Making it: Understanding Adolescent Resilience in Nairobi Slums

Life is an interesting journey- it puts us in touch with people like ourselves, and with others who’ve walked a completely different path. It amazes me that even with a single office building, amongst colleagues doing very similar work, the journeys to where our lives intertwine are so remarkably different. Some have a relatively ‘easy’ journey while others have toiled and fought against all odds. These different pathways invoke two questions: how do people who have undergone severe hardship in childhood and youth, ‘make it’ or become successful? And what can we learn from these people that can enable us to help others in similar situations?

I grew up in a middle-class home where I lacked little, had educated parents who dedicatedly followed my academic progress and ensured that my siblings and I had everything we needed, corrected us when we went astray, and sacrificed much to ensure that we got the best they could afford. Under such circumstances, it almost seems unremarkable that we all completed our education and are ‘gainfully’ employed. Others – my parents included-balanced school with herding animals, fetching firewood, reading under the light of the cooking fire, and sometimes lacking what some might consider basic necessities. And yet, they ‘made it’ – graduated from university, got good jobs, raised a family, and got to that point where life’s basic necessities have been adequately met and they can now afford some luxuries.

Stories of Success:

These stories of success serve as the inspiration for the study on how and why some young people in urban slums ‘make it”. In other words, they progress successfully through adolescence and do well in school, avoid ‘risk behaviors’ and participate in civic activities (including voluntary community service), despite living in such adverse conditions. In the study, we call this success-despite-all-odds, resilience.

The Study- Friends Matter Most:

The study was based on data collected from boys and girls aged 12-19 years living in two Nairobi slums. We found that ‘resilient’ young people tended to have supportive parents who closely monitored their children’s whereabouts, friends and activities; kept friends who valued education and avoided risk behaviors; and belonged to a religious group and valued the role of religion. Of these, the young person’s peers was most consistently linked with resilience. This is hardly surprising-increased identification with peer groups is a key characteristic of adolescence; a young person whose friends avoid risk behaviors such as smoking and drinking, will also tend not to smoke or drink.

Community Values and Research:

Out of curiosity – this must be the reason why I ended up in research – I asked my mother to share the story of her journey: She told me that having a mother, whose own parents valued education enough to make sure that she – my grandmother valued- got at least some basic education, ensured that my mother and her siblings, had a positive role model. My grandmother also encouraged her children, especially the girls, to do well in school and emphasized strong moral values. Growing up in a community that upheld strong moral values was also important. However, it is clear that a person’s motivation and drive also play a role. Having grown up during the early 1950s when the British colonial government declared a state of emergency, she and her siblings witnessed the suffering that may women underwent when fathers and other able men were forced to leave home and work for the colonial government or on white settlers’ farms leaving their families in the villages wallowing in poverty. To my mother, that was a strong motivation to do the best that she could so that she could “leave the village and the poverty behind”. So to her, it was a mix of a supportive social environment and enough personal determination. And succeed she did – of about ten girls in her primary school class, she was in the five that made it to secondary school. Of the five girls, she’s the only one who made it to the university!

Lessons – The Social Context Matters:

Overall, my mother’s story and the study’s findings tally. Resilience is not just a matter of individual character but also of the society one grows up in. In other words, the social context matters. In the paper, we argue that the findings obtained in our study suggest that parents – and the community – should be involved as informal social control agents in programs designed to address youth risk behavior, empowerment and well-being. Our study also suggests a need for policies and programs that increase young people’s access to education, recreational services and opportunities for civic involvement. This will help ensure that young people are adequately involved in activities that promote their well-being and keep meaningfully engaged.

This blog is based on a paper titled: “Making It: Understanding Adolescent Resilience in Two Informal Settlements (Slums) in Nairobi, Kenya” published in the Journal, Child & Youth Services Vol.33, Issue 1, 2012.

