Migori County Research Articles

POLITICAL COMMUNICATION: POLITICAL RALLY MESSAGES EFFECT ON ETHNIC INTOLERANCE AND CONFLICT AMONG VOTERS IN MIGORI COUNTY, KENYA

Purpose: The purpose of this study was to establish political rally messages effect on ethnic intolerance and conflict among voters in Migori County, Kenya.
 Materials and Methods: Descriptive research design was adopted. The study targeted a population of 388, 633 respondents made of voters from Migori County. A sample of 400 respondents was used. The sample for quantitative data was obtained using stratified random sampling method and the other section of the sample; media practitoners were non-randomly sampled. The sample for qualitative data was collected through FGDs on a purposefully selected sample. The data collection was conducted through administering of questionnaires and also Focus Group Discussions (FGDs) using a structured and pilot-tested questionnaires. Data was collected using questionnaires and FGDs. Quantitative data was analyzed using Statistical Package for Social Sciences computer software package (SPSS statistics version 22). Descriptive statistics drawn include mean, and standard deviation which were presented in tables and graphs. Inferential statistics drawn include multiple regression and correlation analysis.
 Results: The findings revealed that there was a positive and significant relationship between propaganda, stereotype, hate messages and vernacular radio stations to ethnic intolerance and conflict among voters in Migori County, Kenya. Based on the findings, it was concluded that, there is a positive and significant relationship between political rally messages and vernacular radio stations used in this study, and ethnic intolerance and conflict among voters in Migori County, Kenya.
 Unique contribution to theory, practice and policy: The study recommends to government agencies such as NCIC and Media Council of Kenya and the IEBC to consider taking measures against these political rally messages as one way to reduce ethnic intolerance and conflict among voters in Migori County, Kenya.

Influence of Farmer Capacity Building in Financial Resource Mobilization on Performance of Smallholder Irrigation Projects in Migori County, Kenya

The study examined influence of farmer capacity building in financial resource mobilization on performance of smallholder irrigation projects in Migori County, Kenya. The study adopted pragmatism as its philosophy, and used cross sectional and correlation research design. The target population was 2,815, and comprised farmers from fifteen smallholder irrigation projects that receive water from River Kuja through Lower Kuja Project. The sample size was 341 farmers. The study used systematic random sampling to draw the sample, used questionnaire to collect data, and analyzed data using descriptive and inferential statistics. The results showed that farmer capacity building in financial resource mobilization has a significant influence on performance of smallholder irrigation projects (r = 801, R2 = 0.641, F (5, 331) = 118.405, 0.000 < p < 0.05). Therefore, the study concluded that financial resource mobilization is a critical factor in performance of smallholder irrigation projects in Migori County. Consequently, the study recommends that Migori County Government educate farmers in smallholder irrigation projects on loan facilities by financial institutions. Further, the study recommends that Migori County develop a framework to assist farmers in smallholder irrigation projects to qualify for loans facilities operated by financial institutions.

Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya.

Background: Community perceptions of quality of maternal healthcare services—including Person-centered maternity care (PCMC)—influences the health-seeking behavior of women. Yet few studies have examined this quantitatively. This study aims to examine community perceptions of PCMC and its associated factors.Materials and Methods: We used data from a survey on community perceptions of PCMC in Migori County, Kenya conducted in August 2016. Community members were relatives or friends of women aged 15 to 49 years who gave birth in the 9 wk preceding the survey (N = 198). PCMC was measured using a 30-item scale with three sub-scales for dignity and respect, communication and autonomy, and supportive care. PCMC scores were standardized to range from 0 to 100, with higher scores indicative of higher PCMC. Descriptive, bivariate, and multivariate analyses were performed in STATA (version 14).Results: The average total PCMC score was 62 (SD = 15.7), with scores of 74, 63, and 53 for dignity and respect, supportive care, and communication and autonomy, respectively. Controlling for other factors, respondents who were employed and literate had higher PCMC perception scores than those who were less literate and unemployed. Respondents who rated their health as very good had higher PCMC perception scores than those who rated their health as poor. Female respondents who previously gave birth at a health facility had lower perceptions of dignity and respect than those with no prior facility birth.Conclusion: The findings imply that community perceptions of PCMC, particularly related to communication and autonomy, are poor. Given the effects of these perceptions on use of maternal health services, there is a need to improve PCMC.

