Enhancing hygiene promotion through access to WASH in informal settlements in Nairobi: the case of wise ladies

Income poverty is not only the deprivation the urban poor face; inhabitants in informal settlements have extremely very little or absolutely no access to basic services such as health, water and sanitation- deprivations that severely erode human capital. Kenya Water for Health Organization (KWAHO), in partnership with WaterCan Canada, has undertaken WASH initiatives in informal settlements as an entry point to rally the inhabitants to address wider community poverty issues through the use of community organization methodology to break this culture of apathy in informal settlements. Technical implementation of WASH in form of construction of water points and toilets is both a capacity transfer means and support mechanism. However, Hygiene promotion is core in the initiatives as a means of encouraging local communities to effectively use water and sanitation infrastructure developed as demonstrated by Wise ladies, a group of women in Kianda village, Kibera, whose case study is presented herein

‘Do I even belong?' Interrogating Afro-diasporic navigation of identity, race and space in the search for belonging

The departure point for this creative project is based on my experience as an African living in diaspora. While I felt many things during my time ‘away' from the African continent, one constant was always this feeling of unbelonging, and this need to find belonging. As such, this project centers around the theme ‘finding belonging in diaspora'. Growing up in Kenya, I had never really come to terms with the politics of my Kenyanness not to mention my blackness. I had simply just been me. While in Kenya, the only real identifiers I had to contend with that carried heavy politics were my gender and my tribal affiliation. After leaving Kenya and arriving in Canada for school at the age of 16, for the first time in my life I felt black and I felt African. Both identities I felt did not belong in this Canadian space. Over the course of 9 years, I lived in both Canada and London and neither ever warmed me like home. In most, if not all the predominantly white spaces I frequented, I always felt too little of something and too much of something else. As such,, I found myself intentionally and unintentionally drawn to those like me, in colour, in language, and culture. It is only today I have realised that those intentional and unintentional unions I formed were a result of my search for belonging, which I came to find is common in the diaspora experience. Ann Hua, a black diaspora scholar, defines diaspora as a community of people who have been dispersed from their homeland to other locations because of genocide, slavery, migration, and war (Hua, 2013; 31). It's important to note that for many, induction into the Afro-diaspora is involuntary. As Hua notes, political unrest, genocide, war, and slavery has forced many to leave their homes and either seek asylum or become indentured laborers elsewhere. We have seen this throughout the eras, from the 15th-century trans-Atlantic slave trade, capturing of Africans, transporting them to the Americas and coercing them into slavery (Gates Jr., 2017), to the 20th-century dispersion of Rwandese nationals fleeing genocide§ (Guichaoua, André & Webster, Don E. 2015). The identity of diaspora comes in both anticipated and unanticipated ways. Fortunately, my induction into the Afro-diasporic community was a voluntary one and the bulk of this project interacts with voluntary Afro-diasporic migrants. During my time in Canada and London, I met many members of the Afro-diasporic community who ended up in these countries in a variety of different ways and for a variety of different reasons. The theme of ‘finding belonging' was omnipresent among my fellow Afro-diasporic community members and it would manifest itself in various ways. For instance, wanting to go to African restaurants to feel more ‘at-home', or wanting to visit African night clubs to listen to more music from ‘home'. Interestingly, I also began to see that this journey towards ‘finding belonging' also manifested in Afro-diasporic communities rejecting assimilation into their new societies and creating spaces of resistance, through organising protests or hosting discussions that centred around issues of race

Do social comparisons matter in relation to health and wellbeing?

