The Role of Changing Housing Policies in Housing Affordability and Accessibility in Developing Countries: The Case of Kenya.

Rapid urbanization has led to the influx of people into urban areas as people seek better life opportunities. This migration has however largely not been planned, resulting in population explosions in the cities. Relying on existing research on the topic and government reports, this study finds that many middle and low-income families in Kenya have ended up living in informal settlements in urban areas due to housing unaffordability. The study further determines that the problem of housing is more pronounced in developing countries. Studies related to this issue establish that the housing crisis cannot only be attributed to rural-urban migration but also other factors like failed housing policies, poor housing financial systems, too much interference in the running of housing by the government and complex land tenure systems among others. This research, therefore, identifies the critical housing crisis issues, housing policy gaps in Kenya and proposes policy actions and the potential role of governments in a housing market to address affordability challenges. The study establishes the role of government and other institutions in the housing sector and proposes land and housing reforms that can add knowledge to future research in similar areas

An Evaluation of Rural Tourism Potential for Rural Development in Kenya

All over the world, tourism continues to be an integral part of economic development by contributing to countries’ gross domestic product (GDP), earning foreign exchange, creating job opportunities among other significant contributions. There is a need for increased diversification of tourism market away from the traditional ones like coastal and wildlife tourism. Over-reliance on mass tourism especially coastal based tourism also has negative degradation impacts on the environment, destruction and exhaustion of tourism products due to overexploitation. The need to improve tourists’ experiences in the destinations has led to increased calls for diversification of tourism products, thus shifting focus to the rural areas. Many potential tourism products like cultural heritage, archaeological sites and the good natural sceneries in rural areas remain unexploited or underexploited. This proposed study aims to deliberate on whether the sustainable development is possible for rural tourism in Kenya. This study examines the existing strategies employed by the Kenya government and other stakeholders in the tourism sectors, to determine areas of weakness that would require interventions. By conducting a SWOT analysis of the tourism potential in Kenya, this paper seeks to identify the untapped tourism potentials in rural Kenya and make necessary proposals for exploitation, to increase the competitiveness of Kenya tourism sector globally. Finally, the research establishes the general challenges facing the tourism sector in Kenya that have or have the potential to limit optimum operation and development in the sector. The research relies on secondary sources of data including research articles, government reports, academic documents and non-governmental organizations research works for a better understanding of the tourism sector in Kenya. Keywords: Cultural heritage, Tourism destination, Rural development, Rural Tourism, Tourism products. DOI: 10.7176/JAAS/63-05 Publication date: April 30th 202

Practitioners Perception of causes and consequences Challenging behaviour presented by Learners with Autistic spectrum Disorders (ASDs) in primary schools

The purpose of the study was to identify the practitioner’s perception of the causes of challenging behaviour presented by learners with ASDs in primary schools in western Kenya.  146 practitioners comprising of 106 teachers and 40 teacher aides participated in the study.  Data was collected using challenging behaviour questionnaire that had two parts. Part one was used to determine practitioners’ cognitive perception of the causes of challenging behaviour while part two determined their perception of the consequences of challenging behaviour. A one-way between-groups multivariate analysis of variance was performed to investigate job title, professional qualification, and experience of working with learners with ASDs in relation to perception of the causes of challenging behaviour.  Seven   dependent variables were used to elicit the practitioners’ perception of the causes of challenging behaviour presented by learners with ASDs. These were Biological, psychodynamic, ecological, behavioral, humanistic, sociological and psychological challenging behavior perception. The independent variables were job title, length of service and professional qualification. The finding of this study indicates that there was no statistically significant difference among the three independent variables on the combined dependent variables.  There were no significant differences in perception of the causes of challenging behaviour based on age, experience and professional qualifications. Teachers perceived challenging behaviour presented by learners with ASDs as time line episodic while teacher aides perceived it as a more permanent feature for learners with ASDs. Teachers also perceived their ability to control challenging behaviour higher than the teacher aides.  It emerged that practitioners’ perceived challenging behaviour as having consequences to learners, their peers, parents and practitioners. These factors need to be considered in designing programmes for management of challenging behaviour presented by learners with ASDs.   Keywords: Autistic spectrum Disorders, Challenging behaviour, Perception Consequence

Utilization of Individual Birth Plan Among Women Attending Postnatal Clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu Kenya: A Hospital-Based Survey

