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UNFORMATTED ATTACHMENT PREVIEW
RESEARCH ARTICLE Determinants of Primary School NonEnrollment and Absenteeism: Results from a Retrospective, Convergent Mixed Methods, Cohort Study in Rural Western Kenya Nia King1*, Cate Dewey1,2, David Borish1 1 Department of Population Medicine, Ontario Veterinary College, Guelph, Ontario, Canada, 2 Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada * nking@mail.uoguelph.ca Abstract OPEN ACCESS Citation: King N, Dewey C, Borish D (2015) Determinants of Primary School Non-Enrollment and Absenteeism: Results from a Retrospective, Convergent Mixed Methods, Cohort Study in Rural Western Kenya. PLoS ONE 10(9): e0138362. doi:10.1371/journal.pone.0138362 Editor: Jacobus van Wouwe, TNO, NETHERLANDS Background Education is a key element in the socioeconomic development required to improve quality of life in Kenya. Despite the introduction of free primary education, primary school enrollment and attendance levels remain low. Drawing on qualitative and quantitative data, this study explores the determinants of non-enrollment and absenteeism in rural western Kenya and potential mitigation strategies to address these issues. Received: March 23, 2015 Methods Accepted: August 27, 2015 The study was conducted in Bwaliro village in rural western Kenya. A random sample of 64 students was obtained by blocking the village primary school’s student population according to grade level, gender, and orphan status. Qualitative and quantitative data were collected through interviews with parents, guardians, and key informants, and focus group discussions with students. Quantitative data were compared using chi-square tests, Student’s T-test, and Poisson regressions. Qualitative data were analyzed using thematic content analysis. Published: September 15, 2015 Copyright: © 2015 King 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. Data Availability Statement: All tabulations of quantitative data are available freely in the manuscript, while restrictions contained in the Research Ethics Board approval render it impossible to make individual data or transcripts available. Instead, if requested, a de-identified qualitative dataset will be made available. Readers are asked to contact Nia King or Karen Richardson (krichard@uoguelph.ca) for this data. Funding: The University of Guelph funded the project. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Results Malaria, menstruation, and lack of money were among the most notable determinants of primary school dropout and absenteeism, and these factors disproportionately impacted orphans and female students. Potential mitigation strategies suggested by the community included provision of malaria treatment or prevention, reduction in education costs, expansion of the established school-feeding program, and provision of sanitary pads. Conclusion Despite free primary education, numerous factors continue to prevent children in rural western Kenya from attending primary school. The findings suggest that interventions should PLOS ONE | DOI:10.1371/journal.pone.0138362 September 15, 2015 1 / 17 Primary School Non-Enrollment and Absenteeism in Rural Western Kenya Competing Interests: Nia King and David Borish have declared that no competing interests exist. Cate Dewey has read the journal’s policy and has declared the following competing interest: she initiated the Children of Bukati project, however, she does not have any financial ties to the project and she did not influence the data collection or the interpretation of the results as presented in this manuscript. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials. primarily target orphaned and female students. Prior to implementation, suggested mitigation strategies should be assessed for cost-effectiveness. Introduction Education is a prerequisite to the socioeconomic development needed to alleviate poverty and improve quality of life. With literacy levels of 90% for men and 83% for women, Kenya is more literate than Sub-Saharan Africa as a whole, which has average levels of 76% for men and 63% for women]. However, with a third of the population having incomplete primary education, Kenya’s labour force lacks the education required to reach its Vision 2030 goals [1–2]. In September 2000, the Kenyan government signed the Millennium Development Goals (MDGs), aimed to combat the many dimensions of poverty, and subsequently developed the Kenya Vision 2030, which aims to make Kenya a middle-income country by 2030 [3–4]. School attendance is an important proxy for educational outcomes; by improving access to education, Kenya would make progress toward achieving both the Vision 2030 Plan and several MDGs including achieving universal primary education, improving food security, promoting gender equality, reducing child mortality, improving maternal health, and reducing the levels of HIV/ AIDS and malaria [2–3,5–7]. The Kenyan government views education as the primary means of socioeconomic development and has therefore identified the challenges to achieving universal primary education [4]. These include: limited community participation, inadequate nutrition and health support services, high drop-out rates, imposition of school levies and other fees, cultural prejudice and negative attitudes towards Orphan and Vulnerable Children (OVCs), and increased numbers of OVCs [4,8–9]. In 2003, the Kenyan government introduced free primary education to cover tuition, however families still shoulder the costs of uniforms, activities, exams, and tuition for the Early Childhood Development (ECD) classes for three to five year old children, which are substantial expenses for poor families with multiple school-aged children [10–14]. Thus, despite the government’s 2012 goal of reducing non-enrollment to 5%, it still stands at 9.1%, in part, due to these costs [15]. Previous studies in Kenya and other Sub-Saharan countries have found that girls, rural children, and impoverished children are at increased risk of being unenrolled [12,16]. As guardians pressure girls to marry because of dowry payments and having fewer dependents, early marriage and teenage pregnancy play significant roles in the high