Level In Kenya Research Articles

The Silos of Natural Resource Governance: Implications of Sector-led Coastal Management at the Village Level in Kenya and Zanzibar-Tanzania

Taking a coordinated, holistic approach to the governance of coastal ecosystems is widely advocated in recognition of the need to manage ecosystems as a whole. Despite commitment to approaches such as integrated coastal zone management and ecosystem-based management of fisheries, governance remains fragmented, with sectors such as environment, fisheries and forestry maintaining separate systems of governance from the national to village level. These systems include the formation of separate community-based structures, reporting directly to the respective sectoral ministry. This raises questions about how this collaborative governance approach aligns with taking a more integrated, holistic approach to management. The paper draws on findings from research in Kenya and Zanzibar-Tanzania in coastal villages where forest and fisheries management groups have been formed. The research found that the groups operate in compartmentalised ‘silos', in contrast to the interrelated ecosystems on which they depend, with little coordination of plans and priorities. In addition, these groups are not consistent in their relationship to local government, answering directly to the sectoral ministry rather than democratic local government, raising issues for accountability and sustainability. These dual challenges of a sectoral-focus and long-term sustainability must be addressed for management of ecosystems to be integrated and effective.

Family planning financing: tracking domestic family planning budget allocations at national and sub-national level in Kenya and Uganda

Background: The Abuja Declaration committed African Union countries to allocate at least 15% of their budget to improving the health sector. Consequently, Deutsche Stiftung Weltbevoelkerung (DSW) has been undertaking annual budget studies in Kenya and Uganda to track financial allocation for health and family planning (FP). Methods: This study, carried out between the months of May and October 2017, involved budget analysis of general health and FP funding at national and sub-national level. The study covered the fiscal year 2017/18. However, for comparison purposes, fiscal years 2015/16 and 2016/17 were included in the analysis. Results: In Uganda, during the 2017/18 fiscal year, the government allocated 0.73% ($3.7 million) of its health sector budget ($506.7 million) to FP; of which 98.8% ($3.6 million) was allocated to National Medical Stores (NMS), mainly for the supply of reproductive health commodities. Analysis of four districts shows that only 0.5% ($7,966), 0.8% ($10,046), 0.9% ($9,663) and 1.9% ($35,395) of the health sector budget was allocated to FP in Kamuli, Mityana, Mukono and Tororo, respectively, during the 2017/18 fiscal year. In Kenya, the FP budget allocation at the national level reduced from $6.05 million in 2015/16 to $2.93 million in 2017/18. At the subnational level, there were combined increases in the estimated sub-national FP budget allocations in all eleven counties of 21.8% ($2.1 million), from $9.6 million (2016/17) to $11.7 million (2017/2018). Conclusions: The findings indicate an overall increase in FP allocations over the last three years in the two countries of study. Advocacy personnel should be enlightened on the budget making process, as it provides an excellent platform for advocating for budgetary increases.

Implementation of an Ultraviolet Phototherapy Service at a National Referral Hospital in Western Kenya: Reflections on Challenges and Lessons Learned.

IntroductionIn order to manage skin conditions at a national referral hospital level in Kenya, specialized dermatology services, such as dermatologic surgery, dermatopathology, phototherapy, and sub-specialty care, should be offered, as is typically available in referral hospitals around the world. A Kenyan patient with prurigo nodularis, whose severe itch remitted after phototherapy treatment at the University of California, San Francisco (UCSF), inspired the development of a phototherapy service at Academic Model Providing Access to Healthcare (AMPATH), a partnership in Western Kenya between Moi Teaching and Referral Hospital, Moi University College of Health Sciences, and a consortium of North American academic medical centers.MethodsInitial project funds were raised through a crowdfunding campaign and fundraising events. A new narrowband ultraviolet B phototherapy unit and replacement bulbs were donated and air shipped to Eldoret, Kenya. A team of dermatologists and phototherapy nurses from UCSF conducted a 2-day training session. US-based dermatologists affiliated with AMPATH provide ongoing support through regular communication and on-site visits.ResultsEarly in implementation, challenges faced included training clinical staff with limited experience in phototherapy and improving communication between nurses and clinicians. More recent challenges include frequent rotation of specialty clinic nurses in the dermatology clinic, adaptation of phototherapy guidelines to balance patient volume with service delivery capacity, and training assessment of disease activity in darkly pigmented skin.ConclusionStrategies that have been helpful in addressing implementation challenges include: increasing on-site and remote training opportunities for clinicians and nurses, developing a tiered payment schema, educating patients to combat misconceptions about phototherapy, dynamic phototherapy referral guidelines to accommodate service delivery capacity, and prioritizing the engagement of a multidisciplinary team.

