Coastal Kenya Research Articles

Determinants of sustainability for community based water projects: the case of Hazina ya Maendeleo ya Pwani in coastal Kenya

Sustainability of development projects is considered essential for the continued delivery of services to beneficiary communities beyond external financing. However, various factors cause community projects to fail the sustainability test. This study investigated the determinants of sustainability for community-based water projects implemented through World Bank and Kenya Government financing known as Hazina ya Maendeleo ya Pwani. Research was conducted using sustainability criteria comprising social, organizational, technical and financial aspects that were selected based on literature review and community perceptions. The research was conducted in Kenya’s coastal region using data collected from 285 respondents. Frequencies, means and percentages were used to describe data while the Structural Equation Modeling technique determined factors influencing sustainability. Results illustrated that all the four indicators assessed predict sustainability. However, only the technical and financial indicators influence sustainability significantly. In conclusion, while it is important to incorporate all the four indicators during planning and designing of community-based water projects, special attention must focus on financial and technical aspects. The study recommends that building the capacity of Community Based Organizations in terms of technical competence and financial resources to support operation and maintenance is a requirement, rather than a choice, for sustainability of community-based water projects.

Effect of initial handling by artisanal fishermen on the quality of penaeid shrimps in Kurawa on the north coast of Kenya

This study was conducted to determine the effect of initial handling on the quality of shrimps during and after catch by the artisanal fishermen in Kurawa on the north coast of Kenya. Fishermen collected shrimps from salt ponds and carried them using both insulated and bucket containers. A portion of samples was preserved with ice immediately after catch (control), while the rest were carried in buckets to the landing site and a portion preserved immediately upon arrival (0-hr). The remaining samples were sub-sampled and preserved with ice after 2 hours (2-hr), 4 hours (4-hr) and 6 hours (6-hr), respectively. Biochemical parameters (Total Volatile Bases - Nitrogen, Trimethylamine-Nitrogen, Peroxide Value, p-Anisidine Value) and proximate composition parameters (dry matter, protein, fat and ash content) were used to monitor quality changes of samples with delayed icing. Results showed a significant increase (p < 0.05) in biochemical parameter values over time. This indicated progressive deterioration in quality of shrimp with increased delay in icing. Samples preserved immediately after catch (control) exhibited best quality, followed by 0-hr, 2-hr, 4-hr and 6-hr samples, respectively. In general, increased delay in icing caused significant deterioration of shrimp quality although most samples remained within acceptable standard quality limits for the 6-hr delayed icing period.

Characterisation of artisanal catches in selected fishing areas of the Lower Tana Delta and Malindi-Ungwana Bay, Kenya

Shore-based assessment of fisheries resources in Ngomeni, Kipini and Ozi fishing areas of Malindi-Ungwana Bay and the Lower Tana Delta on the north coast of Kenya was conducted from January to December 2017 to establish catch composition, species richness, and fishing effort (catch-rate, number and types of fishing gears and crafts) in the marine, estuarine and riverine habitats. Distinct catch composition (R = 0.27, P < 0.05) was observed across the three habitats. Catch composition differed significantly spatially and seasonally across the three fishing areas, and between the north east (NE) and south east (SE) monsoon seasons (R = 0.332, P < 0.05). The wolf herring, Chirocentrus dorab, was the most abundant fish species in Ngomeni, centrally located in Malindi-Ungwana Bay, while the catfishes, Arius africanus and Clarias gariepinus, were the most abundant species in Kipini and Ozi, respectively. Gillnets operated from dhows (mashua) and fibre-reinforced plastic (FRP) boats in Ngomeni (marine), and canoes using-basket traps in Ozi (riverine), landed significantly larger Spanish mackerel, Scomberomorus commerson, and sea catfish, Arius africanus (Kruskal Wallis test: Df = 2; F = 197.141; p < 0.001; Df = 2, F = 490, p < 0.001), respectively. Species diversity by area in combination with habitat and type of fishing craft showed higher diversity for Ngomeni in the marine habitat with mashua fishing crafts than in Kipini. Significantly different catch rates (Df = 2, F = 10.43, p<0.001; Df = 1, F = 5.897, p < 0.021) were observed in the three (3) fishing areas and during the NE monsoon and the SE monsoon, respectively. Canoes were the most common fishing craft used, especially in Ngomeni, accounting for 37.1%, and 97.5% in Ozi, while mashua crafts accounted for 44.5% of the total fishing craft in Kipini. Monofilament nets were most common in Ngomeni (34.0%) while basket traps dominated the Ozi site at 63.6%. The Kipini area was dominated by handlines (28.8%). It is therefore evident that the three (3) fishing areas of the Malindi-Ungwana Bay and Lower Tana Delta showed significant differences in catch composition and size of fish caught, attributed partly to the variation in habitat types and fishing methods between the sites. Overall, the Ngomeni area was characterized by more advanced fishing craft with the majority powered by engines, including mashua and FRP boats, compared to Kipini and Ozi fishing areas where canoes were dominant.

