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Abstract Background Many women in low- and middle-income countries, including Kenya, access antenatal care (ANC) late in pregnancy. Home pregnancy testing can enable women to detect pregnancy early, but it is not widely available. Our study explored the acceptability and potential of home pregnancy testing delivered by community health volunteers (CHV) on antenatal care initiation in rural Kenya. Methods This study was part of a public health intervention to improve uptake and quality of ANC. Between November and December 2020, we conducted 37 in-depth interviews involving women who tested positive or negative for a urine pregnancy test provided by CHVs; CHVs and their supervisors involved in the delivery of the pregnancy tests; facility healthcare workers; and key informants. Using Sekhon et al.‘s framework of acceptability, the interviews explored participants’ perceptions and experiences of home pregnancy testing, including acceptability, challenges, and perceived effects on early ANC uptake. Data were analysed thematically in NVivo12 software. Results Home pregnancy testing was well-received by women who trusted test results and appreciated the convenience and autonomy it offered. Adolescents cherished the privacy, preferring home testing to facility testing which could be a stigmatising experience. Testing enabled earlier pregnancy recognition and linkage to ANC as well as reproductive decision-making for those with undesired pregnancies. Community delivery of the test enhanced the reputation and visibility of the CHVs as credible primary care providers. CHVs in turn were motivated and confident to deliver home pregnancy testing and did not find it as an unnecessary burden; instead, they perceived it as a complement to their work in providing ANC in the community. Challenges identified included test shortages, confidentiality and safeguarding risks, and difficulties accessing facility-based care post-referral. Newly identified pregnant adolescents hesitated to seek ANC due to stigma, fear of reprimand, unwanted parental notification, and perceived pressure from healthcare workers to keep the pregnancy. Conclusion Home pregnancy testing by CHVs can improve early ANC initiation in resource-poor settings. Mitigating privacy, confidentiality, and safeguarding concerns is imperative. Additional support for women transitioning from pregnancy identification to ANC is essential to ensure appropriate care. Future research should focus on integrating home pregnancy testing into routine community health services.

Abstract Savings play a significant role in any country’s economic development. Notably, because farmers tend to have seasonal income from their farming activities, they also tend to be highly vulnerable to poor saving habbit than other occupations, such as those in formal jobs. However, farmers who save part of their income for subsequent production can purchase farm inputs in time as they wait for the onset of rain. Reportedly, there has been poor saving behavior among farmers in sub-Saharan Africa. Therefore, this study aims to determine the factors responsible for farmers’ saving behavior. Descriptive and econometric (binary logistic model) analyses were employed to achieve the objectives of the study. The results indicate that the majority of farmers saved on a monthly and weekly basis. The results of the binary logistic regression model analysis showed that age, marital status, gender, experience, group membership, distance to the markets and markets, farm income, and farmers’ sub-counties of residence had a significant influence on farmers’ saving behavior. From the results, policy measures to increase the rate of savings include the employment of more extension personnel to reach as many farmers as possible. Government and extension agents should target female and less experienced farmers through adult-based education programs because they are vulnerable to poor saving behavior. Farmers should join farmer—based groups and cooperative societies, in which saving information is disseminated. The government, non-governmental organizations and financial institutions should offer financial literacy training on savings to smallholder farmers.

The onset of COVID-19 made governments and other education actors prioritize distance learning, particularly through education technologies (EdTechs). Most sub-Saharan African countries adopted and adapted this approach. This paper examines the extent of EdTechs' deployment in Kenya during the COVID-19 pandemic among marginalized and vulnerable populations. A cross-sectional study design was adopted for the study from which this paper drew its data, with both secondary and primary data utilized. The findings show that marginalized/vulnerable learner populations are still left out on EdTech supported learning. This article proposes salient recommendations that could help advance inclusive education discussion and related EdTechs' discourse.

