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The 2017 general comment (GC21) to the United Nations Convention on the Rights of the Child (UNCRC) on children in street situations, provides a framework of legal guidance for governments developing policies aimed at protecting street-connected children and sets up the rationale for more awareness raising and public education to counter negative and deficit attitudes towards street-connectedness. Within this framework, the media has a role to play in either challenging conceptualisations of street-connected children as out-of-place within the public and predominantly adult domain described by urban streets, or in reinforcing ideological constructions of citizenship and normalised notions of childhood that result in negative stereotypes of these children. GC21 recommends that interventions targeted at street-connected children should be ethically responsible -- adopting child rights approaches aimed at using accurate data/evidence that upholds the dignity of children, their personal integrity, and their right to life. As such, these approaches should also extend to how organisations engage with and utilise the media to represent street-connected children. Focusing on media representations of street-connected children during the six pandemic-affected months of February to July 2020, this paper provides a review of the content of the sources to provide an insight into the structural barriers that face street-connected children because of how they are positioned in society, during the pandemic and in general, and the extent to which the media reinforces or counters the rescue or removal narratives that can lead to inappropriate intervention responses.

The qualitative community embraces transparent dialogue through sharing knowledge to improve rigour and develop new initiatives. In this paper, we recognise there are many complexities within qualitative research, leading to important debates. We explore the benefits and challenges, as well as the practicalities and technicalities, of conducting research that 1) employs multiple methods within the qualitative paradigm, 2) is interdisciplinary, and 3) examines a sensitive research topic 4) with a vulnerable group of participants. Specifically, when research is also 5) cross-cultural and 6) utilises participatory techniques. Through our discussion, we draw upon an existing project and examine the complexity of designing and completing intra-paradigmatic mixed methods research with children from different sociocultural contexts, underpinned by interdisciplinary perspectives, in a complex area like mental health.

This paper contributes to the scarce literature on factors affecting EdTech use in households. These factors were considered through exploratory mixed-methods analyses of cross-sectional data on Kenyan girls and caregivers, captured during the COVID-19 pandemic. Quantitative analysis of the child dataset (n = 544) suggested the importance of both structural factors--such as technology hardware availability--and non-structural factors--including caregiver permission. Findings were supported by a thematic analysis of interview data from girls' caregivers (n = 58), which emphasised the role they play in girls' use of EdTech. Interviews also highlighted numerous caregiver concerns with EdTech, related to the relevance and rigour of educational content, the possibility of children accessing age-inappropriate material and child health (especially eyesight). Policy makers could alleviate these concerns by providing guidance on EdTech use and clearly signalling their approval of verified initiatives.

Refugee children have often witnessed or experienced trauma, violence, and death. While conflict harms the psychosocial well-being and emotional development of children, an inclusive educational environment can serve as a safe haven for refugee students. Drawing on qualitative data collected between 2015-2017 in Kakuma refugee camp in Kenya, including 81 semi-structured interviews and extensive feedback gathered during teacher training workshops, this paper examines the micro-level disciplinary practices among teachers that promote or impede the inclusion of refugee children. The paper presents the tension between teachers' own negative experiences with corporal punishment as students, and their justification for using corporal punishment as teachers. Additionally, it highlights the role that continuous professional development plays in making positive changes to teachers' beliefs and practices. The authors argue that providing a safe space for reflection and discussion on corporal punishment and positive discipline is pertinent to reducing negative practices and stress the key role teachers play in creating such environments.

The conflict situations that have afflicted parts of Kenya every five years, in the wake of general elections, since 1992 were most prominent after the disputed presidential elections of 2007. The magnitude of the clashes, loss of life, destruction of property and internal displacement of people were hitherto unwitnessed. The situation of Orphans and Vulnerable Children (OVC) in Kenya has continued to be of national and international concern. The 2007/2008 post-election violence exacerbated the dire situation of OVC in Kenya. United Nations Children's Fund (UNICEF) estimated the number of children displaced by the 2007/2008 post-election violence (PEV) in Kenya at 100,000 and those orphaned at 300,000 high. Some of the OVC lost both parents during the violence. Many more were born during and after displacement, and have no knowledge of their homes or origin. They do not understand or even remember the circumstances that caused their parents to be displaced. A survey by UNICEF in 2010 noted that on the overall after 2007/08 post-election conflict, about 15% of orphans were 0-4 years old, 35% were between 5 and 9 years old while up to 50% were 10-14 years old. This paper identifies the challenges the OVC are experiencing in schools as absenteeism, lack of physical infrastructure, insecurity, psychological trauma, among others. The paper also proposes strategies and programmes that various stakeholders have, and should put in place to assist OVC.

An abstract of the article "Baseline findings from a pilot study to evaluate the use of postural support, constructed using Appropriate paper-based technology (APT), to be used with children with Cerebral Palsy in Kenya" by Rachel Lindoewood and others is presented.

While evidence confirms that children with disabilities face significant obstacles to schooling, especially in low-income countries like Kenya, there is limited empirical research on which to develop policy. The government of Kenya has long neglected the plight of people with disabilities. Despite numerous policy recommendations from the various education commissions, few, if any, have been fully implemented. Despite the rich information that may inform policy, household surveys are an overlooked source of data on children with disabilities. Therefore, using two sources of household survey data, this paper examines school enrolment and attendance patterns for children with disabilities in Kenya. The evidence suggests lower school participation for children with disabilities. This may be due to the limited availability of educational services. Despite the need for educational services, the analysis also shows that the majority of children with disabilities were not aware of any of the services offered by the government.

Reading research has shown that variable relationships exist between measures of oral reading fluency and reading comprehension, depending on whether the language of the text is the reader's first language or an additional language. This paper explores this phenomenon, using reading assessment data for 2,000 Kenyan children in two or three languages: English, Kiswahili and one of two mother tongues, Dholuo or Gikuyu. The assessment data allowed us to compare reading and comprehension rates across languages. The data indicated that many children could read English words more easily than words in Kiswahili or their mother tongue; nevertheless, their reading comprehension was significantly lower in English than in Kiswahili, Dholuo or Gikuyu. The paper concludes that emphasising English reading fluency is an inefficient route to gaining reading comprehension skills because pupils are actually attaining minimal oral reading fluency in English and only modest comprehension skills in their own languages. The evidence also demonstrates that Kenya's national language policy of mother tongue as a medium of instruction in the early primary grades is consistently ignored in practice.

Kenya has the twelfth largest HIV/AIDS epidemic in the world. In 2016, there was an estimated 1.6 million people living with HIV in Kenya. Youth ages 15-24 accounted for over half (51%) of the HIV incidence reported in 2015, a significant increase from 2013 where youth accounted for 29% of all new cases. The purpose of this paper is to review HIV prevalence and incidence among youth and other key populations in Kenya and to discuss the cultural attitudes and practices that impact the HIV epidemic including relevant laws, policies, and initiatives with a focus on the role of school psychologists in neuropsychological interventions for children and adolescents living with HIV. A broad range of biomedical, behavioral, and structural approaches for addressing the HIV-related needs among youth in Kenya are discussed as is the importance of addressing the psychosocial needs of youth living with HIV by acknowledging the relationship between physical health, mental health, and academic outcomes. The critical role of school psychologists and other school professionals in implementing these strategies is highlighted.