This thesis explores the relationship between social comparisons and health and wellbeing as a possible explanation for health inequalities. This is because, although inequalities in health have been observed in Britain since occupational and mortality statistics were first published in 1851 (Macintyre, 1997), the underlying reasons remain a subject of much debate. This thesis adds to the debate by focusing on one of the most influential arguments in recent decades; that, in developed countries, perceptions of place as a class context in the socioeconomic hierarchy is a psychosocial risk factor related to ill health (Wilkinson, 1992; Wilkinson, 1996). However, despite being implied as the central mechanism in his psychosocial pathway, surprisingly, Wilkinson has given little attention to the process of social comparisons. His reliance on large scale epidemiological data to make inferences at an individual level is unsatisfactory since it offers no understanding of the dimensions of people’s social comparisons and how this may be linked to health and wellbeing. The main aim of this study was, therefore, to investigate the scope and nature of social comparisons amongst people living in proximal socio-economically contrasting neighbourhoods, their perceptions of class and inequality and how this might impact on health and wellbeing. In-depth interviewing was the main methodology, supplemented with media analysis and participant observation in order to gain an understanding of the study areas. A total of 33 interviews were conducted with parents from Drumchapel and Bearsden. These areas were chosen because they were strikingly different class contexts, Drumchapel representing a working class area and Bearsden a middle class area. As Wilkinson focuses on between-class comparisons, the selection of these proximal neighbourhoods provided a good opportunity to investigate the extent to which people make comparisons between classes. Insofar as lay theories map on to explanations of health inequalities, this study found little support for Wilkinson’s assertion that perception of place in the social hierarchy is the determining factor in relation to health and wellbeing. Firstly, unlike his suggestion that social comparisons are more common with decreasing social class, the process was found to be a widespread social phenomenon which people across the hierarchy utilise for both self-evaluation and self-enhancement. Secondly, in contrast to Wilkinson’s focus on a single economic hierarchy, this study found compelling evidence that people often utilise complex multiple status hierarchies that can include material and non-material factors like speech, social mannerisms, moral respectability, education, and family upbringing when making social comparisons. In this respect, though Wilkinson’s call for income redistribution policies is admirable, it would not necessarily eliminate feelings of relative deprivation because status differences can exist even in the most economically equal societies. Thirdly, whilst factors like globalisation, the rise in consumerism, and expansion of the mass media have made people more aware of inequalities in society, comparisons with ‘similar others’ like neighbours, friends, family members, and work colleagues were found to be still the most salient reference groups. Further support for this was that status distinctions within classes (e.g. between ‘old’ and ‘new’ money in Bearsden and ‘rough’ and ‘respectable’ in Drumchapel) were more important than those between classes. Lastly, and most importantly, there was little indication that a psychosocial explanation is at the forefront of people’s minds in accounting for health inequalities. To begin with, none of the participants spontaneously suggested a psychosocial mechanism; instead, those in Drumchapel were more likely to suggest material/structural factors whilst Bearsden participants tended to advocate behavioural/cultural explanations. Furthermore, although there was evidence to suggest that ‘some’ people may be vulnerable to similar negative effects of social comparisons they perceived as impacting on others (including anxiety, stress, pressure and depressive state), such effects appeared to be minimal since they were reported to occur only at particular periods in people’s lives. The fact that this thesis was centred on Wilkinson’s psychosocial hypothesis is testimony to the enormous contribution he has made to the health inequalities debate. However, in examining the association between social comparisons and health and wellbeing, the conclusion drawn from this study is that the role of social comparisons in the psychosocial mechanism may have been exaggerated

Wandering spleen: Case report

Wandering spleens are rare clinical entities found more commonly in women aged 20-40 years. We report one such case found in a 24-year-old nulliparous woman who presented with low abdominal pains of sudden onset and splenomegaly. An emergency abdominal CT scan showed an enlarged spleen located in the right lumbar region and extending into the pelvis. There was a long splenic pedicle containing tortuous vessels. A review of literature and the postulated aetiological factors and associations are discussed

Assessment of Land Governance System in Preventing State Land Conflicts in Zambia

The purpose of the research is to assess the land governance system in preventing state land conflicts in Zambia. In order to obtain insights about the actual realities on the ground, based on a case study strategy (i.e. Lusaka District has a study area), the research examined the present status of state land governance system, and investigated the efficiency of the present state land governance system in preventing state land conflicts. Methodologically, qualitative approach supported by quantitative approach was used to conclude that the present state land governance in Zambia is dysfunctional. This land governance system is characterised by lack of land policy, defective legal framework, defective institutional framework, defective technical issues and defective operational issues. Thus, the present land governance framework is unable to prevent state land conflicts. As a result state land conflicts are occurring with greater frequency in the country in general and Lusaka District in particular. In light of the foregoing, it is recommended that, the Zambian government should consider investing in land conflict prevention measures like formulating an appropriate land policy and land laws, establish effective land institutions, and undertaking effective technical issues (i.e. comprehensive land use planning, systematic cadastral surveying, systematic land registration, and transparent land allocation), improving the government-stakeholders nexus, and improving capacity building and awareness. Keywords: Zambia, Lusaka, land governance, state land conflic

