Homa Bay County Research Articles

Asymptomatic and submicroscopic Plasmodium infections in an area before and during integrated vector control in Homa Bay, western Kenya

BackgroundLong-lasting insecticidal nets (LLINs) have been the primary vector control strategy until indoor residual spraying (IRS) was added in Homa Bay and Migori Counties in western Kenya. The objective of this study was to evaluate the impact of LLINs integrated with IRS on the prevalence of asymptomatic and submicroscopic Plasmodium infections in Homa Bay County.MethodsA two-stage cluster sampling procedure was employed to enroll study participants aged ≥ 6 months old. Four consecutive community cross-sectional surveys for Plasmodium infection were conducted in residents of Homa Bay county, Kenya. Prior to the start of the study, all study households received LLINs, which were distributed between June 2017 and March 2018. The first (February 2018) and second (June 2018) surveys were conducted before and after the first round of IRS (Feb–Mar 2018), while the third (February 2019) and fourth (June 2019) surveys were conducted before and after the second application of IRS (February–March 2019). Finger-prick blood samples were obtained to prepare thick and thin smears for microscopic determination and qPCR diagnosis of Plasmodium genus.ResultsPlasmodium spp. infection prevalence by microscopy was 18.5% (113/610) before IRS, 14.2% (105/737) and 3.3% (24/720) after the first round of IRS and 1.3% (11/849) after the second round of IRS (p < 0.0001). Submicroscopic (blood smear negative, qPCR positive) parasitaemia reduced from 18.9% (115/610) before IRS to 5.4% (46/849) after IRS (p < 0.0001). However, the proportion of PCR positive infections that were submicroscopic increased from 50.4% (115/228) to 80.7% (46/57) over the study period (p < 0.0001). Similarly, while the absolute number and proportions of microscopy positives which were asymptomatic decreased from 12% (73/610) to 1.2% (9/849) (p < 0.0001), the relative proportion increased. Geometric mean density of P. falciparum parasitaemia decreased over the 2-year study period (p < 0.0001).ConclusionsThese data suggest that two annual rounds of IRS integrated with LLINs significantly reduced the prevalence of Plasmodium parasitaemia, while the proportion of asymptomatic and submicroscopic infections increased. To reduce cryptic P. falciparum transmission and improve malaria control, strategies aimed at reducing the number of asymptomatic and submicroscopic infections should be considered.

Determinants of Health Facilities Influencing Utilization of Free Maternity Services Among Women of Reproductive Age 15-49 Years Attending Health Facilities in Homa-Bay County

Free maternity services is the offering of medical and obstetric care to pregnant women without any financial cost. Complications related to pregnancy were a major reproductive health problem that lead to disability and increased maternal deaths. Free maternity was introduced in Kenya in 2013 with a focus of achieving 100% utilization of the service and reducing high mortality rate. Homa-Bay County had a low percentage of 54% deliveries taking place in health facilities within the county. The main objective of this study was to establish Determinants of Health facilities Influencing Utilization of Free Maternity Services among Women of Reproductive Age 15-49 Years Attending Health Facilities in Homa-Bay County. Descriptive cross-sectional study design was applied to establish the main objective of this study. A probability and non-probability sampling techniques was used to select 420 respondents. The study utilized quantitative and qualitative methods of data collection. Data analysis was conducted with aid of Statistical Package for Social Scientists (SPSS) version 23. Analysis methods used were; factor analysis and regression analyses methods for quantitative data to determine the relationship and associations among the variables. Qualitative data was analyzed through content analysis by conducting thematic analysis. A total of 396 that was 94% response rate established 54% (213/396) mothers were interviewed and were aged between 20 years and 29years. Results showed that; age of the mothers was insignificant in utilization of free maternity services. Further analysis using logistics regression revealed that the respondents who agreed with the need for a well-equipped health facility with good sanitation system were 63% (OR 0.37, p = 0.03) more likely to reuse FMS. Distance was insignificant in utilization as long as the facility was well-equipped and adequately staffed as 57% (228/396).This study concluded that there was significant association between staff respect, and honesty of the staff with utilization of free maternity service. This study recommended that the County Government of Homa-Bay should increase awareness to women of reproductive age at the community level about FMS through Community health promotion officers in order to improve FMS uptake in Homa-Bay County.

