https://repository.maseno.ac.ke/handle/123456789/108 Fri, 15 May 2026 12:04:55 GMT 2026-05-15T12:04:55Z https://repository.maseno.ac.ke/handle/123456789/6374 Health providers’ perspectives on effects of the COVID-19 pandemic and anti-epidemic measures on maternal health services in Nairobi, Kenya: a qualitative study Wangamati, Cynthia Khamala; Geissler, Paul Wenzel; Nyambedha, Erick Otieno; Prince, Ruth Jane The first case of COVID-19 in Kenya was confirmed in March 2020; the Kenyan government swiftly introduced measures to curb transmission, some of which negatively impacted maternal health services. Most research on the effects of COVID-19 on maternal health is from the perspectives of pregnant women and mothers. Our study explores health providers’ perspectives on the effect of COVID-19 on maternal health services in Nairobi, Kenya. Fri, 11 Apr 2025 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/6374 2025-04-11T00:00:00Z https://repository.maseno.ac.ke/handle/123456789/6373 Caregivers’ lived experiences of childhood probable pneumonia through a gendered lens in western Kenya Ngere, Sarah Hawi; Olang’o, Charles; Ochola, Kennedy,et al. Gender intersects with multiple forms of socio-cultural, economic and health system factors to influence the overall care-seeking experiences of caregivers. Tue, 08 Jul 2025 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/6373 2025-07-08T00:00:00Z https://repository.maseno.ac.ke/handle/123456789/6372 Caregivers’ perceptions of childhood pneumonia in Western Kenya: a theory of practice perspective Ngere, Sarah Hawi; Olang'o, Charles Omondi; Kiyuka, Patience,et al Caregivers' beliefs about their children’s health, perceived causes of illness, and approaches to treatment significantly influence health-seeking behavior. Using Bourdieu’s Theory of Practice, we explore the influence of caregivers’ social and cultural capital within a specific social environment that shapes pneumonia perceptions. An ethnographic study, a combined mixed method qualitative study, was conducted between April and October 2024. A total of 14 in-depth interviews, 3 focus group discussions, and 11 caregivers participated in the participant observation. Transcribed interviews were analyzed using a phenomenological hermeneutic approach by reading and re-reading transcripts to identify recurrent themes and interpret the understanding of childhood illnesses, perceptions of pneumonia, and how they influence health-seeking behavior. Caregivers have reported three main causes of pneumonia: exposure to cold, hereditary factors, and pathogens. All caregivers identified exposure to cold, such as cold weather or riding motorcycles, as a cause of pneumonia. Few knew that germs could cause pneumonia, while a few believed that pneumonia was hereditary. Asthma, perceived as a hereditary condition, is also believed to cause pneumonia. However, there is confusion regarding whether pneumonia and asthma are distinct illnesses or the same condition. Regardless of the specific belief, exposure to the cold remained the most dominant and widely accepted explanation for pneumonia across all caregivers. Additionally, there was no widely recognized local terminology for pneumonia; instead, caregivers described it using literal descriptions of observed symptoms, such as coughing, chest congestion, and difficulty in breathing. Caregivers’ symptom-based interpretations reflected reliance on observable signs rather than biomedical diagnostic labels. Perceptions of pneumonia and terminologies were predominantly shaped by cultural beliefs and interactions within the social environment. To minimize the gap between biomedical and culturally mediated knowledge, culturally sensitive health education programs that emphasize the recognition of key pneumonia symptoms using locally understandable languages and concepts should be developed and initiated. Tue, 05 Aug 2025 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/6372 2025-08-05T00:00:00Z https://repository.maseno.ac.ke/handle/123456789/6009 Non-adherence to antiretroviral treatment among migrating fishermen in western Kenya’s islands: a rapid qualitative study Ombere, Stephen Okumu; Nyambedha, Erick Otieno Fishing communities in many Sub-Saharan African countries are a high-risk population group disproportionately affected by the HIV epidemic. The association of migration with HIV and AIDS in sub-Saharan Africa is well documented. Frequent mobility, high consumption of alcohol, multiple sexual partners, transactional and commercial sex, poor health infrastructure and limited access to health services are reported among the main factors