Rethinking the Definition of Medicalized Female Genital Mutilation/Cutting.

In 2015, the international community agreed to end Female Genital Mutilation/Cutting (FGM/C) by 2030. However, the target is unlikely to be met as changes in practice, including medicalized female genital mutilation/cutting (mFGM/C), challenge abandonment strategies. This paper critically reviews the current World Health Organization (WHO) definition of mFGM/C to demonstrate that mFGM/C, as currently defined, lacks detail and clarity, and may serve as an obstacle to the collection of credible, reliable, and comparable data relevant to targeted FGM/C prevention policies and programs. The paper argues that it is necessary to initiate a discussion on the revision of the current WHO definition of mFGM/C, where different components (who-how-where-what) should be taken into account. This is argued by discussing different scenarios that compare the current WHO definition of mFGM/C with the actual practice of FGM/C on the ground. The cases discussed within these scenarios are based on existing published research and the research experience of the authors. The scenarios focus on countries where mFGM/C is prevalent among girls under 18 years, using data from Demographic Health Surveys and/or Multiple Indicator Cluster Surveys, and thus the focus is on the Global South. The paper places its arguments in relation to wider debates concerning female genital cosmetic surgery, male genital circumcision and consent. It calls for more research on these topics to ensure that definitions of FGM/C and mFGM/C reflect the real-world contexts and ensure that the human rights of girls and women are protected.

The medicalisation of female genital cutting in Kenya: a threefold exposition.

In Kenya, the prevalence of Female Genital Cutting (FGC) is slowly decreasing. Simultaneously, the practice is increasingly being performed by healthcare providers rather than traditional circumcisers, which may pose the risk of legitimising the practice. To date, the underlying mechanisms remain poorly understood. Using the 1998, 2008-09, and 2014 Kenyan Demographic Health Surveys, this study aims to enhance understanding by mapping both FGC prevalence and medicalisation rates across birth cohorts and ethnic groups. Additionally, the study delves into data from the Kisii community, where FGC medicalisation is particularly high, to examine the association between medicalisation and a mother's social position, as she is typically the primary decision-maker regarding the practice. Findings reveal that the coexisting trends of decreasing prevalence and increasing medicalisation exhibit significant ethnic variation. Among the Kisii, greater wealth is associated with higher odds of a medicalised cut compared to a traditional cut, while higher education and media use are linked to higher odds of not undergoing cutting at all compared to a medicalised cut. Our findings nuance the international community's premise that the medicalisation of FGC hinders the eradication of the practice.

Quality of services offered to women with female genital mutilation across health facilities in a Kenyan County.

BACKGROUND: Female genital mutilation (FGM) curtails women's health, human rights and development. Health system as a critical pillar for social justice is key in addressing FGM while executing the core mandate of disease prevention and management. By leveraging opportune moments, events and experiences involving client-provider interactions, relevant FGM-related communications, behavior change and management interventions can be implemented through health facilities or in communities. It is unclear whether Kenyan health system has maximized this strategic advantage and positioning to address FGM. OBJECTIVE: Determine the quality of services offered to women with FGM across health facilities in West Pokot county, Kenya. METHODS: A mixed quantitative data collection strategies were used. These included: client-provider interactions observations with (61) health care workers (HCWs) and women with FGM seeking services; client-exit interviews with (360) women with FGM seeking services. These approaches sought to determine the content and quality of FGM-related care services; and service data abstractions involving records on services sought/offered from (10) facilities in West Pokot. RESULTS: A large (76%) proportion of women had experienced FGM aged 11-15 years, were married between 15 and 19 years (39%), had primary (47.5%) or no education (33%) with income <30 USD/month (43%). Only 14.8% HCWs identified FGM and related complications (11.5%) during consultations. Few FGM-related prevention interventions were implemented with IEC materials (4.9%) for reinforcing preventive messages lacking. Infrastructure (88.5%) for reproductive health services existed albeit limited human resources (14.8%) and capacity (42.6%) for FGM prevention and management; few (16%) health facilities and workers explained the negative consequences of FGM and need for stopping it (15.3%); and while data on women who sought antenatal (ANC), postnatal (PNC) and family planning (FP) care services were available no information of those with FGM or related complications. CONCLUSION: Health systems in high prevalent settings actively interface with women with FGM, despite the primary reason for seeking services not being FGM. Despite high number of women having undergone the cut, diagnosis, prevention, care services, and documentation of FGM and related complications are suboptimal. This underscores the need for health system strengthening in response to the practice with consideration for training kits for HCWs, empowering HCWs, anchoring of FGM indicators in the HMIS, documentation and IEC material to support FGM prevention at service delivery points, and overall integration of FGM into health programs.

