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BackgroundDiseases of the posterior segment of the eye, including age-related macular degeneration (AMD), have recently been recognised as the leading or second leading cause of blindness in several African countries. However, prevalence of AMD alone has not been assessed. We hypothesized that AMD is an important cause of visual impairment among elderly people in Nakuru, Kenya, and therefore sought to assess the prevalence and predictors of AMD in a diverse adult Kenyan population. Methods and FindingsIn a population-based cross-sectional survey in the Nakuru District of Kenya, 100 clusters of 50 people 50 y of age or older were selected by probability-proportional-to-size sampling between 26 January 2007 and 11 November 2008. Households within clusters were selected through compact segment sampling. All participants underwent a standardised interview and comprehensive eye examination, including dilated slit lamp examination by an ophthalmologist and digital retinal photography. Images were graded for the presence and severity of AMD lesions following a modified version of the International Classification and Grading System for Age-Related Maculopathy. Comparison was made between slit lamp biomicroscopy (SLB) and photographic grading. Of 4,381 participants, fundus photographs were gradable for 3,304 persons (75.4%), and SLB was completed for 4,312 (98%). Early and late AMD prevalence were 11.2% and 1.2%, respectively, among participants graded on images. Prevalence of AMD by SLB was 6.7% and 0.7% for early and late AMD, respectively. SLB underdiagnosed AMD relative to photographic grading by a factor of 1.7. After controlling for age, women had a higher prevalence of early AMD than men (odds ratio 1.5; 95% CI, 1.2–1.9). Overall prevalence rose significantly with each decade of age. We estimate that, in Kenya, 283,900 to 362,800 people 50 y and older have early AMD and 25,200 to 50,500 have late AMD, based on population estimates in 2007. ConclusionsAMD is an important cause of visual impairment and blindness in Kenya. Greater availability of low vision services and ophthalmologist training in diagnosis and treatment of AMD would be appropriate next steps. Please see later in the article for the Editors' Summary
Kenya hosts over half a million refugees, who, along with their hosts in urban and camp areas, face difficult living conditions and limited socioeconomic opportunities. Most refugees in Kenya live in camps located in the impoverished counties of Turkana (40 percent) and Garissa (44 percent), while 16 percent inhabit urban areas—mainly in Nairobi but also in Mombasa and Nakuru.
Refugees in Kenya are not systematically included in national surveys, creating a lack of comparable socioeconomic data on camp-based and urban refugees, and their hosts. As the third of a series of surveys focusing on closing this gap, this Socioeconomic Survey of Urban Refugees's aim is to understand the socioeconomic needs of urban refugees in Kenya, especially in the face of ongoing conflicts, environmental hazards, and others shocks, as well as the recent government announcement to close Kenya’s refugee camps, which highlights the potential move of refugees from camps into urban settings.
The SESs are representative of urban refugees and camp-based refugees in Turkana County. For the Kalobeyei 2018 and Urban 2020–21 SESs, households were randomly selected from the UNHCR registration database (proGres), while a complete list of dwellings, obtained from UNHCR’s dwelling mapping exercise, was used to draw the sample for the Kakuma 2019 SES. The Kalobeyei SES and Kakuma SES were done via Computer-Assisted Personal Interviews (CAPI). Due to COVID-19 social distancing measures, the Urban SES was collected via Computer Assisted Telephone Interviewing (CATI). The Kalobeyei SES covers 6,004 households; the Kakuma SES covers 2,127 households; and the Urban SES covers 2,438 households in Nairobi, Nakuru, and Mombasa.
Questionnaires are aligned with national household survey instruments, while additional modules are added to explore refugee-specific dynamics. The SES includes modules on demographics, household characteristics, assets, employment, education, consumption, and expenditure, which are aligned with the Kenya Integrated Household Budget Survey (KIHBS) 2015–16 and the recent Kenya Continuous Household Survey (KCHS) 2019.
Additional modules on access to services, vulnerabilities, social cohesion, mechanisms for coping with lack of food, displacement trajectories, and durable solutions are administered to capture refugee-specific challenges.
