Pastoralist Community In Kenya Research Articles

Epidemiology of soil-transmitted helminthiasis among school-aged children in pastoralist communities of Kenya: A cross-sectional study.

Soil-transmitted helminthiasis (STH) are a major public health problem in Sub-Saharan Africa. In Kenya, the National School Based Deworming Program (NSBDP) was launched in 2012 with a goal of reducing STH prevalence in school-aged children (SAC) to <1%, however monitoring and evaluation results have consistently showed > 20% prevalence in Narok County. We conducted a study to investigate factors associated with STH infections among SAC in Narok County. A cross-sectional study was conducted among 514 SAC from five schools in Trans Mara West sub-county, Narok County. The sub-county was selected because it had participating schools within the NSBDP with a high prevalence of STH infection. Participants were selected using systematic random sampling. Stool samples collected from participants were examined for STH eggs using Kato-Katz technique. An open data kit questionnaire was used to collect socio-demographics, household, and STH knowledge information from 139 of the 514 SAC. Descriptive statistics was used to summarize the data, prevalence and mean intensity of infections were calculated, and logistic regression used to determine factors associated with STH infections. The overall prevalence of any STH infection was 24.6% (95%CI: 21.1-28.6). Trichuris trichiura 14.4% (95%CI: 11.7-17.8), Ascaris lumbricoides 12.5% (95%CI: 9.9-15.7) and hookworm 0%. From multivariable analysis the only factors significantly associated with increased risk of STH infection were, children attending Karda and Nkarano schools with aOR = 5.29 (95%CI: 1.45-19.24); p = 0.011 and aOR = 4.53 (95%CI: 1.29-15.97); p = 0.019 respectively. For A. lumbricoides, children attending Nkarano School were associated with a significant risk of infection with aOR = 7.81 (95%CI: 1.81-33.63); p = 0.006. Despite the ongoing work of NSBDP, the STH prevalence is still ≥ 20% in Trans Mara West sub-county Narok County, among SAC. This underscores the need for continued annual MDA. Additionally, if possible, drug combinations may effectively manage T. trichiura, the region's most common helminth. The study found a correlation between children attending specific schools and STH infection risk, suggesting the importance of health education and improved water, sanitation, and hygiene practices holistically both in schools and associated catchment areas that can act as STH reservoirs to alleviate the burden of STH.

Treatment outcomes and challenges of treating tuberculosis in children in a nomadic pastoralist community in Kenya

Background: Tuberculosis in children has remained a major cause of childhood morbidity and mortality, especially in the developingcountries where it has been associated with marginalization, vulnerability and poverty.Study objectives: To evaluate treatment outcomes and determine the challenges experienced by health providers while treating tuberculosis in children in a nomadic pastoralist community in Kenya.Methods: This was a descriptive cross sectional study design utilizing mixed methods, conducted at Lodwar County Referral Hospital in Turkana County- Kenya. We utilized census sampling method to get 59 medical records and 8 nurses. Data were collected using data abstraction form and in-depth interviews. Treatment outcomes were determined quantitatively while challenges were described qualitatively using thematic approach.Results: A total of 59 paediatric patients had been diagnosed with tuberculosis between the months of January 2021 and April 2021. Most of them were new cases. Children who were under five years constituted the highest proportion (61%). Most of the patients had completed their treatment (69.5%), loss to follow up 6.8%, transferred out 11.9%, died 8.5% while those who were not evaluated were 3.4%. Lifestyle and habit, lack of system support and lack of properly formulated dosage for children were the challenges experienced by the health care providers.Conclusion: Although, most of the patients (69.5%) had completed their treatment, treatment complete rate remained below the standard set by the World Health Organisation (90%). Health system posed most of the challenges experienced by the health care providers at the hospital.

Spatial and network mapping of comorbidity with trachoma and visual-impairing NCDs in a pastoralist community in Kenya: implications for SDGs and UHC.

