SARS-CoV-2 seroprevalence in three Kenyan health and demographic surveillance sites, December 2020-May 2021

Background Most of the studies that have informed the public health response to the COVID-19 pandemic in Kenya have relied on samples that are not representative of the general population. We conducted population-based serosurveys at three Health and Demographic Surveillance Systems (HDSSs) to determine the cumulative incidence of infection with SARS-CoV-2. Methods We selected random age-stratified population-based samples at HDSSs in Kisumu, Nairobi and Kilifi, in Kenya. Blood samples were collected from participants between 01 Dec 2020 and 27 May 2021. No participant had received a COVID-19 vaccine. We tested for IgG antibodies to SARS-CoV-2 spike protein using ELISA. Locally-validated assay sensitivity and specificity were 93% (95% CI 88–96%) and 99% (95% CI 98–99.5%), respectively. We adjusted prevalence estimates using classical methods and Bayesian modelling to account for the sampling scheme and assay performance. Results We recruited 2,559 individuals from the three HDSS sites, median age (IQR) 27 (10–78) years and 52% were female. Seroprevalence at all three sites rose steadily during the study period. In Kisumu, Nairobi and Kilifi, seroprevalences (95% CI) at the beginning of the study were 36.0% (28.2–44.4%), 32.4% (23.1–42.4%), and 14.5% (9.1–21%), and respectively; at the end they were 42.0% (34.7–50.0%), 50.2% (39.7–61.1%), and 24.7% (17.5–32.6%), respectively. Seroprevalence was substantially lower among children (&lt;16 years) than among adults at all three sites (p≤0.001). Conclusion By May 2021 in three broadly representative populations of unvaccinated individuals in Kenya, seroprevalence of anti-SARS-CoV-2 IgG was 25–50%. There was wide variation in cumulative incidence by location and age. </jats:sec

Dietary intake of HIV-seropositive clients attending Longisa County Hospital Comprehensive Care Clinic, Bomet County, Kenya

Background: Dietary intake of HIV-seropositive persons remains a major concern across various settings around the globe. Inadequate dietary intake, infections and stage of disease progression elicit malnutrition among HIV-seropositive individuals, which hastens progression of HIV to full-blown AIDS. Aim: The study sought to determine the dietary intake of HIV-seropositive clients attending Longisa County Hospital Comprehensive Care Clinic, Bomet County, Kenya. Methods: A cross-sectional analytical study design was administered on a comprehensive sample of 210 patients. A 24-hour dietary recall questionnaire and Food Frequency Questionnaire (FFQ) were used by the researcher to collect data on the dietary intake of the respondents. The 24-hour dietary recall data were analysed using NutriSurvey whereas data obtained from the FFQ were analysed manually. Results: Study respondents comprised more females (61.6%) than males (38.6%). Adequacy in energy intake amongst the respondents was average as males attained 47.4% of recommended energy intake, whereas females attained 50.0%. Intakes for selected nutrients, vitamin A, B1, B2, C, were adequate for males and females. Iron intake was significantly low among female respondents as 89.3% did not meet the RDA. Similarly, zinc intake among male respondents was low as only 28.9% met the RDA. The mean number of meals consumed by the respondents was 3.8 ± 0.1. Consumption frequency of legumes, fruits, other vegetables, meats, eggs and fish was irregular. Conclusion: The dietary intake of the respondents was not satisfactory as evidenced by inadequacies in intake of certain nutrients and low number of meals consumed on a daily basis. Inadequate dietary intake is detrimental to HIV and AIDS management and treatment modalities, hence resulting in poor treatment outcomes. Care and treatment modalities at HIV and AIDS clinics should encompass provision of clear and concise information on the importance of adequate dietary intake as a means of optimising positive treatment outcomes

Understanding sexual behaviors of youth from the lens of caregivers, teachers, local leaders and youth in Homabay County, Kenya

Abstract In Kenya similar to other countries in Eastern and Southern Africa There is a disproportionately high burden of the global HIV incidence among youth ages 15–24 years, and where adolescent girls and young women account for up to a third of all incident HIV infections and more than double the burden of HIV compared to their male peers. Previous work has shown early sexual debut as entry point into risks to sexual and reproductive health among young people including STI/HIV acquisition. This was a formative assessment of the local context of three sexual risk behaviors among youth ages of 15–24 years: early sexual debut, multiple sexual partnerships, and age-mixing /intergenerational sex for purposes of informing comprehensive combination HIV intervention program design. We conducted a cross-sectional formative qualitative study in four sub-counties within Homabay county a high HIV prevalence region of Kenya. Participants were recruited through youth groups, schools, government offices and, community gatekeepers using approved fliers, referred to a designated venue for focus group discussion (FGD). After oral informed consent, twelve FGDs of 8–10 participants were carried out. Transcripts and field notes were uploaded to Atlas.ti qualitative data analysis and research software (version 8.0, 2017, ATLAS.ti GmbH). Open coding followed by grouping, categorization of code groups, and thematic abstraction was used to draw meaning for the data. A total of 111 youth participated in the FGD, 65 males and 46 females. The main findings were that youth engaged in early sex for fear of being labeled ‘odd’ by their peers, belief (among both male and female) that ‘practice makes perfect’, curiosity about sex, media influence, need to prove if one can father a child (among male), the notion that sex equals love with some of the youth using this excuse to coerce their partners into premature sex, and the belief that sex is a human right and parents/guardians should not intervene. Male youth experienced more peer-pressure to have sex earlier. Female youths cited many reasons to delay coitarche that included fear of pregnancy, burden of taking care of a baby, and religious doctrines. Having multiple sexual partners and intergenerational sexual relationships were common among the youth driven by perceived financial gain and increased sexual prowess. HIV prevention strategies need to address gender vulnerabilities, as well as promoting a protective environment, hence application of combination prevention methods is a viable solution to the HIV pandemic. Trial registration number: The study was approved by the KNH/UoN Ethics review committee (KNH/UoN ERC-P73/03/2011) and New York University (NYU Reg no.–00000310)

