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How do national identities matter in global health? Our paper addresses this question through a study of Kenya's vaccine diplomacy during the Covid-19 pandemic. It combines critical perspectives, challenging the neglect of African agency in international relations (IR), with constructivist approaches highlighting the importance of discourse in the exercise of agency. The insight that identity is an important resource in the realization of foreign policy goals is confirmed by our review of interventions by senior Kenyan leaders, as well as ministries and official bodies, concerned with vaccine procurement during the pandemic. Moreover, this material shows that identity is not pre-given, but rather performed in discourse, being adapted and renewed in speeches, briefings, policy documents, and so on. Identities are plural, not singular, drawing on historic and cultural resources proper to individual states. This allows us to link the range of identities performed during the Covid-19 pandemic to earlier moments in Kenya's diplomatic history, noting the continued pertinence of its image, variously, as 'an island of stability', 'a good global health citizen', 'a member of the pan-African community of states', and 'an active contributor to IR'. [ABSTRACT FROM AUTHOR]

Although the refugee phenomenon is not new and refugee camps are rarely temporary, in most cases, the procedures implemented within refugee camps have failed to apply principles of sustainability to ensure refugees' dignity and improve their quality of life, thereby helping them become independent and self-reliant. This improvement, in turn, may help them return to their homes in the future or may, at least, reduce the high cost and negative coping strategies associated with refugee camps and instead increase refugees' social integration within the host community. This paper discusses the procedures applied in both the Zaatari refugee camp in Jordan and the Dadaab Refugee Complex in Kenya and provides evidence regarding the extent to which they meet the United Nations 2030 Agenda for Sustainable Development without leaving refugees behind. Furthermore, this paper shows how sustainable development goals (SDGs) are interconnected in a refugee camp setting. This study concludes that refugee camps not only failed to align with 2030 agenda but failed to ensure refugees' basic rights where a more inclusive and sustainable approach is required to improve the refugees' quality of life and to help them live in dignity and reach self-reliance that can benefit both refugees and their host communities. [ABSTRACT FROM AUTHOR]

Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. Voluntary medical male circumcision (VMMC) programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity. Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. VMMC programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity. [ABSTRACT FROM AUTHOR]

Community engagement is crucial for controlling disease outbreak and mitigating natural and industrial disasters. The COVID-19 pandemic has reconfirmed the need to elevate community engagement to build equity, trust and sustained action in future health promotion preparedness strategies. Using the health promotion strategy of strengthening community action enhances the opportunity for better outcomes. There is, therefore, a need to improve our understanding of community engagement practices during crises, scale-up good community engagement initiatives, and improve and sustain people-centered approaches to emergency responses. This paper presents five case studies from the United States, Singapore, Sierra Leone, Kenya and South Africa that demonstrate the potential strengths that can be nurtured to build resilience in local communities to help mitigate the impact of disasters and emergencies. The case studies highlight the importance of co-developing relevant education and communication strategies, amplifying the role of community leaders, empowering community members to achieve shared goals, assessing and adapting to changing contexts, pre-planning and readiness for future emergencies and acknowledgement of historic context. [ABSTRACT FROM AUTHOR]

Background This paper presents a descriptive analysis of the perceptions of Kenyan midwifery educators regarding the early impact of coronavirus disease 2019 (COVID-19) on the continuity of midwifery education. Methods A cross-sectional online survey was conducted among 51 midwifery/clinical medicine educators from 35 diploma training colleges from all eight regions of Kenya. Educators' concerns and satisfaction regarding the delivery of training during the early phases of the pandemic were expressed as proportions on a three-point Likert scale. Results Of the educators, 76% were extremely concerned about face-to-face teaching during the pandemic; 96% of educators had started delivering virtual teaching (VT), with only 41% being extremely confident in facilitating VT; and 97% were unsatisfied with the measures in place in their institutions to continue face-to-face teaching. Conclusion To minimise the impact of COVID-19 on midwifery education in Kenya, capacity building for VT and mitigation measures for safe in-person training are urgently needed. [ABSTRACT FROM AUTHOR]

