Does insecticide resistance contribute to heterogeneities in malaria transmission in The Gambia?

BACKGROUND: Malaria hotspots, areas with consistently higher than average transmission, may become increasingly common as malaria declines. This phenomenon, currently observed in The Gambia, may be caused by several factors, including some related to the local vectors, whose contribution is poorly understood. METHODS: Using WHO susceptibility bioassays, insecticide resistance status was determined in vector populations sampled from six pairs of villages across The Gambia, each pair contained a low and high prevalence village. RESULTS: Three vector species were observed (23.5% Anopheles arabiensis, 31.2% Anopheles gambiae, 43.3% Anopheles coluzzii and 2.0% An. coluzzii × An. gambiae hybrids). Even at a fine scale, significant differences in species composition were detected within village pairs. Resistance to both DDT and deltamethrin was more common in An. gambiae, most markedly in the eastern part of The Gambia and partly attributable to differing frequencies of resistance mutations. The Vgsc-1014F target site mutation was strongly associated with both DDT (OR = 256.7, (95% CI 48.6-6374.3, p < 0.001) and deltamethrin survival (OR = 9.14, (95% CI 4.24-21.4, p < 0.001). A second target site mutation, Vgsc-1575Y, which co-occurs with Vgsc-1014F, and a metabolic marker of resistance, Gste2-114T, conferred additional survival benefits to both insecticides. DDT resistance occurred significantly more frequently in villages with high malaria prevalence (p = 0.025) though this did not apply to deltamethrin resistance. CONCLUSION: Whilst causality of relationships requires further investigation, variation in vector species and insecticide resistance in The Gambia is associated with malaria endemicity; with a notably higher prevalence of infection and insecticide resistance in the east of the country. In areas with heterogeneous malaria transmission, the role of the vector should be investigated to guide malaria control interventions

Caregiver’s Knowledge, Perception and Mitigation Strategies towards Teenage Pregnancy Prevalence in Siaya County, Kenya

Teenage pregnancy is the percentage of pregnant women aged 19 years or younger in a given period of time. Its affects an estimated 21 million pregnancies each year in LMICs, of which approximately 50% were unintended and which resulted in an estimated 12 million birth. In Africa, the rate of teenage pregnancy is 118 per 1000 females with 700,000 mortalities each year. In Kenya, the prevalence of teenage pregnancy is 15% While 21% in Siaya County. The high percentage in teenage pregnancy prevalence is attributed by factors such as peer pressure, poverty, lack of stable family structure, cultural practices, and lack of education on sexuality among others. In mitigation of teenage pregnancy, caregivers play critical role which is closely linked to their perceptions and knowledge of teenage pregnancy. Gaining an understanding of caregiver perception and knowledge regarding teenage pregnancy and their role in mitigating the issue could help inform the development of effective interventions and policies. Studies specifically focusing on caregiver‘s knowledge, perceptions and mitigation strategies in Siaya County have been lacking. Therefore the goal of this study to determine caregiver‘s knowledge, perceptions and mitigation strategies towards teenage pregnancy prevalence in Siaya County. The specific objectives were to determining the prevalence of teenage pregnancy, determine the knowledge of caregiver towards teenage pregnancy, to determine the perception of caregiver‘s towards teenage pregnancy and to establish the strategies put in place by caregivers in the mitigation of teenage pregnancy and to determine the association between caregiver socio-demographic attributes and teenage pregnancy prevalence in Siaya County. A cross-sectional study design was employed in this study. Pre-tested questionnaires and Key Informant Interview guide were used to collect data. A multi-stage cluster sampling technique was used to select a total of 319 households, while purposive sampling was used to select 6 key informants who participated in the study. Descriptive statistics and Chi-square test of independence were used to analyse quantitative data with the aid of SPSS version 23. Qualitative data were thematically analysed by using Nvivo software The study findings revealed that the majority of caregivers displaying knowledge on teenage pregnancy based on a five-point Likert scale while had experience with a pregnant teenager. Caregivers generally held negative perceptions of teenage pregnancy but expressed positive perception towards perceived mitigation strategies, as indicated by weighted averages. Although caregivers agreed with practicing some of mitigation strategies, they disagreed with others. Additionally, the study findings demonstrated that no statistically significant relationships were found between gender (P=0.218), age (P=0.665), marital status (P=0.752), occupation status (P=0.866), education level (P=0.113), and teenage pregnancy prevalence. Religion (P≤0.050), on the other hand, exhibited a significant influence on teenage pregnancy prevalence in Siaya County. The results of this study provide valuable insights into caregiver perceptions of teenage pregnancy and the mitigation methods they employ. The findings will also inform the in informing policies and interventions that address teenage pregnancy, which could also help to identify best practices, challenges, and gaps in mitigating the problem