female dropout level [6,10,17]. Gender stereotyping, such as the belief that women do not require an education as they belong in the house supporting the family, can also play a role in the higher dropout level for females [12]. The added responsibilities that orphans must take on, including financial, food, and childcare responsibilities, increase orphans’ dropout risk [1,18–21]. In addition to low enrollment and high dropout levels, absenteeism must be addressed given 11.4% of enrolled Kenyan children were absent on any given day in 2012 [15]. Cost of schooling, parental influence, marriage, pregnancy, menstruation, and household chores are recognized contributors to absenteeism [12,16,22–23]. Lastly, among the preventable medical causes of absenteeism, malaria infection accounts for 13% to 50% of school days missed in Kenya [24]. Various interventions aiming to improve primary school enrollment and attendance have been tested. Comprehensive school support, including food supplementation, school fees, uniforms, and a school-based helper, for orphans in Kenya and Zimbabwe significantly reduced PLOS ONE | DOI:10.1371/journal.pone.0138362 September 15, 2015 2 / 17 Primary School Non-Enrollment and Absenteeism in Rural Western Kenya dropout and absence rates [6,10,18]. The provision of free sanitary pads to schoolgirls in Ghana and Kenya has improved girls’ attendance levels, concentration, and confidence [25– 27]. Halliday et al. (2014) found that school-based intermittent malaria screening and treatment was not effective in improving the health or education of school children, while Aikins (1995) found that impregnating bed nets with insecticides reduced absenteeism due to illhealth [28–29]. In Chile, Dinkelman and Martinez (2014) found that providing students with information about the opportunities available to finance higher education effectively improved primary school attendance [30]. Given the widely recognized positive impacts of school-based feeding programs on school attendance and learning achievements, such programs are beginning to be implemented in many developing countries [31]. While some programs have successfully reduced absenteeism, to the authors’ knowledge, no studies have examined the perceived benefits of education within rural Kenyan communities. There is also little knowledge regarding the determinants of dropouts and absenteeism in rural western Kenya, without which it is difficult to develop effective community-based strategies to address these issues. We therefore examined the community’s perceptions of the benefits of education and the main factors contributing to high non-enrollment and absenteeism levels in Bwaliro village of rural western Kenya. The community’s input regarding possible mitigation strategies was also sought. The findings will be useful to policy makers and stakeholders to develop optimal strategies to improve enrollment and attendance levels in rural western Kenya. Methods Study Area and Population This study was conducted in Bwaliro village, located in Busia County of western Kenya between May and July 2014. Bwaliro village lies in one of Kenya’s poorest regions: 66.7% of Busia County’s population lives below the poverty line and 76% is food insecure [32–33]. Subsistence farming is the main economic activity; all families rely on their plot of farming land, or shamba, as a food and/or income source. Western Kenya has the second highest HIV/AIDS prevalence (6.6%) in all Kenyan regions, resulting in a large orphan population who is at increased risk of dropping out of school or being absent [1–2,34]. Malaria was the most common disease treated at the local dispensary in patients over the age of five years. This study was centered on Bwaliro village’s public primary school: Bwaliro Primary School. School administrators have identified approximately 35% of the Bwaliro students as OVCs. In 2010, the Children of Bukati Organization partnered with the school to establish a feeding and agro-forestry program [35]. All students from ECD to grade 3, in addition to OVCs from grades 4 to 8, are fed a lunch of githeri (boiled maize and beans) on a triweekly basis. Additionally, students in grade 8 bring in their own food to cook a daily communal lunch. Yields from the agro-forestry program are used to subsidize the feeding program. Many children travel from neighbouring villages to be involved in these programs. Recruitment and Participants We conducted a retrospective, convergent mixed methods, cohort study [36]. Students from grades 1 to 8 were blocked by grade, OVC status, and gender. Four students from each block were selected, including two replacements, using simple random sampling as follows. Teachers provided class lists divided by OVC status and gender. Students were numbered and four random numbers per block were selected. If multiple students who cited the same guardian were chosen, only one was included, and other randomly chosen students replaced the excluded ones. The researchers visited the selected students’ households. Upon arrival, the interpreter PLOS ONE | DOI:10.1371/journal.pone.0138362 September 15, 2015 3 / 17 Primary School Non-Enrollment and Absenteeism in Rural Western Kenya explained the project and asked if the parent or guardian (henceforth referred to as guardians) was willing to participate. The first two students in each block whose guardian was available and willing to be interviewed were included, yielding a total of 64 students (32 OVCs and 32 NOVCs). The sample size of 64 guardians was based on an estimate of 0.7 days absent for NOVCs and of 1.6 days for OVCs. We expected a similar difference between boys and girls, respectively. Based on a variance of 1.2 days, a power of 80%, and a significance level of 0.05, approximately 28 participants were required in each category. Female guardians were interviewed, as traditionally females are responsible for childcare. If there was no female adult living in the household, the adult male was interviewed. OVCs were categorized based on which parent died, and guardians were categorized based on their relationship with the child. All guardians were willing to participate. No compensation was offered. Key informant interviews were