Nairobi, Mombasa, Nakuru
Households and individuals
All refugees registered with UNHCR via ProGres, verified via the Verification Exercise conducted in 2021
Sample survey data [ssd]
The survey was conducted using the UNHCR proGres data as the sampling frame. Due to the COVID-19 lockdown, the survey data was collected via telephone. Hence, the survey is representative of households with active phone numbers registered by UNHCR in urban Kenya – Nairobi, Mombasa and Nakuru. A sample size of 2,500 was needed to ensure a margin of error of less than 5 percent at a confidence level of 95 percent for groups represented by at least 50 percent of the population.
The sample for the urban SES is designed to estimate socioeconomic indicators, such as food insecurity, for groups whose share represents at least 50 percent of the population. Considering the total urban refugee population as of August 2020 and the proportions of main countries of origin, as well as a 10 percent nonresponse rate, the target sample size is 2,500 households in total, with 1,250 in Nairobi, 700 in Nakuru, and 550 in Mombasa. A total of 2,438 households were reached: 1,300 in Nairobi, 409 in Nakuru, and 729 in Mombasa.
The units in ProGres list are UNHCR proGres families, which are different from households as defined in standard household surveys. Upon registration, UNHCR groups individuals into ‘proGres’ families which do not necessarily meet the criteria to be considered a household. A proGres family is usually comprised by no more than one household. In turn, a household can be integrated by one or more proGres families.
Households were selected as the unit of observation to ensure comparability with national household surveys. Households are a set of related or unrelated people (either sharing the same dwelling or not) who pool ration cards and regularly cook and eat together. As proGres families were sampled, the identification of households was done by an introductory section that confirms that each member of the selected proGres family is a member of the household and whether there are other members in the households that belong to other ProGres families. Thus, the introductory section documents the number of proGres families present in the household under observation.
Before selecting the survey strata, the team attempted to better understand the type of bias observed by focusing on refugees with access to phones. From the proGres data, phone penetration in urban areas is high (Nairobi and Mombasa: 93 percent, Nakuru: 95 percent). To understand the type of bias observed by focusing on refugees with access to phone, we looked at socio-economic outcomes for proGres family refugees with access to a phone number and those without
Computer Assisted Telephone Interview [cati]
African Population and Health Research Center (APHRC) had from 2005 to 2010, conducted a longitudinal survey in two formal settlements (Harambee and Jericho) and two informal (slum) settlements (Korogocho and Viwandani) in Nairobi to understand the uptake and patterns of school enrolment after the introduction of the Free Primary Education (FPE) in Kenya. The results of the study showed increased utilization of private informal schools among slum households as compared to the formal settlements.
That is, by 2010, almost two thirds of pupils in the slum settlements were enrolled in private informal schools while in Harambee and Jericho, more than three quarters of the pupils were enrolled in government primary schools with the remaining portion attending high-end private schools.
In 2012, ERP conducted a cross-sectional survey across six major urban centers to investigate, within the context of FPE, if the pattern of school enrolment observed in Korogocho and Viwandani slums could also be observed in other urban slums in Kenya. Below are some key facts from this study. Data is manly disaggregated by school type - government schools (FPE schools), and non-government schools, specifically the formal private schools and low-cost schools.
The study tried to answer four broad questions: What is the impact of free primary education (FPE) on schooling patterns among poor households in urban slums in Kenya? What are the qualitative and quantitative explanations of the observed patterns? Is there a difference in achievement measured by performance in a standardized test on literacy and numeracy administered to pupils in government schools under FPE and non-government schools?
Kenya - in six urban slums of Nairobi spread across 6 towns - Nairobi, Mombasa, Nyeri, Eldoret, Nakuru and Kisumu. In total 5854 households and 230 schools were covered.
A cross-sectional survey focusing on households with individuals aged between 5 and 19, as well as schools and pupils in grades 3 and 6. Data therefore exits at household, individuals, schools and student levels.