shaping the HIV epidemic in fishing communities. Moreover, studies have been conducted in sub-Saharan Africa on adherence to antiretroviral treatment (ART) among fishers; however, non-adherence to ART remains poorly understood among migrating fishermen in the western Kenya islands. This qualitative study investigated factors contributing to non-adherence among fishermen in the western Kenya islands. This study utilised 51 in-depth interviews and six focus group discussions to highlight factors contributing to non-adherence to ART by mobile fishermen. Data were analysed using a contextualised thematic analysis. Results show that migration, alcohol consumption and ART sharing contributed to non-adherence. Adherence to ART is a powerful predictor of survival for individuals living with HIV and AIDS. The Kenyan government can use lessons from this study to target fishermen to achieve the UNAIDS 2025 recommendations on people-centred and context-specific service responses to AIDS as this would move Kenya closer to the 90% reduction in annual infections by 2030. This article contributes to a deeper understanding of how and why fishermen from the islands in western Kenya struggle to adhere to treatment even though they can access ARTs through the public health care system. Longitudinal studies should be conducted to explore how the factors associated with non-adherence correlate with other key health outcomes such as drug resistance. https://doi.org/10.2989/16085906.2023.2276375 Tue, 28 Nov 2023 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/6009 2023-11-28T00:00:00Z https://repository.maseno.ac.ke/handle/123456789/5786 Anti-Politics and Free Maternal Health Services in Kilifi County, Kenya Ombere, Stephen Okumu; Nyambedha, Erick Otieno; Haller, Tobias; Merten, Sonja Maternal healthcare is a global agenda. Kenya introduced free maternity services (FMS) in 2013 to allow women to give birth for free in all government public health facilities. The introduction of FMS was timely due to the high maternal mortality rate in Kenya. FMS was also introduced to fulfil the Jubilee Party government’s elections campaign promises. It is, however, not known how primary beneficiaries and health providers perceived the FMS roll-out following the presidential directive in 2013. This article aims to explore the roles of political contestations in FMS as a social protection scheme in Kenya. In this qualitative ethnographic study in Kilifi County, we interviewed the mothers who utilised FMS and the health workers who implemented the policy. The data gathered was analysed contextually and thematically. The prevailing narrative from the health services professionals and the mothers who participated in our study is that FMS is ‘the president’s thing’ and has a clear political orientation; it is seen as deceiving the public in two ways: first by shrouding political interests, and second by adding to the burden of women, as delivery was not free – all the other services and medication before and after birth came at a cost. Health workers feel helpless and frustrated and, in most cases, they have to cope with meagre resources to ensure safe births. In some cases, quality of care is compromised due to supply-side constraints. This article shows how social protection has been used to gain political mileage and has not considered the local needs of the maternal healthcare system. https://doi.org/10.1080/00020184.2023.2241833 Mon, 02 Jan 2023 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/5786 2023-01-02T00:00:00Z https://repository.maseno.ac.ke/handle/123456789/5735 Local perspectives on policy implementation of free maternity health services in Kenya: Implications for universal health coverage. Ombere, O. Stephen; Nyambedha, O. Erick; Haller, Tobias; Merten, Sonja Kenya introduced free maternity services (FMS) in 2013 to enable all pregnant women to give birth for free in all government public health facilities. Currently, Kenya is rolling out universal health coverage (UHC), which has been acknowledged as a priority goal for every health system and part of the ‘Big Four Agenda’ for sustainable national development in Kenya. FMS is one of the core services in Kenya, but since its launch, it is not clear whether the decentralized approach chosen to implement FMS is leading to UHC. This nine-month ethnographic study in Kilifi County, Kenya, was conducted between March-July 2016 and FebruaryJuly 2017. A narrative approach to analysis was applied. In this article, we interrogate local perceptions of participation during the crafting and implementation of FMS. Findings show that FMS was detached from local