Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya.

Child undernutrition is a persistent challenge in arid and semi-arid areas due to low and erratic rainfall, recurrent droughts and food insecurity. In these settings, caregivers face several challenges in accessing health services for sick and/or malnourished children, including long distances to health facilities, harsh terrain, and lack of money to pay for transportation costs to the health facilities, leading to low service coverage and sub-optimal treatment outcomes. To address these challenges and optimize treatment outcomes, the World Health Organization recommends utilizing community health volunteers (CHVs) to manage acute malnutrition in the community. This study explored the perceptions of community members regarding acute malnutrition treatment by CHVs in Turkana and Isiolo counties in Kenya. The study utilized a cross-sectional study design and included a purposive sample of caregivers of children, CHVs, officers who trained and supervised CHVs and community leaders in the intervention area. Focus group discussions and key informant interviews were used to explore perceptions towards the management of acute malnutrition by CHVs. Generally, caregivers and CHVs perceived the intervention to be beneficial as it readily addressed acute malnutrition treatment needs in the community. The intervention was perceived to be acceptable, effective, and easily accessible. The community health structure provided a platform for commodity supply and management and CHV support supervision. This was a major enabler in implementing the intervention. The intervention faced operational and systemic challenges that should be considered before scale-up.

Increasing mercury bioaccumulation and biomagnification rates of Nile perch (Lates niloticus L.) in Winam Gulf, Lake Victoria, Kenya.

The Nile perch (Lates niloticus L.) commercial fishery for Lake Victoria in East Africa is an important source of revenue and employment. We focused on shifts in food web structure and total mercury (THg) bioaccumulation and biomagnification in Nile perch, and lower food web items collected from Winam Gulf (Kenya) sampled 24 years apart (1998 and 2022). Stable isotope carbon (δ13C) values were higher in all species from 2022 compared to 1998. Stable nitrogen isotope (δ15N) values in baseline organisms were lower in 2022 compared to 1998. In Nile perch, δ15N values were correlated with total length, but the δ15N-length regressions were steeper in 1998 compared to 2022 except for one large (158 cm) Nile perch from 1998 with an uncharacteristically low δ15N value. Total Hg concentrations were lower in lower trophic species from 2022 compared to 1998. However, the THg bioaccumulation rate (as a function of fish length) in Nile perch was greater in 2022 compared to 1998 resulting in 24.2 % to 42.4 % higher wet weight dorsal THg concentrations in 2022 Nile perch for market slot size (50 to 85 cm) fish. The contrasting observations of increased THg bioaccumulation with size in 2022 against decreases in the rate of trophic increase with size and lower THg concentrations of lower food web items imply reduced fish growth and potential bioenergetic stressors on Winam Gulf Nile perch. All samples except 1 large Nile perch (139 cm total length collected in 2022) had THg concentrations below the European Union trade limit (500 ng/g wet weight). However, for more vulnerable individuals (women, children and frequent fish eaters), we recommend a decrease in maximum monthly meal consumption for 55-75 cm Nile perch from 16 meals per month calculated for 1998 to a limit of 8 meals per month calculated for 2022.

Consequences of calamities and their management: The case of COVID-19 pandemic and flooding on inland capture fisheries in Kenya.

During the period February to June 2020, heavy rainfall caused increases in levels and flooding in many lakes in East Africa. This coincided with the COVID-19 pandemic. These calamities affected ecosystems and livelihoods, especially of fishers who depend on fisheries as their only source of livelihood. This study examined the effects of COVID-19 and flooding on the major inland capture fisheries in Kenya to illustrate the effect of such calamities on vulnerable communities to guide interventions. Socioeconomic data were collected across the fish value chains during the peak of COVID-19 pandemic and flooding in Kenya from May to early June 2020. The measures put in place to contain COVID-19 pandemic notably dusk to dawn curfew (66%) and lock-downs (28%) in major cities that act as main fish markets were cited as the main factors that influenced fishing and fishing trade. Negative consequences reported included livelihood losses from the COVID-19 pandemic. Reduced fishing time and trips as well as a decline in consumables such as boat fuel resulted in low fish catches. Although COVID-19 pandemic affected livelihoods, the fish stocks benefited from reduction in fishing effort. Similarly flooding led to livelihood and material losses but positively impacted on stocks through expansion of fish breeding and nursery areas. The respondents recommended that governments should have disaster preparedness programs in place to address such calamities. There is also need for more detailed research on calamities that are increasing in frequency to provide information and data to guide policy and interventions.

Integrated and simplified approaches to community management of acute malnutrition in rural Kenya: a cluster randomized trial protocol.