Effects of Social, Cultural and Economic Factors on Consumption of Edible Insects for Household Food Security

Edible insects have been identified as a possible sustainable food source not only because they are rich in proteins and other nutrients required by the body, but they can also cheaply and sustainably support the hungry, the malnourished and the poor. Indisputably, people have been slow to embrace the consumption of edible insects across the globe and narrowly in Siaya County of Western Kenya. Few studies have been conducted to provide information on low uptake and consumption of edible insects in the county, especially pertaining to social, culture and economic factors. A multistage random sampling technique was used in the selection of the respondents in this study, followed by a systematic data collection using a digital questionnaire coded and configured in ODK Collect. A descriptive study design was adopted whereby a semi-structured questionnaire was used to collect data on key variables. Additionally, a key informant interview guide was also used to collect data mainly for triangulating information received from the respondents on enabling and limiting factors (social, cultural, and economic variables) on the consumption of insects as a household food security source. Descriptive statistic such as frequencies, percentages, means and standard deviations and graphics were used to report the analysis and visualization of the collected data. An ordinal regression model was used to assess the effects of social, cultural, and economic factors on the consumption of edible insects in the county. It was found that there was no significant association between formal education and insect consumption, family size and insect consumption rate or between age and insect consumption. However, the findings revealed that economic activities of the participants do influence the consumption of insects in households, although the land owned by respondents did not significantly influence the consumption of insects. Insect consumption in the region of study, was also impacted by the cultural beliefs and values of the respondents

Sound analysis prototype to enhance physical security in academic institutions

Thesis submitted in partial fulfillment of the requirements for the Degree of Master of Science in Information Technology (MSIT) at Strathmore UniversityCompetence in the provision of security to the civilians in Kenya has generally deteriorated and hence negatively affecting the public trust accorded to security agencies. Indeed, the police to civilian ratio is low and this has affected the institutions of learning as they have become new attack grounds for the terrorists. Institutions of learning have suffered the worst since they are expected to be accountable of their own security in many cases. As a result, many institutions of learning use available security agencies, most of which employ outdated and less efficient means of implementing security. Examples of commonly used physical security techniques include the use of security guards, perimeter walls, some places use turnstiles as well as CCTVs. The inefficiencies that comes along with these security measures has still however exposed these institutions to great dangers of insecurity. This study proposes the use of sound classification to enhance physical security. The solution relies on the integration of the possible solutions of the artificial neural networks (ANN) in sound classification to detect sound variations in the leaning institutions. It is expected that decisions made through classification assist security personnel on the ground to tighten the physical security. The solution offers automatic analysis of the recorded sound from the environment, compares it to the stored dataset which has urban sounds and the score labels displayed on the output screens for the security personnel to help them enhance the available physical security. The usage of scientific research methodology through experimentation ensured that the sounds were captured, the dataset sounds were collected and trained for comparison to take place and finally results validated to prove the theory. The system proved an accuracy percentage of 78%, and the efficiency, user friendliness and reliability were al passed

Determinants of Point-of-Care Technology Use among Health Care Workers in Comprehensive Care Centres, A Case of Central Kenya

