Prevalence and Associated Risk Factors of Hepatitis B Virus Infections Among HIV-1 Infected Patients Attending the Comprehensive Care Clinic in Malindi Sub-County Hospital in Kenya

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infections are common all over the world. Infection with HIV increases rates of HBV chronicity, prolong the time the HBV stays in circulation and increase liver-related morbidity. Factors such as intravenous drug use, multiple blood transfusions, presence of tattoos, unsafe sexual practices and being health workers have been implicated as drivers of infection & transmission of HBV & HIV. This study aimed to determine the prevalence and genotypes of HBV associated risk factors among HIV infected patients in a descriptive cross-sectional study. Malindi was chosen as a suitable study site because of the high numbers of residents involved in sex tourism as well as intravenous drug use. A structured questionnaire was used to capture social demographic data such as age, gender, employment status, occupation, the level of education and marital status, clinical history information such as duration since diagnosis with HIV, ART drug history, duration taking ARVs and baseline CD4 count and risk factors associated with HBV infections such as intravenous drug use, history of blood transfusion, tattooing/scarification, and the sexual history from 446 consenting randomly selected HIV infected participants. Five millilitres of whole blood was obtained from each participant, 50µl of which was used for CD4 cell counts using a flow cytometer. HBsAg serology was done using Diaspot® rapid diagnostic test and confirmed by Hepanostika® HBsAg Ultra ELISA kit (BioMérieux SA) and HBV DNA was extracted from all HBsAg positive samples. Nested polymerise chain (PCR) reaction and sequencing of the Pre S1 region was done. Sample sequences were compared with published HBV genotypes sequences from GenBank and Phylogenetic trees were constructed using the NJ Plot software using a PHB file created through DNA Database of Japan (DDBJ) to determine the HBV genotypes. Out of the 446 HIV positive participants, 126 (28.3%) were males and 320 (71.7%) females. Only 19/446 (4.26%) participants were positive for HBV based on rapid strip test while 22/446 (4.93%) participants had HBV based on ELISA. Twelve of the 22 ELISA positive samples were successfully amplified by PCR. Out of the 12 PCR positive samples 10 were successfully sequenced. Phylogenetic analysis revealed that 9/10 (90%) samples belonged to genotype A while 1/10 (10%) belonged to genotype E. Males (p=0.028) and intravenous drug use (p= 0.08) were significantly associated HBV infections. The high prevalence (4.9%) of HBV among HIV patients attending Malindi Sub-county hospital is most likely highly driven by intravenous drug use and multiple sexual partners among the male gender and is predominantly genotypes A and E which is similar to the general population. Keywords: Hepatitis B virus, HIV, Co-infection, HBsAg, genotypes, intravenous drug us

Farmers’ Perceptions of Climate Change and Its Effects on Tree Cover in the Drylands of South Eastern Kenya: The Case of Matungulu Sub-County, Machakos County

Matungulu Sub-County is a semi-arid region in Kenya that is prone to frequent droughts, water shortages and food insecurity. Rapid population growth, coupled with climate change, has led to not only an increasing demand for more land, but also to over-exploitation and degradation of local natural resources, leading to a myriad of socio-economic and environmental challenges in the area. The objective of this study was to assess farmers’ perceptions of climate change and its effects on tree cover in Matungulu Sub-County. A structured questionnaire, FDGs, key informants and direct observations were used to collect household socio-economic data from 412 randomly selected households in two locations, namely, Sengani and Koma. Temperature and rainfall data from the Kenya Metrological Department was used to study changes in climatic trends over the three-decade period between 1987 and 2017 in the study area for comparison. Descriptive and inferential statistics were used in the data analysis. Farmer-perceived climatic patterns were collaborated by data from the Kenya Meteorological Department.  84% of respondent farmers perceived climate change to have affected species composition, density and distribution of tree cover. The farmers unanimously indicated climate change was real in the region. Keywords: farmers, climate change, effects, perceptions, livelihoods, indigenous knowledg

The Loss of a Clan: Abandoning Ethos of the East African Revival by the Contemporary Kenyan Christian