In many low- and lower-middle-income countries, private schools are often considered to offer better quality of education than government schools. Yet, there is a lack of evidence to date on their role in reducing inequalities: namely, the extent to which private schooling improves learning among the most disadvantaged children. Our paper uses household survey data from Kenya, Tanzania, and Uganda to identify whether any observed impact of private schooling on core literacy and numeracy skills differs according to children's household wealth. We demonstrate wealth gaps in access to private schooling, and use inferential models to account for observable differences between those who do and do not enrol in private schools. In Kenya and Uganda, we find that private schooling appears to improve the chances of children learning relative to their peers in government schools, but the chances of the poorest children learning in private schools remains low and is at best equivalent to the richest learning in government schools. In Tanzania, private schooling does not seem to improve poorer children's learning, whereas it does for richer children. These findings raise a caution about the extent to which private provision can help narrow learning inequalities.

Based on oral history accounts elicited from 25 Gikuyu elders in Kenya, this paper describes a non-penetrative sexual practice, ngweko, permitted for the sake of pleasure and sexual release among circumcised and unmarried young people in the Gikuyu community. Lessons that can be learned from the pre-colonial Gikuyu sexuality culture are identified, and possible implications for contemporary sexuality education explored.

Background: In the industrialized world opportunities for children to explore movement in active, imaginative ways during free play periods are increasingly threatened for a range of reasons, stemming from caregiver concern for children's safety to the abundance of game technologies that capture the attention of youth. In contrast, Kenya, East Africa, provides indigenous settings wherein children use their unstructured time, in and out of school, to explore and play in active ways. In comparing the two settings, we observe that one problem in the changing childhood environments of the industrialized world is that the value of movement continues to be largely overlooked. Purpose: The purpose of this paper is to revisit discourses that promote mind-body connection, such as physical literacy, or, as we phrase it, movement literacy. We hope to engage educators in conversations respecting how we might practically and theoretically dissolve the boundaries between body and mind with a view to exploring curricular structures and pedagogical methodologies that promote holistic approaches to learning. Setting: This inquiry is part of a larger study that took place in Kenya, East Africa, where movement and dance exist as authentic cultural and aesthetic expression. Participants: Data collection took place primarily in national Kenyan schools (N = 14), which included public (N = 8) and private (N = 6) institutions located in urban (N = 6), suburban (N = 3), and rural (N = 5) settings. Research design: This study was qualitative in its design. Four representative cases were identified within the larger dataset, each of which demonstrates the significance of movement literacy in games and dance among the Kenyan children. These are referred to as "movement texts". An hermeneutical approach, involving interpretation and reinterpretation of data from multiple sources, was employed in data analysis. Data collection: Children's dance, games, and other forms of movement were videotaped. The movement experiences of children and adults were also explored through observations, interviews, and the personal reflections of the participants. Formal interviews occurred with head teachers (N = 8), teachers (N = 5), students (N = 9), a dance director (N = 1), a professional dancer (N = 1), and a cultural expert (N = 1). These were tape-recorded and transcribed for analysis. Dialogue in the context of the video material was transcribed as well. Less formal conversations also transpired with many teachers and students. These were recorded in field notes and a research journal. Data analysis: Data from this range of sources--videotape, audiotape, field notes, journals, and written anecdotes--were compiled and interpreted. Analysis entailed close readings of interview transcripts in relation to video materials, field notes, and so on. Every attempt was made to relate the apparent meaning of an action or statement to the world-view from which it originated. Findings: Our review of data suggested that the most original, inventive learning took place in the playing fields during unstructured time. The absences of formal structures and manufactured toys afforded children the opportunity to create and explore. They invented their own technologies (e.g. footballs made from rubbish bound with a fibrous plant), explored and negotiated gender boundaries, and were constantly on the move. Their activities presented a marked contrast to the behaviours we were familiar with in observing children in industrialized nations in the context of their schools, homes, and community play areas. Conclusions: Observing the contrast between the schoolroom and the playing fields led us to contemplate the fundamental icon of schooling across many cultures: the desk. The desk as a technology for learning is a contrivance aimed at controlling movement and attention in whichever setting it inhabits. As such, it points to the premise underlying education in many cultures: to learn we must be still. Watching the Kenyan children combine learning with movement in a variety of settings sends a message to educators in industrialized nations where a variety of factors are conspiring to limit opportunities for children to move and play freely. The message is this: we must redouble our efforts to engage in holistic methods of education; we must make space within our curricula for movement; we must oppose efforts to remove free play periods such as recess; we must focus on educating caregivers and teachers across disciplines respecting the importance of active play and learning; we must engage children in conversations about their play choices with a view to improving our understanding of the complex interdependencies of movement and learning. Finally, and most importantly, we must stress the inherent value of movement and free play, not only as a means to an educational end, but as an end in itself. (Contains 9 figures.)

Access to clean and functional toilet is quintessential in meeting children's physiological and psychosocial needs in a learning environment. However, little is known on experiences of children's access to quality toilets while in preschool institutions within urban settings of sub-Saharan Africa countries. This paper draws from a study that explored experiences of vulnerable children in early childhood development education (ECDE) institutions in underserved and informal urban settings of Kenya and South Africa. 11 urban ECDE centres were purposively selected and 17 teachers were recruited as key informants. Data was collected using an adapted infrastructural checklist, observation and conversational interviews. Findings indicated that a majority of toilets in ECDE centres were inadequate, inappropriate, poorly maintained, or had structural weaknesses which affected children's experiences of access and use of the facilities. Scheduled toilet visits as a control measure and toilet avoidance potentially exposed them to psychosocial and health risks. Insights into children's toilet facilities, managing their access in institutions located within informal and low resourced areas, and investment policies that target preschool children' sanitary facilities are given. Suggestions are made for interventions for children's positive toilet experiences in poor urban areas. [ABSTRACT FROM AUTHOR]

Purpose: This paper is a commentary which aims to address themes arising from the article by Bunning et al. entitled "Empowering caregivers of children with learning and developmental disabilities: from situation analysis to community-based inclusive development in Kilifi, Kenya". Design/methodology/approach: This commentary provides discussion stimulated by the paper by Bunning et al., including important areas for consideration when developing and evaluating care pathways or solutions to providing support to families of children with disabilities in low- and middle-income countries. Findings: This commentary highlights issues such as: the value of transported and home-grown approaches; the importance of empowerment and advocacy; and the benefits of equitable collaborative partnerships between researchers in low- and middle-income countries and those in high-income countries. Originality/value: This is the personal perspective of two collaborators who have been working in the field of service delivery of complex interventions for children with developmental disabilities in high- and low-income country settings. [ABSTRACT FROM AUTHOR]

