Factors Associated with Health Seeking Behaviour for Reproductive Tract Infections among Young Street Females in Eldoret, Kenya

Reproductive tract infections (RTIs), among young women is a public health concern, especially in developing countries like Kenya. When a reproductive tract infection occurs, urgent treatment should be done to avoid short-and long-term consequences. However, few studies have evaluated factors associated with RTIs and healthcare seeking behaviors especially, among young street women in low and middle-income countries. This study aimed at determining the factors associated with healthcare seeking behavior for RTI infections among young street females in Eldoret town in Kenya. Descriptive cross-sectional study design was used. The study participants were young street females aged between 10-24 years. The independent variables were age, education, occupation, marital status, and healthcare associated factors such as distance to the facility, and health care perspectives on reproductive health were assessed. Informed consent was obtained from participants while assent was obtained from guardians for minors and persons in charge of street families. A total of 77 young street females were enrolled. Those aged ≤15 years were 10 (13%) while those aged ≥ 20 years were 48 (62.3%). The study established that participants aged between 16 to 19 years were less likely to report having had an RTI compared to those aged between 20 to 24 years (95% CI; 0.216 (0.070-0.671), p=0.006). Majority had heard of RTI (62, 80.5%). Out of the fifty respondents (65%) who reported having ever experienced RTI in their lifetime, 36 (72%) sought treatment for the illness with 46 respondents (94%) seeking treatment after two days post-onset of symptoms. Additionally, the main first points of seeking treatment were pharmacies (21, 43%) and health facilities (25, 51%). The study findings show there’s a high burden of RTIs among young street females in Eldoret.


I. INTRODUCTION
Reproductive tract infections (RTIs) impact millions of women worldwide.They are a collection of infectious and non-infectious diseases of the reproductive tract and share common symptoms such as vaginal itching and discharge (Rabiu et al., 2010).RTIs may predispose to spontaneous abortion, pelvic inflammatory disease, increased risk of human immunodeficiency virus infections and preterm delivery (Isik et al., 2016& Kerubo et al., 2016).The risk of RTIs is high among women in the reproductive age group (Geetha, 2014).Several factors such as health education, shame associated with RTIs, life stage, personal health decision making, and accessibility to healthcare resources are associated with the likelihood to seek medical treatment for RTIs and other gynecological issues (Nagarkar et al., 2015).
Concerted efforts should be put in place to enhance the healthcare seeking behavior for RTIs.In the developing countries where the World Health Organization documents that about 200 million RTIs occur as a result of sexually transmitted pathogens, there is a paucity of data regarding reproductive health care seeking behavior among women, especially young street females.Documenting the general healthcare seeking behavior could offer insights into the relationship that young street females have with public health systems for gender-specific diseases could help in designing effective interventions.This study aimed at identifying the factors associated with healthcare seeking behavior, among young street females in Eldoret, Kenya.

A. Study area
The study was carried out within Eldoret municipality; a rapidly growing cosmopolitan town in the western part of Rift valley, Kenya.An estimation of over fifty percent of the population live under the poverty line, exceeding the national average of 47.2% (Embleton et al., 2018& Braitstein et al., 2018).The municipality of Eldoret has a population of approximately 130 young street females.A study done in Eldoret to investigate the burden of STIs among young street females found out that the burden of STIs was high at 54% as compared to that of males which was found to be at 9% (Winston et al., 2015).

B. Research design
This was a descriptive cross sectional study design that used both qualitative and quantitative approaches.An assessment of factors associated with health seeking behavior was done in relation to independent variables of the study.Interviewer structured questionnaires were used to collect quantitative data from the 77 respondents while a key informant guide was used to collect qualitative data from the persons in charge on the health seeking behavior of the Young Street Females.

C. Study population
The study population composed of young street females aged between 10-24years, who spent both nights and days in the street and those spending days only.Street children in Eldoret municipality exist in small communities or homes called barracks/bases.

D. Data collection
The study employed snow balling to select eligible participants who were aged 10-24 years, and had spent at least two months in the streets and were ready to consent for study.The study used guides to collect data, which was then entered into a computer using a software SPSS v.21.Descriptive statistics such as percentages, mean and frequencies were used to describe the health seeking behavior of young street females on RTIs.Odds ratio was used to assess the association between the variables (factors associated with the health seeking behavior) of the study.Qualitative data from key informant guides was categorized into themes and the most common narrative was quoted.We obtained ethical approval from Mount Kenya University ethics and review committee and informed consent and assent was obtained from the participants.