This study investigated two practises of the East African Revival (EAR) movement; the public testimony of one’s salvation and the public confession of all known sins. The study further sought to know the attitude of the contemporary Christian on the same. The study was qualitative in strategy with a phenomenological design. Criterion based purposive sampling was used to select the participants. The tools for gathering data were In-depth interviews, Focus Group Discussions, and Document Review. Thematic Coding Analysis was used to analyse the data. The EDNA model for practical theology was applied as the theological framework. Findings show that the EAR members held the public testimony and public confession of sin as foundational to their doctrine and practice. The two practices helped them to create a unique identity and cohesiveness, after separating from their familial clans at conversion, hence forming a new spiritual clan of their own. The contemporary Christian on the other hand finds these two tenets of the EAR, intrusive and unacceptable. With no alternative ways of building cohesiveness and a unique identity, the younger believers are left without a clan hence becoming spiritual orphans. Traditional Anglicanism, with its focus on sacraments and liturgy, and African Traditional Religions are among the formations fighting to adopt these spiritual orphans. The study recommends that the church and society revisit these practices and apply them appropriately in the fight against corruption and tribalism, among other ills in Kenyan society

"Who has ever loved a drug addict? It's a lie. They think a 'teja' is as bad person": multiple stigmas faced by women who inject drugs in coastal Kenya.

BACKGROUND: A tenth of all people who inject drugs in Kenya are women, yet their social contexts and experiences remain poorly understood. This paper reports how multiple forms of stigma are experienced by women who inject drugs in coastal Kenya and the impact that they have on their ability to access essential health services. METHODS: In 2015, in-depth interviews and focus group discussions were held with 45 women who inject drugs in two coastal towns. These data were supplemented with in-depth interviews with five individual stakeholders involved in service provision to this population. Data were analyzed thematically using NVivo. RESULTS: Women who inject drugs experience multiple stigmas, often simultaneously. These included the external stigma and self-stigma of injection drug use, external gender-related stigma of being a female injecting drug user, and the external stigma of being HIV positive (i.e., among those living with HIV). Stigma led to rejection, social exclusion, low self-esteem, and delay or denial of services at health facilities. CONCLUSION: HIV and harm reduction programs should incorporate interventions that address different forms of stigma among women who inject drugs in coastal Kenya. Addressing stigma will require a combination of individual, social, and structural interventions, such as collective empowerment of injecting drug users, training of healthcare providers on issues and needs of women who inject drugs, peer accompaniment to health facilities, addressing wider social determinants of stigma and discrimination, and expansion of harm reduction interventions to change perceptions of communities towards women who inject drugs

Carbon Sequestration by the Above Ground Biomass Pool in the South West Mau Forest of Kenya, 1985 - 2015

Forests are important for regulation of the global carbon balance. Increase in forest biomass enhances atmospheric carbon sequestration while decrease in forest biomass contributes to carbon dioxide emissions. World over, forest biomass has been declining due to forest loss and degradation. The South West Mau has experienced significant forest loss since 1964. The decline is posited to have significant impacts on carbon sequestration, carbon storage, carbon dioxide emissions and status of atmospheric carbon dioxide. This study assessed interannual trend and variability as well as change point detection in carbon sequestration in South West Mau Forest, Kenya between 1985 and 2015. Above ground biomass carbon sequestration was quantified based on the Carnegie-Ames-Stanford Approach (CASA) and carbon fraction for tropical climate domain. Carbon sequestration dynamics were characterized by increase-decrease cycles of approximately 3 years and low interannual variability (CV= 9.13). It emerged that South West Mau Forest was a net carbon emitter with a carbon sequestration balance of -588.40 Kg/ha between 1985 and 2015. Keywords: Forest, Carbon sequestration, Carnegie-Ames-Stanford Approach, Above ground net primary production DOI: 10.7176/JEES/10-8-05 Publication date:August 31st 202

Trend and Variability in Interannual Air Temperature Over South West Mau Forest, 1985 - 2015

