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This article presents processes for developing contextualized training procedures to better appreciate partnership, capacity-building experiences, and specific implementation challenges and opportunities for mental and public health teams. The program enrolled 469 out-of-school adolescents to participate in the integration of youth mental health into health and life-skill safe spaces. The teams utilized various methods to achieve process outcomes of restructuring and adapting curricula, training youth mentors, and assessing their self-efficacy before integrating the intervention for 18 months. The Coronavirus (COVID-19) pandemic became an additional unique concern in the preliminary and the 18-month implementation period of the program. This necessitated innovation around hybrid training and asynchronous modalities as program teams navigated the two study locations for prompt training, supervision, evaluation, and feedback. In conclusion, out-of-school adolescents face a myriad of challenges, and a safe space program led by youth mentors can help promote mental health. Our study demonstrated how best this can be achieved. We point to lessons such as the importance of adapting the intervention and working cohesively in teams, building strong and trusting partnerships, learning how to carry out multidisciplinary dialogues, and continuous supervision and capacity building. This article aimed to document the processes around the design and implementation of this innovative intervention and present a summary of lessons learned.

Introduction: Research on snakebite has mostly been conducted on settled populations and current risk factors and potential interventions are therefore most suited for these populations. There is limited epidemiological data on mobile and nomadic populations, who may have a higher risk of snakebite. Methods and results: We conducted a scoping review to gather evidence on survey methods used in nomadic populations and compared them with contemporary survey methods used for snakebite research. Only 16 (10.5%) of 154 articles reportedly conducted on pastoralist nomadic populations actually involved mobile pastoralists. All articles describing snakebite surveys (n = 18) used multistage cluster designs on population census sampling frames, which would not be appropriate for nomadic populations. We used geospatial techniques and open-source high-resolution satellite images to create a digital sampling frame of 50,707 households and used a multistage sampling strategy to survey nomadic and semi-nomadic populations in Samburu County, Kenya. From a sample of 900 geo-located households, we correctly identified and collected data from 573 (65.4%) households, of which 409 were in their original locations and 164 had moved within 5km of their original locations. We randomly sampled 302 (34.6%) households to replace completely abandoned and untraceable households. Conclusion: Highly mobile populations require specific considerations in selecting or creating sampling frames and sampling units for epidemiological research. Snakebite risk has a strong spatial component and using census-based sampling frames would be inappropriate in nomadic populations. We propose using open-source satellite imaging and geographic information systems to improve the conduct of epidemiological research in these populations. Author summary: Nomadic populations are at increased risk of snakebites, but interventions will not be developed or improved without reliable data on this risk. Highly mobile populations require specific considerations in selecting or creating sampling frames and sampling units for epidemiological research, and using census-based sampling frames would be inappropriate. We conducted scoping reviews to gather evidence on survey methods used in nomadic populations and compared them with contemporary survey methods used for snakebite research, which we used to inform our methodology. We describe the creation of a sampling frame of 50,707 households, the selection and geo-tagging of a sample of 900 households, and the identification and enrolment of participants from 875 households between August 2019 and March 2020. We propose using open-source satellite imaging and geographic information systems to improve the conduct of epidemiological research in these populations. [ABSTRACT FROM AUTHOR]

Background: Persons with submicroscopic malaria infection are a major reservoir of gametocytes that sustain malaria transmission in sub-Saharan Africa. Despite recent decreases in the national malaria burden in Kenya due to vector control interventions, malaria transmission continues to be high in western regions of the country bordering Lake Victoria. The objective of this study was to advance knowledge of the topographical, demographic and behavioral risk factors associated with submicroscopic malaria infection in the Lake Victoria basin in Kisumu County. Methods: Cross-sectional community surveys for malaria infection were undertaken in three eco-epidemiologically distinct zones in Nyakach sub-County, Kisumu. Adjacent regions were topologically characterized as lakeshore, hillside and highland plateau. Surveys were conducted during the 2019 and 2020 wet and dry seasons. Finger prick blood smears and dry blood spots (DBS) on filter paper were collected from 1,777 healthy volunteers for microscopic inspection and real time-PCR (RT-PCR) diagnosis of Plasmodium infection. Persons who were PCR positive but blood smear negative were considered to harbor submicroscopic infections. Topographical, demographic and behavioral risk factors were correlated with community prevalence of submicroscopic infections. Results: Out of a total of 1,777 blood samples collected, 14.2% (253/1,777) were diagnosed as submicroscopic infections. Blood smear microscopy and RT-PCR, respectively, detected 3.7% (66/1,777) and 18% (319/1,777) infections. Blood smears results were exclusively positive for P. falciparum, whereas RT-PCR also detected P. malariae and P. ovale mono- and co-infections. Submicroscopic infection prevalence was associated with topographical variation (χ2 = 39.344, df = 2, p<0.0001). The highest prevalence was observed in the lakeshore zone (20.6%, n = 622) followed by the hillside (13.6%, n = 595) and highland plateau zones (7.9%, n = 560). Infection prevalence varied significantly according to season (χ2 = 17.374, df = 3, p<0.0001). The highest prevalence was observed in residents of the lakeshore zone in the 2019 dry season (29.9%, n = 167) and 2020 and 2019 rainy seasons (21.5%, n = 144 and 18.1%, n = 155, respectively). In both the rainy and dry seasons the likelihood of submicroscopic infection was higher in the lakeshore (AOR: 2.71, 95% CI = 1.85–3.95; p<0.0001) and hillside (AOR: 1.74, 95% CI = 1.17–2.61, p = 0.007) than in the highland plateau zones. Residence in the lakeshore zone (p<0.0001), male sex (p = 0.025), school age (p = 0.002), and living in mud houses (p = 0.044) increased the risk of submicroscopic malaria infection. Bed net use (p = 0.112) and occupation (p = 0.116) were not associated with submicroscopic infection prevalence. Conclusion: Topographic features of the local landscape and seasonality are major correlates of submicroscopic malaria infection in the Lake Victoria area of western Kenya. Diagnostic tests more sensitive than blood smear microscopy will allow for monitoring and targeting geographic sites where additional vector interventions are needed to reduce malaria transmission. [ABSTRACT FROM AUTHOR]

Background: Survivors of sexual violence deserve timely and high-quality forensic examination, evidence collection, and documentation as part of comprehensive care. However, in many countries, the quality of medical-legal documentation is severely limited. MediCapt is an innovative digital application that enables clinicians to document forensic medical evidence as well as capture and securely store forensic photographs of injuries. This study evaluated the effectiveness and usability of MediCapt to document forensic medical evidence of sexual violence. Methods: This mixed-methods evaluation involved key-informant interviews, usability questionnaires, and forensic record reviews. Participants included clinicians, medical records personnel, information technology personnel, and health facility administrators, as well as law enforcement and legal professionals in Kenya. Results: The Physicians for Human Rights (PHR) data quality checklist found that using MediCapt led to significantly higher data-quality scores compared to paper-based forms. MediCapt forms scored higher on 23 of 26 checklist items. While a wide difference in quality was seen among paper-based forms, MediCapt appeared to both standardize and improve quality of documentation across sites. MediCapt strengths included data security and confidentiality, accuracy and efficiency, and supplemental documentation with photography. Weaknesses included infrastructure challenges, required technological proficiencies, and time to learn the new system. Although it is early to assess the impact of MediCapt on prosecutions, providers and law and justice sector professionals were optimistic about its usefulness. They identified MediCapt as appropriate for use with survivors of sexual violence and reported MediCapt's legibility and photography features had already been commended by the court. Conclusion: MediCapt was well-received across all sectors, its use was perceived as feasible and sustainable, and it significantly improved the quality of collected forensic data. It is anticipated this improvement in forensic documentation will increase successful prosecutions, strengthen accountability for perpetrators, and improve justice for survivors. [ABSTRACT FROM AUTHOR]

