Population In Kenya Research Articles

The African Savers and the Post Office Savings Bank in Colonial Kenya (1910-1954)

ABSTRACT The Post Office Savings Bank operated in colonial Kenya from 1910 as a charitable institution with the objective to facilitate saving and cultivate a thrift mentality among Africans. However, as this research demonstrates, the savings bank did not act in accordance with those proclaimed values. The efforts of colonial authorities to popularise the institution among local communities were a response to historical circumstances, such as the Second World War, the demobilisation of African soldiers, and the Mau Mau uprising (1952-1960), that made African money valuable to the colonisers: Analysing the History of the Post Office Savings Bank in Kenya since its arrival until the Mau Mau uprising, this article sheds light on the complex and untold history of the institution, its motivations for expanding its services and the problems faced to win the trust of potential African savers. Moreover, the article demonstrates that in spite of the effort of the POSB to increase its number of African savers, the social and economic conditions of the African population in colonial Kenya made their traditional savings and investment practices more valuable when compared with the benefits offered by the postal savings bank.

An update on the distribution of the coypu, Myocastor coypus, in Asia and Africa through published literature, citizen-science and online platforms

The coypu, Myocastor coypus, has been introduced worldwide for fur farming and is widely recognized as one of the most invasive alien mammals of the world, affecting natural ecosystems, crops and possibly human health. Here we present a comprehensive up-to-date review of its distribution and status in Asia and Africa. Using a multi-source approach, we collected occurrences from published literature as well as from online biodiversity platforms (e.g. GBIF, iNaturalist), video sharing platforms, and local experts. Additionally, we used an ensemble modelling approach to predict the climatic suitability across Africa and Asia. We present an updated distribution map, including a total of 1506 spatially explicit records from 1973 to 2021, covering 1 African and 16 Asian countries. We find evidence for current populations in Kenya and five new countries since the last review of (Carter and Leonard, Wildl Soc Bull 30:162–175, 2002): Iran, Jordan, Lebanon, Uzbekistan, and Vietnam, and identify main clusters of coypu occurrence in Western (including Transcaucasia) and East Asia. We show that warm temperate and Mediterranean areas on both continents are predicted to be climatically suitable for the coypu and highlight not only areas of possible spread, but also potential data gaps, i.e. with high suitability and low availability of concrete information (e.g. China, Southern Russia). We emphasize the importance of citizen involvement and the urgency for coypu-targeted studies in data-poor regions to obtain a clear picture of the geographical distribution and to better address management strategies.

Estimating county-level overweight prevalence in Kenya using small area methodology

Public health surveillance of overweight prevalence is essential to assess the extent of the problem, identify regions and groups most affected and inform policy-making. However, the needed reliable data at disaggregated levels is lacking in Kenya. The Kenya STEPwise Survey for Non-communicable Diseases and RiskFactors (KSSNDRF) was nationally representative. It was used to obtain various indicators of non-communicable diseases and risk factors including overweight. However, due to small sample sizes at lower levels like at the county, overweight prevalence estimates are statistically imprecise (i.e., high variance). Therefore, to increase the effective sample size we combine data from the KSSNDRF and the Kenya Population and Housing Census by model-based small area methods. In particular, we fit an arcsine square-root transformed Fay–Herriot model. To transform back to the original scale, we use a bias-corrected back transformation. For this model, we smooth the design variance using Generalised Variance Functions. We compute the mean squared error estimates using a bootstrap procedure. We found that counties within urban areas — including the major towns like Nairobi, Nakuru, Nyeri and Mombasa — have a higher prevalence of overweight compared to rural counties. Although the paper focuses on overweight prevalence in Kenya, the presented method can also be applied to other indicators in developing countries with similar data sources.

