George Odwe
University of Nairobi, Kenya, Economics, Post-Doc
Background: Reducing the burden of neonatal sepsis requires timely identification and initiation of suitable antibiotic treatment in primary health care (PHC) settings. Countries are encouraged to adopt simplified antibiotic regimens at... more
Background: Reducing the burden of neonatal sepsis requires timely identification and initiation of suitable antibiotic treatment in primary health care (PHC) settings. Countries are encouraged to adopt simplified antibiotic regimens at PHC level for treating sick young infants (SYI) with signs of possible serious bacterial infection (PSBI). As countries implements PSBI guidelines, more lessons on effective implementation strategies and outcome measurements are needed. We document pragmatic approaches used to design, measure and report implementation strategies and outcomes while adopting PSBI guidelines in Kenya. Methods: We designed implementation research using longitudinal mixed methods embedded in a continuous regular systematic learning and adoption of evidence in PHC context. We synthesized formative data to co-create with stakeholders, implementation strategies to incorporate PSBI guidelines into routine service delivery for SYIs. This was followed by quarterly monitoring fo...
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IntroductionAn ‘on-demand’ contraceptive pill may suit women having infrequent sex. We assessed the feasibility of e-commerce pharmacy provision and acceptability of levonorgestrel (LNG) 1.5 mg for pericoital use in Kenya.MethodsA... more
IntroductionAn ‘on-demand’ contraceptive pill may suit women having infrequent sex. We assessed the feasibility of e-commerce pharmacy provision and acceptability of levonorgestrel (LNG) 1.5 mg for pericoital use in Kenya.MethodsA 12-month prospective, single-arm, open-label, interventional study conducted from August 2020 to August 2021. A total of 897 women aged 18–49 years at risk of pregnancy and having infrequent sex (ie, six times or fewer coital frequency/month) were screened and enrolled. We undertook univariate and bivariate analysis on multiple data points: enrolment dataset, bimonthly surveys, extended survey around 6-month follow-up, and e-commerce pharmacy sales log.ResultsA total of 2291 pericoital LNG 1.5 mg pill doses were dispensed to 300 women over a 12-month period mainly via the USSD (Unstructured Supplementary Service Data) platform. Of the 266 women who obtained the pill and completed the survey, most (83%) were satisfied/very satisfied with e-commerce platform...
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Table S1. Enrollment Overview. Table S2. General attitudes by site. Table S3. Percentage of respondents stating specific characteristics to be â very importantâ by site. Table S4. Percentage of women with specific opinions (traditional... more
Table S1. Enrollment Overview. Table S2. General attitudes by site. Table S3. Percentage of respondents stating specific characteristics to be â very importantâ by site. Table S4. Percentage of women with specific opinions (traditional methods) by site. (PDF 916 kb)
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The role of women in agriculture as producers and providers of food cannot be over emphasised. In Kenya, just as in many other countries of the developing world, women are a critical link in achieving food security. This paper examines... more
The role of women in agriculture as producers and providers of food cannot be over emphasised. In Kenya, just as in many other countries of the developing world, women are a critical link in achieving food security. This paper examines the role of women in ensuring household food security in Kenya. The challenges experienced by women as they participate in household food security are highlighted. A systematic review of literature from published and unpublished sources was useful for examining the fundamental roles that women play in ensuring food security in the family. The paper explores the critical link between women and food security in the Kenyan context, assessing some of the influences on household food security and specifically addressing women's roles and constraints within that framework. The paper reviews the effective strategies that can be adopted by women in order to maximize on household food security. The central argument in this paper is that women play a vital ...
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Introduction Evidence from sub-Saharan Africa, including Kenya, shows that negative beliefs about contraceptive methods are associated with non-use. However, little is known about the relationship between contraceptive beliefs and... more
Introduction Evidence from sub-Saharan Africa, including Kenya, shows that negative beliefs about contraceptive methods are associated with non-use. However, little is known about the relationship between contraceptive beliefs and subsequent method choice. Methodology We used data from a two-year longitudinal survey of married women aged 15–39 years at enrollment from one urban site (Nairobi) and one rural site (Homa Bay) in Kenya. Analysis entails descriptive statistics and estimation of a conditional logit analysis to examine associations between method-specific beliefs and choice of injectables, implants or pills among women who were not using any method or were pregnant at baseline (round 1) but adopted these methods at 12-month follow-up (Nairobi, n = 221; Homa Bay n = 197). Results Beliefs about pills, injectables and implants among non-users were generally negative. With the partial exception of the pill in Nairobi, the majority thought that each method was likely to cause se...
