APHRC Q2 Newsletter 2013
Content
aph r c news
April - June, 2013 Volume 11 Issue 1
The Newsletter of the African Population and Health Research Center
Wanted: A Development Data Revolution
in this issue
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A field worker collects Demographic Surveillance data at Korogocho informal settlement.
Celebrating 50 Years and a new Working Group on Aging and Demographic Dividend at the African Union
Founding Fathers A Visit to the Center 13 Years On
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Are Implants the Future of Family Planning in Burundi?
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he much awaited ‘Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda’ is now available. It calls for a Data Revolution, “a new international initiative to improve the quality of statistics and information available to citizens”, that would take advantage of new technologies and big data platforms to track progress towards development goals.
critical information, improving data availability, and ensuring that the needed baseline information is in place to adequately measure and define progress against established development goals. The report’s focus on data as a cornerstone of the panel’s suggestions for post-2015 development goals is promising. Furthermore, its release in the week of the second APHRCCGD Data for African Development Working Group meeting (May 30-31, 2013) couldn’t be timelier. The Data for African Development Working Group (DFAD), co-chaired by Alex Ezeh from the African Population and Health Research Center (APHRC) and Amanda Glassman with
Investing in Education for the Urban Poor, Jubilee Education Fund
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It envisions a Global Partnership on Development Data supported by a wide variety of data stakeholders - including country national statistics offices, the private sector, civil society, and international organizations - responsible for developing strategy to address gaps in
The APHRC Miracle in a Phenomenal Research Journey Public-Private Partnership Takes Off: Health Facility to Get Facelift in Korogocho Slum Publications Calender of Events Staff Updates
Mission: To be a global center of excellence, consistently generating and delivering relevant scientific evidence for policy and action on population, health, and education in Africa.
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NEWS
the Center for Global Development (CGD), is currently developing recommendations specifically to improve development data from Africa – a region of the world known for variable and often low quality development statistics. Alex Ezeh, APHRC Executive Director, commenting on the report explained that, “We cannot hope to achieve the new post 2015 development goals without finally addressing the issue of development data in Africa.” Dr. Ezeh commended the emphasis on data in the new High Level Panel Report, but urged global leaders to take seriously the implications of the quality of development data and the forthcoming Working Group recommendations if they are to place a very real emphasis on investing in high quality data, and eliminate the hurdles to achieving a true data revolution.
International data is great for cross-country comparability, but it often doesn’t meet the needs of policymakers at the country or local level
explained Amanda Glassman, CGD Director of Global Health Policy and Senior Fellow. T h e D FA D Wo r k i n g G ro u p recommendations, to be released later this year, will provide the tangible next steps key development audiences need to take to achieve the muchneeded Data Revolution in Africa.
What does a Data Revolution Actually Mean?
Some development practitioners will advocate for more data, a lot more. Others will argue there is already much data collection occurring, but not of the right kind. Some experts will suggest we should rely primarily on internationally collected development statistics, and encourage more development partner involvement. Others will suggest that country-developed statistics should be used as the gold standard, and countries should lead in their own data priority setting and production. Meanwhile folks on the Open Data bandwagon would say open access to data is the key. The DFAD Working Group has been examining these perspectives as it has worked through defining the limitations and potential opportunities for improvement of national statistics. “Our Working Group aims to develop recommendations that provide solutions for how best to tackle political economy challenges negatively impacting the quality of development data in Africa,”
Working Group Thoughts
Although the Working Group recommendations on these critical data issues are still in development, the diverse group of Working Group experts – including country reps, donors, and international institutions - had varying opinions on every issue debated, some major discussion synergies included: International data is great for cross-country comparability, but it often doesn’t meet the needs of policymakers at the country or local level. Quality and timeliness of GDP and other development measures have been a concern in recent years. DFAD research shows systematic discrepancies between survey and administrative data. One way forward is for donors, NSOs, and line ministries to align to a new system of norms and standards enforcement— for example national surveys might consider including a small set of questions to validate key administrative data.
Countries should be the primary sources of development data, but there are significant challenges limiting the quality, accuracy, and timeliness of country produced statistics and the data validation processes in many African countries. NSO autonomy and independence is necessary to ensure freedom from political interference, allow for professional independence of NSO staff and management (including aspects such as salary scale, retention), and to support NSO capacity building. Enhanced autonomy does not mean that an NSO would be entirely independent of Government, but that parastatal or société privée status (reporting to Presidency or home ministry), would allow the offices to operate independently and effectively. Investments in statistical office capacity and increasing NSO autonomy could help with project/priority management, staff recruitment and retention, and covering even budget needs thereby increasing the quality and timeliness of country produced data. Open data is a good tool to improve data access and use, but it is not a silver bullet. And while increasingly greater amounts of data are being collected and analyzed, there are dually major gaps in data accessibility and the quality of data when it is accessible. Open data can be used to promote data and workload sharing, ensure greater accountability and use of nationally produced data, and to promote innovation. This article was co-authored by Dr. Alex Ezeh and Jessica Brinton
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PROGRAM UPDATE
Celebrating 50 Years and a new Working Group on Aging and Demographic Dividend at the African Union
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he African Union (AU), which recently celebrated its 50th anniversary, kicked off its next 50 years by coconvening the first meeting of the new Aging, Food and Nutrition Security and Demographic Dividend in Africa Working Group. The Group is convened by the African Union, the African Population and Health Research Center (APHRC) and the United Nations Economic Commission for Africa (UNECA). Over the two-day preliminary meeting (June 6-7, 2013), the expert group explored linkages between Africa’s older population and achieving a demographic dividend in Africa. Bringing
together a wide variety of expertise ranging from government to aging and population, migration, agriculture and youth, participants deliberated the overall concept of the Working Group. The Working Group members determined how to establish what evidence is needed to fill the research gaps in this area and which specific policy approaches and models are most appropriate and effective to harness the potential of older populations in Africa. The group also discussed how to explain and show key stakeholders the impact older people
in African countries might have, both for the parameters of achieving a first demographic dividend and the types of policy approaches that will be needed to attain it. The Working Group secretariat is now tasked with completing several research products determined by the group ahead of the next Working Group meeting which will be held at the APHRC Campus in early 2014. The Working Group will officially launch later this year. More detailed information and a list of Working Group members and organizations is available at www.aphrc.org.
The Working Group members determined how to establish what evidence is needed to fill the research gaps in this area and which specific policy approaches and models are most appropriate and effective to harness the potential of older populations in Africa
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Founding Fathers A Visit to the Center 13 Years On
John Bongaarts and John Cleland were both members of the APHRC Advisory Board under the Population Council, while Anrudh Jain was the Vice President of the Population Council responsible for International Programs Division where APHRC was attached.
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o fully understand APHRC, it is important to understand its founders who just happen to be some of world’s the leading population research experts. Three founding partners, John Bongaarts, John Cleland and Anrudh Jain, visited the APHRC Campus for an afternoon cocktail, following the 2013 International Union for the Scientific Study of Population (IUSSP) seminar on Unmet Need in Nanyuki on May 14-17, 2013. John Bongaarts and John Cleland, who were both members of the APHRC Advisory Board when APHRC was still under the Population Council; and Anrudh Jain, who was the Vice President of the Population Council responsible for International Programs Division where APHRC was originally nested, shared with staff how the Center’s journey started in the early years.
Dr. Ezeh then invited Anrudh Jain, John Bongaarts and John Cleland to share some remarks on the history of APHRC.
Dr. Alex Ezeh, the Executive Director at APHRC, thanked Jain, Bongaarts and Cleland for their vision for APHRC in those early days. “There are two distinguished people here who were on the APHRC advisory board under the Population Council. When I came to the Center, part of the attraction was the vision they had for the Center, the people they were working with and had connections to; who actually are the best minds we have in the field. I believed if the Center had any chance of success, it would be under the guidance and leadership of these eminent scholars, and it would be good to try. They played a significant role in the transition of the Center from a program of the Population Council to becoming an independent entity. I really want to appreciate Anrudh Jain, John Bongaarts and John Cleland for the work they did in laying the foundation for what APHRC is today.”
