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Medical education in Africa is in desperate need of reforms, evident in widespread diseases, and an inability to mobilise and train the required medical workforce to deal with these health issues. However, the exponential rise in the use of mobile technologies due to the spread of the Internet and increased telecommunication networks offer an opportunity for the transformation of medical education and practice through the deployment of mobile devices as a medium for learning and conveying health care services to the remote and resource-constrained locations of Sub-Saharan Africa (SSA). This paper reviewed articles on the affordances of m-learning for distributed medical education in SSA published between 2010-2018. Results from 18 articles identified in the review revealed a slow-paced ascendancy of practice and research in the field; it further exposed competing priorities, infrastructural deficit, and chronic workforce shortages as the bane of m-learning implementation in the subregion. This paper makes recommendations that will enhance the growth of mobile-based distance medical education and practice in SSA.

Management of undernourished children depends only on wasting yet it can coexist with underweight and/or stunting. Among children admitted to hospital with acute illness, we determined the proportion with wasting coexisting with underweight and/or stunting and their risk factors. A retrospective review of hospital records of children 6‒59 months old admitted at Garissa County referral hospital, Kenya, from January 2017 to December 2019 was conducted. Using World Health Organization 2006 growth standards, undernutrition were defined: wasting as Weight‐for‐height Z‐score < −2, stunting Height‐for‐age Z‐score < −2 and underweight Weight‐for‐age Z‐score < −2. We studied wasting coexisting with underweight and/or stunting. Among 624 children recruited, 347 (56%) were males and 511 (82%) <24 months old. Diarrhoea 210 (34%) and pallor/anaemia 310 (50%) were the most frequent admission diagnosis. HIV infection was present among 8 (1.3%) children. Wasting, underweight and stunting were present among 595 (95%), 518 (83%) and 176 (28%) children respectively. 161 (26%), 506 (81%) and 161 (26%) children had wasting coexisting with stunting, underweight and both stunting and underweight respectively. In the multivariable regression, diarrhoea was positively associated with wasting coexisting with stunting (adjusted risk ratio [aRR = 2.96] [95% CI = 2.06‒4.23]) and anaemia with wasting coexisting with underweight (aRR = 1.23) (95% CI = 1.03‒1.47). Overall, 343 (55%) children were discharged alive, 67 (11%) absconded from the wards, 164 (26%) were transferred to another hospital and 50 (8.0%) died before discharge. The risk of inpatient death was 10.3%, 7.9%, 8.4% and 6.8% among children not wasted, wasted only, wasted & underweight, and wasted and underweight and stunted respectively (Chi‐square p = 0.60). The study reports an unacceptably high levels of undernourishment, including coexisting forms of undernutrition among hospitalised children. This highlights a public health priority for current nutrition therapeutic care and need of continuity of care among those children discharged alive in the community‐based management of acute malnutrition programmes. Key messages: In this population of hospitalised children, we found critically high levels of wasting and underweight. The most frequent form of undernutrition coexistence was wasting and underweight.Early detection and effective treatment of hospitalised children with coexisting forms of undernutrition (CFU) deserves more attention in the current nutrition therapeutic treatment programmes.Routine reporting of CFU in hospital settings should be encouraged. Future research to increase our understanding of its mechanism and need for robust interventions should be prioritised. [ABSTRACT FROM AUTHOR]

Background: Sexual behavior (SB) is a well-documented pathway to HIV acquisition in emerging adults and remains common amongst African emerging adults. Previous research in high-income countries indicates a correlation between disordered eating behavior (DEB) and engaging in sexual behaviors. We aimed to describe the relationship between DEB and SB amongst emerging adults attending a tertiary educational institution at the Kenyan Coast. Methods: We applied a cross-sectional design nested in a young adults' cohort study. Eligibility included sexually active emerging adults aged 18–24 years. Three DEBs (emotional, restrained and external eating) were assessed using the Dutch Eating Behavior Questionnaire and analysed using exploratory factor analysis. Seven SB indicators were assessed: non-condom use, casual sex, multiple sex partners, transactional sex, group sex, age-disparate relationship and anal sex, and grouped into low vs. high SB using latent class analysis. Logistic regression was used to assess the association between DEB and SB. Results: Of 273 eligible participants (female, n = 110 [40.3%]), the mean of emotional, restrained and external eating was 1.9 [0.6], 2.0 [0.6] and 3.0 [0.5] respectively. Overall, 57 (20.9%) were grouped into the latent high SB class. Emotional (Adjusted odds ratio, AOR [95% confidence interval, CI]: 1.0 [0.9–1.0], p = 0.398), restrained (AOR, 1.0 [CI: 0.9–1.1], p = 0.301) and External (AOR, 1.0 [CI: 0.8–1.2], p = 0.523) eating were not independently associated with latent high SB. Conclusion: There was no significant association between DEB and SB in this study sample. In low- and middle-income countries like Kenya, interventions targeted at DEB among emerging adults towards controlling SB are unnecessary. [ABSTRACT FROM AUTHOR]

Background: Globally, 15% of reported cancers are virus-associated. Cancercausing viruses include high-risk Human papillomavirus (HR-HPV), the causative agent of cervical cancer, and Human T-lymphotropic virus type-1 (HTLV-1), the causative agent of adult T-cell leukemia (ATL). HTLV-1 infection may enhance susceptibility to acquiring HR-HPV infections due to its retrovirus properties, resulting in increased cervical abnormalities among women living with HIV (WLHIV). In Kenya, there is a paucity of data on the burden of HR-HPV/HTLV-1 co-infection among WLHIV. We determined the prevalence of HR-HPV and HTLV-1 co-infection among WLHIV on antiretroviral therapy (ART) at Kenya's national referral hospital, Kenyatta National Hospital (KNH). Methodology: We conducted a cross-sectional study among WLHIV on ART attending KNH's HIV care clinic. Study nurses collected a cervical sample with a cytobrush for HPV genotyping using Gene Xpert ® assays and HPV Genotypes 14 Real-TM Quant. Peripheral blood mononuclear cells were used for HTLV-1 DNA detection. Differences in frequency distributions of characteristics between WLHIV with and without HR-HPV and HTLV-1 co-infections were assessed using the Chi-square tests. Results: A total of 647 WLHIV enrolled in this study with a mean age of 42.8 years (SD 8.7); 93% were on ART for >1 year and 8.8% were not virally suppressed (>1000 HIV RNA copies/mL). The HTLV-1 positivity rate among WLHIV was 3.1% overall and 7.6% among those with HR-HPV. WLHIV with HR-HPV 31 had the highest proportion of HR-HPV/HTLV-1 co-infection (31.6%). In contrast, WLHIV with HR-HPV 39 had the lowest proportion of co-infection (7.1%). Participants with HR-HPV/HTLV-1 co-infections were older compared to those without the co-infections (35.2% vs. 23.3%). A higher proportion of women with HR-HPV/HTLV-1 co-infections had their sex debut before the age of 18 years (p=0.012). Women co-infected with HR-HPV/HTLV-1 were diagnosed with HIV at = 35 years compared to those without infection (70.6% vs. 41.9%, p= 0.019). Conclusion: We found that HTLV-1 infection was more common among WLHIV on ART who also had HR-HPV and that co-infections were associated with the age of sexual debut and the age of HIV diagnosis. [ABSTRACT FROM AUTHOR]

