Navigating Secondary School: What Cushioned Adolescents in an Education Intervention in Urban Kenya

This paper explains sustained effects and what worked for students in the Advancing Learning Outcomes and Transformational (ALOT Change III) program. Data comes from qualitative narratives from the baseline survey of the program collected by the African Population and Health Research Center (APHRC) between December 4, 2019, and January 31, 2020, using focus group discussions (FGDs) and dialogues. The analysis followed the Miles and Huberman (1994) framework to make comparisons and contrasts. Results showed that students transferred skills such as self-confidence from primary to secondary schools, enabling the adolescents to speak up and engage. This showed an effective implementation uptake. The implication of the study points to the efficacy of community-based programs in impacting behavior of adolescents beyond primary school

Experiences of Girls and Mentors With an Urban Kenyan Afterschool Support Program

This article explores the experiences of female mentees and their mentors in an afterschool support program in two informal urban settlements in Nairobi, Kenya. We sought the perspectives of mentees and mentors to identify what has changed concerning the education and social lives of the girls because of this education intervention. Data come from a qualitative component of the midterm survey collected in May 2014 using in-depth interviews and focus group discussions. The results show improvements in the English and math courses in which support with homework was given; girls were motivated to stay in school and had a higher aspiration for school. However, challenges remained, as some parents did not provide adequate support to their daughters. Overall, the program highlights the role of other significant players and reinforces the out-of-school mentor support for girls’ success in school

El Apoyo a la Educación de Niños en los Barrios Marginales Urbanos de Nairobi: Percepciones de la Comunidad y los Padres con una Fase Expandida de un Programa de Intervención Educativa

The objective of this paper is to examine the perceptions of community elders and parents on their roles regarding support to their children’s education. Data come from the qualitative component of a baseline survey conducted in Korogocho and Viwandani, two urban informal settlements in Nairobi, Kenya. Data were collected in April-May 2016 through in-depth interviews, key informant interviews and focus group discussions. Results demonstrated that community elders internalized their role as the face of government in their respective communities, and enforced the implementation of education policies on behalf of all children. The community leaders also saw as part of their role the need to encourage parents to be active participants in their children’s education. Female parents with boys in the program perceived that parental monitoring and follow-up was important to ensure that their children attended school, and completed work assigned by the teachers, more so in Korogocho. Overall, parents recognized the importance of the role they played in their children’s education. This is a good entry point as parental support will ensure the success and sustainability of the intervention to improve educational outcomes for children, which in turn will help their children navigate the challenging period that adolescence presents.El objetivo de este artículo es examinar las percepciones de los ancianos de la comunidad y los padres sobre sus roles respecto al apoyo educativo a sus hijos. Los datos provienen del componente cualitativo de una encuesta de referencia realizada en Korogocho y Viwandani, dos asentamientos urbanos precarios en Nairobi, Kenia. Los datos se recopilaron en Abril-Mayo de 2016 a través de entrevistas en profundidad, entrevistas con informantes clave y discusiones de grupos focales. Los resultados demostraron que los ancianos de la comunidad internalizaron su papel como la cara del gobierno en sus respectivas comunidades, e impusieron la implementación de políticas educativas en nombre de todos los niños. Los líderes de la comunidad también vieron, como parte de su rol, la necesidad de alentar a los padres a ser participantes activos en la educación de sus hijos. Las madres con niños en el programa percibieron que el control de los padres y el seguimiento era importante para asegurar que sus hijos asistieran a la escuela y completaran el trabajo asignado por los maestros, más aún en Korogocho. En general, los padres reconocieron la importancia en la educación de sus hijos. Este es un buen punto de partida ya que el apoyo de los padres asegurará el éxito y la sostenibilidad de la intervención para mejorar los resultados educativos de los niños, que a su vez ayudará a sus hijos durante la adolescencia

Sociocultural factors influencing breastfeeding practices in two slums in Nairobi, Kenya

Background: Despite numerous interventions promoting optimal breastfeeding practices in Kenya, pockets of suboptimal breastfeeding practices are documented in Kenya’s urban slums. This paper describes cultural and social beliefs and practices that influence breastfeeding in two urban slums in Nairobi, Kenya. Methods: Qualitative data were collected in Korogocho and Viwandani slums through 10 focus group discussions and 19 in-depth interviews with pregnant, breastfeeding women and community health volunteers and 11 key-informant interviews with community leaders. Interviews were audiotaped, transcribed verbatim, coded in NVIVO and analyzed thematically. Results: Social and cultural beliefs and practices that result to suboptimal breastfeeding practices were highlighted including; considering colostrum as ‘dirty’ or ‘curdled milk’, a curse ‘bad omen’ associated with breastfeeding while engaging in extra marital affairs, a fear of the ‘evil eye’ (malevolent glare which is believed to be a curse associated with witchcraft) when breastfeeding in public and breastfeeding being associated with sagging breasts. Positive social and cultural beliefs were also identified including the association of breast milk with intellectual development and good child health. The beliefs and practices were learnt mainly from spouses, close relatives and peers. Conclusion: Interventions promoting behavior change with regards to breastfeeding should focus on dispelling the beliefs and practices that result to suboptimal breastfeeding practices and to build on the positive ones, while involving spouses and other family members as they are important sources of information on breastfeeding

Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi: a cluster randomized controlled trial

Background: Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a homebased intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya. Methods: We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant’s first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis. Results: A total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4–59.9) in the intervention group and 54.6% (95% CI 50.0–59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0–2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0–4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0–6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718). Conclusions: EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions. Trial registration: ISRCTN ISRCTN83692672. Registered 11 November 2012. Retrospectively registered

Feasibility and effectiveness of the baby friendly community initiative in rural Kenya: study protocol for a randomized controlled trial

Background: Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality. Poor infant and young child feeding practices are widely documented in Kenya, with potential detrimental effects on child growth, health and survival. Effective strategies to improve these practices are needed. This study aims to pilot implementation of the Baby Friendly Community Initiative (BFCI), a global initiative aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to infant feeding practices, nutrition and health outcomes in a rural setting in Kenya. Methods: The study, employing a cluster-randomized trial design, will be conducted in rural Kenya. A total of 12 clusters, constituting community units within the government's Community Health Strategy, will be randomized, with half allocated to the intervention and the other half to the control arm. A total of 812 pregnant women and their respective children will be recruited into the study. The mother-child pairs will be followed up until the child is 6 months old. Recruitment will last approximately 1 year from January 2015, and the study will run for 3 years, from 2014 to 2016. The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal, infant and young child nutrition. Regular assessment of knowledge, attitudes and practices on maternal, infant and young child nutrition will be done, coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children. Statistical methods will include analysis of covariance, multinomial logistic regression and multilevel modeling. The study is funded by the NIH and USAID through the Program for Enhanced Research (PEER) Health. Discussion: Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community-based intervention aimed at promoting optimal breastfeeding and other infant feeding practices. The intervention, if proved feasible and effective, will inform policy and practice in Kenya and similar settings, particularly regarding implementation of the baby friendly community initiative. Trial registration:ISRCTN03467700 ; Date of Registration: 24 September 201

A year of genomic surveillance reveals how the SARS-CoV-2 pandemic unfolded in Africa.

The progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Africa has so far been heterogeneous, and the full impact is not yet well understood. In this study, we describe the genomic epidemiology using a dataset of 8746 genomes from 33 African countries and two overseas territories. We show that the epidemics in most countries were initiated by importations predominantly from Europe, which diminished after the early introduction of international travel restrictions. As the pandemic progressed, ongoing transmission in many countries and increasing mobility led to the emergence and spread within the continent of many variants of concern and interest, such as B.1.351, B.1.525, A.23.1, and C.1.1. Although distorted by low sampling numbers and blind spots, the findings highlight that Africa must not be left behind in the global pandemic response, otherwise it could become a source for new variants

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Desde las Mentes de los Adolescentes: Qué Ha Funcionado en una Intervención Educativa en los Barrios Bajos de Nairobi

This paper highlights findings from the, ‘Advancing learning outcomes for transformational change (A LOT-Change), whose goal was to increase efforts towards securing the future of children living in urban informal settlements.  The intervention was implemented in Korogocho and Site 2 respectively. This paper looks at the narratives from girls, boys and their parents and seeks to answer the question, “From the minds of adolescents: What has worked for them in an education intervention in the slums of Nairobi. Qualitative data comes from the qualitative component of the endline evaluation study that was collected in July and August 2018, by the African Population and Health Research Center (APHRC). Findings from this study done by APHRC show that: scores in numeracy skills and literacy skills improved, improved self-confidence, which enabled girls to model the way in their schools and communities. Aspirations for school and higher education improved as girls and boys wanted to go beyond primary school. Communication improved across the board girls and boys, together with their parents. Girls and boys gained the confidence to speak up due to the knowledge gained out of the motivational talks within the leadership component. Overall, this paper reinforces the importance of young people having a voice to speak up on programs that affect their lives.En este documento se destacan las conclusiones del estudio "Advancing learning outcomes for transformational change (A LOT-Change)", cuyo objetivo era aumentar los esfuerzos para asegurar el futuro de los niños que viven en asentamientos urbanos informales. La intervención se llevó a cabo en Korogocho y en Site 2, respectivamente. En este documento se examinan las narraciones de las niñas, los niños y sus padres y se trata de responder a la pregunta "Desde la mente de los adolescentes": qué les ha funcionado en una intervención educativa en los barrios marginales de Nairobi. Los datos proceden del componente cualitativo del estudio de evaluación final que fue recopilado en julio y agosto de 2018 por el Centro Africano de Investigación sobre Población y Salud (APHRC). Las conclusiones de este estudio realizado por el APHRC muestran que: las puntuaciones en las habilidades numéricas y de alfabetización mejoraron. La confianza en sí mismos mejoró, lo que permitió a las niñas modelar el camino en sus escuelas y comunidades. Las aspiraciones para la escuela y la educación superior mejoraron, ya que las niñas y los niños querían ir más allá de la escuela primaria. La comunicación mejoró de forma generalizada entre las niñas y los niños, junto con sus padres. Las niñas y los niños ganaron confianza para hablar, debido a los conocimientos adquiridos en las charlas motivacionales dentro del componente de liderazgo. En general, se refuerza la importancia de que los jóvenes tengan voz para hablar sobre los programas que les afectan