Introduction: The growing impact of non-communicable diseases in low- to middle-income countries makes epilepsy a key research priority. We evaluated peer-reviewed published literature on childhood epilepsy specific to Kenya to identify knowledge gaps and inform future priorities. Methodology: A literature search utilizing the terms "epilepsy" OR "seizure" as exploded subject headings AND "Kenya" was conducted. Relevant databases were searched, generating 908 articles. After initial screening to remove duplications, irrelevant articles, and publications older than 15 years, 154 papers remained for full-article review, which identified 35 publications containing relevant information. Data were extracted from these reports on epidemiology, etiology, clinical features, management, and outcomes. Results: The estimated prevalence of lifetime epilepsy in children was 21–41 per 1,000, while the incidence of active convulsive epilepsy was 39–187 cases per 100,000 children per year. The incidence of acute seizures was 312–879 per 100,000 children per year and neonatal seizures 3,950 per 100,000 live births per year. Common risk factors for both epilepsy and acute seizures included adverse perinatal events, meningitis, malaria, febrile seizures, and family history of epilepsy. Electroencephalography abnormalities were documented in 20%–41% and neurocognitive comorbidities in more than half. Mortality in children admitted with acute seizures was 3%–6%, and neurological sequelae were identified in 31% following convulsive status epilepticus. Only 7%–29% children with epilepsy were on antiseizure medication. Conclusion: Active convulsive epilepsy is a common condition among Kenyan children, remains largely untreated, and leads to extremely poor outcomes. The high proportion of epilepsy attributable to preventable causes, in particular neonatal morbidity, contributes significantly to the lifetime burden of the condition. This review reaffirms the ongoing need for better public awareness of epilepsy as a treatable disease and for national-level action that targets both prevention and management. [ABSTRACT FROM AUTHOR]

Assessment and evaluation activities are conducted to determine whether the curriculum content provided to students resulted to gain of knowledge and understanding. With the Kenya implementing the new Competency Based Curriculum (CBC), not much has been focused on the level of teacher understanding and preparedness towards evaluating special needs learners enrolled in public primary schools. This paper looks at teacher competencies for evaluation of CBC among special needs learners in public primary schools in Kapsaret Sub County, Kenya. The target population involved 83 public primary schools located in the sub county with special needs teachers of the targeted primary schools forming the target population. A sample size of 69 special needs teachers was selected as the sample for the study selected through simple random sampling method. To collect data, questionnaire was used. The analysis of data was done using quantitative and qualitative methods. Research result showed that majority of special needs teachers were not adequately prepared to undertake evaluation and assessment of children with special needs in line with the new curriculum. The lack of adequate understanding and application of formative assessment methods by special needs teachers denied the special needs learners opportunity to acquired competencies and skills as per CBC curriculum. The paper therefore recommends that special needs teachers like other teachers need to be regularly provided with adequate training on different methods of assessment of special needs learners in their classroom. This will ensure that the goals of inclusion are attained hence contributing to special needs learners education growth and development. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the views of orphans and vulnerable children (OVC) on the kind of psychosocial support they receive in a community-based organization (CBO) in Kenya. Design/methodology/approach: This is a mixed approach study that utilized a qualitative approach through individual interviews and quantitative approach through the use of unstructured and structured questionnaire for data collection. This mixed approach was selected since rich information could be obtained from individual interviews and was validated through quantitative data. Qualitative data were collected through individual interviews for OVC, social workers and child counseling psychologist. The items used in the individual interview guide were generated based on three areas of research interests, namely, psychological, educational and social interventions. The individual interview questions focused on what was currently being offered to OVC, their views about such services, the challenges they might be facing and suggestions for improvement. The unstructured questionnaire was designed in an open-ended manner to allow the respondents to express their views freely on the kind of psychosocial support they were receiving within the CBO. The unstructured questionnaire was divided into thematic areas, namely, psychological support, social support and educational support. The structured questionnaire was used to collect data on psychosocial support that children receive within the CBO. The items were in form of a "YES/NO" format since the children could be able to understand them so easily and respond accordingly. Both methods of data collection were selected to allow triangulation of data and improve the credibility and generalizability of data. Findings: The findings of this study revealed that the psychosocial support for the OVC was taken care of within the CBO. The OVC get psychological support through the counseling and peer-group support, while educational intervention was done through the provision of school uniforms and educational materials. But there is a need to encourage the families to engage in income generating activities so as to help them become independent instead of overburdening the CBO which is already straining in terms of resources. The OVC also get health care support as well as shelter and accommodation. Research limitations/implications: The study had few limitations just like any other study. One of the limitations was the few numbers of participants who took part in the study. A larger sample could have provided more information that can easily be generalized to other OVC within any given organization. But despite this limitation, the information obtained was useful in shedding light on the kind of psychosocial support that the OVC is receiving within the CBO. Practical implications: Resources are required for an extensive research to establish the effectiveness of such services on improving the lives of OVC within the society rather than the superficial way of care without considering their psychosocial well-being. This study recommends that more support is required from the governments, the donors and other international bodies to support the escalating numbers of OVC within the society. Social implications: Since the numbers of OVC are escalating globally, the findings of this study could add value to the importance of psychosocial support that the OVC receive within the CBO. It also gives directions for policy and program development that targets OVC in Kenya and in other parts of the world. Originality/value: This is a research paper whereby the data were collected from the OVC and analyzed to generate first-hand information. [ABSTRACT FROM AUTHOR]

Background: The association between school and home is fundamental to sustainable education: parents' understanding of the school's priorities and teachers' understanding of their pupils' home environment are both vital for children to remain in school and succeed academically. The relationship between parents and teachers is closest in preschool settings, providing a valuable opportunity to build bridges between home and school. In this protocol paper, we outline our planned methods for identifying beneficial home and school behaviors. Objective: Our project aims to identify culture-specific structures and behaviors in home and school settings, which influence the quantity and quality of child-directed speech and identify positive experiences that can help improve children's linguistic development and nutrition. Methods: Using a mixed methods approach and focusing on early language learning, nutrition, and responsive caregiving, we will video-record and analyze mealtime language and eating behaviors at home and in school, targeting 80 preschool children and their families in rural Kenya and Zambia. In addition, we will assess children's language skills through audio recordings and use questionnaire-based interviews to collect extensive sociodemographic and dietary data. Results: Between the start of our project in January 2020 and the end of December 2021, we had collected complete sets of sociodemographic, observational, and food recall data for 40 children in Kenya and 16 children in Zambia. By the end of May 2022, we had started data collection for an additional 24 children in Zambia and transcribed and coded approximately 85% of the data. By the end of September, 2022, we plan to complete data collection, transcription, and coding for the entire sample of 80 children across both countries. From September 2022 onwards, we will focus on analyzing our language data, and we hope to have results ready for publication in early 2023. By relating children's language outcomes and nutritional intake to the observed mealtime behaviors, we hope to identify practices that increase the quantity and quality of child-directed speech and improve children's nutritional intake. Conclusions: Good nutrition and the promotion of language learning are key issues in early childhood development. By using a cross-cultural approach, combining a variety of methods, and working closely with stakeholders and policy makers throughout the project, we hope to find and share best practices for improving children's linguistic outcomes and nutrition and lay the foundation for the development of practitioner networks and parent outreach programs. [ABSTRACT FROM AUTHOR]

The benefits of traditional medicine have long been recognized by the World Health Organization. However, as formal education, urbanization, and deforestation increases; the use of traditional medicine has decreased. Within this phenomenon, this paper discusses the continued importance of preventive health practices among the Purko Maasai. Using nurturing as an explanatory framework, qualitative data is analyzed to understand the cultural importance of specific traditional medicine with the goal of building the body with 'engolon' (strength). Results address the importance of nurturing children by administering traditional medicine in order to build the body's immune system. Our data show an interesting gender divide in which both genders play a critical nurturing role, however at different timeframes in the child's life. Findings demonstrate concern with changing frequency of herbal medicine given to children, however there is resiliency within some nurturing components of using preventative traditional medicine to build up children's immune system. [ABSTRACT FROM AUTHOR]

