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Purpose: Managements of humanitarian organizations in arid and semi-arid lands have recently become sensitized to the vulnerability of their supply chains. This is due to an ever-increasing range of security breaches and disruptions that affect global value chains especially in information security management. The current study sought to determine the influence of information security management on the operational performance of humanitarian value chains in arid and semi-arid lands of Kenya. Methodology: The study adopted a cross-sectional design. A target population of 100 respondents was studied through census method from humanitarian organizations operating in arid and semi-arid lands of Kenya. A semi-structured questionnaire was used to collect information whereas descriptive and inferential statistics were used to analyze the data. The results were presented by use of tables. Findings: Scrutiny of the results of linear regression analysis indicated that information security management significantly predicted the operational performance of the organizations (r=.659, p=0.000). Unique contribution to theory, practice and policy: The study recommends that humanitarian organizations should put measures into place to ensure access control and safe storage of information. Employees should also be trained in information security management to understand their role on overall organizational performance.

Climate variability and extreme climate events is one of the many challenges faced by fish farmers. The present study was carried out to assess and compare the socio-economic vulnerability and adaptations of fish farmers to climate variability and extreme climate events in arid and semi-arid lands of Central and Eastern parts of Kitui County, Kenya. Both study sites were purposively selected and the descriptive research design adopted. A total of 60 fish farming households were randomly selected to form the sample size for the study. The socio-economic vulnerability analysis of the fish farmers was based on an index constructed from carefully selected indicators for adaptive capacity. Principal Component Analysis was used to give weights to the indicators. The overall adaptive capacity index results revealed that possession of various assets varied between the two study sites, implying a spatial difference in socio-economic vulnerability between the two study sites. Regarding adaptation, results revealed that the level of adoption of various adaptation strategies to climate variability and extreme climate events also differed significantly between the two study sites and was subject to the adaptive capacity of the fish farmer. Therefore, this study recommends that the socio-economic vulnerability profile of the fish farmers inform any adaptation actions to be taken on fish farmers in arid and semi-arid lands.

The present study assessed the household-level biophysical vulnerability to climate variability and extreme events of fish farmers in Kitui East and Kitui Central Sub counties of Kitui County, Kenya. The study employed a descriptive survey design and a total of 60 farmers constituted the sample. Carefully selected indicators for exposure and sensitivity were used to operationalize vulnerability. Principal Component Analysis (PCA) was used to assign weights to the indicators. Biophysical vulnerability indices indicated that Kitui East fish farmers were more vulnerable (3.70) as compared to Kitui Central fish farmers (-0.80). In conclusion, the study revealed a high biophysical vulnerability of fish farmers to climate variability and extreme events in arid and semi-arid lands. Therefore, fish farmers’ access to off-farm income and their adaptive capacity should be a primary target as fish farming stakeholders lack control over environmental factors that increase the biophysical vulnerability of fish farmers.

Repeated measures data are commonly encountered in a wide variety of disciplines including business, agriculture and medicine. The fact that observations from the same unit, in general, will not be...

Non-tuberculous mycobacteria are of public health significance, and zoonotic infection is attributed to the sociocultural practice of consumption of raw milk and the close human-livestock contact in pastoral communities. This study aimed at isolation, identification of mycobacteria from human sputum and camel milk and risk factors assessment in Samburu East, Kenya. Six hundred and twelve camels and 48 people presumed to have tuberculosis (TB) from 86 households in Wamba and Waso regions were screened. Camels were categorized into Somali, Turkana and Rendile breeds. Single intradermal comparative tuberculin test (SICTT) was used as a herd-screening test on lactating camels and a milk sample collected from reactive camels. Sputum samples were collected from eligible members of participating households. A standard questionnaire on possible risk factors for both humans and camels was administered to respective household heads or their representatives. Total camel skin test reactors were 238/612 (38.9%). Milk and sputum samples were analysed at KEMRI/TB research laboratory for microscopy, GeneXpert® , culture and identification. Isolates were identified using 16S rRNA gene sequencing at Inqaba biotec in South Africa. Sixty-four isolates were acid-fast bacilli (AFB) positive of which M. fortuitum (3), M. szulgai (20), M. monacense (5), M. lehmanni (4), M. litorale (4), M. elephantis (3), M. duvalii (3), M. brasiliensis (1), M. arcueilense (1) and M. lentiflavum (1) were from milk; M. fortuitum (1), M. szulgai (2) and M. litorale (1) were from humans. Risk factors included the following: Turkana breed (OR = 3.4; 95% CI: 1.2-9.3), replacements from outside the County (OR = 2.1; 95% CI: 0.3-12.3), presence of other domestic species (small stock; OR = 4.6) and replacement from within the herd (OR = 3.2; 95% CI: 0.7-14.7). Zoonotic risk practices included raw milk consumption, shared housing and handling camels. Monitoring of zoonotic NTM through surveillance and notification systems is required.

