Using social media in Kenya to quantify road safety: an analysis of novel data

Background: Road trafc injuries are a large and growing cause of morbidity and mortality in low- and middleincome countries, especially in Africa. Systematic data collection for trafc incidents in Kenya is lacking and in many low- and middle-income countries available data sources are disparate or missing altogether. Many Kenyans use social media platforms, including Twitter; many road trafc incidents are publicly reported on the microblog platform. This study is a prospective cohort analysis of all tweets related to road trafc incidents in Kenya over a 24-month period (February 2019 to January 2021). Results: A substantial number of unique road incidents (3882) from across Kenya were recorded during the 24-month study period. The details available for each incident are widely variable, as reported and posted on Twitter. Particular times of day and days of the week had a higher incidence of reported road trafc incidents. A total of 2043 injuries and 1503 fatalities were recorded. Conclusions: Twitter and other digital social media platforms can provide a novel source for road trafc incident and injury data in a low- and middle-income country. The data collected allows for the potential identifcation of local and national trends and provides opportunities to advocate for improved roadways and health systems for the emergent care from road trafc incidents and associated traumatic injurie

Assessment of knowledge, attitudes and practices of infant feeding in the context of HIV: A case study from western Kenya

Guidelines for infant feeding options among HIV-positive mothers are changing with informative research. Cultural factors, socialisation processes, gender dimensions and socio-economic status within communities should be considered in recommending feasible and sustainable options. The objective of this study was to assess the knowledge, attitudes and practices with regards to infant feeding in the context of HIV. A cross-sectional study was conducted between November 2003 and January 2004. The study was carried out in Kosirai Division, Nandi-North District, in western Kenya. The target population was community members aged 18 - 45 years and key informants aged 18 years and above. Structured questionnaires and in-depth interviews were used to collect data. Multistage and snowball sampling methods were used to identify study participants. Quantitative data were analysed using the SPSS statistical package for social scientists (Version 12). Cross-tabulations were calculated and Pearson’s chi-square test used to test significance of relationships between categorical variables. Recorded qualitative data were transcribed and coded. Themes were developed and integrated. A generation of concepts was used to organise the presentation into summaries, interpretations and text. A total of 385 individuals participated in the survey, 50% of whom were women. There were 30 key informants. Farming was the main source of income but half of the women (49.7%) had no income. Most of the respondents (85.5%) knew of breastfeeding as a route of HIV transmission with sex (p=0.003) and age (p=0.000) being highly associated with this knowledge. Breastfeeding wasthe norm although exclusive breastfeeding was not practised. Cow’s milk, the main breast milk substitute, was reported as being given to infants as early as two weeks. It was the most popular (93.5%) infant feeding option in the context of HIV/AIDS. Heating expressed milk, wet nursing and milk banks were least preferred. Thus, the social, cultural and psychological complexity of infant feeding practices should be taken into account when advocating appropriate infant feeding options. Further research is required to determine the safety of using cow’s milk as an infant feeding option. Community engagement, including education and awareness strategies, specific to the benefits of exclusive breastfeeding as a mechanism to reduce the risk of HIV transmission is urgently needed

Survey of Nematode-Destroying Fungi from Selected Vegetable-Growing Areas in Kenya

