Kenya Shillings Research Articles

A GUMBORO-SALMONELLA CO-INFECTION MATHEMATICAL MODEL WITH OPTIMAL CONTROL

Poultry production contributes immensely to the economic growth of a country. For instance in Kenya, 20tonnes of poultry meat worth 3.5 billion kenya shillings and 1.3 billion eggs worth 9.7 billion Kenya Shillingscome from this sector. However, the sector is greatly threatened by poultry diseases among them, Gum-boro(IBD) and Salmonella as inadequate knowledge exists of optimal control strategies for various poultryco-infections. In this research, a Gumboro-Salmonella co-infection mathematical model with optimal controlis developed using a system of ODEs to perform an optimal control analysis. The analysis was done by for-mulating an optimal control problem and using Pontryagin’s maximum principle to solve it. The Numericalsimulation results showed that the best Gumboro-Salmonella co-infection control strategy involved combiningall the interventions

Pre-exposure prophylaxis implementation gaps among people vulnerable to HIV acquisition: a cross-sectional analysis in two communities in western Kenya, 2021-2023.

Despite theincreasing availability of prevention tools like pre-exposure prophylaxis (PrEP), HIV incidence remains disproportionately high in sub-Saharan Africa. We examined PrEP awareness, uptake and persistence among participants enrolling into an HIV incidence cohort in Kenya. We used cross-sectional enrolment data from the Multinational Observational Cohort of HIV and other Infections (MOCHI) in Homa Bay and Kericho, Kenya. The cohort recruited individuals aged 14-55 years with a recent history of sexually transmitted infection, transactional sex, condomless sex and/or injection drug use. Participants completed questionnaires on PrEP, demographics and sexual behaviours. We used multivariable robust Poisson regression to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations with never hearing of PrEP, never taking PrEP and ever stopping PrEP. Between 12/2021 and 5/2023, 399 participants attempted the PrEP questionnaire, of whom 316 (79.2%) were female and median age was 22 years (interquartile range 19-24); 316 of 390 participants (81.0%) engaged in sex work or transactional sex. Of 396 participants who responded to the question, 120 (30.3%) had never heard of PrEP. Of 275 participants who had heard of PrEP, 206 (74.9%) had never taken it. Of 69 participants who had ever taken PrEP, 50 (72.5%) stopped it at some time prior to enrolment. Participants aged 15-19 years more often reported never taking PrEP compared with those 25-36 years (aPR 1.31, 95% CI: 1.06-1.61). Participants who knew someone who took PrEP less often reported never hearing about PrEP (aPR 0.10, 95% CI: 0.04-0.23) and never taking PrEP (aPR: 0.69, 95% CI: 0.60-0.80). Stopping PrEP was more common among participants with a weekly household income ≤1000 versus >1000 Kenyan shillings (aPR 1.40, 95% CI: 1.02-1.93) and those using alcohol/drugs before sex (aPR 1.53, 95% CI: 1.03-2.26). Stopping PrEP was less common among those engaging in sex work or transactional sex (aPR 0.6, 95% CI: 0.40-0.92). We identified substantial gaps in PrEP awareness, uptake and persistence, which were associated with potential system- and individual-level risk factors. Our analyses also highlight the importance of increasing PrEP engagement among individuals who do not know others taking PrEP.

Farmers’ preferences for rice bean production traits in western Kenya

Rice bean (Vigna umbellata) is an important legume for food and nutritional security. However, the level of its cultivation in western Kenya, where there is a serious malnutrition challenge, is still low due to a lack of insights into its attributes. Hence, to bridge this knowledge gap, this study analyzed smallholder farmers' preferences for production traits. We collected data from 204 farmers through a choice experiment (CE) approach in upper and lower midland agro-ecological zones. Subsequently, we used the random parameter logit (RPL) model to analyze the data. Results showed that farmers preferred all attribute levels presented except 61 % or more pest resistance. The lower midland farmers preferred compensation of Kenya shillings (Ksh) 34.93 for yields of 9 or more bags per acre; Ksh 52.22 for 61 to 79 maturity days and; Ksh 20.24 for 40 %–60 % pest resistance level. In comparison, upper midland farmers preferred compensation of Ksh 66.44 for 6 to 8 bags per acre; Ksh 53.82 for 9 or more bags per acre; no compensation for 50 to 60 maturity days; and Ksh 132.98 for 40 %–60 % pest resistance. However, farmers preferred no compensation for intact pods. The observed differences in farmers' preferences for rice bean attributes are explained by heterogeneity in the agroecological conditions, farmers' socio-economic characteristics, and risk perceptions. The findings should inform targeted extension and breeding programs that fit farmers’ diverse environments and resource endowments.

