Environmental and Household-Based Spatial Risks for Tungiasis in an Endemic Area of Coastal Kenya

Tungiasis is a cutaneous parasitosis caused by an embedded female sand flea. The distribution of cases can be spatially heterogeneous even in areas with similar risk profiles. This study assesses household and remotely sensed environmental factors that contribute to the geographic distribution of tungiasis cases in a rural area along the Southern Kenyan Coast. Data on household tungiasis case status, demographic and socioeconomic information, and geographic locations were recorded during regular survey activities of the Health and Demographic Surveillance System, mainly during 2011. Data were joined with other spatial data sources using latitude/longitude coordinates. Generalized additive models were used to predict and visualize spatial risks for tungiasis. The household-level prevalence of tungiasis was 3.4% (272/7925). There was a 1.1% (461/41,135) prevalence of infection among all participants. A significant spatial variability was observed in the unadjusted model (p-value < 0.001). The number of children per household, earthen floor, organic roof, elevation, aluminum content in the soil, and distance to the nearest animal reserve attenuated the odds ratios and partially explained the spatial variation of tungiasis. Spatial heterogeneity in tungiasis risk remained even after a factor adjustment. This suggests that there are possible unmeasured factors associated with the complex ecology of sand fleas that may contribute to the disease’s uneven distribution.

Validity, reliability, and measurement invariance of an adapted short version of the HIV stigma scale among perinatally HIV infected adolescents at the Kenyan coast

Background There is a dearth of instruments that have been developed and validated for use with children living with HIV under the age of 17 years in the Kenyan context. We examined the psychometric properties and measurement invariance of a short version of the Berger HIV stigma scale administered to perinatally HIV-infected adolescents in a rural setting on the Kenyan coast. Methods A cross-sectional study was conducted among 201 perinatally HIV-infected adolescents aged 12–17 years between November 2017 and October 2018. A short version of the Berger HIV stigma scale (HSS-40) containing twelve items (HSS-12) covering the four dimensions of stigma was evaluated. The psychometric assessment included exploratory factor analysis, confirmatory factor analysis (CFA), and multi-group CFA. Additionally, scale reliability was evaluated as internal consistency by calculating Cronbach’s alpha. Results Evaluation of the reliability and construct validity of the HSS-12 indicated insufficient reliability on three of the four subscales. Consequently, Exploratory Factor Analysis (EFA) was conducted to identify problematic items and determine ways to enhance the scale’s reliability. Based on the EFA results, two items were dropped. The Swahili version of this new 10-item HIV stigma scale (HSS-10) demonstrated excellent internal consistency with a Cronbach alpha of 0.86 (95% confidence interval (CI) 0.84–0.89). Confirmatory Factor Analysis indicated that a unidimensional model best fitted the data. The HSS-10 presented a good fit (overall Comparative Fit Index = 0.976, Tucker Lewis Index = 0.969, Root Mean Square Error of Approximation = 0.040, Standardised Root Mean Residual = 0.045). Additionally, multi-group CFA indicated measurement invariance across gender and age groups at the strict invariance level as ΔCFI was ≤ 0.01. Conclusion Our findings indicate that the HSS-10 has good psychometric properties and is appropriate for evaluating HIV stigma among perinatally HIV-infected adolescents on the Kenyan coast. Further, study results support the unidimensional model and measurement invariance across gender and age groups of the HSS-10 measure.

Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators

Background In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people. Methods Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators. Results The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p < 0.01; current illicit drug use, 7% vs. 15%, p < 0.01; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p < 0.01. Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (< 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use. Conclusions At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives.

Correlates of Health-related Quality of Life in Primary Caregivers of HIV Infected and HIV Exposed Uninfected Adolescents at the Kenyan Coast

