1
Root Cause Diagram
Gender (3)
Family background (4)
Peer influence (5)
Stress(5)
Conflicts (5)
Academic qualification (6)
Family background (4)
Individual interest (6)
Education level (3)
Marginalization (3)
Gender Based Violence (3)
Geographical location (3)
Profession (1)
Key
Disease
Risk factors
Determinants of risk factor
Determinants of determinants
Rigid culture (4)
Poverty (2)
Drug abuse (3)
accidental needle stick injuries (1)
sharing contaminated injecting/sharp equipment and drug solutions piercing (1)
unsafe injections, blood transfusions, tissue transplantation, unsterile cutting/ piercing (1)
Unprotected anal or vaginal sex (1)
HIV/AIDs in Kenya
Reference List
1.
WHO. (2021). HIV/AIDS
https://www.who.int/news-room/fact-sheets/detail/hiv-aids
2.
Gatongi, P. M., Lakati, A., Kiarie, J. N., Mutai, K. K., & Gatumia, B. W. (2015). Socio-economic determinants of disease progression among HIV infected adults in Kenya. BMC.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2084-8
3.
Avert. (2019). HIV and AIDS in Kenya.
https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/kenya
4.
The World Bank. (2006). Who gets AIDS and how?
https://openknowledge.worldbank.org/handle/10986/8741?locale-attribute=es
5.
World Health Organization. (2018).
https://www.afro.who.int/health-topics/hivaids
6. the Republic of Kenya. (2020). Revised scheme of service for clinical personnel.
https://www.health.go.ke/wp-content/uploads/2021/02/revised-clinical-sos-final-draft-june-15th-2020-1
Introduction
Kenya is a country that is located on the eastern side of Africa. According to the recent census results conducted in 2019, the country has approximately 50milion people (KNBS, 2020). However, HIV/AIDS is the leading cause of death. HIV/AIDs in Kenya include unprotected sex, unsafe injections, sharing contaminated sharp equipment, and accidental stick injuries.
Justification
According to the National Aids Control Council, the number of new HIV infections in 2021 alone increased by 30 027, while the recorded deaths were 19,486 (NACC, 2021). As of 2016, HIV prevalence was 5.9%, and of that population, 64% were on active treatment while 51% were virally suppressed. (Avert 2019). HIV is also the leading killer disease in Kenya, and it affects both the infected and immediate family members.
Unprotected Anal or Vaginal sex
According to WHO (2021), unprotected anal or vaginal sex is a risk factor for HIV. However, unprotected anal or virginal sex is determined by gender-based violence, poverty, education level, and drug abuse. The majority of those who experience gender-based violence are women. Avert (2019), 33% of the total rape cases in Kenya are experienced by young ladies, while 14% of the married ladies experience sexual abuse. In all cases, no protection was used. Moreover, Gatongi et al. (2015) confirm that family background and culture where women are viewed as inferior to men expose them to unprotected sex. Additionally, statistics from the World Bank show that 36.1% of the Kenyan population lives below the poverty level (World Bank, 2018).
Moreover, education level and drug abuse are other determinants of unprotected sex. Although the government of Kenya offers free primary education, some Kenyans have low education. This is mainly determined by culture, family background, poverty, conflicts, peer pressure, and marginalization. Lack of education inhibits awareness of the importance of having protected sex. Averts 2019 records that in 2014, only 73% and 82% of women and men had knowledge about using protection. However, drug abuse is determined by geographical location, poverty level, stress, marginalization, peer influence, and family background. When people are under the influence of drugs, they tend to be unaware of their environment; thus, they get exposed to unprotected sex.
Unsafe Injections, Blood Transfusions, Tissue Transplantation, Unsterile Cutting/ Piercing
Unsafe injections, blood transfusions, tissue transplantation, and unsterile cutting or piercing risks lead to HIV (WHO, 2021). However, this risk factor is determined by education level and poverty. When people have lower education levels, they tend to be unaware of the risks associated with unsafe injections and other activities that can expose them to HIV (Gatongi et al., 2015). Moreover, poverty forces individuals to seek cheap services of unsafe injections, tissues transplant, blood transfusions, and unsterile cutting or piercing. However, World Bank (2006) and WHO (2018) illustrate that poverty is determined by conflict, marginalization, and rigid culture. The authors also demonstrate that Education level is determined by poverty, rigid culture, conflict, marginalization, family background, and peer influence.
