Abstract Traditional cultural practices and sexual rituals have an important role in
the life and... more Abstract Traditional cultural practices and sexual rituals have an important role in the life and structure of tribal groups within Kenya. These cultural practices and rituals also play a significant role in the spread of HIV. The purpose of this descriptive qualitative study was to document the underlying social and cultural significance of the sexual cleansing ritual and to assess its impact on HIV prevention strategies. The study participants were selected by purposive and snowball sampling. Data were collected using in-depth interviews, focus group discussions and observations; they were analyzed using content analysis. The article gives detailed explanations of the meanings and symbols of the ritual in its cultural context as a ritual of social transition. Sexual intercourse is perceived as a sacred rite when performed as a ritual. It is associated with most social cultural activities like planting, harvesting, weddings and burial ceremonies. The underlying intention of this ritual is to cleanse evil spirits and to sanctify. Widows who are not cleansed are ostracized and discriminated. The continued practice of the ritual is perpetuated by a shared common belief system that affects social interactions of the community members. Widows and cleansers are believed to be purveyors of the HIV virus. The ritual encourages unprotected sex with multiple partners. These are barriers to HIV prevention strategies that are aimed at changing sexual behaviors. R.
... Children on-the-street, who form the majority (about two-thirds in most studies) maintain str... more ... Children on-the-street, who form the majority (about two-thirds in most studies) maintain strong family ties and have a sense of belonging to a household. They are on the street to earn money to contribute to the household income (Ebrahim, 1984; Martins, 1993). ...
Street children are a high priority for health policy and service planning in Kenya. Poverty, war... more Street children are a high priority for health policy and service planning in Kenya. Poverty, wars, famine and disease have resulted in street children having a persistent presence in African cities and towns. The Maastricht Social Network Analysis (MSNA) was implemented as the core instrument in a battery to measure the health status of the street children. Owing to the absence of census data of street children in Kenya and the difficulty in tracking this mobile population, we implemented a mixed snowball and convenience sampling design to recruit research subjects. Three hundred street and orphanage children, and 100 primary school children as a control group, were included in the study. The MSNA provided a social diagnosis that complements the clinical diagnosis of the health status of the sample. Only one main methodological question is presented: is the MSNA applicable to describe the personal social networks of (1) children and of (2) people living in a Kenyan culture? Qualitative field observations, key informant interviews and focus groups inform the adaptation of the MSNA instrument, and improve its face validity. A case series analysis is presented. The main result is that the street children population consists of distinct subgroups defined by the UNICEF classification as 'on' and 'of' the street and by gender. Street children networks have some notable deficiencies depending on the subgroup. Constant across the groups is the deficiency of service providers in their networks. The conclusion is that the MSNA is a suitable instrument for obtaining a social diagnosis and gathering other useful information that helps in understanding the social and health backgrounds, status and daily experiences of Kenyan scavenging street children. Applying the MSNA protocol was successful in the diagnosis and interpretation of the findings.
Sahara J-journal of Social Aspects of Hiv-aids, 2009
Clinical programmes are typically evaluated on operational performance metrics of cost, quality a... more Clinical programmes are typically evaluated on operational performance metrics of cost, quality and outcomes. Measures of patient satisfaction are used to assess the experience of receiving care, but other perspectives, including those of staff and communities, are not often sought or used to assess and improve programmes. For strategic planning, the Kenyan HIV/AIDS programme AMPATH (Academic Model Providing Access to Healthcare) sought to evaluate its performance in 2006. The method used for this evaluation was termed ‘triangulation,’ because it used information from three different sources — patients, communities, and programme staff. From January to August 2006, Indiana University external evaluators and AMPATH staff gathered information on strengths, weaknesses and suggestions for improvement of AMPATH. Activities included in-depth key-informant semi-structured interviews of 26 AMPATH clinical and support staff, 56 patients at eight clinic sites, and seven village health dialogues (mabaraza) at five sublocations within the AMPATH catchment area. Data sources included field notes and transcripts of translated audio recordings, which were subjected to qualitative content analysis. Eighteen recommendations for programme improvement emerged, including ten from all three respondent perspectives. Three recommendations were cited by patients and in mabaraza, but not by staff. Triangulation uncovered improvement emphases that an internal assessment would miss. AMPATH and Kenyan Ministry of Health leadership have deliberated these recommendations and accelerated strategic change actions, including rural satellite programmes, collaboration with village-based workers, and door-to-door village-based screening and counselling.Les programmes cliniques sont