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Campylobacter organisms are the major cause of bacterial gastroenteritis and diarrhoeal illness in man and livestock. Campylobacter is growingly becoming resistant to critically crucial antibiotics; thereby presenting public health challenge. This study aimed at establishing antimicrobial use, susceptibility profiles, and resistance genes in Campylobacter isolates recovered from chicken, cattle, and cattle-trough water samples. The study was conducted between October 2020 and May 2022 and involved the revival of cryopreserved Campylobacter isolates confirmed by PCR from a previous prevalence study in Kajiado County, Kenya. Data on antimicrobial use and animal health-seeking behaviour among livestock owners (from the same farms where sampling was done for the prevalence study) were collected through interview using a pretested semistructured questionnaire. One hundred and three isolates (29 C. coli (16 cattle isolates, 9 chicken isolates, and 4 water isolates) and 74 C. jejuni (38 cattle isolates, 30 chicken isolates, and 6 water isolates)) were assayed for phenotypic antibiotic susceptibility profile using the Kirby–Bauer disk diffusion method for ampicillin (AX), tetracycline (TE), gentamicin (GEN), erythromycin (E), ciprofloxacin (CIP), and nalidixic acid (NA). Furthermore, detection of genes conferring resistance to tetracyclines (tet (O), β-lactams (blaOXA-61), aminoglycosides (aph-3-1), (fluoro)quinolones (gyrA), and multidrug efflux pump (cmeB) encoding resistance to multiple antibiotics was detected by mPCR and confirmed by DNA sequencing. The correlation between antibiotic use and resistance phenotypes was determined using the Pearson’s correlation coefficient (r) method. Tetracyclines, aminoglycosides, and β-lactam-based antibiotics were the most commonly used antimicrobials; with most farms generally reported using antimicrobials in chicken production systems than in cattle. The highest resistance amongst isolates was recorded in ampicillin (100%), followed by tetracycline (97.1%), erythromycin (75.7%), and ciprofloxacin (63.1%). Multidrug resistance (MDR) profile was observed in 99 of 103 (96.1%) isolates; with all the Campylobacter coli isolates displaying MDR. All chicken isolates (39/39, 100%) exhibited multidrug resistance. The AX-TE-E-CIP was the most common MDR pattern at 29.1%. The antibiotic resistance genes were detected as follows: tet (O), gyrA, cmeB, blaOXA-61, and aph-3-1 genes were detected at 93.2%, 61.2%, 54.4%, 36.9%, and 22.3% of all Campylobacter isolates, respectively. The highest correlations were found between tet (O) and tetracycline-resistant phenotypes for C. coli (96.4%) and C. jejuni (95.8%). A moderate level of concordance was observed between the Kirby–Bauer disk diffusion method (phenotypic assay) and PCR (genotypic assay) for tetracycline in both C. coli (kappa coefficient = 0.65) and C. jejuni (kappa coefficient = 0.55). The study discloses relatively high resistance profiles and multidrug resistance to antibiotics of critical importance in humans. The evolution of the multidrug-resistantCampylobacter isolates has been linked to the use and misuse of antimicrobials. This poses a potential hazard to public and animal health, necessitating need to reduce the use of antibiotics in livestock husbandry practice coupled with stringent biosecurity measures to mitigate antimicrobial resistance.

Background: The high maternal and neonatal deaths remain a global concern especially in Low- and Middle-Income Countries. This is largely attributed to the limited skilled workforce including midwives who are required to offer quality maternal and neonatal care. Advanced Practice Midwifery (APM) training has been highlighted as critical in achieving high-quality maternal and neonatal care in all settings and countries. In Kenya, the APM training is at the initial stages, having been launched in May 2022. This paper presents the results of a literature review regarding opportunities and challenges for the APM training and practice with a goal of availing information to any institution willing to begin the program in Kenya and other LMICs. Methodology: A descriptive overview was undertaken through a rapid literature review of the relevant local and international literature to highlight the opportunities and challenges for the APM training and practice based on the Kenyan Context. Results: The APM training and practice has expansive opportunities such as the increased demand for quality care and reduced cost services, supportive policies, advances in technology, profession recognition and regularisation of the training and availability of midwives trained at lower levels. The challenges that the APM training is likely to experience includes; Lack of expert trainers, technological challenges, workload challenges due to the high population in need of the services and clinical environment challenges. Conclusion: APM training and practice has enormous opportunities despite the challenges that may be experienced. Therefore, for any institution preparing to start the APM training, there is need to exploit the existing opportunities and address the likely challenges to ensure the APM training and practice meets the desired outcomes.

