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There is growing evidence supporting the effectiveness of a comprehensive school health program. However, implementation in developing countries is a challenge. Furthermore, the available information on the association between a comprehensive school health program and students' academic attainment is limited. In Kenya, a project to verify the effects of a comprehensive school health program was carried out in Mbita sub-county, Homa Bay County from September 2012 to August 2017. This study aimed to clarify the improvement of school health during the project years and the association between school health and students' academic attainment. Primary schools in Mbita sub-county were selected as study sites. We assessed 44 schools' scores on a school health checklist developed from the Kenyan Comprehensive School Health Program, the students' mean score on the Kenya Certificate of Primary Education (KCPE), and absenteeism during the project years (2013-16). The mean school health checklist score (n = 44 schools) was 135.6 in 2013, 169.9 in 2014, 158.2 in 2015 and 181.3 in 2016. The difference of the mean score between 2013 and 2016 was significant. In addition, correlation analysis showed a significant association between mean KCPE score in the project years and school health checklist score (Pearson's coefficient was 0.43, p = 0.004). The results of this study suggest improvements of school health by the implementation of the Kenyan Comprehensive School Health Program and students' academic attainment., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The Kenyan government established the Kenyan Comprehensive School Health Program (KCSHP) on the basis of Kenyan National School Health Policy. A KCSHP pilot project was carried out in eight primary schools in Mbita Sub-County of Homa Bay County in the Nyanza Region from 2012 to 2017. This pilot project provided health facilities and support for evaluation with a school health checklist, and organized teacher training on health education, a child health club, and school-based health check-ups. The present study aimed to examine the appropriateness and reliability of the strategy of the second KCSHP pilot project in Kenya. We analyzed data from self-administered questionnaires targeted at pupils in seventh-grade in the eight primary schools. The questionnaire consisted of questions on health-related knowledge, attitudes and practices, self-evaluated physical and mental health status, self-awareness of health control, subjective happiness, recognition on the importance of learning about health in school, absenteeism, and sense of school belongingness. The project contributed to improving health-related knowledge, attitudes and practices, self-evaluated health status, sense of school belongingness, recognition on the importance of learning about health in school, self-awareness of health control, and absenteeism. On the contrary, subjective happiness did not improve significantly.

Objectives: To describe the roles of Traditional Birth Attendants (TBAs), to determine the perceptions of TBAs and Skilled Birth Attendants (SBAs) towards the policy discouraging home delivery by TBAs and to establish the working relationship between TBAs and SBAs in Kwale, Kenya., Design: Community based cross-sectional study., Setting: Mwaluphamba, Kinango and Golini locations of Kwale County, Kenya., Subjects: Fifty eight participants were involved in the study. Interviews were conducted with 22 TBAs and 8 SBAs as well as 3 FGDs with 28 TBAs were carried out in July 2012., Main Outcome Measures: Roles of TBAs, policy awareness and support as well as the working relationship between TBAs and SBAs., Results: Before delivery, the main role of TBAs was checking position of the baby in the womb (86%) while during delivery, the main role was stomach massage (64%). However, majority (95%) of the TBAs did not provide any after delivery. All SBAs and 59% of TBAs were aware of the policy while 88% SBAs and 36% of TBAs supported it. The working relationship between TBAs and SBAs mainly involved the referral of women to health facilities (HFs). Sometimes, TBAs accompanied women to the HF offering emotional support until after delivery., Conclusion: TBAs in Kwale have a big role to play especially during pregnancy and delivery periods. Awareness and support of the policy as well as the collaboration between SBAs and TBAs should be enhanced in Kwale.