The study of yield gaps has become more complex, prompting the use of varied approaches to measure yields and a wider range of factors to explain these gaps. In the Global North, the focus is on precision farming, whereas in sub-Saharan Africa (SSA), a broader perspective is necessary due to pronounced variability in farmland conditions. While biogeophysical and management factors have been traditional focal points in yield gap analyses, socio-economic and institutional factors are increasingly recognized as significant, especially in SSA. This review synthesizes research from the past decade in SSA that integrates biogeophysical, management, farm characteristics, and institutional factors in yield gap discussions. The findings indicate a slow shift in including socio-economic factors, with management, particularly nutrient supply and crop management, remaining predominant. However, there is a growing trend towards methodological diversity, such as the adoption of remote sensing and GIS in recent years. Case studies from Kenya and Ghana, utilizing field surveys, interviews, panel data, and spatial analysis, highlight how a multifaceted approach can enhance our understanding of the various elements influencing maize yield gaps in SSA. [ABSTRACT FROM AUTHOR]

Food security, a vital determinant of overall health and well-being, hinges on the simultaneous achievement of four dimensions: physical availability of food, economic and physical access to food, utilization of nutrients, and stability over time. This paper explores the complex and multi-faceted food security situations in Kenya and Zambia, emphasizing key factors such as agricultural production, government policies, and socio-economic conditions. [ABSTRACT FROM AUTHOR]

Climatic events and other natural-related disasters experienced in the arid and semi-arid lands of northern Kenya negatively affect the pastoral livelihoods of the communities. Addressing vulnerability to climate shocks among pastoral communities of Kenya's Arid and Semi-lands presents a persistent challenge. Cash transfer programmes have increasingly grown as one mode of building household resilience. Understanding the role of cash transfer interventions on household resilience to climate shocks is key to policy programming. This paper aimed at determining the effects of cash transfers on household resilience to climate shocks. The paper evaluated the Hunger Safety Net Program, which is one of the largest unconditional cash transfer programs in Kenya. The Hunger Safety Net Program targeted poor people in northern Kenya including the counties of Turkana, Wajir, Marsabit, and Mandera. To establish the impact the paper compares households which received cash transfers with those that did not receive transfers. The panel fixed effects model was used to determine the effects of cash transfers on household resilience. The results indicate that cash transfers have positive significant effects on household resilience to climate shocks. [ABSTRACT FROM AUTHOR]

The prevalence of substandard and falsified medicines in low- and middle-income countries (LMICs) is a major global public health concern. Multiple screening technologies for post-market surveillance of medicine quality have been developed but there exists no clear guidance on which technology is optimal for LMICs. This study examined the return on investment (ROI) of implementing a select number of screening technologies for post-market surveillance of amoxicillin quality in a case study of Kenya. An agent-based model, Examining Screening Technologies using Economic Evaluations for Medicines (ESTEEM), was developed to estimate the costs, benefits, and ROI of implementing screening technologies for post-market surveillance of substandard and falsified amoxicillin for treatment of pediatric pneumonia in Kenya. The model simulated sampling, testing, and removal of substandard and falsified amoxicillin from the Kenyan market using five screening technologies: (1) Global Pharma Health Fund's GPHF-Minilab, (2) high-performance liquid chromatography (HPLC), (3) near-infrared spectroscopy (NIR), (4) paper analytical devices / antibiotic paper analytical devices (PADs/aPADs), and (5) Raman spectroscopy. The study team analyzed the population impact of utilizing amoxicillin for the treatment of pneumonia in children under age five in Kenya. We found that the GPHF-Minilab, NIR, and PADs/aPADs were similar in their abilities to rapidly screen for and remove substandard and falsified amoxicillin from the Kenyan market resulting in a higher ROI compared to HPLC. NIR and PADs/aPADs yielded the highest ROI at $21 (90% Uncertainty Range (UR) $5-$51) each, followed by GPHF-Minilab ($16, 90%UR $4 - $38), Raman ($9, 90%UR $2 - $21), and HPLC ($3, 90%UR $0 - $7). This study highlights screening technologies that can be used to reduce costs, speed up the removal of poor-quality medicines, and consequently improve health and economic outcomes in LMICs. National medicine regulatory authorities should adopt these fast, reliable, and low-cost screening technologies to better detect substandard and falsified medicines, reserving HPLC for confirmatory tests. [ABSTRACT FROM AUTHOR]

Background: Road traffic accidents (RTAs) are a significant contributor to morbidity and mortality in East Africa. Lower extremity (LE) injuries are especially debilitating, negatively impacting quality of life and employment prospects. This systematic review characterizes the proportion of LE injuries due to RTAs in four members of the East African Community: Kenya, Rwanda, Tanzania, and Uganda. Methods: Embase, Medline, Web of Science, and PubMed were queried for studies from 2010 to 2022 providing information on lower extremity injuries caused by RTAs in the countries of interest. Proportions of RTA-related LE injuries were extracted from eligible papers. Study quality and bias were assessed using the framework for systematic reviews established by Zaza et al.1 Results: Seven studies met the eligibility criteria--four for Kenya, two for Uganda, and one for Tanzania; however, no eligible studies were found for Rwanda. The proportion of RTA-related injuries affecting the lower extremities ranged from 0.39 to 0.49. In patients presenting with LE injuries, RTAs were the most frequent cause, representing more than 70% of cases in the examined studies. Motorcycle accidents were not more likely to cause LE injuries, but they were the most significant contributor to the overall LE injury burden due to their prevalence. Conclusions: With urbanization and the increased adoption of low-cost motorcycles, RTAs will continue to pose a public health challenge. Investments in traffic enforcement and physical infrastructure will alleviate the risks to both motorists and pedestrians. In addition to primary prevention, there is a significant need for improvements in emergency care and surgical capacity. [ABSTRACT FROM AUTHOR]

From the colonial time to date, North Eastern Kenya has witnessed sporadic incidents of instability characterised by conflict and insecurity. Scholarly studies have attributed instability to state capacity that includes structural weaknesses such as inability to monopolize the use of violence, poor border controls and ineffective law enforcement. However, such studies do not explain why the state does not function to its optimal capacity in the region. This paper argues that instability in North Eastern Kenya is a deliberate creation of disorder by the state. Measures taken by both the colonial and post-colonial governments to secure their interests have subsequently rendered the region unstable. It argues that the colonial government in an attempt to secure the white highlands used the Northern Frontier District as a buffer zone with minimal investment. Similarly, the post-colonial government curved it out as a security zone to tame insurgency and denied it the necessary attention required to make it safe and secure. [ABSTRACT FROM AUTHOR]