Care seeking during pregnancy: testing the assumptions behind service delivery redesign for maternal and newborn health in rural Kenya.

A health systems reform known as Service Delivery Redesign (SDR) for maternal and newborn health seeks to make high-quality delivery care universal in Kakamega County, in western Kenya, by strengthening hospital-level care and making hospital deliveries the default option for pregnant women. Using a large prospective survey of new mothers in Kakamega County, we examine several key assumptions that underpin the SDR policy's theory of change. We analyse data on place of delivery, travel time and distance, out-of-pocket spending, and self-reported quality of care for 19 127 women prospectively enrolled during antenatal care (ANC) and surveyed two times after their delivery. We analyze changes in womens' delivery location preferences in recent years in Kakamega, and over the course of their most recent pregnancy. We also evaluate travel time, out-of-pocket expenditures and patient satisfaction for women who deliver in public hospitals vs primary health centres. We find substantial changes in delivery location at the population level over time and for individual women over the course of pregnancy. Facility delivery has increased from 50.4% in 2010 to 89.5% in 2019; 70% of respondents deliver at a different facility than their reported intention at ANC. Out-of-pocket delivery expenditures are on average 1351 Kenyan shillings (Ksh) in hospitals compared to 964 Ksh in PHC (primary health care)s (P < 0.01). Transport expenditures are 337 Ksh for PHC level deliveries vs 422 Ksh for hospitals (P < 0.01). Self-reported average travel time is 51 min (PHC delivery) vs 47 min (hospital delivery) (P = 0.78). The average distance to a delivery location is 15.1 km for PHC deliveries vs 15.2 km for hospitals (P = 0.99). There were no differences in overall patient-reported quality scores, while some subcomponents of quality favoured hospitals. These findings support several key assumptions of the SDR theory of change in Kakamega County, while also highlighting important challenges that should be addressed to increase the likelihood of successful implementation.

Costs and cost drivers of comprehensive sexual reproductive health services to female sex workers in Kenya

BackgroundComprehensive sexual reproductive health (SRH) programs for female sex workers (FSW) offering clinical, behavioural, and structural interventions have contributed to declining rates of HIV in this population. However, data on costs and cost drivers is needed to support programs and their donors to better allocate resources, make an investment case for continued funding, and to identify areas of improvement in program design and implementation. We aimed to estimate the annual per-FSW costs of comprehensive services for a standalone FSW program in Kenya.MethodsWe implemented a top–bottom and activity-based costing study of comprehensive FSW services at two drop-in centres (DICs), Mtwapa and Kilifi town, in Kilifi County, Kenya. Service costs were obtained from routinely collected patient data during FSW scheduled and unscheduled visits using Kenyan Ministry of Health records. Costing data were from the program and organization’s expenditure reports, cross checked against bank documents and supported by information from in-depth interviews. Data were collected retrospectively for the fiscal year 2019. We obtained approval from the AMREF Research Ethics Committee (AMREF-ESRC P862/2020).ResultsIn 2019, the unit cost of comprehensive services was 105.93 USD per FSW per year, roughly equivalent to 10,593 Kenya shillings. Costs were higher at Mtwapa DICs compared to Kilifi town DIC; 121.90 USD and 89.90 USD respectively. HIV counselling and testing cost 63.90 USD per person, PrEP was 34.20 USD and family planning was 9.93 USD. Of the total costs, staff salaries accounted for about 60%. Adjusted for inflation, costs in 2024 would be approximately 146.60.ConclusionPrograms should strive to maximize the number of FSW served to benefit from economies of scale. Given that personnel costs contribute most to the unit costs, programs should consider alternative designs which reduce personnel and other costs.

