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Taking place at an altitude of 2,200 metres, the 1968 Olympic Games marked both the advent of Kenyan athletes on the world middle-distance running scene and the emergence of representations of the advantages that the altitude at which they lived would confer on them. These Games remain closely associated with the image of Kenyan athletes as bearers of a fantasised advantage linked to the natural environment in which they evolve. This representation reflects a French media construction that tends to devalue these athletes in a subordinate position in a sports space that is a vector of discrimination. The study is based on the analysis of works on athletics in Kenya published in France, written by journalists, athletes or coaches and of the specialized French press through the issues of Le Miroir de l'athlétisme, l'Équipe athlétisme magazine, VO2 Magazine and l'Athlétisme. The various observers took advantage of the geographical singularity of the Olympic site in Mexico City to euphemise, if not discredit, the Kenyan hegemony in the long races. This was due as much to their difficulty in separating themselves from a racialist vision of sporting performance as to a desire to preserve the faltering lustre of the French middle distance. Although controversial, the image of the influence of altitude brought to light at the Mexico Games has endured to the present day, despite the involvement of scientists to shed light on this phenomenon.

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Primary healthcare (PHC) is recognised as the means to achieve universal health coverage, a national priority for Kenya. With only approximately 200 family physicians for a population of over 54 million, innovative solutions for providing quality PHC are needed. Clinical Officers, as mid-level health workers, already provide much of the primary care across Kenya, but without specialised training. To provide highly trained Family Health practitioners, a Higher Diploma in Family Health for Clinical Officers (FHCO) was launched by the government in 2018. With experience in delivering innovative and strategic higher diplomas, AIC Kijabe Hospital has been involved in curriculum development of this new diploma since its inception, and in October 2021 the first cohort of FHCO trainees was admitted to Kijabe College of Health Science, graduating in 2023. The second cohort is underway with plans for an annual intake. The FHCO graduates are running Family Medicine clinics at AIC Kijabe Hospital and its satellite clinics and are heavily involved in teaching. They are well-trained to deliver comprehensive, evidence-based, cost-effective and holistic care. As the programme expands, we expect graduates to be working across the country and leading efforts in enhancing the health and well-being of individuals, families and communities within primary healthcare networks (PCNs). By training FHCOs, this higher diploma is an efficient and cost-effective way to improve PHC, particularly for underserved Kenyans, and thus is a key part of enabling the Kenyan Government to achieve universal health coverage. This model of training could easily be replicated in other countries.

The literature on the relationship between social policies and the lives of migrants is dominated by a focus on transnational migration. This contribution is dedicated to the less discussed topic of internal migration and the example of old-age provision in Kenya. Since its inception in the colonial period, formal employment has been closely linked to internal migration, but also to land purchase and house building in the region of origin. Initially thought of as temporary, formal employment was later sought permanently, and it benefits from state instruments of old-age provision. However, not even the monthly pension of privileged occupational groups is sufficient. In some cases, retirement is accompanied by a return internal migration, for example to pursue income-generating activities more intensively or to reduce the cost of living. However, a growing and ageing society can afford less and less to rely on solutions based on land ownership.

Through the example of migrants staying at the Kakuma Refugee Camp in north-western Kenya, I show what art consumption and production means for people living in marginalised and restricted places in East Africa. With its 30 years of existence Kakuma refugee camp has developed into a major city-camp and its residents are very active consumers and producers of art. In this context, as shown in this special issue, art has an important function of identity creation, connection to wider East African communities, to home and future places to stay as well as for the imagination, planning and making of alternative futures. This epilogue concludes the NJAS special issue "Art and Imagined Futures in Eastern Africa", edited by Alex Perullo, Claudia Böhme, and Christina Woolner, and has not been peer-reviewed.

Swahili architecture, which developed along the Swahili Coast in East Africa, represents a remarkable amalgamation of African, Arab, and South Asian influences. The region's cultural exchanges gave birth to the distinctive Swahili Culture while thriving trade cities like Mombasa, Mogadishu, and Zanzibar attracted merchants from India, Persia, and China. This cultural convergence also played a pivotal role in the emergence of the Swahili language, which became the widely spoken language across East Africa and the official language of Kenya and Tanzania. However, the impact of Swahili culture extends beyond language; it is also evident in the architectural heritage of the entire Swahili coast. This architectural style holds immense cultural significance and is cherished as a valuable urban asset. Certain sites, including Lamu in Kenya, Kilwa, and Stone Town in Zanzibar, have been granted UNESCO World Heritage status. The enduring allure of Swahili architecture continues to inspire contemporary building designs, celebrating and preserving the rich history and adaptability of Swahili culture to its environment.

Background: Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information. Aim: To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya. Setting: Outpatient medical oncology and palliative care clinics and inpatient medical and surgical wards of Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. Methods: The authors surveyed 207 adults with advanced solid cancers. The survey comprised validated measures developed for a multi-site study of end-of-life care in advanced cancer patients. Outcome variables included prognostic awareness and preference for prognostic information. Results: More than one-third of participants (36%) were unaware of their prognosis and most (67%) preferred not to receive prognostic information. Increased age (OR = 1.04, 95% CI: 1.02, 1.07) and education level (OR: 1.18, CI: 1.08, 1.30) were associated with a higher likelihood of preference to receive prognostic information, while increased symptom burden (OR= 0.94, CI: 0.90, 0.99) and higher perceived household income levels (lower-middle vs low: OR= 0.19; CI: 0.09, 0.44; and upper middle- or high vs low: OR= 0.22, CI: 0.09, 0.56) were associated with lower odds of preferring prognostic information. Conclusion: Results reveal low levels of prognostic awareness and little interest in receiving prognostic information among advanced cancer patients in Kenya. Contribution: Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients.

Recent studies on language and gender that focus on songs and beer drinking sessions within the context of the Bukusu circumcision ceremony have shown that language is gendered and that it espouses male gender. Against this backdrop, in this study we aim to denaturalise this view by focussing on conversations within the circumcision ceremony. By using theoretical and methodological principles from critical discourse and conversation analysis in particular, we argue that, by using linguistic strategies, traditional gender roles are not only discursively highlighted but they are also negotiated and even resisted. This study falls within recent discussions in critical discourse analysis that have shown that language masks asymmetrical power relations on the one hand, and within postcolonial studies that have shown that gender discourses can reflect collisions between differing points of views on the other hand. The data used in this study is four audio recordings of conversations that took place alongside the main ceremony. This data has been analysed at the level of content and prosodic organisation to identify discursive practices that reveal the negotiation and contestation of gender roles. The study contributes to recent discussions in critical discourse analysis by exposing gender asymmetries and contestations that lie behind ‘taken-for-granted’ realities, with specific examples from the postcolonial context of the Bukusu circumcision ceremony.

