanyiva Muindi, Associate Research Scientist, African Population and Health Research CenterSamuel Iddi, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2131582023-09-18T14:25:27Z2023-09-18T14:25:27ZKenya’s new urban school meal plan is ambitious – it could offer lessons for scaling up<p><em>More than 250,000 children in public primary schools in Nairobi will receive <a href="https://www.bbc.co.uk/newsround/65986621">regular subsidised school meals</a> provided by the county government. The Dishi Na County programme is Kenya’s first in an urban setting. The national school meal programme set up in 2009 <a href="https://www.wfpusa.org/articles/school-meals-success-in-kenya/">serves more than 1.5 million children</a> in rural drought-affected counties. We asked Elisheba Kiru, who studies education and empowerment, and Aulo Gelli, whose focus is food policy and nutrition, to analyse the new meal programme.</em> </p>
<h2>Why are school meals an important intervention?</h2>
<p>Households are <a href="https://www.un.org/africarenewal/magazine/january-2023/africa-economic-growth-decelerates-full-recovery-pandemic-led-contraction">wrestling</a> with steep increases in living costs brought about by factors like inflation, climate change and the <a href="https://futures.issafrica.org/special-reports/other/covid/">effects of the COVID pandemic</a>. These pressures are felt most by vulnerable populations, particularly those living in dry regions and in informal urban settlements. </p>
<p>There’s a need for innovative solutions using localised, low-tech approaches that improve the quality of life, especially for children. </p>
<p>We have <a href="https://www.globalpartnership.org/blog/school-meals-read-how-5-partner-countries-are-helping-students-attend-school">known</a> for several decades about the role of school feeding as a lifeline for children during crises. School feeding results in <a href="https://au.int/en/documents/20210301/african-union-biennial-report-home-grown-school-feeding-2019-2020">increased enrolment</a> and <a href="https://www.globalpartnership.org/content/kenya-national-education-sector-strategic-plan-2018-2022">improved retention</a>. It also <a href="https://docustore.wfp.org/stellent/groups/public/documents/newsroom/wfp225966.pdf">improves cognitive abilities and learning capacity, and reduces absenteeism</a>. The meals provide nutrients necessary for brain development, reducing anaemia and stunting, and increasing immunity. These results are <a href="https://jhr.uwpress.org/content/early/2020/12/03/jhr.58.3.1019-10515R1">even more pronounced</a> for girls and children living in poverty, defined as living on less than a dollar a day. </p>
<p>School meal plans operate in nearly every country in the world, reaching over <a href="https://www.wfp.org/publications/state-school-feeding-worldwide-2022">400 million children</a> for about US$48 billion per year. In Ghana, a study <a href="https://pubmed.ncbi.nlm.nih.gov/30212132/">found that the national school feeding programme</a> led to a 14% improvement in literacy scores, 13% in mathematics, and 8% in reasoning ability for girls. Impact evaluations in Kenya over two decades ago <a href="https://pubmed.ncbi.nlm.nih.gov/14672297/">revealed</a> that supplementing animal source food contributed to children’s cognitive performance, weight gain and height gain. Another study <a href="https://pubmed.ncbi.nlm.nih.gov/17531887/">found</a> improvements in the iron status of schoolchildren in Kenya, with meals fortified with whole maize flour.</p>
<p>As of 2018, Kenya’s <a href="https://www.wfpusa.org/articles/school-meals-success-in-kenya/">home-grown school meal programme</a>, launched in 2009, covered 1.5 million children in drought-affected lands. The meal programme <a href="https://www.bread.org/article/in-kenya-with-a-home-grown-school-meals-program/">helped</a> learners stay in school, strengthened their physical and mental health outcomes and increased future financial security.</p>
<h2>What’s new about the Nairobi initiative?</h2>
<p>The Nairobi <a href="https://nairobi.go.ke/10-central-kitchens-for-school-feeding-program-approaching-completion/">subsidised meal programme</a> aims to provide all pre-primary and grade 1-8 learners in the county’s public schools with a daily school meal. It will serve over 250,000 students and has an annual budget of 1.7 billion KES (US$11.8 million). </p>
<p>The Nairobi County government financed the construction of 10 kitchens. They will be operated by Food for Education, a social enterprise with experience in this area. It currently serves 165,000 meals per day in five counties.</p>
<p>The new programme provides an opportunity for learning more about school feeding programmes and effective approaches to address key challenges in Kenya. These challenges include: </p>
<ul>
<li><p>equity in making sure students with special needs benefit </p></li>
<li><p>awareness of food security and nutrition for child development </p></li>
<li><p>accountability in procurement of food sources and equipment </p></li>
<li><p>sustainability through zero waste, recycling and green energy. </p></li>
</ul>
<p><a href="https://www.the-star.co.ke/news/realtime/2023-07-13-lobby-seeks-to-block-sakajas-sh12bn-school-feeding-programme/">Some think the programme falls short in addressing inequalities</a> among Nairobi’s children. They argue that the initiative overlooks a large population of students living in informal settlements and attending low-cost private schools. Those children are ineligible for the programme. </p>
<p>All students deserve school meals and no student should go hungry. The question of eligibility deserves urgent attention to ensure more, not fewer, students are fed. </p>
<p>There are also opportunities to test cost-recovery mechanisms that balance equity and financial sustainability considerations. The national and county level governments could provide farmers and communities with support to encourage local production, through subsidies or cost-sharing.</p>
<h2>What needs to be done to make the Nairobi meals programme a success?</h2>
<p>In our experience, school feeding programmes in Africa usually have two limitations. First, they are <a href="https://reliefweb.int/report/world/generation-risk-nearly-half-global-food-crisis-hungry-are-children-say-wfp-african-union-development-agency-nepad-education-commission-and-education-partners">of limited scale</a> in contrast with the needs. Second, they are <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2022.871866/full">fragmented</a>. </p>
<p>The Nairobi programme provides opportunities to learn and establish evidence at scale about effectiveness and impact. As part of programme monitoring and evaluation, the voices of stakeholders like farmers and community leaders should also be documented to provide an all round perspective. The feedback will also make adjustments possible when they are needed. A strong monitoring and evaluation system can also be used to hold implementers accountable and help governments solicit funding support from development partners.</p>
<p>School meals should strive to provide nutritious diets by serving diverse, safe, palatable, and locally available foods. Governments could explore linking farmers to school feeding programmes to encourage local production and a consistent market for produce. As a starting point, developing clear quality standards for school meals across the country, including food, nutrition, and smallholder sourcing requirements, provides the basis to achieve the multiple benefits from the programme. </p>
<h2>What’s the way forward?</h2>
<p>The political class must build on the interdependencies that school feeding creates. For instance, Kenya’s <a href="https://theconversation.com/kenyas-school-reform-is-entering-a-new-phase-in-2023-but-the-country-isnt-ready-197202">new school curriculum</a> amplifies creativity and problem solving in real-life situations. There’s an opportunity for some public schools with idle land to establish school farms. </p>
<p>To sustain the programme, innovative financing and shared responsibility between government and the private sector must be explored. The main incentive for collaborative planning between the government, actors like Food for Education, and others is increased programme impact and lowered costs due to improved operational efficiency and economies of scale. </p>
<p>The scaling up of the Dishi Na County programme also provides a unique opportunity to generate robust empirical evidence on the costs and benefits of school feeding programmes.</p>
<p><em>Liviya David and Ruth Muendo contributed to this article.</em></p><img src="https://counter.theconversation.com/content/213158/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>School meals should strive to provide nutritious diets by serving diverse, safe, palatable, and locally available foods.Elisheba Kiru, Associate Research Scientist, African Population and Health Research CenterAulo Gelli, Senior Research Fellow, International Food Policy Research Institute (IFPRI) Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2100022023-08-06T08:48:25Z2023-08-06T08:48:25ZLiving in Nairobi’s slums is tough – residents are 35% more likely to suffer from high blood pressure than those in rural areas<figure><img src="https://images.theconversation.com/files/540442/original/file-20230801-29-5f1zo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Slum-dwellers with high blood pressure struggle to get proper treatment</span> <span class="attribution"><span class="source">AlexanderXXI/Shutterstock</span></span></figcaption></figure><p>Hypertension, commonly referred to as high blood pressure, is a non-communicable disease that occurs when there is a sustained elevation in the pressure of the blood that flows through the arteries. </p>
<p>Adults in low- and middle-income countries account for around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979614/">75%</a> of the global cases. </p>
<p>High blood pressure is a manageable condition through regular monitoring, lifestyle changes and treatment. However, untreated blood pressure, also known as uncontrolled hypertension, can lead to damage to organs such as the kidneys, heart and brain. All this increases the risk for heart attack, stroke and other serious health issues.</p>
<p>Globally, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964205/">uncontrolled hypertension</a> is a leading contributor to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388856/">death</a>. </p>
<p>In Kenya, the 2014-2015 <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6052-y">national survey on non-communicable diseases</a> showed that high blood pressure contributed to a significant burden of disease. About <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6052-y">one in four people</a> have high blood pressure in the country. The hypertension prevalence for <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6052-y">Kenya (24.5%)</a> is slightly lower than that of neighbouring countries such as <a href="https://web.archive.org/web/20220401033113/http://www.who.int/ncds/surveillance/steps/UR_Tanzania_2012_STEPS_Report.pdf#page=48">Tanzania (26%)</a> and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138991">Uganda (26.4%)</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hypertension-diabetes-stroke-they-kill-more-people-than-infectious-diseases-and-should-get-a-global-fund-195479">Hypertension, diabetes, stroke: they kill more people than infectious diseases and should get a Global Fund</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883228/">Research</a> suggests that urban slum residents are 35% more likely to be hypertensive than people living in rural areas. In Nairobi, Kenya’s capital city, around <a href="https://unhabitat.org/sites/default/files/2020/09/un-habitat_and_the_kenya_slum_upgrading_programme_-_strategy_document.pdf#page=12">60% of the population</a> lives in slums or slum-like conditions. <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-015-0112-1">Previous</a> <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2610-8">research</a> in <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-1177">Kenya’s urban slums</a> shows high uncontrolled hypertension rates. </p>
<p>In our <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001625">recent study</a>, my colleagues and I wanted to understand the range of factors that put these people at risk for uncontrolled hypertension or protects them from it. </p>
<p>We found that the low socio-economic status of the slum residents, coupled with high medication prices, limited treatment. </p>
<h2>Gaps in care persist in urban areas</h2>
<p>Nairobi’s slum dwellers experience sub-optimal access to essential services. They face conditions that make informal settlements vulnerable to emergencies such as disease outbreaks and natural disasters. </p>
<p>Even though there are effective treatments for hypertension, gaps in care persist in urban areas in Kenya, particularly among the poorest communities.</p>
<p>Our research aimed at understanding the barriers to blood pressure control at various levels – individual, family and community, health system and policy. </p>
<p>We collected data through interviews and focus groups in two Nairobi slums: Korogocho and Viwandani. We interviewed people who had uncontrolled hypertension, aiming to understand their experiences and perspectives about their care. </p>
<p>Healthcare providers were interviewed to gather information about their prescription practices, adherence to national guidelines and knowledge of hypertension. </p>
<p>We also interviewed decision-makers and policymakers to gain their views on the challenges faced in getting hypertension care in the study community. </p>
<p>The research identified barriers to blood pressure control across all the levels studied. Major bottlenecks were the high cost of hypertension medicines, the constant unavailability of medicines at health facilities, and an unsupportive family and environment.</p>
<p>In this <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001625">study</a>, access to medication was a major barrier to blood pressure control.</p>
<p>Countries such as <a href="https://jhpn.biomedcentral.com/articles/10.1186/s41043-017-0090-4">Eritrea</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830110/">South Africa</a> provide free hypertension medications at the community level.</p>
<p>In Kenya, however, free medication is provided only at higher-level health facilities. Slum residents have access to lower-level facilities which are not mandated to provide hypertension medications. </p>
<h2>So what can be done?</h2>
<p>A viable approach is to implement programmes with interventions capable of addressing the complex array of factors influencing hypertension care. </p>
<p>For instance, the provision of free or subsidised medicines would remove barriers that hinder patients’ access to hypertension medication. </p>
<p>It’s also essential to implement policies and directives to ensure equitable care for all, including those in slum communities seeking care at lower-level health facilities.</p><img src="https://counter.theconversation.com/content/210002/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shukri F. Mohamed does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hypertension is a manageable condition – but left untreated, it can damage organs such as the kidneys, heart and brain.Shukri F. Mohamed, Associate Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2096072023-07-16T09:56:52Z2023-07-16T09:56:52ZAfrica’s groundbreaking women’s rights treaty turns 20 - the hits and misses of the Maputo protocol<figure><img src="https://images.theconversation.com/files/537007/original/file-20230712-25-tmsax3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's been improvements in sexual and reproductive health outcomes.</span> <span class="attribution"><span class="source">Lucian Coman/Shutterstock</span></span></figcaption></figure><p><em>2023 marks two decades since the adoption of the Maputo Protocol. The <a href="https://au.int/en/treaties/protocol-african-charter-human-and-peoples-rights-rights-women-africa">Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa</a> (the Maputo Protocol) is <a href="https://au.int/en/newsevents/20230217/african-union-gender-pre-summit-20-years-maputo-protocol">arguably</a> the most progressive legally binding instrument on women’s and human rights instruments globally. A total of 44 African countries have signed and <a href="https://www.sfcg.org/wp-content/uploads/2015/03/Maputo-Protocol-Baseline-Report.pdf">ratified</a> it. The <a href="https://au.int/sites/default/files/treaties/37077-treaty-charter_on_rights_of_women_in_africa.pdf">Maputo Protocol</a> provides for extensive and progressive women’s rights. These include the right to health and reproduction, inheritance, economic and social welfare, education and training, access to justice and equal protection before the law, and elimination of harmful practices. Reproductive health researcher Anthony Ajayi unpacks the significance of the document in women’s lives over the years.</em></p>
<hr>
<h2>What does it mean for sexual and reproductive rights?</h2>
<p>Articles 2 and 14 made specific provisions to protect the sexual and reproductive rights of women and girls.</p>
<p>Article 2 mandates member countries to enact and implement laws and other measures to curb all forms of discrimination, especially harmful practices that endanger health and general well-being. </p>
<p>Advocacy efforts to end child marriage and female genital cutting are anchored on this specific provision. Such efforts have resulted in 43 African countries now having laws that put the minimum age of marriage at 18 years old or above for both girls and boys. While some of these countries have parental consent exceptions and parallel customary marriage laws, the past ten years have seen more countries remove these exceptions. Also, <a href="https://au.int/sites/default/files/documents/42276-doc-GettingtozeroFGM-FinalWebPages-small.pdf">22 out of 29 African countries</a> practising female genital cutting now have national laws in place banning the practice.</p>
<p>Article 14 mandates member countries to ensure the right to health of women, including sexual and reproductive health. This includes the right to control fertility, decide whether to have children, the number of children and the spacing of children, and choose any method of contraception. </p>
<h2>Has it been effective?</h2>
<p>Since the inception of the Maputo Protocol, most African countries have removed <a href="https://academic.oup.com/heapol/article/30/4/432/558465">user fees</a> for maternal health services in government-owned health facilities. This has increased access to quality maternal healthcare services for marginalised women and girls. As a result, <a href="https://www.who.int/publications/i/item/9789240068759">maternal deaths</a> have declined markedly. </p>
<p>More countries have <a href="https://reproductiverights.org/sites/default/files/documents/World-Abortion-Map.pdf">broadened</a> their laws to allow access to safe abortion in cases of sexual assault, rape, incest, life-threatening fetal anomalies, and when a pregnancy endangers the woman’s mental and physical health or her life. Between 2000 and 2021, 22 African countries expanded their legal grounds for abortion. Six – Cape Verde, South Africa, Tunisia, Mozambique, São Tomé and Príncipe (up to 10 weeks of gestation in Angola) – permit abortion at the woman’s request during the first trimester of pregnancy. More countries have developed and launched post-abortion care guidelines to expand access for women and girls.</p>
<p>The success of the Maputo Protocol in protecting and guaranteeing the rights of women and eliminating discrimination is quite remarkable. Where the rights of women and girls are violated, the Maputo Protocol has become an instrument for seeking legal redress and a tool for seeking accountability. It was referenced in these examples:</p>
<ul>
<li><p>A court ruling in December 2020 found that the Kenya government <a href="https://www.equalitynow.org/news_and_insights/9_ways_maputo_protocol/">violated</a> several human rights instruments, including the Maputo Protocol, for failing to investigate and prosecute cases of sexual and gender-based violence that happened during the post-election violence of 2007. The government was ordered to pay compensation to four of the survivors, amounting to KSh 4 million (about US$40,000) each.</p></li>
<li><p>In December 2019, the ECOWAS Court of Justice found that the ban on pregnant schoolgirls going to school in Sierra Leone was discriminatory and in violation of girls’ right to education, in breach of Articles 2 and 12 of the Maputo Protocol. Since the ruling, the government of Sierra Leone has lifted the ban.</p></li>
<li><p>Article 13 and 17 of Tanzania’s Marriage Act, which set the minimum age of marriage for girls at 15 years and 18 years for boys, was challenged at the appeal court in 2019. Citing the Maputo Protocol, the court upheld the earlier ruling that marriage under the age of 18 was illegal.</p></li>
</ul>
<h2>What have its shortcomings been?</h2>