This is a cross sectional study that was conducted in seven slum sites spread across six towns namely Nairobi, Mombasa, Kisumu, Eldoret, Nakuru and Nyeri and targetted hoseholds with individuals aged between 5 and 19 years and schools located within the study site or within a 1KM radius. For the schools to be included in the study they had to have both grade 3 and 6, which were target grades for this study.
This was a cross-sectional study involving schools and households. The study covered six purposively selected major towns (Eldoret, Kisumu, Mombasa, Nairobi, Nakuru and Nyeri) in different parts of Kenya (see Map 1) to provide case studies that could lead to a broader understanding of what is happening in urban informal settlements. The selection of a town was informed by presence of informal settlements and its administrative importance, that is, provincial headquarter or regional business hub. A three-stage cluster sampling procedure was used to select households in all towns with an exception of Nairobi. At the first stage, major informal settlement locations were identified in each of the six towns. The informal settlement sites were identified based on enumeration areas (EAs) designated as slums in the 2009 National Population and Housing Census conducted by the Kenya National Bureau of Statistics (KNBS). After identifying all slum EAs in each of the study towns, the location with the highest number of EAs designated as slum settlements was selected for the study. At the second stage of sampling, 20% of EAs within each major slum location were randomly selected. However, in Nakuru we randomly selected 67% (10) EAs while in Nyeri all available 9 EAs were included in the sample. This is because these two towns had fewer EAs and therefore the need to oversample to have a representative number of EAs. In total, 101 EAs were sampled from the major slum locations across the five towns. At the third stage, all households in the sampled EAs were listed using the 2009 census' EA maps prepared by KNBS. During the listing, 10,388 households were listed in all sampled EAs. Excluding Nairobi, 4,042 (57%) households which met the criteria of having at least one school-going child aged 5-20 years were selected for the survey. In Nairobi, 50% of all households which had at least one school-going child aged between 5 and 20 years were randomly sampled from all EAs existing in APHRC schooling data collected in 2010. A total of 3,060 households which met the criteria were selected. The need to select a large sample of households in Nairobi was to enable us link data from the current study with previous ones that covered over 6000 households in Korogocho and Viwandani. By so doing, we were able to get a representative sample of households in Nairobi to continue observing the schooling patterns longitudinally. In all, there were 7,102 eligible households in all six towns. A total of 14,084 individuals within the target age bracket living in 5,854 (82% of all eligible households) participated in the study. The remaining 18% of eligible households were not available for the interview as most of them had either left the study areas, declined the interview, or lacked credible respondents in the household at the time of the data collection visit or call back.
For the school-based survey, schools in each town were listed and classified into three groups based on their location: (i) within the selected slum location; (ii) within the catchment area of the selected slum area - about 1 km radius from the border of the study locations; and (iii) away from a selected slum. In Nairobi, schools were selected from existing APHRC data. During the listing exercise, lists of schools were also obtained from Municipality/City Education Departments in selected towns. The lists were used to counter-check the information obtained during listing. All schools located within the selected slum areas and those situated within the catchment area (1 km radius from the border of the slum) were included in the sample as long as they had a grade 6 class or intended to have one in 2012. The selection of schools within an informal settlement and those located within 1 km radius was because they were more likely to be accessed by children from the target informal settlement. Two hundred and forty-five (245) schools met the selection criteria and were included in the sample. Two hundred and thirty (230) primary schools (89 government schools, 94 formal private, and 47 low-cost schools) eventually participated in the survey. A total of 7,711 grade 3, 7,319 grade 6 pupils and 671 teachers of the same grades were reached and interviewed. All 230 head teachers (or their deputies) were interviewed on school characteristics.
Face-to-face [f2f]; Focus groups; Assessment; Filming (classroom observation).