Assessing the economic returns of modern and traditional beehives

Beekeeping is a vital economic activity for smallholder farmers; therefore, it is essential to provide beekeepers with information regarding the profitability and productivity of box hives to encourage them to embrace the technology. However, scant information is available to comprehensively compare the profitability and output of traditional and modern beehives. This study seeks to compare the performance of traditional and modern beehives in Baringo South Sub-County. Simple random sampling was used in conjunction with a cross-sectional survey to collect data from the 197 beekeepers who participated in the study. A gross margin analysis was performed to understand the returns of traditional and modern hives. According to the findings, individuals who used traditional beehives had a higher overall operational cost of Ksh. 1449.44 per hive, whereas those who used modern hives had a total operational cost of Ksh. 1000.73. In addition, the study also demonstrated that those that utilised modern beehives received larger gross margins in Kenyan shillings 7917.74, whilst those who used traditional beehives received Ksh. 5590.59. According to the study’s findings, modern beekeeping generates higher returns than traditional beekeeping. As a result, farmers should be encouraged to employ modern beehives to generate higher returns.

Predictors of birth weight in pregnant women with malaria: a prospective cohort facility-based study in Webuye-Kenya

In sub-Saharan Africa, malaria, which remains a major public health burden, has a prevalence of 9 to 28% and malaria in pregnancy is associated with severe adverse outcomes for the mother and her baby. Here, we sought to determine the predictors of birth weight in a cohort of 140 women with malaria in pregnancy, who were recruited at the Webuye County hospital in Western Kenya. All study participants underwent malaria diagnosis through microscopic examination of blood smear samples and were grouped into the malaria-positive and malaria-negative groups. Both groups were followed up beginning at the first antenatal visit (March 2022) until delivery (December 2022) and various data, including demographic, parity, gravidity, socioeconomic, maternal and fetal outcomes were collected. Data analyses were done using SPSS version 27. Chi-square and Fisher’s Exact tests were used for bivariate and relative risk analyses at a p-value of ≤0.05 (95%) confidence level. Most of the participants were aged 18–25 years, were primigravidas and married, had secondary school-level education, earned 20–30 thousand Kenya shillings, resided in rural areas, and were in the second trimester. There were 6 (4.6%) cases of low birth weight, 3 (4.5%) in the malaria-negative group and 3 (4.7%) in the malaria-positive group. During pregnancy, 41 (31.5%) were anaemic, 5 (3.8%) were HIV-positive, 5 (3.8%) had preeclampsia, and 2 (1.5%) had gestational diabetes. Our analyses show that confounding factors like anaemia, HIV, pre-eclampsia and gestational diabetes did not influence birthweight (p ≥ 0.923). The malaria-positive and malaria-negative groups did not differ significantly with regard to the low birth weight (relative risk: 0.999, 95% confidence interval: 0.926–1.077). Marital status, gestational age, and area of residence were associated with malaria p ≤ 0.001, ≤ 0.001 and 0.028 respectively. In both groups, 124 of the 140 deliveries had normal birth weights and of these 63 (95.4%, n = 70) were in the malaria-negative group, whereas 61 (95.3%, n = 70) belonged to the malaria-positive group.

An Analysis of the Derivatives Market Performance in Kenya: A Case of Nairobi Securities Exchange Derivatives Market

The growth of the financial derivatives market has been identified as a significant channel to drive the overall growth of the capital market, and the development of capital market efficiency has been widely regarded as crucial. The performance of derivatives in Kenya has been fluctuating causing uncertainty in the market. The study analyzed the performance of the Nairobi Securities Exchange Derivatives Market in Kenya since its establishment in July 2019. The study draws on secondary data from the Capital Markets Authority and Nairobi Securities Exchange from July 2019 to December 2023. Descriptive statistics was adopted for data analysis with the help of SPSS software. Findings indicated that Safaricom Plc has been active and the best-performing company in trading single futures derivatives contracts at NEXT with the highest total turnover in Kenya shillings. The other companies that followed Safaricom closely were Equity Group Holdings and Kenya Commercial Bank. The overall performance of other companies in terms of derivatives contracts traded over the years has been fluctuating. Overall, the NEXT has made many strides in terms of derivatives trading in Kenya. The securities market regulators need to encourage all listed companies to participate in the Nairobi Securities Exchange Derivatives market to increase options available at the market and improve the Country’s economy.

