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Hands Up, Don’t Shoot

If things continue as they are, 2020 will be one of the deadliest years on record for the police. By 1st June 2020, 95 people had been killed by them.

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Hands Up, Don't Shoot
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Covid-19 regulation enforcement has added a new dimension to police killings in Kenya. 18% of this year’s victims died as a result of police enforcing these rules. You can view data on #policebrutalityke in the database we built with MissingVoicesKE.

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Odipodev is a data analytics and research firm operating out of Nairobi.

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COVID-19 in Kenya: A Situational Analysis of the Now and the Near Future

Using mathematical modelling, Professor Waititu simulates the progress of the coronavirus outbreak.

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The daily positive cases in Kenya are on an upward trend. The highest daily count of 278 cases was reported on 27/06/2020. The total confirmed cases so far are 6,070.

In Africa, the five countries with the highest number of confirmed cases are South Africa with 138,134 cases, Egypt with 65,188 cases, Nigeria with 24,567 cases, Ghana with 16,742 cases and Algeria with 13,273 cases.

Testing

The number of confirmed cases could be attributed to the total number of tests conducted by a country. For example, by 27th June 2020, South Africa had tested 1.53 Million people. Ghana had tested 288,465 people by 25th June 2020, Nigeria had tested 130,164 people by 28th June 2020 while Kenya had 165,196 tests by 29th June 2020. The implication here is that the positive cases in Kenya could increase with increased number of tests. Kenya will therefore have to increase the number of tests across the country incase the government decides to remove its lock down restrictions in the identified hot spots. Early detection of positive cases and proper contact tracing are very important in the recovery of infected cases.

Death Rate

On the death rate, Kenya has registered 143 fatalities, translating to a death rate of 2.36%. South Africa which has the highest number of confirmed cases in Africa at 138,134, has a lower death rate of 1.78%. One of the highest death rates in Africa has been reported in Algeria at 6.78% from 897 deaths. Ghana has one of the lowest reported death rate of 0.67% from 112 deaths. Egypt has a death rate of 4.28% from 2,789 deaths while Nigeria has a death rate of 2.30% from 565 deaths. Kenya is therefore doing relatively well in managing the positive cases compared to other African countries.

Recovery

Kenya’s recovery rate is currently at 32.47% from 1,971 recoveries. This is a much lower recovery rate compared to statistics from other African countries. South Africa has a recovery rate of 49.90 % from 68,925 recoveries, Algeria has a recovery rate of 70.60% from 9,371 recoveries while Ghana and Nigeria have recovery rates of 75.98 % and 36.66% respectively. Kenya needs to raise the recovery rate to a comfortable figure above 60%. This will help the country release pressure on the health system and also motivate the easing of the existing lockdown restrictions.

Infections Prediction

How will Kenyan COVID-19 infections look like in the coming days? The answer may not be definite since the spread of the virus is determined by the nature of community response to safety strategies given by MoH such as regular hand washing, social distancing and staying at home. However, as shown in the prediction graph below, the daily infections in Kenya are going to increase as time goes by. It is predicted that in the near future, the daily cases in Kenya will soon be above 300 with the possibility of a maximum of about 400. This conclusion is based on the assumption that the testing samples will be optimally selected.

Image 2.The Peak

Has Kenya reached it’s peak? The simple answer is no. As a matter of fact, Kenya will hit the 10,000 mark of confirmed cases within the month of July 2020. As seen in the graph below for cummulative confirmed cases, the positive cases are still on an upward trend. A peak will be experienced when the cummulative cases will start stagnating around a certain figure over time. With the current trend of infections, the earliest time Kenya will reach its peak is around September 2020. It should also be noted that incase the lockdown is relaxed, Kenya will definitely experience a surge in the infections before the situation stabilises. This has happened in other countries such as South Africa, Germany and China. Since COVID-19 has spread to most of the counties in Kenya, the focus now should be on the level of preparedness by the county governments in implementing the MoH guidelines and the avalaibility of functioning and COVID-19 equiped hospitals.

