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Snakebites in Kwale, Kenya

I sent our DSS out looking for snake bites, and they found them! We simply asked households if anyone in the household had been bitten by a snake in the past five years. More then 5% of them said “yes” and since we know the locations of the households, we were able to make this cool map. Note that the snake bites tend to cluster around two large areas and are noticeably absent from others.

Kenya hosts many varieties of extremely poisonous snakes included the Puff Adder, the Black and Green Mamba and the spitting Cobra. Snakes are universally feared here and often killed on sight by the locals.


Are Kenyans really paying 16 bribes per month?

Probably not. The popular news is widely reporting this figure based on results from a pilot study sponsored by Transparency International, a German NGO.

“In East Africa’s most prosperous economy, the average city resident pays up to 16 bribes per month, according to Transparency International. Locals have dubbed Kenya “ya kitu kidogo” — the land of the “little something” — a kind of homeland of the bribe. And on the streets of Eastleigh, Nairobi, the victims of those bribes point their finger at one perpetrator.” – USA Today

Aside from the popular press, it is even being quoted in scholarly works.

I grew suspicious as I only pay about two to three bribes per month. While bribery and corruption are persistent problems in Kenya, 16 seems rather excessive based on my experience there.

So I went digging. And found the original research. Turns out, as noted above, it is a pilot study, done with little funding, using a convenience sample pulled off people walking on the streets of Nairobi, or rather a single place where the researchers pulled people aside and asked them questions. The respondents are mostly in their 20s and educated.

The sampling design appears to be not a sampling design at all:

“The survey was designed to capture citizens’ interaction with the government institutions primarily, but the survey itself sought information on both the public and private sector. The sample was selected by cluster sampling from three clusters as follows: i. Micro and small enterprise operators (“jua kali”) sample, drawn from membership of microfinance organisations

ii. Corporate sector, drawn from the membership lists of industry and professional associations

iii. Random “street” sample. The survey was administered to a random sample in public places (restaurants, bus stops, public parks and residential areas etc) to capture people not represented in the other two clusters (e.g. public sector workers and the unemployed) The “jua kali” and “street” clusters were administered through personal interviews. The questionnaire was sent to the corporate cluster respondents by business reply mail and followed up by telephone. However, the response rate was extremely low and had to be complemented with personal interviews to obtain an acceptable response rate.”

I suspect, given the demographic of the respondents, they were hanging out around the U. Nairobi area in the CBD of Nairobi and NOT in Eastleigh as the USA Today article suggests. In fact, the report doesn’t mention Eastleigh at all.

The authors, to their credit, caution against the use of the results:

“The survey is a pilot study, whose primary objective is to establish the viability of empirical corruption research. It was not designed to provide a representative sample from which statistically valid conclusions about the urban population as a whole can be drawn. ”

So… while I get that there isn’t a whole lot of research on the subject, and any contribution is, well, a contribution worth examining, the results of this study should NOT be presented as fact, given the poor sampling design.

We can, of course, excuse the popular press, since they don’t care, but scholars should be extremely wary.

Links I liked

  1. The Return of Yellow Fever (link)
  2. Historical Review: Problematic Malaria Prophylaxis with Quinine (link)
  3. A Single-Payer Plan From Bernie Sanders Would Probably Still Be Expensive (link)
  4. A Unique Perspective on the Making of ‘STALKER’: The Testimony of a Mechanic Toiling Away Under Tarkovsky’s Guidance (link)
  5. Lethality of First Contact Dysentery Epidemics on Pacific Islands (link)

and some nyatiti from Luoland:



Videos of me playing “music”

I was at a friend’s this weekend, who just happens to do video work (for an NGO in East Africa) and who just happened to have a friend from the UK doing video work (in a Somali refugee camp in Kenya) and who both just happened to want to shoot a video, which went from shooting a simple practice video of our band (more on that later) to “Pete, let’s film you doing a couple of solo songs” which turned into 2.5 hours of intense setup (six cameras) and 10 minutes of filming. And hours of editing. And uploading.

The results were great and I’m incredibly thankful to Colin Crowley and Niko Belev for making me look better than I really do. Thank, dudes.



The fictional nation of Wakanda

wakanda_0003I recently went and saw the latest installment of Marvel’s film series, “Captain America: Civil War” and was reminded of Black Panther, Marvel’s other African hero (X-Men’s Storm would be the other). Black Panther is a prince of Wakanda, a fictional African country, which just so happens to be located near Lake Turkana, close to the Sundanese and Kenyan borders. Apparently, I could go and visit Wakanda if I wanted.