Although donor funding has helped to boost the education sector, questions have arisen regarding the sustainability of donor-funded schools. The objective of this study was to investigate the influence of management skills on the sustainability of donor-funded schools in Kiambaa Constituency, Kiambu County, Kenya. Resource Dependency Theory and Agency Theory guided the study. The study employed the descriptive survey design and targeted the population of 122 stakeholders of the White Cottage Schools and the Bridge International Academies comprising 100 parents, 2 managers, and 20 teachers. The systematic sampling method was used to select a sample of 50 parents and 10 teachers while both managers were included in the study sample making a sample size of 62 respondents. Quantitative data were collected from parents using questionnaires, while qualitative data was obtained from the teachers and managers using interview guides. Quantitative data were analyzed using descriptive statistics and the chi-square test, while qualitative data were analyzed using the thematic content analysis technique. Results showed that more than half of the parents believe that their children’s schools would not operate optimally without donor funds. Results further showed that the sustainability of donor-funded primary schools was significantly associated with managerial skills, including creativity, flexibility, and networking. The study concluded that managerial skills are a significant determinant of donor-funded schools' sustainability. The study recommends that school managers improve their creativity, flexibility, and networking skills.

This paper tries to understand the role of assessment in bringing changes in students’ mathematics performance. Quality assessment is a key factor in improving the learning of mathematics. The relationship between learning and assessment is strong and robust. Students learn more in classes where assessment is an integral part of instruction than in those that are not, and brief frequent assessments that provide immediate feedback about learning progress that are more effective than one summative test. Therefore, mathematics teachers should be aware of the roles of assessment, different methods of assessing learners, and the effective assessment practices.

This study sought to determine rehabilitation centre administrators’ preparedness for adequate teaching and learning for effective management of formal education in juvenile centres—the case of Kabete and Dagoretti in Nairobi and Kiambu counties, Kenya. The study used a case study research design. The target population was 144 juvenile delinquents, 13 welfare officers, 18 class teachers and 4 school administrators. The data collection instruments were questionnaires, interview schedules and personal observations piloted at the Shikusa rehabilitation centre in Kakamega. Data were analysed using descriptive statistics using Statistical Package for Social Sciences (SPSS) version 20. The findings showed that the majority of the administrators had no training in leadership and management, the majority of the teachers had not undergone training on curriculum implementation and workshops on improvisation of teaching and learning resources, there were inadequate classrooms and libraries, and none of the centres had all textbooks for all subjects. It is hoped that the findings of the study might be useful to the staff working in the juvenile rehabilitation centres, parents of juvenile delinquents, curriculum developers and the Ministry of Education, science and technology as it reveals the specific factors related to effective management of formal education in the juvenile centres in Kenya.

BackgroundSudden shocks to health systems, such as the COVID-19 pandemic may disrupt health system functions. Health system functions may also influence the health system’s ability to deliver in the face of sudden shocks such as the COVID-19 pandemic. We examined the impact of COVID-19 on the health financing function in Kenya, and how specific health financing arrangements influenced the health systems capacity to deliver services during the COVID-19 pandemic.MethodsWe conducted a cross-sectional study in three purposively selected counties in Kenya using a qualitative approach. We collected data using in-depth interviews (n = 56) and relevant document reviews. We interviewed national level health financing stakeholders, county department of health managers, health facility managers and COVID-19 healthcare workers. We analysed data using a framework approach.ResultsPurchasing arrangements: COVID-19 services were partially subsidized by the national government, exposing individuals to out-of-pocket costs given the high costs of these services. The National Health Insurance Fund (NHIF) adapted its enhanced scheme’s benefit package targeting formal sector groups to include COVID-19 services but did not make any adaptations to its general scheme targeting the less well-off in society. This had potential equity implications. Public Finance Management (PFM) systems: Nationally, PFM processes were adaptable and partly flexible allowing shorter timelines for budget and procurement processes. At county level, PFM systems were partially flexible with some resource reallocation but maintained centralized purchasing arrangements. The flow of funds to counties and health facilities was delayed and the procurement processes were lengthy. Reproductive and child health services: Domestic and donor funds were reallocated towards the pandemic response resulting in postponement of program activities and affected family planning service delivery. Universal Health Coverage (UHC) plans: Prioritization of UHC related activities was negatively impacted due the shift of focus to the pandemic response. Contrarily the strategic investments in the health sector were found to be a beneficial approach in strengthening the health system.ConclusionsStrengthening health systems to improve their resilience to cope with public health emergencies requires substantial investment of financial and non-financial resources. Health financing arrangements are integral in determining the extent of adaptability, flexibility, and responsiveness of health system to COVID-19 and future pandemics.

