Adolescent Fertility Is Lower than Expected in Rural Areas: Results from 10 African HDSS.

The adolescent birth rate (ABR) is an important indicator of maternal health, adolescent sexual health, and gender equity; it remains high in sub-Saharan Africa. While Demographic and Health Surveys (DHS) are the main source of ABR estimates, Health and Demographic Surveillance Systems (HDSS) also produce ABRs. Studies are lacking, however, to assess the ease of access and accuracy of HDSS ABR measures.

Planning a family in Nairobi's informal settlements: results of a qualitative study.

Childbearing intentions among women in high-fertility contexts are usually classified into those wanting to have a baby, those wanting to 'space' a birth and those wanting to 'limit' their family size. However, evidence from Africa increasingly suggests that women's intentions are more complex than this classification suggests, and that there is fluidity in these intentions. This research explores women's accounts of their childbearing intentions and decisions in order to examine how this fluidity plays out in a low-fertility context in urban Africa.

Association between internal migration and epidemic dynamics: an analysis of cause-specific mortality in Kenya and South Africa using health and demographic surveillance data.

Background: Many low- and middle-income countries are facing a double burden of disease with persisting high levels of infectious disease, and an increasing prevalence of non-communicable disease (NCD). Within these settings, complex processes and transitions concerning health and population are underway, altering population dynamics and patterns of disease. Understanding the mechanisms through which changing socioeconomic and environmental contexts may influence health is central to developing appropriate public health policy.

Measuring extended families over time in informal settlements in Nairobi, Kenya: Retention and data consistency in a two-round survey.

Background: Researchers have increasingly turned to longitudinal data to understand how the family environment of children changes over time and how this change affects their well-being. While the value of such efforts is clear, the inherent challenges of collecting robust data over time may limit or bias our understanding of family complexity.

Objective: Drawing on data from an exploratory study on kinship structure and support for low income single mothers and their young children in Nairobi, Kenya, this paper aims to (1) assess the strengths and weaknesses of our approach in reflecting the complexities of kinship dynamics and (2) analyze how methodological issues such as selection and reporting inconsistency can influence our understanding of the role of kin in children's lives.

Who Helps Single Mothers in Nairobi? The Role of Kin Support.

Single mothers often turn to their extended kin for financial assistance and to help with child care. Such support may be especially important in areas of high poverty and poor environmental conditions. Using novel kinship data, this paper assesses the extent of support given by over 3,000 relatives to 462 single mothers living in a slum area of Nairobi, Kenya.

WOMEN'S EDUCATION AND UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A MULTI-COUNTRY AND SOCIOECONOMIC STATUS ANALYSIS.

There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa.

Moving beyond the household: Innovations in data collection on kinship.

Across settings, it has been shown that the co-residential household is an insufficient measure of family structure and support. However, it continues to be the primary means of population data collection. To address this problem, we developed a new instrument, the Kinship Support Tree (KST), to collect kinship structure and support data on co-residential and non-residential kin and tested it on a sample of 462 single mothers and their children in a slum community in Nairobi, Kenya.

Healthy or unhealthy migrants? Identifying internal migration effects on mortality in Africa using health and demographic surveillance systems of the INDEPTH network.

Migration has been hypothesised to be selective on health but this healthy migrant hypothesis has generally been tested at destinations, and for only one type of flow, from deprived to better-off areas. The circulatory nature of migration is rarely accounted for. This study examines the relationship between different types of internal migration and adult mortality in Health and Demographic Surveillance System (HDSS) populations in West, East, and Southern Africa, and asks how the processes of selection, adaptation and propagation explain the migration-mortality relationship experienced in these contexts.

Human capital on the move: Education as a determinant of internal migration in selected INDEPTH surveillance populations in Africa.

Background: Education, as a key indicator of human capital, is considered one of the major determinants of internal migration, with previous studies suggesting that human capital accumulates in urban areas at the expense of rural areas. However, there is fragmentary evidence concerning the educational correlates of internal migration in sub-Saharan Africa.

Objectives: The study questions whether more precise measures of migration in Health and Demographic Surveillance System (HDSS) populations support the hypothesis that migrants are self-selected on human capital and more educated people are more likely to leave rural areas or enter urban areas within a geographical region.

Influence of parental factors on adolescents' transition to first sexual intercourse in Nairobi, Kenya: a longitudinal study.

Background: Several studies have demonstrated a link between young people's sexual behavior and levels of parental monitoring, parent-child communication, and parental discipline in Western countries. However, little is known about this association in African settings, especially among young people living in high poverty settings such as urban slums. The objective of the study was to assess the influence of parental factors (monitoring, communication, and discipline) on the transition to first sexual intercourse among unmarried adolescents living in urban slums in Kenya.

Patterns of fertility preferences and contraceptive behaviour over time: change and continuities among the urban poor in Nairobi, Kenya.

The main objective of this paper is to investigate the association between fertility preferences and contraceptive use among 15-49-year-old women living in Korogocho and Viwandani, informal settlements in Nairobi, Kenya. We draw on longitudinal data collected under the Maternal and Child Health project conducted between 2006 and 2010 in the two settlements. There is substantial regularity and stability but also unusual instability in reported fertility preferences over time among women living in these settings.