Anrudh Jain : “I have been reminiscing about t h e C e n t e r ’s h i s t o r y since I came to Nairobi. The Population Council had been interested in developing institutions around the world, Africa was developing and we had worked with many universities’ population studies centers. For instance, we were working with the PSRI (Population Studies and Research Institute) here in Nairobi. The idea of APHRC was born out of a meeting between Steven Sinding, Sarah Seims and Cheikh Mbacké from the Rockefeller Foundation, and Ayo Ajayi and I from the Population Council.” The Rockefeller Foundation challenged us to develop a center that would be sustainable and that would do policy-relevant research because the university-based centers were not conducting this kind of research. We therefore set out to explore how such a center could be developed and that is how the Center was born! We received an initial grant for 5 years, and right from the beginning, although it was a part of the Population Council, it created its own identity as APHRC. Coming here today, I was grinning with pride. All the credit here goes to Alex Ezeh and his staff that we now have a sustainable research center that is producing policy-relevant research on population, urban health and other areas.”
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NEWS
I really want to appreciate Anrudh Jain, John Bongaarts and John Cleland for the work they did in laying the foundation for what APHRC is today..... To be honest, I think the credit goes to every single staff member of APHRC; the type of commitment they’ve shown over the years
John Cleland: “One of the tussles in those early days was between the focus on population and family planning and the breadth of other interests. I think you got it right by broadening out into health, urbanization and education. I think the big issue for you now is how much broader do you get. Will you take Economics really seriously? How about international migration, is that part of population dynamics? It’s a very important issue and an area where not a lot of good research is being undertaken. I think that this would be an ideal setting [to do that research] if you got a chunk of good technical demographers at APHRC. Well done Alex, well done APHRC.”
Dr. Ezeh closed with some kind words about all APHRC staff. “To be honest, I think the credit goes to every single staff member of APHRC and the type of commitment they’ve shown over the years. You can come here on a Saturday and you will still find people working! The staff is selfmotivated and driven and that is really what has led to the growth and success that the Center has achieved over the years. That is in addition to the support from our many partners. We appreciate all the opportunities we’ve had to collaborate and partner and this is something we pay a lot of attention to as it’s one of the ways in which we’ve been able to grow our work here at APHRC.”
John Bongaarts: “I still remember what dreams we had in the 90s. The start of APHRC was a little rocky, but all that changed when you (Alex) arrived in 1998. Since then I see every one of the board members’ expectations met and I think you get much of the credit for that, so congratulations!”
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OPINION
Are Implants the Future of Family Planning in Burundi?
Dr. Namuunda Mutombo, Associate Research Scientist
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ith a population density of more than 300 persons per square kilometer, coupled with high poverty levels, a high fertility rate and a high unmet need for family planning, there is a glaring need for Burundi to avail birth control methods to its population in order to attain sustainable development. In addressing these challenges, the Government of Burundi in conjunction with the United States Government developed the Global Health Initiative Strategy (2011-2015). One of the key interventions in this strategy is the promotion of voluntary family planning through provision of information and a variety of family planning methods so that individuals can make informed decisions regarding family planning. Earlier in 2010 and in line with the principle of increasing choices among family planning clients, the Government of Burundi introduced Jadelle, also known as Levonorgestrel Implants, in many health facilities across the country. These implants have proven to be quite effective in preventing pregnancy -- evidence shows that only up to 1 percent of women using them can conceive over a period of five years.
...the Ministry of Health in Burundi could not introduce the Jadelle implant services to all health facilities in the country and hence the initiative left out two provinces (Kayanza and Muyinga) of which Kayanza has the highest population density in the country. In order to complement the government effort, the African Population and Health Research Center through the Evidence to Action Program (E2A) moved in to facilitate provision of the Jadelle implant in these two provinces to fill the existing gap
Implant Availability for All?
In 2009, the Burundi government introduced the use of the Jadelle implant in 15 provinces through the Ministry of Health Maternal and Child Health (MCH) program. However, owing to limited resources, the Ministry of Health in Burundi could not introduce the Jadelle implant services to all health facilities in the country and hence the initiative left out two provinces (Kayanza and Muyinga) of which Kayanza has the highest population density in the country. In order to complement the government effort, the African Population and Health Research Center through the Evidence to Action Program (E2A) moved in to facilitate provision of the Jadelle implant in these two provinces to fill the existing gap. The E2A Implant Implementation Project worked to provide technical assistance to the public sector family planning programs with the ultimate goal of increasing the number of community and facility family planning sites and users within the two provinces in Burundi. This technical assistance included training service providers and managers in family planning services and counseling.
A woman seeks family planning advice at a health center in Burundi.
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Implementing Implants
The first step to fully integrating implants into the family planning services offered in Burundi was to assist the Ministry of Health to develop national guidelines and protocols for family planning and reproductive health programs that included implants and the finalization of the national policy on community-based distribution of contraceptives. The second step was to train a group of trainers in Bujumbura. These trainers were selected from Kayanza, Muyinga and three other provinces (Gitega, Makamba and Ruyigi) where Jadelle implants had been introduced by the Ministry of Health. These trainers later taught service providers in both Kayanza and Muyinga Provinces using selected practicum sites. Providing Jadelle implant services at the study sites started in September 2012 and continues today.
OPINION
available shows that after just five months of availability, Jadelle Implants emerged as the third most accepted family planning method after injectables (60.6%) and oral pills (16%). In fact, 13.2% of women accessing family planning methods chose the implant method. Other less popular methods included the intra-uterine device (IUD) (8.3%), condom (1.7%) and the natural family planning method (0.2%). In many health centers, Jadelle implants are already the second most used method after injectables as many clients find it more convenient compared to oral pills. Many service providers found that most family planning clients prefer to “experiment” first with injectables before accepting implants. This means that there is great potential for the method and with an increased number of health facilities that can offer an expanded method mix that includes Jadelle, the method could be one of the most used methods in the two regions. Provinces, the Catholic Church, which is the dominant denomination, discourages women from using artificial family planning methods. Furthermore, pro-natalists and other traditionalists are spreading incorrect information about implants. These include claims that Jadelle implants cause health problems such as cancer and that the implants can move through the veins from the arm to the brain.
What Next?
The evidence we are seeing in Burundi shows the importance of providing family planning clients with a wide choice of methods, which is a key reproductive health right. There is no doubt that scaling up the availability of the implants, coupled with providing appropriate information to potential users and counteracting myths and misinformation will result in improved healthy spacing and timing of pregnancies in Burundi. This development will ultimately improve the health of women and we are likely to see improvements in a range of reproductive health indicators that will help guarantee sustainable economic development in the region. Beyond the work being done by this specific project (E2A), the Ministry of Health in Burundi should work to ensure adequate supply of FP commodities, training and re-training of FP service providers and provision of information on the importance of family planning—and make sure to include the implant option. Lessons from Burundi should also be shared with other African countries facing similar population challenges so that all countries in the African region can fully benefit from the anticipated demographic dividend. The APHRC Evidence to Action for Strengthened RH for Women and Girls (E2A) Project is implemented in partnership with Pathfinder International-Burundi.
Good News for Family Planning in Burundi?
A review of the clinical records of the women who have been visiting the sites for the past year where the new family planning implant method has been
Pushback and Myths
Acceptance of implants is however, being threatened by propaganda against the method. In both Kayanza and Muyinga
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RESEARCH CAPACITY STRENGTHENING
APHRC and My Phenomenal Research Journey
Chidozie Emmanuel Mbada, ADDRF Fellow
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hen I reflect on my PhD research journey, I realize it has been a remarkable one. The African Population and Health Research Centre (APHRC) through the African Doctoral Dissertation Research Fellowship (ADDRF) program has contributed in no mean measure to this. My testimony is evidence that the ADDRF program has achieved its objective to support the training and retention of highly-skilled, locally-trained scholars in research and academic positions across Africa.