 Read more…

http://www.tandfonline.com/doi/abs/10.1080/0145935X.2012.665321#preview

The PDRH Team Heads to San Francisco

By Salome Wawire

Today, APHRC’s Population Dynamic and Reproductive Health (PDRH) Team heads to The Population Association of America (PAA)’s annual conference in San Francisco, USA.  Aside from enjoying the beautiful views of the Golden Gate Bridge, the PDRH team will be actively participating in all of the conference activities including making oral and poster presentations, and attending side meetings and other networking activities with current and potential partners.

This year’s program offers a wealth of information on topics ranging from Fertility, family planning, sexual behavior, and reproductive health; Migration and urbanization; to Economy, labor force, education, and inequality. You can view a full program of events here. More to come on interesting presentations and new ideas for future research in our post-conference blog!

At the conference I will be presenting a paper (co-authored with An-Magritt Jensen, from the Norwegian University of Science and Technology (NTNU)) that examines the connection between changes in marriage and attitudes towards fertility. The focus of the paper is the cohabitation phenomenon commonly known as “come we stay” in Kenya, and how the processes involved in this type of union affect fertility desires and outcomes. The study was done in Bungoma and Kwale, Kenya.

The findings of this study show that generational changes in marriage patterns, as well as the changing social, cultural and economic landscape in Kenya, all combine to have an impact on fertility decisions among women in the study areas.

This paper is based on data from a larger study, in which APHRC, in collaboration with researchers from the University of Nairobi and NTNU are seeking to understand the interplay of fertility and poverty, and its impact on gender systems in two different cultural and religious contexts. The study will allow researchers to analyze ways in which reproductive health and child mortality impact fertility and poverty in the household.

I look forward to hearing feedback from the conference participants.  Attending the conference? You can view my presentation information on the PAA online program.  Or you can stop by and view the presentation in person this coming Thursday, May 3 from 3:30 PM – 5:20 PM.

Fighting Malaria with Financing: Does the Global Fund’s AMFm model work?

By Jessica Brinton and Frederick Wekesah

This week as we continue to celebrate World Malaria Day and the (great) progress in the fight against malaria, we also must take this time to remember the deadly challenge that remains: preventing an estimated 200 million illnesses and 600,000 deaths per year — mostly children under the age of five and most of them in sub-Saharan Africa.

Meanwhile the fight against malaria in Africa is at a critical moment— since many countries that have traditionally funded anti-malaria interventions are now facing major budget cuts. Although the WHO has reported in its 2011 report that malaria-related death rates have dropped by 33% in Africa since 2000 and even heavily affected countries like Uganda have reported large decreases in malaria rates; other countries like the Congo—where malaria rates have more than doubled in the last two years—have seen huge increases in illnesses and deaths from malaria.

Thankfully, even in these times of budget austerity many organizations have remained dedicated to fighting the deadly disease and have recognized that financial and technical assistance cannot waiver if we are to eradicate this physically and economically debilitating illness. From simple but effective public fundraising campaigns like Nothing but Nets and Roll Back Malaria, to The Global Fund, people are working to prevent and treat the disease and ultimately save lives.

One initiative from the Global Fund is using innovative financing to make malaria treatment more available and affordable in highly endemic regions in Africa and especially rural remote areas in Ghana, Kenya, Niger, Mainland Tanzania, Zanzibar, Uganda, Madagascar and Nigeria. These 9 identified countries usually have the worst indicators of access to health care. Called The Global Fund’s Affordable Medicines Facility for Malaria (AMFm), the program is a financing mechanism developed to get the most effective single dose treatment for malaria called artemisinin-based combination therapies (ACTs) to more people who are affected by the disease.

How AMFm works: The Global Fund and its partners and funders have worked with drug manufacturers to decrease the overall price of ACTs, and ensure that sales prices are the same for both public and private sector buyers of the drugs. This is important because if a private buyer pays more to purchase the drugs from the manufacturers that buyer will most likely turn around and sell the drug for more, therefore making the drug unaffordable for many people trying to purchase the treatment.