Changing and challenging social norms is essential to preventing gendered violence, and education is widely regarded as a key means through which this can happen. Whilst good-quality research exploring the outcomes of such educational interventions exists, very little is known about what actually happens inside educational spaces aiming to instigate change. This gap limits understandings of how and why change does (or does not) happen. This paper aims to address this by providing an opportunity to peer into a ‘space for change’. To do this, observational data are analysed from a non-formal education programme aiming to empower girls to be free from violence in Kenya. Three moments are explored which illustrate ‘empowerment’, ‘subversion’ and ‘resistance’. The paper also explores the often hidden stories of the facilitators, showing that who teaches can be as important as the curriculum used in determining what happens inside educational spaces for change. [ABSTRACT FROM PUBLISHER]

Background: Undernourished children in low- and middle-income countries remain at elevated risk of death following hospital discharge, even when treated during hospitalisation using World Health Organisation recommended guidelines. The role of community health workers (CHWs) in supporting post-discharge recovery to improve outcomes has not been adequately explored.Methods: This paper draws on qualitative research conducted as part of the Childhood Acute Illnesses and Nutrition (CHAIN) Network in Bangladesh and Kenya. We interviewed family members of 64 acutely ill children admitted across four hospitals (a rural and urban hospital in each country). 27 children had severe wasting or kwashiorkor on admission. Family members were interviewed in their homes soon after discharge, and up to three further times over the following six to fourteen months. These data were supplemented by observations in facilities and homes, key informant interviews with CHWs and policy makers, and a review of relevant guidelines.Results: Guidelines suggest that CHWs could play a role in supporting recovery of undernourished children post-discharge, but the mechanisms to link CHWs into post-discharge support processes are not specified. Few families we interviewed reported any interactions with CHWs post-discharge, especially in Kenya, despite our data suggesting that opportunities for CHWs to assist families post-discharge include providing context sensitive information and education, identification of danger signs, and supporting linkages with community-based services and interventions. Although CHWs are generally present in communities, challenges they face in conducting their roles include unmanageable workloads, few incentives, lack of equipment and supplies and inadequate support from supervisors and some community members.Conclusion: A multi-pronged approach before or on discharge is needed to strengthen linkages between CHWs and children vulnerable to poor outcomes, supported by clear guidance. To encourage scale-ability and cost-effectiveness of interventions, the most vulnerable, high-risk children, should be targeted, including undernourished children. Intervention designs must also take into account existing health worker shortages and training levels, including for CHWs, and how any new tasks or personnel are incorporated into hospital and broader health system hierarchies and systems. Any such interventions will need to be evaluated in carefully designed studies, including tracking for unintended consequences. [ABSTRACT FROM AUTHOR]

Introduction: High childhood vaccine adherence is critical for disease prevention, and poverty is a key barrier to vaccine uptake. Interventions like microfinance programs that aim to lift individuals out of poverty could thus improve vaccine adherence of the children in the household. BIGPIC Family Program in rural Western Kenya provides group-based microfinance services while working to improve access to healthcare and health screenings for the local community. The aim of the present paper is to evaluate the association between household participation in BIGPIC's microfinance program and vaccine adherence among children in the household. We hypothesize that microfinance group participation will have a positive impact on vaccine adherence among children in the household. Methods: From 2018 to 2019, we surveyed a sample of 300 participants from two rural communities in Western Kenya, some of whom were participants in the BIGPIC Family's microfinance program. The primary outcome of interest was vaccine adherence of children in the household. Log-binomial models were used to estimate the relationship between microfinance group participation and vaccine adherence, adjusted for key covariates. We also assessed whether the relationship differed by gender of the adult respondent. Results: Microfinance group members were more likely to have all children in their households fully vaccinated [aPR (95% CI): 1.68 (1.20,2.35)] compared to non-microfinance group members. Further, the association was stronger when women were the microfinance members [PR (95% CI): 1.87 (1.27,2.76)] compared to men [PR (95% CI): 1.24 (0.81,1.90)]. Conclusions: Microfinance participation was associated with higher childhood vaccine adherence in rural Western Kenya. Microfinance interventions should be further explored as strategies to improve child health and well-being in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Birth registration and obtaining physical birth certificates impose major challenges in developing countries, with impact on child and community health, education, planning, and all levels of development. However despite initiatives, universal registration is elusive, leading to calls for new approaches to understanding the decisions of parents. In this paper, we report results of a survey of students in grades six to eight (age ~12–16) in an under-registered area of Kenya regarding their own understanding of registration issues and their suggestions for improvement. These students were selected because they themselves were also nearing the age for high school enrollment/entrance examinations, which specifically requires possession of a birth certificate. This assessment was also a companion to our previous representative survey of adults in the same Kenyan region, allowing for parent-child comparison. Results supported previous research, showing that only 43% had birth certificates. At the same time, despite these low totals, students were themselves quite aware of registration factors and purposes. The students also made quite prescient sources for understanding their households’ motivations, with many of their suggestions—for focus on communication of pragmatic benefits, or automatic measures shifting responsibility from parents—mirroring our own previous suggestions, and showing a level of pragmatism not witnessed when surveying their parents. This paper therefore adds evidence to the discussion of registration policy planning. More generally, it also builds on an important trend regarding the treatment of children as stakeholders and important sources of information, and raising an intriguing new avenue for future research. [ABSTRACT FROM AUTHOR]

Reading research has shown that variable relationships exist between measures of oral reading fluency and reading comprehension, depending on whether the language of the text is the reader's first language or an additional language. This paper explores this phenomenon, using reading assessment data for 2,000 Kenyan children in two or three languages: English, Kiswahili and one of two mother tongues, Dholuo or Gikuyu. The assessment data allowed us to compare reading and comprehension rates across languages. The data indicated that many children could read English words more easily than words in Kiswahili or their mother tongue; nevertheless, their reading comprehension was significantly lower in English than in Kiswahili, Dholuo or Gikuyu. The paper concludes that emphasising English reading fluency is an inefficient route to gaining reading comprehension skills because pupils are actually attaining minimal oral reading fluency in English and only modest comprehension skills in their own languages. The evidence also demonstrates that Kenya's national language policy of mother tongue as a medium of instruction in the early primary grades is consistently ignored in practice. [ABSTRACT FROM AUTHOR]

Infants with HIV-infection have longevity due to improved Highly Active Antiretroviral Therapy (HAART), making many realise their developmental progression which includes access to schooling. However, there is scant information that focuses on disclosure of their positive sero-status to schools and how these children understand and communicate their illnesses. This paper reports on a study of experiences of children affected by HIV and AIDS in Kenya. Qualitative phenomenological data from children aged between 5 and 7 years and their teachers in Early Childhood Development and Education (ECDE) centres were collected using multiple methods. Thematic content analysis was utilised with several themes emerging from findings. Obstacles to disclosure, anticipation of exceptional care, accidental disclosures, lack of psychosocial structures, a need for specialised skills training for teachers, and lack of clear guidelines to assist in disclosure processes emerged as some of the challenges faced. The findings also provide insights into teachers' scaffolding efforts to educate children in understanding and communicating their illnesses, and forging support structures through relationships with their siblings and peers for care and management. [ABSTRACT FROM AUTHOR]