Effect of self-assessment strategy on Mathematics performance of public secondary school students with learning difficulties in Homabay, Kenya

Introduction: There is a paradigm shift in thinking which requires authentic learning which led to focus on formative assessment. This concern has caused a challenge to educators. Educational experts have recommended the integration of student self-assessment strategy in learning process to address this challenge. Self-assessment is a process where learners reflect on the worth of their work, compare their work to the standards, identify gaps and revise appropriately. Purpose: This study was to determine the effect of self-assessment strategy on mathematics performance of public secondary school students with learning difficulties in Homa-Bay County, Kenya. Methodology: The study adopted a quasi-experimental, pretest-posttest, nonequivalent control group design. The study was carried out in secondary schools in Homa-Bay County. The population of the study consisted secondary school learners’ context, while the sample consisted of 60 form three learners. The instruments were determined as validated and reliable having been used in previous thesis studies after getting permission to use. Results: This study found out that the experimental group mean improvement index and standard deviation were higher than those of the control group. Even though the experimental group had a greater mean improvement index as well as the standard deviation, this was statistically insignificant from the t-test. The study concluded that student’ self-assessment strategy was effective in mathematics among secondary school students with learning difficulties. Recommendations: The study recommended that there was need for a step-up in the integration of the alternative assessment strategies in the classrooms as formative assessment methods to enhance more meaningful learning especially student self-assessment. Further, efforts should be made to ensure both teachers and students embrace the alternative forms of assessments especially self-assessments more so in this era of authenticity.

Implementation of Organizational Learning Strategy as a Determinant of Service Delivery at the County Government of Homa Bay

In recent years, the Homa Bay County government has been associated with poor service due to practices such as corruption, nepotism, and tribal relations. Additionally, Homa Bay County government officials have been charged with rudeness, inherent absenteeism, and therefore incompetence and inability to provide quality services to residents. The purpose of this study was the implementation of organizational learning strategy as a determinant of service delivery in the Homa Bay County government. This study used a descriptive research design and targeted 248 Homa Bay County government employees across all departments. The findings indicated that organizational learning strategy had a substantial positive association with service delivery. The study concluded that organizational learning strategy has an impact on service delivery. Learning organizations are characterized by a high level of motivation to learn and develop on the part of their employees. The study recommends continuous implementation of organizational learning strategy as the techniques should be viewed as management tactics that enable individuals to learn to accomplish beneficial outcomes including innovation, efficiency, environmental adaption, and competitive advantage.

Influence of Parent's Level of Income on Student's Enrolment in Secondary Schools in Rachuonyo East Sub-County, Homabay County, Kenya

Low enrolment rates in secondary schools have been experienced in Homabay County, in particular Rachuonyo East Sub-County. The purpose of the study was to establish the influence of family socioeconomic status on the enrolment of students in Secondary schools in Rachuonyo East Sub-County, Homabay County. A total of 13,786 respondents were targeted comprising 25 Principals, 9 Chiefs, 1 Sub-County Education officer, 5400 parents, and 8350 students. A sample of 355 respondents comprised of 14 Principals, 1 Sub-County Education Officer, 9 Chiefs, 15 parents, and 316 students was sampled for this study. The researcher used simple random sampling to sample the Secondary schools' students, while purposive sampling was applied to sample the principals, Chiefs, and the Sub- County officer. The study depended on questionnaires for students, while an Interview guide was used for Principals, Chiefs, Sub-County Educational officers, and parents. Piloting of research instruments was done in Rachuonyo East Sub-County, on 10% of the sample size. Test-retest technique was used to test for the reliability of the instruments; Cronbach Alpha was used to compute the instruments' reliability at 0.7. To ensure the validity of the research instruments, the instruments were developed under the close guidance of the supervisors. Dependability and credibility are enhanced in the research instruments. After data cleaning, the quantitative data was coded and entered into the computer for analysis using Statistical Package for Social Sciences (SPSS) Version 21 for windows which was analysed through descriptive and inferential statistics which was presented using percentages, frequencies, and coefficient correlation, respectively. Qualitative data was analysed in themes and presented in narrative form. Based on the findings received from the study, it was evident that the socioeconomic status of families had an effect on the enrolment of students in the Rachuonyo east sub-county. There were two strong positive correlations under the level of income objective. There was a high likelihood that students who came from low-income backgrounds would have challenges in enrolling on the next term or class. Additionally, lack of support from parents, demotivation, and indiscipline issues contributed to a decrease in the enrolment of students. It was also vital to note that the two most vulnerable issues that would decrease the enrolment of students were low-income levels and the lower level of education of parents

