An Analysis of Technical Efficiency of Rice Farmers in Ahero Irrigation Scheme, Kenya

Rice has continued to be an important cereal in Kenya in the recent years. Although it is third after maize and wheat in terms of consumption and production, its rate of consumption has increased over the years compared to maize and wheat. Rice production in Kenya does not meet demand, and the deficit has to be met with imports. Improving productivity would ensure increase in production, improved food security, reduced rice import bills and increased income among smallholder farmers. The current study, therefore, estimated technical efficiency of rice farmers in Ahero Irrigation Scheme, Kisumu County, Kenya. Stratified sampling and probability proportionate to size sampling was used to sample 220 rice farmers. A stochastic Cobb Douglas production function was used to estimate technical efficiency. The study further assessed the factors that affect technical efficiency of the rice farmers. The coefficients of fertilizer and labour were found to positively influence paddy productivity while that of chemical cost negatively influenced paddy productivity. The level of efficiency of rice farmers was found to be 0.82.  The study further found that gender, farming experience, income level and distance to market were found to be significant determinants of technical efficiency. The study therefore recommended policies that will ensure that the costs of productive inputs are affordable to farmers and improving households’ income through better prices for their outputs. Improvement in the transport infrastructure is also important in reducing inefficiencies in paddy production. Key words: Rice, technical efficiency, stochastic Cobb Douglas production function, Keny

Determinants of the outcome on traumatic brain injury patients at Kenyatta National Hospital

Introduction: Traumatic brain injury (TBI) is among the leading causes of admissions in hospitals globally. TBI has been attributed with significant morbidity, mortality and disability. Most injuries have mainly been attributed to motor accidents and falls from heights.Traumatic brain injuries represent a significant and growing disease burden in the developing world, and one of the leading causes of death in economically active adults in many low- and middle-income countries.In Kenya, motor vehicle accidents, assaults and motorcycle are significant causes. Per vehicle mile travelled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving vehicles and 8 times more likely to be injured. neurological injury progresses over hours and days, resulting in a secondary injury. Inflammatory and neurotoxic processes result in vasogenic fluid accumulation within the brain, contributing to raised intracranial pressure, hypoperfusion, and cerebral ischaemia a secondary injury may be amenable to intervention. Almost one-third of patients who die after a TBI will talk or obey commands before their death.Physiological insults, Hypoxia, hypotension, hyper - or hypocapnia, hyper - or hypoglycaemia have all been shown to increase the risk of secondary brain injuryObjectives: To determine the patients’ factor, clinical care and systems factor affecting outcome of Traumatic Brain Injury (TBI) patients at Kenyatta National Hospital. Which led to a poor outcome of above 40 years, casual laborers, Polytrauma and time lapse from trauma to hospitalization experienced. The clinical care factors indicating good outcome which included; diagnosis and medication, Nursing care and clinical setting A&E, CCU. Length of hospitalization >10 days. Protocols factors; Patients in surgical wards recording poor outcome.Design: The rationale for using purposive sampling was to be able to distinguish between traumatic brain injury patients, who did not have any neurological problems before the injury, and those who had suffered neurological problems prior to trauma. A descriptive cross-sectional design, Purposive sampling and Quantitative approach to data collection, analysis and presentation was adopted.Setting: The study was carried out at the Accident and Emergency department (A&E), Critical care unit (CCU) and surgical wards of Kenyatta National Hospital (KNH).Subjects: Patients with TBI within 72 hours of injury, aged between 18- 65 years and should have had no previous neurological problem.Results: Patient factors; that led to poor outcome; above 40 years (p=0.042), casual laborers (p=0.043), Polytrauma (p=0.042) and time lapse from trauma to hospitalization (p=0.051). The clinical care factors indicated good outcome which included; diagnosis and medication (p=0.001), Nursing care (p=0.055) and clinical setting A&E (p=0.051), CCU (p=0.032). Length of hospitalization >10 days (p=0.050). Protocols factors; Patients in surgical wards had poor outcome (p=0.051).Conclusion: Patient factor's influenced outcome of TBI, Intensive care and longer time of hospitalization is paramount for better outcome.Recommendation: Setup of a Trauma Neuro Ward and training of Neuro Teams to facilitate professional and quality care to improve outcome of Traumatic Brain Injury patient

