Rural Kenyan Community Research Articles

Population levels and geographical distribution of HIV RNA in rural Ugandan and Kenyan communities, including serodiscordant couples: a cross-sectional analysis

BackgroundAs Sub-Saharan Africa transitions to a new era of universal ART, up-to-date assessments of HIV RNA (viral load, VL) suppression at a population level are needed to understand demographic and geographic sources of ongoing viremia and to inform interventions to optimize ART delivery. We sought to measure population viral load (VL) metrics to assess current viral suppression levels and characterize demographic groups and geographic locations with high-level detectable viremia in East Africa.MethodsIn the SEARCH HIV test-and-treat study (NCT01864683), we conducted baseline HIV testing (89% uptake) and HIV RNA assessments in 32 rural communities in 2013–2014 in Uganda and Kenya (N=303,461). We measured VL in 8,828 HIV+ adults, and defined viral suppression as VL<500 copies/mL. To assess geographic sources of transmission risk, we determined the proportion of all adults (both HIV-positive and HIV-negative) with detectable VL (termed ‘local prevalence of viremia’). Transmission risk ‘hotspots’ were defined as geopolitical subunits within communities with >5.0% local prevalence of viremia. We also assessed sero-discordant couples, measuring the proportion in which the HIV+ partner had detectable viremia.FindingsViral suppression was 82% (3,427/4,202) among adults on ART, and 51% (4,490/8,828) among all HIV+ adults. Regional viral suppression among HIV+ adults was 48% (West Uganda), 45% (East Uganda) and 53% (Western Kenya). Transmission risk ‘hotspots’ included 1/21 W.Uganda, 0/18 E.Uganda, and 16/26 Kenya geopolitical subunits. In Uganda, sero-discordancy was 3.1% (492 discordant/16,023 total couples). In 58% of discordant couples, the HIV+ partner was viremic (14% had VL>100,000). In Kenya, sero-discordancy was 10.0% (859/8,616 total couples). In 53%, the HIV+ partner was viremic (15% with VL>100,000).InterpretationPrior to the 2013–2014 start of the SEARCH trial, 51% of East African HIV+ adults had viral suppression, reflecting ART scale-up efforts to date. However, geographic ‘hotspots’ of potential HIV transmission risk as well as detectable viremia among sero-discordant couples warrant intensified interventions.FundingUS National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health. President’s Emergency Plan for AIDS Relief (PEPFAR).

Forest-Cover Change and Participatory Forest Management of the Lembus Forest, Kenya

Forests are a vital resource supporting the livelihoods of rural communities in Kenya. In spite of this significant role, human activities have put increased pressure on this resource, leading to continued forest-cover decline. To address forest-cover decline, the Kenyan government introduced Participatory Forest Management (PFM) through its Forest Department in the early 2000s, enabling local communities to form and register Community Forest Associations (CFAs). This study was conducted to examine the impacts of the PFM approach on the Lembus Forest-cover change. Three Landsat satellite images (Landsat 5 TM acquired on 9 January 1985; Landsat 7 ETM+ acquired on 1 February 2002; and Landsat 8 OLI (Operational Land Imager) acquired on 1 March 2015) were used to analyse forest-cover change in the 1st period (1985–2002) and the 2nd period (2002–2015). In analysing the contribution of CFAs in conservation and management of the Lembus Forest, questionnaire sheets were distributed randomly to various residents living adjacent to the Lembus Forest; 327 valid responses were obtained from heads of households. The results of the land-cover change show a decrease in the percentage of forest-cover decline from 11.2%, registered in the 1st period, to 8.2% in the 2nd period. This led to the decrease of the annual rate of the forest-cover decline from 0.4 in the 1st period to 0.2 in the 2nd period. Three CFAs operate in this area, and 75% of the respondents participated in tree planting and 16% participated in tree pruning. This type of community participation is thought to most likely be the cause of the decline of the recent decreasing annual rate of forest-cover loss in the study area. Conversely, we found out that important initiatives, such as a forest patrol, had not been implemented due to lack of funding, and that CFAs and Kenya Forest Service had not yet signed any management agreement.