The utility of ultrasonography compared to surgical and pathology findings in evaluating suspected acute appendicitis at a tertiary institution in Kenya

Objective: To investigate the role of ultrasonography in evaluating patients with clinical suspicion of acute appendicitis.Design: A prospective descriptive study of patients clinically suspected to have acute appendicitis. The abdominal sonographic findings were correlated to the surgical and pathology results.Setting: Kenyatta National Hospital and the Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi.Subjects: Patients with a clinical suspicion of acute appendicitis referred for abdominal ultrasonography during the study period.Results: A total of 112 patients were recruited following ethical approval and informed consent. Males were 73 and females 39 giving a male to female ratio of 1.9:1. The age distribution was from 8 to 70 years with a median age of 27.1 years (IQR 11.5, Q1 = 19.6, Q3=37.1). All patients presented with abdominal pain which was localized at the right iliac fossa in 96 (86%) patients and generalized in 16 (14%). Ultrasound examination of abdomen showed that 97 (87%) patients had findings concerning for appendicitis. The rest (15) patients did not have sonographic features concerning for appendicitis. All patients underwent appendicectomy and 61(54.5%) had inflamed appendices, 32 (28.6%) perforated appendices, 27(24.1%) abscess and 5(4.5%) were gangrenous. The histology of the excised appendices resulted in accuracy, sensitivity, specificity, PPV and NPV of sonographic diagnosis of acute appendicitis to be 88.4%, 92%, 58.3%, 95% and 47% respectively. The overall negative appendicectomy rate was 10.7%.Conclusion: Abdominal ultrasonography using graded compression technique is a useful tool for evaluation of suspected acute appendicitis. However, the ultrasound findings should always be carefully correlated with clinical findings since its negative predictive value is quite low (47%)

The prevalence of abnormal chest radiograph findings among HIV infected children

Background: Human Immunodeficiency virus infected children are highly susceptible to opportunistic infections of the respiratory system which are the most common cause of morbidity and mortality. The chest radiograph is the most frequently requested examination for the evaluation of respiratory disease. Its applications include screening, diagnosis and monitoring response to medication of respiratory illnesses.Objective: To determine the prevalence of abnormal chest radiograph findings among HIV infected children. Design: Prospective cross-sectional descriptive study Setting: Kenyatta National Hospital and Mbagathi Level 5 Nairobi County hospital Subjects: The chest radiographs and clinical history of 123 HIV infected children below 15 years were studied between November 2014 and February 2015. Results: The age range of the children was 1-15 years with a median age of 24 months. The male: female ratio was 1:1.02. Normal chest radiographs were found in 54/123 (44%) while 69/123 (56%) had abnormal chest radiographic findings. Pulmonary opacities were identified in the majority of patients with abnormal chest radiographs (67%) while almost 51% showed lymphadenopathy. In the pulmonary opacities, “other infiltrate’’ (61%) was found to be more common than consolidation (39%). Pleural effusions were not common while cavitary lesions and pneumothorax were not identified. There was no significant association between the radiographic findings and the children’s age and sex. The findings of this study correlated well with similar studies in Africa. Conclusion: HIV infected children especially those below the age of 5 years, are highly susceptible to chest infections. This was seen in the high prevalence of cough and severe respiratory distress as well as the significant number of abnormal chest radiograph findings. The high prevalence of ‘other infiltrate’ in this study may indicate that the causative pathogen may not respond to standard antibiotic regimes; and further clinical studies to confirm this are required

Rural road maintenance through labour-based lengthmen system in Zambia.