My PhD research journey with ADDRF started with an application in 2010. I thought the successful enlistment in the 3rd cohort of the ADDRF was the best thing that could ever happen to me; little did I know that it was just the beginning of good things. The ADDRF workshops on research methodology and scientific writing provided me with the opportunity for training, intellectual networking and exposure. I became a fellow in 2010 with only 20 publications accumulated over a 3-year period. I was the lead author in 20% of those publications. After the workshops, my research acumen and writing skills took a quantum leap. In less than two years, the number of my publications has tripled with more articles in international peer-
To quote Sir Isaac Newton, “If I have seen farther, it is by standing on the shoulders of giants.” ADDRF is the giant on whose shoulders I stand!
reviewed journals. I am the lead author in more than 80% of those articles. In addition, I took the 2nd prize in the Postgraduate School Award for the Best PhD Thesis in the University of Ibadan, Nigeria, in 2012. I was also a recipient of the Postgraduate School Award for Publication of Articles from PhD Theses in the University of Ibadan, 2011/2012 session. As a result of this background, as a university lecturer in physiotherapy, I was assigned to teach research methodology to undergraduate and postgraduate students
respectively. My undergraduate research supervisees had the best research projects on the external examiners’ rating and overall scores in the last three consecutive academic sessions. Generally, the ADDRF program has contributed immensely to my research capacity and writing skills; provided publishing opportunities and kept me updated on current trends in health research and information-sharing platforms. It also provided me with opportunities to network with junior research fellows in Africa. Finally, the ADDRF program offered me funding opportunities for research and the exposure that comes with international travel. Ultimately, I thank God for the opportunity to be an ADDRF fellow. To quote Sir Isaac Newton “If I have seen farther, it is by standing on the shoulders of giants.” ADDRF is the giant on whose shoulders I stand! Chidozie Emmanuel Mbada is a lecturer in Physiotherapy at Obafemi Awolowo University in Nigeria in the department of Medical Rehabilitation. He holds a PhD from Obafemi Awolowo University, Nigeria where he conducted research on Comparative Efficacy of Static and Dynamic Endurance Training of Back Extensor Muscles in the Management of Patients with Non-Specific LongTerm Low-Back Pain. Entry date into ADDRF: May 2010 Graduation date: September 2012
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Investing in Education for the Urban Poor Jubilee Education Fund
PROGRAM UPDATE
their secondary education. The other ten are in their third year in different secondary schools within Kenya. An addition to the Center’s social responsibility is the Jubilee Education Fund, established in 2012 to facilitate the transition of students from poor families to secondary school. The program seeks to fund 25 day and 25 boarding students, a feat that requires up to KES 9.25 million ($115,625) over the next 5 years. So far, the fund has raised Kshs.1.3 million and 8 students have been identified for the awarding of scholarships (3 in Korogocho, 3 in Viwandani (Nairobi County) and 2 in Cheleta primary school (Kiambu County). To be selected, the students must attain a minimum of 310 marks at the Kenya Certificate of Primary School Education (KCPE) and hail from low-income family backgrounds. APHRC continues to investigate education challenges in subSaharan Africa through its Education Research Program with the aim of informing policy. As part of its research, the program is focusing on barriers to accessing quality basic education under universal basic education policies, including transition to secondary schooling among marginalized populations in urban contexts. The Jubilee Education Fund was established in honor of APHRC’s Executive Director Dr. Alex Ezeh, on his 50th Birthday.
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Mrs. Nkee Ezeh, founder of the Jubilee Education Fund (second from left) presents a cheque to one of the Fund’s beneficiaries, Ben Agote from Cheleta Primary School in Githunguri slum, Nairobi. Looking on is Ben’s father, Tom Ingolo (extreme right), the headmaster Cheleta Primary School, Mr. Stanley Mukururo (center) and Salma Musa from APHRC (extreme left).
ince 2007, APHRC has, as part of its corporate social responsibility, supported bright students from disadvantaged backgrounds to access secondary education. This has been in partnership with committed APHRC staff and like-minded organizations such as The Hindu Religious and Service Center among others. So far, APHRC has awarded bursaries to 13 students, three of whom have already completed
Public-Private Partnership Takes Off Health Facility to Get Facelift in Korogocho Slum
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n May 21, 2013, APHRC’s Partnerships for Maternal, Newborn and Child Health (PAMANECH) initiative signed a Memorandum of Understanding (MoU) with Jahmii Kipawa Medical Center and TRIAD Architects to facilitate the upgrading of the health center.
Jahmii Kipawa Medical Center is a health facility that provides maternal health services in both Kariobangi and Korogocho areas of Kasarani District. Following a rigorous selection exercise, the health center was among those nominated by the Kasarani District Health Management Team (DHMT) for upgrading. The upgrading comprises of improvement of the health facility’s building structures, provision of equipment and training support. Jahmii Kipawa Medical Center is housed in a two-storied building that will
require renovation and construction of additional rooms to enable better provision of maternal, newborn and child services. This will include, but not limited to, completion of maternity wards, kitchen, washrooms, roofing, improving staircase accessibility and construction of an incinerator. Representatives from the various organizations included Mr. Joseph Gichuru, the director of operations at APHRC and Mr Patrick Waiganjo who is the director of Jahmii Kipawa Medical Center. Witnessing the signing was Dr. Moses Owino, the Kasarani District Medical Officer of Health and Mr. Joseph Gathu, the community representative and chairman of the Korogocho residents committee.
Present at the signing ceremony were the TRIAD Architects, an architectural firm that will work with APHRC to upgrade the medical center. They will develop and standardize procedures of operations and provide technical architectural expertise, pro bono, as part of their corporate social responsibility. Heritage Associates Ltd will take up consultancy services in the design and management of construction activities in the other selected heath facilities, which include Tumaini Health Center, Provide International Health Center (both in Korogocho) and Cana Familycare (in Viwandani) among others. The designs will be approved by the Nairobi County government and the Kasarani DHMTs. The signing of the MOUs paved the way for the commencement of the next phase of the PAMANECH initiative, which aims at improving health service delivery for mothers, newborns and young children.
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OPINION
Running out of Time to Apprehend a Killer Controlling Hypertension
Dr. Samuel Oti, Senior Research Officer
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ypertension is increasingly becoming a serious health problem across the world, especially in developing countries like Kenya. It is believed that one out of every three adults in the world could be hypertensive. In Kenya, it is estimated that up to 40 percent of the adult population could be hypertensive though there is limited data since no national survey has been conducted yet to establish the exact levels of hypertension. And that is where the tragedy lies.
In other words, you could look perfectly healthy and be walking around with a very high blood pressure for many years. Then suddenly, you fall seriously ill and perhaps even drop dead. The bad news is that the exact cause of hypertension is usually not known in majority of cases. However, the good news is that hypertension is both treatable and preventable. There are certain risky health behaviors that have been associated with increasing one’s chances of getting hypertension. For example, people who are in the habit of consuming high amounts of salt (by adding excessive salt to their meals) are at high risk. Also, you may be at risk of getting hypertension if you smoke tobacco, consume excessive amounts of alcohol, don’t exercise regularly or eat a lot of ‘junk food’ (food that is of little nutritional value and often high in fat, sugar, salt, and calories). Therefore, avoiding these risky behaviors could save your life. Additionally, it is advisable that every adult, particularly those above 35 years, get screened at least once a year for hypertension. The condition can be controlled by changing one’s lifestyle, for example by minimizing the risky behaviors mentioned above but in some cases, medication is required to bring the pressure down.
what is known as a “double burden of disease” whereby communicable diseases like HIV and non-communicable conditions like hypertension will continue to claim the lives of our people. We need to raise awareness about hypertension in our society. The need for mass awareness campaigns to educate the citizenry about the dangers of hypertension and the need to be screened regularly is now more urgent that ever. We must make screening for hypertension available, accessible and affordable to all Kenyans. There is no reason why any primary healthcare center in Kenya should not have functional blood-pressure measuring devices. These devices are affordable and now, there are modern versions that do not need highly skilled health personnel such as doctors to operate them. We m u s t a l s o e n s u re t h a t a n t i hypertensive medications are made widely available. There are generic forms of these medications that are quite affordable. Unfortunately, the current policy of the Ministry of Health is to supply such medication to district hospitals only. In other words, primary health centers and dispensaries, which are closer to ordinary people, do not stock the medications. The time for the government (and you) to act is now. APHRC has developed and is implementing a cost-effective, sustainable and scalable community-based model to effectively address cardiovascular diseases in urban slums by focusing on both treatment and prevention. (SCALE UP - Sustainable model for Cardiovascular health by Adjusting Lifestyle and treatment with Economic perspective in settings of Urban Poverty).
