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Appropriate paper-based technology (APT) is used to provide postural support for children with cerebral palsy (CP) in low-resourced settings. This pilot study aimed to evaluate the impact of APT on the children's and families' lives. A convenience sample of children with CP and their families participated. Inclusion was based on the Gross Motor Function Classification System levels IV and V. APT seating or standing frames were provided for six months. A mixed methods impact of APT devices on the children and families included the Family Impact Assistive Technology Scale for Adaptive Seating (FIATS-AS); the Child Engagement in Daily Life (CEDL) questionnaire; and a qualitative assessment from diary/log and semi-structured interviews. Ten children (median 3 years, range 9 months to 7 years). Baseline to follow-up median (IQR) FIATS-AS were: 22.7 (9.3) and 30.3 (10.2), respectively (p=.002). Similarly mean (SD) CEDL scores for "frequency" changed from 30.5 (13.2) to 42.08 (5.96) (p=.021) and children's enjoyment scores from 2.23 (0.93) to 2.91 (0.79) (p=.019). CEDL questionnaire for self-care was not discriminatory; seven families scored zero at both baseline and 6 months. Qualitative interviews revealed three key findings; that APT improved functional ability, involvement/interaction in daily-life situations, and a reduced family burden of care. APT devices used in Kenyan children with non-ambulant CP had a meaningful positive effect on both the children's and their families' lives. Assistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries. APT is a low cost and sustainable solution to make seating and standing devices for disabled children in Kenya. The regular use of a postural support device enhanced the children's motor skills, ability to function and participate in everyday activities, reduced the burden of care for the families and promoted the children's social interaction. The postural support devices were highly valued and utilised by the children and families in this study. [ABSTRACT FROM AUTHOR]

Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower – and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18–75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict. [ABSTRACT FROM AUTHOR]

Since the 1990s, researchers have used community-based participatory approaches to achieve outcomes relevant to local communities, to build collaborative and sustainable research infrastructures, and to address disparities in knowledge production. Notwithstanding these strengths, communities and researchers have questioned its success in addressing power imbalances inherent in collaborative research encounters. In this methodological paper, we describe a novel community-based program science approach to guide an interdisciplinary research project on HIV self-testing among men who have sex with men in three Kenyan counties. Drawing on ethnographic field notes, we detail how community researchers and their academic and programmatic partners collaborated through all phases of the research process, including research design and data collection. Importantly, community researchers also played an integral role in data analysis and dissemination, going well beyond the conventional role of 'community engagement' in global health research. We also present findings from qualitative interviews conducted by community researchers with their peers to inform the rollout of HIV self-testing kits in their respective county-contexts. Our approach highlights that engaging community directly in evidence production allows research findings – owned and generated by communities on their own behalf – to be fed more swiftly and effectively into community-led program delivery. [ABSTRACT FROM AUTHOR]

The optimization of the human-centeredness of technological innovations – policy digitalization - has exceedingly proliferated in most policy sectors. Yet, a few studies exist on the implications of digital policy tools in realizing social protection policies for older people, particularly in Africa. This paper discusses this issue. It examines data on the 'digital capabilities' of older persons and how digital technologies impact their usage and access to social safety net programs in Kenya, where digital policy tools like mHealth and e-Payment platforms are used to realize them. The data collection involved interviews with 81 respondents between 65-90 years of age (individuals targeted by social safety net programs and Social Protection officers). Findings show a need for more robust and policy target-sensitive efforts and budget allocation to overcome policy digitalization challenges, especially those arising from structural governance inequalities or older people's capability deficits that underpin digital transformation pathways for different policy targets. Most older people in rural areas have negative attitudes and low user digital capabilities toward digital services. This is partly due to a range of challenges from infrastructural deficiencies, low access to internet resources to inadequate policy communication around digital tools. However, higher digital capabilities of policy targets and positive societal attitudes toward digital platforms could improve effective 'public policy digitalization' with more targeted investments and user-sensitive designs in place. [ABSTRACT FROM AUTHOR]

Urban refugees often face tremendous adversities during displacement that exacerbate mental health and psychosocial outcomes. Given the lack of research on how extended displacement affects mental health in urban refugee youth, this study examines the differential effects of country of birth on trauma exposure and psychosocial factors that influence mental health experiences among Somali refugee youth in urban Kenya (n = 303). Findings reveals that childhood trauma and impeded social functioning predicted mental health outcomes. Being born in Kenya was a significant predictor of poor mental health despite there being no significant difference in trauma exposures and psychosocial factors between Somali-born and Kenya-born youth. This difference can be attributed to prolonged displacement, disrupted development of cultural identity, and discrimination experienced in the host country. Given the widely devastating effects of childhood trauma and community violence, mental health interventions need to be two-prolonged: addressing and preventing intergenerational trauma sequelae through family-based interventions; and community-level programs and advocacy for safety and protection for the displaced. Our findings also emphasize that future interventions for urban refugee communities should be inclusive to all community members, considering shared vulnerability to community violence as well as intergenerational transmission of traumas through childhood adversities and lacking support. [ABSTRACT FROM AUTHOR]