We explore the spatial distribution of comorbidity with trachoma and potentially visual-impairing non-communicable diseases (NCDs) and their risk factors among Kenyan pastoralists. Using a cross-sectional study design, we recruited and clinically examined 262 study participants for NCDs (hypertension or diabetes) and trachoma using the World Health Organization grading system. Network models estimated interactions and risks linked with trachoma and NCDs while the Poisson point process determined their spatial distribution. Of the 262 participants, 140 (53%) had trachoma, with >71% of these cases identified among females and those >60y of age. A total of 36 trachoma cases co-occurred with hypertension (26%) and diabetes (0.01%). NCDs were frequent among those with recurring trachoma (21%) and trachomatous trichiasis (14.3%). Trachoma and NCDs clustered together in <1km distances (R=0.18, p=0.02). In network analysis, age was strongly associated with trachoma and NCDs. Trachoma was linked with geographic location while diabetes was linked with water source distances. Education level became the central risk factor. We demonstrate a twin trachoma-NCD burden that is higher among elderly pastoralists in southern Kenya. Attenuating adverse population-level visual impairment, including integrating the trachoma SAFE strategy with NCD comprehensive care, amplifies the benefits from economies of scale, accelerating realization of Sustainable Development Goal 3 and universal health coverage in hard-to-reach areas.

Understanding antenatal care use in pastoralist communities: a focused ethnographic study in Kenya

Background/Aims The provision of high-quality antenatal care improves maternal and child health outcomes. Pastoralist communities face unique challenges in accessing healthcare associated with a nomadic, marginalised lifestyle, and have high rates of maternal morbidity and mortality. There is minimal evidence on antenatal care use globally among this group. To develop optimal services for pastoralist communities, there is an urgent need to understand pastoralist women's use of antenatal care services. This study's aim was to explore experiences of antenatal care among pastoralist communities in Kenya, to identify key barriers and facilitators of uptake. Methods This focused ethnographic qualitative study was underpinned by a philosophy of critical realism. A total of 58 participants (women, husbands, traditional birth attendants and nurses) were included. Data were collected using interviews, focus group discussions and observation. Data were collected for 6 months in six villages and five health facilities in a pastoralist region of northern Kenya. Inductive thematic analysis and retroduction were used to identify concepts, structures and mechanisms that influenced antenatal care use. Results Pastoralist women's antenatal care experiences and use were linked to two main themes. The first was government policies that incentivised antenatal care use by linking the provision of the baby's health and citizenship records to antenatal care uptake and encouraging traditional birth attendants to adopt defined referral roles. The second highlighted multiple structural barriers that impeded consistent antenatal care uptake, including the pastoralist lifestyle, cultural barriers, health system constraints and a gap in information sharing. The dissonance between these led to partial, sub-optimal use patterns of antenatal care. Conclusions Government policy created an impetus for the pastoralist community to use contemporary healthcare services. At the same time, multiple barriers impeded access to services. This explains the partial use of antenatal care services among pastoralist communities. The findings throw doubt on the feasibility of antenatal care guidelines that recommend eight contacts during pregnancy. There is a need to work collaboratively with communities to develop context-specific models of care.

Healthcare-seeking behavior for respiratory illnesses in Kenya: implications for burden of disease estimation

BackgroundUnderstanding healthcare-seeking patterns for respiratory illness can help improve estimation of disease burden and target public health interventions to control acute respiratory disease in Kenya.MethodsWe conducted a cross-sectional survey to determine healthcare utilization patterns for acute respiratory illness (ARI) and severe pneumonia in four diverse counties representing urban, peri-urban, rural mixed farmers, and rural pastoralist communities in Kenya using a two-stage (sub-locations then households) cluster sampling procedure. Healthcare seeking behavior for ARI episodes in the last 14 days, and severe pneumonia in the last 12 months was evaluated. Severe pneumonia was defined as reported cough and difficulty breathing for > 2 days and report of hospitalization or recommendation for hospitalization, or a danger sign (unable to breastfeed/drink, vomiting everything, convulsions, unconscious) for children < 5 years, or report of inability to perform routine chores.ResultsFrom August through September 2018, we interviewed 28,072 individuals from 5,407 households. Of those surveyed, 9.2% (95% Confidence Interval [CI] 7.9–10.7) reported an episode of ARI, and 4.2% (95% CI 3.8–4.6) reported an episode of severe pneumonia. Of the reported ARI cases, 40.0% (95% CI 36.8–43.3) sought care at a health facility. Of the74.2% (95% CI 70.2–77.9) who reported severe pneumonia and visited a medical health facility, 28.9% (95% CI 25.6–32.6) were hospitalized and 7.0% (95% CI 5.4–9.1) were referred by a clinician to the hospital but not hospitalized. 21% (95% CI 18.2–23.6) of self-reported severe pneumonias were hospitalized. Children aged < 5 years and persons in households with a higher socio-economic status were more likely to seek care for respiratory illness at a health facility.ConclusionOur findings suggest that hospital-based surveillance captures less than one quarter of severe pneumonia in the community. Multipliers from community household surveys can account for underutilization of healthcare resources and under-ascertainment of severe pneumonia at hospitals.

