Genetic characterization of influenza A(H3N2) viruses circulating in coastal Kenya, 2009-2017

Background Influenza viruses evolve rapidly and undergo immune driven selection, especially in the hemagglutinin (HA) protein. We report amino acid changes affecting antigenic epitopes and receptor‐binding sites of A(H3N2) viruses circulating in Kilifi, Kenya, from 2009 to 2017. Methods Next‐generation sequencing (NGS) was used to generate A(H3N2) virus genomic data from influenza‐positive specimens collected from hospital admissions and health facility outpatients presenting with acute respiratory illness to health facilities within the Kilifi Health and Demographic Surveillance System. Full‐length HA sequences were utilized to characterize A(H3N2) virus genetic and antigenic changes. Results From 186 (90 inpatient and 96 outpatient) influenza A virus‐positive specimens processed, 101 A(H3N2) virus whole genomes were obtained. Among viruses identified in inpatient specimens from 2009 to 2015, divergence of circulating A(H3N2) viruses from the vaccine strains A/Perth/16/2009, A/Texas/50/2012, and A/Switzerland/9715293/2013 formed 6 genetic clades (A/Victoria/208/2009‐like, 3B, 3C, 3C.2a, 4, and 7). Among viruses identified in outpatient specimens from 2015 to 2017, divergence of circulating A(H3N2) viruses from vaccine strain A/Hong Kong/4801/2014 formed clade 3C.2a, subclades 3C.2a2 and 3C.2a3, and subgroup 3C.2a1b. Several amino acid substitutions were associated with the continued genetic evolution of A(H3N2) strains in circulation. Conclusions Our results suggest continuing evolution of currently circulating A(H3N2) viruses in Kilifi, coastal Kenya and suggest the need for continuous genetic and antigenic viral surveillance of circulating seasonal influenza viruses with broad geographic representation to facilitate prompt and efficient selection of influenza strains for inclusion in future influenza vaccines

Human metapneumovirus prevalence and patterns of subgroup persistence identified through surveillance of pediatric pneumonia hospital admissions in coastal Kenya, 2007–2016

Background Human metapneumovirus (HMPV) is an important respiratory pathogen that causes seasonal epidemics of acute respiratory illness and contributes significantly to childhood pneumonia. Current knowledge and understanding on its patterns of spread, prevalence and persistence in communities in low resource settings is limited. Methods We present findings of a molecular-epidemiological analysis of nasal samples from children < 5 years of age admitted with syndromic pneumonia between 2007 and 2016 to Kilifi County Hospital, coastal Kenya. HMPV infection was detected using real-time RT-PCR and positives sequenced in the fusion (F) and attachment (G) genes followed by phylogenetic analysis. The association between disease severity and HMPV subgroup was assessed using Fisher’s exact test. Results Over 10 years, 274/6756 (4.1%) samples screened were HMPV positive. Annual prevalence fluctuated between years ranging 1.2 to 8.7% and lowest in the recent years (2014–2016). HMPV detections were most frequent between October of one year to April of the following year. Genotyping was successful for 205/274 (74.8%) positives revealing clades A2b (41.0%) and A2c (10.7%), and subgroups B1 (23.4%) and B2 (24.9%). The dominance patterns were: clade A2b between 2007 and 11, subgroup B1 between 2012 and 14, and clade A2c in more recent epidemics. Subgroup B2 viruses were present in all the years. Temporal phylogenetic clustering within the subgroups for both local and global sequence data was seen. Subgroups occurring in each epidemic season were comprised of multiple variants. Pneumonia severity did not vary by subgroup (p = 0.264). In both the F and G gene, the sequenced regions were found to be predominantly under purifying selection. Conclusion Subgroup patterns from this rural African setting temporally map with global strain distribution, suggesting a well-mixed global virus transmission pool of HMPV. Persistence in the local community is characterized by repeated introductions of HMPV variants from the global pool. The factors underlying the declining prevalence of HMPV in this population should be investigated

Effects of Participatory Monitoring and Evaluation on Stakeholder Relationships and Project Quality in the Local Authority Service Delivery Action Planning (LASDAP) Process in Bondo Sub County in Siaya County, Kenya

