BackgroundFemale genital mutilation/cutting (FGM/C) is still prevalent in several communities in Kenya and other areas in Africa, as well as being practiced by some migrants from African countries living in other parts of the world. This study aimed at detecting clustering of FGM/C in Kenya, and identifying those areas within the country where women still intend to continue the practice. A broader goal of the study was to identify geographical areas where the practice continues unabated and where broad intervention strategies need to be introduced.MethodsThe prevalence of FGM/C was investigated using the 2008 Kenya Demographic and Health Survey (KDHS) data. The 2008 KDHS used a multistage stratified random sampling plan to select women of reproductive age (15–49 years) and asked questions concerning their FGM/C status and their support for the continuation of FGM/C. A spatial scan statistical analysis was carried out using SaTScan™ to test for statistically significant clustering of the practice of FGM/C in the country. The risk of FGM/C was also modelled and mapped using a hierarchical spatial model under the Integrated Nested Laplace approximation approach using the INLA library in R.ResultsThe prevalence of FGM/C stood at 28.2% and an estimated 10.3% of the women interviewed indicated that they supported the continuation of FGM. On the basis of the Deviance Information Criterion (DIC), hierarchical spatial models with spatially structured random effects were found to best fit the data for both response variables considered. Age, region, rural–urban classification, education, marital status, religion, socioeconomic status and media exposure were found to be significantly associated with FGM/C. The current FGM/C status of a woman was also a significant predictor of support for the continuation of FGM/C. Spatial scan statistics confirm FGM clusters in the North-Eastern and South-Western regions of Kenya (p < 0.001).ConclusionThis suggests that the fight against FGM/C in Kenya is not yet over. There are still deep cultural and religious beliefs to be addressed in a bid to eradicate the practice. Interventions by government and other stakeholders must address these challenges and target the identified clusters.

Background Over the last decade, the Kenyan HIV treatment program has grown exponentially, with improved survival among people living with HIV (PLHIV). In the same period, noncommunicable diseases (NCDs) have become a leading contributor to disease burden. We sought to characterize the burden of four major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) among adult PLHIV in Kenya. Methods We conducted a nationally representative retrospective medical chart review of HIV-infected adults aged ≥15 years enrolled in HIV care in Kenya from October 1, 2003 through September 30, 2013. We estimated proportions of four NCD categories among PLHIV at enrollment into HIV care, and during subsequent HIV care visits. We compared proportions and assessed distributions of co-morbidities using the Chi-Square test. We calculated NCD incidence rates and their confidence intervals in assessing cofactors for developing NCDs. Results We analyzed 3170 records of HIV-infected patients; 2115 (66.3%) were from women. Slightly over half (51.1%) of patient records were from PLHIVs aged above 35 years. Close to two-thirds (63.9%) of PLHIVs were on ART. Proportion of any documented NCD among PLHIV was 11.5% (95% confidence interval [CI] 9.3, 14.1), with elevated blood pressure as the most common NCD 343 (87.5%) among PLHIV with a diagnosed NCD. Despite this observation, only 17 (4.9%) patients had a corresponding documented diagnosis of hypertension in their medical record. Overall NCD incidence rates for men and women were (42.3 per 1000 person years [95% CI 35.8, 50.1] and 31.6 [95% CI 27.7, 36.1], respectively. Compared to women, the incidence rate ratio for men developing an NCD was 1.3 [95% CI 1.1, 1.7], p = 0.0082). No differences in NCD incidence rates were seen by marital or employment status. At one year of follow up 43.8% of PLHIV not on ART had been diagnosed with an NCD compared to 3.7% of patients on ART; at five years the proportions with a diagnosed NCD were 88.8 and 39.2% ( p < 0.001), respectively. Conclusions PLHIV in Kenya have a high prevalence of NCD diagnoses. In the absence of systematic, effective screening, NCD burden is likely underestimated in this population. Systematic screening and treatment for NCDs using standard guidelines should be integrated into HIV care and treatment programs in sub-Saharan Africa.

