Rethinking livestock encroachment at a protected area boundary.

The presence of livestock inside protected areas, or "livestock encroachment," is a global conservation concern because livestock is broadly thought to negatively affect wildlife. The Maasai Mara National Reserve (MMNR), Kenya, exemplifies this tension as livestock is believed to have resulted in the declining wildlife populations, contributing to the strict and sometimes violent exclusion measures targeting Maasai pastoralists. However, research embedded in the real-world setting that draws insights from the social-ecological contexts is lacking. In this study, we conducted 19 mo of ecological monitoring covering 60 sites in MMNR and found that cattle presence inside the reserve did not significantly impact most co-occurring wild herbivores at the current intensity. Using the Hierarchical Modeling of Species Communities and Gaussian copula graphic models, we showed that cattle had no direct associations-neither negative nor positive-with nearly all wild herbivores despite frequently sharing the same space. Moreover, we did not detect resource degradation correlated with cattle presence near the MMNR boundary. Given the colonial legacy and land use history of Mara, entering MMNR becomes the only viable option for many herders. These results corroborate the emerging perspective that the ecological impacts of extensively herded livestock on wildlife might be more nuanced than previously thought. To effectively balance the needs of people, livestock, and wildlife, the current rigid livestock exclusion measures need to be reassessed to holistically consider herbivore ecology, local land use history, and modern politics of protected area management.

Burkitt lymphoma risk shows geographic and temporal associations with Plasmodium falciparum infections in Uganda, Tanzania, and Kenya.

Endemic Burkitt lymphoma (eBL) is a pediatric cancer coendemic with malaria in sub-Saharan Africa, suggesting an etiological link between them. However, previous cross-sectional studies of limited geographic areas have not found a convincing association. We used spatially detailed data from the Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) study to assess this relationship. EMBLEM is a case-control study of eBL from 2010 through 2016 in six regions of Kenya, Uganda, and Tanzania. To measure the intensity of exposure to the malaria parasite, Plasmodium falciparum, among children in these regions, we used high-resolution spatial data from the Malaria Atlas Project to estimate the annual number of P. falciparum infections from 2000 through 2016 for each of 49 districts within the study region. Cumulative P. falciparum exposure, calculated as the sum of annual infections by birth cohort, varied widely, with a median of 47 estimated infections per child by age 10, ranging from 4 to 315 infections. eBL incidence increased 39% for each 100 additional lifetime P. falciparum infections (95% CI: 6.10 to 81.04%) with the risk peaking among children aged 5 to 11 and declining thereafter. Alternative models using estimated annual P. falciparum infections 0 to 10 y before eBL onset were inconclusive, suggesting that eBL risk is a function of cumulative rather than recent cross-sectional exposure. Our findings provide population-level evidence that eBL is a phenotype related to heavy lifetime exposure to P. falciparum malaria and support emphasizing the link between malaria and eBL.

Holocene bidirectional river system along the Kenya Rift and its influence on East African faunal exchange and diversity gradients.

East Africa is a global biodiversity hotspot and exhibits distinct longitudinal diversity gradients from west to east in freshwater fishes and forest mammals. The assembly of this exceptional biodiversity and the drivers behind diversity gradients remain poorly understood, with diversification often studied at local scales and less attention paid to biotic exchange between Afrotropical regions. Here, we reconstruct a river system that existed for several millennia along the now semiarid Kenya Rift Valley during the humid early Holocene and show how this river system influenced postglacial dispersal of fishes and mammals due to its dual role as a dispersal corridor and barrier. Using geomorphological, geochronological, isotopic, and fossil analyses and a synthesis of radiocarbon dates, we find that the overflow of Kenyan rift lakes between 12 and 8 ka before present formed a bidirectional river system consisting of a "Northern River" connected to the Nile Basin and a "Southern River," a closed basin. The drainage divide between these rivers represented the only viable terrestrial dispersal corridor across the rift. The degree and duration of past hydrological connectivity between adjacent river basins determined spatial diversity gradients for East African fishes. Our reconstruction explains the isolated distribution of Nilotic fish species in modern Kenyan rift lakes, Guineo-Congolian mammal species in forests east of the Kenya Rift, and recent incipient vertebrate speciation and local endemism in this region. Climate-driven rearrangements of drainage networks unrelated to tectonic activity contributed significantly to the assembly of species diversity and modern faunas in the East African biodiversity hotspot.

Designing and delivering bioinformatics project-based learning in East Africa.

