title: Spatial modelling and mapping of female genital mutilation in Kenya.
abstract: BACKGROUND
  Female genital mutilation/cutting (FGM/C) is still prevalent in several communities in Kenya and other areas in Africa, as well as being practiced by some migrants from African countries living in other parts of the world. This study aimed at detecting clustering of FGM/C in Kenya, and identifying those areas within the country where women still intend to continue the practice. A broader goal of the study was to identify geographical areas where the practice continues unabated and where broad intervention strategies need to be introduced.
  
  
  METHODS
  The prevalence of FGM/C was investigated using the 2008 Kenya Demographic and Health Survey (KDHS) data. The 2008 KDHS used a multistage stratified random sampling plan to select women of reproductive age (15-49 years) and asked questions concerning their FGM/C status and their support for the continuation of FGM/C. A spatial scan statistical analysis was carried out using SaTScan™ to test for statistically significant clustering of the practice of FGM/C in the country. The risk of FGM/C was also modelled and mapped using a hierarchical spatial model under the Integrated Nested Laplace approximation approach using the INLA library in R.
  
  
  RESULTS
  The prevalence of FGM/C stood at 28.2% and an estimated 10.3% of the women interviewed indicated that they supported the continuation of FGM. On the basis of the Deviance Information Criterion (DIC), hierarchical spatial models with spatially structured random effects were found to best fit the data for both response variables considered. Age, region, rural-urban classification, education, marital status, religion, socioeconomic status and media exposure were found to be significantly associated with FGM/C. The current FGM/C status of a woman was also a significant predictor of support for the continuation of FGM/C. Spatial scan statistics confirm FGM clusters in the North-Eastern and South-Western regions of Kenya (p<0.001).
  
  
  CONCLUSIONS
  This suggests that the fight against FGM/C in Kenya is not yet over. There are still deep cultural and religious beliefs to be addressed in a bid to eradicate the practice. Interventions by government and other stakeholders must address these challenges and target the identified clusters.
authors.affiliation: School of Public Health, University of Witwatersrand, Johannesburg, South Africa. thomas.achia@wits.ac.za.
authors.forename: Thomas N O
authors.initials: TN
authors.lastname: Achia
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D001294:Attitude to Health; D019093:Circumcision, Female / Q000706:statistics & numerical data*; D003469:Culture; D003710:Demography; D005260:Female; D005836:Genitalia, Female; D006306:Health Surveys; D006801:Humans; D007630:Kenya; D008875:Middle Aged; D015995:Prevalence; D012067:Religion; D012098:Reproduction; D012424:Rural Population; D012959:Socioeconomic Factors; D014171:Transients and Migrants; D055815:Young Adult