Muddles in Pentatonic Likert-type scale: Accuracy Cost in Psychometric Measurements for Small Enterprise Development

Likert-type scale is ordinal, hence not compatible with parametric techniques. Disregard of this fact causes flawed research outputs. Enterprises get themselves in precarious situations as ultimate consumers flawed outputs. This paper is motivated by the dearth desire by entrepreneurs to make accurate and valid decisions harvested from a dependable measurement scale. Identifying the pitfalls of Likert-type scale and remedies to address the weaknesses, form the objectives of the study. The study is anchored on the Classical Test and Generation theories. Reviewing literature and from own personal experiences in assessing students’ thesis at university level in Kenya found traditional pentatonic Likert-type scale highly favored by most young researchers in enterprise development. The researchers treated the Likert scale outputs as interval data. Consequently most of them got wrong inferential techniques and findings. This study suggests transformation of ordinal data into binary data, interval or ratio before going into parametric analysis. Secondly, increase the number of points on the Likert scale, preferably to seven (7) to enhance reliability, validity, discriminating power and respondent preferences. Thirdly, adopt newest models of Likert type scale, that is; novel fuzzy Likert scale, phrase completion scale and two-stages Likert scale for measuring direction and intensity dimensions seperately. Finally, Likert type scale could be improved by Rasch analysis, too. The findings and suggestions of the study are relevant for researchers in both academic, clinical and enterprise development for attainment of the Kenya Vision 2030 .

Expanding beyond zoonoses: the benefits of a national One Health coordination mechanism to address antimicrobial resistance and other shared health threats at the human-animal-environment interface in Kenya.

In order to manage global and transnational health threats at the human- animal-environment interface, a multisectoral One Health approach is required. Threats of this nature that require a One Health approach include, but are not limited to, emerging, endemic and re-emerging zoonotic diseases, food safety, antimicrobial resistance (AMR), vector-borne and neglected infectious diseases, toxicosis and pesticides. Relevant Kenyan authorities formally institutionalised One Health in 2011 through the establishment of the Zoonotic Disease Unit (ZDU) and its advisory group, the Zoonoses Technical Group. At that time, the One Health agenda focused on zoonotic diseases. As the issue of AMR began to gain traction globally, a One Health approach to its management was advocated in Kenya in 2015. This paper summarises a series of interviews (with respondents and key informants) that describe how AMR institutionalisation evolved in Kenya. It also examines how responses to other health threats at the human-animal- environment interface were coordinated and used to identify gaps and make recommendations to improve One Health coordination at the national level in Kenya. Results showed that the road to the institutionalisation of AMR through the National Action Plan on Prevention and Containment of Antimicrobial Resistance, 2017-2022 and a formally launched One Health coordination mechanism, the National Antimicrobial Stewardship Interagency Committee (NASIC), took ten years. Moreover, supplementary actions are still needed to further strengthen AMR coordination. In addition to the ZDU and NASIC, Kenya has established two other formal multisectoral and multidisciplinary coordination structures, one for aflatoxicosis and the other for health threats associated with pesticide use. The country has four distinct and separate One Health coordination mechanisms: for zoonoses, for AMR, for aflatoxicosis and for the health threats associated with pesticide use. The main gap lies in the lack of overall coordination between these topic-specific structures. An overall coordination mechanism for all One Health issues is therefore needed to improve synergy and complementarity. None of the topic-specific mechanisms plays a critical role in the policy development process, institutionalisation or implementation of activities related to the other topic areas. The authors recommend renaming the ZDU as the One Health Office, and expanding it to include AMR and food safety teams, and their associated technical working groups. Through this restructuring, the One Health Office would become an umbrella organisation dealing with all four issues mentioned above. Based on Kenya's experience, the authors recommend that other countries also consider expanding the scope of multisectoral One Health coordination mechanisms to include other shared health threats.

