Background The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city. Methods The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program. Results Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance. Conclusions The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities
Amendah, Djesika D.; Buigut, Steven; Mohamed, Shukri
Aims In Kenya, it is estimated that 60 to 80% of urban residents live in slum or slum-like conditions. This study investigates expenditures patterns of slum dwellers in Nairobi, their coping strategies and the determinants of those coping strategies. Method We use a dataset from the Indicator Development for Surveillance of Urban Emergencies (IDSUE) research study conducted in four Nairobi slums from April 2012 to September 2012. The dataset includes information related to household livelihoods, earned incomes of household members, expenditures, shocks, and coping strategies. Results Food spending is the single most important component, accounting for 52% of total households' income and 42% of total expenditures. Households report a variety of coping strategies over the last four weeks preceding the interview. The most frequently used strategy is related to reduction in food consumption, followed by the use of credit, with 69% and 52% of households reporting using these strategies respectively. A substantial proportion of households also report removing children from school to manage spending shortfalls. Formal employment, owning a business, rent-free housing, belonging to the two top tiers of income brackets, and being a member of social safety net reduced the likelihood of using any coping strategy. Exposure to shocks and larger number of children under 15 years increased the probability of using a coping strategy. Policy Implications Policies that contain food price inflation, improve decent-paying job opportunities for the urban poor are likely to reduce the use of negative coping strategies by providing urban slum dwellers with steady and reliable sources of income. In addition, enhancing access to free primary schooling in the slums would help limit the need to use detrimental strategies like “removing” children from school. PMID:24427272
Izugbara, Chimaraoke O
It is still a small body of research that directly addresses female sex workers' relationships with their regular commercial male partners. I used ethnographic data from Nairobi, Kenya to interrogate motivations and strategies for recruiting and retaining regular male clients among female sex workers (FSWs). Regular commercial male partners, popularly called customer care, wera or wesh by Nairobi's FSWs, played diverse roles in their lives. Client retention enabled sex workers to manage the risk of reduced marriage prospects, guaranteed them steady work, livelihoods, and incomes, and prevented their victimization and harassment. To retain clients, sex workers obliged them a great deal, pretended they had quit prostitution, and sometimes resorted to magical practices. However, these strategies were also accompanied by risks that reinforced the vulnerability of sex workers. Lack of critical attention to sex workers' practices for managing perceived risks in their particular type of work may hamper current programmatic efforts to make their job safer.
Musyoki, Helgar; Kellogg, Timothy A; Geibel, Scott; Muraguri, Nicholas; Okal, Jerry; Tun, Waimar; Fisher Raymond, H; Dadabhai, Sufia; Sheehy, Meredith; Kim, Andrea A
We conducted a respondent driven sampling survey to estimate HIV prevalence and risk behavior among female sex workers (FSWs) in Nairobi, Kenya. Women aged 18 years and older who reported selling sex to a man at least once in the past 3 months were eligible to participate. Consenting FSWs completed a behavioral questionnaire and were tested for HIV and sexually transmitted infections (STIs). Adjusted population-based prevalence and 95 % confidence intervals (CI) were estimated using RDS analysis tool. Factors significantly associated with HIV infection were assessed using log-binomial regression analysis. A total of 596 eligible participants were included in the analysis. Overall HIV prevalence was 29.5 % (95 % CI 24.7-34.9). Median age was 30 years (IQR 25-38 years); median duration of sex work was 12 years (IQR 8-17 years). The most frequent client-seeking venues were bars (76.6 %) and roadsides (29.3 %). The median number of clients per week was seven (IQR 4-18 clients). HIV testing was high with 86.6 % reported ever been tested for HIV and, of these, 63.1 % testing within the past 12 months. Of all women, 59.7 % perceived themselves at 'great risk' for HIV infection. Of HIV-positive women, 51.0 % were aware of their infection. In multivariable analysis, increasing age, inconsistent condom use with paying clients, and use of a male condom as a method of contraception were independently associated with unrecognized HIV infection. Prevalence among STIs was low, ranging from 0.9 % for syphilis, 1.1 % for gonorrhea, and 3.1 % for Chlamydia. The data suggest high prevalence of HIV among FSWs in Nairobi. Targeted and routine HIV and STI combination prevention strategies need to be scaled up or established to meet the needs of this population.
Kinney, Patrick L; Gichuru, Michael Gatari; Volavka-Close, Nicole; Ngo, Nicole; Ndiba, Peter K; Law, Anna; Gachanja, Anthony; Gaita, Samuel Mwaniki; Chillrud, Steven N; Sclar, Elliott
Motor vehicle traffic is an important source of particulate pollution in cities of the developing world, where rapid growth, coupled with a lack of effective transport and land use planning, may result in harmful levels of fine particles (PM(2.5)) in the air. However, a lack of air monitoring data hinders health impact assessments and the development of transportation and land use policies that could reduce health burdens due to outdoor air pollution. To address this important need, a study of traffic-related PM(2.5) was carried out in the city of Nairobi, Kenya, a model city for sub-Saharan Africa, in July 2009. Sampling was carried out using portable filter-based air samplers carried in backpacks by technicians on weekdays over two weeks at several sites in and around Nairobi ranging from high-traffic roadways to rural background. Mean daytime concentrations of PM(2.5) ranged from 10.7 at the rural background site to 98.1 μg/m(3) on a sidewalk in the central business district. Horizontal dispersion measurements demonstrated a decrease in PM(2.5) concentration from 128.7 to 18.7 μg/m(3) over 100 meters downwind of a major intersection in Nairobi. A vertical dispersion experiment revealed a decrease from 119.5 μg/m(3) at street level to 42.8 μg/m(3) on a third-floor rooftop in the central business district. Though not directly comparable to air quality guidelines, which are based on 24-hour or annual averages, the urban concentrations we observed raise concern with regard to public health and related policy. Taken together with survey data on commuting patterns within Nairobi, these results suggest that many Nairobi residents are exposed on a regular basis to elevated concentrations of fine particle air pollution, with potentially serious long-term implications for health.
Kinney, Patrick L.; Gichuru, Michael Gatari; Volavka-Close, Nicole; Ngo, Nicole; Ndiba, Peter K.; Law, Anna; Gachanja, Anthony; Gaita, Samuel Mwaniki; Chillrud, Steven N.; Sclar, Elliott
Motor vehicle traffic is an important source of particulate pollution in cities of the developing world, where rapid growth, coupled with a lack of effective transport and land use planning, may result in harmful levels of fine particles (PM2.5) in the air. However, a lack of air monitoring data hinders health impact assessments and the development of transportation and land use policies that could reduce health burdens due to outdoor air pollution. To address this important need, a study of traffic-related PM2.5 was carried out in the city of Nairobi, Kenya, a model city for sub-Saharan Africa, in July 2009. Sampling was carried out using portable filter-based air samplers carried in backpacks by technicians on weekdays over two weeks at several sites in and around Nairobi ranging from high-traffic roadways to rural background. Mean daytime concentrations of PM2.5 ranged from 10.7 at the rural background site to 98.1 μg/m3 on a sidewalk in the central business district. Horizontal dispersion measurements demonstrated a decrease in PM2.5 concentration from 128.7 to 18.7 μg/m3 over 100 meters downwind of a major intersection in Nairobi. A vertical dispersion experiment revealed a decrease from 119.5 μg/m3 at street level to 42.8 μg/m3 on a third-floor rooftop in the central business district. Though not directly comparable to air quality guidelines, which are based on 24-hour or annual averages, the urban concentrations we observed raise concern with regard to public health and related policy. Taken together with survey data on commuting patterns within Nairobi, these results suggest that many Nairobi residents are exposed on a regular basis to elevated concentrations of fine particle air pollution, with potentially serious long-term implications for health. PMID:21779151
Gatari, Michael; Lavrich, Richard; Preston, Bill; Gaita, Samuel; Hays, Michael
Tropospheric aerosols have adverse implications on human health, climate, and visibility. Particles in combustion source emissions have complex physical and chemical characteristics. They regularly contain Polycyclic Aromatic Hydrocarbons (PAH) molecules that can be harmful to human health. Combustion particles in the atmosphere can acts as mutagens or carcinogens and tend to be in the PM2.5 size range (particles with aerodynamic diameters of 2.5 μm or less) and are thus able to access the alveolar region of the respiratory system. Much of the urban carbonaceous aerosol is related to traffic emissions. Generally, particle concentration levels and the abundance of molecular species in atmospheric aerosols are not well studied in developing countries. This study is the first to investigate hydrocarbons (HC) levels in the city of Nairobi, Kenya. The human population in Nairobi is increasing rapidly as is the use of on-road vehicles. Total-suspended particle matter (PM35) in Nairobi air was collected for 24h on quartz fiber filters using a high volume sampler (flow rate = 1130 LPM). The sampling system was used in earlier U.S. air pollution studies but was donated in 1997 by California Air Research Board (CARB) USA to the University of Nairobi's Institute of Nuclear Science & Technology via a World Health Organization (WHO) twinning program. The sampler was placed 20 m above the Earth's surface in a Main Campus building at the University of Nairobi. USEPA analyzed the particle mass for organic markers using direct thermal extraction-gas chromatography mass spectrometry (GC- MS). A thermal optical method was used for determination of the organic (OC) and elemental (EC) carbon in the PM. Ten samples was analyzed for roughly sixty-four HC species. Four filter samples were taken in August and six in October 2006. Of these species, 21 to 26 were PAH. The results show different concentrations between August and October depicting the influence of a regional aerosol. The
Korir, Anne; Okerosi, Nathan; Ronoh, Victor; Mutuma, Geoffrey; Parkin, Max
Cancer incidence rates are presented for the Nairobi Cancer Registry, a population-based cancer registry (PBCR) covering the population of the capital city of Kenya (3.2 million inhabitants in 2009). Case finding was by active methods, with standard and checks for accuracy and validity. During the period 2004-2008 a total of 8,982 cases were registered comprising 3,889 men (an age standardized incidence rate (ASR) of 161 per 100,000) and 5,093 women (ASR 231 per 1,00,000). Prostate cancer was the most common cancer in men (ASR 40.6 per 100,000) while breast cancer was the most common among women (ASR 51.7 per 100,000). Cervical cancer ranked the second most common cancer among women in Nairobi with an ASR of 46.1 per 100,000, somewhat lower than those of other registries in East Africa region. Breast and cervical cancers accounted for 44% of all cancers in women. Cancer of the oesophagus was common in both sexes, with a slight excess of cases in men (sex ratio 1.3). Unlike other regions in East Africa, the rate of Kaposi sarcoma was relatively low during the period (men 3.6/100,000; women 2.0/100,000). Although incidence rates cannot be calculated for the early years of the registry, the increase in relative frequency of prostate cancer and declines in frequency of Kaposi sarcoma may indicate underlying trends in the risk of these cancers.
Kimani, Joshua; McKinnon, Lyle R.; Wachihi, Charles; Kusimba, Judith; Gakii, Gloria; Birir, Sarah; Muthui, Mercy; Kariri, Anthony; Muriuki, Festus K.; Muraguri, Nicholas; Musyoki, Helgar; Ball, T. Blake; Kaul, Rupert; Gelmon, Lawrence
Accurate program planning for populations most at risk for HIV/STI acquisition requires knowledge of the size and location where these populations can best be reached. To obtain this information for sex workers operating at 137 hotspots in the central business district (CBD) in Nairobi, Kenya, we utilized a combined mapping and capture-recapture enumeration exercise. The majority of identified hotspots in this study were bars. Based on this exercise, we estimate that 6,904 male and female sex workers (95% confidence intervals, 6690 and 7118) were working nightly in the Nairobi CBD in April 2009. Wide ranges of captures per spot were obtained, suggesting that relatively few hot spots (18%) contain a relatively high proportion of the area's sex workers (65%). We provide geographic data including relatively short distances from hotspots to our dedicated sex worker outreach program in the CBD (mean<1 km), and clustering of hotspots within a relatively small area. Given the size covered and areas where sex work is likely taking place in Nairobi, the estimate is several times lower than what would be obtained if the entire metropolitan area was enumerated. These results have important practical and policy implications for enhancing HIV/STI prevention efforts. PMID:23372713
Kimani, Joshua; McKinnon, Lyle R; Wachihi, Charles; Kusimba, Judith; Gakii, Gloria; Birir, Sarah; Muthui, Mercy; Kariri, Anthony; Muriuki, Festus K; Muraguri, Nicholas; Musyoki, Helgar; Ball, T Blake; Kaul, Rupert; Gelmon, Lawrence
Accurate program planning for populations most at risk for HIV/STI acquisition requires knowledge of the size and location where these populations can best be reached. To obtain this information for sex workers operating at 137 hotspots in the central business district (CBD) in Nairobi, Kenya, we utilized a combined mapping and capture-recapture enumeration exercise. The majority of identified hotspots in this study were bars. Based on this exercise, we estimate that 6,904 male and female sex workers (95% confidence intervals, 6690 and 7118) were working nightly in the Nairobi CBD in April 2009. Wide ranges of captures per spot were obtained, suggesting that relatively few hot spots (18%) contain a relatively high proportion of the area's sex workers (65%). We provide geographic data including relatively short distances from hotspots to our dedicated sex worker outreach program in the CBD (mean<1 km), and clustering of hotspots within a relatively small area. Given the size covered and areas where sex work is likely taking place in Nairobi, the estimate is several times lower than what would be obtained if the entire metropolitan area was enumerated. These results have important practical and policy implications for enhancing HIV/STI prevention efforts.
Kimani-Murage, Elizabeth W; Holding, Penny A; Fotso, Jean-Christophe; Ezeh, Alex C; Madise, Nyovani J; Kahurani, Elizabeth N; Zulu, Eliya M
The study examines the relationship between orphanhood status and nutritional status and food security among children living in the rapidly growing and uniquely vulnerable slum settlements in Nairobi, Kenya. The study was conducted between January and June 2007 among children aged 6-14 years, living in informal settlements of Nairobi, Kenya. Anthropometric measurements were taken using standard procedures and z scores generated using the NCHS/WHO reference. Data on food security were collected through separate interviews with children and their caregivers, and used to generate a composite food security score. Multiple regression analysis was done to determine factors related to vulnerability with regards to food security and nutritional outcomes. The results show that orphans were more vulnerable to food insecurity than non-orphans and that paternal orphans were the most vulnerable orphan group. However, these effects were not significant for nutritional status, which measures long-term food deficiencies. The results also show that the most vulnerable children are boys, those living in households with lowest socioeconomic status, with many dependants, and female-headed and headed by adults with low human capital (low education). This study provides useful insights to inform policies and practice to identify target groups and intervention programs to improve the welfare of orphans and vulnerable children living in urban poor communities.
Ndetei, David M.; Khasakhala, Lincoln; Ongecha-Owuor, Francisca; Kuria, Mary; Mutiso, Victoria; Syanda, Judy; Kokonya, Donald
Objectives: The authors aim to determine the attitudes of University of Nairobi, Kenya, medical students toward psychiatry. Methods: The study design was cross-sectional. Self-administered sociodemographic and the Attitudes Toward Psychiatry-30 items (ATP-30) questionnaires were distributed sequentially to every third medical student in his or her…
Thompson, Ekundayo J. D.
Nonformal education (NFE) in urban Kenya was examined in a study that focused on Kisumu, Mombasa, and Nairobi. Data were collected from the following sources: a literature review; investigations of 88 nonformal, informal, and community schools and centers in the three cities; and interviews with 14 key persons involved in delivery of NFE. The…
Muthomi, Rintaugu James; Muthee, Jessina
The aim of this study was to analyse predictors of behaviour change among children at risk in juvenile rehabilitation centres within Nairobi County, Kenya. The target population was all the children and managers of Juvenile rehabilitation Centres in Nairobi County. This consisted of 380 boys, 160 girls, 8 managers in Kabete and Getathuru, and 4…
Edwards, J K; Thiongó, A; Van den Bergh, R; Kizito, W; Kosgei, R J; Sobry, A; Vandenbulcke, A; Zuniga, I; Reid, A J
Contexte : Le dispensaire de soins de santé primaire de Médecins sans Frontières au cœur du bidonville de Kibera, Nairobi, Kenya.Objectif : Décrire les caractéristiques démographiques et cliniques d'enfants ayant eu un diagnostic clinique de rachitisme de septembre 2012 à octobre 2013.Schéma : Revue descriptive et rétrospective du diagnostic et du traitement par vitamine D et calcium à travers les données des programmes de routine.Résultats : Sur 82 enfants répondant au diagnostic clinique de rachitisme, 57% étaient des garçons d'un âge médian de 12 mois tandis que l'âge médian des filles était de 14 mois. L'exposition au soleil déclarée par la famille était de ⩽3 heures par semaine pour 71% des enfants et 39% présentaient une malnutrition. Les constatations cliniques à l'arrivée ont mis en évidence un retard de développement moteur marqué chez 44% des enfants. Le taux de perdus de vue pendant le traitement a été de 40%.Conclusion : Cette étude a constaté que le rachitisme était une affection fréquente parmi les enfants vivant dans le bidonville de Kibera et que de nombreux facteurs de l'environnement de Kibera y contribuaient vraisemblablement. Comme le rachitisme est une maladie non transmissible qui peut bénéficier d'une prévention simple et peu coûteuse, nous suggérons qu'une supplémentation en vitamine D soit formellement recommandée par l'Organisation Mondiale de la Santé dans les soins de santé aux enfants en Afrique, surtout dans le contexte de bidonvilles.
van Vliet, E. D. S.; Kinney, P. L.
Air quality is a serious and worsening problem in the rapidly growing cities of sub-Saharan Africa (SSA). However, the lack of ambient monitoring data, and particularly urban roadside concentrations for particulate matter in SSA cities severely hinders our ability to describe temporal and spatial patterns of concentrations, characterize exposure response relationships for key health outcomes, estimate disease burdens, and promote policy initiatives to address air quality. As part of a collaborative transportation planning exercise between Columbia University and the University of Nairobi, air monitoring was carried out in February 2006 in Nairobi, Kenya. The objective of the monitoring was to collect pilot data on air concentrations (PM2.5 and black carbon) encountered while driving in the Nairobi metropolitan area, and to compare those data to simultaneous 'urban background' concentrations measured in Nairobi but away from roadways. For both the background and roadway monitoring, we used portable air sampling systems that collect integrated filter samples. Results from this pilot study found that roadway concentrations of PM2.5 were approximately 20-fold higher than those from the urban background site, whereas black carbon concentrations differed by 10-fold. If confirmed by more extensive sampling, these data would underscore the need for air quality and transportation planning and management directed at mitigating roadway pollution.
Background The prevalence of unintended pregnancy in Kenya continues to be high. The 2003 Kenya Demographic and Health Survey (KDHS) showed that nearly 50% of unmarried women aged 15–19 and 45% of the married women reported their current pregnancies as mistimed or unwanted. The 2008–09 KDHS showed that 43% of married women in Kenya reported their current pregnancies were unintended. Unintended pregnancy is one of the most critical factors contributing to schoolgirl drop out in Kenya. Up to 13,000 Kenyan girls drop out of school every year as a result of unintended pregnancy. Unsafe pregnancy termination contributes immensely to maternal mortality which currently estimated at 488 deaths per 100 000 live births. In Kenya, the determinants of prevalence and determinants of unintended pregnancy among women in diverse social and economic situations, particularly in urban areas, are poorly understood due to lack of data. This paper addresses the prevalence and the determinants of unintended pregnancy among women in slum and non-slum settlements of Nairobi. Methods This study used the data that was collected among a random sample of 1262 slum and non-slum women aged 15–49 years in Nairobi. The data was analyzed using simple percentages and logistic regression. Results The study found that 24 percent of all the women had unintended pregnancy. The prevalence of unintended pregnancy was 21 per cent among women in slum settlements compared to 27 per cent among those in non-slum settlements. Marital status, employment status, ethnicity and type of settlement were significantly associated with unintended pregnancy. Logistic analysis results indicate that age, marital status and type of settlement had statistically significantly effects on unintended pregnancy. Young women aged 15–19 were significantly more likely than older women to experience unintended pregnancy. Similarly, unmarried women showed elevated risk for unintended pregnancy than ever-married women. Women in
Ye, Yazoume; Madise, Nyovani; Ndugwa, Robert; Ochola, Sam; Snow, Robert W
Background In sub-Saharan Africa, knowledge of malaria transmission across rapidly proliferating urban centres and recommendations for its prevention or management remain poorly defined. This paper presents the results of an investigation into infection prevalence and treatment of recent febrile events among a slum population in Nairobi, Kenya. Methods In July 2008, a community-based malaria parasite prevalence survey was conducted in Korogocho slum, which forms part of the Nairobi Urban Health and Demographic Surveillance system. Interviewers visited 1,069 participants at home and collected data on reported fevers experienced over the preceding 14 days and details on the treatment of these episodes. Each participant was tested for malaria parasite presence with Rapid Diagnostic Test (RDT) and microscopy. Descriptive analyses were performed to assess the period prevalence of reported fever episodes and treatment behaviour. Results Of the 1,069 participants visited, 983 (92%) consented to be tested. Three were positive for Plasmodium falciparum using RDT; however, all were confirmed negative on microscopy. Microscopic examination of all 953 readable slides showed zero prevalence. Overall, from the 1,004 participants who have data on fever, 170 fever episodes were reported giving a relatively high period prevalence (16.9%, 95% CI:13.9%–20.5%) and higher among children below five years (20.1%, 95%CI:13.8%–27.8%). Of the fever episodes with treatment information 54.3% (95%CI:46.3%–62.2%) were treated as malaria using mainly sulphadoxine-pyrimethamine or amodiaquine, including those managed at a formal health facility. Only four episodes were managed using the nationally recommended first-line treatment, artemether-lumefantrine. Conclusion The study could not demonstrate any evidence of malaria in Korogocho, a slum in the centre of Nairobi. Fever was a common complaint and often treated as malaria with anti-malarial drugs. Strategies, including testing for malaria
Background Since the 1980s the Majengo Observational Cohort Study (MOCS) has examined sexually transmitted infections, in particular HIV/AIDS, in a cohort of sex workers in Majengo, an impoverished urban village in Nairobi, Kenya. The MOCS investigators have faced criticism since the women have remained in the sex trade for the duration of their participation in the study, prompting concerns about exploitation. Yet despite these concerns, the cohort has survived for almost 30 years. Methods In this retrospective qualitative case study, we examine the community engagement practices of the MOCS and explore the factors that account for its durability. Results Women in sex work in Kenya were a highly stigmatized and disfranchised community. As a result, there was no natural 'community' of sex workers either in Nairobi or in the Majengo village. The Majengo clinic aimed to reduce the barriers to health care the women experienced at the STC clinic by bringing the services closer to them and by providing a non-discriminatory environment. The women acknowledged the fact they had hoped their participation in the MOCS would have helped them find a path out of the sex trade. But our findings also add another dimension to this debate, since every cohort member we interviewed expressed her gratitude for the deep impact the MOCS has had on her life, much of it beyond the improved health status made possible by access to quality healthcare services. Participation in the MOCS has improved and enriched their lives. The CE activities have played a central role in creating a community that did not exist independently of the MOCS. Conclusions Our case study identified 3 distinct phases of community engagement in the MOCS: (1) reaching out: mobilization, dialogue and education; (2) foundations of trust through relationships of care; and (3) leveraging existing social capital to form a cohort community. The findings demonstrate the importance of some of the less obvious benefits of
Moyer, Eileen; Igonya, Emmy Kageha
The availability of free antiretroviral treatment in public health facilities since 2004 has contributed to the increasing biomedicalization of AIDS care in Kenya. This has been accompanied by a reduction of funding for community-based care and support organizations since the 2008 global economic crisis and a consequent donor divestment from HIV projects in Africa. This paper explores the ways that HIV interventions, including support groups, home-based care and antiretroviral treatments have shaped expectations regarding relations of care in the low-income area of Kibera in Nairobi, Kenya, over the last decade. Findings are based on 20 months of ethnographic research conducted in Nairobi between January 2011 and August 2013. By focusing on three eras of HIV treatment--pre-treatment, treatment scale-up, and post-crisis--the authors illustrate how family and community-based care have changed with shifts in funding. Many support groups that previously provided HIV care in Kibera, where the state is largely absent and family networks are thin, have been forced to cut services. Large-scale HIV treatment programmes may allow the urban poor in Nairobi to survive, but they are unlikely to thrive. Many care needs continue to go unmet in the age of treatment, and many economically marginal people who had found work in care-oriented community-based organizations now find themselves jobless or engaged in work not related to HIV.
Moyer, Eileen; Igonya, Emmy Kageha
The availability of free antiretroviral treatment in public health facilities since 2004 has contributed to the increasing biomedicalization of AIDS care in Kenya. This has been accompanied by a reduction of funding for community-based care and support organizations since the 2008 global economic crisis and a consequent donor divestment from HIV projects in Africa. This paper explores the ways that HIV interventions, including support groups, home-based care and antiretroviral treatments have shaped expectations regarding relations of care in the low-income area of Kibera in Nairobi, Kenya, over the last decade. Findings are based on 20 months of ethnographic research conducted in Nairobi between January 2011 and August 2013. By focusing on three eras of HIV treatment – pre-treatment, treatment scale-up, and post-crisis – the authors illustrate how family and community-based care have changed with shifts in funding. Many support groups that previously provided HIV care in Kibera, where the state is largely absent and family networks are thin, have been forced to cut services. Large-scale HIV treatment programmes may allow the urban poor in Nairobi to survive, but they are unlikely to thrive. Many care needs continue to go unmet in the age of treatment, and many economically marginal people who had found work in care-oriented community-based organizations now find themselves jobless or engaged in work not related to HIV. PMID:25175290
Arnold, Christine; Theede, Jason; Gagnon, Anita
In recent years, Kenya's capital city Nairobi has experienced an influx of international economic migrants, as well as migrants forced to flee their neighboring countries of origin, or coming from UNHCR-managed refugee camps into the city. Urban migrants regularly face challenges integrating with host communities and consequently face health vulnerabilities. The International Organization for Migration in Kenya was concerned about the potential marginalization of urban migrants from mainstream health programming and a lack of data upon which to base their activities. The purpose of this project was to gain a greater understanding of urban migrants' barriers to accessing healthcare in Nairobi compared with barriers faced by Kenyans living in the same locations. Guiding our work was a conceptual framework for assessing access to healthcare, which defines availability, geographic accessibility, financial accessibility and acceptability as the four dimensions of access. We identified key informants in collaboration with The National Organisation for Peer Educators, and these individuals assisted in identifying communities within Nairobi where large proportions of migrants reside. Four communities were selected for further study. In each, interviews with government officials and service providers were conducted, and focus group discussions were held with both migrants and Kenyans. Verbatim transcripts were content-analyzed using an open coding technique. Common barriers to accessing care that were shared by migrants and Kenyans included waiting times, drug availability, transportation and cost. Barriers unique to migrants were: threat of harassment; cost discrepancies between migrant and Kenyan clients; real or perceived discrimination; documentation requirements and language barriers. Despite articles from the 2010 Constitution of Kenya that assert the right to health for every person in Kenya, migrants continue to experience unique barriers in accessing healthcare
Corburn, Jason; Karanja, Irene
On an urban planet, slums or informal settlements present an increasing challenge for health promotion. The living conditions in complex informal settlements interact with how people navigate through their daily lives and political institutions to shape health inequities. In this article, we suggest that only a relational place-based characterization of informal settlements can accurately capture the forces contributing to existing urban health inequities and inform appropriate and effective health promotion interventions. We explore our relational framework using household survey, spatial mapping and qualitative focus group data gathered in partnership with residents and non-governmental organizations in the Mathare informal settlement in Nairobi, Kenya. All data interpretation included participation with local residents and organizations. We focus on the inter-relationships between inadequate sanitation and disease, social, economic and human rights for women and girls, who we show are most vulnerable from poor slum infrastructure. We suggest that this collaborative process results in co-produced insights about the meanings and relationships between infrastructure, security, resilience and health. We conclude that complex informal settlements require relational and context-specific data gathering and analyses to understand the multiple determinants of health and to inform appropriate and effective healthy city interventions.
Njuguna, Henry N.; Montgomery, Joel M.; Cosmas, Leonard; Wamola, Newton; Oundo, Joseph O.; Desai, Meghna; Buff, Ann M.; Breiman, Robert F.
Nairobi is considered a low-risk area for malaria transmission, but travel can influence transmission of malaria. We investigated the demographic characteristics and travel history of patients with documented fever and malaria in a study clinic in a population-based surveillance system over a 5-year period, January 1, 2007 to December 31, 2011. During the study period, 11,480 (68%) febrile patients had a microscopy test performed for malaria, of which 2,553 (22%) were positive. Malaria was detected year-round with peaks in January, May, and September. Children aged 5–14 years had the highest proportion (28%) of positive results followed by children aged 1–4 years (23%). Almost two-thirds of patients with malaria reported traveling outside Nairobi; 79% of these traveled to three counties in western Kenya. History of recent travel (i.e., in past month) was associated with malaria parasitemia (odds ratio: 10.0, 95% confidence interval: 9.0–11.0). Malaria parasitemia was frequently observed among febrile patients at a health facility in the urban slum of Kibera, Nairobi. The majority of patients had traveled to western Kenya. However, 34% reported no travel history, which raises the possibility of local malaria transmission in this densely populated, urban setting. These findings have important implications for malaria control in large Nairobi settlements. PMID:26598567
Njuguna, Henry N; Montgomery, Joel M; Cosmas, Leonard; Wamola, Newton; Oundo, Joseph O; Desai, Meghna; Buff, Ann M; Breiman, Robert F
Nairobi is considered a low-risk area for malaria transmission, but travel can influence transmission of malaria. We investigated the demographic characteristics and travel history of patients with documented fever and malaria in a study clinic in a population-based surveillance system over a 5-year period, January 1, 2007 to December 31, 2011. During the study period, 11,480 (68%) febrile patients had a microscopy test performed for malaria, of which 2,553 (22%) were positive. Malaria was detected year-round with peaks in January, May, and September. Children aged 5-14 years had the highest proportion (28%) of positive results followed by children aged 1-4 years (23%). Almost two-thirds of patients with malaria reported traveling outside Nairobi; 79% of these traveled to three counties in western Kenya. History of recent travel (i.e., in past month) was associated with malaria parasitemia (odds ratio: 10.0, 95% confidence interval: 9.0-11.0). Malaria parasitemia was frequently observed among febrile patients at a health facility in the urban slum of Kibera, Nairobi. The majority of patients had traveled to western Kenya. However, 34% reported no travel history, which raises the possibility of local malaria transmission in this densely populated, urban setting. These findings have important implications for malaria control in large Nairobi settlements.
Olack, Beatrice; Burke, Heather; Cosmas, Leonard; Bamrah, Sapna; Dooling, Kathleen; Feikin, Daniel R; Talley, Leisel E; Breiman, Robert F
Malnutrition in sub-Saharan Africa contributes to high rates of childhood morbidity and mortality. However, little information on the nutritional status of children is available from informal settlements. During the period of post-election violence in Kenya during December 2007-March 2008, food shortages were widespread within informal settlements in Nairobi. To investigate whether food insecurity due to post-election violence resulted in high prevalence of acute and chronic malnutrition in children, a nutritional survey was undertaken among children aged 6-59 months within two villages in Kibera, where the Kenya Medical Research Institute/Centers for Disease Control and Prevention conducts population-based surveillance for infectious disease syndromes. During 25 March-4 April 2008, a structured questionnaire was administered to caregivers of 1,310 children identified through surveillance system databases to obtain information on household demographics, food availability, and child-feeding practices. Anthropometric measurements were recorded on all participating children. Indices were reported in z-scores and compared with the World Health Organization (WHO) 2005 reference population to determine the nutritional status of children. Data were analyzed using the Anthro software of WHO and the SAS. Stunting was found in 47.0% of the children; 11.8% were underweight, and 2.6% were wasted. Severe stunting was found in 23.4% of the children; severe underweight in 3.1%, and severe wasting in 0.6%. Children aged 36-47 months had the highest prevalence (58.0%) of stunting while the highest prevalence (4.1%) of wasting was in children aged 6-11 months. Boys were more stunted than girls (p < 0.01), and older children were significantly (p < 0.0001) stunted compared to younger children. In the third year of life, girls were more likely than boys to be wasted (p < 0.01). The high prevalence of chronic malnutrition suggests that stunting is a sustained problem within this urban
Crichton, Joanna; Ibisomi, Latifat; Gyimah, Stephen Obeng
Parental communication and support is associated with improved developmental, health and behavioral outcomes in adolescence. This study explores the quality of mother-daughter communication about sexual maturation, abstinence and unintended pregnancy in Korogocho, an informal settlement in Nairobi, Kenya. We use data from 14 focus group…
Cohen, Jessica; Golub, Ginger; Kruk, Margaret E; McConnell, Margaret
Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these "active" patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the "slums" of) Nairobi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received. We define active antenatal care (ANC) patients as those women who switch ANC providers and explore the prevalence, characteristics and care-seeking behavior of these patients. We analyze whether active ANC patients appear to be seeking out higher quality facilities and whether they are more satisfied with their care. Women in our sample visit over 150 different public and private ANC facilities. Active patients are more educated and more likely to have high risk pregnancies, but have otherwise similar characteristics to non-active patients. We find that active patients are increasingly likely to pay for private care (despite public care being free) and to receive a higher quality of care over the course of their pregnancy. We find that active patients appear more satisfied with their care over the course of pregnancy, as they are increasingly likely to choose to deliver at the facility providing their ANC.
Gatari, Michael; Wagner, Annemarie; Boman, Johan
Air pollution problems in major cities within the developing countries need to be studied. There are scanty measurements from the developing countries on airborne particles despite their adverse implications to human health, visibility and climate. One of the major sources of anthropogenic air pollution is energy production. Energy demand is bound to increase as population increases, especially in major cities of the world. Fine particles, particles with aerodynamic diameter < or = 2.5 microm, are mainly anthropogenic and these particles were collected in the capital cities of Vietnam and Kenya. A cyclone airborne particle collector was used to sample in Hanoi during the months of May to October 2000 and a dichotomous virtual impactor in Nairobi in February 2000. The samples were analysed for elemental content by an energy dispersive X-ray fluorescence (EDXRF) spectrometer. S, Cl, K and Fe exceeded atmospheric concentrations of 100 ng m(-3) at both cities. Atmospheric elemental concentrations in both Hanoi and Nairobi were orders of magnitude higher than their respective rural towns. Traffic, biomass and waste burning emissions were implicated as the main sources of air pollution in Nairobi, while coal combustion and road transport were the major sources in Hanoi. Regional air pollution had a major impact over Hanoi, whereas an influence of that kind was not identified in Nairobi. Pb and other toxic elements had concentration levels below WHO guideline, however, the two cities are threatened by future high levels of air pollution due to the high rate of population growth. Long-term measurements are required in both areas to evaluate if the alarming situation is deteriorating.
Mukiira, Carol; Ibisomi, Latifat
In Kenya, as in other developing countries, diarrhea is among the leading causes of child mortality. Despite being easy to prevent and treat, care seeking for major child illnesses including diarrhea remains poor in the country. Mortality due to diarrhea is even worse in informal settlements that are characterized by poor sanitary conditions and largely unregulated health care system among other issues. The study aims to examine the health care seeking practices of caregivers of children under 5 with diarrhea in two informal settlements in Nairobi, Kenya. The article used data from a maternal and child health (MCH) prospective study conducted between 2006 and 2010. Results show that more than half (55%) of the caregivers sought inappropriate health care in the treatment of diarrhea of their child. Of the 55%, about 35% sought no care at all. Use of oral rehydration solution and zinc supplements, which are widely recommended for management of diarrhea, was very low. The critical predictors of health care seeking identified in the study are duration of illness, informal settlement of residence, and the child's age. The study showed that appropriate health care seeking practices for childhood diarrhea remain a great challenge among the urban poor in Kenya.
Ngumba, Elijah; Gachanja, Anthony; Tuhkanen, Tuula
In this paper, we investigated the occurrence of three antibiotics (sulfamethoxazole, trimethoprim and ciprofloxacin) and three antiretroviral (lamivudine, nevirapine and zidovudine) drugs in the Nairobi River Basin, Kenya. The analytical procedure involved extraction using solid phase extraction followed by liquid chromatography-electrospray ionization tandem mass spectrometry (SPE-LC-ESI-MS/MS). In this study, 40 sites were selected for sampling, including 38 sites along the rivers and 2 wastewater treatment effluent sites. All the studied compounds were detected with sulfamethoxazole having the highest detection frequency of 97.5% and ciprofloxacin had the lowest at 60%. The results showed that the concentration of the drugs increased in highly populated regions especially within the informal settlements. The maximum (median) concentrations in the river waters for sulfamethoxazole, trimethoprim, ciprofloxacin, lamivudine, nevirapine and zidovudine in ng/L were 13,800 (1800), 2650 (327), 509 (129), 5430 (1000), 4860 (769), and 7680 (660), respectively. The maximum concentrations in the river waters were generally higher than those of the wastewater treatment plant effluents signifying that the rivers are substantially contaminated by domestic wastewater. The environmental risk was evaluated by calculating the risk quotients (RQs) for algae, daphnia and fish based on the maximum and median concentrations of the analytes in the river basin and was expressed as the ratios of measured environmental concentrations (MEC) to predicted no effect concentrations (PNEC). The RQs ranged from 0 to 507.8 and apart from lamivudine that had a low RQ, all the other analytes had RQ>1 at maximum and median measured concentrations for at least one taxonomic group. The high RQs are indicative of possible adverse ecological effects and calls for corrective and mitigation strategies.
Mbae, Cecilia; Mulinge, Erastus; Waruru, Anthony; Ngugi, Benjamin; Wainaina, James; Kariuki, Samuel
Introduction Globally Cryptosporidium and Giardia species are the most common non-bacterial causes of diarrhoea in children and HIV infected individuals, yet data on their role in paediatric diarrhoea in Kenya remains scant. This study investigated the occurrence of Cryptosporidium species, genotypes and subtypes in children, both hospitalized and living in an informal settlement in Nairobi. Methods This was a prospective cross-sectional study in which faecal specimen positive for Cryptosporidium spp. by microscopy from HIV infected and uninfected children aged five years and below presenting with diarrhoea at selected outpatient clinics in Mukuru informal settlements, or admitted to the paediatric ward at the Mbagathi District Hospital were characterized. The analysis was done by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) of the 18srRNA gene for species identification and PCR-sequencing of the 60 kDa glycoprotein (GP60) gene for subtyping. Results C. hominis was the most common species of Cryptosporidium identified in125/151(82.8%) of the children. Other species identified were C. parvum 18/151(11.9%), while C. felis and C. meleagridis were identified in 4 and 2 children, respectively. Wide genetic variation was observed within C. hominis, with identification of 5 subtype families; Ia, Ib, Id, Ie and If and 21 subtypes. Only subtype family IIc was identified within C. parvum. There was no association between species and HIV status or patient type. Conclusion C. hominis is the most common species associated with diarrhoea in the study population. There was high genetic variability in the C. hominis isolates with 22 different subtypes identified, whereas genetic diversity was low within C. parvum with only one subtype family IIc identified. PMID:26691531
Kangogo, Mourine; Bader, Oliver; Boga, Hamadi; Wanyoike, Wanjiru; Folba, Claudia; Worasilchai, Navaporn; Weig, Michael; Groß, Uwe; Bii, Christine C
Cryptococcal meningitis infections cause high mortality rates among HIV-infected patients in Sub-Saharan Africa. The high incidences of cryptococcal infections may be attributed to common environmental sources which, if identified, could lead to institution of appropriate control strategies. To determine the genotypes of Cryptococcus gattii/C. neoformans- species complex from Nairobi, Kenya, 123 clinical and environmental isolates were characterised. Typing was done using orotidine monophosphate pyrophosphorylase (URA5) gene restriction fragment length polymorphism (URA5-RFLP). The majority of the isolates [105/123; 85.4%] were C. neoformans genotype (AFLPI/VNI) and 1.6% AFLP1A/VNB/VNII, whereas (13%) were C. gattii (AFLP4/VGI). This is the first report on the genotypes of C. gattii/C. neoformans species complex from clinical and environmental sources in Nairobi, Kenya and the isolation of C. gattii genotype AFLP4/VGI from the environment in Kenya.
Kimani-Murage, E W; Schofield, L; Wekesah, F; Mohamed, S; Mberu, B; Ettarh, R; Egondi, T; Kyobutungi, C; Ezeh, A
Food and nutrition security is critical for economic development due to the role of nutrition in healthy growth and human capital development. Slum residents, already grossly affected by chronic poverty, are highly vulnerable to different forms of shocks, including those arising from political instability. This study describes the food security situation among slum residents in Nairobi, with specific focus on vulnerability associated with the 2007/2008 postelection crisis in Kenya. The study from which the data is drawn was nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which follows about 70,000 individuals from close to 30,000 households in two slums in Nairobi, Kenya. The study triangulates data from qualitative and quantitative sources. It uses qualitative data from 10 focus group discussions with community members and 12 key-informant interviews with community opinion leaders conducted in November 2010, and quantitative data involving about 3,000 households randomly sampled from the NUHDSS database in three rounds of data collection between March 2011 and January 2012. Food security was defined using the Household Food Insecurity Access Scale (HFIAS) criteria. The study found high prevalence of food insecurity; 85% of the households were food insecure, with 50% being severely food insecure. Factors associated with food security include level of income, source of livelihood, household size, dependence ratio; illness, perceived insecurity and slum of residence. The qualitative narratives highlighted household vulnerability to food insecurity as commonplace but critical during times of crisis. Respondents indicated that residents in the slums generally eat for bare survival, with little concern for quality. The narratives described heightened vulnerability during the 2007/2008 postelection violence in Kenya in the perception of slum residents. Prices of staple foods like maize flour doubled and simultaneously household
Murphy, Georgina A V; Gathara, David; Aluvaala, Jalemba; Mwachiro, Jacintah; Abuya, Nancy; Ouma, Paul; Snow, Robert W; English, Mike
Introduction Progress has been made in Kenya towards reducing child mortality as part of efforts aligned with the fourth Millennium Development Goal. However, little advancement has been made in reducing mortality among newborns, which now accounts for 45% of all child deaths. The frequently unanticipated nature of neonatal illness, its severity and the high dependency of sick newborns on skilled care make the provision of inpatient hospital services one key component of strategies to improve newborn survival. Methods and analyses This project aims to assess the availability and quality of inpatient newborn care in hospitals in Nairobi City County across the public, private and not-for-profit sectors and align this to the estimated need for such services, providing a description of the quantity and quality gaps between capacity and demand. The population level burden of disease will be estimated using morbidity incidence estimates from a literature review applied to subcounty estimates of population-adjusted births, providing a spatially disaggregated estimate of need within the county. This will be followed by a survey of neonatal services across all health facilities providing 24/7 inpatient newborn care in the county. The survey will include: a retrospective audit of admission registers to estimate the usage of facilities and case-mix of patients; a structural assessment of facilities to gain insight into capacity; a questionnaire to nursing staff focusing on the process of delivering key obstetric and neonatal interventions; and a retrospective case audit to assess adherence to guidelines by clinicians. Ethics and dissemination This study has been approved by the Kenya Medical Research Institute Scientific and Ethics Review Unit (SSC protocol No.2999). Results will be disseminated: to participating facilities through individualised reports and a joint workshop; to local and national stakeholders through meetings and a summary report; and to the international
Haregu, Tilahun Nigatu; Oti, Samuel; Egondi, Thaddaeus; Kyobutungi, Catherine
Background The four common non-communicable diseases (NCDs) account for 80% of NCD-related deaths worldwide. The four NCDs share four common risk factors. As most of the existing evidence on the common NCD risk factors is based on analysis of a single factor at a time, there is a need to investigate the co-occurrence of the common NCD risk factors, particularly in an urban slum setting in sub-Saharan Africa. Objective To determine the prevalence of co-occurrence of the four common NCDs risk factors among urban slum dwellers in Nairobi, Kenya. Design This analysis was based on the data collected as part of a cross-sectional survey to assess linkages among socio-economic status, perceived personal risk, and risk factors for cardiovascular and NCDs in a population of slum dwellers in Nairobi, Kenya, in 2008-2009. A total of 5,190 study subjects were included in the analysis. After selecting relevant variables for common NCD risk factors, we computed the prevalence of all possible combinations of the four common NCD risk factors. The analysis was disaggregated by relevant background variables. Results The weighted prevalences of unhealthy diet, insufficient physical activity, harmful use of alcohol, and tobacco use were found to be 57.2, 14.4, 10.1, and 12.4%, respectively. Nearly 72% of the study participants had at least one of the four NCD risk factors. About 52% of the study population had any one of the four NCD risk factors. About one-fifth (19.8%) had co-occurrence of NCD risk factors. Close to one in six individuals (17.6%) had two NCD risk factors, while only 2.2% had three or four NCD risk factors. Conclusions One out of five of people in the urban slum settings of Nairobi had co-occurrence of NCD risk factors. Both comprehensive and differentiated approaches are needed for effective NCD prevention and control in these settings.
Haregu, Tilahun Nigatu; Oti, Samuel; Egondi, Thaddaeus; Kyobutungi, Catherine
Background The four common non-communicable diseases (NCDs) account for 80% of NCD-related deaths worldwide. The four NCDs share four common risk factors. As most of the existing evidence on the common NCD risk factors is based on analysis of a single factor at a time, there is a need to investigate the co-occurrence of the common NCD risk factors, particularly in an urban slum setting in sub-Saharan Africa. Objective To determine the prevalence of co-occurrence of the four common NCDs risk factors among urban slum dwellers in Nairobi, Kenya. Design This analysis was based on the data collected as part of a cross-sectional survey to assess linkages among socio-economic status, perceived personal risk, and risk factors for cardiovascular and NCDs in a population of slum dwellers in Nairobi, Kenya, in 2008–2009. A total of 5,190 study subjects were included in the analysis. After selecting relevant variables for common NCD risk factors, we computed the prevalence of all possible combinations of the four common NCD risk factors. The analysis was disaggregated by relevant background variables. Results The weighted prevalences of unhealthy diet, insufficient physical activity, harmful use of alcohol, and tobacco use were found to be 57.2, 14.4, 10.1, and 12.4%, respectively. Nearly 72% of the study participants had at least one of the four NCD risk factors. About 52% of the study population had any one of the four NCD risk factors. About one-fifth (19.8%) had co-occurrence of NCD risk factors. Close to one in six individuals (17.6%) had two NCD risk factors, while only 2.2% had three or four NCD risk factors. Conclusions One out of five of people in the urban slum settings of Nairobi had co-occurrence of NCD risk factors. Both comprehensive and differentiated approaches are needed for effective NCD prevention and control in these settings. PMID:26385542
Simiyu, Cynthia Nekesa; Odhiambo-Otieno, George; Okero, Dominic
The goal of this study was to assess hospital capacity for disaster preparedness within Nairobi County. This information would be valuable to institutional strategists to resolve weaknesses and reinforce strengths in hospital capacity hence ensure efficient and effective service delivery during disasters. Analytical cross-sectional research design was used. Indicator variables for capacity were hospital equipment, hospital infrastructure, surrounding hospital environment, training, drills, staff knowledge and staff capabilities. Thirty two hospitals were studied of which nine of them were public hospitals. Data analysis was done using SPSS and presented in the form of frequency tables at p < 0.05. Study results indicated that hospital capacity to disaster preparedness in Nairobi County existed in 22 (68.88%) hospitals, in 6 (64.95%) public hospitals and 16 (69.64%) private hospitals. The difference in capacity between public and private hospitals within the County was less than 5%. This showed that both public and private hospitals were relatively at par, with regard to the capacity to handle disaster cases. Study findings also revealed that the surrounding hospital environment was the most highly rated indicator while inter hospital training and drills were the least rated. Although existent in hospitals within Nairobi County, for maximum hospital capacity and disaster preparedness within Nairobi County to be achieved, the existent gap in inter hospital training and inter hospital drills, both of which fall under the finance health systems pillar, required addressing.
Bauza, Valerie; Ocharo, R M; Nguyen, Thanh H; Guest, Jeremy S
Diarrhea is a leading cause of mortality in children under 5 years of age. We conducted a cross-sectional study of 54 children aged 3 months to 5 years old in Kibera, an urban slum in Nairobi, Kenya, to assess the relationship between caregiver-reported soil ingestion and child diarrhea. Diarrhea was significantly associated with soil ingestion (adjusted odds ratio = 9.9, 95% confidence interval = 2.1-47.5). Soil samples from locations near each household were also collected and analyzed for Escherichia coli and a human-associated Bacteroides fecal marker (HF183). Escherichia coli was detected in 100% of soil samples (mean 5.5 log colony forming units E. coli per gram of dry soil) and the Bacteroides fecal marker HF183 was detected in 93% of soil samples. These findings suggest that soil ingestion may be an important transmission pathway for diarrheal disease in urban slum settings.
Gyimah, Stephen Obeng; Kodzi, Ivy; Emina, Jacques; Cofie, Nicholas; Ezeh, Alex
Although attitudes to premarital sex may be influenced by several factors, the importance of religion to that discourse cannot be underestimated. By providing standards to judge and guide behaviour, religion provides a social control function such that religious persons are expected to act in ways that conform to certain norms. This study investigated the interconnectedness of several dimensions of religion and premarital sexual attitudes among young people in the informal settlements of Nairobi, Kenya. Using reference group as the theoretical base, it was found that those affiliated with Pentecostal/Evangelical faiths had more conservative attitudes towards premarital sex than those of other Christian faiths. Additionally, while a high level of religiosity was found to associate with more conservative views on premarital sex, the effect was more pronounced among Pentecostal groups. The findings are discussed in relation to programmes on adolescent sexuality.
Taylor, Faith E.; Malamud, Bruce D.; Millington, James D. A.
The configuration of infrastructure networks such as roads, drainage and power lines can both affect and be affected by natural hazards such as earthquakes, intense rain, wildfires and extreme temperatures. In this paper, we present and compare two methods to quantify urban topology on approximate scales of 0.0005 km2 to 10 km2 and create classifications of different 'urban textures' that relate to risk of natural hazard impact in an area. The methods we use focus on applicability in urban developing country settings, where access to high resolution and high quality data may be difficult. We use the city of Nairobi, Kenya to trial these methods. Nairobi has a population >3 million, and is a mix of informal settlements, residential and commercial development. The city and its immediate surroundings are subject to a variety of natural hazards such as floods, landslides, fires, drought, hail, heavy wind and extreme temperatures; all of these hazards can occur singly, but also have the potential for one to trigger another, thus providing a 'cascade' of hazards, or for two of the hazards to occur spatially and temporally near each other and interact. We use two measures of urban texture: (i) Street block textures, (ii) Google Earth land cover textures. Street block textures builds on the methodology of Louf and Barthelemy (2014) and uses Open Street Map data to analyse the shape, size, complexity and pattern of individual blocks of land created by fully enclosed loops of the major and minor road network of Nairobi. We find >4000 of these blocks ranging in size from approximately 0.0005 km2 to 10 km2, with approximately 5 classifications of urban texture. Google Earth land cover texture is a visual classification of homogeneous parcels of land performed in Google Earth using high-resolution airborne imagery and a qualitative criteria for each land cover type. Using the Google Earth land cover texture method, we identify >40 'urban textures' based on visual
Van der Vynckt, Susan, Ed.; Sachs-Israel, Margarete, Ed.
This document contains papers presented at a seminar that examined the Home Economics curriculum at Kenyatta University (Nairobi, Kenya) in the context of Kenya's new educational system. The seminar studied themes of nutrition and health, child development and care, and rural development. Working groups prepared reports on each of these themes.…
Kimani-Murage, Elizabeth W.; Muthuri, Stella K.; Oti, Samuel O.; Mutua, Martin K.; van de Vijver, Steven; Kyobutungi, Catherine
Background Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya. Methods Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults. Results Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese. Conclusion The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further
Kerubo, Glennah; Khamadi, Samoel; Okoth, Vincent; Madise, Nyovani; Ezeh, Alex; Abdalla, Ziraba; Mwau, Matilu
Background HIV-1 and Hepatitis B and C viruses coinfection is common in Sub-Saharan Africa due to similar routes of transmission and high levels of poverty. Most studies on HIV-1 and Hepatitis B and C viruses have occurred in hospital settings and blood transfusion units. Data on Hepatitis B and C viruses and HIV-1 coinfection in informal urban settlements in Kenya are scanty, yet they could partly explain the disproportionately high morbidity and mortality associated with HIV-1 infections in these slums. Objectives The objective of this study was to determine the prevalence of HIV and Hepatitis B and C dual infection in urban slums in Nairobi. Methods Blood samples were collected from residents of Viwandani and Korogocho between 2006 and 2007. A structured questionnaire was used to obtain socio-demographic data from participants. Samples were screened for Hepatitis B surface antigen (HBsAg), anti-HCV and anti-HIV-1. Statistical analysis was done using STATA. Results Samples were successfully collected from 418 (32%) men and 890 (68%) females. The HIV-1, HBV and HCV prevalence was 20.4%, 13.3% and 0.76% respectively at the time of the study. Of the 268 (20.4%) HIV-1 positive participants, 56 (4.26%) had HBV while 6 (0.46%) had HCV. Of the 1041 HIV-1 negative participants, 117 (8.9%) had HBV while 4 (0.31%) had HCV. Only two people (0.15%) were co-infected with all the three viruses together. Discussion The odds of getting hepatitis infection were higher in HIV-1 participants (for HBV OR 2.08,p<0.005 and for HCV OR 5.93, p<0.005). HIV prevalence rates were similar in both informal settlements. HIV infection was highest in age group 35-39 years and among the divorced/separated or widowed. Prevalence of all viruses was highest in those who did not have any formal education. Conclusion The HIV prevalence in these informal settlements suggests a higher rate than what is observed nationally. The prevalence rates of HBV are significantly higher in the HIV-1 positive and
Mwatondo, Athman Juma; Ng'ang'a, Zipporah; Maina, Caroline; Makayotto, Lyndah; Mwangi, Moses; Njeru, Ian; Arvelo, Wences
Introduction Kenya adopted the Integrated Disease Surveillance and Response (IDSR) strategy in 1998 to strengthen disease surveillance and epidemic response. However, the goal of weekly surveillance reporting among health facilities has not been achieved. We conducted a cross-sectional study to determine the prevalence of adequate reporting and factors associated with IDSR reporting among health facilities in one Kenyan County. Methods Health facilities (public and private) were enrolled using stratified random sampling from 348 facilities prioritized for routine surveillance reporting. Adequately-reporting facilities were defined as those which submitted >10 weekly reports during a twelve-week period and a poor reporting facilities were those which submitted <10 weekly reports. Multivariate logistic regression with backward selection was used to identify risk factors associated with adequate reporting. Results From September 2 through November 30, 2013, we enrolled 175 health facilities; 130(74%) were private and 45(26%) were public. Of the 175 health facilities, 77 (44%) facilities classified as adequate reporting and 98 (56%) were reporting poorly. Multivariate analysis identified three factors to be independently associated with weekly adequate reporting: having weekly reporting forms at visit (AOR19, 95% CI: 6-65], having posters showing IDSR functions (AOR8, 95% CI: 2-12) and having a designated surveillance focal person (AOR7, 95% CI: 2-20). Conclusion The majority of health facilities in Nairobi County were reporting poorly to IDSR and we recommend that the Ministry of Health provide all health facilities in Nairobi County with weekly reporting tools and offer specific trainings on IDSR which will help designate a focal surveillance person. PMID:27303581
Bennett, Rachel; Chepngeno-Langat, Gloria; Evandrou, Maria; Falkingham, Jane
This paper examines gender differentials in survival amongst older people (50+ years) in the Nairobi slums and to the best of our knowledge is the first study of its kind in an urban African setting. The results provide evidence contrary to the expected paradox of poorer self-rated health yet better survival amongst older women. Older women in the Nairobi slums have poorer self-rated health and poorer circumstances across other factors, including disability and socio-economic status. Further, older women in the slums do not have better survival. The conventional female advantage in mortality only becomes apparent after accounting for the cumulative influence of individual characteristics, social networks, health and socio-economic status, suggesting the female advantage in unadjusted old-age mortality does not apply to contexts where women experience significant disadvantage across multiple life domains. This highlights the urgent need to redress the support, status and opportunities available for women across the life course in contexts such as the Nairobi slums. In addition, a greater number of factors differentiate mortality risk amongst men than amongst women, suggesting inequality amongst slum dwelling older men and highlighting the need for gender sensitive interventions which account for the particular needs of both genders in old age.
Olack, Beatrice; Shultz, Alvin; Roder, Sanam; Kimani, Kabuiya; Feikin, Daniel R.; Burke, Heather
A healthcare-use survey was conducted in the Kibera informal settlement in Nairobi, Kenya, in July 2005 to inform subsequent surveillance in the site for infectious diseases. Sets of standardized questionnaires were administered to 1,542 caretakers and heads of households with one or more child(ren) aged less than five years. The average household-size was 5.1 (range 1-15) persons. Most (90%) resided in a single room with monthly rents of US$ 4.50-7.00. Within the previous two weeks, 49% of children (n=1,378) aged less than five years (under-five children) and 18% of persons (n=1,139) aged ≥5 years experienced febrile, diarrhoeal or respiratory illnesses. The large majority (>75%) of illnesses were associated with healthcare-seeking. While licensed clinics were the most-frequently visited settings, kiosks, unlicensed care providers, and traditional healers were also frequently visited. Expense was cited most often (50%) as the reason for not seeking healthcare. Of those who sought healthcare, 34-44% of the first and/or the only visits were made with non-licensed care providers, potentially delaying opportunities for early optimal intervention. The proportions of patients accessing healthcare facilities were higher with diarrhoeal disease and fever (but not for respiratory diseases in under-five children) than those reported from a contemporaneous study conducted in a rural area in Kenya. The findings support community-based rather than facility-based surveillance in this setting to achieve objectives for comprehensive assessment of the burden of disease. PMID:21608421
Mawioo, Peter M; Hooijmans, Christine M; Garcia, Hector A; Brdjanovic, Damir
Toilet facilities in highly dense areas such as the slum and emergency settlements fill up rapidly; thus, requiring frequent emptying. Consequently, big quantities of fresh faecal sludge (FS) containing large amounts of pathogens are generated. Fast and efficient FS treatment technologies are therefore required for safe treatment and disposal of the FS in such conditions. This study explores the applicability of a microwave (MW) technology for the treatment of fresh FS obtained from urine-diverting dry toilets placed in slum settlements in Nairobi, Kenya. Two sample fractions containing 100 g and 200 g of FS were exposed to MW irradiation at three input MW power levels of 465, 1085 and 1550 W at different exposure times ranging from 0.5 to 14 min. The variation in the FS temperature, pathogen reduction via the destruction of E. coli and Ascaris lumbricoides eggs, and vol/wt reduction were measured during the MW treatment. It was demonstrated that the MW technology can rapidly and efficiently achieve complete reduction of E. coli and Ascaris lumbricoides eggs, and over 70% vol/wt reduction in the fresh FS. Furthermore, the successful evaluation of the MW technology under real field conditions demonstrated that MW irradiation can be applied for rapid treatment of fresh FS in situations such as urban slum and emergency conditions.
Drake, Alison L.; Wilson, Suzanne K.; Kinuthia, John; Roxby, Alison C.; Matemo, Daniel; Farquhar, Carey; Rao, Deepa
Healthcare-seeking behaviours of HIV-infected mothers in sub-Saharan Africa are poorly characterized and typically focus on individual health conditions rather than overall health. We conducted a qualitative study to understand how HIV-infected mothers, their male partners, and their HIV-exposed infants seek medical services. We performed 32 in-depth interviews (17 female, 15 male) and four focus group discussions (FGDs) among HIV-infected postpartum women and their male partners in Nairobi, Kenya. We used a grounded theory approach to explore the paths followed for health-related concerns. Female participants reported that willingness to be tested for HIV influences whether women sought antenatal care and the type of facility they preferred for childbirth. The need for medical care outside regular clinic hours and securing safe transportation at night were also significant barriers to seeking care. Most men sought services from traditional healers and chemists before HIV diagnosis, and at governmental facilities afterwards. Both men and women sent infants to traditional healers for non-medical conditions such as bewitching and massage, but rarely for medical conditions. Strategies to reduce HIV-related stigma and fears in antenatal and maternity settings, increase access to care after-hours, and improve linkage to HIV care for men early in their infection are needed. PMID:25646645
Atieli, Harrysone; Were, Tom
Background. Although vaccines currently approved for routine childhood immunization are safe and effective, frequent adverse events following immunization often cause illnesses and sometimes loss of public trust in immunization programs. Nurses are essential in this surveillance system. Objective. To determine nurses' knowledge, perception, and practice towards surveillance of postimmunization adverse events within Nairobi County health centers, Kenya. Methods. This is a cross-sectional survey involving nurses (n = 274). Data were collected using self-administered questionnaires. Data analysis was performed using SPSS version 20. Differences in proportions of categorical variables were compared between groups using chi-square tests. Binary logistic regression model was used to compute independent predictors of outcome. Results. 29.2%, 32.1%, and 45.3% of the respondents had good knowledge, good practices, and good perceptions on AEFI surveillance, respectively. Respondents with diploma or degree nursing training level were 1.8 times and 2.5 times more likely to have good knowledge and good perception in AEFI surveillance, respectively. Nurses with previous AEFI training were 9.7 times and 1.8 times more likely to have good AEFI knowledge and practices, respectively. Conclusion. There is a need to train and mentor nurses on AEFI surveillance. Findings of this study will be valuable in informing policy review on childhood immunization programs. PMID:28078288
Blanton, Elizabeth; Wilhelm, Natalie; O'Reilly, Ciara; Muhonja, Everline; Karoki, Solomon; Ope, Maurice; Langat, Daniel; Omolo, Jared; Wamola, Newton; Oundo, Joseph; Hoekstra, Robert; Ayers, Tracy; De Cock, Kevin; Breiman, Robert; Mintz, Eric; Lantagne, Daniele
Populations living in informal settlements with inadequate water and sanitation infrastructure are at risk of epidemic disease. In 2010, we conducted 398 household surveys in two informal settlements in Nairobi, Kenya with isolated cholera cases. We tested source and household water for free chlorine residual (FCR) and Escherichia coli in approximately 200 households. International guidelines are ≥0.5 mg/L FCR at source, ≥0.2 mg/L at household, and <1 E. coli/100 mL. In these two settlements, 82% and 38% of water sources met FCR guidelines; and 7% and 8% were contaminated with E. coli, respectively. In household stored water, 82% and 35% met FCR guidelines and 11% and 32% were contaminated with E. coli, respectively. Source water FCR≥0.5 mg/L (p=0.003) and reported purchase of a household water treatment product (p=0.002) were associated with increases in likelihood that household stored water had ≥0.2 mg/L FCR, which was associated with a lower likelihood of E. coli contamination (p<0.001). These results challenge the assumption that water quality in informal settlements is universally poor and the route of disease transmission, and highlight that providing centralized water with ≥0.5 mg/L FCR or (if not feasible) household water treatment technologies reduces the risk of waterborne cholera transmission in informal settlements.