BACKGROUND: The Eastern Africa Network for Bioinformatics Training (EANBiT) has matured through continuous evaluation, feedback, and codesign. We highlight how the program has evolved to meet challenges and achieve its goals and how experiential learning through mini projects enhances the acquisition of skills and collaboration. We continued to learn and grow through honest feedback and evaluation of the program, trainers, and modules, enabling us to provide robust training even during the Coronavirus disease 2019 (COVID-19) pandemic, when we had to redesign the program due to restricted travel and in person group meetings. RESULTS: In response to the pandemic, we developed a program to maintain "residential" training experiences and benefits remotely. We had to answer the following questions: What must change to still achieve the RT goals? What optimal platforms should be used? How would we manage connectivity and data challenges? How could we avoid online fatigue? Going virtual presented an opportunity to reflect on the essence and uniqueness of the program and its ability to meet the objective of strengthening bioinformatics skills among the cohorts of students using different delivery approaches. It allowed an increase in the number of participants. Evaluating each program component is critical for improvement, primarily when feedback feeds into the program's continuous amendment. Initially, the participants noted that there were too many modules, insufficient time, and a lack of hands-on training as a result of too much focus on theory. In the subsequent iterations, we reduced the number of modules from 27 to five, created a harmonized repository for the materials on GitHub, and introduced project-based learning through the mini projects. CONCLUSION: We demonstrate that implementing a program design through detailed monitoring and evaluation leads to success, especially when participants who are the best fit for the program are selected on an appropriate level of skills, motivation, and commitment.

Metagenomic Detection of Bacterial Zoonotic Pathogens among Febrile Patients, Tanzania, 2007-20091.

Bacterial zoonoses are established causes of severe febrile illness in East Africa. Within a fever etiology study, we applied a high-throughput 16S rRNA metagenomic assay validated for detecting bacterial zoonotic pathogens. We enrolled febrile patients admitted to 2 referral hospitals in Moshi, Tanzania, during September 2007-April 2009. Among 788 participants, median age was 20 (interquartile range 2-38) years. We performed PCR amplification of V1-V2 variable region 16S rRNA on cell pellet DNA, then metagenomic deep-sequencing and pathogenic taxonomic identification. We detected bacterial zoonotic pathogens in 10 (1.3%) samples: 3 with Rickettsia typhi, 1 R. conorii, 2 Bartonella quintana, 2 pathogenic Leptospira spp., and 1 Coxiella burnetii. One other sample had reads matching a Neoerhlichia spp. previously identified in a patient from South Africa. Our findings indicate that targeted 16S metagenomics can identify bacterial zoonotic pathogens causing severe febrile illness in humans, including potential novel agents.

Early agriculture and crop transitions at Kakapel Rockshelter in the Lake Victoria region of eastern Africa.

The histories of African crops remain poorly understood despite their contemporary importance. Integration of crops from western, eastern and northern Africa probably first occurred in the Great Lakes Region of eastern Africa; however, little is known about when and how these agricultural systems coalesced. This article presents archaeobotanical analyses from an approximately 9000-year archaeological sequence at Kakapel Rockshelter in western Kenya, comprising the largest and most extensively dated archaeobotanical record from the interior of equatorial eastern Africa. Direct radiocarbon dates on carbonized seeds document the presence of the West African crop cowpea (Vigna unguiculata (L.) Walp) approximately 2300 years ago, synchronic with the earliest date for domesticated cattle (Bos taurus). Peas (Pisum sativum L. or Pisum abyssinicum A. Braun) and sorghum (Sorghum bicolor (L.) Moench) from the northeast and eastern African finger millet (Eleusine coracana (L.) Gaertn.) are incorporated later, by at least 1000 years ago. Combined with ancient DNA evidence from Kakapel and the surrounding region, these data support a scenario in which the use of diverse domesticated species in eastern Africa changed over time rather than arriving and being maintained as a single package. Findings highlight the importance of local heterogeneity in shaping the spread of food production in sub-Saharan Africa.

Effects of Alcohol Use on Patient Retention in HIV Care in East Africa.