Hypertension refers to a condition in which the blood pressure of an individual is unusually high. Each time the human heart beats, blood is pumped through blood vessels known as arteries to supply the entire body with oxygen and nutrients –both of which are essential for the normal functioning of the human body. High blood pressure occurs when there is increased resistance to this normal flow of blood through the arteries. This may be a result of different factors especially increased rigidity of the blood vessels and increased blood volume. Blood pressure can be measured by simple machines specially made for that purpose. The digital age has ushered in models that will measure your blood pressure at the click of a button and display it on a small screen. These have almost replaced older models that required specialized training and use of a stethoscope.
Silent Killer
Hypertension is a very dangerous condition for two main reasons. First, if left untreated, it can lead to a heart attack, stroke, kidney failure and eventually death. However, what makes hypertension even deadlier is that it usually has no clear-cut symptoms hence it is referred to as a “silent killer”.
Double Burden of Disease
In Kenya, emphasis has often been on communicable diseases like HIV/AIDS, tuberculosis and malaria. These are very important diseases that have posed serious threats to our health systems. However, we cannot ignore other emerging non-communicable health threats like hypertension or we risk being faced with
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List of Publications
1. Egondi, T., Beguy, D., Kanyiva, M., Kabiru, C., & Jessor, R. (2013). Adolescent home-leaving and the transition to adulthood: A psychosocial and behavioral study in the slums of Nairobi. International Journal of Behavioral Development, 37(3). Doi: 10.1177/0165025413479299 4. Beguy, D., Ndugwa, R., & Kabiru, C.W. (2013). Entry into motherhood among adolescent girls in two informal settlements in Nairobi, Kenya. Journal of Biosocial Science, 1-22.Doi: http://dx.doi.org/10.1017/S0021932013000199 5. Xu, H., Mberu, B.U., Goldberg, R.E., & Luke, N. (2013). Dimensions of rural-to-urban migration and premarital pregnancy in Kenya. ANNALS of the American Academy of Political and Social Science, 648, July 2013
2. Onsomu, E.O., Kimani, J.K., Abuya, B. A., Arif, A.A., Moore, D., Duren-Winfield, V., & Harwell, G. (2013). Delaying sexual debut as a strategy for reducing HIV epidemic in Kenya. African Journal of Reproductive Health, 17(2), 46-57
3. Crichton, J., Okal, J., Kabiru, C.W., & Zulu, E.M. (2013). Emotional and psychosocial aspects of menstrual poverty in resource-poor settings: A qualitative study of the experiences of adolescent girls in an informal settlement in Nairobi. Health Care for Women International. doi: 10.1080/07399332.2012.740112
6. Oti, S.O., Mutua, M., Mgomella, G.S., Egondi, T., Ezeh, A., & Kyobutungi, C. (2013). HIV mortality in urban slums of Nairobi, Kenya 2003-2010: A period effect analysis. BMC Public Health, 13:588. Doi: 10.1186/1471-2458-13-588
7. Ngugi, A.K., Bottomley, C., Scott, J.A.G., Mung’ala–Odera, V., Bauni, E., Sander, J.W., Kleinschmidt., Newton, C.R. (2013). Incidence of convulsive epilepsy in a rural area in Kenya. Epilepsia, 1–8. Doi: 10.1111/epi.12236
2013 Calendar of Events: July - September
Date July 8-12, 2013 July 15-17, 2013 July 22-24, 2013 July 31, 2013 Event ADDRF Scientific Writing Workshop, Hilton Hotel, Nairobi ADDRF Symposium for Emerging Scholars in Health, Hilton Hotel, Nairobi Successful Research Grant Writing workshop, Southern Sun Mayfair Hotel, Nairobi Dissemination of the findings of the External evaluation of the Partnerships for Public Education Program in Uganda (PPEP), Uganda July 29-August 22, 2013 August/ September August 1-7, 2013 August 5-9, 2013 CARTA JAS 3 cohort 1, International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria E2A Dissemination of Health Extension Workers Report, Ethiopia Breastfeeding week, Panafric Hotel, Nairobi A Five-member Gates Urban Health Project Team drawn from UWB and SSU undertook a DSS crosssite and capacity building visit to ISSP’s Ouagadougou Urban DSS in Burkina Faso. Institut Supérieur des Sciences de la Population (ISSP), University of Ouagadougou. July-Sept, 2013 Stakeholder meetings on Reproductive Health/Family Planning (RH/FP) Indicators, (Ghana, Kenya, Nigeria, Uganda & Zimbabwe) August 9-14, ECSA Health Community Directors Joint Consultative 2013 Committee (DJCC) and the Best Practices Forum (BPF) Meeting, Ngurdoto Mountain Lodge, Arusha, Tanzania Date August 20, 2013 August 21, 2013 August 2631, 2013 September 9, 2013 September 10-11, 2013 September 12-14, 2013 September 12-14, 2013 September 16, 2013 September 16-18, 2013 September, 2013 Event NCD Knowledge Sharing Network launch, Hilton Hotel, Nairobi Incidence and Complications of Unsafe Abortion study main dissemination, Hilton Hotel, Nairobi 27th IUSSP International Population Conference, Busan, Republic of Korea JAS 4 planning meeting, Hilton Hotel, Nairobi CARTA SIDA Results-Based Management Training, Hilton Hotel, Nairobi Kenya Country Profile Report on Unintended Pregnancy Validation workshop, Enashipai, Naivasha CARTA Partners Forum & Board of Management meeting; selection of cohort 4, Hilton Hotel, Nairobi International Epidemiological Association - African Epidemiological Federation (IEA-AEF), APHRC Campus, Nairobi CARTA Faculty & Administrators Workshop IV, Hilton Hotel, Nairobi Dissemination of research on ‘Understanding the Dynamics of Access, Transition and Quality of Education in Urban Areas’, Kenya Institute of Education, Nairobi
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APHRC staff get insight from WellTold Story experts on what good communication is all about at the APHRC Campus on May 8, 2013.
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ADDRF fellows at a Methodology workshop at the Hilton Hotel, Nairobi on May 23, 2013.
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Senior staff from the William and Flora Hewlett Foundation pay a courtesy call at the Korogocho Chief’s office (Mr. Nyabuto Omache, second from left) on May 30, 2013. Signing the visitors’ book is Ruth Levine, the Director of the William and Flora Hewlett Foundation Global Development and Population Program. Looking on is the William and Flora Hewlett Foundation President, Larry Kramer (second from right), Eric Brown, the Foundation’s Communications Director, Peter Nyongesa (Community Liaison Officer, APHRC) and the Korogocho Community Advisory Committee Chairperson, Joseph Gathu.
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Staff from various INDEPTH sites at a Translating Research to Policy workshop on June 12, 2013.
Staff Updates
New Staff
Maharouf Oyolola – Associate Research Scientist Naomi Makokha – Program Assistant Njora Hungi – Research Scientist Pamela Juma – Postdoctoral Fellow Pauline Bakibinga – Postdoctoral Fellow
Departures
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APHRC researcher, Nicholas Ngomi (Center) participates at the Brown International Advanced Research Institute (BIARI) on Population & Development Brown University Providence, USA (June 12, 2013).
Akinsewa Akiode Deborah Mupusi
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Editorial Team: Benta Abuya | Blessing Mberu | Catherine Kyobutungi | Diana Warira | Eric Mbugua | Jessica Brinton | Joyce Mumah | Martin Njaga l Ruthpearl Ng’ang’a l Samuel Oti l To Subscribe, Contact: The Communications Manager, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box 10787-00100 Nairobi, Kenya Tel: +254 (020) 4001000, 266 2244, or 266 2255 Mob: +254 722 205 933, 733 410 102. Email: [email protected] | www.aphrc.org
April - June, 2013 Volume 11 Issue 1
The Newsletter of the African Population and Health Research Center
Wanted: A Development Data Revolution
in this issue
P3 P4
A field worker collects Demographic Surveillance data at Korogocho informal settlement.