Kakuma refugee camp, one of the biggest refugee camps in the world, lies very marginalized in Northwestern Kenya. People living there are restricted in mobility,access to resources and work. While Kakuma has become a vivid city and home, the majority of people just want to get out. Resettlement means the chance to start a new life in places like the USA, Canada or Europe, it is everybody’s dream. With the use social media and access to wider transnational networks and information, the perception of resettlement has undergone major transformations. Based on conversations with people resettled, field work and online ethnography, I want to analyse how the journey of resettlement is personally experienced vis a vis its presentation on social media. How resettlement is perceived through pictures and texts and what is shown and what is hidden of the journey to a new life abroad.

While Kenyan colonial subjects became citizens at independence, women were excluded from state resources, social services, and full political enfranchisement. This was neither the decolonizing future they had been promised nor the one they had envisioned; for Kenyan women, independence often held more symbolic than material meaning. Continued landlessness – which overlapped with perpetuated structural gendered inequalities and various forms of political exclusion – coloured the ways in which Kenyan women made sense of independence. Relying on archival and oral sources, this article explores how Kenyan women were prohibited from exercising the fullest rights offered and protected by the early postcolonial state. In examining the multilayered politics of women’s marginalization, this paper elucidates how these exclusions shaped political imaginations, and in particular, Kenyan women’s notion of temporality, often marked by a sense of stasis or being placed outside of time. “There Was No Change” thus not only sheds light on the broad question of how gender shapes temporal logics, but it also contributes to an emerging literature on gendered notions of time during political transition.

Context and background Although a growing body of literature maintains that riparian reserves are infrequently conserved, a knowledge gap exists on how their status may be assessed through a triangulation of spatial and temporal approaches. Goal and Objectives: This study, therefore, sought to investigate through geospatial analysis the extent to which riparian reserves in Kenya were conserved as provided for under the legislation. The study area covered sections of Rivers Nyakomisaro and Nyanchwa which flows through Kisii town. Methodology: A case study research design was adopted to query the extent to which the standard that regulates riparian reserves was complied with along the two rivers. Geospatial data were collected using Google Earth images for the years 2005, 2011 and 2021 and analyzed using GIS. Results: Results showed that in 2005, 26% of the riparian reserves had been intruded by eucalyptus trees which are known to deplete water resources. This correspondingly increased to 28% and 29% in 2011 and 2021. Land under cultivation and short vegetation in 2005 covered 53%, 51% in 2011 and declined to 41% in 2021. Built-up land covered 21% in 2005 but increased to 22% in 2011 and 29% in 2021. Built-up land recorded the highest intrusion into the riparian reserves as evidenced by an increase of 8% between 2005 and 2021. The study concludes that intrusion into the riparian reserves in the study area continues unabated due to insufficient development control, the absence of a common legislative framework, and a lack of monitoring to determine the magnitude of land-use change that is shaping the riparian reserves.

Guava (Psidium guajava) is a minor fruit in Kenya. The fruit exists in various flesh colours. There is, however, limited information on the influence of flesh colour on guava fruit morphological characteristics. Such information would be vital for processing of the fruit into various products and also form a basis for future breeding programmes. The objective of this study was to investigate the effect of guava fruit flesh colour on fruit morphological characteristics. The study was conducted in three subcounties, which are situated in different agro ecological zones; Wundanyi (Upper midland zone), Mwatate (Lower midland) and Voi (Inner lowland) in Taita Taveta County of Kenya. The various flesh colours domesticated include; red fleshed, white fleshed, pink fleshed and strawberry guava. Majority of the fruits sampled in Wundanyi were white fleshed (20%); while those sampled in Mwatate were red fleshed (29%). Strawberry guava recorded the least (3%). Strawberry guava differed significantly from white, pink and red fleshed in Mwatate and Voi regions recording the lowest values in fruit width, length, weight, endocarp thickness, pericarp thickness and number of seeds. Highest fruit weight was recorded by pink fleshed fruit (84.5 g) from Mwatate region; while the lowest 3.8 g was recorded by strawberry guava from Voi region. These variations are essential for future guava improvement programmes, targeting fruits for fresh consumption and industrial processing as well. Overall, red fleshed guava is fleshier and less seeded compared to the white and pink fleshed guavas thus more suitable for consumption both as a fresh fruit and making processed products. [ABSTRACT FROM AUTHOR]

Résumé: Si les plateformes ont donné du travail à beaucoup d'Africains, les emplois créés sont de mauvaise qualité, comme la pandémie l'a bien montré. Dans ce contexte, les auteurs examinent la situation particulière des chauffeurs VTC en Afrique en s'appuyant sur des entretiens approfondis, réalisés au Kenya, et sur les méthodes de l'ethnographie virtuelle. Ils montrent que ces travailleurs ont recours à un «régime de débrouille», associant résilience, réajustement et résistance. Pour améliorer les conditions de travail et lutter contre la précarité dans le secteur, il faut à la fois que les pouvoirs publics instaurent des cadres réglementaires et que les travailleurs se mobilisent collectivement. [ABSTRACT FROM AUTHOR]

The global textile & apparel industry is undergoing rapid change driven by fast fashion trends, shift of consumer preferences towards eco-products and intensified environmental and social welfare-motivated regulations. A comprehensive survey was undertaken to determine the baseline status of the uptake of sustainability practices and compliance requirements for the textile and apparel sector in Kenya. The primary objective is to assess the circular economy readiness, identify existing resource efficiency and cleaner production practices and identify barriers and opportunities that if implemented will enable the sector to effectively transition to green and circular economy status characterized with high productivity and competitiveness. The survey covered a total of 12 carefully selected textile and apparel manufacturers in Kenya. Data was collected using semi-structured questionnaires, face-to-face interviews and detailed in-plant assessments were undertaken to verify the authenticity of the provided data. The investigation revealed a high degree of variability among the companies in resource use efficiency and circular transition readiness. The survey recommends the integration of sustainability principles at all stages of the value chain to include sustainable procurement and interactive database enabled textile platforms that aid the monitoring, evaluation and research on how different textile waste streams can be diverted from the landfill.

In Kenya and sub-Saharan Africa more broadly, decentralised solar electrification solutions hold out the promise of local development that both respects the environment and creates jobs. By examining the maintenance, repair, and recycling of photovoltaic solar equipment, this article compares these hopes to the actual impact of Kenya's solar policy on changes in a sector generally considered to provide local jobs, and with the potential to make a major environmental contribution to a resource-efficient circular economy conducive to recycling and reuse. It starts by showing that Kenya’s strategy of developing a dynamic solar market has had little impact on repair activities. First, because the industry’s dominant companies bypass the fundis (as technicians working in the pre-existing urban repair and recycling economy are called). And second, because repair is marginal to these companies’ business models. It then argues that repair services and know-how are being rendered obsolete by the increasing number of disposable microelectronic components in solar equipment, and looks at the environmental consequences of an industry producing increasing quantities of waste that is unsatisfactorily managed. In the light of these observations, it finally discusses the ambiguities of an electricity policy presented as conducive to a new relocalised green economy.

