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Female Genital Mutilation: From the Life Story of Girls in Remote Villages in Pokot County, Kenya


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Objective: Female genital mutilation/cutting (FGM/C) has highest prevalence in African countries. The objective of this qualitative study was to describe the situation of FGM/C victims in Pokot County, located in a remote area of northwest Kenya. Methods: In September 2009, the study team conducted key informant interviews, visited girls at communities and a rescue centre and, conducted group discussion with the girls at rescue centre. Results: FGM/C was common and popular among the Pokot community mainly because the event brings the social recognition of an adolescent or adult female to become eligible for her marriage. Although the hazardous FGM/C practices encompassed many health dangers as witnessed by the Pokot community girls/women, the Pokot community fought to maintain the custom as because it represented prestige and identity, which was their duty and responsibility to maintain. Conclusion: FGM/C was still common in Kenyan Pokot communities, although efforts from the development agencies and government acts kept working against those harmful practices. The Kenyan government's act of prohibition against FGM/C was not being enforced.
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Female Genital Mutilation: From the Life Story of Girls in Remote Villages
in Pokot County, Kenya
Amal K Halder*, Golam Dostogir Harun and Shiuli Das
Freelance Service Provider and Daffodil University, Dhaka, Bangladesh
*Corresponding author: Amal K Halder, Freelance Service Provider and Daffodil University, Dhaka, Tel: +8801712206711; E-mail:
Received date: June 23, 2015, Accepted date: August 28, 2015, Published date: September 03, 2015
Copyright: 2015 © Halder AK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: Female genital mutilation/cutting (FGM/C) has highest prevalence in African countries. The objective
of this qualitative study was to describe the situation of FGM/C victims in Pokot County, located in a remote area of
northwest Kenya.
Methods: In September 2009, the study team conducted key informant interviews, visited girls at communities
and a rescue centre and, conducted group discussion with the girls at rescue centre.
Results: FGM/C was common and popular among the Pokot community mainly because the event brings the
social recognition of an adolescent or adult female to become eligible for her marriage. Although the hazardous
FGM/C practices encompassed many health dangers as witnessed by the Pokot community girls/women, the Pokot
community fought to maintain the custom as because it represented prestige and identity, which was their duty and
responsibility to maintain.
Conclusion: FGM/C was still common in Kenyan Pokot communities, although efforts from the development
agencies and government acts kept working against those harmful practices. The Kenyan government's act of
prohibition against FGM/C was not being enforced.
Keywords: Female genital mutilation/cutting (FGM/C); Pokot;
e procedure of female genital mutilation/cutting (FGM/C)
comprises the involvement of partial or total removal of the external
female genitalia [1,2]. ere are some risks associated with FGM/C
including both short term and long term consequences. e short term
consequences are severe pain, shock, haemorrhage (bleeding), tetanus
or sepsis (bacterial infection), urine retention, open sores in the genital
region and injury to nearby genital tissue. e long term consequences
including recurrent bladder and urinary tract infections, cysts,
infertility, an increased risk of childbirth complications and newborn
death [1-5] ere were other consequences as well including death,
life-long physical disability, life-long disability in sexual life, hindering
natural physical movements, absence of erogenous feelings in sexual
intercourse, severe pain and bleeding during and/or immediately aer
sexual intercourse, and cases of maternal death during delivery [1-5].
In many setting where FGM/C is practiced, it is justied because
there is a social consensus that if households or individuals do not
perform FGM/C on their girls/women, they risk being excluded,
criticized, ridiculed, stigmatized or the household would unable to nd
a suitable partner to marriage for their daughters [6,7]. Coyne and
Coyne speak of the ‘identity economics’ perpetuating FGM/C, and
point out the role of older, circumcised females as being key players in
perpetuating FGM/C [6]. Although the government of Kenya has
made this practice illegal with laws passed long ago, the people of
Pokot regularly disobey the laws and continue practicing FGM/C,
sometimes secretly and sometimes openly. As a result, by August 2009
close to 80% of Pokot girls took part in FGM/C in order to become
eligible for marriage in the traditional society. Because of continued
practices of FGM/C, the international community has continued
support to abolish or eradicate the harmful and risky practice [1,7].