BACKGROUND: In many low income countries, the majority of acutely malnourished children are either brought to the health facility late or never at all due to reasons related to distance and associated costs. Integrated community case management (iCCM) is an integrated approach addressing disease and malnutrition through use of community health volunteers (CHVs) in children under-5 years. Evidence on the potential impact and practical experiences on integrating community-based management of acute malnutrition as part of an iCCM package is not well documented. In this study, we aim to investigate the effectiveness and cost effectiveness of integrating management of acute malnutrition into iCCM. METHODS: This is a two arm parallel groups, non-inferiority cluster randomized community trial (CRT) employing mixed methods approach (both qualitative and quantitative approaches). Baseline and end line data will be collected from eligible (malnourished) mother/caregiver-child dyads. Ten community units (CUs) with a cluster size of 24 study subjects will be randomized to either an intervention (5 CUs) and a control arm (5 CUs). CHV in the control arm, will only screening and refer MAM/SAM cases to the nearby health facility for treatment by healthcare professionals. In the intervention arm, however; CHVs will be trained both to screen/diagnose and also treat moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) without complication. A paired-matching design where each control group will be matched with intervention group with similar characteristics will be matched to ensure balance between the two groups with respect to baseline characteristics. Qualitative data will be collected using key informant and in-depth interviews (KIIs) and focused group discussions (FGDs) to capture the views and experiences of stakeholders. DISCUSSION: Our proposed intervention is based on an innovative approach of integrating and simplifying SAM and MAM management through CHWs bring the services closer to the community. The trial has received ethical approval from the Ethics Committee of AMREF Health Africa - Ethical and Scientific Review Committee (AMREF- ESRC), Nairobi, Kenya. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, and presented to local and international conferences. TRIAL REGISTRATION: PACTR201811870943127 ; Pre-results. 26 November 2018.

Genetic diversity and spatial population structure of a deepwater snapper, Pristipomoides filamentosus in the south-west Indian Ocean.

The crimson jobfish, Pristipomoides filamentosus Valenciennes, 1830 is an economically important demersal species largely distributed in the Indo-Pacific region. Pristipomoides filamentosus constitutes a significant portion of catch landed in demersal fisheries throughout the species' distribution range. Despite the species' economic importance, there is insufficient data to guide the species' conservation management, especially within the south-western (SW) Indian Ocean region. The aims of the present study were to conduct a population genetic analysis to determine the spatial genetic structure of the species and, whether different management units could be established in the region, using an analysis of both mitochondrial DNA fragment (mtDNA), and nuclear microsatellite loci. A total of 193 fin clips were collected from Seychelles, Kenya, Tanzania, Comoros, Madagascar, Mauritius and South Africa, with each having an established fishery of the species. Both haplotype diversity (h) and expected heterozygosity (HE) for mtDNA and microsatellite loci respectively were generally high for all localities, except for Seychelles where both diversity indices were at the lowest (i.e. h = 0.429 ± 0.134; HE = 0.647 ± 0.059). Even though mtDNA failed to detect population differentiation, the hypervariable microsatellite loci consistently indicated presence of four genetic clusters irrespective of the clustering approach applied. Based on present results, we propose recognising the four clusters as distinct fisheries management units of the species in the SW Indian Ocean region.

Comparing performance of mothers using simplified mid-upper arm circumference (MUAC) classification devices with an improved MUAC insertion tape in Isiolo County, Kenya.

BACKGROUND: A novel approach for improving community case-detection of acute malnutrition involves mothers/caregivers screening their children for acute malnutrition using a mid-upper arm circumference (MUAC) insertion tape. The objective of this study was to test three simple MUAC classification devices to determine whether they improved the sensitivity of mothers/caregivers at detecting acute malnutrition. METHODS: Prospective, non-randomised, partially-blinded, clinical diagnostic trial describing and comparing the performance of three "Click-MUAC" devices and a MUAC insertion tape. The study took place in twenty-one health facilities providing integrated management of acute malnutrition (IMAM) services in Isiolo County, Kenya. Mothers/caregivers classified their child (n=1040), aged 6-59 months, using the "Click-MUAC" devices and a MUAC insertion tape. These classifications were compared to a "gold standard" classification (the mean of three measurements taken by a research assistant using the MUAC insertion tape). RESULTS: The sensitivity of mother/caregiver classifications was high for all devices (>93% for severe acute malnutrition (SAM), defined by MUAC < 115 mm, and > 90% for global acute malnutrition (GAM), defined by MUAC < 125 mm). Mother/caregiver sensitivity for SAM and GAM classification was higher using the MUAC insertion tape (100% sensitivity for SAM and 99% sensitivity for GAM) than using "Click-MUAC" devices. Younden's J for SAM classification, and sensitivity for GAM classification, were significantly higher for the MUAC insertion tape (99% and 99% respectively). Specificity was high for all devices (>96%) with no significant difference between the "Click-MUAC" devices and the MUAC insertion tape. CONCLUSIONS: The results of this study indicate that, although the "Click-MUAC" devices performed well, the MUAC insertion tape performed best. The results for sensitivity are higher than found in previous studies. The high sensitivity for both SAM and GAM classification by mothers/caregivers with the MUAC insertion tape could be due to the use of an improved MUAC tape design which has a number of new design features. The one-on-one demonstration provided to mothers/caregivers on the use of the devices may also have helped improve sensitivity. The results of this study provide evidence that mothers/caregivers can perform sensitive and specific classifications of their child's nutritional status using MUAC. TRIAL REGISTRATIONS: Clinical trials registration number: NCT02833740.