Research has uncovered substantial gender, social, and health disparities among children and youth in street situations (CYSS) in Eldoret, Kenya. From 2013-2014 we engaged CYSS aged 11-24 years in a qualitative study to explore the sexual language and practices used in the street subculture in Eldoret, Kenya. We engaged 65 CYSS in 25 in-depth interviews and 5 focus group discussions. This work uncovered stark gender inequities, which result in girls and young women in street situations experiencing profound levels of sexual and gender-based violence and harmful sexual and reproductive health outcomes. To comprehend the underlying drivers of these inequities and to appropriately and adequately intervene, we sought to comprehend how CYSS’s social identities intersect with systems of oppression and privilege to produce and maintain these inequities. We therefore sought to reanalyze the original data from this study using intersectionality as a theoretical framework to explore how systems of oppression in Kenya have shaped the street subculture, construct CYSS’s street and resistance social identities, and how these social identities and the street subculture intersect with macro-level structural factors to produce health and gender inequities. Our analysis identified three distinct social identities that are given to CYSS in Eldoret: Chokoraa (garbage pickers), Mshefa (hustlers), and Mboga ya jeshi (vegetables for soldiers). Our findings revealed how these identities and the street subculture intersect with the Patriarchy, the political-economic context, and social cultural forces in Kenya, resulting in hegemonic masculinity and detrimental gender roles and norms for young men and women. Our findings show that CYSS are a product of the oppressive systems that construct their circumstances and shape their social identities. This population urgently requires policies and programs that intervene at multiple levels to halt the harmful practices within street subculture and associated with street-involvement.

Communication could be oral and written. These forms of communication may be formal or informal depending on the setting, people involved, age and class. Codeswitching is an informal form of communication. It is used most at times in oral communication. However, in recent times, its has been used extensively in written communication. This has raised issues as to whether written communication can also be a possible platform for informal communication. This study investigates codeswitching on public signage by Kiswahili –English bilinguals. The study examines how Kiswahili –English bilinguals use the two languages on public signage by structurally analysing how Kiswahili and English words are distributed in a given mixed constituent. To achieve this, Kiswahili-English codeswitched data was gathered from tokens of public signage from Kenya specifically, Nairobi. Using the Matrix Language Frame Model of Myers-Scotton, the study observes that theories propounded for oral codeswitching data could be used to analyse written communication (public signage texts) data because writers adhere to the syntax of both Kiswahili and English as stipulated by the tenets of the Matrix Language Frame Model. This is possible when the aim is to solely look at text items on public signage without keen considerations to the graphics therein that is, if the analysis is based purely on syntax. The study therefore recommends that the importance of codeswitching especially on public signage is evidence of how language is used and as accepted by members of a speech community.

FR. Les médias se font régulièrement l’échos des exploits, sinon des dérives, des athlètes kényan·e·s qui dominent les épreuves de course de fond les plus prestigieuses à travers le monde. Désormais coutumière de cette hégémonie, la presse sportive française commence à l’interroger dès les années 1960, tandis que l’athlétisme est-africain s’affirme au plus haut niveau international, manifestant sa volonté de comprendre et d’expliquer le « phénomène kényan ». L’objet de cet article est de montrer que l’éclosion au plus haut niveau international de l’athlétisme kényan dans la période post-coloniale est appréhendée par les journalistes français selon une rhétorique s’insérant dans un processus postcolonial. S’inscrivant dans le champ des postcolonial studies, cette étude vise à identifier et expliquer les transformations des modalités discursives selon lesquelles les journalistes français couvrent les succès kényans. Bien que le Kenya soit une ancienne colonie britannique, les textes étudiés reflétent la domination culturelle caractéristique de la période coloniale que les journalistes opposent à la domination sportive des athlètes kényan·e·s. Trois revues spécialisées dans l’athlétisme paraissant dans les années 1960, choisies tant par leur réputation que par l’éclectisme de leurs lignes éditoriales, sont analysées : l’Athlétisme, organe de presse officiel de la Fédération française d’athlétisme, Le Miroir de l’athlétisme, revue déclinée du journal Miroir sprint, proche du parti communiste français, et l’Équipe athlétisme magazine, associée au journal l’Équipe. Portant sur l’ensemble du discours, tant son contenu que ses stratégies énonciatives, l’analyse effectuée met en avant le recours par les journalistes français aux modèles rhétoriques utilisés par leurs homologues britanniques à la fin de la période coloniale. Identifiés par John Bale, ces modèles rhétoriques (la surveillance, l’appropriation, la négation et l’idéalisation) s’affirment progressivement à travers quatre étapes chronologiques de 1960 à 2000. La France n’ayant jamais colonisé le Kenya, cette démarche propose donc d’élargir la question postcoloniale aux interactions culturelles entre des pays dépourvus de liens coloniaux. *** EN. Media regularly report on the high performances, as well as the missteps, of Kenyan athletes occupying top places in the most prestigious international long-distance running competitions. If the French sports press has become accustomed to this podium hegemony, a desire to understand and explain the “Kenyan phenomenon” arose in the 1960’s, when East African athletics was gradually asserting itself at the highest levels of competition. The article aims to demonstrate that the narrative developed by French journalists on Kenyan athletics in the decades following African independences is part of rhetorical processes intertwined with postcolonial mechanisms. Embedded in the field of postcolonial studies, the research aims to identify and explain the evolution of discursive modalities used by French journalists to cover Kenyan sporting successes. Despite Kenya being a former British colony, specific characteristics appear in the analyzed text corpus and highlight how French journalists perpetuate cultural domination mechanisms, which sit in contrast with the sporting preeminence of Kenyan athletes. Three magazines published in the 1960s and specialized in the field of athletics were selected for the research, based on their reputation and the eclecticism of their editorial lines: L'Athlétisme, published by the French Athletics Federation ; Le Miroir de l'athlétisme, a magazine based on the Miroir sprint, known to be close to the French Communist Party ; and l'Équipe athlétisme magazine, a spin-off edition from the newspaper l'Équipe. The analysis of the discourse, from both content and enunciative strategies perspectives, highlights how French journalists resort to rhetorical models used by their British counterparts during the same period. Identified by John Bale, the models include surveillance, appropriation, negation and idealization, and appear chronologically in the press in four stages, from 1960 to 2000. Since Kenya was never under French colonial rule, the article suggests to broaden the postcolonial discussion to cultural interactions between countries without colonial ties. *** PT. Os meios de comunicação informam regularmente sobre as façanhas, senão os desvios, dos atletas quenianos que dominam os eventos de corrida de longa distância de maior prestígio em todo o mundo. Já habituada a esta hegemonia, a imprensa desportiva francesa passou a questioná-la nos anos 1960, enquanto o atletismo da África Oriental se afirmava ao mais alto nível internacional, demonstrando o seu desejo de compreender e explicar o “fenômeno queniano”. O objetivo deste artigo é mostrar que a emergência do atletismo queniano no mais alto nível internacional no período pós-colonial é entendida pelos jornalistas franceses como uma parte retórica de um processo pós-colonial. Inserido no campo dos estudos pós-coloniais, este estudo visa identificar e explicar as transformações das modalidades discursivas segundo as quais os jornalistas franceses cobrem os sucessos quenianos. Embora o Quênia seja uma ex-colônia britânica, os textos estudados refletem a dominação cultural característica do período colonial que os jornalistas opõem à dominação esportiva dos atletas quenianos. Três revistas especializadas em atletismo surgidas na década de 1960, escolhidas tanto por sua reputação quanto pelo ecletismo de suas linhas editoriais, são analisadas: Athletics, órgão oficial de imprensa da Federação Francesa de Atletismo, Le Miroir de athletics, resenha da revista Miroir sprint, próxima ao Partido Comunista Francês, e a revista de atletismo Équipe, associada ao jornal L'Équipe. Abrangendo todo o discurso, tanto o seu conteúdo como as suas estratégias enunciativas, a análise realizada destaca a utilização pelos jornalistas franceses dos modelos retóricos utilizados pelos seus congêneres britânicos no final do período colonial. Identificados por John Bale, esses modelos retóricos (vigilância, apropriação, negação e idealização) afirmam-se gradativamente por meio de quatro estágios cronológicos de 1960 a 2000. Como a França nunca colonizou o Quênia, esta abordagem propõe, portanto, estender a questão pós-colonial às interações culturais entre países desprovidos de laços coloniais. ***