Demographic, occupational and societal risk exposures to physical injuries in a rural community in Western Kenya: a 12-week longitudinal study

ObjectiveWe studied factors associated with the weekly occurrence of physical injuries in a rural setting to determine injury-related burden and risk exposures.DesignProspective cohort study.SettingSuna-West subcounty, Migori County, Western Kenya.Participants390 study...

Assessing the Effectiveness of Selected Aspects of Extension Approaches Across Different Agro Ecological Zones

Aims: Understanding how different agricultural organisations implement extension approaches across different Agricultural Ecological Zones is very critical for the success and impact in agricultural sector. This paper therefore assessed the effect of Agro-Ecological Zones on implementation of agricultural extension approaches to provide an insight into how to improve dissemination of improved technologies. 
 Study Design: A cross-sectional survey combining quantitative and qualitative data collection methodologies was used.
 Place and Duration of Study: The study was conducted in six counties of western Kenya: Nyamira, Kisii, Homa-bay, Migori, Kisumu, and Siaya counties. The study was conducted between September to December 2019.
 Methodology: 12 agricultural institutions within the study area were sampled. A multi stage random sampling technique was used to identify 492 respondents comprising; 12 head of agriculture in the institutions, 120 extension personnel and 360 household heads across different Agricultural Ecological Zones (AEZs). Data was analysed using both descriptive and inferential statistics. The inferential statistics were set at the 0.05 level for significance. Kruskal Wallis test and Dunn-Bonferroni Post Hoc test were used to test significant differences on the implementation aspects of the extension approaches across the different AEZs.
 Results: Climatic conditions, average age, land size, and value of household assets as factors of AEZs influenced how various aspects of agricultural extension approaches were implemented. Level of implementation of aspects influenced uptake of agricultural technologies. Kruskal Wallis test result (H (5) = 126.679, p value < 0.001) indicated that there were significant differences in the level at which smallholder farmers improved their agricultural practices in different AEZs.
 Conclusion: For effective dissemination of agricultural technologies, farmer situation, specifically agro ecological zone must be taken into consideration when recommending extension dissemination approaches to be used. Multivariate analysis needs to be done to inform how to implement various aspects of extension approaches to achieve optimum results in terms of farmer behaviour change.

Factors that influence healthcare service utilization during COVID-19 pandemic among pregnant women and caregivers with children under two years in Rongo sub-county, Migori County, Kenya

Background: Health systems have failed in past epidemics to maintain delivery of routine health essential services. Most resources including human and essential supplies are all diverted to address health emergency, sometimes resulting in lack of important basic and routine health services.Methods: This was a retrospective cross-sectional study with mixed data collection methods, where respondents were asked questions on how COVID-19 affected them with regard to utilization of MCH healthcare during the first peak of the COVID-19 in Kenya. Two high volume facilities were selected purposively based on volume and capacity of services offered. A random sample was drawn from the stratum using a list generated by community health workers (CHWs) attached to the health facilities. Key informant interviews were used to collect data among health care providers and structured questionnaire was used for pregnant women and caregivers. Independent variables, social distancing, social stigma, communication and human mobility restriction were associated with health care service utilization and significant at 0.05 p value.Results: Correlation analysis indicated social stigma (r-0.407, p<0.512), social distancing (r-0.324, p<0.001) and human mobility restrictions (r-0.606, p<0.001) negatively influenced service utilization. Whereas COVID-19 related communication (0.631, p<0.001) was protective and thus promoted service utilization. The hierarchical linear regression model explained 67.73% of the total variations in the health care service utilization, which was r=0.6773.Conclusions: From the findings social stigma, communication, social distancing and human mobility restrictions influence health care service utilization. Ministry of health should strengthen targeted community outreaches for pregnant women and caregivers with children under two years.

Population-based socio-demographic household assessment of livelihoods and health among communities in Migori County, Kenya over multiple timepoints (2021, 2024, 2027): A study protocol.

