The presence of persistent organic pollutants (POPs) and heavy metals in farmed fish raises a global concern. There is the need for comprehensive monitoring of these pollutants, which present risk to the aquatic ecosystem as well as to humans through the dietary consumption of farmed fish. The levels of selected indicators: polychlorinated biphenyls, organochlorine pesticides and heavy metals in water, sediment, cage tilapia and fish feed samples from four cage aquaculture farms on the Volta Basin were investigated. The organochlorine pesticides (OCPs) were quantified using the Gas Chromatography equipped with Electron Capture Detector (GC-ECD); the polychlorinated biphenyls (PCBs) with GC/MS and the heavy metals, the Atomic Absorption Spectrometer (AAS). Hexane was used as a solvent for the water extraction for pesticides. At the same time, sediment, cage tilapia and fish feed were sonicated in an ultrasonic bath using an acetone/hexane (2:1v/v) solvent mixture. After the clean-up, the eluates were condensed in a rotary vacuum evaporator and collected in 2 ml ethyl acetate vial for GC analysis. A mixture of HNO3/HCl/H2O2 was used to digest fish, fish feed, sediment, and water samples for heavy metals. The concentrations of OCPs in water range, <LOD – 0.799 μg/l (fish farm A), <LOD – 0.520 μg/l (fish farm B), <LOD – 1.173 μg/l (fish farm C), <LOD – 0.280 μg/l (fish farm D) and <LOD – 0.037μg/l (Control). The predominant OCPs in water were methoxychlor, o,p'-DDD, α-endosulfan, methoxychlor, and δ-HCH in fish farms A, B, C, D, and control, respectively. The sediment OCPs levels range; <LOD – 8.253 μg/kg (fish farm A), ND – 6.00 μg/kg (fish farm B), ND – 2.362 μg/kg (fish farm C), ND – 13.861 μg/kg (fish farm D) and ND – 0.503μg/kg (control). -HCH, o,p'-DDD, α—endosulfan, o,p'-DDD and heptachlor were the predominantly detected OCPs in sediment sampled from fish farms A, B, C, D and control respectively. For the fish feed, the levels of the OCPs range ND – 2.21 μg/kg, ND – 4.02 μg/kg, ND- 7.87 μg/kg in fish farms A, B and D, respectively. Similarly, for the fish, the ranges were; ND – 2.310 μg/kg (fish farm A), <LOD – 4.260 μg/kg (fish farm B), <LOD – 6.109 μg/kg (fish farm D) and ND – 0.878 μg/kg (control). The highest concentration of 6.109 μg/kg was encountered for -HCH in the tilapia for fish farm D, whiles p,p'-DDE recorded the lowest in farm A. PCBs in water recorded a range of ND – 0.508 ng/l in fish farm A, ND – 0.528 ng/l in farm B, ND – 0.815 ng/l in farm C, ND – 0.594 ng/l in fish farm D and ND – 0.173 ng/l in control. In the sediment, the mean ranges of the PCBs were ND – 0.492 ng/g, ND – 0.475 ng/g, ND – 0.394 ng/g, ND – 3.328 ng/g and ND – 0.113ng/g in fish farms A, B, C, D and control respectively. For the heavy metals, Pb, Zn, Fe, Mn, Ni and Cr were detected in the water, sediment, fish feed and fish samples. The concentrations of OCPs, PCBs, and heavy metals in water, sediment, fish feed and fish were below the EU/WHO/USEPA MRL except for heptachlor in water from fish farms A, B, D, and endrin in the fish farm C. Pb in water and Mn in fish reported levels above the MRL. The study revealed that the pesticides in the sediment were from anthropogenic sources such as agricultural, industrial and municipal waste. Evaluating the ecotoxicological risk of the pesticides in the surface sediment using the sediment quality guidelines, it was evident that only ΣHCH could pose a health risk to the benthic organisms. It was also observed that the heavy metals detected in the sediment originated from both anthropogenic and lithogenic sources. There was a low potential ecological risk of the heavy metals to the organisms in the sediment during the period of observation. There was no health health risk associated with the consumption of caged tilapia, except tilapia from farms B and D contaminated with endrin, Cr, Ni, and As that could pose cancer risk to consumers. Further Laboratory-based research should be conducted on other contaminants and a detailed potential health risk assessment estimated for the sustainability of the aquaculture industry.