One hundred and forty (140) million girls and women are living
with the consequences of FGM/C and most of them reside in 28
African countries [8,9]. A UNICEF study covering 70 countries over a
20-year period revealed that in Somalia, Guinea, Djibouti, Egypt,
Eritrea, Mali, Sierra Leone and Sudan, over 88% of girls and women
were victims of FGM/C and the total number of victims was 125
million [10]. Owing to concern among the international community
about the harmful traditional practice of FGM/C, the situation is
improving [1]. FGM/C in Kenya is common mainly in remote rural
areas. Demographic and Health Surveys conducted on national
samples in Kenya demonstrate a decrease in FGM/C to 27% in 2009
from 32% in 2003 and from 38-40% in 1998 [11]. e prevalence
FGM/C varies by ethnic group in Kenya; high prevalence was found in
the Somali (97%), Kilii (96%), Kuria (96%) and Maasai (93%) tribes,
while low prevalence was found in the Kikuyu, Kamba, Turkana, Luo
and Luhya tribes [8]. West Pokot is a Kenyan county where the Pokot
people live and where FGM/C was found as a common practice (85%)
among girls and women [11]. In accordance with the support from the
international community, human rights organizations continue
campaigning and advocating against FGM/C by educating people
about its negative consequences, which have been recorded through
discussions and observations. Being part of human right promotion
organization, an international humanitarian development organization
for which the senior author was working continued support to the
Halder, et al., J Child Adolesc Behav 2015, 3:5
DOI: 10.4172/2375-4494.1000237
Research Article Open Access
J Child Adolesc Behav, an open access journal
ISSN: 2375-4494
Volume 3 • Issue 5 • 1000237
ISSN: 2375-4494
Journal of Child & Adolescent
people in Pokot community in collaboration with international donor
communities. In fact the mentioned humanitarian development
organization provides supports to the communities through integrated
promotion of interventions in healthcare, livelihood, education and
psychosocial supports to the people in communities. In 2009, the
humanitarian development organization conducted a baseline study
for it’s a newly started program. e baseline study included social
issues related to healthcare, nutrition, livelihood, education for
children and psychosocial support through addressing gender issues.
Although the baseline study was a quantitative study, this particular
qualitative study was part of senior author's special interest, (was not
included into the baseline study design). Data were collected together
with the baseline study and from the same baseline community. e
qualitative study described the situation of girls among the Pokot tribe
in Pokot County of Kenya regarding the traditional harmful practices
e Pokot tribe is the dominant ethnic group in West Pokot County
and in Baringo County located in northwest Kenya in the Ri Valley
Province, and in the Pokot District of the eastern Karamoja region in
Uganda [12-14]. e county is situated in Ri Valley, over 500 km
away from the capital city of Nairobi, Kenya. e common economic
activities among the Pokot people are nomadic pastoralism, mining,
and commercial businesses. Because of the remote and mountainous
geographic conditions of the area and high elevation (2000 meters
above sea level) the major challenges to their livelihoods and daily lives
are year round water scarcity and lack of education [12-15]. Health
problems among the Pokot include infectious diseases such as cholera,
malaria, trachoma and visceral leishmaniasis [16-19], malnutrition
[15], high fertility rates [20], and maternal health problems including
obstetric stula [21]. e popularity of traditional healing practices,
and preference for traditional over modern prevention and treatments,
has long been documented [12,13,22].
roughout the year, the Pokot people are totally dependent on
rainwater for drinking, cooking, cleaning and for other livelihood
requirements. In Pokot County the typical rainy season lies between
March and August (six months). During the other six months of the
year, people depend on stored water preserved during the rainy season.
In some years the rainy season ends early, lasting only 4-5 months.
A team of two members leaded by the senior author travelled to
Pokot County, Kenya during September 2009 for six days and gathered
data. An international humanitarian organization based on Pokot, its
local ocials volunteered to assist in visits to dierent locations,
including visiting the girls at shelters or rescue centres/schools (Figure
1) run by the international humanitarian organization. e team chose
Pokot County because FGM/C was common among the people there
[16]. In Pokot, the team visited over 10 villages, spot-checked the
geographic conditions, and interviewed key informants including ve
(5) teachers and three (3) local leaders. e team conducted group
discussions with 31 girls (Figure 1) at the girls rescue centre and also
conducted group discussions with 4 local ocials of Area
Development Program at Pokot of the international humanitarian
organization. e selection of informants was done purposively
considering that the informants had information and agreed to
respond to questions related to FGM/C. e interview followed a
structured checklist that included items about people's general feelings
and opinions about FGM/C, feelings from the girls, perceived
advantages and disadvantages of FGM/C, societal norms inuenced
the girls and their guardian in terms of their beliefs and behavior
regarding FGM/C, association of resources/wealth with FGM/C,
association of societal status with FGM/C, perceived government
opinion and people's knowledge of government rules regarding
FGM/C, as well as any additional comments and recommendations.
