Masinde Muliro University of Science and Technology

Staphylococcus aureus is one of the most common pathogens associated with hospital infections. Although S. aureusinfections have been well studied in developed countries, far less is known about the biology of the pathogen in sub-Saharan Africa. Here, we report on the isolation, antibiotic resistance profiling, whole genome sequencing, and genome comparison of six multi-drug resistant isolates of S. aureus obtained from a referral hospital in Kakamega, western Kenya. Five of the six isolates contained a 20.7-kb circular plasmid carrying blaZ (associated with resistance to b-lactam antibiotics). These five strains all belonged to the same sequence type, ST152. Despite the similarity of the plasmid these isolates, whole genome sequencing revealed that the strains differed, depending on whether they were associated with hospital-acquired or community-acquired infections. The most striking difference was the larger number of horizontally-acquired genomic islands (GIs) in the nosocomial isolates. The data indicate that adaptation to the hospital environment may also be linked with mutations in the uvrAB genes.

Klebsiella pneumoniae are a frequent cause of nosocomial infections worldwide. Sequence type 147 (ST147) has been reported as a major circulating high-risk lineage in many countries, and appears to be a formidable platform for the dissemination of antimicrobial resistance (AMR) determinants. However, the distribution of this pathogen in Western African hospitals has been scarcely studied. The main objective of this work was to perform whole genome sequencing of K. pneumoniae isolates from a referral hospital in Kakamega (Kenya) for genotyping and identification of AMR and virulence determinants.

Introduction: Point-of-care molecular diagnostics offer solutions to the limited diagnostic availability and accessibility in resource-limited settings. During the COVID-19 pandemic, molecular diagnostics became essential tools for accurate detection and monitoring of SARS-CoV-2. The unprecedented demand for molecular diagnostics presented challenges and catalyzed innovations which may provide lessons for the future selection of point-of-care molecular diagnostics. Areas covered: We searched PubMed from January 2020-August 2023 to identify lessons learned from the COVID-19 pandemic which may impact the selection of point-of-care molecular diagnostics for future use in sub-Saharan Africa. We evaluated this in the context of REASSURED criteria (Real-time connectivity; Ease of specimen collection; Affordable; Sensitive; Specific; User-friendly; Rapid and robust; Equipment free; and Deliverable to users at the point of need) for point-of-care diagnostics for resource-limited settings. Expert opinion: The diagnostic challenges and successes during the COVID-19 pandemic affirmed the importance of the REASSURED criteria but demonstrated that these are not sufficient to ensure new diagnostics will be appropriate for public health emergencies. Capacity for rapid scale-up of diagnostic testing and transferability of assays, data, and technology are also important, resulting in updated REST-ASSURED criteria. Few diagnostics will meet all criteria, and trade-offs between criteria will need to be context specific.

The World Health Organization declared coronavirus disease of 2019 as an epidemic and public health emergency of international concern on January 30 th , 2020. Different factors during a pandemic can contribute to low quality of life in the general population. Quality of life is considered multidimensional and subjective and is assessed by using patient reported outcome measures. The aim and objective of this review is to assess the impact of coronavirus disease of 2019 and associated factors on the Quality of Life in the general population. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A protocol was registered in the international Prospective Register of Systematic Reviews database(CRD42021269897). A comprehensive electronic search in PubMed, EBSCO Host Research Databases, MEDLINE and Google scholar search engine was conducted. A total number of 1,7000,074 articles were identified from electronic search. 25 full text articles were retained for qualitative synthesis and seventeen articles for quantitative analysis. Seven main quality of life scales were used to assess the quality of life of the general population; World Health Organization Quality of Life-bref, EuroQuality of Life-Five dimensions, Short Form, European Quality of Life Survey, coronavirus disease of 2019 Quality of Life, General Health Questionnaire12 and My Life Today Questionnaire. The mean World Health Organization Quality of Life-brief was found to be 53.38% 95% confidence interval [38.50–68.27] and EuroQuality of Life-Five dimensions was 0.89 95% confidence interval [0.69–1.07]. Several factors have been linked to the Coronavirus disease of 2019 such as sociodemographic factors, peoples living with chronic diseases, confinement and financial constraints. This review confirms that the Coronavirus disease of 2019 pandemic affected the quality of life of the general population worldwide. Several factors such as sociodemographic, peoples living with chronic diseases, confinement and financial constraints affected the quality of life.