Plant-parasitic nematodes cause severe damage to a wide range of economic crops, causing upto 5% yield losses globally. In Kenya, vegetables are affected, among other pests, by parasitic nematodes, causing upto 80% loss in yield. Nematode control is very difficult and relies heavily on use of chemical nematicides. Use of these chemical nematicides leads to biological magnification, and elimination of natural enemies of other pathogens, thus creating a need for greater application of pesticides, increased production costs, and development of insecticide-resistance. These factors have led to a growing interest in search for alternate management strategies. The objective of this study was, therefore, to document nematode-destroying fungi in selected, major vegetable-growing areas in Kenya as a step towards developing a self-sustaining system for management of plant-parasitic nematodes. Soil samples were collected from five vegetable-production zones, viz., Kinare, Kabete, Athi-river, Machakos and Kibwezi, and transported to the laboratory for extraction of nematode-destroying fungi. The soil-sprinkle technique described by Jaffee et al (1996) was used for isolating the nematode-destroying fungi from soil, while, their identification was done using identification keys described by Soto Barrientos et al (2001). From this study, a total of 171 fungal isolates were identified as nematodedestroying. The highest population was recorded in Kabete, at 33.9% of the total, followed by Machakos, Kibwezi, Athi-river, with the least in Kinare, at 24.6, 22.2, 11.7 and 7.6% of the total population, in that order. Arthrobotrys was the most frequent genus, with mean occurrence of 7.3, followed by Monacrosporium with 6 and Stylophage with 5.2. A. dactyloides was significantly (P=0.002) affected by the agro-ecological zone, with the highest occurrence recorded in Kabete, and the least in Athi-river. Kibwezi recorded highest diversity index, with a mean of 1.017, while, Athi-river recorded the least, with a mean of 0.333. Kibwezi had the highest species richness, recording a mean of 3.4, while, the least mean of 1.6 was recorded in Athi-river. Mean species richness of 2.2 was recorded for both Kabete and Machakos, and 1.8 for Kinare. From the three genera recorded, Arthrobotrys was more effective at trapping nematodes compared to Monocrosporium and Stylopage. The genus Arthrobotrys had the highest number of trapped nematodes, with a total population of 57, followed by Monacrosporium, the least being Stylopage, with 45 and 36, respectively, in a period of 104 hours. From the study, it is evident that agricultural practices affect occurrence and diversity of nematodedestroying fungi, and, Arthrobotrys can be used as a bio-control agent for managing plant-parasitic nematodes

Plant Parasitic Nematodes Associated With Coffee in Kenya and Factors Influencing their Occurrence, Abundance and Diversity

Frequent detection of galls on coffee roots has raised concerns of nematodes in coffee production systems in Kenya. This study aimed at determining the occurrence of nematodes associated with coffee in Kenya and the role of crop management, cultivars, soil properties and agro ecological zones on the abundance and frequency of nematodes. A survey was conducted in the prime coffee growing areas in 10 counties namely; Machakos, Makueni, Kiambu, Embu, Kirinyanga, Nyeri, Meru, Kisii, Nandi and Trans-Nzoia. Nematodes were extracted using a combination of centrifugal floatation and Modified Baermann techniques and identified to genera level.  Nutrient analysis was carried out using the Double Mehlich method. Results showed that nematodes belonging to 30 genera were recovered from coffee agro-ecosystems. Plant parasitic nematodes were the most prevalent with 64% frequency (19 genera) of occurrence followed by bacterial feeders at 24%. The genus Tylenchulus, Meloidogyne and Pratylenchus were the most dominant across all the coffee growing areas. Coffee farms in the coffee-tea zones (Upper Midland 1) harbored the highest numbers of plant parasitic nematodes, followed by Upper Midland 2 and least in the marginal coffee growing zones (Upper Midland 3). Well managed farms had less plant parasitic nematodes compared to neglected farms. K and P significantly contributed to the variation in the nematode community composition. This study demonstrated the prevalence of plant parasitic nematodes, factors that influence their abundance and distribution and justifies need for further management of nematodes in coffee production. Key words: Abundance, agro-ecologial zones, diversity, nematode genera, nutrient

Reaction of Selected Coffee Germplasm to Root-Knot Nematodes in Kenya

Coffee is one of the most important cash crops in Kenya and a leading export earner. Nematodes are among the most important biotic constraint in coffee production in Kenya and crop improvement work has mainly been breeding for resistance to diseases such as coffee berry disease and coffee leaf rust. However resistance has been used successfully in other coffee producing countries and it is one of the most economical and practical nematode management strategies. A greenhouse study was conducted to test the response of local and exotic coffee germplasm to root knot nematodes (RKNs). Ten (10) cultivars provided by Coffee Research Foundation (CRF) were tested for resistance to Meloidogyne incognita under greenhouse conditions (25±2oC). Nematodes were extracted from the roots using Modified Baermann Technique and enumerated using Cobbs slide. After 90 days of plant growth, the disease severity was evaluated and the experiment repeated twice. Galling indices (GI), egg mass indices (EMI) and nematode populations recovered from soil samples indicated a range of responses from resistant to highly susceptible.  Three breeder’s lines including Robusta tree 1, Robusta tree 2 and Robusta tree 3 were rated resistant with galling indices of 1.2-3.0. This study has demonstrated the potential of host resistance as a strategy in the management of nematodes in coffee for increased productivity. Field evaluation needs to be conducted to confirm these findings. The identified resistance sources can be utilized to deploy resistance genes to improve existing varieties that have high commercial value but lack resistance to nematodes.   Key words: Resistance, susceptible, galling indices, nematode population, cultivar