Surgical anatomy of the femoral nerve in formalin prefixed cadavers in an adult Kenya population

Background: Ethnic variations involving femoral nerve have been described in literature. This nerve is the largest branch of the lumbar plexus. It innervates the hip flexors, knee extensors, and sensory function to medial and anterior aspects of the thigh. Risks of insults to nerve can be non-iatrogenic (trauma), and iatrogenic (approaches to the acetabulum, pelvis and proximal femur). The study aimed at providing precise description of variant anatomy of nerve, hence will help surgeons avoid iatrogenic insults.Methods: An anatomic descriptive cross-sectional study design involving fifty six (56), formalin prefixed adult cadaveric specimens. The length of the femoral nerve in relation to the inguinal ligament and its bony attachments, and the patterns of distribution of main branches in the regions were defined. Results: Males- 35 (Left=17, Right=18); Females- 21(Left=7, Right=14). Femoral nerve location: 53.02 mm (SD 14.59) from the ipsilateral anterior superior iliac spine (ASIS). Nerve trunk in relation to inguinal ligament measured: 47.85mm (SD 13.719) from the psoas muscle proximally and branched 29.32 mm (SD 14.239) distally. Innervations and branches: quadriceps in all specimens (Posterior); Sartorius muscles (Anterior), with noted variability in individual muscles. Branching pattern variations: 6 limbs (10.71%) at ligament level, 2(3.57%) limbs more proximal, while one nerve was split by a slip from the psoas muscle and then united 25.88mm proximal to ligament. The variations in sex were not statistically significant (p> 0.05).Conclusion: The anatomical course, length and branches of the femoral nerve in relation to inguinal ligament concur to great extent with described anatomic studies with some noted variability. Surgeons should be aware of the anatomic variations of femoral nerve and be cautious when operating in the zones traversed by the nerve.

Plasmodium falciparum parasite prevalence in East Africa: Updating data for malaria stratification.

The High Burden High Impact (HBHI) strategy for malaria encourages countries to use multiple sources of available data to define the sub-national vulnerabilities to malaria risk, including parasite prevalence. Here, a modelled estimate of Plasmodium falciparum from an updated assembly of community parasite survey data in Kenya, mainland Tanzania, and Uganda is presented and used to provide a more contemporary understanding of the sub-national malaria prevalence stratification across the sub-region for 2019. Malaria prevalence data from surveys undertaken between January 2010 and June 2020 were assembled form each of the three countries. Bayesian spatiotemporal model-based approaches were used to interpolate space-time data at fine spatial resolution adjusting for population, environmental and ecological covariates across the three countries. A total of 18,940 time-space age-standardised and microscopy-converted surveys were assembled of which 14,170 (74.8%) were identified after 2017. The estimated national population-adjusted posterior mean parasite prevalence was 4.7% (95% Bayesian Credible Interval 2.6–36.9) in Kenya, 10.6% (3.4–39.2) in mainland Tanzania, and 9.5% (4.0–48.3) in Uganda. In 2019, more than 12.7 million people resided in communities where parasite prevalence was predicted ≥ 30%, including 6.4%, 12.1% and 6.3% of Kenya, mainland Tanzania and Uganda populations, respectively. Conversely, areas that supported very low parasite prevalence (<1%) were inhabited by approximately 46.2 million people across the sub-region, or 52.2%, 26.7% and 10.4% of Kenya, mainland Tanzania and Uganda populations, respectively. In conclusion, parasite prevalence represents one of several data metrics for disease stratification at national and sub-national levels. To increase the use of this metric for decision making, there is a need to integrate other data layers on mortality related to malaria, malaria vector composition, insecticide resistance and bionomic, malaria care-seeking behaviour and current levels of unmet need of malaria interventions.

Disparities in HIV/STI burden and care coverage among men and transgender persons who have sex with men in Nairobi, Kenya: a cross-sectional study

ObjectivesThe study aimed to estimate the prevalence of, and associations, with HIV and metrics of HIV care engagement in a representative population of gay, bisexual and other men who have...

Experience in fostering regional collaboration and Coordination to use data for battling infectious diseases in sub-Saharan Africa.