Gallaher, Courtney Maloof; Mwaniki, Dennis; Njenga, Mary; Karanja, Nancy K; WinklerPrins, Antoinette M G A
Cities around the world are undergoing rapid urbanization, resulting in the growth of informal settlements or slums. These informal settlements lack basic services, including sanitation, and are associated with joblessness, low-income levels, and insecurity. Families living in such settlements may turn to a variety of strategies to improve their livelihoods and household food security, including urban agriculture. However, given the lack of formal sanitation services in most of these informal settlements, residents are frequently exposed to a number of environmental risks, including biological and chemical contaminants. In the Kibera slums of Nairobi, Kenya, households practice a form of urban agriculture called sack gardening, or vertical gardening, where plants such as kale and Swiss chard are planted into large sacks filled with soil. Given the nature of farming in slum environments, farmers and consumers of this produce in Kibera are potentially exposed to a variety of environmental contaminants due to the lack of formal sanitation systems. Our research demonstrates that perceived and actual environmental risks, in terms of contamination of food crops from sack gardening, are not the same. Farmers perceived exposure to biological contaminants to be the greatest risk to their food crops, but we found that heavy metal contamination was also significant risk. By demonstrating this disconnect between risk perception and actual risk, we wish to inform debates about how to appropriately promote urban agriculture in informal settlements, and more generally about the trade-offs created by farming in urban spaces.
Cagle, Anthony; McGrath, Christine; Richardson, Barbra A; Donovan, Dennis; Sakr, Sameh; Yatich, Nelly; Ngomoa, Richard; Chepngeno Langat, Agnes; John-Stewart, Grace; Chung, Michael H
Studies on the effects of alcohol use on HIV disease progression have been contradictory, with at least one study finding a positive effect of low alcohol consumption on CD4 count. In addition, most such studies have taken place in the developed West. We investigated the association between alcohol use and immune reconstitution through CD4 count response among HIV-infected individuals on antiretroviral therapy (ART) at an urban sub-Saharan African clinic. This was a retrospective cohort study of treatment-naïve HIV-infected adults initiating ART in Nairobi, Kenya and followed for 12 months between January 2009 and December 2012. At enrollment, a standardized questionnaire was used to collect data on sociodemographic variables and alcohol consumption. CD4 count was measured every six months. Linear regression models assessed the association between CD4 count and alcohol consumption, categorized as abstinent, moderate, or hazardous. Overall, 854 participants were included, 522 of which were women, with 85 (25.6%) men and 50 (9.6%) women reporting any alcohol use, and 8 (2.4%) men and 7 (1.3%) women reporting hazardous drinking. At baseline, alcohol use was associated with higher education and socioeconomic status. Median CD4 count was higher among alcohol users compared to those who abstained at baseline and at 6 and 12 months post-ART initiation, although this was only significant at 6 months. There were no differences in adherence between abstainers and drinkers. While overall alcohol use was significantly associated with higher CD4 counts, moderate and hazardous use treated separately were not. We conclude that, while alcohol use was associated with higher CD4 counts at 12 months post-ART, the mechanism for this association is unclear but may reflect unmeasured socioeconomic or nutritional differences. Additional research is required on the specific drinking patterns of this population and the types of alcoholic beverages consumed to clarify this relationship.
The purpose of this study was to find out whether there exists a relationship between ICT training of principals and ICT integration in management of public secondary schools in Kenya. Cross-sectional survey design was used in Nairobi County where quantitative research strategy was applied for the collection of data using questionnaires. The…
Njuguna, Henry N.; Cosmas, Leonard; Williamson, John; Nyachieo, Dhillon; Olack, Beatrice; Ochieng, John B.; Wamola, Newton; Oundo, Joseph O.; Feikin, Daniel R.; Mintz, Eric D.; Breiman, Robert F.
Background Worldwide, Shigella causes an estimated 160 million infections and >1 million deaths annually. However, limited incidence data are available from African urban slums. We investigated the epidemiology of shigellosis and drug susceptibility patterns within a densely populated urban settlement in Nairobi, Kenya through population-based surveillance. Methods Surveillance participants were interviewed in their homes every 2 weeks by community interviewers. Participants also had free access to a designated study clinic in the surveillance area where stool specimens were collected from patients with diarrhea (≥3 loose stools within 24 hours) or dysentery (≥1 stool with visible blood during previous 24 hours). We adjusted crude incidence rates for participants meeting stool collection criteria at household visits who reported visiting another clinic. Results Shigella species were isolated from 224 (23%) of 976 stool specimens. The overall adjusted incidence rate was 408/100,000 person years of observation (PYO) with highest rates among adults 34–49 years old (1,575/100,000 PYO). Isolates were: Shigella flexneri (64%), S. dysenteriae (11%), S. sonnei (9%), and S. boydii (5%). Over 90% of all Shigella isolates were resistant to trimethoprim-sulfamethoxazole and sulfisoxazole. Additional resistance included nalidixic acid (3%), ciprofloxacin (1%) and ceftriaxone (1%). Conclusion More than 1 of every 200 persons experience shigellosis each year in this Kenyan urban slum, yielding rates similar to those in some Asian countries. Provision of safe drinking water, improved sanitation, and hygiene in urban slums are needed to reduce disease burden, in addition to development of effective Shigella vaccines. PMID:23505506
Trinh, T. Tony; Yatich, Nelly; Ngomoa, Richard; McGrath, Christine J.; Richardson, Barbra A.; Sakr, Samah R.; Langat, Agnes; John-Stewart, Grace C.; Chung, Michael H.
Background Disclosure of HIV serostatus can have significant benefits for people living with HIV/AIDS. However, there is limited data on whether partner disclosure influences ART treatment response. Methods We conducted a retrospective cohort study of newly diagnosed, ART-naïve HIV-infected adults (>18 years) who enrolled at the Coptic Hope Center in Nairobi, Kenya between January 1st 2009 and July 1st 2011 and initiated ART within 3 months. Analysis was restricted to adults who reported to have either disclosed or not disclosed their HIV status to their partner. Analysis of CD4 response at 6 and 12 months post-ART was stratified by age group. Results Among 615 adults newly initiating ART with partner disclosure data and 12 month follow-up, mean age was 38 years and 52% were male; 76% reported that they had disclosed their HIV-status to their partner. Those who disclosed were significantly younger and more likely to be married/cohabitating than non-disclosers. At baseline, median CD4 counts were similar between disclosure groups. Among younger adults (< 38 years) those who disclosed had higher CD4 recovery than those who did not at 6 months post- ART (mean difference = 31, 95% CI 3 to 58 p = 0.03) but not at 12 months (mean difference = 17, 95% CI -19 to 52, p = 0.4). Among older adults (≥ 38years) there was no observed difference in CD4 recovery at 6 or 12 months between disclosure groups. Conclusion Among younger adults, disclosure of HIV status to partners may be associated with CD4 recovery following ART. PMID:27711164
Omollo, Kenneth; Boily-Larouche, Geneviève; Lajoie, Julie; Kimani, Makobu; Cheruiyot, Julianna; Kimani, Joshua; Oyugi, Julius
Abstract Background: Unprotected sexual intercourse exposes the female genital tract (FGT) to semen-derived antigens, which leads to a proinflammatory response. Studies have shown that this postcoital inflammatory response can lead to recruitment of activated T cells to the FGT, thereby increasing risk of HIV infection. Objective: The purpose of this study was to evaluate the impact of sex work on activation and memory phenotypes of peripheral T cells among female sex workers (FSW) from Nairobi, Kenya. Subjects: Thirty FSW were recruited from the Pumwani Sex Workers Cohort, 10 in each of the following groups: HIV-exposed seronegative (at least 7 years in active sex work), HIV positive, and New Negative (HIV negative, less than 3 years in active sex work). Blood was obtained at three different phases (active sex work, abstinence from sex work–sex break, and following resumption of sex work). Peripheral blood mononuclear cells were isolated and stained for phenotypic markers (CD3, CD4, CD8, and CD161), memory phenotype markers (CD45RA and CCR7), activation markers (CD69, HLA-DR, and CD95), and the HIV coreceptor (CCR5). T-cell populations were compared between groups. Results: In HIV-positive women, CD8+CCR5+ T cells declined at the sex break period, while CD4+CD161+ T cells increased when returning to sex work. All groups showed no significant changes in systemic T-cell activation markers following the interruption of sex work, however, significant reductions in naive CD8+ T cells were noted. For each of the study points, HIV positives had higher effector memory and CD8+CD95+ T cells and lower naive CD8+ T cells than the HIV-uninfected groups. Conclusions: Interruption of sex work had subtle effects on systemic T-cell memory phenotypes. PMID:26879184
Fuente, David; Gakii Gatua, Josephine; Ikiara, Moses; Kabubo-Mariara, Jane; Mwaura, Mbutu; Whittington, Dale
The increasing block tariff (IBT) is among the most widely used tariffs by water utilities, particularly in developing countries. This is due in part to the perception that the IBT can effectively target subsidies to low-income households. Combining data on households' socioeconomic status and metered water use, this paper examines the distributional incidence of subsidies delivered through the IBT in Nairobi, Kenya. Contrary to conventional wisdom, we find that high-income residential and nonresidential customers receive a disproportionate share of subsidies and that subsidy targeting is poor even among households with a private metered connection. We also find that stated expenditure on water, a commonly used means of estimating water use, is a poor proxy for metered use and that previous studies on subsidy incidence underestimate the magnitude of the subsidy delivered through water tariffs. These findings have implications for both the design and evaluation of water tariffs in developing countries.
Marjan, R S; Ruminjo, J K
Four hundred antenatal clinic attendants were surveyed for their attitude to testing and notification for HIV infection test results. The participants were systematically sampled from the antenatal clinic at the Kenyatta National Hospital, Nairobi, and interviewed using a closed-ended structured questionnaire. All the attendants had heard of HIV, and only 5(1.3%) did not know how Acquired Immunodeficiency Syndrome (AIDS) presents. Fifty one percent of them had no objection to their blood being tested for HIV. In fact, 52.5% thought, wrongly, that blood was routinely tested for HIV at the hospital's antenatal clinic. More than one third (35.8%) of respondents wished their permission to be obtained before the testing and 95% wished to be informed of the test result. Acceptability of testing was 33.8%, for Named Voluntary Testing, 62.0% for Universal Testing and 1.0% for Anonymous Testing. All the women said they would want to use a method of contraception, principally tubal ligation, if found HIV seropositive and 63.7% would seek a termination of pregnancy. In this study population, acceptability and expressed willingness to know HIV test results and willingness to let a spouse/sexual partner know the result was high. This paper makes recommendations that HIV testing be made available at the ANC, together with competent pre and post-test counselling.
Curriculum Development and Education for Living Together: Conceptual and Managerial Challenges in Africa. Final Report of the Seminar (Nairobi, Kenya, June 25-29, 2001) (Developpement du Curriculum et Education pour Vivre Ensemble: Problemes de Concepts et de Gestion en Afrique. Rapport Final du Seminaire (Nairobi, Kenya, 25-29 Juin 2001).
Aglo, John, Ed.; Lethoko, Mankolo, Ed.
The Nairobi, Kenya, seminar sought to analyze existing official school curricula from the vantage point of their potential contribution to learning and to address the issue of curriculum management with a view to improving the capacity of basic schooling to contribute to enhanced social cohesion. This final report is divided into four parts. Part…
Amuko, Sheila; Miheso, Marguerite; Ndeuthi, Sophie
This presentation is based on a larger study whose purpose was to explore the various opportunities and challenges influencing integration of ICT in teaching and learning Mathematics in secondary schools in Nairobi County. The study, adopted a descriptive survey design. Three instruments questionnaires', a structured interview schedule and an…
Kenyan policy-makers use the language of children's rights to legitimize, within the new global political order, an old colonial concern about controlling the urban marginal population. The local business community's worries about the safety of Nairobi's streets stand paramount, while the growing financial and political leverage of NGOs…
Ndetei, David M.; Khasakhala, Lincoln I.; Mutiso, Victoria; Ongecha-Owuor, Francisca A.; Kokonya, Donald A.
The objective of this study was to evaluate the influence of family, psychosocial, health, demographic, and behavioral characteristics on regular drug use. All the students of 17 randomly stratified public secondary schools in Nairobi were required to complete self-administered sociodemographic and the Drug Use Screening Inventory-Revised (DUSI-R)…
Ramani, Ken; Zhimin, Liu
The broad objective of the study was to determine various mechanisms applied in resolving conflicts within public secondary schools in Nairobi province. This study used descriptive and exploratory research design. A sample comprising of principals, representatives of Boards of Governors (BoG's), class teachers, students and education officers was…
Background Successful treatment of tuberculosis (TB) involves taking anti-tuberculosis drugs for at least six months. Poor adherence to treatment means patients remain infectious for longer, are more likely to relapse or succumb to tuberculosis and could result in treatment failure as well as foster emergence of drug resistant tuberculosis. Kenya is among countries with high tuberculosis burden globally. The purpose of this study was to determine the duration tuberculosis patients stay in treatment before defaulting and factors associated with default in Nairobi. Methods A Case-Control study; Cases were those who defaulted from treatment and Controls those who completed treatment course between January 2006 and March 2008. All (945) defaulters and 1033 randomly selected controls from among 5659 patients who completed treatment course in 30 high volume sites were enrolled. Secondary data was collected using a facility questionnaire. From among the enrolled, 120 cases and 154 controls were randomly selected and interviewed to obtain primary data not routinely collected. Data was analyzed using SPSS and Epi Info statistical software. Univariate and multivariate logistic regression analysis to determine association and Kaplan-Meier method to determine probability of staying in treatment over time were applied. Results Of 945 defaulters, 22.7% (215) and 20.4% (193) abandoned treatment within first and second months (intensive phase) of treatment respectively. Among 120 defaulters interviewed, 16.7% (20) attributed their default to ignorance, 12.5% (15) to traveling away from treatment site, 11.7% (14) to feeling better and 10.8% (13) to side-effects. On multivariate analysis, inadequate knowledge on tuberculosis (OR 8.67; 95% CI 1.47-51.3), herbal medication use (OR 5.7; 95% CI 1.37-23.7), low income (OR 5.57, CI 1.07-30.0), alcohol abuse (OR 4.97; 95% CI 1.56-15.9), previous default (OR 2.33; 95% CI 1.16-4.68), co-infection with Human immune-deficient Virus (HIV) (OR 1
Radcliff, Elizabeth; Racine, Elizabeth F; Brunner Huber, Larissa R; Whitaker, Beth Elise
The objective of this study is to examine the relationship between a vulnerable child's family composition (family size and primary caregiver) and three child well-being indicators (immunization status, access to food, educational security). Using 2006-2009 intake data from a Kenyan non-governmental aid agency, this cross-sectional study evaluated a population of 1,424 children in two urban slum settlements in Nairobi. Logistic regression was used to obtain adjusted odds ratios and 95% confidence intervals to examine the relationship between family composition measures and child well-being. Multivariate results were also stratified by orphan status. Vulnerable children who live in household sizes of 4-6 members and vulnerable children who live with non-relatives had greater odds of inadequate immunization (OR = 1.51, 95% CI: 1.13-2.01, OR = 9.02, 95% CI: 4.62-17.62). Paradoxically, vulnerable children living with non-relative caregivers were at lower risk for inadequate food (OR = 0.19, 95% CI 0.07-0.33). Single orphans with an HIV positive parent were less likely to be fully immunized than single orphans with an HIV negative parent. The results provide information on specific groups which could benefit from increased attention related to childhood immunization education and intervention programs. The findings also underscore the need for policies which support families as a means of supporting vulnerable children. Finally, findings reinforce the wisdom of programs which target vulnerable children based on needs, rather than orphan status. These findings can be useful for informing future program and policy development designed to meet needs of vulnerable children.
Background Estimates place the number of refugees in Nairobi over 100,000. The constant movement of refugees between countries of origin, refugee camps, and Nairobi poses risk of introduction and transmission of communicable diseases into Kenya. We assessed the care-seeking behavior of residents of Eastleigh, a neighborhood in Nairobi with urban refugees. Methods During July and August 2010, we conducted a Health Utilization Survey in Section II of Eastleigh. We used a multistage random cluster sampling design to identify households for interview. A standard questionnaire on the household demographics, water and sanitation was administered to household caretakers. Separate questionnaires were administered to household members who had one or more of the illnesses of interest. Results Of 785 households targeted for interview, data were obtained from 673 (85.7%) households with 3,005 residents. Of the surveyed respondents, 290 (9.7%) individuals reported acute respiratory illness (ARI) in the previous 12 months, 222 (7.4%) reported fever in the preceding 2 weeks, and 54 (1.8%) reported having diarrhea in the 30 days prior to the survey. Children <5 years old had the highest frequency of all the illnesses surveyed: 17.1% (95% CI 12.2-21.9) reported ARI, 10.0% (95% CI 6.2-13.8) reported fever, and 6.9% (3.8-10.0) reported diarrhea during the time periods specified for each syndrome. Twenty-nine [7.5% (95% CI 4.3-10.7)] hospitalizations were reported among all age groups of those who sought care. Among participants who reported ≥1 illness, 330 (77.0%) sought some form of health care; most (174 [59.8%]) sought health care services from private health care providers. Fifty-five (18.9%) participants seeking healthcare services visited a pharmacy. Few residents of Eastleigh (38 [13.1%]) sought care at government-run facilities, and 24 (8.2%) sought care from a relative, a religious leader, or a health volunteer. Of those who did not seek any health care services (99 [23
Ngaira, Jacqueline Asundula Malungu; Kimotho, James; Mirigi, Isaac; Osman, Saida; Ng’ang’a, Zipporah; Lwembe, Raphael; Ochwoto, Missiani
Introduction Hepatitis B Viral Infection (HBV) remains one of the leading cause of morbidity and mortality globally accounting for 38-53% of chronic liver diseases and about 686,000 deaths annually. The prevalence of HBV is 9-20% in Sub-Saharan Africa, and in Kenya it is 5-30% among the general population and 9.4% among pregnant women. This study was aimed at identifying the prevalence, awareness and risk factors associated with HBV infections among pregnant women attending Antenatal clinic (ANC) at Mbagathi District hospital, Nairobi. Methods This was a cross-sectional study involving 287 pregnant women enrolled for three months (September to December 2014) from Nairobi and neighbouring counties. A structured questionnaire that captured social, demographic and explanatory variables was administered to the study participants. Blood samples were also drawn from the participants and tested for HBV using Enzyme-Linked Immunosorbent Assay (ELISA) system. Results The study established that the prevalence of HBV infections among pregnant women attending antenatal clinic at Mbagathi District Hospital was 3.8% with highest infection rate among the 20-24 years age group. Seventy six (60.8 %) of the participants reported sexual encounters in less than a month before the interview of which 5 (7.6%) reported encounters involving other partners apart from their spouses. HBV awareness among the study participants was 12.2%. Before the interview, those with at least tertiary education (Mean =1.33, SD = 1.131), were more informed about HBV infection as compared to those with primary and secondary education (Mean = 0.63, SD = 0.722; (Mean =0.31, SD= 0.664). In regards to assessment of the risk factors; type of family (χ² =19.753 df2 p<0.01), parity (χ² =7.128 df2 p<0.01), History of abortions (χ²=9.094 df1 p<0.01), early age (11-15 years) at first sexual encounter (χ² =8.185 df1 p<0.01) were significantly associated with HBV positivity. Conclusion The prevalence of HBV
Bohnert, Kate; Chard, Anna N; Mwaki, Alex; Kirby, Amy E; Muga, Richard; Nagel, Corey L; Thomas, Evan A; Freeman, Matthew C
The provision of safely managed sanitation in informal settlements is a challenge, especially in schools that require durable, clean, sex-segregated facilities for a large number of children. In informal settlements in Nairobi, school sanitation facilities demand considerable capital costs, yet are prone to breakage and often unhygienic. The private sector may be able to provide quality facilities and services to schools at lower costs as an alternative to the sanitation that is traditionally provided by the government. We conducted a randomized trial comparing private sector service delivery (PSSD) of urine-diverting dry latrines with routine waste collection and maintenance and government standard delivery (GSD) of cistern-flush toilets or ventilated improved pit latrines. The primary outcomes were facility maintenance, use, exposure to fecal contamination, and cost. Schools were followed for one school year. There were few differences in maintenance and pathogen exposure between PSSD and GSD toilets. Use of the PSSD toilets was 128% higher than GSD toilets, as measured with electronic motion detectors. The initial cost of private sector service delivery was USD 2053 (KES 210,000) per school, which was lower than the average cost of rehabilitating the government standard flush-type toilets (USD 9306 (KES 922,638)) and constructing new facilities (USD 114,889 (KES 1,169,668)). The private sector delivery of dry sanitation provided a feasible alternative to the delivery of sewage sanitation in Nairobi informal settlements and might elsewhere in sub-Saharan Africa.
Bohnert, Kate; Chard, Anna N.; Mwaki, Alex; Kirby, Amy E.; Muga, Richard; Nagel, Corey L.; Thomas, Evan A.; Freeman, Matthew C.
The provision of safely managed sanitation in informal settlements is a challenge, especially in schools that require durable, clean, sex-segregated facilities for a large number of children. In informal settlements in Nairobi, school sanitation facilities demand considerable capital costs, yet are prone to breakage and often unhygienic. The private sector may be able to provide quality facilities and services to schools at lower costs as an alternative to the sanitation that is traditionally provided by the government. We conducted a randomized trial comparing private sector service delivery (PSSD) of urine-diverting dry latrines with routine waste collection and maintenance and government standard delivery (GSD) of cistern-flush toilets or ventilated improved pit latrines. The primary outcomes were facility maintenance, use, exposure to fecal contamination, and cost. Schools were followed for one school year. There were few differences in maintenance and pathogen exposure between PSSD and GSD toilets. Use of the PSSD toilets was 128% higher than GSD toilets, as measured with electronic motion detectors. The initial cost of private sector service delivery was USD 2053 (KES 210,000) per school, which was lower than the average cost of rehabilitating the government standard flush-type toilets (USD 9306 (KES 922,638)) and constructing new facilities (USD 114,889 (KES 1,169,668)). The private sector delivery of dry sanitation provided a feasible alternative to the delivery of sewage sanitation in Nairobi informal settlements and might elsewhere in sub-Saharan Africa. PMID:27916914
Beguy, Donatien; Mberu, Blessing
The main objective of this paper is to investigate the association between fertility preferences and contraceptive use among 15-49-year-old women living in Korogocho and Viwandani, informal settlements in Nairobi, Kenya. We draw on longitudinal data collected under the Maternal and Child Health project conducted between 2006 and 2010 in the two settlements. There is substantial regularity and stability but also unusual instability in reported fertility preferences over time among women living in these settings. Younger women, aged 15-24 years, are likely to change their preferences over time, passing from limiting to wanting additional children. But women aged 35-49 are likely to change their preferences from desiring more children to limiting their childbearing. The desire to limit childbearing is strongly associated with the use of modern and long-acting contraceptive methods. Findings have major implications for the success of family planning programmes in informal settlements where access to and knowledge about contraception may be limited.
Karimi, K J; Ayah, R; Olewe, T
Introduction Despite extensive knowledge about effective tobacco control interventions, the prevalence of tobacco use in many middle- and low-income countries continues to rise. In these countries, public appreciation of levels of protection provided by laws and regulations on tobacco use and exposure to tobacco smoke is limited. After ratification of the Framework Convention on Tobacco Control, Kenya enacted the Tobacco Control Act, 2007, banning smoking in public places except in designated smoking areas. Objective To assess adherence to the Tobacco Control Act, 2007 by determining the presence of a workplace policy on tobacco use in bars and restaurants. Methods A survey of 176 liquor licensed bars and restaurants in Nairobi County was carried out. Their managers were asked about the presence of a workplace policy governing smoking of tobacco, and observations made on provisions that determine adherence to the Tobacco Control Act, 2007. Results Smoking took place in almost all bars and restaurants (150 (85%)). Half the establishments (86 (49%)) had a workplace policy governing tobacco use among employees, although a difference between bars (11 (23%)) and restaurants (75 (58%)) was recorded (p<0.001). Establishments at which managers had lower levels of education were less likely to have a workplace policy (p<0.001) and less likely to have ‘no smoking’ signs and designated smoking areas (p<0.005). Conclusions and recommendations Kenya's implementation of the Tobacco Control Act, 2007 does not provide sufficient protection of patrons and workers in bars and restaurants. It is important to sensitise hospitality workers to the dangers of tobacco smoke. Bar and restaurants managers should have a minimum post-secondary education level. The Tobacco Control Act, 2007 requires strengthening to ensure that bars and restaurants have a smoke-free environment. PMID:27683518
Kimani, Violet N; Mitoko, Grace; McDermott, Brigid; Grace, Delia; Ambia, Julie; Kiragu, Monica W; Njehu, Alice N; Sinja, Judith; Monda, Joseph G; Kang'ethe, Erastus K
The aim of the study was to investigate the social and gender determinants of the risk of exposure to Cryptosporidium from urban dairying in Dagoretti, Nairobi. Focus group discussions were held in six locations to obtain qualitative information on risk of exposure. A repeated cross-sectional descriptive study included participatory assessment and household questionnaires (300 randomly selected urban dairy farming households and 100 non-dairying neighbours). One-hundred dairy households randomly selected from the 300 dairy households participated in an additional economic survey along with 40 neighbouring non-dairy households. We found that exposure to Cryptosporidium was influenced by gender, age and role in the household. Farm workers and people aged 50 to 65 years had most contact with cattle, and women had greater contact with raw milk. However, children had relatively higher consumption of raw milk than other age groups. Adult women had more daily contact with cattle faeces than adult men, and older women had more contact than older men. Employees had greater contact with cattle than other groups and cattle faeces, and most (77 %) were male. Women took more care of sick people and were more at risk from exposure by this route. Poverty did not affect the level of exposure to cattle but did decrease consumption of milk. There was no significant difference between men and women as regards levels of knowledge on symptoms of cryptosporidiosis infections or other zoonotic diseases associated with dairy farming. Awareness of cryptosporidiosis and its transmission increased significantly with rising levels of education. Members of non-dairy households and children under the age of 12 years had significantly higher odds of reporting diarrhoea: gender, season and contact with cattle or cattle dung were not significantly linked with diarrhoea. In conclusion, social and gender factors are important determinants of exposure to zoonotic disease in Nairobi.
Mbua, Emma; Kusaka, Soichiro; Kunimatsu, Yutaka; Geraads, Denis; Sawada, Yoshihiro; Brown, Francis H; Sakai, Tetsuya; Boisserie, Jean-Renaud; Saneyoshi, Mototaka; Omuombo, Christine; Muteti, Samuel; Hirata, Takafumi; Hayashida, Akira; Iwano, Hideki; Danhara, Tohru; Bobe, René; Jicha, Brian; Nakatsukasa, Masato
Most Plio-Pleistocene sites in the Gregory Rift Valley that have yielded abundant fossil hominins lie on the Rift Valley floor. Here we report a new Pliocene site, Kantis, on the shoulder of the Gregory Rift Valley, which extends the geographical range of Australopithecus afarensis to the highlands of Kenya. This species, known from sites in Ethiopia, Tanzania, and possibly Kenya, is believed to be adapted to a wide spectrum of habitats, from open grassland to woodland. The Kantis fauna is generally similar to that reported from other contemporaneous A. afarensis sites on the Rift Valley floor. However, its faunal composition and stable carbon isotopic data from dental enamel suggest a stronger C4 environment than that present at those sites. Although the Gregory Rift Valley has been the focus of paleontologists' attention for many years, surveys of the Rift shoulder may provide new perspective on African Pliocene mammal and hominin evolution.
Chung, Michael H; Silverman, Rachel; Beck, Ingrid A; Yatich, Nelly; Dross, Sandra; McKernan-Mullin, Jennifer; Bii, Stephen; Tapia, Kenneth; Stern, Joshua; Chohan, Bhavna; Sakr, Samah R; Kiarie, James N; Frenkel, Lisa M
Antiretroviral-naïve adults initiating antiretroviral therapy in Nairobi, Kenya were tested for HIV-1 drug resistance at codons K103N, Y181C, G190A, M184V, and K65R using an oligonucleotide ligation assay. Prevalence of pretreatment drug resistance increased from 3.89% in 2006 to 10.93% in 2014 (P < 0.001), and 95% of those with resistance had at least one nonnucleoside reverse transcriptase inhibitor mutation. Resistance to tenofovir (K65R) was found in 2014 but not in 2006.
Ngo, Nicole S.; Gatari, Michael; Yan, Beizhan; Chillrud, Steven N.; Bouhamam, Kheira; Kinney, Patrick L.
Few studies examine urban air pollution in sub-Saharan Africa (SSA), yet urbanization rates there are among the highest in the world. In this study, we measured 8-hr average occupational exposure levels of fine particulate matter (PM2.5), black carbon (BC), ultra violet active-particulate matter (UV-PM), and trace elements for individuals who worked along roadways in Nairobi, specifically bus drivers, garage workers, street vendors, and women who worked inside informal settlements. We found BC and re-suspended dust were important contributors to PM2.5 levels for all study populations, particularly among bus drivers, while PM2.5 exposure levels for garage workers, street vendors, and informal settlement residents were not statistically different from each other. We also found a strong signal for biomass emissions and trash burning, which is common in Nairobi's low-income areas and open-air garages. These results suggest that the large portion of urban residents in SSA who walk along roadways would benefit from air quality regulations targeting roadway emissions from diesel vehicles, dust, and trash burning. This is the first study to measure occupational exposure to urban air pollution in SSA and results imply that roadway emissions are a serious public health concern.
It is evident that sexual activity tends to decrease with age. Nonetheless, it is still prevalent enough to be considered a risk factor for the spread of HIV among older people. This paper uses quantitative data for 2053 individuals to examine HIV risk perception and correlates of perceived risk among older people aged 50 years and older living in Nairobi slums. It emerged that a majority of older people did not consider themselves at risk of infection. Of those who felt at risk, a greater proportion sensed only a small chance of contracting HIV. Women cited 'no sexual activity' while men mentioned 'having only one and/or a faithful sexual partner' as the primary reasons for perceiving minimal risk of HIV infection. There were no differences by sex in the basis for perceiving moderate-to-great risk of infection. Religion is a key factor in risk perception with Muslims perceiving higher levels of risk and, conversely, devotees irrespective of faith perceiving lower levels of risk. Older people willing to be tested for HIV had a decreased likelihood of perceived risk compared with those unwilling to be tested. This paper recommends evaluation of older people's perception of risk in order to better inform interventions aimed at minimizing their vulnerability to HIV infection.
Attention in this discussion of Kenya is directed to the following: geography; people; history; government; political conditions; the economy; defense; and relations between Kenya and the US. In 1987, the population was estimated at 21.6 million with an estimated annual growth rate of 4.1%. Traditional herders, Arab Muslims, and cosmopolitan residents of Nairobi all contribute to the culture of Kenya. The standard of living in major cities is among the highest in sub-Saharan Africa. Fossils located in east Africa suggest that protohumans roamed the area more than 20 million years ago. Recent anthropological finds near Kenya's Lake Turkana indicate that the "Homo" genus of humans lived in the area 2.6 million years ago. Kenya's colonial history dates from the Berlin conference of 1885. In 1895, the British government established the East African Protectorate and, soon after, opened the fertile highlands to white settlers. The settlers were allowed a voice in government before it officially was made a British colony in 1920, but Africans were not permitted any direct political participation until 1944. Kenya became independent on December 12, 1963, and in 1964 assumed the status of a republic within the Commonwealth. The president is elected by the National Assembly to serve a 5-year term, but if the president dissolves the assembly, a new presidential election must be held. Since independence, Kenya has maintained remarkable stability during many changes within the democratic system. Kenya's major political challenge is to reinvigorate its economy, which has suffered from a combination of problems such as government deficit spending, a chronic shortage of foreign exchange, and the rising cost of oil imports. Economic growth has declined since 1973, and real gross domestic product (GDP) has grown only by about 2.75% for the 1980-86 period. One of Kenya's basic problems is its population growth rate. With less than 20% of the land classified as potentially arable and
Nutrition Planning and Policy for African Countries. Summary Report of a Seminar Held at the Institute for Development Studies (Nairobi, Kenya, June 2-19, 1976). Cornell International Nutrition Monograph Series, Number 5 (1977).
Latham, Michael C., Ed.; Westley, Sidney B., Ed.
This paper is the summary report of a seminar which was held in Kenya at the Institute for Development Studies of the University of Nairobi from June 2-19, 1976. The seminar was sponsored by USAID through a contract to Cornell University in Ithaca, New York. Ten English-speaking African countries, whose responsibilities are related to nutrition…
Gaita, S. M.; Boman, J.; Gatari, M. J.; Pettersson, J. B. C.; Janhäll, S.
Sources of airborne particulate matter and their seasonal variation in urban areas in Sub-Sahara Africa are poorly understood due to lack of long-term measurement data. In view of this, airborne fine particles matter (particle diameter ≤ 2.5 μm, PM2.5) were collected between May 2008 and April 2010 at two sites (urban background site and suburban site) within the Nairobi metropolitan area. A total of 780 samples were collected and analyzed for particulate mass, black carbon (BC) and thirteen trace elements. The average PM2.5 concentration at the urban background site was 20 ± 8 μg m-3 whereas the concentration at the suburban site was 13 ± 8 μg m-3. The daily PM2.5 concentrations exceeded 25 μg m-3 (the World Health Organization 24 h guideline value) 29% of the days at the urban background site and 7% of the days at the suburban site. At both sites, BC, Fe, S and Cl accounted for approximately 80% of all detected elements. Positive Matrix Factorization analysis identified five source factors that contribute to PM2.5 in Nairobi; traffic, mineral dust, secondary aerosol, industrial and combustion. Mineral dust and traffic factors were related to approximately 74% of PM2.5. Identified source factors exhibited seasonal variation though traffic factor was prominently consistent throughout the sampling period. The results provide information that can be exploited for policy formulation and mitigation strategies to control air pollution in Sub-Sahara African cities.
Gaita, S. M.; Boman, J.; Gatari, M. J.; Pettersson, J. B. C.; Janhäll, S.
Sources of airborne particulate matter and their seasonal variation in urban areas in Sub-Saharan Africa are poorly understood due to lack of long-term measurement data. In view of this, filter samples of airborne particulate matter (particle diameter ≤2.5 μm, PM2.5) were collected between May 2008 and April 2010 at two sites (urban background site and suburban site) within the Nairobi metropolitan area. A total of 780 samples were collected and analyzed for particulate mass, black carbon (BC) and 13 trace elements. The average PM2.5 concentration at the urban background site was 21±9.5 μg m-3, whereas the concentration at the suburban site was 13±7.3 μg m-3. The daily PM2.5 concentrations exceeded 25 μg m-3 (the World Health Organization 24 h guideline value) on 29% of the days at the urban background site and 7% of the days at the suburban site. At both sites, BC, Fe, S and Cl accounted for approximately 80% of all detected elements. Positive matrix factorization analysis identified five source factors that contribute to PM2.5 in Nairobi, namely traffic, mineral dust, industry, combustion and a mixed factor (composed of biomass burning, secondary aerosol and aged sea salt). Mineral dust and traffic factors were related to approximately 74% of PM2.5. The identified source factors exhibited seasonal variation, apart from the traffic factor, which was prominently consistent throughout the sampling period. Weekly variations were observed in all factors, with weekdays having higher concentrations than weekends. The results provide information that can be exploited for policy formulation and mitigation strategies to control air pollution in Sub-Saharan African cities.
Pickering, Amy J.; Davis, Jennifer; Blum, Annalise G.; Scalmanini, Jenna; Oyier, Beryl; Okoth, George; Breiman, Robert F.; Ram, Pavani K.
Handwashing is difficult in settings with limited resources and water access. In primary schools within urban Kibera, Kenya, we investigated the impact of providing waterless hand sanitizer on student hand hygiene behavior. Two schools received a waterless hand sanitizer intervention, two schools received a handwashing with soap intervention, and two schools received no intervention. Hand cleaning behavior after toilet use was monitored for 2 months using structured observation. Hand cleaning after toileting was 82% at sanitizer schools (N = 2,507 toileting events), 38% at soap schools (N = 3,429), and 37% at control schools (N = 2,797). Students at sanitizer schools were 23% less likely to have observed rhinorrhea than control students (P = 0.02); reductions in student-reported gastrointestinal and respiratory illness symptoms were not statistically significant. Providing waterless hand sanitizer markedly increased student hand cleaning after toilet use, whereas the soap intervention did not. Waterless hand sanitizer may be a promising option to improve student hand cleansing behavior, particularly in schools with limited water access. PMID:23836575
Ziraba, Abdhalah Kasiira; Kyobutungi, Catherine; Zulu, Eliya Msiyaphazi
Injuries contribute significantly to the rising morbidity and mortality attributable to non-communicable diseases in the developing world. Unfortunately, active injury surveillance is lacking in many developing countries, including Kenya. This study aims to describe and identify causes of and risk factors for fatal injuries in two slums in Nairobi city using a demographic surveillance system framework. The causes of death are determined using verbal autopsies. We used a nested case-control study design with all deaths from injuries between 2003 and 2005 as cases. Two controls were randomly selected from the non-injury deaths over the same period and individually matched to each case on age and sex. We used conditional logistic regression modeling to identity individual- and community-level factors associated with fatal injuries. Intentional injuries accounted for about 51% and unintentional injuries accounted for 49% of all injuries. Homicides accounted for 91% of intentional injuries and 47% of all injury-related deaths. Firearms (23%) and road traffic crashes (22%) were the leading single causes of deaths due to injuries. About 15% of injuries were due to substance intoxication, particularly alcohol, which in this community comes from illicit brews and is at times contaminated with methanol. Results suggest that in the pervasively unsafe and insecure environment that characterizes the urban slums, ethnicity, residence, and area level factors contribute significantly to the risk of injury-related mortality.
Muraguri, Nicholas; Tun, Waimar; Okal, Jerry; Broz, Dita; Raymond, H. Fisher; Kellogg, Timothy; Dadabhai, Sufia; Musyoki, Helgar; Sheehy, Meredith; Kuria, David; Kaiser, Reinhard; Geibel, Scott
Previous surveys of men who have sex with men (MSM) in Africa have not adequately profiled HIV status and risk factors by sex work status. MSM in Nairobi, Kenya, were recruited using respondent-driven sampling, completed a behavioral interview, and were tested for HIV and sexually transmitted infections. Overlapping recruitment among 273 male sex workers and 290 other MSM was common. Sex workers were more likely to report receptive anal sex with multiple partners (65.7% versus 18.0%, P < 0.001) and unprotected receptive anal intercourse (40.0% versus 22.8%, P = 0.005). Male sex workers were also more likely to be HIV infected (26.3% versus 12.2%, P = 0.007). PMID:25501346
Ngo, Nicole S.; Gatari, Michael; Yan, Beizhan; Chillrud, Steven N.; Bouhamam, Kheira; Kinneym, Patrick L.
Few studies examine urban air pollution in sub-Saharan Africa (SSA), yet urbanization rates there are among the highest in the world. In this study, we measured 8-hr average occupational exposure levels of fine particulate matter (PM2.5), black carbon (BC), ultra violet active-particulate matter (UV-PM), and trace elements for individuals who worked along roadways in Nairobi, specifically bus drivers, garage workers, street vendors, and women who worked inside informal settlements. We found BC and re-suspended dust were important contributors to PM2.5 levels for all study populations, particularly among bus drivers, while PM2.5 exposure levels for garage workers, street vendors, and informal settlement residents were not statistically different from each other. We also found a strong signal for biomass emissions and trash burning, which is common in Nairobi’s low-income areas and open-air garages. These results suggest that the large portion of urban residents in SSA who walk along roadways would benefit from air quality regulations targeting roadway emissions from diesel vehicles, dust, and trash burning. This is the first study to measure occupational exposure to urban air pollution in SSA and results imply that roadway emissions are a serious public health concern. PMID:26034383
Owino, Joseph Ogutu; Odundo, Paul Amolloh
History is one of the teaching subjects studied by Bachelor of Education Arts students at the University of Nairobi. In the last five years, there has been a tremendous increase in the number of students specializing in History as a teaching subject. This paper therefore has examined factors influencing students' selection of History as career…
In the fight against HIV/AIDS, the Behavior Change Communication (BCC) model stands as international best practice in preventive education. Ideally, a BCC intervention aims to changes behaviors and attitudes by facilitating group negotiation and introspection, with a resultant improvement in health. However, introducing this best practice model to…
Kimani-Murage, E W; Norris, S A; Mutua, M K; Wekesah, F; Wanjohi, M; Muhia, N; Muriuki, P; Egondi, T; Kyobutungi, C; Ezeh, A C; Musoke, R N; McGarvey, S T; Madise, N J; Griffiths, P L
Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007-2011; n=5824), Intervention (2012-2015; n=1110) and Comparison (2012-2014; n=487)], which followed mother-child pairs longitudinally to establish EBF rates from 0 to 6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0 to 6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a χ(2) test and logistic regression. At 6 months, the prevalence of EBF was 2% in the Pre-intervention group compared with 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (P<0.05). After adjusting for baseline characteristics, the odds ratio for EBF from birth to 6 months was 66.9 (95% CI 45.4-96.4), 84.3 (95% CI 40.7-174.6) and 3.9 (95% CI 1.8-8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared with the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting EBF in urban poor settings where health care access is limited.
Mabeya, Sepha Nyatichi; Ngugi, Caroline Wangari; Lihana, Raphael W; Khamadi, Samoel Ashimosi; Nyamache, Anthony Kebira
HBV/HIV coinfections are becoming common with information on HBV genetic diversity and drug resistance still remaining elusive. To evaluate the HBV genetic diversity and drug resistance associated mutations among drug experienced HIV patients, the genetic analysis of the partial HBV-pol-reverse trancriptase gene was successfully sequenced from 13 samples. Analysis of the sequences showed that all (13) the sequences belonged to genotype A. Nucleos(t)ide drug resistance mutations were found in six (6) patients. Five subjects had rtV173L, rtL180M, rtM204V and one with rtL180M, rtM204V major mutations. HBV genotype A remains the most predominant genotype circulating in Nairobi city with detected high level of HBV drug resistance to Lamivudine telbivudine and emtricitabine. The detected circulating HBV genotype A in Nairobi reflects its possible spread in the population with its origin being within the country. We suggest that patients should not be on lamivudine monotherapy. These individuals should be managed on combination of tenofovir plus lamivudine or emtricitabine therapy in order to prevent the emergence of HBV drug resistant variants alongside a continuous surveillance monitoring of drug resistance and HBV genotypes.
Buechler, M B; Newman, L P; Chohan, B H; Njoroge, A; Wamalwa, D; Farquhar, C
HIV-infected children are less capable of mounting and maintaining protective humoral responses to vaccination against measles compared to HIV-uninfected children. This poses a public health challenge in countries with high HIV burdens. Administration of anti-retroviral therapy (ART) and revaccinating children against measles is one approach to increase measles immunity in HIV-infected children, yet it is not effective in all cases. Immune anergy and activation during HIV infection are factors that could influence responses to measles revaccination. We utilized a flow cytometry-based approach to examine whether T cell anergy and activation were associated with the maintenance of measles-specific immunoglobulin (Ig)G antibodies generated in response to measles revaccination in a cohort of HIV-infected children on ART in Nairobi, Kenya. Children who sustained measles-specific IgG for at least 1 year after revaccination displayed significantly lower programmed cell death 1 (PD-1) surface expression on CD8(+) T cells on a per-cell basis and exhibited less activated CD4(+) T cells compared to those unable to maintain detectable measles-specific antibodies. Children in both groups were similar in age and sex, CD4(+) T cell frequency, duration of ART treatment and HIV viral load at enrolment. These data suggest that aberrant T cell anergy and activation are associated with the impaired ability to sustain an antibody response to measles revaccination in HIV-infected children on ART.
Abuya, Benta A.; Onsomu, Elijah O.; Moore, Dakysha
In 2010, there was a slight decrease in the number of out-of school adolescents from 75 million in 2009 (UNESCO, 2009) to 71 million in 2010, of which 55% are girls (UNESCO, 2010). In Kenya, only 17% of girls have secondary education (CBS, 2004). This paper analyzes the role of families in girls' secondary education in two schools within Nairobi…
Obeng Gyimah, Stephen; Kodzi, Ivy; Emina, Jacques; Adjei, Jones; Ezeh, Alex
Young people in sub-Saharan Africa are at the centre of the global HIV epidemic as they account for a disproportionate share of new infections. Their vulnerability to HIV has been attributed to a myriad of factors, in particular, risky sexual behaviours. While economic factors are important, increasing attention has been devoted to religion on the discourse on sexual decision-making because religious values provide a perspective on life that often conflicts with risky sexual behaviours. Given the centrality of religion in the African social fabric, this study assesses the relationship between adolescent religiousness and involvement in risky sexual behaviours using data from the informal settlements of Nairobi. Guided by social control theory, the paper explores if and how religion and religiosity affect sexual risk-taking among adolescents.
Kang'ethe, Erastus; Kimani, Violet; Grace, Delia; Mitoko, Grace; McDermott, Brigid; Ambia, Julie; Nyongesa, Concepta; Mbugua, Gabriel; Ogara, William; Obutu, Peninnah
This paper describes a trans-disciplinary process of co-generating and disseminating evidence-based messages for reducing the risk from cryptosporidiosis and other zoonoses in an urban community in Nairobi. Research findings about disease prevalence, risk factors and observed risky and risk-mitigating practices were analysed by a team comprising researchers, community members and local policy- and decision-makers. Using participatory planning, multiple strategies were developed for disseminating key information. We identified five vulnerable groups at higher risk of exposure to cryptosporidiosis and other cattle zoonoses with similar transmission pathways (women, children, elderly people, immunosuppressed people and male farm workers). For each group, targeted messages were developed. Good practices already in use, as were also practices as practices to improve environmental conditions. These messages were disseminated through printed material, in a workshop, through community campaigners and also an edutainment soap opera episode broadcast on Kenyan television. In conclusion, a participatory and trans-disciplinary process can help transform the findings of research into messages that are targeted, attractive and understandable.
Grace, Delia; Monda, Joseph; Karanja, Nancy; Randolph, Thomas F; Kang'ethe, Erastus K
We carried out a participatory risk assessment to estimate the risk (negative consequences and their likelihood) from zoonotic Cryptosporidium originating in dairy farms in urban Dagoretti, Nairobi to dairy farm households and their neighbours. We selected 20 households at high risk for Cryptosporidium from a larger sample of 300 dairy households in Dagoretti based on risk factors present. We then conducted a participatory mapping of the flow of the hazard from its origin (cattle) to human potential victims. This showed three main exposure pathways (food and water borne, occupational and recreational). This was used to develop a fault tree model which we parameterised using information from the study and literature. A stochastic simulation was used to estimate the probability of exposure to zoonotic cryptosporidiosis originating from urban dairying. Around 6 % of environmental samples were positive for Cryptosporidium. Probability of exposure to Cryptosporidium from dairy cattle ranged from 0.0055 for people with clinical acquired immunodeficiency syndrome in non-dairy households to 0.0102 for children under 5 years from dairy households. Most of the estimated health burden was born by children. Although dairy cattle are the source of Cryptosporidium, the model suggests consumption of vegetables is a greater source of risk than consumption of milk. In conclusion, by combining participatory methods with quantitative microbial risk assessment, we were able to rapidly, and with appropriate 'imprecision', investigate health risk to communities from Cryptosporidium and identify the most vulnerable groups and the most risky practices.
K'oreje, K O; Vergeynst, L; Ombaka, D; De Wispelaere, P; Okoth, M; Van Langenhove, H; Demeestere, K
Emerging organic contaminants have not received a lot of attention in developing countries, particularly Africa, although problems regarding water quantity and quality are often even more severe than in more developed regions. This study presents general water quality parameters as well as unique data on concentrations and loads of 24 pharmaceuticals including antibiotic, anti(retro)viral, analgesic, anti-inflammatory and psychiatric drugs in three wastewater treatment plants, three rivers and three groundwater wells in Nairobi and Kisumu. This allowed studying removal efficiencies in wastewater treatment, identifying important sources of pharmaceutical pollution and distinguishing dilution effects from natural attenuation in rivers. In general, antiretrovirals and antibiotics, being important in the treatment of common African diseases such as HIV and malaria, were in all matrices more prevalent as compared to the Western world. Wastewater stabilization ponds removed pharmaceuticals with an efficiency between 11 and 99%. Despite this large range, a different removal is observed for a number of compounds, as compared to more conventional activated sludge systems. Total concentrations in river water (up to 320 μg L(-1)) were similar or exceeded concentrations in untreated wastewater, with domestic discharges from slums, wastewater treatment plant effluent and waste dumpsites identified as important sources. In shallow wells situated next to pit latrines and used for drinking water, the recalcitrant antiretroviral nevirapine was measured at concentrations as high as 1-2 μg L(-1). Overall, distinct pharmaceutical contamination patterns as compared to the Western world can be concluded, which might be a trigger for further research in developing regions.
Lindstrom, U. B.
A survey of graduates from the University of Nairobi, Kenya in the field of veterinary medicine is reported. Areas covered include curriculum; teaching techniques; quality of faculty; and examinations. (JMF)
Nzengy'a, Daniel Muasya; Wishitemi, B. E. L.
The performance of a constructed wetland for wastewater treatment was examined for four months (December 1995 to March 1996). The study area, hereby referred to as the Splash wetland, is approximately 0·5 ha, and is located in the southern part of Nairobi city. Splash wetland continuously receives domestic sewage from two busy restaurants. Treated wastewater is recycled for re-use for various purposes in the restaurants. Both wet and dry season data were analysed with a view of determining the impact of seasonal variation on the system performance. The physical and chemical properties of water were measured at a common intake and at series of seven other points established along the wetland gradient and at the outlet where the water is collected and pumped for re-use at the restaurants. The physico-chemical characteristics of the wastewater changed significantly as the wastewater flowed through the respective wetland cells. A comparison of wastewater influent versus the effluent from the wetland revealed the system's apparent success in water treatment, especially in pH modification, removal of suspended solids, organic load and nutrients mean influent pH = 5·7 +/- 0·5, mean effluent pH 7·7 +/- 0·3; mean influent BOD5 = 1603·0 +/- 397·6 mg/l, mean effluent BOD5 = 15·1 +/- 2·5 mg/l; mean influent COD = 3749·8 +/- 206·8 mg/l, mean effluent COD = 95·6 +/- 7·2 mg/l; mean influent TSS = 195·4 +/- 58·7 mg/l, mean effluent TSS = 4·7 +/- 1·9 mg/l. As the wastewater flowed through the wetland system dissolved free and saline ammonia, NH4+, decreased from 14·6 +/- 4·1 mg/l to undetectable levels at the outlet. Dissolved oxygen increased progressively through the wetland system. Analysis of the data available did not reveal temporal variation in the system's performance. However, significant spatial variation was evident as the wetland removed most of the common pollutants and considerably improved the quality of the water, making it safe for re-use at the
Williams, A N
'Nairobi Eye' is a condition caused by a blister beetle, Paederus eximius, found in Northern Kenya. It has not previously been described as a hazard for troops exercising in this area. Four cases are described. Recommended management is to wash the contact area initially with soap and water, and to treat subsequent lesions with flamazine.
Bennett, Rachel; Chepngeno-Langat, Gloria; Evandrou, Maria; Falkingham, Jane
Older people in slum settings are a vulnerable sub-group during crises, yet have received minimal attention in the development discourse. This paper examines the protective role of different types of social networks for older slum dwellers' wellbeing during adversity by investigating the relationship between social networks, the Kenyan 2007/08 post-election violence, and dimensions of wellbeing namely self-rated health, life satisfaction and happiness amongst older people in the Korogocho slum, Nairobi. The analyses are based on conditional change logistic regression models using data from a unique longitudinal survey of the health and wellbeing of older people. The results show that maintaining or increasing formal local networks reduced the detrimental effects of the post-election violence for older people's wellbeing, whilst household environment and informal local and non-local networks did not influence the relationship. Consequently, the paper provides evidence that supporting inclusive community organisations which are accessible to older people can be valuable in promoting the resilience of this population group.
Obura, D O
The Kenya coast is bathed by the northward-flowing warm waters of the East Africa Coastal Current, located between latitudes 1 and 5 degrees S. With a narrow continental shelf, the coastal marine environments are dominated by coral reefs, seagrass beds and mangroves, with large expanses of sandy substrates where river inputs from Kenya's two largest rivers, the Tana and Athi rivers, prevent the growth of coral reefs. The northern part of the coast is seasonally influenced by upwelling waters of the Somali Current, resulting in lower water temperatures for part of the year. The coast is made up of raised Pleistocene reefs on coastal plains and hills of sedimentary origin, which support native habitats dominated by scrub bush and remnant pockets of the forests that used to cover East Africa and the Congo basin. The marine environment is characterized by warm tropical conditions varying at the surface between 25 degrees C and 31 degrees C during the year, stable salinity regimes, and moderately high nutrient levels from terrestrial runoff and groundwater. The semi-diurnal tidal regime varies from 1.5 to 4 m amplitude from neap to spring tides, creating extensive intertidal platform and rocky-shore communities exposed twice-daily during low tides. Fringing reef crests dominate the whole southern coast and parts of the northern coast towards Somalia, forming a natural barrier to the wave energy from the ocean. Coral reefs form the dominant ecosystem along the majority of the Kenya coast, creating habitats for seagrasses and mangroves in the lagoons and creeks protected by the reef crests. Kenya's marine environment faces a number of threats from the growing coastal human population estimated at just under three million in 2000. Extraction of fish and other resources from the narrow continental shelf, coral reef and mangrove ecosystems increases each year with inadequate monitoring and management structures to protect the resource bases. Coastal development in urban and
DOCTRINE DEVELOPMENT PROCESS IN THE KENYA ARMY: BRIDGING THE GAP A thesis presented to the Faculty of the U.S. Army Command...by ROBA B. WARIO, MAJ, KENYA ARMY Diploma, University of Nairobi, Nairobi, Kenya Fort Leavenworth, Kansas 2014-01...Doctrine Development Process in the Kenya Army: Bridging the Gap 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR
Kamau, Leonard Mwathi
This study examined the factors related to technology adoption by secondary mathematics teachers in Nyandarua and Nairobi counties in the Republic of Kenya. Using a sequential explanatory mixed methods approach, I collected qualitative data from interviews and classroom observations of six teachers to better understand statistical results from the…
Kang'ethe, Erastus K; Kimani, Violet N; McDermott, Brigid; Grace, Delia; Lang'at, Alfred K; Kiragu, Monica W; Karanja, Nancy; Njehu, Alice N; Randolph, Thomas; Mbugua, Gabriel; Irungu, Tabitha W; Ombutu, Peninnah
This paper characterises the dairy farming system in Dagoretti, Nairobi. Characterisation was part of a broader ecohealth project to estimate the prevalence and risk of cryptosporidiosis and develop risk mitigation strategies. In the project a trans-disciplinary team addressed epidemiological, socioeconomic, environmental and policy aspects of cryptosporidiosis, an emerging zoonosis. This paper also provides background and describes sampling methods for the wider project. Three hundred dairy households were probabilistically sampled from a sampling frame of all dairy households in five of the six locations of Dagoretti, one of the eight districts of Nairobi Province. Randomly selected households identified 100 non-dairy-keeping households who also took part in the study. A household questionnaire was developed, pre-tested and administered in the dry and wet seasons of 2006. An additional study on livelihood and economic benefits of dairying took place with 100 dairy farmers randomly selected from the 300 farms (as well as 40 non-dairy neighbours as a control group), and a risk-targeted survey of environmental contamination with Cryptosporidium was conducted with 20 farmers randomly selected from the 29 farmers in the wider survey who were considered at high risk because of farming system. We found that around 1 in 80 urban households kept dairy cattle with an average of three cattle per household. Cross-breeds of exotic and local cattle predominate. Heads of dairy-keeping households were significantly less educated than the heads of non-dairy neighbours, had lived in Dagoretti for significantly longer and had significantly larger households. There was a high turnover of 10 % of the cattle population in the 3-month period of the study. Cattle were zero grazed, but productivity parameters were sub-optimal as were hygiene and husbandry practices. In conclusion, dairy keeping is a minor activity in urban Nairobi but important to households involved and their community
Barth, James L.
Reports on the Third International Social Studies Conference held in Nairobi, Kenya, in 1994. Asserts that problems facing U.S. social studies, such as multiculturalism and individual rights, are not as important as development issues for African nations. (CFR)
Kayima, Joshua K.; Were, Anthony J.; Ezzi, Mohammed S.; McLigeyo, Seth O.; Ogola, Elijah N.
Objectives. To determine the changes in blood pressure levels and antihypertensive medication use in the postrenal transplantation period compared to pretransplantation one. Methods. A comparative cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital, a national referral hospital in Kenya. Sociodemographic details, blood pressure levels, and antihypertensive medication use before and after renal transplantation were noted. Changes in mean blood pressure levels and mean number of antihypertensive medications after renal transplantation were determined using paired t-test. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Compared to the pretransplant period, significantly lower mean systolic and diastolic blood pressure levels after transplantation were noted (mean SBP 144.5 mmHg versus 131.8 mmHg; mean DBP 103.6 mmHg versus 83.5 mmHg in the pre- and posttransplant periods, respectively, p < 0.001). Mean number of antihypertensive medications also reduced significantly after transplantation, with an average of 3.3 (±1.6) versus 2.1 (±0.9) in the pre- and posttransplant periods, respectively (p < 0.001). Conclusion. There is a significant reduction in blood pressure levels and number of antihypertensive medications used after renal transplantation. The positive impact of renal transplantation on blood pressure control should be confirmed using prospective cohort studies of patients with end stage renal disease who then undergo renal transplantation. PMID:28053780
Egondi, Thaddaeus; Kyobutungi, Catherine; Kovats, Sari; Muindi, Kanyiva; Ettarh, Remare; Rocklöv, Joacim
Background Many studies have established a link between weather (primarily temperature) and daily mortality in developed countries. However, little is known about this relationship in urban populations in sub-Saharan Africa. Objectives The objective of this study was to describe the relationship between daily weather and mortality in Nairobi, Kenya, and to evaluate this relationship with regard to cause of death, age, and sex. Methods We utilized mortality data from the Nairobi Urban Health and Demographic Surveillance System and applied time-series models to study the relationship between daily weather and mortality for a population of approximately 60,000 during the period 2003–2008. We used a distributed lag approach to model the delayed effect of weather on mortality, stratified by cause of death, age, and sex. Results Increasing temperatures (above 75th percentile) were significantly associated with mortality in children and non-communicable disease (NCD) deaths. We found all-cause mortality of shorter lag of same day and previous day to increase by 3.0% for a 1 degree decrease from the 25th percentile of 18°C (not statistically significant). Mortality among people aged 50+ and children aged below 5 years appeared most susceptible to cold compared to other age groups. Rainfall, in the lag period of 0–29 days, increased all-cause mortality in general, but was found strongest related to mortality among females. Low temperatures were associated with deaths due to acute infections, whereas rainfall was associated with all-cause pneumonia and NCD deaths. Conclusions Increases in mortality were associated with both hot and cold weather as well as rainfall in Nairobi, but the relationship differed with regard to age, sex, and cause of death. Our findings indicate that weather-related mortality is a public health concern for the population in the informal settlements of Nairobi, Kenya, especially if current trends in climate change continue. PMID:23195509
Opdyke, N. D.; Kent, D. V.; Huang, K.; Patel, J. P.
Field work on this study was carried out in August of 2006 by field parties from the University of Florida and Rutgers University. Mt Kenya is believed to be Plio-Pleistocene in age and an Argon dating survey is underway Ten samples were taken at each site consisting of one exposure in individual lava Flows. These exposures are usually in road cuts, streambeds and in some cases roadbeds. We sampled 100 sites distributed around the Mt Kenya Massif and to the northeast along the Nyambini range. The equator bisex's Mt Kenya and all sites were sampled within 40" north or south of the equator . The samples were returned to the US and processed at the University of Florida paleomagnetic laboratory. Many sites were severely affected by lightning however after demagnetization 68 sites yielded directions with alpha 95's equal to or less than 10°. Normal magnetized sites dominate, with N=58 (Dec=1°,Inc -0.1°,α95=2.6°) whereas only 10 reverse sites(Dec. =181.9,Inc. .6°α 95=8°) were identified. The combined site mean direction is Dec=1.1°, Inc..= -0.2° and α 95=3.2°. This result is not significantly different from what is expected from the geocentric axial dipole. VGP's were calculated from each site and the dispersion is low with the ASD = 11° which is in agreement with model "G" of MacFadden and McElhinny .No transitional directions were identified . Quadrupole components are not resolved. 1 Department of geological Sciences, the University of Florida , 2 Dept of Geology, Rutgers University,3,dept of Physics ,The University of Nairobi
Oti, Samuel Oji; Wamukoya, Marilyn; Mahy, Mary; Kyobutungi, Catherine
Background The Spectrum computer package is used to generate national AIDS mortality estimates in settings where vital registration systems are lacking. Similarly, InterVA-4 (the latest version of the InterVA programme) is used to estimate cause-of-mortality data in countries where cause-specific mortality data are not available. Objective This study aims to compare trends in adult AIDS-related mortality estimated by Spectrum with trends from the InterVA-4 programme applied to data from a Health and Demographic Surveillance System (HDSS) in Nairobi, Kenya. Design A Spectrum model was generated for the city of Nairobi based on HIV prevalence data for Nairobi and national antiretroviral therapy coverage, underlying mortality, and migration assumptions. We then used data, generated through verbal autopsies, on 1,799 deaths that occurred in the HDSS area from 2003 to 2010 among adults aged 15–59. These data were then entered into InterVA-4 to estimate causes of death using probabilistic modelling. Estimates of AIDS-related mortality rates and all-cause mortality rates from Spectrum and InterVA-4 were compared and presented as annualised trends. Results Spectrum estimated that HIV prevalence in Nairobi was 7%, while the HDSS site measured 12% in 2010. Despite this difference, Spectrum estimated higher levels of AIDS-related mortality. Between 2003 and 2010, the proportion of AIDS-related mortality in Nairobi decreased from 63 to 40% according to Spectrum and from 25 to 16% according to InterVA. The net AIDS-related mortality in Spectrum was closer to the combined mortality rates when AIDS and tuberculosis (TB) deaths were included for InterVA-4. Conclusion Overall trends in AIDS-related deaths from both methods were similar, although the values were closer when TB deaths were included in InterVA. InterVA-4 might not accurately differentiate between TB and AIDS deaths. PMID:24160914
Nairobi, Kenya. 6 Shashank, Bengali . How Kenya’s Election Was Rigged, the McClatchy Newspapers. January 31, 2008. Kenya: Current Conditions and the...back a single candidate against Moi. The opposition learned from its mistakes, and in 2002 it succeeded in forming and holding together a coalition...party did not stop an opposition victory in Kenya. The lessons learned from the 2002 Kenyan elections are many and could strengthen democracy
Ejakait, Epari; Mutisya, Maurice; Ezeh, Alex; Oketch, Moses; Ngware, Moses
This article contributes new evidence on factors associated with low achievement among pupils in urban informal neighborhoods in Nairobi, Kenya. The authors use three different data sets to examine the effect of residence in particular neighborhoods, pupil gender, primary school type, and household socioeconomic status on pupil achievement in the…
Pfefferbaum, Betty; North, Carol S.; Doughty, Debby E.; Pfefferbaum, Rose L.; Dumont, Cedric E.; Pynoos, Robert S.; Gurwitch, Robin H.; Ndetei, David
Despite the increasingly dangerous world where trauma and loss are common, relatively few studies have explored traumatic grief in children. The 1998 American Embassy bombing in Nairobi, Kenya, provided an unfortunate opportunity to examine this topic. This report describes findings in 156 children who knew someone killed in the incident, assessed…
Okoko, Janet M.; Scott, Shelleyann; Scott, Donald E.