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The development and practice of inclusive research with people with intellectual disabilities is complex, revealing challenges and lessons that inform innovative and novel methodological approaches. In Africa, inclusive research still lags for various reasons. First, due to societal misconceptions that portray people with intellectual disabilities as unable to self-advocate or as lacking agency and self-determination; second, due to a lack of trained researchers and ethics committees on inclusive research practices. This paper critically reflects on and discusses the strategies and methods used to conduct an inclusive research study in Kenya. The focus was on the methodological approach of including people with intellectual disabilities as researchers in Kenya. Two people with intellectual disabilities were trained as research assistants. This paper describes the experiences with Institutional Review Boards, the processes and experiences while training this research assistants using a UK-developed curriculum, and fieldwork experiences while piloting interview guides, conducting interviews, and conducting focus groups with this research assistants. This study findings indicate the need to culturally adapt co-researcher training, the importance of working with support personnel who empower researchers with intellectual disabilities, and the need for greater advocacy to change negative attitudes towards people with intellectual disabilities that hinder their participation in research. [ABSTRACT FROM AUTHOR]

In Kenya, approximately one in five girls aged 15–19 years old are pregnant or already a mother. Adolescent girls and young women experience significant mental health vulnerabilities during the pregnancy and postpartum periods, leading to poor antenatal and postnatal care attendance and inferior infant and maternal health outcomes. Pregnant adolescents often experience stigma and disenfranchisement due to their pregnancy status and at the same time lack access to mental health support within health settings, schools, religious institutions, and communities. This paper presents the results of qualitative interviews embedded within the human-centered design (HCD) process used to adapt the Helping Adolescents Thrive (HAT) program for Kenyan peripartum adolescents including young fathers. This qualitative study used two phases. First, a HAT advisory group participated in a series of four workshops to help identify and articulate mental health promotion needs and deepened the team's understanding of youth-centered thinking. Second, qualitative interviews were conducted with 39 pregnant and parenting adolescents to understand their perspectives on mental health prevention and promotion. Pregnant and parenting adolescents articulated different needs including poor support, stigma, and psychological disturbances. Parenting adolescents reported disturbed relationships, managing motherhood, poor health, and social empowerment. Participants highlighted sources of stress including economic challenges, fear of delivery, strained relationships, rejection, and stigma. Participants described psychological disturbances such as feeling stressed, worthless, withdrawn, and suicidal. Coping mechanisms reported by participants included engaging in domestic activities, hobbies, and social networking. Peers, family and spirituality were identified as important sources of support, as well as school integration, livelihoods, support groups and mentorships. Findings from this study can be used to strengthen and adapt HAT program, policy and practice for mental health prevention and promotion for pregnant and parenting adolescents. [ABSTRACT FROM AUTHOR]

The study assesses the gender implications of a target product profile for table potato in Kenya. Breeding programs mostly emphasize farmers’ trait requirements and rarely pay attention to other value chain actors’ preferences. This partially contributes to the low uptake of improved varieties. Therefore, efforts are required to assess the gender implications of crop product profile proposals during development, testing, and dissemination. In this paper, we assess the gender implications of traits targeted by a potato breeding program in Kenya using the G+ tools. The study applies the G+ product profile tool to examine the instances the selected traits may exacerbate gender disparity along four domains: unpaid labor, access to employment opportunities, requiring extra inputs and control over benefits. We use mixed methods including a review by social scientists, key informant interviews and a multistakeholder workshop to gather insights from female and male farmers, breeders, and other stakeholders. Findings show that pest, disease resistance, and shelf-life traits benefit women and men in the target customer segments. On the other hand, earliness, dry matter, and yield could increase drudgery for women. The traits increase demand for women’s unpaid labor during harvesting, sorting and food preparation time while also displacing women from profitable nodes. We recommend that gender-responsive strategies accompany the release of the target variety to mitigate inequities and enhance adoption. [ABSTRACT FROM AUTHOR]

Mobile money has been a key innovation in Africa that has increased the financial resilience of vulnerable households by providing an easy way to send and receive remittances. While recent literature has focused on the link between mobile money and its function as a social protection mechanism for the vulnerable population, less is known about the extent to which the costs of using the service affect the transaction behaviour of these people. By exploiting a natural experiment in the form of an excise fee that was imposed on mobile-money transactions in Kenya, this paper estimates the differential effect of a price hike in mobile-money transaction fees on transaction behaviour of households with a daily income below 1.25 USD and households above this threshold. The study finds that households with an income below 1.25 USD reduced their monthly mobile-money transactions volume by 25 per cent compared to households above this threshold. Additionally, the paper finds suggestive evidence that the tax also led to a relative reduction in mobile-money remittances received by households below an income of 1.25 USD. The loss in received remittances was not substituted by an increase in remittances sent by cash or in-kind. [ABSTRACT FROM AUTHOR]

Academic examinations and result rankings has been tipped as the culmination of education achievement by a student in the country. This is manifested through the certificates that are issued with different grades. However, despite having students that excel and those that fail, there still remains the critical issue of quality vis-à-vis the academic outcomes and ranking. It is based on this premise that this paper attempts to give an insight on the implications of ranking students nationally in examinations. This paper employs a desk review method, and endeavoured to answer the following questions: Has the academic system of ranking students nationally helped shape the career destiny of students? What have been the merits and demerits of academic rankings in the country? Has the academic ranking tradition enhanced equity in education quality in the country? What are some of the remedies to the identified bottlenecks in the academic ranking systems of students? The general findings include: one, there has been cases of massive disparity in terms of allocation of staff personnel, finances and infrastructure, that has enhanced social stratification in terms of national, extra county, county, sub county and private schools. Two, there has been the rise of examination malpractices such as cheating for excellence purposes, that has diluted the quality of curriculum delivery among teachers who are its custodians. This paper is thus of the view that, the Ministry of Education is on the right path in discarding academic rankings to enhance quality of curriculum delivery to its students, tapping and nurturing of students talents, and bringing up a holistic all round student to fit in society. This paper thus recommends that more research and inputs should be done on this education sector, more so, on the competency based curriculum to improve it even further, as it is the way to salvage our education standards. [ABSTRACT FROM AUTHOR]

Background: As a disease characterised by non-motor and very visible motor symptoms, Parkinson's disease has been associated with multiple forms of stigma, while awareness about the disease globally remains low. The experience of stigma relating to Parkinson's disease from high-income nations is well-documented, while less is known about low- and middle-income countries (LMICs). Literature on stigma and disease from Africa and the Global South has described the added complexities people face resulting from structural violence, as well as perceptions about symptoms and disease associated with supernatural beliefs, which can have significant implications for access to healthcare and support. Stigma is a recognised barrier to health-seeking behaviour and a social determinant of population health. Methods: This study draws on qualitative data collected as part of a wider ethnographic study to explore the lived experience of Parkinson's disease in Kenya. Participants include 55 people diagnosed with Parkinson's and 23 caregivers. The paper draws on the Health Stigma and Discrimination Framework as a tool to understand stigma as a process. Results: Data from interviews identified the drivers and facilitators of stigma, including poor awareness of Parkinson's, lack of clinical capacity, supernatural beliefs, stereotypes, fear of contagion and blame. Participants reported their lived realities of stigma, and experiences of stigma practices, which had significant negative health and social outcomes, including social isolation and difficulty accessing treatment. Ultimately, stigma had a negative and corrosive effect on the health and wellbeing of patients. Conclusion: This paper highlights the interplay of structural constraints and the negative consequences of stigma experienced by people living with Parkinson's in Kenya. The deep understanding of stigma made possible through this ethnographic research leads us to see stigma as a process, something that is embodied and enacted. Targeted and nuanced ways of tackling stigma are suggested, including educational and awareness campaigns, training, and the development of support groups. Importantly, the paper shows that awareness of, and advocacy for the recognition of, Parkinson's globally needs to improve. This recommendation is in line with the World Health Organization's Technical Brief on Parkinson disease, which responds to the growing public health challenge posed by Parkinson's. [ABSTRACT FROM AUTHOR]