We sought to investigate the association between hazardous alcohol use and gaps in care for people living with HIV over a long-term follow-up period. Adults who had participated in our previously published Phase I study of hazardous alcohol use at HIV programs in Kenya and Uganda were eligible at their 42 to 48 month follow-up visit. Those who re-enrolled were followed for an additional ~ 12 months. Hazardous alcohol use behavior was measured using the Alcohol Use Disorders Identification Test (AUDIT) tool. Deidentified clinical data were used to assess gaps in care (defined as failure to return to clinic within 60 days after a missed visit). The proportion of patients experiencing a gap in care at a specific time point was based on a nonparametric moment-based estimator. A semiparametric Cox proportional hazard model was used to determine the association between hazardous alcohol use at enrollment in Phase I (AUDIT score ≥ 8) and gaps in care. Of the 731 study-eligible participants from Phase I, 5.5% had died, 10.1% were lost to follow-up, 39.5% transferred, 7.5% declined/not approached, and 37.3% were enrolled. Phase II participants were older, had less hazardous drinking and had a lower WHO clinical stage than those not re-enrolled. Hazardous drinking in the re-enrolled was associated with a Hazard Ratio (HR) of 1.88 [p-value = 0.016] for a gap in care. Thus, hazardous alcohol use at baseline was associated with an increased risk of experiencing a gap in care and presents an early target for intervention.

RESUMEN: Buscamos investigar la asociación entre el uso riesgoso de alcohol y retención en programas de VIH a largo plazo. Todo adulto que participó en nuestro estudio previamente publicado sobre el uso riesgoso de alcohol en programas de VIH en Kenia y Uganda era elegible a los 42 a 48 meses de seguimiento. Los adultos reinscritos en la fueron seguidos por ~ 12 meses adicionales. Usamos el "Alcohol Use Disorders Identification Test" (AUDIT) para medir uso de alcohol. Usamos datos clínicos anonimizados para evaluar interrupciones en cuidado (definido como falta de regresar a clínica 60 días después de faltar a una cita). Basamos la proporción de pacientes con una interrupción en cuidado clínico en un estimador momentáneo y no-paramétrico. Determinamos la asociación entre el uso riesgoso de alcohol al inicio de la primera fase (puntuación AUDIT ≥8) con retención en servicios clínicos usando un modelo de riesgo Cox semiparamétrico. De los 731 participantes elegibles, 5.5% habían muerto, 10.1% fueron perdidos a seguimiento clínico, 39.5% se transfirieron a otro programa, 7.5% declinaron participación o no fueron reclutados y 37.3% fueron reinscritos en la segunda fase. Los participantes reinscritos eran mayores, tenían menos uso riesgoso de alcohol y tenían VIH menos avanzado. El uso peligroso del alcohol se vio asociado con el riesgo de tener una interrupción en cuidado clínico [Proporción de Riesgo (Hazard Ratio, HR) PR=1.88, valor-p = 0.016]. Por lo tanto, el uso peligroso del alcohol incrementa el riesgo de perder seguimiento clínico y presenta una oportunidad para intervención.

Comprehensive knowledge of mother-to-child HIV/AIDS transmission, prevention, and associated factors among reproductive-age women in East Africa: insights from recent demographic and national health surveys.

BACKGROUND: More than 90% of babies acquire HIV/AIDS through vertical transmission, primarily due to low maternal comprehensive knowledge about Mother-To-Child Transmission (MTCT) of HIV/AIDS and its prevention, which is a cornerstone for eliminating MTCT of HIV/AIDS. However, there are limitations in terms of population data and literature evidence based on recent Demographic and Health Surveys (DHS) reports in East Africa. Therefore, this study aims to assess the comprehensive knowledge and PMTCT of HIV/AIDS among women, as well as the associated factors in East Africa. METHODS: Our data was obtained from the most recent DHS conducted in East African countries between 2011 and 2022. For our research, we included DHS data from ten nations, resulting in a total weighted sample of 133,724 women for our investigation. A generalized linear model (GLM) with a log link and binomial family to directly estimate prevalence ratios (PR) and 95% confidence intervals (CI) for the association between the independent variables, and the outcome variable. Finally, we reported the adjusted prevalence ratios along with their corresponding 95% CIs. Factors with p-values ≤ 0.2 for univariate logistic regression and < 0.05 were considered statistically significant factors of HIV/AIDS knowledge and prevention in the final model. RESULTS: In this study, 59.41% (95% CI: 59.15-59.67) of respondents had a comprehensive knowledge about MTCT of HIV/AIDS and its prevention among reproductive-age women in East Africa. Being in the older age group, better education level, being from a rich household, employment status, having ANC follow up, institutional delivery, and modern contraception usage were associated with higher prevalence ratios of comprehensive knowledge about MTCT of HIV/AIDS and its prevention. However, being single in marital status, rural women, and traditional contraception utilization were associated with lower ratios of comprehensive knowledge about MTCT of HIV/AIDS and its prevention. CONCLUSION: Our findings indicate a significant deficiency in comprehensive knowledge and prevention of HIV/AIDS MTCT among women in East Africa. These results emphasize the need for significant improvements in maternal-related health services. It is crucial to effectively target high-risk populations during interventions, raise awareness about this critical public health issue, and address the catastrophic consequences associated with MTCT. By implementing these measures, we can make substantial progress in reducing the transmission of HIV/AIDS from mother to child and ensuring better health outcomes for both mothers and their children.