The paper reports on a study undertaken in Nairobi, Kenya with school leaders. We examined their perceptions of the adequacy of their preparation experiences and what aspects remained problematic. This paper only reports on the survey findings which included rating-type and open-ended responses. Principals conceptualized their…
Kurth, Ann E.; Cleland, Charles M.; Des Jarlais, Don C.; Musyoki, Helgar; Lizcano, John A.; Chhun, Nok; Cherutich, Peter
Objective HIV infection in sub-Saharan Africa increasingly occurs among people who inject drugs (PWID). Kenya is one of the first to implement a national needle and syringe program (NSP). Our study undertook a baseline assessment as part of evaluating NSP in a seek, test, treat, and retain approach. Methods Participants enrolled May–December 2012 from 10 sites. Respondent-driven sampling was used to reach n=1,785 PWID for HIV-1 prevalence and viral load determination and survey data. Results Estimated HIV prevalence, adjusted for differential network size and recruitment relationships, was 14.5% in Nairobi (95% CI 10.8–18.2) and 20.5% in the Coast region (95% CI 17.3–23.6). Viral load (log10 transformed) in Nairobi ranged from 1.71 to 6.12 (median 4.41; IQR 3.51–4.94) and in the Coast from 1.71 to 5.88 (median 4.01; IQR 3.44–4.72). Using log10 viral load 2.6 as a threshold for HIV viral suppression, the percentage of HIV-infected participants with viral suppression was 4.2% in Nairobi and 4.6% in the Coast. Heroin was the most commonly injected drug in both regions, used by 93% of participantsin the past month typically injecting 2–3 times/day. Receptive needle/syringe sharing at last injection was more common in Nairobi (23%) than the Coast (4%). Estimated incidence among new injectors was 2.5/100 person-years in Nairobi and 1.6/100 person-years in the Coast. Conclusion The HIV epidemic is well-established among PWID in both Nairobi and Coast regions. Public health scale implementation of combination HIV prevention has the potential to greatly limit the epidemic in this vulnerable and bridging population. PMID:26226249
Oketch, Moses O.
The first step towards the introduction and development of university education in Kenya was a private initiative. Although the initiative was rejected, it led to the establishment of the Royal Technical College in Nairobi. The Royal College, Nairobi was elevated to university status under a special arrangement with the University of London in…
Mudege, Netsayi N.; Ezeh, Alex C.
This paper is based on data from focus group discussions and in-depth individual interviews carried out in two slum areas, Korogocho and Viwandani in Nairobi, Kenya. It discusses how the division between domestic sphere and public sphere impacts on survival during, and adaptation to old age. Although this paper adopts some of the tenets of the life course approach, it posits that women's participation in the domestic sphere may sometimes give them a ‘gender advantage’ over men in terms of health and adaptation to old age. The paper also discusses the impact of gender roles on the cultivation of social networks and how these networks in turn impact on health and social adjustment as people grow older. It investigates how older people are adjusting and coping with the new challenges they face as a result of high morbidity and mortality among adults in the reproductive age groups. PMID:19907648
Quantitation of Medical Research Institute. Nairobi, Kenya. amastigotes of Leishmania donovani in smears of splenic aspirates from patients with...LEISHMANIASIS UNRESPONSIVE TO PENTOSTAM CAUSED BY LEISHMANIA TROPIC IN KENYA YEMANE MEBRAHTU, PHILLIP LAWYER. JOHN GITHURE. JOAB B. WERE, RICHARD MUIGAI...Research Institute. Nairobi. Ken ya: and L’.S. Ary, Medical Research Unit-Kenira Abstract. We report the characterization of 6 Leishmania tropica
January 2008 in Nairobi, Kenya. 8 Shashank, Bengali . How Kenya’s Election Was Rigged, the McClatchy Newspapers. January 31, 2008. 9 European Union...against Moi. The opposition learned from its mistakes, and in 2002 it succeeded in forming and holding together a coalition, known as NARC (National...clout of a ruling party did not stop an opposition victory in Kenya. The lessons learned from the 2002 Kenyan elections are many and could strengthen
government officials. January 2008 in Nairobi, Kenya. 8 Shashank, Bengali . How Kenya’s Election Was Rigged, the McClatchy Newspapers. January 31, 2008. 9...single candidate against Moi. The opposition learned from its mistakes, and in 2002 it succeeded in forming and holding together a coalition, known...the entrenched clout of a ruling party did not stop an opposition victory in Kenya. The lessons learned from the 2002 Kenyan elections are many and
interview with several Kenyan opposition and government officials. January 2008 in Nairobi, Kenya. 6 Shashank, Bengali . How Kenya’s Election Was Rigged, the...single candidate against Moi. The opposition learned from its mistakes, and in 2002 it succeeded in forming and holding together a coalition, known as...the power of incumbency and the entrenched clout of a ruling party did not stop an opposition victory in Kenya. The lessons learned from the 2002
Status of Women Canada, Ottawa (Ontario).
The 1992 edition of the fact sheets provides information on new and revised Canadian government programs and policies about the implementation of the Nairobi Forward-looking Strategies for the Advancement of Women program that were adopted at the United Nations World Conference on Women in Kenya in 1985. This edition continues to address the…
Otieno, Iddah Aoko
This case study uses post-colonial and dependency theoretical lenses to investigate the forces influencing policy, procedures, and participation in international activity in the post-colonial African university environment of Kenya's first national public university-the University of Nairobi (UoN). The research addresses (1) the approaches and…
Ngware, Moses Waithanji; Oketch, Moses; Ezeh, Alex Chika; Mutisya, Maurice; Ejakait, Charles Epari
This paper describes the design and methodology used to assess the impact of free primary education (FPE) policy in Nairobi, Kenya. The key outcome of the study was to assess the impact of FPE on schooling outcomes among the urban poor. The study assesses the impact of FPE by examining how two non-comparable groups responded to the introduction of…
van de Vijver, Steven; Oti, Samuel; Tervaert, Thijs Cohen; Hankins, Catherine; Kyobutungi, Catherine; Gomez, Gabriela B.; Brewster, Lizzy; Agyemang, Charles; Lange, Joep
Introduction Cardiovascular disease (CVD) is a leading cause of death in sub-Saharan Africa (SSA), with annual deaths expected to increase to 2 million by 2030. Currently, most national health systems in SSA are not adequately prepared for this epidemic. This is especially so in slum settlements where access to formal healthcare and resources is limited. Objective To develop and introduce a model of cardiovascular prevention in the slums of Nairobi by integrating public health and private sector approaches. Study design Two non-profit organizations that conduct public health research, Amsterdam Institute for Global Health and Development (AIGHD) and African Population and Health Research Center (APHRC), collaborated with private-sector Boston Consulting Group (BCG) to develop a service delivery package for CVD prevention in slum settings. A theoretic model was designed based on the integration of public and private sector approaches with the focus on costs and feasibility. Results The final model includes components that aim to improve community awareness, a home-based screening service, patient and provider incentives to seek and deliver treatment specifically for hypertension, and adherence support. The expected outcomes projected by this model could prove potentially cost effective and affordable (1 USD/person/year). The model is currently being implemented in a Nairobi slum and is closely followed by key stakeholders in Kenya including the Ministry of Health, the World Health Organization (WHO), and leading non-governmental organizations (NGOs). Conclusion Through the collaboration of public health and private sectors, a theoretically cost-effective model was developed for the prevention of CVD and is currently being implemented in the slums of Nairobi. If results are in line with the theoretical projections and first impressions on the ground, scale-up of the service delivery package could be planned in other poor urban areas in Kenya by relevant policymakers
Kimani-Murage, E.W.; Fotso, J.C.; Egondi, T.; Abuya, B.; Elungata, P.; Ziraba, A.K.; Kabiru, C.W.; Madise, N.
Background We describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials. Methods We use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). Results Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. Conclusions The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums. PMID:25024120
2008-01-01If you live in Europe and buy roses, there is a good chance that they were grown in Kenya specifically, in one of the colossal greenhouses that blot out the once wild shores of Lake Naivasha, 90km north-west of Nairobi. Some 25% of Europe's cut flowers come from Kenya. After a tentative start in the 1980s the industry is now the country's third-largest foreign-currency earner, bringing in $120m a year. But the recent violence in Kenya is having a major impact on the flower growers. A local trade union says 3,000 of the 30,000 workers employed in Naivasha's flower farms have abandoned their jobs. Kenya emerged as a flower power when Israel scaled down its own industry. It has since lost business to neighboring Ethiopia, which offers tax breaks and better security, but Naivasha's perfect intensity of sunlight and days of near-constant length should keep it on top. The ASTER image was acquired February 2, 2008, covers an area of 25 x 26.6 km, and is located near 0.8 degrees south latitude, 36.4 degrees east longitude. The U.S. science team is located at NASA's Jet Propulsion Laboratory, Pasadena, Calif. The Terra mission is part of NASA's Science Mission Directorate.
Newman, Constance; Kimeu, Anastasiah; Shamblin, Leigh; Penders, Christopher; McQuide, Pamela A; Bwonya, Judith
IntraHealth International's USAID-funded Capacity Kenya project conducted a performance needs assessment of the Kenya health provider education system in 2010. Various stakeholders shared their understandings of the role played by gender and identified opportunities to improve gender equality in health provider education. Findings suggest that occupational segregation, sexual harassment and discrimination based on pregnancy and family responsibilities present problems, especially for female students and faculty. To grow and sustain its workforce over the long term, Kenyan human resource leaders and managers must act to eliminate gender-based obstacles by implementing existing non-discrimination and equal opportunity policies and laws to increase the entry, retention and productivity of students and faculty. Families and communities must support girls' schooling and defer early marriage. All this will result in a fuller pool of students, faculty and matriculated health workers and, ultimately, a more robust health workforce to meet Kenya's health challenges.
Nanyingi, Mark O; Mbaria, James M; Lanyasunya, Adamson L; Wagate, Cyrus G; Koros, Kipsengeret B; Kaburia, Humphrey F; Munenge, Rahab W; Ogara, William O
Background Ethnobotanical pharmacopoeia is confidently used in disease intervention and there is need for documentation and preservation of traditional medical knowledge to bolster the discovery of novel drugs. The objective of the present study was to document the indigenous medicinal plant utilization, management and their extinction threats in Samburu District, Kenya. Methods Field research was conducted in six divisions of Samburu District in Kenya. We randomly sampled 100 consented interviewees stratified by age, gender, occupation and level of education. We collected plant use data through semi-structured questionnaires; transect walks, oral interviews and focus groups discussions. Voucher specimens of all cited botanic species were collected and deposited at University of Nairobi's botany herbarium. Results Data on plant use from the informants yielded 990 citations on 56 medicinal plant species, which are used to treat 54 different animal and human diseases including; malaria, digestive disorders, respiratory syndromes and ectoparasites. Conclusion The ethnomedicinal use of plant species was documented in the study area for treatment of both human and veterinary diseases. The local population has high ethnobotanical knowledge and has adopted sound management conservation practices. The major threatening factors reported were anthropogenic and natural. Ethnomedical documentation and sustainable plant utilization can support drug discovery efforts in developing countries. PMID:18498665
Aptekar, Lewis; Ciano-Federoff, Lynda M.
Gender differences among street children in Nairobi suggest familial function, and development and mental-health outcomes. Male children are taught coping skills by their mothers early on to take up street life to support their family. Female children, expected to remain at home and learn to become women, turn to street life as the result of…
Formal guidance and counseling in Kenya is recognized more than ever. The development of effective guidance and counseling programs will be guided by needs assessment. This study used data from a larger study on guidance and counseling needs assessment of primary school pupils of Gachika Sub-location, Nyeri Town, and Nairobi City. Differences in…
Development of the roadmap and guidelines for the prevention and management of high blood pressure in Africa: Proceedings of the PASCAR Hypertension Task Force meeting: Nairobi, Kenya, 27 October 2014.
Dzudie, A; Ojji, D; Anisiuba, B C; Abdou, B A; Cornick, R; Damasceno, A; Kane, A L; Mocumbi, A O; Mohamed, A; Nel, G; Ogola, E; Onwubere, B; Otieno, H; Rainer, B; Schutte, A; Ali, I T; Twagirumukiza, M; Poulter, N; Mayosi, B
Africa has one of the fastest growing economies in the world. The economic changes are associated with a health transition characterised by a rise in cardiovascular risk factors and complications, which tend to affect the African population at their age of maximum productivity. Recent data from Africa have highlighted the increasing importance of high blood pressure in this region of the world. This condition is largely underdiagnosed and poorly treated, and therefore leads to stroke, renal and heart failure, and death. Henceforth, African countries are taking steps to develop relevant policies and programmes to address the issue of blood pressure and other cardiovascular risk factors in response to a call by the World Health Organisation (WHO) to reduce premature deaths from non-communicable diseases (NCDs) by 25% by the year 2025 (25 × 25). The World Heart Federation (WHF) has developed a roadmap for global implementation of the prevention and management of raised blood pressure using a health system approach to help realise the 25 × 25 goal set by the WHO. As the leading continental organisation of cardiovascular professionals, the Pan-African Society of Cardiology (PASCAR) aims to contextualise the roadmap framework of the WHF to the African continent through the PASCAR Taskforce on Hypertension. The Taskforce held a workshop in Kenya on 27 October 2014 to discuss a process by which effective prevention and control of hypertension in Africa may be achieved. It was agreed that a set of clinical guidelines for the management of hypertension are needed in Africa. The ultimate goal of this work is to develop a roadmap for implementation of the prevention and management of hypertension in Africa under the auspices of the WHF.
Korir, Anne; Yu Wang, Emma; Sasieni, Peter; Okerosi, Nathan; Ronoh, Victor; Maxwell Parkin, D
We investigated the ethnic differences in the risk of several cancers in the population of Nairobi, Kenya, using data from the Nairobi Cancer Registry. The registry records the variable "Tribe" for each case, a categorisation that includes, as well as 22 tribal groups, categories for Kenyans of European and of Asian origin, and non-Kenyan Africans. Tribes included in the final analysis were Kikuyu, Kamba, Kisii, Kalenjin, Luo, Luhya, Somalis, Asians, non-Kenyans, Caucasians, Other tribes and unknown. The largest group was taken as the reference category for the calculation of odds ratios; this was African Kenyans (for comparisons by race), and Kikuyus (the tribe with the largest numbers of cancer registrations (38% of the total)) for comparisons between the Kenyan tribes. P-values are obtained from the Wald test. Cancers that were more common among the white population than in black Kenyans were skin cancers and cancers of the bladder, while cancers that are more common in Kenyan Asians include colorectal, lung, breast, ovary, corpus uteri and non-Hodgkin lymphoma. Cancers that were less common among Asians and Caucasians were oesophagus, stomach and cervix cancer. Within the African population, there were marked differences in cancer risk by tribe. Among the tribes of Bantu ethnicity, the Kamba had higher risks of melanoma, Kaposi sarcoma, liver and cervix cancer, and lower risks of oesophagus, stomach, corpus uteri and nervous system cancers. Luo and Luhya had much higher odds of Kaposi sarcoma and Burkitt lymphoma.
Pell, Christopher; Meñaca, Arantza; Were, Florence; Afrah, Nana A.; Chatio, Samuel; Manda-Taylor, Lucinda; Hamel, Mary J.; Hodgson, Abraham; Tagbor, Harry; Kalilani, Linda; Ouma, Peter; Pool, Robert
Background Antenatal care (ANC) is a key strategy to improve maternal and infant health. However, survey data from sub-Saharan Africa indicate that women often only initiate ANC after the first trimester and do not achieve the recommended number of ANC visits. Drawing on qualitative data, this article comparatively explores the factors that influence ANC attendance across four sub-Saharan African sites in three countries (Ghana, Kenya and Malawi) with varying levels of ANC attendance. Methods Data were collected as part of a programme of qualitative research investigating the social and cultural context of malaria in pregnancy. A range of methods was employed interviews, focus groups with diverse respondents and observations in local communities and health facilities. Results Across the sites, women attended ANC at least once. However, their descriptions of ANC were often vague. General ideas about pregnancy care – checking the foetus’ position or monitoring its progress – motivated women to attend ANC; as did, especially in Kenya, obtaining the ANC card to avoid reprimands from health workers. Women’s timing of ANC initiation was influenced by reproductive concerns and pregnancy uncertainties, particularly during the first trimester, and how ANC services responded to this uncertainty; age, parity and the associated implications for pregnancy disclosure; interactions with healthcare workers, particularly messages about timing of ANC; and the cost of ANC, including charges levied for ANC procedures – in spite of policies of free ANC – combined with ideas about the compulsory nature of follow-up appointments. Conclusion In these socially and culturally diverse sites, the findings suggest that ‘supply’ side factors have an important influence on ANC attendance: the design of ANC and particularly how ANC deals with the needs and concerns of women during the first trimester has implications for timing of initiation. PMID:23335973
Sidze, Estelle M; Elungata'a, Patricia; Maina, Beatrice W; Mutua, Michael M
This study investigated the associations between parent-child connectedness and sexual behaviors among adolescents living in informal settlements in Nairobi, Kenya, a vulnerable group with respect to reproductive health outcomes. The study was based on data from the Transition to Adulthood project, a study designed to follow adolescents aged 12-22 for 3 years in the informal settlements of Korogocho and Viwandani. Direct face-to-face questions were asked to adolescents about parenting variables and sexual behaviors. This study used a subsample of 689 sexually experienced 12-22-years-olds at Wave 2. Bivariate analysis compared gender differences for three outcomes-sexual activity in the 12 months prior to the survey and, among those who had had sex in this period, multiple sexual partners and condom use at last sex. Multivariate logistic regressions were used to identify associations between these outcomes and the quality of parent-child connectedness. About 60% of adolescent females and males were sexually active in the 12 months prior to the survey. The multivariate results showed a strong association between the quality of parent-child connectedness and condom use among adolescent males. Living with related or unrelated guardians (versus living with biological parents) was also associated with higher odds of multiple sexual partners and lower odds of condom use at last sex among adolescent females and with higher odds of sexual activity among adolescent males. Sexual and reproductive health programs targeting adolescents living in Nairobi informal settlements would benefit from attention to assisting parents to improve their ability to play the connectedness role.
Background Childhood overweight/obesity and inadequate physical activity burden Western countries, and now, pose a growing threat to the health of children in low and middle income countries. Behavioural transitions toward more sedentary lifestyles coupled with increased consumption of high calorie foods has resulted in rising proportions of overweight/obesity and decreasing levels of physical activity in school-aged children. The objective of this study was to determine the prevalence and to investigate factors associated with overweight/obesity and physical activity in Kenyan children aged 9 to 11 years. Methods Body composition and physical activity measures of participating children were accomplished by anthropometric assessment, accelerometry, and administration of questionnaires related to diet and lifestyle, and the school and neighbourhood environments. Data collection was conducted in the city of Nairobi as part of a larger International Study of Childhood Obesity, Lifestyle and Environment. Results A total of 563 participants (46.5% boys, 53.5% girls) were included in the analyses. Of these, 3.7% were underweight, 14.4% were overweight, and 6.4% were obese based on WHO cut-points. Mean daily sedentary time was 398 minutes, time spent in light physical activity was 463 minutes, and time spent in moderate-to-vigorous physical activity was 36 minutes based on activity cut-points developed by Treuth et al. Only 12.6% of participating children were meeting the recommendation of ≥ 60 minutes of daily moderate-to-vigorous physical activity, and 45.7% of participants used active transportation to/from school. Increasing parental education level, total annual household income, and attending a private rather than public school were associated positively with being overweight/obese and negatively with meeting physical activity guidelines. Conclusions This study provided the evidence for an existing prevalence of childhood overweight/obesity in Nairobi
8217 was within the U.S. Phase III Program design requirements, the ICAO ’reduced capability system’ requirements, and the ICAO ’full capability system’ requirements. The TRSB system installation did not adversely affect the ILS. (Author)
Kilonzo, N; Taegtmeyer, M; Molyneux, C; Kibaru, J; Kimonji, V; Theobald, S
In Kenya many people who have been affected by sexual violence turn to the health sector for clinical treatment and preventive therapies. This interface provides a vital opportunity to impact on the dual epidemics of HIV and sexual violence. Despite this, the uptake of post-rape care services in health facilities is low and health care providers felt ill-prepared to deal with the consequences of sexual violence. A qualitative study was conducted to better understand the reasons for the low uptake of services and to establish perceptions of sexual violence in Kenya. Thirty-four key informants were interviewed and sixteen focus group discussions with women and men were held in three districts in Kenya. Blurred boundaries between forced and consensual sex emerged. Important implications for the delivery of HIV post exposure prophylaxis (PEP) after sexual violence include the need for gender-aware patient-centred training for health providers and for HIV PEP interventions to strengthen on-going HIV-prevention counselling efforts. Further research needs to determine the feasibility of on-going risk reduction measures in the context of PEP delivery.
Obare, Francis; Birungi, Harriet
This paper explores the sexual and reproductive health (SRH) policy context and the realities facing in-school young people in Kenya. It is based on a review of the health and education sector policy documents as well as data from self-administered questionnaires with 3624 male and female students from eight secondary schools in Nairobi. Findings…
Maretzki, Audrey N.
With funding provided by the Center for Higher Education of the United States Agency for International Development, The Pennsylvania State University and Tuskegee University collaborated with the University of Nairobi in establishing women's NutriBusiness Cooperatives in the Rift Valley and Central Provinces of Kenya. Between 1992 and 1999, the…
Unprotected anal sex has long been recognized as a risk factor for HIV transmission among men who have sex with men (MSM). In Africa, however, general denial of MSM existence and associated stigma discouraged research. To address this gap in the literature, partners conducted the first behavioral surveys of MSM in Kenya. The first study was to assess HIV risk among MSM in Nairobi, and the second study a pre-post intervention study of male sex workers in Mombasa. The 2004 behavioral survey of 500 men in Mombasa revealed that MSM were having multiple sexual partners and failed to access appropriate prevention counseling and care at Kenya clinics. A 2006 capture-recapture enumeration in Mombasa estimated that over 700 male sex workers were active, after which a pre-intervention baseline survey of 425 male sex workers was conducted. Awareness of unprotected anal sex as an HIV risk behavior and consistent condom use with clients was low, and use of oil-based lubricants high. Based on this information, peer educators were trained in HIV prevention, basic counseling skills, and distribution of condoms and lubricants. To assess impact of the interventions, a follow-up survey of 442 male sex workers was implemented in 2008. Exposure to peer educators was significantly associated with increased consistent condom use, improved HIV knowledge, and increased use of water-based lubricants. These results have provided needed information to the Government of Kenya and have informed HIV prevention interventions. PMID:24753921
Mulwa, J. K.; Kimata, F.; Suzuki, S.; Kuria, Z. N.
Kenya has had a seismic station since 1963 as part of the World Wide Standardized Seismograph Network (WWSSN). In 1990, the University of Nairobi in collaboration with GeoForschungsZentrum (GFZ) started to build up a local seismological network, the Kenya National Seismic Network (KNSN), which operated for about ten years between 1993-2002. This, however, experienced a myriad of problems ranging from equipment breakdown, vandalism and lack of spares. Kenya is seismically active since the Kenya rift valley traverses through the country from north to south bisecting the country into eastern and western regions. In the central part, the Kenya rift branches to form the NW-SE trending Kavirondo (Nyanza) rift. The Kenya rift valley and the Kavirondo (Nyanza) rift are the most seismically active where earthquakes of local magnitude (Ml) in the order of ⩽2.0-5.0 occur. Furthermore, historical records show that earthquakes of magnitudes of the order of Ml ⩾ 6.0 have occurred in Kenya. Such large magnitude earthquakes include the January 6, 1928 Subukia earthquake (Ml 7.1) and an aftershock (Ml 6.2) four days later, as well as the 1913 Turkana region earthquake (Ml 6.2). Since early 1970's, numerous seismic investigations have been undertaken in Kenya in order to understand the formation and structure of the Kenyan part of the East African rift valley. Earthquake data from these studies is, however, rather disorganized and individual datasets, including that acquired during the period 1993-2002, cannot furnish us with comprehensive information on the seismicity of Kenya for the past ∼100 years. The purpose of this paper is, therefore, to review the seismicity in Kenya for the period 1906-2010 by utilizing data and results from different sources. The general seismicity of Kenya has been evaluated using historical data, data recorded by local seismic networks, the United States Geological Survey catalogue as well as earthquake data from the numerous seismic
Ng’ang’a, Lucy; Williamson, John; Wamicwe, Joyce N.; Vakil, Shobha; Katana, Abraham; Kim, Andrea A.
Introduction Understanding the levels and associated factors of non-adherence to antiretroviral therapy (ART) is crucial in designing interventions to improve adherence and health outcomes of ART. We assessed non-adherence to ART among HIV-infected persons reporting ART use in a nationally representative survey in Kenya. Methods The Kenya AIDS Indicator Survey 2012 was a population-based, household survey of persons aged 18 months-64 years conducted in 2012–2013. Self-reported information was collected on demographics, sexual behaviour, HIV status, and ART use. Blood was collected for HIV testing, and if HIV infected, CD4 and viral load testing. HIV-positive specimens were tested for the presence of antiretroviral (ARV) drugs using a qualitative ARV assay using liquid chromatography-tandem mass spectrometry. HIV-positive persons who reported receiving ART but did not have the ARV biomarker present were defined as being non-adherent to their ARV medication. We restricted our analysis to HIV-infected persons aged 15–64 years who reported receiving ART and had laboratory-confirmed results from ARV testing. Multivariate logistic regression was used to identify variables associated with non-adherence. Results A total of 648 (5.6%; CI 4.9–6.3) tested HIV-positive of whom 559 (86.3%) had sufficient volume of blood to be tested for ARV drugs. Of those, 271 (47.7%; CI 41.8–53.6) self-reported HIV-positive status during the interview and 186 (69.1%; CI 62.2–76.0) of those reported taking ART. The ARV biomarker was absent in 18 of 186 individuals (9.4%; CI 4.9–13.8) who thus were defined as being non-adherent to ART. Non-adherence was associated with being aged 15–29 years (AOR 8.39; CI 2.26–31.22, p = 0.002) compared to aged 30–64 years, rural residence (AOR 5.87; CI 1.39–25.61, p = 0.016) compared with urban residence and taking recreational drugs in the past 30 days (AOR 5.89; CI 1.30–26.70, p = 0.022). Conclusion Overall, less than 10% of Kenyans
Wekesa, Eliud; Coast, Ernestina
Objectives To characterise the experiences of heterosexual men and women living with HIV postdiagnosis and explain these experiences in relation to their identity and sexuality. Design Qualitative study using in-depth interviews and a theoretically informed biographic disruption theory. Setting Interviews were conducted in two Nairobi slums (Kenya). Participants 41 HIV-infected heterosexual men and women aged 18 years or older. Results People living with HIV have divergent experiences surrounding HIV diagnosis. Postdiagnosis, there are multiple phases of identity transition, including status (non-)disclosure, and attempts at identity repair and normalcy. For some people, this process involves a transition to a new self-identity, incorporating both HIV and antiretroviral treatment (ART) into their lives. For others, it involves a partial transition, with some aspects of their prediagnosis identity persisting, and for others it involves a rejection of HIV identity. Those people who were able to incorporate HIV/AIDS in their identity, without it being disruptive to their biography, were pursuing safer sexual and reproductive lives. By contrast, those people with a more continuous biography continued to reflect their prediagnosis identity and sexual behaviour. Conclusions People living with HIV/AIDS (PLWHA) had to rework their sense of identity following diagnosis in the context of living in a slum setting. Men and women living with HIV in slums are poorly supported by health systems and services as they attempt to cope with a diagnosis of HIV. Given the availability of ART, health services and professionals need to support the rights of PLWHA to be sexually active if they want to and achieve their fertility goals, while minimising HIV transmission risk. PMID:23645922
Kenya has a long history of local fish consumption. The population in the Lake Victoria area (Rift Valley Province) Northwest of Nairobi and coastal communities (Coast Province) have historically included fish in their diet. Migration from villages to urban areas and increasing commerce has created ...
McCarron, Margaret; Munyua, Peninah; Cheng, Po-Yung; Manga, Thomas; Wanjohi, Cathryn; Moen, Ann; Mounts, Anthony; Katz, Mark A
Infectious diseases in poultry can spread quickly and lead to huge economic losses. In the past decade, on multiple continents, the accelerated spread of highly pathogenic avian Influenza A (H5N1) virus, often through informal trade networks, has led to the death and culling of hundreds of millions of poultry. Endemic poultry diseases like Newcastle disease and fowl typhoid can also be devastating in many parts of the world. Understanding trade networks in unregulated systems can inform policy decisions concerning disease prevention and containment. From June to December 2008 we conducted a cross-sectional survey of backyard farmers, market traders, and middlemen in 5/8 provinces in Kenya. We administered a standardized questionnaire to each type of actor using convenience, random, snowball, and systematic sampling. Questionnaires addressed frequency, volume, and geography of trade, as well as biosecurity practices. We created a network diagram identifying the most important locations for trade. Of 380 respondents, 51% were backyard farmers, 24% were middlemen and 25% were market traders. Half (50%) of backyard farmers said they raised poultry both for household consumption and for sale. Compared to market traders, middlemen bought their poultry from a greater number of villages (median 4.2 villages for middlemen vs. 1.9 for market traders). Traders were most likely to purchase poultry from backyard farmers. Of the backyard farmers who sold poultry, 51% [CI 40-63] reported selling poultry to market traders, and 54% [CI 44-63] sold to middlemen. Middlemen moved the largest volume of poultry on a weekly basis (median purchases: 187 birds/week [IQR 206]; median sales: 188 birds/week [IQR 412.5]). The highest numbers of birds were traded in Nairobi - Kenya's capital city. Nairobi was the most prominent trading node in the network (61 degrees of centrality). Many smaller sub-networks existed as a result of clustered local trade. Market traders were also integral to the
Cohen, Craig R.; Grossman, Daniel; Onono, Maricianah; Blat, Cinthia; Newmann, Sara J.; Burger, Rachel L.; Shade, Starley B.; Bett, Norah; Bukusi, Elizabeth A.
Objectives To determine if integration of family planning (FP) and HIV services led to increased use of more effective contraception (i.e. hormonal and permanent methods, and intrauterine devices) and decreased pregnancy rates. Design Cohort analysis following cluster randomized trial, when the Kenya Ministry of Health led integration of the remaining control (delayed integration) sites and oversaw integrated services at the original intervention (early integration) sites. Setting Eighteen health facilities in Kenya. Subjects Women aged 18–45 receiving care: 5682 encounters at baseline, and 11628 encounters during the fourth quarter of year 2. Intervention “One-stop shop” approach to integrating FP and HIV services. Main outcome measures Use of more effective contraceptive methods and incident pregnancy across two years of follow-up. Results Following integration of FP and HIV services at the six delayed integration clinics, use of more effective contraception increased from 31.7% to 44.2% of encounters (+12.5%; Prevalence ratio (PR) = 1.39 (1.19–1.63). Among the twelve early integration sites, the proportion of encounters at which women used more effective contraceptive methods was sustained from the end of the first to the second year of follow-up (37.5% vs. 37.0%). Pregnancy incidence including all 18 integrated sites in year two declined in comparison to the control arm in year one (rate ratio: 0.72; 95% CI 0.60–0.87). Conclusions Integration of FP services into HIV clinics led to a sustained increase in the use of more effective contraceptives and decrease in pregnancy incidence 24 months following implementation of the integrated service model. Trial registration ClinicalTrials.gov NCT01001507 PMID:28328966
King, Nia; Dewey, Cate; Borish, David
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. Methods 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. 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 primarily target orphaned and female students. Prior to implementation, suggested mitigation strategies should be assessed for cost-effectiveness. PMID:26371885
Ettarh, Remare Renner; Kimani, James; Kyobutungi, Catherine; Wekesah, Frederick
The prevalence of HIV in the adult population in slum areas in Nairobi, Kenya, is higher than for residents in the city as a whole. This disparity suggests that the characteristics of slum areas may adversely influence the HIV-prevention strategies directed at reducing the national prevalence of HIV. The objective of the study was to identify some of the sociodemographic and behavioural correlates of HIV-status awareness among the adult population of two slums in Nairobi. In a household-based survey conducted by the African Population and Health Research Center (APHRC), 4 767 men and women aged between 15 and 54 years were randomly sampled from two slums (Korogocho and Viwandani) in Nairobi and data were collected on the social and health context of HIV and AIDS in these settlements. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with HIV-status awareness. The proportion of respondents that had ever been tested and knew their HIV status was 53%, with the women having greater awareness of their HIV status (62%) than the men (38%). Awareness of HIV status was significantly associated with age, sex, level of education, marital status and slum of residence. The lower level of HIV-status awareness among the men compared with the women in the slums suggests a poor uptake of HIV-testing services by males. Innovative strategies are needed to ensure greater access and uptake of HIV-testing services by the younger and less-educated residents of these slums if the barriers to HIV-status awareness are to be overcome.
Ogendi, Japheths; Odero, Wilson; Mitullah, Winnie; Khayesi, Meleckidzedeck
Pedestrians are overrepresented in road traffic injuries and deaths in Nairobi, the capital city of Kenya, yet little research has been done to provide better understanding of the characteristics of pedestrian injuries. This paper presents the data obtained from road traffic injury admissions to Kenyatta National Hospital (KNH) over a 3-month period starting from 1 June to 31 August 2011. A total of 176 persons involved road traffic injuries in Nairobi were admitted to KNH during this period. Pedestrians comprised the highest (59.1 %) proportion of road traffic injury admissions, followed by motor vehicle passengers (24.4 %) and motor cyclists (9.7 %). Bicyclists and drivers accounted for 5.1 and 1.7 %, respectively. Cars (39.4 %) were the leading category of motorized four-wheeler vehicles that were involved in collisions with pedestrians, followed by matatus (35.5 %). Seventy percent of pedestrians were hit while crossing the road, 10.8 % while standing by the road, and 8.1 % while walking along the road. The highest proportion of pedestrian crashes occurred on Saturdays (25.5 %) and Sundays (16.7 %). Most of the pedestrian injuries (67.7 %) affected the limbs. The paper argues that safety of pedestrians should be a priority in road safety efforts in the city of Nairobi. Urban road safety planners should adopt existing cost-effective interventions to improve the safety of pedestrians such as area-wide traffic calming to limit the speeds of motor vehicles to 30 km/h, providing sidewalks for pedestrians, traffic calming in residential neighborhoods, people-and-not-car-oriented urban road designs, traffic education, and enforcement of traffic regulations.
Temmerman, M; Fonck, K; Bashir, F; Inion, I; Ndinya-Achola, J O; Bwayo, J; Kirui, P; Claeys, P; Fransen, L
Untreated maternal syphilis during pregnancy will cause adverse pregnancy outcomes in more than 60% of the infected women. In Nairobi, Kenya, the prevalence of syphilis in pregnant women of 2.9% in 1989, showed a rise to 6.5% in 1993, parallel to an increase of HIV-1 prevalence rates. Since the early 1990s, decentralized STD/HIV prevention and control programmes, including a specific syphilis control programme, were developed in the public health facilities of Nairobi. Since 1992 the prevalence of syphilis in pregnant women has been monitored. This paper reports the findings of 81,311 pregnant women between 1994 and 1997. A total of 4244 women (5.3%) tested positive with prevalence rates of 7.2% (95% CI: 6.7-7.7) in 1994, 7.3% (95% CI: 6.9-7.7) in 1995, 4.5% (95% CI: 4.3-4.8) in 1996 and 3.8% (95% CI: 3.6-4.0) in 1997. In conclusion, a marked decline in syphilis seroprevalence in pregnant women in Nairobi was observed since 1995-96 (P<0.0001, Chi-square test for trend) in contrast to upward trends reported between 1990 and 1994-95 in the same population.
Nakata, Hokuto; Nakayama, Shouta M M; Ikenaka, Yoshinori; Mizukawa, Hazuki; Ishii, Chihiro; Yohannes, Yared B; Konnai, Satoru; Darwish, Wageh Sobhy; Ishizuka, Mayumi
Nairobi city in Kenya produces 2000 tons/day of garbage, and most of it is dumped onto the Dandora dumping site, home to a quarter-million residents. This study was conducted (1) to assess the contamination levels of nine metals and a metalloid (arsenic) in the blood of pigs, goats, sheep and cattle from Dandora, and (2) to identify a possible source of lead (Pb) pollution. Cadmium (Cd, 0.17-4.35 μg/kg, dry-wt) and Pb (90-2710 μg/kg) levels in blood were generally high, suggesting human exposure to Cd through livestock consumption and Pb poisoning among pigs (2600 μg/kg) and cattle (354 μg/kg). Results of Pb isotope ratios indicated that the major exposure route might differ among species. Our results also suggested a possibility that the residents in Dandora have been exposed to the metals through livestock consumption.
Beguy, Donatien; Elung'ata, Patricia; Mberu, Blessing; Oduor, Clement; Wamukoya, Marylene; Nganyi, Bonface; Ezeh, Alex
The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was the first urban-based longitudinal health and demographic surveillance platform in sub-Saharan Africa (SSA). The NUHDSS was established in 2002 to provide a platform to investigate the long-term social, economic and health consequences of urban residence, and to serve as a primary research tool for intervention and impact evaluation studies focusing on the needs of the urban poor in SSA. Since its inception, the NUHDSS has successfully followed every year a population of about 65,000 individuals in 24,000 households in two slum communities--Korogocho and Viwandani--in Nairobi, Kenya. Data collected include key demographic and health information (births, deaths including verbal autopsy, in- and out-migration, immunization) and other information that characterizes living conditions in the slums (livelihood opportunities, household amenities and possessions, type of housing etc.). In addition to the routine data, it has provided a robust platform for nesting several studies examining the challenges of rapid urbanization in SSA and associated health and poverty dynamics. NUHDSS data are shared through internal and external collaborations, in accordance with the Centre's guidelines for publications, data sharing.
Analyzes factors influencing the attitudes of secondary school teachers in Nairobi. Finds that, based on a field study and interviews, young male teachers suffered from relative deprivation in status and were therefore the least motivated and the most likely to leave the profession. Adds that direct working conditions didn't seem to have a…
Zwisler, Greg; Simpson, Evan; Moodley, Melissa
Background Diarrheal disease is a leading cause of morbidity and mortality among children under five. Although oral rehydration solution (ORS) has tremendous therapeutic benefits, coverage of and demand for this product have remained low in many developing countries. This study surveyed caregivers and health care providers in India and Kenya to gather information about perceptions and use of various diarrhea treatments, assess reasons for low ORS use, and identify opportunities for expanding ORS use. Methods The project team conducted two rounds of semi–structured, quantitative surveys with more than 2000 caregivers in India and Kenya in 2012. A complementary survey covered more than 500 pharmacy staff and health care workers in both countries. In Kenya, the team also surveyed rural pharmacies to gather pricing and sales data. Results Although caregivers generally had very positive perceptions of ORS, they typically ranked antibiotics ahead of ORS as the strongest medicine for diarrhea (in India 62% ranked antibiotics first and 23% ranked ORS first, n = 404; in Kenya results were 55% and 29%, n = 401). Many caregivers had misconceptions about the purpose and effectiveness of various treatments. For example, most caregivers who gave ORS at last episode expected it to stop their child’s diarrhea (65% in India, n = 190; 73% in Kenya, n = 154). There were noteworthy differences between India and Kenya in the selection and sourcing of treatments. Much of the money spent by families during the last episode of diarrhea was for inappropriate treatments. This was especially true in India, where rural households typically spent US$ 2.29 (median for the 79% of rural households that paid for health care services or treatments, n = 199) with most of this going to pay fees of private health workers and/or for antibiotics. Conclusions Caregivers’ primary treatment goal is to stop diarrhea, and many believe that antibiotics or ORS will accomplish this
Gatari, Michael J.; Boman, Johan
This paper reports measurements of black carbon (BC) and total carbon (TC) (TC=BC+organic carbon) in the lower troposphere in Nairobi and the towns of Nanyuki and Meru in Kenya. The rural sites of Nanyuki and Meru are both located on the equator on the northwestern and northeastern slopes of Mount Kenya, respectively. Particles were collected for 24 h on glass fibre filters using a dichotomous impactor. The content of TC and BC was analysed using a carbon-hydrogen-nitrogen analyser and a black smoke reflectometer. The mean TC concentration in Nanyuki was found to be two times higher than that of Meru, 14±2 and 7±1 μg m -3, respectively. The measured BC concentration in Meru (1.4±0.1 μg m -3) was twice that of Nanyuki (0.72±0.06 μg m -3). The organic carbon (OC) concentration was estimated from the difference between the measured TC and BC. The obtained mean concentrations were lower than those found in the literature for Asia and USA but higher than those of some European cities. The local burning of biomass was seen as the main source of carbonaceous aerosols at all measurement sites. The Nanyuki site exhibited OC concentrations comparable to those of the urban site in Nairobi. Nairobi had the highest concentration of both TC and BC. Vehicular and waste burning emissions in Nairobi may have enriched the carbonaceous aerosols.
Omondi, C. J.; Mbugua, A. W.
The 2011-2012 Horn of Africa drought crisis affected Kenya, resulting in destruction of livelihoods and weakening of traditional drought coping mechanisms and reduced capacities for humanitarian agencies. In response to this catastrophe and in line with the Nairobi Declaration of the Heads of States Summit regarding the crisis, and building on the experience and expertise of its International Hydrological programme, UNESCO launched the Groundwater Resources Investigation for Drought Mitigation in Africa Programme (GRIDMAP). Through GRIDMAP the Turkana groundwater Survey was implemented. The approach comprised of integrating existing ancillary field data, satellite imagery and ground-truthing. High resolution maps identifying groundwater occurrence, soil textures and recharge areas were constructed. Exploratory wells were drilled in some of the identified aquifers.A network of shallow aquifers was identified to spread across the area, only hidden by a few meters of the overburden below the surface. Presently 5 boreholes have been drilled within this aquifer and the average yield per borehole is about 80cu m/hour. The large paleo lake Lotikipi Basin aquifer covers a surface of 4146sq.km and hosts over 248 BCM in its 3-km deep graben structure. These deep aquifer-bearing structures comprise highly permeable Plio-Pleistocene fluvio-deltaic and lacustrine deposits interlayed with volcanic ash layers reworked by nearby rivers. Groundwater in these aquifers is partly static and partly dynamic in the graben-like structures. In view of these findings, the Government of Kenya and UNESCO Nairobi office have signed a cooperative framework agreement in May 2015 to continue with these groundwater assessments in a phased approach but eventually to cover the whole country. In addition and following UNESCO-IHP strategic plan-VIII: Water Security: Responses to Local, Regional, and Global Challenges (2014-2021) under theme 2: Groundwater in a changing environment, Kenya and Tanzania
Carvalho, M; Vinayak, S; Ochieng, R; Choksey, V; Musee, N; Stones, W; Knight, He; Cheikh Ismail, L
The African site in the INTERGROWTH-21(st) Project was Parklands, a wealthy suburb of Nairobi, Kenya, with a largely middle-to-high socio-economic status population. There are three hospitals with obstetric units in Parklands, with approximately 4300 births per year. The Newborn Cross-Sectional Study (NCSS) sample was drawn from all three hospitals, covering 100% of births in this target population. The Fetal Growth Longitudinal Study (FGLS) sample was recruited from antenatal clinics serving these hospitals, using the eligibility criteria in the INTERGROWTH-21(st) protocol. Special activities to raise awareness of the study included securing media coverage and distributing leaflets in antenatal clinic waiting rooms. FGLS required women to be recruited in the first trimester; therefore, a major challenge at this study site was the high background frequency of first antenatal consultations in the second trimester. The problem was overcome by the study awareness campaign, as a result of which more women started attending antenatal care earlier in pregnancy.
Piper, Benjamin; Zuilkowski, Stephanie S.; Ong'ele, Salome
Research in sub-Saharan Africa investigating the effect of mother tongue (MT) literacy instruction at medium scale is limited. A randomized controlled trial of MT literacy instruction was implemented in 2013 and 2014 as part of the Primary Math and Reading (PRIMR) Initiative in Kenya. We compare the effect of two treatment groups--the base PRIMR…
Ochwoto, Missiani; Chauhan, Ranjit; Gopalakrishnan, Deepak; Chen, Chien-Yu; Ng'ang'a, Zipporah; Okoth, Fredrick; Kioko, Henry; Kimotho, James; Kaiguri, Peter; Kramvis, Anna
Hepatitis B virus (HBV) genotypes are important in both the clinical manifestation of disease and treatment response. Although Kenya belongs to the African Region (AFR-E) characterized by high mortality and hyperendemicity of HBV, there is a paucity of HBV genotyping data. The aim of this study was to molecularly characterize the basic core promoter/precore (BCP/PC) and complete surface (S) regions of HBV isolated from 61 HBsAg-positive liver disease patients attending Kenyatta National Hospital in Nairobi. HBsAg, HBeAg and viral loads were determined. HBV DNA was amplified and sequenced from 58/61 patients. In addition to the complete genome of two isolates, the BCP/PC and the complete S regions of 43 and 38 isolates, respectively were sequenced. Following phylogenetic analysis of the S region, 38 isolates clustered with subgenotype A1, whereas two isolates clustered with genotype D, one with subgenotype D1 and another as an outlier of the clade containing subgenotype D6 and the D/E recombinant. When the complete genome of the latter isolate was sequenced it clustered with D6. The majority of isolates belonged to serological subtype adw2 and only four to ayw2. Three distinct groups of subgenotype A1, distinguished by different amino acid motifs, circulate in Kenya: two in the African cluster and a monophyletic clade in the "Asian" cluster. HBeAg-negativity was a result of G1896A in genotype D isolates, whereas in subgenotype A1, the HBeAg-negativity was a result of mutations in the Kozak region (1809-1812) or precore start codon (1814-1816). Mutations at positions 1762 and 1764 occurred more frequently in HCC patients (p<0.05). In conclusion, subgenotypes A1, D1 and D6 circulate in liver disease patients in Kenya, with A1 predominating.
Subtype H1N1 Circulating in Kenya During 2007–2008 Wallace D. Bulimo,1,2 Rachel A. Achilla,1 Janet Majanja,1 Silvanos Mukunzi,1 Meshack Wadegu,1 Finnley... Alfred Odindo,1 Charles Adega,1 Jeremiah Kiponda,1 Ruth Mupa,1 Frida Munyazi,1 George Kissinger,1 Mohammed Mwakuzimu,1 Diana Kamola,1 Elias Muhidin,1...Correspondence: Wallace Bulimo, PhD, US Army Medical Research Unit– Kenya, Box 606, Village Market, 00621 Nairobi, Kenya (email@example.com). The Journal of
Wakasiaka, Sabina; Hoang, Tina Dan My; Bwayo, Job Joab; del Rio, Carlos; Priddy, Frances H.
Abstract Purpose We sought to assess the potential acceptability of intravaginal rings (IVRs) as an HIV prevention method among at-risk women and men. Methods We conducted a qualitative assessment of initial attitudes toward IVRs, current HIV prevention methods, and common behavioral practices among female sex workers (FSWs) and men who frequent FSWs in Mukuru, an urban slum community in Nairobi, Kenya. Nineteen women and 21 men took part in six focus group discussions. Results Most participants, both male and female, responded positively to the concept of an IVR as a device for delivering microbicides. Women particularly liked the convenience offered by its slow-release capacity. Some female respondents raised concerns about whether male customers would discover the ring and respond negatively, whereas others thought it unlikely that their clients would feel the ring. Focus groups conducted with male clients of FSWs suggested that many would be enthusiastic about women, and particularly sex workers, using a microbicide ring, but that women's fears about negative responses to covert use were well founded. Overall, this high-risk population of FSWs and male clients in Nairobi was very open to the IVR as a potential HIV prevention device. Conclusion Themes that emerged from the focus groups highlight the importance of understanding attitudes toward IVRs as well as cultural practices that may impact IVR use in high-risk populations when pursuing clinical development of this potential HIV prevention device. PMID:18681822
Mumah, Joyce N; Machiyama, Kazuyo; Mutua, Michael; Kabiru, Caroline W; Cleland, John
Unmet need for contraception is highest within 12 months post-delivery, according to research. Using longitudinal data from the Nairobi Urban Health and Demographic Surveillance System, we assess the dynamics of contraceptive use during the postpartum period among women in Nairobi's slums. Results show that by 6 months postpartum, 83 percent of women had resumed sexual activity and 51 percent had resumed menses, yet only 49 percent had adopted a modern contraceptive method. Furthermore, almost half of women discontinued a modern method within 12 months of initiating use, with many likely to switch to another short-term method with high method-related dissatisfaction. Women who adopted a method after resumption of menses had higher discontinuation rates, though the effect was much reduced after adjusting for other variables. To reduce unmet need, effective intervention programs are essential to lower high levels of discontinuation and encourage switching to more effective methods.
Studies of female sexuality in Africa tend to adopt an instrumental approach, many times problematizing sexual conduct in relation to HIV infection and/or reproduction. This study aimed to explore sexuality as a relational concept. Using interviews and participant observation, the paper shows how sexuality becomes a point of self-identification for young professional women in Nairobi between 20 and 30 years-old. These women form a group who implicitly and explicitly criticize conventional gender roles through the overt pursuit of sexual pleasure as recognition of their womanhood. This aspect of the feminine sense of self is at odds with normative notions of femininity. To avoid criticism for being 'un-proper', women adopt a deferential attitude towards men. The focus on upwardly mobile professional women and their experiments with new types of heterosexual relations in dating provides insight into both sexuality and gender.
Zulu, Eliya M; Beguy, Donatien; Ezeh, Alex C; Bocquier, Philippe; Madise, Nyovani J; Cleland, John; Falkingham, Jane
The Urbanization, Poverty, and Health Dynamics research program was designed to generate and provide the evidence base that would help governments, development partners, and other stakeholders understand how the urban slum context affects health outcomes in order to stimulate policy and action for uplifting the wellbeing of slum residents. The program was nested into the Nairobi Urban Health and Demographic Surveillance System, a uniquely rich longitudinal research platform, set up in Korogocho and Viwandani slum settlements in Nairobi city, Kenya. Findings provide rich insights on the context in which slum dwellers live and how poverty and migration status interacts with health issues over the life course. Contrary to popular opinions and beliefs that see slums as homogenous residential entities, the findings paint a picture of a highly dynamic and heterogeneous setting. While slum populations are highly mobile, about half of the population comprises relatively well doing long-term dwellers who have lived in slum settlements for over 10 years. The poor health outcomes that slum residents exhibit at all stages of the life course are rooted in three key characteristics of slum settlements: poor environmental conditions and infrastructure; limited access to services due to lack of income to pay for treatment and preventive services; and reliance on poor quality and mostly informal and unregulated health services that are not well suited to meeting the unique realities and health needs of slum dwellers. Consequently, policies and programs aimed at improving the wellbeing of slum dwellers should address comprehensively the underlying structural, economic, behavioral, and service-oriented barriers to good health and productive lives among slum residents.
Creanga, Andreea A.; Galavotti, Christine; Wamalwa, Emmanuel
Introduction Use of family planning (FP) is powerfully shaped by social and gender norms, including the perceived acceptability of FP and gender roles that limit women’s autonomy and restrict communication and decision-making between men and women. This study evaluated an intervention that catalyzed ongoing community dialogues about gender and FP in Siaya county, Nyanza Province, Kenya. Specifically, we explored the changes in perceived acceptability of FP, gender norms and use of FP. Methods We used a mixed-method approach. Information on married men and women’s socio-demographic characteristics, pregnancy intentions, gender-related beliefs, FP knowledge, attitudes, and use were collected during county-representative, cross-sectional household surveys at baseline (2009; n11 = 650 women; n12 = 305 men) and endline (2012; n21 = 617 women; n22 = 317 men); exposure to the intervention was measured at endline. We assessed changes in FP use at endline vs. baseline, and fitted multivariate logistic regression models for FP use to examine its association with intervention exposure and explore other predictors of use at endline. In-depth, qualitative interviews with 10 couples at endline further explored enablers and barriers to FP use. Results At baseline, 34.0% of women and 27.9% of men used a modern FP method compared to 51.2% and 52.2%, respectively, at endline (p<0.05). Exposure to FP dialogues was associated with 1.78 (95% CI: 1.20–2.63) times higher odds of using a modern FP method at endline for women, but this association was not significant for men. Women’s use of modern FP was significantly associated with higher spousal communication, control over own cash earnings, and FP self-efficacy. Men who reported high approval of FP were significantly more likely to use modern FP if reporting high approval of FP and more equitable gender beliefs. FP dialogues addressed persistent myths and misconceptions, normalized FP discussions, and increased its
This paper describes a partnership between the University of Nairobi College of Health Sciences (CHS) Library and the University of Maryland Health Sciences and Human Services Library (HS/HSL). The libraries are collaborating to develop best practices for the CHS Library as it meets the challenge of changing medical education information needs in a digital environment. The collaboration is part of a Medical Education Partnership Initiative. The library project has several components: an assessment of the CHS Library, learning visits in the United States and Kenya, development of recommendations to enhance the CHS Library, and ongoing evaluation of the program's progress. Development of new services and expertise at the CHS Library is critical to the project's success. A productive collaboration between the HS/HSL and CHS Library is ongoing. A successful program to improve the quality of medical education will have a beneficial impact on health outcomes in Kenya.
This paper describes a partnership between the University of Nairobi College of Health Sciences (CHS) Library and the University of Maryland Health Sciences and Human Services Library (HS/HSL). The libraries are collaborating to develop best practices for the CHS Library as it meets the challenge of changing medical education information needs in a digital environment. The collaboration is part of a Medical Education Partnership Initiative. The library project has several components: an assessment of the CHS Library, learning visits in the United States and Kenya, development of recommendations to enhance the CHS Library, and ongoing evaluation of the program's progress. Development of new services and expertise at the CHS Library is critical to the project's success. A productive collaboration between the HS/HSL and CHS Library is ongoing. A successful program to improve the quality of medical education will have a beneficial impact on health outcomes in Kenya. PMID:24860265
Soura, Abdramane Bassiahi; Mberu, Blessing; Elungata, Patricia; Lankoande, Bruno; Millogo, Roch; Beguy, Donatien; Compaore, Yacouba
Studies on informal settlements in sub-Saharan Africa have questioned the health benefits of urban residence, but this should not suggest that informal settlements (within cities and across cities and/or countries) are homogeneous. They vary in terms of poverty, pollution, overcrowding, criminality, and social exclusion. Moreover, while some informal settlements completely lack public services, others have access to health facilities, sewers, running water, and electricity. There are few comparative studies that have looked at informal settlements across countries accounting for these contextual nuances. In this paper, we comparatively examine the differences in child vaccination rates between Nairobi and Ouagadougou's informal settlements. We further investigate whether the identified differences are related to the differences in demographic and socioeconomic composition between the two settings. We use data from the Ouagadougou and Nairobi Urban Health and Demographic Surveillance Systems (HDSSs), which are the only two urban-based HDSSs in Africa. The results show that children in the slums of Nairobi are less vaccinated than children in the informal settlements in Ouagadougou. The difference in child vaccination rates between Nairobi and Ouagadougou informal settlements are not related to the differences in their demographic and socioeconomic composition but to the inequalities in access to immunization services.
Child, Mara J; Kiarie, James N; Allen, Suzanne M; Nduati, Ruth; Wasserheit, Judith N; Kibore, Minnie W; John-Stewart, Grace; Njiri, Francis J; O'Malley, Gabrielle; Kinuthia, Raphael; Norris, Tom E; Farquhar, Carey
A major medical education need in Sub-Saharan Africa includes expanding clinical training opportunities to develop health professionals. Medical education expansion is a complicated process that requires significant investment of financial and human resources, but it can also provide opportunities for innovative approaches and partnerships. In 2010, the U.S. President's Emergency Plan for AIDS Relief launched the Medical Education Partnership Initiative to invest in medical education and health system strengthening in Africa. Building on a 30-year collaborative clinical and research training partnership, the University of Nairobi in Kenya developed a pilot regional medical education program modeled on the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) medical education program at the University of Washington in the United States. The University of Nairobi adapted key elements of the WWAMI model to expand clinical training opportunities without requiring major capital construction of new buildings or campuses. The pilot program provides short-term clinical training opportunities for undergraduate students and recruits and trains clinical faculty at 14 decentralized training sites. The adaptation of a model from the Northwestern United States to address medical education needs in Kenya is a successful transfer of knowledge and practices that can be scaled up and replicated across Sub-Saharan Africa.
Objective To design and implement surveys of malaria infection and coverage of malaria control interventions among school children in Kenya in order to contribute towards a nationwide assessment of malaria. Methods The country was stratified into distinct malaria transmission zones based on a malaria risk map and 480 schools were visited between October 2008 and March 2010. Surveys were conducted in two phases: an initial opportunistic phase whereby schools were selected for other research purposes; and a second phase whereby schools were purposively selected to provide adequate spatial representation across the country. Consent for participation was based on passive, opt-out consent rather than written, opt-in consent because of the routine, low-risk nature of the survey. All children were diagnosed for Plasmodium infection using rapid diagnostic tests, assessed for anaemia and were interviewed about mosquito net usage, recent history of illness, and socio-economic and household indicators. Children's responses were entered electronically in the school and data transmitted nightly to Nairobi using a mobile phone modem connection. RDT positive results were corrected by microscopy and all results were adjusted for clustering using random effect regression modelling. Results 49,975 children in 480 schools were sampled, at an estimated cost of US$ 1,116 per school. The overall prevalence of malaria and anaemia was 4.3% and 14.1%, respectively, and 19.0% of children reported using an insecticide-treated net (ITN). The prevalence of infection showed marked variation across the country, with prevalence being highest in Western and Nyanza provinces, and lowest in Central, North Eastern and Eastern provinces. Nationally, 2.3% of schools had reported ITN use >60%, and low reported ITN use was a particular problem in Western and Nyanza provinces. Few schools reported having malaria health education materials or ongoing malaria control activities. Conclusion School malaria
M D, Baron; B, Holzer
Nairobi sheep disease virus (NSDV) is a tick-borne virus which causes a severe disease in sheep and goats, and has been responsible for several outbreaks of disease in East Africa. The virus is also found in the Indian subcontinent, where it is known as Ganjam virus. The virus only spreads through the feeding of competent infected ticks, and is therefore limited in its geographic distribution by the distribution of those ticks, Rhipicephalus appendiculata in Africa and Haemaphysalis intermedia in India. Animals bred in endemic areas do not normally develop disease, and the impact is therefore primarily on animals being moved for trade or breeding purposes. The disease caused by NSDV has similarities to several other ruminant diseases, and laboratory diagnosis is necessary for confirmation. There are published methods for diagnosis based on polymerase chain reaction, for virus growth in cell culture and for other simple diagnostic tests, though none has been commercialised. There is no established vaccine against NSDV, although cell-culture attenuated strains have been developed which show promise and could be put into field trials if it were deemed necessary. The virus is closely related to Crimean-Congo haemorrhagic fever virus, and studies on NSDV may therefore be useful in understanding this important human pathogen.
Women Fighting AIDS in Kenya (WOFAK) was founded in order to improve the effectiveness of existing AIDS services delivered to women in Kenya. Founded by both seropositive and seronegative women, WOFAK is unique in that it is the only AIDS support organization (ASO) in Kenya run by and for women. WOFAK contributes to the empowerment of HIV positive women and girls by assisting them in gaining control over their own health and serostatus, to live positively with the infection, and to protect their families and communities from becoming infected. WOFAK founders feel that existing ASOs address women's issues as only a small part of their programs and that most existing programs aimed at women focus on commercial sex workers. Whenever possible, WOFAK provides psychological and material support for women affected by HIV/AIDS. They conduct training in home-based care techniques and visit hospitalized members to offer counseling and support. WOFAK conducts HIV/AIDS education and outreach in schools, churches, commercial centers, and rural areas. All activities center around a network of positive women from all parts of society responding to the community and advocating for stronger responses by the government and other agencies providing HIV/AIDS prevention and care services. They stress the basic human rights of HIV positive women such as their right to marriage and reproduction, proper medical care, housing, and jobs. For more information, please contact Dorothy Odhiambo, WOFAK, PO Box 58428, Nairobi, Kenya; tel: +1 254 2 217039; fax: +1 254 2 243164.
Jaouen, Klervia; Beasley, Melanie; Schoeninger, Margaret; Hublin, Jean-Jacques; Richards, Michael P.
In order to explore the possibilities of using zinc (Zn) stable isotope ratios as dietary indicators, we report here on the measurements of the ratio of stable isotopes of zinc (66Zn/64Zn, expressed here as δ66Zn) in bioapatite (bone and dental enamel) of animals from a modern food web in the Koobi Fora region of the Turkana Basin in Kenya. We demonstrate that δ66Zn values in both bone and enamel allow a clear distinction between carnivores and herbivores from this food web. Differences were also observed between browsers and grazers as well as between carnivores that consumed bone (i.e. hyenas) compared to those that largely consume flesh (i.e. lions). We conclude that Zn isotope ratio measurements of bone and teeth are a new and promising dietary indicator. PMID:27189145
Jaouen, Klervia; Beasley, Melanie; Schoeninger, Margaret; Hublin, Jean-Jacques; Richards, Michael P.
In order to explore the possibilities of using zinc (Zn) stable isotope ratios as dietary indicators, we report here on the measurements of the ratio of stable isotopes of zinc (66Zn/64Zn, expressed here as δ66Zn) in bioapatite (bone and dental enamel) of animals from a modern food web in the Koobi Fora region of the Turkana Basin in Kenya. We demonstrate that δ66Zn values in both bone and enamel allow a clear distinction between carnivores and herbivores from this food web. Differences were also observed between browsers and grazers as well as between carnivores that consumed bone (i.e. hyenas) compared to those that largely consume flesh (i.e. lions). We conclude that Zn isotope ratio measurements of bone and teeth are a new and promising dietary indicator.