Many governments worldwide are increasingly using developments in information and communication technologies (ICT) to provide online services to their citizens. This process is commonly referred to as e-government. South Africa is one of the leading nations in technology and overall development in the Sub-Saharan-African region. Nevertheless, South Africa has failed to successfully implement a wide range of e-Government services for its population over the past years. This paper focuses on analyzing the success factors for a seamless implementation of eGovernment systems and how countries such as Kenya, which are not a developed as South Africa, were able to adapt and successfully implement functioning systems for their citizens. The theoretical research results have indicated what the main success factors are in e-government implementation. Further analysis has been conducted to find out what the reasons are that South Africa has a non-functioning e-government system. An embedded case study approach has been selected to focus on selected aspects of the case study. The paper provides a comprehensive overview of the current state of e-government services in South Africa and compares it with other Sub-Saharan countries with similar economic conditions. This comparison allows for a better understanding of the challenges and opportunities faced by South Africa in improving its e-government services. [ABSTRACT FROM AUTHOR]

The paper assessed linkage amongst governance mechanisms and efficiency of insurers in Kenya over 8 year period from 2013 to 2020. The study estimated the efficiency of insurers using DEA approach in light of previous literature during the first stage. During the second stage, the bias-corrected efficiency scores were regressed against corporate governance (CG) proxies and control variables using SW (2007) approach on a sample of 53 insurers. Using this two-stage, bootstrapping SW approach, the study documents that the Kenyan insurers are technically inefficient. Overall, the paper presents evidence showing that CG variables influence technical efficiency of insurers in Kenya. Precisely, board independence, gender diversity and audit quality positively and significantly impact Kenyan insurers' technical efficiency. Further, the paper finds that size of the board negatively affect Kenyan insurers' technical efficiency. However, the study established insignificant relationship between CEO duality, intensity of board activities and technical efficiency. The paper makes contribution to the bourgeoning reservoir of empirical works on the insurers' CG-efficiency nexus from an emerging market perspective. Particularly, the article offers empirical insights on some of the least studied CG proxies such as gender diversity, quality of audit and intensity of board activities. The research outcomes also have practical implications for regulators, academia, insurers, government policy makers, practitioners, shareholders and consumers of insurance products by raising their awareness on the influence of CG proxies on the efficiency of the insurers. This is especially beneficial in countries that are pursuing CG and efficiency policy reforms. [ABSTRACT FROM AUTHOR]

Routine vaccination annually prevents millions of deaths worldwide but is underutilized in sub-Saharan Africa (SSA). The complexity of socio-cultural factors impacting vaccine uptake is not well understood. Hence, this paper aims to review the socio-cultural determinants of vaccine uptake and visualize their interrelationships. We conducted a literature search using Pubmed and Embase databases, including articles published from 2000 to 2019 describing socio-cultural demand-side determinants for vaccine uptake. Using the Andersen and Newman Framework of Health Services Utilization, demand-side determinants were categorized as predisposing, enabling or need factors. A qualitative system dynamics approach was employed to visualize how these factors and their dynamic interrelationships influence vaccine uptake. This visualization, by means of a causal-loop diagram (CLD), was mostly based on a qualitative input, with the majority being statements of the authors. These statements were abstracted from the papers found in the review. Quantification was done by counting direct (statistical) associations between each determinant and 'timely and full routine immunization coverage'. A total of 90 articles, primarily from Nigeria (n = 23), Ethiopia (n = 17) and Kenya (n = 11), met the inclusion criteria. We find that maternal autonomy and the perceived benefits caregivers attach to vaccination and exert their influences on many other factors through several feedback loops, thereby influencing timely and full routine immunization coverage. Utilization of health services (supply-related) and access to information (demand-related) were considered as high-potential leverage points. Quantification has shown that maternal autonomy and perceived benefit have an unclear evidence base. Future research should focus on these key players as they play a central role in multiple complex pathways, through which they could influence the uptake of vaccines in SSA. [ABSTRACT FROM AUTHOR]

The language of instruction at university level in the Kenyan education system is English, so all written work for assignments and examinations is generated in English. And yet, each student probably uses two or three languages in their everyday life in situations away from the classroom. Indeed, the language policy allows the use of mother tongue as language of instruction in Primary School classes One to Three. African languages are structured differently from the English language, particularly where prepositions are concerned. Furthermore, each language grows in a specific cultural context; and the range of vocabulary of the African languages in Kenya is different from that of English. This may present a challenge for university students using English as the language of instruction in understanding academic concepts for which there is no equivalent in their mother tongue. In some instances, only a single word is available in the first language, where several different English words are possible or even necessary for clarity depending on the context. This paper explores this cultural peculiarity of linguistic marginalisation, which is both lexical and syntactic, as manifest in the written research papers of university literature students who would otherwise work simultaneously in different languages. [ABSTRACT FROM AUTHOR]

Worldwide countries are engaged in technological improvements, changes in legislation, economic incentives, strengthened administrative structures, and political strategies to allocate and distribute water among different sections of the population. These macro measures treat water as an object of social, cultural, and environmental production unit for distribution and allocation, distancing it from the micro behavioral practices of drinking water. The poverty of sustainability stems from the gap between macro instrumental measures and the inner human dimensions that determine the micro practices. This paper explores the disconnect between macro sustainability measures and the micro practice of drinking water choice among individuals and their motives in the city of Nakuru in Kenya and the state of North Rhine-Westphalia in Germany. Both Kenya and Germany have developed top-down policies with a fix-it mindset. Kenya aims to provide drinking water to its population through piped network technology despite being a water-scarce region with inadequate housing and governance. In contrast, Germany, which is rich in water resources with highly regulated governance arrangements, spends billions treating water to attain drinking water quality only for most citizens to buy bottled water to drink. Despite water resources being finite, both of these nations source additional water through instrumental approaches to satisfy the demands of the materialistic world. In this context, the challenge of overcoming the poverty of sustainability remains a topic of debate that can be ameliorated by complementing scientific approaches with nonscientific knowledge and practices. [ABSTRACT FROM AUTHOR]

This protocol lays the groundwork for a community-centered investigation into the intersection between climate change and violence against women and girls. Providing a standardized framework, this paper will enable researchers to collect and analyze data on severe weather patterns and their potential impact on violence within communities. The interlinkage between violence and climate is an emerging field of research. There is a need for a comprehensive understanding of the intersection of these two issues focusing on the manifestations of violence, specific vulnerabilities, and coping strategies. This protocol outlines a qualitative research approach employed in Kilifi County, Kenya. The study will include key informant interviews with community leaders and policymakers, along with focus group discussions with women, adolescent girls, and men. Community engagement is a crucial component of this work as it will ensure that the research is conducted ethically and respectfully and ensure that the findings are relevant and applicable to the community being studied. This study will contribute to a deeper understanding of the complex dynamics between violence against women and girls and climate change, informing policies, interventions, and advocacy efforts and elevating the voices of women and girls to promote gender equity in the face of climate change challenges. [ABSTRACT FROM AUTHOR]

