According to World Health Organization use of more than two micronutrients is beneficial to pregnant women. However, anemia prevalence, labor duration, neonatal Apgar score, blood loss and lochia loss, have not been studied in relation to multiple micronutrient use. The study supplemented maternal micronutrients to influence anemia, pregnancy weight gain, labor and birth duration, blood loss, lochia loss and infant development in Kenya. The study using convenience sampling, defined subpopulations at risk of nutritional deficiencies and provided opportunities, for early intervention through use of multiple micronutrients on pregnancy outcomes. The study objective was to determine the effect of multiple micronutrient supplements and Iron Folic acid supplementation on maternal infant health outcomes. This was through a Cluster Randomized Controlled study. The treatment arm was administered with a daily multiple micronutrients while the control arm took the standard care; iron folic acid. A semi structured questionnaire and focus group discussion were applied to collect data on effect of prenatal multiple micronutrients among the pregnant women. The study demonstrated that the difference in means of: hemoglobin levels was 12.1 (11.6, 12.4) in MM group and 11.3 (9.7, 11.8) p=0.038, duration of labor was; 8.0 (6.0,20.0) hours for the MMs and 20.0 (15.0,30.0) for IFA p=0.023. Average birthweight in kilograms at birth; 3.3 (3.2,4.1) for MM and 3.2 (3.0,3.5) kgs for IFA (p=0.024). Blood and lochia loss: light (MM) 79%; (IFA) light- 21%, p=0.001; heavy (MM) 10.5%, (IFA) 48.2% p=0.001 Breastmilk was available within thirty minutes in 85.7% of MM group and 20% of IFA group p=0.001. Third trimester weight gain mean was 67.89 kilograms (SD: 8.5) for MM and 62.7 kilograms (SD: 6.4) for IFA p=0.032. There was significance in subjects effects for labor duration in hours p=0.006, blood loss p=0.001 and lochia loss p, 0.025. Roy’s Largest Root was equivalent to Hotellings’ Trace; therefore, the effect observed was associated with; labor duration p=0.003, blood loss p=0.001 and lochia loss p=0.001. Contrast results demonstrated that there was a significant effect difference observed in the model in the dependent variables; labor duration p=0.003, blood loss p=0.001 and lochia loss p=0.001. Since the significance levels for the dependent variables were less than 0.05, the study concluded that the difference observed was not due to chance variation, therefore, contrast concludes that the multiple micronutrients reduces labor duration during pregnancy, postpartum hemorrhage, lochia loss amount and duration. The study recommends a policy change from iron folic acid use to multiple micronutrients to promote reduced; labor duration, postpartum hemorrhage, lochia loss amount and duration.

Tuberculosis is an infectious bacterial disease caused by Mycobacterium tuberculosis which commonly affects the lungs but can affect other parts of the body. With a burden of disease that accounts for over 10 million cases annually (of which less than two thirds are reported), TB is the leading cause of death from a single infectious agent across the world, ranking above HIV/AIDS. In Kenya, Tuberculosis (TB) remains one of the greatest health threats as it is one of the leading causes of death in the economically active age groups and in people living with HIV. Although the most essential component of tuberculosis control is the early detection and treatment of infectious cases, longer intervals from TB symptom onset to TB diagnosis and treatment continue to adversely affect public health and clinical outcomes. Delays in diagnosis and initiation of effective treatment increase morbidity and mortality from tuberculosis as well as the risk of transmission in the community. This study aimed at investigating the factors associated with delay in commencement of TB treatment in selected health facilities in Kwale County, Kenya. Factors assessed included: social demographic factors, proportions of delayed TB treatment, social cultural and health related system factors that constrain early TB diagnosis and treatment among TB patients in Kwale County. The study adopted descriptive cross-sectional study design. Purposive sampling was used to identify the health facilities and interviewer- assisted structured questionnaires were used for primary data collection. Quantitative data was analyzed using SPSS version 20, descriptive analysis was conducted to determine proportions and probit binary regression analysis was done to identify independent variables influencing dependent variables. Qualitative data was organized using framework and thematic methods using NVivo version 12. All the analyses were done at 95% confidence interval. The results of the study showed that 69.4% of TB patients delayed starting TB drugs. Binary regression analysis showed that social demographic characteristics: gender (OR 8.026, 95% CI of OR: 3.659-17.608, P<0.05), (level of education (OR 2.381, 95% CI of OR: 1.413-4.011, P<0.05) and employment status (OR 6.146, 95% CI of OR: 2.086-18.080, P<0.05) significantly influenced TB treatment delay. Inadequacy of TB diagnostic machines, weak surveillance systems and poor roads were factors in health system found to barriers to timely diagnosis and commencement of TB treatment. In the social cultural context, seven thematic areas (stigma, believing in witchcraft, positive TB diagnosis dispute by TB patients, seeking alternative tradition treatment, and buying drugs over the counter, TB inheritance, religious issues) were reported to constrain the commencement of TB treatment. The study concluded that some there is a high proportion of delay in TB treatment among newly diagnosed TB patients attending Kwale sub-County hospital and Msambweni County Referral Hospitals. Sociodemographic factors that influenced this delay were the level of education, gender and employment status. Health care service-related factors such as inadequacy of diagnostic machines and poor road network as well as sociocultural factors such as belief in witchcraft, and buying drugs over the counter were important barriers to timely TB diagnosis and treatment among newly diagnosed TB patients attending Kwale sub-County and Msambweni County Referral hospitals.