Behaviour change communication experts consider individual beliefs vital to identifying communication needs in healthcare programmes. This study examined the use of four constructs of the health belief model, viz. the belief that a person is vulnerable to a disease, and that the disease is severe; and the belief that an intervention against the disease has benefits and that there are barriers to adopting that intervention, as the basis for developing communication strategies in the implementation of the voluntary medical male circumcision (VMMC) programme for prevention of HIV/AIDS in Siaya county of Kenya. A structured questionnaire was administered on 350 male residents of the county aged between 18 and 50 years selected using the snowball sampling techniques. Qualitative data were collected through two focus groups discussions involving five men and five women residents. The study found that the residents of Siaya, particularly those living along the shores of Lake Victoria, believe that, because of their occupation and lifestyle, they are susceptible to HIV, the same way they perceive the disease as severe. The best known benefit of VMMC among the residents is its ability to reduce a man’s chances of contracting HIV. Other benefits, such as prevention of sex-related diseases among women are largely obscure. There are specific barriers to VMMC such as apprehension over pain and disruption of economic engagements. The study concurs that the health belief model is crucial for the development of audience-focused health communication and recommends its use in VMMC programme to produce targeted messages for different audience segments.

The effectiveness of governmental disaster risk reduction policies in East Africa is influenced by how smallholder farmers react to droughts and adopt drought adaptation measures. In recent research on socio-hydrological feedbacks and the role of farmers’ adaptive behaviour in drought management, agent-based models (ABM) were found to be powerful tools. In this study, we developed an innovative agent-based drought risk model (ADOPT) that explicitly takes into account the two-way relationship between heterogenous individual agricultural adaptation decisions and the agro-hydrological system (modelled using AquacropOS). ADOPT is able to evaluate the effect of drought risk policies on the dynamics of poverty, food security and relief needs, and was applied to a case in Kenya.First, we conducted a multi-method data survey among stakeholders and households in semiarid Kenya to better understand the drivers and barriers, such as knowledge of adaptation measures, fear of droughts, and perceived vulnerability, that determine the adoption of drought adaptation measures in this context. This information was used to calibrate the decision rules in ADOPT. We then applied ADOPT to simulate how drought policy interventions, such as improving extension services, improving early-warning systems, distributing ex-ante rather than ex-post cash transfers, and widening access to credit markets, influence the drought risk and adaptation of smallholders. We found that a holistic approach, including all these measures combined, can reduce the poverty rate with 66%, food insecurity with 70%, and aid needs with 75%, on average over six potential future climate scenarios.

The study was carried out to assess determinants of farmers’ choice of specific adaptation strategies to climate variability and extreme events in selected agro-ecological zones in Kitui County. Descriptive survey design was used. The study area was stratified into four study sites with respect to four different agro-ecological zones and a total of 341 households selected to constitute the sample size. Multivariate probit regression model was run in Stata version 12 to determine the influence of different socio-economic characteristics on farmers’ choice of specific adaptation strategies. The model results indicated that age, gender, farming experience, membership to farmers’ organization, education level, access to extension services and proximity to market had a significant varying influence on farmers’ choice of several adaptation strategies. The study established that different socio-economic characteristics had a different influence on the farmers’ choice of specific adaptation strategies. The study therefore recommends that climate variability adaptation policies, programs and projects by governmental and non-governmental development agencies should target specific socio-economic characteristics that are relevant to the adaptation strategies in question.