Kenya is a major player in the global ornamental trade, exporting substantial quantities of ornamental fish to the global market. The sector plays an important role in the country's economy through foreign exchange. However, the country's ornamental fish industry has not fully developed to generate more economic benefits. This paper sought to identify the existing opportunities for enhancing the production and trade of ornamental fish in the country. The findings reveal that there are opportunities for collection of native freshwater ornamental fish species from the vast freshwater resources in the country; for the culture of marine ornamental fish; for public aquariums as centres of recreation, conservation, research and education; and for employment and development of support industries. The findings also show that there are international legislations and national policies that create an enabling environment for the growth of the industry. To unlock the full potential of the industry, training and research, investment and infrastructure development, quality assurance, collaboration and networking, and environmental sustainability strategies need to be put in place. This will ensure Kenya's position as a key player in the global ornamental fish trade. [ABSTRACT FROM AUTHOR]

This paper draws on biographical research among the Akamba and the Luo communities in Eastern and Western Kenya, respectively. Our research explored how practices of adolescence as a process, an institution, and a performance of identity interact with colonial modernities and imaginaries in complex ways. The biographical research was carried out predominantly with women born in the late colonial period in Kenya. We provide critical reflections on the process and affordances of our embodied storytelling approach, which we position as an Africanist methodology and a decolonial research practice. This research and approach provided women with a space to narrate and perform their lived experience, potentially disrupting epistemic inequities that are embedded in the way research on growing up in the past is carried out. The discussions show how colonialism interacted with other factors, including gender and generational power, tradition, girls' agency, and other life characteristics like poverty and family situation, in order to influence the lived experiences of women. Going beyond the narratives of victimhood that characterise coming of age in similar spaces, we present women's emergent, incomplete, and incongruent agency. We position this agency as the diverse ways in which people come to terms with their difficult contexts. The discussion also points to the need for unsettling the settled thinking about girlhood and coming of age in specific historical spaces in the global South. [ABSTRACT FROM AUTHOR]

Background: The social determinants of health (SDH) play a key role in the health of individuals, communities, and populations. Academic institutions and clinical licensing bodies increasingly recognize the need for healthcare professionals to understand the importance of considering the SDH to engage with patients and manage their care effectively. However, incorporating relevant skills, knowledge, and attitudes relating to the SDH into curricula must be more consistent. This scoping review explores the integration of the SDH into graduate medical education training programs. Methods: A systematic search was performed of PubMed, Ovid MEDLINE, ERIC, and Scopus databases for articles published between January 2010 and March 2023. A scoping review methodology was employed, and articles related to training in medical or surgical specialties for registrars and residents were included. Pilot programs, non-SDH-related programs, and studies published in languages other than English were excluded. Results: The initial search produced 829 articles after removing duplicates. The total number of articles included in the review was 24. Most articles were from developed countries such as the USA (22), one from Canada, and only one from a low- and middle-income country, Kenya. The most highly represented discipline was pediatrics. Five papers explored the inclusion of SDH in internal medicine training, with the remaining articles covering family medicine, obstetrics, gynecology, or a combination of disciplines. Longitudinal programs are the most effective and frequently employed educational method regarding SDH in graduate training. Most programs utilize combined teaching methods and rely on participant surveys to evaluate their curriculum. Conclusion: Applying standardized educational and evaluation strategies for SDH training programs can pose a challenge due to the diversity of the techniques reported in the literature. Exploring the most effective educational strategy in delivering these concepts and evaluating the downstream impacts on patient care, particularly in surgical and non-clinical specialties and low- and middle-income countries, can be essential in integrating and creating a sustainable healthcare force. [ABSTRACT FROM AUTHOR]

Context and background Contract farming has been promoted as a more 'inclusive business model' in which local smallholder farmers can participate in and benefit from the wider benefits of investments in rural areas such as infrastructure development (power supply, roads, water supply), spillovers from increased incomes and, in some cases, mandatory development of education and health facilities. Contract farming models could have a positive impact on agricultural development and innovation in developing countries. Contract farming creates a system that links smallholder farmers with domestic and international buyers. Contract farming could secure existing local land rights of smallholder farmers by continuing farming on their land, promoting investments by investors and fostering the commercialization of smallholder farmers. Contract farming could enhance local food security. However, contract farming models do not always have a positive impact. Sometimes contractors make a profit without supporting or, sometimes, exploiting contracted smallholders. Goal and Objectives: The primary focus of this paper is to analyze the impact of contract farming on household food security. The paper will address the following research questions: What are the determinant factors that affect participation in contract farming? and What is the impact of contract farming on household food security in Kenya and Madagascar? Methodology: This study used three internationally recognized food security indicators to measure the food security status of the household: household dietary diversity score (HDDS), food consumption score (FCS) and the months of adequate household food provisioning (MAHFP). This study used an endogenous switching regression (ESR) model to estimate the impact of contract farming on household food security. The research is purely empirical research is based on observation and measurement of phenomena, as directly experienced by the researcher Results: AI can be effectively applied by Informal Cross-Border Traders (ICBT) to enhance their businesses and enhance competitiveness. There are several AI applications accessible to ICBT within their operational context. Although the adoption and utilization of AI in Africa are still in their infancy, there is considerable promise for the future. Africans must address the challenges hindering the adoption and utilization of AI, as technology is advancing rapidly, and opportunities await those who embrace it. [ABSTRACT FROM AUTHOR]

Illicit gold flows constitute a major development challenge for governments and a social responsibility challenge for many industries along gold supply chains, including gold refiners and jewelry retailers. This paper highlights aspects of gold supply chains that lack transparency and may indicate junctures where illicit activities are taking place, resulting in a loss of tax and customs revenues. Using Peru and Kenya as case study countries, we draw from United Nations Comtrade data and qualitative data from field research to examine the magnitude of the gold trade, the forms in which gold is traded, discrepancies in reported trade data, and key trade partners for each country. We suggest that certain portions of gold supply chains should be given more attention, some types of gold exports and imports present greater traceability challenges than others, and some countries play a much more significant role in the global gold trade. We propose areas where further investigations may be warranted to ensure more transparent and responsible gold supply chains. [ABSTRACT FROM AUTHOR]

The aim of this paper, and more generally, our project "Impact from the ground" (a multi-stage ongoing project), is to reimagine education so that it transcends the walls and harsh constraints of a "universal one size fits all" education. To achieve this, we propose a framework that will inform the design of a participatory approach to co-create a learning hub (an informal lifelong learning opportunity) with and within the community. To weave this framework, we explore the current landscape of education, looking at the challenges that youth from rural settings face to complete their studies in urban universities, and the difficulties they experience when looking for jobs after having done so. We briefly explain our research project and contextualize it in Kinangop, a small region in the Nyandarua County in Kenya, where we explored the enablers and constraints people face to engage in social innovation. We proceed to imagine an alternative education that is local and organic, with different principles and theories weaved into a, kitambaa in Swahili that serves as the ground for an education intervention that is meaningful, binding, and bonding for the community members. In so doing, we aim to center matters of knowledge production as multi-epistemic conversations, situating those at the margins of epistemic divisions at the center of productive and creative debates. [ABSTRACT FROM AUTHOR]

