Assessment of community led total sanitation uptake in rural Kenya

Background: Community Led Total Sanitation (CLTS) is an innovative community led drive to set up pit latrines in rural Kenya with an aim of promoting sustainable sanitation through behaviour change. It’s a behaviour change approach based on social capital that triggers households to build pit latrines without subsidy. The Ministry of Health introduced the CLTS campaign in 2007 and the first road map to ODF ended in 2013. Since the commencement of the CLTS Programme in, there is little documentation on assessment of its uptake from triggering to the certification of open defecation free villages.Objective: To assess the magnitude of Community Led Total Sanitation (CLTS) triggering to certification of Open Defecation free (ODF) villages in rural Kenya.Design: A retrospective descriptive study.Setting: The 47 counties in Kenya. Kenya is projected to have a population of 46 million people with the majority as rural populace. The study unit were Villages across the 47 counties from the data generated in the CLTS monitoring and evaluation dataset.Results: The number of triggered villages (11641) compared to those that reached certification stage (3131) reduced significantly. Busia County achieved the 100% target for triggering. There was a significant decline of the proportions per county in the process of claiming, verifying and certifying ODF villages however Busia, Siaya and Vihiga were leading across the counties. The proportion of CLTS facilitators and CLTS certified villages per county were incongruent.Conclusion: There was low uptake of CLTS from the triggering phase to the certification phase due to plausible factors such as inadequate monitoring of the CLTS process, inadequate funding of CLTS programmeming and conflicting work demands on the CLTS facilitators leading to reduced momentum as observed in Uganda

Large herbivore assemblages in a changing climate: incorporating water dependence and thermoregulation.

The coexistence of different species of large herbivores (ungulates) in grasslands and savannas has fascinated ecologists for decades. However, changes in climate, land-use and trophic structure of ecosystems increasingly jeopardise the persistence of such diverse assemblages. Body size has been used successfully to explain ungulate niche differentiation with regard to food requirements and predation sensitivity. But this single trait axis insufficiently captures interspecific differences in water requirements and thermoregulatory capacity and thus sensitivity to climate change. Here, we develop a two-dimensional trait space of body size and minimum dung moisture content that characterises the combined food and water requirements of large herbivores. From this, we predict that increased spatial homogeneity in water availability in drylands reduces the number of ungulate species that will coexist. But we also predict that extreme droughts will cause the larger, water-dependent grazers as wildebeest, zebra and buffalo-dominant species in savanna ecosystems - to be replaced by smaller, less water-dependent species. Subsequently, we explore how other constraints such as predation risk and thermoregulation are connected to this two-dimensional framework. Our novel framework integrates multiple simultaneous stressors for herbivores and yields an extensive set of testable hypotheses about the expected changes in large herbivore community composition following climate change

An assessment of water, sanitation and hygiene (wash) practices and quality of routinely collected data in Machakos County Kenya

Background: Poor water, sanitation, and hygiene (WASH) practices, predispose to childhood morbidity and mortality globally, and especially from diarrhoeal diseases. Machakos County in its community strategy utilises Community Health Workers (CHWs) to promote WASH practices and to collect household based data using a structured reporting tool. There is no published data on WASH in Machakos County.Objectives: To assess (i) WASH practices, and (ii) completeness and accuracy of routinely collected data on household water, sanitation and hygiene with reported childhood diarrhoea cases of all community units in Machakos County, Kenya.Design: Descriptive ecological studySetting: Machakos County, KenyaSubjects: Household unitsResults: A total of 137,540 households were served by the CHWs between January and December 2014. The number of households was not updated as per ministry of health recommendation, after six months hence the denominator remained constant. There was a high uptake of households with treated drinking water (92%), availability of hand washing facilities in (89%) and availability of functional pit latrines (98%). A total of 4,012 diarrhoea cases were reported in the County, with an average of 90 cases every month, except in the month of August where 3,020 cases of diarrhoea were reported. There was no apparent relationship observed between WASH practices and occurrence of under five diarrhoea cases.Conclusion: Water, sanitation and hygiene practices at community level in Machakos County are in keeping with post 2015 WASH targets and indicators, with few cases of under-five diarrhoea reported. Data quality and completeness need to be addressed for effective programme evaluation

Trends of reported outpatient malaria cases to assess the Test, Treat and Track (T3) policy in Kenya