Background: The human noroviruses are a highly diverse group of diarrheagenic RNA viruses which are globally distributed, and a cause of acute gastroenteritis in all age groups with the elderly and young children usually experiencing severe clinical outcomes. To date, at least 40 different genotypes of noroviruses belonging to two major genogroups have been observed in humans. These different genotypes have been suggested to be associated with different transmission patterns and disease severity in humans. Also, host genetic factors including the presence of ABO antigens and mutations in the fucosyltransferase (FUT2 and FUT3) genes affect the susceptibility of individuals to infection with these diverse norovirus genotypes. This has raised questions on whether the prevalence, as well as the percentage of circulating Histo-Blood Group Antigen (HBGA) mutations within a population, would influence the prevalence of specific norovirus genotypes as a function of their ability to infect certain HBGA types. Moreover, the continuous changes observed in the genetic diversity of the noroviruses highlight the need for sustained surveillance to provide a full overview of norovirus epidemiology for future vaccine policy decisions. The overall aim of this thesis was to get a better understanding of norovirus infection dynamics, strain diversity, evolutionary dynamics, and the host genetic factors associated with the risk of norovirus infection in the Ghanaian pediatric population. Methods: A chronologically comprehensive 10-year study was conducted with diarrheic stool samples collected during active surveillance for diarrhoea in Ghanaian children between January 2008 and December 2017. A total of 1,337 stool specimens were obtained and subjected to RT-PCR and partial nucleotide sequencing for the typing of the polymerase and capsid genes of the norovirus genome. Phylodynamic and evolutionary relationships were performed using MEGA 6.0 and BEAST software, respectively, to analyze sequences that overlapped at open reading frame (ORF) 1 and ORF2 regions. The entire coding region of the FUT2 gene was also amplified from saliva samples collected from a cohort of the study population and genotyped using RLFP. Results: Overall positivity for norovirus infection among the Ghanaian pediatric population was 36.2%. Infection was most commonly (82.7%) observed in children aged between 6-24 months, suggesting that 0-6 months would be the most appropriate age range for effective norovirus vaccination, as early prevention is critical. Results from this thesis showed broad norovirus genotype diversity characterized by the circulation of both GII.4, and non-GII.4 strains. The evolution of these norovirus strains was usually a result of both intra- and intergenic recombination that occurred within the capsid and polymerase genes. A total of 25 capsid/RdRP combinations were detected with GII.4[P4] (25.9%); GII.4[P16] (9.2%); GII.3[P21] (6.3%); GII.4[P31] (4.6%) and GII.6P[7] (4.0%) being the most common norovirus strains. Children infected with non-GII.4 norovirus strains recorded equally severe clinical illness comparable to that caused by GII.4 norovirus strains. Data from this thesis also suggest that most norovirus strains circulated at low prevalence within the population before their recognition as epidemic and pandemic strains associated with increased norovirus outbreaks. The study results further indicate that neither secretor status nor genotype difference affects the susceptibility of an individual to norovirus infection in Ghana. More than half (62.0%; 8/13) of symptomatic patients were found to be carriers of the G428A mutation for inactivation of the FUT2 enzyme. Comparing norovirus genotype GII.4 with non-GII.4 genotypes, we observed that GII. 4norovirus strains infected more secretor-positive children who possessed heterozygous allele of the FUT2 gene than non-GII.4 strains (60.0% vs 40.0%, p=0.035) whereas non-GII.4 norovirus strains had a preference for secretor-positive children with the homozygous allele of the gene (62.5% vs 37.5%, p<0.05) in the study population. Conclusions: In summary, the study confirmed the significant role that noroviruses play in the cause of acute gastroenteritis among Ghanaian children and further contributes to our understanding of the epidemiology and evolution of the virus which hopefully can lead to better preventive measures for norovirus disease as well as baseline data for vaccine policy decisions. Since the epidemiology of norovirus changes rapidly, the establishment of systematic surveillance within sentinel sites across the country would enhance the monitoring of circulating norovirus strains and allow us to have a continuous understanding of the current state of norovirus infection within our settings.