Assessing fertiliser options for sustainable maize production in Africa

&lt;p&gt;&lt;i&gt;Factsheet 1 is dedicated to the assessment of fertiliser options for sustainable maize production in Africa.&nbsp;&lt;/i&gt;&lt;/p&gt;&lt;p&gt;There is a need for sustainable maize production in Africa due to growing food demand and declining soil fertility. This factsheet suggests the promotion and upscaling of organic fertilizer and intergrated soil fertility management (ISFM) options for sustainable maize production in east and west Africa regions based on findings from research carried out in Ghana and Kenya under the EWA-BELT project (GA 862848). Strategies to increase organic fertilizer production should be pursued by governments and all stakeholders.&lt;/p&gt

Maize ISFM - Economic and environmental viability of organic fertilisation for sustainable maize production in Africa

&lt;p&gt;&lt;i&gt;Policy Brief 1 on&nbsp;Integrated Soil Fertility Management Practices is dedicated to maize.&lt;/i&gt;&lt;/p&gt;&lt;p&gt;There is the need for sustainable crop (maize) production in Africa due to growing food demand and the declining soil fertility nexus. This policy brief is aimed at publishing the findings of a research that evaluated the economic and environmental viability of organic fertilizer in maize production. Maize being the most important cereal in sub-Sahara Africa. Three fertilization options (organic, organic + inorganic and inorganic) were tested in east and west Africa to assess their economic and environment feasibility. The major findings include:&lt;/p&gt;&lt;ul&gt;&lt;li&gt;Maize yields increases under all three fertilizer options in both the short to long term, however the yields grows faster under full organic fertilizer than the others producing the highest yields in the long term with better soil health contribution.&lt;/li&gt;&lt;li&gt;All fertilizer options are profitable in both short to long term, but organic amendment generates the highest benefits in both short and long term.&lt;/li&gt;&lt;li&gt;Proportional increased in output price and input cost results in increase farm profit similar to the effect of inflation.&lt;/li&gt;&lt;li&gt;The main limiting factor to organic fertilizer use is the unavailability of organic fertilizer&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;Organic fertilizer and intergrated options are recommended for sustainable maize production in east and west Africa regions. Strategies to increase organic fertilizer production should be pursued by governments.&lt;/p&gt

Expanded eligibility for HIV testing increases HIV diagnoses-A cross-sectional study in seven health facilities in western Kenya.

Homa Bay, Siaya, and Kisumu counties in western Kenya have the highest estimated HIV prevalence (16.3-21.0%) in the country, and struggle to meet program targets for HIV testing services (HTS). The Kenya Ministry of Health (MOH) recommends annual HIV testing for the general population. We assessed the degree to which reducing the interval for retesting to less than 12 months increased diagnosis of HIV in outpatient departments (OPD) in western Kenya. We conducted a retrospective analysis of routinely collected program data from seven high-volume (>800 monthlyOPD visits) health facilities in March-December, 2017. Data from persons ≥15 years of age seeking medical care (patients) in the OPD and non-care-seekers (non-patients) accompanying patients to the OPD were included. Outcomes were meeting MOH (routine) criteria versus criteria for a reduced retesting interval (RRI) of 12 months, and 5% (4,832) met other criteria. The remaining 80% (74,033) met criteria for a RRI of < 12 months. In total 1.3% (1,185) of clients had a positive test. Although the percent yield was over 2-fold higher among those meeting routine criteria (2.4% vs. 1.0%; p<0.001), 63% (750) of all HIV infections were found among clients tested less than 12 months ago, the majority (81%) of whom reported having a negative test in the past 3-12 months. Non-patients accounted for 45% (539) of all HIV-positive persons identified. Percent yield was higher among non-patients as compared to patients (1.5% vs. 1.2%; p-value = <0.001) overall and across eligibility criteria and age categories. The majority of HIV diagnoses in the OPD occurred among clients reporting a negative HIV test in the past 12 months, clients ineligible for testing under the current MOH guidelines. Nearly half of all HIV-positive individuals identified in the OPD were non-patients. Our findings suggest that in the setting of a generalized HIV epidemic, retesting persons reporting an HIV-negative test in the past 3-12 months, and routine testing of non-patients accessing the OPD are key strategies for timely diagnosis of persons living with HIV