Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined protocol: A nested cohort from the ComPAS RCT

INTRODUCTION: Severe and moderate acute malnutrition (SAM and MAM) affect more than 50 million children worldwide yet 80% of these children do not access care. The Combined Protocol for Acute Malnutrition Study (ComPAS) trial assessed the effectiveness of a simplified, combined SAM/MAM protocol for children aged 6-59 months and found non-inferior recovery compared to standard care. To further inform policy, this study assessed post-discharge outcomes of children treated with this novel protocol in Kenya. METHODS: Six 'combined' protocol clinics treated SAM and MAM children using an optimised mid-upper arm circumference (MUAC)-based dose of ready-to-use therapeutic food (RUTF). Six 'standard care' clinics treated SAM with weight-based RUTF rations; MAM with ready-to-use supplementary food (RUSF). Four months post-discharge, we assessed anthropometry, recent history of illness, and body composition by bioelectrical impedance analysis. Data was analysed using multivariable linear regression, adjusted for age, sex and allowing for clustering by clinic. RESULTS: We sampled 850 children (median age 18 months, IQR 15-23); 44% of the original trial sample in Kenya. Children treated with the combined protocol had similar anthropometry, fat-free mass, fat mass, skinfold thickness z-scores, and frequency of common illnesses 4 months post-discharge compared the standard protocol. Mean subscapular skinfold z-scores were close to the global norm (standard care: 0.24; combined 0.27). There was no significant difference in odds of relapse between protocols (SAM, 3% vs 3%, OR = 1.0 p = 0.75; MAM, 10% vs 12%, OR = 0.90 p = 0.34). CONCLUSIONS: Despite the lower dosage of RUTF for most SAM children in the combined protocol, their anthropometry and relapse rates at 4 months post-discharge were similar to standard care. MAM children treated with RUTF had similar body composition to those treated with RUSF and neither group exhibited excess adiposity. These results add further evidence that a combined protocol is as effective as standard care with no evidence of adverse effects post-discharge. A simplified, combined approach could treat more children, stretch existing resources further, and contribute to achieving Sustainable Development Goal Two

Changes in context, typology and programme outcomes between early and recent periods of sex work among young female sex workers in Mombasa, Kenya: a cross-sectional study

INTRODUCTION: The sex work context and typology change continuously and influence HIV related risk and vulnerability for young female sex workers (YFSW). We sought to describe changes in the context and typology of sex work between the first (early) and past month (recent) of sex work among YFSW to inform HIV prevention programming for sex workers. METHODS: We used data from a cross-sectional survey (April-November 2015), administered using physical location-based sampling to 408 cis-women, aged 14-24 years, who self-identified as sex workers, in Mombasa, Kenya. We collected self-reported data on the early and recent month of sex work. The analysis focused on changes in a) sex work context and typology (defined by setting where sex workers practice sex work) where YFSW operated, b) primary typology of sex work, and c) HIV programme outcomes among YFSW who changed primary typology, within the early and recent month of sex work. We analysed the data using a) SPSS27.0 and excel; b) bivariate analysis and χ2 test; and c) bivariate logistic regression models. RESULTS: Overall, the median age of respondents was 20 years and median duration in sex work was 2 years. Higher proportion of respondents in the recent period managed their clients on their own (98.0% vs. 91.2%), had sex with >5 clients per week (39.3% vs.16.5%); were able to meet > 50% of living expenses through sex work income (46.8% vs. 18.8%); and experienced police violence in the past month (16.4% vs. 6.5%). YFSW reported multiple sex work typology in early and recent periods. Overall, 37.2% reported changing their primary typology. A higher proportion among those who used street/ bus stop typology, experienced police violence, or initiated sex work after 19 years of age in the early period reported a change. There was no difference in HIV programme outcomes among YFSW who changed typology vs. those who did not. CONCLUSIONS: The sex work context changes even in a short duration of two years. Hence, understanding these changes in the early period of sex work can allow for development of tailored strategies that are responsive to the specific needs and vulnerabilities of YFSW

Small-scale agricultural grassland management can affect soil fungal community structure as much as continental scale geographic patterns

