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BackgroundNearly 40% of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied.MethodsWe conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n = 61) to explore decision-making about contraceptive use after delivery, including facility choice.ResultsWhen seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality.ConclusionWomen believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care.

Background: The burden of undernutrition is significant in Kenya. Obesity and related non- communicable diseases are also on the increase. Government action to prevent non- communicable diseases is critical. Taxation of sugar-sweetened beverages has been identified as an effective mechanism to address nutrition-related non-communicable diseases, although Kenya is not yet committed to this. Objective: To assess the policy and stakeholder landscape relevant to nutrition related non - communicable diseases and sugar-sweetened beverage taxation in Kenya. Methods: A desk review of evidence and policies related to nutrition related non-communicable diseases and sugar-sweetened beverages was conducted. Data extraction matrices were used for analysis. Key informant interviews were conducted with 10 policy actors. Interviews were thematically analysed to identify enablers of, and barriers to, policy change towards nutrition-sweetened beverage taxation. Results: Although nutrition related non-communicable diseases are recognised as a growing problem in Kenya most food-related policies focus on undernutrition and food security, while underplaying the role of nutrition related non-communicable diseases. Policy development on communicable diseases is multi-sectoral, but implementation is biased towards curative rather than preventive services. An excise tax is charged on soft drinks, but is not specific to sugar-sweetened beverages. Government has competing roles: advocating for industrial growth, such as sugar and food processing industries to foster economic development, yet wanting to control nutrition related non-communicable diseases. There is no national consensus about the dangers posed by sugar-sweetened beverages. Conclusion: Nutrition related non-communicable diseases policies should reflect a continuum of issues, from undernutrition to food security, nutrition transition, and the escalation of nutrition related non-communicable diseases. A local advocacy case for sugar-sweetened beverage taxation has not been made. Public and policy maker education is critical to challenge the prevailing attitudes towards sugar-sweetened beverages and the western diet. [ABSTRACT FROM AUTHOR]

Introduction: Policy transfer theories explain how policy ideas move across time and geography and offer an approach to understanding waves of policy change, a common phenomenon in global health. Four primary mechanisms for the transfer of policies from global to national levels are posited: learning, coercion, socialization and competition.Methods: We used six concurrent country case studies of policy change for child survival followed by a global study to analyse (1) mechanisms for policy transfer and (2) the roles of international organizations in promoting policy transfer. Our six country cases drew upon early adopters of integrated Community Case Management of Childhood Illness policy (Malawi, Niger), as well as countries that were slower to adopt due either to practical implementation challenges (Mozambique, Mali) and/or policy resistance (Burkina Faso, Kenya). In total, 145 semi-structured interviews and 283 document reviews were conducted across the six country cases, and 25 semi-structured interviews and 72 document reviews for the global study.Results: Three of the four diffusion mechanisms (learning, coercion and socialization) were important in these cases, but not competition. Multiple strategies were employed by multilateral organizations to support policy transfer, such as regional meetings or academic publications, frequently serving multiple diffusion mechanisms simultaneously (e.g. both learning and socialization). In just one country case, funding conditionalities were used to press for policy change. The emphasis of policy transfer mechanisms varied between early and later adopters. Early adopters, for example, were more likely to engage in learning. International multilateral organizations were active policy transfer agents, and national policy-makers perception of them as "trusted partners" made them well suited for this role. However, on occasion their role became more that of advocates than neutral facilitators.Conclusions: International actors use multiple synergistic channels to promote uptake of global health policies in low- and middle-income countries, and tailor strategies employed to country contexts. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity accounts for more than 3 million deaths worldwide, and is implicated in causing 6% of coronary heart diseases, 7% of diabetes, and 10% of colon or breast cancer. Globally, research has shown that modifying four commonly shared risky behaviours, including poor nutrition, tobacco use, harmful use of alcohol, and physical inactivity, can reduce occurrence of non-communicable diseases (NCDs). Risk factor surveillance through population-based periodic surveys, has been identified as an effective strategy to inform public health interventions in NCD control. The stepwise approach to surveillance (STEPS) survey is one such initiative, and Kenya carried out its first survey in 2015. This study sought to describe the physical inactivity risk factors from the findings of the Kenya STEPS survey.Methods: This study employed countrywide representative survey administered between April and June 2015. A three stage cluster sampling design was used to select clusters, households and eligible individuals. All adults between 18 and 69 years in selected households were eligible. Data on demographic, behavioural, and biochemical characteristics were collected. Prevalence of physical inactivity was computed. Logistic regression used to explore factors associated with physical inactivity.Results: A total of 4500 individuals consented to participate from eligible 6000 households. The mean age was 40.5 (39.9-41.1) years, with 51.3% of the respondents being female. Overall 346 (7.7%) of respondents were classified as physically inactive. Physical inactivity was associated with female gender, middle age (30-49 years), and increasing level of education, increasing wealth index and low levels of High Density Lipoproteins (HDL).Conclusion: A modest prevalence of physical inactivity slightly higher than in neighbouring countries was found in this study. Gender, age, education level and wealth index are evident areas that predict physical inactivity which can be focused on to develop programs that would work towards reducing physical inactivity among adults in Kenya. [ABSTRACT FROM AUTHOR]