We conducted a randomized, controlled trial with small- and medium-sized enterprises in Kenya to estimate the causal impact of an electronic payment (e-payment) technology on business finance. Using an encouragement design, we exogenously increased e-payment usage among a random subset of firms by relaxing adoption transaction costs and information barriers. Sixteen months after the intervention, we find that the e-payment technology increased access to mobile loans (in the number of loans as well as in the amount borrowed) by at least 50% (0.17 standard deviation), likely because of the reduction of information asymmetries brought by an increase in digital transactions. We find no effect of the e-payment technology on sales and profits, but we do find a reduction of sales volatility and precautionary investment, especially for smaller firms. This suggests that mobile loans help smaller firms cope with short-term negative shocks. We provide a stylized model of business finance that rationalizes these findings. This paper was accepted by Bruno Biais, finance. Funding: This paper was produced under the framework of the "Enabling Innovation and Productivity Growth in Low Income Countries (EIP-LIC/PO5639)" project, funded by the Department for International Development (DFID) of the United Kingdom and implemented by Tilburg University. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4821. [ABSTRACT FROM AUTHOR]

The humanitarian sector has gone through a major shift toward injection of cash into vulnerable communities as its core modality. On this trajectory toward direct currency injection, something new has happened: namely the empowerment of communities to create their own local currencies, a tool known as Complementary Currency systems. This study mobilizes the concepts of endogenous regional development, import substitution and local market linkages as elaborated by Albert Hirschman and Jane Jacobs, to analyze the impact of a group of Complementary Currencies instituted by Grassroots Economics Foundation and the Red Cross in Kenya. The paper discusses humanitarian Cash and Voucher Assistance programs and compares them to a Complementary Currency system using Grassroots Economics as a case study. Transaction histories recorded on a blockchain and network visualizations show the ability of these Complementary Currencies to create diverse production capacity, dense local supply chains, and data for measuring the impact of humanitarian currency transfers. Since Complementary Currency systems prioritize both cooperation and localization, the paper argues that Complementary Currencies should become one of the tools in the Cash and Voucher Assistance toolbox. [ABSTRACT FROM AUTHOR]

The Parliament of Kenya enacted the Data Protection legislation which came into effect on November 25, 2019. The new law was passed given the provisions of Article 31 of the Constitution of Kenya, 2010 which guarantee the right to privacy as a fundamental right. Data Protection and citizens' right to privacy is now a topical concern as evident around the world in many jurisdictions. The increasing globalization, cross-border transactions, internet penetration and the use of social media and digital platforms among citizens, governments and private institutions raises several data security and privacy concerns that breaches may amount to loss of reputation, identity, safety concerns, legal penalties or compensation for damages or loss of business. As a result, the enactment of Data Protection legislations plays a resounding role in providing the requisite legal framework to regulate the activities of market players, government and private entities, in collecting, storing, processing, accessing, transmitting, sharing and disposing of personal or corporate data among other subjects. This paper reviews the crucial provisions of Kenya's Data Protection law which covers regulated actions seeking compliance by data controllers and processors under the stewardship of the Office of the Data Protection Commissioner ('ODPC'). The paper will also provide a comparative analysis of the practice in other jurisdictions, case laws and court decisions, merits and demerits of data protection legislations and areas of possible data breach targets. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to study whether entrepreneurial performance can be explained by entrepreneurial orientation among female entrepreneurs in Kenya. This empirical research is based on the data from 301 small and medium enterprises (SMEs) located in Kenya. A linear multiple regression analysis on the effect of entrepreneurial orientation on entrepreneurial performance among female entrepreneurs was conducted. The paper focused on the five aspects of entrepreneurial orientation (risk-taking, innovativeness, pro-activeness, competitive aggressiveness, and, autonomy) and their ability to prompt entrepreneurial performance which was defined as firm performance, development of personal wealth, and social performance. Social performance was rather well predicted by entrepreneurial orientation (by 4 out of 5 aspects), whereas firm performance was only limitedly predicted by entrepreneurial orientation (only by 2 out of 5 aspects) and development of personal wealth was not predicted by entrepreneurial orientation at all (by 0 out of 5 aspects). On the other hand, we see that the entrepreneurial orientation aspects of innovativeness and pro-activeness have the most predictive value (for 2 out of 3 entrepreneurial performance indicators), whereas risk-taking and autonomy have only limited predictive value (for only 1 out of 3 entrepreneurial performance indicators) and competitive aggressiveness has no predictive value at all (for 0 out of 3 entrepreneurial performance indicators). The paper is based on own-collected empirical data. The paper indicates that the benefits of aligning high levels of entrepreneurial orientation are not unanimous but vary across the different aspects of entrepreneurial orientation and the different entrepreneurial performance indicators. [ABSTRACT FROM AUTHOR]

Pulmonary tuberculosis is among the leading infectious diseases causing mortality worldwide. Therefore, scaling up intervention strategies to reduce the spread of infections in the population is imperative. In this paper, a population-based compartmental approach has been employed to formulate a mathematical model of pulmonary tuberculosis that incorporates an asymptomatic infectious population. The model includes asymptomatic infectious individuals since they spread infections incessantly to susceptible populations without being noticed, thus contributing to the high rate of infection transmission. Qualitative and numerical analyses were performed to determine the impact of various intervention strategies on controlling infection transmission in the population. Sensitivity and numerical results indicate that increasing screening of latently infected and asymptomatic infectious individuals reduces infection transmission to the susceptible population. Numerical results demonstrate that the combination of vaccination, screening, and treatment of all forms of pulmonary tuberculosis is the most effective intervention in decreasing infection transmission. Furthermore, a combination of screening and treatment of all forms of pulmonary tuberculosis proves more effective than a combination of vaccination and treatment of symptomatic infectious individuals alone. Treating the symptomatic infectious population alone is identified as the least effective intervention for curtailing infection transmission in the susceptible population. These study findings will guide healthcare officials in making decisions regarding the screening of latently infected and asymptomatic infectious pulmonary tuberculosis patients, thereby aiding in the fight against epidemics of this disease. [ABSTRACT FROM AUTHOR]

Background: Understanding the impact of disease associations is becoming a priority in Kenya and other countries bearing the load of infectious diseases. With the increased incidences of non-communicable diseases and the endemicity of infectious diseases in Sub-Saharan Africa, their co-existence poses significant challenges to patients, health workers and an overwhelmed health sector. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors especially to patients with family history of confirmed diabetes cases. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Understanding the correlates of HIV and diabetes is crucial to inform management and prevention strategies of the twin infections. We therefore aimed to determine the prevalence of diabetes mellitus and risk factors in a population of HIV infected patients on HAART. This study determined the association of diabetes/impaired glucose regulation in the context of HIV-1. A cross-sectional study was conducted at a comprehensive care clinic in Nairobi (Kenya). Participants were screened for diabetes and impaired glucose regulation using random blood glucose and glycated haemoglobin (HbA1c) This paper describes the prevalence of diabetes mellitus in Human Immunodeficiency Virus positive individuals and the associated risk factors. We have demonstrated that family history is a risk factor for diabetes. While age and BMI are known risk factors, they were not associated with diabetes in this study. [ABSTRACT FROM AUTHOR]

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Under what conditions do incumbents support, tolerate, or try to rein in armed groups within their borders? The paper argues that incumbents strategize toward armed groups in ways that help them manage the ruling coalition and remain in power. I find that incumbents support armed groups in provinces where provincial politicians have defected from the ruling coalition to opposition parties, recruiting armed groups to deliver the province in national elections with fraud and violence and punish elite defectors. Where incumbents are not fighting to keep provinces in the ruling coalition, I show that they tolerate non-dissident groups that enjoy social contracts with local communities, and try to contain their dissident counterparts. Incumbents are likely to repress predatory armed groups, dissident and non-dissident alike. Doing so helps boost elite and mass support for incumbents and project central government power into the province. The argument was inductively built with comparative case studies from Nigeria and then evaluated in Kenya. The findings contribute to an important research agenda on government-armed group relationships and carry implications for security sector aid and reform. [ABSTRACT FROM AUTHOR]