The aim of this paper is to propose a research agenda for future studies of local forms of caregiving. It does this by exploring practices of care giving and receipt through the prism of childcare. Focusing on Nairobi, it investigates one critical form of care work in the city: the labour of women who work as 'nannies' in private homes, a form of labour that has received little systematic study or scholarly attention. Every day, women in Nairobi construct complex and far-ranging care chains that ensure that the socially necessary labour of childcare takes place. The phenomenon of 'diverted mothering' that has been associated with the globalisation of care can also be understood as a local phenomenon. Whereas global care chains involving migrant domestic workers have been the focus of detailed investigation, hitherto the workings of more widespread and highly fragile local care chains in the cities of the third world have been neglected. We argue that it is critical to understand practices of intimate and emotional labour in the context not just of global migration but in situations of severe intersecting inequalities (economic, social and racial) within the global south. [ABSTRACT FROM AUTHOR]

Context: Ambivalence in pregnancy intentions is well-documented in sub-Saharan African (SSA) settings and has been associated with inconsistent use of contraception, thereby exposing women using contraception to the possibility of unintended pregnancies. A better understanding of the potential role for client counseling interventions in enabling women to achieve their pregnancy intentions is essential for aiding program efforts to reduce unintended pregnancies. Objective: To measure ambivalence in pregnancy intentions longitudinally and determine its association with the quality of care received, controlling for demographic, socio-economic and contextual factors among a cohort of family planning (FP) clients in Kenya. Methods: This paper uses data drawn from a prospective cohort study of FP clients to investigate the relationship between the quality of care received during FP service delivery and the decisiveness of their pregnancy intentions over time. The study tests the hypothesis that higher quality of care enables women to be less ambivalent about their pregnancy intentions. Binary logistic regression with random effects and multinomial logistic regression were used to assess the predictive effect of the quality of care received by a woman on the decisiveness or ambivalence of her pregnancy intentions, and on any shifts in ambivalence over time, controlling for background characteristics. The study recruited 1,957 women aged 15–49 years attending twelve family planning clinics in four counties in Central Kenya; of these, 1,053 women were observed for four rounds of data collection over a period of 24 months and form the sample for analysis. Findings: A substantial proportion (43%) of women expressed ambivalence about their intentions to become pregnant at some point during the study period, while over half (57%) remained unequivocal throughout the study. Almost one third of women (31%) shifted from being unequivocal to ambivalent and 12% shifted from ambivalence to being unequivocal. Women experiencing higher quality of care have lower odds of ever expressing ambivalence and higher odds of remaining unequivocal over time, net of other factors. Quality of care was not associated with a shift in ambivalence over time. Conclusion: FP programs offering higher quality of care are likely to support women to be more decisive in their pregnancy intentions. Improving the quality of care can contribute to reduced ambivalence and consequently reduced likelihood of unintended pregnancy among contraceptive users. This study provides further evidence of the benefits gained through providing high quality services. Trial registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Several studies have reported on the association between parental and childhood psychopathologies. Despite this, little is known about the psychopathologies between parents and children in a non-clinical population. We present such a study, the first in a Kenyan setting in an attempt to fill this gap. The objective of this study was to determine the association between self-rating psychopathology in children, parent-rating psychopathology in their children and self-rating psychopathology in parents in a non-clinical population of children attending schools in Kenya. We identified 113 participants, comprising children and their parents in 10 randomly sampled primary schools in South East Kenya. The children completed the Youth Self-Report (YSR) scale and parents completed the Child Behavior Check List (CBCL) on their children and the Adult Self-Reports (ASR) on themselves. These instruments are part of the Achenbach System of Empirically Based Assessment (ASEBA), developed in the USA for a comprehensive approach to assessing adaptation and maladaptive behavior in children and adolescents. There was back and forth translation of the instruments from English to Swahili and the local dialect, Kamba. Every revision of the English translation was sent to the instrument author who sent back comments until the revised version was in sync with the version developed by the author. We used the ASEBA in-built algorithm for scoring to determine cut-off points for problematic and non-problematic behavior. Correlations, linear regression and independent sample t-test were used to explore these associations. The mean age of the children was 12.7. While there was no significant association between child problems as measured by YSR (self-reported) and parent problems as measured by ASR and CBCL in the overall correlations, there was a significant association when examining specific groups (clinical range vs. non-clinical). Moreover, significant association existed between total problems on YSR and ASR internalizing problems (t=-2.3,p = 0.023), with clinical range having a higher mean than the normal range. In addition, a significant relationship (p < 0.05) was found between psychopathology in children as reported by both parents (CBCL) and psychopathology in parents as self-reported (ASR). Mothers were more likely to report lower syndrome scores of their children as compared to fathers. Our findings indicate discrepancies between children self-rating and parent ratings, suggesting that one cannot manage psychopathology in children without reference to psychopathology in their parents. We suggest broad-based psycho-education to include children and parents to enhance shared awareness of psychopathology and uptake of treatment. [ABSTRACT FROM AUTHOR]

Children around the world have been observed to assume caregiving responsibilities when a parent or other family members fall ill. Whilst the circumstances surrounding caregiving children in Anglophone countries have been looked at in detail, we know relatively little about how children in Africa experience young caregiving. This paper seeks to further our understanding of caregiving children in Africa by looking at how local constructions of childhood can facilitate their agency and resilience, paying particular attention to the role of identity and recognition. The study involved 48 caregiving children from Western Kenya who through individual interviews, photography and draw-and-write compositions articulated their experiences. The views of ten local adults have also been included. A thematic analysis revealed that caregiving children in Kenya are active participants in community life. Their participation is encouraged by local understandings of childhood and recognition of their efforts, enabling the children to construct positive identities that enhance their resilience. The paper argues that the way in which caregiving children in Kenya respond to their circumstances is influenced by a social recognition of their activities and agency. This recognition, mediated by local representations of childhood, allows the children to construct positive social identities that facilitate resilience. We conclude that there is a need for policy and practice on young caregiving, in all countries and contexts, to consider the role of social recognition and local constructions of childhood in shaping the resilience of caregiving children. [ABSTRACT FROM PUBLISHER]

Primary school children aged between 10 and 15 years old in a rural community in western Kenya are frequently ill and have considerable knowledge of both herbal remedies and pharmaceuticals in treating common illnesses, such as headache, cold, fever, abdominal complaints and injuries. This paper explores this area of children's medical knowledge and practice, looking at children's ideas about and categorisation of illness and medicines, and their perceptions of medicinal efficacy. Differences between children in their medicinal knowledge and the relation between children's knowledge and that of adults in the community are described. Children appear to learn about medicines and medical practices in an informal, experiential and experimental way, from practical involvement in the treatment of illness in the family, and the authors suggest that the ways in which children learn about medicine should be further explored. The paper contributes to the literature on lay treatment of illness by focusing on children's knowledge of medicinal treatments in a context of medical pluralism. [ABSTRACT FROM AUTHOR]