Copyright of Politique Africaine is the property of Karthala Editions Diffusion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Decentralized solar electrification solutions hold out the hope, in Kenya as well as more broadly in sub-Saharan Africa, of local development respecting the environment and creating jobs. By focusing on the maintenance, repair and recycling of solar photovoltaic equipment, the article compares these expectations with the effects of Kenya's solar policy on the evolution of a sector that is generally considered to provide local employment and whose environmental contribution to a resource-efficient circular economy, conducive to recycling and reuse, is potentially important. First, it shows that the Kenyan strategy of developing a dynamic solar market has little effect on repair activities: on the one hand, the fundis, artisans of a pre-existing urban economy of repair and recycling, are bypassed by the sector's dominant companies; on the other hand, repair occupies a marginal place in the business models of these companies. It then underlines that repair services and know-how are progressively rendered obsolete by the increasing integration of disposable microelectronic components in solar equipment, and questions the environmental consequences of an industry producing increasing quantities of waste in a context where their management remains problematic. In light of these observations, it finally discusses the ambiguities of an electrical policy presented as favorable to the emergence of a new relocalized green economy.

East African floriculture is highly dependent on the European market, which has absorbed rapidly increasing volumes over the past twenty years. Kenya is the leading producer of cut flowers, ahead of Ethiopia, while the other countries in the region are much more marginal. The development of this export sector relies on a logistical organization that guarantees an appropriate access time for this perishable and fragile product by air. The Covid-19 pandemic and the mobility restrictions imposed in the main importing countries have suddenly disrupted the industry and deprived thousands of workers of their jobs. After the shock of the first wave in the spring of 2020, the sector has gradually recovered thanks to the conversion of several passenger planes and the more systematic use of specialized freight companies, whose role has never been so vital to the flower industry. Beyond its cyclical dimension, the pandemic highlights fundamental issues that the players will have to address to ensure the sustainability of this activity.

The cut rose sector is a major component of Kenya’s integration into the global economy. This intensive greenhouse production, born of foreign capital investment, is trying to adapt to recent changes in the global economy and to take advantage of the new opportunities offered by this market. The productive changes underway primarily concern the diversification of varieties and the upmarket production of the Kenyan cluster. They also reveal new interactions between producers and breeders. In addition, this export-based production model must now face new challenges in connection with the affirmation, within the main importing countries, of a capitalism of attention focused on ethical and environmental issues. This context is prompting Kenyan producers to reduce their historical dependence on Europe, and in particular the Netherlands, by focusing on new marketing methods and diversifying their commercial outlets.

Rosiculture and its international related trade are driving logistical innovation and leveraging long-standing interdependencies between floriculture, transport and logistics. The objective of this article is to point out, through the rose consumption supply chain in Europe, that the requirements of the rose sector induce upheavals and innovations within the associated supply chain. These requirements have a specific spatial nature which justifies a geographical analysis of the supply chain evolution: the interrelationships between floriculture and logistics generate neighborghood and distance effects, change of scale, but also spatial concentration effects, space consumption, fluidity, or even impermeability. These spatial recompositions can be read both at the scale of the global supply chain, from greenhouses to consumer markets, and at the scale of the different supply chain’s locations and nodes : the farm pack house, Jomo Kenyatta Airport in Nairobi or even the logistics complex articulated between Amsterdam-Schiphol Airport and the Royal Flora Holland auctions in Aalsmeer.

The commodification and patrimonialization of nature have often been studied separately or considered as contradictory. Following research that highlights the combination of these social logics in tension, this article questions their intertwining by focusing on a seemingly innocuous ornamental plant : the rose intended for bouquets. The paper focuses on the process of creation, which is less studied than that of production or preservation, in order to analyse the characteristics of the new varieties, commercial objects with symbolic values and codified uses. Based on empirical data, the article shows the evolution of cut roses bred in Europe and produced in Kenya, by tracing the partial diffusion of the aesthetic of pseudo-ancient varieties. It shows how the intertwining of market and heritage logics, materialised in the aesthetics of a plant, shed light on the dynamics of a globalised production sector.

This research aims to analyse the construction of enemy states in the social and political consciousness of post-colonial Somalia. After independence, Somalia defended an irredentist project that sought to unify the populations of Italian Somalia, British Somaliland, the Ogaden and Ethiopian Haud, Djibouti and the North Frontier District of Kenya. This study is based on the idea that national cohesion as such did not exist in Somalia due to the clannish nature of pre-1960 Somali societies. Therefore, both Kenya and Ethiopia ended up being built as enemies. Throughout this research, we will analyse how the creation of external enemies was used as an internal cohesion strategy in the Somali state and to what extent this policy worked. The methodology will be based on a review of the literature and then further investigated through political speeches, official documentation, and newspaper sources.

Kenya’s constitution of 2010 provides for recognition, protection, and registration of community land. This is significant because it recognizes customary tenure after decades of historical bias towards private property and brings to the fore the uniqueness of the African commons. We revisit the debate on managing communal land by reviewing the process of implementation of the Community Land. The paper is based on a review of the legal framework, discussions on the implementation of the Community Land Act and authors interaction with communities through workshops. It concludes that while the Act promises greater protection for commons, implementation challenges continue to hinder realization of the promised rights and benefits. Procedural uncertainty in the implementation process, tension in the formalization of customary tenure and institutional overlaps are identified as key bottlenecks in the process. The paper argues that laws should be aligned to community systems and practices to achieve best results.

