Exploring experiences in peer mentoring as a strategy for capacity building in sexual reproductive health and HIV service integration in Kenya.

BACKGROUND: The Integra Initiative designed, tested, and adapted protocols for peer mentorship in order to improve service providers' skills, knowledge, and capacity to provide quality integrated HIV and sexual and reproductive health (SRH) services. This paper describes providers' experiences in mentoring as a method of capacity building. Service providers who were skilled in the provision of FP or PNC services were selected to undergo a mentorship training program and to subsequently build the capacity of their peers in SRH-HIV integration. METHODS: A qualitative assessment was conducted to assess provider experiences and perceptions about peer mentoring. In-depth interviews were conducted with twelve mentors and twenty-three mentees who were trained in SRH and HIV integration. Interviews were recorded, transcribed, and imported to NVivo 9 for analysis. Thematic analysis methods were used to develop a coding framework from the research questions and other emerging themes. RESULTS: Mentorship was perceived as a feasible and acceptable method of training among mentors and mentees. Both mentors and mentees agreed that the success of peer mentoring largely depended on cordial relationship and consensus to work together to achieve a specific set of skills. Mentees reported improved knowledge, skills, self-confidence, and team work in delivering integrated SRH and HIV services as benefits associated with mentoring. They also associated mentoring with an increase in the range of services available and the number of clients seeking those services. Successful mentorship was conditional upon facility management support, sufficient supplies and commodities, a positive work environment, and mentors selection. CONCLUSION: Mentoring was perceived by both mentors and mentees as a sustainable method for capacity building, which increased providers' ability to offer a wide range of and improved access to integrated SRH and HIV services

Validating indicators of the quality of maternal health care: Final report, Kenya

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. Women’s self-report of obstetric and immediate postnatal maternal and newborn care received was compared against a “gold standard” of observations by a trained third-party observer during labor and delivery. This report presents results of the Kenya study

Managing emerging fisheries of the North Kenya Banks in the context of environmental change

The North Kenya Banks have long been considered an important emerging fishery with the potential to spur economic growth for local fishing communities. As a regionally important extension to the otherwise narrow East African continental shelf, the North Kenya Banks remain under studied with implications for efforts to develop a sustainable fisheries management strategy. The local marine ecosystem is known to be strongly influenced by wind driven upwelling processes with seasonal variability driven by the changing monsoon seasons being of particular importance. Nevertheless, the Western Indian Ocean is warming due to anthropogenic climate change with evidence indicating reduced ocean productivity in future. How the ecosystem of the North Kenya Banks will respond is currently uncertain but is of great importance due to the significance of coastal fishery resources to coastal communities, and growing Blue Economy initiatives to exploit the North Kenya Banks fisheries more widely. There is, however, limited knowledge of the processes influencing productivity over the North Kenya Banks regions and currently there is no management plan in place to sustainably manage the fishery resources. Here, information about the North Kenya Banks fisheries are examined in relation to environmental processes and threats from climate change impacts with suggestions for future research and management directions

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Inheritance of fusarium wilts (Fusarium oxysporum F. sp. phaseoli) resistance in climbing beans

Fusarium wilt, caused by Fusarium oxysporum F. sp. phaseoli caused growers to abandon the most popular climbing bean cultivar, Umubano (G2333) in Rwanda. The present objective was to determine the nature of inheritance of fusarium wilt resistance and recommend a breeding strategy to introduce resistance into susceptible cultivars. Two cultivars, vuninkingi (G685) and flora were donors of resistance to fusarium wilt whereas G2333 was highly susceptible. Injured root tips of 10-day old seedlings of the parents, progenies of F1 and F2 (G2333 × G685) and (G2333 × Flora), backcrosses F2 (G685 × Flora) were inoculated with 106 conidia ml-1 of Rwandan isolate of F. oxysporum F. sp phaseoli (FOP-RW2) in a glasshouse. The disease severity was rated 28 days later using the CIAT scale of 1 - 9, where 1 - 3 represent resistant, 4 - 6 tolerant and 7 - 9 susceptible reactions. The chi-square analysis was performed to determine the Mendelian segregation ratios of resistant and susceptibility among the inoculated progenies. The F1 and the backcross progenies to the resistant parents segregated in the ratio of 1:0 as did the F2 population (G685 × Flora). The F2 progenies segregated in the ratio of 3:1. The backcross progenies to the susceptible parent segregated in the ratio of 1:1. Resistance to fusarium wilt is conditioned by a single highly heritable major dominant gene. The resistance can be achieved by backcross breeding