Commentary: What should referral pathways have to improve healthcare experiences of women with female genital mutilation in Australia?

BACKGROUND: We examined the evidence derived from healthcare professionals' interfacing with women with female genital mutilation (FGM) to comprehend the referral pathways available to these women in Australia. MAIN BODY: Clinicians encountered FGM-related complications that included ruptured bladder and total urinary incontinence. Midwives and paediatricians indicated a lack of referral pathways for FGM, but used their discretion to refer such cases to social work departments, obstetric/gynaecological units, child protection service providers, psychological counsellors and surgeons. The continuum of care for women with FGM is characterised by inadequate and lack of clear referral pathways. This underscores the need to develop and strengthen referral pathways in response to physical, birthing and psychological complications of women with FGM to improve their care experiences in Australia. SHORT CONCLUSION: Capacity building initiatives on FGM-prevention and care for trainees and practising health providers and community involvement in high burden areas/populations should be implemented to promote uptake and utilization of the referral services. Provision of infrastructural support, including clinical management tools, job aids, posters, referral algorithms and electronic patient records with "drop-down menus" for referral sites for health complications of FGM to reinforce the providers' efforts are critical.

Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly understood. We sought to explore barriers to care seeking among Somali women with complications related to FGM/C in public health facilities in Kenya. METHODS: We drew on qualitative data collected from purposively selected women aged 15-49 years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Data were collected using in-depth interviews (n = 10), key informant interviews (n = 23) and 20 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. RESULTS: Barriers were grouped into four thematic categories. Structural barriers to care-seeking, notably high cost of care, distance from health facilities, and lack of a referral system. Concerns regarding perceived quality of care also presented a barrier. Women questioned health professionals' and health facilities' capacity to offer culturally-sensitive FGM/C-specific care, plus ensuring confidentiality and privacy. Women faced socio-cultural barriers while seeking care particularly cultural taboos against discussing matters related to sexual health with male clinicians. Additionally, fear of legal sanctions given the anti-FGM/C law deterred women with FGM/C-related complications from seeking healthcare. CONCLUSION: Structural, socio-cultural, quality of service, and legal factors limit health seeking for reproductive health problems including FGM/C-related complications. Strengthening health system should consider integration of FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care. The interventions should address health-related financial, physical and communication barriers, while ensuring culturally-sensitive and confidential care.

Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya.

BACKGROUND: Macro and micronutrients including iron and folic acid deficiencies are prevalent in Kenya, particularly during pregnancy resulting in anaemia. Despite efforts to control anaemia in pregnancy by adopting Iron and Folic Acid Supplementation (IFAS), this public health problem has persisted contributing to significant morbidity and mortality. The problem notwithstanding, there is poor IFAS compliance, whose reasons remain poorly understood, calling for their investigations. We sought to determine compliance status with IFAS and associated factors among pregnant women. METHODS: This was a cross-sectional study involving 364 pregnant women aged 15-49 years. Using two stage cluster sampling, one Sub-County and five public health facilities in Kiambu County were selected. All pregnant women attending antenatal clinics who met inclusion criteria and consented to participate in the study were recruited. Compliance with IFAS was defined as taking supplements at least 5 out of 7 days per week. A structured interviewer-administered questionnaire consisting of sociodemographic data, IFAS maternal knowledge and compliance practices was pretested and administered. Descriptive and inferential statistics were computed using STATA. RESULTS: Of the 364 respondents interviewed, 32.7% were IFAS compliant and 40.9% scored high on its knowledge. Of those with high IFAS knowledge, 48.3% were compliant compared to those with low knowledge (21.4%, n = 46, PR = 2.25;95%CI = 1.59-3.17, p < 0.001). Women who were multigravid (30.4%) were less likely to comply compared to primigravid (37.2%, n = 45, PR = 0.68;95%CI = 0.47-0.99, p = 0.004). Multivariate analysis revealed that respondents counselled on management of IFAS side effects (100%, n = 4) were more compliant (76.2%, n = 112, aPR = 1.31;95%CI = 1.19-1.44, p < 0.001). CONCLUSION: Few pregnant women were compliant with IFAS regimen, associated with: knowledgeability on IFAS, primi-gravidity, and IFAS counselling especially on management of its side effects. These underscore the need for approaches to scale up health awareness on the benefits of IFAS, mitigation measures for the side effects, as well as targeted counselling.

