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High frequency of antibiotic detection in groundwater in informal settlements is attributed to increased usage and improper disposal, thus difficult to identify sources of antibiotic resistance in the environment, worsened by inadequate sanitation facilities and increased population density, particularly in developing-countries. Reliance on groundwater exposes them to pollutants and risk of antibiotic resistance, in addition to experiencing inequities in accessing vital services. Sulfamethoxazole and trimethoprim, used for prophylaxis by HIV/AIDS patients were tested in 49 groundwater sources in Kisumu, Kenya. Only Sulfamethoxazole (SMX) was found, with a detection frequency of 14.3% and concentrations ranging from below limit of quantification (LOQ) to 258.2 ng/L. Trimethoprim (TMP), marketed in combination with sulfamethoxazole, was not detected, owing to its high distribution coefficient (kPa7.12) and, generally, being a bigger molecule with modest water mobility and solubility. Furthermore, TMP ratio in cotrimoxazole is low (5:1), it is expected that mass loading will be lower, as well as influence of the study area’s hydrogeology, where soil is clayey with high porosity and permeability. Escherichia coli was recovered in 98% (n = 48) of water samples, with counts ranging from 16 to 8,850 MPN/100ml. Additionally, resistance to sulfamethoxazole was identified in 6% (n = 3) samples with Inhibition Zone Diameters of 0.8mm(resistant), 10.5mm (resistant), and 11.5mm (intermediate), but not among samples where SMX was detected. Antibiotic concentrations in water that can cause resistance are unknown because antibiotic-resistant E . coli was not found in water samples where sulfamethoxazole was identified, raising concerns about f environmental resistance spread. Concentration of SMX was lower in a previous research, which only collected water from one groundwater source, than the current study, which included additional samples (49). Presence of SMX and Escherichia coli resistance is of concern and necessitates greater attention and regular monitoring for potential contaminants and resistance trigger to avert potential risks to human health.

Objective To assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy. Methods In a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013. Results The absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0 % in the control and intervention groups, respectively ( p  < 0.001). The absolute increases in SBA delivery rates from the pre-intervention period to the intervention period before the implementation of the free maternity care policy were 4.7 and 17.2 % in the control and intervention groups, respectively ( p  < 0.001). After the policy implementation the absolute increases from pre-intervention to post-intervention were 1.8 and 11.6 % in the control and intervention groups, respectively ( p  < 0.001). Conclusion The percentage of SBA deliveries at the intervention health facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care.

Background: Nearly three million neonates die each year, largely from preventable illnesses in developing countries. Sub-Saharan Africa has disproportionately high neonatal mortality. Community health worker (CHW) programs are a promising intervention to reduce mortality rates. This research evaluates a CHW newborn home visitation program in rural Kenya by assessing the frequency of health service utilization and overnight hospitalization. Methods: This quasi-experimental study encompassed two consecutive years and compared the rate of medical service utilization for neonatal illness in an intervention group with that of a control group using a household survey. Severity of neonatal illness was assessed by need for overnight hospitalization. Household, maternal, and child characteristics were collected. Results: A total of 489 surveys were completed and showed that 35% of not-visited families reported taking their infant to a healthcare facility, compared with 21% of CHW-visited families (P < 0.01). Rates of overnight hospitalization were 6% for not-visited infants and 1% for visited infants (P < 0.01). Few significant differences were found in household, maternal, and child characteristics. Discussion: This study found that a CHW newborn home visitation program in rural Kenya significantly decreased rates of health service utilization and overnight hospitalization, but did not have the power to detect an effect on neonatal mortality.

Economic empowerment, HIV risk and AIDS-related stigma appear intricately intertwined for women in Kenya. Their interaction must be understood in order to implement effective economic interventions that also decrease HIV risk and stigma. We conducted a qualitative study amongst women in a rural Kamba-speaking community of southeastern Kenya to pursue whether engagement in an economic empowerment initiative (a basket weaving cooperative) influences women's perspectives and experiences with HIV risk and AIDS-related stigma. We conducted seven women's focus groups: participants in the local basket-weaving cooperative comprised four focus groups and non-participants comprised the remaining three groups. The HIV status of the women was not known. Three dominant themes emerged from the focus groups: empowerment, pervasive vulnerability and unanticipated social paradoxes. Contradictions found in these themes suggest that economic empowerment can become a double-edged sword. Economic empowerment enhanced perceived individual, domestic and social community status. However, this enhancement was not protective of domestic violence and perceived HIV risk. Social perceptions may have paradoxically contributed barriers to HIV testing and treatment putting women at greater HIV risk. In conclusion, economic empowerment initiatives for women in developing countries in the context of the HIV epidemic should be coupled with peer mediated support and HIV-risk education.

Objective: To assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy. Methods: In a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013. Results: The absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0 % in the control and intervention groups, respectively (p < 0.001). The absolute increases in SBA delivery rates from the pre-intervention period to the intervention period before the implementation of the free maternity care policy were 4.7 and 17.2 % in the control and intervention groups, respectively (p < 0.001). After the policy implementation the absolute increases from pre-intervention to post-intervention were 1.8 and 11.6 % in the control and intervention groups, respectively (p < 0.001). Conclusion: The percentage of SBA deliveries at the intervention health facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care.

