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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]

Lung health in Africa is of great public health concern. To exchange knowledge, communicate the latest scientific advances in lung health, build the capacity of young researchers, and provide a platform for networking of lung health stakeholders in Africa, the Pan African Thoracic Society (PATS), in partnership with the Respiratory Society of Kenya organized and held the 3rd Biennial PATS congress, from June 7–10, 2023 in Mombasa, Kenya. There were a total of 30 conference sessions, which included six skills building workshops, two research dissemination workshops, six plenary sessions, and five each of pediatric, adult, and thoracic surgery symposia. A total of 60 abstracts were presented, including 27 oral abstracts and 33 posters. A wide range of issues for lung health in Africa emerged. These include the emerging role of the environment, especially climate change and global warming, on lung health, the threat posed by the use of tobacco and other nicotine products in Africa, the high burden of lung infections, insecurity of medical oxygen supply systems, and high burden of chronic respiratory disease. In this paper, we summarize the proceedings of this conference and draw lessons that can be used to advance lung health in the African continent. [ABSTRACT FROM AUTHOR]

With increasing urbanisation, understanding the variety of historical experience with water in the urban context becomes all the more relevant. Apart from representing an economic and environmental necessity, the physical and sensory access to freshwater is universally understood as socially desirable, pleasing and valued. The history of the East African coast is especially relevant as water scarcity is not a modern phenomenon in the region—in fact, precolonial towns situated on the oceanfront flourished in relatively arid environments too. This paper presents the insights achieved with a 3D scanning survey of the preserved heritage in the now-deserted town of Jumba la Mtwana, located 20 km north of Mombasa, Kenya. Although all of the buildings are partially collapsed, various wells, cisterns and reservoirs have been documented. Considering this archaeological site and other examples of (pre)colonial Swahili towns, this paper adopts multidisciplinary perspectives in analysing and interpreting the distribution of constructed features associated with water, with particular focus on their design, density and spatial context, as well as social and sensory connotations. Its results highlight the socio-spatial role of the element of water in the precolonial built environment, which may be contrasted with later periods and potentially carry broader implications for current urban development. [ABSTRACT FROM AUTHOR]

This paper aims to deal with the impact of COVID-19 on the livelihoods of disadvantaged persons living in slums in Kenya. Months after the first case of COVID-19 was reported in Kenya in March 2020, most of the studies that have been carried out pertaining to its impact on slum dwellers have concentrated on narrowly defined concerns e.g. the impact of COVID-19 on youth, gender based violence and nutrition. It is thus difficult to get a clear global picture of the overall impact of COVID-19 on the livelihoods of slum dwellers in Kenya. This paper relies on information gathered during a comprehensive qualitative micro study covering numerous aspects of slum dwellers' livelihoods, as well as information that has been produced by the Ministry of Health, civil society organizations that work in specific slums, private research organizations as well as local and foreign media houses. The slums whose information is reported in this paper were selected to be indicative of the over 300 slums that are located in Nairobi and Mombasa, the two most important cities in Kenya. The analysis concludes that slum dwellers were potentially at a higher risk under the pressures of COVID-19 of deteriorating conditions with regard to the provision of health services, employment, gender-based violence, education and youth-related problems, and human rights violations, and offers several recommendations to the government. [ABSTRACT FROM AUTHOR]