The emergence of COVID-19 highlights globalisation realties, where diseases may emerge from anywhere and rapidly spread globally. Lessons emphasise the necessity for strengthening regional and global collaboration and coordination to allow rapid risk identification, resource mobilisation and joint actions. We report the experience of the Regional Action through Data (RAD) partnership in fostering regional cooperation and collaboration to use data for battling infectious diseases and the effects of COVID-19. The Partnership comprised;BoadReach company, The West African Health Organization (WAHO) and the Intergovernmental Authority on Development (IGAD); Duke University Global Health Centre and the Jembi Health Systems, South Africa.Main objective:To address the problem of limited used of data to drive performance in healthcare service delivery in sub-Saharan Africa; by changing how and why data is collected, analysed, and then used to achieve results.Specific objectives:1. Regional level: To equip and empower IGAD and WAHO with evidence-based analytics to drive data use for evidence-based policy and program action in public health (regional level). 2. Patient-provider level: To deploy and implement a digital health solution for child-hood vaccination services focused on mobile cross-border populations along the Uganda-Kenya border.Engagement approaches used included; meetings, workshops, technical working groups, establishing monitoring system and annual implementation revision. Targeted training and capacity building were conducted. All activities were built on existing systems and structures to strengthen ownership and sustainability.Regional level achievements:1. Regional health data sharing and protection policy, 2. Strengthened regional health information platform. Patient provider level: Deployment of a cloud based digital health solution to enhance childhood access to vaccination services for cross border populations of Kenya and Uganda, 3. Both regions developed resource mobilisation plans for sustainability.RAD established the foundation for building trust and strengthening regional collaboration and coordination in health in Sub-Saharan Africa.

Effect of Dividend Decisions on Market Performance of Share Prices for Commercial Banks Listed at Nairobi Securities Exchange

Dividend decisions are the approaches undertaken by the management of an organization to facilitate proper allocation of the cash flows from the business activities. They provide reasonable guidelines for the organization's actions based on the satisfaction of the investors' interests and organizational objectives. They strive to achieve the goals while they seek substantial profitability of the organization. The majority of the studies involving dividend decisions focused on determining the necessity for dividend policies in an organization. Others focused on assessing the Influence of the dividend policies on the stock return of the firm. Therefore, this study investigated the effects of dividend decisions on market performance of share prices for commercial banks listed at Nairobi Stock Exchange. The specific objective is; To determine the impact of dividend payouts on the stock performance of the commercial banks listed at Nairobi Stock Exchange The independent variables in the study is dividend payouts. The dependent variable was the performance of share prices for commercial banks listed at Nairobi Stock Exchange. The theoretical review included the bird in hand theory, information signaling theory, and tax differential theory. The research used a descriptive research design approach for 12 commercial banks' target population in Kenya. The study used secondary sources to collect data, which are the bank's annual data published on the Nairobi Stock Exchange website. The research used the SPSS software for analyzing the collected data. The results show that the constant dividend pay-out ratio and residual dividend policy are the major determinants of market performance of share prices. Discretional dividend policy does not significantly influence market performance of share prices of commercial banks. The study recommends the commercial banks to constantly make proper dividend decisions to ensure good market performance of the share prices.

Effect of Cash Transfers on Household Consumption amongst the Vulnerable Population in Awendo Sub-County

Despite the national cash transfer programme, poverty rate among the Kenyan population is still high at a prevalence rate of 48.9% in 2016 up from 45% in 2008. In Kenya, poverty prevalence is disproportionately spread across the 47 counties and sub-counties. In Awendo sub-county, poverty prevalence rate is 49.8 % in 2018 which is higher than the national figure prompting this empirical study. The purpose of this study was to analyze the effects of cash transfer on consumption among vulnerable households in Awendo Sub-County. The study was anchored on the Life Cycle hypothesis of consumption and savings, the study used a correlational design to aid the determination of relationship and association between cash transfers and status of household consumption. Using stratified sampling method, a total of 390 respondents were selected. However, the response rate was 98.7 %. Cronbach’s alpha coefficient was estimated to test for reliability and the value was 0.782 which was greater than the threshold of 0.7. The study used multiple linear regression models which indicated that, there is a positive significant effect of cash transfer on consumption (α1=0.060;p=0.046). In conclusion; cash transfer is an important factor determining levels of consumption of the vulnerable population in Awendo Sub-County. The study recommends for policy to enhance allocations among the vulnerable population in Awendo and Kenya in general. The study provides empirical evidence on the current body of knowledge for researchers and policy makers

A decade and beyond: learnings from HIV programming with underserved and marginalized key populations in Kenya.