Background: Accurate estimation of food portion size among free-living persons during dietary assessment is a common challenge. The weighed food intake presently regarded as the gold standard method is time and resource intensive with a high respondent burden. Retrospective methods such as the food frequency and 24-hour dietary recall where portion size estimation aids are employed in lieu of weighing are thus more frequently used. Among the portion size estimation aids, there is accumulated evidence that photographic food atlases are highly convenient and effective. So far, the only one based on the Ghanaian diet covers carbohydrate foods. Aim: To develop and validate a photographic atlas for portion size estimation of commonly consumed animal and plant protein source foods in the Ghanaian diet. Method: Fifty-four commonly consumed animal and plant protein source foods were identified in a cross-sectional survey among 834 adult residents (age £18 years) in Greater Accra Metropolitan Area. Colour photographs of each food in graduated portions of between 1 and 8 were produced and bound. Following a pilot study (n=50), the atlas was validated by the visual perception method in which 127 participants from the cross-sectional study estimated 47 predetermined portions of 12 test foods by comparing them with portions shown in photo series from the atlas. Participants’ estimations were categorized as correct (if the exact/correct picture of portion displayed was selected), adjacent (if picture immediately before or after the correct picture was selected) or distal (any other selections). Correct and adjacent estimations were classified as acceptable. Differences in proportions of accurate (correct) and acceptable (correct and adjacent) estimations across sex, age group, BMI and educational status were examined by Pearson’s chi square test of independence at p£0.05. Results: A total of 5894 references to 54 commonly consumed protein source foods were found in the 3-day 24HDR assessments. Fish and sea foods were most frequently consumed (34.6% of total protein food consumption occasions) followed by poultry (21.3%), legumes (18.8%), meat and meat products (13.6%), milk and milk products (11.7%). The atlas produced comprises 62 sets of serial, guide and range photos. In the validation, participants with tertiary education made a significantly higher proportion of accurate estimations than those with no formal education, primary or secondary school education. The proportion of accurate and acceptable estimations also differed according to the size of portion evaluated. Small portions were generally better estimated than large portions. No evidence of statistically significant differences in the proportions of accurate or acceptable estimations was found across sex, age group or BMI. Participants found amorphous foods challenging to estimate. In this regard, evaporated milk was the most difficult: nearly half (48.4%) of its portion size estimations were distal. The proportion of accurate (exact/correct) estimations observed for the 12 test foods ranged from 19.3% (fried tilapia fingerlings) to 88% (grilled sausage) while acceptable estimations ranged from 51% (evaporated milk) to 95.8% (boiled egg). Conclusion: In this study, a high proportion (i.e. 80%) of the 5969 portion size evaluations made during validation corresponded to either the correct portion or the one directly adjacent to it. Based on these results, the atlas produced is a potentially useful tool for portion size estimation of animal and plant protein source foods in the Ghanaian diet.