Indigenous chicken farming is a source of livelihood for rural and urban families in Kenya. However, the farmers experience challenges such as infections from Newcastle disease. Vaccination of flocks against Newcastle disease virus (NDV) outbreaks is an approach for controlling the spread of Newcastle disease (ND). Nevertheless, vaccinated chickens’ contract NDV. The study objective was to determine NDV in indigenous chickens (ICs) and the association of the disease with the weather (temperature, humidity, and wind speed) at the time of sample collection, production system, and the interaction of ICs with other species and make inference on the genetic diversity of the NDV matrix and fusion genes. A total of 1,585 samples were collected between 2017 and 2019 from NDV-vaccinated and unvaccinated ICs. The samples collected were from ICs in eight live bird markets in Nairobi (N=372) and ICs from 68 households (N=1210) within the Bomet, Baringo, Kilifi, Nakuru, Kakamega, and Machakos counties in Kenya and clinical samples (N=3). The collected samples were oropharyngeal and cloaca swabs from ICs in markets and households and samples (long bone and internal organs (liver, intestine, caecal tonsils, kidney and heart tissues)) from clinically sick ICs. NDV matrix genes were detected using quantitative reverse transcription-polymerase chain reaction (RT-qPCR), and amplicons of matrix and fusion genes were sequenced using a capillary sequencer. Chi-square and correlation tests were used to test the association between the prevalence of Newcastle disease in IC and the associated factors. The genetic diversity was analysed by haplotype analysis (TCS network) and phylogeny. The NDV prevalence in the Nairobi live bird markets was 65.3% and 72.4% in ICs from the household. Among the vaccinated ICs, the prevalence of NDV was 77%. There were significant relationships between the prevalence of NDV and vaccination history (p = 0.039), of the ICs, the type of production system for ICs (p <0.010) and the interaction between ICs and other birds (p = 0.037). There was no correlation between the prevalence of NDV and the prevailing weather condition. Haplotype analysis revealed non-synonymous mutation of sequences with low nucleotide densities and high haplotype density of the matrix gene and high nucleotide diversity and haplotype diversity of the fusion gene. The phylogeny revealed similarity for the matrix gene with previous isolates and heterogeneity of the fusion gene. The study also revealed the non-relatedness of the circulating NDV strains with the NDV La Sota strain used in NDV vaccine development. The presence of matrix and fusion genes in samples from vaccinated flocks indicated the presence of both virulent and low-virulence strains of NDV. These findings highlight the occurrence of NDV among ICs and suggest the type of production system, viral shedding post-vaccination and interspecies transmission as the drivers of Newcastle disease outbreaks. Therefore, associated factors to the prevalence of NDV and the circulating strains should be considered during the development of vaccines for effective control of ND outbreaks in Kenya.

