Nairobi Research Articles

Comparative performance of pooled cohort equations and Framingham risk scores in cardiovascular disease risk classification in a slum setting in Nairobi Kenya

BackgroundCardiovascular diseases (CVD) cause 18 million deaths annually. Low- and middle-income countries (LMICs) account for 80% of the CVD burden, and the burden is expected to grow in the region in the coming years. Screening for and identification of individuals at high risk for CVD in primary care settings can be accomplished using available CVD risk scores. However, few of these scores have been validated/recalibrated for use in sub-Saharan Africa (SSA). MethodsPooled cohort equations (PCE) and Framingham risk scores for 10-year CVD risk were applied on 1960 men and women aged 40 years and older from the AWI-Gen (Africa, Wits-INDEPTH Partnership for GENomic studies) study 2015. Low, moderate/intermediate or high CVD risk classifications correspond to <10%, 10–20% and >20% chance of developing CVD in 10 years respectively. Agreement between the risk scores was assessed using kappa and correlation coefficients. ResultsHigh CVD risk was 10.3% in PCE 2013, 0.4% in PCE 2018, 2.9% in Framingham and 3.6% in Framingham non-laboratory scores. Conversely, low CVD risk was 62.2% in PCE 2013 and 95.6% in PCE 2018, 84.0% and 80.1% in Framingham and Framingham non-laboratory scores, respectively. A moderate agreement existed between the Framingham functions (kappa = 0.64, 95% CI 0.59–0.68, correlation, rs = 0.711). There was no agreement between the PCE 2013 and 2018 functions (kappa = 0.05, 95% CI 0.04–0.06). ConclusionsNewer cohort-based data is necessary to validate and recalibrate existing CVD risk scores in order to develop appropriate functions for use in SSA.

Experiences of violence among adolescent girls and young women in Nairobi's informal settlements prior to scale-up of the DREAMS Partnership: Prevalence, severity and predictors.

IntroductionWe sought to estimate the prevalence, severity and identify predictors of violence among adolescent girls and young women (AGYW) in informal settlement areas of Nairobi, Kenya, selected for DREAMS (Determined Resilient Empowered AIDS-free, Mentored and Safe) investment.MethodsData were collected from 1687 AGYW aged 10–14 years (n = 606) and 15–22 years (n = 1081), randomly selected from a general population census in Korogocho and Viwandani in 2017, as part of an impact evaluation of the “DREAMS” Partnership. For 10–14 year-olds, we measured violence experienced either in the past 6 months or ever using a different set of questions from those used for 15–22 year-olds. Among 15–22 year-olds we measured prevalence of violence, experienced in the past 12 months, using World Health Organization (WHO) definitions for violence typologies. Predictors of violence were identified using multivariable logit models.ResultsAmong 606 girls aged 10–14 years, about 54% and 7% ever experienced psychological and sexual violence, respectively. About 33%, 16% and 5% experienced psychological, physical and sexual violence in the past 6 months. The 10–14 year old girls who engaged in chores or activities for payment in the past 6 months, or whose family did not have enough food due to lack of money were at a greater risk for violence. Invitation to DREAMS and being a non-Christian were protective. Among 1081 AGYW aged 15–22 years, psychological violence was the most prevalent in the past year (33.1%), followed by physical violence (22.9%), and sexual violence (15.8%). About 7% experienced all three types of violence. Severe physical violence was more prevalent (13.8%) than moderate physical violence (9.2%). Among AGYW aged 15–22 years, being previously married/lived with partner, engaging in employment last month, food insecure were all risk factors for psychological violence. For physical violence, living in Viwandani and being a Muslim were protective; while being previously married or lived with a partner, or sleeping hungry at night during the past 4 weeks were risk factors. The odds of sexual violence were lower among AGYW aged 18–22 years and among Muslims. Engaging in sex and food insecurity increased chances for sexual violence.ConclusionsPrevalence of recent violence among AGYW is high in this population. This calls for increased effort geared towards addressing drivers of violence as an early entry point of HIV prevention effort in this vulnerable group.