Occurrence and Levels of Aflatoxins in Fish Feeds and Their Potential Effects on Fish in Nyeri, Kenya

Aflatoxins are fungal metabolites that contaminate foods and feeds, causing adverse health effects in humans and animals. This study determined the occurrence of aflatoxins in fish feeds and their potential effects on fish. Eighty-one fish feeds were sampled from 70 farms and 8 feed manufacturing plants in Nyeri, Kenya for aflatoxin analysis using competitive enzyme-linked immunosorbent assay. Fish were sampled from 12 farms for gross and microscopic pathological examination. Eighty-four percent of feeds sampled tested positive for aflatoxins, ranging from 1.8 to 39.7 µg/kg with a mean of 7.0 ± 8.3 µg/kg and the median of 3.6 µg/kg. Fifteen feeds (18.5%) had aflatoxins above the maximum allowable level in Kenya of 10 µg/kg. Homemade and tilapia feeds had significantly higher aflatoxin levels than commercial and trout feeds. Feeds containing maize bran and fish meal had significantly higher aflatoxin levels than those without these ingredients. Five trout farms (41.7%) had fish with swollen abdomens, and enlarged livers with white or yellow nodules, which microscopically had large dark basophilic hepatic cells with hyperchromatic nuclei in irregular cords. In conclusion, aflatoxin contamination of fish feeds is prevalent in Nyeri, and may be the cause of adverse health effects in fish in this region.

Health disparities across the counties of Kenya and implications for policy makers, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

SummaryBackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provided comprehensive estimates of health loss globally. Decision makers in Kenya can use GBD subnational data to target health interventions and address county-level variation in the burden of disease.MethodsWe used GBD 2016 estimates of life expectancy at birth, healthy life expectancy, all-cause and cause-specific mortality, years of life lost, years lived with disability, disability-adjusted life-years, and risk factors to analyse health by age and sex at the national and county levels in Kenya from 1990 to 2016.FindingsThe national all-cause mortality rate decreased from 850·3 (95% uncertainty interval [UI] 829·8–871·1) deaths per 100 000 in 1990 to 579·0 (562·1–596·0) deaths per 100 000 in 2016. Under-5 mortality declined from 95·4 (95% UI 90·1–101·3) deaths per 1000 livebirths in 1990 to 43·4 (36·9–51·2) deaths per 1000 livebirths in 2016, and maternal mortality fell from 315·7 (242·9–399·4) deaths per 100 000 in 1990 to 257·6 (195·1–335·3) deaths per 100 000 in 2016, with steeper declines after 2006 and heterogeneously across counties. Life expectancy at birth increased by 5·4 (95% UI 3·7–7·2) years, with higher gains in females than males in all but ten counties. Unsafe water, sanitation, and handwashing, unsafe sex, and malnutrition were the leading national risk factors in 2016.InterpretationHealth outcomes have improved in Kenya since 2006. The burden of communicable diseases decreased but continues to predominate the total disease burden in 2016, whereas the non-communicable disease burden increased. Health gains varied strikingly across counties, indicating targeted approaches for health policy are necessary.FundingBill & Melinda Gates Foundation.

Gender Disparities at Higher Education in Kenya: A Case of Moi University

The purpose of this study was to understand the gender representation in higher education in Kenya, particularly at the Moi University in Eldoret, Kenya. The study was carried out in the 1995/96 academic year and focused on selected faculties and schools in regard to gender disparities in University enrolment at undergraduate level. Proportionate random sampling technique was employed in identifying the respondents to this study. The questionnaire and document analysis guide were the key instruments used in this study. For secondary data, the study used Document Analysis Guide which was used to collect data from the university authorities and the Ministry of Education Statistics Division and number of candidates who sat for Kenya Certificate for Secondary Education in the years 1990-93. Primary data was collected by questionnaires. The questionnaire return rate was 70%. This return rate was therefore considered sufficient to provide the required information. Data from the questionnaire and the Document Analysis Guide were analyzed using descriptive statistics. Gender representation data was analysed per faculty. Findings from the study indicated revealed that female student enrolment at Moi University is quite low compared to male enrolment. The most affected faculties are Wildlife Management and Technology and Forestry Resources represented by 6.38% and 13.4% respectively. Other Science based courses had at least more than 20% of the female student representation. Even in the arts based faculties, parity is far from being achieved. This calls for concerted efforts to increase the female student enrolment at the university level in Kenya particularly in the fields of Science and Technology.