Background: Mothers and other primary caregivers play a crucial role in looking after HIV infected, and HIV exposed uninfected adolescents in sub-Saharan Africa. Daily caring may expose these caregivers to adverse states of health. Unfortunately, very few studies have examined their health-related quality of life (HRQoL) despite the additional risk of poor health outcomes. Our study documents the HRQoL profile, and associated factors in primary caregivers of perinatally HIV infected, perinatally HIV exposed but uninfected and HIV unexposed/uninfected adolescents aged 12 – 17 years at the Kenyan Coast. Methods: This was a cross-sectional analysis of 485 primary caregivers: 195 of perinatally HIV infected adolescents, 128 of perinatally HIV exposed but uninfected adolescents and 162 of HIV unexposed/uninfected adolescents. All caregivers completed a self-report measure of HRQoL, depressive symptoms, and parenting stress. They also provided their sociodemographic information and that of the participating adolescents. We used one-way analysis of variance (and its non-parametric version) to assess statistical differences among the groups. Linear regression analyses were used to identify correlates of HRQoL among caregivers. Results: Linear regression analyses indicated that depressive symptoms, increasing age of caregiver, and caring for an HIV exposed adolescent were significantly associated with reduced HRQoL at both the RAND SF-36 overall and sub-scale level. Having a professional job relative to subsistence farming was the only factor associated with improved overall HRQoL. At subscale level, higher socioeconomic status correlated positively with HRQoL (within the limitations due to emotional problems domain) while being a grandparent, and level of education (physical functioning domain), and parenting stress (vitality domain) were negatively associated with HRQoL. Moreover, caring for a male adolescent (vitality domain) and increasing adolescent age (pain domain) was associated with declining HRQoL. Conclusions: Caregivers in this sample, especially those who are ageing, at risk of mental ill-health, and taking care of HIV exposed adolescents, appear to be vulnerable. Inclusive and multi-component interventions tailored to the caregivers' psychosocial and mental needs will potentially enhance their quality of life. Longitudinal studies are also needed to understand the underlying mechanisms and longer-term implications of the correlates of caregivers HRQoL identified in the present study.

67,000 years of coastal engagement at Panga ya Saidi, eastern Africa

The antiquity and nature of coastal resource procurement is central to understanding human evolution and adaptations to complex environments. It has become increasingly apparent in global archaeological studies that the timing, characteristics, and trajectories of coastal resource use are highly variable. Within Africa, discussions of these issues have largely been based on the archaeological record from the south and northeast of the continent, with little evidence from eastern coastal areas leaving significant spatial and temporal gaps in our knowledge. Here, we present data from Panga ya Saidi, a limestone cave complex located 15 km from the modern Kenyan coast, which represents the first long-term sequence of coastal engagement from eastern Africa. Rather than attempting to distinguish between coastal resource use and coastal adaptations, we focus on coastal engagement as a means of characterising human relationships with marine environments and resources from this inland location. We use aquatic mollusc data spanning the past 67,000 years to document shifts in the acquisition, transportation, and discard of these materials, to better understand long-term trends in coastal engagement. Our results show pulses of coastal engagement beginning with low-intensity symbolism, and culminating in the consistent low-level transport of marine and freshwater food resources, emphasising a diverse relationship through time. Panga ya Saidi has the oldest stratified evidence of marine engagement in eastern Africa, and is the only site in Africa which documents coastal resources from the Late Pleistocene through the Holocene, highlighting the potential archaeological importance of peri-coastal sites to debates about marine resource relationships.

Presence of microplastics in jellyfish (Crambionella orsini) along the Kenyan coast

Microplastics are plastic particles less than 5 mm in diameter. These plastics mostly result from degradation of larger plastics. Due to their small size, they are often accidentally ingested by sea faunas, particularly the deposit and filter feeders. However, information on the ingestion of microplastics by sea fauna such as jellyfish is rare. This paper provides evidence of ingestion of microplastics by jelly fishes (Crambionella orsini) along the Kenyan Coast. Samples were taken from three stations (Mikindani and Makupa in Mombasa, and Dabaso in Mida Creek) between 31st January 2018 and 3rd February 2018 using tow nets. Samples were digested using 10 % KOH at 60 °C for 24 hrs and sieved through a 38 µm sieve. Products below 38 µm were filtered using a 0.8 µm Whatman filters, then dried in an oven and viewed under a dissecting microscope for microplastics. Suspected microplastics were confirmed using a hot needle test. Microplastics obtained were mainly fibres of different colours: black, blue, green, colourless, purple, red and yellow. Colourless fibres were the majority accounting for 53 % of the total number of fibres while purple fibres were the least at only 1 %. Mean concentration of microplastics was highest in Dabaso (0.05 mp/g of tissue), whereas in Mikindani and Makupa were almost equal (i.e., 0.03 ± 0.003 mp/g in Mikindani, and 0.03 ± 0.01 mp/g in Makupa). Statistically, the means were not significantly different between the stations (F1, 2 = 1.34; P = 0.43). This study presents evidence of contamination of the Kenyan coastal waters by microplastics and their ingestion by sea fauna such as jellyfish. Results of this study will help reinforce the plastic ban in the country to prevent further accumulation in the environment.