Metabolic syndrome and its components among university students in Kenya.

BACKGROUND: Metabolic syndrome refers to a cluster of interrelated disorders which occur together causing an increase in the risk of developing cardiovascular disease and diabetes. The university population is an understudied group despite the increase in the frequency of related disorders and metabolic risk factors e.g. obesity and diabetes, majorly due to the assumption that they are in their most active phase of life therefore healthy. This study looked at metabolic syndrome, the sedentary lifestyles and dietary habits present among university students attending Mount Kenya University, main campus. METHODS: Stratified sampling was used to select participants. Self-administered questionnaires were issued to participants after a signed consent had been obtained following which clinical assessments and biochemical measures were performed. They included blood pressure, fasting blood glucose, triglycerides, high density lipoprotein-cholesterol, anthropometric measurements; height, weight, BMI and waist circumference. Pearson's chi-square tests and non-parametric independent t-test were used to analyze the prevalence of metabolic syndrome criteria per gender, the number of metabolic syndrome criteria per BMI and prevalence of metabolic syndrome criteria per BMI category. RESULTS: The study established that 1.9% of the participants met the criteria for diagnosis of metabolic syndrome according to HJSS criteria. Among the elements, there was statistical difference in gender BMI and waist circumference. 11.8% of subjects had two metabolic syndrome components while 3.1% had three components while none of the subjects had all six components. Elevated triglycerides was the most prevalent defining component for metabolic syndrome. There is a statistically significant relationship between sedentary lifestyle and dietary habits as risk factors to metabolic syndrome. CONCLUSION: Young adults in university have begun developing metabolic syndrome and the risk of developing the syndrome continues to increase with the components being reported in early age. Educational initiatives to encourage healthy eating should be conducted within school premises in order to reinforce the message on healthy diets and physical exercise. Pre-admission screening to identify at risk students should be conducted. Targeted interventions development through a mandatory extra co-curricular program should be enforced to positively engage those at risk.

The 'heat' goes away: sexual disorders of married women with female genital mutilation/cutting in Kenya.

BACKGROUND: Female genital mutilation/cutting (FGM/C) has been implicated in sexual complications among women, although there is paucity of research evidence on sexual experiences among married women who have undergone this cultural practice. The aim of this study was to investigate the sexual experiences among married women in Mauche Ward, Nakuru County. METHODS: Quantitative and qualitative data collection methods were used. Quantitative data were obtained from 318 married women selected through multistage sampling. The women were categorized into: cut before marriage, cut after marriage and the uncut. A questionnaire was used to collect demographic information while psychometric data were obtained using a female sexual functioning index (FSFI) tool. The resulting quantitative data were analyzed using SPSS® Version 22. Qualitative data were obtained from five FGDs and two case narratives. The data were organized into themes, analyzed and interpreted. Ethical approval for the study was granted by Kenyatta National Hospital-University of Nairobi Ethics and Research Committee. RESULTS: The mean age of the respondents was 30.59 ± 7.36 years. The majority (74.2%) had primary education and 76.1% were farmers. Age (p = 0.008), number of children (p = 0.035) and education (p = 0.038) were found to be associated with sexual functioning. The cut women reported lower sexual functioning compared to the uncut. ANOVA results show the reported overall sexual functioning to be significantly (p = 0.019) different across the three groups. Women cut after marriage (mean = 22.81 ± 4.87) scored significantly lower (p = 0.056) than the uncut (mean = 25.35 ± 3.56). However, in comparison to the cut before marriage there was no significant difference (mean = 23.99 ± 6.63). Among the sexual functioning domains, lubrication (p = 0.008), orgasm (p = 0.019) and satisfaction (p = 0.042) were significantly different across the three groups. However, desire, arousal and pain were not statistically different. CONCLUSION: Generally, cut women had negative sexual experiences and specifically adverse changes in desire, arousal and satisfaction were experienced among cut after marriage. FGM/C mitigating strategies need to routinely provide sexual complications management to safeguard women's sexual right to pleasure subsequently improving their general well-being.