Cancer incidence is rising rapidly in Sub-Saharan Africa (SSA). Dietary intake is an established risk factor for certain cancers but only a few epidemiological studies have been conducted in SSA. This study systematically reviewed and summarized the published literature on this issue and identified gaps that can be addressed in future research. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and literature searched was conducted until 11/2/2021. Out of the 5,457 potential references, we reviewed 19 eligible studies: 17 case-controls, two cross-sectionals and no cohort study. South Africa and Kenya conducted the majorities of the studies. The commonest studied cancers were esophageal (9/19), colorectal (4/19) and breast (4/19). Only four studies utilized a validated Food Frequency Questionnaire (FFQ). Although most studies (16/19) reported associations between dietary intake and cancer risks, they were lacking important confounders including total energy intake, multivitamin intake, body fat measures, physical-activity, smoking, and alcohol. Despite rapidly expanding cases of cancer associated with diet, the existent evidence on diet-cancer relationship is too scarce to deduce solid conclusions. There is a need for large cohorts with comprehensive datasets, validated dietary instruments while using advanced statistical analyses that can provide further insights into the imperative links between African diet and cancer risk. Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2022.2032217. [ABSTRACT FROM AUTHOR]

Understanding the link between health and place can strengthen the design of health interventions, particularly in the context of HIV prevention. Individuals who might one day participate in such interventions – including youth – may further improve the design if engaged in a meaningful way in the formative research process. Increasingly, participatory mapping methods are being used to achieve both aims. We describe the development of three innovative mapping methods for engaging youth in formative community-based research: ‘dot map’ focus groups, geocaching games, and satellite imagery-assisted daily activity logs. We demonstrate that these methods are feasible and acceptable in a low-resource, rural African setting. The discussion outlines the merits of each method and considers possible limitations. [ABSTRACT FROM AUTHOR]

District health managers (DHMs) lead and manage Ministry of Health programmes and system performance. We report on the acceptability and feasibility of inter-related activities to increase the agency of DHMs in Kenya, Nigeria, South Africa and Uganda using a cross-sectional rapid appraisal with 372 DHMs employing structured questionnaires. We found differences and similarities between the countries, in particular, who becomes a DHM. The opportunity to provide leadership and effect change and being part of a team were reported as rewarding aspects of DHMs' work. Demotivating factors included limited resources, bureaucracy, staff shortages, lack of support from leadership and inadequate delegation of authority. District managers ranked the acceptability of the inter-related activities similarly despite differences between contexts. Activities highly ranked by DHMs were to employ someone to support primary care staff to compile and analyse district-level data; to undertake study tours to well-functioning districts; and joining an African Regional DHM Association. DHMs rated these activities as feasible to implement. This study confirms that DHMs are in support of a process to promote bottom-up, data-driven, context-specific actions that can promote self-actualisation, recognises the roles DHMs play, provides opportunities for peer learning and can potentially improve quality of care. [ABSTRACT FROM AUTHOR]

Several factors influence a victim's decision on whether or not to seek help after experiencing Intimate Partner Violence (IPV). This study used data from the Demographic and Health Surveys (DHS) for Kenya (2014) of ever married women (n = 5265). Majority of the women did not seek help after experiencing IPV (55.5%). Women justification for IPV decreased the odds of seeking help from informal services by 0.75 times and formal services by 0.58 times. Understanding cultural determinants of help seeking would contribute in the development of effective policies and programs for preventing and responding to IPV in Kenya and across the world. [ABSTRACT FROM AUTHOR]

Aflatoxins are naturally occurring food toxins known to contaminate cereals with a carry-over effect in milk and meat products from farm animals raised on contaminated feed. In children, continuous consumption of aflatoxin-contaminated food is linked to immune suppression, vaccine interference and growth faltering while in adult populations, carcinogenesis in the liver has been established. We evaluate the main determinants of aflatoxin exposures among children recruited from primary schools in Makueni and Siaya Counties. A five-part questionnaire was administered to collect information from randomly selected participants. AflatoxinB1-lysine adducts in children's sera and total aflatoxins in food samples were analyzed by High-Performance Liquid Chromatography with Fluorescence detection. Using Chi-squared tests and Kruskal–Wallis tests, children from low-income households had the highest aflatoxin exposure, p-value = 0.0029. Smaller family size, greater food diversity, and good farming practices were associated with low aflatoxin exposures p < 0.001. Individual households living under severe levels of poverty were evidently exposed to higher levels of aflatoxins. [ABSTRACT FROM AUTHOR]