A European transect was established, ranging from Sweden to the Azores, to determine the relative influence of geographic factors and agricultural small-scale management on the grassland soil microbiome. Within each of five countries (factor ‘Country’), which maximized a range of geographic factors, two differing growth condition regions (factor ‘GCR’) were selected: a favorable region with conditions allowing for high plant biomass production and a contrasting less favorable region with a markedly lower potential. Within each region, grasslands of contrasting management intensities (factor ‘MI’) were defined: intensive and extensive, from which soil samples were collected. Across the transect, ‘MI’ was a strong differentiator of fungal community structure, having a comparable effect to continental scale geographic factors (‘Country’). ‘MI’ was also a highly significant driver of bacterial community structure, but ‘Country’ was clearly the stronger driver. For both, ‘GCR’ was the weakest driver. Also at the regional level, strong effects of MI occurred on various measures of the soil microbiome (i.e. OTU richness, management-associated indicator OTUs), though the effects were largely regional-specific. Our results illustrate the decisive influence of grassland MI on soil microbial community structure, over both regional and continental scales, and, thus, highlight the importance of preserving rare extensive grasslands.info:eu-repo/semantics/publishedVersio

Plant Morphoecological Traits, Grass-Weed Interactions and Water Use Efficiencies of Grasses Used for Restoration of African Rangelands

Degradation characterized by depleted vegetation cover is a serious environmental problem in African rangelands. It poses a serious threat to millions of pastoralists and agropastoralists who depend on livestock as a source of livelihood. Consequently, there has been a growing global interest to consolidate efforts to restore degraded ecosystems. For example, the UN decade of Ecosystem Restoration initiative aims at uniting the world behind a common goal of preventing, halting and reversing the degradation of ecosystems. Grass reseeding using native perennial species has been identified as one of the practical ecological strategies for restoring degraded African rangelands, enhancing vegetation cover and forage production. Knowledge of the multifaceted performance of African rangeland grasses in terms of morphoecological traits, interaction with weeds and water use efficiencies is however largely limited and often elusive. Perennial grasses indigenous to African rangelands Cenchrus ciliaris L. (African foxtail grass), Enteropogon macrostachyus (Hochst. Ex A. Rich.) Monro ex Benth. (Bush rye grass) and Eragrostis superba Peyr. (Maasai love grass), were established in an African semi-arid rangeland under natural conditions to fill this knowledge gap. Morphoecological plant traits: aboveground biomass (shoot, leaf and stem) production, plant densities, basal cover, tiller densities and plant height were measured 9 months after establishment. Interaction between the target grass species and weeds and water use efficiencies (WUE) were also determined. Enteropogon macrostachyus displayed significantly higher values for plant densities, tiller densities and basal cover, indices commonly used to estimate the potential of grasses for ecological restoration. Eragrostis superba produced the highest shoot biomass and water use efficiencies. This is attributed to its higher leafy biomass fraction. Higher aboveground biomass production of E. superba demonstrate its suitability for enhancing rangeland productivity. Cenchrus ciliaris suppressed the weeds. This is linked to its aggressive and allelopathic nature. In conclusion, the three perennial grasses displayed distinct morphoecological traits. In order to achieve successful seed-based restoration of degraded African rangelands using native perennial grasses, careful selection species to maximize on their unique traits is recommended. Ultimately, this selection process should match the desired restoration outcomes and subsequent use of the rangeland.Peer reviewe

Small-scale agricultural grassland management can affect soil fungal community structure as much as continental scale geographic patterns

A European transect was established, ranging from Sweden to the Azores, to determine the relative influence of geographic factors and agricultural small-scale management on the grassland soil microbiome. Within each of five countries (factor ‘Country’), which maximized a range of geographic factors, two differing growth condition regions (factor ‘GCR’) were selected: a favorable region with conditions allowing for high plant biomass production and a contrasting less favorable region with a markedly lower potential. Within each region, grasslands of contrasting management intensities (factor ‘MI’) were defined: intensive and extensive, from which soil samples were collected. Across the transect, ‘MI’ was a strong differentiator of fungal community structure, having a comparable effect to continental scale geographic factors (‘Country’). ‘MI’ was also a highly significant driver of bacterial community structure, but ‘Country’ was clearly the stronger driver. For both, ‘GCR’ was the weakest driver. Also at the regional level, strong effects of MI occurred on various measures of the soil microbiome (i.e. OTU richness, management-associated indicator OTUs), though the effects were largely regional-specific. Our results illustrate the decisive influence of grassland MI on soil microbial community structure, over both regional and continental scales, and, thus, highlight the importance of preserving rare extensive grasslands

HIV prevalence, testing and treatment among men who have sex with men through engagement in virtual sexual networks in Kenya: a cross-sectional bio-behavioural study