Reformulating Index Insurance to Protect Women's Assets and Well-Being: Evidence from Pastoralist Communities in Kenya

Reformulating Index Insurance to Protect Women's Assets and Well-Being: Evidence from Pastoralist Communities in Kenya

Sero - epidemiology of brucellosis in people and their livestock: A linked human - animal cross-sectional study in a pastoralist community in Kenya.

Brucellosis is associated with massive livestock production losses and human morbidity worldwide. Efforts to control brucellosis among pastoralist communities are limited by scarce data on the prevalence and risk factors for exposure despite the high human-animal interactions in these communities. This study simultaneously assessed the seroprevalence of brucellosis and associated factors of exposure among pastoralists and their livestock in same households. We conducted a cross-sectional study in pastoralist communities in Marsabit County - Kenya. A total of 1,074 women and 225 children participated and provided blood samples. Blood was also drawn from 1,876 goats, 322 sheep and 189 camels. Blood samples were collected to be screened for the presence of anti-Brucella IgG antibodies using indirect IgG Enzyme-Linked Immunosorbent Assay (ELISA) kits. Further, Individual, household and herd-level epidemiological information were captured using a structured questionnaire. Group differences were compared using the Pearson's Chi-square test, and p-values < 0.05 considered statistically significant. Generalized mixed-effects multivariable logistic human and animal models using administrative ward as the random effect was used to determine variables correlated to the outcome. Household-level seropositivity was 12.7% (95% CI: 10.7-14.8). The individual human seroprevalence was 10.8% (9.1-12.6) with higher seroprevalence among women than children (12.4 vs. 3.1%, p < 0.001). Herd-level seroprevalence was 26.1% (23.7-28.7) and 19.2% (17.6-20.8) among individual animals. Goats had the highest seroprevalence 23.1% (21.2 - 25.1), followed by sheep 6.8% (4.3-10.2) and camels 1.1% (0.1-3.8). Goats and sheep had a higher risk of exposure OR = 3.8 (95% CI 2.4-6.7, p < 0.001) and 2.8 (1.2-5.6, p < 0.007), respectively relative to camels. Human and animal seroprevalence were significantly associated (OR = 1.8, [95%CI: 1.23-2.58], p = 0.002). Herd seroprevalence varied by household head education (OR = 2.45, [1.67-3.61, p < 0.001]) and herd size (1.01, [1.00-1.01], p < 0.001). The current study showed evidence that brucellosis is endemic in this pastoralist setting and there is a significant association between animal and human brucellosis seropositivity at household level representing a potential occupational risk. Public health sensitization and sustained human and animal brucellosis screening are required.

Mineral Nutrition of Samburu Adolescents: A Comparative Study of Pastoralist Communities in Kenya.

This study aimed to characterize mineral nutrition (copper, magnesium, selenium, and zinc) in Samburu pastoralist youth, in the context of differential cultural transitions due to uneven changes in educational access, herding intensity, polygyny, and access to wild, domesticated, and market-sourced foods. Whole dried blood spots were collected in a total of 161 youth (highlands, n = 97; lowlands, n = 64) to assess concentrations of: cadmium, copper, lead, magnesium, mercury, selenium, and zinc. Concentrations were determined through Inductively Coupled Mass Spectrometry. Dietary intakes were assessed by 24-hour recall method and calculation of probability of inadequate intakes. WHO protocols were applied to collect anthropometric measures in the youth. Nearly half of the adolescents (47.8%) fell below the reference range for zinc status, and 88.2% had low zinc-to-copper ratios. High probability of nutrient inadequacies were evident for protein, fat, vitamins A, B12, C, and E. In generalized linear modeling, lowland residence was negatively associated with zinc status and the zinc-to-copper ratio, and positively correlated with selenium and copper status. Other significant correlates were: dairy livestock ownership; wife number of the youth's mother; meat consumption; vegetable consumption; protein intake; infectious disease morbidities; BMI; and hemoglobin concentrations. In recent decades, Samburu pastoralists of northern Kenya have experienced marked dietary changes in the context of market integration, extreme drought, diminishing pasture availability, and violent civil conflict. Some children (particularly boys) successfully supplement their diets by foraging for wild foods, while others (particularly actively herding girls) may be more vulnerable.

