Isaac K. Nyamongo

The integration of traditional medicine into health systems is one of the major objectives of the current World Health Organisation (WHO) strategy on traditional medicine. This may be achieved through a multidisciplinary approach involving conventional health workers (CHWs) and traditional medical practitioners. Whereas the majority of studies have focused on the two groups, a few have prioritized the general public, a key stakeholder. The study aimed to investigate the public perception regarding the regulation and integration of herbal medicine (HM) into the mainstream healthcare system in Kenya. A cross-sectional study design was adopted, and a systematic random sampling strategy was used to select participants, who included one adult participant from each household within a span of 5 kilometres around each sampled public health facility, in Kakamega County, Western Kenya. A total of 317 adults were interviewed, and targeted structured questionnaires were used to obtain their perceptions on key relevant thematic areas, including use, efficacy, improvements of HM practice, and integration into mainstream healthcare. Statistical analysis was performed using IBM SPSS version 28.0. An assessment of support for integration was considered as the motivating objective. From the findings, 88% of the respondents reported that they use HM as part of their treatment when ill, 59% believe that HM provides effective treatment, and 78% believe they are safe. On integration, 52% of the public support integration of herbal and conventional medicine (CM), with 62% of the view that both medicines can be used concurrently. Notably, integration is already being informally implemented in Kenya, mainly through cross-referrals between HPs and CHWs, with 22% reported referrals by CHWs to HPs and 24% from HPs to CHWs. In conclusion, the proposed strategies of integration include cross referrals, registration and licensing of herbal practitioners (HPs), training HPs in modern healthcare practices, as well as documentation and validation of the efficacy of herbal medicines.

The practise of herbal medicine in Kenya is not well-regulated to date. This has resulted in infiltration by quacks and other malpractices that pose serious health problems to the Kenyan public. Additionally, despite treating the same patients in most cases, there is no communication between the medical staff and herbal practitioners, owing to the popularity of herbal medicine. The study aimed to understand herbalists’ opinions on regulation and the integration of their practice into mainstream healthcare. A cross-sectional study design was adopted, and purposive sampling was used to select participants, who included officials from the herbalist’s associations from 21 Kenyan counties where herbal practice is still rife. They comprised the chairman, secretary, treasurer, and organizing secretary for each association. A total of 70 officials who were willing to participate in the study were interviewed. Targeted structured questionnaires were used to obtain their views on several issues, including regulation, disclosure, and integration into mainstay healthcare. Data analysis was implemented using STATA version 13. The findings indicate that the majority (51%) of the herbalists are in support of local and national regulation through the Ministry of Health. Additionally, 99% are willing to work together with conventional healthcare workers by way of referrals. They are also willing to disclose their herbal medications to healthcare professionals (47%) and research institutions (87%). We propose an evidence-based model whereby herbalists are regulated under the Ministry of Health in order to eradicate quacks and malpractice. The herbalists may communicate with doctors by way of referrals and benefit from training from health officials.

This chapter focuses on the nuts and bolts of obtaining consent before embarking on data collection. Why should we obtain consent? What information should the study participant receive before they give consent to participate? And how is that information given?

Understanding the gender-linked dynamics in the small holder poultry value chain is necessary for enabling sustainable agriculture and food systems. Small holder livestock production, including poultry keeping in sub-Saharan Africa (SSA), plays important socio-economic and food security roles in rural communities. Poultry production contributes to sustainable food systems as it supports nutrient cycling through feed, manure, and soils. A qualitative study utilized data from 18 focus group discussions (FGDs) and 22 in-depth interviews (IDIs) to interrogate the gender-linked dynamics in the value chain and inform interventions for sustainable food systems. The data were audio-recorded, transcribed, and coded into themes responding to the study question. The results highlight the gender-linked drivers, namely, the social and economic value placed on poultry, ownership, power positions, and decision making dynamics in production and management among small holder poultry value chain actors in Makueni County, Kenya. The study findings demonstrate the increasing economic and social value placed on poultry in households and communities. The study further discusses gender-disaggregated ownership and decision making in the poultry value chain, highlighting the need to engage all involved actors to develop sustainable food systems. In addition to the social and economic value of poultry to small holder farmers, it is necessary to factor in potential nutrition and environmental benefits. While small holder poultry production has the potential to contribute to sustainable food systems economically, nutritionally, and environmentally, this study found that more emphasis is placed on socio-economic value dimensions. Noteworthy is that in ownership and decision making, gender dynamics inform the role and position of the different actors in a sustainable small holder poultry value chain that is socio-economically, nutritionally, and environmentally sound.

Institutional barriers can hinder effective access and utilisation of Newcastle disease vaccines among smallholder chicken farmers. Many studies have focused on formal institutional barriers with minimal focus on informal institutions - unwritten rules and regulations that govern access and utilisation of Newcastle vaccines. However, informal institutions are more profound and encultured in individuals’ daily activities. This study sought to investigate informal institutional barriers to access and utilisation of Newcastle disease vaccines among women smallholder chicken farmers in Makueni, Kenya. The cross-sectional qualitative study employed in-depth interviews, key informant interviews and focus group discussions as data collection methods. Study informants were conveniently and purposively sampled. Informal institutional barriers to access and utilisation included: fear of Newcastle disease vaccine as a new technology, use of herbal remedies, mistrust of community vaccinators, gender division of labour, ownership of household resources and beliefs that indigenous chickens do not need vaccines. The study concludes that women chicken farmers are constrained by unwritten rules, norms, regulations and gender roles that hinder their access to and utilisation of the Newcastle disease vaccines. The need to examine informal institutions to identify and eradicate barriers to access and utilisation of Newcastle disease vaccines by farmers is recommended.

