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

Background Recruitment and retention of health workers is a major concern. Policy initiatives emphasize financial incentives, despite mixed evidence of their effectiveness. Qualitative studies suggest that nurses especially may be more driven by altruistic motivations, but quantitative research has overlooked such values. This paper adds to the literature through characterizing the nature and determinants of nurses’ altruism, based on a cross-country quantitative study. Methods An experimental ‘dictator game’ was undertaken with 1064 final year nursing students in Kenya, South Africa and Thailand between April 2007 and July 2008. This presents participants with a real financial endowment to split between themselves and another student, a patient or a poor person. Giving a greater share of this financial endowment to the other person is interpreted as reflecting greater altruism. Results Nursing students gave over 30% of their initial endowment to others (compared with 10% in similar experiments undertaken in other samples). Respondents in all three countries showed greater generosity to patients and the poor than to fellow students. Conclusions Consideration needs to be given to how to appeal to altruistic values as an alternative strategy to encourage nurses to enter the profession and remain, such as designing recruitment strategies to increase recruitment of altruistic individuals who are more likely to remain in the profession. [ABSTRACT FROM PUBLISHER]

Technological capabilities that are necessary for industrial development are often learned from others. But where does technology come from and through which channels? This article identifies a change in the source of pharmaceutical know-how in East Africa, from the global north to the global south. This shift in the countries from which know-how arrived coincided with a shift in the channels through which know-how was transferred, from channels that enhance individual capabilities to channels that enhance firm capabilities. What impact do such changes have on local production? I show that these changes not only led to increased inclusion— it became possible for nascent entrepreneurs with lesser resources to enter the sector—but also to increased internal differentiation. I also suggest that foreign direct investment functions as a countervailing force that reverses locally owned industrialization. Understanding sources and channels of technology transfer, and their impact, is an important contribution to the study of technology transfer and of industrial development more generally. [ABSTRACT FROM AUTHOR]

The article comments on the paper "Respiratory Syncytial Virus Infection and Disease in Infants and Young Children Studied From Birth in Kilifi District, Kenya," by J. D. Nokes and colleagues, published within this issue. Findings of this paper suggest that respiratory viral infections is a significant cause of severe respiratory infections among children in a developing country like Kenya. The authors discuss the need to conduct active community surveillance to determine this disease's burden.

Third, the authors did not appropriately disentangle research costs from intervention costs in analysing data from the Zambia randomized controlled trial. We recognize and appreciate the vast undertaking that TorresReudaetal. has taken on with this analysis and reiterate that we believe costing analyses of interventions are vital for scaling up effective VAWG interventions. Not all costs should be treated equally: Commentary on the article 'What will it cost to prevent violence against women and girls in low- and middle-income countries?. [Extracted from the article]

This article analyses how the private governance of global value chains (GVCs) varies across multiple end-markets. This is explored through a two-stage mixed-methods analysis of Kenya's participation in leather value chains serving Europe, China, India and the COMESA region. We first draw on transaction-level customs data to analyse private governance in terms of the stability of buyer–supplier interactions and presence of intermediaries. We then interrogate these results through supplier interviews. Our article highlights the combined role of product specifications and trust in shaping private governance, and heterogeneity of GVCs across the global North and South, as well as within the South. It further questions commonly held assumptions that lower quality products (generally characterising Southern end-markets) are necessarily governed by market-based coordination mechanisms. We therefore challenge links established in the GVC literature between product standards and private governance. [ABSTRACT FROM AUTHOR]

The article presents the authors' comments on economic aspects of national parks in the third world countries. The author specifically refers to the Shaba National Reserve, Kenya, in this regard. It is argued that the economic exploitation of national parks, when rationally planned, need not be at odds with the other goals of conservation. According to the author, the economic motive is compatible with conservation and adds greatly to its viability.

Violence against women and girls (VAWG) is a global problem with profound consequences. Although there is a growing body of evidence on the effectiveness of VAWG prevention interventions, economic data are scarce. We carried out a cross-country study to examine the costs of VAWG prevention interventions in low- and middle-income countries. We collected primary cost data on six different pilot VAWG prevention interventions in six countries: Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia. The interventions varied in their delivery platforms, target populations, settings and theories of change. We adopted a micro-costing methodology. We calculated total costs and a number of unit costs common across interventions (e.g. cost per beneficiary reached). We used the pilot-level cost data to model the expected total costs and unit costs of five interventions scaled up to the national level. Total costs of the pilots varied between ∼US $208 000 in a small group intervention in South Africa to US $2 788 000 in a couples and community-based intervention in Rwanda. Staff costs were the largest cost input across all interventions; consequently, total costs were sensitive to staff time use and salaries. The cost per beneficiary reached in the pilots ranged from ∼US $4 in a community-based intervention in Ghana to US $1324 for one-to-one counselling in Zambia. When scaled up to the national level, total costs ranged from US $32 million in Ghana to US $168 million in Pakistan. Cost per beneficiary reached at scale decreased for all interventions compared to the pilots, except for school-based interventions due to differences in student density per school between the pilot and the national average. The costs of delivering VAWG prevention vary greatly due to differences in the geographical reach, number of intervention components and the complexity of adapting the intervention to the country. Cost-effectiveness analyses are necessary to determine the value for money of interventions. [ABSTRACT FROM AUTHOR]