Across settings, it has been shown that the co-residential household is an insufficient measure of family structure and support. However, it continues to be the primary means of population data collection. To address this problem, we developed a new instrument, the Kinship Support Tree (KST), to collect kinship structure and support data on co-residential and non-residential kin and tested it on a sample of 462 single mothers and their children in a slum community in Nairobi, Kenya. This instrument is unique in four important ways: (1) it is not limited to the co-residential household; (2) it distinguishes potential from functional kin; (3) it incorporates multiple geospatial measures; and (4) it collects data on kin relationships specifically for children. In this paper, we describe the KST instrument, assess the data collected in comparison to data from household rosters, and consider the challenges and feasibility of administration of the KST. [ABSTRACT FROM AUTHOR]

Violence in childhood is a serious health, social and human rights concern globally, there is, however, little understanding about the factors that explain the various forms of violence in childhood. This paper uses data on childhood violence for 10,042 individuals from four countries. We report Odds Ratios from pooled logit regression analysis with country fixed effects model. There is no gender difference in the overall incidence of childhood violence. The data shows that 78% of girls and 79% of boys have suffered some form of violence before the age of 18 years. Odds of violence are higher among richer households, among individuals who have attended school and among individuals who have been married or in marriage-like arrangements. Individuals who justify wife beating have significantly higher likelihood of having faced violence themselves. Most perpetrators of violence against children - physical, emotional and sexual - are people known to them in their homes and community, and not strangers. There is limited understanding of the factors that explain violence in childhood. This study highlights some key factors that can explain this phenomenon. [ABSTRACT FROM AUTHOR]

Background: Giardia duodenalis is an important intestinal protozoan in humans worldwide with high infection rates occurring in densely populated and low resource settings. The parasite has been recorded to cause diarrhea in children. This study was carried out to identify G. duodenalis assemblages and sub-assemblages in children presenting with diarrhea in Kenya.Methods: A total of 2112 faecal samples were collected from children aged ≤ 5 years and screened for the presence of Giardia cysts using microscopy. A total of 96 (4.5%) samples were identified as Giardia positive samples and were genotyped using glutamate dehydrogenase (gdh), triose phosphate isomerase (tpi) and β-giardin loci.Results: The three markers successfully genotyped 72 isolates and grouped 2 (1.4) isolates as Assemblage A, 64 (88.9) as Assemblage B and 7 (9.7%) consisted of mixed infections with assemblage A and B. A further analysis of 50 isolates using GDH Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) categorized 2 assemblage A isolates as sub-assemblage AII while 6 and 14 assemblage B isolates were categorized into sub-assemblage BIII and BIV respectively. A mixed infection with sub-assemblage BIII and BIV was recorded in 28 isolates. Over half (55.6%) of Giardia infections were recorded among the children between 13 to 48 months old.Conclusion: This paper reports the first data on the assemblages and sub-assemblages of Giardia duodenalis in children representing with diarrhea in Kenya. [ABSTRACT FROM AUTHOR]

In the Republic of Kenya, song is widely used to enhance the whole curriculum in lower primary classes. Song is used especially to aid recall and therefore teachers adapt tunes that children already know, inserting relevant words from the subject at hand. Despite this widespread practice, this form of singing in schools is not recognised by the same teachers as music training in the classroom, and so little, if any, effort is put into the actual music production. Teachers do not attend to the sound of the music, as the intention is to capture facts about various things, including the soil, the weather, numbers etc. and present them in a way that the young learners will quickly remember. This paper interrogates the process that 6–8-year-old children underwent as they moved from using song to learn facts (singing to learn), to developing multiple musical abilities and capacities (learning to sing), through participation in the Music for Literacy Development (MLD)1 project in selected schools in the Nyanza region of Kenya. [ABSTRACT FROM PUBLISHER]

Parental involvement in their children's schooling is in recognition that establishing the context in which a child attends school is important. Reading to Learn (RtL)was implemented in two districts of Kwale and Kinango in Kenya and of Amolatar and Dokolo in Uganda. This paper looks at parental involvement and their experiences with RtL. Data are obtained from survey responses at baseline and focus group discussions with parents at endline. Findings indicate that parents are key actors in literacy and numeracy of their children. The study underscores the role of parents and context in literacy activities and policy implementation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the motor fitness of a selected group of Kenyan children and young adolescents and compare the findings with current available data about the motor fitness of German children of the same age. The data were collected from three different school settings from Nairobi and the surrounding area which included one from the private school system and one from a rural environment. A further comparison was made between the results of the children from these three settings. Participants were 120 boys and 131 girls aged between 6 and 14 years. The comparison data were taken from the Motorik-Modul study of physical fitness and physical activity in German children and adolescents (Woll, Kurth, Opper, Worth, & Bös, 2011). The results provided evidence in support of a rejection of the null hypothesis when considering differences between the fitness levels and anthropometric status of children in Germany and Kenya. Specifically, this Kenyan sample was smaller in physical size and performed below the German group’s measures on tests of power and strength. However the results for the Kenyans exceeded the German performances in the tests of coordination and flexibility. The between schools comparison of the Kenyan data showed fewer differences in general. Noteworthy, however was the heavier build of the private school pupils and the superior results for the 6 minute run from the rural public school pupils. The paper concludes with a call for more comparative studies both of an international and interregional nature. [ABSTRACT FROM AUTHOR]

In the midst of the current environmental crisis, scientists, academics, authors, and politicians worldwide are urging citizens to create sustainable communities. However, there is little capability to build a sustainable society without an informed, active, and engaged populous. This requires more than just environmentally knowledgeable citizens. It requires a society that understands the principles of the environment and can also exemplify them in daily life. In order to create a more environmentally literate world, there has been a push for environmental education integrated into schools. This qualitative study sought to examine Kenyan teachers’ perspectives on the human–nature interaction by conducting vignette focus-group interviews. It is a subject not widely explored but vital for conservation not only in this area, but also other areas that seek to have an ecological informed populous. The vignettes were created using photographs and explanations of the photographs that the participants collected and emailed to the authors. For the focus-group vignette interviews, there were a total of 55 participants (30 females and 25 males). After InVivo analysis, we had 6 codes (resentment, pride, perils, blame, pragmatism, and self-interested) within 3 major themes. This study has implications for informing science education to combat these traditions of subjecting students to a science curriculum that demotes Kenyan cultural heritage and lifestyle. By incorporating local knowledge such as the ideas discussed in this paper into Kenyan science education, Kenyans can reach one of most challenging objectives of education, which is to produce children who are fundamentally aware of their environment. [ABSTRACT FROM PUBLISHER]

Objectives: This paper examines the impact of orphanhood on the health of Kenyan Luo children through the use of a clinical history and physical exam. Orphans were hypothesized to have poorer health than non-orphans; differences were expected in both males and females. Methods: Four hundred eleven Luo children (9±1 yr), residing in western Kenya were recruited to participate in a cross-sectional study examining health via a structured clinical history and physical exam. Results: Using a t-testasthe method of analysis, no significant differences in the clinical history and physical exam were found between the two groups of male children or the two groups of female children. Discussion: Results from this study suggest that Luo children would benefit from health education as well as prevention and treatment for parasitic and fungal infections. [ABSTRACT FROM AUTHOR]

Based on oral history accounts elicited from 25 Gĩkũyũ elders in Kenya, this paper describes a non-penetrative sexual practice,ngweko, permitted for the sake of pleasure and sexual release among circumcised and unmarried young people in the Gĩkũyũ community. Lessons that can be learned from the pre-colonial Gĩkũyũ sexuality culture are identified, and possible implications for contemporary sexuality education explored. [ABSTRACT FROM PUBLISHER]