Adapting clinical practice guidelines for diabetic retinopathy in Kenya: process and outputs

BackgroundThe use of clinical practice guidelines envisages augmenting quality and best practice in clinical outcomes. Generic guidelines that are not adapted for local use often fail to produce these outcomes. Adaptation is a systematic and rigorous process that should maintain the quality and validity of the guideline, while making it more usable by the targeted users. Diverse skills are required for the task of adaptation. Although adapting a guideline is not a guarantee that it will be implemented, adaptation may improve acceptance and adherence to its recommendations.MethodsWe describe the process used to adapt clinical guidelines for diabetic retinopathy in Kenya, using validated tools and manuals. A technical working group consisting of volunteers provided leadership.ResultsThe process was intensive and required more time than anticipated. Flexibility in the process and concurrent health system activities contributed to the success of the adaptation. The outputs from the adaptation include the guidelines in different formats, point of care instruments, as well as tools for training, monitoring, quality assurance and patient education.ConclusionGuideline adaptation is applicable and feasible at the national level in Kenya. However, it is labor- and time -intensive. It presents a valuable opportunity to develop several additional outputs that are useful at the point of care.

English

Savings is a vital source of investment funds especially for developing economies. However, like in many developing countries, domestic savings in Kenya remain low. Hence, posing a significant development challenge. Household savings contribute a sizeable share of domestic and national savings in both industrial and developing countries. Households should not however, be considered as fully autonomous actors without the influence of institutions. Institutions influence behavior and therefore outcomes. The institutional theory of saving thus indicates that institutional factors significantly affect the ability to save. This study uses a ranked ordered multinomial/conditional probit model to analyze the effect of institutions on households’ savings in Kenya. Data from the Financial Access National 2006, 2009, and 2013 surveys was used in the analysis. The study results show that institutional factors including the travel cost to access a saving option, trust in a saving option, information and saving expectations influence the saving levels in Kenya. It is therefore important to address the travel cost of accessing the saving options through the promotion of non-traditional means of provision of saving services, build trust in saving options, and enhance financial education in the country. Further, enhancing formal education, income levels and reducing gender gaps is important in order to improve saving performance in the country. Key words: Kenya, institutions, households, saving levels. &nbsp

Designing Business Solutions for Plastic Waste Management to Enhance Circular Transitions in Kenya

Least-developed countries face many challenges regarding their plastic waste management systems. In 2017, Kenya imposed a selective ban targeting manufacturers and consumers of plastic carrier bags. However, this selectivity does not avoid the continuous use of other plastic products. The present paper states that circular priorities, which have been defined to advanced economies, would not be entirely valid for the rest of the world. While high-income countries face only the impacts of their own consumption, developing nations must endure the externalities of these developed economies. Thus, the focus of the least developed part of the world must not be on reducing its relatively normal (or even low) consumption, but to manage its surplus material flow. According to the employed circular evaluation methodology (CEV—Circular Economic Value), the circularity level in Kenya’s plastic material flow stands on a rather low stage with 32.72%. This result outlines the linear deficiencies of the plastic waste management system and urges the prevention of further material leakage (such as energy use). Through the Business Model Canvas (BMC) approach this study offers a holistic business solution which can improve the system’s sustainability.

Describing and evaluating healthcare priority setting practices at the county level in Kenya.