Myiasis is the infestation of living tissues of animals with dipterous larvae. In Africa, Cordylobia species (C. anthropophaga, C. rodhaini, and C. ruandae) and Dermatobia hominis are reported as the principal cause of nonmigratory cutaneous myiasis of domestic animals. None of these have been reported in dogs in Kenya. A cross-sectional study was conducted in eight subcounties of Kitui County, Kenya, from March to August 2021 to estimate the prevalence, risk factors, and etiological agents associated with canine cutaneous myiasis (CCM). A questionnaire was administered to dog owners to collect information on CCM risk factors. A total of 400 dogs were physically examined and larvae collected from myiasis skin lesions and preserved in 70% ethanol, taken to the laboratory, processed and identified using parasitological morphological features. Live larvae were incubated and emerging adults were captured and identified. The overall prevalence of CCM was 45% (180/400) (95% confidence interval: 40.0–50.0%). A total of 434 larvae were collected from 180 dogs infested with cutaneous myiasis. All larvae (100%) were identified as C. anthropophaga and hatched adults were “tumbu” flies. There were no significant differences in the prevalence of CCM at 95% confidence interval among different age and sex groups ( p > 0.05 ), although puppies ( p < 0.05 ). The CCM occurrence was significantly different among breeds ( p < 0.05 ). Cordylobia anthropophaga larvae were the etiological agent of CCM in Kitui County. There is a need for improved dog housing and hygiene measures to prevent the occurrence of CCM, and affected dogs should be treated to prevent the spread of CCM among the dogs.

To explore the experiences of postnatal mothers with health care providers during postnatal care in rural Kenya.This was a visual-based narrative inquiry study that applied the Mmogo method® - a visual projective data-collection method.The participants were women (n=26) receiving postnatal care at purposively sampled rural health facilities (n=4) in Laikipia County Kenya.Two themes emerged from this study. First, the mothers had positive experiences with health care providers. Secondly, the mothers expressed expectations to enhance future experiences with health care providers.Mothers had positive experiences and various expectations to enhance future experiences with health care providers that related to their postnatal needs. The mothers proposed the possible use of mobile phones by health care providers to meet their health education needs as well as receive psychological support.Health care providers can use mobile phone devices to call and address some of the postnatal needs during the postnatal period.

Background In low and middle-income countries like Kenya, critical care facilities are limited, which means acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors influencing their ability to detect and respond to clinical deterioration. Methods This convergent parallel mixed-methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the patients' vital signs 24 hours before a cardiac arrest (death) occurred was retrieved from patients' medical records. Additionally, in-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards. Results This study reviewed 405 patient records and found that most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 hours prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points. Thematic analysis of the interview data identified five broad themes related to detecting and responding promptly to deterioration. These were insufficient monitoring of vital signs, availability of equipment and supplies, staffing conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers. Conclusion The study showed that nurses did not consistently monitor and record vital signs in the general wards. The nurses worked in suboptimal ward environments characterised by inadequate and malfunctioning monitoring equipment, high workload due to staff shortages, communication and teamwork gaps, and little training on handling patient deterioration at the ward level; factors that negatively impact patient safety and outcomes. The findings provide an opportunity for future research to test interventions to improve nurses' assessment and management of clinical deterioration in general wards.

Marine foods produced by small-scale fishers can make vital contributions to sustainable, healthy food systems with multisectoral considerations of public health nutrition, gender equity, economics, and marine ecology. This pilot study aimed to map the multidimensional determinants of fish food security and young child nutrition in four coastal communities of Kenya with a view toward designing a large intervention trial. We compared anthropometric and dietary diversity indicators of children under 5 years in fishing vs. non-fishing households. Mixed methods included household surveys, 24-h recalls for dietary intake, and anthropometric measures of children. Child dietary diversity score (CDDS) and height-for-age Z (HAZ) were primary outcomes tested in ordinary least square regression modeling. Stunting was widely prevalent (20.2%), as were morbidities for acute diarrhea (29.0%) and fever (46.5%), with no statistically significant differences in fishing compared to non-fishing households. High proportions of children showed nutrient intake inadequacies for vitamins A, C, and E, iron and zinc