The Mbita Health and Demographic Surveillance System (Mbita HDSS), located on the shores of Lake Victoria in Kenya, was established in 2006. The main objective of the HDSS is to provide a platform for population-based research on relationships between diseases and socio-economic and environmental factors, and for the evaluation of disease control interventions. The Mbita HDSS had a population of approximately 54 014 inhabitants from 11 576 households in June 2013. Regular data are collected using personal digital assistants (PDAs) every 3 months, which includes births, pregnancies, migration events and deaths. Coordinates are taken using geographical positioning system (GPS) units to map all dwelling units during data collection. Cause of death is inferred from verbal autopsy questionnaires. In addition, other health-related data such as vaccination status, socio-economic status, water sources, acute illness and bed net distribution are collected. The HDSS has also provided a platform for conducting various other research activities such as entomology studies, research on neglected tropical diseases, and environmental health projects which have benefited the organization as well as the HDSS community residents. Data collected are shared with the community members, health officials, local administration and other relevant organizations. Opportunities for collaboration and data sharing with the wider research community are available and those interested should contact shimadam@nagasaki-u.ac.jp or mhmdkarama@yahoo.com.

Background: The Health and Demographic Surveillance System (HDSS) is a longitudinal data collection process that systematically and continuously monitors population dynamics for a specified population in a geographically defined area that lacks an effective system for registering demographic information and vital events., Methods: HDSS programs have been run in 2 regions in Kenya: in Mbita district in Nyanza province and Kwale district in Coast Province. The 2 areas have different disease burdens and cultures. Vital events were obtained by using personal digital assistants and global positioning system devices. Additional health-related surveys have been conducted bimonthly using various PDA-assisted survey software., Results: The Mbita HDSS covers 55,929 individuals, and the Kwale HDSS covers 42 585 individuals. In the Mbita HDSS, the life expectancy was 61.0 years for females and 57.5 years for males. Under-5 mortality was 91.5 per 1000 live births, and infant mortality was 47.0 per 1000 live births. The total fertility rate was 3.7 per woman. Data from the Kwale HDSS were not available because it has been running for less than 1 year at the time of this report., Conclusions: Our HDSS programs are based on a computer-assisted survey system that provides a rapid and flexible data collection platform in areas that lack an effective basic resident registration system. Although the HDSS areas are not representative of the entire country, they provide a base for several epidemiologic and social study programs, and for practical community support programs that seek to improve the health of the people in these areas.

Background: Increasing the distribution and use of insecticide-treated nets (ITNs) in Sub-Saharan Africa has made controlling malaria with ITNs more practical. We evaluated community effects induced by ITNs, specifically long-lasting insecticidal nets (LLINs), under ordinary conditions in an endemic malaria area of Western Kenya., Methods: Using the database from Mbita Health and Demographic Surveillance System (HDSS), children younger than 5 years old were assessed over four survey periods. We analyzed the effect of bed net usage, LLIN density and population density of young people around a child on all-cause child mortality (ACCM) rates using Cox PH models., Results: During the study, 14,554 children were followed and 250 deaths were recorded. The adjusted hazard ratios (HRs) for LLIN usage compared with no net usage were not significant among the models: 1.08 (95%CI 0.76-1.52), 1.19 (95%CI 0.69-2.08) and 0.92 (95%CI 0.42-2.02) for LLIN users, untreated net users, and any net users, respectively. A significant increasing linear trend in risk across LLIN density quartiles (HR=1.25; 95%CI 1.03-1.51) and a decreasing linear trend in risk across young population density quartiles among non-net user children (HR=0.77; 95%CI 0.63-0.94) were observed., Conclusions: Although our data showed that current LLIN coverage level (about 35%) could induce a community effect to protect children sleeping without bed nets even in a malaria-endemic area, it appears that a better system is needed to monitor the current malaria situation globally in order to optimize malaria control programs with limited resources.