The purpose of this article is to provide a narrative on the historical development of Muslim education with the objective of examining challenges and opportunities to support the strengthening of Muslim education agenda through policy dialogue and stakeholders’ engagements. The paper utilizes methods of inquiry such as literature review, observation, and analysis. Key findings are that Kenyan national education is strongly controlled by the Christian missionaries. For example, the Catholic Church controls about 27% of the country’s education. The country’s education is still subjected to the various socioeconomic dynamics, where Muslim education is not the exception. The rights of Muslim students in the Mission institutions are extremely limited, allowing students only a special place for prayers. This is against country constitution and child rights in Kenya. The problem of historical discrimination continues to hurt Muslims to date as the government is yet to appreciate dualism in education in terms of policies and practices. In the earlier 1990s, the government refusal to register the Muslim teachers’ college in Mombasa was practically evident and to date, the country continues to encounter an acute shortage of Islamic and Arabic teachers. Muslim parents remain the most worried as some of their children are subjected to the teaching of Christian religious education. The article calls for an urgent restructuring along with support for the work of the Muslim Education Council, with the objective of facilitating Muslim education policy development, database, curriculum development, training, research, and partnership. This will help transform the knowledge, thought, and practices among the Muslim learners. They must also fight examination corruption in Muslim-dominated areas by creating awareness, promoting capacity building, quality assurance, networking, benchmarking, research, and linkages in order to reach the desired center of excellence for Muslim educational institutions. The Council also must have a special relationship with the country’s judiciary system in order to advance the rights of Muslim students in schools, colleges, and universities. [ABSTRACT FROM AUTHOR]

Mombasa is well known for problems with gangs. Some of them are composed of a high proportion of youths under 18 years, with some as young as 7 years old. Many use drugs, some carry out thefts, and some are known for large-scale violent robberies with the use of knives, severely injuring members of the public. In an attempt to manage the problem, the killing of perpetrators through mob justice or in police operations is commonplace. This paper contributes to our understanding of youths in gangs and interventions to tackle gang violence. We argue that not all "gangs" are involved in criminal activity. However, some gang members may be viewed as perpetrators of violent crime but also as victims of marginalisation and unfavourable environments, which constrain life choices, making violent crime a frequent path. Moreover, criminal justice approaches have failed these youths. The current inconsistent, corrupt and brutal approach by police serves to compound the problem, while external actors benefiting from youth gangs' operations are tolerated by the state. Increased resistance is evident as youth gangs tend to increase their violence against the public in order to take "revenge" against the police. Structural violence is an important cause of the problem and is also replicated in current mitigation approaches. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) endorsed the use of triple-drug mass drug administration (MDA) regimen with ivermectin, diethylcarbamazine (DEC) and albendazole (commonly abbreviated as IDA) to accelerate the elimination of lymphatic filariasis (LF) as a public health problem in settings where onchocerciasis is not co-endemic. The National Programme for Elimination of LF (NPELF) in Kenya was among the first adopters of the IDA-MDA and two annual rounds were provided in 2018 and 2019 to the residents of Lamu County and Jomvu sub-County in the coast region. This study documented the feasibility of successfully delivering the two rounds of IDA-MDA. An operational research study was undertaken to determine efficient sampling strategies, indicators, and the appropriate population groups that could be used for the monitoring and evaluation of LF programs using IDA-MDA for the elimination of the disease as a public health problem. Two cross-sectional surveys were conducted at baseline in 2018 before IDA-MDA and an impact assessment 17 months after the second round of IDA-MDA. The reported epidemiological treatment coverage was at least 80% in all implementation units during each round of IDA-MDA. Blood samples were tested for filarial antigenemia using commercial Filariasis Test Strips (FTS) and any individual found to be positive was tested again at night for the presence of microfilariae in finger prick blood smears using microscopy. The overall prevalence of circulating filarial antigen (CFA) was relatively low at the baseline survey with Jomvu having 1.39% (95% CI: 0.91, 2.11) and Lamu having 0.48% (95% CI: 0.21, 1.13). Significant reduction in CFA prevalence was observed during the impact assessment after two annual rounds of treatment. The overall relative reduction (%) in CFA prevalence following the two rounds of MDA with IDA was significant in both Jomvu (52.45%, Z = -2.46, P < 0.02) and Lamu (52.71%, Z = -1.97, P < 0.05). Heterogeneity, however, was observed in the CFA prevalence reduction between random and purposive clusters, as well as between adult and child populations. The results of the impact assessment survey offered strong evidence that it was safe to stop the IDA-MDA in the two EUs because transmission appears to have been interrupted. It is also important to implement a post-treatment surveillance system which would enable efficient detection of any recrudescence of LF transmission at a sub-evaluation unit level. Our findings show that IDA-MDA may be considered for acceleration of LF elimination in other settings where onchocerciasis is not co-endemic. Author summary: Preventive chemotherapy with antifilarial drugs is currently the mainstay public health intervention recommended for the elimination of lymphatic filariasis (commonly known as elephantiasis) in endemic countries. Two-drug regimen mass drug administration of albendazole plus either diethylcarbamazine or ivermectin has been used widely in most countries since the launch of the Global Programme to Eliminate Lymphatic Filariasis by the World Health Organization in 2000. Safety and efficacy clinical studies conducted in Papua New Guinea have shown that co-administration of three antifilarial drugs namely, ivermectin, diethylcarbamazine and albendazole is superior to the two-drug regimen diethylcarbamazine and albendazole in clearance of microfilariae from the bloodstream. Consequently, the triple-drug regimen was endorsed for accelerating efforts to eliminate lymphatic filariasis as a public health problem in areas where onchocerciasis is not co-endemic. The aim of this study was to assess the feasibility of delivering mass treatment with the triple-drug regimen under programmatic conditions. An operational research study was conducted to determine the optimal sampling strategies, indicator (or set of indicators), and study populations for monitoring and evaluation of lymphatic filariasis elimination programs using the triple-drug regimen mass treatment. Two rounds of mass treatment with the triple-drug regimen were given to the residents of Lamu County (comprising of Lamu East and Lamu West sub-counties) and Jomvu sub-County (in Mombasa) in November 2018 and November 2019. The programme epidemiological treatment coverage was at least 80% in each implementation unit during the two treatment rounds. The preventive treatment resulted in significant reductions in the prevalence of the disease with the number of positive cases being fewer than the threshold recommended for areas where transmission is likely to be no longer sustainable. [ABSTRACT FROM AUTHOR]

