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The extent of flooding in vulnerable inland and lacustrine systems can demonstrate the coverage and the magnitude of such phenomenon for policy enhancement. This study examined the extent of flooding due to rising water levels in selected Afrotropical lakes to guide interventions that would sustain the livelihoods of communities affected. The years that were most prone to flooding (2010 and 2020) were used as a baseline in the extraction of changes in spatial extent and area of lacustrine shoreline, and rainfall and satellite altimetry data, using geospatial and remote sensing technologies. The extent of flooding was strongly but insignificantly related ( R 2 = 0.63; p = 0.07) to the sizes of the studied lakes and the amount of rainfall. Lakes with the smallest surface areas such as Baringo and Naivasha showed the greatest increase in flooding of 52.63% and 42.62%, respectively. Larger lakes such as Lakes Victoria (1.05%), Turkana (3.77%), and Tanganyika (0.07%) had the lowest increases in areal extent. Furthermore, the topography of the lakes studied further determined the residence time and the extent of flooding, such that lakes such as Edward (−0.09%) and Rukwa (−3.25%) receded during the period when other lakes were flooding. The information and data presented here provides the most up-to-date quantification of flooding to support adaptation strategies for inland lake systems and guide policy implementation.

Treatment outcomes for acute malnutrition can be improved by integrating treatment into community case management (iCCM). However, little is known about the cost‐effectiveness of this integrated nutrition intervention. The present study investigates the cost‐effectiveness of treating moderate acute malnutrition (MAM) through community health volunteer (CHV) and integrating it with routine iCCM. A cost‐effectiveness model compared the costs and effects of CHV sites plus health facility‐based treatment (intervention) with the routine health facility‐based treatment strategy alone (control). The costing assessments combined both provider and patient costs. The cost per DALY averted was the primary metric for the comparison, on which sensitivity analysis was performed. Additionally, the integrated strategy's relative value for money was evaluated using the most recent country‐specific gross domestic product threshold metrics. The intervention dominated the health facility‐based strategy alone on all computed cost‐effectiveness outcomes. MAM treatment by CHVs plus health facilities was estimated to yield a cost per death and DALY averted of US $ 8743 and US$397, respectively, as opposed to US $ 13,846 and US$637 in the control group. The findings also showed that the intervention group spent less per child treated and recovered than the control group: US $ 214 versus US$270 and US $ 306 versus US$485, respectively. Compared with facility‐based treatment, treating MAM by CHVs and health facilities was a cost‐effective intervention. Additional gains could be achieved if more children with MAM are enrolled and treated. Key messages Treatment of MAM by CHVs and health facilities involved a lower cost compared with the health facility‐based treatment approach alone. Treatment of MAM by CHVs and health facilities was cost‐effective compared with the health facility‐based treatment approach alone. Greater health and economic gains could be realized if more children with MAM are enrolled and treated by CHVs through the integration of acute malnutrition treatment into iCCM.

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.

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

Components of the lower food web (mussels, Caridina and Omena) were collected from stations from Winam Gulf, Lake Victoria, Kenya in 2022 and 2023 to analyze for stable isotopes and total mercury (THg). Temporal comparisons were made with data generated for the same species in 1998. Values of δ15N in mussels and Caridina were similar (6.89‰ vs. 6.78 ± 0.13‰), while Omena occupied an elevated trophic position (9.97 ± 0.24‰) with minor shifts in δ15N over time. All species had elevated δ13C values in 2022–2023 versus 1998 supportive of enhanced eutrophication in the Gulf. THg concentrations exhibited modest spatial differences between sites (< 2.6 fold), but not between Caridina and Omena. Larger temporal differences were apparent relative to spatial patterns with THg concentrations decreasing in study species by 2.8 to 4.1-fold between years. An exposure assessment indicated that Omena, commonly found in local markets, can be consumed up to 0.74 kg/month without generating excess THg exposures.

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.