Barriers to uptake of breast cancer screening in Kenya

Objectives: To conduct clinical breast cancer screening in three sites in Western Kenya and explore community barriers to screening uptake.Design: Cross-sectional study.Setting: Western Kenya specifically, Mosoriot, Turbo, and Kapsokwony.Subjects: Community members (18 years and older) who did not attend the screening events.Outcome Measure: The outcome measure was having heard about the breast cancer screening events. Both structured and open-ended questions were used for datacollection. Item frequency, correlations, and content analyses were performed.Results: A total of 733 community members were surveyed (63% women, median age 33 years, IQR=26-43). More than half (55%) of respondents had heard about the screening but did not attend. The majority of those who had heard about this particular screening had knowledge of screening availability in general (45% vs. 25%, p<0.001). Only 8.0% of those who heard and 6.0% of those who had not heard of the screening event hadpreviously undergone clinical breast exam (p=0.20). Reasons for not attending the screening event were personal factors, including busy schedule (41.0%), perceived low personal risk (12.7%), lack of transport (4.2%), as well as health facility factors such as poor publicity (14.4%) and long queues (8.7%).Conclusion: Barriers to breast cancer screening uptake were associated with inadequate publicity, perceived long waits at event and busy lives among community women

Refining a questionnaire to assess breast cancer knowledge and barriers to screening in Kenya: Psychometric assessment of the BCAM

Background Our study objective was to determine the validity and reliability of the breast module of a cancer awareness measure (BCAM) among adult women in western Kenya. Methods The study was conducted between October and November 2012, following three breast cancer screening events. Purposive and systematic random sampling methods were used to identity 48 women for cognitive focus group discussions, and 1061 (594 who attended vs. 467 who did not attend screening events) for surveys, respectively. Face and psychometric validity of the BCAM survey was assessed using cognitive testing, factor analysis of survey data, and correlations. Internal reliability was assessed using Cronbach’s alpha. Results Among survey participants, the overall median age was 34 (IQR: 26–44) years. Compared to those women who did not attend the screening events, women attendees were older (median: 35 vs. 32 years, p = 0.001) more often married (79% vs. 72%, p = 0.006), more educated (52% vs. 46% with more than an elementary level of education, p = 0.001), more unemployed (59% vs. 11%, p = 0.001), more likely to report doing breast self-examination (56% vs. 40%, p = 0.001) and more likely to report having felt a breast lump (16% vs. 7%, p = 0.001). For domain 1 on knowledge of breast cancer symptoms, one factor (three items) with Eigen value of 1.76 emerged for the group that did not attend screening, and 1.50 for the group that attended screening. For both groups two factors (factor 1 “internal influences” and factor 2 “external influences”) emerged among domain 4 on barriers to screening, with varied item loadings and Eigen values. There were no statistically significant differences in the factor scores between attendees and non-attendees. There were significant associations between factor scores and other attributes of the surveyed population, including associations with occupation, transportation type, and training for and practice of breast self-examination. Cronbach’s alpha showed an acceptable internal consistency. Conclusion Certain subpopulations are less likely than others to attend breast screening in Kenya. A survey measure of breast cancer knowledge and perceived barriers to screening shows promise for use in Kenya for characterizing clinical and community population beliefs, but needs adaptation for setting, language and culture

Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya

BACKGROUND: Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY's specific vulnerabilities in LMIC. METHODS: As part of three interrelated research projects in western Kenya, we created procedures to address SCCY's vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report. RESULTS: Substantial community engagement provided input on SCCY's participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation. CONCLUSIONS: Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity

The status and future of emergency care in the Republic of Kenya

Kenya is a rapidly developing country with a growing economy and evolving health care system. In the decade since the last publication on the state of emergency care in Kenya, significant developments have occurred in the country\u27s approach to emergency care. Importantly, the country decentralized most health care functions to county governments in 2013. Despite the triple burden of traumatic, communicable, and non-communicable diseases, the structure of the health care system in the Republic of Kenya is evolving to adapt to the important role for the care of emergent medical conditions. This report provides a ten-year interval update on the current state of the development of emergency medical care and training in Kenya, and looks ahead towards areas for growth and development. Of particular focus is the role emergency care plays in Universal Health Coverage, and adapting to challenges from the devolution of health care