Background: The Methadone Maintenance Treatment (MMT) program has been proven to be beneficial in reducing illicit opioid use, increasing access to and retention of HIV treatment and other therapies, and reducing HIV transmission, and other drug-related morbidities and mortalities. However, determinants of treatment retention and outcomes for opioid-dependent persons accessing MMT in Kenya are limited. We sought to identify factors contributing to poor treatment outcomes among opioid-dependent persons enrolled in the Mombasa MMT program, between 2017 and 2019. Method: We conducted a retrospective records review for opioid-dependent persons receiving Methadone treatment in the Kisauni MAT clinic enrolled during 2017–2019. We defined poor clinical or health-related treatment outcome as any client Lost-To-Follow-Up (LTFU), turned HIV or Viral hepatitis positive, and/or missed two or more antiretroviral therapy (ART) appointments intake during MMT. Variables abstracted from clinical and pharmacological MMT service delivery tools included socio-demographic characteristics, clinical history, risk factors, and MMT outcomes. Data were analyzed using Epi Info7. We calculated Prevalence Odds Ratios (POR) and 95% Confidence Intervals (CI) to identify factors associated with adverse health outcomes. Results: Of the total 443 eligible records, the mean age was 37 years (SD ± 7.2) and males comprised 90.7%. The majority of females clients, 79.1% (34/43), were aged ≤35 years, 7.0% (3/43) had no education, 32.6% (14/43) were employed, 39.5% (17/43) were HIV positive and 18.6% (8/43) were HCVpositive. Overall, adverse treatment outcomes were at 27.5% (122/443), namely: LTFU at 22.8% (101/443), new HIV cases at 1.0% (4/391), HCV at 1.2% (5/405), and Hepatitis B Virus (HBV) at 1.2% (5/411), and 1.1% (5/443) died. Of HIV-infected clients linked to Comprehensive Care Clinic (CCC), 3.6% (2/56) defaulted from ART, and 25% (2/8) had detectable Viral Load of those retested. Lack of formal education (POR: 2.7, 95% CI: 1.3–5.7), unemployment (POR: 2.4, 95% CI: 1.4–4.0), and being a Non-Injector (POR: 1.7, 95% CI: 1.0–2.9) were negatively associated with treatment retention. Conclusion: Females were younger, and more educated with higher HIV and HCV prevalence. Being a Non-injector, unemployment, and lack of formal education may increase the likelihood of poor treatment outcomes among MMT clients. Closer monitoring of MMT clients with these characteristics is recommended with the integration of CCC into MMT services. [ABSTRACT FROM AUTHOR]