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Maize (Zea mays) is a major staple food in Africa. However, maize production is severely reduced by damage caused by feeding lepidopteran pests. In East and Southern Africa, Chilo partellus is one of the most damaging cereal stem borers mainly found in the warmer lowland areas. In this study, it was hypothesized that the future distribution and abundance of C. partellus may be affected greatly by the current global warming. The temperature-dependent population growth potential of C. partellus was studied on artificial diet under laboratory conditions at six constant temperatures (15, 18, 20, 25, 28, 30, 32 and 35°C), relative humidity of 75 ± 5% and a photoperiod of L12:L12 h. Several non-linear models were fitted to the data to model development time, mortality and reproduction of the insect species. Cohort updating algorithm and rate summation approach were stochastically used for simulating age and stage structure populations and generate life-table parameters. For spatial analysis of the pest risk, three generic risk indices (index of establishment, generation number and activity index) were visualized in the geographical information system component of the advanced Insect Life Cycle modeling (ILCYM) software. To predict the future distribution of C. partellus we used the climate change scenario A1B obtained from WorldClim and CCAFS databases. The maps were compared with available data on the current distribution of C. partellus in Kenya. The results show that the development times of the different stages decreased with increasing temperatures ranging from 18 to 35°C; at the extreme temperatures, 15 and 38°C, no egg could hatch and no larvae completed development. The study concludes that C. partellus may potentially expands its range into higher altitude areas, highland tropics and moist transitional regions, with the highest maize potential where the species has not been recorded yet. This has serious implication in terms of food security since these areas produce approximately 80% of the total maize in East Africa.

The influence of temperature on the development, mortality, fecundity and life table parameters of two important noctuid African cereal pests, Busseola fusca and Sesamia calamistis was investigated under laboratory conditions. Experiments were carried out with larvae reared on artificial diet under eight constant temperatures (12 ∘ C, 15 ∘ C, 18 ∘ C, 20 ∘ C, 25 ∘ C, 28 ∘ C, 30 ∘ C and 35 ∘ C) and a 12L:12D photoperiod. Life table parameters were calculated using Insect Life Cycle Modelling (ILCYM) software. At 12 ∘ C and 35 ∘ C insects failed to develop. Mean development time for both species decreased with increasing temperature for all stages. Between 15 ∘ C and 30 ∘ C, mean larvae development time is divided by four for both species and adult mean longevity is divided by 1.5 and 2.5, for both sexes of S. calamistis and B. fusca, respectively. Fecundity varied according to temperature; the highest was estimated at 22 ∘ C and 24 ∘ C for B. fusca and S. calamistis, respectively. The lower thermal threshold for B. fusca and S. calamistis was, respectively, 6 ∘ C and 9 ∘ C, while the upper thermal threshold was 31 ∘ C and 32 ∘ C, respectively. The highest intrinsic rate of natural increase for B. fusca was obtained at 25 ∘ C while for S. calamistis it was obtained at 28 ∘ C. The highest net reproduction was obtained at 25 ∘ C for both species, but it was higher for S. calamistis than for B. fusca. The shortest population doubling time was observed at 25 ∘ C for B. fusca and at 28 ∘ C for S. calamistis. The optimum temperature range for development of both species was 25-28 ∘ C. The lower lower thermal threshold found for B. fusca than for S. calamistis and the higher upper thermal threshold found for S. calamistis than for B. fusca explain in part the observed distribution of both species in sub-Saharan Africa with S. calamistis occurring in all the agro-ecological zones but being usually more common than B. fusca in savannah lowland and B. fusca reported mainly from mid and high altitude areas.