Neurological conditions and mental health problems are common in children in low- and middle-income countries, but the risk factors and downstream impact of these problems on children with neurological conditions are not reported. To determine the association of neurological conditions with behavioural and emotional problems in children, the prevalence and risk factors of behavioural and emotional problems, and long-term impact of these conditions. Data on multiple neurological conditions and mental health problems were available for 1,616 children (aged 6–9 years) from Kilifi, Kenya. Neurological conditions were diagnosed using standardised tools and clinical examination. Behavioural and emotional problems assessed using Child Behaviour Questionnaire for Parents. Long-term outcomes were obtained from census data of the Kilifi Health and Demographic Surveillance System. Logistic and linear regression were used to measure associations. Mental health problems were higher in those with any neurological condition compared to those without (24% vs. 12%, p < 0.001). Cognitive (odds ratio (OR) = 2.39; 95% CI: 1.59–3.59), motor (OR = 3.17; 95% CI: 1.72–5.82), hearing (OR = 2.07; 95% CI:1.12–3.83) impairments, and epilepsy (OR = 4.18; 95% CI: 2.69–6.48), were associated with mental health problems. Prevalence of any mental health problem was 15%, with externalizing problems more common than internalizing problems (21% vs. 17%, p = 0.004). Longitudinal follow-up indicated that the disorders affected an individual's future schooling (e.g. OR = 1.25; 95% CI: 0.14–1.46 following cognitive impairments), occupation (OR = 2.44; 95% CI: 1.09–5.44 following mental health problems), and access to household assets (OR = 2.78; 95% CI: 0.99–7.85 following epilepsy). Neurological conditions in school-aged children in Kilifi are associated with mental health problems, and both disorders have long-term consequences. Preventive and therapeutic measures for these conditions are needed to improve outcomes of these children. [ABSTRACT FROM AUTHOR]

Introduction: To assist with the professional development of physical therapists in Kenya, a post-graduate residency program was developed and implemented in the country. Purpose: The purpose of this study was to explore the influence of residency training on the professional development of physical therapists. Methods: The influence of the program on professional development of residents was explored through a mixed-methods research design, including a survey and semi-structured interviews with residents at program completion. Results: The graduates reported a positive impact of residency education on their ability to perform a comprehensive evaluation, utilize clinical reasoning, provide an effective treatment to achieve projected outcomes, treat complex patients, communicate with patients and other health professionals, perform overall patient management, and implement a treatment plan based on scientific literature. Four themes emerged from the interviews: 1) evolution of practice from protocol-driven to individualized treatment plans; 2) promotion of professional development within the wider physical therapy community; 3) positive change in physical therapy practice; and 4) commitment to lifelong learning. Conclusion: The residents expressed how their new knowledge and skills fostered their commitment to providing mentorship to colleagues and lifelong learning. This commitment can provide the framework for advancing the practice of physical therapy in their respective communities. [ABSTRACT FROM AUTHOR]

Male involvement in prevention of mother to child transmission of HIV (PMTCT) care improves maternal and child outcomes. We conducted a mixed-methods study at two Kenyan government hospitals. We quantitatively assessed women's expectations and preferences for male partner involvement in PMTCT and male partner attendance at PMTCT appointments. Qualitative interviews with women during the postpartum period assessed types of support women received from their male partners. At enrollment, most participants wanted (75%) and expected (69%) male partners to attend appointments; yet, only 9% had a male partner attend any appointments. Most women agreed that their partner would: support them financially (81%), help follow doctor's guidance (61%), support a hospital-based delivery (85%), and want to receive text messages (68%). Expectations and preferences varied by women's characteristics, most notably experiences with mistreatment, disclosure status, and knowledge of male partner's HIV status. In qualitative interviews, instrumental (financial) support was the most frequently discussed type of support. Male partners also provided informational support by reminding women of medication or appointments. Women reported a variety of ways in which their male partners supported them through PMTCT; however, there was a gap between women's expectation for male partner attendance and the level of male attendance achieved. [ABSTRACT FROM AUTHOR]

Because outcomes studies are known to facilitate effective use of funds, economic realities in lower-resource countries increase the need for outcome measures for wheelchair effectiveness in these areas. Effective use of funds based on evidence is especially needed since the level of wheelchair provision is low, and many wheelchairs are inappropriate for their intended users. There are very few existing wheelchair specific assistive technology outcome measures. The Wheelchair Satisfaction Questionnaire (WSQ) was designed to be a snapshot of a wheelchair user's level of satisfaction with their wheelchair. The current studies examined the development of the WSQ and its initial face and content validity. The WSQ is comprised of 16 visual analogue scale questions; each question includes a qualitative explanatory comment. In study 1, 15 adult users of manual wheelchairs completed the WSQ and then the completed a follow-up questionnaire which collected feedback on each question. In study 2, 15 secondary school student users of manual wheelchairs in Kenya completed the same procedure used in study 1. High mean satisfaction scores on the follow-up questionnaire support face and content validity in both studies. The WSQ has the potential to give wheelchair users a quantifiable voice on wheelchair function. Data obtained from the WSQ also has the potential to provide data from wheelchair users to wheelchair manufacturers and providers, leading to better design and provision. Based upon the score of a specific item, manufacturers could improve design of wheelchairs for use in lower-and-middle-income countries, and providers could be better-informed as to models sent to specific environments. The WSQ could provide evidence-based information to support improved provision and design. The WSQ could be used in a clinical setting over time to identify the most common interface problems in that particular setting. [ABSTRACT FROM AUTHOR]

