Bridging the Gaps between the Increasing Knowledge and Degrading Land Resource Quality in Mosiro: Analysis of Productivity Decline and Multi-Hierarchal Stakeholders Platform for Redress

Knowledge on the state of land resources has significantly increased in Kenya, and yet land productivity is on downward trends. Therefore, soil quality trends, cluster-specific soil related constraints and multi-hierarchal interventions were examined in Mosiro Irrigation Scheme with an objective of bridging the gaps between the increasing scientific outputs and deteriorating state of land resources. Soil quality trends were studied as a measure of the decline in soil productivity through comparative analysis of soil information collected in 2002 and 2012. Characterization and delineation of the area into clusters were done to assess the suitability of soils for the envisaged crops. Based on the results of the 2002 and 2012 studies, the identified soil-related constraints to crop production included high salinity, high sodicity, presence of surface crusting/sealing/compaction, low soil workability, poor soil structure, adverse silt/clay ratio, high soil pH, low organic matter content, low availability of micro-nutrients, heavy metal toxicity, and nutrient imbalances. Since hardly any recommendations given in the past have been implemented, the magnitude of these problems increased, resulting into significant reduction in productivity index from 56% in the year 2002 to 8% in the year 2012. Five clusters were identified with varied potentials for different crops. Most of the five clusters were found to be non-suitable to marginally suitable for the envisaged crops. The results of this study demonstrate how the identified constraints vary in magnitude in different clusters and their limitations to different crops. To address these problems, multi-hierarchal stakeholder platform was recommended to combat the increasing rate of soil quality decline through adoption and implementation of the appropriate interventions. Keywords: Soil quality index, land degradation and intervention

Application of mid-infrared spectroscopy for rapid characterization of key soil properties for engineering land use

AbstractMethods for rapid and accurate soil tests are needed for the index properties of material attributes commonly applied in civil engineering. We tested the application of mid-infrared (MIR) spectroscopy for the rapid characterization of selected key stability-related soil properties. Two sample sets, representing different soils from across Lake Victoria basin in Kenya, were used for the study: A model calibration set (n=135) was obtained following a conditioned Latin hypercube sampling, and a validation set (n=120) was obtained from independent sites using a spatially stratified random sampling strategy. Air-dried ground (<0.5mm) soil was scanned using a high-throughput screening accessory for diffuse reflectance attached to a Fourier transform infrared spectrometer. The soil properties were calibrated to smoothed first derivative MIR spectra using partial least-square regression (PLS), and screening tests were developed for various limitation classes applicable in civil works using the soft independent modeling of class analogy (SIMCA). The hold-out full cross-validation coefficient of determination (r2)≥0.8 was obtained for the liquid limit (LL), linear shrinkage (LS), coefficient of linear extensibility (COLE), air-dried moisture content, (W) and cation exchange capacity (CEC). Further independent validation gave r2≥0.73 and the ratio of prediction deviation (RPD) 4.4–2.1 for LL, LS, COLE, W, CEC, plastic limit (PL), plasticity index (PI), and volumetric shrinkage (VS). The independent validation likelihood ratios for the diagnostic screening tests were: LL>55%, 4.2; PI>30%, 2.7; LS>12%, 2.4; exchangeable sodium (eNa)>2cmol (+) kg−1, 2.3; exchangeable sodium percent (ESP)>10%, 1.8; W>8.3%, 1.6, and Activity number (A)>1.25units, 1.5. MIR can provide the rapid assessment of several soil properties that yield stability indices in material testing for engineering land use. Further studies should test the ability of MIR PLS for establishing broader calibrations across more diverse soil types and the direct correlation of MIR to material functional attributes

Detectable HIV Viral Load in Kenya: Data from a Population-Based Survey.

IntroductionAt the individual level, there is clear evidence that Human Immunodeficiency Virus (HIV) transmission can be substantially reduced by lowering viral load. However there are few data describing population-level HIV viremia especially in high-burden settings with substantial under-diagnosis of HIV infection. The 2nd Kenya AIDS Indicator Survey (KAIS 2012) provided a unique opportunity to evaluate the impact of antiretroviral therapy (ART) coverage on viremia and to examine the risks for failure to suppress viral replication. We report population-level HIV viral load suppression using data from KAIS 2012.MethodsBetween October 2012 to February 2013, KAIS 2012 surveyed household members, administered questionnaires and drew serum samples to test for HIV and, for those found to be infected with HIV, plasma viral load (PVL) was measured. Our principal outcome was unsuppressed HIV viremia, defined as a PVL ≥ 550 copies/mL. The exposure variables included current treatment with ART, prior history of an HIV diagnosis, and engagement in HIV care. All point estimates were adjusted to account for the KAIS 2012 cluster sampling design and survey non-response.ResultsOverall, 61·2% (95% CI: 56·4-66·1) of HIV-infected Kenyans aged 15-64 years had not achieved virological suppression. The base10 median (interquartile range [IQR]) and mean (95% CI) VL was 4,633 copies/mL (0-51,596) and 81,750 copies/mL (59,366-104,134), respectively. Among 266 persons taking ART, 26.1% (95% CI: 20.0-32.1) had detectable viremia. Non-ART use, younger age, and lack of awareness of HIV status were independently associated with significantly higher odds of detectable viral load. In multivariate analysis for the sub-sample of patients on ART, detectable viremia was independently associated with younger age and sub-optimal adherence to ART.DiscussionThis report adds to the limited data of nationally-representative surveys to report population- level virological suppression. We established heterogeneity across the ten administrative and HIV programmatic regions on levels of detectable viral load. Timely initiation of ART and retention in care are crucial for the elimination of transmission of HIV through sex, needle and syringe use or from mother to child. Further refinement of geospatial mapping of populations with highest risk of transmission is necessary