Sack, D A; Kaminsky, D C; Sack, R B; Itotia, J N; Arthur, R R; Kapikian, A Z; Orskov, F; Orskov, I
We performed a randomized double-blind study to determine the efficacy of doxycycline (100 mg daily) in preventing travelers' diarrhea among 39 Peace Corps volunteers during their first five weeks in Kenya. The volunteers took either doxycycline or placebo for three weeks and were observed for an additional two weeks. Nine of 21 taking placebo and one of 18 taking doxycycline had travelers' diarrhea during the treatment period (P = 0.012). The protection seemed to persist for at least one week after the drug was stopped. Enterotoxigenic Escherichia coli was the only pathogen isolated from the placebo group, but was not detected in persons taking doxycycline. None of these organisms were resistant to doxycycline or tetracycline, whereas resistance to tetracyclines and other antibiotics was common among the nonenterotoxigenic Esch. coli. We conclude that doxycycline effectively prevented most episodes of travelers' dirrhea.
Predicting Neisseria gonorrhoeae and Chlamydia trachomatis infection using risk scores, physical examination, microscopy, and leukocyte esterase urine dipsticks among asymptomatic women attending a family planning clinic in Kenya.
Tyndall, M W; Kidula, N; Sande, J; Ombette, J; Temmerman, M
This cross sectional study presents a risk scoring system that would identify women at highest risk for sexually transmitted infections (STIs). 1058 randomly selected women participated in the study in Nairobi, Kenya; of these, 1048 participants were included in the analysis. The study was conducted from May 1994 to July 1995 at a clinic sponsored by the Family Planning Association of Kenya. Information pertaining to the demographic, behavioral and social characteristics of the participants was gathered. In addition, a clinical algorithm, which includes physical examination, microscopy, and leukocyte esterase (LE) urine dipsticks, was employed to detect gonorrhea and chlamydia infections among asymptomatic women. The results revealed that the prevalence of STIs, including HIV-1, was high among women attending this urban family planning clinic. Standard demographic, behavioral, and clinical characteristics were only weakly associated with infection, resulting in poor sensitivity and specificity calculations in the risk scores. Detection of cervical infections gave a sensitivity of 85% and a specificity of 30%. A positive LE urine dipstick had a sensitivity of 63% and a specificity of 47%. Although the addition of physical examination and LE dipstick to the work-up improved the sensitivity of case detection, it did not improve the overall validity of the scoring system.
Ekirapa, Akaco; Mgomella, George S; Kyobutungi, Catherine
We conducted a needs assessment that describes the landscape of civil society organizations (CSOs) in three informal settlements around Nairobi, Kenya. The numbers of CSOs have rapidly increased in areas underserved by governments including poor urban neighbourhoods but little is known about CSOs capacity to meet the priority health needs of the urban poor. It is also unclear why, despite a proliferation of CSOs, residents still experience unimproved health outcomes. We collected data on core activities, financial management, and governance structures. Of the 952 CSOs assessed, 47 per cent reported HIV/AIDS counselling, prevention, and treatment as their core activity. Most CSOs reported good financial management systems and governance structures but responses were not validated. Representation in district health stakeholder fora was low; most CSOs did not have the capacity to effectively deliver services that would have impact. For CSOs to realize the desired goal to improve the well-being of low-income populations, programmes to build their management capacity are essential.
Waihenya, E W; Kogi-Makau, W; Muita, J W
Most nutrition education programmes in Kenya operate on the premise that nutritional knowledge can have an impact on children's nutritional status. It has, however, been argued that nutritional knowledge among low income groups is unlikely to have an impact, hence, the need to establish whether there is a relationship between nutritional status and maternal nutritional knowledge. In a cross-sectional survey carried out in a Nairobi slum (Kibera), nutritional status of 363 children aged six to 24 months was measured and nutritional knowledge of their mothers assessed. Makina village was randomly selected as the study site and all consenting households were involved in the study. The study established that most mothers (97.5%) have access to nutrition education. Prevalence of stunting (86.2%) and underweight (58.4%) was high but that of wasting (1.9%) was low. There was no significant relationship between the nutritional status of children and overall nutritional knowledge. Unexpectedly, a negative relationship was found between nutritional status and mothers' ability to recognise clinical signs of malnutrition, knowledge in the weaning process and dietary management during sickness. Knowledge on frequency of feeding was, however, positively related to nutritional states. In conclusion, nutritional knowledge alone is inadequate in ensuring young children's nutrition security and, hence, for nutrition education programmes to have a positive impact, facilitational strategies must be incorporated.
Jia, Peng; Anderson, John D.; Leitner, Michael; Rheingans, Richard
Background Access to sanitation facilities is imperative in reducing the risk of multiple adverse health outcomes. A distinct disparity in sanitation exists among different wealth levels in many low-income countries, which may hinder the progress across each of the Millennium Development Goals. Methods The surveyed households in 397 clusters from 2008–2009 Kenya Demographic and Health Surveys were divided into five wealth quintiles based on their national asset scores. A series of spatial analysis methods including excess risk, local spatial autocorrelation, and spatial interpolation were applied to observe disparities in coverage of improved sanitation among different wealth categories. The total number of the population with improved sanitation was estimated by interpolating, time-adjusting, and multiplying the surveyed coverage rates by high-resolution population grids. A comparison was then made with the annual estimates from United Nations Population Division and World Health Organization /United Nations Children's Fund Joint Monitoring Program for Water Supply and Sanitation. Results The Empirical Bayesian Kriging interpolation produced minimal root mean squared error for all clusters and five quintiles while predicting the raw and spatial coverage rates of improved sanitation. The coverage in southern regions was generally higher than in the north and east, and the coverage in the south decreased from Nairobi in all directions, while Nyanza and North Eastern Province had relatively poor coverage. The general clustering trend of high and low sanitation improvement among surveyed clusters was confirmed after spatial smoothing. Conclusions There exists an apparent disparity in sanitation among different wealth categories across Kenya and spatially smoothed coverage rates resulted in a closer estimation of the available statistics than raw coverage rates. Future intervention activities need to be tailored for both different wealth categories and nationally
Zaidi, Sidra S.; Ocholla, Akinyi M.; Otieno, Rena A.
Abstract Purpose: To describe sexual and reproductive health characteristics of women who have sex with women (WSW) in Kenya's three most populous cities: Kisumu, Mombasa, and Nairobi. Although the last decade has shown an upsurge of health-related research studies in African sexual minority populations, these studies have generally concentrated on the health status of men who have sex with men to the exclusion of WSW. This study presents the first findings on Kenyan WSW's sexual and reproductive health. Methods: A community-based, cross-sectional survey was conducted among 280 women who were at least 18 years old, had at least one female sexual partner in the past three years, and were Kenyan residents. Results: A significant proportion of participants reported that they had at least one male sexual partner in the past three years (38.9%), ever had an abortion (13.2%), been infected with at least one sexually transmitted infection (STI) in the past three years (33.9%), and been tested for HIV at least once (88.9%). Of the women who reported having been tested for HIV, 9.4% (7.5% of the total sample) received a positive test result. Some women noted that they were open with their doctors about their sexual orientation, and that their doctors had not reacted negatively to this information. Conclusion: WSW in Kenya are at risk for negative sexual and reproductive health outcomes, including HIV, STIs, unplanned pregnancy, and unsafe abortion, positioning these women as a critical population for public health efforts. Some WSW actively exercise their agency in making important health decisions. Therefore, this study indicates a need to incorporate WSW's health concerns within Kenyan national health policy programming. PMID:26684690
Opot, E N; Magoha, G A
This retrospective study was undertaken to determine the prevalence, clinical characteristics, management methods and prognosis of testicular cancer at Kenyatta National Hospital, Nairobi. All histologically confirmed testicular cancer patients recorded at the Histopathology Department between 1993 and 1997 were analyzed. The mean age was 34.8 years with a peak incidence in the 30-44 year age group. About 10.26% of patients had history of cryptochirdism. The clinical symptoms presented were painless testicular swelling (n = 31, 79.49%), testicular pain (n = 11, 28.08%), scrotal heaviness (n = 9, 23.08%), abdominal swelling (n = 6, 15.38%), gynecomastia (n = 1, 2.56%), and eye swelling (n = 1, 2.56%). On examination, 32 patients (82.05%) had testicular masses, 10 (25.64%) had abdominal masses, 7 (17.91%) had supraclavicular and cervical lymphadenopathy, 1 had gynecomastia, and 1 had an orbital mass. More than 89% of patients had germ cell cancers with seminoma accounting for 67.35%, teratoma for 12.24%, embryonal carcinoma for 8.16%, rhabdomyosarcoma for 6.12%, and malignant germ cell tumor, orchioblastoma, and dysgerminoma each accounting for 2.04%. The various methods of treatment include orchidectomy and radiotherapy and chemotherapy in 3 patients (7.7%), orchidectomy and radiotherapy in 16 patients (41.03%), orchidectomy and chemotherapy in 6 patients (15.38%), and radiotherapy and chemotherapy in 10 patients (25.64%). No cisplatin-based chemotherapy was used. 18 patients were followed up, of whom 7 were alive after 5 years. Prognosis with current regimens was poor, with a 38.89% survival ratio in 5 years. Hence, cisplatin-based chemotherapy with up to 90% cure rates should be included in the testicular cancer management in this hospital.
Madise, Nyovani J; Ziraba, Abdhalah K; Inungu, Joseph; Khamadi, Samoel A; Ezeh, Alex; Zulu, Eliya M; Kebaso, John; Okoth, Vincent; Mwau, Matilu
In 2008, the global urban population surpassed the rural population and by 2050 more than 6 billion will be living in urban centres. A growing body of research has reported on poor health outcomes among the urban poor but not much is known about HIV prevalence among this group. A survey of nearly 3000 men and women was conducted in two Nairobi slums in Kenya between 2006 and 2007, where respondents were tested for HIV status. In addition, data from the 2008/2009 Kenya Demographic and Health Survey were used to compare HIV prevalence between slum residents and those living in other urban and rural areas. The results showed strong intra-urban differences. HIV was 12% among slum residents compared with 5% and 6% among non-slum urban and rural residents, respectively. Generally, men had lower HIV prevalence than women although in the slums the gap was narrower. Among women, sexual experience before the age of 15 compared with after 19 years was associated with 62% higher odds of being HIV positive. There was ethnic variation in patterns of HIV infection although the effect depended on the current place of residence.
Turan, Janet M; Bukusi, Elizabeth A; Onono, Maricianah; Holzemer, William L; Miller, Suellen; Cohen, Craig R
HIV/AIDS stigma is a common thread in the narratives of pregnant women affected by HIV/AIDS globally and may be associated with refusal of HIV testing. We conducted a cross-sectional study of women attending antenatal clinics in Kenya (N = 1525). Women completed an interview with measures of HIV/AIDS stigma and subsequently information on their acceptance of HIV testing was obtained from medical records. Associations of stigma measures with HIV testing refusal were examined using multivariate logistic regression. Rates of anticipated HIV/AIDS stigma were high-32% anticipated break-up of their relationship, and 45% anticipated losing their friends. Women who anticipated male partner stigma were more than twice as likely to refuse HIV testing, after adjusting for other individual-level predictors (OR = 2.10, 95% CI: 1.15-3.85). This study demonstrated quantitatively that anticipations of HIV/AIDS stigma can be barriers to acceptance of HIV testing by pregnant women and highlights the need to develop interventions that address pregnant women's fears of HIV/AIDS stigma and violence from male partners.
Vogl, Adrian L; Bryant, Benjamin P; Hunink, Johannes E; Wolny, Stacie; Apse, Colin; Droogers, Peter
We analyze the impacts of investments in sustainable land use practices on ecosystem services in the Upper Tana basin, Kenya. This work supports implementation of the Upper Tana-Nairobi Water Fund, a public-private partnership to safeguard ecosystem service provision and food security. We apply an integrated modelling framework, building on local knowledge and previous field- and model-based studies, to link biophysical landscape changes at high temporal and spatial resolution to economic benefits for key actors in the basin. The primary contribution of this study is that it a) presents a comprehensive analysis for targeting interventions that takes into account stakeholder preferences, local environmental and socio-economic conditions, b) relies on detailed, process-based, biophysical models to demonstrate the biophysical return on those investments for a practical, decision-driven case, and c) in close collaboration with downstream water users, links those biophysical outputs to monetary metrics, including: reduced water treatment costs, increased hydropower production, and crop yield benefits for agricultural producers in the conservation area. This study highlights the benefits and trade-offs that come with conducting participatory research as part of a stakeholder engagement process: while results are more likely to be decision-relevant within the local context, navigating stakeholder expectations and data limitations present ongoing challenges.
Reiss, Kate; Footman, Katharine; Akora, Vitalis; Liambila, Wilson; Ngo, Thoai D
Objective To assess pharmacy workers’ knowledge and provision of abortion information and methods in Kenya. Methods In 2013 we interviewed 235 pharmacy workers in Nairobi, Mombasa and Kisumu about the medical abortion services they provide. We also used mystery clients, who made 401 visits to pharmacies to collect first-hand information on abortion practices. Results The majority (87.5%) of pharmacy workers had heard of misoprostol but only 39.2% had heard of mifepristone. We found that pharmacy workers had limited knowledge of correct medical abortion regimens, side effects and complications and the legal status of abortion drugs. 49.8% of pharmacy workers reported providing abortion information to clients and 4.3% reported providing abortion methods. 75.2% of pharmacies referred mystery clients to another provider, though 64.2% of pharmacies advised mystery clients to continue with their pregnancy. Pharmacy workers reported that they were experiencing demand for abortion services from clients. Conclusions Pharmacy workers are important providers of information and referrals for women seeking abortion, however their medical abortion knowledge is limited. Training pharmacy workers on medical abortion may improve the quality of information provided and access to safe abortion. PMID:26869694
Makori, L.; Gikera, M.; Wafula, J.; Chakaya, J.; Edginton, M. E.; Kumar, A. M. V.
Setting: Kenyatta National Hospital (KNH), Nairobi, Ken-ya, a large referral and teaching hospital. Objective: 1) To document tuberculosis (TB) case notification rates and trends; 2) to describe demographic, clinical and workplace characteristics and treatment outcomes; and 3) to examine associations between demographic and clinical characteristics, HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) treatment and anti-tuberculosis treatment outcomes among hospital workers with TB at KNH during the period 2006–2011. Design: A retrospective cohort study involving a review of medical records. Results: The TB case notification rate among hospital staff ranged between 413 and 901 per 100 000 staff members per year; 51% of all cases were extra-pulmonary TB; 74% of all cases were among medical, paramedical and support staff. The TB-HIV coinfection rate was 60%. Only 75% had a successful treatment outcome. Patients in the retreatment category, those with unknown HIV status and those who were support staff had a higher risk of poor treatment outcomes. Conclusion: The TB case rate among hospital workers was unacceptably high compared to that of the general population, and treatment outcomes were poor. Infection control in the hospital and management of staff with TB requires urgent attention. PMID:26393055
George, Githuka; Rotich, Jacob; Kigen, Hudson; Catherine, Kiama; Waweru, Bonface; Boru, Waqo; Galgalo, Tura; Githuku, Jane; Obonyo, Mark; Curran, Kathryn; Narra, Rupa; Crowe, Samuel J; O'Reilly, Ciara E; Macharia, Daniel; Montgomery, Joel; Neatherlin, John; De Cock, Kevin M; Lowther, Sara; Gura, Zeinab; Langat, Daniel; Njeru, Ian; Kioko, Jackson; Muraguri, Nicholas
On January 6, 2015, a man aged 40 years was admitted to Kenyatta National Hospital in Nairobi, Kenya, with acute watery diarrhea. The patient was found to be infected with toxigenic Vibrio cholerae serogroup O1, serotype Inaba. A subsequent review of surveillance reports identified four patients in Nairobi County during the preceding month who met either of the Kenya Ministry of Health suspected cholera case definitions: 1) severe dehydration or death from acute watery diarrhea (more than four episodes in 12 hours) in a patient aged ≥5 years, or 2) acute watery diarrhea in a patient aged ≥2 years in an area where there was an outbreak of cholera. An outbreak investigation was immediately initiated. A confirmed cholera case was defined as isolation of V. cholerae O1 or O139 from the stool of a patient with suspected cholera or a suspected cholera case that was epidemiologically linked to a confirmed case. By January 15, 2016, a total of 11,033 suspected or confirmed cases had been reported from 22 of Kenya's 47 counties (Table). The outbreak is ongoing.
Taegtmeyer, Miriam; Davies, Alun; Mwangome, Mary; van der Elst, Elisabeth M; Graham, Susan M; Price, Matt A; Sanders, Eduard J
The role of men who have sex with men (MSM) in the African HIV epidemic is gaining recognition yet capacity to address the HIV prevention needs of this group is limited. HIV testing and counselling is not only a critical entry point for biomedical HIV prevention interventions, such as pre-exposure prophylaxis, rectal microbicides and early treatment initiation, but is also an opportunity for focused risk reduction counselling that can support individuals living in difficult circumstances. For prevention efforts to succeed, however, MSM need to access services and they will only do so if these are non-judgmental, informative, focused on their needs, and of clear benefit. This study aimed to understand Kenyan providers' attitudes towards and experiences with counselling MSM in a research clinic targeting this group for HIV prevention. We used in-depth interviews to explore values, attitudes and cognitive and social constructs of 13 counsellors and 3 clinicians providing services to MSM at this clinic. Service providers felt that despite their growing experience, more targeted training would have been helpful to improve their effectiveness in MSM-specific risk reduction counselling. They wanted greater familiarity with MSM in Kenya to better understand the root causes of MSM risk-taking (e.g., poverty, sex work, substance abuse, misconceptions about transmission, stigma, and sexual desire) and felt frustrated at the perceived intractability of some of their clients' issues. In addition, they identified training needs on how to question men about specific risk behaviours, improved strategies for negotiating risk reduction with counselling clients, and improved support supervision from senior counsellors. This paper describes the themes arising from these interviews and makes practical recommendations on training and support supervision systems for nascent MSM HIV prevention programmes in Africa.
Handa, Sudhanshu; Halpern, Carolyn Tucker; Pettifor, Audrey; Thirumurthy, Harsha
The aim of this study is to assess whether the Government of Kenya's Cash Transfer for Orphans and Vulnerable Children (Kenya CT-OVC) can reduce the risk of HIV among young people by postponing sexual debut. The program provides an unconditional transfer of US$20 per month directly to the main caregiver in the household. An evaluation of the program was implemented in 2007-2009 in seven districts. Fourteen Locations were randomly assigned to receive the program and fourteen were assigned to a control arm. A sample of households was enrolled in the evaluation in 2007. We revisited these households in 2011 and collected information on sexual activity among individuals between 15-25 years of age. We used logistic regression, adjusted for the respondent's age, sex and relationship to caregiver, the age, sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline, to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program. Our results, adjusted for these covariates, show that the program reduced the odds of sexual debut by 31 percent. There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use, number of partners and transactional sex. Since the CT-OVC provides cash to the caregiver and not to the child, and there are no explicit conditions associated with receipt, these impacts are indirect, and may have been achieved by keeping young people in school. Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa.
Lumsden, W. H. R.
The extent of dissemination of 17D yellow fever vaccine among the population of Kenya, especially among Africans, is estimated, largely from information in the records of the Kenya Medical Department. The total recorded vaccinations of Africans between 1941 and 1951 amount to about 379,000, representing 7.2% of the African population in 1948; it is, however, possible that the actual number of vaccinations is considerably higher. At Mombasa, 78,000 persons of races other than Africans were given routine inoculation over the same period. After a study of the economy of use of vaccine, the author discusses the protection-test surveys performed before 1951 and during that year in relation to the dissemination of vaccine. It is tentatively concluded that natural infection of man with yellow fever is rare in both Kenya and Tanganyika. PMID:13209303
Jacques, J; Sauter, M
In many African countries measles is considered to be an important cause of blindness. On the basis of his observations in Kenya and Tanzania in 1972 Franken presumed, however, that in the majority of these cases xerophthalmia was the real cause of blindness, precipitated by the "catalyst" measles. In order to gain a better understanding of this important complicated problem, we performed in the first half of 1974 an investigation in Kenya into the prevalence of xerophthalmia. In December 1974 we had the opportunity to evaluate our Kenyan findings on Java, in the company of Dr. J. ten Doesschate and Professor H.A.P.C. Oomen. The results of this investigation in Kenya and Indonesia are presented in this thesis. (see article) 1. Xerophthalmia occurred nearly everywhere in Kenya in 1974. This demonstrates the prevalence of xerophthalmia in communities which - do not have rice but - have maize for their staplefood. 2. Xerophthalmia appears to be the main cause of blindness in Kenyan children. 3. Measles often plays - by means of local and general "catalysing" effects - an important role in the development of blindness caused by xerophthalmia. 4. In well-nourished children measles is of no consequence as a cause of blindness. 5. Vital staining by 1% rose bengal or 1% lissamine green appears to be a real asset for the early diagnosis of xerophthalmia in Health Centres and in field surveys. This method is therefore of great importance for the prevention of severe, blindness inducing vitamin A deficiency.
Muiya, Bernard Munyao
Globally, decline in employment has affected the youth more compared to other cohorts with youth in developing countries being particularly hard hit. There have been various interventions by the Kenyan government to address the challenge of youth employment through human capital development like the Youth Enterprise Development Fund (YEFD).…
Marima, Esther Wairimu; Kamau-Kang'ethe, Rachael W.; Runo, Mary N.
Reading has been identified as one of the most reliable indicators of whether a learner will attain the competence needed to achieve academic success and contribute actively to society. Research findings in Kenyan primary and secondary schools reveal inadequate reading skills among the students. The purpose of this study was to identify approaches…
Kabiru, Caroline W.; Orpinas, Pamela
The high level of HIV infection in sub-Saharan Africa has led to an increased interest in understanding the determinants of sexual activity among young people, who are at high risk of sexually transmitted infections. The present study examined sociodemographic, behavioral, and psychosocial factors associated with heterosexual activity among a…
Kabiru, Caroline W.; Orpinas, Pamela
Background: Correct and consistent condom use is an effective strategy to reduce the risk of sexually transmitted infections (STIs). This study examines sociodemographic, behavioral, and psychosocial characteristics of 3 groups of adolescent males: consistent, sporadic, and non-condom users. Methods: The sample consisted of 931 sexually…
Kabiru, Caroline W.; Beguy, Donatien; Ndugwa, Robert P.; Zulu, Eliya M.; Jessor, Richard
Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adopt a protection-risk conceptual framework to examine resilience (academic achievement, civic participation, and avoidance of risk behaviors) among 1,722 never-married 12-19 year olds living in two Kenyan urban slums. We find stronger associations…
Kabiru, Caroline W.; Beguy, Donatien; Undie, Chi-Chi; Zulu, Eliya Msiyaphazi; Ezeh, Alex C.
While early sexual experiences are a key marker of the transition from childhood to adulthood, it is widely acknowledged that precocious initiation of sexual activity predisposes adolescents to negative health and psychological outcomes. Extant studies investigating adolescent sexuality in sub-Saharan Africa often rely on cross-sectional data…
Gor, Peter Ochieng
With the increasing popularity of distance education, focus has turned to the role of libraries in distance learning process. It is widely agreed that like their campus-based counterparts, distance education learners need adequate library services if they are to gain quality education. This study sought to examine library utilization by students…
Keyonzo, Nelson; Nyachae, Paul; Kagwe, Peter; Kilonzo, Margaret; Mumba, Feddis; Owino, Kenneth; Kichamu, George; Kigen, Bartilol; Fajans, Peter; Ghiron, Laura; Simmons, Ruth
This paper describes how the Urban Reproductive Health Initiative in Kenya, the Tupange Project (2010-2015), successfully applied the ExpandNet approach to sustainably scale up family planning interventions, first in Machakos and Kakamega, and subsequently also in its three core cities, Nairobi, Kisumu and Mombasa. This new focus meant shifting from a "project" to a "program" approach, which required paying attention to government leadership and ownership, limiting external inputs, institutionalizing interventions in existing structures and emphasizing sustainability. The paper also highlights the project's efforts to prepare for the future scale up of Tupange's interventions in other counties to support continuing and improved access to family planning services in the new context of devolution (decentralization) in Kenya.
Background End-of-life care needs are great in Africa due to the burden of disease. This study aimed to explore public preferences and priorities for end-of-life care in Nairobi, Kenya. Methods Population-based street survey of Kenyans aged ≥18; researchers approached every 10th person, alternating men and women. Structured interviews investigated quality vs. quantity of life, care priorities, preferences for information, decision-making, place of death (most and least favourite) and focus of care in a hypothetical scenario of serious illness with <1 year to live. Descriptive analysis examined variations. Results 201 individuals were interviewed (100 women) representing 17 tribes (n = 90 44.8%, Kikuyu). 56.7% (n = 114) said they would always like to be told if they had limited time left. The majority (n = 121, 61.4%) preferred quality of life over quantity i.e. extending life (n = 47, 23.9%). Keeping a positive attitude and ensuring relatives/friends were not worried were prioritised above having pain/discomfort relieved. The three most concerning problems were pain (45.8%), family burden (34.8%) and personal psychological distress (29.8%). Home was both the most (51.1% n = 98) and least (23.7% n = 44) preferred place of death. Conclusion This first population-based survey on preferences and priorities for end-of-life care in Africa revealed that psycho-social domains were of greatest importance to the public, but also identified variations that require further exploration. If citizens’ preferences and priorities are to be met, the development of end-of-life care services to deliver preferences in Kenya should ensure an holistic model of palliative care responsive to individual preferences across care settings including at home. PMID:24529217
Hoover, Mary Eleanor Rhodes
Describes the Nairobi Day School in East Palo Alto (California), an independent African-American institution. Its history is traced from its founding in 1966 to its closing in 1984. The Nairobi method and model are proposed as solutions to several contemporary educational problems that African Americans face in public schools. (SLD)
Miner, Valerie Jane
Nairobi College, in East Palo Alto, California, is a school concerned with making education relevant to the ghetto community. The school, founded by students, is taught by community members and serves an area that is approximately 80 per cent black. In nine months Nairobi College has enrolled 120 students; 40 instructors offer 25 courses, which…
Kedenge, Sarah V.; Kangwana, Beth P.; Waweru, Evelyn W.; Nyandigisi, Andrew J.; Pandit, Jayesh; Brooker, Simon J.; Snow, Robert W.; Goodman, Catherine A.
Background There is considerable interest in the potential of private sector subsidies to increase availability and affordability of artemisinin-based combination therapies (ACTs) for malaria treatment. A cluster randomized trial of such subsidies was conducted in 3 districts in Kenya, comprising provision of subsidized packs of paediatric ACT to retail outlets, training of retail staff, and community awareness activities. The results demonstrated a substantial increase in ACT availability and coverage, though patient counselling and adherence were suboptimal. We conducted a qualitative study in order to understand why these successes and limitations occurred. Methodology/Principal Findings Eighteen focus group discussions were conducted, 9 with retailers and 9 with caregivers, to document experiences with the intervention. Respondents were positive about intervention components, praising the focused retailer training, affordable pricing, strong promotional activities, dispensing job aids, and consumer friendly packaging, which are likely to have contributed to the positive access and coverage outcomes observed. However, many retailers still did not stock ACT, due to insufficient supplies, lack of capital and staff turnover. Advice to caregivers was poor due to insufficient time, and poor recall of instructions. Adherence by caregivers to dosing guidelines was sub-optimal, because of a wish to save tablets for other episodes, doses being required at night, stopping treatment when the child felt better, and the number and bitter taste of the tablets. Caregivers used a number of strategies to obtain paediatric ACT for older age groups. Conclusions/Significance This study has highlighted that important components of a successful ACT subsidy intervention are regular retailer training, affordable pricing, a reliable supply chain and community mobilization emphasizing patient adherence and when to seek further care. PMID:23342143
This article analyses the factors influencing the attitude of secondary school teachers in Nairobi. The findings are based on data collected in a three months field study. 30 interviews supplemented by questionnaires and observation show that due to the principle of equal pay for equal work the younger male teachers suffer from relative deprivation in status and are therefore the least motivated and the most likely to change the profession. An explanation can be found in their socio-economic situation and in the incompatibility of male expectations with career opportunities. In this context, direct working conditions don't seem to have a significant influence on teachers' attitude.
Mutoro, Antonina; Owino, Victor; Garcia, Ada L.; Wright, Charlotte M.
Little is known about the style and quality of feeding and care provided in child day-care centres in slum areas. This study purposively sampled five day-care centres in Nairobi, Kenya, where anthropometric measurements were collected among 33 children aged 6–24 months. Mealtime interactions were further observed in 11 children from four centres, using a standardized data collection sheet. We recorded the child actions, such as mood, interest in food, distraction level, as well as caregiver actions, such as encouragement to eat, level of distraction and presence of neutral actions. Of the 33 children assessed, with a mean age of 15.9 ± 4.9 months, 14 (42%) were female. Undernutrition was found in 13 (39%) children with at least one Z score <−2 or oedema (2): height for age <−2 (11), weight for age <−2 (11), body mass index for age <−2 (4). Rates of undernutrition were highest (9 of 13; 69%) in children aged 18–24 months. Hand-washing before the meal was lacking in all centres. Caregivers were often distracted and rarely encouraged children to feed, with most children eating less than half of their served meal. Poor hygiene coupled with non-responsive care practices observed in the centres is a threat to child health, growth and development. PMID:26507408
Hillhouse, J.W.; Ndombi, J.W.M.; Cox, A.; Brock, A.
The magnetostratigraphy of the hominid-bearing sediments exposed east of Lake Turkana has been strengthened by new palaeomagnetic results. Ages obtained from several tuffs by the 40Ar/39Ar method suggest an approxmate match between the observed magnetozones and the geomagnetic polarity time scale; however, the palaeomagnetic results are also compatible with a younger chronology suggested by conventional K-Ar dating of the KBS Tuff. ?? 1977 Nature Publishing Group.
Koyio, Lucina N.; van der Sanden, Wil J. M.; Dimba, Elizabeth; Mulder, Jan; Creugers, Nico H. J.; Merkx, Matthias A. W.; van der Ven, Andre; Frencken, Jo E.
Background Better knowledge and skills for diagnosis and management of human immunodeficiency virus (HIV) related oral lesions by primary healthcare workers (PHWs) may increase recognition of HIV-related oral lesions (HROLs) and may improve implementation of HIV testing in Kenya. For this purpose training programs at health facility and community level were evaluated. Design and Methods A pre-post control-test group design in two administrative divisions of Nairobi East District was used. Clinical competencies of PHWs (n = 32 intervention, and n = 27 control) at health facility level were assessed 9 months after training, and after 6 months for community health workers, (CHWs) (n = 411 intervention and n = 404 control) using written questionnaires, clinical data and patient interviews. Effects on referral for HIV testing and actual HIV testing were assessed by comparing laboratory registries pre- and post training. Results PHWs in intervention (n = 27; 84%) and control (n = 15; 60%) divisions, and CHWs in intervention (n = 330; 80%) and control (189; 47%) divisions, completed all questionnaires. Trained PHWs significantly increased their knowledge of HROLs (p<0.02), frequency of oral examinations, diagnosis of HROLs and referral of patients with HROLs for HIV testing. Trained CHWs significantly gained knowledge about HROLs (p<0.02) and referred more patients with HROLs to health facilities. Overall percentage of HIV-positive test results was three-fold for HROLs compared to non-HROLs. Specifically, 70% of patients with oro pharyngeal candidiasis (OPC), the most commonly diagnosed HROL, were confirmed as being HIV-positive. Increase in overall HIV testing rates (1.6% pre-, 1.2% post training) and overall percentage of HIV-positive results (13% pre-, 16% post-intervention) was not significant. Conclusion Training programs significantly increased PHW and CHW knowledge, recognition and management of HROLs but increased neither overall HIV
Clack, Zoanne A; Keim, Mark E; Macintyre, Anthony G; Yeskey, Kevin
In 1998, terrorists simultaneously bombed United States Embassies in Dar es Salaam, Tanzania and Nairobi, Kenya. The local response to these bombings was unorganized and ad hoc, indicating the need for basic disaster preparedness and improvement of emergency management capabilities in both countries. In this context, risk and risk management are defined and are related to the health hazards affecting Tanzanians and Kenyans. In addition, the growing number of injuries in Tanzania is addressed and the relationship between risk management and injury is explored. Also, an emergency medicine-based strategy for injury control and prevention is proposed. Implications of implementing such a protocol in developing nations also are discussed.
van de Vijver, Steven; Oti, Samuel Oji; Gomez, Gabriela B.; Agyemang, Charles; Egondi, Thaddaeus; van Charante, Eric Moll; Brewster, Lizzy M.; Hankins, Catherine; Tanovic, Zlata; Ezeh, Alex; Kyobutungi, Catherine; Stronks, Karien
Background A combination of increasing urbanization, behaviour change, and lack of health services in slums put the urban poor specifically at risk of cardiovascular disease (CVD). This study aimed to evaluate the impact of a community-based CVD prevention intervention on blood pressure (BP) and other CVD risk factors in a slum setting in Nairobi, Kenya. Design Prospective intervention study includes awareness campaigns, household visits for screening, and referral and treatment of people with hypertension. The primary outcome was overall change in mean systolic blood pressure (SBP), while secondary outcomes were changes in awareness of hypertension and other CVD risk factors. We evaluated the intervention's impact through consecutive cross-sectional surveys at baseline and after 18 months, comparing outcomes of intervention and control group, through a difference-in-difference method. Results We screened 1,531 and 1,233 participants in the intervention and control sites. We observed a significant reduction in mean SBP when comparing before and after measurements in both intervention and control groups, −2.75 mmHg (95% CI −4.33 to −1.18, p=0.001) and −1.67 mmHg (95% CI −3.17 to −0.17, p=0.029), respectively. Among people with hypertension at baseline, SBP was reduced by −14.82 mmHg (95% CI −18.04 to −11.61, p<0.001) in the intervention and −14.05 (95% CI −17.71 to −10.38, p<0.001) at the control site. However, comparing these two groups, we found no difference in changes in mean SBP or hypertension prevalence. Conclusions We found significant declines in SBP over time in both intervention and control groups. However, we found no additional effect of a community-based intervention involving awareness campaigns, screening, referral, and treatment. Possible explanations include the beneficial effect of baseline measurements in the control group on behaviour and related BP levels, and the limited success of treatment and suboptimal adherence in
van de Vijver, Steven; Oti, Samuel Oji; Gomez, Gabriela B; Agyemang, Charles; Egondi, Thaddaeus; van Charante, Eric Moll; Brewster, Lizzy M; Hankins, Catherine; Tanovic, Zlata; Ezeh, Alex; Kyobutungi, Catherine; Stronks, Karien
Background A combination of increasing urbanization, behaviour change, and lack of health services in slums put the urban poor specifically at risk of cardiovascular disease (CVD). This study aimed to evaluate the impact of a community-based CVD prevention intervention on blood pressure (BP) and other CVD risk factors in a slum setting in Nairobi, Kenya. Design Prospective intervention study includes awareness campaigns, household visits for screening, and referral and treatment of people with hypertension. The primary outcome was overall change in mean systolic blood pressure (SBP), while secondary outcomes were changes in awareness of hypertension and other CVD risk factors. We evaluated the intervention's impact through consecutive cross-sectional surveys at baseline and after 18 months, comparing outcomes of intervention and control group, through a difference-in-difference method. Results We screened 1,531 and 1,233 participants in the intervention and control sites. We observed a significant reduction in mean SBP when comparing before and after measurements in both intervention and control groups, -2.75 mmHg (95% CI -4.33 to -1.18, p=0.001) and -1.67 mmHg (95% CI -3.17 to -0.17, p=0.029), respectively. Among people with hypertension at baseline, SBP was reduced by -14.82 mmHg (95% CI -18.04 to -11.61, p<0.001) in the intervention and -14.05 (95% CI -17.71 to -10.38, p<0.001) at the control site. However, comparing these two groups, we found no difference in changes in mean SBP or hypertension prevalence. Conclusions We found significant declines in SBP over time in both intervention and control groups. However, we found no additional effect of a community-based intervention involving awareness campaigns, screening, referral, and treatment. Possible explanations include the beneficial effect of baseline measurements in the control group on behaviour and related BP levels, and the limited success of treatment and suboptimal adherence in the intervention group.
Watson-Jones, Deborah; Mugo, Nelly; Lees, Shelley; Mathai, Muthoni; Vusha, Sophie; Ndirangu, Gathari; Ross, David A.
Background Sub-Saharan Africa bears the greatest burden of cervical cancer. Human papillomavirus (HPV) vaccination programmes to prevent the disease will need to reach vulnerable girls who may not be able access health and screening services in the future. We conducted formative research on facilitators and barriers to HPV vaccination and potential acceptability of a future HPV vaccination programme amongst girls living in hard-to-reach populations in Kenya. Methods Stakeholder interviews with Ministry of Health staff explored barriers to and support for the uptake of HPV vaccination. A situation assessment was conducted to assess community services in Maasai nomadic pastoralist communities in Kajiado County and in Korogocho informal settlement in Nairobi city, followed by focus group discussions (n=14) and semi-structured interviews (n=28) with health workers, parents, youth, and community and religious leaders. These covered marriage, knowledge of cervical cancer and HPV, factors that might inhibit or support HPV vaccine uptake and intention to accept HPV vaccine if a programme was in place. Results Reported challenges to an HPV vaccination programme included school absenteeism and drop-out, early age of sex and marriage, lack of parental support, population mobility and distance from services. Despite little prior knowledge of cervical cancer and HPV, communities were interested in receiving HPV vaccination. Adequate social mobilisation and school-based vaccination, supplemented by out-reach activities, were considered important facilitating factors to achieve high coverage. There was some support for a campaign approach to vaccine delivery. Conclusions Given the high level of support for a vaccine against cervical cancer and the experience of reaching pastoralist and slum-dwellers for other immunizations, implementing an HPV vaccine programme should be feasible in such hard-to-reach communities. This may require additional delivery strategies in addition to the
Background The World Health Organization (WHO) and the Government of Kenya alike identify a well-performing health workforce as key to attaining better health. Nevertheless, the motivation and retention of health care workers (HCWs) persist as challenges. This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi. Methods A cross-sectional cluster sample design was used to select 59 health facilities that yielded interviews with 404 health care workers, grouped into 10 different types of service providers. Data were collected in November 2011 using structured questionnaires and a Focus Group Discussion guide. Findings were analyzed using bivariate and multivariate methods of the associations and determinants of health worker motivation and retention. Results The levels of education and gender factors were lowest in Turkana with female HCWs representing only 30% of the workers against a national average of 53%. A smaller proportion of HCWs in Turkana feel that they have adequate training for their jobs. Overall, 13% of the HCWs indicated that they had changed their job in the last 12 months and 20% indicated that they could leave their current job within the next two years. In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana. The working environment is rated as better in private facilities. Adequate training, job security, salary, supervisor support, and manageable workload were identified as critical satisfaction factors. Family health care, salary, and terminal benefits were rated as important compensatory factors. Conclusions There are distinct motivational and retention factors that affect
Muthamia, Michael; Owino, Kenneth; Nyachae, Paul; Kilonzo, Margaret; Kamau, Mercy; Otai, Jane; Kabue, Mark; Keyonzo, Nelson
ABSTRACT Background: Long-acting reversible contraceptives (LARCs) are safe and highly effective, and they have higher continuation rates than short-acting methods. Because only a small percentage of sexually active women in Kenya use LARCs, the Tupange project implemented a multifaceted approach to increase uptake of LARCs, particularly among the urban poor. The project included on-site mentoring, whole-site orientation, commodity security, quality improvement, and multiple demand-promotion and service-provision strategies, in the context of wide method choice. We report on activities in Nairobi between July 2011 and December 2014, the project implementation period. Methods: We used a household longitudinal survey of women of reproductive age to measure changes in the contraceptive prevalence rate (CPR) and other family planning-related variables. At baseline in July 2010, 2,676 women were interviewed; about 50% were successfully tracked and interviewed at endline in December 2014. A baseline service delivery point (SDP) survey of 112 health facilities and 303 service providers was conducted in July 2011, and an endline SDP survey was conducted in December 2014 to measure facility-based interventions. The SDP baseline survey was conducted after the household survey, as facilities were selected based on where clients said they obtained services. Results: The project led to significant increases in use of implants and intrauterine devices (IUDs). Uptake of implants increased by 6.5 percentage points, from 2.4% at baseline to 8.9% by endline, and uptake of IUDs increased by 2.1 percentage points, from 2.2% to 4.3%. By the endline survey, 37.7% of clients using pills and injectables at baseline had switched to LARCs. Contraceptive use among the poorest and poor wealth quintiles increased by 20.5 and 21.5 percentage points, respectively, from baseline to endline. Various myths and misconceptions reported about family planning methods declined significantly between
Heath, Carla W.
There are two categories of children's television in Kenya: television "for" children, most of which is imported, and television "by" children, all of which is produced in Kenya. Most of the television by children is produced and broadcast by Voice of Kenya television, much of it made up of programs growing out of…
Iserson, Kenneth V; Walton, Emily K
A 28-year-old nursing student working in Juba, South Sudan, suddenly developed a rash over her mid-right clavicle. Beginning as a 10-cm-diameter erythematous patch with an irregular border, within 24 hours it had developed an increasingly gray, necrotic center, appearing similar to a burn. The patient was seen by 2 local physicians without a diagnosis being made. Ultimately, it was diagnosed as being caused by the toxic hemolymph, pederin, from the Nairobi fly (Paederus). The rash usually affects body parts not covered by clothing; healing time ranges from 7 to 28 days, usually with permanent skin discoloration. Preventive measures include typical antivector precautions, including bed nets, long-sleeve clothing, and avoiding fluorescent lights. If the beetles are found on the skin, brushing them off, rather than crushing them, avoids producing dermatitis. Treatment includes rapidly washing the affected area, applying cold, wet compresses, and possibly treating with antibiotics, steroids, and antihistamines.
Mberu, Blessing; Wamukoya, Marylene; Oti, Samuel; Kyobutungi, Catherine
What kills people around the world and how it varies from place to place and over time is critical in mapping the global burden of disease and therefore, a relevant public health question, especially in developing countries. While more than two thirds of deaths worldwide are in developing countries, little is known about the causes of death in these nations. In many instances, vital registration systems are nonexistent or at best rudimentary, and even when deaths are registered, data on the cause of death in particular local contexts, which is an important step toward improving context-specific public health, are lacking. In this paper, we examine the trends in the causes of death among the urban poor in two informal settlements in Nairobi by applying the InterVA-4 software to verbal autopsy data. We examine cause of death data from 2646 verbal autopsies of deaths that occurred in the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) between 1 January 2003 and 31 December 2012 among residents aged 15 years and above. The data is entered into the InterVA-4 computer program, which assigns cause of death using probabilistic modeling. The results are presented as annualized trends from 2003 to 2012 and disaggregated by gender and age. Over the 10-year period, the three major causes of death are tuberculosis (TB), injuries, and HIV/AIDS, accounting for 26.9, 20.9, and 17.3% of all deaths, respectively. In 2003, HIV/AIDS was the highest cause of death followed by TB and then injuries. However, by 2012, TB and injuries had overtaken HIV/AIDS as the major causes of death. When this is examined by gender, HIV/AIDS was consistently higher for women than men across all the years generally by a ratio of 2 to 1. In terms of TB, it was more evenly distributed across the years for both males and females. We find that there is significant gender variation in deaths linked to injuries, with male deaths being higher than female deaths by a ratio of about 4 to 1. We
Creanga, Andreea A.; Odhiambo, George Awino; Odera, Benjamin; Odhiambo, Frank O.; Desai, Meghna; Goodwin, Mary; Laserson, Kayla; Goldberg, Howard
Higher use of maternal and neonatal health (MNH) services may reduce maternal and neonatal mortality in Kenya. This study aims to: 1) prospectively explore women’s intentions to use MNH services (antenatal care, delivery in a facility, postnatal care, neonatal care) at <20 and 30–35 weeks’ gestation and their actual use of these services; 2) identify predictors of intention-behavior discordance among women with positive service use intentions; 3) examine associations between place of delivery, women’s reasons for choosing it, and birthing experiences. We used data from a 2012–2013 population-based cohort of pregnant women in the Demographic Surveillance Site in Nyanza province, Kenya. Of 1,056 women completing the study (89.1% response rate), 948 had live-births and 22 stillbirths, and they represent our analytic sample. Logistic regression analysis identified predictors of intention-behavior discordance regarding delivery in a facility and use of postnatal and neonatal care. At <20 and 30–35 weeks’ gestation, most women intended to seek MNH services (≥93.9% and ≥87.5%, respectively, for all services assessed). Actual service use was high for antenatal (98.1%) and neonatal (88.5%) care, but lower for delivery in a facility (76.9%) and postnatal care (51.8%). Woman’s age >35 and high-school education were significant predictors of intention-behavior discordance regarding delivery in a facility; several delivery-related factors were significantly associated with intention-behavior discordance regarding use of postnatal and neonatal care. Delivery facilities were chosen based on proximity to women’s residence, affordability, and service quality; among women who delivered outside a health facility, 16.3% could not afford going to a facility. Good/very good birth experiences were reported by 93.6% of women who delivered in a facility and 32.6% of women who did not. We found higher MNH service utilization than previously documented in Nyanza
Kidder, Daniel; Medley, Amy; Pals, Sherri L.; Carpenter, Deborah; Howard, Andrea; Antelman, Gretchen; DeLuca, Nicolas; Muhenje, Odylia; Sheriff, Muhsin; Somi, Geoffrey; Katuta, Frieda; Cherutich, Peter; Moore, Janet
We conducted a group randomized trial to assess the feasibility and effectiveness of a multi-component, clinic-based HIV prevention intervention for HIV-positive patients attending clinical care in Namibia, Kenya, and Tanzania. Eighteen HIV care and treatment clinics (six per country) were randomly assigned to intervention or control arms. Approximately 200 sexually active clients from each clinic were enrolled and interviewed at baseline and 6- and 12-months post-intervention. Mixed model logistic regression with random effects for clinic and participant was used to assess the effectiveness of the intervention. Of 3522 HIV-positive patients enrolled, 3034 (86 %) completed a 12-month follow-up interview. Intervention participants were significantly more likely to report receiving provider-delivered messages on disclosure, partner testing, family planning, alcohol reduction, and consistent condom use compared to participants in comparison clinics. Participants in intervention clinics were less likely to report unprotected sex in the past 2 weeks (OR = 0.56, 95 % CI 0.32, 0.99) compared to participants in comparison clinics. In Tanzania, a higher percentage of participants in intervention clinics (17 %) reported using a highly effective method of contraception compared to participants in comparison clinics (10 %, OR = 2.25, 95 % CI 1.24, 4.10). This effect was not observed in Kenya or Namibia. HIV prevention services are feasible to implement as part of routine care and are associated with a self-reported decrease in unprotected sex. Further operational research is needed to identify strategies to address common operational challenges including staff turnover and large patient volumes. PMID:26995678
Though pregnancy termination is highly restricted in Kenya, induced abortion remains common. Illegal abortion is often unsafe, putting women at risk of death or severe complications. In eastern Africa as a whole, an estimated 14% of all pregnancies end in abortion, and nearly one in five maternal deaths are due to unsafe abortion.
Dodoo, F Nii-Amoo; Zulu, Eliya M; Ezeh, Alex C
We compare the impact of socioeconomic deprivation on risky sexual outcomes in rural and urban Kenya. Quantitative data are drawn from the Demographic & Health Surveys (DHS) and qualitative data from the Sexual Networking and Associated Reproductive and Social Health Concerns study. Using two separate indicators of deprivation we show that, although poverty is significantly associated with the examined sexual outcomes in all settings, the urban poor are significantly more likely than their rural counterparts to have an early sexual debut and a greater incidence of multiple sexual partnerships. The disadvantage of the urban poor is accentuated for married women; those in Nairobi's slums are at least three times as likely to have multiple sexual partners as their rural counterparts. The implications of these findings are discussed.
Maretzki, Audrey N
With funding provided by the Center for Higher Education of the United States Agency for International Development, The Pennsylvania State University and Tuskegee University collaborated with the University of Nairobi in establishing women's NutriBusiness Cooperatives in the Rift Valley and Central Provinces of Kenya. Between 1992 and 1999, the cooperatives were established, facilities and equipment were supplied and extensive participatory training was provided by university-affiliated investigators and project staff. This initiative enabled approximately 2500 rural Kenyan women farmers to add value to their crops by processing and locally marketing nutritious, convenient, culturally-appropriate weaning food mixes. Implementation of the NutriBusiness model is described and challenges of cultural engagement are highlighted.
Background CCR5 antagonists have clinically been approved for prevention or treatment of HIV/AIDS. Countries in Sub-Saharan Africa with the highest burden of HIV/AIDS are due to adopt these regimens. However, HIV-1 can also use CXCR4 as a co-receptor. There is hence an urgent need to map out cellular tropism of a country’s circulating HIV strains to guide the impending use of CCR5 antagonists. Objectives To determine HIV-1 coreceptor usage among patients attending a comprehensive care centre in Nairobi, Kenya. Methods Blood samples were obtained from HIV infected patients attending the comprehensive care centre, Kenyatta National Hospital in years 2008 and 2009. The samples were separated into plasma and peripheral blood mononuclear cells (PBMCs). Proviral DNA was extracted from PBMCs and Polymerase Chain reaction (PCR) done to amplify the HIV env fragment spanning the C2-V3 region. The resultant fragment was directly sequenced on an automated sequencer (ABI, 3100). Co-receptor prediction of the env sequences was done using Geno2pheno [co-receptor], and phylogenetic relationships determined using CLUSTALW and Neighbor Joining method. Results A total of 67 samples (46 treatment experienced and 21 treatment naive) were successfully amplified and sequenced. Forty nine (73%) sequences showed a prediction for R5 tropism while 18(27%) were X4 tropic. Phylogenetic analysis showed that 46(69%) were subtype A, 11(16%) subtype C, and 10(15%) subtype D. No statistical significant associations were observed between cell tropism and CD4+ status, patient gender, age, or treatment option. There was a tendency for more X4 tropic strains being in the treatment experienced group than the naive group: Of 46 treatment experiencing participants, 14(30%) harboured X4, compared with 4(19%) of 21 of the treatment-naïve participants, the association is however not statistically significant (p = 0.31). However, a strong association was observed between subtype D and CXCR4 co
Keller, Jennifer; Mboya, Benjamin O; Sinclair, Jake; Githua, Oscar W; Mulinge, Munyae; Bergholz, Lou; Paiva, Lee; Golden, Neville H; Kapphahn, Cynthia
This study investigated the effects of a gender-based violence (GBV) educational curriculum on improving male attitudes toward women and increasing the likelihood of intervention if witnessing GBV, among adolescent boys in Nairobi, Kenya. In total, 1,543 adolescents participated in this comparison intervention study: 1,250 boys received six 2-hr sessions of the "Your Moment of Truth" (YMOT) intervention, and 293 boys comprised the standard of care (SOC) group. Data on attitudes toward women were collected anonymously at baseline and 9 months after intervention. At follow-up, boys were also asked whether they encountered situations involving GBV and whether they successfully intervened. Compared with baseline, YMOT participants had significantly higher positive attitudes toward women at follow-up, whereas scores for SOC participants declined. At follow-up, the percentage of boys who witnessed GBV was similar for the two groups, except for physical threats, where the intervention group reported witnessing more episodes. The percentage of boys in the intervention group who successfully intervened when witnessing violence was 78% for verbal harassment, 75% for physical threat, and 74% for physical or sexual assault. The percentage of boys in the SOC group who successfully intervened was 38% for verbal harassment, 33% for physical threat, and 26% for physical or sexual assault. Results from the logistic regression demonstrate that more positive attitudes toward women predicted whether boys in the intervention group would intervene successfully when witnessing violence. This standardized 6-week GBV training program is highly effective in improving attitudes toward women and increasing the likelihood of successful intervention when witnessing GBV.
Maina, Daniel; Omuse, Geoffrey; Revathi, Gunturu; Adam, Rodney D.
Background Accurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data. Methods We have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity and susceptibility data captured in hospital and laboratory electronic records between 2010 and 2014. Results For blood isolates, we used culture collection within the first three days of hospitalization as a surrogate for community onset, and within that group, Escherichia coli was the most common, followed by Staphylococcus aureus. In contrast, Candida spp. and Klebsiella pneumoniae were the most common hospital onset causes of bloodstream infection. Antimicrobial resistance rates for the most commonly isolated Gram negative organisms was higher than many recent reports from Europe and North America. In contrast, Gram positive resistance rates were quite low, with 94% of S. aureus being susceptible to oxacillin and only rare isolates of vancomycin-resistant enterococci. Conclusions The current report demonstrates high rates of antimicrobial resistance in Gram negative organisms, even in outpatients with urinary tract infections. On the other hand, rates of resistance in Gram positive organisms, notably S. aureus, are remarkably low. A better understanding of the reasons for these trends may contribute to ongoing efforts to combat antimicrobial resistance globally. PMID:26807811
Nyamori, Joseph M.; Kimani, Kahaki; Njuguna, Margaret W.; Dimaras, Helen
Purpose: Kenya is a large country with a widely dispersed population. As retinoblastoma requires specialized treatment, we determined the referral pattern for patients with retinoblastoma in Kenya to facilitate the formulation of a national policy. Materials and Methods: A retrospective study was performed for retinoblastoma patients who presented from January 1, 2006 to December 31, 2007. Data were collected on the referral process from presenting health facility to the hospital where patient was treated. Data were also collected on the time interval when the first symptoms were noticed to the time of presentation at a health facility (lag time). For cases that could be traced to a referral hospital, the time delay due to referral (referral lag time) was recorded. Results: There were 206 patients diagnosed with retinoblastoma in 51 Kenyan and 2 foreign healthcare facilities, and they received final treatment at a Kenyan hospital. Mean lag time was 6.8 months (±6.45). Of all patients, 18% (38/206) were treated at the hospital where they first presented and 82% (168/206) were referred elsewhere. Of those referred, 35% (58/168) were lost to follow-up. The mean referral lag time was 1.7 months (±2.5). Conclusions: A significant proportion of cases presented late, and either delayed seeking further treatment or were lost after initial referral. We recommend the implementation of a national strategy that emphasizes early detection, documentation and follow up of retinoblastoma patients. PMID:25371638
Alvarado, Leonardo; Richter, Andreas; Peters, Enno; Wittrock, Folkard; Burrows, John; Vrekoussis, Mihalis; Gratsea, Myrto; Gerasopoulos, Vangelis
Formaldehyde (HCHO) is the most abundant among the carbonyls, while glyoxal (CHOCHO) is the most predominant of the alpha dicarbonyls in the atmosphere. Both species originate from a wide range of natural and anthropogenic sources. In addition, HCHO and CHOCHO are being emitted during biomass burning and the emitted amounts depending on the type of biomass burned as well as the temperatures of the fire. Due to their short lifetime, CHOCHO and HCHO are used as indicators of photochemical activity and intermediate products of the process of degradation of VOCs. While sources and chemistry of CHOCHO and HCHO are similar in many respects, the variation in production efficiency for different sources can be used to better constrain source attribution of VOCs e.g. by analysing the ratio of HCHO to CHOCHO. Atmospheric HCHO and CHOCHO columns can be determined by remote sensing using the Differential Optical Absorption Spectroscopy (DOAS) method. The DOAS method allows the determination of atmospheric amounts of trace gases with narrow absorption bands in the ultraviolet and visible. In this study we report the first HCHO and CHOCHO results from the MAX-DOAS stations in Athens (38N, 24E) and Nairobi (1S, 36E) which are part of the Bremian DOAS Network for Atmospheric Measurements (BREDOM). The results show higher values of CHOCHO and HCHO in summer than in the winter season. Moreover, analyses of the ratio of HCHO to CHOCHO are presented as well as preliminary comparison of CHOCHO columns with satellite data from GOME-2 and OMI.
Ndugwa, Robert P; Cleland, John; Madise, Nyovani J; Fotso, Jean-Christophe; Zulu, Eliya M
Postpartum months provide a challenging period for poor women. This study examined patterns of menstrual resumption, sexual behaviors and contraceptive use among urban poor postpartum women. Women were eligible for this study if they had a birth after the period September 2006 and were residents of two Nairobi slums of Korogocho and Viwandani. The two communities are under continuous demographic surveillance. A monthly calendar type questionnaire was administered retrospectively to cover the period since birth to the interview date and data on sexual behavior, menstrual resumption, breastfeeding patterns, and contraception were collected. The results show that sexual resumption occurs earlier than menses and postpartum contraceptive use. Out of all postpartum months where women were exposed to the risk of another pregnancy, about 28% were months where no contraceptive method was used. Menstrual resumption acts as a trigger for initiating contraceptive use with a peak of contraceptive initiation occurring shortly after the first month when menses are reported. There was no variation in contraceptive method choice between women who initiate use before and after menstrual resumption. Overall, poor postpartum women in marginalized areas such as slums experience an appreciable risk of unintended pregnancy. Postnatal visits and other subsequent health system contacts provide opportunities for reaching postpartum women with a need for family planning services.
Maghenda, M. M.; Bloemer, H. L.; Brumfield, J. O.
LANDSAT can be effectively used to monitor the extent and magnitude of forest cover change in Kenya in order to evaluate the potential for energy supply. Digital processing of LANDSAT data provides a reliable monitoring technique for forest resource management in Kenya. Data analysis was used to illustrate that Kenya's forests are indeed diminishing. A model used to make projections for the availability of fuelwood as an energy source is presented. The resulting figures imply that Kenya's forest will all but disappear around the end of the 20th century. Analysis of LANDSAT data for Mau East substantiates these alarming findings.
Njuguna, Irene N.; Ambler, Gwen; Reilly, Marie; Ondondo, Beatrice; Kanyugo, Mercy; Lohman-Payne, Barbara; Gichuhi, Christine; Borthwick, Nicola; Black, Antony; Mehedi, Shams-Rony; Sun, Jiyu; Maleche-Obimbo, Elizabeth; Chohan, Bhavna; John-Stewart, Grace C.; Jaoko, Walter; Hanke, Tomáš
Background A safe, effective vaccine for breastfeeding infants born to HIV-1-positive mothers could complement antiretroviral therapy (ART) for prevention of mother-to-child transmission of HIV-1. To date, only a few HIV-1 vaccine candidates have been tested in infants. Trial design A phase I/II randomized controlled trial PedVacc 002 was conducted to determine the safety and immunogenicity of a single, low dose of MVA.HIVA vaccine delivered intramuscularly to healthy 20-week-old infants born to HIV-1-positive mothers in Nairobi, Kenya. Methods Pregnant HIV-1-positive women in the 2nd/3rd trimester of gestation were enrolled, provided with ART and self-selected their infant-feeding modality. Infants received nevirapine and cotrimoxazole prophylaxis. At 20 weeks of age, eligible HIV-1-negative infants were randomized to vaccine versus no-treatment arms and followed to 48 weeks of age for assessments of vaccine safety, HIV-1-specific T-cell responses and antibodies to routine childhood vaccines. Results Between February and November 2010, 182 mothers were screened, 104 were eligible and followed on ART during pregnancy/postpartum, of whom 73 had eligible infants at 20 weeks postpartum. Thirty-six infants were randomized to vaccine and 37 to no treatment. Eighty-four percent of infants breastfed, and retention at 48 weeks was 99%. Adverse events were rare and similar between the two arms. HIV-1-specific T-cell frequencies in interferon-γ ELISPOT assay were transiently higher in the MVA.HIVA arm (p = 0.002), but not above the threshold for a positive assay. Protective antibody levels were adequate and similar between arms for all routine childhood vaccines except HBV, where 71% of MVA.HIVA subjects compared to 92% of control subjects were protected (p = 0.05). Conclusions This trial tested for the first time an MVA-vectored candidate HIV-1 vaccine in HIV-1-exposed infants in Africa, demonstrating trial feasibility and vaccine safety, low immunogenicity, and
Ndugwa, Robert Peter; Zulu, Eliya M
The aim of this study was to investigate factors that influence morbidity patterns and health-seeking decisions in an urban slum community. Data were collected between May and August 2003 as part of the ongoing Nairobi urban demographic surveillance system and were analysed to identify factors that influence morbidity patterns and health-seeking decisions. The results show that the factors that influenced morbidity were the child's age, ethnicity and type of toilet facility. Predictors for seeking health care were the child's age, type and severity of illness, survival of father and mother, mother's education, mother's work status and wealth class. The conclusions drawn show that economic resources fall short in preventing child illnesses where children live in poor environmental conditions. However, by enhancing access to health care services, socio-economic status is critical for mitigating disease burden among children in slum settlements.
Klopp, Jacqueline; Ngau, Peter; Sclar, Elliot
This paper describes an innovative collaboration between the Center for Sustainable Urban Development at Columbia University and the Department of Urban and Regional Planning at the University of Nairobi. By bringing universities into urban policy networks, this partnership aims to re-shape pedagogy, policy and research action for sustainable…
Mbogo, Rosemary Wahu
This paper reports the findings of a Master's level thesis work that was done in 1997 to assess the antecedent factors affecting the academic performance of graduate students at the Nairobi Evangelical School of Theology (N.E.G.S.T.), which is currently Africa International University (AIU). The paper reviews the effect of lack of finance on…
De Angelis, Enrico; Tagliabue, Lavinia Chiara; Zecchini, Paolo; Milanesi, Mattia
Informal settlements, namely slums (or bidonville or favelas) are one of the stronger challenge for urban context in developing countries. The increase of urban population leads to a widespread poverty and critical life conditions for a large segment of population, in particular in Sub-Saharan Africa, where a high percentage of people lives in informal settlements. The problems in slums are multiple: people suffer malnutrition and poor sanitation, flooding or drought, and live in shelters providing no thermal comfort in many days of the year, furthermore scarce and highly polluting energy sources are available. Climate change and an unavoidable heat island effect make these living conditions nearly catastrophic. This paper focuses on the main characters of these slums and on how to what promote the improvement of living conditions with a lean, low cost, low impact, feasible upgrading of the housing or more properly shelters. The subject of the analysis is the Mathare 4A Upgrading Programme in the city of Nairobi, Kenya, one of the highest slum-dwellers growing rate. The technological solutions applied in this context have been verified in a different climate condition such as the city of New Delhi, India where the phenomenon of the slums is significantly burdensome. The analysis of the comfort conditions inside a type housing has been carried out using hourly weather data and dynamic heat transfer simulation, without any HVAC system and striving only natural ventilation. Data about internal temperature and relative humidity conditions have been applied to evaluate the comfort hours using the Predicted Mean Vote method, the adaptive thermal comfort principles and the bioclimatic charts for the two climates in Nairobi and New Delhi. The percentage of hours within the comfort range and the amount of degree-hours exceeding comfort values showed for different upgrading strategies, how it is possible to deeply influence the living conditions by technological and
Branicki, F. J.
