Impact of domestic care environment on trauma and posttraumatic stress disorder among orphans in western Kenya

Objective:The aim of this study was to determine the impact of the domestic care environment on the prevalence of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) among orphaned and separated children in Uasin Gishu County, western Kenya. Methods:A total of 1565 (55.5% male) orphaned and separated adolescents aged 10–18 years (mean 13.8 years, sd 2.2),were assessed for PTSD and PTEs including bullying, physical abuse and sexual abuse. In this sample, 746 lived in extended family households, 746 in Charitable Children’s Institutions (CCIs), and 73 on the street. Posttraumatic stress symptom (PTSS)scores and PTSD were assessed using the Child PTSD Checklist. Results:Bullying was the commonest PTE in all domestic care environments, followed by physical and sexual abuse. All PTEs were commonest among the street youth followed by CCIs. However, sexual abuse was more prevalent in households than in CCIs. Prevalence of PTSD was highest among street youth (28.8%), then households (15.0%) and CCIs (11.5%). PTSS scores were also highest among street youth, followed by CCIs and households. Bullying was associated with higher PTSS scores and PTSD odds than either sexual or physical abuse. Conclusion:This study demonstrated differences in distribution of trauma and PTSD among orphaned and separated children in different domestic care environments, with street youth suffering more than those in CCIs or households.Interventions are needed to address bullying and sexual abuse, especially in extended family households. Street youth, a heretofore neglected population, are urgently in need of dedicated mental health services and support

Longitudinal vegetation turnover in an eastern Rift Valley riparian corridor

AbstractEast African riparian corridors are biodiversity hot spots that occur in catchments degrading under deforestation and overgrazing. Quadrats and belt transects were employed to investigate plant succession along the River Gilgil, in the Kenyan Rift Valley. The study found that most species (total 365) were broadly distributed across the tropics, but Rift Valley endemics were 12.5%, and 4%–18% were exotic. Plant composition varied with altitude, lithology, soils and rainfall. Agglomerative (Jaccard) hierarchical clustering and Non‐metric Dimensional Scaling identified two and three vegetation groups, for quadrats and transects, respectively, correlated with lithology and soils. Indicator species analysis highlighted that the upstream portion of the catchment was characterised by forest taxa with few exotics. The downstream included woodland species adapted to mesic/xeric conditions and to overgrazing. Longitudinal change in species composition (β diversity) between sites was assessed by taking into consideration the contribution of 'spatial species turnover' and 'nestedness', resulting from species replacement and species loss, respectively. The β diversity of the riparian corridor vegetation was 0.40 and spatial turnover accounted for 80%–85% of this, while the rest was attributed to the nestedness component. Riverine and native trees increased downstream but with low regeneration. Afromontane vegetation extended its distribution towards lower altitudes

Models of care for orphaned and separated children and upholding children’s rights: cross-sectional evidence from western Kenya

Background Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children’s basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. Methods The Orphaned and Separated Children’s Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher’s exact test was also used if some cells had expected value of less than 5. Results Included in this analysis are data from 300 households, 19 Charitable Children’s Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI’s and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as ‘Pure CCI’ for those only providing residential care, ‘CCI-Plus’ for those providing both residential care and community-based supports to orphaned children , and ‘CCI-Shelter’ which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p < 0.0001) more likely to have their basic material needs met in comparison to those in family-based care (17%) and institutions were better able to provide an adequate standard of living. Conclusions Each model of care we identified has strengths and weaknesses. The orphan crisis in sub-Saharan Africa requires a diversity of care environments in order to meet the needs of children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately care for children

Models of care for orphaned and separated children and upholding children\u27s rights: cross-sectional evidence from western Kenya