généralement évalués en fonction des mesures de performance opérationnelle du coût, de la qualité et des résultats. Les mesures de satisfaction du patient sont utilisées afin d'évaluer l'expérience associée à l'administration des soins, mais d'autres perspectives, comme celles du personnel et des communautés, ne sont pas souvent recherchées ou utilisées à des fins d'évaluation et d'amélioration des programmes. A des fins de planification stratégique, l'AMPATH (Modèle académique pour la Provision d'Accès aux Services de Santé), un programme kenyan consacré au VIH/Sida, a cherché à évaluer sa performance en 2006. La méthode utilisée pour cette évaluation a été appelée « triangulation » du fait qu'elle utilisait des informations provenant de trois sources différentes : les patients, les communautés et le personnel du programme. De janvier à août 2006, des évaluateurs externes de l'université d'Indiana et le personnel d'AMPATH ont rassemblé des informations sur les forces, les faiblesses et les suggestions en vue d'améliorer l'AMPATH. Les activités ont inclus des entretiens semi-structurés approfondis avec des informateurs clés de 26 membres du personnel clinique et de soutien d'AMPATH, 56 patients dans 8 cliniques et 7 dialogues de santé de village (mabaraza) dans cinq sous-locations de la zone concernée par l'AMPATH. Les sources de données incluaient des notes de terrain et les transcriptions des enregistrements audio traduits. Les transcriptions ont fait l'objet d'une analyse du contenu qualitatif par des analystes kenyans et nonkenyans indépendants au moyen de méthodes de codage de contenu standard. Dix-huit recommandations en vue de l'amélioration du programme ont émergé de cet exercice, dont dix issues des perspectives des trois répondants. Trois recommandations (accès supérieur aux centres médicaux, travail de proximité et services basés dans le village) ont été citées par les patients et par les mabaraza, mais non par le personnel. La triangulation a permis de mettre l'accent sur des améliorations ayant émergé qu'une évaluation interne n'aurait pu mettre à jour. L'AMPATH et la direction du Ministère de la Santé kenyan ont délibéré sur ces recommandations et ont accéléré les actions de changement stratégique, dont les programmes satellites en zone rurale, la collaboration avec les travailleurs dans les villages, et le dépistage et le conseil en porte à porte dans les villages.
Traditional cultural practices and sexual rituals have an important role in the life and structur... more Traditional cultural practices and sexual rituals have an important role in the life and structure of tribal groups within Kenya. These cultural practices and rituals also play a significant role in the spread of HIV. The purpose of this descriptive qualitative study was to document the underlying social and cultural significance of the sexual cleansing ritual and to assess its impact on HIV prevention strategies. The study participants were selected by purposive and snowball sampling. Data were collected using in-depth interviews, focus group discussions and observations; they were analyzed using content analysis. The article gives detailed explanations of the meanings and symbols of the ritual in its cultural context as a ritual of social transition. Sexual intercourse is perceived as a sacred rite when performed as a ritual. It is associated with most social cultural activities like planting, harvesting, weddings and burial ceremonies. The underlying intention of this ritual is to cleanse evil spirits and to sanctify. Widows who are not cleansed are ostracized and discriminated. The continued practice of the ritual is perpetuated by a shared common belief system that affects social interactions of the community members. Widows and cleansers are believed to be purveyors of the HIV virus. The ritual encourages unprotected sex with multiple partners. These are barriers to HIV prevention strategies that are aimed at changing sexual behaviors.
The 'Cash Transfer to Orphans and Vulnerable Children' (CT-OVC) in Kenya is a government-supporte... more The 'Cash Transfer to Orphans and Vulnerable Children' (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people's health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT.
Abstract Traditional cultural practices and sexual rituals have an important role in
the life and... more Abstract Traditional cultural practices and sexual rituals have an important role in the life and structure of tribal groups within Kenya. These cultural practices and rituals also play a significant role in the spread of HIV. The purpose of this descriptive qualitative study was to document the underlying social and cultural significance of the sexual cleansing ritual and to assess its impact on HIV prevention strategies. The study participants were selected by purposive and snowball sampling. Data were collected using in-depth interviews, focus group discussions and observations; they were analyzed using content analysis. The article gives detailed explanations of the meanings and symbols of the ritual in its cultural context as a ritual of social transition. Sexual intercourse is perceived as a sacred rite when performed as a ritual. It is associated with most social cultural activities like planting, harvesting, weddings and burial ceremonies. The underlying intention of this ritual is to cleanse evil spirits and to sanctify. Widows who are not cleansed are ostracized and discriminated. The continued practice of the ritual is perpetuated by a shared common belief system that affects social interactions of the community members. Widows and cleansers are believed to be purveyors of the HIV virus. The ritual encourages unprotected sex with multiple partners. These are barriers to HIV prevention strategies that are aimed at changing sexual behaviors. R.
