Publications

In Press
2023
Tita, A. T. N., Carlo, W. A., McClure, E. M., Mwenechanya, M., Chomba, E., Hemingway-Foday, J. J., Kavi, A., et al. (2023). Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal Birth. N Engl J Med, 388, 1161–1170. United States. Abstract
BACKGROUND: The use of azithromycin reduces maternal infection in women during unplanned cesarean delivery, but its effect on those with planned vaginal delivery is unknown. Data are needed on whether an intrapartum oral dose of azithromycin would reduce maternal and offspring sepsis or death. METHODS: In this multicountry, placebo-controlled, randomized trial, we assigned women who were in labor at 28 weeks' gestation or more and who were planning a vaginal delivery to receive a single 2-g oral dose of azithromycin or placebo. The two primary outcomes were a composite of maternal sepsis or death and a composite of stillbirth or neonatal death or sepsis. During an interim analysis, the data and safety monitoring committee recommended stopping the trial for maternal benefit. RESULTS: A total of 29,278 women underwent randomization. The incidence of maternal sepsis or death was lower in the azithromycin group than in the placebo group (1.6% vs. 2.4%), with a relative risk of 0.67 (95% confidence interval [CI], 0.56 to 0.79; P<0.001), but the incidence of stillbirth or neonatal death or sepsis was similar (10.5% vs. 10.3%), with a relative risk of 1.02 (95% CI, 0.95 to 1.09; P = 0.56). The difference in the maternal primary outcome appeared to be driven mainly by the incidence of sepsis (1.5% in the azithromycin group and 2.3% in the placebo group), with a relative risk of 0.65 (95% CI, 0.55 to 0.77); the incidence of death from any cause was 0.1% in the two groups (relative risk, 1.23; 95% CI, 0.51 to 2.97). Neonatal sepsis occurred in 9.8% and 9.6% of the infants, respectively (relative risk, 1.03; 95% CI, 0.96 to 1.10). The incidence of stillbirth was 0.4% in the two groups (relative risk, 1.06; 95% CI, 0.74 to 1.53); neonatal death within 4 weeks after birth occurred in 1.5% in both groups (relative risk, 1.03; 95% CI, 0.86 to 1.24). Azithromycin was not associated with a higher incidence in adverse events. CONCLUSIONS: Among women planning a vaginal delivery, a single oral dose of azithromycin resulted in a significantly lower risk of maternal sepsis or death than placebo but had little effect on newborn sepsis or death. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; A-PLUS ClinicalTrials.gov number, NCT03871491.).
2022
Kweyu, C., Feng, L., Stein, M., & Benner, P. (2022). International Journal of Nonlinear Sciences and Numerical Simulation. Website
Musafiri, C. M., Kiboi, M., Macharia, J., Ng'etich, O. K., Kosgei, D. K., Mulianga, B., Okoti, M., et al. (2022). Adoption of climate-smart agricultural practices among smallholder farmers in Western Kenya: do socioeconomic, institutional, and biophysical factors matter?. Heliyon, 8, e08677. Website Abstract
Rigorous efforts should be channeled to the current low adoption of climate-smart agricultural practices (CSAPs) in sub-Saharan African countries to improve food production. What determines the adoption level and intensity of CSAPs among smallholder farmers in Kenya? While considering their joint adoption, smallholder farmers' CSAPs adoption determinants were assessed based on a sample size of 300 smallholder farmers in Western Kenya. The CSAPs considered were animal manure, soil water conservation, agroforestry, crop diversification, and crop-livestock integration. A multivariate and ordered probit models were used to assess the determinants of joint adoption of CSAPs in Western Kenya. Both complements and substitutes between CSAPs were established. The multivariate probit analysis revealed that household head's gender, education, age, family size, contact with extension agents, access to weather information, arable land, livestock owned, perceived climate change, infertile soil, and persistent soil erosion influenced CSAPs adoption. The ordered probit model revealed that gender, arable land, livestock owned, soil fertility, and constant soil erosion were crucial determinants of CSAPs adoption. The findings implied that policymakers and relevant stakeholders should consider farmer, institutional, and biophysical factors in upscaling or promoting the adoption of CSAPs.

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