Consumer Willingness to Pay for Energy Efficient Refrigerators in Nairobi City County, Kenya

In Kenya, consumer choices regarding home energy appliances, such as refrigerators, are crucial for enhancing energy efficiency and environmental conservation efforts. This study examined the influence of the Kenya Energy Star Rating Label on consumer preferences for refrigerators. Using stratified random sampling, 330 respondents from five constituencies in Nairobi County, Kenya, were surveyed. The research employed a combination of conditional and mixed logit models to analyse the data. The results revealed a significant positive correlation (P = .05) between the Kenyan Energy Star Rating label and consumer preference for energy-efficient refrigerators across all models. Consumers demonstrated a willingness to pay an average premium of 28,708.5 Kenyan shillings for refrigerators displaying the Kenyan Energy Star Rating label, indicating their recognition of the label's value. There was no significant relationship between consumer environmental concern and their willingness to pay for energy labelled refrigerators. These findings have notable policy implications, emphasizing the importance of educating Kenyan consumers about the environmental advantages of energy-efficient appliances. Specifically, the results underscore the effectiveness of the Kenyan Energy Star Rating Label in guiding consumer choices toward more sustainable appliance options.

Delayed breast cancer presentation, diagnosis, and treatment in Kenya.

In this mixed-methods study, we evaluated the factors that contribute to delayed breast cancer (BC) diagnosis and treatment at a Kenyan hospital. Individuals with a diagnosis of BC, either as a referral or index patient, were recruited to participate in this study through convenience sampling. Data were collected on sociodemographics, health history, and cancer history, diagnosis, and treatment of patients at Kenyatta National Hospital (KNH). For the quantitative analyses, the relationship between sociodemographic and health history factors with stage at diagnosis, number of visits before diagnosis, time to diagnosis, and time to initial intervention, stratified by time to onset of symptoms, were examined using regression analyses. For the qualitative analysis, in-depth interviews of every fifth patient were completed to assess reasons for delayed diagnosis and treatment. The final analytic sample comprised of 378 female BC patients with an average age of 50. These females were generally of lower SES: 49.2% attained no or only primary-level education, 57.4% were unemployed, and the majority (74.6%) had a monthly household income of < 5000 Kenyan shillings (equivalent to ~ $41 USD). The median time from BC symptom onset to presentation at KNH was 13 (IQR = 3-36) weeks, from presentation to diagnosis was 17.5 (IQR = 7-36.5) weeks, and from diagnosis to receipt of the initial intervention was 6 (IQR = 3-13) weeks. Female BC patients who were never/unmarried, less educated, less affluent, users of hormonal contraception, and had ≥ 3 children were more likely to experience diagnosis and treatment delays. Qualitative data showed that financial constraints, lack of patient BC awareness, andhealthcare practitioner misdiagnosis and/orstrikes delayed patient diagnosis and treatment. BC patients experience long healthcare system delays before diagnosis and treatment. Educating communities and providers about BC and expediting referrals may minimize such delays and subsequently BC mortality rates in Kenya.

Effect of Corporate Culture on the Performance of the Kenya Commercial Bank

Over the last seven years, Kenya Commercial Bank (KCB) management has initiated various restructuring processes, such as "moving from good to great" positioning strategy, rebranding tactics, value concerns, and behavior reassessment. These restructuring strategies are meant to place the financial institution as the market leader in the banking industry, not only in Kenya but also to encourage it to become a pan-African bank. Indeed, the bank has demonstrated strength in its branch network, accounting for 359 branches, an asset base of 1.1 trillion Kenya shillings (Ksh) as of 2021 financial results, and a significant market share command of 22.5 million customers. However, the human effort applied in explaining the milestone achievements cannot go unnoticed, especially the corporate culture of the bank employees, which is operationalized through involvement culture, consistency, adoptability, and mission cultures. Therefore, the objective of this paper was to interrogate the implication of corporate culture on the performance of Kenya Commercial Bank. The paper employed a qualitative and quantitative research design. Qualitative data was analyzed by using descriptive statistics such as total scores, percentages, and frequencies. Quantitative data was analyzed using Pearson correlation and regression analysis. Primary data was collected using a structured questionnaire and interview guide targeting senior management and worker representatives. The data was analyzed using Pearson correlation and regression analysis. The finding was that corporate culture had a positive and significant effect on Kenyan commercial bank performance. This was evidenced by positive and significant correlations between performance and all corporate culture sub-variables, as follows: involvement culture (r = 0.584, p&lt;0.01), consistency culture (r = 0.541, p&lt;0.01), adaptability culture (r = 0.566, p&lt;0.01), mission culture (r = 0.576, p&lt;0.01), and organization factors (r = 0.517, p&lt;0.05). These findings shed light on the interconnectedness of these variables and how they collectively contribute to an organization's success and effectiveness. Based on the findings, the paper recommends that there should be relevant activities undertaken by the bank to promote corporate culture because they have a positive influence on the performance of the bank and that organizations should consistently apply the various aspects of corporate culture at the strategic, functional, and operational levels.