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Abstract This paper examines gender-related power influences on contraceptive use and coping with consequences in a rural setting in Kenya. Data come from in-depth interviews conducted in 2018 with 42 women who participated in a... more
Abstract This paper examines gender-related power influences on contraceptive use and coping with consequences in a rural setting in Kenya. Data come from in-depth interviews conducted in 2018 with 42 women who participated in a longitudinal study implemented in Homa Bay County. Data were analysed using an exploratory inductive content analytic approach. The findings show that the key drivers of gender-related power influence on contraceptive use and coping with consequences included: 1) the extent to which the women managed to provide sex and sexual pleasure to their partners when they were using contraception; 2) men’s readiness to provide permission and resources that women needed and the latter’s ability to overcome challenges in obtaining the same from their partners; and 3) women’s fears concerning infidelity and partner violence, which influenced the actions they took to reduce instances that could make their partners suspect them of engaging in extra-marital affairs, drive their partners into such affairs, or encourage their partners to direct emotional or physical violence on them. Findings suggest the need for gender-transformative actions combining empowerment programmes for women with information, education and communications activities targeting both men and women.
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Evidence suggests that socio-cultural barriers that limit the ability of women in sub-Saharan Africa to make decisions regarding contraceptive use and childbearing contribute to the slow uptake of contraception in this region. This paper... more
Evidence suggests that socio-cultural barriers that limit the ability of women in sub-Saharan Africa to make decisions regarding contraceptive use and childbearing contribute to the slow uptake of contraception in this region. This paper explores factors influencing women’s decisions regarding contraceptive uptake, switching and discontinuation, and the implications of those decisions for family planning programmes. Data were from in-depth interviews that were conducted in 2018 with 42 women who participated in a longitudinal research project implemented in Homa Bay County of Kenya. Participants comprised women who were aged 15–39 years at the time of recruitment into the study and who discontinued using injectables or implants between the first and second rounds of data collection. Data were analysed using an exploratory inductive content analytic approach. The findings show that uptake of contraception was largely driven by concerns about the negative consequences of frequent chil...
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We explore the demand-side factors associated with the use of implants in Kenya given the notable rapid increase in uptake of the method in the country. Data are from a longitudinal study conducted among married or cohabiting women aged... more
We explore the demand-side factors associated with the use of implants in Kenya given the notable rapid increase in uptake of the method in the country. Data are from a longitudinal study conducted among married or cohabiting women aged 15-39 years at the time of recruitment in one rural (2,424 women) and one urban (2,812 women) site. Analysis entails descriptive statistics and estimation of multivariate logistic regression models. The results show that the key demand-side factors associated with the use of implants were low discontinuation of the method compared with alternatives and strong motivation on the part of the women for long-term spacing of births. However, implants had no perceived advantages over the main alternative methods in terms of beliefs about possible damage to health or unpleasant side effects or in terms of satisfaction with use. The findings suggest that addressing concerns about safety for long-term use and for health may increase demand for implants in particular and long-acting reversible contraceptives in general in the study settings or in similar contexts, especially among women who desire long-term spacing of births.
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Aims: To describe PHC providers’ perspectives on the intervention and differences between intervention and comparison districts in PHC providers’ fistula-related capacity. Methods: At intervention endline, structured interviews were... more
Aims: To describe PHC providers’ perspectives on the intervention and differences between intervention and comparison districts in PHC providers’ fistula-related capacity. Methods: At intervention endline, structured interviews were conducted across 50 PHCs in intervention (n=22) and comparison (n=28) districts with 100 providers on their knowledge of fistula screening, counseling and referral, perceived access barriers and experience implementing the intervention. Results: More than a third of trained providers used the job aid to screen for OF, while 25% used the hotline at least once. Half thought the transportation voucher was the most important intervention component, while 70% selected community agents. Awareness of emergency obstetric care as a prevention strategy was significantly higher in intervention than comparison district (56% v. 16%; p <0.001). A higher proportion of providers in intervention sites recognize and refer women with fistula symptoms (38% v. 26%). Conc...