Injury Characteristics among Traumatic Brain Injury Patients on Admission at a National Teaching and Referral Hospital in Kenya

Introduction: Traumatic brain injury (TBI) is one of the leading causes of admissions in hospitals globally. It is associated with significant morbidity and mortality.TBI is a neurosurgical emergency and timely intervention is critical to favorable outcome. Study objective: To determine the injury characteristics among traumatic brain injury patients on admission at a national teaching and referral hospital in Kenya Methodology: A descriptive cross-sectional design was used for this study, with purposive sampling method being adopted. Data was collected from 91 patients with traumatic brain injuries by use of a check list. Results: The results showed that majority of the patients had severe head injury (n=79). There was a significant relationship between age above 40 years, low GCS and severity of brain injury (P= 0.042). There was no significant relationship between severity of brain injury and patients’ gender, marital status and level of education. However occupation yielded a significant association with severe brain injury with casual laborers having the lowest GCS (P=0.042). Conclusion: Majority of patients who had polytrauma had severe TBI at admission. Key words: Brain Injury, Injury characteristics, Traumatic Injury, Brain injury on admission

Analysing diet composition and food insecurity by socio-economic status in secondary African cities

This chapter takes as its starting point theorizing around nutrition and food system transitions thought to be increasingly occurring in urban Africa, and how this may be linked to a growing non-communicable disease burden. We focus specifically on the secondary city context by analysing household survey data gathered from six cities across Ghana, Kenya and Uganda during 2013–2015. We asked how diet composition and diversity, food sources and food security varied by socio-economic status, using expenditure and demographic data to create a proxy for household well-being. In this way, we investigate one of the claimed keystones affecting urban food systems and dietary health in sub-Saharan Africa—that of obesogenic urban food environments. Our findings indicate that the socio-economic status of a household was the most important factor influencing household dietary diversity and food security status, i.e. better-off households were more likely to feel food secure and eat from a greater variety of food groups. In addition, the number of income sources was additionally associated with higher dietary diversity. We also found that a household’s involvement in agriculture had only a small positive effect on food security in one city and was associated with a reduction in dietary diversity scores. Our findings emphasize the importance of supporting aggregated national and international statistics on agricultural production and trade with detailed local analyses that focus on actual household food access and consumption. We also see reasons to be cautious about making causal claims regarding consumption change and obesogenic urban environments as the major contributor to a rising obesity and non-communicable disease burden in Africa

An Empirical Investigation of Viability of Alternative Approaches to Basic Education among the Samburu Nomadic Pastoralists Of Northern Kenya

Alternative Approaches to Basic Education (AABE) were introduced in Kenya to promote access to basic education and to enhance Universal Primary Education (UPE.) However, in Samburu County, the levels of school enrolment and literacy have been chronically low currently at 44% and 12% respectively. In order to investigate the success of AABE in Samburu County, this study tested government policy, resource-input, perception, nomadic pastoralists’ lifestyle, distance and AABE approaches applied in Samburu County. Primary data were collected using structured questionnaires for 400 learners’ household heads, 56 teachers from 56 AABE Centres and 10 AABE providers, while secondary data was obtained from the Ministry of Education offices, AABE Centres, libraries and the internet.  Stratified random sampling technique was used, while descriptive and inferential statistics were employed to analyze and present the data. The study found that 92.5% of the population regarded AABE as inferior to formal education, 69.1% viewed government policy as lacking, 91.1% viewed AABE approaches as inappropriate, 80% acknowledged that nomadic lifestyle affected success of AABE, 62.7% indicated that AABE Centres were beyond the ideal 2.5 km and 73.4% said that resource input was inadequate. The study recommended for policies with a multi-faceted approach to development in nomadic pastoralist areas, addressing the problems of water, medical facilities, infrastructure, livelihoods and conflicts as a way of mitigating low enrolment and literacy levels. Keywords: non-formal education, alternative education approaches, basic education, literacy, nomadic pastoralists

Factors associated with the prevalence of HIV, HSV-2, pregnancy, and reported sexual activity among adolescent girls in rural western Kenya: A cross-sectional analysis of baseline data in a cluster randomized controlled trial

