Doctor of Philosophy

dissertationSpatial patterns in 13C/12C ratios of soil and sedimentary organic carbon are related to the woody cover distribution in a landscape and can aid in reconstructing environments. Woody cover is, in turn, controlled by climate, hydrology, and disturbance regime within an ecosystem. Geomorphology, disturbance, hydrology, and climate are the major factors that drive material fluxes and biogeochemical transformation in landscapes and should be accounted for when reconstructing past environments from soils and sediments. Disturbance, mainly from fire and other anthropogenic activities such as tree harvesting, offset climatic driven moisture availability by creating open woodlands and grasslands within a landscape. On the other hand, geomorphology and hydrology exert strong effects on floodplains with meandering river systems supporting higher woody cover than straight channels. In lakes, the water inflow and outflow dynamics, bathymetry, and watershed geomorphology influence the water balance, material fluxes, and consequently, the biogeochemical characteristics in the water column and sediments. We evaluate how we may reconstruct historic and prehistoric environments through geochemical proxies including stable isotopes and mineralogy, and biological proxies such as diatoms, charcoal, and palynology

Estimating Hypothetical Bias in Economically Emergent Africa: A Generic Public Good Experiment

This paper reports results from a contingent valuation based public good experiment conducted in the African nation of Botswana. In a sample of university students, we find evidence that stated willingness to contribute to a public good in a hypothetical setting is higher than actual contribution levels. However, results from regression analysis suggest that this is true only in the second round of the experiment, when participants making actual contributions have learned to significantly lower their contribution levels. As globalization expands markets, and economies such as Botswana’s continue to modernize, there is a growing need to understand how hypothetical bias will influence the valuation of public goods.hypothetical bias, public good, willingness to pay, Botswana, Environmental Economics and Policy,

Determinants of Smallholder Maize Farmers’ Choice of Selling Point: A Case of Kwanza District, Trans-Nzoia County, Kenya

Commercialization of the smallholder maize sector in Kenya necessitates improving the ability of farmers to efficiently participate in both the formal and informal maize markets. Smallholder maize farmers of Kwanza district, Trans Nzoia County, however, have limited access to formal maize markets. This limits their competitiveness in the market hence a reduction in their returns. This study was aimed at assessing the factors that influence smallholder maize farmers’ participation in formal maize markets in the region. Multistage sampling technique was used to select 196 smallholder maize farmers from the region. Primary data was collected using semi-structured questionnaires and the Probit model used to assess the factors influencing smallholder choice of selling point. Age of household head, household size and source of market information negatively influenced the probability of the farmers selling through formal maize markets. Education level, access to credit, sorting produce, tarpaulin ownership and output price however positively influenced the probability of selling through the formal maize markets. The study recommends policies that ensure the availability and access of appropriate market information. Farmers could also be assisted in the acquisition of tarpaulin used for drying maize and other necessary infrastructure to avoid losses due to the poor post-harvest handling of their output. This will greatly help in commercialising the smallholder maize sector in the region. Keywords: Formal maize markets, Informal maize markets, Market participation, Transaction costs DOI: 10.7176/JESD/11-10-17 Publication date:May 31st 202

Communalism Versus the Incentive to Free-Ride: Experimental Results From Economically Emergent Africa

This paper reports results from a public good experiment conducted in the African nation of Botswana. Our findings provide a test of whether\u27 African communalism\u27 influences willingness to contribute to the provision of public goods. As globalization expands markets, and economies such as Botswana\u27s continue to modernize, there is an increasing need to understand how cultural factors might influence the valuation of public goods. We find evidence that stated willingness to contribute to a public good in a hypothetical setting is higher than actual contribution levels in a real setting. However, this is only true in the second and final round of the experiment, when participants in the real setting have learned to significantly lower their contribution levels. The results draw into question the existence of a communal spirit in economically emergent Africa when it comes to the provision of public goods

Livestock production and food security in a changing socio-cultural environment due to involuntary relocation of agro-pastoralists into semi-arid areas of Makueni District, Kenya.

