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Previous large-scale education technology interventions have shown only modest impacts on student achievement. Building on results from an earlier randomized controlled trial of three different applications of information and communication technologies (ICTs) on primary education in Kenya, the Tusome Early Grade Reading Activity developed the National Tablets Program. The National Tablets Program is integrated into the Tusome activity by providing tablets to each of more than 1,200 instructional coaches in the country to use when they visit teachers. This enables a national database of classroom instructional quality, which is used by the education system to monitor overall education quality. The tools provided on the tablets are designed to help coaches increase the quality of their instructional support to teachers, and deepen the shallow accountability structures in Kenya's education system. Using results of a national survey, we investigated the ability of the National Tablets Program to increase the number of classroom observations done by coaches and to improve student learning outcomes. Survey results showed high levels of tablet program utilization, increased accountability, and improvements in learning outcomes. We share recommendations regarding large-scale ICT interventions and literacy programs.

Currently, more than 25 million people across the globe live as refugees, having been driven from their countries of origin by crises and conflicts. Although the right to education is articulated in global agreements, national education systems in the host countries are primarily responsible for refugee children's instruction. In one of the first studies of its kind, we assessed all the schools providing lower primary education to refugee children in Kakuma refugee camp in Kenya, one of the largest and oldest refugee camps in the world at the time of data collection. The outcomes for these students were concerningly low, even lower than for those of disadvantaged children in the host community, Turkana County. Literacy outcomes differed among the refugee children, depending on their country of origin, the language of instruction used at the school in Kenya, the languages spoken at home, and the children's self-professed expectation of a return to their country of origin. Our findings point to the urgent need to invest heavily in improving learning among refugee children, rather than focusing solely on their access to education.

Most of what is known about the association between children's executive function (EF) and school readiness skills is derived from research conducted in Western countries. We tested whether these associations were evident in a middle-income country context. Participants were 1,480 children, aged 4-7 years old, who participated in an endline assessment of the Tayari program, an early childhood education (ECE) model that is being delivered by the Kenyan education system. High rates of task completion, low rates of floor effects, and high rates of assessor quality ratings supported the feasibility of large-scale direct assessments of EF with young children. Assessor ratings of children's attention-related behaviors during testing were positively associated with their performance on EF tasks (rs = 0.12-0.27). An EF composite score was not related to demographic factors or to children's exposure to the Tayari program. However, the EF composite score was uniquely associated with performance-based measures of early literacy ([beta] = 0.18, 95% confidence interval [CI] = 0.05, 0.31), early numeracy ([beta] = 0.16, 95% CI = 0.07, 26), and social-emotional competencies ([beta] = 0.12, 95% CI = 0.03, 0.20), even after adjustment for multiple covariates. These results are discussed with respect to the ways in which EF skills inform ongoing efforts to invest in ECE in low- and middle-income countries.

Abstract Background Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV-infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal. Methods A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV-positive members and to prevent new infections. Comprehensive family-centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach. Results Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV- positive partners among those tested: 71% and 89%, respectively. Conclusions The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement.

Background: Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV‐infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal. Methods: A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV‐positive members and to prevent new infections. Comprehensive family‐centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach. Results: Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV‐ positive partners among those tested: 71% and 89%, respectively. Conclusions: The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement., Background Nyanza Province had the highest HIV prevalence in Kenya at 14.9% in 2007, more than twice the national HIV prevalence of 7.1% [1]. Despite this high HIV prevalence, the [...]

Many HIV-positive pregnant women and infants are still not receiving optimal services, preventing the goal of eliminating mother-to-child transmission (MTCT) and improving maternal child health overall. A Rapid Results Initiative (RRI) approach was utilized to address key challenges in delivery of prevention of MTCT (PMTCT) services including highly active antiretroviral therapy (HAART) uptake for women and infants. The RRI was conducted between April and June 2011 at 119 health facilities in five districts in Nyanza Province, Kenya. Aggregated site-level data were compared at baseline before the RRI (Oct 2010–Jan 2011), during the RRI, and post-RRI (Jul–Sep 2011) using pre-post cohort analysis. HAART uptake amongst all HIV-positive pregnant women increased by 40% (RR 1.4, 95% CI 1.2–1.7) and continued to improve post-RRI (RR 1.6, 95% CI 1.4–1.8). HAART uptake in HIV-positive infants remained stable (RR 1.1, 95% CI 0.9–1.4) during the RRI and improved by 30% (RR 1.3, 95% CI 1.0–1.6) post-RRI. Significant improvement in PMTCT services can be achieved through introduction of an RRI, which appears to lead to sustained benefits for pregnant HIV-infected women and their infants.