Image 2.This report is based on the data from the Johns Hopkins University Center for Systems Science and Engineering (JHU CCSE) as at 9:00am E.A.T on 29/06/2010.

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Young, Gifted and…Pregnant

The month of May is dedicated to preventing and ending teenage pregnancies worldwide. But as the month comes to an end, Kenya is still not close to achieving this goal.

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One in every five Kenyan girls aged between 15-19 has had a live birth or is pregnant. It’s a mind-blowing statistic that speaks to the teenage pregnancy crisis in the country – the United Nations Population Fund estimates that there were about 380,000 cases in 2019 alone. Eighteen-year-old Patricia* (not her real name) was referred to me for legal advice, as she had one such pregnancy. Orphaned at an early age, her paternal uncle took her in but sexually abused her for several years. Today Patricia is 5 months pregnant and not in school, even though this should have been her final year. And while her uncle should be charged under the Sexual Offences Act – facing not less than 15 years in prison if convicted – Patricia will not testify against him for fear of losing the only financial support she has.

The month of May is dedicated to preventing and ending teenage pregnancies worldwide. But as the month comes to an end, Kenya is still not close to achieving this goal. Patricia is one of thousands of girls in Kenya stuck in a predicament caused by sexual violence, lack of information on, and access to youth-friendly sexual and reproductive health. For these girls, their education will be interrupted and their social and economic choices taken away from them.

Teen Pregancy Infographic.png

But there are also increased health risks associated with teenage pregnancies, including physical health issues like convulsions, uterine infections and obstetric fistula – a hole in the birth canal, resulting in incontinence of urine or faeces that often affects women who give birth too young – and mental health challenges like depression and anxiety. And there are risks to the unborn child including premature birth, low birth weight and other neonatal conditions. Preventing teenage pregnancies is about protecting the holistic health of both the mother and the potential unborn child, and by extension, society as a whole.

The Kenya Demographic Health Survey 2014 reported a 2% drop in teenage pregnancies over a 20-year period. This was caused by major changes in girl’s education programmes and in the sexual and reproductive health and rights landscape in Kenya that made birth control and other services more accessible to teenage girls. Yet in 2014, the Kenyan Parliament shot down the Reproductive Health Care Bill sponsored by Senator Judith Sijeny, which suggested among other things, that adolescents be given unrestricted access to comprehensive sexual education and confidential sexual and reproductive health services. There was uproar around the bill, with Kenyans citing religious and cultural beliefs to reject it. But the facts betray this opposition: the same survey (KDHS) shows that about 11% of teenagers, nationwide are having sex before their 15th birthday. Kenya’s teenagers need better access to sexual and reproductive health services.

It’s not all doom and gloom though. In 2013, Kenya signed the Ministerial Commitment on Comprehensive Sexuality Education and Sexual and Reproductive Health Services for Adolescents and Young People in Eastern and Southern Africa. In 2015, the Ministry of Health enacted the National Adolescent Sexual and Reproductive Health Policy that aims to enhance the sexual and reproductive health status of adolescents in Kenya and contribute towards realization of their full potential in national development. Additionally, two months ago in March, Kenya through the National Council on Population Development (NCPD), launched the first-ever government-led multi-stakeholder campaign against teenage pregnancy dubbed ‘Let’s Act to End Teenage Pregnancy’.

But sex education is still not being uniformly delivered across the country. Teachers are not all adequately trained and can often pass misinformation onto the students. An African Population and Health Research Center (APHRC) study found that 1 in 4 secondary school students in Homa Bay, Mombasa and Nairobi counties thinks that using a condom during sexual activity is a sign of mistrust. The content of the curriculum is also heavily focused on content covering abstinence and sexually transmitted infections, ignoring other important topics like contraceptive use and access to safe abortion. Furthermore, a new Reproductive Health Care Bill (2019) threatens to negate the gains made on adolescent sexual and reproductive health and rights as it requires health providers to seek parental consent before providing adolescents with sexual and reproductive health services. Requiring parental consent is likely to result in an increase in unintended teenage pregnancy and unsafe abortions because teenagers may not want their parents to know about their sexual activities.