Background: Although tuberculosis (TB) patients coinfected with HIV are at risk of poor treatment outcomes, there is paucity of data on changing trends of TB/HIV co-infection and their treatment outcomes. This study aims to estimate the burden of TB/HIV co-infection over time, describe the treatment available to TB/HIV patients and estimate the effect of TB/HIV co-infection on TB treatment outcomes. Methods: This was a retrospective data analyses from TB surveillance in two counties in Kenya (Nyeri and Kilifi): 2012‒2020. All TB patients aged ≥ 18 years were included. The main exposure was HIV status categorised as infected, negative or unknown status. World Health Organization TB treatment outcomes were explored; cured, treatment complete, failed treatment, defaulted/lost-to-follow-up, died and transferred out. Time at risk was from date of starting TB treatment to six months later/date of the event and Cox proportion with shared frailties models were used to estimate effects of TB/HIV co-infection on TB treatment outcomes. Results: The study includes 27,285 patients, median (IQR) 37 (29‒49) years old and 64% male. 23,986 (88%) were new TB cases and 91% were started on 2RHZE/4RH anti-TB regimen. Overall, 7879 (29%, 95% 28‒30%) were HIV infected. The proportion of HIV infected patient was 32% in 2012 and declined to 24% in 2020 (trend P-value = 0.01). Uptake of ARTs (95%) and cotrimoxazole prophylaxis (99%) was high. Overall, 84% patients completed six months TB treatment, 2084 (7.6%) died, 4.3% LTFU, 0.9% treatment failure and 2.8% transferred out. HIV status was associated with lower odds of completing TB treatment: infected Vs negative (aOR 0.56 (95%CI 0.52‒0.61) and unknown vs negative (aOR 0.57 (95%CI 0.44‒0.73). Both HIV infected and unknown status were associated with higher hazard of death: (aHR 2.40 (95%CI 2.18‒2.63) and 1.93 (95%CI 1.44‒2.56)) respectively and defaulting treatment/LTFU: aHR 1.16 (95%CI 1.01‒1.32) and 1.55 (95%CI 1.02‒2.35)) respectively. HIV status had no effect on hazard of transferring out and treatment failure. Conclusion: The overall burden of TB/HIV coinfection was within previous pooled estimate. Our findings support the need for systematic HIV testing as those with unknown status had similar TB treatment outcomes as the HIV infected. [ABSTRACT FROM AUTHOR]

Across an elevation gradient, several biotic and abiotic factors influence community assemblages of interacting species leading to a shift in species distribution, functioning, and ultimately topologies of species interaction networks. However, empirical studies of climate‐driven seasonal and elevational changes in plant‐pollinator networks are rare, particularly in tropical ecosystems. Eastern Afromontane Biodiversity Hotspots in Kenya, East Africa. We recorded plant‐bee interactions at 50 study sites between 515 and 2600 m asl for a full year, following all four major seasons in this region. We analysed elevational and seasonal network patterns using generalised additive models (GAMs) and quantified the influence of climate, floral resource availability, and bee diversity on network structures using a multimodel inference framework. We recorded 16,741 interactions among 186 bee and 314 plant species of which a majority involved interactions with honeybees. We found that nestedness and bee species specialisation of plant‐bee interaction networks increased with elevation and that the relationships were consistent in the cold‐dry and warm‐wet seasons respectively. Link rewiring increased in the warm‐wet season with elevation but remained indifferent in the cold‐dry seasons. Conversely, network modularity and plant species were more specialised at lower elevations during both the cold‐dry and warm‐wet seasons, with higher values observed during the warm‐wet seasons. We found flower and bee species diversity and abundance rather than direct effects of climate variables to best predict modularity, specialisation, and link rewiring in plant‐bee‐interaction networks. This study highlights changes in network architectures with elevation suggesting a potential sensitivity of plant‐bee interactions with climate warming and changes in rainfall patterns along the elevation gradients of the Eastern Afromontane Biodiversity Hotspot. [ABSTRACT FROM AUTHOR]

Kala-azar is a parasitic disease caused by Leishmania species transmitted by sand fly. In Kenya, kala-azar is endemic in thirty subcounties spread over in eleven counties in the arid zones. Climate change-influenced seasonal weather variability and environmental alterations remain important determinants of many vector-borne diseases. The present study focused on climate change and environmental influence on kala-azar in West Pokot. A descriptive cross-sectional and retrospective research design was adapted. Study area was purposively selected. Locations were randomly selected, and households were systematically selected. Three hundred sixty-three household questionnaires, eleven key informant interviews, and five focus group discussions were undertaken. Secondary data were obtained from Kacheliba subcounty hospital records. Statistical Package for the Social Sciences version 24 was used to analyze quantitative data while qualitative data were analyzed to establish connection for interpretation. Kala-azar cases have been on the rise on aggregate and surge towards the end of dry season and just after the rains. Significant environmental factors included the presence of seasonal rain water pathways and rock piles around houses (AOR = 4.7; 95% CI = (2.3-9.6), p < 0.05), presence of acacia trees in and around homesteads (AOR = 8.5; 95% CI = (2.5-28.6), p < 0.05), presence of anthills around the homesteads (AOR = 5.2; 95% CI = (1.2-23.4), p < 0.05), and presence of animal shed within compound (AOR = 2.8; 95% CI = (0.96-8), p < 0.05). Climate change-induced seasonal weather variability, increased temperature and reduced precipitation as well as environmental alterations influence kala-azar occurrence in West Pokot. Community sensitization on disease prevalence, clearing of vector predilection sites, and improving community environmental risk perception are imperative to promote prevention. [ABSTRACT FROM AUTHOR]

There exist significant inequities in access to family planning (FP) in Kenya, particularly for nomadic and semi-nomadic pastoralists. Health care providers (HCP), are key in delivering FP services. Community leaders and religious leaders are also key influencers in women's decisions to use FP. We found limited research exploring the perspectives of both HCPs and these local leaders in this context. We conducted semi-structured interviews with HCPs (n=4) working in facilities in Wajir and Mandera, and community leaders (n=4) and religious leaders (n=4) from the nomadic and semi-nomadic populations the facilities serve. We conducted deductive and inductive thematic analysis. Three overarching themes emerged: perception of FP as a health priority, explanations for low FP use, and recommendations to improve access. Four overlapping sub-themes explained low FP use: desire for large families, tension in FP decision-making, religion and culture, and fears about FP. Providers were from different socio-demographic backgrounds to the communities they served, who faced structural marginalisation from health and other services. Programmes to improve FP access should be delivered alongside interventions targeting the immediate health concerns of pastoralist communities, incorporating structural changes. HCPs that are aware of religious and cultural reasons for non-use, play a key role in improving access. [ABSTRACT FROM AUTHOR]

[Display omitted] Interaction network resilience can be defined as the ability of interacting organisms to maintain their functions, processes or populations after experiencing a disturbance. Studies on mutualistic interactions between plants and pollinators along environmental gradients are essential to understand the provision of ecosystem services and the mechanisms challenging their network resilience. However, it remains unknown to what level ecological changes along climatic gradients constrain the network resilience of mutualistic organisms, especially along elevation gradients. We surveyed bee species and recorded their interactions with plants throughout the four major seasons (i.e. long and short rainy, and long and short dry) on 50 study sites positioned along an elevation gradient (525 m to 2,530 m asl) in the Eastern Afromontane Biodiversity Hotspots in Kenya, East Africa. We calculated bee and plant network resilience using the network resilience parameter (β eff) and assessed changes in bee and plant network resilience along the elevation gradient using generalised additive models (gams). We quantified the effects of climate, bee and plant diversity, bee functional traits, network structure, and landscape configuration on bee and plant network resilience using a set of multi-model inference frameworks followed by structural equation models (SEM). We found that bee and plant species exhibited higher levels of network resilience at higher elevations. While bee network resilience increased linearly across the elevation gradient, plant network resilience increased exponentially from ∼1500 m and higher. Bee and plant network resilience increased in areas with reduced mean annual temperature (MAT) and decreased in areas with lower mean annual precipitation (MAP). Our SEM model showed that increasing temperatures indirectly influenced plant network resilience via network modularity and community assemblage of bees. We also found that MAP had a direct positive effect on plant diversity and network resilience, while the fragmentation of habitats reduced richness of plant communities and enhanced network modularity. In conclusion, we revealed that mutualistic networks showed higher network resilience at higher elevations. We also unveiled that climate and habitat fragmentation directly or indirectly influences the network resilience of plants and bees via the modulation of community assemblages and interaction networks. These influences are lower at higher elevations such that these systems seem better able to buffer against extinction cascades. We thus suggest that, management efforts should be geared at consolidating natural habitats. In contrast, restoration efforts should aim at mitigating climate change effects and harnessing the ability of mutualists to reconnect broken links to improve the network resilience and functioning of East-African montane ecosystems. [ABSTRACT FROM AUTHOR]

