Search Results (20)

This study investigates how socio-economic characteristics, migration status, and country of origin influence labor market outcomes in Nairobi County, Kenya. By estimating logit and Tobit models using data from the Kenya Refugee and Host Household Survey (KRHHS), we find that age is positively associated with the likelihood of being employed and higher incomes, but this relationship diminishes beyond a certain point. Gender disparities are pronounced, with women being less likely to be employed and generally earning less than men. Larger households are associated with lower employment probabilities, reflecting greater domestic responsibilities for household heads. Local community members are more likely to be employed and earn more than refugees, who face substantial labor market barriers such as legal restrictions and lack of social networks. Having a university education is associated with being employed with higher earnings, compared to workers with either primary or secondary education. Having never been married is positively associated with being employed. Employment and income vary significantly by country of origin, highlighting the complex interplay between integration and discrimination factors in local communities. These findings underscore the need to address educational and gender inequalities that prevail between refugees and local communities. Full article

Background: Front-of-package labeling (FOPL) is shown to support healthier consumer choices. Many countries have adopted different FOPL systems. Objective: This study explored perceptions and understanding of three FOPLs and identified features that could enhance their effectiveness in Kenya. Methods: A qualitative study was conducted across four Kenyan counties—Nairobi, Mombasa, Garissa, and Kisumu. Data from 12 focus group discussions with 137 adults of diverse socio-demographic backgrounds were analysed. Participants evaluated three FOPLs: Red and Green (RG) Octagon, Red and Green Octagon with icons and text (RGI), and Black Octagon Warning Label (WL). The FGDs assessed visibility and memorability, comprehension, potential effectiveness, and cultural relevance of each label. NVivo version 14.0 was used for thematic analysis. Results: Kenyan consumers had mixed perceptions of the proposed FOPLs. The black Octagon WL was found to be the most visible and memorable due to its bright colours. Although the RG and RGI symbols were visually engaging, some participants reported confusion with the colour meanings. The WL was also more readily understood due to its text. Overall, WL was preferred for its potential to influence purchasing decisions, while all three FOPLs were considered culturally suitable. Conclusions: The Black Octagon Warning Label was the most visible and comprehensible of the three FOPLs and shows promise in influencing consumer behaviour in Kenya. While RG and RGI symbols are appealing, their colour scheme could reduce their effectiveness. Educating consumers on FOPLs could enhance their impact in reducing unhealthy food purchases. Full article

Plants of the genus Physalis are of economic interest because of their fleshy edible fruits with high nutritional value. Some species have high medicinal value with a long history of ethno-medicinal use to treat diverse diseases. There is therefore a need to correctly discriminate the different species of Physalis for proper utilization. Although most Physalis species have unique morphologies, their vegetative stages are identical, making it difficult to accurately identify them based on morphological characteristics. DNA barcoding has the potential to discriminate species accurately. In this study, ribulose bisphosphate carboxylase large (rbcL) and internal transcribed spacer 2 (ITS2) regions were used to discriminate Physalis species and to reveal their phylogenetic relationships and genetic diversity. Physalis plant samples were collected from seven counties in Kenya based on the availability of the germplasm. The voucher specimens were identified using the botanical taxonomy method and were deposited in the University of Nairobi herbarium. Genomic DNA was isolated from leaf samples of 64 Physalis accessions and used for PCR amplification and the sequencing of rbcL and ITS2 barcode regions. The discriminatory ability of the barcodes was based on BLASTn comparison, phylogenetic reconstruction and cluster analysis, and the determination of inter- and intra-specific distances. The nucleotide polymorphism, genetic diversity and distance of the identified Physalis species were determined using DnaSP and MEGA 11.0 software. Species discrimination was more robust using ITS2 sequences. The species identified and discriminated by ITS2 sequences were Physalis purpurea, Physalis peruviana and Physalis cordata. The rbcL sequences were only able to identify Physalis to the genus level. There was high interspecific and low intraspecific divergence within the identified Physalis species based on ITS2 sequences. The ITS2 barcode is an ideal DNA barcode for use in the discrimination of species, as well as in genetic diversity studies of Physalis accessions in Kenya. Full article

Introduction: Technology advancements have enhanced artificial intelligence, leading to a user shift towards virtual assistants, but a human-centered approach is needed to assess for acceptability and effectiveness. The AGILE chatbot is designed in Kenya with features to redefine the response towards gender-based violence (GBV) among vulnerable populations, including adolescents, young women and men, and sexual and gender minorities, to offer accurate and reliable information among users. Methods: We conducted an exploratory qualitative study through focus group discussions (FGDs) targeting 150 participants sampled from vulnerable categories; adolescent girls and boys, young women, young men, and sexual and gender minorities. The FGDs included multiple inquiries to assess knowledge and prior interaction with intelligent conversational assistants to inform the user-centric development of a decision-supportive chatbot and a pilot of the chatbot prototype. Each focus group comprised 9–10 members, and the discussions lasted about two hours to gain qualitative user insights and experiences. We used thematic analysis and drew on grounded theory to analyze the data. Results: The analysis resulted in 14 salient themes composed of sexual violence, physical violence, emotional violence, intimate partner violence, female genital mutilation, sexual reproductive health, mental health, help-seeking behaviors/where to seek support, who to talk to, and what information they would like, features of the chatbot, access of chatbot, abuse and HIV, family and community conflicts, and information for self-care. Conclusion: Adopting a human-centered approach in designing an effective chatbot with as many human features as possible is crucial in increasing utilization, addressing the gaps presented by marginalized/vulnerable populations, and reducing the current GBV epidemic by moving prevention and response services closer to people in need. Full article

The rising cases of non-communicable diseases, specifically cancer, have led to the integration of palliative care in their management. However, only 10% of cancer patients have access to palliative care. Healthcare utilization is an important step in disease management as it aids individuals in accessing opportunities for the prevention and treatment of diseases. The study applied the binary probit model to estimate the progressive utilization of palliative care services by cancer patients. The aim of the study was to determine factors influencing the progressive utilization of palliative care by cancer patients. A cross-sectional data survey was conducted for 169 cancer patients seeking palliative care at the Nairobi Hospice in 2013. For each patient, the predisposing, enabling, and need (PEN) factors were analyzed as key criteria for applying progressive utilization of palliative care at the Nairobi Hospice as compared to those residing in other counties in the study. Descriptive statistics showed that 27% of patients studied resided in Nairobi County, where 61% were female, 62% were married, 35% had primary education, 44% were self-employed, and 59% had medical insurance. Probit regression and marginal effects showed that employment and religion were significant in determining the progressive utilization of palliative care. Employment status and religion are consequently the main factors that both governments and health-focused non-governmental organizations need to consider increasing the probability of progressively utilizing palliative care to improve the quality of life of cancer patients. Full article

Anthropogenic activities often compromise the water quality of natural water systems, rendering it unfit for domestic and agricultural use. This paper evaluates the effects of anthropogenic activities on the water quality of Ngong River in Nairobi County, Kenya. It aimed to assess the river’s physico-chemical parameters, identify major anthropogenic activities that act as pollutant sources and establish the relationship between the anthropogenic activities and water quality along the Ngong River. Twelve water samples were systematically collected in each of the twelve study sites in April and August 2021 and analyzed in the laboratory for various water quality parameters. The accumulation factor (AF) indicated that E. coli, total coliforms, BOD and COD were found to significantly build up downstream of Ngong River. The ANOVA test results showed that all the physicochemical parameters studied (BOD, E. coli, pH, total suspended solids, total coliforms, turbidity, conductivity, nitrates, oil and grease and TDS), except COD, were not significantly different (p ≤ 0.05) for the different sites. Measured heavy metals, such as lead (Pb) levels at different sampled points, were all found to be below the detectable limit (0.001 ppm) for both seasons. Cadmium (Cd) was detectable during the dry season with the highest levels (0.113 ppm) being recorded at Ngong Forest Boundary. The findings of this study revealed that anthropogenic activities, such as raw sewage disposal, industrial activities, solid waste dumping and small-scale agriculture, had adverse effects on Ngong River’s water quality. The study recommends a need to closely monitor anthropogenic activities along Ngong River to reduce their probable pollution of the water in the River basin. This will ensure the sustainability of the water resources. Full article

