Western Kenya Research Articles

Employee Perceptions and Intention to Leave Among Academic Staff in Public Universities in Kenya

Purpose: The specific objectives of the study included perceived organizational support, commitment, performance and perceived organizational support as predictors of intention to leave. Methodology: The descriptive survey research designs was adopted. The population consisted of all cadres of academic staff in the chosen three public universities in Western Kenya. Yamane’s (1967) formula was utilised in determining a sample size of 121 respondents. Purposive sampling technique was utilised in coming up with the sample. Questionnaires were used to obtain primary data for analysis. A pilot study was done on 5% of the sample and Cronbach’s alpha helped in testing reliability. Both face and content validity of the research instrument were checked. Descriptive and inferential statistics of frequencies, means and standard deviation and inferential technique were utilised to analyse quantitative data using SPSS. Findings: The results revealed that perceived organizational support had a negative significant relationship with intention to leave. Perceived commitment, performance and manager support were all positively related with intention to leave. Unique Contribution to Theory, Policy and Practice: The study recommends that universities should assess and improve employee perceptions if they want to influence them to stay longer with the firms.

Sugarcane Bagasse Based Adsorbents and their Adsorption Efficacy on Removal of Heavy Metals from Nakuru Industrial Wastewater: Optimization, Kinetic and Thermodynamic Aspects

Currently, researchers are seeking to reduce heavy metal contamination from the environment, using agricultural waste materials like rice husk, groundnuts shells among others. The study focused on the removal of Cu(II), Pb(II), Cd(II), Ni(II), and Cr(III) ions from aqueous solutions and Nakuru industrial wastewater using sugarcane bagasse (NSCB) and valorised bagasse ash (VSCB), as alternative low-cost agricultural waste bio-sorbents. To achieve this goal, sugarcane bagasse was collected from Nzoia sugar industry in western Kenya, while the valorised bagasse was obtained by heating sugarcane bagasse sample in a muffle furnace at 300°C for three hours. Furthermore, batch adsorption studies were performed, and the effects of several factors, i.e. adsorbent particle size, pH, contact time, initial heavy metal ions concentration and temperature were investigated to optimise the removal efficiency of Pb, Cu, Cd, Ni, and Cr. The optimal adsorption conditions were pH of 5.0, adsorbent dosage of 0.1 g and ≤ 150µm particle size, equilibrium time of 60 minutes and at 25 degrees Celcius. The removal kinetics of the metal ions onto both adsorbents fitted well with the pseudo-second-order model. The removal kinetics of the metal ions onto both adsorbents fitted well with the pseudo-second-order model. The adsorption of Pb2+ and Ni2+ onto NSCB fitted better with the Freundlich isotherm model, while Cd2+, Cu2+ and Cr3+ showed better fit for the Langmuir isotherm model. As for VSCB adsorbent, Cr3+ has a better fit with the Langmuir isotherm model whereas Pb2+, Ni2+, Cd2+, and Cu2+ fitted well on the Freundlich isotherm model. Freundlich constant’s (1/n) values and the separation factor (RL) from the Langmuir isotherm model indicate that the metal ions were favourably adsorbed onto the adsorbents. Langmuir isotherm model was used to estimate the maximum adsorption capacities (qmax) for Cu(II), Pb(II), Ni(II), Cd(II), and Cr(III). The negative free energy change (∆G) values revealed that adsorption process of the metal ions onto NSCB and VSCB was spontaneous. Fourier Transform Infrared Spectroscopy (FTIR) was used for characterization studies. Interactions with metal ions caused the frequencies of the active functional groups, –OH, C=O and C=C, on the bio-sorbent surfaces to shift to higher values. Therefore, sugarcane bagasse and valorised bagasse have demonstrated higher potential to remove relatively all selected heavy metals in the industrial wastewater at controlled pH.

Presence of Plasmodium falciparum strains with artemisinin-resistant K13 mutation C469Y in Busia County, Western Kenya

Malaria remains a key health and economic problem, particularly in sub-Saharan Africa. The emergence of artemisinin drug resistance (ART-R) parasite strains poses a serious threat to the control and elimination of this scourge. This is because artemisinin-based combination therapies (ACTs) remain the first-line treatment in the majority of malaria-endemic regions in Sub-Saharan Africa. Certain single-nucleotide polymorphisms in the propeller domains of Plasmodium falciparum Kelch 13 protein (K13) have been associated with delayed parasite clearance in vivo and in vitro. These mutations serve as vital molecular markers for tracking the emergence and dispersion of resistance. Recently, there have been increasing reports of the emergence and spread of P. falciparum ART-R parasites in the Eastern Africa region. This necessitates continued surveillance to best inform mitigation efforts. This study investigated the presence of all reported mutations of K13 propeller domains in the parasite population in Busia County, Kenya, a known malaria-endemic region. Two hundred twenty-six participants with microscopically confirmed uncomplicated malaria were recruited for this study. They were treated with artemether–lumefantrine under observation for the first dose, and microscopic examination was repeated 1 day later after ensuring the participants had taken the second and third doses. P. falciparum DNA from all samples underwent targeted amplification of the K13 gene using a semi-nested PCR approach, followed by Sanger sequencing. The recently validated ART-R K13 mutation C469Y was identified in three samples. These three samples were among 63 samples with a low reduction in parasitemia on day 1, suggesting day 1 parasitemia reduction rate is a useful parameter to enrich the ART-R parasites for further analysis. Our findings highlight the need for continuous surveillance of ART-R in western Kenya and the region to determine the spread of ART-R and inform containment.

Analysis of Technical Efficiency on Orange Fleshed Sweet Potatoes Production Among the Smallholder Farmers in Migori County Kenya

Sweet potatoes (<i>Ipomea batatas </i>L.), particularly the orange fleshed variety, have become increasingly popular due to their ability to thrive in various environmental conditions with minimal inputs. Orange fleshed sweet potatoes (OFSPs) show potential for productivity, yet smallholder farmers in Kenya still struggle to maximize their yields. The factors influencing OFSP production efficiency among these farmers in Western Kenya have not been thoroughly examined. This study evaluated the technical efficiency of OFSP production among smallholder farmers in Migori County. Using a descriptive research design, a sample of 225 OFSP farmers was randomly selected by a cluster sampling technique. Data was collected through a structured questionnaire on inputs and selected socio-economic factors. The data was analyzed using the frontier stochastic model in STATA. Smallholder farmers estimated mean technical efficiency was 77.82% significant variables were; size of the land, availability of planting vines, access to hired labour, gender of the household decision maker, farming experience, household size, land ownership status, participation in training programs and extension services, and proximity to markets, indicating a need to improve OFSP production by 22.18%. These findings suggest that to reduce inefficiencies among smallholder OFSP farmers, targeted training programs are needed to enhance farmers' agronomic knowledge specific to OFSP production. Further, policy interventions should prioritize the provision of extension services to support and improve the performance of OFSP smallholder farmers.

Jitegemee (rely on yourself): a multi-phase process of co-creating a personal savings intervention with female sex workers in western Kenya to reduce their HIV risk

BackgroundHIV prevalence among female sex workers (FSW) is significantly higher than among women in the general population. Studies have shown that FSW engage in unprotected sex which provides higher compensation when they face emergency situations. We co-created a savings intervention – Jitegemee (rely on yourself) – with FSW to encourage them to save part of their earnings to withdraw in emergency situations in order to reduce risk.MethodsWe undertook a five-phase intervention development process between February 2021 and July 2023: 1) qualitative interviews with FSW to identify essential intervention features; 2) pilot trial to assess intervention feasibility; 3) literature review of studies on economic empowerment of FSW; 4) scoring of key components of Phases 1–3 on a scale of 1–5 (1 = definitely exclude, 5 = definitely include), for inclusion in the intervention package; 5) workshops with FSW and other key stakeholders to co-design the intervention.ResultsIn phase 1, nearly all participants (99%) found the intervention acceptable to them and 95% believed it would be acceptable to other FSW. Participants suggested inclusion of financial literacy (75%), savings groups (38%) and goal-setting (24%). In the feasibility assessment, 41% saved, of whom 46% withdrew some savings. Condom use was higher among FSW who withdrew their savings compared to those who did not (χ2 7.52; p = 0.006). In Phase 3, we identified 14 intervention components. In phase 4, all suggested intervention components scored 4.5 on average. In phase 5, we held 3 workshops with FSW to co-design the intervention, which included instructions for how to save and make withdrawals, financial literacy training, and formation of savings groups.ConclusionsA savings intervention for and by FSW was highly acceptable and feasible. Involving end-users in the design process is likely to result in greater economic security among FSW and lower engagement in higher risk transactional sex.

Nasopharyngeal carriage and antibiotic susceptibility of Streptococcus pneumoniae among diabetes patients in western Kenya

AimsTo compare nasopharyngeal carriage and antibiotic susceptibility of Streptococcus pneumoniae among patients with and without diabetes at Moi Teaching and Referral Hospital (MTRH) in western Kenya. MethodsA cross-sectional study was conducted at MTRH diabetes and eye clinics. Participants were selected using systematic random sampling. Sociodemographic data and risk factors were collected through interviewer-administered questionnaires. Blood samples were taken to measure random blood sugar and HbA1c levels. Nasopharyngeal swabs were cultured and tested for antibiotic susceptibility within 24 h. Data analysis was performed using STATA version 13. Associations were assessed using Pearson’s chi-square, Fisher’s exact test, unpaired t-test, and Wilcoxon test. ResultsA total of 124 participants with diabetes and 121 without diabetes were enrolled. Overall, 7.4 % (95 % CI: 4.4, 11.4) of participants carried S. pneumoniae. Carriage was higher in diabetes (12.1 % [95 % CI: 7.0, 19.0]) than non-diabetes participants (2.48 % [95 % CI: 1.0, 7.0]), with a statistically significant difference (p = 0.004). Diabetes was associated with higher odds of carriage (adjusted OR 6.2, p = 0.012). No association was found with age, sex, cooking fuel, presence of children under 5, or prior antibiotic use. Among participants with diabetes, carriage of Streptococcus Pneumoniae was only associated with insulin use. Antibiotic resistance was highest for cotrimoxazole (94.44 %), followed by amoxicillin (16.7 %) and cefuroxime (11.1 %). No resistance to macrolides was observed. ConclusionNasopharyngeal carriage of S. pneumoniae is higher in patients with diabetes, with significant resistance to common antibiotics, though macrolides remain effective.

Talent Retention and Competitive Advantage of Star Rated Hotels in Rift Valley and Western Region, Kenya

The demand for both local and international visitors has seen local investors in the hospitality industry in Kenya jostle for market share. The arrival of the international hotel brands such as Best Western, Pullman and Park-In among others has increased competition as hotels scramble to provide quality products and services to their customers. Consequently, this sought to explore the influence of talent retention on competitive advantage of star rated hotels in Rift Valley and Western region, Kenya. The study was anchored on human capital theory. The study used simple random sampling to select a sample size of 62 respondents. The study adopted a correlational research design and data was collected using a questionnaire and analyzed quantitatively using both descriptive and inferential statistics. Prior to the actual data collection exercise, the study conducted pilot testing which involved both validity and reliability testing. The findings were presented in tables. The findings revealed that talent retention had a positive and significant influence on competitive advantage of star rated hotels in Rift Valley and Western Region, Kenya (P=0.000). The study concluded that hotel's talent retention strategies are generally effective especially enhancing a minimal employee turnover, a positive corporate image, and the use of succession planning and growth opportunities to retain talent. In view of the findings, the study recommends for the strengthening of the internal talent pool by investing in employee development programs. Encourage internal mobility and provide clear career progression paths to retain and motivate top talent. Keywords: Talent Retention, Competitive Advantage, Star-Rated Hotels, Rift Valley, Western Kenya

Talent Retention and Competitive Advantage of Star Rated Hotels in Rift Valley and Western Region, Kenya

The demand for both local and international visitors has seen local investors in the hospitality industry in Kenya jostle for market share. The arrival of the international hotel brands such as Best Western, Pullman and Park-In among others has increased competition as hotels scramble to provide quality products and services to their customers. Consequently, this sought to explore the influence of talent retention on competitive advantage of star rated hotels in Rift Valley and Western region, Kenya. The study was anchored on human capital theory. The study used simple random sampling to select a sample size of 62 respondents. The study adopted a correlational research design and data was collected using a questionnaire and analyzed quantitatively using both descriptive and inferential statistics. Prior to the actual data collection exercise, the study conducted pilot testing which involved both validity and reliability testing. The findings were presented in tables. The findings revealed that talent retention had a positive and significant influence on competitive advantage of star rated hotels in Rift Valley and Western Region, Kenya (P=0.000). The study concluded that hotel's talent retention strategies are generally effective especially enhancing a minimal employee turnover, a positive corporate image, and the use of succession planning and growth opportunities to retain talent. In view of the findings, the study recommends for the strengthening of the internal talent pool by investing in employee development programs. Encourage internal mobility and provide clear career progression paths to retain and motivate top talent. Keywords: Talent Retention, Competitive Advantage, Star-Rated Hotels, Rift Valley, Western Kenya

The role of co-infections on cervical intraepithelial neoplasia prevalence in western Kenya.