Community participation has remained a key concept in the development process in Kenya and many parts of the world today as a measure of improving good governance. Local Authority Service Delivery Action Planning (LASDAP) was meant to achieve community participation in development projects. Participatory monitoring and evaluation (PM&amp;E) was incorporated as the driving force for enhancing community participation. Many projects have been implemented yet no study had been carried out to determine the effect of participatory monitoring and evaluation on the LASDAP project implementation. The study intended to investigate the effect of participatory monitoring and evaluation on the LASDAP project implementation in the former Bondo County Council now named Bondo sub-county in the new structure of county government in Kenya. Ex-post-facto design was used in the study to examine the effects of participatory monitoring and evaluation since it was introduced in 2008.  The target population of the study comprised of 1260 LASDAP project committee members within the Bondo sub-county. Multi-stage sampling method was used to select seven wards out of the 14 wards. 42 projects were selected using both purposive and simple random sampling methods from the eight wards. Seven respondents were selected from each of the 42 projects. Purposive sampling method was then used to select 3 females and simple random sampling method to select four males respectively to yield a study sample of 294 respondents. Questionnaires were used to collect data. Validity of the instruments was examined by a team of experts from the department of Applied Community Development Studies. The questionnaires were pilot tested in Gem sub-county formerly Siaya county council for reliability and a reliability coefficient of 0.78 obtained. Data collected was analyzed using Statistical Package for Social Sciences (SPSS) V.20. Descriptive statistics were used to analyze data, which included frequencies, means, percentages and standard deviations to determine the associations and trends in the interactions of variables. The study found that PM&amp;E in general improved the LASDAP process and especially stakeholder relationships and the project output in terms of quality. PM&amp;E also enhanced good governance with the increased accountability, responsiveness to the needs of the citizens and level of transparency. These findings led to the recommendation that the Siaya county government adopt monitoring structures used by the Project Management Committees (PMCs) in current and future projects. Keywords: Participatory Monitoring and Evaluation, Stakeholder Relationships, Project Qualit

Responding to Major Burn Disasters in Resource-Limited Settings: Lessons Learned From an Oil Tanker Explosion in Nakuru, Kenya.

BACKGROUN

Exploring the Factors That Contribute Towards Information Security Policy Compliance Culture

There is over-reliance on information systems to run virtually all aspects of modern institutions. This has put more burden on information security managers to come up with more robust and efficient ways to enhance information security policy compliance. Therefore, despite existing efforts in the area of information security management, there remains a critical need for more research to be done. The existing research has also concentrated on hypothesis testing rather than a qualitative approach. So, there is an existential methodology gap that can give another alternative result that still needs to be covered. That is why we embarked on exploring the factors that influence information security compliance in organizations. The research was conducted in two universities with a diverse population. The research design was exploratory, encompassing qualitative in-depth case interviews with grounded theory as the analysis strategy. A total of 20 interviews were conducted and each analysis was done after every few batches of interviews in line with grounded theory principles. A theoretical model was generated and discussed. Implications for the research were also discussed and recommendations made. The study found individual factors, organizational factors, and external influence to be important factors in strategizing how to increase compliance with policies. The results also showed that practitioners need to factor in a combination of elements in their strategies in order to enhance compliance with information security policies. Keywords: Information Security Policy Compliance Culture, Theoretical Model, Grounded Theory, Information systems security DOI: 10.7176/IKM/10-5-05 Publication date:August 31st 202

Assessment of Socio Demographic Characteristics on Uptake of Tuberculosis Screening by Community Members in Meru County, Kenya

The trend in tuberculosis in Kenya is worrying. TB is the fourth leading cause of death. In 2015 81,518 cases of TB were identified and treated. The Kenya prevalence survey of 2015-2016 found that estimated prevalence is 558/100,000 way above the WHO estimate of 233/100,000. The objective of the study was to determine the effect of socio- demographics characteristics on tuberculosis screening among community members in Tigania East of Meru County. The study design used was cross-sectional survey and targeted 440 household drawn from the five wards randomly and proportionately selected. Key informant interviews and focus group discussions were used to collect qualitative data. Qualitative data was analysed thematically. Quantitative data was analysed using descriptive statistics and inferential statistics using SPSS version 26. The study found out that there were statistically significant association between TB screening and religion (X2 =13.103, df 3; p value=0.004,), monthly income (X2 =14.970, df 6; p value=0.020. The study concluded that religion and monthly income of community members of Tigania East were associated with TB screening. Keywords; Socio demographic, Uptake of TB screening, Community members. DOI: 10.7176/JBAH/10-22-05 Publication date: November 30th 202

Impact of health management information systems on service delivery among healthcare workers at Iten County Referral Hospital