Background Adolescence is a sensitive time for girls’ sexual and reproductive health (SRH), as biological changes occur concurrently with heightening pressures for sexual activity. In western Kenya, adolescent girls are vulnerable to acquiring sexually transmitted infections (STIs), such as HIV and herpes simplex virus type 2 (HSV-2), and to becoming pregnant prior to reaching adulthood. This study examines associations between individual, household, and partner-related risk factors and the prevalence of sex, adolescent pregnancy, HIV, and HSV-2. Methods and findings We report baseline findings among 4,138 girls attending secondary school who were enrolled between 2017 and 2018 in the Cups or Cash for Girls (CCG) cluster randomized controlled trial in Siaya County, rural western Kenya. Laboratory confirmed biomarkers and survey data were utilized to assess the effects of girls’ individual, household, and partner characteristics on the main outcome measures (adolescent reported sex, prior pregnancy, HIV, and HSV-2) through generalized linear model (GLM) analysis. Complete data were available for 3,998 girls (97%) with median age 17.1 years (interquartile range [IQR] 16.3 to 18.0 years); 17.2% were HSV-2 seropositive (n = 686) and 1.7% tested positive for HIV (n = 66). Sexual activity was reported by 27.3% girls (n = 1,090), of whom 12.2% had been pregnant (n = 133). After adjustment, orphanhood (adjusted risk ratio [aRR] 2.81, 95% confidence interval [CI] 1.18 to 6.71, p-value [p] = 0.020), low body mass index (BMI) (aRR 2.07; CI: 1.00 to 4.30, p = 0.051), and age (aRR 1.34, 1.18 to 1.53, p < 0.001) were all associated with HIV infection. Girls reporting light menstrual bleeding (aRR 2.42, 1.22 to 4.79, p = 0.012) for fewer than 3 days (aRR 2.81, 1.16 to 6.82, p = 0.023) were over twice as likely to have HIV. Early menarche (aRR 2.05, 1.33 to 3.17, p = 0.001) was associated with adolescent pregnancy and HSV-2–seropositive girls reported higher rates of pregnancy (aRR 1.62, CI: 1.16 to 2.27, p = 0.005). High BMI was associated with HSV-2 (aRR 1.24, 1.05 to 1.46, p = 0.010) and sexual activity (aRR 1.14, 1.02 to 1.28, p = 0.016). High levels of harassment were detected in the cohort (41.2%); being touched indecently conveyed the strongest association related to reported sexual activity (aRR 2.52, 2.26 to 2.81, p < 0.001). Study limitations include the cross-sectional design of the study, which informs on the SRH burdens found in this population but limits causal interpretation of associations, and the self-reported exposure ascertainment, which may have led to possible underreporting of risk factors, most notably prior sexual activity. Conclusions Our findings indicate that adolescent girls attending school in Kenya face frequent harassment for sex and are at high risk of pregnancy and HSV-2, with girls experiencing early menarche particularly vulnerable. Targeted interventions, such as earlier sexual education programs, are warranted to address their vulnerability to SRH harms

A pragmatic randomized controlled trial of standard care versus steroids plus standard care for treatment of pneumonia in adults admitted to Kenyan hospitals (SONIA)

Background: It is unclear if adjunctive steroid therapy reduces mortality in community-acquired pneumonia, as very few studies have had mortality as a primary outcome. This question has become even more relevant following demonstration of a mortality benefit of dexamethasone when used in patients with COVID-19 who had severe disease. This has led to increased prescription of steroids in adults with community acquired pneumonia in low-resource settings even when their COVID-19 diagnosis is uncertain due to low testing rates. This pragmatic parallel randomised-controlled open-label trial will determine if adjunctive low-dose steroids for treatment of adults admitted to hospital with community acquired pneumonia whose SARS-CoV-2 status is either unknown or negative reduces mortality. Methods: We will enroll and randomize 2180 patients admitted with a clinical diagnosis of community acquired pneumonia into two arms; in Stratum A-participants will receive standard care for the treatment of community acquired pneumonia. In Stratum B-participants will receive a 10-day course of low-dose oral corticosteroids in addition to standard care. All participants will be followed up to 30 days post randomization and their final status recorded (alive or dead). An immunology sub study will be conducted on a subset of the trial participants (50 per arm) to determine the correlation of pre-existing and treatment induced immune and metabolic changes with study outcomes. Discussion: Mortality among adults admitted to hospital with community acquired pneumonia in resource-limited settings is high. Steroids are readily available in these settings. If the addition of steroids to standard care for community acquired pneumonia is found to be beneficial, this easily scalable intervention would significantly reduce the currently high mortality associated with the illness

