EA-IRES Proposal

Women’s Health in Samburu, Kenya: Social and

Ecological Drivers

Research Proposal

2015-2016 EA-IRES Program

“IRES: Student-Led Social-Ecological Research in the Kenyan Drylands” Project

Samburu County, Kenya

Sara Hines

April 29, 2016

CSU Mentor: Dr. Stacy J. Lynn

University of Nairobi Mentors:

Dr. J.T. Njoka, Dr. M.M. Nyangito, Dr. J.M. Syombua

Sara Hines EA-IRES 2015-2016

2

Research Summary In three villages in Samburu, Kenya, I will talk with local women about their health

concerns. I hope to learn of social and ecological drivers of Samburu women’s health issues, including maternal health, sexually transmitted diseases, malaria, and diarrheal diseases. I will identify the ways in which Samburu women decide whether to consult a traditional healer or a modern dispensary or hospital. After talking with local women, I will compare and contrast perceptions of traditional versus modern medical approaches to treating health conditions. I will present my findings to stakeholders including: Samburu women and Samburu citizens at large, people in governance, traditional medical practitioners, modern medical practitioners, non-governmental organizations, and the research community.

Student Biography Sara is a sophomore studying Ecosystem Science and Sustainability at Colorado State

University. Sara’s biological research experiences and aspirations for environmental justice led her to an interest in ecological research. She looks forward to researching drylands and social-ecological systems in Colorado and Kenya to benefit dryland communities and ecosystems. In her free time, Sara sings with a local acapella group.

This material is based upon work supported by the National

Science Foundation under Grant No. 1460145. Any opinions, findings, and conclusions or recommendations expressed in

this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.


3

Introduction Healthcare has certainly improved over the last century. In the twentieth century,

monumental public health advances were made, particularly in the areas of infectious disease, food safety, maternal and infant mortality, and family planning (CDC 2013). However, there are still serious health concerns. Infectious agents (including Clostridium difficile, Carbapenem-Resistant Enterobacteriaceae, and Neisseria gonorrhoeae—marked as urgent threats by the Centers for Disease Control and Prevention) have developed antibiotic resistance (CDC 2015). Sexually transmitted diseases continue to be a major global concern. Access to modern medical care is still difficult to obtain in many areas. Even in areas where medical care is accessible, it can be expensive. All over the world, it can be difficult to obtain comprehensive, holistic, effective, safe, and patient centered medical care. Though modern medicine is influential in the global mosaic of medical practices, much of the world relies entirely or in part on traditional medicine comprised of spiritual remedies, manual procedures, and plant, animal and mineral medicines (WHO 2003). In 2003, the World Health Organization reported that eighty percent of the African population employs traditional medicine as their primary source of healthcare (WHO 2003). In the Samburu region of Kenya, traditional medical practitioners possess extraordinary knowledge of plant resources which they use to combat ailments ranging from diarrhea to tuberculosis (Fratkin 1996). Still, health threats including infectious diseases, sexually transmitted diseases, and maternal and infant mortality are of major concern in Samburu (Fratkin 1996 and Waweru 2015) largely due to conditions limiting access to reliable care, including the rural and semi-nomadic nature of Samburu pastoralists.

Samburu is a semi-arid county located in the eastern rift valley in Central Kenya. The rift valley experiences highly variable rainfall, with annual precipitation as low as 200 millimeters in some areas, inhibiting predictively productive agriculture (Wakachala et al. 2015). The main economic activity is extensive pastoralism, a land use which allows livestock herders to move across the landscape turning indigestible plant material into animal protein for human consumption (R. Dyson-Hudson and N. Dyson-Hudson 1980). However, even with mobility, severe droughts cause food insecurity—the entire county is classified as food insecure—which puts stress on the health of Samburu people (Humanitarian Response 2013). Furthermore, extreme climate events such as heat waves, droughts, and floods threaten the stability of Samburu’s economic and social systems (Wakachala et al. 2015).