This paper reports a case of implementing the free web-based interactive literacy software, ABRACADBRA, in early childhood education classes of Mombasa County, Kenya. A comprehensive model of training and support was offered to classroom teachers to help them integrate the software in preschool English Language instruction for three terms in 2019. The recorded changes in teaching suggest improvements in young students' foundational reading ability and computer skills among others. A combination of teacher resilience and school leadership drove successful implementation of ABRACADBRA. Avenues for future research include studying the effects of the software on a range of preschoolers' learning outcomes and examining the training and support model for optimal, sustainable, and scalable effects on instruction. [ABSTRACT FROM AUTHOR]

Background: Current formulations of pediatric antiretroviral therapy (ART) for children with HIV present significant barriers to adherence, leading to drug resistance, ART ineffectiveness, and preventable child morbidity and mortality. Understanding these challenges and how they contribute to suboptimal adherence is an important step in improving outcomes. This qualitative study describes how regimen-related challenges create barriers to adherence and impact families. Methods: We conducted key informant interviews (KIIs) with 30 healthcare providers and 9 focus group discussions (FGDs) with a total of 72 caregivers, across three public hospitals in Siaya and Mombasa Kenya. The KIIs and FGDs were audio recorded, translated, and transcribed verbatim. The transcripts were hand coded based on emergent and a-priori themes. Results: Caregivers discussed major regimen-related challenges to adherence included poor palatability of current formulations, complex preparation, and administration (including measuring, crushing, dissolving, mixing), complex drug storage, and frequent refill appointments and how these regimen-related challenges contributed to individual and intrapersonal barriers to adherence. Caregivers discussed how poor taste led to child anxiety, refusal of medications, and the need for caregivers to use bribes or threats during administration. Complex preparation led to concerns and challenges about maintaining privacy and confidentiality, especially during times of travel. Providers corroborated this patient experience and described how these challenges with administration led to poor infant outcomes, including high viral load and preventable morbidity. Providers discussed how the frequency of refills could range from every 2 weeks to every 3 months, depending on the patient. Caregivers discussed how these refill frequencies interrupted work and school schedules, risked unwanted disclosure to peers, required use of financial resources for travel, and ultimately were a challenge to adherence. Conclusion: These findings highlight the need for improved formulations for pediatric ART to ease the daily burden on caregivers and children to increase adherence, improve child health, and overall quality of life of families. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the leading cause of cancer death in Kenyan women. Integrating cervical cancer screening into family planning (FP) clinics is a promising strategy to improve health for reproductive-aged women. The objective of this cluster randomized trial was to test the efficacy of an implementation strategy, the Systems Analysis and Improvement Approach (SAIA), as a tool to increase cervical cancer screening in FP clinics in Mombasa County, Kenya. Methods: Twenty FP clinics in Mombasa County were randomized 1:1 to SAIA versus usual procedures. SAIA has five steps: (1) cascade analysis tool to understand the cascade and identify inefficiencies, (2) sequential process flow mapping to identify bottlenecks, (3) develop and implement workflow modifications (micro-interventions) to address identified bottlenecks, (4) assess the micro-intervention in the cascade analysis tool, and (5) repeat the cycle. Prevalence ratios were calculated using Poisson regression with robust standard errors to compare the proportion of visits where women were screened for cervical cancer in SAIA clinics compared to control clinics. Results: In the primary intent-to-treat analysis in the last quarter of the trial, 2.5% (37/1507) of visits with eligible FP clients at intervention facilities included cervical cancer screening compared to 3.7% (66/1793) in control clinics (prevalence ratio [PR] 0.67, 95% CI 0.45–1.00). When adjusted for having at least one provider trained to perform cervical cancer screening at baseline, there was no significant difference between screening in intervention clinics compared to control clinics (adjusted PR 1.14, 95% CI 0.74–1.75). Conclusions: The primary analysis did not show an effect on cervical cancer screening. However, the COVID-19 pandemic and a healthcare worker strike likely impacted SAIA's implementation with significant disruptions in FP care delivery during the trial. While SAIA's data-informed decision-making and clinic-derived solutions are likely important, future work should directly study the mechanisms through which SAIA operates and the influence of contextual factors on implementation. Trial registration: ClinicalTrials.gov, NCT03514459. Registered on April 19, 2018. [ABSTRACT FROM AUTHOR]