Effect of Inorganic Fertilizers and Farm Yard Manure on Agronomic Characteristics of Upland Rice Straw in Taita Taveta Highlands, Kenya

The study evaluated upland rice varietal agronomic characteristics and differences due to effects of fertilizer treatment and season at Taita Taveta University, Ngerenyi campus. The experiment was conducted during the short rains of 2018 and long rains of 2019. The experiment was a Randomized Complete Block Design with 3 replications. Individual plots measured 2.5 m by 2 m. Varieties evaluated were 17KH09010093B, WDR73 Hybrid, NERICA 1, NERICA 10 and Komboka. The treatments included were farm yard manure (8 tons ha-1), DAP at 75 kg ha-1, NPK (17:17:17) at 65 kg ha-1, and no fertilizer. Plant height, panicle length, leaf length, number of tillers, fresh weight, and dry weight were assessed. Variety, fertilizer and season had significant effects (P=0.05) on the morphological variables. NERICA 10 was the tallest variety at a mean of 72 cm in 2018 and a mean height of 61 cm in 2019. DAP treated plants were the tallest in both 2018 and 2019. Varieties were significantly different (P=0.0004) for panicle length. NERICA 10 had the longest panicles. Varietal effect was significant (P<0.001) for leaf length. NERICA 1 had the longest leaves in both seasons. DAP had the greatest effect on leaf length. Varieties differed significantly (P<0.001) in number of tillers per plant. Variety 17KH09010093B had the highest number of tillers per plant of 34.78 obtained in 2018. DAP resulted in the highest number of tillers. Variety and fertilizers interacted significantly (P=0.007) for foliage weight. WDR73 Hybrid out-yielded other varieties (149.31g) in fresh foliage weight. DAP resulted in the highest fresh morphological yield followed by NPK. There were significant differences in dry foliage weight among varieties and between seasons (P<0.001). Variety 17KH09010093B had the highest dry weight. Further studies on the socio–economics of fertilizer use should be conducted to provide reliable recommendations for upland rice production as forage

Assessing the validity of indicators of the quality of maternal and newborn health care in Kenya

Background: The measurement of progress in maternal and newborn health often relies on data provided by women in surveys on the quality of care they received. The majority of these indicators, however, including the widely tracked “skilled attendance at birth” indicator, have not been validated. We assess the validity of a large set of maternal and newborn health indicators that are included or have the potential to be included in population–based surveys. Methods: We compare women’s reports of care received during labor and delivery in two Kenyan hospitals prior to discharge against a reference standard of direct observations by a trained third party (n=662). We assessed individual–reporting accuracy by quantifying the area under the receiver operating curve (AUC) and estimated population–level accuracy using the inflation factor (IF) for each indicator with sufficient numbers for analysis. Findings: Four of 41 indicators performed well on both validation criteria (AUC \u3e 0.70 and 0.75 \u3c IF \u3c 1.25). These were: main provider during delivery was a nurse/midwife, a support companion was present at birth, cesarean operation, and low birthweight infant ( \u3c 2500 g). Twenty–one indicators met acceptable levels for one criterion only (11 for AUC; 9 for IF). The skilled birth attendance indicator met the IF criterion only. Interpretation: Few indicators met both validation criteria, partly because many routine care interventions almost always occurred, and there was insufficient variation for robust analysis. Validity is influenced by whether the woman had a cesarean section, and by question wording. Low validity is associated with indicators related to the timing or sequence of events. The validity of maternal and newborn quality of care indicators should be assessed in a range of settings to refine these findings

Can surveys of women accurately track indicators of maternal and newborn care? A validity and reliability study in Kenya

