Informal Settlement Of Kibera Research Articles

Exclusive Breastfeeding and Its Determinants Among Adolescent Mothers in Kibera Informal Settlement, Nairobi County, Kenya

Exclusive breastfeeding for the first six months is recommended as the optimal way to feed infants (WHO,2019). The study sought to assess the practice of exclusive breastfeeding and its determinants among adolescent mothers in Kibera informal settlement. A cross-sectional descriptive study design was used. A sample of 300 adolescent mothers were interviewed together with 10 Key informants. Multistage Sampling was the technique used to select villages and households with adolescent mothers with infants less than 6 months. A questionnaire was used to collect data through face-to-face interviews with adolescent mother and key Information Interview guide was used to collect the qualitative data from health care workers at Carolina For Kenya facility. Quantitative data was coded, entered into SPSS software. Descriptive statistics was carried out for all variables whereby categorical variables were evaluated using percentages and frequencies. The chi-square test was applied at a bivariate level to assess relationships associated with exclusive breastfeeding. Significance levels were set at α=0.05. The qualitative data obtained were analyzed according to major themes raised during the interviews. The findings were that most (89%) of the adolescent mothers were unemployed and their mean age was 17 years (±SD= 2.19). More than a half (64%) attained secondary as the highest academic level. The mean birth weight of the infants was 2.7kgs (±SD=1.13) and 61% were females. The prevalence rate of exclusive breastfeeding was low 7.3% while complementary feeding rate was high at 80.7%, Almost half (48.7%) of the infants were being given water and complementary foods like milk (30.3%) and dilute porridge (21%). The variables that were significantly (p<0.05) associated with exclusive breastfeeding were age (χ2=27.992, p=0.006) and knowledge on exclusive breastfeeding (χ2=23,836, p=0.000). Most (80%) of the professionals had been trained for 2 years and above while the remaining 20% had already undergone training for one year and were still enrolled for some more training. The practice of exclusive breastfeeding was low and many adolescent mothers introduced complementary feeding before six months.

Doctor Patient Type of Language Used and Tuberculosis Treatment Adherence in Kibera Informal Settlement in Nairobi County, Kenya

Purpose: To explore the type of language used on tuberculosis treatment adherence in an informal settlement in Nairobi County, Kenya.
 Methodology: This was by a descriptive qualitative research design. The sample size was 67 and comprised 10 healthcare workers and 57 TB patients. Purposive sampling technique was used to sample the participants. The study conducted 37 unstructured in-depth interviews and 3 focus group discussions. Data analysis was conducted by first translating the data, then transcribing the verbatim of the in-depth unstructured interviews and focus group discussions. The transcribed data was later analyzed using thematic analysis. Data was presented using tables, bar charts and pie charts.
 Findings: The findings of the study indicated that majority of the tuberculosis patients found that the type of language used by the healthcare workers when communicating with them determined whether they would adhere to treatment or not. If the language used was not well understood by the patient or if the healthcare worker used complex language, then the patient was not likely to adhere to treatment. The findings further indicated that more than half of the patients were fluent in Swahili language while the remaining patients only had basic knowledge of the language. Sixty percent that is 34 of the participants were fluent in Swahili language whereas thirty- eight percent that is 22 patients had basic knowledge of the language, and one did not understand the language and opted to communicate with the help of an interpreter. Seventy percent that is 40 of the patients indicated that when the healthcare workers communicated with them in simple language they were more likely to adhere to TB treatment. Findings from the healthcare workers indicated that Swahili was the preferred language used by both the healthcare workers and the tuberculosis patients. If a patient did not understand Swahili language, the healthcare workers would look for an interpreter who would then translate to the patient the required information. The use of complex medical language was only used when the healthcare workers were communicating amongst themselves.
 Unique Contribution to Theory and Practice and Policy: The constructs of the theories informed the study in terms of treatment adherence by emphasizing the benefits of seeking healthcare early. On practice, healthcare workers needed to be aware of type of language used when interacting with their patients as they are likely to affect their patients’ adherence to treatment. Based on these findings, policymakers should ensure that all healthcare workers should use simple language that is, the use of plain common words to make it easier for the patients to understand. In addition, any health messages, appointment cards or any other TB information whether spoken or written meant for the patients, should be designed in a language that is simple for the patient to comprehend.