IMPACT OF EXPERIENTIAL SENSORY STIMULATION TRAINING IN CREATING DEMENTIA AWARENESS AND REDUCING STIGMA IN RURAL COMMUNITIES IN KENYA

IMPACT OF EXPERIENTIAL SENSORY STIMULATION TRAINING IN CREATING DEMENTIA AWARENESS AND REDUCING STIGMA IN RURAL COMMUNITIES IN KENYA

A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study

BackgroundDespite large investments in HIV testing, only 45% of HIV-infected persons in sub-Saharan Africa are estimated to know their status. Optimal methods for maximizing population-level testing remain unknown. We sought to demonstrate the effectiveness at achieving population-wide testing coverage of a hybrid mobile HIV testing approach.MethodsFrom 2013–2014, we enumerated 168,772 adult (≥15 years) residents of 32 communities in Uganda (N=20), and Kenya (N=12) using a door-to-door census. “Stable” residence was defined as living in community for ≥6 months over the past year. In each community we performed 2-week multi-disease community health campaigns (CHC) that included HIV testing, counseling, and referral to care if HIV-infected; CHC non-participants were approached for home-based testing (HBT) over 1–2 months. We determined population HIV testing coverage, and predictors of testing via HBT (vs. CHC) and non-testing.FindingsHIV testing was achieved in 89% of stable adult residents (131,307/146,906). HIV prevalence was 9.6% (13,043/136,033 stable and non-stable adults); median CD4+ T-cell count was 514 cells/μL (IQR: 355–703). Among stable adults tested, 43% (56,106/131,307) reported no prior testing. Among HIV-infected adults, 38% (4,932/13,043) were unaware of their status. Among stable CHC attendees, 99.5% (104,635/105,170) accepted HIV testing. Of stable adults tested, 80% (104,635/131,307, range: 60–93%) tested via CHCs. In multivariable analyses of stable adults, predictors of non-testing included male gender (risk ratio [RR]: 1.52, 95% CI: 1.48–1.56), single marital status (RR: 1.70, 95% CI: 1.66–1.75), Kenyan residence (RR: 1.46, 95% CI: 1.41–1.50, vs. Ugandan), and out-of-community migration for ≥1 month in past year (RR: 1.60, 95% CI: 1.53–1.68). Testing was more common among farmers (RR: 0.73, 95% CI: 0.67–0.79) and adults with primary education (RR: 0.84, 95% CI: 0.80–0.89).InterpretationHigh HIV testing coverage was achieved in rural Ugandan and Kenyan communities using a hybrid, mobile approach of multi-disease CHCs followed by HBT. This approach allowed for flexibility at the community and individual level in reaching testing coverage goals. Men and mobile populations remain challenges for universal testing.

Acute toxicity of the aqueous-methanolic Moringa oleifera (Lam) leaf extract on female Wistar albino rats

Background: Herbal preparations are widely assumed to be safe on oral administration and therefore the documentation of the toxic potential of some herbal concoctions used as medicine and nutrients is limited. Moringa oleifera ( MO ) is a plant that is gaining tremendous popularity in rural communities in Kenya as a means of offsetting nutritional and medicinal needs. However, very little is known about the safety of the plant on oral administration. Thus, the aim of the current study was to assess the biochemical and histological changes in the liver following the administration of an aqueous-methanolic (AQ-ME) MO leaf extract in female Wistar albino rats. Methods: Acute oral toxicity study on the AQ-ME MO leaf extract was conducted by the use of the limit test dose of the up and down procedure (OECD guideline number 425) with slight modifications. Briefly, ten (10) healthy, nulliparous, non-pregnant female Wistar strain albino rats aged 8-12 weeks and weighing 180±20 grams were used for the study. These animals were randomly selected into two groups; control and treatment group each having five (5) animals. They were then labelled to enable identification and control group animals were orally administered with physiological buffer saline once daily over a 48-hour period. The five (5) rats in the treatment group were dosed orally one at a time and once daily with a 2000 mg/kg dose of the AQ-ME MO leaf extract to determine the median lethal dose over a 48 hour period. Blood was then collected and used to prepare serum for biochemical analysis of aspartate amino transferase (AST), alanine amino transferase (ALT) and total bilirubin (TB) which are important biomarkers of liver dysfunction. Biochemical assays of these enzymes were performed using the method of the International Federation of Clinical Chemists (IFCC). Death was used as an endpoint, livers harvested and used to prepare transverse sections for histopathological examination. These sections were stained using the haematoxylin and eosin (H&E) method and observed for pathological changes using an optical microscope. Results: A 2000 mg/kg oral dose of AQ-ME MO leaf extract caused a significant (p 0.05) increase in the mean levels of total bilirubin in the treatment group relative to the control group. On the other hand, the extract caused a non-significant (p>0.05) decrease in the mean levels of ALT in the treatment group relative to the control. The post mortem analysis of the hepatic index (liver to body weight ratio) revealed that there was a non-significant increase (p>0.05) in the hepatic index of the treatment group relative to the control. However, the transverse liver sections of treatment group animals showed mild distortions in the architecture of liver cells. Conclusions: Based on these results, the LD 50 of the AQ-ME MO leaf extract was found to be >2000 mg/kg in female wistar albino rats.

Oral Hygiene Status of Chewing Stick Users in a Rural Kenyan Community

Objective: We evaluated oral hygiene status in chewing-stick users compared with tooth-brush users, using multiple logistic regression analyses. Methods: An oral health examination was conducted in November 2011 in Mbita district, Kenya. In total 124, 97 adults underwent an oral health examination and participated in a questionnaire survey. Kenyan dentists examined dental caries and evaluated periodontal status and the presence of dental plaque. Tooth-brushing tools that participants used on a daily basis were categorized as a “tooth brush” or a “chewing stick.” Results: The frequency of tooth brushing was significantly higher among the tooth brush users than the chewing stick users. The adjusted odds ratio of those who had heavy dental plaque was 3.53 (95% CI: 1.1-10.89.9) in chewing stick users compared with tooth brush users. Conclusions: Chewing stick users had a poor oral hygiene status rather than tooth brushing users. To improve oral hygiene status in chewing stick users, appropriate oral health education for rural Kenyan communities should be developed

Photovoice in Kenya: Using a Community-Based Participatory Research Method to Identify Health Needs.

Photovoice, a community-based participatory research method, was utilized to delineate the health-related needs of a small rural community in Kenya. Within the Cherangany Constituency, 13 women were recruited and trained in digital photography and appropriate ethical conduct in photography (respect for privacy, consent, and confidentiality). Both individual and group interviews were conducted with the participants, and data were transcribed and analyzed for common themes by both the participants and the researcher. Common themes present in the photos were coded and prioritized in order of importance: (a) school fees, (b) water, (c) hospital fees, (d) sanitation, (e) orphans, (f) widows, (g) lack of jobs/capital, (h) disabilities, and (i) presence of disease. Data from this study will be utilized for (a) development of culturally competent health education, (b) site-specific education/training of incoming medical teams, and (c) informative meetings with local leaders regarding health and associated challenges.

Identifying interventions to help rural Kenyan mothers cope with food insecurity: results of a focused ethnographic study.

An ethnographic study was conducted in two areas in southern and western Kenya to identify potential interventions to improve the quality, availability and affordability of foods consumed by infants and young children. A cultural–ecological model of determinants of nutrition identified the sectors of information for data collection related to infant and young child (IYC) diet and feeding‐related behaviours, and the focused ethnographic study manual was used to guide the research. The results provide qualitative evidence about facilitators and constraints to IYC nutrition in the two geographical areas and document their inter‐connections. We conclude with suggestions to consider 13 potential nutrition‐sensitive interventions. The studies provide empirical ethnographic support for arguments concerning the importance of combining nutrition‐specific and nutrition‐sensitive interventions through a multi‐sectoral, integrated approach to improve the nutrition of infants and young children in low‐income, resource‐constrained populations. They also document the value of ethnography as a component of landscape analysis in nutrition programme and policy planning. Key messages In addition to constraints on infant and young child diet that originate in environmental and technological conditions in both agro‐ecological zones, other factors that affect feeding practices include features of social organisation, household access to social support, caregivers income‐earning activities and their own health.The results of the ethnographies, which highlight the importance of obtaining the knowledge and perspectives of caregivers of infants and young children, reveal the interactions of the multiple factors that affect child nutrition and the need for simultaneous nutrition‐sensitive interventions to complement nutrition‐specific intervention actions.Most caregivers in both areas not only understood the importance of diet and food quality for child survival, they also regarded it as essential for child growth and development. This indicates that caregivers in these rural Kenyan communities have adopted the basic biomedical interpretation of the importance of child nutrition as an integral part of their ‘knowledge frameworks’.

Energy Transitions for the Rural Community in Kenya's Central Highlands: Small Scale Solar Powered Systems

This paper explores Kenya's central highlands rural community's sources of energy choices’ in the last three decades. The paper tracks the changes in sources of energy (firewood, charcoal, kerosene, car battery and dry cells) up to the option of using the solar homes systems. In Kenya, the demand for clean energy for both industrial and domestic activities is on the rise. Currently, the energy for the industries and urban areas is derived largely from petroleum and hydroelectric power. On the other hand, for the low-income earning rural community in the Kenya's central highlands, firewood is however the major source of energy for most domestic activities. Considering that arid and semi-arid regions constitute over 80% of the country, the demand for firewood for instance impacts the natural ecosystems and disrupts the natural nutrient cycling.

Modelling PV-based communal grids potential for rural western Kenya

Communal grids based on locally available renewable energy resources could be the bridge between national grid extensions and stand-alone power generations systems, offering least-cost paths to rural ‘electrification-beyond-lighting’ in developing nations. In this work the potential to supply electricity to a rural community in Kenya using PV-based communal grids is explored. Results show that for a properly sized system, gridding many solar microgeneration systems together leads to better power management, and thus efficiency, than when each system operates individually in a stand-alone configuration. Results further show that the higher the number of individual systems in each grid configuration, the higher the power exported to the external grid, and thus the better the power system management and efficiency.

Household Air Pollution From Burning Wood Is Associated With Altered Cardiac Hemodynamics And Function Among Women In Western Kenya: Results From The Kenya Hap Echo Study

Introduction: Household air pollution (HAP) from incomplete combustion of solid fuels is responsible for =4 million deaths annually, mostly due to cardiopulmonary disease. Limited data describe the associations between HAP and echocardiographic markers of cardiac structure and function. Thus, we assessed the cross-sectional association of median 24­hour home indoor measures of fine particulate matter (PM2.5) and carbon monoxide (CO) with echocardiographic characteristics among women. Methods: We analyzed baseline data of 44 women (mean age: 34.5 years, SD: 6.4) enrolled in a prospective cookstove replacement study in a rural Kenyan community. Home echocardiographic assessment included chamber size, ventricular function, hemodynamics, and myocardial strain. Linear regression models were used to estimate the cross­sectional association between tertiles of HAP measures and continuous echocardiographic outcomes, while adjusting for age, body mass index, and level of education. Results: All women used wood as cooking fuel. CO levels ranged from 3 to 89 ppm while PM2.5 levels ranged from 7 to 1475 µg/m3. CO was associated with higher pulmonary artery diastolic pressure (2.8 mmHg (95% CI: 0.1, 5.4) for tertile 3 vs 1; Ptrend=0.047) and lower left ventricular ejection fraction ( -6.2% (95% CI: -9.9, -2.5) for tertile 3 vs 1; Ptrend

Introduction of a community water supply in rural western Kenya: impact on community wellbeing and child health.

This study aimed to examine water availability and community health before and after tube wells were introduced in a rural western Kenyan community. Differences in impact among income quintile groups were quantified, and users' perceptions of their water supply measured. We conducted a two-part pre- (2009) and post-intervention (2011), cross-sectional study using structured questionnaires for mothers. In total, 1391 (576 in 2009 and 815 in 2011) mothers participated. Well introduction changed the households' drinking-water source from river to ground water. The median distance to the water source was reduced by 40% (500 to 300 metres) and median collection time was reduced by 50% (30 to 15 minutes). Water consumption per household increased by approximately 20% (from 82.6 to 99.0 L) and drinking of untreated water decreased by approximately 10%. Regression analyses revealed mothers with higher monthly incomes had the highest satisfaction levels (β=0.167, p<0.001). Positive impacts were strongest among wealthier groups. The small-scale community water supply dramatically affected user hygiene behaviours and daily life. Water supply access improved from 'no access' to 'basic access'. Household connections to a water supply and hygiene education are important steps to enhance community health.

Elites, Exit Options, and Social Barriers to Norm Change: The Complex Case of Female Genital Mutilation

Female genital mutilation (FGM) has been the target of significant transnational activism over the past several decades, prompting the development and promotion of a strong international norm against the procedure. However, groups that perform FGM generally view it as a requirement of their culture—they are subscribing to a strong local norm in favor of the practice. What happens when the international and local norms collide? Under what conditions are individuals and communities most likely to abandon the local norm and embrace the international one? The article lays out a theoretical framework for thinking about local-level norm change. I argue that the normally high barriers to defecting from the local norm supporting FGM are more likely to be overcome when there are non-circumcising groups living nearby and when there are local elites among the group of first movers. To evaluate this argument, I administered an original representative survey about FGM among Maa-speaking peoples in three rural Kenyan communities.

Distribution and characteristics of risk factors for cardiovascular–metabolic disease in a rural Kenyan community

BackgroundThe rising prevalence of non-communicable diseases and associated premature mortality in Sub-Saharan Africa contradicts the widely accepted premise that African countries are only dominated by infectious diseases, malnutrition, maternal and child deaths. Among the non-communicable diseases, hypertension and diabetes mellitus continue to be the leading cause of death worldwide, with 10–20million people estimated to have hypertension in Sub-Saharan Africa and 12million people reported to have diabetes mellitus in Africa. The purpose of this study was to assess the cardiovascular–metabolic characteristics of individuals living in one rural community in Central Kenya and to propose interventions to address their needs. MethodsA convenience sample of 262 individuals was screened/treated for cardiovascular–metabolic disease (CVMD) risk factors at a government operated community health center in Central Kenya. Self-reported estimates of physical activity, dietary intake, smoking and perceived health were obtained using questions drawn from the validated Behavioral Risk Factor Surveillance Survey. Standardized protocols (Jackson Heart Study) directed collection of physiologic measures (blood pressure, glucose, anthropometrics). Clinical data was abstracted and analyzed using Stata©. USA/Kenyan IRB/ethics approval was obtained. ResultsN=262, mean age 54 (SD±17.02) years; 81% women, 99% Kikuyu ethnicity. Self-reported history of diabetes mellitus was 4%, overweight (BMI⩾25) 34%, and hypertension 47%. Systolic blood pressure ⩾140mmHg increased with age [(12%, 39%, 52%) (<45, 45–64, 65+), respectively (p⩽.001)]. Glucose measures indicative of diabetes mellitus (⩾126mg/dL fasting or ⩾200mg/dL non-fasting) were 8.3%. Women were more likely than men to be overweight (39% vs 15%) (p=<0.001) and have elevated waist circumference (30% vs 6.3%). Self-reported lifestyle risk factors included: 10% were inactive; 68% of participants consumed <3 servings of vegetables per day; 69% used solid (saturated) fat for cooking; 89% added salt to cooking [with 28% adding salt at the table]; 9% drank soda daily/weekly, 3% currently smoked cigarettes. Overall 65% (n=170) of the sample had moderate to high risk for cardiovascular factors on the Gaziano Global Risk Score Scale. Conclusions/recommendationsThe prevalence of CVMD was high but some risk factors usually associated with CVMD were not observed. There is need for locally-tailored approaches in treatment and prevention of CVMD at the local level.

The Slow Violence of Climate Change in Poor Rural Kenyan Communities: “Water is life. Water is Everything.”

The Slow Violence of Climate Change in Poor Rural Kenyan Communities: “Water is life. Water is Everything.”

Insecticide-treated net use before and after mass distribution in a fishing community along Lake Victoria, Kenya: successes and unavoidable pitfalls.