Economic empowerment, HIV risk and AIDS-related stigma appear intricately intertwined for women in Kenya. Their interaction must be understood in order to implement effective economic interventions that also decrease HIV risk and stigma. We conducted a qualitative study amongst women in a rural Kamba-speaking community of southeastern Kenya to pursue whether engagement in an economic empowerment initiative (a basket weaving cooperative) influences women's perspectives and experiences with HIV risk and AIDS-related stigma. We conducted seven women's focus groups: participants in the local basket-weaving cooperative comprised four focus groups and non-participants comprised the remaining three groups. The HIV status of the women was not known. Three dominant themes emerged from the focus groups: empowerment, pervasive vulnerability and unanticipated social paradoxes. Contradictions found in these themes suggest that economic empowerment can become a double-edged sword. Economic empowerment enhanced perceived individual, domestic and social community status. However, this enhancement was not protective of domestic violence and perceived HIV risk. Social perceptions may have paradoxically contributed barriers to HIV testing and treatment putting women at greater HIV risk. In conclusion, economic empowerment initiatives for women in developing countries in the context of the HIV epidemic should be coupled with peer mediated support and HIV-risk education. L'émancipation économique, les risques liés au VIH et le stigma du sida semblent étroitement entremêlés pour les femmes au Kenya. Cette interaction doit être comprise pour permettre la mise en œuvre d'interventions économiques efficaces, pouvant aussi diminuer les risques liés au VIH et la stigmatisation vis-à-vis des personnes vivant avec le VIH. Nous avons conduit une étude qualitative parmi des femmes vivant dans une communauté rurale - dont la langue est le kamba - du Sud-Est du Kenya, pour examiner si l'engagement dans une initiative d'émancipation économique (coopérative de vannerie) a un impact sur les points de vue et les expériences des femmes concernant les risques et la stigmatisation liés au VIH/sida. Nous avons animé sept groupes de discussion thématique avec des femmes. Quatre de ces groupes étaient composés de femmes qui participaient à la coopérative locale de vannerie, ce qui n'était pas le cas pour les trois autres groupes. Le statut sérologique de ces femmes vis-à-vis du VIH n'était pas connu. Trois thèmes dominants ont émergé des discussions : l'émancipation, la vulnérabilité généralisée et les paradoxes sociaux non anticipés. Les contradictions relevées pour chacun de ces thèmes suggèrent que l'émancipation économique peut devenir un couteau à double tranchant. L'émancipation économique a renforcé les perceptions sur le statut individuel, domestique et socio-communautaire. Cependant, ce renforcement n'a pas eu d'effet protecteur vis-à-vis de la violence domestique et des perceptions des risques liés au VIH. Les perceptions sociales peuvent avoir, de manière paradoxale, contribué aux obstacles au dépistage et au traitement du VIH qui exposent les femmes à de plus grands risques liés au VIH. En conclusion, les initiatives d'émancipation économique destinées aux femmes dans les pays en développement confrontés à l'épidémie de VIH devraient être couplées à des initiatives de soutien par des pairs et à des programmes d'éducation sur le VIH. Para las mujeres de Kenia, el empoderamiento econémico, el riesgo de contraer el vih y el estigma relacionado con el sida guardan estrecha relacién. Es necesario comprender su interaccién a fin de implementar programas econémicos efectivos que disminuyan el riesgo y el estigma ocasionado por el vih. Los autores llevaron a cabo un estudio cualitativo entre mujeres de una comunidad rural de habla kamba en el sureste de Kenia, con el objetivo de investigar si su participacién en una iniciativa de empoderamiento econémico—una cooperativa de tejido de cestas—incide en las perspectivas y experiencias de las mujeres respecto al riesgo de vih y al estigma ocasionado por el sida. En este sentido, se conformaron siete grupos de enfoque integrados por mujeres: quienes participaban en la cooperativa de tejido de cestas se incorporaron a cuatro de los mismos; mientras que aquellas participantes sin afiliacién a la cooperativa se incorporaron a los tres grupos restantes. El estado de salud de estas mujeres con respecto al vih era desconocido. De los grupos surgieron tres ejes principales: empoderamiento, vulnerabilidad generalizada y paradojas sociales no previstas. En dichos ejes se encontraron contradicciones que demuestran que el empoderamiento econémico puede ser un arma de doble filo. Por un lado, el empoderamiento mejoré el estatus individual, doméstico y social-comunitario. Por el otro, dicho mejoramiento no confiere proteccién ante la violencia doméstica y frente al riesgo percibido del vih. Paradéjicamente, las percepciones sociales pudieron haber creado barreras ante la realizacién del examen de vih y el tratamiento de la enfermedad, lo cual habría colocado a las mujeres en una situacién de mayor riesgo de contraer vih. En conclusién, en países en desarrollo, las iniciativas de empoderamiento econémico para las mujeres en el contexto de la epidemia de vih, deberán ser acompañadas por sus pares, así como por el acceso a informacién relativa a los riesgos de contraerlo.

