Smallholder Farmers’ Perspectives on Climatic Variability and Adaptation Strategies in East Africa: The Case of Mount Kilimanjaro in Tanzania, Taita and Machakos Hills in Kenya

Climate change is expected to have serious economic and social impacts in East Africa, particularly on rural farmers whose livelihoods largely depend on rain-fed agriculture, hence adaptation is required to offset projected drawbacks of climate change on crop productivity. This paper examines farmers' perceptions and understanding of climatic variability, coping strategies adopted and factors that influence the choice of a particular adaptation. The study uses cross section data collected from 510 farmers in three mountain gradients sites, namely; Mount Kilimanjaro of Tanzania, Taita and Machakos Hills of Kenya. Farmers’ perceptions were compared to actual trend in meteorological records over the last thirty years (1981-2010). The result revealed that farmers in East Africa were partly aware of climate variability, mainly in temperature and rainfall patterns. Many respondents reported that conditions are drier and rainfall timing is becoming less predictable. The perception of farmers on temperature and rainfall were in line with recorded meteorological data, but contrary with that of recorded rainfall in Machakos which was perceived to be decreasing by the farmers. Farmers perceived changes in rainfall and temperature to have negative effects on the production and management of crops. The common adaptation strategies used by farmers include water harvesting, soil conservation techniques and shifting of planting periods. The most important variables affecting farmers choices in regards to adaptation option were, lack of access to credit, farming experience and household size. As a conclusion, there is a need for these factors to be taken into account in the development and implementation of smallholder farmers’ adaptation strategies to climate variability in East Africa. Additionally, dedicated capacity building and extensive outreach initiatives on adaptation through governments, researchers, policy-makers and the farmers groups themselves are needed to achieve large scale success

Sero-surveillance for IgG to SARS-CoV-2 at antenatal care clinics in three Kenyan referral hospitals: Repeated cross-sectional surveys 2020-21.

INTRODUCTION: The high proportion of SARS-CoV-2 infections that have remained undetected presents a challenge to tracking the progress of the pandemic and estimating the extent of population immunity. METHODS: We used residual blood samples from women attending antenatal care services at three hospitals in Kenya between August 2020 and October 2021and a validated IgG ELISA for SARS-Cov-2 spike protein and adjusted the results for assay sensitivity and specificity. We fitted a two-component mixture model as an alternative to the threshold analysis to estimate of the proportion of individuals with past SARS-CoV-2 infection. RESULTS: We estimated seroprevalence in 2,981 women; 706 in Nairobi, 567 in Busia and 1,708 in Kilifi. By October 2021, 13% of participants were vaccinated (at least one dose) in Nairobi, 2% in Busia. Adjusted seroprevalence rose in all sites; from 50% (95%CI 42-58) in August 2020, to 85% (95%CI 78-92) in October 2021 in Nairobi; from 31% (95%CI 25-37) in May 2021 to 71% (95%CI 64-77) in October 2021 in Busia; and from 1% (95% CI 0-3) in September 2020 to 63% (95% CI 56-69) in October 2021 in Kilifi. Mixture modelling, suggests adjusted cross-sectional prevalence estimates are underestimates; seroprevalence in October 2021 could be 74% in Busia and 72% in Kilifi. CONCLUSIONS: There has been substantial, unobserved transmission of SARS-CoV-2 in Nairobi, Busia and Kilifi Counties. Due to the length of time since the beginning of the pandemic, repeated cross-sectional surveys are now difficult to interpret without the use of models to account for antibody waning

Seroprevalence of Antibodies to Severe Acute Respiratory Syndrome Coronavirus 2 Among Healthcare Workers in Kenya.

BACKGROUND: Few studies have assessed the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among healthcare workers (HCWs) in Africa. We report findings from a survey among HCWs in 3 counties in Kenya. METHODS: We recruited 684 HCWs from Kilifi (rural), Busia (rural), and Nairobi (urban) counties. The serosurvey was conducted between 30 July and 4 December 2020. We tested for immunoglobulin G antibodies to SARS-CoV-2 spike protein, using enzyme-linked immunosorbent assay. Assay sensitivity and specificity were 92.7 (95% CI, 87.9-96.1) and 99.0% (95% CI, 98.1-99.5), respectively. We adjusted prevalence estimates, using bayesian modeling to account for assay performance. RESULTS: The crude overall seroprevalence was 19.7% (135 of 684). After adjustment for assay performance, seroprevalence was 20.8% (95% credible interval, 17.5%-24.4%). Seroprevalence varied significantly (P < .001) by site: 43.8% (95% credible interval, 35.8%-52.2%) in Nairobi, 12.6% (8.8%-17.1%) in Busia and 11.5% (7.2%-17.6%) in Kilifi. In a multivariable model controlling for age, sex, and site, professional cadre was not associated with differences in seroprevalence. CONCLUSION: These initial data demonstrate a high seroprevalence of antibodies to SARS-CoV-2 among HCWs in Kenya. There was significant variation in seroprevalence by region, but not by cadre