Background: Kenya has committed to achieving universal health coverage (UHC) by 2030 and has prioritized purchasing reforms. Enhancing effective provider-purchaser engagements is quintessential to transitioning to strategic purchasing reforms on provider selection or empanelment, benefits package design and provider payments mechanism. This study assessed the challenges hindering effective provider-purchaser engagement in Kenya and proposed actionable solutions to policymakers and actors. Methods: The study applied a cross-sectional qualitative study design. Data was collected using interviews – incorporating both focus group discussions (FGDs), in-depth interviews (IDIs) and a consensus-building workshop with stakeholders representing healthcare providers, medical professional bodies, the National Hospital Insurance Fund (NHIF – at county/branch and national level), health insurance beneficiaries, the Council of Governors (COG) and the ministry of health (MOH). Purposive sampling was employed to select stakeholder representatives for each of the stakeholder clusters. Results: Provider-purchaser challenges were identified to result from 1) human resource gaps (understaffing and staff turnover), 2) infrastructure gaps (both hardware and software), 3) knowledge and skill gaps, and 4) governance issues attributed to bureaucratic processes, poor accountability mechanisms and poor mechanisms of communication between providers and purchasers. Providers and purchasers emphasized the need for 1) automation of processes, 2) review of provider payment mechanisms (PPMs), 3) regular capacity building of providers, 4) effective communication and accountability and 5) development of public-private contracting frameworks as key actionable solutions for implementation. Conclusion: Challenges hindering effective provider-purchaser engagements result largely from human resources, infrastructure, capacity, communication and accountability gaps. Reforms aimed at addressing these gaps must focus on building staff capacity in the payment process , employment or prioritization of staff to the payment process, adoption of information systems or technology to automate processes (both on empanelment and payment) and establishment of working communication channels (both automated and in-person processes) that are regular. Such reforms should be tailored to the stakeholders' actions and monitored to ensure adequate implementation to enhance provider-purchaser engagements.

Lake Magadi is an internally drained, saline and alkaline terminal sump in the southern Kenya Rift. Geochemistry of samples from an ~200 m core representing the past ~1 m.y. of the lake's history shows some of the highest concentrations of transition metals and metalloids ever reported from lacustrine sediment, including redox-sensitive elements molybdenum, arsenic, and vanadium. Elevated concentrations of these elements represent times when the lake's hypolimnion was euxinic—that is, anoxic, saline, and sulfide-rich. Euxinia was common after ca. 700 ka, and after that tended to occur during intervals of high orbital eccentricity. These were likely times when high-frequency hydrologic changes favored repeated episodes of euxinia and sulfide precipitation. High-amplitude environmental fluctuations at peak eccentricity likely impacted water balance in terrestrial habitats and resource availability for early hominins. These are associated with important events in human evolution, including the first appearance of Middle Stone Age technology between ca. 500 and 320 ka in the southern Kenya Rift.

This study evaluated the presence of selected heavy metals in farmed tilapia and catfish) in Nyeri County, Kenya. Live fish comprising of 17 catfish and 33 tilapias were purchased from 15 fish farmers with 31(62%) caught from earthen ponds while 19 (38%) were from liner ponds. The fish were dissected to obtain muscle tissue samples for analysis for levels of lead, mercury and cadmium residues using the Flame Atomic Absorption Spectrometry. Tilapia fish accumulated higher concentrations of lead, mercury and cadmium in the muscles compared to catfish. The difference of lead and mercury ion concentration between fish species was not significant (p>0.05). Fish obtained from earthen ponds recorded a higher mean concentration of the three heavy metals compared to those from liner ponds. Mercury concentration in fish muscles was slightly higher than European Union limits (0.1 Mg/Kg) but lower than codex alimentarius (0.5 Mg/Kg) limits. There is need to continuously monitor levels of heavy metals especially mercury in farmed fish tissues in Nyeri County and other peri-urban areas in Kenya.