Children below five years of age account for about 80% of malaria deaths globally. As malaria continues to decline in many parts of sub-Saharan Africa and malaria rapid diagnostic tests become increasingly used, it is crucial to evaluate the critical outcomes from innovative strategies involving community health workers (CHWs) and local health facilities in fever management accounting for the spatial and temporal heterogeneity in infection risk. This study aimed to determine the proportion of fever cases due to malaria and non-malarial infections in space and time among children below five years of age and their relationship with rainfall in Siaya County in Kenya. A prospective longitudinal incidence study of all children tested for malaria by CHWs, and in health facilities were conducted between January 2013 and December 2015. The incidence proportion of malaria cases reported by CHWs increased with time, and the difference over the years was statistically significant (P<0.001). At health facilities, the incidence proportion of malaria cases decreased with time though the difference between the years was not statistically significant (P=0.399). For non-malarial cases reported by CHWs, the incidence proportion was lowest in 2014 and highest in 2013, and the difference over the years (2013-2015) was not statistically significant (P>0.001). At the health facilities, the incidence proportion of non-malarial cases was highest in 2014 and lowest in 2015, and the difference between the years (2013-2015) was not statistically different (P>0.001). None of the tested rainfall regimes (current, lagged, or cumulative) were associated with malaria and non-malarial cases (P>0.1). Five villages (Ramula, Marenyo, Uranga, Bongo, and Lihanda) had a significantly higher incidence proportion of malaria cases (P<0.05), while all villages except Nyawara, Marenyo, and Nyandiwa had a significantly higher incidence proportion of non-malarial cases (P<0.05). CHWs have the potential to play a role in the management of fever-related illnesses. The risk of diagnosing malaria seems predictable, while non-malarial cases occur throughout the year. These findings present opportunities for preparedness and policy actions to scale-up community health services.

Despite the fact, that malaria is a controllable disease, in sub-Saharan Africa, including Rwanda, it is still killing pregnant mothers and their children aged less than five years. Due to their low immunity, those two groups are most vulnerable to malaria disease, in areas with high to moderate malaria transmission. With 11 years left to the Global Technical Strategy for malaria target of reducing 90% of malaria case incidence and mortality rates, and elimination in 35 countries by 2030, there is limited evidence and a paucity of studies done on malaria knowledge, access, awareness, and use of malaria control interventions among a high-risk group to reduce the maternal and child death caused by malaria disease in Huye district, Rwanda. The main objective of the study was to explore malaria knowledge, preventive practices, and current ownership and utilization levels of LLINs, as well as factors that are associated with the use of these among pregnant women in the Huye district in the southern province of Rwanda. This study used a cross-sectional observation design on knowledge, ownership, and utilization of malaria control interventions. The sample included pregnant women who were interviewed using a semi-structured questionnaire. The study participants were those living in the Tumba sector, Huye district. A questionnaire developed by the research staff of the Rwanda Biomedical Center research team was adapted to collect data on demographic characteristics; knowledge and awareness, guideline compliance, and utilization of malaria intervention strategies. The study was done within the period of three months from May to July 2019. This study used descriptive and logistic regression analysis. Of the 384 respondents, 340 (88.5%) were married and the mean age was 29.5±6.8 years with 172 (44.8%) aged between 25 and 29 years. The majority 224 (58.4%) had a primary level of education and 147(27.9%) were farmers. Of the 384 respondents who had low knowledge 96 (25%) whereas 42 (14.9%) had high knowledge and 246 (64.1%) had moderate knowledge. 298 (77.6%) were aware and knew that malaria is transmitted by female anopheles and the majority of respondents 323 (84.1%) were using LLINs. Education level, marital status, and occupation were associated with malaria knowledge on preventive practices and LLIN utilization (p=0.001). All study participants demonstrated high knowledge and mentioned that using and sleeping under LLINs helps to avoid mosquito bites however 381 (99.2%) knew that LLIN use, helps to fight against the malaria burden. LLIN ownership was 323 (84.1%) while LLIN utilization was 283 (87.6%) among LLIN owners. Level of education (p=0.001) and LLIN utilization (p=0.001) were significantly associated with LLIN ownership. Even though LLINs coverage was high, its utilization was still low across the country. Sixty-one respondents (15.9 %) did not have LLINs and 84 (22%) of respondents had low knowledge of LLINs utilization and its manipulation. This study reported the factors for not using LLINs among 384 study participants, 61 (15.9%) reported not using LLINs. Observed frequent factors that affect LLIN