Fibropapillomatosis infection in a population of green turtles at Watamu Bay, Kenya

Anthropogenic stressors from onshore and offshore activities can act as driving factors of disease for a wide range of marine organisms. Green turtles (Chelonia mydas) are prominently afflicted with a tumour-causing disease known as fibropapillomatosis (FP) caused by the chelonid alphaherpesvirus ChHV5. Previous studies indicate that pathways of FP transmission may be genetic (vertical transmission) or linked to causal factors in a turtle’s environment (horizontal transmission). In this paper patterns of FP prevalence were examined in 10,896 records of green turtles caught or found stranded around Watamu Bay, Kenya, between 2003 – 2020. Findings were focused on locational and seasonal factors that may potentially influence infection. The findings show that FP prevalence varies significantly on an annual basis. Location significantly influenced infection prevalence, with prevalence higher in open ocean sites than sites located within the creek. Infection prevalence was highest at sites around the creek mouth and north of the creek mouth, with both regions exhibiting disparate annual patterns of infection. This paper is the first to examine long-term trends of FP prevalence in-depth in this region and has implications for the health of turtles and marine biota found along the Kenyan coast, and potentially within the wider Western Indian Ocean region. The findings emphasize the need to distinguish the infection pathways of causative agents via: i) further examination of the links between infection and environmental and/or biont community factors; and ii) the collection of data pertinent to the genetic diversity of green turtles and associated ChHV5 viral strains occurring in the Western Indian Ocean.

Tracking the introduction and spread of SARS-CoV-2 in coastal Kenya

Genomic surveillance of SARS-CoV-2 is important for understanding both the evolution and the patterns of local and global transmission. Here, we generated 311 SARS-CoV-2 genomes from samples collected in coastal Kenya between 17th March and 31st July 2020. We estimated multiple independent SARS-CoV-2 introductions into the region were primarily of European origin, although introductions could have come through neighbouring countries. Lineage B.1 accounted for 74% of sequenced cases. Lineages A, B and B.4 were detected in screened individuals at the Kenya-Tanzania border or returning travellers. Though multiple lineages were introduced into coastal Kenya following the initial confirmed case, none showed extensive local expansion other than lineage B.1. International points of entry were important conduits of SARS-CoV-2 importations into coastal Kenya and early public health responses prevented established transmission of some lineages. Undetected introductions through points of entry including imports from elsewhere in the country gave rise to the local epidemic at the Kenyan coast.

Environmental Education Catalyzed by Tourism: Ecoliteracy Initiatives on the Coast of Kenya

The Diani-Ukunda area on the Kenyan coast is one of the main tourism centers of the country. Over time, individuals who originally visited the area as tourists have started sustainability initiatives that are in part funded through donor networks from abroad (drawing on individuals who visited the country initially as tourists). This essay explores select German initiatives in the educational sector that have emerged in the context of the area’s tourism industry. Diani Maendeleo Academy (a secondary school for girls) and the six primary and secondary schools known as Mekaela Academies collectively serve a significant portion of the population of the larger Diani-Ukunda area, including the hinterland extending widely into Kwale County. The study was designed to assess the schools’ approach toward sustainability and ecoliteracy, and centered on the following questions: 1. What kinds of sustainable practices are promoted in the select schools? 2. In what ways do students who attend these schools display environmental literacy? 3. Do these initiatives address UN SDGs, known as Education for Sustainable Development (ESD)? The study follows an interdisciplinary mixed method approach and is based on interviews, survey instruments, research on ecoliteracy and educational policy, and fieldwork data from previous stays. Findings reveal a lesser-known dimension of tourism: namely, the successful pursuit of ESD in schools thriving in the context of tourism through an integrated approach towards teaching ecoliteracy.