IntroductionKey populations (KP) continue to account for high HIV incidence globally. Still, prioritization of KP in the national HIV prevention response remains insufficient, leading to their suboptimal access to HIV programmes. This commentary aims to share Kenya’s challenges and successes in achieving 2020 global HIV targets and scaling up the KP programme in the last decade.DiscussionThe KP programme in Kenya has scaled up in the last decade with the inclusion of female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender people and people in prisons as priority populations in the national HIV response. KP coverage based on official size estimates for FSW is 73%, for MSM is 82%, for PWID through needle syringe programme (NSP) is 71%, and through opioid substitution therapy (OST) is 26% and for transgender people is 5%. The service outcomes for KP have been relatively strong in prevention with high condom use at last paid sex for FSW (92%) and use of sterile equipment among PWID (88%), though condom use at last sex with a non‐regular partner among MSM (78%) is still low. The KP programme has not met care continuum targets for all subpopulations with low case findings. The national KP programme led by the Ministry of Health has scaled up the programme through (a) strategic partnerships with KP‐led and competent organizations, researchers and donors; (b) development of policy guidance and programme standards; (c) continuous sensitization and advocacy to garner support; (d) development of national reporting systems, among others. However, the programme is still struggling with uncertain size estimates; lack of updated bio‐behavioural survey data; inadequate scale‐up of interventions among transgender people and people in prison settings; gaps in reaching adolescent and young KP, and effectively addressing structural barriers like violence and stigma.ConclusionsTo reach the ambitious global HIV targets, sufficient coverage of KP with quality HIV programmes is critical. Despite scaling up the KP programme, Kenya has not yet achieved the 2020 global HIV targets and needs more efforts to scale‐up quality programmes for KP who are underserved in the HIV response.

Trends and predictors of HIV positivity and time since last test at voluntary counselling and testing encounters among adults in Kilifi, Kenya, 2006-2017.

Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of first-time testing (FTT), late retesting (previous test more than one year ago for GP or three months for KP), and test positivity at three voluntary counselling and testing (VCT) centres in coastal Kenya. Methods: Routine VCT data covering 2006-2017 was collected from three VCT centres in Kilifi County. We analysed HIV testing history and test results from encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 24,728 test encounters (32% FTT), we observed declines in HIV positivity (proportion of encounters where the result was positive) among GP men, GP women, first-time testers and MSM but not among FSW. The proportion of encounters for FTT and late retesting decreased for both GP and KP but remained much higher in KP than GP. HIV positivity was higher at FTT and late retesting encounters; at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment and sexually transmitted infection (STI) symptoms. HIV positivity was lower in GP men, never married clients and those less than 35 years of age. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: HIV positive test results were most common at encounters with first-time testers and late re-testers. While the proportion of encounters at which late retesting was reported decreased steadily over the period reviewed, efforts are needed to increase retesting among the most at-risk populations.

Causal mediation analysis for sparse and irregular longitudinal data

Causal mediation analysis seeks to investigate how the treatment effect of an exposure on outcomes is mediated through intermediate variables. Although many applications involve longitudinal data, the existing methods are not directly applicable to settings where the mediator and outcome are measured on sparse and irregular time grids. We extend the existing causal mediation framework from a functional data analysis perspective, viewing the sparse and irregular longitudinal data as realizations of underlying smooth stochastic processes. We define causal estimands of direct and indirect effects accordingly and provide corresponding identification assumptions. For estimation and inference, we employ a functional principal component analysis approach for dimension reduction and use the first few functional principal components instead of the whole trajectories in the structural equation models. We adopt the Bayesian paradigm to accurately quantify the uncertainties. The operating characteristics of the proposed methods are examined via simulations. We apply the proposed methods to a longitudinal data set from a wild baboon population in Kenya to investigate the causal relationships between early adversity, strength of social bonds between animals and adult glucocorticoid hormone concentrations. We find that early adversity has a significant direct effect (a 9–14% increase) on females’ glucocorticoid concentrations across adulthood but find little evidence that these effects were mediated by weak social bonds.