Adolescents have poor antiretroviral therapy (ART) outcomes due to multi-level factors. Adolescent and youth-friendly services (AYFS) have been implemented to address this. Adolescents on ART and HIV clinic managers were interviewed on their experiences with HIV care provision. Facility infrastructure was assessed using a standardized checklist. A 10-point criterion was set for AYFS. Descriptive analysis was used for quantitative data while qualitative data were thematically grouped and coded. Eighty-nine adolescents were interviewed including 46 males (52%) and 43 females (48%). The median age was 16.9 years (Interquartile range: 14.6–19.1 years). Some 36 (40.4%) adolescents raised the following facility-level challenges: long turnaround time, 12 (33.3%); clinic-school calendar conflict, 6 (16.7%); lack of digital media, 4 (11.1%); inadequate staff, 4 (11.1%) while another 10 (27.6%) cited lack of privacy, adolescent day and support groups. Clinic managers listed the availability of separate adolescents' days, adolescent-specific support groups, adolescent champion and use of social media as best practices. They listed several facility-related, society-related and adolescent-related challenges. Six facilities met six criteria of adolescent-friendliness (60%), one met five (50%) while two met four (40%). Although progress has been made in providing AYFS, key challenges remain that call for multi-sectoral interventions to ensure good ART outcomes. [ABSTRACT FROM AUTHOR]

Wheelchair outcomes measures are useful to support evidence-based practice in wheelchair provision, especially in low- and middle-income countries (LMIC). The Wheelchair Interface Questionnaire (WIQ) was developed to provide a professional perspective on the quality of the interface between a wheelchair and its user. Studies conducted during the development of the WIQ indicated it has face validity and content validity. The objective of this field study was to conduct a subsequent investigation of the inter-rater reliability of the WIQ at a school for children with disabilities in Kenya. Eight practitioners with wheelchair experience from disparate cultural backgrounds participated in the study. They evaluated eight wheelchairs and the interface with their users. The interclass correlation coefficient (ICC) of the mean rating for the eight-item dataset was computed using SPSS. The ICC was found to be 0.911, indicating that the WIQ possesses inter-rater reliability. Common comment topics indicated that the qualitative data yielded by the WIQ is meaningful. Informal timing indicated that the WIQ is a brief measure. The WIQ is a reliable tool that can meet the need for a professional assessment of the wheelchair-user interface. The reliability of this questionnaire is important because the tool can be used to evaluate the interface between a wheelchair user and their wheelchair, strengthening evidence-based practice in wheelchair provision. Based on the score of a specific wheelchair interface, a rehabilitation professional could recommend more assessment, seating modification, or wheelchair replacement in order to maximize rehabilitation benefit for a client The WIQ could provide evidence-based information to support the need for wheelchair repair or replacement to funders. In large-scale studies involving many of the same wheelchair type in the same setting, the WIQ could be used to identify problems with the interface between that wheelchair type and its intended user population so that manufacturers can make responsive design changes. The WIQ could be used in a clinical setting over time to identify the most common wheelchair interface issues for that setting. [ABSTRACT FROM AUTHOR]

Background: This study examined factors associated with perceived risks for the harmful use of alcohol among young adults in the context of HIV and AIDS. This is the alcohol use that affects physical and mental health and has social consequences. Informed by the protection motivation theory and the social cognitive theory, the study focused on the motivational and cognitive factors that influence risk perception, which includes knowledge, self-efficacy, and outcome expectancies. Methods: Data were gathered through a self-administered survey among young adults (n = 402) who were recruited using the intercept method (Median = 22 years, Mean = 22.5 years). Results: Key findings show a low level of risk perception for the harmful use of alcohol and a high level of alcohol-related self-efficacy. Participants had moderately high knowledge about HIV and AIDS, low HIV-related risk perception but high HIV-related self-efficacy. There was a correlation between alcohol risk perception and perceived risk of HIV and AIDS. Significant determinants of alcohol risk perception included sex-related alcohol expectancies, HIV risk perception, and HIV self-efficacy. Sex-related alcohol expectancies were correlated with risk perception for HIV infection and the harmful use of alcohol. Conclusion: The study provides insights on factors that public health and communication specialists must consider when communicating about the harmful use of alcohol. Enhancing risk perception and self-efficacy for the harmful alcohol use and communicating in the context of HIV and AIDS in high-risk environments is crucial. Furthermore, addressing sex-related alcohol expectancies may lower the risk of HIV and other sexually transmitted infections among alcohol consumers. [ABSTRACT FROM AUTHOR]