Migori County is located in western Kenya bordering Lake Victoria and has traditionally performed poorly on important health metrics, including child mortality and HIV prevalence. The Lwala Community Alliance is a non-governmental organization that serves to promote the health and well-being of communities in Migori County through an innovative model utilizing community health workers, community committees, and high-quality facility-based care. This has led to improved outcomes in areas served, including improvements in childhood mortality. As the Lwala Community Alliance expands to new programming areas, it has partnered with multiple academic institutions to rigorously evaluate outcomes. We describe a repeated cross-sectional survey study to evaluate key health metrics in both areas served by the Lwala Community Alliance and comparison areas. This will allow for longitudinal evaluation of changes in metrics over time. Surveys will be administered by trained enumerators on a tablet-based platform to maintain high data quality.

Assessment of Strategic Messages Communicated for Sustainable Solid Waste Management: A Study of Migori County, Kenya

Solid waste management has become great concern for governments and cities due to its effects on health, environment and climate change. The aim of sustainable solid waste management (SSWM) is to achieve circular economy and realize sustainable development goals. Communication plays a significant role in empowering communities with knowledge, influencing behaviour and promoting collaboration on waste management between governments and communities. Past research shows indiscriminate dumping of waste and inadequate knowledge on how to manage solid waste including reduce, reuse and recycle waste among communities in Africa. However, there is limited focus in research on messages communicated for SSWM. This study sought to assess strategic messages communicated for SSWM and media used in the communication. The study conducted in Migori county Kenya, using a mixed methods approach involved a total of 399 town residents sampled using purposive, stratified, and simple random sampling techniques. The study found lack of focus on strategic messages for SSWM in the communication by Migori county government. Communication is uncoordinated, conducted in public meetings, local radio, and by waste management supervisors. Most community members lack knowledge on SSWM practices. The study recommends communication of strategic messages for SSWM to improve community knowledge of SSWM; communication using participatory media accessible to the community; and inclusion of community knowledge in the construction of strategic messages for SSWM. Keywords: Strategic, Message, Sustainable Solid Waste Management, Community, Participatory Communication. DOI: 10.7176/NMMC/97-02 Publication date: August 31 st 2021

Causes of preterm and low birth weight neonatal mortality in a rural community in Kenya: evidence from verbal and social autopsy

BackgroundUnder-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study.MethodsVerbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10).ResultsBetween January 2017 to December 2018, 3175 babies were born preterm or LBW, and164 (5.1%) died in the first 28 days of life. VASA was conducted among 88 (53.7%) of the neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 h of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths.ConclusionDeaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced implementation of existing facility-based intrapartum and immediate postpartum care interventions, targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia.

Provider perceptions of lack of supportive care during childbirth: A mixed methods study in Kenya

Supportive care is a key component of person-centered maternity care (PCMC), and includes aspects such as timely and attentive care, pain control, and the health facility environment. Yet, few researchers have explored the degree of supportive care delivered or providers’ perceptions on supportive care practices during childbirth. The researchers’ aim is to evaluate the extent of supportive care provided to women during childbirth and to identify the drivers behind the lack of supportive care from the perspective of maternity providers in a rural county in Western Kenya. Data are from a mixed-methods study in Migori County in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical). Providers were asked structured questions on various aspects of supportive care followed by open ended questions on why certain practices were performed or not. We conducted descriptive analysis of the quantitative data and thematic analysis of the qualitative data. We analyzed data and found inconsistent and suboptimal practices with regards to supportive care. Some providers reported long patient wait times in their facilities as well as the inability to provide the best care due to staff shortages in their facilities. Others also reported low interest and inquiry about women’s experience of pain during childbirth, which was driven by perceptions of pain during childbirth as normal, facility culture and norms, and lack of pain medicine. For the facility environment, providers reported relatively clean facilities. They, however, noted inconsistent water and electricity as well as inadequate safety. We conclude that many drivers of the lack of supportive care are caused by structural health systems issues, therefore a health system strengthening approach can be useful for improving the supportive care dimension of PCMC, and thus quality of care overall.

Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.