Effectiveness of Trans-Theoretical Model-Based Health Education Intervention in the Promotion of Lifestyle Changes among Adults with Metabolic Syndrome: A Randomized Controlled Trial.

Background: Evidence revealed that, 60% of deaths in the underdeveloped nations are linked to adoption of unhealthy lifestyles. The Trans-theoretical Model (TTM) has been considered a useful interventional approach in smoking cessation, drug addiction and weight control. However, its effectiveness in improving changes in dietary pattern, physical activity and alcohol consumption has not been reported. Purpose: The study aimed at evaluating the effectiveness of the TTM-based health education intervention in the promotion of lifestyle changes among adults with metabolic syndrome. Methods: This was an experimental design where 352 participants with metabolic syndrome were allocated to intervention and control groups. The participants were randomly assigned to receive either standard CVD care or a TTM stage-based lifestyle modification intervention for 12-months. Lifestyle patterns were assessed at baseline and endpoint. The mean difference of the subtotal TTM concept scores between pre and post intervention was evaluated using paired t-test. The chi-square test of independence was used to detect between group differences in the categorical data. Results: Most of the participants were in the pre-action stage of change for their dietary intake patterns and physical activity habits at the baseline assessment with no difference between the groups. The intervention group's total level of change toward adopting a healthy lifestyle was markedly (p < 0.001) improved than the control group at the endpoint. The mean scores for the intervention group's stage of change, self-efficacy, and pros and cons of decisional balance all improved significantly (p < 0.001) from the baseline. The mean scores for the control group's pros and cons of decisional balance and stage of change also considerably (p < 0.05) improved from baseline to the endpoint. Conclusion: The TTM- based health education intervention was effective in improving the participants' lifestyles that includes diet and physical activity. Health care providers, particularly nurses should implement TTM staged-matched educational intervention for individuals who are at risk for cardiovascular diseases.

Five-year vegetation conversion from pasture to C3 and C4 plants affects dynamics of SOC and TN and their natural stable C and N isotopes via mediating C input and N leaching.

Understanding the effects of land-use change on stock and composition of soil organic carbon (SOC) and nitrogen (N) is pivotal for sustainable agriculture and climate change adaption. However, previous studies have often overlooked the specific vegetation type in land-use changes. Therefore, a five-year lysimeter block experiment was conducted, involving non-vegetation, eulalia (C4 plant), and clover (C3 plant) to investigate the impacts of vegetation conversion from pasture on SOC and N dynamics and their natural stable isotopes. Non-vegetation caused 26.21 % and 25.88 % decreases in SOC and total N (TN) contents. Five-year eulalia and clover cultivation maintained stable SOC content, with clover exhibiting higher soil TN content. Eulalia-derived soil C was 1.64-7.58 g C kg-1 and SOC loss in eulalia treatment was 1.86-7.90 g C kg-1. Soil δ13C in eulalia increased at a rate of 0.90 ‰ year-1, significantly surpassing clover and non-vegetation treatments. Conversely, soil δ15N decreased over time, showing insignificant difference among all treatments. Eulalia exhibited significantly higher dry weight and δ13C but lower TN content compared with clover. However, no significant differences were observed in total C and δ15N between the two vegetation treatments. Non-vegetation exhibited higher dissolved organic C concentration than two vegetation treatments in 2017, decreasing over time. Dissolved TN and nitrate concentrations in leachate followed the order clover> non-vegetation> eulalia, with nitrate being the predominant form of N leaching from leachate. Our findings reveal that vegetation conversion affects soil C and N contents, and alters their natural isotopes as well as the leaching of labile soluble nutrients. Notably, non-vegetation consistently reduced SOC and TN contents, whereas eulalia cultivation maintained SOC content, improved C/N ratio and δ13C, and reduced N leaching compared with clover cultivation. These results highlight the potential of eulalia as a candidate plant for enhancing C sequestration and reducing N leaching in cold regions of Japan.