Pest management and insect pollination are important services that support crop production but are most often studied in isolation in cropping systems. Avocado Persea americana Mill. is an economically important crop in East Africa, which suffers from pest threats and potential drawbacks of the global pollinator crisis. The integration of pest and pollinator management is a growing research trend as a potential solution for sustainable crop production with minimum adverse effects on the environment and biodiversity. This study assessed potential interactions between landscape context, honeybee Apis mellifera L. introduction and integrated pest management (IPM) on avocado pests Bactrocera dorsalis (Hendel) and Thaumatotibia leucotreta (Meyrick), pollinators, and productivity in Kenya. Results showed an interaction between honeybee introduction and IPM on A. mellifera, with the highest mean abundance on the farms with both honeybee colonies and IPM. The abundance and diversity of non-Apis flower visitors were not affected by IPM and honeybee introduction across the landscapes. Pollinator introduction and IPM implementation resulted in a 941% fruit set increase and up to 97% fruit abscission within the high vegetation productivity class. Pest abundance significantly decreased on the farms with IPM, resulting in a 6% increase of final fruit weight compared with the farms without IPM. Overall, integration of pest and pollinator management did not synergistically increase the final avocado yield but represented a potential strategy to reduce pest densities while preserving wild visitors and benefiting from secondary products of honeybee colonies. [ABSTRACT FROM AUTHOR]

The contribution of seasonality in species communities to elevational diversity of tropical insects remains poorly understood. We here assessed seasonal patterns and drivers of bee diversity in the Eastern Afromontane Biodiversity Hotspot, Kenya, to understand the contribution of seasonality to elevational biodiversity patterns. Bee species and plant species visited by bees were recorded on 50 study plots in regrowth vegetation across four major seasons along two elevation gradients from 525 to 2530 m above sea level. Bees were sampled by transect walks using sweep nets and aspirators. We examined how local species richness (α‐diversity) and seasonal changes in local species communities (β‐diversity) contribute to species richness across seasons (γ‐diversity) along elevation gradients. Using a multimodel inference framework, we identified the contribution of climate and floral seasonality to elevational patterns in bee diversity. We found that both α‐ and γ‐diversity decreased with elevation. Seasonal β‐diversity decreased with elevation and the high turnover of species across seasons contributed to a considerably higher γ‐ than α‐diversity on study plots. A combination of seasonality in climate and the seasonal turnover of floral resources best explained the seasonality in bee species communities (seasonal β‐diversity). We, therefore, conclude that, despite the more stable, and favorable climatic conditions in the tropics (in comparison to temperate regions), climatic seasonality and its influence on bees' floral resources largely determined seasonal patterns of bee species diversity along elevation gradients on tropical mountains. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is one of the leading causes of deaths in Africa, monitoring its treatment outcome is essential to evaluate treatment effectiveness. The study aimed to evaluate proportion of poor TB treatment outcomes (PTO) and its determinants during six-months of treatment at Kilifi County, Kenya.Methods: We conducted a retrospective analysis of data from the TB surveillance system (TIBU) in Kilifi County, Kenya from 2012 to 2019. The outcome of interest was PTO (lost-to-follow-up (LTFU), death, transferred out, treatment failure, drug resistance) or successful treatment (cured or completed treatment). We performed time-stratified (at three months follow-up) survival regression analyses accounting for sub-county heterogeneity to determine factors associated with PTO.Results: We included 14,706 TB patients, their median (IQR) age was 37 (28-50) years and 8,791 (60%) were males. A total of 13,389 (91%) were on first line anti-TB treatment (2RHZE/4RH), 4,242 (29%) were HIV infected and 192 (1.3%) had other underlying medical conditions. During 78,882 person-months of follow-up, 2,408 (16%) patients had PTO: 1,074 (7.3%) deaths, 776 (5.3%) LTFU, 415 (2.8%) transferred out, 103 (0.7%) treatment failure and 30 (0.2%) multidrug resistance. The proportion of poor outcome increased from 7.9% in 2012 peaking at 2018 (22.8%) and slightly declining to 20% in 2019 (trend test P = 0.03). Over two-thirds 1,734 (72%) poor outcomes occurred within first three months of follow-up. In the first three months of TB treatment, overweight ((aHR 0.85 (95%CI 0.73-0.98), HIV infected not on ARVS (aHR 1.72 (95% CI 1.28-2.30)) and year of starting treatment were associated with PTO. However, in the last three months of treatment, elderly age ≥50 years (aHR 1.26 (95%CI 1.02-1.55), a retreatment patient (aHR 1.57 (95%CI 1.28-1.93), HIV infected not on ARVs (aHR 2.56 (95%CI 1.39-4.72), other underlying medical conditions (aHR 2.24 (95%CI 1.41-3.54)) and year of starting treatment were positively associated with PTO while being a female (aHR 0.83 (95%CI 0.70-0.97)) was negatively associated with PTO.Conclusions: Over two-thirds of poor outcomes occur in the first three months of TB treatment, therefore greater efforts are needed during this phase. Interventions targeting HIV infected and other underlying medical conditions, the elderly and retreated patients provide an opportunity to improve TB treatment outcome. [ABSTRACT FROM AUTHOR]

Background: Camps of forcibly displaced populations are considered to be at risk of large COVID-19 outbreaks. Low screening rates and limited surveillance led us to conduct a study in Dagahaley camp, located in the Dadaab refugee complex in Kenya to estimate SARS-COV-2 seroprevalence and, mortality and to identify changes in access to care during the pandemic. Methods: To estimate seroprevalence, a cross-sectional survey was conducted among a sample of individuals (n = 587) seeking care at the two main health centres and among all household members (n = 619) of community health workers and traditional birth attendants working in the camp. A rapid immunologic assay was used (BIOSYNEX® COVID‐19 BSS [IgG/IgM]) and adjusted for test performance and mismatch between the sampled population and that of the general camp population. To estimate mortality, all households (n = 12860) were exhaustively interviewed in the camp about deaths occurring from January 2019 through March 2021. Results: In total 1206 participants were included in the seroprevalence study, 8% (95% CI: 6.6%-9.7%) had a positive serologic test. After adjusting for test performance and standardizing on age, a seroprevalence of 5.8% was estimated (95% CI: 1.6%-8.4%). The mortality rate for 10,000 persons per day was 0.05 (95% CI 0.05–0.06) prior to the pandemic and 0.07 (95% CI 0.06–0.08) during the pandemic, representing a significant 42% increase (p<0.001). Médecins Sans Frontières health centre consultations and hospital admissions decreased by 38% and 37% respectively. Conclusion: The number of infected people was estimated 67 times higher than the number of reported cases. Participants aged 50 years or more were among the most affected. The mortality survey shows an increase in the mortality rate during the pandemic compared to before the pandemic. A decline in attendance at health facilities was observed and sustained despite the easing of restrictions. [ABSTRACT FROM AUTHOR]

Tuta absoluta is one of the most devastating pests of Solanaceae crops in Africa. We previously demonstrated the efficacy of Metarhizium anisopliae isolates ICIPE 18, ICIPE 20 and ICIPE 665 against adult T. absoluta. However, adequate strain selection and accurate spatial prediction are fundamental to optimize their efficacy and formulations before field deployment. This study therefore assessed the thermotolerance, conidial yield and virulence (between 15 and 35 °C) of these potent isolates. Over 90% of conidia germinated at 20, 25 and 30 °C while no germination occurred at 15 °C. Growth of the three isolates occurred at all temperatures, but was slower at 15, 33 and 35 °C as compared to 20, 25 and 30 °C. Optimum temperatures for mycelial growth and spore production were 30 and 25 °C, respectively. Furthermore, ICIPE 18 produced higher amount of spores than ICIPE 20 and ICIPE 665. The highest mortality occurred at 30 °C for all the three isolates, while the LT50 values of ICIPE 18 and ICIPE 20 were significantly lower at 25 and 30 °C compared to those of ICIPE 665. Subsequently, several nonlinear equations were fitted to the mortality data to model the virulence of ICIPE 18 and ICIPE 20 against adult T. absoluta using the Entomopathogenic Fungi Application (EPFA) software. Spatial prediction revealed suitable locations for ICIPE 18 and ICIPE 20 deployment against T. absoluta in Kenya, Tanzania and Uganda. Our findings suggest that ICIPE 18 and ICIPE 20 could be considered as effective candidate biopesticides for an improved T. absoluta management based on temperature and location-specific approach. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, no studies exist on the influence of nomadic pastoralist women's networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). Methods: Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. Results: Women named 10–12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. Conclusions: Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women's networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women's wider networks. Plain language summary: Few studies have asked nomadic women in Kenya to name the important individuals in their lives when it comes to making reproductive and sexual health decisions, including their use of family planning. These important individuals are described as a woman's "network". We used a survey and open-ended interview format to identify the individuals in four nomadic women's networks ("social network analysis"). Data was analysed in R and we created a visual map of these networks. Women named 10–12 individuals. Women's husbands made reproductive health decisions and did not approve of modern family planning use. Apart from their husbands, women did not know who in their network approved of their use of family planning. Female neighbors and mothers provided important support to women. Interventions to increase awareness of modern FP should engage with everyone in a woman's network. [ABSTRACT FROM AUTHOR]