Determinants of Health Facilities Influencing Utilization of Free Maternity Services Among Women of Reproductive Age 15-49 Years Attending Health Facilities in Homa-Bay County

Determinants of Health Facilities Influencing Utilization of Free Maternity Services Among Women of Reproductive Age 15-49 Years Attending Health Facilities in Homa-Bay County

Irrigation-Induced Environmental Changes Sustain Malaria Transmission and Compromise Intervention Effectiveness.

Irrigated agriculture enhances food security, but it potentially promotes mosquito-borne disease transmission and affects vector intervention effectiveness. This study was conducted in the irrigated and nonirrigated areas of rural Homa Bay and Kisumu Counties, Kenya. We performed cross-sectional and longitudinal surveys to determine Plasmodium infection prevalence, clinical malaria incidence, molecular force of infection (molFOI), and multiplicity of infection. We examined the impact of irrigation on the effectiveness of the new interventions. We found that irrigation was associated with >2-fold higher Plasmodium infection prevalence and 3-fold higher clinical malaria incidence compared to the nonirrigated area. Residents in the irrigated area experienced persistent, low-density parasite infections and higher molFOI. Addition of indoor residual spraying was effective in reducing malaria burden, but the reduction was more pronounced in the nonirrigated area than in the irrigated area. Our findings collectively suggest that irrigation may sustain and enhance Plasmodium transmission and affects intervention effectiveness.

Potential application of the haematology analyser XN-31 prototype for field malaria surveillance in Kenya

BackgroundSimple and accurate diagnosis is a key component of malaria control programmes. Microscopy is the current gold standard, however it requires extensive training and the results largely rely on the skill of the microscopists. Malaria rapid diagnostic tests (RDT) can be performed with minimal training and offer timely diagnosis, but results are not quantitative. Moreover, some Plasmodium falciparum parasites have evolved and can no longer be detected by existing RDT. Developed by the Sysmex Corporation, the XN-31 prototype (XN-31p) is an automated haematology analyser capable of detecting Plasmodium-infected erythrocytes and providing species differentiation and stage specific parasite counts in venous blood samples without any preparation in approximately one minute. However, factors such as stable electricity supply in a temperature-controlled room, cost of the instrument and its initial set-up, and need for proprietary reagents limit the utility of the XN-31p across rural settings. To overcome some of these limitations, a hub and spoke diagnosis model was designed, in which peripheral health facilities were linked to a central hospital where detection of Plasmodium infections by the XN-31p would take place. To explore the feasibility of this concept, the applicability of capillary blood samples with the XN-31p was evaluated with respect to the effect of sample storage time and temperature on the stability of results.MethodsPaired capillary and venous blood samples were collected from 169 malaria-suspected outpatients in Homa Bay County Referral Hospital, Kenya. Malaria infections were diagnosed with the XN-31p, microscopy, RDT, and PCR. Capillary blood samples were remeasured on the XN-31p after 24 h of storage at either room (15–25 °C) or chilled temperatures (2–8 °C).ResultsIdentical results in malaria diagnosis were observed between venous and capillary blood samples processed immediately after collection with the XN-31p. Relative to PCR, the sensitivity and specificity of the XN-31p with capillary blood samples were 0.857 and 1.000, respectively. Short-term storage of capillary blood samples at chilled temperatures had no adverse impact on parasitaemia and complete blood counts (CBC) measured by the XN-31p.ConclusionThese results demonstrate the potential of the XN-31p to improve routine malaria diagnosis across remote settings using a hub and spoke model.