Background: Provision of a continuum of care during pregnancy, delivery, and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Complications and lack of skilled postnatal care has consequences for mothers and babies. We examined to what extent a community level integrated maternal health intervention contributed to improvements in uptake of skilled care after delivery by pregnant women. Methods: An Ex post quasi-experimental design was applied. Among 590 reproductive-aged women, we assessed the effectiveness of a community level integrated maternal health intervention and predictors of uptake of postnatal care. Descriptive, bivariate and multivariate analyses were conducted. Results: About three fifths (64%) of the women reported having sought postnatal care services at the health facility within six (6) weeks. Women in the intervention arm were 3.3 times more likely to take up postnatal care at a health facility (AOR= 3.31[95% CI 1.245 to 8.804] p=0.016). Women referred to the health facility for postnatal care by Community Health Workers (CHWs) were 2.72 times more likely to take up the services (AOR= 2.72[95% CI 1.05 to 7.07] p=0.039) than those not referred by CHWs. Distance to health facility (61%) was the major barrier, while some mothers did not feel the need for postnatal care (11%). Conclusion and Implications for Translation: Routine health education by trained providers at community level health facilities, coupled with enhanced CHWs' involvement can improve uptake of postnatal care. Ignorance and accessibility challenges are some barriers to the uptake of postnatal care. Key words: • Community • Maternal • Health • Intervention • Postnatal-Care • Kenya • MAISHA • Community Health Volunteers (CHVs) • Community Health Workers (CHWs) © 2019 Gitonga et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Ongoing research to capture the socio-hydrologic feedbacks between human adaptation decisions and agricultural drought risk has brought agent-based modelling (ABM) tools to the foreground. We explored how such ABM can be used to integrate heterogeneous individual adaptive behaviour in a drought risk framework. Our ABM framework focuses on adaptation decisions (irrigation, land management) by individual farmers and their interaction with drought hazard, exposure and vulnerability. This framework enables us to more correctly reflect the dynamic nature of drought risk in time and space. Moreover, as the effectiveness of disaster risk reduction policies rests on the complexities of drought adaptive behaviour of the targeted group, we completed multiple data collection activities to understand the adaptation decisions of smallholder farmers under drought risk. These activities, inclusing smallholder farmer questionaires, choice experiments and stakeholder interviews, were based on behavioural theories and their links to socio-economic aspects in semi-arid Kenya, so we could assess what drivers and barriers determine the adoption of drought adaption measures in this context. Moreover, people’s preferences towards ex-ante cash transfers, timely extension services, tailored early-warning systems, and access to credit markets were tested.The framework and data collection results were used to calibrate the decision rules in a new ABM (ADOPT), to simulate small-scale agricultural adaptation decisions in response to drought risk in the past. The protection motivation theory is compared with scenarios of no adaptation dynamics and of economic rationality, so as to test different behavioral assumptions. Capturing the spatio-temporal feedbacks between bounded-rational adaptation decisions by smallholder farmers and seasonal weather conditions, ADOPT is capable of mimicking the evolution of heterogeneous adaptation decisions and trends in historic yields over time. We show the benefit of assessing drought risk (poverty, food security and aid needs) on an individual household level. Additionally, we adjusted ADOPT to simulate how smallholder farmers in Kenya respond to drought policy interventions by the government and (future) drought events, explicitly modelling adoption incentives and constraints and the social interactions among farmers. As such, the effect of pro- and reactive top-down decisions by governmental institutions on the household and community vulnerability to droughts could be evaluated in order to find maximized effects on drought resilience.

Background In Kenya, typhoid fever and invasive non-typhoidal salmonellosis present a huge burden of disease, especially in poor-resource settings where clean water supply and sanitation conditions are inadequate. The epidemiology of both diseases is poorly understood in terms of severity and risk factors. The aim of the study was to determine the disease burden and spatial distribution of salmonellosis, as well as socioeconomic and environmental risk factors for these infections, in a large informal settlement near the city of Nairobi, from 2013 to 2017. Methods Initially, a house-to-house baseline census of 150,000 population in Mukuru informal settlement was carried out and relevant socioeconomic, demographic, and healthcare utilization information was collected using structured questionnaires. Salmonella bacteria were cultured from the blood and faeces of children Salmonella serotypes and risk factors were conducted using Pearson Chi-Square (χ2) test. Results A total of 16,236 children were recruited into the study. The prevalence of bloodstream infections by Non-Typhoidal Salmonella (NTS), consisting of Salmonella Typhimurium/ Enteriditis, was 1.3%; Salmonella Typhi was 1.4%, and this was highest among children Salmonella Typhimurium/ Enteriditis was not significantly associated with rearing any domestic animals. Rearing chicken was significantly associated with high prevalence of S. Typhi (2.1%; p = 0.011). The proportion of children infected with Salmonella Typhimurium/ Enteriditis was significantly higher in households that used water pots as water storage containers compared to using water directly from the tap (0.6%). Use of pit latrines and open defecation were significant risk factors for S. Typhi infection (1.6%; p = 0.048). The proportion of Salmonella Typhimurium/ Enteriditis among children eating street food 4 or more times per week was higher compared to 1 to 2 times/week on average (1.1%; p = 0.032). Conclusion Typhoidal and NTS are important causes of illness in children in Mukuru informal settlement, especially among children less than 16 years of age. Improving Water, Sanitation and Hygiene (WASH) including boiling water, breastfeeding, hand washing practices, and avoiding animal contact in domestic settings could contribute to reducing the risk of transmission of Salmonella disease from contaminated environments.