Celebrating 50 Years and a new Working Group on Aging and Demographic Dividend at the African Union
Founding Fathers A Visit to the Center 13 Years On
P6 P9
Are Implants the Future of Family Planning in Burundi?
T
he much awaited ‘Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda’ is now available. It calls for a Data Revolution, “a new international initiative to improve the quality of statistics and information available to citizens”, that would take advantage of new technologies and big data platforms to track progress towards development goals.
critical information, improving data availability, and ensuring that the needed baseline information is in place to adequately measure and define progress against established development goals. The report’s focus on data as a cornerstone of the panel’s suggestions for post-2015 development goals is promising. Furthermore, its release in the week of the second APHRCCGD Data for African Development Working Group meeting (May 30-31, 2013) couldn’t be timelier. The Data for African Development Working Group (DFAD), co-chaired by Alex Ezeh from the African Population and Health Research Center (APHRC) and Amanda Glassman with
Investing in Education for the Urban Poor, Jubilee Education Fund
Plus
It envisions a Global Partnership on Development Data supported by a wide variety of data stakeholders - including country national statistics offices, the private sector, civil society, and international organizations - responsible for developing strategy to address gaps in
The APHRC Miracle in a Phenomenal Research Journey Public-Private Partnership Takes Off: Health Facility to Get Facelift in Korogocho Slum Publications Calender of Events Staff Updates
Mission: To be a global center of excellence, consistently generating and delivering relevant scientific evidence for policy and action on population, health, and education in Africa.
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NEWS
the Center for Global Development (CGD), is currently developing recommendations specifically to improve development data from Africa – a region of the world known for variable and often low quality development statistics. Alex Ezeh, APHRC Executive Director, commenting on the report explained that, “We cannot hope to achieve the new post 2015 development goals without finally addressing the issue of development data in Africa.” Dr. Ezeh commended the emphasis on data in the new High Level Panel Report, but urged global leaders to take seriously the implications of the quality of development data and the forthcoming Working Group recommendations if they are to place a very real emphasis on investing in high quality data, and eliminate the hurdles to achieving a true data revolution.
International data is great for cross-country comparability, but it often doesn’t meet the needs of policymakers at the country or local level
explained Amanda Glassman, CGD Director of Global Health Policy and Senior Fellow. T h e D FA D Wo r k i n g G ro u p recommendations, to be released later this year, will provide the tangible next steps key development audiences need to take to achieve the muchneeded Data Revolution in Africa.
What does a Data Revolution Actually Mean?
Some development practitioners will advocate for more data, a lot more. Others will argue there is already much data collection occurring, but not of the right kind. Some experts will suggest we should rely primarily on internationally collected development statistics, and encourage more development partner involvement. Others will suggest that country-developed statistics should be used as the gold standard, and countries should lead in their own data priority setting and production. Meanwhile folks on the Open Data bandwagon would say open access to data is the key. The DFAD Working Group has been examining these perspectives as it has worked through defining the limitations and potential opportunities for improvement of national statistics. “Our Working Group aims to develop recommendations that provide solutions for how best to tackle political economy challenges negatively impacting the quality of development data in Africa,”
Working Group Thoughts
Although the Working Group recommendations on these critical data issues are still in development, the diverse group of Working Group experts – including country reps, donors, and international institutions - had varying opinions on every issue debated, some major discussion synergies included: International data is great for cross-country comparability, but it often doesn’t meet the needs of policymakers at the country or local level. Quality and timeliness of GDP and other development measures have been a concern in recent years. DFAD research shows systematic discrepancies between survey and administrative data. One way forward is for donors, NSOs, and line ministries to align to a new system of norms and standards enforcement— for example national surveys might consider including a small set of questions to validate key administrative data.
Countries should be the primary sources of development data, but there are significant challenges limiting the quality, accuracy, and timeliness of country produced statistics and the data validation processes in many African countries. NSO autonomy and independence is necessary to ensure freedom from political interference, allow for professional independence of NSO staff and management (including aspects such as salary scale, retention), and to support NSO capacity building. Enhanced autonomy does not mean that an NSO would be entirely independent of Government, but that parastatal or société privée status (reporting to Presidency or home ministry), would allow the offices to operate independently and effectively. Investments in statistical office capacity and increasing NSO autonomy could help with project/priority management, staff recruitment and retention, and covering even budget needs thereby increasing the quality and timeliness of country produced data. Open data is a good tool to improve data access and use, but it is not a silver bullet. And while increasingly greater amounts of data are being collected and analyzed, there are dually major gaps in data accessibility and the quality of data when it is accessible. Open data can be used to promote data and workload sharing, ensure greater accountability and use of nationally produced data, and to promote innovation. This article was co-authored by Dr. Alex Ezeh and Jessica Brinton
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PROGRAM UPDATE
Celebrating 50 Years and a new Working Group on Aging and Demographic Dividend at the African Union
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he African Union (AU), which recently celebrated its 50th anniversary, kicked off its next 50 years by coconvening the first meeting of the new Aging, Food and Nutrition Security and Demographic Dividend in Africa Working Group. The Group is convened by the African Union, the African Population and Health Research Center (APHRC) and the United Nations Economic Commission for Africa (UNECA). Over the two-day preliminary meeting (June 6-7, 2013), the expert group explored linkages between Africa’s older population and achieving a demographic dividend in Africa. Bringing
together a wide variety of expertise ranging from government to aging and population, migration, agriculture and youth, participants deliberated the overall concept of the Working Group. The Working Group members determined how to establish what evidence is needed to fill the research gaps in this area and which specific policy approaches and models are most appropriate and effective to harness the potential of older populations in Africa. The group also discussed how to explain and show key stakeholders the impact older people
in African countries might have, both for the parameters of achieving a first demographic dividend and the types of policy approaches that will be needed to attain it. The Working Group secretariat is now tasked with completing several research products determined by the group ahead of the next Working Group meeting which will be held at the APHRC Campus in early 2014. The Working Group will officially launch later this year. More detailed information and a list of Working Group members and organizations is available at www.aphrc.org.
The Working Group members determined how to establish what evidence is needed to fill the research gaps in this area and which specific policy approaches and models are most appropriate and effective to harness the potential of older populations in Africa
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Founding Fathers A Visit to the Center 13 Years On
John Bongaarts and John Cleland were both members of the APHRC Advisory Board under the Population Council, while Anrudh Jain was the Vice President of the Population Council responsible for International Programs Division where APHRC was attached.
T
o fully understand APHRC, it is important to understand its founders who just happen to be some of world’s the leading population research experts. Three founding partners, John Bongaarts, John Cleland and Anrudh Jain, visited the APHRC Campus for an afternoon cocktail, following the 2013 International Union for the Scientific Study of Population (IUSSP) seminar on Unmet Need in Nanyuki on May 14-17, 2013. John Bongaarts and John Cleland, who were both members of the APHRC Advisory Board when APHRC was still under the Population Council; and Anrudh Jain, who was the Vice President of the Population Council responsible for International Programs Division where APHRC was originally nested, shared with staff how the Center’s journey started in the early years.
Dr. Ezeh then invited Anrudh Jain, John Bongaarts and John Cleland to share some remarks on the history of APHRC.
Dr. Alex Ezeh, the Executive Director at APHRC, thanked Jain, Bongaarts and Cleland for their vision for APHRC in those early days. “There are two distinguished people here who were on the APHRC advisory board under the Population Council. When I came to the Center, part of the attraction was the vision they had for the Center, the people they were working with and had connections to; who actually are the best minds we have in the field. I believed if the Center had any chance of success, it would be under the guidance and leadership of these eminent scholars, and it would be good to try. They played a significant role in the transition of the Center from a program of the Population Council to becoming an independent entity. I really want to appreciate Anrudh Jain, John Bongaarts and John Cleland for the work they did in laying the foundation for what APHRC is today.”