Background: Perceived stigma is a complex societal phenomenon that is harboured especially by female sex workers because of the interplay of a myriad of factors. As such, a precise measure of the contribution of different social practices and characteristics is necessary for both understanding and intervening in matters related to perceived stigma. We developed a Perceived Stigma Index that measures the factors that greatly contribute to the stigma among sex workers in Kenya, and thereby inform a framework for future interventions. Methods: Social Practice Theory was adopted in the development of the Perceived Stigma Index in which three social domains were extracted from data collected in the WHISPER or SHOUT study conducted among female sex workers (FSW), aged 16–35 years in Mombasa, Kenya. The three domains included: Social demographics, Relationship Control and Sexual and Gender-based Violence, and Society awareness of sexual and reproductive history. The factor assessment entailed Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and the internal consistency of the index was measured using Cronbach's alpha coefficient. Results: We developed a perceived stigma index to measure perceived stigma among 882 FSWs with a median age of 26 years. A Cronbach's alpha coefficient of 0.86 (95% confidence interval (CI) 0.85–0.88) was obtained as a measure of the internal consistency of our index using the Social Practice Theory. In regression analysis, we identified three major factors that contribute to the perceived stigma and consists of : (i) income and family support (β = 1.69; 95% CI); (ii) society's awareness of the sex workers' sexual and reproductive history (β = 3.54; 95% CI); and (iii) different forms of relationship control e.g. physical abuse (β = 1.48; 95%CI that propagate the perceived stigma among the FSWs. Conclusion: Social practice theory has solid properties that support and capture the multi-dimensional nature of perceived stigma. The findings support the fact that social practices contribute or provoke this fear of being discriminated against. Thus, in offering interventions to curb perceived stigma, focus should fall on the education of the society on the importance of acceptance and integration of the FSWs as part of the society and the eradication of sexual and gender based violence meted out on them. Trial registration: The trial was registered in the Australian New Zealand Clinical Trials Registry, ACTRN12616000852459. [ABSTRACT FROM AUTHOR]

Background Coronavirus disease 2019 (COVID-19), declared a global pandemic by the World Health Organization (WHO), is a severe acute respiratory disease. The Kenyan Ministry of Health (MoH) put in place measures that included mandatory face masking, hand and cough hygiene and social and physical distancing to reduce disease transmission and increase prevention efforts. The primary objective of this study was to determine how sociodemographic characteristics affect knowledge and practice of the above measures. Methods A cross-sectional study was conducted to assess water, sanitation and hygiene practices for the prevention and control of COVID-19 in Kilifi and Mombasa Counties, Kenya. Data collection was accomplished through a mobile data collection tool. Principal component analysis was used to create a wealth index using data on asset ownership and housing characteristics. Bloom cut-off points of 80–100%, 60–79% and ≤59% were used to determine knowledge and practice. Results Of the 612 households, 339 (55.4%) were from Kilifi County and 273 (44.6%) were from Mombasa County. A total of 431 (70.4%) were female and the mean age of the household members was 38.2±14.8 y. Almost all (99.2%) respondents were aware of COVID-19, with 60% knowing prevention, symptoms and persons at a higher risk of contracting the virus. Females had the highest knowledge of COVID-19 and were likely to practice prevention and control measures, unlike males. Age was significant (p<0.05) with knowledge and practice. Conclusions The sociodemographic characteristics of populations play a key role in behavioural aspects as far as prevention and control of COVID-19 are concerned. There is a need for partnerships between the MoH and county governments to put in place a multisectoral community approach to advance feasible behavioural interventions among targeted populations towards combating the spread of COVID-19. [ABSTRACT FROM AUTHOR]

