Linking Research to Development in Pastoral Communities of Northern Kenya: Recent Experiences and Key Findings in Participatory Research Approaches

Over 50% of Kenya\u27s land mass is arid. The mainstay of the local economies of these areas is nomadic pastoralism. Arable agriculture is limited to the few oases and mountain zones. Due to the harsh climate, there are few alternative livelihood options available to the local communities of mostly herders. Efforts to improve agricultural productivity have often been hampered by low adoption of available technologies. This low adoption is linked to many factors, notably the non-involvement of the stakeholders in the research process and the weak linkage between research and extension. To address these shortcomings, new approaches were tested with the aim of improving acceptability and use of agricultural technologies and knowledge in a pastoral community of northern Kenya

Meeting the needs of schools and communities through improved WASH interventions in Kenya

This is an experience sharing about a strategy for meeting high demand for WASH interventions in school communities. Overwhelming demands for WASH facilities in most primary schools in Kenya has been created by the introduction of free primary education. Many WASH interventions have focused only on implementation of WASH facilities in schools while pupils still face challenges associated with inadequate WASH facilities at home. The paper outlines the approaches of project implementation which incorporated mechanisms for up scaling, replicating and sustaining the WASH projects both within the school and in the community. The approaches are highlighted using a case study about a school WASH project implemented by SANA International and funded by WaterCan in which the impact assessment findings indicated improved accessibility to improved WASH facilities and behaviour change. The paper also outlines the project approaches and technologies and key lessons learnt that can be recommended similar interventions in future

Fungi associated with sweet potato tuber rot at CSIR - PGRRI, Bunso, Eastern Region, Ghana

Rotten sweet potato root tuber samples were collected from a barn and experimental field of the CSIR - Plant Genetic Resources Research Institute (PGRRI), Bunso. Isolation and identification of the fungi associated with the samples were carried out at the Plant Pathology Laboratory of the same institute. In all, six fungal species belonging to four genera, namely Fusarium solani, Sclerotium rolfsii, Lasiodiplodia theobromae, Aspergillus ochraceus, Aspergillus flavus and Aspergillus niger were isolated from the samples from both the barn and the experimental field of CSIR - PGRRI. Fusarium solani and Aspergillus niger were frequently isolated from the sweet potato tuber samples from both the field and the barn. Pathogenicity tests carried out using the six fungal isolates on fresh and healthy sweet potato tubers showed that all the six fungi isolated were pathogenic in causing rot of sweet potato tubers with Lasiodiplodia theobromae being the most virulent

Trends in the prevalence of female genital muti-lation and its effect on delivery outcomes in the kassena-nankana district of northern Ghana

Rational: Female genital mutilation (FGM) is prevalent in northern Ghana, as the practice is seen as a passage rite to women adulthood and thus undertaken just before marriage. Objectives: We determined the changes in trend of FGM in deliveries at the Navrongo War Memo-rial hospital, and compared the outcomes and FGM status.Design: Retrospective extraction and analysis of delivery data at the hospital from 1st January 1996 to 31st December 2003. Results: Of the 5071 deliveries, about 29% (1466/5071) were associated with FGM. The high-est prevalence (95% CI) of 61.5% (50.9, 71.2) was in women aged 40 years and above, and the lowest of 14.4% (11.7, 17.0) was in women below 20 years. The all-age prevalence of FGM showed a significant decline (p-value for linear trend < 0.01) from 35.2% in 1996 to 21.1% in 2003. About 6% (89/1466) of mothers with FGM had stillbirths compared with about 3% (123/3605) of mothers without FGM. Again FGM was associated with 8.2% (120/1466) caesarean section rate compared with 6.7% (241/3605) in mothers without FGM. Mean birth weight and frequency of low birth weights were not significantly associated with FGM status. Conclusion: Although there is a high rate of FGM among mothers in the district and is associated with a higher proportion of stillbirths and caesar-ean sections, practice has shown a significant de-cline in the district in recent years due to the pre-vailing campaigns and intervention studies. There is therefore the need to sustain the ongoing inter-vention efforts

“I don’t know anything about their Culture”: The Disconnect between Allopathic and Traditional Maternity Care Providers in Rural Northern Ghana