The reliability, validity and factorial structure of the Swahili version of the 7-item generalized anxiety disorder scale (GAD-7) among adults living with HIV from Kilifi, Kenya

BackgroundGeneralized Anxiety Disorder (GAD) is under-investigated in people living with HIV/AIDS from sub-Saharan Africa. In part, this is due to paucity of culturally appropriate measures for GAD which are psychometrically robust. This study aimed to evaluate the reliability, factorial structure, and validity of Swahili version of the 7-item GAD questionnaire (GAD-7) among adults living with HIV.Study designDescriptive cross-sectional study.Methods450 adults receiving comprehensive care from an HIV specialized clinic in Kilifi County, coastal Kenya, were consecutively recruited. Swahili versions of GAD-7, Patient Health Questionnaire (PHQ-9) and a 12-item HIV stigma scale were administered alongside measures of psychosocial and health-related characteristics. Internal consistency, test–retest reliability, factorial structure, convergent validity, and discriminant validity of Swahili GAD-7 were examined using Cronbach’s alpha (α), intra-class correlation coefficient (ICC), Confirmatory Factor Analysis (CFA), Pearson’s correlation, and analysis of covariance (ANCOVA), respectively.ResultsInternal consistency of Swahili GAD-7 was good, α = 0.82 (95% CI 0.78, 0.85). Its test–retest reliability (2 weeks apart) was acceptable, ICC = 0.70 (95% CI 0.55, 0.81). A confirmatory analysis of a one-factor solution indicated an excellent fit to the hypothesized structure (RMSEA = 0.00 [95% confidence interval 0.00, 0.05], CFI = 1.00, TLI = 1.00). Multi-group CFA substantiated factorial invariance for sex and age for the one-factor structure of Swahili GAD-7. Scores of GAD-7, Swahili version, significantly correlated with those of PHQ-9 (r = 0.73; p < 0.001) and the HIV stigma scale (r = 0.36; p < 0.001) suggesting good convergent validity. Statistically significant differences were observed between participants on first-line antiretroviral therapy compared to those on second-line treatment (F [1, 441] = 5.55, p = 0.02) indicative of good discriminant validity of Swahili GAD-7.ConclusionGAD-7 Swahili version retained its original unidimensional latent structure with good psychometric properties among adults living with HIV from Kilifi, Kenya. It can be used to identify symptoms of GAD in similar research settings. However, to confidently identify those in need of mental health treatment or referral services in HIV primary care clinics, more research on the validity of Swahili GAD-7 is needed especially its discriminant validity and diagnostic accuracy at different cut-off scores.