Interest-Rate Capping and the Security Prices of Bank Companies Listed on the Nairobi Securities Exchange, Kenya

Banks play an essential role in the creation of new capital in a country, help the growth process by collecting the savings of the individuals and lend them out to a business-people and manufacturers. Banks also play an essential role in the financial system and the economy by allocating funds from individuals with excess cash to borrowers in an efficient manner; thus, make the overall economy more efficient. In September 2016, the Kenyan government enacted a law capping interest to protect borrowers from the exorbitant interest rate. After the enactment of the interest-rate capping law, the share index of bank companies in the NSE N20 continued to decline. The decline is worrying and, of great concern to the investors and the economy as a whole, prompting the researcher to investigate the effect of interest-rate capping on the security prices of the bank companies listed on the NSE, Kenya. The study was guided by the Signaling Theory, the Efficient Market Hypothesis, and the Market Expectation Theory. The study collected data using a questionnaire and schedules from 11 banks listed on the NSE, Kenya, used the event study methodology, and analyzed data using the ANOVA technique. The study revealed a p-value of 0.003 and concluded that interest-rate capping significantly affected the security prices of banks companies listed on the NSE, Kenya, at a 5 percent significant level. The study recommends further research to carried on specific companies that were affected by the decline in security prices. Also, future research should be on companies on other security exchange; finally, the regulators to compel the bank companies to date all their records and financial statement.

Model prediction and climatology of aerosol optical depth (τ550) and angstrom exponent (α470-660) over three aerosol robotic network stations in Sub-Saharan Africa using moderate resolution imaging spectroradiometer data

The spatial and temporal variations of aerosol optical depth at 550 nm (τ550) and Angstrom exponent derived from 470 and 660 nm (α470-660) over Nairobi (NAI), Skukuza (SKU) and Ilorin (ILO) Aerosol Robotic Network (AERONET) stations in sub-Saharan Africa, as recorded by Moderate Resolution Imaging Spectroradiometer (MODIS) satellites for fifteen years (2000-2015), were examined in relation to their climatologies and prediction. The MODIS measurements of τ550 and α470-660 from aqua (MYD04) and terra (MOD04) satellites were used in this study. Retrievals of τ550 for both satellites were validated with AERONET τ550 for the same period. The validation results showed that they compare favourably over the three stations, but MOD04 performed better than MYD04 data in NAI and ILO for τ550. This shows that the τ550 of NAI and ILO are best captured using the MOD04 data while that of SKU is best with MYD04. It was also discovered that MODIS underestimated AERONET τ550 data over NAI and SKU. The most polluted station is ILO while the least polluted one is NAI. Similarly, the station with the highest concentration of absorbing aerosols is NAI and the least was observed in ILO. The aerosol climatology shows that the most polluted months in NAI, SKU and ILO are October, June and March respectively. On the other hand, February, November and March has the highest amount of scattering aerosols in the atmosphere for NAI, SKU and ILO respectively. The highest amount of absorbing aerosols was found, respectively, in the months of June, June and August. The generated time series (TS) models are all good, though a general underestimation of the parameters by the models was also observed.&#x0D; Keywords: Aerosol optical depth, Angstrom exponent, MODIS, Time series, sub-Saharan Africa

Efficacy of revision urethroplasty in the treatment of recurrent urethral strictures at a tertiary hospital (Kenyatta National Hospital–KNH), in Nairobi Kenya: 2015-2018

Background: Urethral strictures cause malfunction of the urethra. Urethroplasty is a cost-effective treatment option. Its success rate is greater than 90% where excision and primary anastomosis(EPA)is performed and 80-85% following substitution urethroplasty. Definitive treatment for recurrent urethral strictures after urethroplasty is not defined. Repeat urethroplasty is a viable option with unknown efficacy.Method: Retrospective analysis of patients who underwent revision urethroplasty for unsuccessful urethroplasty at KNH from 2015 to 2018 was performed. Patients’ age, demographic data, stricture length, location, aetiology, comorbidities and type of urethroplasty was evaluated from records with complete data. Male patients aged 13 to 80years were evaluated. Comparison of urethroplasty outcome between two patient cohorts was made: Fresh urethroplasty patients versus failed urethroplasty who underwent revision so as to determine efficacy of the later. Principal outcome measure was urethral patency, while Subsidiary outcome measures were associated complications. Outcomes were compared using statistical package SPSS version 23.0.Result: 235 patients who met inclusion criteria underwent urethroplasty, 71.5% (n=168) had a successful outcome, while28.5% (n=67) failed and were subjected to revision urethroplasty. Another 58% were successful upon revision but experienced significant morbidity. Majority of urethral strictures were bulbomembranous. Trauma was the leading cause of urethral strictures followed by idiopathic strictures. EPA was the commonest surgery while Tissue transfer featured prominently in revision urethroplasty. A significant correlation was evident between stricture length, prior surgery, and procedure choice and urethroplasty outcome.Conclusion: Revision urethroplasty is feasible after failed urethroplasty but less efficacious. Stricture length, number of prior surgeries and procedure choice affected outcome.EPA and Tissue Transfer techniques are essential surgical armamentarium in revision setting.