The provision of maternal and neonatal health care in rural northern Ghana is pluralistic, consisting of traditional and allopathic providers. Although  women often use these providers interchangeably, important differences exist. This study explored the differences in approaches to maternal and neonatal care provision by these two different types of providers. This  research was part of the Stillbirth and Neonatal Death Study (SANDS),  conducted in northern Ghana in 2010. Trained field staff of the Navrongo Health Research Centre conducted in-depth interviews with 13 allopathic and 8 traditional providers. Interviews were audio-recorded, transcribed, and analyzed using in vivo coding and discussion amongst the research team. Three overarching themes resulted: 1) many allopathic providers were isolated from the culture of the communities in which they practiced, while traditional providers were much more aware of the local cultural  beliefs and practices. 2) Allopathic and traditional healthcare providers have different frameworks for understanding health and disease, with  allopathic providers relying heavily on their biomedical knowledge, and traditional providers drawing on their knowledge of natural remedies. 3) All providers agreed that education directed at pregnant women, providers (both allopathic and traditional), and the community at large is needed to improve maternal and neonatal outcomes. Our findings suggest that, among other things, programmatic efforts need to be placed on the cultural education of allopathic providers. (Afr J Reprod Health 2014; 18[2]: 36-45).Keywords: Allopathic medicine, traditional medicine, maternal health, delivery care, cultur

Assessing the Relationship between Short Birth-to-Pregnancy Interval and the Maternal and Perinatal Outcomes among Multiparous Women in Northern Ghana

Introduction: The World Health Organization (WHO) recommends an optimal Birth-to-Pregnancy Interval (BPI) of 24-59 months, or a 33-month interval between two successive births, to reduce the risk of untoward maternal and newborn outcomes. Short Birth to Pregnancy Interval (SBPI) and unmet need for Family Planning (FP) are the major contributors to rapid population growth and increased maternal and newborn mortalities. The purpose of this study was to assess the adverse perinatal and maternal outcomes associated with SBPI among multiparous women in three municipalities of the Upper East Region (UER) of Ghana. Materials and Methods: We employed a cross-sectional design conducted among 904 women aged 15-49 attending Antenatal Care (ANC) clinics in three municipalities in the UER who had at least two successive live births prior to data collection. A multistage cluster sampling technique was employed to recruit respondents for this study. This was conducted in four steps. Out of the 46 health facilities, we randomly selected 25 respondents using the systematic random selection method. Data was collected using a structured questionnaire, incorporated into the electronic data collection tool (Kobo collect), and administered by trained research assistants. Birth interval was categorized according to the WHO’s classification: &lt;24 months as SBPI, 24-≥59 months as Optimal Birth to Pregnancy Interval (OBPI), and &gt;59 months as Long Birth to Pregnancy Interval (LBPI). Results: Of the 904 respondents, the majority (56.2%) had an OBPI, while 36.9% had a SBPI. Factors that influenced SBPI were parity, mode of delivery, and the educational status of woman’s partner. Participants with a higher parity (≥5 children) had 0.67 times the potential of spacing their births (AOR 0.67; 95% CI 0.46-0.98; p = 0.040). Women who experienced a Caesarean Section (CS) delivery were 3.28 times more likely to have LBPI (AOR 3.28; 95% CI 1.02–10.62; p=0.047). Respondents whose partners had secondary education had a 1.87 chance (AOR 2.07; 95% CI 1.09–3.96; p=0.027) of spacing their births. The birth complications reported were retained products of conception (41.9%), pregnancy-induced hypertension (27.9%), postpartum hemorrhage (11.6%), obstructed labor (10.5%), sepsis (38.1%), neonatal jaundice (23.8%), low birth weight (19%), and preterm birth (14.3%). Conclusion: A significant proportion of the participants in this study reported having a short duration between the birth of one child and the conception of the next. This was associated with various adverse maternal and perinatal outcomes, such as birth complications and mortalities. The study emphasizes the need for health professionals to address challenges in contraceptive uptake, especially among multiparous women, and promote optimal birth spacing to improve maternal and perinatal outcomes

Assessing the Relationship between Short Birth-to-Pregnancy Interval and the Maternal and Perinatal Outcomes among Multiparous Women in Northern Ghana