Modelling geographical accessibility to urban centres in Kenya in 2019.

BackgroundAccess to major services, often located in urban centres, is key to the realisation of numerous Sustainable Development Goals (SDGs). In Kenya, there are no up-to-date and localised estimates of spatial access to urban centres. We estimate the travel time to urban centres and identify marginalised populations for prioritisation and targeting.MethodsUrban centres were mapped from the 2019 Kenya population census and combined with spatial databases of road networks, elevation, land use and travel barriers within a cost-friction algorithm to compute travel time. Seven travel scenarios were considered: i) walking only (least optimistic), ii) bicycle only, iii) motorcycle only, iv) vehicle only (most optimistic), v) walking followed by motorcycle transport, vi) walking followed by vehicle transport, and vii) walking followed by motorcycle and then vehicle transport (most pragmatic). Mean travel time, and proportion of the population within 1-hour and 2-hours of the urban centres were summarized at sub-national units (counties) used for devolved planning. Inequities were explored and correlations between the proportion of the population within 1-hour of an urban centre and ten SDG indicators were computed.ResultsA total of 307 urban centres were digitised. Nationally, the mean travel time was 4.5-hours for the walking-only scenario, 1.0-hours for the vehicle only (most optimistic) scenario and 1.5-hours for the walking-motorcycle-vehicle (most pragmatic) scenario. Forty-five per cent (21.3 million people) and 87% (41.6 million people) of Kenya’s population resided within 1-hour of the nearest urban centre for the least optimistic and most pragmatic scenarios respectively. Over 3.2 million people were considered marginalised or living outside the 2-hour threshold in the pragmatic scenario, 16.0 million Kenyans for walking only, and 2.2 million for the most optimistic scenario. County-level spatial access was highly heterogeneous ranging between 8%-100% and 32%-100% of people within the 1-hour threshold for the least and most optimistic scenarios, respectively. Counties in northern and eastern parts of Kenya were generally most marginalised. The correlation coefficients for nine SDG indicators ranged between 0.45 to 0.78 and were statistically significant.ConclusionTravel time to urban centres in Kenya is heterogeneous. Therefore, marginalised populations should be prioritised during resource allocation and policies should be formulated to enhance equitable access to public services and opportunities in urban areas.

The Role of Medical Camps in Ensuring Equity in Accessing Health Care Services in Kenya

This study was carried out to help improve the management and organization of the medical camps in Kenya by the various key stakeholders thus enabling the medical camps achieve the overall goal of enabling access of quality affordable health care services to the disadvantaged and marginalized population in Kenya in acknowledgement that equity in the accessing and provision of health care services is an underlying principle intertwined in the human rights principles. Everyone irrespective of their social and economic status are entitled to a standard of health that is enjoyed by majority of the advantaged populations within a society and deliberate multi-disciplinary efforts need to be taken to ensure access of quality affordable health care services for all. Medical camps organized by public sector, private and Non-governmental organizations are initiatives aimed at achieving the goal of availing high standard of health to especially the vulnerable and disadvantaged populations in a community. This study sought to establish the role of medical camps in ensuring equity in accessing health care services in Kenya. The study targeted 500 patients who attended a medical camp, mounted by Embu County Government, one of the 47 county governments in Kenya, in Karaba, Mbeere South Sub-County on 1 st of November 2019. A total of 50 respondents were sampled which was 10% of the total population as it was not possible to involve all the patients due to time and cost constraints. A convenience sampling technique was employed where the study relied on information provided by willing respondents. The data was collected using a structured interview schedule comprising of both closed and open-ended questions. The data was analysed using factor analysis by use of SPSS software. Descriptive statistics in form of frequencies and percentages were used. The findings revealed that there was 100% response rate where majority of the respondents were female. It was notable that majority of those who attended the medical camp were vulnerable persons most of them with primary level of education, unemployed and earning a meagre monthly income of estimated US$ 139. The findings established that the medical camp was well planned and organized. The location was convenient to majority of the respondents; it was easy to locate and navigate through and majority resided within 5 kilometres of the venue. The majority of the respondents were to a great extent satisfied with services offered, level of professionalism and friendliness of the health professionals, proximity of the medical camp; hygiene and as well as free services. The study therefore concluded that to a great extent medical camps ensure equity in accessing health care services among the disadvantaged populations and recommended that such medical camps be organized on a regular basis. The study also recommended that consideration be given to build the capacity of local health staff to enable them offer follow up services after medical camps are offer. Expanding and equipping health facilities should also be a priority given that not all services could be offered during medical camps such as complicated major surgeries.