The diagnosis of tuberculosis (TB) in camels at slaughter houses heavily relies on post mortem (PM) meat inspection to detect granulomatous lesions; however, the sensitivity of this technique is not perfect. The objective of this study was to isolate and characterize mycobacteria associated with suspect TB pathological lesions at PM. At PM, 1600 camels were examined in two county slaughterhouses. One hundred and thirty two, 8.25% (132/1600) (Binomial CI 95% 6.95–9.71%), suspect granulomatous lesions were found. Twenty seven, 1.69% (27/1600) (Binomial CI 95% 1.11–2.45%), were confirmed as acid-fast bacilli (AFB) using Ziehl-Neelsen (ZN) staining after culture. Speciation using the GenoType® Mycobacterium assay (Hain Lifesciences, Nehren, Germany) found a majority isolates to be Mycobacterium fortuitum (17), the other species identified included M. szulgai (2), M. scrofulaceum (3), M. marinum (1), M. intracellulare (1), M. gordonae (1), and 2 unidentified mycobacteria species. The types of lesions observed were nodular, caseous masses involving whole organs or cavities, and purulent masses. The highest proportion of suspect lesions were observed in the right, left bronchial lymph nodes, and the mediastinal lymph nodes (59.54%), followed by the retropharyngeal lymph nodes (12.21%), the medial lobe (10.67%), and the left lateral and quadrate lobes of the lungs (17.58%). The 6–7 age category had higher odds (OR = 2.5) of culture positivity. It was concluded that a variety of NTM species of medical importance were associated with TB lesions in the thoracic lymph nodes and lungs. There is need to unravel the public health significance of these mycobacteria.

Background: Skilled birth attendance, a proven way of reducing maternal and perinatal mortality has remained low in low resource settings. Traditional Birth Attendants (TBAs) have continued to be culturally and socially accepted in many societies despite their limitation in handling childbirth complications. The study objective was to assess the perception of traditional birth attendants (TBAs) by the men and women of reproductive age in rural Migori. Methodology: This was a qualitative study carried out in four villages in Migori County, Nyanza region which involved married women of child bearing age and married men. Separate focus group discussions (FGDs) were done for men and women, where one FGD was conducted per group in each village. Content analysis was done after coding and categorizing data into thematic areas. Results: The findings indicated varied perceptions of men and women about the TBAs. Themen appreciated the services of TBAs mainly because of financial reasons while women enjoyed their friendly attitude and welfare services. The community was well aware of the risks of delivering with a TBA, however, they still opted for their services for reasons such as availability, accessibility and their friendly attitude. Conclusion: The men and women of reproductive had varied perceptions, both positive and negative about the traditional birth attendants. The TBAs still have a role to play in the community. Keywords: Traditional birth attendants, Skilled birth attendance, Community perception, Home delivery, Maternal mortality