'If she gets married when she is young, she will give birth to many kids': a qualitative study of child marriage practices amongst nomadic pastoralist communities in Kenya.

Child marriage is associated with adverse health and social outcomes for women and girls. Among pastoralists in Kenya, child marriage is believed to be higher compared to the national average. This paper explores how social norms and contextual factors sustain child marriage in communities living in conflict-affected North Eastern Kenya. In-depth interviews were carried out with nomadic and semi-nomadic women and men of reproductive age in Wajir and Mandera counties. Participants were purposively sampled across a range of age groups and community types. Interviews were analysed thematically and guided by a social norms approach. We found changes in the way young couples meet and evidence for negative perceptions of child marriage due to its impact on the girls' reproductive health and gender inequality. Despite this, child marriage was common amongst nomadic and semi-nomadic women. Two overarching themes explained child marriage practices: 1) gender norms, and 2) desire for large family size. Our findings complement the global literature, while contributing perspectives of pastoralist groups. Contextual factors of poverty, traditional pastoral lifestyles and limited formal education opportunities for girls, supported large family norms and gender norms that encouraged and sustained child marriage.

High incidence of human brucellosis in a rural Pastoralist community in Kenya, 2015.

BackgroundBrucellosis occurs globally with highly variable incidence in humans from very low in North America and Western Europe to high in the Middle East and Asia. There are few data in Sub-Saharan Africa. This study estimated the incidence of human brucellosis in a pastoralist community in Kenya.MethodsBetween February 2015 and January 2016, we enrolled persons living in randomly selected households in Kajiado County. Free health care was offered at three facilities in the study area. Those who met the study clinical case definition completed a standardized questionnaire on demographics, clinical history and presentation. A blood sample was collected and tested by Rose Bengal test (RBT), then later tested at the Kenya Medical Research Institute laboratory for Brucella IgG and IgM by ELISA. Those who tested positive by both RBT and ELISA (IgG or IgM antibodies) were classified as confirmed while those that only tested positive for IgG or IgM antibodies were classified as probable. Further, sera were tested by polymerase chain reaction using a TaqMan Array Card (TAC) for a panel of pathogens causing AFI including Brucella spp. Annual incidence of brucellosis was calculated as the number of confirmed cases in one year/total number in the study population.ResultsWe enrolled a cohort of 4746 persons in 804 households. Over half (52.3%) were males and the median age was 18 years (Interquartile range (IQR) 9 months– 32 years). A total of 236 patients were enrolled at three health facilities; 64% were females and the median age was 40.5 years (IQR 28–53 years). Thirty-nine (16.5%) were positive for Brucella antibodies by IgG ELISA, 5/236 (2.1%) by IgM ELISA and 4/236 (1.7%) by RBT. Ten percent (22/217) were positive by TAC. We confirmed four (1.7%) brucellosis cases giving an annual incidence of 84/100,000 persons/year (95% CI 82, 87). The incidence did not significantly vary by gender, age and location of residence.ConclusionWe report a high incidence of brucellosis in humans among members of this pastoralist community. Brucellosis was the most common cause of febrile illness in this community.

Animal movement in a pastoralist population in the Maasai Mara Ecosystem in Kenya and implications for pathogen spread and control

Livestock movements are important drivers for infectious disease transmission. However, paucity of such data in pastoralist communities in rangeland ecosystems limits our understanding of their dynamics and hampers disease surveillance and control. The aim of this study was to investigate animal movement networks in a pastoralist community in Kenya, and assess network-based strategies for disease control. We used network analysis to characterize five types of between-village animal movement networks. We then evaluated implications of these networks for disease spread and control by quantifying topological changes in the network associated with targeted and random removal of nodes. To construct these networks, data were collected using standardized questionnaires (N = 165 households) from communities living within the Maasai Mara Ecosystem in southwestern Kenya. Our analyses show that the Maasai Mara National Reserve (MMNR), a protected wildlife area, was critical for maintaining village connectivity in the agistment network (dry season grazing), with MMNR-adjacent villages being highly utilized during the dry season. In terms of disease dynamics, the network-based basic reproduction number, R0, was sufficient to allow disease invasion in all the five networks, and removal of villages based on degree or betweenness was not efficient in reducing R0. However, we show that villages with high degree or betweenness may play an important role in maintaining network connectivity, which may not be captured by assessment of R0 alone. Such villages may function as potential “firebreaks.” For example, targeted removal of highly connected village nodes was more effective at fragmenting each network than random removal of nodes, indicating that network-based targeting of interventions such as vaccination could potentially disrupt transmission pathways in the ecosystem. In conclusion, this work shows that animal movements have the potential to shape patterns of disease transmission in this ecosystem, with targeted interventions being a practical and efficient measure for disease control.