Molecular epidemiology of Brucella species in mixed livestock-human ecosystems in Kenya

Brucellosis, caused by several species of the genus Brucella, is a zoonotic disease that affects humans and animal species worldwide. Information on the Brucella species circulating in different hosts in Kenya is largely unknown, thus limiting the adoption of targeted control strategies. This study was conducted in multi-host livestock populations in Kenya to detect the circulating Brucella species and assess evidence of host–pathogen associations. Serum samples were collected from 228 cattle, 162 goats, 158 sheep, 49 camels, and 257 humans from Narok and Marsabit counties in Kenya. Information on age, location and history of abortion or retained placenta were obtained for sampled livestock. Data on age, gender and location of residence were also collected for human participants. All samples were tested using genus level real-time PCR assays with primers specific for IS711 and bcsp31 targets for the detection of Brucella. All genus positive samples (positive for both targets) were further tested with a speciation assay for AlkB and BMEI1162 targets, specific for B. abortus and B. melitensis, respectively. Samples with adequate quantities aggregating to 577 were also tested with the Rose Bengal Test (RBT). A total of 199 (33.3%) livestock and 99 (38.5%) human samples tested positive for genus Brucella. Animal Brucella PCR positive status was positively predicted by RBT positive results (OR = 8.3, 95% CI 4.0–17.1). Humans aged 21–40 years had higher odds (OR = 2.8, 95% CI 1.2–6.6) of being Brucella PCR positive compared to the other age categories. The data on detection of different Brucella species indicates that B. abortus was detected more often in cattle (OR = 2.3, 95% CI 1.1–4.6) and camels (OR = 2.9, 95% CI 1.3–6.3), while B. melitensis was detected more in sheep (OR = 3.6, 95% CI 2.0–6.7) and goats (OR = 1.7, 95% CI 1.0–3.1). Both B. abortus and B. melitensis DNA were detected in humans and in multiple livestock host species, suggesting cross-transmission of these species among the different hosts. The detection of these two zoonotic Brucella species in humans further underpins the importance of One Health prevention strategies that target multiple host species, especially in the multi-host livestock populations.

Genomic insights into the origin, domestication and genetic basis of agronomic traits of castor bean

BackgroundCastor bean (Ricinus communis L.) is an important oil crop, which belongs to the Euphorbiaceae family. The seed oil of castor bean is currently the only commercial source of ricinoleic acid that can be used for producing about 2000 industrial products. However, it remains largely unknown regarding the origin, domestication, and the genetic basis of key traits of castor bean.ResultsHere we perform a de novo chromosome-level genome assembly of the wild progenitor of castor bean. By resequencing and analyzing 505 worldwide accessions, we reveal that the accessions from East Africa are the extant wild progenitors of castor bean, and the domestication occurs ~ 3200 years ago. We demonstrate that significant genetic differentiation between wild populations in Kenya and Ethiopia is associated with past climate fluctuation in the Turkana depression ~ 7000 years ago. This dramatic change in climate may have caused the genetic bottleneck in wild castor bean populations. By a genome-wide association study, combined with quantitative trait locus analysis, we identify important candidate genes associated with plant architecture and seed size.ConclusionsThis study provides novel insights of domestication and genome evolution of castor bean, which facilitates genomics-based breeding of this important oilseed crop and potentially other tree-like crops in future.