Rotavirus gastroenteritis still remains a major cause of morbidity and mortality among young children in developing countries, with ∼150 000–200 000 deaths occurring annually in sub-Saharan Africa. We reviewed papers published over the last 30 years on the epidemiology of rotavirus diarrhoea among the hospitalized and out-patient children in Kenya. The analysis shows rotavirus prevalence of 6–56% with diarrhoea occurring throughout the year and generally exhibiting distinct peaks during the dry months. Among the common genotype, G1 was the most predominant up to the year 2002 but more recently there has been an emergence of genotype G9 as the most predominant genotype and to a less extent G8. It is important to continue rotavirus surveillance in Kenya to determine accurately the burden of rotavirus disease and the emerging new genotypes. This will assist policy makers in decision making on rotavirus vaccine introduction and determining the impact of the vaccine. [ABSTRACT FROM AUTHOR]

Background. In developing countries, introduction of pneumococcal conjugate vaccine has not eliminated circulation of vaccine serotypes. Vaccinating pregnant mothers to increase antibody concentrations in their newborn infants may reduce the acquisition of pneumococcal carriage and subsequent risk of disease. We explored the efficacy of passive immunity, attributable to anti-protein and anticapsular pneumococcal antibodies, against acquisition of carriage. Methods. We examined the rate of nasopharyngeal acquisition of pneumococci in the first 90 days of life associated with varying anticapsular and anti-protein antibody concentrations in infant cord/maternal venous blood in Kilifi, Kenya. We used multivariable Cox proportional hazard models to estimate continuous functions relating acquisition of nasopharyngeal carriage to the concentration of maternally derived antibody. Results. Cord blood or maternal venous samples were collected from 976 mother-infant pairs. Pneumococci were acquired 561 times during 33,905 person-days of follow-up. Increasing concentrations of anti-protein antibodies were associated with either a reduction (PhtD1, PspAFam2, Spr0096, StkP) or, paradoxically, an increase (CbpA, LytC, PcpA, PiaA, PspAFam1, RrgBT4) in acquisition rate. We observed a nonsignificant reduction in the incidence of homologous carriage acquisition with high concentrations of maternally derived anticapsular antibodies to 5 serotypes (6A, 6B, 14, 19F, and 23F). Conclusion. The protective efficacy of several anti-protein antibodies supports the strategy of maternal vaccination to protect young infants from carriage and invasive disease. We were not able to demonstrate that passive anticapsular antibodies were protective against carriage acquisition at naturally occurring concentrations though it remains possible they may do so at the higher concentrations elicited by vaccination. [ABSTRACT FROM AUTHOR]

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In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine water availability and community health before and after tube wells were introduced in a ruralwestern Kenyan community. Differences in impact among income quintile groups were quantified, and users' perceptions of their water supply measured. Methods:We conducted a two-part pre- (2009) and post-intervention (2011), cross-sectional study using structured questionnaires for mothers. Results: In total, 1391 (576 in 2009 and 815 in 2011)mothers participated.Well introduction changed the households' drinking-water source from river to ground water. The median distance to the water source was reduced by 40%(500 to 300 metres) and median collection timewas reduced by 50%(30 to 15minutes).Water consumption per household increased by approximately 20%(from 82.6 to 99.0 L) and drinking of untreated water decreased by approximately 10%. Regression analyses revealedmothers with higher monthly incomes had the highest satisfaction levels (β=0.167, p<0.001). Positive impacts were strongest among wealthier groups. Conclusions: The small-scale communitywater supply dramatically affected user hygiene behaviours and daily life. Water supply access improved from 'no access' to 'basic access'. Household connections to a water supply and hygiene education are important steps to enhance community health. [ABSTRACT FROM AUTHOR]

Objective To measure level and variation of healthcare quality provided by different types of healthcare facilities in Ghana and Kenya and which factors (including levels of government engagement with small private providers) are associated with improved quality. Design Provider knowledge was assessed through responses to clinical vignettes. Associations between performance on vignettes and facility characteristics, provider characteristics and self-reported interaction with government were examined using descriptive statistics and multivariate regressions. Setting Survey of 300 healthcare facilities each in Ghana and Kenya including hospitals, clinics, nursing homes, pharmacies and chemical shops. Private facilities were oversampled. Participants Person who generally saw the most patients at each facility. Main Outcome Measure(s) Percent of items answered correctly, measured against clinical practice guidelines and World Health Organization's protocol. Results Overall, average quality was low. Over 90% of facilities performed less than half of necessary items. Incorrect antibiotic use was frequent. Some evidence of positive association between government stewardship and quality among clinics, with the greatest effect (7% points increase, P = 0.03) for clinics reporting interactions with government across all six stewardship elements. No analogous association was found for pharmacies. No significant effect for any of the stewardship elements individually, nor according to type of engagement. Conclusions Government stewardship appears to have some cumulative association with quality for clinics, suggesting that comprehensive engagement with providers may influence quality. However, our research indicates that continued medical education (CME) by itself is not associated with improved care. [ABSTRACT FROM AUTHOR]