Sharing Contaminated Injecting/Sharp Equipment and Drug Solutions Piercing
Sharing contaminated injecting or sharp equipment and drug solutions piercing is another risk factor of HIV in Kenya (WHO, 2021). However, this kind of sharing is determined by poverty and drug abuse. Poverty limits individuals from acquiring injecting objects such as syringes and drug solutions (Gatongi et al., 2015). As a result, people opt to share to save costs. However, poverty is determined by rigid culture, conflict, and marginalization. However, abuse of drugs is determined by stress, peer influence, geographical location, marginalization, poverty, and family background.
Accidental Needle Stick Injuries
Finally, accidental needle stick injuries are another important risk factor for HIV in Kenya (WHO, 2021). Accidental needle stick injuries are mainly common in hospitals where physicians are dealing with patients who are infected with HIV. Although accidental needle stick injuries are not common, it is determined by drug abuse and profession. When physicians dealing with HIV patients are under the influence of drugs, they may accidentally inject themselves with the sharp objects used by the patients (Avert, 2019). However, drug abuse is caused by poverty, marginalization, peer influence, stress, geographical location, and family background. In a profession such as nursing, doctors, however, exposes individuals who handle sharp objects used by infected people to HIV. A profession is determined by individual risk and academic qualifications (the Republic of Kenya., 2020).
Conclusion
In conclusion, despite the government and international governments putting measures to curb the spread of HIV/ AIDS in Kenya, it is still the leading killer of diseases. Numerous resources have been invested in tackling the disease, thus depriving other sectors of receiving development as they are insufficiently funded since more resources are diverted. Engaging in unprotected sex, unsafe practices, sharing of contaminated injecting or sharp equipment and drug solutions piercing, and accidental needle stick injuries are all risk factors of HIV in Kenya.
References
Avert. (2019). HIV and AIDS in Kenya. https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/kenya
Gatongi, P. M., Lakati, A., Kiarie, J. N., Mutai, K. K., & Gatumia, B. W. (2015). Socio-economic determinants of disease progression among HIV infected adults in Kenya. BMC. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2084-8
Kenya National Bureau of Statistics. (2020). 2019 Kenya population and housing census report. KNBS.
National Aids Control Council. (2021 December, 1). Renewed high level commitment to the HIV response. NACC.
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjH9ZerxMz1AhWj2eAKHZE2DDAQFnoECCMQAQ&url=https%3A%2F%2Fnacc.or.ke%2F&usg=AOvVaw23cZNfpTjjMZmiK-aWatdI
The Republic of Kenya. (2020). Revised scheme of service for clinical personnel. https://www.health.go.ke/wp-content/uploads/2021/02/revised-clinical-sos-final-draft-june-15th-2020-1
The World Bank. (2006). Who gets AIDS and how? https://openknowledge.worldbank.org/handle/10986/8741?locale-attribute=es
WHO. (2021). HIV/AIDS https://www.who.int/news-room/fact-sheets/detail/hiv-aids
World Health Organization. (2018). https://www.afro.who.int/health-topics/hivaids
Root Causes of HIV/AIDS in Kenya
25/
1
/2022
1
Root Cause Diagram
Key
Disease
Risk factors
Determinants of risk factor
Determinants of determinants
School dropout
Lack of sex education
Early marriage
Communism
High illiteracy level
Wife inheritance
uncircumcised
Prostitution
Illegalization policy
Education
Age
Culture
Unprotected Sex
Poverty
FGM
Sharing of personal effects
HIV/AIDs in Kenya
Introduction
Kenya is a country that is located on the eastern side of Africa. According to the recent census results conducted in 2019, the country has approximately 50milion people (KNBS, 2020). The country is one of the diverse countries in east Africa where more than 40 languages are spoken, notwithstanding Kiswahili and English is the official language. Despite the country’s diversity and natural beauty, HIV/AIDS is the leading cause of death. The risk factors of HIV/AIDs in Kenya include having unprotected sex, sharing personal effects, and age.
Justification
According to the National Aids Control Council, the number of new HIV infections in 2021 alone increased by 30 027, while the recorded deaths were 19,486 (NACC, 2021). The national government and international organizations such as USAID and UKAID have invested in reducing the spread of the disease, but it has had minimal impact, especially in the western part of Kenya, where the disease has continued to spread. While the disease affects those infected, the immediate family members and friends suffer immense psychological torture when their loved ones are infected or have perished from HIV/ADS. The Kenyan government health resources also become overstretched as most of the resources that could have been used to improve the standards of living and livelihoods of people are diverted to curbing the effects of HIV/AIDS.