The Point of Care (POC) approach is the highest level of interaction between health care workers (HCW) and the information system, which generally requires interaction during clinical meetings. Although it is hard to do so, it offers the most significant benefits. The POC strategy offers the system’s benefits to healthcare workers, patients, and those who monitor and evaluate them. The study focused on identifying key determinants of point-of-care technology use among healthcare workers offering services in comprehensive care centres in Central Kenya. A Cross-sectional descriptive study was adopted, two-stage cluster sampling design method was used in determining the sample size. The study involved a sample size of 217 respondents and over a 100% was achieved. The study results revealed that social demographic factors of health care workers have no significant influence on POC technology use as a p-value of above 0.05 was observed on all the variables. Some organisational factors such as adequate workstations (p = 0.0) and EMR reducing patient time (p = 0.012) were found to have significant influence on POC technology use. Significant influence on POC use was noted on source of funding for software and hardware maintenance (p = 0.001). The utilisation of EMR to review client progress in real-time (p = 0.001) was found to have a significant influence on POC technology use as well as the use of EMR to report to the national reporting system (KHIS) (p = 0.014). 71% of respondents reported that availability of clinical decision support features in the EMR was contributing to improved use of POC. An overwhelming 72% reported that they were very motivated to use POC technology due to the ability of auto generating reports. In addition, three factors were highlighted as key contributors to the success of POC use, and these were reliable power supply (44%), adequate and trained healthcare workers (24%), standard and stable EMR Systems (17%). The study recommended for adequate training of health care workers, adequate workstations, and reliable power supply. For initial implementers of EMRs, they should consider having Standard EMRs that support both clinical decision support features and automated reporting

INFLUENCE OF PLASTIC WASTE MANAGEMENT ON THE LIVELIHOODS OF INFORMAL SETTLEMENT RESIDENTS IN KAJIADO NORTH CONSTITUENCY, KAJIADO COUNTY (KENYA)

Purpose: The study aimed at examining the influence of plastic waste management on the livelihoods of residents in the informal settlements in Kajiado North Constituency. Methods: This study used mixed method research design. The target population in this study was households which comprised of informal settlement residents, business outlets or owners and waste segregators. The sample population was 96 informants living within the informal settlements in Kajiado North Constituency. Purposive sampling was used during this study. The study collected both quantitative and qualitative data through key informant, interviews and questionnaires. This study also utilized both primary and secondary sources of data. The research instruments were tested to determine their reliability and validity. The data gathered were quantitatively and qualitatively analyzed to determine if certain conjectures were substantiated.&nbsp; Results: The problems facing developing countries in handling of plastic waste are not impossible to solve but they need concerted effort from all sectors of society.&nbsp; Management of plastic waste is the responsibility of every resident. Meaning that an all-inclusive approach should be adopted in order to achieve any meaningful and lasting solution and eliminate the exploitation of the informal plastic waste collectors. Unique contribution to theory, practice and policy: There should be a participatory approach in the management of Plastic Waste by involving all stakeholders who include the civil society, NGOS, CBOs and the informal sector so as to facilitate the planning process, mobilization of resources and the maintenance of economic, social and environmental infrastructure. Key words: Plastic waste management, livelihoods, residents, informal settlements, Kajiado North Constituenc

Cultivating Household Food Security through Resource – Use Efficiency among Cash Crop Farmers: Evidence from Tobacco Producers in Uganda

Poverty, food insecurity and malnutrition cases have been reported among farmers who prioritize cash crops such as tobacco. This is as a result of inefficient allocation of farm resources to tobacco production, with little or no allocation to staple food crops. To increase food production among such farmers, researchers have recommended optimum allocation of farm resources between tobacco and staple food crops. This study therefore aimed at determining the resource use efficiency for tobacco – food crop production, the optimal farm plans and the factors affecting resource use efficiency for food crops production. Data Envelopment Analysis was used to assess the level of resource use efficiency and the optimal farm plans while Tobit model was used to determine the factors affecting resource use efficiency for the optimal farm plans. The results from data drawn from 200 tobacco farmers in Western Uganda depicted that farmers were 61% efficient in their resource allocation to tobacco and food crops. Results for the optimal allocation plans suggested that farmers should optimally allocate their resources to tobacco and food crops in order to achieve household food requirements. Household size, pesticides use, farm income and support from the tobacco contract companies had a positive association with resource use efficiency for food crop production while input prices, land size and gender had a negative relationship with resource use efficiency. In conclusion, farmers are inefficient in allocating their farm resources between tobacco and other food crops which has far-reaching implications for availability of household foods. The study therefore recommends that the governments of SSA should increase the training and extension services on the adoption of optimum resources for cash – food crop production as well as supporting the farmers through inputs subsidies so as to increase household food production