The water–energy–food (WEF) nexus approach is important in promoting sustainable management of resources, alleviating poverty and achieving sustainable development goals (SDGs). Given the importance of the WEF nexus, it is currently being promoted and developed in most countries via policy interventions as a response to climate change‐related problems and other nexus challenges. In the past, Kenya faced numerous challenges in achieving SDGs concerning food, water, and energy security. To address this, cross‐sectorial policy interventions, legal instruments, and institutional frameworks have been developed. Therefore, this review evaluates the major policies, interventions, and strategies related to WEF, their interconnection, and their relevance to SDG targets. The review also assesses the efficacy of the policies and highlights gaps and potential for policy change. The key strategic interventions considered include Kenya Vision 2030, agriculture, energy, and water policies. From the review, there have been some successful policy measures. However, the intricate interconnections between the water, energy, and food sectors necessitate a more integrated strategy for achieving sustainability. The water policy is central to the achievement of SDGs for WEF security. Therefore, there is a need for the implementation of a holistic approach between the WEF agencies and stakeholders to address the policy interventions required for sustainable development. Water policies should be aligned with other interlinked policies on food, energy, and the environment.

Geopolymer concrete has been the ideal replacement for Ordinary Portland cement concrete in producing green concrete. The binder in geopolymer concrete is a cementitious paste made from amorphous Aluminosilicate and activated by an Alkaline solution. The geopolymerization process is initiated at elevated temperatures. Thus, the curing requires elevated temperatures. This curing method limits the application of geopolymer concrete in the construction industry. In a geopolymer mix, the presence of Calcium ions allows the formation of Calcium Aluminate Silicate and Calcium Silicate Hydrate gels, allowing ambient temperature curing. Therefore, this study investigates the effect of micro lime on the Sugarcane Bagasse Ash-based geopolymer concrete. The micro lime was added to the geopolymer concrete in 1, 3, 5 and 7% by the Sugarcane Bagasse Ash weight. A mix design was based on a Densified Mix Design Algorithm. The tests carried out included compressive strength and water absorption. Ambient curing of the SCBA-based geopolymer concrete was achieved with 1% of the micro lime. The compressive strength increased with the increase of the micro lime, 10N/mm2 at 1%, to 18.25N/mm2 at 7% micro lime. The ambient temperature-cured geopolymer concrete at 3% micro lime had the lowest water absorption rate.

Vaccine hesitancy is a significant global public health concern. This study sought to determine the correlates of acceptance and hesitancy regarding COVID-19 vaccines in rural populations of selected counties in Western Kenya and assess the strategies that can be used to improve COVID-19 vaccine acceptance in Kenya. The study used a quantitative research strategy with a sample of 806 individuals in the Kisumu, Vihiga, and Kakamega counties. Descriptive statistics, correlations and regression analyses were used. Of the 806 study participants, 55% were males and 45% females. Vaccine acceptance was significantly associated with being a male (AOR: 1.46, 95% CI: 1.24–1.59, p < 0.031), having no formal education (AOR: 2.25, 95% CI: 1.16–4.40, p < 0.02), working in the private sector (AOR: 5.78, 95% CI: 3.28–10.88 p < 0.02), and have low income (KES 0–999 (USD 0–9.16)), (AOR: 2.35, 95% CI: 1.13–3.47, p < 0.02). Conclusions: The current study suggests that male gender, no formal education, working in the private sector, and low income KES 0–999 (USD 0–9.6) are significant factors influencing awareness of and possible acceptance of COVID-19 vaccination.