realities, and this was a major inadequacy of the top to bottom approach. FMS did not consider local power relations and bargaining power which are requisites during policy formulation and implementation. The participants expressed desire for more localized control over resources from the national government. The findings suggest that as UHC is rolled out in Kenya, consultation of local stakeholders at the grassroots by the state departments would likely improve maternal healthcare outcomes. Such consultations must take into consideration differences in bargaining power and local power relations. Borrowing from the basic tenets of the recent anthropological theorization of constitutionality, this article proposes a bottom to top approach that leverages and integrates local views during policy-making process to create trust, a sense of ownership and accountability. (Afr J Reprod Health 2023; 27 [5s]: 71-81). DOI: 10.29063/ajrh2023/v27i5s.9 Tue, 02 May 2023 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/5735 2023-05-02T00:00:00Z https://repository.maseno.ac.ke/handle/123456789/5734 Olikoye Ransome-Kuti: a treasured advocate for primary health care and a pioneer of good health governance Friday Okonofua, Natalia Kanem, Eyitayo Lambo, Isaac F Adewole, Nimi D Briggs, Elizabeth Millar, Fikadu Mitiku, Honelgn N Hiruy, Janine Barden-O’Fallon, Subeen Lim, Hocheol Lee, Jongin Lee, Nigatu R Geda, Eunwoo Nam, Victoria K Uka, Esienumoh E Ekpoanwan, Alberta D Nsemo, Josephine B Etowa, Stephen O Ombere, Erick O Nyambedha, Tobias Haller, Sonja Merten, Tolulope F Olufunlayo, Olayinka A Abosede, Adebayo T Onajole, Olumuyiwa O Odusanya, Nnabuike C Ngene, Olive P Khaliq, Jagidesa Moodley, Sanae Elomrani, Bouchra Assarag, Vincent De Brouwere, Soufiane Aithammou, Rachid Bezad, Bouchra Benazzouz Given the phenomenal contributions he made to primary health care worldwide, and to the promotion of sexual and reproductive health care in the African region, the African Journal of Reproductive Health (AJRH) has considered it worthwhile to dedicate a special edition to mark the 20th anniversary of his death with the hope that this will help to reawaken consciousness in the principal elements of social justice, equity, and social inclusion in health care for which he devoted his life. The AJRH believes that despite its numerous challenges, Africa has leading innovators and exemplars in the field of health that have helped and can help to revamp the daunting health systems challenge and revigorate development in the continent. It is only by showcasing these leaders and innovators that new patterns of visionaries for growth and development can be thrown up in the region. We believe strongly that Professor Olikoye Ransome-Kuti is one such leader and despite his death, his memories can help to rejig the pathway that need to be followed to reactivate health care delivery and innovations in Africa DOI: 10.29063/ajrh2023/v27i5s.1 Wed, 31 May 2023 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/5734 2023-05-31T00:00:00Z https://repository.maseno.ac.ke/handle/123456789/5726 Tourism memories – a collaborative reflection on inclusion and exclusion Jernsand, Eva Maria; Kraff, Helena; Törngren, Sayaka Osanami; Adolfsson, Caroline; Björner, Emma; Omondi, Lillian; Pederson, Thomas; Ulver, Sofia The purpose of this paper is to explore how people’s differentiated privileged and marginalised positions in society create instances of inclusion and exclusion in tourism. Eight authors utilised their diverse disciplinary and theoretical bases to engage in individual autoethnography and collaborative reflections of their personal experiences of being tourists and hosts. Through our Western and non-Western, White and non-White experiences, we reveal experiences from a multitude of perspectives, and problematise the dominant White racial frame. The methodology illustrates unquestioned privileges and feelings of discomfort when personally faced with exclusionary practices and creates an understanding of how individuals have different experiences of enchantment and the tourist gaze. The experience of marginalisation is serial and dialectical, which illustrates the complexity of tourism. The paper contributes to an enhanced and multifaceted understanding of tourism experiences and proposes measures to reveal issues of exclusion. Also, the use of autoethnography and collaborative reflection as methodological tools provide opportunities for researchers and practitioners to engage in reflexive conversation on discriminatory practices, and how they hinder certain individuals and groups from enjoying tourism products and