Characterization of Sorghum Production and Marketing Systems in Eastern Province, Kenya: Sorghum for Multi-Use (SMU) Baseline Survey Report. Working Paper Series no. 53

A baseline survey was conducted to characterize the sorghum production and marketing system in Eastern Province of Kenya and, in combination with other follow up rapid assessment fora with relevant stakeholders, to aid the setting of project performance targets and implementation of interventions including establishment of a commercial pilot sorghum value chain for testing and upgrading. Eight SMU mandate districts/ sub-counties were grouped into 4 technology-adoption clusters out of which 480 farm households were randomly selected from the most important sorghum producing sub-locations. Women were managers in about 50% of the household farms and about 80% of all farmers reported farming as their main occupation. The mean farm size was 7.8 acres out of which 50% and 30% was under crop and sorghum production, respectively. Farms managed by women were smaller than those managed by men. The farm households exhibited a variable dependency ratio with the women managed farms showing significantly higher dependency ratio (1.3) than male managed farms (0.9) – meaning that labor availability was a more critical constraint in women managed farms. Therefore, labor-saving (mechanization, etc) and land-saving technologies (higher yielding varieties, fertilizer, tied ridges, etc) would enhance sorghum production. The other constraints were poor production and market infrastructure and information asymmetry in which women farmers, with less access to production information than their male counterparts, reporting more dependence on “other farmers” for agricultural information. Majority of farmers depended on agro-dealers, radio and other farmers for agricultural information. Hence innovative information channels such as use of agro-dealers, radio, training of trainers (TOTs) and farmer innovation platforms should be strengthened. Although double the number of male than female farmers reported purchase of seed from markets, use of recycled sorghum seed was the norm by the majority of farmers while use of inorganic fertilizer on sorghum was nil. Sorghum grain production per household was 360 kg out of which 65% was sold, 30% consumed while 5% was kept for seed. Sorghum yield was highest in Mwingi (501 kg per acre) and lowest in Kibwezi (216 kg per acre). Farmers who reported use of farmyard manure reported 35% more sorghum grain yield than those who had not used farmyard manure. Furthermore higher household production and productivity was positively correlated with the practice of row planting and use of soil and water conservation technologies, including dry or early planting. The primary use of sorghum grain at the household level was for making porridge and “ugali” (stiff porridge) while value addition activities were limited to milling of grain or mixtures of sorghum and other grains, wet milling and dehulling. The most important sorghum product marketed was grain, which was bought by brokers, rural assemblers, urban traders and consumers, with the consumers offering the farmers highest prices. Low grain price was the most important marketing constraint and hence, as well as improving market linkage for grain, diversifying value added products of sorghum for household level use and for commercialization would help create demand for sorghum grain and improve prices. Although awareness of collective grain marketing was high, farmers’ participation was minimal and their participation was constrained by low grain production (36%), low grain quality (30%), delayed payment for delivered grain (29%) and restriction on free grain marketing (25%)

Five recommendations to accelerate sustainable solutions in cement and concrete through partnership

Though the technical knowledge to make cement and concrete more sustainable already exists, implementation of solutions lags behind the rate needed to mitigate climate change and meet the targets set by the Sustainable Development Goals. Whilst most of the focus around the built environment is on embodied carbon, we stress an important but neglected dimension: partnership (SDG17). Effective partnerships can be powerful enablers to accelerate sustainable solutions in cement and concrete, and let such solutions transfer from academia to the market. This can be achieved through knowledge generation, solution implementation, and policy development, among other routes. In this article, we share five recommendations for how partnerships can address neglected research questions and practical needs: 1) reform Science, Technology, Engineering and Mathematics (STEM) education to train “circular citizens”; 2) map out routes by which cementitious materials can contribute to a “localization” agenda; 3) generate open‐access maps for the geographical distribution of primary and secondary raw materials; 4) predict the long‐term environmental performance of different solutions for low‐CO2 cements in different geographical areas; 5) overhaul standards to be technically and regionally fit for purpose. These approaches have the potential to make a unique and substantial contribution towards achieving collective sustainability goals

A REVIEW OF DIETARY AND NUTRITIONAL INTERVENTIONS AVAILABLE FOR MANAGEMENT OF AUTISM SPECTRUM DISORDER SYMPTOMS IN CHILDREN AND ADOLESCENTS - KENYA