Study Question: Is bacterial vaginosis (BV) associated with fecundability?Summary Answer: Women with BV may be at increased risk for sub-fecundity.What Is Known Already: While BV has been associated with poor IVF outcomes, the association between vaginal microbiota disruption and non-medically assisted conception has not been thoroughly explored.Study Design, Size, Duration: Kenyan women with fertility intent were enrolled in prospective cohort that included monthly preconception visits with vaginal fluid specimen collection and pregnancy testing. Four hundred fifty-eight women attempting pregnancy for ≤3 menstrual cycles at enrollment were eligible for this fecundability analysis.Participants/materials, Setting, Methods: At monthly preconception visits, participants reported the first day of last menstrual period and sexual behavior, underwent pregnancy testing and provided vaginal specimens. Discrete time proportional probabilities models were used to estimate fecundability ratios (FRs) and 95% CI in menstrual cycles with and without BV (Nugent score ≥ 7) at the visit prior to each pregnancy test. We also assessed the association between persistent BV (BV at two consecutive visits) and fecundability.Main Results and the Role Of Chance: Participants contributed 1376 menstrual cycles; 18.5% (n = 255) resulted in pregnancy. After adjusting for age, frequency of condomless sex and study site, BV at the visit prior to pregnancy testing was associated with a 17% lower fecundability (adjusted FR (aFR) 0.83, 95% CI 0.6-1.1). Persistent BV was associated with a 43% reduction in fecundability compared to cycles characterized by optimal vaginal health (aFR 0.57, 95% CI 0.4-0.8).Limitations, Reasons For Caution: Detection of vaginal microbiota disruption using Gram stain and a point-of-care test for elevated sialidase identified a non-optimal vaginal environment, but these non-specific methods may miss important relationships that could be identified by characterizing individual vaginal bacteria and bacterial communities using molecular methods. In addition, results may be subject to residual confounding by condomless sex as this was reported for the prior month rather than for the fertile window during each cycle.Wider Implications Of the Findings: Given the high global prevalence of BV and infertility, an association between BV and reduced fecundability could have important implications for a large number of women who wish to conceive. Multi-omics approaches to studying the vaginal microbiota may provide key insights into this association and identify potential targets for intervention.Study Funding/competing Interest(s): This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-R.S.M.). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were made possible using REDCap electronic data capture tools hosted at the University of Washington's Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for consulting from Lupin Pharmaceuticals. L.E.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for service on scientific advisory boards from Hologic and Nabriva Therapeutics.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Inadequate access to water, sanitation and hygiene (WaSH) exposes many vulnerable populations, especially women and girls, to preventable diseases around the world. This paper reports findings from a photovoice project that explored water-related risk perceptions and health outcomes among women in Nyanchwa, Kenya. Thirteen women in four age categories were recruited for this study in July 2016 using the 'snowball' technique. From the results, inadequate access to WaSH was associated with increased water collection burden on women and children; environmental pollution; poor educational outcomes; loss of time due to water collection and poor sanitation infrastructure. Some barriers to change identified include financial barriers and inadequate government support. The identified risks and barriers are important considerations for the design, evaluation and mainstreaming of WaSH programs in resource constrained settings. [ABSTRACT FROM AUTHOR]

Increased legal access and the devolution of natural resource administration are generally seen as sources of power for local communities and their institutions. However, beyond this widely held expectation, the politics of land reform suggest that legal recognition of rights and devolution is not the only issue with implications for communal tenure reforms. Misconceptions about communal tenure, which are rooted in history, and their appropriation by local elites in the processes of communal tenure reform are characteristic of both colonial and post-colonial governments in Kenya. Although typically articulated and promulgated to enhance political representation and to devolve control over resources to the local level, unresolved issues in the reform process have worked to undermine the legitimacy of communal land rights in contemporary Kenyan society. A case study of the post-2010 community land legislation process demonstrates the continuing relevance of historically conditioned political and ideological representations of communal tenure built during the colonial period and reproduced in policy in independent Kenya. This paper offers reflections on the centrality of sustained communal tenure misconceptions, fetishization of formal governance institutions, and the institutional and power configurations that primarily benefit powerful stakeholders as sources of the current breakdown in the implementation of community land law. [ABSTRACT FROM AUTHOR]