This study quantified crop losses and economic impacts associated with papaya mealybug (Paracoccus marginatus) infestation in Kenya and identified the most important predictors of papaya tree (Carica papaya L.) yield losses through a household survey of 404 farmers. At least 95% male and 88% female respondents correctly identified papaya mealybug. Papaya was the most affected crop by the pest, with 73% of the respondents indicating that a major part (>60%) of their trees was affected. The estimated papaya yield losses due to papaya mealybug were 57%, with an associated annual economic loss of US$3,009 per ha at the farm level and US$29.8 million at the national level. Regression analysis showed significant yield-reducing effects with high infestation levels of papaya mealybug, use of local varieties, and use of indigenous pest control practices. Economic losses differed significantly by county, with the highest losses reported in Mombasa. Male farmers reported higher losses than their female counterparts. Findings highlight the need for location and gender-specific information on pest management for effectiveness in controlling papaya mealybug. [ABSTRACT FROM AUTHOR]

In the late 1980s and early 1990s, Kenya's coastal region saw the rise of Islamist activism(s). Revisiting this rise, this article traces the history of two contrasting politico-religious groups seeking to address the historical marginalisation of Kenyan Muslim communities: the Mombasa-based Islamic Party of Kenya (IPK) and the southern coastal Ansar Sunnah movement. While the IPK accepted the Kenyan nation-state and sought to empower Kenya's Muslim minority via the electoral process, the 'Ansaris' promoted a rejectionist agenda fundamentally opposed to democracy and the conventional state. Re-investigating the origins and the evolution of these two antithetical projects, our article provides two fieldwork-based contributions, drawing on key informant interviews. First, we tackle several historiographically unsettled questions concerning the biographies of prominent politico-religious entrepreneurs like Khalid Balala and Abdulaziz Rimo. Second, we provide a counterpoint to a growing body of literature focussing on the gradual emergence of a coastal jihadist network. While not denying the significance of this network, we show that the local rise of jihadism has been accompanied by equally important processes of moderation away from violence and exclusivism. Overall, our article therefore underlines the multi-facetted and non-linear dynamics of Islamist activism in coastal Kenya and the wider East African Region. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the most common cancer in sub-Saharan Africa. With appropriate screening and treatment, cervical cancer can be prevented. In Kenya, cervical cancer screening is recommended for all women of reproductive age who visit a health facility. In particular, the Kenyan Ministry of Health has tasked family planning clinics and HIV clinics with implementing cervical cancer screening as part of the overall cervical cancer screening strategy. A cross-sectional survey was conducted to understand cervical cancer screening practices and explore clinic-level barriers and facilitators to screening in family planning clinics (FP) in Mombasa County, Kenya. Methods: Structured interviews were conducted with randomly sampled FP clinic managers to collect information about clinic size, location, type, management support, infrastructure, screening practices, and availability of screening commodities. Data were abstracted from FP registers for a 15-month period from October 1, 2017 until December 31, 2018 to understand cervical cancer screening prevalence. Generalized linear models were used to calculate prevalence ratios (PR) and identify clinic-level correlates of reporting any cervical cancer screening. Results: A total of 70 clinics were sampled, 54% (38) were urban and 27% (19) were public facilities. The median number of staff in a clinic was 4 (interquartile range [IQR] 2–6) with a median of 1 provider trained to perform screening (IQR 0–3). Fifty-four percent (38/70) of clinic managers reported that their clinics performed cervical cancer screening. Of these, only 87% (33) and 71% (27) had dependable access to speculums and acetic acid, respectively. Being a public FP clinic was associated with higher prevalence of reported screening (14/38 [37%] vs 6/32 [16%]; prevalence rate ratio [PR] 1.57, 95%CI 1.05–2.33). Clinics that reported cervical cancer screening were much more likely to have at least one provider trained to perform cervical cancer screening (84%, 32/38) compared to clinics that did not report screening (28%, 9/32; PR 3.77, 95%CI 1.82–7.83). Conclusion: Integration of cervical cancer screening into FP clinics offers great potential to reach large numbers of reproductive-aged women. Increasing training of healthcare providers and ensuring adequate commodity supplies in FP clinics offer concrete solutions to increase screening in a largely unscreened population. [ABSTRACT FROM AUTHOR]

