Kilifi County Research Articles

Community perspectives of heat and weather warnings for pregnant and postpartum women in Kilifi, Kenya.

Extreme weather is a recognised risk factor for stillbirth and preterm birth, disrupts women's access to healthcare during pregnancy and childbirth, and negatively affects the care of newborns. Reliable and accessible heat and weather warning systems are key in alerting individuals to undertake protective measures. There is a notable gap in understanding how women and caregivers in rural East Africa perceive and utilize weather information. We investigated community members' heat and weather warning information-seeking behaviour, identified available sources, assessed their reliability and utility, and examined their influence on behaviour. Our research was conducted in rural Kilifi County in Kenya's coastal region. The area experiences temperatures exceeding 23°C throughout the year, with extended periods of extreme temperatures [> 40°C] and long and severe droughts. We conducted in-depth interviews [IDI] with pregnant and postpartum women [n = 21] and held six focus group discussions [FGDs] involving mothers-in-law and community health volunteers [CHVs]. The data were analysed in NVivo 12 using both inductive and deductive approaches. We found significant gaps concerning pregnant and post-partum women, and their caregivers, having timely access to weather forecasts and heat information from health or meteorological authorities. Information on heat and weather warnings is disseminated through various channels, including television, radio, mobile phones, and word of mouth, which are facilitated by community influencers such as CHVs and local chiefs. Indigenous methods of weather forecasting, such as cloud observation, consulting local "rainmakers", and studying the behavioural patterns of amphibians, are employed in conjunction with warnings from the Kenyan Meteorological Department (KMD). Barriers to accessing weather information include the cost of television and smartphones and a lack of segmented information in local languages. National and county meteorological services need to enhance public participation, communication, and the delivery of heat and weather information to guide community-level response measures and individual behaviour change. They should also collaborate with health professionals to address heat risks for vulnerable groups. Further research is needed to empower indigenous weather predictors with modern weather information and revise national policies to deliver tailored messages to vulnerable populations like pregnant and postpartum women.

Awareness of community-led total sanitation and its impact on sanitation among residents of Kilifi and Marsabit Counties, Kenya

Background: Community-based strategy known as community-led total sanitation (CLTS) is frequently employed to address open defecation and the health issues it causes. Inadequate sanitation is one of the biggest health and environmental problems in the world, contributing to approximately 775,000 deaths per year. This study aimed to assess the level of awareness of community-led total sanitation (CLTS) and its impact on sanitation among communities in Kilifi and Marsabit Counties in Kenya. Methods: The study adopted a comparative study design. Purposive and multistage sampling were used to recruit study respondents in this study. Fischer's formula was used to determine the sample size for this investigation where 811 study participants were enlisted for the research. Propensity score matching (PSM) was used to estimate the impact of CLTS intervention on sanitation status. A significance level of 0.05 was employed as the threshold for all tests conducted in this study. Results: From this study, Among those fully conversant with CLTS, 98% resided in Kilifi County; 77% in Marsabit were fully aware of CLTS. The majority(87.7%) of the study respondents were fully aware of CLTS. Despite CLTS intervention resulting in a 42% increase in households owning a sanitation facility, There was no significant statistical association between CLTS intervention and sanitation status (t=0.42, p=0.0835). Conclusion: The study established that the level of awareness of CLTS in both counties was high. The results from this study demonstrated that CLTS intervention programs had an impact on sanitation levels in Kilifi and Marsabit counties.

The association between food production, food security, household consumer behaviour and waist-hip ratio amongst women in smallholder farming households in Kilifi County, Kenya.

