The Adoption and Dissemination of Fodder Shrubs in Central Kenya

Conference Paper No. 1

Nutritional Status of Psychiatric Inpatients at A National Mental Hospital in Kenya

Malnutrition among psychiatric patients in mental health units stands at 19%. It is a prevailing health care problem, that is affecting many psychiatry patients and it is a major public health problem especially in public hospitals in Kenya. Nutrition care is therefore an important component of mental health that require keen consideration. The goal of the study was to determine the nutritional status of psychiatric inpatients at a National Mental Hospital in Kenya. A cross-sectional design was used and 200 inpatients were recruited to the study using simple random sampling. Data was collected using a structured questionnaire which was adopted and modified from Short Nutritional Assessment Questionnaire (SNAQ) screening tool. Height and weight of the participants were measured and BMI was calculated. Clearance and approval to conduct the study was sought from University of Eastern Africa-Baraton Ethical Review Committee. Results of the study showed that majority of the participants were being treated for schizophrenia (41.5%) followed by drug induced psychosis at 22%. The results of the study also showed that 59.5% of the respondents were well nourished while a significant 40.5% were malnourished. Among the Malnourished patients, 67% had a BMI above 25.00Kg/M2 and 33% had a BMI below18.50Kg/M2. Malnourishment was associated with use of antipsychotic (P=0.021), use of antidepressants (P=0.018). It was also associated with female gender (P=0.001), abuse of cigarettes (P=0.041), abuse of marijuana (P=0.01), abuse of alcohol (P=0.001) and poor appetite (P=0.032). Nutritional management should be a component of the routine inpatient care of psychiatric patients. Keywords: Nutritional status, Psychiatric patients, Malnutrition

Technological Readiness for E-learning among Undergraduate Students at a Private University in Kenya

The domains of learning and teaching are experiencing great changes as higher-education institutions rapidly adopt the concepts and practices of e-learning. Student readiness is crucial in implementation of E-Learning in institutions of higher learning. E-Learning readiness adds the benefit of encouraging learners to take responsibility for their learning and build self-knowledge and self-confidence. This study sought to assess the technological readiness for e-learning among undergraduate students at a private University in Kenya. The study utilized descriptive research design where 157 undergraduate students were stratified sampled to participate in the study. Data was collected using Readiness Assessment Tool for an E-learning Learning Environment Implementation. The study results indicated that 86% (n=113) of the students did not know how to resolve common hardware or software problems. A similar number (64%, n=84) did not have access to reliable internet in campus or cafes while 69% (n=90) did not know how to log in to the internet, navigate web pages and download files using internet browsers. On the other hand, 69% (n=90) did not know how to resolve common errors e.g. ‘page not found’ or ‘connection timed out’ while surfing the internet and 88% (n=115) had not attended any seminars/workshops related to online learning activities. The results from this study point to fact that the University should offer basic training in computers for the undergraduate students in order to enable them use the internet for e-learning. Keywords: Technological readiness, E-learning, Undergraduate students, Computer