Anrudh Jain : “I have been reminiscing about t h e C e n t e r ’s h i s t o r y since I came to Nairobi. The Population Council had been interested in developing institutions around the world, Africa was developing and we had worked with many universities’ population studies centers. For instance, we were working with the PSRI (Population Studies and Research Institute) here in Nairobi. The idea of APHRC was born out of a meeting between Steven Sinding, Sarah Seims and Cheikh Mbacké from the Rockefeller Foundation, and Ayo Ajayi and I from the Population Council.” The Rockefeller Foundation challenged us to develop a center that would be sustainable and that would do policy-relevant research because the university-based centers were not conducting this kind of research. We therefore set out to explore how such a center could be developed and that is how the Center was born! We received an initial grant for 5 years, and right from the beginning, although it was a part of the Population Council, it created its own identity as APHRC. Coming here today, I was grinning with pride. All the credit here goes to Alex Ezeh and his staff that we now have a sustainable research center that is producing policy-relevant research on population, urban health and other areas.”
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NEWS
I really want to appreciate Anrudh Jain, John Bongaarts and John Cleland for the work they did in laying the foundation for what APHRC is today..... To be honest, I think the credit goes to every single staff member of APHRC; the type of commitment they’ve shown over the years
John Cleland: “One of the tussles in those early days was between the focus on population and family planning and the breadth of other interests. I think you got it right by broadening out into health, urbanization and education. I think the big issue for you now is how much broader do you get. Will you take Economics really seriously? How about international migration, is that part of population dynamics? It’s a very important issue and an area where not a lot of good research is being undertaken. I think that this would be an ideal setting [to do that research] if you got a chunk of good technical demographers at APHRC. Well done Alex, well done APHRC.”
Dr. Ezeh closed with some kind words about all APHRC staff. “To be honest, I think the credit goes to every single staff member of APHRC and the type of commitment they’ve shown over the years. You can come here on a Saturday and you will still find people working! The staff is selfmotivated and driven and that is really what has led to the growth and success that the Center has achieved over the years. That is in addition to the support from our many partners. We appreciate all the opportunities we’ve had to collaborate and partner and this is something we pay a lot of attention to as it’s one of the ways in which we’ve been able to grow our work here at APHRC.”
John Bongaarts: “I still remember what dreams we had in the 90s. The start of APHRC was a little rocky, but all that changed when you (Alex) arrived in 1998. Since then I see every one of the board members’ expectations met and I think you get much of the credit for that, so congratulations!”
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OPINION
Are Implants the Future of Family Planning in Burundi?
Dr. Namuunda Mutombo, Associate Research Scientist
W
ith a population density of more than 300 persons per square kilometer, coupled with high poverty levels, a high fertility rate and a high unmet need for family planning, there is a glaring need for Burundi to avail birth control methods to its population in order to attain sustainable development. In addressing these challenges, the Government of Burundi in conjunction with the United States Government developed the Global Health Initiative Strategy (2011-2015). One of the key interventions in this strategy is the promotion of voluntary family planning through provision of information and a variety of family planning methods so that individuals can make informed decisions regarding family planning. Earlier in 2010 and in line with the principle of increasing choices among family planning clients, the Government of Burundi introduced Jadelle, also known as Levonorgestrel Implants, in many health facilities across the country. These implants have proven to be quite effective in preventing pregnancy -- evidence shows that only up to 1 percent of women using them can conceive over a period of five years.
...the Ministry of Health in Burundi could not introduce the Jadelle implant services to all health facilities in the country and hence the initiative left out two provinces (Kayanza and Muyinga) of which Kayanza has the highest population density in the country. In order to complement the government effort, the African Population and Health Research Center through the Evidence to Action Program (E2A) moved in to facilitate provision of the Jadelle implant in these two provinces to fill the existing gap
Implant Availability for All?
In 2009, the Burundi government introduced the use of the Jadelle implant in 15 provinces through the Ministry of Health Maternal and Child Health (MCH) program. However, owing to limited resources, the Ministry of Health in Burundi could not introduce the Jadelle implant services to all health facilities in the country and hence the initiative left out two provinces (Kayanza and Muyinga) of which Kayanza has the highest population density in the country. In order to complement the government effort, the African Population and Health Research Center through the Evidence to Action Program (E2A) moved in to facilitate provision of the Jadelle implant in these two provinces to fill the existing gap. The E2A Implant Implementation Project worked to provide technical assistance to the public sector family planning programs with the ultimate goal of increasing the number of community and facility family planning sites and users within the two provinces in Burundi. This technical assistance included training service providers and managers in family planning services and counseling.
A woman seeks family planning advice at a health center in Burundi.
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Implementing Implants
The first step to fully integrating implants into the family planning services offered in Burundi was to assist the Ministry of Health to develop national guidelines and protocols for family planning and reproductive health programs that included implants and the finalization of the national policy on community-based distribution of contraceptives. The second step was to train a group of trainers in Bujumbura. These trainers were selected from Kayanza, Muyinga and three other provinces (Gitega, Makamba and Ruyigi) where Jadelle implants had been introduced by the Ministry of Health. These trainers later taught service providers in both Kayanza and Muyinga Provinces using selected practicum sites. Providing Jadelle implant services at the study sites started in September 2012 and continues today.
OPINION
available shows that after just five months of availability, Jadelle Implants emerged as the third most accepted family planning method after injectables (60.6%) and oral pills (16%). In fact, 13.2% of women accessing family planning methods chose the implant method. Other less popular methods included the intra-uterine device (IUD) (8.3%), condom (1.7%) and the natural family planning method (0.2%). In many health centers, Jadelle implants are already the second most used method after injectables as many clients find it more convenient compared to oral pills. Many service providers found that most family planning clients prefer to “experiment” first with injectables before accepting implants. This means that there is great potential for the method and with an increased number of health facilities that can offer an expanded method mix that includes Jadelle, the method could be one of the most used methods in the two regions. Provinces, the Catholic Church, which is the dominant denomination, discourages women from using artificial family planning methods. Furthermore, pro-natalists and other traditionalists are spreading incorrect information about implants. These include claims that Jadelle implants cause health problems such as cancer and that the implants can move through the veins from the arm to the brain.
What Next?
The evidence we are seeing in Burundi shows the importance of providing family planning clients with a wide choice of methods, which is a key reproductive health right. There is no doubt that scaling up the availability of the implants, coupled with providing appropriate information to potential users and counteracting myths and misinformation will result in improved healthy spacing and timing of pregnancies in Burundi. This development will ultimately improve the health of women and we are likely to see improvements in a range of reproductive health indicators that will help guarantee sustainable economic development in the region. Beyond the work being done by this specific project (E2A), the Ministry of Health in Burundi should work to ensure adequate supply of FP commodities, training and re-training of FP service providers and provision of information on the importance of family planning—and make sure to include the implant option. Lessons from Burundi should also be shared with other African countries facing similar population challenges so that all countries in the African region can fully benefit from the anticipated demographic dividend. The APHRC Evidence to Action for Strengthened RH for Women and Girls (E2A) Project is implemented in partnership with Pathfinder International-Burundi.
Good News for Family Planning in Burundi?
A review of the clinical records of the women who have been visiting the sites for the past year where the new family planning implant method has been
Pushback and Myths
Acceptance of implants is however, being threatened by propaganda against the method. In both Kayanza and Muyinga
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RESEARCH CAPACITY STRENGTHENING
APHRC and My Phenomenal Research Journey
Chidozie Emmanuel Mbada, ADDRF Fellow
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hen I reflect on my PhD research journey, I realize it has been a remarkable one. The African Population and Health Research Centre (APHRC) through the African Doctoral Dissertation Research Fellowship (ADDRF) program has contributed in no mean measure to this. My testimony is evidence that the ADDRF program has achieved its objective to support the training and retention of highly-skilled, locally-trained scholars in research and academic positions across Africa.