<p>Progress in realising women’s and girls’ rights remains uneven within and between countries. Eleven countries haven’t ratified the protocol. Twenty-four haven’t fulfilled their reporting obligation to the African Commission on Human and Peoples’ Rights. Consequently, <a href="https://www.oecd.org/gender/data/ensuring-strong-equitable-legal-frameworks-as-an-accelerator-for-gender-equality-in-africa.htm">discriminatory laws</a> persist. And customary, common and civil laws remain in parallel with constitutional provisions. This creates loopholes for the violation of women’s and girls’ rights. </p>
<p>For example, 11 countries (Cameroon, Seychelles, Sudan, South Africa, Burkina Faso, Gabon, Guinea-Bissau, Mali, Niger, Senegal, and Tanzania) permit girls below 18 years to marry. One member state has no minimum age for marriage. But legal reforms are happening in five of these countries.</p>
<p>There’s been improvement in sexual and reproductive health outcomes. But sexual and gender-based violence, child marriage and female genital cutting remain high in <a href="https://gh.bmj.com/content/bmjgh/5/1/e002231.full.pdf">most African</a> countries. <a href="https://www.who.int/publications/i/item/9789240068759">Maternal deaths</a> and <a href="https://unaids.org/sites/default/files/media_asset/data-book-2022_en.pdf">new HIV transmission</a> have declined. But incidences remain relatively high in several countries. </p>
<p>Young people, particularly girls, bear a <a href="https://gh.bmj.com/content/bmjgh/6/2/e004129.full.pdf">disproportionate</a> burden of poor sexual and reproductive health outcomes. This hinders their smooth transition into adulthood and affects their immediate and lifelong health (physical and mental) and socioeconomic wellbeing and empowerment.</p>
<h2>What more needs to be done?</h2>
<p>More advocacy is needed to ensure: </p>
<ul>
<li><p>the remaining 11 countries ratify the protocol</p></li>
<li><p>countries with reservations about some of the articles in the protocol need to address them </p></li>
<li><p>those who have ratified it fully domesticate and implement its provisions. </p></li>
</ul>
<p>Such advocacy should be informed by contextually relevant evidence on sexual and reproductive health, including what works in addressing harmful practices, increasing young people’s access to information and services, and reducing new HIV infections and maternal deaths. </p>
<p>The partnership between all actors working to ensure women’s health and reproductive rights are realised should be reinvigorated and sustained to make certain that gains are consolidated and not reversed. </p>
<p>Entrenching a culture of equity around sexual and reproductive rights will also require tailored engagement with community and religious leaders to build their capacity on matters of sexual and reproductive health. Sustained funding of civil society organisations working to ensure women’s rights is also key, and so is the need to bolster the women’s movement on the continent.</p>
<p><em>Juliet Kimotho, senior advocacy officer at the African Population and Health Research Center, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/209607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Idowu Ajayi is affiliated with the African Population and Health Research Center. </span></em></p>The success of the Maputo Protocol in protecting the rights of women and eliminating discrimination is remarkable.Anthony Idowu Ajayi, Associate research scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2060972023-06-21T10:34:01Z2023-06-21T10:34:01ZKenya’s population: 5 key findings in the past 20 years of research<figure><img src="https://images.theconversation.com/files/527685/original/file-20230523-19-sqncv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Gerald Anderson/Anadolu Agency via Getty Images</span></span></figcaption></figure><p>Like many countries on the African continent, Kenya’s population is growing – fast. The country’s population was <a href="https://ncpd.go.ke/wp-content/uploads/2021/02/61-PB-Why-Population-Issues-are-important.pdf">8.1 million</a> in 1963; today it stands at about <a href="https://www.unfpa.org/data/world-population/KE">55 million</a> people. More people have moved into urban areas too. In 1960 <a href="https://data.worldbank.org/indicator/SP.URB.TOTL.IN.ZS?locations=KE">about</a> 7% of the population lived in urban areas; by 2021 it stood at 28%.</p>
<p>Some key changes within Kenya’s society have taken place alongside, and because of, this fast growth. </p>
<p>I’m the executive director of the <a href="https://aphrc.org/">African Population and Health Research Center (APHRC)</a>, an organisation which has been documenting population changes and dynamics in Kenya, and other countries, for 20 years. This work has helped to influence public policy and response. </p>
<p>Some of the key challenges identified in Kenya have been:</p>
<ul>
<li><p>a large number of urban residents, especially those in informal settlements, without social services such as public health facilities; </p></li>
<li><p>shortage of public schools (government funded); </p></li>
<li><p>widespread non-communicable diseases and their risk factors in urban informal settlements; </p></li>
<li><p>a high number of unsafe abortions driven by high levels of mistimed and unwanted pregnancies; and </p></li>
<li><p>uneven progress in <a href="https://sdgs.un.org/goals">sustainable development goals (SDGs)</a> targets related to mothers, children and adolescents.</p></li>
</ul>
<p>These findings are key to driving effective strategies. </p>
<h2>Urban residents without access to services</h2>
<p>Kenya’s development partners have tended to assume that urban areas and residents were well-served by social services, and didn’t need special attention from government and civil society organisations. As a result, in the 1980s and 1990s, poverty alleviation programmes focused on rural areas. </p>
<p>However, in 2002 we <a href="https://aphrc.org/wp-content/uploads/2018/10/Urban-Health-in-Kenya_Key-Findings_2000-Nairobi-Cross-sectional-Slum-Survey.pdf">produced evidence</a> that showed huge differences in health, education and other social outcomes among residents of urban informal settlements when compared to other urban residents. For some outcomes, residents of urban informal settlements were doing as badly as rural residents, if not worse. For instance, we found that children living in slums <a href="https://aphrc.org/wp-content/uploads/2018/10/Urban-Health-in-Kenya_Key-Findings_2000-Nairobi-Cross-sectional-Slum-Survey.pdf">were sicker</a> than those living elsewhere in Kenya. They were also less likely to get treatment when they were sick.</p>
<p>Our work highlighted the important point that simply presenting national statistics for rural and urban areas, without breaking them down further by socioeconomic status, was highly misleading. If countries were to make progress towards various development targets, urban informal settlements needed special attention. </p>
<p>Understanding this led to the design of projects and programmes by governments and other agencies that targeted disadvantaged urban areas. Over time, great progress has been made and the health and other social indicators in these areas have improved.</p>
<h2>Shortage of public schools</h2>
<p>Free primary education was implemented in Kenya in 2003. Its <a href="https://ossrea.net/publications/images/stories/ossrea/ogola.pdf">main objective</a> was to make primary education accessible to all. Research done at APHRC, however, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0883035511000036">showed</a> that the enrolment of children in public schools went up for a couple of years and then rapidly declined. </p>
<p>In 2012, <a href="https://aphrc.org/wp-content/uploads/2018/10/ERP-III-Report.pdf">63%</a> of primary school students in Nairobi urban informal settlements were attending non-government schools, a percentage as high as it had been before the policy. This happened because there were not enough public schools to meet the demand. Parents realised that their children were not receiving the right amount of attention in overcrowded classrooms. Instead, they took their children back to the informal private schools they had been attending before the policy was rolled out.</p>
<p>Once our evidence was shared with the ministry of education, the <a href="https://vision2030.go.ke/wp-content/uploads/2018/05/Re-Alignment-Education-Sector..pdf">Education Taskforce of 2012</a> adopted recommendations to include all learners, including those in non-formal schools, who met set criteria to benefit from capitation grants. This was to ensure that learners in informal settlements benefited from the government programme. </p>
<h2>Widespread diseases in informal settlements</h2>
<p>A key health-related finding was that non-communicable diseases, and their risk factors, <a href="https://www.tandfonline.com/doi/full/10.3402/gha.v8.28697">showed</a> a high prevalence in the urban informal settlements of Nairobi. </p>
<p>There was a huge burden of undiagnosed, untreated and uncontrolled disease. For instance, about <a href="https://journals.lww.com/jhypertension/Abstract/2013/05000/Prevalence,_awareness,_treatment_and_control_of.26.aspx">80%</a> of adults diagnosed with diabetes and high blood pressure were previously undiagnosed. Among those who had been previously diagnosed, the majority had not received treatment in the past 12 months. Only a fraction had received treatment in the past two weeks. As a result, for every 100 people diagnosed with either condition, only one had it under control. </p>
<p>These findings are vital to understanding existing or potential gaps in a healthcare system. They shaped the APHRC’s subsequent research programmes on <a href="https://www.tandfonline.com/doi/full/10.3402/gha.v6i0.22510">developing models</a> to improve care for chronic conditions in these settings. Some of these have been adopted by Nairobi County and other players. </p>
<h2>Huge number of unsafe abortions in Kenya</h2>
<p>In 2013, APHRC <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0621-1">published the report</a> of the first ever incidence and magnitude study on unsafe abortion. The study estimated that over 464,000 abortions had been conducted in Kenya, and an estimated 120,000 women sought care in health facilities for complications. According to the World Health Organisation, <a href="https://www.who.int/news-room/fact-sheets/detail/abortion">4.7% to 13.2% of maternal deaths</a> annually can be attributed to unsafe abortion. </p>
<p>An estimated half (49%) of all pregnancies were unintended and four in ten of these ended in an abortion, highlighting the need for increased access to contraception. </p>
<h2>Uneven progress in supporting mothers and children</h2>
<p>APHRC has been supporting the <a href="https://www.countdown2030.org/">analysis</a> of routine health information and survey data to track African countries’ progress towards meeting the SDG targets related to mothers, children and adolescents. These include the reduction in maternal mortality and the end of preventable deaths of newborns and children.</p>
<p>The analysis – conducted for at least 18 countries – shows a general trend of improvement in various outcomes at the country level, but also huge differences between regions for some indicators. For instance in Kenya, childhood mortality has declined from 99 per 1,000 live births in 2000 to 31 in 2020. Estimates from 2014 show significant regional differences, with the worst performing sub-region (coast) having more than double the rate of child deaths compared with the best performing one (central) – <a href="https://data.unicef.org/countdown-2030/country/Kenya/1/">87.4 against 42.1</a>.</p>
<p>The progress seen at national level can be explained by improvements in health outcomes in some regions, but not all. This analysis is important to provide evidence about how government and development partners can target resources towards disadvantaged regions if Kenya is to <a href="http://countdown2030.org">meet the SDG targets</a>.</p><img src="https://counter.theconversation.com/content/206097/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Kyobutungi receives funding from The Hewlett Foundation, Sida and The Bill and Melinda Gates Foundation</span></em></p>Kenya’s experienced fast population growth and urbanisation - this has brought about some big challenges.Catherine Kyobutungi, Executive Director, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2070662023-06-13T09:57:26Z2023-06-13T09:57:26ZKenya’s budget doesn’t allocate funds for new education initiatives – this will stall innovation in the country<figure><img src="https://images.theconversation.com/files/530394/original/file-20230606-19-nycs2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kenya has over 18.2 million children and youth in educational institutions.</span> <span class="attribution"><span class="source">Wolfgang Kaehler/LightRocket via Getty Images</span></span></figcaption></figure><p>President William Ruto’s first budget for Kenya sets no education priorities. The <a href="http://www.parliament.go.ke/sites/default/files/2023-05/THE%20FINANCE%20BILL%20%2C%202023_compressed.pdf">Finance Bill 2023</a> doesn’t make it clear what Kenya is trying to achieve – stronger foundational learning, technical and vocational skills, or innovation. </p>
<p>This is despite the <a href="https://www.education.go.ke/president-ruto-technical-training-will-drive-our-economic-growth">importance</a> placed on deepening technical capacity to drive economic growth, and education reforms spelt out in the <a href="https://www.education.go.ke/sites/default/files/2022-05/COMPETENCY-BASED-EDUCATION-AND-TRAINING-CBET-POLICY-FRAMEWORK1.pdf">official policy</a>. This also comes against the backdrop of a <a href="https://africacheck.org/sites/default/files/media/documents/2022-08/Kenya%20Kwanza%20UDA%20Manifesto%202022.pdf#page=51">political campaign promise</a> to “bridge current teacher shortage gap of 116,000 within two financial years”.</p>
<p>The <a href="https://www.treasury.go.ke/wp-content/uploads/2023/02/2023-Budget-Policy-Statement.pdf#page=66">allocation</a> to education in the 2023/24 budget stands at KSh597.2 billion (US$4.59 billion) compared to US$4.19 billion in the previous year, an increase of 10%. This is far above the US$3.52 billion combined allocations for <a href="https://www.treasury.go.ke/wp-content/uploads/2023/02/2023-Budget-Policy-Statement.pdf#page=115">health</a>, <a href="https://www.treasury.go.ke/wp-content/uploads/2023/02/2023-Budget-Policy-Statement.pdf#page=59">agriculture</a>, <a href="https://www.treasury.go.ke/wp-content/uploads/2023/02/2023-Budget-Policy-Statement.pdf#page=68">security</a> and the <a href="https://www.treasury.go.ke/wp-content/uploads/2023/02/2023-Budget-Policy-Statement.pdf#page=118">executive office of the president</a>. </p>
<p>The four main spending areas for education are: basic education (primary and secondary); technical and vocational training; higher education and research; and the Teachers’ Service Commission (the national teachers’ employer). Of these, basic education has received the biggest increase in funds.</p>
<p>But it appears the spending won’t be directed to anything new. As usual, the government will subsidise basic education, provide bursaries and loans to students in tertiary institutions, and pay teachers in public institutions. The budgetary allocations imply that there will be no new initiatives in the next financial year. </p>
<p>As a researcher with more than 20 years of <a href="https://www.researchgate.net/profile/Moses-Ngware">experience</a> in the education sector, I think a failure to allocate more funds for priority initiatives – such as competence-based education and junior secondary schools – will hamper the sector’s resilience (after <a href="https://theconversation.com/deeper-divide-what-kenyas-pandemic-school-closures-left-in-their-wake-176098">COVID-19 school closures</a>), stall improvement in learning outcomes and delay Kenya’s capacity for innovation.</p>
<h2>Teacher budget</h2>
<p>The Teachers’ Service Commission is set to receive 54% of the education budget in 2023/24 (down from 55% in last fiscal year).</p>
<p>The allocation – mainly to pay salaries – is set to increase by about 8%. The <a href="https://www.knbs.or.ke/consumer-price-indices-and-inflation-rates-for-may-2023/">annual inflation rate</a> is 8%. </p>
<p>But the number of teachers will increase by about 3,700. Between 2021 and 2022, the number of primary school teachers <a href="https://www.knbs.or.ke/download/economic-survey-2023/">declined</a> by about 0.4%, while that of secondary school teachers increased by 4%. So the budget increase won’t make much real difference to teacher pay. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kenyas-school-reform-is-entering-a-new-phase-in-2023-but-the-country-isnt-ready-197202">Kenya's school reform is entering a new phase in 2023 -- but the country isn't ready</a>
</strong>
</em>
</p>
<hr>
<p>The increase in the number of teachers won’t improve the pupil-teacher ratio (number of pupils for every teacher) either. In regions such as <a href="https://sokodirectory.com/2022/03/poor-student-teacher-ratio-affecting-learning-outcomes-across-kenya/">North Eastern</a> Kenya, the ratio is at 70 pupils to one teacher. It doesn’t cater for the <a href="https://www.knbs.or.ke/download/economic-survey-2023/">growing</a> number of pupil enrolments: 245,000 a year. </p>
<p>While the <a href="https://www.tsc.go.ke/index.php/downloads-b/category/99-current-adverts">policy intent</a> is to increase the number of teachers in support of quality of education, the Finance Bill 2023 cannot afford this. If the government were to employ an additional 20,000 teachers for primary and secondary schools, over and above replacing teachers who retired or resigned, their pay would account for 60% of the education budget. </p>
<h2>Higher education and research</h2>
<p>University enrolment <a href="https://www.treasury.go.ke/wp-content/uploads/2023/05/KNBS-Popular-Version-BOOK-PRESS-%E2%88%9A.pdf#page=26">grew</a> marginally by 0.16%, from 562,100 to 563,000 last year.</p>
<p>In the 2023/24 budget, public universities and research are allocated 20% of the education budget, the same as in the previous year. The university allocation covers both staff costs and direct programme costs. The National Research Fund and National Commission for Science, Technology and Innovation draw from this budget. </p>
<p>The university education budget has increased by about 7%, mainly to cater for changes in staff pay, enhance student higher education loans and deal with pending bills. This implies a “business as usual” approach for university education. </p>
<p>The budget for research and development (Ksh847 million or US$6.52 million) has declined by almost 20% from the previous financial year, implying the government’s low priority for research and development. </p>
<p>This dims the hopes of fostering a research and innovation-driven economy. There is no country in the world that has ever achieved its social and economic goals without heavy investment in research and development.</p>
<p>The research and development financing gap will likely be filled by NGOs and external partners who, in the absence of strong research co-design mechanisms, will most likely push their own research agenda, not the domestic research priorities defined by ministries.</p>
<p><a href="https://www.unesco.org/en/articles/report-reveals-relatively-high-researcher-density-mauritius">Mauritius’ spending </a> on research and development stands at 0.37% of GDP while Kenya’s is at 0.01% of GDP. </p>
<h2>Basic education</h2>
<p>Kenya has <a href="https://www.knbs.or.ke/wp-content/uploads/2022/05/2022-Economic-Survey1.pdf#page=338">18.2 million</a> children and youth in education and training institutions. Of these, 14.2 million are in primary and secondary schools, and <a href="https://www.knbs.or.ke/wp-content/uploads/2022/05/2022-Economic-Survey1.pdf#page=341">2.9 million</a> in early childhood education.</p>
<p>The non-salary allocation to basic education is 22% of the education budget, the same proportion as the previous year. Basic education’s budget grows by 17% in 2023/24. </p>
<p>This is partly explained by the inclusion of curriculum reforms into this budget. The reforms emphasise acquisition of competencies, and also changed the structure of the education system where learners now spend two years in pre-primary, six in primary, six in secondary schools and three in tertiary institutions.</p>
<p>The budgetary allocation doesn’t reflect <a href="https://www.worldbank.org/en/news/press-release/2022/06/23/70-of-10-year-olds-now-in-learning-poverty-unable-to-read-and-understand-a-simple-text">needs created by the COVID-19</a> school closures, such as addressing the <a href="https://www.worldbank.org/en/news/press-release/2022/06/23/70-of-10-year-olds-now-in-learning-poverty-unable-to-read-and-understand-a-simple-text">decline</a> in learning, and providing resources for foundational literacy and numeracy. </p>
<h2>Technical and vocational education and training</h2>