Using technology acceptance model to understand fish farmers’ intention to use black soldier fly larvae meal in Nile tilapia production in Kenya

ABSTRACT The purpose of this study was to identify the underlying socio-psychological factors that influence pond and cage farmers’ intentions to adopt Black Soldier Fly Larvae (BSFL) in Kenya. Based on the Technology Acceptance Model (TAM), this study empirically investigated the relationship between TAM constructs, namely Perceived Ease of Use (PEOU), Perceived Usefulness (PU), Attitude towards Use (ATT), and Behavioral Intention (BI) to use BSFL. The study used a cross-sectional survey design to collect primary data from 211 randomly selected cage operators (98) and pond farmers (113) in Kenya’s Siaya, Kisumu, and Homabay Counties. A structural equation model was employed to examine hypothesized paths in the uptake of BSFL meal with the aid of SmartPLS 3. The inner model path coefficients suggested that ATT had the strongest effect on farmers’ intentions to adopt BSFL (0.411). Further, PU had a greater relative influence on intention to adopt BSFL than PEOU based on the model path coefficients of 0.319 and 0.178 respectively. This indicates that the more respondents believe BSFL is useful in their fish farm's production conditions, the more likely they are to adopt BSFL. Consequently, these findings have direct implications for policy development and the potential use of BSFL in aquaculture.

Impact of Agricultural Irrigation on Anemia in Western Kenya.

Expanding agricultural irrigation efforts to enhance food security and socioeconomic development in sub-Saharan Africa may affect malaria transmission and socioeconomic variables that increase the risk of anemia in local communities. We compared the prevalence of anemia, Plasmodium falciparum infection, and indicators of socioeconomic status related to nutrition in communities in Homa Bay County, Kenya, where an agricultural irrigation scheme has been implemented, to that in nearby communities where there is no agricultural irrigation. Cross-sectional surveys conducted showed that anemia prevalence defined by WHO criteria (hemoglobin < 11 g/dL) was less in communities in the irrigated areas than in the non-irrigated areas during the wet season (38.9% and 51.5%, χ2 = 4.29, P = 0.001) and the dry season (25.2% and 34.1%, χ2 = 7.33, P = 0.007). In contrast, Plasmodium falciparum infection prevalence was greater during the wet season in irrigated areas than in non-irrigated areas (15.3% versus 7.8%, χ2 = 8.7, P = 0.003). There was, however, no difference during the dry season (infection prevalence, < 1.8%). Indicators of nutritional status pertinent to anemia pathogenesis such as weekly consumption of non-heme- and heme-containing foods and household income were greater in communities located within the irrigation scheme versus those outside the irrigation scheme (P < 0.0001). These data indicate that current agricultural irrigation schemes in malaria-endemic communities in this area have reduced the risk of anemia. Future studies should include diagnostic tests of iron deficiency, parasitic worm infections, and genetic hemoglobin disorders to inform public health interventions aimed at reducing community anemia burden.

Molecular characterization and genotype distribution of thioester-containing protein 1 gene in Anopheles gambiae mosquitoes in western Kenya

BackgroundEvolutionary pressures lead to the selection of efficient malaria vectors either resistant or susceptible to Plasmodium parasites. These forces may favour the introduction of species genotypes that adapt to new breeding habitats, potentially having an impact on malaria transmission. Thioester-containing protein 1 (TEP1) of Anopheles gambiae complex plays an important role in innate immune defenses against parasites. This study aims to characterize the distribution pattern of TEP1 polymorphisms among populations of An. gambiae sensu lato (s.l.) in western Kenya.MethodsAnopheles gambiae adult and larvae were collected using pyrethrum spray catches (PSC) and plastic dippers respectively from Homa Bay, Kakamega, Bungoma, and Kisumu counties between 2017 and 2020. Collected adults and larvae reared to the adult stage were morphologically identified and then identified to sibling species by PCR. TEP1 alleles were determined in 627 anopheles mosquitoes using restriction fragment length polymorphisms-polymerase chain reaction (RFLP-PCR) and to validate the TEP1 genotyping results, a representative sample of the alleles was sequenced.ResultsTwo TEP1 alleles (TEP1*S1 and TEP1*R2) and three corresponding genotypes (*S1/S1, *R2/S1, and *R2/R2) were identified. TEP1*S1 and TEP1*R2 with their corresponding genotypes, homozygous *S1/S1 and heterozygous *R2/S1 were widely distributed across all sites with allele frequencies of approximately 80% and 20%, respectively both in Anopheles gambiae and Anopheles arabiensis. There was no significant difference detected among the populations and between the two mosquito species in TEP1 allele frequency and genotype frequency. The overall low levels in population structure (FST = 0.019) across all sites corresponded to an effective migration index (Nm = 12.571) and low Nei’s genetic distance values (< 0.500) among the subpopulation. The comparative fixation index values revealed minimal genetic differentiation between species and high levels of gene flow among populations.ConclusionGenotyping TEP1 has identified two common TEP1 alleles (TEP1*S1 and TEP1*R2) and three corresponding genotypes (*S1/S1, *R2/S1, and *R2/R2) in An. gambiae s.l. The TEP1 allele genetic diversity and population structure are low in western Kenya.