5 year old girl with malignant lymphoblastic lymphoma: Challenges of managing haematological malignancies in a developing country

Background: Lymphoblastic lymphoma (LBL) is a neoplasm of lymphoblasts. The condition is predominantly lymph node–based disease arising from immature T cells in 85-90% of cases and immature B cells in the remainder. The lymphoma is aggressive, progresses rapidly, and often presenting as stage IV disease in more than 70% of patients. This disease makes up approximately 20% of childhood NHLObjective: To show case the management of childhood lymphoblastic lymphoma and the handicap faced by the oncologists and pathologists.Methods: A review of the index case was carried out at the paediatric department of Federal Medical Centre, Bida, Nigeria. This review took into cognisance patient’s demographic bio data, case history, general and physical examination, various investigations, methods of diagnosis and the type treatment. A comprehensive analysis and account of events before and after the commencement of chemotherapy were also reviewed.Results: This case identifies a 5 year old girl with aggressive malignant lymphoma; lymphoblastic type and the myriad of limitations faced by oncologists and pathologists in the management of haematological malignancies. Socio-cultural, financial (cost implications for the patient for both investigative and therapeutic interventions), inadequate resources and facilities were identified as some of the constraints leading to inadequate management and poor outcome in patients with this condition.Conclusion: Given the limitations associated with the management of cancers in this part of the world, efforts on the part of government and non-governmental agencies are necessary to strengthen and upgrade the existing facilities in various hospitals. The social welfare departments of tertiary hospitals should be adequately funded to meet the demand of thisgroup of patients

Evaluation of an empiric risk screening score to identify acute and early HIV-1 infection among MSM in Coastal Kenya.

We evaluated the University of North CarolinaMalawi Risk Screening Score (UMRSS) for detection of acute and early HIV-1 infection (AEHI) in a cohort of Kenyan MSM with approximately 8% annual HIV-1 incidence. Three components of the UMRSS (fever, diarrhea, and discordant rapid HIV tests) were also independent predictors of AEHI in our cohort. The predictive ability (area under the receiver operating characteristic curve, AUC) of the UMRSS was 0.79. A cohort-derived risk score consisting of six characteristics (fever, diarrhea, discordant rapid HIV tests, fatigue, age &lt;30 years, and symptomatic sexually transmitted disease) had a higher AUC of 0.85. Screening for AEHI will have substantial transmission prevention benefits

The epidemiology of HIV and HSV-2 infections among women participating in microbicide and vaccine feasibility studies in Northern Tanzania.

OBJECTIVES: To prepare for future HIV prevention trials, we conducted prospective cohort studies among women working in food and recreational facilities in northern Tanzania. We examined the prevalence and incidence of HIV and HSV-2, and associated risk factors. METHODS: Women aged 18-44 years working in food and recreational facilities were screened to determine their eligibility for the studies. Between 2008-2010, HIV-negative women were enrolled and followed for 12 months. At enrolment and 3-monthly, we collected socio-demographic and behavioural data, and performed clinical examinations for collection of biological specimens that were tested for reproductive tract infections. Risk factors for HIV and HSV-2 incidence were investigated using Poisson regression models. RESULTS: We screened 2,229 and enrolled 1,378 women. The median age was 27 years (interquartile range, IQR 22, 33), and median duration working at current facility was 2 years. The prevalences of HIV at screening and HSV-2 at enrolment were 16% and 67%, respectively. Attendance at the 12-month visit was 86%. HIV and HSV-2 incidence rates were 3.7 (95% confidence interval, CI: 2.8,5.1) and 28.6 (95% CI: 23.5,35.0)/100 person-years, respectively. Women who were separated, divorced, or widowed were at increased risk of HIV (adjusted incidence rate ratio, aRR = 6.63; 95% CI: 1.97,22.2) and HSV-2 (aRR = 2.00; 95% CI: 1.15,3.47) compared with married women. Women reporting ≥3 partners in the past 3 months were at higher HIV risk compared with women with 0-1 partner (aRR = 4.75; 95% CI: 2.10,10.8), while those who had reached secondary education or above were at lower risk of HSV-2 compared with women with incomplete primary education (aRR = 0.42; 95% CI: 0.22,0.82). CONCLUSIONS: HIV and HSV-2 rates remain substantially higher in this cohort than in the general population, indicating urgent need for effective interventions. These studies demonstrate the feasibility of conducting trials to test new interventions in this highly-mobile population