Flooding in the urban fringes: Analysis of flood inundation and hazard levels within the informal settlement of Kibera in Nairobi, Kenya

Overlapping conditions of rapid urbanisation and climate change across developing countries are threatening the capacity of cities to manage climate risks, especially in the flood-exposed low-income peripheral areas. Limited studies have applied hydrodynamic flood models in ascertaining flooding conditions, supportive of risk-informed decisions in such urban fringes. Against this backdrop, we assessed plausible flooding and hazard conditions in the low-lying villages of Lindi and Silanga in Kibera informal settlement. The coupled one-dimensional and two-dimensional hydrodynamic model, customised from the Hydrological Engineering Centre's River Analysis System (HEC-RAS) was parameterised for flood simulation under different hydrological regimes and scenarios associated with flooding in Kibera. Volumetric flow estimates and a computed energy slope were used to define the upstream and downstream modelling boundary conditions respectively. Trial-and-error adjustment of the flow resistance coefficients from land-use features was applied in model calibration, and the results compared to the surveyed flood of 23rd April 2019. Results show that proximal areas to the Ngong River and Nairobi dam face high flood risks. A flood volume of 11.7×105m3 from a 2.5h, 50 mm rainfall could potentially inundate about 2.0% and 8.3% of areas in Lindi and Silanga respectively, while a volume of 48.9×105m3 from a 100-year storm of 172 mm could inundate about 10.6% of Lindi and 29.1% of Silanga. Upstream steeply sloping topographies of the villages increase flood velocities and risk of drowning, while the lower reaches at relatively flatter topographies, experience attenuated flow and rapid accumulation of flood waters, hence, higher flood depths. These results can support policy interventions for integrated flood risk management in Kibera, as a way of mainstreaming the underserved urban communities in climate risk management.

Cleaner Cooking with Charcoal in Kibera Informal Settlement in Nairobi, Kenya, and Its Implications for Livelihoods and the Environment

Woodfuel that is unsustainably sourced and inefficiently used results in negative environmental and health impacts. This study assessed charcoal use and resultant concentrations of indoor air pollutants (IAP) in an urban informal settlement while cooking with a Jikokoa stove (an improved branded charcoal stove) and medium and small-sized artisanal Kenya Ceramic Jikos (KCJs). Fuel stacking was prevalent with charcoal and kerosene being used by 25% of the studied households. Cooking with a Jikokoa stove reduced charcoal consumption by 6.4% and 26% compared to small and medium-sized KCJs, respectively. The small-sized KCJ reduced charcoal consumption by 21% compared to the medium-sized KCJ. The Jikokoa stove reduced concentrations of carbon monoxide (CO) by 10% and 50% and fine particulate matter (PM2.5) by 6% and 77% compared to small-sized and medium-sized KCJs, respectively. The Jikokoa stove reduced carbon dioxide (CO2) concentrations by 15.6% compared to the medium-sized KCJ. The small-sized KCJ reduced CO and PM2.5 concentrations by 45% and 75%, respectively, compared to the medium-sized KCJ. In summary, small-sized KCJs are more effective than medium-sized ones, and Jikokoa stoves more effective than small-sized KCJs, making it the stove of choice. The more efficient charcoal stoves are, the more charcoal consumption and IAP can be reduced, mitigating environmental degradation, climate change and health problems associated with smoke in the kitchen. There is need for participatory research to scale improved stoves and upgrade local practices as they are cheaper and already embedded in the cooking culture.