Figure 1: Pokot girls at a rescue centre-cum-school, Pokot, Kenya,
Human subject protection
Although the study was added with the broader baseline study
related to the international humanitarian organization's internal
intervention strategies where the senior author was part of the
organization. However, this particular objective was the senior author's
individual interest outside the organization's baseline study. Since the
study was not funded research protocol hence IRB approval was not
obtained. Before collecting data from the participants, the interviewers
claried study objectives, purpose of data collection, and explained
that there was no individual benet or compensation for participation
and no loss in case of non-participation, and that participation was
completely voluntary. During data collection respondents' individual
consent was checked and ensured that there was no individual harm or
disclosure of respondents' identity.
e community visits and informant interviews revealed that the
road networks and infrastructure of the Pokot community are poor
and as a result transportation between localities and outside the Pokot
tribal regions was dicult and time consuming. e majority of the
people in remote Pokot localities did not have much access to
education regarding to traditional harmful practices. Men were
dominant in household decision-making, with women assigned
responsibility for entertaining their husbands, child care and domestic
duties. Traditionally, the Pokot community is a polygamous culture
where early marriages to girls, having multiple wives, and fathering
large numbers of children were indicators that brought social dignity
to men. e other indicators of social dignity for men were, owning a
larger number of cows and bualoes compared to others.
As reported by the respondents during the consultations that
FGM/C among adolescent girls was a type of conventional festival at
Citation: Das S, Harun GD, Halder Ak (2015) Female Genital Mutilation: From the Life Story of Girls in Remote Villages in Pokot County, Kenya.
J Child Adolesc Behav 3: 237. doi:10.4172/2375-4494.1000237
Page 2 of 4
J Child Adolesc Behav, an open access journal
ISSN: 2375-4494
Volume 3 • Issue 5 • 1000237
Pokot households. During the festival of FGM/C, the household of the
girl invites local elites, neighbours, relatives, friends, and family well-
wishers. e girl's parents arrange food and drinks, alcohol and local
brews, and traditional dancing along with varieties of local recreational
activities which last throughout the night.
e FGM/C became the most attractive and popular event among
all the events in Pokot community because it brings the social
recognition of an adolescent girl or adult female to become eligible for
her marriage. While discussing with local leaders the eld team was
told that in order to protect and promote the traditional culture, the
male-dominated traditional society was continuously taking part and
standing against the banning of FGM/C system. e key informant
participants also reported that signicance of FGM/C for status and
identity in the community was inculcated in Pokot girls by the family
members and by the people in neighbouring community and relatives
since early childhood. Specically, the girls are oriented like this --"As
long as FGM ceremony is not done and celebrated, irrespective of age
factor, the girl would never been recognized or designated as an adult
enough to be married. Alternatively, no Pokot man would show
interest to marry a girl unless her FGM/C ceremony has been done."
e consultation meeting with by the respondents also found that
the incidences of early/child marriage and/or forced marriage of
female children or girls with elderly men remained a common practice
across Pokot community. ere have been number of case stories like
this - "father of a girl received animals (cow/bualo/goat) from an old
man of age 60 years or more who had ample animals and resources
with the condition that the girl would be married to him, the old man.
Indeed the father of the girl started feeding his family with the
revenues generated by selling those animals received from the old man.
Besides this, the father managed FGM/C expenses as well with the
revenues of selling animals.
e old man (ancé) already had multiple wives and a good number
of children at his home where some of those children were older than
even the girl who the old man intended to marry. All of a sudden, two
months aer the girl's FGM/C, the old man rushed into the girl's house
with his associates and took the girl o to his home against her will,
however the girl's parents consented for her to be taken o. en the
old man started enjoying the girl as his wife."
e other example of a story of a FGM/C victim was - "father of a
girl child brought animals from an old man. e agreement was that
immediately aer the FGM/C of his daughter, she would be handed
over to him as his wife. By noticing the situation, the girl ran away
from the home and took shelter at one of her relatives' house. Later on,
aer two days of staying at her relative's house, the mother of the girl
came in to bring her back home. With the help of the relative, the
mother tied up the girl on the back of a donkey to take her back home.