Thesis (M.Sc.Eng.)-University of Natal, Durban, 2000.Rural road maintenance has received little or no attention in Zambia for a long time, resulting in an adverse impact on the economy. Meanwhile Road Authorities have continued to use traditional capital-intensive periodic and routine maintenance at the expense of scarce foreign exchange. The system has not performed well, hence the current state of roads. Labour-based methods for routine maintenance under the Lengthmen System used in Kenya, Lesotho and other developing countries in the Sub-Saharan Africa have proved to be technically and economically viable. In this report the author examines the desirability of using the Labour-Based Lengthmen System as an alternative to the existing capital -intensive methods in Zambia. This is done through rev iewing rural road maintenance in Zambia and then carrying out a comparative analysis of the same bctween Zambia, Kenya and Lesotho The comparative analysis shows that Zambia is not performing well when compared to Kenya and Lesotho. Meanwhile, the Lengthmen System is more desirable compared to other methods under the current economic conditions. Recommendations, based on the comparative analysis, have been given to improve rural road maintenance in Zambia

Knowledge on ionizing radiation among non-radiologist clinicians at Kenyatta National Hospital – Kenya

Background: Low dose ionizing radiation used in diagnostic imaging has the potential to cause detrimental health effects. Knowledge of the requesting clinician on ionizing radiation will deter inappropriate and unjustifiable imaging requests.Objective: To document the knowledge of ionizing radiation (IR) among the teaching hospital non-radiologist clinicians.Design: Cross-sectional survey.Setting: Kenyatta National Hospital (KNH), the largest teaching and referral hospital in Nairobi, Kenya.Subjects: A total of 170 non-radiology hospital clinicians were recruited into the study after ethical approval and informed consent using simple random sampling method over a six-week period in August -October 2013.Results: Health workers with ionizing radiation (IR) training were more likely to correctly identify all the imaging modalities that use IR compared to those without IR training (50.9% versus 27.5%; OR = 2.83, 95% CI 1.35-5.91). There was significant heterogeneity in knowledge across the cadres (p < 0.0001). Those with formal IR training were able to identify that an abdominal CT has the highest radiation dose compared to those with no formal training (69.8% vs 37.1% p= < 0.001). Length of professional experience, field of clinical training, and formal training in IR of the clinicians had no influence on their knowledge of IR doses. With respect to organ sensitivity only 42% of participants correctly rated bone marrow as a very sensitive organ.Conclusions: The results from this study show that health workers lack the basic knowledge on ionizing radiation doses and its harmful effects. This is likely to impact negatively on their attitude and practice. The implications here are serious for the patient as they are possibly being exposed to unnecessary radiation and its attendant risks which include carcinogenesis.Recommendations: To bridge this knowledge gap, there is need to increase awareness about ionizing radiation through continuous medical education,development of imaging referral guidelines and incorporating modules on medical radiation and its risks during the clinicians’ training programs

Petrography, metamorphism, deformation and P-T conditions in the western arm of the Lufilian Arc - Zambezi, north-western Zambia

The Zambezi area in north-western Zambia is underlain by Neoproterozoic Katanga Supergroup and older, Archean to Mesoproterozoic Basement Supergroup rocks. The area lies within the Domes Region, which is a structural domain of the Lufilian Arc. The stratigraphic succession within Zambezi area is dominated by the Grand Conglomerate Formation (GC) and Mwashia Group which are the most extensive units, and the less abundant Lower and Upper Roan Groups of the Katanga Supergroup. They wrap around the domal Basement Supergroup units. The mineral assemblage of the Mwashia and the GC schists commonly contains garnet, anthophyllite and biotite. GC rocks show remnants of primary structures such as clasts and sedimentary features. Anthophyllite, garnet and biotite are the dominant Mg-Fe rich metamorphic minerals. However, these are iron rich for each mineral phase and has been attributed to iron rich protoliths. The earliest recognised deformation episode (D1) formed NE-SW S1 foliations within GC which is consistent with the regional structural trend in the western Lufilian Arc. S1 was later affected by D2 that generated downward facing F2 folds and S2 foliations. The other associated feature to D2 is garnet that grew as the result of pro-grade metamorphism. The D3 deformation fabric is not developed and did not affect much of the structural geometry of the Zambezi area. The peak assemblages of the Basement Supergroup and the Katanga Supergroup formed at mid-amphibolite facies conditions of 590 °C and 630 °C at an average pressure of 4.0 kbar. The Basement Supergroup has undergone retrograde metamorphism to greenschist facies condition indicated by presence of chlorite and also determined by biotite-anorthite isopleth in THERIAK DOMINO. At the eastern part of Zambezi area, the Katanga Supergroup rocks were retrogressed in the upper greenschist facies at about ~470°C and ~4.0 kbar due to isobaric cooling