During the last decade, importation and use of pesticides and fertilizers in Kenya has more than tripled. Improper handling of these chemicals by the small scale farmers continues to pose untold health risks. In an effort to assess the magnitude of the problems emanating from improper handling of these agrochemicals, a study was conducted in a rural agricultural community in Kenya between 1987 and 1990. The study investigated the extent of use of agrochemicals by farmers, the level of awareness of the dangers posed by these chemicals, and attitudes toward agricultural chemicals. The study population consisted of all 1,797 households in 10 villages randomly selected by cluster sampling in the Githunguri location of Kiambu District. Despite their limited knowledge of safety in handling and storage of agrochemicals or of the antidote for accidental poisoning, 100 percent of the farmers used pesticides extensively. Various health complaints related to agrochemicals were reported. By and large the community's or the individuals' lack of awareness of the risks associated with use of agrochemicals is believed to have contributed to some of the agrochemical poisonings. An intervention program has been initiated with the community as a key participant. The main emphasis is on safe procedures for handling agrochemicals.

Economic empowerment, HIV risk and AIDS-related stigma appear intricately intertwined for women in Kenya. Their interaction must be understood in order to implement effective economic interventions that also decrease HIV risk and stigma. We conducted a qualitative study amongst women in a rural Kamba-speaking community of southeastern Kenya to pursue whether engagement in an economic empowerment initiative (a basket weaving cooperative) influences women's perspectives and experiences with HIV risk and AIDS-related stigma. We conducted seven women's focus groups: participants in the local basket-weaving cooperative comprised four focus groups and non-participants comprised the remaining three groups. The HIV status of the women was not known. Three dominant themes emerged from the focus groups: empowerment, pervasive vulnerability and unanticipated social paradoxes. Contradictions found in these themes suggest that economic empowerment can become a double-edged sword. Economic empowerment enhanced perceived individual, domestic and social community status. However, this enhancement was not protective of domestic violence and perceived HIV risk. Social perceptions may have paradoxically contributed barriers to HIV testing and treatment putting women at greater HIV risk. In conclusion, economic empowerment initiatives for women in developing countries in the context of the HIV epidemic should be coupled with peer mediated support and HIV-risk education.

The use and abuse of antibiotics are directly related to the development of drug resistance, a global public health problem. Whereas the majority of research focus is on the use and misuse of antibiotics in drug resistance development, little is known about improper disposal, as a source of contamination in the environment that includes groundwater, especially in informal settlements. This study sought to determine antibiotic use and disposal in informal settlements in Kisumu, Kenya. A random cross-sectional sample of 447 households in selected informal settlements of Kisumu, Kenya was studied. A structured questionnaire was issued to persons heading households. The prevalence of antibiotic use was 43% (n = 193). Among these people, 74% (n = 144) had consulted a health worker in a healthcare facility for a prescription. Respondents did not always complete doses but kept the remainder for the next time they would become ill (54%). About 32% disposed of the remainder of the antibiotics in pit latrines and compost pits (10%) while 4% disposed through burning. Antibiotic use was fairly high despite a low level of awareness of the health effects of consuming water contaminated with antibiotics (35%) (n = 156); p = 0.03. Misuse and inappropriate disposal of antibiotics as identified may lead to a higher risk of antibiotic resistance, increasing the disease burden in the informal settlements.

Abstract Emissions from household cooking technologies constitute a significant source of household air pollution in developing countries. Household air pollution is estimated to be the leading cause of various health problems and mortality. Studies on household air pollution and health impacts are limited in Kenya. Therefore, this study quantified household particulate matter (PM1, PM2.5, PM10) and carbon monoxide (CO) from different cooking fuels and technologies and modelled their impact on health. A control test was conducted in one kitchen, while the field test was conducted in 42 randomly selected households. Particulate matter and CO monitoring were done using the multifunctional air quality detector EGVOC-180 and a carbon monoxide meter, respectively, for the cooking duration. Simulation of health impacts was done using the AirQ + v 2.1 model. Kitchen PM1, PM2.5, PM10, and CO were observed to be higher for biomass cookstoves (three stone cookstove, improved cookstove (chepkube), ceramic jiko, and sawdust jiko) than for non-biomass cookstoves (kerosene stove, liquefied petroleum gas (LPG), and electric cooker) during the cooking period. The average maximum PM2.5 concentrations for the cookstoves were three stone (481.2 μg/m3 ± 119.9 μg/m3), improved cookstove (chepkube) (304.3 μg/m3 ± 82.7 μg/m3), ceramic jiko (162.4 μg/m3 ± 40.3 μg/m3), sawdust jiko (273.1 μg/m3 ± 84.9 μg/m3), kerosene stove (80.2 μg/m3 ± 14.3 μg/m3), LPG (36.3 μg/m3 ± 6.5 μg/m3), and electric cooker (29.5 μg/m3 ± 5.6 μg/m3). The AirQ + model results showed that approximately 484 mortality cases due to acute lower respiratory infection (ALRI), chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), and lung cancer could be averted if households switch from biomass cookstoves (three stone) to clean cooking technologies (LPG and electricity).