Incentivization of Coastal Tourism Product Through Heritagization As a Value-addition Strategy for Kenya's Coastal Destinations

Kenya's coastal strip has not yet developed a tourism product beyond the three Ss (sun, sand, and sea). Consequently, Kenya's coastal tourism has been regarded as "tired" and less competitive product in today's marketplace. This is despite the coastal strip boasting of rich untapped heritage tourism potential. Thus, even though heritage tourism has gained attention in academia and generated a growing body of literature, its application as a value-addition strategy has hardly been investigated. This study explored how Kenya's coastal tourism destination, with a declining touristic appeal, can be incentivized using heritage to stimulate an enhanced tourism experience. The study conveniently sampled seven heritage sites at the Kenyan coast. Within the sites, a site manager/representative and a tour guide were purposely sampled. In total, 15 heritage site managers and 10 tour guides participated in the study through unstructured in-depth interviews. Systematic literature review as well as field observations were also done. The article argues that traditional coastal tourism products can be enhanced through heritagization to spur sustainability. The study concludes that for Kenya's coastal tourism to rebound, beach tourism cannot continue to be a stand-alone tourism product. Instead, heritage sites need to be integrated into the existing beach tourism offer to create a holistic presentation of Kenya's coastal destination with enriched customer experience.

Analysis of Combining Ability for Early Maturity and Yield in Rice (Genus: Oryza) at the Kenyan Coast

The main challenges facing rain-fed rice farming in Kilifi County at the Kenyan coast are inadequate and erratic rainfall, inadequate skills, and poorly developed infrastructure. Of great importance is erratic rainfall that tends to depress towards the end of long rain season, leading to crop failure. Combining ability analysis is one of the most valuable tools used to ascertain gene action effects and help in selecting desirable parents for making crosses and coming up with high yielding and early maturing lines. Combining ability for early maturity and yield has not been studied at the Kenyan coast. This study aimed at determining and identifying good, general, and specific combiners for selecting better parents and better cross combinations in rice crops for developing high yield and short duration lines in rain-fed rice farming. Seven lines were subjected to half-diallel mating design at the Kenya Agricultural and Livestock Research Organization (KALRO), Mtwapa, and at Bahari in Kilifi town. Evaluation for general combining ability (GCA) and specific combining ability (SCA) analysis was done. Combining ability variance and GCA and SCA effects were determined. Based on GCA effects, best parent for early maturity was Dourado Precoce, while for yield, Supaa, Komboka, and NERICA 10. SCA estimates indicated that best crosses for yield were D/S, D/N1, and K/N10, while the best performing cross for early maturity was D/N1.

Pooled testing conserves SARS-CoV-2 laboratory resources and improves test turn-around time: experience on the Kenyan Coast

Background. International recommendations for the control of the coronavirus disease 2019 (COVID-19) pandemic emphasize the central role of laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent, at scale. The availability of testing reagents, laboratory equipment and qualified staff are important bottlenecks to achieving this. Elsewhere, pooled testing (i.e. combining multiple samples in the same reaction) has been suggested to increase testing capacities in the pandemic period. Methods. We discuss our experience with SARS-CoV-2 pooled testing using real-time reverse transcription polymerase chain reaction (RT-PCR) on the Kenyan Coast. Results. In mid-May, 2020, our RT-PCR testing capacity for SARS-CoV-2 was improved by ~100% as a result of adoption of a six-sample pooled testing strategy. This was accompanied with a concomitant saving of ~50% of SARS-CoV-2 laboratory test kits at both the RNA extraction and RT-PCR stages. However, pooled testing came with a slight decline of test sensitivity. The RT-PCR cycle threshold value (ΔCt) was ~1.59 higher for samples tested in pools compared to samples tested singly. Conclusions. Pooled testing is a useful strategy to increase SARS-CoV-2 laboratory testing capacity especially in low-income settings.

Patterns of individual non-treatment during multiple rounds of mass drug administration for control of soil-transmitted helminths in the TUMIKIA trial, Kenya: a secondary longitudinal analysis

SummaryBackgroundFew studies have been done of patterns of treatment during mass drug administration (MDA) to control neglected tropical diseases. We used routinely collected individual-level treatment records that had been collated for the Tuangamize Minyoo Kenya Imarisha Afya (Swahili for Eradicate Worms in Kenya for Better Health [TUMIKIA]) trial, done in coastal Kenya from 2015 to 2017. In this analysis we estimate the extent of and factors associated with the same individuals not being treated over multiple rounds of MDA, which we term systematic non-treatment.MethodsWe linked the baseline population of the TUMIKIA trial randomly assigned to receive biannual community-wide MDA for soil-transmitted helminthiasis to longitudinal records on receipt of treatment in any of the four treatment rounds of the study. We fitted logistic regression models to estimate the association of non-treatment in a given round with non-treatment in the previous round, controlling for identified predictors of non-treatment. We also used multinomial logistic regression to identify factors associated with part or no treatment versus complete treatment.Findings36 327 participants were included in our analysis: 16 236 children aged 2–14 years and 20 091 adults aged 15 years or older. The odds of having no treatment recorded was higher if a participant was not treated during the previous round of MDA (adjusted odds ratio [OR] 3·60, 95% CI 3·08–4·20 for children and 5·58, 5·01–6·21 for adults). For children, school attendance and rural residence reduced the odds of receiving part or no treatment, whereas odds were increased by least poor socioeconomic status and living in an urban or periurban household. Women had higher odds than men of receiving part or no treatment. However, when those with pregnancy or childbirth in the previous 2 weeks were excluded, women became more likely to receive complete treatment. Adults aged 20–25 years were the age group with the highest odds of receiving part (OR 1·41, 95% CI 1·22–1·63) or no treatment (OR 1·81, 95% CI 1·53–2·14).InterpretationNon-treatment was associated with specific sociodemographic groups and characteristics and did not occcur at random. This finding has important implications for MDA programme effectiveness, the relevance of which will intensify as disease prevalence decreases and infections become increasingly clustered.FundingBill & Melinda Gates Foundation, Joint Global Health Trials Scheme of the Medical Research Council, UK Department for International Development, Wellcome Trust, Children's Investment Fund Foundation, and London Centre for Neglected Tropical Diseases.

The relationship between facility-based malaria test positivity rate and community-based parasite prevalence.

IntroductionMalaria surveillance is a key pillar in the control of malaria in Africa. The value of using routinely collected data from health facilities to define malaria risk at community levels remains poorly defined.MethodsFour cross-sectional parasite prevalence surveys were undertaken among residents at 36 enumeration zones in Kilifi county on the Kenyan coast and temporally and spatially matched to fever surveillance at 6 health facilities serving the same communities over 12 months. The age-structured functional form of the relationship between test positivity rate (TPR) and community-based parasite prevalence (PR) was explored through the development of regression models fitted by alternating the linear, exponential and polynomial terms for PR. The predictive ranges of TPR were explored for PR endemicity risk groups of control programmatic value using cut-offs of low (PR <5%) and high (PR ≥ 30%) transmission intensity.ResultsAmong 28,134 febrile patients encountered for malaria diagnostic testing in the health facilities, 12,143 (43.2%: 95% CI: 42.6%, 43.7%) were positive. The overall community PR was 9.9% (95% CI: 9.2%, 10.7%) among 6,479 participants tested for malaria. The polynomial model was the best fitting model for the data that described the algebraic relationship between TPR and PR. In this setting, a TPR of ≥ 49% in all age groups corresponded to an age-standardized PR of ≥ 30%, while a TPR of < 40% corresponded to an age-standardized PR of < 5%.ConclusionA non-linear relationship was observed between the relative change in TPR and changes in the PR, which is likely to have important implications for malaria surveillance programs, especially at the extremes of transmission. However, larger, more spatially diverse data series using routinely collected TPR data matched to community-based infection prevalence data are required to explore the more practical implications of using TPR as a replacement for community PR.

Habitat use of the endangered golden‐rumped sengi Rhynchocyon chrysopygus

AbstractThe endangered golden‐rumped sengi are found only in Arabuko‐Sokoke Forest with 395.4 km2 of forest habitat, and perhaps in a few isolated forest and thicket fragments of total area less than 30 km2 all within central coastal Kenya. Understanding its habitat use is an important requirement to develop better conservation measures for the species and its remaining forest habitat. A more reliable method for monitoring its status is also needed. We used the Bayesian occupancy modelling with camera trap data and habitat mapping to characterise the species habitat use in the Arabuko‐Sokoke Forest. The species uses 328 km2 (95% CI: 289–364 km2) of Arabuko‐Sokoke Forest habitat, and its site use increases with distance from forest edge, with the highest site use in the Cynometra thicket (0.93; 95% CI: 0.82–1). Its use of the mixed forest habitat has been significantly reduced following years of logging of Afzelia quanzensis. We recommend the use of modelled occupancy, interpreted as the proportion of area used by the species, to monitor the species status. Occupancy models account for detection probability, and heterogeneity in site use and detection can be incorporated. Estimated territory sizes can be combined to obtain abundance estimates.

