Christian Aid-UK, P. O. Box 13864-00800, Nairobi, Kenya.
Kenya Nutritionists and Dieticians Institute, P. O. Box 20436-00100, Nairobi, Kenya.
BMC Public Health. 2020 Apr 19;20(1):537. doi: 10.1186/s12889-020-08690-w.
During pregnancy or lactating, adequate nutrition for adolescents becomes critical to reduce risks for both child and maternal-related morbidity and mortality. Power dynamics play a massive role in health outcomes. The main objective of this study was to examine the power dynamics in the families and communities and their impact on the pregnant and lactating adolescent girls' access and utilization of nutrition services in Trans-Mara East Sub-County, Narok County.
A cross-sectional approach that employed mixed methods with both quantitative and qualitative research was adopted. Probability proportionate to size sampling techniques using cluster and simple random methods were used to practically access pregnant or lactating adolescents. Data was collected using questionnaires, in-depth interview and Focus Group Discussion. Quantitative data was analyzed descriptively using frequencies and inferentially using odds ratio and Z-test. Framework analysis was employed to analyze qualitative data. P ≤ 0.05 was considered statistically significant.
In the power dynamics analyses, the intrinsic capability (Intrinsic capabilities are those adolescent driven initiatives that facilitate their access to nutrition services) was more likely to decrease awareness by half (OR = 0.52, 95% CI = 0.4-0.7, P < 0.01) whereas extrinsic dependency was likely to increase utilization by 1.2 times (OR = 1.2, 95% CI = 1.0-1.5, P = 0.055). From the stakeholder power matrix, the health personnel had observable visible power to influence access and utilization of nutrition services. Additional results revealed that adolescents who draw their support from significant others were more likely to utilize nutrition services as compared to those who attempted to make their own efforts to seek these services. Furthermore, health personnel have the most influential powers in ensuring adolescents access services and thus the most important actors in the stakeholder matrix. Other actors requiring focus included parents, political figures and governments while stakeholder engagement have higher potential of increasing access and utilization of services through dialogue.
Community access to nutritional services can be increased through use of multiple avenues to reach adolescents, including school-based, health system-based, community-based approaches and even marriage registries. A heightened engagement in the identified stakeholder network is necessary when planning community conversations, to ensure a multi-stakeholder approaches in meeting the nutrition needs of adolescents.
在妊娠或哺乳期，青少年获得充足的营养对于降低母婴相关发病率和死亡率至关重要。权力动态在健康结果中起着重要作用。本研究的主要目的是研究家庭和社区中的权力动态及其对跨马拉东县纳罗克县怀孕和哺乳期少女获得和利用营养服务的影响。
采用横断面方法，结合定量和定性研究，采用混合方法。使用集群和简单随机方法的概率比例抽样技术用于实际接触怀孕或哺乳期青少年。使用问卷、深入访谈和焦点小组讨论收集数据。使用频率进行定量数据分析，使用优势比和 Z 检验进行推断性分析。采用框架分析法分析定性数据。P≤0.05 被认为具有统计学意义。
在权力动态分析中，内在能力（内在能力是指促进青少年获得营养服务的主动性）更有可能使意识降低一半（OR=0.52，95%CI=0.4-0.7，P<0.01），而外在依赖则更有可能使利用率增加 1.2 倍（OR=1.2，95%CI=1.0-1.5，P=0.055）。从利益相关者权力矩阵来看，卫生人员拥有影响营养服务获取和利用的可观察到的可见权力。额外的结果表明，与那些试图自己寻求这些服务的青少年相比，从重要他人那里获得支持的青少年更有可能利用营养服务。此外，卫生人员在确保青少年获得服务方面拥有最具影响力的权力，因此是利益相关者矩阵中最重要的角色。其他需要关注的角色包括父母、政治人物和政府，而利益相关者的参与通过对话具有提高服务获取和利用的更高潜力。
通过多种途径为青少年提供营养服务，包括以学校为基础、以卫生系统为基础、以社区为基础的方法，甚至婚姻登记处，都可以增加社区获得营养服务的机会。在规划社区对话时，需要更深入地参与到确定的利益相关者网络中，以确保采取多利益相关者方法满足青少年的营养需求。