Perspectives of stakeholders of the free maternity services for mothers in western Kenya: lessons for universal health coverage

Background: The strategic aim of universal health coverage (UHC) is to ensure that everyone can use health services they need without risk of financial hardship. Linda Mama (Taking care of the mother) initiative focuses on the most vulnerable women, newborns and infants in offering free health services. Financial risk protection is one element in the package of measures that provides overall social protection, as well as protection against severe financial difficulties in the event of pregnancy, childbirth, neonatal and perinatal health care for mothers and their children. Purpose: The aim of this study was to find out the extent of awareness, and involvement among managers, service providers and consumers of Linda mama supported services and benefits of the initiative from the perspectives of consumers, providers and managers. Methods: We carried out cross sectional study in four sub counties in western Kenya: Rachuonyo East, Nyando, Nyakach, and Alego Usonga. We used qualitative techniques to collect data from purposively selected Linda Mama project implementors, managers, service providers and service consumers. We used key informant interview guides to collect data from a total of thirty six managers, nine from each Sub -County and focus group discussion tools to collect data from sixteen groups of service consumers attending either antenatal or post-natal clinics, four from each sub county, selecting two groups from antenatal and two from postnatal clinics in each sub county. Data analysis was based on thematic content analysis. Findings: Managers and service providers were well aware of the initiative and were involved in it. Participation in Linda Mama, either in providing or using, seemed to be more prominent among managers and service providers. Routine household visits by community health volunteers to sensitize mothers and community engagement was core to the initiative. The managers and providers of services displayed profound awareness of how requiring identification cards and telephone numbers had the potential to undermine equity by excluding those in greater need of care such as under-age pregnant adolescents. Maternity and mother child health services improved as a result of the funds received by health facilities. Linda Mama reimbursements helped to purchase drug and reduced workload in the facility by hiring extra hands. Conclusion: The initiative seems to have influenced attitudes on health facility delivery through: Partnership among key stakeholders and highlighting the need for enhanced partnership with the communities. It enhanced the capacity of health facilities to deliver high quality comprehensive, essential care package and easing economic burden

Status of Client Satisfaction for Sexual Reproductive Health Services: A Case Get Up Speak Out (GUSO) Program Implementation in Western Kenya

Young people face a wide range of barriers to accessing SRHR services from structural barriers: - Cost of services, waiting times, distance from health facilities, lack of privacy and confidentiality and lack of necessary commodities among others; Sociocultural barriers: - such as restrictive norms and culture that surround young people’s SRHR, inequitable gender norms among others; Individual barriers: - myths and misconceptions, limited knowledge on SRHR issues, limited knowledge on the SRH services and the sources of such services. Youth-friendly services are designed to address one of the main barriers mentioned above- Structural barriers. The youth-friendly services are tailored for young people to ensure their retention in the SRH seeking routine. TICH in the Get Up Speaks Out program, trained service providers in the various community link health facilities on youth-friendly services to ensure that the youth are attracted to access services at the health facilities. It is for this reason that TICH conducted a client satisfaction survey assessing the quality of services provided to the young people on the aspects of waiting time, availability of equipment and drugs, and satisfaction with service delivery among others. The study was conducted in 2019 among the young people aged 10 to 24 years (members of the TICH-GUSO youth groups) who had accessed the last SRHR services from the community health facilities. Semi-structured questionnaires were developed and administered to the respondents by the field officers. This study highlights the variance between services sought by young people and the ones they receive thereby demonstrating a gap in information among young people on SRH services available at the health facilities. Additionally, the study indicated secondary and primary school students utilise most SRH services among young people. Finally, the evidence indicated that young people appreciate short waiting times at the health facilities (of below 30 minutes). The findings therefore call for strategies to address waiting times at the health facilities and information on SRH services among young people for improved access to YFS among the young people