<p>Kenya <a href="https://www.treasury.go.ke/wp-content/uploads/2023/05/KNBS-Popular-Version-BOOK-PRESS-%E2%88%9A.pdf#page=26">had 580,500</a> young people in technical and vocational education and training in 2022, representing 11.6% growth over 520,200 in 2021.</p>
<p>This sector is critical because unemployment among youth aged 15 to 24 <a href="https://www.statista.com/statistics/812147/youth-unemployment-rate-in-kenya/#:%7E:text=In%202022%2C%20the%20youth%20unemployment,unchanged%20at%20around%2013.35%20percent">stands at around 13.4%</a>. The budget for the sector has risen by about 10% compared to the previous financial year. It gets a very small but growing proportion (about 5%) of the education budget. </p>
<p>At this rate, technical institutions will <a href="https://www.education.go.ke/president-ruto-technical-training-will-drive-our-economic-growth">overtake</a> the university budget in future, a deliberate policy. Currently, enrolment in technical institutions in Kenya matches enrolment in universities. </p>
<p>But the Finance Bill 2023 could have done more. Like its predecessors, it has failed to provide for training in the workplace, a move that would make skills more relevant to employers.</p>
<h2>What lies ahead</h2>
<p>The Finance Bill 2023 provides an indication of where education money is going and it’s clear that the silent budgeting policy was largely to maintain the status quo. </p>
<p>On the positive side, the increments will cushion the system against high prices of goods due to inflation, unpaid bills, staff annual statutory increments and deductions. </p>
<p>On the downside, it will expose the system to learning crises and low productivity in good research and innovation.</p><img src="https://counter.theconversation.com/content/207066/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Moses Ngware receives funding from Echidna Giving, Bill and Melinda Gates Foundation, Center for Global Development, and Well Springs Philanthropic Fund. </span></em></p>Kenya’s budgetary allocation misses opportunities to improve basic education and address unemployment.Moses Ngware, Senior Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050832023-05-17T13:24:05Z2023-05-17T13:24:05ZTeen mothers and depression: lack of support from partners and violence are big drivers in Malawi and Burkina Faso<figure><img src="https://images.theconversation.com/files/526211/original/file-20230515-15365-5il9n2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Ann Rodchua/Shutterstock</span></span></figcaption></figure><p>Up to <a href="https://data.unicef.org/topic/child-health/adolescent-health/">one in four</a> African girls have their first child before the age of 18. Becoming a mother at such a young age can lead to mental health problems like depression. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876179/">Research</a> suggests that pregnant and parenting teenagers have poorer mental health than adult mothers. </p>
<p>Several factors make teenage mothers vulnerable to mental illness. For example, in conservative societies pregnant, unmarried adolescent girls are <a href="https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1751230">shamed</a> and excluded. Parenting is stressful. Early and unintended pregnancy can add to the pressure. Moreover the loss of childhood can overwhelm and distress adolescent girls. </p>
<p>Adolescent mothers from poor homes and communities are at even <a href="https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC3876179&blobtype=pdf">higher risk</a> of depression. These girls experience social inequality, chronic stress, violence and food insecurity. When teenagers become mothers, their adversities are compounded. </p>
<p>Several studies have looked at <a href="https://www.sciencedirect.com/science/article/abs/pii/S0890856718319063">drivers of depression</a> among adolescents in general. But there is scant attention to the mental wellbeing of pregnant and parenting adolescent girls in Africa. Scant research means limited programme or intervention focus. Limited attention means there is a missed opportunity to address poor mental health in this group. Pregnant and parenting adolescents face different challenges from their peers who are not pregnant or parenting.</p>
<p>Our recent <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-023-01588-x">study</a> estimates the level of probable depression among pregnant and parenting girls in Burkina Faso in West Africa and Malawi in southern Africa. We chose these countries because they showed potential for policy change around adolescent sexual and reproductive health. </p>
<p>We used the <a href="https://www.hiv.uw.edu/page/mental-health-screening/phq-9">Patient Health Questionnaire-9</a>, the tool used in diagnosing depression. But only a clinician can ultimately decide if an individual has depression. We thus classify those in this study who met the clinical criteria for depression as probably depressed. </p>
<p>We explored the factors associated with a higher likelihood of depression. We found that depression was highest among girls who experienced sexual, emotional and physical violence from their partners; whose partners denied paternity or refused to provide any support; who received no support from their community; who described their neighbourhood as unsafe. </p>
<p>Our study showed that the prevalence of probable depression in Burkina Faso was 18.8%. In Malawi it was 14.5%. But cases of depression were undiagnosed and untreated. This could have dire implications for the health and wellness of the girls and their babies. </p>
<h2>Our study</h2>
<p>We interviewed 980 adolescent girls in Ouagadougou, Burkina Faso, and 669 girls in Blantyre, Malawi in 2021. We asked them how often they had faced the following problems over the last two weeks: having little interest or pleasure in doing things; feeling down or hopeless; having insomnia or oversleeping; fatigue; loss of appetite or over-eating; having low self-esteem; trouble concentrating; restlessness or slowness; and negative self-thoughts, including self-harm. </p>
<p>We also collected information on the girls’ families, partners and neighbourhoods. </p>
<p><strong>Burkina Faso:</strong></p>
<p>Birth status was the only individual factor associated with probable depression in Burkina Faso. Girls who had already given birth were 35% less likely to report depression compared to girls currently pregnant. This group of girls might have had time to develop coping mechanisms after experiencing the disappointment of early and unintended pregnancy. </p>
<p>Girls exposed to intimate partner violence were twice as likely to report depression compared to those who were not. </p>
<p>One key result of our study in Burkina Faso was that paternity denial was a major risk factor for depression among young girls. Paternity denial brings shame to the girl. It also means she receives no support from her partner in taking care of the child, unlike her married counterparts. Acceptance of paternity can help girls deal with the disappointment of becoming pregnant too early and the fear of facing shame and child upbringing alone. Girls whose partners denied paternity were blamed for sleeping around and their children were deemed illegitimate. The pressure from parents on the girls to identify the person responsible for their pregnancy could result in girls’ prolonged sadness and loss of interest in living.</p>
<p>Consistent with previous <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0581-5">research</a>, we found that girls who got support from their parents and partners were shielded from depression. Having access to support within the community was related to a lower likelihood of depression. Also, having goodwill from neighbours and the community was linked to a lower likelihood of depression.</p>
<p><strong>Malawi:</strong> </p>
<p>Having secondary education level was substantially linked to a lower likelihood of reporting depression in Malawi. The explanation for this is likely that girls with some secondary education may be more optimistic about future job prospects than girls with no or simply elementary education. Other research done in <a href="https://journals.sagepub.com/doi/10.1177/2156869314564399">Malawi</a> has shown education as having a protective effect against depression. Generally, higher education in Malawi is associated with more favourable employment possibilities than having no schooling or only primary schooling. </p>
<p>Exposure to intimate partner violence was associated with a higher risk of depression. </p>
<p>Here, too, we found that girls who got support from their parents and partners were shielded from depression. Young mothers need a lot of support to navigate their new role as parents. Childcare can be tedious even for adults, and requires a lot of money, which these girls lack. Having access to adequate support from parents and partners can lessen the burden of childcare and help girls build their resilience, determination and self-esteem. Girls who considered their neighbourhood to be safe were less likely to report depression. </p>
<h2>Thinking ahead</h2>
<p>Depression is common among pregnant or parenting adolescent girls. </p>
<p>Because depression can harm a girl’s health, routine depression screenings at prenatal and postpartum visits are crucial. </p>
<p>Health systems should be strengthened by governments and developmental partners to develop and provide therapy that addresses all areas of vulnerabilities linked to depression in pregnant and parenting girls.</p><img src="https://counter.theconversation.com/content/205083/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Idowu Ajayi receives funding from SIDA and IDRC. He is affiliated with African Population and Health Research Center. </span></em></p><p class="fine-print"><em><span>Elita Chamdimba is affiliated with Centre for Social Research, UNIMA and University of Strathclyde. </span></em></p>In addition to motherhood these girls experience social inequality, chronic stress, violence, and food insecurity. When teenagers become mothers, their adversities are compounded.Anthony Idowu Ajayi, Associate research scientist, African Population and Health Research CenterElita Chamdimba, Research fellow, Centre for Social Research, University of MalawiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050872023-05-16T14:41:27Z2023-05-16T14:41:27ZHow does food get contaminated? The unsafe habits that kill more than 400,000 people a year<figure><img src="https://images.theconversation.com/files/526039/original/file-20230514-182951-p8iehb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Food-borne illnesses usually present as diarrhoea, vomiting and stomach pains. </span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p><em>Unsafe foods, according to the <a href="https://www.who.int/news/item/07-03-2022-world-food-safety-day-2022-theme-highlights-the-role-that-safe-nutritional-food-plays-in-ensuring-human-health">World Health Organization</a> (WHO), contribute to poor health, including impaired growth and development, micro-nutrient deficiencies, noncommunicable and infectious diseases, and mental illness. Globally, one in ten people are affected by food-borne diseases each year. Antonina Mutoro, a nutrition researcher at the African Population and Health Research Center, explains what causes food contamination and how we can lower the risk of disease.</em></p>
<hr>
<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/how-does-food-get-contaminated-the-unsafe-habits-that-kill-more-than-400-000-people-a-year-205087&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<h2>What is food contamination?</h2>
<p>Access to safe and nutritious food is a basic human right which many do not enjoy, partly because of food contamination. This is defined as the presence of harmful chemicals and microorganisms in food that can cause illness. According to the WHO, food contamination affects about <a href="https://www.who.int/news-room/fact-sheets/detail/food-safety">one in every ten people</a> globally and causes about <a href="https://www.who.int/news-room/fact-sheets/detail/food-safety">420,000 deaths annually</a>. </p>
<p>Food contamination can be:</p>
<ul>
<li><p><strong>physical:</strong> foreign objects in food can potentially cause injury or carry disease-causing microorganisms. Pieces of metal, glass and stones can be choking hazards, or cause cuts or damage to teeth. Hair is another physical contaminant.</p></li>
<li><p><strong>biological:</strong> living organisms in food, including microorganisms (bacteria, viruses and protozoa), pests (weevils, cockroaches and rats) or parasites (worms), can cause disease. </p></li>
<li><p><strong>chemical:</strong> substances like soap residue, pesticide residue and toxins produced by microorganisms such as <a href="https://theconversation.com/what-must-be-done-to-get-toxin-out-of-kenyas-food-supply-127137">aflatoxins</a> can lead to poisoning.</p></li>
</ul>
<h2>What are the most common causes of food contamination?</h2>
<p>The most common cause of food contamination is poor food handling. This includes not washing your hands at the appropriate time – before eating and preparing food, after using the toilet, or after blowing your nose, coughing or sneezing. Using dirty utensils, not washing fruits and vegetables with clean water, and storing raw and cooked food in the same place can also be harmful. Sick people should not handle food. And you should avoid consuming under-cooked foods, particularly meat.</p>
<p>Poor <a href="https://theconversation.com/vegetable-farmers-in-urban-ghana-dont-worry-much-about-food-safety-but-they-should-143706">farming practices</a> can also contaminate food. This includes the heavy use of pesticides and <a href="https://theconversation.com/chickens-from-live-poultry-markets-in-nigeria-could-be-bad-for-your-health-scientists-explain-why-192646">antibiotics</a>, or growing fruits and vegetables using contaminated soil and water. The use of inadequately composted or raw animal manure or sewage is also harmful. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/power-cuts-and-food-safety-how-to-avoid-illness-during-loadshedding-200586">Power cuts and food safety: how to avoid illness during loadshedding </a>
</strong>
</em>
</p>
<hr>
<p>Fresh foods can lead to a number of illnesses. In Kenya, for instance, the <a href="https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-7-627">contamination of meat</a>, <a href="https://www.researchgate.net/publication/329170819_Consumer_Risk_Exposure_to_Chemical_and_Microbial_Hazards_Through_Consumption_of_Fruits_and_Vegetables_in_Kenya">fruits</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/24968591/">vegetables</a> with human waste is relatively common. This is attributed to the use of contaminated water to wash food. Flies carrying contaminants can also directly transfer faecal matter and bacteria onto plant leaves or fruits.</p>
<p><a href="https://theconversation.com/informal-food-markets-what-it-takes-to-make-them-safer-161601">Street foods</a> are another common source of food contamination. These foods are widely consumed in low- and middle-income countries because they’re cheap and easily accessible. </p>
<h2>What are the signs that you’ve eaten contaminated food?</h2>
<p>Biological and chemical substances are the most common food contaminants. They account for <a href="https://www.who.int/news-room/fact-sheets/detail/food-safety">more than 200 food-borne illnesses</a>, including <a href="https://theconversation.com/explainer-causes-symptoms-and-cures-of-typhoid-fever-53645">typhoid</a>, <a href="https://theconversation.com/explainer-why-cholera-remains-a-public-health-threat-74444">cholera</a> and <a href="https://theconversation.com/what-led-to-worlds-worst-listeriosis-outbreak-in-south-africa-92947">listeriosis</a>. Food-borne illnesses usually present as diarrhoea, vomiting and stomach pains.</p>
<p>In severe cases, food-borne illnesses can lead to neurological disorders, organ failure and even death. It’s therefore advisable to seek immediate medical attention if you begin to experience symptoms like persistent diarrhoea and vomiting after eating or drinking.</p>
<p>Children aged under five are the most vulnerable to food-borne illnesses. They bear <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001923">40%</a> of the food-borne disease burden. A child’s immune system is still developing and can’t fight off infections as effectively as an adult’s. </p>
<p>In low- and middle-income countries, reduced immunity in children can also occur as a result of malnutrition and frequent exposure to infections due to poor hygiene and sanitation, including a lack of access to safe water and toilets. Additionally, when children are ill, they tend to have poor appetites. This translates to reduced food intake. Coupled with increased nutrient losses through diarrhoea and vomiting, this can lead to a cycle of infection and malnutrition and, in extreme cases, death. </p>
<p>Pregnant women and people with <a href="https://theconversation.com/how-do-i-improve-my-immunity-expert-shares-tips-on-what-to-do-and-what-to-avoid-198537">reduced immunity</a> due to illness or age are equally vulnerable and extra care should, therefore, be taken to prevent food-borne illnesses among these groups.</p>
<h2>What can we do to prevent food contamination?</h2>
<p>Food-borne illnesses also have negative economic impacts, especially in low- and middle-income countries. The World Bank estimates it costs more than <a href="https://www.worldbank.org/en/news/press-release/2018/10/23/food-borne-illnesses-cost-us-110-billion-per-year-in-low-and-middle-income-countries#:%7E:text=The%20total%20productivity%20loss%20associated,estimated%20at%20US%24%2015%20billion.">US$15 billion</a> annually to treat these illnesses in these countries. So it’s important to have preventive strategies in place.</p>
<p>Food contamination can be prevented through simple measures:</p>
<ul>
<li><p>washing your hands at key times (before preparing, serving or eating meals; before feeding children, after using the toilet or after disposing of faeces) </p></li>
<li><p>wearing clean, protective clothing during food preparation </p></li>
<li><p>storing food properly</p></li>
<li><p>washing raw foods with clean water</p></li>
<li><p>keeping raw and cooked foods separate</p></li>
<li><p>using separate utensils for meats and for food meant to be eaten raw. </p></li>
</ul>
<p>Good farming practices, such as the use of clean water and application of approved pesticides in recommended amounts, can help prevent food contamination. </p>
<p>Food vendors also need to be trained on food safety, and provided with clean water and proper sanitation. </p>
<p>As part of the research team at the African Population and Health Research Center, I’m working on the <a href="https://healthyfoodafrica.eu/blog/promoting-access-to-nutritious-food-in-nairobi-urban-poor-settings/">Healthy Food Africa project</a>, which aims to boost food security in urban informal settlements through the promotion of food safety. In Kenya, the project is working closely with the Nairobi county government to develop a food safety training manual targeting street food vendors. This will go a long way towards improving food safety in the city.</p><img src="https://counter.theconversation.com/content/205087/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Antonina Mutoro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Biological and chemical substances are the most common food contaminants and account for over 200 food-borne illnesses.Antonina Mutoro, Postdoctoral Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2037672023-04-18T12:19:39Z2023-04-18T12:19:39ZKenya should decriminalise homosexuality: 4 compelling reasons why<figure><img src="https://images.theconversation.com/files/520830/original/file-20230413-14-r1pv5c.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Activists agitate for equal rights for all in Nairobi, Kenya, in January 2020. </span> <span class="attribution"><span class="source">Tony Karumba/AFP via Getty Images</span></span></figcaption></figure><p>Kenya has recently seen the <a href="https://kohljournal.press/health-and-freedom">increasing visibility</a> of sexual and gender minorities. However, this has been met with <a href="https://www.aljazeera.com/opinions/2023/3/15/how-an-lgbtq-court-ruling-sent-kenya-into-a-moral-panic">a growing backlash</a>.</p>
<p><a href="https://www.youtube.com/watch?v=t4uGzjZIzM8">Religious</a> and <a href="https://ntvkenya.co.ke/news/gachagua-on-lgbtq-those-are-satanic-beliefs/">political leaders</a> have been spreading homophobic and transphobic rhetoric. This has happened with the <a href="https://www.hrw.org/report/2015/09/28/issue-violence/attacks-lgbt-people-kenyas-coast">tacit approval</a> of a law enforcement apparatus that’s supposed to guarantee the right to equal protection. </p>
<p>The continued criminalisation of same-sex sexual relations among consenting adults in Kenya worsens social disparities and inequalities. It fuels socioeconomic and health vulnerabilities. </p>