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This paper presents an empirical study of schooling attendance and collection of environmental resources using cross-sectional data from Kiambu District of Kenya. Because the decision to collect environmental resources and attend school is jointly determined, we used a bivariate probit method to model the decisions. In addition, we corrected for the possible endogeneity of resource-collection work in the school attendance equation by using instrumental variable probit estimation. One of the key findings is that being involved in resource collection reduces the likelihood of a child attending school. The result supports the hypothesis of a negative relationship between children working to collect resources and the likelihood that they will attend school. The results further show that a child's mother's involvement in resource collection increases school attendance. In addition, although there is no school attendance discrimination against girls, they are overburdened by resource-collection work. The study recommends immediate policy interventions focusing on the provision of public amenities, such as water and fuelwood. [ABSTRACT FROM AUTHOR]

Abstract: This paper is based on the experiences drawn from a long-term social science research programme on the impact of the AIDS pandemic on orphanhood in western Kenya. It discusses the ethical dilemma of maintaining a delicate balance between research ethics, the expectations of the study population and negotiating the community''s vested interests in a health related research project in a low-income society. I argue that informed consent and the intended benefits of the study to the participants continue to be major challenges facing the justification of social research with people affected by or living with AIDS in low-income societies. The paper underscores the importance of community feedback sessions as a way of enhancing chances of acceptability of research efforts and obtaining informed consent. It further shows how community feedback sessions contribute to local knowledge of the problem being studied, creating opportunities for advocacy. This discussion adds to the existing ethical debate on the wider contexts within which research on vulnerable people affected by AIDS is conducted by arguing that research practice is inseparable from epistemological concerns of knowledge production. I suggest that ethnographers should enhance efforts to innovatively design action research projects to serve the twin purposes of data collection and deal with ethical challenges that are experienced when doing long-term research on vulnerable groups. [Copyright &y& Elsevier]

Several risk factors for children's mental health and wellness have been established. These are compounded by inequalities, especially in Majority World Countries (MWC). As evidence is largely based on adult reports, we aimed to capture children's experiences of risk across five MWC resource-constrained settings (Brazil, Pakistan, Turkey, Kenya, and South Africa) during the height of COVID-19 pandemic. Participants included 36 children aged 8–10 years and 37 young people aged 14–16 years. We employed a thematic design using a participatory methodological approach in collecting data through diary entries, drawings, posters, focus groups discussions, and child-led interviews with elders. Two researchers integrated and analysed the data set through a thematic codebook framework. Three identified themes related to exacerbation of existing risks, disruption or loss of protective factors, and lack of access to structural supports. Children linked risk factors along their socioecology. The findings have implications in actively involving children as social actors in determining and addressing risk for mental health and wellness through child-centred and multi-sectoral policy and interventions. [ABSTRACT FROM AUTHOR]

Background: In 2018, of the 1.5 million people dying of Tuberculosis (TB), 11% were children. Tuberculosis preventive therapy (TPT) reduces the risk of contracting active TB by 60%. TPT of children below five years with household contact of bacteriologically diagnosed TB cases in Kenya was at 34% in 2018. The aim of this study was to determine uptake of TPT among eligible children under five years and to assess the knowledge, attitude and practice of health care workers (HCWs) regarding TPT in Mombasa County that has a high TB burden. Methods: A mixed methods cross-sectional study (October 2020-January 2021) was carried out at selected health facilities in Mombasa County, Kenya. Quantitative data was collected using structured questionnaires. Consecutive sampling of bacteriologically confirmed TB index cases was used to acquire the sample size of 150 eligible under five-year children per index case. Thematic coding of qualitative data from in-depth interviews (IDI) was conducted to evaluate barriers of TPT uptake from the perspective of; patients', HCWs, and key informants in health facilities (n=20 for each). Results: The uptake of TPT was 13.3%. The knowledge, attitude and practice among the health workers and index cases toward TPT was 60%, 80% and 68% respectively. The associated barriers to implementation of TPT included lack of awareness on TPT, cumbersome screening process, resistance by index cases, poor socio-economic status, interrupted supply of TPT drugs and resistance of caregivers/parents. Conclusion. There is need to educate HCWs and the community on TPT importance and address the barriers. [ABSTRACT FROM AUTHOR]

Background: Paediatric rheumatic diseases cause considerable disease burden to children and their families (Moorthy LN, Peterson MGE, Hassett AL, et al, Pediatric Rheumatology 8:20, 2010). Delayed diagnosis is a significant determinant of severity and mortality attributed to these conditions (Foster HE, Eltringham MS, Kay LJ, et al, Arthritis Care Res 57(6):921-7, 2007). pGALS is a simple clinical tool used to assess joints and identify musculoskeletal (MSK) conditions in school-going children to enable early referral to paediatric rheumatologists. Objectives: This study aimed to translate and determine the diagnostic accuracy and acceptability of a Kiswahili version of the pGALS screening tool among Kiswahili-speaking children. Methods: The pGALS screening questions were translated into Kiswahili according to the World Health Organisation (WHO) standard for translation of a tool. The validity of the Kiswahili PGALS was ascertained and acceptability rated (time taken, discomfort). Using systematic random sampling, we enrolled children aged 5–16 years presenting at the Aga Khan University Hospital's (AKUH) emergency department in Kenya, who spoke Kiswahili and had symptoms suggestive of an MSK condition. Those already under follow-up at the paediatric rheumatology service at AKUH were excluded. MSK assessment was undertaken by two resident doctors using the newly translated Kiswahili-pGALS and findings were compared with a paediatric rheumatologist examination ('gold-standard') on the same day, and who was blinded to the pGALS findings. We analysed demographic details of the participants and determined the diagnostic accuracy by cross tabulation of the index test results by the results of the reference standard. Results: One hundred children with a median age of nine years (IQR 7–11) were enrolled. The sensitivity and specificity of the Kiswahili-pGALS screening tool were 76.8% (95%CI 63.6–87.0%) and 40.0% (95%CI 23.9–57.9%), respectively. The diagnostic accuracy was 62.7% (95%CI 52.1–72.1%), area under the ROC was 0.58 (95%CI 0.48–0.68). The median time to perform the Kiswahili-pGALS was 5.0 min (IQR 3.5–6.0 min). Ninety percent of the guardians found the practice of Kiswahili-pGALS to have none, or only some discomfort. Conclusions: The Kiswahili-pGALS's was found to be a useful screening tool to aid early identification of MSK conditions in Kiswahili-speaking settings. However, the low specificity implies that relatively large number of false positives would still need to be reviewed by a rheumatologist if the tool is adapted for use. [ABSTRACT FROM AUTHOR]