Kenya started implementing voluntary medical male circumcision (VMMC) for HIV prevention in 2008 and adopted the use of decision makers program planning tool version 2 (DMPPT2) in 2016, to model the impact of circumcisions performed annually on the population prevalence of male circumcision (MC) in the subsequent years. Results of initial DMPPT2 modeling included implausible MC prevalence estimates, of up to 100%, for age bands whose sustained high uptake of VMMC pointed to unmet needs. Therefore, we conducted a cross-sectional survey among adolescents and men aged 10-29 years to determine the population level MC prevalence, guide target setting for achieving the goal of 80% MC prevalence and for validating DMPPT2 modelled estimates. Beginning July to September 2019, a total of 3,569 adolescents and men aged 10-29 years from households in Siaya, Kisumu, Homa Bay and Migori Counties were interviewed and examined to establish the proportion already circumcised medically or non-medically. We measured agreement between self-reported and physically verified circumcision status and computed circumcision prevalence by age band and County. All statistical were test done at 5% level of significance. The observed MC prevalence for 15-29-year-old men was above 75% in all four counties; Homa Bay 75.6% (95% CI [69.0-81.2]), Kisumu 77.9% (95% CI [73.1-82.1]), Siaya 80.3% (95% CI [73.7-85.5]), and Migori 85.3% (95% CI [75.3-91.7]) but were 0.9-12.4% lower than DMPPT2-modelled estimates. For young adolescents 10-14 years, the observed prevalence ranged from 55.3% (95% CI [40.2-69.5]) in Migori to 74.9% (95% CI [68.8-80.2]) in Siaya and were 25.1-32.9% lower than DMMPT 2 estimates. Nearly all respondents (95.5%) consented to physical verification of their circumcision status with an agreement rate of 99.2% between self-reported and physically verified MC status (kappa agreement p-value<0.0001). This survey revealed overestimation of MC prevalence from DMPPT2-model compared to the observed population MC prevalence and provided new reference data for setting realistic program targets and re-calibrating inputs into DMPPT2. Periodic population-based MC prevalence surveys, especially for established programs, can help reconcile inconsistencies between VMMC program uptake data and modeled MC prevalence estimates which are based on the number of procedures reported in the program annually.

Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1.

Voluntary medical male circumcision is a crucial HIV prevention program for men in sub-Saharan Africa. Kenya is one of the first countries to achieve high population coverage and seek to transition the program to a more sustainable structure designed to maintain coverage while making all aspects of service provision domestically owned and implemented. Using pre-defined metrics, we created and evaluated three models of circumcision service delivery (static, mobile and mixed) to identify which had potential for sustaining high circumcision coverage among 10-14-year-olds group, a historically high-demand and accessible age group, at the lowest possible cost. We implemented each model in two distinct geographic areas, one in Siaya and the other in Migori county, and assessed multiple aspects of each model’s sustainability. These included numerical achievements against targets designed to reach 80% coverage over two years; quantitative expenditure outcomes including unit expenditure plus its primary drivers; and qualitative community perception of program quality and sustainability based on Likert scale. Outcome values at baseline were compared with those for year one of model implementation using bivariate linear regression, unpaired t-tests and Wilcoxon rank tests as appropriate. Across models, numerical target achievement ranged from 45–140%, with the mixed models performing best in both counties. Unit expenditures varied from approximately $57 in both countries at baseline to $44-$124 in year 1, with the lowest values in the mixed and static models. Mean key informant perception scores generally rose significantly from baseline to year 1, with a notable drop in the area of community engagement. Consistently low scores were in the aspects of domestic financing for service provision. Sustainability-focused circumcision service delivery models can successfully achieve target volumes at lower unit expenditures than existing models, but strategies for domestic financing remain a crucial challenge to address for long-term maintenance of the program.