<p>It <a href="https://www.researchgate.net/publication/308163037_Freedom_Corner_Redefining_HIV_and_AIDS_care_and_support_among_men_who_have_sex_with_men_in_Nairobi_Kenya">deprives members of these minority groups</a> access to education, a livelihood, and basic services like housing and healthcare. Criminalisation pushes <a href="https://pure.uva.nl/ws/files/18012125/Thesis.pdf">sexual and gender minorities to the margins of society</a>. Research has shown that sexual and gender minorities are <a href="https://www.researchgate.net/publication/308163037_Freedom_Corner_Redefining_HIV_and_AIDS_care_and_support_among_men_who_have_sex_with_men_in_Nairobi_Kenya">consistently targeted</a> for unfair dismissal from jobs or business opportunities. </p>
<p>The decriminalisation of same-sex relations among adults would lead to four positive outcomes: inclusive development for economic growth, improved health outcomes, the safety and security of sexual minorities, and an acceptance of diversity and equality. This view is based on our <a href="https://www.researchgate.net/profile/Emmy-Kageha">research on social exclusion</a>, with a focus on <a href="https://kohljournal.press/health-and-freedom">sexual and gender minorities</a>.</p>
<h2>Inclusive development for economic growth</h2>
<p><a href="https://www.worldbank.org/en/region/afr/brief/social-inclusion-in-africa">Social inclusion</a> is the process of improving the conditions for individuals and groups to participate in society. Social exclusion based on sexual orientation leads to lower societal standing. </p>
<p>This often leads to poorer outcomes in terms of income, human capital endowments and access to employment. People who are discriminated against tend to lack a voice in national and local decision making. </p>
<p>Decriminalisation of same-sex sexual relations would help address institutionalised stigma and discrimination. It would enhance access to equal opportunities by eliminating barriers to employment and other livelihood opportunities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lgbti-refugees-seeking-protection-in-kenya-struggle-to-survive-in-a-hostile-environment-182810">LGBTI refugees seeking protection in Kenya struggle to survive in a hostile environment</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://pure.uva.nl/ws/files/18012125/Thesis.pdf">Research</a> shows that sexual and gender minorities with access to income opportunities support their families financially. This is true even in cases where families aren’t accepting. People who are educated can also compete effectively in the job market. The exclusion of minorities, therefore, means <a href="https://open-for-business.org/kenya-economic-case">the loss of a workforce and their contribution to economic development</a>. </p>
<h2>Better health outcomes</h2>
<p>Social exclusion contributes to poor health among sexual and gender minorities. In 2020, <a href="https://www.unaids.org/sites/default/files/media_asset/2021-global-aids-update_en.pdf#page=6">1.5 million people</a> were newly infected with HIV. Those <a href="https://www.unaids.org/sites/default/files/media_asset/2021-global-aids-update_en.pdf#page=23">most vulnerable</a> to infection include people who inject drugs, transgender women, sex workers, men who have sex with men, and their sexual partners. </p>
<p>These key populations accounted for <a href="https://www.unaids.org/sites/default/files/media_asset/2021-global-aids-update_en.pdf#page=23">65% of HIV infections</a> globally. In sub-Saharan Africa, they accounted for <a href="https://www.unaids.org/sites/default/files/media_asset/2021-global-aids-update_en.pdf#page=24">39% of new infections</a>. </p>
<p><a href="https://open-for-business.org/about">Open for Business</a> is a global research coalition that seeks to address the backlash against the LGBTIQ+ community. In a <a href="https://open-for-business.org/kenya-economic-case">2020 report</a>, the group estimated that discrimination against sexual minorities costs Kenya up to Sh105 billion (US$782 million) annually in poor health outcomes. </p>
<p>Decriminalisation enhances access to healthcare. <a href="https://www.tandfonline.com/doi/full/10.1080/17441692.2018.1462841">Our</a> <a href="https://kohljournal.press/health-and-freedom">research</a> shows, for example, better health such as decreased new HIV infections in societies that adopt laws that advance non-discrimination and decriminalise same-sex relationships. </p>
<h2>Enhancing safety and security</h2>
<p>In 2014, the African Commission on Human and Peoples’ Rights adopted <a href="https://achpr.au.int/en/adopted-resolutions/275-resolution-protection-against-violence-and-other-human-rights-violations">Resolution 275</a>. The resolution expresses grave concerns about increasing violence and other human rights violations – including murder, rape and assault – of individuals based on sexual orientation or gender identity. </p>
<p>Safety and security are some of the <a href="https://www.article19.org/resources/kenya-murder-lgbtq-activist-urgent-reform/">biggest challenges</a> facing sexual and gender minorities in Kenya. The country has seen an escalation of <a href="https://www.aljazeera.com/opinions/2023/3/15/how-an-lgbtq-court-ruling-sent-kenya-into-a-moral-panic">negative rhetoric and violence</a> targeting sexual and gender minorities, and <a href="https://www.bbc.com/news/world-africa-64491276">related organisations</a>. Hate speech, verbal and physical abuse, sexual violence and police harassment <a href="https://www.reuters.com/article/uganda-lgbt-hatecrime-idUSL4N3584J1">have increased</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/justiceforsheila-highlights-the-precarious-lives-of-queer-people-in-kenya-183102">#JusticeForSheila highlights the precarious lives of queer people in Kenya</a>
</strong>
</em>
</p>
<hr>
<p>In Kenya’s coastal city of Mombasa, for instance, sexual minorities <a href="https://www.the-star.co.ke/news/2023-03-16-gay-people-fear-for-their-lives-escape-mombasa-over-planned-demos/">fled</a> recent <a href="https://twitter.com/citizentvkenya/status/1636702221743079425?s=20">homophobic street protests</a>. A <a href="https://www.researchgate.net/publication/334681176_Are_we_doing_alright_Realities_of_violence_mental_health_and_access_to_healthcare_related_to_sexual_orientation_and_gender_identity_and_expression_in_East_and_Southern_Africa_Research_report_based_on_">2019 report</a> on the experiences of the <a href="https://ccprcentre.org/files/documents/INT_CCPR_CSS_KEN_44420_E.pdf#page=6">LGBTIQ+ community in Kenya</a> found that 53% have been physically assaulted and 44% sexually assaulted. </p>
<p>The criminalisation of same-sex sexual relations among adults contributes to a climate of violence and discrimination. Moreover, criminalisation supports the perpetrators of violence who take the law into their own hands. </p>
<h2>Acceptance of diversity</h2>
<p>Sexual and gender minorities are socially excluded because of the <a href="https://theconversation.com/homosexuality-remains-illegal-in-kenya-as-court-rejects-lgbt-petition-112149">criminal label</a> the law imposes on them. This affects their self-acceptance and mental health. </p>
<p>Homophobic acts are widespread even in countries where <a href="https://theconversation.com/sam-smith-how-queerphobia-and-fatphobia-intersect-in-the-backlash-to-the-im-not-here-to-make-friends-video-199437">same-sex relations are legal</a>. However, decriminalisation helps facilitate some level of acceptance among minority groups and within wider society. </p>
<p><a href="https://ualr.edu/socialchange/2013/01/13/impact-of-the-decriminalization-of-homosexuality-in-delhi-an-empirical-study">Studies</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9293432/">have found</a> that decriminalisation reduces societal violence. </p>
<h2>The way forward</h2>
<p>Same-sex relations, or sexual and gender minorities, <a href="https://www.jstor.org/stable/43904926">aren’t new</a> <a href="https://www.arcados.ch/wp-content/uploads/2012/06/MURRAY-ROSCOE-BOY-WIVES-FEMALE-HUSBANDS-98.pdf">in Africa</a>. They aren’t a <a href="https://www.researchgate.net/publication/332192031_An_Exploratory_Journey_of_Cultural_Visual_Literacy_of_Non-Conforming_Gender_Representations_from_Pre-Colonial_Sub-_Saharan_Africa">foreign ideology</a>. </p>
<p>Social exclusion constitutes perhaps the most serious challenge towards attaining sustainable and inclusive development. The criminalisation of same-sex relations among consenting adults in Kenya’s penal code exposes the weaknesses of the constitution in ensuring inclusivity. The law must, therefore, be changed. </p>
<p>Repealing criminalisation clauses is an important step toward reducing stigma, violence and discrimination. It would certainly open a new chapter in the lives of sexual and gender minorities.</p>
<p>There’s also an urgent need to make sexual and gender minorities visible. Awareness campaigns can help debunk perceptions that they are “anti-religious” or “un-African”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-does-the-bible-say-about-homosexuality-for-starters-jesus-wasnt-a-homophobe-199424">What does the Bible say about homosexuality? For starters, Jesus wasn't a homophobe</a>
</strong>
</em>
</p>
<hr>
<p>There’s an equally urgent need to identify all forms of discrimination against sexual and gender minorities under domestic and international laws. This will help address the root causes of inequalities.</p>
<p>Decriminalisation of same-sex relations is imperative. It will help address widening disparities, inequalities in society and the gaps in social integration.</p>
<p><em>Nicholas Etyang, a senior policy advocacy officer at the African Population and Health Research Center, is a co-author of this article.</em></p><img src="https://counter.theconversation.com/content/203767/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucy Wanjiku Mung’ala is affiliated with Hivos, where she works as the strategy and impact lead - gender equality, diversity and inclusion. </span></em></p><p class="fine-print"><em><span>Emmy Kageha Igonya does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The criminalisation of same-sex sexual relations among consenting adults in Kenya worsens social disparities and inequalities.Emmy Kageha Igonya, Associate research scientist, African Population and Health Research CenterLucy Wanjiku Mung’ala, PhD Researcher, University of AmsterdamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2034402023-04-13T12:38:49Z2023-04-13T12:38:49ZSeule une fille sur trois atteint l'école secondaire au Sénégal : voici pourquoi et comment y remédier<figure><img src="https://images.theconversation.com/files/519830/original/file-20230406-16-dy5s4u.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Les raisons qui expliquent pourquoi les filles n'entrent pas dans le secondaire commencent dès l'école primaire. </span> <span class="attribution"><span class="source">Godong via Getty Images</span></span></figcaption></figure><p><em>Le Sénégal a une <a href="https://www.ansd.sn/Indicateur/projections-demographiques">jeune population</a>, avec environ la moitié de ses 18 millions d'habitants âgés de moins de 19 ans. Cela indique une demande potentiellement élevée en matière d'éducation. Cependant, parmi les enfants âgés de 6 à 11 ans, <a href="https://www.epdc.org/sites/default/files/documents/EPDC_NEP_2018_Senegal.pdf#page=1">41%</a> ne sont pas scolarisés. Dans le groupe d'âge des 12 à 18 ans, <a href="https://www.epdc.org/sites/default/files/documents/EPDC_NEP_2018_Senegal.pdf#page=1">43 %</a> ne sont pas scolarisés. Les statistiques <a href="https://www.education.sn/sites/default/files/2019-08/RNSE%20_2018%20%20-DPRE_DSP_BSS-%20vf%20juillet%202019.pdf#page=64">montrent</a> également que le nombre de filles inscrites diminue au fur et à mesure qu'elles avancent dans le système. Pour comprendre cette dynamique, le Centre africain de recherche sur la population et la santé <a href="https://aphrc.org/publication/the-state-of-education-and-implications-of-srhr-on-the-education-of-adolescent-girls-in-senegal/">a mené une étude de deux ans</a> sur l'éducation et le bient-être des filles au Sénégal. Benta A Abuya, chercheur principal de l'étude, analyse les résultats.</em></p>
<h2>Votre étude a révélé que seulement <a href="https://aphrc.org/wp-content/uploads/2020/08/APHRC_The-State-of-Education_ENG-1.pdf#page=2">environ 34% des filles</a> s'inscrivent dans une école secondaire même après avoir terminé leur cycle élémentaire au Sénégal. Comment cela se fait-il ?</h2>
<p>Les raisons commencent dès l'école élémentaire. Au Sénégal, l'âge officiel d'entrée à l'école élémentaire est fixé à six ans. L'école élémentaire dure six ans, le moyen quatre ans et le secondaire trois ans.</p>
<p><a href="https://aphrc.org/wp-content/uploads/2020/08/APHRC_The-State-of-Education_ENG-1.pdf#page=47">Nos résultats</a> montrent qu'en dernière année d'école élémentaire, le taux d'abandon est de 26,7 % pour les filles et de 22,2 % pour les garçons. </p>
<p>Nous avons constaté que les difficultés financières des ménages constituent l'un des obstacles à l'achèvement de la scolarité des filles et des garçons. Environ <a href="https://www.wfp.org/countries/senegal">39 %</a> des Sénégalais vivent en dessous du seuil de pauvreté.</p>
<p>Malgré l'existence de <a href="https://www.consortiumeducation.org/sites/consortiumeducation/files/2021-11/LETTRE%20DE%20POLITIQUE%20GENERALE%20POUR%20LE%20SECTEUR%20DE%20L%E2%80%99EDUCATION%20ET%20DE%20LA%20FORMATION%20LPGS-EF.pdf">programmes gouvernementaux</a> – comme l'enseignement public gratuit jusqu'à l'âge de 16 ans et le Projet d'appui à l'éducation des filles, qui fournit des uniformes scolaires – le coût de la scolarité reste un obstacle pour de nombreuses familles. Elles doivent payer le matériel pédagogique et le transport scolaire. </p>
<p>Nous avons également constaté une préférence pour l'éducation des garçons par rapport à celle des filles. Dans les ménages aux moyens financiers limités, les garçons sont plus souvent envoyés à l'école, au détriment des filles.</p>
<p>En outre, les filles qui sont délinquantes, qui manquent d'intérêt pour l'école ou qui se livrent à des activités sexuelles dangereuses ont tendance à être jugées sévèrement par les communautés. Elles sont considérées comme une source de honte pour leur famille. Elles sont donc retirées de l'école et mariées précocement pour tenter de remédier à ce comportement.</p>
<p>Des croyances et des pratiques culturelles profondément ancrées - telles que les mutilations génitales féminines, les mariages forcés d'enfants et les grossesses précoces - empêchent également certaines filles de progresser à l'école. Elles accusent donc un retard en matière d'éducation et de bien-être. </p>
<p><a href="https://www.tandfonline.com/doi/pdf/10.1080/1554477X.2017.1375786">L'âge légal du mariage</a> au Sénégal est de 16 ans pour les filles et de 18 ans pour les garçons. Mais ce sont les familles qui décident du moment où les filles se marient. Par exemple, dans la région de Kolda, dans le sud du pays, <a href="https://www.ohchr.org/sites/default/files/Documents/Issues/Women/WRGS/Earlyforcedmarriage/States/Senegal.pdf">68 % des filles</a> se marient avant d'avoir 18 ans. C'est plus du double de la moyenne nationale de 31 %.</p>
<p>Dans une étude exploratoire réalisée en 2019, nous avons constaté que sur 1 321 adolescentes, <a href="https://www.jstor.org/stable/pdf/resrep28641.pdf?refreqid=excelsior%3A966c61f0bf91f2b2d091eee177c1417c&ab_segments=&origin=&initiator=&acceptTC=1">78 % sont tombées enceintes entre 12 et 18 ans</a>. Parmi ces grossesses, 25,6 % ont eu lieu avant que les filles n'atteignent l'âge de 15 ans. Et selon une <a href="https://aphrc.org/wp-content/uploads/2023/03/Rapport-IGE-english.pdf#page=10">étude exploratoire</a> que nous avons réalisée en 2021, les grossesses précoces ont été principalement citées dans les régions de Zinguinchor et de Sédhiou, dans le sud-ouest du Sénégal, comme étant à l'origine de l'abandon de l'école par les filles. </p>
<p>Certaines filles se marient tôt parce que leur famille pense qu'elles risquent moins de tomber enceintes dans le cadre d'une relation sexuelle transactionnelle. D'autres se marient tôt parce qu'elles considèrent que c'est la seule possibilité de faire leur vie après avoir abandonné l'école. </p>
<h2>Pourquoi est-ce un problème que tant de filles n'aillent pas à l'école secondaire au Sénégal ?</h2>
<p>Lorsque les filles ne vont pas à l'école secondaire, elles et leurs communautés ne bénéficient pas des <a href="https://www.globalpartnership.org/blog/why-educating-girls-makes-economic-sense">avantages sociaux, économiques et sanitaires qui découlent de l'éducation</a>. </p>
<p>Lorsque le nombre de filles qui accèdent à l'école secondaire augmente, les communautés sont incitées à construire davantage d'établissements secondaires. Cela stimule à son tour l'augmentation des inscriptions à l'école primaire. Les filles ont également plus de chances de se trouver à proximité des écoles qu'elles doivent fréquenter, ce qui <a href="https://aphrc.org/wp-content/uploads/2023/03/Rapport-IGE-english.pdf">motive les parents</a> à s'engager davantage à soutenir de leur scolarité. </p>
<p>Lorsque les filles reçoivent une éducation secondaire, <a href="https://eric.ed.gov/?id=ED500794">toute la société en bénéficie</a>. Les compétences en matière de réflexion critique permettent aux filles de participer à des tâches civiques et de conduire des changements démocratiques au sein de leurs communautés. Les femmes instruites sont mieux placées pour relever certains défis sanitaires auxquels sont confrontés leurs enfants et leurs communautés, car elles sont souvent les principales dispensatrices de soins. </p>
<p>Les mères instruites améliorent la <a href="https://www.worldbank.org/en/topic/girlseducation">vaccination et l'apport nutritif</a> de leurs enfants, réduisent le risque de mortalité infantile et de retard de croissance, ont des taux de fécondité plus faibles et moins de grossesses non désirées. </p>
<p>Enfin, le fait d'aller à l'école secondaire réduit le risque que les filles contractent des maladies sexuellement transmissibles, car elles sont en mesure d'accéder à des informations leur permettant de modifier leur comportement en matière de santé au moment où elles sont le plus vulnérables. </p>
<h2>Vous avez cherché à savoir comment les parents pouvaient contribuer à augmenter le nombre de filles inscrites à l'école secondaire. Qu'avez-vous trouvé ?</h2>
<p>Les parents peuvent contribuer à augmenter le nombre de filles qui accèdent à l'école secondaire s'ils :</p>
<ul>
<li><p>donnent les mêmes chances aux filles et aux garçons d'aller à l'école</p></li>
<li><p>s'abstiennent de marier les filles à un âge précoce</p></li>
<li><p>cessent d'invoquer l'excuse selon laquelle les filles “finiront forcément à la cuisine” </p></li>
<li><p>enregistrent tous leurs enfants, y compris les filles, à la naissance afin qu'ils disposent d'un bulletin de naissance. </p></li>
</ul>
<p>Nous avons constaté que l'absence de suivi de la délivrance des actes de naissance pour les filles <a href="https://aphrc.org/wp-content/uploads/2023/03/Rapport-IGE-english.pdf">entrave leur éducation</a> au-delà de l'école primaire, car elles ne peuvent pas se présenter aux examens de fin d'année.</p>
<p>Le gouvernement et les acteurs de l'éducation doivent encourager les parents à s'impliquer davantage dans les programmes visant à maintenir les filles à l'école. Par exemple, l'implication des parents est nécessaire pour mener la lutte contre les mariages précoces et les mutilations génitales féminines.</p>
<p>Le gouvernement doit également veiller à ce que le <a href="https://evaw-global-database.unwomen.org/en/countries/africa/senegal/2010/the-framework-for-the-coordination-of-girls-education-interventions">Cadre de coordination des interventions sur l'éducation des filles</a> au Sénégal travaille avec les communautés. </p>
<p>Les hommes et les garçons devraient être impliqués dans les programmes d'intervention. Cela pourrait <a href="https://www.unwomen.org/en/what-we-do/youth/engaging-boys-and-young-men-in-gender-equality">modifier la dynamique du pouvoir</a> en remettant en question les normes de genre et les croyances patriarcales selon lesquelles les hommes et les femmes ne sont pas égaux. </p>
<p>Dans les régions où les facteurs culturels et religieux entravent l'éducation des filles, les parents devraient être les premiers à s'attaquer à ces obstacles. Ils peuvent le faire en s'élevant contre les mariages précoces et en maintenant les filles à l'école.</p><img src="https://counter.theconversation.com/content/203440/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benta A. Abuya does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Des pratiques culturelles profondément ancrées - telles que les mutilations génitales féminines et le mariage des enfants - empêchent les filles de progresser à l'école.Benta A. Abuya, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2002942023-04-12T13:40:35Z2023-04-12T13:40:35ZOnly 1 in 3 girls makes it to secondary school in Senegal: here’s why and how to fix it<figure><img src="https://images.theconversation.com/files/519615/original/file-20230405-22-w162fj.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The reasons that explain why girls don’t get into secondary begin in primary school.