Food insecurity disproportionately affects smallholder farming households and within them women, who bear primary caregiving responsibilities and contend with time and resource constraints that heighten their vulnerability to adverse nutrition-related health outcomes. This study cross-sectionally investigates the association between food production practices, household consumer behaviour, and the experience of food insecurity with women's waist-hip ratio (WHR), a key indicator of abdominal obesity, in a coastal community in Kenya. In total, 394 households were randomly selected from a list of farming households in Kaloleni and Rabai sub-counties of Kilifi. Trained enumerators administered questionnaires to adult female family members who play a pivotal role in household management. Household dietary diversity scores (HDDS) were computed from 16 food groups consumed in the 7 days preceding the survey. Waist-hip measurements focused on these females, representing vulnerable populations. Pathway-based regression models were constructed using STATA version 13 (p < 0.05). Most households practised mixed farming (59.9%) and monocropping (73.2%) and most female respondents were widowed (75.1%) with limited education (73.1% had no formal education) and over 20 years of farming experience. Food insecurity was prevalent, affecting 80.7% of households. Limited dietary diversity was noted with an average HDDS of 9. The most commonly consumed foods were cereals, spices, condiments and beverages, while meat, eggs and fruits were infrequently eaten. An inverse association was observed between HDDS and WHR (standardised regression coefficient = -0.1328; p = 0.026) but while food insecurity was inversely associated with both HDD and WHR, these associations did not reach statistical significance (HDDS-standardised regression coefficient -0.0294; p = 0.592: WHR-standardised regression coefficient -0.0155; p = 0.791). Existing research has primarily addressed the undernutrition and hunger-related impacts of food insecurity. The findings underscore the need to better understand the complex interplay between food insecurity and nutritional health, including markers of adiposity, to effectively promote health.

Growth Curves for Children Living with Sickle Cell Anemia in Kilifi County, Kenya, Do Not Follow Who Curves for Normal Children

Growth Curves for Children Living with Sickle Cell Anemia in Kilifi County, Kenya, Do Not Follow Who Curves for Normal Children

Accessibility factors associated with adherence to healthy timing and spacing of pregnancy among women of reproductive age in Kilifi County, Kenya

Background: Globally, about 25% of births occur with shorter intervals annually with over 12 million underage pregnancies mostly from Sub-Saharan Africa. Kenya records about 20% teenage pregnancies while Kilifi County reported 28.9%. In Kilifi County, 19.6% of births do not adhere to the 24-month birth-interval. The study focused on establishing accessibility factors associated with adherence to healthy timing and spacing of pregnancy (HTSP) among reproductive age women in Kilifi County, Kenya. Methods: A descriptive cross-sectional design was adopted with a sample of 293 respondents. All required approvals and consent were obtained. Quantitative data was collected using questionnaires. Descriptive data was analyzed using SPSS version 22.0 and inferential statistics computed through Chi-square tests. Results: About 60.1% respondents adhered to heathy timing and spacing of pregnancy, 69.4% teenage pregnancies occurred and 67.1% of women adhered to the 24-month inter-birth interval. Availability of family planning (FP) services (p=0.008), experience with providers (p=0.005), cost of accessing FP (p=0.001) and source of information (p=0.002) were associated with HTSP. Conclusions: About 4 out of 10 women of reproductive age in Kilifi County do not adhere to the recommended HTSP. Accessibility factors such as cost and availability of family planning services, source of information and experience with healthcare providers significantly influenced adherence to HTSP. The Ministry of Health and relevant stakeholders should scale up awareness activities, provide mobile clinics and concentrate on regular continuous medical education among healthcare providers to enhance their role in provision of reproductive health services.

Gendered socio-economic and mental health effects of the COVID-19 pandemic among adults living in selected informal settlements in Kenya: an intersectional analysis.

COVID-19 pandemic had devastating socio-economic and health effects, including mental health. This study examines the intersectionality between gender and mental health outcomes among Kenyan adults in informal settlements of Nairobi, Kisumu, and Kilifi Counties during the COVID-19 crisis. This is necessary to inform mental health response in case of another pandemic. We analyzed data collected in a longitudinal survey between July 2020 (fourth round) and February 2021 (fifth round). The data covered COVID-19-related effects on job loss, food insecurity, access to health services, and mental health. Participants were randomly sampled from existing cohorts at the Population Council. The outcomes of interest were depressive and anxiety disorders, combined into a binary composite outcome variable. Descriptive statistics included means for continuous variables and frequencies and proportions for categorical variables. Chi-square tests were used to examine the differences between groups. The relationship between the gendered COVID-19 socio-economic effects and participants' mental health was examined using modified Poisson regression. A total of 4,050 participants were interviewed, 66% female and median age 38 [interquartile range (IQR): 29-46]. Complete income loss was strongly associated with negative mental health outcomes in multiple intersections with varied magnitudes. The association was larger among older females (≥50 years) (PR = 1.33, 95% CI = 1.17-1.51, p < 0.001) than older males (PR = 1.22, 95% CI = 1.17-1.27, p < 0.001). Partial loss of income was protective against negative mental health outcomes among young males (18-29 years) (PR = 0.81, 95% CI = 0.76-0.87, p < 0.001) but linked to negative outcomes among middle-aged males (30-49 years old) (PR = 1.14, 95% CI = 1.12-1.16, p < 0.001). Skipping meals was associated with negative mental health outcomes for both genders particularly the married (married male: PR = 1.49, 95% CI = 1.22-1.83, p < 0.001; married female: PR = 1.42, 95% CI = 1.26-1.60, p < 0.001). We observed significant gender differences in the prevalence of depressive symptoms and anxiety disorders during the COVID-19 pandemic, underscoring the importance of socio-economic factors and health services access in shaping mental health outcomes. Interventions targeting pandemic-related mental health issues should be gender-sensitive and address economic vulnerabilities such as job losses and food insecurity. Policies to mitigate these effects, especially for at-risk groups are crucial for reducing mental health burden in future crises.