Influence of Social Capital on Diversification of Livelihood in Slum Areas in Nairobi, Kenya

Influence of Social Capital on Diversification of Livelihood in Slum Areas in Nairobi, Kenya

Messy maps: Qualitative GIS representations of resilience

To include qualitative aspects of flood resilience, such as emotion, social connections and experience, into urban planning, we present a methodology incorporating innovative and experimental map visualisations of informal settlements. The concept of resilience in urban planning is often deployed in technocratic ways using quantitative tools such as geographic information systems (GIS). Yet in the urban Global South, where high proportions of the population live in informal settlements, the knowledge infrastructures used by public authorities leave little room for participation and consideration of local experience. We outline arts-based workshop activities and a qualitative GIS methodology to map resilience as defined by informal settlement residents in two case study cities, Nairobi (Kenya) and Cape Town (South Africa), with applicability across the urban Global South. For each city, four map layers were generated: (i) flood footprints showing resident’s spatial knowledge of floods; (ii) georeferenced, narrated 360° photo spheres capturing different perspectives about a space; (iii) spatial social network maps showing residents connections to formal and informal actors before/during floods; (iv) multimedia pop-ups communicating contextual details missing from traditional GIS maps. We show how these prototype maps can be integrated within planning knowledge infrastructures. For spatially imprecise qualitative aspects of resilience in informal settlements, placing markers on a map makes them visible in ways that planners can begin to engage with. Although challenges remain, we found openness in Nairobi and Cape Town by city-level actors to use qualitative forms of evidence, and that the contextual detail aided their retention and understanding of resilience.

Smart city making? The spread of ICT-driven plans and infrastructures in Nairobi

ABSTRACT Since the late 2000s, the city of Nairobi in Kenya has become a focal point of large-scale and ambitious technology-driven city making processes and ambitions. In this study, we draw upon observations, interviews, and policy analysis to examine processes of city making and the spread of ICT-driven infrastructures, juxtaposing ambitious visions of emergent plans with ordinary realities of the African city. We demonstrate that while processes of smart city making have strongly been inclined toward technocratic approaches and deterministic appeals, this inclination is highly deceptive. We argue that rather than being deterministic, these processes are essentially politicized, highly contested, and shaped by the role and impact of local practices and context-specific realities. In making this argument, we draw from a social studies of technology perspective which engages with the notion of technological determinism to make this contribution to the academic field of critical urbanism.

International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project

BackgroundReference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges.ObjectivesTo produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.Study DesignIn Phase II of the INTERGROWTH-21st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original populations in Pelotas (Brazil), Nairobi (Kenya), and Oxford (United Kingdom) that had participated in the Fetal Growth Longitudinal Study. Women with a singleton pregnancy were recruited at <14 weeks’ gestation, confirmed by ultrasound measurement of crown–rump length, and then underwent standardized ultrasound every 5±1 weeks until delivery. From 22 weeks of gestation umbilical artery indices (pulsatility index, resistance index, and systolic/diastolic ratio) were measured in a blinded fashion, using identical equipment and a rigorously standardized protocol. Newborn size at birth was assessed using the international INTERGROWTH-21st Standards, and infants had detailed assessment of growth, nutrition, morbidity, and motor development at 1 and 2 years of age. The appropriateness of pooling data from the 3 study sites was assessed using variance component analysis and standardized site differences. Umbilical artery indices were modeled as functions of the gestational age using an exponential, normal distribution with second-degree fractional polynomial smoothing; goodness of fit for the overall models was assessed.ResultsOf the women enrolled at the 3 sites, 1629 were eligible for this study; 431 (27%) met the entry criteria for the construction of normative centiles, similar to the proportion seen in the original fetal growth longitudinal study. They contributed a total of 1243 Doppler measures to the analysis; 74% had 3 measures or more. The healthy low-risk status of the population was confirmed by the low rates of preterm birth (4.9%) and preeclampsia (0.7%). There were no neonatal deaths and satisfactory growth, health, and motor development of the infants at 1 and 2 years of age were documented. Only a very small proportion (2.8%–6.5%) of the variance of Doppler indices was due to between-site differences; in addition, standardized site difference estimates were marginally outside this threshold in only 1 of 27 comparisons, and this supported the decision to pool data from the 3 study sites. All 3 Doppler indices decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age for each of the 3 indices are provided, as well as equations to allow calculation of any value as a centile and z scores. The mean pulsatility index according to gestational age = 1.02944 + 77.7456*(gestational age)–2 – 0.000004455*gestational age3.ConclusionWe present here international gestational age-specific normative centiles for umbilical artery Doppler indices produced by studying healthy, low-risk pregnant women living in environments with minimal constraints on fetal growth. The centiles complement the existing INTERGROWTH-21st Standards for assessment of fetal well-being.