Since the adoption of UNSCR 2242, which calls for the integration of the Women, Peace and Security (WPS) and the Preventing and Countering Violent Extremism (P/CVE) agendas, feminist scholars and activists have cautioned that such a move instrumentalises and securitises the WPS agenda and its objectives of gender equality and women's empowerment. Based on over 80 interviews with civil society actors involved in P/CVE in Kenya – specifically, Mombasa, Isiolo and Nairobi – this article argues that both the calls for empowerment and the critiques of instrumentalization similarly draw on racialised constructions of women's agency, or lack thereof, in the global south. Further, the instrumentalised/empowered binary is premised on a liberal feminist conceptualisation of agency only as resistance, which does not accurately capture the complex ways in which WPS actors and feminist peace activists negotiate with and work to transform security agendas. While recognising the harms caused by state and donor-led P/CVE approaches, this article centres the perspectives and experiences of men and women who work in daily violence prevention within and beyond the frame of P/CVE to theorise the agentive capacities that emerge from securitised spaces. [ABSTRACT FROM AUTHOR]

Introduction: In 2018, the National AIDS and sexually transmitted infection (STI) Control Programme developed a national guidelines to facilitate the inclusion of young women who sell sex (YWSS) in the HIV prevention response in Kenya. Following that, a 1‐year pilot intervention, where a package of structural, behavioural and biomedical services was provided to 1376 cisgender YWSS to address their HIV‐related risk and vulnerability, was implemented. Methods: Through a mixed‐methods, pre/post study design, we assessed the effectiveness of the pilot, and elucidated implementation lessons learnt. The three data sources used included: (1) monthly routine programme monitoring data collected between October 2019 and September 2020 to assess the reach and coverage; (2) two polling booth surveys, conducted before and after implementation, to determine the effectiveness; and (3) focus group discussions and key informant interviews conducted before and after intervention to assess the feasibility of the intervention. Descriptive analysis was performed to produce proportions and comparative statistics. Results: During the intervention, 1376 YWSS were registered in the programme, 28% were below 19 years of age and 88% of the registered YWSS were active in the last month of intervention. In the survey, respondents reported increases in HIV‐related knowledge (61.7% vs. 90%, p <0.001), ever usage of pre‐exposure prophylaxis (8.5% vs. 32.2%, p < 0.001); current usage of pre‐exposure prophylaxis (5.3% vs. 21.1%, p<0.002); ever testing for HIV (87.2% vs. 95.6%, p <0.04) and any clinic visit (35.1 vs. 61.1, p <0.001). However, increase in harassment by family (11.7% vs. 23.3%, p<0.04) and discrimination at educational institutions (5.3% vs. 14.4%, p<0.04) was also reported. In qualitative assessment, respondents reported early signs of success, and identified missed opportunities and made recommendations for scale‐up. Conclusions: Our intervention successfully rolled out HIV prevention services for YWSS in Mombasa, Kenya, and demonstrated that programming for YWSS is feasible and can effectively be done through YWSS peer‐led combination prevention approaches. However, while reported uptake of treatment and prevention services increased, there was also an increase in reported harassment and discrimination requiring further attention. Lessons learnt from the pilot intervention can inform replication and scale‐up of such interventions in Kenya. [ABSTRACT FROM AUTHOR]