Research on the challenges of raising a child with autism is mostly reported from Europe, North America and Australia. There is limited autism spectrum disorder (ASD) research in Kenya and families lack support as the etiology is linked to witchcraft and sorcery. Research indicates an increase in ASD prevalence globally and in Africa. Malnutrition and neuro-disability are major public health problems in Africa. Approximately one billion people, 15% of the world’s population, have a disability of some kind and 80% live in Low- and Middle-Income countries (LMICs). Of these, 53 million are children aged below 5 years living in sub-Saharan Africa. In Kenya, 2.2% (0.9 million people) live with some form of disability. Children diagnosed with autism spectrum disorder (ASD) suffer from neuro disabilities eliciting: altered sensory processing, restricted interests, and behavioral rigidity. Autism spectrum disorders have no cure, management is by use of interventional targeting autistic symptoms such as linguistic development, non-verbal cognitive development, and motor development. The objectives of this review were: to identify dietary and nutritional interventions available for the management of ASD symptoms in children and adolescents - Kenya, and to analyze the results of existing research in this area in order to understand and describe the characteristics and results of these studies to enable their use in the management of ASD symptoms. Cochrane Library, PubMed, PMC, Google scholar, and Free Full databases were searched to identify studies published between September 2011 and September 2021. Included were studies on nutrition or dietary interventions given to ASD children and adolescents that assessed autistic behavior and/or gastrointestinal symptoms. Excluded were those articles that evaluated surrogate outcomes as the primary outcome such as urinary peptide excretion and other neuro-disabilities other than ASD. Eighteen articles were included: 12 randomized case-control trials, 3 open-label trials, one 2×2 factorial study, and 2 crossover trials. The following dietary and nutritional interventions were evaluated: gluten and casein-free diet, ketogenic diets; probiotic supplements, specific carbohydrate diets, polyunsaturated fatty acids, vitamin and mineral supplantation (A, B6, B12, D, magnesium, folic acid), and alternative diets. Authors report improvements in the symptoms associated with ASD individuals receiving nutritional interventions such as vitamin and mineral supplementation however, their safety and efficacy needs to be evaluated. The study findings will help policymakers and implementers to understand the consistency and precision and impact of these interventions. These findings will contribute to improving the safety and efficacy of these interventions, positively impacting the health and nutrition outcomes of children and adolescents with ASD. These study findings indicate that more research targeting ASD dietary and Nutritional Interventions for management of ASD symptoms is required in Kenya and other resource constrained settings

A REVIEW OF DIETARY AND NUTRITIONAL INTERVENTIONS AVAILABLE FOR MANAGEMENT OF AUTISM SPECTRUM DISORDER SYMPTOMS IN CHILDREN AND ADOLESCENTS - KENYA

Research on the challenges of raising a child with autism is mostly reported from Europe, North America and Australia. There is limited autism spectrum disorder (ASD) research in Kenya and families lack support as the etiology is linked to witchcraft and sorcery. Research indicates an increase in ASD prevalence globally and in Africa. Malnutrition and neuro-disability are major public health problems in Africa. Approximately one billion people, 15% of the world’s population, have a disability of some kind and 80% live in Low- and Middle-Income countries (LMICs). Of these, 53 million are children aged below 5 years living in sub-Saharan Africa. In Kenya, 2.2% (0.9 million people) live with some form of disability. Children diagnosed with autism spectrum disorder (ASD) suffer from neuro disabilities eliciting: altered sensory processing, restricted interests, and behavioral rigidity. Autism spectrum disorders have no cure, management is by use of interventional targeting autistic symptoms such as linguistic development, non-verbal cognitive development, and motor development. The objectives of this review were: to identify dietary and nutritional interventions available for the management of ASD symptoms in children and adolescents - Kenya, and to analyze the results of existing research in this area in order to understand and describe the characteristics and results of these studies to enable their use in the management of ASD symptoms. Cochrane Library, PubMed, PMC, Google scholar, and Free Full databases were searched to identify studies published between September 2011 and September 2021. Included were studies on nutrition or dietary interventions given to ASD children and adolescents that assessed autistic behavior and/or gastrointestinal symptoms. Excluded were those articles that evaluated surrogate outcomes as the primary outcome such as urinary peptide excretion and other neuro-disabilities other than ASD. Eighteen articles were included: 12 randomized case-control trials, 3 open-label trials, one 2×2 factorial study, and 2 crossover trials. The following dietary and nutritional interventions were evaluated: gluten and casein-free diet, ketogenic diets; probiotic supplements, specific carbohydrate diets, polyunsaturated fatty acids, vitamin and mineral supplantation (A, B6, B12, D, magnesium, folic acid), and alternative diets. Authors report improvements in the symptoms associated with ASD individuals receiving nutritional interventions such as vitamin and mineral supplementation however, their safety and efficacy needs to be evaluated. The study findings will help policymakers and implementers to understand the consistency and precision and impact of these interventions. These findings will contribute to improving the safety and efficacy of these interventions, positively impacting the health and nutrition outcomes of children and adolescents with ASD. These study findings indicate that more research targeting ASD dietary and Nutritional Interventions for management of ASD symptoms is required in Kenya and other resource constrained settings

Assessing mental health literacy of primary health care workers in Kenya: a cross-sectional survey