Uptake of human papilloma virus vaccine and its determinants among females in East Africa: a systematic review and meta-analysis.

INTRODUCTION: Cervical cancer is the most common malignant tumor among women. It is the main cause of death among women in sub-Saharan African countries. Particularly, the incidence and mortality rates are highest in East Africa. Even though the burden of human papilloma virus-related cervical cancer is high in East Africa, there is no conclusive evidence about the prevalence of human papilloma virus vaccine uptake and its predictors. OBJECTIVE: To assess the pooled prevalence of human papilloma virus vaccine uptake and its determinants in East Africa. METHOD: Eligible articles were searched on PubMed, Embase, Scopus, Cochrane Library, Google Scholar, and Google. Those articles incorporating the outcome of interest, both analytical and descriptive study designs, and published or unpublished articles at any time were included. Keywords and Medical Subjects Heading terms or synonyms of human papilloma virus vaccine and Boolean operators were used to retrieve the articles. To assure the quality of articles, Joana Brigg's Institute critical appraisal checklist for cross-sectional studies was used. Sensitivity analysis was conducted to assess the heterogeneity among the studies, and a random effect model was used to analyze the pooled effect size. RESULT: A total of 29 articles were included, and the pooled prevalence of HPV vaccine uptake in East Africa was 35% (95% CI: 26-45%). Good knowledge (OR = 1.6, 95%CI; 1.43-1.8), positive attitude (OR = 2.54, 95% CI; 2.13-3.03), ever heard about HPV vaccine (OR = 1.41, 95% CI; 1.03-1.94), mother educational status above college (OR = 1.84, 95%CI; 1.03-3.31), middle wealth index (OR = 1.33, 95%CI; 1.04-1.7), ≥ 9 family size (OR = 0.76, 95%CI; 0.68-0.98), availability of promotion (OR = 2.53, 95%CI: 1.51-4.26), availability of adequate vaccine (OR = 4.84, 95%CI; 2.9-8.08), outreach vaccination practice (OR = 1.47, 95%CI; 1.02-2.12) and family support (OR = 4.3, 95% CI; 2.98-6.21) were the significant factors for the uptake of human papilloma virus vaccine. CONCLUSION: As compared to the global strategic plan, the pooled prevalence of HPV vaccine uptake in east Africa was low. The uptake of the HPV vaccine was higher among adolescents than youths. Knowledge about the HPV vaccine, attitude towards the HPV vaccine, ever hearing about the HPV vaccine, residence, mother's educational status, mother's occupational status, wealth index, and family size were the significant determinants of HPV vaccine uptake. Therefore, we recommend focusing on awareness creation and behavioral change to expand the uptake of vaccines in East Africa.

The prevalence of adolescent fatherhood and its associated factors in East African countries.