A. Characteristics of study participants
A total of 77 young street females in Eldoret, Kenya were enrolled in this study.Table 4.1 shows their socio-demographic characteristics.The mean age of the study participants was 20.2±3.52 years.Those below 15 years were ten (13%) while those above twenty years were 48 (62.3%).

B. Reproductive tract infection health seeking behaviors among young street children
Table 2 shows the Reproductive tract illness attributes and health seeking behaviors of the study participants.Majority had heard of RTI (62, 80.5%).The most frequently mentioned sources of information on the RTI were friends, colleague and family members (47, 64%) and health promotion educators (22, 30%).Out of the fifty respondents (65%) who reported having ever experienced RTI in their lifetime, 36 (72%) sought treatment for the illness with 46 respondents (94%) seeking treatment after two days post-onset of symptoms.Further, 29 (38%) and nine (12%) respondents said they had one and two RTI, respectively, in their lifetime.
Those who sought treatment in the early stages (onset of symptoms) and advanced stage of disease, were 10 (20%) and 28 (57%) respectively.Additionally, the main first points of seeking treatment were pharmacies (21, 43%) and health facilities (25, 51%).Thirteen respondents (27%) did not complete the prescribed course of treatment.

C. Sexual practices among young street females
Table 3 below shows results for sexual practices and related characteristics.The findings shows that most respondents (45.5%) had their first sexual encounter at the age below 15 years and 59.7% had one sexual partner.Condom usage seemed low with 61% of the respondents admitting to not having used it during their sexual encounter with their partners.The major reason for not using condom was revealed to be the trust they had on their partners.

D. Health facility attributes
Table 4 shows selected attributes related to access to health services.Majority (93.5%) of the study participants were not able to afford health care services.Regarding distance to the healthcare facility, 14.3% of the respondents lived at less than 5 kilometers to the healthcare facility while 11.7% lived at a distance of more than 7 kilometers to the healthcare facility.

E. Factors associated with RTIs among the young street females
Table 5 shows the associations between RTIs and socio-demographic characteristics.
Participants aged between 16 to 19 years were less likely to report having had an RTI compared to those aged between 20 to 24 years (95% CI; 0.216 (0.070-0.671), p=0.006).The odds for having had an RTI with a primary school education level were (OR 18.000 CI (1.242-260.918),p=0.036) while the odds for having had an RTI with a secondary school education level was (OR 11.647 CI (2.279-59.517),p=0.001).A significantly higher proportion (80.5%) of married respondents reported having had an RTI in their lifetime (OR 4.610 (95% CI 1.675 -12.687), p=0.002).Socio-demographic variables such as occupation, residency status and locality were not significantly associated with RTIs.Approximately four out of 5 study participants had primary school education.This has been one of the characteristics of street families.This perhaps is because their families lack enough money to support them through the school period and hence may not finish or may not further their studies after the primary level of education (Cumber et al, 2015).These results agree with a study done by Cumber and colleagues (2015), among the street families in Africa where 70% had primary school education levels.Approximately four out of every five respondents had some information about RTIs and most mentioned sources were friends, colleague and family members.This finding is similar to that of Rabiu et al. (2010) among women in Nigeria where they concluded that most women (77.2%) had information on RTIs.Studies have shown that having connections with guardians/parents/caregivers is associated with youth seeking information regarding RTI (Barman-Adhikar and Rice, 2011).This finding is in line with the study done by Desmennu and colleagues among street youth where the results revealed that the young street females had a lot of information regarding RTIs but they could not identify the various types of these infections (Desmennu et al, 2018).Rabiu and colleagues in their study concluded that despite women having heard about RTIs, they still demonstrated poor understanding on the complications and how to manage the problem (Rabiu et al, 2010).
The findings showed that more than half of the respondents had experienced RTI in their lifetime.This finding were differed with that of a study done in Nigeria by Rabiu et al. (2010) where only 37% of the respondents had experienced RTIs.This perhaps is because the environmental conditions of these groups present difference in level of vulnerability.Of the group that had ever experienced RTIs, approximately four out of every five respondents had sought treatment for the illness more than two days after commencement of symptoms.Most (57%) sought treatment at the advanced stages of the disease followed by those (20%) who sought at the early onset of symptoms.Similar results were reported in Punjab where more than 80% of the study subjects sought care for RTIs (Mamta & Kaur, 2014).Additionally, the main first points of seeking treatment were health facilities (51%) followed by pharmacies (43%)..This is similar to the study done in Nigeria where it was found that most respondents