Having Unprotected Sex
Kenyan culture has exposed many people to having unprotected sex. According to KNBS (2020), the country has more than 44 tribes grouped into different categories. Each tribe has its practices that often risk spreading the disease. Ayikukwei et al. (2008) illustrate that HIV is more common in the western part of Kenya and rift valley where communities still practice traditional practices that expose them to unprotected sex. For instance, the men from the Luo tribe were not circumcised. However, Golub et al. (2016) research illustrates that male circumcision can prevent up to 60 % of getting infected. Additionally, wife inheritance is common among the Luo community, where people inherit the wives of their deceased relatives. In rural areas, the number of early marriages continues to thrive as most communities require that young girls get married as soon as they reach their teens. As a result, young girls are married as second and third wives to older men and thus exposed them to early unprotected sexual activities. However, in urban setups, such as Nairobi, Mombasa, Nakuru, and Kisumu, the culture of prostitution has continued to increase despite prostitution being banned in the country (Bhattacharjee et al., 2019).
Sharing of Personal Effects
Poverty promotes sharing of personal effects, leading to the spread of HIV/AIDS. According to the statistics released by the World Bank, the number of people living below the poverty level in Kenya accounts for 36.1% of the total population (World Bank, 2018). Additionally, Kenya being a low middle-income country with a low employment rate, many people live below one dollar per day; hence, they cannot afford some of the personal effects. As a result, people practice communism where they share personal effects such as syringes, razor blades, and other piercing tools. Additionally, in the rift valley and the central provinces, female genital mutilation (FGM) is still widely practiced even though it is considered illegal by the government. Noah (2019) illustrates that due to the illegality of FGM, women who engage in the practice share the tools used in the mutilation of the genital parts. As a result, those who undergo circumcision are exposed to HIV/AIDS.
AGE
Age is another risk factor that helps spread HIV/AIDS. According to Noah (2016), the number of people infected with the disease is high among young people between 15 to 49 years. NACC (2022) asserts that the lack of education causes the spread of HIV among young people in Kenya. Despite the government offering free primary education in Kenya, the number of illiterate people is still high. The high illiteracy levels is caused by school dropout in the country. According to a UNICEF report released in 2021, Kenay has experienced high levels of school dropout in recent years (UNICEF, 2021). Moreover, sex education is not offered to young people as the locals consider the topic taboo. As a result, there is minimal knowledge of safe sex offered to young people. Therefore, illiteracy levels and lack of exposure to sex education make young people vulnerable to HIV/AIDS.
Conclusion
In conclusion, despite the government and international governments putting measures to curb the spread of HIV/ AIDS in Kenya, it is unfortunate that it is still the leading killer of diseases. Numerous resources have been invested in tackling the disease, thus depriving other sectors of receiving development as they are insufficiently funded since more resources are diverted. Engaging in unprotected sex, sharing of personal effects, and age are risk factors of HIV prevalence in Kenya.
References
Ayikukwei, R., Ngare, D., Sidle, J., Ayuku, D., Baliddawa, J., & Greene, J. (2008). HIV/AIDS and cultural practices in western Kenya: the impact of sexual cleansing rituals on sexual behaviors. Culture, health & sexuality, 10(6), 587-599.
Bhattacharjee, P., Musyoki, H. K., Becker, M., Musimbi, J., Kaosa, S., Kioko, J., … & Blanchard, J. F. (2019). HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya. Journal of the International AIDS Society, 22, e25311.
Golub, G., Herman-Roloff, A., Hoffman, S., Jaoko, W., & Bailey, R. C. (2016). The relationship between distance and post-operative visit attendance following medical male circumcision in Nyanza Province, Kenya. AIDS and behavior, 20(11), 2529-2537.
Kenya National Bureau of Statistics. (2020). 2019 Kenya population and housing census report. KNBS.
National Aids Control Council. (2021 December, 1). Renewed high level commitment to the HIV response. NACC.
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjH9ZerxMz1AhWj2eAKHZE2DDAQFnoECCMQAQ&url=https%3A%2F%2Fnacc.or.ke%2F&usg=AOvVaw23cZNfpTjjMZmiK-aWatdI
Noah Pinheiro, Y. A. (2019). Associations between female genital mutilation/cutting and HIV: a review of the evidence. African Journal of AIDS Research, 18(3), 181-191.
Teshome, R., Youjie, W., Habte, E., & Kasm, N. M. (2016). Comparison and association of comprehensive HIV/AIDS knowledge and attitude towards people living with HIV/AIDS among women aged 15-49 in three east African countries: Burundi, Ethiopia and Kenya. J AIDS Clin Res, 7(4), 1-8.