</span> <span class="attribution"><span class="source">Godong via Getty Images</span></span></figcaption></figure><p><em>Senegal has a <a href="https://www.ansd.sn/Indicateur/projections-demographiques">young population</a>, with about half of its 18 million people aged below 19. This indicates a potentially high demand for education. Of those aged six to 11, however, <a href="https://www.epdc.org/sites/default/files/documents/EPDC_NEP_2018_Senegal.pdf#page=1">41%</a> are out of school. In the age group 12 to 18, <a href="https://www.epdc.org/sites/default/files/documents/EPDC_NEP_2018_Senegal.pdf#page=1">43%</a> aren’t in school. <a href="https://www.education.sn/sites/default/files/2019-08/RNSE%20_2018%20%20-DPRE_DSP_BSS-%20vf%20juillet%202019.pdf#page=64">Statistics show</a>, too, that the enrolment numbers of girls decrease as they advance in grades. To understand these dynamics, the African Population and Health Research Center <a href="https://aphrc.org/publication/the-state-of-education-and-implications-of-srhr-on-the-education-of-adolescent-girls-in-senegal/">carried out a two-year study</a> on girls’ education and wellbeing in Senegal. The Conversation Africa asked Benta A. Abuya, a lead researcher on the study, to unpack the findings.</em></p>
<hr>
<h2>You found that only <a href="https://aphrc.org/wp-content/uploads/2020/08/APHRC_The-State-of-Education_ENG-1.pdf#page=2">a third of girls</a> enrol in a secondary school. Why is this?</h2>
<p>The reasons begin in primary school. In Senegal, the official primary school entrance age is six. Primary school lasts six years, lower secondary lasts four years and upper secondary lasts three years.</p>
<p><a href="https://aphrc.org/wp-content/uploads/2020/08/APHRC_The-State-of-Education_ENG-1.pdf#page=47">Our findings</a> were that in the last grade of primary school, the dropout rate was 26.7% for girls and 22.2% for boys. </p>
<p>We found that financial hardship in households is one of the obstacles to girls and boys completing school. About <a href="https://www.wfp.org/countries/senegal">39%</a> of Senegalese live below the poverty line.</p>
<p>Despite the existence of <a href="https://www.consortiumeducation.org/sites/consortiumeducation/files/2021-11/LETTRE%20DE%20POLITIQUE%20GENERALE%20POUR%20LE%20SECTEUR%20DE%20L%E2%80%99EDUCATION%20ET%20DE%20LA%20FORMATION%20LPGS-EF.pdf">government programmes</a> - like free public school education until age 16 and the Girls’ Education Support Project, which provides school uniforms - the cost of schooling is still an obstacle for many families. They have to pay for learning materials and transport to school.</p>
<p>We also found a preference to educate boys over girls. In households with limited finances, boys are more likely to be sent to school even if girls would like to go.</p>
<p>Additionally, girls who are delinquent, lack interest in school or engage in unsafe sexual activities tend to be judged harshly by communities. They are viewed as bringing shame to their families. They are, therefore, withdrawn from school and married off early in an attempt to address this behaviour.</p>
<p>Deep-seated cultural beliefs and practices – such as female genital mutilation, forced child marriages and early pregnancies – also prevent some girls from making progress in school. They, therefore, lag in education and wellbeing. </p>
<p>The legal age of <a href="https://www.tandfonline.com/doi/pdf/10.1080/1554477X.2017.1375786">marriage in Senegal is 16 for girls and 18 for boys</a>. But families decide when girls get married. For example, in the Kolda region in the south, <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01295-5">68% of girls get married before they turn 18</a>. This is more than double the national average of 31%.</p>
<p>In a scoping review we did in 2019, we found that out of 1,321 adolescent girls, <a href="https://www.jstor.org/stable/pdf/resrep28641.pdf?refreqid=excelsior%3A966c61f0bf91f2b2d091eee177c1417c&ab_segments=&origin=&initiator=&acceptTC=1">78% got pregnant between ages 12 and 18</a>. Of these pregnancies, 25.6% occurred before the girls turned 15. And in an <a href="https://aphrc.org/wp-content/uploads/2023/03/Rapport-IGE-english.pdf#page=10">exploratory study</a> we did in 2021, teenage pregnancy was predominantly cited in Zinguinchor and Sedhiou regions in south-west Senegal, as leading to girls dropping out of school. </p>
<p>Some girls marry early because their families believe it makes them less likely to fall pregnant in a transactional sexual relationship. Others marry early if they see it as the only opportunity to make a life after dropping out of school. </p>
<h2>Why is this a problem?</h2>
<p>When girls don’t get into secondary school, they and their communities miss out on the <a href="https://www.globalpartnership.org/blog/why-educating-girls-makes-economic-sense">social, economic and health benefits that accrue from education</a>. </p>
<p>When more girls get to secondary school, this spurs communities to build more secondary institutions. This in turn spurs higher primary school enrolment. It also increases the chances of girls being near the schools they need to attend, which <a href="https://aphrc.org/wp-content/uploads/2023/03/Rapport-IGE-english.pdf">motivates parents</a> to be more committed to supporting their schooling. </p>
<p>When girls get a secondary school education, <a href="https://eric.ed.gov/?id=ED500794">the whole society benefits</a>. Critical thinking skills enable girls to participate in civic duties and drive democratic change in their communities. Educated women are better placed to address some of the health challenges facing their children and their communities, as they are often primary caregivers. </p>
<p>Educated mothers increase the <a href="https://www.worldbank.org/en/topic/girlseducation">immunisation and nutrition intake</a> of their children, reduce the likelihood of child mortality and stunting, have lower fertility rates, and have fewer unwanted pregnancies. </p>
<p>Lastly, going to secondary school reduces the likelihood that girls will contract sexually transmitted diseases, as they are able to access information to change their health behaviour when they are most vulnerable. </p>
<h2>How can parents help turn the tide?</h2>
<p>Parents can help increase the number of girls getting into secondary school if they: </p>
<ul>
<li><p>give equal chances to girls and boys to attend school</p></li>
<li><p>refrain from marrying girls off early</p></li>
<li><p>stop using the excuse that girls are bound to “end up in the kitchen” </p></li>
<li><p>register all their children, including girls, at birth so that they have birth certificates. </p></li>
</ul>
<p>We found that a failure to follow up on the issuance of birth certificates for girls <a href="https://aphrc.org/wp-content/uploads/2023/03/Rapport-IGE-english.pdf">hinders their education</a> beyond primary school, as they are unable to sit for final exams.</p>
<p>The government and education stakeholders need to encourage parents to get more involved in programmes to keep girls in schools. For instance, parents are needed to drive the fight against early marriage and female genital mutilation.</p>
<p>The government should also ensure that the <a href="https://evaw-global-database.unwomen.org/en/countries/africa/senegal/2010/the-framework-for-the-coordination-of-girls-education-interventions">Coordinating Framework of Interventions on Girls’ Education</a> in Senegal works with communities. </p>
<p>Men and boys should be involved in intervention programmes. This has the potential <a href="https://www.unwomen.org/en/what-we-do/youth/engaging-boys-and-young-men-in-gender-equality">to shift power dynamics</a> by challenging gender norms and patriarchal beliefs that men and women aren’t equal. </p>
<p>In the regions where cultural and religious factors hinder girls’ education, parents should be at the forefront of addressing these barriers. They can do this by speaking up against early marriage and keeping girls in schools.</p><img src="https://counter.theconversation.com/content/200294/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benta A. Abuya is affiliated with The African Population and Health Research Center (APHRC). </span></em></p>Deep-seated cultural practices – such as female genital mutilation and child marriage – prevent girls from making progress in school.Benta A. Abuya, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952352022-11-29T07:35:51Z2022-11-29T07:35:51Z6 priorities to get Kenya’s curriculum back on track – or risk excluding many children from education<figure><img src="https://images.theconversation.com/files/497385/original/file-20221125-12-hp2nad.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>Kenya’s education curriculum was reformed in 2017 to improve its quality – but now many Kenyans are calling for change again. Public <a href="https://nation.africa/kenya/life-and-style/dn2/we-don-t-hate-cbc-we-just-want-its-implementers-to-be-realistic-3947316">disillusionment</a> with the competency-based curriculum has forced a <a href="https://www.education.go.ke/he-president-ruto-appoints-task-force-evaluate-cbc">government review</a>. </p>
<p>Frustrations with the curriculum centre around the complexity of learning activities and its sustainability given the high costs involved in its delivery.</p>
<p>The previous <a href="https://www.schoolsnetkenya.com/critical-review-of-8-4-4-education-system-in-kenya/">8-4-4</a> curriculum, launched in 1985, required eight years of primary schooling and four years each of secondary and tertiary education. Critics were unhappy with its emphasis on rote learning and teacher-centered pedagogical practices. They also noted that graduates of the 8-4-4 curriculum were <a href="https://www.businessdailyafrica.com/bd/news/fresh-graduates-gap-in-skills-in-job-market-worrying-2217574">ill-prepared</a> for the workforce. A 2009 <a href="https://kicd.ac.ke/wp-content/uploads/2018/02/Needs-Assessment-Rpt-ilovepdf-compressed.pdf">government evaluation</a> found the system had limited practical training opportunities and a heavy focus on examinations. </p>
<p>In 2011, the government <a href="https://kenyauptodate.blogspot.com/2011/02/8-4-4-system-review-team-unveiled.html?m=1">appointed a task force</a> to review 8-4-4. This review eventually led to the competency-based curriculum, a <a href="https://www.nexxushub.com/blog/CBC-New-Kenya-Education-System">2-6-3-3-3 system</a>. It requires two years of pre-primary education, six years of primary education, three years each of junior secondary and senior secondary school, and a minimum three years of tertiary education. </p>
<p>The competency-based curriculum emphasises student-centered teaching and practical experiences that better equip learners with 21st-century skills like critical thinking and problem-solving.</p>
<p>As experience from numerous countries shows, education reforms can be messy and rollouts messier. Success requires adequate planning. </p>
<p>In our view as education researchers, the adoption of the competency-based curriculum in Kenya shows glaring gaps in design, planning and execution. At the very basic level, there is a looming question on whether the curriculum is well understood. It is vastly different from 8-4-4, and many stakeholders, including parents and teachers, aren’t clear about how it works and what it requires of them. </p>
<h2>Uphill task</h2>
<p>A national curriculum provides a framework and guidance on the core knowledge students need to learn in key subjects. It’s a critical driver in teaching and learning. However, it exists within an intricate set of interconnected educational components that require intentional planning and execution to function optimally. </p>
<p>Failure to take multiple aspects into consideration – such as teaching capacity, assessments, transitions and resources – compromises the best intentions and harms a large population of learners. </p>
<p>In Kenya’s case, the competency-based curriculum ship has sailed; scrapping it now would do more harm than good. </p>
<p>Firstly, large financial investments have been made. According to the <a href="https://kicd.ac.ke/about-us/">Kenya Institute of Curriculum Development</a>, the government <a href="https://arena.co.ke/we-will-lose-sh-200-billion-and-more-if-we-scrap-cbc-warns-kicd-boss/">has spent</a> more than US$1.6 billion on curriculum reform. This includes the money spent on research, assessments and a two-year pilot study. </p>
<p>Secondly, we believe that the competency-based curriculum may potentially improve Kenya’s education system and provide learners with rich learning experiences. </p>
<p>The government has taken the first step in addressing discontent with the curriculum by <a href="https://www.education.go.ke/he-president-ruto-appoints-task-force-evaluate-cbc">appointing</a> a task force to address the <a href="https://www.pd.co.ke/news/public-engagement-in-cbc-reforms-start-156272/">public’s concerns</a>.</p>
<p>A new academic year begins in January 2023, with the first cohort of 1.3 million learners expected to join junior high school. Kenyans needs <a href="https://www.the-star.co.ke/news/realtime/2022-11-17-ruto-will-make-final-decision-on-junior-secondary-cs-machogu/">clear guidance</a> on this transition. They need to know where junior high schools will be located, for instance, and the costs involved. This will help <a href="https://www.standardmedia.co.ke/entertainment/education/article/2001460093/junior-secondary-classes-dominate-talks-on-cbc">ease the frustrations</a> caused by current uncertainties.</p>
<p>Based on our research experience on curriculum development, teaching and education systems, we have drawn up a list of six priorities the task force should consider. These include acknowledging that Kenyans’ frustrations with the curriculum change are legitimate, and that to be successful, the system needs adaptations.</p>
<h2>What’s wrong?</h2>
<p>The competency-based curriculum focuses on the development of competencies across subject areas, with a shift from students demonstrating what they know to demonstrating what they can do.</p>
<p>Some parents are receptive and enthusiastic about these aspects of the new curriculum. For those against it, the <a href="https://www.pd.co.ke/news/experts-fault-enactment-of-cbc-system-127178/">complaints</a> have focused on affordability and feasibility. </p>
<p>At face value, practical experiences are relevant and can enrich students’ learning. However, challenges arise when resources are unavailable and parents are required to constantly purchase and improvise resources.</p>
<p>In an <a href="https://www.oxfam.org/en/kenya-extreme-inequality-numbers">already unequal society</a>, this model strains many families, particularly those who live in low-resourced households, outside urban centres, and those in places without access to basic infrastructure like electricity.</p>
<p>The curriculum also demands more <a href="https://kicd.ac.ke/wp-content/uploads/2019/07/SERIES-5-FParental-Roles.pdf">parental engagement</a> than 8-4-4 did. Some parents feel unprepared to <a href="https://theconversation.com/education-in-kenyas-informal-settlements-can-work-better-if-parents-get-involved-heres-how-192149">get involved</a>. </p>
<p>The frustrations with the competency-based curriculum may be magnified because of a familiarity with 8-4-4 – in place for 32 years – and the difficulties that come with change. Yet, concerns about its demands, both financial and skill-based, are legitimate for many parents who see the curriculum as catering only to those with particular skills and those who can afford the time and resources required. </p>
<p>Kenya isn’t the first country in the east African region to launch a competency-based curriculum. Rwanda did it in <a href="https://reb.rw/fileadmin/competence_based_curriculum/index0.html">2015</a>. Comparing the experiences of these two countries requires caution, given the differences in contexts, education policies, and political and cultural environments. Rwanda, however, faced some <a href="https://www.ajol.info/index.php/rje/article/view/202582#:%7E:text=Major%20challenges%20included%20the%20lack,to%20overcome%20the%20identified%20challenges">challenges similar to Kenya’s</a>, including limited availability of resources and a persistence of old teaching practices. </p>
<h2>Next steps</h2>
<p>There’s an immediate need for stakeholders, particularly ardent supporters of the curriculum, to lessen the grip on their vision and evaluate where the curriculum rollout in Kenya missed the mark.</p>
<p>Task forces can create change by bringing stakeholders together and forging alliances. But they can also be costly. They have a reputation for under-delivering beyond publishing reports. </p>
<p>The curriculum task force should consider these six priorities.</p>
<ul>
<li><p>Reassure Kenyans that the stakes are high and providing a quality curriculum for learners is the priority. Take steps to rebuild public trust by addressing pressing challenges, such as financial strain accruing from the costs of learning materials. Guide schools on how to address this challenge.</p></li>
<li><p>Provide the public with information that fills knowledge gaps. For instance, teacher training, assessments and transitions.</p></li>
<li><p>Explain how the curriculum works in low-resourced households and schools, among students with special needs, and in settings with large class sizes and high student-teacher ratios.</p></li>
<li><p>Re-evaluate expectations on parents, remove extraneous demands, avoid blaming them and invite them as collaborators.</p></li>
<li><p>Identify the right drivers of change and avoid replicating avoidable mistakes. For instance, prioritise students and set aside the politics and in-fighting among educational agencies and associations.</p></li>
<li><p>Embrace local solutions and creatively use existing resources. Avoid surface-level solutions and remove existing barriers drawing on empirical evidence.</p></li>
</ul>
<p>There is value in curriculum reforms and in adapting best practices from different contexts. However, many challenges with the Kenyan curriculum stem from mismatches with the local context, inadequate preparation and foresight. </p>