Women face tremendous health challenges globally, particularly related to reproduction. Global maternal mortality has declined significantly in the last 25 years, yet, still, globally, 830 women die every day from preventable causes surrounding pregnancy and childbirth (WHO 2015). As 99% of all maternal deaths occur in developing countries, (WHO 2015) maternal health is likely a particularly challenging issue in the rural Samburu area. Sexually transmitted diseases also exert a particularly profound influence on women globally, but especially in Africa. One of the most devastating sexually transmitted diseases, HIV/AIDs, has the most severe impact on African women out of any other demographic worldwide (Dunkle et. al 2004), and may impact the Samburu community as well.

African women also face unique health challenges due to malaria. Malaria is caused by four different parasites, Plasmodium vivax, P. malariae, P. ovale and P. falciparum, with P.


4

falciparum being the most deadly and the most common parasite in sub-Saharan Africa, putting the population at an increased risk for malaria induced mortality (WHO 2007). Besides the increased risk of malaria for Samburu women—and likely, Samburu women—simply due to geographic location and the prevalence of P. falciparum in Samburu County and the surrounding region, women in general are also particularly vulnerable to malaria when pregnant. Pregnant women have lower immunity to malaria and face elevated risk of anemia, miscarriage, stillbirth, premature delivery, and low-birthweight infants if they contract malaria during pregnancy (WHO 2007).

Diarrheal diseases are likely to be another major health concern in Samburu (Fratkin 1996). Samburu pastoralists use at least five different plants against diarrhea—including Commiphora africana, Euclea divinorum, Boswellia hildebrandtii, Warburgia ugandensis, and Rhus natalensis—indicating the prevalence of the problem (Fratkin 1996). Younger children are more severely impacted by diarrheal diseases than adults, but diarrheal diseases can still cause health problems and mortality in adults (WHO 2016). As many diarrheal diseases are caused by water-borne pathogens, and African women often bear the responsibility of fetching and handling water (Food and Agriculture Organization 2007), African women may face particular risk for diarrheal diseases. Both social and ecological factors likely influence women’s health in Samburu pastoral communities. Social dynamics in Samburu likely have a profound influence on women’s reproductive health. For example, gender inequity limits a woman’s ability to make decisions independent of her husband, which may have strong repercussions on women’s health. Ecological factors, such as low precipitation and extreme climate events, may impact Samburu women’s health by impairing food security, completion of daily tasks, and access to medical care. Hyder at al. (2005) identified gender inequality and food insecurity as social and ecological factors in women’s health in Kwale district, Kenya and Bagamoyo district, Tanzania. Gender, food insecurity, and limited education may be social drivers that women identify as affecting their health. Fratkin (1996) and Bussmann (2006) conducted studies of medicinal plants used by Samburu, but they did not attempt to identify the greatest health concerns of Samburu women themselves.

In addition to his survey of medicinal plants, Fratkin (1996) made insights into how Samburu pastoralists decide whether to consult traditional or modern medical care. According to his research, the Samburu consult either traditional healers or “Western medicines” to treat health conditions they consider “naturalistic” and consult traditional laibon curers to treat “personalistic” illnesses they consider to be caused by sorcery. Fratkin acknowledged that Samburu conceptions of illnesses are dynamic and it will be interesting to determine if the “naturalistic” versus “personalistic” paradigm has changed since 1996. Besides the differential treatment of health conditions based on perceived cause, severity of the health condition and access to traditional versus modern care may affect a woman’s decision to consult traditional or modern medical care.

In Samburu County, little apparent research has been conducted on women’s health concerns at the community level. Identification of women’s health concerns and their drivers is necessary so that those concerns can be addressed. In particular, ascertaining gaps in traditional and modern health services available to Samburu women can reveal how Samburu


5

women’s health can be improved. Furthermore, it is essential to examine both the process by which Samburu women decide to consult traditional medical care or modern medical care and the perceptions of traditional and modern medical care held by Samburu women in order to determine how to best improve Samburu women’s access to health services, prioritizing by the gaps that women themselves are experiencing. Comparing Samburu women’s use of traditional and modern health services may also provide useful insights into Samburu conceptions of health. Findings on women’s health in Samburu could lead to improved quality of life for Samburu women and their families and potentially be relevant to other rural populations.