Burden of stigma among tuberculosis patients in a pastoralist community in Kenya: A mixed methods study.

Tuberculosis (TB) stigma remains a barrier to early diagnosis and treatment completion. Increased understanding of stigma is necessary for improved interventions to minimise TB stigma and its effects. The purpose of this study is to quantitatively measure TB stigma and to explore qualitatively its manifestation among TB patients in a rural Kenyan community. This hospital based study using explanatory sequential mixed methods approach was conducted in 2016. In the quantitative part of the study, a questionnaire containing socio-demographic characteristics and scales measuring perceived TB stigma and experienced TB stigma, was administered to 208 adult pulmonary TB patients receiving treatment in West Pokot County. Respondents with high stigma were purposively selected to take part in in-depth interviews and focus group discussions. The qualitative data were collected through 15 in-depth interviews and 6 focus group discussions with TB patients. Descriptive and bivariate analysis was done for the quantitative data while the thematic analysis was done for qualitative data. The internal consistency reliability coefficients were satisfactory with Cronbach alphas of 0.87 and 0.86 for the 11-item and 12-item stigma measurement scale. The investigation revealed that TB stigma was high. The key drivers of TB stigma were the association of TB with HIV/AIDS and the fear of TB transmission. TB stigma was exemplified through patients being isolated by others, self-isolation, fear to disclose TB diagnosis, association of TB with human immunodeficiency virus (HIV) and lack of social support. Being a woman was significantly associated with high levels of both experienced stigma (p = 0.007) and perceived stigma (p = 0.005) while age, marital status, occupation and the patient's religion were not. There is a need to implement stigma reduction interventions in order to improve TB program outcomes.

In Opposing Community Wisdom: Exposing Lexicon Choices in Kimeru Folklore as Agents of Patriarchy and Gender Bias

Since time immemorial, communities across the world exhibit gender inequity whereby the feminine gender is viewed as lesser to their male counterparts. Studies indicate that no one is born a man or a woman, but rather the society makes us men or women through acculturation into roles that are conventionally stereotyped as male or female. However, the roles and duties for men and women vary from community to community; some duties are strictly viewed as being for one gender in one community are considered duties for the other gender in another community. For example, among the Ameru, a patriarchal society of Eastern Kenya, no woman can undertake the task of building a shelter, while among the pastoralist communities of Kenya, women build family shelters. This means there are no duties that are strictly for men or women in the world. This paper argues that one way that society makes men and women out of her people is through the language used in community folklore transmitted through formal or informal linguistic interactions. A case is made from a careful examination of the Ameru proverbs, wise sayings, and riddles. It will be shown that the language used in these genres continually exhorts and invites the male gender to manifest macho and positive qualities while at the same time depicts the female gender as feeble, vain, and weak. The paper proposes the repackaging of community folklore and wisdom through language that establishes positive qualities for members of both genders.

Temporary disengagement and re-engagement in human immunodeficiency virus care in a rural county serving pastoralist communities in Kenya: a retrospective cohort study.

BackgroundPastoralist communities are known to be hard to reach. The magnitude of temporary disengagement from human immunodeficiency virus (HIV) care is understudied.MethodsWe conducted a retrospective cohort study of temporary disengagement (2 weeks late for a next appointment), virologic response, lost to follow-up (6 months late) and re-engagement in care among patients who started antiretroviral therapy between 2014 and 2016 in Baringo County, Kenya. Predictors of re-engagement after disengagement were estimated using logistic regression.ResultsOf 342 patients, 76.9% disengaged at least once (range 0–7). Of 218 patients with a viral load (VL), 78.0% had a suppressed VL. Those with a history of temporary disengagement from care were less likely to suppress their VL (p=0.002). Six patients had treatment failure (two consecutive VLs >1000 copies/mm3) and all had disengaged at least once. After disengagement from care, male patients (adjusted odds ratio [aOR] 0.3 [95% confidence interval {CI} 0.2 to 0.6]; p<0.001) and patients with World Health Organization stage III–IV (aOR 0.3 [95% CI 0.1 to 0.5; p<0.001) were less likely to re-engage in care.ConclusionsTemporary disengagement was frequent in this pastoralist setting. This indicator is often overlooked, as most studies only report binary outcomes, such as retention in care. Innovative strategies are required to achieve HIV control in rural settings like this pastoralist setting.