Research report: Exploring the beliefs, attitudes, and behaviors of MSM engaged in substance use and transactional sex in Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report presents findings from a qualitative study examining the vulnerability to HIV of young men who have sex with men (MSM) in Kumasi, Ghana, and their prevention needs. The study was jointly conducted in Kumasi, Ghana’s second largest urban center, by Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST). It was carried out as a component of Project SEARCH funded by the United States Agency for International Development. The study was designed and conducted in collaboration with FHI 360 (formerly Family Health International (FHI)), an international non‐governmental organization based in the capital city of Accra which operates programs targeting MSM and other key populations in Kumasi, and the Ghana AIDS Commission (GAC). Preventing HIV among key populations in Ghana is a major goal for the National AIDS Control Program (NACP) and the GAC.1 MSM are a particularly stigmatized population in Ghana, in part because male‐to‐male sex has traditionally been viewed as illegal, making them a difficult yet critical to reach population with HIV/AIDS‐related services. This qualitative study was conducted in order to enhance understanding of the beliefs, attitudes, and behaviors of adolescent and young MSM (aged 15‐29). In this population, we particularly sought to focus on two sub‐groups: MSM who engage in transactional sex and those who use alcohol or illicit substances (hereinafter “substances”). The specific objectives were to explore: 1) the types and extent of substance use by MSM; 2) the overlap between substance use and transactional sex among MSM; 3) the beliefs and attitudes related to substance use and transactional sex; 4) knowledge and risk behaviors of both subgroups. The study’s broader goal was to collect and analyze in‐depth data that can be used to improve the outreach and effectiveness of local programs that aim to reach these groups with important HIV prevention and treatment information and with services appropriate to their needs.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Program brief: Exploring the beliefs, attitudes, and behaviors of msm engaged in substance use and transactional sex in Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.Preventing HIV among key populations is a goal of the National AIDS Control Program (NACP) and the Ghana AIDS Commission (GAC).1 Men who have sex with men (MSM) are a particularly stigmatized group in Ghana, in part because male-to-male sex is viewed as “unnatural” and therefore illegal. MSM are a critical though difficult population to reach with HIV-related services. Until recently, specific data on MSM in the country were limited. The Ghana Men’s Study (GMS), which collected data from 1,302 MSM in five regions in 2011, has detailed information on HIV and sexually transmitted infection (STI) prevalence and risk behaviors among MSM. Whereas adult HIV prevalence in Ghana has been estimated at 1.31% in 2013,2 the GMS documented a nationwide average prevalence in 2011 of 17.5% among MSM, with the rate in Accra estimated at 34.3% and 13.7% in Kumasi.3 This qualitative study was designed to complement and supplement quantitative findings about MSM from the GMS. It was conducted by Boston University’s Center for Global Health and Development and the Kwame Nkrumah University of Science and Technology (KNUST) in collaboration with FHI 360 and with funding from the United States Agency for International Development (USAID)/Ghana. It is the first of two qualitative studies focusing on MSM in Ghana. The objectives were to explore: (1) the types and extent of substance use by MSM; (2) the overlap between substance use and transactional sex among MSM; (3) the beliefs and attitudes related to substance use and transactional sex; and (4) knowledge and risk behaviors of both subgroups. In-depth interviews (IDI) and focus group discussions (FGD) were used to collect data from four participant groups: two age groups, adolescent MSM (aged 15-17 years) and young adult MSM (aged 18-29 years), with each group including men who consume high levels of alcohol and/ or use drugs and men who engage in transactional sex (TS). Transactional sex is defined here as self-reported sex with another man in exchange for money, gifts, or favors.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Attitudes and behaviors among older MSM in Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report provides the findings of a qualitative study that explored vulnerability to HIV of men who have sex with men (MSM) in Kumasi, Ghana. It is the second of two related studies focusing on MSM. The first study, “Exploring the beliefs, attitudes, and behaviors of MSM engaged in substance use and transactional sex in Ghana,”1 focused on adolescent and young adult MSM aged 15 to 29 years. This companion study focused on ‘older MSM’, encompassing individuals aged 30 years and above. This research was conducted by a collaborative team comprised of researchers from Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST). The team conducted this research in Kumasi, Ghana’s second largest urban center. It is a component of the ‘Operations Research for Key Populations in Ghana’ Program funded by the United States Agency for International Development (USAID). We designed and carried out the study in collaboration with FHI 360, an organization based in the capital of Accra that operates programs targeting MSM and other high‐risk individuals in Ghana, as well as the Ghana AIDS Commission (GAC). Reducing vulnerability to HIV infection among high‐risk populations in Ghana is a major goal for the National AIDS Control Program (NACP) and the GAC. MSM are highly stigmatized in Ghana, in part because male‐to‐male sex is illegal. This makes it extremely challenging to understand the challenges these men face and ensure that they have access to HIV‐ and AIDS‐related services. We designed this qualitative study to add to what is known about the beliefs, attitudes, and behaviors of older MSM in Ghana. We focused on two groups among older MSM: those aged 30‐39 years and those aged 40 years and above. Given the need for more data on these groups to better reach them with effective HIV prevention and treatment information, the study aimed to explore: 1) How older MSM find their sex partners; 2) Their views of HIV risk; 3) Their risky behaviors, including those situations in which they are most likely to engage in risky sex; 4) HIV‐related services they receive; and 5) What services would be most helpful to them. The broad goal of the study was to collect and analyze in‐depth data in order to improve the outreach and effectiveness of local programs that aim to reach older MSM with important HIV prevention and treatment information and with services appropriate to their needs.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Using a model-based geostatistical approach to design and analyse the prevalence of schistosomiasis in Kenya