Background Screening for co-infections with HIV, HSV-2 and Chlamydia trachomatis (CT ) among high-risk human papilloma virus (hr-HPV) positive women remains essential in alleviating high morbidity of cervical cancer (CC). The aim of this study was to determine the prevalence of cervical intraepithelial neoplasia (CIN) among women referred for CC screening at a referral hospital in Kisumu County, Kenya; and to establish the role of co-infection on CIN. Method In a cross-sectional study, we collected HPV, HIV, HSV-2 and CT data, cervical cytology results, and demographic information from 517 referrals. Blood samples were obtained for HIV and HSV-2 tests; urine for CT test and cervical swabs for hr-HPV test. Results The overall prevalence of CIN was 18.4% (95/517) with CIN1 observed in 56(29.6%), CIN2 in 27(`14.3%), CIN3 + in 12(6.3%) and normal biopsy in 94(49.7%) of the patients out of which high grade CIN2 and above (CIN2+) was 7.54% (39/517) equivalent to 32.5 per 100,000 women per year. HPV/HIV co-infection (infected vs. uninfected: OR 2.79; 95% CI 1.56-5.10, p < 0.001); HPV/HSV-2 co-infection (infected vs. uninfected: OR 2.41, 95% CI: 1.12-5.46, p < 0.024); HPV/CT co-infection (infected vs. uninfected: OR 3.83; 95% CI 1.84-8.51, p < 0.001) were found to be significantly associated with CIN. Conclusion Overall prevalence of CIN was high in the region although high-grade CIN2 + remained relatively lower as reported earlier. Age factor, widowhood and co-infections with HIV, HSV-2 or Chlamydia trachomatis were associated with increased risk of testing positive for CIN.

Forecasting malaria dynamics based on causal relations between control interventions, climatic factors, and disease incidence in western Kenya.

Malaria remains one of the deadliest diseases worldwide, especially among young children in sub-Saharan Africa. Predictive models are necessary for effective planning and resource allocation; however, statistical models suffer from association pitfalls. In this study, we used empirical dynamic modelling (EDM) to investigate causal links between climatic factors and intervention coverage with malaria for short-term forecasting. Based on data spanning the period from 2008 to 2022, we used convergent cross-mapping (CCM) to identify suitable lags for climatic drivers and investigate their effects, interaction strength, and suitability ranges on malaria incidence. Monthly malaria cases were collected at St. Elizabeth Lwak Mission Hospital. Intervention coverage and population movement data were obtained from household surveys in Asembo, western Kenya. Daytime land surface temperature (LSTD), rainfall, relative humidity (RH), wind speed, solar radiation, crop cover, and surface water coverage were extracted from remote sensing sources. Short-term forecasting of malaria incidence was performed using state-space reconstruction. We observed causal links between climatic drivers, bed net use, and malaria incidence. LSTD lagged over the previous month; rainfall and RH lagged over the previous two months; and wind speed in the current month had the highest predictive skills. Increases in LSTD, wind speed, and bed net use negatively affected incidence, while increases in rainfall and humidity had positive effects. Interaction strengths were more pronounced at temperature, rainfall, RH, wind speed, and bed net coverage ranges of 30-35°C, 30-120 mm, 67-80%, 0.5-0.7 m/s, and above 90%, respectively. Temperature and rainfall exceeding 35°C and 180 mm, respectively, had a greater negative effect. We also observed good short-term predictive performance using the multivariable forecasting model (Pearson correlation coefficient = 0.85, root mean square error = 0.15). Our findings demonstrate the utility of CCM in establishing causal linkages between malaria incidence and both climatic and non-climatic drivers. By identifying these causal links and suitability ranges, we provide valuable information for modelling the impact of future climate scenarios.

Fathers' engagement in a parenting program primarily intended for female caregivers: An early qualitative process evaluation in Western Kenya.

