Negative externalities of pesticide use in the vegetable sub-sector in Kenya

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Impact of Organic Vegetable Production System in Kiambu and Kajiado Counties of Kenya

The study was conducted to evaluate the impact of organic production system on profitability of smallholder vegetable production systems in the two counties so as to appraise its contribution to improvement of rural livelihoods. The study collected data on costs and returns for a sample of 208 smallholder vegetable farmers who were composed of 78 organic and 130 conventional farmers. Impact of organic production system was evaluated using propensity score matching technique. Organic vegetable production system was found to have a positive significant impact of increasing farm gross margin by US$0.58 representing 89.5% among smallholder producers in Kiambu and Kajiado Counties of Kenya. The study recommended promotion of organic production system as a tool that can be used to improve livelihoods especially in the rural areas

Adoption and intensity of integrated agriculture aquaculture among smallholder fish farmers in Kenya

This paper examined the adoption and intensity of using integrated agriculture aquaculture (IAA) among smallholder fish farming households in Kenya. The analysis was based on crossectional farm-level data collected from four counties in Kenya: Nyeri, Kakamega, Siaya, and Busia. Results showed that risk plays a central role in farmers’ decisions through the direct effect of the sample moments of the profit distribution. Specifically, the first moment (mean profit) had a highly significant positive effect on the adoption and intensity of IAA. Profit variability, as reflected by the second moment, negatively impacted adoption and the intensity of IAA. Other factors that were important in IAA adoption included the proportion of economically active members, full-time land ownership, awareness of IAA, accessibility to irrigation, and flat farm topography, all of which were statistically significant in influencing IAA adoption positively. Other factors which were found to influence the intensity of IAA positively and significantly were: age, education level, number of economically active members, full-time land ownership, awareness of IAA, flat farm topography, and clay soil type. Thus, IAA should be promoted alongside farmers’ education, farm size, access to affordable and accessible credit, number of farm enterprises, and IAA awareness as a mechanism for enhancing smallholder IAA adoption and intensity of use

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa