Publications

There is limited data on the bleeding safety profile of direct oral anticoagulants, such as rivaroxaban, in low- and middle-income country settings like Kenya. In this prospective observational study, patients newly started on rivaroxaban or switching to rivaroxaban from warfarin for the management of venous thromboembolism (VTE) within the national referral hospital in western Kenya were assessed to determine the frequency of bleeding during treatment. Bleeding events were assessed at the 1- and 3-month visits, as well as at the end of follow-up. The International Society of Thrombosis and Hemostasis (ISTH) and the Bleeding Academic Research Consortium (BARC) criteria were used to categorize the bleeding events, and descriptive statistics were used to summarize categorical variables. Univariate and multivariate logistic regression model was used to calculate unadjusted and adjusted associations between patient characteristics and bleeding. The frequency of any type of bleeding was 14.4% (95% CI: 9.3%-20.8%) for an incidence rate of 30.9 bleeding events (95% CI: 20.1-45.6) per 100 patient-years of follow-up. The frequency of major bleeding was 1.9% while that of clinically relevant non-major bleeding was 13.8%. In the multivariate logistic regression model, being a beneficiary of the national insurance plan was associated with a lower risk of bleeding, while being unemployed was associated with a higher bleeding risk. The use of rivaroxaban in the management of VTE was associated with a higher frequency of bleeding. These findings warrant confirmation in larger and more targeted investigations in a similar population.

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.