Parenting programs predominantly target one caregiver of the child or most commonly the child's mother. However, fathers are also important caregivers whose engagement in interventions can benefit child health, nutrition, and development. In August 2023, a qualitative process evaluation was conducted during the first quarter of implementation to assess initial fidelity, quality, and outcomes of a parenting program in rural Western Kenya. In-depth interviews were conducted with female and male caregivers along with in-depth interviews and focus group discussions with program delivery agents. This secondary analysis specifically focused on stakeholders' perceptions of father involvement in the program and aimed to identify barriers and facilitators to fathers' participation, initial program impacts when fathers were involved, and recommendations for increasing father inclusion. Thematic content analysis was conducted, and data were triangulated across stakeholder groups. Overall, relatively few fathers participated in the program. Nevertheless, for the rare cases of participating fathers, stakeholders highlighted positive changes in fathers' caregiving attitudes and practices. Key barriers to fathers' program engagement included restrictive gender norms and perceived opportunity costs. Stakeholders suggested several strategies for better reaching fathers, including providing financial incentives and flexible scheduling of sessions. Overall, we found that fathers' participation and program experiences were starkly different from those of mothers. Gender-responsive program adaptations and father-targeted implementation strategies are likely to increase the fathers' engagement in parenting programs, which in turn may facilitate greater program impacts on family caregiving and child outcomes. Future evaluations of parenting programs should combine qualitative and quantitative approaches to more comprehensively assess program impacts on fathers and over time.

Outcomes After Loss to Follow-Up for Pregnant and Postpartum Women Living With HIV and Their Children in Kenya: A Prospective Cohort Study.

Many prevention of vertical transmission (PVT) studies assess outcomes within 12 months postpartum and exclude those lost to follow-up (LTFU), potentially biasing outcomes toward those retained in care. Five public facilities in western Kenya. We recruited women living with HIV (WLH) ≥18 years enrolled in antenatal clinic (ANC). WLH retained in care (RW) were recruited during pregnancy and followed with their children through 6 months postpartum; WLH LTFU (LW, last visit >90 days) after ANC enrollment and ≤6 months postpartum were recruited through community tracing. Recontact at 3 years was attempted for all participants. Primary outcomes were retention and child HIV-free survival. Generalized linear regression was used to estimated risk ratios (RRs) for associations with becoming LTFU by 6 months postpartum, adjusting for age, education, facility, travel time to facility, gravidity, income, and new vs. known HIV positive at ANC enrollment. Three hundred thirty-three WLH (222 RW, 111 LW) were recruited from 2018 to 2019. More LW versus RW were newly diagnosed with HIV at ANC enrollment (49.6% vs. 23.9%) and not virally suppressed at study enrollment (40.9% vs. 7.7%). 6-month HIV-free survival was lower for children of LW (87.9%) versus RW (98.7%). At 3 years, 230 WLH were retained in care (including 51 previously LTFU before 6 months), 30 transferred, 70 LTFU, and 3 deceased. 3-year child HIV-free survival was 81.9% (92.0% for children of RW, 58.6% for LW), 3.7% were living with HIV, 3.7% deceased, and 10.8% had unknown HIV/vital status. Being newly diagnosed with HIV at ANC enrollment was the only factor associated with becoming LTFU (aRR 1.21, 95% CI: 1.11 to 1.31). Outcomes among those LTFU were worse than those retained in care, underscoring the importance of retention in PVT services. Some, but not all, LW re-engaged in care by 3 years, suggesting the need for PVT services must better address the barriers and transitions women experience during pregnancy and postpartum.

Spatio-temporal characterization of malaria prevalence in a peri-urban resource limited setting of Western Kenya Highlands

Background: Malaria is the main killer disease in sub-Sahara Africa. Objective: The study identified malaria prevalence patterns in relation to space and time trends in a peri-urban resource limited setting of Western Kenya highlands aimed at strengthening implementation of malaria control strategies. Method: A longitudinal study was carried out in Mbale town and its environs, Vihiga County, from December 2019 to November 2020. Among patients who presented themselves at Mbale Provincial Rural Training health center for different medical issues, 768 malaria confirmed patients were recruited and signed consent before the study commenced. Data was collected using questionnaire and microscopy which was presented through graphs, frequency, means and analyzed using linear regression. P-value ≤ 0.05 was considered statistically significant. Results: Plasmodium falciparum malaria constituted 98.7%,while P. malariae, P. vivax, and P. ovale constituted 1.3%. Linear regression analysis showed effect of age, gender and location on malaria prevalence as (R2 = 0.7, [F (3,764) = 1.854], p &lt; 0136). Malaria prevalence varied in different months due to changes in amount of rainfall and temperatures received. Conclusion: Spatio-temporal characterization and many mosquito breeding grounds influenced malaria prevalence in the study area. Malaria control strategies should be strengthened in relation to space and time-trend. Keywords: Plasmodium species; space; time trend; malaria prevalence; socio-economic factors; demographic factors.