Considering the early inequity in global COVID-19 vaccine distribution, we compared the level of population immunity to SARS-CoV-2 with vaccine uptake and refusal between rural and urban Kenya two years after the pandemic onset. A population-based seroprevalence study was conducted in the city of Nairobi (n = 781) and a rural western county (n = 810) between January and February 2022. The overall SARS-CoV-2 seroprevalence was 90.2% (95% CI, 88.6–91.2%), including 96.7% (95% CI, 95.2–97.9%) among urban and 83.6% (95% CI, 80.6–86.0%) among rural populations. A comparison of immunity profiles showed that >50% of the rural population were strongly immunoreactive compared to <20% of the urban population, suggesting more recent infections or vaccinations in the rural population. More than 45% of the vaccine-eligible (≥18 years old) persons had not taken a single dose of the vaccine (hesitancy), including 47.6% and 46.9% of urban and rural participants, respectively. Vaccine refusal was reported in 19.6% of urban and 15.6% of rural participants, attributed to concern about vaccine safety (>75%), inadequate information (26%), and concern about vaccine effectiveness (9%). Less than 2% of vaccine refusers cited religious or cultural beliefs. These findings indicate that despite vaccine inequity, hesitancy, and refusal, herd immunity had been achieved in Kenya and likely other African countries by early 2022, with natural infections likely contributing to most of this immunity. However, vaccine campaigns should be sustained due to the need for repeat boosters associated with waning of SARS-CoV-2 immunity and emergence of immune-evading virus variants. Full article

An important step towards COVID-19 pandemic control is adequate knowledge and adherence to mitigation measures, including vaccination. We assessed the level of COVID-19 knowledge, attitudes, and practices (KAP) among residents from an urban informal settlement in the City of Nairobi (Kibera), and a rural community in western Kenya (Asembo). A cross-sectional survey was implemented from April to May 2021 among randomly selected adult residents from a population-based infectious diseases surveillance (PBIDS) cohort in Nairobi and Siaya Counties. KAP questions were adopted from previous studies. Factors associated with the level of COVID-19 KAP, were assessed using multivariable regression methods. COVID-19 vaccine acceptance was 83.6% for the participants from Asembo and 59.8% in Kibera. The reasons cited for vaccine hesitancy in Kibera were safety concerns (34%), insufficient information available to decide (18%), and a lack of belief in the vaccine (21%), while the reasons in Asembo were safety concerns (55%), insufficient information to decide (26%) and lack of belief in the vaccine (11%). Our study findings suggest the need for continued public education to enhance COVID-19 knowledge, attitudes, and practices to ensure adherence to mitigation measures. Urban informal settlements require targeted messaging to improve vaccine awareness, acceptability, and uptake. Full article

Many Kenyan base-of-the-pyramid (BoP) consumers—defined as the poorest two-thirds of the economic human pyramid—remain food insecure, despite the availability of nutrient-dense foods in the market. This study reveals how effective marketing strategies can strengthen food security among BoP consumers through increased access to nutritious foods such as nutrient-dense porridge flour. Nutrient-dense porridge flour refers to a multi-composite porridge flour composed of diverse nutritious ingredients that are necessary to achieve a healthy diet. The main objective of the study was to determine the most effective channel for making nutrient-dense porridge flour available to BoP consumers. Data were collected through a cross-sectional survey in Kawangware, Nairobi County, using a multistage sampling design and a sample size of 603, via structured questionnaires. A multivariate Probit (MV-Probit) model was used to analyze the most effective channel for providing nutrient-dense flour to BoP consumers. The study results show that the most common outlets used to access this flour were supermarkets (51.08%), followed by cereal stores (25.54%). According to previous studies, using appropriate marketing strategies leads to increases in the uptake and consumption of nutritious products in informal urban settlements among developing countries. Consequently, policies and interventions targeting BoP consumption of nutritious products toward reducing food and nutrition insecurity in informal urban settlements should be based on appropriate marketing strategies that consider the institutional factors and significant household characteristics of the BoP communities. Full article