The World Bank. (2018 April, 10). Poverty incidence in Kenya declined significantly, but unlikely to be eradicated by 2030.
https://www.worldbank.org/en/country/kenya/publication/kenya-economic-update-poverty-incidence-in-kenya-declined-significantly-but-unlikely-to-be-eradicated-by-2030
UNICEF. (2021 October, 19). New drive launched to get 250,000 out-of-school children back to class in 16 counties. UNICEF Kenya.
https://www.unicef.org/kenya/press-releases/new-drive-launched-get-250000-out-school-children-back-class-16-counties
Overview
In this activity, you’ll learn how to create a root causes diagram for one specific disease, and then writing about the “causes of the causes” for that disease (e.g., analyzing your diagram in narrative format).
You will post posting your final diagram and text to the class and comment on one other student’s assignment through a peer review exercise.
Step 1: Pick a disease
Go to the Institute of Health Metrics and Evaluation (IHME) website (we will discuss this tool and the data in more depth later), and used the tool called “
GBD Compare (Links to an external site.)
.” Select your country from the drop-down menu and then make sure that the settings for each area match those in the image below.
Under Location, select the country you want to write about. Under Measure, start with Deaths (then later switch it to DALYs to see the listing that incorporates both death and disability—we will cover the DALY in more depth later).
You’ll see a chart illustrating trends over time, as well as which diseases have increased/decreased in ranking since 1990. Choose a disease that is ranked within the top 10 for either deaths or DALYs — one that interests you, and that you think would be interesting to evaluate by thinking about underlying determinants, the “causes of the causes….”
Step 2: Make a Root Causes Diagram
Lecture 2.5 walks you through the research and charting process. You will need to do some research about the disease you selected before making the chart.
Step 3: Write it up! Analyze the diagram in 650-800 words (2-2.5 pages)
Present the research you did to make the diagram in narrative form, using academic language and citations where appropriate. Begin by justifying why you selected the disease you did (see below). Then, present a comprehensive picture of the risk factors and determinants of health that impact that health issue. Be sure to consider the “causes of the causes of the causes.” I am looking for an application of the course concepts from the first week of lectures and readings.
Justifying your selection: The issue you select does not have to be the leading cause of deaths or DALYs (death and disability combined), but you must justify your selection by explaining why the health issue is significant to consider (e.g.: it has the highest impact on years lived with disability; or, while the disease is not among the top 5 causes of DALYs, its incidence has increased significantly over time; or, it is the fastest rising NCD; or, it is a “disease of extreme poverty” that has stubbornly shown the same incidence rates over time even though the country is getting wealthier…) I know it is still early in the course, but I think you can do it!
Tips for this section:
· Be as specific as you can. e.g. if your disease is “accidents and injuries,” rather than saying “physical determinants impact vulnerability to earthquakes,” let me know what the physical determinants actually are. Maybe it is crowded urban housing, poor roads, or a lack of primary care facilities in rural areas, all of which are different kinds of “physical infrastructure.”
· Once you have described a risk factor or higher-level determinant (e.g. hand washing as a behavioral determinant, or earthquakes as a physical determinant), think past it to consider how other issues/factors such as vulnerability, policy making, poverty, etc. impact that determinant. Personal choice or living in an earthquake zone do not fully explain why some people are sick/injured and others are not during an earthquake. Keep the “causes of the causes of the causes” in mind.
· Most risk factors and higher-level determinants have multiple sub-determinants, or causes. Discussing several determinants associated with a single risk factor is a stronger argument. e.g., If you selected heart disease, you would find that risk factors for heart disease include diets high in saturated fats and smoking. In your paper, consider the multiple determinants associated with each of those risk factors. If you only discuss determinants that impact one risk factor, your argument won’t be as strong.
Step 4: Submit!
Submit both your diagram and your research paper.
Assignment Expectations and Grading
Your assignment will be graded according to the following criteria:
Diagram (25%)
1. Diagram is clear visually, easy to read. Risk factors are displayed in ways that differentiates them from determinants (ie a different color)
2. Risk factor listing is comprehensive for the disease — e.g. list ALL risk factors for that disease.
3. Determinants listing is detailed and layered.
Select 4-5 risk factors from your comprehensive list and describe 3-8 determinants for each risk factor. There may be multiple determinants for a single risk factor, but for at least one of those determinants, you should have 3-5 “levels” that reflect your inquiry into the “causes of the causes of the causes.”