BACKGROUND: In developing nations, the phenomenon of adolescent fatherhood poses significant challenges, including increased risk of poverty, limited educational opportunities, and potential negative health outcomes for both the young fathers and their children. However, an overwhelming majority of research has concentrated on teenage motherhood. Adolescent fatherhood in poor nations has been the subject of little research. Few public health initiatives address adolescent fatherhood, in contrast to adolescent motherhood. Although there is currently more being done in industrialized nations to recognize adolescent fatherhood in clinical settings and the academic community. Undeveloped nations such as East Africa still have more problems that need to be resolved. Therefore, this study aimed to investigate the prevalence of and factors contributing to adolescent fatherhood in East Africa. METHODS: Data from the Demographic and Health Surveys (DHS), collected between 2011 and 2022 in 12 East African nations, were used in this analysis. For a weighted sample of 36,316 male adolescents aged 15-24 years, we examined variables, as well as the prevalence of adolescent fatherhood. Univariate and multivariable logistic regression analyses were performed to identify candidate factors and significant explanatory variables associated with the outcome variable. The results are presented using adjusted odds ratios (AORs) at 95% confidence intervals (CIs). P values of ≤ 0.2 and < 0.05 were used to investigate statistically significant factors in the univariate and multivariable logistic regression analyses, respectively. RESULTS: The overall prevalence of adolescent fatherhood was 11.15% (95% CI = 10.83,11.48) in East Africa. Age at first sex 20-24 years (AOR = 0.44, 95% CI:0.41,0.48), age-20-24 years old (AOR = 17.03,95% CI = 15.01,19.33), secondary/higher education (AOR = 0.57, 95% CI = 0.49,0.67), poor wealth (AOR = 2.27, 95% CI = 2.05,2.52), middle wealth (AOR = 1.70, 95% CI = 1.51,1.90), employed (AOR = 3.92, 95% CI = 3.40,4.54), utilized modern contraceptives (AOR = 0.75, 95% CI = 0.69,0.81), and female household heads (AOR = 0.43, 95% CI = 0.39,0.48) were associated with adolescent fatherhood. CONCLUSIONS: Adolescent fatherhood is more prevalent, in East Africa. These findings highlight the complexity of adolescent fatherhood and suggest that multiple factors, including socio-demographic characteristics and reproductive health behaviors, play a role in determining the likelihood of becoming an adolescent father. Understanding these associations can inform targeted interventions and policies aimed at reducing adolescent fatherhood rates and addressing the specific needs and challenges faced by young fathers in East Africa. Further research and interventions should focus on promoting education, economic opportunities, and access to modern contraceptives, while also addressing gender dynamics and social norms that contribute to adolescent fatherhood in the region.

Frequency of cigarette smoking and its associated factors among men in East Africa: a pooled prevalence analysis of national survey using multinomial regression.

BACKGROUND: Despite the harmful effects of smoking, there have been few studies to pinpoint the factors of this habit, and little is known about it in the East African region. For this reason, this study sought to determine the frequency and factors of cigarette smoking among men in the region. METHODS: Data from recent demographic and health surveys carried out in ten East African countries between 2015 and 2022 were analyzed in this study. Data from 87,022 men was collected. The key factors affecting the smoking rates in the area were investigated using binary and multiple multinomial logistic regression. To ascertain if variables were statistically significant in the final model for binary regression and multiple regression, P values of ≤ 0.2 and < 0.05 were used respectively. RESULTS: Overall, about 14.69% of people currently smoke cigarettes. Of this about 11.03 (95% CI = 10.82, 11.24) was for daily active tobacco use. As compared to < 26-year-old men, men with an age range of 26-35 years (RRR = 2.17, 95% CI: 2.01,2.34), 36-45 years (RRR = 2.82, 95% CI: 2.60, 3.07), and > 45 years old (RRR = 3.68, 95% CI: 3.38, 4.02), were using cigarettes daily rather than no-smoking cigarettes. Men who had begun their first sexual intercourse at the age of 7-19 years (RRR = 6.27,95% CI, 5.35,7.35), 20-25 years (RRR = 4.01, 95% CI, 3.40,4.72), and greater than 25 years old (RRR = 3.08, 95% CI, 2.55,3.71) have shown a higher relative risk ratio to smoke cigarette daily rather than using not smoke cigarette respectively, married (RRR = 0.86, 95% CI, 0.79,0.93), divorced or widowed (RRR = 2.51, 95% CI, 2.27,2.77), middle wealth index (RRR = 2.11, 95% CI 1.98,2.24), and rich (RRR = 1.44, 95% CI, 1.34,1.54), secondary/higher education (RRR = 0.72, 05% CI, 0.66,0.77), rural men (RRR = 0.69, 95% CI, 0.65,0.73), employed men (RRR = 1.26,95% CI, 1.17,1.36), mass media exposure (RRR = 0.76, 95% CI, 0.73,0.81), men who have one sex partner (RRR = 1.23,95% CI,1.13,1.35), and more than one sex partner (RRR = 1.63, 95% CI, 1.47,1.79) more times as compared to those participants who had no sex partner respectively. CONCLUSIONS: Men in East African nations were substantially more likely to smoke cigarettes if they were older, had less education, had a higher wealth index, were divorced or widowed, had many sexual relationships, had early sexual activity, resided in an urban area, were employed, or had no media exposure. The identified factors should be considered by policymakers and public health professionals to lower smoking initiation and increase smoking cessation among men.

Impact of partner alcohol use on intimate partner violence among reproductive-age women in East Africa Demographic and Health Survey: propensity score matching.