Intestinal parasitic infections in children presenting with diarrhoea in outpatient and inpatient settings in an informal settlement of Nairobi, Kenya

BACKGROUND: The distribution of and factors associated with intestinal parasitic infections are poorly defined in high risk vulnerable populations such as urban slums in tropical sub-Saharan Africa. METHODS: In a cross sectional study, children aged 5 years and below who presented with diarrhoea were recruited from selected outpatient clinics in Mukuru informal settlement, and from Mbagathi District hospital, Nairobi, over a period of two years (2010–2011). Stool samples were examined for the presence of parasites using direct, formal-ether concentration method and the Modified Ziehl Neelsen staining technique. RESULTS: Overall, 541/2112 (25.6%) were positive for at least one intestinal parasite, with the common parasites being; Entamoeba histolytica, 225 (36.7%),Cryptosporidium spp. 187, (30.5%), Giardia lamblia, 98 (16%).The prevalence of intestinal parasites infection was higher among children from outpatient clinics 432/1577(27.4%) than among those admitted in hospital 109/535 (20.1%) p < 0.001. Infections with E. histolytica, and G. lamblia were higher among outpatients than inpatients (13.8% vs 1.3% p < 0.001 and 5.8% vs 1.3% p < 0.049) respectively, while infection with Cryptosporidium spp. was higher among inpatients than outpatients (15.3% vs 6.7%) respectively p < 0.001. Other parasites isolated among outpatients included Isospora belli, 19 (1.2%), Ascaris lumbricoides, 26 (1.6%), and Hymenolepis nana 12 (0.8%), with the remainder detected in less than ten samples each. HIV-infected participants were more likely to be infected with any parasite than uninfected participants, Adjusted Odds Ratio (AOR), 2.04, 95% CI, 1.55-2.67, p < 0.001), and with Cryptosporidium spp. (AOR, 2.96, 95% CI 2.07-4.21, p < 0.001).The inpatients were less likely to be infected with E. histolytica than outpatients (AOR, 0.11, 95% CI, 0.51- 0.24, p < 0.001), but more likely for inpatients to be infected with Cryptosporidium spp. than outpatients (AOR, 1.91, 95% CI, 1.33-2.73, p < 0.001). Mixed parasitic infections were seen in 65 (12.0%) of the 541 infected stool samples. CONCLUSION: Intestinal parasitic infections are common in urban informal settlements’ environment. Routine examinations of stool samples and treatment could benefit both the HIV infected and uninfected children in outpatient and inpatient settings

Where Are the Newly Diagnosed HIV Positives in Kenya? Time to Consider Geo-Spatially Guided Targeting at a Finer Scale to Reach the “First 90”

Background: The UNAIDS 90-90-90 Fast-Track targets provide a framework for assessing coverage of HIV testing services (HTS) and awareness of HIV status – the “first 90.” In Kenya, the bulk of HIV testing targets are aligned to the five highest HIV-burden counties. However, we do not know if most of the new HIV diagnoses are in these five highest-burden counties or elsewhere. Methods: We analyzed facility-level HTS data in Kenya from 1 October 2015 to 30 September 2016 to assess the spatial distribution of newly diagnosed HIV-positives. We used the Moran's Index (Moran's I) to assess global and local spatial auto-correlation of newly diagnosed HIV-positive tests and Kulldorff spatial scan statistics to detect hotspots of newly diagnosed HIV-positive tests. For aggregated data, we used Kruskal-Wallis equality-of-populations non-parametric rank test to compare absolute numbers across classes. Results: Out of 4,021 HTS sites, 3,969 (98.7%) had geocodes available. Most facilities (3,034, 76.4%), were not spatially autocorrelated for the number of newly diagnosed HIV-positives. For the rest, clustering occurred as follows; 438 (11.0%) were HH, 66 (1.7%) HL, 275 (6.9%) LH, and 156 (3.9%) LL. Of the HH sites, 301 (68.7%) were in high HIV-burden counties. Over half of 123 clusters with a significantly high number of newly diagnosed HIV-infected persons, 73(59.3%) were not in the five highest HIV-burden counties. Clusters with a high number of newly diagnosed persons had twice the number of positives per 1,000,000 tests than clusters with lower numbers (29,856 vs. 14,172). Conclusions: Although high HIV-burden counties contain clusters of sites with a high number of newly diagnosed HIV-infected persons, we detected many such clusters in low-burden counties as well. To expand HTS where most needed and reach the “first 90” targets, geospatial analyses and mapping make it easier to identify and describe localized epidemic patterns in a spatially dispersed epidemic like Kenya's, and consequently, reorient and prioritize HTS strategies.publishedVersio