Vulnerability to climate change and variability impacts has been identified as a major cog in the wheel of both livelihood and resilience, particularly in vulnerable groups in rural areas. This study aims to assess genders’ vulnerability dimension to climate change and variability in REDD + (Reducing Emission from Deforestation and Forest Degradation+) piloted site/clusters, Cross River State, Nigeria. Data were proportionately collected from selected 200 respondents on gender disaggregated level using questionnaires. The assessment adopted the sustainable livelihood approach (livelihood vulnerability index) and compared the results with the IPCC vulnerability standard of exposure, sensitivity and adaptive capacity weighted mean. The results revealed a significant difference in the vulnerability dimension of both women and men disaggregated levels (LVI: men 0.509, women 0.618). The women category was more vulnerable to six out of seven major components of LVI assessed: (livelihood strategies (0.646), social networks (0.364), water (0.559), health (0.379), food and nutrition (0.507), and natural hazards and climate variability (0.482), while men only vulnerable to socio-demographic major component (0.346). Vulnerability indices also showed women to be more exposed (0.482), and sensitive (0.489) with the least adaptive capacities (0.462) to the climate change and variability impacts. Overall, on the IPCC-LVI index, women are more vulnerable (0.0098) to climate change and variability impacts than men (−0.0093). The study recommends that the women’s category resilience and adaptive capacity should be empowered in adaptation projects in climate change such as REDD + (Reducing Emissions from Deforestation and Forest Degradation+) to reduce their vulnerability to impacts of climate change and variability in the context of exposure, sensitivity, and adaptive capacities. This will be instrumental in formulating policies to address the specific needs of gender categories in reducing vulnerability to climate change and variability. This pragmatic approach may be used to monitor gender vulnerability dimension, and livelihood enhancement and evaluate potential climate change adaptation programs. Additionally, the introduction of IPCC-LVI as a baseline instrument will enhance information on gender resilience and adaptive capacity for policy effectiveness in a data-scarce region particularly Africa. Full article

Several alphaviruses, such as chikungunya (CHIKV) and Onyong-nyong (ONNV), are endemic in Kenya and often cause outbreaks in different parts of the country. We assessed the seroprevalence of alphaviruses in patients with acute febrile illness in two geographically distant areas in Kenya with no previous record of alphavirus outbreaks. Blood samples were collected from febrile patients in health facilities located in the rural Taita-Taveta County in 2016 and urban Kibera informal settlement in Nairobi in 2017 and tested for CHIKV IgG and IgM antibodies using an in-house immunofluorescence assay (IFA) and a commercial ELISA test, respectively. A subset of CHIKV IgG or IgM antibody-positive samples were further analyzed using plaque reduction neutralization tests (PRNT) for CHIKV, ONNV, and Sindbis virus. Out of 537 patients, 4 (0.7%) and 28 (5.2%) had alphavirus IgM and IgG antibodies, respectively, confirmed on PRNT. We show evidence of previous and current exposure to alphaviruses based on serological testing in areas with no recorded history of outbreaks. Full article

Young people (YP), defined as individuals aged between 10 and 24 years, are a vulnerable population. Leveraging digital platforms to reach YP is essential in identifying protective and risk behaviors among this population. The objectives of this study were to (1) examine the user-inclusive development process of a theory-based digital platform to reach YP, (2) describe aspects of the digital application prototype, and (3) provide preliminary findings from the utilization of the app. We present the five-step design process for building the app. The app, known as the REACH-AYA survey, consisted of 98 closed-ended questions with built-in skip-logic algorithms and took approximately 7 min to complete. The survey questions centered on behavioral, lifestyle, and psychosocial factors, which were adopted from different validated instruments, thereby addressing 10 different domains. During the pilot phase, participants utilized the app, critiqued its features, and provided iterative feedback. We used respondent-driven sampling to recruit participants in Nairobi, Kenya, the leading county in high-speed data connectivity. Once recruited, each participant completed the survey and later sent it to their peers until the desired sample size was achieved. The REACH-AYA app prototype was guided and developed by the design thinking approach with an initial pilot sample of 33 YP for pre-testing. The end-user pre-testing assessed for functionality, time, and adaptability. The app was then launched initially through social media, reaching 1101 YP, with approximately eighty percent (n = 887) having completed the survey by the close of the study. The majority of the participants were male (59%), and approximately (69%) of the participants were aged between 15 and 24 years. This is one of the few studies that demonstrate user-centric methodologies of app development and real-life application in identifying protective and risk factors for the wellbeing of YP. Methodologies and lessons learned from this research may benefit other disciplines using digital technology to reach YP or other difficult-to-reach populations. Full article