Background: Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children\u27s basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. Methods: The Orphaned and Separated Children\u27s Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher\u27s exact test was also used if some cells had expected value of less than 5. Results: Included in this analysis are data from 300 households, 19 Charitable Children\u27s Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI\u27s and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as \u27Pure CCI\u27 for those only providing residential care, \u27CCI-Plus\u27 for those providing both residential care and community-based supports to orphaned children , and \u27CCI-Shelter\u27 which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p \u3c 0.0001) more likely to have their basic material needs met in comparison to those in family-based care (17%) and institutions were better able to provide an adequate standard of living. Conclusions: Each model of care we identified has strengths and weaknesses. The orphan crisis in sub-Saharan Africa requires a diversity of care environments in order to meet the needs of children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately care for children

Prevalence of sexually transmitted infections including HIV in street-connected adolescents in western Kenya

PURPOSE: The objectives of this study were to characterise the sexual health of street-connected adolescents in Eldoret, Kenya, analyse gender disparity of risks, estimate the prevalence of sexually transmitted infections (STIs), and identify factors associated with STIs. METHODS: A cross-sectional study of street-connected adolescents ages 12-21 years was conducted in Eldoret, Kenya. Participants were interviewed and screened for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus-2, syphilis and HIV. Descriptive statistics and logistic regression were used to identify factors associated with having any STI. RESULTS: Of the 200 participants, 81 (41%) were female. 70.4% of females and 60.5% of males reported sexual activity. Of those that participated in at least one STI test, 28% (55/194) had ≥1 positive test, including 56% of females; 14% (28/194) had >1 positive test. Twelve females and zero males (6% overall, 14.8% of females) were HIV positive. Among females, those with HIV infection more frequently reported transactional sex (66.7% vs. 26.1%, p=0.01), drug use (91.7% vs. 56.5%, p=0.02), and reported a prior STI (50.0% vs. 14.7%, p<0.01). Having an adult caregiver was less likely among those with HIV infection (33.3% vs. 71.0%, p=0.04). Transactional sex (AOR 3.02, 95% CI (1.05 to 8.73)), a previous STI (AOR 3.46 95% CI (1.05 to 11.46)) and ≥2 sexual partners (AOR 5.62 95% (1.67 to 18.87)) were associated with having any STI. CONCLUSIONS: Street-connected adolescents in Eldoret, Kenya are engaged in high-risk sexual behaviours and females in particular have a substantial burden of STIs and HIV. There is a need for STI interventions targeted to street-connected youth

Environmental, socio-demographic and behavioural determinants of malaria risk in the western Kenyan highlands: a case–control study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73660/1/j.1365-3156.2009.02370.x.pd

Nutritional Status of Orphaned and Separated Children and Adolescents Living in Community and Institutional Environments in Uasin Gishu County, Kenya

Objective: To describe the nutritional status of orphaned and separated children and adolescents (OSCA) living in households in the community (HH), on the street, and those in institutional environments in western Kenya. Methods: The study enrolled OSCA from 300 randomly selected households (HH), 19 Charitable Children’s Institutions(CCIs), and 100 street-involved children. Measures of malnutrition were standardized with Z-scores using World Health Organization criteria; Z-scores #-2 standard deviations (sd) were moderate-severe malnutrition. Data were analyzed using multivariable logistic regression adjusting for child age, sex, HIV status, whether the child had been hospitalized in theprevious year, time living with current guardian, and intra- household clustering for adequacy of diet and moderate-severe malnutrition. Results: Included are data from 2862 participants (1337 in CCI’s, 1425 in HH’s, and 100 street youth). The population was 46% female with median age at enrolment of 11.1 years. Only 4.4% of households and institutions reported household food security; 93% of children in HH reported an adequate diet vs. 95% in CCI’s and 99% among street youth. After adjustment, OSCA in HH were less likely to have an adequate diet compared to those in CCI’s (AOR 0.4, 95% CI 0.2–1.0). After adjustment, there were no differences between the categories of children on weight-for-age, weight-for-height, or BMI-for-age. Children living in HH (AOR 2.6, 95% CI: 2.0–3.4) and street youth (AOR: 5.9, 95% CI: 3.6–9.5) were more likely than children in CCI’s to be low height-for-age. Conclusion: OSCA in HH are less likely to have an adequate diet compared to children in CCI’s. They and street children are more likely to be moderately-severely low height-for-age compared to children in CCI’s, suggesting chronic malnutrition among them