... Children on-the-street, who form the majority (about two-thirds in most studies) maintain str... more ... Children on-the-street, who form the majority (about two-thirds in most studies) maintain strong family ties and have a sense of belonging to a household. They are on the street to earn money to contribute to the household income (Ebrahim, 1984; Martins, 1993). ...
Street children are a high priority for health policy and service planning in Kenya. Poverty, war... more Street children are a high priority for health policy and service planning in Kenya. Poverty, wars, famine and disease have resulted in street children having a persistent presence in African cities and towns. The Maastricht Social Network Analysis (MSNA) was implemented as the core instrument in a battery to measure the health status of the street children. Owing to the absence of census data of street children in Kenya and the difficulty in tracking this mobile population, we implemented a mixed snowball and convenience sampling design to recruit research subjects. Three hundred street and orphanage children, and 100 primary school children as a control group, were included in the study. The MSNA provided a social diagnosis that complements the clinical diagnosis of the health status of the sample. Only one main methodological question is presented: is the MSNA applicable to describe the personal social networks of (1) children and of (2) people living in a Kenyan culture? Qualitative field observations, key informant interviews and focus groups inform the adaptation of the MSNA instrument, and improve its face validity. A case series analysis is presented. The main result is that the street children population consists of distinct subgroups defined by the UNICEF classification as 'on' and 'of' the street and by gender. Street children networks have some notable deficiencies depending on the subgroup. Constant across the groups is the deficiency of service providers in their networks. The conclusion is that the MSNA is a suitable instrument for obtaining a social diagnosis and gathering other useful information that helps in understanding the social and health backgrounds, status and daily experiences of Kenyan scavenging street children. Applying the MSNA protocol was successful in the diagnosis and interpretation of the findings.
Sahara J-journal of Social Aspects of Hiv-aids, 2009
Clinical programmes are typically evaluated on operational performance metrics of cost, quality a... more Clinical programmes are typically evaluated on operational performance metrics of cost, quality and outcomes. Measures of patient satisfaction are used to assess the experience of receiving care, but other perspectives, including those of staff and communities, are not often sought or used to assess and improve programmes. For strategic planning, the Kenyan HIV/AIDS programme AMPATH (Academic Model Providing Access to Healthcare) sought to evaluate its performance in 2006. The method used for this evaluation was termed ‘triangulation,’ because it used information from three different sources — patients, communities, and programme staff. From January to August 2006, Indiana University external evaluators and AMPATH staff gathered information on strengths, weaknesses and suggestions for improvement of AMPATH. Activities included in-depth key-informant semi-structured interviews of 26 AMPATH clinical and support staff, 56 patients at eight clinic sites, and seven village health dialogues (mabaraza) at five sublocations within the AMPATH catchment area. Data sources included field notes and transcripts of translated audio recordings, which were subjected to qualitative content analysis. Eighteen recommendations for programme improvement emerged, including ten from all three respondent perspectives. Three recommendations were cited by patients and in mabaraza, but not by staff. Triangulation uncovered improvement emphases that an internal assessment would miss. AMPATH and Kenyan Ministry of Health leadership have deliberated these recommendations and accelerated strategic change actions, including rural satellite programmes, collaboration with village-based workers, and door-to-door village-based screening and counselling.Les programmes cliniques sont généralement évalués en fonction des mesures de performance opérationnelle du coût, de la qualité et des résultats. Les mesures de satisfaction du patient sont utilisées afin d'évaluer l'expérience associée à l'administration des soins, mais d'autres perspectives, comme celles du personnel et des communautés, ne sont pas souvent recherchées ou utilisées à des fins d'évaluation et d'amélioration des programmes. A des fins de planification stratégique, l'AMPATH (Modèle académique pour la Provision d'Accès aux Services de Santé), un programme kenyan consacré au VIH/Sida, a cherché à évaluer sa performance en 2006. La méthode utilisée pour cette évaluation a été appelée « triangulation » du fait qu'elle utilisait des informations provenant de trois sources différentes : les patients, les communautés et le personnel du programme. De janvier à août 2006, des évaluateurs externes de l'université d'Indiana et le personnel d'AMPATH ont rassemblé des informations sur les forces, les faiblesses et les suggestions en vue d'améliorer l'AMPATH. Les activités ont inclus des entretiens semi-structurés approfondis avec des informateurs clés de 26 membres du personnel clinique et de soutien d'AMPATH, 56 patients dans 8 cliniques et 7 dialogues de santé de village (mabaraza) dans cinq sous-locations de la zone concernée par l'AMPATH. Les sources de données incluaient des notes de terrain et les transcriptions des enregistrements audio traduits. Les transcriptions ont fait l'objet d'une analyse du contenu qualitatif par des analystes kenyans et nonkenyans indépendants au moyen de méthodes de codage de contenu standard. Dix-huit recommandations en vue de l'amélioration du programme ont émergé de cet exercice, dont dix issues des perspectives des trois répondants. Trois recommandations (accès supérieur aux centres médicaux, travail de proximité et services basés dans le village) ont été citées par les patients et par les mabaraza, mais non par le personnel. La triangulation a permis de mettre l'accent sur des améliorations ayant émergé qu'une évaluation interne n'aurait pu mettre à jour. L'AMPATH et la direction du Ministère de la Santé kenyan ont délibéré sur ces recommandations et ont accéléré les actions de changement stratégique, dont les programmes satellites en zone rurale, la collaboration avec les travailleurs dans les villages, et le dépistage et le conseil en porte à porte dans les villages.