Factors influencing financial performance in marine small-scale fisheries value chain in Kenya

Factors influencing financial performance in marine small-scale fisheries are numerous but are scantily documented and tested, more so from the Structure-Conduct-Performance perspective. The present study empirically tested influence of structure in context value of equipment, on actors’ conduct in context of price collusion, choice of products, access to market information and power to determine prices, and how these and other factors influenced performance in terms of profitability. Data was collected through field interviews targeting 403 actors (fishers, middlemen and small-scale processors) at five sites along the Kenyan coast. Binomial, multinomial, ordinary least squares regressions and regressions with instrumental variables were used in data analysis. Findings revealed that structure did not significantly influence actors conduct, while both structure and conduct influenced performance only on a few variables and actors. Instead other non-Structure-Conduct-Performance variables influenced performance across all actor groups. Increasing sales, improved profitability, while increasing variable and fixed costs decreased profitability. Results of the study provide important insights on actor behaviour that are useful for policy and value chain development interventions.

Evaluation of popular cassava varieties for yield and cyanide content underASAL conditions in Kenya

Cassava (Manihot esculenta Crantz) is a staple food crop grown by smallholder farmers in the marginal regions of western, coastal and eastern Kenya. The objective of this study was to evaluate popular cassava varieties for yield and cyanide content in the arid and semi-arid regions of Kenya. The study was carried out at five sites located in three sub-counties of Nakuru county in Kenya. Treatments included a collection of 27 sweet cassava varieties obtained from Western Kenya. Results revealed significant variations among varieties in all sites, for all parameters measured. The highest yields were obtained at Subukia, with the variety MM99/0067 yielding up to 200 t ha-1. Cyanide content varied significant among the varieties and sites; and was high in most of the cultivars, with highest levels recorded in variety Rao Onyoni (17.3 mg100 g-1) grown at the Lare site. The highest dry matter content was recorded in variety Selele rabuor (60.5%), at the Solai III site. Participating farmers ranked the materials based on yield, taste and order of general preference as follows: Subukia site (MM96/0067, NyaTanga, Adhiambo Lera, KME-1 and MH95/0183); Lare site (Nyar AICAD, Nyar Maseno, NyaTanga, and MM96/2480); and Solai site (KME-1, Nyar AICAD, Adhiambo Lera, Karembo, and Obaro dak).

Evaluation of popular cassava varieties for yield and cyanide content under ASAL conditions in Kenya

Cassava (Manihot esculenta Crantz) is a staple food crop grown by smallholder farmers in the marginal regions of western, coastal and eastern Kenya. The objective of this study was to evaluate popular cassava varieties for yield and cyanide content in the arid and semi-arid regions of Kenya. The study was carried out at five sites located in three sub-counties of Nakuru county in Kenya. Treatments included a collection of 27 sweet cassava varieties obtained from Western Kenya. Results revealed significant variations among varieties in all sites, for all parameters measured. The highest yields were obtained at Subukia, with the variety MM99/0067 yielding up to 200 t ha-1. Cyanide content varied significant among the varieties and sites; and was high in most of the cultivars, with highest levels recorded in variety Rao Onyoni (17.3 mg100 g-1) grown at the Lare site. The highest dry matter content was recorded in variety Selele rabuor (60.5%), at the Solai III site. Participating farmers ranked the materials based on yield, taste and order of general preference as follows: Subukia site (MM96/0067, NyaTanga, Adhiambo Lera, KME-1 and MH95/0183); Lare site (Nyar AICAD, Nyar Maseno, NyaTanga, and MM96/2480); and Solai site (KME-1, Nyar AICAD, Adhiambo Lera, Karembo, and Obaro dak).