Five survey questionnaires were administered at household level:
(i). An individual schooling history questionnaire was administered to individuals aged 5 - 20. The questionnaire was directly administered to individuals aged 12 - 20 and administered to a proxy for children younger than 12 years. Ideally, the proxy was the child's parent or guardian, or an adult familiar with the individual's schooling history and who usually resides in the same household. The questionnaire had two main sections: school participation for the current year (year of interview), and school participation for the five years preceding the year of interview (i.e. 2007 to 2011). The section on schooling participation on the current year collected information on the schooling status of the individual, the type, name and location of the school that the individual was attending, grade, and whether the individual had changed schools or dropped out of school in the current year. Respondents also provided information on the reasons for changing schools and dropping out of school, where applicable. The section on school participation for previous years also collected similar information. The questionnaire also collected information on the individual's year of birth and when they joined grade one.
(ii). A household schedule questionnaire was administered to the household head or the spouse. It sought information on the members of the household, their relationship to the household head, their gender, age, education and parental survivorship.
(iii). A parental/guardian perception questionnaire was administered to the household head or the parent/guardian of the child. It collected information on the parents/guardians' perceptions on Free Primary Education since its implementation, household support to school where child(ren) attends and household schooling decision.
(iv). A parental/guardian involvement questionnaire was strictly administered to a parent or guardian who usually lives in the household and who was equipped with adequate knowledge of the individual's schooling information (i.e. credible respondent). The questionnaire was completed for each individual of the targeted age bracket (5-20 years). The information on the child comprised questions on the gender of the child, parental/guardian aspirations for the child's educational attainment, and parental beliefs about the child's ability in school and their chances of achieving the aspired level.
(v). A household amenities and livelihood questionnaire was administered to the household head or the spouse or a member of the household who could give reliable information. The questionnaire collected information on duration of stay in the
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Wildlife conservation is facing numerous and mounting challenges on private and communal lands in Africa, including in Kenya. We analyze the population dynamics of 44 common wildlife species in relation to rainfall variation in the Nakuru Wildlife Conservancy (NWC), located in the Nakuru-Naivasha region of Kenya, based on ground total counts carried out twice each year from March 1996 to May 2015. Rainfall in the region was quasi-periodic with cycle periods dependent on the rainfall component and varying from 2.8 years for the dry season to 10.9 years for the wet season. These oscillations are associated with frequent severe droughts and food scarcity for herbivores. The trends for the 44 wildlife species showed five general patterns during 1996–2015. 1) Steinbuck, bushbuck, hartebeest and greater kudu numbers declined persistently and significantly throughout 1996–2015 and thus merit the greatest conservation attention. 2) Klipspringer, mongoose, oribi, porcupine, cheetah, leopard, ostrich and Sykes monkey numbers also decreased noticeably but not significantly between 1996 and 2015. 3) Dik dik, eland, African hare, Jackal, duiker, hippo and Thomson’s gazelle numbers first increased and then declined between 1996 and 2015 but only significantly for duiker and hippo. 4) Aardvark, serval cat, colobus monkey, bat-eared fox, reedbuck, hyena and baboon numbers first declined and then increased but only the increases in reedbuck and baboon numbers were significant. 5) Grant’s gazelle, Grevy’s zebra, lion, spring hare, Burchell’s zebra, bushpig, white rhino, rock hyrax, topi, oryx, vervet monkey, guinea fowl, giraffe, and wildebeest numbers increased consistently between 1996 and 2015. The increase was significant only for rock hyrax, topi, vervet monkey, guinea fowl, giraffe and wildebeest. 6) Impala, buffalo, warthog, and waterbuck, numbers increased significantly and then seemed to level off between 1996 and 2015. The aggregate biomass of primates and carnivores increased overall whereas that of herbivores first increased from 1996 to 2006 and then levelled off thereafter. Aggregate herbivore biomass increased linearly with increasing cumulative wet season rainfall. The densities of the 30 most abundant species were either strongly positively or negatively correlated with cumulative past rainfall, most commonly with the early wet season component. The collaborative wildlife conservation and management initiatives undertaken on the mosaic of private, communal and public lands were thus associated with increase or no decrease in numbers of 32 and decrease in numbers of 12 of the 44 species. Despite the decline by some species, effective community-based conservation is central to the future of wildlife in the NWC and other rangelands of Kenya and beyond and is crucially dependent on the good will, effective engagement and collective action of local communities, working in partnerships with various organizations, which, in NWC, operated under the umbrella of the Nakuru Wildlife Forum.