Digital communication between mothers and community health workers to support neonatal health (CHV-NEO): study protocol for a randomized controlled trial

BackgroundProvision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver such interventions. We developed an interactive short message service (SMS) intervention for neonatal health in Kenya, named CHV-NEO. CHV-NEO sends automated, theory-based, actionable, messages throughout the peripartum period that guide mothers to evaluate maternal and neonatal danger signs and facilitate real-time dialogue with a CHW via SMS. We integrated this intervention into Kenya’s national electronic community health information system (eCHIS), which is currently used at scale to support CHW workflow.MethodsThe effect of CHV-NEO on clinical and implementation outcomes will be evaluated through a non-blinded cluster randomized controlled trial. Twenty sites across Kisumu County in Western Kenya were randomized 1:1 to provide either the national eCHIS with integrated CHV-NEO messaging (intervention) or standard of care using eCHIS without CHV-NEO (control). We will compare neonatal mortality between arms based on abstracted eCHIS data from 7200 pregnant women. Secondary outcomes include self-reported provision of essential newborn care (appropriate cord care, thermal care, and timely initiation of breastfeeding), knowledge of neonatal danger signs, and care-seeking for neonatal illness, compared between arms based on questionnaires with a subgroup of 2000 women attending study visits at enrollment in pregnancy and 6 weeks postpartum. We will also determine CHV-NEO’s effect on CHW workflows and evaluate determinants of intervention acceptability, adoption, and fidelity of use through questionnaires, individual interviews, and messaging data.DiscussionWe hypothesize that the CHV-NEO direct-to-client communication strategy can be successfully integrated within existing CHW workflows and infrastructure, improve the provision of at-home essential newborn care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. The intervention’s integration into the national eCHIS tool will facilitate rapid scale-up if it is clinically effective and successfully implemented.Trial registrationClinicalTrials.gov, NCT05187897. The CHV-NEO study was registered on January 12, 2022.

Classroom Climate, Teacher Support and Self-Agency: Perceptions of Students with and without Disabilities

ABSTRACT This study investigated perceptions of classroom climate, the physical environment, and self-agency of students with and without disabilities. Participants were 868 high school students from four mixed-sex day schools and 1 same-sex boarding school in Western Kenya. Of the 868 participants, 431 had disabilities. Participants completed a questionnaire on classroom climate and self-agency. Overall, results showed that even though students perceived their classroom climate to be high in competition and difficulty, they were satisfied with their learning environments and regarded their teachers as being supportive. Friction was low and self-agency was moderate. ANOVA results revealed that there were no statistically significant differences between those with and without disabilities ( F 1 , 862 = 0.69 , p = 0.41 ). MANOVA results for disability status was statistically significant with respect to the classroom climate subscales ( F 6 , 857 = 2.22 , p = 0.04 ). Discriminant analysis structure coefficients identified friction, competition, and cohesion as the primary drivers of this significant result. Group means reveal students identified with a disability had a higher mean for friction, and lower means for cohesion and competition. Self-agency was positively correlated with satisfaction, cohesiveness, competition, and teacher support, and negatively correlated with friction and difficulty. These findings suggest that teacher support plays a significant role in student satisfaction, cohesion, and self-agency, regardless of disability.