SummaryBackgroundHealthcare priority setting research has focused at the macro (national) and micro (patient level), while there is a dearth of literature on meso‐level (subnational/regional) priority setting practices. In this study, we aimed to describe and evaluate healthcare priority setting practices at the county level in Kenya.MethodsWe used a qualitative case study approach to examine the planning and budgeting processes in 2 counties in Kenya. We collected the data through in‐depth interviews of senior managers, middle‐level managers, frontline managers, and health partners (n = 23) and document reviews. We analyzed the data using a framework approach.FindingsThe planning and budgeting processes in both counties were characterized by misalignment and the dominance of informal considerations in decision making. When evaluated against consequential conditions, efficiency and equity considerations were not incorporated in the planning and budgeting processes. Stakeholders were more satisfied and understood the planning process compared with the budgeting process. There was a lack of shifting of priorities and unsatisfactory implementation of decisions. Against procedural conditions, the planning process was more inclusive and transparent and stakeholders were more empowered compared with the budgeting process. There was ineffective use of data, lack of provisions for appeal and revisions, and limited mechanisms for incorporating community values in the planning and budgeting.ConclusionCounty governments can improve the planning and budgeting processes by aligning them, implementing a systematic priority setting process with explicit resource allocation criteria, and adhering to both consequential and procedural aspects of an ideal priority setting process.

Approaching quality improvement at scale: a learning health system approach in Kenya

In 2002, we identified major shortcomings in the management of sick newborns and children at the first referral or district hospital level in Kenya.1 Failure in the dissemination of knowledge...

Bayesian Modelling of Kenya Extreme Debt with Correction for Budgetary Leakage

Total public debt levels in Kenya are exponentially increasing due to rising budget deficit, poor public fund management as well as movement of various macro-economic indicators such as balance of payments, inflation, Gross Domestic Product, exchange rates, and grants leading to worries on whether or not the high debt levels would be sustainable in future. The major concern is that a huge portion of the country’s revenue is committed to debt repayment and budgetary leakage strains the repayment efforts, thereby accelerating the country's debt unsustainability. This study sought to model extreme debt in Kenya with correction for budgetary leakage using a Bayesian approach to Extreme Value Theory (EVT) the main aim being to estimate the maximum debt tolerable for the country. A non-stationary Generalized Pareto Distribution (GPD) model is used for modeling the public debt extremes which depend on some covariates (macro-economic indicators) and Bayesian methods used to directly estimate the threshold and the GPD parameters. A major contribution of this study is the introduction of a compensator to allow for possible leakage due budgetary leakage through corruption, tax evasion, money laundering, and other forms of financial fraud, modelling it as a function of budget deficit. The established debt threshold is approximately KShs. 2 trillion which is the standard amount that should be borrowed, beyond which values are considered extremes. The results indicate that the movements in the macro-economic debt indicators significantly affect total public debt levels, and that budgetary leakage reduces Kenya's debt tolerance. The research concluded that the current debt level of around KShs. 5 trillion is still sustainable but high budgetary leakage may accelerate the country's long-run debt unsustainability. For further work, it is recommended to use a time-varying threshold to capture seasonality of the public debt series.

Challenges Encountered in Implementing NGOs’ Gender Parity Strategies in Secondary Schools of Kibera Informal Settlements

The phenomenon of gender disparities gap at the secondary education level in Kenya presents challenges of achieving Sustainable Development Goals. By these goals, elimination of gender disparities in education is to be through the efforts of educational partners including Governments, Agencies, and Non-Governmental Organizations (NGOs) among others. The purpose of this study was to establish challenges in implementing NGO’s gender parity strategies (GPS) in informal settlement secondary schools of Kibera, Kenya. The study was guided by Adams Stacy's equity theory and Herzberg's two-factor theory. The study utilized a mixed methods design. The study was carried out in the Kibera informal settlement of Nairobi County. The study targeted secondary schools managed by NGOs. Purposive sampling was utilized to select NGOs' mixed secondary schools while stratified and simple random sampling was used to select the respondents. Quantitative data was collected by use of questionnaire while qualitative data was gathered through interviews. Data analysis techniques included frequencies and percentages and qualitative comprised of categorization of themes. Data was presented in form of tables, charts, figures, and percentages. The study established that the challenges encountered in the implementation of genders parity strategies include: Lack of training for leaders on gender parity strategies; inadequate school facilities and child labour among others. This study recommended that the Kenyan government strengthens the affirmative action in the admission of girls into secondary schools and public universities and address poverty as a major cause of gender disparity in secondary education in informal settlements.