Experience and challenges delivering hepatitis C virus treatment for people who inject drugs in Kenya.

Despite having a higher risk of hepatitis C virus (HCV) infections, people who inject drugs (PWID) in sub-Saharan Africa (SSA) have limited access to HCV treatment. There is scarce literature on treatment delivery modalities that overcome logistical and financial barriers. We utilized different service delivery modalities to provide direct-acting antivirals (DAAs) to PWIDs infected with HCV through methadone clinics and needle and syringe program (NSP) sites in Kenya. In collaboration with Kenya's National AIDS and STI Control Programme (NASCOP), we enrolled individuals with active HCV infection confirmed by HCV RNA detection from methadone and NSP sites in Nairobi, Mombasa, and Kilifi counties. Liver function and hepatitis B virus (HBV) status were assessed at baseline. Those eligible for treatment were offered ledipasvir-sofosbuvir treatment provided by NASCOP through directly observed therapy (DOT). Participants completed a follow-up visit 12 weeks after completing treatment to measure sustained viral response (SVR-12). Challenges faced while delivering HCV treatment at participating sites included the limited availability and reliability of laboratory assays, and financial constraints faced by PWIDs to attend daily DOT. Based on our experience, strategies to deliver HCV treatment for PWID in Kenya should consider improving the availability of laboratory tests and prioritizing treatment through methadone centers to achieve good outcomes.

Diagnostic accuracy of a non-invasive spot-check hemoglobin meter, Masimo Rad-67® pulse CO-Oximeter®, in detection of anemia in antenatal care settings in Kenya.

Point of care hemoglobin meters play key roles in increasing access to anemia screening in antenatal care especially in settings with limited access to laboratories. We aimed to determine the diagnostic accuracy of a non-invasive spot-check hemoglobin (SpHb) meter, Masimo Rad-67® Pulse CO-Oximeter®, in the diagnosis of anemia in pregnant women attending antenatal care clinics in Kilifi, Kenya. This was a diagnostic accuracy study that retrospectively evaluated SpHb against a validated reference standard of laboratory assessed hemoglobin (Lab Hb) by a SYSMEX XN-330 automated hematology analyzer. The study was nested within a prospective pregnancy cohort study that recruited unselected pregnant women from antenatal care clinics in two public hospitals in Kilifi County, coastal Kenya. Records with both SpHb and Lab Hb were selected from pregnancy visits between May 2021 and December 2022. Linear regression and Bland-Altman analysis were performed to compare the two tests and diagnostic accuracy parameters obtained for the diagnosis of anemia. A total of 2,975 records (from 2,203 unique participants), with paired SpHb and Lab Hb were analyzed. Linear regression showed a significant but weak positive correlation, a proportional bias of 0.44 (95% CI 0.41-0.47) and a constant of 7.59 (95% CI 7.30-7.87, p < 0.001). The median bias was 1.70 g/dl, with limits of agreement of -0.80 to 4.20. SpHb tended to be higher than Lab Hb on the low hemoglobin range but lower than Lab Hb on the high hemoglobin range. The sensitivity of SpHb in detecting anemia was 18.66%. Prevalence, specificity, positive predictive value, and negative predictive values were 46.37%, 96.77%, 83.33%, and 57.92% respectively. Overall, SpHb by Masimo Rad-67® Pulse CO-Oximeter® did not accurately identify pregnant women with anemia and many cases would be missed. We would not recommend its use in antenatal care settings.