Human milk oligosaccharides (HMO), the third most abundant component of human milk, are thought to be important contributors to infant health. Studies have provided evidence that geography, stage of lactation, and Lewis and secretor blood groups are associated with HMO profile. However, little is known about how variation across the genome may influence HMO composition among women in various populations. In this study, we performed genome-wide association analyses of 395 women from 8 countries to identify genetic regions associated with 19 different HMO. Our data support FUT2 as the most significantly associated (P

Understanding thermal gradients is essential for sustainability of built-up ecosystems, biodiversity conservation, and human health. Urbanized environments in the tropics have received little attention on underlying factors and processes governing thermal variability as compared to temperate environments, despite the worsening heat stress exposure from global warming. This study characterized near surface air temperature (NST) and land surface temperature (LST) profiles across Kenyatta University, main campus, located in the peri-urban using in situ traverse temperature measurements and satellite remote sensing methods respectively. The study sought to; (i) find out if the use of fixed and mobile temperature sensors in time-synchronized in situ traverses can yield statistically significant temperature gradients (ΔT) attributable to landscape features, (ii) find out how time of the day influences NST gradients, (iii) determine how NST clusters compare to LST values derived from analysis of ‘cloud-free’ Landsat 8 OLI (Operational Land Imager) satellite image, and (iv) determine how NST and LST values are related to biophysical properties of land cover features.. The Getis–Ord Gi* statistics of ΔT values indicate statistically significant clustering hot and cold spots, especially in the afternoon (3–5 PM). NST ‘hot spots’ and ‘cold spots’ coincide with hot and cold regions of Landsat-based LST map. Ordinary Least Square Regression (OLS) indicate statistically significant (p

Thermophilic

Foundation years or internships are an important period for junior doctors to apply their knowledge and gain clinical competency. Experiences gained during the foundation years or internships are likely to inform newly qualified doctors' opinions about how they want to continue their career. We aimed to understand how medical doctors' internship experiences influence their career intention/decision.We conducted qualitative evidence synthesis using meta-ethnography. We searched six electronic bibliographic databases for papers published between 2000-2020 and included papers exploring how foundation years or internship experiences shape doctors' career intention/decisions, including in relation to migration, public/private/dual practice preference, rural/urban preference, and specialty choice. We used the GRADE-CERQual framework to rate confidence in review findings.We examined 23 papers out of 6085 citations screened. We abstracted three high-level inter-related themes across 14 conceptual categories: (1) Deciding the personal best fit both clinically and in general (which option is 'more me'?) through hands-on and real-life experiences (2) Exploring, experiencing and witnessing workplace norms; and (3) Worrying about the future in terms of job market policies, future training and professional development opportunities. Confidence in findings varied but was rated high in 8 conceptual categories.Our meta-ethnographic review revealed a range of ways in which internship experience shapes medical doctors' career intentions/decisions allowing us to produce a broad conceptual model of this phenomenon. The results highlight the importance of ensuring sufficient, positive and inspiring clinical exposure, improving workplace environment, relationship and culture, refraining from undermining specific specialities and communicating contractual and job market policies early on to young doctors, in order to attract doctors to less popular specialties or work locations where they are most needed. We propose our conceptual model should be further tested in new research across a range of contexts.

Well-defined and accurate climatic indicators are important for evaluating heat stress in dairy cattle. This is imperative for sound management decisions for mitigating production losses. The most popular indicator for heat stress is the temperature humidity index (THI). Other heat stress indicators have been developed but remain largely unexploited. There is, therefore, possibly room to improve the THI and explore new indicators suitable for predicting production losses due to heat stress in dairy cattle. In this study, we apply the degree-day concept to develop temperature humidity index-day (THI-day). We defined the cooling THI-day as the hourly cumulative THI units above the heat stress threshold for milk production traits over the entire day. We then modeled reaction norms for cooling THI-day to analyze the effect of cumulative heat load expressed by THI-day on milk production traits. Milk performance records were from 16,216,145 monthly test-day records for the Fleckvieh breed for the period 2010 to 2019 in southern Bavaria, Germany. Individual cow records were averaged by herd and test-day resulting in 797,455 herd test-day records from 9,726 herds. Weather data for the same period were provided by the German Meteorological Service. Results indicated that cooling THI-day provided significant (p < 0.001) additional information to the conventional THI models. We found out that reaction norm models of average herd milk yield that do not account for the cumulative heat load tend to underestimate the effects of heat stress on milk production traits. Reaction norms modeled with cooling THI-day were more plausible for milk production traits that have a defined heat stress threshold including milk yield, protein yield, and milk urea.