Unraveling the physicochemical attributes of three cricket (Gryllus bimaculatus)-enriched biscuit products and implications on consumers’ preference and willingness to pay

Disgust and neophobia elicited by whole insect products, has necessitated the need to mask insect-based food products. The physico-chemical parameters, sensory acceptance, and willingness to pay (WTP) for wheat biscuits supplemented with cricket powder was evaluated. The biscuits’ color intensity correlated with the cricket inclusion levels. Spread ration of cricket-enriched-biscuits increased (1.0–1.2-folds), while the hardness and fracturability decreased (1.0–1.3-folds and 1.0–1.2 folds, respectively) compared to the control biscuit. Cricket-biscuits exhibited 1.2–1.7, 1.1–3.7, 1.2–3.0 and 1.1–1.2-folds higher (p < 0.05) protein, ash, fiber, and fat, respectively. Ca, Fe, and Zn were 1.1–3.7, 1.1–1.2 and 1.4–4.0-folds higher, respectively, for cricket-based biscuits. Monounsaturated and polyunsaturated fatty acids proportionally increased with increasing cricket flour. On a likert scale, 71.4%, 71.9%, 38.4% and 57.5% of the caregivers and 38.6%, 58.3%, 40.0% and 34.0% for children (3–5 years) strongly preferred the color, texture, taste and aroma, respectively, of the cricket-based biscuits. Forty-seven (47%) of the caretakers were WTP a premium of 37 Kenyan shillings (0.34 USD) for cricket-based biscuits. Our findings demonstrated that integration of cricket flour into existing market-driven consumer familiar food products significantly increased acceptability and WTP, thus promising potential to contribute to improved food and nutritional security.

Assessment of consumers' preference for orange-fleshed sweet potato puree chapati: a case of rural and urban consumers in Kenya.

Orange-fleshed sweet potato (OFSP) is bio-fortified with vitamin A precursors through breeding and is thus ideal for combating vitamin A deficiency (VAD). One of the potential mechanisms to promote the consumption of OFSP is to enhance its availability through processing into products with a longer shelf life and more desirable to consumers. However, very few farmers and agro-processors practice value addition due to market uncertainties; there is little information on market availability for OFSP products. This study examined consumers' preference for OFSP puree chapati in rural and urban areas of Kenya, using the contingent valuation method. Data was collected from a random sample of 411 sweet potato consumers and a double-bounded logit model was applied to analyze consumers' willingness to pay (WTP) for OFSP puree chapati. Consumers were willing to pay a price of Kenya shillings (KES) 19 (USD 0.14) and 35 (USD 0.26) for OFSP puree chapati in Homa Bay and Nairobi counties, respectively. The presence of children under 5 years in a household, consumers' awareness of OFSP products and benefits of consuming OFSP, and level of education had a positive and significant influence on WTP for OFSP puree chapati in both regions. The study demonstrated that consumers exhibited a positive preference for OFSP puree chapati. In order to increase the consumption of OFSP and its value-added products, it is important to promote consumer awareness of OFSP puree chapati and other such nutritious products through cooking demonstrations and other nudging approaches using attractive illustrations and social media platforms that engage mothers and care-givers of children under 5 years old as well as the youth. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

English

Trade influences economic growth and entails imports and exports. In Kenya, wheat imports have been expanding with no sign of slowing down and this has become a matter of great concern because the country is losing over 30 billion Kenyan shillings in importing wheat on a yearly basis. This motivated the need to estimate wheat import demand model, which was conducted using secondary time series data from 2000 to 2019. The findings of the study show that there is cointegration in the estimated wheat import demand which captures 98.2% of wheat imports. Therefore, the model can be used to predict the amount of wheat imports in Kenya at any given time to achieve the optimal wheat importation. It was also found that yields, relative prices, ending stock and lagged wheat imports explained wheat expansion in Kenya in the last two decades. Therefore, the study recommends that Kenya wheat imports should be monitored to avoid over importation because, it has adverse effects on the domestic wheat sector. Key words: Trade, economic growth, food imports, time series, generalized least squares.