This paper presents the techno-economic feasibility of using grid-connected PV hybrid systems to supply power in large grid-dependent academic institutions. The study was conducted using the administration building of Moi University in Kenya. The power consumption profile of the building was collected using a PCE-360 power analyzer. The peak load demand was found to be 60 kW. Using random variability constants of 4% for day-to-day and 4% time-step load variability, a peak demand of 70.58 kW was obtained, which was used in our simulation. The solar radiation and temperature data for this site were collected from the weather station of the university. The hybrid system was simulated using HOMER Pro software. It was found from the simulation results that the optimal system was the solar PV/grid without battery storage, which had a levelized cost of energy (LCOE) of KSH 8.78/kWh (USD 0.072), net present cost (NPC) of KSH 27,974,492 (USD 230,813), capital expenditure (CAPEX) of KSH 26,300,000 (USD 216,997), and a simple payback period (SPBP) of 5.08 years for a 25-year life span. This system, when compared to the existing grid, showed an 83.94% reduction in the annual electricity bill of the administration building. These results demonstrate a reduction in energy cost by a renewable energy fraction of 67.1%. [ABSTRACT FROM AUTHOR]

Heavy rainfall in eastern Africa between late 2019 and mid 2020 caused devastating floods and landslides throughout the region. These rains drove the levels of Lake Victoria to a record-breaking maximum in the second half of May 2020. The combination of high lake levels, consequent shoreline flooding, and flooding of tributary rivers caused hundreds of casualties and damage to housing, agriculture, and infrastructure in the riparian countries of Uganda, Kenya, and Tanzania. Media and government reports linked the heavy precipitation and floods to anthropogenic climate change, but a formal scientific attribution study has not been carried out so far. In this study, we characterize the spatial extent and impacts of the floods in the Lake Victoria basin and then investigate to what extent human-induced climate change influenced the probability and magnitude of the record-breaking lake levels and associated flooding by applying a multi-model extreme event attribution methodology. Using remote-sensing-based flood mapping tools, we find that more than 29 000 people living within a 50 km radius of the lake shorelines were affected by floods between April and July 2020. Precipitation in the basin was the highest recorded in at least 3 decades, causing lake levels to rise by 1.21 m between late 2019 and mid 2020. The flood, defined as a 6-month rise in lake levels as extreme as that observed in the lead-up to May 2020, is estimated to be a 63-year event in the current climate. Based on observations and climate model simulations, the best estimate is that the event has become more likely by a factor of 1.8 in the current climate compared to a pre-industrial climate and that in the absence of anthropogenic climate change an event with the same return period would have led lake levels to rise by 7 cm less than observed. Nonetheless, uncertainties in the attribution statement are relatively large due to large natural variability and include the possibility of no observed attributable change in the probability of the event (probability ratio, 95 % confidence interval 0.8–15.8) or in the magnitude of lake level rise during an event with the same return period (magnitude change, 95 % confidence interval 0–14 cm). In addition to anthropogenic climate change, other possible drivers of the floods and their impacts include human land and water management, the exposure and vulnerability of settlements and economic activities located in flood-prone areas, and modes of climate variability that modulate seasonal precipitation. The attribution statement could be strengthened by using a larger number of climate model simulations, as well as by quantitatively accounting for non-meteorological drivers of the flood and potential unforced modes of climate variability. By disentangling the role of anthropogenic climate change and natural variability in the high-impact 2020 floods in the Lake Victoria basin, this paper contributes to a better understanding of changing hydrometeorological extremes in eastern Africa and the African Great Lakes region. [ABSTRACT FROM AUTHOR]

Kenya is committed to the global efforts on climate change mitigation and adaptation as seen through investments in various sustainable green and blue economy projects. In this review paper, we present the current status of what has been done, particularly on the blue carbon offset initiatives undertaken in the mangrove and seaweed ecosystems as well as the decarbonization activities at the port of Mombasa and which should form reference information for local, regional, bilateral/multilateral partners, scientists and other climate change stakeholders. The blue carbon offset projects involve mangrove conservation, reforestation and carbon credit sale as well as seaweed farming. The initiatives have several unique features amongst which are the community-led income generation systems that simultaneously act as an inducement for ecosystem preservation, co-management and benefits sharing which are recipes for economic, socio-cultural, and environmental sustainability. A notable project impact is the conferment of economic power to the locals, particularly the women and the youth The model used embraces a collaborative approach involving multisectoral engagements of both the government, multilateral organizations, NGOs, and local communities. This integrated top-down (government) and bottom-up (local community) method deliberately targets the strengthening of economic development while ensuring sustainability. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents with HIV in sub-Saharan Africa face challenges transitioning to adult HIV care, which can affect long-term HIV care adherence and retention. An adolescent transition package (ATP) focused on transition tools can improve post-transition clinical outcomes, but its implementation costs are unknown. Methods: We estimated the average cost per patient of an HIV care visit and ATP provision to adolescents. Data was collected from 13 HIV clinics involved in a randomized clinical trial evaluating ATP in western Kenya. We conducted a micro-costing and activity-driven time estimation to assess costs from the provider perspective. We developed a flow-map, conducted staff interviews, and completed time and motion observation. ATP costs were estimated as the difference in average cost for an HIV care transition visit in the intervention compared to control facilities. We assessed uncertainty in costing estimates via Monte Carlo simulations. Results: The average cost of an adolescent HIV care visit was 29.8USD (95%CI 27.5, 33.4) in the standard of care arm and 32.9USD (95%CI 30.5, 36.8) in the ATP intervention arm, yielding an incremental cost of 3.1USD (95%CI 3.0, 3.4) for the ATP intervention. The majority of the intervention cost (2.8USD) was due ATP booklet discussion with the adolescent. Conclusion: The ATP can be feasibly implemented in HIV care clinics at a modest increase in overall clinic visit cost. Our cost estimates can be used to inform economic evaluations or budgetary planning of adolescent HIV care interventions in Kenya. [ABSTRACT FROM AUTHOR]

Background: Life expectancy has increased over the last century among older people, particularly those aged over 60 years. Aging is associated with increased disability, multiple chronic conditions, and increased use of health services managed with polypharmacy. There are few studies on polypharmacy and aging in sub-Saharan Africa, and it is unclear what older people know and their attitudes toward polypharmacy. This paper presents findings from a study that aimed to understand older people's knowledge, attitudes and beliefs about polypharmacy. Methods: A qualitative study using in-depth interviews of 15 patients aged 60 years and older who were taking more than five medications per day. The study was conducted at the Family Medicine Clinic (FMC), Aga Khan University Hospital, Nairobi. Data were analyzed using NVivo 12 software. Result: Majority of participants had a good understanding of their underlying health conditions, but they did not know the specific names of the medications they were taking. Participants had diverse attitudes toward polypharmacy, with both positive and negative perceptions. Although adverse side effects were reported, participants remained positive because they believed these medicines were beneficial. Religion, faith and living healthy lifestyles were perceived to contribute to their positive attitude toward polypharmacy. Stigma and the cost of medication were reported as barriers. Conclusion: This study provides valuable insights into the complexities of polypharmacy in older people. It highlights the importance of patient education, fostering strong patient-provider relationships, de-stigmatization, and improving medication affordability and accessibility. Further research could explore the polypharmacy of older people attending public institutions in rural Kenya. [ABSTRACT FROM AUTHOR]