Experience gained during 2 1/2 years' work as chief government surgeon for Nyanza Province, Kenya, is outlined. The wide variety of surgical conditions encountered and the problems posed in dealing with these by a chronic shortage of essential drugs, instruments, hospital facilities, and fully qualified staff are emphasised. It is suggested that at present the solution must lie in wider instruction in surgical techniques for general duties officers and clinical officers together with energetic community health, family planning, and preventive medicine programmes. Images Fig. 1 Fig. 2 Fig. A Fig. 4 PMID:7271194
Marima, Esther Wairimu
Reading proficiency has been identified as one of the most reliable indicators of whether a learner will attain the competence needed to achieve academic success and contribute actively to society. Research findings in Kenyan primary and secondary schools reveal inadequate reading skills among the students. There are different approaches in…
Muuro, Maina Elizaphan; Wagacha, Waiganjo Peter; Oboko, Robert; Kihoro, John
Earlier forms of distance education were characterized by minimal social interaction like correspondence, television, video and radio. However, the World Wide Web (WWW) and online learning introduced the opportunity for much more social interaction, particularly among learners, and this has been further made possible through social media in Web…
Abuya, Benta A.; Onsomu, Elijah O.; Moore, DaKysha; Sagwe, Jackline
In 2003, 31% of young Kenyan women ages 15-24 reported sexual harassment and violence (SHV), with a majority experiencing sexual debut due to coercion (Central Bureau of Statistics, 2004). Data were obtained from a sample of 20 girls attending school in Kamu and Lafamu (pseudonyms used for the study sites), 10 girls who had dropped out of school,…
Alarcon, Pablo; Fèvre, Eric M; Murungi, Maurice K; Muinde, Patrick; Akoko, James; Dominguez-Salas, Paula; Kiambi, Stella; Ahmed, Sohel; Häsler, Barbara; Rushton, Jonathan
Nairobi is a large rapidly-growing city whose demand for beef, mutton and goat products is expected to double by 2030. The study aimed to map the Nairobi beef, sheep and goat systems structure and flows to identify deficiencies and vulnerabilities to shocks. Cross-sectional data were collected through focus group discussions and interviews with people operating in Nairobi ruminant livestock and meat markets and in the large processing companies. Qualitative and quantitative data were obtained about the type of people, animals, products and value adding activities in the chains, and their structural, spatial and temporal interactions. Mapping analysis was done in three different dimensions: people and product profiling (interactions of people and products), geographical (routes of animals and products) and temporal mapping (seasonal fluctuations). The results obtained were used to identify structural deficiencies and vulnerability factors in the system. Results for the beef food system showed that 44-55% of the city's beef supply flows through the 'local terminal markets', but that 54-64% of total supply is controlled by one 'meat market'. Numerous informal chains were identified, with independent livestock and meat traders playing a pivotal role in the functionality of these systems, and where most activities are conducted with inefficient quality control and under scarce and inadequate infrastructure and organisation, generating wastage and potential food safety risks in low quality meat products. Geographical and temporal analysis showed the critical areas influencing the different markets, with larger markets increasing their market share in the low season. Large processing companies, partly integrated, operate with high quality infrastructures, but with up to 60% of their beef supply depending on similar routes as the informal markets. Only these companies were involved in value addition activities, reaching high-end markets, but also dominating the
Serrat-Capdevila, A.; Valdes, J. B.; Valdes, R.; Demaria, E. M.; Durcik, M.; Maitaria, K.; Roy, T.
Remote sensing data and hydrologic models can respond to monitoring and forecasting needs in Africa and other poorly gauged regions. We present here the progress to date in developing a multi-model platform to provide hydrologic monitoring and forecasting using real time remote sensing observations. Satellite precipitation products such as CMORPH, TMPA (at 0.25° resolution) and PERSIANN-CCS (at 4km resolution) are used to force two models of different structure. One model is physically based and distributed, and the other is conceptual and lumped at the sub-basin level. The performance of both models is evaluated using different metrics, and the uncertainty in their predictions based on the errors incurred during the historical simulations period is computed. The models were compared and the potential increase in performance from using both models versus a single one will be assessed. This work provides insights into the advantages of a multi-model platform over a single model, with respect to different management and decision-making purposes. The methods were applied to the Mara Basin (Kenya/Tanzania), where growing human demands on water and land use are likely to alter significantly the hydrologic balance of the basin and the ecosystems that depend on it. These efforts are part of the Applied Sciences Team of the NASA SERVIR Program in collaboration with its East Africa Hub at the Regional Center for Mapping of Resources for Development (Nairobi,Kenya).
Kwange, Simeon Owuor; Budambula, Nancy L M; Kiptoo, Michael Kibet; Okoth, Fredrick; Ochwoto, Missiani; Oduor, Margaret; Kimotho, James Hungo
Kenya is one of the high endemic zones for hepatitis B virus (HBV) infection. The consensuses on prevalence of the HBV genotypes and the existence of their variants have not been fully established in Kenya. Hence, there is a need to further monitor the diversity of HBV. This study aimed to extend the current molecular and epidemiological information about the geographical distribution of HBV genotypes and subgenotypes, as well as to describe the hepatitis B surface antigen (HBsAg) variants circulating in different Regional Blood Transfusion Centres of Kenya. A total of 32 HBsAg positive blood units from five different blood transfusion centers in Kenya were used in the study. The HBV DNA preS/S-gene was amplified and sequenced. Alignments of S gene were applied using reference sequence from GeneBank. Phylogenetic analysis was performed using the MEGAv4.0 software with the neighbor-joining and maximum composite likelihood methods. Twenty-one plasma samples (65.6%) were DNA positive and were successfully sequenced. Eighteen out of the twenty-one isolates (85.7%) belonged to subgenotype A1 Afro-Asian: six were from Nairobi, four from Kisumu, two from Embu, and three each from Eldoret and Mombasa. The other three strains (14.3%, 3/21) belonged to subgenotype D4 from Mombasa. The HBsAg mutations were detected in nine isolates (42.9%, 9/21). The HBV/A1 and HBV/D4 are dominant among blood donors in Kenya. This demonstrates that continuous monitoring of the HBV diversity would help reveal circulating genotypes and subgenotypes as well as mutants of clinical significance in Kenya.
Graf, Jürg; Meierhofer, Regula; Wegelin, Martin; Mosler, Hans-Joachim
In this research project, we studied factors that presumably affect the incidence of diarrhoea among young children in urban slums in developing countries: consumption of safe drinks, hygiene behaviour, cleanliness of household surroundings and the quality of raw water. Beliefs concerning the causes of diarrhoea were also related to health-improving behaviour, namely the application of the water-treatment method SODIS (solar water disinfection) and hygiene behaviour. We conducted a survey in a shanty town in Nairobi, Kenya. Field workers interviewed 500 households. Analysis with regression models revealed that two out of the four postulated factors were significant: children have a lower risk of contracting diarrhoea when they consume high percentages of safe drinks and live in households with good hygiene. As regards beliefs, we found that biomedical knowledge of children's diarrhoea as well as the perceived social norm for treating water was associated with the use of SODIS and good hygiene.
Tippens, Julie A
The global increase in refugee migration to urban areas creates challenges pertaining to the promotion of refugee health, broadly conceived. Despite considerable attention to trauma and forced migration, there is relatively little focus on how refugees cope with stressful situations, and on the determinants that facilitate and undermine resilience. This article examines how urban Congolese refugees in Kenya promote psychosocial well-being in the context of structural vulnerability. This article is based on interviews (N = 55) and ethnographic participant observation with Congolese refugees over a period of 8 months in Nairobi in 2014. Primary stressors related to scarcity of material resources, political and personal insecurity, and emotional stress. Congolese refugees mitigated stressors by (a) relying on faith in God's plan and trust in religious community, (b) establishing borrowing networks, and (c) compartmentalizing the past and present. This research has broader implications for the promotion of urban refugees' psychosocial health and resilience in countries of first asylum.
Muthengi, Eunice; Gitau, Tabither; Austrian, Karen
Introduction Previous studies have shown that women’s empowerment, though beneficial in many aspects, can also increase the risk of intimate-partner violence (IPV). This study seeks to examine the association between work and experience of physical violence among married adolescents, and to understand the impact of access to independent financial resources on this risk. Authors draw on the asset-building framework and the ecological model. Methods The data is from a baseline survey of girls aged 15–19 residing in urban slums in four cities and towns in Kenya (Nairobi, Thika, Nakuru and Kisumu). The analytic sample is 452 married girls. Logistic regression is used to examine associations between working status, savings and experience of IPV in the previous six months, controlling for other factors. This is complemented by content analysis of in-depth interviews with 32 adolescent girls and 16 young men. Results Compared to girls who did not work, working with no regular savings was significantly associated with greater odds (OR = 1.96, p<0.01) of experiencing IPV. There was no difference between girls who did not work and those who worked but had regular savings. Qualitative findings indicate savings decrease girls’ dependency on men and allow them to leave abusive partners. Discussion Findings imply that in these communities with patriarchal gender norms and high levels of poverty, female employment and financial conflicts can be triggers of violence in marriages. On the other hand, girls’ management of and access to independent financial resources through savings can potentially help to reduce this risk. PMID:27232997
Winter, E; Midega, C; Bruce, T; Hummel, H E; Langner, S S; Leithold, G; Khan, Z; Pickett, J
study is needed. A second approach made use of species-specific insect monitoring traps baited with highly specific female sex pheromones for attracting and monitoring destructive insect pests. The female sex pheromone (8-methyl-decane-2-ol propanoate) of Diabrotica virgifera virgifera (Coleoptera: Chrysomelidae) (Western Corn Rootworm) is readily available as bait in the "Metcalf sticky cup trap" for trapping males, an extraordinarily sensitive technique for monitoring the presence or absence of male beetles in a given area. Li et al. (2006) had argued for the likelihood of easy immigration of this cosmopolitan maize pest into East Africa. Our results, however, so far indicate the absence of a local population in the area of Mbita, while not excluding its presence at Nairobi or Mombasa. Both investigations contribute to different aspects of Kenyan economic development and may be seen as two independent but complementary contributions towards livelihood improvement of small holder farmers in Kenya.
Background Harmful alcohol use has been linked to the spread of HIV in Kenya. It also adversely affects those on antiretroviral (ARV) treatment through poor compliance. This study using participatory research and action (PRA) methods sought to understand factors related to alcohol abuse and non-adherence and to formulate appropriate interventions in a sample of people living with HIV and AIDS (PLWHA) who were also abusing alcohol, at Kariobangi in Nairobi, Kenya. Methods Entry into the community was gained through previous PRA work in that community and PLWHA were recruited through snowballing. Working together with the community members, the researchers explored the participants’ understanding of alcohol use problem, its effects on compliance to ARV treatment and discussed possible action areas through PRA techniques that included focus group and market place discussions; visual aids such as spider diagrams, community mapping and ranking. Follow-up meetings were held to discuss the progress. Results By the final meeting, 67 PLWHA and 19 community members had been recruited. Through discussions, misconceptions regarding alcohol use were identified. It emerged that alcohol abuse was poorly recognised among both the community and health workers. Screening for alcohol use was not routinely done and protocols for managing alcohol related disorders were not available at the local health centres providing ARVs. The study participants identified improving communication, psychoeducation and screening for alcohol use as possible action areas. Poverty was identified as a major problem but the interventions to mitigate this were not easy to implement. Conclusion We propose that PRA could be useful in improving communication between the health workers and the clients attending primary health care (PHC) facilities and can be applied to strengthen involvement of support groups and community health workers in follow up and counselling. Integrating these features into primary
Davies, F G
Lumpy skin disease virus strains isolated in Kenya over a period of some 20 years have proved to be serologically identical. They were indistinguishable by indirect fluorescent antibody and serum neutralization test from the South African Neethling and West African serotypes. These two serological methods proved of value in studying the antibody responses to infection. While epizootic spread of LSD has occurred in Kenya, most cases are of a sporadic nature and are thought to be the result of accidental contacts with a maintenance cycle. There is evidence of antibody to LSD in the African buffalo (Syncerus caffer) in those areas where LSD is considered to be enzootic in Kenya, and also in small numbers of domestic cattle. No buffalo or bovine sera contained antibody to cowpox virus. An area enzootic for LSD is proposed and it is suggested that the maintenance cycle involves the buffalo. No antibody was found in the other wild ruminant species examined.
Anthony, E. Y.; Espejel, V.; Biggs, J.
A nexus of volcanoes in the rift graben at approximately the latitude of Nairobi consist of central vent trachyte, phonolite, and peralkaline rhyolite and cinder cone and fissure-fed flows of basalt to benmoreite. The volcanoes are referred to as the Central Kenya Peralkaline Province (CKPP, Macdonald and Scaillet, 2006, Lithos 91, 59-73) and formed by a combination of processes including fractional crystallization, magma mixing, and volatile transport (Ren et al., 2006, Lithos 91, 109-124; Macdonald et al., 2008, JPet 49, 1515-1547). This presentation focuses on magma mixing for trachytes and phonolites for Suswa rocks, which are the southernmost part of the CKPP. We also explore the contribution of magma process studies to the interpretation of recent geodetic data, which indicate inflation/deflation of up to 21 cm for Kenyan volcanoes from 1997 to present (Biggs et al., 2009, Geology, in press). Incontrovertible evidence for magma mixing is found in field evidence, where a basaltic trachyandesite ash horizon is found interbedded with syncaldera trachyte (Skilling, 1993, J. Geol. Society London 150, 885-896), hand-specimen and thin-section petrography, and disequilibrium mineral chemistry. Precaldera lavas contain a homogeneous group of anorthoclase crystals with An content 6% or less. Syncaldera samples contain this same group and two other populations: polysynthetic twinned labradorite and andesine and anorthoclase with An content of 17%. Textures for all three groups indicate disequilibrium. Postcaldera flows contain the high and low An anorthoclase populations but lack the polysynthetic twinned labradorite and andesine. These observations suggest a model of injection of mafic magmas via diking into shallow trachtytic magma systems. Recent geodetic studies of dike injection and subsequent seismic/volcanic activity in both Ethiopia and Lengai point to the ongoing importance of these processes to rift evolution in East Africa.
Uitto, J I
Kenya's national survey data have shown patterns of fertility decline in the more socioeconomically advantaged regions. In the central areas, where urbanization and economic development is the highest, fertility has begun to decline rapidly. The lowest fertility was in Nairobi capital region; the Coast Province also experienced recent fertility decline. Fertility has remained high in the Western Province and in Nyanza, Rift Valley, and Eastern Provinces. The case study of Kisii district in Nyanza Province was used to illustrate the preconditions of high fertility. The district is an agriculturally rich region that includes rounded, steep-sided hills and narrow valleys. The district is a primary producer of cash crops such as coffee, tea, and pyrethrum, and other food crops including high-yielding varieties of maize. Farm size varies between 0.11 and 2.2 hectares and farms are owner occupied. All cultivable land is in use with traditional farming methods. Tractors are used in flat areas by 11.6% of farmers. 69.3% of farmers use fertilizers, but only 32% use insecticides and pesticides. Population density is 395 persons per square kilometer. The total fertility rate is 8.2 compared to 7.7 for the nation. 6% currently used contraception, and 23% have ever used. Fertility preferences of women under 25 years old is 6.9 children. Most farm labor, even among the wealthy farmers, is family labor organized by age and gender. Women are responsible for planting, weeding, harvesting and household chores. Male off-farm employment increases the agricultural production responsibilities of women. Only mothers of sons can control property and gain prestige. Modernization and land shortages have pressured families to increase nonfarm employment.
Yator, Obadia; Mathai, Muthoni; Vander Stoep, Ann; Rao, Deepa; Kumar, Manasi
Mothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) among women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending prevention of mother-to-child transmission (PMTCT) clinic at Kenyatta National Hospital located in Nairobi, Kenya. We used the Edinburgh Postnatal Depression Scale and HIV/AIDS Stigma Instrument - PLWHA (HASI - P). Forty-eight percent (N = 59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR = 0.14, 95% CI [0.04-0.46], p = .001) and lack of family support (OR = 2.49, 95% CI [1.14-5.42], p = .02) were associated with the presence of elevated depressive symptoms. The presence of stigma implied more than ninefold risk of development of PPD (OR = 9.44, 95% CI [1.132-78.79], p = .04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother-baby dyad.
Mutai, Beth K; Wainaina, James M; Magiri, Charles G; Nganga, Joseph K; Ithondeka, Peter M; Njagi, Obadiah N; Jiang, Ju; Richards, Allen L; Waitumbi, John N
Abstract Rickettsiae are obligate intracellular bacteria that cause zoonotic and human diseases. Arthropod vectors, such as fleas, mites, ticks, and lice, transmit rickettsiae to vertebrates during blood meals. In humans, the disease can be life threatening. This study was conducted amidst rising reports of rickettsioses among travelers to Kenya. Ticks and whole blood were collected from domestic animals presented for slaughter at major slaughterhouses in Nairobi and Mombasa that receive animals from nearly all counties in the country. Blood samples and ticks were collected from 1019 cattle, 379 goats, and 299 sheep and were screened for rickettsiae by a quantitative PCR (qPCR) assay (Rick17b) using primers and probe that target the genus-specific 17-kD gene (htrA). The ticks were identified using standard taxonomic keys. All Rick17b-positive tick DNA samples were amplified and sequenced with primers sets that target rickettsial outer membrane protein genes (ompA and ompB) and the citrate-synthase encoding gene (gltA). Using the Rick17b qPCR, rickettsial infections in domestic animals were found in 25/32 counties sampled (78.1% prevalence). Infection rates were comparable in cattle (16.3%) and sheep (15.1%) but were lower in goats (7.1%). Of the 596 ticks collected, 139 had rickettsiae (23.3%), and the detection rates were highest in Amblyomma (62.3%; n=104), then Rhipicephalus (45.5%; n=120), Hyalomma (35.9%; n=28), and Boophilus (34.9%; n=30). Following sequencing, 104 out of the 139 Rick17b-positive tick DNA had good reverse and forward sequences for the 3 target genes. On querying GenBank with the generated consensus sequences, homologies of 92-100% for the following spotted fever group (SFG) rickettsiae were identified: Rickettsia africae (93.%, n=97), Rickettsia aeschlimannii (1.9%, n=2), Rickettsia mongolotimonae (0.96%, n=1), Rickettsia conorii subsp. israelensis (0.96%, n=1), Candidatus Rickettsia kulagini (0.96% n=1), and Rickettsia spp. (1.9% n=2). In
Spatial autocorrelation in uptake of antenatal care and relationship to individual, household and village-level factors: results from a community-based survey of pregnant women in six districts in western Kenya
Background The majority of maternal deaths, stillbirths, and neonatal deaths are concentrated in a few countries, many of which have weak health systems, poor access to health services, and low coverage of key health interventions. Early and consistent antenatal care (ANC) attendance could significantly reduce maternal and neonatal morbidity and mortality. Despite this, most Kenyan mothers initiate ANC care late in pregnancy and attend fewer than the recommended visits. Methods We used survey data from 6,200 pregnant women across six districts in western Kenya to understand demand-side factors related to use of ANC. Bayesian multi-level models were developed to explore the relative importance of individual, household and village-level factors in relation to ANC use. Results There is significant spatial autocorrelation of ANC attendance in three of the six districts and considerable heterogeneity in factors related to ANC use between districts. Working outside the home limited ANC attendance. Maternal age, the number of small children in the household, and ownership of livestock were important in some districts, but not all. Village proportions of pregnancy in women of child-bearing age was significantly correlated to ANC use in three of the six districts. Geographic distance to health facilities and the type of nearest facility was not correlated with ANC use. After incorporating individual, household and village-level covariates, no residual spatial autocorrelation remained in the outcome. Conclusions ANC attendance was consistently low across all the districts, but factors related to poor attendance varied. This heterogeneity is expected for an outcome that is highly influenced by socio-cultural values and local context. Interventions to improve use of ANC must be tailored to local context and should include explicit approaches to reach women who work outside the home. PMID:24314170
This community action guide was developed to implement the strategies for the advancement of women developed at the United Nations world conference in Nairobi that ended the Decade for Women in 1985. The guide is intended to: (1) increase understanding and awareness of the existence of the Nairobi Forward-Looking Strategies for the Advancement of…
Lypen, Kathryn D; Lockwood, Nicole M; Shalabi, Firas; Harper, Gary W; Ngugi, Elizabeth
Social support helps youth manage psychosocial stress. Though many studies have investigated the role of social support in helping youth in developed countries cope with their HIV status, such research is lacking among youth living in sub-Saharan African countries, including Kenya. The importance of research on youth living with HIV in Kenya is enhanced given young people's unique developmental stages and the HIV prevalence rate of 8.8% among Kenyans aged 25 to 29 years. To gain further insight, qualitative focus group interviews were conducted with 53 youth aged 18 to 27 years who lived in the informal urban settlement of Kibera in Nairobi, Kenya. A phenomenological approach was used to analyse the data from which four major types of social support were identified: 1) emotional; 2) informational; 3) appraisal; and 4) instrumental. Within each of these overarching themes more specific sub-themes were identified. The youth also reported receiving social support from eight main sources: 1) family; 2) friends; 3) clinicians and clinical services; 4) counsellors; 5) support groups; 6) religious sources; 7) partners; and 8) other. These findings suggest that various forms of social support, provided by diverse sources, which may fall outside of those commonly involved in interventions, can help youth living with HIV cope with their diagnosis and promote healthy lifestyles. Future research should investigate the roles and interactions of different types and sources of support, specifically as they relate to interventions aiming to ameliorate the experiences of youth newly diagnosed with HIV.
Evens, Emily; Otieno-Masaba, Rose; Eichleay, Margaret; McCarraher, Donna; Hainsworth, Gwyn; Lane, Cate; Makumi, Margaret; Onduso, Pamela
Unsafe abortion accounts for 35% of maternal mortality in Kenya. Post-abortion care (PAC) reduces maternal death and provides an opportunity to prevent unwanted pregnancies. Few studies have documented how the receipt of PAC services varies by client age. In this study, descriptive data were collected from clients, providers and eight health facilities in Kenya's Central and Nairobi provinces to examine receipt of PAC services by client age, client satisfaction and provider attitudes. Delivery of PAC treatment, pain management, HIV and STI services and violence screening did not vary by age. However, fewer youth between the ages of 15 and 24 received a contraceptive method compared with adult clients (35% versus 48%; p=0.02). Forty-nine per cent of youth reported not using a family planning method due to fears of infertility, side-effects or lack of knowledge compared with 22% of adults. Additional efforts are needed in Kenya to bolster the family planning services that young PAC clients receive and increase the uptake of contraception.
Parcesepe, Angela M.; L'Engle, Kelly L.; Martin, Sandra L.; Green, Sherri; Sinkele, William; Suchindran, Chirayath; Speizer, Ilene S.; Mwarogo, Peter; Kingola, Nzioki
Aims To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya. Design Randomized controlled trial. Setting HIV prevention drop-in centers in Mombasa, Kenya. Participants 818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively). Intervention 6 session alcohol harm reduction intervention. Comparator 6 session non-alcohol related nutrition intervention. Measurements In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days. Findings The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention. Conclusions The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya. PMID:26872880
Ngolovoi, Mary S.
In response to declining governmental funding, cost-sharing in higher education and dual-track tuition policies were introduced in the 1990s in Kenya. The decline of government funding in higher education was a result of slow economic growth, competing public needs (such as health, elementary education, and infrastructure), and pressure to reduce…
Being a college president has been Kenya Ayers' goal since she started in higher education in the late 1990s. "I'm really clear," she says. "I want to do this." Ayers is well on her way. She's been a provost, an academic dean and an administrative one, and an associate vice president of academic affairs at colleges in…
Henne, S.; Klausen, J.; Junkermann, W.; Kariuki, J. M.; Aseyo, J. O.; Buchmann, B.
transport towards MKN. Although biomass burning had little direct influence on the measurements at MKN it introduces inter-annual variability in the background concentrations of the southern hemisphere that subsequently reaches Kenya. The measurements at MKN were representative of air masses with little photochemical activity as indicated by weak O3-CO correlations, underlining the baseline character of the site. Inter-comparison of O3 at MKN with sounding data from Nairobi revealed a positive offset of the sounding data, most likely due to additional photochemical production of O3 in the Nairobi city plume. Future extensions of the measurement programme will provide better understanding of the atmospheric chemistry of this globally important region.
Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: Results of a consultation with community stakeholders
Background As pre-exposure prophylaxis (PrEP) moves closer to availability in developing countries, practical considerations for implementation become important. We conducted a consultation with district-level community stakeholders experienced in HIV-prevention interventions with at-risk populations in Bondo and Rarieda, Kenya to generate locally grounded approaches to the future rollout of oral PrEP to four populations: fishermen, widows, female sex workers, and serodiscordant couples. Methods The 20 consultation participants represented the Ministry of Health, faith- and community-based organizations, health facilities, community groups, and nongovernmental organizations. Participants divided into breakout groups and followed a structured discussion guide asking them to identify barriers to implementing HIV-prevention interventions (including PrEP) with each population. Questions also solicited solutions for addressing these barriers, as well as other facilitators for PrEP implementation. In particular, questions focused on how to encourage people to screen for PrEP eligibility by having HIV and other blood tests and how to encourage compliance with ongoing HIV testing. Results The barriers and facilitators/solutions discussants provided were frequently population-specific, but there were also broad-level similarities across populations. Service delivery barriers to HIV-prevention interventions concerned the need for staff trained to address the needs of particular populations. Service delivery facilitators to provision of ongoing HIV testing consisted of offering testing options besides facility-based testing. Stigma was the main community-level barrier for all groups, whereas barriers at the level of target populations included mobility; lifestyle and life circumstances, especially cultural norms among fishermen and widows; and fears, lack of awareness, and misinformation. Proposed facilitators and strategies for addressing community- and population
Klisch, A.; Atzberger, C.; Luminari, L.
The University of Natural Resources and Life Sciences (BOKU) in Vienna (Austria) in cooperation with the National Drought Management Authority (NDMA) in Nairobi (Kenya) has setup an operational processing chain for mapping drought occurrence and strength for the territory of Kenya using the Moderate Resolution Imaging Spectroradiometer (MODIS) NDVI at 250 m ground resolution from 2000 onwards. The processing chain employs a modified Whittaker smoother providing consistent NDVI "Mondayimages" in near real-time (NRT) at a 7-daily updating interval. The approach constrains temporally extrapolated NDVI values based on reasonable temporal NDVI paths. Contrary to other competing approaches, the processing chain provides a modelled uncertainty range for each pixel and time step. The uncertainties are calculated by a hindcast analysis of the NRT products against an "optimum" filtering. To detect droughts, the vegetation condition index (VCI) is calculated at pixel level and is spatially aggregated to administrative units. Starting from weekly temporal resolution, the indicator is also aggregated for 1- and 3-monthly intervals considering available uncertainty information. Analysts at NDMA use the spatially/temporally aggregated VCI and basic image products for their monthly bulletins. Based on the provided bio-physical indicators as well as a number of socio-economic indicators, contingency funds are released by NDMA to sustain counties in drought conditions. The paper shows the successful application of the products within NDMA by providing a retrospective analysis applied to droughts in 2006, 2009 and 2011. Some comparisons with alternative products (e.g. FEWS NET, the Famine Early Warning Systems Network) highlight main differences.
Hoedjes, Joost; Said, Mohammed; Becht, Robert; Kifugo, Shem; Kooiman, André; Limo, Agnes; Maathuis, Ben; Moore, Ian; Mumo, Mark; Nduhiu Mathenge, Joseph; Su, Bob; Wright, Iain
The existing meteorological infrastructure in Kenya is poorly suited for the countrywide real-time monitoring of precipitation. Rainfall radar is not available, and the existing network of rain gauges is sparse and challenging to maintain. This severely restricts Kenya's capacity to warn for, and respond to, weather related emergencies. Furthermore, the lack of accurate rainfall observations severely limits Kenya's climate change adaptation capabilities. Over the past decade, the mobile telephone network in Kenya has expanded rapidly. This network makes extensive use of terrestrial microwave (MW) links, received signal level (RSL) data from which can be used for the calculation of rainfall intensities. We present a novel method for the near-real time observation of convective rainfall over Kenya, based on the combined use of MW RSL data and Meteosat Second Generation (MSG) satellite data. In this study, the variable density rainfall information derived from several MW links is scaled up using MSG data to provide full rainfall information coverage for the region surrounding the links. Combining MSG data and MW link derived rainfall data for several adjacent MW links makes it possible to make the distinction between wet and dry pixels. This allows the disaggregation of the MW link derived rainfall intensities. With the distinction between wet and dry pixels made, and the MW derived rainfall intensities disaggregated, these data can then be used to develop instantaneous empirical relationships linking rainfall intensities to cloud physical properties. These relationships are then used to calculate rainfall intensities for the MSG scene. Since both the MSG and the MW data are available at the same temporal resolution, unique empirical coefficients can be determined for each interval. This approach ensures that changes in convective conditions from one interval to the next are taken into account. Initial results from a pilot study, which took place from November 2012
The study was aimed at investigating the students' ability to use technology for distance education with specific reference to the University of Nairobi's External Degree Program. To achieve this, one specific objective was formulated: To find out the student teacher's readiness to accept and utilize technology for learning purposes in relation to…
Browne, A S; Fèvre, E M; Kinnaird, M; Muloi, D M; Wang, C A; Larsen, P S; O'Brien, T; Deem, S L
Dromedary camels (Camelus dromedarius) are an important protein source for people in semi-arid and arid regions of Africa. In Kenya, camel populations have grown dramatically in the past few decades resulting in the potential for increased disease transmission between humans and camels. An estimated four million Kenyans drink unpasteurized camel milk, which poses a disease risk. We evaluated the seroprevalence of a significant zoonotic pathogen, Coxiella burnetii (Q fever), among 334 camels from nine herds in Laikipia County, Kenya. Serum testing revealed 18.6% positive seroprevalence of Coxiella burnetii (n = 344). Increasing camel age was positively associated with C. burnetii seroprevalence (OR = 5.36). Our study confirmed that camels living in Laikipia County, Kenya, have been exposed to the zoonotic pathogen, C. burnetii. Further research to evaluate the role of camels in disease transmission to other livestock, wildlife and humans in Kenya should be conducted.
Attitudes toward intimate partner violence (IPV) were compared between Zambian and Kenyan men on sociodemographic, attitudinal, and structural predictors of such attitudes. Data were retrieved from the latest Demographic and Health Surveys in each country. The results showed that many men in Zambia (71%) and Kenya (68%) justified IPV to punish a woman for transgression from normative domestic roles. In priority order, sociodemographic, autonomy, and access-to-information indicators predicted attitudes toward IPV in both countries. Whereas in Kenya, education reduced the likelihood of justifying IPV, the reverse was observed in Zambia. Access to information reduced the likelihood of justifying IPV among men in Zambia but not in Kenya. Men's positive attitudes toward women's autonomy reduced the likelihood of justifying IPV in Kenya but not in Zambia. Differences in specific predictors between the countries demonstrate the significance of capitalizing on need-adapted interventions tailored to fit conditions in each country.
Elmore-Meegan, Michael; Conroy, Ronán M; Agala, C Bernard
In Kenya in 1999, an estimated 6.9% of women nationally said they had exchanged sex for money, gifts or favours in the previous year. In 2000 and 2001, in collaboration with sex workers who had formed a network of self-help groups, we conducted an exploratory survey among 475 sex workers in four rural towns and three Nairobi townships, regarding where they worked, the number of clients they had and the risks they were exposed to. Participants were identified by a network of social contacts in the seven centres. Most of the women (88%) worked from bars, hotels, bus stages and discos; 57% lived with a stable partner and almost 90% had dependent children. In the previous month, 17% had been assaulted and 35% raped by clients. Unwanted pregnancy was common; 86% had had at least one abortion. Compared with women in rural towns, township sex workers were younger (median age 22 vs. 26), saw more clients (median 9 vs. 4 per week) and earned more from sex work (up to 63-90 euros vs. 12 euros per week). Issues of alternative sources of income, safety for sex workers and the conditions which create the necessity for sex work are vital to address. The question of number of clients and the nature of sex work have obvious implications for HIV/STI prevention policy.
This rare, cloud free view of the East African Rift Valley, Kenya (1.5N, 35.5E) shows a clear view of the Turkwell River Valley, an offshoot of the African REift System. The East African Rift is part of a vast plate fracture which extends from southern Turkey, through the Red Sea, East Africa and into Mozambique. Dark green patches of forests are seen along the rift margin and tea plantations occupy the cooler higher ground.
Robinson, W C; Harbison, S F
In Sub-Saharan Africa Kenya is a prime example of a country experiencing a rapid decline in fertility and greater contraceptive prevalence. These changes have occurred since 1980 when fertility was high at 8.0 children per woman. In 1993 the total fertility rate (TFR) was 5.4, and the growth rate declined to about 2.0%. This transition is swifter than any country in contemporary Asia or historical Europe. The likely projection for Kenya is attainment of replacement level fertility during the 2020s and a leveling of population at about 100 million persons. Fertility has declined the most in urban areas and central and eastern regions. Bongaarts' proximate determinants (TFR, total marital fertility rate, total natural marital fertility rate, and total fecundity) are reduced to the proportion of currently married women using contraception, the proportion in lactational nonfecund status, and the proportion currently married. Actual fertility change is accounted for by total fertility change of 3.0 children. Lactational infecundability accounts for 0.5 potential births, and changes in marital fertility account for 1.0 reduced births per woman. About 70% of fertility reduction is accounted for by contraception and abortion. During 1977-78 80% of fertility control was due to lactational nonfecundity, 10% to nonmarriage, and 10% to contraception. In 1993 lactational nonfecundity accounted for 50% of the reduction, nonmarriage for 20%, and abortion about 30%. Future fertility is expected to be dependent on contraceptive prevalence. Kenya has experienced the Coale paradigm of preconditions necessary for demographic transition (willing, ready, and able). High fertility in Africa is not intractable. Creating the change in attitudes that leads to readiness is linked to education, health, and exposure to modernizing media and urban lifestyles. The public sector family planning program in Kenya has created the opportunity for access and availability of contraception. The key
is unlimited. 13. SUPPLEMENTARY NOTES 14. ABSTRACT This thesis examines the Kenyan government’s (GoK’s) increasingly responsive strategy, and...TRANSNATIONAL TERRORISM THREAT IN THE COUNTRY by Hared H. Adan, Kenya Army, 84 pages. This thesis examines the Kenyan government’s (GoK’s) increasingly...terrorism. Thesis Question This thesis will attempt to answer the following question: Is the Kenyan government’s efforts to fight terrorism
Moriasi, D.; Steiner, J.; Arnold, J.; Allen, P.; Dunbar, J.; Shisanya, C.; Gathenya, J.; Nyaoro, J.; Sang, J.
The Fort Cobb Reservoir Watershed (FCRW) (830 km2) is a watershed within the HELP Washita Basin, located in Caddo and Washita Counties, OK. It is also a benchmark watershed under USDA's Conservation Effects Assessment Project, a national project to quantify environmental effects of USDA and other conservation programs. Population in south-western Oklahoma, in which FCRW is located, is sparse and decreasing. Agricultural focuses on commodity production (beef, wheat, and row crops) with high costs and low margins. Surface and groundwater resources supply public, domestic, and irrigation water. Fort Cobb Reservoir and contributing stream segments are listed on the Oklahoma 303(d) list as not meeting water quality standards based on sedimentation, trophic level of the lake associated with phosphorus loads, and nitrogen in some stream segments in some seasons. Preliminary results from a rapid geomorphic assessment results indicated that unstable stream channels dominate the stream networks and make a significant but unknown contribution to suspended-sediment loadings. Impairment of the lake for municipal water supply, recreation, and fish and wildlife are important factors in local economies. The Thika River Watershed (TRW) (867 km2) is located in central Kenya. Population in TRW is high and increasing, which has led to a poor land-population ratio with population densities ranging from 250 people/km2 to over 500 people/km2. The poor land-population ratio has resulted in land sub-division, fragmentation, over- cultivation, overgrazing, and deforestation which have serious implications on soil erosion, which poses a threat to both agricultural production and downstream reservoirs. Agricultural focuses mainly on subsistence and some cash crops (dairy cattle, corn, beans, coffee, floriculture and pineapple) farming. Surface and groundwater resources supply domestic, public, and hydroelectric power generation water. Thika River supplies 80% of the water for the city of
Objective: Most research on child abuse in Tanzania and Kenya is unpublished in the international literature. The purpose of this paper is to examine the various commentaries and reports extant, toward an overview of the nature and frequency of child sexual abuse in Tanzania and Kenya. Methods: Contacts were made with academics, government…
Chetcuti, Deborah A.; Kioko, Beriter
This study investigated girls' attitudes towards science in Kenya. It was carried out with 120 girls from four secondary schools in the Eastern province of Kenya. These were an urban single-sex (SS) and co-educational (Co-Ed) school and a rural SS and Co-Ed school. Different schools were chosen in order to explore whether there are any differences…
Lillis, Kevin M.
Discusses problems associated with reform of secondary school curricula in Kenya in the period immediately after independence. Follows the course of two innovations--School Mathematics of East Africa (SMEA) and the Africanization of the literature curriculum--and discusses various reasons for their failure and for Kenya's continued dependence on…
Scherer, Laura; Curran, Michael; Alvarez, Miguel
Biodiversity is highly valuable and critically threatened by anthropogenic degradation of the natural environment. In response, governments have pledged enhanced protected-area coverage, which requires scarce biological data to identify conservation priorities. To assist this effort, we mapped conservation priorities in Kenya based on maximizing alpha (species richness) and beta diversity (species turnover) of plant communities while minimizing economic costs. We used plant-cover percentages from vegetation surveys of over 2000 plots to build separate models for each type of diversity. Opportunity and management costs were based on literature data and interviews with conservation organizations. Species richness was predicted to be highest in a belt from Lake Turkana through Mount Kenya and in a belt parallel to the coast, and species turnover was predicted to be highest in western Kenya and along the coast. Our results suggest the expanding reserve network should focus on the coast and northeastern provinces of Kenya, where new biological surveys would also fill biological data gaps. Meeting the Convention on Biological Diversity target of 17% terrestrial coverage by 2020 would increase representation of Kenya's plant communities by 75%. However, this would require about 50 times more funds than Kenya has received thus far from the Global Environment Facility.
Ngware, Moses W.; Oketch, Moses; Ezeh, Alex C.
This article examines the quality of primary school inputs in urban settlements with a view to understand how it sheds light on benchmarks of education quality indicators in Kenya. Data from a school survey that involved 83 primary schools collected in 2005 were used. The data set contains information on school quality characteristics of various…
Adoyo, Maureen Atieno; Mbakaya, Charles; Nyambati, Venny; Kombe, Yeri
Introduction World Health Organization estimates that deaths resulting from diabetes will rise above 50% by the year 2020; hence urgent action is needed to reverse the trend notably through nutrition and lifestyle intervention among populations at risks. Studies have established that nutritional environment and physiology of the mother affects neonate's health at infancy and later in life thus this study sought to investigate the risk factors for development of gestational diabetes focusing age, weight, family history and pre-existing medical condition which could be modified to improve population health. Methods A retrospective cohort study design was used. Subjects were sampled from selected maternity facilities in Nairobi and were subjected to oral glucose test to ascertain Gestational Diabetes mellitus (GDM) status. A questionnaire was administered to a sample of 238 respondents. Quantitative data was then analyzed as descriptive statistic, univariate and multivariate regression. Results Average age for mothers with GDM was high with a mean of 33.06 (95% C.I: 31.59-34.52) compared to a mean of 27.9 (95% C.I: 27.01-28.78) for non-GDM mothers. Weight before pregnancy was high with mean of 74.04 (95% C.I: 70.82-77.30) among mothers with GDM compared to mean of 60.27 (95% C.I:58.59-61.96) among non-GDM mothers. Mothers with diabetic history in the family had twice the risk of developing GDM (OR= 2.27; 95% C.I: 1.23-4.17) compared to those who did not observe diabetic history in the family. Conclusion Gestational diabetes cases are relatively high. Age advancement; high weight and diabetic history in family are determining factors for development of diabetes among pregnant women. PMID:27795753
Marwick, Trent R.
As part of a broader study on the riverine biogeochemistry in the Athi-Galana-Sabaki (A-G-S) River basin (Kenya), we present data collected during three climatic seasons to constrain the sources, transformations and transit of multiple N species as they flow through the A-G-S basin (~47,000 km2), stretching from downstream of heavily polluted Nairobi and surrounds to the outlet at the Indian Ocean. Total dissolved inorganic nitrogen (DIN) concentrations entering the study area were highest during the dry season (1195 µmol/L), almost completely in the form of ammonium (99.8%), whilst total DIN was an order of magnitude lower during the short and long rain seasons (212 and 193 µmol/L, respectively). Nitrate was the dominant form of DIN entering the study area during the short and long rain seasons (97.9% and 85.6% of total DIN respectively), with the increased flow conditions resulting in minimal instream N-cycling prior to discharge to the ocean. Conversely, longer water residence time and intense cycling and removal of N in the upper- to mid-catchment during the dry season creates two polarities comparative to wet season conditions, where (1) significantly less DIN is exported to the ocean during the dry season, and (2) dry season particulate N export is significantly enriched in δ15N, strongly reflecting the dominance of organic wastes as the source of riverine nitrogen. The rapid removal of ammonium in the upper study area during the dry season was followed by a quantitatively similar production of nitrate and nitrous oxide downstream, pointing towards strong nitrification over this reach during the dry season. The nitrous oxide was rapidly degassed downstream, while the elevated nitrate concentrations steadily decreased to levels observed elsewhere in African river networks. Low pelagic primary production rates over the same reach suggest benthic denitrification was the dominant process controlling the removal of these nitrates, although large cyanobacterial
Jinnah, Zaheera; Lowe, Lucy
Female circumcision among Somalis is a deeply personal and subjective practice, framed within traditional norms and cultural practices, but negotiated within contemporary realities to produce a set of processes and practices that are nuanced, differentiated, and undergoing change. Based on ethnographic research among Somali women in Johannesburg and Nairobi, we argue that the context of forced migration provides women with opportunities to renegotiate and reinvent what female circumcision means to them. The complex, subjective, and diverse perceptions and experiences of circumcision as embedded processes, within the context of migration, we argue has been overlooked in the literature, which has tended to be framed within a normative discourse concerned with the medical effects of the practice, or in anthropological studies, counter to the normative discourse based on personal narratives.
At 4%, Kenya's growth rate a decade ago was thought to be the highest in the world. The latest Demographic and Health Survey, however, records a 33% decline in the country's total fertility rate over 15 years, which is one of the most precipitous declines ever measured. This decline was caused by several factors. Traditionally, Kenyans associated large families with wealth, prosperity, and old-age security. Now the traditional family has been reshaped by Western influences such as monogamy, Western medicine, and an emphasis on expensive formal education. The Kenyan government began to try to foster a demographic transition since 1948, but by 1977 only 7% of married women used contraceptives. Once family planning (FP) programs began to decentralize and find more effective ways of distributing contraceptives, however, that figure rose to 34%. With the spread of AIDS, the condom has become an important contraceptive, but the most popular methods are oral and injectable contraceptives. To reach the population with unmet needs (26% of women would like to space their children and 52% wish to stop child bearing), the government has adopted a program of community-based distribution which also used IEC (information, education, and communication) techniques to provide sex education to adolescents. The goals of increasing access to formal education and increasing the length of primary education have also contributed to smaller family sizes. While success has undoubtedly been made, further changes in Kenya's FP program, including providing services to adolescents and targeting men, will broaden its reach. The situation in Kenya has shown that FP progress need not await economic prosperity.
Baki, Paul; Wabwile, Ruth L.; Nyamwandha, Cecilia A.; Odongo, Diana A.
In this paper we give an overview of the challenges Kenyan women physicists face in their educational and career engagements as a result of social-cultural stigma, cultural prejudices, and balancing family and work demands. We also discuss steps being taken in Kenya to address gender inequality in almost all spheres of public and private workplaces and the benefits to a prosperous developing nation of educating the girl child.
vertebrates and/or invertebrates as reservoirs of Haemorrhagic fever viruses particularly Marburg virus . The final results of this particular investigation...Research work done in Kenya has shown that three haemorrhagic fever viruses occur in the country. These are Rift Valley Fever Virus (RVF), Crimean...members for serology and or virus isolation. 2. Virus Isolation Attempts in VRC Haemorrhagic fever viruses are hazardous to culture and handle in
Mamboleo, George Isaboke
Disability rights issues are an emerging area of discourse in Kenya. Persons with disabilities in Kenya face many barriers to integration into the larger Kenyan society possibly due to barriers such as societal negative attitudes. Research has indicated that the greatest barrier to rehabilitation of persons with disabilities is negative attitudes…
Bitek, Austine; Osoro, Eric; Pieracci, Emily G.; Muema, Josephat; Mwatondo, Athman; Kungu, Mathew; Nanyingi, Mark; Gharpure, Radhika; Njenga, Kariuki; Thumbi, Samuel M.
Introduction Zoonotic diseases have varying public health burden and socio-economic impact across time and geographical settings making their prioritization for prevention and control important at the national level. We conducted systematic prioritization of zoonotic diseases and developed a ranked list of these diseases that would guide allocation of resources to enhance their surveillance, prevention, and control. Methods A group of 36 medical, veterinary, and wildlife experts in zoonoses from government, research institutions and universities in Kenya prioritized 36 diseases using a semi-quantitative One Health Zoonotic Disease Prioritization tool developed by Centers for Disease Control and Prevention with slight adaptations. The tool comprises five steps: listing of zoonotic diseases to be prioritized, development of ranking criteria, weighting criteria by pairwise comparison through analytical hierarchical process, scoring each zoonotic disease based on the criteria, and aggregation of scores. Results In order of importance, the participants identified severity of illness in humans, epidemic/pandemic potential in humans, socio-economic burden, prevalence/incidence and availability of interventions (weighted scores assigned to each criteria were 0.23, 0.22, 0.21, 0.17 and 0.17 respectively), as the criteria to define the relative importance of the diseases. The top five priority diseases in descending order of ranking were anthrax, trypanosomiasis, rabies, brucellosis and Rift Valley fever. Conclusion Although less prominently mentioned, neglected zoonotic diseases ranked highly compared to those with epidemic potential suggesting these endemic diseases cause substantial public health burden. The list of priority zoonotic disease is crucial for the targeted allocation of resources and informing disease prevention and control programs for zoonoses in Kenya. PMID:27557120
De Vuyst, Hugo; Mugo, Nelly R.; Franceschi, Silvia; McKenzie, Kevin; Tenet, Vanessa; Njoroge, Julia; Rana, Farzana S.; Sakr, Samah R.; Snijders, Peter J. F.; Chung, Michael H.
Objective To assess residual cervical intraepithelial neoplasia (CIN) 2/3 disease and clearance of high-risk (hr) human papillomavirus (HPV) infections at 6 months after cryotherapy among HIV-positive women. Design Follow-up study. Methods 79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy) and after cryotherapy (cells). Results At 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI): 66.4–85.9). 18 women (22.8%) had residual CIN2/3, and all these women had hrHPV at baseline. CD4 count and duration of combination antiretroviral therapy (cART) were not associated with residual CIN2/3. CIN3 instead of CIN2 was the only significant risk factor for residual disease (odds ratio, OR vs CIN2 = 4.3; 95% CI: 1.2–15.0) among hrHPV-positive women after adjustment for age and HPV16 infection. Persistence of hrHPV types previously detected in biopsies was found in 77.5% of women and was associated with residual CIN2/3 (OR = 8.1, 95% CI: 0.9–70). The sensitivity, specificity, and negative predictive value of hrHPV test in detecting residual CIN2/3 were 0.94, 0.36, and 0.96 respectively. Conclusions Nearly one quarter of HIV-positive women had residual CIN2/3 disease at 6 months after cryotherapy, and the majority had persistent hrHPV. CD4 count and cART use were not associated with residual disease or hrHPV persistence. The value of hrHPV testing in the detection of residual CIN2/3 was hampered by a low specificity. PMID:25343563
Olwendo, O. J.; Baluku, T.; Baki, P.; Cilliers, P. J.; Mito, C.; Doherty, P.
In this study we have used VHF and GPS-SCINDA receivers located at Nairobi (36.8°E, 1.3°S, dip -24.1°) in Kenya, to investigate the ionospheric scintillation and zonal drift irregularities of a few hundred meter-scale irregularities associated with equatorial plasma density bubbles for the period 2011. From simultaneous observations of amplitude scintillation at VHF and L-band frequencies, it is evident that the scintillation activity is higher during the post sunset hours of the equinoctial months than at the solstice. While it is noted that there is practically no signatures of the L-band scintillation in solstice months (June, July, December, January) and after midnight, VHF scintillation does occur in the solstice months and show post midnight activity through all the seasons. VHF scintillation is characterized by long duration of activity and slow fading that lasts till early morning hours (05:00 LT). Equinoctial asymmetry in scintillation occurs with higher occurrence in March-April than in September-October. The occurrence of post midnight VHF scintillation in this region is unusual and suggests some mechanisms for the formation of scintillation structure that might not be clearly understood. Zonal drift velocities of irregularities were measured using cross-correlation analysis with time series of the VHF scintillation structure from two closely spaced antennas. Statistical analyses of the distribution of zonal drift velocities after sunset hours indicate that the range of the velocities is 30-160 m/s. This is the first analysis of the zonal plasma drift velocity over this region. Based on these results we suggest that the east-west component of the plasma drift velocity may be related to the evolution of plasma bubble irregularities caused by the prereversal enhancement of the eastward electric fields. The equinoctial asymmetry of the drift velocities and scintillation could be attributed to the asymmetry of neutral winds in the thermosphere that drives
Background Although HIV counseling and testing (HCT) is widely considered an integral component of HIV prevention and treatment strategies, few studies have examined HCT behavior among youth in sub-Saharan Africa-a group at substantial risk for HIV infection. In this paper we examine: the correlates of HIV testing, including whether associations differ based on the context under which a person gets tested; and the motivations for getting (or not getting) an HIV test. Methods Drawing on data collected in 2007 from 4028 (51% male) youth (12-22 years) living in Korogocho and Viwandani slum settlements in Nairobi (Kenya), we explored the correlates of and motivations for HIV testing using the Health Belief Model (HBM) as a theoretical framework. Multinomial and binary logistic regression analyses were employed to examine correlates of HIV testing. Bivariate analyses were employed to assess reasons for or against testing. Results Nineteen percent of males and 35% of females had been tested. Among tested youth, 74% of males and 43% of females had requested for their most recent HIV test while 7% of males and 32% of females reported that they were required to take their most recent HIV test (i.e., the test was mandatory). About 60% of females who had ever had sex received an HIV test because they were pregnant. We found modest support for the HBM in explaining variation in testing behavior. In particular, we found that perceived risk for HIV infection may drive HIV testing among youth. For example, about half of youth who had ever had sex but had never been tested reported that they had not been tested because they were not at risk. Conclusions Targeted interventions to help young people correctly assess their level of risk and to increase awareness of the potential value of HIV testing may help enhance uptake of testing services. Given the relative success of Prevention of Mother-to-Child Transmission (PMTCT) services in increasing HIV testing rates among females
Cregg, A.K. )
Kenya basins have evolved primarily through extension related to episodic continental rifting. In eastern Kenya, thick accumulations of sediments formed within grabens during the prerift phase (Precambrian to Carboniferous) of the Gondwana breakup. Synrift sedimentation (Late Carboniferous to Middle Jurassic) occurred within a north-south rift system, which included the Mandera basin, South Anza basin, and Lamu embayment. During the Early Jurassic, a marine transgression invaded the margins of the eastern Kenya rift basins, resulting in the deposition of platform carbonates and shales. A Callovian-aged salt basin formed in the offshore regions of the Lamu embayment. Intermittent tectonic activity and eustatic sea-level changes controlled sedimentation, which produced marine shales, carbonates or evaporites, and fluvio-deltaic to lacustrine sandstones. From the Early Cretaceous to recent, continental sediments were deposited within the North Anza and Turkana basins. These fluvial-lacustrine sediments are similar to the Lower Cretaceous sequences that have produced oil in the Mesozoic Sudanese Abu Gabra rift. Although exploration activities began in the early 1950s, significant occurrences of potential reservoir, source, and seal lithologies as well as trapping configurations remain in many areas. Favorable structures and sequences of reservoir sandstones and carbonates overlain by potentially sealing lacustrine or marine shales, evaporites, or volcanics have been noted. Potential source beds are believed to be present within shales of the lacustrine or marine depositional environments.
Davies, F. G.
The epizootic range of Rift Valley fever in Kenya is defined from the results of virus isolations during epizootics, and form an extensive serological survey of cattle which were exposed during an epizootic. A study of the sera from a wide range of wild bovidae sampled immediately after the epizootic, showed that they did not act as reservoir or amplifying hosts for RVF. Virus isolation attempts from a variety of rodents proved negative. Rift Valley fever did not persist between epizootics by producing symptomless abortions in cattle in areas within its epizootic range. A sentinel herd sampled annually after an epizootic in 1968 revealed not one single seroconversion from 1969 to 1974. Certain forest and forest edge situations were postulated as enzootic for Rift Valley fever, and a small percentage of seroconversions were detected in cattle in these areas, born four years after the last epizootic. This has been the only evidence for the persistence of the virus in Kenya since 1968, and may be a part of the interepizootic maintenance cycle for Rift Valley fever in Kenya, which otherwise remains unknown. PMID:1058243
Kebebe, E G; Oosting, S J; Baltenweck, I; Duncan, A J
While there is a general consensus that using dairy technologies, such as improved breeds of dairy cows, can substantially increase farm productivity and income, adoption of such technologies has been generally low in developing countries. The underlying reasons for non-adoption of beneficial technologies in the dairy sector are not fully understood. In this study, we characterised adopters and non-adopters of dairy technologies in Ethiopia and Kenya based on farmers' resources ownership in order to identify why many farmers in Ethiopia and Kenya have not adopted improved dairy technologies. As compared to non-adopters, farmers who adopt dairy technology own relatively more farm resources. The result signals that differences in resource endowments could lead to divergent technology adoption scenarios. Results show that a higher proportion of sample smallholders in Kenya have adopted dairy technologies than those in Ethiopia. Except for the use of veterinary services, fewer than 10% of sample farmers in Ethiopia have adopted dairy technologies-less than half the number of adopters in Kenya. The higher level of dairy technology adoption in Kenya can be ascribed partly to the long history of dairy development, including improvements in the value chain for the delivery of inputs, services and fluid milk marketing. Interventions that deal with the constraints related to access to farm resources and input and output markets could facilitate uptake of dairy technology in developing countries.
Masika, Moses Muia; Omondi, Gregory Barnabas; Natembeya, Dennis Simiyu; Mugane, Ephraim Mwatha; Bosire, Kefa Ogonyo; Kibwage, Isaac Ongubo
Introduction Mobile phone penetration has increased exponentially over the last decade as has its application in nearly all spheres of life including health and medical education. This study aimed at assessing the use of mobile learning technology and its challenges among final year undergraduate students in the College of Health sciences, University of Nairobi. Methods This was a cross-sectional descriptive study conducted among final year undergraduate students at the University of Nairobi, College of Health Sciences. Self-administered, anonymous questionnaires were issued to all final year students in their lecture rooms after obtaining informed consent. Data on demographics, mobile device ownership and mobile learning technology use and its challenges was collected. Data entry and analysis was done using SPSS®. Chi-square and t-test were used for bivariate analysis. Results We had 292 respondents; 62% were medical students, 16% were nursing students, 13% were pharmacy students and 9% were dental surgery students. The majority were female (59%) and the average age was 24 years. Eighty eight percent (88%) of the respondents owned a smart device and nearly all of them used it for learning. 64% of the respondents used medical mobile applications. The main challenges were lack of a smart device, lack of technical know-how in accessing or using apps, sub-optimal internet access, cost of acquiring apps and limited device memory. Conclusion Mobile learning is increasingly popular among medical students and should be leveraged in promoting access and quality of medical education. PMID:26327964
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). Conclusion This suggests that the
Background A detailed knowledge of the distribution of the main Anopheles malaria vectors in Kenya should guide national vector control strategies. However, contemporary spatial distributions of the locally dominant Anopheles vectors including Anopheles gambiae, Anopheles arabiensis, Anopheles merus, Anopheles funestus, Anopheles pharoensis and Anopheles nili are lacking. The methods and approaches used to assemble contemporary available data on the present distribution of the dominant malaria vectors in Kenya are presented here. Method Primary empirical data from published and unpublished sources were identified for the period 1990 to 2009. Details recorded for each source included the first author, year of publication, report type, survey location name, month and year of survey, the main Anopheles species reported as present and the sampling and identification methods used. Survey locations were geo-positioned using national digital place name archives and on-line geo-referencing resources. The geo-located species-presence data were displayed and described administratively, using first-level administrative units (province), and biologically, based on the predicted spatial margins of Plasmodium falciparum transmission intensity in Kenya for the year 2009. Each geo-located survey site was assigned an urban or rural classification and attributed an altitude value. Results A total of 498 spatially unique descriptions of Anopheles vector species across Kenya sampled between 1990 and 2009 were identified, 53% were obtained from published sources and further communications with authors. More than half (54%) of the sites surveyed were investigated since 2005. A total of 174 sites reported the presence of An. gambiae complex without identification of sibling species. Anopheles arabiensis and An. funestus were the most widely reported at 244 and 265 spatially unique sites respectively with the former showing the most ubiquitous distribution nationally. Anopheles gambiae
Harris, Julie R.; Worrell, Caitlin M.; Davis, Stephanie M.; Odero, Kennedy; Mogeni, Ondari D.; Deming, Michael S.; Mohammed, Aden; Montgomery, Joel M.; Njenga, Sammy M.; Fox, LeAnne M.; Addiss, David G.
Background Programs for control of soil-transmitted helminth (STH) infections are increasingly evaluating national mass drug administration (MDA) interventions. However, “unprogrammed deworming” (receipt of deworming drugs outside of nationally-run STH control programs) occurs frequently. Failure to account for these activities may compromise evaluations of MDA effectiveness. Methods We used a cross-sectional study design to evaluate STH infection and unprogrammed deworming among infants (aged 6–11 months), preschool-aged children (PSAC, aged 1–4 years), and school-aged children (SAC, aged 5–14 years) in Kibera, Kenya, an informal settlement not currently receiving nationally-run MDA for STH. STH infection was assessed by triplicate Kato-Katz. We asked heads of households with randomly-selected children about past-year receipt and source(s) of deworming drugs. Local non-governmental organizations (NGOs) and school staff participating in school-based deworming were interviewed to collect information on drug coverage. Results Of 679 children (18 infants, 184 PSAC, and 477 SAC) evaluated, 377 (55%) reported receiving at least one unprogrammed deworming treatment during the past year. PSAC primarily received treatments from chemists (48.3%) or healthcare centers (37.7%); SAC most commonly received treatments at school (55.0%). Four NGOs reported past-year deworming activities at 47 of >150 schools attended by children in our study area. Past-year deworming was negatively associated with any-STH infection (34.8% vs 45.4%, p = 0.005). SAC whose most recent deworming medication was sourced from a chemist were more often infected with Trichuris (38.0%) than those who received their most recent treatment from a health center (17.3%) or school (23.1%) (p = 0.05). Conclusion Unprogrammed deworming was received by more than half of children in our study area, from multiple sources. Both individual-level treatment and unprogrammed preventive chemotherapy may serve an
Gatebe, C. K.; Tyson, P. D.; Annegarn, H.; Piketh, S.; Helas, G.
A climatology of air transport to and from Kenya has been developed using kinematic trajectory modeling. Significant months for trajectory analysis have been determined from a classification of synoptic circulation fields. Five-point back and forward trajectory clusters to and from Kenya reveal that the transport corridors to Kenya are clearly bounded and well defined. Air reaching the country originates mainly from the Saharan region and northwestern Indian Ocean of the Arabian Sea in the northern hemisphere and from the Madagascan region of the Indian Ocean in the southern hemisphere. Transport from each of these source regions show distinctive annual cycles related to the northeasterly Asian monsoon and the southeasterly trade wind maximum over Kenya in May. The Saharan transport in the lower troposphere is at a maximum when the subtropical high over northern Africa is strongly developed in the boreal winter. Air reaching Kenya between 700 and 500 hPa is mainly from Sahara and northwest India Ocean flows in the months of January and March, which gives way to southwest Indian Ocean flow in May and November. In contrast, air reaching Kenya at 400 hPa is mainly from southwest Indian Ocean in January and March, which is replaced by Saharan transport in May and November. Transport of air from Kenya is invariant, both spatially and temporally, in the tropical easterlies to the Congo Basin and Atlantic Ocean in comparison to the transport to the country. Recirculation of air has also been observed, but on a limited and often local scale and not to the extent reported in southern Africa.
Fietkau, S.; Medeke, T.; Richter, A.; Sheode, N.; Sinnhuber, B.-M.; Wittrock, F.; Theys, N.; van Roozendael, M.; Burrows, J. P.
Ground based observations of stratospheric and tropospheric bromine monoxide, BrO, from a multi axial differential optical absorption spectrometer, MAXDOAS, located at the UNEP/UNON site in Nairobi (1° S, 36° E) are presented for the year 2003. Differences in BrO slant column densities at 90° and 80° solar zenith angle retrieved from the zenith-sky measurements are used to study stratospheric BrO. They show only small variations with season, as expected for the small seasonality in stratospheric Bry and NO2 in this region. A pronounced diurnal variation can be observed, the average value for the morning being 1.3×1014 molecules/cm2 and for the evening 1.5×1014 molecules/cm2. The measurements are compared with simulations from a one-dimensional photochemical stacked box model which is coupled with a radiative transfer model to allow direct comparisons between the observations and the model calculations. In general the model reproduces the measurements very well. The differences in the absolute values are 15% for the evening and 20% for the morning which is within the limits of the combined uncertainties. Both seasonality and diurnal variation are well reproduced by the model. A sensitivity study shows that inclusion of the reaction BrONO2 + O(3P) significantly improves the agreement between model calculations and measurements, indicating an important role of this reaction in the stratosphere near to the equator. Tropospheric BrO columns and profile information is derived from the combined results obtained in the different viewing directions for the average over several clear days. The resulting tropospheric BrO columns are in the range of 4-7.5×1012 molecules/cm2 which is significant but lower than in previous studies at mid and high latitudes. The vertical distribution of the tropospheric BrO peaks at about 3 km indicating the absence of local sources at this high altitude site.