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This study examined the extent of birth displacement and its effect on the under-five mortality estimates in Kenya. Using data from 2003 and 2008/09 Kenya Demographic and Health Surveys, we evaluate the variability of birth displacement... more
This study examined the extent of birth displacement and its effect on the under-five mortality estimates in Kenya. Using data from 2003 and 2008/09 Kenya Demographic and Health Surveys, we evaluate the variability of birth displacement by region and place of residence based on the survival status of the child. We compute birth ratios for children born in the 5th calendar year preceding each survey and note the possible effect on under-five mortality estimates. Results show that under-five mortality estimates in 2008/09 survey are smaller than that of a similar period in 2003 survey by 17 percent. Overall, birth ratios for the 5th calendar year were below 100 percent suggesting presence of birth displacement. However, there was no variance in the displacement between surviving and dead children, hence modest impact on the under-five mortality rate. Evidence suggests that the remarkable decline in the under-five mortality rate recorded in 2008/09 is a function of both overestimation ...
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The paper examines the extent to which spousal communication influences reproductive health decisions in two provinces of Kenya. Data for analysis is derived from couple data collected in the Kenya Demographic and Heath Survey 2008-9 and... more
The paper examines the extent to which spousal communication influences reproductive health decisions in two provinces of Kenya. Data for analysis is derived from couple data collected in the Kenya Demographic and Heath Survey 2008-9 and supplemented by in-depth interviews and focus group discussions from two districts within the two provinces. Bivariate and multivariate analyses were employed to assess the association between background variables and measures of spousal communication and reproductive health behaviour (that is contraceptive use and fertility desires). Transcripts from qualitative data were imported into the Atlas.ti software for ease of analysis. Results indicate that spousal communication is a crucial factor in determining levels of fertility in the two provinces and should be considered in fertility reduction strategies.
BackgroundCommunity health volunteers (CHVs) play crucial roles in enabling access to healthcare at the community levels. Although CHVs are considered volunteers, programmes provide financial and non-financial incentives. However, there... more
BackgroundCommunity health volunteers (CHVs) play crucial roles in enabling access to healthcare at the community levels. Although CHVs are considered volunteers, programmes provide financial and non-financial incentives. However, there is limited evidence on which bundle of financial and non-financial incentives are most effective for their improved performance.MethodsWe used a discrete choice experiment (DCE) to understand incentive preferences of CHVs with the aim to improve their motivation, performance and retention. Relevant incentive attributes were identified through qualitative interviews with CHVs and with their supervisors. We then deployed a nominal group technique to generate and rank preferred attributes among CHVs. We developed a DCE based on the five attributes and administered it to 211 CHVs in Kilifi and Bungoma counties in Kenya. We used mixed multinomial logit models to estimate the utility of each incentive attribute and calculated the trade-offs the CHWs were w...
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Background Understanding communities’ beliefs about the causes of illnesses in sick young infants (SYIs) is key to strengthening interventions and improving newborn health outcomes. This study explored communities' perception of the... more
Background Understanding communities’ beliefs about the causes of illnesses in sick young infants (SYIs) is key to strengthening interventions and improving newborn health outcomes. This study explored communities' perception of the etiology of illnesses in SYIs 0–59 days old in four counties in Kenya. Methods We used an exploratory qualitative study design. Data were collected between August and September 2018 and involved 23 in-depth interviews with female caregivers aged 15-24years; 25 focus group discussions with female caregivers aged 15–18 years, 19–24 years and 25–45 years; and 7 focus group discussions with fathers aged 18–34 years and 35 or more years. Participants were purposely sampled, only those with SYIs 0–59 days old were eligible to participate. Data were analyzed using inductive thematic analysis framework approach. Results Female caregivers and fathers attributed illnesses in SYIs 0–59 days old to natural (biomedical) and supernatural causes which sometimes co-...