In response to the rise in extremist violence within Kenya, the Strengthening Resilience to Violent Extremism Programme was launched to counter the threat of violent extremism (VE) and prevent the radicalisation and recruitment of vulnerable youth. To assess the extent to which the Programme was able to achieve its objective, an evaluation of the Programme's key component – a mentoring and counselling-based project intervention, was conducted between 2017-19. In total, 347 youth, identified as being 'at risk', were included as part of the evaluation. This paper presents the principal findings of the evaluation and assesses the effect of the intervention on three key dimensions: the youth's attitudes, their social networks and levels of awareness of the risks of VE and the strategies for countering violent extremist activities. Using logit models and controlling for any confounding effects of socio-demographic differences, the evaluation finds evidence of improvements in the at-risk groups' knowledge of the risks posed by VE groups as well as the strategies for countering VE. However, mixed results were noted in the groups' attitudes towards violence, their levels of self-confidence and the extent and diversity of their social networks. Across two of the dimensions, more significant effects were also observed among 'at-risk' groups who were employed versus those who were unemployed. Some variability in outcomes was also found among at-risk groups who had been exposed to the intervention for longer compared to those who had been in the Project for shorter periods. Taken together, these findings underscore the need for extending the Project's existing engagements and incorporating a nuanced and sustained approach for engendering more long-term change. The analytical insights presented also offer critical lessons for designing and implementing similar interventions in Kenya and in the wider global context.

This study seeks to contribute to filling the prevailing research deficit in empirical data informed by Foreign Terrorist Fighters (FTFs) and their experiences of, and challenges in, reintegration, through qualitative interviews with returning FTFs in Kwale County, Kenya; a county producing a relative majority of Kenyan recruits to Al Shabaab, who are offered amnesty upon return to their county of origin. The Life Psychology framework, which assumes an inherent human strive to obtain a good life, i.e. life embeddedness, is adopted for the analysis. The study finds that returnees commit to reintegration in the absence of other alternatives, due to economic incentives and longing for acceptance. It confirms that the process requires the societal motivation in facilitation, but will fail without the sustained commitment of the returning FTF. The study further establishes that returning FTFs are not able to obtain a flow in life embeddedness, which would indicate inability to reintegrate. Yet, many of the interviewed returning FTFs express the contrary, which challenges the concept of life embeddedness as an indicator for reintegration. The study further challenges the general assumption that deradicalization is a precondition for reintegration, as it finds that radicalized individuals are able to reintegrate into communities of origin without deserting held radical beliefs, if those communities share radical sentiments.

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During their community oriented primary care (COPC) rotation in rural coastal Kenya, residents of the Family Medicine programme at the Aga Khan University–Nairobi, identified a high burden of upper respiratory tract infections (URTI) in the dispensaries with high prescription of antimicrobials (AMs) in over 80% of the patients presenting with URTI. An interactive participatory education intervention, designed based on principles of community participation and capacity building, reduced AM prescription in the under 5-year age group with 44% in the 2 weeks after the intervention, and with 18% at week 8 and 9. In the over 5-year age group, this was reduced with 18% and 8%, respectively. Key challenges for upholding AM stewardship after the intervention included the high patient workload in the clinics, difficulties in addressing patient’s concerns regarding the prognosis, inaccessibility to ingredients for home therapies, and easy availability of AMs without prescription at local chemists. Interventions addressing improper prescription at the facility level should include provision of continuous training, including communication training, for health facility staff, as well as audits on prescription practices. Collaboration with Community Health Volunteers (CHVs) can help in increasing community awareness on antimicrobial resistance (AMR). This study demonstrates the value of family physicians in clinical governance and improving the quality of care through implementation of guidelines and training. Joint action with the Kilifi county Ministry of Health and the private sector is needed to address mal-regulated access to AMs beyond health facility control.

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The article examines the results of the Commission of Inquiry into the Illegal/Irregular Allocation of Public Land related to the case study of the Mau forest (Rift Valley region). The Commission’s work (2002-05) has brought to light the close link between land and political patronage, illustrating how land allocation has been used by the political, judicial and military élite to pursue their own political and personal interests. The paper aims to reflect on the effects of the Ndung’u Commission Report in the south-western region of the Mau forest; in particular, it analyses the process of “degazettement” that in the period of democratic transition (1991-2002) led to the conversion of large portions of forest into agricultural land.

The accelerated exploration of sub-surface mineral resources across much of Africa has created the need for proper administration of sub-surface land rights. The trend world-wide is a separate cadastre for mining. The reasons advanced for this separation are: the relatively short-term (issued as leases) nature of the mining rights, the mining laws relate exclusively to the right of exploiting minerals and are not modifying the property right; the boundaries of these rights are not linked to the limits of the "property" rights; the need for independence of decision regarding minerals and mining. The link between the mining and surface property cadastre is established during the application process of the mining license, the consent from the owners of the surface land rights is required. The land in question is then identified in relation to the cadastral coordinates defining the mineral right area and this information is kept in the mining cadastre.

Focused Antenatal Care (FANC) is crucial to improving maternal and infant health. Despite the Government of Kenya' efforts to reduce maternal and neonatal morbidities and mortalities, these conditions prevail in Murunga. The current study examined how individual, organizational, and policy factors influence the utilization of focused antenatal care services amongst women in the Gatanga sub-county, Murang'a County, Kenya. The cross-sectional survey data was collected between June and July 2019 from three sampled wards. A structured questionnaire was administered to 334 women of reproductive age, aged 18 years and above, who delivered within the past one year or above 38 weeks of gestation. Descriptive statistics and chi-square tests at a 5% level of significance were done using SPSS version 22. The findings indicated that 37.3% of respondents do not utilize FANC services. Level of education (X2 (3) = 16.05; p = 0.05), occupation (X2 (3) = 16.50; p = 0.05), level of income (X2 (4) = 15.53; p = 0.05), time taken to the facility (X2 (3) = 34.72; p = 0.05), and waiting time (X2 (3) = 14.17; p = 0.05) were found to significantly influence utilization of FANC services. Therefore, women should be empowered through education and economic activities to remain financially independent. The government should also improve access to health care, especially in rural areas, by building new health facilities to improve the utilization of FANC services. Besides, more health care providers should be employed to reduce the waiting time at the facility.

INTRODUCTION: This study assessed the availability of Family Planning (FP) services in the social franchise and non-franchise private health facilities in Kajiado County, Kenya. Social franchises refer to a standardized delivery model of engaging private health facilities under a common brand name/contractual arrangement. METHODS: This was a facility-based mixed-method approach. Quantitative data was collected through 581 FP client exit interviews and a facility inventory in 32 health facilities. Association between the clients´ characteristics and use of FP services was tested using univariable and multivariable logistic regression. Qualitative data were collected through five focus group discussions with FP clients and 16 key informant interviews with service providers and analysed through thematic analysis. RESULTS: The findings show that FP methods availability was the same across all facilities (p = 0.206). The findings were supported by views from the clients who indicated that contraceptives were available. Statistically significant predictors of FP use were found to be women’s age group 20-24 years (Adjusted Odds Ratio (AOR) = 2.30, 95% Confidence Interval (CI): 1.12, 4.69) or 25 to 34 years (AOR = 2.10, 95% CI: 1.86, 2.36) versus the 15-19 years and the clients with tertiary level education and above compared primary level education and below (AOR = 0.020, 95% CI: 1.13, 4.41). CONCLUSION: This study demonstrates the need to support all private health facilities with policies and supplies to expand access to all FP services, especially for adolescents.