The traditional production of earthenware bowls in Ghana, as any other production activity, generates environmental and health issues over its production cycle. Over the years, little attention has been paid to the impacts related to earthenware production and use in the country. A common and useful tool in evaluating the environmental impacts of a product and promote its sustainability is the Life Cycle Assessment (LCA) tool. This thesis presents a comparative study of the life cycle of traditional earthenware pots produced in Mpraeso and Vume, in Ghana. The LCA methodology employed considered the International Organization for Standardization (ISO) 14040 rules and data from the potters on the production cycle. The unit of analysis was 1kg of the product and the scope of the study was from cradle to grave to examine the stages of the earthenware pot, a commonly used product in Ghana. At the production stage of the cycle, several analyses were carried out on raw materials. Plasticity of raw materials including raw clays, mixed clays and clay additives were performed according to ASTM D4318-05 methodology to ascertain the plastic limit of the substances. Mineralogical analyses of raw materials and pots were ascertained by Scanning Electron Microscopy (SEM). Physio-chemical properties of the clay were also studied, likewise, heavy metals were measured using the Atomic Absorption Spectrometer (AAS). Possible leaching of heavy metals from pots into food through the processes of grinding, serving and storage of food at different temperatures at the use stage were also examined. Further, the human health risk impact of the production and usage of earthenware pots were assessed employing the USEPA health risk and the cancer risk models. Additionally, the pottery socio – cultural issues and perception on production methods and environmental impacts of the industry among the 2 communities were verified through the administration of questionnaire to the potters. The data was analyzed by Principal Component Analysis, Pearson coefficient of correlation and Analysis of Variance. Clay mineralogical and chemical composition showed that the clays of Mpraeso and Vume are composed mainly of Si, Al, Fe, smectite (montmorillonite), kaolinite, illite and quartz as major minerals, and the plasticity of the clays increases with the addition of a temper. There were gender and socio-cultural systems governing the pottery industry in the study areas. Indigenes were not happy with the mass destruction of the environment coupled with no plan of reclamation. Leaching and health risks analyses indicated that, food consumption and storage in unglazed pots is associated with metals of Fe, Co and Ni which were found to be above WHO/FAO recommended levels. More so, human contact during processing and inhalation during extraction over a long period could affect indigenes health. Further assessment of the environmental impact by ReCipe endpoint method in Simapro 7.1 software during the stages of extraction and firing using the traditional methods of production showed intense devastation. The results also demonstrated that energy used in the industry was the major contributor towards resource depletion, environmental and health impacts in the industry. There is the need therefore, for the regularization of the industry by National Board for Small Scale Industry, Environmental Protection Agency, Environment and Sanitation office for health, safety and environmental protection since there are some socio-economic and environmental implications of the pottery production cycle. Regulations and training will also ensure economic benefits to local assemblies and national government through taxation and foreign exchange earnings.

Issues of impacts of small-scale gold mining activities on the environment continue to take a center stage in environmental discourse in developing countries more especially sub-Saharan Africa. This study was carried out to assess ecological footprint of artisanal and small-scale gold mining on soil and provisioning ecosystem services in the Mpohor Wassa East and Amansie West Districts, Ghana. Composite samples of soil and water were taken in selected artisanal and small-scale mining areas for analysis. A total of one hundred and sixty-two (162) soil samples including control soil sample were analyzed over a period of three-months. Seventy-five (75) and eighty-seven (87) composite soil samples were taken from Amansie West and Mpohor Wassa East Districts, respectively. In addition, twenty-seven (27) water samples including control were taken and analyzed during the entire study period. From Mpohor Wassa East water samples, the mean pH ranged from 6.5 to7.1; Electrical Conductivity (EC); 58.7 to 152.3μS/cm; Total Dissolved Solids (TDS); 33.3 to 101mg/L, Total Suspended Solids (TSS); 5.3 to 645 mg/L; Dissolved Oxygen (DO); 5.4 to 12.9mg/L, Biological Oxygen Demand (BOD); 1.0 to 1.7mg/L. The DO, BOD and EC in most sampling sites exceeded the WHO permissible limit. The EC, TDS, alkalinity, and salinity values, however, were all within WHO recommended limits. The results of analysis of the water samples from Amansie West were also as follows: pH; 4.6 to 7.8; EC; 42.7 to 484.8μS/cm; TDS; 25.3 to 221.2mg/L; TSS; 12.5 to 390.7mg/L, DO; 4.3 to 11.8mg/L; BOD; 1.4 to 2.5mg/L. Mercury, arsenic, cadmium and nickel in water samples at both Mpohor Wassa East District sampling sites and Amansie West sampling sites exceeded the WHO and EPA (Ghana) acceptable limits. The concentrations of the following heavy metals in soils; Fe, Hg, Ni, Cu, Pb, Cr and As were above the FAO acceptable limit for agricultural soils. This suggests (which specifically?) that artisanal and small-scale gold activities have impacted on the soil. The study further revealed that change in land use due to artisanal and small-scale mining activities significantly influenced the following ecosystem services; drinking water, wood fuel, medicinal plants, raw material for construction and food crop production. However, in this study, all heavy metals analyzed with Atomic Absorption Spectrometer had Threshold Exceedance Ratio (TER) less than the total concentration when extracted with nitric acid. This translates that limited soil function might not occur since the TER values are smaller compared to the total concentrations and could not limit the function of the soil for agriculture purposes however, the re-mobility percentage especially, Cu was high and had higher percentage mobility in all sampling sites above 20% which suggest that, Cu has a higher potential to remobilized into the soil structure when environmental conditions are favorable. The geo-accumulation index showed that the soils in both study districts are moderately contaminated. The overall conclusion is that artisanal and small-scale mining activities have impacted on provisioning ecosystem services in the two study areas. Efforts aimed at restoring the provisioning ecosystem services therefore need to be considered by relevant authorities. Recommendations made from the study include mandated agencies such as Environmental Protection Agency (EPA) and Ministry of Minerals and Land Commission should regulate the activities of ASGM to stop the discharge of poisonous heavy metals into soil and water bodies. Also, Phytoextraction ability plants such as Sun flower (Helianthus annuus), Cannabis sativa, Tobacco (Nicotiana tabacum), Maize (Zea mays) can be cultivated to demobilize Cu and Hg in the soil and this can be championed by EPA and the Ministry of Agriculture in Ghana. Lastly, it was recommended that the Forestry Commission, relevant stakeholders or NGOs should champion Land reclamation activities such as reafforestation and afforestation should be encouraged at the mined sites to revamp provisioning ecosystem services supply.

Cultural ecosystem services (non-material benefits that are derived from ecosystems that are derived from coastal systems are increasingly reducing due to ecological changes that are occurring within the coastal environment. Understanding the dynamics of these changes and their implications for sustainable coastal environmental management is imperative. Cultural ecosystem services in coastal areas are affected by several factors such as erosion, saline intrusion, loss of place and coastal flooding. Coastal flooding along the coast of Ghana has led to significant damage to properties and livelihoods with negative social consequences. However, various ways in which coastal flooding affects cultural ecosystem services is yet to be fully understood. This thesis assesses the interlinkages between coastal erosion, coastal flooding and cultural ecosystem services in Ada along the eastern coast of Ghana. Firstly, assessed community perceptions of the drivers of coastal flooding, assessed the status of ecosystems services and predicted the future implications of flooding on cultural ecosystem services in Ada. Quantitative and qualitative data was collected from 358 respondents in seven communities in the Ada East and Ada West Districts of the Greater Accra Region. Perceptions of the drivers of flooding among community residents in Ada were investigated and compared to data on the drivers of flooding from 1985 to 2017. Structural Equation Model (SEM), a confirmatory analysis tool, was used to validate the relationship between the latent variable flooding and various categories of drivers. The results showed that the drivers of flooding in Ada are both climatic and anthropogenic with climatic drivers being dominant. Three cultural ecosystems services identified in Ada which were Place, Aesthetics and Recreation. Cultural livelihood was discovered as new cultural ecosystem service which expands the suite of cultural ecosystem services further. Extensive flooding has resulted in loss of place (physical, cultural and even imaginary location that is differentiated and emotionally meaningful to people), vegetation degradation and deterioration of landscape. The path analysis results indicate that the effect of flooding is a significant predictor of place with a coefficient of 0.015 and a p-value of 0.01. In addition, the mediation effect of flooding is a statistically significant predictor of cultural livelihood and recreation (p-values 0.00 and 0.05, respectively), but an insignificant predictor of aesthetic (p-value -0.02). Results from the Bayesian network model, climatic drivers including sea level rise, rainfall, wave and wind