Influence of Teacher Motivation on Learner Academic Achievement in Migori County, Kenya

Education is a fundamental human right which promotes acquisition of knowledge and skills for development. Despite efforts by policy makers, administrators, teachers and learners to improve learner achievement, performance remains poor (MOEST, 2012). The purpose of this was to establish the influence of teacher motivation on promoting student’s academic achievement in public secondary school education. The study adopted concurrent triangulation research design. The target population for this study was 184 public secondary schools, 1233 teachers, and 73,385 learners. A sample involving 56 public secondary schools whereby 56 principals, 370 teachers and 398 learners was drawn from target population. Purposive sampling was used to get 56 schools, simple random sampling was used to get 370 teachers and stratified random sampling technique was used to get 398 learners. Data for the study was collected by the use of three different questionnaires and three different interview schedules. Validity of questionnaires was tested during the pilot study in Homa-Bay County which is neighboring Migori County. Split Half reliability test which is a measure of internal consistency was used. All pre-testing procedure for Reliability of instruments was based on reliability coefficient of 0.79 indexes. The data collected was summarized and analysed qualitatively and quantitatively. Inferential statistics was used whereby Correlation, Regression and Chi-square tests were used to gauge influence of teacher motivation on student academic achievement. The research revealed that teacher motivation had no significant influence on learner academic achievement in secondary schools Therefore, the study concluded that administrators should put in place measures to enhance teacher Motivation. In conclusion, institutional managers should design proactive processes that can inculcate positive support for teacher motivation.

An Exploratory Study of Community Involvement in Communication for Sustainable Solid Waste Management: A Study of Migori County, Kenya

Sustainable solid waste management (SSWM) is intended to reduce impacts of solid waste on the environment and achieve of sustainable development goals on sustainable cities and communities. Past research focused on the role of mass media in awareness creation and influencing attitude towards solid waste management. However, studies show that awareness and attitude do not translate to positive behaviour towards solid waste management. Objectives of this study were to explore community involvement in the communication of SSWM, establish media used to involve community in the communication of sustainable solid waste management and examine community awareness on SSWM. Qualitative data was collected using face-to-face interviews and focus group discussions from162 participants sampled using purposive, snowball and stratified sampling techniques. Results show minimal community involvement in the communication of SSWM due to lack of structures for community involvement in communication. There was minimal communication of SSWM through radio, public fora and stakeholder meetings which resulted to limited knowledge of SSWM among the community. The study recommends community involvement in the communication of SSWM using participatory media so as to improve their understanding and participation in SSWM. Keywords: Sustainable solid waste management, Communication, Community involvement, Dialogue, Social change. DOI: 10.7176/JEES/11-5-04 Publication date: May 31 st 2021

Exploring the Thin Line Between Misinformation and Facts in the Era of COVID-19 in Selected Border Counties of Kenya.

Introduction: Information seeking behavior of the affected populations during a pandemic is believed to significantly influence the way the population manages the epidemic and curb its spread. This study sought to identify and profile reliable sources of information that the residents of Migori and Homa-Bay Counties in Kenya could use to curb the spread of COVID-19 virus and enhance efficient management of risks associated with the pandemic.Material and Methods: A survey method was used in which quantitative data was generated through administration of online questionnaires to 250 participants which were purposively selected. Data was analyzed using SPSS version 20 and results presented in form of tables and graphs. A survey method was used in which quantitative data was generated through administration of online questionnaires to 250 participants which were purposively selected. Data was analyzed using SPSS version 20 and results presented in form of tables and graphs.Results: The study found out that the top 3 frequently used sources information was television, official government press releases and social media. The study also found out that there was high correlation between the sources that were frequently used and their perceived credibility with a coefficient of R2=0.8426. English was the most preferred language for use in sharing information. Further, the respondents preferred to receive information based on how to protect self and the family.Conclusion: To counter the spread of misinformation, the study has therefore profiled information sources and recommended that television, official government press releases and properly managed social media should be used to package and share relevant COVID-19 information to reach the target population.

A mixed-method investigations of work, government and social factors associated with severe injuries in artisanal and small-scale mining (ASM) operations