Correlates of observing and willingness to report stigma towards HIV clients by (TB) health workers in Africa.

Health care facilities in Kenya, Tanzania and Namibia. To study the factors associated with the observation of and willingness to report stigmatising behaviour towards persons living with the human immunodeficiency virus (HIV) among health care workers (HCWs). Mixed-effect logistic regression analyses of 9516 HCW interviews, including those of 4062 (43%) TB workers carried out as part of the Service Provision Assessments (SPAs) between 2006 and 2010. Discrimination (i.e., enacted stigma) was observed by respectively 1042 (60%), 384 (40%) and 907 (69%) TB workers in Kenya, Namibia and Tanzania, similar to the trend observed among all HCWs. Observations of discrimination were clustered at facility level in Kenya, and mapping of facility-level discrimination suggested geographic clustering. HCWs were more likely to observe discrimination in facilities without regular supportive supervision (adjusted OR [aOR] 2.33, 95%CI 1.09-4.96). No HCW characteristics were found to predict intention to report. Training in patients' rights and in confidentiality predisposed HCWs to recognise discrimination (aOR 2.51, 95%CI 1.19-5.28) and the willingness to report it (aOR 2.23, 95%CI 1.11-4.47). Exposure to training in TB infection control (IC) was associated with greater willingness to report discrimination (aOR 2.13, 95%CI 1.03-4.39). Supervision and exposure to training in patient's rights and confidentiality improved HCWs' understanding and advocacy of dignified and respectful TB-HIV care. All HCWs are equally likely to be allies, agents of change and amplifiers of an anti-stigma message, and broad engagement is required. Innovative approaches to reduce discrimination-while ensuring proper IC-should be explored.

Geographic-genetic analysis of Plasmodium falciparum parasite populations from surveys of primary school children in Western Kenya.

Background.Malaria control, and finally malaria elimination, requires the identification and targeting of residual foci or hotspots of transmission. However, the level of parasite mixing within and between geographical locations is likely to impact the effectiveness and durability of control interventions and thus should be taken into consideration when developing control programs. Methods.In order to determine the geographic-genetic patterns of Plasmodium falciparum parasite populations at a sub-national level in Kenya, we used the Sequenom platform to genotype 111 genome-wide distributed single nucleotide polymorphic (SNP) positions in 2486 isolates collected from children in 95 primary schools in western Kenya. We analysed these parasite genotypes for genetic structure using principal component analysis and assessed local and global clustering using statistical measures of spatial autocorrelation. We further examined the region for spatial barriers to parasite movement as well as directionality in the patterns of parasite movement. Results.We found no evidence of population structure and little evidence of spatial autocorrelation of parasite genotypes (correlation coefficients <0.03 among parasite pairs in distance classes of 1km, 2km and 5km; p value<0.01). An analysis of the geographical distribution of allele frequencies showed weak evidence of variation in distribution of alleles, with clusters representing a higher than expected number of samples with the major allele being identified for 5 SNPs. Furthermore, we found no evidence of the existence of spatial barriers to parasite movement within the region, but observed directional movement of parasites among schools in two separate sections of the region studied. Conclusions. Our findings illustrate a pattern of high parasite mixing within the study region. If this mixing is due to rapid gene flow, then "one-off" targeted interventions may not be currently effective at the sub-national scale in Western Kenya, due to the high parasite movement that is likely to lead to re-introduction of infection from surrounding regions. However repeated targeted interventions may reduce transmission in the surrounding regions.