<p>Ignoring the realities of large populations of learners and parents, and making sweeping assumptions doesn’t make these realities go away. </p>
<p>The task force has a monumental and urgent responsibility to bring Kenyans closer to a resolution.</p><img src="https://counter.theconversation.com/content/195235/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ignoring local realities risks excluding children from learning.Elisheba Kiru, Postdoctoral Research Scientist, African Population and Health Research CenterBrenda Wawire, Associate Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1945612022-11-21T14:06:28Z2022-11-21T14:06:28ZPregnant students in Tanzania may stay in school according to a new ruling by African child rights experts<figure><img src="https://images.theconversation.com/files/496495/original/file-20221121-14-ffo75k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Gettyimages</span></span></figcaption></figure><p><em>The African Committee of Experts on the Rights and Welfare of Children <a href="https://reproductiverights.org/acerwc-ruling-tanzania-pregnant-schoolgirls/#:%7E:text=The%20ACERWC%20found%20that%20the,education%2C%20health%20and%20health%20services%3B">recently</a> made what experts call a landmark ruling. The committee is a regional quasi-judicial organ of the African Union. Its task is to monitor and implement the African Charter on Child’s Rights and Welfare, interpret the provisions of the charter and promote and protect children’s rights in Africa. The group of experts denounced the Tanzanian government’s policy of expelling pregnant and married girls from school. Tanzania has a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30856-4/fulltext">history</a> of using the country’s controversial <a href="https://www.reuters.com/article/us-tanzania-women-education-idUSKBN2801II">1961</a> law to deny adolescent mothers access to education. The late president John Magufuli <a href="https://www.youtube.com/watch?v=OcyxnnxPMEE">openly</a> referred to adolescent pregnancy as “immoral behaviour” that would not be allowed “to permeate primary and secondary schools”.</em></p>
<p><em>Reproductive health researcher Anthony Ajayi is optimistic that the recent ruling will compel more African countries to keep pregnant adolescents in school. He unpacks the details of the complaint and what Tanzania has been ordered to do.</em></p>
<hr>
<h2>What was the complaint against Tanzania?</h2>
<p>In 2019, the Legal and Human Rights Centre (an NGO based in Dar es Salaam) and the Centre for Reproductive Rights (a global advocacy organisation) <a href="https://reproductiverights.org/case/tanzania-acerwc-expulsion-pregnant-schoolgirls/">filed</a> a complaint against the Tanzanian government. The two organisations are representing Tanzanian girls. </p>
<p>They accused the government of subjecting primary and secondary school girls to compulsory pregnancy tests and expelling them from school if they are found to be pregnant. The complainants alleged that school administrators were interpreting pregnancy as a moral offence punishable by expulsion. Under the expulsion policy, pregnant girls are subjected to unlawful detention or harassment until they expose the identity of the person who impregnated them. </p>
<p>Moreover, the government’s expulsion of pregnant and married girls is considered permanent. The affected girls are only allowed to be readmitted to private or vocational training schools and not their previous public schools. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tanzanian-girls-need-support-not-threats-to-avoid-pregnancy-126540">Tanzanian girls need support, not threats, to avoid pregnancy</a>
</strong>
</em>
</p>
<hr>
<p>Another key complaint was that the government deprived pregnant
girls of access to sexual reproductive health information and services. </p>
<h2>What are the decisions?</h2>
<p>The <a href="https://www.acerwc.africa/sites/default/files/2022-10/ACERWC%20Decision%20final%20Communication%20No-%200012Com0012019.Tanzania.pdf">decision</a> obligates the Tanzanian government to immediately prohibit mandatory pregnancy testing – in schools and in health facilities. The government also has to remove wedlock as a ground for expulsion, readmit school girls affected by the ban, and provide special support to compensate for the lost years.</p>
<p>The country is also mandated to investigate cases of detention of pregnant girls, release those detained and stop the arrest of pregnant girls. Girls who dropped out of school due to pregnancy or wedlock must be readmitted without preconditions. </p>
<p>Moreover, the Tanzanian government is required to provide sexuality education for adolescent children as well as child-friendly sexual reproductive and health services. It must sensitise teachers, school administrators, healthcare providers, police, and other actors about the protection that should be accorded to pregnant and married girls.</p>
<h2>How will this affect the lives of young women and girls in Tanzania?</h2>
<p>Adolescent childbearing in Tanzania has been on an <a href="https://preview.dhsprogram.com/pubs/pdf/FR321/FR321.pdf">upward trajectory</a>. In 2010 an estimated 22.8% of teenagers aged 15-19 had a child or were pregnant. By 2016, the estimate had risen 26.8%. </p>
<p>However, the <a href="http://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/crr_Tanzania_Report_Part2.pdf">number</a> of girls dropping out of school due to pregnancy has declined from 9,800 girls in 2009 to 6,500 in <a href="https://www.worldbank.org/en/news/statement/2021/11/24/world-bank-statement-on-the-announcement-by-government-of-tanzania-on-equal-access-to-education-for-pregnant-girls-and-y">2021</a>. </p>
<p>Education is important for girls’ future earning power and the promotion of their lifelong health and socioeconomic well-being. Implementing the committee’s decision would help break the persistent poverty cycle associated with early childbearing and missing out on education.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/punishment-wont-stop-teenage-pregnancies-in-tanzania-because-bad-behaviour-isnt-the-cause-90187">Punishment won't stop teenage pregnancies in Tanzania because 'bad behaviour’ isn't the cause</a>
</strong>
</em>
</p>
<hr>
<p>This decision will also open doors for more contributions from development partners keen on promoting girls’ education and working to achieve gender equality. </p>
<p>The decision directly mandates Tanzania to comply. But all 49 countries that have ratified the <a href="https://au.int/sites/default/files/treaties/36804-sl-AFRICAN%20CHARTER%20ON%20THE%20RIGHTS%20AND%20WELFARE%20OF%20THE%20CHILD.pdf">African Charter on the Rights and Welfare of the Child</a> are subject to this interpretation. </p>
<p>With this decision, civil society organisations now have an additional yardstick to measure their government’s compliance with the African Charter on Child’s Rights and Welfare. </p>
<h2>What has been the impact of other decisions by the African committee of experts on the rights and welfare of the child in other countries?</h2>
<p>Since 2005, the African Committee of Experts on the Rights and Welfare of Children has received 22 complaints.</p>
<p>Of the complaints filed, the monitoring body has to date:</p>
<ul>
<li><p>finalised seven</p></li>
<li><p>settled two of them amicably with relevant government organs and their complainants</p></li>
<li><p>declared five inadmissible due to the complainants’ failure to exhaust in-country remedies</p></li>
<li><p>dismissed complaints that fail to meet the conditions laid down in the Charter and the committee’s Guidelines on Consideration of Communications or that fall outside of the mandate of the commission. </p></li>
</ul>
<p>Though the committee lacks enforcement powers, we believe this decision about Tanzania is significant. </p>
<p>The transition of power to Samia Suluhu Hassan, the country’s first female president, offers renewed hope for girls’ education. The education minister, Joyce Ndalichako, and the permanent secretary at the ministry of education have <a href="https://www.theguardian.com/global-development/2021/nov/26/tanzania-to-lift-ban-on-teenage-mothers-returning-to-school">stated</a> that the policy will be changed. </p>
<p>This ruling however goes beyond changing the Tanzanian policy. It calls on countries to address existing gaps in their laws, policies and programmes, to be fully compliant with the charter. Merely stating that a school reentry policy is in place will no longer be sufficient. </p>
<p>Tanzania’s current administration has already expressed goodwill by offering to change the policy. This goodwill can be harnessed to ensure that the decisions are fully implemented. </p>
<p><em>Juliet Kimotho, Senior Advocacy Officer at the African Population and Health Research Center, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/194561/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Idowu Ajayi is affiliated with the African Population and Health Research Center. </span></em></p>Education is important for girls’ future earning power and the promotion of their lifelong health and socioeconomic well-being.Anthony Idowu Ajayi, Associate research scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921492022-11-16T14:35:47Z2022-11-16T14:35:47ZEducation in Kenya’s informal settlements can work better if parents get involved – here’s how<figure><img src="https://images.theconversation.com/files/494689/original/file-20221110-13-iiqx2x.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Anthony Asael/Art in All of Us via Getty Images</span></span></figcaption></figure><p>Education is a public good. All children should have access to education as a human right, irrespective of their gender, socioeconomic or disability status. </p>
<p>This is reinforced and validated by countries’ commitment to <a href="https://iite.unesco.org/publications/education-2030-incheon-declaration-framework-action-towards-inclusive-equitable-quality-education-lifelong-learning/">Sustainable Development Goal 4</a>. Its promise is inclusive and equitable education, and lifelong learning for all children. </p>
<p>This right is not assured, however. About <a href="https://www.unicef.org/turkiye/en/press-releases/more-104-million-children-and-young-people-1-3-are-out-school-countries-affected-war">303 million</a> children and adolescents aged between five and 17 are out of school. </p>
<p>Research studies have underscored that parental involvement and empowerment make a difference to student education outcomes and well-being. There are <a href="https://www.proquest.com/openview/9e3a9e802f80705150dceec414b8ed1c/1?pq-origsite=gscholar&cbl=41842">five ways</a> in which parents can improve students’ schooling outcomes: </p>
<ul>
<li><p>meeting basic parental obligations</p></li>
<li><p>family involvement in the home</p></li>
<li><p>exchange and collaboration at the community level</p></li>
<li><p>active communication between teachers and parents</p></li>
<li><p>opportunities for parents to offer their services in school as volunteers. </p></li>
</ul>
<p>Over the past nine years, my research through the <a href="https://aphrc.org/wp-content/uploads/2020/01/Advancing-Learning-outcomes-brief.pdf">Advancing Learning Outcomes for Transformational Change</a> (A LOT Change) programme in Kenya has shown that when parents get involved, students’ academic and psychosocial attributes improve.</p>
<p>This study – which ran from 2013 to 2022 in Nairobi – has shown that parents are enablers, motivators and facilitators of their children’s education at all levels of schooling. This runs from the early years, through the provision of <a href="https://gh.bmj.com/content/bmjgh/6/4/e004436.full.pdf">nurturing care</a>, to the completion of the basic education cycle. </p>
<h2>The research</h2>
<p>To establish the impact of parents’ involvement in adolescent lives, the African Population and Health Research Center implemented the A LOT Change programme in Korogocho and Viwandani in Nairobi, Kenya. Korogocho and Viwandani are informal settlements.</p>
<p>The community-based programme was implemented among adolescent girls between 2013 and 2015, and between girls and boys in primary school from 2016 to 2018. A cohort of secondary school students was followed from primary school between 2019 and 2022. </p>
<p>The programme provided after-school support and mentorship in life skills. It also provided school transition subsidies, and exposed parents to guidance and counselling to support their adolescents’ schooling. It further gave girls and boys opportunities to enhance their leadership skills through training and motivational talks. </p>
<p>ALOT Change sought to secure the future of children in urban informal settlements by improving learning outcomes, leadership skills and social behaviour. It also aimed to improve the transition rate for girls and boys aged 12 to 19 to secondary school. </p>
<p>The initiative was informed by the realisation that teachers – and schools in general – cannot do it all. They need the support of parents and communities to effectively nurture the educational aspirations of adolescents. </p>
<h2>Findings on the importance of parents</h2>
<p>A LOT Change initiatives improved parental involvement in children’s education. This included encouraging parents to actively communicate with their children, provide homework support and follow up on academic performance. Parents also got to know who their children associated with, or their whereabouts if the children weren’t home. </p>
<p><strong>Enhanced communication between parents and adolescents:</strong> Parents who participated in the programme noted that establishing <a href="https://aphrc.org/publication/advancing-learning-outcomes-and-leadership-skills-among-children-living-in-informal-settlements-of-nairobi-through-community-participation-2/">open communication channels</a> bridged the generation gap between them and their children. This made them more useful to their children than their parents had been to them. </p>
<p>Evidence from the programme reinforced the effectiveness of two-way communication – parent and child spending enough time together and expressing their opinions. </p>
<p>A father from Viwandani said this of his relationship with his daughter: </p>
<blockquote>
<p>I can say before this project, she was not open, but nowadays she is open and tells me whatever is going on in her life.</p>
</blockquote>
<p><strong>Monitoring progress in school and homework support:</strong> My findings showed that one of the ways in which parents can monitor their children’s progress is by following up on their <a href="https://aphrc.org/publication/advancing-learning-outcomes-and-leadership-skills-among-children-living-in-informal-settlements-of-nairobi-through-community-participation-2/">participation in school</a>. This requires that parents have a good relationship with teachers. As a mother explained: </p>
<blockquote>
<p>You must collaborate with the teacher since sometimes some children go to roam around, and when as parents we are called by the teacher, we refuse to go. So we must work together and become one.</p>
</blockquote>
<p>On the subject of homework support, a father from one of the study sites explained: </p>
<blockquote>
<p>Initially, when the child comes with the book, you as parents are not even bothered to look at it. But when we attend the (ALOT Change) meetings, we are told what is happening so we know where to start or follow up with our children. </p>
</blockquote>
<p><strong>Knowledge of adolescents’ whereabouts:</strong> The need to know the whereabouts of adolescents and the friends they keep is of utmost importance. One mother said:</p>
<blockquote>
<p>The children could easily be pressured into engaging in the many social ills around them … as parents, we contribute because you look at the friends your children walk with … in this community, the friends are the ones who mislead. </p>
</blockquote>
<p>When parents were asked about their obligations to adolescents, they prioritised the provision of basic needs, such as food and shelter. As one mother said:</p>
<blockquote>
<p>It is a parent’s responsibility to make sure that she gets to know the progress of the child, and also it is a parent’s responsibility … to give them food, shelter. </p>
</blockquote>
<p><strong>Championing success at the community level:</strong> Parents also reported that they had teamed up with the larger community to be champions of change. They were passing on lessons learned from ALOT Change to community members who were not part of the programme. </p>
<p>A mother from Korogocho observed that:</p>
<blockquote>
<p>If you see a child doing other things, you just ignore because he is not yours. That does not help us or Kenya. Maybe this child would have been a leader. </p>
</blockquote>
<h2>Way forward</h2>
<p>Parental involvement is a major ingredient in a child’s educational success. Parents are leaders in the home and collaborators with teachers. This means parents need to provide basic necessities, provide a safe environment where a child studies and know the whereabouts of their children when they are not in school. They also need to offer support with school work. </p>
<p>Overall, the success of adolescents in school is an outcome of communication.</p><img src="https://counter.theconversation.com/content/192149/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benta A. Abuya does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Parents are enablers, motivators and facilitators of their children’s education.Benta A. Abuya, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1911912022-10-04T15:45:56Z2022-10-04T15:45:56ZDiabetes in South Africa: 60% aren’t being screened for complications, according to new study<figure><img src="https://images.theconversation.com/files/487728/original/file-20221003-18-l1d9q2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eleven percent of South African adults live with diabetes. </span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>The world is experiencing a <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">steep rise</a> in the number of people living with diabetes, a chronic condition of significant public health concern. Many developing countries like South Africa now bear the greatest burden. </p>
<p>Diabetes refers to a high level of glucose in the blood.