Background: Approximately 40% of the 110,000 adolescents living with HIV (ALHIV) in Kenya have not achieved viral suppression. Despite the increasing availability of adolescent-friendly services, adolescents face barriers that impact ART adherence. This study aimed to identify key stigma-related barriers to ART adherence and strategies used by adolescents in overcoming these barriers.Methods: Data were collected by LVCT Health, a Kenyan organization with a programmatic focus on HIV testing, prevention, and care. 122 participants were recruited from 3 clinical sites affiliated with LVCT Health in Nairobi, Kisumu, and Mombasa. In-depth interviews were conducted with ALHIV (n = 12). Focus group discussions were conducted with ALHIV (n = 5), peer leaders (n = 3), and adolescents receiving HIV services in community settings (AIC) irrespective of HIV status (n = 3). Interviews and focus groups were audio recorded, translated, and transcribed. Data were analyzed thematically, with a focus on stigma and resilience.Results: While AIC primarily focused on adherence barriers and stigma, ALHIV and, to some extent, peer leaders, also identified resilience factors that helped overcome stigma. Four major themes emerged: 1) knowledge and future-oriented goals can drive motivation for ALHIV to remain healthy; 2) disclosure to others strengthens support systems for ALHIV; 3) medication-taking strategies and strategic disclosure can overcome adherence challenges in school; and 4) a supportive clinic environment promotes continuous adolescent engagement in HIV care. These concepts were used to develop a conceptual stigma/resilience model depicting how resilience moderates negative effects of stigma among ALHIV.Conclusions: This study demonstrates the positive effects of ALHIV resilience on ART adherence and illuminates how stigma impacts ALHIV differently depending on their resilience. Strengths-based interventions, focused on increasing resilience among ALHIV in Kenya, and more formal involvement of adolescent peers to bolster adolescent support, have the potential to improve ART adherence among ALHIV. [ABSTRACT FROM AUTHOR]

Kenya is a widely cited case for proponents of fintech for development. This article shows how Kenya's fintech boom replicates patterns of uneven development inherited from the colonial era. In particular, fintech use is unevenly distributed between urban and rural areas, and heavily concentrated on Nairobi and Mombasa in particular. The article seeks to explain these patterns by situating them in relation to the spatiality and political economy of settler‐colonial agriculture, tracing successive (unsuccessful) efforts at reforming the financial system to ameliorate social and spatial disparities inherited from the colonial era. It does so drawing on recent debates about "financial infrastructures", alongside considerations of the political economy of land, property relations, and the state. [ABSTRACT FROM AUTHOR]

Due to the shortage of high-quality fly ash (FA) in Kenya, the successful construction of the Mombasa–Nairobi railway had to rely on the abundant natural pozzolan resources in the country instead. In the work reported in this article, concrete samples produced using 30% FA, 30% fine tuff (FT), 30% fine volcanic slag (FVS), or 10% FA and 20% FVS to replace cement were tested. The hydration activity of the FT was found to be poor. The mechanical properties and durability of the concrete made with FVS were close to those of the FA concrete and optimal performance was obtained from a mixture of FA and FVS. Mercury intrusion porosimetry, X-ray diffraction and differential thermal analysis were used for microanalysis of cementitious systems with 70% cement and 30% FA, 70% cement and 30% FT, and 70% cement and 30% FVS. The results were promising and suggested that the FVS possessed obvious secondary hydration activity and could improve the microstructure of the concrete matrix. It is therefore feasible to use natural pozzolans instead of FA to produce high-performance concrete in railway projects, which would reduce construction costs and help protect the environment. [ABSTRACT FROM AUTHOR]