Indigenous knowledge practices for sustainable lifelong education in pastoralist communities of Kenya

Despite setting high hopes on education, very few pastoral nomad children in Kenya transition from primary education to secondary education. This article argues that the national Kenyan compulsory formal curriculum fails to accommodate the needs of pastoralist communities. Literacy rates are particularly low among the Turkana people, pastoralist nomads who live in the Northwest of Kenya. Low literacy has resulted in an acute shortage of local teachers, a state of affairs which exacerbates the situation. Nomadic communities like the Turkana people rarely attract national discussions on education curriculum even as their children continue to perform poorly on national examinations. The author of this article demonstrates the importance of integrating Indigenous knowledge and mother-tongue instruction in the curriculum for pastoralist schools. Based on his own research in Turkana County, he identifies two main problems besides the shortage of teachers, namely the inappropriateness of the materials used for instruction, which do not reflect the pastoralist children’s local Indigenous culture and everyday environment; and the failure to use Turkana mother tongue in early childhood education, which would support children’s literacy development, and thus serve to improve literacy rates in the community as a whole. The author presents a family literacy project he was involved in which has made a promising start in addressing these two issues. Stories were collected from parents and elders and made into storybooks, thereby creating tailor-made, meaningful instruction materials. The author expresses his hope that this article will stimulate critical discussions in Kenya which will respect the participation of pastoralist nomadic communities in making decisions about education policy.

Menstrual hygiene management practices among primary school girls from a pastoralist community in Kenya: a cross sectional survey.

Introductionpubescent girls from developing countries are confronted with diverse menstrual hygiene management (MHM) challenges, especially at school. Girls from rural pastoralist communities experience insurmountable MHM barriers. Inadequate coping strategies adopted result in sub-optimal school performance, absenteeism and physical problems. We conducted a study to assess MHM practices among primary school girls from a pastoralist community in Kenya.Methodsa cross sectional survey was done among primary school girls in Kajiado County, Kenya. Accent was sought. We administered structured questionnaires which sought information on socio-demographics, knowledge, perceptions and practices.Resultswe enrolled 320 girls; with mean age of 14.9 years. Their parents were mostly (69.4%) self-employed pastoralists. Good menstruation knowledge was observed in 51.6%, while 45.5% reported diverse perceptions about menstruation. Majority, (80.9%) used sanitary towels as absorbents, but 40.3% delayed changing by > 6 hours. Poor MHM practices were documented in 28.8% and 32.2% kept the issue secret. Factors associated with poor MHM practices on univariable analysis were age (p=0.016), religion (p=0.037), non-discussions (p=0.001), lack of sanitary pads (p<0.0001), lack of latrine privacy (p=0.031), lack of water (p=0.001) and teasing by boys (p=0.016). On logistic regression, factors that independently influenced MHM practices were inadequate latrine privacy (p=0.031) and fear of teasing by boys (p=0.016).Conclusiona third of pubescent pastoralist girls had poor MHM practices largely determined by inadequate latrine privacy and fear of teasing by boys.

Knowledge and perceptions of tuberculosis among patients in a pastoralist community in Kenya: a qualitative study.

IntroductionTuberculosis awareness is crucial to the success of control and prevention of tuberculosis. However, the knowledge and perceptions of tuberculosis patients in rural Kenya is not well documented. The study sought to explore the knowledge and perceptions of TB patients in West Pokot County Kenya.MethodsThis was a qualitative descriptive study conducted between January-March 2016. A total of 61 pulmonary tuberculosis patients took part in the study which comprised 6 focus group discussion and 15 in-depth interviews. Thematic analysis was used to analyse the data.ResultsParticipants perceived TB as a serious contagious disease that is hard to diagnose and treat. They attributed tuberculosis to smoking, drinking alcohol, dust, cold air, witchcraft, trauma to the chest, contact with livestock and genetic factors. They believed that TB was transmitted through casual contact with TB patients and sharing of utensils.ConclusionThe study showed a lot of misperceptions among tuberculosis patients. The tuberculosis program should heighten patient education to improve patient knowledge and put more effort to dispel misinformation about the cause and mode of transmission of the disease.