Para athletes present a broad range of sports-related injuries and illnesses, frequently encountering barriers when accessing healthcare services. The periodic health evaluation (PHE) is a valuable tool for continuously monitoring athletes’ health, screening for health conditions, assisting in the surveillance of health problems by establishing baseline information and identifying barriers to athlete’s performance. This position statement aims to guide sports healthcare providers in the PHE for Para athletes across key impairment categories: intellectual, musculoskeletal, neurological and vision. A panel of 15 international experts, including epidemiologists, physiotherapists, optometrists and physicians with expertise in Para athlete health, convened via videoconferences to discuss the position statement’s purpose, methods and themes. They formed working groups to address clinical, cardiorespiratory, neuromusculoskeletal, nutritional status, mental and sleep health, concussion and female Para athlete health assessment considerations. The PHE’s effectiveness lies in its comprehensive approach. Health history review can provide insights into factors impacting Para athlete health, inform physical assessments and help healthcare providers understand each athlete’s needs. During the PHE, considerations should encompass the specific requirements of the sport modality and the impairment itself. These evaluations can help mitigate the common tendency of Para athletes to under-report health issues. They also enable early interventions tailored to the athlete’s health history. Moreover, the PHE serves as an opportunity to educate Para athletes on preventive strategies that can be integrated into their training routines, enhancing their performance and overall health. This position statement can potentially enhance clinical translation into practice and improve the healthcare quality for Para athletes.

Objective: To estimate the economic cost of GBV from the perspective of a women survivor who sought help from two identified programs (Makueni GBVRC and Life Bloom Services International [LBSI]). Design: A mixed method research design combining qualitative and quantitative approaches. Site: Makueni GBVRC in Makueni County, overseen by the Makueni County government, and LBSI in Naivasha, Nakuru County, a non-profit organization devoted to serving local communities. Participants: Study participants include women survivors of GBV, aged 18 and above, actively seeking services at Makueni GBVRC and LBSI. Interventions: The study adopts a qualitative approach to delve into the intricate economic costs of GBV on survivors. Additionally, quantitative data analysis employs an accounting model to ascertain the financial implications. Main measurements: The costs analyses were done from the perspective of the women survivors. An accounting model was utilized to evaluate the cost of GBV on selected survivors. Furthermore, the research explores the enduring consequences for survivors, including psychological trauma and susceptibility to stress-related diseases. Results: The findings reveal substantial economic costs linked to GBV, adversely affecting survivors, their children, and society at large. These costs encompass direct expenditures on medical care, legal representation, and counseling, as well as indirect costs, such as lost productivity. Conclusions: Beyond immediate and indirect costs, the study underscores the existence of opportunity costs—what survivors and affected children could attain in the absence of GBV. Resumen: Objetivo: Estimar el costo económico de la violencia de género desde la perspectiva de una mujer sobreviviente que buscó ayuda de dos programas identificados (Makueni GBVRC y Life Bloom Services International [LBSI]). Diseño: Un diseño de investigación de método mixto que combina enfoques cualitativos y cuantitativos. Sitio: Makueni GBVRC en el condado de Makueni, supervisado por el gobierno del condado de Makueni, y LBSI en Naivasha, condado de Nakuru, una organización sin fines de lucro dedicada a servir a las comunidades locales. Participantes: Los participantes del estudio incluyen mujeres sobrevivientes de violencia de género, de 18 años o más, que buscan activamente servicios en Makueni GBVRC y LBSI. Intervenciones: El estudio adopta un enfoque cualitativo para profundizar en los intrincados costos económicos de la violencia de género para los sobrevivientes. Además, el análisis de datos cuantitativos emplea un modelo contable para determinar las implicaciones financieras. Mediciones principales: Los análisis de costos se realizaron desde la perspectiva de las mujeres sobrevivientes. Se utilizó un modelo contable para evaluar el costo de la violencia de género en sobrevivientes seleccionados. Además, la investigación explora las consecuencias duraderas para los supervivientes, incluido el trauma psicológico y la susceptibilidad a enfermedades relacionadas con el estrés. Resultados: Los hallazgos revelan costos económicos sustanciales relacionados con la violencia de género, que afectan negativamente a los sobrevivientes, sus hijos y la sociedad en general. Estos costos abarcan gastos directos en atención médica, representación legal y asesoramiento, así como costos indirectos, como la pérdida de productividad. Conclusiones: Más allá de los costos inmediatos e indirectos, el estudio subraya la existencia de costos de oportunidad: lo que los sobrevivientes y los niños afectados podrían lograr en ausencia de violencia de género.