Why do women deliver where they had not planned to go? A qualitative study from peri-urban Nairobi Kenya

BackgroundIn urban Kenya, couples face a wide variety of choices for delivery options; however, many women end up delivering in different facilities from those they had intended while pregnant. One potential consequence of this is delivering in facilities that do not meet minimum quality standards and lack the capacity to provide treatment for obstetric and neonatal complications.MethodsThis study investigated why women in peri-urban Nairobi, Kenya deliver in facilities they had not intended to use. We used 60 in-depth audio-recorded interviews in which mothers shared their experiences 2–6 months after delivery. Descriptive statistics were used to summarize socio-demographic characteristics of participants. Qualitative data were analyzed in three steps i) exploration and generation of initial codes; ii) searching for themes by gathering coded data that addressed specific themes; and iii) defining and naming identified themes. Verbatim excerpts from participants were provided to illustrate study findings. The Health Belief Model was used to shed light on individual-level drivers of delivery location choice.ResultsFindings show a confluence of factors that predispose mothers to delivering in unintended facilities. At the individual level, precipitate labor, financial limitations, onset of pain, complications, changes in birth plans, undisclosed birth plans, travel during pregnancy, fear of health facility providers, misconception of onset of labor, wrong estimate of delivery date, and onset of labor at night, contributed to delivery at unplanned locations. On the supply side, the sudden referral to other facilities, poor services, wrong projection of delivery date, and long distance to chosen delivery facility, were factors in changes in delivery location. Lack of transport discouraged delivery at a chosen health facility. Social influences included others’ perspectives on delivery location and lack of aides/escorts.ConclusionsResults from this study suggest that manifold factors contribute to the occurrence of women delivering in facilities that they had not intended during pregnancy. Future studies should consider whether these changes in delivery location late in pregnancy contribute to late facility arrival and the use of lower quality facilities. Deliberate counseling during antenatal care regarding birth plans is likely to encourage timely arrival at facilities consistent with women’s preferences.

Impact of Double-Intake Programmes on the Teacher Co-Efficient Determinant of Quality Education at the University of Nairobi, Kenya

This research was carried out in order to determine the impact of double-intake programmes on the quality of education in the University of Nairobi in Kenya using the teacher coefficient measure. It had one objective and one research question. Using descriptive survey research design the target population consisted of 61,000 regular students enrolled in 43schools/faculties, 5,900 students in their fourth year of study and 2,000 teaching staff. Calmorin and Calmorin (2007) formula for scientifically determining sample size yielded a total of 489 respondents. Simple random sampling was used to select 251 fourth year students while stratified random sampling was used to select 238 teaching staff as actual respondents. Data were collected using questionnaires, document analysis, observation and interview. Quantitative and qualitative data analysis methods were used with the aid of statistical package for social sciences (SPSS) version 26.The findings show that the number of students admitted overwhelmed both the academic and non-academic staff members who served them because the university accepted to engage in double intake programmes without considering an increase in the number of the staff members and this skewed student to faculty ratio led to degenerated service provision. Consequently, the research recommends that the university plans adequately for the number of staff required versus the anticipated students to be enrolled in future since a compromise in the student to faculty ratio will definitely have a negative impact on the quality of education.