Over the past 30 years, scholars have criticized the propensity of the international media to reproduce damaging and racist stereotypes about Africa. How do foreign correspondents, who are key actors in the production of Africa's media image, position themselves in relation to this criticism? Based on 35 interviews conducted with correspondents in Kenya and South Africa between 2013 and 2017, I find that many correspondents recognize the negative contributions of the news industry to representational Othering, thereby agreeing with the general tenets of the criticism. This paper is an in-depth exploration of this phenomenon, which I call postcolonial reflexivity. I outline the features of this postcolonial reflexivity, discuss its impact on journalistic practices, and explore the reasons for its prevalence among correspondents. Overall, the research contributes to bridging the gap between the textual orientation of postcolonial studies and the inclination for analyzing production practices in journalism studies. [ABSTRACT FROM AUTHOR]

List experiments (LEs) are an increasingly popular survey research tool for measuring sensitive attitudes and behaviors. However, there is evidence that list experiments sometimes produce unreasonable estimates. Why do list experiments "fail," and how can the performance of the list experiment be improved? Using evidence from Kenya, we hypothesize that the length and complexity of the LE format make them costlier for respondents to complete and thus prone to comprehension and reporting errors. First, we show that list experiments encounter difficulties with simple, nonsensitive lists about food consumption and daily activities: over 40 percent of respondents provide inconsistent responses between list experiment and direct question formats. These errors are concentrated among less numerate and less educated respondents, offering evidence that the errors are driven by the complexity and difficulty of list experiments. Second, we examine list experiments measuring attitudes about political violence. The standard list experiment reveals lower rates of support for political violence compared to simply asking directly about this sensitive attitude, which we interpret as list experiment breakdown. We evaluate two modifications to the list experiment designed to reduce its complexity: private tabulation and cartoon visual aids. Both modifications greatly enhance list experiment performance, especially among respondent subgroups where the standard procedure is most problematic. The paper makes two key contributions: (1) showing that techniques such as the list experiment, which have promise for reducing response bias, can introduce different forms of error associated with question complexity and difficulty; and (2) demonstrating the effectiveness of easy-to-implement solutions to the problem. [ABSTRACT FROM AUTHOR]