Kimeu, Redemptar; Kariuki, Charles
Summary Introduction The demographics, clinical characteristics and management of patients presenting at the Nairobi Hospital with acute myocardial infarction have not been documented in the past. There is a paucity of studies on this subject in this region. Methods A retrospective, hospital-based study was carried out, examining data of patients presenting at Nairobi Hospital with acute myocardial infarction between January 2007 and June 2009. The data collected were patient demographics, coronary artery disease (CAD) risk factors, clinical presentation, GRACE score risk stratification, coronary anatomical findings on angiography, interventions and outcomes during hospitalisation. Results Sixty-four patients were recruited (mean age 56.7 years). The CAD risk-factor profile included systemic hypertension in 71.9% of patients, age over 55 or 65 years in men and women, respectively in 42.2%, 35.9% of subjects were smokers, low high-density lipoprotein cholesterol levels in 25%, diabetes mellitus in 25%, family history of premature coronary artery disease in 8%, prior acute coronary syndrome in 18.8%, ST-segment elevation myocardial infarction (STEMI) in 60.9% and non-ST-segment elevation myocardial infarction (NSTEMI) in 39.1% of patients. In the STEMI arm, 79.5% of patients underwent thrombolysis, 17.9% had rescue percutaneous coronary intervention (PCI) and 2.6% had no reperfusion therapy. Medical management was carried out in 29% of the patients, 19.1% had a coronary artery bypass graft and 40.4% had PCI. The mean duration of hospitalisation was 6.69 days. The in-hospital mortality rate was 9.4% and mean in-hospital probability of death according to the GRACE risk score was 16.05%. Discharge medication was a β-blocker in 84.5% of patients, an ACE inhibitor or angiotensin receptor blocker in 48.3%, low-dose aspirin in 96.6%, clopidogrel in 96.6% and statins in 93.1%. Conclusion: The risk-factor assessment in our population, albeit small, was in keeping with the
Bin Tarif, Abid; Lasecka, Lidia; Holzer, Barbara; Baron, Michael D
Partly due to climate change, and partly due to changes of human habitat occupation, the impact of tick-borne viruses is increasing. Nairobi sheep disease virus (NSDV) and Ganjam virus (GV) are two names for the same virus, which causes disease in sheep and goats and is currently known to be circulating in India and East Africa. The virus is transmitted by ixodid ticks and causes a severe hemorrhagic disease. We have developed a real-time PCR assay for the virus genome and validated it in a pilot study of the pathogenicity induced by two different isolates of NSDV/GV. One isolate was highly adapted to tissue culture, grew in most cell lines tested, and was essentially apathogenic in sheep. The second isolate appeared to be poorly adapted to cell culture and retained pathogenicity in sheep. The real-time PCR assay for virus easily detected 4 copies or less of the viral genome, and allowed a quantitative measure of the virus in whole blood. Measurement of the changes in cytokine mRNAs showed similar changes to those observed in humans infected by the closely related virus Crimean Congo hemorrhagic fever virus.
Mudege, Netsayi Noris; Zulu, Eliya M
Using qualitative data collected from a sample of rural-urban migrants over the age of 15 in two Nairobi slums interviewed in 2008, this paper discusses the migrants' extent of satisfaction with their residential location and decision to migrate. The study sheds light on why people continue to migrate to, and stay in, the rapidly growing slum settlements despite the high levels of poverty and poor health conditions in these areas. Tenure status is related to satisfaction for all ages. Environmental factors were frequently mentioned as a source of dissatisfaction. Life cycle and 'age-cohort effects' may also affect satisfaction for different age groups in terms of who is satisfied as well as the issues that are considered for satisfaction. High levels of dissatisfaction with slum life may be responsible for high out-migration in slum areas, although it does not mean that those who remain do so because they are satisfied. At the same time, challenges associated with slum life do not automatically signify dissatisfaction. Perceived success, as well as conditions in the area of origin can be used to explain and understand satisfaction/dissatisfaction with slum life. Satisfaction with migration and residential location may be related not only to the destination place, but also to events in the area of origin.
Rowland-Jones, S L; Dong, T; Fowke, K R; Kimani, J; Krausa, P; Newell, H; Blanchard, T; Ariyoshi, K; Oyugi, J; Ngugi, E; Bwayo, J; MacDonald, K S; McMichael, A J; Plummer, F A
Many people who remain persistently seronegative despite frequent HIV exposure have HIV-specific immune responses. The study of these may provide information about mechanisms of natural protective immunity to HIV-1. We describe the specificity of cytotoxic T lymphocyte responses to HIV in seronegative prostitutes in Nairobi who are apparently resistant to HIV infection. These women have had frequent exposure to a range of African HIV-1 variants, primarily clades A, C, and D, for up to 12 yr without becoming infected. Nearly half of them have CTL directed towards epitopes previously defined for B clade virus, which are largely conserved in the A and D clade sequences. Stronger responses are frequently elicited using the A or D clade version of an epitope to stimulate CTL, suggesting that they were originally primed by exposure to these virus strains. CTL responses have been defined to novel epitopes presented by HLA class I molecules associated with resistance to infection in the cohort, HLA-A*6802 and HLA-B18. Estimates using a modified interferon-gamma Elispot assay indicate a circulating frequency of CTL to individual epitopes of between 1:3,200 and 1:50,000. Thus, HIV-specific immune responses-particularly cross-clade CTL activity- may be responsible for protection against persistent HIV infection in these African women. PMID:9802890
Egondi, Thaddaeus; Kyobutungi, Catherine; Ng, Nawi; Muindi, Kanyiva; Oti, Samuel; van de Vijver, Steven; Ettarh, Remare; Rocklöv, Joacim
Air pollution is among the leading global risks for mortality and responsible for increasing risk for chronic diseases. Community perceptions on exposure are critical in determining people’s response and acceptance of related policies. Therefore, understanding people’ perception is critical in informing the design of appropriate intervention measures. The aim of this paper was to establish levels and associations between perceived pollution and health risk perception among slum residents. A cross-sectional study of 5,317 individuals aged 35+ years was conducted in two slums of Nairobi. Association of perceived score and individual characteristics was assessed using linear regression. Spatial variation in the perceived levels was determined through hot spot analysis using ArcGIS. The average perceived air pollution level was higher among residents in Viwandani compared to those in Korogocho. Perceived air pollution level was positively associated with perceived health risks. The majority of respondents were exposed to air pollution in their place of work with 66% exposed to at least two sources of air pollution. Less than 20% of the respondents in both areas mentioned sources related to indoor pollution. The perceived air pollution level and related health risks in the study community were lowamong the residents indicating the need for promoting awareness on air pollution sources and related health risks. PMID:24157509
Njagi, Nkonge A; Oloo, Mayabi A; Kithinji, J; Kithinji, Magambo J
There are practically no low cost, environmentally friendly options in practice whether incineration, autoclaving, chemical treatment or microwaving (World Health Organisation in Health-care waste management training at national level,  for treatment of health-care waste. In Kenya, incineration is the most popular treatment option for hazardous health-care waste from health-care facilities. It is the choice practiced at both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret. A study was done on the possible public health risks posed by incineration of the segregated hazardous health-care waste in one of the incinerators in each of the two hospitals. Gaseous emissions were sampled and analyzed for specific gases the equipment was designed and the incinerators Combustion efficiency (CE) established. Combustion temperatures were also recorded. A flue gas analyzer (Model-Testos-350 XL) was used to sample flue gases in an incinerator under study at Kenyatta National Hospital--Nairobi and Moi Teaching and Referral Hospital--Eldoret to assess their incineration efficiency. Flue emissions were sampled when the incinerators were fully operational. However the flue gases sampled in the study, by use of the integrated pump were, oxygen, carbon monoxide, nitrogen dioxide, nitrous oxide, sulphur dioxide and No(x). The incinerator at KNH operated at a mean stack temperature of 746 °C and achieved a CE of 48.1 %. The incinerator at MTRH operated at a mean stack temperature of 811 °C and attained a CE of 60.8 %. The two health-care waste incinerators achieved CE below the specified minimum National limit of 99 %. At the detected stack temperatures, there was a possibility that other than the emissions identified, it was possible that the two incinerators tested released dioxins, furans and antineoplastic (cytotoxic drugs) fumes should the drugs be subjected to incineration in the two units.
The purpose of this quantitative research study was to determine the economic feasibility of a stand-alone PV system to electrify a rural area in Kenya. The research conducted involved a comprehensive review of all the relevant literature associated with the study. Methodologies were extrapolated from this extensive literature to develop a model for the complete design and economic analysis of a stand-alone PV system. A women's center in rural Kenya was used as a worked example to demonstrate the workings of the model. The results suggest that electrifying the center using a stand-alone PV system is an economically viable option which is encouraging for the surrounding area. This model can be used as a business model to determine the economic feasibility of a stand-alone PV system in alternative sites in Kenya.
Huttemann, Lutz, Ed.; Inganji, Francis K., Ed.
This workshop attended by 21 participants from 13 countries was designed to promote the use of computerized information and documentation services in the eastern and southern African subregion, and increase the exchange of experiences of the personnel involved in the field. The full text is provided for the following papers presented at the…
Papers concerning remote sensing and the environment are presented, including topics such as information for decision making, global monitoring and research, information systems for resource management, environmental monitoring and desertification, and early warning of environmental causes of African famine. Other aspects covered are geology and mineral resources, hydrology and water resources, agriculture and food resources, forestry and rangeland resources, mapping and charting, ocean and coastal applications, and earth observation systems for resource and environmental assessment. The use of Landsat MSS and TM, SIR, SPOT, MOMS, Meteosat, and NOAA/AVHRR data, computer based geographic information systems, gold exploration, groundwater survey, flood monitoring, crop estimations, rangeland monitoring, wildlife tracking, coral reef studies, coastal change detection, international cooperation in remote sensing, monitoring sand movement, structural analysis, mapping sediments, image processing, rainfall assessment, watershed management, biomass energy mapping, impacts of dam construction, vegetation mapping, extraction of hydrological parameters, remote sensing of urban environments, space maps, topographic mapping, Fourier models for interpreting thermal-IR imagery, and the monitoring of landuse changes.
Mbwesa, Joyce Kanini
There is a long history of study and recognition of the critical role of interaction in supporting and even defining distance education. Interaction has been identified as key to the success of distance learning. It is key in fostering, supporting and engaging in the learning process. Moore (1989) posits that the physical distance that exists in…
Kagendo, D; Magambo, J; Agola, E L; Njenga, S M; Zeyhle, E; Mulinge, E; Gitonga, P; Mbae, C; Muchiri, E; Wassermann, M; Kern, P; Romig, T
To investigate the presence of Echinococcus spp. in wild mammals of Kenya, 832 faecal samples from wild carnivores (lions, leopards, spotted hyenas, wild dogs and silver-backed jackals) were collected in six different conservation areas of Kenya (Meru, Nairobi, Tsavo West and Tsavo East National Parks, Samburu and Maasai Mara National Reserves). Taeniid eggs were found in 120 samples (14.4%). In total, 1160 eggs were isolated and further analysed using RFLP-PCR of the nad1 gene and sequencing. 38 of these samples contained eggs of Echinococcus spp., which were identified as either Echinococcus felidis (n=27) or Echinococcus granulosus sensu stricto (n=12); one sample contained eggs from both taxa. E. felidis was found in faeces from lions (n=20) and hyenas (n=5) while E. granulosus in faeces from lions (n=8), leopards (n=1) and hyenas (n=3). The host species for two samples containing E. felidis could not be identified with certainty. As the majority of isolated eggs could not be analysed with the methods used (no amplification), we do not attempt to give estimates of faecal prevalences. Both taxa of Echinococcus were found in all conservation areas except Meru (only E. felidis) and Tsavo West (only E. granulosus). Host species identification for environmental faecal samples, based on field signs, was found to be unreliable. All samples with taeniid eggs were subjected to a confirmatory host species RLFP-PCR of the cytochrome B gene. 60% had been correctly identified in the field. Frequently, hyena faeces were mistaken for lion and vice versa, and none of the samples from jackals and wild dogs could be confirmed in the tested sub-sample. This is the first molecular study on the distribution of Echinococcus spp. in Kenyan wildlife. The presence of E. felidis is confirmed for lions and newly reported for spotted hyenas. Lions and hyenas are newly recognized hosts for E. granulosus s.s., while the role of leopards remains uncertain. These data provide the basis for
This article examines the inter-relationship between psychiatry and sex, both fertile fields within the recent historiography of colonialism and empire. Using a series of case files pertaining to European patients admitted to the Mathari Mental Hospital in Nairobi during the 1940s and 1950s, this article shows how sexual transgression among colonial Europeans precipitated, and was combined with, mental distress. Considering psychiatric treatment as a form of social control, the article investigates a number of cases in which a European patient had been perceived to have transgressed the normative sexual behaviour codes of settler society in Kenya. What these files suggest is that transgressive sexuality in Kenya was itself framed by indices, as insistent as they were uncertain, of gender, race and class. While psychiatry as social control has some degree of purchase here, more valuable is an attempt to discern the particular ways in which certain forms of sexual behaviour were understood in diagnostic terms. Men who had sex with Africans, we see, tended to be diagnosed as 'depressed' on arrival at the hospital but were judged to be mentally normal consequently. Women, by contrast, were liable to be diagnosed as psychopathic, a diagnosis, I argue, that helped to explain the uniquely transgressive status of impoverished European women living alone in the margins of white society. Unlike white men, moreover, women did not have to have sex with non-Europeans to transgress sexual codes: this is because female poverty was a sexual problem in a way that male poverty decidedly was not. Poor white women were marked by uncertainty over their sexual behaviour—and dubious racial identity in its turn—and the problem of social contamination was described by reference both to the polluted racial ancestry of an individual and to the prospective contamination of healthy racial stocks. This article aims to address current historical debates around sex and empire, 'white
Data from a household survey were used to analyse the distribution of newborn deliveries in a rural area of Kenya. It was found that 52% of deliveries occurred at home or with traditional birth attendants. Using regression techniques, the most significant predictors of choosing an informal delivery setting are the household's distance from the nearest maternity bed and whether a household member has insurance. The results suggest that travel time is an important barrier to access. Therefore, quality improvements at existing facilities may not result in greater use of modern sector delivery, particularly if improvements are partially offset by user fees.
Background People’s perceptions of and attitudes towards pollution are critical for reducing exposure among people and can also influence the response to interventions that are aimed at encouraging behaviour change. This study assessed the perceptions and attitudes of residents in two slums in Nairobi regarding air pollution. Methods We conducted focus group discussions with residents aged 18 years and above using an emergent design in the formulation of the study guide. A thematic approach was used in data analysis. Results The discussions revealed that the two communities experience air pollution arising mainly from industries and dump sites. There was an apparent disconnect between knowledge and practice, with individuals engaging in practices that placed them at high risk of exposure to air pollution. Residents appear to have rationalized the situation in which they live in and were resigned to these conditions. Consequently, they expressed lack of agency in addressing prevalent air pollution within their communities. Conclusions Community-wide education on air pollution and related health effects together with the measures needed to reduce exposure to air pollution are necessary towards reducing air pollution impacts. A similar city-wide study is recommended to enable comparison of perceptions along socio-economic groups and neighbourhoods. PMID:24597487
Marwick, T. R.; Tamooh, F.; Ogwoka, B.; Teodoru, C.; Borges, A. V.; Darchambeau, F.; Bouillon, S.
As part of a broader study on the riverine biogeochemistry in the Athi-Galana-Sabaki (A-G-S) River catchment (Kenya), we present data constraining the sources, transit and transformation of multiple nitrogen (N) species as they flow through the A-G-S catchment (~47 000 km2). The data set was obtained in August-September 2011, November 2011, and April-May 2012, covering the dry season, short rain season and long rain season respectively. Release of (largely untreated) wastewater from the city of Nairobi had a profound impact on the biogeochemistry of the upper Athi River, leading to low dissolved oxygen (DO) saturation levels (36-67%), high ammonium (NH4+) concentrations (123-1193 μmol L-1), and high dissolved methane (CH4) concentrations (3765-6729 nmol L-1). Riverine dissolved inorganic nitrogen (DIN; sum of NH4+ and nitrate (NO3-); nitrite was not measured) concentration at the most upstream site on the Athi River was highest during the dry season (1195 μmol L-1), while DIN concentration was an order of magnitude lower during the short and long rain seasons (212 and 193 μmol L-1, respectively). During the rain seasons, low water residence time led to relatively minimal in-stream N cycling prior to discharge to the ocean, whereas during the dry season we speculate that prolonged residence time creates two differences comparative to wet season, where (1) intense N cycling and removal of DIN is possible in the upper to mid-catchment and leads to significantly lower concentrations at the outlet during the dry season, and (2) as a result this leads to the progressive enrichment of 15N in the particulate N (PN) pool, highlighting the dominance of untreated wastewater as the prevailing source of riverine DIN. The rapid removal of NH4+ in the upper reaches during the dry season was accompanied by a quantitatively similar production of NO3- and nitrous oxide (N2O) downstream, pointing towards strong nitrification over this reach during the dry season. Nitrous oxide
53 (male, femalej. Holotype: 0, Zika Forest, Uganda, C. Khamala, light trap, 17-V-66 (BMNH). Paratypes: 1 0, 1 6, Kakamega Forest, Kenya, C...types: 3 &?, same data as holotype (1 6, BMNH; 1 6, MRAC; 1 8, NMK); 8 QQ, 2 86, Zika Forest, Uganda, C. Khamala, light trap, 5-V-66 (1 Q, 1 8, BMNH; 1...collected several adults in East Africa, in- cluding one from a savanna in Kenya and three from the Zika Forest in Uganda. In Nigeria, Di- peolu (197613
Omenda, P. A.; Simiyu, S.; Anthony, E. Y.; Keller, G. R.; Dean, R. L.
Lithospheric structure, as delineated by geophysics, plays a fundamental role in both felsic and mafic magmatic compositions in the Kenya Rift. With respect to the mafic rocks, there are, first, silica-undersaturated basanites of the Chyulu Hills. This location is off-axis to the rift, where the lithosphere is thick. The lavas have been modeled as high-pressure, small degree partial melts. This origin contrasts to that for the silica-saturated transitional basalts, basaltic trachy-andesites, and andesites in the axis of the rift. These magmas were generated by higher degrees of partial melt and are also much more evolved, with Mg numbers approximately 40 to 50. The lavas have seen substantial crystal fractionation prior to eruption. An important component of lithospheric structure within the rift axis is the Kenya Dome: it is an area of thick crust and high elevation and heat flow. The crust is made thicker by a 6.8 km/sec lower crustal layer. Immediately below this crust is a very slow upper mantle. Velocities become more lithospheric to the south of the Kenya Dome in the vicinity of Suswa. This lithosphere then thickens southward into Tanzania. The felsic central volcanoes of the rift, which are significant geothermal targets, reflect these lithospheric variations. Eburru and Olkaria are both centered on the Kenya Dome. Eburru is pantellerite and can be modeled as resulting from crystallization of silica-saturated basalt. Olkaria is comendite and resulted from fusion of lower crustal syenite. That we find such distinct petrogenesis for two closely spaced volcanoes indicates that this area of very warm mantle has the temperatures necessary to generate high degree partial melt magmas, which evolve into pantellerites, and also fuse the lower crust. Suswa, which is the southernmost volcano and in the area where lithosphere thickens, is composed on phonolites, which can be modeled as resulting from crystallization of silica-undersaturated mafic parents. Presumably
Attitudes toward intimate partner violence (IPV) were compared between Zambian and Kenyan men on sociodemographic, attitudinal, and structural predictors of such attitudes. Data were retrieved from the latest Demographic and Health Surveys in each country. The results showed that many men in Zambia (71%) and Kenya (68%) justified IPV to punish a…
Liu, Zhimin; Mutinda, Gladys
Mass higher education is a huge force to be reckoned with and its existence, already in the expansion of tertiary institutions is undeniable. This study will focus on three countries: Lebanon, Kenya and Oman. The purpose of this study is to evaluate mass tertiary education progress in these countries. It will synthesize data results of gross…
Echaune, Manasi; Ndiku, Judah M.; Sang, Anthony
The factors associated with students' academic performance may have been addressed but the impact of parental involvement continues to be a significant issue. Some schools in Kenya post poor results amid claims that parents are not supportive. This study examined the effect of parental involvement in homework on academic performance in public…
Marais, Petro; Maithya, Redempta
Drug abuse is becoming an increasing problem among students in Kenya. The major cause for concern is that a high proportion of the Kenyan youth in secondary schools are involved in drugs (NACADA 2012). As a result, these young people eventually become addicted, posing a threat to their own health and safety. This study sought to establish the…
Dogbey, James; Quigley, Cassie; Che, Megan; Hallo, Jeffrey
This study engaged key stakeholders in an economically and environmentally fragile region in Kenya in a unique, interdisciplinary, and integrative approach to explore the extent to which the use of smartphone technology helps access the environmental values and sustainability perspectives of the people of the Maasai land. The results of the study…
Munene, Ishmael I.; Ruto, Sara J.
Since 1948, various UN conventions have recognised basic education as a human right. Yet this right continues to be denied to many child labourers across the world. This articles draws on the results of a study examining how children in domestic labour in Kenya access and participate in education. Three issues were explored: (1) the correlates of…
Maritim, Ezra K.
Globally, distance learning has gained legitimacy as an effective mode for learning and training. This legitimacy has occurred as a result of, "inter alia", its flexibility with respect to time, pace and entry requirements, affordability, cost-effectiveness, and reputation for high quality. In Kenya, distance learning--although…
Mucherah, Winnie; Herendeen, Abbey
This study examined primary school students' reading motivation and performance on the standardized exam. Participants included 901 seventh and eighth grade students from Kenya. There were 468 females and 433 males. Contrary to previous studies, results showed reading challenge and aesthetics, but not efficacy, predicted reading achievement,…
Ochieng', Josephine Atieno
In December 2007, unprecedented violence erupted in Kenya following the announcement of disputed presidential election results. The electorate was divided along ethnic lines and tribal clashes bordering on ethnic cleansing escalated. Those supporting opposing camps found themselves on the wrong side of the political divide leading to killings,…
Syvertsen, Jennifer L.; Ohaga, Spala; Agot, Kawango; Dimova, Margarita; Guise, Andy; Rhodes, Tim; Wagner, Karla D.
Background Illegal drug markets are shaped by multiple forces, including local actors and broader economic, political, social, and criminal justice systems that intertwine to impact health and social wellbeing. Ethnographic analyses that interrogate multiple dimensions of drug markets may offer both applied and theoretical insights into drug use, particularly in developing nations where new markets and local patterns of use traditionally have not been well understood. This paper explores the emergent drug market in Kisumu, western Kenya, where our research team recently documented evidence of injection drug use. Methods Our exploratory study of injection drug use was conducted in Kisumu from 2013-2014. We draw on 151 surveys, 29 in-depth interviews, and 8 months of ethnographic fieldwork to describe the drug market from the perspective of injectors, focusing on their perceptions of the market and reports of drug use therein. Results Injectors described a dynamic market in which the availability of drugs and proliferation of injection drug use have taken on growing importance in Kisumu. In addition to reports of white and brown forms of heroin and concerns about drug adulteration in the market, we unexpectedly documented widespread perceptions of cocaine availability and injection in Kisumu. Examining price data and socio-pharmacological experiences of cocaine injection left us with unconfirmed evidence of its existence, but opened further possibilities about how the chaos of new drug markets and diffusion of injection-related beliefs and practices may lend insight into the sociopolitical context of western Kenya. Conclusions We suggest a need for expanded drug surveillance, education and programming responsive to local conditions, and further ethnographic inquiry into the social meanings of emergent drug markets in Kenya and across sub-Saharan Africa. PMID:26838470
Ndetei, David M.; Khasakhala, Lincoln I.; Mutiso, Victoria; Ongecha-Owuor, Francisca A.; Kokonya, Donald A.
The objective of this study was to establish the association between substance abuse and the sociodemographic characteristics of secondary school students. All the students of 17 randomly stratified public secondary schools in Nairobi were required to complete self-administered sociodemographic and the School Toolkit questionnaires in a…
Olwendo, O. J.; Baki, P.; Cilliers, P. J.; Doherty, P.; Radicella, S.
In this study we have used a VHF and GPS-SCINDA receiver located at Nairobi (36.8°E, 1.3°S, dip -24.1°) in Kenya to investigate the climatology of ionospheric L-band scintillation occurrences for the period 2009 to 2012; and seasonal variation of the zonal plasma drift irregularities derived from a VHF receiver for the period 2011. The annual and diurnal variations of L-band scintillation indicate occurrence at post sunset hours and peaks in the equinoctial months. However VHF scintillation occurs at all seasons around the year and is characterized by longer duration of activity and a slow fading that continues till early morning hours unlike in the L-band where they cease after midnight hours. A directional analysis has shown that the spatial distribution of scintillation events is mainly on the Southern and Western part of the sky over Nairobi station closer to the edges of the crest of the Equatorial Ionization Anomaly. The distribution of zonal drift velocities of the VHF related scintillation structures indicates that they move at velocities in the range of 20-160 m/s and their dimension in the East-West direction is in the range of 100-00 km. The December solstice is associated with the largest plasma bubbles in the range of 600-900 km. The most significant observation from this study is the occurrence of post-midnight scintillation without pre-midnight scintillations during magnetically quiet periods. The mechanism leading to the formation of the plasma density irregularity causing scintillation is believed to be via the Rayleigh Tailor Instability; it is however not clear whether we can also attribute the post-midnight plasma bubbles during magnetic quiet times to the same mechanism. From our observations in this study, we suggest that a more likely cause of the east ward zonal electric fields at post-midnight hours is the coupling of the ionosphere with the lower atmosphere during nighttime. This however needs a further investigation based on relevant
Cardinal, Judith L.
After providing background information on Kenya, examines the history of the country's educational system. Describes the administrative and pedagogical organization and goals of the Harambee Institutes of Technology, designed to train middle-level technicians. Discusses the institutes' financial support problems and issues faced in adapting the…
Abstract Established under Section 25 of the HIV Prevention and Control Act of 2006, the HIV and AIDS Tribunal of Kenya is the only HIV-specific statutory body in the world with the mandate to adjudicate cases relating to violations of HIV-related human rights. Yet, very limited research has been done on this tribunal. Based on findings from a desk research and semi-structured interviews of key informants conducted in Kenya, this article analyzes the composition, mandate, procedures, practice, and cases of the tribunal with the aim to appreciate its contribution to the advancement of human rights in the context of HIV. It concludes that, after a sluggish start, the HIV and AIDS Tribunal of Kenya is now keeping its promise to advance the human rights of people living with and affected by HIV in Kenya, notably through addressing barriers to access to justice, swift ruling, and purposeful application of the law. The article, however, highlights various challenges still affecting the tribunal and its effectiveness, and cautions about the replication of this model in other jurisdictions without a full appraisal. PMID:27781008
Shamberger, Cynthia T.
As a former special education teacher at the elementary, middle and high school levels, many unique and complex learning situations were encountered. The author, who was a junior faculty member on her initial trip to Kenya, experienced a very challenging, yet rewarding, learning opportunity with teachers gathered in a community located in rural…
East Africa is home to a rich array of stone-tool traditions that span human prehistory. It is unsurprising, therefore, that the region attracted pioneer prehistorians in the early twentieth century, including L. S. B. Leakey, E. J. Wayland and T. P. O'Brien, who created the first cultural framework for East African prehistory during the 1930s. Although aspects of this framework remain relevant today, others have become misunderstood relics of an old classification system that hinders current research. This is particularly evident in the classification of a Later Stone Age (LSA) culture - the Kenya (East African) Aurignacian, later known as Kenya (East African) Capsian. Although this cultural entity was redressed during the 1970s and 1980s and redefined as the Eburran industry, there is still mystique surrounding the current status of the Kenya Capsian, its original scope and definition, the relationship with the Eburran and its position within a modern understanding of the East African LSA. This is largely due to paradigmatic shifts in researcher attitudes, leading to the use of the Eburran as a false proxy. It is necessary now to completely remove the term Kenya Capsian as an indication of similarity among the different LSA technologies. However, there also needs to be less emphasis on the importance of the Eburran and recognition that it is just one example of a multitude of diverse localised LSA industries. This will open the way for future research into the LSA and facilitate our greater understanding of recent prehistory in East Africa.
Orwenjo, Daniel Ochieng
Arguments that have been advanced against multilingual education in Kenya and Africa in general are not new. Most post-colonial African governments have stuck to the pre-colonial education policies which have no relevance to the present day Africa and were, at best, guided by the interests of the colonial power. Unfortunately, most of the claims…
Sub-Saharan Africa has the highest incidence of child labor in the world and estimates show that it continues to grow. This paper examines the causes and magnitude of child labor in Kenya. Unlike previous studies that examined child labor as only an economic activity, this paper includes household chores. Including household chores is important…
Clark, Shelley; Kabiru, Caroline; Mathur, Rohini
The process of courtship and marriage in sub-Saharan Africa has changed remarkably. These changes, however, have received scant attention because recent research has focused on adolescent relationships' links to HIV/AIDS rather than to marriage. Drawing on detailed reports of 1,365 romantic and sexual partnerships from youths in Kisumu, Kenya, we…
Coldevin, G. O.
Describes the development and use of educational broadcasting, notably radio, in Kenya since its independence. Published and unpublished reports, a 1978 survey, numerous interviews with educational radio and television officials, mass media seminars, and field visits to schools and broadcast facilities are used to analyze the major projects. (CHC)
Background Intervention coverage and funding for the control of malaria in Africa has increased in recent years, however, there are few descriptions of changing disease burden and the few reports available are from isolated, single site observations or are of reports at country-level. Here we present a nationwide assessment of changes over 10 years in paediatric malaria hospitalization across Kenya. Methods Paediatric admission data on malaria and non-malaria diagnoses were assembled for the period 1999 to 2008 from in-patient registers at 17 district hospitals in Kenya and represented the diverse malaria ecology of the country. These data were then analysed using autoregressive moving average time series models with malaria and all-cause admissions as the main outcomes adjusted for rainfall, changes in service use and populations-at-risk within each hospital's catchment to establish whether there has been a statistically significant decline in paediatric malaria hospitalization during the observation period. Results Among the 17 hospital sites, adjusted paediatric malaria admissions had significantly declined at 10 hospitals over 10 years since 1999; had significantly increased at four hospitals, and remained unchanged in three hospitals. The overall estimated average reduction in malaria admission rates was 0.0063 cases per 1,000 children aged 0 to 14 years per month representing an average percentage reduction of 49% across the 10 hospitals registering a significant decline by the end of 2008. Paediatric admissions for all-causes had declined significantly with a reduction in admission rates of greater than 0.0050 cases per 1,000 children aged 0 to 14 years per month at 6 of 17 hospitals. Where malaria admissions had increased three of the four sites were located in Western Kenya close to Lake Victoria. Conversely there was an indication that areas with the largest declines in malaria admission rates were areas located along the Kenyan coast and some sites in
A resolution condemning the September 2013 terrorist attack at the Westgate Mall in Nairobi, Kenya, and reaffirming United States support for the people and Government of Kenya, and for other purposes.
Sen. Coons, Christopher A. [D-DE
11/06/2013 Resolution agreed to in Senate without amendment and with a preamble by Unanimous Consent. (consideration: CR S7888-7889) (All Actions) Tracker: This bill has the status Passed SenateHere are the steps for Status of Legislation:
Morgan, Gwendolyn; Keesbury, Jill; Speizer, Ilene
Rates of emergency contraception (EC) use in sub-Saharan Africa are highest in Kenya and Nigeria, although little is understood about user characteristics and use dynamics in these countries. In order to better meet the emergency contraceptive needs of women, and contribute to the limited knowledge base on EC in Africa, this study examines a large, representative sample of EC users. It draws on data collected from household surveys that included 7,785 sexually experienced women in urban Kenya and 12,653 sexually experienced women in urban Nigeria. Bivariate and multivariate analyses found that among these urban women, knowledge of EC was higher than reported in other nationally representative surveys (58% in Kenya and 31% in Nigeria). About 12% of sexually-experienced women in Kenya and 6% in Nigeria ever used EC, although fewer women (less than 5%) reported using EC in the past one year. Recent users of EC were more likely to be in their twenties, unmarried, and more highly educated than never users or ever users of EC in both countries. Results contradict public perceptions of EC users as younger adolescents, and indicate the importance of strengthening EC provision in Africa, including targeting information and services to unmarried women and supporting private pharmacies in delivering quality EC services. PMID:24615575
Okumu, Tequiero Abuom; Munene, John Njenga; Wabacha, James; Tsuma, Victor; Leeuwen, John Van
Aim: The objective of this study was to determine the seroprevalence of Neospora caninum (NC) and its risk factors in farm dogs in Kenya. Materials and Methods: As part of a longitudinal study on dairy cattle abortion in 2010 in Kenya, serum samples were collected from 84 dogs in 53 randomly selected dairy cattle farms to determine the seroprevalence and risk factors of seropositivity for NC. Results: 15 (17.9%) of the dogs were seropositive to NC antibodies, and at least one seropositive dog was found in 12 (22.6%) of the 53 farms. The final multivariable logistic regression model identified free-roaming as the only factor significantly associated with seropositivity (odds ratio=4.48; p=0.03). Conclusion: The findings of this study indicate that canine neosporosis does exist in Kenya and that farmers should restrict their dogs from roaming to reduce the risk of their dogs becoming a reservoir for NC. More studies need to be carried out to determine the reproductive effects of NC on dairy cattle in Kenya. PMID:27847430
Muchukuri, Esther; Grenier, Francis R
Background Dramatic inequalities dominate global health today. The rapid urban growth sustained by Kenya in the last decades has created many difficulties that also led to worsening inequalities in health care. The continuous decline in its Human Development Index since the 1990s highlights the hardship that continues to worsen in the country, against the general trend of Sub-Saharan Africa. This paper examines the health status of residents in a major urban centre in Kenya and reviews the effects of selected social determinants on local health. Methods Through field surveys, focus group discussions and a literature review, this study canvasses past and current initiatives and recommends priority actions. Results Areas identified which unevenly affect the health of the most vulnerable segments of the population were: water supply, sanitation, solid waste management, food environments, housing, the organization of health care services and transportation. Conclusion The use of a participatory method proved to be a useful approach that could benefit other urban centres in their analysis of social determinants of health. PMID:19439105
Anyamba, A; Linthicum, K J; Tucker, C J
All known Rift Valley fever(RVF) outbreaks in Kenya from 1950 to 1998 followed periods of abnormally high rainfall. On an interannual scale, periods of above normal rainfall in East Africa are associated with the warm phase of the El Niño/Southern Oscillation (ENSO) phenomenon. Anomalous rainfall floods mosquito-breeding habitats called dambos, which contain transovarially infected mosquito eggs. The eggs hatch Aedes mosquitoes that transmit the RVF virus preferentially to livestock and to humans as well. Analysis of historical data on RVF outbreaks and indicators of ENSO (including Pacific and Indian Ocean sea surface temperatures and the Southern Oscillation Index) indicates that more than three quarters of the RVF outbreaks have occurred during warm ENSO event periods. Mapping of ecological conditions using satellite normalized difference vegetation index (NDVI) data show that areas where outbreaks have occurred during the satellite recording period (1981-1998) show anomalous positive departures in vegetation greenness, an indicator of above-normal precipitation. This is particularly observed in arid areas of East Africa, which are predominantly impacted by this disease. These results indicate a close association between interannual climate variability and RVF outbreaks in Kenya.
Disease spreads as a result of people moving and coming in contact with each other. Thus the mobility patterns of individuals are crucial in understanding disease dynamics. Here we study the impact of human mobility on HIV transmission in different parts of Kenya. We build an SIR metapopulation model that incorporates the different regions within the country. We parameterise the model using census data, HIV data and mobile phone data adopted to track human mobility. We found that movement between different regions appears to have a relatively small overall effect on the total increase in HIV cases in Kenya. However, the most important consequence of movement patterns was transmission of the disease from high infection to low prevalence areas. Mobility slightly increases HIV incidence rates in regions with initially low HIV prevalences and slightly decreases incidences in regions with initially high HIV prevalence. We discuss how regional HIV models could be used in public-health planning. This paper is a first attempt to model spread of HIV using mobile phone data, and we also discuss limitations to the approach. PMID:26599277
Anyamba, A.; Linthicum, K. J.; Tucker, C. J.
All known Rift Valley fever(RVF) outbreaks in Kenya from 1950 to 1998 followed periods of abnormally high rainfall. On an interannual scale, periods of above normal rainfall in East Africa are associated with the warm phase of the El Nino/Southern Oscillation (ENSO) phenomenon. Anomalous rainfall floods mosquito-breeding habitats called dambos, which contain transovarially infected mosquito eggs. The eggs hatch Aedes mosquitoes that transmit the RVF virus preferentially to livestock and to humans as well. Analysis of historical data on RVF outbreaks and indicators of ENSO (including Pacific and Indian Ocean sea surface temperatures and the Southern Oscillation Index) indicates that more than three quarters of the RVF outbreaks have occurred during warm ENSO event periods. Mapping of ecological conditions using satellite normalized difference vegetation index (NDVI) data show that areas where outbreaks have occurred during the satellite recording period (1981-1998) show anomalous positive departures in vegetation greenness, an indicator of above-normal precipitation. This is particularly observed in arid areas of East Africa, which are predominantly impacted by this disease. These results indicate a close association between interannual climate variability and RVF outbreaks in Kenya.
Mungai, David N.
Recent developments have led to a lot of emphasis being placed on early childhood education. Massive growth has also occurred in this segment of the education sector. Emphasis continues to be placed not just on growth but also on quality of the educational experiences that children are exposed to. In Kenya reports continue to emerge of pupils in…
Rutto, Jane Jemeli; Osano, Odipo; Thuranira, Elias Gitonga; Kurgat, Richard Kiptum; Odenyo, Victor Agab Omondi
Background Kenya and Uganda have reported different Human African Trypanosomiasis incidences in the past more than three decades, with the latter recording more cases. This cross-sectional study assessed the demographic characteristics, tsetse and trypanosomiasis control practices, socio-economic and cultural risk factors influencing Trypanosoma brucei rhodesiense (T.b.r.) infection in Teso and Busia Districts, Western Kenya and Tororo and Busia Districts, Southeast Uganda. A conceptual framework was postulated to explain interactions of various socio-economic, cultural and tsetse control factors that predispose individuals and populations to HAT. Methods A cross-sectional household survey was conducted between April and October 2008. Four administrative districts reporting T.b.r and lying adjacent to each other at the international boundary of Kenya and Uganda were purposely selected. Household data collection was carried out in two villages that had experienced HAT and one other village that had no reported HAT case from 1977 to 2008 in each district. A structured questionnaire was administered to 384 randomly selected household heads or their representatives in each country. The percent of respondents giving a specific answer was reported. Secondary data was also obtained on socio-economic and political issues in both countries. Results Inadequate knowledge on the disease cycle and intervention measures contributed considerable barriers to HAT, and more so in Uganda than in Kenya. Gender-associated socio-cultural practices greatly predisposed individuals to HAT. Pesticides-based crop husbandry in the 1970's reportedly reduced vector population while vegetation of coffee and banana's and livestock husbandry directly increased occurrence of HAT. Livestock husbandry practices in the villages were strong predictors of HAT incidence. The residents in Kenya (6.7%) applied chemoprophylaxis and chemotherapeutic controls against trypanosomiasis to a larger extent than
Gatari, Michael; Ngo, Nicole; Ndiba, Peter; Kinney, Patrick
Air quality is a serious and worsening problem in the rapidly growing cities of sub-Saharan Africa (SSA), due to rapid urbanization, growing vehicle fleets, changing life styles, limited road infrastructure and land use planning, and high per-vehicle emissions. However, the absence of ambient monitoring data, and particularly urban roadside concentrations of particulate matter in SSA cities, severely limits our ability to assess the real extent of air quality problems. Emitted fine particles by on-road vehicles may be particularly important in SSA cities because large concentrations of poorly maintained vehicles operate in close proximity to commercial and other activities of low-income urban residents. This scenario provokes major air quality concerns and its investigation should be of priority interest to policy makers, city planners and managers, and the affected population. As part of collaboration between Columbia University and the University of Nairobi, a PM2.5 air monitoring study was carried out over two weeks in July 2009. The objectives of the study were 1) to assess average daytime PM2.5 concentrations on a range of Nairobi streets that represent important hot-spots in terms of the joint distribution of traffic, commercial, and resident pedestrian activities, 2) to relate those concentrations to motor vehicle counts, 3) to compare urban street concentrations to urban and rural background levels, and 4) to assess vertical and horizontal dispersion of PM2.5 near roadways. Portable, battery-operated PM2.5 samplers were carried by field teams at each of the five sites (three urban, one commuter highway, and one rural site), each of which operated from 7 AM to 7 PM during 10 weekdays in July 2009. Urban background monitoring took place on a rooftop at the University of Nairobi. Preliminary findings suggest highly elevated PM2.5 concentrations at the urban sites where the greatest pedestrian traffic was observed. These findings underscore the need for air
livelihood, ൲ Historical Setting while others made illegal arrangements with African proxies to operate their busine :;ses. Even Asians who held...mutually intelligible dialects of a single language, whereas Kipsigis and Pokot are not. Two kinds of multilingualism are to be found in Kenya. In the... intelligently critical Marxism without the jargon. Still of value is the 1972 International Labour Office report Employment, Incomes, and Equality: A Strategy
horizon- tal transmission involving vertebrate hosts (1). Rickettsiae are small, gram-negative, fastidious bacteria of the a sub- division of...Human Infection with Rickettsia felis, Kenya Allen L. Richards, Ju Jiang, Sylvia Omulo, Ryan Dare, Khalif Abdirah~a~, P:bdile Ali, Shanaaz K...infection with obligate intracellular rickettsiae , which are transmitted to humans by arthropod vectors (e.g., lice, fleas, ticks, and mites
Nestle, Switzerland Ivory Coast COCOA PRODUCTS: Cadbury Schweppes, UK Kenya, Ghana, Nigeria Gill & Duffus, UK Ghana Interfood, Switzerland Ivory Coast...Japan Kenya, Ghana, Mauritius Kellogg’s, USA Somalia SOFT DRINKS CONCENTRATES: Beecham, UK Nigeria Cadbury Schweppes, UK Zambia, Zimbabwe Lonrho...CONFECTIONERY PRODUCTS: Cadbury Schweppes, UK Kenya, Tanzania Nestle, Switzerland Ivory Coast Standard Brands, USA Zimbabwe Wrigley, USA Kenya BEER: Allied
Mungai, Anne M.
This book examines the education of rural girls in Kenya and reports on a study of factors influencing girls' educational success or failure. Three chapters provide background on traditional values and practices affecting girls' education; describe Kenya's education system, including preprimary, primary (grades 1-8), secondary, university,…
This paper identifies, examines and discusses higher education funding policy shifts that have taken place in Kenya. The paper argues that even though Kenya's higher education funding policy shifts, from free higher education to cost-sharing, and privatisation and commercialisation, are (to a greater extent) products of the country's encounter…
This article reports some findings of study regarding practices and procedures of internal instructional supervision in public secondary schools in Kenya. The findings are part of a large-scale project undertaken in Kenya to determine the perceptions of headteachers, teachers and senior government education officers regarding the practices of…
Muhula, Samuel Opondo; Peter, Memiah; Sibhatu, Biadgilign; Meshack, Ndirangu; Lennie, Kyomuhangi
Recent improvements in access to Anti-Retroviral Therapy (ART) have radically reduced hospitalizations and deaths associated with HIV infection in both developed countries and sub-Saharan Africa. Not much is known about survival of patients on ART in slums. The objective of this study was to identify factors associated with mortality among adult patients on ART in resource poor, urban, sub-Saharan African setting. A prospective open cohort study was conducted with adult patients on ART at a clinic in Kibera slums, Nairobi, Kenya. The patients' enrollment to care was between March 2005 and November 2011. Descriptive statistics were computed and Kaplan-Meier (KM) methods used to estimate survival time while Cox's proportional hazards (CPH) model fitted to determine mortality predictors. A total of 2,011 adult patients were studied, 69% being female. Female gender (p=0.0016), zidovudine-based regimen patients (p<0.0001), CD4 count>351 patients (p<0.0001), WHO stage I patients (p<0.0001) and "Working" functional status patients recorded better survival probability on ART. In CPH analysis, the hazard of dying was higher in patients on Stavudine-based regimen(hazard ratio (HR)=.8; 95% CI, 1.5-2.2; p<0.0001),CD4 count<50 cells/µl (HR=1.6; 95% CI, 1.5-1.7;p<0.0001), WHO Stage IV at ART initiation (HR=1.3; 95% CI, 1.1-1.6; p=0.016) and bedridden patients (HR=2.7; 95% CI, 1.7-4.4;p<0.0001). There was increased mortality among the males, those with advanced Immunosuppression, late WHO stage and bedridden patients. The findings further justify the need to switch patients on Stavudine-based regimen as per the WHO recommendations.
Neervoort, Femke; von Rosenstiel, Ines; Bongers, Karlien; Demetriades, Matthew; Shacola, Marina; Wolffers, Ivan
To reduce malnutrition and improve child survival, school feeding programmes have been established in many parts of Africa, although prevalence of child malnutrition and anaemia remains high, especially in urban slums. The objective of this study is to evaluate the effect of a school feeding programme in the slums of Nairobi (Kenya) on anaemia and nutritional status, together with an investigation for socioeconomic determinants that may overrule this effect. Sixty-seven children at the St. George primary school in Kibera participated in the school feeding programme for 1 year and data concerning anaemia rate, nutritional status and socioeconomic status were collected during a medical health check. Data were compared with a control group of children attending the same school, of the same age and with the same gender distribution without participation in a feeding programme. Data were analyzed with statistical software (SPSS 17.0). Children participating in the school feeding programme were less stunted (p = 0.02) and wasted (p = 0.02) than children in the control group, and levels of anaemia were lower (p = 0.01). Having no father (p = 0.01) and living in small families (p = 0.003) overruled the effect of the feeding programme. Also, the higher the mother's education, the more wasting was seen (p = 0.04) despite participation in the programme. The programme reduced anaemia and malnutrition and has improved child growth in our study group greatly, but we found that education level of the mother, family size and absence of a father overruled the effect of the school feeding programme. Because sample size of our study is small, we encourage further large-scaled research on reviewing programmatic interventions to develop optimal feeding strategies and improve nutritional status of children.
van de Vijver, Steven; Gomez, Gabriela B; Agyemang, Charles; Egondi, Thaddaeus; Kyobutungi, Catherine; Stronks, Karien
Abstract Objective To describe the processes, outcomes and costs of implementing a multi-component, community-based intervention for hypertension among adults aged > 35 years in a large slum in Nairobi, Kenya. Methods The intervention in 2012–2013 was based on four components: awareness-raising; improved access to screening; standardized clinical management of hypertension; and long-term retention in care. Using multiple sources of data, including administrative records and surveys, we described the inputs and outputs of each intervention activity and estimated the outcomes of each component and the impact of the intervention. We also estimated the costs associated with implementation, using a top-down costing approach. Findings The intervention reached 60% of the target population (4049/6780 people), at a cost of 17 United States dollars (US$) per person screened and provided access to treatment for 68% (660/976) of people referred, at a cost of US$ 123 per person with hypertension who attended the clinic. Of the 660 people who attended the clinic, 27% (178) were retained in care, at a cost of US$ 194 per person retained; and of those patients, 33% (58/178) achieved blood pressure control. The total intervention cost per patient with blood pressure controlled was US$ 3205. Conclusion With moderate implementation costs, it was possible to achieve hypertension awareness and treatment levels comparable to those in high-income settings. However, retention in care and blood pressure control were challenges in this slum setting. For patients, the costs and lack of time or forgetfulness were barriers to retention in care. PMID:27429489
Zemsky, Robert; Shaman, Susan; Shapiro, Daniel B.
Describes the Collegiate Results Instrument (CRI), which measures a range of collegiate outcomes for alumni 6 years after graduation. The CRI was designed to target alumni from institutions across market segments and assess their values, abilities, work skills, occupations, and pursuit of lifelong learning. (EV)
Kennedy, E T; Oniang'o, R
This study examined the effects of an income-generating policy to expand the commercialization of subsistence agriculture in southwestern Kenya on household and preschooler macro- and micronutrient consumption. A representative sample of 617 household was included, and all preschoolers under the age of 6 y (1677) residing in these households were included in the study. Results of this analysis indicate that although increases in household income do result in improved household level vitamin A consumption, increases in household income are not significantly associated with the intake of dietary vitamin A by preschoolers. The analysis suggests that although increases in household income have some very positive effects on household food security and household micronutrient consumption, other community-based health, sanitation and nutrition interventions are needed to address the dietary needs of individuals within the household.
Widmann, Marina; Warsame, Abdulkadir Hussein; Mikulica, Jan; von Beust, Johannes; Isse, Maimuna Mohamud; Ndetei, David; al’Absi, Mustafa; Odenwald, Michael G.
In East-African and Arab countries, khat leaves are traditionally chewed in social settings. They contain the amphetamine-like alkaloid cathinone. Especially among Somali refugees, khat use has been associated with psychiatric symptoms. We assessed khat-use patterns and psychiatric symptoms among male Somali refugees living in a disadvantaged urban settlement area in Kenya, a large group that has not yet received scientific attention. We wanted to explore consume patterns and study the associations between khat use, traumatic experiences, and psychotic symptoms. Using privileged access sampling, we recruited 33 healthy male khat chewers and 15 comparable non-chewers. Based on extensive preparatory work, we assessed khat use, khat dependence according to DSM-IV, traumatic experiences, posttraumatic stress disorder (PTSD), and psychotic symptoms using standardized diagnostic instruments that had been adapted to the Somali language and culture. Hazardous use patterns like chewing for more than 24 h without interruption were frequently reported. All khat users fulfilled the DSM-IV-criteria for dependence and 85% reported functional khat use, i.e., that khat helps them to forget painful experiences. We found that the studied group was heavily burdened by traumatic events and posttraumatic symptoms. Khat users had experienced more traumatic events and had more often PTSD than non-users. Most khat users experience khat-related psychotic symptoms and in a quarter of them we found true psychotic symptoms. In contrast, among control group members no psychotic symptoms could be detected. We found first evidence for the existence and high prevalence of severely hazardous use patterns, comorbid psychiatric symptoms, and khat use as a self-medication of trauma-consequences among male Somali refugees in urban Kenyan refugee settlements. There is a high burden by psychopathology and adequate community-based interventions urgently need to be developed. PMID:25072043
Marwick, T. R.; Tamooh, F.; Ogwoka, B.; Teodoru, C.; Borges, A. V.; Darchambeau, F.; Bouillon, S.
As part of a broader study on the riverine biogeochemistry in the Athi-Galana-Sabaki (A-G-S) River catchment (Kenya), we present data constraining the sources, transit and transformation of multiple nitrogen (N) species as they flow through the A-G-S catchment (~47 000 km2). The data-set was obtained in August-September 2011, November 2011, and April-May 2012, covering the dry season, short-rain season and long-rain season respectively. Release of, largely untreated, waste water from the city of Nairobi had a profound impact on the biogeochemistry of the upper Athi river, leading to low dissolved oxygen (DO) saturation levels (67-36%), high ammonium (NH4+) concentrations (1193-123 μmol L-1), and high dissolved methane (CH4) concentrations (6729-3765 nmol L-1). Total dissolved inorganic nitrogen (DIN) concentrations entering the study area were highest during the dry season (1195 μmol L-1), while total DIN concentration was an order of magnitude lower during the short and long rain seasons (212 and 193 μmol L-1, respectively). During the rain seasons, low water residence time led to relatively minimal instream N-cycling prior to discharge to the ocean. Conversely, increased residence time during the dry season creates two differences comparative to wet season conditions, where (1) intense cycling and removal of DIN in the upper- to mid-catchment leads to significantly less DIN export during the dry season, and (2) as a result of the intense DIN cycling, dry season particulate N export is significantly enriched in the N stable isotope ratio (δ15NPN), strongly reflecting the dominance of organic matter as the prevailing source of riverine nitrogen. The rapid removal of NH4+ in the upper study area during the dry season was accompanied by a quantitatively similar production of NO3- and nitrous oxide (N2O) downstream, pointing towards strong nitrification over this reach during the dry season. Nitrous oxide produced was rapidly degassed downstream, while the
Miller, N N
The Institute of Cultural Affairs (ICA) in Kenya and the Zimbabwe Project in Zimbabwe are organizations working to promote local level development in their respective countries and a major challenge to these organizations has been how to change the attitudes and perceptions of the poor in ways that help them help themselves. ICA efforts are carried out in Kenya by several hundred volunteer staff, including 30 expatriates. Most are assigned to 1 of the 21 projects spread across southern Kenya. Since 1975 the ICA has launched projects in over 200 villages. Village clean up, public health, school construction, water development, and agricultural improvement are some of the project categories. Tangible results include starting demonstration farms, field terracing projects, building pit latrines and compost pits, constructing new pathways, roads, and schoolrooms. Many of ICA's efforts are funded by local companies and through Kenyan offices of development organizations. In the field of health, ICA provides training courses at the village level that emphasize preventive care, sanitation, hygiene, nutrition, family planning, first aid, and treatment of common illnesses. ICA's mobilization techniques are based on motivating villagers to help themselves, to "catalyze and energize" the resources at hand. The process begins with a "consult" in which 12 or more ICA staff conduct a 3- or 4-day meeting with villagers to reorient local thinking. A special effort is made to break old attitudes that have held traditional villagers back. The consult is also designed to confront traditional assumptions about what the longterm reality might be. For urban slum villages the focus is on the transient nature of community that serves as low cost housing for thousands of newly arrived migrants. Today the Zimbabwe Project (ZP) is working with former soldiers, although when established in 1978 in Britain its purpose was to assist refugees from the Rhodesian struggle who had fled to Botswana
Plas, R.J. van der
This paper presents results of two recent World Bank efforts made in Kenya, Niger, and Cameroon to study the impact of two different renewable projects, one a Micro-Lights program involving about 500 lanterns and the second a survey of 410 households using solar electricity systems. The Micro-Lights program showed that users have distinct preferences in the style of the lamps, that they are willing to spend cash, and that they demand good quality. They may be initially satisfied, but rapidly want more from their purchases. The photoelectric system survey touched less than 1% of such households, and looked at user education, system size, satisfaction, expectations, age of system, appliances, and expectations.
Fritz, H.; Hauzenberger, C. A.; Tenczer, V.
Tanzania and southern Kenya hold a key position for reconstructing Gondwana consolidation because here different orogen belts with different tectonic styles interfere. The older, ca. 650-620 Ma East African Orogeny resulted from the amalgamation of arc terranes in the northern Arabian-Nubian Shield (ANS) and continental collision between East African pieces and parts of the Azania terrane in the south (Collins and Pisarevsky, 2005). The change form arc suturing to continental collision settings is found in southern Kenya where southernmost arcs of the ANS conjoin with thickened continental margin suites of the Eastern Granulite Belt. The younger ca. 570-530 Ma Kuunga orogeny heads from the Damara - Zambesi - Irumide Belts (De Waele et al., 2006) over Tanzania - Mozambique to southern India and clashes with the East African orogen in southern-central Tanzania. Two transitional orogen settings may be defined, (1) that between island arcs and inverted passive continental margin within the East African Orogen and, (2) that between N-S trending East African and W-E trending Kuungan orogenies. The Neoproterozoic island arc suites of SE-Kenya are exposed as a narrow stripe between western Azania and the Eastern Granulite belt. This suture is a steep, NNW stretched belt that aligns roughly with the prominent southern ANS shear zones that converge at the southern tip of the ANS (Athi and Aswa shear zones). Oblique convergence resulted in low-vorticity sinstral shear during early phases of deformation. Syn-magmatic and syn-tectonic textures are compatible with deformation at granulite metamorphic conditions and rocks exhumed quickly during ongoing transcurrent motion. The belt is typified as wrench tectonic belt with horizontal northwards flow of rocks within deeper portions of an island arc. The adjacent Eastern Granulite Nappe experienced westward directed, subhorizontal, low-vorticity, high temperature flow at partly extreme metamorphic conditions (900°C, 1.2 to 1.4 GPa
Corroon, Meghan; Kebede, Essete; Spektor, Gean; Speizer, Ilene
ABSTRACT Background: The Family Planning 2020 initiative aims to reach 120 million new family planning users by 2020. Drug shops and pharmacies are important private-sector sources of contraception in many contexts but are less well understood than public-sector sources, especially in urban environments. This article explores the role that drug shops and pharmacies play in the provision of contraceptive methods in selected urban areas of Nigeria and Kenya as well as factors associated with women's choice of where to obtain these methods. Methods: Using data collected in 2010/2011 from representative samples of women in selected urban areas of Nigeria and Kenya as well as a census of pharmacies and drug shops audited in 2011, we examine the role of drug shops and pharmacies in the provision of short-acting contraceptive methods and factors associated with a women's choice of family planning source. Results: In urban Nigeria and Kenya, drug shops and pharmacies were the major source for the family planning methods of oral contraceptive pills, emergency contraceptives, and condoms. The majority of injectable users obtained their method from public facilities in both countries, but 14% of women in Nigeria and 6% in Kenya obtained injectables from drug shops or pharmacies. Harder-to-reach populations were the most likely to choose these outlets to obtain their short-acting methods. For example, among users of these methods in Nigeria, younger women (<25 years old) were significantly more likely to obtain their method from a drug shop or pharmacy than another type of facility. In both countries, family planning users who had never been married were significantly more likely than married users to obtain these methods from a drug shop or a pharmacy than from a public-sector health facility. Low levels of family planning-related training (57% of providers in Kenya and 41% in Nigeria had received training) and lack of family planning promotional activities in pharmacies and
The use of numerical models for the evaluation of the generating potential of high temperature geothermal fields has increased rapidly in recent years. In the present paper a unified numerical approach to the modeling of geothermal systems is discussed and the results of recent modeling of the Krafla geothermal field in Iceland and the Olkaria, Kenya, are described. Emphasis is placed on describing the methodology using examples from the two geothermal fields.
Case, Jonathan L.; Mungai, John; Sakwa, Vincent; Zavodsky, Bradley T.; Srikishen, Jayanthi; Limaye, Ashutosh; Blankenship, Clay B.
Flooding, severe weather, and drought are key forecasting challenges for the Kenya Meteorological Department (KMD), based in Nairobi, Kenya. Atmospheric processes leading to convection, excessive precipitation and/or prolonged drought can be strongly influenced by land cover, vegetation, and soil moisture content, especially during anomalous conditions and dry/wet seasonal transitions. It is thus important to represent accurately land surface state variables (green vegetation fraction, soil moisture, and soil temperature) in Numerical Weather Prediction (NWP) models. The NASA SERVIR and the Short-term Prediction Research and Transition (SPoRT) programs in Huntsville, AL have established a working partnership with KMD to enhance its regional modeling capabilities. SPoRT and SERVIR are providing experimental land surface initialization datasets and model verification capabilities for capacity building at KMD. To support its forecasting operations, KMD is running experimental configurations of the Weather Research and Forecasting (WRF; Skamarock et al. 2008) model on a 12-km/4-km nested regional domain over eastern Africa, incorporating the land surface datasets provided by NASA SPoRT and SERVIR. SPoRT, SERVIR, and KMD participated in two training sessions in March 2014 and June 2015 to foster the collaboration and use of unique land surface datasets and model verification capabilities. Enhanced regional modeling capabilities have the potential to improve guidance in support of daily operations and high-impact weather and climate outlooks over Eastern Africa. For enhanced land-surface initialization, the NASA Land Information System (LIS) is run over Eastern Africa at 3-km resolution, providing real-time land surface initialization data in place of interpolated global model soil moisture and temperature data available at coarser resolutions. Additionally, real-time green vegetation fraction (GVF) composites from the Suomi-NPP VIIRS instrument is being incorporated
Mechie, J.; Keller, Gordon R.; Prodehl, C.; Gaciri, S.; Braile, L.W.; Mooney, W.D.; Gajewski, D.; Sandmeier, K.-J.
Modelling of the KRISP 90 axial line data shows that major crustal thinning occurs along the axis of the Kenya Rift from Moho depths of 35 km in the south beneath the Kenya Dome in the vicinity of Lake Naivasha to 20 km in the north beneath Lake Turkana. Low Pn velocities of 7.5-7.7 km/s are found beneath the whole of the axial line. The results indicate that crustal extension increases to the north and that the low Pn velocities are probably caused by magma (partial melt) rising from below and being trapped in the uppermost kilometres of the mantle. Along the axial line, the rift infill consisting of volcanics and a minor amount of sediments varies in thickness from zero where Precambrian crystalline basement highs occur to 5-6 km beneath the lakes Turkana and Naivasha. Analysis of the Pg phase shows that the upper crystalline crust has velocities of 6.1-6.3 km/s. Bearing in mind the Cainozoic volcanism associated with the rift, these velocities most probably represent Precambrian basement intruded by small amounts of igneous material. The boundary between the upper and lower crusts occurs at about 10 km depth beneath the northern part of the rift and 15 km depth beneath the southern part of the rift. The upper part of the lower crust has velocities of 6.4-6.5 km/s. The basal crustal layer which varies in thickness from a maximum of 2 km in the north to around 9 km in the south has a velocity of about 6.8 km/s. ?? 1994.