speeds, present severe threats to the coastal dwellers of Ada East and West Districts. Currently, cultural ecosystem services are impacted. The model predicts that an increase in intensity of climatic drivers from 38.7% to 80% is likely to increase flood incidence from 42.1% to 58.3%. An increase in the intensity of non-climatic drivers also by 80% is likely to increase flood incidence by to 44.5% from the current level of 42.1%. This shows that relative to climatic drivers, non-climatic drivers have less impact on flooding in Ada. Cultural ecosystem services which local people depend on will decline significantly from 44.6% poor to 54.3% poorer. With adequate policy interventions such as provision of alternative livelihood support, construction of landing beaches and involvement of local people in the design of policies to address coastal flooding, the model predicts an improvement in ecosystem health from 36.7% to 48.5%. This implies that policy intervention should be more aligned towards measures to reduce the intensity of climatic drivers while maintaining anthropogenic drivers at their current levels.

Background: Weight Loss Maintenance (WLM) although necessary for the preservation of the health benefits derived from weight loss, is difficult to attain. Research investigating the perceived barriers and predictors of WLM success as well as the impact of WLM success on cardiovascular related biomarkers are usually limited to short-term post weight loss periods not exceeding two years. Studies on commercial weight loss programmes are mostly limited to short-term efficacy studies with little known about the long-term outcomes. Additionally, investigations on WLM so far, are mostly carried out in developed countries with no data on WLM outcomes of commercial weight loss programmes in developing countries such as Ghana, and the associated factors of WLM success. Given the global importance of commercial programmes for weight loss, there is the need to gain insight into their long-term outcomes in developing countries including Ghana, and determine the perceived barriers, predictors, and the associated biomarkers of WLM success. Methods: A retrospective cohort study involving 230 participants who formerly enrolled in a commercial weight loss programme between 2008 and 2016 was undertaken in Accra, Ghana. The prevalence of WLM success was determined using a definition of successful WLM as achieving ≥ 5.0% weight loss below starting weight for a period of at least six months post weight loss intervention and unsuccessful WLM as otherwise. An interviewer-administered questionnaire was used to obtain information on the demographic, behavioural, psychosocial and programme based characteristics of participants as well as the perceived barriers to WLM success. A sub-sample of 112 individuals were selected for biochemical analysis on fasting blood lipids and glucose parameters. Categorical Principal Component Analysis (CATPCA) was employed to determine the various components of perceived healthy eating and physical activity related barriers to WLM success. Multivariate binary logistic regression analysis was conducted to identify the predictors of WLM success. Multiple linear regression was used to determine the association between WLM and the concentrations of lipids/glucose biomarkers. Results: The prevalence of WLM success was 23.9%. The healthy eating related barriers to WLM success were locational, cost of healthy eating, food craving, emotional factors and lack of social support and accounted for 66.9% of the variance in data. The physical activity related barriers to WLM success were the cost of physical activity, environmental factors and personal factors and accounted for 65.6% of the variance in data. Achieving ≥ 10% weight loss at the end of the weight reduction programme increased the odds of WLM success compared to not achieving ≥10.0% weight loss (AOR = 6.72, 95.0% C.I = 3.15-14.31). Similarly, logging physical activity compared to not logging (AOR = 3.52, 95.0% C.I = 1.49-8.32), limiting food portions at meal times compared to not limiting (AOR = 3.51, 95.0% C.I = 1.07-11.57), and a good/excellent perceived competence in carrying out behaviours for weight maintenance compared to a poor/disappointing perceived competence (AOR = 5.93, 95.0% C.I = 1.74-20.19), increased the odds of successful WLM. Being out of the weight loss treatment for three years or more as at the time of this study reduced the odds of WLM success compared to being out of treatment for less than three years (AOR = 0.46, 95.0% C.I = 0.22-0.97). Successful Weight Loss Maintainers (SWLM) compared to Unsuccessful Weight Loss Maintainers (UWLM) had significantly lower concentrations of adjusted serum total cholesterol (TC) (5.69±0.24mmol/L versus 6.26±0.18mmol/L, respectively, P<0.013) and triglycerides (TG) (1.11±0.10mmol/L versus 1.34±0.07mmol/L, respectively, P<0.021). SWLM with 10.0% or more weight loss had significantly lower concentrations of adjusted LDL compared to UWLM (3.86±0.31mmol/L versus 4.46±0.18mmol/L, respectively, P = 0.046). The adjusted serum High Density Lipoprotein (HDL), Fasting Blood Glucose (FBG) and glycosylated haemoglobin (HbA1c) concentrations did not differ between SWLM and UWLM.