Background Sputum remains the most preferred specimen for detection of Mycobacterium tuberculosis due to its non-invasive method of production. Good quality sputum specimen is essential for accurate diagnosis of pulmonary tuberculosis (PTB). It is therefore imperative to assess factors that are related to the production of sputum that is of the best quality. Objective We assessed the intrinsic and extrinsic characteristics of presumed tuberculosis patients and the quality of sputum they produced. Methods This was a cross-sectional study in which consenting enrolled presumed tuberculosis patients were subjected to medical examination and a structured questionnaire administered to collect clinical history, demographic information, environmental and behavioral characteristics. The enrolled participants were instructed on how to collect spot and morning sputum specimens for macroscopic and microscopic assessment to determine any association. Results A total of 309 patients were enrolled into the study with an even distribution on gender (50.5% males). Of these, 202 (65.3%) submitted both a spot and a morning specimen for analysis. On macroscopic examination, 70% spot and 68% morning sputum were characterized as good quality (Purulent/mucoid). The factors associated (p

A Thesis submitted in partial fulfillment of the requirements for the award of the Degree of Masters of Business Administration at Strathmore University Business School Insurance is a critical component of any country’s economic system. Insurance penetration is one of the measures of relative importance of the insurance sector to the specific country. Insurance penetration in Kenya has been very low at below three percent irrespective of the significant focus by regulators, policymakers and the insurance industry players. The factors impacting insurance penetration in Kenya have been studied over the years. While various studies have been carried out focusing on the corporate insurance industry players, this study sought to investigate the factors affecting insurance penetration in Kenya from the view of insurance agents who intermediate insurance products to the masses. The study conceptualized these factors as national culture, customer service, regulatory environment and public awareness. The specific objectives focused on examining how national culture, customer service, regulatory environment and public awareness impact insurance penetration in Kenya from the view of registered insurance agents. The theoretical perspective of the study was consistent with the Hofstede five dimensions of national culture, the service qualify model of measuring and capturing service quality and the agency model which defines the relationship between principals and agents. The methodology involved a descriptive approach in a cross-sectional study. The population for the study was the insurance agents approved by the Insurance Regulatory Authority (IRA). A sample of insurance agents was targeted and data was collected using a questionnaire administered manually at the insurance agents’ meetings at their branches in the respective insurance companies. The data was then presented using tables. The study achieved a response rate of seventy one percent. The study revealed that regulatory environment, public awareness, customer service and national culture impact insurance penetration in Kenya to a marginal extent of just above one percent. Only two of the independent variables (public awareness and customer service) had a significant impact on the dependent variable, insurance penetration. The study concluded that there are other factors which impact the remainder of insurance penetration in Kenya. Other factors should be considered in future research to establish their effects on insurance penetration

Cancer is the third leading cause of death in Kenya. However, there is scarce information on the nutritional status of cancer patients to guide in decision making. The present study sought to assess the risk of malnutrition, and factors associated with malnutrition and cachexia, among cancer out-patients, with the aim of informing nutrition programmes for cancer management in Kenya and beyond. This was a facility-based cross-sectional study performed at Kenyatta National Hospital and Texas Cancer Centre in Nairobi, Kenya. The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool (MUST). Diagnoses of malnutrition and cachexia were done using the European Society of Clinical Nutrition and Metabolism (ESPEN) and Fearon criteria, respectively. A total of 512 participants were assessed. Those at risk of malnutrition were 33·1 % (12·5 % at medium risk, 20·6 % at high risk). Prevalence of malnutrition was 13·4 %. The overall weight loss >5 % over 3 months was 18·2 % and low fat-free mass index was 43·1 %. Prevalence of cachexia was 14·1 % compared with 8·5 % obtained using the local criteria. Only 18·6 % participants had received any form of nutrition services. Age was a predictor of malnutrition and cachexia in addition to site of cancer for malnutrition and cigarette smoking for cachexia. The use of the MUST as a screening tool at the first point of care should be explored. The predictive value of current nutrition assessment tools, and the local diagnostic criteria for malnutrition and cachexia should be reassessed to inform the development of appropriate clinical guidelines and future capacity-building initiatives that will ensure the correct identification of patients at risk for timely care.