Globally, public health measures like face masks, hand hygiene and maintaining social distancing have been implemented to delay and reduce local transmission of COVID-19. To date there is emerging evidence to provide effectiveness and compliance to intervention measures on COVID-19 due to rapid spread of the disease. We synthesized evidence of community interventions and innovative practices to mitigate COVID-19 as well as previous respiratory outbreak infections which may share some aspects of transmission dynamics with COVID-19. In the study, we systematically searched the literature on community interventions to mitigate COVID-19, SARS (severe acute respiratory syndrome), H1N1 Influenza and MERS (middle east respiratory syndrome) epidemics in PubMed, Google Scholar, World Health Organization (WHO), MEDRXIV and Google from their inception until May 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO (CRD42020183064). Of 41,138 papers found, 17 studies met the inclusion criteria in various settings in Low- and Middle-Income Countries (LMICs). One of the papers from LMICs originated from Africa (Madagascar) with the rest from Asia 9 (China 5, Bangladesh 2, Thailand 2); South America 5 (Mexico 3, Peru 2) and Europe 2 (Serbia and Romania). Following five studies on the use of face masks, the risk of contracting SARS and Influenza was reduced OR 0.78 and 95% CI = 0.36–1.67. Equally, six studies on hand hygiene practices reported a reduced risk of contracting SARS and Influenza OR 0.95 and 95% CI = 0.83–1.08. Further two studies that looked at combined use of face masks and hand hygiene interventions showed the effectiveness in controlling the transmission of influenza OR 0.94 and 95% CI = 0.58–1.54. Nine studies on social distancing intervention demonstrated the importance of physical distance through closure of learning institutions on the transmission dynamics of disease. The evidence confirms the use of face masks, good hand hygiene and social distancing as community interventions are effective to control the spread of SARS and influenza in LMICs. However, the effectiveness of community interventions in LMICs should be informed by adherence of the mitigation measures and contextual factors taking into account the best practices. The study has shown gaps in adherence/compliance of the interventions, hence a need for robust intervention studies to better inform the evidence on compliance of the interventions. Nevertheless, this rapid review of currently best available evidence might inform interim guidance on similar respiratory infectious diseases like Covid-19 in Kenya and similar LMIC context. [ABSTRACT FROM AUTHOR]

Introduction: In Kenya, pre-exposure prophylaxis (PrEP) for HIV prevention is almost exclusively delivered at HIV clinics. Developing novel PrEP delivery models is important for increasing the reach of PrEP. Delivery of PrEP through pharmacies is one approach utilized in the US to improve accessibility. Retail pharmacies are commonly used as a first-line access point for medical care in Kenya, but have not been utilized for PrEP delivery. We conducted a collaborative consultative meeting of stakeholders to develop a care pathway for pharmacy-based PrEP delivery in Kenya.Methods: In January 2020, we held a one-day meeting in Nairobi with 36 stakeholders from PrEP regulatory, professional, healthcare service delivery, civil society, and research organizations. Attendees reviewed a theory of change model, results from formative qualitative research with pharmacy providers and clients, and anticipated core components of pharmacy-based PrEP delivery: counseling, HIV testing, prescribing, and dispensing. Stakeholders participated in small and large group discussions to identify potential challenges and solutions. We synthesized the key findings from these discussions.Results: Stakeholders were enthusiastic about a model for pharmacy-based PrEP delivery. Potential challenges identified included insufficient pharmacy provider knowledge and skills, regulatory hurdles to providing affordable HIV testing at pharmacies, and undefined pathways for PrEP procurement. Potential solutions identified included having pharmacy providers complete the Kenya Ministry of Health-approved PrEP training, use of a PrEP prescribing checklist with remote clinician oversight and provider-assisted HIV self-testing, and having the government provide PrEP and HIV self-testing kits to pharmacies during a pilot test. A care pathway was developed over the course of the meeting.Conclusions: PrEP delivery stakeholders in Kenya were strongly supportive of developing and testing a model for pharmacy-based PrEP delivery to increase PrEP access. We collaboratively developed a care pathway for pilot testing that has the potential to expand PrEP delivery options in Kenya and other similar settings. [ABSTRACT FROM AUTHOR]

Gall midges (Diptera: Cecidomyiidae) comprise a diverse family of small nematoceran flies. While most species are phytophagous, the family also includes predatory species, and endoparasitoids. Endoparasitic species have been reared from aphids and psyllids. We discovered parasitoid-infected weaver ant, Oecophylla longinoda (Latreille) (Hymenoptera: Formicidae) in nests on mango trees in coastal Kenya. Examination of 5 colonies revealed the presence of parasitoids in all of them, with parasitism rates ranging from 2 to 21%. Morphological examination of larval parasitoids indicated that they were gall midges, and molecular data were consistent with the identification. Attempts to rear adults were unsuccessful. This study presents to the best of our knowledge the first report of Cecidomyiidae parasitising Hymenoptera, as well as the first report of a parasitoid of weaver ants. This species should be investigated further because its damage may limit the ability of weaver ants to control pests of cultivated fruits and other insects. [ABSTRACT FROM AUTHOR]

The hirola antelope (Beatragus hunteri) is considered to be the most endangered antelope in the world. In the ex situ translocated population at Tsavo East National Park, calf mortality and the critically low population numbers might suggest low genetic diversity and inbreeding depression. Consequently, a genetic study of the wild population is pivotal to gain an understanding of diversity and differentiation within its range before designing future translocation plans to increase the genetic diversity of the ex situ population. For that purpose, we assessed 55 individuals collected across five localities in eastern Kenya, covering its entire natural range. We used the complete mitochondrial DNA control region and microsatellite genotyping to estimate genetic diversity and differentiation across its range. Nuclear genetic diversity was moderate in comparison to other endangered African antelopes, with no signals of inbreeding. However, the mitochondrial data showed low nucleotide diversity, few haplotypes and low haplotypic differentiation. Overall, the inferred low degree of genetic differentiation and population structure suggests a single population of hirola across the natural range. An overall stable population size was inferred over the recent history of the species, although signals of a recent genetic bottleneck were found. Our results show hope for ongoing conservation management programmes and that there is a future for the hirola in Kenya. [ABSTRACT FROM AUTHOR]

This document is a correction notice for a study titled "Seroprevalence of SARS-CoV-2 antibodies and retrospective mortality in a refugee camp, Dagahaley, Kenya." The correction addresses errors in the Funding and Competing Interests statements. The study was funded by the Operational Centre of Geneva of Médecins Sans Frontières (MSF), and MSF programmatic funding covered all other costs associated with the study. The authors declare that there are no competing interests, patents, products in development, or marketed products associated with this research. The correction notice is authored by Etienne Gignoux, Frida Athanassiadis, Ahmed Garat Yarrow, Abdullahi Jimale, Nicole Mubuto, Carole Déglise, Denis Onsongo Mosoti, Andrew S. Azman, Matilu Mwau, Francisco Luquero, and Iza Ciglenecki. [Extracted from the article]