Poorly managed medical waste produced at the health facilities are potential source of infections including occupational exposure to Hepatitis B Virus (HBV). This study evaluated the prevalence of HBV infection among healthcare workers (HCWs) in Kisumu County. We determined prevalence of HBV infections among 192 HCWs from nine purposively selected high-patient volume public hospitals in Kisumu County. A structured questionnaire was administered, and 4.0 ml of venous blood sample collected for Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and total hepatitis B core antibody (anti-HBc) testing using enzyme immunoassay (EIA). Of 192 HCWs sampled, 52.1% were males and the median participants age was 34.4 years with interquartile range (IQR) of 11 (28–39) years. Most participants (44%) had worked for between 1–5 years. There was low HBV vaccine uptake with 35.9% completing the required 3 doses, while 40.6% had never been vaccinated. HBV prevalence was 18.8% (36/192), prevalence of past resolved infection was 25.5% (49/192), while 37.5% (72/192) of HCW had evidence of vaccine-derived immunity and 17.7% (34/192) were susceptible. HBV prevalence among HCW who had worked for less than one year and those who had never been vaccinated was 37.5% and 35.9% respectively. Significant risk of HBV lifetime exposure was noted among HCWs with one vaccine dose, those with no known exposure, while highest in those with knowledge on HBV transmission (aOR, 7.97; 95% CI, 2.10–153.3, p-value = 0.008). HCWs who had received ≥2 doses of HBV vaccine (aOR, 0.03; 95% CI, 0.01–0.10, p-value = <0.0001) had significant HBV protection. Duration of service was not associated with HBV among HCWs. HBV prevalence was high among HCWs from nine high patient volume public hospitals in Kisumu County. Efforts to strengthen HBV vaccination uptake and dose completion are needed to reduce HBV infections among HCWs.

Globally, conflicts are phenomenal and are caused by multivariate risk factors; however, purely land-use-based conflicts are gradually growing and becoming conspicuous. Authoritative studies project that violent conflicts over land and resource distribution are set to be on the upsurge with the African Continent set to bear the greatest brunt. These are set to take homegrown extremist trajectories thereby redefining global, regional, and national counter-violent extremist architecture. This paper sought to investigate demographic risk factors for homegrown extremism in the squatter enclaves of Mount Elgon region. Using a convergent parallel mixed method research design, primary data were collected from 400 households. Study findings on demographic risk factors for homegrown extremism are an antithesis of conventional Euro-American train of thoughts. The results established that that gender (being both male and female), age (being older) and being married posed a high risk factor to homegrown extremism. The paper recommends the need to expedite multi-stakeholder human development needs based approaches in pursuit to reverse the risk of homegrown extremism in the squatter enclaves of Mount Elgon region, Kenya.