Purpose: In Kenya, the employment rate for persons with disabilities is about 1% compared to 73.8% for the general population, and the situation is even worse for persons with mental disabilities. Persons with mental disabilities are often regarded as "mad", and stand little or no chance of employment. We undertook an exploratory study with employers and potential employers to understand factors that hinder or facilitate their employment and to gain insight into employers' perceptions of mental disability. Materials and methods: We adopted a mixed method study design, including in-depth interviews (n = 10) and questionnaires (n = 158) with (potential) employers in Kenya to explore the barriers and facilitators of employment for persons with mental disabilities. Results: Out of the 158 employers who completed the questionnaire, only 15.4% had ever employed persons with mental disabilities. The perceptions that these persons are not productive and may be violent was associated with an unwillingness to employ them (OR: 10.11, 95%CI: 2.87–35.59 and OR: 3.6, 95%CI: 1.34–9.64, respectively). The possession of skills was the highest reported facilitator of employing persons with mental disabilities. Employers suggested that information about mental illness and the disclosure by prospective employees with mental disabilities are relevant for the provision of reasonable accommodation in the workplace. Conclusion: Possession of skills and disclosure by persons with mental disabilities could improve their employability. Information targeted at all actors including employers, employees, government, and policymakers is necessary for balancing employers and employees expectations. Disabled persons' organisations or mental disability programs that seek to improve the employment of persons with mental disabilities should incorporate methods that address employer expectations through dialogue to find mutual benefits. Employers require essential information about mental illness, and guidance and support in order to provide reasonable accommodation in the workplace for persons with mental disabilities. Disabled persons' organisations and inclusive employment programs should share the positive experiences of employers of persons with mental disabilities with employers who are unaware of the work abilities of persons with mental disabilities to stimulate adoption of inclusive practices. [ABSTRACT FROM AUTHOR]

Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences. [ABSTRACT FROM AUTHOR]

HIV remains a major health problem in sub-Saharan Africa, and innovations—such as HIV self-testing (HST)—that break down barriers to testing are required to move toward elimination. Four anonymous cross-sectional surveys were conducted assessing HST knowledge and attitudes among sports-based HIV prevention tournament attendees in Nairobi, Kenya. Results suggest HST may increase testing rates in this population. Participants expressed interest in using HST and were willing to use HST as a tool to motivate others. This poses a unique opportunity for a community intervention aimed to increase knowledge of HST, and to increase HIV testing rates using HST kits. [ABSTRACT FROM AUTHOR]

Inappropriate use of antibiotics can lead to the development of resistant pathogens. Ensuring proper use of these important drugs in all healthcare facilities is essential. Unfortunately, however, very little is known about how antibiotics are used in LMIC clinical settings, nor to what degree antibiotic stewardship programmes are in place and effective. We aimed to record all Antibiotic Stewardship policies and structures in place in 16 Kenyan hospitals. We also wanted to examine the context of antibiotic-related practices in these hospitals. We generated a set of questions intended to assess the knowledge and application of antibiotic stewardship policies and practices in Kenya. Using a set of 17 indicators grouped into four categories, we surveyed 16 public hospitals across the country. Additionally, we conducted 31semi-structured interviews with frontline healthcare workers and hospital managers to explore the context of, and reasons for, the results. Only one hospital had a resourced ABS policy in place. In all other hospitals, our survey teams commonly identified structures, resources and processes that in some way demonstrated partial or full control of antibiotic usage. This was verified by the qualitative interviews that identified common underlying issues. Most positively, we find evidence discipline-specific clinical guidelines have been well accepted and have conditioned and restricted antibiotic use. Only one hospital had an official ABS programme, but many facilities had existing structures and resources that could be used to improve antibiotic use. Thus, ABS Strategies should be built upon existing practices with national ABS policies taking maximum advantage of existing structures to manage the supply and prescription of antimicrobials. We conclude that ABS interventions that build on established responsibilities, methods and practices would be more efficient than interventions that presume a need to establish new ABS apparatus. [ABSTRACT FROM AUTHOR]

Purpose: The Wheelchair Components Questionnaire for Condition (WCQ-C) enables the collection of data on wheelchair maintenance condition and durability in resource-limited environments. It can be used in large studies to indicate typical patterns of wear at a location, or for a type of wheelchair. It can also be used in clinical settings as an evidence based indication that a wheelchair may need repair or replacement. This type of data can enable effective use of limited funds by wheelchair providers, manufacturers and users. The goal of this study was to investigate the inter-rater reliability of the WCQ-C. Methods: Two therapists from North America who have worked extensively in low-resource areas used the WCQ-C to independently evaluate 46 wheelchairs at a primary school for children with disabilities in Kenya. Results: Mean scores of ratings for each wheelchair by the two raters were used to calculate a two-way random interclass correlation coefficient. A value of 0.82 with a 95% confidence interval of 0.67-0.89 indicated good preliminary reliability. Conclusion: Preliminary results indicate that the WCQ-C is a reliable method of assessment. Additional studies are needed with larger and more diverse groups of raters. Because WCQ-C findings are specific to wheelchair wear and maintenance at each location, studies at other locations are also needed. Implications for rehabilitation: The importance of inter-rater reliability testing in confirming the reliability of an assessment tool such as the WCQ-C. The use of the WCQ-C to monitor wheelchair condition in low-resource settings and other field settings. If used at regular interval can produce data that can be used to describe typical changes over time at each individual setting. This could enable proactive planning at that setting to avoid typical breakdowns and the injuries or clinical complications that could result. The use of the WCQ-C to monitor the condition of groups of wheelchairs of the same type. It can describe typical patterns of wear and failure in a way that enables responsive change by manufacturers and designers. This enables more effective use of limited funds. On an individual basis, the use of the WCQ-C to alert users and health professionals of a need for repair or replacement. This could minimize the clinical problems and accidents that can result from wheelchair breakdown. Assessment of a wheelchair using the WCQ-C could provide evidence based data to insurance companies or wheelchair providers which indicates a need for wheelchair repair or replacement. [ABSTRACT FROM AUTHOR]