Influence of Youth Socio-Demographic Characteristics on their Perceptions of Health Facility Factors in Kisumu, Kakamega and Homabay Counties

Worldwide, societal shifts and behavioural patterns exacerbated by unique developmental vulnerabilities create a confluence of factors that place today’s adolescents and youth at heightened risks for poor health outcomes. Youth’s Sexual and Reproductive Health (SRH) has emerged as an area of key concern globally and a major topic regarding planning and establishing health goals, as noted by the importance brought out by World Health Organization. The purpose of this study was to determine the influence of youth socio-demographic characteristics on their perceptions of Health Facility factors in Homabay, Kisumu, and Kakamega Counties. The study utilised a cross-sectional descriptive design to understand the perceptions of youth seeking SRH services on health facility factors in Homabay, Kisumu, and Kakamega Counties. Findings indicate that SRH services received among youth were comparable, where 97% of males and 100% of females who visited health facilities for services received SRH services, respectively. Furthermore, findings show that only the sex variable among the socio-demographic characteristics had no significant difference, while age, education, and marital status all show significant differentials in perceptions among the youth seeking and utilising SRH services. The study also found statistically insignificant perceptions for the cost of service, opening hours convenience, cleanliness at the facility, and privacy in healthcare delivery, as a statistically significant difference was found in feeling comfortable to return any time for service and youth users to recommend health facility to friends, availability of prescribed drugs, knowledge, and skills of health personnel, waiting time, and overall satisfaction in manner youths was treated. This study recommends maximum optimisation of the opportunity presented by the existing healthcare system to provide SRH services to youths with the aim of reducing or eliminating differentials in SRH services access due to socio-demographic characteristics of youths.

Adherence challenges and opportunities for optimizing care through enhanced adherence counseling for adolescents with suspected HIV treatment failure in Kenya

BackgroundAdolescents living with HIV (ALHIV) experience higher mortality and are more likely to have poor antiretroviral therapy (ART) adherence and unsuppressed viral load (VL) compared to adults. Enhanced adherence counseling (EAC) is a client-centered counseling strategy that aims to identify and address barriers to optimal ART use and can be tailored to the unique needs of adolescents. This study aimed to better understand adherence barriers among ALHIV with suspected treatment failure and their experience with EAC to inform future programming.MethodsA qualitative study was conducted in Homa Bay and Turkana counties, Kenya in 2019 with adolescents and caregivers of children and adolescents living with HIV with suspected treatment failure after ≥6 months on ART and who had received ≥1 EAC sessions. Sixteen focus group discussions (FGDs) were conducted; five FGDs each were held with adolescents 12–14 years (n = 48) and 15–19 years (n = 36). Caregivers (n = 52) participated in six FGDs. Additionally, 17 healthcare workers providing pediatric/adolescent HIV services participated in in-depth interviews. Audio recordings were transcribed and translated from Kiswahili or Dholuo into English and coded using MAXQDA software. Data were thematically analyzed by participant group.ResultsParticipants identified adolescents’ fear of being stigmatized due to their HIV status and their relationship with and level of support provided by caregivers. This underpinned and often undermined adolescents’ ART-taking behavior and progress towards more independent medication management. Adolescents were generally satisfied with EAC and perceived it to be important in improving adherence and reducing VL. However, problems were noted with facility-based, individual EAC counseling, including judgmental attitudes of providers and difficulties traveling to and keeping EAC clinic appointments. Participant-suggested improvements to EAC included peer support groups in addition to individual counseling, allowing for greater flexibility in the timing and location of sessions and greater caregiver involvement.ConclusionsThe findings provide opportunities to better tailor EAC interventions to promote improved ALHIV adherence and caregiver-supported disease management. Multi-prong EAC interventions that include peer-led and community approaches and target adolescent and caregiver treatment literacy may improve EAC delivery, address issues contributing to poor adherence, and position adolescents to achieve viral suppression.Trial registrationClinicalTrials.gov: NCT04915469.