The aim of this research was to explore people's knowledge, attitude, behaviour and practice towards HIV/AIDS and sexual activity in rural Kenya, where HIV is widespread. The study community was located in south-eastern Kenya, 50 km north of Mombassa, and had an estimated population of 1500. Subjects aged between 16 and 49 were recruited using a stratified cluster-sampling method and they completed self-administered questionnaires. Almost all respondents knew the word 'IV' Around 50% knew of a person living with HIV. About 80% gave 'death' or 'fear' as words representing their image of AIDS. With regard to sexual activity, the distribution of answers to the question 'how many partners have you ever had in your life' was bimodal in males but had only one peak in females, indicating that some men have a large number of sexual partners in their lifetime. First sexual intercourse was at around 12-13 years for both sexes, but female teenagers were more sexually experienced than their male counterparts.

The effect of a piped water supply on human water contact in a Schistosoma haematobium-endemic area in Coast Province, Kenya was studied. After the construction of five community standpipes and one shower unit, there was a 35.1% reduction in the number of people observed using river water, a 44.1% reduction in the frequency of contact with river water, and a 25.4% reduction in the amount of contact. The frequency of river water contact per person also decreased significantly, but the amount of contact per person did not decrease. The total frequency of contact decreased significantly except for washing clothes by the river, washing utensils, and fishing. The frequency per person did not change for most of the activities and significantly increased for washing clothes. The frequency of river water contact in households with high piped water consumption showed a significant decrease compared with those with low piped water consumption. The volume of consumption of piped water was inversely proportional to the distance from the home to the community standpipe. These results indicate that in the study area, the effect of a piped water supply on river water contact behavior was heterologous while the total river water contact decreased significantly, and that the piped water had a beneficial effect on some villagers but very little effect on others.

Parasitic helminths can not choose a strategy for fighting against their hosts but can only compromise with them. They do not kill their hosts because the host is necessary for their survival. Schistosoma haematobium, one of the main causes of tropical parasitic diseases, is a parasitic helminth whose only host is human beings and therefore is considered to evolve fully while adapting to humans. In a human community, the peak intensity and peak prevalence of S. haematobium infection occur in adolescence and suddenly decline thereafter. This is advantageous for the hosts and could be explained as a typical strategy of parasitic helminths. The possible mechanisms of maintaining this host-parasite relationship are the development of acquired protective immunity and the change of human water-contact behavior by age. However, our study in Kenya indicates that the worm burden is regulated mainly by the change of human water-contact behavior. Since human behavior depends on the cultural background of the society, the relation between humans and S. haematobium is an example of the great influence that the human culture has on the host-parasite relationship. For any further investigation of tropical infectious diseases, socio-cultural research is indispensable.

From June 1982 to May 1986 in a small village in Kwale, Kenya, we studied seasonal fluctuations in populations of Bulinus globosus, prevalence of Schistosoma haematobium infection in this snail, and effects of chemotherapy and piped water supply on infection rate of snails. In the perennially-flowing Pemba River, relatively small numbers of snails were collected; they were found only during the hot dry season (December to March). In a tributary stream, the Kadingo River, whose flow ceased at the end of both the cool and hot dry seasons, snail numbers peaked at the end of the cool dry season (October to November) and at the beginning of the hot dry season (January). Large numbers of infected snails were found in the Kadingo River from November to January (short rainy season and beginning of dry season). Selective mass chemotherapy with metrifonate and provision of piped water were begun in February and March 1984. These control measures achieved a significant reduction in the infection rate of snails (P less than 0.001); the annual infection rate for the 2 years before treatment was 9.3% and 13.1%, and for the 2 years after treatment was 3.5% and 3.4%.

In a community in Kwale district, Kenya, selective mass chemotherapy with metrifonate caused a marked reduction in the intensity of Schistosoma haematobium infection from 46.5 to 9.4 eggs/hr and a sharp fall in prevalence of gross hematuria from 18.3% to 5.1%, although overall prevalence was reduced only slightly from 67.4% to 54%. The effect of metrifonate on cure rate and reduction of infection intensity was limited by both age and pretreatment infection intensity. Rate of improvement from gross hematuria was similar in all ages and in all classes of intensity of infection. Two doses of metrifonate reduced the prevalence of gross hematuria as much as 3 doses did, while the effect of a single dose on morbidity remains to be clarified.