Conceptual Diagram

Figure 1: Social and ecological factors impacting women’s health in Samburu. Note: TEK=Traditional Ecological Knowledge.


6

Research Questions and Hypotheses 1. What are Samburu women’s greatest health concerns, and what social and ecological

factors contribute to these health concerns? Hypothesis a. Samburu women’s greatest health concerns are food insecurity,

maternal health, sexually transmitted diseases, malaria, and diarrheal diseases. Social factors that impact Samburu women’s health include gender roles and socioeconomic challenges. Ecological factors that impact Samburu women’s health include water quality and quantity, extreme climate events, and other ecosystem variables.

2. When faced with health challenges, how do Samburu women decide whether to consult traditional or modern medical care?

Hypothesis a. When faced with health challenges, Samburu women apply traditional medical care first, and seek modern medical care only when traditional approaches fail.

Hypothesis b. When faced with health challenges, Samburu women consult traditional medical care for more ecologically oriented health concerns, such as malaria and diarrheal diseases, and consult modern medical care for more socially oriented health concerns, such as maternal health and sexually transmitted diseases.

Hypothesis c. When faced with health challenges, Samburu women seek either traditional medical care or modern medical care for “natural” illnesses and seek exclusively traditional medical care for health conditions caused by “supernatural” illnesses (following Fratkin 1996).

3. What are the gaps in traditional and modern health services available to Samburu women, and how do these vary by distance to the nearest town?

Hypothesis a. Women lack access to health services including accurate diagnosis and treatment of conditions, especially those which are particularly severe or rare. As distance to the nearest town increases, women’s access to health services decreases.

Methods Over the course of three weeks I will cover one village each week, each village

progressively further from the nearest town. I will conduct one focus group with women of one settlement each day for five days of the week. Through the focus groups, I hope to identify Samburu women’s greatest health concerns and social and ecological drivers of those health concerns. I will also investigate the process by which women decide to seek traditional medical care or modern medical care. Based on the women’s experiences with health challenges, I will identify the gaps in traditional and modern health services available to Samburu women and examine the relationship between distance to the nearest town and gaps in available health services.


7

It is vital that I research women’s health issues by learning from the women themselves because, naturally, they have the most complete and central perspectives on women’s health. Focus groups will be conducted with the help of a female interpreter, and will include approximately eight women of diverse ages from young, married childbearing age through elders. A diverse set of participants will help me to capture diverse experiences and knowledge. I will work with a female interpreter, which will help the women feel more comfortable with sharing sensitive experiences.

I also hope to document several firsthand stories about health issues that Samburu women encountered in the past year, if they are willing to share. Having individual stories will help bring a personal perspective to Samburu women’s health issues. Through the focus groups and interviews with Samburu women, I will capture a diverse set of experiences and knowledge of stakeholders in Samburu women’s health.

Research Products

I will produce a final report of my findings on women’s health issues in Samburu, which will form part of our EA-IRES report to stakeholders. Additionally, I will produce and present a poster depicting my findings at the Ecosystem Science and Sustainability Symposium and the Celebrate Undergraduate Research and Creativity’s Research Poster Exhibition. Disseminating my findings to different stakeholders and audiences will increase the potential positive impacts of my work.


8

Literature Cited Bussmann, R. W. (2006). Ethnobotany of the Samburu of Mt. Nyiru, South Turkana, Kenya.

Journal of Ethnobiology and Ethnomedicine, 2, 35. Addis, G., Abebe, D., Genebo, T., & Kelbessa, U. (2002). Perceptions and practices of modern

and traditional health practitioners about traditional medicine in Shirka District, Arsi Zone, Ethiopia. Ethiopian Journal of Health Development, 16(1), 1-11.