Background Kawasaki disease (kDa) is a childhood vasculitides that affects small and medium-sized arteries. It is self-limiting but when left untreated can cause coronary artery aneurysms in about 25% of children1. The diagnosis is clinical and is made with the criteria of fever for at least five days, and at least four out of five other clinical signs: bilateral non-exudative conjunctivitis, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. Incomplete kDa is diagnosed with fever for at least five days and at least 2–3 of the principal signs, with suggestive lab investigations and lack of an alternative diagnosis1. kDa is named after Dr Tomisaku Kawasaki who first described it in 1967 in Japan2. The highest incidence of kDa continues to be reported among Asian children, with an incidence rate of 264.8 per 100 000 population aged 0–4 years as per Japan's latest nationwide survey3. In Africa, the true incidence is unknown but several case reports have been published. A 2016 paper by Gorrab et al.4 found that the annualized incidence rate of kDa in the Maghreb children living in Quebec (18.49/year/100 000 children under 5 years of age) was 4–12 times higher than reported in their countries of origin- Tunisia, Morocco, and Algeria (0.95, 4.52, and 3.15, respectively) suggesting a likelihood of under-diagnosis. This case series sought to highlight the characteristics, presentation, and management of patients diagnosed with kDa in a tertiary hospital in Kenya. Methods This was a retrospective cross-sectional study carried out by reviewing the charts of all the patients with a discharge diagnosis of kDa from January 2013 to December 2017 at the Aga Khan University Hospital, Nairobi. Their demographics, presentation, diagnostic work-up, and management are reported. Analysis was done by descriptive statistics using the Microsoft Excel 2016 Application. Results A total of 15 cases were identified and the patient characteristics and presentation are as tabulated below: Characteristic.  n (%).  Age (mean+/-SD, range, years)   2+/-1.5 (0.3-5.7)  Sex—Males   8 (53.3)  Duration of fever at diagnosis (mean +/-SD, range, days)   6.8+/-3.4 (2-13)  Incomplete KD   7 (46.7)  Clinical Features: Fever   15 (100)  Oral Changes   15 (100)  Extremity changes   12 (80)  Cervical lymphadenopathy   9 (60)  Non-exudative conjunctivitis   8 (53.3)  Characteristic.  n (%).  Age (mean+/-SD, range, years)   2+/-1.5 (0.3-5.7)  Sex—Males   8 (53.3)  Duration of fever at diagnosis (mean +/-SD, range, days)   6.8+/-3.4 (2-13)  Incomplete KD   7 (46.7)  Clinical Features: Fever   15 (100)  Oral Changes   15 (100)  Extremity changes   12 (80)  Cervical lymphadenopathy   9 (60)  Non-exudative conjunctivitis   8 (53.3)  Open in new tab Characteristic.  n (%).  Age (mean+/-SD, range, years)   2+/-1.5 (0.3-5.7)  Sex—Males   8 (53.3)  Duration of fever at diagnosis (mean +/-SD, range, days)   6.8+/-3.4 (2-13)  Incomplete KD   7 (46.7)  Clinical Features: Fever   15 (100)  Oral Changes   15 (100)  Extremity changes   12 (80)  Cervical lymphadenopathy   9 (60)  Non-exudative conjunctivitis   8 (53.3)  Characteristic.  n (%).  Age (mean+/-SD, range, years)   2+/-1.5 (0.3-5.7)  Sex—Males   8 (53.3)  Duration of fever at diagnosis (mean +/-SD, range, days)   6.8+/-3.4 (2-13)  Incomplete KD   7 (46.7)  Clinical Features: Fever   15 (100)  Oral Changes   15 (100)  Extremity changes   12 (80)  Cervical lymphadenopathy   9 (60)  Non-exudative conjunctivitis   8 (53.3)  Open in new tab In addition to elevated inflammatory markers (C reactive protein and/or Erythrocyte Sedimentation Rate), a significant number of the patients also had sterile pyuria (9/9), hypoalbuminemia (8/10), thrombocytosis (8/15), and anaemia (11/15). Nine out of eleven had negative blood cultures. Fourteen out of the fifteen patients had echocardiograms done during admission. Only one patient was found to have abnormal findings of bilaterally dilated coronaries arteries. Five patients had at least one documented repeat echocardiogram. Fourteen patients received Intravenous Immunoglobulin (IVIG), with 13 of them responding to treatment. No adverse effects were reported after treatment. One patient did not improve and needed a second dose of IVIG and intravenous methylprednisone (30 mg/kg). Fourteen patients received aspirin but dosing varied from high (80–90 mg/kg/day) to moderate (30–50 mg/kg/day) to low dose (3 mg/kg/day). One patient on high-dose aspirin was noted to have developed symptoms consistent with aspirin-induced bronchospasm and was changed to low dose. Conclusion This case series highlights the presence of kDa in the Kenyan pediatric population with patient characteristics similar to what is reported globally. Diagnosis was made after a mean of about 7 days, possibly due to low awareness of the disease among healthcare professionals. Management with IVIG in most cases was successful but more guidance is needed around the use of steroids and the dosing of aspirin. [ABSTRACT FROM AUTHOR]