On the way home, a human rights agency rescued her and sheltered
her at a rescue centre."
As one respondent reported, "it has been a customary that if an
elderly man who already has multiple wives, is ready to marry another
girl, who is in fact a teenager, the value of the dowry (livestock) to the
father of the teenage girl increases up to double or triple times
compared to an ordinary situation of dowry to the father of a girl who
gets marry in the society". As reported by the respondents, that there
have even been instances where fathers of girls appointed brokers for
their teenage girls in search of an old men who have ample resources
along with multiple wives, and wanted to marry again to a teenage girl
in exchange for cows and/or bualos. e only objective of these
fathers was getting more and more animals in exchange of his
e respondents also reported that in order to discourage FGM/C,
the human rights organizations in collaboration with the government
hold occasional mass gatherings, weekly gatherings/ meetings through
conducting sessions, changes in school curriculum that incorporate
the issues of harmful practices of FGM/C, and they also arrange
courtyard sessions at household in communities. rough these
activities, they educate people about harmful FGM/C practices. e
human rights organizations and NGOs have also established rescue
centres for the FGM/C victims and are providing support including
health treatment, schooling, and arrangement of marriages.
In the Pokot communities where this consultation was conducted,
societal recognition to become an eligible for her marriage of a girl/
female was a strong motivator for carrying out FGM/C. In exchange
for societal recognition, girls/females were willing to subject
themselves to such a risky custom of FGM/C by accepting the situation
irrespective of the result of mental and physical pressure. Even though,
the other immediate consequences to health were known to them up to
some level.
As we understand through this investigation that the traditional
custom of FGM/C never was associated with health benets for the
girls/women, the benets accrued to the invited guests and relatives
attending the ceremony. Although the hazardous FGM/C practices
encompass many health dangers as were witnessed by the Pokot
community people and elsewhere, the tradition-respecting Pokot
community still seeks to retain these practices/ ey see them as
emblematic of their culture, and symbols of prestige and identity;
therefore, propagating these practices and passing them down to future
generations is their duty and responsibility [6,8]. Hence, they are
responsible for protecting and promoting the Pokot identity.
Although FGM/C is common across some other dierent ethnic
groups in Kenya, the ndings of this study were limited to the specic
Pokot community. erefore, the ndings may not generalizable to the
entire Kenyan population.
FGM/C was still common in Pokot Communities in Kenya. In order
to abolish the harmful FGM/C practices, UN agencies implemented
government-level advocacy initiatives and collaborative programmes
with the Kenyan government and development organizations in Kenya
[7]. ese indicated that assistance through joint involvement of
international communities along with government could be more
eective in implementation of Kenyan FGM/C act.
Finally, the study concluded that the girls and women did not
support FGM/C. Although the Kenyan government has strong laws
prohibiting FGM/C, enforcement of such laws was taking time [2,8].
e study recommended that advocacy initiatives and integrated
support from government, development agencies and international
community to eliminate FGM/C to be continued.
Authors' contributions
SD initiated preparing the manuscript and leaded the manuscript;
PJW reviewed critically and provided advisory support in arranging
Citation: Das S, Harun GD, Halder Ak (2015) Female Genital Mutilation: From the Life Story of Girls in Remote Villages in Pokot County, Kenya.
J Child Adolesc Behav 3: 237. doi:10.4172/2375-4494.1000237
Page 3 of 4
J Child Adolesc Behav, an open access journal
ISSN: 2375-4494
Volume 3 • Issue 5 • 1000237
the write up; MR reviewed and provided feedback; GDH reviewed and
provided feedback; FAN reviewed and provided feedback; AKH was
the supervisor of the study, initiated the study design, collected data
and reviewed the write up. All authors read and approved the nal
e study was a part of experiences gathered independently by the
authors. In gathering information, the team received assistance from
International humanitarian organization such as facilitation of data
collection activities. e authors are very thankful to the humanitarian
organization and community participants of the Pokot community.
e authors also acknowledge Mr. Stephen Berno and Ms. Yvonne
Agengo, Kenyan colleagues, formerly worked for the same
humanitarian organization for their thoughtful review and proof
checking in the background and other characteristics in the
introduction and method sections. We also acknowledge Ms. Meghan
Scott (icddr,b scientic writing consultant) for her thoughtful review,
and comments on write up of this manuscript.
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Citation: Das S, Harun GD, Halder Ak (2015) Female Genital Mutilation: From the Life Story of Girls in Remote Villages in Pokot County, Kenya.