Rotavirus is an important cause of fatal pediatric diarrhea worldwide. Many national immunization programs began adding rotavirus vaccine following a 2009 World Health Organization recommendation. Kenya added rotavirus vaccine to their immunization program at the end of 2014. From a cohort of 38,463 children in the Kisumu health and demographic surveillance site in western Kenya, we assessed how the implementation of the rotavirus vaccine affected mortality in children under 3 years of age. Following its introduction in late 2014, the span of rotavirus vaccine coverage for children increased to 75% by 2017. Receiving the rotavirus vaccine was associated with a 44% reduction in all-cause child mortality (95% confidence interval = 28–68%, p < 0.0001), but not diarrhea-specific mortality (p = 0.401). All-cause child mortality declined 2% per month following the implementation of the rotavirus vaccine (p = 0.002) among both vaccinated and unvaccinated children, but diarrhea-specific mortality was not associated with the implementation of the rotavirus vaccine independent of individual vaccine status (p = 0.125). The incidence of acute diarrhea decreased over the study period, and the introduction of the rotavirus vaccine was not associated with population-wide trends (p = 0.452). The receipt of the rotavirus vaccine was associated with a 34% reduction in the incidence of diarrhea (95% confidence interval = 24–43% reduction). These results suggest that rotavirus vaccine may have had an impact on all-cause child mortality. The analyses of diarrhea-specific mortality were limited by relatively few deaths (n = 57), as others have found a strong reduction in diarrhea-specific mortality. Selection bias may have played a part in these results—children receiving rotavirus vaccine were more likely to be fully immunized than children not receiving the rotavirus vaccine. [ABSTRACT FROM AUTHOR]

Introduction: Traditional male circumcision (TMC) inculcates masculine-dominance norms in young men. Early infant male circumcision (EIMC) and medical male circumcision (MMC) can potentially minimise these adverse gender norms. We explored the perceptions about EIMC and MMC among communities practising TMC in Kenya. Method: We conducted focus group discussions with men and women and councils of elders, and key informant interviews with traditional circumcisers. Data were analysed using NVivo 10. Results: Most participants described MC as a rite of passage into adulthood, with the preferred age for MC to occur at 10 to 15 years old. Interestingly, awareness of the advantages of EIMC, especially among younger men and women, was high. Participants acknowledged that TMC reinforces hegemonic masculinity that undermines gender equality. Except among traditional circumcisers and some members of councils of elders, MMC and female providers were largely deemed acceptable. Conclusion: EIMC and MMC are slowly gaining acceptance, providing important tools to challenge adverse gender norms associated with TMC. [ABSTRACT FROM AUTHOR]

This study explores common factors associated with not meeting minimum dietary diversity (MDD) among 27,072 children aged 6–23 months in Eastern and Southern Africa using data from nine Demographic and Health Surveys from 2013 to 2016. MDD was defined as consumption of more than or equals to five of eight food groups including breast milk in the past 24 h. Equity gaps were calculated as the difference in MDD prevalence between the top and bottom wealth quintiles. Logistic regression was conducted to identify common factors for not meeting MDD at the household, maternal and child levels across two or more countries to inform regional policies to improve children's diets. Kenya had the highest MDD wealth equity gap (40.4 pts), and South Africa had the smallest (14.4 pts). Equity gaps for flesh foods or eggs (up to 39.8 pp) were larger than for grain or legumes (up to 20 pp). Common risk factors for not reaching MDD included younger child age (6–11 months) (n = 9 countries), no formal maternal occupation (n = 6), not receiving vitamin‐A supplementation (n = 3), younger maternal age (n = 3), lower maternal education (n = 3), no media (n = 3) or newspaper (n = 3) exposure, lower household wealth quintile (n = 3), use of nonefficient cooking fuel (n = 2), longer time to get to the water source (n = 2), not listening to the radio (n = 2) and higher birth order (n = 2). Priorities for improving MDD in the region include introducing diverse foods at a young age from 6 months with early nutrition counselling, promoting higher maternal education, increasing food purchasing power and ensuring the support of younger mothers. Key messages: Diets of children in Eastern and Southern Africa (ESA) lack diversity.A number of common risk factors predict dietary diversity across countries.Risk factors for low dietary diversity include wealth, education and media access.Wide equity gaps were apparent for most food groups in ESA.Interventions addressing affordability and access to diverse diets are needed. [ABSTRACT FROM AUTHOR]

Objectives: In Africa and Asia, 190 million preschoolers are vitamin A deficient. This study examined the social determinants of intake of vitamin A supplementation (VAS) among children aged 6–59 months during three different time periods in Kenya to identify those most vulnerable to vitamin A deficiency and highlight the varied targeting and outreach efforts; before the onset of a national restructuring and targeted distribution of VAS in children below 5 years through a twice-yearly door-to-door campaign called Child Health Weeks, during the implementation period, and several years later. Methods: The cross-sectional, national Demographic and Health Surveys were administered in Kenya in 2003, 2008-09, and 2014. Bivariate and multivariable logistic regression analyses were used to assess variables associated with VAS among children (n = 28,239). Results: An overall two-fold increase in VAS was recorded between 2003 (31.8%) and 2014 (67.5%). In 2008-09, children aged 6–11 months were the most likely to receive VAS. In 2003 and 2014, geographical regions and settings, birth order of the child, educational level of the mother, religion, wealth index, number of antenatal visits, and access to a radio were identified as being significantly associated with VAS, in at least one of the years. These determinants were not significant in 2008-09 during the initial Child Health Weeks promotion campaign. The determinants of VAS varied during the three study periods, particularly in 2008-09 when the Child Health Weeks was first implemented. Conclusion: As efforts to increase VAS continue, addressing child-specific determinants will be essential to reduce health disparities. Significance: Childhood vitamin A deficiency has been identified as one of the public health priorities in Kenyan children below 5 years that causes severe malnutrition. The importance of VAS was identified as a cost-effective strategy of combating and eradicating childhood malnutrition based on a previous national micronutrient survey. However, Kenya's VAS inequities are exacerbated by the social and economic differences of women. The WHO defines these disproportionate differences as the social determinants of health. Identifying these factors will be influential for policy makers to make targeted efforts towards increasing VAS supplementation and contribution towards reducing child mortality. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore 232 service providers' and policymakers' experiences of supporting children's well-being during the pandemic, across sectors, in 22 countries – including Kenya, the Philippines, South Africa, India, Scotland, Sweden, Canada and the USA, in the last quarter of 2020. Design/methodology/approach: A smartphone survey delivered via a custom-built app containing mostly open-ended questions was used. Respondents were recruited via professional networks, newsletters and social media. Qualitative content analysis was used. Findings: The findings reveal numerous system-level challenges to supporting children's well-being, particularly virus containment measures, resource deficiencies and inadequate governance and stakeholder coordination. Those challenges compounded preexisting inequalities and poorly affected the quality, effectiveness and reach of services. As a result, children's rights to an adequate standard of living; protection from violence; education; play; and right to be heard were impinged upon. Concurrently, the findings illustrate a range of adaptive and innovative practices in humanitarian and subsistence support; child protection; capacity-building; advocacy; digitalisation; and psychosocial and educational support. Respondents identified several priority areas – increasing service capacity and equity; expanding technology use; mobilising cross-sectoral partnerships; involving children in decision-making; and ensuring more effective child protection mechanisms. Practical implications: This study seeks to inform resilience-enabling policies and practices that foster equity, child and community empowerment and organisational resilience and innovation, particularly in anticipation of future crises. Originality/value: Using a novel approach to gather in-the-moment insights remotely, this study offers a unique international and multi-sectoral perspective, particularly from low- and middle-income countries. [ABSTRACT FROM AUTHOR]