INTRODUCTION: Intimate Partner Violence (IPV) is the most prevalent form of violence against women globally and is more prevalent than rape or other violent attacks by strangers. Different observational studies have established a strong positive association between alcohol use and intimate partner violence. Even though there are a lot of studies that show the association between partner alcohol use and intimate partner violence limited studies were conducted that show the direct causative relations of partner alcohol use and IPV among reproductive-age women in East Africa. Therefore, this study aimed to determine the effect of partner alcohol use on intimate partner violence in East Africa's recent Demographic and Health Survey (DHS) data with Propensity Score Matching (PSM). METHOD: Community-based cross-sectional study design with a propensity score matching was used from the East African countries' DHS data. A total of the weighted sample size of 72,554 reproductive-age women was used for this study. Propensity score matching analysis was conducted to determine the causal relation between partner alcohol use and intimate partner violence. Intimate partner violence was the outcome variable and partner alcohol use was the treatment variable. Propensity score matching was carried out through Stata software by using psmatch2 of the logit-based model. The assumption of common support was verified and achieved. Mantel-Haenszel boundaries have been used to investigate the possibility of hidden bias in the outcome. RESULT: The prevalence of partner alcohol use and intimate partner violence from East African countries was 37.94 with a CI of (37.58%, 38.29%) and 41.45% with a CI (41.09%, 41.80%) respectively. Partner alcohol use contributed to a 2.78% increase in intimate partner violence according to the estimated average treatment on treated values in the treated and control groups were 59.41% and 31.51%, respectively. Ultimately, it was found that among all research participants, the average effect on the population as a whole was 25.33%. CONCLUSION: We conclude that partner alcohol use has a direct cause for intimate partner violence. Therefore, controlling partner alcohol consumption can reduce the burden of intimate partner violence.

Six in ten female youths in low-income East African countries had problems in accessing health care: a multilevel analysis of recent demographic and health surveys from 2016-2021.

BACKGROUND: Access to health care services is a basic human right, and an individual's health and overall quality of life may suffer as a result of barriers to accessing health services. Access to comprehensive and quality health care is fundamental for promoting and maintaining health, preventing and treating diseases, and reducing premature deaths. However, only half of the African population has access to modern health services. Therefore, this study aimed to assess the health care access and associated factors among female youths in low-income East African countries. METHODS: This study used secondary data from 2016 to 2021 demographic and health surveys of 7 low-income East African countries. A total weighted sample of 51,064 youths was included. A multilevel binary logistic regression was employed to identify the associated factors of access to health care since the data has a hierarchical structure. Adjusted Odds Ratio (AOR) with a 95% confidence interval (CI) at a p-value less than 0.05 was used to measure the association of variables whereas Intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), and proportional change in variance (PCV) were used to measure random effects. RESULT: The overall magnitude of access to healthcare among female youths in low-income East African countries was 38.84% (95% CI: 38.41, 39.26). Youth's educational level, rich wealth status, media exposure, and community level education were the positive while higher youth's age and rural residence were the negative predictors of access to healthcare among female youths. Besides, living in different countries compared to Burundi was also an associated factor for accessing healthcare in low-income East African countries. CONCLUSION: About six in ten female youths were not accessing health care in low-income East African countries. Therefore, to increase healthcare access, health managers and policymakers needed to develop strategies to improve the poor household wealth index, and redistribution of health services for rural residents. The decision-makers and program planners should also work on increasing access to education and media exposure for youths. Further research including health system and quality of service-related factors for accessing healthcare should also be considered by researchers.

Barriers and facilitators of colorectal cancer screening among East African men in Minnesota: a qualitative investigation.

Objective: This study aimed to explore barriers and facilitators to colorectal cancer (CRC) screening among East African men in Minnesota.Design: Six focus groups were conducted in Minneapolis and St. Paul, MN, USA. Participants were asked to describe individual and structural barriers to CRC screening, and discuss strategies that would address individual and structural barriers to screening. Audio-recorded conversations were transcribed verbatim and translated to English. The transcriptions were analyzed using a thematic analysis. Major themes that emerged on individual barriers were lack of knowledge, fear, and privacy.Results: Themes that emerged on structural barriers were distrust in the medical system, lack of health care coverage, and access to the health care system. Education, client reminders, mass media, increased clarity in communication with the provider and translator, and increased access to health care were frequently mentioned strategies to increase CRC screening in the East African community. Participants expressed favorable views toward the concept of patient navigation.Conclusion: Our findings indicate the need to develop culturally appropriate, multi-faced, intervention programs that are aimed at eliminating personal, cultural, and structural barriers.

Unintended pregnancies in the lives of young people in Luwero, Uganda: a narrative analysis.

Using a feminist narrative approach, this article explores how unintended pregnancy can rupture young lives, and how young people respond to and navigate these ruptures. We analyse qualitative data from a longitudinal cohort study in Luwero, Uganda, focusing on narratives of a girl and a boy about their recent experiences of unintended and unwanted pregnancy during COVID-19 school closures. We argue that laws, policies and norms relating to education, sexual and reproductive health, and the family in Uganda position young people in complex and contradictory ways, that create the conditions for unintended pregnancies, and restrict the choices open to them. The analysis traces how pregnancy ruptures their everyday lives, their identities, and relationships. Their narratives reveal gendered ways in which they enact identities to manage the ruptures. Families are sites of contestation, where gender and sexuality are regulated, but are also mobilised by young people to support their efforts to repair the ruptures. Our analysis underscores the importance of working with young people to understand their positionalities, resource environments and social networks as they make and navigate decisions about pregnancy, and of addressing the structural forces that underpin the rupturing effects of pregnancy on teenage lives.

Genomic analysis reveals limited hybridization among three giraffe species in Kenya.

BACKGROUND: In the speciation continuum, the strength of reproductive isolation varies, and species boundaries are blurred by gene flow. Interbreeding among giraffe (Giraffa spp.) in captivity is known, and anecdotal reports of natural hybrids exist. In Kenya, Nubian (G. camelopardalis camelopardalis), reticulated (G. reticulata), and Masai giraffe sensu stricto (G. tippelskirchi tippelskirchi) are parapatric, and thus, the country might be a melting pot for these taxa. We analyzed 128 genomes of wild giraffe, 113 newly sequenced, representing these three taxa. RESULTS: We found varying levels of Nubian ancestry in 13 reticulated giraffe sampled across the Laikipia Plateau most likely reflecting historical gene flow between these two lineages. Although comparatively weaker signs of ancestral gene flow and potential mitochondrial introgression from reticulated into Masai giraffe were also detected, estimated admixture levels between these two lineages are minimal. Importantly, contemporary gene flow between East African giraffe lineages was not statistically significant. Effective population sizes have declined since the Late Pleistocene, more severely for Nubian and reticulated giraffe. CONCLUSIONS: Despite historically hybridizing, these three giraffe lineages have maintained their overall genomic integrity suggesting effective reproductive isolation, consistent with the previous classification of giraffe into four species.

Local sources of vulnerability to climate change and armed conflicts in East Africa.

While socioeconomic and institutional factors are crucial in explaining the onset and evolution of conflicts, recent research suggests that climate change is a further indirect driver acting as a "threat multiplier". This paper focuses on the concept of vulnerability to both climate change and conflicts to explain why some locations are more likely to engage in armed conflicts than others in the presence of a similar level of exposure to climatic changes. In particular, by means of a Spatial Autoregressive Model, we identify a set of local-specific vulnerability factors that increase conflict risk in East Africa. We employ a georeferenced database with a resolution of 25 × 25 km, covering the period 1997-2016. Results from our analysis provide some interesting insights: first, climate change does not increase conflict risk per se, but only in the presence of pre-existing vulnerabilities. Second, resource access and socioeconomic factors play a key role in driving the climate-conflict nexus especially in urban areas. In particular, vulnerability is increased whenever power is not distributed in such a way as to ensure an equitable distribution of resources. Overall, our findings suggest that, by addressing vulnerability factors that prevent adaptive capacity and an equitable distribution of resources, societies may benefit in terms of both diminished conflict risk and alleviation of climate change impacts.

Assessment of the health impacts of air pollution exposure in East African countries.