Drivers of Health Insurance Coverage in Low Income Settlements: A Case of Kibera Informal Settlement, Nairobi County, Kenya

Insurance is critical for any country's economic growth and development to be sustainable. In rural areas of Kenya, among the illiterate, unemployed, poor, and vulnerable in society, health insurance adoption is extremely low. This paper focuses on determining the drivers for health insurance uptake among low-income populations in Kibera, Nairobi County. Semi structured questionnaires were administered to households located in Kibera informal settlements to collect data. The Yamane (1967) formula was used to select the sample size. Simple random sampling was adopted in selecting 399 respondents. Both descriptive and inferential analysis were conducted. The binary probit regression model was employed. Health insurance ownership was used as the dependent variable while age, gender, marital status, household size, school attainment, occupation, income levels, religion, cultural beliefs, frequency of hospital visits, cost of premiums, and pre-existing illness were used as the independent variables. Findings revealed that only 27.6 percent of the respondents had health insurance coverage. The findings further revealed that occupation, income levels, and religion significantly influence health insurance ownership among low-income populations in Kibera, Nairobi. Public health insurance cover was the most owned type of health insurance scheme. Recommendations were highlighted for the ministry of health and other relevant stakeholders to raise knowledge on the various health insurance options available and improve flexibility of the products to drive insurance uptake. In addition, national and county governments need to develop programmes and policies that could empower households in the informal settlements. Further, it is necessary for the government to subsidise the cost of acquiring public health insurance covers since this would encourage uptake among low-income families. The ministry of health should also work in conjunction with various religious denominations to campaign for uptake of health insurance among the poor.

A citizen science approach for air quality monitoring in a Kenyan informal development

This paper investigates the use of a citizen science approach for air quality monitoring to explore the likely pollution impacts of the new Missing Link #12 road passing through the informal settlement of Kibera, within Nairobi. Citizen science approaches are gaining relevance in air quality monitoring thanks to the advancement in environmental monitoring technology and the opportunities created for community-based organizations to collect data on air pollution through low-cost sensors. Fourteen households located in proximity to the Missing Link#12 were equipped with optical particle sensors. Data collected indicated that people living along the road are exposed to levels of PM2.5 and PM10 above WHO recommendations, mainly due to the particulate generated by the construction site and fuels used for indoor cooking. A community engagement workshop revealed that participatory approaches are useful for improving awareness of air pollution and associated health implications. It also allowed the community to enhance their capability to gain and use scientific tools to address local issues, and potentially lobby decision-makers to solve them. In the context of transport infrastructure development in African cities, such an approach can be a means of collecting data and monitoring the impacts of air pollution during and after road building.

Improvements in Diarrheal Disease Prevalence with Point-of-use Water Filter Implementation in the Informal Settlement of Kibera, Kenya

Background: There is increasing evidence of the efficacy of point-of-use water filters on diarrhea prevalence in numerous global settings, in both observational studies and randomized experiments. Most studies, however, are focused on rural locations. Here we use self-report household surveys, and select drinking water testing, to monitor a set of approximately 10,000 households receiving Sawyer® point-of-use water filters, WASH training, and Albendazole in Kibera, Kenya.

Six-Months Retention on Treatment and Attrition Risk Factors among People Living with HIV in Kibera Informal Settlement, Nairobi, Kenya.

Early retention of patients on HIV treatment is vital in preventing new infections, reducing transmissions, preventing AIDS related deaths and achieving viral suppression. This study sought to determine the effectiveness of non-cash intervention (reminding HIV positive patients at every clinic visit that they stand to receive free T-shirts of their favorite football team or free Kiondos based on preference if they made it to the sixth month visit without missing a treatment appointment) and psychosocial support on retention during the first six months of HIV treatment. This unblinded randomized control trial was conducted at three health centers within the Kibera informal settlement in Nairobi, Kenya. Participants were randomly assigned to the intervention and control groups at a ratio of 1:1. Eligible participants were patients who newly tested HIV positive and enrolled for treatment at the study sites, were 18 years and older and were willing and able to provide informed consent to participate in the study. The primary outcome of interest was retention on treatment at six months. The overall retention on treatment at six months was 93%. Retention at six months among the intervention and control groups was 94% and 91%, respectively (aRR: 1.03; 95% CI: 0.98–1.09; p-value = 0.24). Attrition from treatment was significantly associated with being divorced, being single/never married, time to clinic, participant weight and being on other first line ART regimens other than TDF/3TC/DTG and TDF/3TC/EFV. Mortality and lost to follow-up rates were 1.6 and 13.5 per 100 person-years, respectively. The combination of non-cash incentives and psychosocial support did not improve retention during the first six months of HIV treatment. To reduce further attrition in the early stages of HIV treatment, innovative strategies are needed to reach divorced and not married/single patients earlier and support them to remain on treatment. Efforts should also be made to further decentralize ART treatment to reduce costs and time associated with travelling to and from hospitals.