Bussmann, Rainer W
Traditional plant use is of extremely high importance in many societies, and prevalent in African communities. This knowledge is however dwindling rapidly due to changes towards a more Western lifestyle. The influence of modern tourism cannot be neglected in this context. This paper examines the plant use of the Samburu of the Mt. Nyiru area in Northern Kenya. The Samburu pastoralists of Kenya are still amongst the most traditional communities of the country and have retained most of their knowledge about the use of a large part of the plants in their environment for a wide variety of purposes. The results indicate that the local population has a very high knowledge of the plants in their surroundings, and attributes a purpose to a large percentage of the plants found. 448 plant species were collected, identified and their Samburu names and traditional uses recorded. 199 species were reported as of "no use". The high proportion of 249 plant species however had some traditional use: The highest number (180 species) was used as fodder, followed by 80 species that had medicinal use. Firewood (59 species), construction (42 species), tools (31 species), food (29 species) and ceremonial use (19 species) ranked far behind. Traditionally the Samburu attribute most illnesses to the effect of pollutants that block or inhibit digestion. This can include "polluted" food, contagion through sick people as well as witchcraft. In most cases the treatment of illness involves herbal purgatives to cleanse the patient. There are however frequent indications of plant use for common problems like wounds, parasites, body aches and burns. The change from a nomadic to a more sedentary lifestyle, often observed in other areas of the country, has affected the Samburu of remote Mt. Nyiru to a much lesser extent and did so far not lead to a major loss of traditional plant knowledge. However, overgrazing and over-exploitation of plant resources have already led to a decline of the plant
Bussmann, Rainer W
Traditional plant use is of extremely high importance in many societies, and prevalent in African communities. This knowledge is however dwindling rapidly due to changes towards a more Western lifestyle. The influence of modern tourism cannot be neglected in this context. This paper examines the plant use of the Samburu of the Mt. Nyiru area in Northern Kenya. The Samburu pastoralists of Kenya are still amongst the most traditional communities of the country and have retained most of their knowledge about the use of a large part of the plants in their environment for a wide variety of purposes. The results indicate that the local population has a very high knowledge of the plants in their surroundings, and attributes a purpose to a large percentage of the plants found. 448 plant species were collected, identified and their Samburu names and traditional uses recorded. 199 species were reported as of "no use". The high proportion of 249 plant species however had some traditional use: The highest number (180 species) was used as fodder, followed by 80 species that had medicinal use. Firewood (59 species), construction (42 species), tools (31 species), food (29 species) and ceremonial use (19 species) ranked far behind. Traditionally the Samburu attribute most illnesses to the effect of pollutants that block or inhibit digestion. This can include "polluted" food, contagion through sick people as well as witchcraft. In most cases the treatment of illness involves herbal purgatives to cleanse the patient. There are however frequent indications of plant use for common problems like wounds, parasites, body aches and burns. The change from a nomadic to a more sedentary lifestyle, often observed in other areas of the country, has affected the Samburu of remote Mt. Nyiru to a much lesser extent and did so far not lead to a major loss of traditional plant knowledge. However, overgrazing and over-exploitation of plant resources have already led to a decline of the plant
Rostrup, Morten; Edwards, Jeffrey K.; Abukalish, Mohamed; Ezzabi, Masoud; Some, David; Ritter, Helga; Menge, Tom; Abdelrahman, Ahmed; Rootwelt, Rebecca; Janssens, Bart; Lind, Kyrre; Paasma, Raido; Hovda, Knut Erik
Background Outbreaks of methanol poisoning occur frequently on a global basis, affecting poor and vulnerable populations. Knowledge regarding methanol is limited, likely many cases and even outbreaks go unnoticed, with patients dying unnecessarily. We describe findings from the first three large outbreaks of methanol poisoning where Médecins Sans Frontières (MSF) responded, and evaluate the benefits of a possible future collaboration between local health authorities, a Non-Governmental Organisation and international expertise. Methods Retrospective study of three major methanol outbreaks in Libya (2013) and Kenya (May and July 2014). Data were collected from MSF field personnel, local health personnel, hospital files, and media reports. Findings In Tripoli, Libya, over 1,000 patients were poisoned with a reported case fatality rate of 10% (101/1,066). In Kenya, two outbreaks resulted in approximately 341 and 126 patients, with case fatality rates of 29% (100/341) and 21% (26/126), respectively. MSF launched an emergency team with international experts, medications and equipment, however, the outbreaks were resolving by the time of arrival. Interpretation Recognition of an outbreak of methanol poisoning and diagnosis seem to be the most challenging tasks, with significant delay from time of first presentations to public health warnings being issued. In spite of the rapid response from an emergency team, the outbreaks were nearly concluded by the time of arrival. A major impact on the outcome was not seen, but large educational trainings were conducted to increase awareness and knowledge about methanol poisoning. Based on this training, MSF was able to send a local emergency team during the second outbreak, supporting that such an approach could improve outcomes. Basic training, simplified treatment protocols, point-of-care diagnostic tools, and early support when needed, are likely the most important components to impact the consequences of methanol poisoning
Ulrich, Anne; Speranza, Chinwe Ifejika; Roden, Paul; Kiteme, Boniface; Wiesmann, Urs; Nusser, Marcus
The rural population of semi-arid lands in Kenya face multiple challenges that result from population growth, poor markets, land use and climatic changes. In particular, subsistence oriented farmers face various risks and opportunities in their attempt to secure their livelihoods. This paper presents an analysis on how livelihood assets and…
Analysis of household survey data in Kenya revealed that children's enrollment in school was affected by parents' expectations for future financial help from children and (for girls) by parents' perceptions of labor market discrimination against women, but not by patriarchal norms or child labor. The results challenge traditional explanations of…
Thiga, Jacqueline W; Mutai, Beth K; Eyako, Wurapa K; Ng'ang'a, Zipporah; Jiang, Ju; Richards, Allen L; Waitumbi, John N
Serum samples from patients in Kenya with febrile illnesses were screened for antibodies against bacteria that cause spotted fever, typhus, and scrub typhus. Seroprevalence was 10% for spotted fever group, <1% for typhus group, and 5% for scrub typhus group. Results should help clinicians expand their list of differential diagnoses for undifferentiated fevers.
Ngala, Frederick B. J. A.; Odebero, Stephen O.
Results-based management has gained currency in Kenya. After pre-service training, teachers take various staff development programmes to enhance their role effectiveness. Many studies which have associated staff development with employee productivity have not delved into the actual mechanisms in which staff development impact on teachers'…
Mears, Melynda; Singletary, Jon; Rogers, Rob
This qualitative study explored the extent to which programs in a religiously affiliated agency in Kenya incorporate 12 internationally sanctioned strategies for supporting orphans and vulnerable children in Sub-Saharan Africa (Olson, Knight, & Foster, 2006). The results indicated that all 12 strategies were being employed, though to varying…
Kenya has introduced policies to promote universal primary schooling at least three times since independence. Analysis of enrolments over four decades shows how these initiatives have resulted in gains in participation which have not always been sustained. This study illuminates the dynamics of efforts to increase access to education and acts as a…
Bold, Tessa; Kimenyi, Mwangi S.; Mwabu, Germano; Sandefur, Justin
A large empirical literature has shown that user fees significantly deter public service utilization in developing countries. While most of these results reflect partial equilibrium analysis, we find that the nationwide abolition of public school fees in Kenya in 2003 led to no increase in net public enrollment rates, but rather a dramatic shift…
Kock, N D; Kock, R A; Wambua, J; Kamau, G J; Mohan, K
An epizootic in free-ranging lesser flamingos (Phoeniconaias minor) in Kenya resulted in more than 18,500 deaths from August through mid-November 1993. Disease was concentrated along the shores of Rift Valley Lakes Bogoria and Nakuru (Kenya) and did not involve any of the other avian or mammalian species frequenting the lakes. Coincidental to the outbreak was a bloom of algae on Lake Bogoria, toxins from which were first suspected to be causative. Discrete necrotic and granulomatous lesions were often noted in spleen and liver, and Mycobacterium avium serovar I was isolated from both organs. Escherichia coli and Pseudomonas aeruginosa also were often recovered in pure culture from liver. Gross and histopathological evaluation of the cases disclosed signs of acute sepsis and also chronic, potentially life-threatening lesions of mycobacteriosis, primarily involving the spleen and liver. Lesions typical for algae toxicosis were not seen in any birds. Deaths were attributed to septicemia complicated in those affected, by mycobacteriosis.
Background Ocular rhinosporidiosis is a chronic granulomatous infection caused by a newly classified organism that is neither a fungus nor bacterium. It often presents as a benign conjunctival tumour but may mimic other ocular conditions. It is most often described in India. In Africa cases have been reported from South Africa, Kenya, Tanzania, Malawi, Uganda, Congo and Ivory Coast. Case presentation A 54 year old man was seen in Kenya with a lesion that resembled a conjunctival papilloma. We report resemblance to conjunctival papilloma and the result of vital staining with 0.05% Toluidine Blue. Conclusion Ocular rhinosporidiosis occurs in East Africa. It may resemble conjunctival squamous papilloma. Vital staining with 0.05% Toluidine blue dye did not distinguish the two lesions well. PMID:24708655
Chetcuti, Deborah A.; Kioko, Beriter
This study investigated girls' attitudes towards science in Kenya. It was carried out with 120 girls from four secondary schools in the Eastern province of Kenya. These were an urban single-sex (SS) and co-educational (Co-Ed) school and a rural SS and Co-Ed school. Different schools were chosen in order to explore whether there are any differences in attitudes in SS and Co-Ed schools and in schools in rural and urban areas. The methodology included the use of both questionnaires and focus group interviews. The main aim was to gain insight into the extent and depth of students' attitudes towards science. The findings of the study showed that the majority of Kenyan girls who participated in the study have a favourable attitude towards science. Girls in SS schools were found to have a more favourable attitude than those in Co-Ed schools, while girls in rural area schools were found to find science more relevant than those in urban schools. It emerged from this study that the attitudes of Kenyan girls are influenced by their perceptions of the relevance of science, enjoyment of studying science, perceptions of the suitability of science for a career, and their perceptions of subject difficulty.
It is taboo in Africa to discuss sexual issues with strangers and even trained family planning providers often feel uncomfortable discussing reproductive health issues with groups of people, especially men. In the wake of the successful use of puppets to teach audiences in South Africa about AIDS, the Family Planning Association of Kenya used puppets to teach men about family planning, sexually transmitted diseases, and HIV/AIDS. Trained puppetry troops now perform regularly in Kenya at male-dominated institutions in Nakuru and Kakamega. The approach has proved highly effective in drawing crowds of men to listen to reproductive health information. Puppetry represents real life, but remains one step removed from the real world. As such, puppets can be used to break down racial, social, and political barriers and stereotypes; they can say more on controversial issues than can a live actor without offending the audience; and they are highly portable and adaptable. Puppets offer the viewer and listener a nonthreatening opportunity to look and laugh at themselves.
INFECTIOUS DISEASES, KENYA, LABORATORIES, MORTALITY RATES, PUBLIC HEALTH, RATS, RIFT VALLEY FEVER , SURVIVAL(PERSONNEL), THREATS, VETERINARY MEDICINE, WEST AFRICA , YEASTS, YELLOW FEVER , ZAIRE...EPIDEMIOLOGY, *VIRUSES, *VIRUS DISEASES, AFRICA , CONVALESCENCE, DISEASES, ECOLOGY, EQUATORIAL REGIONS, FEVERS , HEMORRHAGIC FEVERS , HUMANS, ILLNESS
Emukule, Gideon O.; Paget, John; van der Velden, Koos; Mott, Joshua A.
Background In Kenya data on the burden of influenza disease are needed to inform influenza control policies. Methods We conducted a systematic review of published data describing the influenza disease burden in Kenya using surveillance data collected until December 2013. We included studies with laboratory confirmation of influenza, well-defined catchment populations, case definitions used to sample patients for testing and a description of the laboratory methods used for influenza testing. Studies with or without any adjustments on the incidence rates were included. Results Ten studies reporting the incidence of medically-attended and non-medically attended influenza were reviewed. For all age groups, the influenza positive proportion ranged from 5–10% among hospitalized patients, and 5–27% among all medically-attended patients (a combination of in- and outpatients). The adjusted incidence rate of hospitalizations with influenza among children <5 years ranged from 2.7–4.7 per 1,000 [5.7 per 1,000 in children <6 months old], and were 7–10 times higher compared to persons aged ≥5 years. The adjusted incidence of all medically-attended influenza among children aged <5 years ranged from 13.0–58.0 per 1,000 compared to 4.3–26.0 per 1,000 among persons aged ≥5 years. Conclusions Our review shows an expanding set of literature on disease burden associated with influenza in Kenya, with a substantial burden in children under five years of age. Hospitalizations with influenza in these children were 2–3 times higher than reported in the United States. These findings highlight the possible value of an influenza vaccination program in Kenya, with children <5 years and pregnant women being potentially important targets. PMID:26398196
Masakhwe, Clement; Ochanda, Horace; Nyakoe, Nancy; Ochiel, Daniel; Waitumbi, John
Background Most acute febrile illnesses (AFI) are usually not associated with a specific diagnosis because of limitations of available diagnostics. This study reports on the frequency of EBV viremia and viral load in children and adults presenting with febrile illness in hospitals in Kenya. Methodology/Principal Findings A pathogen surveillance study was conducted on patients presenting with AFI (N = 796) at outpatient departments in 8 hospitals located in diverse regions of Kenya. Enrollment criterion to the study was fever without a readily diagnosable infection. All the patients had AFI not attributable to the common causes of fever in Kenyan hospitals, such as malaria or rickettsiae, leptospira, brucella and salmonella and they were hence categorized as having AFI of unknown etiology. EBV was detected in blood using quantitative TaqMan-based qPCR targeting a highly conserved BALF5 gene. The overall frequency of EBV viremia in this population was 29.2%, with significantly higher proportion in younger children of <5years (33.8%, p = 0.039) compared to patients aged ≥5 years (26.3% for 5–15 years or 18.8% for >15 years). With respect to geographical localities, the frequency of EBV viremia was higher in the Lake Victoria region (36.4%), compared to Kisii highland (24.6%), Coastal region (22.2%) and Semi-Arid region (25%). Furthermore, patients from the malaria endemic coastal region and the Lake Victoria region presented with significantly higher viremia than individuals from other regions of Kenya. Conclusions/Significance This study provides profiles of EBV in patients with AFI from diverse eco-regions of Kenya. Of significant interest is the high frequency of EBV viremia in younger children. The observed high frequencies of EBV viremia and elevated viral loads in residents of high malaria transmission areas are probably related to malaria induced immune activation and resultant expansion of EBV infected B-cells. PMID:27163791
Izulla, Preston; McKinnon, Lyle R; Munyao, Julius; Ireri, Naomi; Nagelkerke, Nico; Gakii, Gloria; Gelmon, Lawrence; Nangami, Mabel; Kaul, Rupert; Kimani, Joshua
As ART-based prevention becomes available, effectively targeting these interventions to key populations such as female sex workers (FSW) will be critical. In this study we analyze patterns of repeated post-exposure prophylaxis (PEP) access in the context of a large FSW program in Nairobi. During close to 6000 person-years of follow-up, 20 % of participants (n = 1119) requested PEP at least once and 3.7 % requested PEP more than once. Repeat PEP users were younger, had a higher casual partner volume, and were more likely to use condoms with casual and regular partners, have a regular partner, and test for HIV prior to enrolment. Barriers to PEP included stigma, side effects, and lack of knowledge, suggesting repeated promotion may be required for higher rates of uptake. A small subset of FSW, potentially those with heightened risk perception, showed a higher frequency of PEP use; these individuals may be most amenable to rollout of pre-exposure prophylaxis.
Gaciri, S. J.; Davies, T. C.
In recent years the acquisition of considerable additional data on the hydrogeochemical behaviour of fluoride in natural waters of Kenya has been made possible by extensive surface-water and groundwater sampling campaigns as well as by improvements in analytical techniques. Ultimately, the principal source of fluoride relates to emissions from volcanic activity associated with the East African Rift System. Through various intermediate steps, but also directly, fluoride passes into the natural water system and components of the food chain. Ingestion by man is mainly through drinking water and other beverages. River waters in Kenya generally have a fluoride concentration lower than the recommended level (1.3 ppm) for potable water, thus promoting susceptibility to dental caries. Groundwaters and lake waters show considerably higher fluoride contents, resulting in the widespread incidence of fluorosis in areas where groundwater is the major source of drinking water, and lake fish is a regular component of the diet. This paper presents a synthesis of the data so far obtained on the sources and distribution of fluoride in the hydrological system of Kenya, examines the extent of fluorine toxicity and puts forward recommendations to combat or minimise the problem.
Mungai, Teresiah Muciku; Owino, Anita Awino; Makokha, Victorine Anyango; Gao, Yan; Yan, Xue; Wang, Jun
The concentration distribution and toxicological assessment of eight heavy metals including lead (Pb), cadmium (Cd), copper (Cu), chromium (Cr), nickel (Ni), mercury (Hg), arsenic (As), and zinc (Zn) in agricultural soils from Kenya, Eastern Africa, were investigated in this study. The results showed mean concentrations of eight heavy metals of Zn, Pb, Cr, Cu, As, Ni, Hg, and Cd in agricultural soils as 247.39, 26.87, 59.69, 88.59, 8.93, 12.56, 8.06, and 0.42 mg kg(-1), respectively. These mean values of eight heavy metals were close to the toxicity threshold limit of USEPA standard values of agricultural soils, indicating potential toxicological risk to the food chain. Pollution index values revealed that eight heavy metals severely decreased in the order Hg > Cd > As > Cu > Pb > Zn > Ni > Cr and the mean value of the overall pollution index of Hg and Cd was 20.31, indicating severe agriculture ecological risk. Potential pollution sources of eight heavy metals in agricultural soils were mainly from anthropogenic activities and natural dissolution. The intensification of human agricultural activities, the growing industrialization, and the rapid urbanization largely influenced the concentration levels of heavy metals in Kenya, Eastern Africa. Moreover, the lack of agricultural normalization management and poor enforcement of environmental laws and regulations further intensified the widespread pollution of agricultural soils in Kenya.
Mercer, T.; Kimani, S.; Braitstein, P.; Buziba, N.; Carter, E. J.
Background: Street-connected youth and young adults (SCY) suffer a myriad of health problems. In Kenya, SCY are at high risk for tuberculosis (TB) due to their congregate living situations. TB screening is not routinely implemented in SCY and there has been no published literature on the burden of TB in SCY in western Kenya. Program description: In 2011, the AMPATH TB Program, an experienced TB screening program, partnered with the Tumaini Center, a trusted street youth organization, to conduct intensified case finding (ICF) for pulmonary TB among SCY. Our program aimed to investigate the numbers of SCY who reported symptoms and those diagnosed with smear-positive pulmonary TB, and link SCY with TB to treatment. Results: Of 116 SCY who were screened, 114 (98%) had a positive questionnaire; 104 (90%) provided a spot sputum sample, 39 (34%) provided a morning sputum sample, and 111 (97%) reported cough of >2 weeks. One street youth tested smear-positive for TB and was treated through to cure. Conclusions: Implementing TB ICF is feasible in low-resource settings through unique collaborations between health care programs and community-based organizations. In addition to identifying smear-positive TB, our program uncovered a high burden of respiratory symptoms among SCY in Eldoret, Kenya. PMID:27358809
Yalwala, Sancto; Clark, Jeffrey; Oullo, David; Ngonga, Daniel; Abuom, David; Wanja, Elizabeth; Bast, Joshua
All traditional surveillance techniques for Aedes aegypti have been developed for the cosmopolitan domestic subspecies Ae. aegypti aegypti, and not the sylvatic subspecies, Ae. aegypti formosus. The predominant form in Western Kenya is Ae. aegypti formosus that is rarely associated with human habitations but is linked to transmission of sylvatic dengue virus strains. We compared five surveillance methods for their effectiveness in sampling Ae. aegypti formosus with the goal of determining a sustainable surveillance strategy in Kenya. The methods included larval and pupal surveys, oviposition trapping, BG-Sentinel trapping, resting boxes, and backpack aspirations. Larval and pupal surveys collected the highest number of Ae. aegypti formosus (51.3%), followed by oviposition traps (45.7%), BG-Sentinel traps (3.0%), and zero collected with either backpack aspiration or resting box collections. No Ae. aegypti formosus larvae or pupae were found indoors. The results indicate that oviposition traps and outdoor larval and pupal surveys were better surveillance methods for Ae. aegypti formosus in Western Kenya.
Jomo 0 13 Kenyatta , told the people that we had to work hard together in order to have progress and prosperity in Kenya. Many outsiders had thought that...Kenya would be in turmoil after independence in 1963, but to their astonishment, Kenyatta led the country to great heights. Furthermore, after his...has the "harambee" and "nyayo" philosophies. If Mzee Kenyatta had not instituted the "harambee" spirit of pulling together, things would probably
Virus Research Centre (VRC) permitting the safe handling of specimens suspected to contain haemorrhagic fever viruses . Incidence and prevalence rates of...in Kenya Research work done in Kenya has shown that three naemorrnagic fever viruses occur in the country. These are Rift Valley Fever Virus , Crimean... viruses are nazardous to culture and handle in conventional type I and two oiohazard hoods. It wds therefore necessary to construct an absolute virus
Matanda, Dennis Juma; Urke, Helga Bjørnøy; Mittelmark, Maurice B.
Objective(s) Using nationally representative surveys conducted in Kenya, this study examined optimal health promoting childcare practices in 2003, 2008–9 and 2014. This was undertaken in the context of continuous child health promotion activities conducted by government and non-government organizations throughout Kenya. It was the aim of such activities to increase the prevalence of health promoting childcare practices; to what extent have there been changes in optimal childcare practices in Kenya during the 11-year period under study? Methods Cross-sectional data were obtained from the Kenya Demographic and Health Surveys conducted in 2003, 2008–9 and 2014. Women 15–49 years old with children 0–59 months were interviewed about a range of childcare practices. Logistic regression analysis was used to examine changes in, and correlates of, optimal childcare practices using the 2003, 2008–9 and 2014 data. Samples of 5949, 6079 and 20964 women interviewed in 2003, 2008–9 and 2014 respectively were used in the analysis. Results Between 2003 and 2014, there were increases in all health facility-based childcare practices with major increases observed in seeking medical treatment for diarrhoea and complete child vaccination. Mixed results were observed in home-based care where increases were noted in the use of insecticide treated bed nets, sanitary stool disposal and use of oral rehydration solutions, while decreases were observed in the prevalence of urging more fluid/food during diarrhoea and consumption of a minimum acceptable diet. Logit models showed that area of residence (region), household wealth, maternal education, parity, mother's age, child’s age and pregnancy history were significant determinants of optimal childcare practices across the three surveys. Conclusions The study observed variation in the uptake of the recommended optimal childcare practices in Kenya. National, regional and local child health promotion activities, coupled with changes
Tchouassi, David P.; Bastos, Armanda D. S.; Sole, Catherine L.; Diallo, Mawlouth; Lutomiah, Joel; Mutisya, James; Mulwa, Francis; Borgemeister, Christian; Sang, Rosemary; Torto, Baldwyn
Rift Valley fever (RVF) outbreaks in Kenya have increased in frequency and range to include northeastern Kenya where viruses are increasingly being isolated from known (Aedes mcintoshi) and newly-associated (Ae. ochraceus) vectors. The factors contributing to these changing outbreak patterns are unclear and the population genetic structure of key vectors and/or specific virus-vector associations, in particular, are under-studied. By conducting mitochondrial and nuclear DNA analyses on >220 Kenyan specimens of Ae. mcintoshi and Ae. ochraceus, we uncovered high levels of vector complexity which may partly explain the disease outbreak pattern. Results indicate that Ae. mcintoshi consists of a species complex with one of the member species being unique to the newly-established RVF outbreak-prone northeastern region of Kenya, whereas Ae. ochraceus is a homogeneous population that appears to be undergoing expansion. Characterization of specimens from a RVF-prone site in Senegal, where Ae. ochraceus is a primary vector, revealed direct genetic links between the two Ae. ochraceus populations from both countries. Our data strongly suggest that unlike Ae. mcintoshi, Ae. ochraceus appears to be a relatively recent, single 'introduction' into Kenya. These results, together with increasing isolations from this vector, indicate that Ae. ochraceus will likely be of greater epidemiological importance in future RVF outbreaks in Kenya. Furthermore, the overall vector complexity calls into question the feasibility of mosquito population control approaches reliant on genetic modification. PMID:25474018
Mbabu, Murithi; Njeru, Ian; File, Sarah; Osoro, Eric; Kiambi, Stella; Bitek, Austine; Ithondeka, Peter; Kairu-Wanyoike, Salome; Sharif, Shanaaz; Gogstad, Eric; Gakuya, Francis; Sandhaus, Kaitlin; Munyua, Peninah; Montgomery, Joel; Breiman, Robert; Rubin, Carol; Njenga, Kariuki
A One Health (OH) approach that integrates human,animal and environmental approaches to management of zoonotic diseases has gained momentum in the last decadeas part of a strategy to prevent and control emerging infectious diseases. However, there are few examples of howan OH approach can be established in a country. Kenya establishment of an OH office, referred to asthe Zoonotic Disease Unit (ZDU) in 2011. The ZDU bridges theanimal and human health sectors with a senior epidemiologist deployed from each ministry; and agoal of maintaining collaboration at the animal and human health interface towards better prevention and control of zoonoses. The country is adding an ecologist to the ZDU to ensure that environmental risks are adequately addressed in emerging disease control. PMID:25722779
McMahon, J. P.; Highton, R. B.; Goiny, H.
S. neavei, the vector of onchocerciasis, has been virtually eradicated from Kenya by larviciding measures in which DDT was used. Only a very small area remains infested and this is in the course of being treated by the Uganda medical authorities as it is part of a much larger focus occurring in that country. An account is given of the various surveys which have been carried out during the last ten years in Nyanza Province, involving 15 000 square miles (about 40 000 km2), and survey techniques are described. An account is given of the eradication measures carried out in North and South Nyanza, and techniques in connexion with dosing and checking operations are described. Costs for both surveys and eradication schemes are given, and minimum requirements for transport are indicated. PMID:13585062
Circular migration is a central phenomenon in the lives of smallholders in East Africa. Many migration decisions are not individual decisions, but rather household decisions in which the household allocates its labor force among activities to maximize household utility. A probit model which incorporates circular migration and takes into account contacts, information, and indivisibilities is used to analyze migration among 763 farm households in the Central and Nyanza provinces of Kenya. Study data are from a 1982 survey. The pull of high urban wages appears to be a far more important determinant of migration decision outcomes than the push of land scarcity, while a strong local nonagricultural economy does not seem to restrict migration. Networks of personal contacts were found to be highly significant determinants of migration. These findings suggest that rural development will probably not reduce the flow of migration.
Clark, Shelley; Kabiru, Caroline; Mathur, Rohini
The process of courtship and marriage in sub-Saharan Africa has changed remarkably. These changes, however, have received scant attention, as recent research has focused on adolescent relationships’ links to HIV/AIDS rather than to marriage. Drawing on detailed reports of 1,365 romantic and sexual partnerships from youths in Kisumu, Kenya, we find that marital aspirations, school enrollment, emotional attraction, pregnancy, and independence from kin are all predictors of getting engaged or married. Furthermore, though men and women are much more likely to marry partners they believe are sexually exclusive, men who have multiple partners are actually more likely to get married. By focusing on the contemporary process of marriage, this paper offers an alternative portrayal of premarital relationships in sub-Saharan Africa. PMID:20885992
Davies, T. C.; Nyambok, I. O.
On 15 May 1991, a landslide occurred at Gacharage Village in the Murang'a District of Kenya; it buried a house near the toe of a cliff, killing all eight residents in their sleep. The principal determining factors of the slide were a high, mechanically unstable slope of deeply weathered volcanic soil and a high sorption capacity of the surface soil layer. The slide was triggered by rapid saturation of the soil following a heavy downpour. Based on field investigations and laboratory studies, this paper discusses the physical properties and environmental factors that affected slope stability at Murang'a. It also points out the economic and social impact of landslides in the region and suggests remedial measures.
This study focuses on wood-energy production and consumption strategies among small-scale farm households in central Kenya. The specific objective were: (1) to determine how households had responded to specific wood-energy policies; (2) to identify factors associated with household adoption or non-adoption of the strategies. Different programs aimed at addressing wood-energy shortages in Kenya were initiated or strengthened during the 1980s: fuelwood or multipurpose tree planting; development and dissemination of improved stoves and fireplaces; promotion of increased accessibility to wood-energy substitutes. Household adoption levels for policy-supported strategies have remained low despite promotion. Survey data from two villages in Nyeri district were collected to determine the factors associated with adoption of the Kenya Ceramic Jiko, the [open quotes]Kuni Mbili[close quotes] stove/fireplace, kerosene stoves, electric cookers, and fuelwood or multipurpose tree planting. Adoption rates varied from as low as 1 percent for electricity to 43 percent for the Kenya Ceramic Jiko. Important policy variables included extension visits per year, income levels, years of formal education received by head of household, access to different fuels, area of farm-land owned, household size, and locational characteristics of the villages. Policy recommendations included: use of research results to direct policy; improvement of information flows between policy makers, extension agents, and technology-users; increased support of agroforestry; and better program coordination. Recommendations for further research included: examining more areas where efficiency gains in energy production and consumption can be made, extending the study to cover the drier parts of central Kenya, and conducting regular case studies in order to better understand the adoption process over time.
Graham, Edward; Vaughan, Richard; Buckley, David A. H.; Tirima, Koi
The goal of the Search for an Astronomical Site in Kenya (SASKYA) project is to identify the best possible site(s) in Kenya for astronomical optical observation, using ERA-interim climate reanalyses and high-resolution UK Met Office Africa Limited Area meteorological model (Africa-LAM) data. This initial search focusses on a selection of 13 candidate mountain peaks across Kenya. A mixture of 30 years (1981-2010) of relatively coarse-grained ERA-interim reanalyses data and 12 months' (2011-2012) of much higher resolution UK Met Office Africa-LAM data were used to determine the best possible sites. Cloud cover, precipitable water vapour (specific humidity), vertical velocity, aerosol loadings and wind data were analysed. The results confirm that many sites in Kenya are reasonably cloud free, with estimated photometric night fractions of possibly 50 % at the best sites. Significant seasonal inter-annual and inter-decadal variations in cloud cover can be expected, however. Average precipitable water vapour (PWV) values are uncomfortably high, but periods of much lower PWV can be expected during favourable conditions in the dry seasons. Long-term vertical velocities (as a proxy to determine areas of improved "seeing" conditions) indicate that good astronomical viewing conditions are likely to be dependent on the season and wind direction across Kenya. Finally, after full consideration of the climatological data, a trade-off is expected between the best possible site in climatological terms, and the practicalities of installing remote equipment in isolated, inaccessible areas with little or no infrastructure.
... 7 Agriculture 5 2013-01-01 2013-01-01 false French beans and runner beans from Kenya. 319.56-54... § 319.56-54 French beans and runner beans from Kenya. French beans (Phaseolus vulgaris L.) and runner beans (Phaseolus coccineus L.) may be imported into the United States from Kenya only under...
... 7 Agriculture 5 2012-01-01 2012-01-01 false French beans and runner beans from Kenya. 319.56-54... § 319.56-54 French beans and runner beans from Kenya. French beans (Phaseolus vulgaris L.) and runner beans (Phaseolus coccineus L.) may be imported into the United States from Kenya only under...
... 7 Agriculture 5 2014-01-01 2014-01-01 false French beans and runner beans from Kenya. 319.56-54... § 319.56-54 French beans and runner beans from Kenya. French beans (Phaseolus vulgaris L.) and runner beans (Phaseolus coccineus L.) may be imported into the United States from Kenya only under...
Akaranga, Stephen; Simiyu, Patrick Cheben
In Kenya, Christian Religious Education is taught and examined by the Kenya National Examinations Council in the Kenya Certificate of Secondary Education at the end of the four years of Secondary Education cycle. The teaching of this subject in Secondary Schools ensures that learners are offered an opportunity to develop morally and spiritually…
Evans, Catrin; Ndirangu, Eunice
Routine "provider-initiated testing and counselling" (PITC) for HIV has been implemented amidst concern over how consent, confidentiality and counselling (the 3Cs) can be maintained in under-resourced health care settings. In Kenya, PITC has been rolled out since 2005, HIV prevalence is 7.1% and more than 86% of adults have not been tested. Kenyan nurses are the main cadre implementing PITC, but little is known about their experiences of incorporating HIV testing into everyday practice and the challenges faced in maintaining the 3Cs within their work environments. This study aimed to explore these issues and adopted a qualitative multi-method design using a convenience sampling approach. Two focus group discussions (total n=12) and 13 in-depth individual interviews were undertaken with nurses from 11 different public health care facilities in Nairobi and its surrounding areas (including in-patient and outpatient settings). Data were analysed thematically. Nurses identified a range of personal, client and health system challenges in the everyday application of PITC. These included (i) the contradictions of normalising a highly stigmatised disease and the difficulty in providing client-centred care within a routinised and target-oriented work culture; (ii) the challenge of dealing with ethically complex client situations in which the principles of the 3Cs could be difficult to uphold; and (iii) lack of time, resources, space and recognition within workplace environments (especially in-patient settings) that, likewise, led to problems with maintaining the 3Cs. In-patient nurses in particular identified problems associated with testing in a multi-disciplinary context, suggesting that other health professionals appeared to routinely flout the PITC guidelines. In conclusion, this study shows that the process of translating policy into practice is invariably complex and that more research is needed to explore PITC practices, particularly in in-patient settings. Nurses
Hunink, Johannes E.; Bryant, Benjamin P.; Vogl, Adrian; Droogers, Peter
We analyse the multiple impacts of investments in sustainable land use practices on ecosystem services in the Upper Tana basin (Kenya) to support a watershed conservation scheme (a "water fund"). We apply an integrated modelling framework, building on previous field-based and modelling studies in the basin, and link biophysical outputs to economic benefits for the main actors in the basin. The first step in the modelling workflow is the use of a high-resolution spatial prioritization tool (Resource Investment Optimization System -- RIOS) to allocate the type and location of conservation investments in the different subbasins, subject to budget constraints and stakeholder concerns. We then run the Soil and Water Assessment Tool (SWAT) using the RIOS-identified investment scenarios to produce spatially explicit scenarios that simulate changes in water yield and suspended sediment. Finally, in close collaboration with downstream water users (urban water supply and hydropower) we link those biophysical outputs to monetary metrics, including: reduced water treatment costs, increased hydropower production, and crop yield benefits for upstream farmers in the conservation area. We explore how different budgets and different spatial targeting scenarios influence the return of the investments and the effectiveness of the water fund scheme. This study is novel in that it presents an integrated analysis targeting interventions in a decision context that takes into account local environmental and socio-economic conditions, and then relies on detailed, process-based, biophysical models to demonstrate the economic return on those investments. We conclude that the approach allows for an analysis on different spatial and temporal scales, providing conclusive evidence to stakeholders and decision makers on the contribution and benefits of the land-based investments in this basin. This is serving as foundational work to support the implementation of the Upper Tana-Nairobi Water Fund
Naanyu, Violet; Asirwa, Chite Fredrick; Wachira, Juddy; Busakhala, Naftali; Kisuya, Job; Otieno, Grieven; Keter, Alfred; Mwangi, Anne; Omenge, Orango Elkanah; Inui, Thomas
AIM: To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cancer. METHODS: In October-November 2012, we recruited men and women (18 years and older) from households and health facilities in three different parts of Western Kenya, chosen for variations in their documented burdens of breast cancer. A standardized and validated tool, the breast cancer awareness measure (BCAM), was administered in face-to-face interviews. Survey domains covered included socio-demographics, opinions about causes, symptoms, severity, and treatment of breast cancer. Descriptive analyses were done on quantitative data while open-ended answers were coded, and emerging themes were integrated into larger categories in a qualitative analysis. The open-ended questions had been added to the standard BCAM for the purposes of learning as much as the investigators could about underlying lay beliefs and perceptions. RESULTS: Most respondents were female, middle-aged (mean age 36.9 years), married, and poorly educated. Misconceptions and lack of knowledge about causes of breast cancer were reported. The following (in order of higher to lower prevalence) were cited as potential causes of the condition: Genetic factors or heredity (n = 193, 12.3%); types of food consumed (n = 187, 11.9%); witchcraft and curses (n = 108, 6.9%); some family planning methods (n = 56, 3.6%); and use of alcohol and tobacco (n = 46, 2.9%). When asked what they thought of breast cancer’s severity, the most popular response was “it is a killer disease” (n = 266, 19.7%) a lethal condition about which little or nothing can be done. While opinions about presenting symptoms and signs of breast cancer were able to be elicited, such as an increase in breast size and painful breasts, early-stage symptoms and signs were not widely recognized. Some respondents (14%) were ignorant of available treatment altogether while others felt breast cancer treatment is both dangerous and expensive. A
Wagner, Anjuli D.; Cranmer, Lisa M.; Otieno, Vincent O.; Onyango, Judith A.; Chebet, Daisy J.; Okinyi, Helen M.; Benki-Nugent, Sarah; Maleche-Obimbo, Elizabeth; Slyker, Jennifer A.; John-Stewart, Grace C.; Wamalwa, Dalton C.
Abstract To identify missed opportunities in HIV prevention, diagnosis, and linkage to care, we enrolled 183 hospitalized, HIV-infected, ART-naïve Kenyan children 0–12 years from four hospitals in Nairobi and Kisumu, and reviewed prevention of mother-to-child transmission of HIV (PMTCT), hospitalization, and HIV testing history. Median age was 1.8 years (IQR = 0.8, 4.5). Most mothers received HIV testing during pregnancy (77%). Among mothers tested, 60% and 40% reported HIV-negative and positive results, respectively; 33% of HIV-diagnosed mothers did not receive PMTCT antiretrovirals. First missed opportunities for pediatric diagnosis and linkage were due to failure to test mothers (23.1%), maternal HIV acquisition following initial negative test (45.7%), no early infant diagnosis (EID) or provider-initiated testing (PITC) (12.7%), late breastfeeding transmission (8.7%), failure to collect child HIV test results (1.2%), and no linkage to care following HIV diagnosis (8.7%). Among previously hospitalized children, 38% never received an HIV test. Strengthening initial and repeat maternal HIV testing and PITC are key interventions to prevent, detect, and treat pediatric HIV infections. PMID:27308805
Schouten, M. A. C.; Mathenge, R. W.
Despite the prominence of communal practices as a last resort for any decent way of sanitation in slum areas, its application and use is flagrantly ignored. This paper provides insight in the appropriateness of communal sanitation facilities for slum conditions. Recent scholarly investigations in developing countries provide theoretical and empirical evidence of a divergence between the expectations from the users of sanitation facilities, and the expectations from other stakeholders. This paper presents the results from a case study in the Kibera slum attached to Nairobi, which is one of the largest African slums. A series of interviews with government agencies, Non-Governmental Organisations and Community Building Organisations was carried out. In addition, a survey was conducted of 76 users of different sanitation facilities. The research culminates in a series of concerns on financial, technological, situational and participatory dimensions. The main conclusion is a firm confirmation that communal sanitation are indeed the only viable alternative for slums, and therefore, the results of the research advocate a serious recognition of the use and appropriateness of communal sanitation for slum dwellers.
Hazzah, Leela; Dolrenry, Stephanie; Naughton-Treves, Lisa; Naughton, Lisa; Edwards, Charles T T; Mwebi, Ogeto; Kearney, Fiachra; Frank, Laurence
Lion (Panthera leo) populations are in decline throughout most of Africa. The problem is particularly acute in southern Kenya, where Maasai pastoralists have been spearing and poisoning lions at a rate that will ensure near term local extinction. We investigated 2 approaches for improving local tolerance of lions: compensation payments for livestock lost to predators and Lion Guardians, which draws on local cultural values and knowledge to mitigate livestock-carnivore conflict and monitor carnivores. To gauge the overall influence of conservation intervention, we combined both programs into a single conservation treatment variable. Using 8 years of lion killing data, we applied Manski's partial identification approach with bounded assumptions to investigate the effect of conservation treatment on lion killing in 4 contiguous areas. In 3 of the areas, conservation treatment was positively associated with a reduction in lion killing. We then applied a generalized linear model to assess the relative efficacy of the 2 interventions. The model estimated that compensation resulted in an 87-91% drop in the number of lions killed, whereas Lion Guardians (operating in combination with compensation and alone) resulted in a 99% drop in lion killing.
Valadez, J J; Transgrud, R; Mbugua, M; Smith, T
This report demonstrates the use of Lot Quality Assurance Sampling (LQAS) to evaluate the technical competence of two cohorts of family planning service providers in Kenya trained with a new curriculum. One cohort had just finished training within two months of the study. The other cohort was the first group trained with the new curriculum about one year before the study. LQAS was adapted from industrial and other public health applications to assess both the individual competence of 30 service providers and the competence of each cohort. Results show that Cohorts One and Two did not differ markedly in the number of tasks needing improvement. However, both cohorts exhibited more tasks needing improvement in counseling skills as compared with physical examination skills or with all other skills. Care-givers who were not currently providing services accounted for most service-delivery problems. This result suggests that providers' use of their skills explains their ability to retain service-delivery skills learned in training to a greater degree than does the amount of time elapsed since they were trained. LQAS proved to be a rapid, easy-to-use empirical method for management decisionmaking for improvement of a family planning training curriculum and services.
Otieno, O. M.
The study proposes to use Geographic Information Systems and Remote Sensing techniques to spatially model Maize Lethal Necrosis (MLN) disease in maize growing areas in Kenya. Results from this work will be used for prediction, monitoring and to guide intervention on MLN. This will minimize maize yield losses resulting from MLN infestation and thus safeguard the livelihoods of maize farmers in Kenya. MLN was first reported in Kenya in September 2011 in Bomet county. It then subsequently spread to other parts in Kenya. Maize crops are susceptible to MLN at all growth stages. Once infected the only option left for the farmers is to burn their maize plantations. Infection rate and damage is very high affecting yields and sometimes causing complete loss of maize yield.The modelling exercise will cover the period prior to and after the incidence of MLN. Specifically, the analysis will integrate spatio-temporal information on maize phenology and field surveys with the intention of delineating the extent of MLN infestation and the degree of damage as a result of MLN. Additionally, the task will identify potential predisposing factors leading to MLN resurgence and spread and to predict potential areas where MLN is likely to spread and to estimate the potential impact of MLN on the farm holders. The area of study for this task will be Bomet County. Historical and current environmental and spatial indicators including temperature, rainfall, soil moisture, vegetation health and crop cover will be fed into a model in order to determine the main factors that aide the occurrence and the spread of MLN. Multi-spectral image processing will be used to produce indices to study maize crop health whilst image classification techniques will be used to identify crop cover clusters by differentiating the variations in spectral signatures in the area of study and hence distinguish infected, unaffected maize crops and other crop cover classes. Variables from these indicators will then be
Moi Intl Aprt, Kenya 638200 Musoma, Tanzania 637330 Mwanza, Tanzania 637560 Nairobi/ Jomo Kenyatta , Kenya 637400 Tabora Aprt, Tanzania 638320 Victoria...12 MONTH/YR ANNUAL TOTALS MAY NOT EQUAL THE SUM OF MONTHLY TOTALS DUE TO ROUNDING A-44 OPERATIONAL CLIMATIC DATA SU3MMARY STATION: NAIROBI/ JOMO ...ALL HOURS 1# # # # # # # # # # A 0 OPERATIONAL CLIMATIC DATA SUMMARY STATION: NAIROBI/ JOMO KUNYATTA, KENYA STATION #: 637400 ICAO
Magadi, Monica Akinyi; Agwanda, Alfred O
Findings from previous studies linking the HIV/AIDS epidemic and fertility of populations have remained inconclusive. In sub-Saharan Africa, demographic patterns point to the epidemic resulting in fertility reduction. However, evidence from the 2003 Kenya Demographic and Health Survey (KDHS) has revealed interesting patterns, with regions most adversely affected with HIV/AIDS showing the clearest reversal trend in fertility decline. While there is suggestive evidence that fertility behaviour in some parts of sub-Saharan Africa has changed in relation to the HIV/AIDS epidemic, more rigorous empirical analysis is necessary to better understand this relationship. In this paper, we examine individual and contextual community HIV/AIDS factors associated with fertility patterns in Kenya, paying particular attention to possible mechanisms of the association. Multilevel models are applied to the 2003 KDHS, introducing various proximate fertility determinants in successive stages, to explore possible mechanisms through which HIV/AIDS may be associated with fertility. The results corroborate findings from earlier studies of the fertility inhibiting effect of HIV among infected women. HIV-infected women have 40 percent lower odds of having had a recent birth than their uninfected counterparts of similar background characteristics. Further analysis suggests an association between HIV/AIDS and fertility that exists through proximate fertility determinants relating to sexual exposure, breastfeeding duration, and foetal loss. While HIV/AIDS may have contributed to reduced fertility, mainly through reduced sexual exposure, there is evidence that it has contributed to increased fertility, through reduced breastfeeding and increased desire for more children resulting from increased infant/child mortality (i.e. a replacement phenomenon). In communities at advanced stages of the HIV/AIDS epidemic, it is possible that infant/child mortality has reached appreciably high levels where the
Onunga, Daniel O; Kowino, Isaac O; Ngigi, Anastasiah N; Osogo, Aggrey; Orata, Francis; Getenga, Zachary M; Were, Hassan
Carbofuran (2,3-dihydro-2,2-dimethylbenzofuran-7-yl methylcarbamate) has been used within the Nzoia River Basin (NRB), especially in Bunyala Rice Irrigation Schemes, in Kenya for the control of pests. In this study, the capacity of native bacteria to degrade carbofuran in soils from NRB was investigated. A gram positive, rod-shaped bacteria capable of degrading carbofuran was isolated through liquid cultures with carbofuran as the only carbon and nitrogen source. The isolate degraded 98% of 100-μg mL(-1) carbofuran within 10 days with the formation of carbofuran phenol as the only detectable metabolite. The degradation of carbofuran was followed by measuring its residues in liquid cultures using high performance liquid chromatography (HPLC). Physical and morphological characteristics as well as molecular characterization confirmed the bacterial isolate to be a member of Bacillus species. The results indicate that this strain of Bacillus sp. could be considered as Bacillus cereus or Bacillus thuringiensis with a bootstrap value of 100% similar to the 16S rRNA gene sequences. The biodegradation capability of the native strains in this study indicates that they have great potential for application in bioremediation of carbofuran-contaminated soil sites.
Tsaknis, J; Lalas, S; Gergis, V; Dourtoglou, V; Spiliotis, V
The oil from Moringa oleifera variety Mbololo seeds from Kenya was extracted using three different procedures including cold press (CP), extraction with n-hexane (H), and extraction with a mixture of chloroform/methanol (50:50) (CM). The oil concentration ranged from 25.8% (CP) to 31.2% (CM). The density, refractive index, color, smoke point, viscosity, acidity, saponification value, iodine value, fatty acid methyl esters, sterols, tocopherols (by HPLC), peroxide value, and at 232 and 270 nm and the susceptibility to oxidation measured with the Rancimat method were determined. The oil was found to contain high levels of unsaturated fatty acids, especially oleic (up to 75.39%). The dominant saturated acids were behenic (up to 6. 73%) and palmitic (up to 6.04%). The oil was also found to contain high levels of beta-sitosterol (up to 50.07%), stigmasterol (up to 17.27%), and campesterol (up to 15.13%). alpha-, gamma-, and delta-tocopherols were detected up to levels of 105.0, 39.54, and 77. 60 mg/kg of oil, respectively. The induction period (at 120 degrees C) of M. oleifera seed oil was reduced from 44.6 to 64.3% after degumming. The M. oleifera seed oil showed high stability to oxidative rancidity. The results of all the above determinations were compared with those of a commercial virgin olive oil.
Kyalo Mutisya, Albanus; KagureKarani, Anna; Kigondu, Christine
Introduction: In the era of evidence based practice (EBP), health care delivery should be grounded on new or validated knowledge and evidence from research. The aim of the study was to assess research utilization by nurses and the influencing factors at Kenyatta National Hospital (KNH), the largest teaching hospital in Kenya. Methods: The study employed a descriptive design that utilized both quantitative and qualitative methods of data collection. It incorporated the Barriers to Research Utilization Scale. It was conducted in six specialized care areas at KNH. Data was collected using questionnaires, Focus Group Discussion and in-depth interviews. Data was analyzed using SPSS version 13 and qualitative data analyzed using themes. Results: The study found that 20.6% of the nurses were participating in research related to their work and 53.6% of these were implementing research findings to practice. Over 2/3 (70.5%) of the respondents were basing their evidence for practice on the knowledge gained during their nursing school. The three greatest barriers to research utilization were that research reports are not readily available (68.7%), unclear implications for practice (66.5%) and inadequate facilities for implementation (66.4%). Conclusion: It is recommended that sensitization trainings on nursing research/ utilization of findings in nursing practice be established to create awareness, motivate and enhance nurses' abilities and also facilities should be provided to enable implementation. PMID:26161364
Kikulwe, Enoch M.; Fischer, Elisabeth; Qaim, Matin
The use of mobile phones has increased rapidly in many developing countries, including in rural areas. Besides reducing the costs of communication and improving access to information, mobile phones are an enabling technology for other innovations. One important example are mobile phone based money transfers, which could be very relevant for the rural poor, who are often underserved by the formal banking system. We analyze impacts of mobile money technology on the welfare of smallholder farm households in Kenya. Using panel survey data and regression models we show that mobile money use has a positive impact on household income. One important pathway is through remittances received from relatives and friends. Such remittances contribute to income directly, but they also help to reduce risk and liquidity constraints, thus promoting agricultural commercialization. Mobile money users apply more purchased farm inputs, market a larger proportion of their output, and have higher profits than non-users of this technology. These results suggest that mobile money can help to overcome some of the important smallholder market access constraints that obstruct rural development and poverty reduction. PMID:25286032
Funk, Christopher C.
Introduction This brief report draws from a multi-year effort by the United States Agency for International Development's Famine Early Warning System Network (FEWS NET) to monitor and map rainfall and temperature trends over the last 50 years (1960-2009) in Kenya. Observations from seventy rainfall gauges and seventeen air temperature stations were analyzed for the long rains period, corresponding to March through June (MAMJ). The data were quality controlled, converted into 1960-2009 trend estimates, and interpolated using a rigorous geo-statistical technique (kriging). Kriging produces standard error estimates, and these can be used to assess the relative spatial accuracy of the identified trends. Dividing the trends by the associated errors allows us to identify the relative certainty of our estimates (Funk and others, 2005; Verdin and others, 2005; Brown and Funk, 2008; Funk and Verdin, 2009). Assuming that the same observed trends persist, regardless of whether or not these changes are due to anthropogenic or natural cyclical causes, these results can be extended to 2025, providing critical, and heretofore missing information about the types and locations of adaptation efforts that may be required to improve food security.
Kikulwe, Enoch M; Fischer, Elisabeth; Qaim, Matin
The use of mobile phones has increased rapidly in many developing countries, including in rural areas. Besides reducing the costs of communication and improving access to information, mobile phones are an enabling technology for other innovations. One important example are mobile phone based money transfers, which could be very relevant for the rural poor, who are often underserved by the formal banking system. We analyze impacts of mobile money technology on the welfare of smallholder farm households in Kenya. Using panel survey data and regression models we show that mobile money use has a positive impact on household income. One important pathway is through remittances received from relatives and friends. Such remittances contribute to income directly, but they also help to reduce risk and liquidity constraints, thus promoting agricultural commercialization. Mobile money users apply more purchased farm inputs, market a larger proportion of their output, and have higher profits than non-users of this technology. These results suggest that mobile money can help to overcome some of the important smallholder market access constraints that obstruct rural development and poverty reduction.
Chema, S; Gathuma, J M
Private veterinary practice has existed in Kenya for more than half a century. Between the early 1930s and the mid-1960s, provision of clinical and advisory services almost entirely involved servicing commercial ranches and dairy farms. The Department of Veterinary Services (VSD) was mainly responsible for providing regulatory services in these areas. Until the mid-1960s, public sector veterinary responsibilities were predominantly associated with the prevention of notifiable diseases outside the commercial farming areas. In a major agrarian reform programme initiated in 1954, Kenya initiated an aggressive campaign promoting the dairy industry in the wetter areas of the country among small-scale farmers. In an effort to encourage dairy development, the VSD decided to provide some services, mainly tick control and subsidised artificial insemination. This support had a great positive impact on the 'smallholder' dairy industry. After the end of the colonial administration in 1963, most private practitioners left the country. A decision was therefore taken to transfer the responsibility of providing services of a 'private goods' nature, such as clinical services, temporarily to the public sector through the VSD. This was accompanied by significant expansion of training and the deployment of both professional veterinarians and para-professionals. By 1988, personnel costs had escalated to over 80% of the recurrent budget, leaving little for operational costs. This necessitated a policy change, which led to decreased government involvement in the delivery of animal health services. The private sector, as expected, responded appropriately to the change in policy. The Kenya Veterinary Association (KVA) launched a privatisation scheme (the Kenya Veterinary Association Privatisation Scheme) in 1994 to provide members with credit to set up private practices. The first phase of the scheme (1994-1996) was rated a success, with 100% loan repayments. The second phase of the
Female genital mutilation is still practiced in 28 African countries despite international calls for its abolishment. A 1991 survey of 1365 14-year-old girls undertaken by a nongovernmental organization in Kenya revealed that 90% had suffered mutilation ranging from the least mutilating form, "sunna" to excision to infibulation. Most of the procedures had taken place when the girls were aged 10-14 years as part of a ritual where the same unsterile knife was used on several girls. Whereas 65% of respondents stated that they approved of female genital mutilation, a little more than a third would abolish the practice. In Sudan, a 1989-90 Demographic and Health Survey of 5860 ever married women aged 15-49 included a number of questions related to female genital mutilation. 89% of respondents were mutilated, and 82% of these had suffered infibulation. This prevalence rate showed a decrease from the 96% level recorded in 1977-78. Among younger women, the incidence of sunna is increasing. Most of these procedures were performed by medical workers such as trained midwives or traditional birth attendants. 79% of the respondents favored continuation of the procedure, but women with a secondary-level education and urban women showed strong opposition. Most women cite tradition as the reason for their approval, and almost half of the women who disapprove cite medical complications. This survey provided the necessary data to implement a policy of eradication of this harmful practice through increasing women's education and provoking open discussion about the procedure.
Although Kenya's current 5-Year National Development Plan cites communications as a public policy issue in terms of the establishment of basic infrastructural facilities, little attention has been given to this area. At the national level, a more specific approach to communication policy demands the formulation of coherent policies and their implementation through adequate institutional bodies. However, most policymakers are poorly equipped to deal with communication questions since they are interdisciplinary, technically complex, and politically sensitive. Policymaking must be based on a database that allows a minimal level of resource assessment, an inventory of locally available resources, a projection of needs for imported resources, and a scenario for resource development. The institutional location and accountability of communication need to be defined. Moreover, in promoting the strategies of self-reliance and decentralization, communication policy must consider the 4 aspects of a national information system: function, resource inventory, structure content, an control. The 1st task is to carry out a needs assessment exercise that determines what is required from a communications policy. A related task is audience analysis. Also essential is the analysis of policies that guide and constrain system development and the distribution and nature of political and economic power. Finally, feedback mechanisms must be devised for the determination of policy impact. Methods helpful in analyzing policy impact include systems analysis, resource assessment, trend extrapolation, the Delphi technique, and brainstorming.
Unregulated biomedical research has previously caused untold suffering to humankind. History is full of examples of abuse of animal and human subjects for research. Several codes and instruments have been formulated to regulate biomedical research. In Kenya, the Science, Technology and Innovation Act, 2014, together with the Constitution of Kenya, 2010, provide a fairly robust legal framework. Possible challenges include capacity building, overlap of functions of institutions, monitoring and evaluation, scientific/technological advances, intellectual property rights, funding for research, and dispute resolution. It is hoped that the new legislation will adequately address these challenges.
Schmidt, Ray C; Bart, Henry L; Nyingi, Dorothy Wanja; Gichuki, Nathan Ndegwa
African suckermouth catfishes (Mochokidae: Chiloglanis) occur in freshwater throughout tropical Africa. Specimens from all major drainages across Kenya were collected over three field seasons. Here we present a phylogeny inferred from both mitochondrial cytochrome b (cyt b) and introns of the nuclear Growth Hormone gene (GH). The phylogeny inferred from introns is largely congruent with the results from an analysis of cyt b. The length and variability of GH introns make them ideal species level nuclear markers without the problem of introgression commonly encountered with mitochondrial genes. This analysis confirmed the presence of two previously known undescribed Chiloglanis species and also suggests the presence of previously unknown diversity within the Athi River system. The resulting phylogeny also indicates the presence of two separate lineages within C. brevibarbis. The historical biogeography of Chiloglanis within Kenya is discussed. The utility of GH intron for species level phylogenies of Siluriformes is compared to that in other groups.
King, C. H.; Muchiri, E. M.; Ouma, J. H.
We examined the long-term efficacy of praziquantel against Schistosoma haematobium, the causative agent of urinary schistosomiasis, during a school-based treatment program in the Msambweni area of Coast Province, Kenya, where the disease is highly endemic. Our results, derived from treating 4,031 of 7,641 children from 1984 to 1993, indicate substantial year-to- year variation in drug efficacy. However, the pattern of this variation was not consistent with primary or progressive emergence of praziquantel resistance. Mathematical modeling indicated that, at current treatment rates, praziquantel resistance will likely take 10 or more years to emerge. PMID:11076716
Mushinzimana, Emmanuel; Munga, Stephen; Minakawa, Noboru; Li, Li; Feng, Chen-chieh; Bian, Ling; Kitron, Uriel; Schmidt, Cindy; Beck, Louisa; Zhou, Guofa; Githeko, Andrew K; Yan, Guiyun
Background In the past two decades the east African highlands have experienced several major malaria epidemics. Currently there is a renewed interest in exploring the possibility of anopheline larval control through environmental management or larvicide as an additional means of reducing malaria transmission in Africa. This study examined the landscape determinants of anopheline mosquito larval habitats and usefulness of remote sensing in identifying these habitats in western Kenya highlands. Methods Panchromatic aerial photos, Ikonos and Landsat Thematic Mapper 7 satellite images were acquired for a study area in Kakamega, western Kenya. Supervised classification of land-use and land-cover and visual identification of aquatic habitats were conducted. Ground survey of all aquatic habitats was conducted in the dry and rainy seasons in 2003. All habitats positive for anopheline larvae were identified. The retrieved data from the remote sensors were compared to the ground results on aquatic habitats and land-use. The probability of finding aquatic habitats and habitats with Anopheles larvae were modelled based on the digital elevation model and land-use types. Results The misclassification rate of land-cover types was 10.8% based on Ikonos imagery, 22.6% for panchromatic aerial photos and 39.2% for Landsat TM 7 imagery. The Ikonos image identified 40.6% of aquatic habitats, aerial photos identified 10.6%, and Landsate TM 7 image identified 0%. Computer models based on topographic features and land-cover information obtained from the Ikonos image yielded a misclassification rate of 20.3–22.7% for aquatic habitats, and 18.1–25.1% for anopheline-positive larval habitats. Conclusion One-metre spatial resolution Ikonos images combined with computer modelling based on topographic land-cover features are useful tools for identification of anopheline larval habitats, and they can be used to assist to malaria vector control in western Kenya highlands. PMID:16480523
Background Mental health policy is needed to set the strategy and direction for the provision of mental health services in a country. Policy formulation does not occur in a vacuum, however, but is influenced by local and international factors in the health sector and other sectors. Methods This study was carried out in 1997 to examine the evolution of mental health policy in Kenya between 1965 and 1997 in the context of changing international concepts of health and development. Qualitative content analysis of policy documents was combined with interviews of key policy makers. Results The study showed that during the period 1965-1997 the generic health policy in Kenya changed from one based on the Medical Model in the 1960s and 1970s to one based on the Primary Health Care Model in the late 1970s and the 1980s and finally to one based on the Market Model of health care in the 1990s. The mental health policy, on the other hand, evolved from one based on the Medical Model in the 1960s to one based on the Primary Health Care Model in the 1990s, but did not embrace the Market Model of health care. This resulted in a situation in the 1990s where the mental health policy was rooted in a different conceptual model from that of the generic health policy under which it was supposed to be implemented. This "Model Muddlement" may have impeded the implementation of the mental health policy in Kenya. Conclusions Integration of the national mental health policy with the general health policy and other sector policies would be appropriate and is now underway. PMID:20426855
Background The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Methods Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. Results The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. Conclusions The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health
Nyawade, Shadrack; Charles, Gachene; Karanja, Nancy; Elmar, Schulte-Geldermann
Soil erosion has been identified as one of the major causes of soil productivity decline in the potato growing areas of East African Highlands. Potato establishes a protective soil cover only at about 45-60 days after planting and does not yield sufficient surface mulch upon harvest which leaves the soil bare at the critical times when rainfall intensities are usually high thus exposes soil to erosion. A field study was carried out using runoff plots during the short and long rainy seasons of 2014/15 respectively at the University of Nairobi Upper Kabete Farm, Kenya. The objectives were to assess the effect of soil surface roughness and potato cropping systems on soil loss and runoff, to determine the effect of erosion on nutrient enrichment ratio and to evaluate the soil organic matter fraction most susceptible to soil erosion. The treatments comprised of Bare Soil (T1); Potato + Garden Pea (Pisum sativa) (T2); Potato + Climbing Bean (Phaseolus vulgaris) (T3); Potato + Dolichos (Lablab purpureus) (T4) and Sole Potato (Solanum tuberosum L.) (T5). The amount of soil loss and runoff recorded in each event differed significantly between treatments (p<0.05) and were consistently highest in T1 and lowest in T4. Mean cumulative soil loss reduced by 6.4, 13.3 and 24.4 t ha-1from T2, T3 and T4 respectively compared to sole potato plots (T5), while mean cumulative runoff reduced by 8.5, 17.1 and 28.3 mm from T2, T3 and T4 respectively when compared with the sole potato plots (T5) indicating that T4 plots provided the most effective cover in reducing soil loss and runoff. Regression analyses revealed that both runoff and soil loss related significantly with surface roughness and percent cover (R2=0.83 and 0.73 respectively, p<0.05). Statistically significant linear dependence of runoff and soil loss on surface roughness and crop cover was found in T4 (p<0.05) indicating that this system was highly effective in minimizing soil loss and runoff. Enrichment ratio was on average
There have been current controversial discussions concerning the performance of private primary schools versus public primary schools in the Kenya Certificate of Primary Examination (K.C.P.E.). Lately, the private primary schools appear to be performing better than public primary schools. For example; in the 2003 K.C.P.E. results, more than 31% of…
Napwora, Jesse Wekesa; Gudu, Benter Oseno; Mukwa, Chris Wekesa
This paper highlights the results of a research conducted in Bungoma County of Kenya between 2008-2009. The objective of the study was to investigate the attitudes of teachers and students towards the impact of availability and use of daily newspapers on students' speaking competence in English language. The study was based on the Communicative…
Matheka, Duncan Mwangangi; Omar, Faraj Alkizim; Kipsaina, Chebiwot; Witte, Jeffrey
Introduction Motorcycle injuries contribute a substantial number of deaths and hospital admissions in Kenya. There is paucity of data to inform prevention strategies to address the issue. Therefore, the current study sought to explore the characteristics of 2 and 3-wheeler related road traffic injuries (RTIs) in Kenya. Methods A cross-sectional survey of motorcycle drivers involved in a RTI in the preceding 3 months was conducted in 11 urban and rural sites in Kenya's Thika town through face- to -face structured interviews. Drivers’ demographic information, comprehensive crash characteristics and socioeconomic impact of injury data were collected. Results Of 200 drivers injured, 98% were male, with average age of 28.4 years (SD±6.6). Of these drivers, 33% were not wearing any protective equipment. Negligence was the most reported cause of crash (33%), followed by slippery roads (21.0%) and speeding (17.5%). The risk of sustaining a bodily injury was 1.3 times higher in drivers who had not received prevention education compared to those who had received such education. People injured at night were 5 times more likely to sustain a bodily injury compared to those injured during the day. Only 8.5% of the drivers reported the injury incident to the police. Conclusion Majority of motorcycle related injuries in Thika town occur among young, productive, working-age male drivers. A high proportion of injuries are due to negligence on riding while not wearing any protective equipment compounded by lack of injury prevention education. Initiatives to foster helmet wearing, provision of high-quality affordable helmets, responsible driving and advocacy for stronger legislation, are recommended. PMID:26401211
Munyua, Peninah M.; Murithi, R. Mbabu; Ithondeka, Peter; Hightower, Allen; Thumbi, Samuel M.; Anyangu, Samuel A.; Kiplimo, Jusper; Bett, Bernard; Vrieling, Anton; Breiman, Robert F.; Njenga, M. Kariuki
Background To-date, Rift Valley fever (RVF) outbreaks have occurred in 38 of the 69 administrative districts in Kenya. Using surveillance records collected between 1951 and 2007, we determined the risk of exposure and outcome of an RVF outbreak, examined the ecological and climatic factors associated with the outbreaks, and used these data to develop an RVF risk map for Kenya. Methods Exposure to RVF was evaluated as the proportion of the total outbreak years that each district was involved in prior epizootics, whereas risk of outcome was assessed as severity of observed disease in humans and animals for each district. A probability-impact weighted score (1 to 9) of the combined exposure and outcome risks was used to classify a district as high (score ≥ 5) or medium (score ≥2 - <5) risk, a classification that was subsequently subjected to expert group analysis for final risk level determination at the division levels (total = 391 divisions). Divisions that never reported RVF disease (score < 2) were classified as low risk. Using data from the 2006/07 RVF outbreak, the predictive risk factors for an RVF outbreak were identified. The predictive probabilities from the model were further used to develop an RVF risk map for Kenya. Results The final output was a RVF risk map that classified 101 of 391 divisions (26%) located in 21 districts as high risk, and 100 of 391 divisions (26%) located in 35 districts as medium risk and 190 divisions (48%) as low risk, including all 97 divisions in Nyanza and Western provinces. The risk of RVF was positively associated with Normalized Difference Vegetation Index (NDVI), low altitude below 1000m and high precipitation in areas with solonertz, luvisols and vertisols soil types (p <0.05). Conclusion RVF risk map serves as an important tool for developing and deploying prevention and control measures against the disease. PMID:26808021
Mbogo, Charles; Mwangangi, Joseph; Imbahale, Susan; Kibe, Lydia; Orindi, Benedict; Girma, Melaku; Njui, Annah; Lwande, Wilber; Affognon, Hippolyte; Gichuki, Charity; Mukabana, Wolfgang Richard
Background The World Health Organization (WHO) recommends integrated vector management (IVM) as a strategy to improve and sustain malaria vector control. However, this approach has not been widely adopted. Objectives We comprehensively assessed experiences and findings on IVM in Kenya with a view to sharing lessons that might promote its wider application. Methods The assessment used information from a qualitative external evaluation of two malaria IVM projects implemented between 2006 and 2011 and an analysis of their accumulated entomological and malaria case data. The project sites were Malindi and Nyabondo, located in coastal and western Kenya, respectively. The assessment focused on implementation of five key elements of IVM: integration of vector control methods, evidence-based decision making, intersectoral collaboration, advocacy and social mobilization, and capacity building. Results IVM was more successfully implemented in Malindi than in Nyabondo owing to greater community participation and multistakeholder engagement. There was a significant decline in the proportion of malaria cases among children admitted to Malindi Hospital, from 23.7% in 2006 to 10.47% in 2011 (p < 0.001). However, the projects’ operational research methodology did not allow statistical attribution of the decline in malaria and malaria vectors to specific IVM interventions or other factors. Conclusions Sustaining IVM is likely to require strong participation and support from multiple actors, including community-based groups, non-governmental organizations, international and national research institutes, and various government ministries. A cluster-randomized controlled trial would be essential to quantify the effectiveness and impact of specific IVM interventions, alone or in combination. Citation Mutero CM, Mbogo C, Mwangangi J, Imbahale S, Kibe L, Orindi B, Girma M, Njui A, Lwande W, Affognon H, Gichuki C, Mukabana WR. 2015. An assessment of participatory integrated vector
Amin, Abdinasir A; Zurovac, Dejan; Kangwana, Beth B; Greenfield, Joanne; Otieno, Dorothy N; Akhwale, Willis S; Snow, Robert W
Backgound Sulphadoxine/sulphalene-pyrimethamine (SP) was adopted in Kenya as first line therapeutic for uncomplicated malaria in 1998. By the second half of 2003, there was convincing evidence that SP was failing and had to be replaced. Despite several descriptive investigations of policy change and implementation when countries moved from chloroquine to SP, the different constraints of moving to artemisinin-based combination therapy (ACT) in Africa are less well documented. Methods A narrative description of the process of anti-malarial drug policy change, financing and implementation in Kenya is assembled from discussions with stakeholders, reports, newspaper articles, minutes of meetings and email correspondence between actors in the policy change process. The narrative has been structured to capture the timing of events, the difficulties and hurdles faced and the resolutions reached to the final implementation of a new treatment policy. Results Following a recognition that SP was failing there was a rapid technical appraisal of available data and replacement options resulting in a decision to adopt artemether-lumefantrine (AL) as the recommended first-line therapy in Kenya, announced in April 2004. Funding requirements were approved by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and over 60 million US$ were agreed in principle in July 2004 to procure AL and implement the policy change. AL arrived in Kenya in May 2006, distribution to health facilities began in July 2006 coincidental with cascade in-service training in the revised national guidelines. Both training and drug distribution were almost complete by the end of 2006. The article examines why it took over 32 months from announcing a drug policy change to completing early implementation. Reasons included: lack of clarity on sustainable financing of an expensive therapeutic for a common disease, a delay in release of funding, a lack of comparative efficacy data between AL and
Chiao, Chi; Mishra, Vinod; Ksobiech, Kate
High HIV rates among cohabiting couples in many African countries have led to greater programmatic emphasis on spousal communication in HIV prevention. This study examines how demographic and socioeconomic characteristics of cohabiting adults influence their dyadic communication about HIV. A central focus of this research is on how the position of women relative to their male partners influences spousal communication about HIV prevention. The authors analyze gaps in spousal age and education and females' participation in household decision making as key factors influencing spousal communication about HIV, while controlling for sexual behaviors of both partners as well as other individual and contextual factors. Data were obtained from the 2003 Kenya Demographic and Health Survey for 1,388 cohabiting couples. Information regarding spousal communication was self-reported, assessing whether both, either, or neither partner ever discussed HIV prevention with the other. Analyses showed higher levels of education for the female partner and participation in household decision making are positively associated with spousal communication about HIV prevention. With females' education and other factors controlled, couples with more educated male partners were more likely to have discussed HIV prevention than couples in which both partners have the same level of education. Spousal communication was also positively associated with household wealth status and exposure to the mass media, but couples in which male partners reported having nonspousal sex in the past year were less likely to have discussed HIV prevention with their spouses. Findings suggest HIV prevention programs should promote female empowerment and encourage male participation in sexual health discussion.