This study aimed to examine individual and community level factors associated with adequate use of maternal antenatal health services in Kenya. Individual and community level factors associated with adequate use of maternal health care (MHC) services were obtained from the 2008-09 Kenya Demographic and Health Survey data set. Multilevel partial-proportional odds logit models were fitted using STATA 13.0 to quantify the relations of the selected covariates to adequate MHC use, defined as a three-category ordinal variable. The sample consisted of 3,621 women who had at least one live birth in the five-year period preceding this survey. Only 18 percent of the women had adequate use of MHC services. Greater educational attainment by the woman or her partner, higher socioeconomic status, access to medical insurance coverage, and greater media exposure were the individual-level factors associated with adequate use of MHC services. Greater community ethnic diversity, higher community-level socioeconomic status, and greater community-level health facility deliveries were the contextual-level factors associated with adequate use of MHC. To improve the use of MHC services in Kenya, the government needs to design and implement programs that target underlying individual and community level factors, providing focused and sustained health education to promote the use of antenatal, delivery, and postnatal care.

BackgroundDelays in seeking quality post abortion care services remain a major contributor to high levels of mortality and morbidity among women who experience unsafe abortion. However, little is known about the causes of and factors associated with delays in seeking care among women who suffer complications of unsafe abortion. This study looks at factors that are associated with delays in seeking post-abortion care among women in Kenya.MethodsData for this study were from a nationally representative sample of 350 healthcare facilities that participated in the 2012 Incidence and Magnitude of Unsafe Abortion study in Kenya. Data included socio-demographic characteristics, reproductive health and clinical histories from all women treated with PAC during a one-month data collection period.ResultsDelay in seeking care was associated with women’s age, education level, contraceptive history, fertility intentions and referral status.ConclusionsThere is need to improve women’s access to quality sexual and reproductive health information and services, contraception and abortion care. Improving current PAC services at lower level facilities will also minimize delays resulting from long referral processes.

BackgroundMalaria accounts for ~21% of outpatient visits annually in Kenya; prompt and accurate malaria diagnosis is critical to ensure proper treatment. In 2013, formal malaria microscopy refresher training for microscopists and a pilot quality-assurance (QA) programme for malaria diagnostics were independently implemented to improve malaria microscopy diagnosis in malaria low-transmission areas of Kenya. A study was conducted to identify factors associated with malaria microscopy performance in the same areas.MethodsFrom March to April 2014, a cross-sectional survey was conducted in 42 public health facilities; 21 were QA-pilot facilities. In each facility, 18 malaria thick blood slides archived during January–February 2014 were selected by simple random sampling. Each malaria slide was re-examined by two expert microscopists masked to health-facility results. Expert results were used as the reference for microscopy performance measures. Logistic regression with specific random effects modelling was performed to identify factors associated with accurate malaria microscopy diagnosis.ResultsOf 756 malaria slides collected, 204 (27%) were read as positive by health-facility microscopists and 103 (14%) as positive by experts. Overall, 93% of slide results from QA-pilot facilities were concordant with expert reference compared to 77% in non-QA pilot facilities (p < 0.001). Recently trained microscopists in QA-pilot facilities performed better on microscopy performance measures with 97% sensitivity and 100% specificity compared to those in non-QA pilot facilities (69% sensitivity; 93% specificity; p < 0.01). The overall inter-reader agreement between QA-pilot facilities and experts was κ = 0.80 (95% CI 0.74–0.88) compared to κ = 0.35 (95% CI 0.24–0.46) between non-QA pilot facilities and experts (p < 0.001). In adjusted multivariable logistic regression analysis, recent microscopy refresher training (prevalence ratio [PR] = 13.8; 95% CI 4.6–41.4), ≥5 years of work experience (PR = 3.8; 95% CI 1.5–9.9), and pilot QA programme participation (PR = 4.3; 95% CI 1.0–11.0) were significantly associated with accurate malaria diagnosis.ConclusionsMicroscopists who had recently completed refresher training and worked in a QA-pilot facility performed the best overall. The QA programme and formal microscopy refresher training should be systematically implemented together to improve parasitological diagnosis of malaria by microscopy in Kenya.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-2018-2) contains supplementary material, which is available to authorized users.