Background: Globally in 2016, 1.7 million people died of Tuberculosis (TB). This study aimed to estimate all-cause mortality rate, identify features associated with mortality and describe trend in mortality rate from treatment initiation. Method: A 5-year (2012–2016) retrospective analysis of electronic TB surveillance data from Kilifi County, Kenya. The outcome was all-cause mortality within 180 days after starting TB treatment. The risk factors examined were demographic and clinical features at the time of starting anti-TB treatment. We performed survival analysis with time at risk defined from day of starting TB treatment to time of death, lost-to-follow-up or completing treatment. To account for ‘lost-to-follow-up’ we used competing risk analysis method to examine risk factors for all-cause mortality. Results: 10,717 patients receiving TB treatment, median (IQR) age 33 (24–45) years were analyzed; 3,163 (30%) were HIV infected. Overall, 585 (5.5%) patients died; mortality rate of 12.2 (95% CI 11.3–13.3) deaths per 100 person-years (PY). Mortality rate increased from 7.8 (95% CI 6.4–9.5) in 2012 to 17.7 (95% CI 14.9–21.1) in 2016 per 100PY (Ptrend<0.0001). 449/585 (77%) of the deaths occurred within the first three months after starting TB treatment. The median time to death (IQR) declined from 87 (40–100) days in 2012 to 46 (18–83) days in 2016 (Ptrend = 0·04). Mortality rate per 100PY was 7.3 (95% CI 6.5–7.8) and 23.1 (95% CI 20.8–25.7) among HIV-uninfected and HIV-infected patients respectively. Age, being a female, extrapulmonary TB, being undernourished, HIV infected and year of diagnosis were significantly associated with mortality. Conclusions: We found most deaths occurred within three months and an increasing mortality rate during the time under review among patients on TB treatment. Our results therefore warrant further investigation to explore host, disease or health system factors that may explain this trend. [ABSTRACT FROM AUTHOR]

Background: A blend of compounds (pentanoic acid, guaiacol, δ-octalactone and geranylacetone) identified in waterbuck (Kobus defassa) body odour referred to as waterbuck repellent compounds (WRC) and a synthetic repellent 4-methylguaiacol have previously been shown to repel tsetse flies from the morsitans group. However, these repellents have not been evaluated on palpalis group tsetse flies. In this study, we evaluated the effect of these repellents on catches of Glossina fuscipes fuscipes (major vector of human sleeping sickness) in biconical traps and on sticky small targets which are visually attractive to palpalis group flies. The attractive devices were baited with different doses and blends of the repellent compounds. We also assessed the effect of removal of individual constituents in the synthetic blend of WRC on catches of G. f. fuscipes. Methodology/Principal findings: The study was conducted in western Kenya on four islands of Lake Victoria namely Big Chamaunga, Small Chamaunga, Manga and Rusinga. The tsetse fly catches from the treatments were modeled using a negative binomial regression to determine their effect on catches. In the presence of WRC and 4-methylguaiacol (released at ≈2 mg/h and ≈1.4 mg/h respectively), catches of G. f. fuscipes were significantly reduced by 33% (P<0.001) and 22% (P<0.001) respectively in biconical traps relative to control. On sticky small targets the reduction in fly catches were approximately 30% (P<0.001) for both 4-methylguiacol and WRC. In subtractive assays, only removal of geranylacetone from WRC significantly increased catches (by 1.8 times; P <0.001) compared to the complete blend of WRC. Conclusions/Significance: We conclude that WRC and 4-methylguaiacol reduce catches of G. f. fuscipes at stationary visually attractive traps and suggest that they may serve as broad spectrum repellents for Glossina species. We recommend further studies to investigate the effects of these compounds on reduction of G. f. fuscipes attracted to human hosts as this may lead to development of new strategies of reducing the prevalence and incidence of sleeping sickness. [ABSTRACT FROM AUTHOR]

Background: Home delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya. Methods: A cross-sectional design using mixed methods was used. Quantitative data were collected using interviewer-administered questionnaires from HIV-infected women with a recent pregnancy (within 5 years, n = 425), whilst qualitative data were collected using focused group discussions (FGD, n = 5). Data were analysed using logistic regression and a thematic framework approach respectively. Results: Overall, 108 (25.4%, [95% CI: 21.3–29.8]) participants delivered at home. Correlates of home delivery included lack of formal education (aOR 12.4 [95% CI: 3.4–46.0], p<0.001), history of a previous home delivery (2.7 [95% CI:1.2–6.0], p = 0.019) and being on highly active antiretroviral therapy (HAART, 0.4 [95% CI:0.2–0.8], p = 0.006).Despite a strong endorsement against home delivery, major thematic challenges included consumer-associated barriers, health care provider associated barriers and structural barriers. Conclusion: A quarter of HIV-infected women delivered at home, which is comparable to estimates reported from the general population in this rural setting, and much lower than estimates from other sSA settings. A tailored package of care targeting women with no formal education and with a history of a previous home delivery, coupled with interventions towards scaling up HAART and improving the quality of maternal care in HIV-infected women may positively contribute to a decline in home delivery and subsequent maternal mortality in this setting. [ABSTRACT FROM AUTHOR]

Abstract: Effective reintroduction strategies require accurate estimates of vital rates and the factors that influence them. The hirola (Beatragus hunteri) is the rarest antelope on Earth, with a global population size of <500 individuals restricted to the Kenya–Somali border. We estimated vital rates of hirola populations exposed to varying levels of predation and rangeland quality from 2012 to 2015, and then built population matrices to estimate the finite rate of population change (λ) and demographic sensitivities. Mean survival for all age classes and population growth was highest in the low‐predation–high‐rangeland‐quality setting (λ = 1.08 ± 0.03 [mean ± SE]), and lowest in the high‐predation–low‐rangeland‐quality setting (λ = 0.70 ± 0.22). Retrospective demographic analyses revealed that increased fecundity (the number of female calves born to adult females annually) and female calf survival were responsible for higher population growth where large carnivores were absent. In contrast, variation in adult female survival was the primary contributor to differences in population growth attributable to rangeland quality. Our analyses suggest that hirola demography is driven by a combination of top‐down (predation) and bottom‐up (rangeland quality) forces, with populations in the contemporary geographic range impacted both by declining rangeland quality and predation. To enhance the chances of successful reintroductions, conservationists can consider rangeland restoration to boost both the survival and fecundity of adult females within the hirola's historical range. [ABSTRACT FROM AUTHOR]

Ticks and tick-borne pathogens (TBPs) of domestic animals in Somalia and neighbouring regions of Ethiopia and Kenya are reviewed to identify knowledge gaps in these regions, where unrestricted livestock movements across borders are common. Major scientific databases, such as PubMed, Web of Science, Scopus, CABI, and Google Scholar were searched, to retrieve articles based on papers published between 1960 and March 2023. Thirty-one tick species representing six genera (Rhipicephalus, Hyalomma, Amblyomma, Haemaphysalis, Ornithodoros and Argas) were reported to infest domestic animals, mainly livestock. Overall, the most represented species were Rhipicephalus pulchellus (up to 60% of specimens identified), followed by Hyalomma dromedarii (up to 57%), Hyalomma truncatum (up to 57%), Amblyomma lepidum (up to 21%), Amblyomma variegatum (up to 21%) and Amblyomma gemma (up to 19%), with morphological characterization being the principal method of tick identification. In addition, 18 TBPs, including zoonotic pathogens (e.g., Crimean-Congo haemorrhagic fever virus), were detected, with Babesia spp., Theileria spp., and Rickettsia spp. being the most commonly reported. Half of the pathogens documented were detected using molecular techniques, while the other half were detected by serology and microscopic techniques. Generally, ticks and TBPs in the region are under-studied, particularly, data relating to pet animals and equines is lacking. Further, the infection intensity and herd prevalence of ticks and TBPs is unclear because of insufficient data and poor approaches to quantitative analysis, making it difficult to propose management policies in the region. There is an urgent need, therefore, for more and better studies, particularly those that take a 'One Health' perspective, focusing on the prevalence and socioeconomic impact of ticks and TBPs in animals as well as in humans, so that sustainable control strategies against them can be planned. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Conventional diagnosis of malaria has relied upon either clinical diagnosis or microscopic examination of peripheral blood smears. These methods, if not carried out exactly, easily result in the over- or under-diagnosis of malaria. The reliability and accuracy of malaria RDTs, even in extremely challenging health care settings, have made them a staple in malaria control programmes. Using the setting of a pilot introduction of malaria RDTs in Greater Garissa, North Eastern Province, Kenya, this study aims to identify and understand perceptions regarding malaria diagnosis, with a particular focus on RDTs, and treatment among community members and health care workers (HCWs). Methods The study was conducted in five districts of Garissa County. Focus group discussions (FGD) were performed with community members that were recruited from health facilities (HFs) supported by the MENTOR Initiative. In-depth interviews (IDIs) and FGDs with HCWs were also carried out. Interview transcripts were then coded and analysed for major themes. Two researchers reviewed all codes, first separately and then together, discussed the specific categories, and finally characterized, described, and agreed upon major important themes. Results Thirty-four FGDs were carried out with a range of two to eight participants (median of four). Of 157 community members, 103 (65.6%) were women. The majority of participants were illiterate and the highest level of education was secondary school. Some 76% of participants were of Somali ethnicity. Whilst community members and HCWs demonstrated knowledge of aspects of malaria transmission, prevention, diagnosis, and treatment, gaps and misconceptions were identified. Poor adherence to negative RDT results, unfamiliarity and distrust of RDTs, and an inconsistent RDT supply were the main challenges to become apparent in FGDs and IDIs. Conclusion Gaps in knowledge or incorrect beliefs exist in Greater Garissa and have the potential to act as barriers to complete and correct malaria case management. Addressing these knowledge gaps requires comprehensive education campaigns and a reliable and constant RDT supply. The results of this study highlight education and supply chain as key factors to be addressed in order to make large scale roll out of RDTs as successful and effective as possible. [ABSTRACT FROM AUTHOR]