The susceptibility of miners to severe injuries in Artisanal and Small-scale Mining (ASM) operations is significantly higher than in the larger-scale mining industry. However, the most prevalent and least studied safety aspects are the factors affecting the severe injuries and miners’ awareness of the state of their health and safety. Severe injuries are ASM-related injuries that have resulted in more than two weeks lost workdays. This paper aims to demonstrate that severe injuries in ASM industry do not occur simply due to individual personality but also because of other underlying factors like ignorance of illegality of the activity. The paper also reports on the injured miners’ perception of the nature of health and safety. Two hundred and thirty-six miners from Migori County of Western Kenya ASM site were administered closed-ended structured survey questionnaires, followed by face-to-face qualitative interview of thirty-three severely injured mineworkers identified from the quantitative survey respondents. The survey results were analysed using logistic regression. While the interview results were subjected to thematic analysis, the identified themes confirmed or complemented quantitative findings as well as demonstrated the state of occupational health and safety (OHS) in ASM industry. The results showed that alcohol and drug usage, inadequate earnings, safety training, lack of hazard identification and risk control measures, lack of safety equipment, poor management-miners interaction, poor communication of safety concerns, and government support were indicators of poor safety culture influenced the recurrence of severe injuries. Research outcomes will support decision-making processes and implementation of programs in this industry.

Factors Influencing Academic Performance of Learners with Visual Impairment in Inclusive Primary Schools in Uriri Sub-County, Migori County, Kenya

Learners with Visual Impairment have varied nature of difficulties that require special attention in curriculum implementation if they have to achieve good academic performance. These learners require comprehensive educational programs such as individualized techniques and services, appropriate assessment and instructional adaptation that enable them to complete current and future tasks in the school, home, workplace and community. Academic performance of learners with visual impairment is measured through examination (KCPE) in inclusive primary schools in Uriri sub -county. The poor performance has raised concern and effort has to be made to find out factors leading to this problem. Therefore, the purpose of this study was to find out factors influencing academic performance of learners with visual impairment in inclusive primary schools in Uriri sub-county, Migori County, Kenya. Objectives of the study were to determine the influence of teachers’ and parents’ attitude on academic performance of learners with visual impairment. The research hypotheses were drawn from the objectives of the study. The study adopted a descriptive survey research design. Saturated and purposive sampling techniques were used to select 3 head teachers, 28 teachers and 23 parents, giving a study population of 54 respondents. Piloting was done in one of the integrated public primary schools in Rongo sub-county to establish the reliability of the instruments where 1 head teacher 4 teachers and 3 parents were used in piloting. Internal consistency reliability coefficient was used to determine reliability of the instruments. Cronbach’s reliability coefficient of above 0.70 was obtained for teacher’s and parent’s questionnaire, hence was considered reliable. Validity was determined by the supervisors and lecturers from the department of Educational Psychology, Rongo University. The analysis of the data was performed using Statistical Package for the Social Sciences (SPSS) version 20. Quantitative data was collected using a questionnaire. Qualitative data was collected using interview schedule. The quantitative data obtained was analyzed using percentages, means, standard deviation, weighted averages, Pearson’s correlation, and binary logistics regression while qualitative data was coded, transcribed and organized thematically. Lev. Vygotsky social cultural theory was applied. The theory considers the society and its culture as the main source of child’s development. Ethics was observed during both data collection and reporting of findings. The study established that; teacher attitude had a positive moderate significant influence (r= .537, p&lt; .05), parent’s attitude had a positive weak influence which was not statistically significant (r= .243, p&lt; .05) on academic performance of learners with visual impairment. Based on the odds ratio, teachers’ attitude had an odds ratio of 3.337, and parental attitude had the least odd ratio of 1.5. This implied that teachers attitude had the greatest influence on the performance of learners with visual impairment. Parental attitude had the least influence which was not statistically significant. The study therefore concluded that teachers’ attitude is the key driver of the performance of learners with visual impairment and parents’ attitude towards learners with visual impairment should be enhanced as reflected by the ratings. The study is significant to education policy makers, planners and implementers on how to organize seminars and workshops on attitude change, will help teachers and other stakeholders change their attitude towards learners with visual impairment and lastly give baseline to other researchers to carry out further research on the same topic. Based on the study findings it is recommended that teachers and parents of learners with visual impairment be encouraged to be more positive and closer to the children.