In Kenya, employment rates for persons with disabilities are very low and those with psychosocial disabilities have even more dismal rates of employment. This situation has negative impact on the individual’s recovery, quality of life, mental and physical health. The systemic exclusion of persons with psychosocial disabilities in work and employment disproportionately affects women. The aim of this study is to test the feasibility of disability inclusion training to improve work and employment opportunities for women with psychosocial disabilities in Tana River County, Kenya. The study will adopt a mixed methods research design using action research approach. A sample of women with psychosocial disabilities will be trained using a researcher designed disability inclusion training manual, while employers and other stakeholders will be trained on inclusive employment. Trainings will be tailored to suit different employers and for different types of psychosocial disabilities. Interactive learning and linking sessions involving the two groups and process evaluations will be conducted at different time points to measure the impact of the intervention. Findings from this pilot study will inform future research on work and employability programs for rural women with psychosocial disabilities. The study protocol was approved by Maseno University Ethics Review Committee (MUERC/00851/20). Findings from this study will be disseminated through conference presentations and scientific publications in peer reviewed journals.

The Kenya National Archives in Nairobi hosts a large collection of photos of British refugee camps taken during the Italian occupation of Ethiopia. This brief overview of the collection does not endeavour to analyse this little-known aspect of Ethiopian history but to introduce the photo collection as a possible tool to assess the history of migration and refuge in this part of the world.

INTRODUCTION: During the storage of transfusion blood, it may undergo a series of cellular changes that in speculation could be the reason behind the risk of using prolonged stored blood. It´s important therefore to monitor the cellular changes that may reduce its survival and function. The objective was to assess the cellular changes in whole blood stored for transfusion at Bungoma county referral hospital. METHODS: A single center, prospective and observational study design involving 20 randomly selected donor blood units in citrate phosphate dextrose adenine (CPDA-1) anticoagulant was employed, cellular changes were evaluated for 35 days. The changes were tested using the Celtac F Haematology analyzer. Statistical Analysis of variance was employed in the descriptive statistics. All the investigation was executed using statistical package for social sciences (SPSS V.23). Results were regarded as significant at P=0.05. Results were presented in tables and charts. RESULTS: At the end of the 35 days blood storage at blood bank conditions , WBC, RBC, platelets counts and MCHC decreased significantly (P=0.0001, =0.0182, 0.0001,=0.0035). The MCV, HCT and MCH increased significantly (P=0.0003, =0.0115) while HGB had insignificant variance (P =0.4185). CONCLUSION: Platelets, WBC, RBC counts, and indices are significantly altered in stored blood especially when stored over two weeks based on most of the cellular components analyzed in this study. The study, therefore, recommends the utilization of fresh blood to avoid the adverse outcome of cellular changes of reserved blood.

INTRODUCTION: Anthrax is endemic in some parts of Kenya causing mortalities in livestock and morbidity in humans. On January 20, 2018, news media reported suspected anthrax in a remote southern Kenyan village after villagers became ill following consumption of meat from a dead cow that was confirmed, by microscopy, to have died of anthrax. We assessed community knowledge, attitude and practices (KAP) to identify intervention gaps for anthrax prevention. METHODS: we conducted a KAP survey in randomly selected households (HHs) in villages from selected wards. Using multi-stage sampling approach, we administered structured questionnaire to persons aged ≥15 years to collect KAP information from February 11-21, 2018. From a set of questions for KAP, we scored participants’ response as “1” for a correct response and “0” for an incorrect response. Univariate analysis and Chi-square tests were performed to explore determinants of KAP. Concurrently, we gathered qualitative data using interview guides for thematic areas on anthrax KAP from key informant interviews and focus group discussions. Qualitative data were transcribed in Ms Word and analyzed along themes by content analysis. RESULTS: among 334 respondents: 187/334 (56%) were male; mean age, 40.7±13.6 years; 331/334 (99.1%) had heard of anthrax and 304/331(91.8%) knew anthrax to be zoonotic. Transmission was considered to be through eating dead-carcasses by 273/331 (82.5%) and through contact with infected tissue by 213/331 (64.4%). About 59% (194/329) regularly vaccinated their livestock against anthrax, 53.0% (174/328) had slaughtered or skinned a dead-animal and 59.5% (195/328) practiced home slaughter while 52.9% (172/325) treated sick-animals by themselves. Sex (p=0.001), age (p=0.007) and livestock-rearing years (p=0.001) were significantly associated with knowledge and practice. CONCLUSION: there were differences in knowledge and practices towards anthrax by age-group and sex. Enhanced public health education and targeted interventions by relevant government agencies is recommended.

INTRODUCTION: Delayed diagnosis of Mycobacterium tuberculosis infection leads to accelerated individual to individual transmission. This study evaluated this aspect of delayed diagnosis among patients visiting Isiolo level four hospital in northern Kenya. METHODS: this was a cross-sectional cohort study conducted during January, 2018-January, 2019 with systematically sampled 172 tuberculosis(TB) patients. Epidemiological and clinical characteristics were abstracted from records to serve as independent variables. Outcome variable was delayed diagnosis dichotomised into less than 21 or greater than 21 days and treated as a binary outcome. Pre-tested interviewer-administered questionnaires, focused group discussions, and key informant interview guides were used to collect relevant information. RESULTS: most (n=89, 57.8%) of the TB diagnosis fell in the category of 21 day delay. Overall, among all patients, delay in days constituted a median of 27.6, a mean of 37.3 ± 57 days (range 0-414 days). Factors associated with delayed diagnosis (happening 21 days)included(i) use of dispensary and private health facilities, (OR=4.3, 95% CI: 1.44,13.14; P=0.009) and (OR= 4.9, 95% CI: 1.64, 14.73; P=0.004), respectively (ii) Self-employed individuals (OR=21.7, 95% CI: 2.47,190.93; P=0.006) and employed individuals (OR=9.9, 95% CI: 1.14, 85.80; P=0.038) (iii) Secondary-level education (OR=0.03, 95% CI: 0.01,0.21; P=0.000) and tertiary education (OR=0.033, 95% CI: 0.01, 0.23; P=0.001). CONCLUSION: delayed diagnosis of Tb was found to be associated with health-seeking behaviour of TB patients, proxied by diagnosis facility, occupation, and education levels in our study area. Curtailment of local transmission of M. tuberculosis needs intensified health promotion and education in affected communities complemented with active case findings.