This research of registered businesses with one to four employees was conducted in Kenya between April 2013 and January 2014, at the same time with Kenya Enterprise Survey 2013. Data from 360 establishments was analyzed. Stratified random sampling was used to select the surveyed businesses. The objective of the survey was to obtain feedback from enterprises on the state of the private sector and constraints to its growth.
Micro-Enterprise Survey topics include firm characteristics, gender participation, access to finance, annual sales, costs of inputs/labor, workforce composition, bribery, licensing, infrastructure, trade, crime, competition, capacity utilization, land and permits, taxation, informality, business-government relations, innovation and technology, and performance measures. Over 90 percent of the questions objectively ascertain characteristics of a country's business environment. The remaining questions assess the survey respondents' opinions on what are the obstacles to firm growth and performance.
Central, Nyanza, Mombasa, Nairobi, and Nakuru regions
The primary sampling unit of the study is an establishment. An establishment is a physical location where business is carried out and where industrial operations take place or services are provided. A firm may be composed of one or more establishments. For example, a brewery may have several bottling plants and several establishments for distribution. For the purposes of this survey an establishment must make its own financial decisions and have its own financial statements separate from those of the firm. An establishment must also have its own management and control over its payroll.
The whole population, or the universe, covered in the Enterprise Surveys is the non-agricultural private economy. It comprises: all manufacturing sectors according to the ISIC Revision 3.1 group classification (group D), construction sector (group F), services sector (groups G and H), and transport, storage, and communications sector (group I). Note that this population definition excludes the following sectors: financial intermediation (group J), real estate and renting activities (group K, except sub-sector 72, IT, which was added to the population under study), and all public or utilities sectors. Companies with 100% government ownership are not eligible to participate in the Enterprise Surveys.
Sample survey data [ssd]
The sample for Ethiopia was selected using stratified random sampling. Two levels of stratification were used: firm sector and geographic region.
For industry stratification, the universe was divided into four manufacturing industries (food, textiles and garments, chemicals and plastics, other manufacturing) and two service sectors (retail and other services).
Regional stratification was defined in five regions: Central, Nyanza, Mombasa, Nairobi, and Nakuru.
2012 Census of Business Establishments of the Kenya National Bureau of Statistics was used as a sample frame for the survey of micro firms.
The enumerated establishments with less than five employees (micro establishments) were used as sample frame for the Kenya micro survey with the aim of obtaining interviews at 360 establishments.
The quality of the frame was assessed at the onset of the project through visits to a random subset of firms and local contractor knowledge. The sample frame was not immune from the typical problems found in establishment surveys: positive rates of non-eligibility, repetition, non-existent units, etc. In addition, the sample frame contains no telephone/fax numbers so the local contractor had to screen the contacts by visiting them.
Given the impact that non-eligible units included in the sample universe may have on the results, adjustments may be needed when computing the appropriate weights for individual observations. The percentage of confirmed non-eligible units as a proportion of the total number of sampled establishments contacted for the survey was 5.2% (39 out of 756) for micro firms.
Face-to-face [f2f]
The following survey instruments are available: - Manufacturing Module Questionnaire - Services Module Questionnaire
The survey is fielded via manufacturing or services questionnaires in order not to ask questions that are irrelevant to specific types of firms, e.g. a question that relates to production and nonproduction workers should not be asked of a retail firm. In addition to questions that are asked across countries, all surveys are customized and contain country-specific questions. An example of customization would be including tourism-related questions that are asked in certain countries when tourism is an existing or potential sector of economic growth.
There is a skip pattern in the Service Module Questionnaire for questions that apply only to retail firms.
Data entry and quality controls are implemented by the contractor and data is delivered to the World Bank in batches (typically 10%, 50% and 100%). These data deliveries are checked for logical consistency, out of range values, skip patterns, and duplicate entries. Problems are flagged by the World Bank and corrected by the implementing contractor through data checks, callbacks, and revisiting establishments.