α1-Antitrypsin modulates lung endothelial cell inflammatory responses to TNF-α.

α1-Antitrypsin (A1AT) is an acute-phase reactant, but also a major protective factor against the development of chronic obstructive pulmonary disease, a complex disease with sustained chronic inflammation. The lung-protective effects of A1AT have been attributed to the inhibition of proteases involved in lung matrix fragmentation, macrophage activation, and endothelial-cell apoptosis. More recently, A1AT has been shown to directly interact with or modulate the actions of cytokines such as TNF-α or IL-1 in inflammatory cells, but its effect on the lung endothelium, an active participant in the amplification and resolution of inflammation, has received little attention. An important role of A1AT in modulating lung endothelial inflammatory responses is expected, given the high concentrations of circulating A1AT during inflammation and its active uptake by endothelial cells. We investigated the role of A1AT in primary lung microvascular endothelial cell activation by relevant cytokines such as TNF-α or IL-1ß. Despite an initial marked augmentation of TNF-α self-induced transcription, A1AT inhibited TNF-α receptor 1 up-regulation and significantly reduced TNF-α secretion, effects that were associated with inhibition of TNF-α-converting enzyme activity. Furthermore, A1AT inhibited calpain activity, whose activation by TNF-α contributed to decreased intracellular A1AT concentrations. These data indicate that A1AT initially facilitates acute responses of the endothelium to TNF-α, followed by selective inhibition of TNF-α-induced-self amplification, which may assist the vasculature in the resolution of chronic inflammation.

Effect of a Nurse-Led Intervention on Knowledge of the Modifiable Risk Behaviors of Cardiovascular Disease: A Randomized Controlled Trial.

Introduction: Cardiovascular disease (CVD) has disproportionately burdened the low- and middle-income countries where awareness and detection rates remain very low. Interventions directed to promote the community's awareness of CVD may help reduce the public's exposure to behavioral risk factors. However, the effectiveness of interventions implemented through a nurse on knowledge of the modifiable behavioral risk factors and preventive measures of CVD has not been determined in Kenya. Objective: To establish the effect of a nurse-led intervention on knowledge of the modifiable risk behaviors of CVD in adults with metabolic syndrome (MetS) attending a mission-based hospital in Kenya. Methods: A two-armed parallel-group randomized controlled trial design was conducted among 352 adults aged 18-64 years with MetS. The participants were recruited from a faith-based hospital in Nairobi, Kenya and randomly allocated to either a nurse-led lifestyle intervention or a control group. The intervention group received a comprehensive health education intervention using the World Health Organization (WHO) guideline recommendations for CVD control and prevention. Individuals in the control group were exposed to the usual CVD care according to hospital protocol. The duration of the intervention was 12 months. The primary outcome measure was a change in levels of knowledge on the modifiable risk factors and preventive measures of CVD. Outcome measures were assessed at baseline and at 15 months postintervention. Pre- and postintervention difference in the level of knowledge between the two groups was determined using the chi-square test of independence. Results: The knowledge level of CVD risk factors and preventive measures was very low in both groups at baseline without significant difference. A significant improvement in the level of knowledge on CVD risk factors (78.2% vs. 30.4%, p < .001) and preventive measures (74.4% vs. 29.0%, p < .001) was observed in the intervention group relative to the control at the end-line. Conclusions: The nurse-led lifestyle intervention significantly improved participants' level of knowledge on CVD risk factors and preventive measures. It is highly recommended that nurses incorporate routine health education interventions for patients with cardio-metabolic abnormalities.

Community-based lifestyle intervention improves metabolic syndrome and related markers among Kenyan adults.