Wakanda is a special, though reclusive place. Wakanda is the world’s only source of Vibranium, the metal from which Captain America’s shield was created. Wakandans, though historically hunter gatherers, profited from the sale of Vibranium, and became one of the richest countries on earth. The prince of Wakanda, in contrast to many of his peers, reinvested the money in technological development ventures, and allowed his people to flourish. Wakanda’s tech is like nowhere else on Earth, designed specifically by Wakandans for Wakandans. In short, Wakanda is what Kagame wishes Rwanda could be.

I had no idea that Black Panther was slated to appear in “Civil War” and was happy they chose to film in Lagos rather than in some stereotypical African landscape of lions and elephants. People on this side of the world are excited about the prospect of a Black Panther stand alone film, due in 2018. Africa needs heroes, particularly ones who can stand on equal footing with heroes from everywhere else.

A fan made trailer, but…

Links I liked

While I’m fighting multiple infections at once (not bedridden, just annoyed), I though I’d post a collection of articles that caught my eye today: Haven’t done this in a while.

  1. Dispatches: Scapegoating Refugees in Kenya (link) and Why Kenya’s threat to close its refugee camps is even worse than you think (link) and Refugee Nation: The Escape Artist in Tanzania (link)
  2. The Communist Manifesto in pictures (link)
  3. Socioeconomic Inequalities in Neglected Tropical Diseases: A Systematic Review (link) – Poor people get sick. The title is somewhat misleading as the article focuses merely on poverty.
  4. Between-Country Inequalities in the Neglected Tropical Disease Burden in 1990 and 2010, with Projections for 2020 (link)
  5.  “I shared:” Can tagging papers that share data boost the practice? (link) – Scientists need to encourage one another to make their data available to the public.
  6. Every Insane Anti-Obama Conspiracy in One Chart (link) – Brilliant
  7. Kenya:Democracy on Trial? – A brutal grilling of opposition leader Raila Odinga. He has no idea how to respond. (link)

Why malaria? Over-researched, over-funded, diminishing returns? Rambling on the need for student mentorship.

Last week I gave an informal lecture on survey sampling to a small group of graduate students from a number of countries. With only one exception, all of the students were working on various aspects of malaria, primarily in basic sciences. The lone non-malaria student was from Vietnam and is interested in Dengue fever.

I praised her for working on Dengue. Dengue presents a serious threat to human health in all countries where the vectors exist, but the burden of disease will be particularly felt in rapidly urbanizing areas of developing countries.

Developing countries are ill equipped to deal with Dengue, and the antiquated nature of their health care systems, leftover by the colonialists, means that diagnostics are mostly non-existent and drugs wholly unavailable. Any fever in most of Sub-Saharan Africa is diagnosed simply as malaria, drugs administered and the patient left on their own.

We have extensive experience, however, with malaria. While there are numerous challenges to reducing malaria incidence, preventing recrudescence and postponing drug resistance, the basic fact is that the best way to eliminate or control malaria is to simply make people less poor. Even countries with holoendemic transmission, wealthier people get malaria less often than poor people, and poor people who live in wealthier areas get sick less than wealthier people in poor areas. This is known (in Game of Thrones parlance).

So, as we discussed the topic during lecture, I softly tried to encourage the students to look at other areas where they might be able to better apply their skills. They were mostly unresponsive, which is fine. Someone has to tell them, it might as well be me.

One of the students, however, indicated that “malaria is where the money is.” I couldn’t disagree. The reason that we put so much money and effort into diseases like malaria and HIV is simply because they yield marketable products. Medications for diseases like tungiasis (jiggers) are so simple as to not be profitable, customers too poor to buy them, and governments and donors too distracted by big diseases like malaria, HIV and TB to be concerned with dumping money to provide them for free.

And this is where the problem lies. We have a self propagating system of companies, researchers and donors, which simply float money between one another with little regard for the needs of the poorest of the poor. Breaking the cycle is difficult, but it starts with academics who need to push students to do work with neglected, overlooked or under-researched diseases. Even small grants can support small, but meaningful projects.

We have reached a point where malaria funding for malaria research is yielding ever diminishing returns. Money needs to be put into programs to deliver the tools we have and make ITNs, ACTs and IRS available to the people who need them, who often have trouble getting them. Moreover, we need economic development to make people less poor in developing coutnries so that fewer of their babies die. Human resources in developed countries need to start focusing on emerging (or already emerged but ignored) threats lke antibiotic resistance, Dengue fever, emerging zoonotics and others. That starts with us as mentors.


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