BackgroundInsecticide-treated nets (ITNs) have proven instrumental in the successful reduction of malaria incidence in holoendemic regions during the past decade. As distribution of ITNs throughout sub-Saharan Africa (SSA) is being scaled up, maintaining maximal levels of coverage will be necessary to sustain current gains. The effectiveness of mass distribution of ITNs, requires careful analysis of successes and failures if impacts are to be sustained over the long term.MethodsMass distribution of ITNs to a rural Kenyan community along Lake Victoria was performed in early 2011. Surveyors collected data on ITN use both before and one year following this distribution. At both times, household representatives were asked to provide a complete accounting of ITNs within the dwelling, the location of each net, and the ages and genders of each person who slept under that net the previous night. Other data on household material possessions, education levels and occupations were recorded. Information on malaria preventative factors such as ceiling nets and indoor residual spraying was noted. Basic information on malaria knowledge and health-seeking behaviours was also collected. Patterns of ITN use before and one year following net distribution were compared using spatial and multi-variable statistical methods. Associations of ITN use with various individual, household, demographic and malaria related factors were tested using logistic regression.ResultsAfter infancy (<1 year), ITN use sharply declined until the late teenage years then began to rise again, plateauing at 30 years of age. Males were less likely to use ITNs than females. Prior to distribution, socio-economic factors such as parental education and occupation were associated with ITN use. Following distribution, ITN use was similar across social groups. Household factors such as availability of nets and sleeping arrangements still reduced consistent net use, however.ConclusionsComprehensive, direct-to-household, mass distribution of ITNs was effective in rapidly scaling up coverage, with use being maintained at a high level at least one year following the intervention. Free distribution of ITNs through direct-to-household distribution method can eliminate important constraints in determining consistent ITN use, thus enhancing the sustainability of effective intervention campaigns.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-466) contains supplementary material, which is available to authorized users.

Oral Health Status among 12 Year Old Children in a Rural Kenyan Community

Oral Health Status among 12 Year Old Children in a Rural Kenyan Community

Household food insecurity associated with child cognitive development in a rural Kenyan community on Lake Victoria (378.6)

Household food insecurity around Kenya’s Lake Victoria is widespread. The goal of this study was to examine the associations between food insecurity, child anthropometry and child development in 300 children 0‐2 years old living in a rural lakeside community in Kenya. Outcome measures obtained included anthropometric measurements (length and weight) and the Ages and Stages Questionnaire [ASQ] (Gross Motor, Personal‐Social, and Communication sub‐scales). Household food insecurity was assessed using the Household Food Insecurity Access Scale [HFIAS], and a scale of household food security was created using standard techniques. Results indicate that household food insecurity was associated with scores on the ASQ. In sub‐scale analyses, performance on the Gross Motor sub‐scale was most strongly associated with food insecurity (p=0.008). Stunting is significantly associated with gross motor scores (β=‐0.012, 95%CI:‐0.022 to ‐0.0029, p=0.01) and personal‐social scores (β=‐0.021, 95%CI:‐0.042 to ‐0.00079, p=0.04). Mediation analyses suggest that some of the association between household food security and child development is explained by child anthropometry (length‐for‐age). The associations between food insecurity and child development have potential policy and program implications. Understanding these findings may also inform future interventions designed to improve child cognitive development.Grant Funding Source: NSF‐GEO grant #115057, NAS Partnerships for Enhanced Engagement in Research

Oral Health Status among 12 Year Old Children in a Rural Kenyan Community

Oral Health Status among 12 Year Old Children in a Rural Kenyan Community

How Serious is the Impact of Type II Diabetes in Rural Kenya?

Over 50% of all adult hospital admissions and 55% of hospital deaths in Kenya are non-communicable, of which diabetes is among the leading. We aimed to describe the impact of type II diabetes at a rural community in Kenya. 200 healthy adult patients underwent random blood sucrose (RBS) testing after ethical approval by the Isiolo County Hospital. Diabetes was defined as RBS ≥11.1 mmol/l. A thorough history, physical examination and dipstick urinalysis for urine protein was done to identify risk factors and/or evidence of end organ damage. 32 patients (16%) had RBS ≥11.1 mmol/l. 12 patients (37.5%) never knew they were diabetic and those who knew 63% were not taking any medication. The most common risk factors were high fat diet (59.4%), sedentary lifestyle (46.8%) and family history of diabetes in first degree relative (37.5%). 43.7% of patients (n=14) had abdominal obesity while 21.9% (n=7) had various foot abnormalities. 8 patients (25%) had proteinuria of ≥ +1 on dipstick urinalysis. The 16% diabetes prevalence is among the highest recorded for a community living on ≤ 1 dollar/day. Further, evidence of end organ damage as depicted by massive proteinuria warrants urgent attention to this underprivileged group. It is hoped the results will form basis for future screening of diabetic nephropathy and other diabetes-related end organs involvement in this part of the world.