The health effects of air pollution remain a public concern worldwide. Using data from the Global Burden of Disease 2019 report, we statistically analyzed total mortality, disability-adjusted life years (DALY), and years of life lost (YLL) attributable to air pollution in eight East African countries between 1990 and 2019. We acquired ambient ozone (O3), PM2.5 concentrations and household air pollution (HAP) from the solid fuel from the State of Global Air report. The multilinear regression model was used to evaluate the predictability of YLLs by the air pollutants. We estimated the ratio rate for each health burden attributable to air pollution to compare the country's efforts in the reduction of air pollution health burden. This study found that the total number of deaths attributable to air pollution decreased by 14.26% for 30 years. The drop came from the reduction of 43.09% in mortality related to Lower Respiratory tract Infection (LRI). However, only five out of eight countries managed to decrease the total number of deaths attributable to air pollution with the highest decrease observed in Ethiopia (40.90%) and the highest increase in Somalia (67.49%). The linear regression model showed that HAP is the pollutant of the most concern in the region, with a 1% increase in HAP resulting in a 31.06% increase in regional YLL (R2 = 0.93; p < 0.05). With the increasing ground-level ozone, accompanied by the lack of adequate measures to reduce particulate pollutants, the health burdens attributable to air pollution are still a threat in the region.

Cryptic diversity of Crocidura shrews in the savannahs of Eastern and Southern Africa.

Crocidura (Eulipotyphla, Soricidae) is the most species-rich genus among mammals, with high cryptic diversity and complicated taxonomy. The hirta-flavescens group of Crocidura represents the most abundant and widespread shrews in savannahs of eastern and southern Africa, making them a suitable phylogeographical model for assessing the role of paleoclimatic changes on current biodiversity in open African habitats. We present the first comprehensive study on the phylogeography, evolutionary history, geographical distribution, systematics, and taxonomy of the group, using the integration of mitochondrial, genome-wide (ddRAD sequencing), morphological and morphometrical data collected from specimens over most of the known geographic distribution. Our genomic data confirmed the monophyly of this group and its sister relationship with the olivieri group of Crocidura. There is a substantial genetic variation within the hirta-flavescens group, with three highly supported clades showing parapatric distribution and which can be distinguished morphologically: C. hirta, distributed in both the Zambezian and Somali-Masai bioregions, C. flavescens, known from South Africa and south-western Zambia, and C. cf. flavescens, which is known to occur only in central and western Tanzania. Morphometric data revealed relatively minor differences between C. hirta and C. cf. flavescens, but they differ in the colouration of the pelage. Diversification of the hirta-flavescens group has most likely happened during phases of grassland expansion and contraction during Plio-Pleistocene climatic cycles. Eastern African Rift system, rivers, and the distinctiveness of Zambezian and Somali-Masai bioregions seem to have also shaped the pattern of their diversity, which is very similar to sympatric rodent species living in open habitats. Finally, we review the group's taxonomy and propose to revalidate C. bloyeti, currently a synonym of C. hirta, including the specimens treated as C. cf. flavescens.

Access to Workplace Supports is Positively Associated with Exclusive Breastfeeding among Formally Employed Mothers in Kenya.

BACKGROUND: Mothers in low-income settings who work in agricultural employment are challenged to meet breastfeeding (BF) recommendations. Recent legislation in Kenya mandates maternity leave and workplace supports, yet the relation of these benefits with BF practices is poorly understood. OBJECTIVES: We evaluated the associations with workplace-provided BF supports and BF practices among formally employed mothers in Kenya. The availability of supports was hypothesized to be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). METHODS: We conducted repeated cross-sectional surveys among formally employed mothers at 1-4 d and 6, 14, and 36 wk (to estimate 24 wk) postpartum in Naivasha, Kenya. We used logistic regression adjusted for maternal age, education, physical burden of work, HIV status, and income to evaluate associations between workplace supports and EBF practices. RESULTS: Among formally employed mothers (n = 564), those who used onsite workplace childcare were more likely to practice EBF than those who used community- or home-based childcare at both 6 wk (95.7% compared with 82.4%, P = 0.030) and 14 wk (60.6% compared with 22.2%, P < 0.001; adjusted OR: 5.11; 95% CI: 2.3, 11.7). Likewise, at 14 wk among mothers who currently used daycare centers, a higher proportion of mothers who visited daycare centers at or near workplaces practiced EBF (70.0%) than of those not visiting daycare centers (34.7%, P = 0.005). EBF prevalence was higher among mothers with access to workplace private lactation spaces than among mothers without such spaces (84.6% compared with 55.6%, P = 0.037), and among mothers who lived in workplace housing than those without onsite housing (adjusted OR: 2.06, 95% CI: 1.25, 3.41). CONCLUSIONS: Formally employed mothers in Kenya who have access to and use workplace-provided BF supports were more likely to practice EBF than mothers who lacked these supports. As the Kenya Health Act is implemented, lactation rooms, onsite housing and daycare, and transportation to visit children can all support BF and EBF among employed mothers.