INTRODUCTION: In Kenya, men who have sex with men (MSM) are increasingly using virtual sites, including web-based apps, to meet sex partners. We examined HIV testing, HIV prevalence, awareness of HIV-positive status and linkage to antiretroviral therapy (ART), for HIV-positive MSM who solely met partners via physical sites (PMSM), compared with those who did so in virtual sites (either solely via virtual sites (VMSM), or via both virtual and physical sites (DMSM)). METHODS: We conducted a cross-sectional bio-behavioural survey of 1200 MSM, 15 years and above, in three counties in Kenya between May and July 2019, using random sampling of physical and virtual sites. We classified participants as PMSM, DMSM and VMSM, based on where they met sex partners, and compared the following between groups using chi-square tests: (i) proportion tested; (ii) HIV prevalence and (iii) HIV care continuum among MSM living with HIV. We then performed multivariable logistic regression to measure independent associations between network engagement and HIV status. RESULTS: 177 (14.7%), 768 (64.0%) and 255 (21.2%), of participants were classified as PMSM, DMSM and VMSM respectively. 68.4%, 70.4% and 78.5% of PMSM, DMSM and VMSM, respectively, reported an HIV test in the previous six months. HIV prevalence was 8.5% (PMSM), 15.4% (DMSM) and 26.7% (VMSM), p < 0.001. Among those living with HIV, 46.7% (PMSM), 41.5% (DMSM) and 29.4% (VMSM) were diagnosed and aware of their status; and 40.0%, 35.6% and 26.5% were on antiretroviral treatment. After adjustment for other predictors, MSM engaged in virtual networks remained at a two to threefold higher risk of prevalent HIV: VMSM versus PMSM (adjusted odds ratio 3.88 (95% confidence interval (CI) 1.84 to 8.17) p < 0.001); DMSM versus PMSM (2.00 (95% CI 1.03 to 3.87), p = 0.040). CONCLUSIONS: Engagement in virtual networks is associated with elevated HIV risk, irrespective of individual-level risk factors. Understanding the difference in characteristics among MSM-seeking partners in different sites will help HIV programmes to develop subpopulation-specific interventions

Combining Rainwater Harvesting and Grass Reseeding to Revegetate Denuded African Semi-arid Landscapes

In African drylands, perennial grasses preferred by grazing livestock are disappearing at an alarming rate. This has led to recurrent livestock feed shortages threatening pastoralist’s livelihoods. Combining native grass reseeding and rainwater harvesting offers a viable and innovative solution to reverse this trend. However, studies to determine how biomass yields are affected by soil moisture availability attributed to in situ rainwater harvesting in African drylands are limited. We investigated how biomass yields of three grasses native to Africa, i.e., Enteropogon macrostachyus (Bush rye grass), Cenchrus ciliaris (African foxtail grass), and Eragrostis superba (Maasai love grass), are affected by soil moisture content in a typical semi-arid landscape. Rainwater harvesting structures included trenches, micro-catchments and furrows. Additionally, rain runoff was diverted from an adjacent road used as a catchment area. Soil moisture was measured between November 2018 and August 2019 using PlantCare Mini-Logger sensors installed at 40 and 50 cm depths and 0, 1, 5 and 15 m away from the trench. Quadrat method was used to determine biomass yields in August 2019. Peaks in soil moisture were observed after rainfall events. Soil moisture content gradually decreased after the rainy season, but was higher closer to the trench. This is attributed to the prolonged rainwater retention in the trenches. Biomass yields were in the order Eragrostis superba > Cenchrus ciliaris > Enteropogon macrostachyus. Biomass production was higher near the trenches for all the studied species. Sensitivity to soil moisture demonstrated by the magnitude to yield reduction during the growing season was in the order Eragrostis superba > Cenchrus ciliaris > Enteropogon macrostachyus. These results suggest that Eragrostis superba is more sensitive to drought stress than Enteropogon macrostachyus that is adapted to a wide range of soil moisture conditions. We demonstrated that in situ rainwater harvesting structures enhanced soil moisture availability and displayed great potential for revegetating denuded natural rangelands in semi-arid African landscapes. Thus, combining rainwater harvesting and reseeding techniques can produce measurable improvements in pastoral livelihoods and should be incorporated in dryland development policies in the region. Ultimately, incorporating such innovative strategies can strengthen the effectiveness of ecological restoration in African drylands to meet the objectives of the UN Decade on Ecosystem Restoration and achieving the UN Sustainable Development Goals.Peer reviewe

HIV acquisition prior to entry into formal sex work: inference from next-generation viral sequencing.

