Exploring early childhood development programming in Kenya’s arid and semi-arid lands

Background: Promoting high-quality early childhood development (ECD) is vital for individuals’ physical and social well-being and yields significant societal returns. However, children in marginalised regions like Kenya’s arid and semi-arid lands (ASALs) face significant barriers to accessing quality ECD services. Aim: This study aimed to document existing ECD services in Kenya’s ASAL areas, including their availability, types and key characteristics; identify gaps in their provision and propose solutions to enhance access and quality. Setting: This qualitative study was conducted in 10 ASAL counties in Kenya. Methods: Using purposive and snowball sampling techniques, 103 key informants, including pre-primary teachers, parents, healthcare workers, religious leaders and county ECD coordinators, were interviewed. The interviews were audio-recorded, transcribed verbatim and analysed thematically. Results: The study found that while diverse ECD programmes exist in ASAL regions, their quality and effectiveness are hindered by challenges such as inadequate funding, insecurity, extreme weather events, food insecurity, poor infrastructure, inadequate healthcare access and limited early learning opportunities. Recommendations include increasing ECD funding, improving healthcare, enhancing early learning opportunities, promoting livelihood diversification and addressing security and food insecurity. Conclusion: Despite investments in ECD programmes, significant challenges persist, underscoring the need to provide children with high-quality services that foster nurturing care and mitigate risks to their development. This study highlights the urgency of adopting a multi-sectoral approach to strengthen ECD programmes and services in Kenya’s ASAL. Contribution: This article contributes to the scarce literature on ECD programming in Kenya’s ASALs by documenting existing ECD services, identifying critical gaps in their provision and offering actionable recommendations to address barriers to programmed quality and effectivenes

Small and sick newborn care: changes in service readiness scoring between baseline and 2023 for 65 neonatal units implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania

Health Facility Assessments (HFAs) are important for measuring and tracking service readiness for small and sick newborn care (SSNC). NEST360 Alliance aims to reduce neonatal mortality in four countries (Kenya, Malawi, Nigeria, Tanzania). NEST360 and UNICEF facilitated HFA tool design with ministries of health in four African countries and developed two complimentary approaches to summarize readiness. Using the NEST360/UNICEF HFA tool, we collected data, developed two service readiness scoring approaches for SSNC (standards-based scoring by adapted World Health Organization (WHO) health system building blocks (HSBBs) and assessing service readiness across the health system, and level-2+ scoring by WHO clinical interventions), and applied across 65 neonatal units implementing NEST360. Service readiness change was assessed between baseline (Sept 2019-March 2021) and follow-up HFA (May-July 2023). For each neonatal unit, a percentage difference score was computed between baseline and 2023 HFA scores. Scores were calculated for each neonatal unit as the unit of analysis, and disaggregated by HSBB, clinical intervention, and sub-modules. Data from 65 neonatal units were analysed, i.e., 36 in Malawi, 13 in Kenya, 7 in Tanzania, and 9 in Nigeria. Median time between baseline and 2023 HFAs was 31 months [IQR 29–34 months]. Median baseline and 2023 scores were 41% [IQR 35–52%] and 55% [IQR 46–62%] respectively with 14% median score change [IQR 4–18%] for level-2+ scores. For standards-based scores, median baseline and 2023 scores were 51% [IQR 48–58%] and 60% [IQR 54–66%] respectively with a 9% median score change [IQR 3–11%]. Hospitals in Tanzania [Median 24%, IQR 16–30%] and Nigeria [Median 28%, IQR 17–30%] showed greater improvements on average for level-2+ scores compared to hospitals in Kenya and Tanzania. Data on changes in service readiness scores can be used to track service readiness over time, benchmark between hospitals, identify gaps, and assess progress towards newborn targets

Navigating the complexities of managing placenta accreta spectrum: A case series and literature review