conducted with the principal, four teachers, the village chief, the District Education Officer, a church official, and two local nurses. The 24 grade 6 to 8 students whose guardians had been interviewed were invited to participate in focus group discussions (FGDs). All of these students participated. Interview Approach The data were collected using a household questionnaire through a local interpreter who spoke either Kimarachi (the local vernacular language) or Kiswahili, depending on the guardian’s preference. The questionnaire was written by the authors in English. Questions were translated into both Kimarachi and Kiswahili by one interpreter and were then back translated by another interpreter to ensure that the meaning of the question was maintained. The questionnaire was piloted in 20 randomly selected village households; appropriate changes were made thereafter. The opening questions addressed independent variables. Household-level variables were: selfreported household income and number of days the randomly chosen child was absent from school within the previous two weeks. Guardian level variables were: age, gender, and level of education. Next, the questionnaire asked open-ended questions regarding perceived level of community support for education, perceived benefits of education, determinants of dropout and absenteeism, potential mitigation strategies, and the impacts of pre-established programs on students’ education. During the interview process, the interpreter would ask the question, listen to the answer, and then translate the response for the first author who transcribed the answers. Interviews were conducted within the guardian’s compound and typically lasted between 30 and 40 minutes. Key informant interviews were conducted in English, since all respondents were fluent in English. Key informants were asked about the level of community support for education, perceived benefits of education, determinants of dropout and absenteeism, potential mitigation strategies, and observed impacts of pre-established school programs. These interviews were conducted in the informant’s office, classroom, or home, depending on the interviewee. No repeat interviews were conducted. A review of the notes showed that after these interviews, data saturation had been reached. All interviews were audio recorded and recordings were referenced to ensure accurate transcription. The first and third authors, who had been trained by the second author in interview methodology, conducted all interviews. Transcripts were not returned to participants; however, results were sent to the interpreters to confirm accuracy. Initial findings were shared with the community at a community gathering to obtain feedback. School enrollment and exam results were also obtained from the school’s records. PLOS ONE | DOI:10.1371/journal.pone.0138362 September 15, 2015 4 / 17 Primary School Non-Enrollment and Absenteeism in Rural Western Kenya Focus-Group Approach The first author conducted the FGDs and was trained in facilitation using The Focus Group Kit [37]. The first author had been integrated into the school community for over a month prior to starting FGDs. To ensure open discussion, FGDs were conducted according to gender, grade, and OVC status, yielding a total of six FGDs. The FGDs took place in a private setting at school, intentionally not within a classroom, to foster an open dialogue. At the outset of the FGD, the researcher explained the purpose of the study, and all participants gave verbal assent. The participants were instructed that the discussion could be held in any language and typically English, with intermittent Kiswahili, was used. Participants were informed that all information was confidential and that if they felt uncomfortable at any time they could choose to skip the question or leave the discussion. All FGDs were audio recorded with permission. Local high school graduates acted as moderators; a female moderator was used for the female FGDs and a male for the male groups. Both moderators were fluent in Kimarachi, Kiswahili, and English and were given moderation training by the first author. The first author acted as a note taker to capture the key issues raised. Each discussion lasted for 45 to 60 minutes. In order to standardize the FGDs, a broad open-ended question guide was formulated. Topics included: benefits of education, reasons for dropout and absenteeism, family and community support of education, and feeding program impacts. For the female groups, menstruation was also included as a topic. At the conclusion of the FGDs, the moderator and researcher debriefed the FGD to ensure that the notes were comprehensive and accurate. A review of the notes showed that after these six FGDs, data saturation had been reached. Transcripts were not returned to participants. Analysis Key informant interview and student FGD qualitative data were independently analyzed using inductive thematic content analysis [38]. The first and third authors coded the data using semantic themes and sub-themes to ensure consistency and accuracy [38]. Open-ended question responses from guardians were not blocked during analysis, as most guardians were caring for both OVCs and NOVCs, and girls and boys. As such, it was impossible to separate these responses according to OVC status or gender. Given FGDs were conducted according to OVC status and gender, these data were already blocked as necessary. Household and guardian level quantitative data were blocked by OVC status and gender, and results from these groups were compared to investigate differences in the number of days absent. Chi-square tests were used to compare OVC versus NOVC status and girls versus boys for proportional data including guardian category. Student’s T-tests were used to compare OVC and NOVC status and guardian education attained for normally distributed data including self-reported household income. Poisson regressions were used to compare OVC versus NOVC status, girls versus boys, and guardian category for count data including number of school days absent and number of school days absent for particular reasons. Significance level was set at α
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