Considerations for the shift in roles of national and county governance towards the realization of food security in Kenya

The international community’s view on the state’s role in a country’s development and by extension food security situation is currently very positive. As a means to improve governance, decentralization in its many forms is being advocated all over the world. In August of 2010, Kenya embraced a new system of governance which involved the devolution of the central government and public participation as its new and critical components. This implied a shift in the roles of national and county governance towards the achievement of food security. Since food security is a multi-dimensional phenomenon, it is affected by many factors including governance. Thus, the government among other actors, plays a critical role in the achievement of food security. The scope of this review was ‘Good Food Security Governance’ within the national context, specifically focusing on the two tiers of government; national and county. This study aimed to call to attention the areas under governance in need of special attention by outlining the history of Kenya’s political economy that has contributed to the current state of food insecurity. It also seeks to reinforce government’s role in food security and propose possible key roles the national and county governments could embrace towards the realization of food security. There is need to eradicate corruption, streamline land tenure systems through effective land reforms, strengthen institutions that were weakened during former government regimes and empower county governments. The role of governments at both county and national level in food security should be reinforced by viewing food security as a public good and on the basis of the right to food as stipulated in the constitution of Kenya. While the national government needs to focus on capacity building of county governments, spurring economic growth, aiding poor rural farmers and putting in place social safety nets, the county government’s role should be the identification and implementation of context-specific integrated approaches to improve food security of their peoples. In conclusion, if these considerations are to be properly addressed then governance for food security in Kenya can be improved.Key words: Kenya, Governance, Decentralization, Roles, Food Security, Political Economy, Count

Considerations for the shift in roles of national and county governance towards the realization of food security in Kenya

The international community's view on the state's role in a country's development and by extension food security situation is currently very positive. As a means to improve governance, decentralization in its many forms is being advocated all over the world. In August of 2010, Kenya embraced a new system of governance which involved the devolution of the central government and public participation as its new and critical components. This implied a shift in the roles of national and county governance towards the achievement of food security. Since food security is a multi-dimensional phenomenon, it is affected by many factors including governance. Thus, the government among other actors, plays a critical role in the achievement of food security. The scope of this review was 'Good Food Security Governance' within the national context, specifically focusing on the two tiers of government; national and county. This study aimed to call to attention the areas under governance in need of special attention by outlining the history of Kenya's political economy that has contributed to the current state of food insecurity. It also seeks to reinforce government's role in food security and propose possible key roles the national and county governments could embrace towards the realization of food security. There is need to eradicate corruption, streamline land tenure systems through effective land reforms, strengthen institutions that were weakened during former government regimes and empower county governments. The role of governments at both county and national level in food security should be reinforced by viewing food security as a public good and on the basis of the right to food as stipulated in the constitution of Kenya. While the national government needs to focus on capacity building of county governments, spurring economic growth, aiding poor rural farmers and putting in place social safety nets, the county government's role should be the identification and implementation of context-specific integrated approaches to improve food security of their peoples. In conclusion, if these considerations are to be properly addressed then governance for food security in Kenya can be improved

Trends and factors associated with declining lifetime fertility among married women in Kenya between 2003 and 2014: an analysis of Kenya demographic health surveys

Background Globally, fertility has declined in the last three decades. In sub-Saharan Africa Including Kenya, this decline started more recent and at a slower pace compared to other regions. Despite a significant fertility decline in Kenya, there are disparities in intra- and interregional fertility. Reduction in lifetime fertility has health benefits for both the mother and child, thus it is important to improve women and children health outcomes associated with high fertility. The study, therefore evaluated the factors associate with change in lifetime fertility among married women of reproductive age in Kenya between 2003 and 2014. Methods The study used the Kenya Demographic and Health Survey (KDHS) datasets of 2003, 2008 and 2014. Analysis of variance (ANOVA) was used to calculate the mean number of children ever born and to assess the change in fertility across different factors. Poisson regression model with robust standard errors was used to study the relationship between number of children ever born (lifetime fertility) and independent variables. A Poisson-based multivariate decomposition for the nonlinear response model was performed to identify and quantify the contribution of demographic, socioeconomic and reproductive correlates, to the change in lifetime fertility between 2003 and 2014. Results The study included 3,917, 4,002, and 7,332 weighted samples of women of reproductive age in 2003, 2008, and 2014, respectively. The mean number of children born declined from 3.8 (95% CI: 3.6–3.9) in 2003 to 3.5 (95% CI: 3.4–-3.7) in 2008 and 3.4 (95% CI: 3.3–3.4) in 2014 (p = 0.001). The expected number of children reduced with the age at first sexual intercourse, the age at first marriage across the survey years, and household wealth index. Women who had lost one or more children in the past were likely to have increased number of children. The changes in the effects of women’s characteristics between the surveys explained 96.4% of the decline. The main contributors to the change in lifetime fertility was the different in women level of education. Conclusion The lifetime fertility declined by one-tenth between 2003 and 2014; majorly as a result of the effects of characteristics of women in terms of level of education. These highlights a need to implement education policies that promotes women education focuses on gender equality and women empowerment. Continuous strengthening of the healthcare systems (access to quality antenatal care, skilled delivery, and postpartum care) to reduce child mortality is essential