Background: Globally, alcohol consumption contributes to 3.3 million deaths and 5.1% of Disability Adjusted Life Years (DALYs), and its use is linked with more than 200 disease and injury conditions. Our study assessed the frequency and patterns of Heavy Episodic Drinking (HED) in Kenya. HED is defined as consumption of 60 or more grams of pure alcohol (6+ standard drinks in most countries) on at least one single occasion per month. Understanding the burden and patterns of heavy episodic drinking will be helpful to inform strategies that would curb the problem in Kenya.Methods: Using the WHO STEPwise approach to surveillance (STEPS) tool, a nationally representative household survey of 4203 adults aged 18-69 years was conducted in Kenya between April and June 2015. We used logistic regression analysis to assess factors associated with HED among both current and former alcohol drinkers. We included the following socio-demographic variables: age, sex, and marital status, level of education, socio-economic status, residence, and tobacco as an interaction factor.Results: The prevalence of HED was 12.6%. Men were more likely to engage in HED than women (unadjusted OR 9.9 95%, CI 5.5-18.8). The highest proportion of HED was reported in the 18-29-year age group (35.5%). Those currently married/ cohabiting had the highest prevalence of HED (60%). Respondents who were separated had three times higher odds of HED compared to married counterparts (OR 2.7, 95% CI 1.3-5.7). Approximately 16.0% of respondents reported cessation of alcohol use due to health reasons. Nearly two thirds reported drinking home-brewed beers or wines. Tobacco consumption was associated with higher odds of HED (unadjusted OR 6.9, 95% CI 4.4-10.8); those that smoke (34.4%) were more likely to engage in HED compared to their non-smoking counterparts.Conclusion: Our findings highlight a significant prevalence of HED among alcohol drinkers in Kenya. Young males, those with less education, married people, and tobacco users were more likely to report heavy alcohol use, with male sex as the primary driving factor. These findings are novel to the country and region; they provide guidance to target alcohol control interventions for different groups in Kenya. [ABSTRACT FROM AUTHOR]

Background: Hypertension is the most important risk factor for cardiovascular diseases and the leading cause of death worldwide. Despite growing evidence that the prevalence of hypertension is rising in sub-Saharan Africa, national data on hypertension that can guide programming are missing for many countries. In this study, we estimated the prevalence of hypertension, awareness, treatment, and control. We further examined the factors associated with hypertension and awareness.Method: We used data from the 2015 Kenya STEPs survey, a national cross-sectional household survey targeting randomly selected people aged 18-69 years. Demographic and behavioral characteristics as well as physical measurements were collected using the World Health Organization's STEPs Survey methodology. Descriptive statistics were used to estimate the prevalence, awareness, treatment and control of hypertension. Multiple logistic regression models were used to identify the determinants of hypertension and awareness.Results: The study surveyed 4485 participants. The overall age-standardized prevalence for hypertension was 24.5% (95% confidence interval (CI) 22.6% to 26.6%). Among individuals with hypertension, only 15.6% (95% CI 12.4% to 18.9%) were aware of their elevated blood pressure. Among those aware only 26.9%; (95% CI 17.1% to 36.4%) were on treatment and 51.7%; (95% CI 33.5% to 69.9%) among those on treatment had achieved blood pressure control. Factors associated with hypertension were older age (p < 0.001), higher body mass index (BMI) (p < 0.001) and harmful use of alcohol (p < 0.001). Similarly, factors associated with awareness were older age (p = 0.013) and being male (p < 0.001).Conclusion: This study provides the first nationally-representative estimates for hypertension in Kenya. Prevalence among adults is high, with unacceptably low levels of awareness, treatment and control. The results also reveal that men are less aware of their hypertension status hence special attention should focus on this group. [ABSTRACT FROM AUTHOR]

Background: The rise of non-communicable diseases (NCDs) in Africa requires a multi-sectoral action (MSA) in their prevention and control. This study aimed to generate evidence on the extent of MSA application in NCD prevention policy development in five sub-Saharan African countries (Kenya, South Africa, Cameroon, Nigeria and Malawi) focusing on policies around the major NCD risk factors.Methods: The broader study applied a multiple case study design to capture rich descriptions of policy contents, processes and actors as well as contextual factors related to the policies around the major NCD risk factors at single- and multi-country levels. Data were collected through document reviews and key informant interviews with decision-makers and implementers in various sectors. Further consultations were conducted with NCD experts on MSA application in NCD prevention policies in the region. For this paper, we report on how MSA was applied in the policy process.Results: The findings revealed some degree of application of MSA in NCD prevention policy development in these countries. However, the level of sector engagement varies across different NCD policies, from passive participation to active engagement, and by country. There was higher engagement of sectors in developing tobacco policies across the countries, followed by alcohol policies. Multi-sectoral action for tobacco and to some extent, alcohol, was enabled through established structures at national levels including inter-ministerial and parliamentary committees. More often coordination was enabled through expert or technical working groups driven by the health sectors. The main barriers to multi-sectoral action included lack of awareness by various sectors about their potential contribution, weak political will, coordination complexity and inadequate resources.Conclusion: MSA is possible in NCD prevention policy development in African countries. However, the findings illustrate various challenges in bringing sectors together to develop policies to address the increasing NCD burden in the region. Stronger coordination mechanisms with clear guidelines for sector engagement are required for effective MSA in NCD prevention. Such a mechanisms should include approaches for capacity building and resource generation to enable multi-sectoral action in NCD policy formulation, implementation and monitoring of outcomes. [ABSTRACT FROM AUTHOR]