Non-governmental organizations (national and international) are important actors in addressing health issues in Kenya. Sandflea/jigger infections (tungiasis) are a public health challenge that severely affect children, older adults, and other vulnerable people in poor communities worldwide. In Kenya, NGOs have been involved in sandflea eradication for more than twenty years. Without treatment, the flea may cause debilitating infections and sores, resulting in difficulties with walking and grasping, as well as social harassment. This paper aims to shed light on health workers' and volunteers' perceptions of the government and civil society's role in fighting jigger infections. Data were collected through a qualitative case study design, with a three-month fieldwork including participation in mobile jigger removal programs, 18 semi-structured in-depth interviews, informal talks, and observations, in five villages in Bungoma County. The thematic analysis of the data resulted in three recurring themes: (1) the NGO-driven jigger program as a (fragile) resource for local communities, (2) the need for more consistent collaboration between NGOs and public health services, and (3) the local perceptions of the governments' responsibilities in combatting the plague. The findings imply that the 10-year-old national policy guidelines on the prevention and control of jigger infestations need to be updated; this includes the coordination of the public and private actors' roles, the incorporation of lessons learned, and the need for a multisectoral One Health approach to combat the jigger menace in the country. [ABSTRACT FROM AUTHOR]

Background: Parental stress often arises when parenting demands exceed the expected and actual resources available for parents to succeed in the parenting role. Parental stress is an important contributor to parent-child relationships. This, in turn, affects opportunities to engage their children in stimulating activities which could improve their development outcomes. However, limited evidence exists from sub-Saharan Africa (SSA) on the association between parental stress, caregiving practices, and child developmental outcomes. Methods: The findings reported in this paper were derived from data collected through previous longitudinal work on nurturing care evaluation studies in Kisumu and Nairobi Counties in Kenya, and Chisamba District in Zambia. A total of 341 caregivers and their children who participated in the three rounds of data collection were included in this study. The children's mean age was 9.3 (SD = 8.2) months pre-intervention, 25.5 (SD = 8.6) months in mid-intervention, and 36 (SD = 10.0) months post-intervention. The Ages and Stages Questionnaire (ASQ), Parental Stress Scale (PSS), and caregiving tools were used to assess children's developmental outcomes, parental stress, and stimulation practices, respectively. A Random Intercept Cross-Lagged Panel model (RI-CLPM) was used to determine the association between caregivers' parenting stress, child stimulation practices, and child developmental outcomes. Results: The findings showed that caregiver stimulation practices were positively associated with developmental outcomes. Findings on the associations between parental stress and caregivers' stimulation practices and children's developmental outcomes were not universally supported. Conclusion: The findings show that improved caregiver stimulation practices are likely to improve children's developmental outcomes. The policy implications of the findings from this study focus on improving parenting practices by addressing the predictors of parental stress. This includes subsidising childcare services to reduce costs. Trial registration: Pan African Clinical Trials Registry (https://pactr.samrc.ac.za/) database (ID number: PACTR20180774832663 Date: 26/July/2018. [ABSTRACT FROM AUTHOR]

This study presents a comprehensive analysis of historical fire and climatic data to estimate the monthly frequency of vegetation fires in Kenya. This work introduces a statistical model that captures the behavior of fire count data, incorporating temporal explanatory factors and emphasizing the predictive significance of maximum temperature and rainfall. By employing Bayesian approaches, the paper integrates literature information, simulation studies, and real-world data to enhance model performance and generate more precise prediction intervals that encompass actual fire counts. To forecast monthly fire occurrences aggregated from the Moderate Resolution Imaging Spectroradiometer (MODIS) data in Kenya (2000-2018), the study utilizes maximum temperature and rainfall values derived from global GeoTiff (.tif) files sourced from the WorldClim database. The evaluation of the widely used Negative Binomial (NB) model and the proposed Bayesian Negative Binomial (BNB) model reveals the superiority of the latter in accounting for seasonal patterns and long-term trends. The simulation results demonstrate that the BNB model outperforms the NB model in terms of Root Mean Square Error (RMSE), and Mean Absolute Scaled Error (MASE) on both training and testing datasets. Furthermore, when applied to real data, the Bayesian Negative Binomial model exhibits better performance on the test dataset, showcasing lower RMSE (163.22 vs. 166.67), lower MASE (1.12 vs. 1.15), and reduced bias (-2.52% vs. -2.62%) compared to the NB model. The Bayesian model also offers prediction intervals that closely align with actual predictions, indicating its flexibility in forecasting the frequency of monthly fires. These findings underscore the importance of leveraging past data to forecast the future behavior of the fire regime, thus providing valuable insights for fire control strategies in Kenya. By integrating climatic factors and employing Bayesian modeling techniques, the study contributes to the understanding and prediction of vegetation fires, ultimately supporting proactive measures in mitigating their impact. [ABSTRACT FROM AUTHOR]

Optimal complementary feeding between the ages of 6 and 23 months provides children with the required range of nutritious and safe foods while continuing to be breastfed to meet their needs for essential nutrients and develop their full physical and cognitive potential. The rates of exclusive breastfeeding in the first 6 months of life have increased from 32% in 2008 to 60% in 2022 in Kenya. However, the proportion of children between 6 and 23 months receiving a minimum acceptable diet remains low and has declined from 39% in 2008 to 31% in 2023. The Kenyan Ministry of Health, GAIN and UNICEF collaborated to understand the drivers of complementary feeding practices, particularly proximal determinants, which can be directly addressed and acted upon. A secondary analysis of household surveys and food composition data was conducted to outline children's dietary patterns within the different regions of Kenya and the extent to which the affordability of animal‐source foods could be improved. Ethnographic data were analyzed to identify socio‐cultural barriers to optimal complementary feeding. Furthermore, we outlined the critical steps for developing user‐friendly and low‐cost complementary feeding recipes. The results of all the analyses are presented in five of the six papers of this Special Issue with this additional paper introducing the Kenyan context and some of the critical findings. The Special Issue has highlighted multidimensional barriers surrounding the use and availability of animal‐source foods. Furthermore, it emphasizes the need for a multi‐sectoral approach in enacting policies and programmes that address these barriers. [ABSTRACT FROM AUTHOR]

The Educational system in Kenya has undergone significant transformation from the 8-4-4 system to Competency-Based Curriculum (CBC). This shift presents emerging issues that affect both learners and teachers, as well as the society at large. Through an analysis of current literature, this paper examines key issues such as teacher training, assessment methods, and societal expectations. The study findings revealed that there is a significant association at 5% significance level between the variables of emerging issues and transition by the teachers' respondents (χ2 = 157.072, df = 9, p = 0.00). One of the challenges is the cost of implementing the new curriculum, which requires a lot of money to purchase resources and hire new teachers. Another challenge is the inadequate professional preparation of Kenyan teachers, who are not yet familiar with the approaches of CBC. The transition period will enable the government to develop adequate infrastructure for the new system. By addressing these challenges proactively, Kenya can ensure that its education system remains relevant and responsive to future needs. [ABSTRACT FROM AUTHOR]