Background: Kenya has a maternal mortality rate (MMR) of 362 women per 100,000, partly attributed to inadequate or lack of birth and emergency preparedness, including the individual birth plan. Moreover, a paucity of data on determinants of individual birth plan use hampers its promotion and utility against MMR. This study assessed the determinants of individual birth plan use among women attending the postnatal clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, Kenya. Methods: Hospital-based survey was conducted among 354 expectant women between November 2018 and February 2019. Data were collected using questionnaires and a Focus Group Discussion guide. A Logistic regression model was also used to determine factors associated with IBP utilization, where only p-value's <0.05 were considered significant. Textual data were analyzed thematically using NVIVO. Results: Most mothers (68.6%) had an individual birth plan. Determinants for having birth plans included client factors such as education, OR 8.93, p<0.001, occupation, OR=2.40, p=0.020, and parity, AOR=3.29, p=<0.034; knowledge of danger signs, AOR 8.1, p=0.001. Health facility factors included birth plan counseling, OR=3.45, p=0.013, emergency preparedness, OR=2.06, p=0.034, access to motorized transport such as a car, OR=3.8, p=0.035 or motorcycle, OR=2.7, p=0.006 and attending a clinic in a referral hospital, OR=5.8, p=0.003 Conclusion: This study has demonstrated most women utilize individual birth plans. However, they were ill-prepared for an emergency. Determinants of IBP use included client factors such as education level, employment status, parity, knowledge of danger signs, maternal attitude; and facility factors including counseling, attending a clinic in a referral hospital, the use of an automobile to reach the hospital, and hostility by the health care providers. Therefore, we recommend that prenatal counseling should emphasize emergency preparedness among pregnant women. There is a need to empower women through education and employment to enhance IBP utilization

Access to artemisinin-based combination therapy (ACT) and quinine in malaria holoendemic regions of western Kenya

Findings from this research show a low availability of subsidized Artemisinin-based combination therapy (ACT) in the form of artemether-lumefantrine (AL). There is higher frequency of stock-outs in government facilities, while the private sector sells AL at higher prices, thus making it less affordable. In addition, frequent stock-outs of the required antimalarials for different weight groups calls for more emphasis on the implementation of malaria treatment policy. Evaluation of the subsidy policy, its implementation and role in malaria burden is necessary. ACT has been adopted following widespread malarial parasite resistance to more affordable antimalarial drugs

Factors determining anti-malarial drug use in a peri-urban population from malaria holoendemic region of western kenya

<p>Abstract</p> <p>Background</p> <p>Interventions to reverse trends in malaria-related morbidity and mortality in Kenya focus on preventive strategies and drug efficacy. However, the pattern of use of anti-malarials in malaria-endemic populations, such as in western Kenya, is still poorly understood. It is critical to understand the patterns of anti-malarial drug use to ascertain that the currently applied new combination therapy to malaria treatment, will achieve sustained cure rates and protection against parasite resistance. Therefore, this cross-sectional study was designed to determine the patterns of use of anti-malarial drugs in households (n = 397) in peri-urban location of Manyatta-B sub-location in Kisumu in western Kenya.</p> <p>Methods</p> <p>Household factors, associated with the pattern of anti-malarials use, were evaluated. Using clusters, questionnaire was administered to a particular household member who had the most recent malaria episode (within <2 weeks) and used an anti-malarial for cure. Mothers/caretakers provided information for children aged <13 years.</p> <p>Results</p> <p>Stratification of the type of anti-malarial drugs taken revealed that 37.0% used sulphadoxine/pyrimethamine (SP), 32.0% artemisinin-based combined therapy (ACT), 11.1% anti-pyretics, 7.3% chloroquine (CQ), 7.1% quinine, 2.5% amodiaquine (AQ), while 3.0% used others which were perceived as anti-malarials (cough syrups and antibiotics). In a regression model, it was demonstrated that age (<it>P </it>= 0.050), household size (<it>P </it>= 0.047), household head (<it>P </it>= 0.049), household source of income (<it>P </it>= 0.015), monthly income (<it>P </it>= 0.020), duration of use (<it>P </it>= 0.029), dosage of drugs taken (<it>P </it>= 0.036), and source of drugs (<it>P </it>= 0.005) significantly influenced anti-malarial drug use. Overall, 38.8% of respondents used drugs as recommended by the Ministry of Health.</p> <p>Conclusion</p> <p>This study demonstrates that consumers require access to correct and comprehensible information associated with use of drugs, including self-prescription. There is potential need by the Kenyan government to improve malaria care and decrease malaria-related morbidity and mortality by increasing drug affordability, ensuring that the recommended anti-malarial drugs are easily available in all government approved drug outlets and educates the local shopkeepers on the symptoms and appropriate treatment of malaria. Following a switch to ACT in national drug policy, education on awareness and behaviour change is recommended, since the efficacy of ACT alone is not sufficient to reduce morbidity and mortality due to malaria.</p

Provider knowledge of treatment policy and dosing regimen with artemether-lumefantrine and quinine in malaria-endemic areas of western Kenya