Simulation of flood peak discharges and volumes for flood risk management in the ungauged urban informal settlement of Kibera, Kenya

In spite of the increasing extremity and adverse consequences of urban floods under climate change, flood characteristics in most developing countries are still largely unknown due to lack of continuous monitoring. This portentous uncertainty stances high flood risk, especially to a majority low-income urban population inhabiting the flood-prone informal settlements. Physically-based hydrologic models, whose parameters are derivable from catchment features, are often used for hydrological analysis in the ungauged regions. In this study, the Hydrologic Engineering Centre's-Hydrologic Modelling System (HEC-HMS) was used for rainfall-runoff simulation in the upper Ngong River Basin of Kenya, draining into the Kibera informal settlement, for purposes of estimating flood peak discharges (FPDs) and direct runoff volumes (DRVs), often required for flood risk management. The Soil Conservation Service-Curve Number (SCS-CN), SCS-Unit Hydrograph (SCS-UH) and Muskingum models were used for hydrological simulation from four (4) observed and fifty-four (54) hypothetical extreme rainfalls. The results obtained indicated that a 50 mm rainfall event with a duration of 2.5 h has the potential of producing FPD and DRV of about 90m3s−1 and 1.17×106m3 respectively at the Ngong River confluence at Sokomoko in Kibera. On the other hand, the non-intermittent 100-year storm event of about 172 mm in depth, occurring over a period of about 4 h, potentially generated FPD of about 460m3s−1 and DRV of about 4.89×106m3, portending calamitous impacts in the basin. These results can offer preliminary information on potential flood characteristics, that can be used as a baseline to support local-level flood risk mitigation measures in the ungauged Ngong River Basin.

Intestinal Parasite Infections and Associated Risk Factors among Pre-School Aged Children in Kibera Informal Settlement, Nairobi, Kenya

Infections with intestinal parasites are a major public health problem in children in developing countries like Kenya. School going children are considered at most risk and are included in school-based de-worming program. Less focus is given to pre-school children and information is scarce about intestinal parasitosis among this age group. In this study, we determined the prevalence and intensity of protozoa and helminth infections, and associated risk factors in an informal settlement. A community based cross-sectional study was conducted from October 2016 to January 2017 among 406 children aged 2-5 years in Kibera informal settlements in Nairobi County, Kenya. Structured interviewer-administered questionnaire was used to collect sociodemographic information and data on associated factors. Stool samples were examined microscopically using formal ether concentration, iodine wet mounting, modified Ziehl-Neelsen staining, and Kato-Katz methods. Multivariable logistic regression analysis was used to identify risk factors associated with intestinal parasites. The overall prevalence of any helminth and protozoa infections was 13.1% 53/406) and 22.4% (91/406) respectively. The predominant parasites were Giardia lamblia (13.8%), Ascaris lumbricoides (11.3%), Entamoeba histolytica/dispar (9.4%), Trichuris trichiura (3.9%), Entamoeba coli (1.5%) and hookworm (0.2%). Prevalence of co-infection with any helminths or protozoan was 2.7%. About 10.8% (44/406) and 20.7% (84/406) children were infected with single species of helminth and protozoan parasites. All helminth infections were light, with a mean intensity of 592 egg per gram. Intensity of any protozoan infections was heavy 62.6% (57/406). Dirt floors in the household (aOR = 2.22, p = .046), dirty toilets (aOR = 2.33, p=.014), water from communal taps (aOR = 0.27, p=.019), parent's education level (aOR=0.27, p=.032) and parent's earning (aOR =3.34, p=.007) were factors significantly associated with intestinal parasites. The study found both helminth and protozoan parasites to be prevalent among pre-school aged children in Kibera. Intervention measures including education on the improvement of hygiene and health, socio-economic conditions, sanitation, and provision of safe drinking water could reduce the prevalence of these infections.