EFFECT OF CAREGIVERS’ HIV DISCLOSURE TRAINING ON PEDIATRIC HIV STATUS DISCLOSURE AND ART ADHERENCE IN HOMABAY COUNTY, KENYA: A COMPARATIVE LONGITUDINAL STUDY.

Purpose: The study objective was to establish the effect of HIV disclosure training on children’s HIV status disclosure and on ART adherence.&#x0D; Methodology:This was a comparative longitudinal study in ten health facilities in Homabay County with 860 non-disclosed HIV positive children on ART aged 6-10 years between 2016 to 2018.A randomized sample of 430 caregivers was trained on HIV status disclosure while another 430 caregivers not trained. All caregivers then performed HIV status disclosure to their HIV positive children, and children’s disclosure and adherence to ART status established. We used semi structured questionnaires, FGDs and KIIs for data collection and IBM SPSS version 20, logistic regression, chi-square and Nvivo software for data analysis.&#x0D; Results: Mean child age was 8 years for both groups, 35 and 37years for caregivers in control and intervention respectively. 409(95%) interventional caregivers had good overall knowledge on disclosure process compared to control (116(27%). Longitudinal viral suppression increased in both groups; intervention group 345(80.2%) to 384(90.1%), control (279(64.9%) to 296(70.1%). Trained caregivers were 2 times (OR-2.369) likely to disclose children’s HIV status. Disclosure training had significant effect (P&lt;0.05) on child’s adherence. Children of trained caregivers were nine times (OR-9.145) likely to have good adherence. Level of education of caregivers (p=0. 035) and knowledge of care givers on the disclosure process (p=0.05) were significantly associated with ART adherence. Disclosure knowledge and lack of disclosure skills were cited in FGDs and KIIs as the major facilitator and barrier to disclosure and ART adherence respectively.&#x0D; Unique contribution to theory, practice and policy: The findings provide evidence – based interventions that will guide caregivers, the Ministry of Education and Ministry of Health on how and when to disclose to a child his own HIV status. Disclosure culminates into behavior change which is anticipated to enhance the reduction in the spread of HIV to the next generation and it is one way of sustaining the fight against HIV and AIDS.The study recommends all children in the age bracket of 6-10 years be disclosed to their own HIV status in order to increase their level of adherence to ART.

Records Management Policy in Enhancing Governance in Homa Bay County Headquarters, Kenya

Globally, records management plays major role in enhancing governance. The study objective was to examine the role of records management policy in enhancing governance at Homa Bay (HB) County Headquarters, Kenya. Target population comprised of 306 employees who are the custodians of records within the County Headquarters. Stratified technique was used to classify employees into strata. Yamane simplified formula was used to obtain a sample size of 174 respondents, which was proportionately distributed per department using random sampling technique. Structured questionnaires and interview schedules were pretested to determine validity and reliability and thereafter employed to collect data. Quantitative data was analyzed using descriptive statistics with the aid of IBM – SPSS (Version 23), presented in a table and interpreted in mean, frequencies, percentages, and standard deviation. Qualitative data was analysed using content analysis. The finding showed that records management policy was available in HB, though some employees were unaware. The study concluded that records managers in HB County should instill awareness among staff on the importance of records management policy. Based on the finding and conclusion, the study recommends, firstly, that HB records managers should ensure records management policy is properly documented and shared with all employees managing records with a view of increasing efficiency in the information flow thus enhancing governance and secondly, HB would identify areas of weakness in records management policy and focus on improvement.