The article focuses on a campaign conducted by Kenya during December 14-18, 2013 providing inactivated poliovirus vaccine (IPV) together with oral poliovirus vaccine (OPV) as part of a response to a polio outbreak caused by wild poliovirus (WPV) type 1. Topics discussed include the challenges in field implementation of the IPV/OPV campaign, and suggestions on how to address similar problems in future campaigns.

This study determined the serotype-specific acquisition rates for pneumococcal colonization in a cohort of 1404 newborn infants followed intensively for 3 months. By observing pneumococcal carriage in family members, we were able to determine serotype-specific transmission probabilities between relatives.Background. Herd protection and serotype replacement disease following introduction of pneumococcal conjugate vaccine (PCV) are attributable to the vaccine's impact on colonization. Prior to vaccine introduction in Kenya, we did an epidemiological study to estimate the rate of pneumococcal acquisition, by serotype, in an uncolonized population.Methods. Nasopharyngeal swab specimens were taken from newborns aged ≤7 days and weekly thereafter for 13 weeks. Parents, and siblings aged <10 years, were swabbed at monthly intervals. Swabs were transported in skim milk-tryptone-glucose-glycerin and cultured on gentamicin blood agar. Pneumococci were serotyped by the Quellung reaction. We used survival analysis and Cox regression analysis to examine serotype-specific acquisition rates and risk factors and calculated transmission probabilities from the pattern of acquisitions within the family.Results. Of 1404 infants recruited, 887 were colonized by 3 months of age, with the earliest acquisition detected on the first day of life. The median time to acquisition was 38.5 days. The pneumococcal acquisition rate was 0.0189 acquisitions/day (95% confidence interval, .0177–.0202 acquisitions/day). Serotype-specific acquisition rates varied from 0.00002–0.0025 acquisitions/day among 49 different serotypes. Season, coryza, and exposure to cigarettes, cooking fumes, and other children in the home were each significant risk factors for acquisition. The transmission probability per 30-day duration of contact with a carrier was 0.23 (95% CI, .20–.26).Conclusions. Newborn infants in Kilifi have high rates of nasopharyngeal acquisition of pneumococci. Half of these acquisitions involve serotypes not included in any current vaccine. Several risk factors are modifiable through intervention. Newborns represent a consistent population of pneumococcus-naive individuals in which to estimate the impact of PCV on transmission. [ABSTRACT FROM AUTHOR]

Background: Pneumococcal conjugate vaccines (PCV) reduce nasopharyngeal carriage of vaccine-serotype pneumococci but increase in the carriage of non-vaccine serotypes. We studied the epidemiology of carriage among children 3-59 months old before vaccine introduction in Kilifi, Kenya. Methods: In a rolling cross-sectional study from October 2006 to December 2008 we approached 3570 healthy children selected at random from the population register of the Kilifi Health and Demographic Surveillance System and 134 HIVinfected children registered at a specialist clinic. A single nasopharyngeal swab was transported in STGG and cultured on gentamicin blood agar. A single colony of pneumococcus was serotyped by Quellung reaction. Results: Families of 2840 children in the population-based sample and 99 in the HIV-infected sample consented to participate; carriage prevalence was 65.8% (95% CI, 64.0-67.5%) and 76% (95% CI, 66-84%) in the two samples, respectively. Carriage prevalence declined progressively with age from 79% at 6-11 months to 51% at 54-59 months (p<0.0005). Carriage was positively associated with coryza (Odds ratio 2.63, 95%CI 2.12-3.25) and cough (1.55, 95%CI 1.26-1.91) and negatively associated with recent antibiotic use (0.53 95%CI 0.34-0.81). 53 different serotypes were identified and 42% of isolates were of serotypes contained in the 10-valent PCV. Common serotypes declined in prevalence with age while less common serotypes did not. Conclusion: Carriage prevalence in children was high, serotypes were diverse, and the majority of strains were of serotypes not represented in the 10-valent PCV. Vaccine introduction in Kenya will provide a natural test of virulence for the many circulating non-vaccine serotypes. [ABSTRACT FROM AUTHOR]

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Avocado (Persea americana Mill.) production contributes to the economic growth of East Africa. However, poor fruit quality caused by infestations of tephritid fruit flies (Tephritidae) and the false codling moth, Thaumatotibia leucotreta (Meyrick), hampers access to lucrative export markets. Remote sensing and spatial analysis are increasingly applied to crop pest studies to develop sustainable and cost-effective control strategies. In this study, we assessed pest abundance in Muranga, Kenya, across three vegetation productivity classes, viz., low, medium and high, which were estimated using the normalised difference vegetation index at a landscape scale. Population densities of the oriental fruit fly, Bactrocera dorsalis (Hendel) and T. leucotreta in avocado farms were estimated through specific baited traps and fruit rearing. The population density of T. leucotreta varied across the vegetation productivity classes throughout the study period, although not significantly. Meanwhile, B. dorsalis showed a clear trend of decrease over time and was significantly lower in high vegetation productivity class compared to low and medium classes. Ceratitis cosyra (Walker) was the most abundant pest reared from fruit with few associated parasitoids, Pachycrepoideusvindemmiae (Rondani) and Toxeumorpha nigricola (Ferriere). [ABSTRACT FROM AUTHOR]