Serological Evidence of Exposure to Onyong-Nyong and Chikungunya Viruses in Febrile Patients of Rural Taita-Taveta County and Urban Kibera Informal Settlement in Nairobi, Kenya.

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

Informal Food Vendors and the Obesogenic Food Environment of an Informal Settlement in Nairobi, Kenya: A Descriptive and Spatial Analysis

ObjectivesThe objective of this study was to characterize the food environment of an informal settlement in Nairobi, Kenya according to the obesogenic properties and spatial distribution of informal food vendors. MethodsFrom July 15 to August 9, 2019, we identified 524 vendors in the informal settlement of Kibera. Guided by the NOVA classification system for food processing, we dichotomized foods sold into categories of high- vs. low-risk and protective vs. non-protective with respect to their propensity to promote weight gain. Then, we classified vendors into obesogenic risk groups based on a 1/3 cutpoint for the proportion of high-risk and protective foods sold: 1) low-risk, protective, 2) low-risk, non-protective, 3) high-risk, protective, 4) high-risk, non-protective. We calculated descriptive statistics of the types of foods sold according to vendor type and obesogenic risk group. To assess clustering by obesogenic risk, for each group, we calculated the mean distance to the nearest vendor of the same group, and used Ripley’s K function and 100 Monte Carlo simulations to identify significant clustering. ResultsThe 456 vendors in the analytic sample included approximately 30% stands, 29% kiosks, 17% market stalls, 13% hawkers, and 12% restaurants. Foods most commonly sold were sweets/confectionary (29% of vendors), raw vegetables (28%), fried starches (23%), and fruits (21%). Forty-four % of vendors were classified as low-risk, protective, 34% as high-risk, non-protective, 16% as low-risk, non-protective, and 6% as high-risk, protective. The mean distance (95% CI) to the nearest vendor of the same group was 26 m (21, 31) for vendors in the low-risk, protective group, 29 m (25, 33) in the high-risk, non-protective group, 114 m (88,139) in the high-risk, protective group, and 43 m (30, 56) in the low-risk, non-protective group. Clustering was significant for all obesogenic risk groups except high-risk, protective. ConclusionsOur findings demonstrate a duality of obesogenic and non-obesogenic foods in this environment. Clustering of vendors selling obesogenic foods highlights the need for strategies to ensure consistent access to health-promoting foods throughout informal settlements. Funding SourcesUNC-Chapel Hill Department of Nutrition; Robertson Scholars Leadership Program at Duke University; NHLBI predoctoral traineeship.

Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020.

Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomicchallenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection. Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27 th November and 5 th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity. Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 - 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 - 21.3%) among children (<5 years), 32.7% (95% CI, 22.9 - 44.4%) among children 5 - 9 years, 41.8% (95% CI, 33.0 - 51.1%) for those 10-19 years, and 54.9%(46.2 - 63.3%) for adults (≥20 years). Relative to those from medium-sized households (3 and 4 individuals), participants from large (≥5 persons) households had significantly increased odds of being seropositive, aOR, 1.98(95% CI, 1.17 - 1.58), while those from small-sized households (≤2 individuals) had increased odds but not statistically significant, aOR, 2.31 (95% CI, 0.93 - 5.74). Conclusion: In densely populated urban settings, close to half of the individuals had an infection to SARS-CoV-2 after eight months of the COVID-19 pandemic in Kenya.This highlights the importance to prioritize mitigation measures, including COVID-19 vaccine distribution, in the crowded, low socioeconomic settings.