Iannotti, Lora; Gillespie, Stuart
This report on the key findings from a series of assessments of successful community nutrition programming conducted in Kenya, Tanzania, and Uganda between 1999 and 2000. The aim of the assessments was to identify key lessons learned from the successful processes and outcomes in these programs. The report is divided into eight chapters: (1)…
This article presents the findings of a qualitative study on the "Bang' jomariek," a women's group in West Reru in Western Kenya who engage in the production of indigenous arts and crafts (pots, baskets, and architecture) to generate income and explore politics, medicine, and other matters that affect them and their community. The women…
Maakrun, Julie; Maher, Marguerite
Yunkaporta's (2009) pedagogical "eight ways" conceptual framework, inspired by Nakata's (2007) cultural interface theory, provided the platform for interpretation of the data in the current study. Here we considered the transferability of the framework to a current initiative in Kenya and its usefulness in preparation for an expansion of…
Limukii, Kaberia E.; Mualuko, Ndiku J.
Educational reforms are crucial in a country if the reforms benefit the intended target group. One of the educational reforms in Kenya was the introduction of Free Primary Education. This was informed by the need to improve access and equity in provision of education. Informed by the need to eradicate ignorance, poverty and disease, the…
Datta, Dipankar; Phillip, Serene; Verma, Prashant Kumar
Both (a) in-school factors such as over-focus on academic performance, absence of uniform, and corporal punishment, and (b) out-of school factors such as caring for ailing parents, child labor, etc., hinder participation of orphan and vulnerable children (PVC) in Free Primary Education (FOE) system in Nyasa Province, Kenya. In this context Concern…
Karimi, Florah Katanu
The aim of this study was to establish the levels and types of didactic competencies that exist among teaching staff in universities in Kenya, giving recognition to curriculum development, pedagogical attributes and quality assurance competencies. The study was carried out in two phases among two samples of the teaching staff population. The first…
Nyerere, Jackline Anyona; Gravenir, Frederick Q.; Mse, Godfrey S.
The increased demand and need for continuous learning have led to the introduction of open, distance, and e-learning (ODeL) in Kenya. Provision of this mode of education has, however, been faced with various challenges, among them infrastructural ones. This study was a survey conducted in two public universities offering major components of ODeL,…
Okech, Jane E. Atieno; Kimemia, Muthoni
The authors examine the history and development of the counseling profession in Kenya. This profession is deeply rooted in responses to the HIV/AIDS epidemic, the emergence of mental health needs created by the impact of political and community-based violence, increasing student unrest in public institutions, and government efforts to provide…
In 2003, York University awarded an honorary doctorate to Phoebe Asiyo, a former Kenyan member of Parliament, in recognition of her impressive human rights work. The author learned at the time that Ms. Asiyo's family provided major support to Wikondiek School (located near their home in western Kenya), many of whose students were AIDS orphans.…
Gitonga, E. R.; Andanje, M.; Wanderi, P. M.; Bailasha, N.
This study investigates the attitudes of teacher trainees towards physical education (PE). It was hypothesised that teacher-trainees have negative attitudes towards PE. A total of 132 teacher trainees were randomly selected from a teacher Training College in Kenya completed a questionnaire adapted from Wear's attitude scale with equivalent forms.…
Elder, Brent C.
This article explores the current inclusive education system in Kenya, and how those practices relate to Article 24 of the United Nations' Convention on the Rights of Persons with Disabilities (CRPD). Local laws and international instruments are presented to shed light on the extent to which students with disabilities have a right to inclusive…
Macharia, Mwangi J.
In the last decade, student politics and governance of universities in Kenya and in other African countries have undergone a tremendous transformation. The unprecedented expansion and massification of public universities, the introduction of "Module 2" programmes, the admission of private, "parallel" and…
Feldman, Robert H. L.
A study investigated the effectiveness of various combinations of teacher expertise and teacher-audience similarity in improving the nutrition knowledge and attitudes of high school students in Kenya, East Africa. Both teacher-audience similarity and teacher expertise were found to be important. (CJ)
Since Independence in 1963, Kenya has launched three Free Primary Education programmes: the first in 1974, the second in 1979 and the most recent in 2003. Using historical data, this paper first outlines each initiative in turn, and discusses why, in the case of the earlier initiatives, impressive initial gains in improved access proved difficult…
Sileo, L; Grootenhuis, J G; Tuite, C H; Hopcraft, J B
In 1974, 51 debilitated lesser flamingos (Phoeniconaias minor) were easily captured at Lake Nakuru, Kenya. Nineteen (37%) of these had extensive mycobacterial lesions. Two years later it was difficult to locate any debilitated flamingos and no evidence of mycobacterial infection was found. Possible reasons for the high prevalence of mycobacteriosis in the 1974 collection are discussed.
Mbithi, Esther K
Language use and creative writing go hand in hand. In the process of exploring language, we also engage in the study of literature. An engagement with literature is, indeed, a continuing process of improving our capacity to use language and refining our sensibility to good language use. In Kenya, there are clearly discernible patterns of creative…
Combat, Victor F. O.
Even though female teachers in Kenya municipal primary schools are majority and highly qualified, they fill fewer administrative positions than men. This study assesses the extent of women's participation in leadership positions, society's perception of female leaders, selection criteria of educational administrators, and barriers that affect or…
Muyanga, Milu; Jayne, T. S.
Private extension system has been at the centre of a debate triggered by inefficient public agricultural extension. The debate is anchored on the premise that the private sector is more efficient in extension service delivery. This study evaluates the private extension system in Kenya. It employs qualitative and quantitative methods. The results…
Makokha, George L.; Mutisya, Dorothy N.
The purpose of this study was to assess the status of e-learning in public universities in Kenya. Data were collected using questionnaires administered to both students and lecturers randomly sampled from seven public universities. Questionnaire responses were triangulated with interviews from key informants and focus group discussions (FGDs).…
Ouma, Gordon O.; Awuor, Fredrick M.; Kyambo, Benjamin
As e-learning becomes useful to learning institutions worldwide, an assessment of e-learning readiness is essential for the successful implementation of e-learning as a platform for learning. Success in e-learning can be achieved by understanding the level of readiness of e-learning environments. To facilitate schools in Kenya to implement…
Onsomu, Elijah O; Abuya, Benta A; Okech, Irene N; Moore, DaKysha; Collins-McNeil, Janice
Child morbidity and mortality due to infectious diseases continues to be a major threat and public health concern worldwide. Although global vaccination coverage reached 90 % for diphtheria, tetanus and pertussis (DTP3) across 129 countries, Kenya and other sub-Saharan countries continue to experience under-vaccination. The purpose of this study was to examine the association between maternal education and child immunization (12-23 months) in Kenya. This study used retrospective cross-sectional data from the 2008-2009 Kenya Demographic and Health Survey for women aged 15-49, who had children aged 12-23 months, and who answered questions about vaccination in the survey (n = 1,707). The majority of the children had received vaccinations, with 77 % for poliomyelitis, 74 % for measles, 94 % for tuberculosis, and 91 % for diphtheria, whooping cough (pertussis), and tetanus. After adjusting for other covariates, women with primary, secondary, and college/university education were between 2.21 (p < 0.01) and 9.10 (p < 0.001) times more likely to immunize their children than those who had less than a primary education. Maternal education is clearly crucial in ensuring good health outcomes among children, and integrating immunization knowledge with maternal and child health services is imperative. More research is needed to identify factors influencing immunization decisions among less-educated women in Kenya.
The training of early childhood development and education (ECDE) teachers in Kenya remains a priority in recognition of the vital role well-trained professionals play in the quality of early childhood experiences for children ages 0+ to 5+. This article provides a detailed overview of the current structure and training of ECDE professionals,…
This paper undertakes a critique of the gendered nature of leadership in modern universities in Kenya. The paper argues that the inclusive nature of African feminism makes it easier for both men and women to join in this discussion since African feminism demands a more holistic perspective that does not pit men against women but encourages them to…
Muthwii, Margaret Jepkirui
This paper is a critique of the interaction between language planning and literacy in Kenya. It demonstrates that, contrary to the reasons given at independence for not favouring indigenous languages as languages of instruction or as languages for communication in public discourse, the very things that the language policy was meant to safeguard…
Across Sub-Saharan Africa it is evident that humanities and social sciences research is in urgent need of support. Universities and researchers face many challenges, the results of declining funding in the face of huge increases in enrollments. Infrastructure and facilities are insufficient and incomes have fallen. Many academics have been forced…
Shioda, Kayoko; Cosmas, Leonard; Audi, Allan; Gregoricus, Nicole; Vinjé, Jan; Parashar, Umesh D.; Montgomery, Joel M.; Feikin, Daniel R.; Breiman, Robert F.; Hall, Aron J.
Background Diarrheal diseases remain a major cause of mortality in Africa and worldwide. While the burden of rotavirus is well described, population-based rates of disease caused by norovirus, sapovirus, and astrovirus are lacking, particularly in developing countries. Methods Data on diarrhea cases were collected through a population-based surveillance platform including healthcare encounters and household visits in Kenya. We analyzed data from June 2007 to October 2008 in Lwak, a rural site in western Kenya, and from October 2006 to February 2009 in Kibera, an urban slum. Stool specimens from diarrhea cases of all ages who visited study clinics were tested for norovirus, sapovirus, and astrovirus by RT-PCR. Results Of 334 stool specimens from Lwak and 524 from Kibera, 85 (25%) and 159 (30%) were positive for norovirus, 13 (4%) and 31 (6%) for sapovirus, and 28 (8%) and 18 (3%) for astrovirus, respectively. Among norovirus-positive specimens, genogroup II predominated in both sites, detected in 74 (87%) in Lwak and 140 (88%) in Kibera. The adjusted community incidence per 100,000 person-years was the highest for norovirus (Lwak: 9,635; Kibera: 4,116), followed by astrovirus (Lwak: 3,051; Kibera: 440) and sapovirus (Lwak: 1,445; Kibera: 879). For all viruses, the adjusted incidence was higher among children aged <5 years (norovirus: 22,225 in Lwak and 17,511 in Kibera; sapovirus: 5,556 in Lwak and 4,378 in Kibera; astrovirus: 11,113 in Lwak and 2,814 in Kibera) compared to cases aged ≥5 years. Conclusion Although limited by a lack of controls, this is the first study to estimate the outpatient and community incidence rates of norovirus, sapovirus, and astrovirus across the age spectrum in Kenya, suggesting a substantial disease burden imposed by these viruses. By applying adjusted rates, we estimate approximately 2.8–3.3 million, 0.45–0.54 million, and 0.77–0.95 million people become ill with norovirus, sapovirus, and astrovirus, respectively, every year in
Oketch, Moses; Mutisya, Maurice; Sagwe, Jackline
With the introduction of free primary education (FPE) in Kenya in 2003, it was expected that the burden on poor households in financing primary education would be reduced substantially. This in turn would increase enrolment in public schools and lead to universal primary education. However, studies have shown that a considerable proportion of…
Mitchell, Claudia; Chege, Fatuma; Maina, Lucy; Rothman, Margot
This article studies the ways in which researchers working in the area of health and social research and using participatory visual methods might extend the reach of participant-generated creations such as photos and drawings to engage community leaders and policy-makers. Framed as going 'beyond engagement', the article explores the idea of the production of researcher-led digital dialogue tools, focusing on one example, based on a series of visual arts-based workshops with children from eight slums in Nairobi addressing issues of safety, security, and well-being in relation to housing. The authors conclude that there is a need for researchers to embark upon the use of visual tools to expand the life and use of visual productions, and in particular to ensure meaningful participation of communities in social change.
Sippel, Judith; Meeßen, Christian; Cacace, Mauro; Mechie, James; Fishwick, Stewart; Heine, Christian; Scheck-Wenderoth, Magdalena; Strecker, Manfred R.
We present three-dimensional (3-D) models that describe the present-day thermal and rheological state of the lithosphere of the greater Kenya rift region aiming at a better understanding of the rift evolution, with a particular focus on plume-lithosphere interactions. The key methodology applied is the 3-D integration of diverse geological and geophysical observations using gravity modelling. Accordingly, the resulting lithospheric-scale 3-D density model is consistent with (i) reviewed descriptions of lithological variations in the sedimentary and volcanic cover, (ii) known trends in crust and mantle seismic velocities as revealed by seismic and seismological data and (iii) the observed gravity field. This data-based model is the first to image a 3-D density configuration of the crystalline crust for the entire region of Kenya and northern Tanzania. An upper and a basal crustal layer are differentiated, each composed of several domains of different average densities. We interpret these domains to trace back to the Precambrian terrane amalgamation associated with the East African Orogeny and to magmatic processes during Mesozoic and Cenozoic rifting phases. In combination with seismic velocities, the densities of these crustal domains indicate compositional differences. The derived lithological trends have been used to parameterise steady-state thermal and rheological models. These models indicate that crustal and mantle temperatures decrease from the Kenya rift in the west to eastern Kenya, while the integrated strength of the lithosphere increases. Thereby, the detailed strength configuration appears strongly controlled by the complex inherited crustal structure, which may have been decisive for the onset, localisation and propagation of rifting.
Mwaura, F; Moore, T R
Research geographers combined LANDSAT imagery analysis and vegetation survey (LANDSAT data interpretation, ground truthing, and quantitative transect sampling) to study the spatial dynamics of forest and woodland areas in the Lake Elementeita watershed in the central Rift Valley of Kenya. Between 1973-1984, trees in forests and woodlands disappeared rapidly from a cover of 152-64 sq. km, i.e. 45-19% of total catchment. The most rapid decrease occurred between 1973-1976 which was associated with immigration into the area in the 1960s and 1970s. Indeed the annual population growth rate in the area was 5.7%. Further most of the population concentrated in the upper and middle catchment areas of Ndunduri, Ngorika, and Nyaituga where the soils and climate were best for commercial crop and livestock farming. This high concentration of people in 1 area along with the high population growth rate contributed greatly to deforestation. In fact, it resulted in a 57.9% loss of total forest and woodland areas. These trees used to cover most of the Ndunduri and Ngorika areas. Agroecosystems have replaced the Juniperus procera and Olea africana forest belts which dominated the Ngorika plains in the past. Further, in 1988, field observations revealed that very limited forest and woodland areas have remained undisturbed. Based on these results and the fact that little substantial efforts towards conservation and afforestation, the researchers predicted that most of the watershed would be with forests and woodlands by 2000. They further noted that deforestation could cause lower water levels in Lake Elementeita, especially during droughts, and worsen soil erosion. Therefore the government should initiate environmental controls in this watershed that match local conditions and the true and increasing needs of the rural population.
Ogutu, Z A
Population pressure in Kenya evolved out of colonial policies and was present in early periods because of soil erosion and degradation, declining crop yields, changes in farming systems, use of marginal lands, shortages of fuelwood and food, and landlessness. Between 1900 and 1910, colonists made room for European settlers by seizing control of "empty lands." These schemes failed to account for pastoral or shifting land use patterns, failed to balance African land use with resources, and failed to recognize individual title to land based on continuous use. The result was loss of pastoral lands and confinement to other unused lands, a change in the spatial economy of Africans, and disruption of equitable access to natural resources. Population concentration in areas with high potential resulted in small plots and the necessity to migrate to marginal lands. The African Land Commission was formed during the 1920s and 1930s. Rehabilitation programs and protected areas were established during the early 1940s. Agricultural development focused on high potential areas and ecological potential rather than on sociocultural factors or population pressure on drier lands. The presence of privileged classes exacerbated inequalities in land distribution. Only 17-18% of Kenyan lands were high potential areas, and, by 1963, it was recognized that there was an imbalance between resources and population numbers. Reliance on land for survival further contributed to land congestion. The land entitlement strategies of the 1940s and 1950s contributed to buy-outs and increasing landlessness. Technological innovation contributed to greater use of marginal or semiarid lands. Policies and strategies were introduced in the colonial period to reduce environmental degradation. These included intensive farming, zero grazing, intercropping, agroforestry, development of roadside reserves, and industrialization. Recommendations were made to address poverty and to invest in longterm agricultural
Mwajita, Mwashasha Rashid; Murage, Hunja; Tani, Akio; Kahangi, Esther M
Rice (Oryza sativa L.) is the most important staple food crop in many developing countries, and is ranked third in Kenya after maize and wheat. Continuous cropping without replenishing soil nutrients is a major problem in Kenya resulting to declining soil fertility. The use of chemical fertilizers to avert the problem of low soil fertility is currently limited due to rising costs and environmental concerns. Many soil micro-organisms are able to solubilize the unavailable phosphorus, increase uptake of nitrogen and also synthesize growth promoting hormones including auxin. The aim of this study was to isolate and characterize phyllosphere, rhizoplane and rhizosphere micro-organisms from Kenyan rice with growth promoting habits. In this study whole plant rice samples were collected from different rice growing regions of Kenya. 76.2%, over 80% and 38.5% of the bacterial isolates were positive for phosphate solubilization, nitrogenase activity and IAA production whereas 17.5% and 5% of the fungal isolates were positive for phosphate solubilization and IAA production respectively. Hence these micro-organisms have potential for utilization as bio-fertilizers in rice production.
Maleche, Allan; Day, Emma
To what extent has the right to access generic HIV medication been implemented in Kenya for the 1.6 million people living with HIV? How does this relate to the right to health under international and national law? This paper examines a constitutional challenge brought to the High Court of Kenya in 2009 (the "Anti-Counterfeit Case") against the Anti-Counterfeit Act of 2008, which the petitioners, all of whom were living with HIV, argued would affect their ability to access affordable and generic antiretroviral medication. They argued that this would amount to a violation of their right to life, dignity, and health. This case is particularly interesting because the new Kenyan Constitution came into force in 2010, after the case had been filed, and specifically provided for the right to health for all of Kenya's citizens, as well as giving direct effect to all international laws ratified by the Kenyan government. This paper follows the Anti-Counterfeit Case, which includes amendments filed by the petitioners following the new constitutional changes, the arguments by the different parties in the case, and the inappropriateness of counterfeit laws as measures to control substandard and falsified medicine. The case has resulted in the suspension of significant parts of the Anti-Counterfeit Act that would pose a challenge to parallel importation, and to the court issuing a directive that the sections be amended. The judgment is examined in detail, as are the broader implications of this case for other countries in Eastern Africa.
Thirumurthy, Harsha; Halpern, Carolyn Tucker; Pettifor, Audrey; Handa, Sudhanshu
Purpose This study investigates the causal effect of Kenya's unconditional cash transfer program on mental health outcomes of young people. Methods Selected Locations in Kenya were randomly assigned to receive unconditional cash transfers in the first phase of Kenya's Cash Transfer Program for Orphans and Vulnerable Children (CT-OVC). In intervention Locations, low-income households and those with OVCs began receiving monthly cash transfers of $20 in 2007. In 2011, four years after program onset, data were collected on the psychosocial status for youth aged 15-24 from households in intervention and control Locations (N=1960). The primary outcome variable was an indicator of depressive symptoms using the 10-question Center for Epidemiologic Studies Depression Scale (CES-D10). Secondary outcomes include Hope and physical health measures. Logistic regression models that adjusted for individual and household characteristics were used to determine the effect of the cash transfer program. Results The cash transfer reduced the odds of depressive symptoms by 24 percent among young persons living in households that received cash transfers. Further analysis by gender and age revealed that the effects were only significant for young men and were larger among men aged 20-24 and orphans. Conclusions This study provides evidence that poverty targeted unconditional cash transfer programs, can improve the mental health of young people in low-income countries. PMID:26576822
Papas, Rebecca K; Sidle, John E; Martino, Steve; Baliddawa, Joyce B; Songole, Rogers; Omolo, Otieno E; Gakinya, Benson N; Mwaniki, Michael M; Adina, Japheth O; Nafula, Tobista; Owino-Ong'or, Willis D; Bryant, Kendall J; Carroll, Kathleen M; Goulet, Joseph L; Justice, Amy C; Maisto, Stephen A
Two-thirds of those with HIV worldwide live in sub-Saharan Africa. Alcohol use is associated with the HIV epidemic through risky sex and suboptimal ARV adherence. In western Kenya, hazardous drinking was reported by HIV (53%) and general medicine (68%) outpatients. Cognitive behavioral treatment (CBT) has demonstrated strong efficacy to reduce alcohol use. This article reports on a systematic cultural adaptation and pilot feasibility study of group paraprofessional-delivered CBT to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. Following adaptation and counselor training, five pilot groups were run (n = 27). Overall attendance was 77%. Percent days abstinent from alcohol (PDA) before session 1 was 52-100% (women) and 21-36% (men), and by session 6 was 96-100% (women) and 89-100% (men). PDA effect sizes (Cohen's d) between first and last CBT session were 2.32 (women) and 2.64 (men). Participants reported treatment satisfaction. Results indicate feasibility, acceptability and preliminary efficacy for CBT in Kenya.
McClanahan, T R; Baird, A H; Marshall, P A; Toscano, M A
We compared the bleaching and mortality response (BMI) of 19 common scleractinian corals to an anomalous warm-water event in 1998 to determine the degree of variation between depths, sites, and regions. Mombasa corals experienced a greater temperature anomaly than those on the Great Barrier Reef (GBR) sites and this was reflected in the greater BMI response of most taxa. Comparing coral taxa in different sites at the same depth produced high correlation coefficients in the bleaching response in Kenya at 2 m (r=0.86) and GBR at 6 m depth sites (r=0.80) but less in the GBR for shallow 2 m sites (r=0.49). The pattern of taxa susceptibility was remarkably consistent between the regions. Coral taxa explained 52% of the variation in the response of colonies to bleaching between these two regions (Kenya BMI=0.90 GBR BMI+26; F(1,19) - 18.3; p < 0.001; r2 = 0.52). Stylophora and Pocillopora were consistently susceptible while Cyphastrea, Goniopora Galaxea and Pavona were resistant in both regions. Three taxa behaved differently between the two regions; Acropora, and branching Porites were both moderately affected on the GBR but were highly affected in Kenya while the opposite was true for Pavona. These results suggest that a colonies response to bleaching is phylogenetically constrained, emphasizing the importance of features of the host's physiology or morphology in determining the response to thermal stress.
House, Darlene R; Cheptinga, Philip; Rusyniak, Daniel E
Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.
Hill, Jessica A.; Lee, Su Yeon; Njambi, Lucy; Corson, Timothy W.; Dimaras, Helen
Background Clinical genetic testing is becoming an integral part of medical care for inherited disorders. While genetic testing and counseling are readily available in high-income countries, in low- and middle-income countries like Kenya genetic testing is limited and genetic counseling is virtually non-existent. Genetic testing is likely to become widespread in Kenya within the next decade, yet there has not been a concomitant increase in genetic counseling resources. To address this gap, we designed an interactive workshop for clinicians in Kenya focused on the genetics of the childhood eye cancer retinoblastoma. The objectives were to increase retinoblastoma genetics knowledge, build genetic counseling skills and increase confidence in those skills. Methods The workshop was conducted at the 2013 Kenyan National Retinoblastoma Strategy meeting. It included a retinoblastoma genetics presentation, small group discussion of case studies and genetic counseling role-play. Knowledge was assessed by standardized test, and genetic counseling skills and confidence by questionnaire. Results Knowledge increased significantly post-workshop, driven by increased knowledge of retinoblastoma causative genetics. One-year post-workshop, participant knowledge had returned to baseline, indicating that knowledge retention requires more frequent reinforcement. Participants reported feeling more confident discussing genetics with patients, and had integrated more genetic counseling into patient interactions. Conclusion A comprehensive retinoblastoma genetics workshop can increase the knowledge and skills necessary for effective retinoblastoma genetic counseling. PMID:26035834
Wekesa, M; Asembo, J. M.; Njororai, W. W.S.; Mutuli
Rugby, like other contact sports, is associated with injuries. We set out to investigate all injuries that led either to a temporary stoppage of the game and/or substitution of a player during the Rugby World Cup pre-qualifying tournament. A total of six matches were played involving the Arabian Gulf, Kenya, Namibia and Zimbabwe. We recorded a total of 47 injuries, giving an injury rate of eight per match. The number of injuries decreased from 38.3% in the first matches to 23.4% in the final ones. The majority of the injuries affected soft tissues, the most serious of them being a concussion. Anatomically, the lower limbs suffered the majority of injuries (46.81%) followed by the head, trunk and upper limbs with 21.29%, 17.03% and 12.78% respectively. Slightly more injuries occurred during the defensive actions (53.19%) than offensive (46.81%) ones. More injuries occurred in thee second half (61.70%) than the first (38.3%). Some of our findings are in agreement with those of earlier studies. However, further investigations are necessary to establish a clear cut pattern of injuries in this sport.
Epule, Epule Terence; Mirielle, Moto Wase; Peng, Changhui; Nguh, Balgah Sounders; Nyagero, Josephat M.; Lakati, Alice; Mafany, Ndiva Mongoh
Voluntary counseling and testing (VCT) services have been set up in most Districts in Kenya due to the rising surge of HIV/AIDS. However, the use of these services among married persons has not been fully explored. In Kissi, the issue of VCT is pressing as the rate of HIV prevalence is close to 3%. In 2006, about 20 000 clients came for VCT services in Kenya yet only 165 of these were married persons. In the Keumbu sub-district hospital, of the more than 1000 clients that came for VCT services, approximately 29% were married persons. This paper therefore aims at determining the utilization of VCT services by married persons in the study area. The qualitative data was obtained principally through two focus group discussions (FGDs) in which the respondents were asked to comment on their use of VCT services while the quantitative data was obtained from interviews with 245 respondents. The qualitative data was analyzed through verbatim transcription while for the quantitative data; the responses were coded and populated into SPSS from which the frequencies and percentages were calculated. The results show that actual use of the VCT services is low (28.1%) but slightly higher among female respondents than males. The low usage may be attributed to (a) fear of results, (b) death anxiety, (c) lack of confidentiality and lastly, (d) fear of stigmatization. Female respondents were found to have a greater awareness of VCT and thus its potential use. PMID:23283034
Robertson, E.; Biggs, J.; Edmonds, M.; Vye-Brown, C.
The East African Rift (EAR) system is a 5,000 km long series of fault bounded depressions that run from Djibouti to Mozambique. In the Kenyan Rift, fourteen Quaternary volcanoes lie along the central rift axis. These volcanoes are principally composed of trachyte pyroclastics and trachyte and basaltic lavas forming low-angle multi-vent edifices. Between 1997 and 2008, geodetic activity has been observed at five Kenyan volcanoes, all of which have undergone periods of caldera collapse and explosive activity. We present a remote-sensing study to investigate the temporal and spatial development of volcanic activity at Longonot volcano. High-resolution mapping using ArcGIS and an immersive 3D visualisation suite (GeovisionaryTM) has been used with imagery derived from ASTER, SPOT5 and GDEM data to identify boundaries of eruptive units and establish relative age in order to add further detail to Longonot's recent eruptive history. Mapping of the deposits at Longonot is key to understand the recent geological history and forms the basis for future volcanic hazard research to inform risk assessments and mitigation programs in Kenya. Calderas at Kenyan volcanoes are elliptical in plan view and we use high-resolution imagery to investigate the regional stresses and structural control leading to the formation of these elliptical calderas. We find that volcanoes in the central and northern segments of the Kenyan rift are elongated nearly parallel to the direction of least horizontal compressive stress, likely as a reflection of the direction of the plate motion vector at the time of caldera collapse. The southern volcanoes however are elongated at an acute angle to the plate motion vector, most likely as a result of oblique opening of the Kenyan rift in this region.
Kimani, Tabitha; Ngigi, Margaret; Schelling, Esther; Randolph, Tom
Introduction One Health (OH) can be considered a complex emerging policy to resolve health issues at the animal–human and environmental interface. It is expected to drive system changes in terms of new formal and informal institutional and organisational arrangements. This study, using Rift Valley fever (RVF) as a zoonotic problem requiring an OH approach, sought to understand the institutionalisation process at national and subnational levels in an early adopting country, Kenya. Materials and methods Social network analysis methodologies were used. Stakeholder roles and relational data were collected at national and subnational levels in 2012. Key informants from stakeholder organisations were interviewed, guided by a checklist. Public sector animal and public health organisations were interviewed first to identify other stakeholders with whom they had financial, information sharing and joint cooperation relationships. Visualisation of the OH social network and relationships were shown in sociograms and mathematical (degree and centrality) characteristics of the network summarised. Results and discussion Thirty-two and 20 stakeholders relevant to OH were identified at national and subnational levels, respectively. Their roles spanned wildlife, livestock, and public health sectors as well as weather prediction. About 50% of national-level stakeholders had made significant progress on OH institutionalisation to an extent that formal coordination structures (zoonoses disease unit and a technical working group) had been created. However, the process had not trickled down to subnational levels although cross-sectoral and sectoral collaborations were identified. The overall binary social network density for the stakeholders showed that 35 and 21% of the possible ties between the RVF and OH stakeholders existed at national and subnational levels, respectively, while public health actors’ collaborations were identified at community/grassroots level. We recommend
Gross, Jessica M; Rogers, Martha F; Teplinskiy, Ilya; Oywer, Elizabeth; Wambua, David; Kamenju, Andrew; Arudo, John; Riley, Patricia L; Higgins, Melinda; Rakuom, Chris; Kiriinya, Rose; Waudo, Agnes
Objective To examine the impact of out-migration on Kenya's nursing workforce. Study Setting This study analyzed deidentified nursing data from the Kenya Health Workforce Informatics System, collected by the Nursing Council of Kenya and the Department of Nursing in the Ministry of Medical Services. Study Design We analyzed trends in Kenya's nursing workforce from 1999 to 2007, including supply, deployment, and intent to out-migrate, measured by requests for verification of credentials from destination countries. Principle Findings From 1999 to 2007, 6 percent of Kenya's nursing workforce of 41,367 nurses applied to out-migrate. Eighty-five percent of applicants were registered or B.Sc.N. prepared nurses, 49 percent applied within 10 years of their initial registration as a nurse, and 82 percent of first-time applications were for the United States or United Kingdom. For every 4.5 nurses that Kenya adds to its nursing workforce through training, 1 nurse from the workforce applies to out-migrate, potentially reducing by 22 percent Kenya's ability to increase its nursing workforce through training. Conclusions Nurse out-migration depletes Kenya's nursing workforce of its most highly educated nurses, reduces the percentage of younger nurses in an aging nursing stock, decreases Kenya's ability to increase its nursing workforce through training, and represents a substantial economic loss to the country. PMID:21413982
Austrian, Karen; Anderson, Althea D.
Adolescent girls and young women in urban slum areas in developing countries face a myriad of challenges regarding education, sexual health, livelihoods and gender-based violence. One way of understanding how these challenges interact with each other is through the Asset Building Framework, which posits that girls need a combination of social,…
Goyette, Marielle; Wamuti, Beatrice Muthoni; Owuor, Mercy; Bukusi, David; Maingi, Peter Mutiti; Otieno, Felix Abuna; Cherutich, Peter; Ng'ang'a, Anne; Farquhar, Carey
Assisted partner services (APS) are more effective than passive referral in identifying new cases of HIV in many settings. Understanding the barriers to the uptake of APS in sub-Saharan Africa is important before its scale up. In this qualitative study, we explored client, community, and healthcare worker barriers to APS within a cluster randomized trial of APS in Kenya. We conducted 20 in-depth interviews with clients who declined enrollment in the APS study and 9 focus group discussions with health advisors, HIV testing and counseling (HTC) counselors, and the general HTC client population. Two analysts coded the data using an open coding approach and identified major themes and subthemes. Many participants reported needing more time to process an HIV-positive result before providing partner information. Lack of trust in the HTC counselor led many to fear a breach of confidentiality, which exacerbated the fears of stigma in the community and relationship conflicts. The type of relationship affected the decision to provide partner information, and the lack of understanding of APS at the community level contributed to the discomfort in enrolling in the study. Establishing trust between the client and HTC counselor may increase uptake of APS in Kenya. A client's decision to provide partner information may depend on the type of relationship he or she is in, and alternative methods of disclosure may need to be offered to accommodate different contexts. Spreading awareness about APS in the community may make clients more comfortable providing partner information.
Dellicour, Stephanie; Aol, George; Ouma, Peter; Yan, Nicole; Bigogo, Godfrey; Hamel, Mary J; Burton, Deron C; Oneko, Martina; Breiman, Robert F; Slutsker, Laurence; Feikin, Daniel; Kariuki, Simon; Odhiambo, Frank; Stergachis, Andreas; Laserson, Kayla F; ter Kuile, Feiko O; Desai, Meghna
Objective Information on adverse pregnancy outcomes is important to monitor the impact of public health interventions. Miscarriage is a challenging end point to ascertain and there is scarce information on its rate in low-income countries. The objective was to estimate the background rate and cumulative probability of miscarriage in rural western Kenya. Design This was a population-based prospective cohort. Participants and setting Women of childbearing age were followed prospectively to identify pregnancies and ascertain their outcomes in Siaya County, western Kenya. The cohort study was carried out in 33 adjacent villages under health and demographic surveillance. Outcome measure Miscarriage. Results Between 2011 and 2013, among 5536 women of childbearing age, 1453 pregnancies were detected and 1134 were included in the analysis. The cumulative probability was 18.9%. The weekly miscarriage rate declined steadily with increasing gestation until approximately 20 weeks. Known risk factors for miscarriage such as maternal age, gravidity, occupation, household wealth and HIV infection were confirmed. Conclusions This is the first report of weekly miscarriage rates in a rural African setting in the context of high HIV and malaria prevalence. Future studies should consider the involvement of community health workers to identify the pregnancy cohort of early gestation for better data on the actual number of pregnancies and the assessment of miscarriage. PMID:27084287
Mucherah, Winnie; Owino, Elizabeth; McCoy, Kaleigh
While the past decade has seen an improvement in attitudes toward homosexuality, negative attitudes are still prevalent in many parts of the world. In general, increased levels of education tend to be predictive of relatively positive attitudes toward homosexuality. However, in most sub-Saharan countries, it is still believed that people are born heterosexual and that nonheterosexuals are social deviants who should be prosecuted. One such country is Kenya, where homosexuality is illegal and attracts a fine or jail term. The purpose of this study was to examine high school students' perceptions of homosexuality in Kenya. The participants included 1,250 high school students who completed a questionnaire on perceptions of homosexuality. The results showed that 41% claimed homosexuality is practiced in schools and 61% believed homosexuality is practiced mostly in single-sex boarding schools. Consistently, 52% believed sexual starvation to be the main cause of homosexuality. Also, 95% believed homosexuality is abnormal, 60% believed students who engage in homosexuality will not change to heterosexuality after school, 64% believed prayers can stop homosexuality, and 86% believed counseling can change students' sexual orientation. The consequences for homosexuality included punishment (66%), suspension from school (61%), and expulsion from school (49%). Significant gender and grade differences were found. The implications of the study findings are discussed.
Mucherah, Winnie; Owino, Elizabeth; McCoy, Kaleigh
While the past decade has seen an improvement in attitudes toward homosexuality, negative attitudes are still prevalent in many parts of the world. In general, increased levels of education tend to be predictive of relatively positive attitudes toward homosexuality. However, in most sub-Saharan countries, it is still believed that people are born heterosexual and that nonheterosexuals are social deviants who should be prosecuted. One such country is Kenya, where homosexuality is illegal and attracts a fine or jail term. The purpose of this study was to examine high school students’ perceptions of homosexuality in Kenya. The participants included 1,250 high school students who completed a questionnaire on perceptions of homosexuality. The results showed that 41% claimed homosexuality is practiced in schools and 61% believed homosexuality is practiced mostly in single-sex boarding schools. Consistently, 52% believed sexual starvation to be the main cause of homosexuality. Also, 95% believed homosexuality is abnormal, 60% believed students who engage in homosexuality will not change to heterosexuality after school, 64% believed prayers can stop homosexuality, and 86% believed counseling can change students’ sexual orientation. The consequences for homosexuality included punishment (66%), suspension from school (61%), and expulsion from school (49%). Significant gender and grade differences were found. The implications of the study findings are discussed. PMID:27672345
Ren, G; Liu, X; Xiong, H; Wang, J; Zhao, G
A new strain of Bacillus thurinigiensis Bt with high toxicity against noctuidae larvae has been screened for many generations since isolated from larvae candle of Aphomia gularis in Yiyang County, Jiangxi Province, in China. By comparison and analysis of results of physiological and biochemical test, flagella antigen identification and esterase type, the strain is identified as H4a-4c Bt serovar. kenyae. Since its crystal protein type and plasmid type are different from those of Bt serovar. kenyae's type 023. The strain is assigned a novel strain: Btken-Ag. Btken-Ag's parasporal crystals are multi-morphorous: bipyramid, cube, small irregular sphere and embedded. After UMT dissolve, PAGE and SDS-PAGE separation preparation and analysis, it is found that its major insecticide component to Heliothis armigera is 61kD toxic protein. By ELISA homology analysis, it is found that this toxic protein has high homology with crystal protein of 023 and 7501 (H4a-4c), partly homology with that of HD-1(H3a-3b), but no homology with that of Bti(H14) and (Bacillus sphaericus) Ts-1 strain. In bioassay with larvae from Culex pipiens, Pseudaletia unipuncta and Heliothis armigera, together with other ten Bt strains, Btken-Ag is toxic to 3 star larvae of Culex pipiens; two isolates of Btken-Ag (b1-4 and H4-1) show higher toxicity than type strain 023 and HD-1 do to Pseudaletia unipuncta and Heliothis armigera.
Anthony, E.; Deino, A. L.; White, J. C.; Omenda, P. A.
We report here a synthesis of the geochemistry of magma evolution correlated with 40Ar/39Ar, 14 C, and U-series chronology for volcanoes in the Central Kenya Peralkaline Province (CKPP). The volcanic centers - Menengai, Eburru, Olkaria, Longonot, and Suswa - are at the apex of the Kenya Dome, and consist of trachyte, phonolite, comendite, and pantellerite. These volcanic centers are within the graben of the EARS and are characterized by a shield-building phase followed by caldera collapse and subsequent post-caldera eruptions. Geochemical modeling demonstrates that the magmas are the result of fractional crystallization of alkali basaltic magmas and magma mixing. Longonot and Suswa have the most chronologic data -14 C, Ar/Ar and U-series - and they show that the youngest eruptions have 230 Th/232Th of 0.8, which was inherited from the magma system prior to eruption. Subsequent changes in 230 Th/232 Th are due to post-eruptive decay of 230 Th and correlate well with 14 C and Ar/Ar.
Cohen, Ted; Zignol, Matteo; Nyakan, Edwin; Hedt-Gauthier, Bethany L.; Gardner, Adrian; Kamle, Lydia; Injera, Wilfred; Carter, E. Jane
Objective To classify the prevalence of multi-drug resistant tuberculosis (MDR-TB) in two different geographic settings in western Kenya using the Lot Quality Assurance Sampling (LQAS) methodology. Design The prevalence of drug resistance was classified among treatment-naïve smear positive TB patients in two settings, one rural and one urban. These regions were classified as having high or low prevalence of MDR-TB according to a static, two-way LQAS sampling plan selected to classify high resistance regions at greater than 5% resistance and low resistance regions at less than 1% resistance. Results This study classified both the urban and rural settings as having low levels of TB drug resistance. Out of the 105 patients screened in each setting, two patients were diagnosed with MDR-TB in the urban setting and one patient was diagnosed with MDR-TB in the rural setting. An additional 27 patients were diagnosed with a variety of mono- and poly- resistant strains. Conclusion Further drug resistance surveillance using LQAS may help identify the levels and geographical distribution of drug resistance in Kenya and may have applications in other countries in the African Region facing similar resource constraints. PMID:27167381
Mital, Sasha; Miles, Gillian; McLellan-Lemal, Eleanor; Muthui, Mercy; Needle, Richard
Introduction While relatively rare events, abrupt disruptions in heroin availability have a significant impact on morbidity and mortality risk among those who are heroin dependent. A heroin shortage occurred in Coast Province, Kenya from December 2010 to March 2011. This qualitative analysis describes the shortage events and consequences from the perspective of heroin users, along with implications for health and other public sectors. Methods As part of a rapid assessment, 66 key informant interviews and 15 focus groups among heroin users in Coast Province, Kenya were conducted. A qualitative thematic analysis was undertaken in Atlas.ti. to identify salient themes related to the shortage. Results Overall, participant accounts were rooted in a theme of desperation and uncertainty, with emphasis on six sub-themes: (1) withdrawal and strategies for alleviating withdrawal, including use of medical intervention and other detoxification attempts; (2) challenges of dealing with unpredictable drug availability, cost, and purity; (3) changes in drug use patterns, and actions taken to procure heroin and other drugs; (4) modifications in drug user relationship dynamics and networks, including introduction of risky group-level injection practices; (5) family and community response; and (6) new challenges with the heroin market resurgence. Conclusions The heroin shortage led to a series of consequences for drug users, including increased risk of morbidity, mortality and disenfranchisement at social and structural levels. Availability of evidence-based services for drug users and emergency preparedness plans could have mitigated this impact. PMID:26470646
Rashid, Zahra Aly; Millodot, Michel; Evans, Katharine S. E.
PURPOSE: To describe the characteristics of keratoconus (KC) patients seen in a contact lens clinic of a children's hospital in Kenya. RESULTS: A total of 254 patients’ records were analyzed. Mean age at presentation to the clinic was 20.97 ± 11.13 year (range, 6–84 years) with 75% between the ages of 6 and 25 years. There was a preponderance of males (59.8%). Most patients were referred by an ophthalmologist. All patients were Africans. The most common complaints were blurred vision (50%), poor visual acuity with spectacles (33.5%), contact lens intolerance (11.8%), and other (unspecified). Most cases were severe (71%) followed by moderate (22.9%) and mild (6.2%). Mean BCVA was 0.24 ± 0.23 (6/11). An optical correction was provided in 98% of cases; 34.6% with spectacles, 31.1% with gas permeable lenses and the remaining with both. Referral for keratoplasty was warranted in 16.5%. CONCLUSION: This is the first study of KC conducted in Kenya. KC presented at a very early age and tended to be severe. Ophthalmologists were the main source of referral. The main presenting symptom was reduced vision. Optical correction was the most common management and the percentage of patients referred for surgery concurred with other studies. PMID:27994389
Restoy, Enrique; Kibuchi, Evaline; Holland, Paula; Harries, Anthony D.
Abstract Adherence to treatment is a key element for global TB control. Public health laws can be used to enforce isolation, adherence, and completion of TB treatment. However, the practical application of public health laws can potentially range from voluntary measures to involuntary detention approaches. This paper explores the potential risks and impacts of using detention approaches to enforce TB treatment adherence. In August 2015, we conducted a literature search regarding the application of public health laws to enforce adherence to TB treatment globally, and specifically in Kenya. Texts were analyzed using narrative synthesis. Results indicated that in Kenya, people lost to follow-up on TB treatment were frequently detained in prisons. However, incarceration and detention approaches curtail the rights to health, informed consent, privacy, freedom from non-consensual treatment, freedom from inhumane and degrading treatment, and freedom of movement of people lost to follow-up. Detention could also worsen social inequalities and lead to a paradoxical increase in TB incidence. We suggest the incorporation of less intrusive solutions in legislation and policies. These include strengthening health systems to reduce dependency on prisons as isolation spaces, decentralizing TB treatment to communities, enhancing treatment education, revising the public health laws, and addressing socioeconomic and structural determinants associated with TB incidence and loss to follow-up. PMID:27780998
Temu, Tecla M; Bahiru, Ehete; Bukachi, Fredrick; Bloomfield, Gerald S; Muiruri, Peter; Farquhar, Carey
Objective Hypertension affects 23% of Kenyans and is the most prevalent modifiable risk factor for cardiovascular disease. Despite this, hypertension awareness and treatment adherence is very low. We conducted a qualitative study to explore lay beliefs about hypertension among HIV-infected adults to inform the development of culture sensitive hypertension prevention and control program. Methods Eight focus group discussions were held for 53 HIV-infected adults at the HIV clinic in Kenya. Results Respondents had difficulties in describing hypertension. Hypertension was considered a temporary illness that is fatal and more serious than HIV. Stress was perceived as a main cause for hypertension with a large majority claiming stress reduction as the best treatment modality. Alcohol and tobacco use were not linked to hypertension. Obesity was cited as a cause of hypertension but weight control was not considered as a treatment modality even though the majority of our participants were overweight. Most participants did not believe hypertension could be prevented. Conclusion Our findings suggest a limited understanding of hypertension among people living with HIV and points to an urgent need to integrate hypertension education programmes in HIV care facilities in Kenya. To effect change, these programmes will need to tie in the culture meaning of hypertension.
Lim, Jason LitJeh; Yih, Yuehwern; Gichunge, Catherine; Tierney, William M.; Le, Tung H.; Zhang, Jun; Lawley, Mark A.; Petersen, Tomeka J.; Mamlin, Joseph J.
Objective The AMPATH program is a leading initiative in rural Kenya providing healthcare services to combat HIV. Malnutrition and food insecurity are common among AMPATH patients and the Nutritional Information System (NIS) was designed, with cross-functional collaboration between engineering and medical communities, as a comprehensive electronic system to record and assist in effective food distribution in a region with poor infrastructure. Design The NIS was designed modularly to support the urgent need of a system for the growing food distribution program. The system manages the ordering, storage, packing, shipping, and distribution of fresh produce from AMPATH farms and dry food supplements from the World Food Programme (WFP) and U.S. Agency for International Development (USAID) based on nutritionists' prescriptions for food supplements. Additionally, the system also records details of food distributed to support future studies. Measurements Patients fed weekly, patient visits per month. Results With inception of the NIS, the AMPATH food distribution program was able to support 30,000 persons fed weekly, up from 2,000 persons. Patient visits per month also saw a marked increase. Conclusion The NIS' modular design and frequent, effective interactions between developers and users has positively affected the design, implementation, support, and modifications of the NIS. It demonstrates the success of collaboration between engineering and medical communities, and more importantly the feasibility for technology readily available in a modern country to contribute to healthcare delivery in developing countries like Kenya and other parts of sub-Saharan Africa. PMID:19717795
Prator, Clifford H.
The Survey of Language Use and Language Teaching in Eastern Africa, founded in 1967 with headquarters in Nairobi, Kenya, covers Kenya, Uganda, Tanzania, Ethiopia, and Zambia. This article reports on the Survey's organization, methods, participants, achievements and goals. (FWB)
Makori, Rebecca S.; Onyango, Maria; Attyang, Judith Miguda; Bantu, Edward; Onderi, Peter Omae
It is observed that the major setback to economic development in Kenya is stagnation in industrial development. To overcome these, Kenya plans to be a middle level income nation by the year 2030. These plans are to be realized through "Vision 2030." To achieve these goals, Kenya requires gender mainstreamed team of highly skilled workers…
Gray, Clark L.
Soil degradation is widely considered to be a key factor undermining agricultural livelihoods in the developing world and contributing to rural out-migration. To date, however, few quantitative studies have examined the effects of soil characteristics on human migration or other social outcomes for potentially vulnerable households. This study takes advantage of a unique longitudinal survey dataset from Kenya and Uganda containing information on household-level soil properties to investigate the effects of soil quality on population mobility. Random effects multinomial logit models are used to test for effects of soil quality on both temporary and permanent migration while accounting for a variety of potential confounders. The analysis reveals that soil quality significantly reduces migration in Kenya, particularly for temporary labor migration, but marginally increases migration in Uganda. These findings are consistent with several previous studies in showing that adverse environmental conditions tend to increase migration but not universally, contrary to common assumptions about environmentally-induced migration. PMID:22016577
Malonza, Patrick K; Bauer, Aaron M; Ngwava, Jacob M
A new species of blind snake in the genus Letheobia (L. mbeerensis sp. nov.) is described from the Mbeere area on the extreme lower slopes of southeastern Mt. Kenya. It is an attenuate blind snake, superficially similar to Letheobia lumbriciformis but with 20 midbody scale rows and 670 middorsal scales. It has a total length of 280 mm with the proportionally longest tail in the genus (2.9% of total length), a broad rostral, eyes barely visible and in life it is pink in color. The new species is known from only a single specimen collected at Siakago, in Mbeere-Embu, which lies at an elevation of about 1200m. It is a burrowing species and like many other blind snakes it is likely to be nocturnal and rarely encountered on the soil surface. The new species is incorporated into a key to the scolecophidian snakes of Kenya.
Jones, B.F.; Eugster, H.P.; Rettig, S.L.
New and more complete compositional data are presented for a large number of water samples from the Lake Magadi area, Kenya. These water samples range from dilute inflow (300 g/kg dissolved solids). Five distinct hydrologic stages can be recognized in the evolution of the water compositions: dilute streamflow, dilute ground water, saline ground water (or hot spring reservoir), saturated brines, and residual brines. Based on the assumption that chloride is conserved in the waters during evaporative concentration, these stages are related to each other by the concentration factors of about 1:28:870:7600:16,800. Dilute streamflow is represented by perennial streams entering the Rift Valley from the west. All but one (Ewaso Ngiro) of these streams disappear in the alluvium and do not reach the valley floor. Dilute ground water was collected from shallow pits and wells dug into lake sediments and alluvial channels. Saline ground water is roughly equivalent to the hot springs reservoir postulated by Eugster (1970) and is represented by the hottest of the major springs. Saturated brines represent surficial lake brines just at the point of saturation with respect to trona (Na2CO3.NaHCO3.2H2O), while residual brines are essentially interstitial to the evaporite deposit and have been subjected to a complex history of precipitation and re-solution. The new data confirm the basic hydrologic model presented by Eugster (1970) which has now been refined, particularly with respect to the early stages of evaporative concentration. Budget calculations show that only bromide is conserved as completely as chloride. Sodium follows chloride closely until trona precipitation, whereas silica and sulfate are largely lost during the very first concentration' step (dilute streamflow-dilute ground water). A large fraction of potassium and all calcium plus magnesium are removed during the first two concentration steps (dilute streamflow-dilute ground water-saline ground water). Carbonate and
Background Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Methods Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. Results The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. Conclusions OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government’s role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize
Kenya had a relatively open political system. Kenya’s first president was Jomo Kenyatta , an independence advocate from Kenya’s largest ethnic group...son of Jomo Kenyatta , for the presidency with a 62% majority. Moi had designated Kenyatta as the KANU candidate for president in October 2002...leader Kibaki defeated Uhuru Kenyatta , the leader of KANU. On December 27, 2007, millions of Kenyans went to the polls in Kenya’s fourth multi-party
that the organizers forgot to include the National Anthem in the program.5 CRS-4 6 Shashank, Bengali . How Kenya’s Election Was Rigged, the McClatchy...of the opposition to back a single candidate against Moi. The opposition learned from its mistakes, and in 2002 it succeeded in forming and holding...For example, the power of incumbency and the entrenched clout of a ruling party did not stop an opposition victory in Kenya. The lessons learned from
Mooney, W.D.; Christensen, N.I.
We infer the composition of the crust beneath and on the flanks of the Kenya rift based on a comparison of the KRISP-90 crustal velocity structure with laboratory measurements of compressional-wave velocities of rock samples from Kenya. The rock samples studied, which are representative of the major lithologies exposed in Kenya, include volcanic tuffs and flows (primarily basalts and phonolites), and felsic to intermediate composition gneisses. This comparison indicates that the upper crust (5-12 km depth) consists primarily of quartzo-feldspathic gneisses and schists similar to rocks exposed on the flanks of the rift, whereas the middle crust (12-22 km depth) consists of more mafic, hornblende-rich metamorphic rocks, probably intruded by mafic rocks beneath the rift axis. The lower crust on the flanks of the rift may consist of mafic granulite facies rocks. Along the rift axis, the lower crust varies in thickness from 9 km in the southern rift to only 2-3 km in the north, and has a seismic velocity substantially higher than the samples investigated in this study. The lower crust of the rift probably consists of a crust/mantle mix of high-grade metamorphic rocks, mafic intrusives, and an igneous mafic residuum accreted to the base of the crust during differentiation of a melt derived from the upper mantle. ?? 1994.
Piper, Benjamin; Zuilkowski, Stephanie Simmons
In recent years, the Education for All movement has focused more intensely on the quality of education, rather than simply provision. Many recent and current education quality interventions focus on literacy, which is the core skill required for further academic success. Despite this focus on the quality of literacy instruction in developing countries, little rigorous research has been conducted on critical issues of assessment. This analysis, which uses data from the Primary Math and Reading Initiative (PRIMR) in Kenya, aims to begin filling this gap by addressing a key assessment issue - should literacy assessments in Kenya be administered orally or silently? The authors compared second-grade students' scores on oral and silent reading tasks of the Early Grade Reading Assessment (EGRA) in Kiswahili and English, and found no statistically significant differences in either language. They did, however, find oral reading rates to be more strongly related to reading comprehension scores. Oral assessment has another benefit for programme evaluators - it allows for the collection of data on student errors, and therefore the calculation of words read correctly per minute, as opposed to simply words read per minute. The authors therefore recommend that, in Kenya and in similar contexts, student reading fluency be assessed via oral rather than silent assessment.
Ndhine, Edwardina Otieno; Slotved, Hans-Christian; Osoro, Eric Mogaka; Olsen, Katja N; Rugutt, Moses; Wanjohi, Cathryn W; Mwanda, Walter; Kinyagia, Benson Mburu; Steenhard, Nina R; Hansen, John-Erik Stig
A biosecurity survey was performed to gather information on the biosecurity level and laboratory capacity in Kenya for the purpose of providing information outlining relevant components for biosecurity legislation, biosecurity implementation, and enforcement of biosecurity measures in Kenya. This survey is, to the authors' knowledge, the first to be published from an African country. A total of 86 facilities with laboratories covering relevant categories, such as training laboratories, human diagnostic laboratories, veterinary diagnostic laboratories, and research laboratories, were selected to participate in the survey. Each facility was visited by a survey team and staff were asked to answer 29 groups of questions from a questionnaire. The survey showed that Kenyan laboratory facilities contain biological agents of biosecurity concern. The restrictions for these agents were found to be limited for several of the facilities, in that many laboratory facilities and storage units were open for access by either students or staff who had no need of access to the laboratory. The survey showed a great deal of confusion in the terms biosecurity and biosafety and a generally limited biosecurity awareness among laboratory personnel. The survey showed that the security of biological agents of biosecurity concern in many facilities does not meet the international requirements. The authors recommend developing a legal framework in Kenya for effective controls, including national biosecurity regulations, guidelines, and procedures, thereby reducing the risk that a Kenyan laboratory would be the source of a future biological attack.
Suwa, Kanenori; Suzuki, Kazuhiro; Agata, Takashi
Green vanadium grossulars occur as porphyroblasts in calc-silicate-graphite gneiss associated with marble, pelitic-psammitic gneiss and granitoid gneiss in the Mozambique metamorphic belt, south Kenya. Calc-silicate-graphite gneiss contains scapolite, vanadian zoisite, vanadian diopside, vanadian sphene and vanadian magnetite, in addition to vanadium grossular. The vanadium grossular porphyroblasts are mantled by a kelyphitic rim that consists mainly of symplectic intergrowth of fine-grained scapolite, vanadium grossular, vanadian diopside, vanadian sphene, vanadian magnetite, plagioclase, calcite and quartz. Vanadian minerals (vanadian muscovite, vanadian zoisite, vanadian sphene and vanadian rutile) also occur in the marble. The occurrence of scapolite and the enrichment in vanadium suggest that the protolith of calc-silicate-graphite gneiss was evaporite or related sediment. The mode of occurrence of vanadium grossular in Kenya is quite similar to that in the Sør Rondane Mountains, East Antarctica. The vanadium-grossular-bearing gneisses in Kenya might be correlated with those in Antarctica, since the Sør Rondane Mountains had continued from the Mozambique metamorphic belt before the breakup of Gondwanaland.
Mugoya, George C. T.; Mutua, Kagendo N.
The overarching purpose of this study was to ascertain the prevalence of maternal and infant/child health indices that have an established link to childhood disability (CHD) and their association with socio-economic status (SES) in Kenya. Data were drawn from the 2008/2009 Kenya Demographic and Health Survey. Descriptive and weighted Pearson's…