Influence of Building Information Modelling (BIM) on Engineering Contract Management in Nairobi, Kenya

Building Information Modelling (BIM) is a technology and a process that has brought changes in the construction’s traditional procurement system. Kenya lacks contractual guidelines on implementation of BIM; this makes the adoption of BIM slow and difficult. Previous research has identified a gap in contractual relationships, roles and resulting risks. The objectives of this study were to investigate BIM adoption in Nairobi and to investigate the influence of BIM on Engineering Contract Management (ECM) in Nairobi Kenya. The survey research was a descriptive study with 175 responsive questionnaires. Respondents comprised of Civil Engineers, Construction Project Managers, Architects, Quantity Surveyors, Contractors and Facility Managers. Data was collected through self-administered questionnaire and in-depth interview. Descriptive analytics, correlation and Exploratory factor analysis methods were used to analyse quantitative data. Qualitative data was analysed thematically. It emerged that adoption level was at 56.6% and shallow understanding of BIM capabilities remains to be a barrier to its adoption and implementation. It also emerged that BIM improves ECM; when time, cost, quality, collaboration and return on investment improve, ECM becomes easier. Latent factors found in BIM and ECM relationship were Legal Implications, awareness and knowledge, efficiency, versatility, mandate and leadership, and competitiveness. Further, the study found out that BIM influence on ECM demands for establishment of standards, guidelines, policy, legal framework, and regulations, which can be achieved by amending the public procurement act which dictates the operation of all the other standard forms of contract. Further research should be conducted to measure whether the understanding of BIM had positively improved.

Prevalence of Anthracycline Induced Cardiomyopathy amongst Cancer Patients Treated at Tertiary Teaching and Refferal Hospital in Nairobi Kenya

Background: Cardiovascular complication is a major consequence of cancer treatment. Anthracycline induced cardiomyopathy is a known cause of long term morbidity and mortality among cancer survivors. The burden of this complication is unknown in our setting&#x0D; Objective: This study aimed to determine the prevalence of cardiomyopathy in ambulatory patients treated with anthracycline (Ac) containing chemotherapy at Kenyatta National Hospital (KNH) as measured by two dimensional (2D) echocardiography (ECHO).&#x0D; Study design: A hospital based inpatient/outpatient cross sectional, descriptive study.&#x0D; Study setting: This study was carried out in various outpatient clinics and oncology wards in Kenyatta National Hospital. These included the adult hematooncology clinic 23, Ground floor C (GF-C), Ward 8C and Ground floor D (GF-D)&#x0D; Subjects: The study population included patients who have been exposed to Ac. The minimum Ac dose was 200mg/m2. A total of 129 patients with various types of cancers were sampled consecutively over a period of 3 months. Eligible patients underwent a 2D ECHO and left ventricular ejection fraction (LVEF) was assessed.&#x0D; Results: Patients between the ages of 15 and 75 participated in the study, the mean age was 45.6 years, with the female to male ratio of 4.3:1. Majority of the patients had breast cancer (67.4%) and the treatment regimen in over 65% of them was doxorubicin and cyclophospomide (AC). The mean cumulative dose was 236mg/m2. All patients recruited had received a cumulative dose of between 200 - 450mg/m2. Most of the patients (63%) had completed Ac within one year of their cardiac evaluation. Only 14.0 % of the patients had a pretreatment ECHO. The overall prevalence of LV systolic dysfunction detected by echocardiography was 3.1% (95% CI 0.9– 7.8). The study was not powered to make associations with age, sex and cumulative dose and presence of cardiomyopathy.&#x0D; Conclusions: The study demonstrates a prevalence of 3.1% cardiomyopathy among cancer patients treated with anthracyclines. This figure is comparable to similar studies done. The prevalence described in most studies ranges from between 1% to 20.5%.Anthar

Sub-Standard Pharmaceutical Services in Private Healthcare Facilities Serving Low-Income Settlements in Nairobi County, Kenya.

Background: Quality pharmaceutical services are an integral part of primary healthcare and a key determinant of patient outcomes. The study focuses on pharmaceutical service delivery among private healthcare facilities serving informal settlements within Nairobi County, Kenya and aims at understanding the drug procurement practices, task-shifting and ethical issues associated with drug brand preference, competition and disposal of expired drugs. Methods: Forty-five private facilities comprising of hospitals, nursing homes, health centres, medical centres, clinics and pharmacies were recruited through purposive sampling. Structured electronic questionnaires were administered to 45 respondents working within the study facilities over an 8-week period. Results: About 50% of personnel carrying out drug procurement belonged to non-pharmaceutical cadres namely; doctors, clinical officers, nurses and pharmacy assistants. Drug brand preferences among healthcare facilities and patients were mainly pegged on perceived quality and price. Unethical business competition practices were recorded, including poor professional demeanour and waiver of consultation fees veiled to undercut colleagues. Government subsidized drugs were sold at 100% profit in fifty percent of the facilities stocking them. In 44% of the facilities, the disposal of expired drugs was not in conformity to existing government regulatory guidelines. Conclusions: There is extensive task-shifting and delegation of pharmaceutical services to non-pharmaceutical cadres and poor observance of ethical guidelines in private facilities. Strict enforcement of regulations is required for optimal practices.