BackgroundDespite evidence of the beneficial effects of skilled birth attendance (SBA) on maternal health and childbirth outcomes, there are disparities in access across counties in Kenya. These include Migori County which has historically recorded high maternal mortality rates. In 2007, the Lwala Community Alliance was founded to improve health outcomes in this county. The objective of this study is to provide a baseline status of facility childbirth and SBA in Migori and to characterize the effect of Lwala intervention on these outcomes.MethodsA cross-sectional household survey was designed for a 10-year study to evaluate the effectiveness of Lwala initiatives. The 2019 and 2021 household surveys were conducted in Lwala intervention wards and in comparison wards with sample sizes of 3,846 and 5,928 mothers, respectively. The survey captured demographic, health, and socioeconomic data at each household, data on SBA and facility childbirth, and explanatory variables. A generalized linear model was used to determine factors associated with SBA. A secondary trend analysis was conducted to determine change over time in the explanatory variables and SBA. To determine the change in SBA rate due to Lwala intervention, controlling for background temporal trends, a difference-in-differences (DiD) model compared SBA rates in intervention wards and comparison wards.ResultsSBA increased in all surveyed wards and across all explanatory variables from 2019 to 2021. The DiD analysis showed that the SBA rate increased more in Lwala intervention wards than in comparison wards (Adjusted Prevalence Rate Ratio 1.05, p

Abstract Background Early attendance at antenatal care (ANC), coupled with good-quality care, is essential for improving maternal and child health outcomes. However, achieving these outcomes in sub-Saharan Africa remains a challenge. This study examines the effects of a community-facility health system strengthening model (known as 4byFour) on early ANC attendance, testing for four conditions by four months of pregnancy, and four ANC clinic visits in Migori county, western Kenya. Methods We conducted a mixed methods quasi-experimental study with a before-after interventional design to assess the impact of the 4byFour model on ANC attendance. Data were collected between August 2019 and December 2020 from two ANC hospitals. Using quantitative data obtained from facility ANC registers, we analysed 707 baseline and 894 endline unique ANC numbers (attendances) based on negative binomial regression. Logistic regression models were used to determine the impact of patient factors on outcomes with Akaike Information Criterion (AIC) and likelihood ratio testing used to compare models. Regular facility stock checks were undertaken at the study sites to assess the availability of ANC profile tests. Analysis of the quantitative data was conducted in R v4.1.1 software. Additionally, qualitative in-depth interviews were conducted with 37 purposively sampled participants, including pregnant mothers, community health volunteers, facility staff, and senior county health officials to explore outcomes of the intervention. The interview data were audio-recorded, transcribed, and coded; and thematic analysis was conducted in NVivo. Results There was a significant 26% increase in overall ANC uptake in both facilities following the intervention. Early ANC attendance improved for all age groups, including adolescents, from 22% (baseline) to 33% (endline, p = 0.002). Logistic regression models predicting early booking were a better fit to data when patient factors were included (age, parity, and distance to clinic, p = 0.004 on likelihood ratio testing), suggesting that patient factors were associated with early booking.The proportion of women receiving all four tests by four months increased to 3% (27/894), with haemoglobin and malaria testing rates rising to 8% and 4%, respectively. Despite statistical significance (p

Abstract Background Understanding the impact of disease associations is becoming a priority in Kenya and other countries bearing the load of infectious diseases. With the increased incidences of non-communicable diseases and the endemicity of infectious diseases in Sub-Saharan Africa, their co-existence poses significant challenges to patients, health workers and an overwhelmed health sector. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors especially to patients with family history of confirmed diabetes cases. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Understanding the correlates of HIV and diabetes is crucial to inform management and prevention strategies of the twin infections. We therefore aimed to determine the prevalence of diabetes mellitus and risk factors in a population of HIV infected patients on HAART. This study determined the association of diabetes/impaired glucose regulation in the context of HIV-1. A cross-sectional study was conducted at a comprehensive care clinic in Nairobi (Kenya). Participants were screened for diabetes and impaired glucose regulation using random blood glucose and glycated haemoglobin (HbA1c) This paper describes the prevalence of diabetes mellitus in Human Immunodeficiency Virus positive individuals and the associated risk factors. We have demonstrated that family history is a risk factor for diabetes. While age and BMI are known risk factors, they were not associated with diabetes in this study.