Contribution of cassava and cassava-based products to food and nutrition security in Migori County, Kenya

The promotion of cassava as a staple and food security crop is widespread in Africa,Kenya included. Overreliance on cassava as a sole energy provider could lead to malnutrition. Consumption of high hydro-cyanide levels from cassava products could lead to health complications for consumers.This study sought to establish the contribution of cassava consumption to nutrition in Migori County.A cross-sectional survey was carried out and data collected on households’cassava production and consumption practices. Two hundred and fifty-three households were randomly selected and household farming heads interviewed in West Kanyamkago, Orango Central and Kamgundho locations as areas where cassava is predominantly grown. Seven cassava flour samples of different cassava varieties grown in the area were obtained from farmers.Analyses were done to determine the moisture, cyanide and protein contents on flour and cooked stiff porridge (ugali). Results indicated that 99.1% of the households were farming. They highly depended on sale of farm and livestock produce as income.Ninety four percent of the households consumed cassava,of which 88.4% produced cassava on their farms. The most preferred cassava variety was ‘Rateng’.The main cassava products consumed were ugali(stiff porridge)and porridge. Majority of the households (95%) never consumed cassava leaves and were not aware that cassava leaves could be consumed.The cyanide level on average on dry flours was 53.23mg/kg while on consumed cooked ugali was13.44mg/kg. These levels were above the maximum limit of 10mg/kg recommended by WHO.Low average protein levels of &lt;0.5g/100g were observed in the cooked ugali. This could pose a danger of protein energy malnutrition if no other sources are consumed by the household members.Cassava farming households in the study area require support to promote growth of low cyanide varieties in order to reduce intake.

Determinants of modern contraceptive prevalence and unplanned pregnancies in Migori County, Kenya: results of a cross-sectional household survey.

Family planning and contraceptive utilization can have significant effects in reducing unplanned pregnancies and improving maternal and child health indicators. We conducted a retrospective cross-sectional study analyzing survey response data within six sub-locations of Migori County, Kenya in 2018 and 2019. We utilize this survey data to estimate both the prevalence of contraceptive uptake and unwanted pregnancies in the study populations, and to examine the potential role that different factors play in meeting related family planning targets. Descriptive statistics were calculated, and multivariable logistic regression was used to model determinants of contraceptive use and reported unplanned pregnancy. A total of 3,642 female heads of household were included. 63% of respondents reported that they currently use some form of contraception, and the prevalence of unplanned pregnancy was 36.7%. Our findings reflect the need for family planning programs to focus interventions on those at highest risk. There is a need for additional research and investigation into community and individual beliefs surrounding family planning in order to ensure that interventions are culturally sensitive and locally responsive.

Implementing an intrapartum package of interventions to improve quality of care to reduce the burden of preterm birth in Kenya and Uganda

BackgroundQuality of care during the intrapartum and immediate postnatal period for maternal and newborn health remains a major challenge due to the multiple health system bottlenecks in low-income countries. Reports of complex interventions that have been effective in reducing maternal and newborn mortality in these settings are usually limited in description, which inhibits learning and replication. We present a detailed account of the Preterm Birth Initiative (PTBi) implementation process, experiences and lessons learnt to inform scale-up and replication.MethodsUsing the TiDieR framework, we detail how the PTBi implemented an integrated package of interventions through a pair-matched cluster randomized control trial in 20 health facilities in Migori County, Kenya, and the Busoga region in east central Uganda from 2016 to 2019. The package aimed to improve quality of care during the intrapartum and immediate postnatal period with a focus on preterm birth. The package included data strengthening (DS) and introduction of a modified WHO Safe Childbirth Checklist (mSCC), simulation-based training and mentoring (PRONTO), and a Quality Improvement (QI) Collaborative.ResultsIn 2016, DS and mSCC were introduced to improve existing data processes and increase the quality of data for measures needed to evaluate study impact. PRONTO and QI interventions were then rolled out sequentially. While package components were implemented with fidelity, some implementation processes required contextual adaptation to allow alignment with national priorities and guidelines, and flexibility to optimize uptake.ConclusionLessons learned included the importance of synergy between interventions, the need for local leadership engagement, and the value of strengthening local systems and resources. Adaptations of individual elements of the package to suit the local context were important for effective implementation, and the TIDieR framework provides the guidance needed in detailed description to replicate such a complex intervention in other settings. Detailed documentation of the implementation process of a complex intervention with mutually synergistic components can help contextualize trial results and potential for scale-up. The trial is registered at ClinicalTrials.govNCT03112018, registered December 2016, posted April 2017.