Background: This paper present findings on current strategies utilised within selected Developing Excellence in Leadership, Training and Science in Africa’ (DELTAS Africa) consortia to promote gender equitable scientific career progression for researchers, as well as participants’ recommendations for change. Findings are drawn from a wider research study nested within this health-based scientific research capacity strengthening initiative that was aimed at gaining an in-depth understanding of the barriers and enablers of gender equitable scientific career progression for researchers in Sub-Saharan Africa. Methods: We adopted an exploratory qualitative cross-sectional study design. The main method of data collection was in-depth interviews (IDIs) with trainees/research fellows at various career stages affiliated to three purposively selected DELTAS Africa Research Consortia. In addition, key informant interviews (KIIs) with consortia research leaders/directors, co-investigators, and management team were also conducted to corroborate information gathered from the IDIs, and to provide additional insights on the enabling factors/actions and policy processes that were currently in place or proposed to enhance gender equitable career progression. In total, fifty-eight IDIs (32 female and 26 male) and twenty KIIs (4 female and 16 male) were conducted. Interviews were carried out between May and December 2018 in English. Data were analysed inductively based on emergent themes, and aligned to the developed integrated conceptual framework. Results: Three overarching themes were identified. First: micro level efforts - individual coping mechanisms and familial level support. Second: Meso level efforts -existing enabling mechanisms at the institutional level. Third: proposed solutions for positive change towards enhancing gender equitable career progression at micro, meso and macro levels. Conclusions: These findings have implications for future research capacity strengthening programming, including DELTAS Africa II initiative (2021-2025); they provide valuable insights on potential strategies and actions aiming to narrow gender inequities in scientific career progression in the context of sub-Saharan African research institutions.

Improving access to paediatric HIV treatment requires large-scale antiretroviral treatment programmes and medication adapted to infants and children’s needs. The World Health Organisation recommends lopinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors as first-line treatment for all HIV-infected children younger than three years, usually given as a syrup. A pellet formulation (i.e. tiny cylinders of compressed medication put in capsules) was developed to overcome the syrup formulation’s disadvantages such as bitterness, toxicity and cold storage. This study assessed multi-level factors influencing caregivers’ acceptance of and adherence to lopinavir/ritonavir pellets as well as their underlying mechanisms. A realist evaluation (a theory-driven evaluation method considering the social context and mechanisms of change), embedded in a clinical trial was carried out in three hospital settings in Kenya. Data were collected through document review, observations (n = 34) in home and clinic settings and semi-structured interviews (n = 44) with caregivers and providers. Data analysis was based on realist principles. High levels of treatment initiation and adherence were observed. Taste masking, neutral packaging and easy storage made the new formulation highly acceptable. Caregivers developed individual strategies to deliver the treatment, particularly to overcome specific problems e.g. in case of just-weaned babies or food shortage. A refined program theory emerged from the triangulated findings showing that ease of administration combined with increased self-efficacy and competences of the caregivers, and effective provider support contributed to high levels of adherence. Formulating combined antiretroviral treatment in the form of pellets is clearly a more acceptable solution for infants and children and their caregivers compared to the syrup. Further research in non-trial settings may shed light on factors related to providers, services and the health system that contribute to better adherence of such formulations.

Baseline information that is essential for determining the areas to target with larval control includes estimates of vector diversity and larval habitat preferences. Due to a lack of such information in Baringo County, Kenya, this study assessed species diversity and larval habitat preference of potential mosquito vectors of Rift Valley fever (RVF) and malaria. Mosquito larvae were sampled from nine types of larval habitats and were identified morphologically. Species diversity was estimated by the Shannon’s diversity index while larval habitat preference by RVF and malaria vectors was determined by ANOVA. A total of 7724 immature mosquitoes comprising 17 species belonging to four genera, namely Anopheles, Culex, Aedes and Mansonia, were identified. Among the 17 species, three Anopheles species are responsible for malaria transmission: An. gambiae (s.l.), An. funestus (s.l.) and An. pharoensis. Rift Valley fever vectors included Mansonia spp. and Culex spp. The highest Shannon's diversity index was observed during the cold dry season (H = 2.487) and in the highland zone (H = 2.539) while the lowest diversity was recorded during the long rain season (H = 2.354) and in the riverine zone (H = 2.085). Ditches had the highest mean number of Anopheles larvae (16.6 larvae per sample) followed by swamp (12.4) and seasonal riverbed (10.7). Water pit and water pan had low mean numbers of Anopheles larvae (1.4 and 1.8, respectively) but relatively high mean numbers of culicines (16.9 and 13.7, respectively). Concrete tank was the least sampled type of habitat but had highest mean number of culicine larvae (333.7 l) followed distantly by water spring (38.9) and swamp (23.5). Overall, larval habitats were significantly different in terms of larval density (F(8,334) = 2.090, P = 0.036). To our knowledge, the present study reports culicine larval species diversity in Baringo for the first time and the most preferred habitats were concrete tanks, water springs and swamps. Habitats preferred by Anopheles were mainly riverbed pools, ditches and swamps. Environmental management targeting the habitats most preferred by potential vectors can be part of integrated vector control in Baringo, especially during dry seasons.