Background: Tracking progress on maternal and newborn survival requires accurate information on the coverage of essential interventions. Despite widespread use, most indicators measuring maternal and newborn intervention coverage have not been validated. This study assessed the ability of women delivering in two Kenyan hospitals to recall critical elements of care received during the intrapartum and immediate postnatal period at two time points: hospital discharge and 13–15 months following delivery. Methods: Women’s reports of received care were compared against observations by trained third party observers. Indicators selected for validation were either currently in use or have the potential to be included in population-based surveys. We used a mixed-methods approach to validate women’s reporting ability. We calculated individual-reporting accuracy using the area under the receiver operating curve (AUC), population-level accuracy using the inflation factor (IF), and compared the accuracy of women’s reporting at baseline and follow-up. We also assessed the consistency of women’s reporting over time. We used in-depth interviews with a sub-set of women (n=20) to assess their understanding of key survey terms. Results: Of 606 women who participated at baseline and agreed to follow-up, 515 were re-interviewed. Thirty-eight indicators had sufficient sample size for validation analysis; ten met criteria for high or moderate reporting accuracy (0.60 \u3c AUC) alone and ten met criteria for low population-level bias alone (0.75 \u3c IF \u3c 1.25). There was a significant decline in the individual level reporting accuracy between baseline and follow-up for ten indicators. Seven indicators had moderate or higher (0.4 ≤ rphi) consistency between self–reports at baseline and follow-up. Four indicators met all criteria at follow-up: support person was present during the birth, episiotomy, caesarean section, and low birthweight infant ( \u3c 2500 g). Conclusion: The few indicators that women reported accurately at baseline were consistently recalled with accuracy at 13–15 months follow-up. Although there is deterioration in women’s recall in some indicators over time, the extent of deterioration does not appreciably compromise reporting accuracy for indicators with high baseline validity. Indicators related to initial client assessment and the immediate postnatal period have generally low accuracy and poor reporting consistency over time

Fertilizer Effects on Panicle Characteristics, Grain Weight and Yield of Upland Rice in Lowlands of Taita Taveta, Kenya

This study was done at Mlughi Agricultural demonstration farm in Bura, Taita Taveta County-Kenya to test upland rice varietal performance and di-ammonium fertilizer effects on panicle characteristics and yield parameter. A randomized complete block design (RCBD) was used with seven upland rice varieties and three fertilizer levels. The treatments were replicated thrice to give a total of 63 treatment combinations or plots. The experiment was carried out for two seasons (short rains from October to December 2018 and long rains from March to May 2019). The upland rice varieties included 17KH09010014B, 17KH09010093B, AT 058, China Hybrid, NERICA 1, NERICA 4, and NERICA 10. The fertilizer treatments were di-ammonium phosphate fertilizer (DAP), farm yard manure (FYM), and a control of no fertilizer. Topdressing was done at the flowering stage with NPK fertilizer. Data collected included plant height, number of leaves, tiller number, panicle length, spikelets count per panicle, grain yield ha-1 and weight of 1000 grains. The data were subjected to multivariate analysis of variance (MANOVA) using R version 3.6.1 program and Tukey’s HSD test, p ≤ 0.05 was used to separate the significant means. The results showed that there was significant influence (p = 0.0001) of overall seasonal, treatment and variety on the yield of rice grains in tonnes per hectare. The 2018 season had the lowest tonnage compared to the 2019 season. Crops under the control treatment yielded the least tonnage per hectare while the DAP treated fields yielded the highest in both seasons. NERICA 4 was the highest yielding variety while AT 058 was the least yielding among the treatments in both seasons. It was therefore concluded that the application of DAP and FYM significantly increased rice productivity. Farmers are therefore encouraged to carry out soil fertility testing occasionally and to plant NERICA varieties

Response of Paddy Rice (Oryza sativa L.) Morphological Characteristics to Nitrogen Fertilizers in Taveta, Kenya

This study investigated the effect of applying nitrogenous fertilizers on the morphological traits in six paddy rice varieties in Taveta, Kenya. The six paddy rice varieties, including local control, were tested during the 2018 and 2019 seasons. The experiments were laid out in a split-plot design with three replications. The main plot was the fertilizer treatment while the subplot was the varieties tested including NIBAM-11, K2-9, MWIR-2, R-1081, Silewa, and a local control Saro. The fertilizer treatments were no fertilizer, farm yard manure (FYM) alone, FYM+Urea fertilizer, and FYM+CAN fertilizer. Significant differences (P < 0.05) among varieties were observed for all the morphological traits that were assessed. Silewa was the tallest plant (111 cm), had the highest number of grains per panicle (163), and also the highest 1000-grain weight (29.2 g). Fertilizer treatments had significant effects on plant height, leaf length, number of tillers, panicle length, and number of grains per panicle. FYM+Urea resulted in the highest number of grains per panicle while FYM alone resulted in the highest 1000- grain weight (25.56 g). Varieties significantly interacted with fertilizers for the number of grains per panicle. Leaf length had significant direct association with 1000-grain weight (r = 0.427) and grains per panicle (r = 0.874). It can be recommended that there is an opportunity to use farm yard manure alone or in combination with an inorganic fertilizer to improve yield traits while reducing dependence on inorganic fertilizers