Background: Decision-making process and effective planning within the health sector relies majorly on availability of reliable, accurate and prompt information. Most referral healthcare facilities in Kenya utilize health management information systems (HMIS) yet delivery of effective services remains relatively challenging. Against this backdrop, we assessed the impact of use of HMIS on service delivery among healthcare workers at Iten County Referral Hospital (ICRH).Methods: This study used a cross-sectional study design target population was all healthcare workers at ICRH. Closed and open-ended questionnaires were used to obtain data. Purposive and stratified sampling techniques were used to select study site and participants respectively. The sample size was 185 healthcare workers but 142 participants filled out the questionnaire.Results: Most respondents were nurses (37.4%). Least cohort were pharmacists (1.40%). About 62.7% were diploma-holders, 26.8% had a bachelor’s degree. Further, 66.9% of participants had <10 years working experience, 22.5% had 11-20 years while; 10.6% had 21-30 years. Participants (26.1-47.2%) agreed that using HMIS is efficient and effective for managing hospital data. Majority were undecided whether HMIS can be used for managing financial imperatives and providing epidemiological data. Participants (77.5%) rated HMIS as being user-friendly. Remarkably, 22.5% rated the HMIS as suitable for use as a centralized planning system for the hospital. Data also showed that HMIS is yet to be fully integrated into the hospital system.Conclusions: The use of HMIS has positively impacted service-delivery at ICRH. We therefore recommend that healthcare facilities integrate the use of HMIS in management of hospital data.

Access to Water among Slum Dwellers in Nakuru Town, Kenya: Lessons from Kaptembwa Location

Majority of urban residents in sub-Saharan Africa live in slums often characterised by lack of basic services such as water and sewerage.  With increasing pressures due to population growth, aging infrastructure, climate change, coupled with an unsustainable conventional water management, cities and urban areas in sub-Saharan African countries are facing enormous difficulties and will experience huge challenges in future in efficiently managing the scarce and increasingly unreliable water resources. This paper examines the level of access to water among slum dwellers in Nakuru town, Kaptembwo location, Kenya. The guiding questions the paper addresses are: (1) What is the level of households’ access to water? and (2) Has NAWASSCO met the demand for water by residents? A descriptive survey design was used and structured questionnaire administered to 280 households to collect the requisite data. Data was analyzed using descriptive statistical techniques and statistical software (SPSS) version 20. Results show that only 65.6% of the basic water requirements of the residents are met and that only 25% of the households access the minimum recommended 50 l/c/d. The low levels of investment in water infrastructure is the major explanatory reason for reduced access to water services. The paper shows that the domestic water supply in Kaptembwo is quite low according to the international standards. This situation is attributed to poor and inefficient water distribution system, unreliable and irrational rationing system, and poor management of water delivery services by NAWASSCO. This paper thus recommends that NAWASSCO should improve its distribution network and related infrastructure in order to facilitate adequate and reliable water provision to the study area. Other strategies including roof-harvesting and collection of run-off water if properly planned and managed could increase the water supply situation in the study area. Keywords: Access, water services, water supply, slums, household, water infrastructur

Health Implications of Sexual Violence Among Survivors in Selected Health Facilities in Kenya: Are There Gender Disparities?

Sexual based violence (SBV) is a serious public health problem with profound impact on physical, social and mental health, both immediately and many years after the assault. The global statistics on sexual assault against women indicates that, at least one in every three (34%) has been beaten and/or coerced into sex. A World Health Organisation (WHO) multi-country study reports that between 16% and 59% women from Africa had ever experienced sexual violence. In Kenya, about 24% of women have been raped at least once. Nairobi women Hospital alone receives an average of 230 survivors per month, with approximately 45% being children, 49% women and 6% men respectively. The main aim of this study was to investigate the gender disparities in health implications of SBV among survivors in three health facilities in Kenya. This was a cross-sectional study involving 236(84.3%) female and 44(15.7%) male survivors were enrolled in the study. The study established that sexual based violence resulted into health consequences (76.8%) including psychological trauma 143(51%), physical injuries 75(27%), STIs 38(14%), gynaecological disorders 35(12%), Human Immunodeficiency Virus (HIV) 32(11%), gastrointestinal disorders 21(7%) and unwanted pregnancies 17(6%). The results showed that females and males who developed health complications were not significantly different (χ2=0.223; df=1; p= 0.637). Males were more likely to suffer from psychological trauma, physical injuries and gastrointestinal injuries compared to females (OR= 1.2, CI= 0.6- 2.2; OR= 0.2, CI= 0.1- 5.0; and OR= 0.7, CI= 0.4- 1.5). On the hand, the study established that females were more likely to suffer from Sexually Transmitted Infection (STIs) (OR= 1.4, CI= 0.3- 6.0), gynaecological disorders (OR= 1.5, CI=0.5- 4.5), HIV (OR= 1.9, CI= 0.6- 6.6), and unwanted pregnancies (OR= 2.3, CI= 0.7- 8.1) compared to males. There is an urgent need to deal with the problems of SBV by preventing and stopping it. There should be a collaborative approach between all the stakeholders including the community, ministries of Medical Services and Public Health &amp; Sanitation, private and non-governmental organization in dealing with sexual based violence and health implications resulting from it. Keywords: Sexual based violence, health implications, survivors, males DOI: 10.7176/JHMN/66-03 Publication date:September 30th 201