Risk factors for loss to follow-up among at-risk HIV negative men who have sex with men participating in a research cohort with access to pre-exposure prophylaxis in coastal Kenya.

IntroductionRetention in preventive care among at‐risk men who have sex with men (MSM) is critical for successful prevention of HIV acquisition in Africa. We assessed loss to follow‐up (LTFU) rates and factors associated with LTFU in an HIV vaccine feasibility cohort study following MSM with access to pre‐exposure prophylaxis (PrEP) in coastal Kenya.MethodsBetween June 2017 and June 2019, MSM cohort participants attending a research clinic 20 km north of Mombasa were offered daily PrEP and followed monthly for risk assessment, risk reduction counselling and HIV testing. Participants were defined as LTFU if they were late by >90 days for their scheduled appointment. Participants who acquired HIV were censored at diagnosis. Cox proportional hazards models were used to estimate adjusted Hazard Ratio (aHR) of risk factors for LTFU.Results and discussionA total of 179 participants with a median age of 25.0 years (interquartile range [IQR]: 23.0 to 30.0) contributed a median follow‐up time of 21.2 months (IQR: 6.5 to 22.1). Of these, 143 (79.9%) participants started PrEP and 76 (42.5%) MSM were LTFU, for an incidence rate of 33.7 (95% confidence interval [CI], 26.9 to 42.2) per 100 person‐years. Disordered alcohol use (aHR: 2.3, 95% CI, 1.5 to 3.7), residence outside the immediate clinic catchment area (aHR: 2.5, 95% CI, 1.3 to 4.6 for Mombasa Island; aHR: 1.8, 95% CI, 1.0 to 3.3 for south coast), tertiary education level or higher (aHR: 2.3, 95% CI, 1.1 to 4.8) and less lead‐in time in the cohort prior to 19 June 2017 (aHR: 3.1, 95% CI, 1.8 to 5.6 for zero to three months; aHR: 2.4, 95% CI, 1.2 to 4.7 for four to six months) were independent predictors of LTFU. PrEP use did not differ by LTFU status (HR: 1.0, 95% CI, 0.6 to 1.5). Psychosocial support for men reporting disordered alcohol use, strengthened engagement of recently enrolled participants and focusing recruitment on areas close to the research clinic may improve retention in HIV prevention studies involving MSM in coastal Kenya.ConclusionsAbout one in three participants became LTFU after one year of follow‐up, irrespective of PrEP use. Research preparedness involving MSM should be strengthened for HIV prevention intervention evaluations in coastal Kenya.

Presence of microplastics in benthic macroinvertebrates along the Kenyan coast

Microplastics (MPs) are plastics less than 5 mm in diameter. Their small size renders them invisible to deposit- and filter-feeding fauna, leading to unintentional ingestion. This study investigated the presence of MPs in an oyster (Saccostrea cuccullata) and three species of brachyuran crabs (Tubuca dussumieri, Cranuca inversa and Gelasimus vocans) along the Kenyan coast. Sampling was carried out at eight stations distributed between three sites: Tudor, Port Reitz and Mida creeks, in January and February 2018, during low spring tide. The sample comprised 206 crabs and 70 oysters. Samples were digested using 10% KOH at 60 °C for 24 hours and then passed through 38-µm sieves. Sieved products (<38 µm) were filtered through Whatman filter membranes (0.8 µm) and viewed under a dissecting microscope for MPs. The study identified mainly MP fibres, which were of different colours: red, yellow, black, pink, orange, purple, green, blue and colourless. Colourless fibres were the most prevalent, comprising at least 60% of the total MPs. Mean lengths of MPs fibres of different colours were between 0.1 and 4.2 mm. The mean concentration of MPs (MPs g−1 wet tissue) was 0.65 (SE 0.13) in crabs and 3.36 (SE 0.53) in oysters, and the difference between the two taxa was significant (independent two-sample t-test: t = 5.61, df = 14, p = 0.01). The higher mean concentration in oysters was attributed mainly to their filter-feeding habit. This study exposes MP pollution along the Kenyan coast and its uptake by marine fauna, and thus strengthens the case for better control of plastic wastes in the ocean.