To sell or store? Assessing smallholder farmers' willingness to pay for potato cold storage in Kenya

AbstractStorage of food commodities for some time after harvest can play an important role in alleviating the downside of price fluctuations in developing countries. While storage can offer smallholder farmers substantial inter‐temporal arbitrage opportunities, existing evidence shows that many farmers in developing countries store little of their harvest. Using a cross sectional survey of 502 households in Nyandarua and Bomet Counties of Kenya, this paper assessed smallholder farmers' willingness to pay (WTP) for cold storage and compares their WTP with the arbitrage opportunities. Our results reveal that the storage of potato was generally limited with only 26% storing in the season preceding the study. Using a hypothetical scenario with double‐bounded contingent valuation formats, our findings show that a considerable proportion of households (70.7%) were willing to rent cold storage facilities. The WTP for storing a 90 kg bag of Shangi, a common variety with a short shelf life (1 month) was Kenya shillings (KES) 104 (1.16/kg/month) compared KES 96.4 (1.07/kg/month) for the Unica variety (slightly longer shelf life). The probit model results show that gender (being female), and transaction costs associated with access to markets (e.g., geographical location and distance to the road) were positively associated with WTP. Furthermore, household endowment, reflected in household expenditure, income and level of potato commercialization had a positive influence on WTP to store. In addition, institutional characteristics of collective action, previous experience with storage and use of certified seed (often associated with extension) enhanced households WTP for potato storage. The results on potato prices over a 5‐year period (2014–2019) show that seasonal price gaps were higher than the estimated WTP, suggesting that potato storage could be economically viable. These findings have significant policy implications not only for commodities whose harvest is perishable and season bound (e.g., vegetables, fruits) where arbitrage may offer price stabilization.

How do malaria testing and treatment subsidies affect drug shop client expenditures? A cross-sectional analysis in Western Kenya

ObjectivesTo examine how drug shop clients’ expenditures are affected by subsidies for malaria diagnostic testing and for malaria treatment, and also to examine how expenditures vary by clients’ malaria test...

Economic feasibility of fish cage culture in Lake Victoria, Kenya

AbstractFish cage culture has rapidly grown throughout Lake Victoria's shores, with Nile tilapia (Oreochromis niloticus) being the primarily cultured species. However, there is inadequate information on its economic viability. The study investigated the economic feasibility of fish cage farming system in Lake Victoria, Kenya, by evaluating the relationship between cost of inputs and revenue from fish sales and analysing the overall profitability of the fish cage culture in the lake. Systematic sampling was employed to select 200 cage farmers for the study. Structured questionnaire was used for data collection. Data was analysed using descriptive statistics, multiple regression analysis, gross margin analysis, net farm income and profitability ratios. The average quantity of fish produced in the production cycle was 11,971.53 kg from which an average of 9020.77 kg was sold at an average selling price of Kenyan Shillings (KSH) 281.36 (USD 2.60) per kg. The multiple regression results revealed that the cost of feeds (coefficient of −0.603) and fish seed (coefficient of −0.387) had a significant influence on returns from fish cage culture business at p &lt; 0.01 and p &lt; 0.05, respectively. The costs of feeds and fish seed were significant components of the total production cost, accounting for 60.25% and 33.50%, respectively. Fish cage production was profitable, with an average gross margin of KSH 1146,727.68 (USD 10,545.59) and net farm income of KSH 1020,518.78 (USD 9384.94) in a production cycle, with a benefit cost ratio of 1.43, an expense structure ratio of 0.06, a gross revenue ratio of 0.70 and a return on investment of 0.43. The study recommends formulation of friendly policies, legislations, operating guidelines and an enabling environment for feed and fish seed producers by policy makers to enhance fish feed and seed production and subsequently reduce prices of feed and seed. Through this, economic viability of fish cage culture will be enhanced.

AMPATH surgical app: Low-cost simulator for the open appendectomy

BackgroundDue to a shortage and maldistribution of surgeons within Kenya, doctors with limited formal surgical training often perform emergency surgical procedures such as appendectomy. This lack of training can compromise patient outcomes and complicate care delivery. Our aim was to develop a low-cost simulator and skills curriculum to effectively teach open appendectomy. MethodsSurgeons from 4 countries participated in semi-structured interviews to define the steps and technique of open appendectomy using cognitive task analysis. Using this input, our Academic Model Providing Access to Healthcare surgical team developed a curriculum, including a simulator and feedback mechanism. Surgeons and surgical trainees from Kenya and the United States tested the simulator prototype and provided feedback for its refinement based on clarity, utility, and realism. ResultsInstructions for a self-constructed simulator were developed at the cost of 70 Kenyan shillings (0.64 US dollars). Fifteen surgeons and surgical residents gave feedback on the simulator and curriculum, and each was presented with an updated version based on feedback. Overall, the curriculum was clear, with each sub-step receiving a median score of ≥83.5 out of 100 for clarity; however, through iterative design, the utility of sub-steps on the simulator improved. ConclusionA comprehensive open appendectomy curriculum, including a low-cost appendectomy simulator model, was developed and refined using surgeon feedback. Such curricula may benefit trainees in low-resource settings who may otherwise have limited access to quality training material.