Background: Plasmodium falciparum malaria is a leading cause of pediatric morbidity and mortality in holoendemic transmission areas. Severe malarial anemia [SMA, hemoglobin (Hb) < 5.0 g/dL in children] is the most common clinical manifestation of severe malaria in such regions. Although innate immune response genes are known to influence the development of SMA, the role of natural killer (NK) cells in malaria pathogenesis remains largely undefined. As such, we examined the impact of genetic variation in the gene encoding a primary NK cell receptor, natural cytotoxicity-triggering receptor 3 (NCR3), on the occurrence of malaria and SMA episodes over time. Methods: Susceptibility to malaria, SMA, and all-cause mortality was determined in carriers of NCR3 genetic variants (i.e., rs2736191:C > G and rs11575837:C > T) and their haplotypes. The prospective observational study was conducted over a 36 mos. follow-up period in a cohort of children (n = 1,515, aged 1.9-40 mos.) residing in a holoendemic P. falciparum transmission region, Siaya, Kenya. Results: Poisson regression modeling, controlling for anemia-promoting covariates, revealed a significantly increased risk of malaria in carriers of the homozygous mutant allele genotype (TT) for rs11575837 after multiple test correction [Incidence rate ratio (IRR) = 1.540, 95% CI = 1.114-2.129, P = 0.009]. Increased risk of SMA was observed for rs2736191 in children who inherited the CG genotype (IRR = 1.269, 95% CI = 1.009-1.597, P = 0.041) and in the additive model (presence of 1 or 2 copies) (IRR = 1.198, 95% CI = 1.030-1.393, P = 0.019), but was not significant after multiple test correction. Modeling of the haplotypes revealed that the CC haplotype had a significant additive effect for protection against SMA (i.e., reduced risk for development of SMA) after multiple test correction (IRR = 0.823, 95% CI = 0.711-0.952, P = 0.009). Although increased susceptibility to SMA was present in carriers of the GC haplotype (IRR = 1.276, 95% CI = 1.030-1.581, P = 0.026) with an additive effect (IRR = 1.182, 95% CI = 1.018-1.372, P = 0.029), the results did not remain significant after multiple test correction. None of the NCR3 genotypes or haplotypes were associated with all-cause mortality. Conclusions: Variation in NCR3 alters susceptibility to malaria and SMA during the acquisition of naturally-acquired malarial immunity. These results highlight the importance of NK cells in the innate immune response to malaria.

Al–Mg–Si alloys are used in aircraft, train, and car manufacturing industries due to their advantages, which include non-corrosivity, low density, relatively low cost, high thermal and electrical conductivity, formability, and weldability. This study investigates the bulk mechanical properties of Al–Mg–Si alloys and the influence of the Si/Mg ratio on these properties. The Al cell was used as the starting structure, and then nine structures were modeled with varying percentages of aluminium, magnesium, and silicon. Elastic constant calculations were conducted using the stress–strain method as implemented in the quantum espresso code. This study found that the optimum properties obtained were a density of 2.762 g/cm3, a bulk modulus of 83.3 GPa, a shear modulus of 34.4 GPa, a Vickers hardness of 2.79 GPa, a Poisson’s ratio of 0.413, a Pugh’s ratio of 5.42, and a yield strength of 8.38 GPa. The optimum Si/Mg ratio was found to be 4.5 for most of the mechanical properties. The study successfully established that the Si/Mg ratio is a critical factor when dealing with the mechanical properties of the Al–Mg–Si alloys. The alloys with the optimum Si/Mg ratio can be used for industrial applications such as plane skins and mining equipment where these properties are required.

Background. Aquatic insect community structure is dynamic due to threats by anthropogenic activities coupled with changing climatic conditions. Te insect's survival is dependent on the substrate, water quality, and environmental efects. Te changes in water quality infuence their distribution and abundance and are refected in spatial and temporal trends. Tis study sought to document the efects of spatial variation on aquatic insects in Winam Gulf of Lake Victoria, Kenya. Materials and Methods. Systematic random design was used in sampling, and water quality parameters were assessed. Insects were sampled by profundal lake procedure, pooled, sorted, and identifed based on the morphological approach and diversity indices analyzed. Te relationship between insects and water quality was established. Results. Statistical homogeneity in water quality parameters was documented with the exception of nitrates, nitrites, soluble reactive phosphorus, ammonium, and silicates, which displayed signifcant variation at p < 0.05. A total of 383 individual insects representing 19 species, 19 genera, 16 families, and six orders were obtained from Winam Gulf. Hemiptera, Ephemeroptera, and Diptera were the most predominant orders, respectively. Chironomus spp. and Ablebesmyia spp. were representatives of the Chironomidae family. Species distribution and water quality were determined using cluster analysis (CA) and conical correspondence analysis (CCA). Conclusion. Te fndings of this study demonstrated that spatial variations were associated with change in water quality and had a corresponding infuence on insect community structure.