Literature review on contraceptive use among adolescent students in kibera informal settlements in nairobi country

The question revolving around birth control or contraceptive use has sufficed the lips and minds of social demography think tanks, guided by the desired vision of having equitable and sufficient resources for the people. However, the issue of contraceptive use among adolescents, who are school going children in informal settlements, still remains a challenge, attracting a discourse for those for or against contraceptive use. This literature review attempts to answer some questions. What is the status of contraceptive use among adolescents in Kibera informal settlements? What are the discourses for or against contraceptive use among adolescents in Kibera informal settlements? How have government and nongovernmental organizations contributed to the proper usage of contraceptives among adolescents in Kibera informal settlements? What are the existing policy framework and programs on contraceptive use and have they been effective? This topic on contraceptives has undergone numerous research studies in different parts of the world, thus a desk review is employed. These research findings are of the view that, contraceptives are easily accessed at the pharmacies over the counter by adolescents though its frequency is not properly regulated due to their business nature, contraceptive use is viewed in terms of reducing unplanned pregnancies that is deemed to bring additional economic burden to a girl, the government and non-governmental organizations have been at the forefront of providing advocacy and community sensitization to sex education and contraceptive use among the youth, though poverty levels of the locals has derailed the process and despite having policies on contraceptive use on the ground, there still exists loopholes that need to be filled. It is thus the submission of this paper that the issue of early sexual debut among adolescents is a growing menace, and all the efforts geared towards championing proper contraceptive usage among adolescents should be supported.

Seroevidence of Zoonotic Viruses in Rodents and Humans in Kibera Informal Settlement, Nairobi, Kenya.

Rodents are known reservoir hosts for a number of pathogens that can spillover into humans and cause disease. These threats are likely to be elevated in informal urban settlements (i.e., slums), where rodent and human densities are often high, rodents live in close proximity to humans, and human knowledge of disease risks and access to health care is often limited. While recent research attention has focused on zoonotic risks posed by urban rodents in major cities around the world, informal urban settlements have received far less attention. Here we report on a study in which samples were collected from 195 commensal rodents and 124 febrile human patients in the Kibera informal settlement in Nairobi, Kenya (one of the largest informal urban settlements in the world). Using immunofluorescence assays, samples were screened for antibodies against common rodent-borne zoonotic virus groups, namely orthopoxviruses, arenaviruses, and hantaviruses. We detected antibodies against orthopoxviruses in rodents (4.1% positive) and antibodies in humans against orthopoxviruses, arenaviruses, and hantaviruses (4.8%, 3.2%, and 8.1% positive, respectively). No rodents had antibodies against arenaviruses or hantaviruses. These results provide strong evidence for the circulation of zoonotic viruses in rodents and humans in Kibera urban settlement, but discordance between viruses detected in host groups indicates that other species or taxa may also serve as reservoirs for these zoonotic viruses or that humans testing positive could have been exposed outside of the Kibera settlement. More broadly, this study highlights the threat posed by zoonotic viruses in informal urban settlements and the need to mitigate human exposure risks.

Impacts of two-year multisectoral cash plus programs on young adolescent girls\u2019 education, health and economic outcomes: Adolescent Girls Initiative-Kenya (AGI-K) randomized trial

BackgroundEarly adolescence is a critical window for intervention when it is possible to lay a foundation for a safe transition to adulthood, before negative outcomes occur. The Adolescent Girls Initiative–Kenya randomized trial tested the effects of combinations of interventions for young adolescent girls in two sites – the Kibera informal settlement in Nairobi and rural Wajir County in the Northeastern region.MethodsThe interventions included community dialogues on the role and value of girls (violence prevention), a conditional cash transfer (education), weekly group meetings for girls with health and life skills training (health), and training and incentives for financial literacy and savings activities (wealth creation). Participants were randomized to one of four study arms: 1) violence prevention only, 2) violence prevention and education, 3) violence prevention, education and health or 4) violence prevention, education, health and wealth creation. An intent-to-treat (ITT) analysis was conducted using longitudinal data to estimate the impact of each combination of interventions and various sensitivity analyses conducted addressing potential attrition bias and multiple hypothesis testing concerns.ResultsIn Kibera, the education conditional cash transfer had small effects on grade attainment but larger impacts on completion of primary school and the transition to secondary school in the most comprehensive arm; the health intervention improved sexual and reproductive health knowledge and condom self-efficacy; and the wealth intervention improved financial literacy and savings behavior. In Wajir, the education conditional cash transfer increased school enrollment and grade attainment, and the wealth intervention improved savings behavior.ConclusionsThe results indicate that when trying to improve a range of outcomes related to adolescent wellbeing for young girls, a multisectoral intervention with components addressing household economic constraints is a promising approach.Trial registrationTrial Registry: ISRCTN, ISRCTN77455458. Registered 24/12/2015 - Retrospectively registered.

Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020

Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomicchallenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection. Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27 th November and 5 th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity. Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 - 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 - 21.3%) among children (<5 years), 32.7% (95% CI, 22.9 - 44.4%) among children 5 - 9 years, 41.8% (95% CI, 33.0 - 51.1%) for those 10-19 years, and 54.9%(46.2 - 63.3%) for adults (≥20 years). Relative to those from medium-sized households (3 and 4 individuals), participants from large (≥5 persons) households had significantly increased odds of being seropositive, aOR, 1.98(95% CI, 1.17 - 1.58), while those from small-sized households (≤2 individuals) had increased odds but not statistically significant, aOR, 2.31 (95% CI, 0.93 - 5.74). Conclusion: In densely populated urban settings, close to half of the individuals had an infection to SARS-CoV-2 after eight months of the COVID-19 pandemic in Kenya.This highlights the importance to prioritize mitigation measures, including COVID-19 vaccine distribution, in the crowded, low socioeconomic settings.

Impact of the First Wave of the COVID-19 Pandemic on HIV/AIDS Programming in Kenya: Evidence from Kibera Informal Settlement and COVID-19 Hotspot Counties

The study sought to determine the impact of COVID-19 on HIV/AIDS programming in the Kibera informal settlement and COVID-19 hotspot counties during the first wave of the pandemic. The study was conducted in two phases. The first phase entailed the analysis of HIV care and treatment secondary data (2018–2020) from the Kenya Health Information System. In the second phase, a prospective cohort study was conducted among people living with HIV in the Kibera informal settlement. A total of 176 participants aged 18 years and above accessing HIV services at selected healthcare facilities in Kibera were randomly sampled from facility electronic medical records and followed up for three months. Socio-demographics and contact details were abstracted from the records and telephone interviews were conducted with consenting participants. Results from the retrospective review of HIV program data indicated a 56% (p < 0.000, 95% CI: 31.3%–62.8%) reduction in uptake of HIV services. Clients starting antiretroviral therapy (ART) reduced significantly by 48% (p < 0.001, 95% CI: 35.4%–77%) in hotspot counties. However, pre-exposure prophylaxis uptake increased significantly by 24% (p < 0.019, 95% CI: 4%–49%). In Kibera, 14% reported missing medications at the onset of the COVID-19 pandemic because of lack of food (38%) and government measures (11%), which affected ART access; 11% did not access health facilities due to fear of contracting COVID-19, government regulations and lack of personal protective equipment. Socioeconomic factors, food insecurity and government measures affected uptake of HIV/AIDS services; hence, the need for scaling up measures to increase access to HIV/AIDS services during the onset of pandemics.

Whose Agency: The Politics and Practice of Kenya’s HIV-Prevention NGOs, Megan Hershey