Predicting the impact of temperature change on the future distribution of maize stem borers and their natural enemies along east african mountain gradients using phenology models

Lepidopteran stem borers are among the most important pests of maize in East Africa. The objective of the present study was to predict the impact of temperature change on the distribution and abundance of the crambid Chilo partellus, the noctuid Busseola fusca, and their larval parasitoids Cotesia flavipes and Cotesia sesamiae at local scale along Kilimanjaro and Taita Hills gradients in Tanzania and Kenya, respectively. Temperature-dependent phenology models of pests and parasitoids were used in a geographic information system for mapping. The three risk indices namely establishment, generation, and activity indices were computed using current temperature data record from local weather stations and future (i.e., 2055) climatic condition based on downscaled climate change data from the AFRICLIM database. The calculations were carried out using index interpolator, a sub-module of the Insect Life Cycle Modeling (ILCYM) software. Thin plate algorithm was used for interpolation of the indices. Our study confirmed that temperature was a key factor explaining the distribution of stem borers and their natural enemies but other climatic factors and factors related to the top-down regulation of pests by parasitoids (host-parasitoid synchrony) also played a role. Results based on temperature only indicated a worsening of stem borer impact on maize production along the two East African mountain gradients studied. This was attributed to three main changes occurring simultaneously: (1) range expansion of the lowland species C. partellus in areas above 1200 m.a.s.l.; (2) increase of the number of pest generations across all altitudes, thus by 2055 damage by both pests will increase in the most productive maize zones of both transects; (3) disruption of the geographical distribution of pests and their larval parasitoids will cause an improvement of biological control at altitude below 1200 m.a.s.l. and a deterioration above 1200 m.a.s.l. The predicted increase in pest activity will significantly increase maize yield losses in all agro-ecological zones across both transects but to a much greater extent in lower areas

Identifying at-risk populations in Kenya and South Africa: HIV incidence in cohorts of men who report sex with men, sex workers, and youth.

Objective To identify and describe populations at risk for HIV in 3 clinical research centers in Kenya and South Africa. Design Prospective cohort study Methods Volunteers reporting recent sexual activity, multiple partners, transactional sex, sex with an HIV-positive partner, or, if male, sex with men (MSM; in Kenya only) were enrolled. Sexually active minors were enrolled in South Africa only. Risk behavior, HIV testing, and clinical data were obtained at follow-up visits. Results From 2005 to 2008, 3023 volunteers were screened, 2113 enrolled, and 1834 contributed data on HIV incidence. MSM had the highest HIV incidence rate of 6.8 cases per 100 person-years [95% confidence interval (CI): 4.9 to 9.2] followed by women in Kilifiand Cape Town (2.7 cases per 100 person-years, 95% CI: 1.7 to 4.2). No seroconversions were observed in Nairobi women or men in Nairobi or Cape Town who were not MSM. In 327 MSM, predictors of HIV acquisition included report of genital ulcer (Hazard Ratio: 4.5, 95% CI: 1.7 to 11.6), not completing secondary school education (HR: 3.4, 95% CI: 1.6 to 7.2) and reporting receptive anal intercourse (HR: 8.2, 95% CI: 2.7 to 25.0). Paying for sex was inversely associated with HIV infection(HR:0.2,95%CI:0.04to0.8).279(13.0%) volunteers did not return after the first visit; subsequent attrition rates ranged from 10.4 to 21.8 volunteers per 100 person-years across clinical research centers. Conclusions Finding, enrolling, and retaining risk populations for HIV prevention trials is challenging in Africa. African MSM are not frequently engaged for research, have high HIV incidence, need urgent risk reduction counseling, and may represent a suitable population for future HIV prevention trials.</p