A more responsive, multi-pronged strategy is needed to strengthen HIV healthcare for men who have sex with men in a decentralized health system: qualitative insights of a case study in the Kenyan coast.

IntroductionHIV healthcare services for men who have sex with men (MSM) in Kenya have not been openly provided because of persistent stigma and lack of healthcare capacity within Kenya’s decentralized health sector. Building on an evaluation of a developed online MSM sensitivity training programme offered to East and South African healthcare providers, this study assessed views and responses to strengthen HIV healthcare services for MSM in Kenya.MethodsThe study was conducted between January and July 2017 in Kilifi County, coastal Kenya. Seventeen policymakers participated in an in‐depth interview and 59 stakeholders, who were purposively selected from three key groups (i.e. healthcare providers, implementing partners and members of MSM‐led community‐based organizations) took part in eight focus group discussions. Discussions aimed to understand gaps in service provision to MSM from different perspectives, to identify potential misconceptions, and to explore opportunities to improve MSM HIV healthcare services. Interviews and focus group discussions were recorded, transcribed verbatim and analysed using Braun and Clarke’s thematic analysis.ResultsParticipants’ responses revealed that all key groups navigated diverse challenges related to MSM HIV health services. Specific challenges included priority‐setting by county government staff; preparedness of leadership and management on MSM HIV issues at the facility level; data reporting at the implementation level and advocacy for MSM health equity. Strong power inequities were observed between policy leadership, healthcare providers and MSM, with MSM feeling blamed for their sexual orientation. MSM agency, as expressed in their actions to access HIV services, was significantly constrained by county context, but can potentially be improved by political will, professional support and a human rights approach.ConclusionsTo strengthen HIV healthcare for MSM within a decentralized Kenyan health system, a more responsive, multi‐pronged strategy adaptable and relevant to MSM’s healthcare needs is required. Continued engagement with policy leadership, collaboration with health facilities, and partnerships with different community stakeholders are critical to improve HIV healthcare services for MSM.

VP34.27: Qualitative assessment of the feasibility and acceptability of a low‐cost device for gestational age assessment in a low‐resource setting

The transcerebellar (TraCer) tool is a low-cost wireless probe linked to a commercially available tablet computer, with an artificial intelligence based software interface created to assess the fetal head circumference and transcerebellar diameter and provide a gestational age (GA). In this study we evaluate the acceptability, feasibility and the role of the TraCer tool in a low-resource setting. The study was set in two health facilities in rural and peri-urban coastal Kenya. Prior to data collection, study participants were shown a video role-play on the use of TraCer at a typical antenatal care visit. Qualitative data were collected from pregnant women and their families through six focus group discussions (n = 52) and from 18 interviews with health care workers and managers. We applied thematic analysis using an a priori framework. Women and their family members felt that the tool would fit easily into usual antenatal care and that it would be of value particularly in women uncertain of their last menstrual period (LMP). However, there was a tendency for women to perceive the tool as providing a reassurance of fetal well-being rather than GA assessment. Nurses / midwives felt the tool could be easily implemented and would boost their confidence and positive image in the community. Health care managers viewed it as implementable but did express concern regarding increased workload with limited staff. There were suggestions to reserve its use for women with uncertain or unknown LMP only. Unanimously, nurses were deemed the most appropriate cadre to use the tool. The need for appropriate training of providers was emphasised. The use of TraCer was perceived to be acceptable and feasible in coastal Kenya. This work informs the development of a simple training program and key patient communication messages to guide implementation. These are prerequisites for wider scale clinical testing.