This study sought to determine the effect of corruption on productivity of manufacturing firms in Kenya. Specifically, the study sought to investigate the extent to which the productivity of firms in the manufacturing sector is affected by corruption. Additionally, the study compared how corruption affects the productivity of different firm sizes. The study employed panel data from the World Enterprise Survey covering the period 2007-2018. The study found out that corruption had an insignificant positive effect on the productivity of manufacturing firms. Ownership type has also an insignificant effect on productivity. However, large firms engaged in corrupt activities showed a positive effect on their productivity compared to medium sized firms which also showed a positive effect when compared to smaller firms. Thus overall, corruption positively affects the productivity of large firms: large firms have the financial muscles for paying bribe tax and time tax reducing bureaucracies hence improved efficiency.

Realization of ODF communities and progression on the sanitation ladder to 100% utilization of improved sanitation facilities has become an elusive goal for the WaSH sector both globally and in Kenya. The development WaSH sector has engaged governments in the last two decades in developing various strategic frameworks in a bid to achieve the Millennium Development Goals of 2015 and the Sustainable Development goals of 2030 for sanitation. Additionally, research studies have developed theoretical models and descriptive frameworks that endeavor to guide behavior change interventions related to sanitation. Kenya is among countries that have integrated the development goals in its sanitation strategic frameworks however; the country’s OD rate stands at 14% with an annual decline rate of 0.75%, while the rate of uptake of improved sanitation facilities is at 1%. This research study aimed to determine the effects of socioeconomic factors on utilization of improved sanitation facilities by households in Kenya. It followed the Integrated Behavior Model for Water Sanitation and hygiene and, employed probit model in analysis of the 2018 Kenya Integrated Budget Household Survey data to determine the effects of income, education level, gender and age on utilization of improved sanitation facilities by households in Kenya. The study applied probit model. The study findings indicate, the type of sanitation facility utilized by a household is determined by, the sex of the household head, the highest level of education attained by the household head and, the household income. The study concludes that sanitation policy formulation and implementation should target resources towards knowledge empowerment and increasing household income generating streams for investment in improved sanitation.