Traditional cultural practices and sexual rituals have an important role in the life and structur... more Traditional cultural practices and sexual rituals have an important role in the life and structure of tribal groups within Kenya. These cultural practices and rituals also play a significant role in the spread of HIV. The purpose of this descriptive qualitative study was to document the underlying social and cultural significance of the sexual cleansing ritual and to assess its impact on HIV prevention strategies. The study participants were selected by purposive and snowball sampling. Data were collected using in-depth interviews, focus group discussions and observations; they were analyzed using content analysis. The article gives detailed explanations of the meanings and symbols of the ritual in its cultural context as a ritual of social transition. Sexual intercourse is perceived as a sacred rite when performed as a ritual. It is associated with most social cultural activities like planting, harvesting, weddings and burial ceremonies. The underlying intention of this ritual is to cleanse evil spirits and to sanctify. Widows who are not cleansed are ostracized and discriminated. The continued practice of the ritual is perpetuated by a shared common belief system that affects social interactions of the community members. Widows and cleansers are believed to be purveyors of the HIV virus. The ritual encourages unprotected sex with multiple partners. These are barriers to HIV prevention strategies that are aimed at changing sexual behaviors.
The 'Cash Transfer to Orphans and Vulnerable Children' (CT-OVC) in Kenya is a government-supporte... more The 'Cash Transfer to Orphans and Vulnerable Children' (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people's health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT.
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Papers by David Ayuku
the life and structure of tribal groups within Kenya. These cultural practices and
rituals also play a significant role in the spread of HIV. The purpose of this
descriptive qualitative study was to document the underlying social and cultural
significance of the sexual cleansing ritual and to assess its impact on HIV prevention
strategies. The study participants were selected by purposive and snowball sampling.
Data were collected using in-depth interviews, focus group discussions and
observations; they were analyzed using content analysis. The article gives detailed
explanations of the meanings and symbols of the ritual in its cultural context as a
ritual of social transition. Sexual intercourse is perceived as a sacred rite when
performed as a ritual. It is associated with most social cultural activities like
planting, harvesting, weddings and burial ceremonies. The underlying intention of
this ritual is to cleanse evil spirits and to sanctify. Widows who are not cleansed are
ostracized and discriminated. The continued practice of the ritual is perpetuated by a
shared common belief system that affects social interactions of the community
members. Widows and cleansers are believed to be purveyors of the HIV virus. The
ritual encourages unprotected sex with multiple partners. These are barriers to HIV
prevention strategies that are aimed at changing sexual behaviors.
R.
the life and structure of tribal groups within Kenya. These cultural practices and
rituals also play a significant role in the spread of HIV. The purpose of this
descriptive qualitative study was to document the underlying social and cultural
significance of the sexual cleansing ritual and to assess its impact on HIV prevention
strategies. The study participants were selected by purposive and snowball sampling.
Data were collected using in-depth interviews, focus group discussions and
observations; they were analyzed using content analysis. The article gives detailed
explanations of the meanings and symbols of the ritual in its cultural context as a
ritual of social transition. Sexual intercourse is perceived as a sacred rite when
performed as a ritual. It is associated with most social cultural activities like
planting, harvesting, weddings and burial ceremonies. The underlying intention of
this ritual is to cleanse evil spirits and to sanctify. Widows who are not cleansed are
ostracized and discriminated. The continued practice of the ritual is perpetuated by a
shared common belief system that affects social interactions of the community
members. Widows and cleansers are believed to be purveyors of the HIV virus. The
ritual encourages unprotected sex with multiple partners. These are barriers to HIV
prevention strategies that are aimed at changing sexual behaviors.
R.