Introduction: Kenya adopted the Integrated Disease Surveillance and Response (IDSR) strategy in 1998 to strengthen disease surveillance and epidemic response. However, the goal of weekly surveillance reporting among health facilities has not been achieved. We conducted a crosssectional study to determine the prevalence of adequate reporting and factors associated with IDSR reporting among health facilities in one Kenyan County. Methods: Health facilities (public and private) were enrolled using stratified random sampling from 348 facilities prioritized for routine surveillance reporting. Adequately-reporting facilities were defined as those which submitted >10 weekly reports during a twelve-week period and a poor reporting facilities were those which submitted

In West Africa, social factors influence whether couples with unmet need for family planning act on birth-spacing desires. Tékponon Jikuagou is testing a social network-based intervention to reduce social barriers by diffusing new ideas. Individuals and groups judged socially influential by their communities provide entrée to networks. A participatory social network mapping methodology was designed to identify these diffusion actors. Analysis of monitoring data, in-depth interviews, and evaluation reports assessed the methodology's acceptability to communities and staff and whether it produced valid, reliable data to identify influential individuals and groups who diffuse new ideas through their networks. Results indicated the methodology's acceptability. Communities were actively and equitably engaged. Staff appreciated its ability to yield timely, actionable information. The mapping methodology also provided valid and reliable information by enabling communities to identify highly connected and influential network actors. Consistent with social network theory, this methodology resulted in the selection of informal groups and individuals in both informal and formal positions. In-depth interview data suggest these actors were diffusing new ideas, further confirming their influence/connectivity. The participatory methodology generated insider knowledge of who has social influence, challenging commonly held assumptions. Collecting and displaying information fostered staff and community learning, laying groundwork for social change.

Background: Death of a baby in-utero is a very devastating event to the mother and the family. Most stillbirths occur during labor and birth with other deaths occurring during the antenatal period. Millions of families experience stillbirths, yet these deaths remain uncounted, and policies have not been clearly stipulated to address this issue. The aim of the study was to identify the possible causes of stillbirths as recorded in the medical records. Methods: A retrospective study looking at medical records of women who experienced stillbirths between 1st January 2009 and 31st December 2013 at Nyeri Provincial General Hospital, Kenya. The hospital records containing cases of stillbirths were retrieved and data abstraction forms were used to collect data and information. Results: Both fresh and macerated stillbirths were equally common. The stillbirth rate was 12.2 per 1,000 births. There was signifi cant association between stillbirths and the clients who were referred and reason for referral, (p=0.029) and (p=0.005), respectively. The number of ANC visits during pregnancy was also signifi cant (p=0.05). Mode of delivery and the reason for cesarean section were signifi cantly associated with stillbirths, (p=0.003) and (p=0.032), respectively. The type of labor and delivery complications experienced was associated with stillbirths (p= 0.022). Conclusion and Global Health Implications: There were several factors associated with stillbirths thus efforts should be made to establish approaches aimed at prevention. Addressing the causes of stillbirths will contribute to reduction of perinatal mortality. Key words: Stillbirths • Medical Records • Labor • Delivery • Referral • Nyeri • Kenya Copyright © 2016 Cheptum et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

OBJECTIVE Developing countries are undergoing an epidemiologic transition accompanied by increasing burden of cardiovascular disease (CVD) linked to urbanization and lifestyle modifications. Metabolic syndrome is a cluster of CVD risk factors whose extent in Kenya remains unknown. The aim of this study was to determine the prevalence of metabolic syndrome and factors associated with its occurrence among an urban population in Kenya. RESEARCH DESIGN AND METHODS This was a household cross-sectional survey comprising 539 adults (aged ≥18 years) living in Nairobi, drawn from 30 clusters across five socioeconomic classes. Measurements included waist circumference, HDL cholesterol, triacylglycerides (TAGs), fasting glucose, and blood pressure. RESULTS The prevalence of metabolic syndrome was 34.6% and was higher in women than in men (40.2 vs. 29%; P < 0.001). The most frequently observed features were raised blood pressure, a higher waist circumference, and low HDL cholesterol (men: 96.2, 80.8, and 80%; women: 89.8, 97.2, and 96.3%, respectively), whereas raised fasting glucose and TAGs were observed less frequently (men: 26.9 and 63.3%; women: 26.9 and 30.6%, respectively). The main factors associated with the presence of metabolic syndrome were increasing age, socioeconomic status, and education. CONCLUSIONS Metabolic syndrome is prevalent in this urban population, especially among women, but the incidence of individual factors suggests that poor glycemic control is not the major contributor. Longitudinal studies are required to establish true causes of metabolic syndrome in Kenya. The Kenyan government needs to create awareness, develop prevention strategies, and strengthen the health care system to accommodate screening and management of CVDs.