Sustainable Vanilla Farming in Kilifi, Kenya: A Pathway to Biodiversity Conservation

The article investigates how Kilifi County, Kenya’s sustainable vanilla growing could contribute to both economic growth and ecological preservation. Although the region’s warm, humid environment makes it ideal for growing vanilla, its ecosystems are in peril due to the intense agricultural methods. The study emphasizes the value of biodiversity and how it contributes to the preservation of ecosystem services that are essential to agricultural output. It promotes environmentally friendly methods that can boost farmers’ livelihoods and biodiversity, such as integrated pest control, organic farming, and agroforestry. The lack of technical expertise, early financial investment, and the effects of climate change are among the obstacles to sustainable vanilla production that are mentioned in the article. It suggests focused interventions—such as research development, government policy, and community involvement—to deal with these issues and advance a model of ecologically sustainable vanilla production in Kilifi.

Influence of Household Socio-Economic, Demographic, And Cultural Factors on Women's Access to Maternal Healthcare in Malindi Sub County, Kilifi County, Kenya

Globally, maternal healthcare access remains a critical concern due to significant disparities, particularly in developing countries where access rates are notably lower. The Sustainable Development Goals underscore the importance of prioritizing maternal health, urging nations to improve access to maternal healthcare services. However, various factors hinder full access to such services. This study investigated the influence of social and economic factors on household access to maternal healthcare in Malindi Sub County, Kilifi County. Specifically, it examined the impact of income levels, literacy rates, parental age, and religious beliefs. The study, grounded in the Behavioral Model of Healthcare Service Utilization, Maternal Morbidity Measurement (MMM), and the Three Delay Theory, employed a descriptive survey design approach. A sample size of 382 respondents was determined using the Krejcie and Morgan’s (1970) formula from a population of 73,547 households. Stratified sampling was employed to divide the sub-county into five strata based on wards, selecting households with mothers accessing maternal health services using purposive sampling. Additionally, twenty respondents were purposively chosen for key informant interviews. Because the dependent variable in the questionnaire was binary (access to maternal healthcare was either yes or no), the study used binomial logistic regression modeling to ascertain the influence of income levels, literacy levels, parental age and religious beliefs on the access to maternal healthcare. Income levels, with a coefficient of 2.236 (p-value = 0.007), literacy levels, with a coefficient of 1.981 (p-value = 0.002), and religious beliefs, with a coefficient of 1.004 (p-value = 0.037), were identified as significant factors positively influencing access to maternal healthcare. Conversely, parental age demonstrated a significant negative impact on access, with a coefficient of -1.262 (p-value = 0.004). The study concludes that socioeconomic status, education, and religious beliefs significantly influence maternal healthcare access, with a particular concern regarding diminished access as parental age increases. Consequently, this research emphasizes the critical need for targeted interventions to alleviate these disparities, recommending economic empowerment for women with lower income levels, health literacy education initiatives for vulnerable populations, and a multimodal approach to address cultural barriers and support both younger and older mothers in accessing healthcare services.

Molecular xenomonitoring reveals Anopheles funestus and An. rivulorum as the primary vectors of lymphatic filariasis in coastal Kenya