Risk factors for Aedes aegypti household pupal persistence in longitudinal entomological household surveys in urban and rural Kenya

BackgroundAedes aegypti is an efficient vector of several arboviruses of public health importance, including Zika and dengue. Currently vector management is the only available avenue for disease control. Development of efficient vector control strategies requires a thorough understanding of vector ecology. In this study, we identified households that are consistently productive for Ae. aegypti pupae and determined the ecological and socio-demographic factors associated with the persistence and abundance of pupae in households in rural and urban Kenya.MethodsWe collected socio-demographic, environmental and entomological data monthly from July 2014 to June 2018 from 80 households across four sites in Kenya. Pupae count data were collected via entomological surveillance of households and paired with socio-demographic and environmental data. We calculated pupal persistence within a household as the number of months of pupal presence within a year. We used spatially explicit generalized additive mixed models (GAMMs) to identify the risk factors for pupal abundance, and a logistic regression to identify the risk factors for pupal persistence in households.ResultsThe median number of months of pupal presence observed in households was 4 and ranged from 0 to 35 months. We identified pupal persistence in 85 house-years. The strongest risk factors for high pupal abundance were the presence of bushes or tall grass in the peri-domicile area (OR: 1.60, 95% CI: 1.13–2.28), open eaves (OR: 2.57, 95% CI: 1.33–4.95) and high habitat counts (OR: 1.42, 95% CI: 1.21–1.66). The main risk factors for pupal persistence were the presence of bushes or tall grass in the peri-domicile (OR: 4.20, 95% CI: 1.42–12.46) and high number of breeding sites (OR: 2.17, 95% CI: 1.03–4.58).ConclusionsWe observed Ae. aegypti pupal persistence at the household level in urban and rural and in coastal and inland Kenya. High counts of potential breeding containers, vegetation in the peri-domicile area and the presence of eaves were strongly associated with increased risk of pupal persistence and abundance. Targeting households that exhibit pupal persistence alongside the risk factors for pupal abundance in vector control interventions may result in more efficient use of limited resources.

A Malagasy element in Continental Africa: a new subspecies of the rare Amauris nossima (Nymphalidae, Danainae) from the Kenyan coast

Amauris nossima Ward (Nymphalidae, Danainae) was known before this study only from Madagascar and the island of Mayotte, without clearly defined subspecies, but with five names considered invalid or infrasubspecific. It has generally been considered a rare species of butterfly classified by IUCN as vulnerable (Vu B1 + 2c). Here, it is reported for the first time from continental Africa. A new subspecies A. nossima mrima n. ssp. is described from two remnants of rain forest, Mrima and Buda, on the southern Kenyan coast, where it occurs sympatrically with Amauris ochlea Boisduval, widely distributed in East Africa. Their, previously predicted, sister-species status is confirmed by morphological (male and female genitalia) and partial mitochondrial (COI) data. The finding of A. nossima in Kenya opens the discussion on a possible recolonization of Africa from Madagascar, which would be an exception to a predominant biogeographical pattern of African origin of Malagasy butterflies via overseas dispersal.

Movement and habitat use of striped marlin Kajikia audax in the Western Indian Ocean.

Striped marlin Kajikia audax are globally Near Threatened and their stock in the Indian Ocean was last assessed as "overfished and subject to overfishing". Significant gaps in our understanding of their ecology remain, hampering the efforts of fisheries managers to ensure stock sustainability. There is a particular lack of fisheries-independent data. Here we present the results from the first large-scale satellite tracking study of K. audax in the Indian Ocean. We tagged 49 K. audax with pop-up archival satellite-linked tags off the Kenyan coast from 2015 to 2019. Individuals were highly mobile, covering horizontal distances of up to 9187 km over periods ranging up to 183 days, with a mean daily distance of ~48 km. Long-distance movements were recorded to the east and north of East Africa, with the most distant tracks extending north to the Arabian Sea and east to near the Maldives. None of the K. audax swam south of East Africa. Kernel utilization distributions of fish locations demonstrated their shifting seasonal activity hotspots. Over the sport-fishing season (and tagging period) in Kenya, from December to March, K. audax typically stayed off the East African coast. After March, the activity hotspot shifted north to a region close to the Horn of Africa and Socotra Island. Remotely sensed sea surface temperature and chlorophyll-a maps indicated that this seasonal movement could be driven by a shift in prey availability. Our results show the high mobility of K. audax in the Western Indian Ocean, and that individuals seasonally range between two major fishing areas.