use among the respondents included: high temperature/heat 56 (94.9%), no access to LLIN 52 (88.1%), and used mosquito coil/spray 8 (13.6 %). Generally, formal education is strongly associated with LLIN utilization. Pregnant women who had high education levels were more expected to be LLIN users than those without formal education (OR 3.4 (95% CI 2.3–4.9). Also, pregnant women aged less than 29 years were less likely to utilize LLINs compared to older pregnant women (OR 0.7; 95% CI 0.5–0.9, p = 0.001). Finally, the overall mean score ±SD for the compliance index was 13.71 (5.4). Compliance index level of malaria control strategies, the model was, R2 = .131, F (5,486) = 13.18, p < .001. Two predictors, both age and education variables have significantly predicted the compliance towards malaria control measures with p < .03. Regression results on the impact of the maternal status on compliance index showed that pregnant women with under-five children were more likely to comply with policy guidelines on the malaria intervention strategies compared to those without under-five children. The study results have shown that the education level variable has an impact on the compliance index of malaria control interventions indicating that as the education level rises, the compliance index also raises. Therefore, this study revealed satisfactory knowledge of malaria control and prevention among pregnant women in southern Rwanda despite the poor implementation of current malaria control strategies. Malaria control policies were reported to be poorly implemented in the study area regardless of efforts made in malaria control and prevention. Yet there is a long journey in behavioral changes and communication among community members, lack of transportation means for referring malaria patients, and lack of feedback and decentralized supervision of health professionals were identified as possible challenges in malaria control policies execution in the study area. Forthcoming efforts need to emphasize behavioral changes and communication built on further research findings and regular national malaria control surveillance.

People who inject drugs (PWIDs) are increasingly becoming a public health concern in various parts of the world. It is estimated that between 11 and 21.1 million people inject drugs worldwide. This group of people is therefore considered a high-risk group mainly for Hepatitis C virus transmission since they act as a bridge of infection to the general population. Epidemiologically, the seven recognized genotypes (1-7) of HCV exhibits high genetic diversity, characterized by regional variations in genotype, posing a challenge to vaccine development and HCV treatment which in many countries is still genotype-specific. This cross-sectional study aimed to determine the prevalence of Hepatitis C and the circulating genotypes among PWIDs in Nairobi County. The snowball sampling technique was used to recruit 212 participants from two drop-in centers in Nairobi who consented to participate in the study. Up to 5 mL of blood was collected. The blood samples were screened using Bio-Elisa HCV 4.0 kit to determine the serostatus of the samples. Sero-positive samples were subjected to molecular analysis by amplifying the nucleic acids using PCR, where detecting the desired region was done by gel electrophoresis and finally sequencing analysis to determine the genetic diversity of the circulating strains. Socio-demographic characteristics, including individual parameters such as age, gender, and behavior on needle use, were determined using a questionnaire that was administered during recruitment. Summaries on socio-demographics were presented using descriptive statistics and multi multivariate analysis was performed to determine the association between the socio-demographic characteristics and the presence of anti-HCV in the selected population (P< 0.05 was considered significant). The Neighbor-Joining method on the MEGA6 programmer was used to generate a bootstrap consensus phylogenetic tree out of 1000 bootstrap replicates. For results, a total of 212 PWID were successfully recruited for the study, out of whom 29(13.7%) tested seropositive, with males accounting for 72.4% (n=21) and females were 27.6% (n=8). Age (OR=15; P=0.09), duration of injecting drugs (OR= 11.38; P=0.001), and the frequency of injecting drugs (OR=0.28; P=0.042) were found to be significantly associated with HCV infection. Of the 29 seropositive samples, 27(93.1%) were PCR-positive and were used for genotypic identification. The HCV circulating strains detected were genotype 1 at 51.8% (n=14), genotype 4 at 14.8% (n= 4), genotype 6 at 14.8% (n=4) genotype 5 at 7.4% (n=2), genotype 3 at 3.7% (n=1) and undefined genotypes at 7.4% (n=2). The study concludes that there is a potential emergence of circulation of foreign strains in Nairobi demonstrated by the identification of genotypes 5 and 6 which are not known to circulate in the region and the presence of the 2 unidentified genotypes. This calls for a change of treatment strategy from genotype-specific therapy to pangenotype therapy. The study recommends further genotype characterization with a larger number of samples to establish the magnitude of circulation of the genotypes considered not found in the region. These will influence policy on treatment strategy for HCV infection which is considered genotype-specific.