Two cores were recovered from the Lake Magadi and Nasikie Engida Basins in the south Kenya Rift. Core MAG14-2A (194 m) contains a middle Pleistocene to Holocene record, whereas core NAS15/19 (4.36 m) covers only the late Holocene. Surficial sediments from springs and shallow-water sites were sampled in both basins. MAG14-2A rests on trachyte dated at 1.08 Ma. Diatoms are rare in the oldest sediments, but well preserved after about 545 ka, documenting a trend from less to more saline water. Core MAG14-2A contains fifteen facies, five of which are diatomaceous. In contrast, NAS15/19 is dominated by two facies, each containing well-preserved diatoms. Both sequences are distinct from others of similar age in the Kenya Rift in lacking pedogenic horizons, reflecting the location of Lake Magadi and Nasikie Engida in a tectonic sump where aquatic environments were maintained by geothermal and meteoric springs. Canonical Correspondence Analysis distinguishes three assemblages in the modern surface muds of Lake Magadi and Nasikie Engida, but with no pre-Holocene counterparts. Eleven diatom zones are recognised in MAG14-2A: Zones D2 to D10 contain rare to common diatoms dominated by Aulacoseira granulata and its varieties, Aulacoseira agassizii, Thalassiosira faurii, Thalassiosira rudolfi and Cyclotella meneghiniana. Individual samples commonly include a mixture of benthic and planktonic taxa and saline and freshwater species. These assemblages indicate waters that ranged between pH 7.4 and 11.5 with conductivities of ~ 300 to > 25,000 μS cm−1. Correlations with the neighbouring Olorgesailie and Koora Basins indicate four major environmental phases that affected the south Kenya Rift during the last million years with fresh to moderately saline water, or land surfaces, developing during Phase I (1000 to 750 ka). These environments gave way to generally wetter conditions and freshwater lakes in all basins during Phase II (~ 750 to 500 ka). Phase III (~ 500 to 325 ka) was characterised by drier conditions with paleoenvironments becoming more variable and dry during Phase IV (325 ka to present).

Background One in five young children globally suffer the consequences of stunted growth and development and millions experience deficiencies in zinc, iron, iodine, vitamins A and B12, nutrients found bioavailable in fish foods. Small-scale fisheries have the potential to generate income and augment fish consumption while being environmentally sustainable if appropriately managed. However, those engaged in small-scale fisheries are often marginalized, poor, and malnourished. The Samaki Salama project seeks to better understand and address these challenges through a three-arm, longitudinal matched cluster study which evaluates the impact of an integrated nutrition social marketing and modified fishing trap intervention. Methods There will be 400 small-scale fisher households enrolled from Kilifi county, Kenya and residing in communities matched on location (rural), livelihoods, and child nutritional status. The sample will include mothers and other caregivers, children 6–60 months, and fishers in the family. Applying a cluster design, the matched communities will be divided into three groups: (1) control; (2) multi-tiered nutrition social marketing intervention to fishers, mothers, and health workers; and (3) multi-tiered nutrition social marketing intervention plus modified fishing traps and training. Primary outcomes include child growth, fish food intakes, and fisheries yield of mature fish. Secondary outcomes are diet diversity, child diarrheal morbidity, and fisheries revenue. A process evaluation will be used to monitor and ensure fidelity of intervention delivery. Discussion This study builds on a growing body of literature illustrating the effectiveness of nutrition focused social marketing campaigns to promote active engagement of participants, high compliance to the intervention, and sustained behavior change. The second intervention element of modified fishing traps that allow immature fish to escape enables participants to act on the messaging they receive and promotes sustainable fishing through increased harvest efficiency and reduced catch of immature fish. Samaki Salama’s integrated approach provides an example of how to leverage multiple disciplines to address key challenges to human and environmental health and illustrates a pathway for scaling study innovations to other small-scale fisheries systems.

Saline alkaline lakes that precipitate sodium carbonate evaporites are most common in volcanic terrains in semi‐arid environments. Processes that lead to trona precipitation are poorly understood compared to those in sulphate‐dominated and chloride‐dominated lake brines. Nasikie Engida (Little Magadi) in the southern Kenya Rift shows the initial stages of soda evaporite formation. This small shallow (