High social status males experience accelerated epigenetic aging in wild baboons

Aging, for virtually all life, is inescapable. However, within populations, biological aging rates vary. Understanding sources of variation in this process is central to understanding the biodemography of natural populations. We constructed a DNA methylation-based age predictor for an intensively studied wild baboon population in Kenya. Consistent with findings in humans, the resulting 'epigenetic clock' closely tracks chronological age, but individuals are predicted to be somewhat older or younger than their known ages. Surprisingly, these deviations are not explained by the strongest predictors of lifespan in this population, early adversity and social integration. Instead, they are best predicted by male dominance rank: high-ranking males are predicted to be older than their true ages, and epigenetic age tracks changes in rank over time. Our results argue that achieving high rank for male baboons - the best predictor of reproductive success - imposes costs consistent with a 'live fast, die young' life-history strategy.

Mothers' perceptions of the medicalisation of female genital cutting among the Kisii population in Kenya.

While within the Kisii community in Kenya the prevalence of female genital cutting (FGC) is decreasing, the practice is increasingly being performed by health professionals. This study aims to analyse these changes by identifying mothers' motives to opt for medicalised FGC, and how this choice possibly relates to other changes in the practice. We conducted face-to-face semi-structured in-depth interviews with mothers who had daughters around the age of cutting (8-14 years old) in Kisii county, Kenya. Transcripts of the interviews were coded and analysed thematically, applying researcher triangulation. According to mothers' accounts, the main driver behind the choice to medicalise was the belief that medicalising FGC reduces health risks. There were suggestions that medicalised FGC may be becoming the new community norm or the only option. The shift to medicalisation was examined in relation to other changes in the practice of FGC signalling how medicalisation may provide a way to increase the practice's secrecy and decrease its visibility.

Modeling the Effect of HIV/AIDS Stigma on HIV Infection Dynamics in Kenya

Stigma toward people living with HIV/AIDS (PLWHA) has impeded the response to the disease across the world. Widespread stigma leads to poor adherence of preventative measures while also causing PLWHA to avoid testing and care, delaying important treatment. Stigma is clearly a hugely complex construct. However, it can be broken down into components which include internalized stigma (how people with the trait feel about themselves) and enacted stigma (how a community reacts to an individual with the trait). Levels of HIV/AIDS-related stigma are particularly high in sub-Saharan Africa, which contributed to a surge in cases in Kenya during the late twentieth century. Since the early twenty-first century, the United Nations and governments around the world have worked to eliminate stigma from society and resulting public health education campaigns have improved the perception of PLWHA over time, but HIV/AIDS remains a significant problem, particularly in Kenya. We take a data-driven approach to create a time-dependent stigma function that captures both the level of internalized and enacted stigma in the population. We embed this within a compartmental model for HIV dynamics. Since 2000, the population in Kenya has been growing almost exponentially and so we rescale our model system to create a coupled system for HIV prevalence and fraction of individuals that are infected that seek treatment. This allows us to estimate model parameters from published data. We use the model to explore a range of scenarios in which either internalized or enacted stigma levels vary from those predicted by the data. This analysis allows us to understand the potential impact of different public health interventions on key HIV metrics such as prevalence and disease-related death and to see how close Kenya will get to achieving UN goals for these HIV and stigma metrics by 2030.

Trends and predictors of HIV positivity and time since last test at voluntary counselling and testing encounters among adults in Kilifi, Kenya, 2006-2017.

Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of first-time testing (FTT), late retesting (previous test more than one year ago for GP or three months for KP), and test positivity at three voluntary counselling and testing (VCT) centres in coastal Kenya. Methods: Routine VCT data covering 2006-2017 was collected from three VCT centres in Kilifi County. We analysed HIV testing history and test results from encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 24,728 test encounters (32% FTT), we observed declines in HIV positivity (proportion of encounters where the result was positive) among GP men, GP women, first-time testers and MSM but not among FSW. The proportion of encounters for FTT and late retesting decreased for both GP and KP but remained much higher in KP than GP. HIV positivity was higher at FTT and late retesting encounters; at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment and sexually transmitted infection (STI) symptoms. HIV positivity was lower in GP men, never married clients and those less than 35 years of age. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: HIV positive test results were most common at encounters with first-time testers and late re-testers. While the proportion of encounters at which late retesting was reported decreased steadily over the period reviewed, efforts are needed to increase retesting among the most at-risk populations.