The research is sponsored by Jomo Kenyatta University of Agriculture and Technology and National Commission for Science, Technology and Innovation Kenya. Abstract Globally high altitude forest regions are considered to be more prone to rapid warming. These regions have also shown great seasonal and inter annual temperatures variability. In Kenya mean annual temperatures increased by 1.00C since 1960. Going by global trends it is plausible to argue that high altitude forest areas in Kenya might have shown great seasonal and inter annual temperatures variability over time. This study assessed interannual trend and variability as well as change point detection in average annual air temperature in South West Mau Forest, Kenya between 1985 and 2015. South West Mau Forest is an indigenous montane ecosystem with a tropical montane climate. Annual average air temperature over the South West Mau forest pointed towards climate warming of 0.01880C per year (Kendall’s tau = 0.3677, p value = 0.0033) but with low interannual variability (CV= 0.11%). A shift in the annual average air temperature of 0.3680C at p= 0.0051 was detected between 1985-1998 and 1999- 2015. There was a weak positive anomaly in the annual average air temperature with a slope of 0.0192 and R2 = 0.3074. Overall the region experienced climate warming. Keywords: Climate warming, Trend, Variability, Average temperature DOI: 10.7176/JNSR/11-16-04 Publication date:August 31st 202

Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya:findings from a qualitative study

Introduction The Kenyan government has committed to increasing access to comprehensive reproductive, maternal, neonatal and child health (RMNCH) services. However, inequalities still exist. Women who inject drugs are an important sub-population for public health interventions, yet their RMNCH needs have largely been overlooked. Additionally, there is a lack of research to inform RMNCH interventions for this sub-population. Methods In 2015, we undertook interviews and focus group discussions with 45 women who inject drugs and five key stakeholders to understand these women’s RMNCH experiences and needs. Results Women’ access to essential services across the RMNCH continuum was low. Two thirds of the women were not using contraception. Many discovered they were pregnant late, due to amenorrhea of drug use, and thus were unable to enroll for antenatal care early. Facility-based deliveries were limited with many choosing to deliver at home. Following delivery, women’s attendance to immunization services was sub-optimal. Stigma from healthcare workers was a major factor impeding women’s use of existing RMNCH services. The prospect of experiencing withdrawals at health facilities where waiting times were long, deterred utilization of these services. Additionally, women faced competing priorities, having to choose between purchasing heroin or spending their money on health-related costs. Conclusions Several barriers disrupted women’s access to services across the RMNCH continuum. Consequently, there is a need to develop equitable, comprehensive, and family-centered RMNCH interventions tailored to women who inject drugs, through a combination of supply- and demand-side interventions. For optimal impact, RMNCH services should be integrated into harm reduction programs

Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs:role of community-based outreach and drop-in centers

There is limited data regarding women who inject drugs, and how harm-reduction services can be made more women-centered. This study explored experiences of Kenyan women who inject drugs, with regard to access to HIV, harm reduction and sexual and reproductive health (SRH) services. A total of 45 women who inject drugs and 5 key stakeholders participated in-depth interviews and focus group discussions. Thematic analysis of the data revealed that stigma, long distances, lack of confidentiality, user fees, multiple appointments, drug users’ unfamiliarity with health facilities, disconnect in communication with healthcare providers, and healthcare providers’ lack of understanding of women’s needs were factors that impede women’s access to health services. Community-based services, comprising of outreach and drop-in centers mitigate these barriers by building trust, educating women on their health and rights, linking women to health facilities, sensitizing health providers on the needs of women who inject drugs, and integrating women’s SRH services into community-based harm-reduction outreach. Inclusion of SRH services into community-based harm-reduction activities increased women’s interest and access to harm-reduction interventions. These findings underscore the need to strengthen community-based programming for women who inject drugs, and to integrate SRH services into needle and syringe exchange programs

Contraceptive Use among Women who Inject Drugs:Motivators Barriers and Unmet Needs

We explored contraceptive use among 45 women who inject drugs in coastal Kenya. Overall, 29% were using contraceptives, motivated by a fear of unplanned pregnancy, a desire to shield children from the difficulties of drug use, the need to prevent HIV and other sexually transmitted infections, encouragement from health providers and outreach workers, or because they had achieved the desired number of children. However, 69% were not using contraceptives. Barriers to use included current pregnancy intentions, perceived infertility due to drug-induced amenorrhea, side effects, intimate partners’ influence, lack of information, complex health care appointments, and transportation costs. Rights-based integration of sexual and reproductive health into harm reduction services for women who inject drugs is required to minimize unmet contraception needs