O’Nyong-nyong fever (ONNF) is an acute, mosquito-borne, non-fatal illness characterized primarily by debilitating polyarthralgia and/or polyarthritis. It is caused by O’Nyong-nyong virus (ONNV), first isolated from a febrile patient in 1959 in Northern Uganda. O’Nyong-nyong virus has been associated with rapidly spreading epidemics in Africa recording more than 2 million cases to date. A key element for control of arbovirus transmission is early diagnosis of infections. The main challenges in ONNV diagnosis, include (i) lack of commercial kits and specific assays to distinguish the closely related group A alphaviruses, in which ONNV belongs, and (ii) lack of effective treatments and vaccines. This study aimed to (i) determine the best cell line for ONNV isolation and large-scale production of ONNV purified proteins, (ii) generate ONNV monoclonal and polyclonal antibodies and (ii) assembly of an ELISA-based assay for sensitive detection of ONNV. O’Nyong-nyong virus strain SG650 was isolated in Vero cells, purified by sucrose gradient centrifugation, and used as an immunogen in BALB/c mice and New Zealand White rabbit immunization. Mice that developed sufficient antibody titers against ONNV were sacrificed and their spleen cells fused with parental myeloma cells using hybridoma technology for generation of anti-ONN monoclonal antibodies (mAbs). Similarly, rabbits that developed sufficient antibody titer were sacrificed and their serum purified and used to generate polyclonal antibodies (pAbs). The five MAbs generated were characterized and their potential for diagnostics determined and confirmed using an indirect IgG ELISA and Focus Neutralization Assay (FRNT50). The polyclonal antibodies were either conjugated with horseradish peroxidase for antigen detection ELISA development, used as capture antibodies for antigen detection ELISA or used unconjugated as primary antibodies for FRNT assays. To the best of our knowledge, this is the first documented effort to generate mAbs and pAbs against ONNV strain SG650. Generated antibodies can be explored and utilized for development and evaluation of serological assays to facilitate fast and timely diagnosis of ONNV infections in the laboratory, conduct surveillance and enhance differential diagnostic capability of arboviral and undefined febrile illnesses.

Section 10(1)(cN) of the Income Tax Act 58 of 1962 (the Act) in South Africa makes provision for approved Public Benefit Organisations (PBOs) in South Africa to enjoy preferential tax treatment. An organisation is approved as a PBO according to the requisites in section 30 of the Act. Accordingly, approved PBOs enjoy partial exemption from Capital Gains Tax (CGT). Income generated from trading activities must meet specific criteria to enjoy preferential tax treatment. One of the restrictions of this section is that an approved PBO may never have as its sole or primary object the operation of a commercial business to fund their public benefit activity. The South African non-profit sector continues to struggle financially, despite the progressive development of the tax legislation since 2000. The South African Revenue Service (SARS) believes that changes made at the commencement of 2000 to the Act that applies to approved PBO’s, are sufficient to strengthen the financial resources of the non-profit sector. However, the Legal Resources Centre believes that the changes made to the Act imbed a dependence on sporadic donor funding. After 1994, several nonprofit organisations that offered much needed socio-economic services to various South African communities, announced that they were struggling financially. Rape Crisis Cape Town was established in Cape Town in 1976 to help survivors of rape and sexual violence. In 1987, the Institute for Democracy in South Africa (IDASA) was set up to monitor the quality of democracy and hold the decision-makers accountable in Southern Africa. Both organisations made public announcements that they were struggling financially, and since then, IDASA has closed its operations in South Africa, and Rape Crisis Cape Town continues to struggle financially. South Africa’s non-profit sector finds its origin in the UK. The UK has implemented and changed its income tax legislation over a more extended period than South Africa. This research undertakes a comparative study between South Africa’s PBOs and registered Charities in the United Kingdom, emphasising England and Wales. It critically analyses the similarities and differences between PBOs and Charities with a specific focus on business undertakings and trading activities to increase the finances of the non-profit sector. One of the shortfalls of the study is that South Africa has a limited number of decided cases and research articles assessing this topic. This study highlights the complementary link between profit share accrual of PBOs and the basic requirements, conditions, and nature of these entities to address the social and economic challenges highlighted in the National Plan. There is not enough existing case law in which the courts adequately define concepts like “income”, “expenditure”, “surplus”, “profit” and “accrual” for PBOs. The study concludes by discussing the lessons learned from Charities in England and Wales, and it makes recommendations to the South African government for future implementation.