Several factors contribute to diabetes, but obesity and unhealthy lifestyle behaviours are the major drivers. It is a costly disease, and it reduces the quality of life and lifespan, especially if not properly managed. </p>
<p>Eleven percent of South African adults now <a href="https://idf.org/our-network/regions-members/africa/members/25-south-africa.html">live with diabetes</a>, the highest prevalence in Africa. Most of them have poorly controlled diabetes. And many others are yet to be diagnosed. A lot of people develop <a href="https://www.cdc.gov/diabetes/managing/problems.html#:%7E:text=Common%20diabetes%20health%20complications%20include,how%20to%20improve%20overall%20health.">complications</a> as a result of poorly controlled diabetes. These include eye problems, kidney disease and cardiovascular diseases. Some even develop wounds that don’t heal, resulting in limb amputation. </p>
<p>When people develop such complications, they spend more money on healthcare. And it places a greater burden on the already overstretched health system. Some even lose their livelihood which, in turn, affects their families.</p>
<p>There have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565451/">some</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709478/">studies</a> in South Africa looking at the level of screening for complications for people living with diabetes. But there’s very little focus on the primary healthcare level. And some of these <a href="https://www.researchgate.net/publication/14037605_Public_sector_primary_care_of_diabetics_-_A_record_review_of_quality_of_care_in_Cape_Town">studies</a> were conducted many years ago, so the data may no longer be valid. </p>
<p>It is imperative to determine the current situation, especially at primary healthcare level. Our recent <a href="https://www.researchgate.net/publication/360198427_Coverage_of_diabetes_complications_screening_in_rural_Eastern_Cape_South_Africa_A_cross-sectional_survey">study</a> focused on the Eastern Cape province. It’s one of the poorest provinces in South Africa, with a high prevalence of poorly controlled diabetes.<br>
We assessed the extent of screening for diabetes-related complications at primary healthcare clinics in this province.</p>
<p>We found that the rate of screening for these complications was very low. Our findings are similar to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709478/">research</a> done in another rural province in the country. This points to the need to promptly implement measures to improve screening coverage for people with diabetes in South Africa. Doing this will improve health outcomes and quality of life, and reduce the incidence of devastating diabetes complications.</p>
<h2>Checking for complications</h2>
<p>To keep blood glucose levels under control and avoid complications, people with diabetes need to pay detailed attention to their health. They must be involved in their care, live a healthy life, and undergo important tests and examinations that help to quickly identify potential problems. </p>
<p>There are <a href="http://www.jemdsa.co.za/index.php/JEMDSA/article/view/647">guidelines</a> for diabetes management and complications screening in South Africa. Healthcare providers also have a duty to check whether these individuals’ blood glucose is under control, so they don’t develop complications which can cut their life short or disable them. </p>
<p>Primary healthcare clinics are the entry points into the healthcare system. Most people with diabetes are first managed at these facilities. Here they receive medication and are supposed to check their blood glucose level at every visit. </p>
<p>In addition, primary healthcare providers are supposed to check patients’ eyes and kidney function when they make the diagnosis – and every year after that. Healthcare workers are also supposed to check the patients’ feet at least once a year. Patients at higher risk of developing foot ulcers need more frequent check-ups to prevent complications like leg amputation. </p>
<h2>Our study</h2>
<p>We wanted to find out how the people living with diabetes in some rural areas of the Eastern Cape, South Africa are being managed. We recruited participants with diabetes from six primary healthcare facilities. By asking them questions and by looking at their medical records, we determined if these measures and examinations were in place at these primary healthcare clinics.</p>
<p>Our analysis showed that out of 372 people, only 71 (19%) of them had been checked for blood glucose control in the past year. Sixty (16%) of them had been assessed for kidney function and 33 (8.9%) had been checked for blood cholesterol levels. Just 52 (14%) had undergone eye examinations in the past year. </p>
<p>Foot examination, which helps to prevent leg amputation, was done for only 9 (2.3%). More than half (60%) of these patients had not undergone any form of examination for these potential complications in the past year. </p>
<p>None of them had undergone all of these five important screenings.</p>
<h2>Way forward</h2>
<p>Our study shows that without urgent intervention, a lot of people with diabetes will soon develop complications that could be prevented through proper screenings. This will affect the individuals, their families, jobs, and even the overburdened health system. </p>
<p>Prevention is cheaper than cure. Understanding the potential reasons for the gaps in diabetes management and finding effective solutions for improving screening coverage will cut healthcare costs, prolong the life of patients and enable them to lead a quality life. </p>
<p>There are a number of approaches that the country can take. For instance <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617530/">mobile health technology</a> can be used as a tool to facilitate screening. A similar approach is being used in developed countries. As a result, many of them have been able to cut down the number of <a href="https://link.springer.com/article/10.1007/s00125-018-4711-2">diabetes-related complications</a>. </p>
<p>Other countries have also embraced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398859/">technology-based solutions</a> to train community health workers to conduct some of these examinations under the guidance of experts.</p><img src="https://counter.theconversation.com/content/191191/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eyitayo Omolara Owolabi received funding for her PhD from South African National Research Foundation. </span></em></p><p class="fine-print"><em><span>Anthony Idowu Ajayi is affiliated with African Population and Health Research Center. </span></em></p>Most people with diabetes are poorly controlled. This makes them vulnerable to complications like eye problems, kidney disease, and even amputations.Eyitayo Omolara Owolabi, Postdoctoral fellow, Arizona State UniversityAnthony Idowu Ajayi, Associate research scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1915922022-09-30T06:12:59Z2022-09-30T06:12:59ZL'avortement au Kenya et au Bénin : la sécurité médicale ne suffit pas - les filles et les femmes doivent aussi se sentir en sécurité socialement<figure><img src="https://images.theconversation.com/files/487471/original/file-20220930-16-c8p206.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">La protection sociale n'est effective que lorsque l'avortement se fait dans la discrétion.</span> </figcaption></figure><p>L'avortement sécurisé et les soins post-avortement sont des services de santé essentiels. Mais jusqu'à la publication en 2022 des <a href="https://www.who.int/fr/news/item/09-03-2022-access-to-safe-abortion-critical-for-health-of-women-and-girls#:%7E:text=Personne%20ne%20devrait%20%C3%AAtre%20expos%C3%A9,r%C3%A9duire%20le%20nombre%20d'avortements.">nouvelles lignes directrices</a> de l'Organisation Mondiale de la Santé (OMS) sur la définition de l'avortement sécurisé était étroite. Dans les <a href="https://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.pdf">précédentes directives</a> de l'OMS, la sécurité médicale était le principe directeur de l'avortement sécurisé. La sécurité, selon l'OMS, faisait référence à un avortement effectué selon les méthodes recommandées, par une personne ayant les compétences requises ou dans un environnement conforme aux normes médicales minimales, ou les deux.</p>
<p>Toutefois, les recherches montrent que de nombreuses filles et jeunes femmes ne recherchent pas la sécurité médicale lorsqu'elles cherchent à se faire avorter. Elles privilégient la protection sociale. Et cela, indépendamment du fait qu'elles vivent dans des contextes où les législations sont <a href="https://aphrc.org/publication/lived-experiences-and-pathways-to-abortion-in-kilifi-county-kenya-2/">restrictives</a> ou <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01243-3">libérales</a>. La priorité des femmes est d'éviter les poursuites judiciaries et la stigmatisation sociale.</p>
<p>Leur besoin de discrétion est l'une des raisons pour lesquelles les femmes et les jeunes filles continuent à utiliser des méthodes d'avortement à risque.</p>
<p>Les dernières lignes directrices <a href="https://www.who.int/publicati.ons/i/item/9789240039483">adoptent une approche</a> plus holistique. Elles vont au-delà de l'accent mis sur la sécurité médicale pour promouvoir la qualité des soins en matière d'avortement. Ces directives respectent le droit à la non-discrimination et l'égalité d'accès aux services d'avortement. Mais ce changement fera-t-il une différence pour les filles et les jeunes femmes vivant dans des zones rurales ou dans des pays où la législation sur l'avortement est restrictive, et où la protection sociale reste un impératif ?</p>
<p>La <a href="https://www.sciencedirect.com/science/article/pii/S0277953615300356?via%3Dihub">protection sociale</a> va au-delà de la santé physique. Elle inclut le bien-être émotionnel et économique des femmes, leur statut social, leur réputation et leurs relations. Dans le cadre de l'avortement, cela signifie pouvoir trouver un prestataire de soins abordables, dissimuler l'avortement et être protégées des agents chargés d'appliquer la loi.</p>
<p>Nous avons mené une étude au <a href="https://aphrc.org/publication/lived-experiences-and-pathways-to-abortion-in-kilifi-county-kenya-2/">Kenya</a> et au <a href="https://aphrc.org/publication/experiences-de-lavortement-au-benin-determinants-sociaux-et-parcours-de-soins-dans-le-departement-de-latlantique/">Bénin</a> pour en savoir plus sur ce qui permet aux filles et aux jeunes femmes de se sentir en sécurité (ou non) lorsqu'elles souhaitent avorter. Dans les deux pays concernés, le taux de grossesses non désirées et d'avortements non médicalisés est élevé. Et l'avortement est socialement mal vu.</p>
<p>L'étude a révélé que dans ces contextes, la sécurité sociale n'est atteinte que lorsque l'avortement est pratiqué de manière discrète.</p>
<h2>La protection sociale</h2>
<p>Nous avons mené une étude ethnographique sur une période de six mois en milieu urbain et rural dans le comté de Kilifi (Kenya) et le département de l'Atlantique (Bénin). Nous avons observé des filles et des jeunes femmes recrutées dans des établissements de santé et dans les communautés environnantes. Nous avons également mené des discussions informelles et des entretiens approfondis.</p>
<p>Notre étude a montré que les femmes connaissaient les méthodes d'avortement sécurisées telles que l'avortement médicamenteux et l'avortement chirurgical dans les structures de santé.</p>
<p>Mais pour les filles et les femmes qui souhaitaient avorter, les structures de santé n'étaient pas le premier choix. La raison étant que la discrétion n'était pas garantie. Les soins étaient proposés à la maternité ou dans le service des urgences, sans espace privé pour les procédures. En outre, les femmes et les filles craignaient d'être dénoncées par les prestataires ou de tomber sur leurs voisins dans l'établissement. Elles étaient également confrontées à des des violences psychologiques ou physiques de la part de soignants moralisateurs.</p>
<p>À la place, les filles et les femmes de notre étude commençaient leur parcours d'avortement en tentant des méthodes alternatives disponibles localement, peu coûteuses et utilisées pour traiter d'autres affections. Il s'agit notamment de concoctions à base de plantes et de fortes doses d'antipaludéens, d'analgésiques ou d'antibiotiques. Cela leur permettait de dissimuler leur avortement - mais seulement de manière temporaire. La plupart des cas évoluaient vers des complications nécessitant un traitement urgent, voire entrainant la mort. Au Bénin, une étude a montré que près de la moitié des cas de femmes traitées pour des soins post-avortement étaient liés à des complications d'avortements à risque. Au Kenya, près de 30% des avortements provoqués ont abouti à des complications traitées dans les structures de santé..</p>
<p>Là où la conception de la sécurité chez les femmes qui veulent avorter est en conflit avec la définition de la santé publique, la solution peut, dans certains contextes, être trouvée dans l'auto-prise en charge.</p>
<h2>L'auto-prise en charge pour la protection sociale</h2>
<p>Ces dernières années, et surtout depuis la pandémie de la COVID-19, le concept d'auto-prise en charge a été mis en avant dans le domaine de la santé publique. L'OMS <a href="https://www.who.int/fr/publications-detail/9789240052239#:%7E:text=L'OMS%20recommande%20des%20interventions,et%20servir%20les%20populations%20vuln%C3%A9rables">définit l'auto-prise</a> en charge comme :</p>
<blockquote>
<p>« la capacité des individus, des familles et des communautés à promouvoir la santé, prévenir la maladie, rester en bonne santé et faire face à la maladie et au handicap avec ou sans l’aide d’un agent de santé »</p>
</blockquote>
<p>L'auto-prise en charge de l'avortement implique une capacité à gérer soi-même son avortement autant qu'on le souhaite. Cela inclut l'accès à l'information et aux pilules abortives sans ordonnance. Elle implique également l'utilisation de plateformes numériques pour faciliter l'accès et l'utilisation des pilules abortives.</p>
<p>Des recherches ont montré un taux de réussite de l'auto-prise en charge de l'avortement <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15684">de plus de 93 %</a> dans les pays ayant un système libéral et à revenu élevé.</p>
<p>L'auto-prise en charge de l'avortement permet aux femmes et aux filles d'être plus discrètes lorsqu'elles se font avorter et renforce leur autonomie et leur contrôle. En théorie, l'auto-prise en charge de l'avortement pourrait donc offrir une protection sociale. <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-020-01016-4">Elle permet la discrétion, et pourrait empêcher l'interaction avec des prestataires peu sympathiques, ou le manque d'intimité</a> et le risque d'arrestation dans les structures de santé.</p>
<p>Dans la pratique, cependant, il est très difficile d'imaginer comment les femmes et les familles qui n'ont peut-être pas leur propre téléphone portable ni un smartphone ni internet ni de <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15684">l'argent nécessaire</a> pour utiliser ces appareils peuvent avoir accès à l'auto-prise en charge.</p>
<p>Les inégalités en matière d'accès numérique, de genre, de classe sociale et <a href="https://www.tandfonline.com/doi/full/10.1080/26410397.2022.2040776">d'alphabétisation</a> empêchent de nombreuses femmes et filles pauvres d'accéder à l'auto-prise en charge de l'avortement. Pour elles, l'auto-prise en charge de l'avortement n'est pas encore la solution. La protection sociale autour de l'avortement ne pourrait être obtenue que par des méthodes d'avortement à domicile qui peuvent entraîner de graves complications. Il convient donc de poursuivre les efforts visant à accroître l'accessibilité à l'avortement sans risque.</p>
<p>L'une des voies possibles pourrait consister à investir dans des services d'avortement discret <a href="https://www.psi.org/project/self-care/vitala-global-foundation-digital-tools-uhc/">centrés sur l'utilisateur</a>, par exemple par le biais <a href="https://www.ipas.org/news/health-intermediaries-in-kenya-support-women-in-abortion-self-care/">intermédiaires</a> de la la santé. Toutefois, il demeure nécessaire de s'attaquer aux préjugés des prestataires et aux attitudes de la communauté, et de faire en sorte que les autorités et les agents chargés de l'application de la loi comprennent mieux les lois existantes et les améliorent au besoin.</p>
<p>Les résultats de notre étude ont montré que les partenaires, les parents et les champions communautaires peuvent également servir d'intermédiaires. Par conséquent, une autre voie pourrait être celle des interventions transformatrices du genre. Celles-ci permettrait d’impliquer les partenaires masculins et autres membres de la famille dans les interventions d'auto-prise en charge de l'avortement. Les hommes sont souvent impliqués dans les parcours d'avortement et ont souvent un meilleur accès aux technologies numériques. Pour autant qu'ils soient bien informés, ils pourraient soutenir les femmes en quête d'auto-prise en charge.</p><img src="https://counter.theconversation.com/content/191592/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ramatou Ouedraogo est affiliée au Centre africain de recherche sur la population et la santé (APHRC). L'étude mentionnée dans cet article a été réalisée en collaboration avec Rutgers. </span></em></p><p class="fine-print"><em><span>Grace Kimemia est affilié est affiliée au Centre africain de recherche sur la population et la santé (APHRC).. L'étude mentionnée dans cet article a été réalisée en collaboration avec Rutgers.</span></em></p><p class="fine-print"><em><span>Jonna Both est affiliée à Rutgers qui a pour but d'améliorer la santé et les droits sexuels et reproductifs des jeunes aux Pays-Bas et dans le monde. Il s'agit notamment de réduire considérablement le nombre d'avortements non médicalisés dans le monde. Rutgers reçoit des fonds du ministère néerlandais des Affaires étrangères et de la National Postcode Lottery (NPL), entre autres.</span></em></p>Les femmes qui veulent avorter privilégient la protection sociale au détriment de la sécurité médicale pour échapper à la loi et à la stigmatisation. L’auto-prise en charge peut-elle être la réponse?Ramatou Ouedraogo, Associate Research Scientist , African Population and Health Research CenterGrace Kimemia, Research officer, African Population and Health Research CenterJonna Both, Researcher, Rutgers internationalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1891512022-09-27T11:48:48Z2022-09-27T11:48:48ZAbortion in Kenya and Benin: medical safety isn’t enough – women and girls need to feel safe socially too<figure><img src="https://images.theconversation.com/files/486863/original/file-20220927-7898-d91da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social safety is only attained when the abortion is achieved discreetly.</span> <span class="attribution"><span class="source">Author supplied</span></span></figcaption></figure><p>Safe abortion and post abortion care are essential health services. But until the publication of the 2022 World Health Organization (WHO) abortion care <a href="https://www.who.int/publications/i/item/9789240039483">guidelines</a> there was a narrow definition of abortion safety. In previous WHO <a href="https://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.pdf">guidelines</a>, medical safety was the guiding principle of safe abortion. Safety, according the WHO, referred to abortion carried out using the recommended methods, by a person with the necessary skills or in an environment that conformed to minimal medical standards, or both. </p>
<p>However, research shows that many girls and young women do not search for medical safety when seeking abortion care. They prioritise “social safety”. This is the case regardless of whether they live in settings with <a href="https://aphrc.org/publication/lived-experiences-and-pathways-to-abortion-in-kilifi-county-kenya-2/">restrictive</a> or more <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01243-3">liberal</a> laws. Women’s priority is avoiding prosecution and social stigma.</p>
<p>Their need for secrecy is one of the reasons why women and girls continue to use unsafe methods for abortion. </p>
<p><a href="https://www.who.int/publicati.ons/i/item/9789240039483">The latest WHO guidelines</a> have a more holistic approach. They move beyond the focus on medical safety towards promoting quality abortion care. These guidelines respect the right to non-discrimination and equal access to abortion services. But will this shift make a difference for girls and young women in rural areas or countries with restrictive abortion laws, where social safety remains a must?</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0277953615300356?via%3Dihub">Social safety</a> goes beyond physical health. It includes women’s emotional and economic well-being, social status, reputation, and relationships. In the context of abortion, it means being able to find an affordable provider, conceal the abortion and be protected from law enforcers. </p>
<p>We conducted a study in <a href="https://aphrc.org/publication/lived-experiences-and-pathways-to-abortion-in-kilifi-county-kenya-2/">Kenya</a> and <a href="https://aphrc.org/publication/experiences-de-lavortement-au-benin-determinants-sociaux-et-parcours-de-soins-dans-le-departement-de-latlantique/">Benin</a> to find out more about what makes girls and young women feel safe (or unsafe) when they want an abortion. In both study locations, the rate of unintended pregnancies and medically unsafe abortions is high. And abortion is socially frowned upon. </p>
<p>The study found that in these settings, social safety is only attained when the abortion is achieved discreetly. </p>
<h2>Social safety</h2>
<p>We carried out a six-month study in urban and rural settings in Kilifi County (Kenya) and Atlantique Department (Benin). We observed girls and young women recruited from health facilities and the surrounding communities. We also conducted informal and in-depth interviews. </p>
<p>Our study documented that women were aware of safe abortion methods such as medical abortion drugs and surgical abortion in health facilities. </p>
<p>But for women and girls who wanted an abortion, health facilities were not the first choice. This was because privacy was not guaranteed. The care was offered in the maternity or casualty ward, with no private spaces for the procedures. Also, women and girls feared being reported by providers or bumping into their neighbours at the facility. They also faced emotional or physical abuse from judgemental healthcare providers.</p>
<p>Instead, the girls and women in our study would start their abortion process by trying alternative methods that were locally available, inexpensive and used to treat other ailments. These include plant-based concoctions, and high dosages of anti malaria drugs, pain killers or antibiotics. This concealed their abortion – but only temporarily. Most of the cases would progress to complications needing urgent treatment or even resulting in death. In Benin, a <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1034/j.1600-0412.2001.080006568.x">study</a> showed that close to half of the cases of women treated for post-abortion care were related to unsafe abortion complications. In Kenya, close to <a href="https://aphrc.org/wp-content/uploads/2019/07/Incidence-and-Complications-of-Unsafe-Abortion-in-Kenya-Key-Findings-of-a-National-Study.pdf">30%</a> of induced abortion ended in complications treated in health facilities.</p>
<p>Where the understanding of safety among abortion seekers conflicts with the public health definition, the solution can in some contexts be found in self-care. </p>
<h2>Self-care for social safety</h2>
<p>In recent years, and especially since the COVID-19 pandemic, the idea of self-care has come to the fore in public health. The WHO <a href="https://www.who.int/news-room/feature-stories/detail/what-do-we-mean-by-self-care">defines self-care</a> as: </p>
<blockquote>
<p>the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider. </p>
</blockquote>
<p>Self-care for abortion includes being able to manage abortion on one’s own as much as one wants to. It includes obtaining access to information and medical abortion pills without prescription. It also involves the use of <a href="https://pubmed.ncbi.nlm.nih.gov/30869829/">digital platforms to support access to and use of abortion pills</a>. </p>
<p>Research has shown a self-care success rate of <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15684">more than 93%</a> in liberalised and high income countries.</p>
<p>Abortion self-care allows women and girls to be more discreet about obtaining an abortion and enhances their autonomy and control. In theory, then, self-care for abortion could offer social safety. It allows <a href="https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-020-01016-4">for discretion, and could avoid the interaction with unsympathetic providers, or the lack of privacy</a> and risk of arrest in health settings. </p>
<p>In practice, however, it is very hard to imagine how it would reach <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15684">poor and less educated</a> women and girls who might not have their own mobile phone, let alone a smartphone or the internet or the money to make use of these devices.</p>
<p>Inequalities in digital access, gender, social class and <a href="https://www.tandfonline.com/doi/full/10.1080/26410397.2022.2040776">literacy</a> stand in the way of abortion self-care access for many poor girls and women. For them, abortion self-care is not yet the solution. Social safety around abortion might only be obtained through home-based abortion methods that may cause severe complications. Therefore, work on increasing the accessibility to safe abortion needs to continue. </p>
<p>One route is through investing in <a href="https://www.psi.org/project/self-care/vitala-global-foundation-digital-tools-uhc/">user-centred</a> discreet abortion services, for example through <a href="https://www.ipas.org/news/health-intermediaries-in-kenya-support-women-in-abortion-self-care/">health intermediaries</a>. But there remains a need for addressing provider bias, community attitudes, and making law enforcers and authorities understand the existing laws better, and improving them where needed.</p>
<p>Our study findings showed that partners, relatives and community champions can also be intermediaries. Therefore, another avenue could be gender transformative interventions. These would involve male partners and other relatives in abortion self-care interventions. Men are often involved in pathways to abortion and often have better digital technology access. Provided they are well informed, they can support women in search of self-care.</p><img src="https://counter.theconversation.com/content/189151/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ramatou Ouedraogo is affiliated with the African Population and Health Research Center. The study mentioned in this article was done in collaboration with Rutgers.</span></em></p><p class="fine-print"><em><span>Grace Kimemia is affiliated to the African Population and Health Research Center. The study mentioned in this article was done in collaboration with Rutgers.</span></em></p><p class="fine-print"><em><span>Jonna Both is affiliated to Rutgers. Rutgers aims to improve the sexual and reproductive health and righst of young people in the Netherlands and worldwide. This includes a focus on drastically reducing the number of unsafe abortions worldwide. Rutgers receives funding from the Dutch Ministry of Foreign Affairs and the National Postcode Lottery (NPL) amongst others.</span></em></p>Girls and young women do not search for medical safety when seeking abortion care. They prioritise “social safety” to avoid prosecution and social stigma. Can self-care be a solution?Ramatou Ouedraogo, Associate Research Scientist , African Population and Health Research CenterGrace Kimemia, Research officer, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1910212022-09-24T09:31:31Z2022-09-24T09:31:31ZEbola outbreak in Uganda: the health system has never been better prepared<figure><img src="https://images.theconversation.com/files/485855/original/file-20220921-26-p2vwyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medical staff prepare to enter a hospital isolation unit in western Uganda during a suspected Ebola outbreak in 2018.