Risks are a central part of life for households in low-income countries and health shocks in particular are associated with poverty. Formal mechanisms protecting households against the financial consequences of shocks are largely absent, especially among poor rural households. Our aim is to identify the relative importance of health shocks and to explore factors associated with coping behaviour and foregone care. We use a cross-sectional survey among 1226 randomly selected agricultural households in Kenya. In our sample, illness and injury shocks dominate all other shocks in prevalence. Almost 2% of households incurred catastrophic health expenditure in the last year. Using a probit model we identified the main coping strategies associated with facing a health shock: (1) use savings, (2) sell assets and (3) ask for gifts or loans. One in five households forewent necessary care in the last 12 months. We conclude that health shocks pose a significant risk to households. Implementing pre-payment or saving mechanisms might help protect households against the financial consequences of ill health. Such mechanisms, however, should take into account the competing shocks that agricultural households face, making it almost impossible to reserve a share of their limited resources for the protection against health shocks only. [ABSTRACT FROM PUBLISHER]

Objective: We analyze whether adverse childhood experiences predict weekly alcohol consumption patterns of Kenyan mothers and their partners. Method: Randomly selected respondents (n = 1,976) were asked about adverse childhood experiences and alcohol consumption patterns for themselves and their partners. Fixed effect models were used to determine odds of reporting weekly alcohol consumption and the number of beverages typically consumed, controlling for wealth, age, education, and partner alcohol consumption. Results: Cumulative adverse childhood experiences predicted higher odds of weekly alcohol consumption of the respondent and her partner. Childhood exposure to physical abuse, emotional neglect, and mental illness in the household significantly increased odds of weekly alcohol consumption by the respondent. More drinks consumed per typical session were higher among respondents with more cumulative adversities. Physical and emotional abuse significantly predicted number of drinks typically consumed by the respondent. Conclusions: To our knowledge, this is the first study to explore and find associations between adverse childhood experiences and alcohol consumption in Kenya. Consistent with high-income settings, exposure to childhood adversities predicted greater alcohol consumption among Kenyan women. [ABSTRACT FROM AUTHOR]

PurposeThe Lower Limb Function Questionnaire (LLFQ) was developed as a self-report assessment of lower-limb functional ability for orthotic and prosthetic (O&P) device users to be suitable for a wide range of conditions, cultures, and ages. The measure aims to address an existing gap in tools for the assessment of functional ability in this population. The purpose of this study is to evaluate LLFQ reliability and validity in a sample of young adult O&P users.MethodsAdolescents from a secondary school in Kenya completed the LLFQ twice, 6 d apart, and test–retest reliability was assessed using intra-class correlation coefficients. Validity evaluations involved Timed Up-and-Go, 6-min walk, 6-min obstacle course, and/or spatiotemporal gait assessments. Oxygen consumption was measured during walk tests. Associations between the LLFQ and each measure were evaluated using Pearson correlation coefficients for construct validity. ResultsLLFQ reliability was acceptable (ICC = 0.79, 95% CIs 0.64–0.89). Construct validity was demonstrated via moderate correlation (r >  0.60) with obstacle course distance, gait velocity, stride length, and stance/single support/double support percent of gait cycle.ConclusionsBoth LLFQ reliability and validity were acceptable in the sample of youth in Kenya. Further testing is required to determine applicability in other cultural contexts.Implications for RehabilitationThe LLFQ may be clinically useful across a variety of cultures and conditions to provide feedback on the effectiveness of rehabilitative treatment or assistive devices for youth with lower limb impairments.The LLFQ may enable specific strengths and challenges to lower limb function to be identified to enable planning of well-targeted rehabilitation. [ABSTRACT FROM PUBLISHER]

Considerable research has investigated work/life balance challenges faced by professional women in the West; considerably less research has focused on challenges faced by Sub-Saharan African women, in spite of the dramatic increase in women professionally employed in these countries. One strategy used to cope with work/life challenges is hiring domestic helpers, and interpersonal conflicts often arise between these workers and their female employers. Therefore, this qualitative study focuses on these conflicts that arise in Kenyan households. Seventy university female faculty and staff members completed a questionnaire asking them to describe these conflicts and the conflict strategies they use during these difficult interactions. Follow-up interviews also were conducted. Data analysis revealed specific areas of conflict that reflected the unique dialectical tensions that occur in this work context; for example, the workspace is both public and private and the employer–domestic worker relationship is both intimate and distant. Communication strategies used by these professional women to deal with these conflicts also were identified as were suggestions for reducing conflict and maintaining a collaborative working environment to ensure more equitable and satisfying work relationships. Finally, suggestions for future research as well as theoretical challenges for organizational communication scholarship are presented and discussed. [ABSTRACT FROM PUBLISHER]