Background Whilst significant progress has been made in the fight against malaria, vector control continues to rely on just two insecticidal methods, i.e., indoor residual spraying and insecticidal bed nets. House improvement shows great potential to complement these methods and may further reduce indoor mosquito biting and disease transmission. Open eaves serve as important mosquito house entry points and provide a suitable location for intercepting host-seeking anophelines. This study describes semi-field experiments in western Kenya with eave tubes, a household protection product that leverages the natural behaviour of host-seeking malaria mosquitoes. Methods Semi-field experiments were conducted in two screen-houses. In both of these a typical western Kenyan house, with mud walls and corrugated iron sheet roofing, was built. Eave tubes with bendiocarb- or deltamethrin-treated eave tube inserts were installed in the houses, and the impact on house entry of local strains of Anopheles gambiae and Anopheles arabiensis was determined. Experiments with open eave tubes (no netting) were conducted as a control and to determine house entry through eave tubes. Insecticidal activity of the inserts treated with insecticide was examined using standard 3-min exposure bioassays. Results Experiments with open eave tubes showed that a high percentage of released mosquitoes entered the house through tubes during experimental nights. When tubes were fitted with bendiocarb- or deltamethrin-treated inserts, on average 21% [95% CI 18–25%] and 39% [CI 26–51%] of An. gambiae s.s. were recaptured the following morning, respectively. This contrasts with 71% [CI 60–81%] in the treatment with open eaves and 54% [CI 47–61%] in the treatment where inserts were treated with fluorescent dye powder. For An. arabiensis recapture was 21% [CI 14–27%] and 22% [CI 18–25%], respectively, compared to 46% [CI 40–52%] and 25% [CI 15–35%] in the treatments with open tubes and fluorescent dye. Conclusions Insecticide-treated eave tubes resulted in significant reductions in recapture rates for both malaria vector species, representing the first and promising results with this novel control tool against Kenyan malaria vectors. Further field evaluation of eave tubes under more realistic field conditions, as well as their comparison with existing approaches in terms of cost-effectiveness and community acceptance, is called for.

Background Data on emergency and critical care services in Somalia and other countries with fragile and conflict-affected (FCA) situations are limited, although the burden of emergency health conditions remain high. Improving emergency care services could significantly help improve health outcomes and realize the goals of achieving the Universal Health Coverage in these fragile countries. Methods We conducted a cross-sectional survey to assess the service availability and readiness for emergency and critical care (ECC) services in the country covering 131 hospitals in Somalia. The survey included both the public and private sector hospitals as well as those at the district, regional and national level hospitals representing the whole organizational structure of emergency health care system in the country. We administered the WHO Hospital Emergency Unit assessment tool which was slightly modified and adapted for this assessment. The survey included questions on the availability of staff, supplies/equipment, services, and systems. The respondents were hospital administrators and clinicians in outpatient departments, emergency departments and inpatient units. An overall median capacity score indicating the service availability and readiness for ECC was calculated for the country as well as for each hospital. Data were collected from December 2020 to March 2021. Result A total of 524 staff members across 131 hospitals participated in the survey. The median and interquartile range (IQR) ECC readiness score for all health facilities in the country was 0.31 (0.22–0.46) and only 26 (19.8%) facilities assessed had a median readiness score of more than 0.5 ( p value = 0.001). Using the cut-off point of 0.5, over 80% of the hospitals assessed were not considered ready to provide ECC services in the country. The third-level hospitals of the private sector including those facilities situated in predominantly urban areas were found to have better readiness to provide ECC services. User fees, lack of equipment and the absence of staff availability around the clock were identified as the most common barriers to emergency and critical care readiness. Conclusion This is the first study of its kind to be conducted in Somalia using a standardized tool and methodology and provides a comprehensive understanding of emergency and critical care services available in Somalia by facility type and levels of care. The study highlighted that significant capacity gaps exist at all levels in the provision of emergency care services especially in the public sector and at the first-level of care. Investment in emergency care services is urgently needed in the country bringing the primary care into the care continuum for ECC services along with implementing a set of cost-efficient interventions at the first-level of care given the country’s high burden of emergency health conditions. Clinical trial number Not applicable as this assessment was not a clinical trial.

The use of arbuscular mycorrhizal fungi (AMF) to enhance soil phosphate uptake is a biological technique considered to cure phosphate deficiency in soils. This study investigated association of Aspilia pruliseta Schweif shrub with AMF in Kenya. The study aims at profiling a tropical shrub with multiple ecological benefits that could reduce addition of chemical phosphatic fertilizer into the soil and reverse negative consequences of eutrophication. Sampling was purposive to have areas with or without Aspilia pruliseta vegetation growing. A small amount (10 g) of the soil from 27 composite samples was used for spore count determination and a similar amount for next generation sequencing. Spore counts varied significantly among soil textural types, sample locations, and soil depth. Sandy loam had the highest spore counts with a mean average of 404 spores. The spore count decreased significantly (P < .05) with the depth of soil from a mean of 514 spores to 185 along the rhizosphere. The intensity of spore morphotypes was significantly higher at P < .05 for soils whose vegetation was covered with Aspilia pruliseta than those without. Aspilia pruliseta vegetation used together with sandy loam soil could culture commercial mycorrhiza fungi production for use in agrisystems.