CDC. "Antibiotic/Antimicrobial Resistance." Centers for Disease Control and Prevention. United States, Aug. 2015. Web. 14 Feb. 2016.

CDC. "Ten Great Public Health Achievements in the 20th Century." Centers for Disease Control and Prevention. United States, Apr. 2013. Web. 2 Mar. 2016.

Dunkle, K. L., Jewkes, R. K., Brown, H. C., Gray, G. E., McIntryre, J. A., & Harlow, S. D. (2004). Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet (London, England), 363(9419), 1415–21.

Dyson-hudson, R., & Dyson-hudson, N. (2016). Nomadic Pastoralism. Annual Review of Anthropology, 9(1980), 15-61.

Fratkin, E. (1996). Traditional Medicine and Concepts of Healing Among Samburu Pastoralists of Kenya. Journal of Ethnobiology, 16(1), 63–97.

Heise, Lori L.; Pitanguy, Jacqueline; Germain, Adrienne. 1994. Violence against women: the hidden health burden. World Bank discussion papers; WDP 255. Washington, D.C.: The World Bank.

Humanitarian Response. "Samburu Secondary Data Review." Humanitarian Response. Humanitarian Response, Nov. 2013. Web. 31 Mar. 2016.

Hyder, A. A., Maman, S., Nyoni, J. E., Khasiani, S. A., Teoh, N., Premji, Z., & Sohani, S. (2005). The pervasive triad of food security, gender inequity and women’s health: Exploratory research from sub-Saharan Africa. African Health Sciences, 5(4), 328-334.

Food and Agriculture Organization (2007). “Mapping our community’s future: why and how to practice participatory land-use planning.”

Wakachala, F. M., Shilenje, Z. W., Nguyo, J., Shaka, S., & Apondo, W. (2015). Statistical Patterns of Rainfall Variability in the Great Rift Valley of Kenya. Journal of Environmental & Agricultural Sciences, 5, 17-26.

Waweru, Nduta. “Kenya: Fighting Maternal Deaths in Samburu.” AllAfrica. AllAfrica, 2016. Web. 2 Mar. 2016.

World Health Organization (2016). Diarrhoeal disease. Retrieved April 30, 2016, from http://www.who.int/mediacentre/factsheets/fs330/en/

World Health Organization (2007). Gender, Health, and Malaria [Pamphlet]. WHO. World Health Organization. "Maternal Mortality." World Health Organization. WHO, Nov. 2015.

Web. 31 Mar. 2016. World Health Organization. "Traditional Medicine." World Health Organization. WHO, May

2003. Web. 2 Mar. 2016.

http://www.who.int/mediacentre/factsheets/fs330/en/


9

Appendix A: Focus Group Questions

1. What are your personal biggest health concerns?

2. Who is affected by each of these health concerns?

3. Which of these health issues have you faced firsthand in the past year?

4. Rank the frequency of the issues – which occur most frequently to least frequently.

5. Rank the severity of the issues – which are most severe when they occur.

6. Is there a seasonality to the health issue?

7. Is there a social component to the health issue?

8. What is/are the cause(s) of the health issue?

9. What is/are the traditional and modern medical treatment(s)?

10. Do you have access to a traditional healer?

11. Do you have access to dispensary or hospital care?

12. How effective are traditional medical treatments for each condition (1-5)?

13. How effective are modern medical treatments for each condition (1-5)?

14. Is traditional medical care safe in general?

15. Is modern medical care safe in general?

16. Do you have a preference of traditional vs modern medical care?

17. How do you decide whether to treat a health issue on your own, to consult a traditional

healer, to go to a dispensary, or to go to a hospital?

18. Do you personally use medicinal plants for treatment of conditions? If so, which plants

and at what frequency?

19. What health treatments or services would you like to have access to that you don’t

currently have access to?

20. What health services, resources, or treatments, if provided to you, would have the

biggest positive impact on you and your family?

Documents

EA-IRES Proposal