Background: Multiple drug resistance has become a major threat to the treatment of cholera. Recent studies in Kenya have described the epidemiology, especially the risk factors, of cholera; however, there is little information on the phenotypic and drug susceptibility patterns of Vibrio cholerae (V. cholerae) in outbreaks that in the recent past have occurred in western Kenya. Aim: To characterise and determine the antibiotics’ susceptibility profiling of toxigenic V. cholerae isolates from Kisumu County. Setting: The project was conducted in Kisumu County, Kenya. Methods: A total of 119 V. cholerae O1, biotype El Tor, isolates collected during 2017 cholera outbreak in Kisumu County were used for this study. The samples were cultured on thiosulphate-citrate-bile salts sucrose (TCBS) agar and biochemical tests were carried out using standard procedures. Susceptibility tests were conducted by using various conventional antibiotics against standard procedures. Results: Of the 119 isolates, 101 were confirmed to be V. cholerae belonging to serotypes Inaba and Ogawa, with Inaba being the predominant serotype (73.95%). The isolates were susceptible to ciprofloxacin (100%), ofloxacin (100%), gentamycin (100%), doxycycline (99%), ceftriaxone (99%) and streptomycin (96.04%) antimicrobials, and resistant to erythromycin (53.47%), amoxicillin (64.4%), nalidixic acid (83.2%) and ampicillin (89.11%), with high resistance to cotrimoxazole (99%) and tetracycline (97%). Conclusion: Vibrio cholerae was resistant to multiple antibiotics, including those commonly used in the management of cholera. Taken together, there is a need to carry out regular surveillance on antimicrobial drug resistance during outbreaks.

INTRODUCTION: There is scarcity of published data on blood pressure (BP) management patterns in rural health facilities in resource constrained settings. The objective was, therefore, to characterize the hypertension management patterns among adult hypertensive outpatients in a sub-county hospital in Kenya. METHODS: cross-sectional study was undertaken among 167 adult patients undergoing hypertension management in Murang´a sub-county hospital in central Kenya. Patients´ sociodemographic characteristics and lifestyles activities were obtained through face-to-face interviews. The level of BP and details of antihypertensive drugs prescribed were acquired from medical files. Statistical associations between adequacy of BP control and sociodemographics as well as management patterns were computed at p=0.05 using STATA® version 14 software. RESULTS: adequate blood pressure control was achieved by 40.7% patients. Renin inhibitors (81.5%) and thiazide diuretics (74.3%) were the most prescribed antihypertensive agents, with enalapril-hydrochlorothiazide combination being the preferred dual therapy (34.0%). Adequate BP control was significantly associated with restriction of salt and red meat consumption (p=0.001), living with hypertension for less than five years and use of 2 antihypertensives (p=0.05). Patients who restricted salt intake were 2.92 times more likely to have their BP controlled compared to those who did not (AOR=2.92, 95% CI=0.96-8.80), p=0.058) while prescription of a three or more-drug combination reduced the likelihood of BP control by 14% (AOR=0.86, 95% CI=0.69-1.07, p=0.176). CONCLUSION: there was poor overall BP control rate among adult outpatients in Murang´a sub-county hospital. Clinicians should use the fewest number of antihypertensive pharmacotherapies and encourage hypertensive patients to continually engage in lifestyle activities.

INTRODUCTION: Non-communicable diseases (NCDs) are projected to become the leading cause of death in Africa by 2030. Gender and socio-economic differences influence the prevalence of NCDs and their risk factors.. METHODS: we performed a secondary analysis of the STEPS 2015 data to determine prevalence and correlation between diabetes, hypertension, harmful alcohol use, smoking, obesity and injuries across age, gender, residence and socio-economic strata.. RESULTS: tobacco use prevalence was 13.5% (males 19.9%, females 0.9%, p=0.001); harmful alcohol use was 12.6% (males 18.1%, females 2.2%, p=0.001); central obesity was 27.9% (females 49.5%, males 32.9%, p=0.017); type 2 diabetes prevalence 3.1% (males 2.0%, females 2.8%, p=0.048); elevated blood pressure prevalence was 23.8% (males 25.1%, females 22.6%, p=0.001), non-use of helmets 72.8% (males 89.5%, females 56.0%, p=0.031) and seat belts non-use 67.9% (males 79.8%, females 56.0%, p=0.027). Respondents with 12 years of formal education had higher prevalence of non-use of helmets (81.7% versus 54.1%, p=0.03) and seat belts (73.0% versus 53.9%, p=0.039). Respondents in the highest wealth quintile had higher prevalence of type II diabetes compared with those in the lowest (5.2% versus 1.6%,p=0.008). Rural dwellers had 35% less odds of tobacco use (aOR 0.65, 95% CI 0.49, 0.86) compared with urban dwellers, those with 12 years of formal education had 89% less odds of tobacco use (aOR 0.11, 95% CI 0.07, 0.17) compared with 12 years, and those belonging to the wealthiest quintile had 64% higher odds of unhealthy diets (aOR 1.64, 95% CI 1.26, 2.14). Only 44% of respondents with type II diabetes and 16% with hypertension were aware of their diagnosis. CONCLUSION: prevalence of NCD risk factors is high in Kenya and varies across socio-demographic attributes. Socio-demographic considerations should form part of multi-sectoral, integrated approach to reduce the NCD burden in Kenya.

INTRODUCTION: Western region of Kenya has high early childhood mortality and maternal mortality. Maternal services have been shown to an effective strategy for reducing early childhood mortality and maternal mortality. METHODS: the study used data drawn from the 2014 Kenya Demography and Health Survey. It focuses on 1397 women who had a live birth in the five years preceding the survey. The study is guided by Anderson behavioural model. Descriptive statistics and logistic regression are used to analysis the data. RESULTS: almost all the women sought ANC care services during their most recent pregnancy. Only 20% of the women initiated ANC visits during the first trimester and 54% of the women made at least four ANC visits. Mother’s education, household wealth index, county of residence and the timing of ANC visits were strongly associated with making at least four ANC visits. About 55% of the women had skilled attendance at delivery and 54% delivered in a health facility. Delivery in a health facility was influenced by the mother’s education, household wealth index, type of place of residence, county of residence, timing of ANC visits and whether or not a women made at least four ANC visits. CONCLUSION: the uptake of ANC services is universal in the region. However majority of the women do not start ANC visits early and do not make at least four ANC visits as recommended. Slightly over half of the women receive skilled attendance at delivery and deliver in health facilities. A number of factors are closely associated with the uptake of maternal services in the region. Concerted efforts should be made to have the majority of the women in the region to initiate ANC visits early, to make at least 4 ANC visits and to deliver in health facilities.