The literature on Human Resettlement and the socio-economic adjustment processes involved has been reviewed with special reference to planned and unplanned relocation and how models of social change apply to them. As a result of the findings of this study the investigator has concluded it by developing a unique 5-Step Socio-Economic Chan2e Model based on the unplanned involuntary relocation of agro-pastoralists within the semi-arid areas of Kenya. A study of the Kenyan resettlement at Muuni was carried out over two growing seasons in 1997/98. Detailed information on the social structure prevailing and of the social and economic practices was gathered. This information was supplemented by data recorded on the agricultural activities of a sample of 30 fanning households, each having 10 acres of land. This information was supplemented by data on rainfall and soil type. Income from non-farming activities was also gathered. Data has been summarised and analysed and results discussed in the light of previous findings. Among the principal findings were: • That the role livestock production plays in socio-economic processes of change in semi-arid areas of Malcueni District became secondary or even tertiary following change of land tenureship by relocating agro-pastoralists from areas of communal use of forage and water resources to small-scale private land holding areas. • That failure to plan the involuntary relocation of the approx. 1000 households involved had placed them in difficult circumstances. • Hardship was the result due to failing to appreciate the inadequate potential of the limited private areas allocated and/or to provide a sufficient water supply in the resettlement scheme. • That failure to plan for suitable livestock disease control measures, medical care and education in the area imposed additional burdens on the people. • That the people proved capable of alleviating their conditions and meeting short-term needs by undertaking a range of non-farming activities and by collaborating at critical times in the farming and other social cycles. • That the delayed issuance of land title deeds to the farming households placed the families in an inequitable position and restricted their right of free movement

Determinants of Tea Marketing Channel Choice and Sales Intensity among Smallholder Farmers in Kericho District, Kenya

The aim of this study was to determine the socio-economic and institutional factors influencing smallholder farmers’ choice on tea marketing channel in Kericho District. A semi-structured and pre-tested questionnaire was used to collect data from smallholder tea farmers through face to face interview. Multistage sampling procedure was employed to contact 155 respondents. The study used Heckman two stage model to identify factors that determine tea growers’ choice of marketing channel and sales volume decisions once a marketing channel has been selected. The results showed that age, gender, education in years, farming years and second payments significantly affected the participation in marketing channel. Tea production, farming years, age and second payment significantly affected the intensity of participation.  The results of the study provide an insights to the policy makers on what needs to be done to promote and improve farmer-market linkages hence improve farmers’ incomes from their farming and marketing activities. Keywords: Tea, Marketing channel, socioeconomic factors

Prevalence of porcine cysticercosis among scavenging pigs in western Kenya

Background: Porcine Cysticercosis (PC) infection is globally classified as a neglected and re-emerging tropical disease. The disease is endemic in Western Kenya yet smallholder farmers continue to practice scavenging pig production, thereby posing public health risk. This study determined the prevalence of PC infection at the farms and slaughter slabs in a cross-sectional survey in two Counties (Busia and Kakamega) of Western Kenya. Materials and Methods: Two hundred and eighty-seven (287) heparinized blood samples were collected at the farm from 162 households in 9 villages and 113 pigs from 5 slaughter slabs. The prevalence of PC was detected through meat inspection at slaughter slabs, and the prevalence of Taenia solium antigen determined by using the ApDia AgELISA test at the farms and slaughter slabs. Results: At meat inspection, the PC prevalence was 1.8%, while prevalence of Taenia Species cysts detected with AgELISA test was 3.8% at the farms, and 5.3 % at the slaughter slabs. The Ag-ELISA test had sensitivity of 100% (95% CI: 19.79– 100.00) and specificity of 96.4% (95% CI: 90.49– 98.84). Conclusion: The PC prevalence levels observed among scavenging pigs in Western Kenya should be a cause of public health risk concern. This observation warrant enforcing mandatory pig confinement, and use of latrines at the farms and meat inspection at local slaughter slabs. Further studies are recommended to identify different Taenia species in cysticercoids pigs in the region, which this study could not differentiate. Keywords: Pig, Taenia spps, meat inspection, ELISA test, Slaughter slabs, Smallholder farmers

Assessment of Inequalities in Coverage of Essential Reproductive, Maternal, Newborn, Child, and Adolescent Health Interventions in Kenya