BackgroundInfections caused by both Schistosoma mansoni and Schistosoma haematobium are endemic in Kenya, with over six million children at risk. A national school-based deworming programme was launched in 2012 with the goal of eliminating parasitic worms as a public health problem. This study used a model-based geostatistical (MBG) approach to design and analyse the impact of the programme and inform treatment strategy changes for schistosomiasis (SCH).MethodsA cross-sectional survey of 200 schools across 27 counties of Kenya was utilised. The study design, selection of the schools, and analysis followed the MBG approach, which incorporated historical data on treatment, morbidity, and environmental covariates.ResultsThe overall SCH prevalence was 5.0% (95% CI 4.9%–5.2%) and was estimated, with a high predictive probability of 0.999, to be between 1% and< 10%. The predictive probabilities at county level revealed county heterogeneity, with that of four counties estimated to be between 0% and< 1%, that of 20 counties estimated to be between 1% and< 10%, that of two counties estimated to be between 10% and< 20%, and that of one county estimated to be between 20% and< 50%.ConclusionSCH treatment requirements can now be confidently refined based on the World Health Organization’s guidelines. The four counties with prevalences of between 0% and< 1% may consider suspending treatment only in areas (i.e., sub-counties and wards) where the prevalence is< 1%

The adoption and dissemination of fodder shrubs in Central Kenya

Includes bibliographical referencesAvailable from British Library Document Supply Centre- DSC:6077. 203637(no 131) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

How can we better serve adolescent key populations? Strategies to encourage and inform future data collection, analysis, and use

Young key populations (ages 10–24) (YKPs) are uniquely vulnerable to HIV infection. Yet they are often underserved, due in part to a limited understanding of their needs. Many successful approaches to understanding YKPs exist but are not widely used. To identify the most useful approaches and encourage their uptake, we reviewed strategic information on YKPs and experiences collecting, analysing, and utilising it from countries in Africa, Asia, and Central and Eastern Europe. As a result, we recommend one central guiding principle – any effort to understand and serve YKPs should include a specific focus on adolescent key populations (AKPs) (ages 10–19) – and three strategies to inform data collection, analysis, and use: tailor recruitment practices to ensure young people’s representation, select indicators and research methods based on their ability to inform responsive programming for and give a voice to YKPs, and thoroughly disaggregate data. We demonstrate the utility of each strategy in YKP research and programmes, and in doing so note the particular importance for AKPs. We hope that this paper encourages additional research on YKPs and helps bridge the gap between research and effective programmes to serve the youngest and most vulnerable members of key populations

Using a model-based geostatistical approach to design and analyse the prevalence of schistosomiasis in Kenya

Background: Infections caused by both Schistosoma mansoni and Schistosoma haematobium are endemic in Kenya, with over six million children at risk. A national school-based deworming programme was launched in 2012 with the goal of eliminating parasitic worms as a public health problem. This study used a model-based geostatistical (MBG) approach to design and analyse the impact of the programme and inform treatment strategy changes for schistosomiasis (SCH). Methods: A cross-sectional survey of 200 schools across 27 counties of Kenya was utilised. The study design, selection of the schools, and analysis followed the MBG approach, which incorporated historical data on treatment, morbidity, and environmental covariates. Results: The overall SCH prevalence was 5.0% (95% CI 4.9%–5.2%) and was estimated, with a high predictive probability of 0.999, to be between 1% and< 10%. The predictive probabilities at county level revealed county heterogeneity, with that of four counties estimated to be between 0% and< 1%, that of 20 counties estimated to be between 1% and< 10%, that of two counties estimated to be between 10% and< 20%, and that of one county estimated to be between 20% and< 50%. Conclusion: SCH treatment requirements can now be confidently refined based on the World Health Organization’s guidelines. The four counties with prevalences of between 0% and< 1% may consider suspending treatment only in areas (i.e., sub-counties and wards) where the prevalence is< 1%