The Global Fund reports that as a result of the program, today private importers pay up to 80 % less than they did in 2008-2009. The reason the drug manufacturers agreed to this process is because The Global Fund covers most of the reduced price by paying it directly to manufacturers. As a result, the first-line buyers pay only the remainder so patients are able to purchase ACTs from many locations (public, private, NGOs) at lower prices. In Kenya, the ACTs are available at public outlets such as health centers and pharmacies at minimal cost to patients treated in these facilities.

Where APHRC comes in: Last year APHRC was sub-contracted by Population Services International Kenya on behalf of the AMFm Independent Evaluators (IE) to conduct the endline survey. This survey will help answer the question of whether the program was effective in at least increasing access to the malaria treatment at a more affordable and subsidized price. APHRC was also sub-contracted this year by the IE to conduct a similar survey in areas of Kenya classified as remote because remote areas are also.

Both studies used quantitative methods and relied on data from the baseline survey to collect data for the endline and remote areas outlet surveys. The study looked at both the amount of co-paid (price reduced) ACTs purchased or received at the outlet (which is any place, store or center that has the potential to stock anti-malarials) measured by the proportion of outlets in these locations that had co-paid ACTs in stock at the time of the researchers visit.

At the population level, the study measured the amount of co-paid ACTs sold or distributed in the last week before the survey was taken, as a proportion of the total volume of all anti-malarials sold or distributed in the last week before the survey via outlets located in the study locations. Because of the cost and need of the drugs the study assumes that anti-malarials that are sold or distributed are ultimately used by people.

So what did we find? Right now the data is being analyzed and the report being written by the IE, so stay tuned for the results of this innovative new Global Fund program. If it is successful, this model could be another key tool in the war on malaria toolkit and coupled with preventive efforts could mean more lives saved.

To be continued…

Petrol Blast Leaves Trail of Death and Destruction in Nairobi’s Demographic Surveillance Site

By Jonathan Odhong

“I have basically lost everything. My life has been turned upside down!” laments Catherine Wamaitha one of the Viwandani residents still trying to come to terms with life in the aftermath of the tragic fire blaze that nearly wiped out the entire Sinai village in Viwandani, Nairobi on the morning of September 12, 2011. For a day that started normally like any other, she still can’t comprehend how chaos straight from hell descended on the residents. The Sinai Village probably acquired its name from the Biblical Mount Sinai where Moses received the 10 commandments engulfed in white clouds, however for the residents of Viwandani this cloud was black, smoky cloud of fire and death.

“On the day, I had woken up and gone around my chores for the house as usual, I sent my three children to school and then at about 8 am I stepped out of the house to find my neighbors in a mad rush for fuel which was flowing as usual from one of the Kenya Pipeline ducts. This was a usual occurrence to me because my house is about 10 meters from this pipe. So Like everybody else I dashed out to see everyone dashing about to get bigger containers to store the precious commodity, this time it was overflowing and everyone thought they could get some.

Redcross help in removing the charred remains of the unfortunate residents caught in the inferno.

As I got closer to the duct the strong stinging and nauseating smell of the fumes made me step back and because of my allergy I walked away. As I walked off I noticed a few people had already been intoxicated by the fumes and some were high while others had fainted. I walked off thinking this wasn’t the usual diesel fuel that we had time and time again carried off and sold to Matatu drivers for Kshs. 50 per litre. As I later came to confirm, this was super petrol. When I had walked a distance of about 250 meters the first blast came, and then the second. I ran as far as I could. I still cannot believe I am alive! I was saved by my allergy to strong scents! Although all my belongings are reduced to ashes, at least my husband and children who were away at the time are safe and sound”.

The fire which claimed over a hundred lives didn’t discriminate by age as both the young and old bear scars of the tragedy. Samwel Wanga, a 13-year old school boy was yet to resume school after the teachers strike had been called-off by the Kenya National Union of Teachers (KNUT). Earlier that day, his older brother had left home for school to check if learning had resumed.

Samwel Wanga (in a blue sweater) being escorted away from the scene of the fire by his mother Anne Odemba. Samwel barely escaped with his life.