Associations of Sociodemographic and Clinical Factors with Late Presentation for Early Infant HIV Diagnosis (EID) Services in Kenya

Background: Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya. Methods: We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President’s Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing. Results: Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity. Conclusion and Global Health Implications: Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines.publishedVersio

Evaluation and validation of TAMSAT-ALERT soil moisture and WRSI for use in drought anticipatory action

Reliable information on the likelihood of drought is of crucial importance in agricultural planning and humanitarian decision-making. Acting based upon probabilistic forecasts of drought, rather than responding to prevailing drought conditions, has the potential to save lives, livelihoods and resources, but is accompanied by the risk of acting in vain. The suitability of a novel forecasting tool is assessed in the present paper in terms of its ability to provide skilful information of the likeli hood of drought impacts on crops and pasture within a timeframe that allows for anticipatory action. The Tropical Applications of Meteorology using SATellite data—AgriculturaL Early waRning sysTem (TAMSAT-ALERT) tool provides forecasts of seasonal mean soil moisture and the water requirement satisfaction index (WRSI). TAMSAT-ALERT metrics were found to be strongly correlated with pasture availability and maize yield in Kenya and provided skilful forecasts early in key seasons, allowing sufficient time for preparatory actions. Incorporating TAMSAT-ALERT forecasts in a layered approach, with actions triggered by spatiotemporally varying triggers and fundamentally informed by humanitarian actors, will provide reliable information on the likelihood of drought, ultimately mitigating food insecurity

Audio computer-assisted self-interviewing (ACASI) may avert socially desirable responses about infant feeding in the context of HIV

BACKGROUND: Understanding infant feeding practices in the context of HIV and factors that put mothers at risk of HIV infection is an important step towards prevention of mother to child transmission of HIV (PMTCT). Face-to-face (FTF) interviewing may not be a suitable way of ascertaining this information because respondents may report what is socially desirable. Audio computer-assisted self-interviewing (ACASI) is thought to increase privacy, reporting of sensitive issues and to eliminate socially desirable responses. We compared ACASI with FTF interviewing and explored its feasibility, usability, and acceptability in a PMTCT program in Kenya. METHODS: A graphic user interface (GUI) was developed using Macromedia Authorware(® )and questions and instructions recorded in local languages Kikuyu and Kiswahili. Eighty mothers enrolled in the PMTCT program were interviewed with each of the interviewing mode (ACASI and FTF) and responses obtained in FTF interviews and ACASI compared using McNemar's χ(2 )for paired proportions. A paired Student's t-test was used to compare means of age, marital-time and parity when measuring interview mode effect and two-sample Student's t-test to compare means for samples stratified by education level – determined during the exit interview. A Chi-Square (χ(2)test) was used to compare ability to use ACASI by education level. RESULTS: Mean ages for intended time for breastfeeding as reported by ACASI were 11 months by ACASI and 19 months by FTF interviewing (p < 0.001). Introduction of complementary foods at ≤3 months was reported more frequently by respondents in ACASI compared to FTF interviews for 7 of 13 complementary food items commonly utilized in the study area (p < 0.05). More respondents reported use of unsuitable utensils for infant feeding in ACASI than in FTF interviewing (p = 0.001). In other sensitive questions, 7% more respondents reported unstable relationships with ACASI than when interviewed FTF (p = 0.039). Regardless of education level, respondents used ACASI similarly and majority (65%) preferred it to FTF interviewing mainly due to enhanced usability and privacy. Most respondents (79%) preferred ACASI to FTF for future interviewing. CONCLUSION: ACASI seems to improve quality of information by increasing response to sensitive questions, decreasing socially desirable responses, and by preventing null responses and was suitable for collecting data in a setting where formal education is low

Mainstreaming forecast based action into national disaster risk management systems: experience from drought risk management in Kenya

Drought and food security crises heighten risks to lives and livelihoods in East Africa. In recent years, a shift towards acting in advance of such events has gained momentum, notably among the humanitarian and development community. This shift is premised on tools that link climate forecasts with pre-agreed actions and funding, known as Forecast-based Action (FbA), or anticipatory action more widely. While FbA approaches have been developed by a number of humanitarian agencies, the key to scaling-up is mainstreaming these approaches into national risk management systems. This paper addresses this gap in the context of drought risk management in Kenya. We analyse Kenya's current drought management system to assess the potential usability of climate forecast information within the existing system, and outline steps towards improved usability of climate information. Further, we note the critical importance of enabling institutions and reliable financing to ensure that information can be consistently used to trigger early action. We discuss the implications of this for scaling-up FbA into national risk management systems