BACKGROUND: Due to widespread anti-malarial drug resistance in many countries, Kenya included, artemisinin-based Combination Therapy (ACT) has been adopted as the most effective treatment option against malaria. Artemether-lumefantrine (AL) is the first-line ACT for treatment of uncomplicated malaria in Kenya, while quinine is preferred for complicated and severe malaria. Information on the providers’ knowledge and practices prior to or during AL and quinine implementation is scanty. The current study evaluated providers’ knowledge and practices of treatment policy and dosing regimens with AL and quinine in the public, private and not-for-profit drug outlets. METHODS: A cross-sectional survey using three-stage sampling of 288 (126 public, 96 private and 66 not-for-profits) providers in drug outlets was conducted in western Kenya in two Plasmodium falciparum-endemic regions with varying malarial risk. Information on provider in-service training, knowledge (qualification, treatment policy, dosing regimen, recently banned anti-malarials) and on practices (request for written prescription, prescription of AL, selling partial packs and advice given to patients after prescription), was collected. RESULTS: Only 15.6% of providers in private outlets had received any in-service training on AL use. All (100%) in public and majority (98.4%) in not-for-profit outlets mentioned AL as first line-treatment drug. Quinine was mentioned as second-line drug by 47.9% in private outlets. A total of 92.0% in public, 57.3% in private and 78.8% in not-for-profit outlets stated correct AL dose for adults. A total of 85.7% of providers in public, 30.2% in private and 41.0% in not-for-profit outlets were aware that SP recommendations changed from treatment for mild malaria to IPTp in high risk areas. In-service training influenced treatment regimen for uncomplicated malaria (P = 0.039 and P = 0.039) and severe malaria (P < 0.0001 and P = 0.002) in children and adults, respectively. Most (82.3%) of private outlets sell partial packs of AL while 72.4% do not request for written prescription for AL. In-service training influenced request for written prescription (P = 0.001), AL prescription (P < 0.0001) and selling of partial packs (P < 0.0001). CONCLUSION: Public-sector providers have higher knowledge on treatment policy and dosing regimen on recommended anti-malarials. Changes in treatment guidelines should be accompanied by subsequent implementation activities involving all sector players in unbiased strategies

A non-synonymous polymorphism in IL-23R Gene (rs1884444) is associated with reduced risk to schistosomiasis-associated Immune Reconstitution Inflammatory Syndrome in a Kenyan population

BACKGROUND: Human Immunodeficiency Virus (HIV) and Schistosomiasis co-infection is common among residents at the shores of Lake Victoria in Kenya. About 36% of this population initiating antiretroviral therapy (ART) experience Immune Reconstitution Inflammatory Syndrome (IRIS) that complicates recovery. Several IL-23R alleles have been associated with susceptibility to both autoimmune and inflammatory diseases through T-helper type 17 (TH(17)) cells. However, whether or not variants within the IL-23R increase susceptibility to IRIS in western Kenya is unknown. The objective of the current study was to determine the association between IL-23R gene polymorphisms, CD4+ cell counts and HIV RNA levels and IRIS in HIV and Schistosoma mansoni co-infected patients undergoing highly active anti-retroviral therapy (HAART). METHODS: A three-month case–control study was conducted on antiretroviral naïve schistosomiasis/HIV co-infected fishermen starting HAART in Uyoma Rarieda, Siaya County, Kenya. Seventy one patients were sampled at baseline and followed up for three months, to establish if they developed Schistosoma-related IRIS. In addition, the CD4+ cell counts and HIV RNA levels were determined in pre- and post-administration of HAART. Variations at five polymorphic sites of IL-23R (rs1884444, rs11465754, rs6682925, rs7530511 and rs7539625) based on >10% minor allele frequency in Yoruban reference population was determined using Allelic Discrimination Assay. The association between the five variants and susceptibility to IRIS was determined using logistic regression while controlling for potential confounders. In addition, the functional differences between the baseline CD4 + Cell counts and viral loads were determined using medians while across IL-23R genotypes were determined using Kruskal-Wallis tests. RESULTS: Overall, 26 (36.6%) patients developed schistosomiasis-associated IRIS at a median age of 35.5 years. Carriage of the TT genotype at the non-synonymous rs1884444 T > G relative to GG, was associated with a decreased risk of schistosomiasis-associated IRIS (OR, 0.25, 95% CI, 0.07-0.96, P = 0.043) while both baseline CD4+ cell counts and viral loads had no association with IRIS. CONCLUSION: These findings indicate that the non-synonymous variant rs1884444 T > G of IL-23R is associated with a decreased risk to schistosomiasis-associated IRIS. However, additional studies in a larger cohort and with an all inclusive polymorphic variants in the synonymous and non-synonymous regions need to be evaluated