OBJECTIVE: To infer the timing of HIV acquisition in relation to self-reported events in the sexual life course of adolescent girls and young women (AGYW) who self-identify as female sex workers (FSW) in Mombasa, Kenya. DESIGN: Next-generation viral sequencing of samples of AGYW living with HIV in the Transitions study, a cross-sectional bio-behavioural survey of AGYW aged 14-24 years in Mombasa, Kenya. METHOD: Dried blood spot specimens were collected from study participants ( n  = 37, all FSW). A portion of the HIV pol gene was sequenced using an in-house next-generation sequencing assay for HIV drug resistance mutation genotyping. Estimated time since infection (ETI) was inferred using the HIV EVO web-based tool ( https://hiv.biozentrum.unibas.ch/ETI/ ), and data on self-reported events were obtained from the survey. RESULTS: The median ETI among FSW was 3.4 (interquartile range = 1.7, 6.3) years, with a median ETI of 1.5 years prior to entry into formal sex work. We estimated that 74.1% (95% confidence interval = 53.7-88.9%) of participants living with HIV and who self-identified as FSW likely acquired HIV prior to self-identification as a sex worker. CONCLUSIONS: Findings suggest a large fraction of prevalent HIV infection among AGYW engaged in sex work stems from acquisition prior to entry into formal sex work. Current HIV prevention programs tailored for sex workers may miss key opportunities for HIV prevention as they are designed to reach women after entry into formal sex work, signaling a need for tailored programs to reach high-risk AGYW earlier on in their sexual life course

Assessing awareness and use of HIV self-testing kits after the introduction of a community-based HIV self-testing programme among men who have sex with men in Kenya

Men who have sex with men (MSM) bear a disproportionate burden of new HIV infections in Kenya, while experiencing discrimination, leading to suboptimal levels of HIV care. HIV self-testing (HIVST) is a tool to increase HIV screening and earlier diagnosis; however, questions remain regarding how best to scale-up HIVST to MSM in Kenya. The main objective of this study was to examine changes in knowledge and use of HIVST after implementation of a community-led HIVST project. Participants were MSM recruited from Kisumu, Mombasa, and Kiambu counties. Data were collected from two rounds (Round 1: 2019; Round 2: 2020) of serial cross-sectional integrated biological and behavioural assessments (IBBA), pre-, and post-project implementation. Two main outcomes were measured: 1) whether the respondent had ever heard of HIVST; and 2) whether they had ever used HIVST kits. Changes in outcomes between IBBA rounds were examined using modified multivariable Poisson regression models; adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) are reported. A total of 2,328 respondents were included in main analyses. The proportion of respondents who had heard of HIVST increased from 75% in Round 1 to 94% in Round 2 (aPR: 1.2, 95% CI: 1.2-1.3), while those reporting using an HIVST kit increased from 20% to 53% (aPR: 2.3, 95% CI: 2.0-2.6). Higher levels of education and HIV programme awareness were associated with both outcomes. Awareness and use of HIVST kits increased after implementation of a community-led HIVST implementation project, demonstrating the importance of integration with existing community groups

Use of Maerua Decumbens as a Natural Coagulant for Water Purification in the Dry Lands of Kenya

ABSTRACT: Indigenous management and utilization of naturally occurring tree species and shrubs/lianas is not a new culture worldwide. Various communities in the world use their indigenous tree /shrub / liana species to meet their needs for food (human and livestock), shelter and medicine among other diverse wood and non-wood forest products. Introduction of new exotic species has eroded the importance of some of these important indigenous plant species to great extends. It is however, important to consider that while these exotic species have multiple uses, most of them are not well adapted to our arid and semi-arid regions hence the need to promote the management and sustainable use of the indigenous species. Maerua decumbens is a shrub or woody herb species in the Capparaceae family and grows to a height of 0.5 to 3m with a large swollen root. It mostly occurs naturally in the arid and semiarid areas in Kenya and is used traditionally by rural communities for medicinal and water purification purposes. Members of the Mearua species are indicated as poisonous and probably a health risk and yet some of the communities chew the roots of Mearua decumbens against thirst and also use them for purifying water (Beenje H.1994). The study was done to enhance the use of Maerua decumbens as a natural coagulant for water purification by determining whether the plant used for water purification in Mutha in Kitui County is toxic or not. A reconnaissance survey was done to confirm its use for water purification and toxicity tests were done to determine the safety of the plant for human utilization as a natural coagulant for water purification. The results of the study revealed that M.decumbens is completely safe for human consumption and does not have any heavy metals that pose a risk to human health