Health & Demographic Surveillance System Profile: The Nairobi Urban Health and Demographic Surveillance System (NUHDSS).

The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was the first urban-based longitudinal health and demographic surveillance platform in sub-Saharan Africa (SSA). The NUHDSS was established in 2002 to provide a platform to investigate the long-term social, economic and health consequences of urban residence, and to serve as a primary research tool for intervention and impact evaluation studies focusing on the needs of the urban poor in SSA. Since its inception, the NUHDSS has successfully followed every year a population of about 65,000 individuals in 24,000 households in two slum communities--Korogocho and Viwandani--in Nairobi, Kenya.

Pregnancy-related mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites.

Background: Women continue to die in unacceptably large numbers around the world as a result of pregnancy, particularly in sub-Saharan Africa and Asia. Part of the problem is a lack of accurate, population-based information characterising the issues and informing solutions. Population surveillance sites, such as those operated within the INDEPTH Network, have the potential to contribute to bridging the information gaps.

Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.

Background: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites.

Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.

Background: Because most deaths in Africa and Asia are not well documented, estimates of mortality are often made using scanty data. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering all deaths over time and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.

Understanding inequities in child vaccination rates among the urban poor: evidence from Nairobi and Ouagadougou health and demographic surveillance systems.

Studies on informal settlements in sub-Saharan Africa have questioned the health benefits of urban residence, but this should not suggest that informal settlements (within cities and across cities and/or countries) are homogeneous. They vary in terms of poverty, pollution, overcrowding, criminality, and social exclusion. Moreover, while some informal settlements completely lack public services, others have access to health facilities, sewers, running water, and electricity.

Adverse life events and delinquent behavior among Kenyan adolescents: a cross-sectional study on the protective role of parental monitoring, religiosity, and self-esteem.

Background: Past research provides strong evidence that adverse life events heighten the risk of delinquent behavior among adolescents. Urban informal (slum) settlements in sub-Saharan Africa are marked by extreme adversity. However, the prevalence and consequences of adverse life events as well as protective factors that can mitigate the effects of exposure to these events in slum settlements is largely understudied.

Unintended pregnancies among young women living in urban slums: evidence from a prospective study in Nairobi city, Kenya.

Background: Despite the significant proportion of young people residing in slum communities, little attention has been paid to the sexual and reproductive health (SRH) challenges they face during their transition to adulthood within this harsh environment. Little is known about the extent to which living in extreme environments, like slums, impact SRH outcomes, especially during this key developmental period. This paper aims to fill this research gap by examining the levels of and factors associated with unintended pregnancies among young women aged 15-22 in two informal settlements in Nairobi, Kenya.

The INDEPTH standard population for low- and middle-income countries, 2013.

Crude rates such as the crude death rate are functions of both the age-specific rates and the age composition of a population. However, differences in the age structure between two populations or two time periods can result in specious differences in the corresponding crude rates making direct comparisons between populations or across time inappropriate. Therefore, when comparing crude rates between populations, it is desirable to eliminate or minimize the influence of age composition.

Adolescent home-leaving and the transition to adulthood: A psychosocial and behavioural study in the slums of Nairobi.

Home-leaving is considered an important marker of the transition to adulthood and is usually framed as an individual decision. We move beyond this limited assumption to examine a broader conceptualization that might better illuminate home-leaving among youth in impoverished circumstances. We adopt the Problem Behavior Theory-framework to investigate the association of home-leaving with behavioral and psychosocial variables and with other transitions.

Health and demographic surveillance systems: contributing to an understanding of the dynamics in migration and health.

Background: Migration is difficult to measure because it is highly repeatable. Health and Demographic Surveillance Systems (HDSSs) provide a unique opportunity to study migration as multiple episodes of migration are captured over time. A conceptual framework is needed to show the public health implications of migration.

Entry into motherhood among adolescent girls in two informal settlements in Nairobi, Kenya.

The contribution of adolescents' childbearing to total fertility rates in many sub-Saharan African countries is higher than in other parts of the world. In this paper, data collected from 897 female adolescents aged 15-19 years are analysed to investigate patterns and determinants of entry into motherhood in two informal settlements in Nairobi, Kenya, using Kaplan-Meier estimates and Cox regression models. About 15% of these adolescents have had a child.

Predictors of sexual debut among young adolescents in Nairobi's informal settlements.

Context: There is a need to better understand the various social, psychosocial and behavioral factors associated with sexual activity among young adolescents in various settings in Sub-Saharan Africa.

Methods: Data were drawn from Wave 1 (2007-2008) and Wave 2 (2009) of the Transition to Adulthood study, which collected information about key markers of the transition to adulthood and social, demographic and psychosocial characteristics of male and female youth living in two informal settlements in Nairobi, Kenya. Logistic regression analyses were used to examine variables associated with experience of sexual debut by Wave 2 among youth who were aged 12-16 and sexually inexperienced at Wave 1.