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The Consortium has produced these medical and service delivery guidelines about oral emergency contraceptive pills to assist family planning programs and providers in assuring that the women they serve can use these regimens effectively... more
The Consortium has produced these medical and service delivery guidelines about oral emergency contraceptive pills to assist family planning programs and providers in assuring that the women they serve can use these regimens effectively and safely. This document reflects the latest available evidence and has been reviewed by internationally recognized reproductive health experts. Local programs are welcome to adapt these guidelines as needed to comply with national or other requirements. These guidelines do not discuss the use of the copper-bearing intrauterine device for emergency contraception. This device is the most effective emergency contraceptive option and should be offered to women when appropriate. Some of the new research and data updated include: New details on the hormone UPA and new studies on the influence of BMI on effectiveness are briefly discussed as well as how ECP regimens work their efficacy and safety guidelines on repeat use and considerations for starting or...
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Background Despite well-documented individual-level barriers to fistula care access including limited awareness, psychosocial deterrents, and contextual factors, less is known about how these factors manifest and operate at community... more
Background Despite well-documented individual-level barriers to fistula care access including limited awareness, psychosocial deterrents, and contextual factors, less is known about how these factors manifest and operate at community level. Social normative community perspectives – their knowledge, attitudes and actions in relation to women living with fistula – can offer insight into this mechanism. Our study describes changes in fistula knowledge and attitudes toward those living with fistula among community members in Nigeria and Uganda following implementation of a multi-component intervention addressing treatment barriers. Methods This study adopts a pre-post qualitative design with a comparison site and draws on focus group discussions with female and male community members from three sites in Nigeria and Uganda. Transcripts were analyzed for passages presenting community knowledge and attitudes related to fistula and perceptions of women living with fistula. Summary memos wer...
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ABSTRACTBackgroundUnderstanding the perceptions of quality of care given to sick young infants in primary health care settings is key for developing strategies for effective uptake and utilization of PSBI guidelines. The purpose of this... more
ABSTRACTBackgroundUnderstanding the perceptions of quality of care given to sick young infants in primary health care settings is key for developing strategies for effective uptake and utilization of PSBI guidelines. The purpose of this study is to assess families’ and providers’ perceptions of care given to sick young infants at primary healthcare facilities in four diverse counties in Kenya.MethodsA cross-sectional qualitative design involving in-depth interviews (23) and focus group discussions (25) with very young (15-18 years), young (19-24 years) and older (25-45 years) caregivers of young infants 0-59 days; and key informant interviews with community- and facility-based frontline health providers (14) in primary health care facilities. Qualitative data were captured using audio tapes and field notes, transcribed, translated, and exported into QSR NVivo 12 for analysis. A thematic framework approach was adopted to classify and analyze data.ResultsPerceived care given to SYIs w...
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This study examines factors associated with satisfaction with oral pills and injectables among past users in Kenya based on a baseline survey for the 2-year prospective longitudinal study Improving Measurement of Unintended Pregnancy and... more
This study examines factors associated with satisfaction with oral pills and injectables among past users in Kenya based on a baseline survey for the 2-year prospective longitudinal study Improving Measurement of Unintended Pregnancy and Unmet Need for Family Planning conducted in 2016. Married women aged 15–39 years were interviewed using a structured questionnaire that captured information on reproduction, contraceptive knowledge and beliefs and attitudes towards contraception in general and towards specific methods. A multivariate logistic regression analysis was used to examine factors that influenced satisfaction with oral pills and injectables among past users in one urban site (Nairobi slums) and one predominantly rural site (Homa Bay in western Kenya). Results showed that dissatisfaction with pills and injectables is common among past users in both rural and urban Kenya (ranging from 39% to 56%). The distinctive contribution of the study lies in its ability to relate method-...
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Unmet need for family planning points to the gap between women's reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern... more
Unmet need for family planning points to the gap between women's reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women's self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women's perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys. A multi-site ...