J Child Adolesc Behav 3: 237. doi:10.4172/2375-4494.1000237
Page 4 of 4
J Child Adolesc Behav, an open access journal
ISSN: 2375-4494
Volume 3 • Issue 5 • 1000237
... Despite international condemnation against FGM, it is still widely practiced in Somalia, where 98% of women aged 15-49 have undergone some forms of FGM. 2 Women, who live in rural areas, are only slightly more likely to undergo FGM than those who live in urban areas. In Somalia, FGM has been associated with the social recognition of women to become eligible for marriage 7 For that reason, almost all girls undergo FGM with very few exceptions. 8 Like other African countries, FGMs were widely conducted by traditional practitioners using local instruments such as a knife or razor blade on very young girls. ...
... On the other hand, a woman who has not undergone this procedure is thought to be of a loose character and therefore may result in less bride wealth for her family. 7 There have been many awareness programs supported by the United Nations and other international donors. In 2008, WHO and other UN partners issued a statement to advocate for the abandonment of FGM. ...
Full-text available
Background Despite a strong international standpoint against female genital mutilation, the prevalence of female genital mutilation in Somalia is extremely high. Objectives This study assessed the knowledge, attitude, and practice of female genital mutilation among female health care service providers in order to formulate appropriate policies and programs to eliminate this harmful practice. Design Facility-based cross-sectional survey conducted in 2019 among female doctors and nurses working in Banadir Hospital, Mogadishu, Somalia. Methods A total of 144 female health care service providers were randomly selected, and data were collected through a pre-tested, semi-structured questionnaire. Quantitative data were analyzed by using the statistical software SPSS (Version 21), and qualitative data were analyzed thematically in accordance with the objectives of the study. Results The study found that about three-fifths of the respondents had undergone some forms of female genital mutilation during their life. An overwhelming majority believed that female genital mutilation practices were medically harmful, and a majority of them expressed their opinion against the medicalization of the practice of female genital mutilation. The study also observed a significant association between participants’ age and their negative attitudes regarding the legalization of female genital mutilation. Conclusion Health care service providers’ effort is critical to eliminating this harmful practice from the Somalian society. Strong policy commitment and a comprehensive health-promotion effort targeting the parents and community leaders are essential to avert the negative impact of female genital mutilation.
... 19 The prevalence of FGM is high in this area, with sources citing the prevalence as between 85% and 96%. 20,21 Infibulation (the removal of the inner and outer labia and suturing of the vulva known as FGM type 3) is reported to be the most common type of FGM practised by the Pokot. 22 Some interventions to end FGM, led by local community-based organisations, national media and district governments, were known to have taken place. ...
... In this setting, those who committed FGM were easily avoiding detection by the police. 21 Those who publicly opposed FGMgovernment leaders, church leaders and NGOswere said to lack moral credibility, as their positions on the issue often shifted or they were known to be married to women with FGM themselves and had already "received the benefits" of FGM. ...
The Girl Summit held in 2014 aimed to mobilise greater effort to end Female Genital Mutilation (FGM) within a generation, building on a global movement which viewed the practice as a severe form of violence against women and girls and a violation of their rights. The UN, among others, endorse “comprehensive” strategies to end FGM, including legalistic measures, social protection and social communications. FGM is a sensitive issue and difficult to research, and rapid ethnographic methods can use existing relations of trust within social networks to explore attitudes towards predominant social norms which posit FGM as a social necessity. This study used Participatory Ethnographic Evaluation Research (PEER) to understand young men’s (18-25 years) perceptions of FGM, demand for FGM among future spouses, and perceptions of efforts to end FGM in a small town in West Pokot, Kenya, where FGM is reported to be high (between 85% to 96%). Twelve PEER researchers were recruited, who conducted two interviews with their friends, generating a total of 72 narrative interviews. The majority of young men who viewed themselves as having a “modern” outlook and with aspirations to marry “educated” women were more likely not to support FGM. Our findings show that young men viewed themselves as valuable allies in ending FGM, but that voicing their opposition to the practice was often difficult. More efforts are needed by multi-stakeholders – campaigners, government and local leaders – to create an enabling environment to voice that opposition.
... FGC might fall on the stronger end, as it is often (though not always) celebrated in a public ceremony marking girls' passage to womanhood. Halder and colleagues (Halder, Das, & Harun, 2015), for instance, reported that the Pokot of Northwest Kenya describe the cutting ceremony as a very attractive and popular event that gathers a crowd of people from neighboring villages. There, the practice is witnessed by many: Parents know that their daughter's potential future husbands and his parents will know (or will know someone who knows) if their daughter has been cut or not. ...