Purpose: Metabolic syndrome (MetS) is a major risk factor for cardiovascular diseases and type-2 diabetes. The study aimed to establish the efficacy of a community-based lifestyle intervention on MetS in Kenyan adults using randomized control trial involving a 15-months follow up. Methods: A randomized controlled trial involving 352 (18-64 years old) adults with MetS spanning 15-months duration. Participants were recruited from a Nairobi based Mission-led outpatient clinic, randomly assigned equally into intervention and control groups. The intervention group was exposed to a community-based health education on lifestyle modification, while control group was subjected to hospital-led routine care involving treatment and general lifestyle advice. The study was structured into baseline, intervention and evaluation phases with inbuilt data collection in each phase. Physiologic, anthropometric, and clinical parameters as well lifestyle characteristics were measured at baseline, midline and end-line. The parameters were compared across the groups and between the time points during analyses using chi-square test, binary logistic, independent t-test and paired t-test. Results: Proportion of participants with MetS declined significantly (p < 0.001) with marked (p < 0.05) improvement in markers of MetS (elevated BP, raised sugars, cholesterols, central obesity) in intervention compared to control group. The rates of consumption of fruits, vegetables, legumes, nuts and uptake of physical activity significantly (p < 0.05) improved in the intervention group. However, the intake of processed/fast foods, salt, sugar, and alcohol significantly (p < 0.05) declined in the intervention compared to controls by the end-line. Conclusion: One in three adults under the community-based lifestyle intervention had improvement in physiologic, anthropometrics and clinical markers relevant to definition of MetS. Additionally, an improved adherence to the recommended dietary intake and increased uptake of physical activity in adults with MetS was observed. These findings underscore the feasibility, effectiveness and proof of concept for community-based lifestyle approach as a viable strategic intervention for addressing premorbid risk factors for cardiovascular CVDs and diabetes before evolving into full blown conditions in low-income settings.

A Situation Assessment of Community Health Workers' Preparedness in Supporting Health System Response to COVID-19 in Kenya, Senegal, and Uganda.

BACKGROUND: Coronavirus disease (COVID-19) caused socio-economic disruptions across the globe. The pandemic disrupted the health system (HS) calling for reengineering in response to high infection rates, deaths, and resultant containment measures. To deal with COVID-19 and promote resilience, community health workers (CHWs) were engaged across countries. OBJECTIVE: Assess the preparedness of CHWs in supporting health system response in prevention and management of COVID-19 in Kenya, Senegal, and Uganda. METHODS: A mixed methods design study involving national and subnational jurisdictions in the 3 countries. Key informant interviews were conducted with policy actors (16) and health care workers (24) while in-depth interviews involved CHWs (14) and community members (312) subjected to survey interviews. RESULTS: Most (>50%) households survived on

Association of dietary patterns and practices on metabolic syndrome in adults with central obesity attending a mission hospital in Kenya: a cross-sectional study.

OBJECTIVE: Dietary patterns and practices can predispose or protect against metabolic syndrome (MetS) in humans. Despite the growing problem of MetS in adults, the underpinning dietary behaviour is poorly understood. We determined the dietary patterns and practices relevant to MetS in adults with central obesity attending a mission hospital in Kenya. STUDY DESIGN: Descriptive, cross-sectional. SETTING: Outpatient clinic of a mission-based hospital in Nairobi. PARTICIPANTS: Adults (N=404) aged 18-64 years diagnosed with central obesity as per the International Diabetes Federation definition for MetS. PRIMARY OUTCOMES: Anthropometric measurements, clinical-biochemical markers and dietary components, quantity and frequency of food intake, as well as time-lapse between consumption of dinner and sleeping. RESULTS: A high (87.2%) prevalence of MetS was observed for respondents who reported consumption of large amount of carbohydrates (p<0.001), proteins (p<0.001), processed/fast foods (p<0.001) and sugar (p=0.009). Frequent consumption of legumes (p<0.001), nuts (p<0.001), fruits (p<0.001) and vegetables (p=0.021) was linked to reduced MetS. Additionally, longer interval between eating dinner and going to bed was associated with reduced MetS. CONCLUSION: Regular consumption of fruits, vegetables, legumes and nuts, as well as observing sometime after eating dinner before sleeping, was the dietary pattern significantly associated with a lower risk of MetS. Whereas, consumption of a large quantity of carbohydrates, proteins, processed/fast foods and sugar is likely to predispose to MetS. The findings underscore the need to focus on specific dietary intake patterns including frequency, quantity, quality and variety for MetS prevention and management. The MetS-related interventions could be implemented during individual consultation, group and community health messaging sessions.

Gender Differences in the Pattern of Socio-Demographics Relevant to Metabolic Syndrome Among Kenyan Adults with Central Obesity at a Mission Hospital in Nairobi, Kenya.