This study investigated the levels, mass loadings, removal efficiency, and associated ecotoxicological risks of selected endocrine disrupting chemicals (EDCs), namely, dibutylphthalate (DBP), diethylhexylphthalate (DEHP), dimethylphthalate (DMP), linuron (LNR) and progesterone (PGT) in wastewater, sludge, and untreated dry biosolid (UDBS) samples from twelve wastewater treatment plants (WWTPs) in nine major towns in Kenya. Analysis was done using high-performance liquid chromatography coupled with triple quadrupole mass spectrometry (LC-MS/MS). All the wastewater influents had quantifiable levels of EDCs with DBP being the most abundant (37.49%) with a range of 4.33 ± 0.63 to 19.68 ± 1.24 μg L−1. DEHP was the most abundant in sludge and accounted for 48.2% ranging between 278.67 and 9243.49 ng g−1 dry weight (dw). In the UDBS samples, DEHP was also the most abundant (40%) of the total EDCs detected with levels ranging from 78.77 to 3938.54 ng g−1 dw. The average removal efficiency per pollutant was as follows: DMP (98.7%) > DEHP (91.7%) > PGT (83.4%) > DBP (77.9%) > LNR (72.2%) which can be attributed to sorption onto the biosolid, biological degradation, photolysis, and phytoremediation. The pH was negatively correlated to the EDC concentrations while total dissolved solids (TDS), chemical oxygen demand (COD), biochemical oxygen demand (BOD5), and electrical conductivity (EC) were positively correlated. The mass loadings were as high as 373.33 g day−1 of DBP in the treatment plants located in densely populated cities. DEHP and PGT had their Risk Quotients (RQs) > 1, posing a high risk to biota. DMP, DBP, and LNR posed medium risks as their RQ values were between 0.1 and 1. EDCs are therefore loaded to environmental compartments through either the effluent that loads these pollutants into the receiving aquatic ecosystem or through the UDBS, which are used as fertilizers in agricultural farmlands causing potential toxicological risks to aquatic and terrestrial life.

This study investigates the increased commercialization of African indigenous vegetables (AIV)-former subsistence crops such as African nightshade, cowpea leaves and amaranth species grown mainly by women-from a feminist economics perspective. The study aims to answer the following research question: How does AIV commercialization affect the gendered division of labor, women's participation in agricultural labor, their decision-making power, and their access to resources? We analyze commercialization's effects on gender relations in labor and decision-making power and also highlight women's agency. Based on a mixed method design and analyzing household-level panel data and qualitative focus groups from Kenya, we observe an economic empowerment of women that we relate to women's individual and collective strategies as well as their retention of control over AIV selling and profits. Yet, while we see economic empowerment of women through com-mercialization-how they broaden their scope of action and are empowered by generating revenue-that does not contribute to a redistribution of labor or land rights, which are key for gender equality, instead it increases women's labor burden.

Background Preconception care (PCC) is the provision of health interventions to women and couples before conception occurs and is valuable in preventing and controlling noncommunicable diseases. In Africa, more so in Kenya, maternal and neonatal health indicators have remained poor. The key constraint limiting progress has been the gap between what is needed and what exists in terms of skills and human resources and infrastructure. This gap was yet to be measured for PCC in Kenya, more so in Kisumu County. Methods. Using a cross-sectional design, this study specifically sought to determine the rate of self-reported PCC provision and to illustrate how it is influenced by health provider characteristics. Structured interviews were conducted with health providers (n=476) to ascertain their knowledge, perceptions and practice of PCC care. The significance of the differences in proportions was determined by the x². Student’s t test and linear regression were used to show the relationship between the factors and the PCC provision rate. Results. Self-reported PCC provision was estimated at 37%. There was a significant difference in the mean for cadres {nurses (M=70.04, SD=8.951) and non-nurses (M=71.90, SD=8.732); t (473) =-2.23, P=0.026)}, years of experience up to 5 years (M=72.04, SD=8.417) and more than 5 years (M=69.89, SD=9.283); t (465) =2.63, P = 0.009. PCC inclusion in reporting tool was a significant predictor (β=0.6, t (26) =8.64, P<0.001, 95% CI=0.46-0.74) of provision. The mean provision per level (M=60.21, SD=4.902; t (26) =-5.06, P<0.001) and type of service (M=69.36, SD=4.924; t (26) =4.63, P<0.001) were significantly different. The health workers felt PCC was an important service whose provision was low due to inadequate human capital investment. Conclusion. Self-reported provision of PCC by health workers was relatively low and was influenced by the cadre of health workers and their years of experience. It was also demonstrated that the inclusion of PCC in reporting systems, the levels and types of facilities were significant predictors of self-reported provision of PCC. Investing in on-the-job training for health providers, especially nurses, establishing a reporting system for PCC activities, and providing care in primary health facilities in rural areas can improve PCC service delivery.