Understanding the association between climate variability and the Nile's water level fluctuations and water storage changes during 1992–2016

With the construction of the largest dam in Africa, the Grand Ethiopian Renaissance Dam (GERD) along the Blue Nile, the Nile is back in the news. This, combined with Bujagali Dam on the White Nile are expected to bring ramification to the downstream countries. A comprehensive analysis of the Nile's waters (surface, soil moisture and groundwater) is, therefore, essential to inform its management. Owing to its shear size, however, obtaining in-situ data from “boots on the ground” is practically impossible, paving way to the use of satellite remotely sensed and models’ products. The present study employs multi-mission satellites and surface models’ products to provide, for the first time, a comprehensive analysis of the changes in Nile's stored waters’ compartments; surface, soil moisture and groundwater, and their association to climate variability (El Niño Southern Oscillation (ENSO) and Indian Ocean Dipole (IOD)) over the period 1992–2016. In this regard, remotely sensed altimetry data from TOPEX/Poseidon (T/P), Jason-1, and Jason-2 satellites along with the Gravity Recovery And Climate Experiment (GRACE) mission, and the Tropical Rainfall Measuring Mission Project (TRMM) rainfall products are applied to analyze the compartmental changes over the Nile River Basin (NRB). This is achieved through the creation of 62 virtual gauge stations distributed throughout the Nile River that generate water levels, which are used to compute surface water storage changes. Using GRACE total water storage (TWS), soil moisture data from multi-models based on the Triple Collocation Analysis (TCA) method, and altimetry derived surface water storage, Nile basin's groundwater variations are estimated. The impacts of climate variability on the compartmental changes are examined using TRMM precipitation and large-scale ocean-atmosphere ENSO and IOD indices. The results indicate a strong correlation between the river level variations and precipitation changes in the central part of the basin (0.77 on average) in comparison to the northern (0.64 on average) and southern parts (0.72 on average). Larger water storages and rainfall variations are observed in the Upper Nile in contrast to the Lower Nile. A negative groundwater trend is also found over the Lower Nile, which could be attributed to a significantly lower amount of rainfall in the last decade and extensive irrigation over the region

Randomized controlled field trial to assess the immunogenicity and safety of rift valley fever clone 13 vaccine in livestock

BACKGROUND:Although livestock vaccination is effective in preventing Rift Valley fever (RVF) epidemics, there are concerns about safety and effectiveness of the only commercially available RVF Smithburn vaccine. We conducted a randomized controlled field trial to evaluate the immunogenicity and safety of the new RVF Clone 13 vaccine, recently registered in South Africa. METHODS:In a blinded randomized controlled field trial, 404 animals (85 cattle, 168 sheep, and 151 goats) in three farms in Kenya were divided into three groups. Group A included males and non-pregnant females that were randomized and assigned to two groups; one vaccinated with RVF Clone 13 and the other given placebo. Groups B included animals in 1st half of pregnancy, and group C animals in 2nd half of pregnancy, which were also randomized and either vaccinated and given placebo. Animals were monitored for one year and virus antibodies titers assessed on days 14, 28, 56, 183 and 365. RESULTS:In vaccinated goats (N = 72), 72% developed anti-RVF virus IgM antibodies and 97% neutralizing IgG antibodies. In vaccinated sheep (N = 77), 84% developed IgM and 91% neutralizing IgG antibodies. Vaccinated cattle (N = 42) did not develop IgM antibodies but 67% developed neutralizing IgG antibodies. At day 14 post-vaccination, the odds of being seropositive for IgG in the vaccine group was 3.6 (95% CI, 1.5 - 9.2) in cattle, 90.0 (95% CI, 25.1 - 579.2) in goats, and 40.0 (95% CI, 16.5 - 110.5) in sheep. Abortion was observed in one vaccinated goat but histopathologic analysis did not indicate RVF virus infection. There was no evidence of teratogenicity in vaccinated or placebo animals. CONCLUSIONS:The results suggest RVF Clone 13 vaccine is safe to use and has high (>90%) immunogenicity in sheep and goats but moderate (> 65%) immunogenicity in cattle