BackgroundLymphatic filariasis (LF) is an infectious neglected tropical disease caused by mosquito-borne nematodes such as Wuchereria bancrofti, Brugia malayi, and Brugia timori. Globally, LF affects 51 million people, with approximately 863 million at risk in 47 countries. In Kenya, filariasis is endemic along the entire coastal strip, and more recently, at the Kenya–Ugandan border. The World Health Organization (WHO) recommends mass drug administration to reduce disease transmission and morbidity. Monitoring the effectiveness of such interventions relies on robust surveillance, achieved through microscopic examination of microfilariae in nighttime blood, detection of circulating filarial antigens (CFA), and molecular xenomonitoring. We focused on molecular xenomonitoring along the Kenyan coast due to its noninvasive nature and the opportunity to identify new vectors.MethodsIn 2022, mosquitoes were collected from Kilifi, Kwale, and Taita-Taveta counties located within the LF endemic region in Kenya. Subsequently, genomic deoxyribonucleic acid (gDNA) was extracted from these mosquitoes for speciation and analysis of Wuchereria bancrofti infection rates. The impact of sociodemographic and household attributes on infection rates was assessed using generalized estimating equations.ResultsA total of 18,121 mosquitoes belonging to Culicinae (63.0%, n = 11,414) and Anophelinae (37.0%, n = 6707) subfamilies were collected. Morphological identification revealed that Anopheline mosquitoes were dominated by An. funestus (45.4%, n = 3045) and An. gambiae (42.8%, n = 2873). Wuchereria bancrofti infection rates were highest in Kilifi (35.4%; 95% CI 28.0–43.3%, n = 57/161) and lowest in Taita Taveta (5.3%; 95% CI 3.3–8.0%, n = 22/412). The major vectors incriminated are An. rivulorum, An. funestus sensu stricto, and An. arabiensis. Mosquitoes of the An. funestus complex were significantly associated with LF transmission (OR 18.0; 95% CI 1.80–180; p = 0.014). Additionally, a higher risk of transmission was observed outdoors (OR 1.74; 95% CI 1.08–2.82; p = 0.024) and in homesteads that owned livestock (OR 2.00; 95% CI 1.09–3.66; p = 0.025).ConclusionsIn this study, we identified An. funestus s.l. sibling species, An. rivulorum and An. funestus s.s., as the primary vectors of lymphatic filariasis along the Kenyan coast. These findings also highlight that a significant portion of disease transmission potentially occurs outdoors where indoor-based vector control tools, including long-lasting insecticidal nets and indoor residual spray, may not be effective. Therefore, control measures targeting outdoor resting mosquitoes such as zooprophylaxis, larval source management, and attractive sugar baits may have potential for LF transmission reduction.Graphical

Inpatient and postdischarge mortality among children with anaemia and malaria parasitaemia in Kenya: a cohort study

BackgroundAnaemia and malaria are leading causes of paediatric hospitalisation and inpatient mortality in sub-Saharan Africa. However, there is limited empirical data on survival following hospital discharge. We aimed to estimate...

Major factors influencing the effectiveness of community-led total sanitation among communities in Kilifi and Marsabit Counties in Kenya

Background: Poor sanitation contributes to about 775,000 deaths annually and is one of the world's most significant health and environmental challenges, especially in developing nations. This study examined factors influencing the effectiveness of CLTS as an approach to delivering open defecation-free communities in Kilifi and Marsabit Counties in Kenya. Methods: The study methodology included a comparative cross-sectional study of the two diverse study populations. The researchers recruited 811 participants after a multistage sampling procedure was used to sample the villages and the households. Quantitative data was analysed using SPSS tool version 26.0. Descriptive and inferential statistics and propensity score matching (PSM) were used to analyse the data. All tests were done at p≤0.05. Results: Open defecation dropped from 30% to 13.45% after CLTS interventions. There was a significant statistical association between household heads having a college-level education (A.O.R=10.273, p=0.013), being above 61 years (A.O.R=4.046, p=0.009), having a higher monthly income (A.O.R=6.461, p=0.091), and being female (A.O.R=1.792, p=0.03), and owning a sanitation facility. Also, households with heads with good handwashing and CLTS awareness (A.O.R=2.459, p=0.002) and (A.O.R=4.317, p=0.022) were statistically associated with owning sanitation facilities. PSM analysis found that CLTS programs impacted sanitation status, resulting in a 42% increase in facility ownership. Conclusions: The study established a statistical significance of CLTS and ownership of sanitation facilities in both counties. The results show that the CLTS program is effective and has positively impacted sanitation status by reducing open defecation levels in Kilifi and Marsabit.

Health System Structural Factors Associated with Use of Scorecard to Improve RMNCAH Performance Indicators in Public Primary Health Facilities in Kenya

Purpose: Researchers looked into how the structure of the health system affects the use of scorecards to boost reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Kenya's Kwale and Kilifi Counties' public primary health facilities. Specifically, this includes use of the RMNCAH indicators, trainings received on RMNCAH indicators, and factors associated with the utilization of the RMNCAH indicators. Materials and Methods: We conducted a cross-sectional study to gather quantitative data from 119 primary healthcare workers in chosen public primary facilities via one-on-one interviews. We collected data using tablets and the Kobo Collect app. Findings: The findings revealed that 89% of the selected facilities analyzed RMNCAH variables, whereas only 13% used scorecards at the time of the study. The study found that 75% of the facilities that used scorecards did not indicate the specific type of scorecard they received training on. Further research revealed a relationship between scorecard type and utilization (p&lt;0.001, χ2= 2.365), with 84% of facilities analyzing RMNCAH indicators on a monthly basis, focusing on immunization and family planning. However, 63% of healthcare workers rated the health system's structures as either low or poor. Only 11% of facilities had monitoring and evaluation budgets, yet 78% had RMNCAH indicator targets. While most public primary facilities analyze RMNCAH indicators, only a small percentage of these facilities use scorecards due to barriers such as limited training on different types of scorecards, a lack of monitoring and evaluation budget commitments, and poor structural components of the health system Implications to Theory, Practice and Policy: While facilities appreciate the availability of RMNCAH indicators, still the main focus is on immunization and family planning, hence the need for a more comprehensive monitoring of all RMNCAH indicators.