Little did he know that this would make the difference between him and his brother, one which would see one of the brothers miss death by a whisker as the other has a regular “boring day” in school”. I was playing with my friends and then suddenly noticed the adults running towards the pipe. I guess curiosity got the better of me and I followed. One of my neighbors, I can’t remember her name, she told me to move closer and get some. Just as I was getting closer the first blast went off and I started running away. I can’t clearly remember the rest of the details”.

Samwel’s mother Ms Anne Odemba, a single mother of two is clearly stung by the narration her son gives of the ordeal. She was still in her house which is a good distance away from the scene of fire when all this was unfolding. All she can mutter amidst the sorrow is “thanks to God” for the fact that Samwel sustained non-fatal burns and is alive.

The Sinai fire incident brings into focus the difficulties of life in Nairobi’s informal settlements which APHRC’s research has continually focused on. Various research studies from the Center have invariably pointed out to the fact that every day is an emergency in the slums from the state of health, education to the living conditions as well as the many hazards the residents are exposed to. This therefore requires a multi-pronged approach by all stakeholders to change the status quo.

Research Communication Summit in Nigeria

By Jonathan Odhong

Prof Osita Ogbu explains a point during his presentation at the summit

Failure by researchers to communicate their findings is probably the single biggest obstacle to the utilization of research findings in policymaking by African leaders. This is the problem that knowledge translation – a process through which research is brought to life – is meant to solve.

Knowledge translation is the intersection between research and action through a communicative relationship that relies on partnerships, collaborations and personal contacts between researchers and the people who use research results to make policy.

The Policy Engagement and Communication (PEC) Unit of APHRC has, since inception, actively promoted research communication, which is part of knowledge translation, in Africa. In continuing these efforts, the Unit collaborated with the University of Nigeria, Nsuka, (UNN) to hold a research communication summit for Nigerian researchers at the Rockview Hotel, Abuja, on 13th to 14th December 2010.

Al-Hajji Ibrahim Shehu Shema Governor of Katsina state

Journalists, communication officers, policymakers and public affairs officers from different federal states in Nigeria also attended. Resource persons included policymakers, established researchers and communication experts drawn from Kenya and Nigeria. Participants were exposed to effective research communication principles using the IDRC Knowledge Translation Toolkit.

Al-Hajji Ibrahim Shehu Shema, Executive Governor of Katsina Federal State, officially opened the summit. In his speech, delivered on his behalf by his Special Assistant in charge of Special Duties, Daura Zone, Mr Nafwi Lawal, Governor Shema lauded the conference as a timely event that would serve to enable researchers and policymakers see their relationship in a new and more useful light.

He singled out three factors contributing to poor communication of research results as researchers’ narrow focus on peers through journals; policymakers’ aversion to research information; and lack of incentives for evidence-based policymaking. The governor concluded by extending an invitation to APHRC and UNN to hold a similar summit in Katsina State in 2011.

Other speakers included Prof. Bartho Okolo, the Vice Chancellor of UNN; Prof. Osita Ogbu, a member of the APHRC Board and economic policy scholar and consultant; Ms Njoki Ndung’u, an ex-MP from Kenya who shared her experiences in policymaking; Mr. Michael Otieno, the Managing Director of Hill and Knowlton; and Dr Ejike Oji, Country Director, IPAS

How we did it: Njoki Ndungu narrates to the participants how together with her team they successfully for the enactment of the Sexual Offences bill in Kenya

Plans are already underway to hold the 2011 Research Communication Summit in Katsina State, Nigeria.

New home for robust team

By Albert Mwangi

The new office complex in Kitusuru, Nairobi

The continent’s premier health and population research center has a new home in Kitisuru, Nairobi.

Staff officially moved to the Kshs. 416 million premises on June 2, 2011. The complex will host all departments of the African Population and Health Research Center (APHRC) and boasts ultra-modern training facilities.