The prevalence of HIV/AIDS among men who have sex with men (MSM) in Nairobi has been reported to be 16.4% which is a public health concern. The aim of this study was to determine factors that affected accessibility to, acceptability of, and adherence to HIV/AIDS prevention services by men who have sex with men in Nairobi County, Kenya.Methods. The study used a mixed methods design, applying both quantitative and qualitative methods.Results. Over 70% of MSM reported that TB drugs, antiretroviral drugs, lubricants, condoms, and other STI treatment services were accessible. However, 31.6% of MSM reported that discrimination at the health facility level was a hindrance to accessing HIV/AIDS prevention services while 26.3% reported encountering stigma. 48.4% of MSM consumed alcohol while taking of drugs was reported, at 36.1%.Conclusion. Discrimination and stigma adversely affected MSM seeking HIV/AIDS prevention services in health facilities. MSM engaged in alcohol and substance abuse that likely affected their health seeking behavior. Although most prevention services are reported as accessible, uptake of the same needs to be considered.

Introduction: Hypertension has been identified as the leading risk factor for mortality worldwide. The common clinical practice of one arm blood pressure measure and the presence of a difference between arm measurements is likely to lead to delayed diagnosis of hypertension and is associated with a higher prevalence of poor control of hypertension. Objective: To examine inter-arm differences that could give rise to undetected hypertension. Methods: A household cross-sectional survey was undertaken amongst 293 females who were participating in agricultural farm activities in lower Eastern Kenya. Six alternating arm blood pressure readings were taken, three on each arm with 3 minutes rest between each session. Results: Marginal but statistically significant inter-arm differences were observed in mean systolic blood pressure (right-arm 124.4 ± 12.5 mmHg; left-arm 123.3 ± 13.2 mmHg) and diastolic blood pressure (right-arm 75.4 ± 8.9 mmHg; left-arm 76.2 ± 9.1 mmHg). Right arm blood pressure readings indicated a higher prevalence of prehypertension and hypertension (51.2% and 12.3%) than left-arm (47.8 and 10.6%; p=0.001) readings. Statistically significant intra-arm differences (p=0.001) were observed between the 1st vs. 2nd and the 1st vs. 3rd right and left arm systolic blood pressure and diastolic blood pressure readings respectively. Conclusion and recommendation: Repeated blood pressure readings when measured on both arms can assist in more accurate identification of elevated blood pressure and timely diagnosis of hypertension. Population-wide studies are needed to examine the long term significance of blood pressure differences between arms.

Background Schistosoma mansoni is widely distributed in sub-Saharan Africa with Biomphalaria pfeifferi being its most widespread and important snail intermediate host. Few studies have examined the compatibility of field-derived B. pfeifferi snails with S. mansoni miracidia derived from human hosts. We investigated compatibility (as defined by shedding of cercariae following exposure to miracidia) of two isolates of S. mansoni from school children from Asao (western Kenya) and Mwea (central Kenya) with B. pfeifferi collected directly from Asao stream or the Mwea rice fields. Methods We exposed snails from both regions to four different doses of miracidia (1, 5, 10 and 25) from sympatric or allopatric S. mansoni, and maintained them in a shaded, screened out-of-doors rearing facility in Kisian, in western Kenya. Both snail survival and the number of snails that became infected were monitored weekly. This was done for 25 weeks post-exposure (PE). Those infected snails which survived beyond this period were monitored until they all died. Results Although overall survival of Mwea snails maintained in western Kenya was generally low, both sympatric and allopatric combinations of parasites and snails exhibited high compatibility (approximately 50% at a dose of one miracidium per snail), with an increase in infection rates as the miracidial dose was increased (P

Background: Developing countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept was applied at district level in Kenya to assess how many women had UONs and where the women with unmet needs were located. Methods: A facility based retrospective study was conducted in 2010 in Malindi District, Kenya. Data on pregnant women who underwent a major obstetric intervention (MOI) or died in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were the magnitude of UONs and their geographical distribution. Results: 566 women in 2008 and 724 in 2009 underwent MOI. Of these, 185 (32.7%) in 2008 and 204 (28.1%) in 2009 were for Absolute Maternal Indications (AMI). The most common MOI was caesarean section (90%), commonly indicated by Cephalopelvic Disproportion (CPD)–narrow pelvis (27.6% in 2008; 26.1% in 2009). Based on a reference rate of 1.4%, the overall MOI for AMI rate was 1.25% in 2008 and 1.3% in 2009. In absolute terms, 22 (11%) women in 2008 and 12 (6%) in 2009, who required a life saving intervention failed to get it. Deficits in terms of unmet needs were identified in rural areas only while urban areas had rates higher than the reference rate (0.8% vs. 2.2% in 2008; 0.8% vs. 2.1% in 2009). Conclusions: The findings, if used as a proxy to maternal mortality, suggest that rural women face higher risks of dying during pregnancy and childbirth. This indicates the need to improve priority setting towards ensuring equity in access to life saving interventions for pregnant women in underserved areas. publishedVersion