In-vitro Activity of Medicinal Plant Crude Extract and In-vivo Toxicity Testing of Dichloromethane Root Extract of Citrus limon in laboratory Rabbits

Aims: To identify viable phytomedicines traditionally employed for the treatment of malaria in Kenya that could be developed into antimalarial agents.&#x0D; Study Design: Quantitative analysis of antiplasmodial activities and brine shrimp bioassays were carried out using standard procedures. The experiment was set in duplicate for each concentration of the drug and average IC50 determined.&#x0D; Place and Duration of Study: Seven indigenous plants: Achyranthes aspera, Heinsiacrinita, Bridelia cathartica, Citrus limon, Microglossapyrifolia, Vernoniaglabra and Carissa edulis obtained from Kilifi and Homa-Bay counties in Kenya were evaluated for their anti-Plasmodium falciparum potential. Collection of samples and analysis took about three months from April 2018.&#x0D; Methodology: Both Chemical and aqueous crude extraction methods were carried out to identify the most active extracts against P. Falciparum and then isolate pure active phytochemicals. Pure compounds were subjected to Nuclear Magnetic Resonance (NMR), Infra-Red (IR) and Mass Spectroscopy (MS) analyses for structure elucidation.&#x0D; Results: Four extracts (hexane, dichloromethane (DCM),methanoland water) of seven different species of plants were analyzed for their anti-plasmodial activities.W2 and D6 strains of Falciparum were tested. However, the three most active extracts were from Citrus lemon roots (DCM) with IC50 value of 7.017 µg/mL, C. edulis root (aqueous) with IC50 value of 8.054 µg/Ml and B. Cathertical eaves (methanol) with IC50 value of 15.647 µg/Ml. However, three pure compounds were obtained; suberosin IC5026.7 (Strain W2), 53.1 (Strain D6) and xanthyletin IC501580 (Strain W2) from C. limon (DCM) and spinasterol IC50 43.2 (Strain W2) from M. pyrifolia (hexane).&#x0D; Conclusion: The three different species of plants with most active compounds have demonstrated their potentiality in treatment for falciparum malaria. Structures of the isolated three compounds can be modelled to synthesis of anti- plasmodial drugs as they are active in vitro.

Perception of proposed preliminary food-based dietary guidelines for Lake Victoria region of Kenya: findings from a qualitative study among adult community members

Background: Diets in the Lake Victoria region of Kenya have been described as monotonous, consisting chiefly of starchy staple foods, accompanied by green vegetables and oil. To promote healthy eating in the region, 11 food-based dietary guidelines (FBDGs) were proposed. Objective: This study was designed to assess perception of the proposed FBDGs amongst consumers in Lake Victoria region. Design and setting: A qualitative, descriptive cross-sectional design was used to collect data from 36 focus-group discussions (FGD) among adult males (18) and females (18) in Kisumu and Homa Bay Counties. Subjects: A total of 207 adult males (26–74 years) and 211 females (18–71 years) participated in this study. Data collection and analysis: Proposed FBDGs were printed on posters and presented to FGD participants. Proceedings were audio-taped, transcribed, translated and analysed based on themes. Results: The proposed FBDGs were perceived as promoting the consumption of a balanced diet. As a concept, a balanced diet was misrepresented as composed of only three nutrients: carbohydrates, proteins and vitamins. There was no mention of fats/oils and minerals as other significant nutrient constituents of a balanced diet. Other concepts, which included ‘three regular meals’, ‘snacks’, ‘food variety’, ‘healthy and physically active lifestyle’, were polysemous. Conclusion: The findings provide insight to guide the adaptation of the national FBDGs. The findings also provide a basis for nutrition advocacy programmes and a rationale for the revision of nutrition education materials, including the school curriculum, to align content with current evidence-based information.

Food insecurity, a perceived barrier to healthy eating in the lake Victoria region, Kenya: findings from a qualitative study

Consumption of poor-quality diets was noted as prevalent in the Lake Victoria Region, Kenya. As a strategy to communicate desirable change and promote healthy eating in the region, a 30-member panel of policymakers and implementers developed and proposed 12 food-based dietary guidelines (FBDGs) in 2017-2018. The objective of this study was to assess barriers in adopting the proposed FBDGs amongst community members in the lowlands of Kisumu and Homa Bay counties. Qualitative, descriptive cross-sectional design was used to collect data from 72 focus-group discussions (FGD). The FGD was conducted among 216 school going children (10-13y), 216 high school students (15-18y), 207 adult males (26-74y) and 211 females (18-71y). The participants were asked to state whether the proposed FBDGs reflected their daily dietary practices? If the answer was no, the FGD participants were asked to elaborate on the perceived barriers. Each FGD consisted of 8-12 participants. The demographics of FGD participants were collected before the start of FGD sessions. All FGD proceedings were audio-recorded and transcribed verbatim. Demographic information of participants was analyzed and presented using descriptive statistics. The FGD responses were coded and analyzed based on the main code, the barriers. Barriers to healthy eating in the study area were mainly linked to low production of food, food unavailability and inaccessibility. Specific factors which contributed to the food insecurity situation included; dry and sunny weather, seasonality in food availability, limited resources to secure potential farmland with fences, gender influence on land use, high cost of food, lack of money to purchase food, low income, sale of farm produce with resultant inadequate quantities of food consumed and inappropriate meal composition. Food insecurity was a perceived barrier to healthy eating in the lowlands of the Lake Victoria region. This research suggests the need to address food systems and economic structures to improve food production, distribution, accessibility and consumption in the region. Coding was done with the aid of NVivo8 (QSR International Pty Ltd Version 8, 2008). This study was registered with the Kenyan National Commission for Science Technology and Innovation (NACOSTI/P/18/12634/22291). Key words: Healthy eating, Lake Victoria, barriers, food insecurity, food unavailability, food inaccessibility

