Background: Rift Valley Fever (RVF) is a climate-sensitive mosquito-borne zoonotic disease with the potential to cause major economic losses due to its high mortality rate in domestic animals including cattle, sheep, goats, and camels. Disease outbreaks are closely associated with climate-driven ecosystem changes that modify interfaces between animals, humans, and the ecosystem. This study evaluated Baringo County, an administrative county in the Rift Valley of Kenya, to determine its preparedness to implement the One-Health Approach (OHA) to combat Rift Valley Fever. Methods: A cross-sectional study design was used to interview 31 officers from One Health-related government departments in Baringo County. A structured questionnaire based on a One-Health (OH) scorecard system was used to interrogate four components of One-Health. These included capacity, intervention science, risk management, and impact. A binary characterization of the responses was used to assign affirmative responses corresponding to good intervention practices a value of 1 and negative responses a value of zero. Chi-square tests of association were used to determine the associations between existing intervention practices and OHA preparedness. Results: The study established that Baringo County lacked a structured governance system for operationalizing OHA activities. This was characterized by poor organizational culture and insufficient resource allocation. There was no coordinated implementation of interventions between the different sectors, no implementation research to assess the efficiency of interventions, and no systems analysis within OHA interfaces. The County was, therefore, not resilient to environmental drivers of RVF and had weak risk mitigation strategies in the three One-Health interfaces that include animal, human, and ecosystems. RVF risk potential was determined to be highest in the previous RVF hotspots where its impact was severe. Conclusion: Baringo County lacks the preparedness for operationalizing the OHA in controlling RVF outbreaks. Based on these findings, the paper recommends: 1) The establishment of a County One-Health Unit comprising interdisciplinary experts from relevant sectors, 2) Capacity building to enhance OHA preparedness, 3) A continuous systems analysis to identify vulnerabilities and changes in the three One Health interfaces and 4) Integrated multisectoral planning and intervention against RVF threat.

Background: In many Low and Middle Income Countries (LMIC) HIV and cervical cancer have always been interlinked, as HIV patients are more likely to develop early onset cervical cancer, hence the researched and published studies at young age at diagnosis of the women with HIV. At the Jaramogi Hospital (JOOTRH) Kenya, we have lately been recording increase in incidences of early onset cancer of the cervix of HIV negative women, mean age 23.Objective: This study aimed at examining the prevalence of Early Onset Cervical Cancer in HIV negative women, presenting at the Oncology Clinic.Methodology: A review of hospital records of all patients aged 13-35 years presenting with Cancer of the Cervix regardless of HIV status at time of diagnosis from 2012 - 2019 was done in the retrospective arm of the study and purposive active recruitment of <35 done for the prospective arm from 2020 - 2021.Findings: There is a significant increase in Early Onset Cancer of the Cervix in the Prospective arm (2020-2021) with P-value 0.017 at CI (2.562, 18.938) as compared to the Retrospective arm (2012-2019) with P-value 0.012 at CI (1.921, 11.079).Conclusion: We concluded that Early Onset Cancer of the Cervix Incidences in HIV Negative women is increasing substantially at the Jaramogi Oginga Odinga Teaching and Referral Hospital in Western Kenya.Funding: The PhD candidate used his funds, and was helped by the personnel at the hospital, together with volunteering students and the investigators availed their expertise locally to conduct the study. We used the local hospital paper records in the cabinets of the oncology department and the records office. Uzima University School of Medicine supported the study by availing the volunteering students.Declaration of Interest: None.Ethical Approval: This proposal has been reviewed and approved by ethical committees of Jaramogi Oginga Odinga Teaching and Referral Hospital and Uzima University College. This committee makes sure that Study members are protected from harm.