Somalia, Kenya and Ethiopia, situated in the Horn of Africa, are highly vulnerable to climate change, which manifests itself through increasing temperatures, erratic rains and prolonged droughts. Millions of people have to flee from droughts or floods either as cross-border refugees or as internally displaced persons (IDPs). The aim of this study was to identify knowledge status and gaps regarding public health consequences of large-scale displacement in these countries. After a scoping review, we conducted qualitative in-depth interviews during 2018 with 39 stakeholders from different disciplines and agencies in these three countries. A validation workshop was held with a selection of 13 interviewees and four project partners. Malnutrition and a lack of vaccination of displaced people are well-known challenges, while mental health problems and gender-based violence (GBV) are less visible to stakeholders. In particular, the needs of IDPs are not well understood. The treatment of mental health and GBV is insufficient, and IDPs have inadequate access to essential health services in refugee camps. Needs assessment and program evaluations with a patients’ perspective are either lacking or inadequate in most situations. The Horn of Africa is facing chronic food insecurity, poor population health and mass displacement. IDPs are an underserved group, and mental health services are lacking. A development approach is necessary that moves beyond emergency responses to the building of long-term resilience, the provision of livelihood support and protection to reduce displacement by droughts. Full article

The United Nations’ Sustainable Development Goal 3 is to ensure health and well-being for all at all ages with a specific target to end malaria by 2030. Aligned with this goal, the primary objective of this study is to determine the effectiveness of utilizing local spatial variations to uncover the statistical relationships between malaria incidence rate and environmental and behavioral factors across the counties of Kenya. Two data sources are used—Kenya Demographic and Health Surveys of 2000, 2005, 2010, and 2015, and the national Malaria Indicator Survey of 2015. The spatial analysis shows clustering of counties with high malaria incidence rate, or hot spots, in the Lake Victoria region and the east coastal area around Mombasa; there are significant clusters of counties with low incidence rate, or cold spot areas in Nairobi. We apply an analysis technique, geographically weighted regression, that helps to better model how environmental and social determinants are related to malaria incidence rate while accounting for the confounding effects of spatial non-stationarity. Some general patterns persist over the four years of observation. We establish that variables including rainfall, proximity to water, vegetation, and population density, show differential impacts on the incidence of malaria in Kenya. The El-Nino–southern oscillation (ENSO) event in 2015 was significant in driving up malaria in the southern region of Lake Victoria compared with prior time-periods. The applied spatial multivariate clustering analysis indicates the significance of social and behavioral survey responses. This study can help build a better spatially explicit predictive model for malaria in Kenya capturing the role and spatial distribution of environmental, social, behavioral, and other characteristics of the households. Full article

Background: Quality pharmaceutical services are an integral part of primary healthcare and a key determinant of patient outcomes. The study focuses on pharmaceutical service delivery among private healthcare facilities serving informal settlements within Nairobi County, Kenya and aims at understanding the drug procurement practices, task-shifting and ethical issues associated with drug brand preference, competition and disposal of expired drugs. Methods: Forty-five private facilities comprising of hospitals, nursing homes, health centres, medical centres, clinics and pharmacies were recruited through purposive sampling. Structured electronic questionnaires were administered to 45 respondents working within the study facilities over an 8-week period. Results: About 50% of personnel carrying out drug procurement belonged to non-pharmaceutical cadres namely; doctors, clinical officers, nurses and pharmacy assistants. Drug brand preferences among healthcare facilities and patients were mainly pegged on perceived quality and price. Unethical business competition practices were recorded, including poor professional demeanour and waiver of consultation fees veiled to undercut colleagues. Government subsidized drugs were sold at 100% profit in fifty percent of the facilities stocking them. In 44% of the facilities, the disposal of expired drugs was not in conformity to existing government regulatory guidelines. Conclusions: There is extensive task-shifting and delegation of pharmaceutical services to non-pharmaceutical cadres and poor observance of ethical guidelines in private facilities. Strict enforcement of regulations is required for optimal practices. Full article