Ending teenage pregnancies will take a concerted effort of policy mixes. The judiciary must strictly implement the Sexual Offences Act. The legislature must review the issue of bride price, particularly, where teenage girls are concerned to de-incentives teenage marriages. Increased girls educational programs and opportunities created. Teachers must receive adequate training on comprehensive sexuality education. A wide range of sexual and reproductive health topics should be taught in the classroom but also parents and guardians must take the lead in providing their teenagers with correct and age appropriate information on sex. Lastly, the legislature must urgently amend Section 33(a) of the proposed reproductive health care law, to enable teenagers freely access quality, youth friendly sexual and reproductive health services. It’s time to bring down Kenya’s startling teenage pregnancy statistics.

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Modelling the COVID-19 Pandemic in East Africa

Using mathematical modelling to track and predict the progress of the coronavirus outbreak.

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Modelling the COVID-19 Pandemic in East Africa
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Mathematical models allow us to extrapolate from information currently available about the state and progress of an outbreak, to predict future cases. In this article, we illustrate how, using mathematical models, the COVID-19 outbreak can be modelled mathematically to help prepare for the worst-case scenario and to develop a vaccination policy.

As can be seen from Figure 1, it is clear that the outbreak of COVID-19 in East Africa is taking a similar shape to that of China, USA and other European countries. The infections in China seem to have flattened by the last week of February 2020. East African countries seem to be at different phases of the disease outbreak. Kenya has the highest number of reported cases so far. This could be attributed to the relatively higher number of tests Kenya is carrying out compared to other East African countries. The United States has over 800,000 confirmed cases so far. The time it will take for the infections to significantly slowdown is of much interest to all the stakeholders.

Figure 1: COVID-19 Cumulative confirmed cases in East Africa, Europe, USA and China between 22/01/2020 and 21/04/2020. Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

Daily Confirmed Cases

The daily confirmed cases in East Africa, China, USA and some selected countries in Europe are given in Figure 2. It is clear that the confirmed cases in East Africa are still very low compared to Europe, the US and China. This could be attributed to the relatively fewer tests in East Africa. However, Tanzania has reported the highest daily confirmed cases (84) followed by Kenya (29). Daily confirmed cases in China, UK, Italy, France, and Germany are declining while they are increasing in Russia. The trend is quite unstable in USA.

Figure 2: COVID-19 Daily confirmed cases in East Africa, Europe, USA and China between 22/01/2020 and 21/04/2020. Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

Daily Confirmed Cases Curve in Europe, USA and China

As can be seen from Figure 3, the infections in China, Italy, France, Germany and Spain are in the decline. On the other hand, the daily infections in the US and Russia are yet to start declining.

Figure 3: Daily confirmed cases in China and some selected countries in Europe
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

Considering that the follow-up in China started on 2 December 2019 while in all other countries in the world it started on 22 January 2020, Figure 4 shows the time it took China, Italy, France, Germany and Spain to experience a downward trend in daily infections.

Figure 4: Time taken to experience a downward trend in the Infections in Chinam Italy, France, Germany and Spain
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

These countries took 67 days, on average, to experience a downward trend in daily infections. Considering the health facilities in these countries and the time they took to implement a total lockdown, 67 days seems to be the earliest time a country can take to experience a downward trend in COVID–19 infections taking into account the measures taken by these countries such as testing, lockdown, social distancing, surveillance and contact tracing. 140 days (about 5 months) is the minimum time any country will take to return to normalcy in terms of COVID-19.