</span> <span class="attribution"><span class="source">Sumy Sadurni/AFP via Getty Images</span></span></figcaption></figure><iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/ebola-outbreak-in-uganda-the-health-system-has-never-been-better-prepared-191021&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p><em>An outbreak of the deadly Ebola virus was <a href="https://twitter.com/MinofHealthUG/status/1572104820735242241">announced</a> by Uganda’s ministry of health on 21 September 2022. Uganda has had at least six <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease?gclid=Cj0KCQjwj7CZBhDHARIsAPPWv3ennosVtaUFIYNWFdyia94wYtYp3Zgl7TjYG4-yccNy5P3xg3Hu2-0aAljpEALw_wcB">previous episodes of Ebola</a> in 2000 (224 dead), 2007 (37 dead), 2011 (1 dead), two events in 2012 (21 dead) and 2019 (4 dead). The recently confirmed case is of the less deadly <a href="https://news.un.org/en/story/2022/09/1127181">Sudan strain</a>. Abdhalah Ziraba, a public health researcher who heads the emerging and re-emerging infectious diseases research unit at <a href="https://aphrc.org/?gclid=Cj0KCQjw7KqZBhCBARIsAI-fTKLIQ5oo5NysMkYwJPvVr-sV4FhjKHQAThy_SmhcnesmGn3NbUFDnJcaAqUnEALw_wcB">African Population and Health Research Center</a>, outlines Uganda’s preparedness this time around.</em></p>
<h2>What is known about the latest outbreak of Ebola in Uganda?</h2>
<p>The first confirmed case is a 24-year-old man who presented on the 11th of September 2022 with symptoms of Ebola. The case was confirmed on 19 September 2022 through laboratory testing. Laboratory results showed that he died from the Sudan strain of Ebola, which was last identified in the country in 2012. The Sudan ebolavirus generally has a lower case fatality rate than the Zaire strain, which broke out in DRC and parts of Uganda in <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010205">2018</a>.</p>
<p>Other <a href="https://news.un.org/en/story/2022/09/1127181">suspicious deaths</a> in the month of September 2022 and patients in the same district are being investigated to establish whether they succumbed to Ebola. As of the 23rd September 2022, there were 11 confirmed cases. </p>
<h2>What are the risks to public health?</h2>
<p>The Ebola virus is <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease?gclid=Cj0KCQjwj7CZBhDHARIsAPPWv3ennosVtaUFIYNWFdyia94wYtYp3Zgl7TjYG4-yccNy5P3xg3Hu2-0aAljpEALw_wcB">highly infectious</a> and mainly transmitted through contact with body fluid of infected persons.</p>
<p>The risk to the public is real as the first documented case could have exposed family members and also members of the public in close contact. The next few days are critical to identify any secondary cases and their potential contacts.</p>
<p>Ebola tends to have a high case fatality rate – out of those infected a high proportion end up dying. In the 2000 outbreak in <a href="https://doi.org/10.1046/j.1365-3156.2002.00944.x">northern Uganda</a>, more than half (53%) of all those infected with the virus succumbed to it. Depending on the strain of the virus and public health response in place, the fatality rate can <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease">range</a> anywhere between 25% and 90% of those infected. The 2000 <a href="https://pubmed.ncbi.nlm.nih.gov/12460399/">outbreak</a> resulted in 224 deaths out of 425 cases that were reported countrywide.</p>
<h2>What response measures has Uganda put in place over the years?</h2>
<p>Uganda borders on regions of the Democratic Republic of Congo that have suffered <a href="https://www.msf.org/drc-ebola-outbreaks">numerous outbreaks</a> of Ebola. The last of these was <a href="https://news.un.org/en/story/2022/08/1125212">reported</a> in August 2022. Uganda itself has experienced several past outbreaks. For these reasons the country has developed a functional <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894352/">surveillance system</a> to flag and confirm suspicious cases early.</p>
<p>Uganda’s viral haemorrhagic fever surveillance programme was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894352/#:%7E:text=Uganda's%20national%20viral%20haemorrhagic%20fever,s%20Viral%20Special%20Pathogens%20Branch.">established</a> in 2010 in collaboration with the viral special pathogens branch of the US Centers for Disease Control and Prevention (CDC). The surveillance programme has a diagnostic laboratory, staff, supplies and sentinel surveillance centres for the rapid detection of outbreaks. In the current outbreak, the turnaround time (24-48 hours) for laboratory testing was short and done at a laboratory located within the country.</p>
<p>Delayed action, poor health education messaging and slow behaviour change helped spur the outbreaks in West Africa in 2014-2016 and eastern DRC in 2019. Uganda has drawn lessons from these and its own large outbreak in 2000 and it is not taking chances.</p>
<h2>What useful lessons can Uganda offer based on previous experience?</h2>
<p>Public health messaging is critical and has worked well for Uganda in past outbreaks. Health education campaigns carry messages on prevention practices, manifestation of symptoms and what to do in case of contact or infection.</p>
<p>Another critical factor is having <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00548-5">rapid</a> response teams on standby. Uganda has developed this capability.</p>
<p>Just as important is the need for a strong surveillance system to pick up suspicious cases early. Front-line health care workers have been trained to be able to pick out suspected cases, which in turn get isolated. Suspected cases are given supportive treatment, reported and specimens collected and sent to the reference lab for analysis. Once a case is confirmed efforts are made to manage cases and prevent further transmission. The ministry of health and partners also provide the capacity to evaluate and care for a markedly increased volume of patients. </p>
<p>Uganda has local laboratory capacity at the Uganda Virus Research Institute at Entebbe. The laboratory has the capacity to test and confirm whether suspect cases are indeed Ebola virus disease cases. Timely confirmation is important to trigger the rapid response required. This includes contact tracing, health education and care for those who are infected.</p>
<p>Uganda has also learnt the value of sounding the international alarm at the earliest. It did so this time round, alerting the WHO within hours of detecting the first suspected case.</p>
<h2>What challenges remain?</h2>
<p>Tracing of contact cases can be challenging due to population mobility. For example, an infected person might travel to a populated urban centre using public transport and possibly get attended to in a health facility by unsuspecting health workers. Along the way many contacts will be made which are difficult to trace should the suspect case be confirmed.</p>
<p>On top of this, rigorous contact tracing and treatment of confirmed cases costs money. So technical support and resources need to be made available. </p>
<p>Looking to the future, the EVD problem needs to be addressed from all angles. <a href="https://www.cdc.gov/vhf/ebola/transmission/index.html#:%7E:text=Scientists%20think%20people%20are%20initially,a%20large%20number%20of%20people.">Human-wildlife</a> contacts, including eating wild meat, is a risk for transmission. It is suspected that bats and primates are the animal sources of the virus and therefore they are better avoided, especially in endemic areas. </p>
<p>Lastly, the available vaccine may not be effective against the strain that has broken out in Uganda. Currently, the only approved vaccine is one for the Zaire strain. The vaccine for the Sudan strain has not yet been approved.</p>
<p>This Ebola virus disease outbreak and others before it as well as the COVID-19 pandemic are a reminder that infectious diseases – new or old – pose a major threat to public health that requires investment and action to safeguard human health.</p><img src="https://counter.theconversation.com/content/191021/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Abdhalah Ziraba does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Sudan strain of the Ebola virus has been identified in Uganda for the first time in more than a decade.Abdhalah Ziraba, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869542022-07-19T13:48:08Z2022-07-19T13:48:08ZWhy sexual and reproductive law for east African countries is being resisted<figure><img src="https://images.theconversation.com/files/474625/original/file-20220718-76655-yr3tdw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Six of the countries of the East African Community – Burundi, Kenya, Rwanda, South Sudan, Uganda and Tanzania – recently concluded public hearings on a new sexual and reproductive health bill. Proponents of the bill argue that it will improve access to sexual and reproductive health which, in turn, will improve other public health and development indicators such as maternal mortality and HIV infection rates. But the bill has faced fierce opposition since it was first tabled in 2017. The Conversation Africa’s Ina Skosana spoke to researchers Anthony Ajayi and Nicholas Etyang to unpack what the bill covers and where the sticking points are.</em></p>
<hr>
<h2>Is a regional response practical? Has it worked anywhere else?</h2>
<p>Article 118 of the <a href="https://www.eacj.org/?page_id=33">Treaty for the Establishment of East African Community</a> mandates partner states to cooperate around health issues, and to develop policies for the region. </p>
<p>Regional responses can help fast-track progress, harmonise laws and create a uniform front for addressing sexual and reproductive health issues. The development of regional frameworks is not new on the continent. Other examples include the South Africa Development Community sexual and reproductive health strategy 2019-2030, South Africa Development Community model law on gender-based violence, and the regional body’s model law on eradicating child marriage and protecting children already in marriage. </p>
<p>Regional frameworks help citizens hold their governments to account. The East Africa region is pushing for integration on many fronts. These include immigration policies, trade, and security. Remarkable progress has been made in the areas of <a href="https://www.eac.int/trade">trade</a> and <a href="https://www.eac.int/immigration">immigration</a>. This could be repeated with health cooperation.</p>
<p>But getting regional laws through is hard. In the case of East Africa, seven countries are part of the East Africa Community. Getting everyone on board is a tough ask especially when it comes to contentious issues like sexual and reproductive healthcare.</p>
<p>The first attempt to pass an East African sexual and reproductive health bill was in 2017, with the 3rd Legislative Assembly. But <a href="https://www.eac.int/press-releases/1933-eala-withdraws-bill-on-sexual-and-reproductive-health-rights">numerous concerns were raised by stakeholders</a>. And limited time for consultation before the end of their term meant the bill could not move forward. </p>
<p>The 4th Legislative Assembly began working on a revised bill in January 2020 and has conducted a series of stakeholder consultations. But resistance continues.</p>
<h2>Why does the bill matter?</h2>
<p>The 2021 version of the bill is a progressive legislation. It has huge potential to address the sexual and reproductive health challenges of East Africans. Adolescent girls are disproportionately affected by sexual and reproductive health issues. The bill addresses these disparities substantively. </p>
<p>In East Africa, complications arising from early pregnancy and child birth are among the leading causes of death among girls aged <a href="https://apps.who.int/adolescent/second-decade/section3/page2/mortality.html">15 to 19 years</a>. Young girls are also disproportionately exposed to new HIV infections and sexual violence. If passed, the bill will address adolescent pregnancy and protect the right of young mothers to return to school. </p>
<p>Unsafe abortions are also among the leading causes of maternal death. These account for <a href="https://www.sciencedirect.com/science/article/pii/S2214109X1470227X">about 10%</a> of maternal mortality. By expanding access to safe abortion, more lives would be saved. If passed, the bill will be a huge win for women’s and girls’ reproductive rights in the region.</p>
<h2>What’s in the Bill?</h2>
<p>The sexual and reproductive health Bill lays out five ambitious objectives. These are: </p>
<ul>
<li><p>to protect and facilitate the fulfilment of all persons’ sexual and reproductive health and rights across the life course;</p></li>
<li><p>to promote and provide age-appropriate sexual and reproductive health information and services for all persons, including adolescents and young people</p></li>
<li><p>to facilitate and promote the prevention of newborn, child mortality, maternal mortality, and morbidity from preventable causes;</p></li>
<li><p>to facilitate and promote the reduction and elimination of unsafe abortions, HIV and other sexually transmitted infections, early and unintended pregnancies; and</p></li>
<li><p>to prohibit and facilitate the elimination of harmful practices. </p></li>
</ul>
<p>The Bill has 29 clauses covering a range of issues. These include integration of sexual and reproductive health services into universal health coverage, sexuality education, continuation of education after pregnancy, menstrual health as well as family planning. </p>
<p>In addition, the Bill makes provisions to safeguard the sexual and reproductive health and rights of people with disabilities. </p>
<p>Section 16 provides limited access to abortion on the grounds that, in the opinion of a health worker, the pregnancy can endanger the mental or physical health or life of the woman. Additionally, in case of sexual assault, rape, and incest. </p>
<p>Section 17 protects the right of women and girls to post-abortion care irrespective of the legality of the abortion. It also shields health workers from prosecution for providing post-abortion care.</p>
<p>Section 21 recommends restricting the use of assisted reproductive technology such as surrogacy for only those medically diagnosed as unable to bear children. In addition, it recommends that partner states give special licenses to designated providers and protect surrogate mothers from exploitation. </p>
<p>Section 22 prohibits harmful cultural practices such as child marriage, forced sterilisation, and female genital mutilation. </p>
<p>Lastly, the Bill mandates partner states to develop and implement common strategies for detecting, preventing and reporting sexual and gender-based violence.</p>
<h2>What’s the hold-up in passing it?</h2>
<p>The Bill faced opposition at the public hearings held on June 27-30. Some oppose the Bill entirely, while others want specific provisions removed. </p>
<p>Resistance is primarily from religious and conservative groups, who maintain that some provisions of the Bill are part of the Western agenda, and against East African cultural values. </p>
<p>Three sections of the Bill remain contentious despite the revisions made after the first reading and stakeholder consultations.</p>
<p>First is the provision for comprehensive sexuality education for young people, which they oppose because they believe it will expose children to early sex. Some question why the government should be responsible for providing sex education to children instead of parents. They also oppose contraceptive access for young people and argue that abstinence-only messages should be provided to young people. This is despite <a href="https://www.jahonline.org/article/S1054-139X(07)00426-0/fulltext">scientific evidence</a> to the contrary.</p>
<p>A representative of the ministry of education in Uganda wants the word “comprehensive” removed because it is inconsistent with the language approved nationally. </p>
<p>Advocates for the Bill maintain that sexuality education is not all about sex but encompasses information on menstrual health, decision making, body awareness, social skills (family, respect, and kindness), sexual consent, healthy relationship, gender-based violence, HIV testing, and pregnancy.</p>
<p>The provision on abortion faces the most opposition. Opponents take issue with the definition of abortion in the Bill and argue that it does not reflect African values. They claim that, if passed, the Bill would make abortion services available on-demand. </p>
<p>Partner states have ratified the <a href="https://au.int/en/treaties/protocol-african-charter-human-and-peoples-rights-rights-women-africa">Maputo protocol</a>, which allows for the termination of pregnancy on the grounds provided for in the proposed Bill. But opponents reject the provision that allows for pregnancy termination in cases of rape, incest and sexual assault. Stakeholders from the Burundi government claim the bill promotes immorality and voluntary termination of pregnancy, contrary to divine principles, the national constitution, and culture.</p>
<p>Lastly, critics oppose the section on surrogacy, claiming it deviates from the order of creation and allows for LGBT individuals to have children. A few Muslim leaders in Kenya and Tanzania reject the ban on child marriage and argue that once menstruation starts, regardless of age, a girl can be married.</p><img src="https://counter.theconversation.com/content/186954/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Idowu Ajayi is affiliated with the African Population and Health Research Center. </span></em></p><p class="fine-print"><em><span>Nicholas Okapu Etyang is affiliated with the African Population and Health Research Center. </span></em></p>Adolescent girls are disproportionately affected by sexual and reproductive health issues. These proposed law substantively addresses these disparities.Anthony Idowu Ajayi, Associate research scientist, African Population and Health Research CenterNicholas Okapu Etyang, Policy officer, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.