services. https://doi.org/10.1080/02508281.2023.2207153 Mon, 15 May 2023 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/5726 2023-05-15T00:00:00Z https://repository.maseno.ac.ke/handle/123456789/5671 Effects of COVID-19 on Kenya’s Healthcare System: Healthcare Providers’ Experiences with Maternal Health Services Utilization in Coastal Kenya Okumu Stephen Ombere, Adiedo Agnetta Nyabundi The COVID-19 pandemic overstretched health systems in developed and developing nations. Like other African nations, Kenya has a frail health system, making responding to the pandemic a problem. Recent studies during COVID-19 have shown that Kenya’s health systems were either strained to their maximum capability or worse in handling patients. Therefore, citizens were advised not to go to the hospital unless necessary. This advice applies to all, including pregnant mothers. This article utilized the anthropological description of the healthcare system, viewed as a cultural system attached to particular provisions of social institutions and forms of social connections. It is a social and cultural system in origin, structure, function, and significance. In every society, healthcare systems are forms of social reality in which they embody specific social roles and relationships between these roles. There is a dearth of information on how healthcare providers experienced the effects of COVID-19 on Kenya’s healthcare system, which this study addresses for those in Coastal Kenya. This rapid qualitative study utilized data from sixteen purposefully selected healthcare providers in charge of various departments in Kilifi County of Coastal Kenya. We utilized thematic analysis and textual description to present our findings. It emerged that there was a diversion in resources allocated for maternal health programs, health facilities were temporarily shut down due to inadequate resources and equipment for health workers, there was a lack of preparation by health workers, there was a reduced flow of pregnant mothers and missing scheduled appointments for ante- and postnatal clinics, maternal mortality increased, and mothers resorted to traditional midwives for deliveries. These findings show that maternal health services were negatively affected. Thus, the government needs to institute alternative measures for continued access to maternal health services during pandemics. We recommend expanding and supporting the existing community midwifery model (CMM). For instance, incorporating community health workers (CHWs) and other local health institutions in the community, such as traditional birth attendants (TBAs), and creating midwifery centers managed by trained midwives in communities. https://doi.org/10.3390/world4010010 Tue, 28 Feb 2023 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/5671 2023-02-28T00:00:00Z https://repository.maseno.ac.ke/handle/123456789/5639 Measures adopted by indigent mothers in Kilifi County to tackle maternal health challenges during the COVID-19 pandemic: A qualitative study Ombere Stephen O, Nyambedha Erick O , Haller Tobias, Sonja Merten Many sub-Saharan African countries have experienced various challenges that threaten the quality of health services offered to the population. The COVID-19 pandemic disrupted access to healthcare services in many countries as they grappled with implementing measures to curb its spread. The consequences of COVID-19 have been catastrophic for maternal and newborn health. There is a dearth of information on expectant mothers’ negotiation mechanisms to access maternal health services during COVID-19 in Kenya. This rapid qualitative study draws data from purposefully selected 15 mothers who were either pregnant or had newborn babies during the COVID-19 pandemic in Kilifi county in Kenya. Data were analyzed thematically and presented in a textual description. Women used the following alternatives to access maternal health: giving birth at the homes of traditional birth attendants (TBAs), substituting breastfeeding with locally available food supplements, relying on limited resources and neighbours for delivery and local savings and rotating credit associations. This study shows that urgent measures are needed to provide high quality maternal and child health services during and after the COVID-19 pandemic. These include but are not limited to developing special interventions for the pregnant women for any emergency and establishing trust between communities and individuals through the TBAs. https://www.ajol.info/index.php/ajrh/article/view/238626 Sat, 01 Jan 2022 00:00:00 GMT https://repository.maseno.ac.ke/handle/123456789/5639 2022-01-01T00:00:00Z