Introduction: Esophageal cancer (EC) is the ninth most common cancer and the sixth leading cause of cancer deaths worldwide. More than 80% of cases and deaths from EC occur within developing countries. In Kenya, cancer is the second leading cause of non-communicable disease deaths, and the trend of cancer deaths is projected to increase as per the 2020 GLOBOCAN report showing 42,116 new cases annually with a mortality of 27,092 cases. EC is the leading cancer in men and the third most common in women in Kenya. The Garissa Regional Cancer Center (GRCC) is one of the three regional cancer centres in Kenya. Despite the rising EC incidence in the region, there is limited data about the clinicopathological features and treatment outcomes of EC, therefore, this is the first study to look at the landscape of EC in the northern Kenya region. Methods: This was a retrospective study involving patients' file review of confirmed EC cases diagnosed or treated at the GRCC from 2019 to 2023. Data collected from each patient's chart included age, sex, risk factors, family history of EC, histological type, stage at diagnosis, treatment type and survival outcomes. For patients who were no longer in contact with the staff through clinic visits, the patients or their next of kin were contacted through phone calls for patients' survival status. Data were collected and stored using the STATA software. Results: Over the study period, 124 esophageal cases were identified, 64 (51.4%) were males and 60 (48.4%) were females with a mean age of 57.56 years. In terms of risk factors, hot beverage consumption was the highest (47 cases, 37.9%), followed by history of peptic ulcer disease (27 cases, 21.8%), smoking (8.9%) and gastresophageal reflux disease (2 cases, 1.6%). Stage of diagnosis at presentation was stage 1 (1 case, 0.8%), stage 2 (22 cases, 17.8%), stage 3 (25 cases, 20.2%), stage 4 (50 cases, 40.3%), not staged (26 cases, 21%). The majority had squamous cell carcinoma (SCC) (105 cases, 84.7%), followed by adenocarcinoma (5 cases, 4%), anaplastic (5 cases, 4%), SCC+ adenocarcinoma (1 case, 0.8%), unknown histology (8 cases, 3.2%). Nearly all patients had triple assessment (Endoscopy, histology and staging scans) accounting for 92 cases (74.2%), 24 cases (20%) had endoscopy+ histology only, and 8 cases (3.2%) had only imaging scans. In terms of family history of EC, 20 cases (16.1%) had a family history of EC. Most of the patients were of ethnic Kenyan-Somali background (108 cases, Kenyan Somali, 87.1%) and majority were from Garissa County 96 cases (77.4%), 12 cases (9.7%) Wajir County, 12 cases (9.7%) from Tana River County and 4 cases (3.2%) from other counties. Many patients lacked health insurance (27 cases, 25.8%), while the majority paid out of pocket (92 cases,74.1%). Only 21% (26 cases) received chemotherapy alone, 5 cases (4%) got radiotherapy alone, 12.9% (16 cases) got chemoradiotherapy and a significant number of patients (77 cases, 62.1%) did not receive hospital-based cancer treatment. Conclusion: This study is the first esophageal study at the GRCC and in northern Kenya in general. Our study confirmed the clinicopathological features of one of the most common cancers in Kenya and more so among Kenyan-Somalis. The study also validates the predominance of histological subtypes of esophageal SCC with the late presentation, short survival and significant loss of follow-up. We recommend future EC studies employing a large prospective design with a large sample size to determine the impact of the new GRCC on the outcomes of EC patients and the local community. [ABSTRACT FROM AUTHOR]

Background: High-risk human papillomavirus (HR-HPV) is the primary cause of cervical cancer, leading to over 311 000 global deaths, mainly in low- and middle-income countries. Kenyan women living with HIV (WLHIV) face a disproportionate burden of HR-HPV. Objectives: We determined the prevalence of HR-HPV infections and their association with cervical cytology findings among Kenyan WLHIV. Method: We conducted a cross-sectional study among WLHIV attending the HIV care and treatment clinic at the Kenyatta National Hospital (KNH), Kenya's national referral hospital. Study nurses collected a cervical sample with a cytobrush for HR-HPV genotyping using Gene Xpert® assays and HPV Genotypes 14 Real-TM Quant V67-100FRT. Bivariate analysis explored the associations. Results: We enrolled 647 WLHIV (mean age of 42.8 years), with 97.2% on antiretroviral therapy (ART) and 79% with a suppressed viral load (< 50 copies/mL plasma). The prevalence of any and vaccine-preventable HR-HPV was 34.6% and 29.4%, respectively, with HPV 52 being the most common genotype (13.4%). Among WLHIV with HR-HPV infections, 21.4% had abnormal cervical cytology. Women with multiple HR-HPV infections were more likely to have abnormal cytology compared to those with single HR-HPV infections (34.9 vs 9.3%, adjusted odds ratio [aOR] = 6.2, 95% confidence interval [CI]: 2.7–14.1, P = 0.001). Women with HR-HPV infection (single or multiple) were more likely to be on the second-line ART regimen compared to those without HR-HPV infections (53.1% vs 46.7%, aOR = 2.3, 95% CI: 1.3–4.1, P = 0.005). Conclusion: Among WLHIV at KNH, abnormal cytology was common and more frequent among women with multiple HR-HPV infections. [ABSTRACT FROM AUTHOR]

There is growing recognition among global health practitioners of the importance of rights-based family planning (FP) programming that addresses inequities. Despite Kenya achieving its national FP target, inequities in access and use of modern FP remain, especially amongst marginalised nomadic and semi-nomadic pastoralist communities. Few studies explore norms affecting FP practices amongst nomadic and semi-nomadic pastoralists and how these can influence social and behaviour change (SBC) interventions. We carried out 48 in-depth interviews and 16 focus group discussions with women and men from pastoralist communities in North Eastern Kenya in November 2018. Data were analysed thematically. Results from focus groups and interviews confirmed themes, while allowing differences between the qualitative approaches to emerge. We found that large family size was a descriptive and injunctive norm in both nomadic and semi-nomadic communities. The desire for around 10 children was sustained by religious beliefs and pastoralist ways of living. Despite a desire for large families, maintaining child spacing was encouraged and practised through breastfeeding and sexual abstinence. Most participants viewed modern FP negatively and as something used by "others". However, it was acceptable in order to prevent severe negative health outcomes. Future FP research to inform interventions should continue to consider community fertility preferences and the rationale for these, including norms, religion and power dynamics. Targeted qualitative social norms research could inform multi-component SBC interventions in this context. [ABSTRACT FROM AUTHOR]

In Kenya, cancer is the second leading cause of non-communicable disease deaths, and the trend of cancer deaths is projected to increase as per the 2018 GLOBOCAN report showing 47,887 new cases annually with a mortality of 32,987. Common cancers in men in Kenya are esophageal cancers (EC), prostate, colon, and rectum cancers. In contrast, breast, cervical, and EC are the leading cancers in women. However, EC is the most diagnosed cancer in both males and females and the leading cancer-related mortality in Kenya. Published studies regarding the epidemiological factors that may or may not drive the high incidence of EC in Kenya include poor diet and nutritional insufficiencies with high intake of red meat, use of alcohol and tobacco, environmental carcinogenic exposure, intake of hot beverages, and genetic susceptibility citing a remarkable positive close family history of esophageal cancers. Despite the availability of radiation and chemotherapy services at the Garissa Regional Cancer Center (GRCC), there is limited data about the clinicopathologic features and treatment outcomes of EC in this region. Therefore, this is the first study to look at the epidemiological patterns of EC in the northern Kenya region. This was a retrospective study involving patients' file review of confirmed EC cases diagnosed or treated at the GRCC, a regional referral cancer center between 2019 and 2023. Data collected on each patient's chart included age, sex, risk factors, family history, histological type, stage at diagnosis, treatment type, and survival outcomes. For patients who were no longer in contact with the staff through clinic visits, the patients or their next of kin were contacted through phone calls for patients' survival status. Data were collected and stored using the STATA software. 124 esophageal cases were identified, 64 (48%) were males and 60 (52%) were females with a mean age of 57.56 years. In terms of risk factors, hot beverage consumption was the highest (47 cases, 57%), followed by history of peptic ulcer disease (27 cases, 33.5%), smoking (8.9%), gastroesophageal reflux disease (2 cases, 1.6%), unknown (8.7%), and 37% of the patients were lost to follow up with no identifiable risk factors. Stage of diagnosis at presentation was stage 1 (1 case, 0.8%), stage 2 (22 cases, 17.8%), stage 3 (25 cases, 20.2%), stage 4 (50 cases, 40.3%), not staged (26 cases, 21%). The majority had squamous cell carcinoma (105 cases, 84.7%), followed by adenocarcinoma (5 cases, 4%), anaplastic (5 cases, 4%), SCC+ adenocarcinoma (1 case, 0.8%), unknown histology (4 cases, 3.2%). In terms of diagnostic modality, 92 cases (74.2%) had triple modality assessment (Endoscopy, histology, and staging scans), 4 cases (3.2%) had only imaging scans, and 24 cases (20%) had endoscopy+ histology only. 20 cases (16.1%) had a family history of cancer (irrespective of sub-type). Most of the patients were of ethnic Kenyan-Somali background (108 cases, Somali, 87.1%), and other tribes (7 cases, 0.6%). 96 cases (77.4%) were from Garissa County, 12 cases (9.8%) were from Wajir county, 12 cases (12.8%) from Tana River County, and 4 cases (3.2%) from other counties. Most patients paid cash for their treatment (92 cases,77%) while only (27 cases, 23%) paid through the National Hospital Insurance Fund (NHIF). This study is the first esophageal study in northern Kenya and confirmed the clinicopathological features of one of the most common cancers in Kenya and more so among Kenyan-Somalis. The study also validates the predominance of histological subtypes of esophageal squamous cell carcinoma with the late presentation, short survival, and significant loss of follow-up. Our data demonstrates the need for the county government of Garissa in collaboration with the National Cancer Control Program to prioritize EC on the national health agenda, including promoting preventative strategies, cost-effective early screening, early detection, and timely treatment and designing interventions to improve treatment adherence such as using appointment reminders via mobile phones, setting up an up-to-date cancer registry, and enhancing referral pathways. We recommend future esophageal cancer studies employing a large prospective design with a large sample size to determine the impact of the new GRCC on the outcomes of Esophageal cancer patients and the local community. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) remains a top global health problem and its transmission rate among contacts is higher when they are cohabiting with a person who is sputum smear-positive. Our study aimed to describe the prevalence of TB among student contacts in the university and determine factors associated with TB transmission. Methods: We performed a cross-sectional study with an active contact case finding approach among students receiving treatment at Kilifi County Hospital from January 2016 to December 2017. The study was conducted in a public university in Kilifi County, a rural area within the resource-limited context of Kenya. The study population included students attending the university and identified as sharing accommodation or off-campus hostels, or a close social contact to an index case. The index case was defined as a fellow university student diagnosed with TB at the Kilifi County Hospital during the study period. Contacts were traced and tested for TB using GeneXpert. Results: Among the 57 eligible index students identified, 51 (89%) agreed to participate. A total of 156 student contacts were recruited, screened and provided a sputum sample. The prevalence of TB (GeneXpert test positive/clinical diagnosis) among all contacts was 8.3% (95% CI 4.5–14%). Among the 8.3% testing positive 3.2% (95% CI 1.0–7.3%) were positive for GeneXpert only. Sharing a bed with an index case was the only factor significantly associated with TB infection. No other demographic or clinical factor was associated with TB infection. Conclusion: Our study identified a high level of TB transmission among university students who had contact with the index cases. The study justifies further research to explore the genetic sequence and magnitude of TB transmission among students in overcrowded university in resource limited contexts. [ABSTRACT FROM AUTHOR]