Navigating the local foodscape: qualitative investigation of food retail and dietary preferences in Kisumu and Homa Bay Counties, western Kenya

IntroductionNon-communicable diseases have risen markedly over the last decade. A phenomenon that was mainly endemic in high-income countries has now visibly encroached on low and middle-income settings. A major contributor to this is a shift towards unhealthy dietary behavior. This study aimed to examine the complex interplay between people’s characteristics and the environment to understand how these influenced food choices and practices in Western Kenya.MethodsThis study used semi-structured guides to conduct in-depth interviews and focus group discussions with both male and female members of the community, across various socioeconomic groups, from Kisumu and Homa Bay Counties to further understand their perspectives on the influences of dietary behavior. Voice data was captured using digital voice recorders, transcribed verbatim, and translated to English. Data analysis adopted an exploratory and inductive analysis approach. Coded responses were analyzed using NVIVO 12 PRO software.ResultsIntrapersonal levels of influence included: Age, the nutritional value of food, occupation, perceived satiety of some foods as opposed to others, religion, and medical reasons. The majority of the participants mentioned location as the main source of influence at the community level reflected by the regional staple foodscape. Others include seasonality of produce, social pressure, and availability of food in the market. Pricing of food and distance to food markets was mentioned as the major macro-level influence. This was followed by an increase in population and road infrastructure.ConclusionThis study demonstrated that understanding dietary preferences are complex. Future interventions should not only consider intrapersonal and interpersonal influences when aiming to promote healthy eating among communities but also need to target the community and macro environments. This means that nutrition promotion strategies should focus on multiple levels of influence that broaden options for interventions. However, government interventions in addressing food access, affordability, and marketing remain essential to any significant change.

Effects of behavioural change communication on HIV and AIDS related high risk behaviour among fishermen in Homabay and Siaya Counties, Kenya

Background: Risky sexual behaviors such as sexual concurrency, sexual networks (fish for sex exchange) and unprotected sex, have been reported as the main cause of sexually transmitted diseases (STIs) /HIV infections among fisher folks. Behavioral change mechanisms as condom use and abstinence are some of interventions used in prevention HIV/AIDS spread in Kenya. Risky sexual behaviors increase risk of contracting STIs including HIV/AIDSMethods: This was a cross-sectional descriptive study involving 246 randomly selected fisher folks in Mbita- and Usenge along Lake Victoria. The survey used questionnaires to collect data among respondents. Using a sample frame in the beach management unit offices, fisherfolks were identified and invited to participate. Consent was obtained from participantsResults: The mean age of respondents was 31 years old. The 72% of the participants were directly involved in fishing. Participants who had extra marital relationship though married were 56.1% in Mbita and 47% in Usenge. Respondents who took alcohol with friends were 94.1% in Mbita and 96.2% in Usenge. Respondents who indicated that they had unprotected sex under influence of alcohol were 48.3% in Mbita and 77.1% in Usenge. Those who were sexually taken advantage of while under the influence of alcohol were 23.8% in Mbita and 38.3% in Usenge while those had sexually taken advantage of under the influence of alcohol were 18.3% in Mbita and 37.8% in Usenge.Conclusions: Targeted behaviour change communication (BCC) strategies designed specifically for fisherfolks is needed to curb high incidences of risky sexual behaviours noted among the fishermen.