· Be sure that your determinants go beyond individual/behavioral/biological determinants to consider a wide range of causes. The determinants is where the important detail of the assignment is located, and this should reflect your understanding of the lectures in Unit 2.
· Since determinants themselves are layered and operate in complex ways, rather than just listing one determinant under a risk factor, list determinants which feed that determinant. You are likely to have many layers of sub-determinants for some risk factors.
4. Determinants accurately display the relationship between risk factors and determinants (ie the determinant is linked to correct risk factor, and sub-layers of determinants are appropriately associated with the next layer of determinants). The links between each level/layer are clear (you may need to write more than a single word to make that connection clear; but sometimes the connection between 2 levels will be obvious. Use your best judgement)
Research paper (75%):
1. Justification of why you selected this particular disease.
2. Paper discusses 2-3 causal chains in the diagram, accurately using the terms and language from lectures and readings.
1. Paper considers the “causes of the causes of the causes” and goes beyond a risk factor or first-order determinant, to think about the sub-determinants.
2. Paper considers the complexity of the relationship between different determinants.
3. In-text citations and a full bibliography, with sources that are reputable and high quality, in APA style, provided at the end of the document.
. Minimum of 5 sources required. (for example, the CDC, the World Health Organization, or other reputable sources).
Another example:
Below is a sample root causes diagram from The Compass, a group that focuses on Social and Behavioral Change for public health. This one is more focused on behaviors than yours will be, but it illustrates the thinking involved in causes-of-the-causes-of-the-causes, or of having multiple layers/levels of determinants:
(Links to an external site.)
Image source:
https://www.thecompassforsbc.org/how-to-guides/how-conduct-root-cause-analysis (Links to an external site.)
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Root Causes Diagram & Paper |
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Criteria |
Ratings |
Pts |
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Paper: Justification of why you selected this particular disease. This should be data-driven. It does not have to be the leading cause of death, but your reader should understand why it is important to know more about the determinants of the disease. |
7 pts Full Marks 0 pts No Marks |
3 / 7 pts |
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Paper discusses 2 causal chains in the diagram in depth, accurately using the terms and language from lectures and readings 1. Paper considers the “causes of the causes of the causes” and goes beyond a risk factor or first-order determinant, to think about the sub-determinants. 2. Paper considers the complexity of the relationship between different determinants 3. Paper may acknowledge behavioral determinants, but then digs deeper to describe the political, social and structural determinants |
5 6 pts Full Marks The discussion on unprotected sex has me concerned that you think “traditional culture” is to blame for unprotected sex, but I don’t see any real facts that would explain that. Wife inheritance is not a reason for the spread of HIV. What source says that it is? This paper seems to be based on your own assumptions and stereotypes rather than real research or studies. NOTHING in the paragraph on “sharing personal effects” seems true or a main cause of HIV, and there are no sources for most of it. |
20 / 56 pts |
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Paper: In-text citations and a full bibliography w min. 5 reputable sources 1. With sources that are reputable and high quality, in APA style, provided at the end of the document. 2. Minimum of 5 sources required (for example, the CDC, the World Health Organization, academic journal articles, or other reputable sources). |
7 / 7 pts |
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Diagram: Risk factors comprehensive, clear visually Risk factors are displayed in ways that differentiates them from determinants (e.g., a different color or shape). Risk factor listing is comprehensive for the disease — list ALL risk factors for that disease. |
6 pts Full Marks 0 pts No Marks Comments risk factors are not comprehensive: |
3 / 6 pts |
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Diagram: Determinants are multi-layered, reflect “causes of the causes of the causes” 1. Select 3-4 risk factors from your comprehensive list and, for each one, list 3-8 sub-determinants. You should have several “sub-levels” or layers to your diagram that reflect your inquiry/research into the “causes of the causes of the causes.” 2. Be sure that your determinants go beyond individual/behavioral/biological determinants to consider a wide range of underlying social, political and structural causes. This should reflect your understanding of the lectures in Units 2 and 3. |
18 pts Full Marks |
9 / 18 pts |
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Diagram: Difference between risk factors and determinants is clear For example, the determinant is linked to correct risk factor, and sub-layers of determinants are appropriately associated with the next layer of determinants. The connections between each level/layer should be clear to the reader. Sometimes the connection between different levels will be obvious, but in other cases you may need to write more than a single word to make that the connection clear; use your best judgement. |
3 pts Full Marks |
0 / 3 pts |
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Diagram: Sources Sources used to make the diagram are listed somewhere on the diagram or next page (hyperlinks are fine, a formal bibliography is only required for the paper) |
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