Geographic-genetic analysis of Plasmodium falciparum parasite populations from surveys of primary school children in Western Kenya

Background. Malaria control, and finally malaria elimination, requires the identification and targeting of residual foci or hotspots of transmission. However, the level of parasite mixing within and between geographical locations is likely to impact the effectiveness and durability of control interventions and thus should be taken into consideration when developing control programs. Methods. In order to determine the geographic-genetic patterns of Plasmodium falciparum parasite populations at a sub-national level in Kenya, we used the Sequenom platform to genotype 111 genome-wide distributed single nucleotide polymorphic (SNP) positions in 2486 isolates collected from children in 95 primary schools in western Kenya. We analysed these parasite genotypes for genetic structure using principal component analysis and assessed local and global clustering using statistical measures of spatial autocorrelation. We further examined the region for spatial barriers to parasite movement as well as directionality in the patterns of parasite movement. Results. We found no evidence of population structure and little evidence of spatial autocorrelation of parasite genotypes (correlation coefficients <0.03 among parasite pairs in distance classes of 1km, 2km and 5km; p value<0.01). An analysis of the geographical distribution of allele frequencies showed weak evidence of variation in distribution of alleles, with clusters representing a higher than expected number of samples with the major allele being identified for 5 SNPs. Furthermore, we found no evidence of the existence of spatial barriers to parasite movement within the region, but observed directional movement of parasites among schools in two separate sections of the region studied. Conclusions. Our findings illustrate a pattern of high parasite mixing within the study region. If this mixing is due to rapid gene flow, then “one-off” targeted interventions may not be currently effective at the sub-national scale in Western Kenya, due to the high parasite movement that is likely to lead to re-introduction of infection from surrounding regions. However repeated targeted interventions may reduce transmission in the surrounding regions.

Resource Allocation, Evaluational Capacity Building M&amp;E Results Utilization Among Community Based Organizations in Meru County in Kenya

Building capacity for evaluation has become a big concern in the effort of ensuring that evaluations are meaningful. Part of this capacity includes making sure that M&amp;E activities have resources needed to carry them out. This study sought to establish the influence of allocating resources for M&amp;E activities on the utilization of M&amp;E result at the project level in Kenya’s Meru County. The study used a mixed mode approach in methodology and it was both a descriptive survey and a cross-sectional survey and used both descriptive and inferential analysis of the data collected. The study sampled 186 respondents from a targeted population of 430 employees working in Non-Governmental organizations and other community based organizations in the county. The study showed that resources were allocated for various M&amp;E activities to a great extent. The study also noted high level of M&amp;E results utilization at project level by project employees and all the indicators of resources allocation had positive correlation with M&amp;E result utilization. It was noted that for every unit increase in resource allocation, there was an increase of 26.1% in M&amp;E result utilization score which is a percentage that would justify allocating resources for M&amp;E activities by project organizations.

Geographic-genetic analysis of Plasmodium falciparum parasite populations from surveys of primary school children in Western Kenya

Background. Malaria control, and finally malaria elimination, requires the identification and targeting of residual foci or hotspots of transmission. However, the level of parasite mixing within and between geographical locations is likely to impact the effectiveness and durability of control interventions and thus should be taken into consideration when developing control programs. Methods. In order to determine the geographic-genetic patterns of Plasmodium falciparum parasite populations at a sub-national level in Kenya, we used the Sequenom platform to genotype 111 genome-wide distributed single nucleotide polymorphic (SNP) positions in 2486 isolates collected from children in 95 primary schools in western Kenya. We analysed these parasite genotypes for genetic structure using principal component analysis and assessed local and global clustering using statistical measures of spatial autocorrelation. We further examined the region for spatial barriers to parasite movement as well as directionality in the patterns of parasite movement. Results. We found no evidence of population structure and little evidence of spatial autocorrelation of parasite genotypes (correlation coefficients &lt;0.03 among parasite pairs in distance classes of 1km, 2km and 5km; p value&lt;0.01). An analysis of the geographical distribution of allele frequencies showed weak evidence of variation in distribution of alleles, with clusters representing a higher than expected number of samples with the major allele being identified for 5 SNPs. Furthermore, we found no evidence of the existence of spatial barriers to parasite movement within the region, but observed directional movement of parasites among schools in two separate sections of the region studied. Conclusions. Our findings illustrate a pattern of high parasite mixing within the study region. If this mixing is due to rapid gene flow, then “one-off” targeted interventions may not be currently effective at the sub-national scale in Western Kenya, due to the high parasite movement that is likely to lead to re-introduction of infection from surrounding regions. However repeated targeted interventions may reduce transmission in the surrounding regions.