Background: Kenya reports over six million malaria cases annually. In 2012 the country adopted the Test, Treat and Track (T3) policy to ensure that all suspected malaria cases are tested, confirmed cases are treated with quality-assured drugs and timely accurate malaria surveillance are in place to guide policy and practice.Objective: To describe the trends of confirmed outpatient malaria cases and the consumption of artemisinin-based combination therapy (ACT) in the government health facilities in Kenya following the roll out of the T3 initiative.Design: A retrospective review study.Setting: All government health facilities in the 47 counties.Subjects: Secondary data on all outpatient malaria cases and ACT consumed as reported in the District Helth Information Software (DHIS).Results: Total malaria cases decreased from 8.5 to 6.8million cases in 2012 and 2015, respectively. Confirmed malaria cases increased from 1.97 (23%) to 4.9 (72%) million cases. The greatest decrease in total malaria cases and the greatest rise in confirmation of suspected cases occurred in the lower level health facilities. More confirmation of suspected cases occurred in the malaria endemic regions compared to other epidemiological zones. Excess ACT consumption reduced by 46% to reach 27% in 2015.Conclusion: Though there was increased confirmation of suspected malaria, still onethird of the outpatients were treated clinically in 2015. About one-third of ACTs were also used in excess in 2015. There is need for enhanced efforts to adhere to the T3 policy and malaria elimination guidelines

New Priorities for Agricultural Research in Africa

The agricultural economies of Africa have witnessed three major changes during the past 10 to 15 years that justify a reassessment of agricultural research priorities. First, liberalization of macroeconomic and trade policies has increased the relative importance of tradeables in the commodity mix. Second, agricultural input and product markets have expanded, broadening the range of livelihood strategies available to rural households. Finally, broader partnerships for technology development and dissemination are creating new opportunities

How rainfall variation influences reproductive patterns of African Savanna ungulates in an equatorial region where photoperiod variation is absent.

In high temperate latitudes, ungulates generally give birth within a narrow time window when conditions are optimal for offspring survival in spring or early summer, and use changing photoperiod to time conceptions so as to anticipate these conditions. However, in low tropical latitudes day length variation is minimal, and rainfall variation makes the seasonal cycle less predictable. Nevertheless, several ungulate species retain narrow birth peaks under such conditions, while others show births spread quite widely through the year. We investigated how within-year and between-year variation in rainfall influenced the reproductive timing of four ungulate species showing these contrasting patterns in the Masai Mara region of Kenya. All four species exhibited birth peaks during the putative optimal period in the early wet season. For hartebeest and impala, the birth peak was diffuse and offspring were born throughout the year. In contrast, topi and warthog showed a narrow seasonal concentration of births, with conceptions suppressed once monthly rainfall fell below a threshold level. High rainfall in the previous season and high early rains in the current year enhanced survival into the juvenile stage for all the species except impala. Our findings reveal how rainfall variation affecting grass growth and hence herbivore nutrition can govern the reproductive phenology of ungulates in tropical latitudes where day length variation is minimal. The underlying mechanism seems to be the suppression of conceptions once nutritional gains become insufficient. Through responding proximally to within-year variation in rainfall, tropical savanna ungulates are less likely to be affected adversely by the consequences of global warming for vegetation phenology than northern ungulates showing more rigid photoperiodic control over reproductive timing

Editorial: Structured operational research and training in the public health sector: the Kenyan experience

No Abstrac

Spatial distribution and co-infection with urogenital and intestinal schistosomiasis among primary school children in Migori County, Kenya

Background: Schistosomiasis is the most prevalent helminthic infection in sub-Saharan Africa. School age children have the highest burden. Chronic schistosome infections in children can have irreversible effects lasting throughout adulthood.Objective: To determine the prevalence, intensity and distribution of urogenital and intestinal schistosomiasis among primary school children in Migori County, Kenya.Design: Descriptive cross-sectional study.Setting: Primary schools in Migori County, Kenya.Subjects: Children aged seven to fourteen years.Results: We enrolled 1,784 children with the ratio of female to males being 1:1. Their mean age was 11.4 years (standard deviation ± 1.6). The overall prevalence of infection was 26%, with urogenital and intestinal schistosomiasis being found in 9% and 20% of children, respectively. A trend of increasing prevalence with increasing age of children was observed. Boys had a 50% higher risk of being infected with schistosomiasis when compared to girls (adjusted odds ratio 1.5, 95% confidence interval 1.2-1.9). Intensities of schistosome infections did not vary significantly across gender and age. Nyatike Constituency had the highest prevalence of schistosomiasis (54%).Prevalence in schools ranged from 1.7 to 89%. Seven schools (23%) had a schistosomiasis prevalence of at least 50% while 12 (39%) schools had schistosomiasis prevalence of between 10 and 50%.Conclusion: Our study showed that schistosomiasis is endemic in the study area and represents a significant public health problem among school children. The area should be prioritised for interventions including mass deworming, public health education and sanitation improvement