Introduction:as a public health policy, the ongoing global coronavirus disease 2019 vaccination drives require continuous tracking, tracing, and testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diagnostic testing is important in virus detection and understanding its spread for timely intervention. This is especially important for low-income settings where the majority of the population remains untested. This is well supported by the fact that of about 9% of the Kenyan population had been tested for the virus.Methods:this was a cross-sectional study conducted at the Kisumu and Siaya Referral Hospitals in Kenya. Here we report on the sensitivity and specificity of the rapid antigen detection test (Ag-RDT) of SARS-CoV-2 compared with the quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) using stool and nasopharyngeal swab samples. Further, the mean Immunoglobulin M (IgM) and Immunoglobulin G (IgG) antibody levels among symptomatic and asymptomatic individuals in western Kenya were evaluated.Results:the sensitivity and specificity of Ag-RDT were 76.3% (95% CI, 59.8-88.6%) and 96.3% (95% CI, 87.3-99.5%) with a negative and positive predictive value of 85% (95% CI, 73.8%-93.0%) and 93% (95% CI, 78.6%-99.2%) respectively. There was substantial agreement of 88% (Kappa value of 0.75, 95% CI, 0.74-0.77) between Ag-RDT and nasopharyngeal swab RT-qPCR, and between stool and nasopharyngeal swab RT-qPCR results (83.7% agreement, Kapa value 0.62, 95% CI 0.45-0.80). The mean IgM and IgG antibody response to SARS-CoV-2 were not different in asymptomatic individuals, 1.11 (95% CI, 0.78-1.44) and 0.88 (95% CI, 0.65-1.11) compared to symptomatic individuals 4.30 (95% CI 3.30-5.31) and 4.16 (95% CI 3.32 -5.00).Conclusion:the choice of an appropriate SARS-CoV-2 diagnostic, screening, and surveillance test should be guided by the specific study needs and a rational approach for optimal results.

Background: Early growth and body composition may influence the risk of obesity and health in adulthood. Few studies have examined how undernutrition is associated with body composition in early life. Objectives: We assessed stunting and wasting as correlates of body composition in young Kenyan children.Methods: Nested in a randomized controlled nutrition trial, this longitudinal study assessed fat and fat-free mass (FM, FFM) using deuterium dilution technique among children at age 6 and 15 months. This trial was registered at http://controlled-trials.com/ (ISRCTN30012997). Cross-sectional and longitudinal associations between z-score categories of length-for-age (LAZ) or weight-for-length (WLZ) and FM, FFM, fat mass index (FMI), fat-free mass index (FFMI), triceps, and subscapular skinfolds were analyzed by linear mixed models.Results: Among the 499 children enrolled, breastfeeding declined from 99% to 87%, stunting increased from 13% to 32%, and wasting remained at 2% to 3% between 6 and 15 mo. Compared with LAZ >0, stunted children had a 1.12 kg (95% CI: 0.88, 1.36; P < 0.001) lower FFM at 6 mo and increased to 1.59 kg (95% CI: 1.25, 1.94; P < 0.001) at 15 mo, corresponding to differences of 18% and 17%, respectively. When analyzing FFMI, the deficit in FFM tended to be less than proportional to children's height at 6 mo (P < 0.060) but not at 15 mo (P > 0.40). Stunting was associated with 0.28 kg (95% CI: 0.09, 0.47; P = 0.004) lower FM at 6 mo. However, this association was not significant at 15 mo, and stunting was not associated with FMI at any time point. A lower WLZ was generally associated with lower FM, FFM, FMI, and FFMI at 6 and 15 mo. Differences in FFM, but not FM, increased with time, whereas FFMI differences did not change, and FMI differences generally decreased with time.Conclusions: Overall, low LAZ and WLZ among young Kenyan children were associated with reduced lean tissue, which may have long-term health consequences.