INTRODUCTION: Metabolic syndrome (MetS) is a risk factor for cardiovascular-related morbidity and mortality. Although the risk factors for MetS are well documented, differences in gender-based demographics among Kenyan adults with central obesity are lacking. AIM: Determine gender differences in the pattern of socio-demographics relevant to metabolic syndrome among Kenyan adults with central obesity at a mission hospital, Nairobi. METHODS: A cross-sectional baseline survey involving adults (N = 404) with central obesity aged 18-64 years, as part of a community-based lifestyle intervention study. Respondents were systematically sampled using the International Diabetes Federation definition for MetS. Lifestyle characteristics, anthropometric, clinical and biochemical markers were measured and analyzed using SPSS. RESULTS: High (87.2%) MetS prevalence associated with advanced age in males (p < 0.001) and females (p = 0.002) was observed. MetS was likely among divorced/separated/widowed (p = 0.021) and high income males (p = 0.002) and females (p = 0.017) with high income. Unemployed males (p = 0.008) and females with tertiary education (p = 0.019) were less likely to have MetS. Advanced age was likely to lead to high blood pressure, fasting blood glucose and triglycerides (p < 0.05). Males were more likely (p = 0.026) to have raised triglycerides, while females (p < 0.001) had low high density lipoproteins. CONCLUSION: A high prevalence of MetS associated with social and gender differences among Kenyan adults with central obesity. These underscore the need to look beyond the behavioral and biological risks and focus on every nuance of gender differences in addressing MetS and CVDs.

Female genital mutilation/cutting: Emerging factors sustaining medicalization related changes in selected Kenyan communities.

Although female genital mutilation/cutting (FGM/C) has declined, it is pervasive albeit changing form among communities in Kenya. Transformation of FGM/C include medicalization although poorly understood has increased undermining abandonment efforts for the practice. We sought to understand drivers of medicalization in FGM/C among selected Kenyan communities. A qualitative study involving participants from Abagusii, Somali and Kuria communities and key informants with health care providers from four Kenyan counties was conducted. Data were collected using in-depth interviews (n = 54), key informant interviews (n = 56) and 45 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. We found families practiced FGM/C for reasons including conformity to culture/tradition, religion, marriageability, fear of negative sanctions, and rite of passage. Medicalized FGM/C was only reported by participants from the Abagusii and Somali communities. Few Kuria participants shared that medicalized FGM/C was against their culture and would attract sanctions. Medicalized FGM/C was perceived to have few health complications, shorter healing, and enables families to hide from law. To avoid arrest or sanctions, medicalized FGM/C was performed at home/private clinics. Desire to mitigate health complications and income were cited as reasons for health providers performing of FGM/C. Medicalization was believed to perpetuate the practice as it was perceived as modernized FGM/C. FGM/C remains pervasive in the studied Kenyan communities albeit changed form and context. Findings suggest medicalization sustain FGM/C by allowing families and health providers to conform to social norms underpinning FGM/C while addressing risks of FGM/C complications and legal prohibitions. This underscores the need for more nuanced approaches targeting health providers, families and communities to promote abandonment of FGM/C while addressing medicalization.

Effect of a community-based approach of iron and folic acid supplementation on compliance by pregnant women in Kiambu County, Kenya: A quasi-experimental study.

INTRODUCTION: Iron and Folic Acid Supplementation (IFAS) is an essential and affordable intervention strategy for prevention of anaemia during pregnancy. The supplements are currently provided for free to pregnant women in Kenya during antenatal care (ANC), but compliance remains low over the years. There is need for diversification of IFAS programme implementation by exploring other distribution channels to complement existing antenatal distribution and ensure consistent access to IFAS supplements. OBJECTIVES: To determine the effect of a community-based approach of IFAS distribution on compliance and assess side-effects experienced and their mitigation by pregnant women in Kiambu County. METHODOLOGY: A pretest-posttest quasi-experimental study design was used, consisting of an intervention and a control group, among 340 pregnant women 15-49 years, in five health facilities in Lari Sub-County in Kiambu County, between June 2016 and March 2017. Community health volunteers provided IFAS supplements, counselling and weekly follow-up to pregnant women in the intervention group while the control group followed standard practice from health facilities. Baseline and endline data were collected during antenatal care and compared. Quantitative data was analyzed using STATA version 14. Analysis of effect of intervention was done using Difference-In-Difference regression approach. RESULTS: Levels of compliance increased by 8% in intervention group and 6% in control group. There was increased awareness of IFAS side-effects across groups. The intervention group reported experiencing less side-effects and were better able to manage them compared to the control group. CONCLUSION: Implementation a community-based approach improved maternal compliance with IFAS, awareness of IFAS side effects and their management, with better improvement being recorded in the intervention group. Hence, there is need to integrate community-based approach with antenatal distribution of IFAS to improve supplementation.