Importance: Previous work has underscored subnational inequalities that could impede additional health gains in Kenya. Objective: To provide a comprehensive assessment of the burden, distribution, and change in inequalities in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) interventions in Kenya from 2003 to 2014. Design, Setting, and Participants: This population-based cross-sectional study used data from the 2003, 2008, and 2014 Kenya Demographic and Health Surveys. The study included women of reproductive age (ages 15-49 years) and children younger than years, with national, regional, county, and subcounty level representation. Data analysis was conducted from April 2018 to November 2018. Exposures: Socioeconomic position that was derived from asset indices and presented as wealth quintiles. Urban and rural residence and regions of Kenya were also considered. Main Outcomes and Measures: Absolute and relative measures of inequality in coverage of RMNCAH interventions. Results: For this analysis, representative samples of 31 380 women of reproductive age and 29 743 children younger than 5 years from across Kenya were included. The RMNCAH interventions examined demonstrated pro-rich and bottom inequality patterns. The most inequitable interventions were skilled birth attendance, family planning needs satisfied, and 4 or more antenatal care visits, whereby the absolute difference in coverage between the wealthiest (quintile 5) and poorest quintiles (quintile 1) was 61.6% (95% CI, 60.1%-63.1%), 33.4% (95% CI, 31.9%-34.9%), and 31.0% (95% CI, 30.5%-31.6%), respectively. The most equitable intervention was early initiation of breastfeeding, with an absolute difference (quintile 5 minus quintile 1) of −7.9% (95% CI, −11.1% to −4.8%), although antenatal care (1 visit) and diphtheria-tetanus-pertussis immunization (3 doses) demonstrated the best combination of high coverage and low inequalities. Our geospatial analysis revealed significant socioeconomic disparities in the northern and eastern regions of Kenya that have translated to suboptimal intervention coverage. A significant gap remains for rural, disadvantaged populations. Conclusions and Relevance: Coverage of RMNCAH interventions has improved over time, but wealth and geospatial inequalities in Kenya are persistent. Policy and programming efforts should place more emphasis on improving the accessibility of health facility-based interventions, which generally demonstrate poor coverage and high inequalities, and focus on integrated approaches to maternal health service delivery at the community level when access is poor. Scaling up of health services for the urban and, in particular, rural poor areas and those residing in Kenya’s former north eastern province will contribute toward achievement of universal health coverage

Comparison of the prevalence and characteristics of inpatient adverse events using medical records review and incident reporting

Background. Information on adverse events (AEs) in hospitalised patients in developing countries is scanty.Objective. To compare the magnitude and characteristics of inpatient AEs in a tertiary, not-for-profit healthcare facility in Kenya, using medical records review and incident reporting.Methods. Estimation of prevalence was done using incidents reported in 2010 from a random sample of medical records for hospital admissions. Nurse reviewers used 18 screening criteria, followed by physician reviewers to confirm occurrence. An AE was defined as an unexpected clinical event (UE) associated with death, disability or prolonged hospitalisation not explained by the disease condition. The kappa statistic was used to estimate inter-rater agreement, and analysis was done using logistic regression.Results. The study identified 53 UEs from 2 000 randomly selected medical records and 33 reported UEs from 23 026 admissions in the index year. The prevalences of AEs from medical records review and incident reports were 1.4% (95% confidence interval (CI) 0.9 - 2.0) and 0.03% (95% CI 0.012 - 0.063), respectively. Compared with incident reporting, review of medical records identified more disability (13.2% v. 0%; p=0.03) and prolonged hospital stays (43.4% v. 18.2%; p=0.02).Conclusions. Review of medical records is preferable to incident reporting in determining the prevalence of AEs in health facilities with limited inpatient quality improvement experience. Further research is needed to determine whether staff education and a positive culture change through promotion of non-punitive UE reporting or a combination of approaches would improve the comprehensiveness of AE reporting

Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: A countdown to 2015 country case study

Background: Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.Methods: We did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 to 2015, using data from nationally representative Demographic Health Surveys done between 1989 and 2014. For comparison, we used modelled mortality estimates from the UN Inter-Agency Groups for Child and Maternal Mortality Estimation. We estimated time trends for key RMNCH indicators, as defined by Countdown to 2015, at both the national and the subnational level, and used linear regression methods to understand the determinants of change in intervention coverage during the past decade. Finally, we used the Lives Saved Tool (LiST) to model the effect of intervention scaleup by 2030.Findings: After an increase in mortality between 1990 and 2003, there was a reversal in all mortality trends from 2003 onwards, although progress was not substantial enough for Kenya to achieve Millennium Development Goal targets 4 or 5. Between 1990 and 2015, maternal mortality declined at half the rate of under-5 mortality, and changes in neonatal mortality were even slower. National-level trends in intervention coverage have improved, although some geographical inequities remain, especially for counties comprising the northeastern, eastern, and northern Rift Valley regions. Disaggregation of intervention coverage by wealth quintile also revealed wide inequities for several healthsystems-based interventions, such as skilled birth assistance. Multivariable analyses of predictors of change in family planning, skilled birth assistance, and full vaccination suggested that maternal literacy and family size are important drivers of positive change in key interventions across the continuum of care. LiST analyses clearly showed the importance of quality of care around birth for maternal and newborn survival.Interpretation: Intensified and focused efforts are needed for Kenya to achieve the RMNCH targets for 2030. Kenya must build on its previous progress to further reduce mortality through the widespread implementation of key preventive and curative interventions, especially those pertaining to labour, delivery, and the first day of life. Deliberate targeting of the poor, least educated, and rural women, through the scale-up of community-level interventions, is needed to improve equity and accelerate progress