My PhD research journey with ADDRF started with an application in 2010. I thought the successful enlistment in the 3rd cohort of the ADDRF was the best thing that could ever happen to me; little did I know that it was just the beginning of good things. The ADDRF workshops on research methodology and scientific writing provided me with the opportunity for training, intellectual networking and exposure. I became a fellow in 2010 with only 20 publications accumulated over a 3-year period. I was the lead author in 20% of those publications. After the workshops, my research acumen and writing skills took a quantum leap. In less than two years, the number of my publications has tripled with more articles in international peer-
To quote Sir Isaac Newton, “If I have seen farther, it is by standing on the shoulders of giants.” ADDRF is the giant on whose shoulders I stand!
reviewed journals. I am the lead author in more than 80% of those articles. In addition, I took the 2nd prize in the Postgraduate School Award for the Best PhD Thesis in the University of Ibadan, Nigeria, in 2012. I was also a recipient of the Postgraduate School Award for Publication of Articles from PhD Theses in the University of Ibadan, 2011/2012 session. As a result of this background, as a university lecturer in physiotherapy, I was assigned to teach research methodology to undergraduate and postgraduate students
respectively. My undergraduate research supervisees had the best research projects on the external examiners’ rating and overall scores in the last three consecutive academic sessions. Generally, the ADDRF program has contributed immensely to my research capacity and writing skills; provided publishing opportunities and kept me updated on current trends in health research and information-sharing platforms. It also provided me with opportunities to network with junior research fellows in Africa. Finally, the ADDRF program offered me funding opportunities for research and the exposure that comes with international travel. Ultimately, I thank God for the opportunity to be an ADDRF fellow. To quote Sir Isaac Newton “If I have seen farther, it is by standing on the shoulders of giants.” ADDRF is the giant on whose shoulders I stand! Chidozie Emmanuel Mbada is a lecturer in Physiotherapy at Obafemi Awolowo University in Nigeria in the department of Medical Rehabilitation. He holds a PhD from Obafemi Awolowo University, Nigeria where he conducted research on Comparative Efficacy of Static and Dynamic Endurance Training of Back Extensor Muscles in the Management of Patients with Non-Specific LongTerm Low-Back Pain. Entry date into ADDRF: May 2010 Graduation date: September 2012
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Investing in Education for the Urban Poor Jubilee Education Fund
PROGRAM UPDATE
their secondary education. The other ten are in their third year in different secondary schools within Kenya. An addition to the Center’s social responsibility is the Jubilee Education Fund, established in 2012 to facilitate the transition of students from poor families to secondary school. The program seeks to fund 25 day and 25 boarding students, a feat that requires up to KES 9.25 million ($115,625) over the next 5 years. So far, the fund has raised Kshs.1.3 million and 8 students have been identified for the awarding of scholarships (3 in Korogocho, 3 in Viwandani (Nairobi County) and 2 in Cheleta primary school (Kiambu County). To be selected, the students must attain a minimum of 310 marks at the Kenya Certificate of Primary School Education (KCPE) and hail from low-income family backgrounds. APHRC continues to investigate education challenges in subSaharan Africa through its Education Research Program with the aim of informing policy. As part of its research, the program is focusing on barriers to accessing quality basic education under universal basic education policies, including transition to secondary schooling among marginalized populations in urban contexts. The Jubilee Education Fund was established in honor of APHRC’s Executive Director Dr. Alex Ezeh, on his 50th Birthday.
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Mrs. Nkee Ezeh, founder of the Jubilee Education Fund (second from left) presents a cheque to one of the Fund’s beneficiaries, Ben Agote from Cheleta Primary School in Githunguri slum, Nairobi. Looking on is Ben’s father, Tom Ingolo (extreme right), the headmaster Cheleta Primary School, Mr. Stanley Mukururo (center) and Salma Musa from APHRC (extreme left).
ince 2007, APHRC has, as part of its corporate social responsibility, supported bright students from disadvantaged backgrounds to access secondary education. This has been in partnership with committed APHRC staff and like-minded organizations such as The Hindu Religious and Service Center among others. So far, APHRC has awarded bursaries to 13 students, three of whom have already completed
Public-Private Partnership Takes Off Health Facility to Get Facelift in Korogocho Slum
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n May 21, 2013, APHRC’s Partnerships for Maternal, Newborn and Child Health (PAMANECH) initiative signed a Memorandum of Understanding (MoU) with Jahmii Kipawa Medical Center and TRIAD Architects to facilitate the upgrading of the health center.
Jahmii Kipawa Medical Center is a health facility that provides maternal health services in both Kariobangi and Korogocho areas of Kasarani District. Following a rigorous selection exercise, the health center was among those nominated by the Kasarani District Health Management Team (DHMT) for upgrading. The upgrading comprises of improvement of the health facility’s building structures, provision of equipment and training support. Jahmii Kipawa Medical Center is housed in a two-storied building that will
require renovation and construction of additional rooms to enable better provision of maternal, newborn and child services. This will include, but not limited to, completion of maternity wards, kitchen, washrooms, roofing, improving staircase accessibility and construction of an incinerator. Representatives from the various organizations included Mr. Joseph Gichuru, the director of operations at APHRC and Mr Patrick Waiganjo who is the director of Jahmii Kipawa Medical Center. Witnessing the signing was Dr. Moses Owino, the Kasarani District Medical Officer of Health and Mr. Joseph Gathu, the community representative and chairman of the Korogocho residents committee.
Present at the signing ceremony were the TRIAD Architects, an architectural firm that will work with APHRC to upgrade the medical center. They will develop and standardize procedures of operations and provide technical architectural expertise, pro bono, as part of their corporate social responsibility. Heritage Associates Ltd will take up consultancy services in the design and management of construction activities in the other selected heath facilities, which include Tumaini Health Center, Provide International Health Center (both in Korogocho) and Cana Familycare (in Viwandani) among others. The designs will be approved by the Nairobi County government and the Kasarani DHMTs. The signing of the MOUs paved the way for the commencement of the next phase of the PAMANECH initiative, which aims at improving health service delivery for mothers, newborns and young children.
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OPINION
Running out of Time to Apprehend a Killer Controlling Hypertension
Dr. Samuel Oti, Senior Research Officer
H
ypertension is increasingly becoming a serious health problem across the world, especially in developing countries like Kenya. It is believed that one out of every three adults in the world could be hypertensive. In Kenya, it is estimated that up to 40 percent of the adult population could be hypertensive though there is limited data since no national survey has been conducted yet to establish the exact levels of hypertension. And that is where the tragedy lies.
In other words, you could look perfectly healthy and be walking around with a very high blood pressure for many years. Then suddenly, you fall seriously ill and perhaps even drop dead. The bad news is that the exact cause of hypertension is usually not known in majority of cases. However, the good news is that hypertension is both treatable and preventable. There are certain risky health behaviors that have been associated with increasing one’s chances of getting hypertension. For example, people who are in the habit of consuming high amounts of salt (by adding excessive salt to their meals) are at high risk. Also, you may be at risk of getting hypertension if you smoke tobacco, consume excessive amounts of alcohol, don’t exercise regularly or eat a lot of ‘junk food’ (food that is of little nutritional value and often high in fat, sugar, salt, and calories). Therefore, avoiding these risky behaviors could save your life. Additionally, it is advisable that every adult, particularly those above 35 years, get screened at least once a year for hypertension. The condition can be controlled by changing one’s lifestyle, for example by minimizing the risky behaviors mentioned above but in some cases, medication is required to bring the pressure down.
what is known as a “double burden of disease” whereby communicable diseases like HIV and non-communicable conditions like hypertension will continue to claim the lives of our people. We need to raise awareness about hypertension in our society. The need for mass awareness campaigns to educate the citizenry about the dangers of hypertension and the need to be screened regularly is now more urgent that ever. We must make screening for hypertension available, accessible and affordable to all Kenyans. There is no reason why any primary healthcare center in Kenya should not have functional blood-pressure measuring devices. These devices are affordable and now, there are modern versions that do not need highly skilled health personnel such as doctors to operate them. We m u s t a l s o e n s u re t h a t a n t i hypertensive medications are made widely available. There are generic forms of these medications that are quite affordable. Unfortunately, the current policy of the Ministry of Health is to supply such medication to district hospitals only. In other words, primary health centers and dispensaries, which are closer to ordinary people, do not stock the medications. The time for the government (and you) to act is now. APHRC has developed and is implementing a cost-effective, sustainable and scalable community-based model to effectively address cardiovascular diseases in urban slums by focusing on both treatment and prevention. (SCALE UP - Sustainable model for Cardiovascular health by Adjusting Lifestyle and treatment with Economic perspective in settings of Urban Poverty).