The population's antibody response is a key factor in comprehending SARS-CoV-2 epidemiology. This is especially important in African settings where COVID-19 impact, and vaccination rates are relatively low. This study aimed at characterizing the Immunoglobulin G (IgG) and Immunoglobulin M (IgM) in both SARS-CoV-2 asymptomatic and symptomatic individuals in Kisumu and Siaya counties in western Kenya using enzyme linked immunosorbent assays. The IgG and IgM overall seroprevalence in 98 symptomatic and asymptomatic individuals in western Kenya between December 2021-March 2022 was 76.5% (95% CI = 66.9-84.5) and 29.6% (95% CI = 20.8-39.7) respectively. In terms of gender, males had slightly higher IgG positivity 87.5% (35/40) than females 68.9% (40/58). Amidst the ongoing vaccination roll-out during the study period, over half of the study participants (55.1%, 95% CI = 44.7-65.2) had not received any vaccine. About one third, (31.6%, 95% CI = 22.6-41.8) of the study participants had been fully vaccinated, with close to a quarter (13.3% 95% CI = 7.26-21.6) partially vaccinated. When considering the vaccination status and seroprevalence, out of the 31 fully vaccinated individuals, IgG seropositivity was 81.1% (95% CI = 70.2-96.3) and IgM seropositivity was 35.5% (95% CI = 19.22-54.6). Out of the participants that had not been vaccinated at all, IgG seroprevalence was 70.4% (95% CI 56.4-82.0) with 20.4% (95% CI 10.6-33.5) seropositivity for IgM antibodies. On PCR testing, 33.7% were positive, with 66.3% negative. The 32 positive individuals included 12(37.5%) fully vaccinated, 8(25%) partially vaccinated and 12(37.5%) unvaccinated. SARs-CoV-2 PCR positivity did not significantly predict IgG (p = 0.469 [95% CI 0.514-4.230]) and IgM (p = 0.964 [95% CI 0.380-2.516]) positivity. These data indicate a high seroprevalence of antibodies to SARS-CoV-2 in western Kenya. This suggests that a larger fraction of the population was infected with SARS-CoV-2 within the defined period than what PCR testing could cover.

Globally, biosecurity is instrumental in prevention, control and management of livestock diseases and protection of human health. It is defined, prescribed, adopted and enforced through global, regional and national frameworks, laws, policies and strategies. There is more biosecurity practice research conducted in developed countries than developing ones. Consequently, the gap between the ideals recommended in biosecurity frameworks and what is practical in under-resourced rural settings is poorly understood. This anthropological study sought to assess adoption of biosecurity practices across a cattle, sheep and goat value chains continuum to demonstrate where risks lie. The cross-sectional mixed-methods study took place in Baringo County, Kenya. Qualitatively, it utilized 26 focus group discussions with community members and 10 observational interviews with slaughter facility workers. Quantitatively, it included a household survey with 560 community members and a separate survey with 231 livestock traders. Results show that producers, traders and slaughter facility workers did observe some biosecurity practices but not others due but not limited to personal preference, limitations in veterinary service delivery and enforcement of some biosecurity measures, and lack of requisite infrastructure. The study concludes that the implementation of biosecurity measures in rural settings is more complex than envisioned in biosecurity policies and frameworks. It can be hampered by resource limitations, poor enforcement, and contestations with cultural practices. The study recommends that further studies on willingness to adopt biosecurity measures targeting community members in under-resourced settings be conducted to identify possible critical points of intervention at county and national levels.

Background: Metagenomics approaches are increasingly being utilized as "dipstick" for microbial carriage.In this study, 16S rRNA metagenomics was used to probe for microbial community that resides in the ticks, those they pick from the environment, wildlife and livestock and to identify potential tick borne zoonoses.Methods: Tick DNA from 463 tick pools collected from domestic animals between 2007 and 2008 were amplified with primers that target the 16S rRNA V3-V4 domain and then sequenced on Illumina Miseq platform using 300 cycles version 3 kits.Ticks were pooled according to species and animal from which they were collected.A non-target control was used to track laboratory contaminants.Sequence data were analyzed using Mothur v1.3 pipeline and R v3.3.1 software and taxonomy determined using SILVA rRNA database.Shannon diversity index was used to compute bacterial diversity in each tick species before computing the means.Results: A total of 645 bacteria genera grouped into 27 phyla were identified.Four phyla contributed 97.4% of the 36,973,934 total sequences.Proteobacteria contributed 61.2% of these sequences that tarried to 33.8% genera, compared to 15.9% (23.4% genera) for Firmicutes, 15.6% (20% genera) for Actinobacteria and 4.7% (11.6% genera) for Bacteroidetes.The remaining 23 phyla only contributed 2.6% of the sequence reads (11.2% genera).Amongst the 645 genera, three groups were discernible, with the biggest group comprised commensals/symbionts that contributed 93.6% of the genera, but their individual sequence contribution was very low.Group two comprised genera that are known to contain pathogenic species, with Coxiella contributing 15,445,204 (41.8%) sequences, Corynebacterium (13.6%),Acinetobacter (4.3%), Staphylococcus (3.9%), Bacillus (2.7%) and Porphyromonas (1.6%), Ralstonia (1.5%), Streptococcus (1.3%), Moraxella (1.3%), amongst others.Group three com-