INFLUENCE OF TEACHER TRAINING ON USE OF MUSIC AS A MEDIUM OF TEACHING MATHEMATICS IN PRE PRIMARY SCHOOLS IN NAIROBI CITY COUNTY, KENYA

Music is a significant teaching strategy in early childhood education it improves development of young children’s self-confidence, self-esteem and their expression orally and mentally. Despite the fact that, use of music is a strategy that motivates and sustains children’s interest in the learning of mathematics, research studies in this area are scanty. The purpose of this study therefore was to find out influence of preschool teacher training on the use of music as a mode of teaching mathematics within Kasarani, Nairobi County. The study sought to determine the link between preschool teacher training and use of music in teaching mathematics. The descriptive survey research design was used to structure and guide the study. The study’s dependent variable was use of music as a medium of teaching mathematics while the independent variable was preschool teacher training in use of music in teaching mathematics. Random sampling was used to select 15 preschools out of the 30 targeted and purposive sampling used to select 15 head teachers out of 30 and 45 out of 90 preschool teachers. An observation guide and questionnaires were used to collect data for preschool teachers and head teachers. The study findings established a significant association between teacher training and use of music during mathematic instructions. The study concluded that preschool teachers in Kasarani Sub-County were using music to teach mathematics and that trained teachers used music to teach mathematics than their untrained counterparts. The study recommended the Kenya institute of curriculum development should come up with modules on step by step guidelines on how to teachers should integrate music during maths lessons. Article visualizations:

Characterizing the Spatial Determinants and Prevention of Malaria in Kenya.

The United Nations’ Sustainable Development Goal 3 is to ensure health and well-being for all at all ages with a specific target to end malaria by 2030. Aligned with this goal, the primary objective of this study is to determine the effectiveness of utilizing local spatial variations to uncover the statistical relationships between malaria incidence rate and environmental and behavioral factors across the counties of Kenya. Two data sources are used—Kenya Demographic and Health Surveys of 2000, 2005, 2010, and 2015, and the national Malaria Indicator Survey of 2015. The spatial analysis shows clustering of counties with high malaria incidence rate, or hot spots, in the Lake Victoria region and the east coastal area around Mombasa; there are significant clusters of counties with low incidence rate, or cold spot areas in Nairobi. We apply an analysis technique, geographically weighted regression, that helps to better model how environmental and social determinants are related to malaria incidence rate while accounting for the confounding effects of spatial non-stationarity. Some general patterns persist over the four years of observation. We establish that variables including rainfall, proximity to water, vegetation, and population density, show differential impacts on the incidence of malaria in Kenya. The El-Nino–southern oscillation (ENSO) event in 2015 was significant in driving up malaria in the southern region of Lake Victoria compared with prior time-periods. The applied spatial multivariate clustering analysis indicates the significance of social and behavioral survey responses. This study can help build a better spatially explicit predictive model for malaria in Kenya capturing the role and spatial distribution of environmental, social, behavioral, and other characteristics of the households.

Access to public transportation and health facilities offering long-acting reversible contraceptives among residents of formal and informal settlements in two cities in Kenya