Abstract Background There is a high prevalence of autoimmune conditions in women specially in the reproductive years; thus, the association with adverse pregnancy outcomes has been widely studied. However, few autoimmune conditions/adverse outcomes have been studied more than others, and this umbrella review aims to consolidate existing knowledge in this area with the aim to provide new knowledge and also identify gaps in this research area. Methods Medline, Embase, and Cochrane databases were searched from inception to December 2023. Screening, data extraction, and quality appraisal (AMSTAR 2) were done by two independent reviewers. Data were synthesised narratively and quantitatively. Relative risks (RR)/odds ratio (OR) with 95% confidence intervals were reported. Results Thirty-two reviews were included consisting of 709 primary studies. The review reported the association between 12 autoimmune conditions and 16 adverse pregnancy outcomes. Higher risk of miscarriage is reported in women with Sjögren’s syndrome RR 8.85 (95% CI 3.10–25.26) and systemic lupus erythematosus (SLE) OR 4.90 (3.10–7.69). Pre-eclampsia was reported higher in women with type 1 diabetes mellitus (T1DM) OR 4.19 (3.08–5.71) and SLE OR 3.20 (2.54–4.20). Women reported higher risk of diabetes during pregnancy with inflammatory bowel disease (IBD) OR 2.96 (1.47–5.98). There was an increased risk of intrauterine growth restriction in women with systemic sclerosis OR 3.20 (2.21–4.53) and coeliac disease OR 1.71 (1.36–2.14). Preterm birth was associated with T1DM OR 4.36 (3.72–5.12) and SLE OR 2.79 (2.07–3.77). Low birth weight babies were reported in women with women with SLE or systemic sclerosis OR 5.95 (4.54–7.80) and OR 3.80 (2.16–6.56), respectively. There was a higher risk of stillbirth in women with T1DM OR 3.97 (3.44–4.58), IBD OR 1.57 (1.03–2.38), and coeliac disease OR 1.57 (1.17–2.10). T1DM in women was associated with 32% lower odds of small for gestational age baby OR 0.68 (0.56–0.83). Conclusions Pregnant women with autoimmune conditions are at a greater risk of developing adverse pregnancy outcomes. Further research is required to develop better preconception to postnatal care for women with autoimmune conditions.

Abstract Background Despite many systematic reviews and meta-analyses examining the associations of pregnancy complications with risk of type 2 diabetes mellitus (T2DM) and hypertension, previous umbrella reviews have only examined a single pregnancy complication. Here we have synthesised evidence from systematic reviews and meta-analyses on the associations of a wide range of pregnancy-related complications with risk of developing T2DM and hypertension. Methods Medline, Embase and Cochrane Database of Systematic Reviews were searched from inception until 26 September 2022 for systematic reviews and meta-analysis examining the association between pregnancy complications and risk of T2DM and hypertension. Screening of articles, data extraction and quality appraisal (AMSTAR2) were conducted independently by two reviewers using Covidence software. Data were extracted for studies that examined the risk of T2DM and hypertension in pregnant women with the pregnancy complication compared to pregnant women without the pregnancy complication. Summary estimates of each review were presented using tables, forest plots and narrative synthesis and reported following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. Results Ten systematic reviews were included. Two pregnancy complications were identified. Gestational diabetes mellitus (GDM): One review showed GDM was associated with a 10-fold higher risk of T2DM at least 1 year after pregnancy (relative risk (RR) 9.51 (95% confidence interval (CI) 7.14 to 12.67) and although the association differed by ethnicity (white: RR 16.28 (95% CI 15.01 to 17.66), non-white: RR 10.38 (95% CI 4.61 to 23.39), mixed: RR 8.31 (95% CI 5.44 to 12.69)), the between subgroups difference were not statistically significant at 5% significance level. Another review showed GDM was associated with higher mean blood pressure at least 3 months postpartum (mean difference in systolic blood pressure: 2.57 (95% CI 1.74 to 3.40) mmHg and mean difference in diastolic blood pressure: 1.89 (95% CI 1.32 to 2.46) mmHg). Hypertensive disorders of pregnancy (HDP): Three reviews showed women with a history of HDP were 3 to 6 times more likely to develop hypertension at least 6 weeks after pregnancy compared to women without HDP (meta-analysis with largest number of studies: odds ratio (OR) 4.33 (3.51 to 5.33)) and one review reported a higher rate of T2DM after HDP (hazard ratio (HR) 2.24 (1.95 to 2.58)) at least a year after pregnancy. One of the three reviews and five other reviews reported women with a history of preeclampsia were 3 to 7 times more likely to develop hypertension at least 6 weeks postpartum (meta-analysis with the largest number of studies: OR 3.90 (3.16 to 4.82) with one of these reviews reporting the association was greatest in women from Asia (Asia: OR 7.54 (95% CI 2.49 to 22.81), Europe: OR 2.19 (95% CI 0.30 to 16.02), North and South America: OR 3.32 (95% CI 1.26 to 8.74)). Conclusions GDM and HDP are associated with a greater risk of developing T2DM and hypertension. Common confounders adjusted for across the included studies in the reviews were maternal age, body mass index (BMI), socioeconomic status, smoking status, pre-pregnancy and current BMI, parity, family history of T2DM or cardiovascular disease, ethnicity, and time of delivery. Further research is needed to evaluate the value of embedding these pregnancy complications as part of assessment for future risk of T2DM and chronic hypertension.