Quantifying social contacts in a household setting of rural Kenya using wearable proximity sensors

International audienc

International Perspectives on Nonformal Education

The New England Regional Meeting of the Comparative and International Education Society was held on the campus of the University of Massachusetts, Amherst, on 3 May, 1979. The conference was co-sponsored by the Division of Community Education, Springfield College, and the Center for International Education, School of Education, University of Massachusetts. The theme of the conference was International Perspectives on Nonformal Education. The papers delivered ranged in topics from the use of traditional art forms and poetry as a medium of nonformal education to the discussion of the philosophical foundations underlying the field. Case studies of specific nonformal education projects helped to highlight the conference. A total fifteen papers were delivered, all of which are included in their original form in this document. The papers represent the views of the authors and not necessarily those of the organizers

Results and Impacts of the Integrated Land and Water Management for Adaptation to Climate Variability and Change (ILWAC) Project: Evaluation Report

The objective of the evaluation was to assess the results and impacts of the activities of all ILWAC Trust Fundfinanced projects in West Africa using a selected subset, to identify key lessons learned, and to document best climatesmart practices for scaling up. The study entailed participatory evaluation of the results and impacts of various interventions geared towards integrated water resources management for climate change and variability preparedness in West Africa. In this respect, the study identified key lessons learned and documented best climate-resilient practices for scaling up and dissemination to multiple stakeholders in the West African region. 1. Agriculture remains the backbone for sustaining livelihoods in West Africa but faces numerous challenges. Agriculture is an important source of income, food and raw materials in West Africa, employing more than half of the region’s population, which culminated in the adoption of the Comprehensive Africa Agriculture Development Programme (CAADP) in 2003. Few countries, however, have managed to mobilize their agriculture sector to deliver on development outcomes such as food and nutrition security, poverty reduction, economic growth, job creation, youth employment and industrialization. Agriculture is vulnerable to climate change, resulting from sensitivity and exposure to climate shocks and lack of capacity to cope with and adapt to such changes. ILWAC evaluation study results from household surveys, focus group discussions and key informant interviews indicate that agricultural productivity in the region remains low, lagging far behind other regions of the world. Contributors to such low productivity include incidence of climate risks (drought, floods and high temperatures), pests and diseases, low technology adoption, limited access to financial services, limited access to markets and market information and limited access to good road networks (Plate 1). All the aforementioned contributors are valid denominators for all the seven ILWAC project areas that were evaluated. 2. Farmers in West Africa are particularly vulnerable to climatic shocks because of their high dependence on rainfed agriculture for their livelihoods. There is an evident lack of access to formal safety nets as indicated by farmers in Senegal (ENRACCA-WA) and Burkina Faso (AmREACCAF and APESS) projects. Climate change has already exerted significant impacts in the region. Since the 1970s, the region has experienced the occurrence of many droughts. Temperatures have increased in the second half of the 20th Century, especially in the latter 20 years of the same period. Farmers reported drought (about 40% of treatment and control groups), as the most prevalent climatic shock experienced over the last five years, followed by erratic rainfall, floods and invasion of crop pests and locusts. We identified eleven coping strategies, out of which three strategies were categorized based on a gradient of severity of food insecurity into low, moderate, and high food insecurity. During low food insecurity, households employ food-maximizing strategies such as purchasing food and eating less food and involving a low commitment of domestic resources that all enable quick recovery of households once the crisis eases. In times of moderate food insecurity, a greater commitment of household resources is increasingly required to meet subsistence needs. Coping strategies developed by households include sale of food reserves, use of savings, sale of livestock, borrowing food, and borrowing money (from friends, relatives, private lenders and banks). During high food insecurity, strategies are a sign of failure to cope with the food crisis and may involve drastic options that may undermine their future ability to prevent, mitigate, cope, and recover from shocks. Households adopt sale of assets such as land and homes, keeping children home from school, food aid and migration. The use of irrigation and rainfall water harvesting for agriculture remain low, despite prevalent droughts and widespread rainfed agricultural practices. One of the reasons is that most farming communities are far from rivers: hence considerable investment is required to develop irrigation in many project areas. 