A cross-sectional analysis identifies a low prevalence of Plasmodium ovale species infections in symptomatic and asymptomatic individuals in Kilifi county, Kenya.

Background The focus on P. falciparum diagnosis has led to an underestimation of the global burden of malaria resulting from neglected Plasmodium species. However, there is still scarce data on the prevalence of P. ovale species (spp) globally. To address this knowledge gap, data collected from cross-sectional studies in Kilifi county were used to: 1) determine the prevalence of P. ovale spp infections; and 2) determine the sensitivity of different diagnostic assays in detecting P. ovale spp infections. Methods A total of 531 individuals were sampled across three study sites in Kilifi County, Kenya between 2009 and 2020. Blood smears were prepared from peripheral blood and screened for Plasmodium parasite stages using light microscopy. Molecular screening involved DNA extraction of dried blood spots and blood in ethylenediaminetetraacetic acid, polymerase chain reaction (PCR) using primers targeting the 18 small ribosomal subunit and sequencing. Results Microscopy screening revealed that the most prevalent species was P. falciparum (32.0%) followed by P. malariae (9.0%) and then P. ovale spp( 1.5%). PCR screening identified additional P. ovale spp positives cases. Overall PCR results indicate that43 (8.1%) out of the 531 individuals harbored P. ovale spp infection with the highest prevalence reported in the tertiary health facility, (14.6%, 95% CI 8-23.6%), followed by the primary health facility (8.3%, 95% CI 5.4-11.9%), and the community from a cross-sectional blood survey, (3.6%, 95% CI 1.2-8.2%). Microscopy screening for P. ovale spp had a low sensitivity of 7% (95% CI 1-19-30%) and a high specificity of 99% (95% CI 98-100%). Sequencing results confirmed the presence of P.ovale curtisi. Conclusions This study provides baseline data for P.ovale spp surveillance in Kilifi County, primarily using PCR to improve diagnosis. These results suggest that malaria elimination and eradication efforts should not only concentrate on P. falciparum but should embrace a holistic approach towards elimination of all Plasmodium spp.

Can "the expanded free maternity services" enable Kenya to achieve universal health coverage by 2030: qualitative study on experiences of mothers and healthcare providers.

Universal health coverage is a global agenda within the sustainable development goals. While nations are attempting to pursue this agenda, the pathways to its realization vary across countries in relation to service, quality, financial accessibility, and equity. Kenya is no exception and has embarked on an initiative, including universal coverage of maternal health services to mitigate maternal morbidity and mortality rates. The implementation of expanded free maternity services, known as the Linda Mama (Taking Care of the Mother) targets pregnant women, newborns, and infants by providing cost-free maternal healthcare services. However, the efficacy of the Linda Mama (LM) initiative remains uncertain. This article therefore explores whether LM could enable Kenya to achieve UHC. This descriptive qualitative study employs in-depth interviews, focus group discussions, informal conversations, and participant observation conducted in Kilifi County, Kenya, with mothers and healthcare providers. The findings suggest that Linda Mama has resulted in increased rates of skilled care births, improved maternal healthcare outcomes, and the introduction of comprehensive maternal and child health training for healthcare professionals, thereby enhancing quality of care. Nonetheless, challenges persist, including discrepancies and shortages in human resources, supplies, and infrastructure and the politicization of healthcare both locally and globally. Despite these challenges, the expanding reach of Linda Mama offers promise for better maternal health. Finally, continuous sensitization efforts are essential to foster trust in Linda Mama and facilitate progress toward universal health coverage in Kenya.