BackgroundDespite improved health facility access relative to rural areas, distance and transportation remain barriers in some urban areas. Using household and facility data linked to residential and transportation geographic information we describe availability of health facilities offering long-acting reversible contraceptive (LARC) methods and measure access via matatus (privately owned mid-size vehicles providing public transport) in urban Kenya.MethodsStudy data were collected by the Measurement, Learning and Evaluation (MLE) Project. Location information for clusters (2010) representative of city-level population were used to identify formal and informal settlement residents. We measured straight-line distances between clusters and facilities that participated in facility audits (2014) and offered LARCs. In Kisumu, we created a geographic database of matatu routes using Google Earth. In Nairobi, matatu route data were publicly available via the Digital Matatus Project. We measured straight-line distance between clusters and matatu stops on ‘direct’ routes (matatu routes with stop(s) ≤1 km from health facility offering LARCs). Facility and matatu access were compared by settlement status using descriptive statistics. We then used client exit interview data from a subset of facilities in Nairobi (N = 56) and Kisumu (N = 37) Kenya (2014) to examine the frequency of matatu use for facility visits.ResultsThere were 141 (Informal = 71; Formal = 70) study clusters in Nairoibi and 73 (Informal = 37; Formal = 36) in Kisumu. On average, residential clusters in both cities were located ≤1 km from a facility offering LARCs and ≤ 1 km from approximately three or more matatu stops on direct routes regardless of settlement status. Client exit interview data in Nairobi (N = 1602) and Kisumu (N = 1158) suggest that about 25% of women use matatus to visit health facilities. On average, women who utilized matatus travelled 30 min to the facility, with 5% travelling more than 1 hour. Matatu use increased with greater household wealth.ConclusionsOverall, formal and informal settlement clusters were within walking distance of a facility offering LARCs, and multiple matatu stops were accessible to get to further away facilities. This level of access will be beneficial as efforts to increase LARC use expand, but the role of wealth and transportation costs on access should be considered, especially among urban poor.

Hustling themtaaway: the Brain Work of the Garbage Business in Nairobi’s Slums

Abstract:The inhabitants of slums have developed creative ways of addressing the inherent instability of their lives. Chułek analyzes two approaches to self-organizing work on the basis of data gathered in two slum areas of Nairobi, Kibera and Korogocho, arguing that the key element of slum inhabitants’ actions is the reproduction of structures which enable their survival by making their lives predictable. These structures are evident in the work of trash pickers andorodhapeople, who have developed a finely-tuned infrastructure that governs their actions while allowing room for as many as possible to participate. They can also be seen in the work of hustlers, whose “brain work” is dependent on their network of relationships and on their constant improvisation. These are two examples of the way that inhabitants of Nairobi’s slums manage to maintain a sense of autonomy and agency in the face of constant economic challenge.

Taxonomic studies on seven species of the genus Opopaea (Araneae, Oonopidae) from Kenya

Seven species of the genus Opopaea Simon, 1892 from Kenya are recognized, including five new species: O. berlandi (Simon &amp;amp; Fage, 1922), O. kulczynskii (Berland, 1914), O. makadara Tong &amp;amp; Li, sp. nov. (♀♂), O. ngangao Tong &amp;amp; Li, sp. nov. (♀♂), O. ngulia Tong &amp;amp; Li, sp. nov. (♂), O. sheldrick Tong &amp;amp; Li, sp. nov. (♀♂), and O. wundanyi Tong &amp;amp; Li, sp. nov. (♀♂). Morphological descriptions and illustrations of all the species are given. All types are preserved in the National Museums of Kenya in Nairobi, Kenya (NMK).

Hybrid infrastructures, hybrid governance: New evidence from Nairobi (Kenya) on green-blue-grey infrastructure in informal settlements

In expanding informal neighborhoods of cities in sub-Saharan Africa, sustainable management of storm and wastewater drainage is fundamental to improving living conditions. Planners debate the optimal combination between "green" or natural infrastructure, traditional "grey" infrastructure, and "blue" infrastructure, which mimics natural solutions using artificial materials. Many advocate for small-scale, niche experiments with these approaches in informal settings, in order to learn how to navigate the intrinsic constraints of space, contested land tenure, participation, and local maintenance. This paper reports the benefits and limitations of implementing and managing local green, blue and grey infrastructure solutions in an urban informal setting. We studied ten completed public space projects that featured urban drainage infrastructure in the informal neighborhood of Kibera, Nairobi. The analysis drew from ten surveys with project designers and seven semi-structured interviews with site managers. The studied spaces featured different combinations of green, grey, and blue drainage infrastructure that have evolved over years of operation, maintenance, and change in the settlement. All projects featured participation in design, mixed design methods, hybrid infrastructure, and community governance models with potential to interact successfully with municipal actors. Results show that involvement in the co-development of small-scale green infrastructure changed people's valuation, perception, and stewardship of nature-based systems and ecosystem services. These results have implications for the larger scale adoption, integration, and management of urban drainage infrastructure. They also suggest that hybrid systems of infrastructure and governance constitute a resilient approach to incremental and inclusive upgrading.