Placenta accreta spectrum (PAS) poses a significant risk for maternal morbidity and mortality. There is a global rise in incidence of PAS in tandem with an increase in rates of cesarian section. Previous cesarian section and presence of placenta previa are two independent risk factors for development of PAS. Other risk factors are dilatation and curettage, endometrial ablation, and hysteroscopy. Ultrasound and magnetic resonance imaging are useful in prenatal diagnosis, antenatal follow-up, and pre-operative planning. Patient care is individualized to optimize outcomes with appropriate preoperative counseling. However, a significant number of cases remain undiagnosed and are incidentally discovered during cesarian section or management for retained placenta. Patients may suffer significant morbidity such as postpartum hemorrhage, massive blood transfusion, injury to pelvic viscera, hysterectomy, acute kidney infection, and even death. Cesarean hysterectomy is the mainstay of treatment. In selected cases, conservative management may be offered. This includes leaving the placenta in situ with interval resolution, manual removal, application of compression sutures and balloon tamponade, myometrial resection with repair, and the triple P procedure. In this series, we present seven patients with PAS managed at a tertiary teaching and referral hospital in Kenya. We highlight and discuss their antenatal presentation, intraoperative findings, management and the postoperative course. Early diagnosis, involvement of multidisciplinary team, and good preoperative planning are key to achieving a good outcome. Patients with PAS should be managed in facilities with sufficient resources, skilled personnel to manage complications arising from treatment such as need for massive transfusion, and intensive care

Air pollution exposures in early life and brain development in children (ABC): protocol for a pregnancy cohort study

Introduction Air pollution is linked with poor neurodevelopment in high-income countries. Comparable data are scant for low-income countries, where exposures are higher. Longitudinal pregnancy cohort studies are optimal for individual exposure assessment during critical windows of brain development and examination of neurodevelopment. This study aims to determine the association between prenatal ambient air pollutant exposure and neurodevelopment in children aged 12, 24 and 36 months through a collaborative, capacity-enriching research partnership. Methods and analysis This observational cohort study is based in Nairobi, Kenya. Eligibility criteria are singleton pregnancy, no severe pregnancy complications and maternal age 18 to 40 years. At entry, mothers (n=400) are administered surveys to characterise air pollution exposures reflecting household features and occupational activities and provide blood (for lead analysis) and urine specimens (for polycyclic aromatic hydrocarbon (PAH) metabolites). Mothers attend up to two additional antenatal study visits, with urine collection, and infants are followed through age 36 months for annual neurodevelopment and caregiving behaviour assessment, and child urine and blood collection. Primary outcomes are child motor skills, language and cognition at 12, 24 and 36 months, and executive function at 36 months. The primary exposure is urinary PAH metabolite concentrations. Additional exposure assessment in a subset of the cohort includes residential indoor and outdoor air monitoring for fine particulate matter (PM2.5), carbon monoxide (CO), ultrafine particles (UFP) and black carbon (BC). Ethics and dissemination This study was approved by the Kenyatta National Hospital - University of Nairobi Ethics and Research Committee, and the University of Washington Human Subjects Division. Results are shared at annual workshops

A discourse on Madina Fāzila, Virtuous State, in Muslim Thought: An overview of Jalāl-Al-Dīn Muḥammad Davānī’s Aḵlāq-e-Jalālī

This study focuses on Jālāl-al-Dīn Muḥammad Davānī (1426–1502) as an illustrative figure in Muslim political thought, who offered a comprehensive perspective on the characteristics of an ideal Muslim state. Drawing on Davānī’s magnum opus, Akhlaq-e-Jalālī, the study explores his ethical framework for understanding the interrelationship between the individual, the state, and society. This work remained among the most influential writings on Muslim ethics, particularly in the Indian context, and continued to shape Muslim intellectual discourseand educational curricula well into the late 20th century. Its enduring presence highlights its intellectual relevance and its capacity to inspire ongoing debates on Muslim ethics.This paper concentrates on the third section of Akhlaq-e-Jalālī, which addresses fundamental questions concerning politics, governance,statecraft, and the contested notion of the ideal state, Madina Fāzila (the virtuous city/state). Davānī outlines the constitutive elements of such a state by synthesizing Peripatetic rationalism, Illuminationist metaphysics, and Sufi ethics. Central to his political philosophy is the principle of ‘adl (justice)’which he regards as requiring morality to permeate political praxis. This morality, rooted in Islamic values and piety, necessitates ethical behavior at individual, familial, societal levels.Consequently, the core components of Davānī’s virtuous state include morally guided citizens, ethical politics, principled statecraft, and an ideal ruler whose actions are rooted in Islamic morality and who surpasses others in knowledge and understanding. Davānī’s conception of the ideal ruler closely parallels Plato’s philosopher-king, though it is reinterpreted through the framework of Islamic ethical thought. In his vision, the virtuous state is one in which morality and justice are not only interdependent but also mutually reinforcing, working together to promote happiness and well-being at both the individual and societal levels