Background: Patient safety has recently been declared a global health priority. Achievement and sustenance of a culture of patient safety require a regular and timely assessment of the organization. The Safety Attitudes Questionnaire is a patient safety culture assessment tool whose usefulness has been established in countries, but a few studies have been published from Africa, more so, in Kenyan settings. Objective: To evaluate the reliability of the Safety Attitudes Questionnaire in assessing the patient safety culture in a Kenyan setting and to assess healthcare workers' perceptions of patient safety culture. Methods: A descriptive quantitative approach was utilized whereby the Safety Attitudes Questionnaire was administered to 241 healthcare workers in two public hospitals. The Cronbach’s α was calculated to determine the internal consistency of the SAQ. Descriptive and inferential statistics were used to analyze and describe the data on patient safety culture. Results: The total scale Cronbach’s alpha of the SAQ was 0.86, while that of the six dimensions was 0.65 to 0.90. The overall mean score of the total SAQ was 65.8 (9.9). Participants had the highest positive perception for Job Satisfaction with a mean score of 78.3 (16.1) while the lowest was evaluated for Stress Recognition with a mean score of 53.8 (28.6). Conclusion: The SAQ demonstrated satisfactory internal consistency and is suitable for use in the Kenyan context. The perception of patient safety culture in the Kenyan hospital is below international recommendations. There is a need for implementation of strategies for the improvement of the organization culture in Kenyan hospitals.

Nile tilapia (Oreochromis niloticus) is the most cultured and available fish for Kenyan consumers, and therefore, any tilapine disease deprives them the valuable source of protein. Nile tilapia farm was diagnosed with severe concurrent black spot disease and multiple bacteriosis using gross lesions and parasitological, histopathology, and standard bacteriological procedures. A total of 25 fish were sampled and inspected, and all of them had raised, macroscopic 1 mm-sized black spot lesions. The mean intensity of black spots per fish was 728 with an abundance of 2–1740 metacercariae cysts per fish. A high intensity of black spot infestation was observed in the fins (43.9%), skin and underlying muscles (18.3%), and gills (18%). In addition, histopathological data confirmed presence of a metacercaria of Neascus spp. as the aetiological agent of black spot disease. Furthermore, a thick fibrous capsule around the metacercaria, black pigment melanomacrophages, and moderate muscle atrophy were observed. The most prevalent bacteria isolated were Aeromonas, Enterobacter cloacae, Klebsiella pneumoniae, and Micrococcus luteus. Physicochemical parameters of pond water were temperature (28.2°C), dissolved oxygen (4.2 mgl−1), pH (8.5), ammonia free nitrogen (15.8 mgl−1), alkalinity (112 mgl−1), hardness (68 mgl−1), nitrites (0.058 mgl−1), nitrates (58 mgl−1), and phosphates (0.046 mgl−1). However, the levels of nitrates, nitrites, alkalinity, and ammonia free nitrogen exceeded the recommended limits. In conclusion, these findings suggest that coinfections by these organisms coupled by water quality-related stress can be associated with low-grade mortality observed in postfingerling tilapia as well as reduced growth. The authors recommended immediate destocking, thorough disinfection, and control of piscivorous birds. Moreover, attention ought to be geared towards prevention of parasitic infestations in fish so as to minimize fish deaths related to secondary bacteriosis. Further experimental studies should be carried out to elucidate the relationship of these pathogens.

Fish bacterial pathogens cause diseases which result in a considerable economic impact on the aquaculture industry, necessitating the use of antimicrobials for their control. However, intensive and indiscriminate use of antimicrobials has led to increased occurrence of drug resistance in pathogenic bacteria, as well as normal flora. The aim of the current study was to determine the susceptibility patterns of bacteria isolated from fish, with respect to some commonly used antibiotics and disinfectants. Bacteria were isolated between December 2017 and April 2018 from farmed Nile tilapia, African catfish, goldfish, and koi carp in Kirinyaga County, Kenya. Antibiotic and disinfectant susceptibility patterns of 48 isolates belonging to the genera Aeromonas, Proteus, Klebsiella, Citrobacter, Salmonella, Streptococcus, Pseudomonas, Escherichia, Serratia, and Micrococcus were established using the Kirby–Bauer disc diffusion method and agar well diffusion technique, respectively. The antibiotics evaluated included ampicillin, tetracycline, co-trimoxazole, streptomycin, kanamycin, gentamicin, co-trimoxazole, and chloramphenicol, while the disinfectants tested were quaternary ammonium compound, formalin, hydrogen peroxide, sodium hypochlorite, and iodine. All the bacteria except Micrococcus, Escherichia, and Salmonella species showed multiple drug resistance patterns. Streptococcus showed resistance to six antibiotics, while Proteus, Pseudomonas, and Serratia were resistant to five antibiotics. The multiple antibiotic resistance index ranged from 0.1 to 0.8, with Streptococcus spp. having the highest score value. All the organisms were sensitive to gentamicin, while co-trimoxazole and ampicillin showed the highest resistance at 73% (n = 34) and 62% (n = 31), respectively. Most of the disinfectants showed antibacterial activity with varying magnitudes. The isolates were 100% sensitive to hydrogen peroxide and formalin, but were resistant to sodium hypochlorite at recommended user-dilution. The study has shown that some of the bacterial isolates were resistant to common antibiotics and disinfectants; thus, it is recommended to include an antibiogram whenever making any therapeutic decision. The resistant bacteria may transmit resistance genes to other fish bacteria and also to human bacteria, thus making it difficult to treat the resultant disease(s); thus, there is a possibility that these resistant bacteria may be transmitted to humans who consume or handle the carrier fish. It is, therefore, advisable that fish are cooked properly before consumption, so as to kill bacteria that may be present.

