Health-seeking behaviour among pregnant women during the COVID-19 pandemic: A qualitative study

BACKGROUND: The novel coronavirus pandemic has killed millions of people globally while significantly destroying the social, economic, and political wellbeing of people. The global pandemic has negatively impacted pregnant women's access to prenatal care. The current study sought to understand the health-seeking behaviour of women who were pregnant during the onset of the COVID-19 pandemic in Kenya. METHODS: The “Three Delay” model theoretical framework was applied to piece together the pregnant women's health-seeking behaviour during the early stages of the pandemic through focus group discussions. The collected qualitative data was analysed using thematic analysis. RESULTS: The delays in deciding to seek care, delays in reaching healthcare facilities and delays in receiving quality healthcare services at the healthcare facility were a result of the fear of contracting the virus. These delays were occasioned by participants’ personal experiences and uncertainties about COVID-19 pandemic, compulsory quarantines, national cessation of movements, compulsory lockdowns, loss of income to many households and the influence of traditional birth attendants (TBAs). CONCLUSION: The current study found that fear of COVID-19 was a major factor that hindered access to maternal healthcare services. In this regard, there is a need to upscale awareness creation on the significance of seeking maternal health services during the pandemic to reduce the possibility of obliterating the gains made in reducing poor health-seeking behaviours among pregnant women

Anxiety and depression due to 2019 SARS-CoV-2 among frontier healthcare workers in Kenya

Background: The novel coronavirus disease continues to spread across the globe, causing anxiety and depression among healthcare workers. Objectives: The current study aimed to determine the levels of anxiety and depression due to the coronavirus pandemic among healthcare workers in Kenya. Methods: A total sample of 476 respondents participated. The 7-item Generalized Anxiety Disorder Scale (GAD-7) and Patient-Health Questionnaire (PHQ-9), together with a socio-demographic questionnaire, were applied. Stratified sampling was used. Data was analysed using the Statistical Package Programme for Social Science Version 23.0.0. Kruskal Wallis test and Mann-Whitney U test were employed to establish the differences in levels of anxiety and depression across socio-demographic characteristics. Ordinal logistic regression analysis was used to establish the predictors of levels of anxiety and depression, and associations were considered significant at p 0.027), years of work experience (p = 0.005), and the cadre of respondents (p = 0.0028). Gender was statistically significant with the level of depression (p = 0.045). About 62.6% (n = 298) of healthcare workers had been trained, and only 9% (n = 43) were confident in managing COVID-19 cases. A large proportion, 98% (n = 458) had concerns about the availability of personal protective equipment. Conclusion: The study findings indicated that the majority of healthcare workers had mild anxiety and depression. Female healthcare workers were more likely to experience severe anxiety and depression. Also, levels of anxiety and depression differed across different cadres of healthcare workers

The effects of climate on decomposition of cattle, sheep and goat manure in Kenyan tropical pastures

Aims Decomposition of manure deposited onto pasture from grazing animals represents an important process for carbon (C) and nitrogen (N) cycles in grassland systems. However, studies investigating manure decomposition are scarce; especially in sub-Saharan Africa (SSA). Methods In this study, we measured decomposition of three types of animal manure (cattle, sheep, goat) over >1 year using litter bags at four climatically different sites across Kenya. Results Manure dry matter, total C, total N and ammonium concentrations decreased exponentially, with the most rapid decrease occurring during the first few weeks following application, followed by slower changes during the following 2-3 months. Rates of N mineralization were lower than those for C mineralization, resulting in decreasing C/N ratios over time. Generally, cattle manure decomposed faster than sheep or goat manure despite having a higher initial C/N ratio and lower N concentration, with decomposition rates for dry matter ranging from 0.200 to 0.989 k year(-1). Cellulose decomposed first, while lignin concentrations increased among all manure types and at all sites. Conclusions We found that total manure decomposition rates were positively correlated with cumulative precipitation and aridity index, but negatively correlated with mean temperature. Our results show much slower decomposition rates of manures in semi-arid tropical environments of East Africa as compared to the few previous studies in temperate climates.Peer reviewe

Carbon footprint of smallholder rain-fed sorghum cropping systems of Kenya: A typology-based approach

Agricultural ecosystems are the main sources of soil-atmosphere exchange (methane-CH4, Carbon dioxide-CO2 and Nitrous oxide -N2O) in sub-Saharan African countries, including Kenya. To feed the ever-growing population, there is a need to identify agricultural management practices to increase food production while reducing GHG emissions for climate change mitigation and adaptation. This study aimed to estimate the GHG balance at the farm scale and identify environmental hotspots and mitigation opportunities among smallholder sorghum farms in Western Kenya. The study hypothesized that different intensification levels influenced the GHG balance. The study collected data from 300 smallholder farms in western Kenya. The principal component analysis and hierarchical clustering analysis were used for farm typologies construction. Five farm types were constructed that ranged from no or minimal external inputs and highly intensified, small to large, and low to highly endowed in tropical livestock units. The Cool Farm Tool Excel program model was used to estimate GHG balances. that the sorghum cropping systems were net sinks of soil GHGs. The GHG balance, carbon footprint, and monetary footprint significantly varied across the farm types at p = 0.025, p = 0.018, and p = 0.004, respectively. The GHG balance ranged from – 818.76 kg CO2 eq. ha−1 in manure-intensive and low fertilizer-intensity small farms to 174.29 kg CO2 eq. ha−1 in fertilizer-intensive and moderate manure application rates on small farms. Fertilizer production and direct and indirect emissions (fertilizer application) were the environmental hotspots accounting for 63 and 30 % of the GHG emissions. The carbon and monetary footprints ranged from -1.29 to 0.45 kg CO2 eq. kg sorghum −1 and -2.02 to 0.13 kg CO2 eq. US$−1 generated, respectively. The study established that sorghum cropping systems in Kenya produced limited greenhouse gas emissions