The impact of undernutrition and overnutrition on early brain development

In this review, we explore the effects of malnutrition on childhood neurodevelopment. Early brain development is highly sensitive to nutritional status. Both undernutrition and overnutrition can disrupt critical neurodevelopmental processes, affecting cognition, emotional regulation, and long-term mental health. Nutrient deficiencies, such as iron, iodine, folate, and vitamin B12, have been linked to impaired brain growth and function. Similarly, excessive caloric intake can also negatively impact brain development as it may contribute to neuroinflammation and altered neurocircuitry. The effects are most pronounced during prenatal life and early childhood, with lasting consequences on academic performance, behavior, and productivity. In addition to health-related outcomes, undernutrition and overnutrition can also have significant social and financial repercussions for individuals and their communities. This review synthesizes current insights on the relationship between nutrition and brain development, explores specific nutrient effects, and highlights the role of public health interventions. Addressing both undernutrition and overnutrition through early and targeted action is essential for optimizing neurodevelopment and reducing the long-term societal burden of cognitive and mental health disorders. Continuous monitoring of both existing and emerging nutritional deficiencies is necessary, particularly in marginalized communities and low- and middle-income regions, where the risk of undernutrition remains high

Human immunodeficiency virus and associated pneumonia

Pneumonia is a major global health concern and a leading cause of death worldwide. According to the World Health Organization, pneumonia accounts for over 2.5 million deaths annually, which means almost 1% of all deaths occur every 13 seconds due to this disease. Pneumonia affects approximately 450 million people globally per year, and in the United States alone, about 1 million adults are hospitalized each year because of pneumonia, leading to approximately 50,000 deaths annually. This disease can be caused by various pathogens, including bacteria, fungi, and viruses, and has significant implications for global health, particularly in vulnerable populations like children, the elderly, and immunocompromised individuals. This comprehensive work aims to explore pneumonia in-depth, detailing its pathology, physiology, and treatment strategies. The book is organized into two sections: Section 1 deals with pneumonia in general, providing a foundation for understanding the disease. Section 2 explores pneumonia in the context of specific conditions and populations, offering a targeted perspective on the disease. Understanding pneumonia’s multifaceted nature is crucial for effective diagnosis and treatment, especially given its significant impact on global health. This book is designed to provide valuable information for medical students, nurses, clinicians, healthcare providers, and specialists, equipping them with the knowledge necessary to manage patients effectively

What did Jan Hjärpe choose from the Islamic basket? A study of the dominant voice on Islam in Sweden, 1980–2000

This chapter analyses the non-Muslim Islam of a Swedish academic, Professor Jan Hjärpe, who was the most prominent voice in the public sphere of Sweden from 1979 until the first years of the twenty-first century.While Hjärpe was always nuanced when writing about Islam, he produced – mainly as side-effect of choices – certain normalities and interpretations of Islam. I argue that these can be seen as expressions of non-Muslim Islam. This chapter is not a critique of Hjärpe’s writing, which has by and large stood the test of time, but a case-study aiming to discuss researchers’ awareness and control of the logical consequences of choices of words and topics. It addresses non-Muslim Islam as an often-unintended by-product of scholarly writing