Background: Globally, contact lenses are an important part of the management process for refractive errors. Contact lenses are accepted widely in developed countries, but they are currently less used in developing countries like Kenya. Aim: To assess the knowledge, attitudes and perceptions (KAP) (both pre- and post-education) to contact lens uptake specifically for correction of refractive errors by patients attending a Kenyan University Eye Clinic. Setting: Academic Vision Centre, Masinde Muliro University of Science and Technology, Kakamega, Kenya. Methods: A quasi-experimental cross-sectional study was performed by reviewing all records from February 2014 to March 2020; 360 records were purposively selected. Thereafter, a structured questionnaire with educative content on contact lenses was administered by phone and online to determine KAP. Responses were collected over a period of one month. Knowledge, attitudes and perceptions were categorised and scored, and descriptive statistics and paired t-tests were used for data analysis. Results: More women (58.3%) and mostly students (59.2%) participated, with ages from 16 to 38 years (mean age and standard deviation of 22.85 ± 4.32). Overall, there was poor knowledge of contact lenses for refractive errors (96.7%). Attitudes to contact lenses were unfavourable, both pre- and post-education (94.7% and 92.8%). Perceptions of contact lens uptake were negative pre-education (92.5%) but positive post-education (95.3%). Conclusion: Education changed perceptions of contact lens usage for refractive errors correction, but even with some focused education, negative attitudes and poor knowledge regarding contact lenses persisted in the sample. Practitioners should inform patients about contact lenses as a possibility for refractive error management, and institutions training eye care providers should consolidate their clinical teaching regarding contact lenses. Contribution: This study showed that the more people with refractive errors are knowledgeable about contact lenses, the more uptake of contact lenses will happen, optometrists and ophthalmologists should educate people more on contact lenses.

Drought assessment is necessary for creating adaptation and resilience measures for the livelihoods of the affected communities. This study assessed drought trends in Kenya's Upper Ewaso Ng'iro River Basin (UENB) from 1981 to 2020. A Standardized Precipitation Index (SPI), a precipitation-based index, and a Standardized Precipitation Evapotranspiration Index (SPEI), a multivariate index that considers the difference between precipitation and potential evapotranspiration (PET), were used to evaluate drought severity and frequency over varying timescales. Monthly rainfall and temperature data for 10 stations within the basin were analyzed to calculate the SPI and SPEI time series values for 3, 6, and 12 months. The results demonstrate an alarming increase in the severity and frequency of drought events in the UENB since 1999. Additionally, the study reveals that the SPI and SPEI indices differ in identifying temporal and spatial drought characteristics, with longer timescales showing improved accuracy. Notably, the SPEI identifies more extensive and severe drought periods in the region compared to the SPI. The research findings are crucial in guiding policy decisions related to SDGs as they provide valuable information on drought trends necessary for implementing effective drought adaptation and resilience measures and promoting sustainable development in the UENB. HIGHLIGHTS The study describes the temporal and spatial evolution characteristics of meteorological drought in the region.; There has been an increase in drought frequency in the basin over the 40 years, and it has significantly increased since 2000.; The study shows the relationship between the SPI and SPEI in identifying drought events and that the SPEI performed better than the SPI in identifying drought.;