Adolescent and young adult preferences for financial incentives to support adherence to antiretroviral therapy in Kenya: a mixed methods study.

IntroductionTo develop a patient‐centred financial incentive delivery strategy to improve antiretroviral treatment adherence in adolescents and young adults (AYA) living with HIV in Kisumu, Kenya, we conducted a mixed methods study exploring preferences.MethodsA discrete choice experiment (DCE) and focus group discussion (FGD) were conducted simultaneously to identify preferences for five incentive delivery strategy features: value, eligibility, recipient, format and disbursement frequency. We used consecutive sampling to recruit AYA (14–24 years) living with HIV attending three health facilities in Kisumu, Kenya. We calculated mean preferences, willingness to trade, latent class membership and predictors of latent class membership. The FGD explored preferred incentive features, and, after deductive and inductive coding, qualitative findings were triangulated with DCE results.ResultsTwo hundred and seven AYA living with HIV (46% 14–17 years, 54% 18–24 years; 33% male sex, 89% viral load <50 copies/ml) were recruited to the study (28 October–16 November 2020). Two distinct preference phenotypes emerged from the DCE analysis (N = 199), 44.8% of the population fell into an “immediate reward” group, who wanted higher value cash or mobile money distributed at each clinic visit, and 55.2% fell into a “moderate spender” group, who were willing to accept lower value incentives in the form of cash or shopping vouchers, and accrued payments. The immediate reward group were willing to trade up to 200 Kenyan Shillings (KSH)—approximately 2 US dollars (USD)—of their 500 KSH (∼5 USD) incentive to get monthly as opposed to accrued yearly payments. The strongest predictor of latent class membership was age (RR 1.45; 95% CI: 1.08–1.95; p = 0.006). Qualitative data highlighted the unique needs of those attending boarding school and confirmed an overwhelming preference for cash incentives which appeared to provide the greatest versatility for use.ConclusionsProviding small financial incentives as cash was well‐aligned with AYA preferences in this setting. AYA should additionally be offered a choice of other incentive delivery features (such as mobile money, recipient and disbursement frequency) to optimally align with the specific needs of their age group and life stage.

Cost of maternal near miss and potentially life-threatening conditions, Kenya.

ObjectiveTo estimate the direct costs of treating women with maternal near misses and potentially life-threatening conditions in Kenya and the factors associated with catastrophic health expenditure for these women and their households.MethodsAs part of a prospective, nationally representative study of all women with near misses during pregnancy and childbirth or within 42 days of delivery or termination of pregnancy, we compared the cost of treating maternal near-miss cases admitted to referral facilities with that of women with potentially life-threatening conditions. We used logistic regression analysis to assess clinical, demographic and household factors associated with catastrophic health expenditure.FindingsOf 3025 women, 1180 (39.0%) had maternal near misses and 1845 (61.0%) had potentially life-threatening conditions. The median cost of treating maternal near misses was 7135 Kenyan shillings (71 United States dollars, US$) compared with 2690 Kenyan shillings (US$ 27) for potentially life-threatening conditions. Of the women who made out-of-pocket payments, 26.4% (122/462) experienced catastrophic expenditure. The highest median costs for treatment of near misses were in Nairobi and Central region (22 220 Kenyan shillings; US$ 222). Women with ectopic pregnancy complications and pregnancy-related infections had the highest median costs of treatment, at 7800 Kenyan shillings (US$ 78) and 3000 Kenyan shillings (US$ 30), respectively. Pregnancy-related infections, abortion, ectopic pregnancy, and treatment in secondary and tertiary facilities were significantly associated with catastrophic expenditure.ConclusionThe cost of treating maternal near misses is high and leads to catastrophic spending through out-of-pocket payments. Universal health coverage needs to be expanded to guarantee financial protection for vulnerable women.