Background: Helminth (worm) infections cause morbidity among poor communities worldwide. An influential study conducted in Kenya in 1998-99 reported that a school-based drug-and-educational intervention had benefits regarding worm infections and school attendance. Effects were seen among children treated with deworming drugs, untreated children in intervention schools and children in nearby non-intervention schools. Combining these effects, the intervention was reported to increase school attendance by 7.5% in treated children. Effects on other outcomes (worm infections, anaemia, nutritional status and examination performance) were also investigated.Methods: In this pure replication, we used data provided by the original authors to re-analyse the study according to their methods. We compared these results against those presented in the original paper.Results: Although most results were reproduced as originally reported, we identified discrepancies of several types between the original findings and re-analysis. For worm infections, re-analysis showed reductions similar to those originally reported. For anaemia prevalence, in contrast to the original findings, re-analysis found no evidence of benefit. For nutritional status, both original findings and re-analysis described modest evidence for a small improvement. For school attendance, re-analysis showed benefits similar to those originally found in intervention schools for both children who did and those who did not receive deworming drugs. However, after correction of coding errors, there was little evidence of an indirect effect on school attendance among children in schools close to intervention schools. Combining these effects gave a total increase in attendance of 3.9% among treated children, which was no longer statistically significant. As in the original results, re-analysis found no effect of the intervention on examination performance.Conclusions: Re-applying analytical approaches originally used, but correcting various errors, we found little evidence for some previously-reported indirect effects of a deworming intervention. Effects on worm infections, nutritional status, examination performance and school attendance on children in intervention schools were largely unchanged. [ABSTRACT FROM AUTHOR]

Providing development inputs like electrical energy is a formidable task in many parts of the developing world. The generally rural nature of developing countries makes it necessary to devise innovative ways of getting electricity to the non-urban majority. It is also imperative that adequate and productive electrical power is made available, for sustainable development to be achieved by rural communities and by extension the national economies. Therefore, institutional and other innovations are being continuously mooted to meet the challenges; and it is in this context that rural electricity co-operatives have been introduced to developing countries. The co-operatives are promoted largely because of their social strengthening characteristics. However, questions arise as to whether social capital upon which the co-operatives are based is a facilitator or an impediment to the co-operatives, and the sustainable development that is ultimately targeted. It is argued in this paper that rather overstretched virtues of social capital mask undesirable elements of the capital. Importantly, organizations like co-operatives that depend on it can fail because of the neglected dark aspects. Empirical evidence from Kenya is used to support the contention. It is concluded that electricity co- operatives could remain a far-fetched possibility, unless desirable and undesirable characteristics of social capital are carefully taken into account. [ABSTRACT FROM AUTHOR]

This paper draws on the experience of conducting participatory video in the Rift Valley of Kenya after the 2007–2008 post-election crisis, when the country underwent a period of intense ethnic violence. By linking development communication to conflict transformation theory, this article offers a framework that highlights the impact that communication for social change can have in post-conflict settings through the use of participatory media. It shows how this type of media productions can contribute to re-establishing relationships and creating a shared understanding of the conflict, while building the view of an interconnected future among opposing groups. In this case study, I illustrate how a collection of participatory videos became a peacebuilding tool for the youth in the Rift Valley. Through the information gathered from the interviews with young victims and perpetrators of the Kenya Post-election Violence, I discuss how both the filming and the screening of these films have opened a dialogue between different groups and contributed to processes of social change. [ABSTRACT FROM PUBLISHER]

Background: Kenya recently transitioned from a paper to an electronic system for recording and reporting of tuberculosis (TB) data. Methods: During September-October 2013, the data quality of the new system was evaluated through an audit of data in pa per source documents and in the national electronicsystem, and an analysis of all 99 281 cases reported in 2012. Results: While the new electronic system overall is robust, this assessment demonstrated limitations in the concordance and completeness of data reaching the national level. Conclusions: Additional oversight and training in data entry are needed to strengthen TB surveillance data quality in Kenya. [ABSTRACT FROM AUTHOR]