Full-text available
Health promotion interventions in low and midincome countries (LMIC) are increasingly integrating strategies to change local social norms that sustain harmful practices. However, the literature on social norms and health in LMIC is still scarce. A well-known application of social norm theory in LMIC involves abandonment of female genital cutting (FGC) in West Africa. We argue that FGC is a special case because of its unique relationship between the norm and the practice; health promotion interventions would benefit from a wider understanding of how social norms can influence different types of health-related behaviors. We hypothesize that four factors shape the strength of a norm over a practice: (1) whether the practice is dependent or interdependent; (2) whether it is more or less detectable; (3) whether it is under the influence of distal or proximal norms; and (4) whether noncompliance is likely to result in sanctions. We look at each of these four factors in detail, and suggest that different relations between norms and a practice might require different programmatic solutions. Future findings that will confirm or contradict our hypothesis will be critical for effective health promotion interventions that aim to change harmful social norms in LMIC. (PsycINFO Database Record
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Background. Cholera remains endemic in sub-Saharan Africa. We characterized the 2009 cholera outbreaks in Kenya and evaluated the response. Methods. We analyzed surveillance data and estimated case fatality rates (CFRs). Households in 2 districts, East Pokot (224 cases; CFR = 11.7%) and Turkana South (1493 cases; CFR = 1.0%), were surveyed. We randomly selected 15 villages and 8 households per village in each district. Healthcare workers at 27 health facilities (HFs) were surveyed in both districts. Results. In 2009, cholera outbreaks caused a reported 11 425 cases and 264 deaths in Kenya. Data were available from 44 districts for 6893 (60%) cases. District CFRs ranged from 0% to 14.3%. Surveyed household respondents (n = 240) were aware of cholera (97.5%) and oral rehydration solution (ORS) (87.9%). Cholera deaths were reported more frequently from East Pokot (n = 120) than Turkana South (n = 120) households (20.7% vs. 12.3%). The average travel time to a HF was 31 hours in East Pokot compared with 2 hours in Turkana South. Fewer respondents in East Pokot (9.8%) than in Turkana South (33.9%) stated that ORS was available in their village. ORS or intravenous fluid shortages occurred in 20 (76.9%) surveyed HFs. Conclusions. High CFRs in Kenya are related to healthcare access disparities, including availability of rehydration supplies.
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Between 2000 and 2010, Médecins Sans Frontières diagnosed and treated 4,831 patients with visceral leishmaniasis (VL) in the Pokot region straddling the border between Uganda and Kenya. A retrospective analysis of routinely collected clinical data showed no marked seasonal or annual fluctuations. Males between 5 and 14 years of age were the most affected group. Marked splenomegaly and anemia were striking features. An Rk39 antigen-based rapid diagnostic test was evaluated and found sufficiently accurate to replace the direct agglutination test and spleen aspiration as the first-line diagnostic procedure. The case-fatality rate with sodium stibogluconate as first-line treatment was low. The VL relapses were rare and often diagnosed more than 6 months post-treatment. Post-kala-azar dermal leishmaniasis was rare but likely to be underdiagnosed. The epidemiological and clinical features of VL in the Pokot area differed markedly from VL in Sudan, the main endemic focus in Africa.
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Female genital mutilation/cutting (FGM/C) is a harmful traditional practice deeply rooted in 28 Sub-Saharan African countries. Its prevalence in The Gambia is 76.3%. The objective of this study was to gain precise information on the long-term health consequences of FGM/C in The Gambia as well as on its impact on delivery and on the health of the newborns. Data were collected from 588 female patients examined for antenatal care or delivery in hospitals and health centers of the Western Health Region, The Gambia. The information collected, both through a questionnaire and medical examination, included sociodemographic factors, the presence or not of FGM/C, the types of FGM/C practiced, the long-term health consequences of FGM/C, complications during delivery and for the newborn. Odds ratios, their 95% confidence intervals, and P values were calculated. The prevalence of patients who had undergone FGM/C was 75.6% (type I: 75.6%; type II: 24.4%). Women with type I and II FGM/C had a significantly higher prevalence of long-term health problems (eg, dysmenorrhea, vulvar or vaginal pain), problems related to anomalous healing (eg, fibrosis, keloid, synechia), and sexual dysfunction. Women with FGM/C were also much more likely to suffer complications during delivery (perineal tear, obstructed labor, episiotomy, cesarean, stillbirth) and complications associated with anomalous healing after FGM/C. Similarly, newborns were found to be more likely to suffer complications such as fetal distress and caput of the fetal head. This study shows that FGM/C is associated with a variety of long-term health consequences, that women with FGM/C are four times more likely to suffer complications during delivery, and the newborn is four times more likely to have health complications if the parturient has undergone FGM/C. These results highlight for the first time the magnitude of consequences during delivery and for the newborn, associated with FGM/C in The Gambia.