3. Although farmers use various strategies highlighted above, they will need support to double their efforts with innovative climate- smart agricultural practices and technologies to remain food secure. Areas where ILWAC interventions were targeted showed positive results, but broader efforts to scale out the successes are needed to achieve a greater impact. Overall, the ILWAC project beneficiaries reported higher adoption rates of climate-smart practices, demonstrating a favourable impact of the project. However, low awareness of the most appropriate technologies to cope with climate shocks was reported across all study areas yet, the region is expected to experience increasing climatic shocks with total precipitation predicted to increase for the most part more notably between July and October by 2050. Increases in precipitation are predicted to cause crop damages and floods. Overall, temperatures will rise by about 2°C to 3°C over the same time period. Higher temperatures of 3°C to 6°C are projected for the end of the 21st century (Niang et al., 2014). Despite these impending changes, few farmers have adjusted their farming strategies in response to climate risks, owing to limited knowledge on appropriate adaptation options and low endowment with production resources. As a result, ILWAC interventions were targeted to reverse these challenges. Their successful implementation showed positive results, which are largely limited to specific areas of implementation. Therefore, broader scaling out ILWAC interventions provided success stories tailored to specific contexts (biophysical and socio- economic); hence offered lessons and opportunities for replicating the bright spots with a regional approach. Across the seven projects, evaluation results indicated a couple of selected successes in the region (Plate 1). Selected successes make up potential candidates for scaling up climate-smart agricultural technologies and practices, and innovative approaches notably, including: i. Innovation platforms as a pillar for change: The successful establishment of innovation platforms across all project countries was evident but have remained largely underdeveloped and not utilized to their full potential. Platforms provided a framework for sharing knowledge on adaptation innovations to climate change, providing a good entry point for technology dissemination in target areas across all project countries. The study showed that the innovation platform model can offer the potential to organize stakeholders to address the objective of improving the livelihood of their members. IPs, however, need a strong voice to demand the needed services from service providers, negotiate and advocate for collective interests with the private sector and government. The use of a participatory development communication (PDC) within IPs would greatly increase their sustainability; ii. Increased human and institutional capacity for stakeholders: The enhancement of capacity for diverse stakeholder groups, including farmers, players in all segments of priority value chains, extension agents, policymakers and researchers (All project countries) resulted in significant positive results such as increased capacity towards awareness of CSA technologies and application of appropriate adaptation measures in their communities. This highlights the need to prioritize linkages amongst farmer organizations, extension and agricultural research; iii. Integrated landscape approaches for natural resources management provided exponential benefits: The pioneering of integrated land and water management for adaptation to climate variability and change improved management of natural resources in specific target countries, for example, in Burkina Faso, the relative reduction in sedimentation by up to 70%; and that in reduced runoff by up to 30% which helped improve the farmers’ agricultural practices and livelihoods (AmREACCAF-Burkina Faso). This also increased storage of water in the Boura reservoir through avoided sedimentation. Beyond water provision for household use, these reservoirs serve as key food baskets for fisheries and irrigation for households; iv. Integrated and diversified options offered opportunities to increase resilience and unlock the potential for rural smallholder livelihoods: The ILWAC project improved implementation of innovative agronomic interventions that substantially reduced the yield gap for millet for example the use of improved crop varieties (drought tolerant and early maturing) resulted in a 10 fold yield increase in grain biomass (ENRACCASenegal). Additional strategies include soil amendments in the form of organic and inorganic fertilizer sources, weed control practices as well as improved storage techniques (ISFM-Benin); Household enterprise diversification with agroforestry tree species enhanced the resilience of smallholder communities with climatesmart benefits such as windbreaks, these modified the micro-climate of the area that enhanced food security and revenue generation within target communities, increased farmer adaptive capacity and overall soil health attributes (ENRACCA- Senegal). 