The feasibility, acceptability, cost and benefits of a "communities of practice" model for improving the quality of childcare centres: a mixed-methods study in the informal settlements in Nairobi.

Background: Informal childcare centres have mushroomed in the informal settlements of Nairobi, Kenya to meet the increasing demand. However, centre providers are untrained and the facilities are below standard putting children at risk of poor health and development. We aimed to co-design and test the feasibility, acceptability, cost and potential benefits of a communities of practice (CoP) model where trained community health volunteers (CHVs) provide group training sessions to build skills and improve practices in informal childcare centres. Methods: A CoP model was co-designed with sub-county health teams, centre providers and parents with inputs from Kidogo, government nutritionists and ECD experts and implemented in 68 childcare centres by trained CHVs. Its feasibility and potential benefits were measured quantitatively and qualitatively. Centre provider (n = 68) and CHV (n = 20) knowledge and practice scores before and after the intervention were assessed and compared. Intervention benefits were examined using linear regressions adjusting for potential confounding factors. We conducted in-depth interviews with 10 parents, 10 CHVs, 10 centre providers and 20 local government officials, and two focus groups with CHVs and centre providers. Qualitative data were analysed, focusing on feasibility, acceptability, potential benefits, challenges and ideas for improvement. Cost for delivering and accessing the intervention were examined. Results: The intervention was acceptable and feasible to deliver within existing government community health systems; 16 CHVs successfully facilitated CoP sessions to 58 centre providers grouped into 13 groups each with 5-6 centre providers, each group receiving four sessions representing the four modules. There were significant improvements in provider knowledge and practice (effect size = 0.40; p < 0.05) and quality of centre environment (effect size = 0.56; p < 0.01) following the intervention. CHVs' scores showed no significant changes due to pre-existing high knowledge levels. Qualitative interviews also reported improvements in knowledge and practices and the desire among the different participants for the support to be continued. The total explicit costs were USD 22,598 and the total opportunity costs were USD 3,632 (IQR; USD 3,570, USD 4,049). Conclusion: A simple model delivered by CHVs was feasible and has potential to improve the quality of informal childcare centres. Leveraging these teams and integration of the intervention into the health system is likely to enable scale-up and sustainability in Kenya and similar contexts.

Characterizing anecdotal claims of groundwater contamination in shale energy basins.

The increased societal monitoring of unconventional oil and gas development (UD) has brought forth tremendous scrutiny over the environmental stewardship and subsequent public health impacts of surface and sub-surface activities. Concerns over groundwater quality in shale energy basins have prompted concerned citizens into monitoring UD activities for a series of qualitative parameters, and even coordinating sampling efforts for chemical analysis. Here we present a list of analytical parameters, hierarchically structured to guide concerned citizens through an efficient and cost-effective monitoring program. Utilizing this multi-step testing regime, we assessed groundwater quality from 36 private water wells involved in 19 anecdotal claims of alleged UD-related contamination across the Barnett, Eagle Ford, Haynesville, and Marcellus Shale formations in the United States. Our analytical findings aligned with the landowners' accounts of their situation in only 5 of the 36 collected samples, with several cases revealing environmental abnormalities that were unbeknownst to the landowners but likely unrelated to UD activities. These data are some of the first to assess the relationship between landowner perception and analytical determination in a cohort of highly variable anecdotal cases of alleged groundwater contamination, revealing a notable disconnect that is likely attributable to a myriad of societal and environmental factors. The analytical modalities presented here also serve as a step-wise method in a weight of evidence approach to assess the presence or absence of anthropogenic contamination under the most variable hydrogeological conditions.