Abstract:

Introduction: Despite overall global progress and concerted efforts, MDGs 4 (reduce child mortality) and 5 (improve maternal and new born health) have been and are seriously off target for many countries. In Africa, south of the Sahara a woman has a 1 in 39 chance of dying in pregnancy or childbirth, compared to a 1 in 3,800 similar risk in developed countries. The leading causes of maternal deaths are related to obstetric complications around the time of childbirth, with three-quarters of those deaths and significant morbidity being preventable through access to a full continuum of quality reproductive health services. Evidence shows that Africa still has the highest proportion of under-five deaths, with 1 in 91 children dying before their fifth birthday (UNICEF, 2016).

Aim: To explore experiences, knowledge, beliefs, practices and attitudes of caregivers and community members associated with the causes of common childhood illnesses, prevention and treatment options.

Materials and Methods: The study adopted qualitative approaches grounded in social and health promotion theories (Berkowitz, 2004; Rosenstock, 1966; Bradley et al., 2009). Maximum variability, in combination with sampling designs employed to capture a diversity of perspectives.

Results: The study findings identified the most common childhood illnesses as; malaria, diarrhoea, measles, coughs, and colds related to increased cases of child and infant mortality. Pneumonia was rarely cited, the fear of HIV and cancer tests mentioned as key barriers of early initiation and continued use of ANC services. Side effects of vaccines prevent mothers from having their children vaccinated.

Conclusion: This study provides a contextual and evidence-based approach for the design of MNCH interventions that are effective, user-friendly and more likely to elicit optimum participation from the targeted community members in Homa Bay County.

Keywords: MNCH services, MDG 4 and 5, uptake, barriers, children/pregnant women, Homa Bay.

References:

[1].     African Union (2012). Status Report on Maternal, New Born and Child Health.

[2].     Berggren W.L, and Wray JD. (2002). Positive deviant behavior and nutrition education. Food Nutr Bull 2002;23(suppl 4):9-10.

[3].     Berkowitz A. D. (2004) The Social Norms Approach: Theory, Research, and Annotated Bibliography

[4].     Birmeta Kidist, Yohannes Dibaba and Desalegn Woldeyohannes (2013): Determinants of maternal health care utilization in Holeta town, central Ethiopia: BMC Health Services Research 2013, 13:256 doi:10.1186/1472-6963-13-256

[5].     Bradley Elizabeth H, Leslie A Curry, Shoba Ramanadhan, Laura Rowe, Ingrid M Nembhard and Harlan M Krumholz (2009): Research in action: using positive deviance to improve quality of health care: Implementation Science 4:25

[6].     Bryan (2008). Social Research Methods. New York: OUP.Carlsen Benedicte and Claire Glenton (2011) What about N? A methodological study of sample-size reporting in focus group studies. BMC Medical Research Methodology 2011, 11:26.

[7].     Carpenter, Christopher J. (2010). "A meta-analysis of the effectiveness of health belief model variables in predicting behavior". Health Communication 25 (8): 661–669

[8].     Glanz, Karen; Barbara K. Rimer, K. Viswanath (2008). Health behavior and health education: theory, research, and practice. (4th Ed.). San Francisco, CA: Jossey-Bass. pp. 45–51.

[9].     Glanz, Karen; Bishop, Donald B. (2010). "The role of behavioral science theory in development and implementation of public health interventions". Annual review of public health 31: 399–418.

[10]. Guest, G.K.M, Macqueen and E. Namey (2012). Applied Thematic Analysis. Thousand Oaks, CA: Sage

[11]. Hahn, R.A and M.C. Inhorn (Eds) (2009). Anthropology and Public Health: Bridging differences in culture and society. Oxford: OUP.

[12]. Kenya Demographic and Health Survey (2008-2009) Report.

[13]. Kirkwood, BR et al., (2008): Developing community-based intervention strategies to save newborn lives: lessons learned from formative research in five countries; Journal of Perinatology 28:2–8

[14]. Lozano R et al., (2011). Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis, Lancet 2011, 378(9797):1139–1165.

[15]. Marsh D.R, Sternin M, Khadduri R, Ihsan T, Nazir R, Bari A, et al (2002). Identification of model newborn care practices through a positive deviance inquiry to guide behavior change interventions in Haripur, Pakistan. Food Nutrition Bulletin 2002; 23(suppl 4):109-18.

[16]. McLeroy KR, Bibeau D, Steckler A, Glanz K (1988). An ecological approach on health promotion programs. Health Educ Q. 15:351–377.

[17]. Newes-Adeyi G, Helitzer DL, Caulfield LE, Bronner Y. (2000). Theory and practice: applying the Ecological model to formative research for a WIC training program in New York State. Health Educ Research. 15:283–291.

[18]. Pope C, S. Ziebland and N. Mays (2009). Qualitative Research in Health Care. BMJ, 320 (7227), 114-116.

[19]. Ritchie J.and J. Lewis (2008). Qualitative Research Practice. Thousand Oaks, CA: Sage.

[20]. Ritchter, M. (2008). Global Health: Why cultural perceptions, social representations and biopolitics matter. Tucson: University of Arizona Press.

[21]. Rosensck, Irwin M.; Strecher, Victor J., Becker, Marshall H. (1988). "Social learning theory and the health belief model". Health Education & Behavior 15 (2): 175–183.

[22]. Rosenstock, Irwin M.; Strecher, Victor J., Becker, Marshall H. (1988). "Social learning theory and the health belief model". Health Education & Behavior 15 (2): 175–183.

[23]. Sternin J, and Choo R 2000): The power of positive deviancy. An effort to reduce malnutrition in Vietnam offers an important lesson about managing change. Harv Bus Rev 2000, 78:14-25.

[24]. Stewart DW, Shamdasani PN, Rook DW (2007): Focus Groups. Theory and Practice. Thousand Oaks: Sage Publications.

[25]. UNICEF (2012). Pneumonia and Diarrhea: Tackling the deadliest diseases for the world’s poorest children, New York.

[26]. United Nations (2012). Every Woman, Every Child; UN Commission on increasing commodities for women and children. Implementation Plan. UN; New York.

[27]. Walker L.O, Sterling B.S, Hoke M.M, Dearden K.A (2007). Applying the concept of positive deviance to public health data: a tool for reducing health disparities. Public Health Nurs 2007, 24:571-576.

[28]. WHO, UNICEF, UNFPA and the World Bank (2012): Trends in maternal mortality: 1990 to 2010: Estimates developed by WHO, UNICEF, UNFPA and The World Bank.

[29]. WHO/UNICEF (2010). Countdown to 2015 Decade Report (2000–2010) with country profiles: Taking stock of maternal, newborn and child survival. Geneva.