A cross-sectional study was conducted to assess the extent of unstructured HIV treatment interruptions (TIs) and investigate the effects of socioeconomic, socio-demographic, HIV treatment-related and clinical factors on the magnitude and rate of the same among adult patients at a Kenyan regional referral center. Four hundred and twenty-one adult patients actively receiving antiretroviral therapy at Nyeri County Referral Hospital since 2003 were randomly selected to complete a health survey questionnaire. Electronic records were used to obtain their HIV treatment utilization history. The marginal effects of selected determinants on prevalence and rate of TI were assessed by fitting multiple Poisson log-linear regression models. In total, 392 patients participated in the study. HIV TI was prevalent with 64.5% having had at least one TI of 3 months or more during treatment. The risk of TI was significantly higher in those longer on treatment (prevalence ratio = 1.2, 95% confidence interval [CI] 1.12-1.28). Greater risk of TI was also associated with lower income (prevalence rate ratio [PRR] = 0.9, 95% CI 0.83-1.00), low medication adherence (PRR = 0.3, 95% CI 0.13-0.72), inconsistent treatment engagement (PRR = 0.4, 95% CI 0.19-0.75) and, contrarily, fewer adverse drug reactions (PRR = 0.9, 95% CI 0.90-0.97). Unstructured HIV TIs appear to be fairly common at the study site. The results suggest that efforts to minimize HIV TI could benefit from treatment-continuity monitoring strategies that target the high-risk sub-samples identified. [ABSTRACT FROM AUTHOR]

This article models key motivational factors that contribute to youth effort and future intentions to resist risk behaviors for HIV/AIDS. Quantitative questionnaire data were collected from 6,816 youth ages 10–24, in high-risk communities in Kenya and Tanzania. Lisrel 9.1 analysis tested a best-fitting model for individual and environmental predictors of youth effort and intentions to resist HIV/AIDS risk. It yielded 12 statistically significant paths that explained 46–65% of variance in abstinence effort and self-efficacy, future intentions, and success expectations. It represents a relatively comprehensive motivational framework to date for predicting youth resistance to HIV/AIDS risk. [ABSTRACT FROM PUBLISHER]

Voluntary medical male circumcision is one of the most effective measures in preventing male acquisition of HIV during heterosexual intercourse. In Kenya, the voluntary medical male circumcision programme was launched in the year 2008 as part of a comprehensive national HIV prevention strategy. With the global challenge of funding HIV intervention programs, the sustainability of the programme beyond the donor periods need to be assessed. The purpose of this study was to determine the household ability and willingness to pay for voluntary medical male circumcision as an alternative method of funding the programme. The findings show that 62.2% of the households were “able” to pay for medical circumcision. However, 60.4% of them were not “willing” to pay for the service regardless of the cost. The findings indicate that ability to pay is not a significant predictor of willingness to pay for voluntary medical male circumcision within Kisumu County. Knowledge on the role of medical circumcision is a more important factor in determining willingness to pay for the service. [ABSTRACT FROM PUBLISHER]

Knowledge of one’s own HIV status is essential for long-term disease management, but there are few data on how disclosure of HIV status to infected children and adolescents in sub-Saharan Africa is associated with clinical and psychosocial health outcomes. We conducted a detailed baseline assessment of the disclosure status, medication adherence, HIV stigma, depression, emotional and behavioral difficulties, and quality of life among a cohort of Kenyan children enrolled in an intervention study to promote disclosure of HIV status. Among 285 caregiver–child dyads enrolled in the study, children’s mean age was 12.3 years. Caregivers were more likely to report that the child knew his/her diagnosis (41%) compared to self-reported disclosure by children (31%). Caregivers of disclosed children reported significantly more positive views about disclosure compared to caregivers of non-disclosed children, who expressed fears of disclosure related to the child being too young to understand (75%), potential psychological trauma for the child (64%), and stigma and discrimination if the child told others (56%). Overall, the vast majority of children scored within normal ranges on screenings for behavioral and emotional difficulties, depression, and quality of life, and did not differ by whether or not the child knew his/her HIV status. A number of factors were associated with a child’s knowledge of his/her HIV diagnosis in multivariate regression, including older age (OR 1.8, 95% CI 1.5–2.1), better WHO disease stage (OR 2.5, 95% CI 1.4–4.4), and fewer reported caregiver-level adherence barriers (OR 1.9, 95% CI 1.1–3.4). While a minority of children in this cohort knew their HIV status and caregivers reported significant barriers to disclosure including fears about negative emotional impacts, we found that disclosure was not associated with worse psychosocial outcomes. [ABSTRACT FROM AUTHOR]