Survey non-response must be differentiated from item non-response. The former refers to refusals to participate in the survey altogether whereas the latter refers to the refusals to answer some specific questions. Enterprise Surveys suffer from both problems and different strategies were used to address these issues.
Item non-response was addressed by two strategies: a- For sensitive questions that may generate negative reactions from the respondent, such as corruption or tax evasion, enumerators were instructed to collect "Refusal to respond" (-8) as a different option from "Don't know" (-9). b- Establishments with incomplete information were re-contacted in order to complete this information, whenever necessary.
Survey non-response was addressed by maximizing efforts to contact establishments that were initially selected for interview. Attempts were made to contact the establishment for interview at different times, days of the week before a replacement establishment (with similar strata characteristics) was suggested for interview. Survey non-response did occur but substitutions were made in order to potentially achieve strata-specific goals.
In an effort to address the ICT data challenges, the Communications Commission of Kenya (CCK) partnered with Kenya National Bureau of Statistics (KNBS) to undertake a comprehensive National ICT Survey. This was planned and executed during the months of May and June 2010.
The main objective of the study was to collect, collate and analyse data relating to ICT access and usage by various categorizations in Kenya. The survey captured data and information on critical ICT indicators as defined by international bodies such as the International Telecommunications Union (ITU). These indicators focused on household and individuals; and the data was be disaggregated by age, gender, administrative regions, rural and urban locations.
The specific objectives of the study were to; Obtain social economic information with a view of understanding usage patterns of ICT services; (a) Obtain social economic information with a view of understanding usage patterns of ICT services; (b) Collect, collate and analyze ICT statistics in line with ICT indicators; (c) Evaluate the factors that will have the greatest impact in ensuring access and usage of ICTs and; (d) Develop a database on access and usage of ICT in Kenya
National coverage
District, Household, Individual
Households from the sampled areas.
Sample survey data [ssd]
The National Sample Survey and Evaluation Programme (NASSEP IV) maintained by the Bureau was used as the sampling frame. The frame has 1,800 clusters spread all over the country, and covers all socio-economic classes and hence able to get a suitable and representative sample of the population. The survey was distributed into four domains, namely: 1. National, 2. Major Urban areas, 3. Other Urban areas, and 4. Rural areas.
The major urban towns included Nairobi, Thika, Mombasa, Kisumu, Nakuru and Eldoret. All other areas defined as urban by KNBS but fall outside the major municipalities above were categorized as 'other urban areas'. The rural domain was further sub-divided into their respective provinces, excluding Nairobi which is purely urban. For the 'rural' component, the districts that display identical socio-cultural and economic conditions have been pooled together to create strata from which a representative set of districts is selected to represent the group of such districts. A total of 42 such stratifications were done and one district in each categorization was selected. The major urban areas of the country namely Nairobi, Mombasa, Kisumu, Nakuru, Eldoret and Thika were all sub-stratified into five sub-strata based on perceived levels of income into the: 1. Upper income 2. Lower Upper 3. Middle 4. Lower Middle and 5. Lower.
In this survey, all the six 'major urban' are included while just a few of the 'other urban areas' are selected depending on their population (household) distribution.
Selection of the Clusters for the Survey The selection of the sample clusters was done systematically using the Equal Probability Selection method (EPSEM). Since NASSEP IV was developed using Probability Proportional to Size (PPS) method, the resulting sample retains its properties. The selection was done independently within the districts and the urban /rural sub-stratum.
Selection of the Households From each selected cluster, an equal number of 15 households were selected systematically, with a random start. The systematic sampling method was adopted as it enables the distribution of the sample across the cluster evenly and yields good estimates for the population parameters. Selection of the households was done at the office and assigned to the Research Assistants, with strictly no allowance for replacement of non-responding households.
Owing to the some logistical challenges the following clusters were partially or not covered at all: • One cluster in Tana River due to floods. • Two clusters in Molo where households shifted to safer areas after the Post Election Violence (PEV). As a result, fewer than the expected households were covered. • One cluster in Koibatek was covered halfway due to relocation of households to pave way for a large plantation.