Kenya: Helping adolescent mothers remain in school through strengthened implementation of school re-entry policies

By applying robust evidence, securing the support of decisionmakers, and engaging stakeholders, STEP UP enabled national and local decisionmakers to better understand the consequences of unintended pregnancy for adolescent girls’ schooling in Homa Bay County, Kenya. STEP UP is playing an important role in informing the implementation of policies within the Kenyan educational sector that will improve educational opportunities for school-age mothers. Through early stakeholder engagement, strong partnerships, the support of implementers and policymakers, effective communication and dissemination strategies, decisionmaker capacity, and the dedication of the adolescent mothers themselves, evidence generated by STEP UP was successfully utilized by key stakeholders. Through this work, STEP UP has seen a positive shift in the discourse among Homa Bay County stakeholders on the continued education of all girls and the development of culturally appropriate models to better address unintended pregnancy in this population

Study of assessment of awareness for screening of cervical cancer in women attending gynecology outdoor patient department

Background: Nearly every family in the world is touched by cancer, which is now responsible for almost one in six deaths globally. Aim of this study was to access Indian woman's awareness towards cervical screening methods to promote strategies for increasing its uptake.Methods: A comprehensive questionnaire based cross-sectional observational survey was conducted in Pt. JNM Medical College and Dr. BRAM hospital, Raipur, Chhattisgarh from September 2018 to July 2019. Participants were selected by sampling between 21 to 59 years of age who have given consent for study.Results: Out of 1008 participants only 336 (33.3%) participants were aware about screening of cervical cancer and less than 28% participants were aware about pap smear, time of investigation, method of pap smear, health centre, association of HPV virus with cervical cancer, availability at vaccination, and with regard to risk factors only 27.9% women were aware that there is increased risk of cervical cancer due to multiple partners, 17.6% aware of risk due to increase in number of children’s, 11.1% aware of increase in risk of cervical cancer due to early initiation of  sexual activity. Younger women (age 30-35, odds ratio 1.24, 95% CI 0.78-1.32, p-value 0.05), low socioeconomic status (odds ratio 1.74, 95% CI 0.76-2.12, p-value 0.01), education level (≤ secondary education odds ratio 1.64 95% CI 0.85-2.18 p-value 0.000, ≥ higher secondary or above education odds ratio 2.32 95% CI 1.21-2.89  p-value 0.001) and age at marriage (odds ratio 2.21, 95% CI 0.78-2.18, p-value 0.000) all had a significant relationship with the awareness of Pap smear test. Two-third of the females in the study stated that lack of awareness as the major reason for not getting a pap smear while another one- third stated lack of recommendation by health care professionals as major hurdle.Conclusions: This study found that woman's fear, pain and embarrassment, along with cultural influences, deterred them from undergoing screening

Prevalence of sepsis among neonates admitted to Kisii Level 5 Hospital

Introduction: Infections are the third commonest cause of death in the neonate, with the vast majority of deaths occurring in resource limited countries such as Kenya which has a neonatal mortality rate of 22 per 1000 live births according to the Kenya Demographic and Health Survey, 2014.Objectives: To determine the prevalence, pattern of bacterial causes and the economic and socio-demographic factors associated with sepsis in neonates admitted to Kisii Level 5 Hospital.Design: A descriptive cross- sectional study.Setting: Newborn Unit and Paediatric Wards of the Kisii Level 5 Hospital.Subjects: Eighty neonates admitted at Kisii Level 5 Newborn Unit and Paediatric wards.Methods: Out of a study population of 406, consecutive sampling was done until the sample size of 80 neonates with clinical definition of sepsis was achieved. Sepsis was defined as refusal to breastfeed, convulsions, lethargy, fast breathing, grunting, nasal flaring, severe lower chest wall in- drawing, fever ≥ 37.5°C or hypothermia <35.5°C, deep jaundice involving palms and soles of the feet, ten or more pustules, umbilical redness extending to the periumbilical skin, pus draining from the ear and central cyanosis. These neonates had blood taken for full blood count and culture with sensitivity.Results: The prevalence of clinical sepsis was 19.7% (95% CI 15.9- 23.9). Neonatal sepsis was significantly associated with maternal dysuria (p= 0.018). There were no significant associations between socio -demographic factors and neonatal sepsis.Conclusion: Neonatal sepsis contributes to a significant proportion of neonatal admissions to Kisii Level 5 Hospital