Influence of soil fertility management technologies on phosphorus fractions, sorption characteristics, and use efficiency in humic Nitisols of Upper Eastern Kenya

Fractions of phosphorus (P) and its sorption characteristics are affected by different soil fertility (FM) technologies which ultimately affect crop growth and productivity. However, the response of P fractions and sorption characteristics to soil fertility technologies that integrate diverse amendments is still poorly understood in acidic Nitisols. A randomized complete block design was layout in an acidic Nitisol to determine fractions of P, its sorption characteristics and use efficiencies in acidic Nitisols under various FM technologies in field conditions. The use of minimum tillage + maize residue + inorganic fertilizer + goat manure (MTCrGF) had the highest impact on and significantly increased resin-Pi, NaHCO3-Pi, and maximum P sorption (Smax) by 182, 76, and 52 mg P kg−1. Moreover, NaOH-Pi and Smax concentrations were higher under conventional tillage + maize residue + inorganic fertilizer + goat manure (CTCrGF) by 216 mg P kg−1 and 49 mg P kg−1 than the control. MTCrGF and CTCrGF also had the lowest P bonding energy (0.04 L mg−1). CTCrGF had the highest P partial productivity factor (0.093 and 0.140 kg biomass kg−1 P) and P agronomic efficiency (0.080 and 0.073 kg biomass kg−1 P) during the two cropping seasons. The results demonstrate the positive influence of combining multiple P sources on soil P fractions, sorption characteristics, and use efficiencies. Notably, combining either conventional or minimum tillage with maize straw and applying integrated manure and inorganic fertilizer (MTCrGF or CTCrGF) can increase the labile P concentrations and reduce the potential depletion of the non-renewable rock phosphate and the use of inorganic phosphatic fertilizers for agricultural production

Multiple introductions of multidrug-resistant typhoid associated with acute infection and asymptomatic carriage, Kenya.

BackgroundUnderstanding the dynamics of infection and carriage of typhoid in endemic settings is critical to finding solutions to prevention and control.MethodsIn a 3-year case-control study, we investigated typhoid among children aged Results148 S. Typhi isolates from cases and 95 from controls (stool culture) were identified; a carriage frequency of 1 %. Whole-genome sequencing showed 97% of cases and 88% of controls were genotype 4.3.1 (Haplotype 58), with the majority of each (76% and 88%) being multidrug-resistant strains in three sublineages of the H58 genotype (East Africa 1 (EA1), EA2, and EA3), with sequences from cases and carriers intermingled.ConclusionsThe high rate of multidrug-resistant H58 S. Typhi, and the close phylogenetic relationships between cases and controls, provides evidence for the role of carriers as a reservoir for the community spread of typhoid in this setting.FundingNational Institutes of Health (R01AI099525); Wellcome Trust (106158/Z/14/Z); European Commission (TyphiNET No 845681); National Institute for Health Research (NIHR); Bill and Melinda Gates Foundation (OPP1175797)

BREATHER Plus clinical trial design: A randomised non-inferiority trial evaluating the efficacy, safety and acceptability of short cycle (five days on, two days off) dolutegravir/tenofovir-based triple antiretroviral therapy (ART) compared to daily ART in virologically suppressed adolescents living with HIV aged 12 to <20 years in sub-Saharan Africa

Background: Novel strategies to improve ART adherence, retention in care and quality of life among adolescents living with HIV (ALHIV) are needed. Short-Cycle Therapy (SCT) with 4/5 sequential days on ART, 2/3 days off ART per week has shown non-inferior virological outcomes and high acceptability, but most data are in adults and are very limited for dolutegravir (DTG)-based SCT. Methods: BREATHER Plus is an ongoing 96-week non-inferiority randomised trial evaluating efficacy, safety and acceptability of SCT (5 sequential days on, 2 days off at the weekend) with DTG/tenofovir (TNV)-based triple ART versus continuous (daily) therapy (CT) in ALHIV. Participants are aged 12 to <20 years in Kenya/South Africa/Uganda/Zimbabwe, virologically suppressed (Viral Load (VL) <50copies/mL) for ≥12 months at enrollment, with no prior treatment failure. Randomisation is 1:1 to SCT versus CT. VL monitoring for clinical management is 6–12 monthly aligning with standard-of-care. The primary outcome is confirmed virological rebound ≥50 copies/mL by 96 weeks. The trial employs the Smooth Away From Expected (SAFE) non-inferiority frontier, where the non-inferiority margin depends on the observed event risk in the CT arm. Secondary outcomes include HIV resistance, toxicities, patient-reported outcomes and cost-effectiveness. Enrolment of 470 participants completed in June 2023. Discussion: BREATHER Plus is the first randomised trial specifically evaluating DTG/TNV-triple based SCT. Rapid roll-out of DTG and a pragmatic approach to VL monitoring mean results will be generalisable to ALHIV across sub-Saharan Africa. If SCT provides non-inferior virological suppression to CT, it may offer choice for ALHIV on how they take their ART