Coronavirus is a disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which emerged as a global pandemic in 2019 from Wuhan, China. Since its emergence, it has caused immense suffering to human life, 6.27 million lives have been lost, movement curtailed and social dynamics disrupted. The golden standard for getting samples for SARS-CoV-2 detection is through oral- nasopharyngeal swab, this method of sample collection is invasive and uncomfortable, thus stigmatized the general population, and thereby impeded the progress of controlling the spread through mass testing. Being a contact disease, mechanisms to encourage mass testing is key to reduce the spread. This study thus developed a complimentary sample type to test for SARS-CoV-2, the use of human feces. Fecal samples were collected from 100 asym-symptomatic individuals suspected to be infected with COVID-19, virus RNA was then extracted and profiled through Real Time Polymerase Chain Reaction (RT-qPCR). The antigen rapid diagnostic test revealed high positivity rate of 44%, but the real time polymerase chain reaction results on nasopharyngeal and fecal samples revealed a significant variation, high number of the patients tested positive with stool samples compared to the nasopharyngeal swabs, with 43 and 37%, respectively. SARS-CoV-2 virus was detected in both symptomatic and asymptomatic individuals; however, the symptomatic registered a higher positivity of 25% compared to 20% among the asymptomatic patients. Vaccination only lowered the risk of infection, fully and partially vaccinated lowered the infection level to 10% compared to 20% among the unvaccinated. Finally, gender parity in relation to COVID19 was evaluated, more females (56%) compared to males were recruited in this study, out of which (20; 43.4%) were positive, and 26 (56.6%) were negative based on fecal RT-qPCR outcomes. Based on the outcome of this study, rapid diagnostic test (Ag-RDT) however cheap and or fast does not provide accurate information, moreover, the virus does not stay longer within the Oro-nasopharyngeal region, thus the invalid or negative results, thus use of feces should be adopted as a confirmatory test to ascertain the COVID19 status of an individual.

Rift Valley Fever and malaria are zoonotic and human diseases respectively that pose major production and health challenges to pastoralists. This study aimed to determine the spatiotemporal distribution of mosquito vectors of these two diseases in Baringo County, Kenya. A longitudinal study design was used to collect mosquitoes from twenty four sites. Rainfall seasonality was determined using rainfall data from the WorldClim database. Negative binomial and zero-inflated negative binomial regression models were used to determine the effect of rainfall seasonality and ecogeographical conditions on vector distribution. Spatio-temporal maps showing vector distribution were made using the sf package in R. Four Rift Valley Fever vector species and four malaria vector species were collected and were predominantly found in the lowland and riverine zones. Vector control interventions against the two diseases should therefore target these two zones. The study also recommends integrated vector management methods targeting both larval and adult stages.