The Luo are a Nilotic people living in western Kenya, north-eastern Tanzania and in western Uganda. Their language, Dholuo, forms part of the Western Nilotic group of languages. This article presents the traditional kincepts (kinship terminology) of the Luo people as described by elders living in Central Sakwa location, Siaya County, western part of Kenya. The kincepts for consanguine as well as affine relatives in up to three ascending and five descending generations are described. The paper applies a combined linguistic and anthropological approach. Linguistically, the terms are analysed in relation to current Dholuo vocabulary, grammar and modes of expression. Anthropologically, the Luo kinship rules of patrilineality and virilocality are considered. The domain of kincepts is a research field bringing together linguistics, anthropology and history. It contributes to the inquiry of diachronic linguistics, which can provide insights on the development and interaction of related languages as well as population groups’ migratory patterns not least in parts of the world where written historical sources are scarce.

INTRODUCTION: Pregnant women need access to skilled attendance at birth and emergency obstetric care (EmOC) to avert maternal deaths. While poor EmOC services may explain the high maternal mortality, inadequate knowledge of providers is also part of the problem. This forms the basis of this paper, in a setting where 50.2% of women deliver in a health facility but maternal mortality remains high at 531/100,000 live births, compared to the national average of 362/100,000 in Kenya. METHODS: a facility based cross-sectional survey was conducted in 2018 with a set of knowledge questions extracted from the averting maternal death and disability toolkit. Providers knowledge for maternal and newborn health (MNH) was assessed by interviewing nurses on duty in the maternity units. Data were entered in Ms Access and exported to R version 3.6.2 for descriptive and logistic regression analysis. Ethical clearance was obtained from Kenya Medical Research unit. RESULTS: a total of 55 nurses were interviewed. Majority (71%) of the respondents were diploma nurses. The overall knowledge score for MNH among the providers was adequate with a score of (64%). Generally, the midwives and higher diploma nurses consistently scored higher than diploma nurses in all the topic areas of MNH. In the mixed linear regression, determinants of knowledge score were seen in provider-level variables. CONCLUSION: overall, the providers scores were higher on intrapartum and newborn care compared to scores on care for complications. We conclude that in-service training on EmOC to providers is critical to reduction of maternal mortality.

INTRODUCTION: Household Contacts (HHCs) of Pulmonary Tuberculosis (PTB) patients have a higher risk of latent tuberculosis infection (LTBI). However, its prevalence and risk factors among adults living with PTB patients are poorly documented in Kenya. To determine the prevalence and risk factors for LTBI among adult HHCs of PTB patients in Kenya. METHODS: this was an analytical cross-sectional study of HHCs of PTB patients in Nairobi, Kenya. Socio-demographic data was captured on questionnaires and blood samples drawn for Interferon gamma (IFN-γ) quantification. Univariate and multivariate analyses using the Statistical Package for Social Scientists (SPSS) was used to determine the prevalence of LTBI and risk factors at 95% Confidence Interval (CI). RESULTS: a total of 166 PTB patients yielded 175 HHCs of whom 29.7% (52/125) were males and 70.3% (123/125) were females. A majority of HHCs [65.7% (115/175)] lived in a single-room house with the patient and [37.7% (66/175)] were in the age group 30-39-years. The overall prevalence of LTBI was 55.7%, peaking among spouses of the patients [70.0% (14/20) and the 30-39 year age group [63.5% (42/66)]. Potential risk factors for LTBI included cohabiting with a PTB patient for 8 to 12 weeks [OR = 3.6 (0.70-18.5), p = 0.107], being a spouse of the patient [OR = 2.0 (0.72-5.47), p = 0.173] and sharing a single room with the patient [OR = 1.58 (0.84 - 2.97), p = 0.158]. CONCLUSION: the high prevalence of LTBI among adult HHCs of PTB patients in this population demonstrates the need for targeted contact-screening programs in high TB transmission settings.

Background: Family medicine (FM) was introduced in Kenya in 2005. Up to date (August 2019), 42 family physicians have graduated from Kenyan Universities. Aim: The aim of the study was to establish the current state of FM in Kenya and identify areas for more research and actions to support and improve FM in Kenya. Setting: Interviews were conducted at the different work sites of the participants, four of them in hospitals, one at a University and one in a hotel where a FM conference was held. Methods: An online questionnaire (response rate = 56%) and six semi-structured interviews were conducted amongst family physicians who completed their studies in Kenya. However, the focus was on the interviews. Results: Family physicians have different ideas of how FM should look like ideally, but all agree that family physicians should be team leaders of a primary healthcare team, taking care of a defined population. Lack of policies, low numbers of family physicians and the misunderstanding of FM by all stakeholders are the major challenges. Sixty-four percent of the participants work in rural areas, and 77% perceive their current work as FM. Conclusion: Family medicine must be defined and properly promoted. Various areas have been identified that require further research: assessing required number of family physicians, reasons and solutions for the low number of family physicians, funding possibilities, and research the most suitable definition of a Kenyan family physician.

INTRODUCTION: The study aimed to investigate the prevalence and factors associated with underweight and overweight or obesity in an adult population in Kenya. METHODS: data from a cross-sectional nationally representative community-based study in Kenya (N=4283, 18-69 years) conducted in 2015 was utilized. Assessments included anthropometric, interview, blood pressure and biochemistry mesures. Multinomial logistic regression was used to assess the determinants of underweight and overweight or obesity relative to normal weight. RESULTS: in all, 11.9% of the study sample was underweight (BMI 18.5kg/m²), 60.1% had normal weight (BMI 18.5-24.9kg/m²), 18.9% overweight (25.0-29.9kg/m²) and 9.1% obesity (BMI 30.0kg/m²). In adjusted multinomial logistic regression, male sex (adjusted relative risk ratio-ARRR: 1.47, confidence interval-CI: 1.01, 2.13), lower education (ARRR: 0.63, CI: 0.46, 0.88), lower wealth status (ARRR: 0.47, CI: 0.29, 0.78), inadequate fruit and vegetable consumption (ARRR: 1.79, CI: 1.19, 2.70), adding daily sugar into beverages (ARRR: 1.49, CI: 1.01, 2.22) and having no hypertension (ARRR: 0.54, CI: 0.40, 0.74) were associated with underweight. Factors associated with overweight or obesity were middle and older age (ARRR: 2.15, CI: 1.46, 3.80), being female (ARRR: 0.30, CI: 0.22, 0.41), higher education (ARRR: 1.61, CI: 1.26, 2.24), greater wealth (ARRR: 2.38, CI: 1.41, 3.50), being a Kikuyu by ethnic group (ARRR: 1.68, CI: 1.19, 2.37), urban residence (ARRR: 1.45, CI: 1.06, 1.99), no current tobacco use (ARRR: 0.39, CI: 0.24, 0.54), low physical activity (ARRR: 1.49, CI: 1.02, 2.18) and having hypertension (ARRR: 1.96, CI: 1.54, 2.50). CONCLUSION: more than one in ten were underweight and almost three in ten were overweight or obese among adults in Kenya. Several risk factors, including sociodemographic, lifestyle and health status risk variables, were identified for underweight and overweight or obesity, which can assist in developing intervention strategies targeting both these conditions.

INTRODUCTION: In 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. METHODS: we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged 2 years with acute watery diarrhea (4 stools/â12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli. RESULTS: during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). CONCLUSION: we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.