People with noninsulin-dependent diabetes mellitus are prone to urinary tract infections. There is a wide gap of information in developing countries regarding the sociodemographic factors linked to UTI among diabetics and the gender disparity among the same. Sociodemographic factors differ with geographical location and many other factors, and this makes them an important aspect that can influence the social burden of UTI among diabetics. The objective of this study was to determine the association between sociodemographic factors and UTI among diabetics. The study was carried out in the Kisii Teaching and Referral Hospital in Kenya. One hundred and eighty diabetic patients were enrolled in cross-sectional study design. Clean-catch midstream urine was collected from all participants and cultured in cysteine lactose electrolyte deficient agar for bacterial isolation. Classification of a positive culture for urinary tract infection was based on more than 100,000 (≥105) colony-forming units of a single bacterial species. The data were analyzed using frequencies, chi-square (p<0.05), and logic regression with the help of the Statistical Package for the Social Sciences (SPSS) version 20 to find the odds ratio. One hundred and seven participants were male (59.4%), and 73 (40.6%) were female. The majority of the participants were between the age of 55 and 59 years old (77.2%), and 125 participants (69.4%) had attained tertiary education as the highest level of education. The overall prevalence of urinary tract infections was 20.6% with 37 participants testing positive for urinary tract infection. Age was found to have a significant association with urinary tract infection (p=0.002) while gender (p=0.45) and level of education (p=0.11) showed no significant association with urinary tract infections among diabetic patients. These findings suggest that age was the biggest association factor that influenced urinary tract infections among diabetic patients.

Social support is a strong predictor of social well-being. Older people are key providers of social support to others, but an overemphasis on received social support in gerontological literature portrays them as mere recipients. We examined the association between social support provided by older people and its influence on their social well-being. Data were collected from 369 respondents residing in rural dwellings in Kitui County using mixed methods and were analyzed for association using chi-square statistics. Instrumental, emotional, and information support provision was determined by asking four questions in each category about whether the respondents provided social support to close network members. The subjective experience of support provision using a satisfaction question for each domain of social support was used to determine the influence of providing social support on the social well-being of older people. Provision of social support across the three domains was found to be significantly associated with social well-being. The level of statistical significance was highest for emotional and information support compared to instrumental support. Older people are important providers of social support. The majority of those who provided social support reported being satisfied. Therefore, offering social support, especially emotional and information support, is an important contributor to satisfaction with these aspects of social well-being.

Research on the social well-being (SWB) of older persons in relation to social support provided and received has generated considerable amount of scholarly debate. Social support received or provided has been found in literature to produce mixed effects (positive and negative) on SWB, necessitating further research. The current study provides Kenyan evidence to a corpus of research mostly focused on European and American studies, contributing to the current discussion on SWB. Thus, the aim of the present study is to investigate how closeness to close network members (CNM) influences older persons’ satisfaction with social support provided and received. The study adopted a descriptive cross-sectional study design and mixed methods approach. Chi-square analyses were conducted, and the results revealed that there was a significant relationship between closeness and satisfaction with providing social support with exact P value of 0.002. In addition, there was a significant relationship between closeness and satisfaction with received social support with exact P value of 0.000 (P

Additional file 1: Supplementary Figure 1: Flowchart of the study sample.

Additional file 4: Supplementary Table 3. STROBE Statement—Checklist of items that should be included in reports of cross-sectional studies.

Additional file 2: Supplementary Table 1. Operational definition of the study variables.

Additional file 3: Supplementary Table 2. Factors associated with caesarean section at population level.