Data on pathogen prevalence is crucial for informing exposure and disease risk. We evaluated serological evidence of tick-borne encephalitis (TBE), West Nile (WN), Hepatitis E virus (HEV), Crimean-Congo Hemorrhagic Fever (CCHF), Yersiniosis, Lyme Disease (LD), and brucellosis in 1033 patients presenting with acute febrile illness at 9 health care facilities from diverse ecological zones of Kenya: arid and semiarid (Garissa District Hospital, Lodwar District Hospital, Marigat District Hospital, Gilgil District Hospital), Lake Victoria basin (Kisumu District Hospital, Alupe District Hospital, Kombewa Sub-County Hospital), Kisii highland (Kisii District Hospital), and coastal (Malindi District Hospital). Epidemiological information of the patients such as geography, age, gender, and keeping animals were analyzed as potential risk factors. Of the 1033 samples, 619 (59.9%) were seropositive to at least one pathogen by IgM (current exposure), IgG/IgM (recent exposure), and IgG (past exposure). Collective seroprevalence for current, recent, and past to the pathogens was 9.4%, 5.1%, and 21.1% for LD; 3.6%, 0.5%, and 12.4% for WN; 0.9%, 0.5%, and 16.9% for HEV; 5.8%, 1.3%, and 3.9% for brucellosis; 5.7%, 0.2%, and 2.3% for yersiniosis; 1.7%, 0%, and 6.2% for TBE; and 0.4%, 0%, and 1.9% for CCHF. Brucellosis risk was higher in patients recruited at Garissa District Hospital (odds ratio [OR] = 3.41), HEV (OR = 2.45) and CCHF (OR = 5.46) in Lodwar District Hospital, LD in Alupe District Hospital (OR = 5.73), Kombewa Sub-district hospital (OR = 8.17), and Malindi District hospital (OR = 3.3). Exposure to LD was highest in the younger age group, whereas yersiniosis did not vary with age. Age was a significant risk for WN, brucellosis, CCHF, TBE, and HEV and in those aged >14 years there was an increased risk to WN (OR = 2.30, p < 0.0001), brucellosis (OR = 1.84, p = 0.005), CCHF (OR = 4.35, p = 0.001), TBE (OR = 2.78, p < 0.0001), and HEV (OR = 1.94, p = 0.0001). We conclude that LD is pervasive and constitutes a significant health burden to the study population, whereas yersiniosis and CCHF are not significant threats. Going forward, community-based studies will be needed to capture the true seroprevalence rates and the associated risk factors.

Agriculture is a leading source of employment for rural populations in Kenya. Through a mixed methods approach, this study sought to investigate youth participation in smallholder livestock production and marketing in Baringo County. The specific focus is on how social norms and micropolitics enable or constrain participation of particular groups of young people. The study established that personal choice, preference for paid over unpaid labour and gender norms in asset access, ownership and control influence smallholder participation in livestock production and trade. This shows a disconnect between Kenya’s youth policy which advocates for equitable distribution of employment opportunities and the reality at community level. Interventions that seek to improve livestock production and marketing, particularly involving young people, should therefore adopt strategies that recognise these norms as a first step to addressing social exclusion.

Ticks harbor multiple pathogens, most of which can be transmitted to humans. The ensuing zoonoses display non-specific symptoms that make definitive diagnosis difficult. We report here the development and evaluation of multiplex real time polymerase chain reaction (qPCR) assays for eight tick-borne zoonoses (TBZ). The assays were organized in duo formats of 4-plex each. Format 1 was optimized for Anaplasma phagocytophilum, Coxiella burnetii, Borrelia burgdoferi and Ehrlichia chaffeensis. Format 2 was optimized for Rickettsia species (spp.), Bartonella spp., Borrelia spp. other than B. burgdoferi and Babesia spp. Synthetic plasmids were used to show that the assays can specifically detect all target sequences in the same reaction tube. Assays were assayed eight times to determine assay performance and the limit of detection was determined as the lowest plasmid concentration that was amplified for all the targets. Standard curves of threshold cycle (Ct) versus copy numbers were generated and used to determine linearity and efficiency of the assays. Pairwise comparison of singleplex and multiplex assays was done using Bland-Altman plots. Prevalence was calculated as overall percentage of positive patients to each TBZ tested Assay 1 had a limit of detection of 2 copy numbers for all targets. Assay 2 was less sensitive and on average had a limit of detection of 18 gene copies. In replicate tests, both assays had intra-assay variation of less than two cycles. Multiplex assays performance was comparable to respective singleplex assays. Evaluation of 512 clinical samples collected between 2008 and 2016 from acute febrile illness patients attending hospitals in different counties in Kenya revealed a 20% prevalence of tick-borne pathogens comprising B. burgdorferi (6%), non B. burgdorferi Borrelia spp. (3%), C. burnetii (5%), A. phagocytophilum (5%), Rickettsia spp. (2%), E. chaffeensis (0.8%), Bartonella spp. (0.8%), and Babesia spp. (0.4%). The high analytical sensitivity suggests potential for the duo 4-plex qPCR for detection of common TBZ.