Where there was no school found within the cluster, Research Assistant was allowed to sample an institution from a neighbouring cluster. In some districts, the schools were found to be very far from the cluster and therefore could not be covered. Where a cluster was to be covered over a weekend, it was often not possible to find a responsible person in institutions to respond to the questionnaire.
Face-to-face [f2f]
Household questionnaire: This will be used to collect background information pertaining to the members of the household and businesses operated by household members. It will collect information about each person in the household such as name, sex, age, education, and relationship to household head etcetera. This information is vital for calculating certain socio-demographic characteristics of the household. The Business module in the household questionnaire will be used to collect information pertaining to usage of ICT in businesses identified in the household. To estimate the magnitude, levels and distribution of ICT usage in the country, all the selected respondents 15 years and above will be subjected to business questionnaire.
Institutional Questionnaire: This will collect information pertaining to institutions providing ICT related programmes in the country. This information will be analyzed to identify gaps and other issues of concern, which need to be addressed in the promotion ICT provision in the country.
As a matter of procedure initial manual editing was done in the field by the RAs. The supervisors further checked the questionnaires and validated the data in the field by randomly sampling 20 per cent of the filled questionnaires. After the questionnaires were received from the field, an office editing team was constituted to do office editing.
Data was captured using Census and Survey Processing System (CSPRO) version 4.0 through a data entry screen specially created with checks to ensure accuracy during data entry. All questionnaires were double entered to ensure data quality. Erroneous entries and potential outliers were then verified and corrected appropriately. A total of 20 data entry personnel were engaged during the exercise.
The captured data were exported to Statistical Package for Social Sciences (SPSS) for cleaning and analysis. The cleaned data was weighted before final analysis. The weighting of the data involved application of inflation factors derived from the selection probabilities of the EAs and households detailed in section 2.2.7, on weighting the Sample Data.
The overall response rate stood at 85.9 per cent. Nairobi had the lowest response rate at 69.4 per cent while the highest (94.6 per cent) was realized in North Eastern. More than 95.5 per cent of all the sampled households were occupied out of which 85.9 per cent were interviewed.
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BackgroundDiseases of the posterior segment of the eye, including age-related macular degeneration (AMD), have recently been recognised as the leading or second leading cause of blindness in several African countries. However, prevalence of AMD alone has not been assessed. We hypothesized that AMD is an important cause of visual impairment among elderly people in Nakuru, Kenya, and therefore sought to assess the prevalence and predictors of AMD in a diverse adult Kenyan population. Methods and FindingsIn a population-based cross-sectional survey in the Nakuru District of Kenya, 100 clusters of 50 people 50 y of age or older were selected by probability-proportional-to-size sampling between 26 January 2007 and 11 November 2008. Households within clusters were selected through compact segment sampling. All participants underwent a standardised interview and comprehensive eye examination, including dilated slit lamp examination by an ophthalmologist and digital retinal photography. Images were graded for the presence and severity of AMD lesions following a modified version of the International Classification and Grading System for Age-Related Maculopathy. Comparison was made between slit lamp biomicroscopy (SLB) and photographic grading. Of 4,381 participants, fundus photographs were gradable for 3,304 persons (75.4%), and SLB was completed for 4,312 (98%). Early and late AMD prevalence were 11.2% and 1.2%, respectively, among participants graded on images. Prevalence of AMD by SLB was 6.7% and 0.7% for early and late AMD, respectively. SLB underdiagnosed AMD relative to photographic grading by a factor of 1.7. After controlling for age, women had a higher prevalence of early AMD than men (odds ratio 1.5; 95% CI, 1.2–1.9). Overall prevalence rose significantly with each decade of age. We estimate that, in Kenya, 283,900 to 362,800 people 50 y and older have early AMD and 25,200 to 50,500 have late AMD, based on population estimates in 2007. ConclusionsAMD is an important cause of visual impairment and blindness in Kenya. Greater availability of low vision services and ophthalmologist training in diagnosis and treatment of AMD would be appropriate next steps. Please see later in the article for the Editors' Summary