Constraints and capacities for novel livelihood adaptation: lessons from agricultural adoption in an African dryland pastoralist system

Climate change, land use change, and sociopolitical and institutional transitions in African drylands have resulted in the loss, fragmentation, and degradation of environmental resources that pastoralists rely upon to sustain their livestock-based livelihoods. Diversification into irrigated agriculture is a potential strategy to increase food security. However, successful livelihood adaptation depends on access to key forms of natural, human, social, financial, and physical capitals, which may be lacking or unequally distributed in pastoralist communities. In two dryland pastoralist communities in Kenya, an international relief organization introduced irrigated farming in 2010. Nearly 200 individuals began farming, but within 4 years, all had quit. This study investigated the role of household access to different forms of capital in decisions to adopt agriculture, and how adaptive capacities, environmental conditions, and farming as a new livelihood practice interacted to shape household vulnerability. We found that decisions to farm were largely decoupled from access to assets that would afford greater adaptive capacity. The analysis also identified critical constraints that households encountered once they adopted farming. This study highlights the importance of more nuanced understandings of local capacities in the dynamics of adapting to environmental change. We recommend that prior to introducing interventions that promote new livelihood activities, development organizations should assess local capacities and pursue targeted strategies to increase household-level access to the forms of assets that will facilitate successful adaptation.

Community and provider perceptions of traditional and skilled birth attendants providing maternal health care for pastoralist communities in Kenya: a qualitative study.

BackgroundKenya has a high burden of maternal and newborn mortality. Consequently, the Government of Kenya introduced health system reforms to promote the availability of skilled birth attendants (SBAs) and proscribed deliveries by traditional birth attendants (TBAs). Despite these changes, only 10 % of women from pastoralist communities are delivered by an SBA in a health facility, and the majority are delivered by TBAs at home. The aim of this study is to better understand the practices and perceptions of TBAs and SBAs serving the remotely located, semi-nomadic, pastoralist communities of Laikipia and Samburu counties in Kenya, to inform the development of an SBA/TBA collaborative care model.MethodsThis descriptive qualitative study was undertaken in 2013–14. We conducted four focus group discussions (FGDs) with TBAs, three with community health workers, ten with community women, and three with community men. In-depth interviews were conducted with seven SBAs and eight key informants. Topic areas covered were: practices and perceptions of SBAs and TBAs; rewards and challenges; managing obstetric complications; and options for SBA/TBA collaboration. All data were translated, transcribed and thematically analysed.ResultsTBAs are valued and accessible members of their communities who adhere to traditional practices and provide practical and emotional support to women during pregnancy, delivery and post-partum. Some TBA practices are potentially harmful to women e.g., restricting food intake during pregnancy, and participants recognised that TBAs are unable to manage obstetric complications. SBAs are acknowledged as having valuable technical skills and resources that contribute to safe and clean deliveries, especially in the event of complications, but there is also a perception that SBAs mistreat women. Both TBAs and SBAs identified a range of challenges related to their work, and instances of mutual respect and informal collaborations between SBAs and TBAs were described.ConclusionsThese findings clearly indicate that an SBA/TBA collaborative model of care consistent with Kenyan Government policy is a viable proposition. The transition from traditional birth to skilled birth attendance among the pastoralist communities of Laikipia and Samburu is going to be a gradual one, and an interim collaborative model is likely to increase the proportion of SBA assisted deliveries, improve obstetric outcomes, and facilitate the transition.

African early childhood development curriculum and pedagogy for Turkana nomadic pastoralist communities of Kenya.

Western conceptions of child development and the models of early education they engender predominantly shape services for young children in the first eight years of life all over Africa. This chapter brings a reconceptualist perspective to the critique of Kenya's continuing failure to ground early childhood programs and services in local cultural conceptions, developmental values, childrearing practices, and the practical day-to-day realities of children's learning through participation and apprenticeship in the contexts of family routines, community experiences, and economic survival activities. The chapter draws on work I have conducted in nomadic pastoralist communities in Kenya. That research reveals the disconcerting reality that (a) early childhood education programs privilege Western pedagogical practices over equally effective and locally more relevant ones, and (b) local communities are increasingly resentful of an educational system that alienates their children from their cultural roots in the name of modernization. Asserting the educational value of indigenous knowledge, I present a framework for integrating that knowledge and the naturalistic learning processes in local contexts into instructional programs in formal ECE settings.