There is an increasing interest in studying the association between spirituality and addiction, and the effect of mindfulness on recovery. There have been some attempts at exploring the mediators of the association, but seldom in the context of Christian contemplation and rarely within a single theoretical framework of psychology. This article reports two case studies from an intervention study carried out in Nairobi, Kenya, that suggest that the Christian contemplative practice has the potential to reduce alcohol misuse while facilitating the emergence of a three-dimensional religious-spirituality model involving the character strengths of self-awareness, self-regulation, humility, and leading to forgiveness, social responsibility, and social intelligence. [ABSTRACT FROM PUBLISHER]

This study aimed to examine individual and community level factors associated with adequate use of maternal antenatal health services in Kenya. Individual and community level factors associated with adequate use of maternal health care (MHC) services were obtained from the 2008–09 Kenya Demographic and Health Survey data set. Multilevel partial-proportional odds logit models were fitted using STATA 13.0 to quantify the relations of the selected covariates to adequate MHC use, defined as a three-category ordinal variable. The sample consisted of 3,621 women who had at least one live birth in the five-year period preceding this survey. Only 18 percent of the women had adequate use of MHC services. Greater educational attainment by the woman or her partner, higher socioeconomic status, access to medical insurance coverage, and greater media exposure were the individual-level factors associated with adequate use of MHC services. Greater community ethnic diversity, higher community-level socioeconomic status, and greater community-level health facility deliveries were the contextual-level factors associated with adequate use of MHC. To improve the use of MHC services in Kenya, the government needs to design and implement programs that target underlying individual and community level factors, providing focused and sustained health education to promote the use of antenatal, delivery, and postnatal care. [ABSTRACT FROM AUTHOR]

The study evaluated airborne exposures and blood lead (BPb) levels in 233 production workers at six diverse industrial plants in Kenya. Blood and personal breathing zone air samples were collected and analyzed for lead (Pb) using atomic absorption spectroscopy. Blood pressure (BP) levels were measured using a standard mercury sphygmomanometer. The results indicated mean airborne Pb levels ± standard deviation (SD) as follows: 183.2 ± 53.6 μg/m3in battery recycling, 133.5 ± 39.6 μg/m3in battery manufacturing, 126.2 ± 39.9 μg/m3in scrap metal welding, 76.3 ± 33.2 μg/m3in paint manufacturing, 27.3 ± 12.1 μg/m3in a leather manufacturing, and 5.5 ± 3.6 μg/m3in a pharmaceutical plant. The mean airborne Pb levels exceeded the U.S. Occupational Safety and Health Administration (OSHA) 8-hr time-weighted average (TWA) permissible exposure limit (PEL) for Pb of 50 μg/m3in the battery manufacturing, battery recycling, welding, and paint manufacturing plants. Similarly, mean BPb concentrations exceeded the American Conference of Governmental Industrial Hygienists (ACGIH®) biological exposure index (BEI) for Pb of 30 μg/dl. A significant positive association was observed between BPb and breathing zone air Pb (R2= 0.73, P < 0.001). Approximately 30% of the production workers (N = 233) were in the hypertensive range with an average systolic and diastolic blood pressure (BP) of 134.7 ± 12.7 mmHg and 86.4 ± 8.9 mmHg, respectively. In the multivariate regression analysis, age, duration of work, airborne Pb and BPb levels were significantly associated (P < 0.05) with a change in BP. We recommend improved engineering controls, work practices, and personal hygiene to reduce Pb exposures. In addition, workers should undergo comprehensive medical surveillance to include BPb and BP testing, and airborne Pb assessments in all industries with significant lead exposures. [ABSTRACT FROM AUTHOR]

Background: The vast majority of deaths in the health and Kombewa demographic surveillance system (HDSS) study area are not registered and reported through official systems of vital registration. As a result, few data are available regarding causes of death in this population. Objectives: To describe causes of death among residents of all ages in the Kombewa HDSS, located in rural Western Kenya. Methods: Verbal autopsy (VA) interviews at the site were conducted using the modified 2007 and later 2012 standardized WHO questionnaires. Assignment of causes of death was made using the InterVA-4 model version 4.02. Cox regression model, adjusted for sex, was built to evaluate the influence of age on mortality. Results: There were a total of 5196 deaths recorded between 2011 and 2015 at the site. VA interviews were successfully completed for 3903 of these deaths (75.1%). Mortality rates were highest among neonates HR = 38.54 (<0.001) and among Infants HR = 2.07 (<0.006) in the Kombewa HDSS. Among those deaths in which VA was performed, the top causes of death were HIV/AIDS (12.6%), Malaria (10.3%), Pneumonia (10.1%), Acute abdomen (7.0%), Stroke (5.2%) and TB (4.9%) for the whole population in general. Stroke, acute abdomen heart diseases and Pneumonia were common causes of death (CODs) among the elderly over the age of 65. Conclusions: The analysis established the main CODs among people of all ages within the area served by the Kombewa HDSS. We hope that information generated from this study will help better address preventable deaths in the surveyed community as well as help mitigate negative health impacts in other rural communities throughout the Western Kenya region. [ABSTRACT FROM AUTHOR]