The move coincides with the 10th anniversary of the organization which has recorded solid achievements in improving life in Africa through policy-relevant research. Established in 1995 as a programme of the Population Council, the center became autonomous in 2001 and bases its work on population, health, urbanization and education issues.

It also promotes the use of research to influence policy and has invested heavily in strengthening the capacity of African scholars and institutions.

APHRC researchers have published more than 220 peer-reviewed journal articles and successfully implemented over 20 primary research projects.

The center has established itself as a leader in urban health, particularly using its Nairobi Urban Demographic Surveillance System. Focusing on HIV/Aids, adolescent reproductive health and the status and needs of urban slums residents, APHRC has assisted other African organizations to enhance their capabilities.

It also developed the Nairobi Urban Health and Poverty Project to find cost-effective strategies for addressing the health and livelihood needs of those living in informal settlements.

The Population Dynamics and Reproductive Health theme has tested the use of the menstrual cups as an alternative method for managing menstrual flow among women in resource poor settings.

The Education theme has initiated studies to offer scientific evidence on the quality of teaching and learning in classrooms and factors influencing school participation. This involves slum and non-slum populations within the context of Kenya’s free primary education program.

There has been continuous dialogue with stakeholders and dissemination of findings in a timely and clear way through the policy, engagement and communications unit.

The center also boasts strong links with donors and partner organization, including UN agencies, government ministries and departments, professionals, Members of Parliament and other non-governmental organizations.

For example, APHRC works closely with Members of Parliament in Kenya and the entire region through the Southern and East African Parliamentary Alliance of Committees on Health.

The Center — which has expanded in terms of human resources, countries covered and programs undertaken — has gradually become a leading think-tank on urbanization and well-being; population and reproductive health; health challenges and systems and education. This has grown APHRC’s credibility globally as a source of evidence-based information. As it enters a new decade, the Center looks forward to maintaining this tempo.

It is a new dawn for diabetics and hypertensive patients in the slums

Non-communicable diseases are no longer an affliction of the affluent in society. Research conducted by African Population and Health Center (APHRC) in Korogocho and Viwandani in 2008 to 2009 is a clear testimony of rising numbers of people suffering from diabetes and high blood pressure in informal urban settlements. During the research, APHRC in collaboration with the World Diabetes Foundation (WDF) established outreach clinics in Korogocho and Viwandani, have held a clinic after every fortnight for residents suffering from these non-communicable diseases. The clinics have been a blessing to many patients who otherwise could have remained at home due to lack of funds to seek treatment elsewhere.

Dr Catherine Kyobutungi Dr Sam Oti and former area Member of Parliament Reuben Ndolo during the hand over ceremony at Lunga Lunga Health Center

March 27th 2011, marked a new dawn to the long suffering diabetes and high blood pressure patients in the Korogocho and Viwandani slums. This is the day that APHRC donated a ‘starter kit’ worth more than Kshs. 200,000 of drugs and consumables to patients who are now registered as community based organizations by the name Korogocho/Viwandani Diabetes and Hypertensive Movement. The ‘starter kit’ will form the basis of a revolving fund where patients will pay monthly subscription fees to their respective movement. This will entitle them to a full dose of drugs prescribed during the two outreach clinics. The fees will be channeled to a joint fund that will be used to replenish the drugs and consumables. By so doing, the sustainability of the clinics will be attained at the long term.

Listening to speeches from invited guests, one could not miss the fact that the menace of diabetes and hypertension is real with moving testimonies by patients about their buried family members, friends and relatives who had succumbed to either diabetes, hypertension or from complications from the two diseases. According to Dr Catherine Kyobutungi, the project leader, the two disease conditions need concerted effort by all, the government, pharmaceutical companies and private sector to tackle them.

In an address to the patients who came to witness the colorful ceremony, she reiterated the importance of personal responsibility. The buck stops with each and every individual, she said. There is need for people to actively sensitize fellow country men and women on the need to be screened for the two conditions. Increased screening will lead to increased detection and diagnosis and with better reporting, the magnitude of these conditions will be clearer to policy and decision makers.