• Zebra skin-derived blend K repelled riverine tsetse flies Glossina fuscipes fuscipes. • Sex-specific variations occur in the repellent effect of blend K and WRC. • Geranyl acetone accounts for the repellent effect of blend K on G. f. fuscipes. • Olfactory cues are important in the bioecology of riverine tsetse flies. The riverine tsetse fly Glossina fuscipes fuscipes is a major vector of trypanosome pathogens causing African trypanosomiasis. This fly species uses a combination of olfactory and visual cues to locate its hosts. Previously, traps and targets baited with visual cues have been used in vector control, but the development of olfactory-based tools has been challenging. Recently, repellents have shown promise as olfactory-based tools in tsetse vector control. Here, we evaluated a three-component blend comprising 6-methyl-5-hepten-2-one, acetophenone and geranyl acetone (blend K), previously identified as a repellent for savannah tsetse flies in zebra skin odor, on G. f. fuscipes populations. Using a series of 6 × 6 randomized Latin square-designed experiments, G. f. fuscipes catches in biconical traps were monitored on four islands of Lake Victoria in western Kenya between July and September 2019, after the long rainy season. Traps were baited with blend K and individual components of this blend. The known tsetse repellent blend WRC (waterbuck repellent compounds) and trap alone were included as controls. Daily catch data in thirty-six replicate trials were analyzed using generalized linear model with negative binomial error structure using the package "MASS" in R. Treatment, day and site were set as predictor variables. Our results showed that, blend K significantly reduced G. f. fuscipes catches by 25.6% (P < 0.01) compared to the control trap alone but was not significantly different from WRC which reduced catches by 20.7% (P < 0.05). Of the individual compounds, geranyl acetone solely significantly reduced catches by 29.1% (P < 0.01) which did not differ from blend K or WRC. We conclude that geranyl acetone accounts for the repellent effect of blend K on the riverine tsetse fly, G. f. fuscipes , demonstrating the ecological importance of animal skin odors in the host-seeking behavior of medically-important tsetse fly vectors. Zebra skin-derived blend K and its component, geranyl acetone, repel Glossina fuscipes fuscipes showing their potential for use in the control of these medically-important tsetse flies. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Abstract The camel milk trade in Kenya has evolved significantly from a small-scale business undertaken in local villages to its current status involving a large number of different stakeholders supplying urban towns, particularly Nairobi City. Despite the evident growth pattern, the supply of camel milk to Nairobi has largely remained informal, with minimal enforcement of regulations. The aim of this study was to characterise the camel milk system supplying Nairobi and assess its governance, main challenges and the potential food safety risk practices. A value chain analysis framework was used to carry out data collection between August 2014 and July 2015. Qualitative and quantitative data were collected through focus group discussions and key informant interviews with stakeholders operating in different nodes of the value chains. Three milk value chains supplying Nairobi were identified and mapped: the Isiolo chain, the Kajiado chain and the camel milk processing company chain. Overall, the results indicate that 94% of the milk supplied to Nairobi city is informally traded (traded without any effective regulation), while 6% originates from a formal milk processing company. In the informal chains, milk traders (mostly women) were reported to play a pivotal role in the organisation and daily functioning of the chains. The processing company had partly integrated activities and reported exporting 5% of their products to regional and international markets. Food safety themes identified were associated with i) lack of cold chain, ii) gaps in hygiene practices, particularly at farm and market levels, iii) consumption of raw camel milk, and iv) lack of food safety training, among other issues. Low level involvement by government agencies in enforcing stipulated food safety measures were reported in the informal chains, as these concentrate efforts in the regulation of dairy milk chains. Isiolo milk traders were identified as the dominant group, setting milk prices and providing sanctions. The framework and findings obtained can help future research and policy makers to reach informed decision about what to regulate, where to target and importantly how to make the camel milk value chain more efficient and safer. [ABSTRACT FROM AUTHOR]

• StS-target is more efficient in sampling Glossina fuscipes fuscipes than ES-target and biconical trap. • Cost of catching a fly using the StS-target was 3.4 times lower compared to the biconical trap. • Cost of catching a fly using StS-target was over 19 times lower compared to the ES-target. • Tsetse fly collected from StS target are suitable for PCR base molecular tests. • There is a presence of Spiroplasma in wild G. fuscipes fuscipes of western Kenya. Monitoring the effectiveness of tsetse fly control interventions that aim to reduce transmission of African trypanosomiasis requires highly efficient sampling tools that can catch flies at low densities. The sticky small target (StS-target) has previously been shown to be more effective in sampling Glossina fuscipes fuscipes compared to the biconical trap. However, its efficiency in terms of the proportion of flies it catches out of those that visit it has not been reported. Furthermore, there are no reports on whether tsetse samples caught using the StS-target can be used for subsequent processes such as molecular tests. In this study, we evaluated the efficiency of the biconical trap and targets for sampling G. f. fuscipes. All targets were tiny (0.25 × 0.50 m) but varied in their capture system. We used targets with sticky surface (StS-targets) and those with an electrified surface (ES-targets). We also assessed the suitability of flies caught on the StS-target for molecular tests by amplifying DNA of bacterial communities. Randomized block design experiments were undertaken in Mbita area and Manga Island on Lake Victoria of western Kenya. Fly catches of each sampling tool were compared to those of the sampling tool flanked by electric (E) nets and analyzed using a negative binomial regression. The total catch for each sampling tool alone was divided by the total catch of the sampling tool flanked by two E-nets to obtain its efficiency expressed as a percentage. A proportion of flies caught on the StS-target was preserved for molecular tests. Overall, the efficiencies of the biconical trap, ES-target and StS-target were 7.7%, 13.3% and 27.0%, respectively. A higher proportion of females (69 to 79%) than males approached all the sampling tools, but the trap efficiency was greater for male G. f. fuscipes than females. Furthermore, sequencing the 16S rRNA gene from fly samples caught on the StS-target revealed the presence of Spiroplasma. Our results indicate that the SS-target is the most efficient trap to monitor G. f. fuscipes population during interventions, with the biconical trap being the least efficient, and samples collected from StS-targets are suitable for molecular studies. [ABSTRACT FROM AUTHOR]