Local sediment amendment can potentially increase barley yield and reduce the need for phosphorus fertilizer on acidic soils in Kenya

Soil acidification and low nutrient availability are two major challenges facing agriculture in most regions of East Africa, resulting in aluminum toxicity and poor crop yields. The amendment of local sediments to cropland can potentially alleviate these challenges, but responses are variable. In this study, we investigated the potential of two different local sediments influenced by volcanic deposits to increase soil pH, Si and P availability and reduce Al toxicity, thereby improve barley yield. Hence, a field experiment was established in Eldoret, Western Kenya, using 1% and 3% addition by weight of two sediments in barley cultivated plots. The Baringo 3% amendment significantly increased soil pH (from 4.7 to 7.0), the available P content (from 0.01 mg g−1 to 0.02 mg g−1) and decreased the Al availability (from 3.03 mg g−1–2.17 mg g−1). This resulted in a barley yield of 4.7 t/ha (+1061%). The Nakuru 3% and Baringo 1% amendments increased yield to 2–3 t/ha, while the Nakuru 1% did not significantly increase yield. These results highlight that, from a biophysical perspective, there are natural and local opportunities to reduce soil acidification and to partly replace mineral fertilizer, but its magnitude depends on the sediment and the amendment rate.

Delivery effectiveness of and adherence to intermittent preventive treatment for malaria in pregnancy with dihydroartemisinin–piperaquine with or without targeted information transfer or sulfadoxine–pyrimethamine in western Kenya: a three-armed, pragmatic, open-label, cluster-randomised trial

Delivery effectiveness of and adherence to intermittent preventive treatment for malaria in pregnancy with dihydroartemisinin–piperaquine with or without targeted information transfer or sulfadoxine–pyrimethamine in western Kenya: a three-armed, pragmatic, open-label, cluster-randomised trial

Cost-effectiveness analysis of alternative screening strategies for the detection of cervical cancer among women in rural areas of Western Kenya.

While the incidence of cervical cancer has dropped in high-income countries due to organized cytology-based screening programs, it remains the leading cause of cancer death among women in Eastern Africa. Therefore, the World Health Organization (WHO) now urges providers to transition from widely prevalent but low-performance visual inspection with acetic acid (VIA) screening to primary human papillomavirus (HPV) DNA testing. Due to high HPV prevalence, effective triage tests are needed to identify those lesions likely to progress and so avoid over-treatment. To identify the optimal cost-effective strategy, we compared the VIA screen-and-treat approach to primary HPV DNA testing with p16/Ki67 dual-stain cytology or VIA as triage. We used a Markov model to calculate the budget impact of each strategy with incremental quality-adjusted life years and incremental cost-effectiveness ratios (ICER) as the main outcome. Deterministic cost-effectiveness analyses show that the screen-and-treat approach is highly cost-effective (ICER 2469 Int$), while screen, triage, and treat with dual staining is the most effective with favorable ICER than triage with VIA (ICER 9943 Int$ compared with 13,177 Int$). One-way sensitivity analyses show that the results are most sensitive to discounting, VIA performance, and test prices. In the probabilistic sensitivity analyses, the triage option using dual stain is the optimal choice above a willingness to pay threshold of 7115 Int$ being cost-effective as per WHO standards. The result of our analysis favors the use of dual staining over VIA as triage in HPV-positive women and portends future opportunities and necessary research to improve the coverage and acceptability of cervical cancer screening programs.

Influence of Financial Intermediation on Sustainability of Youth Owned Enterprises in Western region, Kenya

Purpose: Despite the challenges besetting youth-owned enterprises in accessing funds from sources such as YEDF, county youth funds, Uwezo Fund, and Women Enterprise Fund, the financial sustainability of the enterprise remains an issue. This research investigates the influence of financial intermediation on sustainable youth-owned enterprises in Western Kenya. Design/Methodology/Approach: The research adapted a pragmatic approach and descriptive survey design based on the framed financial intermediation theory. It focused on chairpersons or owners of 443 registered youth-owned enterprises within Kakamega, Vihiga, Busia, and Bungoma counties and used Taro Yamane’s proportional sampling formula to arrive at 210 respondents. Both structured and semi-structured questionnaires were used to collect primary data, while financial data was obtained from secondary data sheets. Data analysis was done using SPSS (version 23) with descriptive and inferential statistics, and tables were used to present the results. Findings: The results of linear regression analysis revealed that financial intermediation (β = 0. 629) had a positive and significant (P≤0.001) relationship with sustainability. Implications/Originality/Value: Findings reveal that financial intermediation exerts a considerable influence on the survival of start-ups and businesses owned and operated by youth. This exploration appropriates financing policies, partnerships, financial training, risk management, planning services, networking, and capacities for enhancing sustainability.

Health care-seeking behavior for childhood illnesses in western Kenya: Qualitative findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) Study

Health care-seeking behavior for childhood illnesses in western Kenya: Qualitative findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) Study