The impact of quality complementary food products on infant growth and body composition has not been adequately investigated. This study evaluated the effect on fat-free mass (FFM) accrual, linear growth, and iron status of locally produced complementary food products comparing to a standard product. In a randomized, double-blind trial, 499 infants at 6 months received nine monthly rations of (a) WinFood Classic (WFC) comprising germinated amaranth (71%), maize (10.4%), small fish (3%), and edible termites (10%); (b) WinFood Lite (WFL) comprising germinated amaranth (82.5%), maize (10.2%), and multimicronutrient premix; or (c) fortified corn-soy blend plus (CSB+). Primary outcomes were changes in FFM, length, and plasma ferritin and transferrin receptors (TfR). FFM was determined using deuterium dilution. Analysis was by intention to treat, based on available cases. Compared with CSB+, there were no differences in change from 6 to 15 months in FFM for WFC 0.0 kg (95% CI [-0.30, 0.29]) and WFL 0.03 kg (95% CI [-0.25, 0.32]) and length change for WFC -0.3 cm (95% CI [-0.9, 0.4]) and WFL -0.3 cm (95% CI [-0.9, 0.3]). TfR increased in WFC group 3.3 mg L-1 (95% CI [1.7, 4.9]) and WFL group 1.7 mg L-1 (95% CI [0.1, 3.4]) compared with CSB+. Compared with the increase in Hb in CSB+ group, there was a reduction in Hb in WFC of -0.9 g dl-1 (95% CI [-1.3, -0.5]) and a lower increase in WFL -0.4 g dl-1 (95% CI [-0.8, 0.0]). In conclusion, the tested WinFoods had the same effect on FFM and length as CSB+, whereas Hb and iron status decreased, suggesting inhibited iron bioavailability from the amaranth-based WinFoods.

Baseline information that is essential for determining the areas to target with larval control includes estimates of vector diversity and larval habitat preferences. Due to a lack of such information in Baringo County, Kenya, this study assessed species diversity and larval habitat preference of potential mosquito vectors of Rift Valley fever (RVF) and malaria. Mosquito larvae were sampled from nine types of larval habitats and were identified morphologically. Species diversity was estimated by the Shannon’s diversity index while larval habitat preference by RVF and malaria vectors was determined by ANOVA. A total of 7724 immature mosquitoes comprising 17 species belonging to four genera, namely Anopheles, Culex, Aedes and Mansonia, were identified. Among the 17 species, three Anopheles species are responsible for malaria transmission: An. gambiae (s.l.), An. funestus (s.l.) and An. pharoensis. Rift Valley fever vectors included Mansonia spp. and Culex spp. The highest Shannon's diversity index was observed during the cold dry season (H = 2.487) and in the highland zone (H = 2.539) while the lowest diversity was recorded during the long rain season (H = 2.354) and in the riverine zone (H = 2.085). Ditches had the highest mean number of Anopheles larvae (16.6 larvae per sample) followed by swamp (12.4) and seasonal riverbed (10.7). Water pit and water pan had low mean numbers of Anopheles larvae (1.4 and 1.8, respectively) but relatively high mean numbers of culicines (16.9 and 13.7, respectively). Concrete tank was the least sampled type of habitat but had highest mean number of culicine larvae (333.7 l) followed distantly by water spring (38.9) and swamp (23.5). Overall, larval habitats were significantly different in terms of larval density (F(8,334) = 2.090, P = 0.036). To our knowledge, the present study reports culicine larval species diversity in Baringo for the first time and the most preferred habitats were concrete tanks, water springs and swamps. Habitats preferred by Anopheles were mainly riverbed pools, ditches and swamps. Environmental management targeting the habitats most preferred by potential vectors can be part of integrated vector control in Baringo, especially during dry seasons.

Hepatocellular carcinoma (HCC) is a malignant cancer of the liver and a leading cause of cancer-related mortality worldwide. Human immunodeficiency virus (HIV) has not been known to have a direct causal relationship with HCC despite independently causing inflammation of the liver. However, little is known on risk factors for HCC patients in an HIV endemic area. The objective of this study was to ascertain the risk factors of HCC and its association with HIV infection.