The Influence Of Job Evaluation On The Wage Bill In Public Sector Organizations

Public service is the main driver of growth for most developing countries. It is a key component because it facilitates the delivery of services to the citizens. However, despite the efforts to grow the economy and deliver quality services, there are challenges with the costs associated with ever-increasing public sector wages. Although a well-paid public sector could be more efficient, the wage bill should be maintained at fiscally sustainable levels to enable the achievement of development goals. Kenya like other developing countries has been grappling with the management of costs associated with wages in the public sector, which were growing at an alarming rate. This is mainly because of the large number of employees, arbitrary determination of wages and implementation of the Constitution of Kenya, 2010. This study will seek to examine the influence of human resource strategies for managing the public sector wage bill in Kilifi County, Kenya. The study will particularly focus on human resource strategies such as job evaluation, total rewards, and performance-related pay and their influence on the management of the public sector wage bill in public sector organizations within Kilifi County. These public sector organizations are expected to be implementing these strategies although the degree of implementation may be varying. The study will, therefore, seek to find out the extent to which their application influences the management of the wage bill costs to a manageable level. The study will also examine the theories associated with wage management. The theories of equity, efficiency wage, and public sector motivation will be examined to determine their influence on the management of wages in the public sector. Questionnaires will be developed and self-administered to the human resource management professionals in the public sector organizations. This will enable the Researcher to capture perceptions of the application of these strategies in their organizations. Their in-depth understanding of the human resource strategies being studied will be useful to the study. The study design will be a survey of the 52 government organizations within Kilifi County thus the target population for the survey will be a census of the 52 public sector organizations. The sampling method applied will be purposive thus the HR professionals will be the respondents. The data collected will be analyzed using analysis of variance (ANOVA) which will be used to establish the relationship between the independent variables and the dependent variable. The findings of the study will be presented in the form of tables, charts and statistical measures such as an analysis of variance

“Akili zetu ziwe moja / Let our minds be one”: Emergent strategy for adapting to seafood insecurity in coastal Kenyan fishing communities

Small-scale fisheries provide food sovereignty and capital for millions globally. However, coastal Kenyan communities who harvest reef fishery resources are often still food insecure, especially due to the detrimental effects of climate change and overfishing in their communities. This study aims to understand the environmental perceptions and priorities of fishing families in Kilifi County, Kenya, and how these relate to both food security and sustainable development policy. We rely on qualitative methods including interviews with household caregivers from 42 fishing families to provide insights not only on fishery sustainability but also on the additional aspects of reproductive labor related to fish food security, including the food securing aspects of availability, accessibility, utilization, and stability. Our findings highlight the complex challenges that environmental change places on families in this situation: lack of fish availability, seasonal food inaccessibility, shifting baselines, and experiences of loss in the food system are markedly a prevalent result. Despite these struggles, we see emergent strategies to address food needs unfold in a variety of resilient and opportunistic ways, including adaptation, trust, and multimodal networks of support. Further policy support must be given to communities to practice food sovereignty in their own contexts, especially as climate changes continue and these strategies become salient adaptive practices elsewhere.

Conceptualizing Community Engagement for Mental and Brain Health Research in Low- and Middle-Income Countries: A Case of Kilifi County, Kenya.

Community engagement (CE) has increasingly been recognized as a critical element for successful health promotion and intervention programs. However, the term CE has been used to mean different things in different settings. In this article, we explore how CE has been conceptualized in the field of mental and brain health in Kilifi County, Kenya. We used ethnographic methods encompassing focused group discussions, key informant interviews, and observations with 65 participants, purposively recruited from Kilifi County. Data were transcribed verbatim and thematically analyzed. Our findings show that community members and stakeholders had diverse perceptions of and experiences with CE. Factors such as trust between researchers and community members, sensitization, and awareness creation were key for acceptance of research projects. Partial involvement in research, lack of access to information, poverty and socio-economic challenges, and financial expectations from researchers hindered CE and led to resistance to participation in research projects. For effective CE, there is a need to work closely with community gatekeepers, create awareness of the research projects, use local languages, and ensure continuous engagement that promotes equitable research participation. Our findings suggest that tacit knowledge, context, and mechanisms for research are all critical features of CE and should be considered to enhance acceptance and sustainability of mental and brain health interventions in Kenya.

The Troubled Marine Resource Frontier between local Communities and Salt Firms in Kilifi County, Kenya

The Troubled Marine Resource Frontier between local Communities and Salt Firms in Kilifi County, Kenya