Co-application of poultry-litter biochar with Azolla has synergistic effects on CH4 and N2O emissions from rice paddy soils.

Poultry-litter biochar and Azolla as green manure amendments are reported to enhance paddy soil fertility and rice yields. However, whether their co-application in lowland rice paddies has synergistic effects and whether those benefits are accompanied by greenhouse gas (GHG) emissions remains unknown. The objective of this study was to determine the effects of poultry-litter biochar (hereafter: biochar) and its co-application with Azolla as green manure (hereafter: Azolla), on the simultaneous methane (CH4) and nitrous oxide (N2O) emissions from a lowland paddy soil planted with rice during a single rice growing season in Tsuruoka, Yamagata, Japan. Biochar and Azolla amendments were applied once before rice was transplanted at a density of 20 t ha-1 and 133.9 kg N ha-1, respectively. Compared with NPK, NPK + biochar, and Azolla only treatments, Azolla and biochar co-application (i.e., Azolla + biochar) significantly increased CH4 emissions by 33%-197.6% in the early stages of rice growth (before 63 days after transplanting, DAT), but did not significantly influence CH4 emissions at both late rice growth stages (after 63 DAT,) and whole rice growth period (112 DAT). Conversely, Azolla + biochar significantly reduced N2O emissions by 83.0%-97.1% before 63 DAT, and by 76.4%-95.9% during the whole rice growth period at 112 DAT, with a significantly high interaction between biochar and fertilizer amendments. There were no significant N2O emission differences among all treatments after 63 DAT. Additionally, Azolla + biochar significantly increased rice grain yield by 27.3%-75.0%, and consequently, decreased both yield-equivalent CH4 emissions by 24.7%-25.0% and N2O emissions by 81.8%-97.7%. Our findings suggest that the co-application of poultry-litter biochar and Azolla as green manure offers a novel approach to increase rice yield while reducing the emissions of non-carbon dioxide greenhouse gases.

Counselling and knowledge on iron and folic acid supplementation (IFAS) among pregnant women in Kiambu County, Kenya: a cross-sectional study.

Background: The increased demand for iron and folic acid during pregnancy is not met through diet due to insufficiency or reduced bioavailability of nutrients among women from low income countries. Thus, iron and folic acid supplementation (IFAS) is a promising interventional strategy for control of anaemia during pregnancy. Kenya adopted the global IFAS intervention with a target of 80% coverage by 2017, however, the compliance remains low. Increasing awareness, counselling, communication and community education on IFAS have improved compliance among pregnant women. Thus, we aimed to determine: IFAS knowledge, availability, practices, and content of IFAS counselling among pregnant women attending health facilities in Kiambu County, Kenya. Methods: A cross-sectional study involving 364 pregnant women aged 15-49 years. A two stage cluster sampling, including one sub-county and five public health facilities were used. A pre-tested structured questionnaire consisting of socio-demographic data, maternal knowledge and counselling on IFAS was used. An observation checklist was used to observe practices and content of antenatal counselling session in each facility. Data was analysed using STATA in which descriptive and inferential statistics were computed. Results: Of 364 respondents, less than half (40.9%) scored high on knowledge on IFAS. Women who were counselled on duration of IFAS intake, side effects, and their mitigation were more likely (p <0.005) to have high IFAS knowledge. Although all the health facilities had varied IFAS posters displayed, none had key IFAS counselling documents. Conclusion: Less than half of the pregnant women had high IFAS knowledge, IFAS documents were scarce in health facilities, IFAS counselling information in different health facilities was limited and varied and content of counselling was associated with levels of knowledge on IFAS. This underscores the need to strengthen focused and targeted IFAS counselling for pregnant women and standardization of counselling messages to improve compliance and pregnancy outcomes.