Management in hospitals just like any other organization is very important as nothing moves without it. Kenyan public hospitals have not been doing well in their service delivery and the management’s role in hospital performance has not been evident. Objective : The objective of this study was to analyze the effect of hospital management practices on hospital outcomes Design: The study employed a mixed method research design where both qualitative and quantitative data were collected from all the 25 hospitals in central Kenya. The qualitative data was analysed thematically while quantitative data was analysed statistically. Setting : 25 hospitals in central Kenya. Subjects : Patients, next of kin, health workers and hospital managers. Interventions: There was no intervention measures taken. Results : The study identified eleven management practices in Kenya public hospitals with regular supervision being practiced widely. The results further showed that hospitals practicing motivation and inspiration of staff, effective communication, delegation, work plan, work plan implementation and, staff empowerment had an increase in total live births. At the same time the results also indicate that hospitals that practiced empowerment, delegation and managers residing in hospitals had a reduction in fresh still births. All management practices identified in this study improved overall inpatient and outpatient satisfaction though not statistically significant. Conclusion : This study concluded that better management of hospitals translates to improved hospital outcomes and general health improvement of population served. This results in reduction of fresh still births, increase in total live births, and overall satisfaction in both inpatient and outpatient services.

The global increase in vector borne diseases has been linked to climate change. Seasonal vegetation changes are known to influence disease vector population. However, the relationship is more theoretical than quantitatively defined. There is a growing demand for understanding and prediction of climate sensitive vector borne disease risks especially in regions where meteorological data are lacking. This study aimed at analyzing and quantitatively assessing the seasonal and year-to-year association between climatic factors (rainfall and temperature) and vegetation cover, and its implications for malaria risks in Baringo County, Kenya. Remotely sensed temperature, rainfall, and vegetation data for the period 2004-2015 were used. Poisson regression was used to model the association between malaria cases and climatic and environmental factors for the period 2009-2012, this being the period for which all datasets overlapped. A strong positive relationship was observed between the Normalized Difference Vegetation Index (NDVI) and monthly total precipitation. There was a strong negative relationship between NDVI and minimum temperature. The total monthly rainfall (between 94 -181mm), average monthly minimum temperatures (between 16-21°C) and mean monthly NDVI values lower than 0.35 were significantly associated with malaria incidence rates. Results suggests that a combination of climatic and vegetation greenness thresholds need to be met for malaria incidence to be significantly increased in the county. Planning for malaria control can therefore be enhanced by incorporating these factors in malaria risk mapping.

Malaria, a major cause of morbidity and mortality, is the most prevalent vector borne disease in Baringo County; a region which has varied house designs in arid and semi-arid areas. This study investigated the association between house structures and indoor-malaria vector abundance in Baringo County. The density of malaria vectors in houses with open eaves was higher than that for houses with closed eaves. Grass thatched roof houses had higher density of malaria vectors than corrugated iron sheet roofs. Similarly, mud walled houses had higher vector density than other wall types. Houses in the riverine zone were significantly associated with malaria vector abundance (p<0.000) possibly due to more varied house structures. In Kamnarok village within riverine zone, a house made of grass thatched roof and mud wall but raised on stilts with domestic animals (sheep/goats) kept at the lower level had lower mosquito density (5.8 per collection) than ordinary houses made of same materials but at ground level (30.5 mosquitoes per collection), suggestive of a change in behavior of mosquito feeding and resting. House modifications such as screening of eaves, improvement of construction material and building stilted houses can be incorporated in the integrated vector management (IVM) strategy to complement insecticide treated bed nets and indoor residual spray to reduce indoor malaria vector density.

The paper uses the DEA technique to estimate efficiency scores in Kenyan public hospitals and then applies the Tobit regression to study inter-hospital variation in the scores. The DEA analysis reveals that small hospitals are more efficient than large hospitals, with efficiency levels ranging from 74-91% in small DMUs and from 57-78% in large DMUs. Tobit regression analysis shows efficiency scores are negatively correlated with the hospital’s distance from the manager’s residence and from the capital city. Internal and external supervisions are suggested as mechanisms for increasing performance of hospitals.