Reviewed by: Whose Agency: The Politics and Practice of Kenya's HIV-Prevention NGOs by Megan Hershey Brad Crofford BOOK REVIEW of Hershey, Megan. 2019. Whose Agency: The Politics and Practice of Kenya's HIV-Prevention NGOs. Madison: University of Wisconsin Press. 224 pp. $69.95 (cloth). In Whose Agency, political scientist Megan Hershey uses a mixed-methods research approach to argue that local nongovernmental organizations (NGOs) in Kenya are highly adaptable and thus able "to thrive within the interplay of donor, state, and religious demands" (20). She balances discussion of academic works on NGOs with examples from participant-observation, interviews, focus groups, and surveys in nuanced and engaging ways. The first chapter summarizes the literature on NGOs and program evaluations of HIV-prevention programs as well as key terms and methodologies for the remainder of the book. Hershey focuses on local NGOs, as opposed to international NGOs or community-based organizations. She measures NGO success through its direct reach ("the number of individuals who attended a training program"), indirect reach ("the number of individuals with whom trainees shared HIV-prevention information"), the number of individuals obtaining HIV tests as a proxy for individual behavioral change, and the use of participatory approaches (15–17). She uses four case studies of local NGOs in Nairobi, Kenya: two each that operate in universities or informal settlements and two each that are faith based or secular. She conducted participant-observation and staff interviews at each site over a period of six weeks or more, surveyed youth in the NGOs' target areas, and interviewed youth who participated in the NGOs' programs. In chapter 2, she provides background information for future chapters, with a brief history of the NGO sector and HIV/AIDS contexts in Kenya. She discusses the settings of the four case studies: the Kibera and Mathare informal settlements, the University of Nairobi, and Daystar University. Chapter 3 details the four local NGOs Hershey studied, including their locations, work cultures, and programs. It includes survey results relating to the organizations' direct reach, indirect reach, and effects on behavior (as reflected in HIV testing rates) in their target areas. Hershey finds "NGOs are effecting real behavior change in addition to reaching people directly and indirectly" (70). The next chapter describes how the NGOs conduct their training and how they adapt "to attract and meet the needs of their target audiences," as by providing a small financial incentive in informal settlements or making the training entertaining to compete with other activities available to university students (90). Interestingly, Hershey finds that a lower percentage of survey respondents in informal settlements attended HIV training sessions, but those who did so shared the information more widely, reaching as many as twenty-six people per trainee. In chapter 5, Hershey focuses on participation, including "whether local NGOs were responding to community members' needs and whether these community members were meaningfully incorporated into the decision-making [End Page 97] process as participants" (91). She finds that the NGOs in informal settlements incorporated more participation into their processes, such as involving local youth groups, although neither they nor their university-based peers incorporated ideal amounts of participation. She attributes this to poor internal communication within the NGOs and donor restrictions, which may lead NGOs to prioritize the donor's desired outcomes over the community's participation or preferences. The following chapter examines the role of religion. Hershey reports that "faith is not a key element of NGO programs" for either the religious or secular NGOs, since religious NGOs downplay faith to align with donor restrictions and attract participants, while secular NGOs include some religious practices, like prayer, to boost their legitimacy in local contexts (123). There is thus no difference in programs, but there are nonetheless some differences in the NGOs' cultures, their approaches to networking, and their employees' perceptions of their own and their organizations' work. In chapter 7, Hershey discusses the relationship between HIV/AIDS NGOs and the Kenyan state. After providing a brief history of the state's response to HIV/AIDS, she argues that NGOs have "carefully cultivat[ed] positive relationships with the state in order to access more resources with which to better serve their communities...

Analysis of rainfall extremes in the Ngong River Basin of Kenya: Towards integrated urban flood risk management

Extreme rainfall events are a major cause of highly disruptive flooding in small urban watersheds with limited flood risk management systems. In the Ngong River Basin of Kenya, such floods affect more than 0.5 Million residents within the Kibera informal settlements of Nairobi. However, there is paucity of information about the characteristics of the extreme rainfalls to support flood risk management. This study investigated the best-fit probability distribution models for the extreme rainfalls of the Ngong Basin using Block Maxima approach as a basis for anticipatory flood risk management. Daily rainfall data for the period between 1968 and 2017 were acquired from the existing two rainfall stations to support the analysis at monthly, seasonal and annual timescales. The Gamma, Pearson Type III, Gumbel and Generalized Extreme Value distributions were selected and applied to each timescale. Parameters of the distributions were determined using the Maximum-Likelihood estimator. The validity of the fitted probability models was tested using the Kolomogorov- Smirnov, Anderson-Darling and Cramer von Misses measures for Goodness of Fit. The best-fit probability distributions were subsequently used to establish the rainfall frequencies and return levels at annual timescales. The results show that Pearson Type III provided the best fit at monthly timescales during the dry spell months, while the Generalized Extreme Value distribution provided best results during the wet periods. At seasonal timescales, the Gamma distribution was noted to be the best-fit model. The return levels developed could essentially support the design of urban flood control structures for appropriate flood risk management.