This paper describes the funding and financial services provided by the Akiba Mashinani Trust (AMT) to support the Kenyan Homeless People's Federation (Muungano wa Wanavijiji). Muungano is a federation of autonomous savings groups with over 60,000 members from informal settlements across Kenya. Savings are critical because they enable wealth accumulation, demonstrate the capacity of the community to repay loans and hence leverage additional resources, and build social capital among members. AMT is able to use these savings as seed capital for revolving funds at the community, city and national scales. The funds offer informal settlers a range of financial products, including community project loans, which allow savings groups to finance social housing, sanitation and basic infrastructure in an affordable way. Therefore, unlike formal banking and microfinance institutions, AMT positions its financial services within a broader effort to improve the physical and social fabric of urban informal settlements. The experiences of Muungano and AMT demonstrate the catalytic impact of establishing appropriate financial services geared towards low-income groups-and crucially, how the savings of low-income people can leverage government resources to achieve more inclusive cities.

Wambui MB, Opere A, Githaiga MJ, Karanja FK. 2017. Assessing the impacts of climate variability and climate change on biodiversity in Lake Nakuru, Kenya. Bonorowo Wetlands 1: 13-24. This study evaluates the impacts of the raised water levels and the flooding of Lake Nakuru and its surrounding areas on biodiversity, specifically, the phytoplankton and lesser flamingo communities, due to climate change and climate variability. The study was to review and analyze noticed climatic records from 2000 to 2014. Several methods were used to ascertain the past and current trends of climatic parameters (temperature, rainfall and evaporation), and also the physicochemical characteristics of Lake Nakuru (conductivity, phytoplankton, lesser flamingos and the lake depth). These included time series analysis, and trend analysis, so the Pearson’s correlation analysis was used to show a relationship between the alterations in lake conductivity to alterations in population estimates of the lesser flamingos and the phytoplankton. Data set extracted from the Coupled Model Intercomparison Project Phase 5 (CMIP5) (IPCC Fifth Assessment Report (AR5) Atlas subset) models were subjected to time series analysis method where the future climate scenarios of near surface temperature, rainfall and evaporation were plotted for the period 2017 to 2100 (projection) for RCP2.6 and RCP8.5 relative to the baseline period 1971 to 2000 in Lake Nakuru were analysed. The results were used to evaluate the impact of climate change on the lesser flamingos and phytoplankton abundance. It was noticed that there was a raise in the mean annual rainfall during the study period (2009 to 2014) which brought the increment in the lake’s surface area from a low area of 31.8 km² in January 2010 to a high of 54.7 km² in Sept 2013, indicating an increment of 22.9 km² (71.92% surface area increment). Mean conductivity of the lake also lessened leading to the loss of phytoplankton on which flamingos feed making them to migrate. A strong positive correlation between conductivity and the lesser flamingo population was noticed signifying that low conductivity affects the growth of phytoplankton and since the lesser flamingos depend on the phytoplankton for their feed, this subsequently revealed that the phytoplankton density could be a notable predictor of the lesser flamingo occurrence in Lake Nakuru. There was also a strong positive correlation noticed between phytoplankton and the lesser flamingo population which confirms that feed availability is a key determining factor of the lesser flamingo distribution in the lake. It is projected that there would be an increment in temperatures, rainfall and evaporation for the period 2017 to 2100 under RCP2.6 and RCP8.5 relative to the baseline period 1971 to 2000 obtained from the Coupled Model Intercomparison Project phase 5 (CMIP5) multi-model ensemble. As a result, it is expected that the lake will further increment in surface area and depth by the year 2100 due to increased rainfall thereby affecting the populations of the lesser flamingos and phytoplankton, as the physicochemical factors of the lake will alter as well during the projected period.

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BackgroundThe success of antiretroviral therapy in resource-scarce settings is an illustration that complex healthcare interventions can be successfully delivered even in fragile health systems. Documenting the success factors in the scale-up of HIV care and treatment in resource constrained settings will enable health systems to prepare for changing population health needs. This study describes changing demographic and clinical characteristics of adult pre-ART cohorts, and identifies predictors of pre-ART attrition at a large urban HIV clinic in Nairobi, Kenya.MethodsWe conducted a retrospective cohort analysis of data on HIV infected adults (≥15 years) enrolling in pre-ART care between January 2004 and September 2015. Attrition (loss to program) was defined as those who died or were lost to follow-up (having no contact with the facility for at least 6 months). We used Kaplan-Meier survival analysis to determine time to event for the different modes of transition, and Cox proportional hazards models to determine predictors of pre-ART attrition.ResultsOver the 12 years of observation, there were increases in the proportions of young people (age 15 to 24 years); and patients presenting with early disease (by WHO clinical stage and higher median CD4 cell counts), p = 0.0001 for trend. Independent predictors of attrition included: aHR (95% CI): male gender 1.98 (1.69–2.33), p = 0.0001; age 20–24 years 1.80 (1.37–2.37), p = 0.0001), or 25–34 years 1.22 (1.01–1.47), p = 0.0364; marital status single 1.55 (1.29–1.86), p = 0.0001) or divorced 1.41(1.02–1.95), p = 0.0370; urban residency 1.83 (1.40–2.38), p = 0.0001; CD4 count of 0–100 cells/µl 1.63 (1.003–2.658), p = 0.0486 or CD4 count >500 cells/µl 2.14(1.46–3.14), p = 0.0001.ConclusionsIn order to optimize the impact of HIV prevention, care and treatment in resource scarce settings, there is an urgent need to implement prevention and treatment interventions targeting young people and patients entering care with severe immunosuppression (CD4 cell counts <100 cells/µl). Additionally, care and treatment programmes should strengthen inter-facility referrals and linkages to improve care coordination and prevent leakages in the HIV care continuum.