Introduction: The World Health Organization (WHO) recommends an optimal Birth-to-Pregnancy Interval (BPI) of 24-59 months, or a 33-month interval between two successive births to reduce the risk of untoward maternal and newborn outcomes. Short Birth to Pregnancy Interval (SBPI), and unmet need for Family Planning (FP) are the major contributors to rapid population growth and increased maternal and newborn mortalities. The purpose of this study was to assess the adverse perinatal and maternal outcomes associated with SBPI among multiparous women in three municipalities of the Upper East Region (UER) of Ghana. &nbsp;Materials and Methods:The study employed the Cross-sectional Design conducted among 904 women aged 15-49 years attending Antenatal Care (ANC) clinics in three municipalities in the UER who had at least two successive live births prior to data collection. Data was collected using structured questionnaire, incorporated into the electronic data collection tool, Kobo collect and administered by trained research assistants. Birth interval was categorized according to the WHO’s classification, &lt;24 months as SBPI, 24-≥59 months as Optimal Birth to Pregnancy Interval (OBPI) and &gt;59 months as Long Birth to Pregnancy Interval (LBPI). Results: Of the 904 respondents, the majority (56.2%) had an OBPI, while 36.9% had a SBPI. Factors that influenced SBPI were parity, mode of delivery, and the educational status of women’s partner. Participants with a higher parity (≥5 children) had 0.67 times the potential of spacing their births (AOR 0.67; 95% CI 0.46-0.98; p = 0.040). Women who experienced a Caesarean Section (CS) delivery were 3.28 times more likely to have LBPI (AOR 3.28; 95% CI 1.02-10.62; p=0.047). Respondents whose partners had secondary education had a 1.87 chance (AOR 2.07; 95% CI 1.09-3.96; p=0.027) of spacing their births. The birth complications reported were retained products of conception (41.9%), pregnancy-induced hypertension (27.9%), postpartum hemorrhage (11.6%), obstructed labor (10.5%), sepsis (38.1%), neonatal jaundice (23.8%), low-birth-weight (19%), and preterm birth (14.3%). Conclusion and Global Health Implications: The study recommends health professionals in direct contact with maternal, reproductive, and child health to be proactive in FP counseling, and to support women decision making

A Policy Brief on Adopting the Somali Camel for Enhanced Profitability and Pastoral Resilience in Northern Kenya

Persistent drought and high temperatures in Isiolo and Marsabit counties of northern Kenya repeatedly devastate livestock herds particularly cattle making the pastoralists less resilient, more vulnerable to climate change and poor. To address this challenge, an IGAD funded project promoted adoption of Somali camel breed, trained farmers on improved management and also estimated potential profitability of rearing the camel. Through the project, trainers were trained and facilitated to train 240 peri-urban Somali camel producers in Isiolo and Marsabit on breeding, health, routine husbandry and marketing. Impact study documenting positive stories of change was conducted at the end. Producers who hitherto made zero money from their camels were making KES. 42,000 a month from sale of 20 litres of milk daily from only 5 milking camels; producers had adopted a new grazing management strategy that ensured daily access of the camel milk market and conservation of grazing areas around settlements; motor bikes had been adopted as means delivering milk to collection centers thus creating jobs for the youth; the beneficiary producers were spending more money on production inputs. In terms of policy, the county governments of Isiolo and Marsabit need to appreciate the huge business potential in Somali camel rearing and the magnitude of positive change that can be brought about by capacity training of producers on improved camel management technologies and agree to allocate more funds in support of livestock production extension services

Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined protocol: A nested cohort from the ComPAS RCT

INTRODUCTION: Severe and moderate acute malnutrition (SAM and MAM) affect more than 50 million children worldwide yet 80% of these children do not access care. The Combined Protocol for Acute Malnutrition Study (ComPAS) trial assessed the effectiveness of a simplified, combined SAM/MAM protocol for children aged 6-59 months and found non-inferior recovery compared to standard care. To further inform policy, this study assessed post-discharge outcomes of children treated with this novel protocol in Kenya. METHODS: Six 'combined' protocol clinics treated SAM and MAM children using an optimised mid-upper arm circumference (MUAC)-based dose of ready-to-use therapeutic food (RUTF). Six 'standard care' clinics treated SAM with weight-based RUTF rations; MAM with ready-to-use supplementary food (RUSF). Four months post-discharge, we assessed anthropometry, recent history of illness, and body composition by bioelectrical impedance analysis. Data was analysed using multivariable linear regression, adjusted for age, sex and allowing for clustering by clinic. RESULTS: We sampled 850 children (median age 18 months, IQR 15-23); 44% of the original trial sample in Kenya. Children treated with the combined protocol had similar anthropometry, fat-free mass, fat mass, skinfold thickness z-scores, and frequency of common illnesses 4 months post-discharge compared the standard protocol. Mean subscapular skinfold z-scores were close to the global norm (standard care: 0.24; combined 0.27). There was no significant difference in odds of relapse between protocols (SAM, 3% vs 3%, OR = 1.0 p = 0.75; MAM, 10% vs 12%, OR = 0.90 p = 0.34). CONCLUSIONS: Despite the lower dosage of RUTF for most SAM children in the combined protocol, their anthropometry and relapse rates at 4 months post-discharge were similar to standard care. MAM children treated with RUTF had similar body composition to those treated with RUSF and neither group exhibited excess adiposity. These results add further evidence that a combined protocol is as effective as standard care with no evidence of adverse effects post-discharge. A simplified, combined approach could treat more children, stretch existing resources further, and contribute to achieving Sustainable Development Goal Two