In this study, we aimed to assess gender disparities in access to agricultural extension services and the determinants of access to extension among male and female-headed households in Western Uganda. A cross-sectional survey was conducted to extract primary data from 200 farmers using a semi-structured questionnaire. The collected data were analyzed using descriptive statistics and Binary Logit model. Our findings revealed that majority of the male-headed households had access to extension compared to their female-headed household counterparts. This was also evident in the sources of agricultural extension. The socio-demographic characteristics of farmers also indicated that male-headed households were better off in many areas, for example, male-headed households boasted 498.83 kg/ha maize productivity, while households headed by females produced 405.36 kg/ha, indicating a 94 kg/ha yield gap. Similarly, adoption of agricultural practices was high among the male-headed households than their fellow female-headed counterparts. Finally, the estimates from the Binary Logit revealed that male-headed households’ access to extension was influenced by age, education, farm size, crop diversity, and group membership. The predictor variables that significantly influenced female-headed households’ access to extension include age, education, experience, household size, farm size, distance to extension, crop diversity, non-farm income, and credit access. The study concluded that there are gender disparities in agricultural extension as evident in the access to, sources and determinants of access to agricultural extension. To bridge the gender gap, the study advocates for more training and extension services to female-headed households regarding access to and sources of extension services.

Sustainability serves as a normative principle in the context of food policy but also represents a hotly debated arena. Ongoing crises in contemporary agriculture suggest that the current model of food production may not be sustainable in the long run to guarantee global food security. Advocacy for more comprehensive and sustainable models has increased because of the pressing need to improve agriculture, particularly in Africa. Thus, the status quo cannot be maintained. Agroecology-based food system transformation has received increased attention from social movements, academics, researchers and policymakers. In many countries around the world, agroecology is becoming increasingly popular as a transformative movement. However, it receives little attention in global agricultural research and development plans, particularly in sub-Saharan Africa (SSA). Scaling up agroecological outputs requires amplification. This research explores amplification dynamics through a literature review, providing insights into SSA’s emerging agroecology policy landscape while drawing on Cuba’s experiences. Adopting agroecological practices contributes to accomplishing Sustainable Development Goal (SDG) number 2 of the United Nations while providing solutions to food insecurity in SSA. The findings suggest that while agroecology is becoming more common and well-known in SSA, its presence is still modest, and there is little policy support for its expansion. Agroecology’s holistic approach with an ecological foundation is yet to take a foothold in SSA’s food system policy arena. Several policy recommendations have been suggested in this review paper to support agroecology research and policy discourse in SSA and its role in transforming agri-food systems.

AbstractSmall-scale fishers (SSFs) are finding it difficult to cope with the limited returns from fishing activities. Diversification of fishing activities becomes necessary in ensuring the sustainable use of fishing resources by exploring entrepreneurial opportunities available in other sectors including the tourism value chain. Little is known on the extent to which small-scale fishers in South Africa have explored opportunities available along the tourism value chain. The qualitative study was conducted in the Western and Eastern Capes Provinces of South Africa. Using data from key informant interviews, focus group discussions and literature reviews, we found that the majority of small-scale fishers depend on activities within the fishing mainstream with limited integration in the tourism value chain through diversification strategy. For fishers to diversify out of the fishing industry and engage in tourism activities, they should be supported with the necessary resources, such as finances, and common leadership structures in addition to instituting policy changes within the two sectors to accommodate linkages through diversification.