Daily Confirmed and Recovered Cases

Figure 5 gives the daily confirmed and recovered cases in China and Kenya. It is clear that the number of recovered cases in Kenya is currently lower than the number of daily infections. The daily infections in Kenya seem to be increasing despite the country having experienced a decline around the second week of April 2020. This could be attributed to the increased number of daily tests. The recoveries in China had overshot the infections by the first week of March 2020.

Figure 5: Daily Confirmed and Recovered Cases in Kenya and China
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

Daily Recovered and Dead Cases in East Africa

Figure 6 gives the percentage of recovered and dead cases in East Africa. Burundi has reported the highest percentage deaths (20 per cent). South Sudan has not recorded any recoveries or deaths so far despite reporting four confirmed cases so far. Uganda and Rwanda have not reported any deaths so far. The percentage of recoveries in the two countries (Uganda and Rwanda) are the highest so far in East Africa. The percentage recovered is a key parameter in modelling of infectious diseases. Every country in the world will have its own recovery rate based on such factors as status of health facilities and mean age at infection.

Figure 6: Percentage Recovered and Dead Cases in East Africa
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

African Countries with the Highest Number of Confirmed Cases

As can be seen in Figure 7, Egypt, South Africa and Morocco have over 3,000 confirmed cases while Algeria has slightly over 2,500 cases. Ghana and Cameroon have slightly over 1,000 confirmed cases so far.

Figure 7: African Countries with the highest confirmed cases
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

Recoveries and Deaths in African Countries with the highest number of Confirmed Cases

As can be seen in Figure 8, Algeria has the highest recovery and death rates amongst the six countries. Furthermore, among the six African countries, only Algeria has a death rate higher than 10%. Ghana has the lowest death rate of the six African countries while having the highest number of confirmed cases.

Figure 8: Cumulative Recovered and Dead cases in some selected countries in Africa
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

Recoveries and Deaths in some selected countries outside Africa

Figure 9 gives the percentage of recoveries and deaths in China, the US and some selected countries in Europe. Surprisingly, recoveries in the UK are very low compared to other major economies in Europe. Also, the number of deaths in the UK are greater than the recoveries. This could be pointing to a strained National Health System (NHS). The recoveries are highest in China (92.6 per cent), an indication of the expected recovery rate in a well-developed country which took the necessary steps early enough. Similarly, a death rate of 5.5 per cent in China points to the expected long-term death rate in a well-developed country which took the necessary steps early enough.

Figure 9: Percentage recoveries and deaths in some selected countries outside Africa
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

Prediction of Infection in Kenya

The transmissibility of COVID-19 was assessed through the estimation of the reproduction number R, defined as the number of expected secondary cases per infected case. In the early stages of an outbreak, and assuming no immunity in the population, this quantity is also the basic reproduction number R0, i.e. R in a fully susceptible population.

Figure 10 gives the estimated reproduction number of 1.241. This estimate is derived from the available daily COVID-19 incidences in Kenya so far. A serial interval distribution with a mean of 7.5 days and a standard deviation of 3.4 days was used, similar to the COVID-19 Wuhan characteristics.

Figure 10: Reproduction Number
Data Source: Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE)

Predicted Infections in Kenya for the next 5 days

Figure 11 gives the projected incidences in Kenya for the next five (5) days. For the country to experience a reduction in infections, measures must be taken to reduce the reproduction number by continuing to stress on social distancing, hand washing, etc. Infections can be minimised by implementing targeted total lockdown.

Figure 11: Predicted Infections in Kenya for the next 5 days
Source: Author

Table 1 shows the projected daily infections from 22/04/2020 to 26/04/2020. The upper limits can be taken as the worst-case scenario for the given transmission rate of 1.2 for about 600 daily tests for COVID-19 in Kenya. A similar analysis can be done for any other country whose daily incidences are available.

Table 1: Projected Infections in Kenya

 

       Date

 

Prediction

               95% Confidence Interval
Lower Limit Upper Limit
22/04/2020 12 5 20
23/04/2020 12 6 20
24/04/2020 13 6 21
25/04/2020 13 7 22
26/04/2020 14 7 23

 

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