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The prevalence of Female Genital Mutilation (FGM) is reducing in almost all countries in which it is a traditional practice. There are huge variations between countries and communities though, ranging from no change at all to countries and communities where the practice has been more than halved from one generation to the next. Various interventions implemented over the last 30-40 years are believed to have been instrumental in stimulating this reduction, even though in most cases the decrease in prevalence has been slow. This raises questions about the efficacy of interventions to eliminate FGM and an urgent need to channel the limited resources available, where it can make the most difference in the abandonment of FGM. This paper is intended to contribute to the design of more effective interventions by assessing existing knowledge of what works and what does not and discusses some of the most common approaches that have been evaluated: health risk approaches, conversion of excisers, training of health professionals as change agents, alternative rituals, community-led approaches, public statements, and legal measures.
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Obstetric fistula is a complication of pregnancy that affects women following prolonged obstructed labour. Although there have been achievements in the surgical treatment of obstetric fistula, the long-term emotional, psychological, social and economic experiences of women after surgical repair have received less attention. This paper documents the challenges faced by women following corrective surgery and discusses their needs within the broader context of women's health. We interviewed a small sample of women in West Pokot, Kenya, during a two-month period in 2010, including eight in-depth interviews with fistula survivors and two focus group discussions, one each with fistula survivors and community members. The women reported continuing problems following corrective surgery, including separation and divorce, infertility, stigma, isolation, shame, reduced sense of worth, psychological trauma, misperceptions of others, and unemployment. Programmes focusing on the needs of the women should address their social, economic and psychological needs, and include their husbands, families and the community at large as key actors. Nonetheless, a weak health system, poor infrastructure, lack of focus, few resources and weak political emphasis on women's reproductive health do not currently offer enough support for an already disempowered group. Résumé La fistule obstétricale est une complication de la grossesse qui touche les femmes après un travail prolongé ou obstrué. Si le traitement chirurgical de la fistule a fait des progrès, les expériences émotionnelles, psychologiques, sociales et économiques à long terme des femmes après l'intervention réparatrice ont reçu moins d'attention. L'article documente les difficultés des femmes après l'opération et discute de leurs besoins dans le contexte plus large de la santé féminine. Nous avons interrogé un petit échantillon de femmes à West Pokot, Kenya, pendant deux mois en 2010, avec huit entretiens approfondis avec des patientes présentant une fistule et deux discussions de groupe, chacune avec des femmes ayant une fistule et des membres de la communauté. Les femmes ont déclaré que leurs problèmes se sont poursuivis après l'intervention réparatrice : séparation, divorce, infécondité, stigmatisation, isolement, honte, diminution du sentiment de valeur personnelle, traumatisme psychologique, conceptions erronées des autres et chômage. Les programmes axés sur les besoins des femmes doivent aborder leurs besoins sociaux, économiques et psychologiques et associer les conjoints, les familles et l'ensemble de la communauté comme acteurs clés. Néanmoins, la faiblesse du système de santé, la médiocrité des infrastructures, le manque d'attention, l'insuffisance des ressources et la faible priorité politique accordée à la santé génésique des femmes ne permettent pas de soutenir suffisamment un groupe déjà démuni. Resumen La fistula obstétrica es una complicación del embarazo que afecta a las mujeres tras un parto obstruido prolongado. Aunque se han visto logros en el tratamiento quirúrgico de la fístula obstétrica, las experiencias emocionales, psicológicas, sociales y económicas de las mujeres a largo plazo después de la reparación quirúrgica han recibido menos atención. En este artículo se documentan los retos que enfrentan las mujeres después de una cirugía correctiva y se discuten sus necesidades en el contexto más amplio de la salud de las mujeres. Entrevistamos a una pequeña muestra de mujeres en West Pokot, Kenia, durante un plazo de dos meses en 2010: ocho entrevistas a profundidad con sobrevivientes de fístula y dos discusiones en grupos focales, una con sobrevivientes de fístula y la otra con integrantes de la comunidad. Las mujeres informaron problemas continuos después de la cirugía correctiva, tales como separación y divorcio, infertilidad, estigma, aislamiento, vergüenza, disminuida autoestima, trauma psicológico, percepciones erróneas de otras personas y desempleo. Los programas centrados en las necesidades de las mujeres deben atender las necesidades sociales, económicas y psicológicas de cada mujer e incluir a su esposo, familia y comunidad como actores clave. Sin embargo, debido a las deficiencias del sistema de salud y la infraestructura, falta de enfoque, pocos recursos y poco énfasis político en la salud reproductiva de las mujeres, no se ofrece suficiente apoyo a un grupo de por sí desempoderado.