Hypertension refers to a condition in which the blood pressure of an individual is unusually high. Each time the human heart beats, blood is pumped through blood vessels known as arteries to supply the entire body with oxygen and nutrients –both of which are essential for the normal functioning of the human body. High blood pressure occurs when there is increased resistance to this normal flow of blood through the arteries. This may be a result of different factors especially increased rigidity of the blood vessels and increased blood volume. Blood pressure can be measured by simple machines specially made for that purpose. The digital age has ushered in models that will measure your blood pressure at the click of a button and display it on a small screen. These have almost replaced older models that required specialized training and use of a stethoscope.
Silent Killer
Hypertension is a very dangerous condition for two main reasons. First, if left untreated, it can lead to a heart attack, stroke, kidney failure and eventually death. However, what makes hypertension even deadlier is that it usually has no clear-cut symptoms hence it is referred to as a “silent killer”.
Double Burden of Disease
In Kenya, emphasis has often been on communicable diseases like HIV/AIDS, tuberculosis and malaria. These are very important diseases that have posed serious threats to our health systems. However, we cannot ignore other emerging non-communicable health threats like hypertension or we risk being faced with
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List of Publications
1. Egondi, T., Beguy, D., Kanyiva, M., Kabiru, C., & Jessor, R. (2013). Adolescent home-leaving and the transition to adulthood: A psychosocial and behavioral study in the slums of Nairobi. International Journal of Behavioral Development, 37(3). Doi: 10.1177/0165025413479299 4. Beguy, D., Ndugwa, R., & Kabiru, C.W. (2013). Entry into motherhood among adolescent girls in two informal settlements in Nairobi, Kenya. Journal of Biosocial Science, 1-22.Doi: http://dx.doi.org/10.1017/S0021932013000199 5. Xu, H., Mberu, B.U., Goldberg, R.E., & Luke, N. (2013). Dimensions of rural-to-urban migration and premarital pregnancy in Kenya. ANNALS of the American Academy of Political and Social Science, 648, July 2013
2. Onsomu, E.O., Kimani, J.K., Abuya, B. A., Arif, A.A., Moore, D., Duren-Winfield, V., & Harwell, G. (2013). Delaying sexual debut as a strategy for reducing HIV epidemic in Kenya. African Journal of Reproductive Health, 17(2), 46-57
3. Crichton, J., Okal, J., Kabiru, C.W., & Zulu, E.M. (2013). Emotional and psychosocial aspects of menstrual poverty in resource-poor settings: A qualitative study of the experiences of adolescent girls in an informal settlement in Nairobi. Health Care for Women International. doi: 10.1080/07399332.2012.740112
6. Oti, S.O., Mutua, M., Mgomella, G.S., Egondi, T., Ezeh, A., & Kyobutungi, C. (2013). HIV mortality in urban slums of Nairobi, Kenya 2003-2010: A period effect analysis. BMC Public Health, 13:588. Doi: 10.1186/1471-2458-13-588
7. Ngugi, A.K., Bottomley, C., Scott, J.A.G., Mung’ala–Odera, V., Bauni, E., Sander, J.W., Kleinschmidt., Newton, C.R. (2013). Incidence of convulsive epilepsy in a rural area in Kenya. Epilepsia, 1–8. Doi: 10.1111/epi.12236
2013 Calendar of Events: July - September
Date July 8-12, 2013 July 15-17, 2013 July 22-24, 2013 July 31, 2013 Event ADDRF Scientific Writing Workshop, Hilton Hotel, Nairobi ADDRF Symposium for Emerging Scholars in Health, Hilton Hotel, Nairobi Successful Research Grant Writing workshop, Southern Sun Mayfair Hotel, Nairobi Dissemination of the findings of the External evaluation of the Partnerships for Public Education Program in Uganda (PPEP), Uganda July 29-August 22, 2013 August/ September August 1-7, 2013 August 5-9, 2013 CARTA JAS 3 cohort 1, International Institute of Tropical Agriculture (IITA), Ibadan, Nigeria E2A Dissemination of Health Extension Workers Report, Ethiopia Breastfeeding week, Panafric Hotel, Nairobi A Five-member Gates Urban Health Project Team drawn from UWB and SSU undertook a DSS crosssite and capacity building visit to ISSP’s Ouagadougou Urban DSS in Burkina Faso. Institut Supérieur des Sciences de la Population (ISSP), University of Ouagadougou. July-Sept, 2013 Stakeholder meetings on Reproductive Health/Family Planning (RH/FP) Indicators, (Ghana, Kenya, Nigeria, Uganda & Zimbabwe) August 9-14, ECSA Health Community Directors Joint Consultative 2013 Committee (DJCC) and the Best Practices Forum (BPF) Meeting, Ngurdoto Mountain Lodge, Arusha, Tanzania Date August 20, 2013 August 21, 2013 August 2631, 2013 September 9, 2013 September 10-11, 2013 September 12-14, 2013 September 12-14, 2013 September 16, 2013 September 16-18, 2013 September, 2013 Event NCD Knowledge Sharing Network launch, Hilton Hotel, Nairobi Incidence and Complications of Unsafe Abortion study main dissemination, Hilton Hotel, Nairobi 27th IUSSP International Population Conference, Busan, Republic of Korea JAS 4 planning meeting, Hilton Hotel, Nairobi CARTA SIDA Results-Based Management Training, Hilton Hotel, Nairobi Kenya Country Profile Report on Unintended Pregnancy Validation workshop, Enashipai, Naivasha CARTA Partners Forum & Board of Management meeting; selection of cohort 4, Hilton Hotel, Nairobi International Epidemiological Association - African Epidemiological Federation (IEA-AEF), APHRC Campus, Nairobi CARTA Faculty & Administrators Workshop IV, Hilton Hotel, Nairobi Dissemination of research on ‘Understanding the Dynamics of Access, Transition and Quality of Education in Urban Areas’, Kenya Institute of Education, Nairobi
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1
APHRC staff get insight from WellTold Story experts on what good communication is all about at the APHRC Campus on May 8, 2013.
2
ADDRF fellows at a Methodology workshop at the Hilton Hotel, Nairobi on May 23, 2013.
3
Senior staff from the William and Flora Hewlett Foundation pay a courtesy call at the Korogocho Chief’s office (Mr. Nyabuto Omache, second from left) on May 30, 2013. Signing the visitors’ book is Ruth Levine, the Director of the William and Flora Hewlett Foundation Global Development and Population Program. Looking on is the William and Flora Hewlett Foundation President, Larry Kramer (second from right), Eric Brown, the Foundation’s Communications Director, Peter Nyongesa (Community Liaison Officer, APHRC) and the Korogocho Community Advisory Committee Chairperson, Joseph Gathu.
4
Staff from various INDEPTH sites at a Translating Research to Policy workshop on June 12, 2013.
Staff Updates
New Staff
Maharouf Oyolola – Associate Research Scientist Naomi Makokha – Program Assistant Njora Hungi – Research Scientist Pamela Juma – Postdoctoral Fellow Pauline Bakibinga – Postdoctoral Fellow
Departures
5
APHRC researcher, Nicholas Ngomi (Center) participates at the Brown International Advanced Research Institute (BIARI) on Population & Development Brown University Providence, USA (June 12, 2013).
Akinsewa Akiode Deborah Mupusi
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Editorial Team: Benta Abuya | Blessing Mberu | Catherine Kyobutungi | Diana Warira | Eric Mbugua | Jessica Brinton | Joyce Mumah | Martin Njaga l Ruthpearl Ng’ang’a l Samuel Oti l To Subscribe, Contact: The Communications Manager, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box 10787-00100 Nairobi, Kenya Tel: +254 (020) 4001000, 266 2244, or 266 2255 Mob: +254 722 205 933, 733 410 102. Email: [email protected] | www.aphrc.org