AIM: To assess mental health literacy of health workers in primary health care services in Kenya. BACKGROUND: Mental illness is common in Kenya, yet there are fewer than 500 specialist mental health workers to serve Kenya’s population of over 50 million. The World Health Organization recommends the integration of mental health care into primary health care services to improve access to and equity of this care, especially in low and middle-income countries. An important step to integrating mental health care into primary health care services is to determine mental health literacy levels of the primary health care workforce. METHOD: A cross-sectional survey using Jorm’s Mental Health Literacy Instrument (adapted for the Kenyan context) was administered to 310 primary health care workers in four counties of Kenya. RESULTS: Of the 310 questionnaires distributed, 212 (68.3%) were returned. Of the respondents, 13% had a formal mental health qualification, while only 8.7% had received relevant continuing professional development in the five years preceding the survey. Just over one third (35.6%) of primary health care workers could correctly identify depression, with even fewer recognising schizophrenia (15.7%). CONCLUSIONS: This study provides preliminary information about mental health literacy among primary health care workers in Kenya. The majority of respondents had low mental health literacy as indicated by their inability to identify common mental disorders. While identifying gaps in primary health care workers’ mental health knowledge, these data highlight opportunities for capacity building that can enhance mental health care in Kenya and similar low and middle-income countries

Supporting child development through parenting interventions in low- to middle-income countries: An updated systematic review

Background: Over 250 million children in low- and middle-income countries are at risk of not achieving their fullest developmental potential due to co-occurring risks such as poor nutrition and inadequate learning opportunities. Early intervention programs integrating the aspects of nurturing care, that is, good health, adequate nutrition, safety and security, responsive caregiving, and learning opportunities, may ameliorate against the negative impact of these adverse conditions. Methods: This meta-analytic review updates the evidence base of parenting interventions comprising stimulation and responsive caregiving components on developmental outcomes for children under age 2 years in low- and middle-income countries. It also describes and assesses the moderation effects of population characteristics and implementation features on the intervention effectiveness. Studies were identified based on previous systematic reviews and an updated literature search in eight databases and the gray literature up to December 2020. A random-effect model was used to explore the pooled effect sizes accounted for by the intervention for developmental outcome of cognition, language, motor, and social-emotional capacities. Exploratory moderation analyses were also conducted. Results: Twenty-one randomized controlled trials representing over 10,400 children from 12 low- and middle-income countries and regions across three continents (Africa, Latin America, and Asia) were identified. The interventions showed overall small-to-moderate effects on children's cognitive development (ES = 0.44; 95% CI = [0.30, 0.57]); language development (ES = 0.33; 95% CI = [0.18, 0.49]); and motor skills (ES = 0.21; 95% CI = [0.10, 0.32]). The overall effect on social-emotional development was non-significant (ES = 0.17; 95% CI = [−0.01, 0.34]). Effect sizes (ES) varied significantly across the studies. Parenting programs that targeted vulnerable groups, including rural communities and caregivers with lower education levels, had more significant effects on children's development. Group sessions (vs. individual visits) and high program dose (≥12 sessions) were also associated with stronger effects on child development. Further research is needed to determine the effectiveness of the workforce and training on programmatic outcomes. Conclusion: The findings indicate that parenting interventions that encourage nurturing care are effective in improving the early development of children, especially among vulnerable populations. We discuss opportunities to strengthen the implementation of research-based parenting interventions in such contexts

Science into Policy: Participatory Development of Biomass Energy Regulatory Instruments in Kenya

Biomass energy, mainly as solid biomass charcoal and firewood (woodfuel), plays a significant role as cooking energy in Kenya, as in many other countries in Africa. Despite its multiple benefits, unsustainable practices have negative environmental and health impacts. Efforts to transition from woodfuel to other forms of cooking energy have been in place for many years, but woodfuel still remains the key cooking fuel in Kenya due to its affordability and accessibility, cultural norms, as well as lack of access to affordable clean cooking alternatives

Mental health during COVID-19 pandemic among caregivers of young children in Kenya's urban informal settlements. A cross-sectional telephone survey

The emergence of COVID-19 has profoundly affected mental health, especially among highly vulnerable populations. This study describes mental health issues among caregivers of young children and pregnant women in three urban informal settlements in Kenya during the first pandemic year, and factors associated with poor mental health. A cross-sectional telephone survey was administered to 845 participants. Survey instruments included the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, COVID-19 Anxiety Scale, and questions on the perceived COVID-19 effects on caregiver wellbeing and livelihood. Data were analyzed using descriptive statistics, and univariate and multivariate analysis. Caregivers perceived COVID-19 as a threatening condition (94.54%), affecting employment and income activities (>80%). Caregivers experienced discrimination (15.27%) and violence (12.6%) during the pandemic. Levels of depression (34%), general anxiety (20%), and COVID-19 related anxiety (14%) were highly prevalent. There were significant associations between mental health outcomes and economic and socio-demographic factors, violence and discrimination experiences, residency, and perceptions of COVID-19 as a threatening condition. Caregivers high burden of mental health problems highlights the urgent need to provide accessible mental health support. Innovative and multi-sectoral approaches will be required to maximize reach to underserved communities in informal settlements and tackle the root causes of mental health problems in this population