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Female Genital Mutilation/Cutting (FGM/C) is a harmful traditional practice with severe health complications, deeply rooted in many Sub-Saharan African countries. In The Gambia, the prevalence of FGM/C is 78.3% in women aged between 15 and 49 years. The objective of this study is to perform a first evaluation of the magnitude of the health consequences of FGM/C in The Gambia. Data were collected on types of FGM/C and health consequences of each type of FGM/C from 871 female patients who consulted for any problem requiring a medical gynaecologic examination and who had undergone FGM/C in The Gambia. The prevalence of patients with different types of FGM/C were: type I, 66.2%; type II, 26.3%; and type III, 7.5%. Complications due to FGM/C were found in 299 of the 871 patients (34.3%). Even type I, the form of FGM/C of least anatomical extent, presented complications in 1 of 5 girls and women examined. This study shows that FGM/C is still practiced in all the six regions of The Gambia, the most common form being type I, followed by type II. All forms of FGM/C, including type I, produce significantly high percentages of complications, especially infections.
Targeted interventions can work, but more remains to be done to change people’s behaviour In December 2012, the United Nations General Assembly adopted a resolution to intensify global efforts to eliminate female genital mutilation/cutting. As the recent Unicef report argues, evidence played a major part in driving this resolution through.1 But what is the character of the available evidence, and what is known about how to accelerate change to bring about the desired result? Although the tone of the report is resolutely upbeat, the reality on the ground seems more uncertain and fragile. The report provides the largest ever number of nationally representative surveys from all 29 countries where female genital mutilation/cutting is concentrated, as well as providing comparative data for age cohorts. This allows an assessment not only of how these practices are changing, but also the progress being made in the battle to eliminate them. However, the report also notes that even with the current evidence for declining prevalence …
The prevalence of visceral leishmaniasis and malaria in the human population of West Pokot district of Kenya was studied in 1986. A total of 2139 people was proportionately screened for the two diseases according to four age categories (0-4, 5-14, 15-44 and greater than 45 years). Diagnostic methods included the enzyme linked immunosorbent assay (ELISA) and Leishmanin skin test for visceral leishmaniasis, and parasitological examination for malaria. The epidemiological value of the spleen rate was evaluated in relation to visceral leishmaniasis and malaria endemicity. A general decline of infection rates with altitude was observed for both diseases. Visceral leishmaniasis was less prevalent than malaria, with less than 2% active cases in any age group and had the same distribution in both sexes. Malaria infection rate was highest in the younger age groups, declining from 21.5% in the 0-4 year old age group to 5.5% in people more than 45 years old. Malaria affected significantly more males than females. The spleen rate was inappropriate for epidemiological survey of either malaria or visceral leishmaniasis due to an overlap in the distribution of the two diseases.
In order to provide effective and sympathetic health care in a community, it is essential to have a detailed understanding of the culture. This is particularly true when one is concerned with the health of mothers and their children. The Pokot people of Kenya have developed a social structure and cultural practices which aim to optimize the chance of survival of the community in an often difficult and hostile environment. When examined in detail, some of these practices are seen to be beneficial, while others are associated with significant morbidity and mortality, especially in the area of mother and child health. In recent times, Pokot society has been in a phase of transition, influenced by new opportunities of educational, economic and social interaction, particularly since the completion of a tarmac road through the district in 1983. While many of these changes are undoubtedly beneficial to the community, they have been associated with a disintegration of traditional Pokot society and accompanied by changing patterns of existing diseases, as well as the opportunity for introduction and dissemination of diseases which were previously absent from or rarely encountered in the area.