This dissertation involved a discussion and analysis of the international and domestic legal framework, and case law governing the immunity, arrest and surrender of heads of State wherein international crimes are addressed. This is in light of the visit by Omar Al Bashir, as then President of Sudan (Al Bashir), to South Africa when he attended an AU summit in the country. Before engaging discussions and analysis on the international and domestic legal framework, the dissertation starts by providing a background on immunity, arrest and surrender within the context of the Al Bashir matter. This was undertaken because the dissertation makes reference to the Al Bashir matter throughout, in order to demonstrate the conflicting obligations that arise for South Africa under the current legal framework, that is, the Rome Statute, Implementation Act and the DIPA. On this note, the dissertation discusses the international position on immunity, arrest and surrender of heads of State, emphasizing the conflicting obligations that arise from the Rome Statute, being the international legal instument governing it. This part of the discussion involves the clash between customary international law immunity and Rome Statute provisions, as well as international case law thereon. As a result, the basis to measure the extent of South Africa’s compliance with the international law position on immunity, arrest and surrender, was provided. The dissertation then proceeds with a discussion on whether South Africa’s law complies with the international position on immunity, arrest and surrender of head of State to the ICC for trial. The discussion highlights the domestic laws of South Africa and case law on South Africa’s failure to cooperate with ICC requests for the arrest and surrender of Al Bashir when he arrived in South Africa with two pending arrest warrants. Following this, the dissertation proceeds to discuss the effect of ICC cases on the international law position on immunity, arrest and surrender of heads of State such as Al Bashir. Finally, the dissertation provides an overall analysis to establish whether South Africa’s law complies with the international legal position and provides a recommendation based on the findings of the dissertation. Generally, South Africa has successfully incorporated the Rome Statute into its domestic laws under the Implementation Act. However, the pressing issue is the conflicting obligations that arise under the Rome Statute given that it recognises customary international law immunity, and in other provisions it denies immunity. This results in conflicting obligations for South Africa, as such, South Africa failed to arrest and surrender Al Bashir on the basis of customary international law immunity, recognised in the Rome Statute. Moreover, South Africa has incorporated as part of their law, both the Implementation Act which precludes immunity, as well as the DIPA, which grants immunity to heads of State. As such, this dissertation recommends an amendment to the Implementation Act in order to ensure South Africa’s compliance with provisions of the Rome Statute, to cooperate with ICC requests which is supported by international and domestic case law.

This research analyses the current policy and regulatory framework in South Africa to establish whether or not it is effective and responsive in promoting financial inclusion and facilitating access to basic bank accounts for the poor and the low-income households. The research takes a “back to basics” approach and focuses on access to basic bank accounts as the simplist form of financial service provided by banks and a gateway to other financial services. The main objective of the study is to determine whether the regulatory framework in South Africa that applies to commercial banks as deposit-taking institutions imposes obligations on them to provide access to basic bank accounts for consumers. The study applies Ayres and Braithwaite’s theory of responsive regulation and the pyramid of regulatory strategies to determine the type of regulatory instruments that may be applied to promote financial inclusion and access to basic bank accounts, and whether the current regulatory framework in South Africa should be redeveloped and improved to make it more effective and responsive to achieving this objective. The study uses existing regulatory frameworks for financial inclusion and access to basic bank accounts adopted by global standard-setting bodies, continental bodies, national legislatures, and associations of banks to benchmark the forms of regulatory responses and to determine whether these responses are responsive and effective in promoting financial inclusion generally, and access to basic bank accounts in particular. It further discusses the role that various regulatory bodies play through mutual collaboration and coordination to enforce and promote compliance with measures that promote financial inclusion and access to basic bank accounts. This research makes a number of findings and identifies gaps in the current policy and regulatory framework in South Africa. It, therefore, makes specific recommendations for improving and developing policy and regulatory measures to promote financial inclusion with a specific focus on access to basic bank accounts.