Changing Face of Family Planning Funding in Kenya: A Cross-Sectional Survey of Two Urban Counties

As international development partners reduce funding for family planning (FP) programs, the need to estimate the financial resources devoted to FP is becoming increasingly important both at all levels. This cross-sectional assessment examined the FP financing sources, agents, and expenditures in two counties of Kenya for fiscal years 2010/2011 and 2011/2012 to guide local decision-making on financial allocations. Data were collected through a participatory process. This involved stakeholder interviews, review of financial records and service statistics, and a survey of facilities offering FP services. Financing sources and agents were identified, and source amounts calculated. Types of FP provider organizations and the amounts spent by expenditure categories were identified. Overall, five financing sources and seven agents for FP were identified. Total two-year expenditures were KSh 307.8 M (US$ 3.62 M). The government‘s share of funding rose from 12% to 21% over the two years (p=0.029). In 2010/2011, the largest expense categories were administration, commodities, and labor; however, spending on commodities increased by 47% (p=0.042). This study provides local managers with FP financing and expenditure information for use in budget allocation decision-making. These analyses can be done routinely and replicated in other local counties or countries in a context of devolution. Keywords: Contraception, Expenditure, Budget, Decision-makin

Clinical and perceived quality of care for maternal, neonatal and antenatal care in Kenya and Namibia: the service provision assessment.

BackgroundThe majority of women in sub-Saharan Africa now deliver in a facility, however, little is known about the quality of services for maternal and newborn basic and emergency care, nor how this is associated with patient's perception of their experiences.MethodsUsing data from the Service Provision Assessment (SPA) survey from Kenya 2010 and Namibia 2009, we explore whether facilities have the necessary signal functions for providing emergency and basic maternal (EmOC) and newborn care (EmNC), and antenatal care (ANC) using descriptives and multivariate regression. We explore differences by type of facility (hospital, center or other) and by private and public facilities. Finally, we see if patient satisfaction (taken from exit surveys at antenatal care) is associated with the quality of services (specific services provided).ResultsWe find that most facilities do not have all of the signal functions, with 46 and 27 % in Kenya and 18 and 5 % in Namibia of facilities have high/basic scores in routine and emergency obstetric care, respectively. We found that hospitals preform better than centers in general and few differences emerged between public and private facilities. Patient perceptions were not consistently associated with services provided; however, patients had fewer complaints in private compared to public facilities in Kenya (-0.46 fewer complaints in private) and smaller facilities compared to larger in Namibia (-0.26 fewer complaints in smaller facilities). Service quality itself (measured in scores), however, was only significantly better in Kenya for EmOC and EmNC.ConclusionsThis analysis sheds light on the inadequate levels of care for saving maternal and newborn lives in most facilities in two countries of Africa. It also highlights the disconnect between patients' perceptions and clinical quality of services. More effort is needed to ensure that high quality supply of services is present to meet growing demand as an increasing number of women deliver in facilities

Access to medicines for asthma, diabetes and hypertension in eight counties of Kenya

OBJECTIVES: To assess access to noncommunicable diseases (NCD) medicines in Kenya for patients diagnosed and prescribed treatment for asthma, diabetes and hypertension. METHODS: Households in eight purposively chosen counties were randomly selected. To be eligible, a household needed to have at least one member aged 18 years or older who had been previously diagnosed and prescribed medicines for one of the following NCDs: asthma, diabetes or hypertension. Using a logistic regression model, we explored the relationship between patient characteristics and the probability that patients had the medicines available at the time of the survey visit. RESULTS: A total of 627 individuals were included in the analysis. The highest percentage of medicines availability was in households with diabetes patients (83.1%), followed by hypertension (77.1%) patients. The lowest availability of medicines was found in households with asthma patients (53.1%). The median household expenditure on medicines per month was US$7.00 for households with diabetes patients; it was US$4.00 for asthma. In general, strong predictors of having medicines at home was being older, having some education compared to no education, few household members, wealth, being diagnosed at private nonprofit facilities and having only one patient with NCDs in the household. CONCLUSIONS: Our study found that nearly three-quarters of patients diagnosed and prescribed a medicine for hypertension, asthma or diabetes had the medicine available at home. Access challenges remain, in particular for patients from low-income households and for those diagnosed with asthma

Associations of Sociodemographic and Clinical Factors with Late Presentation for Early Infant HIV Diagnosis (EID) Services in Kenya

Background: Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya. Methods: We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President’s Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing. Results: Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity. Conclusion and Global Health Implications: Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines.publishedVersio