AbstractThe global feed production has increased in the past few years. Despite the growing trend, the current production does not meet the demand in Kenya. The government of Kenya has initiated several efforts towards promoting fodder production to increase milk production and household income. This study analysed the effects of fodder production on household income in Homa Bay County, Kenya using the Propensity Score Matching (PSM) technique. The study used primary data collected through structured questionnaires in Homabay County, Kenya from a sample size of 300 smallholder farmers. Results indicated that years of schooling, herd size, household size, labour used in land preparation, and land size under fodder had a positive influence on the probability of farmers to mainly feed their livestock on Napier grass. On the contrary, the number of extension contacts negatively influenced the probability of farmers feeding their livestock on Napier grass. Results show that there was a significant difference between the incomes of farmers who fed their cattle on Napier grass and those who mainly grazed their cattle on natural grass. Specifically, smallholder farmers who fed their livestock on Napier grass reported a Kshs. 3,916.67 (USD 25.71) higher income than their counterparts who grazed their livestock on natural grass reflecting an increase by 24.94%. Thus, the study recommends the need for both the national and county governments to incorporate fodder production as a key area for livestock development agenda in their policy plans to improve the farmers’ income.

AbstractSustainable agricultural practices (SAPs) increase crop productivity. This is achieved by increasing soil fertility, preserving moisture in the soil, and reducing pest and disease build-up, among other significant roles. Strikingly, maize farmers are still deeply rooted into the traditional methods of production which do not consider the adoption of SAPs. As such, they report low maize yields. Similarly, despite government efforts to increase the adoption rate, farmers remain reluctant to adopt SAPs. Therefore, this study aims to determine the adoption intensity of SAPs and its determinants using data collected from 101 randomly selected farmers in Northern Uganda. The adoption index (AI) and Tobit model approaches were used to determine the adoption intensity and its determinants, respectively. Based on the results, adoption intensity stood at 70%, while the determinants of adoption of the selected SAPs were education level (P

Malaria transmission depends on the presence of Plasmodium gametocytes that are the only parasite life stage that can infect mosquitoes. Gametocyte production varies between infections and over the course of infections. Infection duration is highly important for gametocyte production but poorly quantified. Between 2017 and 2019 an all-age cohort of individuals from Tororo, eastern Uganda was followed by continuous passive and routine assessments. We longitudinally monitored 104 incident infections from 98 individuals who were sampled once every 28 days and on any day of symptoms. Among infections that lasted ≥ 3 months, gametocyte appearance was near-universal with 96% of infections having detectable gametocytes prior to clearance. However, most infections were of much shorter duration; 55.7% of asymptomatic infections were detected only once. When considering all asymptomatic infections, regardless of their duration, only 36.3% had detectable gametocytes on at least one time-point prior to parasite clearance. Infections in individuals with sickle-cell trait (HbAS) were more likely to have gametocytes detected (Hazard Rate (HR) = 2.68, 95% CI 1.12, 6.38; p = 0.0231) and had gametocytes detected at higher densities (Density Ratio (DR) = 9.19, 95% CI 2.79, 30.23; p = 0.0002) compared to infections in wildtype (HbAA) individuals. Our findings suggest that a large proportion of incident infections is too short in duration and of too low density to contribute to onward transmission.

BackgroundClimate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time. ObjectiveThe aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures. MethodsWe conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes. ResultsOur cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness. ConclusionsOur study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study’s application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change.

Purpose: Examine the effect of access to finance on performance of small and medium enterprise of fish trading along Lake Victoria region Kenya. Methodology/Approach: The study was anchored on positivism philosophy while credit rationing theory was used as a guide to the study. Mixed design was used. Target population of 4,500 respondents with a sample size 173 of traders was selected using the Yamane formula. Questionnaire as data collection instrument. The study data were analyzed using descriptive and inferential statistics which include mean and mode. Descriptive statistics was computed to summarize data before regression analyses. This was presented using tables. Findings: Simple linear regression results showed financial access had a significant effect on performance of SMEs of fish trading along Lake Victoria region (Coefficient of correlation 0.403, p=0.000