Africa’s population is expected to rise to 1.8 billion by 2050 (Gregory 2009). In Kenya the population was 15.3 million in 1979 and by 2009 it had grown by 23.3 million to reach 38.6 million (MOP 2009) population and housing census results. Projections indicate that the country’s population will stand at 51.3 million by 2025 representing a growth rate of 1 million people per year (1.45 %) (UNFPA 2011). This increase is due to enhanced fertility rate, poverty and high illiteracy levels (Masci 2007). The population increase has already amounted to unprecedented pressure on land, environmental degradation and strained water resources. The situation has been aggravated by effects of global warming. The circumstances have made the people poorer. There is a correlation between environmental degradation and poverty (Ramshackle 2010) resulting into many poor people engaging in environmentally destructive practices which only lessens survival chances. The arid and semi arid environments are particularly vulnerable by virtue of their ecological conditions and neglect by the government development systems. This chapter analyses the role of the South Eastern University College (SEUCO), a constituent college of The University of Nairobi, Kenya in acting in response to the challenges of food production at the community level in light of global warming. The institution has made major strides in developing technologies and measures that are adaptable by local communities as well as raise community awareness and community participation in living with climate change. Knowledge on sustainable improvement in water availability through rainwater harvesting, soil and water conservation measures, harnessing the use of drought-tolerant crops and adopting crop diversification have been found to be important adaptation strategies for the people in the arid and semi-arid environments. The results of the interventions by the university in the local environment reveal a need to increase the use of emerging technologies and the enactment of appropriate policies on climate change by all stakeholders.

Since 2007, Kenya has been leading the way with the M-Pesa mobile phone money transfer service that has transformed the lives of millions of people and businesses in the country. This chapter focuses on the impact that the M-Pesa innovation has had on the first group, namely livestock traders. The unprecedented spread of mobile devices, wireless networks and mobile communication services across Kenya has resulted in efficient communication, payments and marketing systems for an increasing number of people. The chapter considers the adoption and application of M-Pesa services by the Maasai pastoralists of Kajiado County in southern Kenya. The Maasai pastoralists' habitats, located in some of Kenya's remotest and harshest environments, have a myriad of problems, one of the major ones being financial transactions. Issues of monetary gain, time advantages, convenience, security, insurance during periods of stress and other innovative developments are finally discussed. Keywords: financial transactions; Kajiado County; Kenya; livestock traders; M-Pesa innovation; Maasai pastoralists

Background A measure of the proportion of deliveries assisted by skilled attendants is one of the indicators of progress towards achieving Millennium Development Goal (MDG) 5, which aims at improving maternal health. This study aimed at establishing delivery practices and associated factors among mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya to determine whether mothers were receiving appropriate delivery care. Methods A hospital-based cross-sectional survey among women who had recently delivered while in the study area was carried out between August and October 2009. Binary Logistic regression was used to identify factors that predicted mothers' delivery practice. Results Among the 409 mothers who participated in the study, 1170 deliveries were reported. Of all the deliveries reported, 51.8% were attended by unskilled birth attendants. Among the deliveries attended by unskilled birth attendants, 38.6% (452/1170) were by neighbors and/or relatives. Traditional Birth Attendants attended 1.5% (17/1170) of the deliveries while in 11.7% (137/1170) of the deliveries were self administered. Mothers who had unskilled birth attendance were more likely to have Conclusion Among the mothers interviewed, utilization of skilled delivery attendance services was still low with a high number of deliveries being attended by unqualified lay persons. There is need to implement cost effective and sustainable measures to improve the quality of maternal health services with an aim of promoting safe delivery and hence reducing maternal mortality.