5. Women empowerment resulted in improved rural livelihoods: Improved gender dynamics regarding the roles, activities and representativeness within the selected projects had a positive impact on women empowerment for all project countries. There are numerous ways by which women were empowered e.g. conducting off-season vegetable cultivation allowed women to fetch increased returns (3 times than the normal price) in the off-season months. There were efforts to promote increased participation of women in the projects, offering opportunities to freely express themselves, highlight their needs and specific experiences. However, participation of women in leadership positions was generally low (less than 10%). In addition, women were able to benefit from the capacity building provided by the project, and access technologies and inputs resulting in higher production and subsequent incomes than before. Male-headed households were more likely to practice more CSA technologies by a factor of about 1 compared to female headed households. There was evidence of better access to financial services and training through village savings and loan associations, and gender empowerment. A key attribute of the assessed projects was that for the most part, women farmers were not well organized into interest groups with the capacity to promote their interests and engage in advocacy activities geared at influencing policy for their ultimate benefit. This was a missed opportunity especially in the context of existing innovation platforms that needs concerted efforts and strengthening. 6. More economic and social safety nets for smallholder livelihoods beyond ILWAC beneficiaries are needed: ILWAC enhanced farmers’ access to climate-resilient and low-emission practices and technologies, including crop, livestock, soil and water management options and energy saving technologies. ILWAC increased the number of CSA practices implemented by three practices more compared to non-participation. Results further showed that education level is associated with higher income. Higher value assets such as livestock did also significantly influenced income. ILWAC increased significantly the value of assets to almost 90%; a factor attributable to additional assets that were distributed to farmer groups such as the case of Gambia, Senegal and Sierra Leone. This study therefore confirms that more assets in ILWAC supported households offered better livelihood options than those in the control group. Results further show that male-headed households have a higher value of assets than female-headed households. On the overall, although participation in ILWAC increased income by 19%, there remains room for further improvement amongst the ILWAC beneficiaries given the lower differences in the economic domain for sustainable intensification exemplified before and after the ILWAC project on Plate 2. Likewise, Plate 2 highlights that better options are needed in the social domain to ensure that ILWAC beneficiaries can significantly gain from social dividends (e.g. strengthened farmer groups, collective action, and shared labor). Given the highlighted successes among the ILWAC beneficiaries, efforts will be needed to scale these bright spots beyond the ILWAC beneficiaries to wider geographical coverages. 7. There is need for concerted efforts towards supporting technical, financial, institutional and governance needs within the target countries in order to make community livelihoods more resilient to climate change. Despite the recorded successes there remains room for improvement in several institutional and governance realms. Farmers in the project sites are faced by poor extension, with the ratio of government paid extension officers to that of farmers being low, only 33% of the households have access to extension service. This has a negative impact on the quality of extension services being offered and building adaptive capacity to deal with climate change. A significant challenge remains in all project countries to get the technologies widely used due to the lack of a suitable enabling environment among others — extension services, financial resources, infrastructure, risk management and cross-sectoral linkages. Farmers are further constrained by having limited access to climatic information. Effective research and innovation are also needed to continuously improve practices and technologies. This calls for a policy recommendation where concerted efforts are needed to mobilize financial resources and build the capacity of West African researchers, policy-makers and institutions to understand, carry out and use good quality data towards informed decision making and scenario analyses (Also see evidence revealed by Plate 2).Enabling policy and institutional environment can provide the conditions and incentives for scaling out