Purpose: The purpose of the study was to examine the effect of usage of finance on performance of small and medium enterprise of fish trading along Lake Victoria region Kenya. The study was anchored on positivism philosophy while credit rationing theory was used as a guide to the study. Methodology/Approach: Mixed research design was adopted in the study. Target population of 4,500 respondents with a sample size 173 of traders was selected using the Yamane formula. Questionnaire and interview schedules were used as data collection instrument. The study data were analyzed using descriptive and inferential statistics which include mean and mode. Descriptive statistics was computed to summarize and describe the demographic characteristics of the respondents. Data was presented using tables. Findings: Simple linear regression results showed that usage of finance had a positive significant effect on performance of Small and Medium Enterprises of fish trading along Lake Victoria region (coefficient of correlation 0.698, p=0.000

Abstract Aquaculture is the world's fastest‐growing food‐producing sector, making it a significant contributor to food and nutrition security for the globally growing human population. Nevertheless, its long‐term growth is limited by the effects of climate change. Aquaculture in Sub‐Saharan Africa (SSA), which is dominated by small‐scale fish farming, is increasingly threatened by climate change, which has a substantial influence on its productivity and scalability. In this context, the present research looks at the socio‐economic consequences of climate change on small‐scale fish producers in SSA, as well as potential adaptation techniques to the effects of climate change. A clear understanding of these socio‐economic repercussions of climate change is critical for developing effective strategies to reduce future impacts and safeguard aquaculture‐based livelihoods. Furthermore, understanding the socio‐economic consequences of climate change on communities dependent on aquaculture is important for advising policymakers and decision‐makers on formulating and implementing policies that sustain aquaculture production amidst the climate change crisis. This article suggests various adaptation strategies to increase resilience to climate change, including diversification of livelihoods and species, use and incorporation of local and indigenous knowledge, shifting to aquaculture species less vulnerable to changing climatic conditions, capacity building through aquaculture insurance schemes, continued fish supply from capture fisheries, and consolidation of equity and human rights concerns. These adaptive methods, when combined, have the potential to enhance outcomes for populations who are more susceptible owing to their unstable socio‐economic conditions.

Implementation science and human-centered design (HCD) offer useful frameworks and methods for considering and designing for individuals' needs and preferences when implementing new interventions or technologies in global health. When used in tandem, the two approaches may blend creative and partnered research methods with a focus on the factors necessary to design, implement, and sustain interventions. However, research is needed that describes the process of blending these two approaches and explores the experiences of community partners. This study builds from a stepped-wedge cluster-randomized trial in Western Kenya, wherein teachers and community health volunteers have been trained to provide trauma-focused cognitive behavioral therapy (TF-CBT). Mobile phones emerged as a tool to supervise lay counselors from afar; however, their use was characterized by unique challenges. Informed by human-centered design and implementation science, we first engaged lay counselors (n = 24) and supervisors (n = 3) in individual semi-structured interviews then hosted an in-person participatory workshop to “co-design” solutions to optimize the use of mobile phone supervision. Lay counselors participated in focus group discussions regarding their experiences in the workshop. Focus group transcripts were analyzed using thematic analysis. We describe our approach as well as focus group discussion results. Counselors felt the workshop was a valuable experience to learn new strategies from their colleagues, and they enjoyed the “collaborative spirit” that emerged as they worked together. Counselors felt that varying small and large group discussions fostered participation by creating opportunities for more people to engage and share their thoughts. Counselors suggested the approach be improved by providing more tangible materials (e.g., hand-outs) and more closely following a schedule of activities. It is important to also center stakeholders’ experiences as partners in the research process. Though counselors largely expressed positive sentiments, they also shared valuable suggestions for how to improve participatory research practices in the future.

Work-life balance has always been concerned with those interested in the quality of working life and its relation to broader quality of life. This study sought to establish the influence of characteristics of work-life balance on teachers' levels of job satisfaction in public secondary schools in Nairobi County, Kenya. The purpose of this study was to determine the influence of supervisor support and gender on the teachers' levels of job satisfaction. The study used Stacy Adams' equity theory of which holds that individuals compare their ratio of inputs and outcomes to the input-outcomes of other individuals. This study was a descriptive survey design. The target population was 83 public secondary schools and 1759 public secondary school teachers' with 67 principals and 670 teachers sampled. Data were collected using an interview schedule and questionnaires. Descriptive statistics was performed to analyze quantitative data. Pearson Product Moment Correlation Coefficient was used to determine the linear correlation between the independent variables and the dependent variable. Using null hypotheses, multiple regression analysis was done. The key findings were that the principals were supportive to their teachers especially in terms of readily giving them permission to attend to their personal needs and training opportunities. There was no statistically significant difference in teachers' levels of job satisfaction between male and female teachers. The study recommends that the Teachers Service Commission should formulate policies that are specifically geared towards enhancing teachers' work-life balance. Comparative studies should be carried out in the rural areas.