Commercial poultry production is an important farming enterprise in most parts of Kenya. The treatment of enteric infections in animals has been complicated through development of antimicrobial-resistant microbes. Occurrence of Multiple forms of drug resistance patterns has rendered chemotherapy drugs less effective in management of microbial infection. Multidrugresistant Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae places great threat towards public health by raising morbidity and mortality particularly in developing countries. Accurate statistics on the frequency and mechanism of antibiotic resistance development in enteric micro-organisms isolated from poultry and persons in Kenya is scarce. This current study determined the extent of antimicrobial use, and resistance patterns in selected Enterobacteriaceae isolated from commercial poultry production systems in Kiambu County, Kenya. A descriptive cross-sectional study was conducted on commercial poultry production systems of Kiambu County to ascertain the knowledge level, attitudes, and practices on antibiotics use in addition to their resistant patterns on selected Enterobacteraceae species. One hundred and fifty six commercial poultry farmers were purposively selected from the following subcounties; Ruiru (n=33), Juja (n=20), Gatundu North (n=20), Gatundu South (n=19), Thika (n=27) and Kikuyu (n=37) respectively. One hundred and fifty-six (n=156) semi-structured questionnaires imprinted in a mobile Open data kit were administered to capture the knowledge level, attitudes, and practices on antimicrobial usage in commercial poultry production systems of Kiambu County. A total of 437 fecal samples (cloacal swabs (n=365), and Human stool (n=72)) were collected, followed by bacterial isolation, confirmation, antibiotics susceptibility tests, and molecular detection of ESBLs genes and Quinolones resistance (QNRs) were detected using Polymerase chain reaction (PCR) methods. Out of 156 commercial poultry farmers who participated in this study, females accounted for (64%) with 51% of them keeping layers between 50-500 birds as medium-scale farmers. Sixty-one percent (61%) of the farmers were 45 years and above, and they had obtained a secondary level of education (34%). Sixty seven percent (67%) of the farmers obtain antibiotics through self-prescription/personal experience from the drug shops. Farmers identified lack of enough veterinary officers (77%) and consultation services (72%) as key challenges in poultry production system. Sixty three percent (63%) of the respondents, indicated tetracycline as the most commonly used antibiotic in their farms, with oxytetracyclines subtype (85%) being the most preferred. Also amoxicillin (63%) was equally preferred by farmers with amoxi (88%) sub-types being the most preferred, xxi respectively. Nearness to veterinary services significantly (P<0.05) contributed to the use of antibiotics agents. Additionally, the area of residence, type of production, number of years in farming, and average number of birds kept also significantly (P<0.05) influenced the level of knowledge and practice on antimicrobial usage. Out of 437 fecal and stool samples collected, 591 (Cloacal isolates=544; human isolates= 47) isolates were recovered, with E.coli (48.9%) being the most frequently identified, followed by Shigella spp. (18.8%), Salmonella spp. (18.3%), and Klebsiella spp. (14.0%).There was a great occurrence of multiple resistance among isolates especially towards sulfamethoxazole (79%), trimethoprim (71%), and tetracyclines (59%), respectively. Additionally, the isolates showed the highest rate of susceptibility against cefuroxime (94%), gentamicin (93%), ceftriaxone (91%), cefepime (89%), cefotaxime (85%), ceftazidime (84%), and chloramphenicol (77%), respectively. Out of the isolates (n=78) collected with potential ESBLs production, only 66 (84%) tested positive for the target genes with the utmost detected ESBL genetic factor from the isolates being blaOXA (n=20; 26%), followed by blaTEM (n=16, 21%), with the majority of them detected in Escherichia coli. In all the four enteric's bacteria-type isolates tested, the blaCTXM gene was detected. Three (n=3) Salmonella, and E.coli spp respectively harbored all the five tested antimicrobial resistance (AMR) gene types. The blaTEM, blaOXA, blaSHV, and QnrS genes were not detected from Klebsiella and Shigella spps. Additionally, most of the AMR gene co-carriage was detected in both E.coli and Salmonella spps as follows blaTEM+blaOXA (n=4); blaTEM+QnrS (n=3); blaTEM+blaOXA+Qnrs (n=3), concurrently. It was concluded that both fecal and stool materials from commercial poultry and humans can be a reservoir of multi-drug resistance enterics. This is a potential route of spreading out resistance genes amongst livestock and Humans, which pose a great danger to public health of Kiambu County residence. There is also need to strengthen antimicrobial surveillance and monitoring strategies at County level. It was recommended that the results of the current study be used in formulating strategies and informed decisions in combating antibiotic resistance and irrational usage of antibiotics in commercial poultry production in Kiambu County and other areas with similar poultry production systems in Kenya.