Objectives: HIV and malaria coinfection impacts disease management and clinical outcomes. This study investigated hematologic abnormalities in malaria-asymptomatic people living with HIV (PLHIV) in regions with differing malaria transmission. Methods: Study participants were enrolled in the African Cohort Study: two sites in Kenya, one in Uganda, and one in Nigeria. Data was collected at enrollment and every 6 months. Logistic regression estimated odds ratios for associations between HIV/malaria status and anemia, thrombocytopenia, and leucopenia. Results: Samples from 1587 participants with one or more visits comprising 1471 (92.7%) from PLHIV and 116 (7.3%) without HIV were analyzed. Parasite point prevalence significantly differed across the study sites (P

Abstract Reliable real-world data on direct acting anti-retroviral (DAA) uptake and treatment outcomes are lacking for patients with hepatitis C virus (HCV) in sub-Saharan Africa. This study provides data on HCV DAA-based treatment outcomes, mortality, loss-to-follow up, and associated factors among patients in Eritrea. A multicenter retrospective observational cohort study was conducted in two tertiary hospitals in Asmara, Eritrea. A structured checklist was used to collect data from patient’s cards. Descriptive and inferential statistics used included means (± Standard deviation (SD), medians (Interquartile range (IQR), chi-squire (χ2), Kaplan–Meier estimates, and multivariate Cox proportional hazard models. A total of 238 patients with median age of 59 years (IQR 50–69 years) were enrolled in the study. Out of the 227 patients initiated on treatment, 125 patients had viral load measurements at 12 weeks after end of treatment (EOT) whereas 102 patients had no viral load measurements at 12 weeks EOT. Among the patients with HCV RNA data post-EOT 12, 116 (92.8%) had sustained viral response (SVR). The prevalence of death and loss-to-follow up (LTFU) were (7.5%, 95% CI 1.7–4.1) and 67 (28.1%, 95% CI 22.3–33.9) translating into an incidence of 1.1 (95% CI 0.8–1.5) per 10,000 person days. Independent predictors of LTFU included the enrollment year (2020: aHR = 2.2, 95% CI 1–4.7; p value = 0.04); Hospital (Hospital B: aHR = 2.2, 95% CI 1–4.7; p value = 0.03) and the FIB-4 score (FIB-Score

African swine fever virus (ASFV) is endemic to African wild pigs (Phacochoerus and Potamochoerus), in which viral infection is asymptomatic, and Ornithodoros soft ticks. However, ASFV causes a lethal disease in Eurasian domestic pigs (Sus scrofa). While Sub-Saharan Africa is believed to be the original home of ASFV, publicly available whole-genome ASFV sequences show a strong bias towards p72 Genotypes I and II, which are responsible for domestic pig pandemics outside Africa. To reduce this bias, we hereby describe nine novel East African complete genomes in p72 Genotype IX and present the phylogenetic analysis of all 16 available Genotype IX genomes compared with other ASFV p72 clades. We also document genome-level differences between one specific novel Genotype IX genome sequence (KE/2013/Busia.3) and a wild boar cell-passaged derivative. The Genotype IX genomes clustered with the five available Genotype X genomes. By contrast, Genotype IX and X genomes were strongly phylogenetically differentiated from all other ASFV genomes. The p72 gene region, on which the p72-based virus detection primers are derived, contains consistent SNPs in Genotype IX, potentially resulting in reduced sensitivity of detection. In addition to the abovementioned cell-adapted variant, eight novel ASFV Genotype IX genomes were determined: five from viruses passaged once in primary porcine peripheral blood monocytes and three generated from DNA isolated directly from field-sampled kidney tissues. Based on this methodological simplification, genome sequencing of ASFV field isolates should become increasingly routine and result in a rapid expansion of knowledge pertaining to the diversity of African ASFV at the whole-genome level.